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Suppose that we disagree about a matter of constitutional law. Say that one of us contends, and the other denies, that transgender persons have constitutional rights to be treated in accord with their gender identity. It appears that we disagree about "what the law is." And, most probably, we disagree about what the law is on this matter because we disagree about what generally makes it the case that our constitutional law is this rather than that. Constitutional theory should provide guidance. Theorists should try to explain what gives our constitutional rules the contents that they have, or what makes true constitutional propositions true; they should aim to provide what I will call a "constitutive theory" of constitutional law. It is obvious that we do not all share a constitutive theory. It is less obvious, and strikingly underappreciated, that we have precious few candidates to choose from. Few of our many prescriptive theories regarding how judges should exercise the power of judicial review have straightforward constitutive implications. This Article presents an original constitutive theory of American constitutional law (and of law generally), founded on the familiar distinction between two types of constitutional norms: "principles" and "rules." It argues: first, that rules are determined by the interaction of principles, in a manner that can be loosely modeled as force addition; and second, that the principles are "grounded" in mental states, speech-acts, and behaviors of persons who make up the constitutional community, much as rules of fashion or of billiards are grounded in behaviors of persons who make up their normative communities. In short: social facts determine constitutional principles, and constitutional principles determine constitutional rules. I call the account "principled positivism." It is positivist, pluralist, and dynamic. Principled positivism maintains that we can come to know our constitutional rules by discerning the contents, contours, and weights of our constitutional principles. Accordingly, the Article offers a preliminary and partial inventory of our constitutional principles--principles concerning the legal significance of what the enacted text says and what its authors intended; principles about the force of judicial precedents and of extra-judicial practices; principles of popular sovereignty, the distribution of governing power, and the demands of liberty and equality. It then puts the principles to work, illustrating how they operate in diverse constitutional controversies, from same-sex marriage to the scope of Congress's commerce power. [ABSTRACT FROM AUTHOR]

Background: It is widely acknowledged that health policy and management decisions rarely reflect research evidence. Therefore, it is important to determine how to improve evidence-informed decision-making. The primary aim of this systematic review was to evaluate the effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The secondary aim of the review was to describe factors perceived to be associated with effective strategies and the inter-relationship between these factors.Methods: An electronic search was developed to identify studies published between January 01, 2000, and February 02, 2016. This was supplemented by checking the reference list of included articles, systematic reviews, and hand-searching publication lists from prominent authors. Two reviewers independently screened studies for inclusion, assessed methodological quality, and extracted data.Results: After duplicate removal, the search strategy identified 3830 titles. Following title and abstract screening, 96 full-text articles were reviewed, of which 19 studies (21 articles) met all inclusion criteria. Three studies were included in the narrative synthesis, finding policy briefs including expert opinion might affect intended actions, and intentions persisting to actions for public health policy in developing nations. Workshops, ongoing technical assistance, and distribution of instructional digital materials may improve knowledge and skills around evidence-informed decision-making in US public health departments. Tailored, targeted messages were more effective in increasing public health policies and programs in Canadian public health departments compared to messages and a knowledge broker. Sixteen studies (18 articles) were included in the thematic synthesis, leading to a conceptualisation of inter-relating factors perceived to be associated with effective research implementation strategies. A unidirectional, hierarchal flow was described from (1) establishing an imperative for practice change, (2) building trust between implementation stakeholders and (3) developing a shared vision, to (4) actioning change mechanisms. This was underpinned by the (5) employment of effective communication strategies and (6) provision of resources to support change.Conclusions: Evidence is developing to support the use of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The design of future implementation strategies should be based on the inter-relating factors perceived to be associated with effective strategies.Trial Registration: This systematic review was registered with Prospero (record number: 42016032947). [ABSTRACT FROM AUTHOR]

The article discusses pluralistic nonoriginalism and a reported combinability problem in regards to U.S. constitutional law and the originalism theory of constitutional interpretation as of June 2013. Other topics include constitutional theorists, the U.S. Supreme Court case Marbury v. Madison, and legal philosopher H.L.A. Hart's book "The Concept of Law." Fellow philosopher and legal theorist Ronald Dworkin is also mentioned.

