bluuebunny/crossref_metadata_2025_split huggingface dataset:
Work stress and burnout among dental hygienists
Authors: Gorter RC 
Published: April 2005

Abstract:Objectives:  The aim of this study was to describe the factors associated with work stress and burnout among dental hygienists. Furthermore, how to deal with work stressors in order to prevent burnout in the dental hygienist work environment will be discussed.Methods:  From a small literature search, only a few empirical studies could be traced that describe work stress or burnout among dental hygienists.Results:  Burnout incidence among dental hygienists appears to be relatively favourable, when compared with other professions, according to a 20‐year‐old study. On the contrary, in a recent study, it was described that one out of eight dental hygienists felt emotionally exhausted from work. Dental hygienists, when compared with other professionals, are relatively negative about the variety of tasks they find in their work. Factors associated with experienced work stress are, according to another study, musculoskeletal pain, combining work and private life, highly efficient organization of work, long working hours, working without assistant, difficult or demanding patients, lack of leisure time, lack of support by practice management and doubts about one's own capabilities. Some factors that may prevent burnout are: recognition of one's own work pressure, learning to unwind, time management and organization of work, realistic career expectancies, social skills, healthy life‐style, peer‐group contacts and pre‐graduate reflection.Conclusions:  There appears to be a lack of recent data on burnout among dental hygienists. Although some knowledge exists on work stressors, a thorough investigation on burnout incidence, risk factors, as well as job resources is needed.
Tooth loss among habitual chewing‐stick and plastic toothbrush users in the adult population of Mtwara, rural Tanzania1
Authors: Mumghamba EGS , Fabian FM 
Published: April 2005

Abstract:Objectives:  The aim of this study was to determine the extent and type of tooth loss in relation to habitual chewing‐stick (CS) and plastic toothbrush (PT) users in adults.Methods:  A cross‐sectional descriptive study was conducted in Mtwara's rural population aged ≥40 years. A total of 206 randomly selected study participants – males (55.8%) and females (44.2%) – were interviewed on oral hygiene practices using a structured questionnaire, and a clinical examination performed for assessment of tooth loss.Results:  Of the total, 93.2% were partially edentulous, 2.4% completely edentulous and those with no tooth loss 4.4%. The total number of missing teeth were 1728 (mean, 8.38 ± 7.9), and the causes were caries (74.9%), mutilation (4.8%) and others including periodontal and trauma (20.3%). There was no significant difference in the mean number of tooth loss between the upper and lower jaw, and between males and females. However, the mean number of missing teeth in the lower jaw was higher in females than in males (P = 0.04), and on lower left than lower right jaw (P = 0.008). Lower molars, especially first molars, were the teeth lost most often. Tooth‐cleaning devices included PT (51.5%), CS (25.7%), both type (BT; 17.0%) and unspecified (5.8%). The differences in the mean number of missing teeth were higher in CS than habitual PT users (P = 0.024) and in BT (P = 0.029). Tooth loss was also higher among those who brushed once when compared with those who brushed two times or more per day (P = 0.046).Conclusion:  Tooth loss was significantly higher in CS than PT habitual users and affected mostly the lower molars and especially the first molar. However, for economical reasons, effective use of CS should be promoted for enhanced tooth retention.
GOLBALIZATION, CORPORATE FINANCE, AND THE COST OF CAPITAL
Authors: Stulz René M. 
Published: April 2005

International financial markets are progressively becoming one huge, integrated, global capital market—a development that is contributing to higher stock prices in developed as well as developing economies. For companies that are large and visible enough to attract global investors, having a global shareholder base means having a lower cost of capital and hence a greater equity value for two main reasons:First, because the risks of equity are shared among more investors with different portfolio exposures and hence a different “appetite” for bearing certain risks, equity market risk premiums should fall for all companies in countries with access to global markets. Although the largest reductions in cost of capital resulting from globalization will be experienced by companies in liberalizing economies that are gaining access to the global markets for the first time, risk premiums can also be expected to fall for firms in long‐integrated markets as well.Second, when firms in countries with less‐developed capital markets raise capital in the public markets of countries (like the U.S.) with highly developed markets, they get more than lower‐cost capital; they also import at least aspects of the corporate governance systems that prevail in those markets. For companies accustomed to less‐developed markets, raising capital overseas is likely to mean that more sophisticated investors, armed with more advanced technologies, will participate in monitoring their performance and management. And, in a virtuous cycle, more effective monitoring increases investor confidence in the future performance of those companies and so improves the terms on which they raise capital.Besides reducing market risk premiums and improving corporate governance, globalization also affects the systematic risk, or “beta,” of individual companies. In global markets, the beta of a firm's equity depends on how the stock contributes to the volatility not of the home market portfolio, but of the world market portfolio. For companies with access to global capital markets whose profitability is tied more closely to the local than to the global economy, use of the traditional Capital Asset Pricing Model (CAPM) will overstate the cost of capital because risks that are not diversifiable within a national economy can be diversified by holding a global portfolio. Thus, to reflect the new reality of a globally determined cost of capital, all companies with access to global markets should consider using a global CAPM that views a company as part of the global portfolio of stocks. In making this argument, the article reviews the growing body of academic studies that provide evidence of the predictive power of the global CAPM as well as the reduction in world risk premiums.
PETROZUATA: A CASE STUDY OF THE EFFECTIVE USE OF PROJECT FINANCE
Authors: Estry Benjamin C. 
Published: April 2005

