A Unifying Theory for the Religion Clauses of the First Amendment

According to Justice Powell, the first amendment religion clauses are the source of some of the most perplexing questions that the Supreme Court confronts. In a long and rapidly expanding line of religion clause cases the Court has struggled, with a conspicuous lack of success, to articulate principles of broad applicability. The Court\u27s efforts to date have resulted in a jumble of tests, standards, and theoretical approaches from which predicting the outcome in future cases is very difficult. The conceptual problems that have frustrated the Court\u27s attempts at doctrinal development center in two broad areas: first,the meaning and effect of the establishment clause and second, the relationship between the establishment clause and the free exercise clause. In a third area, the meaning and effect of the free exercise clause, the Court has had somewhat less trouble articulating a doctrinal approach, but even here the Court has not applied the doctrine consistently and has not reached entirely predictable results. Perhaps the most telling measure of the Court\u27s doctrinal frustration in the religion clause area is the extent to which it recently has attempted to elevate its conspicuous lack of doctrinal consistency into an accepted methodology for decision making. Chief Justice Burger summarized current thinking on the relationship between the two religion clauses by noting that there is internal tension in the First Amendment between the Establishment Clause and the Free Exercise Clause. Finding a clearer acknowledgement of the Court\u27s failure to articulate a unifying theory underlying the two clauses would be difficult. Concerning the meaning and effect of the establishment clause, Chief Justice Burger has observed with apparent approval (or at least resignation) that the Court has been unwilling to tie establishment clause analysis to a single test. With the same apparent approval, Justice White has noted that our decisions have tended to avoid categorical imperatives and absolutist approaches .... This course sacrifices clarity and predictability for flexibility .. .., Describing the same phenomenon in another case, Justice O\u27Connor concluded that [e]very government practice must be judged in its unique circumstances to determine whether it constitutes an endorsement or disapproval of religion. In effect, the Court seems to have accepted the inevitability of an ad hoc approach with a final result in any case possible only after Supreme Court review... The thesis of this Article is that such a single overriding objective can be identified and articulated. This objective reflects the basic purpose of those who authored and adopted the religion clauses and, to a remarkable degree, harmonizes the Court\u27s apparently disparate results in religion clause cases. The Court\u27s conscious acceptance of the unifying theory proposed in this Article would provide a satisfying explanation for a large number of results arrived at by intuition in the past and would provide a theoretical basis from which to predict results in future cases

Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006-2013.

ObjectiveTo examine temporal trends in utilization of glucose-lowering medications, glycemic control, and rate of severe hypoglycemia among patients with type 2 diabetes (T2DM).Research design and methodsUsing claims data from 1.66 million privately insured and Medicare Advantage patients with T2DM from 2006 to 2013, we estimated the annual 1) age- and sex-standardized proportion of patients who filled each class of agents; 2) age-, sex-, race-, and region-standardized proportion with hemoglobin A1c (HbA1c) <6%, 6 to <7%, 7 to <8%, 8 to <9%, ≥9%; and 3) age- and sex-standardized rate of severe hypoglycemia among those using medications. Proportions were calculated overall and stratified by age-group (18-44, 45-64, 65-74, and ≥75 years) and number of chronic comorbidities (zero, one, and two or more).ResultsFrom 2006 to 2013, use increased for metformin (from 47.6 to 53.5%), dipeptidyl peptidase 4 inhibitors (0.5 to 14.9%), and insulin (17.1 to 23.0%) but declined for sulfonylureas (38.8 to 30.8%) and thiazolidinediones (28.5 to 5.6%; all P < 0.001). The proportion of patients with HbA1c <7% declined (from 56.4 to 54.2%; P < 0.001) and with HbA1c ≥9% increased (9.9 to 12.2%; P < 0.001). Glycemic control varied by age and was poor among 23.3% of the youngest and 6.3% of the oldest patients in 2013. The overall rate of severe hypoglycemia remained the same (1.3 per 100 person-years; P = 0.72), declined modestly among the oldest patients (from 2.9 to 2.3; P < 0.001), and remained high among those with two or more comorbidities (3.2 to 3.5; P = 0.36).ConclusionsDuring the recent 8-year period, the use of glucose-lowering drugs has changed dramatically among patients with T2DM. Overall glycemic control has not improved and remains poor among nearly a quarter of the youngest patients. The overall rate of severe hypoglycemia remains largely unchanged

