VALUATION EFFECTS OF BUSINESS PROCESS OUTSOURCING: MAKING THE CASE FOR SELECTIVE GOVERNANCE

Business Process Outsourcing (BPO) has grown in incidence and importance over the past few years. However, beyond some expository studies, academic research on this phenomenon is sparse. Further, studies on IT outsourcing have primarily used a transaction cost economics (TCE) lens, and largely neglected other key theoretical explanations of the outsourcing decision and performance. In this dissertation, we examine how process level variables (process value chain position, relational governance, and process maturity) affect the excess stock return of a company. Drawing on the value chain framework, TCE, the resource based view, and institutional perspectives, we present a research model and propose a number of direct and moderating hypotheses. The three direct hypotheses suggest that BPOs of primary processes, BPOs with a higher level of relational governance, and abstention based BPOs induce stronger positive valuation impact than BPOs of supportive processes, BPOs with a lower level of relational governance, and disintegration based BPOs respectively. Based on TCE\u27s discriminant alignment hypothesis, the two moderating hypotheses suggest that primary BPOs and disintegration based BPOs are likely to bring stronger positive valuation enhancement when aligned with stronger relational governance capabilities. Using secondary data on 298 BPO announcements from 1998 to 2005, we test the proposed model with multivariate regression, group t tests, and nonparametric analyses. Overall, the results from statistical analyses validate our process based view of outsourcing as an alternative to the dominant functional view of outsourcing. In contrast to the significant positive excess returns received by primary BPOs, supportive BPOs suffer negative abnormal returns. The negative returns become even more pronounced for those supportive processes outsourced after internal deployment. Although we do not find the predicted performance superiority associated with abstention based BPOs, we confirm that a higher level of relational governance strongly enhances firm valuation. This positive valuation impact of relational governance reaches an even higher level in situations of primary BPOs and disintegration-based BPOs, which are posited to require a greater presence of relational governance. For researchers, this study provides a novel approach that demonstrates how TCE and other traditionally competing theories can be used in a complementary manner. We illustrate the importance of alignment between process characteristics and relational governance. In addition, we sensitize researchers to the importance of the temporal dimension of processes and the concept of abstention based outsourcing. Future research can add granularity to these concepts and build on the discriminating alignment hypotheses. Based on the empirical results, we present BPO guidelines that reflect the importance of considering all processes for outsourcing, the critical consideration of relational governance, and the importance of planning governance structures that are aligned with the maturity and nature of the process being outsourced. Keeping in mind the dynamic nature of business process, managers should also be prepared to periodically reassess the alignment between the governance mechanism and process requirements, and make structural adjustments if necessary

Stroke genetics informs drug discovery and risk prediction across ancestries

Previous genome-wide association studies (GWASs) of stroke - the second leading cause of death worldwide - were conducted predominantly in populations of European ancestry(1,2). Here, in cross-ancestry GWAS meta-analyses of 110,182 patients who have had a stroke (five ancestries, 33% non-European) and 1,503,898 control individuals, we identify association signals for stroke and its subtypes at 89 (61 new) independent loci: 60 in primary inverse-variance-weighted analyses and 29 in secondary meta-regression and multitrait analyses. On the basis of internal cross-ancestry validation and an independent follow-up in 89,084 additional cases of stroke (30% non-European) and 1,013,843 control individuals, 87% of the primary stroke risk loci and 60% of the secondary stroke risk loci were replicated (P < 0.05). Effect sizes were highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis(3), and transcriptome-wide and proteome-wide association analyses revealed putative causal genes (such as SH3PXD2A and FURIN) and variants (such as at GRK5 and NOS3). Using a three-pronged approach(4), we provide genetic evidence for putative drug effects, highlighting F11, KLKB1, PROC, GP1BA, LAMC2 and VCAM1 as possible targets, with drugs already under investigation for stroke for F11 and PROC. A polygenic score integrating cross-ancestry and ancestry-specific stroke GWASs with vascular-risk factor GWASs (integrative polygenic scores) strongly predicted ischaemic stroke in populations of European, East Asian and African ancestry(5). Stroke genetic risk scores were predictive of ischaemic stroke independent of clinical risk factors in 52,600 clinical-trial participants with cardiometabolic disease. Our results provide insights to inform biology, reveal potential drug targets and derive genetic risk prediction tools across ancestries.</p

