Background. Cystinuria is a rare autosomal recessive disorder leading to recurrent cystine stone formation, often necessitating repeated surgical interventions. In Türkiye, tiopronin—a proven medical therapy—has become inaccessible since 2019, raising concerns about its economic and clinical consequences. This study aimed to compare the annual hospital costs of surgical management with the theoretical cost of tiopronin therapy in pediatric cystinuria patients. Methods. This single-center, retrospective study included 10 consecutive pediatric patients (median age: 12 years; range: 3-17 years) with genetically or biochemically confirmed cystinuria who underwent surgery for cystine stones in 2023. The annual cost of surgical management was calculated by summing all direct medical costs (operating room, anesthesia, devices, hospitalization, and related diagnostics) obtained from the hospital billing database. The theoretical annual cost of tiopronin therapy was calculated based on the last accessible market price of the drug in Türkiye, converted to Turkish Lira at the 2023 average exchange rate, and adjusted per patient using a standard dosing regimen of 15 mg/kg/day. Costs were compared using the Mann-Whitney U test. Results. The median annual surgical cost per patient was 49,936 TL (range: 14,791–84,576 TL), compared to a theoretical tiopronin cost of 27,923 TL (range: 9,307–27,925 TL). Surgical management was significantly more expensive than tiopronin therapy (p=0.001) in 9 of 10 cases. Six patients had a history of tiopronin use, and five of them experienced a surgery-free interval during medication (median duration: 3 years; range: 2-6 years). Preliminary follow-up data for 2024 revealed that 70% of patients required further surgical interventions (median: 2 surgeries per patient), demonstrating the persistent and recurrent nature of the disease when managed solely with surgery. Conclusion. Surgical treatment of cystinuria poses a substantially higher economic burden compared to tiopronin therapy. Our findings support the reintroduction of tiopronin into the Turkish healthcare system, particularly for pediatric patients with frequent stone recurrence.

Learning outcomes The learning outcomes are as follows: Case overview/synopsis This case study examines the strategic dilemma faced by Nothing Before Coffee, a fast-growing Indian café brand recognized for its culturally rooted, youth-focused appeal. Established in 2017 in Jaipur, Nothing Before Coffee disrupted the traditional café market by catering to underserved Tier II and III cities with accessible pricing, distinctive offerings like the “Shrappe,” and visually engaging store designs. By 2025, Nothing Before Coffee had expanded to over 90 outlets, entered the international market with a store in Portugal, and adopted a company-owned, company-operated model to maintain brand consistency. However, its ambitious goal of scaling to 400 outlets in two years presented a challenge – how to achieve rapid expansion without losing authenticity or becoming indistinguishable from other chains. This tension was further compounded by the need for external funding, operational efficiency and navigating diverse consumer expectations across urban and international markets. Through Anand Jain’s strategic considerations, the case explores the complexities of balancing growth with brand identity, investor expectations with customer loyalty and operational scale with cultural relevance. It provides a strong foundation for discussions on strategic expansion, brand positioning and managing purpose-driven businesses in competitive emerging markets. Intended for upper-level undergraduate and MBA courses in Strategic Management and Marketing, this case enables students to engage with real-world challenges of scaling a brand while preserving the distinctive elements that made it successful. Let me know if you need any refinements! Complexity academic level This case study is suitable for undergraduate and postgraduate courses such as Strategic Management and Marketing Management in MBA and BBA programs. It is also applicable to students studying Retail Management, Operations Strategy and Consumer Behavior. With a moderate level of difficulty, the case allows students to explore strategic decision-making in the rapidly growing Indian Quick Service Restaurant industry, especially within emerging market contexts where growth aspirations must be balanced with brand identity and operational capability. Supplementary materials Teaching notes are available for educators only. Subject code CSS 11: Strategy.

This study investigates the effect of social influence and price value on the behavior of high school students in using the Ruangguru educational application, with behavioral intention as a mediator. The research addresses the gap in understanding the adoption of digital learning platforms among Indonesian students, where usage decisions are often driven by contextual rather than purely psychological factors. A quantitative approach using PLS-SEM was employed, with data collected from 277 respondents through validated questionnaires (Cronbach’s α > 0.7, AVE > 0.5), chosen for its ability to test both direct and indirect relationships simultaneously. Results indicate that price value has a significant positive effect on user behavior (β = 0.421, t = 5.312, p < 0.001, R² = 0.46), while social influence (β = 0.097, p > 0.05) and behavioral intention (β = 0.083, p > 0.05) do not show significant effects. Descriptive analysis also revealed that 72% of students reported high satisfaction, and 68% expressed willingness to recommend the app, although this intention did not translate into actual usage behavior. These findings highlight that affordability and perceived benefits outweigh peer encouragement or intention in driving adoption, reflecting students’ sensitivity to price-value alignment in digital learning. The study implies that educational technology providers should prioritize accessible pricing strategies, though further research is needed to integrate other UTAUT2 constructs for a more comprehensive understanding.