The partial defense of provocation provides that a person who kills in the heat of passion brought on by legally adequate provocation is guilty of manslaughter rather than murder. The defense traces back to the twelfth century and exists today, in some form, in almost every U.S. state and other common law jurisdictions. But long history and wide application have not produced agreement on the rationale for the doctrine. To the contrary, the search for a coherent and satisfying rationale remains among the main occupations of criminal law theorists. The dominant scholarly view holds that provocation is best explained and defended as a partial excuse on the grounds that the killer's inflamed emotional state so compromised his ability to conform his conduct to the demands of reason and law as to render him substantially less blameworthy for his conduct. In contrast, a small minority of scholars have maintained, without significant argumentative support, that provocation is best understood as a partial justification on the ground that the provoked killing is less wrongful than is an unprovoked killing, ceteris paribus. Recently, other commentators have argued that provocation mitigation is neither partial excuse nor partial justification. Against all of these familiar positions, we argue that partial excuse and partial justification are necessary and sufficient conditions for provocation manslaughter. In our view, an intentional killing deserves to be punished and labeled as manslaughter rather than murder only when, because of provocation, this particular killing is significantly less wrongful than the standard intentional killing and when, because of the actor's partial lack of control, he is less blameworthy for committing an act that remains all-things-considered wrongful. In elaborating and defending our account, we rebut the oft-repeated but rarely challenged propositions that justification and excuse, even in partial forms, are mutually exclusive, and that the very notion of partial justification is incoherent. We also draw forth implications for how the sentencing ranges for murder and manslaughter should be related. [ABSTRACT FROM AUTHOR]

An essay on the construction of constitutional texts and how they relate to the constitutional decision and implementation is presented. It addresses the originalist views on linguistic meaning with regards to the constitutional texts, the constraints imposed by the law and the view of pragmatists on the fundamental mistake of the taxonomic project. It concludes that portions of the U.S. Constitution could be distinguished as legal or linguistic interpretation if they could not always be identical in legal meaning or semantic content.

Discusses the concept of partisan gerrymandering in the U.S. History and legal landscape of gerrymandering; Definition of excessive partisanship; Information on the doctrine of partisan gerrymandering.

For generations, American constitutional theorists and judges have struggled with problems of constitutional interpretation, exploring how meaning is properly derived from the Constitution and, in so far as the answer may be different, how courts ought to derive such meaning. Recent years, however, have seen an upsurge in scholarship addressed to a related but distinct subject. Without entirely abandoning debates over constitutional interpretation, constitutional theorists have started increasingly to wonder about those judicial outputs that feature in the enterprise of constitutional adjudication and yet are something other than a court's determination as to what any given provision of the Constitution means. Theorists have turned their attention from constitutional meaning to what they may call, at least on a first pass, constitutional doctrine.

This report summarizes the deliberations of a multidisciplinary committee, sponsored by the Pharmaceutical Research and Manufacturers of America, on current “best practices” within the U.S. pharmaceutical industry in assessing the role of drug metabolites as potential mediators of the toxicity of new drug products. Input to the document was obtained from numerous sources, including members of the pharmaceutical industry, academic investigators, and representatives of regulatory agencies who attended a workshop on the subject in November 2000. The overall goal of the paper is to define practical and scientifically based approaches to the use of metabolite data that address contemporary issues in the safety evaluation of drug candidates. Although there remains a lack of consensus on how best to deal with several aspects of this complex subject, this paper raises a number of points to consider, which emphasize the need to treat drug metabolite issues on a case-by-case basis. It is hoped that the discussion will promote continued dialog among industrial scientists and regulators charged with ensuring the clinical safety of new therapeutic agents. [Copyright &y& Elsevier]

Discusses the unconstitutional dimensions of coercive proposals under the Twenty-First Amendment to the United States Constitution. Description of the conditional offer problem; Dimensions of constitutional violation; Key components to appraise the constitutionality of individual conditional governmental proposals; Analysis on the several United States Supreme Court cases dealing with the issue.

Focuses on the application of the federal intellectual property law on the case of Florida Prepaid Postsecondary Education Expense Board versus College Savings Bank. History of the United States Supreme Court's state sovereign immunity doctrine; Impact of state intellectual property violations on foreign affairs; Conclusion.

