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Within governance agencies, academia, and communities alike, there are increasing calls to recognize the value and importance of culture within social‐ecological systems and to better implement Indigenous sciences in research, policy, and management. Efforts thus far have raised questions about the best ethical practices to do so. Engaging with plural worldviews and perspectives on their own terms reflects cultural evolutionary processes driving paradigm shifts in 3 fundamental areas of natural resource management: conceptualizations of natural resources and ecosystems, processes of public participation and governance, and relationships with Indigenous Peoples and communities with differing worldviews. We broadly describe evolution toward these paradigm shifts in fish and wildlife management. We then use 3 case studies to illustrate the ongoing cultural evolution of relationships between wildlife management and Indigenous practices within specific historical and social‐ecological contexts and reflect on common barriers to appropriately engaging with Indigenous paradigms and lifeways. Our case studies highlight 3 priorities that can assist the field of wildlife management in achieving the changes necessary to bridge incommensurable worldviews: acknowledging and reconciling historical legacies and their continued power dynamics as part of social‐ecological systems, establishing governance arrangements that move beyond attempts to extract cultural information from communities to integrate Indigenous Knowledges into dominant management paradigms, and engaging in critical reflexivity and reciprocal, accountable relationship building. Implementing these changes will take time and a commitment to processes that may initially feel uncomfortable and unfamiliar but have potential to be transformative. Ethical and culturally appropriate methods to include plural and multivocal perspectives and worldviews on their own terms are needed to transform wildlife management to achieve more effective and just management outcomes for all. [ABSTRACT FROM AUTHOR]

Numerous oral histories and substantial ethnographic evidence illustrate how plant species, communities, and even landscapes were extensively managed and cared for by ancestral communities in the Pacific Northwest. Camas (Camassia spp.) is one such cultural keystone plant, common from the Pacific Ocean to the Rocky Mountains, with numerous records describing its role as a staple food for many Northwest peoples. Supporting deep time archeological evidence for such management or stewardship practices, however, has remained elusive. In this paper we analyze archived collections of archeological camas bulbs from 11 sites across the Willamette Valley, Oregon to demonstrate people began preparing camas within earth ovens by approximately 8000 calendar years before present and deliberately harvesting sexually mature camas plants circa 3500 calendar years before present. We compare these findings with climatological, palynological, and fire history reconstructions to discuss stewardship strategies for camas and associated plant communities through time at the population, community, and landscape levels. These findings confirm and expand upon Indigenous knowledges as well as offer time-tested methods for cultural keystone conservationists seeking to revitalize traditional plant stewardship practices throughout this region and beyond. This "camas case study" also offers another example of a human-plant symbiotic relationship, expanding our knowledge of plant food pathways, processes, and mutualisms. [ABSTRACT FROM AUTHOR]

Purpose The need for monitoring and standardization of anticoagulation management has garnered the attention of national organizations, driving the implementation of antithrombotic stewardship programs (ASPs). Established ASPs have highlighted interdisciplinary collaboration between physicians, nurses, and pharmacists and demonstrated financial benefits and positive patient care outcomes. While pharmacy technicians are key members of the pharmacy profession, they are rarely utilized to expand clinical programs. The aim of this report is to describe the impact of adding a pharmacy technician to an ASP at an academic medical center. Summary The departments of pharmacy and quality at West Virginia University Hospitals (WVUH) developed a business plan and financially justified an ASP. The ASP was implemented in January 2022 and consisted of 2 full-time clinical pharmacist specialists, 1 full-time clinical pharmacy technician, 2 full-time clinical nurse specialists, and 1 part-time physician medical director. The clinical pharmacy technician's primary role was to review patients' sequential compression device (SCD) compliance and newly started oral anticoagulants prior to discharge. The clinical nurse specialists educated patients newly started on oral anticoagulants within 24 hours of discharge and triaged any postdischarge medication access issues. The medical director provided high-level program oversight and acted as a clinical consultant on complex patient cases. In the first 6 months after the program's implementation, the clinical pharmacy technician made 174 recommendations to the clinical pharmacist specialists regarding discharge transitions of care and assessed SCD compliance in 246 patients. Of the 246 patients assessed, 217 patients (88%) were deemed to be noncompliant. Conclusion The pharmacy department at WVUH successfully justified and implemented an interprofessional ASP at an academic medical center, which is the first ASP to date to incorporate a clinical pharmacy technician. [ABSTRACT FROM AUTHOR]

Background A commonly used guideline for community-acquired pneumonia (CAP) is the joint American Thoracic Society and Infectious Diseases Society of America practice guideline. We aimed to investigate the effect of guideline-concordant therapy in the treatment of CAP. Methods We systematically searched MEDLINE, Embase, CENTRAL, Web of Science, and Scopus from 2007 to December 2023. We screened citations, extracted data, and assessed risk of bias in duplicate. Primary outcomes were mortality rates, intensive care unit (ICU) admission, and length of stay. Secondary outcomes were guideline adherence, readmission, clinical cure rate, and adverse complications. We performed random-effect meta-analysis to estimate the overall effect size and assessed heterogeneity using the I2 statistics. Results We included 17 observational studies and 82 240 patients, of which 10 studies were comparative and pooled in meta-analysis. Overall guideline adherence rate was 65.2%. Guideline-concordant therapy was associated with a statistically significant reduction in 30-day mortality rate (crude odds ratio [OR], 0.49 [95% confidence interval.34–.70; I2 = 60%]; adjusted OR, 0.49 [.37–.65; I2 = 52%]) and in-hospital mortality rate (crude OR, 0.63 [.43–.92]; I2 = 61%). Due to significant heterogeneity, we could not assess the effect of guideline-concordant therapy on length of stay, ICU admission, readmission, clinical cure rate, and adverse complications. Conclusions In hospitalized patients with CAP, guideline-concordant therapy was associated with a significant reduction in mortality rate compared with nonconcordant therapy; however, there was limited evidence to support guideline-concordant therapy for other clinical outcomes. Future studies are needed to assess the clinical efficacy and safety of current guideline recommendations. [ABSTRACT FROM AUTHOR]

