Autistic and other neurodivergent youth face social, sensory, and environmental challenges at school that negatively impact learning and well-being. Yet, most educators are not trained in neurodevelopmental disabilities, leaving them with outdated knowledge and limited confidence about how to support neurodivergent youth at school. In a two-phase project, we sought to (1) co-design a comprehensive professional development training for school educators and (2) pilot test this training in one US public school district. First, we used community-based participatory research methods to form an interdisciplinary team of neurodivergent educators and autistic community members. We then used human-centered design methods to iteratively design the Schools Unified in Neurodiversity professional development training for US K-12 educators. In Phase 2, we demonstrated feasibility and acceptability of the resulting training in a sample of 192 educators, grades K-12. Significant improvements were noted in educator knowledge and self-efficacy in pre- to post-assessments. Together, community-based participatory research and human-centered design provided a promising community-driven approach to development, resulting in a training that was well received and conducive to implementation. Future work will test the effects of the Schools Unified in Neurodiversity training on youth outcomes and explore the role of professional learning communities to support implementation and sustain change.Lay AbstractNeurodivergent children are children who have neurodevelopmental or cognitive disabilities (e.g. autism spectrum disorder, attention deficit hyperactivity disorder, brain injury, dyslexia, Tourette's, and other neurological disorders). Neurodivergent children have heightened risk for mental health problems and poor learning outcomes compared to their peers. Sadly, school experiences contribute to these poor outcomes. Every day, neurodivergent children face a multitude of barriers and negative events at school that exacerbate their neurocognitive, sensory, and social communication differences, and even make them feel unsafe. Educators do not have the knowledge of how to support neurodivergent children and cannot practically provide individualized supports to each neurodivergent child in their classroom. A new approach is needed to ensure that school is a positive, enriching experience instead of the stressful, negative experience that it is for most neurodivergent students. This project aimed to transform schools for neurodivergent children by giving public school educators the knowledge they need to create a safe and inclusive school climate for all children. We developed the Schools Unified in Neurodiversity training with a group of researchers, teachers, counselors, principals, administrators, and advocates all with personal connections to neurodiversity. The Schools Unified in Neurodiversity training program teaches a series of practical tools to design classrooms and instruction in ways that eliminate unnecessary barriers and set neurodivergent children up for success at school. We tested the Schools Unified in Neurodiversity training program in one school district with 192 educators. Results suggest that this program is agreeable to teachers and improves their knowledge and confidence in supporting their neurodivergent children. Future work will test how the Schools Unified in Neurodiversity training program helps neurodivergent youth directly and if teachers can sustain these positive changes in knowledge and confidence.

Within a 2-year Master of Biostatistics program, we reconsidered the mathematics requirements for admission, and also the premise that the most distinguishing feature of a top candidate is deep exposure to mathematics. Our assessment took place within a broad curriculum review intended to enhance alignment: aligning programmatic goals with job skills, aligning the use of mathematics within our curriculum with programmatic goals, aligning our admission criteria with our curriculum, and aligning our application materials with these admission criteria. We developed a specific list of mathematical skills required by the curriculum, and are revising the application materials to include self-report on applicant's exposure to and functional mastery of those skills. We illustrate how functional mastery is operationally defined. Our criteria for identifying top candidates was broadened to include those with especial skills in analytics, biology and/or communication (i.e., the three conceptual pillars of our program). Deep mathematical training is one of many ways to become a top candidate. Within STEM fields such as biostatistics, and despite the commonly held assumption that admission criteria should emphasize depth of mathematical training, a systematic analysis suggests that this assumption imposes a gratuitous requirement on applicants. Reconsidering this assumption can help remove unnecessary barriers, reduce challenges, and support success for aspiring or emerging biostatisticians from diverse or multifaceted backgrounds. It is one way to contribute to a more inclusive and equitable learning environment in our STEM discipline. We believe similar programs might benefit from performing this type of analysis and reflection.

