We examine the question, “What is the effect of internationalization on the CSR performance of firms in service sectors compared to non-service sectors?”. Drawing on a stakeholder and institutional theory-based perspective, we hypothesize: (1) in non-service firms, their social performance increases steadily with increasing internationalization, while the relationship between internationalization and their environmental performance follows an S-shape pattern; (2) in service firms, internationalization has little effect on both social and environmental performance at low to medium levels of internationalization but strong positive effects at high levels of internationalization. We tested our hypotheses with panel data on 4,693 publicly listed MNEs in 41 economies from 2002 to 2021. The results supported our hypotheses.

BACKGROUND:Greater understanding of the impact of skeletal maturity on outcomes is needed to guide operative treatment of diaphyseal forearm fractures in children and adolescents. The purpose of this study was to compare the complications and outcomes of pediatric diaphyseal forearm fractures treated with intramedullary nailing (IMN) or open reduction internal fixation (ORIF) and to identify a radiographic marker of skeletal maturity that will aid in selecting between treatment options. METHODS:A retrospective review of patients aged 10 to 16 years treated operatively for diaphyseal forearm fractures was performed. Markers of skeletal maturity including the olecranon apophysis score, the presence of the thumb adductor sesamoid, and radial epiphyseal capping. Complications were graded with the modified Clavien-Dindo system. Outcomes were scored based on final postoperative range of motion combined with complication grade. RESULTS:A total of 260 patients were included: 163 treated with IMN, 97 treated with ORIF, mean age 12.7 years, 72% male. Among closed forearm fractures treated with IMN, open reduction was required in 45% (53/118). Patients treated with IMN had a higher complication rate than ORIF (27.0% vs. 9.3%, P <0.05), including when stratified by age. Complication rates were not impacted by greater skeletal maturity as indicated by the presence of thumb sesamoid or radial epiphyseal capping. There was no significant difference in outcomes between the ORIF and IMN groups. More skeletally immature patients, as identified by a lack of either the thumb adductor sesamoid or radial epiphyseal capping, had significantly better outcomes with ORIF than patients with greater maturity. CONCLUSIONS:Across all age groups and levels of skeletal maturity, ORIF had a significantly lower rates of complications compared with IMN with equivalent outcomes. More skeletally immature patients had significantly better outcomes with ORIF treatment when compared with older patients. The thumb adductor sesamoid, radial epiphyseal capping, and the olecranon apophysis score did not provide useful information to select between ORIF over IMN in this population. LEVEL OF EVIDENCE:Level III-retrospective comparative study.

PurposeThis paper aims to examine the question, "How do firm-level, home-country and host-country environmental performance (EP) affect the outward foreign direct investment (OFDI) of Chinese multinational enterprises (MNEs)?" Design/methodology/approachThe authors examine the relationships between EP and OFDI propensity and between EP and OFDI intensity using a sample of 359 Chinese firms in industries with a significant environmental footprint between 2009 and 2019 (2,002 firm-year observations) and a Heckman two-stage model. FindingsThis study shows that the propensity for OFDI by Chinese MNEs is significantly and positively related to the firm's prior EP and the country-level EP of China. However, the amount of FDI invested is significantly and positively related to the firm's prior EP and negatively related to the EP of the host country. Research limitations/implicationsThe findings suggest that FDI in a country by an MNE is determined by a combination of firm-level EP, home-country EP and host-country EP. This study finds that the decision to undertake FDI (propensity) and the decision about how much to invest (intensity) are determined by different factors. The propensity for FDI is determined by the home-country EP and firm-level EP. However, the intensity of FDI is determined by a combination of the host country EP and firm-level EP. A limitation is that this study only examines MNEs in China, so the findings may not apply to other countries. Originality/valueThis paper shows that MNEs' EP is positively related to the propensity and intensity of their OFDI decisions. However, this paper shows that the home-country and host-country EP may also play an important role in determining the propensity or intensity of OFDI.

Compared to studies of ethnic identity development in adolescence, fewer investigations have examined the development of ethnic identity during middle childhood, a developmental period of dynamic social and cognitive changes that have direct implications for social identity and group membership. Moreover, research on the developmental processes of Asian American youth has also primarily utilized cross-group comparisons, while neglecting consideration of variations in acculturation, socioeconomic status, and other sociodemographic characteristics within Asian American ethnic groups. Using a socioeconomically- and acculturatively-diverse sample of Chinese immigrant families in the United States (N = 169; 49.1% girls; M = 9.16 years; SD = 1.05), the present study examined how parents' ERS practices varied by parents' socioeconomic status, education, and cultural orientations, then tested associations between parents' ERS and children's self-reported ethnic centrality and ethnic regard. More highly-educated Chinese American immigrant parents reported more frequent cultural socialization and more acculturated parents reported more preparation of their children for racial and ethnic bias. Consistent with hypotheses, parents' cultural socialization was positively associated with children's self-reported ethnic centrality and positive regard. Results highlight the roles of social status and acculturation in Chinese immigrant parents' ERS, and point to middle childhood as a key developmental window for ethnic identity socialization and development in immigrant families.

