Women in the control arm received routine antenatal care. As is standard practice at our institution, this did not involve any formal dietary advice or specific advice about gestational weight gain. Women randomised to the intervention group attended one dietary education session lasting two hours in groups of two to six women with the research dietitian. The mean gestational age of those attending the dietary session was 15.7 (SD 3.0) weeks. The diet was designed to meet current recommendations for pregnant women.22 Women were first advised on general healthy eating guidelines for pregnancy, following the food pyramid. The remainder of the education session focused on the glycaemic index—its definition, concept, and rationale for use in pregnancy. Women were encouraged to choose as many low glycaemic index foods as possible and to exchange high glycaemic index carbohydrates for low glycaemic index alternatives. Women received written resources about low glycaemic index foods after the education session (web appendix). The recommended low glycaemic index diet was eucaloric, and women were not advised to reduce their total caloric intake. The research dietitian met with the patients at 28 and 34 weeks’ gestation for reinforcement of the low glycaemic index diet and to answer any dietary queries they had.
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Institutional Practice
Institutional Practice
Institutional Practice refers to the established procedures, guidelines, and standards that govern the operations and decision-making processes within healthcare organizations, research institutions, or other professional settings.
This domain encompasses the policies, protocols, and best practices that guide the delivery of services, the conduct of research, and the overall management of an institution.
Institutional Practice aims to ensure consistency, quality, and compliance with relevant regulations, while also promoting efficiency and optimizing outcomes for patients, clients, or stakeholders.
Key aspects include resource allocation, staff training, quality assurance, risk management, and the integration of technological innovations to enhance institutional performance.
By adhering to Institutional Practice, organizations can foster a culture of professionalism, accountability, and continuous improvement, ultimately delivering superior services and advancing their respective fields.
This domain encompasses the policies, protocols, and best practices that guide the delivery of services, the conduct of research, and the overall management of an institution.
Institutional Practice aims to ensure consistency, quality, and compliance with relevant regulations, while also promoting efficiency and optimizing outcomes for patients, clients, or stakeholders.
Key aspects include resource allocation, staff training, quality assurance, risk management, and the integration of technological innovations to enhance institutional performance.
By adhering to Institutional Practice, organizations can foster a culture of professionalism, accountability, and continuous improvement, ultimately delivering superior services and advancing their respective fields.
Most cited protocols related to «Institutional Practice»
Carbohydrates
Care, Prenatal
Diet
Dietitian
Food
Gestational Age
Hypoglycemia
Institutional Practice
Patients
Pregnancy
Pregnant Women
Reinforcement, Psychological
Therapy, Diet
Woman
COMPOSER consists of three modules. First, a weighted input layer that scales the value of a clinical variable depending on the time since it was last measured. Intuitively, this layer attempts to mimic a clinician’s thought process of putting more importance on the most updated vitals and labs, depending on the physiologically plausible rates at which such measurements can change. As such, the weighted input layer was designed to incorporate some information about the timing of clinical measurements without allowing the network to exploit the correlation between frequency of measurements and disease severity or patients’ level of care47 (link). Such factors are often affected by the institution-specific workflow practices and care protocols and likely to reduce the generalizability of a predictive algorithm. The output of this layer was fed into an encoder network (a feed forward neural network) that is used to reduce data dimensionality. The second module is a conformal predictor which is used to establish the ‘conditions for use’ of the model by statistically assessing the conformity of any new test instance to a pre-constructed bag of examples (‘conformal set’) drawn from the training set. The third module includes a sepsis predictor, which is a feedforward neural network whose output is a probability score (between 0 and 1) that represents the risk of sepsis. All the modules are parametrized as neural networks and trained end-to-end, and enable the application of local interpretability methods such as relevance scores (RS) and layer-wise relevance propagation (LRP)48 (link).
Conformal prediction enables the algorithm to determine the level of data distribution shift, including data quality and missingness level, at which the input data remains appropriate for prediction. The development and evaluation of COMPOSER involved two steps: First, the first and the second modules were trained using the combined Hospital-A ICU and ED training sets. Second, the conformal set (consisting of representations from the encoder module) was constructed from the combined Hospital-A ICU and ED training sets. Finally, the trained modules along with the conformal set were used for model evaluation. Each of the individual components of COMPOSER, namely the weighted input layer and conformal prediction are explained in detail in the following sections.
