WASHINGTON — DC Metrorail instructors did not provide key lessons during training and certified at least one operator who wasn’t tested on crucial safety functions, according to a report from the independent agency that oversees Metrorail safety.

The Washington Post reports the information was presented at a Tuesday meeting of the Washington Metrorail Safety Commission and raised new concerns about Metrorail certification, after a major controversy last year when it was discovered about half of the agency’s rail operators were not properly certified.

Meanwhile, WTOP Radio reports the safety commission released new details about a December 2022 incident in which a operator was arrested for running a train while intoxicated, saying he had been at the controls of the train for hours.

The latest training issue was revealed after a Feb. 9 incident when an operator moved a train against the flow of rail traffic while a report of smoke was being investigated, without permission from Metro’s Rail Operations Control Center and without use of a system to prevent collisions. During investigation of that incident, inspectors discovered the operator had been certified despite not receiving required retraining after failing a test, instead retaking the test the same day. The testing also did not cover how to operate the train ventilation system, which would be important during a fire.

Metrorail training came under scrutiny in May of last eary when it was discovered nearly half the system’s train operators had not received required recertification training, leading more than 72 operators to be removed from service and triggering service delays [see “DC Metrorail removes operators from service …,” Trains News Wire, May 17, 2022]. That failure led to the resignation of Washington Metropolitan Area Transit Authority General Manager Paul J. Wiedefeld and Chief Operating Officer Joseph Leader [see “Top DC Metro officials resign …,” News Wire, May 18, 2022].

Safety Commission member Richard Lauby made it clear he considered the new problems unacceptable, the Post reported, saying, ““After the history of problems with certification, I would expect that this would be one area that they would get right, and apparently they’re still not paying attention — proper attention — to this.”

Supervisor did not react to operator’s erratic performance

The Dec. 23, 2022 incident with the intoxicated operator [see “DC metrorail operator arrested …,” News Wire, Jan 5, 2023] began with the individual arriving about 2½ hours late for the second part of a split shift. A supervisor was on board as the operator began his first run about 20 minutes after arriving and did not take any action even though the operator stopped short of the platform at several stations.

After about an hour, the operator briefly went inside a break room at the Downtown Largo station; a review of security video shows him “displaying signs of impairment … swaying and not walking in a straight line,” Natalie Quiroz, a safety commission investigations analyst, told Tuesday’s meeting. In time, the operator’s performance became more erratic, to the point where the train stopped between two stations for 40 minutes and the operator did not respond to radio communications.

With stranded passengers calling 911 and another train instructed to find out what was happening, the operator finally stirred and brought the train into the next station, Franconia Springfield, where transit police and other Metro personnel stopped him before he could depart again. He was arrested, recorded a .081 blood alcohol level in a subsequent breath test, and was later fired.

Metrorail has subsequently introduced a procedure to determine employees’ fitness for duty when they arrive for the second half of a split shift.

Faced with alarming teacher shortages, Virginia last month agreed to partner with a for-profit online teacher credentialing company, hoping to get more teachers into classrooms faster and without the higher tuition costs of traditional colleges and universities.

While some of the Virginia school board members had qualms about the process, they agreed to supply it a try due to the nagging high teacher vacancy rate. The board unanimously approved a three-year pilot program and partnered with one of the bigger companies in the fast-track credentialing business, iteach.

Such companies pledge they will get a candidate teacher-ready in about a year. The iteach program includes online courses, after which candidates are placed in classrooms, with some supervision and the agreement of the school districts.

According to state statistics, Virginia had more than 3,500 full-time teacher vacancies for the 2022-2023 school year, which is about a 4.5% rate, though vacancies in some specialties are higher. The situation was worse than the year before, the statistics showed.

Daniel Gecker, a then-member of the state board of education who voted for the online certification plan, said he agreed only because the program is a three-year pilot and an “opportunity to gather data.”

Whitmer signs legislation aimed at recruiting, retaining Michigan teachers and counselors

“We are in the middle of a fairly significant teacher shortage,” Gecker said in an interview. “Having the online-trained teachers is better than having the untrained subs we’ve been having.”

He said that before the COVID-19 pandemic, it probably would have been possible to make up the teacher gap with better retention. “Post-pandemic, the gulf is just too wide; we can’t fill it with better retention and people coming out of school.”

Virginia is just the latest state to turn to for-profit teacher certification companies in an urgent effort to recruit and train more teachers. The states hope the new paths to certification will help ease the shortages, but critics argue those who take the programs are not as well trained as traditionally credentialed teachers and will do a disservice to young students.

States have other options to address the teacher shortage, including lowering standards to try to bring in more recruits.

