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PubMed1978

Career choice and performance on state licensing examinations of "Fifth Pathway" students.

Between 1975 and 1977, 340 American citizens trained in foreign medical schools (mostly Mexican) completed a year of supervised clinical training (Fifth Pathway) in New York State before beginning residency training. Analysis of 335 such students revealed a greater tendency to remain in the State for residency training as compared to graduates of New York State medical schools (P less than 0.01). A primary-care specialty was chosen by these students significantly less often than be American graduates (P less than 0.001). Their pass rate on state licensing examinations, although higher than that of other foreign-trained medical graduates, was significantly lower than that of American-trained students (P less than 0.001). Fifth Pathway programs can provide a source of United States-citizen house officers for hospitals currently staffed mainly by alien physicians. Such programs offer foreign-trained United States physicians an opportunity to improve their clinical skills before starting residencies, but evidently do not fully overcome their educational deficits.

Career Choice↗
PubMed2006

Evidence for licensing of IFN-gamma-induced IFN regulatory factor 1 transcription factor by MyD88 in Toll-like receptor-dependent gene induction program.

The recognition of microbial components by Toll-like receptors (TLRs) initiates signal transduction pathways, which trigger the expression of a series of target genes. It has been reported that TLR signaling is enhanced by cytokines such as IFN-gamma, but the mechanisms underlying this enhancement remain unclear. The MyD88 adaptor, which is essential for signaling by many TLRs, recruits members of the IFN regulatory factor (IRF) family of transcription factors, such as IRF5 and IRF7, to evoke the activation of TLR target genes. In this study we demonstrate that IRF1, which is induced by IFN-gamma, also interacts with and is activated by MyD88 upon TLR activation. We provide evidence that MyD88-associated IRF1 migrates into the nucleus more efficiently than non-MyD88-associated IRF1 and that this IRF1 selectively participates in the TLR-dependent gene induction program. The critical role of MyD88-dependent "IRF1 licensing" is underscored by the observation that the induction of a specific gene subset downstream of the TLR-MyD88 pathway, such as IFN-beta, inducible NO synthase, and IL-12p35, are impaired in Irf1-deficient cells. Thus, our present study places IRF1 as an additional member participating in MyD88 signaling and provides a mechanistic insight into the enhancement of the TLR-dependent gene induction program by IFN-gamma.

Animals↗
PubMed2000

Sequential MCM/P1 subcomplex assembly is required to form a heterohexamer with replication licensing activity.

Replication licensing factor (RLF) is a multiprotein complex involved in ensuring that chromosomal DNA replicates only once in a single cell cycle. It comprises two components, termed RLF-M and RLF-B. Purified RLF-M consists of a mixture of complexes containing all six members of the MCM/P1 family of minichromosome maintenance proteins. The precise composition of these different complexes and their contribution to RLF-M activity has been unclear. Here we show that in Xenopus extracts, MCM/P1 proteins mainly form heterohexamers containing each of the six proteins. This heterohexamer is readily split into subcomplexes, whose interactions and subunit composition we characterize in detail. We show for the first time an ordered multistep assembly pathway by which the heterohexamer can be reformed from the subcomplexes. Importantly, this novel pathway is essential for DNA replication, since only the full heterohexamer can bind productively to chromatin and provide RLF-M activity.

Biopolymers↗
PubMed2004

Making licensed venues safer for patrons: what environmental factors should be the focus of interventions?

The Queensland Safety Action Projects operationalized a problem-focused responsive regulatory model in order to make nightclubs and other venues safer. A problem-focused approach requires a careful analysis of the total environment of licensed venues, including drinking and its controls but also the social and physical environments, patron mix and management practices. We present new analyses of observational data collected in 1994 and 1996 in the north Queensland cities of Cairns, Townsville and Mackay. Major reductions in aggression and violence were observed, as well as improvements in many aspects of the venue environment and management practices. We do not argue in this paper that the interventions caused the environmental and management changes, although we believe this to be true. Rather, our assumption is that whatever caused them, some of the environmental and management changes were critical to the reductions in aggression. Regression techniques were used to identify those factors that best explained the declines in aggression. For reduced physical violence four key predictors were identified: improved comfort, availability of public transport, less overt sexual activity and fewer highly drunk men. For reduced non-physical aggression, four key predictors were: fewer Pacific Islander patrons, less male swearing, fewer intoxicated patrons requiring that management be called and more chairs with armrests. The analyses are consistent with the argument that the control of drinking is necessary but not sufficient to reduce aggression and violence.

