High Level Of Uncertainty Research Articles

Researching two Compassionate Cities: Study protocol for a mixed-methods process and outcome evaluation.

Background/Targeted community: Compassionate Cities are social ecology approaches that apply a set of actions, targeting a broad range of stakeholders, with the intention of renormalising caring, dying and grieving in everyday life. While several initiatives have been described in the literature, a rigorous evaluation of their processes and outcomes is lacking. This paper describes the protocol for a mixed-methods study to evaluate the development process and the outcomes of two Compassionate Cities in Flanders, Belgium. 
 Involved stakeholders: While the concept of Compassionate Cities is introduced by the researcher to the cities of Bruges and Herzele, the development is realised through the input from involved local stakeholders and the local project leaders. The project leaders are appointed by the cities of Bruges and Herzele. Their primary task revolves around coordinating the project and guarding its cocreational character. The stakeholders can be anyone with an interest in developing the Compassionate Cities. A community facilitator with expertise in change projects guides, with respect to local ownership, the development of both Compassionate Cities.
 Methods and analysis, planning: We will use a convergent multi-phase mixed-methods design, in which a combination of qualitative and quantitative data collection methods will be triangulated in the data analysis stage to capture both development processes and outcomes. Our design includes a quasi-experimental component of a quantitative outcome evaluation in both Compassionate Cities and two comparable control cities with no formal Compassionate City programme. A critical realism lens will be applied to understand how and why certain processes manifest themselves.
 Discussion: The creation of Compassionate Cities implies high levels of complexity, adaptivity, unpredictability and uncertainty. This requires various data collection methods that can be applied flexibly. A researcher taking on the role of active participant in the project’s development has several advantages, such as access to scholarly information. Reflexivity in this role is paramount to questioning where the ownership of the project lies. By applying a critical realism lens, we remain cautious about our interpretations, and we test the homogeneity of our findings through other forms of data collection.
 Learning for the international audience: This is the first published study protocol to describe both a process and outcome evaluation of a Compassionate City project. By transparently describing our aims and data collection methods, we try to maximise information exchange among researchers and to inform others who desire to implement and evaluate their own initiatives.

Reducing Costs and Creating Value in the Hotel Industry - Forced Good Practices

External business environmental challenges such as the effects of climate change and sustainable operation required hotel managers to take strategically planned action. All of this was exacerbated by the COVID-19 pandemic, which appeared in several waves from 2020, and the energy crisis resulting from the Ukrainian-Russian armed conflict. The periodic return of the pandemic has created a high level of uncertainty not only for operators but also for workers. The energy price boom that unfolded from the second half of 2021 required cost-saving solutions from market players that typically necessitate a significant investment and provide a long-term return. In the planning process, the guest experience and value-added approach became paramount, as the long payback period required forward thinking and good prediction of the future. In this article, focusing on relevant literature sources and using a constructivist grounded theory strategy, data mostly from the period between 2020 and 2022 has been collected and analysed, . The purpose of these two research questions is to answer what challenges Hungarian hotel market players face and what factors negatively impact their business during the period of 2020 and2022, as well as how hotel operators respond to the identified challenges and how these responses relate to the global best practices. In addition to studying general cost-saving practices in Hungarian hotels, the focus is on improving the guest experience and providing operators with real cost-effective operational solutions. Value creation occurs in all areas of hotel operations, including front and back-of-house work areas. Solutions such as heating system modernisation, digitalisation, organisational development and outsourcing of activities will be presented.