Education Week reported last year that about a dozen states had relaxed credentialing standards for teachers or were considering doing so. California lawmakers decided in 2021 to allow aspiring teachers to eliminate two different exams as long as they had taken courses to address basic skills and the subject matter they intend to teach. Oklahoma enacted a law last year to remove the requirement for a general education exam.

Some states are pressing “temporary” teachers into service. Arizona last year allowed substitute teachers to take full-time positions to address the teacher shortage in that state. In addition, a law passed last year allows Arizona teacher candidates working toward a college degree to teach at the same time.

Iteach is working in 11 states, according to its website: Arkansas, Arizona, Florida, Hawaii, Indiana, Louisiana, Nevada, Tennessee, Texas, Virginia and West Virginia. The Mississippi Teacher Licensure Commission, a panel created to evaluate such programs for that state, unanimously recommended iteach as a certification provider at the commission’s meeting July 7. That recommendation now goes to the state board of education.

Another large company, Teachers of Tomorrow, is working in nine states, though its credentials may be in jeopardy in Texas, where the company has been placed on probation after state regulators found the company misled potential teachers in its advertising, and hadn’t shown that its training was based in research.

Iteach has been accredited by the Council for the Accreditation of Educator Preparation, which credentials traditional educator training colleges. Andrew Rozell, president of certification at iteach, said it is the only for-profit program of its kind so credentialed.

The for-profit companies are separate and different from online university programs, such as Western Governors University or the Southern New Hampshire University, which also have teacher education courses but are not focused on quick credentialing. The for-profit credentialing firms tout their ability to get people into classrooms within a year or 18 months, depending on when they begin.

Nationwide, teacher shortages are just as bad as in Virginia, particularly in very rural or low-income inner-city school districts. A working paper from Brown University “conservatively” estimated that as of August 2022, there were 36,000 teacher vacancies across the United States.

And the paper noted that those vacancies are not distributed equally. “The vacancy rate per 10,000 students is more than 159 times as high in Mississippi as it is in Missouri,” the authors wrote. The paper found a shortage of 0.43 teachers per 10,000 students in Missouri and 68.59 teachers per 10,000 in Mississippi.

By taking the step to help fill the vacancies, the Virginia state education board was following Republican Gov. Glenn Youngkin’s Executive Directive No. 3 to address the teacher shortage, in part by reducing “red tape associated with teacher licensure, while assuring high standards.”

Iteach fills that criteria, according to Youngkin spokesperson Macaulay Porter, in an email to Stateline. “Governor Youngkin fully supports high-quality alternative pathways to becoming a teacher. The State Board of Education rigorously reviewed iteach data to ensure that iteach will provide school divisions with another effective and efficient option for recruiting and preparing new teachers,” Porter wrote.

The iteach method counts on reducing barriers to time and cost, according to Rozell, “without reducing rigor.” It is designed to take about a year to get candidates ready for initial teaching, if they pass state exams.

Then, the newly trained teachers are granted temporary licenses and teach under intermittent observation by iteach professionals who drop into classes, sometimes unannounced. All this occurs with the knowledge of school administrators, who can provide their own support.

But critics contend that iteach and the other programs that turn out teachers quickly are not subject to the same requirements and depth of instruction as teachers who go the traditional path of four undergraduate years, sometimes at least a year getting a master’s degree, and many months of student teaching under nearly constant supervision by a trained teacher.

Heather Peske, president of the National Council on Teacher Quality, a research and advocacy group, said in a phone interview that for-profit online teaching programs are a “blunt instrument” to address teacher shortages. The programs, she said, don’t take into account whether the teachers are qualified for the subjects they will be teaching or whether they will be satisfied with their jobs and stay in the profession or leave after a year or two.

“If you have a fast-track program and your model is entirely online, it begs the question of how they are assuring aspiring teachers get a place to practice … content knowledge and clinical practice,” she said. School districts should tailor recruiting and educating new teachers to the vacancies and needs, she said, which are most often “specialized teachers” such as special education or multi-language learners.

Iteach advertises that its cost for a complete program is $4,399, plus a $99 enrollment fee. Teachers of Tomorrow’s program costs about $5,000.

By contrast, annual average tuition at a four-year institution in education can range from $9,193 at an in-state school to $26,543 at an out-of-state school, according to the website College Tuition Compare, an independent college evaluation site. Elite institutions are higher. Graduate tuition ranges from $10,806 annually to $19,796, the site found.

Iteach’s Rozell said many of the students in his company’s programs are already working in classrooms, as paraprofessionals, aides for special needs kids or in other non-teaching capacities, and already have some idea of classroom management and other skills needed to be a teacher.

