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University Library Radboud University ~~DOI 10.1007/s00330-016-4317-3 CHEST Software performance~~ Europeanization Beyond the Goodness of Fit: Domestic Politics in segmenting ground-glass and solid components of subsolid nodules in pulmonary adenocarcinomas ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇,2 • Jin Mo Goo 1,3 • Roh-Eul Yoo1 • ▇▇▇▇▇ Min Park1,3 • ▇▇▇▇▇ ▇▇▇▇ ▇▇▇ 1 • ▇▇▇▇ van Ginneken4 • ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ • Young ▇▇▇ ▇▇▇ 3,6 Received: 8 July 2015 / Revised: 14 February 2016 / Accepted: 2 March 2016 / Published online: 5 April 2016 Ⓒ European Society of Radiology 2016 Abstract Objective To evaluate the performance of software in segmenting ground-glass and solid components of subsolid nodules in pulmonary adenocarcinomas. glass and solid components with pathology measurements of tumour and invasive components. Results Segmentation of ground-glass components at a threshold of -750 HU yielded mean differences of +0.06 mm (p = 0.83, 95 % limits of agreement, 4.51 to 4.67) and - 2.32 mm (p < 0.001, -8.27 to 3.63) when compared with pa- thology and manual measurements, respectively. For solid components, mean differences between the software (at - 350 HU) and pathology measurements and between the man- ual (lung and mediastinal windows) and pathology measure- ments were -0.12 mm (p = 0.74, -5.73 to 5.55]), 0.15 mm (p = 0.73, -6.92 to 7.22), and -1.14 mm (p < 0.001, -7.93 to 5.64), respectively. Jin Mo Goo ▇▇▇▇▇@▇▇▇▇▇.▇▇▇.▇▇.▇▇ 1 Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, ▇▇▇ ▇▇▇▇▇▇-▇▇, ▇▇▇▇▇▇-▇▇, ▇▇▇▇▇ ▇▇▇-▇▇▇, ▇▇▇▇▇ 2 Clinique Universitaire de Radiologie et Imagerie Médicale (CURIM), Université ▇▇▇▇▇▇ ▇▇▇▇▇▇▇, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9, France 3 Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea 4 Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Forefront1 ▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇~~▇ ▇▇, ▇▇~~▇▇ ▇▇ and ▇▇▇▇~~▇▇▇▇,~~ ▇▇▇ ▇▇▇▇▇▇▇▇ aRadboud University Nijmegen, Department of Public Administration and Political Science, PO Box 9108, 6500 HK, Nijmegen, The Netherlands. E-mail: ▇.▇▇▇▇▇▇▇▇▇▇▇@▇▇.▇▇.▇▇ ▇▇▇▇▇▇▇ 5 University, Department of ~~Pathology~~Public Administration, ~~Seoul National University College~~ PO Box 9555, 2300 RB Leiden, The Netherlands. This paper provides a critical assessment of ~~Medicine~~the ‘goodness of fit’ hypothesis, ~~Seoul~~which is central to the literature on Europeanization. According to this hypothesis, ~~Korea ence~~ the ease of adaptation to European policies depends upon the extent to which these fit national policies and institutions. On the basis of a literature review and integration of research findings, we conclude that the goodness of fit lacks empirical and conceptual strength. We argue that part of the problem is that the relationship between the status quo and the response to the EU is spurious, as both variables are contingent upon the preferences or beliefs held by domestic political and administrative actors. This shortcoming has been recognized by advocates of the thesis, who have crafted more dynamic frameworks revolving around the goodness of fit by bringing in ‘political’ variables that may capture the overriding power of substantive positions of domestic policy-makers. However, we provide various examples showing that the goodness of fit is not a necessary condition for domestic change. We argue, therefore, that it would be theoretically sounder to directly focus on domestic preferences or beliefs, and no longer incorporate the goodness of fit into our models. We provide the outline of such an approach, building on rational choice and sociological institutionalism, giving some examples of particular models under these broad headings. We argue that such applications are more parsimonious than the expanded goodness of fit frameworks, in that they make the goodness of fit, and most of the additional variables suggested, redundant. In doing so, we hope to provide the foundations for further theoretical and empirical work on the dynamics of Europeanization. Keywords: Europeanization; adaptation; goodness of fit; neo-institutionalism; rational choice institutionalism; sociological institutionalism Introduction How can we explain the effects of European integration on the member states? This is the central theme of the literature on Europeanization, a fashionable 332 branch of EU studies (▇▇▇▇, 2004).2 Central to this literature is the ‘goodness of fit’ hypothesis, which holds that smooth adaptation to EU policies depends on the degree to which these fit existing national policies and institutions.3 This paper provides a critical theoretical assessment of this hypothesis, and the more complex theoretical frameworks built around it later. Our main argument is that theories on Europeanization gain parsimony if the goodness of fit is left out, while domestic preferences or beliefs are brought to the forefront of theory-building and analysis. The paper proceeds in four steps. First, we review the goodness of fit literature. After discussing the intuitively strong original hypothesis, we will show that its empirical record has been rather disappointing, in that no actual link has been established between the goodness of fit and the ease of adaptation. This has led advocates of the hypothesis to modify their frameworks, proposing several additional variables. After discussing these modified frameworks, we explain why the results for the original hypothesis have been so poor. To begin with, we argue that the hypothesis is logically flawed, in that the alleged relationship between fit and the ease of adaptation is spurious. In addition, we argue that the hypothesis is too deterministic, assuming that policy-makers want to maintain the status quo. We posit that the later additions to the goodness of fit hypothesis must be seen in this light, namely as attempts to bring in the dynamism lacked by the goodness of fit hypothesis. The downside of these revised frameworks, though, is that several authors have unmasked the goodness of fit as a necessary condition for domestic change. We argue that it would be more fruitful to leave out the goodness of fit altogether, and theorize the dynamics of EU compliance in a more direct way, namely by bringing the preferences and beliefs of domestic political center stage. Drawing from rational choice and sociological institutionalism, we sketch two broad competing approaches. We claim that, by directly including either preferences or domestic beliefs, the goodness of fit and most of the additional variables suggested become logically redundant, which yields more parsimonious approaches. The Goodness of Fit The roots of the goodness of ft hypothesis can be found in the work by He´ ritier (1995). Her argument is that member states try to upload their policies to the EU level, with ~~pathology~~the aim of