Official Regulations Research Articles

Análisis de la gestión de residuos peligrosos biológico-infecciosos, en unidades médico veterinarias de Morelia

The management of bio-hazardous and infectious waste from veterinarians in Morelia: a model of analysis. Bio-hazardous and infectious waste is defined by the Mexican official regulations as all the materials that can be produced mainly during the medical-health care services and that contains agents with bio infectious properties that can damage public health and environment. Veterinarians produce this type of waste, but, since they are not identified in a punctual manner by the legislation, there is confusion about the fact that this kind of establishments are subjects of the law. This document contents a review of 69 establishments of this type through surveys. Despite the fact that 94.2% of veterinarians give their waste to an authorized company for collection, 63.8% did not know the law and 44.9% has never received training on the subject. Situations that suggest management deficiencies, especially in terms of handling it in the sites of production.

The Recent Progress and Applications of Digital Technologies in Healthcare: A Review.

Background The implementation of medical digital technologies can provide better accessibility and flexibility of healthcare for the public. It encompasses the availability of open information on the health, treatment, complications, and recent progress on biomedical research. At present, even in low-income countries, diagnostic and medical services are becoming more accessible and available. However, many issues related to digital health technologies remain unmet, including the reliability, safety, testing, and ethical aspects. Purpose The aim of the review is to discuss and analyze the recent progress on the application of big data, artificial intelligence, telemedicine, block-chain platforms, smart devices in healthcare, and medical education. Basic Design. The publication search was carried out using Google Scholar, PubMed, Web of Sciences, Medline, Wiley Online Library, and CrossRef databases. The review highlights the applications of artificial intelligence, “big data,” telemedicine and block-chain technologies, and smart devices (internet of things) for solving the real problems in healthcare and medical education. Major Findings. We identified 252 papers related to the digital health area. However, the number of papers discussed in the review was limited to 152 due to the exclusion criteria. The literature search demonstrated that digital health technologies became highly sought due to recent pandemics, including COVID-19. The disastrous dissemination of COVID-19 through all continents triggered the need for fast and effective solutions to localize, manage, and treat the viral infection. In this regard, the use of telemedicine and other e-health technologies might help to lessen the pressure on healthcare systems. Summary. Digital platforms can help optimize diagnosis, consulting, and treatment of patients. However, due to the lack of official regulations and recommendations, the stakeholders, including private and governmental organizations, are facing the problem with adequate validation and approbation of novel digital health technologies. In this regard, proper scientific research is required before a digital product is deployed for the healthcare sector.

The development of strength under endurance conditions and agility in international soccertennis players

Soccer tennis is a sport which appeared in 1922, and in 1940 the first official regulations appeared. It is a sport practiced both individually and as a team, here finding the single, double and triple events, and double and triple mixed events.
 Purpose: Our study highlights the aspects of the training programme for worldwide players in soccer tennis from Romania.
 Method and instruments for data collection: This study highlights in particular the development of the mobility quality of the force under endurance and agility conditions with the help of the Opto Jump device. It is a complex sport wherein all the muscle groups are involved, technical–tactical aspects are involved and all mobility qualities are involved: speed (reaction, execution, movement, in force and endurance); force (force-speed and force-resistance); resistance (specific and anaerobic); flexibility and mobility; and coordinating capacity.
 Conclusion and recommendation: The specialised literature at national and international levels does not abound in scientific publications about football tennis.
 
 Keywords: Performance, soccer, strength, mobility, agility, training, evaluation

Development of diet cereal bar sweetened with stevia leaves pre-treated with ethanol

Abstract The objective of this work was to perform the ethanolic pretreatment of stevia leaves from the plant Stevia UEM-13 line and to characterize its physical-chemical properties aiming its use as a sweetener in the development of a diet cereal bar. The same formulation of the cereal bar with stevia leaves without pretreatment was elaborated for comparative purposes. The following ingredients were used in the preparation of the produtc: fine oat flakes, no sugar granola, cranberry, dehydrated apricots, water, gum acacia and stevia leaf pretreated (F1) and without treatment (F2). According to the results, the diet cereal bars presented significant amounts ​​of crude fiber, protein and antioxidant activity. The product was microbiologically safe for human consumption, reporting lower microbiological values​​than those foreseen by official regulation. The overall sensory evaluation indicates that the two formulations did not present statistically significant differences regarding the analyzed attributes, being the averages between “liked very much” and “moderately liked”. However, considering the group of cereal bars consumers, the formulation sweetened with pretreated leafs (F1) was found more than twice the acceptance regarding to the formulation sweetened with the leaf in natura (F2). These results demonstrate a viable option of a diet food product naturally sweetened.