SYSTEM-PARAMETRIC IMPERATIVES OF THE DEVELOPMENT OF AQUACULTURE IN THE UKRAINIAN BLACK SEA REGION

Topicality. Modern socio-economic development is characterized by a steady growth of resource-ecological, economic, political and other crisis problems. These factors create a high level of threats to food security both at the national and international levels. For Ukraine, this problem is actualized as a result of russia's military aggression. This situation determines the need for comprehensive knowledge of the specified problems in the interests of sustainable development of Ukraine.
 Aim and tasks. The purpose of the article is a scientific and methodological search for promising directions and effective solutions to the problems of sustainable food security in Ukraine over a fairly long time scale. At the same time, the task of scientific substantiation of the mobilization strategy for the development of domestic (within the territory of Ukraine) natural resource potential of aquaculture is set.
 Materials and methods. Regulatory and legal materials, including the Law of Ukraine "On Aquaculture", the report of the State Fisheries Agency of Ukraine, etc., which determine state policy in the field of fisheries and aquaculture development, were used as the information base of the research. The methodology and methods of the theory of complex systems, the principles of nonlinear and synergistic interpretations, etc. are used as tools for solving the tasks in the work.
 Research results. The scientific and economic foundations of the development of the aquaculture development program based on the natural resource potential of the Ukrainian Black Sea region have been developed. The work presents the results of research related to the formation of a conceptual basis for the development of a program-oriented direction of aquaculture development in relation to the conditions of Ukraine. Based on the high level of uncertainty of the studied problems in the work, the field of aquaculture of the state (region) is considered as a complex (non-linear) socio-ecological-economic system (SEES). Particular importance in the work is given to the question of the methodology of forming a system of imperatives for the development of complex objects, which is considered according to such directions as actual, categorical, modal and hypothetical imperatives. The specified system of imperatives is considered in connection with other development factors as one of the important elements of the driving forces of the development of the SEES, in relation to the conditions of development of the Ukrainian Black Sea region.
 Conclusion. Methodological and methodological approaches to the system-parametric understanding of complex socio-ecological-economic objects discussed in the work are an important basis for substantiating effective directions of development and ways of solving problems of sustainable development of natural and economic systems. The development of aquaculture in the Ukrainian Black Sea region is considered as a problem of solving the issues of ensuring national food security, improving the quality of life of the country's population and a factor in the revival of Ukraine as a maritime state.

Exploring the interplay between entrepreneurial orientation, causation and effectuation under unexpected covid-19 uncertainty: Insights from large French banks

Entrepreneurial orientation, causation, and effectuation are the main strategies that firms use to address businesses under high uncertainty conditions. This study investigates the influence of internal (entrepreneurial orientation) and external contingency factors (the COVID-19 crisis) on both decision-making logics effectuation and causation in response to disruption. The study also investigates how and when the combination of effectual, causal, and entrepreneurial approaches positively affects bank outcomes. Using a qualitative method and data collected from five large French banks, the results revealed that under, high levels of uncertainty (i.e., the COVID-19 crisis), high entrepreneurial-oriented banks benefitted from the combination of effectuation and causation to produce favorable outcomes. In contrast, moderate or weak entrepreneurial-oriented banks, which tended to exploit the logic of effectuation driven by new resources or the resources at hand, showed inferior or even negative financial results compared to those with a strong entrepreneurial orientation.

Attribution of neuropsychiatric symptoms and prioritisation of evidence in the diagnosis of neuropsychiatric lupus: mixed methods analysis of patient and clinician perspectives from the international INSPIRE study.

Neuropsychiatric lupus (NPSLE) is challenging to diagnose. Many neuropsychiatric symptoms, such as headache and hallucinations, cannot be verified by tests or clinician assessment. We investigated prioritisations of methods for diagnosing NPSLE and attributional views. Thematic and comparative analyses were used to investigate how clinicians prioritise sources of evidence from a 13-item list, and explore discordances in clinician and patient perspectives on attribution. We identified high levels of variability and uncertainty in clinicians' assessments of neuropsychiatric symptoms in SLE patients. In attributional decisions, clinicians (surveys n = 400, interviews n = 50) ranked clinicians' assessments above diagnostic tests (many of which they reported were often unenlightening in NPSLE). Clinicians ranked patient opinion of disease activity last, and 46% of patients reported never/rarely having been asked if their SLE was flaring, despite experienced patients often having "attributional insight". SLE Patients (surveys n = 676, interviews n = 27) estimated higher attributability of neuropsychiatric symptoms to the direct effects of SLE on the nervous system than clinicians (p < 0.001 for all symptoms excluding mania), and 24% reported that their self-assessment of disease activity was never/rarely concordant with their clinicians. Reports of misattributions were common, particularly of non-verifiable diffuse symptoms. Terminology differed between clinicians and influenced attribution estimates. NPSLE diagnostic tests and clinician assessments have numerous limitations, particularly in detecting diffuse neuropsychiatric symptoms that can be directly attributable and benefit from immunosuppression. Our findings suggest that incorporating patient attributional insights-although also subject to limitations-may improve attribution decision-making. Consensus regarding terminology and interpretations of "direct attributability" is required.

