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Parental Rights, Parental Choice, and State Public Education Mandates
Get PDFPierce v. Society of Sisters and Meyer v. Nebraska were cases about parental rights in general, and parental choice in particular. Both centered on a challenge to a state’s legal effort to reduce or eliminate the educational choices available to parents—in the former, by requiring students to attend public schools, in the latter, by requiring instruction in all schools, public and private, be conducted in English. Pierce and Meyer also were about state efforts to forge a homogeneous American citizenry by limiting the educational choices available to parents. As Justice McReynolds observed in Meyer, “The desire of the Legislature to foster a homogeneous people with American ideals . . . is easy to appreciate,” but, as he observed a year later in Pierce, “the fundamental theory of liberty upon which all governments in this Union repose excludes any general power of the State to standardize its children by forcing them to accept instruction from public teachers only.
Understanding California\u27s Climate Zones
Get PDFCalifornia’s diverse geography led the California Energy Commission (CEC) to divide the state into 16 Climate Zones, each reflecting local weather patterns and energy demands. These zones guide energy-efficient building standards by setting energy budgets tailored to regional conditions. This fact sheet explains the role of climate zones in shaping energy policy, using San Diego County’s four distinct zones as an example of how local climates influence building code requirements.https://digital.sandiego.edu/npi-sdclimate/1043/thumbnail.jp
Building Climate Resilience Through Food Recovery
Get PDFIn an effort to combat GHG emissions from food waste, California passed Senate Bill 1383 (SB 1383) into law in 2016. The bill contains key provisions aimed at increasing edible food recovery. By rescuing food that would otherwise go to the landfill, California entities have been able to help save precious food and advance sustainable solutions to address climate change in their local communities. Since the food recovery requirements took effect in January of 2022, over 217,000 tons of unsold food have been recovered annually, providing more than 700 million meals to food-insecure Californians.https://digital.sandiego.edu/npi-sdclimate/1039/thumbnail.jp
Empowering Voices: The Impact of Collective Storytelling Within College Support Programs
Get PDFThe Torero Renaissance Scholars Program (TRSP) supports undergraduate and graduate students who have experienced foster care, homelessness, or who are emancipated minors or in legal guardianship. My action research aimed to explore and improve TRSP practices related to sharing personal narratives, community building, and fostering mutual understanding between students, campus, and community partners. Using an action research model focused on community engagement, I conducted three research cycles involving narrative inquiry-based individual interviews and surveys to evaluate group activities. Findings revealed a tension around sharing personal stories and highlighted the importance of self-authorship and holistic mentorship. Interviews showed students prioritize resources critical to financial and academic success, while also valuing connections within the TRSP community. Further evaluation of TRSP programs underscored the value of facilitating both individual reflection and community building. Additionally, it emphasized the importance of empowering students to participate in events that encourage sharing personal narratives
Coming Back to Life: Inner Work, Intentional Containers and Feminine Leadership for Social Change — A Phenomenological Case Study of a Social Change-Oriented Organization and the Self
Get PDFThis qualitative study explores the phenomenon of inner work within social change organizations through an in-depth case study of a nonprofit organization dedicated to women’s empowerment and transformation. Using a phenomenological approach and ethnographic methods, the research combines intensive 7-month fieldwork in 2016 with reflective analysis years later, shaped by my own evolving relationship with inner work practices, providing a unique perspective on how inner work lived experience shapes individuals, organizational culture, and social change efforts.
The findings reveal that the social change organization (SCO) operated through three distinct yet interconnected levels of inner work practice: tending to the personal container through embodiment, presence, self-reflection, shadow work and intention; crafting intentional collective containers that balance structure and flow; and tending to universal containers through earth-based, energetic and spiritual practices.