Formación de maestros rurales y salud escolar, 1935-1945

El presente trabajo forma parte de una investigación más amplia en la que mostramos algunos fenómenos que, desde nuestro punto de vista, han influido en la construcción de la negociación como estrategia para conseguir la atención y respuesta de las autoridades en el normalismo rural. Ya sea en las relaciones cotidianas entre profesores y estudiantes, entre los estudiantes de una escuela en particular y su dirigencia nacional, entre los estudiantes y las autoridades locales o a través de las disposiciones oficiales, las Normales Rurales viven envueltas en una negociación constante, una negociación que da cuenta de la autonomía asistida que se fue construyendo como resultado de estas interacciones desde sus propios orígenes en la mitad de los años treinta del siglo XX en estas instituciones. Las Normales Rurales en México han tenido que luchar históricamente por su reconocimiento político, a pesar de lo cual las investigaciones e historiografía de las últimas décadas en este campo se han producido generalmente en contextos de acontecimientos críticos y violentos. En esta ocasión ponemos atención en situaciones relacionadas con el cuidado de la salud y la higiene escolar. Al reconocer el interés del gobierno por promover el cuidado de la salud en las escuelas, nos centramos particularmente en la identificación de las principales enfermedades que aquejan a las Normales Rurales y las formas en que las autoridades de estas escuelas las atendieron entre 1939 y los años cuarenta, cuando funcionaban con matrícula mixta. Además de la literatura de la época referente al tema, para la realización de este trabajo ha sido de suma importancia la consulta de documentos en algunos archivos de Escuelas Normales Rurales, el Archivo Histórico de la Secretaría de Educación Pública y el Archivo General de la Nación.

Evaluation of the Current Knowledge About Bacterial Endocarditis Prevention Among General Dentists in the City of Santo Domingo, Dominican Republic.

Infective endocarditis (IE) is a life-threatening disease caused by bacterial adherence to the lining of the heart and heart valve, and it can be caused by bacterial contamination of the bloodstream during invasive dental procedures. The American Heart Association (AHA) recommended guidelines for antibiotic prophylaxis in 2008 before invasive dental procedures; however, in the Dominican Republic, no official guidelines or regulations on this topic have been yet established. This study aimed to evaluate the current knowledge about bacterial endocarditis prevention among dentists in Santo Domingo. The study participants were dentists who attended a conference organized by Universidad Federico Henríquez y Carvajal (n = 95), of which 74 responded to the questionnaire survey. Seventy-eight percentage of the participants responded that an indication of antibiotics is recommended in cases of prophylaxis for IE. The prescription of antibiotics was applied to patients with prosthetic valves (78.4%), presented a history of previous IE (77%) among others. Among all the interventions in which the respondents would prescribe antibiotics, tooth extraction (70.7%) was the most frequent. Amoxicillin was the preferred drug choice (63.5%) and clindamycin was the antibiotic of choice in allergic patients (55.4%). Even though the choice of antibiotics were according to AHA guidelines (2008), majority of the dentists (58.82 and 55.4%) were not aware of the correct dosage and timing of administration of azithromycin and clindamycin in drugs in patients allergic to penicillin.

Demonstrating Real-World Applications of Chemistry in Customs Laboratories Facilitating Global Trade and Regulation by Guiding Students through Organoleptic Assessment of Olive Oil Using Their Senses of Taste and Smell

Recently, the customs chemistry laboratory of Bari, Italy, initiated a project to organize activities for students, with the purpose of promoting awareness of its role and services in the Apulia region, as well as to encourage students to study chemistry. This paper aims to show how the project can be an effective way to introduce students to the role of chemical analysis in the evaluation and valorization of one of the more-exported Italian products, by means of a 2 h lab-integrated lecture. Extra virgin olive oil (EVOO) was the product chosen as it is one of the more widely known symbols in the world of being “made in Italy”. Great attention has been devoted to the importance of the sensorial analysis of EVOO. Through this activity, students are introduced to the richness of their own sensory skills in the context of the official custom regulations. Evidence collected from the postactivity student survey responses indicates that this integrated lab–lecture was extremely successful at accomplishing the aims identified, and that students particularly appreciated the multidisciplinary approach.

