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L’analisi condotta nella tesi mira ad indagare le determinanti del debito delle piccole e medie imprese italiane: la domanda di ricerca è indirizzata a capire se la struttura finanziaria di queste ultime segue i modelli teorici sviluppati nell’ambito della letteratura di Corporate Finance o se, d’altro canto, non sia possibile prescindere dalle peculiarità delle piccole e medie imprese per spiegare il ricorso alle diverse fonti di finanziamento. La ricerca empirica effettuata nella dissertazione vuole essere un tentativo di coniugare le teorie di riferimento e le evidenze empiriche relative alle piccole e medie imprese italiane, analizzandone il comportamento attraverso lo studio del campione di dati fornito da Capitalia, relativo alla Nona Indagine per il periodo 2001-2003. Il campione in oggetto fa riferimento a circa 4000 imprese con più di 10 addetti, prevalentemente del settore manifatturiero. Per indagare le determinanti del debito nelle sue componenti più tradizionali, si sono prese in considerazione il debito commerciale e il debito bancario a breve termine come forme di finanziamento correnti mentre, tra le forme di finanziamento di medio-lungo periodo, le variabili usate sono state il ricorso al debito bancario a lungo termine e a strumenti obbligazionari. Inoltre, si è ricorso anche a misure più tradizionali di leva finanziaria, quali il rapporto di indebitamento, la proporzione tra debiti bancari, sia di breve che di lungo periodo, e l’ammontare dei finanziamenti esterni rispetto al valore dell’impresa, distinguendo anche qui, tra finanziamenti a breve e a lungo termine. L’analisi descrittiva ha mostrato il massiccio ricorso al debito bancario e, in generale, alle forme di indebitamento a breve. Le imprese di dimensioni minori, più giovani e opache tendono a ricorrere alle fonti interne e a forme di indebitamento a breve, mentre le imprese maggiormente dimensionate mostrano una struttura del debito più articolata. Questo ha suggerito la definizione di una diversa misura di debito, che tiene conto della complessità della sua struttura all’interno delle imprese, in base ad un ricorso di tipo gerarchico alle fonti di finanziamento: il grado di complessità dipende dalle tipologie e dalla quantità dei contratti di debito conclusi dall’impresa . E’ plausibile pensare che le imprese ricorrano prima alle fonti interne di finanziamento, perché prive di costi, e poi all’indebitamento nei confronti di diversi stakeholders: rispetto alla prossimità e alla facilità dell’ottenimento del finanziamento, è sembrato naturale pensare che un’impresa ricorra dapprima al debito commerciale, poi al debito bancario e solo infine all’emissione di obbligazioni, in un ordine gerarchico. Ne consegue che se un’impresa (non) ha contratto debiti con fornitori, banche e mercato, la complessità della struttura del suo debito è massima (nulla). L’analisi econometrica successiva è stata indirizzata in tre direzioni. In primis, l’analisi longitudinale dei dati è stata volta ad evidenziare se la struttura finanziaria delle PMI risponde ad un particolare modello teorico, in accordo con le teoria tradizionali di riferimento. In secondo luogo, l’analisi delle determinanti si è allargata allo studio degli aspetti peculiari delle imprese medio-piccole. Infine, si è indagato se, nell’ambito delle imprese di dimensioni minori, si osservano comportamenti omogenei oppure se determinate scelte nelle fonti di finanziamento sono da ricondurre all’esistenza di alcuni vincoli. Quindi, partendo dalla rassegna dei principali riferimenti nella letteratura, costituiti dalla Trade-off theory (Modigliani e Miller, 1963, De Angelo e Masulis, 1980, Miller, 1977), dalla Pecking order theory (Myers 1984, Myers e Majluf, 1984) e dalla Financial growth cycle theory (Berger e Udell, 1998), una prima serie di analisi econometriche è stata rivolta alla verifica empirica delle teorie suddette. Una seconda analisi mira, invece, a capire se il comportamento delle imprese possa essere spiegato anche da altri fattori: il modello del ciclo di vita dell’impresa, mutuato dalle discipline manageriali, così come il contesto italiano e la particolarità del rapporto bancaimpresa, hanno suggerito l’analisi di altre determinanti al ricorso delle diverse fonti di debito. Di conseguenza, si sono usate delle opportune analisi econometriche per evidenziare se la struttura proprietaria e di controllo dell’impresa, il suo livello di complessità organizzativa possano incidere sulla struttura del debito delle imprese. Poi, si è indagato se il massiccio ricorso al debito bancario è spiegato dalle peculiarità del rapporto banca-impresa nel nostro Paese, rintracciabili nei fenomeni tipici del relationship lending e del multiaffidamento. Ancora, si sono verificati i possibili effetti di tale rapporto sulla complessità della struttura del debito delle imprese. Infine, l’analisi della letteratura recente sulla capital structure delle imprese, l’approccio sviluppato da Fazzari Hubbard e Petersen (1988) e Almeida e Campello (2006 , 2007) ha suggerito un ultimo livello di analisi. La presenza di vincoli nelle decisioni di finanziamento, legati essenzialmente alla profittabilità, alla dimensione delle imprese, alle sue opportunità di crescita, e alla reputazione verso l’esterno, secondo la letteratura recente, è cruciale nell’analisi delle differenze sistematiche di comportamento delle imprese. Per di più, all’interno del lavoro di tesi, così come in Almeida e Campello (2007), si è ipotizzato che la propensione agli investimenti possa essere considerata un fattore endogeno rispetto alla struttura del debito delle imprese, non esogeno come la letteratura tradizionale vuole. Per questo motivo, si è proceduto ad un ultimo tipo di analisi econometrica, volta a rilevare possibili differenze significative nel comportamento delle imprese rispetto al ricorso alle fonti di finanziamento a titolo di debito: nel caso in cui esse presentino una dimensione contenuta, una bassa redditività e una scarsa reputazione all’esterno infatti, vi dovrebbe essere un effetto di complementarietà tra fonti interne ed esterne. L’effetto sarebbe tale per cui non sussisterebbe, o per lo meno non sarebbe significativa, una relazione negativa tra fonti interne ed esterne. Complessivamente, i risultati delle analisi empiriche condotte, supportano sia le teorie classiche di riferimento nell’ambito della disciplina della Corporate finance, sia la teoria proposta da Berger e Udell (1998): le variabili che risultano significative nella spiegazione della struttura del debito sono principalmente quelle relative alla dimensione, all’età, al livello e alla qualità delle informazioni disponibili. Inoltre, il ricorso a fonti interne risulta essere la primaria fonte di finanziamento, seguita dal debito. Il ricorso a fonti esterne, in particolare al debito bancario, aumenta quanto più l’impresa cresce, ha una struttura solida e la capacità di fornire delle garanzie, e ha una reputazione forte. La struttura del debito, peraltro, diventa più complessa all’aumentare della dimensione, dell’età e del livello di informazioni disponibili. L’analisi della struttura proprietaria e della componente organizzativa all’interno delle imprese ha evidenziato principalmente che la struttura del debito aumenta di complessità con maggiore probabilità se la proprietà è diffusa, se vi è un management indipendente e se la piramide organizzativa è ben definita. Relativamente al rapporto banca-impresa, i principali risultati mostrano che l’indebitamento bancario sembra essere favorito dai fenomeni di relationship lending e dal multiaffidamento. Tali peculiarità assumono tratti diversi a seconda della fase del ciclo di vita delle imprese della Nona Indagine. Infine, per quanto attiene all’ultima tipologia di analisi condotta, le evidenze empiriche suggeriscono che le piccole e medie imprese possano essere soggette a delle restrizioni che si riflettono nell’ambito delle loro politiche di investimento. Tali vincoli, relativi alla dimensione, ai profitti conseguiti e alla reputazione all’esterno, aiutano a spiegare le scelte di finanziamento delle PMI del campione.

