Multinational Experience Research Articles

Language Barriers in Multinationals and Knowledge Transfers

Abstract We study communication frictions within multinationals (MNCs), hypothesizing that language barriers reduce management knowledge transfers within the organization. A distinct feature of such MNCs is a three-tier hierarchy: foreign managers (FMs) supervise domestic managers (DMs) who supervise production workers. Tailored surveys from our setting – MNCs in Myanmar – reveal that language barriers impede interactions between FMs and DMs. A first experimental protocol offers DMs free English courses and confirms that lowering communications costs increases their interactions with FMs. A second experimental protocol that asks human-resource managers at domestic firms to rate hypothetical resumes reveals that multinational experience and, specifically, DM-FM interactions are valued in the domestic labor market. Together, these results suggest that reducing language barriers can improve transfers of management knowledge, an interpretation supported by improvements in soft skills among treatment DMs in the first experiment. A model in which communication within MNCs is non-contractible – a realistic feature of workplace life – reveals that the experimental results are consistent with underinvestment in language training and provide a rationale for policy intervention.

Stories of our Grandmothers: How Modern Ukrainian Women's Literature Deconstructs the Soviet Myth about the Great Patriotic War

The article analyses how contemporary women’s literature deconstructs the Soviet myth of the Great Patriotic War under the influence of contemporary Russian aggression. This myth defined the narrative of World War II as a heroic sacrifice of the Soviet people. As a result, the diversity of experiences was suppressed and the memory of them was not formed. Since independence, Ukrainian culture has been restoring the gaps in history and memory, which has become especially important in the context of the ongoing war. Women’s literature participates in this process by focusing on women’s experiences, which are usually marginalized in the national-focused narrative. This study aims to identify the contribution of women’s literature to the process of decolonization. The object of the study is such women’s novels as The Museum of Abandoned Secrets by Oksana Zabuzhko (as a precursor to the modern treatment of the topic), Amadoka by Sofia Andruhovych, Because it Hurts by Yevgenia Senik, Eva’s Apples by Khrystyna Kotsira and Faride by Iren Rozdobudko. The study found that women’s literature most often addresses the topics of women combatants, deportations, and the Holocaust. In this way, the authors contribute to the process of returning to national history. At the same time, the study demonstrates the complex interaction of nationality and gender in contemporary women’s literature. As women’s literature also contradicts the traditional nationally oriented discourse, emphasizing female agency and appealing to multinational experience (except Ukrainian, Jewish, and Crimean Tatar). This understanding of the theme of the Second World War by contemporary Ukrainian women’s literature creates a context for the perception of the specifically female experience of the current war and resists attempts at ideological manipulation around women’s roles.

Multinational experience with next-generation sequencing: opportunity to identify transthyretin cardiac amyloidosis and Fabry disease.

