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We analyze governance in two contemporary nuclear power plant projects: Olkiluoto 3 (Finland) and Flamanville 3 (France). We suggest that in the governance of large multi-firm projects, any of the prevalent governance approaches that rely on market, hierarchy, or hybrid forms, is not adequate as such. This paper opens up avenues towards a novel theory of governance in large projects by adopting a project network view with multiple networked firms within a single project, and by simultaneously going beyond organizational forms that cut across the traditional firm-market dichotomy. Our analysis suggests four changes in the prevailing perspective towards the governance of large projects. First, there should be a shift from viewing multi-firm projects as hierarchical contract organizations to viewing them as supply networks characterized by a complex and networked organizational structure. Second, there should be a shift in the emphasis of the predominant modes of governance, market and hierarchy towards novel governance approaches that emphasize network-level mechanisms such as self-regulation within the project. Third, there should be a shift from viewing projects as temporary endeavors to viewing projects as short-term events or episodes embedded in the long-term sphere of shared history and expected future activities among the involved actors. Fourth, there should be a shift from the prevailing narrow view of a hierarchical project management system towards an open system view of managing in complex and challenging institutional environments.

Purpose: To estimate the prevalence of potentially severe drug-drug interactions (DDIs) and their relationship with age, sex and number of prescribed drugs. Methods: We analysed all prescriptions dispensed from 1 January 2003 to 31 December 2003 to individuals aged 65 or more registered under the Local Health Authority of Lecco, a northern Italian province with a population of almost 330 000 persons. Elderly who received at least two co-administered prescriptions were selected to assess the presence of DDIs. Results: The prevalence of potentially severe DDIs was 16%, and rose with increasing patient's age and number of drugs prescribed. At multivariate analysis, the adjusted odds ratios rose from 1AE07 (95% CI 1AE03-1AE11) in patients aged 70-74 to 1AE52 (95% CI 1AE46-1AE60) in those aged 85 or older. Elderly taking more than five drugs on a chronic basis had a statistically significant higher risk of sever DDIs than those receiving less than 3 or 3-5 such drugs. Conclusions:The elderly constitutes a population at high risk of DDIs. As physicians still have some difficulty in managing this problem, it is essential to highlight for them, which factors raise the risk of DDIs.

This is a repository copy of An island of constancy in a sea of change: rethinking project temporalities with long-term megaprojects.

Projects delivered in complex environments are often late, over-budget and provide fewer benefits than what originally expected. Systems Engineering is the emerging paradigm in complex and thereby increase the chance of holistic success. Systems Engineering is a multidisciplinary approach to enable the successful delivery of systems in complex environments through a comprehensive set of approaches, techniques and tools, initially developed in the USA after the Second World War. This paper focuses on how Systems Engineering can transform the governance from "project governance" to "system governance", improving the performance of projects delivered in a complex environment. The paper presents Systems Engineering tools and techniques focusing, in particular, on the most relevant for the project management, project governance and management. At the end it provides a rich research agenda for further studies.

The importance of organizational citizenship behaviors for the environment (OCBEs) has been clearly established in the environmental literature. However, the OCBEs construct has rarely been examined in the specific and increasingly important realm of megaproject environmental responsibility (MER). To fill this gap, this paper presents an individual-level analysis that explores the impact of project participants' perceptions of MER practices on their environmental commitment and OCBEs. The results show that project participants' perceptions of MER practices directed toward internal stakeholders (i.e., stakeholders linked by project contracts) are positively related to their OCBEs. This relationship is partially mediated by the environmental commitment of project participants. Conversely, project participants' perceptions of MER practices directed toward external stakeholders (i.e., the local community and general public) have only an insignificant impact on their OCBEs. These findings provide new insights for managing MER practices to stimulate the emergence of OCBEs and thereby improve environmental performance.

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