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Mehr als die Hälfte aller HIV-positiven Tansanier sind Frauen. Ihre schwächere gesellschaftliche Stellung ist einer der Faktoren, der dazu beiträgt, dass sie einem erhöhten Infektionsrisiko ausgesetzt sind. Aufgrund geringerer Bildungschancen und einer anhaltenden gesellschaftlichen Idealvorstellung von der Frau als Mutter sind Frauen auch auf dem Arbeitsmarkt benachteiligt. Im Kontext von HIV/AIDS werden afrikanische Frauen häufig als passive Opfer der Epidemie dargestellt und es wird zu selten aufgezeigt, wie sie als Akteure eigene Strategien im Kampf gegen die Krankheit entwickeln. In letzter Zeit gewinnen Frauenorganisationen an Bedeutung, denn viele Frauen wollen ausdrücklich eigenverantwortlich und ohne Männer arbeiten. Eine solche Organisation ist die in meiner Arbeit vorgestellte NGO KIWAMWAKU („Kikundi cha Wanawake Mwanga kupambana na Ukimwi“ – Vereinigung von Frauen aus Mwanga zum Kampf gegen AIDS). Meine Forschung hat gezeigt, dass Frauen ihre gesellschaftliche Stellung durch das Engagement in einer NGO verbessern können. Sie können ein eigenes Einkommen erwirtschaften und nützliche Kenntnisse etwa in der Führung einer Organisation erlangen. Allerdings profitieren nicht alle Beteiligten gleichermaßen. Die drei Leiterinnen der erforschten NGO verfügten über die meisten Vorteile; sie profitierten finanziell, aber auch ideell, denn sie genossen durch ihre Arbeit hohes Ansehen im gesamten Mwanga-Distrikt. Dagegen konnten einige der Klientinnen nur in sehr geringem Maße von Interventionen profitieren. Letztlich bin ich jedoch überzeugt davon, dass durch solche Frauenorganisationen ein wichtiger Prozess angestoßen worden ist, durch den Frauen mittel- oder langfristig eine stärkere Stellung innerhalb der tansanischen Gesellschaft erlangen können, was sich wiederum positiv auf die immer noch steigenden HIV/AIDS-Infektionsraten auswirken kann.

