Key Determinant Research Articles

Impact of health tourism visitor experiences on behavioral intention

PurposeThis paper examines the factors that influence behavioral intention in the context of medical tourism in Türkiye. With the growing popularity of Türkiye as a destination for medical tourism, it is essential to understand the key determinants influencing individuals’ intention to engage in medical tourism activities.Design/methodology/approachThis study used the Extended Theory of Planned Behavior (E-PBT) variables, which include attitude, subjective norm and perceived behavioral control, to measure their influence on behavioral intention. In addition, a customer experience scale was used to assess the influence of dimensions such as education, entertainment, aesthetics and escapism on behavioral intention. The research instrument was validated by expert review, and data were collected using purposive sampling. A total of 420 surveys were deemed suitable for analysis.FindingsThe path analysis revealed that attitudes and perceived behavioral control positively impacted behavioral intention within the domain of medical tourism in Türkiye. Conversely, subjective norms did not have a significant positive effect on behavioral intention. Furthermore, it was observed that the dimensions of entertainment, escape and aesthetics positively affected behavioral intention. However, education and aesthetics did not significantly influence behavioral intentions.Practical implicationsThe results of this paper have practical implications for marketers and policymakers in the medical tourism industry in Türkiye. Understanding the factors that drive individuals’ behavioral intentions can assist in developing effective marketing strategies to attract and serve potential medical tourists. Medical tourism providers can enhance their services by optimizing attitudes and perceived behavioral control while emphasizing entertainment and escapism for their clientele.Originality/valueThis research focuses on uncovering factors influencing individuals’ behavioral intentions in medical tourism in Türkiye. Using the E-PBT framework and exploring the dimensions of the customer experience scale, this study aimed to understand the driving forces behind individuals’ decisions to engage in medical tourism.

Improved estimation of gross primary productivity (GPP) using solar-induced chlorophyll fluorescence (SIF) from photosystem II

Solar-induced chlorophyll fluorescence (SIF) contains contributions from both photosystem I (PSI) and photosystem II (PSII). In theory, SIF emitted from PSII (SIFPSII) should be extracted from at-sensor SIF to quantify photosynthetic CO2 assimilation, as PSI fluorescence yield is nearly insensitive to changes in photochemical yield. In many SIF-related studies, the fraction of chlorophyll-absorbed energy allocated to PSII (β2), a key factor controlling the flux of excitation energy for SIFPSII, is simply assigned a fixed value. However, β2 is regulated in response to variations in environmental conditions to avoid an energy imbalance between PSI and PSII. By quantifying the regulating effect of the cytochrome b6f complex (Cyt b6f) on the electron transport from PSII to PSI, and its interaction with energy dissipation in both photosystems, we develop a framework to estimate β2 and PSII fluorescence yield (ΦF2), two key determinants for SIFPSII, from SIF emission, PAR, air temperature, the maximum carboxylase activity of Rubisco (Vcmax), and the maximum activity of Cyt b6f (JCB6F_max). The framework is equipped with a two-leaf scheme, enabling us to estimate SIFPSII for sunlit and shaded leaves from top-of-canopy SIF observations (SIFTOC). Our simulation results showed that β2 and ΦF2 tend to change in opposite directions with varying PAR, making the contribution of PSII to SIFTOC relatively constant. We compare gross primary productivity (GPP) mechanistically estimated from SIFPSII obtained with fixed (GPPSIF_Fβ) and dynamic β2 (GPPSIF_Dβ) against the eddy-tower-derived GPP (GPPEC) at a winter-wheat experiment site. At a half-hourly time scale, GPPSIF_Dβ is better than GPPSIF_Fβ, showing higher correlations with GPPEC (R2 = 0.74 versus R2 = 0.64 and RMSE = 6.61 μmol m−2 s−1 versus RMSE = 7.67 μmol m−2 s−1). The study provides a practical way to estimate the contribution of SIFPSII to SIFTOC, giving a better theoretical basis to SIF-based GPP estimation models.

A study on the influence of academic passion on PhD students' research engagement-The role of ambidextrous learning and academic climate.

