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PubMed1998

Impact from changes in Illinois drivers license renewal requirements for older drivers.

In late 1989, Illinois revised the length of license term and renewal requirements for older drivers. The term was shortened from 4 to 2 years for those ages 81-86 and 1 year for those ages 87 and up. A mandatory road test which had been required at renewal for all drivers ages 69 and over, was eliminated for those ages 69 to 74. Data are available to explore the impact of these changes on crashes, fatal crashes, crash rates, and licensure rates of senior drivers. Comparisons are made between 1987-1989 averages and 1995 for three age groups: 70-74, 75-80 (the control group that had no changes in requirements), and 81 and up. It does not appear that eliminating the road test for those ages 69 to 74 had any negative impact. On the contrary, it does not appear that the more frequent renewal period for those ages 81 and up produced any benefit compared to the control group. As the number of older drivers continue to increase into the future, the analysis of licensing requirements and their impact is important.

Accidents, Traffic↗
PubMed2003

Graduated driver licensing in the United States: evaluation results from the early programs.

BACKGROUND: Seventeen states enacted graduated driver licensing (GDL) programs that were implemented from 1996 through 1999 and for which evaluations are of interest. METHODS: We received evaluation results reported for six states for which data were available. Summarizing results is difficult in other than the most global terms because of differences in pre-GDL programs, differences in GDL programs, and differences in evaluation methodology. RESULTS: All states identified some crash reduction among teen drivers following GDL implementation. This positive effect was observed across different geographic regions, and with different GDL programs. Simple counts are down-fewer teens are experiencing crashes and becoming injured. After calculating crash rates to adjust for changes over time in populations or licensed drivers, reductions generally were still found. Population-adjusted risks of injury/fatal crash involvement of 16-year-old drivers in Florida and Michigan were reduced by 11% and 24%, respectively. Population-adjusted risks of any crash involvement of 16-year-old drivers in Michigan and North Carolina were reduced by 25% and 27%, respectively. Reductions in night (restricted hours) crash risk were impressive in Florida, Michigan, and North Carolina. A comparison state design was only possible in the Florida evaluation, and results showed greater crash reductions under GDL. Change-point analyses of Michigan's crash data trends over time provided additional support of GDL's effectiveness in reducing crashes. DISCUSSION: Taken as a whole, and including the preliminary findings from California, Ohio, and Pennsylvania, these reports demonstrate the early effectiveness of GDL in reducing the crash risk of teen drivers. The impact of these studies and others to come will guide future research, practice, and policy.

Accidents, Traffic↗
PubMed2003

The provisional license: nighttime and passenger restrictions--a literature review.

PROBLEM: Due to inexperience and inadequate driving skills, the road is a very risky place for young and beginning drivers, yet such experience and skills can only be built by increased driving and exposure to risks on the road. Graduated driver licensing (GDL) allows beginning drivers to get their initial driving experience under less risky conditions and gradually eases them into more complex driving situations. This paper reviews the literature exploring two key features of the intermediate licensing phase of GDL, nighttime driving restrictions and passenger restrictions. METHOD: Literature review. RESULTS: Nighttime driving restrictions have been shown to effectively reduce the number and rate of crash involvements on the part of teenage drivers. Data suggest that having passengers in the car increases the likelihood of a fatal injury in young drivers and that this risk increases with the number of passengers. Young drivers were more likely to cause a crash when accompanied by their peers. DISCUSSION: Nighttime driving and passenger restrictions are effective in decreasing injuries among teenage drivers and their passengers, especially in the context of a full GDL system. Several research questions remain to be answered in order to fully refine and optimize the impact of these provisional measures.

Adolescent↗
PubMed2001

The driving license examination as a stress model: effects on blood picture, serum cortisol and the production of interleukins in man.

We have studied the following stress model: the tension caused by sitting for the theoretical part of the driving license examination. Volunteers were investigated twice, after their driving license examination and after a (stress-free) control session. The effects of the stress were investigated by studying the blood picture (differential counts), serum concentration of cortisol, and cytokine production in stimulated blood cells. Relationships between the subjective perception of stress and the physiological reaction were also investigated. This stress induced significant increase in the concentrations of cortisol and hemoglobin, and in the values of hematocrit and MCV, and in the lipopolysaccharide-induced release of IL-1beta and -6. The subjective feelings of irritability and wakefulness were also significantly higher after the exam. A significant relationship was found between the changes in the stimulated production of IL-1beta and irritability. The responsiveness to psychological stress might be influenced by the temporary mood of the subjects.