Fearful pathways to social entrepreneurship intention: A fuzzy-set qualitative content analysis

The context of social entrepreneurship, the constantly evolving challenges that it seeks to resolve, and the accompanying high levels of uncertainty creates a useful opportunity context for us to study the dynamics of fear of failure. Fear of failure has been championed as an ideal construct for developing understanding of entrepreneurial motivation as it impacts on one's level of entrepreneurial intention. Most research has taken fear of failure to be absolute, you either fear failing in entrepreneurship as a whole or you do not. Furthermore, research has largely focused on fear of failure's debilitative effects which can limit our understanding of a rich and complex construct. In this paper we embrace fear of failure's complexity via drawing on contemporary work on both it's situated nature and how it interacts with the entrepreneur-opportunity nexus. We use Fuzzy-set Comparative Qualitative Analysis (fsQCA) on a sample of 173 entrepreneurship undergraduate students in Spain. Our findings uncover the equifinal pathways that can lead to a social entrepreneurship intention.

A coupled approach for planning in vulnerable coastal landscapes

One of the most problematic steps in planning and management of vulnerable coastal systems under high level of uncertainties is anticipating potential design scenarios where multiple spatial scales interact. The mutual interference between beach morphodynamics and infrastructural needs of the wide territory poses several questions to urban planners and architects. In this study we assess the ability of the proposed coupled approach of MIKE 21 Spectral Wave and XBeach to significantly improve our understanding of vulnerable barrier beaches in urbanized areas, and hence to contribute to improved system design and management. Specifically, to improve the result accuracy and the time-computational efficiency of the proposed coupled approach, an additional module was developed. Located in the West Metropolitan Area of Cagliari city (Sardinia, IT), the barrier beach of La Playa is an important evacuation route that has experienced a coastal squeeze process under the increase in magnitude and frequency of sea storms. From an extensive beach survey, the “whole model composition” supports the selection of the territorial scale as the reference for defining a potential design scenario at the local scale in La Playa beach. While ordinary (10-year return time) storms create a nearshore sand berm with a protective function for the barrier beach and evacuation route against future storms, extreme (140-year return time) storms significantly erode the beach with a shoreline moving approximately 15 m landward and an overwash of Qcrest >20 l/m/s. Acting as a rigid impermeable obstacle against landward barrier migration, the evacuation route is destroyed. Urban planners and architects should consider the downgrade of the evacuation route as a part of a design potential scenario capable of minimizing the territorial vulnerability and reducing the local vulnerability. Rebuilt with environment-friendly functional road materials, this design scenario can also define a new flexible landward limit of the barrier beach and restore an eventual migration.

Cost-effectiveness of Spironolactone for Adult Female Acne (SAFA): economic evaluation alongside a randomised controlled trial

ObjectiveThis study aims to estimate the cost-effectiveness of oral spironolactone plus routine topical treatment compared with routine topical treatment alone for persistent acne in adult women from a British NHS...

Ablative and non-surgical therapies for early and very early hepatocellular carcinoma: a systematic review and network meta-analysis.

