Exploring the critical role of different routine connectors in post acquisition integration

M&A are considered as the key drivers of strategic growth (Angwin 2007) even though organizational performance studies continue to show that they underperform with approximately 50% failing (Schoenberg 2006). While contemporary thinking suggests that post acquisition integration is an important source of value creation (Haspeslagh and Jemison 1991), clear links between integration activities and post acquisition outcomes are yet to be made. Focusing on the sub organizational levels, this thesis uses organizational routines as the unit of analysis to unpack integration activities. Organizational routines are building blocks of capabilities (Winter 2003) that are critical to strategic advantage (Barney 1991). By conceptualising integration as an amalgamation of routines of two participating firms, this thesis aims to untangle interrelated routines and link these chains of routines to outcomes. Breaking away from the current norm of atomistic routine investigation, this thesis looks at interrelated routines and puts forward the concept of routine connectors that connect one routine to another. In other words, this work shows how routines are held together. Case studies are constructed from 18 integrations to explain how business functions such as operations or marketing are integrated. While doing so, the role of interconnected routines is examined for integration outcome. This thesis establishes the existence of routine connectors and their properties. Typology of connectors based on their function – vertical or horizontal, and nature –fixed or floating, is presented. The findings show that the floating connectors evolve over time and their tacit nature triggers unintended consequences during planned change initiatives. This thesis also shows that integration outcomes such as customer attrition or increase in costs are a result of misplaced or inappropriate connectors. As routines and their connectors are firm specific, this thesis shows that while prior acquisition experience matters, it does not influence integration outcomes. In addition to establishing the role of routine connectors for integration outcomes, this thesis opens up the black box of post acquisition integration

P-475: Uncontrolled hypertension in Fabry disease

Fabry disease is a x-linked lysosomal storage disease leading to early death related to renal, cardiac, and cerebrovascular disease. Therefore, proper diagnosis and therapy of elevated blood pressure may improve morbidity and mortality of these patients. However, the prevalence of uncontrolled hypertension in Fabry disease is unknown. We examined blood pressure of patients with Fabry disease using a large international database, the Fabry Outcome Survey (FOS). We defined uncontrolled hypertension as a systolic blood pressure (SBP) ≥130, and/or a diastolic blood pressure (DBP) ≥ 80 mmHg (threshold for blood pressure control in renal disease, JNC7). We used the short MDRD-GFR formula for assessment of renal function, and we classified chronic kidney disease according to K/DOQI. Among 459 patients with Fabry disease, 306 had blood pressure readings entered in the database. Mean SBP was 124.6 ± 16.9 mmHg and mean DBP was 73.6 ± 11.7 mmHg (mean age: 38.4 ± 15.6 years, 142 females, 164 males). Fourty-three percent of men and and 28% of women showed uncontrolled hypertension. In 291 patients both, blood pressure readings and GFR estimates, were available. In patients with normal GFR (>90 ml/min/1.73m2) mean SBP was 119.5 ± 15.6 mmHg and mean DBP was 69.7 ± 11.1 mmHg (n=120). In patients with mild decreased GFR (60-89 ml/min/1.73m2) mean SBP was 126.7 ± 15.9 mmHg and mean DBP was 75.0 ± 11.0 mmHg (n=110). In patients with moderate decreased GFR (30-59 ml/min/1.73m2) mean SBP was 132.7 ± 20.8 mmHg and mean DBP was 79.0 ± 13.3 mmHg (n=41). In 70 patients blood pressure readings were available before start of enzyme replacemen therapy (ERT) with agalsidase alfa (Replagal, TKT 5S Europe, 0.2 mg/kg bodyweight fortnightly i.v.), in 87 at 12 months and in 76 at 24 months of therapy. At baseline, at 12 and at 24 months of ERT, 39%, 30% and 42%of the patients presented with uncontrolled hypertension, respectively. Our study revealed a high prevalence of uncontrolled hypertension among patients with Fabry disease. Thus, there is need for improvement of blood pressure control in these patients. Am J Hypertens (2004) 17, 206A-206A; doi: 10.1016/j.amjhyper.2004.03.54