The environmental performance (EP) of multinational enterprises (MNEs) has attracted increasing attention amid rising concerns over environmental problems such as climate change. However, questions remain about the relationship between the internationalization of MNEs and their EP. In this paper, we show that the relationship varies depending on the home country's economic development level. For MNEs from an advanced economy, there is a U-shaped relationship between the level of internationalization and EP of MNEs such that there is a negative relationship at low levels of internationalization but a positive relationship at high levels of internationalization. For MNEs from a less advanced economy, there is an inverted U-shaped relationship such that there is a positive relationship at low levels of internationalization but a negative relationship at high levels of internationalization.

Objectives: Dual plate fixation has been proposed as a solution to the high rates of reoperation secondary to operative management of displaced midshaft clavicle fractures. Previous studies have recommended dual plating for patients specifically at higher risk of reoperation. Therefore, the purpose of this study was to compare reoperation rates among patients who underwent single superior, single anterior, and dual plating while adjusting for risk factors including age, smoking status, and high-risk fracture morphology. We hypothesized lower rates of reoperation among patients who underwent dual plate fixation. Methods: This was a retrospective cohort study of all patients who presented with a midshaft clavicle fracture and underwent ORIF between 2007 and 2021 to our trauma/sports divisions. Patient demographics, fracture pattern, plating technique, postoperative complications, date of surgery, reoperation status, date of last follow up, and date of reoperation were documented. We report hazard ratio (HR) estimates using a multivariate multilevel mixed-effects parametric survival model, which accounted for patients with multiple reoperations and adjusted for covariates. Results: A cohort of 395 patients (mean age 38.5±14.4 years, 81.7% male) were identified with average follow-up of 5.5±8.6 months. There were 77 z-type, 157 transverse, and 161 oblique fractures. With regards to plating technique, 152 underwent single superior plating, 149 experienced single anterior plating, and 94 had dual plating. After initial operation, there were 8 total instances of non-union (2.0%), 0 in the dual plating cohort (0%), 4 in the superior plating cohort (2.6%), and 4 in the anterior plating cohort (2.7%) (p=0.35). A total of 28 reoperations took place among 19 patients (4.8%), with 6 patients experiencing multiple reoperations. Single plating with superior placement revealed the highest reoperation rate of 0.26 per person-years, followed by anterior placement with 0.17 per person-years, and finally dual plating with 0.02 per person-years ( Figure 1). Patients who underwent single plating (either anterior or superior placement) revealed a greater rate of reoperation when compared to patients who underwent dual plating (HR: 8.3, p=0.045). Patients who underwent single plating with superior placement had a rate of reoperation ten- times greater than patients who underwent dual plating (HR:10.1, p=0.03). Patients who underwent single plating with anterior placement had a rate of reoperation six-times greater than patients who underwent dual plating (HR: 6.4, p=0.09), although not statistically significant. Conclusions: Dual plate fixation of displaced midshaft clavicle fractures has an eight-fold lower risk of reoperation compared to single plate fixation, while accounting for age, smoking, and high-risk fracture morphology. More specifically, dual plating had lower rates of reoperation than both single plating with anterior and superior placement. When operative management is indicated for a midshaft clavicle fracture, dual plating may be an excellent treatment alternative in patients at high risk for reoperation.

