Background: The CDC recommends that nurses improve the evaluation of penicillin allergies as part of antimicrobial stewardship programs. We evaluated the feasibility of a multifaceted implementation strategy to improve nurses’ documentation of penicillin allergy histories and to encourage nurses to notify prescribers of patients with low-risk symptoms of reported penicillin allergy. The implementation strategy was guided by the COM-B model of behavior change and addressed nurses’ capability, opportunity, and motivation to implement practices (Figure 1). The implementation strategy included education on the STORY mnemonic that details the questions of a penicillin allergy history, education on low-risk symptoms of penicillin allergy, dot phrases in EPIC to facilitate nurses’ documentation of STORY and communication of patients with low-risk penicillin allergy symptoms, and educational pocket cards and flyers. We define feasibility as the implementation and acceptability of practices. Methods: This was a six-month feasibility study conducted in an outpatient perioperative area. We compared penicillin allergy documentation pre- and post- implementation strategy and report on nurses’ notification of prescribers regarding patients with low-risk penicillin allergies in the post-implementation period. We engaged nurses in a focus group to assess factors that facilitated or hindered practice adoption. Results: A total of 426 unique patients with 482 penicillin allergy records were included in our study (n= 207 records pre-implementation, n = 275 records post-implementation). We found little to no change in the percentage of records that included symptom information post vs. pre-implementation (88.36% vs 88.41%). A greater percentage of allergy records in the post vs. pre-implementation periods included information on: timing/years since reaction (25.6% vs. 8.2%), onset of reaction (20.7% vs. 0%), resolution of symptoms (20.4% vs. 0%), and penicillin re-exposure (21.1% vs. 2.4%). There were 24 documented instances of nurses’ notifying prescribers of patients with a low-risk penicillin allergy. Focus group data revealed nurses perceived their comprehensive documentation of penicillin allergies highly acceptable and likely to improve patient care and outcomes. Whereas nurses’ notification of prescribers concerning patients meeting low-risk penicillin allergy criteria had little appeal. Nurses described the STORY mnemonic, pocket cards describing the penicillin allergy assessment mnemonic, and the associated dot phrase in EPIC as particularly helpful. Conclusions: A multifaceted implementation strategy showed promise in improving the comprehensive documentation of penicillin allergy histories. Future studies are needed to determine the efficacy of the multifaceted implementation strategy on penicillin allergy documentation, the selection of antibiotic prophylactic treatment, and clinical outcomes among surgical patients.

We surveyed clinicians to evaluate the perceived usefulness of a mnemonic, STORY, to improve penicillin allergy evaluation. Survey responses indicated that the perceived usefulness of STORY was high, and support for nurses’ involvement in penicillin allergy assessment was high. Future research may evaluate the feasibility of STORY implementation in clinical care.

A comprehensive analysis of early dinosaur relationships raised the possibility that the group may have originated in Laurasia (Northern Hemisphere), rather than Gondwana (Southern Hemisphere) as often thought. However, that study focused solely on morphology and phylogenetic relationships and did not quantitatively evaluate this issue. Here, we investigate dinosaur origins using a novel Bayesian framework uniting tip-dated phylogenetics with dynamic, time-sliced biogeographic methods, which explicitly account for the age and locality of fossils and the changing interconnections of areas through time due to tectonic and eustatic change. Our analysis finds strong support for a Gondwanan origin of Dinosauria, with 99 % probability for South America (83 % for southern South America). Parsimony analysis gives concordant results. Inclusion of time-sliced biogeographic information affects ancestral state reconstructions (e.g., high connectivity between two regions increases uncertainty over which is the ancestral area) and influences tree topology (disfavouring uniting fossil taxa from localities that were widely separated during the relevant time slice). Our approach directly integrates plate tectonics with phylogenetics and divergence dating, and in doing so reaffirms southern South America as the most likely area for the geographic origin of Dinosauria.

We consider a continuous review (s, S) model of perishable items with lost sales. Once items are perished the entire inventory drops instantaneously to zero. The total cost includes the cost of: ordering, unsatisfied demand, units destroyed, holding, and fixed cost of perishability. Both the time to perishability and the lead times are assumed to be exponentially distributed while two cases of demand distribution are considered: Poisson and compound Poisson with general demand sizes. We study the average cost criterion and provide computational results on the problem of finding the optimal re-order level, s, and order up-to level, S. None of the known work on the subject is as general as the model presented here. Our analysis leads to several insights on the optimal (s, S) policies for perishable items in the presence of lead times. For example, we demonstrate that the effectiveness of a heuristic that ignores perishability (and is also analyzed here) decreases with the demand variability and that the cost may either increase or decrease with this variability.

