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Uncertainty is a ubiquitous, yet often misunderstood condition studied by academia. In the humanities, subjects wield it as a tool, using it as a source of inspiration and entertainment. In the social sciences, subjects consider it a weapon that, when controllable, is leveraged for competitive advantage and, when not, is defended against to minimize harm. We describe the dangers of its misunderstanding—specifically, those arising from mistaking untreatable uncertainties as treatable ones and vice versa. We draw from the analysis of these uses and misuses of uncertainty to make a call to action to improve how we study and address this unique condition that makes strategic decisions so much harder to optimize.

Acute kidney injury secondary to methotrexate therapy for hematologic malignancies is relatively uncommon. Methotrexate crystals in these cases are rarely seen on kidney biopsy, and in particular, their appearance in tissue prepared for transmission electron microscopy has not been described. A male patient with recurrent primary central nervous system lymphoma received high-dose methotrexate and rituximab for treatment. On day 2 of cycle 3, one day after the infusion of high-dose methotrexate, the patient was found to have high levels of serum methotrexate. Shortly after, he developed acute kidney injury. A kidney biopsy was performed, which showed methotrexate crystals only on tissue submitted for electron microscopy. To our knowledge, this is the first report to characterize methotrexate crystals on toluidine blue-stained thick sections and their ultrastructure on transmission electron microscopy.

Abstract NK models are agent-based simulations of market evolution generated through new entry and firm innovation, and are often focused on better understanding complex interdependencies in organizational phenomena. We provide a counterpoint to the mostly optimistic descriptions of the advantages and of the requirements for these fitness-landscape-based analyses. We do so by offering a comprehensive list of limitations of that modelling technique as well as a critical analysis of two recent applications of the NK model—one of a theory-testing application and one of a theory-building application. Our analysis reveals that when care is not taken to capture the essential parts of a phenomenon, the NK approach may be unnecessary at best, and misleading at worst. We discuss the implications of these analyses and update past suggestions for future uses of NK simulations in organizational research.

In the present business environment, the strategic challenge of increasing performance along multiple dimensions simultaneously—e.g., financial, social, and personal—has never been greater. Thus, the purpose of this study is to improve the understanding of how firms can successfully pursue diverse performance goals simultaneously. To that end, specifically, this study’s objectives are to not only explore whether entrepreneurs are more successful than their corporate manager peers in that pursuit but also to explore how being an entrepreneur and being spiritual provide possible paths to being successful in such a pursuit. We draw upon a recent survey of 168 medium-sized venture entrepreneurs and their corporate executive peers in the US to better understand how such integration of roles and goals can be managed. Results indicate that being an entrepreneur and being spiritual lead to greater synergies among the performance outcomes, with some exceptions. The holistic nature underlying the findings has implications for policy (e.g., resource allocation) and for practice in that all firms should be seeking ways to find synergies not only between pairs of outcomes (e.g., profits and CSR) but among networks of outcomes (and at different levels of impact).

We prove a fundamental attribution error connecting rule-breaking behavior to entrepreneurs. We do so in the research context of the US, where we recently sampled from medium-sized venture entrepreneurs and their corporate executive peers (as an applicable reference point). We chose the US not only for its high entrepreneurial activity, but also because of the not uncommon relationship between business leaders and religion. By including various measures of religiosity in the study, we could control for factors that would likely influence rule-breaking, which standard models like the fraud triangle do not explicitly consider. In fact, we add contingency theory ideas to the fraud triangle to determine whether it is the decision conditions that determine rule-breaking rather than the role of the person (i.e., as an entrepreneur). We find that once demographic, religious, firm and industry contingencies are controlled for, any statistically significant influence of being an entrepreneur (relative to being a corporate executive with similar opportunity, motivation, capability and rationalization) disappears when it comes to self-admitted value-bending behaviors at work. Our contribution consists of a novel analysis, results and discussion of the ‘bent’repreneur—adding to conversations on the under-researched nexus of entrepreneurship with religiosity and ethical decision-making.

Teece asserts that competition policy is so outdated that it now significantly degrades the ability of Big Tech firms to bring socially beneficial innovations to market. He suggests that strategic management research is essential in the struggle to update such policies. We counter that none of these assertions are accurate, let alone backed by evidence. While the larger goal of improving laws and policies through scientific research is a worthy one, the specific focus on doing so to aid a set of powerful firms that have allegedly caused—directly or indirectly—great societal damage is quite unappealing. To balance his pro-Big Tech perspective, we provide logical and theory-based arguments and evidence that indicates Big Tech has often been bad for innovation and society while their regulation has been good, and that more oversight—specifically tailored to digital platforms—would be better. We then offer three alternative paths for us, as management scholars, to take that leverage our distinctive skills and that fulfill our ethical and professional mandates, in the pursuit of improving the strategic decisions and actions that policymakers and firms take.

