Multinational Experience Research Articles

Design of E-learning System: M-learning Component

Nowadays the progress in information technologies filed is opening great new possibilities for people in all areas of living. As education is fundamental step in every person's life we have to increase its’ popularity, availability and convenience for everybody. Information technologies present a lot of new tools and approaches which expand the infrastructure of the educational process. Our idea integrates the simplicity and reliability of client-server architecture and usability of various forms of user interfaces. The design describes an e-learning system, which has an m-learning interface, and several new modules which increase the efficiency of the studies. For these purposes we propose module for preliminary homework checking, statistical module and feedback module that can be extended to the separate rating system. The variety of interfaces is supported by three components: desktop application, mobile application and web-based application. Although we concentrate on desktop and mobile forms as according to the statistical data they are more usable. The difference of European, American and Russian systems of education predetermine some aspects in the design approach. It allows to use the strongest advantages of every model in the solution and to share the multinational experience. The paper describes in details the highlighted moments.

Implementation Analysis of Lean Sigma in IT Applications. A Multinational Oil Company Experience in Brazil

Abstract Several process improvement methodologies have emerged in recent decades, but a lack of studies continues on their applicability and effective results in organizations. This article analyzes the Lean Sigma methodology implementation results in the cost and time allocation process for a multinational oil company IT application in Brazil. The analytical criteria were based on the literature review: a) cost, b) time, c) quality, d) effectiveness, e) efficiency and f) internal customer satisfaction. The action research methodology was used and the findings showed Lean Sigma improved the IT application, however it revealed the methodology has low adherence to processes where the intangibles and people participation has greater influence.

Multinational experiences in reducing and preventing the use of restraint and seclusion.

Restraint and seclusion (R/S) have been used in many countries and across service sectors for centuries. With the recent and increasing recognition of the harm associated with these procedures, efforts have been made to reduce and prevent R/S. Following a scathing media exposé in 1998 and congressional scrutiny, the United States began a national effort to reduce and prevent R/S use. With federal impetus and funding, an evidence-based practice, the Six Core Strategies to Prevent Conflict, Violence and the Use of Seclusion and Restraint, was developed. This model was widely and successfully implemented in a number of U.S. states and is being adopted by other countries, including Finland, Australia, and the United Kingdom. Recently, the first cluster randomized controlled study of the Six Core Strategies in Finland provided the first evidence-based data of the safety and effectiveness of a coercion prevention methodology. Preliminary findings of some of the international efforts are discussed. Reduction in R/S use and other positive outcomes are also reported.

Multinational experience with hypersensitivity drug reactions in Latin America

BackgroundEpidemiologic drug allergy data from Latin America are scarce, and there are no studies on specific procedures focusing on this topic in Latin America. ObjectiveTo assess the clinical characteristics and management of hypersensitivity drug reactions in different Latin American countries. MethodsAn European Network of Drug Allergy questionnaire survey was implemented in 22 allergy units in 11 Latin American countries to report on consecutive patients who presented with a suspected hypersensitivity drug reaction. Each unit used its own protocols to investigate patients. ResultsIncluded were 868 hypersensitivity drug reactions in 862 patients (71% of adults and elderly patients were women and 51% of children were girls, P = .0001). Children presented with less severe reactions than adults and elderly patients (P < .0001). Urticaria and angioedema accounted for the most frequent clinical presentations (71%), whereas anaphylaxis was present in 27.3% of cases. There were no deaths reported. Nonsteroidal anti-inflammatory drugs (52.3%), β-lactam antibiotics (13.8%), and other antibiotics (10.1%) were the drugs used most frequently. Skin prick tests (16.7%) and provocation tests (34.2%) were the study procedures most commonly used. A large proportion of patients were treated in the emergency department (62%) with antihistamines (68%) and/or corticosteroids (53%). Only 22.8% of patients presenting with anaphylaxis received epinephrine. ConclusionNonsteroidal anti-inflammatory drugs and antibiotics were the drugs used in at least 75% of patients. More than half the reactions were treated in the emergency department, whereas epinephrine was administered in fewer than 25% of patients with anaphylaxis. Dissemination of guidelines for anaphylaxis among primary and emergency department physicians should be encouraged.

