Licensing Restrictions Research Articles

Diabetes and Driving: A Statement of the American Diabetes Association.

Many people with diabetes in the U.S. will seek or currently hold a license to drive. For many, a driver's license is essential for everyday life. Considerable discussion has focused on whether, and the extent to which, diabetes may be a relevant factor in determining driver ability and eligibility for a license. This statement addresses such issues in relation to current scientific and medical evidence. A diagnosis of diabetes on its own is not sufficient to make judgments about an individual driver's ability or safety. This statement provides an overview of existing licensing rules for people with diabetes in the U.S., addresses the factors that affect driving ability, identifies general guidelines for assessing driver fitness and determining appropriately tailored licensing restrictions, and provides practical guidance for health care professionals regarding clinical interventions and education for people with diabetes.

Occupational Licensing restrictions and early-stage entrepreneurship: a US state-level analysis

ABSTRACT Various literatures have evaluated the economic consequences associated with both entrepreneurship and occupational licencing. However, there has been a relative lack of research that attempts to tie the two together. This study empirically investigates if and how occupational licencing restrictions impact early-stage entrepreneurship across US states. By utilizing a new index of state licensure restrictiveness, various measures from the Kauffman Index of Entrepreneurial Activity, along with establishment birth and death rates, our study finds that early-stage entrepreneurship and establishment deaths are negatively and significantly associated with more restrictive occupational licencing, though the channels are nuanced. Implications are discussed.

Reforming Physician Licensure in the United States to Improve Access to Telehealth: State, Regional, and Federal Initiatives.

Policy Points The reinstitution of pre-COVID-19 pandemic licensure regulations has impeded interstate telehealth. This has disproportionately impacted patients who live near a state border; geographically mobile patients, such as college students; and patients with rare diseases who may need care from a specialist outside their state. Several promising and feasible reforms are available, at both state and federal levels, to facilitate interstate telehealth. For example, states can offer exemptions to licensure requirements for certain types of telehealth such as follow-up care or create licensure registries that impose little reduced paperwork and fees on physicians. On the federal level, congressional interventions that mimic the Department of Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act of 2018 can waive provider licensing and geographic restrictions to telehealth within certain federal programs such as Medicare. Any discussion of medical licensure reform, however, must also consider the current political climate, one in which states are taking divergent stances on sensitive topics such as reproductive care, gender-affirming care, and substance use treatments.

Telehealth visit type and patient-reported outcomes among patients with cancer

BackgroundRelaxed licensing restrictions on telehealth use during the COVID-19 pandemic allowed broad use irrespective of visit type. As these telehealth waivers expire, optimal uses of telehealth must be assessed to inform policy and clinical care. We evaluated patient experience associated with telehealth and in-person new or established visits. MethodsPatients seen in-person and via telehealth for urologic cancer care from August 2019 to June 2022 received a survey on satisfaction with care, perceptions of communication during their visit, travel time, travel costs, and days of work missed. We assessed survey responses with descriptive statistics. ResultsSurveys were completed for 1,031 patient visits (N = 494 new visits, N = 537 established visits). Satisfaction rates were high for all visit modalities among new and established patients (mean score range 59.9–60.7 [maximum 63], P > 0.05). Patient-rated quality of the encounter did not differ by visit type and modality (P > 0.05, for nearly all comparisons). New in-person patient visits were associated with significantly higher travel costs (mean $496.10, SD $1021) compared with new telehealth visits (mean $26.60, SD $141; P < 0.001); 27% of new in-person patients required plane travel and 41% required a hotel stay (P < 0.001 vs. 0.8% and 3.2% of new telehealth patients, respectively). ConclusionsSatisfaction outcomes among patients with urologic cancer receiving new patient telehealth care equaled those of new patients cared for in-person while costs were significantly lower. Offering telehealth exemption beyond COVID-19 licensing waivers to include new patient visits would allow for ongoing delivery of high-quality urologic cancer care irrespective of geographic location.

