Re-evaluating the impact of institutional distance on the location choice and success of foreign Investors : comparing Chinese and Western investors in Africa

This dissertation seeks to add to our understanding how the internationalization process of Chinese firms relates to the internationalization process of Western firms. The focus of this project was on the assumed competitive advantage for Chinese firms in relatively high-risk host countries. In the first part of my study I use a conceptual framework presented by Child and Marinova (2014) to study the role of institutional distance for the location choice of Chinese and U.S. firms. Contrary to popular believe, I found that Chinese investments are not directed to countries with a low level of IM and investments from both China and the U.S. are directed to countries with a low level of political stability. In the second study I use process tracing to further study the causal mechanism that could explain how the levels of political stability and institutional maturity in China could give Chinese firms an advantage in high-risk emerging markets far away from China. The combination of the two studies shows that the success of Chinese firms in challenging host markets depends on much more than push factors only

Hospital Variation in Time to Endovascular Treatment for Ischemic Stroke:What Is the Optimal Target for Improvement?

Background Time to reperfusion in patients with ischemic stroke is strongly associated with functional outcome and may differ between hospitals and between patients within hospitals. Improvement in time to reperfusion can be guided by between-hospital and within-hospital comparisons and requires insight in specific targets for improvement. We aimed to quantify the variation in door-to-reperfusion time between and within Dutch intervention hospitals and to assess the contribution of different time intervals to this variation. Methods and Results We used data from the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry. The door-to-reperfusion time was subdivided into time intervals, separately for direct patients (door-to-computed tomography, computed tomography-to-computed tomography angiography [CTA], CTA-to-groin, and groin-to-reperfusion times) and for transferred patients (door-to-groin and groin-to-reperfusion times). We used linear mixed models to distinguish the variation in door-to-reperfusion time between hospitals and between patients. The proportional change in variance was used to estimate the amount of variance explained by each time interval. We included 2855 patients of 17 hospitals providing endovascular treatment. Of these patients, 44% arrived directly at an endovascular treatment hospital. The between-hospital variation in door-to-reperfusion time was 9%, and the within-hospital variation was 91%. The contribution of case-mix variables on the variation in door-to-reperfusion time was marginal (2%-7%). Of the between-hospital variation, CTA-to-groin time explained 83%, whereas groin-to-reperfusion time explained 15%. Within-hospital variation was mostly explained by CTA-to-groin time (33%) and groin-to-reperfusion time (42%). Similar results were found for transferred patients. Conclusions Door-to-reperfusion time varies between, but even more within, hospitals providing endovascular treatment for ischemic stroke. Quality of stroke care improvements should not only be guided by between-hospital comparisons, but also aim to reduce variation between patients within a hospital, and should specifically focus on CTA-to-groin time and groin-to-reperfusion time

Endovascular Treatment for Posterior Circulation Stroke in Routine Clinical Practice:Results of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry

BACKGROUND AND PURPOSE: The benefit of endovascular treatment (EVT) for posterior circulation stroke (PCS) remains uncertain, and little is known on treatment outcomes in clinical practice. This study evaluates outcomes of a large PCS cohort treated with EVT in clinical practice. Simultaneous to this observational study, several intervention centers participated in the BASICS trial (Basilar Artery International Cooperation Study), which tested the efficacy of EVT for basilar artery occlusion in a randomized setting. We additionally compared characteristics and outcomes of patients treated outside BASICS in trial centers to those from nontrial centers. METHODS: We included patients with PCS from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry: a prospective, multicenter, observational study of patients who underwent EVT in the Netherlands between 2014 and 2018. Primary outcome was a score of 0 to 3 on the modified Rankin Scale at 90 days. Secondary outcomes included reperfusion status and symptomatic intracranial hemorrhage. For outcome comparison between patients treated in trial versus nontrial centers, we used ordinal logistic regression analysis. RESULTS: We included 264 patients of whom 135 (51%) had received intravenous thrombolysis. The basilar artery was most often involved (77%). Favorable outcome (modified Rankin Scale score 0-3) was observed in 115/252 (46%) patients, and 109/252 (43%) patients died. Successful reperfusion was achieved in 178/238 (75%), and symptomatic intracranial hemorrhage occurred in 9/264 (3%). The 154 nontrial patients receiving EVT in BASICS trial centers had similar characteristics and outcomes as the 110 patients treated in nontrial centers (modified Rankin Scale adjusted cOR: 0.77 [95% CI, 0.5-1.2]). CONCLUSIONS: Our study shows that high rates of favorable clinical outcome and successful reperfusion can be achieved with EVT for PCS, despite high mortality. Characteristics and outcomes of patients treated in trial versus nontrial centers were similar indicating that our cohort is representative of clinical practice in the Netherlands. Randomized studies using modern treatment approaches are needed for further insight in the benefit of EVT for PCS