Adolescent↗
PubMed1999

Authorities and procedures for licensing veterinary biological products in the United States.

The licensing procedures reviewed above provide a framework for the production of pure, safe, potent, and efficacious veterinary biological products. The licensing, inspection, and testing activities of the Veterinary Biologics program provide the oversight necessary to ensure the continued availability of high-quality veterinary biological products in the United States.

Biological Products↗
PubMedDate not supplied

Licensed practical nurses in critical care areas: intensive care unit nurses' perceptions about the role.

OBJECTIVE: The purpose of this study was to determine critical care nurses' perceptions about the reintroduction of the licensed practical nurse into critical care areas. DESIGN: A qualitative research design was used, with focus groups used as the method for data collection. SETTING: A large midwestern university-affiliated medical center. SUBJECTS: Registered nurses (RNs) and licensed practical nurses (LPNs) employed in the medical center's critical care units. PROCEDURES: RNs and LPNs were interviewed separately in groups of 3 to 8 members. Open-ended questioning was used to collect information about nurses' perceptions concerning the reintroduction of the LPN role into critical care units. Data were analyzed for themes within and across groups. RESULTS: Registered nurses were unprepared for reintroduction of the role and were unsure of legal versus hospital-directed restrictions on LPN practice. LPNs were frequently placed in situations in which they assumed patient assignments outside those described in job descriptions or unit standards. CONCLUSION: When LPNs are reintroduced into critical care units, clear descriptions of roles and responsibilities are needed as is orientation of RNs to the roles of delegator and resource nurse.

Attitude of Health Personnel↗
PubMed1997

Complementary medicine: legal status of the non-licensed provider in the USA.

European providers of complementary medicine may be surprised by the formal strictures which their US counterparts face. A major hurdle to holistic practice in the USA is the statutory prohibition against the unlicensed practice of medicine. State statutes define 'medicine' broadly, creating a legal risk for unlicensed providers of holistic health care, as well as for licensed providers whose services are deemed to exceed their legislatively authorized scope of practice and cross into 'diagnosis' and 'treatment' of disease. This paper does not address scope of practice; rather, it focuses on the legal status of non-licensed (or 'unenfranchised') providers. For these providers, seeking occupational licensure will provide some protection against medical practice acts, as well as opportunity to elevate professional competence and prestige. However, many holistic providers prefer to remain outside the regulatory scheme. Mandatory licensure, title licensure and registration offer means of upgrading professional status and achieving state sanction for professional practice.

Complementary Therapies↗
PubMed2000

Using Evidence to Improve Evaluation: A Comprehensive Psychometric Assessment of a SP-Based OSCE Licensing Examination.

Background: Bridging the theory of psychometric assessment to an evaluation instrument is a challenging and continuous task. Such a task was completed for the SP-based OSCE licensing examination used in Quebec since 1990. Purpose: To review the comprehensive series of psychometric studies undertaken on the examination based on the theory of psychometric assessment. Methods: The examination is a 5.5 hour-long OSCE composed of 26 clinical cases of 7, 10 or 15 minutes' duration. Candidates' total scores and case scores are used for licensing decisions. Reliability coefficients were obtained as well as generalizability studies to assess the impact of examination sites (4), tracks (14) and languages (French and English) on candidates' results. Its content validity was assessed by experts as well as by practicing family physicians, examiners and exam coordinators. Concurrent validity was assessed. Through differential item functioning (DIF) statistical approach, possible gender biases were analyzed. The predictive validity of the examination scores on selected aspects of practice was analyzed as well as the impact of the examination on the teaching and learning process. Results: These studies confirmed the validity, reliability and generalizability of the examination scores. No biases were demonstrated. Examination scores predicted elements of practice. Educational impact was present. Conclusion: This study confirmed the quality of the examination, ensured its continuous improvement and supported the inferences made from the examination results.