The creation school of opportunity formation is a relatively new partial theory of entrepreneurship built upon a relatively new approach to theorizing. Given their significant respective impacts, we critically evaluate both that school and that approach to better understand their respective values to theorizing. We apply a comprehensive, critical framework to evaluate the creation school. We determine that it is not yet a theory, but that it raises several important theoretical questions, from the origins of valuable heterogeneity to which meta-heuristics should be assumed and to what types of uncertainty are involved in entrepreneurial opportunities. We then describe its comparison-based approach for theorizing, delineating it from similar approaches that also contrast against the given benchmark ideas in a field, to determine its benefits and costs to advancing the modeling of phenomena. We determine that this new approach differs from problematization and constrastivity; instead of developing assumptions from induction, it uses a strawman to simply assert them. We finish by discussing the implications for how we can take more control over what kinds of theories affect the definition, and the legitimacy earned, in important fields of research like entrepreneurship.

Background: ALPPS leads to fast and effective liver hypertrophy. This enables the resection of extended tumors. Conventional ALPPS is associated with high morbidity and mortality. MILS reduces morbidity and the robot adds technical features that make complex procedures safe., Material and Methods: The MD-MILS was screened for patients who underwent rALPPS. Demographic and perioperative data were evaluated retrospectively. Ninety days postoperative morbidity was scored according to the CD classification. The findings were compared with the literature., Results: Since November 2021, five patients have been identified. The mean age and BMI of the patients were 50.0 years and 22.7 kg/m 2 . In four cases, patients suffered from colorectal liver metastases and, in one case, intrahepatic cholangiocarcinoma. Prior to the first operation, the mean liver volume of the residual left liver was 380.9 mL with a FLR-BWR of 0.677%. Prior to the second operation, the mean volume of the residual liver was 529.8 mL with a FLR-BWR of 0.947%. This was an increase of 41.9% of the residual liver volume. The first and second operations were carried out within 17.8 days. The mean time of the first and second operations was 341.2 min and 440.6 min. The mean hospital stay was 27.2 days. Histopathology showed the largest tumor size of 39 mm in diameter with a mean amount of 4.7 tumors. The mean tumor-free margin was 12.3 mm. One complication CD > 3a occurred. No patient died during the 90-day follow up., Conclusion: In the first German series, we demonstrated that rALPPS can be carried out safely with reduced morbidity and mortality in selected patients.

