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Phenylephrine, pseudoephedrine and ephedrine are the sympathomimetic drugs that have been used most commonly in oral preparations for the relief of nasal congestion. These drugs stimulate the central nervous system that is affected by the alpha and beta adrenergic agonism. Sympathomimetic agents used in the treatment of flu and common cold with ephedrine and pseudoephedrine are case reports. That the manic and psychotic episodes are triggered. In this article, we would like to present a bipolar manic disorder with two manic episodes and both of them triggered by influenza drugs.
A 25-year-old man patient was admitted to psychiatric outpatient clinic with increasing complaints such as increasing energy, speaking much, decreasing sleep, increasing the libido after using the flu drug that prescribed to him containing phenylephrine. Also, 2 years ago, he has manic attack triggered after the flu drug.
In recent years the study of epilepsy and bipolar disorder in common suggests that bipolar disorder may affect the kindling phenomenon. In our case, two of reasons in the neurobiology of developing manic attacks the kindling phenomenon is likely to be effective. First, the possibility of using cold medicine containing ephedrine or pseudoephedrine in the first manic episode, in the second manic episode having spent the attack with FAQ stimulant effect of lower phenylephrine. Second, in the first episode after using the 5–6 tablets developing manic attacks. In the second attack to be triggered with just 2 doses may indicate the effect of kindling.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Gold has been a major economic asset for Suriname for more than a century. The long history of gold mining, concentrated in large parts of a greenstone belt in the northeast of the country, began with small-scale artisanal extraction activities and has recently seen the development of major open-pit operations. Despite the range of mining activities, Suriname's gold deposits and occurrences are under-explored from a scientific point of view. Primary gold mineralisations in the greenstone belt occur in multiple forms, and although their origin is commonly related to the Palaeoproterozoic Trans-Amazonian orogeny, the controls of ore formation in specific cases often remain obscure. This contribution presents an abridged overview of currently available information on the geological setting and characteristics for some of the main deposits where gold is extracted. In view of the consistent link between gold metallogeny and granitoid–greenstone belts in the northern Guiana Shield, the mineralised settings in Suriname are discussed in a regional context.
This book brings together a series of studies that we have conducted over a period of about ten years. Our research program has examined stakeholder responses to CR in numerous stakeholder realms, across a wide range of settings, and utilizing a variety of research methods. The breadth of our research agenda enables us to triangulate our findings, examining the issue from multiple standpoints. This substantially increases the validity and generalizability of our framework. Below we describe a number of the studies that are profiled frequently in the chapters above; additional information about the studies is available from the authors.
General CR Insights Study
Multiple methods were used to assess consumer responses to CR. About 100 respondents took part in a series of focus groups and interviews conducted with the general population of the US. The studies covered all major aspects of the framework. The central objective of the studies was to understand how CR inputs lead to Understanding, Usefulness, and Unity, and how these initial internal outcomes (i.e., outcomes that occur in the mind of the consumer) lead in turn to business value and social value. Findings established these linkages and identified a number of context factors that influence the linkages.
In the previous section, we explained that when it comes to managing CR, stakeholder reactions matter. That is why a critical pathway linking CR activity to improvements in business and societal performance (i.e., CR value) lies in what we call the stakeholder route. As a result, CR value is often best understood by examining the behaviors of individual stakeholders. For example, consumers may become loyal patrons, and employees may make the extra effort to perform well on the job.
Of course, such positive or desired responses to CR activity are not guaranteed. Responses are driven by a psychological process in which stakeholders interpret the CR activities of the company. Companies with an understanding of this psychological process are the ones best prepared to engage in the types of CR activity that stakeholders find most compelling. And these activities ultimately lead to the sort of CR value that managers seek.
In the previous chapters, we laid out how stakeholders see CR, how they interpret CR information, and how they respond to CR. This straightforward multi-step process will – all things being equal – predict stakeholder behavior and help build the business case for engaging in CR activity.
But all things are rarely equal. That's why CR's ability to create value depends greatly on the context in which it is implemented. Knowing how context influences outcomes is critical to effective CR management, because only managers who build this knowledge into their decision-making can take full advantage of the opportunities, while also steering clear of the potential pitfalls.
The significance of context
This chapter presents some of the most important contributing contextual factors in stakeholder responses to CR. We call these multipliers. Multipliers magnify or dampen the effects of one part of our framework – and therefore its influence – on another part.
