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REVIEW : The specialist physician`s approach to rheumatoid arthritis in South Africa
( Frederik C. J. Bester ),( Fredricka J. Bosch ),( Barend J. Jansen Van Rensburg ) 대한내과학회 2016 The Korean Journal of Internal Medicine Vol.31 No.2
Rheumatoid arthritis (RA) is expected to increase in Africa and South Africa. Due to the low numbers of rheumatologists in South Africa, specialist physicians also have to care for patients with RA. Furthermore several new developments have taken place in recent years which improved the management and outcome of RA. Classification criteria were updated, assessment follow-up tools were refined and above all, several new biological disease-modifying anti-rheumatic drugs were developed. Therefore it is imperative for specialist physicians to update themselves with the newest developments in the management of RA. This article provides an overview of the newest developments in the management of RA in the South African context. This approach may well apply to countries with similar specialist to patient ratios and disease profiles.
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Frederik Taylor Pitter,Matt Sikora,Martin Lindberg-Larsen,Alma Becic Pedersen,Benny Dahl,Martin Gehrchen 대한척추신경외과학회 2020 Neurospine Vol.17 No.1
Objective: To report the 1-year pre and postoperative analgesic use in patients undergoing primary surgery for adult spinal deformity (ASD) and assess risk factors for chronic postoperative opioid use. Methods: Patients >18 years undergoing primary instrumented surgery for ASD in Denmark between 2006 and 2016 were identified in the Danish National Patient Registry. Information on analgesic use were obtained from the Danish National Health Service Prescription Database. Use of analgesics was calculated one year before and after surgery for each patient, per quarter (-Q4 to -Q1 before and Q1 to Q4 after). Users were defined as patient with one or more prescriptions in the given quarter. Results: We identified 892 patients. Preoperatively, 28% (n=246) of patients were opioid users in -Q4 and 33% (n=295) in -Q1. Postoperatively, 85% (n=756) of patients were opioid users in Q1 and 31% (n=280) in Q4. Proportions of users of other analgesics (paracetamol, antidepressants, and anticonvulsants) were stable before and after surgery. Use of nonsteroidal anti-inflammatory drug decreased postoperatively by 40% (-Q1 vs. Q4). 26% of patients had chronic preoperative opioid use (one or more prescriptions in each -Q2 and -Q1) and 24% had chronic postoperative use (prescription each of Q1–Q4). Multivariate logistic regression analysis showed age increment per 10 years and preoperative chronic opioid use as risk factors for chronic postoperative opioid use. Conclusion: One year after ASD surgery, opioid use was not reduced compared to preoperative usage.
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Frederik C. Gulmark Hansen,Mads Gustaf Jørgensen,Jens Ahm Sørensen 한국유방암학회 2023 Journal of breast cancer Vol.26 No.1
Purpose: Breast cancer-related lymphedema (BCRL) is a chronic, progressive side effect of breast cancer treatment, occurring in one-third of patients treated with axillary lymph node dissection and nodal radiotherapy. Cluster of differentiation 4-positive (CD4+) cells plays a key role in BCRL by facilitating inflammation and inhibiting lymphangiogenesis. Tacrolimus is an anti-inflammatory and immunosuppressive macrolide that targets CD4+ cells. Treatment of lymphedema with topical tacrolimus has revealed promising results in preclinical trials. This clinical trial was aimed at evaluating the feasibility, safety, and effect of tacrolimus in women with stage I or II BCRL, according to the International Society of Lymphology. Methods: We conducted this open-label, single-arm, phase II pilot trial from September 2020 to April 2021. Eighteen women with BCRL stage I or II BCRL were treated with topical tacrolimus for 6 months and followed up at 3 and 6 months. The primary outcome was arm volume, and secondary outcomes were the lymphedema index (L-Dex), health-related quality of life (HRQoL), lymph flow and function, and safety and feasibility of the trial design. Results: The mean lymphedema arm volume and L-Dex reduced significantly by 130.44 ± 210.13 mL (p < 0.05; relative reduction: 3.6%) and 3.54 ± 4.98 (p < 0.05), respectively, and health-related quality of