Effect of First-Pass Reperfusion on Outcome After Endovascular Treatment for Ischemic Stroke

Background First-pass reperfusion (FPR) is associated with favorable outcome after endovascular treatment. It is unknown whether this effect is independent of patient characteristics and whether FPR has better outcomes compared with excellent reperfusion (Expanded Thrombolysis in Cerebral Infarction [eTICI] 2C-3) after multiple-passes reperfusion. We aimed to evaluate the association between FPR and outcome with adjustment for patient, imaging, and treatment characteristics to single out the contribution of FPR. Methods and Results FPR was defined as eTICI 2C-3 after 1 pass. Multivariable regression models were used to investigate characteristics associated with FPR and to investigate the effect of FPR on outcomes. We included 2686 patients of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry. Factors associated with FPR were as follows: history of hyperlipidemia (adjusted odds ratio [OR], 1.05; 95% CI, 1.01-1.10), middle cerebral artery versus intracranial carotid artery occlusion (adjusted OR, 1.11; 95% CI, 1.06-1.16), and aspiration versus stent thrombectomy (adjusted OR, 1.07; 95% CI, 1.03-1.11). Interventionist experience increased the likelihood of FPR (adjusted OR, 1.03 per 50 patients previously treated; 95% CI, 1.01-1.06). Adjusted for patient, imaging, and treatment characteristics, FPR remained associated with a better 24-hour National Institutes of Health Stroke Scale (NIHSS) score (-37%; 95% CI, -43% to -31%) and a better modified Rankin Scale (mRS) score at 3 months (adjusted common OR, 2.16; 95% CI, 1.83-2.54) compared with no FPR (multiple-passes reperfusion+no excellent reperfusion), and compared with multiple-passes reperfusion alone (24-hour NIHSS score, (-23%; 95% CI, -31% to -14%), and mRS score (adjusted common OR, 1.45; 95% CI, 1.19-1.78)). Conclusions FPR compared with multiple-passes reperfusion is associated with favorable outcome, independently of patient, imaging, and treatment characteristics. Factors associated with FPR were the experience of the interventionist, history of hyperlipidemia, location of occluded artery, and use of an aspiration device compared with stent thrombectomy

South-South Cooperation through investment – South African and Chinese support to development in Lesotho?

CCS Policy Briefings are drawn from the published reports and other material produced by the Centre. They aim to highlight specific recommendations and outcomes from the larger reports and present them in a concise, easily consumable format.The original publication is available at http://www.sun.ac.za/ccsThe 4th High Level Forum of Aid Effectiveness in Busan/Korea focused on defining a new paradigm for aid and development and to build a new, all-inclusive, development partnership, sparked by increasing involvement of emerging economies. Emerging economies are promoting an alternative development cooperation model in which economic transactions such as trade and investment play an important role. South-South Cooperation (SSC) has been often compared with the development aid traditional donors have been offering to developing countries for many decades. The emphasis has been thereby on the equivalent to aid. This risks neglecting the crucial role of trade and investment in SSC. This Policy Briefing is based on a study on the role of investment in SSC and, more specifically, the role of state agencies of emerging economies in ensuring that the investments of their nationals contribute to social and economic development in the host country.HanbanPublishers' versio

