Fiscal Affairs Research Articles

Identification of factors associated with opioid-related and hepatitis C virus-related hospitalisations at the ZIP code area level in the USA: an ecological and modelling study

Opioid overdose and related diseases remain a growing public health crisis in the USA. Identifying sociostructural and other contextual factors associated with adverse health outcomes is needed to improve prediction models to inform policy and interventions. We aimed to identify high-risk communities for targeted delivery of screening and prevention interventions for opioid use disorder and hepatitis C virus (HCV). In this ecological and modelling study, we fit mixed-effects negative binomial regression models to identify factors associated with, and predict, opioid-related and HCV-related hospitalisations for ZIP code tabulation areas (ZCTAs) in South Carolina, USA. All individuals aged 18 years or older living in South Carolina from Jan 1, 2016, to Dec 31, 2021, were included. Data on opioid-related and HCV-related hospitalisations, as well as data on additional individual-level variables, were collected from medical claims records, which were obtained from the South Carolina Revenue and Fiscal Affairs Office. Demographic and socioeconomic variables were obtained from the United States Census Bureau (American Community Survey, 2021) with additional structural health-care barrier data obtained from South Carolina's Center for Rural and Primary Health Care, and the American Hospital Directory. Between Jan 1, 2016, and Dec 31, 2021, 41 691 individuals were hospitalised for opioid misuse and 26 860 were hospitalised for HCV. There were a median of 80 (IQR 24-213) opioid-related hospitalisations and 61 (21-196) HCV-related hospitalisations per ZCTA. A standard deviation increase in ZCTA-level uninsured rate (relative risk 1·24 [95% CI 1·17-1·31]), poverty rate (1·24 [1·17-1·31]), mortality (1·18 [1·12-1·25]), and social vulnerability index (1·17 [1·10-1·24]) was significantly associated with increased combined opioid-related and HCV-related hospitalisation rates. A standard deviation increase in ZCTA-level income (0·79 [0·75-0·84]) and unemployment rate (0·87 [0·82-0·93]) was significantly associated with decreased combined opioid-related and HCV-related hospitalisations. Using 2016-20 hospitalisations as training data, our models predicted ZCTA-level opioid-related hospitalisations in 2021 with a median of 80·4% (IQR 66·8-91·1) accuracy and HCV-related hospitalisations in 2021 with a median of 75·2% (61·2-87·7) accuracy. Several underserved high-risk ZCTAs were identified for delivery of targeted interventions. Our results suggest that individuals from economically disadvantaged and medically under-resourced communities are more likely to have an opioid-related or HCV-related hospitalisation. In conjunction with hospitalisation forecasts, our results could be used to identify and prioritise high-risk, underserved communities for delivery of field-level interventions. South Carolina Center for Rural and Primary Healthcare, National Institute on Drug Abuse, and National Library of Medicine.

Sexual orientation and gender identity measures and viral suppression for people living with HIV: a protocol for a population-based cohort study

IntroductionThe measure of sexual orientation and gender identity (SOGI) data in electronic health records (EHR) has been critical for addressing health disparities and inequalities, especially for HIV care. Given that...

Exploring low back and pelvic pain challenges: Administrative insights into prevalence during pregnancy among 2016-2021 South Carolina Medicaid beneficiaries.