The organization’s culture reflected core beliefs and assumptions that transformation is cyclical and a way of life, that inner work is both source of healing and leadership, involves reclaiming the feminine, and thrives within community. Underlying these assumptions, the research uncovered an organization that embraced tensions, as expressions of both the purpose and result of inner work. Most profoundly, the SCO approached inner work and social change as inseparable—a unified field of experience and practice. This research revealed how inner work at the organization transcended conventional understanding—evolving from merely acknowledging the inner realm to fundamentally reorienting to it as the primary source of guidance, authority, and alignment with Life itself.
This research contributes to organizational theory by extending Laloux’s (2014) Teal framework, articulating how inner work supports self-organization, how intentional containers contribute to organizational wholeness, and how explicitly feminine approaches enhance evolutionary purpose. An emergent Whole Living Being conceptual map offers a new framework for understanding inner work practices across individual and collective dimensions.
This study reveals the transformative potential and significant challenges of integrating inner work into organizational life, providing insights for individuals and organizations seeking more authentic, sustainable approaches to social change that reorient to the inner realm as a source of authority for work that is meaningful, vibrant, and truly in service of the whole
Optimizing Psychiatric Care through Pharmacogenomics: An Evidence-Based Program to Increase Multi-gene Pharmacogenomic Testing and Provider Competence in Mental Health Settings
Get PDFObjective: This scholarly project aimed to enhance psychiatric providers\u27 competency, confidence, and knowledge in the PHASER pharmacogenomic (PGx) testing program at the VA San Diego Healthcare System.
Background: PGx testing enhances psychiatric care by enabling precise medication management tailored to a patient’s genetic profile, improving treatment effectiveness and reducing adverse drug reactions. Despite demonstrated clinical utility, adoption of PGx remains limited due to provider knowledge gaps. This project addresses these gaps through targeted education.
Methods: Two educational modules, developed with input from the PHASER site-lead, aimed to enhance provider knowledge and confidence in PGx. Module one introduced the PHASER program and PGx applications, while the second utilized case studies to illustrate PGx’s clinical utility. Pre- and post-assessments measured provider knowledge, competence, and confidence, while PGx test utilization data assessed the initiative\u27s impact.
Results: Analysis demonstrated improved provider competence and confidence in PGx application. Statistically significant competence gains occurred in PGx principles (p = 0.040), informed consent (p = 0.026), and ethical considerations (p = 0.011). Providers reported significantly greater confidence in applying PGx testing (p = 0.018) and communicating results (p = 0.028); however, improvements in managing concerns did not reach significance (p = 0.16). Knowledge scores increased from 86 to 94 percent, reflecting a 7.33% improvement (p = 0.039).
Conclusion: This project demonstrated the effectiveness of targeted education in enhancing PGx adoption in psychiatric care. These findings also highlight the intervention’s effectiveness in enhancing provider confidence, competence, and knowledge in PGx application.
Keywords: Pharmacogenomics, major depressive disorder, clinical psychiatry, PGx testing, Veterans Health Administration, PHASER, healthcare provider education, quality improvemen
Leading Change for Transgender and Gender Diverse Healthcare: Assessing Organizational Readiness
No full textBackground: Transgender and gender-diverse (TGD) individuals face persistent stigma and systemic discrimination across multiple societal domains, with healthcare settings—intended as safe spaces—often being among the most harmful. Despite increased visibility of TGD populations and growing research on their health inequities, inclusive healthcare remains insufficiently addressed by many healthcare leaders, adding to the urgency to advance equitable, inclusive care. Additionally, structural cisnormativity and binary gender frameworks continue to perpetuate misinformation, erasure, and health disparities. Addressing these entrenched barriers requires systemic reform rooted in cultural humility, inclusive practices, and a commitment to dismantling cisnormative bias within healthcare delivery and policy. This study aims to examine leadership readiness for change toward inclusive healthcare policy and practice by exploring the relationships among change commitment, change efficacy, and the degree to which healthcare leaders value the experiences of TGD communities.
Study Population: The study population consisted of healthcare leaders, in varying leadership roles, varying systems of care, and varying geographic locations who completed an online survey.
