Stores Licensing Scheme in remote Indigenous communities of the Northern Territory, Australia: a meta-evaluation.

A form of food retail regulation called the Stores Licensing Scheme was introduced by the Australian Government in 2007-2022 to ensure food security in remote Indigenous communities of the Northern Territory. We examined evaluations of this Scheme implemented under the Northern Territory National Emergency Response and Stronger Futures Northern Territory Acts. Grey literature search identified nine primary source evaluations. Reported outcomes were extracted and thematic analysis utilised to determine barriers and enablers. Outcomes included improved availability and quality of groceries, financial structures, and retail practices, albeit not consistently reported. Governance and food cost were perceived barriers. Future policy aimed to improve food security through community stores should consider food cost subsidy, measures to incentivise all stores to improve standards, and improved governance arrangements enabling self-determination for Aboriginal and Torres Strait Islander Store Directors.

Clinical Pharmacist with DEA License: Efforts to Increase Access to Buprenorphine in a Veteran Population.

BACKGROUND: Opioid overdoses continue to rise in the United States. In 2021, a record 80,411 reported overdoses occurred in the US alone, nearly double that in 2017. Buprenorphine's pharmacology is ideal for management of patients with opioid use disorder (OUD) with or without chronic pain. Within the VA, clinical pharmacist practitioners (CPP) are uniquely equipped to operate with significant scope of practice to prescribe medications including controlled substances, an opportunity to vastly increase access to care for veterans suffering from OUD, complex opioid dependency or pain. PURPOSE/HYPOTHESIS: The purpose of this case series is to describe how DEA licensed pain CPP safely and effectively manages 1) Suboxone home inductions to increase access for OUD 2) rotations from traditional full mu opioids to chronic pain buprenorphine products and 3) off label use of Suboxone for pain. Procedures/data/observations: Cases were collected in usual workload for clinical pharmacist. High rate of tolerability and efficacy noted with buprenorphine across all products. CONCLUSIONS/APPLICATIONS: DEA licensed Pain CPPs can make an immediate positive impact for veterans with OUD and/or complex pain and may be more comfortable with buprenorphine than many other providers.

One Psychology Profession, Many Standards: A Narrative Review of Training, Licensing, and Practice Standards and Their Implications for International Mobility.

This narrative review paper contrasts the professional prospects of psychologists in Japan and the U.S., discussing how divergent training, licensing, and practice standards appear to influence psychologists' profession in each country. Licensed psychologists in the U.S. practice with significant autonomy, which can be seen as a reflection of rigorous training requirements. In contrast, certified public psychologists in Japan complete a shorter-duration training regimen yet encounter more restrictive professional standards and greater financial challenges. These varying standards often create barriers to professional practice that impact psychologists on a global scale. Limited international mobility restricts opportunities for psychologists to learn abroad, exchange knowledge, and deliver culturally sensitive care to diverse populations, despite the need for such services among foreign individuals or immigrants in both countries. Furthermore, these disparities impede broader collaborative efforts to address global mental health challenges. Aligning training and licensing standards globally could enhance psychologists' international mobility, ensure consistent quality of care, and foster global collaboration. This alignment could improve access to culturally sensitive psychological services and help bridge the mental health care gap worldwide. This review emphasizes the necessity of further cross-cultural comparisons to understand the impact of training and licensing standards on clinical practice quality and accessibility. By presenting this comparative analysis, the study aims to inspire similar efforts, promoting global licensing reciprocity and the integration of professional psychology in an increasingly interconnected world.

International medical graduates and PAs: A history and update.

