Full License Research Articles

Complicating the Narrative about Emergency Certified Special Educators

ABSTRACT For decades, school districts have relied on unlicensed teachers to fill vacancies in special education, leaving students with disabilities to receive educational services from individuals without the necessary preparation, resulting in inequitable educational opportunities. An emergency certification, granted in numerous states, allows unlicensed teachers to provide students’ instruction. We utilized teacher licensure data from a state education agency to examine the preparation pathways of emergency certified special educators in one Midwestern state. Through our descriptive analysis of 798 special educators, 62.5% obtained a full special education teaching license. Traditional educator preparation programs (50.4%) and alternative programs (48.9%) were completed at comparable rates, and special educators worked most frequently on an emergency certification for one year before obtaining full licensure. We provide implications for future research and practice to increase students’ access to qualified special educators.

Safety and immunogenicity of an inactivated eastern equine encephalitis virus vaccine

BackgroundEastern equine encephalitis virus (EEEV) is a mosquito borne alphavirus spread primarily in Atlantic and Gulf Coast regions of the United States. EEEV is the causative agent of a devastating meningoencephalitis syndrome, with approximately 30% mortality and significant morbidity. There is no licensed human vaccine against EEEV. An inactivated EEEV vaccine has been offered under investigational new drug (IND) protocols at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) since 1976. MethodsHealthy at-risk laboratory personnel received inactivated PE-6 strain EEEV (TSI-GSD 104) vaccine under two separate IND protocols. Protocol FY 99–11 (2002–2008) had a primary series consisting of doses on day 0, 7, and 28. Protocol FY 06–31 (2008–2016) utilized a primary series with doses on day 0 and 28, and month 6. Participants with an inadequate immune response, plaque reduction neutralization test with 80% cut-off (PRNT80) titer < 40, received booster vaccination. Volunteers with prior EEEV vaccination were eligible to enroll for booster doses based on annual titer evaluation. ResultsThe FY06-31 dosing schema resulted in significantly greater post-primary series immune response (PRNT80 ≥ 40) rates (84% vs 54%) and geometric mean titers (184.1 vs 39.4). The FY 06–31 dosing schema also resulted in significantly greater cumulative annual immune response rates from 1 to up to 7 years post vaccination (75% vs 59%) and geometric mean of titers (60.1 vs 43.0). The majority of probably or definitely related adverse events were mild and local; there were no probably or definitely related serious adverse events. ConclusionsInactivated PE-6 EEEV vaccine is safe and immunogenic in at-risk laboratory personnel. A prolonged primary series, with month 6 dose, significantly improved vaccine immunogenicity both post-primary series and longitudinally on annual titers. Despite decades of safe use under IND, full licensure is not planned due to manufacturing constraints, and ongoing development of alternatives.

B Lymphocytes Contribute to Celiac Disease Pathogenesis

Celiac disease (CD) is a complex intestinal disorder with autoimmune features that develops in genetically susceptible individuals expressing HLA-DQ8 or HLA-DQ2 molecules. 1 Abadie V. Sollid L.M. Barreiro L.B. et al. Integration of genetic and immunological insights into a model of celiac disease pathogenesis. Annu Rev Immunol. 2011; 29: 493-525 Crossref PubMed Scopus (351) Google Scholar The presence of anti–tissue transglutaminase 2 (TG2) and anti–deamidated gluten peptide antibodies represent strong disease markers. 2 Husby S. Koletzko S. Korponay-Szabo I. et al. European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. J Pediatr Gastroenterol Nutr. 2020; 70: 141-156 Crossref PubMed Scopus (231) Google Scholar Inflammation and villous blunting in the small intestine result from an abnormal immune response to gluten proteins. CD is characterized by the loss of oral tolerance to gluten manifested by HLA-DQ2– or HLA-DQ8–restricted antigluten inflammatory CD4 T cells and a massive expansion of cytotoxic CD8+ intraepithelial lymphocytes (IELs) that mediate the killing of intestinal epithelial cells (IECs). 3 Abadie V. Kim S.M. Lejeune T. et al. IL-15, gluten and HLA-DQ8 drive tissue destruction in coeliac disease. Nature. 2020; 578: 600-604 Crossref PubMed Scopus (49) Google Scholar These observations have led to the general idea that CD is primarily a T-cell–mediated immune disorder. However, studies in human suggest that B cells could play a central role in CD pathogenesis. 4 Iversen R. Sollid L.M. Autoimmunity provoked by foreign antigens. Science. 2020; 368: 132-133 Crossref PubMed Scopus (11) Google Scholar We have recently engineered a mouse model of CD that develops villous atrophy (VA) in a gluten, HLA-DQ8, and TG2-dependent manner. Intestinal tissue destruction in this model is also dependent on CD4+ and CD8+ T cells and requires interferon-γ. We now demonstrate that B cells are required for the development of VA and the associated full licensing of cytotoxic IELs in this pathophysiologically relevant mouse model of CD, providing support for the exploration of B-cell–directed therapies for the treatment of CD.

