Les travaux de recherche menés dans cette thèse répondent à plusieurs problématiques concernant les Petites et Moyennes Entreprises (PME). Après un état de l'art et une proposition de classification des types de rationnement de crédit, les deux premières études s'interrogent sur l'accès des PME aux crédits bancaires : la première question concerne la prédiction du rationnement de crédit à partir des caractéristiques des PME, la deuxième est relative aux déterminants des conditions de crédit. Enfin, la troisième étude teste l'existence et les causes de la divergence des notations de crédit des PME. Les travaux économétriques menés dans ces trois études se sont appuyés sur deux échantillons différents : l'un construit à partir d'un questionnaire sur le rationnement du crédit envoyé à un panel de PME, l'autre contenant les PME clientes d'un établissement bancaire, ayant obtenu au moins un crédit sur la période d'étude de quatre ans. / This dissertation addresses several issues facing Small and Medium Enterprises (SMEs). The first three articles are focusing on SMEs' access to bank loans. This issue contains two areas for intervention. The first is the prediction of credit rationing decision based upon SMEs characteristics. The second relates to the determinants of credit terms. The fourth article approaches the issue of the existence and causes of split rating. Researches covered in this thesis are based on two different samples. The first sample was constructed from a credit rationing survey sent to an SMEs panel. The second sample was supplied by one French mutual bank and relates to information on its credit reports and credit history over the period from 2007 to 2010.

Malgré les encouragements visant à soutenir les PME, la création de ces entreprises demeure inférieure aux attentes ; nombre de celles-ci disparaissent. L'octroi de crédit est la ontrainte primordiale pesant sur le développement et la pérennité de ces entreprises puisque les banquiers accordent du crédit seulement lorsqu'ils s'assurent que les clients sont solvables et qu'ils sont aptes à honorer leur engagement. Cette politique financière discriminatoire des banques se justifie par la difficulté d'évaluer leurs risques et le manque de crédibilité de leurs systèmes d'informations puisque les informations sont insuffisantes et souvent unilatérales ; une des deux parties dispose d'une meilleure information ; il en sait davantage que l'autre. Ce phénomène est appelé asymétrie de l'information et pourrait engendrer l'aléa moral et la sélection adverse. Cependant, le contrat signé entre d'un côté, les emprunteurs, et de l'autre, les créanciers, pourrait se traduire par une information asymétrique conduisant, tout au plus, au rationnement de crédit, ou dans certains cas, à des taux d'intérêt élevé, freinant ainsi le développement de la relation banque-entreprise. Notre recherche s'appuie sur une enquête conduite auprès de 160 chargés de clientèle de deux banques tunisiennes, la Société Tunisienne de Banque (STB), et la Banque Internationale Arabe de Tunisie (BIAT), afin d'étudier leur comportement dans la décision d'attribution de crédit aux ppetites et moyennes entreprises (PME). L'utilisation de la méthode des équations structurelles montrent une diversité des comportements des banques privées par rapport à ceux étatiques. / Despite the encouragement to support the SMEs, the creation of these companies still bellow expectations, number of these disappears. The granting of credit is the essential constraint pressing on the development and the sustainability of these companies because the bankers provide credit only when they make sure that the customers are solvent and that they are capable of honoring their commitment. This discriminatory fisal policy banks is justified by the difficulty in assessing their risks and the lack of credibility of their information systems, since the information is insufficient and often unilateral, one of two parties has better information, he know more than the other. This phenomenon is alled asymmetric information and could cause moral hazard and adverse selection. However, the contract between the borrowers, on one hand, and creditors, on the other hand, the creditors ould be shifted by asymmetric information leading, at the most, rationing of credit, or in some cases, to high rate interest ; thus limiting the development of the relationship between banks and companies. Our research is based on a survey conducted among with 160 account managers of two Tunisian banks, Tunisian Banking company ("Société Tunisienne de Banque", STB) and the Arab International Bank of Tunisia ("Banque Internationale Arabe de Tunisie", BIAT) to study their behavior in the decision of allocation credit to small and medium enterprises (SMEs). The results, achieved through Structural Equations Analysis, show differences between private versus public banks in regard.

Neste estudo, a rede elétrica é utilizada como instrumento de análise para a integração territorial restrita da cidade de Tefé ao meio técnico-científico-informacional. A ocorrência de interrupções e racionamentos no fornecimento de energia elétrica na cidade, localizada no interior do estado do Amazonas, proporciona prejuízos econômicos, sociais e culturais significativos à população, dificultando seu pleno desenvolvimento. Dessa forma, o conhecimento dos principais eventos da evolução histórica da rede elétrica no território nacional e das políticas de planejamento governamental que corroboraram para o surgimento deste problema é analisado com o propósito de entender as dinâmicas socioespaciais que não facilitam a inserção dessa fração do território ao meio geográfico contemporâneo. Os projetos de integração na fronteira amazônica produziram um crescimento sem planejamento dos objetos técnicos, que, estruturados às pressas, proporcionaram obras imediatistas, realizadas em curto prazo -- o que Milton Santos (1994) chama, para os países subdesenvolvidos, de -saltar etapas?. Isso propiciou à população consequências negativas vinculadas às estruturas sociotécnicas amazônicas, que não atendem integralmente às funções que deveriam realizar, como é o caso da rede elétrica do Amazonas. A realização de uma análise de eventos, projetos e propostas que permitem sugestionar uma mitigação ou solução para esse obstáculo ao exercício do direito à cidadania do tefeense é direcionada nesta pesquisa. / In this study, the grid is used as an analytical tool for the restricted territorial integration in the city of Tefé to the technical and scientific-informational mean. The occurrence of interruptions and shortages in the electricity supply in the city, located within the State of Amazonas, provides significant economic, social and cultural losses to the population, hindering their full development. Thus, the knowledge of the main events of the historical evolution for the electric grid in the country and the government planning policies which confirmed to the emergence of this problem is analyzed in order to understand the socio-spatial dynamics that do not facilitate the insertion of this fraction in the contemporary geographical territory. Integration projects in the Amazon frontier produced an unplanned growth of technical objects, which were structured hastily, providing immediately works made in the short term, which according to Milton Santos (1994) is named by -leap-frog? in developing countries. With that, the population is linked to negative consequences related to the Amazonians socio-technical structures that do not match the functions they should undertake such as Amazon electricity grid. Performing an analysis of the events, projects and proposals allow us to suggest a mitigation or a solution to this obstacle that is related to the exercise of the tefeense citizenship right.