Companies are increasingly using project finance to fund large‐scale capital expenditures. In fact, private companies invested $96 billion in project finance deals in 1998, down from $119 billion in 1997 largely due to the Asian crisis, but up more than threefold since 1994.The decision to use project finance involves an explicit choice of organizational form as well as financial structure. With project finance, sponsoring firms create legally distinct entities to develop, manage, and finance the project. These entities borrow on a limited or non‐recourse basis, which means that loan repayment depends on the project's cash flows rather than on the assets or general credit of the sponsoring organizations. Despite the non‐recourse nature of project borrowing, projects are highly leveraged entities, with debt to total capitalization ratios averaging 60–70%.Petrozuata, a $2.4 billion oil field development project in Venezuela, is a recent example of the effective use of project finance for several reasons. First, the analysis shows a typical setting where project finance is likely to create value, that of a large‐scale investment in Greenfield assets (in this case, wells, pipelines, and upgrader) that can function as a stand‐alone economic entity and support a high leverage ratio. Given the nature of this investment, one can think of project finance as venture capital for fixed assets, except that the investments are 100 to 1000 times larger and financed primarily with debt rather than equity.Besides highlighting the types of assets appropriate for project finance, this article illustrates the sizeable transactions costs associated with structuring a deal as well as the full range of benefits accruing to project sponsors. The structure allows sponsors to capture tax benefits not otherwise available, reduces information costs for creditors and other investors, and lowers the overall cost of financial distress. The combination of high leverage, concentrated equity ownership, and direct control in project finance also addresses a wide range of incentive problems that destroy value in diversified companies.Analysis of the explicit contractual terms of the deal reveals a careful allocation of project risks in an attempt to elicit optimal behavior by each of the participants. As illustrated in the Petrozuata case, limiting completion and operating risks are important undertakings. But project finance is most valuable as an instrument for managing sovereign risks. Indeed, the ability of project finance to limit sovereign risk is the one feature that cannot be replicated under conventional corporate financing schemes.
STRATEGIC HEDGING
Authors: Mello Antonio S. , Parsons John E. 
Published: April 2005

This article presents a new approach to financial risk management whose primary objective is to ensure that companies have sufficient internal funds and access to outside capital to carry out their strategic investments. The foundation of this approach is a comprehensive measure of corporate exposure that views the firm as a collection of current cashgenerating assets and future investment opportunities and that attempts to show how changes in fundamental economic variables can threaten the firm's ability to realize its strategic objectives. As such, the measure of exposure reflects the effect of expected changes in economic variables not only on the firm's operating cash flows but also on its future investment requirements.Because its focuses only on the exposures that need protection when regular sources of funds are exhausted, this strategic hedging approach will generally lead to a more conservative hedging policy. In so doing, it should enable companies to avoid the excessive and costly “micro” hedging of individual transactions—an approach that can easily degenerate into speculation.
MEASURING THE COST OF CAPITAL IN AN INTERNATIONAL CAPM FRAMEWORK
Authors: Schramn Ronald M. , Wang Henry N. 
Published: April 2005