The management of Chinese foreign direct investment

CCS Policy Briefings are drawn from the published reports and other material produced by the Centre. They aim to highlight specific recommendations and outcomes from the larger reports and present them in a concise, easily consumable format.The original publication is available at http://www.sun.ac.za/ccsChina is becoming an important source country for foreign direct investment (FDI) for many African countries, catching up fast with the historical main FDI source countries to Africa, such as the United States, the United Kingdom or France. One of the charms of China to African policy makers in the last years was a change of discourse, shifting from ‘challenges in development’ to ‘opportunities in doing business’ in Africa. Popular claims link the inflow of FDI almost automatically to economic development. This paper looks into framework conditions for investment, assuming that they matter strongly for investment to become beneficial for development. In order to better regulate, conditions in the host country have to be considered. Additionally, the investment promo-tion policies and institutions of the home country to investment – China in this case – need to be understood in order to engage with the right actors in the ‘sending’ country.Publishers' versio

CREC7‘s infrastructural investment in the DRC : an in-depth study of the motives for Chinese outward FDI

Thesis (MA)--Stellenbosch University, 2011.ENGLISH ABSTRACT: The purpose of this Masters‘ thesis was twofold, namely, to contribute to a more holistic approach of the study of the motives of Chinese overseas investors and, secondly, to contribute to the adjustment of general FDI theory in such a way that it becomes more suited to the study of the motives of investors from any country of origin. FDI scholars who study emerging markets argue that general FDI theory needs to be adjusted because most of its theories are derived from studying outward FDI in an Anglo-Saxon context. The theories are therefore not necessarily applicable to investors from a non-Anglo-Saxon context. Furthermore, the study of the motives of foreign investors is of importance to policy makers of FDI host countries in order to create a balance between attracting FDI by deregulating, and controlling FDI by enforcing strict laws and regulations, thereby harnessing the full potential of incoming FDI. Therefore, the model that Lee (1966) developed in migration theory was introduced to FDI theory and tested by applying it to the case of the infrastructural investments in the DRC of a subsidiary of CREC, the world‘s largest contractor, namely CREC7. The main factors that influence the motives of CREC7 were investigated using the Four Factors Model, an adjusted version of Lee‘s model. A single-case study design was chosen in order to shed light on certain dynamics – in particular, the interrelation between the particular firm-specific, push, pull and intervening factors that influence CREC7‘s motives to invest in the DRC. In order to maximise the validity of this study, multiple sources of evidence were used, namely: documentation, face-to-face interviews and direct observations, the latter two of which occurred during August 2010. Lee‘s (1966) model indeed appeared to be useful for identifying the main factors that influence the motives of CREC7 for investing in the infrastructure sector in the DRC and the interrelatedness of these factors. The collected data from the desktop research and the fieldwork showed how conditions in the country of origin, conditions in the country of destination, firm-specific factors, and intervening factors influence each other in a highly complex way. In order to illustrate this complexity, the factors that influence each other most actively were grouped together in clusters. The two clusters of factors that were of specific importance for CREC7‘s decision to invest in the DRC, are: (1) relationship with the central government, access to finance, experience and skills, market access, and intervening factors; (2) experience and skills, experience of operating in a challenging institutional environment, high level of competition in the domestic market, high demand for infrastructure in the DRC, and the relatively low level of competition in large infrastructure projects in the DRC. Because the Four Factors Model uses broad categories of factors that apply to all foreign investors, this model