Prevalence of Uncontrolled Hypertension in Patients With Fabry Disease

Background: Fabry disease is a rare X-linked disease arising from deficiency of α-galactosidase A. It results in early death related to renal, cardiac, and cerebrovascular disease, which are also important outcomes in patients with elevated blood pressure (BP). The prevalence of uncontrolled hypertension, as well as the effect of enzyme replacement therapy on BP, in patients with Fabry disease is unknown. Methods: We examined uncontrolled hypertension (systolic BP [SBP] ≥130 mm Hg or diastolic BP [DBP] ≥80 mm Hg) among 391 patients with Fabry disease who were participating in the Fabry Outcome Survey (FOS). Results: Uncontrolled hypertension was present in 57% of men and 47% of women. In patients with chronic kidney disease (CKD) stage 1 (n100), median SBP was 120 mm Hg and median DBP was 74 mm Hg. In patients with CKD stage 2 (n172), median SBP was 125 mm Hg and median DBP was 75 mm Hg. In patients with CKD stage 3 (n63), median SBP was 130 mm Hg and median DBP was 75 mm Hg. There was a significant decrease in both SBP and DBP during a 2-year course of enzyme replacement therapy. Conclusions: This study revealed a high prevalence of uncontrolled hypertension among patients with Fabry disease. Thus there is a need to improve BP control and renoprotection in patients with Fabry diseas

Progressive hemorrhage and myotoxicity induced by echis carinatus venom in murine model: neutralization by inhibitor cocktail of n,n,n `,n `-tetrakis (2-pyridylmethyl) ethane-1,2-diamine and silymarin

Viperbite is often associated with severe local toxicity, including progressive hemorrhage and myotoxicity, persistent even after the administration of anti-snake venom (ASV). In the recent past, investigations have revealed the orchestrated actions of Zn2+ metalloproteases (Zn(2+)MPs), phospholipase A(2)s (PLA(2)s) and hyaluronidases (HYs) in the onset and progression of local toxicity from the bitten site. As a consequence, venom researchers and medical practitioners are in deliberate quest of potent molecules alongside ASV to tackle the brutal local manifestations induced by aforesaid venom toxins. Based on these facts, we have demonstrated the protective efficacy of inhibitor cocktail containing equal ratios of N,N,N', N'-tetrakis (2-pyridylmethyl) ethane-1,2-diamine (TPEN) and silymarin (SLN) against progressive local toxicity induced by Echis carinatus venom (ECV). In our previous study we have shown the inhibitory potentials of TPEN towards Zn(2+)MPs of ECV (IC50: 6.7 mu M). In this study we have evaluated in vitro inhibitory potentials of SLN towards PLA(2)s (IC50: 12.5 mu M) and HYs (IC50: 8 mu M) of ECV in addition to docking studies. Further, we have demonstrated the protection of ECV induced local toxicity with 10 mM inhibitor cocktail following 15, 30 min (for hemorrhage and myotoxicity); 60 min (for hemorrhage alone) of ECV injection in murine model. The histological examination of skin and thigh muscle sections taken out from the site of ECV injection substantiated the overall protection offered by inhibitor cocktail. In conclusion, the protective efficacy of inhibitor cocktail is of high interest and can be administered locally alongside ASV to treat severe local toxicity

The effect of routine aggregations in post merger integration performance:whether to ‘combine’ or ‘superimpose’ for synergy gains

