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Purpose This study aims to compare the relative importance of service quality (SQ), customer satisfaction (CS) and positive emotional experiences (PEE) to determine which is more influential in customers’ intention to spread positive eWOM. Design/methodology/approach A questionnaire that had been translated previously into English, German and Spanish and contained scales from previous studies, as well as a new scale created for electronic word-of-mouth (eWOM) (which was tested before fieldwork commenced), was sent through an online survey to all customers who had stayed in a hotel during the previous three months and were selected from the customers’ database of two international hotel chains that operate hotels worldwide, most of which are middle-upper class establishments that specialize in the holiday market. A total of 3,671 valid questionnaires were obtained, and the research model was tested using partial least squares. Findings The findings suggested that, in the context of mid-upscale hotels, SQ is of paramount importance for CS, but by itself, does not guarantee customers’ involvement in generating and spreading positive eWOM. CS, by itself, neither guarantees customer involvement in positive eWOM spreading. However, the provision of services that can generate PEE among hotel guests is a powerful determinant of positive eWOM spreading and also has a very positive effect on CS. Research limitations/implications The results are based on a sample selected from customers of mid-upper-class hotels that cater to the holiday segment, and therefore, apply only to customers who use this category of hotel services. Further research should be conducted on mid-lower-class hotels to determine whether the results obtained in this paper can be generalized throughout the hotel industry. Practical implications This study provides useful insights for hotel marketing managers by identifying a key causal element that fosters consumer creativity and consumer content creation by spreading eWOM. Managerial practices should strive to provide guest experiences that have the ability to increase emotional outcomes. The results have practical implications for product/service development, communication and customer relationship activities, as well as price and revenue management. Specifically, SME hotels could benefit from an increased volume of positive eWOM to increase their competitiveness. Originality/value The antecedents of eWOM have received less attention in research than its effects. Drawing on a large sample of hotel customers, this paper sheds light on the important issue of identifying which factors motivate customers to engage in spreading positive eWOM specifically in the hotel industry. The results also suggested that WOM and eWOM should not be considered strictly equivalent either in their features and effects or in their antecedents.

Introduction and hypothesisThe aim of this study was to evaluate the long-term effect of thermoablative fractional CO2 laser (TACO2L) as an alternative treatment for early stages of stress urinary incontinence (SUI) in postmenopausal women with genitourinary syndrome of menopause.MethodsA total of 161 postmenopausal patients (age 53.38 ± 5.1 years, range 45–65 years) with a clinical diagnosis of mild SUI were prospectively enrolled in the study. Patients received one treatment with TACO2L every 30–45 days, each treatment comprising four sessions, followed in all patients by a yearly treatment session at 12, 24 and 36 months. SUI was evaluated using the International Continence Society 1-h pad test and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before and after TACO2L treatment.ResultsTACO2L treatment was associated with a significant improvement in ICIQ-UI SF scores and 1-h pad weight test at 12 months (both p < 0.001), 24 months (both p < 0.001) and 36 months (both p < 0.001). Improvements were maintained for up to 36 months without the need for any further intervention. The results were confirmed by significant histological changes related to trophic restoration of the vagina, responsible for extrinsic and intrinsic mechanisms involved in urinary continence.ConclusionsOur results suggest that TACO2L is an efficient and safe novel treatment strategy in patients with mild SUI. Further investigation to confirm the long-term results presented here is still warranted.

•The safety results in this study were consistent with the safety profile of PCV vaccines in adults.•Noninferior immunogenicity was demonstrated for each of the 13 shared serotypes (ST) in V114 compared to PCV13.•In addition to non-inferiority, superiority was also analyzed for shared ST3.•Superior immunogenicity of V114 compared to PCV13 was demonstrated for shared ST3, and two serotypes unique to V114 (ST22F, and ST33F). Pneumococcal conjugate vaccines (PCVs) have greatly reduced the incidence of pneumococcal disease, yet unmet medical need remains due to increased disease caused by non-vaccine serotypes (STs). V114 (VAXNEUVANCETM, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA) is a 15-valent PCV containing 13 serotypes in licensed PCV13 and 2 additional serotypes (22F, 33F) which significantly contribute to pneumococcal disease burden. This phase 3 trial compared safety, tolerability, and immunogenicity of V114 to PCV13 in adults ≥50 years of age. Adults were randomized 1:1 to receive a single dose of V114 or PCV13; randomization was stratified by age (50–64 years, 65–74 years, and ≥75 years). Adverse events (AEs) were collected following vaccination. Serotype-specific opsonophagocytic activity (OPA) and immunoglobulin G (IgG) antibodies were measured prior to and 30 days after vaccination (Day 30). Primary objectives included assessing noninferiority of V114 to PCV13 for the 13 shared serotypes and superiority of V114 to PCV13 for the two unique serotypes. Superiority of V114 to PCV13 for shared serotype 3 was assessed as a secondary objective. Overall, 1,202 participants were vaccinated (V114 N = 602, PCV13 N = 600). The most commonly reported AEs across both groups were injection-site pain, fatigue, and myalgia. V114 met noninferiority criteria compared to PCV13 for the 13 shared serotypes (using a 2-fold non-inferiority margin for the ratio of OPA geometric mean titers [GMTs] [V114/PCV13] at Day 30) and met superiority for the 2 unique serotypes (using a 2-fold super-superiority margin for the ratio of OPA GMTs [V114/PCV13] at Day 30 and a 0.10 super-superiority margin for the difference in proportions of participants with ≥4-fold rise from prevaccination to Day 30). V114 met superiority criteria compared to PCV13 for serotype 3 (based on a super-superiority margin of 1.2 for the ratio of the OPA GMTs [V114/PCV13] and a superiority margin of 0 for the difference in proportions of participants with ≥4-fold rise). [NCT03950622, EudraCT#2018-004316-22, Japic-CTI#194845].

