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Chapter 18, The End (1931 - 2022). Since the narrative IS the analysis, there is no conclusion as such. Instead, The End provides a discussion of what a forward looking, thick description, humanistic approach to the financial crisis of 1931 have contributed to our knowledge in combination with the concepts embodied in the narrative. First, it is argued that the historical narrative provides new information exactly because writing the history forward brings out the uncertainty and need for sensemaking and narrative emplotment. This argument is discussed briefly in the context of the historiography of the 1931 crisis. Secondly, I ask what this narrative approach has contributed to our emprical and theoretical understanding of decision-making. By very briefly comparing with the Great financial crisis of 2008 I argue that uncertainty is a basic condition that requires sensemaking and narrative construction. I end by suggesting that rather than drawing lessons from history, history can be used as a way to reflect upon the past and the present.
When considering the implications of the shareholder-stakeholder debate in defining the purpose of a company, epistemological clarity is vital in this emerging theory of the firm. Such clarity can prevent recurrence based solely on rephrasing key terms. To understand how various stakeholders develop and interpret a shared purpose, I argue for the necessity of a pragmatist approach that is normative and process-oriented. Mental models play a crucial role in interpretive processes that define decision-making, where individual perspectives converge. The figures of Milton Friedman and Ed Freeman serve as “beacons,” as artefacts, in the transmission of knowledge through which we, as individuals, shape a shared understanding. In current societies, profound polarization obstructs solutions to grand challenges. Pragmatism starts by questioning the underlying values of everyone involved. It assumes that sound deliberative processes are the only way to reach real solutions—not only for the mind but, above all, for the heart.
Ministry of Health (MOH) Malaysia stakeholders seek primary care access to sodium-glucose cotransporter 2 inhibitor (SGLT2i). Addressing this required a complex decision, selecting among three SGLT2i for two different indications and two practice settings. The options include expanding the existing SGLT2i (empagliflozin) in the MOH Medicines Formulary to primary care and/or having dapagliflozin and/or luseogliflozin as alternatives. This study aimed to conduct a multiple health technology assessment (HTA) to determine the SGLT2i of choice for the MOH setting.
Methods
The clinical benefits of SGLT2i were assessed through a systematic literature review and affordability was assessed through the development of three budget impact analysis models simulating seventy scenarios. Each model varied by prescribing indications, restrictions, and SGLT2i involved (M1: glycemic control, HbA1c between 6.5 percent and 10 percent, empagliflozin–dapagliflozin–luseogliflozin; M2: cardiovascular benefits, HbA1c less than 10 percent, empagliflozin-dapagliflozin; M3: a composite of M1 and M2). The outcome of the HTA was presented to the MOH decision-makers.
Results
Although there was no significant difference in glycemic control between the SGLT2i, differences exist in cardiovascular benefits conferred. Despite having scenarios with lower net budget impact (NBI) in the M1, M2, and M3 models, decision-makers decided to expand empagliflozin use to primary care setting and add dapagliflozin for hospital-only setting for both indications [NBI of $4.38 mil] due to empagliflozin’s advantage in reducing risk for cardiovascular death and prior experience of its use in MOH.
Conclusions
The multiple HTA approach guided the complex decision-making process by providing a holistic understanding of the decision’s impact.
Many populist leaders politicise disputes with external financial ‘elites’, but most are forced by economic pressures to fundamentally change their ‘people-versus-elite’ problem representations and ‘concede defeat’. Notable exceptions are Hungary’s Viktor Orbán, Argentina’s Cristina Kirchner, and Turkey’s Recep Tayyip Erdoğan, who sooner or later resisted strong push-back and defied the IMF or distressed-debt funds. These instances of prolonged populist defiance differ widely across commonly used structural and agential explanatory factors at international, domestic, and individual levels. To explain how Orbán, Kirchner, and Erdoğan managed to ‘beat the elite’, this paper clusters several root causes into a parsimonious framework of two intervening variables. The temporality of strong ‘elite’ push-back and the openness of advisory systems are theorised as shaping distinct cognitive mechanisms of representational continuity or change, through which ‘people-versus-elite’ input is either preserved until – or discarded before – feeding into decision outputs. As the two-by-two matrix of early/later external shocks and open/closed inner circles explains, Orbán did not move beyond marginal representational adjustments; Kirchner’s contingent representational fluidity benefited from opportune situational developments; and Erdoğan defied significant socio-economic cost with fundamental representational continuity. These insights highlight the potential of studying populism at the intersection of foreign policy analysis and international political economy.