But Peske said the “grow your own” movement, which takes paraprofessionals or other employees and turns them into teachers, while a good idea, still requires “thoughtful clinical experience to prepare them. The notion that you would rely on candidates themselves to already be in the classrooms or already working with students, that concerns me,” she said.

“Someone could have been a paraprofessional working as an aide to a student with disabilities, but may never have had the experience [learning] about neuro-differences in those students or who may never had had a mentor.”

The American Federation of Teachers, the nation’s largest teachers union, in a 2022 report called for more rigor in teacher training, not less, criticizing state efforts to lower the qualifications needed to be a teacher.

“[T]here are more alternative and nontraditional ways to become a teacher in the U.S. than ever before, and unfortunately many of them are low quality,” the report said.

The teachers union stressed methods that are reflected in traditional training, saying aspiring teachers should get “extensive” classroom experiences “alongside a skilled practitioner over a significant period,” and “a strong foundation in subject-area content.”

“We cannot put a bandage on the teacher and school staff shortage by cutting corners and lowering the bar for entry,” the report said.

The biggest knock on the swift accreditation companies came in Texas, where Texas Teachers of Tomorrow, also known as A+ Texas Teachers, has been put on probation. The Texas Education Agency found that the company failed to address numerous deficiencies, including the number of content hours required for teacher candidates, and whether they are evaluated regarding whether their existing skills are “appropriate for the certification sought.” The audit came after complaints from school districts and teacher candidates who utilized the firm, The Dallas Morning News reported.

Attempts to reach Texas Teachers of Tomorrow were unsuccessful.

A University of Texas at Austin College of Education 2021 study of teacher preparation nationally found that in every tested subject, “students do better if they have university-certified teachers,” and that for low-income students, “having a university-certified teacher can offset half or more of the disadvantages that comes from living in poverty.”

In addition, the study showed that university-certified teachers had a 73% retention rate over nine years, while only 59% of “alternatively certified” teachers remained teaching.

But Rozell said that study was skewed because of the problems with Teachers of Tomorrow. He said an internal survey of his company’s students showed that after the first year in the classroom, 93% said “they were excited to be back next year,” and that they planned to be a teacher for at least five years.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: [email protected]. Follow Stateline on Facebook and Twitter.

Image source: The Motley Fool.

Nano-X Imaging (NNOX -1.79%)
Q2 2023 Earnings Call
Aug 17, 2023, 8:30 a.m. ET

Contents:

• Prepared Remarks
• Questions and Answers
• Call Participants

Prepared Remarks:

Operator

Good morning and thank you for standing by. Welcome to the Nano-X second quarter 2023 earnings call. At this time, all participants are in a listen-only mode. After the speakers' presentation, there will be a question-and-answer session.

[Operator instructions] Please be advised that today's conference is being recorded. I would like now to turn the conference over to Mike Cavanaugh, investor relations. Please go ahead.

Mike Cavanaugh -- Investor Relations

Good afternoon and thank you for joining us today. Earlier today, Nano-X Imaging Limited released financial results for the quarter ended June 30, 2023. The release is currently available on the investors section of the company's website. Erez Meltzer, chief executive officer; and Ran Daniel, chief financial officer, will host this morning's call.

Before we get started, I would like to remind everyone that management will be making statements during this call that include forward-looking statements regarding the company's financial results, research and development, manufacturing and commercialization activities, regulatory process operations, and other matters. These statements are subject to risks, uncertainties, and assumptions that are based on management's current expectations as of today and may not be updated in the future. Therefore, these statements should not be relied upon as representing the company's views as of any subsequent date. Factors that may cause such a difference include, but are not limited to, those described in the company's filings with the Securities and Exchange Commission.

Management will also refer to certain non-GAAP financial measures to provide additional information to investors. A reconciliation of each non-GAAP financial measure to the nearest GAAP financial measure is provided in the company's press release filed today. The non-GAAP financial measures include non-GAAP net loss attributable to ordinary shares, non-GAAP cost of revenue, non-GAAP gross profit, non-GAAP gross profit margin, non-GAAP research and development expenses, non-GAAP sales and marketing expenses, non-GAAP general and administrative expenses, non-GAAP other expenses, and non-GAAP gross loss per share. With that, I'd like to turn the call over to Erez Meltzer.

Erez Meltzer -- Chief Executive Officer

Thanks, Mike, and welcome all to the Nanox second quarter 2023 earnings conference call. Throughout this quarter, we achieved significant advancements across multiple business segments. I would like to highlight that today's call will extend a bit beyond our typical duration as I aim to offer more comprehensive insights. I will delve into specifics, including our strategic approach to the U.S.

market, the reinforcement of our manufacturing and supply chain, and our regulatory process. During the quarter ended June 30, 2023, we continued to advance our commercialization efforts outside the U.S. following FDA clearance to market the multisource Nanox.ARC. With this clearance, we are now preparing to establish our foothold in the U.S.

market, complemented by our ongoing commercialization initiatives outside the U.S. Today, I'm excited to delve into our commercial efforts in both the U.S. and the non-U.S. markets.

