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Resumen: El ex-utero intrapartum treatment (EXIT) es una estrategia de parto que permite brindar soporte cardiopulmonar al feto con el objetivo de realizar una intervención vital durante la transición a la vida extrauterina. El EXIT proporciona tiempo para el abordaje de una variedad de malformaciones potencialmente mortales en un ambiente de máximo control fisiológico.Según la finalidad de tratamiento, se han descrito distintos tipos de EXIT, incluyendo EXIT-to-airway (para el control de la vía aérea fetal), EXIT-to-ECMO (para la colocación de cánulas de oxigenación por membrana extracorpórea), EXIT-to-resection (para la resección de masas que impiden la ventilación o el retorno venoso) y EXIT-to-separation (para el abordaje de siameses). El objetivo general de un EXIT es mejorar la seguridad de procedimientos que resultan críticos para la supervivencia del recién nacido.La relajación uterina máxima y controlada para maximizar la perfusión placentaria y fetal, manteniendo el bienestar fetal y materno, son los paradigmas de cualquier tipo de EXIT. El aspecto más importante de una intervención en soporte placentario es consolidar un equipo multidisciplinario altamente capacitado, bien coordinado y preparado para cualquier contingencia. Una evaluación prenatal completa, incluyendo ultrasonido, ecocardiografía fetal, resonancia magnética y pruebas genéticas, es imprescindible para la selección de pacientes. La planificación preoperatoria exhaustiva, las reuniones de equipo ad-hoc y las simulaciones quirúrgicas para casos desafiantes son estrategias críticas para lograr los mejores resultados clínicos.El presente artículo describe el algoritmo de estudio prenatal, la planificación preoperatoria, los aspectos técnicos, los principios básicos y los fundamentos del procedimiento EXIT. Summary: Ex-utero intrapartum treatment (EXIT) is a delivery strategy that allows for providing fetal cardiopulmonary support while performing a vital intervention during the transition to newborn life. EXIT provides time to address a variety of life-threatening congenital malformations in an environment of maximum physiological control.Depending on the treatment purpose, different types of EXIT have been described; including EXIT-to-airway (to establish a fetal airway), EXIT-to-ECMO (for extracorporeal membrane oxygenation circuit cannulation), EXIT -to-resection (for the resection of masses that impair ventilation or venous return), and EXIT-to-separation (for the approach of conjoined twins). The overall goal of an EXIT is to improve the safety of procedures that are critical to the survival of the newborn.Maximal but controlled uterine relaxation to ensure placental perfusion and thus fetal oxygenation, while maintaining fetal and maternal well-being, are the paradigms of any type of EXIT. The most important aspect of any intervention on placental support is to consolidate a highly trained, well-coordinated, multidisciplinary team that is prepared for every contingency. A comprehensive prenatal assessment, including ultrasound, fetal echocardiogram, MRI, and genetic testing, is imperative for the selection of patients. Extensive preoperative planning, ad-hoc team meetings, and surgical simulations for challenging cases are critical strategies to achieve the best clinical outcomes.This article outlines the prenatal work-up, preoperative planning, technical aspects, basic principles, and fundamentals for a successful EXIT procedure.

In bioethics vaccine refusal is often discussed as an instance of free riding on the herd immunity of an infectious disease. However, the social science of vaccine refusal suggests that the reasoning behind refusal to vaccinate more often stems from previous negative experiences in healthcare practice as well as deeply felt distrust of healthcare institutions. Moreover, vaccine refusal often acts like an exit mechanism. Whilst free riding is often met with sanctions, exit, according to Albert Hirschman’s theory of exit and voice is most efficiently met by addressing concerns and increasing the quality and number of feedback channels. If the legitimate grievances responsible for vaccine refusal are not heard or addressed by healthcare policy, further polarization of attitudes to vaccines is likely to ensue. Thus, there is a need in the bioethics of vaccine refusal to understand the diverse ethical questions of this inflammable issue in addition to those of individual responsibility to vaccinate.

The historical dynamics of entry and exit in the financial exchange industry are analyzed for a panel of 327 US exchanges from 1855 through 2012. We focus on economic, technological and regulatory factors. Using novel panel data evidence, we empirically test whether these factors are consistent with existing financial theories. We find that US exchanges are more likely to exit per year after the passage of the Securities Exchange Act. The telephone, literacy and regulation are robust predictors of financial exchange dynamics, whereby an upward trend in literacy is an important driver of exchange entry.

Rapid technological developments are inducing the shift in consumer demand from existing products towards new alternatives. When operating in a declining market, the profitability of incumbent firms is largely dependent on the ability to correctly time the introduction of product innovations. This paper contributes to the existing literature on technology adoption by considering the optimal innovation The authors thank seminar participants at the INFORMS Annual Meeting in Nashville (November 2016) and the Annual Real Options Conference in Boston (July 2017) for helpful comments. We study the investment in the context of the declining market. We study the problem of a firm that has an option to undertake the innovation investment and thereby either to add a new product to its portfolio (add strategy) or to replace the established product by the new one (replace strategy). We are able to quantify the value of the option to adopt a new technology, as well as the optimal timing to exercise it. We find that it can be optimal for the firm to innovate not only because of the significant technological improvement, but also due to demand saturation. In the latter case profits of the established product may become so low that the firm will adopt a new technology even if the newest available innovation has not improved for some time. This way, our approach allows to explicitly account for the effect of a decline in the established market on technology adoption. Furthermore, we find that under certain conditions an inaction region exists, in which the firm does not innovate, while for lower technology levels it applies the add strategy and for higher technology levels the replace strategy.