Sarcomeric hypertrophic cardiomyopathy (HCM) must be differentiated from phenotypically similar conditions because clinical management and prognosis may greatly differ. Patients with unexplained left ventricular hypertrophy require an early, confirmed genetic diagnosis through diagnostic or predictive genetic testing. We tested the feasibility and practicality of the application of a 17-gene next-generation sequencing (NGS) panel to detect the most common genetic causes of HCM and HCM phenocopies, including treatable phenocopies, and report detection rates. Identification of transthyretin cardiac amyloidosis (ATTR-CA) and Fabry disease (FD) is essential because of the availability of disease-specific therapy. Early initiation of these treatments may lead to better clinical outcomes. In this international, multicenter, cross-sectional pilot study, peripheral dried blood spot samples from patients of cardiology clinics with an unexplained increased left ventricular wall thickness (LVWT) of ≥13 mm in one or more left ventricular myocardial segments (measured by imaging methods) were analyzed at a central laboratory. NGS included the detection of known splice regions and flanking regions of 17 genes using the Illumina NextSeq 500 and NovaSeq 6000 sequencing systems. Samples for NGS screening were collected between May 2019 and October 2020 at cardiology clinics in Colombia, Brazil, Mexico, Turkey, Israel, and Saudi Arabia. Out of 535 samples, 128 (23.9%) samples tested positive for pathogenic/likely pathogenic genetic variants associated with HCM or HCM phenocopies with double pathogenic/likely pathogenic variants detected in four samples. Among the 132 (24.7%) detected variants, 115 (21.5%) variants were associated with HCM and 17 (3.2%) variants with HCM phenocopies. Variants in MYH7 (n=60, 11.2%) and MYBPC3 (n=41, 7.7%) were the most common HCM variants. The HCM phenocopy variants included variants in the TTR (n=7, 1.3%) and GLA (n=2, 0.4%) genes. The mean (standard deviation) ages of patients with HCM or HCM phenocopy variants, including TTR and GLA variants, were 42.8 (17.9), 54.6 (17.0), and 69.0 (1.4) years, respectively. The overall diagnostic yield of 24.7% indicates that the screening strategy effectively identified the most common forms of HCM and HCM phenocopies among geographically dispersed patients. The results underscore the importance of including ATTR-CA (TTR variants) and FD (GLA variants), which are treatable disorders, in the differential diagnosis of patients with increased LVWT of unknown etiology.

Stakeholder Insights into Czech Performance-Based Managed Entry Agreements: Potential for Transformative Change in Pharmaceutical Access?

Managed Entry Agreements (MEAs) play a pivotal role in addressing the challenges arising from escalating prices of innovative medical technologies, especially in areas like oncology, immunology, and rare diseases. Among MEAs, Performance-Based MEAs (PB MEAs) and Outcome-Based MEAs (OB MEAs) stand out as innovative strategies. This study examines the adoption of PB MEAs in the Czech Republic post a 2022 legislative change. Interviews with key stakeholders, including the Ministry of Health, pharmaceutical companies, insurers, and patient groups, were conducted to explore perceptions and challenges. Stakeholders expressed concerns about legislation completeness, data quality, transparency, and methodology. Interestingly, pharmaceutical companies were less concerned about transparency and methodology, likely due to their multinational experience. Despite legislative progress, challenges persist, especially in data infrastructure, risk-sharing perceptions, and stakeholder readiness. Addressing these issues requires collaboration between pharmaceutical companies and payers. Patient involvement, though mandated, remains limited, potentially due to a lack of awareness. This study emphasizes the need for a comprehensive transformation beyond legislation for a successful PB MEA implementation. Trust, technical infrastructure, and data availability are crucial, necessitating a holistic approach. It contributes to the global discourse on PB MEAs, stressing the adjustment of financial frameworks, embracing value-based healthcare principles, and ensuring high-quality health data metrics. A more holistic, value-based MEA approach could reshape pharmaceutical reimbursement in the future.

Dietary goals and current challenges in the management of classical homocystinuria: insights from multinational real-world experience

Dietary goals and current challenges in the management of classical homocystinuria: insights from multinational real-world experience

Community responses to COVID-19 pandemic first wave containment measures: a multinational study.

National strategies to control COVID-19 pandemic consisted mostly of social distancing measures such as lockdowns, curfews, and stay-home guidelines, personal protection such as hand hygiene and mask wearing, as well as contact tracing, isolation and quarantine. Whilst policy interventions were broadly similar across the globe, there were some differences in individual and community responses. This study explored community responses to COVID-19 containment measures in different countries and synthesized a model. This exaplains the community response to pandemic containment measures in the local context, so as to be suitably prepared for future interventions and research. A mutlinational study was conducted from April-June 2020 involving researchers from 12 countries (Japan, Austria, U.S., Taiwan, India, Sudan, Indonesia, Malaysia, Philippines, Myanmar, Vietnam and Thailand). Steps in this research consisted of carrying out open-ended questionnaires, qualitative analyses in NVivo, and a multinational meeting to reflect, exchange, and validate results. Lastly, a commuinty response model was synthesized from multinational experiences. Effective communication is key in promoting collective action for preventing virus transmission. Health literacy, habits and social norms in different populations are core components of public health interventions. To enable people to stay home while sustaining livelihoods, economic and social support are essential. Countries could benefit from previous pandemic experience in their community response. Whilst contact tracing and isolation are crucial intervention components, issues of privacy and human rights need to be considered. Understanding community responses to containment policies will help in ending current and future pandemics in the world.

