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Prior research has found that consumers who perceive themselves to be members of a brand community are more likely to help the brand recover from a transgression, particularly when they feel psychological ownership of the community. We examine whether consumers are also more likely to help when they perceive that the brand is a member, and therefore a co-owner, of the brand community. We find that perceptions of brand membership in the community increase the likelihood to help after a transgression via perceptions of the brand as a co-owner of the community and brand forgiveness. This suggests that brands perceived as members and co-owners of their communities benefit from protections derived from both ingroup favouritism and expectations of group reciprocity. These relationships are strengthened when the brand is perceived as an active community member through the visibility, but not necessarily the quality, of its interactions with the community. [ABSTRACT FROM AUTHOR]

Quality is central to value-based care, and measurement is essential for assessing performance and understanding improvement over time. Both value-based care and methods for quality measurement are evolving. Infectious diseases (ID) has been less engaged than other specialties in quality measure development, and ID providers must seize the opportunity to engage with quality measure development and research. Antimicrobial stewardship programs are an ideal starting point for ID-related quality measure development; antimicrobial stewardship program interventions and best practices are ID specific, measurable, and effective, yet they are grossly undercompensated. Herein, we provide a scheme for prioritizing research focused on development of ID-specific quality measures. Maturation of quality measurement research in ID, beginning with an initial focus on stewardship-related conditions and then expanding to non-stewardship topics, will allow ID to take control of its future in value-based care and promote the growth of ID through greater recognition of its value. [ABSTRACT FROM AUTHOR]

ABSTRACT Recreational fisheries are dynamic social‐ecological systems. Identification of anticipated future trends supports the design of policies and management to deliver outcomes for fisheries resources, users, and communities. To this end, we applied a forecasting method (i.e., Delphi survey) to recreational fisheries in five Nordic countries. The survey consisted of three rounds and included 20 diverse experts from each country. The study focused on expert perceptions of future trends in angler behaviors linked to specific angling activities (e.g., gear used, species targeted), and more general behavior (e.g., social media use, stewardship). Experts unanimously expected increases in fly fishing, stewardship, and use of angling‐related technologies and social media platforms in the upcoming decade. Results can guide future research, management, and collaboration related to recreational fishing in the Nordic countries and beyond. [ABSTRACT FROM AUTHOR]

This paper analyses Gen 2:4b–15, emphasizing its relevance to the primary purpose of human creation. The text explains why the earth lacks productivity and plants, attributing it to the absence of rain and lack of someone to till the ground. The creation of human beings is seen as the solution, with a mandate to care for the earth. The article urges humanity to uphold the dignity of labour and protect earth's integrity, criticizing modern society, particularly Northern Nigeria, for chemical abuse and destructive practices. The study employs qualitative research and an analytical method, and contextualizes the text in contemporary society. [ABSTRACT FROM AUTHOR]

Building perceptions of trustworthiness that encourage donors to give is critical for nonprofit organizations that depend on charitable giving. Several studies focused on the disclosure of financial and performance information to foster public trust and help donors to make giving decisions. Drawing from stewardship theory, this study explores how additional content dimensions of a more relational nature—including appreciation for the support received and willingness to dialog with donors—might be combined with financial and performance dimensions to design effective online disclosure in the view of nonprofits. By focusing on the viewpoint of European community foundations and using the configurational approach of qualitative comparative analysis, we found that information about fundraising campaigns is deemed must‐have content to discharge online. However, this information alone is not considered to be enough; to retain current donors or attract new ones, it must be combined properly with disclosures demonstrating gratitude to and engagement with donors alongside organizational finances and performance. [ABSTRACT FROM AUTHOR]

Nunatsiavut is a self-governing Inuit territory in northern coastal Labrador, where cultural knowledge and social values are incorporated into co-managed subsistence and commercial fisheries. Snow crab (Chionoecetes opilio), known as Putjotik in Inuttitut (the Nunatsiavut dialect of Inuktitut), is a comanaged fishery through the Torngat Joint Fisheries Board (TJFB) and plays a crucial role in sustaining the community of Makkovik. Arctic Char (IKaluk) is also harvested in co-managed subsistence and commercial fisheries, and is a staple in local economies and culture. In 2022, the TJFB partnered with Inuit educators to foster youth stewardship in a project called Paigitsiaguk. The Paigitsiaguk project bridges Inuit and scientific knowledge to nurture cultural values and environmental stewardship through providing place and land-based resources to educators. The project team created a comprehensive database of curriculum outcomes required by the Newfoundland and Labrador school system, and then designed culturally relevant learning activities that presented Inuit knowledge with science and social studies for students in Nunatsiavut. These resources include learning activities that are organized into education kits: one of which is centered on Putjotik and another on IKaluk. The Putjotik kit has 23 activities tailored to meet grade-specific learning outcomes, while the IKaluk kit provides 12 place-based learning activities appropriate for multiple grade levels. By providing localized and culturally relevant education resources to teachers that revolve around stewarding local fish species and their ecosystems, youth are connecting to their communities and to the coastal environment. Educational resources and learning activities reflect Inuit and scientific knowledge systems, and position teachers as facilitators to encourage students to learn from the land and Elders, knowledge holders, fishers, scientists, and managers. This paper reflects the promising futures that this work can contribute to; from facilitating intergenerational knowledge transmission from knowledge holders to youth, to encouraging self-determined stewardship activities that encourage care for the ocean and its fisheries. [ABSTRACT FROM AUTHOR]