Background:Prior studies have highlighted lower rates of reoperation if fixation of a displaced midshaft clavicle fracture is performed with dual plating (DP) compared with single plating (SP). Despite higher initial costs associated with the DP construct, the observed reduction in secondary surgeries compared with the SP construct may make it a more cost-effective treatment option. The objective of this study was to assess the cost-effectiveness of DP compared with SP in patients with operatively indicated displaced midshaft clavicle fractures.Methods:We developed a decision tree to model the occurrence of postoperative complications (acute hardware complications, wound healing issues, deep infection, nonunion, and symptomatic hardware) associated with secondary surgeries. Complication-specific risk estimates were pooled for both plating techniques using the available literature. The time horizon was 2 years, and the analysis was conducted from the health-care payer's perspective. The costs were estimated using direct medical costs, and the benefits were measured in quality-adjusted life-years (QALYs). We assumed that DP would be $300 more expensive than SP initially. We conducted probabilistic and 1-way sensitivity analyses.Results:The model predicted reoperation in 6% of patients in the DP arm compared with 14% of patients in the SP arm. In the base case analysis, DP increased QALYs by 0.005 and costs by $71 per patient, yielding an incremental cost-effectiveness ratio (ICER) of $13,242 per QALY gained. The sensitivity analysis demonstrated that the cost-effectiveness of DP was driven by the cost of the index surgery, risk of symptomatic hardware, and nonunion complications with SP and DP. At a willingness-to-pay threshold of $100,000 per QALY gained, 95% of simulations suggested that DP was cost-effective compared with SP.Conclusions:When indicated, operative management of displaced midshaft clavicle fractures using DP was found to be cost-effective compared with SP. Despite its higher initial hardware costs, DP fixation appears to offset its added costs with greater health utility via lower rates of reoperation and improved patient quality of life.Level of Evidence:Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.

Objectives: Many studies have highlighted lower rates of secondary operations with dual-plating compared to single-plating. Despite higher upfront costs associated with the dual-plating construct, the observed reduction in secondary operations compared to single-plating may make it a more cost- effective treatment option. The objective of this study was to assess the cost-effectiveness of dual-plate fixation compared to single-plate fixation in patients with operatively indicated displaced midshaft clavicle fractures. We hypothesized dual-plating would be a more cost-effective surgical option than single-plating, given its lower rates of postoperative complications. Methods: We developed a decision tree to model the occurrence of postoperative complications (hardware issues, wound healing issues, deep infection, non-union, and symptomatic hardware) associated with secondary surgeries. Complication-specific risk estimates were summarized for both plating techniques. The time horizon was two years, and the analysis was conducted from the healthcare payer’s perspective. The costs included direct medical costs, while the benefits were measured in quality-adjusted life-years (QALYs). We assumed that dual-plating would be $300 more expensive than single-plating upfront. We conducted probabilistic and one-way sensitivity analyses. Results: The model predicted reoperation in 6% of patients in the dual-plating arm compared to 14% of patients in the single-plating arm. In the base case analysis, the dual-plating increased QALYs by 0.007 and costs by $70 per patient yielding an incremental cost-effectiveness ratio (ICER) of $10,600 per QALY gained. The sensitivity analysis demonstrated that the cost-effectiveness of dual plating is driven by the cost of index surgery, risk of non-union, and symptomatic hardware complications in single- and dual- plating. At a willingness to pay threshold of $100,000 per QALY gained, 92% of simulations suggested dual-plating is cost-effective compared to single-plating (Figure 1). Conclusions: When indicated, operative management of displaced midshaft clavicle fractures with dual- plating is cost-effective compared to single-plating. Despite its higher initial upfront hardware costs, dual plating appears to offset added costs via lower rates of reoperations and improved patient quality of life.

The United Nations (UN) Sustainable Development Goal (SDG), Goal 16: Peace, justice, and strong institutions can drive positive environmental, social, and economic changes in sub-Saharan Africa while transforming informal sectors. Peer-reviewed English language publications on Google Scholar were explored based on a systematic literature review using loop analysis modelling, mapping out currently underdeveloped gaps such as the intersection of circular economy and the ASM sector in African countries. By identifying the significance of circular economy adoption within the realm of sub-Saharan Africa, which is rightly rich in quarried natural resources, this chapter laid the groundwork for the significance of strong institutions for the adoption of a circular approach and environmental management. Thereby, the problem of mining waste was highlighted, and the state of institutions was identified as the main facilitator of a circular economy for the ASM sector. Countries with institutional voids, weak policies, and marginal international collaboration are instructed by this chapter to carry out formalization that can enable stakeholder participation as well as institutional and policy changes, which support targets and indicators of SDG16. Given the blurred margins of functioning systems in emerging economies such as the case of developing sub-Saharan African countries, often the indicators for implementation, monitoring, and distribution data may be inadequate. Therefore, stronger regard for further research is encouraged to target more refined versions of clearer circular economy approaches, which would offer clearer and supportive adoption guidelines, i.e., easier to implement in poor or informal communities. The chapter is aligned with the need of formalizing the ASM sector toward efficiency and the decarbonization of the global economy at all levels of production, starting with the sourcing of raw materials – "mining."