Musculoskeletal changes occur during pregnancy; one-half of pregnant women experienced low back pain and/or pelvic pain during pregnancy. Prescription opioid use for Medicaid enrolled pregnant women has increased dramatically due to severe low back pain/pelvic pain. This study aimed to explore the prevalence of low back pain/pelvic pain and related risk factors among a broader population. This is a retrospective cohort study. This study utilized de-identified Medicaid claims data provided by the South Carolina Revenue and Fiscal Affairs Office, including individuals who gave birth between 2016 and 2021 during pregnancy. Low back pain/pelvic pain and a group of musculoskeletal risk factors were identified with International Classification of Diseases v10. Comparisons were made for the prevalence of low back pain and pelvic pain between those with pregnancy-related musculoskeletal risk and those without. Among 167,396 pregnancies, 65.6% were affected by musculoskeletal risk factors. The overall prevalence of low back pain was 15.6%, and of pregnancy-related pelvic pain was 25.2%. The overall prevalence for either low back pain or pelvic pain was 33.3% (increased from 29.5% in 2016 to 35.3% in 2021), with 24.6% being pregnancy-induced. Pregnancies with musculoskeletal risk factors were more likely to be diagnosed with low back pain (20.7% versus 5.7%, p < 0.001) or pelvic pain (35.3% versus 6.0%, p < 0.001) than those without. This study found a very high prevalence of musculoskeletal risk and a high prevalence of low back pain or pelvic pain, with an increasing trend, among South Carolina pregnancies enrolled in Medicaid during the period 2016-2021. Most of the diagnosed low back pain or pelvic pain were pregnancy induced. Musculoskeletal risk factors were associated with low back pain or pelvic pain.

Retrospective Review of Complications and Revision Rates Between Isolated Talonavicular vs Talonavicular and Subtalar (Double) Arthrodesis vs Triple Arthrodesis.

Hindfoot fusion procedures are common for the treatment of end-stage arthritis or deformity. Surgical treatments for these conditions include talonavicular joint (single) arthrodesis, talonavicular and subtalar (double) arthrodesis, or talonavicular, subtalar, and calcaneocuboid (triple) arthrodesis. This study evaluated the complication rate, revision surgery rate, and hardware removal rate for those treated with either single, double, or triple arthrodesis. A retrospective review was conducted for patients who underwent single (Current Procedural Terminology [CPT] code 28740), double (CPT 28725 and 28740), or triple (CPT 28715) arthrodesis to treat hindfoot arthritis/deformity (International Classification of Diseases, Ninth Revision [ICD-9] code: 734, International Classification of Diseases, Tenth Revision [ICD-10] codes: M76821, M76822, and M76829) from 2005 to 2022 using the South Carolina Revenue and Fiscal Affairs databank. Data collected included demographics, comorbidities, procedure data, and postoperative outcomes within 1 year of principal surgery. Student t test, chi-squared test, and multivariable logistic regression analysis were utilized during data analysis. A total of 433 patients were identified, with 248 undergoing single arthrodesis, 67 undergoing double arthrodesis, and 118 undergoing triple arthrodesis. There was no significant difference between single, double, and triple arthrodesis in the rate of complications, hardware removals, revision surgeries, or 30-day readmission when controlling for confounding variables. However, a decrease in Charlson Comorbidity Index (CCI) was found to be predictive of an increase in the revision surgery rate (OR = 0.46, 95% CI 0.22-0.85, P = .02). We found no difference in the rate of complications, hardware removals, or revision surgeries in those undergoing single, double, or triple arthrodesis. Surprisingly we found that a lower Charlson Comorbidity Index, indicating a healthier patient had a significant relationship with a higher rate of revision surgery. Further study including radiographic indications for surgery or the impact of overall health status on revision surgery rates may further elucidate the other components of this relationship. Level III, cohort study.