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Measurement of bladder wall thickness (BWT) using transvaginal ultrasound has previously been shown to discriminate between women with confirmed detrusor overactivity and those with urodynamic stress incontinence. Aim of the current study was to determine if vaginally measured BWT correlates with urodynamic diagnoses in a female population.

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Background: Body mass index (BMI) is a risk factor for endometrial cancer. We quantified the risk and investigated whether the association differed by use of hormone replacement therapy (HRT), menopausal status, and histologic type. Methods: We searched MEDLINE and EMBASE (1966 to December 2009) to identify prospective studies of BMI and incident endometrial cancer. We did random-effects meta-analyses, meta-regressions, and generalized least square regressions for trend estimations assuming linear, and piecewise linear, relationships. Results: Twenty-four studies (17,710 cases) were analyzed; 9 studies contributed to analyses by HRT, menopausal status, or histologic type, all published since 2003. In the linear model, the overall risk ratio (RR) per 5 kg/m2 increase in BMI was 1.60 (95% CI, 1.52–1.68), P < 0.0001. In the piecewise model, RRs compared with a normal BMI were 1.22 (1.19–1.24), 2.09 (1.94–2.26), 4.36 (3.75–5.10), and 9.11 (7.26–11.51) for BMIs of 27, 32, 37, and 42 kg/m2, respectively. The association was stronger in never HRT users than in ever users: RRs were 1.90 (1.57–2.31) and 1.18 (95% CI, 1.06–1.31) with P for interaction ¼ 0.003. In the piecewise model, the RR in never users was 20.70 (8.28–51.84) at BMI 42 kg/m2, compared with never users at normal BMI. The association was not affected by menopausal status (P ¼ 0.34) or histologic type (P ¼ 0.26). Conclusions: HRT use modifies the BMI-endometrial cancer risk association. Impact: These findings support the hypothesis that hyperestrogenia is an important mechanism underlying the BMI-endometrial cancer association, whilst the presence of residual risk in HRT users points to the role of additional systems. Cancer Epidemiol Biomarkers Prev; 19(12); 3119–30.