can be applied to the study of the motives of foreign investors from both developed and developing countries, thereby contributing to make general FDI theory more relevant.AFRIKAANSE OPSOMMING: Die doelstelling van dié Meesterstesis is tweevoudig. Eerstens, om `n meer holistiese benadering tot die studie van die motiewe van Sjinese buitelandse beleggers by toe te voeg en tweedens om by te dra tot die aanpassing van algemene direkte buitelandse beleggings teorie dat dit meer bruikbaar vir die studie van die motiewe van beleggers, onafhanklik van hulle land van herkoms, kan wees. Algemene direkte buitelandse beleggings moet aangepas word aangesien meeste van die teorie ontwikkel is deur uitwaartse direkte buitelandse beleggings binne `n Anglo-Saxon konteks. Die studie van die motiewe van buitelandse beleggers is ook belangrik vir beleidsmakers aan die ontvangkant van direkte buitelandse beleggings aangesien `n balans tussen deregulasie met die doel om buitelandse beleggings aan te lok en direkte buitelandse belegging te reguleer deurmiddel van streng wetgewing en sodoende die volle potensiaal van direkte buitelandse belegging te ontsluit. Sodoende is die model wat Lee (1966) ontwikkel het in migrasie teorie toegepas op direkte buitelandse beleggings teorie en getoets op infrastruktuur beleggings in die Demokratiese Republiek van die Kongo (DRK) deur CREC7 `n vleuel van die grootste kontrakteerder CREC. Die hooffaktore wat CREC7 beïnvloed is ondersoek deurmiddel van die Four Factors Model, `n aanpasing van Lee se model, gebruik te maak. `n Enkele gevallestudie was gebruik om lig te werp op sekere verwikkelinge veral die interverhouding tussen verskeie faktore spesifieke tot die maatskappy en die mark wat werk op die beleggingsmotiewe van CREC7 in die DRK. Om die geldigheid van hierdie studie te maksimeer is verskeie bronne gebruik. Naamlik dokumentasie asook onderhoude en direkte observering tydens Augustus 2010. Lee (1966) se model was bruikbaar gewees vir die identifisering van die hooffaktore wat CREC7 se motiewe om te belê in infrastruktuur in die DRK beïnvloed asook die interafhanklikheid tussen hierdie faktore. The versamelde data het geïllustreer hoe omstandighede in die land van oorsprong, die land van ontvangs en omstandighede spesifiek tot die firma mekaar beïnvloed in `n baie komplekse manier. Om die kompleksitieit te illustreer is die faktore wat die meeste op mekaar inwerk in clusters gegroepeer. Die twee clusters wat die meeste op CREC7 se beleggingsbesluit ingewerk het is: (1) verhoudinge met die sentrale regering, toegang tot bevondsing, ondervinding en vaardighede, marktoegang en ingrypende faktore; (2) ondervinding en vaardighede, ondervinding om in `n uitdagende institutionele ongewing, hoë vlakke van kompetisie in die plaaslike mark, hoë aanvraag na infrastruktuur in die DRK. Aangesien die Four Factors Model breë kategorieë van fakore wat van toepassing is op alle buitelandse beleggers kan die model toegepas word op die studie an motiewe van buitelandse beleggers van ontwikkelde en ontwikkelende lande en sodoende daartoe bydra om direkte buitelandse belegging teorie meer relevant te maak

Eine Neubewertung der Auswirkungen von institutioneller Distanz auf die Standortwahl und den Erfolg ausländischer Investoren : ein Vergleich chinesischer und westlicher Investoren in Afrika

This dissertation seeks to add to our understanding how the internationalization process of Chinese firms relates to the internationalization process of Western firms. The focus of this project was on the assumed competitive advantage for Chinese firms in relatively high-risk host countries. In the first part of my study I use a conceptual framework presented by Child and Marinova (2014) to study the role of institutional distance for the location choice of Chinese and U.S. firms. Contrary to popular believe, I found that Chinese investments are not directed to countries with a low level of IM and investments from both China and the U.S. are directed to countries with a low level of political stability. In the second study I use process tracing to further study the causal mechanism that could explain how the levels of political stability and institutional maturity in China could give Chinese firms an advantage in high-risk emerging markets far away from China. The combination of the two studies shows that the success of Chinese firms in challenging host markets depends on much more than push factors only