Asymptomatic ST segment elevation

Asymptomatic ST segment elevation in a life insurance applicant's ECG raises several prognostically important possibilities such as myocardial infarction, pericarditis, Brugada syndrome and early repolarization. This ECG case study discusses the ECG features involved in the differential diagnosis.     

Are lending relationships beneficial or harmful for public credit guarantees? Evidence from Japan's Emergency Credit Guarantee Program

This paper examines the effectiveness of Japan's Emergency Credit Guarantee (ECG) Program set up during the financial turmoil following the failure of Lehman Brothers, in increasing credit availability and improving the ex-post performance of small businesses. In particular, using a unique firm–bank matched dataset, the paper examines whether lending relationships enhanced or dampened the effects of the ECG program. It is found that the ECG program significantly improved credit availability for firms using the program. However, when it was a relationship lender (main bank) that extended an ECG loan, the increased availability was partially, if not completely, offset by a decrease in non-ECG loans by the same bank. Further, propensity score matching estimations show that the ex-post performance of firms that received ECG loans from the main bank deteriorated more than that of firms that received non-ECG loans. We do not find such loan “substitution” or performance “deterioration” effects when a non-main bank extended ECG loans. Our findings suggest that close firm–bank relationships may have perverse effects on the efficacy of public credit guarantees.     

Tall R wave in lead V1

Tall R waves in lead V1 present the life insurance company medical director with a diagnostic dilemma. This ECG pattern may be present in applicants with right bundle branch block, right ventricular hypertrophy, Wolff-Parkinson-White syndrome, posterior myocardial infarction, hypertrophic cardiomyopathy, muscular dystrophy, dextrocardia, misplaced precordial leads, as well as in normal individuals. This ECG case study discusses the ECG features involved in the differential diagnosis.     

Poor R-wave progression

Poor R-wave progression is a common ECG pattern, which is often inconclusively interpreted by medical directors. Although this ECG pattern is commonly attributed to anterior myocardial infarction, it may also be caused by left bundle branch block, Wolff-Parkinson-White syndrome, right and left ventricular hypertrophy as well as by faulty ECG recording technique. Failure to make a definitive interpretation of this pattern may result in a delay or loss of business.     

Do small businesses adjust their capital structure? Evidence from the global financial crisis in Japan

We investigate the extent to which small businesses adjust their capital structures to target levels when their leverage increases substantially during a financial crisis. We examine Japan's Emergency Credit Guarantee (ECG) program during the 2008 global financial crisis. The increased leverage from the use of the ECG program during the crisis increased the probability of default. Additionally, small businesses adjusted their leverage ratios to the target range before the crisis. However, such adjustments were weak during and after the crisis, particularly for target firms in the ECG program.     

The Brugada syndrome--an electrocardiogram with important mortality implications

The electrocardiogram (ECG) is a valuable screening tool for increased risk in underwriting life insurance applicants. This article discusses a recently described ECG pattern associated with a high risk of sudden unexpected death.     

Early repolarization ECG pattern--still a benign finding?

A life insurance applicant with an early repolarization pattern on his electrocardiogram (ECG) previously assessed as a standard risk, wishes to increase the amount of his coverage. The risk assessment implications of recent studies of early repolarization ECG patterns are reviewed.     

Myocardial infarction or technical artifact?

Misplacement of recording electrodes can generate misleading patterns on the standard 12-lead electrocardiogram (ECG). Some lead placement errors are easily recognizable, others are more difficult to detect and can be quite important in risk selection because the resulting changes in ECG morphology can mimic other conditions such as myocardial infarction. Therefore, identification of incorrectly performed ECGs is an important task for the medical director.     

Left axis deviation

Left axis deviation is one of the most commonly encountered ECG abnormalities. Its presence should alert medical directors and underwriters to the possibility of underlying structural heart disease. Many of the causes of left axis deviation are apparent from the clinical findings. Left anterior fascicular block is one of the commonest causes of left axis deviation and has specific ECG criteria for its diagnosis.     

Positive computer-generated exercise electrocardiogram

The use of computerized averaging of the electrocardiogram (ECG) during stress testing has facilitated the removal of motion artifacts and baseline shifts. However, this process can introduce errors, which may not be appreciated by medical directors. Such errors can lead to significant ST depression in the absence of coronary artery disease. Such false-positive tests may lead to anxiety in the applicant, delays in accepting the application and unnecessary additional testing. This case study illustrates a common pitfall associated with using only a computer-generated exercise ECG for risk assessment of a life insurance applicant.     

Low amplitude P, QRS and T wave pattern in lead I--the "isoelectric lead I sign"

An applicant's electrocardiogram contains a low amplitude P, QRS and T wave pattern in lead I. The diagnostic and prognostic implications of this ECG pattern are discussed.     

Assessment for congenital long QT syndrome

A 29-year-old male presented for an evaluation of his risk for having congenital long QT syndrome. Despite being asymptomatic and having a normal QTc interval on the resting ECG, a suggestive family history was an indication for a thorough cardiac evaluation. A geneticist reviewed this workup and recommended against genetic testing. While up to 10% of affected carriers of a congenital long QT syndrome gene mutation can be asymptomatic with a normal QTc, consideration of all of the clinical factors allowed for further risk stratification. The evaluation of an ECG for the long QT syndrome includes calculating a corrected QT interval for the heart rate and assessing the T-waves for morphology associated with this syndrome.     

Q waves--does depth matter?

