Unmet Needs of Unaccompanied Minors from Central America: Perceptions of Professionals from Multiple Sectors

Background: In recent years, there has been a significant influx of Central American youth who cross the U.S.-Mexico border without a parent or legal guardian. While federal procedures are established to oversee the treatment and placement of unaccompanied minors, less is known about the needs of unaccompanied minors and available services afterthey are placed in appropriate custody. Methods: Purposive and strategic sampling of professionals from medical, social work, education and legal fields was conducted. Fourteen informants were recruited across the U.S. for confidential semi-structured interviews, which were audio recorded and transcribed in 2016 to 2017. Standard anthropological methods were employed, including immersion and crystallization techniques that incorporated within-case and across-case analytic strategies. Results: Recruited informants had previous or current direct experience working with immigrant minors for three or more years in addition to extensive public health experience. Unaccompanied minors were described as predominantly adolescent boys, ranging from 2 to 18 years old. Children faced unmet mental, medical and psychosocial needs that are interconnected and largely unmet due to children’s legal status and ineligibility to access services in most jurisdictions. The most pressing challenge affecting the health of youth was their immigration status. Across sectors,informants revealed an imbalance between the growing demand for services, including legal counsel, and the limited supply of professionals and well-funded services to meet children’s complex needs. Informants emphasized the value of trauma-informed practice, Spanish language proficiency, child-informed practice and intercultural awareness and humility towards their clients as key features of equipped professionals working with this vulnerable population. Regardless of sector, professionals emphasized the importance of culturally-informed care to immigrant youth. Building these skills is associated with greater confidence to provide services to unaccompanied minors, many of whom have experienced as significant burden of childhood trauma. Conclusions: The health needs of unaccompanied minors are complex and span across medical, social work, education, and legal fields. Interdisciplinary collaboration is needed to address the challenges faced by unaccompanied minors in their efforts to integrate themselves into their new communities and promote their resilience. Promising initiatives include co-location of inter-sector services for increased access and efficiency of services and development of professional trainings and resources for professionals in sectors that serve this population

Can we measure hospital quality from physicians' choices?

In this paper, we propose an alternative methodology for ranking hospitals based on the choices of Medical School graduates over hospital training vacancies. Our methodology is therefore a revealed preference approach. Our methodology for measuring relative hospital quality has the following desirable properties: a) robust to manipulation from hospital administrators; b) conditional on having enough observations, it allows for differences in quality across specialties within a hospital; c) inexpensive in terms of data requirements, d) not subject to selection bias from patients nor hospital screening of patients; and e) unlike other rankings based on experts' evaluations, it does not require physicians to provide a complete ranking of all hospitals. We apply our methodology to the Spanish case and find, among other results, the following: First, the probability of choosing the best hospital relative to the worst hospital is statistically significantly different from zero. Second, physicians value proximity and nearby hospitals are seen as more substitutable. Third, observable time-invariant city characteristics are unrelated to results. Finally, our estimates for physicians' hospital valuations are significantly correlated to more traditional hospital quality measures

A methodology to measure hospital quality using physicians' choices over training vacancies

In this paper, we propose an alternative methodology to rank hospitals based on the choices of Medical Schools graduates over training vacancies. We argue that our measure of relative hospital quality has the following desirable properties: a) robustness to manipulation from the hospital's administrators; b) comprehensiveness in the scope of the services analyzed; c) inexpensive in terms of data requirements, and d) not subject to selection biases. Accurate measures of health provider quality are needed in order to establish incentive mechanisms, to assess the need for quality improvement, or simply to increase market transparency and competition. Public report cards in certain US states and the NHS ranking system in the UK are two attempts at constructing quality rankings of health care providers. Although the need for such rankings is widely recognized, the criticisms at these attempts reveal the difficulties involved in this task. Most criticisms alert to the inadequate risk-adjustment and the potential for perverse consequences such as patient selection. The recent literature, using sophisticated econometric models is capable of controlling for case-mix, hospital and patient selection, and measurement error. The detailed data needed for these evaluations is, however, often unavailable to researchers. In those countries, such as Spain, where there is neither public hospital rankings nor public data on hospital output measures such as mortality rates our methodology is a valid alternative. We develop this methodology for the Spanish case. In a follow-up paper we will present results using Spanish data. In Spain graduates choose hospital training vacancies in a sequential manner that depends on their average grade. Our framework relies on three assumptions. First, high quality hospitals provide high quality training. Second, graduates are well informed decision makers who are well qualified to assess hospital quality. Third, they prefer to choose a high quality vacancy rather than a low quality one ceteris paribus. If these assumptions hold, then the first physicians to choose are likely to grab the best vacancies while the ones who choose last are stuck with the worst available. Thus, it is possible to infer from physicans' choices quality differentials amongst hospitals. We model the physician's decision as a nested-logit a la McFadden. Unlike in standard applications of McFadden's model, in our application the choice set is not constant across physicians but it shrinks along the sequential hospital choice proces

Scalar and Spinor Field Actions on Fuzzy S4S^4: fuzzy CP3CP^3 as a SF2S^2_F bundle over SF4S^4_F

We present a manifestly Spin(5) invariant construction of squashed fuzzy $CP^3$ as a fuzzy $S^2$ bundle over fuzzy $S^4$. We develop the necessary projectors and exhibit the squashing in terms of the radii of the $S^2$ and $S^4$. Our analysis allows us give both scalar and spinor fuzzy action functionals whose low lying modes are truncated versions of those of a commutative $S^4$.Comment: 19 page

