It’s all relative : how customer-perceived competitive advantage influences referral intentions

Better understanding the mechanisms that influence customer intentions to spread positive word-of-mouth (WOM) is crucial to both marketing scholars and managers. This multimethod research contributes to marketing knowledge by revealing how a firm’s customer-perceived competitive advantage (CPCA) influences positive WOM intentions. Analyses of (1) cross-sectional survey data on bank customers in Germany and (2) experimental data on customers of car insurance companies in the USA reveal two crucial insights. First, CPCA influences WOM intentions in both industries, over and above numerous established antecedents of customer loyalty (e.g., satisfaction, trust, and perceived value). Second, this research demonstrates a robust and pervasive CPCA-by-satisfaction interaction effect, such that the influence of CPCA on WOM intentions increases as customer satisfaction decreases. The results show that customer-perceived competitive advantage plays an important role in shaping WOM intentions, especially among less-satisfied customers. Theoretical and managerial implications of these findings are discussed

Evaluasi Prosedur Pengeluaran Kas atas Klaim Asuransi Pada PT. Asuransi Jasa Indonesia (Persero) Kantor Cabang Manado

Untuk mengawasi pengeluaran kas yang ada, diperlukan pengendalian yang baik terhadap kas dan memerlukan prosedur-prosedur yang memadai supaya  bisa melindungai setiap pengeluaran kas. Tujuan dari penelitian ini adalah untuk  mengevaluasi prosedur pengeluaran kas atas klaim asuransi. Penelitian ini  menggunakan pendekatan kualitatif deskriptif. Hal pertama yang dilakukan yaitu mengumpulkan serta mengamati semua bagian informasi yang berhubungan  dengan pengeluaran kas atas klaim asuransi. Setelah itu setiap metode dijadikan  satu untuk mendapatkan gambaran yang jelas. Hasil penelitian menunjukkan bahwa  prosedur pengeluaran kas atas klaim asuransi PT Asuransi Jasa Indonesia (Persero)  Cabang Manado sudah cukup baik dan sesuai dengan teori yang ada. Akan tetapi masih ada fungsi yang melakukan perangkapan tugas. Prosedur pengeluaran kas  telah distandarisasi dan dijalankan dengan sebaik-baiknya untuk menghindari  kemungkinan terjadinya kesalahan sehingga prosedur pengeluaran kas atas klaim  asuransi pada PT Asuransi Jasa Indonesia (Persero) Kantor Cabang Manado dapat  dilakukan dengan efektif

PENERAPAN METODE ROOT CAUSE ANALYSIS (RCA) UNTUK MENENTUKAN AKAR PENYEBAB KELUHAN KONSUMEN

The development of the business world in Indonesia, today has shown an encouraging direction. It can be seen from the proliferation of various forms of business entities engaged in the field of goods and services both small and large scale. One of them is wedding organizer service. Wedding organizer provider company must be able to provide maximum service to increase consumer satisfication.This research is related to the application of the Root Cause Analysis (RCA) method in determining the factors that influence the low level of customer satisfaction in wedding organizer service providers.The purpose of this study is to determine the important factors that cause the low levels of customer satisfaction and provide suggestions for improving the performance of service providers in wedding organizers. This analysis uses SERVQUAL variables which contain service quality dimensions such as tangibles, reliability, empathy, responsiveness, and assurance.The results of research conducted using these 14 variables, show that there are three factors that cause low levels of customer satisfaction, they are not acting fast when consumers need (complaints given by consumers are not immediately responded to), not able to provide information according to customer needs (no service list), not having the availability of interesting event photobooths ( no availability of photographer at photobooth place, and five improvement proposals for wedding organizer service providers, such as procurement of communication equipment, assigning tasks based on mastered fields, scheduling more carefully, more thoroughly in providing information, paying more attention to concept and theme of the event according to the consumer wishes.Keywords: Wedding Organizer, SERVQUAL, Consumer Satisfaction, Fault Tree

Sodium-glucose co-transporter-2 inhibitors in patients with type 2 diabetes : Barriers and solutions for improving uptake in routine clinical practice