2399. Changing Demographics of Infective Endocarditis in South Carolina: An Ecological Study

Abstract Background The opioid epidemic in America is likely changing the demographics of patients with infective endocarditis (IE). Traditionally, IE is attributed to older patients and those with prosthetic heart valves or cardiac devices. Rising rates of opioid use (OU), usually via injection, has resulted in younger patients being diagnosed with IE, which raises treatment challenges. Methods This retrospective ecological study analyzed hospitalization records from the South Carolina Revenues and Fiscal Affairs Office (SC RFA) from 2016-2021. ICD-10 codes for the diagnosis of IE yielded 7,175 hospitalizations with 5,066 unique patients. Cases of IE with concurrent OU were identified. Rurality of hospital county, hospital teaching status, hospital bed size, length of stay, total costs, discharge status, and distance to hospital zip were reviewed. Data was analyzed by year and age group (18-34, 35-49, 50-64,65-79, and 80+). Poisson regression was used to examine change in trends. Results From 2016-2021, inpatient stays related to IE showed no significant trend for age groups 35 years and older (p &amp;gt; 0.19), while showing a significant positive trend in the 18-to-34 age group (p = 0.04). Of the 7,175 IE hospitalizations, 977 (13.6%) had a concurrent diagnosis of OU. The percentage of patients with concurrent IE and OU diagnosis increased from 7% to 17% of patients/year. The rate of inpatient stays related to concurrent IE and OU increased from 3.8 to 11.1 (p = 0.01) and 2.5 to 8.7 per 100,000 of SC population (p = 0.01), for the 18–34 year-old and 35-49 year old groups, respectively, while not significantly changing in patients 50 years and older over the study period (p = 0.57). Rate Per 100,000 SC Population of Inpatient Stays Related to IE and OU by Age Group Conclusion There are few epidemiologic studies of IE since the 2015 Infectious Diseases Society of America treatment guidelines, though significant concern about the juxtaposition of the opioid epidemic with diseases like IE. There are major changes in the demographics of IE patients. This study supports the need for updated guidelines to specifically address IE in the setting of OU, particularly in younger patients. This includes possible disparities in treatment due to lack of access to ID physicians in rural communities and challenges in providing prolonged intravenous antibiotic therapy. Disclosures Julie Ann Justo, PharmD, MS, FIDSA, BCPS, Gilead Sciences: Advisor/Consultant|Shionogi: Advisor/Consultant|Vaxart: Stocks/Bonds

Transparency in Financial and Fiscal Affairs at Municipal Level: The Lessons from the Gandaki Province, Nepal

Transparency in Financial and Fiscal Affairs at Municipal Level: The Lessons from the Gandaki Province, Nepal

Impact of the "39-week rule" on adverse pregnancy outcomes: a statewide analysis.

The "39-week rule," adopted by the American College of Obstetricians and Gynecologists circa 2009, discouraged routine elective induction of labor in early-term gestations (37 weeks 0 days-38 weeks 6 days) to decrease the risk of adverse neonatal outcomes. However, little research exists regarding any unintended adverse pregnancy outcomes associated with this policy shift. This study aimed to quantify the difference in incidence of adverse pregnancy outcomes before and after the implementation of the 39-week rule. Deidentified data from all births in the state of South Carolina from 2000 to 2008 (before the 39-week rule) and from 2013 to 2017 (after statewide implementation and enforcement of the rule) were obtained from the South Carolina Revenue and Fiscal Affairs Office. Demographic data and International Classification of Diseases 9/10 codes were obtained for each birth. Our primary outcome was the incidence of any of the following adverse pregnancy outcomes: cesarean delivery, hypertensive disorders, chorioamnionitis, postpartum hemorrhage, high-degree lacerations, placental abruption, and intensive care unit admission. Propensity score analysis was used to control for age, body mass index, and race. After stratification by propensity score, the Cochran-Mantel-Haenszel test was used to compare the prerule and postrule groups. A total of 633,985 births were eligible for inclusion-412,632 from 2000 to 2008, and 221,353 from 2013 to 2017. There was a significant increase in the primary outcome in the postrule period (39.94% pre vs 42.76% post; P<.01). The incidence of all hypertensive disorders was significantly increased in the postrule period compared with the prerule period (7.75% pre vs 10.1% post; P<.01). The incidence of chorioamnionitis and cesarean delivery also increased in the postrule period (1.45% pre vs 1.92% post; P<.01; 29.6% pre vs 31.82% post; P<.01; respectively). There was a significant increase in the primary outcome following the implementation of the 39-week rule. Although the policy shift was driven by a desire to decrease adverse neonatal outcomes, aggregate benefit was not observed for pregnancy outcomes.