O sistema elétrico brasileiro utiliza o custo do déficit como parâmetro no seu planejamento da expansão e operação para indicar o custo econômico da escassez de energia elétrica para a sociedade. Para o desenvolvimento de um método confiável de cálculo deste parâmetro, é importante compreender a dependência do suprimento de energia nos diversos setores econômicos. Este trabalho apresenta e discute a percepção das empresas do setor de telecomunicações dos impactos resultantes de restrições no fornecimento de energia elétrica. O trabalho foi desenvolvido em duas etapas: revisão da literatura referente aos métodos utilizados para o cálculo do custo do déficit no modelo brasileiro e na experiência internacional e, em seguida, pesquisa empírica com realização de estudos de casos em duas empresas de telecomunicações. As informações obtidas mostram que, no setor de serviços de telecomunicações, qualquer nível de interrupção ou restrição de energia tem impacto econômico para as empresas. Tendo em vista o caráter de serviço essencial para a população, as empresas investem em estruturas de contingenciamento que mitigam os riscos em caso de pequenas restrições ou interrupções curtas de energia. Indisponibilidade de energia acima da capacidade de contingenciamento prevista pelas empresas requer investimentos adicionais e implica em aumento dos custos operacionais para redução dos riscos de falhas na prestação dos serviços e suas consequentes sanções regulatórias. Em relação aos métodos para o cálculo do custo do déficit, concluiu-se que, baseado nas análises dos casos estudados, no perfil de consumo de energia e nas características de negócio do setor de telecomunicações, para pesquisas diretas ao consumidor, o método de preferência revelada é o mais adequado para este setor econômico e possivelmente outros com as mesmas características. Neste método o custo da insuficiência de energia é inferido através das decisões de investimento feitas pelo consumidor em equipamentos de contingência, tais como geradores de reserva. / The Brazilian electricity system uses the deficit cost as a parameter in its planning processes to indicate the economic cost for the society of electricity shortages. In developing a reliable method of calculating this parameter, it is important to understand the dependence of different economic sectors on the energy supply. This work presents and discusses the telecommunication companies\' perception of the impacts resulting from restrictions to the power supply. It was developed in two stages: a literature review on the methods used to calculate the deficit cost in Brazil and other countries, followed by an empirical research with case studies in two telecommunication companies. The research showed that for the telecommunication service providers, any level of power interruption or restriction has an economic impact. In view of the essential nature of the service to the population, companies invest in contingency structures to mitigate the risks for small power restrictions and short interruptions. Providing mitigation measures for larger levels of power shortage would require additional investments and result in higher operational costs, in order to decrease the risk of service interruption and consequent regulatory sanctions. Regarding the deficit cost calculation method, it is shown, based on the case studies analysis, the power consumption profile, and the business characteristics, that for consumer surveys, the revealed preference method is most suitable for the telecommunications economic sector, and possibly for other similar ones. In this method, the power shortage cost is inferred from the investment decisions made by the company in power contingency equipment, such as backup generators.

Cette recherche est une contribution au débat sur la possibilité de concilier rentabilité, faible coût du crédit et large portée relative des institutions de microfinance. Elle discute aussi l’efficacité des subventions accordées à ces institutions. Enfin elle cherche à articuler la microfinance et la croissance économique dans les pays d’Afrique subsaharienne. Notre étude produit des résultats qui tendent à montrer qu’en Afrique subsaharienne les institutions de microfinance issues de la privatisation directe ou indirecte d’anciens réseaux de collecte étatiques ont une rentabilité négative mais touchent un grand nombre de personnes. A l’inverse les institutions de microfinance d’origine locale ont une taille relative beaucoup plus faible, leur part dans la distribution du crédit total à l’économie est faible, mais elles sont rentables. Deuxièmement la politique de subventions doit encourager les institutions à devenir autonomes plutôt que chercher à pérenniser les situations acquises d’endettement, tout en cherchant à réduire l’effet des coûts fixes sur le taux du crédit. Finalement, de la nature de la politique économique dépendra le développement relatif des secteurs formel et informel. Par exemple, une politique monétaire restrictive favorisera le secteur informel alors qu’une politique monétaire expansionniste favorisera le secteur formel. / The aim of this dissertation is to contribute on the debate about the possibility to reconcile return, low cost of credit and high relative outreach of microfinance institutions. It deals with efficiency of the granted subsidies to these institutions and at last with the interaction between microfinance and economic growth in sub-Saharan Africa. The results of our study tend first of all to suggest that, in sub-Saharan Africa, microfinance institutions coming from the direct or indirect privatization of public development banks have a negative return but a high level of outreach, whereas microfinance institutions coming from local groups have a relative low size but are profitable and self-sufficient. The ratio of their gross loan portfolio to total loan is marginal. Secondly, subsidy policy should enforce microfinance institutions to become self-sufficient rather than perpetuate overdraft situations coming from the past. It should also aim at reducing fixed cost on loan rate. The development of formal and informal markets will depend on the nature of economic policy: a restrictive monetary policy will increase the informal market while an expansionist monetary policy will increase the formal market.