Acute Abdomen and Appendicitis in 1010 Pediatric Patients With COVID-19 or MIS-C: A Multinational Experience from Latin America.

Background:To date, there are only sporadic reports of acute abdomen and appendicitis in children with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C).Methods:Children 17 years of age or younger assessed in 5 Latin American countries with a diagnosis of microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and children fulfilling MIS-C definition were included. For children with acute abdomen, we investigate main radiologic patterns, surgical treatment and intraoperative findings, outcomes.Findings:One-thousand ten children were enrolled. Forty-two children (4.2%) had a clinical diagnosis of acute abdomen. Four (9.5%) were diagnosed with MIS-C and did not undergo surgery. The remaining 38 children (3.8%) underwent abdominal surgery due to suspected appendicitis, 34 of them (89.7%) had an intraoperative diagnosis of acute appendicitis (AA), while 4 of them had nonsurgical findings. Eight children died (0.8%), none of them being diagnosed with appendicitis. Children with AA were significantly older than those without (P < 0.0001). Children with complicated appendicitis had more frequently fever (85.7% vs. 60%), intestinal distension on the abdominal radiograph (7.1% vs. none), leukocytosis (85.7% vs. 40%) and high levels of C-reactive protein (35.7% vs. 5%), although differences were not statistically significant.Conclusions:Our study showed that children may present with acute abdomen during COVID-19 or MIS-C, which is not always associated with intraoperative findings of appendicitis, particularly in case of MIS-C. Further studies are needed to better characterize children with acute abdomen during COVID-19 or MIS-C, to avoid delay in diagnosis of surgical conditions and at the same time, minimize unnecessary surgical approaches.

High rates of antibiotic prescriptions in children with COVID-19 or multisystem inflammatory syndrome: A multinational experience in 990 cases from Latin America.

AimThis study aims to assess rates of antibiotic prescriptions and its determinants in in children with COVID‐19 or Multisystem Inflammatory Syndrome (MIS‐C).MethodsChildren <18 years‐old assessed in five Latin Americas countries with a diagnosis of COVID‐19 or MIS‐C were enrolled. Antibiotic prescriptions and factors associated with their use were assessed.ResultsA total of 990 children were included: 921 (93%) with COVID‐19, 69 (7.0%) with MIS‐C. The prevalence of antibiotic use was 24.5% (n = 243). MIS‐C with (OR = 45.48) or without (OR = 10.35) cardiac involvement, provision of intensive care (OR = 9.60), need for hospital care (OR = 6.87), pneumonia and/or ARDS detected through chest X‐rays (OR = 4.40), administration of systemic corticosteroids (OR = 4.39), oxygen support, mechanical ventilation or CPAP (OR = 2.21), pyrexia (OR = 1.84), and female sex (OR = 1.50) were independently associated with increased use of antibiotics. There was significant variation in antibiotic use across the hospitals.ConclusionOur study showed a high rate of antibiotic prescriptions in children with COVID‐19, in particular in those with severe disease or MIS‐C. Prospective studies are needed to provide better evidence on the recognition and management of bacterial infections in COVID‐19 children.

Robot-Assisted Radical Prostatectomy in Low-Volume Regions: Should It Be Abandoned or Adopted? A Multi-Institutional Outcome Study.