This article explores the precarity that surrounds the acquisition of techigi (yeddo hawthorn) trees, a material used in the production of traditional and contemporary textiles, on the island of Amami Ōshima, southern Japan. A waste product of industrial forestry, the article suggests that the difficulties craftspeople face in accessing techigi are symptoms of complex historical and contemporary processes linked to property regimes and resource management that have dispossessed local residents of ecological stewardship. [ABSTRACT FROM AUTHOR]

Using resources provided by the Bible, tradition, experience, and reason, a close look at magazine articles from the 2023 summer considers the reality of global warming. Scientists exploring a lake's strata, Canadian wildfires, phosphorous runoff, algal blooms, and Phoenix's string of high temperatures suggest we have entered the Anthropocene Era. The idea of domination borrowed from the first chapter of Genesis coupled with Aristotle's Great Chain of Being are used to encourage practices leading to global warming. Theological anomalies from this history raise questions about our continuing use of the triumphal metaphor of God as King of kings. A new ecological awareness and the metaphor of God's Body as the World re-animates theological conversation in this area. Theologians Jürgen Moltmann and Sallie McFague are helpful in this consideration. [ABSTRACT FROM AUTHOR]

Bulk commodity row crop production in the United States is frequently subject to narrow profit margins, often complicated by weather, supply chains, trade, and other factors. Farmers seeking to increase profits and hedge against market volatility often seek to diversify their operations, including producing more lucrative or productive crop varieties. Recombinant plants producing animal or other non-native proteins (commonly referred to as plant molecular farming) present a value-added opportunity for row crop farmers. However, these crops must be produced under robust identity preserved systems to prevent comingling with bulk commodities to maintain the value for farmers, mitigate against market disruptions, and minimize any potential food, feed, or environmental risks. [ABSTRACT FROM AUTHOR]

Copyright of Turkey Journal of Theological Studies is the property of Turkey Journal of Theological Studies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper examines the effect of state-level monitoring on municipal governance, focusing on outcomes in financial reporting quality, local corruption, political entrenchment, and municipal financial soundness. I exploit the staggered adoption of fiscal monitoring policies that entail a regular review of municipal financial reports for signs of fiscal distress. I find that introducing these monitoring policies is associated with an increase in the proxies for reporting quality, a decrease in the number of corruption convictions, and a reduction in re-election likelihood for incumbent politicians. Consistent with the purpose of the policies, my evidence shows that fiscal health ratios of municipalities improve after initiating state monitoring. Collectively, my results are consistent with state fiscal monitoring improving several important aspects of municipal governance. Data Availability: Data are available from the public sources cited in the text. JEL Classifications: G18; G38; H1; H11; H7; H83; M4. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic, a consensus crisis that has had a profound effect on societies and economies globally, compelled family businesses to respond strategically in order to remain afloat. We examine the role of their owner-managers' emotions in the strategic response to the COVID-19 pandemic, drawing on 38 in-depth interviews with owner-managers of small family businesses in Cyprus. Our findings reveal that owner-managers have experienced mainly negative emotions during the pandemic, including higher levels of stress, insecurity, fear, and doubt. By reflecting on these emotions, owner-managers can activate affective mechanisms and apply a stewardship logic to respond strategically. We contribute to the family business literature by conceptualizing key processes at the intersection between owner-manager emotions and strategic responses to the COVID-19 pandemic. By focusing on individual (that is, owner-manager) emotional processes and stewardship attitudes, our study provides a microfoundational explanation of strategic responses during external crises and offers both theoretical and practical implications. [ABSTRACT FROM AUTHOR]

The UK has a long history of providing and managing urban parks. The formal park and garden, developed as a morally improving 'place apart' in the city, can inform people's idea of what a park is. This paper aims to explore the legacy of this conceptualisation of the park through an extensive review of literature and policy documents. This paper examines prevailing discourses by locating them more accurately within its political, economic and social context of the times. The paper also examines why, despite being described as 'treasured assets' by national government today, UK urban parks continue to be undervalued and taken for granted? Why does the lamenting of the fate of UK urban parks sector persist in the twenty-first century? To answer this question, the paper will focus on the formal urban park by applying the analytical framework of place-keeping as a conceptualisation of long-term green space management and stewardship. [ABSTRACT FROM AUTHOR]

Summary: Background: The United States Food and Drug Administration recently announced a national blood culture (BC) bottle shortage; the exact date of restoration is still being determined. Aim: Implement a workflow to mitigate the BC bottle shortage at our hospital. Methods: We created the following clinical decision support workflow in electronic medical record to help mitigate BC bottle use: (a) limit to two BC in 24 hours, (b) only repeat BC if 72 hours have passed from the prior sets, (c) do not repeat BC for coagulase-negative Staphylococcus bacteremia when considered a contaminant (i.e., no implanted vascular device), (d) do not repeat BC for Streptococcus bacteremia, (e) do not repeat cultures for Gram-negative rod bacteremia unless an unknown source, immunosuppression, or clinical worsening. Findings: Post implementation, our weekly average BC bottle use decreased to 29.5%. Conclusion: Within three weeks of the BC bottle shortage announcement, we successfully deployed evidence-based BC restrictions in the electronic medical record (EMR), reducing our BC orders by 29.5%. We encourage others to consider and potentially replicate our workflow to contribute to diagnostic stewardship.

