High Levels Of Conflict Research Articles

Human–Asiatic black bear (Ursus thibetanus) interactions in the Kaghan Valley, Pakistan

Few studies have reported on the distribution, food choices, general behaviour, and interactions of the Asiatic black bear (Ursus thibetanus) with humans. We explored the conservation status of the species and its conflicts with humans in the Kaghan Valley, northwest Pakistan. From September 2013 to December 2015, residents from 24 villages in three major regions of the Kaghan Valley were interviewed about human–bear conflicts. In parallel, a survey for signs of bear presence was conducted to assess bear presence, including bear attacks and crop damage that occurred during the survey period. Most interviewees (70%) confirmed that human–bear conflicts exist, and that they arise primarily from crop raiding (n = 40), followed by attacks on livestock (n = 32) and humans (n = 15). Most interviewees stated that they actively disliked bears (47.3%), or had a generally negative perception of bears (63.3%). Such responses were strongly associated with living close to or within bear habitat. Bears raided approximately 3.8 ha of maize per year, mainly from July to September. Our survey revealed that bears used habitats ranging from dense forest to scrub lands, but preferred steep, high-altitude habitats with dense tree cover. Anthropogenic activities (such as hunting, clear-cutting, expansion of infrastructure, and conversion of forest to agricultural land) were the main causes of conflict between humans and bears. Future studies should collect data on the movement and habitat use of individual bears to facilitate the development of appropriate management strategies to conserve this species effectively. We also recommend training Wildlife Department employees to interact with the local communities to implement acceptable mitigation measures to reduce the currently high conflict levels and thus improve acceptance for bear presence and conservation.

From conflict to collaboration: can better governance systems facilitate the sustainable development of the northern pastoral industry, communities and landscapes?

The past decade has seen several high profile national policy conflicts related to sustainable development beset the northern Australian pastoral industry. Examples include the live cattle export ban, tree clearing legislation in Queensland and significant pastoral sector concerns about exploration and development of coal and gas reserves across the north. Although these are very legitimate cross-societal debates, the high levels of conflict associated with them impact on the willingness of corporate, family and Indigenous farming enterprises in northern Australia to invest in development. They also affect the willingness and capacities of pastoralists to cooperate with governments in various approaches to change management in northern landscapes. In the pursuit of a better pathway that might resolve policy problems while also delivering industry benefit, this paper analyses several high-profile industry and landscape scale conflicts from recent years, teasing out the key features of governance system dysfunction. At the same time, I also look at positive governance developments emerging in related contexts. Drawing on this analysis, I suggest the current system of governance affecting the northern Australian pastoral industry might have much to learn from the application of more evidence rich and engaging systems of co-management. I suggest that moving in this direction, however, would require Australian, state and Northern Territory (NT) governments to genuinely partner the industry, Traditional Owners and other key sectoral interests, leading to long-term vision building, strategy development and delivery partnerships that benefit industry and communities while resolving wider societal concerns.

Parent Psychopathology and Parent-Child Conflict Interact to Predict Children’s Anxiety but Not Depression

Author(s): Gomez, Valerie; Quinones-Camacho, Laura; Davis, Elizabeth | Abstract: Correlates of child psychology have been studied for decades (Ollendick a Herson, 1989). Researchhas shown that parental psychopathology can influence child psychopathology through a combinationof familial and environmental factors (Biedel a Turner, 1997; Burstein et al., 2010). Parent-childinteractions have also been found to relate to child psychopathology (Donenberg a Weisz, 1997). Apossible explanation for these relations is that the behavior of parents experiencing psychopathologysymptoms differs from parents not facing these difficulties, like displaying more hostile behaviortowards their offspring (Burstein et al., 2010). The present study examines the interaction of parentpsychopathology and parent-child conflict during a stressful task to see if conflict moderated therelation between parents’ and children’s psychopathology. We studied whether the relation betweenparent and child symptoms would be stronger for dyads characterized by conflict. 184 children aged3 to 11 (91 boys and 93 girls) visited the lab. Parents completed questionnaires to measure theirdepression and anxiety symptoms, as well as the child’s anxiety and depressive symptoms. Theparent and the child also participated in a Lego task where instances of child conflict were observed.Results showed that parent anxiety interacted with parent-child conflict to predict children’s anxietysymptoms, such that parents’ anxiety predicted children’s anxiety only among dyads characterizedby high levels of conflict. The same was not true for depressive symptoms. The current study expandsresearch about moderators by showing that the link between parent and child psychopathology isqualified by other aspects of the family environment.