life scores was improved significantly (p < 0.05). According to the MD Anderson scale, in terms of lymph flow and function, three patients (16.7%) showed improvement, while none showed worsening. Lymph flow or function showed no change according to the Arm Dermal Backflow scale. Conclusion: In this trial, treatment with tacrolimus was safe and feasible in women with stage I or II BCRL. Tacrolimus alleviated BCRL in terms of improved arm volume, L-Dex, and HRQoL. Assessments of lymph flow and function were positive, although inconclusive. Larger randomized controlled trials are required to verify these findings. Trial Registration: ClinicalTrials.gov Identifier: NCT04541290
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Frederik Fuchs,Gregor Habl,Michal Deveč,ka,Severin Kampfer,Stephanie E,Combs,Kerstin A,Kessel 대한방사선종양학회 2019 Radiation Oncology Journal Vol.37 No.2
Purpose: The aim of this study was to identify volume changes and dose variations of rectum and bladder during radiation therapy in prostate cancer (PC) patients. Materials and Methods: We analyzed 20 patients with PC treated with helical tomotherapy. Daily image guidance was performed. We re-contoured the entire bladder and rectum including its contents as well as the organ walls on megavoltage computed tomography once a week. Dose variations were analyzed by means of Dmedian, Dmean, Dmax, V 10 to V 75 , as well as the organs at risk (OAR) volume. Further, we investigated the correlation between volume changes and changes in Dmean of OAR. Results: During treatment, the rectal volume ranged from 62% to 223% of its initial volume, the bladder volume from 22% to 375%. The average Dmean ranged from 87% to 118% for the rectum and 58% to 160% for the bladder. The Pearson correlation coefficients between volume changes and corresponding changes in Dmean were -0.82 for the bladder and 0.52 for the rectum. The comparison of the dose wall histogram (DWH) and the dose volume histogram (DVH) showed that the DVH underestimates the percentage of the rectal and bladder volume exposed to the high dose region. Conclusion: Relevant variations in the volume of OAR and corresponding dose variations can be observed. For the bladder, an increase in the volume generally leads to lower doses; for the rectum, the correlation is weaker. Having demonstrated remarkable differences in the dose distribution of the DWH and the DVH, the use of DWHs should be considered.
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CAN’T HELP FALLING IN LOVE: HOW LUXURY BRANDS GENERATE CONSUMER AFFECT IN SOCIAL MEDIA
Jan-Frederik Gräve,Marius Johnen,Sina Kaltenbach,Timo Mandler 글로벌지식마케팅경영학회 2018 Global Marketing Conference Vol.2018 No.07
Introduction Today, many luxury brands use social media channels such as Facebook, Instagram, Twitter, or YouTube to communicate with their target consumers worldwide. Previous research has shown that engaging consumers in social media can lead to increase commitment and loyalty (e.g., Hudson, Huang, Roth, & Madden, 2016; Wirtz et al., 2013), purchase intentions (e.g., Beukeboom, Kerkhof, & de Vries, 2015; Kim & Ko, 2010) and sales (e.g., Kumar et al., 2016). Although researchers have investigated the role of social media marketing for luxury brands at an aggregate level (e.g., Godey et al., 2016; Kim & Ko, 2012), little is known about the success drivers of luxury brand communication at a more granular level. Therefore, our study aims to identify the characteristics of luxury brand posts that elicit positive consumer affect. Specifically, we examine the effect of different luxury appeals (e.g., conspiciousness, uniqueness, quality), alongside other brand post characteristics (e.g., vividness, call-to-action, informative/entertaining content) on consumers‟ affective reactions (“Love”) towards a luxury brand post. For this purpose, we draw on field data from Facebook that comprises 2,343 individidual brand posts published by 18 leading luxury brands between 1st January 2017 and 30th June 2017. Our study contributes to literature on luxury brand communication in at least three ways: First, from a theoretical perspective, we are shedding the first light on the relevance of different luxury appeals for generating consumer engagement in social media. Methodologically, we further introduce a novel measure of consumer engagement termed Love-Ratio (short, LoveR), which is based on Facebook‟s new “reactions”-feature that was introduced in 2016. Finally, from a managerial point of view, our insights that help managers of luxury brands to „engineer“ emotionally engaging social media content that contributes to strong consumer-brand relationships. Literature Review Conceptual BackgroundLiterature provides initial empirical evidence for the general advantageousness of social media activities for luxury brands (Godey et al., 2016; Kim & Ko 2010, 2012). Importantly, these studies commonly examine consumers‟ overall assessment of a brand‟s social media activities, i.e. whether a brand‟s (entire) social media presence “enables information sharing with others” (interaction) or “offers customized information search” (customization; Kim & Ko, 2012, p. 1483). Therefore, it constitutes an aggregate measure of a brand‟s social media presence as a whole, and is not concerned with the specifics of the individual interactions between a brand and consumers (post as the unit of analysis). Recent research, however, clearly indicates that the extent to which consumers interact with a brand in social media (e.g., liking, sharing, or commenting) depends on the characteristics of a given brand post (e.g., De Vries, Gensler, & Leeflang, 2012; Sabate, Berbegal-Mirabent, Canabate, & Lebherz, 2014; Schultz, 2017). Most studies in this regard examined correlations between certain characteristics (e.g., use of photos, videos, and/or links, post length and timing) and different measures of consumer engagement or post popularity (i.e., number of likes, comments, or shares).5) These studies provide useful insights into several “hard” criteria that determine consumer interactions with brand posts. However, due to the tremendous coding efforts required, only few studies have also considered “soft” criteria, such as the appeal – i.e., “the overall theme of a post” (Wagner, Baccarella, & Voigt, 2017, p. 2) – that is communicated within a post. To extend knowledge in the field of luxury brand communication in social media, we are adopting a similar approach by (1) proposing a comprehensive set of luxury-specific appeals that may be communicated within brand posts and (2) empirically investigating their effectiveness in evoking positive consumer affect. Conceptual Background Based on a synthesis of prior work (e.g., Vigneron & Johnson, 2004) we propose a set of six distinct luxury appeals that can be communicated via social media posts: 1. Conspicuousness: Conspicuous consumption refers to the consumption of goods or services with the intention of social status improvement and communication to others (Eastman, Goldsmith, & Flynn, 1999). It involves high levels of self-monitoring and a status-signaling mentality (Wilcox, Kim, & Sen, 2009), aimed at presenting oneself by means of a product that is recognized and highly regarded by others. The general aim is to express a brand„s capability to enable a person to become the center of attention and stand out of the crowd by conveying a high social status (Phau & Prendergast, 2000). 2. Uniqueness: Uniqueness refers to the quality of being particularly special due to sheer rarity or remarkable characteristics. Brands express their uniqueness by highlighting their products‟ (a) excellent craftmanship, (b) innovativeness, or (c) their exclusiveness in terms of consumption. Examples for uniqueness through craftmanship include creative product designs, the use of rare materials or ingredients (e.g., diamonds in the context of jewelry), or even tailor-made/personalized products (e.g., configuration of a car; inscription of personal initials onto fashion items). The general aim is to distinguish a product from others, rendering it extraordinary and remarkable. The same can be accomplished through innovation, since a pioneering product is by definition unique in that it has certain features that distinguish it from any other existing competing product. Furthermore, uniqueness can be achieved through exclusiveness of consumption. One method to create contrived rarity is a limitation of the quantity of products manufactured (e.g., limited editions; Vigneron & Johnson, 2004). 3. Quality: Luxury brands are generally expected to deliver high quality products and services (Vigneron & Johnson, 2004). Indicators that can be used in the communication of quality include specific materials (e.g., cashmere, gemstones) or performance data (e.g., power, top speed) that convey a high standard of (instrinsic) quality. 