ABSTRACT: During the 1980s and 1990s, international medical graduates (IMGs) sought legal and educational measures aimed at obtaining licensure as physician associates/assistants (PAs). Proponents of IMGs asserted that their ethnic backgrounds and identification with their respective communities could increase access to care for some segments of the population and therefore should be permitted pathways to qualify as PAs. A variety of legal measures were introduced into state legislatures in at least five states and were firmly opposed and defeated by the PA profession. Recent attempts by IMGs to obtain licensure as PAs have occurred in Puerto Rico and Arizona. In their haste to address healthcare access and satisfy various constituencies, state legislators and regulatory boards fail to recognize established professional norms. This is occurring as medical organizations are examining alternative pathways for state licensure of physicians who have completed training and/or practiced outside of the United States. PA organizations, particularly state chapters, must be vigilant in upholding qualifications for practice and licensure standards, and state PA organizations must work to convince legislators to avoid using PA professional regulations to solve a workforce issue that is essentially an issue of physician medical education remediation.

Trends and disparities in alcohol-DWI license suspensions by suspension duration, North Carolina, 2007-2016.

PURPOSE: To examine trends and potential disparities in North Carolina (NC) driving while impaired by alcohol (alcohol-DWI) license suspensions from 2007-2016. Specific objectives included: 1) examining personal (e.g., race/ethnicity) and contextual (e.g., residential segregation) characteristics of alcohol-DWI license suspensions by suspension duration; and 2) examining trends in annual suspension rates by race/ethnicity, sex, and duration. METHODS: We linked NC administrative licensing and county-level survey data from several sources from 2007-2016. Suspensions were categorized by duration: 1 to <4 years and 4 years or longer (proxies for initial and repeat suspensions, respectively). We calculated counts, percentages, and suspensions rates (per 1,000 person-years) with 95% confidence intervals, examined trends in annual suspension rates by race/ethnicity, sex, and suspension duration. RESULTS: We identified 220,471 initial and 41,526 repeat license suspensions. Rates among males were three times that of females. 21-24-year-old (rates: 6.9 per 1,000 person-years for initial; 1.5 for repeat) and Black (4.1 for initial; 1.0 for repeat) individuals had the highest suspension rates. We observed decreases in annual initial and repeat suspension rates among males, but only in repeat suspensions for females during the study period. A substantial decrease in annual initial suspension rates was observed among Hispanic individuals relative to other racial/ethnic groups, while annual repeat suspension rates exhibited large decreases for most racial/ethnic groups. The highest overall suspension rates occurred in counties with higher proportions of the population without health insurance and with the highest levels of Black/White residential segregation. CONCLUSIONS: Potential disparities by race/ethnicity and sex existed by alcohol-DWI license suspension duration (i.e., initial vs. repeat suspensions) in NC. Contextual characteristics associated with suspensions, including a high degree of residential segregation, may provide indications of underlying structures and mechanisms driving potential disparities in alcohol-DWI outcomes.

Predictive Factors of State Licensure Board Disciplinary Actions in Occupational Therapy.

IMPORTANCE: One primary function of occupational therapy state licensure boards (SLBs) is the discipline of ethical misconduct by licensed occupational therapy practitioners. However, SLB sanctioning is poorly understood by practitioners, regulators, and the public. OBJECTIVE: To identify predictors of occupational therapy practitioner sanctioning outcomes in the United States. DESIGN: Retrospective study; all public final consent orders and database entries provided online by SLBs were analyzed. Supervised gradient boosting machine learning, logistic regression, and contingency tables were used to generate odds ratios for variables associated with each sanctioning outcome. Multinomial testing was used to identify attribute overrepresentation among cases and national practitioner distributions. PARTICIPANTS: A total of 2,400 cases were analyzed across 47 states and Washington, DC. INTERVENTION: None. OUTCOMES AND MEASURES: Numerous complaint and respondent attribute variables were collected from final consent orders and database entries. RESULTS: Complaint reason, practice setting, and complaint source had the highest influence on predicting sanction outcome; geographic region, number of complaints in a given case, and length of investigation in months were secondarily influential. Being male or a certified occupational therapy assistant was associated with higher odds of severe sanctioning outcomes. CONCLUSIONS AND RELEVANCE: Disciplinary actions against occupational therapy practitioners were determined by numerous contextual factors; however, the most influential factors were complaint reason, practice setting, and complaint source. These results provide direction for exploring factors that predict sanctioning outcomes in the United States and also provide occupational therapy practitioners and SLBs a basis of applied outcomes that may improve implementation and education regarding clinical practice ethics. Plain-Language Summary: Occupational therapy state licensure boards (SLBs) are responsible for disciplining licensed occupational therapy practitioners for ethical misconduct. SLB sanctioning is poorly understood by practitioners, regulators, and the public. In this study, we identify the factors that predict the sanctioning outcomes of occupational therapy practitioners. The results may help state regulators, educators, and national associations more effectively act in a way that protects the public faith in occupational therapy services by providing contextualized information on practitioner behaviors that result in specific sanctioning outcomes. The study findings also provide occupational therapy practitioners and SLBs a basis of applied outcomes that may improve the implementation of and education regarding clinical practice ethics.

