U.S. Immigration: The Origins and Evolution of Contemporary Issues and the Architecture of Future Reform

In 1965, the United States Congress passed the Immigration and Nationality Act, attempting to remove racial, religious, and cultural discrimination from the immigration system. However, the infamous act and subsequent legislation have caused unintended consequences. Illegal immigration has skyrocketed despite a massive increase in border enforcement; and Central Americans, particularly Mexicans, have become the target of racial and cultural discrimination, much like the Southern European immigrants of the early 1900s. The current immigration system still relies on the framework passed nearly 50 years ago, proving to be insufficient for contemporary United States. This thesis investigates the historical patterns in immigration legislation that have led to the contemporary issues that remain a subject of intense debate. The current system’s ineffective and increasingly expensive programs have created backlogs of family members, simultaneously preventing the inflow of immigrants in specific sectors the U.S. economy and workforce desperately need. The thesis investigates current reform bills and proposals, objective research done by the Congressional Budget Office and Congressional Research Service, and research provided by a host of nongovernmental policy institutes. There is an objective reform proposal presented by the thesis to demonstrate how political bias and the current gridlocked Congress have prevented necessary reform

Femoroacetabular impingement and classification of the cam deformity: the reference interval in normal hips

BACKGROUND AND PURPOSE: Most patients with femoroacetabular impingement (FAI) have a cam deformity, which may be quantified by measuring the alpha angle and anterior offset ratio (AOR). Knowledge of what constitutes a "normal" alpha angle and AOR is limited. We defined the reference intervals of these measurements from normal hips in the general population. PATIENTS AND METHODS: 157 individuals from the general population were reviewed clinically and radiographically. 74 individuals with clinical evidence of hip disease or radiographic evidence of osteoarthritis (OA) were excluded, leaving a study group of 83 individuals (mean age 46 (22-69) years, 44 females) with normal hips. The alpha angles and AORs were measured from cross-table lateral radiographs taken in 15 degrees internal rotation. A validation study consisting of a cadaver study and a measurement reliability study was also performed. RESULTS: The mean alpha angle was 48 degrees in men and 47 degrees in women. The mean AOR was 0.19, the same in men and women. Thus, sexes were combined to derive 95% confidence intervals for the population mean alpha angle (46-49 degrees ) and AOR (0.18-0.20). The 95% reference interval for the alpha angle was 32-62 degrees degrees, and for the AOR it was 0.14-0.24. The validation study confirmed that these measurements were resistant to a reasonable degree of variation in positioning and that the repeatability and reproducibility of the measurements was good. INTERPRETATION: These reference intervals indicate that clinically and radiographically normal hips may have alpha angles and AORs that have previously been considered "abnormal". The thresholds provided by this study will aid classification of individuals involved in longitudinal studies of FAI and OA, and may be of use to the practicing clinician in evaluating the young adult with hip pain

Outcomes of cartilage repair techniques for chondral injury in the hip-a systematic review.

OBJECTIVE/PURPOSE: The aim of the study was to assess the options of treatment and their related outcomes for chondral injuries in the hip based on the available evidence whilst highlighting new and innovative techniques. METHODS: A systematic review of the literature from PubMed (Medline), EMBASE, Google Scholar, British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine Database (AMED) was undertaken from their inception to March 2017 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical outcome studies, prospective/retrospective case series and case reports that described the outcome of cartilage repair technique for the chondral injury in the hip were included. Studies on total hip replacement, animal studies, basic studies, trial protocols and review articles were excluded. RESULTS: The systematic review found 21 relevant papers with 596 hips. Over 80% of the included studies were published in or after 2010. Most studies were case series or case reports (18 studies, 85.7%). Arthroscopy was used in 11 studies (52.4%). The minimum follow-up period was six months. Mean age of the participants was 37.2 years; 93.5% of patients had cartilage injuries of the acetabulum and 6.5% of them had injuries of the femoral head. Amongst the 11 techniques described in the systematic review, autologous matrix-induced chondrogenesis, osteochondral autograft transplantation and microfracture were the three frequently reported techniques. CONCLUSION: Over ten different techniques are available for cartilage repair in the hip, and most of them have good short- to medium-term outcomes. However, there are no robust comparative studies to assess superiority of one technique over another, and further research is required in this arena