Fiscal Crises: The Role of the Public Debt Investor Base and Domestic Financial Markets as Aggravating and Mitigating Factors

The paper evaluates the key drivers of fiscal crises in a sample of countries from all three income groups—advanced, emerging, and low-income countries, using fiscal crisis data recently developed by the IMF’s Fiscal Affairs Department. The empirical study focuses on three questions: (1) How does the composition of debtholders (domestic vs. foreign, resident vs. non-resident, or official vs. non-official) affect the probability of a fiscal crisis, after controlling for the level of public debt and other relevant variables?; (2) How does the development and size of the domestic financial sector affect the probability of a fiscal crisis?; and (3) How do changes in the debt level affect the probability of a fiscal crisis, for given compositions of the sovereign debt investor base and different levels of development and size of domestic financial markets? Our findings confirm the benefits of financial development, the danger of heavy reliance on a non-resident investor base, and also that emerging market economies have a lower debt carrying capacity compared to the full sample.

Impact of restricting early-term deliveries on adverse neonatal outcomes: a statewide analysis

The "39-Week Rule" was adopted by the American College of Obstetricians and Gynecologists in 2009 to eliminate nonmedically indicated (elective) deliveries before 39 weeks in an effort to improve neonatal outcomes. Our primary objective was to quantify the effect of this policy change on adverse neonatal outcomes among a cohort of term births in South Carolina. Deidentified data from all births in the state of South Carolina from 2000 to 2008 (before the 39-week rule) and from 2013 to 2017 (after statewide implementation and enforcement of the rule) were obtained from the South Carolina Revenue and Fiscal Affairs Office. Demographic data and International Statistical Classification of Diseases and Related Health Problems Ninth/Tenth Revision codes were obtained for each birth. Our primary outcome was admission to a neonatal intensive care unit. Our secondary outcomes were respiratory morbidities (including respiratory distress syndrome and transient tachypnea of the newborn), hypoxic-ischemic encephalopathy,seizure, sepsis, birth injuries, hyperbilirubinemia, hypoglycemia, and feeding difficulties. Propensity score analysis was used to control for maternal age, body mass index, race, gestational hypertension, infection, placental abruption, and gestational and pregestational diabetes mellitus. After stratification by propensity score, the Cochran-Mantel-Haenszel test was used to compare groups. A total of 620,121 infants were liveborn at term during the 2 study periods. After implementation of the 39-week rule, there was a significant reduction in early-term deliveries. In adjusted analyses, neonatal intensive care unit admission was significantly more common in the postimplementation period. Respiratory morbidities were also significantly more common postimplementation. In contrast, there were significant reductions in birth injuries and hyperbilirubinemia in the postimplementation period. Implementation of the 39-week rule was associated temporally with an increase in adverse neonatal outcomes. The outcomes intended to be reduced by the 39-week rule, including neonatal intensive care unit admission and respiratory morbidity, seem to have increased in incidence despite adherence to the proposed guidelines.

How Different Pre-existing Mental Disorders and Their Co-occurrence Affects COVID-19 Clinical Outcomes? A Real-World Data Study in the Southern United States.

BackgroundAlthough a psychiatric history might be an independent risk factor for COVID-19 infection and mortality, no studies have systematically investigated how different clusters of pre-existing mental disorders may affect COVID-19 clinical outcomes or showed how the coexistence of mental disorder clusters is related to COVID-19 clinical outcomes.MethodsUsing a retrospective cohort study design, a total of 476,775 adult patients with lab-confirmed and probable COVID-19 between March 06, 2020 and April 14, 2021 in South Carolina, United States were included in the current study. The electronic health record data of COVID-19 patients were linked to all payer-based claims data through the SC Revenue and Fiscal Affairs Office. Pre-existing mental disorder diagnoses from Jan 2, 2019 to Jan 14, 2021 were extracted from the patients' healthcare utilization data via ICD-10 codes.ResultsThere is an elevated risk of COVID-19-related hospitalization and death among participants with pre-existing mental disorders adjusting for key socio-demographic and comorbidity covariates. Co-occurrence of any two clusters was positively associated with COVID-19-related hospitalization and death. The odds ratio of being hospitalized was 1.26 (95% CI: 1.151, 1.383) for patients with internalizing and externalizing disorders, 1.65 (95% CI: 1.298, 2.092) for internalizing and thought disorders, 1.76 (95% CI: 1.217, 2.542) for externalizing and thought disorders, and 1.64 (95% CI: 1.274, 2.118) for three clusters of mental disorders.ConclusionsPre-existing internalizing disorders and thought disorders are positively related to COVID-19 hospitalization and death. Co-occurrence of any two clusters of mental disorders have elevated risk of COVID-19-related hospitalization and death compared to those with a single cluster.

