Best Practices for the Implementation of the REAL ID Act

The REAL ID Act specifies the minimum standards that must be used to produce and issue driver’s license and identification cards that are REAL ID compliant. Beginning in 2020, if a person does not possess a form of identification that meets REAL ID standards they will not be able to board an aircraft that is regulated by the Federal Aviation Administration. Currently, of the 56 states and jurisdictions required to implement the REAL ID Act, only 23 are in compliance. Although the Commonwealth of Kentucky has not yet implemented the REAL ID Act, an extension allowing Federal agencies to accept state driver’s licenses is currently in effect. This report summarizes the eight REAL ID requirements, discusses the results of a survey that asked compliant states about their implementation experiences, identifies different strategies for implementation, and proposes recommendations. This should begin with development of a state security plan and execution of a public information campaign about REAL ID. It is recommended that Kentucky require Division of Driver Licensing (DLL) field offices to handle REAL ID applications, offer an online renewal system, and create a centralized distribution of driver’s licenses and identification cards. Several KY Statutes will have to be amended to allow for changes in license renewal cycles, third party vendor distribution, and the resulting changes in license fees

Assessment of the learning curve in health technologies: a systematic review

Objective: We reviewed and appraised the methods by which the issue of the learning curve has been addressed during health technology assessment in the past. Method: We performed a systematic review of papers in clinical databases (BIOSIS, CINAHL, Cochrane Library, EMBASE, HealthSTAR, MEDLINE, Science Citation Index, and Social Science Citation Index) using the search term "learning curve:" Results: The clinical search retrieved 4,571 abstracts for assessment, of which 559 (12%) published articles were eligible for review. Of these, 272 were judged to have formally assessed a learning curve. The procedures assessed were minimal access (51%), other surgical (41%), and diagnostic (8%). The majority of the studies were case series (95%). Some 47% of studies addressed only individual operator performance and 52% addressed institutional performance. The data were collected prospectively in 40%, retrospectively in 26%, and the method was unclear for 31%. The statistical methods used were simple graphs (44%), splitting the data chronologically and performing a t test or chi-squared test (60%), curve fitting (12%), and other model fitting (5%). Conclusions: Learning curves are rarely considered formally in health technology assessment. Where they are, the reporting of the studies and the statistical methods used are weak. As a minimum, reporting of learning should include the number and experience of the operators and a detailed description of data collection. Improved statistical methods would enhance the assessment of health technologies that require learning

Assessing the learning curve effect in health technologies: Lessons from the non-clinical literature

Introduction: Many health technologies exhibit some form of learning effect, and this represents a barrier to rigorous assessment. It has been shown that the statistical methods used are relatively crude. Methods to describe learning curves in fields outside medicine, for example, psychology and engineering, may be better. Methods: To systematically search non–health technology assessment literature (for example, PsycLit and Econlit databases) to identify novel statistical techniques applied to learning curves. Results: The search retrieved 9,431 abstracts for assessment, of which 18 used a statistical technique for analyzing learning effects that had not previously been identified in the clinical literature. The newly identified methods were combined with those previously used in health technology assessment, and categorized into four groups of increasing complexity: a) exploratory data analysis; b) simple data analysis; c) complex data analysis; and d) generic methods. All the complex structured data techniques for analyzing learning effects were identified in the nonclinical literature, and these emphasized the importance of estimating intra- and interindividual learning effects. Conclusion: A good dividend of more sophisticated methods was obtained by searching in nonclinical fields. These methods now require formal testing on health technology data sets

Grandiose Narcissism Predicts Willingness to Behave Badly, Without Proportional Tolerance for Others’ Bad Behavior

Narcissists characteristically behave badly; our study investigated how they respond to experiencing others’ bad behavior. After completing the Narcissistic Personality Inventory, a measure of grandiose narcissism, participants reported their willingness to engage in different inconsiderate or unethical common behaviors. Then they reported how bothered they would feel in response to experiencing each of the same bad behaviors—perpetrated by someone else. Participants overall reported feeling bothered by others’ bad behavior, but narcissism was unrelated to intolerance judgments. Narcissists are often highly reactive when their inflated self-views are challenged, but our study suggests that narcissists are not uniquely bothered by everyday minor offenses. However, when viewed from a different angle, narcissists’ level of intolerance could be interpreted as unjustly high, because they reported more willingness to engage in behavior that could bother others, yet did not show proportional tolerance for others’ bothersome behavior

Commercial Driver’s License (CDL) Workflow Study

Kentucky uses federally funded, time-limited (FFTL) employees to handle some of the administrative work necessary to meet federal compliance standards for commercial driver’s licenses (CDLs). The Federal Motor Carrier Safety Administration (FMCSA) has decided not to continue funding FFTLs for these purposes, meaning that states will have to find other ways to meet CDL program requirements and maintain compliance. Given the potential ramifications of losing federal transportation and enforcement funding due to lack of compliance with federal standards, it is imperative that state lawmakers act to ensure KYTC has the resources to carry out its mandated functions. The study delineates federal and state CDL requirements, current workflow processes, surveys practices in other states, reports on the status of CDL workflow automation and develops three alternative funding mechanisms to stabilize program workflow while developers gather requirements for web-based applications to increase workflow efficiency. It also recommends other changes that would benefit KYTC, particularly the staff responsible for CDL program administration and compliance

IL-15 promotes human myogenesis and mitigates the detrimental effects of TNFα on myotube development

