The entry mode choices of multinational corporations in turbulent markets : the case of Ukraine

Entry strategies for the turbulent markets of Eastern and Central Europe are high on the strategic agenda of firms, who wish to capitalise upon the opportunities, which they represent, whilst minimising the risks. The rapidity and discontinuity of the change in these countries calls into question the validity of rational planning approaches to assessing market attractiveness. It also calls for re-examination of a number of the theories proposed for determining mode of entry. These are often predicated upon data gathered in stable market environments. Literature relevant to the study of international entry strategies can be found in the fields of marketing, corporate strategy, international business, economics and organisational behaviour. This thesis takes the view that it is important not to prejudge which, if any, of the existing theories are relevant to study of entry into Eastern Europe. Therefore, it takes an inductive, interdisciplinary approach to studying the entry decisions of fifteen multinational corporations in Ukraine. In-depth analysis of case studies in business-to-business service, mass-market and high-margin consumer goods and industrial product sectors is used to gain an understanding of these decisions. Data are explored within and between cases, to identify patterns of similarity and difference. Firms are analysed according to demographic, location-specific and strategic variables derived from a review of literature. From this analysis, four groups of investment behaviour can be identified on the dimensions of criteria for entry, acceptance of risk and level of commitment to Ukraine. Both competitive and co-operative entry strategies are found. During the period of data collection, five additional decisions were made. Both positive decisions, to expand in Ukraine, and negative decisions not to expand or to withdraw were seen. Data were analysed to identify the explanatory variables for these differing fortunes. The findings are then set against their theoretical context to draw conclusions

Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies.

BACKGROUND: Whole-body magnetic resonance imaging is advocated as an alternative to standard pathways for staging cancer. OBJECTIVES: The objectives were to compare diagnostic accuracy, efficiency, patient acceptability, observer variability and cost-effectiveness of whole-body magnetic resonance imaging and standard pathways in staging newly diagnosed non-small-cell lung cancer (Streamline L) and colorectal cancer (Streamline C). DESIGN: The design was a prospective multicentre cohort study. SETTING: The setting was 16 NHS hospitals. PARTICIPANTS: Consecutive patients aged ≥ 18 years with histologically proven or suspected colorectal (Streamline C) or non-small-cell lung cancer (Streamline L). INTERVENTIONS: Whole-body magnetic resonance imaging. Standard staging investigations (e.g. computed tomography and positron emission tomography-computed tomography). REFERENCE STANDARD: Consensus panel decision using 12-month follow-up data. MAIN OUTCOME MEASURES: The primary outcome was per-patient sensitivity difference between whole-body magnetic resonance imaging and standard staging pathways for metastasis. Secondary outcomes included differences in specificity, the nature of the first major treatment decision, time and number of tests to complete staging, patient experience and cost-effectiveness. RESULTS: Streamline C - 299 participants were included. Per-patient sensitivity for metastatic disease was 67% (95% confidence interval 56% to 78%) and 63% (95% confidence interval 51% to 74%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -5% to 13%; p = 0.51). Specificity was 95% (95% confidence interval 92% to 97%) and 93% (95% confidence interval 90% to 96%) respectively, a difference of 2% (95% confidence interval -2% to 6%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 96% and 95% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 8 days (95% confidence interval 6 to 9 days) and 13 days (95% confidence interval 11 to 15 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 5 days (95% confidence interval 3 to 7 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £216 (95% confidence interval £211 to £221) versus £285 (95% confidence interval £260 to £310). Streamline L - 187 participants were included. Per-patient sensitivity for metastatic disease was 50% (95% confidence interval 37% to 63%) and 54% (95% confidence interval 41% to 67%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -7% to 15%; p = 0.73). Specificity was 93% (95% confidence interval 88% to 96%) and 95% (95% confidence interval 91% to 98%), respectively, a difference of 2% (95% confidence interval -2% to 7%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 98% and 99% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 13 days (95% confidence interval 12 to 14 days) and 19 days (95% confidence interval 17 to 21 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 6 days (95% confidence interval 4 to 8 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £317 (95% confidence interval £273 to £361) versus £620 (95% confidence interval £574 to £666). Participants generally found whole-body magnetic resonance imaging more burdensome than standard imaging but most participants preferred the whole-body magnetic resonance imaging staging pathway if it reduced time to staging and/or number of tests. LIMITATIONS: Whole-body magnetic resonance imaging was interpreted by practitioners blinded to other clinical data, which may not fully reflect how it is used in clinical practice. CONCLUSIONS: In colorectal and non-small-cell lung cancer, the whole-body magnetic resonance imaging staging pathway has similar accuracy to standard staging pathways, is generally preferred by patients, improves staging efficiency and has lower staging costs. Future work should address the utility of whole-body magnetic resonance imaging for treatment response assessment. TRIAL REGISTRATION: Current Controlled Trials ISRCTN43958015 and ISRCTN50436483. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 66. See the NIHR Journals Library website for further project information

Systemic chemotherapy with or without cetuximab in patients with resectable colorectal liver metastasis (New EPOC): long-term results of a multicentre, randomised, controlled, phase 3 trial.

