The concept of customer centricity is frequently debated by sales and marketing researchers and practitioners. However, to date no validated scale exists that measures to what extent customers ...perceive companies as customer centric. Against this backdrop, drawing on prior literature, qualitative interviews, and a customer survey (N = 246), the authors develop and validate a measurement scale for perceived customer centricity. In addition, using matched survey and financial data from industrial customers (N = 1,089), the authors examine antecedents and consequences of perceived customer centricity. Results show that customers perceive firms as customer centric if the supplier is customer oriented on both the overall firm level and the salesperson level. Furthermore, perceived customer centricity is strongly linked to customers' loyalty intentions and objective sales revenue, particularly if customers perceive a firm to exhibit high prices. Thus, this article equips managers with a validated and easy-to-use measurement that allows monitoring a firm's progress toward customer centricity.
Infranodal conduction disorders are common after transcatheter aortic valve replacement (TAVR). Risk factors are incompletely understood.
The purpose of this study was to assess the impact of valve ...implantation depth and calcium burden of the device landing zone on infranodal conduction intraprocedure pre- and post-TAVR.
In all patients undergoing TAVR between June 2020 and June 2021, the His-ventricle (HV) interval was measured pre- and post-valve deployment. The difference between the 2 measurements defined delta HV, whereas infranodal conduction delay was defined as HV interval >55 ms. Valve implantation depth was measured as the distance between the aortic annular plane and the ventricular prosthesis end. Calcium burden was quantified as the volume of calcium in 6 regions of interest: the non-, right, and left coronary cusps (NCC, RCC, and LCC, respectively) and the corresponding regions of the left ventricular outflow tract (LVOT) underlying each cusp (LVOTNCC, LVOTRCC, LVOTLCC, respectively).
Of 101 patients (mean age 81 ± 5.7 years; 47% women), 37 demonstrated infranodal conduction delay intraprocedure post-TAVR. Overall, mean implantation depth was 5 ± 3.1 mm, median calcium volume was 2080 mm3 interquartile range 632–2400. Delta HV showed no correlation with implantation depth or calcium burden (r = –0.08 and r = 0.12, respectively). However, LVOTNCC calcification was a significant predictor for infranodal conduction delay post-valve deployment in a multivariable logistic regression model (odds ratio 1.62 per 100-mm3 increase (95% confidence interval 1.06–2.69; P = .04).
Assessment of LVOTNCC calcification may identify patients at risk for infranodal conduction delay after TAVR, whereas implantation depth did not predict infranodal conduction delay.
•Compared to men, women with acute myocarditis were older at the time of diagnosis, presented with more severe heart failure symptoms and higher levels of NT-proBNP.•During hospitalization, women ...received more advanced therapies, experienced severe arrhythmia 3.8 times more often and were 1.9 times more likely to develop incident or worsening heart failure.•Men presented more often with chest pain, ST-elevation and showed more non-ischemic affected segments in cardiac MRI compared to women.
This study investigated sex differences in acute myocarditis patients during index hospitalization.
We included 365 patients with acute myocarditis, hospitalized with continuous monitoring at the Intensive care unit (ICU), from 2000-2023 into the Basel Myocarditis Cohort study. We compared sex differences in clinical presentation, the presenting ECG prior medical history, inflammatory and cardiac biomarkers, cardiac imaging, arrhythmia occurrence and short to midterm outcomes.
