Healthcare Firms Research Articles

Can Sustainability Pay Off? Evaluating ESG Disclosure and Financial Outcomes in Chinese's Health Care Firms

ABSTRACTThis study analyzes the influence of environmental, social, and governance disclosure (ESG) on the financial performance (FP) of health care firms listed in Shanghai and Shenzhen Stock Exchange Markets in China. Based on both stakeholder and signaling theory, using panel data from 2012 to 2022 Ordinary Least Squares (OLS) and System Generalized Method of Moments (GMM), we investigate the influence of ESG overall disclosure score together with their individual components (environmental, social, and governance) on the FP of health care firms. We find that ESG activities have a significant positive impact on the company's both accounting and market‐based measures of performance. In addition, governance and social activities have a positive significant effect on FP. However, environmental activities and disclosure were negatively and significantly associated with FP. The study provides novel insights by describing the nuanced financial trade‐offs of ESG practices in a highly regulated and capital‐intensive industry like health care. It contributes to the literature by emphasizing that although environmental investments may hinder short‐term FP, strong governance and social activities remain essential drivers of sustainable performance in health care. The study provides empirical insights on how ESG practices impact FP in the health care industry and complements the available literature on the economic efficiency of ESG performance, particularly in FP. This calls for more refined ESG strategies tailored to sector‐specific realities.

ADHERENCE TO THE WHO CRITERIA ON DRUG PROMOTION LITERATURE: AN EVALUATION OF PHARMACEUTICAL ADVERTISING AT A TERTIARY HEALTHCARE FACILITY IN NORTH INDIA

Objective: This research seeks to evaluate how closely drug promotional materials at a tertiary care center in North India follow the WHO’s ethical standards. Methods: A cross-sectional analysis was carried out, involving the organized gathering of drug promotion literatures (DPLs) from the healthcare institution over a specific timeframe. A checklist, derived directly from the WHO’s guidelines for ethical drug promotion, was used to evaluate the DPLs’ content. The data were thoroughly examined to determine the degree of adherence to the WHO standards. Results: In an analysis of 149 DPLs, all included both generic and brand names. Information on the amount of active ingredient and therapeutic applications was present in 91% and 86% of the DPLs, respectively, and dosage forms appeared in 91%, with the remainder depicted pictorially. Only 32% of DPLs described the pharmacological mechanism. Details about side effects and significant adverse drug reactions, as well as precautions and warnings, contraindications, and major drug interactions, were included in 19%, 16%, 18%, and 11% of DPLs, respectively. The manufacturer’s name was mentioned in 72% of the documents, while the manufacturer’s address appeared in 26%. References to scientific literature were included in just 29% of the DPLs. Conclusion: This research highlights the need for improved oversight and regulation of drug promotion activities within the healthcare facility. Less than 20% of DPLs provide information on drug safety. Compliance with the WHO standards is crucial for ethical drug promotion, protecting patient care, and maintaining the integrity of healthcare services. Cooperative initiatives among healthcare facilities, pharmaceutical firms, and regulatory agencies are urgently required.

Impact of intellectual capital on financial competitiveness in context of listed Indian healthcare enterprises

PurposeThis study aims to determine impact of Intellectual Capital (IC) and its constituents in impacting Financial Competitiveness (FC) of Standard & Poor’s Bombay Stock Exchange Healthcare index constituents for years 2013–2023.Design/methodology/approachThis research work used Modified Value-Added Intellectual Coefficients model to gauge IC, whilst an index has been used to apprehend alterations in FC of enterprises. Generalised method of moments (GMM) model was used to determine association between IC and FC of these enterprises.FindingsResults demonstrated that IC in entirety had a notable role in FC of healthcare firms. Results showed that human and relational capital had an affirmative role, while structural capital, capital employed and innovation capital had adverse roles in competitiveness.Research limitations/implicationsThis study provides important contributions to academicians, researchers, management, directors and policymakers by equipping them for preparing a roadmap for future performances. Outcomes imply that IC and its segments must be efficaciously managed in the highly knowledge intensive and intricately interconnected healthcare sector, to establish greater competitive acumen thereby rendering improved and superior results.Originality/valueThis work focusses in lesser researched Indian healthcare sector, scrutinising association between IC efficiency and FC for years 2013–2023.