ABSTRACT This article develops a normative framework for interpreting the Fair, Reasonable and Non-Discriminatory (FRAND) platform-access obligation in Article 6(12) of the Digital Markets Act (DMA), with Apple’s iOS App Store as the central case study. Whereas the DMA couples contestability and fairness, EU enforcement has focused almost exclusively on contestability while avoiding the more difficult question of what constitutes a fair access fee. Yet, due to network effects and developer lock-in, effective contestability may not materialize, compelling the European Commission to confront the substantive fairness of app-store commissions. Drawing on FRAND principles in standard essential patents, EU competition law, and telecoms regulation, the article shows that none of these frameworks can be transposed directly to digital ecosystems characterized by intangible assets and reciprocal value creation. It argues instead for a principles-based approach built around four propositions: gatekeepers should not be remunerated for network-effect rents; FRAND must reflect the reciprocal value that developers generate for the ecosystem; access pricing should account for the net exchange of value between platform and developer; and fees should reflect Long-Run Average Incremental Costs. Implemented together, these principles offer a coherent method for operationalizing fairness under Article 6(12) and rebalancing value capture in digital markets.

This study examines the relationship between demographic segmentation and masstige marketing effectiveness across different age groups in the Bareilly region of Uttar Pradesh, India. Masstige (mass prestige) marketing represents a strategic approach where brands offer premium products at accessible price points, targeting middle-class consumers aspiring for luxury. Through a comprehensive survey of 450 respondents across five age cohorts, this research investigates how age-related factors influence consumer response to masstige brands. The findings reveal significant variations in brand perception, purchase intention, and value consciousness across age groups. Younger consumers (18-30 years) demonstrate higher susceptibility to social media influence and status symbolism, while older segments (51+ years) prioritize quality and functional value. The study contributes to the limited literature on masstige marketing in tier-2 Indian cities and provides actionable insights for marketers seeking to optimize segmentation strategies.

Track access pricing in cross-border rail transport

The rapid growth of the culinary industry, particularly in the MSME sector, has intensified competition, requiring business actors to understand factors influencing consumer purchasing decisions. Price, promotion, and ease of access are key variables shaping consumers’ perceived value. This study aims to analyze the effects of price, promotion, and ease of access on purchasing decisions at the culinary MSME Angkringan Mas Gun in South Semarang. A quantitative approach was applied using a survey of 385 respondents determined through the Lemeshow formula. Data were collected using Likert-scale questionnaires and analyzed with SPSS, including validity, reliability, classical assumption tests, and hypothesis testing using t-tests and F-tests. The partial t-test results indicate that price has a positive and significant effect on purchasing decisions (β = 0.402; p = 0.000), promotion also shows a positive and significant effect (β = 0.232; p = 0.000), and ease of access has a positive and significant effect (β = 0.331; p = 0.000). Simultaneously, all three variables have a positive and significant influence on consumer purchasing decisions. The study concludes that affordable pricing, effective promotional strategies, and easily accessible locations enhance consumers’ purchasing decisions. These findings provide practical insights for culinary MSMEs in developing competitive and sustainable marketing strategies.

The local skincare industry in Indonesia has experienced rapid growth alongside increasing public awareness of skin health and personal appearance. Although the level of local skincare product usage is relatively high, this phenomenon is not always accompanied by the formation of strong consumer loyalty toward specific brands. This study aims to analyze consumer purchase intention and loyalty toward local skincare products, as well as to identify the factors influencing the development of such loyalty.This research adopts a qualitative approach using in-depth interviews with eight informants who are users of local skincare products in Denpasar City. The data were analyzed through processes of data reduction, data display, and conclusion drawing in order to obtain a comprehensive understanding of consumer behavior.The findings indicate that consumer beliefs regarding product safety, suitability for skin type, perceived benefits, affordable pricing, and ease of access are the primary factors driving purchase intention toward local skincare products. Beliefs formed through positive usage experiences play a crucial role in encouraging repeat purchases and fostering consumer loyalty. These findings emphasize that loyalty toward local skincare brands is not solely determined by product quality, but is also shaped by perceptions of safety, relevance to local needs, and consistent usage experiences. This study is expected to contribute to the development of consumer behavior research and to serve as a strategic reference for stakeholders in the local skincare industry.