Australia↗
PubMed1993

The crime cocktail: licensed premises, alcohol and street offences.

There is widespread acknowledgment for a connection between alcohol consumption and crime, but the extent of the connection and its implications continue to promote debate. Previous research has concentrated on assessment of alcohol involvement of offenders following arrest. Not all incidents coming to the notice of police result in an arrest. Arrest-centred alcohol involvement research is limited as arrest is not the most common outcome of police attendance.This study utilized an incident survey card to allow operational police officers to record their assessment of alcohol involvement for all incidents, not just arrests. Police were given clear guidelines to assist in their assessment of alcohol involvement. The survey was conducted over a 4-week period in six metropolitan Sydney Police Patrols. Levels of alcohol involvement were very high, with 77% of street offence incidents (assault, offensive behaviour and offensive language) found to be alcohol-related. Also identified was the high proportion of offences occurring in or near licensed premises. Sixty per cent of all alcohol-related street offences were included in this category. Other offences which also received a high alcohol involvement assessment were malicious damage (58%), domestic violence (40%) and noise complaints (59%). Drink driving offences were, by definition, 100% alcohol-related.

Journal Article↗
PubMedDate not supplied

Evaluating the evaluators: interrater reliability on EMT licensing examinations.

INTRODUCTION: Current methods of evaluating the technical competence of Michigan emergency medical technician (EMT) licensure candidates are subjective and potentially unreliable. Evaluators are required to attend a workshop before evaluating practical examination candidates. Despite the workshop, there is too much score variation and not enough observational consistency on the standardized examination. OBJECTIVE: To determine the level of rater reliability for evaluators of EMT practical examinations. METHODS: Data were collected from 104 licensed instructor-coordinators (ICs). Participants watched and scored two practical examinations simulated on videotape, one passing and one failing performance. Variation in student score and level of evaluator agreement concerning skill performance were determined. Michigan's basic EMT practical examination scoring instrument was used. RESULTS: Nine basic EMT, 9 EMT specialist, and 86 EMT-paramedic ICs participated. Thirty-four percent had high school diplomas, 43% associate's degrees, 19% bachelor's degrees, 3% master's degrees, and 1% a doctoral degree. The ICs averaged 14 years of provider experience, and 6.35 years as an IC. The average score for scenario 1 (passing) was 86.4% (SD = 9.15, range = 53). An 80% score is required to pass. Nine ICs (9%) failed the student. Scenario 1 evaluator agreement was 79.4%. The average score for scenario 2 (failing) was 60.9% (SD = 11.57, range = 57). Seventeen ICs (18%) gave the student a passing score. Scenario 2 evaluator agreement was 67.8%. There was no significant difference in student scores based on evaluator level of education, licensure, or evaluator workshop attendance for either scenario. CONCLUSION: Notable variation in scores given by evaluators for a single observed student, combined with low levels of evaluator agreement about skill performance, suggests that evaluators do not reliably rate student performance using the Michigan practical examination instrument.

Educational Measurement↗
PubMed2006

The role of driver education in the licensing process in Quebec.

PROBLEM: In many jurisdictions, driver education (DE) graduates, compared to non-graduates, are granted a time-discount that allows them to drive unsupervised several months earlier, despite little evidence of a safety benefit and consistent evidence of increased crash risk. Confounding factors may be threatening the validity of DE evaluations. A theoretical framework called the "licensing process" (LP) is proposed to identify and explore potential confounding factors in DE evaluations. METHOD: Prospective study data on a cohort of 1804 novice drivers 16 to 19 years of age of both sexes are analyzed in relation to the LP framework. These data derive from two sources that were linked together: an extensive questionnaire on learning methods, risk-taking, and lifestyles, and government records on exam performance, violations, and crashes. RESULTS: Violation and crash records are not associated with DE attendance. DE attendance is associated with younger ages, greater financial support from family, and fewer hours of supervised driving practice with a learner's permit. For both sexes, more hours of supervised driving practice with a learner's permit is associated with increased crash risk. Most participants, particularly males under 19 years of age, attended DE partly or entirely to save time or money; these motivations are associated with higher violation and crash rates. DISCUSSION: DE evaluations need to identify and control for potential confounding factors. Research is needed to understand the associations between increased crash risk and potential confounding factors like motivation to attend DE and hours of supervised driving practice.