The engagement in research, as the primary form of learning engagement for PhD students, is crucial for enhancing their competitive edge. Academic passion, a key determinant of learning engagement, plays a significant role in driving the research enthusiasm of PhD students. However, the "black box" concerning whether and how academic passion influences PhD students' research engagement remains to be explored. Addressing this gap, the present study draws upon self-determination theory, adopts the "motivation-behavior-effect" analytical framework, and incorporates ambidextrous learning as a mediator to elucidate the specific pathway through which academic passion impacts PhD students' engagement in research activities. Furthermore, it examines the facilitating role of the academic climate in this process. From December 2022 to March 2023, a questionnaire survey was conducted, collecting 522 responses from PhD students across 25 universities in China. The survey primarily assessed the PhD students' academic passion, ambidextrous learning behaviors (including tendencies towards exploratory and exploitative learning), and their perceived academic climate, investigating how these factors collectively influence their engagement in research activities. The questionnaire data were analyzed using a combination of SEM and bootstrapping with SPSS 26.0 and Mplus 8.3 software. The findings reveal that academic passion significantly positively affects PhD students' research engagement; ambidextrous learning (exploratory and exploitative learning) mediates the relationship between academic passion and PhD students' research engagement; and the academic climate effectively facilitates the transformation of PhD students' academic passion into ambidextrous learning (exploratory and exploitative learning). The study's conclusions not only foster PhD students' enthusiasm for research but also enhance learning effectiveness and innovation vitality, providing a theoretical basis for reforming the doctoral training system.

Use of systems thinking and adapted group model building methods to understand patterns of technology use among older adults with type 1 diabetes: a preliminary process evaluation

BackgroundA growing number of older adults (ages 65+) live with Type 1 diabetes. Simultaneously, technologies such as continuous glucose monitoring (CGM) have become standard of care. There is thus a need to understand better the complex dynamics that promote use of CGM (and other care innovations) over time in this age group. Our aim was to adapt methods from systems thinking, specifically a participatory approach to system dynamics modeling called group model building (GMB), to model the complex experiences that may underlie different trajectories of CGM use among this population. Herein, we report on the feasibility, strengths, and limitations of this methodology.MethodsWe conducted a series of GMB workshops and validation interviews to collect data in the form of questionnaires, diagrams, and recordings of group discussion. Data were integrated into a conceptual diagram of the “system” of factors associated with uptake and use of CGM over time. We evaluate the feasibility of each aspect of the study, including the teaching of systems thinking to older adult participants. We collected participant feedback on positive aspects of their experiences and areas for improvement.ResultsWe completed nine GMB workshops with older adults and their caregivers (N = 33). Each three-hour in-person workshop comprised: (1) questionnaires; (2) the GMB session, including both didactic components and structured activities; and (3) a brief focus group discussion. Within the GMB session, individual drawing activities proved to be the most challenging for participants, while group activities and discussion of relevant dynamics over time for illustrative (i.e., realistic but not real) patients yielded rich engagement and sufficient information for system diagramming. Study participants liked the opportunity to share experiences with peers, learning and enhancing their knowledge, peer support, age-specific discussions, the workshop pace and structure, and the systems thinking framework. Participants gave mixed feedback on the workshop duration.ConclusionsThe study demonstrates preliminary feasibility, acceptability, and the value of GMB for engaging older adults about key determinants of complex health behaviors over time. To our knowledge, few studies have extended participatory systems science methods to older adult stakeholders. Future studies may utilize this methodology to inform novel approaches for supporting health across the lifespan.

O-GlcNAcylation controls pro-fibrotic transcriptional regulatory signaling in myofibroblasts