Moderating model marketplaces: platform governance puzzles for AI intermediaries

ABSTRACT The AI development community is increasingly making use of hosting intermediaries, such as Hugging Face, which provide easy access to user-uploaded models and training data. These model marketplaces lower technical deployment barriers for hundreds of thousands of users, yet can be used in numerous potentially harmful and illegal ways. In this article, we explain the ways in which AI systems, which can both ‘contain’ content and be open-ended tools, present one of the trickiest platform governance challenges seen to date. We provide case studies of several incidents across three illustrative platforms – Hugging Face, GitHub and Civitai – to examine how model marketplaces moderate models. Building on this analysis, we outline important (and yet nevertheless limited) practices that industry has been developing to respond to moderation demands: licensing, access and use restrictions, automated content moderation, and open policy development. While the policy challenge at hand is a considerable one, we conclude with some ideas as to how platforms could better mobilise resources to act as a careful, fair, and proportionate regulatory access point.

Data blanks by design: Intellectual property and restrictions on genetic diversity assessments of the maize standing crop in the USA Upper Midwest

Societal Impact StatementAll US commercial maize (Zea mays) is a single race, “Corn Belt Dent,” and its genetic base has been in decline for at least 40 years. Independent genotyping can only be conducted after patent and licensing restrictions have expired, a period of 20 years. These restrictions also impede a molecular based assessment of the standing crop by the United States Department of Agriculture (USDA) as recommended by experts. Data blanks about landscape vulnerability put farmers at risk of crop failure and the public at risk of food insecurity. Understanding maize diversity experts' perspectives and analysis helps describe the contours of these data blanks and inform policy recommendations.Summary Recommendations by the Maize Crop Germplasm Committee to the United States Department of Agriculture (USDA) for a molecular based vulnerability assessment on the US standing maize (Zea mays) crop have not been acted on because of intellectual property and licensing restrictions. This research explores maize diversity experts' access to data and perceptions and analysis of the standing crop. The data come from semi‐structured interviews conducted with 44 maize diversity experts in the public and private sectors. Experts explain that genetic data blanks restrict non‐industry research, describe public sector concerns that standing diversity is narrow(ing), and find historic sources of pedigree data in Plant Variety Protection and patent records are no longer reliable. Some interviewees perceive that industry monitoring of standing diversity is in their best financial interest. Industry participants describe concentration in US maize allows them to control diversity over time, while public researchers discuss efficiency of scale narrowing genetic diversity and global concentration spreading this trend. Knowledge gaps about genetic diversity in US commercial maize are designed through patents, contracts, non‐disclosure agreements, and confidentiality agreements by patent holders who do not want their inbred lines genotyped by competitors. This restricts research and knowledge flow about genetic information into public networks. The Maize Crop Germplasm Committee is a node for knowledge flow; however, the lack of mechanisms for action suggests it is performative. We recommend all protections used on seed include exemptions for research, breeding, and seed saving; an independent assessment of how industry monitors standing diversity; and a molecular analysis of the standing crop conducted by the USDA.

The Likelihood That Remedial Continuing Medical Education (CME) Reduces Disciplinary Recidivism Among Physicians.

State medical boards are charged through their medical practice acts to regulate physician practice and, when necessary, discipline physicians for incompetent or inappropriate behavior. Boards often authorize remedial continuing medical education (CME) as part of a disciplinary action; however, it is unclear how effective remedial CME is in reducing the likelihood of physicians receiving additional discipline. This study examined the relationship between physicians who were required to complete remedial CME as part of their first discipline by state medical boards and the likelihood of additional discipline. The national-level sample included 4,061 MD-physicians whose first discipline included license restrictions, probation, or other conditions imposed by state medical boards between 2011 and 2015. A multivariate logistic regression model examined whether physicians required to complete remedial CME as part of their first discipline were less likely to receive additional discipline by boards within 5 years. Of the 4,061 physicians, 36% (n = 1,449) were required to complete remedial CME as part of their first discipline, and 35% (n = 1,426) received additional discipline within 5 years. After accounting for other factors, physicians who were required to complete remedial CME as part of their first discipline by boards were less likely to receive additional discipline (odds ratio = 0.597; 95% confidence interval = 0.513, 0.696; P < .001) within 5 years compared to physicians who were not required to complete remedial CME. Findings support remedial CME as a means to help reduce physician disciplinary recidivism in certain circumstances. Physicians required to complete remedial CME as part of their first discipline were less likely to receive additional discipline by state medical boards within 5 years.