Objective: This study aims to measure the extent of LPG usage inequality and to examine the factors influencing it across 13 provinces in Eastern Indonesia (KTI) over the period 2015–2023. Specifically, this study seeks to address two research questions: (1) To what extent does LPG usage inequality vary across provinces in Eastern Indonesia? and (2) What factors contribute to the occurrence of this inequality?Methods: This study uses panel data sourced from the National Socioeconomic Survey (Susenas) and official publications of BPS-Statistics Indonesia. LPG usage inequality is measured using the Gini Coefficient and the Lorenz Curve. The empirical model is analyzed using the Fixed Effect Model (FEM), which is then corrected with Feasible Generalized Least Squares–Seemingly Unrelated Regression (FGLS-SUR) to address heteroskedasticity and cross-sectional unit correlation issues.Findings: The research findings reveal that five provinces (East Nusa Tenggara, Maluku, North Maluku, Papua, and West Papua) experience very high disparities in LPG usage, primarily influenced by limited access and high LPG prices. Empirically, it was found that per capita income and education significantly reduce inequality, while an increase in LPG prices significantly increases inequality.Originality/Value: This research makes a novel contribution by focusing on LPG usage inequality across the provinces of Eastern Indonesia. The use of panel data analyzed through the FGLS-SUR method enables a more robust and precise identification of the determinants of inequality.Practical/Policy implication: The government should enhance the equity of energy distribution infrastructure, ensure price stability, and promote energy literacy as part of a just clean energy transition. Furthermore, improving educational attainment and strengthening micro, small, and medium enterprises (MSMEs) are essential to increasing public awareness, raising income levels, and stimulating regional economic development.

HPR65 Early Access Programs and Pricing and Reimbursement Agreements in Portugal for Orphan Medicines Centrally Approved in the European Union

Abstract It is well known that food insecurity contributes to disparities in dementia risk; however, no studies have examined the role of food environments in exacerbating the relationship between food insecurity and dementia risk in older adults. We conducted a multi-methods study to examine the associations of food insecurity and food environments with dementia risk and explore how food environments affect food purchasing and healthy eating. We analyzed data from 6,551 participants aged 50+ without dementia in 2014 from the Health Care and Nutrition Study. We conducted individual interviews with 16 community-dwelling adults aged 50+. Food insecurity was assessed in 2013 using the six-item Short Form US Household Food Security Survey Module. Food environmental factors included the county-level price of low-fat milk, as well as low-income, low-food access, and low-vehicle access at Census-tract-level. Incident dementia from 2016 to 2020 was identified using a validated algorithm. Discrete-time proportional hazard models were fitted, adjusting for age, gender, education, racialized group, survey mode, living arrangement, and urbanicity. Residing in neighborhoods characterized by low-income, low-vehicle access, and higher low-fat milk prices was associated with a greater risk of incident dementia. Our qualitative findings further demonstrated food environmental factors relevant to healthy food purchasing and eating—both protective against dementia—including convenience, portion variety, prices, quality, safety, supply, mobility aids, proximity, and transportation. However, food environment factors did not modify the association between food insecurity and dementia risk. These findings underscore the significant role of both food environments apart from food insecurity in shaping dementia risk.

Abstract There is a paucity of research that seeks to understand why race disparities in health across the life course remain elusive. Two such explanations that have been garnering attention are stress and discrimination. The symposium includes several papers addressing the effects of discrimination and stress on health disparities across the life course. Cobb used latent class analysis to identify discrimination subgroups among Black men aged 50 and older, finding that those in the Race/Ancestry Discrimination group had significantly lower odds of hospital visits. Thomas Tobin examined the association between everyday discrimination and multimorbidity among Black Americans, revealing that the discrimination-multimorbidity association was strongest among young adults and decreased among middle-aged and older adults. Kim conducted a multi-methods study on food insecurity and food environments, finding that residing in neighborhoods with low-income, low-vehicle access, and higher low-fat milk prices was associated with a greater risk of incident dementia. Qualitatively, food environmental factors relevant to healthy food purchasing and eating—both protective against dementia. Whilby characterized racial discrimination trajectories and identified correlates of the trajectories among Black adults, identifying individuals reporting higher levels of major lifetime experiences of discrimination and greater neighborhood social cohesion were associated with membership in the “moderate” and the “persistently high and increasing” racial discrimination trajectory groups. These findings highlight the variability in the cumulative patterning of racial discrimination and stress among midlife and older Black adults, providing insights into how these factors impact health outcomes in middle to late life.