Ecologically considerate use of nature (including agriculture) has often been associated with ‘stewardship’ as a human-nature relationship which involves human care, responsibility and accountability and is thus more sustainable than the alternative human-nature relationship of manager of nature. We show that the consideration of nature in agriculture can go further than stewardship by presenting data from qualitative interviews with Swiss Alpine farmers indicating that many of them view their relationship with nature as a form of partnership. Drawing on literature of human-nature partnership, we characterize this relationship by 1) bidirectionality – a give and take between nature and humans–, 2) the understanding of nature as a subject rather than an object and 3) interaction with nature that consists of collaboration rather than giving commands. The mountain farmers expressed all of these features in their farming practices and descriptions of their role in nature. A few farmers even saw their role as subordinates to nature, for which we introduced the new human-nature relationship category of “apprenticeship”. We further suggest that the partnership relation between humans and nature in many respects shares key features with relational values, for instance in its non-centric nature and in its emphasis of the combination of benefits for people with care for nature. In that sense, we aim at combining different accounts of inclusive, non-dichotomous and context-sensitive dealings with nature and we suggest that this combination is applicable also to contexts beyond agriculture.

ABSTRACTObjective To estimate the economic impact of the developed antimicrobial stewardship program (ASP) versus the preliminary ASP use, in the adults’ general medicine settings in Qatar.Methods Patient records were retrospectively reviewed during two periods: preliminary ASP was defined as the 12 months following ASP implementation (i.e. May 2015-April 2016), and developed ASP was defined as the last 12 months of a 5-year ASP implementation in Hamad Medical Corporation (HMC) (i.e. February 2019-January 2020). The economic impact was the overall cost savings in resource use, including operational costs, plus the cost avoidance associated with ASP.Results A total of 500 patients were included in the study. The operational costs decreased with the developed ASP. Whereas antimicrobial consumption and resource utilisation, and their associated costs, appear to have declined with the developed ASP, with a cost saving of QAR458 (US$125) per 100-patient beds, the avoided cost was negative, by QAR4,807 (US$1,317) per 100-patient beds, adding to a total QAR4,224 (US$1,160) increase in the 100-patient beds cost after ASP development.Conclusions Despite that the developed ASP attained a total cost saving QAR458 (US$125) per 100-patient beds, the avoided cost was QAR-4,807 (US$−1,317) per 100-patient beds, which exceeded the cost savings achieved.

ABSTRACTThis Perspective considers the potential value and limitations of introducing Responsible Innovation approaches from the Global North into Australia and Aotearoa New Zealand. We reflect on the relationship of predominantly Western European understandings of responsibility and endogenous ‘Antipodean’ forms of responsibility, including Indigenous relationalities, collective stewardship, and care that extends to more-than-human worlds. Commencing a dialogue between these different modes of responsibility, we outline incommensurabilities, complementarities, and tensions within two core dimensions of Responsible Innovation, namely anticipation and inclusion. To realise benefits from introducing Responsible Innovation and avoid neo-colonial enforcements of adventitious understandings of responsibility, ‘Antipodean’ practitioners need to understand their multidimensional cultural contexts with the aim of collectively reconfiguring responsible practices. Pursuing intercultural dialogue with ‘Antipodean’ modes of responsibility can, in turn, help to responsibly innovate Responsible Innovation outside of the Global North and strengthen the concept’s foundational ethos of collective stewardship by making it more inclusive and multifaceted.

IntroductionUrinary tract infection (UTI) is one of the most common medical complaints in the emergency department (ED). The aim of this study was to assess the real indication of an initial broad-spectrum treatment administered in the ED for hospitalized patients with a diagnosis of community-acquired UTI (CAUTI).Materials and methodsThis is a monocentric observational retrospective study conducted in the ED of one of the largest tertiary care centers in Lebanon, on a two-year period, including adult patients admitted to the hospital for a CAUTI. The primary outcome was to evaluate the need of downgrading empirical antibiotherapy started in the ED. Secondary outcomes included a description of CAUTIs characteristics: prevalence and risk factors for (extended spectrum beta lactamases) ESBL-related infection, complicated and uncomplicated UTIs, empirical and targeted treatment, and finally the rate of adherence to local guidelines.ResultsThe most isolated strains on urine cultures were gram negative bacilli (GNB) with 29.1% producing ESBL; 69.4% of patients received an ESBL-targeting empirical treatment in the ED, in agreement with local guidelines, 46% of which needed a downgrade. Amikacin adjunction was only indicated in 42.8% of the cases. Patients who received antibiotics in the last 6 months had a 2.36 times higher risk of developing an ESBL-related infection.ConclusionThis study showed a high adherence rate to local recommendations suggesting the use of empirical ESBL-targeting antibiotherapy even in uncomplicated UTIs. However, the frequent need of de-escalation highlights the importance of establishing an efficient multi-drug resistant (MDR) bacteria surveillance system in the community in order to elaborate a stewardship program with more solid local guidelines.