laying these down in binding EU legislation. ~~• Software~~ In this way member states try to minimize the costs of adaptation and to establish a level European playing field for their industry (He´ ritier, 1995, 278). This notion was later extended to the process of EU adaptation: if member states do not succeed in uploading their policies, they will not happily adjust to the resulting decision-making outcome, because of the high costs of adaptation. Hence, the assumption is that implementation4 depends on the ‘goodness of fit’ between EU policy demands and existing national policies (Duina, 1997, 1999; ▇▇▇▇▇ and ▇▇▇▇▇▇▇▇, 1998; ▇▇▇▇▇ and ▇▇▇▇▇▇, 1999; Green ▇▇▇▇▇▇ et al., 2001; ▇▇▇▇▇, 2001; ▇▇▇▇▇▇, 2002; ▇▇¨ rzel, 2003; Bo¨ rzel and ▇▇▇▇▇, 2003). The goodness of fit can ~~effectively segment~~ be usefully presented as a historically institutionalist argument (see ▇▇▇▇▇▇▇, 2000; ▇▇▇▇▇▇▇, 2004). The central claim made is that existing institutional paths are ‘sticky’ and resistant to change. If European policy demands can be accommodated within the confines of the path already taken, adaptation will be smooth. Conversely, if a directive requires profound changes of the existing institutions, EU adaptation will be time-consuming and initially incorrect. In underpinning this relationship, two different mechanisms have been put forward, along the lines of rational choice and sociological institutionalism.5 Some focus on the cost-awareness of national actors (▇▇▇▇▇, 1997; ▇▇▇▇▇ and ▇▇▇▇▇▇▇▇, 1998; Bo¨ rzel, 2003). Others suggest normative notions, bringing the logic of appropriateness to the forefront (see He´ ritier et al., 2001; ▇▇▇▇▇, 2001; Bo¨ rzel and ▇▇▇▇▇, 2003). The original hypothesis The first author to formulate the goodness of fit argument was ▇▇▇▇▇ (1997, 1999). He claims that the time and extent of EU compliance depend on the fit between a directive and two nation-specific institutions: the organization of interest groups and national policy legacies. He hypothesizes that a directive that is in line with these will be implemented fast and well. Conversely, implementation will be poor for directives requiring major policy shifts and the re-organization of interest groups. The key to this relationship is with parliaments, which act as ‘guardians of the status quo’ (Duina, 1999, 6). ▇▇▇▇▇ tests his hypothesis while controlling for three rival explanations: a member state’s stance towards the EU, the interests of key political actors, and the length of the legislative process. ▇▇▇▇▇ analyzes the implementation of the 1975 equal pay directive in France, Italy, and the UK, and a 1980 air pollution directive in the UK, Italy, and Spain. His conclusion is that the hypothesis needs not be rejected, because the directives’ demands on the policy legacies of a nation proved influential (Duina, 1999, 120).6 A second ground-~~glass~~ breaking study on the goodness-of-fit was carried out by ▇▇▇▇▇ and ~~solid components in subsolid nodules~~▇▇▇▇▇▇▇▇ (1998). ~~• Software measurements show no significant difference~~ Focusing on national administrative traditions, they hypothesize that implementers’ responses to EU requirements are institutionally framed. They put forward the ‘intuitive hypothesis’ that the correctness of implementation depends on the fit between European legislation and relevant national policies. However, after confronting this hypothesis with ~~pathology measurements. • Manual measurements are more accurate~~ data on lung windows than on mediastinal windows. Keywords Solitary pulmonary nodule . Lung cancer . Subsolid nodule . Adenocarcinoma . Segmentation Introduction Persistent pulmonary ground-glass nodules (GGNs) have been a growing concern the implementation of four environmental directives in the ~~last few~~ UK and in Germany, they reach a totally different conclusion than ▇▇▇▇▇. Only three of 334 the eight cases are in line with the hypothesis. For instance, two directives requiring major adaptations in the UK were implemented rather smoothly. At the same time, one directive requiring hardly any changes in Germany was implemented with a huge delay. Therefore, ▇▇▇▇▇ and ▇▇▇▇▇▇▇▇ (1998, 602) conclude that the goodness of fits by itself is insuﬃcient to explain implementation performance. Striking a more critical note, ▇▇▇▇▇▇▇▇▇ (2000) finds that the goodness of fit is not decisive in explaining the implementation of a directive on packaging waste. Despite facing a high misfit, the UK, for example, implemented the directive relatively fast and correctly. Germany, on the other hand, only faced moderate adaptation pressure, but implemented the directive 2 years ~~because many of them turned out~~ late. The key to ~~be pulmonary adenocarcinomas or their precursors [1~~these puzzling results, 2]according to ▇▇▇▇▇▇▇▇▇, is with institutional veto points. In the ~~2011 IASLC/ATS/ERS classification [3]~~UK, ~~it was recommended~~ the bad fit did not prove consequential because the opposition had no effective veto point to ~~report~~ frustrate implementation. In Germany, however, the ~~size~~ Bundesrat managed to oppose one directive provision on refillables, which delayed the whole process. His conclusion is that veto points shape the ease of implementation, rather than the goodness of fit. Finally, evidence against the goodness of fit as a stand-alone hypothesis has been produced by a recent comparative study on the implementation of six labour directives (▇▇▇▇▇▇▇ et al., 2005, 289–291), which reports a ‘failure of the ~~solid component and entire tumour size separately for part-solid GGNs as the invasive component of pulmonary adenocar- cinoma is closely related to a patient’s prognosis~~misfit hypothesis’. ~~A sub- sequent study showed that the diameter~~ Only 22 % of the ~~solid com- ponent was~~ cases are in line with the hypothesis. Moreover, there is no correlation between a ~~better prognostic predictor than~~ country’s average degree of misfit and transposition performance. Denmark, Ireland and the ~~largest diameter~~ UK, show high misfits, but transpose really fast. On the other side of the ~~whole nodule in adenocarcinomas appearing as part-solid GGNs [4]~~spectrum we find Germany and France, which had a hard time complying with several well- fitting directives. The authors argue that we must take into account the role of domestic politics (also see Treib, 2003), and the culture of compliance (▇▇▇▇▇▇▇ et al., 2005) of the different member states. Towards auxiliary variables The goodness of fit hypothesis is rather intuitively appealing and parsimonious. Therefore, despite the ~~diameter~~ disappointing empirical results various authors continued to use it. The general response by advocates of the ~~solid component~~ thesis has been to identify various auxiliary variables, so as ~~well~~ to bring in the dynamism needed to explain smooth adaptation in the face of a misfit, or conversely (see Table 1 for an overview). For