Which acetabular measurements most accurately differentiate between patients and controls? A comparative study

Abstract: Background Acetabular morphology is an important determinant of hip biomechanics. To identify features of acetabular morphology that may be associated with the development of hip symptoms while accounting for spinopelvic characteristics, one needs to determine acetabular characteristics in a group of individuals older than 45 years without symptoms or signs of osteoarthritis. Previous studied have used patients with unknown physical status to define morphological thresholds to guide management. Questions/purposes (1) To determine acetabular morphological characteristics in males and females between 45 and 60 years old with a high Oxford hip score (OHS) and no signs of osteoarthritis; (2) to compare these characteristics with those of symptomatic hip patients treated with hip arthroscopy or periacetabular osteotomy (PAO) for various kinds of hip pathology (dysplasia, retroversion, and cam femoroacetabular impingement); and (3) to assess which radiographic or CT parameters most accurately differentiate between patients who had symptomatic hips and those who did not, and thus, define thresholds that can guide management. Methods Between January 2018 and December 2018, 1358 patients underwent an abdominopelvic CT scan in our institution for nonorthopaedic conditions. Of those, we considered 5% (73) of patients as potentially eligible as controls based on the absence of major hip osteoarthritis, trauma, or deformity. Patients were excluded if their OHS was 43 or less (2% [28]), if they had a PROMIS less than 50 (1% [18]), or their T\uf6nnis score was higher than 1 (0.4% [6]). Another eight patients were excluded because of insufficient datasets. After randomly selecting one side for each control, 40 hips were left for analysis (age 55 \ub1 5 years; 48% [19 of 40] were in females). In this comparative study, this asymptomatic group was compared with a group of patients treated with hip arthroscopy or PAO. Between January 2013 and December 2020, 221 hips underwent hip preservation surgery. Of those, eight were excluded because of previous pelvic surgery, and 102 because of insufficient CT scans. One side was randomly selected in patients who underwent bilateral procedure, leaving 48% (107 of 221) of hips for analysis (age 31 \ub1 8 years; 54% [58 of 107] were in females). Detailed radiographic and CT assessments (including segmentation) were performed to determine acetabular (depth, cartilage coverage, subtended angles, anteversion, and inclination) and spinopelvic (pelvic tilt and incidence) parameters. Receiver operating characteristics (ROC) analysis was used to assess diagnostic accuracy and determine which morphological parameters (and their threshold) differentiate most accurately between symptomatic patients and asymptomatic controls. Results Acetabular morphology in asymptomatic hips was characterized by a mean depth of 22 \ub1 2 mm, with an articular cartilage surface of 2619 \ub1 415 mm2, covering 70% \ub1 6% of the articular surface, a mean acetabular inclination of 48\ub0 \ub1 6\ub0, and a minimal difference between anatomical (24\ub0 \ub1 7\ub0) and functional (22\ub0 \ub1 6\ub0) anteversion. Patients with symptomatic hips generally had less acetabular depth (20 \ub1 4 mm versus 22 \ub1 2 mm, mean difference 3 mm [95% CI 1 to 4]; p < 0.001). Hips with dysplasia (67% \ub1 5% versus 70% \ub1 6%, mean difference 6% [95% CI 0% to 12%]; p = 0.03) or retroversion (67% \ub1 5% versus 70% \ub1 6%, mean difference 6% [95% CI 1% to 12%]; p = 0.04) had a slightly lower relative cartilage area compared with asymptomatic hips. There was no difference in acetabular inclination (48\ub0 \ub1 6\ub0 versus 47\ub0 \ub1 7\ub0, mean difference 0.5\ub0 [95% CI -2\ub0 to 3\ub0]; p = 0.35), but asymptomatic hips had higher anatomic anteversion (24\ub0 \ub1 7\ub0 versus 19\ub0 \ub1 8\ub0, mean difference 6\ub0 [95% CI 3\ub0 to 9\ub0]; p < 0.001) and functional anteversion (22\ub0 \ub1 6\ub0 versus 13\ub0\ub1 9\ub0, mean difference 9\ub0 [95% CI 6\ub0 to 12\ub0]; p < 0.001). Subtended angles were higher in asymptomatic at 105\ub0 (124\ub0 \ub1 7\ub0 versus 114\ub0 \ub1 12\ub0, mean difference 11\ub0 [95% CI 3\ub0 to 17\ub0]; p < 0.001), 135\ub0 (122\ub0 \ub1 9\ub0 versus 111\ub0 \ub1 12\ub0, mean difference 10\ub0 [95% CI 2\ub0 to 15\ub0]; p < 0.001), and 165\ub0 (112\ub0 \ub1 9\ub0 versus 102\ub0 \ub1 11\ub0, mean difference 10\ub0 [95% CI 2\ub0 to 14\ub0]; p < 0.001) around the acetabular clockface. Symptomatic hips had a lower pelvic tilt (8\ub0 \ub1 8\ub0 versus 11\ub0 \ub1 5\ub0, mean difference 3\ub0 [95% CI 1\ub0 to 5\ub0]; p = 0.007). The posterior wall index had the highest discriminatory ability of all measured parameters, with a cutoff value of less than 0.9 (area under the curve [AUC] 0.84 [95% CI 0.76 to 0.91]) for a symptomatic acetabulum (sensitivity 72%, specificity 78%). Diagnostically useful parameters on CT scan to differentiate between symptomatic and asymptomatic hips were acetabular depth less than 22 mm (AUC 0.74 [95% CI 0.66 to 0.83]) and functional anteversion less than 19\ub0 (AUC 0.79 [95% CI 0.72 to 0.87]). Subtended angles with the highest accuracy to differentiate between symptomatic and asymptomatic hips were those at 105\ub0 (AUC 0.76 [95% CI 0.65 to 0.88]), 135\ub0 (AUC 0.78 [95% CI 0.70 to 0.86]), and 165\ub0 (AUC 0.77 [95% CI 0.69 to 0.85]) of the acetabular clockface. Conclusion An anatomical and functional acetabular anteversion of 24\ub0 and 22\ub0, with a pelvic tilt of 10\ub0, increases the acetabular opening and allows for more impingement-free flexion while providing sufficient posterosuperior coverage for loading. Hips with lower anteversion or a larger difference between anatomic and functional anteversion were more likely to be symptomatic. The importance of sufficient posterior coverage was also illustrated by the posterior wall indices and subtended angles at 105\ub0, 135\ub0, and 165\ub0 of the acetabular clockface having a high discriminatory ability to differentiate between symptomatic and asymptomatic hips. Future research should confirm whether integrating these parameters when selecting patients for hip preservation procedures can improve postoperative outcomes