Quantum Mechanical Corrections to the Schwarzschild Black Hole Metric

Motivated by quantum mechanical corrections to the Newtonian potential, which can be translated into an $\hbar$-correction to the $g_{00}$ component of the Schwarzschild metric, we construct a quantum mechanically corrected metric assuming $-g_{00}=g^{rr}$. We show how the Bekenstein black hole entropy $S$ receives its logarithmic contribution provided the quantum mechanical corrections to the metric are negative. In this case the standard horizon at the Schwarzschild radius $r_S$ increases by small terms proportional to $\hbar$ and a remnant of the order of Planck mass emerges. We contrast these results with a positive correction to the metric which, apart from a corrected Schwarzschild horizon, leads to a new purely quantum mechanical horizon.Comment: 14 pages Latex, enlarged version as compared to the published on

A METHODOLOGY TO MEASURE HOSPITAL QUALITY USING PHYSICIANS' CHOICES OVER TRAINING VACANCIES

In this paper, we propose an alternative methodology to rank hospitals based on the choices of Medical Schools graduates over training vacancies. We argue that our measure of relative hospital quality has the following desirable properties: a) robustness to manipulation from the hospital’s administrators; b) comprehensiveness in the scope of the services analyzed; c) inexpensive in terms of data requirements, and d) not subject to selection biases. Accurate measures of health provider quality are needed in order to establish incentive mechanisms, to assess the need for quality improvement, or simply to increase market transparency and competition. Public report cards in certain US states and the NHS ranking system in the UK are two attempts at constructing quality rankings of health care providers. Although the need for such rankings is widely recognized, the criticisms at these attempts reveal the difficulties involved in this task. Most criticisms alert to the inadequate risk-adjustment and the potential for perverse consequences such as patient selection. The recent literature, using sophisticated econometric models is capable of controlling for case-mix, hospital and patient selection, and measurement error. The detailed data needed for these evaluations is, however, often unavailable to researchers. In those countries, such as Spain, where there is neither public hospital rankings nor public data on hospital output measures such as mortality rates our methodology is a valid alternative. We develop this methodology for the Spanish case. In a follow-up paper we will present results using Spanish data. In Spain graduates choose hospital training vacancies in a sequential manner that depends on their average grade. Our framework relies on three assumptions. First, high quality hospitals provide high quality training. Second, graduates are well informed decision makers who are well qualified to assess hospital quality. Third, they prefer to choose a high quality vacancy rather than a low quality one ceteris paribus. If these assumptions hold, then the first physicians to choose are likely to grab the best vacancies while the ones who choose last are stuck with the worst available. Thus, it is possible to infer from physicans’ choices quality differentials amongst hospitals. We model the physician’s decision as a nested-logit a la McFadden. Unlike in standard applications of McFadden’s model, in our application the choice set is not constant across physicians but it shrinks along the sequential hospital choice process

Extension of Tycho catalog for low-extinction windows in the galactic bulge

We present in this work secondary catalogs up to $m_{Val} \sim 13$ based on the Tycho reference frame (ESA, 1997) for 12 selected low-extinction fields towards the galactic bulge. The observations have been performed with the Askania-Zeiss Meridian Circle equiped with a CCD camera, located at the Abrah\~ao de Moraes Observatory (Valinhos, Brazil) and operated by the Institute of Astronomy and Geophysics, S\~ao Paulo University. The presented catalog, though not complete, has been designed to help in intensive search programmes (e.g. microlensing and variable searches) and therefore the selected standards have a high astrometric and photometric ($V$ band, approximately) quality. The mean precisions obtained were $0.0018^{s}$ in $\alpha$, 0.013'' in $\delta$, 0.030 for the standard deviation in magnitude and 0.0042 for the magnitude when weighted with the error bars in each night (in the mean, 42 stars for the catalog of each window). Tables B.1 to B.12 are also available in eletronic form at the CDS via anonymous ftp to cdsarc.u-strasbg.fr (130.79.128.5) or via http://cdsweb.u-strasbg.fr/Abstract.html.Comment: 16 pages, 6 figures, A&A Latex style. Published in A&A

Stellar variability in low-extinction regions towards the Galactic Bulge

Intensive monitoring of low-extinction windows towards the galactic bulge has provided in the last years valuable information for studies about the dynamics, kinematics and formation history of this part of the galaxy, mainly by characterizing the bulge stellar populations (Paczy\'nski, 1996). Since 1997, we have been conducting an intensive photometric-astrometric survey of the galactic bulge, with the monitoring of about 120000 stars in 12 windows uniformly distributed in galactic latitude and longitude (Blanco & Terndrup, 1989 e Blanco, 1988) never before submitted to this kind of survey. For this purpose, we have used the IAG/USP CCD Meridian Circle of the Abrah\~ao de Moraes Observatory. The main objective of this work is the identification and classification of variable objects. In this work we present the set up and development of the necessary tools for a project like this and the posterior analysis of our data. We briefly describe the construction of a program to organize and detect variables among the observed stars, including real time alerts (for variations greater than 0.3 magnitudes). The preliminary analysis after the processing of 76 nights of observation yielded 479 variable stars, from which 96.7 % of them are new. We discuss the preliminary classification of this variables, based on: a) the observed amplitude of variation; b) the shape of light curve; c) the expected variable classes among our data and d) the calculated periods, whenever possible. Finally, we discuss the future perspectives for the project and for the applications and analysis of the discovered variable stars.Comment: 10 pages, 14 figures. Accepted by A&A