This final chapter demonstrates how the catastrophe (CAT) models described in previous chapters can be used as inputs for CAT risk management. CAT model outputs, which can translate into actionable strategies, are risk metrics such as the average annual loss, exceedance probability curves, and values at risk (as defined in Chapter 3). Practical applications include risk transfer via insurance and CAT bonds, as well as risk reduction, consisting of reducing exposure, hazard, or vulnerability. The forecasting of perils (such as tropical cyclones and earthquakes) is explored, as well as strategies of decision-making under uncertainty. The overarching concept of risk governance, which includes risk assessment, management, and communication between various stakeholders, is illustrated with the case study of seismic risk at geothermal plants. This scenario exemplifies how CAT modelling is central in the trade-off between energy security and public safety and how large uncertainties impact risk perceptions and decisions.
The literature on emotion and risk-taking is large and heterogeneous. Whereas some studies have found that positive emotions increase risk-taking and negative emotions increase risk aversion, others have found just the opposite. In this study, we investigated this question in the context of a risky decision-making task with embedded high-resolution sampling of participants’ subjective emotional valence. Across two large-scale experiments (N = 329 and 524), we consistently found evidence for a negative association between self-reported emotional valence and risk-taking behaviors. That is, more negative subjective affect was associated with increased risk-seeking, and more positive subjective affect was associated with increased risk aversion. This effect was evident both when we compared participants with different levels of mean emotional valence as well as when we considered within-participant emotional fluctuations over the course of the task. Prospect-theoretic computational modeling analyses suggested that both between- and within-participant effects were driven by an effect of emotional valence on the curvature of the subjective utility function (i.e., increased risk tolerance in more negative emotional states), as well as by an effect of within-person emotion fluctuations on loss aversion. We interpret findings in terms of a tendency for participants in negative emotional states to choose high-risk, high-reward options in an attempt to improve their emotional state.
Our study aims to contribute to the existing body of research on age-related changes in decision-making by investigating susceptibility to the attraction effect across adulthood. Prior studies have produced inconsistent conclusions regarding the decision-making abilities of older individuals, with some portraying them as easily manipulated and risk-averse, while others suggest the opposite. To address this issue, we conducted two experiments using a novel paradigm of the roulette task: (1) in an online environment with 357 participants and (2) in a laboratory setting with 173 participants. The results were consistent and demonstrated the robustness of the attraction effect. However, no age differences in susceptibility to the attraction effect as a common decision bias were found. As predicted, older adults were more likely to commit simple decision-making mistakes, especially in the preliminary trials, which could have serious financial or societal consequences. Additionally, older adults exhibited more risk-seeking behaviours. Furthermore, we observed that the dynamics of decision competence (as indicated by a decrease in the selection of erroneous decoy options and an increase in decision fluency) were similar for both younger and older adults, suggesting preservation of the ability to optimise decision-making while becoming familiar with new tasks. These findings provide insight into the cognitive functioning of older adults and indicate that decision-making abilities in late adulthood may be more complex than commonly assumed.
This work presents a reflection on the meaning and significance of knowledge coproduction in the field of glaciology. We start by invoking the paradigm of Structure–Form–Environment Interplay (SFEI) to formulate a generalised definition of glaciology, which highlights the relevance of knowledge coproduction. The adoption of a relational view of glaciological knowledge leads us to identify five core dimensions of knowledge coproduction: purpose, ethics, ambiguity, inclusion/exclusion, and relationships. Based on those dimensions, we delve into the decisive methodological aspects of the coproduction process, namely the definition of its purpose, the identification of participants, the organisation of the process, the recognition of ambiguity in Ways of Knowing (WoKs), and the consideration of ethical implications. In addition to the already known three stages of knowledge coproduction process (codesign, codevelopment, and codelivery), we propose the inclusion of an additional preparation stage, which entails the acknowledgment of the identity and involvement of all human and nonhuman participants, their positionality, and means to ensure their cultural and ontological safety. We reason that knowledge coproduction does not replace the scientific method, but rather complements it, eliciting the possibility to unveil deeper insights that might be difficult to attain through unilateral means.
