CRM Implementation Strategy: Aligning the Organization and the Customer

In the majority of Customer Relationship Management (CRM) Implementations customers have been ignored with CRM either being viewed solely as a technology initiative [1] or with organizations focusing only on internal process improvements [2]. While many authors have argued the individual importance of either a technology focus or the importance of the customer relationship, this paper proposes that the appropriate CRM Strategy will vary depending on how the organization is aligned with their customers. It is proposed that a modified version of the Strategic Alignment Model originally proposed by Henderson & Venkatraman [3] is appropriate for evaluating organizational CRM Strategic Alignment with their customers. By evaluating alignment along two key CRM dimensions, Technological Centricity and Relational Centricity, four strategic quadrants are created. By identifying the organizations current position on the strategic map quadrants and then mapping the location within the quadrants that their customers wish to be engaging the company the degree of CRM Alignment with the customer is identified. If areas of misalignment are identified, then the organization can follow the appropriate strategy to achieve alignment

Where Have All the Trust Marks Gone?

In the early days of e-commerce and online retailing, trust was seen as a significant element required for developing online consumer buying intention and initial trustworthiness could be communicated through seals of approval or trust marks. Moving forward eight years has done little to change the issues that face online retailers and consumer perceptions. In fact, Jupiter Media Metrix reported that in 2006 over $24 billion worth of online sales was lost due to privacy and security concerns. This paper explores the current practice and utilization of trust marks by the top 100 online retailers to identify the connection and disconnection between business practice and theory

Spinal Deformity, Surgery at the Cervicothoracic Junction, and American Society of Anesthesiologists Class Increase the Risk of Post-surgical Intensive Care Unit Treatment after Dorsal Spine Surgery: A Single-Center Multivariate Analysis of 962 Patients

Study Design This was a retrospective multivariate analysis of preoperative risk factors leading to intensive care unit (ICU) admissions in patients undergoing elective or acute dorsal spine surgery. Purpose Numerous studies have predicted a substantial increase in spine surgeries within the next decades, potentially overwhelming hospitals’ resources, including ICU occupancy. Accurate estimates of whether patients need postsurgical ICU treatment are pivotal for both resource allocation and patient safety. Overview of Literature Risk factors leading to ICU admissions after dorsal spine surgery have been extensively examined for lumbar elective surgery. Studies including other anatomical segments of the spine and nonelective surgery regarding postsurgical ICU treatment probability are lacking. Methods This study was designed to be a single-center multivariate analysis of data retrospectively collected from a tertiary care university hospital. Patients undergoing dorsal spine surgery from 2009 to 2019 were included in this study. The patients’ demographic data were analyzed to determine potential preoperative risk factors for ICU admission after surgery using multiple logistic regression. Results In our cohort, 962 patients with a mean age of 71.1±0.55 years were included. Surgeries involved 3.24±0.08 spinal levels on average. The incidence of ICU treatment after surgery was 30.4% (n=292). Multivariate logistic regression showed a markedly increased odds ratio (OR) for patients undergoing surgery of the cervicothoracic junction (OR, 8.86) and those undergoing surgery for spinal deformity treatment (OR, 7.7). Additionally, cervical procedures (OR, 3.29), American Society of Anesthesiologists (ASA) class 3–4 (OR, 2.74), spondylodiscitis (OR, 2.47), fusion of ≥3 levels (OR, 1.94), and age >75 years (OR, 1.33) were associated with an increased risk of postsurgical ICU admission. Conclusions The findings highlight the relevance of anatomical location, preoperative diagnosis, ASA class, and length of surgery regarding the predictability of postoperative ICU admission. Our data allowed for more sophisticated estimates regarding the need for ICU treatment after dorsal spine surgery, guiding the surgeon through patient selection, communication, and ICU admission predictability

Circulating adrenomedullin estimates survival and reversibility of organ failure in sepsis: the prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock-1 (AdrenOSS-1) study