Background and aim: There have been a growing interest in investigating the effect of stewardship on other functions of rehabilitation service delivery. Effective stewardship of rehabilitation services can ensure that these services are of high quality, accessible, affordable, and sustainable, and can help achieve the goals of universal health coverage. The purpose of this study was to identify and analyze the policies adopted in the field of rehabilitation services in Iran and in the international arena, and finally to identify policy gaps, areas for improvement, and areas that have been overlooked. Method: This research is a policy analysis, carried out through document analysis and Dalglish et al.'s READ approach. Data were analyzed and interpreted using qualitative methodology and directed content analysis. For this purpose, Veillard et al.'s health system stewardship framework was used to analyze the stewardship of rehabilitation services. The dimensions of the stewardship framework, were: Defining the vision for health and strategies and policies to achieve better health; influencing all sectors and advocating for better health; ensuring good governance in line with prevailing values; ensuring the alignment of system design with health system goals; improving existing legal and regulatory instruments; and compiling, disseminating, and applying information. Scott's four criteria were used to assess the authenticity, credibility, representativeness, and meaning of the documents. Those that did not meet even one of the Scott's criteria were excluded from content analysis. Findings: A total of 16 documents were identified, all of which met Scott's criteria and none were excluded from the study. A total of six themes and 56 subthemes were extracted. The contents of all the documents were extracted under six themes of Veillard et al.'s health system stewardship framework. Overall, the results show that national documents place greater emphasis on the development of preventive healthcare and health promotion. Documents often focus on engaging NGOs and the families of people with disabilities and on intersectoral collaboration for knowledge production and the development of intersectoral knowledge networks. In terms of health system governance in line with prevailing values, documents are mainly focused on health system stewardship by the Ministry of Health and on evidence-based decision-making with the participation of target groups. Also, documents place more emphasis on upgrading the national infrastructure and increasing access to rehabilitation services. Conclusion: In some areas of rehabilitation services, there is a gap between national documents, which reflects differences in priorities, approaches, resources, and instruments available to strengthen rehabilitation services at the national and international levels. [ABSTRACT FROM AUTHOR]

Introduction: Urinary 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 methods: This 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. Results: The 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. Conclusion: This 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. [ABSTRACT FROM AUTHOR]

This retrospective study found lower antibiotic prescribing rates by outpatient dentists than previous literature, but with deviations from guideline recommendations in antibiotic indications and durations of treatment for oral pain and swelling. These findings will guide future stewardship interventions to promote guideline-directed therapy plans. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is an increasing global concern in small animal veterinary practices. The overuse and misuse of antimicrobials in companion animals can contribute to the spread of AMR between animals and humans. This study aimed to assess small animal veterinarians' knowledge, attitudes, and behaviors towards antimicrobial use (AMU) and AMR in North Macedonia. A web-based questionnaire was developed, including questions addressing demographics, owner influence on antibiotic prescription and prescribing practices. The response rate of the small animal veterinarians was 47.50% (57/120), with most of them (84.20%) having 1-15 years of work experience. Pearson's chi-square test of independence was used for contingency tables that met the chi-square assumption, and Fisher's exact test was conducted for contingency tables that did not. Most veterinarians responded that they had perceived pressure and direct demands from pet owners to prescribe antimicrobials (35.09% frequently, 45.61% occasionally). In the survey, 50.77% of the veterinarians reported frequently administering antibiotics without conducting bacteriological or antimicrobial susceptibility testing. They typically resorted to these tests in cases with recurrent infections, such as skin infections (19.63%), or when empirical therapy is ineffective (14.72%). Based on the findings, it can be concluded that veterinarians play a crucial role in tackling the AMR in North Macedonia. The lack of stewardship programs or guidelines for responsible antimicrobial use in companion animals is a critical issue that requires urgent attention, emphasizing the vital role of veterinarians in combating AMR. [ABSTRACT FROM AUTHOR]

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Limited evidence is available on the most effective diagnostic approaches, management strategies, and long-term outcomes for CAP in patients who have undergone solid organ transplantation. What is the acute and long-term morbidity and mortality after CAP in organ transplant recipients? We retrospectively analyzed hospitalizations for CAP in solid organ recipients at the largest German transplant center. The study included patients admitted between January 1, 2010, and May 31, 2021. The reported outcomes are in-hospital and 1-year mortality, risk of cardiovascular events during hospitalization and at 1 year, admission to the ICU, and risk of pneumonia with Pseudomonas aeruginosa. Multivariable binary logistic regression using stepwise forward selection was performed to determine predictive factors for pneumonia with P aeruginosa. We analyzed data from 403 hospitalizations of 333 solid organ recipients. In > 60% of cases, patients had multiple comorbidities, with cardiovascular and chronic kidney disease being the most prevalent. More than one-half of the patients required oxygen supplementation after admission. In-hospital mortality (13.2%) and the death rate at 1 year postevent (24.6%) were higher than data reported from immunocompetent patients. We also observed high rates of acute cardiovascular events and events occurring 1 year after admission. Early blood cultures and bronchoscopy in the first 24 h significantly increased the odds of establishing an etiology. In our low-resistance setting, the burden of antimicrobial resistance was driven by bacteria from chronically colonized patients, mostly lung transplant recipients. This comprehensive analysis highlights the high morbidity associated with CAP after transplantation. It also emphasizes the need for prospective multicenter studies to guide evidence-based practices and improve outcomes for these vulnerable patients. [ABSTRACT FROM AUTHOR]

The aim of this study is to explore the relationships and perspectives of stakeholders involved in the stewardship of 'urban green infrastructure' in England. We used stewardship of the urban forest network (trees and associated green space) as a focal point by referring to four meanings of 'Stewardship', i.e. Motivation, Ethic, Outcome and Action proposed by Peçanha Enqvist et al. (2018). We studied the perspectives of stakeholders through a multi-regional approach, in five English cities (Newcastle/Gateshead, Leeds, Sheffield, Coventry and Bristol), assessing their views expressed via questionnaire and analysing responses through NVivo. We found support for stewardship as a key aspect of urban green infrastructure planning, one that encourages 'bottom up' participation. In the specific area of urban forestry in England we propose that to ensure a co-stewardship role, planning professionals and citizens should work together at all levels to identify key roles and stewardship niches that are complementary. [ABSTRACT FROM AUTHOR]

