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Concept: License

12

Conflict can arise when bats roost in human dwellings and householders are affected adversely by their presence. In the United Kingdom, the exclusion of bats from roosts can be licensed under exceptional circumstances to alleviate conflict, but the fate of excluded bats and the impact on their survival and reproduction is not well understood. Using radio-tracking, we investigated the effects of exclusion on the soprano pipistrelle Pipistrellus pygmaeus, a species that commonly roosts in buildings in Europe. Exclusions were performed under licence at five roosts in England in spring, when females were in the early stages of pregnancy. Following exclusion, all bats found alternative roosts and colonies congregated in nearby known roosts that had been used by radio-tagged bats prior to exclusion. We found no difference in roosting behaviour before and after exclusion. Both the frequency of roost switching and the type of roosts used by bats remained unchanged. We also found no change in foraging behaviour. Bats foraged in the same areas, travelled similar distances to reach foraging areas and showed similar patterns of habitat selection before and after exclusion. Population modelling suggested that any reduction in survival following exclusion could have a negative impact on population growth, whereas a reduction in productivity would have less effect. While the number of soprano pipistrelle exclusions currently licensed each year is likely to have little effect on local populations, the cumulative impacts of licensing the destruction of large numbers of roosts may be of concern.

Concepts: Demography, Population, World population, License, Common Pipistrelle, Pipistrellus, Soprano Pipistrelle, Eastern Pipistrelle

11

Driving may increase mobility and independence for adolescents with autism without intellectual disability (autism spectrum disorder); however, little is known about rates of licensure. To compare the proportion of adolescents with and without autism spectrum disorder who acquire a learner’s permit and driver’s license, as well as the rate at which they progress through the licensing system, we conducted a retrospective cohort study of 52,172 New Jersey residents born in the years 1987-1995 who were patients of the Children’s Hospital of Philadelphia healthcare network ⩾12 years of age; 609 (1.2%) had an autism spectrum disorder diagnosis. Electronic health records were linked to New Jersey’s driver licensing database (2004-2012). Kaplan-Meier curves and log-binomial regression models were used to determine the age at and rate of licensure, and estimate adjusted risk ratios. One in three adolescents with autism spectrum disorder acquired a driver’s license versus 83.5% for other adolescents and at a median of 9.2 months later. The vast majority (89.7%) of those with autism spectrum disorder who acquired a permit and were fully eligible to get licensed acquired a license within 2 years. Results indicated that a substantial proportion of adolescents with autism spectrum disorder do get licensed and that license-related decisions are primarily made prior to acquisition of a permit instead of during the learning-to-drive process.

Concepts: Cohort study, Autism, Autism spectrum, Driver's license, Driver's education, Licensure, License, Learner's permit

6

Approaches to postgraduate medical training have evolved substantially in recent years, reflecting the complexity of the educational mission. Residency programs seek to produce clinicians who achieve board certification as an attestation of their competency. Certification criteria are established by the American Board of Medical Specialties, are consistent from state to state, and include periods of supervised instruction ranging from as few as three years (for primary care specialties) to much longer for selected disciplines. In contrast, minimum postgraduate training criteria necessary for licensure as an independent practitioner are established by state medical boards and vary significantly among and within jurisdictions. In most states, licenses can be granted to individuals who have completed as little as one year of postgraduate training. The discrepancy between the minimum time commitment necessary to become a competent physician and that to be licensed as an independent practitioner has implications for health care quality and safety. Data are lacking as to the number of licenses issued nationally to individuals who have only partially completed residency training and the nature of practices they pursue. Extrapolating from available evidence, these individuals may very well provide care inferior to those who have satisfied training requirements for certification eligibility and be more prone to problematic behavior resulting in disciplinary action. Efforts to establish more rigorous licensure criteria will require dialog between members of the academic community, professional organizations, state medical boards, and legislatures. The recently proposed Interstate Medical Licensure Compact may serve as a prototype for achieving this goal.

Concepts: Health care, Medicine, Physician, Academia, Medical school, Licensure, License, Professional certification

5

Data from clinical trials in adults, extrapolated to predict benefits in paediatric patients, could result in fewer or smaller trials being required to obtain a new drug licence for paediatrics. This article outlines the place of such extrapolation in the development of drugs for use in paediatric epilepsies. Based on consensus expert opinion, a proposal is presented for a new paradigm for the clinical development of drugs for focal epilepsies. Phase I data should continue to be collected in adults, and phase II and III trials should simultaneously recruit adults and paediatric patients aged above 2 years. Drugs would be provisionally licensed for children subject to phase IV collection of neurodevelopmental safety data in this age group. A single programme of trials would suffice to license the drug for use as either adjunctive therapy or monotherapy. Patients, clinicians and sponsors would all benefit from this new structure through cost reduction and earlier access to novel treatments. Further work is needed to elicit the views of patients, their parents and guardians as appropriate, regulatory authorities and bodies such as the National Institute for Health and Care Excellence (UK).