instance, ▇▇▇▇▇ and ▇▇▇▇▇▇▇▇ (1998, 602–603) expand their original framework by adding three variables. First, they claim that the goodness of fit is not given, but defined by policy actors. Second, they claim that the possibility that actors perceive the adaptation pressure as high depends on the ‘embeddedness’ of national regulatory patterns, that is, the extent to which they are deeply and/or widely institutionalized. Third, they suggest the Table 1 Synopsis of the goodness of fit literature ▇▇▇▇▇ (1997) Necessary K Organization of NA ▇▇▇▇▇ and ▇▇▇▇▇▇▇▇ (1998) Necessary K Regulatory style K Regulatory structure K Embeddedness K Policy context J Degree of domestic support J Policy salience ▇ ▇▇▇▇▇- and international pressures Green ▇▇▇▇▇▇ Necessary K Policies K Institutions K Structure J Multiple veto points J Mediating formal institutions K Agency J Differential empowerment of actors J Learning He´ ritier et al. (2001) Necessary, nor suﬃcient — K Nature of EU policies J Degree of prescription J Market-making vs market- correcting J Degree of flexibility K Variance in domestic constellations J Reform stage J Dominant belief system national reform capacity Bo¨ rzel and ▇▇▇▇▇ (2003) Necessary K Policies K Institutions Bo¨ rzel (2003) Necessary K Problem-solving approach K Policy instruments K Policy standards K Domestic pressure for adaptation K External pressure for adaptation 336 additional hypothesis of policy context, defined as the ~~size~~ degree of domestic support, policy salience, and the ~~whole nodule~~ supra- and international pressure on the member state to comply. All in all, they try to bring more dynamism into the framework. He´ ritier et al. (2001) also propose a revised goodness of fit framework. They take a two-pronged explanatory approach: the impact of Europe depends both on the member states pre-existing policies, and on the dynamics of political processes (He´ ritier et al., 2001, 9). As to the first element, the authors are cautious to put too much emphasis on the goodness of fit argument. Yet they do not discard it completely and claim that it is a ~~key element in~~ necessary condition.7 That is, if national policies differ from EU policies, there is a pressure for member states to adjust the ~~recent recommendations for the management of subsolid nodules [2]~~former (ibid., 9). However, ~~when~~ this pressure does not explain the ~~variability~~ differential impact of ~~manual measurements was assessed~~Europe, ~~95 % limits~~ which is why they introduce the national political process as a second explanatory element. Specifically, they claim that the adjustment to European policies depends on the stage of ~~interobserver agreement were reported~~ liberalization already present in a member state, the national reform capacity, and the dominant belief system or problem-solving approach (ibid., 257–259). These variables combine to sketch a more dynamic picture of adaptation processes. A similar strategy can be ~~1.72 mm~~ seen in the comparable frameworks developed by ▇▇▇▇▇ et al. (2001), and ~~1.73 mm~~ ▇▇¨ rzel and ▇▇▇▇▇ (2003). Maintaining misfit as a necessary rather than a suﬃcient condition for ~~GGNs~~ change, they identify several ‘mediating factors’, which explain the final degree of domestic change. First, they propose two structural variables: the number of veto points in a political system and ~~solid nodules, respectively [5, 6]~~the political and organizational culture. As ~~for~~ to the former variable, they claim that the more power is dispersed in a ~~part-solid GGN~~system, the ~~interob- server measurement variability~~ more diﬃcult it is to bring about domestic change. Political and or organizational cultures, for their part, affect whether domestic actors can use adaptational pressures to induce structural change. Alongside these structural mediating factors, they identify two variables at the level of ~~solid component~~ agency. First, they claim that the differential empowerment of actors makes a difference: structural changes may be lead to a redistribution of power among the stakeholders, thus allowing for adaptation, even ~~higher given~~ if there is a misfit. On the ~~fact that solid components are usually very small~~other hand, ~~with~~ they stress the ~~largest diameters~~ effect of ~~no more than~~ learning: Europeanization may bring about a ~~few millimetres~~redefinition of actors’ interests and identities. ~~Furthermore~~Finally, given their slow growth rate, it may not be easy to determine interval changes in GGNs with manual measurements, especially when the solid component is small. Fig. 1 Example of an excellent segmentation for a part-solid GGN in the right upper lobe before Bo¨ rzel (a) and after (b) segmentation with thresholds of - 750 HU and -350 HU for ground-glass and solid components, respectively. Software measurements were 16.8 mm for the ground- glass component and 8.7 mm for the solid component. Pathology obtained with wedge resection revealed a lepidic predominant adenocarcinoma with a maximal tumour size of 17 mm and an invasive component size of 9 mm As computer-aided volumetry was reported to reduce inter- observer variability in solid nodules; a similar approach may be applicable to GGNs [7–9]. While several articles have ex- plored the topic of semi-automated segmentation in GGNs, most of them focused on the feasibility of volumetry and mass measurements as well as their intra/interobserver, and intrascan variability [10–13]. However, these studies did not compare the software measurements with manual measure- ments of maximal diameters of ground-glass and solid com- ponents of nodules, which are still the reference standard for GGNs [2]. More importantly, there have been no studies which compared the software measurements with pathology measurements of invasive components and the entire tumours in pulmonary adenocarcinomas [3].2003

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End User Agreement. This publication is distributed under the terms of Article 25fa of the Dutch Copyright Act. This article entitles the maker of a short scientific work funded either wholly or partially by Dutch public funds to make that work publicly available for no consideration following a reasonable period of time after the work was first published, provided that clear reference is made to the source of the first publication of the work. Research outputs of researchers employed by Dutch Universities that comply with the legal requirements of Article 25fa of the Dutch Copyright Act, are distributed online and free of cost or other barriers in institutional repositories. Research outputs are distributed six months after their first online publication in the original published version and with proper attribution to the source of the original publication. You are permitted to download and use the publication for personal purposes. All rights remain with the author(s) and/or copyrights owner(s) of this work. Any use of the publication other than authorised under this licence or copyright law is prohibited. If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the University Library know, stating your reasons. In case of a legitimate complaint, the University Library will, as a precaution, make the material inaccessible and/or remove it from the website. Please contact the University Library through email: ▇▇▇▇▇▇▇▇▇@▇▇▇.