Treaty-Based Nondiscrimination: Now You See It Now You Don't

A broad nondiscrimination provision appears in every income tax treaty that the United States has entered into in the last quarter century. The nondiscrimination article of these treaties purports to prohibit discriminatory taxes levied against foreign nationals or their businesses. However, some distinctions have always been permitted, based on the fact that domestic and foreign taxpayers are not similarly situated because different taxing jurisdictions are concerned. The problem is that it is difficult to articulate a consistent and rational standard to apply to determine when proscribed discrimination is present.The language used in a typical U.S. nondiscrimination provision, such as Article 24 of the 1981 U.S. Model Income Tax Treaty (the "1981 U.S. Model"), can be traced to the 1963 draft model convention published by the Organization for Economic Cooperation and Development Committee on Fiscal Affairs, Draft Double Taxation Convention on Income and on Capital (the "1963 OECD Model"). The 1977 draft of the Organization for Economic Cooperation and Development Model Double Taxation Convention on Income and on Capital (the "1977 OECD Model") includes a similar provision as its Article 24. Both the 1963 OECD Model and the 1977 OECD Model have been instrumental in guiding development of the language of bilateral income tax treaties. Copies of Article 24 of the 1981 U.S. Model and of Article 24 of the 1977 OECD Model are attached as Appendix A and Appendix B.

Studying patterns and predictors of HIV viral suppression using A Big Data approach: a research protocol

BackgroundGiven the importance of viral suppression in ending the HIV epidemic in the US and elsewhere, an optimal predictive model of viral status can help clinicians identify those at risk of poor viral control and inform clinical improvements in HIV treatment and care. With an increasing availability of electronic health record (EHR) data and social environmental information, there is a unique opportunity to improve our understanding of the dynamic pattern of viral suppression. Using a statewide cohort of people living with HIV (PLWH) in South Carolina (SC), the overall goal of the proposed research is to examine the dynamic patterns of viral suppression, develop optimal predictive models of various viral suppression indicators, and translate the models to a beta version of service-ready tools for clinical decision support.MethodsThe PLWH cohort will be identified through the SC Enhanced HIV/AIDS Reporting System (eHARS). The SC Office of Revenue and Fiscal Affairs (RFA) will extract longitudinal EHR clinical data of all PLWH in SC from multiple health systems, obtain data from other state agencies, and link the patient-level data with county-level data from multiple publicly available data sources. Using the deidentified data, the proposed study will consist of three operational phases: Phase 1: “Pattern Analysis” to identify the longitudinal dynamics of viral suppression using multiple viral load indicators; Phase 2: “Model Development” to determine the critical predictors of multiple viral load indicators through artificial intelligence (AI)-based modeling accounting for multilevel factors; and Phase 3: “Translational Research” to develop a multifactorial clinical decision system based on a risk prediction model to assist with the identification of the risk of viral failure or viral rebound when patients present at clinical visits.DiscussionWith both extensive data integration and data analytics, the proposed research will: (1) improve the understanding of the complex inter-related effects of longitudinal trajectories of HIV viral suppressions and HIV treatment history while taking into consideration multilevel factors; and (2) develop empirical public health approaches to achieve ending the HIV epidemic through translating the risk prediction model to a multifactorial decision system that enables the feasibility of AI-assisted clinical decisions.

Geographic Disparities in Readmissions for Peripheral Artery Disease in South Carolina.