BACKGROUND: The interim analysis of the multicentre New EPOC trial in patients with resectable colorectal liver metastasis showed a significant reduction in progression-free survival in patients allocated to cetuximab plus chemotherapy compared with those given chemotherapy alone. The focus of the present analysis was to assess the effect on overall survival. METHODS: New EPOC was a multicentre, open-label, randomised, controlled, phase 3 trial. Adult patients (aged ≥18 years) with KRAS wild-type (codons 12, 13, and 61) resectable or suboptimally resectable colorectal liver metastases and a WHO performance status of 0-2 were randomly assigned (1:1) to receive chemotherapy with or without cetuximab before and after liver resection. Randomisation was done centrally with minimisation factors of surgical centre, poor prognosis cancer, and previous adjuvant treatment with oxaliplatin. Chemotherapy consisted of oxaliplatin 85 mg/m2 administered intravenously over 2 h, l-folinic acid (175 mg flat dose administered intravenously over 2 h) or d,l-folinic acid (350 mg flat dose administered intravenously over 2 h), and fluorouracil bolus 400 mg/m2 administered intravenously over 5 min, followed by a 46 h infusion of fluorouracil 2400 mg/m2 repeated every 2 weeks (regimen one), or oxaliplatin 130 mg/m2 administered intravenously over 2 h and oral capecitabine 1000 mg/m2 twice daily on days 1-14 repeated every 3 weeks (regimen two). Patients who had received adjuvant oxaliplatin could receive irinotecan 180 mg/m2 intravenously over 30 min with fluorouracil instead of oxaliplatin (regimen three). Cetuximab was given intravenously, 500 mg/m2 every 2 weeks with regimen one and three or a loading dose of 400 mg/m2 followed by a weekly infusion of 250 mg/m2 with regimen two. The primary endpoint of progression-free survival was published previously. Secondary endpoints were overall survival, preoperative response, pathological resection status, and safety. Trial recruitment was halted prematurely on the advice of the Trial Steering Committee on Nov 1, 2012. All analyses (except safety) were done on the intention-to-treat population. Safety analyses included all randomly assigned patients. This trial is registered with ISRCTN, number 22944367. FINDINGS: Between Feb 26, 2007, and Oct 12, 2012, 257 eligible patients were randomly assigned to chemotherapy with cetuximab (n=129) or without cetuximab (n=128). This analysis was carried out 5 years after the last patient was recruited, as defined in the protocol, at a median follow-up of 66·7 months (IQR 58·0-77·5). Median progression-free survival was 22·2 months (95% CI 18·3-26·8) in the chemotherapy alone group and 15·5 months (13·8-19·0) in the chemotherapy plus cetuximab group (hazard ratio [HR] 1·17, 95% CI 0·87-1·56; p=0·304). Median overall survival was 81·0 months (59·6 to not reached) in the chemotherapy alone group and 55·4 months (43·5-71·5) in the chemotherapy plus cetuximab group (HR 1·45, 1·02-2·05; p=0·036). There was no significant difference in the secondary outcomes of preoperative response or pathological resection status between groups. Five deaths might have been treatment-related (one in the chemotherapy alone group and four in the chemotherapy plus cetuximab group). The most common grade 3-4 adverse events reported were: neutrophil count decreased (26 [19%] of 134 in the chemotherapy alone group vs 21 [15%] of 137 in the chemotherapy plus cetuximab group), diarrhoea (13 [10%] vs 14 [10%]), skin rash (one [1%] vs 22 [16%]), thromboembolic events (ten [7%] vs 11 [8%]), lethargy (ten [7%] vs nine [7%]), oral mucositis (three [2%] vs 14 [10%]), vomiting (seven [5%] vs seven [5%]), peripheral neuropathy (eight [6%] vs five [4%]), and pain (six [4%] vs six [4%]). INTERPRETATION: Although the addition of cetuximab to chemotherapy improves the overall survival in some studies in patients with advanced, inoperable metastatic disease, its use in the perioperative setting in patients with operable disease confers a significant disadvantage in terms of overall survival. Cetuximab should not be used in this setting. FUNDING: Cancer Research UK

International marketing relationships

xxii, 288 p. : ill. ; 25 cm

Substitution and complementarity between managers and subordinates : evidence from British football