OBJECTIVE: Reliable airway patency diagnosis in fetal tracheolaryngeal obstruction is crucial to select and plan ex utero intrapartum treatment (EXIT) surgery. We compared the clinical utility of magnetic resonance imaging (MRI) super-resolution reconstruction (SRR) of the trachea, which can mitigate unpredictable fetal motion effects, with standard 2-dimensional (2D) MRI for airway patency diagnosis and assessment of fetal neck mass anatomy. STUDY DESIGN: A single-center case series of 7 consecutive singleton pregnancies with complex upper airway obstruction (2013-2019). SETTING: A tertiary fetal medicine unit performing EXIT surgery. METHODS: MRI SRR of the trachea was performed involving rigid motion correction of acquired 2D MRI slices combined with robust outlier detection to reconstruct an isotropic high-resolution volume. SRR, 2D MRI, and paired data were blindly assessed by 3 radiologists in 3 experimental rounds. RESULTS: Airway patency was correctly diagnosed in 4 of 7 cases (57%) with 2D MRI as compared with 2 of 7 cases (29%) with SRR alone or paired 2D MRI and SRR. Radiologists were more confident (P = .026) in airway patency diagnosis when using 2D MRI than SRR. Anatomic clarity was higher with SRR (P = .027) or paired data (P = .041) in comparison with 2D MRI alone. Radiologists detected further anatomic details by using paired images versus 2D MRI alone (P < .001). Cognitive load, as assessed by the NASA Task Load Index, was increased with paired or SRR data in comparison with 2D MRI. CONCLUSION: The addition of SRR to 2D MRI does not increase fetal airway patency diagnostic accuracy but does provide improved anatomic information, which may benefit surgical planning of EXIT procedures. ispartof: OTO OPEN vol:5 issue:4 ispartof: location:United States status: accepted

Ex utero intrapartum treatment (EXIT) to airway has been described as a safe method to secure challenging fetal airways while on placental support. Herein, we present a unique case of a monochorionic-diamniotic twin pregnancy where both fetuses presented with oropharyngeal tumors requiring airway securement on placental bypass. A multidisciplinary tabletop simulation was convened to allow for personnel coordination between multiple services, OR equipment allocation, and preparation for a range of possible clinical scenarios. A tabletop simulation was chosen for planning since this is a simulation methodology commonly used for preparation in acute, high intensity multidisciplinary situations such as disaster preparation, and allows for exploration of multiple potential scenarios when outcomes are uncertain. The twins were urgently delivered for decreased fetal movement and decelerations in Twin B at 28 weeks 6 days. Twin A was delivered via EXIT to airway while Twin B had debulking of the tumor on placental support, with subsequent airway securement through a tracheostomy. In conclusion, for complex fetal procedures, detailed pre-operative planning with tabletop simulation may be a useful tool in achieving successful patient outcomes.

An emerging literature in behavioral public administration shows that performance information affects the perceptions and choices of citizens vis-a-vis public services and programs. Methodologically, a significant share of these studies rely on hypothetical scenario experiments or they focus on citizen assessments of broader government entities that citizens have little or no direct interaction with or personal information about. Yet, among actual service users, performance data is only one among many sources of information, potentially limiting its influence. Service users might also engage in motivated reasoning, for instance, by questioning the validity and relevance of inconvenient information about service providers they are otherwise happy with, or whom they are responsible for choosing. In this study, we conducted a survey experiment in the field, offering true performance data to service users, namely parents with children in public schools. We consistently find little or no evidence that performance information affects user satisfaction, intended voice and exit behaviors, incumbency voting, or goal prioritization. These findings question the feasibility of using performance information disclosure to affect the judgments and choices of service users, with potentially important downstream effects on the incentives facing public service providers. An emerging literature in behavioral public administration shows that performance information affects the perceptions and choices of citizens vis-a-vis public services and programs. Methodologically, a significant share of these studies rely on hypothetical scenario experiments or they focus on citizen assessments of broader government entities that citizens have little or no direct interaction with or personal information about. Yet, among actual service users, performance data is only one among many sources of information, potentially limiting its influence. Service users might also engage in motivated reasoning, for instance, by questioning the validity and relevance of inconvenient information about service providers they are otherwise happy with, or whom they are responsible for choosing. In this study, we conducted a survey experiment in the field, offering true performance data to service users, namely parents with children in public schools. We consistently find little or no evidence that performance information affects user satisfaction, intended voice and exit behaviors, incumbency voting, or goal prioritization. These findings question the feasibility of using performance information disclosure to affect the judgments and choices of service users, with potentially important downstream effects on the incentives facing public service providers.

This article is focused on the finite element modeling of burr formation in high speed micromilling of Ti6Al4V. Studies show that the burr produced at the up milling side at the exit of the micromilling tool is the biggest among burrs at other locations. Therefore, side exit burr at the up milling side has been modeled through finite element modeling. Johnson cook material constitutive model has been implemented in the formulation of burr formation. Experimental work has been performed to validate the developed model. It is found that the burr height and width obtained from the simulation has been validated experimentally with a maximum error of 15%. It was found from the literature review that the cutting speed is the factor, which influences the burr formation. Therefore, the model has been further extended to study the effect of cutting speed on the burr size. A maximum tool rotation of 200,000 rpm was considered with a tool diameter of 500 mu m. It is predicted from the simulation that, the burr size was reduced by 96% (both height and width) if cutting tool speed was increased from 10,000 to 200,000 rpm. Therefore, it is concluded that the cutting speed is the major factor to reduce the burr size in micromilling of Ti6Al4 V. This study shows that the high speed micromachining center can be helpful in producing the micro parts with less or no burrs. It is expected that further extension of the burr formation model can minimize the burr size to zero/near zero size. (C) 2017 Elsevier Inc. All rights reserved.