•This study evaluated PCV20 given with QIV.•Adults ≥ 65 years of age received QIV and PCV20 at the same time or separately.•Immune response to coadministered QIV + PCV20 was noninferior to separate QIV/PCV20.•The PCV20 safety profile was acceptable and similar across groups. Older adults are at increased risk of adverse outcomes from pneumococcal disease and influenza infections. Vaccination is an established strategy for preventing both illnesses. This study evaluated coadministration of 20-valent pneumococcal conjugate vaccine (PCV20) and an adjuvanted quadrivalent inactivated influenza vaccine (QIV). This phase 3, randomized, double-blind, multicenter study included 1796 US adults ≥ 65 years of age randomized 1:1 to receive either PCV20 and QIV followed 1 month later by saline (Coadministration group) or QIV and saline followed 1 month later by PCV20 (Separate Administration group). Primary immunogenicity objectives were to show noninferiority of PCV20 and QIV coadministration compared with separate administration of either vaccine based on serotype-specific opsonophagocytic activity (OPA) titers for PCV20 and strain-specific hemagglutination inhibition assay (HAI) titers for QIV. Safety endpoints included local reactions, systemic events, and adverse events (AEs). Noninferiority for pneumococcal and influenza antibody responses (lower bound 95 % CI of the OPA and HAI geometric mean ratios of > 0.5 and > 0.67, respectively) was shown for the Coadministration group compared with the Separate Administration group for all 20 pneumococcal serotypes and all 4 influenza vaccine strains. Local reactions and systemic events were mostly mild or moderate in severity across groups; injection site pain was the most frequent local reaction, and fatigue was the most frequent systemic event. Mild and moderate fatigue were reported more frequently after PCV20 and QIV coadministration compared with separate administration (mild, 20.0 % vs 10.8 %-12.6 %; moderate, 12.3 % vs 8.4 %-9.6 %); this was not considered clinically significant. AE reporting rates were similar across groups, and no serious AEs were considered vaccination-related. Immune responses after coadministration of PCV20 and QIV were noninferior to separate administration of either vaccine. The PCV20 safety profile was similar when given together with or after QIV. These findings support PCV20 and QIV coadministration. Trial Registration:ClinicalTrials.gov, NCT04526574.