▇▇.▇▇. You will be contacted as soon as possible. University Library Radboud University ~~DOI 10.1007/s00330~~User co-~~016-4317-3 CHEST Software performance in segmenting ground-glass and solid components~~ production of ~~subsolid nodules in pulmonary adenocarcinomas~~ public service delivery: An uncertainty approach Joost Fledderus Institute for Management Research, Radboud University, Nijmegen, The Netherlands Taco ▇▇▇▇▇▇▇▇ ▇. Institute for Management Research, Radboud University, Nijmegen, The Netherlands Marlies ▇▇▇▇▇▇,2 • Jin Mo Goo 1,3 • Roh-Eul Yoo1 • ▇▇▇▇▇ Min Park1,3 • ▇▇▇▇▇ ▇▇▇▇ ▇▇▇ 1 • ▇▇▇▇ van Ginneken4 • ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ • Young ▇▇▇ ▇▇▇ 3,6 Received: 8 July 2015 / Revised: 14 February 2016 / Accepted: 2 March 2016 / Published online: 5 April 2016 Ⓒ European Society of Radiology 2016 Abstract Objective To evaluate the performance of software in segmenting ground-glass and solid components of subsolid nodules in pulmonary adenocarcinomas. glass and solid components with pathology measurements of tumour and invasive components. Results Segmentation of ground-glass components at a threshold of -750 HU yielded mean differences of +0.06 mm (p = 0.83, 95 % limits of agreement, 4.51 to 4.67) and - 2.32 mm (p < 0.001, -8.27 to 3.63) when compared with pa- thology and manual measurements, respectively. For solid components, mean differences between the software (at - 350 HU) and pathology measurements and between the man- ual (lung and mediastinal windows) and pathology measure- ments were -0.12 mm (p = 0.74, -5.73 to 5.55]), 0.15 mm (p = 0.73, -6.92 to 7.22), and -1.14 mm (p < 0.001, -7.93 to 5.64), respectively. Jin Mo Goo ▇▇▇▇▇@▇▇▇▇▇.▇▇▇.▇▇.▇▇ 1 Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, ▇▇▇ ▇▇▇▇▇▇-▇▇, ▇▇▇▇▇▇-▇▇, ▇▇▇▇▇ ▇▇▇-▇▇▇, ▇▇▇▇▇ 2 Clinique Universitaire de Radiologie et Imagerie Médicale (CURIM), Université ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Institute for Management Research, Radboud University, Nijmegen, The Netherlands Abstract Engaging public service users as co-producers is expected to lead to more efficient services and better outcomes. What has been missing so far, however, is a solid the- oretical basis to explain what compels actors to pursue co-production, or not, and what strategies they adopt in this pursuit. Building on established theories, it is argued that although co-production of public service delivery decreases uncertainty for users, it seems to increase uncertainty for organizations. The main conclusion is that the need of organizations to reduce this uncertainty might diminish the possibilities for users to coproduce. The consequences of this conclusion for future research are discussed in this article. Keywords Contingency theory, co-production, institutional theory, public service delivery, public service organization, uncertainty Introduction Users of public services can take on different roles. They can be regarded as con- ▇▇▇▇▇▇, ~~Centre Hospitalier Universitaire de Grenoble~~which became a popular view in the 1980s (▇▇▇▇▇▇ and ▇▇▇▇▇▇, ~~CS 10217~~2005), 38043 Grenoble Cedex 9, France 3 Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea 4 Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, but Corresponding author: ▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇, Institute for Management Research, Radboud University, Thomas ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇ ▇.▇.▇▇, ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇▇▇, ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇. Email: ▇.▇▇▇▇▇▇▇▇▇@▇▇.▇▇.▇▇ ~~5 Department~~ nowadays the perspective of ~~Pathology~~service users as co-producers of public service delivery has gained attention (Brandsen et al., ~~Seoul National University College~~ 2012). The contribution of ~~Medicine~~users to the delivery of public services, ~~Seoul~~such as parent participation in child care (Vamstad, ~~Korea ence with pathology~~2012), citizen co-production of safety (Meijer, 2012), or patient involvement in health care (▇▇▇▇▇▇ and ▇▇▇▇▇▇, 2006), is believed to improve the eﬃciency and outcomes of those services. ~~• Software can effectively segment ground~~Current research focuses for a large part on the motivations and characteristics of coproducing users (▇▇▇▇▇▇▇▇▇ and ▇▇▇▇▇▇▇, forthcoming; ▇▇▇▇▇▇▇ et al., 2013; ▇▇▇ ▇▇▇▇ and ▇▇▇▇▇, 2014), and on specific, often successful cases (▇▇▇▇▇▇▇ and Lo¨ ﬄer, 2012; ▇▇▇▇▇▇ and ▇▇▇▇▇▇▇▇, 2013). What has been missing so far, however, is a solid theoretical basis for explaining what compels actors to pursue co-~~glass~~ produc- tion, or not, and ~~solid components~~ what strategies they adopt in ~~subsolid nodules~~this pursuit. • Software measurements show no significant difference with pathology measurements. • Manual measurements are more accurate on lung windows than on mediastinal windows. Keywords Solitary pulmonary nodule . Lung cancer . Subsolid nodule . Adenocarcinoma . Segmentation Introduction Persistent pulmonary ground-glass nodules (GGNs) have been a growing concern In particular, the role of organizations remains relatively understudied in the ~~last few years because many~~ current literature. In this art- icle, we will define such a theoretical basis, building on established theories. A central hypothesis that emerges from the theoretical analysis is that although co-production of ~~them turned out~~ public service delivery decreases uncertainty for users, it seems to increase uncertainty for organizations. Therefore, it might not be ~~pulmonary adenocarcinomas~~ so easy to realize co-production as it is sometimes assumed. This raises the question how organizations deal with these uncertainties and importantly, whether they are eager to allow users to coproduce or ~~their precursors [1~~not. We argue that organizations may employ “closed” or “open systems” approaches to uncertainty, 2]but that the choice for one or the other depends on the institutional context. In the ~~2011 IASLC/ATS/ERS classification [3]~~final section, ~~it was recommended~~ we will discuss the implications of our theoretical analysis for future research on co-production. Uncertainty for service users and organizations Users of public services and the organizations providing those services would not have to ~~report~~ deal with uncertainty if they were able to see and know everything. In reality, both parties have incomplete information about possible solutions and their ultimate consequences. For instance, when