Objectives This study aims to examine whether older workers aged 50–64 years with multimorbidity are at increased risk to transition from full-time paid employment to part-time employment, partial retirement, unemployment, disability, economic inactivity, full retirement or die than workers without a chronic health condition and workers with one chronic health condition, and whether socioeconomic position (SEP) modifies these transitions. Method Using data from the Health and Retirement Study (1992–2014; n = 10,719), sub-distribution hazard ratios with 95% confidence intervals were calculated with a time-varying Fine and Gray competing-risks survival regression model to examine exit from full-time paid employment. We investigated the modifying effect of SEP by examining its interaction with multimorbidity. Results Workers with multimorbidity had a higher risk of transitioning to partial retirement (1.45; 1.22, 1.72), disability (1.84; 1.21, 2.78) and full retirement (1.63; 1.47, 1.81), and they had a higher mortality risk (2.58; 1.71, 3.88) than workers without chronic disorders. Compared to workers with one chronic health condition, workers with multimorbidity had an increased risk for partial (1.19; 1.02, 1.40) and full retirement (1.29; 1.17, 1.42), and mortality (1.49; 1.09, 2.04). Only SEP measured as educational level modified the relationship between multimorbidity and mortality. Discussion Workers with multimorbidity seem more prone to leave full-time paid employment than workers without or with one a chronic health condition. Personalized work accommodations may be necessary to help workers with multimorbidity prolong their working life.

Private Equity (PE) funds are active investors. Besides providing capital, they improve the governance, operational performance and innovation of the investee companies. However, potential misalignment between the fund manager and the company owner regarding exit timing is a limitation of the model. PE funds have a finite-life, and thus they have to liquidate investments after holding them for a certain period. They tend to time the market to exploit favorable market conditions and obtain higher selling prices, and consequently, PE funds may divest before accomplishing the value creation plan. In this article, we use the hazard model to investigate the magnitude of the impact of market conditions on the exit rate of PE deals in Brazil, a volatile emerging economy, and if it increases the chances of exiting investments with holding periods shorter than two years. We analyze a sample of 470 PE deals invested between 1994 and 2014, and we investigate four variables related to market conditions: the stock market price-earnings ratio, the number of IPOs, the Brazilian real (the Brazilian currency) appreciation against the US dollar and the Brazilian interest rate. Our results show that favorable market conditions more than double the exit rate and increase the probability of quick flips.

Purpose Physical work exposures and common mental disorders (CMD) have been linked to increased risk of work disability, but their joint associations with disability retirement due to any cause, mental disorders or musculoskeletal diseases have not been examined. Methods The data for exposures and covariates were from the Finnish Helsinki Health Study occupational cohort surveys in 2000–2002, 2007 and 2012. We used 12,458 observations from 6159 employees, who were 40–60 years old at baseline. CMD were measured by the General Health Questionnaire (GHQ-12, cut-off point 3+). Four self-reported work exposures (hazardous exposures, physical workload, computer and shift work) were combined with CMD and categorized as “neither”, “work exposure only”, “CMD only”, and “both”. Associations with register-based disability retirement were assessed with Cox proportional hazards models for sample survey data adjusting for confounders over 5-year follow-up. Additionally, synergy indices were calculated for the combined effects. Results Those reporting CMD and high physical workload had a greater risk of disability retirement due to any cause (HR 4.26, 95% CI 3.60–5.03), mental disorders (HR 5.41, 95% CI 3.87–7.56), and musculoskeletal diseases (HR 4.46, 95% CI 3.49–5.71) when compared to those with neither. Synergy indices indicated that these associations were synergistic. Similar associations were observed for CMD and hazardous exposures, but not for combined exposures to CMD and computer or shift work. Conclusions Identification of mental health problems among employees in physically demanding jobs is important to support work ability and reduce the risk of premature exit from work due to disability.

The Publisher's final version can be found by following the DOI link. The coincidence of productivity improvements and growth of agriholdings in Ukraine over the last decade is often interpreted as evidence of technology-induced increasing returns to scale and superiority of very large farms. Panel data for the country’s commercial farms in 2001–2012 do not allow us to reject the hypothesis of constant returns to scale but point toward the importance of farms and rayon- (district) fixed effects. This suggests productivity growth was driven by exit of unproductive and entry of more efficient farms. Higher initial shares of area under farms above 3,000 or 5,000 ha at rayon level significantly reduce subsequent exit, pointing towards one channel through which land concentration may reduce productivity growth.

This paper examines the impact of government versus private independent venture capital (VC) backing on the exit performance of entrepreneurial firms. Our analyses are based on the VICO dataset, which avoids the coding problems of VC type in the Thompson Financial SDC dataset. The data indicate that private independent VC-backed companies have better exit performance than government-backed companies. Mixed-syndicates of private-independent and governmental VC investors give rise to a higher (but not statistically different) likelihood of positive exits than that of IVC-backing. Our findings are not influenced by the composition of the syndicate in terms of size and institutional heterogeneity. Our results remain stable after controlling for endogeneity concerns, selection bias, omitted variable bias, legal and institutional differences across countries and over time through several econometric techniques. Moreover, our results are not driven by: i) the holding period of the different types of VC investors; ii) the potential signaling effect of GVC towards IVC investors; iii) the firm's financial structure and net cash-flow ratio; iv) the investment stage; and v) the distance between the VC investor and the target company.

[EN] This study presents an updated diagnosis of the SV ecosystem itself and offers an insight into the entrepreneurial mobility trends prospects and expectations of the growing number of start-ups launched by immigrant entrepreneurs arriving in SV. The purpose is to determine and rank the attributes most valued by investors when assessing projects and start-ups founded by immigrant entrepreneurs. The model of analysis composed by three hypotheses leads to a series of findings about the profile and expectations of the immigrant entrepreneurs, and reveals remarkable hints and key targets to be met by immigrant entrepreneurs in SV in order to successfully close investment rounds in a hypercompetitive environment. The study discloses the low impact of the founder's profile as a driver of external investment. A key conclusion states that Venture Capitalists and Business Angels in the top-ranked entrepreneurial ecosystem are primarily led by factors linked to the competitive environment and the product development process, along with the traditional performance indicators: revenue and profitability.

