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Refereed/Peer-reviewed Foreign institutional actors (INAs) can act as a liaison between firms and authorities and other power players to navigate bureaucratic structures, both as resource and legitimacy providers in the host market. Building on institutional theory, this study draws from broader organizational sociological literature, to explore the structural position of INAs in a host country context, and engages with fundamental questions of legitimacy, status, and power. It responds to repeated calls that more studies in international business research are needed on the impact of institutional differences, how to obtain legitimacy, and enhance the home country support networks. To understand INAs' position, specifically within the social structure of a bureaucratic host environment, our study uses in-depth interviews with elite actors from the support networks. Japan is chosen for this study as a host market, because it is the European Union's second largest trading partner in Asia, has a strong central bureaucracy, and historically and currently remains a challenging market for Westerners due to complex market entry barriers. The findings provide a new theoretically derived empirical model demonstrating the positional leverage of these INAs, to “open-doors” into a complex environment and offer a nuanced understanding of their formal and informal structural positions of power. The findings also demonstrate a significant overlap between organizational legitimacy and the exemplary status of these INAs in the bureaucratic environment, which enhances and empowers their leverage to reach authorities, press, and other important actors in the market.

This paper examines dynamic capabilities as a second-order construct and the antecedents and outcomes of dynamic capabilities. Analyzing data collected from 242 tourism firms in Vietnam, this paper finds a positive influence of firms’ human capital, organizational learning, environmental dynamism, and digital marketing on the dynamic capabilities. Dynamic capabilities have a significant and positive impact on these firms’ competitive advantage. The paper contributes to ongoing efforts to measure dynamic capabilities and explore the micro-foundations of dynamic capabilities.

Evidence for textiles in viking-age Scotland and the adjacent Irish Sea region derives from small fragments usually surviving as mineralised products associated with metal dress fittings and grave goods such as shield bosses and weaving battens, excavated from the furnished graves of both women and men. Since Scottish viking-age textiles were last reviewed over twenty years ago, this paper collates information from antiquarian finds and more recent excavations which employed considerably enhanced techniques for retrieving fragile archaeological textiles. Evidence is presented for the occurrence and role of plant-based textiles derived from flax and hemp including linen in funerary processes as burial garments, shrouds and wrapping other grave goods, such as weapons and tools. Many richly appointed women's graves in viking-age Scotland were accompanied by tool assemblages used in the manufacture and maintenance of textiles. The presence of these tools raises questions about the status of textile production and the roles women played in it.

The purpose of this quality improvement project was to evaluate the efficacy of the facility's Hypoglycemia Protocol when treating severe hypoglycemia (defined as blood glucose50 mg/dL).The diabetes clinical nurse specialists conducted a retrospective chart review of diabetic inpatients with severe hypoglycemia who were treated per the Hypoglycemia Protocol from October 1, 2017, through April 30, 2019. The primary outcome was achievement of euglycemia (defined as blood glucose ≥ 80 mg/dL) 15 to 30 minutes post treatment with either oral carbohydrates or intravenous dextrose.Two hundred twenty-two patients received treatment with oral carbohydrates versus 120 patients who received intravenous dextrose. Fifty patients receiving oral carbohydrates versus 106 patients receiving intravenous dextrose achieved euglycemia after 1 treatment. Compared with treatment with intravenous dextrose, the odds ratio of the rise in blood glucose to 80 mg/dL or greater within 15 to 30 minutes post treatment for a patient given oral carbohydrate was decreased by 97.2%.Intravenous dextrose was more efficacious than oral carbohydrate treatment in patients with diabetes experiencing severe hypoglycemia. In response, the Hypoglycemia Protocol was revised to increase oral carbohydrate treatment for severe hypoglycemia and to expedite escalation from oral to intravenous treatment.