Analysis of Responses of GPT-4 V to the Japanese National Clinical Engineer Licensing Examination.

Chat Generative Pretrained Transformer (ChatGPT; OpenAI) is a state-of-the-art large language model that can simulate human-like conversations based on user input. We evaluated the performance of GPT-4 V in the Japanese National Clinical Engineer Licensing Examination using 2,155 questions from 2012 to 2023. The average correct answer rate for all questions was 86.0%. In particular, clinical medicine, basic medicine, medical materials, biological properties, and mechanical engineering achieved a correct response rate of ≥ 90%. Conversely, medical device safety management, electrical and electronic engineering, and extracorporeal circulation obtained low correct answer rates ranging from 64.8% to 76.5%. The correct answer rates for questions that included figures/tables, required numerical calculation, figure/table ∩ calculation, and knowledge of Japanese Industrial Standards were 55.2%, 85.8%, 64.2% and 31.0%, respectively. The reason for the low correct answer rates is that ChatGPT lacked recognition of the images and knowledge of standards and laws. This study concludes that careful attention is required when using ChatGPT because several of its explanations lack the correct description.

Performance of ChatGPT-3.5 and GPT-4 in national licensing examinations for medicine, pharmacy, dentistry, and nursing: a systematic review and meta-analysis.

BACKGROUND: ChatGPT, a recently developed artificial intelligence (AI) chatbot, has demonstrated improved performance in examinations in the medical field. However, thus far, an overall evaluation of the potential of ChatGPT models (ChatGPT-3.5 and GPT-4) in a variety of national health licensing examinations is lacking. This study aimed to provide a comprehensive assessment of the ChatGPT models' performance in national licensing examinations for medical, pharmacy, dentistry, and nursing research through a meta-analysis. METHODS: Following the PRISMA protocol, full-text articles from MEDLINE/PubMed, EMBASE, ERIC, Cochrane Library, Web of Science, and key journals were reviewed from the time of ChatGPT's introduction to February 27, 2024. Studies were eligible if they evaluated the performance of a ChatGPT model (ChatGPT-3.5 or GPT-4); related to national licensing examinations in the fields of medicine, pharmacy, dentistry, or nursing; involved multiple-choice questions; and provided data that enabled the calculation of effect size. Two reviewers independently completed data extraction, coding, and quality assessment. The JBI Critical Appraisal Tools were used to assess the quality of the selected articles. Overall effect size and 95% confidence intervals [CIs] were calculated using a random-effects model. RESULTS: A total of 23 studies were considered for this review, which evaluated the accuracy of four types of national licensing examinations. The selected articles were in the fields of medicine (n = 17), pharmacy (n = 3), nursing (n = 2), and dentistry (n = 1). They reported varying accuracy levels, ranging from 36 to 77% for ChatGPT-3.5 and 64.4-100% for GPT-4. The overall effect size for the percentage of accuracy was 70.1% (95% CI, 65-74.8%), which was statistically significant (p < 0.001). Subgroup analyses revealed that GPT-4 demonstrated significantly higher accuracy in providing correct responses than its earlier version, ChatGPT-3.5. Additionally, in the context of health licensing examinations, the ChatGPT models exhibited greater proficiency in the following order: pharmacy, medicine, dentistry, and nursing. However, the lack of a broader set of questions, including open-ended and scenario-based questions, and significant heterogeneity were limitations of this meta-analysis. CONCLUSIONS: This study sheds light on the accuracy of ChatGPT models in four national health licensing examinations across various countries and provides a practical basis and theoretical support for future research. Further studies are needed to explore their utilization in medical and health education by including a broader and more diverse range of questions, along with more advanced versions of AI chatbots.