Recent advances in type 2 diabetes (T2D) research have highlighted the benefits of sodium-glucose co-transporter-2 (SGLT-2) inhibitors, including cardiovascular and renal protection. However, uptake rates of these drugs remain low in patients with T2D, particularly in subpopulations most likely to benefit from them. This review considers the potential barriers to prescribing SGLT-2 inhibitors in T2D in clinical practice and outlines potential multidisciplinary recommendations to overcome these barriers. Safety concerns and a lack of clarity in and divergence of guidelines around the introduction of SGLT-2 inhibitors into treatment regimens may represent a barrier to uptake from the clinicians' perspective, including a general lack of understanding of the benefits associated with SGLT-2 inhibitors. Patient characteristics, such as socioeconomic status, may influence uptake because of the cost of SGLT-2 inhibitors, especially in the United States, where health insurance coverage could be a concern. SGLT-2 inhibitor prescription rates vary between clinical specialty (endocrinology, primary care, cardiology, and nephrology) and country, with cardiologists the lowest prescribers, and endocrinologists the highest. Primary care practitioners may experience more challenges in following SGLT-2 inhibitor-related guidelines than diabetes specialists as there may be fewer opportunities for education on how this drug class improves cardiovascular and renal outcomes in patients with T2D. Uptake rates appear to vary between countries because of differences in guidelines and health insurance systems. The amendment of SGLT-2 inhibitor-related guidelines for more multidisciplinary use and the implementation of patient and clinician education may encourage uptake of these drugs, potentially improving long-term health outcomes among patients with T2D

Combined Coronary CT-Angiography and TAVI-Planning: A Contrast-Neutral Routine Approach for Ruling-Out Significant Coronary Artery Disease

Background: Significant coronary artery disease (CAD) is a common finding in patients undergoing transcatheter aortic valve implantation (TAVI). Assessment of CAD prior to TAVI is recommended by current guidelines and is mainly performed via invasive coronary angiography (ICA). In this study we analyzed the ability of coronary CT-angiography (cCTA) to rule out significant CAD (stenosis ≥ 50%) during routine pre-TAVI evaluation in patients with high pre-test probability for CAD. Methods: In total, 460 consecutive patients undergoing pre-TAVI CT (mean age 79.6 ± 7.4 years) were included. All patients were examined with a retrospectively ECG-gated CT-scan of the heart, followed by a high-pitch-scan of the vascular access route utilizing a single intravenous bolus of 70 mL iodinated contrast medium. Images were evaluated for image quality, calcifications, and significant CAD; CT-examinations in which CAD could not be ruled out were defined as positive (CAD+). Routinely, patients received ICA (388/460; 84.3%; Group A), which was omitted if renal function was impaired and CAD was ruled out on cCTA (Group B). Following TAVI, clinical events were documented during the hospital stay. Results: cCTA was negative for CAD in 40.2% (188/460). Sensitivity, specificity, PPV, and NPV in Group A were 97.8%, 45.2%, 49.6%, and 97.4%, respectively. Median coronary artery calcium score (CAC) was higher in CAD+-patients but did not have predictive value for correct classification of patients with cCTA. There were no significant differences in clinical events between Group A and B. Conclusion: cCTA can be incorporated into pre-TAVI CT-evaluation with no need for additional contrast medium. cCTA may exclude significant CAD in a relatively high percentage of these high-risk patients. Thereby, cCTA may have the potential to reduce the need for ICA and total amount of contrast medium applied, possibly making pre-procedural evaluation for TAVI safer and faster

The Wnt secretion protein Evi/Gpr177 promotes glioma tumourigenesis

Malignant astrocytomas are highly aggressive brain tumours with poor prognosis. While a number of structural genomic changes and dysregulation of signalling pathways in gliomas have been described, the identification of biomarkers and druggable targets remains an important task for novel diagnostic and therapeutic approaches. Here, we show that the Wnt-specific secretory protein Evi (also known as GPR177/Wntless/Sprinter) is overexpressed in astrocytic gliomas. Evi/Wls is a core Wnt signalling component and a specific regulator of pan-Wnt protein secretion, affecting both canonical and non-canonical signalling. We demonstrate that its depletion in glioma and glioma-derived stem-like cells led to decreased cell proliferation and apoptosis. Furthermore, Evi/Wls silencing in glioma cells reduced cell migration and the capacity to form tumours in vivo. We further show that Evi/Wls overexpression is sufficient to promote downstream Wnt signalling. Taken together, our study identifies Evi/Wls as an essential regulator of glioma tumourigenesis, identifying a pathway-specific protein trafficking factor as an oncogene and offering novel therapeutic options to interfere with the aberrant regulation of growth factors at the site of production