Accidents, Traffic↗
PubMed1997

Cell cycle regulation of the replication licensing system: involvement of a Cdk-dependent inhibitor.

The replication licensing factor (RLF) is an essential initiation factor that is involved in preventing re-replication of chromosomal DNA in a single cell cycle. In Xenopus egg extracts, it can be separated into two components: RLF-M, a complex of MCM/P1 polypeptides, and RLF-B, which is currently unpurified. In this paper we investigate variations in RLF activity throughout the cell cycle. Total RLF activity is low in metaphase, due to a lack of RLF-B activity and the presence of an RLF inhibitor. RLF-B is rapidly activated on exit from metaphase, and then declines during interphase. The RLF inhibitor present in metaphase extracts is dependent on the activity of cyclin-dependent kinases (Cdks). Affinity depletion of Cdks from metaphase extracts removed the RLF inhibitor, while Cdc2/cyclin B directly inhibited RLF activity. In metaphase extracts treated with the protein kinase inhibitor 6-dimethylaminopurine (6-DMAP), both cyclin B and the RLF inhibitor were stabilized although the extracts morphologically entered interphase. These results are consistent with studies in other organisms that invoke a key role for Cdks in preventing re-replication of DNA in a single cell cycle.

Adenine↗
PubMed2006

Vanin-1 licenses inflammatory mediator production by gut epithelial cells and controls colitis by antagonizing peroxisome proliferator-activated receptor gamma activity.

Colitis involves immune cell-mediated tissue injuries, but the contribution of epithelial cells remains largely unclear. Vanin-1 is an epithelial ectoenzyme with a pantetheinase activity that provides cysteamine/cystamine to tissue. Using the 2,4,6-trinitrobenzene sulfonic acid (TNBS)-colitis model we show here that Vanin-1 deficiency protects from colitis. This protection is reversible by administration of cystamine or bisphenol A diglycidyl ether, a peroxisome proliferator-activated receptor (PPAR)gamma antagonist. We further demonstrate that Vanin-1, by antagonizing PPARgamma, licenses the production of inflammatory mediators by intestinal epithelial cells. We propose that Vanin-1 is an epithelial sensor of stress that exerts a dominant control over innate immune responses in tissue. Thus, the Vanin-1/pantetheinase activity might be a new target for therapeutic intervention in inflammatory bowel disease.

Active Transport, Cell Nucleus↗
PubMed2005

Strategy of following voriconazole versus amphotericin B therapy with other licensed antifungal therapy for primary treatment of invasive aspergillosis: impact of other therapies on outcome.

BACKGROUND: In a previous randomized trial of voriconazole versus amphotericin B deoxycholate for primary therapy of invasive aspergillosis, voriconazole demonstrated superior efficacy and better survival. In that trial, treatment with voriconazole or amphotericin B deoxycholate could be followed with other licensed antifungal therapies (OLAT). Here, we report the impact of OLAT on the outcome of patients with invasive aspergillosis. METHODS: Data on dose, duration, and the reason for switching to the first OLAT were analyzed, and outcome at week 12 was assessed. RESULTS: Fewer patients in the voriconazole group (52 [36%] of 144) switched to OLAT, compared with patients in the amphotericin B deoxycholate group (107 [80%] of 133). Lipid formulations of amphotericin B were the most common OLAT (38% of patients). Switches were made because of intolerance or insufficient response in 70% for patients in the amphotericin B deoxycholate group, compared with 24% of patients in the voriconazole group. Favorable responses to OLAT in the amphotericin B deoxycholate group occurred in only 19% of patients with initial insufficient response and 38% of patients with intolerance. Salvage therapy with a lipid formulation of amphotericin B after initial treatment with amphotericin B deoxycholate was successful for only 30% of patients (14 of 47). Treatment success among patients randomized to receive amphotericin B, including those whose treatment was switched to OLAT, was 32%, compared with 55% among patients who received voriconazole alone (P<.001). CONCLUSIONS: This study highlights the limited efficacy of salvage antifungal therapy, including therapy with lipid formulations of amphotericin B, and demonstrates the importance of effective initial therapy in invasive aspergillosis.

Amphotericin B↗
PubMed2006

RADCONTAB 1.0: a look-up tables tool for radiological assessment of contaminated land on Nuclear Licensed sites.

