Licensure Policies May Help States Ensure Access To Opioid Use Disorder Medication In Specialty Addiction Treatment.

Despite the devastating toll of the overdose crisis in the United States, many addiction treatment programs do not offer medications for opioid use disorder (MOUD). Several states have incorporated MOUD requirements into their standards for treatment program licensure. This study examined policy officials' and treatment providers' perspectives on the implementation of these policies. During 2020-22, we conducted thirty-one semistructured interviews with forty policy officials and treatment providers in nine states identified through a legal analysis. Of these states, three states required treatment organizations to offer MOUD, and two prohibited organizations from denying admission to people receiving MOUD. Qualitative findings revealed that licensure policies were part of a broader effort to transition the specialty treatment system to a model of care more consistent with medical evidence; states perceived tension between raising quality standards and maintaining adequate treatment capacity; aligning other state policies with MOUD access goals facilitated implementation of the licensure requirement; and measuring compliance was challenging. Licensure may offer states an opportunity to take a more active role in ensuring access to effective treatment.

Development and validation of a 6-plex Luminex-based assay for measuring human serum antibodies to group B streptococcus capsular polysaccharides.

Six serotypes (Ia, Ib, II, III, IV, and V) cause nearly all group B streptococcal (GBS) disease globally. Capsular polysaccharide (CPS) conjugate vaccines aim to prevent GBS disease, however, licensure of a vaccine would depend on a standardized serological assay for measuring anti-CPS IgG responses. A multiplex direct Luminex-based immunoassay (dLIA) has been developed to simultaneously measure the concentration of serum IgG specific for the six prevalent GBS CPS serotypes. Assay validation was performed using serum samples obtained from human subjects vaccinated with an investigational 6-valent GBS CPS conjugate vaccine. Results for the assay are expressed as IgG concentrations (µg/mL) using a human serum reference standard composed of pooled sera from vaccinated subjects. The lower limits of quantitation (LLOQ) for all serotypes covered in the 6-plex GBS IgG dLIA fell within the range of 0.002-0.022 µg/mL IgG. Taken together, the 6-plex GBS IgG dLIA platform is specific for the six GBS serotypes included in Pfizer's investigational vaccine, has a wide dilution adjusted assay range, and is precise (<18.5% relative standard deviation) for all serotypes, and, therefore, is suitable for quantitatively measuring vaccine-induced or naturally acquired serotype-specific anti-CPS IgG responses against GBS.

Social processes influencing nursing students in passing the nursing licensure examination: A grounded theory approach.

AIM: To explore the strategies used by nursing students in passing the nursing licensure examination. DESIGN: This study uses a classic grounded theory design to explore the social processes influencing a nursing license examination. METHODS: Eight graduate students participated in this research study and were interviewed in-depth twice. The Classic Grounded Theory method of Glaser was applied to collect and analyse the data until saturation was reached. RESULTS: The findings revealed that students who passed the nursing licensure examination described the strategies as a preliminary model comprising a core category, Reviewing (Phase 1), which consisted of two sub-categories: Entering Time and Reviewing Styles. Additionally, two other main categories emerged: the Tutoring category (Phase 2) and the Testing Practice category (Phase 3). It was observed that each course (subject) does not necessarily follow a specific order in traversing these phases; they may move back and forth between them until the conclusion of the examination. Furthermore, it was found that the time allocated to Entering Time and completing the three phases significantly influences the successful passing of the nursing licensure examination.

Evolving Licensure Examination: Assessing Student Confidence and Accuracy With Next Generation NCLEX.

BACKGROUND: The Next Generation NCLEX (NGN) includes new item types. Little is known about nursing students' confidence and accuracy in answering these questions. METHOD: A descriptive comparative study examined prelicensure nursing students' confidence and accuracy in answering NGN-style items versus multiple-choice questions (MCQs) of the same content via a 12-item quiz. RESULTS: Less than one third of students (n = 194; 32.1%) reported feeling confident in answering NGN questions. Students' confidence levels had no relationship on scores with NGN items. When comparing NGN-style items to MCQs, students' (n = 221) scores on NGN-style items were lower with bowtie or a select-all-that-apply questions but higher with highlight table or matrix multiple-choice questions. CONCLUSION: Students' lack of confidence with certain item types suggests faculty should incorporate these item types into classroom activities or course assignments. NGN test-taking strategies also should be incorporated and frequently reinforced throughout the curriculum. [J Nurs Educ. 2024;63(4):252-255.].