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This study explores the impact of higher education on 3,942 arts and sciences students as measured by change in their freshman and senior ratings of four Clark-Trow "educational philosophies": vocational, academic, collegiate, and nonconformist (Clark and Trow, 1966). A repeated measures analysis of variance was applied to each of the four philosophies, controlling for sex, entering year, major, parents' educational background, scholastic aptitude, and academic motivation. As expected from Clark-Trow theory, students showed significant increases in academic and nonconformist philosophies, and decreases in vocational and collegiate philosophies. Relationships between independent variables and freshman-senior change suggested post hoc reinterpretation of the dimensions underlying the Clark-Trow "phenotypes": i. e., from "identification with the college" and "involvement with ideas" to "social interests" and "academic interests" (the latter suggested by Terenzini and Pascarella, 1977).

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An improved chemical strategy for processing of the generator produced 68Ga was developed based on processing of the original 68Ge/68Ga generator eluate on a micro-column. Direct pre-concentration and purification of the eluted 68Ga is performed on a cation-exchange resin in hydrochloric acid/acetone media. A supplementary step based on a second micro-column filled with a second resin allows direct re-adsorption of 68Ga eluted from the cation exchanger. 68Ga is finally striped from the second resin with a small volume of pure water. For this purpose a strong anion exchanger and a novel extraction chromatographic resin based on tetraalkyldiglycolamides are characterized. The strategy allows online pre-concentration and purification of 68Ga from the original generator eluate. The supplementary column allows transferring 68Ga with high radionuclide and chemical quality in the aqueous solution with small volume and low acidity useful for direct radiolabeling reactions.

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Species coexistence and local-scale species richness are limited by the availability of seeds and microsites for germination and establishment. We conducted a seed addition experiment in seminatural grassland at three sites in southern Switzerland and repeated the experiment in two successive years to evaluate various circumstances under which seed limitation and establishment success affect community functioning. A collection of 144000 seeds of 22 meadow species including grasses and forbs of local provenance was gathered, and seeds were individually sown in a density that resembled natural seed rain. The three communities were seed limited. Three years after sowing, single species varied in emergence (0–50%), survival (0–69%), and establishment rates (0–27%). One annual and 13 perennial species reached reproductive stage. Low establishment at one site and reduced growth at another site indicated stronger microsite limitation compared to the third site. Recruitment was influenced by differences in abiotic environmental conditions between sites (water availability, soil minerals) and by within-site differences in biotic interaction (competition). At the least water-limited site, sowing resulted in an increase in phytomass due to establishment of short-lived perennials in the second and third years after sowing. This increase persisted over the following two years due to establishment of longer-lived perennials. After sowing in a wetter year with higher phytomass, however, productivity did not increase, because higher intensity of competition in an early phase of establishment resulted in less vigorous plants later on. Due to the generally favorable weather conditions during this study, sowing year had a small effect on numbers of established individuals over all species. Recruitment limitation can thus constrain local-scale species richness and productivity, either by a lack of seeds or by reduced seedling growth, likely due to competition from the established vegetation.

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BACKGROUND: Purpose of this study was to compare the correlation of statin use with long-term mortality in patients with abdominal (AAA) and thoracic aortic aneurysm (TAA). PATIENTS AND METHODS: We compared long-term survival of 731 AAA and 59 TAA patients undergoing elective endovascular repair (EVAR). Kaplan-Meier survival curves were compared by the log-rank method. Propensity score-adjusted multivariable logistic regression models were used to determine independent associations of statin use on vital status after EVAR. RESULTS: Statin use was associated with decreased long-term mortality in AAA patients in bivariate and multivariable regression analysis, in which the effect of propensity to receive a statin was considered (adjusted HR: .613, 95%-CI: .379- .993, p = .047) whereas mortality of TAA patients was not associated with use of statins (adjusted HR: 1.795, 95%-CI: .147 -21.942, p = .647). CONCLUSIONS: Use of statins is an independent predictor of decreased mortality after elective EVAR in AAA, but not in TAA patients. These findings indirectly support the concept of a distinct pathogenesis of AAA and TAA.