Research Summary: Adopting the attention-based view of the firm as our principal theoretical lens, we explore the mechanisms by which subsidiaries attract or avoid headquarters attention in developing successful assumed autonomy-based initiatives. To this end, our study utilizes qualitative data from subsidiary and headquarters perspectives in a multiple case study design. Our study reveals that subsidiaries first engage in non-disclosure of assumed autonomy-based initiatives to avoid negative headquarters attention. We then highlight the way in which subsidiaries undertake initiative selling to attract positive headquarters attention; in particular, we identify the unique selling criteria of demonstrable financial success and corporate alignment. Finally, we reveal the importance of timing in balancing the competing dual requirements of non-disclosure and initiative selling. Managerial Summary: Our paper aims to explore the mechanisms by which subsidiaries attract or avoid attention from headquarters, to ensure that their proactive, autonomous actions facilitate the attainment of an extended role within the MNE. We highlight three mechanisms as especially important here for subsidiary managers. First, we reveal that subsidiaries initially engage in “non-disclosure” of these actions to avoid negative headquarters attention. Second, we discover that subsidiaries ultimately look to demonstrate the financial success and corporate alignment of their autonomous actions. Finally, we emphasize the importance of timing in balancing the requirements of non-disclosure and the “selling” of the subsidiary's actions to headquarters Refereed/Peer-reviewed

PurposeThe purpose of this study is to develop and test a multilevel conceptual model which explains how authentic leadership (AL), through an innovative team atmosphere and promotion of self-efficacy, influences creativity. The study delineates two pathways from AL to creativity. The first pathway is an indirect effect through an innovative atmosphere at the team level and self-efficacy at the individual level, while the second pathway focuses on the moderating effect of AL between self-efficacy and individual creativity.Design/methodology/approachData were collected from 58 team leaders and 283 employees in a creative industry park in the Yangtze River Delta region from China. Path analysis was conducted to test the proposed hypotheses using the statistical package M-plus (v. 7).FindingsThe results reveal that AL is an important antecedent of creativity. Furthermore, an innovation-based atmosphere at the team level mediates the theorized relationship between AL and individual creativity. However, creative self-efficacy at the individual level does not mediate this relationship. Finally, the study found that AL moderates the relationship between creative self-efficacy and individual creativity.Originality/valueThe implications of this study highlight important considerations for enterprises in creative industry parks within and beyond China. This study provides industry leaders with a clearer and more insightful and coherent means of understanding the mediating mechanism between AL and creativity, and the moderating effects of AL between individual self-efficacy and creativity through a new linkage model.

Radiology plays an essential role in the management of malignant gynaecological conditions. Multiple imaging modalities are utilized to investigate suspected gynaecological malignancy including: ultrasound, computed tomography, magnetic resonance imaging and positron emission tomography/computed tomography. Each modality has a different role in diagnosis, staging, treatment selection and follow-up. This review discusses the different imaging modalities and their recommended roles in the imaging of malignant gynaecological disease. The imaging findings of common female pelvic pathology are discussed and illustrated.

This conceptual paper bridges international management literature with paradox theory to contribute to a paradoxical perspective for understanding expatriate competence. Synthesizing the international management literature, we argue for a ‘both/and’ approach for expatriates to effectively engage with tensions in a dynamic and ever-changing international environment. Our discussions provide novel insights on salient paradoxical tensions across three areas, namely, expatriate learning, expatriate identity, and expatriate performance. We develop strategies to address those tensions and a theoretical model that delineates the interactions of these three areas for superior performance on international assignments. We contribute to the international management literature by drawing attention to the dynamic and enabling role of paradoxical tensions as facilitators of, rather than barriers to, the development of expatriate competence and superior performance on international assignments. Refereed/Peer-reviewed

PurposeThis study clarifies how intra-organizational social capital (IOSC) and unit-organizational ambidexterity (UOA), using resource-based view and dynamic capability theory, together support organizational value creation. While there is research in strategic human resource management (SHRM) exploring the role of resources and its uses, there remains limited understanding of how resources are linked and their effective utilization in the service sector. This study aims to examine the mediating process linking employee-experienced service-oriented high-performance work systems (SHPWS) experienced by employees and service performance by integrating IOSC and UOA.Design/methodology/approachThis study uses time lagged data from managers and employees of different branches of Chinese state-owned banks. To test the proposed hypotheses, path analysis was applied.FindingsThe path analysis results reveal that employee-experienced SHPWS is an important antecedent of service performance. Moreover, IOSC (as resources) and UOA (uses) strongly mediate the theorized relationship.Originality/valueThis study attempts to refine theory and practice with clearer, more insightful and coherent means to better understand and help unpack the ‘black box’ between SHPWS-performance relationships through a new linkage model.