The effect of color on license plate recall.

Previous research has shown there are particular patterns of license plate designs that are easier to recall. Missouri license plate patterns (AB1-C2D) somewhat diverge from what research suggests works best for recall. The current study examined whether incorporating color into license plates would improve recall, and also whether awareness or explanation of license plate formats would affect recall accuracy. Across two experiments, participants viewed license plate stimuli with and without color and attempted to recall them. The hypothesis was that incorporating color would improve recall, but the hypothesis was not supported. Results also did not show that prior exposure or explanation of formats affected accuracy. Future research should explore additional ways to improve license plate designs that would be easy to implement. Such improvements to license plate design would be useful because efforts to improve the public's awareness of formats would be expensive and likely ineffective.

Program Directors' Perspectives on Residency Applications in the Post‒United States Medical Licensing Examination Step 1 Era: A Case for Standardized Letters of Recommendation?

INTRODUCTION: The United States Medical Licensing Examination (USMLE) Step 1 test evolved into a key metric utilized by program directors (PDs) in assessing candidates for residency. The transition to a USMLE Step 1 binary pass/fail scoring system has resulted in a loss of an important objective assessment. With national movements toward pass/fail systems for clerkship grading and trends toward abandonment of class ranking, assessing residency applications has become increasingly challenging. METHODS: The Society of Academic Urologists convened a task force to, in part, assess the perspectives of urology PDs regarding the importance of various aspects of a residency application for predicting clinical performance. An anonymous survey was disseminated to all urology PDs in the US. Perspectives on 11 potential application predictors of clinical performance and demographics were recorded. Descriptive statistics characterized PD responses. Friedman test and pairwise Wilcoxon tests were used to evaluate the relative ranks assigned to application elements by PDs. RESULTS: There was a 60.5% response rate (89/147). Letters of recommendation (LORs) were ranked as the most important predictor, with a mean rank of 2.39, median of 2 (IQR 1-3). Clerkship grades and USMLE Step 1 were comparable and ranked second. Medical school reputation ranked the lowest. There was significant subjective heterogeneity among categories; however, this was less so for LORs, which predominated as the most important factor among application elements (P < .001). CONCLUSIONS: To our knowledge, this is the largest sample size assessing PD perspectives on application factors that predict clinical performance. The second (clerkship grades) and third (USLME Step 1) most important factors moving toward binary pass/fail systems create an opportunity for actionable change to improve assessment objectivity. Our data demonstrate LORs to be the most important factor of residency applications, making a compelling argument for moving toward a standardized LOR to maximize this tool, mitigate bias, and improve interreviewer reliability.

Racial Disparity in Social Work Professional Licensure Exam Pass Rates: Examining Institutional Characteristics and State Licensure Policy as Predictors.

PURPOSE: The Association of Social Work Boards (2022a) released a report evidencing test-taker demographics as the strongest predictor of professional licensure exam pass-rates. The purpose of this study was to examine statistical predictors of social work professional licensure exam pass rate disparities between first-time Black/African American and White test-takers. MATERIALS AND METHODS: The study addressed the following research question: To what extent do institutional and state licensure characteristics predict race-based disparities in social work licensure exam pass rates? To answer this question, the authors built a data set in an Excel spreadsheet comprised of institutional and state licensure variables using publicly available and reliable sources. RESULTS: States requiring more clinical supervision hours and imposing higher licensure fees tended to report higher overall pass rates on the ASWB exam. Additionally, a notable correlation was found between states with a higher proportion of Black/African American residents and increased pass rates. Conversely, states that had established a larger number of licensure tiers typically saw lower overall pass rates. Furthermore, it was noted that schools located in the Southern U.S. demonstrated significantly lower ASWB pass rates compared to schools in other regions of the country. DISCUSSION: Recommendations are made regarding future research efforts and professional licensure and regulation standards. CONCLUSION: Pass rate disparities have implications for individual exam-takers and their families; for clients and constituencies; and for social work practice, research, ethics, and education.

Alternative Pathways to Social Work Licensure: A Critical Review and Social Equity Policy Analysis.

