Financial Strategies in Mergers and Acquisitions (M&A): The Case of Regulated Firms

In this paper, a general model of strategic behaviour of (regulated and non-regulated) firms in M&A is presented. For non-regulated firms, the model indicates that targeted firms issue new debt strategically. In this case, the firm's capital structure is chosen so that it maximizes the (ex-ante) market value of the firm. However, the focus of the paper is on regulated firms (mostly monopolies). For these firms, the model shows that managers, acting on behalf of shareholders, make their strategic decisions on debt issuing and investment, in anticipation of both the decisions of the regulatory body and the responses of financial markets. These decisions are aimed at influencing the probability that an acquisition occurs as well as the price the potential bidder will have to pay. However, such decisions are also made with a view to influencing the regulatory policies (maximum price or rate of return permitted), thereby mitigating the probability that, in the regulatory game, the regulator adopts an opportunistic behaviour. Application of these results to some real-world situations (such as regulated public utilities´companies) is straighforward.Mergers & Acquisitions, Capital and Ownership Structure, Economics of Regulation

Síndrome de Down como fator de risco genético para a Doença de Alzheimer

Objetivo: Explicar os motivos da Síndrome de Down ser considerada um fator de risco para a Doença de Alzheimer, através da descrição dos marcadores genéticos envolvidos nessa relação. Metodologia: Foram feitas buscas na Biblioteca Virtual em Saúde e na PubMed, com uso destes descritores, em inglês e português: “Síndrome de Down”, “Trissomia do 21”; “Doença de Alzheimer”; “Demência”, “Mongolismo”, “Envelhecimento”; “Demência por Alzheimer”; “Fatores de riscos”. Foram recuperados 45 artigos, resultando, após o refinamento, em 15 selecionados, todos referentes à PubMed. Resultados e discussão: O aumento da expectativa de vida das pessoas com Síndrome de Down trouxe um maior risco para a demência pela Doença de Alzheimer. Tal evolução juntou-se aos efeitos genéticos vindos da trissomia, em especial da sua forma total, sendo os principais as cópias extras de genes, como o APP, aumentando ainda mais o risco para o desenvolvimento dessa doença, por desencadear eventos como o excesso do peptídeo -amilóide. Conclusão: A trissomia do cromossomo 21 e os seus efeitos genéticos e moleculares são essenciais para o surgimento da demência pela Doença de Alzheimer, comprovando-se a necessidade de mais estudos que elucidem essa relação genética entre essa patologia e a Síndrome de Down.

Noninvasive ventilation immediately after extubation improves weaning outcome after acute respiratory failure: a randomized controlled trial

Abstract\ud \ud \ud \ud Introduction\ud \ud Noninvasive ventilation (NIV), as a weaning-facilitating strategy in predominantly chronic obstructive pulmonary disease (COPD) mechanically ventilated patients, is associated with reduced ventilator-associated pneumonia, total duration of mechanical ventilation, length of intensive care unit (ICU) and hospital stay, and mortality. However, this benefit after planned extubation in patients with acute respiratory failure of various etiologies remains to be elucidated. The aim of this study was to determine the efficacy of NIV applied immediately after planned extubation in contrast to oxygen mask (OM) in patients with acute respiratory failure (ARF).\ud \ud \ud \ud Methods\ud \ud A randomized, prospective, controlled, unblinded clinical study in a single center of a 24-bed adult general ICU in a university hospital was carried out in a 12-month period. Included patients met extubation criteria with at least 72 hours of mechanical ventilation due to acute respiratory failure, after following the ICU weaning protocol. Patients were randomized immediately before elective extubation, being randomly allocated to one of the study groups: NIV or OM. We compared both groups regarding gas exchange 15 minutes, 2 hours, and 24 hours after extubation, reintubation rate after 48 hours, duration of mechanical ventilation, ICU length of stay, and hospital mortality.\ud \ud \ud \ud Results\ud \ud Forty patients were randomized to receive NIV (20 patients) or OM (20 patients) after the following extubation criteria were met: pressure support (PSV) of 7 cm H2O, positive end-expiratory pressure (PEEP) of 5 cm H2O, oxygen inspiratory fraction (FiO2) ≤ 40%, arterial oxygen saturation (SaO2) ≥ 90%, and ratio of respiratory rate and tidal volume in liters (f/TV) < 105. Comparing the 20 patients (NIV) with the 18 patients (OM) that finished the study 48 hours after extubation, the rate of reintubation in NIV group was 5% and 39% in OM group (P = 0.016). Relative risk for reintubation was 0.13 (CI = 0.017 to 0.946). Absolute risk reduction for reintubation showed a decrease of 33.9%, and analysis of the number needed to treat was three. No difference was found in the length of ICU stay (P = 0.681). Hospital mortality was zero in NIV group and 22.2% in OM group (P = 0.041).\ud \ud \ud \ud Conclusions\ud \ud In this study population, NIV prevented 48 hours reintubation if applied immediately after elective extubation in patients with more than 3 days of ARF when compared with the OM group.\ud \ud \ud \ud Trial Registration number\ud \ud ISRCTN: 41524441.We thank all the physicians, physiotherapists, and nurses that took care of the patients throughout the protocol, the statisticians for the statistical analyses, and Adriana Pardini for revision of the language. This study was supported by Division of Critical Care, Hospital de Base de São José do Rio Preto, Rio Preto, SP, Brazil, and Division of Pulmonary and Critical Care Hospital das Clínicas of São Paulo Medical School, University of São Paulo, São Paulo, Brazil