Background Objectives Subjects Methods Results Conclusions and Clinical Importance Minimizing harm from antimicrobials requires use of the narrowest spectrum drug, at an effective dose for the minimum effective duration. Many prescribers are not currently following these guidelines. To address suboptimal antimicrobial use, the underlying reasons must be understood.To identify factors influencing choices of antimicrobial drug, dose, and duration for companion animals.Twenty‐two veterinarians treating companion animals in Australia. Diversity of participants was deliberately sought.Semistructured interviews were conducted online. Two case studies were discussed, and then a range of broader questions was posed. Transcripts were analyzed thematically, using an inductive approach.Few participants chose guideline‐concordant management for the case studies. Prescribing choices were influenced by a complex array of factors associated with the clinical case, pet owner, drug, veterinarian, veterinary colleagues, and external factors. Key factors driving broad‐spectrum antimicrobial use included a sense of safety, habit, ease of administering the drug (especially in cats), pharmaceutical marketing, and the self‐perpetuating dispensary cycle. Many participants were concerned about antimicrobial resistance, but insufficiently informed about how to minimize this risk. Several participants believed that longer duration of treatment and ensuring patients finish a predetermined course would decrease the risk of antimicrobial resistance and improve clinical outcomes.Veterinarians are engaged with the concept of antimicrobial stewardship, but face numerous practical barriers and require more information. In particular, improved education is needed on enhancing patient safety by minimizing both spectrum of activity and duration of treatment, and dispelling myths about “finishing the course.” [ABSTRACT FROM AUTHOR]

Communities have a strong role in protecting biodiversity. In addition to participation in restoration, a range of actions in the public or private sphere may support biodiversity. Despite this, there is a lack of clarity about what actions should be prioritized for behavior change campaigns. We developed and applied a method to prioritize community actions for biodiversity conservation that incorporates an expert‐based assessment of impact and a community‐informed measure of the likelihood of uptake. In stage 1, experts (n = 143) completed a survey that quantified the relative impact of actions based on best–worst scaling of perceived impact. In stage 2, surveyed community members (n = 3200) ranked the likelihood of adopting actions based on the ease or difficulty of performing each action, and the opportunity for change based on the proportion of respondents not yet engaging in each behavior. Experts gave the following actions the highest ranking for impact: voting for the environment (first), participating in restoration in ecological priority areas (second), and purchasing and protecting remnant bushland (third). When considering the disciplinary background and institutional background of experts, voting and participating in restoration activities remained in the upper ranked options. However, there was some divergence between these groups. For example, reducing beef consumption was ranked third by university‐based experts but ranked 28th by experts based in state government. Overall, community members ranked the following behaviors as most likely to be adopted: following quarantine laws (first), reducing plastic use (second), and managing pets (third). Top likelihood ranking of actions was minimally affected by community characteristics (nature relatedness, gender, location). Integrating these findings, the action ranked most favorably for impact, likelihood, and opportunity was participating in restoration. Choosing actions for behavior change campaigns requires consideration of the entire social–ecological system—from social factors that enable or constrain adoption to the ecological impact of actions across relevant social and ecological contexts. [ABSTRACT FROM AUTHOR]

This article describes the reallocation of space and construction of a new adult shock trauma intensive care unit implementing methods to mitigate the environmental impact. The environmental burden was reduced through innovative reallocation of space and diversity of lighting sources. Circular economy principles were implemented which enabled much of the infrastructure materials to be reused. Collaboration among interdisciplinary health care teams, such as described in this article, helped to ensure expertise was shared so that the environmental impact was lessened. This article provides insight into innovative methods to mitigate the carbon footprint of a critical care renovation project. [ABSTRACT FROM AUTHOR]

The words we choose to describe our research ultimately directs its course. A dominant term in soil science now, is 'sequestration', referring to the removal of carbon (C) from air and its irreversible seclusion in soil, ideally as stable soil organic carbon (SOC). An emerging view, however, now sees SOC as an inherently dynamic assemblage of forms, all potentially vulnerable to decay, with no discrete, measurable fraction holding C in 'sequestered' form. Rather than speaking of C 'sequestration', then, we might refer instead to SOC 'stewardship'. This word, now, enfolds the entire spectrum of SOC, not merely some elusive 'persistent' or 'stable' fraction, perhaps redirecting inquiry; for example, does C need to be 'sequestered' in stable form for SOC to serve as effective repository of excess atmospheric CO2? 'Stewardship' explicitly accepts the relentless turnover of SOC, emphasizing the need to manage not only fixed stocks of C, but also the cyclical flows of C through ecosystems that drive their functions. Among other benefits, 'stewardship' might motivate us to consider all functions of SOC (not only climate mitigation), consider the entire C cycle (not only enhancing soil C), and preserve existing troves of SOC (not only augmenting them in selected places.) Perhaps most fundamentally, by its etymology, 'stewardship' poses a compelling, timeless question: for whom do we steward SOC? Asking why look after SOC, not only reflects our own underlying quest for resilience, but also expands our potential audience and entices the more creative minds that must succeed us. Although 'stewardship' may elicit new and fruitful inquiry, we may need to look for words even more evocative, more alluring, more true to our mandate of living well within the circling C that must always sustain us. [ABSTRACT FROM AUTHOR]

The article offers a complete overview of the normative framework provided by Italian law and self-regulation regarding the stewardship of asset managers and asset owners. In particular, it focuses on the relationship between hard law and soft law by outlining overlaps and divergences under five different perspectives: the scope of application, the integration of ESG factors, the extension to debtholder stewardship, the type of collaborative engagement promoted, and the problem of enforcement. Building on extant authoritative scholarship, the paper argues that in order to achieve a dynamic synergy between the two layers of the regulatory framework and avoid useless overlaps, Italian soft law should highlight the specificities of the national corporate governance landscape by nudging institutional investors (including foreign ones) into a set of behaviours that is country-specific, offer guidelines to integrate ESG factors, stimulate stewardship for debtholders, further develop platforms for collaborative engagement, and advance a complementary enforcement strategy to the one provided by hard law. [ABSTRACT FROM AUTHOR]