PurposeThe paper addresses the following research question: how do decision-makers use heuristics in their international business (IB) environment? Whereas, the literature has focused on entrepreneurial companies, here contrasting approaches to learning and using heuristics in international marketing (IM) decisions are examined and discussed.Design/methodology/approachThe paper aims to address a gap in the study of micro-foundations of internationalization, exploiting research from other disciplinary fields. It combines a multidisciplinary literature review and longitudinal case studies to illustrate different approaches in learning and using heuristics by international marketers.FindingsInternational marketers can adopt “closed” heuristics that are consolidated and consistently followed, or “open” heuristics, which are constantly being adapted and learned. Established multinationals learn heuristics in international marketing decision-making, following both “closed” and “open” models.Originality/valueThis paper offers an original contribution by presenting different approaches not yet examined in the literature, focusing on how international marketers make decisions through learning and using heuristic rules. The focus is on established exporters, in contrast to the literature that has largely paid attention to the effectiveness of heuristics in new entrepreneurial firms.

Leiomyomas are the most common benign tumors of the uterus. On the opposite side, leiomyosarcomas are rare malignant uterine tumors that account for a significant proportion of uterine cancer deaths. Especially when large and degenerated, leiomyomas and leiomyoma variants can have overlapping imaging characteristics with those of leiomyosarcomas. Although not always possible, it is paramount to be able to differentiate between leiomyomas and leiomyosarcomas on imaging, as the therapeutic management can differ. This pictorial review aims to familiarize radiologists with imaging features of leiomyomas and various types of leiomyoma degeneration and variants, together with their pathology correlates.

Background Treatment of advanced epithelial ovarian cancer results in a relapse rate of 75%. Early markers of response would enable optimization of management and improved outcome in both primary and recurrent disease. Purpose To assess the apparent diffusion coefficient (ADC), derived from diffusion-weighted MRI, as an indicator of response, progression-free survival (PFS), and overall survival. Materials and Methods This prospective multicenter trial (from 2012-2016) recruited participants with stage III or IV ovarian, primary peritoneal, or fallopian tube cancer (newly diagnosed, cohort one; relapsed, cohort two) scheduled for platinum-based chemotherapy, with interval debulking surgery in cohort one. Cohort one underwent two baseline MRI examinations separated by 0-7 days to assess ADC repeatability; an additional MRI was performed after three treatment cycles. Cohort two underwent imaging at baseline and after one and three treatment cycles. ADC changes in responders and nonresponders were compared (Wilcoxon rank sum tests). PFS and overall survival were assessed by using a multivariable Cox model. Results A total of 125 participants (median age, 63.3 years [interquartile range, 57.0-70.7 years]; 125 women; cohort one, n = 47; cohort two, n = 78) were included. Baseline ADC (range, 77-258 × 10-5mm2s-1) was repeatable (upper and lower 95% limits of agreement of 12 × 10-5mm2s-1 [95% confidence interval {CI}: 6 × 10-5mm2s-1 to 18 × 10-5mm2s-1] and -15 × 10-5mm2s-1 [95% CI: -21 × 10-5mm2s-1 to -9 × 10-5mm2s-1]). ADC increased in 47% of cohort two after one treatment cycle, and in 58% and 53% of cohorts one and two, respectively, after three cycles. Percentage change from baseline differed between responders and nonresponders after three cycles (16.6% vs 3.9%; P = .02 [biochemical response definition]; 19.0% vs 6.2%; P = .04 [radiologic definition]). ADC increase after one cycle was associated with longer PFS in cohort two (adjusted hazard ratio, 0.86; 95% CI: 0.75, 0.98; P = .03). ADC change was not indicative of overall survival for either cohort. Conclusion After three cycles of platinum-based chemotherapy, apparent diffusion coefficient (ADC) changes are indicative of response. After one treatment cycle, increased ADC is indicative of improved progression-free survival in relapsed disease. Published under a CC BY 4.0 license. Online supplemental material is available for this article.