Research and Analysis on Policy Governance Based on Traffic Congestion in Beijing

This paper proposes three-game models to improve Beijing's traffic environment through the analysis method of game theory. First, the author examines the impact of improving drivers' moral character on alleviating traffic congestion. Second, this paper focus on the role of improving the public transportation environment in reducing road stress. Finally, this research examines the possibility of mitigating traffic congestion through a reward-punishment system. Comprehensive analysis of the results of these three game models, this paper conclude that a single policy of license restriction and traffic restriction is not enough to solve the traffic congestion problem in Beijing, and multiple policy measures need to be considered comprehensively. However, these policy measures also face some challenges and limitations, including time and education investment, people's travel needs and transportation network layout, and the design and implementation of the reward and punishment system. Therefore, future research and policy development need to further explore these issues and find more comprehensive and feasible policy solutions. Finally, this article recommends that the Beijing Municipal Government comprehensively consider the results of different game models and formulate comprehensive policy measures based on the actual situation, including improving road transportation facilities, encouraging green travel methods, and promoting intelligent transportation systems. Through these efforts, it is expected to improve Beijing's traffic environment, enhance citizens' travel experience, and achieve the goal of sustainable urban transportation.

From waste to resource: demystifying the policy challenges and identifying opportunities for a circular economy in Zambia

Policy plays a significant role in accelerating or hindering a circular shift; Governments can set long-term visions and drive legislative change to create an enabling environment. Reflecting the regional picture, Zambia is experiencing increasing waste burdens due to a growing population and economic development. The current management approach is linear, characterized by low collection rates, inadequate disposal, and limited waste revalorization. From a sustainable development perspective, how waste is managed impacts pressing issues such as climate change and public health. The concept of the Circular Economy (CE) has gained global and regional interest given its potential to transform how resources are viewed and managed. Circular strategies may help to reduce waste burdens and create local socioeconomic opportunities while safeguarding the environment. This qualitative study uses document review and expert interviews to explore the current waste management regime in Zambia and understand if and how circularity is embedded into the policy approach. The findings suggest that the CE is potentially highly relevant for Zambia, but there are various policy challenges that could impede its successful integration into the national agenda. These challenges relate to ownership and coordination; gaps in implementation and enforcement; a restrictive licensing approach; obstacles to innovation and new entrants; as well as the role of informal sector actors. The challenges point to opportunities to overturn these policy shortfalls, which also presents future research avenues.

Australian atmospheric pressure and sea level data during the 2022 Hunga-Tonga Hunga-Ha’apai volcano tsunami

On January 15, 2022, an ongoing eruption at the Hunga-Tonga Hunga-Ha’apai volcano generated a large explosion which resulted in a globally observed tsunami and atmospheric pressure wave. This paper presents time series observations of the event from Australia including 503 mean sea level pressure (MSLP) sensors and 103 tide gauges. Data is provided in its original format, which varies between data providers, and a post-processed format with consistent file structure and time zone. High-pass filtered variants of the data are also provided to facilitate study of the pressure wave and tsunami. For a minority of tide gauges the raw sea level data cannot be provided, due to licence restrictions, but high-pass filtered data is always provided. The data provides an important historical record of the volcanic pressure wave and tsunami in Australia. It will be useful for research on atmospheric and ocean waves associated with large volcanic eruptions.

An open-source framework for balancing computational speed and fidelity in production cost models

Abstract Studies of bulk power system operations need to incorporate uncertainty and sensitivity analyses, especially around exposure to weather and climate variability and extremes, but this remains a computational modeling challenge. Commercial production cost models (PCMs) have shorter runtimes, but also important limitations (opacity, license restrictions) that do not fully support stochastic simulation. Open-source PCMs represent a potential solution. They allow for multiple, simultaneous runs in high-performance computing environments and offer flexibility in model parameterization. Yet, developers must balance computational speed (i.e. runtime) with model fidelity (i.e. accuracy). In this paper, we present Grid Operations (GO), a framework for instantiating open-source, scale-adaptive PCMs. GO allows users to search across parameter spaces to identify model versions that appropriately balance computational speed and fidelity based on experimental needs and resource limits. Results provide generalizable insights on how to navigate the fidelity and computational speed tradeoff through parameter selection. We show that models with coarser network topologies can accurately mimic market operations, sometimes better than higher-resolution models. It is thus possible to conduct large simulation experiments that characterize operational risks related to climate and weather extremes while maintaining sufficient model accuracy.