German resuscitation registry : science and resuscitation research

Sudden death due to cardiac arrest represents one of the greatest challenges facing modern medicine, not only because of the massive number of cases involved but also because of its tremendous social and economic impact. For many years, the magic figure of 1 per 1000 inhabitants per year was generally accepted as an estimate of the annual incidence of sudden death in the industrialized world, with a survival rate of 6 %. This estimate was based on large numbers of published reports of local, regional, national and multinational experience in the management of cardiac arrest. Measuring the global incidence of cardiac arrest is challenging as many different definitions of patient populations are used. Randomized controlled trials (RCT) provide insights into the value of specific treatments or treatment strategies in a well-defined section of a population. Registries do not compete with clinical studies, but represent a useful supplement to them. Surveys and registries provide insights into the ways in which scientific findings and guidelines are being implemented in clinical practice. However, as with clinical studies, comprehensive preparations are needed in order to establish a registry. This is all the more decisive because not all of the questions that may arise are known at the time when the registry is established. The German resuscitation registry started in May 2007 and currently more than 230 paramedic services and hospitals take part. More than 45,000 cases of out-of-hospital cardiac arrest and in-hospital cardiac arrest are included. With this background the German resuscitation registry is one of the largest databases in emergency medicine in Germany. After 5 years of running the preclinical care dataset was revised in 2012. Data variables that reflect current or new treatment were added to the registry. The postresuscitation basic care and telephone cardiopulmonary resuscitation (CPR) datasets were developed in 2012 and 2013 as well. The German resuscitation registry is an instrument of quality management and a research network. The registry documents the course in patients who have undergone resuscitation at the time points of first aid, further management and long-term outcome and it can therefore provide a complete presentation of the procedures carried out and the quality of the outcomes. In addition, important scientific questions can be answered from the database. For example, a score for benchmarking the outcome quality after out-of-hospital resuscitation, known as the return of spontaneous circulation (ROSC) after cardiac arrest (RACA) score, has been developed. The registry is available for all emergency medical services (EMS) and hospitals in Germany and other German-speaking countries.

Endoscopic treatment of native lung hyperinflation using endobronchial valves in single‐lung transplant patients: a multinational experience

Hyperinflation of the native lung (NLH) is a known complication to single-lung transplantation for emphysema. The hyperinflation can lead to compression of the graft and cause respiratory failure. Endobronchial valves have been used to block airflow in specific parts of the native lung, reducing the native lung volume and relieving the graft. We report short-term follow-up and safety from 14 single-lung transplant patients with NLH treated with bronchoscopic lung volume reduction using endobronchial valves. Retrospective clinical information related to endobronchial valve treatment was obtained from four centres. All patients were treated with IBV(TM) Valve System (Spiration, Olympus Respiratory America, Redmond, WA, USA). All patients had evidence of severe NLH with mediastinal displacement. A total of 74 IBV valves were placed in 14 patients, with an average of 5.3 (range 2-10). Five patients had two procedures with staged treatment. Eleven patients reported symptom relief, and nine had lung function improvements. There was a significant increase in forced expiratory volume in 1 s of 9% (P = 0.013) and forced vital capacity of 15% (P = 0.034) within the first months after treatment. There were no reported device-related adverse events nor reports of migration. Two patients had pneumothorax. One patient had pneumonia in the location of the valve placement, and another had infection within days. Three other patients were hospitalised with infection 2 months after treatment. Treating NLH with IBV endobronchial valves leads to clinical improvement in the majority of patients, and the treatment has an acceptable safety.