A wide range of ablative and non-surgical therapies are available for treating small hepatocellular carcinoma in patients with very early or early-stage disease and preserved liver function. To review and compare the effectiveness of all current ablative and non-surgical therapies for patients with small hepatocellular carcinoma (≤ 3 cm). Systematic review and network meta-analysis. Nine databases (March 2021), two trial registries (April 2021) and reference lists of relevant systematic reviews. Eligible studies were randomised controlled trials of ablative and non-surgical therapies, versus any comparator, for small hepatocellular carcinoma. Randomised controlled trials were quality assessed using the Cochrane Risk of Bias 2 tool and mapped. The comparative effectiveness of therapies was assessed using network meta-analysis. A threshold analysis was used to identify which comparisons were sensitive to potential changes in the evidence. Where comparisons based on randomised controlled trial evidence were not robust or no randomised controlled trials were identified, a targeted systematic review of non-randomised, prospective comparative studies provided additional data for repeat network meta-analysis and threshold analysis. The feasibility of undertaking economic modelling was explored. A workshop with patients and clinicians was held to discuss the findings and identify key priorities for future research. Thirty-seven randomised controlled trials (with over 3700 relevant patients) were included in the review. The majority were conducted in China or Japan and most had a high risk of bias or some risk of bias concerns. The results of the network meta-analysis were uncertain for most comparisons. There was evidence that percutaneous ethanol injection is inferior to radiofrequency ablation for overall survival (hazard ratio 1.45, 95% credible interval 1.16 to 1.82), progression-free survival (hazard ratio 1.36, 95% credible interval 1.11 to 1.67), overall recurrence (relative risk 1.19, 95% credible interval 1.02 to 1.39) and local recurrence (relative risk 1.80, 95% credible interval 1.19 to 2.71). Percutaneous acid injection was also inferior to radiofrequency ablation for progression-free survival (hazard ratio 1.63, 95% credible interval 1.05 to 2.51). Threshold analysis showed that further evidence could plausibly change the result for some comparisons. Fourteen eligible non-randomised studies were identified (n ≥ 2316); twelve had a high risk of bias so were not included in updated network meta-analyses. Additional non-randomised data, made available by a clinical advisor, were also included (n = 303). There remained a high level of uncertainty in treatment rankings after the network meta-analyses were updated. However, the updated analyses suggested that microwave ablation and resection are superior to percutaneous ethanol injection and percutaneous acid injection for some outcomes. Further research on stereotactic ablative radiotherapy was recommended at the workshop, although it is only appropriate for certain patient subgroups, limiting opportunities for adequately powered trials. Many studies were small and of poor quality. No comparative studies were found for some therapies. The existing evidence base has limitations; the uptake of specific ablative therapies in the United Kingdom appears to be based more on technological advancements and ease of use than strong evidence of clinical effectiveness. However, there is evidence that percutaneous ethanol injection and percutaneous acid injection are inferior to radiofrequency ablation, microwave ablation and resection. PROSPERO CRD42020221357. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) programme (NIHR award ref: NIHR131224) and is published in full in Health Technology Assessment; Vol. 27, No. 29. See the NIHR Funding and Awards website for further award information.

The Impact of Projected Changes in Hurricane Frequencies on U.S. Hurricane Wind and Surge Damage

Abstract We use a simple risk model for U.S. hurricane wind and surge economic damage to investigate the impact of projected changes in the frequencies of hurricanes of different intensities due to climate change. For average annual damage, we find that changes in the frequency of category-4 storms dominate. For distributions of annual damage, we find that changes in the frequency of category-4 storms again dominate for all except the shortest return periods. Sensitivity tests show that accounting for landfall, uncertainties, and correlations leads to increases in damage estimates. When we propagate the distributions of uncertain frequency changes to give a best estimate of the changes in damage, the changes are moderate. When we pick individual scenarios from within the distributions of frequency changes, we find a significant probability of much larger changes in damage. The inputs on which our study depends are highly uncertain, and our methods are approximate, leading to high levels of uncertainty in our results. Also, the damage changes we consider are only part of the total possible change in hurricane damage due to climate change. Total damage change estimates would also need to include changes due to other factors, including possible changes in genesis, tracks, size, forward speed, sea level, rainfall, and exposure. Nevertheless, we believe that our results give important new insights into U.S. hurricane risk under climate change. Significance Statement We investigate how changes in the frequencies of hurricanes of different intensities as a result of climate change may contribute to changes in U.S. economic damage due to wind and surge. We find that economic damage will likely increase as a result of projected increases in the frequency of landfalling hurricanes. Analysis of our results shows that increases in the frequency of category-4 storms are the main driver of the changes. Our best estimate results, based on a multimodel ensemble, give modest increases in damage, but within the ensemble there are individual scenarios that give much larger increases in damage. The large range of individual damage estimates is a motivation for continuing efforts to reduce the uncertainty around hurricane projections under climate change.