About the U.S. deployment and strategy. Obtaining the 510(k) clearance from the FDA for the multisource Nanox.ARC has been a long-standing strategic goal for the company and enable us to deploy the Nanox.ARC in the U.S. for the indication of use cleared by the FDA.

As previously announced, we are in the process of establishing a U.S. demo as part of our strategic approach for our U.S. commercial activities. We have decided to ship this first unit and are now planning to install the unit in a clinical setting rather than a stand-alone commercial site.

The system is planned to be installed in an East Coast facility and will expect to start generate revenues alongside training and demonstrations. We believe that this first site will serve a dual purpose. First, as a training and demonstration center for the Nanox.ARC, which will provide potential buyers with live demonstration of the technology, which we believe is essential for informed acquisition purposes by healthcare practices, hospitals, and health systems. Secondly, we believe the clinical site can raise awareness of the Nanox.ARC among key opinion leaders, radiologists, and hospital system personnel.

The first Nanox.ARC system was shipped from Israel and arrived in the U.S. for installation in the clinical site, which we expect to open the clinical site during the fourth quarter of this year. Based on market analysis of the U.S. market of clinicians, imaging administrators, and directors, stakeholders recognized the clinical benefits of the Nanox.ARC and its more affordable approach to advanced imaging techniques.

Furthermore, outpatient facilities such as skilled nursing facilities, free-standing emergency clinics, and pulmonary clinics showed interest in adopting the Nanox.ARC, specifically because such facilities typically do not have CT capabilities, and we believe such facilities view the Nanox.ARC as the more affordable way to keep patients in-house for advanced imaging needs, combined with the 2D X-ray. Outpatient facilities also expressed potential interest in our MSaaS business model, which we believe reduces the risk of an upfront purchase because the cost is based on equipment use. We believe that gathering further clinical evidence will strengthen the support of our technology. Our U.S.

go-to-market strategy is comprised of three primary components: customer targeting, building a sales team, and using a hybrid business model. In terms of the customer targeting, we believe several factors impact willingness to adopt our system, including the type of facility, its current imaging capabilities and imaging volumes, and geographic locations, namely rural versus urban. Our aim is to strategically engage segments that show early adoption potential such as orthopedic clinics, skilled nursing facilities, free-standing emergency departments, and urgent care facilities. We intend to continue to build clinical evidence, particularly with the U.S.

market, to support the adoption of our system, as well as reimbursement mechanisms, specifically with commercial payers. We have strategically realigned our focus to enhance our presence in the U.S. market. Our initial efforts in commercialization and deployment within the U.S.

will be concentrated on select states. This approach allows us to optimize customer service delivery and support in the near term. To execute our strategy, we have allocated internal sales resources and we are planning to leverage the USARAD network in order to accelerate our initial penetration in the market. Furthermore, we are in the process of enhancing a U.S.-based sales and service team that will seek to generate leads, close sales, manage relationships, and provide services for the Nanox.ARC installed base.

We are also in the process of engaging an independent service provider to provide service needs in remote geographies and to decrease equipment downtime. We expect that the other operating areas such as medical affairs, regulatory, billing, finance, and contracting will be supported by the existing international Nanox organization. For our business model in the U.S., we intend to use a hybrid approach, combining a usage-based MSaaS model with a capex model to help promote adoption based on different segments. We have designed a training program to promote the Nanox.ARC.

We intend to use a combination of pilot size, training, sales, and marketing efforts to help meet customer needs. These aspects of our business strategy will require us to hire additional experienced healthcare business development professionals who will be charged with raising awareness of the Nanox.ARC among physicians, hospitals, urgent care operators, and large health systems throughout the USA. To support these important efforts, I intend to increase my personal presence in the U.S. and make myself available of meeting -- for meetings with potential customers, as well as investors who would like to have an in-depth conversation about our technology, commercial strategy, and future strategic plans.

We look forward to providing further details in the upcoming month. With respect to the rest of the world deployments, turning to our commercialization efforts outside of the U.S., we continue to make significant progress in multiple countries, principally in Africa. As we have previously announced, we had an agreement with a distributor in Morocco and are working to accelerate deployments. We have deployed a Nanox.ARC system in a prominent hospital in Morocco that is a major healthcare provider in the southern region of the country.