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The clinical value of early exercise stress testing (EST) after coronary stenting to predict long-term clinical outcomes is unknown. Of 1,000 unselected patients who underwent coronary stenting, 446 random patients underwent early EST the day after intervention. Clinical long-term outcomes (41 +/- 20 months) were correlated with normal (n = 314 [70%]) or positive (n = 102 [23%]) EST results. Patients with inconclusive test results (n = 30 [7%]) were excluded from the analysis. Overall mortality was significantly higher in patients with positive EST results (9.3% vs 3.9%, p = 0.04). Major adverse cardiac events and cardiac mortality also tended to be higher in patients with positive stress test results (45.4% vs 35.4%, p = 0.08, and 4.1% vs 1.1%, p = 0.05, respectively). Patients with the combination of positive stress test results and incomplete revascularization appeared to be the group at highest risk for major adverse cardiac events (47.1% vs 33.3% for patients with normal stress test results and complete revascularization, p = NS). Negative stress test results reduced (odds ratio 0.329, 95% confidence interval 0.120 to 0.905, p = 0.031) and a lower ejection fraction increased (odds ratio 0.942, 95% confidence interval 0.897 to 0.989, p = 0.017) the risk for death. In conclusion, an early stress test after coronary stenting provides important prognostic information. Positive stress test results, especially in combination with incomplete revascularization, are associated with higher mortality, a trend toward more repeat revascularization procedures, and higher risk for major adverse cardiac events.

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Electrochemical reactivity and structure properties of electrogenic bacteria, Geobacter sulfurreducens (Gs) were studied to explore the heterogeneous electron transfer at the bacteria/electrode interface using electrochemical and in-situ spectroscopic techniques. The redox behavior of Gs adsorbed on a gold electrode, which is modified with a ω-functionalized self-assembled monolayer (SAM) of alkanethiols, depends strongly on the terminal group. The latter interacts directly with outermost cytochromes embedded into the outer membrane of the Gs cells. The redox potential of bacterial cells bound electrostatically to a carboxyl-terminated SAM is close to that observed for bacteria attached to a bare gold electrode, revealing a high electronic coupling at the cell/SAM interface. The redox potentials of bacterial cells adsorbed on amino- and pyridyl-terminated SAMs are significantly different suggesting that the outermost cytochromes changes their conformation upon adsorption on these SAMs. No redox activity of Gs was found with CH3-, N(CH3)3+- and OH-terminated SAMs. Complementary in-situ spectroscopic studies on bacteria/SAMs/Au electrode assemblies were carried out to monitor structure changes of the bacterial cells upon polarization. Spectro-electrochemical techniques revealed the electrochemical turnover of the oxidized and reduced states of outer membrane cytochromes (OMCs) in Gs, providing evidence that the OMCs are responsible for the direct electron transfer to metal electrodes, such as gold or silver, during the electricity production. Furthermore, we observed spectroscopic signatures of the native structure of the OMCs and no conformational change during the oxidation/reduction process of the microorganisms. These findings indicate that the carboxyl-anchoring group provides biocompatible conditions for the outermost cytochromes of the Gs, which facilitate the heterogeneous electron transfer at the microorganism/electrode interface.