Digitizing Halal Tourism and Designing Muslim-Friendly Tourism Categorization as an Effort to Minimize Uncertainty in Halal Tourism in Blitar Raya

Halal tourism in practice is still full of uncertainty. This is due to inconsistency from Muslims, especially in Blitar Raya. This article will discuss three issues, the first is about why halal tourism is still full of uncertainty, the second is designing a Muslim-friendly tourism categorization that supports the implementation of Muslim-friendly tourism and the third is discussing the digitalization of quality Muslim-friendly tourism. This research uses a qualitative method with a mixed approach. The first result of this research is that Muslim-friendly tourism has a high level of uncertainty and causes inconsistencies. Second, uncertainty regarding Muslim-friendly tourism can be minimized by categorizing Muslim-friendly tourism starting from the red, yellow and green categories. Third, this categorization needs to be supported by digitalization to encourage the availability of Muslim-friendly tourism in Blitar Raya.

Nurse escorts' perceptions of nurse-led inter-hospital ambulance transfer in the Wheatbelt region of Western Australia: A descriptive survey study.

The Western Australia (WA) Country Health Service (WACHS) requires the ward or emergency department (ED) registered nurse (RN) to assume the responsibility of conducting nurse-led interhospital patient road ambulance transfers, in the absence of an available registered paramedic (RP). The generalist nurse escort with no specialised training is allocated to the patient transport from their rostered shifts when the need arises, and, in some instances, this nurse may not have been in an ambulance before. Patients requiring transfer are usually prioritised over hospital patient care because of the life-threatening nature of these situations and the urgency to get them to tertiary care facilities. This study explored nurses' perceptions about caring for a patient during road ambulance transfer, with an aim of supporting future policy formulation and decision-making to guide nurses' training, induction and ongoing education on interhospital transfers. To examine the perceptions of hospital-employed registered nurses caring for a patient during road ambulance transfer from rural Western Australia. A descriptive survey design included 23 questions to clarify the level of experience and training, the prevalence of clinical deterioration and the confidence to manage patient care. Findings from the surveys indicated that nurses often felt overwhelmed by the responsibility of the patient transfer, unclear guidelines, limited preparation and handover, lack of orientation to the ambulance environment, difficulty escalating care during transfer and no insight into the return to base process. To explore how the RN who normally works within a well-organised and accessible multidisciplinary team manages caring for a patient in an unfamiliar mobile environment, the study was conducted within WACHS in the Wheatbelt Region of WA involving 27 health care sites. Participating nurses were asked several broad questions to explore their perceptions on how well-equipped they are in managing clinical care and deterioration during transfer; what are the challenges that they face while doing so and how confident they are about their knowledge, skill level and scope of clinical practice in supporting patients during interhospital transfer? Wheatbelt nurse escorts were capable, generalist nurses with a demonstrated skill set in managing patient care during transfer when needed. The 'back of the ambulance' was a challenging environment for nurses to engage in the type of care usually provided in the hospital setting, which come with a high level of uncertainty and anxiety for both patient outcome and own well-being.

Uncertainty Reduction Strategies on Share in Jar Skincare’s Purchase Intention

Share-in-jar skincare products come up with a relatively high level of uncertainty as sales are commonly only made online, thus making it impossible for consumers to ascertain the product’s quality and suitability. Indonesians, on the other hand, are said to have a low uncertainty avoidance, which tends to be more tolerant of uncertainty and is supposed to be less active in seeking information to reduce uncertainty. This study aims to analyse the effect of uncertainty reduction strategies on the purchase intention of share-in-jar skincare products on marketplaces and social networking sites (SNS) in Indonesia. This study used an explanatory quantitative approach with a survey method. It involved 395 Indonesian consumers who had searched for information about share-in-jar skincare products through marketplaces or SNS. The multiple linear regression analysis revealed that Indonesian consumers had a low level of uncertainty avoidance but actively sought information before purchasing products. The passive, active, and interactive strategies simultaneously affected the intention to buy share-in-jar skincare products, but the active strategy had no effect when tested partially. The passive strategy was the most influential uncertainty reduction strategy toward the purchase intention of share-in-jar skincare products.