The multi-national experience on long-term enzyme replacement therapy in children with Fabry disease

The multi-national experience on long-term enzyme replacement therapy in children with Fabry disease

Local enablers of business models: The experience of Brazilian multinationals acquiring in North America

Despite the rapid growth of South–North investments, the literature is still incipient to look into the broad range of issues associated with them. This article focuses on reverse takeovers and discusses the reasons why emerging-country firms, Brazilian multinationals in particular, are able to profitably acquire firms in developed countries, chiefly in the United States. The research addresses two specific subjects in international business literature: country-choice and entry-mode. The analytical approach assumes that reverse takeovers are part of the dynamic reconfiguration of global production systems which, in turn, are influenced by shifting conditions in countries' business environments. Changes in business environments impact local firms' business models and their positioning in global production networks and international markets as well. Reverse takeovers are facilitated when both the simultaneous evolution of the developed country multinational and the emerging country multinational business models establish a common ground for the transaction. Through the analysis of Brazilian multinationals' acquisitions in North America, relevant insights pertaining to the realms of firm-specific advantages, country-choice and entry mode in reverse takeovers are unveiled.

Minimally Invasive Prostatic Urethral Lift: Surgical Technique and Multinational Experience

BackgroundMany men with benign prostatic hyperplasia (BPH) are dissatisfied with current treatment options. Although transurethral resection of the prostate (TURP) remains the gold standard, many patients seek a less invasive alternative. ObjectiveWe describe the surgical technique and results of a novel minimally invasive implant procedure that offers symptom relief and improved voiding flow in an international series of patients. Design, setting, and participantsA total of 102 men with symptomatic BPH were consecutively treated at seven centers across five countries. Patients were evaluated up to a median follow-up of 1 yr postprocedure. Average age, prostate size, and International Prostate Symptom Score (IPSS) were 68 yr, 48 cm3, and 23, respectively. Surgical procedureThe prostatic urethral lift mechanically opens the prostatic urethra with UroLift implants that are placed transurethrally under cystoscopic visualization, thereby separating the encroaching prostatic lobes. Outcome measurements and statistical analysisPatients were evaluated pre- and postoperatively by the IPSS, Quality-of-Life (QOL) scale, Benign Prostatic Hyperplasia Impact Index, maximum flow rate (Qmax), and adverse event reports including sexual function. Results and limitationsAll procedures were completed successfully with a mean of 4.5 implants without serious adverse effects. Patients experienced symptom relief by 2 wk that was sustained to 12 mo. Mean IPSS, QOL, and Qmax improved 36%, 39%, and 38% by 2 wk, and 52%, 53%, and 51% at 12 mo (p<0.001), respectively. Adverse events were mild and transient. There were no reports of loss of antegrade ejaculation. A total of 6.5% of patients progressed to TURP without complication. Study limitations include the retrospective single-arm nature and the modest patient number. ConclusionsProstatic urethral lift has promise for BPH. It is minimally invasive, can be done under local anesthesia, does not appear to cause retrograde ejaculation, and improves symptoms and voiding flow. This study corroborates prior published results. Larger series with randomisation, comparator treatments, and longer follow-up are underway.

China’s Innovation Gap

This article highlights innovation, research and development (R&amp;D), and other efforts that are being made to assure China’s progress in the coming future. Chinese leaders understand that innovation is central to their critical interests. Without it, China will never capture the true wealth generated by its dynamic manufacturing sector, improve its competitiveness, or reduce its overall dependence on foreign technology. China has created the educational and research infrastructure needed to embed itself in emerging transnational knowledge networks. Thriving foreign enterprises are likely to have a significant impact on China’s R&amp;D culture. The study reveals that to thrive in the future, China needs to build on its brains, not its brawn. The central government has laid the groundwork for a more innovative economy. A series of medium-to-long-term initiatives are funding science and technology research, reforming education, developing talent, and supporting emerging industries. The results are mixed, but show signs of China’s progress over the past two decades. If Taiwan is any indicator, Chinese with multinational experience are likely to become the technology entrepreneurs of China’s future.