The Jurisdictional Approach in Indonesia: Incentives, Actions, and Facilitating Connections

As recently as 2014, the “jurisdictional approach” (JA) was a new, unfamiliar, and contested term among civil society organizations and international donor agencies working on initiatives to reduce deforestation and promote sustainable land use in Indonesia. Understood as a more comprehensive approach to low-emissions development than jurisdictional-scale accounting for REDD+, JA gained steam from challenges faced by early efforts to implement corporate commitments to deforestation-free supply chains. JA initiatives sought to align government-led, multistakeholder processes within provinces and districts with multiple external incentives for jurisdictional-scale performance. By early 2020, elements of the concept had been incorporated into official plans and regulations in several provinces and districts and was recognized in the government’s national medium-term development plan. Over the intervening years, the community of JA proponents and practitioners had grown rapidly, attracted interest from government and corporate officials, and coalesced around a common understanding of what the approach entails. Credible, locally led JA initiatives were underway with international support in at least a dozen provinces and districts, and a national platform had been established to link districts that had committed to sustainability. Those initiatives were accompanied by active discourses on proposals for fiscal transfers and preferential market access to provide incentives for improved jurisdictional-scale performance based on indicators such as reduced deforestation. The potential of JA to generate significant results has been hampered by a number of factors, including: still-limited material incentives for change compared to the factors that drive business as usual deforestation; limited availability of data for better land-use planning; low capacity of district-level officials; and misalignment of government policies between subnational and national entities and across ministries. Assessment of impact is challenged by lag times and confounding variables. In order to adequately test the JA theory of change, greater emphasis on creating external incentives and linking JA initiatives across jurisdictions and scales is needed to complement the facilitation of activities within individual provinces and districts.

Roles de la resolución de problemas en el currículo oficial

En este trabajo describimos el papel de la resolución de problemas en distintos documentos que componen el currículo oficial de educación primaria en Chile. Nuestro marco teórico toma en cuenta tres dimensiones de la resolución de problemas: los roles que puede tomar según Schoenfeld (1992) y Schroeder y Lester (1989), las características que facilitan su incorporación al currículo y los tipos de problemas sugeridos en los documentos curriculares. Elaboramos un sistema de categorías y llevamos a cabo un análisis de contenido. Concluimos que los documentos reflejan visiones diferentes y hasta contradictorias sobre el papel que juega la resolución de problemas para la enseñanza de las matemáticas, dificultando su total implementación según lo dispuesto en la normativa oficial.

“Quick and dirty”: Intuitive cognitive style predicts trust in Didier Raoult and his hydroxychloroquine-based treatment against COVID-19

AbstractIn the context of the COVID-19 pandemic, French public opinion has been divided about Pr. Didier Raoult and his hydroxychloroquine-based treatment against COVID-19. In this paper, our aim is to contribute to the understanding of this polarization of public opinion by investigating the relationship between (analytic vs. intuitive) cognitive style and trust in Didier Raoult and his treatment. Through three studies (totalNafter exclusion = 950), we found that a more intuitive cognitive style predicted higher trust in Didier Raoult and his treatment. Moreover, we found that Trust in Raoult was positively associated with belief that truth is political, belief in conspiracy theories, belief in pseudo-medicines and pseudo-medical and conspiratorial beliefs regarding the COVID-19 pandemic. We also found a negative association with knowledge of scientific methods and regard for scientific method over personal experience. However, higher trust in Didier Raoult was not associated with self-reported compliance with official regulations concerning the COVID-19 pandemic.