Introdução: A sepse é uma condição clínica de inflamação disseminada e descontrolada associada a um foco infeccioso. É uma condição de difícil estudo pela variedade de interações existentes entre as diversas instâncias do organismo e um conceito uniforme ainda está sendo debatido na literatura, o que dificulta a pesquisa e o estabelecimento de legislação que garanta fomento específico. Somado a isto, a exemplo de outras condições tempo-dependentes como infarto agudo do miocárdio, trauma e acidente vascular cerebral, a organização do fluxo do paciente através do sistema de saúde, garantindo leitos de terapia intensiva é fundamental. A U.E.- HCFMRP-USP é referência terciária para emergências para uma população de aproximadamente 4,5 milhões de habitantes e vem introduzindo mecanismos de gestão de fluxo como a priorização de leitos de terapia intensiva e desospitalização. Estas duas estratégias são recentes no Sistema Único de Saúde (SUS) e sua avaliação é fundamental para identificar o perfil de pacientes com Sepse e a importância da organização do sistema no prognóstico desta condição. Objetivos: 1) Avaliar a associação da priorização de Vagas em Terapia Intensiva com a mortalidade, morbidade e tempo de permanência hospitalar dos pacientes; 2) Avaliar o perfil epidemiológico dos pacientes com Sepse admitidos na U.E.-HCFMRP-USP; 3) Avaliar a estratégia de priorização de vagas no acesso de pacientes em sepse grave ou choque séptico aos leitos de terapia intensiva; 4) Avaliar a estratégia de transferência para leitos de retaguarda na oferta de leitos de terapia intensiva. 5) Avaliar a estratégia de priorização de vagas no retardo ao acesso de pacientes em sepse grave ou choque séptico aos leitos de terapia intensiva; 6) Avaliar a estratégia de priorização de vagas na mortalidade de pacientes em sepse grave ou choque séptico aos leitos de terapia intensiva; 7) Avaliar o índice prognóstico \"Quick\" SOFA nos pacientes com sepse grave ou choque séptico admitidos na U.E.-HCFMRP-USP. Metodologia: Trata-se de uma coorte retrospectiva realizada a partir de dados administrativos obtidos do sistema eletrônico de gerenciamento de pacientes da UEHCFMRP- USP de 01 janeiro de 2010 a 31 de dezembro de 20016. Foram construídas duas bases de dados. A primeira embasada em internação como identificador, na qual foram derivadas variáveis que representam priorização, dados demográficos, Comorbidade (Índice de Comorbidade de Charlson), a gravidade (\"Quick SOFA\"), linha de cuidado, presença de sepse e variáveis de desfecho. A segunda embasada em cada dia do período de estudo composta por variáveis sobre o número de leitos de CTI disponíveis, número de admissões, número de altas, número de transferências para hospital geral e para hospital de retaguarda. As variáveis quantitativas foram expressas como média e desvio-padrão ou mediana e mínimo e máximo de acordo com o teste de normalidade e as variáveis categóricas como percentagem. Para análise univariada foram utilizados testes t de Student, Análise de Variância ou equivalentes não-paramétricos, qui-quadrado ou teste exato de Fisher e \"Receiver Operating\'\' Curves\". Para a análise multivariada foram utilizadas a regressão logística multivariada com desfecho binário ou categórico conforme apropriado e a regressão multivariada de Poisson. A significância estatística foi expressa por p<0,05 ou a exclusão da unidade do intervalo de confiança. Resultados: 1) O processo de priorização de leitos de terapia intensiva se mostrou apropriado. Os pacientes que receberam prioridade maior para acesso ao CTI (prioridade 1- 5826;62,5%) eram mais jovens (55;12-100 - p<0,01), apresentavam menos comorbidades ( Charlson 0, 3583:61,5% - p<0,01) e menor gravidade (Quick\" SOFA\" 0,2170;37,2% - p<0,01; SOFA <10% - 1782;0,5% - p<0,01). Estes pacientes foram admitidos em maior proporção (2097;35,9% - p<0,01) e tiveram acesso mais rápido ao CTI (1081;52,5% - p<0,01), apresentando menor mortalidade (1853;31,8% - p<0,01). Ao se ajustar os possíveis fatores de confusão para estabelecer a razão de chances de receber prioridade 1 pelo intensivista, maior valor da classe de Charlson (Comorbidade) - OR 0,53; 0,49-0,57, do \"Quick SOFA\" (Gravidade) - OR 0,45; 0,43- 0,48 e a presença da condição Sepse - OR 0,20-0,17;0,23 estiveram associados independentemente à menor chance de receber esta classificação. 2) Os pacientes sépticos identificados neste estudo tinham maior idade (61;12-97 - p<0,01), maior prevalência do gênero masculino (646;56,2% - p<0,01) , menor amparo social (714;61,8% - p=0,048), maior índice de Comorbidade (Charlson 2 - 222;19,3% - p<0,01) e de Gravidade (SOFA >90% - 152;13,2% - p<0,01), apresentaram maior mortalidade intrahospitalar (838;73% - p<0,01), maior retardo para admissão no CTI e maior duração da internação hospitalar (7,3;0-304 - p<0,01). Quando comparados com outras linhas de cuidado bem estabelecidas, observou-se que a Sepse pode ser equiparada com o Trauma em termos de incidência (sepse 1148;22,5% - p<0,01; trauma 1138;22,3% - p<0,01), sendo inferior apenas às Síndromes Coronarianas Agudas (SCA)(1972;38,7% - p<0,01). Na análise multivariada, a Sepse está associada à menor chance de receber prioridade 1(0,2 ; IC 95% - 0,17;0,23) independente de outros fatores de confusão, persistiu como fator independente para mortalidade intra-hospitalar total (2,7; IC 95% - 2,32;3,17) e para a mortalidade de pacientes admitidos no CTI (2,38; IC 95% - 1,82;3,11). 