Conformal prediction enables the algorithm to determine the level of data distribution shift, including data quality and missingness level, at which the input data remains appropriate for prediction. The development and evaluation of COMPOSER involved two steps: First, the first and the second modules were trained using the combined Hospital-A ICU and ED training sets. Second, the conformal set (consisting of representations from the encoder module) was constructed from the combined Hospital-A ICU and ED training sets. Finally, the trained modules along with the conformal set were used for model evaluation. Each of the individual components of COMPOSER, namely the weighted input layer and conformal prediction are explained in detail in the following sections.
CARE protocol
Institutional Practice
Mental Processes
Patients
Septicemia
Institutional Practice
Patient Monitoring
Patients
Subclinical Seizure
Subdural Space
We collected DNA from 685 B-NHL tumors, including 199 FL, 196 MCL, 148 DLBCL, 107 BL, 21 high-grade B-cell lymphoma not otherwise specified (HGBL-NOS), and 14 high-grade B-cell lymphoma with MYC, BCL2 and/or BCL6 rearrangement (DHL) (Online Supplementary Table S1). All samples were archival and deidentified. The study was approved by the institutional review board of the University of Nebraska Medical Center (203-15-EP) and performed in accordance with the Declaration of Helsinki. A total of 462 samples were obtained from the University of Nebraska Medical Center, and were prioritized for inclusion in this study if they had previously undergone pathology review and been interrogated by Affymetrix U133 Plus 2.0 gene expression microarrays10-12 (link) (n=284). An additional series of 223 formalin-fixed paraffin-embedded tumors were provided by other centers. Samples were de-identified and accompanied by the patients’ diagnosis from the medical records, plus overall survival time and status when available. Medical record diagnosis was used in all cases except for those with fluorescence in situ hybridization (FISH) showing translocations in MYC and BCL2 and/or BCL6, which were amended to DHL. Sequencing results for a subset of 52 BL tumors were described previously.13 (link) All MCL samples were either positive for CCND1 translocation by FISH or positive for CCND1 protein expression by immunohistochemistry, depending on the diagnostic practices of the contributing institution.
B-Cell Lymphomas
B-Lymphocytes
BCL2 protein, human
BCL6 protein, human
CCND1 protein, human
Cyclin D1
Diagnosis
DNA, Neoplasm
Ethics Committees, Research
Fluorescent in Situ Hybridization
Formalin
Gene Expression
Immunohistochemistry
Institutional Practice
Lymphoma, High-Grade
Neoplasms
Paraffin Embedding
Patients
Translocation, Chromosomal
Disease Progression
Institutional Practice
Neoplasms
Pathologists
Patients
Most recents protocols related to «Institutional Practice»
For the purposes of this review, “midlife” was defined as adults age <65 years. No lower age limit was applied to allow for flexibility of “midlife” definitions used by various studies and thus include as many studies as possible in our review. Although there is no universal definition for midlife, this upper threshold is used widely in clinical practice to delineate between middle‐aged versus older adults.31 , 32 Dyslipidemia was defined as any lipid parameter (TC, LDL, HDL, TG) identified as outside of its normal range of values on a blood test. This normal range varied by country and institution of practice, and thus between studies. Data on specific thresholds for dyslipidemia and their associated outcomes were collected according to the original authors’ definition and reported as such in our analysis.
Adult
Aged
Dyslipidemias
Hematologic Tests
Institutional Practice
Lipids
All patients included in this study were aged >18 years and had a polymerase chain reaction (PCR) confirmed diagnosis of COVID-19.
As is standard practice in our institution, the size and type of tracheostomy selected for insertion remained at the discretion of the senior ICU physician and/or Ear, Nose and Throat (ENT) surgeon. Percutaneous tracheostomy consisted of a small 1–2 cm horizontal incision in the anterior neck, just below the level of the cricoid cartilage. Blunt dissection was performed to the level of the pre-tracheal fascia, followed by cannulation of the trachea under bronchoscope guidance. The “Blue Rhino G2-Multi Percutaneous Tracheostomy Introducer Set” was used for all patients (COOK MEDICAL EUROPE LTD. Europe Shared Service Centre, O’Halloran Road National Technology Park Limerick, IRELAND).