Readmissions constitute a major health care burden among peripheral artery disease (PAD) patients. This study aimed to 1) estimate the zip code tabulation area (ZCTA)-level prevalence of readmission among PAD patients and characterize the effect of covariates on readmissions; and (2) identify hotspots of PAD based on estimated prevalence of readmission. Thirty-day readmissions among PAD patients were identified from the South Carolina Revenue and Fiscal Affairs Office All Payers Database (2010–2018). Bayesian spatial hierarchical modeling was conducted to identify areas of high risk, while controlling for confounders. We mapped the estimated readmission rates and identified hotspots using local Getis Ord (G*) statistics. Of the 232,731 individuals admitted to a hospital or outpatient surgery facility with PAD diagnosis, 30,366 (13.1%) experienced an unplanned readmission to a hospital within 30 days. Fitted readmission rates ranged from 35.3 per 1000 patients to 370.7 per 1000 patients and the risk of having a readmission was significantly associated with the percentage of patients who are 65 and older (0.992, 95%CI: 0.985–0.999), have Medicare insurance (1.013, 1.005–1.020), and have hypertension (1.014, 1.005–1.023). Geographic analysis found significant variation in readmission rates across the state and identified priority areas for targeted interventions to reduce readmissions.

Mr. Yeaman, from Kentucky

Mr. Yeaman, from Kentucky Forrest Roberts (bio) In January 1865, a young congressman from Kentucky was faced with a decision many politicians face—whether to do what was politically expedient or what was right. George Yeaman chose the path often not taken and voted according to his principles, even though it was not advantageous to him politically. Yeaman's affirmative vote for the Thirteenth Amendment destroyed his political career and made him many enemies, but his courage allowed him the opportunity to have a role on an international stage and to be immortalized in Steven Spielberg's movie Lincoln as one of the congressmen whose vote was critical for the passage of the amendment. George Helm Yeaman was born on November 1, 1829 in Hardin County, Kentucky, the second of seven children. His mother, Lucretia Helm Yeaman, was the brother of John Helm, who was twice governor of the state. Despite this political connection, the Yeamans were not well off. George's father, Stephen Minor Yeaman, was a member of the Kentucky Bar, but did not practice much law. He taught school for a while and obtained two patents, one for a wheat winnowing machine and another for a straw cutter. In the census of 1850, he was listed as a "fan maker."1 [End Page 5] Yeaman described his childhood as having "no early facilities—the old story of born to poverty and 'pursuing knowledge under difficulties.'" He received a grammar school education and then read law on his own before being admitted to the Kentucky Bar at the age of twenty-three. He moved to Owensboro, the county seat of Daviess County, and opened a law practice. To supplement his income, Yeaman worked as the editor of the Owensboro Gazette.2 In August 1854, at the age of twenty-four, Yeaman was elected county judge of Daviess County. The county judge's responsibilities consisted of keeping the peace, maintaining and building public structures, including a county jail, and overseeing the fiscal affairs of the county, which involved imposing and collecting a county levy. The county judge also had judicial responsibilities and presided over the Quarterly Court, which had jurisdiction for civil matters not exceeding $100 and which did not involve a land boundary. The county judge also presided over the County Court, which along with two justices of the peace, could hear appeals of cases from the Justice of the Peace Courts ranging from four to sixteen dollars. Once a year the county judge, along with most of the county's justices of the peace, presided over the Court of Claims, which transacted the business of the county. After serving a four-year term, Yeaman did not seek re-election and concentrated his energies on his law practice.3 Yeaman married Lelia Pegram Triplett in 1855. Lelia was the daughter of Robert Triplett, one of the richest men in Daviess County, who owned manufacturing and coal interests in Bon Harbor, west of Owensboro. The 1850 U.S. Census listed the value of Robert Triplett's real estate holdings at $167,000, a sum equal to over $5.8 million in 2021. George and Lelia were married in her parents' home, called Haphazard, [End Page 6] which still sits on a ridge overlooking the Ohio River east of Owensboro. The Yeamans built a home on the same ridge, which runs along what is now East Fourth Street, where three of their five children were born.4 Yeaman's personal political beliefs in the 1850s are not well documented, but by conjecture it can be assumed he was a Whig. Daviess County was a Whig county, and it would not be unreasonable that the county judge's politics would be the same as his constituents. Also, in the 1860 presidential election Yeaman supported the John Bell and Edward Everett ticket, of the Constitutional Union party. Even if Yeaman did not consider himself to be a Whig, his beliefs aligned with those of that party.5 The Constitutional Union party was formed in 1860 on three principles: the U.S. Constitution, the union of the states, and the enforcement of all laws. The party was made up of voters who rejected...