ДЕТЕРМИНАНТЫ СОВЕРШЕНСТВОВАНИЯ СИСТЕМЫ РЕГЛАМЕНТИРУЮЩЕЙ ДОКУМЕНТАЦИИ ОРГАНОВ ИСПОЛНИТЕЛЬНОЙ ВЛАСТИ СУБЪЕКТОВ РФ

A study of the regulatory documentation of the executive authority of the constituent entity of the Russian Federation in the field of forestry was carried out in order to identify the determinants of improving the regulatory documentation system. It is noted that the system of regulatory documentation of the executive body under review is represented by status, functional and official regulations. It is indicated that the body in the field of its activities in the provision of public services and the performance of public functions to exercise control (supervision) performs a significant number of interagency interactions. Moreover, these interactions do not rely on specific regulatory documents – administrative regulations for interagency cooperation. Such a lacunae in the system of administrative regulations of the body in question causes the imperfection, non-optimality of its work. It is shown that one of the most significant manifestations of this situation is the state of affairs in the field of cooperation with law enforcement agencies in the prompt identification of violators of forest legislation and timely recovery of damage from these violations. The system of this interaction does not have a proper regulatory document and is characterized by low efficiency. It is concluded that the regulation of interaction with law enforcement agencies is a determinant of improving the system of regulatory documentation of this body. In this regard, the relevance of the activities of the body in question in the field of formulating proposals for the development of regulations, and, possibly, their more than approved local testing as an experiment at the level of individual regions, was noted. It is proposed in order to establish the procedure for interaction between bodies exercising powers in the field of forest relations and law enforcement agencies in identifying, suppressing, investigating and solving crimes in the field of forest use, to develop a regulation for interaction at the regional level.

Opportunistic mold fungi in urban air environment (analytical review)

The review presents data about microscopic mold fungi that contaminating the air environment of various buildings and structures in cities. Information about the conditions of origin of mycosis and mycetogenic allergies in urban residents in modern conditions is given on. A synthesis of data on patterns of distribution and accumulation of opportunistic mold fungi in urban premises is presented. It was noted that the majority of the most detailed studies, taking into account the number and species composition of microscopic fungi, were carried out in Europe, the USA and Russia. It is indicated that the accumulation of opportunistic fungi in the external environment increases the risk of their entry into the premises. It has been revealed that in the air of premises even on different continents, similar groups of fungi are usually dominant: namely, species of the genuses Aspergillus, Alternaria, Cladosporium, Penicillium. It is noted that mycetogenic air contamina -tion in the urban environment is a serious medical and social problem for many countries of the world. Attention to the absence of clear criteria for the safe level of conditionally pathogenic fungi in human habitat in world practice is drawn. The issue of the maximum permissible concentration of spores of mold fungi in the air of residential premises is still open. Despite many years of research on the problem, to present day there are no official uniform regulations or standards for the permissible content of mold fungi in the air environment of the premises, and there are no regulatory and methodological documents governing the environmental and hygienic examination of fungal damage to residential premises. Such a situation requires a review and updating of the information and methodological base, since the control of mycetogenic contamination of residential premises is one of the means of ensuring the biological safety of the human habitat.

Development and validation of an instrument to assess adherence to occupational health protocols in dentistry.

The purpose of this study was the creation and validation of an instrument to evaluate adherence to occupational health protocols used in dentistry that arise from official regulations and international recommendations on infection control, biosafety, and occupational health in dentistry. Additionally, in May 2017 the effectiveness of the instrument was documented within the dental care clinics in the postgraduate area. The instrument was developed based on constructs of occupational health, infection control, and biosafety in dentistry, made up of 21 indicators of 5 dimensions called protocols. Using direct observation through 35 measurements during 1 week, adherence to occupational health protocols was evaluated in postgraduate residents within the clinical sections of endodontics/pediatric dentistry, periodontics, prosthodontics, and orthodontics. The instrument presents an index of 0.88 in Cronbach's alpha analysis. There is a 34.4% adherence within the postgraduate dental clinic to the proposed occupational health protocols. The protocol with the highest adherence at 41.1% was the personal protection protocol. The periodontics section had a 52.9% observance of the proposed protocols and had the highest adherence to occupational health protocols. The proposed instrument is valid and reliable to evaluate adherence to the proposed occupational health protocols within dental care clinics. Dental clinics must be inspected and evaluated to ensure adherence to infection control, biosafety, and occupational health protocols within routine dental practice.