Impact of childhood parent-child relationships on cardiovascular risks in adolescence

This study aims to determine prospective effects of the childhood parent-child relationships on the development of cardiovascular risks in adolescence. Using available 917 parent-child dyads from the Study of Early Child Care and Youth Development (1991 to 2006), we analyzed the prospective effects of childhood parent-child relationships of Conflict and Closeness, as well as their categorized combinations (Harmonic, Dramatic, Hostile, and Indifferent) on the development of subscapular and triceps skinfold thickness (SST/TST), body mass index (BMI), systolic and diastolic blood pressure (SBP/DBP), and heart rate (HR) during adolescence. We found that higher levels of Conflict in the relationship with mothers (slope=0.05, P<0.001) and fathers (slope=0.04, P=0.03) increased the growth rate of TST among girls during adolescence, but not among boys. The maternal-girl dyadic with higher Conflict scores also increased girl's growth rate of BMI percentile (slope=0.10, P=0.02), though the paternal-boy dyadic with higher Conflict scores decreased boy's growth rate of BMI percentile (slope=−0.13, P=0.04). A Hostile maternal-son relationship lowered boy's growth rate of SBP (slope=−3.15, P<0.001) and DBP (slope=−4.42, P<0.001). A Dramatic maternal-son relationship increased boy's growth rate of SST (slope=0.89, P<0.001) and TST (slope=0.64, P=0.03). Hostile paternal-daughter relationships were positively associated with the growth rate of TST (slope=0.28, P=0.03). Overall, there was a significant influence of childhood parent-child relationships on the development of cardiovascular risks during adolescence, and the effect was further modified by both parents' and child's gender.

The Effect of Autism Spectrum Disorders, Down Syndrome, Specific Learning Disorders and Hyperactivity and Attention Deficits on the Student-Teacher Relationship

Introduction. Despite the clear relevance of the Student-teacher relationship, studies have rarely encompassed subjects with special education needs. Our study focused on the differences perceived by teachers in their relationships with these students.Method. We described the results obtained with different groups of children with special education needs: ASDs (N = 14), Down Syndrome (N = 18), Learning Disorders (N = 38) and children with hyperactive behaviors and attention deficits (N = 56). Results from each group were then compared with those obtained by children with typical development (N = 254). The teachers were asked to fill out the Student-Teacher Relationship Scale (STRS).Results. Our study found that the social bonds formed by children with special needs differ for at least one relational aspect from those formed by children taken from the Control Group, the sole exception being children with Down’s Syndrome.Discussion and Conclusion. The Closeness dimension was hampered in the case of children who suffered from ASDs, attention deficits or hyperactive behaviors. Furthermore, the relationships with the latter group of children were characterized by a higher level of conflict and dependency. Children with Learning Disorders also suffered an increase in the dependency dimension.

Teaching in conflict settings: Dimensions of subjective wellbeing in Arab teachers living in Israel and Palestine

The aim of the study was to identify domains of wellbeing that are salient to Palestinian teachers in West Bank, Gaza Strip and Israel. We set out to identify the social and environmental factors that influence the ecological wellbeing of teachers working in environments characterized by high levels of conflict and social exclusion. Sixteen focus group discussions were conducted with 104 teachers and interviews were administered to 36 key informants. Thematic content analysis was applied to the data using a combination of bottom-up and top-down methodologies. Seventeen distinct themes concerning teachers’ wellbeing emerged. Implication for practitioners and directions for future research are discussed.