The article discusses the prevalence of severe asthma in South Korea and the challenges associated with oral corticosteroid (OCS) use for managing severe asthma. The Korean Severe Asthma Registry (KoSAR) provides valuable insights into patients with severe asthma in Korea, highlighting the need for OCS stewardship to minimize risks associated with long-term OCS use. The implementation of OCS stewardship involves strategies such as biologics as alternatives to OCS, stepwise OCS tapering protocols, and multidisciplinary collaboration among healthcare providers. By adopting these approaches, the management of severe asthma in South Korea can be improved, leading to better patient outcomes and quality of life. [Extracted from the article]

This study seeks to deepen our understanding of how Spanish-speaking Latinos interact with and view public lands and parks to shape policies that meet their needs. Employing Salt Lake City as a case study, a focus group was used to gather insights on community experiences with an emphasis on the importance of the proximity, maintenance, and safety of parks. The study supports findings found in existing literature regarding the significance of diversity, accessibility, inclusivity, livability, and cultural vibrancy in parks. However, it also brings attention to challenges that Spanish-speaking Latino communities encounter, such as lower usage rates, less diversity of people, and the necessity for parks to serve as substitutes for limited private outdoor areas. Furthermore, Spanish-speaking Latinos expressed concerns about losing parks to new developments in their community because of gentrification. The study emphasizes that addressing these issues is crucial for public lands and parks that promote stewardship, inclusivity, equity, and community welfare.

Abstract Background Resistance to multiple antibiotics by several pathogens has been widely described in children and has become a global health emergency. This is due to increased use by parents, caregivers, and healthcare providers. This study aims to describe the prevalence rates of antibiotic prescribing, ascertain the impact of antimicrobial stewardship programs, and target improving the quality of antibiotic prescribing in the paediatric population over time in a hospital. Method A point prevalence survey of antibiotic use was performed yearly for 4 years to monitor trends in antibiotic prescribing. Data from all patients admitted before 8 a.m. on the day of the PPS were included. A web-based application designed by the University of Antwerp was used for data entry, validation, and analysis ( http://www.global-pps.com ). Results A total of 260 children, including 90 (34.6%) neonates and 170 (65.4%) older children, were admitted during the four surveys. Overall, 179 (68.8%) patients received at least one antibiotic. In neonates, the prevalence of antibiotic use increased from 78.9 to 89.5% but decreased from 100 to 58.8% in older children. There was a reduction in the use of antibiotics for prophylaxis from 45.7 to 24.6%. The most frequently prescribed antibiotic groups were third generation cephalosporins and aminoglycosides. The most common indications for antibiotic prescription were sepsis in neonates and central nervous system infection in older children. The documentation of reason in notes increased from 33 to 100%, while the stop-review date also increased from 19.4 to 70%. Conclusion The indicators for appropriate antibiotic prescription improved over time with the introduction of antibiotic stewardship program in the department.

Abstract Background The burden of antimicrobial resistance (AMR) in Latin America is high. Little is known about healthcare workers’ (HCWs) knowledge, attitudes, and perceptions of antimicrobial stewardship (AS), AMR, and antibiotic use (AU) in the region. Methods HCWs from 42 hospitals from 5 Latin American countries were invited to take an electronic, voluntary, anonymous survey regarding knowledge, attitudes, and perceptions of AS, AMR, and AU between March–April 2023. Findings Overall, 996 HCWs completed the survey (52% physicians, 32% nurses, 11% pharmacists, 3% microbiologists, and 2% “other”). More than 90% of respondents indicated optimizing AU was a priority at their healthcare facility (HCF), 69% stated the importance of AS was communicated at their HCF, and 23% were unfamiliar with the term “antibiotic stewardship”. Most (> 95%) respondents acknowledged that appropriate AU can reduce AMR; however, few thought AU (

Background: The mass gathering in Hajj (Islamic pilgrimage) makes the spread of infectious diseases inevitable. Antibiotics are frequently prescribed during this season. We aimed to measure antimicrobial utilization during the 2022 Hajj and evaluate the practice using quality indicators. Methods: Antimicrobial utilization by Hajj medical facilities (77 primary clinics and 7 hospitals) was measured using the anatomic therapeutic classification defined daily dose (DDD) and DDD/1,000-inhabitant/day (DID), where inhabitants were the Hajj 2022 pilgrims (n = 899,353). Quality indicators included percentages of consumption of different antibiotic classes of the total consumption of antibacterials for systemic use in DID. Results: During Hajj, there was 87,173 outpatient visits and 740 hospitalizations (215 critically ill). Amoxicillin was the most prescribed antibiotic (DID=11.708) followed by azithromycin (DID=7.395). Penicillins fell in the second quartile (i.e., highly prescribed) with a quality indicator value (J01_CE%) of 48.149. The consumption of other antibacterials, including fluoroquinolones, fell in the first quartile (

Climate change is having an immediate and devastating effect on archaeological sites in Florida. The Florida Public Archaeology Network's Heritage Monitoring Scouts (HMS Florida) program empowers local communities to document the impacts of climate change at sites throughout the state. Our ability to document sites shows humanity's resilience to climate fluctuations in the past while also making it clear that adaptation and mitigation of coastal areas in the face of modern anthropogenic climate change must be paramount. This article describes two case studies from coastal Florida that have served as visceral points of focus for local communities to see the impacts of climate change. At Shell Bluff Landing in the northeast part of the state a site stewardship program was developed to closely document changes in time starting in 2016 with alarming results. In the opposite corner of the state at Calusa Island, a private land trust was created to protect local natural environments from the impacts of development. The coastal island has subsequently seen massive loss due to erosion. The article concludes with actions archaeologists can take today to make the communities they work with more resilient, using a prioritization system developed with Palm Beach County as an example. [ABSTRACT FROM AUTHOR]