Studies in murine cell lines and in mouse models suggest that IL-15 promotes myogenesis and may protect against the inflammation-mediated skeletal muscle atrophy which occurs in sarcopenia and cachexia. The effects of IL-15 on human skeletal muscle growth and development remain largely uncharacterised. Myogenic cultures were isolated from the skeletal muscle of young and elderly subjects. Myoblasts were differentiated for 8 d, with or without the addition of recombinant cytokines (rIL-15, rTNFα) and an IL-15 receptor neutralising antibody. Although myotubes were 19% thinner in cultures derived from elderly subjects, rIL-15 increased the thickness of myotubes (MTT) from both age groups to a similar extent. Neutralisation of the high-affinity IL-15 receptor binding subunit, IL-15rα in elderly myotubes confirmed that autocrine concentrations of IL-15 also support myogenesis. Co-incubation of differentiating myoblasts with rIL-15 and rTNFα, limited the reduction in MTT and nuclear fusion index (NFI) associated with rTNFα stimulation alone. IL-15rα neutralisation and rTNFα decreased MTT and NFI further. This, coupled with our observation that myotubes secrete IL-15 in response to TNFα stimulation supports the notion that IL-15 serves to mitigate inflammatory skeletal muscle loss. IL-15 may be an effective therapeutic target for the attenuation of inflammation-mediated skeletal muscle atrophy

Past, present, and future old growth in frequent-fire Conifer Forests of the Western United States

Old growth in the frequent-fire conifer forests of the western United States, such as those containing ponderosa pine (Pinus ponderosa), Jeffrey pine (P. jeffreyi), giant sequoia (Sequioa giganteum) and other species, has undergone major changes since Euro-American settlement. Understanding past changes and anticipating future changes under different potential management scenarios are fundamental to developing ecologically based fuel reduction or ecological restoration treatments. Some of the many changes that have occurred in these forests include shifts from historically frequent surface fire to no fire or to stand-replacing fire regimes, increases in tree density, increased abundance of fire-intolerant trees, decreases in understory productivity, hydrological alterations, and accelerated mortality of old trees. Although these changes are widespread, the magnitude and causes of changes may vary within and among landscapes. Agents of change, such as fire exclusion or livestock grazing, likely interacted and had multiple effects. For example, historical ranching operations may have altered both fire regimes and understory vegetation, and facilitated institutional fire exclusion through fragmentation and settlement. Evidencem exists for large variation in presettlement characteristics and current condition of old growth across this broad forest region, although there are many examples of striking similarities on widely distant landscapes. Exotic species, climate change, unnatural stand-replacing wildfires, and other factors will likely continue to degrade or eradicate old growth in many areas. As a policy of fire exclusion is proving to be unsustainable, mechanical tree thinning, prescribed fire, or wildland fire use will likely be key options for forestalling continued eradication of old growth by severe crown fires. For many practical and societal reasons, the wildland–urban interface may afford some of the most immediate opportunities for re-establishing old growth typical of presettlement forests resistant to crown fires

Pathogenesis of HIV-associated sensory neuropathy: evidence from in vivo and in vitro experimental models

HIV-associated sensory neuropathy (HIV-SN) is a frequent neurological complication of HIV infection and its treatment with some antiretroviral drugs. We review the pathogenesis of the viral- and drug-induced causes of the neuropathy, and its primary symptom, pain, based on evidence from in vivo and in vitro models of HIV-SN. Viral coat proteins mediate nerve fibre damage and hypernociception through direct and indirect mechanisms. Direct interactions between viral proteins and nerve fibres dominate axonal pathology, while somal pathology is dominated by indirect mechanisms that occur secondary to virus-mediated activation of glia and macrophage infiltration into the dorsal root ganglia. The treatment-induced neuropathy and resulting hypernociception arise primarily from drug-induced mitochondrial dysfunction, but the sequence of events initiated by the mitochondrial dysfunction that leads to the nerve fibre damage and dysfunction are still unclear. Overall, the models that have been developed to study the pathogenesis of HIV-SN, and hypernociception associated with the neuropathy, are reasonable models and have provided useful insights into the pathogenesis of HIV-SN. As new models are developed they may ultimately lead to identification of therapeutic targets for the prevention or treatment of this common neurological complication of HIV infection

Effects of CO\u3csub\u3e2\u3c/sub\u3e on Growth Rate, C:N:P, and Fatty Acid Composition of Seven Marine Phytoplankton Species

Carbon dioxide (CO2) is the primary substrate for photosynthesis by the phytoplankton that form the base of the marine food web and mediate biogeochemical cycling of C and nutrient elements. Specific growth rate and elemental composition (C:N:P) were characterized for 7 cosmopolitan coastal and oceanic phytoplankton species (5 diatoms and 2 chlorophytes) using low density, nutrient-replete, semi-continuous culture experiments in which CO2 was manipulated to 4 levels ranging from post-bloom/glacial maxima (ppm) to geological maxima levels (\u3e2900 ppm). Specific growth rates at high CO2 were from 19 to 60% higher than in low CO2 treatments in 4 species and 44% lower in 1 species; there was no significant change in 2 species. Higher CO2 availability also resulted in elevated C:P and N:P molar ratios in Thalassiosira pseudonana (~60 to 90% higher), lower C:P and N:P molar ratios in 3 species (~20 to 50% lower), and no change in 3 species. Carbonate system-driven changes in growth rate did not necessarily result in changes in elemental composition, or vice versa. In a subset of 4 species for which fatty acid composition was examined, elevated CO2 did not affect the contribution of polyunsaturated fatty acids to total fatty acids significantly. These species show relatively little sensitivity between present day CO2 and predicted ocean acidification scenarios (year 2100). The results, however, demonstrate that CO2 availability at environmentally and geologically relevant scales can result in large changes in phytoplankton physiology, with potentially large feedbacks to ocean biogeochemical cycles and ecosystem structure