Caracterización de la función de valor empleada en las decisiones ambientales por las grandes organizaciones: Estudio de los grandes proyectos hidroeléctricos en Colombia.

Esta investigación ofrece una explicación sobre una de las fuentes generadoras de los altos niveles de conflictividad, actualmente predecibles entre las comunidades locales y la construcción de megaproyectos hidroeléctricos en Colombia, a través de una mirada endógena de las grandes organizaciones, específicamente en su proceso de toma de decisiones ambientales basado en juicio de expertos. En este caso el análisis se aplica a la construcción de megaproyectos hidroeléctricos (&gt;350 MW) en Colombia durante el período 2010 al 2020. La investigación emplea la teoría prospectiva acumulativa (Cumulative Prospect Theory - CPT). Se inicia determinando el uso de la heurística de disponibilidad y su cuantificación, a partir de los criterios de facilidad de recordación y tiempo de deliberación de las respuestas. Paso siguiente, se caracteriza la función de preferencias de los expertos, determinando las dimensiones en las que se presentan zonas de aptitudes de ganancia (altas y bajas) y zonas de aptitudes de pérdidas (bajas y altas). Su aplicación a las organizaciones según las simulaciones realizadas, permite mejorar la influencia de las comunidades locales en las decisiones ambientales, teniendo presente los resultados sobre las aptitudes de pérdidas que han experimentado los tomadores de decisiones, ante peticiones externas en las dimensiones tecnológicas y ambientales.

Оптимальное позиционирование источников выбросов загрязнений в задачах промышленной экологии

The problem related to the conflict between sources group’s excessive emissions and region’s pollution standards has been considered. It is possible to resolve the conflict by emissions sources efficiencies restrictions or reduction of pollution standards. Both actions lead to economic losses. It has been proposed to ease the conflict by the optimal sources allocation, in comparison with the initial one. The sources’ efficiencies and the region’s standards have been preserved during optimization. The sources emissions were modeling by parabolic functions, thus was solving the geometric problem of optimizing the coordinates for allocation of paraboloids with constant volumes. Different sources coordinates usually lead to a multiextremal function of pollution excess over the region's standards. The optimization problem is reduced to excess function control. The sources coordinates are becoming the control parameter. The numerical integral of the excess function has been defined as optimization criterion. Assuming a unimodal relationship between the criterion and the parameter, the Nelder-Mead procedure has been chosen as an algorithm for multidimensional nonlinear optimization. The optimization criterion’s convinced convergence to zero has been established due to a change on the sources coordinates’ iterations. Numerical experiments have been carried out, in which a high level of conflict (pollution function’s multiple excesses over the standards) has been set by the initial parameters. The region has been divided into 6 regulatory zones with non-standard flexible boundaries. The excess function was generating by 24 sources with different emissions efficiencies. A series of iterations has been performed, at which the conflict level was reduced to 1.32% due to the sources displacement. Such a decrease has required a selective withdrawal of 18 sources out of the region. This withdrawal does not exclude further trans-boundary pollutions emissions into the controlled area. The problems of trans-boundary pollutions transfer have been discussed. Iterations results have been shown in 2D-3D graphics. Having at disposal detailed iterations tapes, including their visualization, a designer is free to choose different input data of the model and to achieve the required conflict level. The presentation of optimization results in numerical and graphical formats is a convenient tool for designing of areas with complex infrastructure.

Mediating High Conflict Matters

To what extent is practice and training adapting to meet the challenge of an increase in high conflict levels in dispute resolution – including developments in social media and electronic communications? This article explores recent changes in disputants’ conflict behaviour, together with potential implications for practitioner skills, strategies, values and training. It will provide some theoretical frameworks related to conflict behaviour and conflict ideologies that can be applied to practice. Recent developments in electronic and social mass media communications are explored, together with the impact these have had on conflict patterns in dispute resolution. It considers the extent to which developments in conflict behaviour may need to be challenged more overtly by mediators, for example through a more pro-active mentoring dialogue, including in individual pre-mediation meetings. Finally it offers some recommendations as to how such challenges and ideas for change, can be utilised in a way that does not impair the quality of the client mediator relationship.