Correcting COVID-19 vaccine misinformation: Lancet Commission on COVID-19 Vaccines and Therapeutics Task Force Members.

Correcting COVID-19 vaccine misinformation: Lancet Commission on COVID-19 Vaccines and Therapeutics Task Force Members.

The clinical correlates of vaccine-induced immune thrombotic thrombocytopenia after immunisation with adenovirus vector-based SARS-CoV-2 vaccines.

SummaryWe are at a critical stage in the COVID-19 pandemic where vaccinations are being rolled out globally, in a race against time to get ahead of the SARS-CoV-2 coronavirus and the emergence of more highly transmissible variants. A range of vaccines have been created and received either emergency approval or full licensure. To attain the upper hand, maximum vaccine synthesis, deployment, and uptake as rapidly as possible is essential. However, vaccine uptake, particularly in younger adults is dropping, at least in part fuelled by reports of rare complications associated with specific vaccines. This review considers how vaccination with adenovirus vector-based vaccines against the SARS-CoV-2 coronavirus might cause rare cases of thrombosis and thrombocytopenia in some recipients. A thorough understanding of the underlying cellular and molecular mechanisms that mediate this syndrome may help to identify methods to prevent these very rare, but serious side effects. This will also help facilitate the identification of those at highest risk from these outcomes, so that we can work towards a stratified approach to vaccine deployment to mitigate these risks.

Change of the Way of Thinking and Institutional Reform about Equal Suffrage - Reverse Income-based Suffrage -

Change of the Way of Thinking and Institutional Reform about Equal Suffrage - Reverse Income-based Suffrage -

Remdesivir for COVID-19 in Europe: will it provide value for money?

Remdesivir for COVID-19 in Europe: will it provide value for money?

The Western Equine Encephalitis Lyophilized, Inactivated Vaccine: An Update on Safety and Immunogenicity.

BackgroundWestern Equine Encephalitis (WEE) is a naturally acquired infection and potentially devastating bioweapon, with no specific human countermeasures. An experimental inactivated Western Equine Encephalitis Vaccine (WEEV; WEE TSI-GSD 210) has been used under an IND (investigational New Drug) protocol at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) since 1976.MethodsOver 24 years from 1987 to 2011, 876 subjects received 3 primary vaccine doses under 3 studies with 1,537 booster doses administered (FY87-8, phase 2, laboratory workers, vaccine lots 1-81-1, 1-81-2, and 2-1-91; FY99-12, phase 2 laboratory workers, lot 2-1-91; and FY09-02, phase 1 healthy volunteer, lot 3-1-92). Post-vaccination safety and immunogenicity [plaque reduction neutralization test 80% (PRNT80) > 1:40] were analyzed.ResultsOverall PRNT80 response to the primary series in FY87-8 was 42% (326/770) but dropped to 16% (14/87) in FY99-12, prompting study FY09-02, which achieved 89% (17/19). The first booster response rate was 68% (814/1194) in FY87-8, 53% (171/324) in FY99-12, and 100% (10/10) in FY09-02. The majority of definitely related adverse reactions (AEs) were mild and local with no definitely related serious AEs. No laboratory acquired WEE infection was documented during this period despite 4 reported exposures in vaccinated subjects.ConclusionThe TSI-GSD 210 WEE vaccine was immunogenic, safe and well tolerated. Use of this vaccine could be considered in an emergency setting. Despite decades of safe and effective use under IND, full licensure is not planned due to manufacturing constraints, and a strategic decision to develop alternatives.Clinical Trial Registration https://clinicaltrials.gov/, identifier NCT01159561.