PURPOSE: In August 2022, the Association of Social Work Boards released a long called for pass rate analysis that revealed significant disparities. While many states look to cease the requirement of the Bachelors, Masters, and Advanced Generalist exams in their licensure process, status quo bias leads to hesitancy to remove the requirement of the Clinical exam. METHOD: A critical review was undertaken to identify possible alternatives to the current multiple-choice competency-based exam which yielded three assessment formats (oral exams, portfolios, and performance assessment/simulations) and two alternatives (jurisprudence exams and provisional licensure). Informed by an Afrocentric lens, we undertook a social and racial policy analysis to examine alternative pathways for licensure from the perspective of a social work board member. We centered our analysis on the impacts on (1) Black social workers, who currently have the highest pass-rate disparities; (2) social workers whose primary language is not English, and (3) social workers with disabilities who have anecdotally reported difficulty with getting testing accommodations. We rated each alternative on four social equity analysis criteria of procedural fairness, access, quality, and outcomes. These ratings were computed into an overall rating for each alternative from equitable to inequitable. RESULTS: We found jurisprudence exams and provisional licensure have the best possibility of being equitable pathways to licensure, with potential impacts on the regulation of supervision and continuing education. CONCLUSION: Anti-racism and social justice as praxis require social work as a profession to divest from competency-based testing to eliminate racism in our own professional policies.

Capability of GPT-4V(ision) in the Japanese National Medical Licensing Examination: Evaluation Study.

BACKGROUND: Previous research applying large language models (LLMs) to medicine was focused on text-based information. Recently, multimodal variants of LLMs acquired the capability of recognizing images. OBJECTIVE: We aim to evaluate the image recognition capability of generative pretrained transformer (GPT)-4V, a recent multimodal LLM developed by OpenAI, in the medical field by testing how visual information affects its performance to answer questions in the 117th Japanese National Medical Licensing Examination. METHODS: We focused on 108 questions that had 1 or more images as part of a question and presented GPT-4V with the same questions under two conditions: (1) with both the question text and associated images and (2) with the question text only. We then compared the difference in accuracy between the 2 conditions using the exact McNemar test. RESULTS: Among the 108 questions with images, GPT-4V's accuracy was 68% (73/108) when presented with images and 72% (78/108) when presented without images (P=.36). For the 2 question categories, clinical and general, the accuracies with and those without images were 71% (70/98) versus 78% (76/98; P=.21) and 30% (3/10) versus 20% (2/10; P≥.99), respectively. CONCLUSIONS: The additional information from the images did not significantly improve the performance of GPT-4V in the Japanese National Medical Licensing Examination.

The effectiveness of badging systems in engaging, motivating, and incentivizing students in the mastery of nursing licensure materials.

INTRODUCTION: Integrating gamification methods into undergraduate nursing programs has prepared students to pass the nursing comprehensive predictor test and the licensure examination. LITERATURE REVIEW: Research demonstrates that the motivational factors of game elements like badging and leaderboards are of great value and utility to student engagement and motivation. The badges symbolize achievement, authority, and belonging, whereas leaderboards rank students based on different levels of course engagement. DISCUSSION: This paper explores the benefits, challenges, and strategies of incorporating digital badges and leaderboards in the undergraduate program. Immersion courses preparing students for professional practice are usually one of the last didactic courses offered in the undergraduate curriculum, designed to integrate all knowledge gained from the nursing program. IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE: The digital badging system can encourage nurse educators globally to engage, motivate, and power students to achieve professional goals. Furthermore, nursing programs worldwide can benefit from adding digital badges and leaderboards to final semester preparatory courses or any nursing course with the same emphasis. CONCLUSIONS: Digital badges and leaderboards engage and motivate students to integrate knowledge and skills learned in the nursing program and successfully master nurse licensure materials.

An exploratory study of parent acceptance of sanctions for driving offenses committed by their children.

OBJECTIVE: Graduated driver licensing (GDL) systems are effective at reducing young driver crashes but rely on active parental involvement. However, some parents may accept sanctions (e.g., demerit points, monetary fines) for traffic offenses committed by their children, leading to experiences of punishment avoidance by young drivers. This aim of this exploratory study was to investigate several demographic and psychosocial influences that could possibly be associated with parent acceptance of sanctions. METHOD: An online survey was completed by parents of young drivers (N = 149, M = 48.88 years, SD = 4.76 years; female = 86%) from 3 Australian states. The survey included measures of sociodemographic characteristics and driving history (e.g., crash involvement), socioeconomic status, parenting style, knowledge of their child's driving behavior, perceptions of their ability to manage their child's driving, attitudes toward GDL, and previous or potential acceptance of demerit points or payment of fines for road offenses committed by their child. RESULTS: Twenty-nine percent of parents had accepted or would accept a sanction on behalf of their child. Number of children overall, number of children licensed, and household income were associated with parent acceptance of a sanction. Parenting style, attitude toward GDL restrictions, parent confidence in their knowledge of GDL restrictions and ability to manage their child's driving, and belief that their child would follow rules were not associated with (non)acceptance of a sanction. CONCLUSIONS: These exploratory findings suggest that family size and income may be important influences on parent acceptance of sanctions on behalf of their offending children. The findings related to the psychosocial variables are discussed considering other research and the limitations of the study.

