The financial conglomerate discount: Insights from stock return skewness

Abstract Diversified banks (i.e. financial conglomerates) trade often at a discount compared to matched portfolios of specialized stand-alone banks. The existing research explains this evidence primarily with inefficiencies in the cash flow management of banks. This article analyzes the financial conglomerate discount by focusing on the role of expected returns approximated by measures of stock return skewness. Our empirical findings support the hypothesis that diversified banks have less skewed stock returns, i.e. they are more likely to perform badly than non-diversified banks. Due to the lower skewness exposure investors demand higher future returns, thereby lowering corporate value. Although the conglomerate puzzle is observed across industries, the previous literature examines banks separately, as the financial industry is hardly comparable to other sectors. We follow this field of research and show that huge banks quote at a discount as diversification into investment banking activities affects negatively the corporate performance

Internal capital markets and bank holding company efficiency

Bank Holding Companies and in particular their internal capital markets have been widely discussed in recent financial literature. The financial crisis especially brought regulatory intervention in financial markets into question. Empirical evidence suggests that bank holding companies have clear preferences for double leverage, which are not based on unambiguous and explicit economic foundations. In this article, we analyze the effects of equity, debt and double leverage on the efficiency of bank holding companies. We show that Bank Holding Company efficiency is negatively affected by equity financing from parents to subsidiaries and this effect is even more pronounced in case of double leveraging. Our findings indicate that further measures from regulators are necessary in order to prevent inefficient financing via double leverage, which may be used to circumvent regulatory capital requirements

the interplay between dividends and leverage inside commercial banks

The paper analyzes the dividends paid by a large sample of commercial banks in the United States during 2006-2011. The most interesting findings arise after the end of 2008. Our measures for the probability of paying dividends and for the dividend payout ratio are positively related to the banks´ non-deposit leverage. Conversely, banks´ dividends correlate negatively to deposit leverage. We argue that during the crisis of 2007-2009 the liquidity needs of banks resorted more to deposits, than to non-deposit debt. This, in turn, had an impact on banks´ dividend policies, to the extent that firms which could raise deposits preferred to preserve their financial stability, and did not pay huge dividends

Assessment and management of paediatric Head Injuries in the Emergency Department