We use data on British football managers and teams over the 1994-2007 period to study substitution and complementarity between leaders and subordinates. We find for the Premier League (the highest level of competition) that, other things being equal, managers who themselves played at a higher level raise the productivity of less-skilled teams by more than that of highly skilled teams. This is consistent with the hypothesis that one function of a top manager is to communicate to subordinates the skills needed to succeed, since less skilled players have more to learn. However, we also find that managers with more accumulated professional managing experience raise the productivity of talented players by more than that of less-talented players. This is consistent with the hypothesis that a further function of successful managers in high-performance workplaces is to manage the egos of elite workers. Such a function is potentially more important the more accomplished the workers are-as indicated, in our data, by teams with greater payrolls. (C) 2010 Elsevier B.V. All rights reserved

The impact of Internet on internationalization Managers' perceptions, an integration of the literature and implications

Includes bibliographical referencesAvailable from British Library Document Supply Centre- DSC:9261. 954(no 347) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

P200 Acceptability of a brief fatigue intervention for patients with inflammatory arthritis: A qualitative process evaluation

AbstractBackground/Aims Patients with inflammatory arthritis report fatigue as a primary symptom that affects everyday life. FREE-IA (Fatigue - Reducing its Effects through individualised support Episodes in Inflammatory Arthritis) is a feasibility study of a brief intervention (2-4 sessions of 20-30 minutes) designed to reduce fatigue impact. The intervention designed with patients and health professionals is delivered by rheumatology practitioners in one-to-one sessions, after training and using a manual. The aim of this process evaluation was to understand the perspectives of patients and practitioners in FREE-IA.Methods One-to-one telephone interviews were conducted with patients who had received the intervention and practitioners who had delivered it. Interviews were audio-recorded, transcribed and anonymised. An inductive thematic analysis approach was used to identify and analyse patterns within each data set.Results Twenty-two patients, and eight practitioners across the five sites participated. We identified four patient and three practitioner themes. Patient themes: Collaborative, non-judgemental consultations: participants reported positive relationships in which their fatigue was validated, and they were able to reflect. They expressed their preference for a responsive, flexible approach to sessions, rather than a rigid, ‘protocolised’ approach. Relevant and useful, but not ground-breaking: participants appreciated the opportunity to tailor content to their individual priorities. They found it helpful to visualise fatigue and identified daily dairies as useful. Although the content was not seen as ground-breaking, it provided focus. Insights and self-awareness: sessions increased participants’ awareness of lifestyle factors and patterns influencing their fatigue, which increased their sense of control and confidence to manage fatigue. Degrees of openness to change: sessions prompted some participants to engage in positive behaviour change or make plans for changes. However, some participants expressed frustration, explaining that it was not the right time because their lives were complicated. Practitioner themes: Engagement with the intervention: practitioners liked training face-to-face with peers and their enjoyment of the intervention increased with experience of delivery. However, for practitioners with extensive experience of providing fatigue support, the low level of treatment intensity and the manualised approach limited the perceived usefulness of the intervention. Research versus clinical practice: practitioners expressed concern about fitting sessions into clinic appointments, and it was often a challenge to offer patients a follow-up session within the proposed two-week time frame. Collaborating with patients: practitioners reported that many patients were willing to try the tools and strategies. While some practitioners followed the manual in a linear way, others used it more flexibly.Conclusion There is potential for this brief fatigue intervention to benefit patients. Future research will focus on flexibility to fit with local services and creating educational learning resources for practitioners to use in a range of contexts

Acceptability of a brief fatigue intervention for inflammatory arthritis: A qualitative process evaluation

Background We developed a brief cognitive-behavioural, one-to-one intervention to reduce fatigue impact for patients with inflammatory arthritis. This qualitative process evaluation explored intervention acceptability and potential refinements from the perspective of (i) patients who attended sessions and (ii) rheumatology health professionals (RHPs) who delivered the intervention.Methods Interviews were conducted with patients and RHPs from five NHS sites. Data were analysed using inductive thematic analysis. Results Twenty-two patients and eleven RHPs participated. Patient themes - Collaborative, non-judgemental consultations: patients valued having space to reflect, where their fatigue was validated. Relevant content, but not ground-breaking: patients appreciated the opportunity to tailor content to individual priorities. Daily diaries were useful to visualise fatigue. Self-awareness: patients reported increased acceptance, sense of control, and confidence to manage fatigue. Degrees of openness to change: sessions prompted patients to engage in behaviour change. For some, complicated lives made it difficult to plan for change. RHP themes - Engagement with intervention: RHPs liked training face-to-face, and sessions were more enjoyable with experience of delivery. Research versus clinical practice: RHPs expressed concern about fitting sessions into NHS clinic appointments. It was difficult to offer follow-up sessions within two-weeks. Collaborating with patients: RHPs reported that patients engaged with the tools and strategies. Some RHPs followed the manual in a linear way, others used it flexibly. ConclusionsThere is potential for this brief fatigue intervention to benefit patients. Future research will focus on flexibility to fit with local services and creating educational resources to use in a range of contexts