The violent death toll from the Iraq War: 2003-2023.

From the beginning of the Iraq war, in March of 2003, to the present day, controversy has swirled around the death toll of the war. This paper narrows down the range of uncertainty for the numbers and trends in violent deaths in the war. I assemble and appraise all primary sources that cover the period from March of 2003 onwards-six sample surveys plus a casualty recording project (Iraq Body Count [IBC]). Data permitting, I present cumulative monthly figures with, for the surveys, 95% bootstrapped uncertainty intervals. The analysis uncovers a core of high-quality mainstream sources that are highly consistent with each another. In addition, there are three outlier surveys that are compromised by serious flaws and produce estimates far outside the mainstream. Discarding the outlying and flawed surveys reveals a clear picture of the violent death toll from the Iraq war. IBC figures, extended to include combatants, occupy a central position within the mainstream range of estimates. The strong consistency across the high-quality sources provides a rare validation of three war-death-measurement methodologies-household-based surveys, sibling-based surveys, and casualty recording. Methodological success notwithstanding, we must transcend the numbers to truly comprehend the human costs of the war.

Quantitative and qualitative survey feedback of pharmacists regarding current and prospective licensure models.

BACKGROUND: Despite variation in licensure requirements and models for pharmacy practice nationwide, there is little published data within the United States regarding pharmacist perspectives. OBJECTIVES: The purpose of this study was to identify the demographics, awareness, and perceptions about current pharmacist licensure models. METHODS: A fifteen-question mixed-methods survey was created and distributed via Qualtrics-XM Survey to all Utah licensed pharmacists (n = 4154). Data collection was August 22-September 22, 2022. Before survey distribution, pilot feedback was sought from the Utah Board of Pharmacy and pharmacists at the 118th National Association of Boards of Pharmacy (NABP) national conference. Exempt status was granted by Roseman University Institutional Review Board. Quantitative and qualitative data analysis allowed for descriptive statistics and thematic content identification. RESULTS: The survey collected 972 responses for a response rate of 23% and a completion rate of 94%. Respondents self-identified 36 practice areas. Distribution of years in practice was well dispersed between the predefined ranges. Primary state of licensure was Utah (80%), with additional representation from all 50 states and Guam. The survey showed a variation in awareness regarding other healthcare professional licensing models with 40.83% "aware," 40.62% "unaware," and 18.55% "unsure". A majority showed awareness of the NABP Verify program (55.8%), but unawareness of the Electronic Licensure Transfer Program program (56.14%). Respondents agreed with increased license portability for medically underserved and rural areas (71.79%) and preference for having a law exam (56.72%). Pharmacists (n = 405) noted concerns regarding multistate renewal requirements, fees, and continuing education. CONCLUSION: This study provided baseline data on a topic that is missing in existing literature. Results illustrated a high completion rate, a diversity of demographics including well dispersed age ranges, years in practice, and qualitative responses. The quantitative data shed light on a variety of pharmacist perspectives and varied awareness about NABP licensure programs and compacts.

Have your say on Welsh government proposals.

The Welsh government is calling for perspectives on the proposed Sustainable Farming Scheme and the licensing of animal welfare establishments, activities and exhibits.

Performance of ChatGPT on Chinese national medical licensing examinations: a five-year examination evaluation study for physicians, pharmacists and nurses.

BACKGROUND: Large language models like ChatGPT have revolutionized the field of natural language processing with their capability to comprehend and generate textual content, showing great potential to play a role in medical education. This study aimed to quantitatively evaluate and comprehensively analysis the performance of ChatGPT on three types of national medical examinations in China, including National Medical Licensing Examination (NMLE), National Pharmacist Licensing Examination (NPLE), and National Nurse Licensing Examination (NNLE). METHODS: We collected questions from Chinese NMLE, NPLE and NNLE from year 2017 to 2021. In NMLE and NPLE, each exam consists of 4 units, while in NNLE, each exam consists of 2 units. The questions with figures, tables or chemical structure were manually identified and excluded by clinician. We applied direct instruction strategy via multiple prompts to force ChatGPT to generate the clear answer with the capability to distinguish between single-choice and multiple-choice questions. RESULTS: ChatGPT failed to pass the accuracy threshold of 0.6 in any of the three types of examinations over the five years. Specifically, in the NMLE, the highest recorded accuracy was 0.5467, which was attained in both 2018 and 2021. In the NPLE, the highest accuracy was 0.5599 in 2017. In the NNLE, the most impressive result was shown in 2017, with an accuracy of 0.5897, which is also the highest accuracy in our entire evaluation. ChatGPT's performance showed no significant difference in different units, but significant difference in different question types. ChatGPT performed well in a range of subject areas, including clinical epidemiology, human parasitology, and dermatology, as well as in various medical topics such as molecules, health management and prevention, diagnosis and screening. CONCLUSIONS: These results indicate ChatGPT failed the NMLE, NPLE and NNLE in China, spanning from year 2017 to 2021. but show great potential of large language models in medical education. In the future high-quality medical data will be required to improve the performance.

A comparison of licensed driver counts from the Federal Highway Administration and driver licensing agencies in 11 states.

Objective: Those who study motor vehicle crashes may rely on counts of licensed drivers to estimate crash, injury, or fatality rates. These counts may be obtained from the U.S. Department of Transportation Federal Highway Administration's (FHWA) annual Highway Statistics Series or directly from state driver licensing agencies. However, previous studies have questioned the accuracy of these counts provided by the FHWA.Methods: To investigate this issue, we compared counts of licensed drivers from the FHWA and state licensing agencies in 11 states, categorized by sex and age group, from 2013 through 2017. We then assessed the impact of any potential differences by fitting two sets of Poisson regression models to estimate age- and sex-based driver fatality rate ratios. One set of models used counts from the FHWA as the offset and the other used counts from state licensing agencies.Results: Our analysis found that the differences between FHWA and state counts varied markedly. Seven states had substantial differences for at least one age group that spanned the entire study period. In several cases, these differences in license counts were large enough to produce directly contradictory driver fatality rate ratio estimates when comparing age groups.Conclusions: These findings highlight the continued concern regarding the accuracy of licensed driver counts from the FHWA and extend previous studies by illustrating the impact of using FHWA counts on statistical inference. We recommend against using these data for traffic safety research or policy evaluation. Nevertheless, we acknowledge the need for a centralized, easily accessible database for licensed driver data.

Reporting Requirements, Confidentiality, and Legal Immunity for Physicians Who Report Medically Impaired Drivers.

Importance: Physicians play an important role in assessing patients' ability to drive. There is a dearth of peer-reviewed information on policies regarding physician reporting of medically impaired drivers. Objective: To investigate state reporting requirements and the availability of confidentiality and legal immunity for physicians who report medically impaired drivers. Design, Setting, and Participants: This cross-sectional study was conducted from November 1 to 30, 2022, in 3 rounds. First, all 50 US states' Department of Motor Vehicle (DMV) websites were systematically reviewed. Second, DMV staff from each state were surveyed via telephone. Third, each state's legal codes for driver licensing were reviewed. Main Outcomes and Measures: Outcome measures included the percentage of states with mandatory and voluntary reporting policies, reporting instructions on DMV websites, anonymous reporting options, and legal immunity for reporting physicians, in addition to characteristics of states' mandatory reporting policies (ie, types of medical conditions that require reporting) and policies surrounding the confidentiality of reports. The data were analyzed using descriptive statistics. Results: One-third of state DMV websites (17 [34%]) lacked instructions regarding physician reporting. Six states had mandatory reporting requirements; 4 of these states only required reporting of conditions characterized by lapses of consciousness. Only 3 states (6%) accepted anonymous reports, and 7 states (14%) deemed physician reports of medically impaired drivers confidential without exception. Nearly one-third of states (15 [30%]) deemed reports by physicians confidential, with the exception that reported drivers could find out who reported them if they asked for a copy of the reporting form. Most states (37 [74%]) had statutes that protected physicians from liability related to reporting medically impaired drivers. Conclusions and Relevance: This cross-sectional study of state reporting requirements regarding medically impaired drivers found many differences in state policies regarding mandatory reporting and the conditions that require reporting. There was also limited availability of online reporting instructions, anonymous reporting options, and legal protections for reporting physicians.