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BACKGROUND The addition of bevacizumab to chemotherapy improves progression-free survival in metastatic breast cancer and pathological complete response rates in the neoadjuvant setting. Micrometastases are dependent on angiogenesis, suggesting that patients might benefit from anti-angiogenic strategies in the adjuvant setting. We therefore assessed the addition of bevacizumab to chemotherapy in the adjuvant setting for women with triple-negative breast cancer. METHODS For this open-label, randomised phase 3 trial we recruited patients with centrally confirmed triple-negative operable primary invasive breast cancer from 360 sites in 37 countries. We randomly allocated patients aged 18 years or older (1:1 with block randomisation; stratified by nodal status, chemotherapy [with an anthracycline, taxane, or both], hormone receptor status [negative vs low], and type of surgery) to receive a minimum of four cycles of chemotherapy either alone or with bevacizumab (equivalent of 5 mg/kg every week for 1 year). The primary endpoint was invasive disease-free survival (IDFS). Efficacy analyses were based on the intention-to-treat population, safety analyses were done on all patients who received at least one dose of study drug, and plasma biomarker analyses were done on all treated patients consenting to biomarker analyses and providing a measurable baseline plasma sample. This trial is registered with ClinicalTrials.gov, number NCT00528567. FINDINGS Between Dec 3, 2007, and March 8, 2010, we randomly assigned 1290 patients to receive chemotherapy alone and 1301 to receive bevacizumab plus chemotherapy. Most patients received anthracycline-containing therapy; 1638 (63%) of the 2591 patients had node-negative disease. At the time of analysis of IDFS, median follow-up was 31·5 months (IQR 25·6-36·8) in the chemotherapy-alone group and 32·0 months (27·5-36·9) in the bevacizumab group. At the time of the primary analysis, IDFS events had been reported in 205 patients (16%) in the chemotherapy-alone group and in 188 patients (14%) in the bevacizumab group (hazard ratio [HR] in stratified log-rank analysis 0·87, 95% CI 0·72-1·07; p=0·18). 3-year IDFS was 82·7% (95% CI 80·5-85·0) with chemotherapy alone and 83·7% (81·4-86·0) with bevacizumab and chemotherapy. After 200 deaths, no difference in overall survival was noted between the groups (HR 0·84, 95% CI 0·64-1·12; p=0·23). Exploratory biomarker assessment suggests that patients with high pre-treatment plasma VEGFR-2 might benefit from the addition of bevacizumab (Cox interaction test p=0·029). Use of bevacizumab versus chemotherapy alone was associated with increased incidences of grade 3 or worse hypertension (154 patients [12%] vs eight patients [1%]), severe cardiac events occurring at any point during the 18-month safety reporting period (19 [1%] vs two [<0·5%]), and treatment discontinuation (bevacizumab, chemotherapy, or both; 256 [20%] vs 30 [2%]); we recorded no increase in fatal adverse events with bevacizumab (four [<0·5%] vs three [<0·5%]). INTERPRETATION Bevacizumab cannot be recommended as adjuvant treatment in unselected patients with triple-negative breast cancer. Further follow-up is needed to assess the potential effect of bevacizumab on overall survival.

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INTRODUCTION AND HYPOTHESIS The prevalence of female stress urinary incontinence is high, and young adults are also affected, including athletes, especially those involved in "high-impact" sports. To date there have been almost no studies testing pelvic floor muscle (PFM) activity during dynamic functional whole body movements. The aim of this study was the description and reliability test of PFM activity and time variables during running. METHODS A prospective cross-sectional study including ten healthy female subjects was designed with the focus on the intra-session test-retest reliability of PFM activity and time variables during running derived from electromyography (EMG) and accelerometry. RESULTS Thirteen variables were identified based on ten steps of each subject: Six EMG variables showed good reliability (ICC 0.906-0.942) and seven time variables did not show good reliability (ICC 0.113-0.731). Time variables (e.g. time difference between heel strike and maximal acceleration of vaginal accelerator) showed low reliability. However, relevant PFM EMG variables during running (e.g., pre-activation, minimal and maximal activity) could be identified and showed good reliability. CONCLUSION Further adaptations regarding measurement methods should be tested to gain better control of the kinetics and kinematics of the EMG probe and accelerometers. To our knowledge this is the first study to test the reliability of PFM activity and time variables during dynamic functional whole body movements. More knowledge of PFM activity and time variables may help to provide a deeper insight into physical strain with high force impacts and important functional reflexive contraction patterns of PFM to maintain or to restore continence.