Tissue injury causes activation of mesenchymal lineage cells into wound-repairing myofibroblasts (MFs), whose uncontrolled activity ultimately leads to fibrosis. Although this process is triggered by deep metabolic and transcriptional reprogramming, functional links between these two key events are not yet understood. Here, we report that the metabolic sensor post-translational modification O-linked β-D-N-acetylglucosaminylation (O-GlcNAcylation) is increased and required for myofibroblastic activation. Inhibition of protein O-GlcNAcylation impairs archetypal myofibloblast cellular activities including extracellular matrix gene expression and collagen secretion/deposition as defined in vitro and using ex vivo and in vivo murine liver injury models. Mechanistically, a multi-omics approach combining proteomic, epigenomic, and transcriptomic data mining revealed that O-GlcNAcylation controls the MF transcriptional program by targeting the transcription factors Basonuclin 2 (BNC2) and TEA domain transcription factor 4 (TEAD4) together with the Yes-associated protein 1 (YAP1) co-activator. Indeed, inhibition of protein O-GlcNAcylation impedes their stability leading to decreased functionality of the BNC2/TEAD4/YAP1 complex towards promoting activation of the MF transcriptional regulatory landscape. We found that this involves O-GlcNAcylation of BNC2 at Thr455 and Ser490 and of TEAD4 at Ser69 and Ser99. Altogether, this study unravels protein O-GlcNAcylation as a key determinant of myofibroblastic activation and identifies its inhibition as an avenue to intervene with fibrogenic processes.

Diffuse tumors: Molecular determinants shared by different cancer types

Most cancer types have both diffuse and non-diffuse subtypes, which have rather distinct morphologies, namely scattered tiny tumors vs. one solid tumor, and different levels of aggressiveness. However, the causes for forming such distinct subtypes remain largely unknown. Using the diffuse and non-diffuse gastric cancers (GCs) as the illustrative example, we present a computational study based on the transcriptomic data from the TCGA and GEO databases, to address the following questions: (i) What are the key molecular determinants that give rise to the distinct morphologies between diffuse and non-diffuse cancers? (ii) What are the main reasons for diffuse cancers to be generally more aggressive than non-diffuse ones of the same cancer type? (iii) What are the reasons for their distinct immunoactivities? And (iv) why do diffuse cancers on average tend to take place in younger patients? The study is conducted using the framework we have previously developed for elucidation of general drivers cancer formation and development. Our main discoveries are: (a) the level of (poly-) sialic acids deployed on the surface of cancer cells is a significant factor contributing to questions (i) and (ii); (b) poly-sialic acids synthesized by ST8SIA4 are the key to question (iii); and (c) the circulating growth factors specifically needed by the diffuse subtype dictate the answer to question (iv). All these predictions are substantiated by published experimental studies. Our further analyses on breast, prostate, lung, liver, and thyroid cancers reveal that these discoveries generally apply to the diffuse subtypes of these cancer types, hence indicating the generality of our discoveries.

Structural empowerment, personal initiative, and job satisfaction in service employees: Exploring the mediating role of psychological empowerment.

This study explores how empowering human resource management (HRM) practices based on structural empowerment (access to opportunities, resources, support, and information) affect both personal initiative and job satisfaction of service employees through individual-level factors (psychological empowerment). We conducted a cross-sectional survey study and collected 439 valid responses from service employees in Spain. The hypotheses were tested using structural equation modeling (SEM) with confidence intervals based on 10,000 resamples (i.e., bootstrapping technique). Our results showed that psychological empowerment partially mediated the relationship between structural empowerment and job satisfaction. It also fully mediated the relationship between structural empowerment and personal initiative at work. These findings emphasize the importance of HRM practices that can empower employees as key determinants of job satisfaction and personal initiative at service companies. Furthermore, a structural empowerment approach is a valid theoretical framework for studying and understanding employees' affective evaluations of work and, more specifically, their personal initiative.

Consumer Behavior in the World of Cryptocurrencies

Abstract Cryptocurrencies are a new form of digital assets that have gained increasing popularity in recent years. Investors have a dual objective of maximizing profits while minimizing risks. In today's world, there is an increase in the demand for cryptocurrencies, with focus on the emotional aspects as well as on the underlying technical analysis. This abstract provides a synthesis of recent research and insights into the behavior of consumers engaging with cryptocurrencies. Key determinants such as trust, perceived usefulness, and ease of use play pivotal roles in driving consumer adoption of cryptocurrencies. Furthermore, behavioral uncertainty and risk perception emerge as critical considerations impacting investment decisions within this dynamic ecosystem. The abstract also highlights the significant influence of digital platforms and social media on shaping consumer attitudes and behaviors towards cryptocurrencies, underscoring the importance of online discourse and information dissemination in this context. As the cryptocurrency market develops and grows, understanding consumer behavior becomes increasingly paramount for stakeholders, policymakers, and researchers alike. By unraveling the complexities of consumer preferences, motivations, and perceptions, this abstract offers valuable perspectives to inform strategic decision-making and foster sustainable growth in the cryptocurrency industry. This research was based on scientific articles and carefully selected and studied important data from trusted sources like academic journals, financial databases, and websites focusing on cryptocurrency information.