A Comparative Study of India’s Foreign Trade in Pre and Post Reform Period

Foreign trade has been playing a vital role in the economic progress and prosperity of every country. In modern days foreign trade has assumed an immense prominence and substance for economic development of a country because of interdependence of economies, increasing specialization and joining regional cooperation. In 1991, the major program of economic reform were introduced which emphasize on external sector wherein the protective tariffs were decreased, changes into foreign investment and the restrictive import licensing system was relaxed and simplified. After the New economic reforms, India’s foreign trade has undergone substantial changes, volume of trade rose up and composition of trade was also frequently changed. The main objective of the paper is to study the trends of India’s foreign trade pre and post new economic reforms in India. The entire data for the present study is collected from the secondary sources. The collected data has been analyzed by using Paired t-test from SPSS software package and graphs. The findings of this paper said that there is positive relationship between economic reforms and India’s foreign trade. A push has been given to the exports but analyzes says that the increasing rate of imports is higher in comparison to the increasing rate of exports.

Immobilized: (In)congruent collateral consequences and racialized driver's license restrictions

For Americans convicted of crimes, collateral consequences impose barriers extending long past the completion of official sentences. The present study develops a novel distinction between congruent and incongruent collateral consequences. Congruent consequence laws impose barriers that are closely linked to their triggering offenses, while incongruent measures impose barriers that are only loosely connected to triggering offenses—or are disconnected entirely. Focusing specifically on the impactful consequence of restricting legal driving privileges, this article examines how the determinants of these policies vary according to the degree of congruity between triggering offense and collateral consequence. Using novel data on driver's license restriction laws, we find that the Black composition of state felony record populations is positively associated with the extensiveness of license restrictions for nondriving safety offenses. Conversely, we do not find a statistically significant relationship between states’ felony record racial composition and their volume of license restrictions for driving safety offenses. These findings reveal a major divergence in pathways leading to congruent and incongruent collateral consequence statutes at the state level. The results are further notable given driving's central role in the US socioeconomic system.

Addressing challenges in radiomics research: systematic review and repository of open-access cancer imaging datasets

ObjectivesOpen-access cancer imaging datasets have become integral for evaluating novel AI approaches in radiology. However, their use in quantitative analysis with radiomics features presents unique challenges, such as incomplete documentation, low visibility, non-uniform data formats, data inhomogeneity, and complex preprocessing. These issues may cause problems with reproducibility and standardization in radiomics studies.MethodsWe systematically reviewed imaging datasets with public copyright licenses, published up to March 2023 across four large online cancer imaging archives. We included only datasets with tomographic images (CT, MRI, or PET), segmentations, and clinical annotations, specifically identifying those suitable for radiomics research. Reproducible preprocessing and feature extraction were performed for each dataset to enable their easy reuse.ResultsWe discovered 29 datasets with corresponding segmentations and labels in the form of health outcomes, tumor pathology, staging, imaging-based scores, genetic markers, or repeated imaging. We compiled a repository encompassing 10,354 patients and 49,515 scans. Of the 29 datasets, 15 were licensed under Creative Commons licenses, allowing both non-commercial and commercial usage and redistribution, while others featured custom or restricted licenses. Studies spanned from the early 1990s to 2021, with the majority concluding after 2013. Seven different formats were used for the imaging data. Preprocessing and feature extraction were successfully performed for each dataset.ConclusionRadiomicsHub is a comprehensive public repository with radiomics features derived from a systematic review of public cancer imaging datasets. By converting all datasets to a standardized format and ensuring reproducible and traceable processing, RadiomicsHub addresses key reproducibility and standardization challenges in radiomics.Critical relevance statementThis study critically addresses the challenges associated with locating, preprocessing, and extracting quantitative features from open-access datasets, to facilitate more robust and reliable evaluations of radiomics models.Key points- Through a systematic review, we identified 29 cancer imaging datasets suitable for radiomics research.- A public repository with collection overview and radiomics features, encompassing 10,354 patients and 49,515 scans, was compiled.- Most datasets can be shared, used, and built upon freely under a Creative Commons license.- All 29 identified datasets have been converted into a common format to enable reproducible radiomics feature extraction.Graphical