This paper can be viewed as extending the traditional CAPM framework in two important ways. The first expands the concept of the market portfolio to include international securities. The second extends the definition of systematic risk to include currency risk.What becomes clear in estimating the cost of capital for an international asset is that both extensions have become necessary if the traditional CAPM is to remain relevant. International markets have become increasingly integrated over the past two decades and so all assets might now be considered “international” and priced accordingly. The inclusion of the currency risk factor is not an ad hoc addition to the CAPM but rather results quite naturally from the fact that foreign returns need to be converted into a domestic currency.Based on an examination of 18 companies, the article shows that the use of a broader market portfolio will tend to lower the estimated cost of capital for most firms, but in some cases could actually raise it. (In the case of Singapore Airlines, for example, the currency risk factor adds substantially to the cost of capital, while materially reducing it in the case of Nestlé.) Using a simple regression, the authors also attempt to show how the specifics of a particular company—for example, the currencies that are part of their cost/ revenue structure—determine the impact of currency risk on the cost of capital.
REVISITING THE HIGH YIELD BOND MARKET: MATURE BUT NEVER DULL
Authors: Altman Edward I. 
Published: April 2005

Ten years ago the author of this article wrote a piece for this journal reviewing the history of the “junk” bond market from its start in the mid‐1970s through the collapse of the leveraged restructuring movement at the end of the 1980s. In the summer of 1990, the high yield market was at a critical point in its development. With defaults high and still rising, the yield spreads over Treasuries of junk bonds had jumped to over 700 basis points and the new issue market had all but dried up. Drexel Burnham Lambert had recently filed for Chapter 11, and Michael Milken had been indicted. At that time, when many market observers were pronouncing the junk bond market “finished,” the author of this article said that the market performed a valuable economic function and, despite investor losses, would weather the crisis.In describing the remarkable recovery of the high yield market in 1990s, this article notes some important changes in the market. And, although there are now troubling similarities (including rising default rates and spreads) to conditions in the early ‘90, there are also important differences that are likely to make the start of this decade a better one for investors.
ARE PROJECT FINANCE LOANS DIFFERENT FROM OTHER SYNDICATED CREDITS?
Authors: Kleimeier Stefanie , Megginson William L. 
Published: April 2005

This paper provides the first full‐length empirical analysis of project finance, which is defined as “limited or non‐recourse financing of a newly to be developed project through the establishment of a vehicle company.” The article compares the characteristics of a sample of 4,956 project finance loans (worth $634 billion) to comparable samples of non‐project finance loans, all of which are drawn from a comprehensive sample of 90,784 syndicated loans (worth $13.2 trillion) booked on international capital markets since 1980.The authors find that project finance (PF) loans differ significantly from non‐project finance loans in that PF loans have a longer average maturity, are more likely to have third‐party guarantees, and are far more likely to be extended to non‐U.S. borrowers and to borrowers in riskier countries. Project finance credits also involve more participating banks, have fewer loan covenants, are more likely to use fixed‐rate rather than floating‐rate loan pricing, and are more likely to be extended to borrowers in tangible‐asset‐rich industries, such as real estate and electric utilities. Despite being nonrecourse finance, floating‐rate project finance loans have lower credit spreads (over LIBOR) than do most comparable non‐PF loans. The authors also report that projects funded with PF loans are heavily leveraged, with an average loan to value ratio of 67%.
OPEN MARKET REPURCHASES: THE VALUE FROM BUYING SHARES AT A DISCOUNT
Authors: Porter Gary E. , Roenfeldt Rodney L. , Sicherman Neil W. 
Published: April 2005

This article shows that share repurchase announcements create value for shareholders when the shares of the industrial firm sell at a discount from the value of the underlying assets, even when shareholders and managers share full information about the firm's prospects and the firm's operating performance is not expected to improve. The value created by capturing the discount on the repurchased shares is a function of only two variables: the percentage discount prior to the announcement and the proportion of shares to be repurchased.For a sample of 100 companies selling below net asset value, the authors report that the excess stock returns surrounding their announcements of open market repurchases are (significantly) positively associated with the authors' estimates of the value captured from buying shares at a discount. Moreover, the stock market's response to repurchase announcements by companies that are selling at a discount is considerably more positive than to announcements by firms selling at a premium.
REAL OPTIONS AND CORPORATE RISK MANAGEMENT
Authors: Triantis Alexander J. 
Published: April 2005

By formulating an integrated strategy that combines the creation and exercise of real options together with other risk management techniques, management can reduce risk and thereby increase firm value. For example, a company that is in a position to delay investing without losing its competitive edge, to abandon a project that becomes unprofitable, or to adjust its operating strategy at low cost can avoid risks and exploit profitable opportunities. But, even when real options are used in this way to limit the risk profile of the firm, financial derivatives can help to hedge any residual risk that would otherwise affect the value of the real options and the overall firm.An integrated risk management approach requires a careful process of diagnosing a company's risk exposure. First, management must decompose the company's risk exposure to understand the fundamental sources of risk. Second, the company's capacity to bear risk must be determined, which requires an understanding of why individual risks (if left unmanaged) would reduce the value of the firm. Third, different approaches for addressing risk should be explored, ranging from diversification to use of financial derivatives and other contracts to investing in (or exercising) a wide array of real options. Fourth, the firm must properly integrate the different risk management solutions to optimize its strategy.
OPTION EXERCISE GAMES: THE INTERSECTION OF REAL OPTIONS AND GAME THEORY
Authors: Grenadier Steven R. 
Published: April 2005