Background: Resistance to multiple antibiotics by several pathogens has been widely described in children and has become a global health emergency. This is due to increased use by parents, caregivers, and healthcare providers. This study aims to describe the prevalence rates of antibiotic prescribing, ascertain the impact of antimicrobial stewardship programs, and target improving the quality of antibiotic prescribing in the paediatric population over time in a hospital. Method: A point prevalence survey of antibiotic use was performed yearly for 4 years to monitor trends in antibiotic prescribing. Data from all patients admitted before 8 a.m. on the day of the PPS were included. A web-based application designed by the University of Antwerp was used for data entry, validation, and analysis (http://www.global-pps.com). Results: A total of 260 children, including 90 (34.6%) neonates and 170 (65.4%) older children, were admitted during the four surveys. Overall, 179 (68.8%) patients received at least one antibiotic. In neonates, the prevalence of antibiotic use increased from 78.9 to 89.5% but decreased from 100 to 58.8% in older children. There was a reduction in the use of antibiotics for prophylaxis from 45.7 to 24.6%. The most frequently prescribed antibiotic groups were third generation cephalosporins and aminoglycosides. The most common indications for antibiotic prescription were sepsis in neonates and central nervous system infection in older children. The documentation of reason in notes increased from 33 to 100%, while the stop-review date also increased from 19.4 to 70%. Conclusion: The indicators for appropriate antibiotic prescription improved over time with the introduction of antibiotic stewardship program in the department. [ABSTRACT FROM AUTHOR]

Purpose: The majority of pediatric antibiotic prescribing occurs in the outpatient setting and inappropriate use contributes to antimicrobial resistance. There are regional variations in outpatient antibiotic use with the highest rates occurring in the Southern states, including in Appalachia. The purpose of this study was to describe the rates and risk factors for inappropriate antibiotic prescription among pediatric patients enrolled in North Carolina (NC) Medicaid. Methods: We used Medicaid prescription claims data from 2013 to 2019 to describe patterns of pediatric antibiotic prescription in NC. We assessed patient and provider factors to identify variations in prescribing. Findings: Children who were less than 2 years of age, non‐Hispanic White, and living in a rural area had the highest overall rates of antibiotic prescription. Compared to pediatricians, the risk of inappropriate antibiotic prescription was highest among other specialists and general practioners and lowest among nurse practitioners. Rural areas of NC had the highest rates of inappropriate antibiotic prescribing, and the risk for non‐Hispanic Black children compared to children of other races/ethnicities was compounded by rurality. Conclusions: Prescribing practices in NC differ compared to neighboring states with a lower overall risk of inappropriate prescription in Appalachian regions; however, disparities by race and rurality exist. Outpatient stewardship efforts in NC should focus on ensuring health equity by appreciating racial and geographic variations in prescribing patterns and providing education to all health care providers. [ABSTRACT FROM AUTHOR]

Purpose: This paper examines whether the adoption of Japan's Stewardship Code by institutional investors influences their preference for investee companies' governance quality. The Code, introduced by the Financial Services Agency in 2014, promotes constructive engagement between institutional investors and investee companies. Engagement with investees should improve institutional investors' ability to assess governance quality across their portfolios. The paper examines if this results in a positive relationship between the levels of Code-compliant institutional shareholding and investee governance quality. Design/methodology/approach: The association between Code-compliant institutional shareholding levels and a governance quality score is examined for Nikkei 500 companies. Findings: A positive association is observed between shareholdings by Code-compliant institutional investors and investee governance, with board independence playing a key role. Analysis shows that the association between institutional shareholding and governance is stronger for the Code-compliant shareholding than for overall institutional shareholdings. In addition, no significant relationship is found between the levels of shareholding by non-Code-compliant institutional investors and the governance quality score of investee companies. Taken together, the results suggest that Code adoption strengthens institutional investors' preference for high-quality investee governance. Originality/value: Despite the introduction of stewardship regulation worldwide, there is a scarcity of empirical research that examines its operation. The study contributes to the existing literature by providing insights into how compliance with stewardship regulation influences institutional investor decision-making. [ABSTRACT FROM AUTHOR]

The Constitutional and legal landscape for environmental protection in the country, by its nature, can be characterized as a form of anthropocentric extensionism, where stewardship over the environment and natural resources is structured as conserving the environment to advance the rights of human beings, and not as moral extensionism which considers stewardship as acting on behalf of the rights of the environment. The concept of perpetual land trust, as operationalized in the Masungi Geopark Project, looks at stewardship in the context of protecting the environment as a value in itself. Thus, the idea of a perpetual land trust, as implemented in the Masungi Geopark Project, is consistent with moral extensionism. While the Constitution limits the period of exploration, development and utilization of natural resources to 25 years, renewable for a period of 25 years, the perpetual land trusts as operationalized in the Masungi Geopark Project is not for the exploration, development and utilization of natural resources, but solely for protection and rehabilitation purposes. Thus, it can be argued that this management approach does not violate the Constitution or any law. [ABSTRACT FROM AUTHOR]