Estimating the real price of CAR-T cells in France: From list price to net price

The global agri-food system (AFS) is increasingly vulnerable to a complex web of economic, environmental, and geopolitical disruptions. This review paper critically examines the economic vulnerabilities embedded within agri-food supply chain (AFSC), focusing particularly on smallholder farmers, export-oriented economies, and the broader risks associated with globalization. Drawing on recent crises such as the COVID-19 pandemic and the Russia–Ukraine conflict, the paper explores how systemic shocks disrupt production, distribution, and consumption, leading to increased food insecurity, especially in the Global South. Key issues include limited financial access, infrastructural deficits, digital exclusion, and food price volatility. The paper highlights a range of mitigation strategies, including policy reform, digital technology adoption (e.g., blockchain, internet of things), local food system strengthening, financial risk transfer instruments, and collaborative capacity building. Through global case studies and critical analysis, the paper identifies persistent research gaps—particularly regarding informal food systems and the contextual adaptability of technological innovations. It calls for interdisciplinary approaches and multi-stakeholder cooperation to foster resilient, inclusive, and sustainable AFSs capable of withstanding future shocks. Moreover, this paper advances key Sustainable Development Goals by protecting smallholder livelihoods (SDG 1 and 2), promoting digital agriculture and infrastructure (SDG 9), improving supply chain transparency (SDG 12), and addressing climate risks with adaptive strategies (SDG 13). It lays a foundation for resilient and sustainable AFSs through policy and innovation.

Shopping cart abandonment is a frequently observed phenomenon in online retailing, yet it has received relatively limited scholarly attention within the marketing literature. In response to this gap, the present study undertakes theory-advancing research to examine digital cart abandonment as a form of online non-buyer behaviour. The specific objectives and contributions of the present study are to identify the factors that lead to digital cart cancellation, a form of online non-buyer behaviour, and to clarify the reasons underlying such abandonment. A total of 250 completed questionnaires were received from the study, which was conducted between August and October of 2025. All of the data were statistically tested through factor analysis and analysed using SPSS. The findings indicate that there are five primary factors responsible for shopping cart abandonment: inflated price, time compression, social considerations, security issues, and lack of accessibility. Among these factors, inflated price emerged as the most significant, whereas accessibility issues were found to be the least significant. This study contributes to the marketing literature by providing empirical evidence on the drivers of online cart abandonment and enhances understanding of digital consumer behaviour. The findings also offer practical implications for e-commerce firms seeking to reduce cart abandonment by improving pricing strategies, enhancing trust, and optimising the online shopping experience Keywords: Online Shopping, Window Shopping, Shopping Carts, Consumer Behaviour etc

This study examines the influence of 3 major social media platforms—TikTok, Instagram, and Facebook—on hotel selection among Zennial travelers (Millennials and Gen Z) across the UK, Ireland, and Spain. As tourism in these regions becomes increasingly shaped by digital engagement, social media has evolved into a central driver of travel inspiration, evaluation, and booking behavior. Using the Theory of Planned Behavior (TPB), this study explores how attitudes (shaped by visual appeal and influencer credibility), subjective norms (driven by peer interactions, likes, shares, and group discussions), and perceived behavioral control (influenced by accessible booking links, price transparency, and informational clarity) contribute to travelers’ booking intentions. The findings reveal that TikTok primarily drives initial desire and discovery, Instagram strengthens emotional connection and expectation-setting, and Facebook provides informational security that supports final booking decisions. Collectively, these platforms form an interconnected digital pathway that guides travelers from inspiration to confirmation across the UK, Ireland, and Spain. The research underscores the need for hospitality marketers to adopt cross-platform strategies that integrate authenticity, visual storytelling, and community-based trust to effectively influence the modern travel consumer.

