Time, Due Process, and Representation: An Empirical and Legal Analysis of Continuances in Immigration Court

Since 2014, U.S. immigration courts have expedited the cases of many children and families fleeing persecution in Mexico and Central America. This Article conducts an empirical and legal analysis of this policy, revealing that reasonable time between immigration court hearings is necessary to protect the statutory and constitutional rights to legal representation. A large majority of immigrants facing deportation- including those part of the recent surge of children and families from Central America and Mexico-appear at their first deportation hearing without a lawyer, often because they cannot afford one. When an immigrant appears without a lawyer and does not expressly waive his or her right to counsel, the immigration judge (IJ) must grant a continuance that allows a reasonable period of time for an immigrant to search for and retain counsel. Yet existing law does not specify what period of time is reasonable, and the courts of appeals disagree over how closely to scrutinize an IJ\u27s decision to deny a continuance. In this Article, we use schedule data from the Executive Office for Immigration Review to show that the length of a continuance has a large effect on immigrants\u27 likelihood of finding counsel, of appearing at subsequent hearings, and of eventually avoiding removal. Our analysis demonstrates that shorter continuances for unrepresented children and families prevented many from finding counsel and avoiding deportation. In light of these findings, we examine the due process and statutory consequences of an IJ\u27s decision to deny a continuance or to grant an overly short continuance. We conclude by recommending that initial continuances of fewer than ninety days should be presumptively invalid

Variations in visceral leishmaniasis burden, mortality and the pathway to care within Bihar, India

BACKGROUND: Visceral leishmaniasis (VL) has been targeted by the WHO for elimination as a public health problem (< 1 case/10,000 people/year) in the Indian sub-continent (ISC) by 2020. Bihar State in India, which accounts for the majority of cases in the ISC, remains a major target for this elimination effort. However, there is considerable spatial, temporal and sub-population variation in occurrence of the disease and the pathway to care, which is largely unexplored and a threat to achieving the target. METHODS: Data from 6081 suspected VL patients who reported being clinically diagnosed during 2012-2013 across eight districts in Bihar were analysed. Graphical comparisons and Chi-square tests were used to determine differences in the burden of identified cases by season, district, age and sex. Log-linear regression models were fitted to onset (of symptoms)-to-diagnosis and onset-to-treatment waiting times to estimate their associations with age, sex, district and various socio-economic factors (SEFs). Logistic regression models were used to identify factors associated with mortality. RESULTS: Comparisons of VL caseloads suggested an annual cycle peaking in January-March. A 17-fold variation in the burden of identified cases across districts and under-representation of young children (0-5 years) relative to age-specific populations in Bihar were observed. Women accounted for a significantly lower proportion of the reported cases than men (41 vs 59%, P < 0.0001). Age, district of residence, house wall materials, caste, treatment cost, travelling for diagnosis and the number of treatments for symptoms before diagnosis were identified as correlates of waiting times. Mortality was associated with age, district of residence, onset-to-treatment waiting time, treatment duration, cattle ownership and cost of diagnosis. CONCLUSIONS: The distribution of VL in Bihar is highly heterogeneous, and reported caseloads and associated mortality vary significantly across different districts, posing different challenges to the elimination campaign. Socio-economic factors are important correlates of these differences, suggesting that elimination will require tailoring to population and sub-population circumstances

Billing by residents and attending physicians in family medicine: the effects of the provider, patient, and visit factors

BACKGROUND: Medical billing and coding are critical components of residency programs since they determine the revenues and vitality of residencies. It has been suggested that residents are less likely to bill higher evaluation and management (E/M) codes compared with attending physicians. The purpose of this study is to assess the variation in billing patterns between residents and attending physicians, considering provider, patient, and visit characteristics. METHOD: A retrospective cohort study of all established outpatient visits at a family medicine residency clinic over a 5-year period was performed. We employed the logistic regression methodology to identify residents' and attending physicians' variations in coding E/M service levels. We also employed Poisson regression to test the sensitivity of our result. RESULTS: Between January 5, 2009 and September 25, 2015, 98,601 visits to 116 residents and 18 attending physicians were reviewed. After adjusting for provider, patient, and visit characteristics, residents billed higher E/M codes less often compared with attending physicians for comparable visits. In comparison with attending physicians, the odds ratios for billing higher E/M codes were 0.58 (p = 0.01), 0.56 (p = 0.01), and 0.63 (p = 0.01) for the third, second, and first years of postgraduate training, respectively. In addition to the main factors of patient age, medical conditions, and number of addressed problems, the gender of the provider was also implicated in the billing variations. CONCLUSION: Residents are less likely to bill higher E/M codes than attending physicians are for similar visits. While these variations are known to contribute to lost revenues, further studies are required to explore their effect on patient care in relation to attendings' direct involvement in higher E/M-coded versus their indirect involvement in lower E/M-coded visits