This study explores the process of place branding in identity development and is based on the Mewar royal family, who own Mewar's heritage through descent. Qualitative data were obtained through in-depth interviews, focus group interviews, and participant observation. Through thematic analysis, a conceptual framework shows the relationship between place branding and place brand identity. The findings contribute to place branding and stewardship theories by showing that place brand leadership and efforts to protect and sustain age-old place brand values require custodians to have stewardship qualities and follow sustainable practices in shaping a place's brand identity. The findings provide valuable lessons for current and future heritage organisations, policymakers, and internal stakeholders. [ABSTRACT FROM AUTHOR]

Aims: In‐hospital prescribing errors may result in patient harm, such as prolonged hospitalisation and hospital (re)admission, and may be an emotional burden for the prescribers and healthcare professionals involved. Despite efforts, in‐hospital prescribing errors and related harm still occur, necessitating an innovative approach. We therefore propose a novel approach, in‐hospital pharmacotherapeutic stewardship (IPS). The aim of this study was to reach consensus on a set of quality indicators (QIs) as a basis for IPS. Methods: A three‐round modified Delphi procedure was performed. Potential QIs were retrieved from two systematic searches of the literature, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) statement. In two written questionnaires and a focus meeting (held between the written questionnaire rounds), potential QIs were appraised by an international, multidisciplinary expert panel composed of members of the European Association for Clinical Pharmacology and Therapeutics (EACPT). Results: The expert panel rated 59 QIs and four general statements, of which 35 QIs were accepted with consensus rates ranging between 79% and 97%. These QIs describe the activities of an IPS programme, the team delivering IPS, the patients eligible for the programme and the outcome measures that should be used to evaluate the care delivered. Conclusions: A framework of 35 QIs for an IPS programme was systematically developed. These QIs can guide hospitals in setting up a pharmacotherapeutic stewardship programme to reduce in‐hospital prescribing errors and improve in‐hospital medication safety. [ABSTRACT FROM AUTHOR]

Shemitah , the Jewish sabbatical year, is increasingly being explored in ecological contexts. This research delves into the concept of stewardship examining the evolving discourse on Shemitah across different community sectors in the Israeli press during the last three sabbatical cycles (2007–2008, 2014–2015, and 2021–2022). Our analysis reveals stewardship worldviews that portray Jewish law as either the practical pathway to implement these worldviews or as an inspiration for contemporary socio-environmental initiatives. The secular-liberal sector emphasizes universal stewardship, aligning with Western environmental concepts, while the national-religious sector integrates both universal and particular stewardship, emphasizing the land's moral dimensions and connecting religious observance with environmental ethics. The ultra-Orthodox sector, though not explicitly expressing eco-theological views, focuses on soil regeneration. This empirical investigation serves as a significant case study and offers valuable guidance for addressing the challenge of instigating behavioral change in religious and traditional populations. [ABSTRACT FROM AUTHOR]

Family firms face significant challenges in professionalizing their management, while the professionalization effects on the firms' performance are unclear. Drawing on stewardship and agency theories, we theorize and test the effects of family ownership and professionalization on firms' financial performance and sustainability (environmental, social and governance) reputation. Using a large-scale management practices dataset of both public and private companies in the US, UK, Germany, and France, we find that family firms outperform nonfamily ones in terms of both financial performance and sustainability reputation, and professionalization helps strengthen such positive effects. We theorize that this is because professionalization can address agent opportunistic behaviors, while enhancing steward behaviors unique to family firms. The findings contribute to the literature on family business governance and professionalization. [ABSTRACT FROM AUTHOR]

Aim. Diagnostic uncertainty, risk perceptions, time constraints, and pressure from resident/family members and nurses have been identified as potential barriers to reducing antibiotic prescribing in residential aged-care facilities. The current study investigated the relationship between nurses' anxiety, clinical tolerance of uncertainty, and behaviors that favor antimicrobial initiation. Methods. A cross-sectional online survey was used to present a clinical vignette with measures of situational anxiety, clinical tolerance to uncertainty using the Physicians Reactions to Uncertainty Scale (adapted for nurses), and self-reported behavior on the Immediate Assessment and Antibiotics scale. The vignette described a hypothetical resident with a potential upper respiratory tract infection. Incremental information was provided with varying levels of symptoms, input from aged-care staff, and the availability of test results. Results. A total of 157 registered and enrolled nurses completed the survey from August 2021 to August 2022. Nurses' anxiety fully mediated on the relationship between clinical tolerance of uncertainty and perceived need for antibiotics and immediate assessment (P = 0.004), with 6% of variation explained by the model. Significant effects of clinical tolerance of uncertainty on anxiety (P < 0.001) and anxiety on antibiotic initiation (P = 0.002) were found, but there was no significant direct effect between clinical tolerance of uncertainty and antibiotic initiation (P = 0.34). Conclusions. This is the first study that links perceived need for antibiotics and assessment to nurses' anxiety and clinical tolerance of uncertainty. Thus, it may be that providing strategies for the management of anxiety related to uncertainty could nullify some processes contributing to inappropriate prescribing in aged-care settings Highlights: The impact of non-clinical factors (e.g., resident and family preferences) on prescribing is well-established. There is a gap in the literature regarding the mechanisms through which these preferences are experienced as pressure by prescribers within the unique context of residential aged-care facilities (RACFs). A significant relationship was found between nurses' anxiety, clinical tolerance of uncertainty, and the perceived need for antibiotics and assessment. As such, there is a need to expand stewardship beyond education alone to include interventions that help nurses manage uncertainty and anxiety and include other stakeholders (e.g., family members) when making clinical decisions in the RACF setting. [ABSTRACT FROM AUTHOR]