Journal Article↗
PubMed1995

Purification of an MCM-containing complex as a component of the DNA replication licensing system.

Replication licensing factor (RLF) ensures that eukaryotic chromosomal DNA is replicated exactly once in each cell cycle. On exit from metaphase, RLF is activated and binds to or modifies chromatin. This modification (the 'licence') is required for subsequent DNA replication; the licence is also inactivated in the process of replication. Active RLF is not imported into the nucleus, so further DNA replication cannot occur until the DNA is relicensed by passage throught mitosis. We have developed an assay to purify RLF from Xenopus eggs. Activity resolves into two components, RLF-M and RLF-B, both of which are required for licensing. RLF-M has been purified to apparent homogeneity: it consists of three polypeptides, one of which is a Xenopus homologue of the yeast MCM3 protein. Xenopus Mcm3 associates with chomatin in G1 and is removed during replication, consistent with its being a component of the RLF system.

Adenine↗
PubMed2002

Oncogenic potential of the DNA replication licensing protein CDT1.

The expression of a gene, designated as Retroviral insertion site (Ris)2, was activated by retroviral DNA integration in an immortalized primitive erythroid cell line, EB-PE. Ris2 was also expressed at high levels in all human tumor cell lines analysed. Consistently, NIH3T3 fibroblasts overexpressing Ris2 formed tumors in Rag2 -/- mice when injected subcutaneously. The putative RIS2 protein shows a high sequence similarity to Xenopus CDT1, Drosophila DUP, and human CDT1, a newly identified DNA replication licensing protein, suggesting that Ris2 is a mouse homologue of CDT1. Cells overexpressing Ris2/Cdt1 exhibited a quicker entry into S phase when released from serum starvation compared to controls. Our results suggest that CDT1, an essential licensing protein for DNA replication, can function as an oncogene in mammals.

3T3 Cells↗
PubMed1998

Alcohol education in licensed premises using brief intervention strategies.

AIMS: The aim of this feasibility study is to present a description of a new approach based on alcohol brief intervention strategies to intervene with at-risk drinkers in licensed premises. DESIGN: The data presented are from a convenience sample of tavern patrons. SETTING: The intervention called Operation Drinksafe was conducted on 75 occasions in 67 licensed premises in an Australian rural area. PARTICIPANTS: There were 2761 voluntary participants who were provided with a personal risk assessment of their alcohol use. MEASUREMENTS: The main measurements were the Alcohol Use Disorders Identification Test (AUDIT) combined with a blood alcohol concentration (BAC) reading. FINDINGS: The median AUDIT score was 11.0, with 53% scoring in the hazardous range and 25% in the harmful range. For binge drinking, almost two-thirds (62%) of males drank six or more drinks once a week or more compared to 29% of females. Median BAC was 0.03 mg/100 ml with 11% of males above 0.10. Regression analysis revealed that significant predictors of alcohol-related injury were being aged less than 30 years, forgetting the previous night, having had another person express concern about your drinking, and binge drinking weekly or more. CONCLUSIONS: The program had high acceptance among licensees and their patrons. Patrons who are ready to change their at-risk drinking behaviour may benefit from this type of minimal intervention when presented in an interesting way in their drinking environments.

Adult↗
PubMed1993

Use of a licensed electrolyte solution as an alternative to tissue culture medium for bone marrow collection.

Bone marrow for transplantation is traditionally collected into tissue culture medium with heparin. A licensed electrolyte solution (Plasma-Lyte A [PLA]) was used as a substitute for tissue culture medium in the harvesting of 28 bone marrows, 17 autologous and 11 allogeneic, which were subsequently transplanted. Data that were analyzed from the 25 evaluable patients consisted of the numbers of cells and colony-forming units in the transplanted marrow as well as the time to neutrophil and platelet engraftment. These results were compared with those in the 30 (26 evaluable) preceding transplanted marrows that were collected into a tissue culture medium (RPMI-1640 [RPMI]). The autologous marrow transplant patients in both the PLA and RPMI groups reached a neutrophil count of > or = 0.5 x 10(9) per L a mean of 19 days following transplantation. The patients who underwent transplantation with allogeneic bone marrow collected in RPMI achieved > or = 0.5 x 10(9) per L of neutrophils an average of 20 days following transplantation, while those who received marrow collected in PLA achieved engraftment of neutrophils to that level in a mean of 21 days. Because in vitro and in vivo results with RPMI and PLA are similar in this study, further work using a licensed solution for clinical bone marrow transplantation is indicated.