To Zoom, or not to Zoom? The growing role of telepsychiatry in the treatment of children

The COVID‐19 pandemic has forced many psychiatric providers into a personal crash course in telepsychiatry that we, perhaps, never planned to sign up for. Our comfortable workplaces filled with toy houses, markers, and board games have been reduced to a 12‐inch computer screen in a rapidly constructed home office. The urgency of continued psychiatric care in the setting of a pandemic allowed for rapid expansion of telepsychiatry services at a pace never previously experienced in our history. We have seen changes to restrictions and regulations in the field happen quickly, even those that had previously sat on the table for years. This includes emergency exceptions allowing psychiatrists to see patients by video in states where they do not have full licensure. Before March, the word Zoom meant nothing more to most of us than a muffled sound a car makes as it drives by. It now represents a telepsychiatry platform that has become the (temporary) backbone of our careers.

Survey of physician attitudes to using multisource feedback for competence assessment in Alberta

BackgroundThe use of multisource feedback (MSF) for assessing physician performance is widespread and rapidly growing. Findings from early very small research studies using highly selected participants suggest high levels of...

Fintech Toolkit: Smart Regulatory and Market Approaches to Financial Technology Innovation

Finance has been transformed by digitalization and datafication over the past five decades. The latest wave of technology in finance (Fintech) is re-shaping the sector at an unprecedented pace. This digital financial transformation brings about structural changes, with positive and negative effects, likely even more in the high-potential markets of the Middle East and North Africa. Fintech can stimulate competition and product variety with positive outcomes for societies and economies. The fundamental changes taking place in the financial system, however, call for the design of adequate approaches to Fintech innovation. An ecosystem is required that allows innovation balanced with financial inclusion, financial stability, market integrity and consumer protection. This toolkit presents novel regulatory and market approaches policymakers, regulators, and development professionals can adopt to enable safe Fintech innovation. Regulatory frameworks will determine the future of Fintech. Following principles from global good practice (mainly activity-based, proportional, and technology-neutral regulation), regulatory approaches in sequenced stages help to create pathways for innovative Fintech firms. First, regulators ought to identify and modernize unsuitable regulation based on a regulatory impact assessment that determines whether legacy rules remain useful. Second, proportional regulation, reflected in provisions for market stability and integrity depending on the extent of risks underlying the regulated activity, create supportive pathways for new, particularly inclusive non-bank financial services. Third, an Innovation Hub with experts of the regulatory authority is best suited to guide Fintech firms through the regulatory maze, yield valuable insights into market innovations, and assess possibilities of dispensation. Fourth, testing and piloting regimes allow to apply leniency in a wait-and-see or test-and-learn approach to assist innovative firms. Authorities can further decide to tolerate innovations by licensed institutions and possibly by start-ups by extending on a case-by-case basis waivers or no-action-letters which declare certain activities as permissible or suspend certain rules. Fifth, a regulatory sandbox, which standardizes the scope of testing and piloting, allows regulators to create a tightly defined safe space for granting dispensation from specific regulatory requirements for innovative firms that qualify. Sixth, restricted licences allow feasible innovative firms to further develop their client base and financial and operational resources in a controlled manner. Seventh, a full licence is essential for innovative firms as size requires and permits. Over these stages, as regulatory rigour and costs increase so tend to do Fintech firms’ maturity and ability to cope with risks and compliance, while maintaining a level playing field for licensed entities. Demand and supply side factors will eventually propel innovative entrepreneurship and Fintech growth. Market approaches to Fintech innovation combine the support of financial and digital literacy in the population, cybersecurity capacities in the sector, acceleration programmes and investor-friendliness in the business environment, and technology clusters or digital centres in public-private- academic partnerships. Sequenced reforms that are informed by global good practise, responsive to the local context and that contribute to regionally consistent frameworks, are policymakers best pick in support of an enabling ecosystem for Fintech. Concerted efforts will enable innovative financial service providers to tap the market and scale as well as Fintech to be beneficial for financial inclusion, competition and economic development across the region.