The distributor in Morocco received appropriate clearance to conduct certain scans with the Nanox.ARC. Subject to the clearance, the Nanox.ARC system has generated human images on incoming patients at the hospital, including chest. In Nigeria, we have installed the Nanox.ARC systems, which we accept will become operational upon receipt of the necessary regulatory approvals and certification that has been formally submitted to the local authorities, the NNRA, to facilitate clinical activities. We hope to begin generating human images in the very near future.

As previously reported, we have already placed a system in Ghana at the UGMC Hospital, mainly for training purposes. Meantime, our distributor has submitted the specific Nanox.ARC designs for approval to the Ghana Food and Drugs Authority for commercial use. We anticipate receiving an initial response in the fourth quarter of 2023. And in addition, we have engaged a clinical research organization to potentially hold clinical trials in both Morocco and Ghana, subject to local regulatory approvals.

In alignment with our global initiatives and as announced in the past, we established a partnership with BIO Ventures for Global Health, BVGH, a nonprofit organization dedicated to solving global health issues by forming connections between people, resources, and ideas. We completed the first phase of this program and are excited to begin the second series in just a few weeks, which involves a series of expert-led seminars to train Nigerian and other African healthcare professionals on imaging topics. We also regularly host radiologists, distributors, representatives from hospital systems, investors, and analysts at Nanox headquarter in Israel to discuss the Nanox.ARC system in detail and conduct live demonstration of the system on site, providing firsthand insight into the capabilities of the Nanox.ARC. I'm happy to report that these meetings resulted in very positive feedback in writing.

All of those efforts constitute just the beginning of our goal to help people achieve better health outcomes. Lastly on this front, as part of our global commercialization, we have started to generate initial revenues from the medical imaging equipment and MSaaS. With respect to the OEM, before I provide an update on the manufacturing and production front, I'd like to share the news that we have entered an original equipment manufacturing, OEM, relationship with a U.S. government agency that we have signed and are working to develop.

The government agency I referred to has procured Nanox MEMs systems for assessment. Their interest in our technology is for the purposes of developing next-generation security scanning and nondestructive testing applications. The project is scheduled to commence next month. As part of our OEM efforts, we have sent several demo units to industry partners, out of which a leading partner independently examined Nanox Cold cathode chip and reported a real technological breakthrough.

With respect to the mass production, as we begin to deploy the Nanox.ARC and prepare for mass production, I would like to provide updates regarding research and development and manufacturing. We are currently using chips produced by our Korean fabrication facility in our Nanox.ARC systems. However, to secure additional chip supply in anticipation of commercialization scale-up and acceleration of manufacturing activity, we recently entered into an agreement with CSEM, a chipmaker located in Switzerland. We have proceeded to phase 2 lab-to-fab development, which is expected to manufacture sample chips by the end of this year and provide production of chips in Q1 2024.

For the commercial production of our digital X-ray tubes for use in Nanox.ARC, we plan to engage third-party manufacturers and suppliers based on, among other things, cost-effectiveness. We are currently developing both ceramic- and glass-based digital X-ray tubes for use in Nanox.ARC. Our Korean facility is currently our primary manufacturer and provider for our ceramic digital X-ray tubes, and we are working with a third party for the production of glass-based digital X-ray tubes. For example, we recently started testing glass-based digital X-ray tubes manufactured by CEI.

The testing includes performance, integration, and radiation testing. Furthermore, we are negotiating with additional third party to produce the digital X-ray tubes. Along with our existing manufacturing facilities in Israel and Korea, we believe these developments further strengthens our future supplies of both chips and tubes, the two key components of the Nanox.ARC, to support the scaled deployment of the Nanox.ARC units. In an additional step toward optimizing our mass manufacturing capabilities, we have initiated collaboration with Skanray for Nanox.ARC systems assembly at scale.

Skanray, a medical equipment manufacturer, meets essential standard requirements and serves as a provider for prominent global medical entities. It is also the parent company of CEI, our Italian provider of glass-based digital X-ray tubes. With the robust technological manufacturing capabilities in India, we plan to leverage in the coming years of the Nanox.ARC deployment. Regarding regulatory, I'd like to now turn our attention to regulatory and clinical trials updates.

On April 28, 2023, we obtained a 510(k) clearance from the FDA to market the Nanox.ARC, including the Nanox.CLOUD, it's a company cloud-based infrastructure. The Nanox.ARC is a stationary X-ray system intends to produce tomographic images of the human MSK system adjunctive to conventional radiology on adult patients. The approved device is intended to be used in professional healthcare facilities or radiological environments such as hospital, clinics, imaging center, and other medical practices by trained radiographers, radiologists, and physicians. This version of the Nanox.ARC has the required capabilities to scan MSK, chest, and abdomen and to provide 2D X-ray images conventional radiography, subject to local regulatory approvals.