This study aims to determine the effect of price, promotion, and ease of access on the decision to use Maxim services in Bengkulu City, both partially and simultaneously. Data collection was conducted using a questionnaire. The sample consisted of 114 Maxim app service users in Bengkulu City. The analysis methods used were validity testing, reliability testing, multiple linear regression, coefficient of determination, F-test, and t-test.Based on the results of the research and discussion, it was found that price did not have a significant effect on the decision to use Maxim services in Bengkulu City because the significance value was 0.386 > 0.05. Promotions had a significant effect on the decision to use Maxim services in Bengkulu City because the significance value was 0.000 < 0.05. Ease of access has a significant effect on the decision to use Maxim application services in Bengkulu City because the significance value is 0.000 < 0.05. Meanwhile, simultaneously, price, promotion and ease of access have a significant effect on the decision to use Maxim application services in Bengkulu City because the significance value is 0.000 < 0.05.

The study focused on factors Influencing Coffee Cooperative Performance and Farmer Livelihoods in Kasese District, Uganda. The study is guided by one objective which was to; identify the key factors affecting the performance of primary coffee cooperatives. The study employed a cross-sectional research design and primary data was collected from 200 respondents. The data was analyzed using SPSS version 22.0. The study used questionnaires and interview guide to collect data. The study concludes that significant factors included; member’s participation, Sig. = 0.004, Capacity building and technical support, Sig. = 0.04, Market linkage and price volatility, Sig. = 0.000, Effective governance and leadership, Sig. = 0.014, Poor quality coffee harvested, Sig. = 0.024 and non-significant factors included; Infrastructure deficits, Sig. = 0.140, lack of Knowledge on value addition technologies, B = 0.009, Sig. = 0.831, Inaccessibility to inputs, Sig. = 0.435 and Coffee pests and disease pressure, Sig. = 0.339. The study recommends enhancing access to inputs, credit, and extension services to improve the operational efficiency and sustainability of cooperatives. Local governments and coffee-related authorities should formulate policies that directly support cooperative development. There is a need to stabilize market access and coffee prices. Establish long-term contracts with buyers to minimize price fluctuations. There is a need to promote certification schemes like organic, fairtrade to encourage coffee quality.

High gold price volatility due to global economic instability poses challenges in investment decision-making. This research aims to develop a web-based gold price prediction application using a time series model, focusing on the Gated Recurrent Unit (GRU) algorithm. This application is designed to present real-time, accurate, and easily accessible gold price predictions, thereby increasing the efficiency and transparency of information for investment decision making. The development process starts from collecting and preprocessing daily gold price data for the period 2013-2023, then comparing four predictive models: LSTM, GRU, ARIMA, and XGBoost. Evaluation is performed using MAE, RMSE, and R² metrics. Results showed that GRU provided the best performance with an RMSE value of 17.76 and R² of 0.9410. The GRU model is integrated into a web application using the Flask framework, with an interactive HTML-based interface and Chart.js visualization. This application presents real-time gold price predictions and can be accessed by general users and investors. The results of this study show that the time series approach with GRU is effective in projecting gold prices, and can be a relevant tool in supporting data-based investment decisions.

Drinking water is a basic human need that must meet health requirements to be suitable for direct consumption without causing health risks. Drinkable water must be free from various contaminants, both physical, chemical, and microbiological that can harm the human body. One of the sources of drinking water that is widely used by the community is refillable drinking water (DAMIU), which is now growing due to its affordable price and ease of access. However, the water quality from DAMIU is often a concern due to potential contamination due to sanitation that does not meet standards. This study aims to analyze the sanitary conditions of the refillable drinking water depot (DAMIU) and assess the quality of drinking water based on physical, chemical, and microbiological parameters in the working area of the Punti Kayu Health Center, Palembang. A total of 15 DAMIU are the object of research that are examined through laboratory tests and direct observation of the sanitary conditions and equipment of the depot. The results showed that all DAMIU (100%) had met the general sanitation requirements, such as room cleanliness, equipment, and workers. However, microbiological testing found that 33.4% of the water samples contained E. coli and Coliform bacteria, indicating the presence of contamination. In addition, all samples (100%) did not meet the ideal drinking water pH requirements, and as many as 40% of the samples had aluminum content that exceeded the threshold set by the Indonesian Minister of Health. From these findings, it can be concluded that although the sanitary conditions of DAMIU are relatively good, the quality of the drinking water produced still requires serious attention.