Because Not Always B Comes after A: Critical Reflections on the New Article 12B of the UN Model on Automated Digital Services

On 20 April 2021, the UN Tax Committee approved the final version of the new article 12B to be incorporated into the 2021 version of the UN Model. In the absence of a permanent establishment or physical presence of the service provider in the source state, article 12B allows a contracting state to tax income from automated digital services (ADS) paid to a resident of the other contracting state on a gross basis at the rate negotiated bilaterally, with an option to the taxpayer to pay tax on a net profit basis. This article analyses the new article from a critical perspective and argues that, first, the new article is unnecessary, as the alleged need for the new article is only the result of the restrictive and incorrect reading of article 12A of the UN Model (2017) made by the Commentaries on the Model. Second, the new article is not only unnecessary but also counterproductive, as it jeopardizes the institutional prestige of the Committee on Fiscal Affairs, extraordinarily and unnecessarily reduces the scope of application of article 12A, exacerbates the already severe problems of conceptual delimitation between fees for technical services and ADS and, therefore, between articles 12A and 12B and, finally, introduces serious asymmetries in the treatment of these two types of services. The article closes with some advice for those states that have negotiated conventions containing article 12A or similar provisions and intend to retain their taxing rights on ADS without the need to renegotiate their conventions.

Hallux Valgus Deformities: Preferred Surgical Repair Techniques and All-Cause Revision Rates.

Hallux valgus is a commonly treated condition by foot and ankle surgeons with more than 200 different described correction techniques. Recurrence rates range from 5% to 50%, with increasing support of the theory that arthrodesis procedures may have a lower recurrence rate than osteotomies. Arthrodesis procedures to the first metatarsophalangeal (MTP) joint or tarsometatarsal (TMT) joint for correction of hallux valgus deformity are becoming more commonly utilized. The purpose of this study is to investigate the surgical incidence and revision rates of hallux valgus deformities corrected by arthrodesis compared to osteotomy in the state of South Carolina. The South Carolina Revenue and Fiscal Affairs Office was queried from 2000 to 2017 to identify all surgically treated hallux valgus deformities. Data extraction included patient demographics, ICD-9 diagnoses, CPT procedure codes, and dates of surgery. A logistic regression model was used for statistical inference. A total of 22 199 feet had surgical treatment for hallux valgus during this time period, with 20 422 (92.0%), 592 (2.7%), and 1185(5.3%) receiving an osteotomy, arthrodesis, or other procedure at initial treatment, respectively. There was an all-cause revision rate of 5.6% in the osteotomy group and 6.4% in the arthrodesis group. Demographic factors such as female sex, white race, and surgery pre-2010 were associated with higher revision rates. Multiple comorbidities were correlated with higher revision rates such as tobacco use, hypothyroidism, osteoarthritis, recurrent dislocations, hallux rigidus, lesser toe deformities, metatarsus varus, and talipes cavus. Despite the recent increase in arthrodesis procedures for the treatment of hallux valgus deformity, our results suggest that osteotomy procedures are more commonly performed and there is no difference in all-cause revision surgery. However, there are multiple patient demographics and comorbidities that are associated with higher rates of revision surgery and should be considered and discussed during the preoperative planning period. Level IV.