The two patients who required surgical tracheostomies had these performed in the operating theatres. A horizontal incision was followed by dissection of the strap muscles and division of the thyroid isthmus to expose tracheal rings 2–4. Tracheal stay-sutures were applied to the tracheal rings above and below the tracheal incision. The endotracheal tube was then withdrawn with the ventilator placed in apnoea mode, the tracheostomy was inserted and the cuff immediately inflated to minimise aerosolisation. PEEP was maintained as far as possible throughout and apnoeic times, although not recorded, were kept to a minimum.
Staffing for percutaneous tracheostomy insertion comprised the minimum number of staff (three) required to safely perform the procedure (40 (link),60 (link)). This included an experienced ICU nurse, and either two Consultants, or a Consultant and a Fellow. All staff wore full personal protective equipment (PPE) including; FFP3 (N95) mask, full gown, gloves, goggles and hooded face shields (61 (link)-63 ). This complied with local infection control policies and conformed to World Health Organisation and Centre for Disease Control recommendations (44 (link),64 ,65 ). All patients were preoxygenated, sedated and muscle relaxed (62 (link),63 ). Ventilation was ceased prior to tracheal dilatation to minimise aerosolization, and correct positioning was confirmed with bronchoscopy, end-tidal capnography and chest X-ray (30 (link),31 (link),44 (link),48 (link),49 (link),60 (link)-63 ). The apnoea time was not recorded but kept at a minimum to reduce the risk of clinical harm and patient desaturation. Following insertion, cuff pressures were monitored and recorded four hourly and kept in the green zone of the manometer 20–30 cmH2O. Where leaks were apparent, cuffs were inflated to higher pressures to maintain tidal volumes.
We wished to determine the incidence of unplanned tracheostomy change, the reason for the change, and the tracheostomy inserted during the change. Unplanned tracheostomy change was defined as a change in the size or type of tracheostomy necessitated by clinical need, such as persistent leak or patient-ventilator dyssynchrony. Persistent leak and ventilator dyssnychrony was assessed clinically by the Consultant ICU physician. The requirement for tracheostomy change was determined clinically on a case-by-case basis. It did not include tracheostomy changes to facilitate respiratory weaning such as downsizing, or changing a cuffed to an uncuffed tracheostomy.
Each time an unplanned tracheostomy change was undertaken (outside of downsizing for weaning) the patient was deeply sedated and muscle relaxed. The tracheostomy was changed by mounting the introducer over a guidewire from the new sterile insertion set. This is standard practice in our institution. Where upsizing was required, the Blue Rhino dilator was used as described previously.
We also sought to assess time from intubation to tracheostomy insertion, time from ICU admission to tracheostomy, ICU LOS and time to decannulation, and to examine the changes, if any, in FiO2, PEEP and PP at the time of tracheostomy insertion and at days 1, 3 and 5 post insertion. The follow-up time to determine time to decannulation, overall outcome of mortality rate was 6 months post tracheostomy insertion.
As is standard practice in our institution, the size and type of tracheostomy selected for insertion remained at the discretion of the senior ICU physician and/or Ear, Nose and Throat (ENT) surgeon. Percutaneous tracheostomy consisted of a small 1–2 cm horizontal incision in the anterior neck, just below the level of the cricoid cartilage. Blunt dissection was performed to the level of the pre-tracheal fascia, followed by cannulation of the trachea under bronchoscope guidance. The “Blue Rhino G2-Multi Percutaneous Tracheostomy Introducer Set” was used for all patients (COOK MEDICAL EUROPE LTD. Europe Shared Service Centre, O’Halloran Road National Technology Park Limerick, IRELAND).
The two patients who required surgical tracheostomies had these performed in the operating theatres. A horizontal incision was followed by dissection of the strap muscles and division of the thyroid isthmus to expose tracheal rings 2–4. Tracheal stay-sutures were applied to the tracheal rings above and below the tracheal incision. The endotracheal tube was then withdrawn with the ventilator placed in apnoea mode, the tracheostomy was inserted and the cuff immediately inflated to minimise aerosolisation. PEEP was maintained as far as possible throughout and apnoeic times, although not recorded, were kept to a minimum.