A policy analysis of sleep-related legislation for Canadian licensed childcare facilities.

BACKGROUND: National legislative guidelines for sleep and rest are lacking in the Canadian licensed childcare sector. No review of Canadian legislation for licensed childcare facilities has focused on sleep. This paper provides a review of the Canadian provincial and territorial legislative landscape, regarding sleep, rest, and naps in licensed childcare centers. METHODS: Childcare statutes and regulations for each province and territory were identified and downloaded on a particular date. Statutes and regulations were reviewed focusing on sections articulating licensed childcare facility mandates governing sleep, rest, naps, and sleep equipment. An excel file was used to facilitate systematic data retrieval and comparisons across provinces and territories. Two authors developed and discussed themes that summarized data from the documents. RESULTS: No statutes indicated recommendations for sleep, rest, or naps. Only one regulation defined rest (Alberta). Our analysis of regulations identified four themes representing sleep, rest, and naps: programming (general programming, daily programming); space (dedicated space, amount of space, age-specific space); equipment (developmental appropriateness, acceptable sleep equipment, age-specific equipment); and safety (staffing during sleep/rest, sleep position, sleep monitoring, sleep equipment safety, prohibited practices). In Canada, minimal regulatory consistency is evident in required sleep programming, space, acceptability of sleep equipment, and sleep safety considerations. Most jurisdictions' regulations indicated necessity for developmentally appropriate rest or sleep areas and equipment, in particular for infants, but there was minimal consistency in defining infant age groups. CONCLUSIONS: Although we identified themes related to sleep across regulations, childcare regulations differ in their definitions of infants and specifications for children's sleep and rest in licensed Canadian childcare facilities. Without adequate definitions in legislative components of appropriate sleep duration linked to children's developmental stages, childcare facilities lack guidance to support healthy sleep for children in their care. Future research can examine translation of healthy sleep guidelines into government legislation and mandates for sleep, rest, and naps among young children in licensed childcare.

A Review of the Ethics of Patient-Based Licensure Examinations.

Purpose Concerns regarding the ethical justification for the use of single-encounter, procedure-based examinations on live patients for the licensure of dental hygienists and dentists in the United States persists despite decades of debate and publication on the subject. The purpose of this literature review was to summarize the specific ethical concerns and quantify recommendations in favor or against this examination methodology.Methods A population, intervention, control or comparison, outcome (PICO) question was developed to review the topic as follows: "For individuals receiving dental care as part of determination of candidates for competency and readiness for licensure, do patient-based licensure examinations, as compared to other assessment methods, violate or infringe upon ethical principles or ethical standards for health care or society?" An electronic search was performed in three databases: PubMed/Medline, Scopus, and Embase. Key search terms and Medical Subject Headings (MeSH) included the following: ethics, clinical, competence, dental, dental hygiene, dentistry, education, licensure, live patient, and practice.Results Ethical concerns about the use of patient examinations have been published in the professional literature for over 35 years. Of the 29 selected or endpoint articles identified, 27 articles cited one or more ethical concerns relating to single-encounter patient-based examinations while 20 articles recommended the elimination of this type of examination with an additional 6 articles citing elimination as an option in resolving the ethical issues regarding this type of licensure examination.Conclusion The literature holds a predominant, prevailing professional opinion that single-encounter, procedure-based examinations on live patients presents significant ethical concerns and should be eliminated as a method in initial dental hygiene and dental licensure. The literature also suggests that state dental boards should initiate corrective regulatory or legislative actions to expeditiously end recognition of live patient examinations in their licensure processes.