3) A priorização de vagas facilitou o acesso dos pacientes ao CTI; 4) A estratégia de transferência de pacientes de alta dependência que deixaram de requerer recursos de alta complexidade se mostrou importante para o sistema. As três instituições parceiras não se distinguiram com relação ao índice de Comorbidade de Charlson (Altinópolis , Charlson 0, 25;28,1%, Charlson 1, 29;32,6%, Charlson 2, 35;39,3%; Guariba Charlson 0, 60;35,7%, Charlson 1, 50;29,7%, Charlson 2, 58;34,5%; São Simão, Charlson 0, 20;28,5%, Charlson 1, 17;24,3%, Charlson 2, 33;47,2% - p=0,894) e tiveram desempenho semelhante com relação à mortalidade(Altinópolis 35;39,33%, Guariba 78;46,4%, São Simão 33;47,1% - p=0,26) e alta domiciliar (Altinópolis 37;41,5%; Guariba 60;35,71%, São Simão 19;27,1% - p=0,26). Os pacientes com problemas neurológicos foram responsáveis pela maioria das transferências (Altinópolis 61;68,5%, Guariba 92;54,7%, São Simão 40;57,1% - p=0,06). Ao longo dos anos, houve melhora do desempenho das instituições com relação à mortalidade (2013,16 óbitos;44,4%, 2016, 37 óbitos;35,2% - p<0,01) e a relação de permanência na U.E.-HCFMRP-USP comparada à permanência total (soma da internação na U.E.- HCFMRP-USP e da internação nos leitos de longa permanência) decresceu (2013, 67,8 dias;0-97,7, 2016, 58,87 dias;0-100 - p=0,005). Na análise multivariada, observou-se que a transferência para leitos de longa permanência foi fator independente em aumentar a disponibilidade de leitosde CTI na U.E.-HCFMRP-USP (com o ano de 2016 1,54; IC 95% - 1,18-2,01, excluindo-se o ano de 2016 1,73; IC 95% - 1,26;2,39). 5) Não houve retardo de admissão no CTI dos pacientes sépticos que receberam prioridade 1 quando se ajustou por possíveis fatores de confusão (0,43; IC 95% - 0,35;0,53); 6) O índice prognóstico \"Quick\" SOFA teve baixa acurácia nos pacientes com sepse grave ou choque séptico admitidos na U.E.-HCFMRPUSP (AUROC= 0,5646, IC95% - 0,52991;0,59930-p<0,001). Conclusões: A Sepse apresentou elevada mortalidade mesmo quando foi garantida a admissão ao CTI em comparação com outros estudos, o que pode refletir o viés de seleção da Regulação Médica. As estratégias de gerenciamento de fluxo foram eficazes em garantir acesso e aumentar a disponibilidade de leitos. / Introduction: Sepsis is a clinical condition of disseminated and uncontrolled inflammation associated with an infectious outbreak. It is a condition difficult to study because of the variety of interactions between the various organs of the organism and lack of a uniform concept in the literature, which makes it difficult to research and establish legislation that guarantees specific promotion. Added to this, like other timedependent conditions such as acute myocardial infarction, trauma and stroke, the organization of patient flow through the health system, ensuring intensive care beds is critical. The U.E.-HCFMRP-USP is a tertiary reference for emergencies for a population of approximately 4.5 million inhabitants and has been introducing flow management mechanisms such as the prioritization of intensive care and de-hospitalization beds. These two strategies are recent in the Unified Health System (SUS) and their valuation is fundamental to identify the profile of patients with Sepsis and the importance of the organization of the system in the prognosis of this condition. Objectives: 1) To evaluate the association of the prioritization of Vacancies in Intensive Care with the mortality, morbidity and hospital stay time of the patients; 2) To evaluate the epidemiological profile of patients with sepsis admitted to U.E.-HCFMRP-USP; 3) Evaluate the strategy of prioritizing vacancies in the access of patients in severe sepsis or septic shock to intensive care beds; 4) Evaluate the transfer strategy for back beds in the offer of intensive care beds. 5) Evaluate the strategy of prioritization of vacancies in the delay to access of patients in severe sepsis or septic shock to intensive care beds; 6) To evaluate the strategy of prioritization of vacancies in the mortality of patients in severe sepsis or septic shock to intensive care beds; 7) To evaluate the \"Quick\" SOFA prognostic index in patients with severe sepsis or septic shock admitted to U.E.- HCFMRP-USP. Methodology: This is a retrospective cohort based on administrative data obtained from the electronic patient management system of the EU-HCFMRP-USP from January 01, 2010 to December 31, 20016. Two databases were constructed. The first was based on admission as an identifier, in which variables were derived, such as prioritization, demographic data, Comorbidity (Charlson Comorbidity Index), severity (\"Quick SOFA\"), clinical pathway, presence of sepsis and outcome variables. The second, based on each day of the study period, contains variables on the number of CTI beds available, number of admissions, number of discharges, number of transfers to general hospital and back hospital. We expressed quantitative variables as mean and standard deviation or median and minimum and maximum according to the normality test and categorical variables as percentage. We used Student t tests, Analysis of Variance or non-parametric equivalents, chi-square or Fisher\'s exact test and \"Receiver Operating Curves\" for univariate analysis. We used Multivariate logistic regression with binary or categorical outcome and multivariate Poisson regression as appropriate for the multivariate analysis. A p <0.05 or the exclusion of the unit from the confidence interval signaled statistical significance. Results: 1) The process of prioritizing intensive care beds was appropriate. Patients who received higher priority for CTI access (priority 1 - 5826;62,5%) were younger (55;12- 100 - p<0,01), had less comorbidities ( Charlson 0, 3583;61,5%, p<0,01) and less severity (Quick\" SOFA\" 0,2170;37,2% - p<0,01; SOFA <10% - 1782;0,5% - p<0,01). These patients were admitted in greater proportion (2097;35,9% - p<0,01) and had faster access to ICU (1081;52,5% - p<0,01), presenting lower mortality (1853;31,8% - p<0,01). When adjusting the possible confounding factors to establish the odds ratio to receive priority 1 by the intensivist, higher value of the Charlson class OR 0,53; 0,49-0,57, the \"Quick SOFA\" (Severity) - OR 0,45; 0,43-0,48 and the presence of Sepsis condition - OR 0,20-0,17;0,23 were independently associated with a lower chance of being classified as priority 1. 