Staffing for percutaneous tracheostomy insertion comprised the minimum number of staff (three) required to safely perform the procedure (40 (link),60 (link)). This included an experienced ICU nurse, and either two Consultants, or a Consultant and a Fellow. All staff wore full personal protective equipment (PPE) including; FFP3 (N95) mask, full gown, gloves, goggles and hooded face shields (61 (link)-63 ). This complied with local infection control policies and conformed to World Health Organisation and Centre for Disease Control recommendations (44 (link),64 ,65 ). All patients were preoxygenated, sedated and muscle relaxed (62 (link),63 ). Ventilation was ceased prior to tracheal dilatation to minimise aerosolization, and correct positioning was confirmed with bronchoscopy, end-tidal capnography and chest X-ray (30 (link),31 (link),44 (link),48 (link),49 (link),60 (link)-63 ). The apnoea time was not recorded but kept at a minimum to reduce the risk of clinical harm and patient desaturation. Following insertion, cuff pressures were monitored and recorded four hourly and kept in the green zone of the manometer 20–30 cmH2O. Where leaks were apparent, cuffs were inflated to higher pressures to maintain tidal volumes.
We wished to determine the incidence of unplanned tracheostomy change, the reason for the change, and the tracheostomy inserted during the change. Unplanned tracheostomy change was defined as a change in the size or type of tracheostomy necessitated by clinical need, such as persistent leak or patient-ventilator dyssynchrony. Persistent leak and ventilator dyssnychrony was assessed clinically by the Consultant ICU physician. The requirement for tracheostomy change was determined clinically on a case-by-case basis. It did not include tracheostomy changes to facilitate respiratory weaning such as downsizing, or changing a cuffed to an uncuffed tracheostomy.
Each time an unplanned tracheostomy change was undertaken (outside of downsizing for weaning) the patient was deeply sedated and muscle relaxed. The tracheostomy was changed by mounting the introducer over a guidewire from the new sterile insertion set. This is standard practice in our institution. Where upsizing was required, the Blue Rhino dilator was used as described previously.
We also sought to assess time from intubation to tracheostomy insertion, time from ICU admission to tracheostomy, ICU LOS and time to decannulation, and to examine the changes, if any, in FiO2, PEEP and PP at the time of tracheostomy insertion and at days 1, 3 and 5 post insertion. The follow-up time to determine time to decannulation, overall outcome of mortality rate was 6 months post tracheostomy insertion.
Apnea
Bronchoscopes
Bronchoscopy
Cannulation
Capnography
Consultant
COVID 19
Cricoid Cartilage
Diagnosis
Dilatation
Dissection
Face
Fascia
Infection Control
Institutional Practice
Intubation
Manometry
Muscle Tissue
Neck
Nose
Nurses
Operative Surgical Procedures
Patients
Pharynx
Physicians
Polymerase Chain Reaction
Positive End-Expiratory Pressure
Radiography, Thoracic
Respiratory Rate
Sterility, Reproductive
Surgeons
Sutures
Thyroid Gland
Tidal Volume
Trachea
Tracheostomy
The disease stage at HSCT for hematological malignancies was defined according to the European Group for Blood and Marrow Transplantation (EBMT) risk score (31 (link)). The disease stage for nonmalignancies was defined as the hematopoietic cell transplant comorbidity index (HCT-CI) (32 (link)). The myeloablative conditioning regimen was defined as total body irradiation ≥ 8 Gy, busulfan 16 mg/kg, or melphalan 140 mg/m2 (53 (link)). All patients were treated according to the standard myeloablative protocols based on chemotherapy and radiation dosing, as previously described (46 (link), 54 (link)). GVHD prophylaxis was performed with tacrolimus. Additional GVHD prophylaxis included mycophenolate mofetil for the matched unrelated donor (MUD), with the addition of posttransplant cyclophosphamide from 2013 in the case of a haploidentical donor. Serotherapy with anti-thymocyte globulin was also assessed as an independent variable. Prevention and treatment of infection and other elements of transplant-specific supportive care were performed according to institutional standard practices. Duration of follow-up was defined as the time from HSCT to last contact or death. Acute and cGVHD were diagnosed and graded using standard criteria (55 , 56 (link), 57 (link)).