The proliferation of cybercriminal activities from 2023 to 2025 has highlighted the critical role of digital forensics in legal proceedings; however, resource constraints often limit access to effective investigative capabilities. Despite the technical adequacy of open-source digital forensic tools, courts typically favor commercially validated solutions because of the absence of standardized validation frameworks for open-source alternatives, creating unnecessary financial barriers to high-quality forensic investigations. This study aims to validate and enhance the conceptual open-source digital forensic framework developed by Ismail et al. (2024) to ensure the legal admissibility of evidence acquired through open-source tools. Through a rigorous experimental methodology utilizing controlled testing environments, we conducted comparative analyses between commercial tools (FTK and Forensic MagiCube) and open-source alternatives (Autopsy and ProDiscover Basic) across three distinct test scenarios: preservation and collection of original data, recovery of deleted files through data carving, and targeted artifact searching. Each experiment was performed in triplicate to establish repeatability metrics, with error rates calculated by comparing the acquired artifacts with control references. Our findings demonstrate that properly validated open-source tools consistently produce reliable and repeatable results with verifiable integrity comparable to their commercial counterparts. The enhanced three-phase framework integrating basic forensic processes, result validation, and digital forensic readiness to satisfy Daubert Standard requirements while providing practitioners with a methodologically sound approach. This study contributes significantly to digital forensics by democratizing access to forensically sound investigative capabilities without compromising legal admissibility requirements, ultimately benefiting resource-constrained organizations while maintaining the evidentiary standards necessary for judicial acceptance.

Introduction. Vascular neurology is overwhelmed by specialty physician shortages. We aimed to understand the lived experience of specialist acute neurovascular nurse practitioners (NPs) working in expanded roles, to build knowledge of the role’s place within acute stroke systems. Methods. A convergent mixed methods research design was used to provide a comprehensive representation of the acute neurovascular NP lived experience. Acute neurovascular NPs completed a demographic, work role, and scope of practice barrier questionnaire, along with the Dempster Practice Behavior Scale (DPBS), followed by semi-structured focus group interviews. Quantitative data were analyzed using SPSS; qualitative data were analyzed with NVivo to identify themes. Quantitative and qualitative data were then integrated to elucidate meta-inferences. Results. A total of 14 acute neurovascular NPs participated, with a median age of 44 years (IQR 38.75, 50.25) years, 85.7% female, and median work experience of 13 years (IQR 4.5, 21). Acute neurovascular NP duties entailed diagnosis, treatment including thrombolysis administration, and ongoing hospital-based patient management. The DPBS revealed a high Autonomy median score of 130 (IQR 120.75, 140.50). Themes from the qualitative data were: 1) Independence (subthemes- work related confidence and clinical leadership); 2) Barriers (subthemes- policy-driven and physician-driven practice restrictions); and 3) Collaboration. Meta-inferences confirmed that expanded role acute neurovascular NPs are highly educated, experienced clinicians with high levels of practice autonomy that is discordant with both practice barriers and scope of practice. Conclusions. As role expansion continues to be driven by physician shortages, acute neurovascular NPs must make clear their legal scope of practice restrictions to ensure regulatory compliance, while advocating for the removal of unnecessary practice barriers.

Rethinking Standards for Minimum Short-Term Follow-Up Duration for Clinical Outcome in Orthopaedic and Sports Medicine Studies.

In international trading system, trade in services covers a wide range of intangible and heterogeneous products and activities which making it complex in the implementation phase. Association of Southeast Asian Nations (ASEAN) had established a progressive agreement on trade in services, the ASEAN Trade in Services Agreement (ATISA) that brings trade liberalization on services by recognizing progressive negative list approach. Nevertheless, there is no clear framework on how this agreement will be applied as ASEAN Member States (AMS) have difference economic policies considered the complexities of services sector. This paper aims to explore the regulation on trade in services, in particular the legal analysis of transparency of the implementation of the negative list approach brought by ATISA. This new agreement has a built-in agenda for AMS to convert their previous commitments of positive approach under ASEAN Framework Agreement on Services (AFAS). This paper is a doctrinal research based on secondary data by analysing the existing international legal instruments on trade, ASEAN agreements and policies on the liberalization of trade in services in the context of the ASEAN single market and production base as well as epicentre of growth. Despite its’ potential benefits of ATISA, this article identifies substantial challenges in implementing newly trade in services agreement in ASEAN. This article argues that ASEAN still needs improving the regulatory standards for the service sector and reducing the unnecessary barriers to service trade within ASEAN, as well as increasing the respective regulatory transparency in each AMS.

The current ABR Alternate Pathway creates unnecessary barriers that discourage qualified international medical physicists from contributing to the U.S. healthcare system.