Background: Hirschman’s 1970; 1980 analytical conceptualization of the influence of competition on exit vs. voicing, the point of departure for this study, suggests that the presence of competitive providers’ fosters patients’ decisions to switch GPs exit. In Norway, the list patient system introduced in 2001 gives patients the option of changing GPs up to twice within a year. Although patient exiting can signal dissatisfaction with a particular GP, this signal is less informative about which aspect of the service is the issue. A private web-based rating site, Legelisten, was launched in Norway in May of 2012 to give patients a platform for voicing their opinions about the health care they receive, thereby also providing feedback that doctors can use to improve their services. Higher exit opportunities in a competitive market can reduce a patient’s motivation to voice about his or her provider; however, online voicing creates available knowledge about GPs and becomes a public good of high interest, especially in large-market settings, leading to higher participation in voicing in these markets than in smaller ones. Objective : The study aims to test the influence of GP market competition on dissatisfied patients’ choice to exit switch physician or to voice participate in online rating. Method : A panel data set covering the entire population of Norwegian GPs was utilized for every half year from January 2010 to January 2015 for patient exiting and from January 2012 to January 2015 for patient voicing. The analysis was primarily quantitative, involving descriptive statistics and appropriate panel regression methods for both GP and market-level analyses multilevel mixed-effect linear regression for the GP-level exit, multilevel mixed-effects logistic regression for the GP-level voice, linear regression for the market-level exit, and the Tobit regression for market-level voice. Findings : Higher GP market competition both with and without adjusting for municipality size increased the proportion of patients switching exit. However, for voice, higher GP market competition not adjusted for municipality size led to more participation for both dissatisfied and overall voice, while adjusted for municipality size led to less participation. This opposite effect, reflects the municipality size effect and the associated difference in the public good motive for contributing to the online voice. This result is consistent in both the GP-level and market-level analyses, strongly supporting the hypothesis adopted by this study.

In the context of international public debates on vaccination the National Institute for Public Health and the Environment (RIVM), the Dutch public health body responsible for the National Immunization Programme (NIP), fears that the high vaccination rate of children in the Netherlands obscures the many doubts and criticisms parents may have about vaccination. The question arises as to how the robustness of this vaccination rate and the resilience of the NIP can be assessed. To answer this question, we explore the vaccination practices and relationships between professionals and parents using qualitative methods. Drawing on Hirschman's concepts of exit, voice and loyalty, we distinguish between two different approaches to vaccination: one which enforces parental loyalty to the vaccination programme, and one which allows for voice. The analysis shows that due to their lack of voice in the main vaccination setting, parents' considerations are unknown and insight into their loyalty is lacking. We argue that the Dutch vaccination programme is caught between the insecurity of enforced parental loyalty to the NIP and the insecurity of enabling parental voice and negotiating space. We conclude that to increase the resilience of the NIP, experimenting with voice and exit is inevitable.

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Extant research offers limited and inconclusive findings on the effects of early exporting by new ventures. This longitudinal study examines such effects, taking into consideration the roles of competition and adaptation in international venturing and exiting. The findings alert us to the potentially negative impact of early exporting on exit. Despite the deterrent effect of exporter competition, those new ventures that engage in early international venturing are impelled to keep strategically alert and expedite their learning process, therefore prospering in the highly competitive environment. By attracting foreign investors, new ventures will be able to start exporting early, and endorsed by the knowledge advantages associated with foreign partners the rapid entrants have better continuation chances. At the same time, early exporting in a relatively less competitive environment or without foreign ownership will lead to higher exit likelihood. By highlighting the polarizing effects of early exporting in the life cycle of new ventures, this study reconciles the difference between the process model and theories on international entrepreneurship to some extent.

This paper investigates two main questions: Are affiliates of foreign multinationals more likely to exit the market than domestic firms? Does the exit probability of foreign firms depend on the technological environment in which they operate? Controlling for a set of firm- and industry-specific characteristics, our results show that Italian firms owned by foreign firms are more footloose than domestic ones regardless of the macro sector of activity in which they are involved (i.e. manufacturing and services). By taking into consideration the technological environment where firms operate, we also find that foreign ownership still exerts a negative influence on firm survival in both less and more technologically advanced industries. However, there is evidence of a stronger negative influence on the survival of firms operating in low- and medium-low technology industries and in less-knowledge-intensive services.

This paper investigates how business establishment entry and exit are affected by cycles in business density. We assess how entry/exit behave when markets over and under shoot a dynamic equilibrium number of businesses and whether these effects differ between manufacturing and service industries. Overall, we find persistent cycles where the actual number of business establishments is typically not equal to the dynamic equilibrium number even though it gravitates towards it. We uncover a systematic pattern which indicates that in disequilibrium entry is dis-equilibrating while closure is equilibrating. For example, the entry rate plays a dis-equilibrating role by accelerating in an overshoot, however as exits accelerate even faster in an overshoot they help move the industry towards an equilibrium. Overall, the results indicate that entrepreneurs and corporations operate with a herd instinct thereby increasing establishments in a cyclical business density over shoot and decreasing them in an under shoot. In terms of economic policy, the results question whether government policy aimed at promoting business creation and expansion ought to have a counter business density cyclical dimension. In other words, should business start-up and growth be promoted more strongly in business density under shoots than over shoots?

A 37 year-old primipara women was referred for management of a large solid tumor found in the neck of her fetus, showing the trachea to be compressed by the mass, and intubation through the ex utero intrapartum treatment (EXIT) was planned. After the mother was anesthetized using a Fentanyl with Isofluorane, the head and left arm of the baby were delivered through a standard lower segment cesarean section, and the baby was intubated with a 3.0 mm tracheal tube before clamping and dividing the umbilical cord, then transferred to a resuscitation table. Time from partial delivery to transfer was 9 min, and the baby weighed 3300 g and quickly achieved acceptable oxygen saturations. A tracheostomy and biopsy of the mass were performed on day 1, and Rhabdomyosarcoma was diagnosed. Multiagent chemotherapy was commenced without any reduction in size (82 × 80 × 70 mm), and radical resection was performed 8 weeks after EXIT. Preoperatively, arterial feeders to the mass arising mainly from the right external carotid artery, were selectively embolized, and surgical excision was performed. After additional chemotherapy and radiotherapy, the child is doing well without recurrence after 3 years of follow-up.