The specific characteristics faced by the public health system in Baja California Sur are presented, based on its demographics, epidemiological circumstances and geographical conditions. Based on this, the adaptation to these characteristics and the main public health challenges that the system has faced in the last two decades are described, trough strategies that have increased the universal health access and coverage based on stewardship and governance. [ABSTRACT FROM AUTHOR]

This paper explores the potential role of the private sector, particularly the crop protection industry, in enhancing emergency pest prevention, preparedness and response (EPPPR) in relation to invasive pests. By leveraging their position and knowledge, private companies can contribute significantly to mitigating pest-related risks, enabling sustainable responses. We outline a comprehensive framework for EPPPR, covering prevention, preparedness, early detection, emergency response and integrated pest management, and we discuss how the private sector can contribute to this framework. We highlight the value that greater private sector involvement could bring to emergency pest prevention, preparedness and early pest detection through its on-the-ground networks and data-sharing capabilities with national plant protection organisations. Additionally, we stress the importance of robust and agile regulatory frameworks and policies for creating an enabling environment for the effective management of emergency pest outbreaks. We also emphasise the potential opportunities provided by private sector investment in research and development in driving innovation in pest management technologies. By fostering partnerships with governments, international organisations, local communities and other stakeholders, the private sector can play a vital role in building a resilient agricultural system capable of withstanding pest challenges. [ABSTRACT FROM AUTHOR]

Background Intraamniotic infection (IAI) affects 2%–5% of pregnancies, causing significant neonatal and maternal morbidity. The American College of Obstetrics and Gynecology suggests ampicillin and gentamicin as first-line IAI treatment. Due to potential drug toxicity, changes in gentamicin susceptibility cutoff points, and rising Enterobacterales gentamicin and ampicillin resistance, changes in IAI antibiotic treatment were implemented at Vanderbilt University Medical Center. Methods Combination ampicillin, gentamicin, and clindamycin were replaced by piperacillin-tazobactam in institutional IAI treatment. Implementation strategies included repeated education sessions to gain stakeholder trust and buy-in and changing preexisting electronic clinical decision support tools (eCDSTs) to a default selection of piperacillin-tazobactam, capitalizing on highly reliable intervention strategies of forcing function and automatization/computerization. Change in antibiotic use, measured in days of therapy (DOT)/1000 patient-days present (1000PDP) by week initiated, before and after eCDST changes, was analyzed with interrupted time series analysis. Effects on hospital length of stay, repeat antibiotics within 14 days, and 30 day readmission were evaluated using multivariable linear and logistic regression. Results After updated eCDST go-live, piperacillin-tazobactam use increased by 1.9 DOT/1000PDP (95% CI, 0.7 to 3.1) by week initiated, and ampicillin, gentamicin, and clindamycin use decreased by −2.5 DOT/1000PDP (95% CI, −3.8 to −1.2) by week initiated. Hospital length of stay, repeat antibiotics within 14 days, and 30-day readmission rate did not significantly change. Conclusions Forced function changes to existing eCDSTs, supported by stakeholder education, successfully changed IAI empiric antibiotic use without unintended patient safety consequences. [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]

The Agreement under the United Nations Convention on the Law of the Sea on the Conservation and Sustainable Use of Marine Biological Diversity of Areas beyond National Jurisdiction (BBNJ Agreement) contains the terms 'stewardship' and 'inherent value' in reference to the protection of ocean areas beyond national jurisdiction (ABNJ). Both terms are situated in specific ethical contexts that give rise to different approaches to valuing, and ultimately protecting, ecosystems. The Sargasso Sea Commission is a useful case study for the application of stewardship and inherent value in the protection of ocean ABNJ, as it combines science, ecosystem valuation, and stakeholder engagement to achieve conservation outcomes. [ABSTRACT FROM AUTHOR]

Managing neonatal sepsis is challenging due to nonspecific clinical signs, hematological markers with poor accuracy, and a lengthy turnaround time for the identification of microorganisms. Delaying the initiation of antibiotics in truly infected infants can lead to severe morbidity and mortality. Therefore, decisions regarding empiric antibiotic treatment are risk stratified, which exposes many uninfected infants to antibiotics. This causes gut microbiota perturbation, unnecessary hospital admissions, and the generation of multi-resistant organisms. High-speed diagnostic assays could expedite discontinuation or avert the initiation of antibiotics in uninfected infants. This study will evaluate the diagnostic performance of molecular culture (MC), a rapid broad-range PCR-based bacterial profiling technique, for diagnosing neonatal sepsis in infants below 90 days old. A multi-center prospective observational cohort study will include infants evaluated for early and late-onset sepsis. Routine evaluation for suspected sepsis includes microbiological cultures of blood. Additionally, blood for MC will be collected. For early-onset sepsis, umbilical cord blood may be used alternatively. Primary outcome is the agreement between MC and conventional blood culture results. Secondary outcome is the agreement of both assays with clinical sepsis using four different, commonly used definitions. Faster diagnostic pathways for sepsis may reduce antibiotic exposure time. Broad-range molecular assays may identify pathogens undetectable by conventional methods. Employment of umbilical cord blood samples for early-onset sepsis diagnosis can resolve challenges in collecting adequate blood volume and could further expedite treatment decisions. [ABSTRACT FROM AUTHOR]