The impact of geopolitical risks on foreign exchange markets: Evidence from the Russia–Ukraine war

We examine the relationship between geopolitical risks and foreign exchange markets using the Russia–Ukraine conflict as a natural experiment. Our main findings indicate that, due to intensified geopolitical risks, the conflict had a negative effect on foreign exchange rates. This adverse effect of geopolitical risks is more pronounced in countries with high reliance on Russian energy, countries with a high level of economic policy uncertainty, countries with geographic proximity to Russia and Ukraine, and countries where the degree of political rights, and freedom of political expression is elevated. Our additional analyses suggest that the Russian invasion of Ukraine has also negatively affected the return and volatility of the global equity markets.

The effects of high uncertainty risk on international stock markets

AbstractWe conduct an international analysis of the cross-sectional risk premiums of uncertainty risk factors in addition to traditional risk factors. We consider international stock markets in five regions separately. We measure uncertainty by the local and US economic policy uncertainty indices. Economic policy uncertainty risk has negative risk premiums. This implies that investors get lower returns for assets with high uncertainty betas. We further analyze a nonlinear relationship between excess returns and uncertainty risk by adding the downside economic policy uncertainty risk factor which captures high levels of uncertainty, similar to downside market risk. The downside uncertainty risk factor has negative risk premiums.

The improved “four- line model” of the organization of the risk management system in banks and banking groups of Ukraine

Introduction. The deepening global economic downturn, high level of uncertainty and significant losses of Ukraine’s economy as a result of russia’s military aggression lead to restrictions on business activity and require economic agents to focus on improving the efficiency of their activities in the face of a constantly changing landscape of growing risks and limited resources. This is especially true of the banking sector, where transformation processes are ongoing, accompanied by modern external and internal challenges and threats.Purpose. The purpose of the study is to improve the model of organization of the risk management system in banks and banking groups in today’s dynamic environment with a significant level of uncertainty of transformation processes in the country’s financial sector. Methods. To achieve this goal, the research uses both general scientific methods of analysis, synthesis, analogies, and special methods of scientific knowledge, in particular, system analysis, risk management and modeling of the organization of the risk management system in a bank.Results. It is shown that the traditional model of “three lines of defense” against risks recommended for use by Ukrainian banks, as well as the updated “three lines model”, have certain drawbacks due to suboptimal distribution of information and insufficient effectiveness of risk management measures at different levels of management. The well- known model of “four lines of defense” does not take into account the specifics of the subjects of influence on risk management in the banking sector of Ukraine. An improved “four lines model” of organization of the risk management system in banks and banking groups of Ukraine is proposed, which is focused on the synergy of interaction between the subjects of influence and the use of opportunities to achieve certain goals.Perspectives. In the future, it is promising to study the use of artificial intelligence when using the proposed improved «four-line model” in risk management systems.

Fostering supply chain agility by prominent enablers’ identification and developing conceptual modeling based on the ISM-MICMAC approach