The aim of this paper is to investigate whether and how multinational status and foreign ownership affect the survival of Italian manufacturing and service firms. To this end, we analyze firm survival by distinguishing Italian firms as foreign multinationals (FMNEs) domestic multinationals (DMNEs) or domestic non-multinational firms (NMNEs). The empirical analysis is based on the Kaplan-Meier survival estimator and on the Cox proportional hazard model, in which we look for the impact of ownership dummies on firm survival, controlling for several firm and industry specific covariates. Our findings reveal that manufacturing and service firms owned by foreign multinationals are more likely to exit the market than either DMNEs or NMNEs. Moreover, DMNEs show a higher chance of survival in services. By decomposing firm activities into different technological classes, we also find that foreign ownership still exerts a negative influence on firm survival in both static and dynamic industries, while domestic multinationals in less-knowledge-intensive services appear more persistent. © 2014 Vilnius Gediminas Technical University (VGTU) Press Technika.

The Blood–Lymph-Node Connection in Breast Cancer Metastasis The presence of breast cancer cells in the sentinel lymph node is used to determine prognosis. These cells may metastasize to distant org...

Objective Human resource primacy (HRP) refers to employees’ perceptions of how the organization shows interests in its employees’ welfare, happiness, and health. The aims of this study were to determine whether (i) perceptions of HRP are related to the risk for disability retirement and (ii) HRP moderates the impact of psychological distress on later risk for disability retirement. Methods The study relied on a combination of self-report survey questionnaire data on HRP and psychological distress supplemented with official register data on disability benefits from the Norwegian Labor and Welfare Administration. The sample comprised 14 501 Norwegian employees from various occupations and industries. Results HRP was significantly associated with reduced risk of disability retirement [hazard ratio (HR) in bivariate analysis 0.84, 95% confidence interval (95% CI) 0.77–0.93] and after adjusting for gender and educational level. However, HRP (HR 0.97, 95% CI 0.87–1.07) was not associated with later risk for disability retirement after adjusting for psychological distress and did not moderate the association between psychological distress and disability retirement. Conclusions A positive impression of HRP may reduce the risk of disability retirement in general but not in cases following psychological distress. Upcoming research should identify other factors that may be more beneficial with regard to reducing the risk for disability retirement following distress.

Aim:The aim of this study was to review prenatally diagnosed tumors of the head and neck in the fetus and to report antenatal and postnatal outcomes.Methods:PubMed/Medline, EMBASE/SCOPUS, Cochrane database and Google Scholar were reviewed over the last 20 years. No language or article type restriction was used.Results:A total of 1940 record were retrieved. Of the 713 records screened, 566 full-text articles were assessed for eligibility. After 445 articles were excluded for specified reasons, 111 studies met the research criteria and were included for qualitative analysis. Overall, 306 cases of fetal tumors of the head and neck were reviewed. Maternal age was an independent factor. The mean maternal age was 28.2 years and gestational age at prenatal diagnosis was 27.1 weeks. Conventional 2D ultrasound was the standard diagnostic procedure in 27.9% of cases and was implemented in 27.3% of cases by 3D ultrasound and fetal magnetic resonance imaging (MRI). Diagnostic evaluation of intracranial spreading and high-airway obstructions was greatly enhanced by fetal MRI. The more common type of fetal tumor was hemangioma/lymphangioms (42.1%), followed by teratomas (29.7%), tumors of the gingiva (10.1%) and lymphatic venous malformations (9.1%), respectively. Fetal karyotyping was performed only in 9.8% of cases; within fetuses undergoing karyotype, chromosomal abnormalities accounted for 20% of cases. The most common pregnancy complication was polyhydramnios (26.3%). Ex utero intrapartum treatment (EXIT) procedure was performed in 30.1% of cases while surgical excision was used in 22.9% during postnatal life. The survival rate was 35.35%.Conclusion:Fetal tumors of the head and neck are rare congenital malformations. Two-dimensional ultrasound is diagnostic in almost all cases; however, MRI may be an important diagnostic adjunct in targeted cases and help patient selection for immediate intubation at the time of delivery. EXIT procedure and surgical removal of the tumor was associated with good prognosis.

Hirschman has repeatedly stated that Voice is better than Exit as citizens or clients response to dissatisfaction with the service provided by organizations of various nature. He also maintained that all too often Exit was preferred to Voice and the negative result would be that services of worse quality will be supplied in the system as a whole. Unfortunately, Hirschman never formalized his powerful categories and his fascinating ideas. The paper is an attempt to fill this gap; it also aims at showing how helpful Hirschaman’s approach can be in the endeavour to design efficient institutions. This paper provides a definition of efficiency convenient for our purposes and presents a model where both Exit and Voice can be necessary in order to achieve efficient results, given that the decline of organizations can have several different originating factors. Then it identifies the analytical conditions under which Exit is spontaneously chosen by citizens or clients despite being less efficient than Voice. The paper shows that the use of Exit when Voice would be more efficient is not as general as Hirschman seemed to imply but it can arise under well-specified circumstances. In its final part, the paper suggests how institutions should be designed in order to prevent such inefficient results.

International audience; Alliance portfolio diversity (APD) - defined as differences between firms' types of alliance partners (i.e. horizontal, upstream, and downstream) - is a strategic determinant of firm survival. This article analyzes APD in the context of high tech firms who rely on various partners to access complementary resources and secure their business survival, and argues that APD has different impacts on two main types of exit - sell-off and shut-down - which have been combined in previous research. Findings from a comprehensive study of French biotech firms from 1994 to 2002 show that the relationship between APD and shut-down is positive and linear whereas that between APD and sell-off is an inverted U-shaped. The article also finds evidence that the association between APD and firm exit mode is contingent on a firm's resources and capabilities. The implications for research and managerial practice are discussed.