Urban forestry programs across North America rely on volunteers to lead urban forest stewardship activities and encourage participation in tree planting and general maintenance. We examined the leadership structure of a tree planting initiative (TPI) in the greater Philadelphia region to understand the role and labor contributions of volunteer leaders, and the current challenges of achieving equitable urban tree canopy within community-led TPIs. Using an online survey, we found that leaders contribute unpaid labor, time, and skills within the following categories: group organization and communication, tree-planting and event coordination, tree care and maintenance, and broader environmental education and advocacy. Volunteer leaders also face challenges related to leadership and administrative tasks. This study deepens understandings of the labor needs within volunteer TPIs and potential ways to support the equitable growth of these initiatives moving forward. Future research is needed to understand recognitional equity gaps in volunteer leadership more broadly. [ABSTRACT FROM AUTHOR]

Objectives Considering the rapid growth of the aged population and given that older people are the main consumers of health services, it is important to address the effects of population ageing on the health system function. Therefore, this study aims to review the evidence related to the impacts of population ageing on various functions of the health system, including stewardship, financing, resource development, and service provision. Methods & Materials This is a systematic review study. The data were collected through searching in PubMed, Web of Science, ProQuest and Google Scholar for articles published from 2000 to 2022, using the related keywords. Quality assessment of selected articles was done using the STROBE checklist. To analyze the extracted data, the World Health Organization's health system performance assessment framework was used. Results Of 1954 identified articles, 23 were finally selected based on inclusion and exclusion criteria. In the function of stewardship, the impacts were related to the managerial and policy aspects and the increased need to respond to the growing health needs of the elderly. In the function of financing, the impacts included the increase of financial burden on the health system and the need to provide financial resources. In the resource generation function, the impacts were categorized into human, information and physical resources. In the function of service provision, the impacts were on the demand for services, the complexity of service provision, and the method of service provision to elderly. Conclusion The impacts of population ageing on the functions of the health system, especially the financing function, are inevitable. The increase in the aged population is associated with the increase in health costs. Policy makers and managers of the health system should use practical strategies to strengthen the health system against the effects of population ageing. [ABSTRACT FROM AUTHOR]

The automotive industry is actively pursuing a course of sustainable development; however, to date, progress has been limited. This is because a truly sustainable future requires a substantial and transformative approach to automobility. Some scholars argue that this transformative approach might be found by exploring an industry transition based on stewardship rather than the current status quo of incremental change. Hence, as a way of offering new insights to stimulate action for sustainability, this study presents the first comprehensive review of stewardship in the automotive sector. From an analysis of 161 peer‐reviewed articles published between 1990 and 2022, we identified two underconceptualized forms of stewardship—environmental and social—both of which have an interconnected relationship. Environmental stewardship involves actions that address ecological challenges, while social stewardship pertains to broader, positive impacts on communities. We argue that understanding the interplay between these different forms of stewardship is crucial for achieving comprehensive sustainability outcomes. Additionally, this research identifies gaps in the literature and outlines areas for future research to help both managers and society navigate the complex sustainability issues facing the automotive industry. [ABSTRACT FROM AUTHOR]

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Abstract Background and aim There have been a growing interest in investigating the effect of stewardship on other functions of rehabilitation service delivery. Effective stewardship of rehabilitation services can ensure that these services are of high quality, accessible, affordable, and sustainable, and can help achieve the goals of universal health coverage. The purpose of this study was to identify and analyze the policies adopted in the field of rehabilitation services in Iran and in the international arena, and finally to identify policy gaps, areas for improvement, and areas that have been overlooked. Method This research is a policy analysis, carried out through document analysis and Dalglish et al.’s READ approach. Data were analyzed and interpreted using qualitative methodology and directed content analysis. For this purpose, Veillard et al.‘s health system stewardship framework was used to analyze the stewardship of rehabilitation services. The dimensions of the stewardship framework, were: Defining the vision for health and strategies and policies to achieve better health; influencing all sectors and advocating for better health; ensuring good governance in line with prevailing values; ensuring the alignment of system design with health system goals; improving existing legal and regulatory instruments; and compiling, disseminating, and applying information. Scott’s four criteria were used to assess the authenticity, credibility, representativeness, and meaning of the documents. Those that did not meet even one of the Scott’s criteria were excluded from content analysis. Findings A total of 16 documents were identified, all of which met Scott’s criteria and none were excluded from the study. A total of six themes and 56 subthemes were extracted. The contents of all the documents were extracted under six themes of Veillard et al.‘s health system stewardship framework. Overall, the results show that national documents place greater emphasis on the development of preventive healthcare and health promotion. Documents often focus on engaging NGOs and the families of people with disabilities and on intersectoral collaboration for knowledge production and the development of intersectoral knowledge networks. In terms of health system governance in line with prevailing values, documents are mainly focused on health system stewardship by the Ministry of Health and on evidence-based decision-making with the participation of target groups. Also, documents place more emphasis on upgrading the national infrastructure and increasing access to rehabilitation services. Conclusion In some areas of rehabilitation services, there is a gap between national documents, which reflects differences in priorities, approaches, resources, and instruments available to strengthen rehabilitation services at the national and international levels.

Antimicrobial resistance (AMR) is an increasing global concern in small animal veterinary practices. The overuse and misuse of antimicrobials in companion animals can contribute to the spread of AMR between animals and humans. This study aimed to assess small animal veterinarians’ knowledge, attitudes, and behaviors towards antimicrobial use (AMU) and AMR in North Macedonia. A web-based questionnaire was developed, including questions addressing demographics, owner influence on antibiotic prescription and prescribing practices. The response rate of the small animal veterinarians was 47.50% (57/120), with most of them (84.20%) having 1-15 years of work experience. Pearson’s chi-square test of independence was used for contingency tables that met the chi-square assumption, and Fisher’s exact test was conducted for contingency tables that did not. Most veterinarians responded that they had perceived pressure and direct demands from pet owners to prescribe antimicrobials (35.09% frequently, 45.61% occasionally). In the survey, 50.77% of the veterinarians reported frequently administering antibiotics without conducting bacteriological or antimicrobial susceptibility testing. They typically resorted to these tests in cases with recurrent infections, such as skin infections (19.63%), or when empirical therapy is ineffective (14.72%). Based on the findings, it can be concluded that veterinarians play a crucial role in tackling the AMR in North Macedonia. The lack of stewardship programs or guidelines for responsible antimicrobial use in companion animals is a critical issue that requires urgent attention, emphasizing the vital role of veterinarians in combating AMR.

