Early Internationalization in the Digital Context : A Capabilities-based Approach

In the fields of international entrepreneurship (IE) and international business (IB), digitalization influences the early internationalization of firms. While we know that digitalization facilitates early internationalization, we do not yet know the exact underlying capabilities that drive this process. The dissertation attempts to bridge this gap by utilizing a capabilities-based approach. This approach offers relevant insights for both IE and IB literature and provides new understanding on how early internationalizing firms develop their digital capabilities for achieving sustainable internationalization outcomes. The dissertation consists of four essays. The first essay, which is a literature review, evaluates IE and IB literature dealing with digitalization and examines to what extent digitalization underlies the causes, processes, and outcomes of early internationalization. The second, third, and fourth essays focus on the capabilities underlying early internationalization processes and outcomes in a digital context. The essays illustrate how the development of international dynamic capabilities and learning advantage of newness of early internationalizing firms occur; they also open up the functionality of digital technology as a supportive mechanism. Theoretically, the essays contribute to IE and IB research streams by providing novel insights and understanding of the phenomenon of early internationalization in a digital context from a capabilities-based approach. Overall, the dissertation cross-fertilizes perspectives from IE, IB, and information systems to contribute to our understanding of early internationalization in the digital context. It also responds to the calls for more research on the impact of digitalization on internationalization, and capability development studies.Digitalisaatio vaikuttaa yritysten varhaiseen kansainvälistymiseen kansainvälisessä yrittäjyydessä ja kansainvälisessä liiketoiminnassa. Tiedämme, että digitalisaatio kiihdyttää varhaista kansainvälistymistä, mutta emme tiedä tarkalleen, mitkä kyvykkyydet edistävät tätä prosessia. Väitöskirja pyrkii vastaamaan tähän tutkimusvajeeseen kyvykkyyksiin perustuvan lähestymistavan kautta. Lähestymistapa antaa olennaisia näkemyksiä sekä kansainvälisen yrittäjyyden että kansainvälisen liiketoiminnan kirjallisuuteen ja lisää ymmärrystä siitä, kuinka varhain kansainvälistyneet yritykset kehittävät kyvykkyyksiään digitaalisesti siten, että kansainvälistymisen tulokset ovat kestäviä. Väitöskirja koostuu neljästä esseestä. Ensimmäinen essee on kirjallisuuskatsaus, jossa arvioidaan kansainvälisen yrittäjyyden ja kansainvälisen liiketoiminnan digitalisuutta käsittelevää kirjallisuutta ja tarkastellaan missä määrin digitaalisuus määrittää syitä, prosesseja ja kansainvälistymisen tuloksia. Toisessa, kolmannessa ja neljännessä esseessä keskitytään kyvykkyyksiin, jotka toimivat varhaisen kansainvälistymisprosessin sekä kansainvälistymisprosessin tulosten taustalla digitaalisessa kontekstissa. Esseet havainnollistavat, miten varhain kansainvälistyvien yritysten kansainväliset dynaamiset kyvykkyydet ja varhaisen oppimisen etu kehittyvät. Esseissä käsitellään myös digitaalitekniikan toimivuutta tukimekanismina. Esseiden teoreettinen kontribuutio kohdistuu kansainvälisen yrittäjyyden ja kansainvälisen liiketoiminnan tutkimuskenttään tarjoten uusia oivalluksia ja ymmärrystä varhaisen kansainvälistymisen ilmiöstä digitaalisessa kontekstissa kyvykkyyksiin perustuvan lähestymistavan kautta. Väitöskirjassa hyödynnetään kansainvälisen yrittäjyyden, kansainvälisen liiketoiminnan ja tietojärjestelmätieteen näkökulmia lisäämään ymmärrystä varhaisesta kansainvälistymisestä digitaalisessa kontekstissa. Väitöskirja vastaa myös toivomuksiin lisätä tutkimusta digitalisaation vaikutuksesta kansainvälistymiseen sekä kyvykkyyksien kehittämiseen.fi=vertaisarvioitu|en=peerReviewed

Liminality and developmental process of learning advantage of newness of early internationalizing firms