Exploring determinants of freeway service area usage in the context of sustainable and collaborated development for transport and tourism

Freeway service areas (FSA) provide a variety of services for road users, but these services in some cases do not guarantee the satisfaction of road users. Understanding the factors that affect the satisfaction of FSA is crucial for transportation and tourism-related departments. This paper uses a structural equation model (SEM) to examine the relationships between geographical location, routine function and satisfaction with FSA, in the context of six representative FSAs in Shaanxi province, China. The samples are divided into three clusters to investigate the sensitivity of tourists with different travel demands to the above relationship. In addition, the ordered logit model is used to verify the results of SEM and analyze the influencing factors of FSA satisfaction. Results indicate that increasing attraction levels of transport and tourism are considered to be the key determinants in improving the satisfaction with FSA, and policies and suggestions should meet tourists’ different demands. Undifferentiated policies, while useful to help improve satisfaction with FSA, may have a negative impact on some certain groups, such as those on an official business trip. This study provides theoretical and practical insights into how relevant departments and organizations with respect to transport and tourism formulate strategies for the construction and sustainable development of FSA.

Structural Basis for Recognition of the FLAG-tag by Anti-FLAG M2

The FLAG-tag/anti-FLAG system is a widely used biochemical tool for protein detection and purification. Anti-FLAG M2 is the most popular antibody against the FLAG-tag, due to its ease of use, versatility, and availability in pure form or as bead conjugate. M2 binds N-terminal, C-terminal and internal FLAG-tags and binding is calcium-independent, but the molecular basis for the FLAG-tag specificity and recognition remains unresolved.Here we present an atomic resolution (1.17 Å) structure of the FLAG peptide in complex with the Fab of anti-FLAG M2, revealing key binding determinants. Five of the eight FLAG peptide residues form direct interactions with paratope residues. The FLAG peptide adopts a 310 helix conformation in complex with the Fab. These structural insights allowed us to rationally introduce point mutations on both the peptide and antibody side. We tested these by surface plasmon resonance, leading us to propose a shorter yet equally binding version of the FLAG-tag for the M2 antibody.

Comparative survival analysis of patients with HER2-low and HER2-positive metastatic breast cancer with or without brain metastases treated with trastuzumab deruxtecan.

1036 Background: Breast cancer outcomes vary among HER2-amplified and HER2 low-expression patients, particularly in the presence of brain metastases (BM). Trastuzumab deruxtecan (T-DXd) is FDA approved for the treatment of adult patients with unresectable or metastatic human epidermal growth factor receptor 2 (HER2)-low and HER2-positive (HER2+) patients (pts). This study aims to evaluate the impact of T-DXd treatment on overall survival among HER2 low and HER2-positive metastatic breast cancer (MBC) patients with and without brain metastases (BM). Methods: A retrospective analysis was conducted by using de-identified data available from seven US-based health systems part of Guardian Research Network (GRN). Patients treated with T-DXd from December 2019 to December 2023 with a diagnosis of HER2 low (immunohistochemistry [IHC] 1 + or IHC 2+/negative with HER2 FISH non-amplified) and HER2+ (IHC 3+ or HER2+ and FISH amplified MBC were included. Median overall survival (mOS), calculated from the initiation of T-DXd treatment, was assessed using Kaplan-Meier Curve analysis and Log-rank test. Results: A total of 380 MBC pts were identified. Among these 231 (61.1%) were stratified as having HER2 low and 149 (38.9%) HER2+ MBC. Pts with HER2+ disease had a higher prevalence of BM (n=70; 47%) compared to HER2-low pts (n=55;23.8%). The median age at BM diagnosis was 60.5 years, range: 21.6 to 87.1 years. Within the entire BM group (n=125), there were more pts with ER+ disease (81.9%) in the HER2 low group compared to HER2+ group (55.8%, p=0.01). The majority of these patients had multiple prior lines of therapy. HER2+ BM pts had a median overall survival (mOS) of 9.3 months [CI: 6.79-11.88, log rank p <0.001], compared to 4.3 months [CI: 1.89-6.82, log rank p <0.001] in the HER2-low pts. Without BM, HER2+ pts had a mOS of 10.7 months [CI: 0.71-20.82, log rank p <0.001], compared to 6 months [CI: 3.47-8.67, log rank p <0.001] in the HER2-low pts. Conclusions: In this retrospective study of heavily pretreated MBC patients with multiple prior lines of therapy, pts with HER2+ MBC with and without BM had a longer mOS compared to those with HER2- low disease, suggesting HER2 expression as a key determinant of T-DXd efficacy. Poor survival in MBC patients without BM was attributed to pre-treatment with multiple lines of therapy. Future research should explore combination therapies and predictive biomarkers while conducting clinical trials to optimize treatment strategies for HER2+ metastatic breast cancer patients.