'Representative voice' can be defined as actions in which one or more speakers represent others when speaking up about a problem at the workplace or making a suggestion. The purpose of this paper is to introduce the concept of representative voice, assess the frequency of its occurrence and examine department characteristics associated with its frequency. We present a theoretical framework and develop and test hypotheses about the effects of characteristics of the departmental context on the frequency of representative voice. Our focus is on organizational design features, i.e. characteristics that can be directly implemented by management. Data on 40 departments of a large Dutch childcare organization suggested that representative voice occurred in most of the organization's departments, although not frequently. Multilevel analyses showed that representative voice was best predicted by the presence of shared problems. Further, representative voice was more frequent in departments in which employees worked directly with clients (i.e. children), and in larger departments. Frequent contact with the department's manager and among the department's employees had no effect.

Research on entrepreneurial exit has established itself as a more recognized component of the entrepreneurial process and a distinctive domain of entrepreneurship research. Despite the progress made, there still exists important topics within entrepreneurial exit where scholarly understanding is scant. This special issue discusses new and open topics of research on entrepreneurial exit. Three papers examine three such topics including pricing intentions of exiting entrepreneurs, exit considerations among angel investors, and the relationship between exit and failure in new ventures. Funding Agencies|Marcus Wallenberg foundation for International Scientific Cooperation

A broad literature has found that the misallocation of entrepreneurial talent has strong effects on productivity. To investigate whether the government can improve entrepreneurial activity, we analyze a policy aimed at promoting innovative startups through the provision of funding and technical assistance to potential entrepreneurs in Buenos Aires, Argentina. We conduct a survey and use regression discontinuity methods to identify the effects of the policy. We find significant effects on enterprise creation and survival as well as on employment. Overall, we show that small-scale public policy can help entrepreneurs overcome a wide variety of barriers to firm entry and improve the allocation of their entrepreneurial talent. CAF "Fondo para la Investigacion Cientifica y Tecnologica" (FONCyT) [PICT/2588-2010]

The factors affecting the demand for agricultural insurance in the USA have been extensively studied over the last two decades. However, the determinants of a farm's entry and exit decisions in the insurance market have received relatively little attention. Turnover in the insurance book of business is an important issue in most private and public crop insurance plans. Moreover, insurance markets in the EU are still largely under-investigated. We investigate empirically the determinants of crop insurance participation in Italy. We show that the participation rate is high for large firms and that it is negatively correlated with crop diversification, which is itself a form of insurance. High premiums tend to inhibit both entry and exit from the insurance market. Larger and wealthier farms are more likely to adopt insurance and renew coverage over time. We discuss implications of our results for public intervention and the private industry. In particular, we demonstrate that the decision to drop coverage by an insured grower may differ significantly from the corresponding decision to enroll in an insurance programme by an uninsured farmer. To the extent that policymakers want to encourage participation in subsidized crop insurance programmes, education and outreach efforts toward uninsured farmers may differ substantially from those directed toward keeping insured farmers enrolled in the programme. We investigate these differences.

Hirschman contrasts exit and voice as 'recuperation' mechanisms for making organisations responsive to users. However, the emergence of health-care quasi-markets and of network governance structures since Hirschman necessitate revising his theory, for they complicate the relationships between governance structures and recuperation mechanisms. Using a case study of nine primary care trusts (PCTs), this paper analyses the recuperation mechanisms, governance structures and relations between them in primary care in England. User voice can be exercised through dedicated networks besides hierarchies. As well as the 'user exit' described by Hirschman, two new 'exit' mechanisms now exist in quasi-markets. Commissioner exit occurs when a third-party payer stops using a given provider. Professional proxy exit occurs when a general practitioner (GP) fund-holder (or analogous budget-holder) behaves similarly. Neither exit mechanism requires the existence of mechanisms for user exit from healthcare purchasers, provided strong voice mechanisms exist instead to make commissioners responsive to users' demands. Establishing such voice mechanisms is not straightforward, however, as the experience of English PCTs illustrates. © 2006 Elsevier Ltd. All rights reserved.

International audience; This paper analyzes industry adjustments to trade liberalization. It introduces cross-border mergers and acquisitions (M&A) as an alternative mode of industrial restructuring to firms' exit. In a two-country Cournot model, we examine the responses of domestic and foreign firms endowed with different technologies for different stages of trade openness. It is found that the less efficient firm loses market shares in its home market at the beginning of trade liberalization. Only for a more advanced level of liberalization, does it take advantage of a larger access to foreign demand. Trade liberalization may therefore harm its profits too strongly, forcing it to leave the market. However, although its incentives decrease with trade liberalization, the high-technology firm may be willing to take it over for low organizational and technological costs of firms' integration. In addition, it may buy it out even if the less efficient firm manages to stay. Then, trade liberalization affects M&A incentives depending on the technological gap. For low and high (medium) gap, there is an inverted U- (W-) shaped relation between trade costs and incentives to merge. Moreover, although technology transfer is assumed to be complete, M&A may lead to a reduction in consumers' welfare. Firms may capture some pro-competitive gains from economic openness. Lastly, an empirical analysis based on a data set of OECD members' multinationals gives some support to these theoretical predictions.

Buzzelli M. (2005) What explains firm transience in house-building? A regional analysis of Ontario, Canada, 1991 and 1996, Regional Studies 39 , 699-712. This paper presents cross-sectional analyses of firm exit (1991) and entry (1996) in house-building using a geographic information system of firms in Ontario's 48 counties (regions). Ordinary least-squares and logit regressions of entry and exit rates reveal several regional determinants, some specific to the housing market (prior construction) and others usually found in regional studies of firm dynamics (population density, market growth, incomes, immigration, unemployment and home ownership). The results suggest that housing policy may be best administered at the regional scale - the scale at which builders typically operate in North America.