While the real options approach has proven useful in providing an analytical framework for analyzing the timing of investment decisions, a notable failure of the approach has been an almost complete lack of strategic considerations. In standard real options models, invest‐ment (and exercise) strategies are for‐mulated in isolation, without considering the potential impact of other firms' exercise strategies. This paper illustrates how the intersection of real options and game theory provides powerful new insights into the behavior of economic agents under uncertainty.Introducing strategic considerations into the real options framework can lead to a rethinking of standard real option analysis. For example, one of‐ten cited conclusion of the real options literature is the overturning of the standard capital budgeting rule of in‐vesting immediately in any project with a positive NPV. Because the fu‐ture value of the asset is uncertain, there may be significant benefits to deferring the investment until condi‐tions prove even more favorable. But this result clearly depends on the lack of competitive access to the project. If firms fear preemption, then the option to wait becomes less valuable. For example, while the standard real op‐tions models suggest that a real estate developer should wait until the devel‐opment option is considerably “in the money,” competition and the fear of preemption will likely force develop‐ers to build much earlier.
BANKING ON REAL OPTIONS
Authors: Patrick Steven C. 
Published: April 2005

This article discusses why many companies use committed bank facilities to finance their real options. The pace of change in the current economic environment has increased the value of financial flexibility. If and when companies choose to exercise their real options, they often require capital to finance these initiatives. Committed bank facilities meet this requirement by providing the assurance of funding (subject to explicit conditions), or at least a starting point for raising the new capital.Raising the capital necessary to finance very large real options is so critical that many companies use a single financial advisor to evaluate M&A transactions and raise the funds. In the case of ClubCorp, Bank of America provided M&A advice and an interim loan to finance an acquisition that exceeded the company's committed bank capacity. Later that year, Bank of America “agented” a new deal to refinance this acquisition debt. In a second case, Ferrellgas hired Bank of America to evaluate, help negotiate, and finance its acquisition of Thermogas. Financing this transaction required a bridge loan and synthetic lease as well as monetizing $175 million of equity securities.
WHY SOCIETY NEEDS “IRRATIONAL EXUBERANCE”—AND WHAT THIS MEANS FOR VALUATIONS AND MONETARY POLICY
Authors: Brenner Reuven 
Published: April 2005

Despite all the talk of a New Economy and the revolutionary import of the Internet, this article suggests that there is nothing really new under the sun. When Christopher Columbus was building the ships for his expeditions to the East Indies, only the vaguest estimates could be made of their potential value. At this stage, nobody knew if Columbus would be able to manage the crossing, when the ships would return, and what cargo they would eventually carry. In this sense, Columbus's venture bears a striking resemblance to many of today's Internet stocks.This paper raises and attempts to answer a number of interesting questions. For example, how do risky ventures with very high fixed (startup) costs but very low expected variable costs raise the capital necessary to fund the fixed costs? What role should government (and, in particular, monetary) policy play in encouraging (or discouraging) funding for such ventures? And how does one establish the value of such ventures when there is little or no revenue and, in some cases, no clearly defined product?The answer to the first question is investor enthusiasm–or, in Alan Greenspan's terms, “irrational exuberance.” Irrational exuberance plays a very important economic role in giving entrepreneurs access to the cheap financing necessary to fund ventures with heavy startup costs. Indeed, “irrational exuberance” may be the best solution for financing large fixed costs, not only because it is a private (as opposed to a government‐financed) solution, but because it gives investors direct access to the risks and rewards of promising investment opportunities. Before the recent “democratization” of capital markets, such ventures would have been funded by large corporations if not government agencies.As for the third question, this paper suggests there is only one useful way to estimate the value of ventures without revenues or products. The author provides a back‐of‐the‐envelope, “Fermitype” valuation method that is based on the principle of “human capital arbitrage.” For those Internet startups that lure top executives away from established firms with large grants of stock options but relatively low salaries, there is a “breakeven level” for the future stock price that can be calculated using a fairly modest amount of information about the executive's past and current compensation plans. For outside investors, such movements of human capital provide what is perhaps the most reliable basis for estimating the value of the firm.