Stroke genetics informs drug discovery and risk prediction across ancestries

Previous genome-wide association studies (GWASs) of stroke — the second leading cause of death worldwide — were conducted predominantly in populations of European ancestry1,2. Here, in cross-ancestry GWAS meta-analyses of 110,182 patients who have had a stroke (five ancestries, 33% non-European) and 1,503,898 control individuals, we identify association signals for stroke and its subtypes at 89 (61 new) independent loci: 60 in primary inverse-variance-weighted analyses and 29 in secondary meta-regression and multitrait analyses. On the basis of internal cross-ancestry validation and an independent follow-up in 89,084 additional cases of stroke (30% non-European) and 1,013,843 control individuals, 87% of the primary stroke risk loci and 60% of the secondary stroke risk loci were replicated (P < 0.05). Effect sizes were highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis3, and transcriptome-wide and proteome-wide association analyses revealed putative causal genes (such as SH3PXD2A and FURIN) and variants (such as at GRK5 and NOS3). Using a three-pronged approach4, we provide genetic evidence for putative drug effects, highlighting F11, KLKB1, PROC, GP1BA, LAMC2 and VCAM1 as possible targets, with drugs already under investigation for stroke for F11 and PROC. A polygenic score integrating cross-ancestry and ancestry-specific stroke GWASs with vascular-risk factor GWASs (integrative polygenic scores) strongly predicted ischaemic stroke in populations of European, East Asian and African ancestry5. Stroke genetic risk scores were predictive of ischaemic stroke independent of clinical risk factors in 52,600 clinical-trial participants with cardiometabolic disease. Our results provide insights to inform biology, reveal potential drug targets and derive genetic risk prediction tools across ancestries

Determinants of Research and Development Intensity from a Network Perspective

We model and examine the research and development (R&D) intensity of a focal industry from an inter-industry network perspective. More specifically, we estimate how a focal industry’s R&D investment is affected by partner (suppliers and customers) industries’ R&D expenditure. We also investigate the impact of the overall economy on the focal industry’s R&D expenditure and finally how a focal industry’s position in the supply chain network moderates the overall economy’s impact on the focal industry’s R&D expenditure. We found that, in general, a focal industry’s R&D intensity is positively associated with its partner industries’ R&D intensity. In addition, an industry’s R&D intensity is positively associated with the growth rate of the overall economy. Finally, we found that a more central industry is subjected to a stronger impact of macroeconomic shocks on its R&D intensity though there is no significant association between an industry’s centrality and its R&D intensity

Examining clinical capability of township healthcare centres for rural health service planning in Sichuan, China: an administrative data analysis

Objective This study aimed to examine the clinical capability of township healthcare centres (THCs), the main primary care providers in rural China, as a basis for rural health service planning.Design Observational study of quantitative analysis using administrative data.Setting Three counties with low, middle and high social economic development level, respectively, in Sichuan province western China.Participants 9 THCs and 6 county hospitals (CHs) were purposively selected in the three counties. Summary of electronic medical records of 31 633 admissions from 1 January 2015 to 30 December 2015 of these selected health institutions was obtained from the Health Information Centre of Sichuan province.Main outcome measures Six indicators in scope of inpatient services related to diseases and surgeries in the THCs as proxy of clinical capability, were compared against national standard of capability building of THCs, among counties, and between THCs and CHs of each county.Results The clinical capability of THCs was suboptimal against the national standard, though that of the middle-developed county was better than that in the rich and the poor counties. THCs mainly provided services of infectious or inflammatory diseases, of respiratory and digestive systems, but lacked clinical services related to injuries, poisoning, pregnancy, childbirth and surgeries. A large proportion of the top 20 diseases of inpatients were potentially avoidable hospitalisations (PAHs) and were overlapped between THCs and CHs.Conclusions The clinical capability of THCs was generally suboptimal against national standard. It may be affected by the economics, population size, facilities, workforce and the share of services of THCs in local health systems. Identification of absent services and PAHs may help to identify development priorities of local THCs. Clarification of the roles of THCs and CHs in the tiered rural health system in China is warranted to develop a better integrated health system