PurposeThe purpose of this paper is to examine the influence of high-performance work systems (HPWS) on unit performance relative to the mediating roles of collective human capital (CHC) at the unit level and perceived HPWS at the employee level.Design/methodology/approachData were collected from 181 branch managers and 504 employees. The proposed path model was tested using the statistical package M-plus (v. 7) using a 2-1-2 multilevel approach for mediation analysis.FindingsGenerally, branch managers actively implement HPWS, and employees perceive a fairly high level of HPWS. Further, the path model indicated that CHC at the unit level and perceived HPWS at the employee level partially mediate the relationship between implemented HPWS and unit performance.Originality/valueThis study is the first to explore multilevel mediating mechanisms in the context of the largest four state-owned banks in China. A 2-1-2 multilevel analysis procedure was used to separate measurement error into relevant employee- and branch-level components to create more precise assessments of multivariate associations. Such analyses have not yet been conducted in research on HPWS prior to this study of the Chinese banking sector, but they are essential for teasing out the micro- and macro-level effects of HPWS.

Refereed/Peer-reviewed Although internationalizing small and medium enterprises (SMEs) have been extensively examined, the literature has mainly classified them based on size than on other factors disclosing different international dynamics, their diverse performance records, relevant strategies and support needs/expectations. This study examines internal and external barriers and key success factors of internationalizing companies, using data from 38 in-depth interviews of Australian SMEs conducted between 2016 and 2018. These cases were then categorized, using an inductive approach and text analysis software, along two dimensions of international experience and exposure, and product and/or service uniqueness and innovation. Moreover, internal and external liabilities and assets were diagnosed for each category. The resulting taxonomy, consisting of ‘prominent’, ‘performing’, ‘promising’, and ‘precluded’ sub-groups of SMEs, provides a useful categorization of exporting SMEs elucidating their differentiated needs and priorities. This research highlights that the current ‘catch-all’ category used in research and practice for internationalizing SMEs is not consistent and should instead be unpacked.

Refereed/Peer-reviewed Although scholars recognise that social networks within marketing channels can enhance cooperation (the implementation of joint goals), research provides a deficient understanding of how suppliers can efficiently manage them. Our study investigates the 'visible hand' behind franchising cooperation by asking: How do franchisors build cooperation within franchise systems? Using multiple case study research on retail franchises recognised for high-quality cooperation, our study builds a model of how franchisor practices maintain and increase cohesive ties that foster cooperation within the franchising community; a type of social network nested within the franchise system. This model is underpinned by social capital theory, self-categorisation theory, and the constructs relational norms and behaviour from research on marketing channels. Our study provides insight into the key organisational, social network, and individual agency drivers of cooperation within branding marketing channels. This provides an understanding of: 1) how centralised organisational practices interact with individual agency to maintain efficient cooperation, and 2) heterarchical processes to improve cooperation efficiency.

Funder: We acknowledge funding from Cancer Research UK BIDD grant C1353/A12762 and Cancer Research UK and Engineering and Physical Sciences Research Council support to the Cancer Imaging Centre at the Institute of Cancer Research and Royal Marsden Hospital in association with the Medical Research Council and Department of Health C1060/A10334, C1060/A16464 and National Health Service funding to the National Institute for Health Research Biomedical Research Centres at Royal Marsden Hospital/Institute of Cancer Research and Cambridge, Experimental Cancer Medicine Centres, the Clinical Research Facility in Imaging, and the Cancer Research Network. We are also grateful for financial support from Addenbrooke’s Charitable Trust. The views expressed in this publication are those of the author(s) and not necessarily those of the National Health Service, the National Institute for Health Research or the Department of Health., BACKGROUND: Diffusion-weighted magnetic resonance imaging (DW-MRI) potentially interrogates site-specific response to neoadjuvant chemotherapy (NAC) in epithelial ovarian cancer (EOC). METHODS: Participants with newly diagnosed EOC due for platinum-based chemotherapy and interval debulking surgery were recruited prospectively in a multicentre study (n = 47 participants). Apparent diffusion coefficient (ADC) and solid tumour volume (up to 10 lesions per participant) were obtained from DW-MRI before and after NAC (including double-baseline for repeatability assessment in n = 19). Anatomically matched lesions were analysed after surgical excision (65 lesions obtained from 25 participants). A trained algorithm determined tumour cell fraction, percentage tumour and percentage necrosis on histology. Whole-lesion post-NAC ADC and pre/post-NAC ADC changes were compared with histological metrics (residual tumour/necrosis) for each tumour site (ovarian, omental, peritoneal, lymph node). RESULTS: Tumour volume reduced at all sites after NAC. ADC increased between pre- and post-NAC measurements. Post-NAC ADC correlated negatively with tumour cell fraction. Pre/post-NAC changes in ADC correlated positively with percentage necrosis. Significant correlations were driven by peritoneal lesions. CONCLUSIONS: Following NAC in EOC, the ADC (measured using DW-MRI) increases differentially at disease sites despite similar tumour shrinkage, making its utility site-specific. After NAC, ADC correlates negatively with tumour cell fraction; change in ADC correlates positively with percentage necrosis. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT01505829.