Background: Adrenomedullin (ADM) regulates vascular tone and endothelial permeability during sepsis. Levels of circulating biologically active ADM (bio-ADM) show an inverse relationship with blood pressure and a direct relationship with vasopressor requirement. In the present prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock 1 (, AdrenOSS-1) study, we assessed relationships between circulating bio-ADM during the initial intensive care unit (ICU) stay and short-term outcome in order to eventually design a biomarker-guided randomized controlled trial. Methods: AdrenOSS-1 was a prospective observational multinational study. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use, and need for renal replacement therapy. AdrenOSS-1 included 583 patients admitted to the ICU with sepsis or septic shock. Results: Circulating bio-ADM levels were measured upon admission and at day 2. Median bio-ADM concentration upon admission was 80.5 pg/ml [IQR 41.5-148.1 pg/ml]. Initial SOFA score was 7 [IQR 5-10], and 28-day mortality was 22%. We found marked associations between bio-ADM upon admission and 28-day mortality (unadjusted standardized HR 2.3 [CI 1.9-2.9]; adjusted HR 1.6 [CI 1.1-2.5]) and between bio-ADM levels and SOFA score (p < 0.0001). Need of vasopressor/inotrope, renal replacement therapy, and positive fluid balance were more prevalent in patients with a bio-ADM > 70 pg/ml upon admission than in those with bio-ADM ≤ 70 pg/ml. In patients with bio-ADM > 70 pg/ml upon admission, decrease in bio-ADM below 70 pg/ml at day 2 was associated with recovery of organ function at day 7 and better 28-day outcome (9.5% mortality). By contrast, persistently elevated bio-ADM at day 2 was associated with prolonged organ dysfunction and high 28-day mortality (38.1% mortality, HR 4.9, 95% CI 2.5-9.8). Conclusions: AdrenOSS-1 shows that early levels and rapid changes in bio-ADM estimate short-term outcome in sepsis and septic shock. These data are the backbone of the design of the biomarker-guided AdrenOSS-2 trial. Trial registration: ClinicalTrials.gov, NCT02393781. Registered on March 19, 2015

Assessing The Practice of Systems Administration in United States Federal District Courts

The United States District Courts employ a decentralized automation strategy. This strategy allows each federal district to utilize automation resources in such areas as case management, court financial services, and decision support systems. With changes in technology and increased demand for automation support courts have adopted additional hardware platforms and communications technology at the direction of the Administrative Office of the Courts in Washington, D.C. with an increased demand for automation technology increased technical expertise is also required. This expertise needs to be accompanied by sound system administration practices. The literature indicates that no administrative model exists for the courts that thoroughly deals with the administration of hardware, software, security, operations, and networks. The literature supports that the lack of procedural formalization in automation operations can put information resources at risk. Consequently, this study is designed to assess t \ e practice of system administration in the courts. The assessment is based on the development of a system administration model that allows the courts to conform to sound UNIX administration practices as well as federal regulations and guidelines. The assessment is based on a survey instrument that addresses general and specific areas of system administration. The results of the survey accept the basic hypothesis that United States District Court system administration practices do not presently conform to accepted data center operation practices. This indicates that court information resources are at risk and expected administration tasks are not entirely supported by court information systems. However, it could not be ascertained that the man-machine interface of court systems is unreliable. This study provided a means to assist the courts to strengthen their administration practices. From the assessment it is recommended that the courts adopt a control systems methodology that can support the various court environments. Additional study is also required to better assess the reliability of the court system man-machine interface

A novel role for Drosophila Akt during embryonic development, positive regulation of the Trh transcription factor

grantor: University of TorontoSince 1991, much work has focused on the signaling pathway for the activation and function of Protein Kinase B (PKB)/Akt, the mammalian homologue of a retroviral oncogene, 'v-akt'. Despite intensive research on the functions) of this enzyme, few 'in vivo' phosphorylation targets have been identified. The recent identification of a mutation in the 'Drosophila melanogaster' homologue of PKB, 'Dakt1q', has provided a new genetic tool for identifying gene products that have an ' in vivo' role in the DAkt1 signaling pathway. A genetic screen has implicated the 'trachealess' ('trh') gene, which is essential for tubulogenesis during development of the 'Drosophila ' tracheal system, as being a component of this signaling pathway. Analysis of data from both genetic and ectopic expression studies revealed that DAkt1 is a positive regulator of Trh transcriptional activity and that the mechanism by which DAkt1 regulates this activity is through the control of Trh nuclear translocation.M.Sc