726 Endoscopic Treatment of Native Lung Hyperinflation with One-Way Valves in Single Lung Transplant Patients: A Multinational Experience

726 Endoscopic Treatment of Native Lung Hyperinflation with One-Way Valves in Single Lung Transplant Patients: A Multinational Experience

346 Dormant conduction after pulmonary vein isolation for AF: Prevalence and predictive factors from the advice trial

Single-center observational studies have suggested that elimination of dormant conduction between pulmonary veins (PV) and the left atrium (LA) after PV isolation (PVI) may be associated with a reduction in recurrent AF. We prospectively assessed the prevalence and predictors of dormant PV conduction after PVI in the context of a randomized multicenter study (ADVICE). Patients with paroxysmal AF undergoing PVI were enrolled from 11 centers. PVI was performed using irrigated-tip radiofrequency ablation guided by a circular mapping catheter. After PVI, spontaneous recovery of conduction was assessed over a 20-min observation period and PVs that recovered were re-isolated. Thereafter, dormant conduction was assessed in each PV by injecting intravenous adenosine (12 mg or more to obtain complete AV block). Dormant conduction was defined as a recovery of PV conduction for ≥1 beat. Predictors of dormant conduction were explored by logistic regression analyses. A total of 150 patients (mean age 60 ± 10 yrs, 30% female) were included. Symptoms of AF were present for 5.8 ± 5.6 years prior to the procedure, and patients failed 1.7 ± 1.0 antiarrhythmic drugs. Hypertension was present in 57 (38%) and structural heart disease in 16 (11%) patients. Mean LA size was 40 ± 6 mm. During the 20-min observation period after PVI, PVs spontaneously reconnected in 30 (20%) patients, corresponding to 39/586 (7%) PVs. All affected PVs were re-isolated. Dormant PV conduction was subsequently assessed in all patients with a mean adenosine dose of 15.7 ± 5.5 mg. It was identified in 122/586 (21%) PVs. Dormant PV conduction in at least 1 PV was revealed by adenosine in 79 patients (53%) for an average of 1.5 ± 0.8 PVs per patient. The presence of dormant PV conduction could not be predicted by clinical, hemodynamic, or anatomic parameters. Our multinational experience revealed a high prevalence of dormant PV conduction (53%) unmasked by adenosine after a standard 20-min observation period following PVI. The ADVICE trial is currently assessing whether elimination of dormant PV conduction will translate into a lower rate of recurrent AF.

Permanent versus Mobile Entry Decisions in International Construction Markets: Influence of Home Country– and Firm-Related Factors

When entering a selected foreign market, the contractor must decide between permanent entry mode and mobile entry mode. By following theories and previous studies in international business, hypotheses were developed regarding the influences of several firm- and home country–related factors upon the selection between the two generic entry modes. These factors include home market attractiveness, uncertainty avoidance, long-term orientation, firm size, and multinational experience. A binary logistic regression analysis was then performed, with results supporting most of the hypotheses. With other conditions held constant, contractors do not tend to determine entry mode under the influence of their long-term orientation but are more likely to use permanent entry than mobile entry when home market size is insignificant and uncertainty avoidance, firm size, or multinational experience is significant. The interaction effects of entry restriction by other factors were also explored. The findings can aid contractors when selecting or evaluating their entry modes for overseas construction markets.

Regional Government and Governance in China and the United States

A comparative analysis of regional governance policies in China and the United States is presented from multiple perspectives, including jurisdictional structure, intergovernmental relationship, and performance outcomes. Policy reviews and case studies contrast how regional approaches may assist governments to learn seminal lessons from multinational experiences.