2) The septic patients identified in this study had older age (61;12- 97 - p<0,01), higher prevalence of male gender (646;56,2% - p<0,01), lower social protection (714;61,8% - p=0,048), higher Comorbidity (Charlson 2 - 222;19,3% - p<0,01) and Severity index (SOFA >90% - 152;13,2% - p<0,01), higher in-hospital mortality (838;73% - p<0,01), longer ICU admission delay and longer hospital stay(7,3;0-304 - p<0,01). When compared to other clinical pathways, it was observed that Sepsis can be equated with Trauma in terms of incidence (sepsis 1148;22,5% - p<0,01; trauma 1138;22,3% - p<0,01), being inferior only to Acute Coronary Syndromes (ACS) (1972;38,7% - p<0,01). In the multivariate analysis, Sepsis was more associated to lower chance of receiving priority 1(0,2; IC 95% - 0,17;0,23) independent of other confounding factors, it persisted as an independent factor for total in-hospital mortality(2,7; IC 95% - 2,32;3,17) and for the mortality of patients admitted to the ICU(2,38; IC 95% - 1,82;3,11). 3) The prioritization of vacancies facilitated the access of the septic patients to the ICU. 4) The strategy of transference of patients of high dependence that stopped requesting resources of high complexity proved to be important for the system. The three partner institutions did not differ in relation to the Charlson Comorbidity Index (Altinópolis , Charlson 0, 25;28,1%, Charlson 1, 29;32,6%, Charlson 2, 35;39,3%; Guariba Charlson 0, 60;35,7%, Charlson 1, 50;29,7%, Charlson 2, 58;34,5%; São Simão, Charlson 0, 20;28,5%, Charlson 1, 17;24,3%, Charlson 2, 33;47,2% - p=0,894) and had a similar performance in relation to mortality (Altinópolis 35;39,33%, Guariba 78;46,4%, São Simão 33;47,1% - p=0,26) and household discharge (Altinópolis 37;41,5%; Guariba 60;35,71%, São Simão 19;27,1% - p=0,26). Patients with neurological problems were responsible for most of the transfers (Altinópolis 61;68,5%, Guariba 92;54,7%, São Simão 40;57,1% - p=0,06). Over the years, there has been an improvement in the institutions\' performance in relation to mortality (2013,16 deaths;44,4%, 2016, 37 deaths;35,2% - p<0,01) and the length of stay in the EUHCFMRP- USP compared to the total stay (sum of hospitalization in the EU-HCFMRP-USP and length of stay in long-stay beds) decreased (2013, 67,8 days;0-97,7, 2016, 58,87 days;0-100 - p=0,005).In the multivariate analysis, we observed that the transfer to long-stay beds was an independent factor in increasing the availability of ICU beds in U.E.-HCFMRPUSP (with year 2016 1,54; IC - 95% 1,18;2,01, without year 2016 1,73; IC - 95% 1,26;2,39). 5) There was no delay in ICU admission for septic patients who received priority 1 when adjusted for possible confounding factors (0,43; IC 95% - 0,35;0,53).7) The \"Quick\" SOFA prognostic index had low accuracy in patients with severe sepsis or septic shock admitted to U.E.-HCFMRP-USP (AUROC= 0,5646, IC95% - 0,52991;0,59930 - p<0,001).Conclusions: Sepsis presented a high mortality even when admission to the ICU was guaranteed in comparison to other studies, which may reflect the selection bias of the Medical Regulation. Flow management strategies were effective in securing access and increasing bed availability.

O presente trabalho tem por objetivo analisar os modelos da firma bancária e crédito a partir de uma visão keynesiana. Inicialmente são apresentadas as proposições teóricas de Keynes e as derivações dessa a partir dos velhos e novos keynesianos. Na 2 parte os modelos representativos da firma bancária dessas escolas são descritos através de Tobin e Stiglitz, sendo neste último caso introduzido o conceito de assimetria de informação. No 3 capítulo é desenvolvida a abordagem pós-keynesiana de endogeneidade da oferta de moeda, sendo apresentados os modelos horizontalista de Moore, bem como as críticas da visão estruturalista, além do modelo de estratégia bancária de Alves, Dymski e Paula, desenvolvido a partir da hipótese de fragilidade financeira de Minsky. No capítulo 4 efetua-se uma discussão, feita por autores pós-keynesianos, sobre a possibilidade de compatibilizar em alguma medida o modelo de Tobin e o modelo de racionamento de crédito com a concepção pós-keynesiana de banco e crédito. / The present work aims at analyzing the models of the banking firm and credit from a Keynesian approach. Initially the theoretical proposals of Keynes and the Old and New Keynesian view of banking and credit are presented. In chapter 2 the representative models of the banking firm of these schools are described through Tobin and Stiglitzs model. In chapter 3 is developed the Post-Keynesian approach of money endogeneity - Moores banking firm model and the criticism made by the Post-Keynesian structuralist view. We also consider other Post Keynesian banking firm model, such as Dymskis model and Alves, Dymski and Paula banking strategy model. In chapter 4 we discuss if compatible the Post Keynesian approach is compatible or not with the conventional Keynesian theory of banking. In chapter 4 we consider the hypothesis of financial fragility of Minsky.