Background: Head injuries (HI) are one of the most common causes of morbidity and mortality in the paediatric population in developed countries. Their management places a considerable burden on emergency services, being one of the most common reasons to visit the Emergency Department (ED). The care delivered in the ED covers multiple key aspects to ensure a timely successful recovery and prevent re-injury. Despite evidence supporting the care of paediatric HIs has substantially increased in recent years, many aspects of care still benefit from further research for an optimal management of these patients. Objectives: To investigate different elements of the journey of paediatric patients with HI in the ED, including: 1. Diagnosis of possible intracranial injuries; 2. Management of concussion; 3. HI prevention. Methods: This is a collection of eight observational studies with both prospective and retrospective designs, conducted at the paediatric EDs of either Padova Hospital, in Italy, or at the Royal Children’s Hospital Melbourne, in Australia. All the studies included patients presenting to the ED following a head trauma with some project focusing on specific populations (i.e. minor HIs, concussions, and recreational vehicles-related HIs). Data were collected between November 2009 and June 2014, with study periods for each project ranging between nine months and approximately three years. Results: Key findings are presented for the three research topics listed in the objectives section. 1. Diagnosis of possible intracranial injuries, including the following aspects: a) Clinical decision rules validation and implementation We externally validated in 2439 children the Pediatric Emergency Care Applied Research Network (PECARN) rule for computed tomography (CT) scan decision-making in children with minor HI. We found a diagnostic accuracy comparable to the derivation and internal validation cohorts (overall sensitivity 100%, 95% confidence interval (CI) 83.2%-100%; specificity 55%, 95% CI 52.5%-56.6%, and negative predictive value 100%, 95% CI 99.6%-100%). The PECARN rule was successfully implemented in the paediatric ED of Padova, Italy, showing high adherence (93.5%), unchanged CT rate compared to previous practice (8.4%, 95% CI 6.0%-11.8% vs. 7.3%, 95% CI 4.8%-10.9%), high safety and efficacy (100%, 95% CI 36.8%-100% and 92.3%, 95% CI 89%-95% respectively) and increased medical staff satisfaction compared with the previous minor HI guideline (96% vs. 51%, p<0.0001). When the PECARN rule was used in clinical practice neither single nor multiple intermediate-risk predictors were significantly associated with ordering a CT scan. Only age younger than three months was found to be significantly associated to the decision to perform a CT (OR 18.1, 95% CI 4.91-66.61). b) Risks associated with CT – sedation use, practice and adverse events In our study, sedation for cranial CT scan in children with HI was needed in only 6.3% (95% CI 4.2%-9%), with a higher rate in children < 5 years (OR 22.8 95% CI 6.7-119.1). A Glasgow Coma Scale < 12 was not associated with a lower sedation rate (OR 0.34, 95% CI 0.1-2.2). The most commonly used sedative agent was chloral hydrate in 64.3% of cases. No adverse effects were recorded. c) Role of an Infrared device as screening tool to reduce CT scan use We demonstrated the feasibility of use in children (completion of test in 94% of patients after a mean of 4.4±2.9 minutes) of a near-infrared handheld device (Infrascanner) able to detect traumatic intracranial haematomas. Our exploratory analysis showed a specificity of 93% (95% CI 86.5%-96.6%) and a negative predictive value of 100% (95% CI, 81.6%-100%). The use of Infrascanner would have reduced the CT scan rate by 58.8%. 2. Management of concussion. a) Sport –related concussions. When exploring compliance with and awareness of on-field management and return to play guidelines we found that 42% of children who sustain a sport-related concussion are not managed according to recommended guidelines on the field. Almost all parents (93%) and patients (96%) were unaware of concussion or return to play guidelines from their organization. Overall, 72% were compliant with return to play guidelines provided in the ED before discharge. b) Post-concussive symptoms. The majority of patients recovered within 2 weeks post-injury. The prevalence of patients with clinically significant post-concussive symptoms was 30% (95% CI, 21%-46%) at 2 and 15% (95% CI 5%-32%) at 3 months post-injury. The health-related quality of life (HRQOL) score at 1 month was significantly worse in patients with clinically significant post-concussive symptoms at 2 weeks compared with asymptomatic or improving subjects (median 68, interquartile range (IQR) 55-89 vs 96, IQR 90-100, p=0.000 for the child report and 71, IQR 55-82 vs 89, IQR 79-95, p=0.002 for the parent report). HRQOL was still worse at 3-months post-injury as per child report (83, IQR 69-92 vs 97, IQR 81-100, p=0.020), but significantly improving compared to the 1-month time point (p=0.031). 3. Prevention of recreational vehicle (RV)-related HIs. RV-related HIs accounted for 7.5% of all HIs presenting to the ED. The RVs most commonly involved were bicycles (36.3%), push scooters (18.5%) and motorcycles (18.4%). Motorized vehicles were responsible for the most severe HIs. Helmet use was documented in 85.3%, with a positive use in 66.7%.The highest rates of helmet use were recorded for motorcycle riders (83.2%), horse riders (82.9%) and cyclists (65.1%). The CT scan and neurosurgery rate was higher in non-helmeted children compared with children wearing a helmet (37.0% vs. 20.1%, p<0.001 and 5.4% vs. 0.8%, p<0.001 respectively). Conclusions: 1. The work presented in this thesis provides evidence for the wide implementation of the PECARN rule in clinical practice and supports further research to investigate which rule predictors mostly influence clinicians’ decision-making on CT scan in children at intermediate risk of clinically significant intracranial injury. The use of an infrared device to screen for intracranial haemorrhages and refine the CT scan decision-making seemed promising and should be investigated further. The need of sedation in children undergoing a CT scan for HI was overall quite low and mainly associated to patients’ age. The data provided may help with resource allocation in the ED. 2. Compliance with on-field management and information provided for sport-related concussions in organised sport were not optimal. Education based on return to play guidelines should be routinely provided in the ED for these patients. The majority of children recovered within two weeks following their concussion. The prevalence of children with clinically significant post-concussive symptoms halved from 2 weeks to 3 months post-injury. Symptomatic children showed a worse HRQOL at 1 and 3 months post-injury. 3. Helmet use and documentation varied by RV with highest usage rates amongst children riding a motorcycle or a horse. Motorized RVs accounted for a small proportion of cases overall, but the majority of intracranial injuries. Helmet use was associated with less severe RV-related HIs and should be encouraged through legislative, social marketing strategies and education in the ED

Pandemic influenza A (H1N1v) infection in pediatric population: a multicenter study in a North-East area of Italy