Cross-border private equity syndication: Institutional context and learning

Private equity (PE) has become an increasingly international phenomenon but there is a lack of research that looks at the process by which PE firms invest across borders. We aim to fill this gap in the literature by examining the role of institutional context and organizational learning as determinants of cross-border PE syndication. We examine these issues by studying the international expansion by later-stage UK PE investors into continental Europe over the period 1990 to 2006. Our results indicate that institutional context (in terms of the number of PE firms in the local environment and the presence of investment bankers in the local market) and organizational learning (in terms of the PE firm's experience in the host country; the PE firm's multinational experience; and the number of investment managers per portfolio company; but not the presence of local offices) are significantly related to the use of cross-border syndicates. Implications for theory and practice are suggested.

Superficial Dermatomycoses Worldwide: Multinational Treatment Experience with a Combination of Isoconazole Nitrate and Diflucortolone Valerate

Superficial Dermatomycoses Worldwide: Multinational Treatment Experience with a Combination of Isoconazole Nitrate and Diflucortolone Valerate

Robotic-Assisted Laparoscopic Ureteral Reimplantation with Psoas Hitch: A Multi-institutional, Multinational Evaluation

To report the collective experience of three multinational institutions with the use of robotics to evaluate and treat complex distal ureteral obstruction. A total of 12 patients from The Ohio State University, Columbus, Ohio; Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium; and Hospital Sultanah Aminah, Kuala Lumpur, Malaysia underwent robotic-assisted laparoscopic ureteral reimplantation between August 2004 and July 2006. The indications for ureteral reimplantation included ureteral stricture (n = 10) and ureterovaginal fistula (n = 2). Nine patients had pathology on the left side and 4 patients had right-sided disease. Surgery was performed by three experienced laparoscopic robotic surgeons with the daVinci Surgical System. The mean patient age (range) was 41.3 years (19 to 67 years). The mean operative time was 208 minutes (80 to 360 minutes). The mean robot time was 173 minutes (75 to 300 minutes). The mean estimated blood loss was 48 mL (45 to 100 minutes). The mean length of hospitalization was 4.3 days (2 to 8 days). All the procedures were completed successfully robotically without open conversion. There were no intraoperative or postoperative complications. Postoperative intravenous urography and Mercapto Acetyl TriGlycine 3 showed normal findings in 10 patients and a mild residual hydronephrosis in 2 patients. After a mean follow-up of 15.5 months, all patients were asymptomatic of their initial disease state. This multi-institutional, multinational experience illustrates that ureteral reimplantation with psoas hitch can be performed safely and effectively to treat lower tract ureteral obstruction.

43. Multinational military experience in the use of frozen blood products

43. Multinational military experience in the use of frozen blood products

Firm's Intangible Assets and Multinational Activity: Joint-Venture Versus FDI

This paper provides a theoretical formalisation of the joint-venture contract, as an alternative to Foreign Direct Investment (FDI), within a Dissipation of Intangible Assets framework. In a two-period, two-country equilibrium model, we discuss how the threat of knowledge spillover shapes the boundaries of a Multinational Enterprise. Similarly to the theoretical findings on the FDI-licensing trade off, we show that Foreign Direct Investment is more likely to emerge when know-how easily spills over – i.e. when firms are endowed with more intangible assets or they belong to high tech industries. Probit estimates, from an entirely new firm-level dataset, constructed by the author, show that the experience of Italian multinationals in Asia is in line with our theoretical predictions.

An Afro-Asian nexus: South African multinational firm experiences in Chinese labour markets – key focus areas

This exploratory study examines perspectives of multinational corporations (MNCs) from South Africa (SA) in respect of the variables considered important in product and labour markets in China. These include how MNCs first interpret and understand cultural, human capital, regulatory factors and employment practices, before considering how they might adapt to or seek to influence them. A survey of thirteen SA firms operating or trading in these markets and interviews with South Africans who had undertaken exploratory assignments in China, were done. Key factors were identified and evaluated based on relevant literature and research. The following six focus areas were found to be important for business effectiveness in this market: understanding its market complexity, importance of joint venture partners, guanxi relationship networks, human capital, language and culture, and regulatory environment.