Assessing the Gap Between Women's Expectations and Perceptions of the Quality of Intrapartum Care in Jordan: A Two-Stage Study Using the SERVQUAL Model.

Although Jordan has made significant progress toward expanding the utilization of facility-based intrapartum care, prior research highlights that poor service quality is still persistent. This study aimed to identify quality gaps between women's expectations and perceptions of the actual intrapartum care received, while exploring the contributing factors. Utilizing a pre-post design, quality gaps in intrapartum care were assessed among 959 women pre- and postchildbirth at a prominent tertiary hospital in northern Jordan. Data were gathered using the SERVQUAL scale, measuring service quality across reliability, responsiveness, tangibles, assurance, and empathy dimensions. The overall mean gap score between women's expectations and perceptions of the quality of intrapartum care was -0.60 (±0.56). The lowest and highest mean gap scores were found to be related to tangibles and assurance dimensions, -0.24 (±0.39) and -0.88 (±0.35), respectively. Significant negative quality gaps were identified in the dimensions of assurance, empathy, and responsiveness, as well as overall service quality (p < 0.001). The MLR analyses highlighted education (β = 0.61), mode of birth (β = -0.60), admission timing (β = -0.41), continuity of midwifery care (β = -0.43), physician's gender (β = -0.62), active labour duration (β = 0.37), and pain management (β = -0.33) to be the key determinants of the overall quality gap in intrapartum care. Our findings underscore the importance of fostering a labour environment that prioritizes enhancing caregivers' empathetic, reassuring, and responsive skills to minimize service quality gaps and enhance the overall childbirth experience for women in Jordan. This paper is a collaborative effort involving women with lived experiences of childbirth, midwives, and obstetrics and gynaecologist physicians. The original idea, conceptualization, data generation, and coproduction, including manuscript editing, were shaped by the valuable contributions of stakeholders with unique perspectives on intrapartum care in Jordan.

Multi-omics analysis reveals the pivotal role of phytohormone homeostasis in regulating maize grain water content

Grain water content (GWC) is a key determinant for mechanical harvesting of maize (Zea mays). In our previous research, we identified a quantitative trait locus, qGWC1, associated with GWC in maize. Here, we examined near-isogenic lines (NILs) NILL and NILH that differed at the qGWC1 locus. Lower GWC in NILL was primarily attributed to reduced grain water weight (GWW) and smaller fresh grain size, rather than the accumulation of dry matter. The difference in GWC between the NILs became more pronounced approximately 35 d after pollination (DAP), arising from a faster dehydration rate in NILL. Through an integrated analysis of the transcriptome, proteome, and metabolome, coupled with an examination of hormones and their derivatives, we detected a marked decrease in JA, along with an increase in cytokinin, storage forms of IAA (IAA-Glu, IAA-ASP), and IAA precursor IPA in immature NILL kernels. During kernel development, genes associated with sucrose synthases, starch biosynthesis, and zein production in NILL, exhibited an initial up-regulation followed by a gradual down-regulation, compared to those in NILH. This discovery highlights the crucial role of phytohormone homeostasis and genes related to kernel development in balancing GWC and dry matter accumulation in maize kernels.

Life expectancy in relation to societal development level: significant discordant factors.