We are also continuing to pursue the CE mark in the European Union with our notified body, aiming to submit during Q3 of 2023. In Israel, we are pursuing the AMAR clearance, the Israeli medical device listing. The required technical file was completed and submitted in early July 2023, and we expect a decision in the few months. Clinical, as previously discussed, under our Helsinki permit, we started to collect clinical sample images of multiple human body anatomies with the Nanox.ARC system that was deployed in the Shamir Hospital in Israel.

We have completed the first phase of clinical sampling and have begun the second phase. We are in the final stages of approval of additional clinical sites in Israel, and this additional trial aims to utilize the Nanox.ARC, subject to receiving the final approval from the institutional IRB. This trial will aim to assess the diagnostic capabilities of Nanox.ARC in detecting chest and lung diseases. Installation of the Nanox.ARC is expected to be completed within a month from its commencement, and the trial itself is scheduled to commence in the third quarter.

With respect to Nanox.AI, I am excited to share the progress we have made in the ADOPT trial with the National Health Service in the U.K. To date, all five of the testing sites in the U.K. have signed the collaboration agreement. And in addition, three sites, Cambridge, Southampton, and Bradford, have begun sending images to the Nanox.CLOUD platform, and we expect two more sites in Nottingham and Cardiff to begin sending images very soon.

Nanox.AI is currently engaged in showcasing the product across a range of platforms to 10 integrated delivery networks in both the United States and in other regions. With that, I'd like to turn the call over to Ran Daniel, chief financial officer, to review our financial results.

Ran Daniel -- Chief Financial Officer

Thank you, Erez. We reported a GAAP net loss for the second quarter of 2023 of $17.4 million, compared with a net loss of $19.6 million in the second quarter of 2022. The decrease was largely due to a goodwill impairment of $14.3 million that was recorded in the comparable period and not in the three months ended June 30, 2023, which effect was offset, in part, by a decrease in the company's earnout liabilities in the amount of $12.8 million in the second quarter of 2022, versus an increase of $0.1 million in the second quarter of 2023. Revenues for the second quarter of 2023 were $2.6 million and the gross loss was $1.7 million on a GAAP basis.

Revenues from the teleradiology services for the same period was $2.5 million, with a gross profit of $0.4 million on a GAAP basis and a gross profit of $0.9 million on a non-GAAP basis, which represents a gross profit margin of approximately 14% on a GAAP basis and 36% on a non-GAAP basis. The increase in the company's revenues in the second quarter of 2023 is mainly due to the increase in the number of radiologists that engaged in practicing during the overnight and weekend shifts. The decrease in the gross profit margin on a GAAP and a non-GAAP basis is mainly due to an increase in the cost of the company's radiology due to the incentive payments which the company paid to the radiologist to engage in practicing during the overnight and weekend shifts. Research and development expenses for the second quarter of 2023 were $6.9 million, as compared to $6.5 million for the comparable period in 2022.

The increase of $0.4 million in our research and development expenses was mainly due to an increase in the company's cost of labor in the amount of $0.7 million, mainly due to an increase in the headcount in connection with the development of the Nanox.ARC system, which was partially offset, in part, by a decrease in share-based compensation of $0.3 million, an increase in research and development grants that the company have received in the amount of $0.1 million. Sales and marketing expenses for the second quarter of 2023 were $0.8 million, as compared to $1.1 million for the comparable period in 2022. General and administrative expenses for the second quarter of 2023 were $7.6 million, as compared to $11.2 million for the comparable period in 2022. The decrease of $3.6 million in general and administrative expenses was mainly due to a decrease in the company's cost of labor in the amount of $0.5 million due to a reduction in headcount as part of the company's plan to increase efficiencies.

In addition, we had a decrease in our share-based compensation in the amount of $2.8 million and a decrease in the cost of directors' and officers' liability insurance premium in the amount of $0.3 million. During the second quarter of 2023, we had accrued $0.7 million for the future settlement expenses in connection with the SEC investigation. As previously disclosed, the company and Ran Poliakine, our chairman of the board of directors, reached agreement in principle with the SEC staff to settle the SEC investigation. The agreements are subject to finalization, including any financial remedies, which the company estimates will be approximately of $0.7 million in civil penalties from the company.

Final resolution of this matter is subject to the preparation and negotiation of the documentation satisfactory to all parties, including with respect to the company approval by the company's board of directors and, in the case of the SEC, authorization by the commission, as well as approval by a federal district court. As mentioned above, we incurred an expense of $0.1 million in change in contingent earnout liability in the three months ended June 30, 2023. During the second quarter of 2023, we entered into an amendment to the stock purchase agreement with the former stockholders of USARAD. Under this amendment, the company paid an aggregate amount of approximately of $0.3 million in cash and 45,392 ordinary shares to the former stockholders of USARAD in consideration for their achievement of certain milestones in connection with the first earnout period as defined in the USARAD Stock Purchase Agreement.