Long-term effects of an alcohol prevention program at licensed premises: a Swedish 20-year follow-up study.

Background: In 1996, a multicomponent community-based alcohol prevention program in Responsible Beverage Service (RBS) targeting licensed premises was developed by STAD (Stockholm Prevents Alcohol and Drug Problems) and implemented in Stockholm, Sweden. The program consists of community mobilization and collaboration, training, and enforcement. Early evaluations have shown a significant increase in the refusal rates of alcohol service to intoxicated patrons, from 5% in 1996 to 70% in 2001, and a 29% decrease in the frequency of police-reported violence. A cost-effectiveness analysis showed a cost-saving ratio of 1:39. The program was institutionalized by a collaborative steering group consisting of community stakeholders. This study aimed to evaluate the long-term effects over 20 years of the RBS program. The indicator chosen was the rate of alcohol overserving to obviously intoxicated patrons at licensed premises in Stockholm. Methods: A 20-year follow-up study was conducted using the same procedure as the baseline and previous follow-ups. Professional male actors (pseudopatrons) were trained by an expert panel to enact a standardized scene of obvious alcohol-intoxication. In 2016, 146 licensed premises located in the central part of Stockholm were randomly selected and visited. A review of program implementation from its initiation 1996 was conducted, examining critical events, including commitment from key actors in the community, training of bar staff, and enforcement. Results: At the 20-year follow-up, pseudopatrons were refused alcohol service in 76.7% of the attempts, which was at the same level (70%) as in the follow-up in 2001, thus indicating sustained effects of the RBS program. Compared with previous follow-ups, serving staff used more active intervention techniques in 2016 toward intoxicated patrons, such as refusing to take the order (56.9% in 2016 vs. 42.0% in 2001), and fewer passive techniques, such as ignoring patrons (6.5% in 2016 vs. 15.5% in 1999) or contacting a colleague (4.1% in 2016 vs. 25% in 2001). Conclusion: The sustained long-term effects of the RBS program are unique and can be explained by the high level of institutionalization of the multicomponent program, which is still ongoing in Stockholm. These findings can inform the dissemination of the program to other countries and settings.

Driver's license, head protection devices and severity of motorcyclists' injuries in traffic accidents.

OBJECTIVES: to describe traffic accidents involving motorcyclists and analyze the association between possession of a motorcycle driver's license and use of helmets according to the severity of injuries. METHODS: a cross-sectional study was conducted among all patients hospitalized in the traumatology and orthopedics sector of a public reference hospital in northeastern Brazil. RESULTS: 170 patients were surveyed, the majority were male (95.9%). Their ages ranged from 18 to 67 years. Most were black or brown (52.3%), had completed elementary school (58.9%) and had monthly income smaller than two minimum wages (56.5%). An association was found between being licensed to drive a motorcycle and wearing a helmet. Among those who suffered moderate injuries, this association was OR=5.66(1.85-17.23) and among those who suffered severe injuries it was OR=13.57(2.82-65.14). CONCLUSIONS: people who were licensed to drive motorcycles used a helmet as protective equipment more often and, in accidents, suffered fewer injuries.

Ethical Challenges in Social Work Licensing Examinations: A Call for Integrity and Strategies for Success.

This article discusses four questions. First, what is the operational framework of the Association of Social Work Boards (ASWB)? Second, how congruent is the ASWB's operational framework with social work values and ethics? Third, why do ASWB exam candidates from disadvantaged backgrounds-those who identify as African American, who are older, and who do not speak English as a first language-register comparatively lower pass rates in the clinical licensure examination? Fourth, what are ethically sound novel strategies for improving the ASWB exam? This article argues that (1) ASWB, in its present state, operates under a business model philosophy, which is incongruent with the social work value of integrity, and (2) the disparities in pass rates in the ASWB exam may reflect its lack of validity. This article also presents three relatively innovative strategies for restoring confidence and increasing success in the ASWB social work licensing exam and two contingent solutions to the problem of exam pass rate disparities based on race, age, and primary language. The implications of this study for social work stakeholders are also discussed.