Public debt and economic growth: contemporary evidence from a developing economy

PurposeConsidering the continuous rise in the public debt stock of developing countries (particularly Ghana) with the unstable economic growth rate for the past decades and the recent borrowing because of the impact of COVID 19, this paper aims to examine the causal relationships between public debt and economic growth over time.Design/methodology/approachThe paper uses a dynamic multivariate autoregressive-distributed lag (ARDL)-based Granger-causality model to test the causal relationships between public debt and economic growth [gross domestic product (GDP)]. Annual time-series data that spanned 1978–2018 were sourced from the World Bank Development Indicator database and the IMF fiscal Affairs Department Database and WEO.FindingsThe results reveal that public debt has no causal relationship with GDP in the short-run but there is unidirectional Granger causality running from public debt to GDP in the long run. Again, investment spending has a negative bi-directional causal relationship with GDP in the short-run but they have a positive bi-directional causal relationship in the long run. Conversely, no short-run causal relationship exists between government consumption expenditure and GDP but long-run Granger causality runs from government consumption expenditure to GDP. Finally, public debt has a positive impact on the inflation rate in the short run.Practical implicationsThe findings imply that government(s) must ensure high fiscal discipline to serve as a precursor for the effective and efficient use of recent borrowing, that is, the loans should be used for highly prioritized projects (preferably investment spending) that are well evaluated and self-sustained to add positively to the GDP.Originality/valueThis paper provides contemporary findings to augment extant literature on public debt and economic growth by using variables and empirical models, which prior studies could not sufficiently cover in a developing country perspective and affirms that public debt contributes to GDP only in the long run.

The Use of General Anti-Avoidance Rules as Quasi-Transfer Pricing Control Mechanisms in the Commonwealth Caribbean

In spite of being deemed non-cooperative jurisdictions for the purposes of taxation by the European Union, the member states of the Caribbean Community (CARICOM) maintain the ideals of taxation autonomy in dealing with their fiscal affairs. With Jamaica being the only CARICOM jurisdiction that has enacted comprehensive transfer pricing legislation that complies with the OECD Guidelines, other Member States have sought to use general anti-avoidance rules (GAAR) to manage and assess this type of transaction. These GAAR are encompassed in the statues of the various Caribbean jurisdictions and tend to be interpreted purposively in order to capture instances of tax arbitrage through transfer pricing. This article will assess the policies existing in three CARICOM nations – Guyana, St. Lucia, and Trinidad and Tobago – and determine their effectiveness in addressing the implications of base erosion and profit shifting in transfer pricing.

Priorities for the COVID-19 pandemic at the start of 2021: statement of the Lancet COVID-19 Commission

Priorities for the COVID-19 pandemic at the start of 2021: statement of the Lancet COVID-19 Commission

Racial Disparities and Diagnosis-to-Treatment Time Among Patients Diagnosed with Breast Cancer in South Carolina.

Diagnosis-to-treatment interval is an important quality measure that is recognized by the National Accreditation Program for Breast Centers, and the American Society of Breast Surgeons and the National Quality Measures for Breast Care. The aim of this study was to assess factors related to delays in receiving breast cancer treatment. This retrospective cohort study (2002 to 2010) used data from the South Carolina Central Cancer Registry (SCCCR) and Office of Revenue and Fiscal Affairs (RFA) to examine racial differences in diagnosis-to-treatment time (in days), with adjuvant hormone receipt, surgery, chemotherapy, and radiotherapy assessed separately. Chi-square tests, and logistic regression and generalized linear models were used to compare diagnosis-to-treatment days. Black women on average received adjuvant hormone therapy, surgery, chemotherapy, and radiotherapy 25, 8, 7, and 3days later than their White counterparts, respectively. Black women with local stage cancer had later time to surgery (OR: 1.6; CI: 1.2-2.2) compared with White women with local stage cancer. Black women living in rural areas had higher odds (OR: 2.0; CI: 1.1-3.7) of receiving late chemotherapy compared with White women living in rural areas. Unmarried Black women also had greater risk (OR: 2.0; CI: 1.0-4.0) of receiving late radiotherapy compared to married White women. To improve timely receipt of effective BrCA treatments, programs aimed at reducing racial disparities may need to target subgroups of Black breast cancer patients based on their social determinants of health and geographic residence.