This paper contributes to the emerging field of business transfer studies by providing qualitative, in-depth evidence on the role of intermediaries at different stages of the transfer process. Building on the resource-based view of the firm and agency theory, this paper identifies the specific resources different types of intermediaries offer small businesses in the transfer process. Further, it explores the role of intermediaries in managing risk and uncertainty in the interaction between buyer and seller. The results suggest that small business owners may need to navigate the use of a variety of intermediaries throughout different times leading-up-to and throughout the business transfer process. Finally, opportunities for further research are explored.

This paper aims at examining the role played by inward foreign direct investment (FDI) in affecting the exit probabilities of German manufacturing firms in the pre-crisis year 2008. We introduce two main novelties: in the first place, we include the FDI variable, dividing it between types of foreign investor (industrial versus financial) besides the analysis with the division by country of origin. Second, we analyse whether FDIs may have effects not only on the probability that a firm exits from the domestic market, but also on whether it stops being internationally involved, that is, whether it stops importing or exporting. We find that German firms, in most cases, suffer from higher competition introduced by foreign firms except when they are part of a high-R&D region or a high-tech sector, because they have enough absorptive capacity to take advantage of possible spillover effects. We also find that US FDIs have a crowding out effect for firms located in low-tech sectors but not in high-tech sectors. The results are reversed when considering financial investments instead of industrial investments. Finally, we find that FDIs are negatively correlated with exits from export markets but positively with those from import markets.

Temporary tracheal balloons have been shown to improve lung growth in fetuses with severe congenital diaphragmatic hernia. Fetoscopic Endoluminal Tracheal Occlusion (FETO) is performed at 26-28 weeks gestation, and then is removed in utero at 34 weeks gestation at highly specialized centers. In case of preterm labor at a hospital without a specialized team, a number of techniques have been used to remove the balloon, sometimes with death of the newborn. We have successfully performed an ultrasound-guided approach to puncture and remove the tracheal balloon in a premature infant in an emergency setting at birth. After that she was treated for congenital diaphragmatic hernia at our Newborn Intensive Care Unit.

This paper makes several contributions to the emerging literature on the post-entry behavior of international new ventures. Based on an extensive longitudinal data set, we investigate the dynamics of commitment, growth and survival of different types of newly internationalizing Belgian firms. Global start-ups have the highest initial and rapidly rising export commitment per market and are also more likely to continue exporting over time than geographically focused start-ups, and traditional staged exporters. However, global start-ups also display the highest failure rate. This high failure rate appears to result primarily fromthe ‘liability of newness’ and less from the added complexity associated with rapid and wide scope internationalization. publisher: Elsevier articletitle: International commitment, post-entry growth and survival of international new ventures journaltitle: Journal of Business Venturing articlelink: http://dx.doi.org/10.1016/j.jbusvent.2013.01.001 content_type: article copyright: Copyright © 2013 Elsevier Inc. All rights reserved. ispartof: Journal of Business Venturing vol:29 issue:1 pages:101-120 status: published

The ex utero intrapartum treatment is a rare surgical procedure performed in cases of expected postpartum fetal airway obstruction. The technique lies on a safe establishment of a patent airway during labor in anticipation of a critical respiratory event, without interrupting maternal–fetal circulation.Anesthetic management is substantially different from that regarding standard cesarean delivery and its main goals include uterine relaxation, fetal anesthesia and preservation of placental blood flow.We present the case of an ex utero intrapartum treatment procedure performed on a fetus with a large cervical lymphangioma and prenatal evidence of airway compromise. Modifications to the classic ex utero intrapartum treatment management strategies were successfully adopted and will be discussed in the following report.

Background/Purpose: Bidirectional trafficking of cells between the mother and the fetus is routine in pregnancy and a component of maternal-fetal tolerance. Changes in fetal-to-maternal cellular trafficking have been reported in prenatal complications, but maternal-to-fetal trafficking has never been studied in the context of fetal intervention. We hypothesized that patients undergoing open fetal surgery would have altered maternal-fetal cellular trafficking. Methods: Cellular trafficking was analyzed in patients with myelomeningocele (MMC) who underwent open fetal surgical repair (n = 5), patients with MMC who had routine postnatal repair (n = 6), and healthy control healthy patients (n = 9). As an additional control for the fetal operation, trafficking was also analyzed in patients who were delivered by an ex utero intrapartum treatment procedure (n = 6). Microchimerism in maternal and cord blood was determined using quantitative real-time polymerase chain reaction for nonshared alleles. Results: Maternal-to-fetal trafficking was significantly increased in patients who underwent open fetal surgery for MMC compared with healthy controls, patients who underwent postnatal MMC repair, and patients who underwent ex utero intrapartum treatment. There were no differences in fetal-to-maternal cell trafficking among groups. Conclusion: Patients undergoing open fetal surgery for MMC have elevated levels of maternal microchimerism. These results suggest altered trafficking and/or increased proliferation of maternal cells in fetal blood and may have important implications for preterm labor. © 2012 Elsevier Inc. All rights reserved.

The aim of this paper is to investigate the determinants of survival for Italian firms according to their ownership status. To this end, we analyze firm survival distinguishing the Italian firms in foreign multinationals (FMNEs), domestic multinationals (DMNEs) and domestic non-multinational firms (NMNEs). The empirical analysis, carried out over the period 2004–2008, is based on the Cox Proportional Hazard Model, in which we look for the impact of ownership dummies on firm survival controlling for several firm and industry specific covariates. Our main findings reveal that FMNEs are more likely to exit the market than national firms in manufacturing and services. In contrast, DMNEs have a higher chance of survival compared with the other firm categories in services. However, when we conduct a finer level of industry classification, we observe the presence of some heterogeneity in the patterns of firm survival. Moreover, we find that the presence of foreign firms has a positive impact on firms’ survival mainly in the service sectors.