Application of a life cycle assessment for assessing municipal solid waste management systems in Bolivia in an international cooperative framework.

Using a life cycle assessment (LCA) to evaluate municipal solid waste management (MSWM) systems is strongly recommended and the approach has been used in high-income contexts. However, stakeholders in low to middle income countries are not aware of the potential of this approach, mainly due to a lack of financial resources and technical ability. The present work introduces a LCA of MSWM system scenarios into a developing city using an academic licence for the LCA software that is available for use exclusively by researchers. The MSWM system in place in 2018 in La Paz (Bolivia) was assessed according to seven scenarios. The novelty of the research is twofold: the use of LCA academic licensing in a low to middle income region where LCA is unknown as planning tool; and discussing the potential of the approach in conjunction with local and international stakeholders with a view to starting MSWM projects. The results of the analysis allow for the consideration of energy recovery and materials recycling as the main methods by which the environmental impact of MSW can be reduced, as has also been reported by other LCA studies conducted with full licensing of the relevant software. Moreover, the research is the basis for cooperative development projects that will adopt the LCA approach as the main assessment tool. The study discusses the importance of cooperation between universities and local governments for implementing new strategies for MSWM assessment and planning. The research is a contribution towards improving technical knowledge in developing countries for boosting sustainable development.

Potency and stability of a trivalent, catalytically inactive vaccine against botulinum neurotoxin serotypes C, E and F (triCEF)

Botulism is an acute neuroparalytic affliction of the motor and autonomic neurons caused by the toxins produced from Clostridium botulinum and related bacterial strains. The botulinum neurotoxins, or BoNTs, consist of a phylogenetically diverse group of highly potent protein toxins. Current medical interventions for confirmed cases of botulism are limited to immediate administration of antitoxins and respiratory support. There is currently no licensed vaccine against botulism in the United States. The most widely distributed botulism vaccine was a pentavalent BoNT toxoid (PBT) against serotypes A-E administered until 2011 under an investigational new drug license. A binary vaccine composed of the recombinant, non-toxic, receptor binding domains (RBD) of serotypes/A1 and/B1 has completed a phase II clinical trial, but has yet to attain full licensure. We have previously published data demonstrating catalytically inactive, full length botulinum neurotoxin holoproteins (ciBoNT HPs) against serotypes/A1,/B1,/C1,/E1 and/F1 provide equivalent or superior potency against parental and dissimilar subtype toxins as compared the RBD vaccines. Here we describe the consistent potencies of the three independent lots each of ciBoNT/C1,/E1, and/F1 HPs against substantial monovalent challenges of the parental toxins. We also present data that a trivalent formulation of ciBoNT/C1,/E1 and/F1 (triCEF) maintains potency against both monovalent and polyvalent toxin challenges when stored as an adjuvanted vaccine at 4–8 °C for up to 2 years.

Crossref: The sustainable source of community-owned scholarly metadata

This paper describes the scholarly metadata collected and made available by Crossref, as well as its importance in the scholarly research ecosystem. Containing over 106 million records and expanding at an average rate of 11% a year, Crossref’s metadata has become one of the major sources of scholarly data for publishers, authors, librarians, funders, and researchers. The metadata set consists of 13 content types, including not only traditional types, such as journals and conference papers, but also data sets, reports, preprints, peer reviews, and grants. The metadata is not limited to basic publication metadata, but can also include abstracts and links to full text, funding and license information, citation links, and the information about corrections, updates, retractions, etc. This scale and breadth make Crossref a valuable source for research in scientometrics, including measuring the growth and impact of science and understanding new trends in scholarly communications. The metadata is available through a number of APIs, including REST API and OAI-PMH. In this paper, we describe the kind of metadata that Crossref provides and how it is collected and curated. We also look at Crossref’s role in the research ecosystem and trends in metadata curation over the years, including the evolution of its citation data provision. We summarize the research used in Crossref’s metadata and describe plans that will improve metadata quality and retrieval in the future.

