Kazarian v. United States Citizenship and Immigration Services: Clarifying “Extraordinary Ability” Visa Qualifications

In 2007, Dr. Poghos Kazarian appealed the United States Citizenship and Immigration Service’s denial of his application for an “extraordinary ability” visa. Prior to Kazarian v. US Citizenship & Immigration Services, the Ninth Circuit had never addressed the issue of how the statutory and regulatory requirements for the “extraordinary ability” visa should be interpreted. The Kazarian court determined that the regulations outlining the evidence sufficient to qualify for the “extraordinary ability” classification were extremely restrictive. The court then concluded that, since Dr. Kazarian had presented only two of the three types of evidence required to meet the eligibility criteria, the agency’s determination that his petition was insufficient to support an “extraordinary ability” visa was correct

IMPLEMENTATION OF DONOR HUMAN MILK IN A NEWBORN NURSERY: A QUALITY IMPROVEMENT INITIATIVE TO INCREASE EXCLUSIVE BREAST MILK FEEDING

Background: At the site of this quality improvement project, exclusive breast milk feeding rates before discharge from a newborn nursery were behind benchmark goals. The aim of this project was to improve exclusive breast milk feeding rates by implementing a Pasteurized Donor Human Milk (PDHM) Program for breastfeeding newborns requiring medically indicated supplementation. The study site was a Level I newborn nursery of a 20-bed, labor, delivery, recovery, and postpartum unit within a 100-bed community hospital (i.e., the agency). Methods: This retrospective pre-post cohort study used the Plan, Do, Study, Act (PDSA) framework for rapid cycle change to assess the impact of the program on breast milk feeding exclusivity on discharge. The primary outcomes of interest were on the change in exclusivity among the full-term population according to the Joint Commission’s Perinatal Care Core Measures PC-05 and PC-05a (retired). Variables of interest included the hour of newborn age at first supplementation, indications for supplementation, and formula use in the breastfeeding population within the first two days of life. Data were collected by abstraction and medical record review for 3 months pre- and 3 months post- PDHM Program implementation. Interventions: A multi-disciplinary team was developed to plan and implement the PDHM Program. The process began by developing necessary documents and workflows and ended with staff training and safe provision of PDHM. Results: Three months after implementation, exclusive breast milk feeding rates increased 3% (pre- 68%, post- 71%) in the full-term population and 11% (pre- 77%, post- 88%) within the full-term, breastfeeding population. Conclusions: The implementation of a PDHM Program was successful in improving exclusive breast milk feeding rates. Exclusive breast milk feeding rates exceeded the intended 10% increase based on the PC-05a metric. While many successes were realized in this quality improvement project, further work is needed to better grasp the impact of a PDHM Program at the agency and the implications of using PDHM in the full-term population