Part 3: Governance, Openess and Institutions; International audience; This paper examines if, and how, the manner in which the state is viewed changes when an e-government system is implemented. The motivation for this paper lies in the fact that the nature of the state is under-theorised in e-government literature. The state, in a developing country context, is formulated as being scarce, presenting choices of exit and voice to citizens, and of having authority over violence. A specific grievance registration system from India, called Lokvani, is used as an example to show the effect of the system on how residents of that region view the state. Field data collected from participant interviews of those interacting with the system is analysed. The results show that the nature of the state changes when the system is used, however, for some aspects it remains the same. Further, the paper concludes that it is imperative to have a formal theory of the state for evaluating and designing e-government systems.

Between 1990 and 2004, Nigeria’s urban population jumped to nearly half the national population, while access to improved sources of water in urban areas dropped by nearly 15 per cent during the same period. This paper presents preliminary results on the relationship between water supply, neighbourhood characteristics, and household strategies in response to dissatisfaction with water provision as reported by 389 respondents in 10 neighbourhoods in Lagos and Benin City, Nigeria between October 2007 and February 2008. In this paper, a conceptual model of consumer demand for water is used, based upon Hirschman’s exit, voice and loyalty (EVL) framework. The model explicitly factors in the quality of water provision and variables at the household and neighbourhood levels that could affect perceptions about quality and the strategies that households use to cope with inadequate public services. Preliminary results show that reported household strategies to secure water are affected by community-level factors such as the range, cost, and quality of water supply alternatives, as well as neighbourhood composition. Furthermore, the percentage of urban migrants and households that live in rented flats in a neighbourhood seems to be associated with the use of exit strategies (as opposed to voice) in response to problems with their primary water supply.

From a model by Hopenhayn, three hypotheses can be derived: (H1) Firms that exit in year t were less productive in t- 1 than firms that continue to produce in t. (H2) Firms that enter in year t are less productive than incumbent firms in year t. (H3) Surviving firms from an entry cohort were more productive than non-surviving firms from this cohort in the start year. This paper uses unique newly available panel datasets for all manufacturing plants from Germany (1995-2002) to test these hypotheses. All three hypotheses are supported empirically for West and East Germany. © 2009 The Author. Journal Compilation © Verein für Socialpolitik and Blackwell Publishing Ltd. From a model by Hopenhayn, three hypotheses can be derived: (H1) Firms that exit in year t were less productive in t-1 than firms that continue to produce in t. (H2) Firms that enter in year t are less productive than incumbent firms in year t. (H3) Surviving firms from an entry cohort were more productive than nonsurviving firms from this cohort in the start year. This paper uses unique newly available panel datasets for all manufacturing plants from Germany (1995 - 2002) to test these hypotheses. All three hypotheses are supported empirically for West and East Germany.

Within a structural model we explicitly allow for the trade orientation of companies to estimate productivity dynamics within 4-digit UK manufacturing industries. We use the FAME data on UK companies over the period 1994-2003. Following Ackerberg et al. (2005) we adjust the algorithm in Olley and Pakes (1996) by augmenting investment and exit decisions to allow for exogenous demand shocks by trade orientation, assuming that labour and capital are state variables, and productivity follows a first-order Markov process. We extend the framework further by allowing exporting to be an additional control variable that is driven by lagged productivity as in Melitz (2003), leading productivity to follow a second-order Markov process. We find that over the period of introduction of the Euro improvements in aggregate productivity were driven by exporters - mainly by market share reallocations away from inefficient and towards efficient export companies. Aggregate productivity also benefited from improvements in productivity of non-exporters but was driven by improvements within companies rather than by market share reallocations. In a period of sustained real exchange rate appreciation both export cleansing and competitive pressure on non-exporters seem to have contributed to improvements of productivity in the UK manufacturing.

Although there is a large literature on the economic effects of minimum wages on labour market outcomes (especially employment), there is hardly any evidence on their impact on firm performance. This is surprising: minimum wages appear to have a significant impact on wages, but only a limited impact on jobs, so it is natural to imagine there must be a stronger impact on other aspects of firm behaviour. In this paper we consider the impact of minimum wages on firm profitability by exploiting the introduction of a minimum wage to the UK labour market in 1999. We use pre-policy information on the distribution of wages to construct treatment and comparison groups and implement a difference in differences approach. We show evidence that firm profitability was significantly reduced (and wages significantly raised) by the minimum wage introduction. This emerges from separate analyses of two distinct types of firm level panel data (one on firms in a very low wage sector, UK residential care homes, and a second on firms across all sectors). Interestingly, we find no evidence that the profitability reductions resulted in increases in firm exit, so our findings may be consistent with redistribution of quasi-rents towards low wage employees.

This paper investigates the interdependence between firm entry and exit from an industrial dynamics perspective. The paper discusses how entry and exit rates in industrial sectors are affected by previous exit and entry rates. Economic theory presents two different approaches to how entry and exit of firms are interrelated, the multiplier effect and the competition effect. This paper intends to investigate which force is the predominant one, for entry and exit patterns, respectively. The empirical analysis is based on data for 25 Swedish manufacturing industries at the 2-digit SIC level, during the period 1991–2000. In the estimation work the study applies a dynamic panel data approach as suggested by Anderson and Hsiao [Journal of the American Statistical Association, 76:598–606, 1981] and Arellano and Bond [Review of Economic Studies, 58(2):277–297, 1991]. With respect to entry, the empirical results support the multiplier effect such that entry stimulates future entry, but also a competition effect such that past exit induces additional entry. With regard to exit, on the other hand, the competition effect rules, implying that previous entry causes subsequent exit and previous exit reduces subsequent exit.

©The original publication is available at www.springerlink.com This paper analyses the role played by both competitive pressure (increasing imports) and the restructuring of industries through entry and exit in productivity growth of Spanish manufacturing during the eighties, the key period of its accession to the EEC economy. A GMM panel estimation of the determinants of corrected Solow residual for 75 manufacturing during 1979–1990, shows that these forces accounted for 80% of productivity growth, playing an important role the displacement of inefficient firms by competitive entry. Publicado