Objectives Considering the rapid growth of the aged population and given that older people are the main consumers of health services, it is important to address the effects of population ageing on the health system function. Therefore, this study aims to review the evidence related to the impacts of population ageing on various functions of the health system, including stewardship, financing, resource development, and service provision. Methods & Materials This is a systematic review study. The data were collected through searching in PubMed, Web of Science, ProQuest and Google Scholar for articles published from 2000 to 2022, using the related keywords. Quality assessment of selected articles was done using the STROBE checklist. To analyze the extracted data, the World Health Organization’s health system performance assessment framework was used. Results Of 1954 identified articles, 23 were finally selected based on inclusion and exclusion criteria. In the function of stewardship, the impacts were related to the managerial and policy aspects and the increased need to respond to the growing health needs of the elderly. In the function of financing, the impacts included the increase of financial burden on the health system and the need to provide financial resources. In the resource generation function, the impacts were categorized into human, information and physical resources. In the function of service provision, the impacts were on the demand for services, the complexity of service provision, and the method of service provision to elderly. Conclusion The impacts of population ageing on the functions of the health system, especially the financing function, are inevitable. The increase in the aged population is associated with the increase in health costs. Policy makers and managers of the health system should use practical strategies to strengthen the health system against the effects of population ageing.

Purpose: This paper aims to analyze the direct and indirect effects of investor protection on forced CEO turnover. Design/methodology/approach: The authors investigate 5,175 firm-year observations from 16 European countries over 2012–2018, collect data on four national investor protection indicators, identify 196 forced CEO turnovers and use multiple logistic regression models. Findings: The results show that a reduction in the degree of investor protection significantly increases the probability of a forced change of the company's CEO. Furthermore, when the degree of investor protection increases, directors are attributed a lower degree of responsibility in the event of a decline in earnings performance. Therefore, the relation between a decrease in profitability and a forced change of CEO is reduced. Research limitations/implications: The research is focused on countries belonging to the European Economic Area and most of the investor protection indicators are derived from surveys. Concerning policy implications, the findings suggest that regulators should focus on the effective enforcement of investor protection mechanisms. Social implications: The results confirm that characteristics at the country level have an impact on corporate decisions, highlighting the importance of increasing the degree of investor protection as a means of mitigating agency conflicts and improving stewardship. Originality/value: To the best of the authors' knowledge, this study explores a relatively underinvestigated topic as it uses investor protection indicators to jointly evaluate both direct and indirect effects on forced changes of CEO through cross-national research. [ABSTRACT FROM AUTHOR]

Objectives: Dental antibiotic stewardship is crucial in low‐ and middle‐income countries where the burden of antimicrobial resistance (AMR) is high and antibiotic misuse is common. Given that India is the most populous country, the largest antibiotic consumer and has a large dental prescriber population, this study investigated the extent to which current Indian policy and practice for dental antibiotic prescribing and stewardship aligns with the global policy and best practice. Methods: The READ approach was used to identify and extract data and synthesize the findings. Policy documents on dental antimicrobial stewardship were identified using a systematic search strategy involving nine medical and grey literature databases (Medline, Global Health, Web of Science, Cochrane, CINAHL, Eldis, Global Index Medicus, Proquest and Opengrey), targeted websites (government organizations and dental regulatory bodies) and contact with experts. Framework analysis was used to code extracted data into themes related to dental antimicrobial stewardship. Results: Of the 3039 records screened, 25 documents were included in the final analysis. The analysis showed a lack of guidelines or toolkits for appropriate antibiotic prescribing in dentistry in India. The treatment guidelines for antimicrobial use in common syndromes published by the Indian Council of Medical Research had no section or content for dental practitioners. Furthermore, the undergraduate dental curriculum developed by the Dental Council of India (DCI), included little content on appropriate antibiotic prescribing and no mention of AMR or stewardship. There were no educational resources either for dental practitioners or patients in the documents. Conclusion: This document analysis showed that there was little or no mention of dental antibiotic prescribing guidelines in key policy documents such as the National Action Plan on AMR. In addition, contradictory and subjective information provided in some policy documents could encourage dentists and other health professionals such as general practitioners to prescribe antibiotics for common dental conditions for which they are contra‐indicated. There is an urgent need to develop relevant guidelines and include these in Indian policy documents on AMR particularly the National Action Plan on AMR. [ABSTRACT FROM AUTHOR]