This note describes a simple electronic spreadsheet 'look-up tables' tool (RADCONTAB version 1.0), developed by British Nuclear Fuels plc (BNFL) to facilitate the radiological assessment of land affected by existing 'historic' radioactive contamination on UK Nuclear Licensed sites. The specification and design of the tool have been subject to open consultation and peer review. The tool with accompanying guide is now freely available on the internet.

Environmental Exposure↗
PubMed1997

Nutrition coverage on medical licensing examinations in the United States.

The 1985 National Academy of Sciences report Nutrition Education in US Medical Schools recommended that the National Board of Medical Examiners (NBME), who develops the US Medical Licensing Examination (USMLE), cover basic nutrition knowledge. According to the NBME, the USMLE includes nutrition on their Step 1 and 2 exams; however, this coverage has been questioned. To document whether the NBME adequately addresses nutrition, the 1986 Part I and Part II and the 1993 Step 1 and step 2 exams, which replaced the Part I and II exams, were reviewed by five nutrition professionals. This review identified the nutrition-related areas of the two-part exams and how the extent of nutrition coverage changed from 1986 to 1993. Nutrition items were coded on four dimensions: 1) specific nutrition-related topic area, 2) normal or abnormal scenario, 3) related organ system, and 4) importance in clinical medicine. The percentage of nutrition-related items, as identified by the nutrition professionals, increased from 9% on the 1986 Part I exam to 11% on the 1993 Step 1 exam and from 6% on the 1986 Part II exam to 12% on the 1993 Step 2 exam. The percentage of nutrition items related to vitamin deficiencies increased from 1986 to 1993 on both halves of the exam. Nutrition coverage on the USMLE Step 1 and Step 2 seems adequate in amount, however, the content and appropriateness of the items were not evaluated. The observed increased focus on vitamin deficiencies should be further considered.

Education, Medical, Undergraduate↗
PubMed1975

Evaluation of hepatitis B antigen testing in federally licensed blood banks in the United States.

Between August 1972 and January 1974, the Burear of Biologics distributed four panels of 20 coded serum samples to all federally licensed blood banks for hepatitis B antigen testing. Initially, all but six blood banks reported results by counterelectrophoresis (CEP) only, but by January 1974, 152 of 247 banks reported results by radioimmunoassay (RIA). On the four panels distributed, correct results were reported for 63 to 83% of all potentially detectable samples by CEP and for 98 to 100% of all samples potentially detectable by RIA. Perfect scores were obtained by only 5 to 25% of blood banks using CEP but by 77 to 100% using RIA. Nonreproducible results on duplicate reactive samples, included to evaluate internal consistency, ranged from 0.5 to 25% by CEP and from zero to 5% by RIA. These results demonstrate greater reliability in addition to greater sensitivity of "third generation" RIA testing in comparison with "second generation" CEP testing.

Blood Banks↗
PubMedDate not supplied

Alcohol licensing laws: proposals for changes in Scottish law.

Scotland, England and Wales, and Ireland have each recently reviewed how licensing laws might influence the increasing levels of alcohol-related problems in each of these countries. Each legislature has arrived at somewhat different recommendations. Scotland may move towards liberalization, albeit within firm guidelines. It is unknown whether emphasis on local review, server training and some restrictions on bar venues offering discount pricing, will be sufficient to alter current trends in alcohol-related problems.

Alcohol Drinking↗
PubMedDate not supplied

Licensed vaccines.

The cell substrate, virus strain, route of administration, and safety of the rubella vaccines were all considered given the experience with other vaccines. Tissues from closed colonies of ducks, rabbits, and quails-in addition to human diploid cells-are now well established as suitable substrates. Production of rubella vaccine is now based on the principle that the vaccine virus is a live attenuated strain. RA27/3, Cendehill, Takahashi, Matsuura, and HPV-77 were initially licensed in 1969-1970; HPV-77 grown in dog kidney cells has since been withdrawn. The subcutaneous route of administration is the most acceptable. Safe and effective vaccines include RA27/3 and Cendehill, which are widely available, and five other vaccines grown in two tissues available only in Japan. The key issue is the extent to which the vaccines should be used alone or together with other vaccines in individual countries. The World Health Organization's requirements for the vaccines, first formulated in 1976, are open to revision. These requirements did not include a test for stability, which will be especially pertinent in the developing world.

Adult↗
PubMed2001

Accuracy and bias of licensed practical nurse and nursing assistant ratings of nursing home residents' pain.