In addition, we paid an aggregate of $0.5 million in cash and 210,000 ordinary shares to the former stockholders of USARAD as consideration for the remainder of the milestones and applicable announced earnout under the USARAD Stock Purchase Agreement. Turning to our balance sheet. As of June 30, 2023, we had cash, cash equivalents, restricted cash, and marketable securities of approximately of $80.3 million and had 3.4 million loans from banks. We ended the quarter with the property and equipment of $45.2 million.

As of June 30, 2023, we had approximately 55.5 million shares outstanding, as compared to 52.1 million shares outstanding as of December 31, 2022. The increase was mainly due to the issuance of approximately 255,000 ordinary shares to the former stockholders of USARAD under the amendment to the USARAD Stock Purchase Agreement previously discussed. On July 26, 2023, we raised $30 million in a registered direct offering by selling approximately 2.1 million shares and warrants to purchase up to 2.1 million shares. The net proceeds of the raise are intended to be used to further development of manufacturing and commercial deployment of our systems.

With that, I'll hand the call back over to Erez.

Erez Meltzer -- Chief Executive Officer

Once again, I want to thank you all for being here today and for being with Nanox on our multiyear journey to make medical imaging more accessible around the world. We have made tremendous strides in realizing our vision this year, and I'm proud of what our team has done to bring our company to the doorstep of commercializing the ARC system at scale. Before we end the call, I want to announce that we will be hosting an Investor Day to be held in New York City at the end of September or the beginning of October 2023. And if you would like to attend either in person or virtually, please contact our investor relations partners at ICR Westwicke.

Have a great day. Operator, please open the call for questions.

Questions & Answers:

Operator

[Operator instructions] The first question will come from Ross Osborn with Cantor Fitzgerald. Your line is open.

Ross Osborn -- Cantor Fitzgerald -- Analyst

Hi. Congrats on the progress and thank you for taking our questions. So, starting off, would you discuss the level to which your system in Nigeria is operating in terms of scans per day?

Erez Meltzer -- Chief Executive Officer

I think it was indicated that the one in Nigeria right now is operating without the approval of getting scans per patients or for humans. And we're waiting for the final NNRA approval for the scans in human or getting human images.

Ross Osborn -- Cantor Fitzgerald -- Analyst

Apologies, I may have misspoken. So, is Ghana operating on human scans or is that also waiting?

Erez Meltzer -- Chief Executive Officer

Ghana is waiting for the final approval for commercial use.

Ross Osborn -- Cantor Fitzgerald -- Analyst

OK. Understood. And then following up --

Erez Meltzer -- Chief Executive Officer

The one in Morocco is operating with human scans with images like it's in a full operation at the hospital.

Ross Osborn -- Cantor Fitzgerald -- Analyst

OK. Great. Would you be able to provide [Inaudible] 

Erez Meltzer -- Chief Executive Officer

With all the -- yeah. I beg your pardon.

Ross Osborn -- Cantor Fitzgerald -- Analyst

Would you be able to provide the level to which it's operating in terms of scans per day?

Erez Meltzer -- Chief Executive Officer

Right now, we don't disclose what's the number of scans per day. But I think that in the next call or probably even earlier in the Investor Day, we will provide the initial indication for the scans per day in all the units that we have installed.

Ross Osborn -- Cantor Fitzgerald -- Analyst

OK. Understood. And then following up on this, when can we expect for you to deliver more systems to your commercialized African countries? I believe Nigeria calls for 1,000, Ghana for 350, and Morocco for 270 systems.

Erez Meltzer -- Chief Executive Officer

But first of all, as soon as we get the final approvals, but this basically will start in the next two quarters, for sure.

Ross Osborn -- Cantor Fitzgerald -- Analyst

OK. And then turning to the U.S., you know, could you just walk us through the rationale for the delay in the training center operating? I believe it was previously calling for this summer.

Erez Meltzer -- Chief Executive Officer

The one thing that we've had an early indication is that we're going to send the first systems. We are waiting for the approval of the demo center itself. But in the meanwhile, we have decided, as mentioned in the -- in my preliminary, in the -- what I said actually earlier today that we wanted to -- we preferred to have the first system to be installed in a clinical site and to make it commercial earlier than the original plan. Since we have already a few clinical locations or clinics that are willing to install the systems even before we have the full operating U.S.

operation system -- U.S. operation, then we decided that the first system will be installed in the next few weeks in one of these locations, and we'll start those, first of all, to generate -- to scan patients and to generate revenues.