a patient is in need of treatment, both the ~~size~~ patient and the doctor will be confronted with some uncertainty about the effectiveness of the ~~solid component and entire tumour size separately for part-solid GGNs as~~ proposed treatment—the ~~invasive component~~ patient because he or she does not possess the required professional knowledge; the doctor because he or she has limited knowledge of ~~pulmonary adenocar- cinoma is closely related to a~~ the patient’s ~~prognosis~~body and mind. ~~A sub- sequent study showed that~~ Both service users and public service organizations (PSOs) have to bear with “cognitive costs” of decision making because of their incapacity to retain, process, and collect all relevant infor- mation (▇▇▇▇▇▇ and ▇▇▇▇, 2000: 528). These cognitive costs are substantially higher for providing and receiving services than for producing and purchasing goods. This is because (1) the ~~diameter~~ quality of services is less easily assessed because of their intangibility; (2) services cannot be produced in standard, homogeneous ways as products can; (3) and because with services, production, and consumption cannot be separated, but this occurs during the inter- action between the user and service staff (▇▇▇▇▇▇▇▇▇▇▇ et al., 1985). Because of these features, the delivery of services is characterized by interdependence between the user and the service provider. An effective service depends on synergy between the actions of the ~~solid com- ponent was a better prognostic predictor than the largest diameter of the whole nodule in adenocarcinomas appearing as part-solid GGNs [4]. Therefore, the diameter of the solid component~~ user as well as ~~the size~~ those of the ~~whole nodule is~~ provider (▇▇▇▇▇▇, 1996). This inter- dependence constitutes the main source of uncertainty for both parties. Both individuals and organizations are likely to benefit from reducing uncer- tainty. Uncertainty at the individual level has been related to all sorts of aversive outcomes (e.g., ▇▇▇▇▇▇▇▇▇▇ and ▇▇▇▇▇, 1986) as it leads to a ~~key element in~~ sense of reduced control over one’s life (▇▇▇▇, 2000). Personal control, on the ~~recent recommendations~~ other hand, has been asso- ciated with, inter alia, stress reduction, sense of ownership, and responsibility (▇▇▇▇ et al., 1999; ▇▇▇▇▇ and ▇▇▇▇▇▇, 1979). For organizations, lack of control and uncer- tainty may lead to less satisfied employees (▇▇▇▇▇▇▇▇▇▇▇ et al., 1989), but also to suboptimal decision making (▇▇▇▇▇, 1979). Uncertainty can be reduced by increasing the predictability of behavior, for instance, by simplifying processes through established routines, rules, and habits. When services are relatively simple and require little personal interaction, simplifi- cation can be a useful strategy. Renewing a passport can be done easily because clear procedures and rules can prescribe the ~~management~~ expected behavior of ~~subsolid nodules [2]~~both the citizen and the municipal worker. However, when the ~~variability~~ environment becomes more complex and less predictable, more active strategies may be needed to reduce uncertainty (▇▇▇▇▇▇▇▇ and Lorsch, 1967). Such complexity is inherent to enduring social services, such as education, health care, and social housing. Here, the problems and their solutions are often defined less clearly, the preferences of ~~manual measurements was assessed~~users are more diverse, ~~95 % limits~~ and the range of ~~interobserver agreement were reported~~ potential service providers and/or particular services is more varied. A health issue is obviously more complex than renewing a passport; residential care is more intricate than putting your garbage at the curb side. The types of uncertainties that come along with this interdependence and com- plexity differ between users on the one hand and PSOs on the other hand. The specific strategies that might be used to cope with these uncertainties might also differ therefore. For users, uncertainty predominantly relates to service outcomes. Gaining more influence over the way the outcome is reached can reduce feelings of uncertainty. ▇▇▇▇▇▇▇▇▇ (1970) distinguished two mechanisms to influence service delivery: through the use of voice and exit. Co-production can be added to this model as an alternative way to perceive some kind of control over the service outcome. With regard to organizations, there are two ways of looking at uncertainty, one based on a contingency theory, and the other on institutional theory. In the first view, uncertainty is a technical problem, which hinders the production of outputs. Uncertainty is then the “critical contingency” with which organizations have to deal with in order to be ~~1.72 mm~~ effective (▇▇▇▇ and ~~1.73 mm~~ ▇▇▇▇, 1978; ▇▇▇▇▇▇▇▇, 1967). Lack of information about technology and uncertainty about financial support are typical forms of organizational uncertainty (▇▇▇▇▇▇, 1982; ▇▇▇▇▇▇▇▇▇, 1983). When users become co-producers of services, they become also a source of uncertainty. Within contingency theory, this is known as input uncertainty (▇▇▇▇▇▇▇ and ▇▇▇▇▇, 1989). Using this concept, we are able to discuss organizational strategies that deal with such input uncertainty. We will argue that the choice for ~~GGNs~~ these specific strategies to cope with uncer- tainty depends on the institutional context. Institutional theory gives important input to this statement. Institutional theory also takes coping with uncertainty as a starting point, although here, it entails uncertainty about the legitimacy of organ- izations (▇▇▇▇▇ and ~~solid nodules~~▇▇▇▇▇, ~~respectively [5~~1977). Yet, ~~6]. As for a part-solid GGN~~before addressing the organizational and institutional context, the interob- server measurement variability of solid component may be even higher given the fact that solid components are usually very small, with the largest diameters of no more than a few millimetres. Furthermore, given their slow growth rate, it may not be easy to determine interval changes in GGNs with manual measurements, especially when the solid component is small. Fig. 1 Example of an excellent segmentation for a part-solid GGN in the right upper lobe before (a) and after (b) segmentation with thresholds of - 750 HU and -350 HU for ground-glass and solid components, respectively. Software measurements were 16.8 mm for the ground- glass component and 8.7 mm for the solid component. Pathology obtained with wedge resection revealed a lepidic predominant adenocarcinoma with a maximal tumour size of 17 mm and an invasive component size of 9 mm As computer-aided volumetry was reported strategies to reduce ~~inter- observer variability in solid nodules;~~ uncertainty for individual users are described. Uncertainty reduction by users: Beyond exit and voice There are different strategies for users to influence the way public services are pro- vided. At a ~~similar approach~~ fundamental level, being