Although rare, uterine sarcoma is a diagnosis that no one wants to miss. Often benign leiomyomas (fibroids) and uterine sarcomas can be differentiated due to the typical low T2 signal intensity contents and well-defined appearances of benign leiomyomas compared to the suspicious appearances of sarcomas presenting as large uterine masses with irregular outlines and intermediate T2 signal intensity together with possible features of secondary spread. The problem is when these benign lesions are atypical causing suspicious imaging features. This article provides a review of the current literature on imaging features of atypical fibroids and uterine sarcomas with an aide-memoire BET

Rapid growth and urbanizing populations are transforming Africa, despite environmental turbulence, uncertainty and relational complexity. Research highlights how small firms rely upon trust-based buyer-supplier relationships in such contexts. Our study adopts a micro-foundational perspective and builds on dynamic capabilities literature and psychological trust theory. Our conceptual model shows how relational dimensions (i.e. communication, social bonds, and knowledge), influenced by meta-capabilities (strategic sensitivity, resource fluidity and leadership unity) embedded in micro-foundational activities build trust in small business cross-border buyer-seller relationships to support dynamic relational capability and enhance strategic agility intransitional economies. Refereed/Peer-reviewed

MRI was recently included as a standard pre-operative diagnostic tool for patients with endometrial cancer. MR findings allow a better risk assessment and ultimately guides the surgical planning. Therefore, it is vital that the radiological interpretation is as accurate as possible. This requires essential knowledge regarding the appropriate MRI protocol, as well as different appearances of the endometrium, ranging from normal peri- and post-menopausal changes, benign findings (e.g. endometrial hyperplasia, polyp, changes due to exogenous hormones) to common and rare endometrium-related malignancies. Furthermore, this review will emphasize the role of MRI in staging endometrial cancer patients and highlight pitfalls that could result in the underestimation or overestimation of the disease extent.

PurposeAmbidexterity’s effects on exploration and exploitation have been widely studied in the innovation literature. However, to date, no studies have determined how combining or balancing the two strategic marketing foci may improve new product performance outcomes. This is an important issue in emerging markets, which have considerable potential to introduce new products, given the rising affordability and intense competition between Western and local firms. These challenges compel managers to offer new products and solutions in these markets. However, firms may adopt different strategic marketing foci for new product development. Using Pakistan as an emerging-market context, this paper aims to provide novel insights into how managers can choose the right balance of a customer-driving versus customer-driven strategy to optimise new-product performance.Design/methodology/approachA multi-industry approach surveyed senior strategy managers (N = 106) of Pakistani businesses.FindingsUsing polynomial regression and surface test analyses, the findings showed that balancing the two strategies influenced new-product performance more than either strategy alone. Surprisingly, the imbalance of greater customer-driving over customer-driven strategy or vice versa did not improve new-product performance. Moreover, new-product performance was greater when the level of balance was higher compared to when it was lower.Originality/valueGrounded in behavioural and strategic adaptation theory, this study extends ambidexterity’s theoretical foundations in marketing by empirically determining the optimal balance of an orientation and performance implication model. The findings can assist emerging market managers in choosing the right balance and combination of the two strategies for better performance of new products.