Exclusion from Within: Noncitizens and the Rise of Discriminatory Licensing Laws

In the United States in the early twentieth century, state and local laws discriminating on the basis of alienage proliferated. Progressive reformers, nativist groups, state legislatures, and city councils sought new methods for restricting noncitizen access to the workplace and the marketplace. As this article demonstrates, the primary vehicle they utilized was state and local licensing laws. Licensing proved to be a powerful tool of exclusion; by 1930, citizenship-based licensing restrictions were present in every state and most major cities. Noncitizens challenged some of these laws, pushing for greater protection of their constitutional rights. The resulting court contests over exclusionary licensing laws led to the creation of a new branch of legal doctrine, one that redefined the relationship between noncitizens and state power. This article highlights the significant and underappreciated role played by state and local laws in shaping the immigrant experience in the Progressive Era. It furthers our understanding of the licensing power and illuminates a pivotal moment in the development of immigrant rights. Today, noncitizens are still excluded from a range of economic activities due to licensing restrictions. This article explores the roots and the spread of this little understood – and still consequential – technique of exclusion.

Photography and electroplate in 1840s Birmingham

Industrial improvements to silver plating through the work of electroplating firms such as Elkington, Mason and Co are an important part of our industrial heritage, bridging art, science and industry to form a significant portion of museum collections. However, the impact of this development of silverplating technology upon photography has not previously been explored. This article details the improvements that electroplated silver brought to the daguerreotype photographic process and to the manufacture of daguerreotype plates in Birmingham, offering a material reappraisal of the inventive qualities of the daguerreotype within a wider narrative of industrial manufacture. Chemists in 1840s Birmingham were developing photographic techniques and silverplating processes at the Birmingham Royal School of Medicine and Surgery, later Queens College on Paradise Street. These scientists – George Shaw (1818–1904) and John Percy (1817–1889) – had detailed, tactile knowledge of the convergent chemistry and processes in both arenas. Developments in the industrial manufacture of silverplate in 1840s Birmingham created significant improvements to the materials used in the daguerreotype photographic process, making photography more viable as a commercial venture. Shaw planned an early portrait studio and worked with early innovators in electroplating techniques the Marrian brothers (Francis (1802–1893) and Benjamin James Pratt Marrian (1811–1891)) using magneto-plate technology developed by another Birmingham industrial entrepreneur John Woolrich (c. 1791–1843). This potential studio did not emerge due to restrictive patenting and licensing restrictions around the practice of daguerreotype photography, yet extant daguerreotypes tell a story of improvements stemming from technical innovation. These daguerreotypes situate industrial Birmingham as a place of innovation and invention and place the daguerreotype photographic process within narratives of industrial improvements and radically inventive manufacturing practices. Key to the analysis presented here is the role of the recreation of historic techniques in historical research and the value of acquiring tactile knowledge of the behaviour of materials during the processes explored. Here practical experiments allowed the author to look beyond the surviving daguerreotypes via material knowledge to the circumstances and social environment of production. This approach revealed new knowledge which offers an alternative reading of the history of objects through their materials.

Interstate Telemedicine for Urologic Cancer Care.

US states eased licensing restrictions on telemedicine during the COVID-19 pandemic, allowing interstate use. As waivers expire, optimal uses of telemedicine must be assessed to inform policy, legislation, and clinical care. We assessed whether telemedicine visits provided the same patient experience as in-person visits, stratified by in- vs out-of-state residence, and examined the financial burden. Patients seen in person and via telemedicine for urologic cancer care at a major regional cancer center received a survey after their first appointment (August 2019-June 2022) on satisfaction with care, perceptions of communication during their visit, travel time, travel costs, and days of work missed. Surveys were completed for 1058 patient visits (N = 178 in-person, N = 880 telemedicine). Satisfaction rates were high for all visit types, both interstate and in-state care (mean score 60.1-60.8 [maximum 63], P > .05). More patients convening interstate telemedicine would repeat that modality (71%) than interstate in-person care (61%) or in-state telemedicine (57%). Patients receiving interstate care had significantly higher travel costs (median estimated visit costs $200, IQR $0-$800 vs median $0, IQR $0-$20 for in-state care, P < .001); 55% of patients receiving interstate in-person care required plane travel and 60% required a hotel stay. Telemedicine appointments may increase access for rural-residing patients with cancer. Satisfaction outcomes among patients with urologic cancer receiving interstate care were similar to those of patients cared for in state; costs were markedly lower. Extending interstate exemptions beyond COVID-19 licensing waivers would permit continued delivery of high-quality urologic cancer care to rural-residing patients.