Social stability in times of change: effects of group fusion and water depth on sociality in a globally invasive fish

Many animals form dynamic societies in which the fission and fusion of subgroups occurs on a regular basis. Such societies are intriguing, because it is unclear whether stable dominance relationships that form within subgroups are retained upon fusion with other subgroups, and what the implications of rank instability may be at higher levels of ecological organization. Additionally, little is known about how environmental change affects the fission–fusion process, even though environments often fluctuate and are predicted to become increasingly variable, in part due to climate change. Here we investigated the social organization, levels of conflict and stability of dominance relationships during group fusion in a globally invasive fish, the eastern mosquitofish, Gambusia holbrooki . To assess the effect of environmental variation, we conducted group fusion experiments at high and low water depths, to simulate normal and drought conditions, and recorded dominance interactions during prefusion, early fusion and late fusion stages. Individuals formed size-based hierarchies within prefusion groups, although the relationship between size and dominance varied with group fusion. Levels of conflict were affected by group fusion and water depth, with higher levels of conflict after fusion and at low depth. Rank relationships in early and late fusion groups were stable and unaffected by water depth. Finally, there was no evidence of coat-tail effects, as familiarity with the alpha dominant in postfusion groups did not lead to a significant increase in subordinate dominance rank. All in all, these results provide key experimental evidence that environmental change in terms of water level is unlikely to impact social organization or rank stability in response to group fusion in this species. More generally, they indicate that sociality in fission–fusion societies may be relatively robust to changes in both social and environmental contexts.

Fatalities from Firearm-Related Injuries in Selected Governorates of Iraq, 2010-2013.

In Iraq, where Islamic State of Iraq and Syria (ISIS) and other groups have contributed to escalating violence in recent years, understanding the epidemiology of intentional firearm-related fatalities is essential for public health action. The Iraqi Ministry of Health (MoH; Baghdad, Iraq) compiles surveillance of fatal injuries in eight of Iraq's 18 governorates (Baghdad, Al-Anbar, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya). Information is collected from coroner's reports and interviews with family members. Analysis was performed on intentional firearm-related injuries, excluding injuries from intentional self-harm or negligent discharges, that occurred during 2010-2013, a subset of all fatal injuries, and compared to previously published explosive-related fatalities. Overall, the dataset included 7,985 firearm-related fatalities. Yearly fatalities were: 2010=1,706; 2011=1,642; 2012=1,662; and 2013=2,975. Among fatalities, 86.0% were men and 13.7% women; 83.4% were adults and 6.2% children <18 years of age. Where age and sex were both known, men aged 20-39 years accounted for 56.3% of fatalities. Three "high-burden" governorates had the highest fatality rate per 100,000 population-Baghdad (12.9), Ninevah (17.0), and Al-Anbar (14.6)-accounting for 85.9% of fatalities recorded in the eight governorates. Most fatalities occurred in the street (56.3%), followed by workplace (12.2%), home (11.3%), and farm/countryside (8.4%). Comparing the ratio of firearm-related fatalities to explosives-related fatalities revealed an overall ratio of 2.8:1. The ratio in Baghdad more than doubled from 2.9 in 2010 to 6.1 in 2013; the highest ratios were seen outside the high-burden governorates. Firearm-related fatalities remained relatively stable throughout 2010-2012, and almost doubled in 2013, correlating with increased ISIS activity. Three governorates contributed the majority of fatalities and experienced the highest fatality rates; these saw high levels of conflict. Firearm-related fatalities disproportionately affected younger men, who historically are over-represented as victims and perpetrators of violence. More than one-half of fatalities occurred in the street, indicating this as a common environment for conflict involving firearms. Firearms appear to account for more fatalities in Iraq than explosives and largely accounted for escalating violence in Baghdad during the study period. The high ratio observed outside the high-burden governorates is reflective of very low numbers of explosives-related fatalities; thus, violence in these governorates is likely non-conflict-related. These observations provide valuable public health information for targeted intervention to prevent violence. Nerlander MP , Leidman E , Hassan A , Sultan ASS , Hussain SJ , Browne LB , Bilukha OO . Fatalities from firearm-related injuries in selected governorates of Iraq, 2010-2013. Prehosp Disaster Med. 2017;32(5):548-555.