Purpose: To present multinational experience in robot-assisted radical prostatectomy (RARP) by fellowship-trained expertise in low-volume regions in Gulf Cooperation Council (GCC) countries and to compare the current results with global outcomes reported in recent meta-analyses. Methods: A retrospective review of prospectively collected data was performed for patients undergoing RARP for localized prostate cancer (PCa). Three fellowship-trained surgeons at four academic and referral centers in Saudi Arabia and Kuwait performed all procedures between February 2014 and December 2019. Data on demographics, perioperative characteristics, pathology, and adverse events were collected. Results: A total of 207 patients were included with a median (IQR) follow-up duration of 28 (15-38) months. The median prostate volume and prostate-specific antigen were 42 (32-53) g and 9.1 (5.8-14.1) ng/mL, respectively. While 65.2% of patients had a Gleason score ≥7, 20% had grade group 4 disease, and 7.8% had ≥cT3 disease. The mean ± SD operative time was 203 ± 52 minutes, and the mean estimated blood loss was 158 ± 107 mL. Only 4 (1.9%) patients received perioperative blood transfusions. Positive surgical margins were observed in 21.7% of patients, all of whom had ≥pT3 disease. There were 23 complications in 18 (8.7%) patients, including Clavien-Dindo grade III complications in 2.4%. At the 12-month follow-up, 35.8% of patients were potent, 94.6% were continent, and 9.2% had biochemical recurrence. Conclusions: The safety and efficacy of RARP by fellowship-trained expertise in GCC countries were well established. The outcomes seem promising and comparable to international centers and should improve with increasing case volume and fellowship-trained expertise.

Research on Writing Tasks for International Students

As the number of international students increased, liberal arts classes at local universities for their own people were reorganized. In particular, the role and importance of liberal arts Korean language has been expanded as a foundation for students to improve their Korean language skills and acquire knowledge of their majors. In order to come up with a level-based education plan that considers learners' academic abilities in various ways, the professor in charge of liberal arts first worked to list reading materials that can stimulate learners' interest and to step up the writing process so that students could complete their writing. Most important of all, it is that students find the topic of writing on their own and solve the problem of writing on their own. For this purpose, he noted finding various writing topics related to the multinational experience of overseas Korean students. It also created and provided various notices to help students carry out their assignments. These guides were used as reference books for students to easily understand the theory of writing. This writing assignment was completed with team speaking activities (comrade correction) and professors' correction. The professor was a guide to learning, and had the students perform complete and convergent tasks. In doing this task, students can develop a sense of cooperation in solving writing problems, along with an active attitude in selecting topics on their own.

Adapting to post-COVID19 research in Parkinson's disease: Lessons from a multinational experience

• COVID-19 has significant impact on PD research and education activities. • Country-specific restrictions may pose challenges to PD research and require careful adaptations. • Neurological Symptoms of COVID-19 may overlap with PD.

Introduction: Soviet Sound Spaces and the Late Soviet Multinational Experience

Introduction: Soviet Sound Spaces and the Late Soviet Multinational Experience

NATO Military Medical Exercise Vigorous Warrior 2017.

Our intent in presenting this information is to increase the awareness of the Special Operations Forces (SOF) medical community and the overall international medical/military communities about the North Atlantic Treaty Organization (NATO) military medicine's premiere Vigorous Warrior Exercises organized by NATO Centre of Excellence for Military Medicine (MILMED COE). The Vigorous Warrior medical exercise series is conducted biennially, with four successful iterations since 2011. These international medical exercises engage military medical elements that enhance NATO capabilities and ensure that new NATO medical concepts are being exercised and tested across the full capability-requirement spectrum. The primary aims of these exercises are to provide NATO and partner nations a multipurpose platform to collectively train their medical forces and personnel; test and experiment new concepts and doctrines; medically evaluate national or multinational medical treatment facilities in accordance with NATO doctrine; produce medical lessons identified and lessons learned; and provide the participants with multinational experience to enhance the provision of health care in NATO operations. These exercises directly strengthen partnerships, improve military medical interoperability, and demonstrate the Alliance's commitment to improving international military collaboration. More than 1,000 medical personnel from 26 NATO and partner nations successfully conducted the joint, multilevel, multinational, medical live exercise Vigorous Warrior 2017 (VW17) throughout three locations in Germany during 4-22 September 2017. This article details the highly successful VW17 and paves the way for a very bright future for the Alliance's military medicine as well as a Vigorous Warrior 2019.