Adolescent↗
PubMed2000

Complementary medicine: legal status of the non-licensed provider in the USA.

European providers of complementary medicine may be surprised by the formal structures which their US counterparts face. A major hurdle to holistic practice in the USA is the statutory prohibition against the unlicensed practice of medicine. State statutes define 'medicine' broadly, creating a legal risk for unlicensed providers of holistic healthcare, as well as for licensed providers whose services are deemed to exceed their legislatively authorized scope of practice and cross into 'diagnosis' and 'treatment' of disease. This paper does not address scope of practice; rather, it focuses on the legal status of non-licensed (or 'unenfranchised') providers. For these providers, seeking occupational licensure will provide some protection against medical practice acts, as well as opportunity to elevate professional competence and prestige. However, many holistic providers prefer to remain outside the regulatory scheme. Mandatory licensure, title licensure and registration offer means of upgrading professional status and achieving state sanction for professional practice.

Complementary Therapies↗
PubMed2001

Production processes of licensed recombinant factor VIII preparations.

The state-of-the-art treatment for hemophilia A is replacement therapy with recombinant factor VIII (rFVIII) made possible by genetic engineering advances. Currently, there are four different products licensed and available for hemophilia A patients. All are produced by recombinant mammalian cells in large-scale fermenter cultures, purified to high purity, formulated in stable formulations and freeze dried. The first-generation products Recombinate and Kogenate (also sold as Helixate by Aventis) are characterized as full-length human factor VIII molecules and formulated using human serum albumin as a stabilizer. The second-generation product ReFacto contains an improved albumin-free sucrose formulation and incorporates advanced antiviral safety procedures in the manufacturing process. It is a truncated B region-deleted form of factor VIII (FVIII) that makes use of a nonhuman peptide linker 14 amino acids in length to connect the 80 and 90 kD subunits. The most recently licensed rFVIII product is the second-generation Kogenate product called KOGENATE Bayer/Kogenate FS, which combines the advantages of the human full-length FVIII molecule with an albumin-free, sucrose-based synthetic formulation as well as an improved viral safety profile. In this article, the manufacturing processes for each of the four different products are discussed in detail, focusing on expression systems and cell lines, culture medium, technical culture systems, purification process (including viral removal potential), and final formulation.

Animals↗
PubMed2005

[Implementation of the new Federal Medical Licensing Regulations for doctors in the interdisciplinary subject "Rehabilitation, physical medicine, naturopathic treatment" by the German medical faculties].

The introduction of the new interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Treatment" based on the 9th revision of the Federal Medical Licensing Regulations (Approbationsordnung fur Arzte) implies new opportunities and challenges for teaching. In order to investigate the transfer of the new subject to teaching practise, a written questionnaire was sent to all German medical faculties. With regard to the implementation of new teaching structures and procedures in the subject, a range of different indicators was examined. 50 % of the medical faculties have been planning for comprehensive teaching sessions as compared to distribution over the whole semester. Lectures predominate with an average of more than half of the teaching time available for the subject. For examination purposes written tests are used in 83 %, compared to only 17 % Objective Structured Clinical Examinations. Considering the diversity among the medical faculties, there is room for improvement in many universities concerning more patient- and practice-oriented medical training as intended by the Federal Medical Licensing Regulations. However, in spite of increased demands, supplementary funds for additional equipment or manpower are rarely provided for. In the future, enhanced allocation of resources based on performance-related evaluation within the medical faculties and teaching competition between universities may provide significant stimuli for advances in medical training also in the new interdisciplinary subject. Further improvement of general teaching conditions is necessary in order to utilize all the opportunities offered by the new Federal Medical Regulations.

Complementary Therapies↗
PubMed2006

Progesterone blocks estrogen-induced DNA synthesis through the inhibition of replication licensing.