knowledgeable about several aspects of services may ~~be applicable~~ reduce uncertainty (▇▇▇▇▇▇▇, 1973). Being well informed helps to ~~GGNs [7–9]. While several articles have ex- plored the topic~~ understand service characteristics and procedures and contributes to a sense of ~~semi-automated segmentation in GGNs, most of them focused on the feasibility of volumetry and mass measurements as well as their intra/interobserver, and intrascan variability [10–13]~~control. However, ~~these studies did~~ available information may not ~~compare~~ always be complete, or adequate. Some users are more capable of understanding complex information about possible choices, or are better in finding the ~~software measurements~~ channels to express their concerns, than others. This tends to be socially stratified, where the lower class is worse off (▇▇▇▇▇▇-▇▇▇▇▇, 1999). Information is thus insuﬃcient to decrease uncertainty. ▇▇▇▇▇▇▇▇▇’▇ (1970) well-known mechanisms of exit and voice might provide some alternatives then. Exit, however, will not always reduce uncertainty, as it is not given that the desired out- come will be reached with ~~manual measure- ments~~ another provider. Also, alternatives are not always pre- sent, or high transaction costs may be involved. Voice only reduces uncertainty when the organization is able to modify its current service provision, and often, this will take time (▇▇▇▇▇▇▇▇▇, 1970: 33). In general, it is very hard for users to notice the effectivity of ~~maximal diameters~~ being consulted, involved, or engaged (▇▇▇▇▇▇▇ et al., 2012). Important is the notion that exit, choice, voice, and knowledge only provide indirect influence over the service outcome. Within each strategy, the user is, the- oretically, placed outside the service provision; in other words, there is a clear demarcation between consumption of ~~ground-glass~~ the service and ~~solid com- ponents~~ production of ~~nodules~~the service. Within the service dominant approach, however, this logic is strongly contested (e.g., ▇▇▇▇▇▇▇ et al., 2013). We now turn toward this approach, which ~~are still~~ leads to co-production as an alternative way of reducing outcome uncertainty. professionals, which is in fact co-production. Such behavioral control directly influ- ences or modifies the ~~reference standard~~ characteristics of the service (▇▇▇▇▇▇▇, 1973: 287), and might even be able to prevent organizations from delivering poor quality. Co-production is not a steady state, but rather a continuum (▇▇▇▇▇▇▇ and ▇▇▇▇▇▇▇▇▇, 2013). At a basic level, co-production is inherent to the logic of service provision (▇▇▇▇▇▇▇ and ▇▇▇▇▇▇▇▇▇, 2013). Every service experience is shaped and defined by the behavior and perceptions of users. Service organizations can only “promise” a certain process or experience—the actual service delivery is a result of the collision between users’ expectations and their experience. Yet, some services require more intense levels of co-production, and others less. Organizations may also be able to provide room for ~~GGNs [2]~~more or less client participation. ~~More importantly~~Thus, co-produc- tion can be understood as an arrangement to which both clients and PSOs actively contribute a mix of activities at the point of delivery of public services (Fledderus et al., 2014a). Please note that this narrow definition excludes forms of collabor- ation between, for instance, nonprofit organizations and government, and it also leaves out forms of user involvement in other stages of service delivery, such as design or prioritization (▇▇▇▇▇▇▇, 2007). Important to stress is that co-production goes “beyond” traditional forms of voice (▇▇▇▇▇▇▇ et al., 2009). Traditionally, “giving users a say” in enduring social services means the constitution of a representative body, where a small sample of users communicates complaints and/or suggestions within formal arrangements. Here, users do not bear any responsibility in the actual service delivery. During co-production, users become (sometimes literally) “partial” employees (▇▇▇▇▇▇ et al., 1990). They do not only supply ideas to the service creation, but also behav- ior, time, and other resources, taking over a portion of the service delivery func- tions (▇▇▇▇▇ et al., 2004). Thus, co-production might be described as the most direct way of influencing public services and their outcomes. However, there are also barriers for undertaking co-production. The more demanding the act of co-production, the more resources of the user are required, in terms of time, physical work, or money (▇▇▇▇▇▇▇▇, 2013). Users would not only have ~~been~~ to be able to contribute these resources, they also have to be motivated to do so (▇▇▇▇▇▇, 2009). Moreover, recent research has shown that self-eﬃcacy, i.e. the belief citizens can make a difference, is an important determinant of coproductive efforts, especially of collective co-production (▇▇▇▇▇▇▇ et al., 2015; ▇▇▇▇▇▇▇ et al., 2013). As ability, willingness and self-eﬃcacy might be lacking among the most vulnerable group of users, co-production could lead to marginalization (Fledderus and Honingh, forthcoming). Importantly, when users are required to coproduce, but they are unable or unwilling, it is unlikely that this will lead to the expected perception of influence that is supposed to decrease feelings of uncertainty. Another barrier arises when co-production represents a collective act. Here, groups of users participate and cooperate in the delivery of public services. Because cooperation is the precondition for successful collective co-production, trust within the group becomes an important factor (Fledderus and Honingh, forthcoming). There are several possibilities for this trust to arise. When users are known to each other, the building of trust is easier than when they are relative strangers. Residents who unite and coproduce neighborhood safety within community policing are likely to know each other, or have some sense of common interest as they live in the same area. However, when such linkages do not exist, there should be other factors than group identification that facilitate trust. Strangers are less likely to trust each other because they have no ~~studies which compared the software measurements with pathology measurements of invasive components and the entire tumours in pulmonary adenocarcinomas [3].~~information about each other’s intentions. When there are doubts whether othe