Mean age was 41.3 years and 26.3% were female. Compared to men, women were older (median 49.7 vs 38.3 years, p<0.001) at the time of diagnosis and presented more frequently with dyspnea (41 vs 26%, p=0.013) and a higher Killip class (p=0.011). In the presenting ECG, men had a higher occurrence of diffuse ST-elevation (38 vs 9%, p<0.001) and PQ-depression (31 vs 20%, p=0.042), compared to women. Women had higher NT-proBNP levels (1180 vs 387 ng/l, p=0.015), lower cardiac troponin T levels (389 vs 726 ng/l, p=0.006), less segments with non-ischemic LGE on CMR (1 vs 3, p=0.005) but similar LVEF (55 vs 55%, p=0.629), compared to men. Overall, hospital stay was longer in women compared to men (7 vs 5 days, p=0.018) with a similar length of ICU stay (2.6 vs 2.7 days, p=0.922). Women developed more often severe arrhythmia (8.3 vs 2.2%, p=0.015) and heart failure during the hospitalization (31.3 vs 16.4%, p=0.003).
Compared to men, women with acute myocarditis were older at the time of diagnosis, presented more often with heart failure and had an increased frequency of severe arrhythmia.
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Zusammenfassung
Hintergrund
Internetbasierte Interventionen (IBIs) zur Behandlung von Depressionen zeigen in internationalen Metaanalysen positive Effekte. Es ist jedoch unklar, ob diese Effekte sich ...auch auf die in Deutschland verfügbaren IBIs erstrecken. Ziel dieser Metaanalyse war es, die unmittelbaren Effekte und die Langzeiteffekte der in Deutschland frei oder als sog. digitale Gesundheitsanwendungen (DiGA) auf Rezept verfügbaren IBIs abzuschätzen und die Wirkstärke von DiGA und frei verfügbaren IBIs zu vergleichen.
Methode
Es erfolgte eine systematische Literaturrecherche und Random-effects-Metaanalyse (Präregistrierung: INPLASY202250070). Berücksichtigt wurden RCTs von in Deutschland frei verfügbaren oder als DiGA erhältlichen IBIs an Erwachsenen mit erhöhter depressiver Symptomatik im Vergleich zu aktiven und inaktiven Kontrollen zum Erhebungszeitpunkt im Mai 2022.
Ergebnisse
Es wurden sechs Interventionen identifiziert: COGITO, deprexis, iFightDepression, moodgym, Novego und Selfapy. Die gepoolte Effektstärke von insgesamt 28 Studien mit 13.413 Teilnehmer*innen entsprach einem Effekt von Cohen’s
d
= 0,42, (95 %-KonfidenzintervallKI: 0,31; 0,54,
I
2
= 81 %). Die Analyse der Langzeiteffekte zeigte eine geringere Effektstärke von
d
= 0,29, (95 %-KI: 0,21; 0,37,
I
2
= 22 %,
n
= 10). Subgruppenanalysen deuteten auf eine mögliche Überlegenheit der drei im DiGA-Verzeichnis gelisteten Interventionen (
d
= 0,56, 95 %-KI: 0,38; 0,74,
I
2
= 83 %,
n
= 15) im Vergleich zu den drei frei verfügbaren Interventionen (
d
= 0,24, 95 %-KI: 0,14; 0,33,
I
2
= 44 %,
n
= 13) hin (
p
=
0,002
).
Schlussfolgerung
Die in Deutschland verfügbaren IBIs für depressive Störungen sind wirksam und können daher in der therapeutischen Versorgung von Menschen mit depressiven Störungen eingesetzt werden. Möglicherweise sind nicht alle Interventionen gleich gut wirksam.
Misdiagnosis of acute myocardial infarction (AMI) may significantly harm patients and may result from inappropriate clinical decision values (CDVs) for cardiac troponin (cTn) owing to limitations in ...the current regulatory process.