Current Liabilities and Financial Performance of Healthcare Firms in Nigeria

The study evaluated the relationship between current liabilities and financial performance of healthcare firms in Nigeria. The specific objectives of the study are to assess the effect of Trade Payables, Current Tax Liabilities and Short-Term Borrowings on Return on Assets of Healthcare firms in Nigeria. Ex post facto research design was adopted. Data were collected from annual reports and accounts of sampled firms within the industry to test the null hypotheses that selected current liabilities do not affect return on assets significantly. Correlational analysis was the tool of analysis using panel data set covering Fifty (50) observations from Five (5) firms in the Healthcare sector. The findings revealed that Trade Payables (TP) have weak but significant positive relationship with Return on Assets of Healthcare firms in Nigeria with a correlation coefficient of 0.524514 and a p-value of 0.0001. Current Tax Liabilities have weak but significant positive relationship with Return on Assets of Healthcare firms in Nigeria with a correlation coefficient of 0.539686 and a p-value of 0.0001. Short-Term Borrowings have weak but significant positive association with Return on Assets of Healthcare firms in Nigeria with a correlation coefficient of 0.538232 and a p-value of 0.0001. The implication of the findings is that current liabilities such as trade payables, current tax liabilities and short-term borrowings are significant positive determinants of financial performance of healthcare firms in Nigeria. The study therefore concluded that while the observed relationships were statistically significant, the weak correlations suggest that other factors not examined in this study may have stronger association with return on assets of healthcare firms. The study recommends that effective management of trade payables and current tax liabilities is essential for healthcare firms to successfully navigate the tedious regulatory requirements and enhance financial performance. Furthermore, strategic utilization of short-term borrowings would provide healthcare firms with the necessary financial flexibility to support growth initiatives and address short-term funding needs.

Cash flow Practices and Dividend Policy of Listed Health Care Firms in Nigeria

Cash flow Practices and Dividend Policy of Listed Health Care Firms in Nigeria

Public Healthcare Spending, Business Dynamism, and Wage Inequality: Evidence from Developed and Developing Economies

AbstractThis paper examines the effects of public healthcare spending on wage inequality and social welfare in an economy with rural and urban regions. The objectives are twofold. First, we introduce a simple theoretical framework that captures the link between public healthcare spending and firms' output choice and subsequent wage provisions. We demonstrate that in the short run, a rise in public healthcare services can increase urban output and lower urban unemployment and raise both skilled and unskilled wage rates. In the long run, firm entry produces a business‐dynamism effect that enhances the rate of return on capital, reduces the unskilled wage rate and intensifies wage inequality. Second, we empirically test our theoretical predictions using data from 112 economies in the period 2006–2018. We find evidence supporting our theoretical findings concerning the effects of public healthcare on wage outcomes, especially in the long run. Results are highly consistent across the two groups: advanced economies (mainly OECD/European economies), and emerging and developing economies based on alternative measures for wage inequality, including the GINI coefficient and top income share. The paper provides useful information for the public healthcare policy.

The Relation between ESG Performance and Financial Performance: Evidence from Healthcare Firms

The Relation between ESG Performance and Financial Performance: Evidence from Healthcare Firms

Metaverse adoption as a cornerstone for sustainable healthcare firms in the industry 5.0 epoch

PurposeThis research looks into the revolutionary potential of Industry 5.0, healthcare, sustainability and the metaverse, with a focus on the transformation of healthcare firms through cutting-edge technologies such as artificial intelligence (AI) and Internet of Things (IoT). The study emphasizes the significance of sustainability, human-machine collaboration and Industry 5.0 in the development of a technologically advanced, inclusive and immersive healthcare system.Design/methodology/approachThe study surveyed 354 medical professionals and used structural equation modeling (SEM) to investigate healthcare sustainability, Industry 5.0 and the metaverse, emphasizing the integration of modern technology while maintaining ethical issues.FindingsThe findings highlight Industry 5.0’s and the metaverse’s transformational potential in healthcare firms. The study finds that human centricity (HC) has only a minor direct impact on healthcare sustainability, whereas intelligent automation (IA) and innovation (INN) play important roles that are regulated by external factors.Practical implicationsUtilizing IA inside healthcare organizations can result in significant industrial advancements. However, these organizations must recognize the importance of moderating factors and attempt to find a balance between INN and thesev restraints.Originality/valueThis study makes a substantial contribution to the field by investigating the potential of Industry 5.0, healthcare, sustainability and the metaverse. It discusses how these advances can transform healthcare firms, with an emphasis on patient-centered treatment, environmental sustainability and data ethics. The study emphasizes the importance of having a thorough awareness of these trends and their implications for healthcare practices.

COVID-19 IMPACT ON DEBT CHOICES OF HEALTHCARE COMPANIES: EVIDENCE FROM INDONESIA

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has had a huge global impact since its emergence in December 2019. This research explores the various impacts of the pandemic on the Indonesian economy, with a particular focus on the healthcare sector from 2019 to 2022. This research aims to determine the impact of COVID-19 on debt choices in the health sector listed on the IDX. The research timeline encompasses the years 2019 through 2022, designating the period from 2019 to 2021 as the active COVID-19 timeframe, with 2022 denoted as a post-COVID-19 phase. Debt choice is represented by the debt-to-equity ratio (DER). Then, this research uses panel data, which is secondary data. This research uses Repeated Measure ANCOVA, which is regressed using the STATA 14.2 application. This research concludes that the COVID-19 pandemic affects the debt choices of healthcare companies. The findings support the idea that the pandemic has a marked impact on the debt choices of healthcare firms in Indonesia, emphasizing the need for adaptability in financial strategies during times of significant global disruption.

Impact of Capital Structure on Financial Performance of Firms in the Nigerian Health Care Sector

This study aims to explore how the capital structure affects the financial performance of healthcare companies listed on the Nigerian Stock Exchange (NSE) from 2012 to 2021. Capital structure which considers how a company combine its mix of equity and debt in financing its business is important to its overall operations and growth. To conduct this research, eight healthcare firms listed on the NSE were deliberately chosen. The study examined the financial data of various firms, through their annual reports. The data included short-term and long-term debts, equity (the value of a company's shares), return on equity, and size. The study used correlation and regression for its analysis. The results showed that short-term debt, long-term debt, and equity had a negative but significant relationship with return on equity. However, the size of the company had a positive and significant relationship with return on equity. Based on the findings, the study recommends that healthcare firms should consider using long-term debts to increase the time to repay the borrowed capital and generate more profit.

The Role of Cloud Integration in Healthcare Sector: A Comprehensive Review

Abstract: Cloud computing has become a game-changing technology that will have a significant impact on many other industries, including healthcare. This research paper provides a thorough analysis of cloud computing's role in the healthcare industry, emphasizing its uses, advantages, difficulties, and potential. Healthcare firms may improve patient care, streamline operations, and increase overall efficiency by utilizing the scalability, flexibility, and affordability of cloud-based solutions. Cloud computing adoption in the healthcare industry is not without its difficulties, though, as security, privacy, and regulatory issues are major obstacles. It highlights the enormous potential of cloud computing to alter the delivery of healthcare services by examining these issues and offering solutions

Strategic Assessment of Intricacies in Healthcare Cyber Security: Analyzing Distinctive Challenges, Evaluating Their Ramifications on Healthcare Delivery, and Proposing Advanced Mitigation Strategies

Healthcare firms have access to highly sensitive and valuable data, such as patient health records and payment card information. They are also becoming more reliant on Internet of Medical Things (IoMT) devices to provide treatment, and assaults on this networked equipment can result in data breaches or disruptions to crucial care of patients. Hence there is need to critically assess the intricacies in healthcare cyber security by analyzing the unique challenges facing healthcare sector, their impact on healthcare delivery and suggest some effective cyber security measures to mitigate the identified Cyber security challenges facing health care sector. The research employs a quantitative method by using the descriptive and survey approach through the use of questionnaires to elicit and gather relevant information regarding the Unique Cyber security Challenges in the Healthcare Industry. The descriptive method was used to achieve the objectives of the study while the survey technique was used to get qualitative information from respondents about effect of those cyber security challenges in the health care industry. The target sample size used for this study was 1300. However, only 980 responses were recovered and used for the analysis. Future research work suggested that strong encryption procedures can be developed and implemented for healthcare security, sophisticated anomaly detection tools can be incorporated, and cooperative frameworks for information exchange across the healthcare ecosystem could be established. Also the suggested effective measures to mitigate cyber security challenges in healthcare sector can be implemented in order to secure the patient sensitive and valuable data.