Students’ Oppositional Behaviors and Engagement in School: The Differential Role of the Student-Teacher Relationship

Students presenting oppositional behaviors often display lower behavioral and emotional engagement in class as compared to their peers. Moreover, children in general are known to be deeply affected by their relationships with teachers while in school. It is therefore possible that such relationships could also influence the engagement of students presenting higher levels of oppositional behavior. As a way of verifying this hypothesis, the present study investigated the contribution of students’ levels of oppositional behavior to their behavioral and emotional engagement in literacy. Furthermore, it examined whether these relationships were different for boys and girls, or changed as a function of two components of student-teacher relationships: closeness and conflict. Three hundred and eighty five third and fourth grade students and their teachers participated in the study. Two series of linear regressions were conducted. Findings indicate that students who presented higher levels of oppositional behavior showed lower behavioral engagement than their peers. Moreover, students who had close relationships with their teachers reported higher behavioral engagement. Although closeness in student-teacher relationships protected students from behavioral disengagement, students with higher oppositional behaviors were less protected than students who presented lower levels of oppositional difficulty. Having a warm relationship with a teacher was also more beneficial for the behavioral engagement of girls, whereas a high level of conflict between student and teacher was more harmful for the emotional engagement of boys. This was deemed to be true whether the boys or girls presented high levels of oppositional behavior or not. Overall, our findings highlight the importance of the student-teacher relationship in fostering all students’ engagement in school.

Parental Child-Rearing Conflicts Through Adolescence: Trajectories and Associations With Child Characteristics and Externalizing Patterns.

Research on longitudinal interparental conflict patterns and offspring development is scarce. The population-based TOPP study (N=459) was used to investigate (1) child-rearing conflict trajectories through four time points during childhood and adolescence (ages 8-16), and (2) associations between conflict trajectories and child characteristics (i.e., birth order, gender, externalizing patterns from early childhood). Latent profile analysis identified six distinct trajectories. Conflict levels decreased for most respondents over the adolescent offspring period, but offspring's birth order and externalizing problems were related to less typical trajectories and higher levels of conflict. Onset of externalizing problems was of additional importance for the course of parental child-rearing conflicts. The results highlight the perception of the whole family as an interwoven system.