In an international, prospective, multicenter study, we quantified the incidence of inconsistencies in the diagnosis of AMI using fully characterized and clinically available high-sensitivity (hs) cTn assays (hs-cTnI, Abbott; hs-cTnT, Roche) among 2300 consecutive patients with suspected AMI. We hypothesized that the approved CDVs for the 2 assays are not biologically equivalent and might therefore contribute to inconsistencies in the diagnosis of AMI. Findings were validated by use of sex-specific CDVs and parallel measurements of other hs-cTnI assays. AMI was the adjudicated diagnosis in 473 patients (21%). Among these, 86 patients (18.2%) had inconsistent diagnoses when the approved uniform CDV was used. When sex-specific CDVs were used, 14.1% of female and 22.7% of male AMI patients had inconsistent diagnoses. Using biologically equivalent CDV reduced inconsistencies to 10% (P<0.001). These findings were confirmed with parallel measurements of other hs-cTn assays. The incidence of inconsistencies was only 7.0% for assays with CDVs that were nearly biologically equivalent. Patients with inconsistent AMI had long-term mortality comparable to that of patients with consistent diagnoses (P=NS) and a trend toward higher long-term mortality than patients diagnosed with unstable angina (P=0.05).
Currently approved CDVs are not biologically equivalent and contribute to major inconsistencies in the diagnosis of AMI. One of 5 AMI patients will receive a diagnosis other than AMI if managed with the alternative hs-cTn assay.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00470587.
Granulomas are immune cell aggregates formed in response to persistent inflammatory stimuli. Granuloma macrophage subsets are diverse and carry varying copy numbers of their genomic information. The ...molecular programs that control the differentiation of such macrophage populations in response to a chronic stimulus, though critical for disease outcome, have not been defined. Here, we delineate a macrophage differentiation pathway by which a persistent Toll-like receptor (TLR) 2 signal instructs polyploid macrophage fate by inducing replication stress and activating the DNA damage response. Polyploid granuloma-resident macrophages formed via modified cell divisions and mitotic defects and not, as previously thought, by cell-to-cell fusion. TLR2 signaling promoted macrophage polyploidy and suppressed genomic instability by regulating Myc and ATR. We propose that, in the presence of persistent inflammatory stimuli, pathways previously linked to oncogene-initiated carcinogenesis instruct a long-lived granuloma-resident macrophage differentiation program that regulates granulomatous tissue remodeling.
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•Polyploid macrophage fate is controlled by persistent inflammatory stimuli•Polyploid granuloma macrophages form by modified cell divisions and mitotic defects•Polyploid macrophages grow by overcoming p53-dependent barriers to their proliferation•Myc and the DNA Damage Response promote polyploid macrophage differentiation
Polyploid macrophages develop in response to chronic inflammatory signaling from toll-like receptors via replication stress and activation of the DNA damage response.
Internet-based interventions (IBIs) for the treatment of depression have been found to have positive effects in international meta-analyses; however, it is unclear whether these effects also extend ...to IBIs specifically available in Germany. The aim of this meta-analysis was to estimate the immediate effects and the long-term effects of IBIs available in Germany free of charge or available on prescription and covered by the public health insurances as so-called digital health applications (DiGAs) and to compare the efficacy of DiGAs and freely available IBIs.
A systematic literature search and random-effects meta-analysis were performed (preregistration: INPLASY202250070). Randomized controlled trials (RCTs) of IBIs freely available in Germany or as DiGA in adults with elevated depressive symptoms were compared with active and inactive controls available at the time of the survey in May 2022.
A total of six interventions were identified: COGITO, deprexis, iFightDepression, moodgym, Novego, and Selfapy. The pooled effect size of a total of 28 studies with 13,413 participants corresponded to an effect of Cohen's d = 0.42, (95% confidence interval, CI: 0.31-0.54, I
= 81%). The analysis of long-term effects showed a smaller effect size of d = 0.29, (95% CI: 0.21-0.37, I
= 22%, N = 10). Subgroup analyses indicated a possible superiority of the three interventions listed in the DiGA directory (d = 0.56, 95% CI: 0.38-0.74, I
= 83%, N = 15) compared to the three freely available IBIs (d = 0.24, 95% CI: 0.14-0.33, I
= 44%, N = 13, p = 0.002).
The IBIs for depressive disorders available in Germany are effective and can therefore be used in the treatment of people with a depressive disorder; however, it is possible that not all interventions are equally effective.
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