The study’s primary endpoints were comparing the incidence of aGVHD and chronic GVHD-free survival between the defibrotide group and the control group. The incidence of GVHD was defined as any GVHD requiring systemic immune suppressive therapy. The secondary endpoints evaluated the influence of defibrotide prophylaxis on the incidence of early and late transplant-related complications. Early transplant-related complications were defined as events occurring within 100 d after HSCT unrelated to primary disease recurrence.
The study’s primary endpoints were comparing the incidence of aGVHD and chronic GVHD-free survival between the defibrotide group and the control group. The incidence of GVHD was defined as any GVHD requiring systemic immune suppressive therapy. The secondary endpoints evaluated the influence of defibrotide prophylaxis on the incidence of early and late transplant-related complications. Early transplant-related complications were defined as events occurring within 100 d after HSCT unrelated to primary disease recurrence.
Bone Marrow Transplantation
Busulfan
Cell Transplants
Cyclophosphamide
defibrotide
Donors
Europeans
Grafts
Hematologic Neoplasms
Hematopoietic System
Immunosuppression
Infection
Institutional Practice
Lymphocyte Immune Globulin, Anti-Thymocyte Globulin
Melphalan
Mycophenolate Mofetil
Patients
Pharmacotherapy
Radiotherapy
Recurrence
Serotherapy
Tacrolimus
Therapeutics
Treatment Protocols
Unrelated Donors
Whole-Body Irradiation
Protocol full text hidden due to copyright restrictions
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Ethics Committees
Ethics Committees, Research
Institutional Practice
Kidney
Magnetic Resonance Imaging
Neoplasms
Nephrectomy
Operative Surgical Procedures
Patients
Surgeons
Tertiary Healthcare
X-Ray Computed Tomography
We created an online survey with thirty multiple choice and eight free response questions. The survey allowed respondents to skip questions, choose not to disclose demographic information, select multiple answer choices for specified questions, and only receive certain relevant questions when they had experience with BFHIV due to branching logic. Before dissemination, the survey was reviewed by two community advisors in individualized focus groups and piloted with six public health and medical professionals; all input was incorporated into survey design. Nine questions focused on demographics, four on formal and informal institutional practice, two on individual practice, ten on provider comfort and perceptions, four on equity and ethics, seven on prior experience and outcomes, and two on survey feedback. Survey respondents ranked their comfort in optimal or outside of optimal scenarios with four clinical situations (Table 1 ). The finalized survey was built into an online platform for distribution (Qualtrics, Provo, UT).
The target population was US based providers with experience in the clinical issues associated with BFHIV. The online survey was sent with one or two email reminders to multiple national breastfeeding and HIV provider listservs: ReproID 414 members, American Academy of Pediatrics Section on Breastfeeding 845 members, American Academy of HIV Medicine ∼14,500 members (member email open rate reported as 20–35%), and Pacific AIDS Education Training Center 2585 members. Total listservs membership included ∼18,344 members from different states and countries. Email open rates were not available for all distribution networks; an adjusted response rate could not be calculated. Information on overlapping membership between listservs was not obtained. All survey responses were anonymous; survey respondents were not compensated. Respondent IP addresses were reviewed for duplicates.
Community advisors were an essential part of the research team from the onset of study design. People with direct or indirect experience with BFHIV were invited to participate through flyers distributed by local providers; positive HIV status was not a requirement for the role and applicants were not asked their status. Community advisors were research collaborators who deeply informed survey content as well as interpretation and dissemination of results, and they were compensated for their time in these roles. Advisors had an option to continue in an uncompensated role regarding presentations and publications.
Survey responses occurred between June 21 and July 22, 2021. Inclusion criteria were 80% survey completion and primary practice in the US. Four researchers (G.C., H.K., A.L., and E.S.Y.) independently reviewed all responses for inclusion, assessed that each set of demographic responses was distinct, and collated free-response identified institutions to eliminate duplications. The University of California San Francisco Institutional Review Board approved this study. All participants provided informed consent.