Aims: Judicious antimicrobial use in companion animal practice is critical for maintaining the effectiveness of antimicrobial agents against bacterial infections and reducing the selection of antimicrobial‐resistant bacteria. This study aimed to provide insights into companion animal veterinarians' antimicrobial treatment recommendations for common bacterial infections in dogs and cats and describe the factors influencing their prescription choices. Methods and Results: An online survey using QualtricsXM® software was administered between September and November 2022 to companion animal veterinarians who were Illinois State Veterinary Medical Association members. Descriptive and text analyses were conducted to assess the participants' responses. A total of 78 surveys were included in the analysis. Skin infections were ranked as the most common bacterial infections for which veterinarians prescribed antimicrobial agents, followed by ear, urinary tract, respiratory, and enteric infections. The severity of clinical symptoms and the results of bacterial culture and susceptibility tests were the most influential factors for veterinarians when making antimicrobial prescription choices. Veterinarians were aware of the current antimicrobial prescription guideline recommendations when prescribing antimicrobials empirically to nine hypothetical scenarios of bacterial infections. According to the results of the text analysis that assessed veterinarians' responses to an open‐ended question, regarding their challenges when prescribing antimicrobial agents, the pairwise correlation of word frequencies within each response showed the highest correlations between the words 'owner' and 'compliance', 'administration' and 'route', 'cost' and 'culture', and 'patients' and 'acceptance'. Conclusions: The study results can support animal health stakeholders in the development of antimicrobial stewardship programmes to promote appropriate antimicrobial use and limit the emergence of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Every culture creates and keeps records. Archivists have a pivotal responsibility toward the relationality of the historical past to present societal structure to preserve records of evidential and historical value and ensure their accessibility. Despite cultural differences, archivists impose colonial theory onto Indigenous archival materials that result in a lack of context. Because provenance is a colonial construct, it is often challenged when applied to cultural materials. In this article, the principle of provenance is discussed and challenged, against the backdrop of Indigenous archival practice that centers relationality and reciprocity in stewardship. Highlighting the example of the Jean Chaudhuri Collection at the Arizona State University Labriola National American Data Center, archivists employed a storytelling provenance providing rich context and description about the impactful life of Indigenous activist, Jean Chaudhuri. By reimagining and employing a practical, alternative provenance method, the principle of provenance, expands to respectfully support and provide context that was lacking, resulting in improved accessibility to a collection. [ABSTRACT FROM AUTHOR]

This study assesses the importance of dominion beliefs in relationship to stewardship beliefs in shaping attitudes related to climate change among the American people. Though typically viewed as alternative viewpoints, this study examines two separate measures—one capturing dominion and another capturing stewardship beliefs—allowing for an analysis of how these two viewpoints relate to each other and whether they have differential relationships on attitudes toward climate change. Using a large national sample conducted in 2022, this study reveals that one's dominion position can only be fully understood in relationship to one's stewardship position, with the resultant combined measure retaining statistical significance in multivariate analysis, suggesting that theological beliefs related to dominion and stewardship significantly shape climate attitudes beyond what can be accounted for by political variables or other important variables related to climate change. [ABSTRACT FROM AUTHOR]

Nicole Adams,1 Carol A Ott,2 Cody J Mullen,3 Yitong Wang4 1Purdue Regenstrief Center for Healthcare Engineering, West Lafayette, IN, USA; 2Purdue Department of Pharmacy Practice, West Lafayette, IN, USA; 3Purdue Department of Public Health, West Lafayette, IN, USA; 4Purdue School of Nursing, West Lafayette, IN, USACorrespondence: Nicole Adams, Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA, 47907, Email adams417@purdue.eduAbstract: The opioid crisis in the United States continues to take the lives of tens of thousands of Americans each year. Opioid medications are important components of acute pain management and opioid stewardship is necessary to mitigate opioid misuse while providing adequate pain control for patients with severe medical needs. The definition of opioid stewardship includes the use of evidence-based guidelines, policies, and patient-centered practices to promote appropriate prescribing, use, and deprescribing of opioids to optimize treatment and minimize adverse consequences. There is little concrete guidance about how to achieve these goals or define the role and importance of various healthcare professionals in opioid stewardship programs. An integrative review process was used to evaluate and collate best practices in opioid stewardship from a variety of published papers. The integrative review was chosen to be inclusive of papers outside of quantitative research, allowing for interpretation of qualitative research, position statements, reports, editorials, and opinions. Data extraction included 71 publications that revealed common characteristics that can improve and coalesce opioid stewardship programs. Top characteristics and themes developed include prescribing guidelines, patient and provider education, referral and consultation, prescribing audits, barriers to opioid stewardship, the use of multidisciplinary teams and non-physician healthcare providers, accountability, risk of misuse, access to care, and patient-centeredness. The use of electronic health record tools, decision support tools, patient screening and discharge standards, and opioid tapering were recommended. Open and consistent communication between patients and healthcare providers is deemed essential. Staffing resources were found to be a significant barrier to opioid stewardship. This integrative review of publications related to opioid stewardship seeks to provide a comprehensive list of best practices that can be incorporated into programs to streamline processes and contribute to an organized foundation that can be used in research to illuminate practices that lead to enhanced outcomes.Keywords: opioid, stewardship, multidisciplinary, education, patient-centered, barriers

Background: Antimicrobial stewardship is vital for our hospital practice but it requires a knowledge of antibiotic prescribing practices, which is currently lacking. This survey aimed to assess the antimicrobial prescribing practices in our hospital. Method: To obtain baseline information on antimicrobial prescribing practices, a uniform and standardized method for surveillance of antibiotic use in hospitals was employed. A point prevalence survey (PPS) was conducted in all the wards of the Massey Street Children’s hospital in June 2019. The PPS included all i n p a t i e n t s r e c e i v i n g a n antimicrobial on the day of survey. Data collected included age, gender, antimicrobial agents, microbiological data, and compliance to guidelines, documentation of reasons and stop/ review date of prescription. The denominator was the number of eligible patients. A web-based application developed by the University of Antwerp was used for data-entry, validation and reporting. Results: Sixty-seven children were eligible, of which 62 (92%) CC –BY 4.0 received 128 antimicrobials. Fifty- seven (85%) were on multiple antimicrobial therapies, and route of administration was parenteral in 86%. All prescriptions were empiric. Reasons for prescribing were documented in 121(94.5%) therapies in case notes; Stop/review dates were not documented in 126(98.4%). The most frequently prescribed antibiotics we r e c e f u r o x i m e ( 1 8 % ) , Ampicillin-sulbactam (15%) and gentamicin (12%). Antibiotic guidelines were not available. Most common diagnoses were sepsis (42%), pneumonia (15%) and malaria (9%). Conclusion: This survey revealed v e r y h i g h a n t i m i c r o b i a l prescribing rates in the hospital and the need to assess it appropriateness. We disclosed areas to improve antibiotic prescribing: antibiotic prescribing according to guidelines and low reporting of a stop/review date. There is a need to create awareness for evidence based antibiotic guidelines.

