Objective We examine the association between emergency physician characteristics and practice factors with the risk of being named in a malpractice claim. Methods We used malpractice claims along with provider, operational, and jurisdictional data from a national emergency medicine group (87 emergency departments (EDs) in 15 states from 1/1/2010 to 6/30/2014) to assess the relationship between individual physician and practice variables and being named in a malpractice claim. Individual and practice factors included: years in practice, emergency medicine Board Certification, visit admission rate, Relative Value Units/hour generated, total visits seen as attending physician of record, working at multiple facilities, working primarily overnight shifts, patient experience data percentile, and state malpractice environment. We assessed the relationship between emergency physician and practice variables and malpractice claims using logistic regression. Results In 9,477,150 ED visits seen by 1,029 emergency physicians, there were 98 malpractice claims against 90 physicians (9%). Increasing total number of years in practice (adjusted odds ratio 1.04, 95% CI 1.02–1.06) and higher visit volume (adjusted odds ratio 1.09 per 1000 visits, 95% CI 1.05–1.12) were associated with being named in a malpractice claim. No other factors were associated with malpractice claims. Conclusion In this sample of emergency physicians, one in 11 were named in a malpractice claim over 4.5 years. Total number of years in practice and visit volume were the only identified factors associated with being named, suggesting that exposure to higher patient volumes and longer practice experience are the primary contributors to malpractice risk.

This study examines the influences of market orientation, supply chain relationship quality, and absorptive capacity on competitive advantage in green supply chains. We examine the intensity of these relationships in a green supply chain context. This study aims to figure out the effects of green market orientation (GMO), green supply chain relationship quality (GRQ), and green absorptive capacity (GAC) on green competitive advantage (GCA) in a supply chain. We find a significant positive association between these constructs. It highlights the importance of antecedents such as GMO, GRQ, and GAC on improving GCA. We jointly investigate the effects of GMO, GRQ, and GAC on green supply chain competitive advantage. This study uses Process Macro 2.15 to test the mediation effect between GMO and GCA. The result shows that GRQ and GAC completely mediate the relationship between GMO and GCA and that the effect sizes are 0.11 and 0.20, respectively. This study also reruns the model to clarify whether competing models are better than our model. However, the performance of such a competing model is poor. Finally, we accept our model instead of the competing model. GMO and GRQ among team managers and employees appear to contribute positively to GCA. Although GAC does not directly influence GCA, GMO has a significant total effect on GCA when intervened by GRQ and GAC. The key contribution is that green market orientation, i.e., the employee culture and the emphasis on being environmentally responsible, is a key antecedent to GRQ, GAC, and GCA. Managerial implications of the findings are listed.

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ImportanceGreater than 20% of cases and 0.4% of deaths from COVID-19 occur in children. Following demonstration of the safety and efficacy of the adjuvanted, recombinant spike protein vaccine NVX-CoV2373 in adults, the PREVENT-19 trial immediately expanded to adolescents.ObjectiveTo evaluate the safety, immunogenicity, and efficacy of NVX-CoV2373 in adolescents.Design, Setting, and ParticipantsThe NVX-CoV2373 vaccine was evaluated in adolescents aged 12 to 17 years in an expansion of PREVENT-19, a phase 3, randomized, observer-blinded, placebo-controlled multicenter clinical trial in the US. Participants were enrolled from April 26 to June 5, 2021, and the study is ongoing. A blinded crossover was implemented after 2 months of safety follow-up to offer active vaccine to all participants. Key exclusion criteria included known previous laboratory-confirmed SARS-CoV-2 infection or known immunosuppression. Of 2304 participants assessed for eligibility, 57 were excluded and 2247 were randomized.InterventionsParticipants were randomized 2:1 to 2 intramuscular injections of NVX-CoV2373 or placebo, 21 days apart.Main Outcomes and MeasuresSerologic noninferiority of neutralizing antibody responses compared with those in young adults (aged 18-25 years) in PREVENT-19, protective efficacy against laboratory-confirmed COVID-19, and assessment of reactogenicity and safety.ResultsAmong 2232 participants (1487 NVX-CoV2373 and 745 placebo recipients), the mean (SD) age was 13.8 (1.4) years, 1172 (52.5%) were male, 1660 (74.4%) were White individuals, and 359 (16.1%) had had a previous SARS-CoV-2 infection at baseline. After vaccination, the ratio of neutralizing antibody geometric mean titers in adolescents compared with those in young adults was 1.5 (95% CI, 1.3-1.7). Twenty mild COVID-19 cases occurred after a median of 64 (IQR, 57-69) days of follow-up, including 6 among NVX-CoV2373 recipients (incidence, 2.90 [95% CI, 1.31-6.46] cases per 100 person-years) and 14 among placebo recipients (incidence, 14.20 [95% CI, 8.42-23.93] cases per 100 person-years), yielding a vaccine efficacy of 79.5% (95% CI, 46.8%-92.1%). Vaccine efficacy for the Delta variant (the only viral variant identified by sequencing [n = 11]) was 82.0% (95% CI, 32.4%-95.2%). Reactogenicity was largely mild to moderate and transient, with a trend toward greater frequency after the second dose of NVX-CoV2373. Serious adverse events were rare and balanced between treatments. No adverse events led to study discontinuation.Conclusions and RelevanceThe findings of this randomized clinical trial indicate that NVX-CoV2373 is safe, immunogenic, and efficacious in preventing COVID-19, including the predominant Delta variant, in adolescents.Trial RegistrationClinicalTrials.gov Identifier: NCT04611802