The aim of this study is to determine the interdependence between life expectancy and numerous social indicators, i.e., to determine the factors that encourage an increase or decrease in life expectancy. Pearson coefficients as well as linear and logarithmic trends and correlations between the dependent variable of life expectancy and numerous independent variables were calculated and analysed. The calculations were carried out for all countries in the world for which data is available. Based on the strength of the correlations between life expectancy and numerous indicators, we have tried to determine the reasons for the different values of life expectancy in the various countries. Important factors for achieving high life expectancy values are economic development and healthcare spending but the spread of "diseases of the modern era", such as obesity or diabetes, have a significant negative impact on life expectancy. Other important limiting factors for life expectancy are large income inequalities, a higher share of private healthcare expenditure in total healthcare expenditure and lower total healthcare expenditure. Less developed societies can significantly increase their life expectancy by providing clean water and safe sanitation and by combating various infectious diseases (especially HIV). Life expectancy is a meaningful indicator of the state of social development and accurately reflects the general state of a particular society. It has been shown that GDP per capita (PPP) is a key determinant of life expectancy, while other important factors play the role of a further modifier.

Mitochondrial plasticity as a key determinant for CVD risk in T2D

Mitochondrial plasticity as a key determinant for CVD risk in T2D

Why Startups Outpace Multinationals in Leveraging DevOps

Abstract This paper explores the differential impacts of DevOps across varying organizational structures, specifically analyzing why startups may outpace multinational companies in leveraging the benefits of DevOps methodologies. DevOps drives organizational efficiency and innovation. Comparative studies often examine its implementation in startups versus large-scale enterprises. The literature pinpoints the agility, culture, and size of an organization as key determinants influencing the adoption of DevOps principles. In response, this study employs an extensive questionnaire distributed to DevOps and related professionals to investigate the hypothesis that startups are uniquely positioned to harness DevOps for technological advancement and cultural synergy. The survey gathered quantitative and qualitative data reflecting experiences with DevOps adoption, challenges faced, and the perceived benefits drawn from such practices. The findings reveal that while startups and multinationals share common challenges, the former's organizational agility, innovative mindset, and less encumbered cultural practices offer startups a distinct advantage in the effective assimilation of DevOps practices. This paper contributes to the field by providing evidence supporting the notion that startups possess intrinsic advantages over multinationals in DevOps implementation, chiefly due to their flexibility and lean structures for rapid innovation. By mapping out the relative successes and impediments to DevOps adoption in diverse corporate environments, this research extends the understanding of how organizational characteristics can be leveraged to optimize DevOps strategies in the evolving landscape of software engineering.

Maternal pre-pregnancy BMI influences the associations between bisphenol and phthalate exposures and maternal weight changes and fat accumulation

BackgroundBisphenols and phthalates are two classes of endocrine-disrupting chemicals (EDCs) thought to influence weight and adiposity. Limited research has investigated their influence on maternal weight changes, and no prior work has examined maternal fat mass. We examined the associations between exposure to these chemicals during pregnancy and multiple maternal weight and fat mass outcomes. MethodsThis study included a sample of 318 women enrolled in a Canadian prospective pregnancy cohort. Second trimester urinary concentrations of 2 bisphenols and 12 phthalate metabolites were quantified. Self-reported and measured maternal weights and measured skinfold thicknesses were used to calculate gestational weight gain, 3-months and 3- to 5-years postpartum weight retention, late pregnancy fat mass gain, total postpartum fat mass loss, and late postpartum fat mass retention. Adjusted robust regressions examined associations between chemicals and outcomes in the entire study population and sub-groups stratified by pre-pregnancy body mass index (BMI). Bayesian kernel machine regression examined chemical mixture effects. ResultsAmong women with underweight or normal pre-pregnancy BMIs, MBzP was negatively associated with weight retention at 3- to 5-years postpartum (B = −0.04, 95%CI: −0.07, −0.01). Among women with overweight or obese pre-pregnancy BMIs, MEHP and MMP were positively associated with weight retention at 3-months and 3- to 5-years postpartum, respectively (B's = 0.12 to 0.63, 95%CIs: 0.02, 1.07). DEHP metabolites and MCNP were positively associated with late pregnancy fat mass gain and late postpartum fat mass retention (B's = 0.04 to 0.18, 95%CIs: 0.001, 0.32). Further, the mixture of EDCs was positively associated with late pregnancy fat mass gain. ConclusionIn this cohort, pre-pregnancy BMI was a key determinant of the associations between second trimester exposure to bisphenols and phthalates and maternal weight changes and fat accumulation. Investigations of underlying physiological mechanisms, windows of susceptibility, and impacts on maternal and infant health are needed.