In the uterus, progesterone (P4) acts early in G1 as a physiological inhibitor of estradiol-17beta (E2)-induced epithelial cell proliferation. Gene expression profiling of uterine epithelial cell RNA isolated 3 h after hormonal treatment of ovariectomized mice revealed the co-coordinate down-regulation by P4 of >20 genes whose functions are associated with DNA replication. This group included all of the minichromosome maintenance (MCM) proteins that are required for DNA replication licensing. E2 regulated loading of these MCM proteins onto chromatin in parallel with its induction of DNA synthesis. E2 caused this chromatin loading by retention of MCM proteins in the nucleus and through the induction of the loading factor Cdt1, which is necessary for the MCM heterohexamer to bind to the origin of DNA replication. P4 dramatically reduced the binding of the MCMs to chromatin by a number of mechanisms. First, MCM mRNA and protein abundance was down-regulated. Second, P4 inhibited the E2 induction of Cdt1. Third, P4 treatment sequestered the normally nuclear MCM proteins into the cytoplasm. This reduced MCM binding resulted in the complete inhibition of E2-induced DNA synthesis by P4. These data reveal mechanisms not only for female sex steroid hormone action but also in the regulation of DNA replication licensing.

Animals↗
PubMed2026

A two-factor authentication mechanism licenses pilins for pilus assembly in gram-positive bacteria.

Gram-positive bacteria display virulence-associated pili that facilitate adhesion and biofilm formation. These pili are covalently polymerized by class C sortase enzymes, which selectively recognize their cognate pilin substrates amid numerous cell wall sorting signal (CWSS)-bearing proteins. The molecular basis for this stringent substrate specificity has remained unclear. Here, we develop a rapid, quantitative fluorescence-activated cell sorting assay to monitor pilus assembly in Corynebacterium diphtheriae, enabling high-throughput analysis of SpaA pilin and SrtA sortase variants. Using this platform, together with molecular modeling and dynamics simulations, we show that SrtA engages nearly the entire SpaA CWSS to form a membrane-embedded complex that incorporates not only the LPXTG motif but also its connector and transmembrane helix elements. Formation of this interface displaces an inhibitory active-site lid and activates the enzyme to load the pilin substrate. Systematic CWSS swapping experiments and deep mutational scanning further support this model, demonstrating that noncognate pilins are excluded because they fail to form the required interface. Conversely, SrtA variants with an artificially unlatched lid bypass the need for this interface, indicating that membrane-driven complex formation is important for substrate licensing. Together, these findings define a "two-factor authentication" mechanism for pilus assembly in gram-positive bacteria: class C sortases first verify pilin identity by forming a membrane-embedded interface that activates the enzyme, then they recognize the LPXTG motif to initiate loading and crosslinking. This work provides a unified molecular framework for selective pilin incorporation in gram-positive bacteria and identifies potential vulnerabilities in the licensing machinery that may be exploited therapeutically.

Fimbriae, Bacterial↗
PubMed2004

Proteolysis of DNA replication licensing factor Cdt1 in S-phase is performed independently of geminin through its N-terminal region.

Licensing of replication origins is carefully regulated in a cell cycle to maintain genome integrity. Using an in vivo ubiquitination assay and temperature-sensitive cell lines we demonstrate that Cdt1 in mammalian cells is degraded through ubiquitin-dependent proteolysis in S-phase. siRNA experiments for Geminin indicate that Cdt1 is degraded in the absence of Geminin. The N terminus of Cdt1 is required for its nuclear localization, associates with cyclin A, but is dispensable for the association of Cdt1 with Geminin in cells. This region is responsible for proteolysis of Cdt1 in S-phase. On the other hand, the N terminus-truncated Cdt1 is stable in S-phase, and associates with the licensing inhibitor, Geminin. High level expression of this form of Cdt1 brings about cells having higher DNA content. Proteasome inhibitors stabilize Cdt1 in S-phase, and the protein is detected in the nucleus in a complex with Geminin. This form of Cdt1 associates with chromatin as tightly as that of G1-cells, when no Geminin is detected. Our data show that proteolysis and Geminin binding independently inactivate Cdt1 after the onset of S-phase to prevent re-replication.

Animals↗