Customer search strategies of entrepreneurial telehealth firms – how effective is effectuation?

PurposeThe demand for healthcare innovation is increasing, and not much is known about how entrepreneurial firms search for and sell to customers in the highly regulated and complex healthcare market. Drawing on effectuation perspectives, we explore how entrepreneurial digital healthcare firms with disruptive innovations search for early customers in the healthcare sector.Design/methodology/approachThis study uses a qualitative, longitudinal multiple-case design of four entrepreneurial Nordic telehealth firms. In-depth interviews were conducted with founders and senior managers over a period of 27 months.FindingsWe find that when customer buying conditions are highly flexible, case firms use effectual logic to generate customer demand for disruptive innovations. However, under constrained buying conditions firms adopt a more causal approach to customer search.Practical implicationsManagers need to gain a deep understanding of target buying environments when searching for customers. In healthcare sector markets, the degree of flexibility customers have over buying can constrain them from engaging in demand co-creation. In particular, healthcare customer access to funding streams can be a key determinant of customer flexibility.Originality/valueWe contribute to effectuation literature by illustrating how customer buying conditions influence decision-making logics of entrepreneurial firms searching for customers in the healthcare sector. We contribute to entrepreneurial resource search literature by illustrating how entrepreneurial firms search for customers beyond their networks in the institutionally complex healthcare sector.

Cash Flow Ratios and Business Failure of Healthcare Firms in Nigeria

The study examined cash flow ratios as predictors of business failure of healthcare firms in Nigeria. The objectives of the study were to ascertain the effect of operating cash flow ratio, cash flow to debt ratio, and price to cash flow ratio on Altman’s zeta score of healthcare firms in Nigeria. The study adopted ex-post-facto research design, covering a period of 10 years (from 2013 to 2022). Secondary data used for the study were extracted from annual reports and accounts of selected healthcare firms listed on the Nigeria Exchange Group (NGX) from 2013 to 2022. Multiple regression technique was used to test the hypotheses. The result of the test of hypotheses revealed that the operating cash flow ratio has a statistically non-significant negative effect on the Altman z-score of healthcare firms in Nigeria (p-value = 0.3397). The finding also indicates that the cash flow to debt ratio has a statistically non-significant negative effect on the Altman z-score of healthcare firms in Nigeria (p-value = 0.2937). Lastly, the finding reveals that the price to cash flow ratio has a non-significant positive effect on the Altman z-score of healthcare firms in Nigeria (p-value = 0.5281). The policy implications of these findings suggest that when assessing the financial health and bankruptcy risk of healthcare firms in Nigeria, policymakers and regulators should consider factors beyond cash flow ratios. It was recommended therefore that healthcare firms in Nigeria should diversify their sources of cash flow beyond operating cash flow to improve financial stability and mitigate bankruptcy risk. Healthcare firms should have a careful evaluation of debt management practices is necessary to maintain a healthy balance between cash flow generation and debt obligations in healthcare firms. Market sentiment reflected in the price to cash flow ratio should not be relied upon as the sole indicator of financial stability. Healthcare firms should prioritize fundamental financial and operational indicators to assess their financial health and mitigate bankruptcy risk.

Opportunities Presented by COVID-19 for Healthcare Green Supply Chain Management and Sustainability Performance: The Moderating Effect of Social Media Usage

This research explores the opportunities presented by COVID-19 for green supply chains' environmental practices and ecological sustainability performances in the healthcare sector. This study investigates the connections between uncertainty-fear of COVID-19, healthcare green supply chain management (GSCM), and the three pillars of a firm's sustainability performance (environmental, economic, and social). Moreover, this study examines the moderating role of social media usage (SMU) on the effect of uncertainty-fear of COVID-19 on healthcare-GSCM. When conducting the empirical part, this study uses the partial least squares structural equation modeling method based on a sample of 483 healthcare managers. The findings prove that the uncertainty-fear of COVID-19 has a beneficial impact on healthcare-GSCM. Besides, SMU moderates the relationship between uncertainty-fear of COVID-19 and healthcare-GSCM, indicating the importance of SMU in gathering information for the healthcare sector during COVID-19. Likewise, when interacting with healthcare firms' sustainability performances, healthcare-GSCM positively impacts environmental and social performances, though it has a negligible impact on economic performance. This study adds to the “social cognitive theory” by introducing the concept of uncertainty-fear of COVID-19. Furthermore, this research adds to the “resource-based view theory” and the “knowledge-based view theory” by exploring the SMU's role during the outbreak.