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University Library Radboud University ~~DOI 10.1007/s00330-016-4317-3 CHEST Software performance~~ Understanding “Failed” Markets: Conflicting Logics and Dissonance in ~~segmenting ground-glass and solid components of subsolid nodules in pulmonary adenocarcinomas~~ Attempts to Price the Priceless Child ▇▇~~▇▇▇▇ ▇. ▇▇▇▇▇▇,2 • Jin Mo Goo 1,3 • Roh-Eul Yoo1 • ▇▇▇▇▇ Min Park1,3 •~~ ▇▇▇▇▇ ▇▇▇~~▇ ▇▇▇ 1 •~~ ▇▇▇~~▇ van Ginneken4 •~~ ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ ~~• Young~~ ▇▇▇ ▇▇▇ 3,6 Received: 8 July 2015 / Revised: 14 February 2016 / Accepted: 2 March 2016 / Published online: 5 April 2016 Ⓒ European Society of Radiology 2016 Abstract Objective To evaluate the performance of software in segmenting ground-glass and solid components of subsolid nodules in pulmonary adenocarcinomas. glass and solid components with pathology measurements of tumour and invasive components. Results Segmentation of ground-glass components at a threshold of -750 HU yielded mean differences of +0.06 mm (p = 0.83, 95 % limits of agreement, 4.51 to 4.67) and - 2.32 mm (p < 0.001, -8.27 to 3.63) when compared with pa- thology and manual measurements, respectively. For solid components, mean differences between the software (at - 350 HU) and pathology measurements and between the man- ual (lung and mediastinal windows) and pathology measure- ments were -0.12 mm (p = 0.74, -5.73 to 5.55]), 0.15 mm (p = 0.73, -6.92 to 7.22), and -1.14 mm (p < 0.001, -7.93 to 5.64), respectively. Jin Mo Goo ▇▇▇▇▇@▇▇▇▇▇.▇▇▇.▇▇.▇▇ 1 Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, ▇▇▇ ▇▇▇▇▇▇-▇▇, ▇▇▇▇▇▇-▇▇, ▇▇▇▇▇ ▇▇▇-▇▇▇, ▇▇▇▇▇ 2 Clinique Universitaire de Radiologie et Imagerie Médicale (CURIM), Université ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ Downloaded by RADBOUD UNIVERSITY NIJMEGEN At 05:07 01 March 2017 (PT) To cite this document: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ . "Understanding “Failed” Markets: Conflicting Logics and Dissonance in Attempts to Price the Priceless Child" In How Institutions Matter! Published online: 22 Dec 2016; 37-68. Permanent link to this document: Downloaded on: 01 March 2017, ~~Centre Hospitalier Universitaire de Grenoble~~At: 05:07 (PT) References: this document contains references to 0 other documents. 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Downloaded by RADBOUD UNIVERSITY NIJMEGEN At 05:07 01 March 2017 (PT) Downloaded by RADBOUD UNIVERSITY NIJMEGEN At 05:07 01 March 2017 (PT) UNDERSTANDING “FAILED” MARKETS: CONFLICTING LOGICS AND DISSONANCE IN ATTEMPTS TO PRICE THE PRICELESS CHILD‌‌‌‌‌‌‌‌‌‌‌‌‌‌‌‌‌ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇~~▇▇ ▇▇~~, ▇▇▇▇ ▇▇▇▇▇▇ and ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ How Institutions Matter! Research in the Sociology of Organizations, Volume 48B, 37—68 Copyright Ⓒ 2017 by Emerald Group Publishing Limited All rights of reproduction in any form reserved ISSN: 0733-558X/doi:10.1108/S0733-558X201600048 B002 Downloaded by RADBOUD UNIVERSITY NIJMEGEN At 05:07 01 March 2017 (PT) Keywords: Cognitive dissonance; institutional logics; marketization; institutional change; failure; childcare 1). These wider trends are often linked to the ascendance of neo-liberal thought (▇▇▇▇▇▇▇▇ & ▇▇▇▇▇▇▇▇, 2001) rooted in the Chicago School of Economics which aggressively suggested that all arenas of social and eco- nomic life could be efficiently organized as markets (▇▇▇▇▇▇, 1976), and successfully advocated market-embracing social policies. In turn, policy- makers became influenced by conservative think tanks such as the American Enterprise Institute as well as major international NGOs and institutions such as the World Bank and IMF that promoted market- based solutions. However, despite the seeming hegemony of market-based policies, research has shown that markets are complex social structures that can be extraordinarily difficult to construct (▇▇▇▇▇▇▇▇▇, 2001; ▇▇▇▇▇▇▇▇, 1990). This has been vividly demonstrated in macro-societal research on transitions from Socialism to Capitalism (▇▇▇▇, Szele´nyi, & ▇▇▇▇▇▇▇▇, 1998; ▇▇▇▇▇▇▇, 1999; ▇▇▇▇▇, 1992). Yet, our understanding of market construction remains limited, especially with regard to how market creation efforts can go awry. While markets have seemingly taken over the world, it would be especially useful for us to understand the conditions under which they fail to take hold. We argue that societal institutions and institutionalized practices in organizations matter in shaping markets, or in our case, how they constrain neo-liberal attempts to privatize public sectors, often under the guise of the so-called new public management (▇▇▇▇▇ & ▇▇▇▇▇▇▇▇▇▇▇▇, 2006). Downloaded by RADBOUD UNIVERSITY NIJMEGEN At 05:07 01 March 2017 (PT) Given that the successful creation and functioning of markets requires shared belief systems that enable producers and consumers to understand the nature and quality of what is being exchanged, situations of institu- tional complexity, where alternative institutional logics offer competing behavioral prescriptions (▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇, ▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇, & ▇▇▇▇▇▇▇▇▇, 2011; ▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇, & ▇▇▇▇▇▇▇▇▇, 2012) can undermine the creation of such shared beliefs around markets. For instance, the remaking of an existing field animated by social welfare or religious logics into a market may meet with resistance by dominant incumbents (▇▇▇▇▇▇▇▇▇, 1996). That is, in situations where incumbents feel threatened by efforts to alter dominant logics, established actors may counter-mobilize to protect their jurisdictions and established routines (▇▇▇▇▇, ▇▇▇▇▇▇, & ▇▇▇▇▇▇▇▇, 2008). ▇▇▇▇▇▇▇ and ▇▇▇▇▇▇▇▇▇ (2007) showed how banking professionals sought to maintain their professionally oriented community logic that was under assault by large, outsider banks promulgating a corporate-oriented market logic, by creating a variety of new community banks. We believe that more needs to be done to conceptually understand how the particular contexts of different fields may make them more or less prone to the creation of markets. For instance, we believe that resistance to market logics may be more likely to be observed and effective under condi- tions where the field experiencing a threatening change is relatively homo- geneous and dominated by a single logic that underpins core incumbents. Under conditions of institutional complexity (▇▇▇▇▇▇▇▇▇ et al., 2011), where fields are informed by multiple conflicting logics, and fragmented with a variety of organizations with different values and beliefs, resistant collective action may be more difficult to mobilize in response to efforts to create a market. However, pockets of resistance may still occur in this latter situation if some organizations interpret institutional change as a threat to their core identities and values. But whether and how such pockets of resis- tance can lead to halting market creation remains an important puzzle. To aid in this broader theory-building effort, we illustrate our arguments with an attempt by the Dutch state to marketize childcare organizations by creating a childcare market (see also ▇▇▇▇▇▇▇▇▇▇~~▇ 5 Department~~ ▇, ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇, & ▇▇▇▇▇▇▇, 2015). We probe how a field comprised of ~~Pathology~~multiple logics