Who should have a say in a given decision for it to count as democratic? This is the question with which the so-called democratic boundary problem is concerned. Two main solutions have emerged in the literature: the All-Affected Principle (AAP) and the All-Subjected Principle (ASP). My aim in this chapter is to question the presuppositions underpinning the boundary-problem debate. Scholars have proceeded by taking democracy for granted, treating it as an ultimate value. Consequently, the best solution to the boundary problem has been framed as the one that most loyally reflects the value of democracy. But it is not at all obvious that democracy is best conceptualised as an ultimate value. Arguably, democracy marks out a family of decision-making systems that are themselves justified by appeal to how they reflect and promote important values in particular circumstances. The values in question range from equality and self-determination, to peace, security, and respect for fundamental rights. Thus, what we call “democracy” is itself one of several possible solutions to the boundary problem: a solution that is contingently justified by appeal to a variety of different values. This means that neither the AAP nor the ASP can provide one-size-fits-all solutions to the problem.
Critical space assets require continuous monitoring to prevent potential losses. Auxiliary satellites protect these assets by observing and tracking approaching targets. Although observation satellites can make rapid autonomous onboard decisions, they face challenges due to limited computational capacity. The two mainstream command and control methods currently available do not meet the demands of onboard decision-making. Highly procedural decision-making methods require extended decision times, while rapid-response intuitive or heuristic methods carry significant error risks. To address this, this paper proposes a multi-granularity decision-making method for optical space surveillance satellites. First, multi-granularity relative orbit determination algorithm models and multi-granularity impulsive orbit manoeuver algorithm models were developed. Based on these models, a granularity selection method for sequential three-way decisions is proposed. In non-emergency situations, fine-granularity models are preferred to conserve fuel, while in emergency situations, coarse-granularity models are used to enhance decision-making speed and reduce positional deviations caused by the manoeuvering game. In random multi-scenario tests, the proposed method demonstrates lower average terminal positional deviations and fuel consumption compared to single-granularity (highly procedural or rapid-response) and random-granularity methods.
The aim of this study is to understand the path for establishing digital health technologies-health technology assessment (DHT-HTA) in India.
Methods
A rapid review of HTA and DHT frameworks on PubMed (MEDLINE) and Google Scholar was conducted to identify DHT-HTA guidelines, and HTA processes in India. MS-Excel template was created with key domains for assessing DHT in resource-constrained settings based on studies and reports identified. Responses received from seventeen experts with varying expertise in DHT, HTA, clinical, and research were contacted using an online form. Following the principles of qualitative research rooted on grounded theory approach, themes and domains were derived for a framework which was again circulated through participants. Weightage for each theme was assigned based on the frequency of responses and qualifiers were used to interpret results. Inductively derived themes from these responses were clubbed together to identify macro-level systems requirements, and finally pre-requisites for setting up DHT-HTA framework was synthesized.
Results
HT are commonly perceived by experts (64.7 percent participants) as a technology strictly connected to health information. Real-world data (i.e., electronic health data) are recognized as a relevant tool in support of decision-making for clinical and managerial levels. Experts identified some pre-requisites for the establishment of DHT-HTA in the country in terms of infrastructure, contextual factors, training, finance, data security, and scale-up.
Conclusion
Our research not only identified the pre-requisites for the adoption of a DHT-HTA framework for India, but confirmed the need to address DHT-HTA’s acceptability among. Hospitals and health insurance providers.
This book draws on the disciplines of law, philosophy, and psychiatry to interrogate whether the Mental Capacity Act 2005 meets the challenges posed by mental disorder to decision-making. It is often assumed that to allow space for individuality, any test for capacity must focus only on decision-making processes and not on the substance of the values that underpin decisions. Auckland challenges this assumption, arguing that the current law serves merely as a façade, behind which judgements can be made about the nature of a person's values, free from proper scrutiny. This book provides an in-depth analysis of when and how a person's disordered values should be relevant to the determination of their capacity, offering novel suggestions for reforming the capacity test to better reflect the impact of disorder on decision-making. It also explores the implications of this analysis for people found to lack capacity, concluding that reforms to the best interest provisions are urgently needed. This title is part of the Flip it Open Programme and may also be available Open Access. Check our website Cambridge Core for details.
