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Committed Business-to-Business (B2B) relationships are linked to sustainable business partnerships and greater profitability. As competition increases, suppliers must seek to differentiate by shifting the focus of their offerings from the product to services that contribute to create additional value to buyers. This empirical research proposes a product-service system (PSS) framework within the context of a relationship marketing (RM) model tested across a sample of United States (US) and Brazilian buyers. The study examines the impact of value-added benefits on building sustainable B2B partnerships. Results demonstrate that a firm’s servitization strategy that delivers both functional and social benefits fosters greater information exchange and mutual cooperation, which in turn contributes to increase buyer’s trust in, satisfaction with and commitment to a supplier. Despite some noted differences found in the commitment-building process, results show the importance that additional services have on promoting long-term, sustainable B2B partnerships across countries in distinct stages of economic development.

Objectives Space, an extreme environment, poses significant challenges to human physiology, including adverse effects on oral health (e.g., increase of periodontitis prevalence, caries, tooth sensitivity). This study investigates the differences in oral health routines and oral manifestations among analog astronauts during their daily routines and simulated space missions conducted on Earth. Materials and methods This research focused on scientist-astronaut candidates of the International Institute for Astronautical Sciences (IIAS) and analog astronauts from other institutions. The study used a cross-sectional methodology with a descriptive component. A total of 16 participants, comprising individuals aged between 21 and 55 years, were invited to complete an online questionnaire. A comparison was made between the subjects’ oral hygiene practices in everyday life (designated as Earth in this research) and their oral hygiene routines during their space analog missions. Results (i) Toothbrushing duration was mostly “1–3 minutes” ( n  = 13; 81.30% on Earth; n  = 11; 68.80% on a mission); (ii) “time spent” was the greatest difficulty in maintaining oral hygiene routine on a mission ( n  = 9; 53,6%); (iii) There were more experienced oral symptoms on Earth ( n  = 12; 75%) than on mission ( n  = 7; 43.80%); (iv) The most frequent frequency of oral check-ups was “> 12 months” ( n  = 6; 37,5%); (v) Oral health materials were scarce on the mission ( n  = 9; 56.30%); (vi) For the majority, personal oral hygiene was classified as “good” ( n  = 9; 56.30% on Earth; n  = 7; 43.80% on the mission). Conclusion and Clinical relevance This research contributes to increasing knowledge of oral hygiene measures in extreme environments, but further research is needed as this topic remains relatively understudied. This study represents an initial contribution to oral health in analog space missions, aiming to propose guidelines for future missions, including deep space missions and expeditions to extreme environments.

This study extends research on humor effectiveness to videos intended for social media engagement. A survey and content analysis of 2,911 videos revealed an attitude favorability toward humor over serious entertainment, especially when the message is intended for goods classified as low involvement and emotionally motivated. The study also suggests, however, that humor may dissuade social media participants from imparting comments. Although examination of structural characteristics suggests no significant differences in the performance of humor types suggested in Speck's (1991) taxonomy, results showed that content is more favorably received when humor dominates than when humor is subordinate to message information.

The research examines the suitability of relationship marketing paradigms to emerging markets (EMs) through the lens of communication, relationship benefits and commitment. Using the U.S. as a developed nation sample and Brazil as a proxy for EM countries like the BRIC nations, a B2B buyer-supplier commitment-building model is conceptualized and tested for context-specific boundaries. The study compares communication behaviors and relationship benefits along functional, psychological and social dimensions to discern the evaluation process and governance mechanisms influenced by an EM buyer's institutional environment. Results showed that buyers from relation-based EMs like Brazil base their relationship commitment more on the psychological attributes of the partnership, while a buyer's commitment-building process in rule-based, developed nations like the US is largely influenced by functional attributes.