COVID‐19 pandemic‐related lockdown: response time is more important than its strictness

The rapid spread of SARS‐CoV‐2 and its threat to health systems worldwide have led governments to take acute actions to enforce social distancing. Previous studies used complex epidemiological models to quantify the effect of lockdown policies on infection rates. However, these rely on prior assumptions or on official regulations. Here, we use country‐specific reports of daily mobility from people cellular usage to model social distancing. Our data‐driven model enabled the extraction of lockdown characteristics which were crossed with observed mortality rates to show that: (i) the time at which social distancing was initiated is highly correlated with the number of deaths, r2 = 0.64, while the lockdown strictness or its duration is not as informative; (ii) a delay of 7.49 days in initiating social distancing would double the number of deaths; and (iii) the immediate response has a prolonged effect on COVID‐19 death toll.

Implementation of an ISO 17025 flexible scope in the phytosanitary field at the National Reference Centre in the Netherlands

Quality systems in plant health laboratories are common these days. Most of these laboratories are accredited under a fixed scope, but because of the high diversity of organism–matrix combinations tested yearly in phytosanitary laboratories, the National Reference Centre (NRC) of the National Plant Protection Organization in the Netherlands chose to implement a phytosanitary focused flexible scope, the Phytoflex scope. This allows for the inclusion of additional activities in its scope of accreditation, without prior evaluation by the accreditation body. One of the reasons to implement a flexible scope was the initiation of the Official Control Regulation by the European Union, which states that official laboratories in plant health should be accredited according to ISO/IEC 17025 for all methods used when working as an official laboratory. The quality management system of the NRC is the foundation of the Phytoflex scope. The results of diagnoses given are based on the pillars Validation, Expertise and Assurance. Before the implementation of the Phytoflex scope in 2014, the scope only covered six tests for a combination of organism and matrix. As a result of the introduction of the Phytoflex scope, the number of organisms that are covered under ISO 17025 accreditation at the NRC has increased from six to almost 90 in November 2019. Management of the Phytoflex scope demands high awareness of quality systems for personnel and management, and puts more responsibility on the laboratory. If the different aspects of management of the scope are not accurately organized, the flexible scope may be revoked by the accreditation body. The Phytoflex scope makes it possible to act more quickly to add tests for new and emerging risks to the accreditation. However, this is not possible for all tests and further discussions are required to fulfil the accreditation requirement from the Official Control Regulation.

European Respiratory Society statement on sleep apnoea, sleepiness and driving risk.

Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea-hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk of OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a task force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA; the mechanisms involved in this association; the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance; the impact of treatment on MVA risk in affected drivers; and highlights the evidence gaps regarding the identification of OSA patients at risk of MVA.

Doing paying during the Covid-19 pandemic

The Covid-19 pandemic has affected not only the health of populations but also their everyday social practices, transformed by orienting to risks of contagion and to health prevention discourses. This paper emanates from a project investigating the impact of Covid-19 on human sociality and more particularly the situated and embodied organization of social interactions. It discusses how Covid-19 impacts the design of ordinary actions in social interaction, how this is made publicly accountable by the participants orienting to the pandemic in formatting their actions and in responding to the actions of others. Adopting an ethnomethodological and conversation analytic perspective, the analyses focus on a particular social activity: paying. The organization of payments in shops and services has been affected by the pandemic, not only by official regulations, favoring some modes of payment over others, but also in how sellers and customers situatedly adapt their practices to imperatives of prevention. On the basis of a rich corpus of video-recorded data, which spans from the pandemic’s prodromes to and after its peak, we show how money transfer is methodically achieved – imposed, negotiated, and readjusted – while variously taking into account possible risks of contagion. Thus, we show not only how pandemics affect social interaction, and how prevention is incarnated in social actions, but also how, in turn, situated solutions implemented by people during the pandemic reveal fundamental features of human action.

Challenges of complying with both food value chain specifications and agroecology principles in vegetable crop protection