Depression in Hospital-Employed Nurses

Depression impacts 9.4% of the adult population in the United States, and it is known to impact work performance. Nurses with depression are not only likely to suffer themselves, but their illness may have an impact on their coworkers and potentially the quality of care they provide. Thus, the purpose of this study was to determine the prevalence of depression in a random sample of hospital-employed nurses to determine individual and workplace characteristics that are associated with depression. A cross-sectional survey design of 1171 registered nurses was used. Measures included individual characteristics, workplace characteristics, work productivity, and depression (9-item Patient Health Questionnaire). Data analysis demonstrated a depressive symptom rate of 18%. The linear regression model accounted for 60.6% of the variation in the 9-item Patient Health Questionnaire depression scores. Body mass index, job satisfaction, number of health problems, mental well-being, and health-related productivity had significant relationships with depression (P < .05). Hospital-employed nurses have higher rates of depressive symptoms than national norms. Advanced practice nurses can assist with educating nurses on recognizing depression and confidential interventions, including the use of computerized cognitive-based therapy

Reliability and Validity of the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration for Nurse Practitioners

Background: The Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (JSATPNC) has been used to measure attitudes regarding nurse-physician collaboration. However, psychometric evaluation is lacking for the nurse practitioner (NP) population. Purpose: This study details a confirmatory approach in testing the factor analytic structure of the JSATPNC against previously reported structures. Methods: A Web survey invited 4,673 licensed NPs where 915 responded. Confirmatory factor analysis (CFA) was performed to assess factorial validity. Results: A previously proposed 3-factor model based had significantly better fit compared to a 1-factor structure (Dx2 5 165.3, Ddf 5 3, p , .0001). Cronbach's alpha for the 3 subscales were 0.61, 0.62, and 0.54. Reliability with all 15 items was .72. Conclusions: Three collaboration subscales could have use in measuring attitudes toward physician-NP collaboration

Save, Even If It’s a Penny”: Transnational Financial Socialization of Black Immigrant Women

The purpose of this study is to investigate Black-Caribbean and African women’s transnational financial socialization. Analysis of the data show 1) financial socialization in the country of origin: (a) parents stressed the importance of saving, (b) learned about money management explicitly, (c) learned about money management through observation, (d) learned by observing parent’s struggle; and 2) the impact to women’s financial navigation in the U.S.: (a) not receiving financial education, (b) unexpected financial stressors in the U.S., (c) difficulty saving, (d) the need for more financial education. Implications for mental health and financial practitioners and researchers are provided

Self-selected Foot Strike Patterns in Runners when Transitioning from the Shod to Barefoot Condition: A Systematic Review of the Literature

Purpose and Background: Recent research has begun to focus on foot strike patterns as they relate to injuries in runners. Runners who employ a rear-foot strike (RFS) pattern (in which the heel lands before the ball of the foot) are more likely to experience repetitive stress injuries such as tibial stress fractures, patellofemoral pain syndrome (PFPS), and plantar fasciitis. Conversely, runners demonstrating a forefoot strike (FFS) pattern (defined as the ball of the foot-usually the 4th and 5th metatarsal heads-landing before the heel) are more susceptible to Achilles tendon, plantarflexor, and metatarsal injuries. Several systematic studies have concluded that barefoot runners employed a FFS pattern while shod runners used a RFS pattern. The purpose of this systematic review was to determine the effects of transitioning from traditionally shod running to barefoot running on self-selected initial contact patterns in long distance runners.https://jdc.jefferson.edu/dptcapstones/1010/thumbnail.jp

Dynamics at a smeared phase transition

We investigate the effects of rare regions on the dynamics of Ising magnets with planar defects, i.e., disorder perfectly correlated in two dimensions. In these systems, the magnetic phase transition is smeared because static long-range order can develop on isolated rare regions. We first study an infinite-range model by numerically solving local dynamic mean-field equations. Then we use extremal statistics and scaling arguments to discuss the dynamics beyond mean-field theory. In the tail region of the smeared transition the dynamics is even slower than in a conventional Griffiths phase: the spin autocorrelation function decays like a stretched exponential at intermediate times before approaching the exponentially small equilibrium value following a power law at late times.Comment: 10 pages, 8eps figures included, final version as publishe