Design rationale is the justification behind a product component, often captured via written reports and oral presentations. Research shows that the structure and information used to communicate and document rationale significantly influence human behavior. To better understand the influence of design rationale on engineering design, we investigate the information engineers and designers include in design rationales in written reports. Eight hundred and forty-six pages of student engineering design reports from 28 teams representing 116 individuals were analyzed using a mixed-methods approach and compared across project types. The rationales from the reports were coded inductively into concepts and later applied to five industry reports consisting of 218 pages. The findings reveal a spectrum of rationales underpinning design decisions. Grounded in the data, the feature, specification and evidence (FSE) framework emerged as a feature-based and low-effort capture approach. We discuss the need to improve design communication in engineering design, through structuring rationales (i.e., using the proposed FSE framework or other representations) and improving technical writing skills. Lastly, by enhancing design rationale communication and documentation practices, significant benefits can be realized for computational support tools such as automatic rationale extraction or generative approaches.
Any system health work must look at decision-making because decisions propagate throughout a system, shaping system dynamics. Usually, human decision-making is conducted from an individualist, objectivist perspective. What happens when we use an approach based on the radical relationality of Radical Participatory Design and Relational Design? This is the fourth paper in a series of papers which introduced Radical Participatory Design in the first two papers and Relational Design in the third paper. In this fourth paper, we explore the decision-making dynamics in Radical Participatory Design and Relational Design projects.
We use the term political ecology to speak about the power dynamics within any ecological system – a geographical population, a community, an ecosystem, and so forth. We analyze the political ecologies of individualist decision-making models. Then we explore how to embody a relational ontology within decision-filled human ecosystems and how a relational way of being changes decision-making. Referring to biology, we discuss ingredients for relational decision-making – relationality, emergent design principles, and autonomy. Those ingredients can lead to emergent and symbiotic design. Emergent design refers to design that emerges from consistently following a few basic principles. Symbiotic design occurs over time when deeply, relationally embedded entities retain autonomy and indirectly evolve to create a design that would not have occurred through an intentional design process. We then introduce Radical Biocracy as a type of decision-making model where decisions are not deliberated by groups or team members but emerge from the relationally autonomous choices and actions of individuals.
The policy-making process for health financing in most places lacks equity, failing to adequately consider the voices of ordinary citizens, residents, and especially those facing significant disadvantage. Procedural fairness is about addressing this imbalance, which requires a recalibration of power dynamics, ensuring that decision-making incorporates a more diverse range of perspectives. In this comment, we highlight the important contributions made by the report ‘Open and inclusive: Fair processes for financing universal health coverage’ in furthering the understanding and importance of procedural fairness in health financing decision-making especially as it relates to the three sub-functions of financing – revenue raising, pooling, and purchasing. We also argue for the importance of conceptual clarity – especially as to the added value of procedural fairness vis-à-vis accountability – and critically review the proposed framework for procedural fairness, emphasising the role of voice as the linchpin to advancing equity in influence.
In this special issue titled ‘Sustainability and SMEs: Opening the black box’, we compile eight articles that dissect the multifaceted relationship between small- and medium-sized enterprises (SMEs) and sustainability. This special issue promoted interdisciplinary research at the intersection of the design, management, organisation, and reporting of sustainable actions in the context of SMEs. Stemming from the need to apply different theoretical and analytical lenses to the study of sustainability in SMEs than in large corporations, each paper provides unique insights into the formal and informal approaches, drivers, barriers, and enablers of sustainable practices in SMEs. The collection not only furthers the dialogue on the role of SMEs in sustainable development but also paves the way for future research directions and practical applications in this dynamic and still underexplored field.
This chapter reviews the Mental Capacity Act (2005), and Deprivation of Liberty Safeguards (Liberty Protection Safeguards). It reviews how to assess capacity, using the two-stage test, followed by when it is appropriate to undertake best interests meetings. Some of the main decisions are reviewed which are likely to be relevant to people with dementia, such as care and residence, managing finances, and deciding on medical treatment.
Durable mechanical circulatory devices are commonly used to support children and adolescents in end-stage heart failure. However, these patients remain at high risk of acute medical complications, which may lead to significant impairment in functional capacity, altered quality of life, or death. We explore the incorporation of adolescent directives into medical decision-making in this scenario through a clinical case vignette.