Intellectual property licensing of therapeutics during the COVID-19 crisis: lessons learnt for pandemic preparedness and response.

During the COVID-19 pandemic, intellectual property licensing through bilateral agreements and the Medicines Patent Pool were used to facilitate access to new COVID-19 therapeutics in low- and middle-income countries (LMICs). The lessons learnt from the application of the model to COVID-19 could be relevant for preparedness and response to future pandemics and other health emergencies.The speed at which affordable versions of a new product are available in LMICs is key to the realization of the potential global impact of the product. When initiated early in the research and development life cycle, licensing could facilitate rapid development of generic versions of innovative products in LMICs during a pandemic. The pre-selection of qualified manufacturers, for instance building on the existing network of generic manufacturers engaged during the COVID-19 pandemic, the sharing of know-how and the quick provision of critical inputs such as reference listed drugs (RLDs) could also result in significant time saved. It is important to find a good balance between speed and quality. Necessary quality assurance terms need to be included in licensing agreements, and the potentials of the new World Health Organization Listed Authority mechanism could be explored to promote expedited regulatory reviews and timely access to safe and quality-assured products.The number, capacity, and geographical distribution of licensed companies and the transparency of licensing agreements have implications for the sufficiency of supply, affordability, and supply security. To foster competition and support supply security, licenses should be non-exclusive. There is also a need to put modalities in place to de-risk the development of critical pandemic therapeutics, particularly where generic product development is initiated before the innovator product is proven to be effective and approved. IP licensing and technology transfer can be effective tools to improve the diversification of manufacturing and need to be explored for regional manufacturing for accelerated access at scale in in LMICs and supply security in future pandemics.

Transferability of Effective Consultation Skills for Decision-Making Support in the Voluntary Surrender of Older Adult Drivers' Licences in Super-Aged Japan.

INTRODUCTION: Previously, we identified eight effective consultation skills to support decision-making in the voluntary surrender of older adult drivers' licences in super-aged Japan. This study aimed to clarify the transferability of these skills. METHODS: We collected text data by interviewing 11 safe-driving counsellors (four police officers, four clerical staff and three nurses) in the License Division of the National Police Agency from February to March 2022. Interviews were semi-structured and conducted by telephone or email. During the interview, participants were asked to recall their experiences as counsellors providing decision-making support to older drivers and to compare their experiences with the eight consultation skills. We analysed the content of the responses by quantitative text analysis with KH Coder 3 software. RESULTS: As a characteristic of the words and phrases used by counsellors in their narratives about consultation skills, the most frequently extracted words from among 3147 words were think, parties and family, and promote had the highest mediation centrality. The eight subgraphs were 'Respecting the will of relevant parties from their standpoint is natural', 'Listening attentively and empathetically to relevant parties is effective', 'Presenting objective data to guide decisions is successful', 'Showing cognitive functioning test results is often effective', 'Counselors with medical expertise can elicit positive counseling outcomes', 'Intervention by medical or police counselors facilitates the decision to surrender voluntarily', 'Counseling skills need to be improved' and 'A diagram of the 8 skills is helpful for inexperienced counselors'. CONCLUSION: The results suggest that the eight consultation skills have similarities and are transferable. This transferability might contribute to practical application or cohort follow-up study research. These skills can be incorporated into counsellor training, and counsellors can be expected to use these skills in the future. Regardless of the safe-driving counsellor's years of experience, the skills can help them provide uniform and accurate support in decision-making regarding the voluntary surrender of older adult drivers' licences. These skills are a promising approach to help older adults lead safe and secure lives as they age.

The Phenomenon of Teen Delay in Driving Licensure: Considerations at the Intersection of Mobility and Social Welfare for Emerging Adults.

In 2021, there were 11.7 million licensed young drivers in the U.S. This is 1.5 million fewer young drivers compared to 2007. The phenomenon of delay in driving licensure among teens has notable implications for opportunities positioning them for life success when transitioning into emerging adulthood and in later life.