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To develop and implement antibiotic stewardship activities in urgent care targeting non–antibiotic-appropriate acute respiratory tract infections (ARIs) that also reduces overall antibiotic prescribing and maintains patient satisfaction.
Patients and setting:
Patients and clinicians at the urgent care clinics of an integrated academic health system.
Intervention and methods:
The stewardship activities started in fiscal 2020 and included measure development, comparative feedback, and clinician and patient education. We measured antibiotic prescribing in fiscal years 2019, 2020, and 2021 for the stewardship targets, potential diagnosis-shifting visits, and overall. We also collected patient satisfaction data for ARI visits.
From FY19 to FY21, 576,609 patients made 1,358,816 visits to 17 urgent care clinics, including 105,781 visits for which stewardship measures were applied and 149,691 visits for which diagnosis shifting measures were applied. The antibiotic prescribing rate decreased for stewardship-measure visits from 34% in FY19 to 12% in FY21 (absolute change, −22%; 95% confidence interval [CI], −23% to −22%). The antibiotic prescribing rate decreased for diagnosis-shifting visits from 63% to 35% (−28%; 95% CI, −28% to −27%), and the antibiotic prescribing rate decreased overall from 30% to 10% (−20%; 95% CI, −20% to −20%). The patient satisfaction rate increased from 83% in FY19 to 89% in FY20 and FY21. There was no significant association between antibiotic prescribing rates of individual clinicians and ARI visit patient satisfaction.
Although it was affected by the COVID-19 pandemic, an ambulatory antimicrobial stewardship program that focused on improving non–antibiotic-appropriate ARI prescribing was associated with decreased prescribing for (1) the stewardship target, (2) a diagnosis shifting measure, and (3) overall antibiotic prescribing. Patient satisfaction at ARI visits increased over time and was not associated with clinicians’ antibiotic prescribing rates.
Chest radiography compares left ventricular decompression in the same patient supported with extracorporeal membrane oxygenation with atrial septal fenestration and subsequently supported with left ventricular assist device with apical cannulation.
This chapter examines the Shareholder Primacy Norm (SPN) as a widely acknowledged impediment to corporate social responsibility (CSR), including how this relates to Stakeholder Theory. We start by explaining the SPN and then review its status under US and UK law and show that it is not a legal requirement, at least under the guise of shareholder value maximization. This is in contrast to the common assertion that managers are legally constrained from addressing CSR issues if doing so would be inconsistent with the economic interests of shareholders. Nonetheless, while the SPN might be muted as a legal norm, we show that it is certainly evident as a powerful social norm among managers and in business schools— reflective, in part, of the sole voting rights of shareholders on corporate boards and of the dominance of Shareholder Theory. We argue that this view of CSR is misguided, not least when associated with claims of a purported legally enforceable requirement to maximize shareholder value. We propose two ways by which the influence of the SPN among managers might be attenuated: extending voting rights to non-shareholder stakeholders or extending fiduciary duties of executives to non-shareholder stakeholders.
In the decades since R. Edward Freeman first introduced stakeholder theory, which views firms in terms of their relationships to a broad set of partners, the stakeholder approach has drawn increasing attention as a model for ethical business. Edited by Freeman, alongside other leading scholars in stakeholder theory and strategic management, this handbook provides a comprehensive foundation for study in the field, with eighteen chapters covering some of the most important topics in stakeholder theory written by respected and highly cited experts. The chapters contain an overview of the topic, an examination of the most important research on the topic to date, an evaluation of that research, and suggestions for future directions. Given the pace of new scholarship in the field, this handbook will provide an essential reference on both foundational topics as well as new applications of stakeholder theory to entrepreneurship, sustainable business, corporate responsibility, and beyond.
Seven half-day regional listening sessions were held between December 2016 and April 2017 with groups of diverse stakeholders on the issues and potential solutions for herbicide-resistance management. The objective of the listening sessions was to connect with stakeholders and hear their challenges and recommendations for addressing herbicide resistance. The coordinating team hired Strategic Conservation Solutions, LLC, to facilitate all the sessions. They and the coordinating team used in-person meetings, teleconferences, and email to communicate and coordinate the activities leading up to each regional listening session. The agenda was the same across all sessions and included small-group discussions followed by reporting to the full group for discussion. The planning process was the same across all the sessions, although the selection of venue, time of day, and stakeholder participants differed to accommodate the differences among regions. The listening-session format required a great deal of work and flexibility on the part of the coordinating team and regional coordinators. Overall, the participant evaluations from the sessions were positive, with participants expressing appreciation that they were asked for their thoughts on the subject of herbicide resistance. This paper details the methods and processes used to conduct these regional listening sessions and provides an assessment of the strengths and limitations of those processes.
Herbicide resistance is ‘wicked’ in nature; therefore, results of the many educational efforts to encourage diversification of weed control practices in the United States have been mixed. It is clear that we do not sufficiently understand the totality of the grassroots obstacles, concerns, challenges, and specific solutions needed for varied crop production systems. Weed management issues and solutions vary with such variables as management styles, regions, cropping systems, and available or affordable technologies. Therefore, to help the weed science community better understand the needs and ideas of those directly dealing with herbicide resistance, seven half-day regional listening sessions were held across the United States between December 2016 and April 2017 with groups of diverse stakeholders on the issues and potential solutions for herbicide resistance management. The major goals of the sessions were to gain an understanding of stakeholders and their goals and concerns related to herbicide resistance management, to become familiar with regional differences, and to identify decision maker needs to address herbicide resistance. The messages shared by listening-session participants could be summarized by six themes: we need new herbicides; there is no need for more regulation; there is a need for more education, especially for others who were not present; diversity is hard; the agricultural economy makes it difficult to make changes; and we are aware of herbicide resistance but are managing it. The authors concluded that more work is needed to bring a community-wide, interdisciplinary approach to understanding the complexity of managing weeds within the context of the whole farm operation and for communicating the need to address herbicide resistance.
A symptom of mild cognitive impairment (MCI) and Alzheimer’s disease
(AD) is a flat learning profile. Learning slope calculation methods vary, and
the optimal method for capturing neuroanatomical changes associated with MCI and
early AD pathology is unclear. This study cross-sectionally compared four
different learning slope measures from the Rey Auditory Verbal Learning Test
(simple slope, regression-based slope, two-slope method, peak slope) to
structural neuroimaging markers of early AD neurodegeneration (hippocampal
volume, cortical thickness in parahippocampal gyrus, precuneus, and lateral
prefrontal cortex) across the cognitive aging spectrum [normal
control (NC); (n=198;
age=76±5), MCI (n=370;
age=75±7), and AD (n=171;
age=76±7)] in ADNI. Within diagnostic group,
general linear models related slope methods individually to neuroimaging
variables, adjusting for age, sex, education, and APOE4 status. Among MCI,
better learning performance on simple slope, regression-based slope, and late
slope (Trial 2–5) from the two-slope method related to larger
parahippocampal thickness (all p-values<.01) and
hippocampal volume (p<.01). Better regression-based
slope (p<.01) and late slope
(p<.01) were related to larger ventrolateral
prefrontal cortex in MCI. No significant associations emerged between any slope
and neuroimaging variables for NC (p-values ≥.05) or
AD (p-values ≥.02). Better learning performances
related to larger medial temporal lobe (i.e., hippocampal volume,
parahippocampal gyrus thickness) and ventrolateral prefrontal cortex in MCI
only. Regression-based and late slope were most highly correlated with
neuroimaging markers and explained more variance above and beyond other common
memory indices, such as total learning. Simple slope may offer an acceptable
alternative given its ease of calculation. (JINS, 2015,