A study and analysis on the role of legal accounting in fraud detection and prevention

Forensic accountants are CPAs that look for evidence of crimes and commonly work for insurance companies, financial institutions, and law enforcement agencies. Forensic accountants analyze financial records and accounts that may be used as legal evidence and often testify in court cases as expert witnesses. Forensic accounting is a specialized area of accounting and a challenging one. A forensic accountant investigates incidents of fraud, bribery, money laundering and embezzlement by analyzing financial records and transactions, tracing assets, and more. This study on forensic accounting services and fraud prevention was empirically investigated. The study is vital as it portrays the extent to which the application of forensic accounting services influence the incidence of fraud in health care firms in Nigeria. Two hypotheses were formulated to guide the investigation and the statistical test of parameter estimates was conducted using Kendall’s Coefficient of Concordance. The study anchored on the White Collar Crime Theory adopted a Survey Design Approach. Hence, data were collected using questionnaire survey administered to the relevant accounting sections of health care firms in Nigeria. The empirical analysis of the study indicates that the application of forensic accounting service has reduced the incidence of frauds and has also led to fraud prevention at 1% significant level. Thus, the study concludes that the application of forensic accounting services prevents fraud in health care firms in Nigeria. In lieu of this, the study recommended that adequate internal control system should also be established to have checks and balances among the staff to reduce fraud to its nearest minimum, thereby, restoring confidence to potential and prospective investors. Also, since staff of health care firms in Nigeria are strategic in prevention of fraud, their remunerations and welfare should be made a priority and taken serious. Also, training and re-training of these staff would encourage them to detect early warning signals for fraud activities in the company.

Integrating Adam Optimizer to Enhance Efficiency of Transfer Learning Model for Diagnosing Cancers

Despite huge advancements in medical fields, diseases like cancer continue to plague people since we are still prone to them. The main purpose is to design a critical analysis of cancers, including breast, pancreatic, colon, skin, lung, and other cancers from the year 1990 to 2019, to identify some of the rising factors of both lung and colon cancers that cause unnecessary deaths. Thus, early detection on the other hand greatly improves the chances of survival rates in humans. At that place, Transfer Learning (TL) techniques have made significant improvements these days.
 Material and Methods: We herein implemented the exploratory data analysis (EDA) technique to analyze 29 types of cancer deaths worldwide since 1990th century. Between them, we have emphasized lung cancer (LC) and colon cancers (CC) for our study and taken 25,000 histopathology image data from the publicly available Kaggle repository. Further, we proposed a novel methodology using the EfficientNetB7 model defining each step to classify five types of lung and colon tissues (two benign and three malignant) from the histopathological images. Although, an algorithm has been designed that clearly describes the workflow of our proposed method. This experiment has been done through input_shape=(X, Y, 3) on the ‘ImageNet’ dataset, Adam optimizer, and accuracy metrics using Python 3.8.8 software on Jupyter 6.4.3 environment.
 Results: We evaluated the model progress using 50 epochs during the training phase, which resulted in more than 98% accuracy and less than 2% loss in both the training/ validation phases. Besides that, we designed a classification report that describes the performance of our model, where we achieved more than 98.07% accuracy score, 98% precision score, 98% of recall score, and 98% of f1-score. These results signify that implementing an optimization technique on the EfficientNetB7 model improves the overall performance as compared to 93.19% for LC 1 and 93.91% for CC 2 for the RestNet50 model.
 Conclusion: A novelty of this research specifies the methodology to predict LC and CC by applying the EfficientNetB7 model to the cancer dataset which might be beneficial for both doctors as well as healthcare firms.