BACKGROUND: This study evaluated the accuracy of licensed practical nurses' (LPN) and nursing assistants' (NA) Minimum Data Set (MDS) pain ratings of nursing home residents and evaluated the bias in pain ratings associated with residents' race, gender, mental status, function, depression, or disruptive behavior. METHODS: Data were obtained on the same day directly from residents, LPNs, and NAs by trained interviewers in two safety-net nursing homes. A total of 252 residents were included in this study: 79% were Black, and 60% were men. MDS items J2a and J2b evaluated pain frequency and pain intensity during the last 7 days (weekly pain frequency and weekly pain intensity). A parallel question evaluated pain intensity on the day of the interview (daily pain intensity). MDS data were obtained for the MDS Cognition Scale, the MDS Activities of Daily Living-Long Form Scale, the MDS Depression Rating Scale, and the MDS Disruptive Behavior Scale. RESULTS: Kappa coefficients documented fair to good resident-LPN (K =.70,.56, and.50) and resident-NA (K =.72,.58, and.60) agreement for weekly pain frequency, weekly pain intensity, and daily pain intensity ratings. LPNs and NAs underestimated residents' weekly pain frequency (p <.001 for LPNs, and p <.001 for NAs), weekly pain intensity (p <.001 for LPNs, and p <.001 for NAs), and daily pain intensity (p <.001 for LPNs, and p =.002 for NAs). LPNs underestimated weekly and daily pain intensity more than NAs did (p =.016 for weekly pain intensity, and p =.035 for daily pain intensity). LPN and NA pain ratings were not biased by resident race, gender, mental status, function, depression, or disruptive behavior. CONCLUSIONS: Results documented that (i) LPNs and NAs underestimated residents' pain frequency and pain intensity, (ii) NAs were more accurate than LPNs for pain intensity, and (iii) resident characteristics did not bias LPN or NA pain ratings.

Activities of Daily Living↗
PubMed2006

Effect of staff turnover on staffing: A closer look at registered nurses, licensed vocational nurses, and certified nursing assistants.

PURPOSE: We examined the effects of facility and market-level characteristics on staffing levels and turnover rates for direct care staff, and we examined the effect of staff turnover on staffing levels. DESIGN AND METHODS: We analyzed cross-sectional data from 1,014 Texas nursing homes. Data were from the 2002 Texas Nursing Facility Medicaid Cost Report and the Area Resource File for 2003. After examining factors associated with staff turnover, we tested the significance and impact of staff turnover on staffing levels for registered nurses (RNs), licensed vocational nurses (LVNs) and certified nursing assistants (CNAs). RESULTS: All three staff types showed strong dependency on resources, such as reimbursement rates and facility payor mix. The ratio of contracted to employed nursing staff as well as RN turnover increased LVN turnover rates. CNA turnover was reduced by higher administrative expenditures and higher CNA wages. Turnover rates significantly reduced staffing levels for RNs and CNAs. LVN staffing levels were not affected by LVN turnover but were influenced by market factors such as availability of LVNs in the county and women in the labor force. IMPLICATIONS: Staffing levels are not always associated with staff turnover. We conclude that staff turnover is a predictor of RN and CNA staffing levels but that LVN staffing levels are associated with market factors rather than turnover. Therefore, it is important to focus on management initiatives that help reduce CNA and RN turnover and ultimately result in higher nurse staffing levels in nursing homes.

Cross-Sectional Studies↗
PubMed2000

Oocyte and semen donation: a survey of UK licensed centres.

In view of the difficulties encountered by licensed clinics in the recruitment of oocyte and semen donors, the present survey was commissioned by the National Gamete Donation Trust (NGDT) to provide systematic information on current practice as a basis for planning future recruitment strategies. Sixty-four clinics agreed to participate in the survey, of which 55 recruited oocyte donors, 30 recruited semen donors, and 24 recruited both oocyte and semen donors. Almost all of the clinics had experienced difficulty in obtaining a sufficient supply of donated oocytes, and many patients requiring treatment with donated oocytes were placed on a waiting list for more than one year. Three-quarters of potential donors changed their mind about donating after receiving information on the procedures involved. The difficulties in recruiting semen donors were generally less acute. In this case, the greatest problem was the high proportion of potential semen donors who were deemed unsuitable after completing the screening process. Clinics also reported a shortage of both oocyte and semen donors from specific ethnic groups.

Data Collection↗