University of Maine School of Law

To explore the safety and effectiveness of using two preventive calcitonin gene-related peptide (CGRP) antagonists in patients with chronic migraine. Although the literature supports concurrent use of CGRP antagonists for acute and preventive treatment of chronic migraine, it is unknown whether two concurrent preventive CGRP agents are safe and effective. Adults with chronic migraine who were prescribed two preventive CGRP antagonists, one monoclonal antibody (e.g., eptinezumab, erenumab, fremanezumab, galcanezumab) and one oral agent (gepant) (e.g., atogepant, rimegepant) were included in this retrospective cohort study. Patients served as their own controls in a pre-post analysis completed at the University of Vermont Health Network, including data from January 1, 2020 through December 31, 2024. Demographic, clinical, and medication data were recorded at baseline (immediately prior to the addition of a second CGRP antagonist) and after a minimum of 3 months of dual therapy. The primary outcome was the change in patient-reported headache in days per month. Secondary outcomes included changes in severe headache or migraine in days per month, adverse events, and the rate and reasons for discontinuation of dual preventive therapy. Of the 37 patients who were included, the average age was 54 years, and the population was primarily female (86%), White (94%), and commercially insured (57%). There was a significant decrease in headache days (median = 0; interquartile range = -5 to 0; p = 0.031) while on two CGRP antagonists, including 8 patients (22%) who achieved at least a 50% reduction in reported headache days. There was also a significant reduction in severe headache or migraine days (median = -2; interquartile range = -6 to 0; p < 0.001). There was no significant increase in adverse events with two CGRP antagonists (p = 0.219 sign test, p = 0.103 McNemar test). However, a single case of ischemic stroke was reported in a patient with multiple risk factors. Half of all patients (19, 51%) discontinued at least one CGRP antagonist by the end of the study period, primarily due to insurance restrictions or lack of perceived benefit. No patients discontinued due to reported side effects. Trialing two preventive CGRP antagonists may be an effective approach for some patients with chronic migraine who have exhausted other preventive treatment options, with some patients in this study experiencing a significant reduction in headache frequency and severity. Prospective studies with larger, more diverse populations should be completed to confirm these findings and investigate any potential stroke risks.

Abstract Psychological and psychoeducational evaluation reports are often criticized for being too long and difficult to understand. Nonetheless, these reports inform, and are often required for, high‐stakes educational decisions. Very little prior research has documented whether general and special educators read the entirety of such reports. This study utilized a survey of 349 general and special education teachers and administrators to learn about their report reading habits and preferences. About one‐third of participants indicated that they typically read the entire report. In cases where selected sections were read, the recommendations and summary were the most common. A majority of participants indicated a preference for shorter reports, bullet points, and visual summaries. Together the findings suggest that certain report characteristics are more useful to educators than others. Implications for reporting practices and future research are discussed.

This paper was originally written for the Second Invitational Conference on Professionalism in Tax Practice, which was scheduled to be held in Washington in January 1996 under the sponsorship of the American Bar Association Section of Taxation, the American College of Tax Counsel, the American Institute of Certified Public Accountants, the National Association of Enrolled Agents, the National Association of Tax Practitioners, the National Society of Public Accountants, and the Tax Executives Institute. The Conference was postponed because of the Blizzard of 1996.Copyright © 1996 by Michael B. Lang.Our income tax system requires that taxpayers report their income annually and assess the correct amount of tax on this income. This selfassessment system, however, depends on taxpayers ferreting out the provisions of the tax law that apply to them and properly applying those provisions to their factual situations. The immensity and complexity of the tax law and the difficulty of applying even apparently clear legal provisions to complex sets of facts (the most difficult lesson in law school for the typical law student) make this process impossible for many taxpayers. As a result, they turn to tax professionals for assistance in preparing tax returns.These professionals generally fall into one or more of four groups: (1) lawyers licensed to practice law in at least one state or the District of Columbia (licensed lawyers); (2) certified public accountants (CPAs); (3) those admitted to practice before the IRS under the provisions of Circular 230; and (4) "income tax return preparers," as defined in section 7701 (a)(36 (return preparers). Professionals in each category are subject to their own set of practice standards. Many professionals in the tax field are members of more than one group and thus subject to multiple sets of standards. For example, licensed lawyers or CPAs may be subject to their respective state regulatory authorities, Circular 230 (because they are admitted to practice before the IRS), and the statutory provisions affecting return preparers.Once the taxpayer seeks the help of a professional, several difficulties inevitably mar the return preparation process. First, although the professional should be more skilled at finding the tax law relevant to the taxpayer's situation, the professional's knowledge of the facts underlying the taxpayer's tax situation depends entirely on the information known to and conveyed by the taxpayer. The way in which the professional inquires about the facts may influence how the facts are reported by the taxpayer. Hence, the taxpayer's response is a function of the professional's inquiry. Furthermore, the taxpayer may deliberately slant the facts in the hope of reducing her tax, or simply fail to report all of the relevant facts because of misunderstanding, misperception, forgetfulness, or the like. These considerations raise the prospect that a return prepared by even the most assiduous professional may be less accurate than what a well-informed, well-intentioned taxpayer might have prepared independently.