Concepts: Pharmacology, Clinical trial, Pharmaceutical industry, Drug discovery, Drug development, Pre-clinical development, License

4

In 2007, as part of the Massachusetts graduated driver-licensing program designed to allow junior operators (ages 16½-17 years) to gain experience before receiving full licensure, stringent penalties were introduced for violating a law prohibiting unsupervised driving at night; driver education, including drowsy driving education, became mandatory; and other new restrictions and penalties began. We evaluated the impact of these changes on police-reported vehicle crash records for one year before and five years after the law’s implementation in drivers ages 16-17, inclusive, and two comparison groups. We found that crash rates for the youngest drivers fell 18.6 percent, from 16.24 to 13.22 per 100 licensed drivers. For drivers ages 18-19 the rates fell by 6.7 percent (from 9.59 to 8.95 per 100 drivers), and for those ages 20 and older, the rate remained relatively constant. The incidence rate ratio for drivers ages 16-17 relative to those ages 20 and older decreased 19.1 percent for all crashes, 39.8 percent for crashes causing a fatal or incapacitating injury, and 28.8 percent for night crashes. Other states should consider implementing strict penalties for violating graduated driver-licensing laws, including restrictions on unsupervised night driving, to reduce the risk of sleep-related crashes in young people.

Concepts: Law, Youth, Driving, Driver's license, Driver's education, Licensure, Young, License

3

Aboriginal and Torres Strait Islander people are overrepresented in transport-related morbidity and mortality. Low rates of licensure in Aboriginal communities and households have been identified as a contributor to high rates of unlicensed driving. There is increasing recognition that Aboriginal people experience challenges and adversity in attaining a licence. This systematic review aims to identify the barriers to licence participation among Aboriginal people in Australia.

Concepts: Papua New Guinea, Driver's license, Indigenous Australians, Queensland, Torres Strait Islands, Licensure, Torres Strait Islanders, License

3

Take-home naloxone is increasingly provided to prevent heroin overdose deaths. Naloxone 0.4-2.0 mg is licensed for use by injection. Some clinicians supply improvised nasal naloxone kits (outside lisenced approval). Is this acceptable?

Concepts: Heroin, Naloxone, Clinical death, Drug overdose, License

2

Evaluations of alcohol policy changes demonstrate that restriction of trading hours of both ‘on’ and ‘off’ license venues can be an effective means of reducing rates of alcohol-related harm. Despite this, the effects of different trading hour policy options over time, accounting for different contexts and demographic characteristics, and the common co-occurrence of other harm reduction strategies in trading hour policy initiatives are difficult to estimate. The aim of this study was to use dynamic simulation modelling to compare estimated impacts over time of a range of trading hour policy options on various indicators of acute alcohol related harm.

Concepts: Alcohol, Carbon dioxide, Enzyme, Evaluation, Redox, Policy, Estimation, License

2

The Medicines Patent Pool (MPP) was established in 2010 to ensure timely access to low-cost generic versions of patented antiretroviral (ARV) medicines in low- and middle-income countries (LMICs) through the negotiation of voluntary licences with patent holders. While robust data on the savings generated by MPP and other major global public health initiatives is important, it is also difficult to quantify. In this study, we estimate the savings generated by licences negotiated by the MPP for ARV medicines to treat HIV/AIDS in LMICs for the period 2010-2028 and generate a cost-benefit ratio-based on people living with HIV (PLHIVs) in any new countries which gain access to an ARV due to MPP licences and the price differential between originator’s tiered price and generics price, within the period where that ARV is patented. We found that the direct savings generated by the MPP are estimated to be USD 2.3 billion (net present value) by 2028, representing an estimated cost-benefit ratio of 1:43, which means for every USD 1 spent on MPP, the global public health community saves USD 43. The saving of USD 2.3 billion is equivalent to more than 24 million PLHIV receiving first-line ART in LMICs for 1 year at average prices today.

Concepts: Antiretroviral drug, AIDS, Investment, Patent, Patent law, Cost-benefit analysis, License, Cross-licensing

2

Audio information plays a rather important role in the increasing digital content that is available today, resulting in a need for methodologies that automatically analyze such content: audio event recognition for home automations and surveillance systems, speech recognition, music information retrieval, multimodal analysis (e.g. audio-visual analysis of online videos for content-based recommendation), etc. This paper presents pyAudioAnalysis, an open-source Python library that provides a wide range of audio analysis procedures including: feature extraction, classification of audio signals, supervised and unsupervised segmentation and content visualization. pyAudioAnalysis is licensed under the Apache License and is available at GitHub (https://github.com/tyiannak/pyAudioAnalysis/). Here we present the theoretical background behind the wide range of the implemented methodologies, along with evaluation metrics for some of the methods. pyAudioAnalysis has been already used in several audio analysis research applications: smart-home functionalities through audio event detection, speech emotion recognition, depression classification based on audio-visual features, music segmentation, multimodal content-based movie recommendation and health applications (e.g. monitoring eating habits). The feedback provided from all these particular audio applications has led to practical enhancement of the library.

Concepts: Scientific method, Signal, Free software, Information retrieval, Operating system, Audio signal processing, License, Audio mining