4. Hedonism: In general, the term hedonism refers to the pursuit of pleasure in the sense of sensual self-indulgence. Luxury brands commonly offer emotional and sensual benefits that can be experienced by and transferred to consumers in a consumption situation (Moore & Lee, 2012). Communication aimed at conveying hedonism commonly neglects utilitarian (i.e., functional) aspects of the product of interest and, instead, emphasizes the emotional experience associated with the consumption of that product or service (Vigneron & Johnson, 2004), e.g., pleasure, joy, self-reward, love, passion, or excitement (Holbrook & Hirschman, 1982). 5. Extended Self: The term extended self describes the definition of a person‟s selfconcept by his/her personal possessions. In other words, consumers use products (or services) to define who they are. For example, wearing luxury fashion items enables a person to associate himself/herself with characteristics of the brand, and vice versa (Vigneron & Johnson, 2004). Brand communication reflecting this appeal attempts to suggest that the consumption of a product or service helps them to establish, reinforce, and express an aspired personality trait, such as elegance, confidence, success, or power. 6. Heritage: Many luxury brands have a long history and rich tradition. Communication efforts that intend to convey a brand‟s rich heritage either showcase a brand‟s founder as a person, elaborate on the founder‟s or company‟s history, or highlight a traditional, iconic product which has made the brand what it is today. Data and Method To investigate the effectiveness of these luxury appeals in evoking positive consumer affect, we conducted an empirical analysis using field data from Facebook. We compiled a set of 18 luxury brands from different categories, including fashion, cars, cosmetics, and champagne. For this set of brands, we extracted all brand posts (mostly photos and videos) that were published between 1st January and 30th June 2017, yielding 2,343 individual posts that constitute our unit of analysis. We enriched the raw data by manually coding all brand posts in terms of the luxury appeals of interest, following a two step-procedure. First, we developed a detailed codebook that defines each luxury appeal, provides a list of relevant indicators, and further illustrates each luxury appeal with the help of exemplary brand posts. Using the codebook we instructed two independent coders to code the absence (0) or presence (1) of each luxury appeal within a given post. The inter-rater reliabilities were satisfactory for all luxury appeals, ranging from .79 to .91. We further requested the coders to capture other content characteristics and controls that potentially affect consumer interactions with brand posts, e.g., Vividness, Calls-to-Action, Entertaining vs. Informative Content, Visibility of the Brand, and Type of Endorser. Instead of examining conventional measures of consumer engagement, such as likes, comments, or shares, we introduce a new measure of consumer affect that we label “Love-Ratio” or, short, LoveR. This measure is based on Facebook‟s new class of user reactions that enable users to indicate their feelings about certain posts, such as “Love” or “Anger”. LoveR represents the amount of “Love”-reactions relative to all reactions toward a given brand post. Thus, it reflects an aggregate measure of users‟ positive affect towards a brand post. We consider LoveR an important extension of commonly investigated outcomes such as Likes or Shares, which are considered “fairly low-level form[s] of engagement” (Stephen, Sciandra, & Inman, 2015, p. 20). Consumer affect, by contrast, is generally considered a “chief motivator of behavior” (O‟Cass & Frost, 2002, p. 73) and a “mediating factor in the purchase process” (Schiffman, Bendall, Watson, & Kanuk, 1997, p. 361), therefore representing a useful proxy of consumer attitudes. Model estimation Given the nested structure of the data (i.e., posts are nested within brand pages), we use hierarchical linear modeling (Raudenbush & Bryk, 2002) with random intercepts to analyze the data. We specify the proposed luxury appeals (Conspiciousness, Uniqueness, Quality, Hedonism, Extended Self, and Heritage) alongside additional content characteristics, and brand dummies as predictors of LoveR. After estimating the direct effects, we