O sistema elétrico brasileiro utiliza o custo do déficit como parâmetro no seu planejamento da expansão e operação para indicar o custo econômico da escassez de energia elétrica para a sociedade. Para o desenvolvimento de um método confiável de cálculo deste parâmetro, é importante compreender a dependência do suprimento de energia nos diversos setores econômicos. Este trabalho apresenta e discute a percepção das empresas do setor de telecomunicações dos impactos resultantes de restrições no fornecimento de energia elétrica. O trabalho foi desenvolvido em duas etapas: revisão da literatura referente aos métodos utilizados para o cálculo do custo do déficit no modelo brasileiro e na experiência internacional e, em seguida, pesquisa empírica com realização de estudos de casos em duas empresas de telecomunicações. As informações obtidas mostram que, no setor de serviços de telecomunicações, qualquer nível de interrupção ou restrição de energia tem impacto econômico para as empresas. Tendo em vista o caráter de serviço essencial para a população, as empresas investem em estruturas de contingenciamento que mitigam os riscos em caso de pequenas restrições ou interrupções curtas de energia. Indisponibilidade de energia acima da capacidade de contingenciamento prevista pelas empresas requer investimentos adicionais e implica em aumento dos custos operacionais para redução dos riscos de falhas na prestação dos serviços e suas consequentes sanções regulatórias. Em relação aos métodos para o cálculo do custo do déficit, concluiu-se que, baseado nas análises dos casos estudados, no perfil de consumo de energia e nas características de negócio do setor de telecomunicações, para pesquisas diretas ao consumidor, o método de preferência revelada é o mais adequado para este setor econômico e possivelmente outros com as mesmas características. Neste método o custo da insuficiência de energia é inferido através das decisões de investimento feitas pelo consumidor em equipamentos de contingência, tais como geradores de reserva. / The Brazilian electricity system uses the deficit cost as a parameter in its planning processes to indicate the economic cost for the society of electricity shortages. In developing a reliable method of calculating this parameter, it is important to understand the dependence of different economic sectors on the energy supply. This work presents and discusses the telecommunication companies\' perception of the impacts resulting from restrictions to the power supply. It was developed in two stages: a literature review on the methods used to calculate the deficit cost in Brazil and other countries, followed by an empirical research with case studies in two telecommunication companies. The research showed that for the telecommunication service providers, any level of power interruption or restriction has an economic impact. In view of the essential nature of the service to the population, companies invest in contingency structures to mitigate the risks for small power restrictions and short interruptions. Providing mitigation measures for larger levels of power shortage would require additional investments and result in higher operational costs, in order to decrease the risk of service interruption and consequent regulatory sanctions. Regarding the deficit cost calculation method, it is shown, based on the case studies analysis, the power consumption profile, and the business characteristics, that for consumer surveys, the revealed preference method is most suitable for the telecommunications economic sector, and possibly for other similar ones. In this method, the power shortage cost is inferred from the investment decisions made by the company in power contingency equipment, such as backup generators.

Small and medium-sized enterprise (SME) business owners influence the growth and development of sub-Saharan Africa and the welfare of its citizens. However, SME owners often lack the strategies to access and obtain invoice factoring financing to fund their businesses. Guided by the pecking order theory and the credit rationing theory, the purpose of this multiple case study was to explore strategies that 3 SME owners in Kenya used to access and obtain invoice factoring financing to fund their businesses. Data were collected from in-depth semistructured Skype interviews and organizational documents. Data were analyzed using the Krippendorff content analysis methodology. Member checking was used to validate the interview responses and enhance the credibility of results. Three strategy themes emerged from data analysis: proper documentation, effective third-party relationships, and connections with government officials. The study may contribute to positive social change for SME owners in sub-Saharan Africa by providing actionable strategies they can use to access and obtain invoice factoring financing to fund and sustain their businesses. Citizens of Kenya may experience more job opportunities, improved quality of life, increased household incomes, and sustained economic growth.