The target population was US based providers with experience in the clinical issues associated with BFHIV. The online survey was sent with one or two email reminders to multiple national breastfeeding and HIV provider listservs: ReproID 414 members, American Academy of Pediatrics Section on Breastfeeding 845 members, American Academy of HIV Medicine ∼14,500 members (member email open rate reported as 20–35%), and Pacific AIDS Education Training Center 2585 members. Total listservs membership included ∼18,344 members from different states and countries. Email open rates were not available for all distribution networks; an adjusted response rate could not be calculated. Information on overlapping membership between listservs was not obtained. All survey responses were anonymous; survey respondents were not compensated. Respondent IP addresses were reviewed for duplicates.
Community advisors were an essential part of the research team from the onset of study design. People with direct or indirect experience with BFHIV were invited to participate through flyers distributed by local providers; positive HIV status was not a requirement for the role and applicants were not asked their status. Community advisors were research collaborators who deeply informed survey content as well as interpretation and dissemination of results, and they were compensated for their time in these roles. Advisors had an option to continue in an uncompensated role regarding presentations and publications.
Survey responses occurred between June 21 and July 22, 2021. Inclusion criteria were 80% survey completion and primary practice in the US. Four researchers (G.C., H.K., A.L., and E.S.Y.) independently reviewed all responses for inclusion, assessed that each set of demographic responses was distinct, and collated free-response identified institutions to eliminate duplications. The University of California San Francisco Institutional Review Board approved this study. All participants provided informed consent.
Acquired Immunodeficiency Syndrome
Ethics Committees, Research
HIV Seropositivity
Institutional Practice
Pharmaceutical Preparations
Target Population
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The 32 channel dStream Torso coil is a radiofrequency (RF) coil designed for Philips MRI systems. It is a multi-channel receive coil that provides signal reception from the torso region of the human body. The core function of this coil is to efficiently detect and capture the magnetic resonance signals generated within the target anatomy during an MRI examination.
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More about "Institutional Practice"
Institutional Practice encompasses the established procedures, guidelines, and standards that govern the operations and decision-making processes within healthcare organizations, research institutions, and other professional settings.
This domain covers the policies, protocols, and best practices that guide the delivery of services, the conduct of research, and the overall management of an institution.
The goal of Institutional Practice is to ensure consistency, quality, and compliance with relevant regulations, while also promoting efficiency and optimizing outcomes for patients, clients, or stakeholders.
Key aspects include resource allocation, staff training, quality assurance, risk management, and the integration of technological innovations to enhance institutional performance.
By adhering to Institutional Practice, organizations can foster a culture of professionalism, accountability, and continuous improvement, ultimately delivering superior services and advancing their respective fields.
This includes the use of statistical software like Stata version 14, medical devices like the Licox and GE 690 scanner, and the 32 channel dStream Torso coil, as well as the utilization of animal models such as C57BL/6 male and female mice and BALB/c mice.
Additionally, the ARIA Oncology Information System and the GenElute Mammalian Genomic DNA Miniprep Kit can be leveraged to support institutional practices.
In the healthcare sector, the MitraClip system and the IntelliVue MP70 are examples of technologies that can be integrated into institutional practices to enhance patient care and outcomes.
By embracing these tools and technologies, organizations can optimize their processes, improve reproducibility, and deliver superior services to their stakeholders.
This domain covers the policies, protocols, and best practices that guide the delivery of services, the conduct of research, and the overall management of an institution.
The goal of Institutional Practice is to ensure consistency, quality, and compliance with relevant regulations, while also promoting efficiency and optimizing outcomes for patients, clients, or stakeholders.
Key aspects include resource allocation, staff training, quality assurance, risk management, and the integration of technological innovations to enhance institutional performance.
By adhering to Institutional Practice, organizations can foster a culture of professionalism, accountability, and continuous improvement, ultimately delivering superior services and advancing their respective fields.
This includes the use of statistical software like Stata version 14, medical devices like the Licox and GE 690 scanner, and the 32 channel dStream Torso coil, as well as the utilization of animal models such as C57BL/6 male and female mice and BALB/c mice.
Additionally, the ARIA Oncology Information System and the GenElute Mammalian Genomic DNA Miniprep Kit can be leveraged to support institutional practices.
In the healthcare sector, the MitraClip system and the IntelliVue MP70 are examples of technologies that can be integrated into institutional practices to enhance patient care and outcomes.
By embracing these tools and technologies, organizations can optimize their processes, improve reproducibility, and deliver superior services to their stakeholders.