Purpose/Aims: The purpose of this study was to identify the potential impact that leadership readiness to change has on the pervasive nature of systemic barriers to improved patient health outcomes for TGD patients by exploring the relationships among select demographics, leadership characteristics, readiness to change scores, and attitudes and beliefs towards transgender and gender diverse populations.
Methods: A descriptive correlational cross-sectional design study was conducted. An investigator-designed survey guided by implementation science and Weiner’s (2009) theory of organizational readiness for change was deployed online between December 2024 and February 2025. A convenience sample of 103 participants across systems of care was collected and analyzed.
Results: Healthcare leaders indicate readiness to integrate inclusive healthcare strategies for TGD population, as evidenced by high average agreeability scores on both standardized instruments—Organizational Readiness for Implementing Change (ORIC) and Transgender Attitudes and Beliefs Scale (TABS). Bivariate statistics revealed significant group differences between ORIC and participant education, as well as between TABS and religious affiliation, geographic location, gender identity, education, leadership role, hospital type, and tenure within an organization. Linear regression analysis indicated predictors (education, leadership role, hospital type, TABS human value) explained 25.4% of the variability in readiness to change among participant leaders; predictors (gender, religion, education, leadership role, tenure, hospital type, geographic location) explained 42.3% of the variability in leaders\u27 attitudes and beliefs.
Implications: Organizational readiness for change is a multi-level, multifaceted construct that must uniquely appraise and address perceptions of key determinants and be responsive to their unique demands. Healthcare leaders indicate readiness to integrate inclusive healthcare strategies for TGD population, however, awareness of complex interactions between contextual readiness and content agreeability is critical when considering change related to TGD populations. Further, readiness does not necessarily translate into effective action, as individual beliefs, implicit biases, and structural barriers may still hinder meaningful progress.
Keywords: transgender, gender diverse, health disparity, gender inclusivity, leadership readiness, change implementatio
Chess as a Visual Language: Women Playing Love in the Medieval Courts of Spain and France
Get PDFThis thesis explores the visual representations of the game of chess in two case studies during the medieval period in the courts of Europe: manuscript illustrations in Spain, and a carved ivory mirror case in France. These case studies reveal how visual objects were used to construct cultural realities. Specifically, they illustrate how depictions of chess combined with the presence of women not only alluded to romantic possibilities, but also dictated the role, conduct, and perception of women in the medieval courts. The imagined woman’s adherence to expected court rules, rules stemming from chess games, and the art of love displayed in these visual objects served as instructive examples for female viewers to align themselves to.
The first case study, a thirteenth-century Castilian treaty of chess and board games, Libro de ajedrez ( Book of Games ), contains vivid illustrations of chess games, one of them titled “Problem 25.” The scene illustrates a game between two men, with women flanking the outer edges of the work. At first glance, the work’s sole purpose is to detail the game in progress. However, the transparent clothing of the women, and intense gaze of the man allude to erotic desire. The next case study, a fourteenth-century French ivory relief Mirror Case with a Couple Playing Chess, serves as a key example of the historically popular personal ivory-sculpted treasures. The scene carved onto the mirror case captures a chess game between a man and a woman. The woman opens her legs, the man grasps a pole, and the game transforms into courtly foreplay to indulge in desire. Ultimately, whether featured as an opponent or a distraction, the presence of women in chess scenes became a tool for art to materialize the courtly love tradition, transmitting women’s expected conduct both within the courts and within love
Patient Education on Conversion from Oral ART/PrEP to Long-Acting Injectable (LAI) to Improve Patient Treatment Adherence
Get PDFPatient Education on conversion from oral ART/PrEP to Long-Acting Injectable (LAI) improves patient adherence.
Marnel Reina Mae Hernandez, MSN, RN
Joseph, F. Burkard, DNSc, CRNA, EBP-C
Background: Long-acting injectables (LAI) have been shown to be equally effective in viral load suppression. Implementing nurse led educational interventions in the use of oral treatment to LAI will address if LAI prescriptions can improve adherence and patient retention. Despite the availability of LAI for ART (antiretroviral treatment) and PrEP (pre-exposure prophylaxis for HIV) patients continue to have a low appointment adherence which can impact adherence and overall viral detectability. LAIs will continue to be part of HIV and HIV prevention medicine.