Most patients with irritable bowel syndrome (IBS) are managed in primary care. When first-line therapies for IBS are ineffective, the UK National Institute for Health and Care Excellence guideline suggests considering low- dose tricyclic antidepressants as second-line treatment, but their effectiveness in primary care is unknown, and they are infrequently prescribed in this setting. This randomised, double-blind, placebo-controlled trial (Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment [ATLANTIS]) was conducted at 55 general practices in England. Eligible participants were aged 18 years or older, with Rome IV IBS of any subtype, and ongoing symptoms (IBS Severity Scoring System [IBS-SSS] score ≥75 points) despite dietary changes and first-line therapies, a normal full blood count and C-reactive protein, negative coeliac serology, and no evidence of suicidal ideation. Participants were randomly assigned (1:1) to low-dose oral amitriptyline (10 mg once daily) or placebo for 6 months, with dose titration over 3 weeks (up to 30 mg once daily), according to symptoms and tolerability. Participants, their general practitioners, investigators, and the analysis team were all masked to allocation throughout the trial. The primary outcome was the IBS-SSS score at 6 months. Effectiveness analyses were according to intention-to-treat; safety analyses were on all participants who took at least one dose of the trial medication. This trial is registered with the ISRCTN Registry (ISRCTN48075063) and is closed to new participants. Between Oct 18, 2019, and April 11, 2022, 463 participants (mean age 48·5 years [SD 16·1], 315 [68%] female to 148 [32%] male) were randomly allocated to receive low-dose amitriptyline (232) or placebo (231). Intention-to-treat analysis of the primary outcome showed a significant difference in favour of low-dose amitriptyline in IBS-SSS score between groups at 6 months (–27·0, 95% CI –46·9 to –7·10; p=0·0079). 46 (20%) participants discontinued low-dose amitriptyline (30 [13%] due to adverse events), and 59 (26%) discontinued placebo (20 [9%] due to adverse events) before 6 months. There were five serious adverse reactions (two in the amitriptyline group and three in the placebo group), and five serious adverse events unrelated to trial medication. To our knowledge, this is the largest trial of a tricyclic antidepressant in IBS ever conducted. Titrated low-dose amitriptyline was superior to placebo as a second-line treatment for IBS in primary care across multiple outcomes, and was safe and well tolerated. General practitioners should offer low-dose amitriptyline to patients with IBS whose symptoms do not improve with first-line therapies, with appropriate support to guide patient-led dose titration, such as the self-titration document developed for this trial. National Institute for Health and Care Research Health Technology Assessment Programme (grant reference 16/162/01).

Background Use of electronic methods to support informed consent (‘eConsent’) is increasingly popular in clinical research. This commentary reports the approach taken to implement electronic consent methods and subsequent experiences from a range of studies at the Leeds Clinical Trials Research Unit (CTRU), a large clinical trials unit in the UK. Main text We implemented a remote eConsent process using the REDCap platform. The process can be used in trials of investigational medicinal products and other intervention types or research designs. Our standard eConsent system focuses on documenting informed consent, with other aspects of consent (e.g. providing information to potential participants and a recruiter discussing the study with each potential participant) occurring outside the system, though trial teams can use electronic methods for these activities where they have ethical approval. Our overall process includes a verbal consent step prior to confidential information being entered onto REDCap and an identity verification step in line with regulator guidance. We considered the regulatory requirements around the system’s generation of source documents, how to ensure data protection standards were upheld and how to monitor informed consent within the system. We present four eConsent case studies from the CTRU: two randomised clinical trials and two other health research studies. These illustrate the ways eConsent can be implemented, and lessons learned, including about differences in uptake. Conclusions We successfully implemented a remote eConsent process at the CTRU across multiple studies. Our case studies highlight benefits of study participants being able to give consent without having to be present at the study site. This may better align with patient preferences and trial site needs and therefore improve recruitment and resilience against external shocks (such as pandemics). Variation in uptake of eConsent may be influenced more by site-level factors than patient preferences, which may not align well with the aspiration towards patient-centred research. Our current process has some limitations, including the provision of all consent-related text in more than one language, and scalability of implementing more than one consent form version at a time. We consider how enhancements in CTRU processes, or external developments, might affect our approach.

Purpose The purpose of this research is to show how institutional factors affect buyer–supplier relationships. Specifically, the authors examine a model of relationship quality and its antecedents across rule-based, relation-based and family-based governance environments. Design/methodology/approach A conceptual model and accompanying research hypotheses are tested on data from a survey of 169 US (rule-based), 110 Brazilian (family-based) and 100 Chinese (relation-based) managers and buyers. Structural equation modeling is used to test the relationship quality framework and the hypothesized moderation of governance environment. Findings Results suggest that the informal institutions which shape a nation’s governance environment impact the relationship building process between buyers and suppliers. Communication quality was found to influence relationship quality more in developed economies where relationships are protected and managed under rule-based governance. Interaction frequency was found to be more relevant in emerging market firms characterized by relation-based societies. relationship benefits are applied more to relationships in emerging markets operating under family-based governance. No differences were found across governance environments for the influence that conflict resolution has on relationship quality. Practical implications Results provide insight into how the fairness and effectiveness of political and economic institutions surrounding a buyer’s nation of operation impact “rules of the game” differently for developed and emerging market firms. Originality/value This study extends research on cross-cultural relationship marketing to more than just communications context and cultural heritage. Results demonstrate that a buyer’s quest for legitimacy impacts its sensitivity to what supplier behaviors matter the most.