Reshaping Goals and Values in Times of Penal Transition: The Dynamics of Penal Change in the Collateral Consequences Reform Space

Over the past decade, reform efforts in the area of collateral consequences of conviction have succeeded in emancipating themselves from standard discourses and dynamics in the US criminal legal reform space. This article draws on concepts and insights from the literature on penal transformation to explore the unique interplay of goals and values that have led to recent collateral consequences reforms. It identifies three major drivers of change that have had a significant impact, particularly, on softening occupational licensing restrictions for individuals with a criminal history and passing criminal record clearance legislation. First, advocates of the economic libertarian agenda joined forces with civil libertarian groups to reduce occupational licensing hurdles for criminal record holders. Second, an attitude promoting redemption and second chances through criminal record clearance reform has been championed, in particular, by the Christian right. Third, economic concerns by employers seeking to hire individuals with a criminal record have become more pronounced in tight labor markets, both pre- and post-pandemic. The analysis concludes that, although much remains to be done, ongoing reforms represent a significant reshaping of the collateral consequences landscape. A logic of unworthiness toward individuals with criminal records, however, remains hard to eradicate and can easily resurface in the current unstable phase of penal transition.

Analysis of spatial distribution characteristics of electric vehicle sales and service shops and the corresponding influencing factors

AbstractThe electric vehicle industry is essential for China's economic transformation and industrial upgrading. Identifying the distribution of electric vehicle sales and service shops is of great significance to boost the development of retail geography theory and promote the optimization of industrial space. Regression and spatial econometric methods analyze the influencing factors of electric vehicle sales and service shop distribution. According to the point of interest data of electric vehicle sales and service shops, taking 10 typical cities in China as an example, the spatial distribution of electric vehicle sales and service shops and its influencing factors are empirically explored by spatial econometric methods. The results indicate the following: (1) From high to low, the influence degree of spatial dependence factors are car license restriction policy, the average age of residents, number of schools, built‐up area, the amount of investment in real estate, electric vehicle sales, and GDP; (2) On the whole, the spatial distribution of electric vehicle sales and service shops shows the characteristics of a multi‐center circle‐layered spatial structure that spreads from the inside to the outside; and (3) The spatial influencing factors such as electric vehicle sales, charging stations, permanent resident population, schools, and subway stations in the four first‐tier cities is evident.

“We do not appreciate being experimented on”: Developer and researcher views on the ethics of experiments on open-source projects

A tenet of open source software development is to accept contributions from users–developers (typically after appropriate vetting). But should this also include interventions done as part of research on open source development? Following an incident in which buggy code was submitted to the Linux kernel to see whether it would be caught, we conduct a survey among open source developers and empirical software engineering researchers to see what behaviors they think are acceptable. This covers two main issues: the use of publicly accessible information, and conducting active experimentation. The survey had 224 respondents. The results indicate that open-source developers are largely open to research, provided it is done transparently. In other words, many would agree to experiments on open-source projects if the subjects were notified and provided informed consent, and in special cases also if only the project leaders agree. While researchers generally hold similar opinions, they sometimes fail to appreciate certain nuances that are important to developers. Examples include observing license restrictions on publishing open-source code and safeguarding the code. Conversely, researchers seem to be more concerned than developers about privacy issues. Based on these results, it is recommended that open source repositories and projects address use for research in their access guidelines, and that researchers take care to ask permission also when not formally required to do so. We note too that the open source community wants to be heard, so professional societies and IRBs should consult with them when formulating ethics codes.