Aim: The purpose of the current study was to develop and assess the psychometric properties of a measure that captures nursing behaviours that have the potential to influence the initiation of antibiotics in residential aged‐care facilities. Design: Cross‐sectional online survey. Method: One hundred and fifty‐seven nurses completed an online survey. The survey consisted of two clinical vignettes and measures of tolerance of uncertainty and anxiety. The vignettes consisted of the most common presentations (urinary tract infections and upper respiratory tract infections) of two hypothetical residents in aged‐care facilities. The vignettes provided participants with incremental information with varying levels of symptoms, input from other people and availability of test results. Both vignettes were subjected to exploratory factor analysis. Results: The results focus on the 16 items in the second vignette which resulted in the extraction of three factors. The derived factors were labelled as follows: (i) Noting and Calling GP, (ii) Consult a Colleague and (iii) Immediate Assessment and Antibiotics. Reliability analysis revealed excellent to satisfactory reliability. All three scales were significantly correlated with measures of clinical tolerance of uncertainty, and the 'noting and calling GP' scale was also negatively correlated with measures of anxiety and general tolerance of uncertainty. The measure showed satisfactory reliability and validity for capturing nursing behaviours that have the potential to influence decisions regarding antibiotics. As such, the current study provides a first step towards addressing the lack of ecologically valid measures that capture the complex and nuanced context of nurses' behaviours in RACF that have the potential to inform future stewardship interventions. [ABSTRACT FROM AUTHOR]

Background: The burden of antimicrobial resistance (AMR) in Latin America is high. Little is known about healthcare workers' (HCWs) knowledge, attitudes, and perceptions of antimicrobial stewardship (AS), AMR, and antibiotic use (AU) in the region. Methods: HCWs from 42 hospitals from 5 Latin American countries were invited to take an electronic, voluntary, anonymous survey regarding knowledge, attitudes, and perceptions of AS, AMR, and AU between March–April 2023. Findings: Overall, 996 HCWs completed the survey (52% physicians, 32% nurses, 11% pharmacists, 3% microbiologists, and 2% "other"). More than 90% of respondents indicated optimizing AU was a priority at their healthcare facility (HCF), 69% stated the importance of AS was communicated at their HCF, and 23% were unfamiliar with the term "antibiotic stewardship". Most (> 95%) respondents acknowledged that appropriate AU can reduce AMR; however, few thought AU (< 30%) or AMR (< 50%) were a problem in their HCF. Lack of access to antibiogram and to locally endorsed guidelines was reported by 51% and 34% of HCWs, respectively. Among prescribers, 53% did not consider non-physicians' opinions to make antibiotic-related decisions, 22% reported not receiving education on how to select antibiotics based on culture results and 60% stated patients and families influence their antibiotic decisions. Conclusions: Although HCWs perceived improving AU as a priority, they did not perceive AU or AMR as a problem in their HCF. AS opportunities include improved access to guidelines, access to AMR/AU data, teamwork, and education on AS for HCWs and patients and families. [ABSTRACT FROM AUTHOR]

The microbiology of severe community acquired pneumonia (SCAP) has implications on management, clinical outcomes and public health policy. Therefore, knowledge of the etiologies of SCAP and methods to identify these microorganisms is key. Bacteria including Streptococcus pneumoniae, Staphylococcus aureus and Enterobacteriaceae continue to be important causes of SCAP. Viruses remain the most commonly identified etiology of SCAP. Atypical organisms are also important etiologies of SCAP and are critical to identify for public health. With the increased number of immunocompromised individuals, less common pathogens may also be found as the causative agent of SCAP. Traditional diagnostic tests, including semi-quantitative respiratory cultures, blood cultures and urinary antigens continue to hold an important role in the evaluation of patients with SCAP. Many of the limitations of the aforementioned tests are addressed by rapid, molecular diagnostic tests. Molecular diagnostics utilize culture-independent technology to identify species-specific genetic sequences. These tests are often semi-automated and provide results within hours, which provides an opportunity for expedient antibiotic stewardship. The existing literature suggests molecular diagnostic techniques may improve antibiotic stewardship in CAP, and future research should investigate optimal methods for implementation of these assays into clinical practice. [ABSTRACT FROM AUTHOR]

Background and Objectives: Intravenous immunoglobulin (IVIG) is one of the most costly and limited‐supply blood products. Judicious use of this therapy is important to ensure a continued supply is available for patients in need. The Saskatchewan IG Stewardship Program was initiated to monitor and reduce inappropriate IG use. Materials and Methods: The Program was developed and implemented through the collaborative efforts of a multidisciplinary, inter‐organizational team. Funding was provided from provincial organizations to create new positions within the Program and to support stakeholder engagement throughout the process of implementation. Data were collected from local and national databases regarding the amount of IVIG used and appropriateness of orders based on published criteria. Results: Over 20 months, the Program helped to reduce unnecessary IVIG use from pre‐intervention levels by more than 20%. Interventions from nurse navigators alone reduced inappropriate IVIG use by 2.6%. During the 20‐month period following Program initiation, more than 4 million CAD less was spent on IVIG compared with the previous 20 months. Conclusion: The Saskatchewan IG Stewardship Program has led to more appropriate IVIG use across the province, more effective preservation of this limited healthcare resource, and cost savings that more than cover the cost of administering the Program. [ABSTRACT FROM AUTHOR]