The Center for Responsive Politics reports that U.S. lobbying expenditures substantially exceed interest group campaign contributions, without including the lobbying that is not required to be reported to the government. Although it has grown in Europe, particularly with respect to the European Union, lobbying is less important than in the United States. Bennedsen and Feldmann (BF) provide an important and insightful explanation for the difference in terms of the institutional structure of governments. They present a model of informational lobbying in client politics where an interest group provides information to a majority-rule (three-member) legislature. The legislature chooses the scale of a program whose benefits can be distributed among legislative districts. The legislative agenda setter has a vote buying problem and allocates benefits to one other legislator to obtain her vote. BF compare legislatures operating with and without a confidence procedure that allows the agenda setter to tie passage of its proposal the continuation of the government. This commentary considers the method for comparing these two institutions, assesses the implications of the theory, and considers future research related to the theory.

eBay provides an online auction venue for remote and anonymous members of its online community to realize gains from trade. As a venue it never sees the items sold, verifies the item listings, handles settlements, or represents the buyer or seller. Despite the associated market imperfections and incentive problems, over five million auctions are active on an average day. Trading is based on trust among members of the eBay community, and trust is supported by a multilateral reputation mechanism based on member feedback. eBay supplements the reputation mechanism with rules and policies that mitigate incentive problems, reduce transactions costs, and support trust among members and between members and the company. Reputations and the rules and policies provide a private ordering of eBay's community. This paper examines this private ordering in the context of the company's strategy and in the shadow of the public order.

Few studies report animal grazing effects on weed populations. A study was conducted to assess weed populations in annual and perennial forage grasses grazed at various intensities by cattle over a 4-yr period. The perennial forages were Bromus inermis and Bromus riparius, and the annual forages were winter Triticosecale and a mixture of Hordeum vulgare and winter Triticosecale. With few exceptions, results from the two annual pastures could be adequately described as a group, as could the results from the two perennial pastures. The two most prevalent weed species were Capsella bursa-pastoris and Taraxacum officinale; other species encountered over the course of the study were analyzed as a group. Tillage (seedbed preparation) in the annual system supported a proliferation of annual weeds in the spring. In the perennial pasture system, a lack of tillage and spring MCPA allowed T. officinale to increase as the study progressed, especially at the highest grazing intensity. In the perennial pastures, each unit increase in grazing intensity led to 51 more C. bursa-pastoris m−2 and 4 more T. officinale m−2. At lower levels of grazing intensity, C. bursa-pastoris and other species were most abundant in the annual pastures. Weed population shifts in response to grazing pressure in the annual pasture systems were restricted because of annual tillage and MCPA. Therefore, pasture managers may subject annual pastures to heavy grazing pressure with less negative weed population consequences than perennial pastures where herbicides are not applied.

Firms operate in a capital market, a product market, and a market for social pressure directed at them by social activists, NGOs, and governments. An equilibrium in these three markets yields a three-equation structural model that relates corporate financial performance (CFP), corporate social performance (CSP), and social pressure. This paper estimates the simultaneous equation model for a panel of over 1,600 firms and finds that CFP is uncorrelated with CSP and negatively correlated with social pressure. CSP is decreasing in CFP and increasing in social pressure. Social pressure is increasing in CSP and decreasing in CFP, which is consistent with social pressure being directed to soft targets. Disaggregating the panel indicates that CFP is positively correlated with CSP for firms in consumer markets and negatively correlated for industrial markets. For consumer markets, CSP is increasing in CFP, which is consistent with a perquisites hypothesis that managers spend on CSR when they can afford it. For industrial markets CSP is decreasing in CFP, which is consistent with a moral management hypothesis. For both consumer and industrial markets, CSP is responsive to social pressure.

This paper provides a model of integrated market and nonmarket strategies in the context of an industry facing regulation that differentially affects the firms in the industry. The regulation is chosen in a majority rule institution, and to affect the stringency of the regulation, the firms in the industry can take nonmarket action in the form of providing support to legislators based on how they vote. The nonmarket action is considered in the context of client and interest group politics, where the latter involves competition with an environmental interest group. An integrated strategy is composed of the firm's strategy for its market environment and its strategy for its nonmarket environment. Also the integrated strategies of the firms must constitute an equilibrium in their market competition and an equilibrium for their nonmarket competition, including that with the environmental interest group. Collective action in the form of coalition building and rent chain mobilization is also considered.

The frontier between Gubbio (ancient Umbria) and Perugia (ancient Etruria), in the northeast part of the modern region of Umbria, was founded in the late sixth century bc. The frontier endured in different forms, most notably in the late antique and medieval periods, as well as fleetingly in 1944, and is fossilized today in the local government boundaries. Archaeological, documentary and philological evidence are brought together to investigate different scales of time that vary from millennia to single days in the representation of a frontier that captured a watershed of geological origins. The foundation of the frontier appears to have been a product of the active agency of the Etruscans, who projected new settlements across the Tiber in the course of the sixth century bc, protected at the outer limit of their territory by the naturally defended farmstead of Col di Marzo. The immediate environs of the ancient abbey of Montelabate have been studied intensively by targeted, systematic and geophysical survey in conjunction with excavation, work that is still in progress. An overview of the development of the frontier is presented here, employing the data currently available.