<p>Abstract</p> <p>Background -</p> <p>Data on clinical presentation, morbidity and mortality of 2009 pandemic influenza virus (H1N1v) in paediatric population are still emerging; most of the data so far available came from selected cohorts of children admitted to tertiary care paediatric hospitals.</p> <p>Methods -</p> <p>An observational study involving all the 19 Divisions of Paediatrics of the Veneto Region was conducted with the aim of investigating into the demographic and clinical characteristics, the treatment, the outcome and the risk factors for disease severity of H1N1v infection occurring in children.</p> <p>Results -</p> <p>Two hundred children, median age of 4.15 years (range 0-15) were enrolled from the last week of October till the first week of January 2010 for an overall hospitalization rate of 23/100.000. At least one underlying medical condition was found in 44% of patients. Fever and cough were the most frequent symptoms (93% and 65% respectively). 11 patients (6%) were admitted to a PICU and 5 (2.5%) required mechanical ventilation. Antiviral therapy was administered in 103 patients (51.5%) Death occurred in 2 patients (1%); both had severe prior medical conditions. Pre-existing neurologic diseases (OR 7.82; 95%CI: 1.15-53.34), the presence of hypoxemia (OR 10.47; 95%CI: 2.12-51.70) and anemia (Haemoglobin < 10 g/dL) (OR 14.15; 95%CI: 2.36-84.64) were risk factor for Intensive Care Unit admission.</p> <p>Conclusions -</p> <p>This observational study in a given area of North-East Italy confirms the rather favourable prognosis of children with influenza A H1N1 (2009). Pre-existing conditions, and which is new, significant anemia, are risk factors for a complicated course.</p

Parental help-seeking behaviour for, and care of, a sick or injured child during the COVID-19 pandemic: a European online survey

BACKGROUND: Globally, the COVID-19 pandemic had a huge impact on patients and healthcare systems. A decline in paediatric visits to healthcare settings was observed, which might have been due to lower incidence of injury and infectious illness, changes in healthcare services and parental concern. The aim of our study was to examine parental experiences of help-seeking for, and care of, a sick or injured child during COVID-19 lockdown periods in five European countries with different healthcare systems in place. METHODS: An online survey for parents with a child with any kind or illness of injury during COVID-19 lockdowns was circulated through social media in five European countries: Italy, Spain, Sweden, the Netherlands, and the United Kingdom. Parents living in one of these countries with self-identification of a sick or injured child during COVID-19 lockdown periods were eligible to fill in the survey. Descriptive statistics were used for the level of restrictions per country, children's characteristics, family characteristics and reported help-seeking behaviour of parents prior to the lockdown and their real experience during the lockdown. The free text data was subjected to thematic analysis. RESULTS: The survey was fully completed by 598 parents, ranging from 50 to 198 parents per country, during varying lockdown periods from March 2020 until May 2022. Parents who completed the survey were not deterred from seeking medical help for their sick or injured child during the COVID-19 pandemic. This finding was comparable in five European countries with different healthcare systems in place. Thematic analysis identified three main areas: parental experiences of access to healthcare, changes in parents' help-seeking behaviours for a sick or injured child during lockdowns, and the impact of caring for a sick or injured child during the lockdowns. Parents reported limited access to non-urgent care services and were anxious about either their child or themselves catching COVID-19. CONCLUSION: This insight into parental perspectives of help-seeking behaviour and care for a sick or injured child during COVID-19 lockdowns could inform future strategies to improve access to healthcare, and to provide parents with adequate information concerning when and where to seek help and support during pandemics

Genome sequence analysis of the first human West Nile virus isolated in Italy in 2009.

In 2009, six new human cases of West Nile neuroinvasive disease (WNND) were identified in Veneto region, following the six cases already reported in 2008. A human West Nile virus (WNV) isolate was obtained for the first time from an asymptomatic blood donor. Whole genome sequence of the human WNV isolate showed close phylogenetic relatedness to the Italy-1998-WNV strain and to other WNV strains recently isolated in Europe, with the new acquisition of the NS3-Thr249Pro mutation, a trait associated with avian virulence, increased virus transmission, and the occurrence of outbreaks in humans

Traumatic brain injury in young children with isolated scalp haematoma

Objective Despite high-quality paediatric head trauma clinical prediction rules, the management of otherwise asymptomatic young children with scalp haematomas (SH) can be difficult. We determined the risk of intracranial injury when SH is the only predictor variable using definitions from the Pediatric Emergency Care Applied Research Network (PECARN) and Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) head trauma rules.Design Planned secondary analysis of a multicentre prospective observational study.Setting Ten emergency departments in Australia and New Zealand.Patients Children 5 cm haematoma in any region of the head) rule-based definition of isolated SH in both childre