Industry dynamics in the German merger and acquisitions market

The recent wave of mergers and acquisitions (M&As) is not only profoundly altering the structure of businesses, but has also triggered a thorough reshuffling in the location of economic decision-making. This paper explores these changes in Germany over the last decade, with particular attention being paid to industry-specific transformations. In order to identify the logic behind changes in the location of economic decision-making, four factors are analysed across ten different industrial sectors. These determinants include the presence of economies of proximity and agglomeration, the degree of metropolitan interconnectivity (or 'archipelago economies'), the concentration of economic decision-making in large urban metropolitan areas, and the role played by geographical distance in shaping M&As. The results indicate that different industries display significantly different spatial merging behaviours, with economies of proximity, concentration and agglomeration playing a capital, but different role in determining the dynamics of M&As across sectors in Germany. There is also - with the exception of the media industry, as well as information and communication technologies - little sign of geography losing importance in economic transactions. Copyright (c) 2006 by the Royal Dutch Geographical Society KNAG.

Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database

The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013