BackgroundPregnant people are often excluded from clinical trials, primarily due to safety concerns. However, exclusion causes population-level harms as well as sometimes providing individual protection. Harms caused to pregnant people by exclusion from clinical trials have been clearly evidenced and highlighted during the COVID pandemic. The National Institute for Health and Care Research (NIHR) has since provided guidance on improving inclusion of under-served groups, which includes pregnant people, in clinical research. Appropriate inclusion and active facilitation to participate are required to provide equitable evidence-based healthcare during pregnancy and to comply with ethical principles for research.MethodsWe carried out an exploratory, online, cross-sectional survey of trialists to assess whether, why, and how pregnant people are included or excluded from clinical trials funded by the NIHR Health Technology Assessment (HTA) Programme, with awards starting in 2022–2023. Trialists were the respondents, with trials the primary focus of this survey. Invitations were sent to trialists between October 2023 and March 2024. Summary statistics were calculated to describe the characteristics of the trials and respondents, to describe eligibility of pregnant people, reasons for this, and how this eligibility is documented and implemented.ResultsWe identified 120 trials of which 88 were eligible for this survey. Responses were received for 81 trials. Pregnant people are excluded from 34 of these 81 trials. Pregnant people are eligible for inclusion in 40 of the 81 trials, including four which partially exclude people during pregnancy. Eligibility is unclear for seven trials. Exclusions are mostly for safety reasons. Sponsors and regulatory authorities are unnecessary barriers to inclusion in some trials. Eight trials of 40 trials make explicit or deliberate attempts to include people during pregnancy.ConclusionsA minority of the 120 trials include people during pregnancy. Most trials for which pregnant people are eligible do not report explicitly including people during pregnancy or facilitating their inclusion. A small number of trials, different in setting, clinical area, and intervention type, are intentionally designed and conducted in a way that include people during pregnancy. There are clear opportunities to improve the inclusion of pregnant people in clinical trials in the NIHR HTA Programme.

Using updated clinical recommendations to support contraceptive decision-making: U.S. medical eligibility criteria for contraceptive use, 2024.

This article explores the evolving concept of investment facilitation as a crucial legal and policy tool to support sustainable development. While investment promotion traditionally focuses on marketing a location as an attractive destination for foreign direct investment (FDI), investment facilitation seeks to reduce unnecessary regulatory and administrative barriers to ensure smooth entry, operation, and retention of investment. The study highlights how effective facilitation strategies must move beyond investor-centered approaches to align with environmental, social, and developmental goals. It examines national, regional, and international governance tools, with particular attention to Brazil’s innovative model of Cooperation and Facilitation Investment Agreements (CFIAs), which emphasizes institutional support over investor–state dispute settlement. The article also analyzes ongoing WTO negotiations on a multilateral framework for investment facilitation and the tensions between soft law cooperation and binding obligations. By integrating legal, administrative, and policy perspectives, the paper provides a structured roadmap for policymakers to develop investment facilitation strategies that are transparent, inclusive, and tailored to advance sustainable development outcomes at all levels.

Abstract Many Indigenous Māori students journey to tertiary education in Aotearoa New Zealand, following diverse journeys with varying degrees of encouragement. However, on arrival, they can be faced with the prospect of living simultaneously in two worlds; te ao Māori (the Māori world), which privileges relational connection, and the world of formal education, which tends towards individualization. In this situation, rangatahi (Māori youth) deal with their new context by leveraging relational support, informal and formal. This article discusses the experiences of four rangatahi in one university. Their stories, drawn from oral encounters between rangatahi and the researchers as part of a video project, point to the significance of encouragement to attend tertiary study, unnecessary barriers to wellbeing at university, and the importance to flourishing of Māori spaces that support Māori identity within the university. Engaging with rangatahi voices offers opportunities to understand aspects of university life that tell of strengths within Māori communities but also indicate the depth of relational change required to provide equity in tertiary educational experiences for Māori.