Post-acquisition integration matters for overall M&A outcome. However within this phase researchers have struggled to identify clear links between integration activities and post-acquisition outcome. This may be due to using organisational levels of analysis, where sub-organisational issues serve to confound findings. In order to unpack the post-acquisition phase, and to delve more deeply into organisations, this paper adopts a more granular perspective on integration activities by focusing upon the building blocks of organisations. Specifically we investigate ordinary routine amalgamation and their impact upon meta-routine outcome during acquisition integration. Drawing upon two longitudinal integration cases and using ‘retroductive’ analysis, two types of amalgamation are identified, namely ‘combination’ and ‘superimposition’. We find that, while the basic nature of routines, such as multiplicity and nestedness, inhibit routine amalgamation, external interference in the form of context, structural change or introduction of additional routines is needed to stabilise amalgamated routines. From our findings we are able to suggest a number of testable propositions about the factors that influence the amalgamation of routines. This empirical study contributes to the M&A literature by opening up the ‘black box’ of post-acquisition integration by providing details at a granular level of what actually happens during integrations

Routine transformation – sine qua non of post acquisition integration outcomes

Little is known about routine interconnectedness and its temporal dimension, and yet, in fast changing environments, the dynamics of routine interaction may matter. In order to investigate this issue, this paper focuses upon routine transformation and their impact upon meta-routine outcome. This paper draws upon 3 longitudinal cases in a complex dynamic setting – post acquisition integration to explore routine combinations. Conceptualizing post acquisition integration as amalgamation of routines of two participating firms, we find that temporal nature of routines inhibit routines combinations and new routines in the form of connectors are required to restore the interconnectedness of the combined routine networks. This empirical study, in addition to advancing routines theory, opens up the black box of post acquisition integration by providing details of what actually happens during integrations

Not all Acquirers perform the same, and that matters

Many studies of M&A performance suggest that most fail, using a wide range of methods and criteria for evaluation but based on the general assumption that they aim to maximise value. M&A are also studied at different levels of analysis, notably from strategy, CEO and macro perspectives and yet performance studies have not yet integrated these in a single analysis. This paper draws upon these three levels to create an M&A typology that can then be tested using a CAAR methodology. Results indicate significant differences in performance by M&A type. This suggests that each of the levels of analysis matters and in particular that context plays a crucial role. Our evidence suggests that, contrary to current M&A performance dogma, M&As with a classical strategy and good agent CEO during a boom period, out perform the market and other M&A deals

Anemia is a new complication in Fabry disease: Data from the Fabry Outcome Survey

Anemia is a new complication in Fabry disease: Data from the Fabry Outcome Survey.BackgroundThe prevalence and causes of anemia among patients with Fabry disease are unknown.MethodsIn a cross-sectional study we examined hemoglobin concentrations of patients with Fabry disease using a large international database, the Fabry Outcome Survey (FOS), and analyzed the association of renal function, heart failure, gastrointestinal symptoms, and inflammation, with anemia (hemoglobin <12 g/dL in females and <13 g/dL in males).ResultsAnemia was present in 34% of 345 patients with Fabry disease. Median hemoglobin in 158 females was 12.9 g/dL and the median hemoglobin of 187 male patients was 13.2 g/dL. The prevalence of anemia among females was 20%, and among males 47%. Among patients with normal renal function [estimated glomerular filtration rate (GFR) >90 mL/min/1.73 m2] and anemia, heart failure [New York Heart Association (NYHA) class II to IV] and/or elevated C-reactive protein (CRP) levels were documented in 82% of patients. Up to 67% of patients with decreased estimated GFR presented with anemia. There was also a trend for lower hemoglobin levels among patients with signs of inflammation (defined by an elevated CRP level). We observed no association of the presence of gastrointestinal symptoms with anemia. Analyses in 53 patients receiving enzyme replacement therapy for up to 2 years, suggest no effect on anemia.ConclusionThe results of this study point to a high prevalence of anemia among patients with Fabry disease that is in most instances related to impaired renal function, heart failure, and inflammation. This finding may be of clinical relevance, because anemia is a major risk factor for patients with kidney disease, heart failure, or stroke, which are important manifestations of Fabry disease