Fluid-Damping-Controlled Instability of Tubes in Crossflow

A mathematical model for fluid damping controlled instability of tubes presented in this paper is based on the unsteady flow theory. Motion dependent fluid forces are measured in a water channel. From the measured fluid forces, fluid stiffness and fluid damping coefficients, are calculated as a function of reduced flow velocity, oscillation amplitude, and Reynolds number. Once these coefficients are known, the mathematical model can be applied to predict structural instability due to fluid damping. Many cases are considered: single tube, twin tubes, tube row, triangular array, and square arrays. The results show the instability regions based on the fluid damping coefficients and provide the answers to a series of questions on fluid elastic instability of tube arrays in crossflow

Identifying bottlenecks in the iron and folic acid supply chain in Bihar, India: a mixed-methods study

Background: Maternal anaemia prevalence in Bihar, India remains high despite government mandated iron supplementation targeting pregnant women. Inadequate supply has been identified as a potential barrier to iron and folic acid (IFA) receipt. Our study objective was to examine the government health system’s IFA supply and distribution system and identify bottlenecks contributing to insufficient IFA supply. Methods: Primary data collection was conducted in November 2011 and July 2012 across 8 districts in Bihar, India. A cross-sectional, observational, mixed methods approach was utilized. Auxiliary Nurse Midwives were surveyed on current IFA supply and practices. In-depth interviews (n = 59) were conducted with health workers at state, district, block, health sub-centre, and village levels. Results: Overall, 44% of Auxiliary Nurse Midwives were out of IFA stock. Stock levels and supply chain practices varied greatly across districts. Qualitative data revealed specific bottlenecks impacting IFA forecasting, procurement, storage, disposal, lack of personnel, and few training opportunities for key players in the supply chain. Conclusions: Inadequate IFA supply is a major constraint to the IFA supplementation program, the extent of which varies widely across districts. Improvements at all levels of infrastructure, practices, and effective monitoring will be critical to strengthen the IFA supply chain in Bihar

Web-based Investigation of Multistate Salmonellosis Outbreak

We investigated a large outbreak of Salmonella enterica serotype Javiana among attendees of the 2002 U.S. Transplant Games, including 1,500 organ transplant recipients. Web-based survey methods identified pre-diced tomatoes as the source of this outbreak, which highlights the utility of such investigative tools to cope with the changing epidemiology of foodborne diseases

Meson Production in p+d Reactions

The production of neutral and charged pions as well as eta mesons is studied in the Delta and N* resonance region, respectively. Heavy A=3 recoils were measured with the GEM detector. The differential cross sections covering the full angular range are compared with model calculations.Comment: 4 pages, latex, 4 figures, talk presented at the XVIIth European Conference on Few-Body Problems in Physics, Evora, Portugal, September 2000; to be published in Nucl. Phys.

Making Nutrition Services Work for Socially Excluded Groups: Lessons from the Integrated Nutrition and Health Project

A relatively large proportion of India's underweight children belong to groups facing multiple disadvantages. Addressing child malnutrition among these communities is critical if India is to eliminate undernutrition and achieve the MDG goals. This article draws evidence from the Integrated Nutrition and Health Project II (INHP?II), a USAID funded project, implemented by CARE in India, to show how, by ensuring universal service coverage, a programme can enhance equity and inclusion. INHP?approaches such as: Nutrition and health days (NHD); prioritising home contacts; system strengthening; community participation; tracking left?out children; enhancing convergence and coverage of nutritional and health services, all help to improve nutritional outcomes among all sections of society, particularly socially excluded groups

Cluster randomised trial and development of a sandfly sex pheromone lure to reduce Leishmania infantum infection

Introduction: Vector control tools are needed to combat leishmaniasis. A semi-synthetic version of a Lutzomyia longipalpis aggregation/sex pheromone (9-methlygermacrene-B) has been developed, and shown efficacy to attract sandflies in the lab and to chicken sheds in the field. Here, we present results from a cluster-randomised trial performed in Brazil where we test the efficacy of the pheromone deployed with insecticide, a novel lure-and-kill intervention, to reduce leishmaniasis transmission to the canine reservoir. Aim: Investigate the efficacy of sandfly sex pheromone baited + insecticide treated chicken roosts to reduce transmission of Leishmania infantum among the reservoir population (dogs). Methods: We conducted a cluster-randomised trial across 42 communities in Brazil. Pheromone lures plus insecticide were applied in 14 communities, and outcomes compared to that of 28 other communities that received either a placebo (sham lure + insecticide) or deltamethrin-impregnated collars fitted to dogs. We quantify the primary intervention effects by comparison of the number of uninfected dogs that seroconverted in each arm over the course of the 2-year trial. Results: A reduction in canine incidence is attributed to the pheromone + insecticide intervention, which is consistent across the levels of hierarchical analysis, though the errors are broad. The performance of the pheromone followed similar patterns as the collar arm which significantly reduced seroconversion incidence. Conclusion: These data represent the first trial of a synthetic vector pheromone applied in public health control, and the first cluster-randomised trial of dog collars in Brazil. Both methods show potential for the control of zoonotic visceral leishmaniasis in the Americas; developments of the pheromone lure-and-kill strategy are underway