Coadministration of a respiratory syncytial virus (RSV) vaccine with seasonal influenza or SARS-CoV-2 vaccines could reduce health-care visits and increase vaccination uptake in older adults who are at high risk for severe respiratory disease. The RSV mRNA-1345 vaccine demonstrated efficacy against RSV disease with acceptable safety in the ConquerRSV trial in adults aged 60 years and older. We aimed to evaluate the safety and immunogenicity of mRNA-1345 coadministered with a seasonal influenza vaccine or SARS-CoV-2 mRNA vaccine. We conducted a two-part, phase 3, observer-blinded, placebo-controlled, randomised trial in medically stable adults aged 50 years or older in the USA. In part A, participants were randomly assigned in a 7:10:10 ratio to receive 50 μg mRNA-1345 plus placebo (0·9% sodium chloride) or coadministered with 60 μg of a standard-dose quadrivalent inactivated influenza vaccine (SIIV4), or SIIV4 plus placebo. In part B, participants were randomly assigned in a 1:1:1 ratio to receive 50 μg mRNA-1345 plus placebo or coadministered with 50 μg SARS-CoV-2 mRNA-1273.214 (bivalent [Wuhan-Hu-1 plus omicron BA.1]), or mRNA-1273.214 plus placebo. Random allocation in both parts was stratified by age group (50–59 years, 60–74 years, and ≥75 years) and used interactive response technology. The coprimary objectives in each part were safety in the safety set throughout the study and non-inferiority for six immunogenicity endpoints in the per-protocol set comparing coadministered versus individual vaccines on day 29. Immunogenicity endpoints were geometric mean titre (GMT) ratios (GMRs) of RSV-A neutralising antibodies (nAbs; in parts A and B), GMRs of haemagglutination inhibition (HAI) titres to each of the four influenza strains in SIIV4 (A/Victoria/2570/2019 [H1N1]pdm09-like virus [A/H1N1], A/Cambodia/e0826360/2020 [H3N2]-like virus [A/H3N2], B/Washington/02/2019-like virus [B/Victoria], and B/Phuket/3073/2013-like virus [B/Yamagata]; in part A), GMRs of nAbs against SARS-CoV-2 (ancestral [D614G] and omicron BA.1; part B), and differences in seroresponse rates for nAbs against RSV-A (parts A and B) and SARS-CoV-2 (ancestral [D614G] and omicron BA.1; part B). Non-inferiority was declared when the lower bound of the 95% CI for GMRs was greater than 0·667 and for seroresponse rate differences was greater than −10%. This trial is registered with ClinicalTrials.gov (NCT05330975) and is ongoing. Between April 1 and June 9, 2022, 1631 participants were randomly allocated in part A and 1623 received vaccinations on day 1 (685 [42%] received mRNA-1345 plus SIIV4, 249 [15%] mRNA-1345 plus placebo, and 689 [42%] SIIV4 plus placebo). Due to an interactive response technology error, the mRNA-1345 plus placebo group was smaller than planned (249 vs 420 participants). Of the 1623 participants in the safety set, 877 (54%) were female and 746 (46%) were male. Between July 27 and Sept 28, 2022, 1691 participants were randomly allocated in part B and 1681 received vaccinations on day 1 (564 [34%] received mRNA-1345 plus mRNA-1273.214, 558 [33%] mRNA-1345 plus placebo, and 559 [33%] mRNA-1273.214 plus placebo). Among the 1681 participants in the safety set, 924 (55%) were female and 757 (45%) were male. The reactogenicity profiles of the coadministered regimens were generally similar to the profiles when the vaccines were administered alone. As of the 6-month and 7-month follow-up times for parts A and B, respectively, no serious adverse events, adverse events of special interest, discontinuations due to adverse events, or fatal events considered related to study vaccination were reported. In part A, the GMR of nAbs against RSV-A in the mRNA-1345 plus SIIV4 group versus the mRNA-1345 alone group was 0·81 (95% CI 0·67 to 0·97), and the seroresponse rate difference in nAbs against RSV-A between the groups was −11·2% (95% CI −17·9 to −4·1). GMRs of anti-HAI titres in the mRNA-1345 plus SIIV4 versus SIIV4 alone groups were 0·89 (0·77 to 1·03) for A/H1N1, 0·97 (0·86 to 1·09) for A/H3N2, 0·93 (0·82 to 1·05) for B/Victoria, and 0·91 (0·81 to 1·02) for B/Yamagata. In part B, the GMR of nAbs against RSV-A in the mRNA-1345 plus mRNA-1273.214 versus the mRNA-1345 alone groups was 0·80 (95% CI 0·70 to 0·90), and the seroresponse rate difference was –4·4% (95% CI –9·9 to 1·0). Comparing the mRNA-1345 plus mRNA-1273.214 group with the mRNA-1273.214 alone group, the GMR of nAbs was 0·96 (0·87 to 1·06) for the ancestral (D614G) virus and 1·00 (0·89 to 1·14) for omicron BA.1; seroresponse rate differences were 0·2% (95% CI –6·0 to 6·3) for SARS-CoV-2 ancestral and –0·9% (–6·6 to 4·7) for omicron BA.1. Coadministered mRNA-1345 plus SIIV4 or mRNA-1273.214 vaccines had acceptable safety profiles and elicited mostly non-inferior immune responses compared to individual vaccines in adults aged 50 years or older; only the seroresponse rate difference in nAbs against RSV-A in part A did not meet the non-inferiority criterion. Overall, these data support coadministration of mRNA-1345 with these vaccines in this population; longer-term evaluation continues in this study. Moderna.