To meet the challenges of sustainability in agricultural system design, reducing the dependency on synthetic plant protection products has become a core issue. There are currently two major reasons for farmers' decision to reduce their use of synthetic products: public policies, and the extralegal requirements of food supply chains. To reduce or eliminate synthetic plant protection products, agroecological crop protection (ACP) relying on the development of agroecology science and practices is a promising holistic approach focused on crop health overall. ACP requires a consistent combination of various agronomic practices at different spatiotemporal and trophic levels. Vegetable crops are minor crops facing the major challenges of producing high-quality produce and of controlling sanitary pressure on yields. Thus, agroecological vegetable systems must not only be adapted to official regulations and environmental parameters but must also comply with the specifications of the targeted food value chains (FVC), which are variable: marketing standards regarding cosmetic issues are very strict in long value chains, whereas they are more flexible in local short chains. Whereas fresh vegetable production is strongly challenged by the reduction of synthetic plant protection products, there are few studies that show how to design, manage and assess agroecological crop protection strategies for such systems, considering the main specifications and criteria of the FVC as a whole. This article reports on the challenges of complying with both FVC specifications and agroecology principles in protected vegetable crop protection. This study relies on four cropping systems implemented in an experimental station for 4.5 years, each of which had a specific strategy of crop protection management and was devoted to a particular FVC. The four FVCs are “local direct sale in low-pesticide farming”, “local direct sale in organic farming”, “super- and hypermarket value chain in low-pesticide farming” and “super- and hypermarkets value chain in organic farming”. Results consist in the description of combination of agronomic practices used, as well as the corresponding decision-making processes. They then present the performance of the four systems tested, showing that agroecological crop protection strategies are successful in reducing or eliminating synthetic plant protection products. We then discuss failure and success factors highlighted by this multi-year experiment. It illustrates that agroecological crop protection and compliance with the FVC's expectations can be compatible but involve specific trade-offs, depending on the targeted food value chain. We finally stress key areas to investigate further in order to achieve still challenging objectives in vegetable systems.

Discipline Development Of Civil State Employees In Improving Community Services In Pemalang District

Civil servants as servants of the state and servants of the community in carrying out their duties to provide services to the community must be equitably distributed with the ability to carry out their duties in a professional and responsible manner, by obeying their obligations and avoiding prohibitions stipulated in statutory regulations and or official regulations. Based on the above facts, it is necessary to have a scientific study in a study with the title: Fostering Discipline of Civil Servants (PNS) in Improving Community Services Based on Government Regulation Number 53 of 2010 in Pemalang Regency. The approach method used or used in this research is to use a sociological juridical approach (socio legal research). This research is a descriptive analysis research, that is, this research is a descriptive analysis research, which describes the existing situation more clearly, based on legal theory. Data analysis was carried out using qualitative analysis methods, namely an analysis carried out on the Discipline Development of Civil Servants in improving community services in Pemalang Regency.In Fostering Discipline for Civil Servants in Improving Community Service in Pemalang Regency, in general, Civil Servants as State Servants and Servants of the Community in carrying out their duties to provide services to the community must be disciplined, namely the existence of good Discipline Development for Civil Servants will create harmonious interactions, both between Civil Servants themselves and fellow bureaucratic officials as well as between employees and community members. Constraints faced Not exactly the promised time, Lack of quality of community services. in making Identity Cards (KTP) and Family Cards (KK), and for solutions to overcome Constraints / Obstacles are as follows: Implement services on time, Improve the quality of services to the community.Keywords: Civil Servant Discipline, Service to Society

Prescribing Antibiotics in Rural China: The Influence of Capital on Clinical Realities.

Primary care clinicians in rural China are required to balance their immediate duty of care to their patients with patient expectations for antibiotics, financial pressures, and their wider responsibilities to public health. The clinicians in our sample appear to make greater efforts in managing immediate clinical risks and personal reputation than in considering the long-term consequences of their actions as potentially contributing to antimicrobial resistance. This paper employs Bourdieu's theory of capital to examine the perspectives and practices of Chinese primary care clinicians prescribing antibiotics at low-level health facilities in rural Anhui province, China. We examine the institutional context and clinical realities of these rural health facilities and identify how these influence the way clinicians utilize antibiotics in the management of common upper respiratory tract infections. Confronted with various official regulations and institutional pressures to generate revenues, informants' desire to maintain good relations with patients coupled with their concerns for patient safety result in tensions between their professional knowledge of “rational” antibiotic use and their actual prescribing practices. Informants often deferred responsibility for antimicrobial stewardship to the government or upper echelons of the healthcare system and drew on the powerful public discourse of “suzhi” (human quality) to legitimize their liberal prescribing of antibiotics in an imagined socioeconomic hierarchy. The demands of both practitioners' and patients' social, cultural, and economic forms of capital help to explain patterns of antibiotic prescribing in rural Chinese health facilities.