The institutional context of transitional economies in Africa can neither be explored nor understood without consideration of its complex colonial history and its legacy of influence on business today. Nor can we understand Africa as a continent without understanding the different regions and diverse influences experienced from past external powers. Africa is not homogenous. While other parts of the continent remain war-torn, improvised and debt-ridden, managed by corrupt regimes, others are experiencing more positive trajectories. Tanzania, for example, has sustained economic growth of around 7% annually during this time period, a rate considerably higher than in many other emerging and advanced economies. The economic importance of small to medium-sized enterprises (SMEs) is substantial, helping to explain Tanzania’s exceptional growth. We explore the following question—how does the institutional environment affect SME development in a transitional economy, especially contemporary institutional challenges, reflecting many interrelated past colonial influences? Many SMEs lack resources and expertise to mitigate uncertainties and challenges they face in their international business partnerships. Highlighting the heterogeneity of Africa, we focus on East Africa, explaining why some economies, such as Tanzania, are increasingly observed as highly promising locations for business opportunities. Refereed/Peer-reviewed

To compare the accuracy of placental MRI in reporting placental adhesive disease in readers with different expertise and to identify the most reliable MRI features that predict placental pathology regardless of reader expertise.Retrospective analysis of 27 placental MRI studies by six radiologists with different expertise levels; specificity, sensitivity, and accuracy were used to quantify the predictive performance of eight radiological features previously described in the literature. Histopathological evaluation was used as a diagnostic gold standard when available and the presence of the radiological features was decided by consensus. Features with higher sensitivity and specificity were identified and the optimal cut-off was calculated to obtain the resulting accuracy.The accuracy for seniors with expertise was non-statistically higher (0.83) compared to senior with no expertise (SWE) (0.65) and juniors (0.74) with SWE having tendency to over-estimate the severity of abnormality (26% vs 17%), whilst junior underestimated the degree of placental infiltration when compared to seniors with expertise (18.5% vs 0%, p = 0.006). Dark bands was the criteria with the highest sensitivity (95%) and high specificity (74%), followed by myometrial thinning (89%-76%) and uterine bulging (86%-81%). These three features demonstrated substantial (K) agreement. Using these features with optimal diagnostic cut-off, the accuracy increased to 0.91 for both the seniors and SWE and to 0.93 for the juniors.Placental MRI is most accurately interpreted by experienced radiologists; however, less experienced readers can obtain an accurate diagnosis relying on set criteria that are easier to be identified.

Background Antibodies to the aquaporin-4 (AQP4) water channel in neuromyelitis optica spectrum disorder (NMOSD) are reported to trigger the complement cascade, which is implicated in astrocyte damage and subsequent neuronal injury. The PREVENT study demonstrated that the terminal complement inhibitor eculizumab reduces adjudicated relapse risk in patients with anti-AQP4 immunoglobulin G-positive (AQP4+) NMOSD. The objective of this analysis was to evaluate the efficacy of eculizumab in reducing relapse risk and its safety in AQP4+ NMOSD across clinically relevant subgroups in PREVENT. Methods In the randomized, double-blind, time-to-event, phase 3 PREVENT trial, 143 adults received eculizumab (maintenance dose, 1200 mg/2 weeks) or placebo (2:1), with stable-dose concomitant immunosuppressive therapy (IST) permitted (except rituximab and mitoxantrone). Post hoc analyses of relapses and adverse events were performed for prespecified and post hoc subgroups based on concomitant IST and prior rituximab use, demographic and disease characteristics, and autoimmune comorbidity. Results The significant reduction in relapse risk observed for eculizumab versus placebo in the overall PREVENT population was consistently maintained across subgroups based on concomitant IST and previous rituximab use, age, sex, region, race, time since clinical onset of NMOSD, historical annualized relapse rate, baseline Expanded Disability Status Scale score, and history of another autoimmune disorder. The serious infection rate was lower with eculizumab than placebo regardless of rituximab use in the previous year, concomitant IST use, or history of another autoimmune disorder. Conclusion Across a wide range of clinically relevant AQP4+ NMOSD patient subgroups in PREVENT, eculizumab therapy was consistently effective versus placebo in reducing relapse risk, with no apparent increase in serious infection rate. Trial registration NCT01892345 (ClinicalTrials.gov).