PurposeToday’s marketplace has witnessed intense competitive pressures and high levels of uncertainty and disruption. Therefore, supply chains require agility to obtain a sustainable competitive advantage and cope with uncertainties as well as disruptions. Although a wide range of studies exists on supply chain agility (SCA) from the perspective of antecedents or consequences, there is little research on the investigation of enablers of SCA and their relations among them. Furthermore, the literature has investigated proactive and reactive enablers for enhancing SCA, but most studies have not sufficiently framed their analysis of both aspects synchronically. This paper aims to find out the interrelationships among the proactive and reactive enablers for enhancing SCA.Design/methodology/approachAn extensive literature review has been conducted to identify SCA enablers and a Delphi study has been performed to elucidate SCA enablers in the manufacturing industry in Turkey. Interpretive structural modeling (ISM) has been used to identify the contextual relationship among the SCA enablers, and the model has been validated based on Matriced Impact Croises Multiplication Appliquee a un Classement (MICMAC) analysis.FindingsOn theoretical and practical levels, the proposed ISM model in this study can help organizations analyze and interpret interrelationships among enablers of SCA. For managers, it can provide better insights and understanding of the facilitators of SCA to enhance the effectiveness of the supply chain and cope with uncertainties and turbulence. According to results, enhancing “supply and demand side competency”, “delivery speed” and “strategic sourcing” are the most significant enablers of SCA.Originality/valueThe study extends the existing literature related to the enablers of SCA by modeling the proactive and reactive enablers of SCA based on the Al Humdan et al. (2020) classification. Arranging the enablers of SCA in a hierarchy and classifying the enablers into different levels with the help of the ISM-MICMAC approach is an exclusive effort to achieve successful management of the supply chain.

Understanding the Inverted U-Shaped Relationship Between Contractual Complexity and Negotiation Efficiency: An Institutional Perspective

Construction project transactions are characterized by long-term duration and a high level of task uncertainty. Improving negotiation efficiency is of great significance for the handling of task conflicts and completing projects on time. The project contract represents the legal basis for conflict negotiation between the buyer (owner) and the seller (contractor). However, a dispute still exists over the relationship between contractual complexity and negotiation efficiency. To settle this dispute, we draw on institutional theory to establish a research model and use a dataset collected from 327 construction project transactions in China to empirically test it. The results show that the relationship between contractual complexity and negotiation efficiency is inverted U-shaped. The increase in legal enforceability steepens this curvilinear relationship and moves its vertex to the lower right, meaning that the maximum negotiation efficiency is lower in an institutional environment with higher legal enforceability, despite the effect of the contract being more obvious and contractual complexity being more likely to promote negotiation efficiency in a wider range. This article can offer practical guidance for construction project managers to design contracts according to the institutional environment where the transaction is embedded in a manner that promotes negotiation efficiency.

State-level economic uncertainty and cardiovascular disease deaths: evidence from the United States

The relationship between economic recessions and cardiovascular mortality has been widely explored. However, there is limited evidence on whether economic uncertainty alone is linked to cardiovascular disease deaths. This study examines the association between economic uncertainty and mortality from diseases of the circulatory system in the United States. We obtained monthly state-level mortality data from 2008 to 2017 and used indices capturing economic uncertainty from national/international sources and local sources. Panel data modelling was used to account for unobserved time-invariant differences between the states. Our findings suggest that economic uncertainty is independently linked to cardiovascular mortality. Uncertainty arising from national/international sources is associated with cardiovascular deaths, whereas the respective index capturing uncertainty from state/local sources is not. Deaths respond asymmetrically with respect to uncertainty fluctuations – with high levels of uncertainty driving the association. One- and two-month lagged uncertainty levels are also associated with mortality. Several robustness checks further validate the baseline findings. Overall, economic uncertainty is an independent predictor of cardiovascular mortality which appears to act as a psychosocial stressor and a short-term trigger. Public health strategies for cardiovascular disease need to consider factors driving economic uncertainty. Preventive measures and raising awareness can intensify in periods of economic uncertainty.

Digital Transformation and Real Options: Evaluating the Investment in Cloud ERP

The purpose of this research is to explore and advance the knowledge regarding digital transformation. Toward this end, this paper is focused on the valuation of the assessment methodologies of cloud ERP projects. The investment in digitalization systems entails high levels of uncertainty, which gives these investment projects a high strategic value. The importance of emergent digitalization in ERP systems has made it necessary to use assessment tools that consider strategic information as well as financial information. In this paper, the real options methodology, specifically the option to defer, is proposed to account for the strategic value of investment projects in digitalization. In this sense, an empirical study is conducted by applying the binomial option pricing model to real data on the costs and revenue of investing in cloud ERP to study its viability.