People of African ancestry are overrepresented among lives lost prematurely and persons unnecessarily afflicted with the highest burden of cancer among nonindigenous Americans. Amid the growing advancements in cancer discoveries and innovations, the persistence of cancer disparities affecting Black/AfricanAmerican populations is particularly disturbing and disappointing. Ashing and colleagues in the Alliance of Black Community Outreach and Engagement Scientific Directors of National Cancer Institute-designated cancer centers discuss the excessive cancer burden in Black populations and propose a Cancer Moonshot-focused framework. The paper posits for research to remedy cancer disparities, there are three critical areas that require action: (1) examine Black/African American heterogeneity; (2) eradicate policies and practices that are biased toward Black/African American populations and limit access to clinical studies/trials; and (3) embrace community engagement and collaborations. This paper extends a call to action focused on eight critical areas for making significant strides to reduce cancer disparities in Black/African American communities: (1) implementation of policies for inclusion, accountability, and coverage; (2) removal of unnecessary barriers to clinical research participation; (3) introduction of continuing clinical research engagement training; (4) broad deployment of provider communication tools and resources for effective patient communication and referrals; (5) diversification of the scientific and clinical workforce; (6) practice of multisectoral and team science; (7) inclusion of community engagement in science; and (8) development of broad and authentic partnerships with our Black/African American communities. Taken together, these pillars support improved engagement with multistakeholder Black/African American communities to close disparities gaps and achieve health equity and justice.

Personalised medicine in chronic complex diseases such as rheumatoid arthritis (RA) is within reach but requires international multi-stakeholder collaboration. We exemplify how national implementations of the General Data Protection Regulation (GDPR) have introduced administrative delays and created disincentives for data sharing and collaborative research. Our Danish/Swedish/Norwegian research collaboration (the 3-year NordForsk-funded "NORA" project) aims to develop a personalised medicine approach for the management of RA, built on the exploitation of unique existing data sources: longitudinal data from clinical rheumatology registries, research cohorts, nationwide health care registries, and biobank material from >20 sample collections. Data and results are shared and accessed remotely by collaborators at secure servers. New biomarker assays and patient-centric implementations of the results are to be explored, validated, and disseminated to patients and health care via the development of digital tools. Following the advice of legal experts at the involved academic or public institutions and private companies, GDPR compliance resulted in >20 legal documents to govern the collaboration (consortium-, joint controller-, research collaboration-, data sharing-, and a series of unique two-way data processing-, and material transfer agreements). Lack of agreed-upon templates, policies, procedures, and a shortage of legal resources have caused considerable delays. Thus, our research consortium has spent more time ensuring GDPR compliance than on actual research activities. The current interpretation and implementation of the legal premises (rather than the GDPR per se) for research collaborations caused unnecessary barriers and delays. Our experiences call for Nordic trust-based code-of-conduct-like framework agreements, and for harmonisation of procedures and templates, lest the Nordic advantage in research be lost.

The Belt and Road Initiative is of strategic importance to the economic development of Eurasia, which can effectively promote further cooperation among the participants and break down unnecessary barriers to trade and exchange. The year 2024 commemorates the milestone 10th anniversary of the inaugural journey of the Madrid-Yiwu Train, which stands as a pivotal element within the Belt and Road Initiative. This transcontinental railway holds immense importance for fostering economic prosperity and societal advancement in the nations traversed by its route. As a developing and emerging regional economic integration organization, the Eurasian Economic Union has achieved a series of achievements in the process of economic integration, but it also faces many challenges. The continuous improvement of the operation efficiency of the Madrid-Yiwu Train, it will further help the countries along the Belt and Road to optimize and integrate the rich natural resources more efficiently, realize the transformation and upgrading of industrial structure, and improve the industrial system within the alliance. This paper specifically analyzes the current situation and challenges of the Madrid-Yiwu Train and the Eurasian Economic Union, and puts forward relevant suggestions on how to further promote the Madrid-Yiwu Train connecting the Eurasian Economic Union to the development of regional economy, politically, economically and culturally.

Permanent contraception in the childfree population: An exploratory study

With the increasing recognition of the role of trade policies in supporting sustainability approaches, countries are adopting a wide array of trade measures aimed at greening the industrial sector, and one such example is the transition to a circular economy. A transition towards a more resource-efficient and circular economy is closely intertwined with international trade. As circular economy is gradually turning into a global endeavour with dozens of national circular roadmaps being launched, it is crucial to examine how circular economy approaches interact with the economic and trade diversification objectives of developing countries. Circular economy policies and trade policies need to be aligned so that the transition to the circular economy at the global level does not create unnecessary barriers to trade for developing countries. In this context, the broad objective of this paper is to discuss the potential implications of trade rules linked to circular economy for developing countries.