eggNOG 6.0: enabling comparative genomics across 12 535 organisms

The eggNOG (evolutionary gene genealogy Non-supervised Orthologous Groups) database is a bioinformatics resource providing orthology data and comprehensive functional information for organisms from all domains of life. Here, we present a major update of the database and website (version 6.0), which increases the number of covered organisms to 12 535 reference species, expands functional annotations, and implements new functionality. In total, eggNOG 6.0 provides a hierarchy of over 17M orthologous groups (OGs) computed at 1601 taxonomic levels, spanning 10 756 bacterial, 457 archaeal and 1322 eukaryotic organisms. OGs have been thoroughly annotated using recent knowledge from functional databases, including KEGG, Gene Ontology, UniProtKB, BiGG, CAZy, CARD, PFAM and SMART. eggNOG also offers phylogenetic trees for all OGs, maximising utility and versatility for end users while allowing researchers to investigate the evolutionary history of speciation and duplication events as well as the phylogenetic distribution of functional terms within each OG. Furthermore, the eggNOG 6.0 website contains new functionality to mine orthology and functional data with ease, including the possibility of generating phylogenetic profiles for multiple OGs across species or identifying single-copy OGs at custom taxonomic levels. eggNOG 6.0 is available at http://eggnog6.embl.de

proGenomes3: approaching one million accurately and consistently annotated high-quality prokaryotic genomes

The interpretation of genomic, transcriptomic and other microbial 'omics data is highly dependent on the availability of well-annotated genomes. As the number of publicly available microbial genomes continues to increase exponentially, the need for quality control and consistent annotation is becoming critical. We present proGenomes3, a database of 907 388 high-quality genomes containing 4 billion genes that passed stringent criteria and have been consistently annotated using multiple functional and taxonomic databases including mobile genetic elements and biosynthetic gene clusters. proGenomes3 encompasses 41 171 species-level clusters, defined based on universal single copy marker genes, for which pan-genomes and contextual habitat annotations are provided. The database is available at http://progenomes.embl.de/

The impact of tumor metabolic activity assessed by 18^{18}F-FET amino acid PET imaging in particle radiotherapy of high-grade glioma patients

Selective uptake of (18)F-fluoro-ethyl-tyrosine ($^{18}$F-FET) is used in high-grade glioma (HGG) to assess tumor metabolic activity via positron emission tomography (PET). We aim to investigate its value for target volume definition, as a prognosticator, and associations with whole-blood transcriptome liquid biopsy (WBT lbx) for which we recently reported feasibility to mirror tumor characteristics and response to particle irradiation in recurrent HGG (rHGG)

<i>MYCN</i> amplification drives an aggressive form of spinal ependymoma

Spinal ependymal tumors form a histologically and molecularly heterogeneous group of tumors with generally good prognosis. However, their treatment can be challenging if infiltration of the spinal cord or dissemination throughout the central nervous system (CNS) occurs and, in these cases, clinical outcome remains poor. Here, we describe a new and relatively rare subgroup of spinal ependymal tumors identified using DNA methylation profiling that is distinct from other molecular subgroups of ependymoma. Copy number variation plots derived from DNA methylation arrays showed MYCN amplification as a characteristic genetic alteration in all cases of our cohort (n = 13), which was subsequently validated using fluorescence in situ hybridization. The histological diagnosis was anaplastic ependymoma (WHO Grade III) in ten cases and classic ependymoma (WHO Grade II) in three cases. Histological re-evaluation in five primary tumors and seven relapses showed characteristic histological features of ependymoma, namely pseudorosettes, GFAP- and EMA positivity. Electron microscopy revealed cilia, complex intercellular junctions and intermediate filaments in a representative sample. Taking these findings into account, we suggest to designate this molecular subgroup spinal ependymoma with MYCN amplification, SP-EPN-MYCN. SP-EPN-MYCN tumors showed distinct growth patterns with intradural, extramedullary localization mostly within the thoracic and cervical spine, diffuse leptomeningeal spread throughout the whole CNS and infiltrative invasion of the spinal cord. Dissemination was observed in 100% of cases. Despite high-intensity treatment, SP-EPN-MYCN showed significantly worse median progression free survival (PFS) (17 months) and median overall survival (OS) (87 months) than all other previously described molecular spinal ependymoma subgroups. OS and PFS were similar to supratentorial ependymoma with RELA-fusion (ST-EPN-RELA) and posterior fossa ependymoma A (PF-EPN-A), further highlighting the aggressiveness of this distinct new subgroup. We, therefore, propose to establish SP-EPN-MYCN as a new molecular subgroup in ependymoma and advocate for testing newly diagnosed spinal ependymal tumors for MYCN amplification