Prostate cancer navigation: initial experience and association with time to care.

OBJECTIVE: To evaluate factors associated with use of patient navigation in a prostate cancer population and identify whether navigation is associated with prolonged time to care. Cancer patient navigation has been shown to improve access to cancer screening, diagnosis, and treatment, but little is known about patient navigation in prostate cancer care. METHODS: All men diagnosed with localized prostate cancer between 2009 and 2015 were abstracted from the MaineHealth multi-specialty tumor registry. Regression analyses controlling for patient-, disease-, and system-level factors evaluated characteristics associated with navigation utilization. The association between navigation utilization, barriers to care, and longer time to treatment was assessed with Cox proportional hazards regression. RESULTS: Of the patient population (n = 1587), 85% of men were navigated. Navigation use was associated with earlier year of diagnosis, treatment by a high-volume urologist, and lower risk disease (p \u3c 0.05). Treatment delay was associated with low-risk disease (vs: intermediate OR 0.62, 95% CI 0.46-0.85 and high OR 0.16, 95% CI 0.1-0.25) and receipt of navigation services (OR 1.65, 95% CI 1.12-2.45) but not distance to care, insurance, or treatment choice. CONCLUSIONS: We observed that patients with low-risk prostate cancer were more likely to utilize navigation, but traditional barriers to care were not associated with utilization. Navigation was associated with longer time to treatment, which likely reflects clinically appropriate delays associated with greater shared decision making. Time to treatment may not be the ideal metric for evaluating navigation in prostate cancer; shared decision making, patient satisfaction, and psychosocial outcomes may be more appropriate