A FISIOTERAPIA EM GRUPO NO FORMATO DE CIRCUITO PODE MELHORAR A VELOCIDADE DA MARCHA DE PACIENTES COM DOENÇA DE PARKINSON?

A Doença de Parkinson (DP) é caracterizada pela degeneração progressiva de neurônios dopaminérgicos da substância negra, resultando em desordens não motoras e motoras que estão relacionadas com o aparecimento de tremor de repouso, bradicinesia, rigidez articular, instabilidade postural, alterações no padrão da marcha, declínio do equilíbrio. A Fisioterapia em Grupo no formato de Circuit Training (FGCT) é um modelo terapêutico baseado em estações de trabalho dispostos num formato de circuito dirigido que reproduzem atividades físicas. O objetivo foi avaliar a velocidade de marcha rápida, de indivíduos com DP submetidos a sessões de FGTC. Participaram deste estudo 13 pessoas com DP. A avaliação inicial (AV1) foi realizada utilizando o Time up and go (TUG) p e o Teste de velocidade de marcha de 10 metros (TV10M). No TUG, a velocidade de execução média foi de 0,68 ± 0,19 m/s na AV1 e 0,66 ± 0,14 m/s AV2 e no TV10M de 1,36 ± 0,26 m/s na AV1 enquanto na AV2 foi 1,45 ± 0,32 m/s, sem diferença significante entre os dois momentos de medida. Os parkinsonianos não apresentaram melhoras funcionais talvez porque a terapia não teve exercícios com enfoque na velocidade da marcha e o tempo de terapêutica pode não ter sido suficiente para ocorrer mudanças nesse aspecto. Porém sabe-se que a reabilitação em grupo contribui na melhora do estado de saúde global do paciente, permitindo maior socialização entre os indivíduos. Pode-se conclui que protocolo terapêutico utilizado não foi suficientemente para alterar a velocidade da marcha dos pacientes

Mantle cell lymphoma involving the oral and maxillofacial region : a study of 20 cases

OBJECTIVE : To investigate the clinicopathologic features of mantle cell lymphoma (MCL) involving the oral and maxillofacial region. METHODS : The MCL cases were retrieved from the pathosis database of 6 pathology laboratories. Original hematoxylin and eosin slides and immunohistochemical reactions were reviewed for confirmation of the initial diagnosis. Clinical data of the cases were obtained from the patients’ pathosis and/or medical charts. RESULTS : Twenty cases were included in the study, showing a male predominance and a mean age of 66 years. The oral cavity (12 cases) and the oropharynx (5 cases) were the most commonly involved subsites. Most cases presented as asymptomatic swellings, with 2 cases showing bilateral involvement of the palate. The classic histologic variant predominated (12/20 cases). All cases expressed CD20 with nuclear cyclin D1 positivity. SOX11 was seen in 9/13 cases, CD5 in 6/16 cases, Bcl2 in 16/19 cases, CD10 in 2/20 cases, and Bcl6 in 4/16 cases. Ki67 showed a mean proliferation index of 40.6%. The Epstein-Barr virus (EBV) was negative in all cases investigated. Follow-up data was available for 7 patients, with 5 currently alive and 2 deceased. CONCLUSION : Mantle cell lymphoma, albeit rare, may manifest in the oral and maxillofacial region. Its histologic heterogeneity demands a high degree of diagnostic skill from pathologists.The Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, the São Paulo State Research Foundation, the Minas Gerais State Research Foundation and the Conselho Nacional de Desenvolvimento Científico e Tecnológico.http://www.journals.elsevier.com/oral-surgery-oral-medicine-oral-pathology-and-oral-radiologyhj2024Oral Pathology and Oral BiologySDG-03:Good heatlh and well-bein

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio