Firms are complex entities that often engage in activities that pull them in different directions. This realization has been widely heralded in the organizational ambidexterity literature. Our research extends this literature by introducing the concept of Relationship Ambidexterity (RA) and examining its antecedents and consequences. We propose that RA is a firm-level strategy in which a buyer is simultaneously committed to an existing supplier while actively pursuing diversification via new relations with potential suppliers. Thus, while organizational ambidexterity focuses on the simultaneous pursuit of existing and novel offerings, RA focuses on the simultaneous pursuit of existing and novel relationships. Our inquiry begins by integrating ambidexterity theory with insights gleaned from a qualitative study among nearly two dozen buyers to form a set of hypotheses. We then test these hypotheses via two survey studies (i.e., US and China) among nearly 550 respondents. Our findings reveal that RA is enhanced by buyer resources and experience and that supplier trust amplifies the effect of resources, while supplier market uncertainty weakens the effect of experience. Furthermore, our results also show that RA enhances firm performance, particularly when buyers have trusted suppliers and operate in uncertain supply markets.

Abstract This analysis aimed to examine the degree of decision-making involvement (DMI) of Hispanic and Latinx (H&L) dementia caregivers of people living with dementia (PLWD). Data was used from an ongoing study on the daily mental health experiences of H&L caregivers of PLWD, entitled “Nuestros Días” (Our Days). Analysis of variance was used to examine differences in caregiver involvement in everyday decisions, such as determining meals (Decision-Making Involvement Scale), based on H&L dementia caregiver age (e.g., 40-49, 50-59, etc.). A subset of 47 H&L dementia caregivers from the main study who completed the DMI scale were included in the analysis. The majority of the H&L caregivers identified as female (91.3%), with a mean age of 47 (SD = 17.4). Around half (48.6%) of the H&L caregivers were working full-time (30+ hours a week). H&L dementia caregivers reported moderate involvement (M = 22.9, SD = 7.1, Range 0-36) in DMI for the PLWD. Caregiver age was significantly associated with DMI (F(3, 40) = 3.08, p =.03). Post hoc comparisons using the Tukey HSD test indicated that the mean DMI for caregivers in the 60-69 age group was significantly higher than the mean DMI for caregivers in the 70+ age group (MD = 11.05, SD = 2.93, p =.027). Age may influence H&L caregiver DMI for the PLWD. Further studies are needed to identify additional factors (e.g., contextual, cultural, contextual) associated with H&L dementia caregiver’s DMI for the PLWD and potential associations with caregiver stress and burden.

In recent decades, multinational enterprises (MNEs) have increasingly harnessed local knowledge through various customer involvement practices implemented by their foreign subsidiaries. Our study, using a multi-informant survey of 230 MNE subsidiaries in China, explores how these subsidiaries manage customer involvement in new product development (NPD). We specifically focus on two practices: using customers as an information source (CIS) or as a co-developer (CIC). We posit that the two types of customer involvement have distinct effects on a subsidiary's innovation capability, which in turn impacts two critical NPD outcomes: innovativeness and speed to market. Moreover, we suggest that the roles that customers play in CIS and CIC, as well as their contribution to the subsidiary's innovation capability, depend on whether the specific knowledge is derived from the parent headquarters or local partners. Our findings reveal that technological knowledge transfer from the parent headquarters enhances CIS's effect on innovation capability, yet diminishes that of CIC. In contrast, knowledge sharing from local partners exerts the opposite effects. By elucidating the underlying mechanisms and contingencies, our study fosters a deeper understanding of customer involvement in NPD and provides insightful guidance for MNEs seeking to leverage local knowledge for successful innovations in foreign markets.

BackgroundThe landscape of substance use behavior among young adults has observed rapid changes over time. Intensive longitudinal designs are ideal for examining and intervening in substance use behavior in real time but rely on high participant compliance in the study protocol, representing a significant challenge for researchers. ObjectiveThis study aimed to evaluate the effect of including a personalized data dashboard (DD) in a text-based survey prompt on study compliance outcomes among college students participating in a 21-day ecological momentary assessment (EMA) study. MethodsParticipants (N=91; 61/91, 67% female and 84/91, 92% White) were college students who engaged in recent alcohol and cannabis use. Participants were randomized to either complete a 21-day EMA protocol with 4 prompts/d (EMA Group) or complete the same EMA protocol with 1 personalized message and a DD indicating multiple metrics of progress in the study, delivered at 1 randomly selected prompt/d (EMA+DD Group) via a microrandomized design. Study compliance, completion time, self-reported protocol experiences, and qualitative responses were assessed for both groups. ResultsLevels of compliance were similar across groups. Participants in the EMA+DD Group had overall faster completion times, with significant week-level differences in weeks 2 and 3 of the study (P=.047 and P=.03, respectively). Although nonsignificant, small-to-medium effect sizes were observed when comparing the groups in terms of compensation level (P=.08; Cohen w=0.19) and perceived burden (P=.09; Cohen d=-0.36). Qualitative findings revealed that EMA+DD participants perceived that seeing their progress facilitated engagement. Within the EMA+DD Group, providing a DD at the moment level did not significantly impact participants’ likelihood of completing the EMA or completion time at that particular prompt (all P>.05), with the exception of the first prompt of the day (P=.01 and P<.001). ConclusionsProviding a DD may be useful to increase engagement, particularly for researchers aiming to assess health behaviors shortly after a survey prompt is deployed to participants’ mobile devices. International Registered Report Identifier (IRRID)RR2-10.2196/57664

Reduced functional magnetic resonance imaging (fMRI)-complexity in Alzheimer's disease (AD) progression has been demonstrated and found to be associated with tauopathy and cognition. However, association of fMRI-complexity with amyloid and influence of genetic risk (APOEɛ4) remain unknown. Here we investigate the association between fMRI-complexity, tau-PET, and amyloid-PET as well as influence of APOE genotype using multivariate generalized linear models. We show that fMRI-complexity has a strong association with tau but not amyloid deposition and that the presence of an APOEɛ4 allele enhances this effect. Thus fMRI-complexity provides a surrogate marker of impaired brain functionality in AD progression.

INTRODUCTION:Behavioral and psychological symptoms in dementia (BPSD) are dynamic phenomena with a high amount of intraindividual variability. We applied a multilevel framework to identify subsyndromes (between-person factors) that represent clinically relevant profiles of BPSD and identify symptom clusters (within-person factors) that represent contextually driven daily symptom experiences. METHODS:This study used an intensive longitudinal design in which 68 co-residing family caregivers to persons living with dementia were recruited to proxy report on their care recipient's daily symptom experiences of 23 different BPSD for eight consecutive days (n = 443 diaries). A multilevel exploratory/confirmatory factor analysis was used to account for nested data and separate within-person variances from between-level factor estimates. RESULTS:Exploratory factor analysis identified a 4-between 3-within factor structure based on fit statistics and clinical interpretability. DISCUSSION:This study offers major methodological and conceptual advancements for management of BPSD within Alzheimer's disease and related dementias by introducing two related but distinct concepts of subsyndromes and symptom clusters. HIGHLIGHTS:Because behavioral and psychological symptoms of dementia (BPSD) are dynamic temporal phenomenon, this introduces measurement error into aggregate group-level estimates when trying to create subsyndromes. We propose a multilevel analysis to provide a more valid and reliable estimation by separating out variance due to within-person daily fluctuations. Using a multilevel exploratory factor analysis with intensive longitudinal data, we identified distinct and meaningful groups of BPSD. The four factors at the between-person level represented subsyndromes that are based on how BPSD co-occurred among persons with Alzheimer's disease (AD). These subsyndromes are clinically relevant because they share features of established clinical phenomena and may have similar neurobiological etiologies. We also found three within-person factors representing distinct symptom clusters. They are based on how BPSD clustered together on a given day for an individual with AD and related dementias. These clusters may have shared environmental triggers.

Abstract The objective of this study was to examine coping strategies employed by Hispanic and Latinx (H&L) family caregivers (FCGs) of people living with dementia (PLWD) and associations with sociodemographic characteristics. A nonparametric analysis was used to analyze data from an ongoing study on the daily experiences of H&L dementia caregivers, entitled Nuestros Días. A total of 52 H&L FCGs were assessed using Brief-COPE. Most H&L FCGs identified as female (92.2%), with a mean age of 56 years (SD = 8.6), were adult children caring for biological parent (59.6%), and provided care for 3 or more years (61.5%). Most PLWD were female (68%) with a mean age of 78 years (SD= 8.6). Overall coping strategies most frequently utilized by H&L FCGs included acceptance (M= 3.14, SD= 1), religion (M= 2.98, SD= 1), positive reframing (M=2.91, SD=0.9), and planning (M=2.8, SD=1). Conversely, substance use (M=1.13, SD=0.3), behavioral disengagement (M=1.39, SD=0.72), denial (M=1.44, SD=0.8), and humor (M=1.47, SD=0.8) were the least utilized by H&L FCGs. The use of acceptance as a coping strategy was found to have a significant association with employment status with working caregivers more frequently endorsing acceptance as a coping strategy (p=.04; Cramer’s V=.409). These findings suggest that H&L caregivers utilize specific coping strategies and that sociodemographic factors, such as employment, may influence coping strategies use d. Additional studies are needed to examine the relationship between additional contextual factors (e.g., caregiving-related stressors and burden) and types of coping strategies used by H&L FCGs to inform ecologically valid and cultural interventions.

This research employs upper echelons theory to examine whether executive hubris augments a firm's customer acquisition while concurrently impairing its customer retention. Drawing on an information processing perspective, we suggest that the influence of executive hubris on customer acquisition and retention is shaped by executives' selective attention to information. This influence is observed to amplify in the presence of market uncertainty and recede with an increase in firm product market experience. We validate these predictions through a mixed-method research design. Study 1 includes an original survey that gathers multi-informant responses, coupled with the subsequent year's ROA data, to assess the role of hubris and the moderating effects of market uncertainty and firm product market experience. Study 2 consists of two experimental studies that manipulate executive hubris to test its causal influence on customer acquisition and retention. Moreover, we utilize an eye-tracking method to examine whether the proposed influence is driven by executives' selective information processing. Our findings enhance the existing literature on upper echelons and marketing strategy, providing practical insights to align executive traits with firms' marketing objectives.

Background Ecological momentary assessments (EMA) are ideal for capturing the dynamic nature of young adult substance use behavior in daily life and identifying contextual risk factors that signal higher-risk episodes. These methods could provide a signal to trigger real-time intervention delivery. Study compliance and engagement are common barriers to participation but may be improved by personalizing messages. This study compares compliance outcomes between one group of young adults receiving standard (generic) prompts at each assessment and another group that received additional personalization and an updated data dashboard (DD) showing study progress to date at 1 randomly selected prompt per day. Objective The primary objectives are to (1) develop a real-time DD for giving participants personalized updates on their progress in the study and (2) examine its preliminary overall effects on study compliance and experiences. Secondary objectives are to identify person-, day-, and moment-level characteristics associated with study compliance and person-level characteristics associated with perceived usefulness of the DD. Methods This is a protocol for Project ENGAGE, a 2-arm randomized controlled trial. Arm 1 (EMA group) is engaged in a standard EMA protocol, and arm 2 (EMA+DD group) is engaged in the same study but with additional personalization and feedback. Inclusion criteria are (1) previous participation in a recent college student survey about health behavior and mental health who indicated willingness to participate in future research studies and (2) indicated past-month alcohol use; lifetime marijuana, hashish, or Delta-8-tetrahydrocannabinol (THC) use; or some combination of these on that survey. All participants in this study completed a baseline survey; EMA at 11 AM, 2 PM, 5 PM, and 8 PM each day for 21 days; and an exit survey. Participants in arm 2 engaged in a microrandomized trial, receiving a personalized DD at 1 randomly selected prompt per day. Primary outcomes include whether a survey was completed, time to complete a survey, and subjective experiences in the study. Primary analyses will compare groups on overall study compliance and, for arm 2, use marginal models to assess the momentary effect of receiving 1 updated DD per day. Results Approval was granted by the university’s institutional review board on February 8, 2023. Recruitment via direct email occurred on March 30 and April 6, 2023; data collection was completed by April 29, 2023. A total of 91 individuals participated in the study. Results have been accepted for publication in JMIR Formative Research. Conclusions Results from the evaluation of this study will indicate whether providing (at randomly selected prompts) real-time, personalized feedback on a participant’s progress in an EMA study improves study compliance. Overall, this study will inform whether a simple, automated DD presenting study compliance and incentives earned to date may improve young adults’ compliance and engagement in intensive longitudinal studies. International Registered Report Identifier (IRRID) DERR1-10.2196/57664

Abstract Family members providing informal care to individuals living with Alzheimer’s disease and related dementias (ADRDs) have an increased risk of poor mental and cognitive health. Social connection has been proposed as an intervention target to support the health and well-being of ADRD caregivers; however, little is known about daily variation in social connection, contextual factors that impact social connection, and its association with caregiver mental health experiences. Thus, the purpose of this study was to examine the relationship between role captivity and daily social isolation (i.e., lack of social connection) among dementia caregivers, as well as associations between social isolation and depression and anxiety-related symptoms. A sample of community-dwelling ADRD caregivers (N=30) completed a baseline survey followed by 14 days of daily diaries (n=323 data points). Participants were asked about role captivity, social isolation, and daily depression and anxiety-related symptoms. Data were analyzed using mixed-level modeling. Role captivity reported at baseline was significantly associated with daily social isolation (B=0.82, 95% CI [0.68, 0.96], p <0.001). Further, daily social isolation was significantly associated with both depression (B=0.69, 95% CI [0.61, 0.77], p <0.001) and anxiety (B=0.55, 95% CI [0.48, 0.62], p <0.001) related symptoms reported on a given day. The findings from this study contribute knowledge on ecologically valid interventions that target daily experiences of social isolation and support the mental health of dementia caregivers. Such interventions are critically important given the proposed links between mental health, social isolation, and cognitive health in later life.

Abstract Family dementia caregivers experience increased burden and stress that can negatively impact emotion regulation and overall well-being. Further, a lack of social connection may contribute to emotion dysregulation among dementia caregivers. The purpose of this study was to examine relationships between daily caregiving stress, social isolation, emotion regulation, and depression in a sample of community-dwelling dementia caregivers. Participants (N=30) completed a baseline survey and a series of daily diaries over a 14-day period (n=323 data points) that asked about day-to-day caregiving experiences. Data were analyzed using mixed-level modeling. Higher than average stress related to behavioral symptoms of dementia was associated with an increase in the odds of experiencing feelings of losing control over one’s emotions (OR=1.08, 95% CI [1.01, 1.15], p<0.05). Similarly, higher perceived social isolation on a given day was associated with an increase in the daily odds of feeling a loss of control over one’s emotions (OR=1.28, 95% CI [1.00, 1.27], p<0.05). Further, feeling a loss of control over one’s emotions was associated with an increase in the daily odds of depression-related symptoms (OR=3.39, 95% CI [1.43, 8.08], p<0.01). These findings highlight the importance of addressing the emotional well-being of family dementia caregivers, particularly in the context of stress related to behavioral symptoms of dementia and social isolation. Caregiver support programs and interventions that focus on improving emotion regulation and reducing social isolation may help promote the mental health and well-being of dementia caregivers.

Neurodegenerative mechanisms affect the brain through a variety of processes that are reflected as changes in brain structure and physiology. Although some biomarkers for these changes are well established, others are at different stages of development for use in clinical trials. One of the most challenging biomarkers to harmonize for clinical trials is cerebral blood flow (CBF). There are several magnetic resonance imaging (MRI) methods for quantifying CBF without the use of contrast agents, in particular arterial spin labeling (ASL) perfusion MRI, which has been increasingly applied in clinical trials. In this review, we present ASL MRI techniques, including strategies for implementation across multiple imaging centers, levels of confidence in assessing disease progression and treatment effects, and details of image analysis.

First described in 2012, the glymphatic system is responsible for maintaining homeostasis within the central nervous system, including nutrient delivery, waste clearance, and consistency of the ionic microenvironment. It is comprised of glial cells and barrier systems that modulate neurofluid production, circulation, and exchange. Experimental interrogation of neurofluid dynamics is restricted to ex vivo and in vitro studies in animals and humans, therefore diagnostic imaging plays an important role in minimally invasive evaluation. This review article will synthesize current knowledge and theories regarding neurofluid circulation and implications for neuroimaging. First, we will discuss the anatomy of the neurogliovascular unit, including paravascular and perivascular pathways of fluid exchange. In addition, we will summarize the structure and function of barrier systems including the blood–brain, blood–cerebrospinal fluid, and brain–cerebrospinal fluid barriers. Next, we will mention physiologic factors that yield normal variations in neurofluid circulation, and how various disease pathologies can disrupt glymphatic drainage pathways. Lastly, we will cover the spectrum of diagnostic imaging and interventional techniques with relevance to glymphatic structure, flow, and function. We conclude by highlighting current barriers and future directions for translational imaging and applications to neurologic disorders.

The automated segmentation and analysis of small vessels from in vivo imaging data is an important task for many clinical applications. While current filtering and learning methods have achieved good performance on the segmentation of large vessels, they are sub-optimal for small vessel detection due to their apparent geometric irregularity and weak contrast given the relatively limited resolution of existing imaging techniques. In addition, for supervised learning approaches, the acquisition of accurate pixel-wise annotations in these small vascular regions heavily relies on skilled experts. In this work, we propose a novel self-supervised network to tackle these challenges and improve the detection of small vessels from 3D imaging data. First, our network maximizes a novel shape-aware flux-based measure to enhance the estimation of small vasculature with non-circular and irregular appearances. Then, we develop novel local contrast guided attention(LCA) and enhancement(LCE) modules to boost the vesselness responses of vascular regions of low contrast. In our experiments, we compare with four filtering-based methods and a state-of-the-art self-supervised deep learning method in multiple 3D datasets to demonstrate that our method achieves significant improvement in all datasets. Further analysis and ablation studies have also been performed to assess the contributions of various modules to the improved performance in 3D small vessel segmentation. Our code is available at https://github.com/dengchihwei/LCNetVesselSeg .

Behavioral and psychological symptoms in dementia (BPSD) are dynamic phenomena with a high amount of intraindividual variability. Many studies have used single-level factor analysis approaches to identify subsyndromes of BPSD based upon meaningful groupings of co-occurring symptoms yet, proposed subsyndromes have not been successfully replicated and lack stability over time. This may be due to measurement issues which do not account for dependencies in the data and create temporal misalignment. We applied an innovative multi-level framework to overcome limitations of prior research to identify subsyndromes of BPSD. This study used an intensive longitudinal design in which co-residing family caregivers to persons living with dementia in the community were recruited to proxy-report on their care recipient’s daily symptom experiences of 23 different BPSD for 8 consecutive days. A multi-level exploratory/confirmatory factory analysis was utilized to account for nested data and separate within-person variances from between-level factor estimates. Family caregivers (N = 70) were on average African American (54%) females (69%) most often caring for a parent with dementia (62%) average 74 years old requiring assistance with 4.5/7 activities of daily living. Data were provided on 79% of sampled days (n = 443 diaries). Exploratory factor analysis identified a 4-between 3-within factor structure based on fit statistics and clinical interpretability. The between-level subsyndromes include wandering/aggression/care resistance (F1), affective/apathy/psychosis/vocalizations (F2), cognitive/ lability/ euphoria/ impulsivity/ compulsions (F3), and hallucinations/uncooperative (F4). Reliability estimates were high: 0.88 (F1), 0.91 (F2), 0.83 (F3), and 0.79 (F4). The between-level factor structure identified through the multilevel factor analysis framework provide a more valid and reliable estimation of clinical subsyndromes within a population by separating out the variance due to within-person daily fluctuations. At the between-level, hallucinations was the only BPSD to cross-load, which may indicate they are a byproduct of unmanaged depression in the affective/psychosis factor and their own unique subsyndrome. Support for the between-level subsyndromes can be found in studies on shared neurobiological mechanisms of BPSD. The within-level factors are similar to structures found in a recent systematic review. We argue these within-level factors are more representative of symptom clusters, as they are driven by fluctuating contextual factors.

INTRODUCTION: We investigated whether retinal capillary perfusion is a biomarker of cerebral small vessel disease and impaired cognition among Black Americans, an understudied group at higher risk for dementia. METHODS: We enrolled 96 Black Americans without known cognitive impairment. Four retinal perfusion measures were derived using optical coherence tomography angiography. Neurocognitive assessment and brainmagnetic resonance imaging (MRI) were performed. Multiple linear regression analyses were performed. RESULTS: Lower retinal capillary perfusion was correlated with worse Oral Symbol Digit Test (P<= 0.005) and Fluid CognitionComposite scores (P<= 0.02), but not with the Crystallized Cognition Composite score (P>= 0.41). Lower retinal perfusion was also correlatedwith higher free water and peakwidth of skeletonizedmean diffusivity, and lower fractional anisotropy (all P < 0.05) on MRI (N = 35). DISCUSSION: Lower retinal capillary perfusion is associated with worse information processing, fluid cognition, andMRI biomarkers of cerebral small vessel disease, but is not related to crystallized cognition.