Unveiling the key determinants and consequences of Virtual Reality in the immersion experience

Unveiling the key determinants and consequences of Virtual Reality in the immersion experience

Consumer Preferences and Reactions to Brand Expansion

Abstract Consumer purchasing power is one of the key determinants of consumer behavior, among other factors. Acceptance of new brands or product line extensions of existing brands is influenced by perceived value. New products can be added to existing product lines by introducing new products within them, or brands can expand horizontally by entering entirely new categories or product lines. Any vertical expansion, whether to a higher or lower level, comes after a price shift and a product quality achievement relative to its base product. While survey-based research provides valuable insights that support the growth of the Premium brand, building a strong relationship with customers, quickly identifying preferences, personalizing the offer and fostering a climate of trust remain its main sources of value. The purpose of the paper is to show the positive relationship that exists between the vertical growth of the brand and the increase in customer loyalty, as shown by the research conducted on a deliberate sample.

Burn Mortality in an Appalachian Referral Center: An Examination of Mortality Prediction Scores in a 13-Year Retrospective Study.

Introduction Burn injuries have profound implications, prompting the use of various mortality scoring systems. This study aimed to evaluate their effectiveness within our Appalachian burn referral center, which serves as the sole burn center in the state of West Virginia. Given this unique status, understanding the efficacy of mortality scoring systems within our center is crucial for resource allocation and optimizing patient outcomes in our region. Methods A retrospective analysis of patients admitted to Cabell Huntington Hospital Burn Intensive Care Unit (BICU) from January 2010 to June 2023 was conducted, assessing Baux (B), revised Baux (rB), Belgian Outcome in Burn Injury (BOBI), and Abbreviated Burn Severity Index (ABSI) scores. Logistic regression and receiver operating characteristic analysis were employed to examine survival status and determine optimal cut points. Results Among 1,104 patients, 57 died (5% mortality rate). Deceased patients had significantly higher B/rB/BOBI scores (mean: 98/98/92) than survivors (45/46/4.19) (p < 0.001), with ABSI showing no significance (p = 0.079). Each one-point increase in B/rB/BOBI scores correlated with a 1.09/1.09/2.34 times higher mortality risk (p < 0.001). The AUC for B score in predicting mortality was 0.926 (95% CI: 0.890, 0.962), with sensitivity and specificity values of 0.789 and 0.92, respectively, and an optimal cutoff point of 79. The AUC for the rB score was 0.927 (95% CI: 0.892, 0.962), with sensitivity and specificity values of 0.789 and 0.926, respectively, and an optimal cutoff point of 80. The AUC for the BOBI score was 0.901 (95% CI: 0.865, 0.937), with sensitivity and specificity values of 0.895 and 0.775, respectively, and an optimal cutoff point of 2. For patients with B scores above 79, their odds of mortality were 42.6 times higher than those with B scores of 79 or lower (95% CI: 22.6, 85.6, p < 0.001). Similarly, for patients with rB scores exceeding 80, their odds of mortality were 42.9 times higher than those with rB scores of 80 or lower (95% CI: 22.9, 84.8, p < 0.001). Finally, for patients with BOBI scores greater than 2, their odds of mortality were 17.8 times higher than those with BOBI scores of 2 or lower (95% CI: 9.88, 33.4, p < 0.001). Conclusion Our study underscores the vital role of mortality scoring systems in guiding clinical decision-making and resource allocation for burn patients, particularly within the Appalachian region served by the Cabell Huntington Hospital BICU. By leveraging tools such as the Baux, revised Baux, and BOBI scores, healthcare providers can identify high-risk patients early in their treatment course, facilitating personalized interventions and improving overall patient outcomes. Moreover, our findings highlight the significance of age and total body surface area burned as key determinants of mortality risk, emphasizing the need for tailored approaches to care for elderly patients and those with extensive burns. Continued research and refinement of mortality scoring systems are essential to further enhance their effectiveness and ensure optimal patient care in the challenging field of burn management.