Metro Area Client Bases, Metro Area Auditor Bases, and Client Auditor Choice

Prior research finds no consistent association between metropolitan audit market competition (henceforth “competition”) and either audit fees or measures of audit quality (“AQ”). We revisit the association of competition with fees and AQ using a novel proxy for competition: the Office to Client Ratio (OCR). OCR equals the number of PCAOB inspected audit offices in a metro area divided by the number of public clients purchasing audit services in the area. We conduct a “contest” to determine which variable, OCR or the prevailing proxy for competition, the Herfindahl index (HERF), performs best (i.e. is significantly associated with audit fees and measures of AQ as theory suggests). To investigate the association of competition with fees, we employ a unique natural experiment: the exogenous shock to audit costs and fees in 2004 that accompanied implementation of auditors’ SOX 404(b) reports for their largest (i.e. accelerated filer (AF) clients). We document that audit offices appear to have imposed substantial fee increases in 2004 on their smaller non-accelerated filer (NAF) clients, although those clients were not required to obtain SOX 404(b) reports. Evidence suggests that these fee increases served to subsidize extension of the new SOX 404(b) services to the larger AF clients. In this setting, unusually high levels of conflict over audit fees should have existed between audit offices and managers of their NAF clients. The ability of NAF clients to resist paying fee increases should depend powerfully on competition. We find that higher levels of OCR are associated with smaller audit fee levels paid by NAFs in the shock year of 2004, and smaller fee increases from 2003 to 2004. HERF does not perform as a (reverse) proxy for competition in either year. We then investigate the associations of OCR and HERF with fee levels in three more recent years, 2010-2012. We again find that OCR outperforms HERF. In additional analyses we investigate the associations of OCR and HERF with three measures of AQ in the 2010-2012 period: absolute discretionary accruals, misstatements of audited data, and auditors’ propensity to issue first-time going concern modified opinions to potentially distressed clients. We find some evidence that competition, measured as OCR but not as HERF, is associated with improved AQ (i.e. reduced likelihood of misstatements and higher likelihood of going concern opinions). In summary, OCR appears to be an effective proxy for competition in the audit fees context. It also is significantly associated with AQ metrics although to a lesser extent. We find no evidence that HERF serves as a (reverse) proxy for competition.

Genome-wide interrogation advances resolution of recalcitrant groups in the tree of life.

Much progress has been achieved in disentangling evolutionary relationships among species in the tree of life, but some taxonomic groups remain difficult to resolve despite increasing availability of genome-scale data sets. Here we present a practical approach to studying ancient divergences in the face of high levels of conflict, based on explicit gene genealogy interrogation (GGI). We show its efficacy in resolving the controversial relationships within the largest freshwater fish radiation (Otophysi) based on newly generated DNA sequences for 1,051 loci from 225 species. Initial results using a suite of standard methodologies revealed conflicting phylogenetic signal, which supports ten alternative evolutionary histories among early otophysan lineages. By contrast, GGI revealed that the vast majority of gene genealogies supports a single tree topology grounded on morphology that was not obtained by previous molecular studies. We also reanalysed published data sets for exemplary groups with recalcitrant resolution to assess the power of this approach. GGI supports the notion that ctenophores are the earliest-branching animal lineage, and adds insight into relationships within clades of yeasts, birds and mammals. GGI opens up a promising avenue to account for incompatible signals in large data sets and to discern between estimation error and actual biological conflict explaining gene tree discordance.

Commensal in conflict: Livestock depredation patterns by free-ranging domestic dogs in the Upper Spiti Landscape, Himachal Pradesh, India

In human-populated landscapes worldwide, domestic dogs (Canis lupus familiaris) are the most abundant terrestrial carnivore. Although dogs have been used for the protection of livestock from wild carnivores, they have also been implicated as predators of livestock. We used a combination of methods (field surveys, interview surveys, and data from secondary sources) to examine the patterns and factors driving livestock depredation by free-ranging dogs, as well as economic losses to local communities in a Trans-Himalayan agro-pastoralist landscape in India. Our results show that livestock abundance was a better predictor of depredation in the villages than local dog abundance. Dogs mainly killed small-bodied livestock and sheep were the most selected prey. Dogs were responsible for the majority of livestock losses, with losses being comparable to that by snow leopards. This high level of conflict may disrupt community benefits from conservation programs and potentially undermine the conservation efforts in the region through a range of cascading effects.

“It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters

ABSTRACTPurpose: Clinical encounters related to medically unexplained physical symptoms (MUPS) are associated with high levels of conflict between patients and doctors. Collaborative difficulties are fused by the medical uncertainty that dominates these consultations. The main aim of this study is to explore the interactional dynamics of clinical encounters riddled by medical uncertainty, as experienced by people living with long-term medically unexplained fatigue in Norway. Method: A qualitative thematic analysis of written texts from 256 study participants. Results: We found that patients experience being met with disbelief, inappropriate psychological explanations, marginalisation of experiences, disrespectful treatment, lack of physical examination and damaging health advice. The main source of their discontent is not the lack of biomedical knowledge, but doctors who fail to communicate acknowledgement of patients’ experiences, knowledge and autonomy. War metaphors are emblematic of how participants describe their medical encounters. The overarching storyline depicts experiences of being caught in a power struggle with doctors and health systems, fused by a lack of common conceptual ground. Conclusion: When physical symptoms cannot be detected, explained and managed by biomedical knowledge and technology, good doctor-patient partnerships are crucial. Without clearly acknowledging patients’ perspectives and capabilities in clinical practice, such partnerships cannot be achieved.