Common themes and challenges in hemophilia care: a multinational perspective

ABSTRACTObjective: To identify ways that provision of hemophilia care can be maximized at the local level, irrespective of available resources or cultural or geographic challenges.Methods: The SHIELD group used its multinational experience to share examples of local initiatives that have been employed to deliver optimal hemophilia care.Results: The examples were reviewed and categorized into four key themes: guidelines and algorithms for delivery of care; collaboration with patients and allied groups for care and education; registries for the monitoring of treatment and outcomes and health care planning and delivery; and opportunities for personalization of care. These themes were then incorporated into a road map for collaborative care in hemophilia that reflected the contribution of best practice.Discussion: Differing healthcare reimbursement systems, budgetary constraints, and geographical and cultural factors make it difficult for any country to fully deliver ideal care for people with hemophilia. The SHIELD approach for collaborative care provides illustrative examples of how four key themes can be used to optimize hemophilia care in any setting.Abbreviations: AHCDC: Association of Hemophilia Clinic Directors of Canada; AICE: Italian Association of Hemophilia Centres; ATHN: American Thrombosis and Hemostasis Network; EAHAD: European Association for Haemophilia and Allied Disorders; EHC: European Hemophilia Consortium; FIX: Coagulation Factor IX; FVIII: Coagulation Factor VIII; HAL: Haemophilia Activity List; HJHS: Haemophilia Joint Health Score; HTC: Hemophilia Treatment Centre; HTCCNC: Hemophilia Treatment Centre Collaborative Network of China; MASAC: Medical and Scientific Advisory Council; MDT: Multidisciplinary team; NHD: National Haemophilia Database; NHF: National Hemophilia Foundation; PK: Pharmacokinetics; POCUS: Point of care ultrasound; PWH: People with haemophilia; SHIELD: Supporting Hemophilia through International Education, Learning and Development; WFH: World Federation of Hemophilia

Productivity spillovers through labor flows: productivity gap, multinational experience and industry relatedness

Labor flows are important channels for knowledge spillovers between firms; yet competing arguments provide different explanations for this mechanism. Firstly, productivity differences between the source and recipient firms have been found to drive these spillovers; secondly, previous evidence suggests that labor flows from multinational enterprises provide productivity gains for firms; and thirdly, industry relatedness across firms have been found important, because industry-specific skills have an impact on organizational learning and production. In this paper, we aim to disentangle the effects of productivity gap, multinational experience and industry relatedness in a common framework. Hungarian employee–employer linked panel data from 2003–2011 imply that the incoming labor from more productive firms is associated with increasing future productivity. The impact of multinational spillovers cannot be confirmed, once productivity differences between the firms are taken into account. Furthermore, we find that flows from related industries outperform the effect of flows from same and unrelated industries even if we control for the effects of productivity gap and multinational spillovers.

1180 - Outcomes of periurethral bulking agent injection for treatment of postprostatectomy incontinence after sling placement: A multi-national experience

1180 - Outcomes of periurethral bulking agent injection for treatment of postprostatectomy incontinence after sling placement: A multi-national experience

Motivation of Engineering Students Participating in Multinational Design Projects – Comparison Based on Gender and Class Status