Strategy of Achievement Target Marketing of Services Licensed Operator Products PT Telkom Regional I

PT Telekomunikasi Indonesia, Tbk (PT Telkom) as the National Flag Carrier of telecommunications in Indonesia which has a Full Network Service Provider license serving almost all digital services for all licensed operators in Indonesia. One of the operators served by PT Telkom is Telkomsel. Telkomsel is the largest operator in Indonesia. In providing its best services to Telkomsel, Telkom Indonesia has a number of SoW (Scope of Work) that is used to share services provided to operators who are customers of licensed operator products, namely modernization: sites built using optical fiber but previously were on air using Telkom radios and rollout: sites built using fiber optics in areas where there is no service at all. In Sumatra, Telkom Regional I is tasked with serving Telkomsel in 3 areas, namely Telkomsel in the Sumbagut area (North Sumatra), Sumbagteng (Central Sumatra) and Sumbagsel (South Sumatra). In 2018 the construction of Telkomsel's BTS site has reached 9,566 Site ID Node-b which has reached 75% of the inner city of Sumatra. This type of research is a descriptive study by evaluating the factors that become obstacles in achieving Telkom Serviced Licensed Operator product targets in Telkom Regional I Sumatra and formulating strategies that can be done in increasing the achievement of the Serviced Licensed Operator product targets in Telkom Regional I Sumatra. To obtain strategies, various analyzes are carried out such as internal environmental analysis such as management, marketing, finance, production and operations, human resources, and external environmental factors such as the macro and industrial environment. In analyzing these factors, IFE (Internal Factor Evaluation) and EFE (External Factor Evaluation) score measurements, IE (Internal External) analysis and SWOT (Strength, Weakness, Opportunity, Thread) analysis are used

Defects in the origin licensing checkpoint stresses cells exiting G0.

The full licensing of replication origins in late G1 is normally enforced by the licensing checkpoint. In this issue, Matson et al. (2019. J. Cell Biol. https://doi.org/10.1083/jcb.201902143) show that this checkpoint is inoperative in cells exiting from G0, resulting in incomplete origin licensing and consequent replicative stress.

Exploring Knowledge and Safety Practices for Driving in Youth With Type 1 Diabetes

ObjectivesThe aim of this work was to survey how well adolescents with type 1 diabetes mellitus (T1D) of legal driving age understand the risks associated with driving with diabetes and report adherence to recommendations. MethodsThis study was a cross-sectional survey of 191 adolescents, 14 to 18 years of age, with T1D. ResultsThe average (standard deviation [SD]) glycated hemoglobin of respondents with a learner's or a driver's license was 9.0% (SD, 1.9%) and 8.9% (SD, 1.9%), respectively (p=0.91). The proportions of adolescents with a learner's or a driver's license who almost always or always checked their blood glucose prior to driving was 69% and 41%, respectively (p=0.01). Eighteen percent of adolescents with a learner's license and 41% with a driver's license experienced hypoglycemia while driving. The average number of weekly hypoglycemic events in each group was 2.0 (SD, 1.4) and 2.3 (SD, 2.0), respectively. There was a higher reported frequency of weekly mild hypoglycemic events between drivers who reported pulling over at least once while driving due to symptoms of hypoglycemia (3.25±2.38) and those who reported never having pulled over for hypoglycemia (1.87±1.31) (p=0.012). Respondents with a learner's license reported higher adherence to guidelines than those with a full license. ConclusionsClinical education needs to reinforce adherence to recommendations, particularly checking blood glucose or wearing a continuous glucose monitor prior to driving, for all adolescents of driving age. The frequency of mild hypoglycemic events per week is associated with self-reported hypoglycemic events while driving.