Objectives: Optimal management of midshaft clavicle fractures remains controversial. This study assessed demographic factors, injury patterns, and surgical technique as potential predictors of complications following open reduction internal fixation (ORIF) of midshaft clavicle fractures. We hypothesize that smoking, diabetes, obesity, and fracture pattern would be risks factors for surgical complications. Methods: Consecutive patients who presented to a single tertiary institution who underwent ORIF of midshaft clavicle fractures were identified retrospectively from 2007-2019. Patients who were lost to follow-up or had a follow-up period of 12 weeks or less, were excluded from analyses. Of the 354 eligible patients, 223 (63%) completed at least 12 weeks of follow-up. Demographics, injury data, surgery characteristics, and postoperative complications were recorded. Postoperative complications were obtained via chart review and separated into major (reoperation) and minor (no reoperation) complications based on reoperation status. Chi-squared statistics, Fisher’s Exact test, and multivariate logistic regression were utilized with significance level set to p<0.05. Results: 223 patients (average 39.3 + 15.2 yo) were identified with average follow-up of 9.2 months Table 1 . Overall complication incidence was 21.5% (95% [CI], 16.3% to 27.5%), minor complication incidence was 15.2% (95% [CI], 10.8% to 20.6%), major complication incidence was 6.3% (95% [CI], 3.5% to 10.3%), and incidence of non-union was 1.8% (95% [CI], 0.5% to 4.5%). Major complications requiring reoperation revealed 4 cases of non-union (28.6%), 4 instances of symptomatic hardware (28.6%), 3 incidents of deep infections (21.4%), 1 instance of acromioclavicular joint dislocation (7.1%), and 1 incident of broken hardware (7.1%). Smoking status, obesity, and fracture morphology were significant prognostic factors for overall complication risk while diabetes was not. Results from a multivariate analysis demonstrated a 2.4- and 3.2-times greater risk of overall post-operative complications among smokers and obese patients, respectively (p=0.013 and p=0.004, respectively). After adjusting for BMI and smoking status, the risk of post-operative complications among patients with a transverse fracture was 2.26 times greater compared to a patient with an oblique fracture (p = 0.035). Regarding major complications, obese patients were 3.5-times more likely to require reoperative intervention. Moreover, after adjusting for obesity status, transverse and z-type fractures had an 8.9- and 22.7-times greater risk for reoperation, relative to patients with oblique fractures respectively (p=0.04 and p=0.006, respectively. Finally, there were no reported major complications among patients with dual plating, and nonunion occurred exclusively among patients with transverse fractures. Conclusions: Fracture pattern, obesity, and smoking status were significant predictors of postoperative complications. However, only fracture morphology, BMI, and surgical technique were significant predictors of reoperative risk. Transverse and z-type fractures may require increased vigilance, especially among obese patients, with potential consideration for dual plating in these circumstances. Table 1. Baseline Characteristics

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Accurate characterization of foot type can facilitate identification of patients at risk for different foot disorders and direct operative treatment. Foot type can be determined qualitatively with visual assessment and quantitatively using arch index (AI), calcaneal pitch (CP), Meary's angle (MA), and foot posture index (FPI). Agreement between various foot typing measures is unclear. The purpose of this study was to assess the agreement between different measurements of foot type. We hypothesized that quantitative measures would have better interrater reliability than qualitative measures, and that visual assessment of foot type would be strongly correlated with radiographic assessment. Methods: Bilateral foot photographs were acquired from 92 asymptomatic participants (50 men, 42 women, mean age of 43.3+- 18.6 years) to assess photographic arch type (PAT) and photographic foot posture (PFP). Hindfoot alignment and lateral radiographs were acquired of each foot to assess calcaneal pitch (CP), Meary's angle (MA), x-ray foot posture (XFP), and x-ray arch type (XAT). Photographs and radiographs were assessed by five reviewers in random order. Foot Posture Index (FPI) was determined through manual exam. Arch Index (AI) was measured on lightbox images. Interrater reliability was assessed using Intraclass Correlation Coefficient (ICC) for continuous variables and Kendall's W for categorical variables. Correlations between measures and sensitivity/specificity were assessed using calcaneal pitch as the reference standard with cavus feet >= 26 degrees and planus feet measuring <= 19 degrees. Results: Interrater reliability of XFP (W=0.522), XAT (W=0.676), PAT (W=0.831), PFP (W=0.612) ranged from strong to extremely strong. Interrater reliability of MA (ICC=0.711) and CP (ICC=0.804) were moderate and good. Correlations between foot arch measurements ranged from low to high (Table 1). Fair correlations were identified between foot posture measurements (r=0.356 to r=0.442). Overall, XAT had the greatest sensitivity and specificity for planus (0.68, 0.93) and normal feet (0.92, 0.62), and the greatest specificity for cavus feet (0.98). AI demonstrated the greatest sensitivity (0.47) for cavus feet. Compared to AI, photographs had superior sensitivity for identifying normal feet (0.73 vs. 0.43), the greatest sensitivity for identifying planus feet (0.54 vs. 0.06), and the greatest specificity for identifying cavus feet (0.95 vs. 0.71). Conclusion: Agreement between methods varied widely, suggesting that classification is dependent upon methodology and cutoff values selected. PAT had the highest interrater reliability, whereas correlation between XAT and PAT was moderate, suggesting that radiographs are needed to accurately assess the longitudinal arch.