The Health Insurance Portability and Accountability Act (HIPAA) aims to safeguard patient information; however, complex legal language may lead to confusion and mistrust, and hinder enrollment in clinical trials. To evaluate the effect of a standard HIPAA authorization included in mailed survey packets on study enrollment for a multi-site pragmatic trial. This study is nested within an advance care planning pragmatic trial at 50 primary care clinics across three University of California (UC) Health Systems. We included English and Spanish-speaking seriously ill patients. One third of eligible patients received and 2/3 did not receive the HIPAA authorization in their enrollment packet. We compared enrollment rates at 3months and assessed the readability, understandability, and actionability of the standard HIPAA form using the Federal Plain Language Guidelines Checklist for Plain Language, the Automatic Readability Checker consensus calculator (grade 8 is the average reading level for US adults), and the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P, 0-100%, 70% considered the minimum). Of 4632 eligible patients (mean age 71, 48% women, 11% Spanish-speaking, 40% racial/ethnic minority); 1543 received a mailed enrollment packet with a HIPAA form and 3089 did not. Patients mailed the HIPAA form were less likely to enroll (10.2% vs. 14.8%, p < 0.001). The standard HIPAA form scored at the 12th grade reading level, had a PEMAT-P Understandability score of 42%, had an Actionability score of 40%, and only met 50% of Federal Plain Language Guideline Checklist items. The inclusion of a standard HIPAA authorization in mailed enrollment packets for a large pragmatic trial led to lower rates of study enrollment. This study informs how HIPAA authorization forms should be redesigned to be more accessible to patients to prevent unnecessary barriers to research enrollment.

The main objective of this study is to examine and quantify the effects of Non-Tariff Barriers (NTBs) on cargo trade movement in Tanzania, focusing on the Dar es Salaam-Namanga Border Post. Specifically, the study aims to identify the main administrative or technical requirements along this trade route (both old and new), analyze the regularity of these requirements based on respondents’ feedback, and provide recommendations for mitigating NTBs. The study utilized an empirical survey design, collecting mostly qualitative data on border trade performance and perceived non-tariff barriers. The research was guided by economic theory and targeted formal and informal cross-border traders, transport companies, truck drivers, weighbridge attendants, and customs and revenue authorities. Data was collected through desk research, interviews, questionnaires, and stakeholder consultations. The Dar es Salaam-Namanga route was chosen for its importance as the busiest commercial corridor in the East African Community (EAC). The study employed both probability and non-probability sampling techniques, restricted to the Arusha-Namanga roadway. Four data collection methods were used: desk research, interviews, questionnaires, and stakeholder consultations. The data were analyzed using thematic analysis for qualitative information, and an econometric model based on Newton's gravitational equation (a modified gravity model) was used to quantify trade effects. Statistical Package for Social Sciences (SPSS) was employed for stepwise multiple linear regression analysis. The model's predictive power was tested using an F-test, and it was verified to meet assumptions of linearity, homoscedasticity, and multicollinearity. The results revealed that roadblocks, customs clearance, permits, and road infrastructure significantly affected trade performance. Unethical practices at weighbridges, frequent police checks, and customs procedures lead to monetary losses and time delays for cross-border traders. Bribery, police checks, and unloading processes during inspections were identified as factors contributing to the perception of NTBs as costly and time-consuming. On a positive note, improved road conditions have reduced transportation costs by lowering vehicle repair expenses and decreasing travel time. The study concludes that there is a need for regional cooperation within the EAC to eliminate existing NTBs. It recommends streamlining administrative procedures and working hours at border points, and implementing monitoring systems to ensure the effective removal of unnecessary barriers to trade. These measures are essential to improving trade efficiency and promoting the goals of the re-established East African Community.

The effects of incivility on student nurses in the clinical setting: A grounded theory approach

Abstract Students with disability tend to report lower levels of school engagement. To date, research has focused on building students’ extrinsic motivation and self-regulation with limited consideration of the impact of instructional barriers. In this mixed-methods study, we investigated the effect of teachers’ participation in the Accessible Pedagogies™ Program of Learning on the classroom experiences and engagement of 56 Year 10 students with disabilities impacting language and information processing. When asked in interviews what their teacher did to help them pay attention and to understand, students described teachers’ increased use of practices that were the focus of the program. Self-report questionnaire data revealed a positive, statistically significant increase in cognitive engagement for students whose teachers participated in Accessible Pedagogies™. No increase was observed for a Comparison Group. Findings suggest that the reduction of extraneous language and cognitive load through teachers’ use of Accessible Pedagogies™ may have helped students deploy available mental effort to engage in learning, rather than expend that effort to overcome unnecessary instructional barriers. Future research will investigate the impact of Accessible Pedagogies™ with larger samples and a wider range of students.