Взаимосвязь между типом привязанности и уровнем конфликтности у студентов

The article presents the results of research aimed studying connections between level of conflict and type of the students’ attachment to mother. The study involved 60 students of MSUPE in the age from 19 to 21. There were used two methods for studying the level of conflict: the method for assessing the level of conflict (V.I. Rogov) and self-assessment of conflict (S.M. Emelianov). The type of attachment was investigated using a questionnaire on attachment to parents (M.V. Yaremchuk). Based on the results obtained it’s possible to conclude about connections between the type of attachment and the level of conflict. Significant differences were obtained between the level of students’ conflict with an anxious-ambivalent type and the reliable type of attachment. Students with a reliable type of attachment have a lower level of conflictability compared to students who have other types of attachment. The highest level of conflict was obtained in students with an anxious-ambivalent attachment type.

Managing the Room of Maneuver in Design Build Contracts – A Comparative Study of Norwegian Road Projects

Most public infrastructure projects in Norway are conducted with design-bid-build contract form. However, the traditional design-bid-build contract seems to be both time consuming and demand a lot of resources. And at the same time contribute to a high level of conflict between the project owner and the contractor. Because of this, and an increased amount of big and complex infrastructure projects, public project owners are boosting their use of design-build contracts. Use of design-build contracts can potentially shorten project time, and reduce cost. In addition, the use of this contract form can release the project owner's resources and make use of the contractor's competence. Within the design-build contract form and delivery method there is a certain room of maneuver. This can be utilized and potentially contribute to achieve the mentioned benefits. The problem occurs when the public project owner's laws and regulations limits this room of maneuver, and puts too many restrictions on the contractor's choice of technical solutions and ways of construction. To explore this a literature review and multiple case studies were conducted. Four public road projects were explored through semi-structured in depth interviews and document studies. This identified the room of maneuver in the studied projects, as well as the potential room of maneuver for the projects. The level of detail set in the contract by the project owner, through deployment of the laws and regulations, seems to be the most critical factor. This decides whether the contractor has a satisfying room of maneuver or is too restricted and not able to propose and execute alternative solutions.

High Levels of Decisional Conflict and Decision Regret When Making Decisions About Biologics.

The aim of the study was to understand the association between parents' perceptions of the decision process and the decision outcomes in decisions about the use of biologics in pediatric chronic conditions. We mailed surveys to parents of children with inflammatory bowel disease or juvenile idiopathic arthritis who had started treatment with biologics in the prior 2 years and were treated at either of 2 children's hospitals. The survey included measures of the decision process, including decision control and physician engagement, and decision outcomes, including conflict and regret. We used means and frequencies to assess the response distributions. General linear models were used to test the associations between decision process and decision outcomes. We had 201 respondents (response rate 54.9%). Approximately 47.0% reported using shared decision making. Each physician engagement behavior was experienced by the majority of parents, with the highest percentage reporting that their child's physician used language they understood and listened to them. Approximately 48.5% of parents had decisional conflict scores of 25 or greater, indicating high levels of conflict. Approximately 28.2% had no regret, 31.8% had mild regret, and the remaining 40.0% had moderate to severe regret. Shared decision making was not associated with improved decisional conflict, but physician engagement behaviors were associated with both decisional conflict and regret. Improving decision outcomes will require more than just focusing on who parents perceive as controlling the final decision. Developing interventions that facilitate specific physician engagement behaviors may decrease parents' distress around decision making and improve decision outcomes.