Judicial Deference and Political Power in Fourteenth Amendment and Dormant Commerce Clause Cases

The Supreme Court lacks a coherent approach to deciding how much to defer to state legislatures when reviewing allegedly unconstitutional legislation. The Court grants very little deference to state legislatures in dormant Commerce Clause cases but significant deference to state legislatures in Fourteenth Amendment cases. The Court has never acknowledged this divergence, let alone justified it. Scholars have also failed to note this divergence or explore whether it can be justified. By ignoring this divergence, the Court and scholars have ignored a situation that exacerbates existing power imbalances and fails to recognize a more promising approach to judicial deference. This Article argues that the Court should base its level of deference to legislatures on the political power of the plaintiff challenging the law, engaging in more active review when plaintiffs lack political power and more passive review when plaintiffs are politically powerful. Following this approach, the Court should defer to state legislatures more in dormant Commerce Clause cases and less in Fourteenth Amendment cases—precisely the opposite of its current practice

Non-Gaussian fluctuations in stochastic models with absorbing barriers

The dynamics of a one-dimensional stochastic model is studied in presence of an absorbing boundary. The distribution of fluctuations is analytically characterized within the generalized van Kampen expansion, accounting for higher order corrections beyond the conventional Gaussian approximation. The theory is shown to successfully capture the non Gaussian traits of the sought distribution returning an excellent agreement with the simulations, for {\it all times} and arbitrarily {\it close} to the absorbing barrier. At large times, a compact analytical solution for the distribution of fluctuations is also obtained, bridging the gap with previous investigations, within the van Kampen picture and without resorting to alternative strategies, as elsewhere hypothesized.Comment: 2 figures, submitted to Phys. Rev. Let

Can a microscopic stochastic model explain the emergence of pain cycles in patients?

A stochastic model is here introduced to investigate the molecular mechanisms which trigger the perception of pain. The action of analgesic drug compounds is discussed in a dynamical context, where the competition with inactive species is explicitly accounted for. Finite size effects inevitably perturb the mean-field dynamics: Oscillations in the amount of bound receptors spontaneously manifest, driven by the noise which is intrinsic to the system under scrutiny. These effects are investigated both numerically, via stochastic simulations and analytically, through a large-size expansion. The claim that our findings could provide a consistent interpretative framework to explain the emergence of cyclic behaviors in response to analgesic treatments, is substantiated.Comment: J. Stat. Mech. (Proceedings UPON2008

Towards a Business Intelligence Maturity Model for Healthcare

Healthcare is a very complex, knowledge-driven industry. Electronic health record implementations have created massive amounts of clinical and financial data. The accumulation of data is outpacing the ability of organizations to leverage the data for improving financial and clinical efficiencies and quality of care. It is believed that careful and attentive use of business intelligence (BI) in healthcare can transform data into knowledge that can improve patient outcomes and operational efficiency. BI maturity models are a way of identifying strengths and weaknesses of the information maturity of a business. This paper presents a comprehensive review of existing BI maturity models to determine their adequacy for use in healthcare. The review identifies gaps in existing BI maturity models and presents requirements for a healthcare-specific maturity model. The results of this study will be used to develop a BI maturity model that addresses the complex characteristics and needs of healthcare organizations

Partnerships in Service Learning and Civic Engagement

Developing campus-community partnerships is a core element of well-designed and effective civic engagement, including service learning and participatory action research. A structural model, SOFAR, is presented that differentiates campus into administrators, faculty, and students, and that differentiates community into organizational staff and residents (or clients, consumers, advocates). Partnerships are presented as being a subset of relationships between persons. The quality of these dyadic relationships is analyzed in terms of the degree to which the interactions possess closeness, equity, and integrity, and the degree to which the outcomes of those interactions are exploitive, transactional, or transformational. Implications are then offered for how this analysis can improve practice and research

Status of Simulation-Based Training in Departments of Surgery in the United States