Background: Influenza vaccination is recommended for adults regardless of human immunodeficiency virus (HIV) status. There may be facilitators or barriers to vaccinating people with HIV (PWH) that differ from people without HIV (PWoH). We sought to describe the uptake of influenza vaccination by HIV status and identify factors associated with vaccination., Methods: We abstracted data from the electronic health records of PWH and PWoH in Kaiser Permanente Northern California during 6 influenza seasons (2013-2018). We determined vaccination uptake and used Poisson regression models to evaluate factors associated with vaccination in PWH and PWoH., Results: 9272 PWH and 194 393 PWoH matched by age, sex, and race/ethnicity were included (mean age: 48 vs 49 years; men: 91% vs 90%; White race: 53% for both groups). PWH were more likely to receive the influenza vaccine (65-69% across years for PWH and 37-41% for PWoH) with an adjusted risk ratio for all years of 1.48 (95% CI: 1.46-1.50). For PWH, lower vaccination uptake was associated with several factors that suggested more complex health needs, such as lower CD4 cell counts, higher HIV viral loads, prior depression diagnoses, having Medicare insurance, and having a higher number of comorbidities. Associations with vaccination uptake were attenuated in PWH, compared with PWoH, for smoking, alcohol, and demographic factors., Conclusions: PWH had an almost 50% higher uptake of influenza vaccination than PWoH, possibly reflecting greater engagement with the healthcare system. We also found that PWH with more complex health needs had reduced vaccination uptake. Findings may inform outreach strategies to increase influenza vaccination in PWH., Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Despite decades of investment and improvements in infant health in the United States, efforts to ensure the health and well-being of birthing people, especially those from racialized and minoritized communities, have been underfunded and neglected. As a result, many birthing people do not have access to the quality care they deserve and suffer disproportionately from adverse health outcomes such as severe maternal morbidity and maternal mortality. Through a Reproductive Justice lens, this paper will discuss structural causes for maternal health disparities as well as some of the structural solutions necessary to support the correction of centuries of discrimination on the basis of race, sex, gender, and other minoritized identities., Competing Interests: Disclosures We certify that, to the best of our knowledge, no aspect of our current personal or professional circumstance places us in the position of having a conflict of interest with this chapter., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Unlabelled: Quantitative ECG Analysis., Introduction: Optimal atrial tachyarrhythmia management is facilitated by accurate electrocardiogram interpretation, yet typical atrial flutter (AFl) may present without sawtooth F-waves or RR regularity, and atrial fibrillation (AF) may be difficult to separate from atypical AFl or rapid focal atrial tachycardia (AT). We analyzed whether improved diagnostic accuracy using a validated analysis tool significantly impacts costs and patient care., Methods and Results: We performed a prospective, blinded, multicenter study using a novel quantitative computerized algorithm to identify atrial tachyarrhythmia mechanism from the surface ECG in patients referred for electrophysiology study (EPS). In 122 consecutive patients (age 60 ± 12 years) referred for EPS, 91 sustained atrial tachyarrhythmias were studied. ECGs were also interpreted by 9 physicians from 3 specialties for comparison and to allow healthcare system modeling. Diagnostic accuracy was compared to the diagnosis at EPS. A Markov model was used to estimate the impact of improved arrhythmia diagnosis. We found 13% of typical AFl ECGs had neither sawtooth flutter waves nor RR regularity, and were misdiagnosed by the majority of clinicians (0/6 correctly diagnosed by consensus visual interpretation) but correctly by quantitative analysis in 83% (5/6, P = 0.03). AF diagnosis was also improved through use of the algorithm (92%) versus visual interpretation (primary care: 76%, P < 0.01). Economically, we found that these improvements in diagnostic accuracy resulted in an average cost-savings of $1,303 and 0.007 quality-adjusted-life-years per patient., Conclusions: Typical AFl and AF are frequently misdiagnosed using visual criteria. Quantitative analysis improves diagnostic accuracy and results in improved healthcare costs and patient outcomes., (© 2010 Wiley Periodicals, Inc.)