Patients with cancer are at increased risk of morbidity and mortality from COVID-19 but were underrepresented in pivotal vaccine trials. Data on the magnitude and determinants of immune responses to mRNA SARS-CoV-2 vaccination in this population remain limited. I-SPARC is a prospective, phase IV clinical trial evaluating humoral and cellular immune responses to mRNA SARS-CoV-2 vaccination in 115 patients with cancer, including those receiving systemic therapy and those in remission. Anti-Spike antibody titers were measured longitudinally, and immunophenotyping was performed to assess T and B cell subsets. Clinical outcomes, including SARS-CoV-2 infection, were recorded. All patients developed detectable anti-Spike antibodies, although absolute titers varied by cancer type and treatment. Patients with hematologic malignancies and/or receiving chemotherapy had the lowest anti-Spike antibody levels. Booster doses significantly increased titers, particularly in patients in remission or receiving non-cytotoxic therapies. Prior SARS-CoV-2 infection and the number of vaccine doses were associated with better responses. Immunophenotyping confirmed vaccine-induced expansion of memory T and B lymphocyte subpopulations. SARS-CoV-2 infection occurred in 16% of our cohort, with infrequent severe cases. mRNA SARS-CoV-2 vaccines elicit robust humoral and cellular immune responses in patients with cancer, despite variability according to disease type and treatment. These findings support the use of booster strategies and provide a rationale for tailored vaccination approaches in immunocompromised populations.

The severe acute respiratory syndrome coronavirus 2 (SARS–CoV‐2) has given rise to a pandemic of unprecedented proportions in the modern era because of its highly contagious nature and impact on human health and society: coronavirus disease 2019 (COVID‐19). Patients with cardiovascular (CV) risk factors and established CV disease (CVD) are among those initially identified at the highest risk for serious complications, including death. Subsequent studies have pointed out that patients with cancer are also at high risk for a critical disease course. Therefore, the most vulnerable patients are seemingly those with both cancer and CVD, and a careful, unified approach in the evaluation and management of this patient population is especially needed in times of the COVID‐19 pandemic. This review provides an overview of the unique implications of the viral outbreak for the field of cardio‐oncology and outlines key modifications in the approach to this ever‐increasing patient population. These modifications include a shift toward greater utilization of cardiac biomarkers and a more focused CV imaging approach in the broader context of modifications to typical practice pathways. The goal of this strategic adjustment is to minimize the risk of SARS–CoV‐2 infection (or other future viral outbreaks) while not becoming negligent of CVD and its important impact on the overall outcomes of patients who are being treated for cancer.

Kasabach-Merritt phenomenon (KMP) is a rare but life-threatening condition characterized by consumptive coagulopathy associated with a vascular tumor. This phenomenon usually presents in early infancy and commonly reported sites of tumor include extremities, trunk, and neck. We report a newborn with KMP, presenting with parotid gland hemangioma and associated vascular complications. This case report and literature review, aim to describe the imaging features of KMP in an infant, along with a compilation of cases from the literature, with a particular focus on the radiological findings of the vascular tumor. Sixteen patients described in seven articles published between 1993 and 2021 were analyzed. Most of the cases were males (56%), with a median age of 13.5 days, an interquartile range (IQR) of 2.75 to 30 days, and lesions primarily located in the parotid gland. The most commonly affected side was 87.5% of cases involved the main gland, 6.25% the thoracic wall and 6.25 the supraclavicular region. The lesions also involved secondary sites such as the temporal region, submandibular area, neck, facial region, and extensive areas involving the thorax and extremities. KMP in the parotid gland is a rare manifestation. Advanced radiological imaging, particularly MRI and contrast-enhanced CT, plays a critical role in the diagnosis, staging, and detection of associated complications. The integration of imaging findings with clinical and laboratory data is essential for timely therapeutic decisions. Continued efforts to refine imaging protocols and gather epidemiological data will improve the prognosis of patients with this complex condition, emphasizing the need for a multidisciplinary approach.

Heart failure (HF) in patients with cancer is associated with high morbidity and mortality. The success of cancer therapy has resulted in an exponential rise in the population of cancer survivors, however cardiovascular disease (CVD) is now a major life limiting condition more than 5 years after cancer diagnosis [Sturgeon, Deng, Bluethmann, et al 40(48):3889-3897, 2019]. Prevention and early detection of CVD, including cardiomyopathy (CM) and HF is of paramount importance. The European Society of Cardiology (ESC) published guidelines on Cardio-Oncology (CO) [Lyon, López-Fernández, Couch, et al 43(41):4229-4361, 2022] detailing cardiovascular (CV) risk stratification, prevention, monitoring, diagnosis, and treatment throughout the course and following completion of cancer therapy. Here we utilize a case to summarize aspects of the ESC guideline relevant to HF clinicians, with a focus on risk stratification, early detection, prevention of CM and HF, and the role for guideline directed medical therapy in patients with cancer.