Brand Trust and Brand Evangelism of Healthcare Firms in South- South Nigeria: The Moderating Role of Brand Love

When we consider that humans, plants and animals receive their wellness and wellbeing from medical products and services in modern society, we see that it is vitally important that firms in the healthcare ecosystem recognize and nurture customers’ trust and love for their brands. This study carefully investigated the impact of brand trust on brand evangelism of healthcare firms in south-south Nigeria and the moderating role of brand love. In spite of the growing insight into customers’ brand relationship and its impact on brand evangelism in developed economies, brand trust and evangelism for healthcare brands in south-south Nigeria, remains tenuous, revealing a significant gap in literature. Addressing this gap, we adopt the Commitment-trust Theory perspective to uncover how customers’ trust in healthcare brands can impact on brand evangelism. A quantitative and exploratory research design was the methodological approach employed to investigate customers of healthcare firms in south-south Nigeria. Due to the infinite nature of the population, the cluster probability sampling technique was used and the population divided into twenty (20) clusters of adults within the ages of 25-55years in Akwa Ibom, Bayelsa, Cross River, Delta, Edo, and Rivers State. Hence, one hundred (100) copies of questionnaire in a five-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree were designed and administered to obtain primary data. With the aid of the International Business Machine (IBM), Statistical Package for the Social Sciences (SPSS) software, version 23, multiple linear regression was used to determine the degree of impact brand trust has on brand evangelism while Andrew F. Hayes’ PROCESS Procedure for SPSS Version 4.2 was used to determine the extent of moderation of brand love on the impact of brand trust (brand credibility and brand integrity) on brand evangelism of healthcare firms in south-south Nigeria. In view of the test result

Innovation, advertising, personal selling, and sustainability in the industries massively benefited from major public health emergencies: paradoxical evidence from China.

While major public health emergencies have severe socio-economic impacts, they may also present many opportunities for certain industries. For these industries that have benefited significantly (e.g., China' s healthcare industry), the traditional emphasis on improving business performance through increased investment in innovation, marketing and sustainability may face contextual applicability challenges. We used the data of healthcare industry in China during Covid-19 and the methods of hierarchical regression, moderating effect test to analyze the impact of innovation, advertising, personal selling, and sustainability on healthcare firms' profitability. Three kinds of robust test including increasing the measurement range of variables, changing the data source and parameter estimation method, and Quantile regression are used. This paper finds that innovation, advertising, and environmental sustainability have significant negative impacts on profitability, while personal selling, social sustainability, and governance sustainability have significant positive impacts on profitability in the industries massively benefited from major public health emergencies. Besides, social sustainability can significantly moderate the relationship between innovation and profitability. On one hand, for companies in industries that have benefited greatly from major public health emergencies, a shift in resource allocation from innovation, advertising, and environmental sustainability to personal selling, social sustainability, and governance sustainability may be more conducive to improving their profitability. On the other hand, for public health regulatory authorities, it is necessary to strengthen the supervision of sales representatives of health care enterprises, hospitals, public health organizations, etc., and appropriately subsidize the innovation of enterprises to enhance their innovation motivation.

Nexus between technology enabled supply chain dynamic capabilities, integration, resilience, and sustainable performance: An empirical examination of healthcare organizations

Due to the twin impacts of the COVID-19 pandemic and sustainability requirements, many healthcare organizations face disruptions and uncertainties, which put patient safety at risk and decrease the overall quality of health services. Drawing on the dynamic capability view, this study aims at exploring the relationship among supply chain dynamic capabilities (SCDCs), supply chain integration (SCI), supply chain resilience (SCR), sustainable competitive advantage (SCA), and sustainable supply chain performance (SSCP). The study collected 325 usable responses from healthcare supply chain organizations in the developing country of Pakistan, including hospitals, pharmaceutical manufacturing firms, surgical and equipment manufacturing firms, etc. Structural equation modeling using Smart-PLS v.3.3.2 was adopted for the data analysis. The results indicate that SCDCs positively influence SCI, SCR, SCA, and SSCP. This study finds that SCA, SCI, and SCR mediate the relationship between SCDCs and SSCP. This study contributes by aligning the SC dynamic capabilities for supply chain visibilities (i.e., sensing, learning, and coordinating) in the healthcare context. It has examined the impacts of SCDC, SCI, and SCR collectively rather than addressing them piecemeal. Sensing, learning, and coordinating capabilities through frequent collaborative meetings offer healthcare firms SC integration, allowing them to respond to the changing environment quickly and resiliently, further improving their SCA and SSCP. Since disruptions are inevitable, healthcare organizations must turn uncertainties into opportunities and activate a dynamic and resilient strategy to absorb stress. SCA and SSCP improve when SCDCs/SCR and disruptions are properly balanced.