Cannabis and related products in the treatment of epilepsy

There has been much recent heightened interest in the possible use of cannabinoid products in the treatment of complex epilepsies. Although systematic studies have now been performed and reported showing benefit of cannabidiol as Epidiolex (GW Pharma) in the treatment of Dravet and Lennox Gastaut syndromes, there remains much confusion with the role of hemp oils and other products for which there is no consistent product or evidence base for use. There is also much debate as to whether the psychoactive component, tetrahydrocannabinol is required for optimal effect, with no sound evidence base for support. The current position is that that data has been acquired for Epidiolex, and licence for use granted by the Federal Drug Administration, with data submitted to the European Medicines Authority. We await full licence and availability to enable prescription as a further therapeutic option for the complex developmental epileptic encephalopathies.

Implementation is not enough: Graduated drivers licensing benefits from a comprehensive enforcement, education, and awareness campaigns.

Graduated drivers license (GDLs) are required in most states. Graduated drivers licenses are intermediate licenses requiring a supervisory period prior to full licensure. Surveys suggests poor acceptance of GDL restrictions high variability in GDL compliance. New Jersey initiated GDLs in 2002 and introduced a comprehensive public health campaign in 2010. This study analyzed the effect of GDL and the campaign on teen driver-related fatalities and hypothesized that implementation alone was insufficient to decrease deaths. Data were analyzed from 1998 to 2016 from New Jersey's Fatal Accident Investigation Unit. In 2005, collaboration with state police added total crash fatalities and teen passenger deaths to the data set. Patterns in data before and after GDL implementation in 2002 and a comprehensive campaign in 2010 were evaluated to determine effects in New Jersey. Paired t tests, analysis of variance, and regression analyses were performed, with p value less than 0.05 considered significant. Little effect was seen after initiation of GDL, with no change in number of dead teen drivers (44 vs. 49, p > 0.05) or fatal accidents (117 vs.115, p > 0.05) in the 4 years before and after implementation. However, after the comprehensive campaign, decreases are seen in dead teenaged drivers (42 vs. 22, p < 0.005) and total fatal accidents involving teens (107 vs. 61, p < 0.005). Comparing 4 years before and 6 years after the campaign demonstrates decreases in total crash fatalities involving teen drivers (112 vs. 66, p < 0.05) and in the number of dead teenaged passengers in a vehicle operated by another teen (19 vs. 11 p < 0.05). Implementation of GDLs alone may not be an effective strategy in decreasing the number of teen fatalities. A multipronged approach combining comprehensive, public-health based campaign with targeted enforcement is necessary to decrease the number of teen driver-related deaths. Additional studies are needed to assess the relationship between decreased death and compliance with GDLs. Retrospective comparative study, level III.

The prevalence and correlates of texting while driving among a population-based sample of Ontario students

Objective: Texting while driving (TWD) has a deleterious impact on driving performance and may pose a significant challenge to traffic safety. This challenge may be particularly relevant for young and inexperienced drivers. This study examined the prevalence and risk factors of writing text messages or emails while driving during the past 12 months.Method: This study analyzed a subpopulation of 1,133 licensed students 16 years of age or older from the 2013 Ontario Student Drug Use Survey (OSDUHS), a population-based survey of students in Ontario, Canada.Results: Our results indicate that 36% of licensed drivers reported writing a text message while driving during the past 12 months; of those who did, 56% reported doing so 4 or more times. Graduated licensing was the strongest factor predicting TWD. Compared to students with the more restrictive G1 license, students with a G2 or full license were 9.4 times more likely to report TWD after controlling for the effect of all other factors. Older students, white students, and students attending school in urban centers were more likely to report TWD, and the amount of time spent on social media sites, being a passenger with a driver using substances, and past-year collisions were also significantly associated with TWD. Gender differences and participation in driver education training were not associated with TWD.Conclusions: This research demonstrates that TWD is an extremely common behavior among licensed student drivers in Ontario, particularly among those who have passed the first stage of graduated licensing. TWD is associated with other risky driving behaviors and outcomes, and the findings from this study underscore the need to better understand the harms associated with this behavior.