The Coronavirus disease 2019 (COVID-19) pandemic increased the burden of critically ill patients who required hospitalization in the intensive care unit (ICU). Bacterial and fungal co-infections, including bloodstream infections (BSIs), increased significantly in ICU patients with COVID-19; this had a significant negative impact on patient outcomes. Reported data pertaining to BSI episodes from the ICU setting during the COVID-19 pandemic were collected and analyzed for this narrative review. We searched the PubMed database for articles published between March 2020 and October 2023; the terms “COVID-19” AND “bloodstream infections” AND “ICU” were used for the search. A total of 778 articles were retrieved; however, only 27 were exclusively related to BSIs in ICU patients with COVID-19. Data pertaining to the epidemiological characteristics, risk factors, characteristics of bacterial and fungal BSIs, patterns of antimicrobial resistance, and comparisons between ICU and non-ICU patients during and before the COVID-19 pandemic were obtained. Data on antimicrobial stewardship and infection-control policies were also included. The rates of BSI were found to have increased among ICU patients with COVID-19 than in non-COVID-19 patients and those admitted during the pre-pandemic period. Male gender, 60–70 years of age, increased body mass index, high Sequential Organ Failure Assessment scores at admission, prolonged hospital and ICU stay, use of central lines, invasive ventilation, and receipt of extracorporeal membrane oxygenation were all defined as risk factors for BSI. The use of immune modulators for COVID-19 appeared to increase the risk of BSI; however, the available data are conflicting. Overall, Enterococci, Acinetobacter baumannii, and Candida spp. emerged as prominent infecting organisms during the pandemic; along with Enterobacterales and Pseudomonas aeruginosa they had a significant impact on mortality. Multidrug-resistant organisms prevailed in the ICU, especially if antimicrobial resistance was established before the COVID-19 pandemic and were significantly associated with increased mortality rates. The unnecessary and widespread use of antibiotics further increased the prevalence of multidrug-resistant organisms during COVID-19. Notably, the data indicated a significant increase in contaminants in blood cultures; this highlighted the decline in compliance with infection-control measures, especially during the initial waves of the pandemic. The implementation of infection-control policies along with antibiotic stewardship succeeded in significantly reducing the rates of blood contamination and BSI pathogens. BSIs considerably worsened outcomes in patients with COVID-19 who were admitted to ICUs. Further studies are needed to evaluate adequate preventive and control measures that may increase preparedness for the future.

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.

AbstractBackgroundMethodsResultsConclusionThe literature on the ethics of biobanking often overlooks the practical operations of biobanks. The ethics of stewardship requires that biobank resources are used to conduct beneficial science. Networked biobanks have emerged to increase the scientific benefit of biobank resources, but little is known about whether and how operations of networking may accomplish this goal.As part of a larger study on the ethical, legal, and social implications (ELSI) of networked biobanking, we conducted 38 interviews with representatives of 31 networked biobanks. Interviews explored operations of the networks. We used thematic analysis to examine how respondents describe three topics associated with stewarding biobank resources—funding, utilization, and sustainability.Our results highlight that funding, utilization, and sustainability are critical not only to the operation of biobanks, but also to the ethical obligations that biobankers owe to stakeholders to steward the resources. Based on prior research, we hypothesized that respondents would describe networking as beneficial to increasing funding, utilization, and sustainability of the network. Respondents generally found value in networked biobanking, but networking did not necessarily increase funding, utilization, and sustainability.The results presented here support inclusion of funding, utilization, and sustainability as topics of ethical concern in the practice of biobanking and networked biobanking. These issues are rooted in the stewardship obligations that biobankers feel to their partners, client investigators, and participants. The goal of promoting stewardship through networking requires significant time and effort to build governance models that honor the obligations of each individual biobank to their donors and advance the collective goals of the network. We conclude with suggestions offered by respondents to address improving these aspects of stewardship. [ABSTRACT FROM AUTHOR]

Antimicrobial drug use (AMU) in veterinary medicine may contribute to antimicrobial resistant (AMR) infections in both animals and people. Efforts to improve AMU in companion animal medicine are underway and should include all members of the veterinary team, including veterinary support staff. Our objective was to describe knowledge and attitudes regarding AMU, AMR, and antimicrobial stewardship (AMS) in companion animal medicine among veterinary support staff professionals in the United States using an anonymous, online questionnaire. Additionally, we sought to explore veterinary support staff perceptions of their role in the antimicrobial drug (AMD) prescribing process. Veterinary technicians, nurses, assistants, client care representatives, and hospital managers (n = 337) considered AMR a global concern (83.4%), and 40% reported receiving AMR education from their employer. Few (18.3%) were aware of AMS, with only 6.4% indicating that their clinic had an AMS program. Frequent involvement in the AMD prescribing process was reported (43.4%), but only 19.7% perceived involvement with AMS interventions. Approximately one-third of participants (34.9%) said that advice regarding the need for AMDs was routinely provided by staff to pet owners prior to veterinary consultation. Participants estimated that 82.6% of all AMD prescriptions were filled at the clinic as opposed to an outside pharmacy. Given their direct involvement in the AMD prescribing process and frequent interactions with pet owners, AMS should be emphasized to all veterinary staff. Involving support staff in AMS interventions is necessary to improve AMU in companion animal medicine. [ABSTRACT FROM AUTHOR]

In a retrospective, ecological analysis of US medical claims, visit rates explained more of the geographic variation in outpatient antibiotic prescribing rates than per-visit prescribing. Efforts to reduce antibiotic use may benefit from addressing the factors that drive higher rates of outpatient visits, in addition to continued focus on stewardship. [ABSTRACT FROM AUTHOR]

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]