Extant internationalization studies have devoted limited attention to the dynamics of the learning advantage of newness (LAN), which we, in response, investigate through the process approach and the novel lens of the concept of liminality. We conduct a longitudinal multiple-case study of five Finnish internationalizing firms. We inductively derive a process model that shows how the underlying liminal factors, such as international opportunity scaffolding activities, learning from communitas, and rituals, contribute to the development of learning advantage of newness. Originating in anthropology, the liminality perspective offers a novel perspective on LAN of early internationalizing firms. We also provide directions for future research and recommendations for practitioners.© 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).fi=vertaisarvioitu|en=peerReviewed

Social factors influencing child health in Ghana

Objectives Social factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals’ target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the non-realisation of this goal. Methods ScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review. Results Major social factors influencing child health in the country include maternal education, rural-urban disparities (place of residence), family income (wealth/poverty) and high dependency (multiparousity). These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices. Conclusions Several social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother’s health knowledge is emphasised

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Gender Diversity and Leadership Style in Virtual Working Environment

The main purpose of this study is to improve readers’ understanding of the dynamics be-hind virtual team performance. It focuses on how gender differences, leadership styles and behaviours influence virtual team performance among teachers in Haaga-Helia and Estonia Business School. It also aims to identify whether leadership styles and behaviours vary due to gender differences and have dissimilar effects on virtual team performance. Another intention is to investigate whether gender diversity (i.e. differences) typically bring greater success to teams or working groups in a virtual learning environment. The theoretical framework was based on the full-range leadership model. However, the scope was concentrated on transformational and transactional leadership styles and behaviours aspect of the model. These leadership styles were chosen by the researcher because they have attracted extensive research attention since their inception; transformational and transactional leadership styles have been proved to impact virtual teams in meaningfully diverse ways; and transformational, and transactional leadership styles can be translated into practical recommendations and suggestions for leadership training. (Hambley, O’Neil and Kline, 2007). The research strategy for this study was a survey. Having an intention to explore the phenomenon under study, identify themes and patterns, the researcher adopted an abductive form of research approach. Collection of data was obtained from primary and secondary sources. Simple random sampling technique was used select the sample. The analytical approach was both qualitative and quantitative (mixed approach). From an empirical perspective, two opposing views were obtained. From quantitative approach aspect of the study, it was discovered that both genders exhibited transformational and transactional leadership styles and behaviours when working in virtual teams or tasks. These behaviours were not gender linked, meaning there are no differences between genders. However, based on the result obtained from the qualitative aspect of the study, it has been known that leadership styles are gender linked. It therefore means that there are differences between male and female leadership styles. Besides these inconsistencies, these leadership styles and their associated behaviours have been empirically proven to be linked to positive virtual team performance. Finally, it has been proved by this study that gender diversity generates greater success to teams or work groups in a virtual working environment. In conclusion, this study has a provided an interpretive view of gender and leadership styles in virtual environment. It has investigated for the leadership styles and behaviours of teachers in virtual working environment, and the inherent differences with respect to gender; and the efficacy of gender diversity to virtual teams or working groups

Planning Entrepreneurship –A Viable Option for the 21st Century Graduate

According to the Euromonitor Global Market Research article published on the 2oth of April, 2010, Finland is one of the countries that have a higher proportion of unemployed graduates due to the problem of skills mismatch. There is a possibility that a time will come when many graduates may choose to return to further education rather than be unemployed while seeking for employment in an unfavourable economic climate. Being a business management student interested in entrepreneurship, the researcher chose to research into this field putting emphases on the barriers that deter graduates in taking entrepreneurship planning through self-establishment as an option after graduation. With emphasis on this research, data has been collected from primary sources, secondary sources, and tertiary sources. Primary source data involved the use of an in-depth interview and questionnaire. Secondary sources of data were obtained from scientific articles and journals from Emerald, Elsevier Science Direct, Ebrary, published theses and other electronic publications. Dictionaries, Wikipedia, the Encyclopedia Britannica, and Statistics Finland were used as the source of the tertiary data collected. In analysing the data gathered, both quantitative (Predictive Analyses Software Statistics) and qualitative methods were used. From the research results, it was observed that the barriers to entrepreneurship are in many forms and defining a situation as a barrier depends on the individual. In some of the results obtained from the interviews and questionnaires, there were slight differences and similarities. Moreover, it was discovered that establishing a new business in Finland is relatively easy but according to the research the reason why many unemployed graduates are reluctant to enter into entrepreneurship planning as expressed by interviewees were the fear or risks, inexperience, poor networking skills and inadequacy of confidence