Ross Osborn -- Cantor Fitzgerald -- Analyst

Got it. And then last one for us, and we'll jump back in the queue. Would you discuss the size of your U.S. contract you announced today? And just so we're on the same page, did the OEMs sign on for your comprehensive system or are you now selling your chips on a stand-alone basis?

Erez Meltzer -- Chief Executive Officer

You mean the OEM agreement?

Ross Osborn -- Cantor Fitzgerald -- Analyst

Yes.

Erez Meltzer -- Chief Executive Officer

OK. The OEM -- we have a few OEM arrangements and collaboration. The one that was mentioned, it's for the chip only. The others are aimed to either chip or chip and tube.

In addition, we are in the process of having a full demo, not only the tube itself, that will be tested in the next, I would say, six months.

Ross Osborn -- Cantor Fitzgerald -- Analyst

OK. And then are you able to disclose the size of the contract with the U.S. government agency?

Erez Meltzer -- Chief Executive Officer

We are not allowed to.

Ross Osborn -- Cantor Fitzgerald -- Analyst

OK. Thanks for taking our questions. We'll jump back in the queue.

Operator

Please stand by for the next question. The next question comes from Jeff Cohen with Ladenburg. Your line is now open.

Destiny Hance -- Ladenburg Thalmann and Company -- Analyst

Hi, Erez and Ran. Thank you so much for taking our questions. This is actually Destiny on for Jeff. I will start by kind of continuing on the last group of questions.

And I'm curious how are you determining the initial physicians that will be welcomed into your demo site? And is this going to be more of a group demonstration or is this going to be on a kind of one-to-one basis?

Erez Meltzer -- Chief Executive Officer

First of all, right now, as we have shared, it's -- actually, it's a full range. So, we have individuals that are coming to see the systems and will be coming to see the system. We have some delegations. One of them was even like 10 or 15 people.

We are willing and will be willing to host any size of group that will be able to see what we do.

Destiny Hance -- Ladenburg Thalmann and Company -- Analyst

Got it. OK. And there could be multiple people from a single site, I would assume. So, that makes sense.

Thank you.

Erez Meltzer -- Chief Executive Officer

Absolutely.

Destiny Hance -- Ladenburg Thalmann and Company -- Analyst

Got it. OK. And then you mentioned a sales team, a direct sales force in the U.S. I'm wondering about the size of that sales team, the timing of the onboarding of your initial sales reps, and then how we should be thinking about the impact to sales and marketing expense going forward for modeling purposes?

Erez Meltzer -- Chief Executive Officer

OK. Let's start with the first question. So, as I've indicated, we are building the team as we speak. We mentioned in the past that we are in the final process of conclude and complete the full action plan or execution plan of the deployment in the U.S.

Part of what -- of this I've shared with earlier today. And the full -- I would say a more detailed plan, including numbers and further indications, will be presented in the Investor Day that we are planning to the end of September. By that -- by then, we are going to have probably most of the team already ready to do the work. We are planning the kick off early October in the U.S.

A few of the people have already engaged and working in the U.S. So, I think that more of this you will be able to hear. We are talking, by the way, on the September 22nd at the Nasdaq to have the Investor Day that we're planning, and more details to come on this.

Destiny Hance -- Ladenburg Thalmann and Company -- Analyst

Excellent. Looking forward to that Investor Day. And then lastly for us, you're collecting a lot of clinical and some real-world data. I'm wondering if you'll create some kind of registry to kind of capture all of that.

Erez Meltzer -- Chief Executive Officer

The answer is yes. Part of it will be shown and presented in our website. Everything is based on what is allowed, what we can. It will be based on regulation related to the -- this disclosure.

We are also in the process of preparing the -- all the clinical data collected and prepare the paper that we're going to release. So, this is actually -- at the same time that we do all the commercial deployment, we're going to make a lot of efforts and emphasize the clinical side of what we are doing. I think that I've shared a little bit today that, as you know, in the U.S., we are allowed, right now, to do the MSK. But in the rest of the world, we do chest, abdomen, and other anatomies.

So, both in Israel and in Morocco, we have already tested and scanned human in the other anatomies used. So, basically, this is the plan that we move forward in order to enhance our ability to do the clinical -- to provide the clinical data and explore the opportunities for the future intended use.

Destiny Hance -- Ladenburg Thalmann and Company -- Analyst

OK. Got it. Thank you so much for taking our questions. I'll hop back into queue.

Operator

[Operator signoff]

Duration: 0 minutes

Call participants:

Mike Cavanaugh -- Investor Relations

Erez Meltzer -- Chief Executive Officer

Ran Daniel -- Chief Financial Officer

Ross Osborn -- Cantor Fitzgerald -- Analyst

Destiny Hance -- Ladenburg Thalmann and Company -- Analyst

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