There have been different active-learning initiatives introduced in academia to provide engineering students with the necessary knowledge, skills and attitude to be competitive in the global market. These initiatives have been in response to the need in the corporate world for engineers with exposure to global collaborative environments. Consequently, multinational collaborative design projects have been used by the authors as means of introducing professional global skills to engineering students while exposing them to a project-based learning experience. This educational activity is expected to motivate students so that they can start developing the professional skills that will help them to overcome difficulties and to carry out the project successfully. However, this activity faces many challenges including, among others, cultural and academic background differences, language and time zone barriers, and issues with communication tools. Therefore, this work compares the motivation of students before and after their participation in a multinational design project, using gender and class standing as differentiating parameters. To accomplish this objective, the Intrinsic Motivation Inventory (IMI) was adapted to the implemented multinational collaborative experience and administered to the participating students. For this study, three motivation constructs are taken into consideration: (a) interest/enjoyment, (b) perception of choice, and (c) perceived competence. Results are discussed based on the research questions posed for this comparative work, and result reflections are presented.

Expansion Mode Choices: The Case of US Multinationals in Brazil

The traditional theory of expansion modes argue that local experience would bring Multinationals (MNEs) more knowledge of the particularities of the local market, mitigating subsequent same local expansion risk and will choose greenfield and wholly-owned subsidiary. However, local complementary inputs become relevant in this expansion decision, when local complementary assets are not always available and freely negotiated (Hennart, 2009). This paper analyzes the sequential expansion decision made by 10 major and large experienced US multinationals in Brazil between 2004 and 2013, identifying the possible motives for this decision considering MNEs expansion theories and Brazilian inter-regions differences. We found evidence that supports Hennart Bundling Model: i) the experience of multinationals in Brazil not always increases multinationals’ commitment in the host countries by establishment of new wholly-owned subsidiaries; ii) US MNEs make acquisitions when they need to enter in a new region with significant difference of local economic development from where MNE already operated; iii) also, Brazilian regional factors such as concentration, growth and industries’ intrinsic features are determinants of acquisitions and joint ventures choices

As Variáveis Relacionadas à Escolha do Modo de Entrada em Mercados Internacionais

O objetivo do presente trabalho é analisar as variáveis relacionadas à escolha do modo de entrada em mercados internacionais feita por executivos de empresas brasileiras do setor eletroeletrônico. Para tanto, foi realizado um estudo qualitativo de natureza exploratória. Mais especificamente, foram coletadas entrevistas com nove executivos de empresas, que vivenciaram processos de internacionalização e de escolha de modos de entrada, e com cinco especialistas sobre o tema. Os dados, tratados através da técnica de análise de conteúdo temática, permitiram constatar que as variáveis consideradas pelos executivos brasileiros durante a decisão do modo de entrada são as seguintes: (i) custo; (ii) controle; (iii) risco; (iv) distância cultural; (v) distância geográfica; (vi) velocidade de internacionalização e tempo total de viagem; (vii) experiência multinacional da firma; (viii) atratividade do mercado; (ix) incentivos de entidades brasileiras; (x) escolha do parceiro certo; e, (xi) retorno da operação. Ainda, com base nos dados obtidos, foi possível observar que o modo de entrada mais utilizado pelas empresas entrevistadas do setor eletroeletrônico é a exportação, enquanto que as franquias não despertam o interesse dos executivos.

Leadership positioning among U.S. firms investing in China

This study investigates leadership positioning by U.S. firms in China using the awareness, motivation, capability (AMC) perspective. We define leadership as first in industry to invest in China, and find that leaders have characteristics associated with higher AMC, evidenced by pre-existing multinational experience, higher product market orientation, smaller scale of operations, and higher input cost structure. Notably, the motivation to lower input costs and the prior capability in multinational operations mattered only for the first wave of firms leading industry investment earlier in time, while firms with smaller scale of operations exhibited a preference to lead investment in less popular provinces. Overall, these results provide a unique view on how AMC characteristics influence international investment decisions, suggesting that firms both strategically lead and strategically follow. In additional analysis, we examine how leaders and followers positioned themselves with respect to ownership, and find that leaders were more likely to choose entry modes that offered ownership control over flexibility, consistent with internalization theories.