Highly Recommended? How Relation-Specific Attachment Styles Bias Customers Willingness to Recommend

Recently concepts from attachment theory are being applied to business situations. In this paper we focus on how relationship specific (RS) versus general (G) attachment styles affect the willingness-to-recommend (WtR) by customers. Such WtR refers to the likelihood of customers to recommend the services of their service provider to other customers, based on their experiences with the provider. This WtR is often measured by means of the Net Promoter Score (NPS) which is assumed to be a reliable (credible) market signal as it originates from customers themselves and not from the firm. This study provides insights in this issue using data from 798 members of an online panel from the Netherlands, covering four service industries. Customers are surveyed on their RS and G attachment styles, trust in, satisfaction with, and commitment to their service provider, as well as their WtR this provider. Findings emerge from econometric parallel mediation analyses. This study shows that customers' RS but not the G attachment styles bias their appraisal of trust in, satisfaction with and commitment to the service provider, which in turn affects their WtR. More specifically, across the four service industries, customers scoring higher on RS anxiety and/or avoidance show systematically lower levels of trust in and satisfaction with, and commitment to the firm, ultimately leading to lower WtR. Firms should especially target those customers that score higher on RS avoidance (possibly in combination with higher levels of RS anxiety) as their WtR is strongly biased which might create uncertainty for other customers about the firm's reputation

Facilitators and barriers for the implementation of exercise are medicine in routine clinical care in Dutch university medical centres:a mixed methodology study on clinicians' perceptions

Objectives Despite the many proven advantages of a physically active lifestyle in patient populations, prescription of exercise is currently not widely implemented in routine clinical practice. The aims of this study were twofold: (1) to assess perceptions of clinicians on the current practice of exercise is medicine (E=M) prescription in two Dutch university medical centres and (2) to determine their perceived barriers and facilitators for the implementation of E=M in routine clinical care in Dutch university medical centres. Design A mixed methodologies study, using both online questionnaires and semi-structured interviews. Setting Dutch university medical centres. Participants Clinicians working within the departments of medical oncology, orthopaedics and rehabilitation medicine of two university medical centres. Results Forty-five clinicians (response rate of 51%) completed the questionnaire, and 19 clinicians were interviewed. The results showed that even though clinicians had a positive attitude towards prescribing E=M, only a few reported to regularly prescribe E=M to their patients. The 52 identified facilitators and barriers for implementation of E=M were categorised into four main themes: (1) beliefs toward the implementation of E=M (eg, clinicians knowledge and skills, and social support), (2) factors related to the patient perspective (eg, patient priorities or motivation), (3) factors related to the referral options (eg, knowledge of and trust in local referral options) and (4) practical considerations when implementing E=M (eg, time constraints). Conclusions Our study showed that even though many clinicians have a positive attitude toward an active lifestyle, many are not prescribing E=M on a regular basis. In order for clinicians to effectively implement E=M, strategies should focus on increasing clinicians E=M referral skills, improving clinicians knowledge of E=M referral options and develop a support system to ensure that E=M is high on the priority list of clinicians

A comparison of the Accuracy of Ultrasound and Computed Tomography in common diagnoses causing acute abdominal pain

Head-to-head comparison of ultrasound and CT accuracy in common diagnoses causing acute abdominal pain. Consecutive patients with abdominal pain for > 2 h and <5 days referred for imaging underwent both US and CT by different radiologists/radiological residents. An expert panel assigned a final diagnosis. Ultrasound and CT sensitivity and predictive values were calculated for frequent final diagnoses. Effect of patient characteristics and observer experience on ultrasound sensitivity was studied. Frequent final diagnoses in the 1,021 patients (mean age 47; 55% female) were appendicitis (284; 28%), diverticulitis (118; 12%) and cholecystitis (52; 5%). The sensitivity of CT in detecting appendicitis and diverticulitis was significantly higher than that of ultrasound: 94% versus 76% (p <0.01) and 81% versus 61% (p = 0.048), respectively. For cholecystitis, the sensitivity of both was 73% (p = 1.00). Positive predictive values did not differ significantly between ultrasound and CT for these conditions. Ultrasound sensitivity in detecting appendicitis and diverticulitis was not significantly negatively affected by patient characteristics or reader experience. CT misses fewer cases than ultrasound, but both ultrasound and CT can reliably detect common diagnoses causing acute abdominal pain. Ultrasound sensitivity was largely not influenced by patient characteristics and reader experience

Micro-simulation as a tool to assess policy concerning non-point source pollution: the case of ammonia in Dutch agriculture

Non-point source pollution is notoriously difficult to assess. A relevant example is ammonia emissions in the Netherlands. Since the mid 1980s the Dutch government has sought to reduce emissions through a wide variety of measures, the effect of which in turn is monitored using modeling techniques. This paper presents the current generation of mineral emission models from agriculture based on micro-simulation of farms in combination with a spatial equilibrium model for the dispersion of manure from excess regions with high livestock intensities within the country to areas with low livestock intensities. The micro-simulation approach retains the richness in the heterogeneity of farm household decision making that are the core cause of the difficulty of assessing non-point source pollution, while using the best available data to track corresponding pollution. Examples are provided that illustrate the strengths of the modeling framework for both pollution monitoring and environmental policy scenario analyses

Micro-simulation as a tool to assess policy concerning non-point source pollution: the case of ammonia in Dutch agriculture