The Music Export Business examines the workings of the fast-changing world of music industry exports The music industry is in a state of flux, resulting from changes in technology, markets, government policies and most recently the COVID-19 pandemic In analysing the ability of organisations to access international markets from inception, this book assesses global trends in music industry business models, including streaming and national export policies The book deploys author interviews with industry insiders including musicians, managers, record labels and government stakeholders, using case studies to highlight cultural and economic value creation in a global value chain Providing research-based insights into “export readiness” in the global music industry, this book reassesses the “born global” phenomenon, providing a unique and valuable resource for scholars and reflective practitioners interested in the evolving relationship between music industries, national economies, government policies and cultural identity © 2021 Stephen Chen, Shane Homan, Tracy Redhead and Richard Vella

This study investigates how the state influences the outward foreign direct investment (OFDI) of hybrid stateowned enterprises (SOEs) in China. Previous studies have provided conflicting arguments and empirical findings on the internationalization of SOEs, with some studies proposing a positive relationship between state ownership and OFDI, while others propose a negative relationship. In this paper, we argue that the mixed effects are due to different influences of different levels of state ownership and different types of political connections. We investigate our proposed hypotheses based on a sample of publicly listed hybrid Chinese SOEs between 2009 and 2016. We find an S-shaped relationship between state ownership and OFDI such that at low levels of state ownership, OFDI increases as state ownership increases; at medium levels of state ownership, OFDI decreases as state ownership increases; at high levels of state ownership, OFDI increases again as state ownership increases. We further find that executive-branch political connections between boards and top management teams of firms and the government have a negative effect on OFDI, while legislative-branch political connections have no significant effect on OFDI.

Introduction There is no consensus on the optimal treatment for acute ischemic stroke (AIS) large vessel occlusions (LVOs) or near-occlusions with underlying intracranial atherosclerotic stenosis (ICAS). We report the first American series using intra-arterial (IA) glycoprotein IIb/IIIa inhibitors (GPIs) as a stand-alone revascularization technique for ICAS presenting with large vessel ischemic syndromes. Methods Records at two centers of 140 patients presenting with AIS undergoing stroke intervention from January 2017 to June 2019 were retrospectively reviewed. Patients treated with IA GPIs were identified, and baseline factors, imaging, procedural characteristics, hospital course, and outcomes were collected. Six patients with ICAS underlying their acute symptomatic near occlusion or LVO were treated with IA GPI. Four near-occlusions were treated with IA GPI as the first-line therapy, while two LVOs were treated with IA GPI as an adjunct therapy to thrombectomy. Results The mean age was 61.3 years (range 36-79), presentation National Institute of Health Stroke Scale (NIHSS) was 10 (4-18), time from last seen well to treatment was 434.5 minutes (164-1290), and time from groin puncture to revascularization was 67.3 minutes (26-94). Three patients received intravenous (IV) tissue plasminogen activator (tPA), and all patients received an IA weight-based GPI infusion. Five patients had thrombolysis in cerebral ischemia (TICI) 3, and one patient had TICI 2b. The mean discharge NIHSS was 2.5 (0-8). The mean modified Rankin scale was 1.3 (range 0-4) at discharge and .8 at three months. No patients had a postprocedural symptomatic hemorrhage. Conclusion Our results highlight the utility of IA GPI administration as the first-line therapy for symptomatic ICAS near occlusions or as a rescue technique after failed thrombectomy for LVO patients suspected of underlying ICAS.

This paper examines the effects of organizational culture and national cultural distance between the headquarters and the subsidiary on the adaptation of management innovations in multinational enterprises (MNEs). Data on Total Quality Management (TQM) implementations were collected from a sample of 126 MNEs operating in Saudi Arabia and analyzed using fuzzy-set qualitative comparative analysis (fs-QCA). The findings highlight the critical roles that national and organizational cultures jointly play in the adaptation of a management innovation. The results suggest that different configurations of organizational culture and national cultural distance result in different levels of fidelity and extensiveness of the implementation when management innovations are transferred from MNE headquarters to subsidiaries. More specifically, our findings show that a greater level of national cultural distance is not necessarily a barrier to the transfer of a management innovation within an MNE and that the organizational culture can offset the effect of national cultural distance.