Purpose of Project: This project aimed to implement a patient education program providing educational foundation to nursing staff to optimize the LAI prescribing as an alternative regimen from oral regimen to ensure viral load compliance and follow up appointment and treatment adherence.
EBP Model: The Johns Hopkins Evidence-Based Practice Model supports a problem-solving approach to clinical decision-making and fosters enhanced team collaboration between healthcare center staff, the pharmacy team, and promotion of patient self-efficacy as well as enhancing patient satisfaction and experience.
Evidenced-Based Interventions: This evidence-based intervention provided multi-modal educational resources (exam room QR codes, paper handouts, or e-resource via portal/secured messaging) for staff demonstration on the importance of adhering to oral treatment and completing provider visits in maintaining and preventing HIV transmission risk. The nursing team included registered nurses (RNs), licensed vocational nurses (LVNs), and/or medical assistants (MA) to provide interventions at patient appointment visits as well as using multiple patient communication platforms for care follow-up.
Evaluation/Results: Evaluation of results reviewed institutional/organizational data on completed appointment rates, patient no show rates, pharmacy refill and fill data, and viral load suppression data pre-implementation and post-implementation.
Implications for Practice: The successful implementation of this project allowed more nurse-led educational interventions at the clinic level with the goal of enterprising this technique at multiple clinic sites as a method to improve patient retention and patient treatment adherence.
Conclusion: The initiation of a nurse-led educational intervention designed to improve patient’s basic understanding of continuing their treatment and provided self-efficacy as well as autonomy in their care. Using an educational intervention allowed improvement in overall patient treatment adherence and retain patients in care. The goal will be to standardize this process over multiple clinic sites as an available tool for the clinical team and enhance patient experience.
Keywords: Long-Acting Injectables, Viral Load Suppression, Patient Treatment Adherenc
Increasing Advance Directive Completion: A Future Initiative for All
Get PDFAbstract
Problem Statement: Healthcare providers focus on delivering quality and patient-centered care. Yet, without any direction, healthcare providers treat patients as a full code until someone can speak on the patient’s behalf. Therefore, it is crucial that patients make their wishes known.
Description of Innovation: On a cardiac step-down unit, registered nurses were educated on the PREPARE advance directive. Upon admission to the unit, patients were asked if they had an advance directive. If the patient did not have an advance directive, they were educated on the importance of having an advance directive. Then they were given the PREPARE For Your Care Pamphlet, advance directive form (in their preferred language), and shown the PREPARE website via an iPad— as a resource to help the patient (and their loved ones) fill out their advance directive.
Outcomes: Baseline patient advance directive completion was 8%. After three months of implementation, advance directive completion increased to 27% for September, 16% for October, and 40% for November. Prior to this intervention, RN’s confidence to speak about ACP was 50%, post intervention it was 72%. Prior to intervention, 54% of RN’s reported know how to locate ACP documents, post intervention RN’s reported 92%. Prior to intervention, 50% of nurses stated they knew how to document advance care planning education, post intervention it was 92%. Pre intervention, 7% of RN’s strongly agreed that they had adequate knowledge regarding advance directives, post intervention 24% of RN’s strongly agreed that they had adequate knowledge regarding advance directives.
Implications/Significance: When advance directives are in place, it helps reduce hospital costs, helps decrease out-of-pocket costs for the patient, and provides patient-centered care.
Recommendations: In order to encourage nurses to discuss advance directives, the following recommendations are suggested: 1) Educate nurses on the importance of advance directives 2) Make advance directive resources available and easily accessible 3) Use audit tool to reinforce compliance 4) Hospital wide implementation. Despite this study being aimed at the geriatric population, it is important to note that advance directives would be beneficial to all