Throughout this book, we have argued that CR value is derived in part by the stakeholder route, whereby stakeholders react to CR based on the information to which they are exposed. For this reason, we recommend that companies work hard to develop an appreciation of how stakeholders interpret and ultimately respond to CR activity. In Part I we described the link between CR activity and stakeholder responses to CR (i.e., CR value); and in Part II we outlined the psychology behind such responses.
But what is a company to do with these insights? In this part, we discuss the implications of our approach. We do this by highlighting three ways that companies can maximize CR value and maintain this value over the long term.
To that end, Chapter 7 shows how companies can empower stakeholders so that they become co-creators of CR – a process that draws them closer to the activities for better Understanding, ensures that programs are optimally Useful, and enhances Unity, the stakeholders’ sense that the company shares their values.
What then of Chevron and Shell? In our opening chapter, we discussed the struggles of these two massive and influential global oil companies to engage in meaningful, useful, and impactful CR. While each was trying to do right by its desire simultaneously to help itself and the world around it, both companies found themselves buffeted by the uncertain storms of increasingly influential and competing stakeholder demands and actions. These stakeholder reactions derailed company efforts, literally in the case of Shell, at being socially responsible. In other words, the actions taken by these companies in Barendrecht and the Yadana Valley resonated far beyond – their success in creating value for the company, as well as for the world at large, turned out to be contingent on the thoughts, feelings, and actions of important stakeholders.
In this book, we have made the case for why all companies, large and small, local and global, must ground their CR strategies in a sound and thorough understanding of their impact on two key stakeholder groups: consumers and employees. In making our case, we have drawn on academic research in this domain to proffer an individual stakeholder perspective on CR, providing a sense for when, why, and how stakeholders respond to a company's initiatives. In particular, we have presented a stakeholder psychology model of CR, which underscores the need for three psychological levers – Understanding, Usefulness, and Unity – to work in unison in order for CR to create maximal stakeholder value. The power behind these levers is, in turn, impacted by several stakeholder- and company-specific features, which amplify or dampen the extent to which they create CR value for both the stakeholder and the company.
The basic take-away from our stakeholder-centric research is as simple as it is powerful: CR strategies need to bring consumers and employees closer to a company's CR, and ultimately to the company. The proximity of stakeholders to a company's CR actions ranges from a complete lack of awareness of any such activities, to a central, driving role in the company's CR strategy. A fundamental goal of a company's CR strategy, then, must be to move the most important and/or valued stakeholder – employees and consumers – up this proximity continuum, from utter unawareness to complete involvement.
The previous chapter focused on both the importance of co-creation of such an endeavor as well as how a company can formulate and implement its CR programs in a way that maximizes the likelihood of effective co-creation. However, this is only part of the story. Clearly, co-creation is restricted, almost by definition, to those most valued stakeholders whose needs and welfare matter the most to the company.
The corporate social and environmental responsibility movement, known more generally as corporate responsibility (CR), shows little sign of waning. Almost all large corporations now run some form of corporate responsibility program. Despite this widespread belief that CR can simultaneously improve societal welfare and corporate performance, most companies are largely in the dark when it comes to understanding how their stakeholders think and feel about these programs. This book argues that all companies must understand how and why stakeholders react to such information about companies and their actions. It examines the two most important stakeholder groups to companies - consumers and employees - to comprehend why, when and how they react to CR. Armed with this insight, it shows how companies can maximize the value of their CR initiatives by fostering strong stakeholder relationships to develop, implement and evaluate compelling social responsibility programs that generate value for both the company and its stakeholders.
The roots of CR have a long and rich history. The idea that businesses can be managed in ways that benefit society dates back to at least the early eighteenth century. In those days “CR” initiatives, in the form of policies and programs helpful to workers, were implemented by industrialists. These were the days of CR's pioneers, idealists who single-handedly pursued a vision of using business to “give back” to society.
For example, Robert Owen was a Welsh-born textile entrepreneur, who in 1799 bought a cotton mill in New Lanark, Scotland so that he could conduct what he called “an experiment” in business practice. Upon purchasing the mill, he instituted a series of socially responsible policies aimed at improving the lives of his workers. He created a fund for those who became sick. He abolished child labor in the factory town. He set up a bank and store to provide services and products at reasonable rates. Owen even started the “Institution for the Formation of Character,” which functioned as a school for both children and adults.