Background: Surgical simulation is particularly attractive because it allows training in a safe, controlled, and standardized environment. However, the status of surgical simulation among Departments of Surgery (DoS) in the United States is unknown. The objective of this study was to characterize the status of simulation-based training in DoS in the United States. Materials and methods: A Qualtrics online survey was sent to 177 chairs of DoS in the United States in March 2018 regarding the utilization of surgical simulation in their department. Questions in the survey were focused on simulation capacities and activities as well as chairs' perception of the value and purpose of simulation. Results: A total of 87 of 177 chairs responded to the survey (49% response rate). Most programs had either 20-50 trainees (42 of 87; 48%) or more than 50 trainees (37 of 87; 43%). Most chairs reported having a simulation center in their institution (85 of 87; 98%) or department (60 of 86; 70%) with a formal simulation curriculum for their trainees (83 of 87; 95%). Ninety percent (78 of 87) of DoS had protected time for simulation education for their residents, with most residents engaging in activities weekly or monthly (65 of 85; 76%). Although most chairs felt simulation improves patient safety (72 of 84; 86%) and is useful for practicing surgeons (68 of 84; 81%), only 40% reported that faculty use simulation to maintain technical skills and only 17% reported that faculty use simulation to address high complication rates. Conclusions: The vast majority of the DoS in the United States have established simulation activities for their trainees. However, engagement of faculty in simulation to maintain or improve their skills remains low

Technical considerations in repowering a nuclear plant for fossil fueled operation

Repowering involves replacement of the reactor by a fossil fuel source of steam. This source can be a conventional fossil fueled boiler or the heat recovery steam generator (HRSG) on a gas turbine exhaust. The existing steam turbine plant is used to the extent possible. Alternative fuels for repowering a nuclear plant are coal, natural gas and oil. In today`s world oil is not usually an alternative. Selection of coal or natural gas is largely a matter of availability of the fuel near the location of the plant. Both the fossil boiler and the HRSG produce steam at higher pressures and temperatures than the throttle conditions for a saturated steam nuclear turbine. It is necessary to match the steam conditions from the new source to the existing turbine as closely as possible. Technical approaches to achieve a match range from using a topping turbine at the front end of the cycle to attemperation of the throttle steam with feedwater. The electrical output from the repowered plant is usually greater than that of the original nuclear fueled design. This requires consideration of the ability to use the excess electricity. Interfacing of the new facility with the existing turbine plant requires consideration of facility layout and design. Site factors must also be considered, especially for a coal fired boiler, since rail and coal handling facilities must be added to a site for which these were not considered. Additional site factors that require consideration are ash handling and disposal

Anatomic variations in the surgical anatomy of the thoracic esophagus and its surrounding structures

BACKGROUND: Esophagectomy is a challenging procedure due to: a) it is a complex operation; b) it is linked to very high morbidity and mortality rates; c) surgical anatomy of the esophagus is very peculiar. The anatomic variations that can be unexpectedly found during an operation may cause complications and influence the outcome. AIM: To review the anatomic basis for esophagectomy focusing on anatomic variations found in the mediastinal structures based on literature review and cadaver dissection. METHODS: Literature related to the surgical anatomy of the esophagus and mediastinal structures was reviewed. Also, a total of 20 fresh (non-embalmed, non-preserved, time of death under 12 h) human cadavers were dissected. There were 16 male and mean age was 53 ± 23 years. RESULTS: Anatomic variations for aorta, azygos system, pleura, vagus nerve, lymph nodes and thoracic duct were documented. CONCLUSIONS: The organs and structures of the mediastinum may frequently present anatomic variations. Some of these may be clinically significant during an esophagectomy. Because only a part of them may be identified before the operation with the current imaging tools, surgeons must be aware of these anatomic variations.RACIONAL: A esofagectomia é procedimento difícil, devido a: a) ser operação complexa; b) apresentar alta morbidade e mortalidade; c) a anatomia cirúrgica do esôfago é muito peculiar. As variações anatômicas que podem ser encontradas inesperadamente durante uma operação podem causar complicações e influenciar os resultados. OBJETIVO: Revisar a base anatômica para esofagectomia destacando as variações encontradas nas estruturas mediastinais através de revisão de literatura e dissecção de cadáveres. MÉTODOS: A literatura relacionada com a anatomia cirúrgica das estruturas esôfago e mediastino foi revista. Além disso, um total de 20 cadáveres humanos frescos (não embalsamados, não preservados e com tempo de morte com menos de 12 h) foram dissecados. Dezesseis eram do sexo masculino com idade média de 53±23 anos. RESULTADOS: Variações anatômicas de aorta, sistema ázigos, pleura, nervo vago, linfonodos e ducto torácico foram documentadas. CONCLUSÕES: Os órgãos e estruturas do mediastino podem, frequentemente, apresentar variações anatômicas. Algumas delas podem ser clinicamente significativas durante esofagectomia. Devido a que apenas uma parte dessas variações são identificadas antes da operação com os meios de imagens atuais, os cirurgiões devem estar cientes da possibilidade dessas variações anatômicas.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de CirurgiaUniversity of Chicago Pritzker School of Medicine Department of SurgeryUNIFESP, EPM, Depto. de CirurgiaSciEL