Purpose This study aims to investigate how indigenous socio-cultural (ISC) practices within informal networks, such as guanxi and wasta, provide benefits beyond mere access. Specifically, the authors explore their global impact on B2B relationships, focusing on reciprocity. A multiregional sample extends research on ISC practices in B2B relationships by examining contingency effects of informal network ties. Design/methodology/approach The authors surveyed 404 buyers in two developed (Hong Kong and Portugal) and two emerging economies (Kuwait and Colombia), and also categorized by strong and weak informal network ties. Using structural equation modeling, the authors examined a relationship marketing (RM) model from a typology (Clubs, Sociocracies, Clans and Compadres) for assessing contingency effects. Findings The study reveals that in developed economies with strong formal institutions, negative aspects of favor reciprocity norms intensify unless informal networks are driven by strict sociomoral obligations. This supports research indicating that contractual governance competes rather than complements relational governance. Moreover, trust-building processes are crucial in regions with low uncertainty tolerance to mitigate adverse effects. Practical implications Suppliers from developed nations need more than cultural communication insights when engaging in business in emerging markets. We acknowledge changes buyers may expect adherence to reciprocity rules embedded in the ISC practices of their informal networks. Originality/value This study pioneers a typology of social structures to analyze ISC practices across buyers with varying formal institutional strength and informal network ties. It sheds light on institutional dynamics, trust-building processes, and nuances surrounding both positive and negative aspects of reciprocity practices. Furthermore, it broadens the scope of RM to Asia, Europe, Latin America and the Middle East.

The importance of nonprofit organizations in offering, supporting and promoting solutions to the world’s greatest problems cannot be underscored. However, in order to accomplish its goals and objectives and maintain a sustainable competitive position, charitable organizations must focus on effective segmentation and marketing strategies that create value for donors. This research draws from charitable giving theory, social exchange theory and relationship marketing literature to examine the influence of a social factor (social recognition), an emotional factor (attitude towards helping others) and a functional factor (attitude towards the charitable organizations) on increasing value for donors from their involvement with a charitable organization. Based on an overall sample of 320 U.S. donors, all three factors have a significant influence on driving donor’s value. However, there are significant differences found when the sample is compared separately based on age, religiosity, donation type and the nature of a donor’s personal involvement with the organization. Social recognition is significantly more important among younger and religious donors and donors with a history of family ties with the organization. However, a donor’s attitude towards the charitable organizations is found to have a greater effect on perceived value among older donors and those who benefit personally from the organization’s charitable work. Finally, for donors who know someone who benefitted from the charitable organization and have a religious affiliation, their attitude towards helping others is the greater driver of perceived value. The study offers practical insight for nonprofit organizations to create value for donors by suggesting effective marketing communication strategies aimed at different segments of the American donor market.

Purpose The purpose of this paper is to examine the strategic decision-making process regarding communication flows and trust and their impact on firm cooperation in the context of buyer-supplier relationships in rule-based vs relation-based countries. An institutional view is explored to demonstrate how informal institutions shape a firm’s strategic decision making in the internationalization process. Design/methodology/approach A conceptual model and accompanying research hypotheses are tested on data from a survey of 169 US and 110 Brazilian buyers. Structural equation modeling is used to test the hypotheses. Findings Results suggest that the pattern of flows of communication on building trust and increasing strategic cooperation is based upon the governance of the individual’s country of origin. Quality communication is found to have a greater impact on trust in the USA, while two-way communication is the factor with the greatest effect on trust in Brazil. Frequency of communication and socialization are also found to have indirect, but important distinct roles in the flows of communication in both countries. Trust is also found to be a strong predictor of strategic cooperation. Practical implications Results provide insight into what patterns of communication flows are most influential in increasing a buyer’s trust in a supplier, so that suppliers can better formulate strategies to enter overseas markets. Originality/value This study extends the communication, trust, and cooperation literature to the context of buyer-supplier relationships in distinct county settings. Comparisons are made between one developed country characterized by rule-based governance, with a low-context style of communication and high country trust and one emerging market characterized by relation-based governance, with a high-context style of communication and low country trust.