Supply chain issues disrupt veterinary care and cause downstream consequences that alter the practice of veterinary medicine. Antimicrobials are just 1 class of pharmaceuticals that have been impacted by supply chain issues over the last couple of years. Since February 2021, 2 sponsors/manufacturers of penicillin products have reported shortages in the active pharmaceutical ingredient. With the release of the 2021 Summary Report on Antimicrobials Sold or Distributed for Use in Food-Producing Animals by the FDA, a key finding was a 19% decrease in penicillin sales and distribution from 2020 to 2021. Herein, we provide our clinicians' professional perspective regarding how drug shortages, specifically that of penicillin, might contribute to misconstrued patterns in antimicrobial use and what can be done by veterinarians and the FDA to minimize the impact of an antimicrobial drug shortage on animal health and well-being. [ABSTRACT FROM AUTHOR]

The WHO Model List of Essential Medicines (EML) prioritizes medicines that have significant global public health value. The EML can also deliver important messages on appropriate medicine use. Since 2017, in response to the growing challenge of antimicrobial resistance, antibiotics on the EML have been reviewed and categorized into three groups: Access, Watch, and Reserve, leading to a new categorization called AWaRe. These categories were developed taking into account the impact of different antibiotics and classes on antimicrobial resistance and the implications for their appropriate use. The 2023 AWaRe classification provides empirical guidance on 41 essential antibiotics for over 30 clinical infections targeting both the primary health care and hospital facility setting. A further 257 antibiotics not included on the EML have been allocated an AWaRe group for stewardship and monitoring purposes. This article describes the development of AWaRe, focussing on the clinical evidence base that guided the selection of Access, Watch, or Reserve antibiotics as first and second choices for each infection. The overarching objective was to offer a tool for optimizing the quality of global antibiotic prescribing and reduce inappropriate use by encouraging the use of Access antibiotics (or no antibiotics) where appropriate. This clinical evidence evaluation and subsequent EML recommendations are the basis for the AWaRe antibiotic book and related smartphone applications. By providing guidance on antibiotic prioritization, AWaRe aims to facilitate the revision of national lists of essential medicines, update national prescribing guidelines, and supervise antibiotic use. Adherence to AWaRe would extend the effectiveness of current antibiotics while helping countries expand access to these life-saving medicines for the benefit of current and future patients, health professionals, and the environment. [ABSTRACT FROM AUTHOR]

Rural society consists of both humans and other-thanhuman species, whose needs may appear to contradict each other. There is a growing awareness of the shared ecological fate of all members of this interspecies community and the importance of transitioning to more caring, sustainable relationships between species. Various rural activities, and relationships with other species, are considered to be avenues for promoting care and stewardship of other-than-human species. Using interviews, archives and ethnographic research, this article explores how beekeepers navigate multiple and interrelated challenges as they care for their bees and the implications of this care for other species. The beekeeping community is heterogeneous and experiencing dramatic changes. This article finds that beekeepers have different motivations underpinning their diverse practices, yet all share a sense of stewardship for their own bees and for the wider physical environment; this manifests in their understanding of and interactions with other members of rural society. We propose that interspecies understandings and caring relationships, as exemplified within beekeeping, can support efforts towards sustainable socio-ecological transitions. [ABSTRACT FROM AUTHOR]

This paper enriches the understanding of actually existing state entrepreneurialism (SE) through politics of scale, regulatory flexibility, and financialization. The emphasis on "actually existing" uncovers how political discourses are materialized into variegated policy outcomes and territorial politics. The central-local relations and their reinforcement through scalar politics are essential to state regulation, revealing power dynamics in SE. SE represents a distinct governance capacity with regulatory flexibility expressed through state-orchestrated processes designed to meet multifaceted goals. Financialization is instrumentalized in revamping state intervention with commercial and financial logic. Finally, the state is seen as polymorphous in nature given its active stewardship in growth agendas. [ABSTRACT FROM AUTHOR]

The mass gathering in Hajj (Islamic pilgrimage) makes the spread of infectious diseases inevitable. Antibiotics are frequently prescribed during this season. We aimed to measure antimicrobial utilization during the 2022 Hajj and evaluate the practice using quality indicators. Antimicrobial utilization by Hajj medical facilities (77 primary clinics and 7 hospitals) was measured using the anatomic therapeutic classification defined daily dose (DDD) and DDD/1,000-inhabitant/day (DID), where inhabitants were the Hajj 2022 pilgrims (n = 899,353). Quality indicators included percentages of consumption of different antibiotic classes of the total consumption of antibacterials for systemic use in DID. During Hajj, there was 87,173 outpatient visits and 740 hospitalizations (215 critically ill). Amoxicillin was the most prescribed antibiotic (DID=11.708) followed by azithromycin (DID=7.395). Penicillins fell in the second quartile (i.e., highly prescribed) with a quality indicator value (J01_CE%) of 48.149. The consumption of other antibacterials, including fluoroquinolones, fell in the first quartile (<25%). The overall ratio of broad- to narrow-spectrum antibiotic prescribing (J01_B/N) was 1.49. Although the prescribing of β-lactams over fluoroquinolones indicates a good practice, clinicians should be reminded that most infections spreading in mass gatherings are viral; hence, do not require antibiotics. Implementation of antimicrobial stewardship is recommended to improve antimicrobial utilization. [ABSTRACT FROM AUTHOR]