enabled organizations to variously resist adopting and implementing market logic practices. We document that even though the heterogeneity among child- care managers and their logics inhibited organized collective resistance, ~~Seoul National University College~~ marketization efforts never took root, and have even been rolled back. We argue that underlying this resistance and failed market creation were strong institutionalized beliefs about childcare and a considerable amount of ~~Medicine~~cog- nitive dissonance (▇▇▇▇▇▇▇▇▇, ~~Seoul~~1957) that cumulated into profound ambiva- lence at the field level, ~~Korea ence with pathology~~which constrained the privatization efforts of the government. • Software can effectively segment ground-glass and solid components in subsolid nodules. • Software measurements show no significant difference with pathology measurements. • Manual measurements are more accurate on lung windows than on mediastinal windows. Keywords Solitary pulmonary nodule . Lung cancer . Subsolid nodule . Adenocarcinoma . Segmentation Introduction Persistent pulmonary ground-glass nodules Downloaded by RADBOUD UNIVERSITY NIJMEGEN At 05:07 01 March 2017 (~~GGNs~~PT) ~~have been a growing concern in the last few years because many of them turned out to be pulmonary adenocarcinomas or their precursors [1, 2].~~ In the ~~2011 IASLC/ATS/ERS classification [3]~~next section, ~~it was recommended~~ we discuss how institutional complexity can stimu- late variegated responses, motivating our empirical illustration. We then provide an analytical narrative that tracks the effort to ~~report~~ marketize Dutch childcare. Following the ~~size~~ presentation of our illustrative case, we provide a process model of resistance under conditions of institutional complexity, and discuss its implications for future theorizing on institutional change. — While the market logic has become increasingly pervasive, fields are typi- cally characterized by multiple institutional logics that fuel the emergence of new practices as actors invoke, blend, or fuse logics to solve problems (▇▇▇▇▇▇▇▇▇ et al., 2011; ▇▇▇▇▇▇▇▇▇ & ▇▇▇▇▇▇, 2013; ▇▇▇▇▇▇, 2010). Institutional logics define the ends and shape the means by which interests are determined and pursued and provide the glue that links action and institutional effects in organizational fields arenas where actors “compete over the definition of issues and the form of institutions that will guide organizational behavior” (▇▇▇▇▇▇▇, 1999, p. 352). While ▇▇▇▇▇▇▇▇▇ and ▇▇▇▇▇▇ (1991) identified five societal-level logics, capitalism, family, the bureaucratic state, democracy, and religion, scholars later identified other categories, notably corporate, professional, and more recently, community logics (▇▇▇▇▇▇▇▇, 2004; ▇▇▇▇▇▇▇▇ et al., 2012). Many fields and organiza- tions are by their very nature “an incarnation or embodiment of multiple logics” (▇▇▇▇▇▇ & ▇▇▇▇▇, 2008, p. 244). For instance, healthcare is shaped by the logics of the solid component and entire tumour size separately for part-solid GGNs as the invasive component of pulmonary adenocar- cinoma is closely related to a patient’s prognosis. A sub- sequent study showed that the diameter of the solid com- ponent was a better prognostic predictor than the largest diameter of the whole nodule in adenocarcinomas appearing as part-solid GGNs [4]. Thereforemarket, the ~~diameter~~ state, and professional medical care (▇▇▇▇▇, 2004) as is the field of ~~the solid component~~ pharmacy (▇▇▇▇▇▇▇▇ & ▇▇▇▇, 2011). Organizations in pluralistic fields operate across institutional spheres subject to “incompa- tible prescriptions from multiple institutional logics” (▇▇▇▇▇▇▇▇▇ et al., 2011, p. 317). While earlier work often portrayed multiple institutional logics as starting or endpoints of change where subordinate, secondary or “minor- ity” logics may disrupt dominant logics (▇▇▇▇▇▇ & ▇▇▇▇▇▇▇, 2012; Downloaded by RADBOUD UNIVERSITY NIJMEGEN At 05:07 01 March 2017 (PT) ▇▇▇▇▇▇▇▇▇, 2001, 2007; ▇▇▇, ▇▇▇▇▇, & ▇▇▇▇▇▇, 2003; ▇▇▇▇▇▇▇▇, 2002), more recent work has shown that logic multiplicity and institutional com- plexity may persist and ▇▇▇▇▇▇ (▇▇▇▇▇▇▇▇ & ▇▇▇▇, 2011; ▇▇▇▇▇▇▇▇▇ et al., 2011; ▇▇▇▇▇▇, 2010; ▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇, & ▇▇▇▇, 2015). Competing prescriptions may co-exist and require organizations to con- tinuously manage “constellations” of logics, both dominant and subordi- nate (▇▇▇▇▇▇ & ▇▇▇▇▇▇▇, 2012), as well as ~~the size of the whole nodule is a key element in the recent recommendations for the management of subsolid nodules [2]. However~~cooperative and competing (▇▇▇▇▇▇▇▇ & ▇▇▇▇, ~~when the variability of manual measurements was assessed~~2011; ▇▇▇ & ▇▇▇▇▇▇▇▇▇, 95 % limits of interobserver agreement were reported to be 1.72 mm and 1.73 mm for GGNs and solid nodules, respectively [5, 6]. As for a part-solid GGN, the interob- server measurement variability of solid component may be even higher given the fact that solid components are usually very small, with the largest diameters of no more than a few millimetres. Furthermore, given their slow growth rate, it may not be easy to determine interval changes in GGNs with manual measurements, especially when the solid component is small. Fig. 1 Example of an excellent segmentation for a part-solid GGN in the right upper lobe before (a) and after (b) segmentation with thresholds of - 750 HU and -350 HU for ground-glass and solid components, respectively. Software measurements were 16.8 mm for the ground- glass component and 8.7 mm for the solid component. Pathology obtained with wedge resection revealed a lepidic predominant adenocarcinoma with a maximal tumour size of 17 mm and an invasive component size of 9 mm As computer-aided volumetry was reported to reduce inter- observer variability in solid nodules; a similar approach may be applicable to GGNs [7–9]2015). While ~~several articles have ex- plored the topic of semi-automated segmentation~~ often driven by a dominant logic, organizations may also borrow and experiment with other socially available logics and practices grounded in ~~GGNs~~these logics to solve local problems (▇▇▇▇▇▇, ~~most of them focused on the feasibility of volumetry and mass measurements as well as their intra/interobserver~~2012; ▇▇▇▇▇▇▇▇▇▇, ~~and intrascan variability [10–13]~~2007). However, these studies did not compare the software measurements with manual measure- ments of maximal diameters of ground-glass and solid com- ponents of nodules, which are still the reference standard for GGNs [2]. More importantly, there have been no studies which compared the software measurements with pathology measurements of invasive components and the entire tumours But how do organizations navigate through conflicting institutional pressures in ~~pulmonary adenocarcinomas [3].~~pluralistic fields where multiple logics guide behavior?

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