Non-point source pollution is notoriously difficult to assess. A relevant example is ammonia emissions in the Netherlands. Since the mid 1980s the Dutch government has sought to reduce emissions through a wide variety of measures, the effect of which in turn is monitored using modeling techniques. This paper presents the current generation of mineral emission models from agriculture based on micro-simulation of farms in combination with a spatial equilibrium model for the dispersion of manure from excess regions with high livestock intensities within the country to areas with low livestock intensities. The micro-simulation approach retains the richness in the heterogeneity of farm household decision making that are the core cause of the difficulty of assessing non-point source pollution, while using the best available data to track corresponding pollution. Examples are provided that illustrate the strengths of the modeling framework for both pollution monitoring and environmental policy scenario analyses.micro-simulation, spatial equilibrium model, non-point source pollution, Environmental Economics and Policy, Research Methods/ Statistical Methods,

Septic thrombosis of the inferior vena cava treated with percutaneous mechanical thrombectomy

The present report describes a patient with septic thrombosis of the inferior vena cava (IVC) related to a subhepatic abscess adjacent to the IVC. Despite prolonged antimicrobial therapy and systemic anticoagulation, sepsis and septic embolism persisted while the size of the thrombus increased. Percutaneous mechanical thrombectomy was performed, resulting in removal of the infected thrombus and complete clinical recover

Systematic Review of Sentinel Lymph Node Mapping Procedure in Colorectal Cancer

The clinical impact of sentinel lymph node (SN) biopsy in colorectal cancer is still controversial. The aim of our study was to determine the accuracy of this procedure from published data and to identify factors that contribute to the conflicting reports. A systematic search of the Medline, Embase, and Cochrane databases up to July 2011 revealed 98 potentially eligible studies, of which 57 were analyzed including 3,934 patients (3,944 specimens). The pooled SN identification rate was 90.7 % (95 % CI 88.2-93.3), with a significant higher identification rate in studies including more than 100 patients or studies using the ex vivo SN technique. The pooled sensitivity of the SN procedure was 69.6 % (95 % CI 64.7-74.6). Including the immunohistochemical findings increased the pooled sensitivity of SN procedure to 80.2 % (95 % CI 4.7-10.7). Subgroups with significantly higher sensitivity could be identified: a parts per thousand yen4 SNs versus <4 SNs (85.2 vs. 66.3 %, p = 0.003), colon versus rectal cancer (77.6 vs. 65.7 %, p = 0.04), early T1 or T2 versus advanced T3 or T4 carcinomas (93.4 vs. 58.8 %, p = 0.01). Serial sectioning and immunohistochemistry resulted in a mean upstaging of 18.9 % (range 0-50 %). True upstaging defined as micrometastases (pN1mi+) rather than isolated tumor cells (pN0itc+) was 7.7 %. The SN procedure in colorectal cancer has an overall sensitivity of 70 %, with increased sensitivity and refined staging in early-stage colon cancer. Because the ex vivo SN mapping is an easy technique it should be considered in addition to conventional resection in colon cance

Highly Recommended? How Relation-Specific Attachment Styles Bias Customers Willingness to Recommend

Recently concepts from attachment theory are being applied to business situations. In this paper we focus on how relationship specific (RS) versus general (G) attachment styles affect the willingness-to-recommend (WtR) by customers. Such WtR refers to the likelihood of customers to recommend the services of t

The effect of exercise counselling with feedback from a pedometer on fatigue in adult survivors of childhood cancer:a pilot study

OBJECTIVE: The aim of this study was to evaluate the results of home-based exercise counselling with feedback from a pedometer on fatigue in adult survivors of childhood cancer. PATIENTS: Adult survivors of childhood cancer were recruited from the long-term follow-up clinic of the University Medical Centre Groningen, The Netherlands. A score of 70 mm on a visual analogue scale (scale, 0–100 mm) for fatigue was used as an inclusion criterion. Controls were recruited by the survivors among their healthy siblings or peers. METHODS: During 10 weeks, the counselor encouraged the survivors to change their lifestyle and enhance daily physical activity such as walking, cycling, housekeeping and gardening. As a feedback to their physical activity, the daily number of steps of each survivor was measured by a pedometer and registered using an online step diary at the start of the programme and after 4 and 10 weeks. Fatigue was the primary outcome measure, assessed with the Checklist Individual Strength (CIS) at start (T0), 10 weeks (T10) and 36 weeks (T36). Thirty-three healthy age-matched control persons were asked to complete the CIS. RESULTS: Out of 486 cancer survivors, 453 were interested and were asked to complete the VAS to measure fatigue; 67 out of 254 respondents met the inclusion criteria, 21 refused, 46 were enrolled and eight dropped out during the study. The mean scores on the CIS in the survivors at T0 was 81.42 (SD ± 20.14) and at T10 62.62 (SD ± 20.68), which was a significant improvement (p < 0.0005). At T36, the end of the study, the mean CIS score was 63.67 (SD ± 23.12); this was a significant improvement compared with the mean CIS at the start (p < 0.0005). There was no significant difference in the mean CIS scores of the controls during the follow-up period. CONCLUSION: The stimulation of daily physical activity using exercise counselling and a pedometer over 10 weeks leads to a significant decrease in fatigue in adult survivors of childhood cancer, and this improvement lasts for at least 36 weeks