Like many governmental actors in recent decades, the U.S. National Park Service (NPS) has operated increasingly through partnerships with other state and federal agencies, non-governmental organizations (NGOs), community groups, and private sector corporations. Perhaps the most salient example of this trend toward partnerships is the rapid growth and development of national heritage areas (NHAs). Since the first NHA received congressional designation in 1984, NHAs have become an increasingly popular strategy for protecting and managing landscapes. To date, congressional designation has been granted to 49 NHAs, making them one of the fastest growing initiatives involving the NPS. Despite this growth, no prior research has examined the efficacy or effectiveness of the NHA model. This article introduces the NHA concept, while reviewing the literature on evaluation research and its application to protected area management. We then offer an NHA program theory model for evaluating NHAs. The model was developed using a theory-based, process evaluation approach, along with 90 qualitative interviews conducted at three study sites: Blackstone River Valley National Heritage Corridor, MA-RI (BLAC); Delaware and Lehigh National Heritage Corridor, PA (DELE); and Cane River National Heritage Area, LA (CANE). We conclude by discussing the key challenges and implications associated with developing a long-term research agenda for evaluating NHAs.

People aging into Medicare need to choose a health plan. Several challenges exist for consumers in choosing a Medicare health plan, including limited knowledge of Medicare, limited experience in using comparative health plan quality information, and limited experience and ability to pull together and use plan information from different sources like employers and the Medicare program. The Choose with Care System was developed to help consumers aging into Medicare make informed Medicare health plan choices. Choose with Care is an innovative decision support tool for employers to use to assist people approaching age 65 to learn about their Medicare health plan options and how to incorporate information on the quality of care and services offered by health plans into their choices. Employers are the targeted channel for distributing the Choose with Care materials because they are one of the most recognized and accessible formal intermediaries for information about health insurance. We used multiple methods to test the Choose with Care products. Product testing showed that the Choose with Care materials increase older consumers' knowledge of Medicare and how it relates to retiree health insurance and improves their comprehension and use of comparative quality information when choosing a health plan.

We report on a federal initiative to develop a CAHPS (The Consumer Assessment of Healthcare Providers and Systems) survey to measure residents' experiences with quality-of-care and quality-of-life in nursing homes (known as NHCAHPS). We focus on how we created and tested questions for inclusion in the instrument and tested a possible cognitive screener to determine which residents could participate in a NHCAHPS interview. The major lessons learned were: (1) In contrast to other CAHPS surveys, ratings were more useful than reports because of the difficulty that residents had with summarizing over time and people; (2) consistent with other CAHPS surveys, the 0 to 10 response scale appeared to work well with nursing home residents for many of the quality-of-care questions; however, a different response scale was needed for many of the quality-of-life items; and (3) in contrast with typical survey methodology and other CAHPS surveys where explicit time reference periods are used, a non-specific present reference period in questions seemed to work best.

Coronary heart disease (CHD) is the leading cause of mortality in the United States. Hypertension, diabetes mellitus, hypercholesterolemia, and smoking have all been directly related to CHD. Obesity is on the rise in the United States and has also been associated with CHD. This review clearly establishes obesity as an independent risk factor for CHD as demonstrated by the Framingham Heart Study, Nurses Health Study, Buffalo Health Study, and the Cancer Prevention Study II. Morbid obesity was found to correlate with a significant risk of mortality from CHD, especially in young men. Prevention of obesity, and therefore reduction in risk from cardiovascular disease, is paramount in the management of obesity. New approaches to behavioral, medical, and surgical management of obesity are reviewed, including thalidomide, an antiangiogenic agent. A primary and secondary prevention model details a multidisciplinary approach to reducing risk in obesity., (Copyright 2003 CHF, Inc.)

Three record-keeping models were examined by an interdisciplinary committee at the Rochester Mental Health Center to see which would best meet the needs for a standardized record format that could be used by an outpatient comprehensive community mental health center. The systems examined were: (1) Model Criteria Set, (2) Problem Oriented Record, and (3) a Combination Diagnosis and Standardized Problem List. A modification of the Combination System used at the Cleveland Metropolitan General Hospital was developed. Using this tool, an audit committee began the process of Utilization Review. It is a suggested schema to other outpatient mental health centers who are in the process of developing a utilization review process.

A discussion of the legal process that resolves disputes involving the questions of causation of exposure to chemical substances is presented. Toxicologists and pharmacologists called upon to testify in private litigation of whether or not exposure to a particular chemical caused an illness will have a clearer view of the law's notion of causation by the examples cited. The trends in the law on this subject are reviewed and ways are offered for scientists to influence future chemical exposure litigation.