Electricity is the most preferred source of energy, because of its quality and convenience of usage. It is probably one of the most vital infrastructural inputs for economic development of a country. Indeed it is the fulcrum which can leverage the future pace of growth and development. These reasons have made the electric power industry one of the fastest growing sectors in most developing countries and particularly in India. Therefore it is not surprising to observe the economic growth of a country being related to the increase in electricity consumption. In India, the growth rate of demand for power is generally higher than that of Gross Domestic Product (GDP). However, to achieve this kind of growth in electricity supply, the capital investments required are very huge. Even though the electricity sector generally gels a major share in the budgetary allocations in India, this is inadequate to add the required quantum of new generation capacity to keep pace with the increase in demand for electricity. Additional constraints like capital scarcity in the public sector, lack of enthusiasm among the private and foreign investors, and strong opposition from the environmentalists have further contributed to this slow pace of new generating capacity addition. This has resulted in severely constrained systems in India. The main focus of the present research work is on the development of an integrated approach for electricity planning using a mathematical modeling framework in (he context of resource constrained systems. There are very few attempts in the literature to integrate short, medium and long term issues in electricity planning. This is understandable from the point of view of unconstrained electricity systems where this type of integration is unnecessary since such systems have a luxury of surplus capacity to meet the current demand and capacity additions are required only for meeting predicted future increase in demand. However, in the case of constrained electricity systems, which are characterized by shortages, this kind of integration is very essential. These systems have to manage with inadequate capacity in the present, plan capacity additions to bridge the existing gap and to meet future increase in demand, and always explore the possibility of adding capacity with short gestation period. The integrated approach is expected to achieve effective supply-demand matching on a continuous basis encompassing both the short term and long term horizons. To achieve this, we have considered three alternatives- existing supply, new supply and non-supply (rationing) of electricity. The electricity system of the state of Karnataka, which is severely constrained by both limited capital and energy resources, has been selected for this purpose. As a first step, the supply and demand situation has been studied in the context of resource constraints. In terms of supply, both existing and future additions are studied in detail with respect to the potential created, generation types, import potential, technical constraints, energy and power shortages, planned and proposed capacity additions by both public and private sectors, etc. The demand patterns have been studied by introducing a new concept of "Representative Load Curves (RLCs)". These RLCs are used to model the temporal and structural variations in demand for electricity. Also, appropriate non-supply options (rationing measures) for effective management of shortages are identified. Incorporating this information, an integrated mathematical model, which is expected to generate a target plan for a detailed generation scheduling exercises and a requirement plan for a regular generation expansion planning, has been developed. The other important alternative "Demand-Side-Management (DSM)", which could be considered as an effective option to achieve efficient supply-demand matching has not been included in the present research work. The major reason for not including the DSM alternatives is due to the difficulty in integrating these in the modelling approach adopted here. In the present approach we have used typical daily load curves (RLCs) to represent the demand for electricity. These are aggregate load curves and do not contain any sector-wise or end-use-wisc details. On the other hand, DSM alternatives are end-use focused. To incorporate DSM alternatives, we should have information on end-usc-wisc power demand (kW or MW), savings potential, time-of-use, etc. For this purpose it may be required to have end-use-wisc daily load curves. This information is not available and a separate detailed survey may be required to generate these load curves. This, we felt, is out of the scope of this present research work and a separate study may be required to do this. Therefore, we restricted our focus to supply planning alone. A detailed literature review is conducted to understand different types of modeling approaches to electricity planning. For the present study, however, the review of literature has been restricted to the methods of generation expansion planning and scheduling. In doing so, we attempted to bring out the differences in various approaches in terms of solution methods adopted, alternatives included and modifications suggested. Also, we briefly reviewed the literature on models for power and energy rationing, because management of shortages is an important aspect of the present study. Subsequently, a separate section is devoted to present an overview of the non-supply of electricity and its economic impacts on the consumers. We found that the low reliability of the electrical system is an indicator of the existence of severe shortages of power and energy, which cause non-supply of electricity to the consumers. The overview also presented a discussion on reasons for non-supply of electricity, and the types of non-supply options the utilities adopt to over come these shortages. We also attempted to explain what we mean by non-supply of electricity, what are its cost implications, and the methods available in the literature to estimate these costs. The first objective of the research pertains to the development of a new approach to model the varying demand for electricity. Using the concept of Representative Load Curves (RLCs) we model the hourly demand for a period of four years, 1993-94, 1994-95, 1995-96 and 1996-97, to understand the demand patterns of both unconstrained and constrained years. Multiple discriminant analysis has been used to cluster the 365 load curves into nine RLCs for each of the four years. The results show that these RLCs adequately model the variations in demand and bring out the distinctions in the demand patterns existed during the unconstrained and constrained years. The demand analysis using RLCs helped to study the differences in demand patterns with and without constraints, impacts of constraints on preferred pattern of electricity consumption, success of non-supply options in both reducing the demand levels and greatly disturbing the electricity usage patterns. Multifactor ANOVA analyses are performed to quantify the statistical significance of the ability of the logically obtained factors in explaining the overall variations in demand. The results of the ANOVA analysis clearly showed that the considered factors accounted for maximum variations in demand at very high significance levels. It also brought out the significant influence of rationing measures in explaining the variations in demand during the constrained years. Concerning the second objective, we explained in detail, the development of an integrated mixed integer-programming model, which we felt is appropriate for planning in the case of resource constrained electricity systems. Two types of integrations are attempted (i) existing supply, non-supply and new supply options for dynamically matching supply and demand, (ii) operational and strategic planning in terms of providing target plans for the former and requirement plans for the latter. Broadly, the approach addresses the effective management of existing capacity, optimal rationing plan to effectively manage shortages and rationally decide on the new capacity additions both to bridge the existing gap between supply and demand, and to meet the future increases in demand. There is also an attempt to arrive at an optimal mix of public and private capacity additions for a given situation. Finally, it has been attempted to verify the possibility of integration of captive generation capacity with the grid. Further, we discussed in detail about the data required for the model implementation. The model is validated through the development of a number of scenarios for the state of Karnataka. The base case scenario analyses are carried out for both the unconstrained and constrained years to compare the optimal allocations with actual allocations that were observed, and to find out