Introduction: Sepsis, the leading cause of acute kidney injury (AKI), is associated with a high morbidity and mortality. Alkaline phosphatase (ALP) is an endogenous detoxifying enzyme. A recombinant human ALP compound, ilofotase alfa, showed no safety or tolerability concerns in a phase 2 trial. Renal function improvement over 28 days was significantly greater in the ilofotase alfa group. Moreover, a significant relative reduction in 28-day all-cause mortality of >40% was observed. A follow-up trial has been designed to confirm these findings., Methods and Analysis: This is a phase 3, global, multi-centre, randomised, double-blind, placebo-controlled, sequential design trial in which patients are randomly assigned to either placebo or 1.6 mg/kg ilofotase alfa. Randomisation is stratified by baseline modified Sequential Organ Failure Assessment (mSOFA) score and trial site. The primary objective is to confirm the survival benefit with ilofotase alfa by demonstrating a reduction in 28-day all-cause mortality in patients with sepsis-associated AKI requiring vasopressors. A maximum of 1400 patients will be enrolled at ∼120 sites in Europe, North America, Japan, Australia and New Zealand. Up to four interim analyses will take place. Based on predefined decision rules, the trial may be stopped early for futility or for effectiveness. In addition, patients with COVID-19 disease and patients with 'moderate to severe' chronic kidney disease are analysed as 2 separate cohorts of 100 patients each. An independent Data Monitoring Committee evaluates safety data at prespecified intervals throughout the trial., Ethics and Dissemination: The trial is approved by relevant institutional review boards/independent ethics committees and is conducted in accordance with the ethical principles of the Declaration of Helsinki, guidelines of Good Clinical Practice, Code of Federal Regulations and all other applicable regulations. Results of this study will determine the potential of ilofotase alfa to reduce mortality in critically ill patients with sepsis-associated AKI and will be published in a peer-reviewed scientific journal., Trial Registration Number: EudraCT CT Number 2019-0046265-24. US IND Number 117 605 Pre-results., Clinicaltrials: gov number: NCT04411472., Competing Interests: Competing interests: PP received advisory board consultancy and travel reimbursements from AM-Pharma. DCA and CJD serve as advisory board consultants for AM-Pharma. JA, EvdB and JB are employees of AM-Pharma. RB, MB, KD, BF, JAK, P-FL, VP and PY received advisory board consultancy reimbursements from AM Pharma. KB worked as an employee of Berry Consultants KB and acted as a consultant to numerous pharmaceutical and device companies. KB is currently an employee of and holds stock in AstraZeneca. JC, ALK and SR are consultants to AM-Pharma. RF received advisory board consultancy reimbursements from AM Pharma and additional consulting reimbursements from BioMerieux, Baxter, Pfizer, MSD, Gilead, Shionogi, Grifols and Beckton Dickinson unrelated to the current study. MJ received advisory board consultancy reimbursements from AM Pharma, additional consulting reimbursement from Baxter and Gilead and grant support from Fresenius and Baxter, unrelated to the current study. KL received advisory board consultancy reimbursements from AM-Pharma, owns stock in Amgen and consultant for Biomerieux, Neumora, Seastar and BOA Medical. RLM received advisory board consultancy reimbursements from AM Pharma and additional consulting reimbursement from BioMerieux, Baxter, Nova Biomed, Abiomed, GE Healthcare, Medtronic, Sanofi and Mallinckrodt, unrelated to the current study. PTM received Trial Steering Committee consultancy payments from AM-Pharma. Other consultancy payments: FAST Biomedical, Novartis, Renibus Therapeutics. MO received speaker honoraria from Fresenius Medical Care, Biomerieux, Baxter and Gilead, and research funding from Fresenius Medical Care, Biomerieux, Baxter and LaJolla Pharma and advisory board consultancy reimbursements from AM-Pharma. AZ received advisory board consultancy reimbursements from AM-Pharma. AZ has received consulting and/or lecture fees from Astute Medical/BioMerieux, Fresenius, Paion, Guard Therapeutics, and Baxter, unrelated to the current study. AZ has received grant support from Astute Medical/BioMerieux, Fresenius and Baxter, unrelated to the current study., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Robotic procedures are an integral part of modern liver surgery. However, the advantages of a robotic approach in comparison to the conventional laparoscopic approach are the subject of controversial debate. The aim of this systematic review and meta-analysis is to compare robotic and laparoscopic liver resection with particular attention to the resection margin status in malignant cases., Methods: A systematic literature search was performed using PubMed and Cochrane Library in accordance with the PRISMA guidelines. Only studies comparing robotic and laparoscopic liver resections were considered for this meta-analysis. Furthermore, the rate of the positive resection margin or R0 rate in malignant cases had to be clearly identifiable. We used fixed or random effects models according to heterogeneity., Results: Fourteen studies with a total number of 1530 cases were included in qualitative and quantitative synthesis. Malignancies were identified in 71.1% (n = 1088) of these cases. These included hepatocellular carcinoma, cholangiocarcinoma, colorectal liver metastases and other malignancies of the liver. Positive resection margins were noted in 24 cases (5.3%) in the robotic group and in 54 cases (8.6%) in the laparoscopic group (OR = 0.71; 95% CI (0.42-1.18); p = 0.18). Tumor size was significantly larger in the robotic group (MD = 6.92; 95% CI (2.93-10.91); p = 0.0007). The operation time was significantly longer in the robotic procedure (MD = 28.12; 95% CI (3.66-52.57); p = 0.02). There were no significant differences between the robotic and laparoscopic approaches regarding the intra-operative blood loss, length of hospital stay, overall and severe complications and conversion rate., Conclusion: Our meta-analysis showed no significant difference between the robotic and laparoscopic procedures regarding the resection margin status. Tumor size was significantly larger in the robotic group. However, randomized controlled trials with long-term follow-up are needed to demonstrate the benefits of robotics in liver surgery.

Background: Liver failure is a crucial predictor for relevant morbidity and mortality after hepatic surgery. Hence, a good patient selection is mandatory. We use the LiMAx test for patient selection for major or minor liver resections in robotic and laparoscopic liver surgery and share our experience here., Patients and Methods: We identified patients in the Magdeburg registry of minimally invasive liver surgery (MD-MILS) who underwent robotic or laparoscopic minor or major liver surgery and received a LiMAx test for preoperative evaluation of the liver function. This cohort was divided in two groups: patients with normal (LiMAx normal) and decreased (LiMAx decreased) liver function measured by the LiMAx test., Results: Forty patients were selected from the MD-MILS regarding the selection criteria (LiMAx normal, n = 22 and LiMAx decreased, n = 18). Significantly more major liver resections were performed in the LiMAx normal vs. the LiMAx decreased group (13 vs. 2; p = 0.003). Hence, the mean operation time was significantly longer in the LiMAx normal vs. the LiMAx decreased group (356.6 vs. 228.1 min; p = 0.003) and the intraoperative blood transfusion significantly higher in the LiMAx normal vs. the LiMAx decreased group (8 vs. 1; p = 0.027). There was no significant difference between the LiMAx groups regarding the length of hospital stay, intraoperative blood loss, liver surgery related morbidity or mortality, and resection margin status., Conclusion: The LiMAx test is a helpful and reliable tool to precisely determine the liver function capacity. It aids in accurate patient selection for major or minor liver resections in minimally invasive liver surgery, which consequently serves to improve patients' safety. In this way, liver resections can be performed safely, even in patients with reduced liver function, without negatively affecting morbidity, mortality and the resection margin status, which is an important predictive oncological factor.