Deep narrow Q waves in an electrocardiogram may be significant and should suggest several possible diagnoses. By considering the leads where they are observed, the presence of additional ECG abnormalities, the applicant's age and any relevant clinical information, one can considerably narrow the diagnostic possibilities.     

Right atrial abnormality

Occasionally, a prominent P wave is encountered in a life insurance applicant's electrocardiogram. Prominent P waves may be normal variants or alert the medical director to prognostically significant structural heart or pulmonary disease. This case study reviews the commonly used criteria for the ECG pattern of right atrial abnormality and some of the pitfalls associated with its use.     

Increased QRS voltage in the limb leads

Increased QRS voltage accompanied by repolarization abnormalities in a life insurance applicant's electrocardiogram should alert the medical director to the possibility of left ventricular hypertrophy. If confirmed, left ventricular hypertrophy or increased left ventricular mass is a strong independent risk factor for future cardiac events and all cause mortality. The use of the electrocardiogram to diagnose left ventricular hypertrophy can be helpful, but there are limitations that need to be considered. This ECG case study illustrates some of the pitfalls in the electrocardiographic diagnosis of left ventricular hypertrophy.     

美国货币政策推升了新兴市场国家非金融企业杠杆率吗？

全球金融危机后,美国量化宽松货币政策的实施导致全球流动性异常充裕,对新兴市场国家非金融企业外部融资环境造成显著影响。本文运用28个新兴市场国家2003-2015年非金融类上市企业财务数据和美国影子利率数据对美国货币政策调整与新兴市场国家非金融企业杠杆率变动之间的关系进行了实证分析。结果显示,美国影子利率与新兴市场国家非金融企业杠杆率变动之间存在显著负相关关系,即美国影子利率的降低会促使新兴市场国家非金融企业杠杆率出现更大幅度的上涨。进一步地,这一影响在融资约束程度较高的企业、外部融资依赖度较高的行业以及资本账户开放程度较高但汇率弹性僵化的国家表现得更为显著。上述发现意味着新兴市场国家在调控企业部门杠杆率的过程中,除要考虑国内因素外,也应高度重视美国货币政策的变化。     

International comparison of industrial development in the European context — the problems

Conclusion The index of production enables us to analyse current developments in the countries considered in the cyclical context, the information on real value added that is available for these branches of industry not being sufficiently up to date. In 1999, the division of labour within industry and between industry and the services sector changed, both nationally and in the international context. There was a rise in the nominal and the real ratios of intermediate input. Our conclusion is that, at least in some branches, the structural changes between 1995 and 1999 were of greater importance in Germany than in the other countries. In view of such structural changes the index of production cannot adequately reflect the dynamic of these branches in an international comparison. Different developments in the real ratios of intermediate input and divergent real developments in value added that are evident in the statistics are partly the result of the different methods of price deflation used in the countries and branches considered. The real value added gives a distorted picture of the development in output in these branches in the individual countries. The development in the index of production probably overstates the dynamic of German industry compared with industry in the other countries considered for the period on which this article is based, while understating the trend in value added. It follows from this that the indicators designed to measure output in economic sectors are not enough to give a realistic picture of the trend in output in branches of industry for international comparison. More information, e.g. the trends in employment and investment, also needs to be taken into account.     

英国政府会计管理与改革情况及对我国的启示

本文按照英国政府会计的历史沿革、管理现状、现行特点,以及对我国推行政府会计改革的启示这一逻辑顺序,较为系统、详细地介绍了英国中央政府会计改革的基本历程、会计法律体系、中央政府会计规范的制定、地方政府会计管理情况、英国政府整体财务报告编制情况等,对英国政府会计管理的特点进行了总结,得出了对我国推行政府会计改革的若干启示。     

The Leveraging of Corporate America: A Long‐Run Perspective on Changes in Capital Structure

In a study published recently in the Journal of Financial Economics, the authors of this article documented a substantial increase in the use of debt financing by U.S. companies over the past century. From 1920 until the mid‐1940s, the aggregate leverage of unregulated U.S. companies was low and stable, with the average debt‐to‐capital ratio staying within the narrow range of 10% to 15%. But during the next 25 years, the use of debt by U.S. companies more than doubled, rising to 35% of total capital. And since 1970, aggregate leverage has remained above 35%, peaking at 47% in 1992. Moreover, this pattern has been observed in companies of all sizes and operating in all unregulated sectors. Changes in the characteristics of U.S. public companies during this period provide little help in explaining the increase in corporate leverage. For example, the displacement of tangible by intangible assets in many sectors of the U.S. economy during the past 50 years would have led most economists to predict, holding all other things equal, a reduction rather than an increase in aggregate corporate leverage. Instead, according to the authors' findings, the main contributors to the increases in U.S. corporate leverage since the 1940s have been external changes, including increases in corporate income tax rates, the development of financial markets and intermediaries, and the reduction in government borrowing in the decades following World War II. The authors' analysis also identifies these last two changes—the development of financial markets, including the rise of institutional investors and shareholder activism, and the post‐War reduction in government debt—as having played the biggest roles in the leveraging of corporate America.     

Recent working time developments in the UK : Insights from the engineering industry

Numerous factors in the UK have resulted in a step-like reduction in working time over the past century. However, the author argues that it is necessary to go beyond tracking the changes in the duration of the working week. Recent developments in the UK, particularly in the engineering industry, show that while unions continue to focus on negotiating reductions in the duration of the working period, employers have been paying increased attention to the arrangement of working hours and their intensity. As a result, in future it will be necessary to consider the working period in terms of the interrelatedness of duration, arrangement and intensity.