how sensitive are the results for any change in the values of various parameters. For the constrained years, a few more scenarios are used to compare the optimal practice of managing shortages with to what has been actually followed by the utility. The optimal allocations of the predicted demand to various existing supply and non-supply options clearly showed that the actual practice, reflected by the actual RLCs, are highly ad hoc and sub-optimal. The unit cost comparisons among different scenarios show that the least cost choice of options by the utility does not necessarily lead to good choices from the consumers’ perspective. Further, a number of future scenarios are developed to verify the ability of the model to achieve the overall objective of supply-demand matching both in the short and long term. For this purpose both the short horizon annual scenarios (1997-98 to 2000-01) and long horizon terminal year scenarios (2005-06 and 2010-11) are developed assuming capacity additions from only public sector. Overall, the results indicated that with marginal contributions from non-supply options and if the public sector generates enough resources to add the required capacity, optimal matching of supply and demand could be achieved. The scenario analyses also showed that it is more economical to have some level of planned rationing compared to having a more reliable system. The quantum of new capacity additions required and the level of investments associated with it clearly indicated the urgent need of private sector participation in capacity additions. Finally, we made an attempt to verify the applicability of the integrated model to analyse the implications of private sector participation in capacity additions. First, a number of scenarios are developed to study the optimal allocations of predicted hourly demand to private capacity under different situations. Secondly, the impacts of privatisation on the public utility and consumers are analysed. Both short term and long term scenarios are developed for this purpose. The results showed the advantage of marginal non-supply of electricity both in terms of achieving overall effective supply-demand matching and economic benefits that could be generated through cost savings. The results also showed the negative impacts of high guarantees offered to the private sector in terms of the opportunity costs of reduced utilization of both the existing and new public capacity. The estimates of unit cost of supply and effective cost of supply facilitated the relative comparison among various scenarios as well as finding out the merits and demerits of guarantees to private sector and non-supply of electricity. The unit cost estimates are also found to be useful in studying the relative increase in electricity prices for consumers on account of privatization, guarantees and reliable supply of electricity. Using the results of scenario analyses, likely generation expansion plans till the year 2010-11 are generated. The analyses have been useful in providing insights into fixing the availability and plant load factors for the private sector capacity. Based on the analysis, the recommended range for plant utilization factor is 72.88 - 80.57%. The estimated generation losses and the associated economic impacts of backing down of existing and new public capacity on account of guarantees offered to private sector are found to be significantly high. The analyses also showed that the backing down might take place mainly during nights and low demand periods of monsoon and winter seasons. Other impacts of privatization that studied are in terms of increased number of alternatives for the utility to buy electricity for distribution and the associated increase in its cost of purchase. Regarding the consumers, the major impact could be in terms of significant increase in expected tariffs. The major contributions of this thesis are summarized as follows: i. An integrated approach to electricity planning that is reported here, is unique in the sense that it considers options available under various alternatives, namely, existing supply, non-supply and new supply. This approach is most suited for severely constrained systems having to manage with both energy and capital resource shortages. ii. The integration of operational and strategic planning with coherent target plans for the former and requirement plans for the latter bridges the prevailing gap in electricity planning approaches. iii. The concept of Representative Load Curves (RLCs), which is introduced here, captures the hourly, daily and seasonal variations in demand. Together, all the RLCs developed for a given year are expected to model the hourly demand patterns of that year. These RLCs are useful for planning in resource constrained electricity systems and in situations where it is required to know the time variations in demand (e.g. supply-demand matching, seasonal scheduling of hydro plants and maintenance scheduling). RLCs are also useful in identifying the factors influencing variations in demand. This approach will overcome the limitations of current method of representation in the form of static and aggregate annual load duration curves. iv. A new term, "non-supply of electricity" has been introduced in this thesis. A brief overview of non-supply presented here includes reasons for non-supply, type of non-supply, methods to estimate cost of non-supply and factors influencing these estimates. v. The integrated mixed integer programming model developed in the study has been demonstrated as a planning tool for- • Optimal hourly and seasonal scheduling of various existing supply, non-supply and new supply options • Estimation of supply shortages on a representative hourly basis using the information on resource constraints • Effectively planning non-supply of electricity through appropriate power/energy rationing methods • Estimation of the need for the new capacity additions both to bridge the existing gap and to take care of increase in future demand levels • Optimal filling of gaps between demand and supply on a representative hourly basis through new supply of electricity • Optimally arriving at the judicious mix of public and private capacity additions • Studying the impacts of private capacity on the existing and new public sector capacity, and on the consumers • Optimally verifying the feasibility of integrating the captive generation with the total system vi. The demand analysis using RLCs helped to bring out the differences in demand patterns with and without constraints, impacts of constraints on preferred pattern of electricity consumption, success of non-supply options in both reducing the demand levels and greatly disturbing the electricity usage patterns. Multifactor ANOVA analyses results showed that the logically obtained factors accounted for maximum variations in demand at very high significance levels. vii. A comparison of optimal (represented by optimal predicted RLCs) and actual (reflected by actual RLCs) practices facilitated by the model showed that the actual practice during constrained years is highly ad hoc and sub-optimal. viii. The results of the scenario analyses showed that it is more economical to have some amount of planned rationing compared to having a more reliable system, which does not allow non-supply of electricity. ix. The scenarios, which analysed the impacts of high guarantees offered to the private sector, showed the negative impacts of these in terms of reduced utilization of both the existing and new public capacity. x. Generation expansion plans till the year 2010-11 are developed using the results of various kinds of scenario analyses. Two groups of year-wise generation expansion plans are generated, one with only public sector capacity additions and the other with private sector participation. xi. The impacts of privatization of capacity additions are studied from the point of view of the utility and consumers in terms of expected increase in cost of purchase of electricity and tariffs. xii. The analyses are also made for developing some insights into fixing the availability and plant load factors for the private capacity. Based on the analysis, the recommended range for plant utilization factor is 72.88 - 80.57%. We believe that the integrated approach presented and the results obtained in this thesis would help utilities (both suppliers and distributors of electricity) and governments in making rational choices in the context of resource constrained systems. The results reported here may also be used towards rationalization of Government policies vis-a-vis tariff structures in the supply of electricity, planning new generation capacity additions and effective rationing of electricity. It is also hoped that the fresh approach adopted in this thesis would attract further investigations in future research on resource constrained systems.