The corporate social and environmental responsibility movement, known more generally as corporate responsibility (CR), shows little sign of waning. All Fortune 500 companies now run some form of corporate responsibility (CR) program and the desire to “do well by doing good” motivates the world's largest corporations collectively to direct billions of dollars towards a wide spectrum of social and environmental issues, whether through donations, volunteer programs, or other means.
The framework that guides this book synthesizes years of research conducted by us, and also incorporates insights from other leading scholars on CR. The evidence presented so far has provided support for each link in the model. To validate the framework in a comprehensive way, this chapter describes studies conducted in two separate settings: the retail sector and the yogurt industry.
The studies show how the “3 U's” that make up the framework are connected to multiple forms of CR value: outcomes that are of great importance to managers. The full array of levers is then tested as a unified driver of CR value by using a technique known as structural equation modeling. The latter tests have also been designed to isolate the effects of CR activity by controlling for external factors, essentially ruling out alternative explanations. The first study examined reactions of 660 employees in the retail sector. The second study involved the reactions to CR activity of over 1,000 consumers in the yogurt industry.
For CR to have a legitimate place at the corporate table, it cannot be an end in itself. CR needs to produce tangible value not only for the environment and society, but also for the company. Otherwise, CR is simply not sustainable.
The global business community knows this. As a result, many companies, as a matter of course, try to measure the value created by their CR activities. That's why new emerging standards, like those set forth by the UN's Global Reporting Initiative, have made it easier for companies to evaluate their CR activity.
If annual CR reports are any indication, companies are making progress in tying CR actions to a variety of both social and business outcomes. Managers are setting ambitious CR-related goals, and, in many cases, achieving them. For example, 3M plans to reduce emissions by 50 percent over the next fifteen years with expected savings to the company of $200 million. More examples of the direct route to CR value are shown in Figure 3.1.
Think back to the opening paragraphs of the book: you are a stakeholder, and you've heard something about a company's CR activity. Do you have an immediate and strong reaction? Would you take some action as a result of learning about a company's programs? And if so, under what conditions?
These kinds of questions are central to our research. We find that while it is tempting to assume that stakeholders respond to CR automatically and immediately once they learn something new about a company's efforts, in fact, it is rare that such information elicits in a knee-jerk reaction. Most responses unfold as each stakeholder interprets the CR activity, making a very personal determination of whether or not it “makes sense” and how it fits into his or her life.
On September 5, 2007, the Buddhist monks of Pakokku, Myanmar joined the citizen protests that erupted in that impoverished country in August of that year. The uprising was triggered by a long-simmering array of discontents ranging from high commodity prices to human rights abuses, including the long-term detention of pro-democracy leader Aung San Suu Kyi. The ruling military government in Myanmar, in power since 1962, took action to quell the protests. A few days after the monks joined the protests, troops fired on protesters in a crackdown that left at least ten people dead by the government's account (opposition groups put the fatalities at around 200). Independent reports suggest that several monks were beaten and killed.
Amid the international outcry over these events, the only company in the US to issue a public statement was Chevron (see Exhibit 1.1). Why? Because Chevron is the only American company doing business in Myanmar, in the face of a systematic, comprehensive and sustained US trade boycott of that nation. Chevron acquired a minority stake in Unocal (a US conglomerate) that operates the Yadana Valley Project, which produces 650 million cubic feet per day of natural gas for export to neighboring Thailand. A loophole in US sanctions has allowed Chevron to operate in Myanmar.
Interested readers already know that there are innumerable ways in which companies enact their commitment to serve society. This chapter focuses on how stakeholders learn about CR and what characteristics of CR stakeholders are looking for when they evaluate socially responsible activity. Such information is vital to know, because what managers care about may be very different from what stakeholders care about. Moreover, what companies think they are saying may be quite different from what stakeholders are seeing and hearing.
There are two aspects of communications that CR managers need to be aware of in order to have the impact they need for success:
First, they must understand what CR characteristics stakeholders look for as they evaluate CR activity. This is important because it enables managers to make these characteristics prominent in communications.
Second, managers must understand that stakeholders acquire information from a variety of communication channels. Getting a handle on the costs and benefits of these channels is the first step to designing integrated communications campaigns for stakeholders. We now look at each of these aspects in turn.