stepwise include interaction terms to test potential moderating effects of Vividness and Entertainment. The results suggest that three of the six luxury appeals evoke positive consumer affect. The strongest driver of LoveR is Quality (β = .978, p < .001), followed by Hedonism (β = .479, p < .05) and Heritage (β = .451, p < .01). Conspiciousness and Uniqueness, by contrast, are not significantly related to consumers‟ affective reactions towards brand posts. Furthermore, the use of an appeal that communicates Extended Self even decreases LoveR (β = -.530, p < .10), although the effect is only marginally significant. To further contextualize these main effects, we included additional interaction terms involving Vividness and Entertainment. We find (a) that the effect of Hedonism on LoveR is further enhanced by the use of videos (relative to photos and other less vivid types of media; interaction effect: β = 1.023, p < .05, conditional effect of Hedonism for vivid content β = .934, p < .01,) and (b) that the effect of Heritage on LoveR tends to be larger when it is communicated in an entertaining rather than informative style (interaction effect: β = .753, p = .001; conditional effect of Heritage for entertaining style: β = .660, p < .001). Conclusions Our study sheds light onto the effectiveness of luxury brands‟ communication in social media in terms of generating positive consumer affect. Our results based on an analysis of 2,343 individual luxury brand posts in Facebook show that only certain luxury appeals can trigger consumers‟ “Love”-reactions towards a brand post. Specifically, we find that brand posts that convey Quality, Hedonism, and Heritage appeals increase the likelihood of a brand post being “loved“, whereas Conspiciousness and Uniqueness exert no influence at all. Posts which communicate an Extended Self may even decrease favorable affective reactions by users. The effects of Hedonism and Heritage are further enhanced by the use of videos or entertaining content, respectively. These findings have direct implications for the marketing communications of luxury brands. From a content perspective, marketers should develop and run media content that (a) emphasizes hedonic consumption motives (as reflected by Hedonism) rather than status-signaling motives (as reflected by Conspiciousness), preferably using rich media such as videos; (b) educates consumers about the history and values of a brand, preferably in an informative rather than entertaining way; and (c) reinforces a brand‟s quality claim.
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Fuchs, Frederik,Habl, Gregor,Devecka, Michal,Kampfer, Severin,Combs, Stephanie E.,Kessel, Kerstin A. The Korean Society for Radiation Oncology 2019 Radiation Oncology Journal Vol.37 No.2
Purpose: The aim of this study was to identify volume changes and dose variations of rectum and bladder during radiation therapy in prostate cancer (PC) patients. Materials and Methods: We analyzed 20 patients with PC treated with helical tomotherapy. Daily image guidance was performed. We re-contoured the entire bladder and rectum including its contents as well as the organ walls on megavoltage computed tomography once a week. Dose variations were analyzed by means of Dmedian, Dmean, Dmax, V<sub>10</sub> to V<sub>75</sub>, as well as the organs at risk (OAR) volume. Further, we investigated the correlation between volume changes and changes in Dmean of OAR. Results: During treatment, the rectal volume ranged from 62% to 223% of its initial volume, the bladder volume from 22% to 375%. The average Dmean ranged from 87% to 118% for the rectum and 58% to 160% for the bladder. The Pearson correlation coefficients between volume changes and corresponding changes in Dmean were -0.82 for the bladder and 0.52 for the rectum. The comparison of the dose wall histogram (DWH) and the dose volume histogram (DVH) showed that the DVH underestimates the percentage of the rectal and bladder volume exposed to the high dose region. Conclusion: Relevant variations in the volume of OAR and corresponding dose variations can be observed. For the bladder, an increase in the volume generally leads to lower doses; for the rectum, the correlation is weaker. Having demonstrated remarkable differences in the dose distribution of the DWH and the DVH, the use of DWHs should be considered.
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