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Investor Perceptions of the Corporate Alternative Minimum Tax
Get PDFThe Inflation Reduction Act establishes a new 15% corporate minimum tax on the adjusted financial accounting income for large U.S. corporations. Although the minimum tax is estimated to raise $222 billion over 10 years, some fear firms will manipulate their accounting earnings to reduce their tax liabilities, resulting in less revenue raised. Using an event study, we examine the extent to which investors believe this tax will reduce firm value. We examine stock market reactions around key legislative developments leading to the enactment of the book minimum tax. Our findings show targeted firms experience significantly lower stock returns than nontargeted firms during the enactment process (about 1.4%–1.8% of firm value). In aggregate, our findings are consistent with the Joint Committee on Taxation’s revenue estimates. In cross-sectional tests, we fail to find evidence that firms most likely to avoid the tax via earnings management experience more positive returns. We also fail to find less negative returns for firms most likely to pass on the tax to consumers. Overall, our results suggest investors do not expect firms to avoid this tax. Instead, they appear to expect a significant portion of the corporate minimum tax to be remitted by firms and borne by shareholders. This paper was accepted by Ranjani Krishnan, accounting. Funding: F. B. Gaertner acknowledges support from the Cynthia and Jay Ihlenfeld Professorship, M. Pflitsch acknowledges support of a postdoc fellowship of the German Academic Exchange Service (DAAD), S. O. Kelley gratefully acknowledges support from the James L. Henderson Chair, and J. L. Hoopes gratefully acknowledges support from the Harold Q. Langenderfer fellowship. Supplemental Material: The data files are available at https://doi.org/10.1287/mnsc.2024.04750
Enhancing engagement in HIV care among adolescents and young adults: A focus on phone-based navigation and relationship building to address barriers in HIV care
Get PDFStructural, psychological, and clinical barriers to HIV care engagement among adolescents and young adults living with HIV (AYAH) persist globally despite gains in HIV epidemic control. Phone-based peer navigation may provide critical peer support, increase delivery flexibility, and require fewer resources. Prior studies show that phone-based navigation and automated text messaging interventions improve HIV care engagement, adherence, and retention among AYAH. However, little is known about AYAH experiences utilizing electronic phone-based peer navigation and automated text messaging (E-NAV). We assessed the experiences of AYAH receiving phone-based peer navigation to address barriers to HIV care engagement and viral suppression. We purposefully selected participants randomized to E-NAV within the Adapt for Adolescents in Kisumu, Kenya, and conducted 20 in-depth interviews. Interviews were conducted by a trained qualitative researcher between October and December 2021 and explored topics such as health-seeking and care experiences, E-NAV acceptability and benefits, and the client-navigator relationship. The interviews were audio-recorded and transcribed. We then applied inductive and deductive coding, followed by thematic analysis. Overall, participants found E-NAV acceptable in regard to content and frequency–particularly the opportunity to select a preferred time for calls/text messages, including evenings and weekends. They found the tone of navigator calls and messages friendly, supporting relationship building. Further, AYAH-navigator relationships were described as fraternal, client-focused, and confidential, which supported a personal connection and trust. Reported E-NAV benefits included adherence and appointment reminders, increased knowledge about HIV care, and strategies to address HIV stigma. Electronic navigation is a promising method for youth peer navigation because it optimizes reach (both in time and space) for youth that have severe constraints on both while preserving the ability to create a rapport and a relationship with patients
Abortion provision and characteristics of abortion patients in an academic medical center in Washington state before and after Dobbs
Get PDFObjective To examine abortion care in the largest academic medical center in Washington, a state protective of abortion rights, before and after the Supreme Court Dobbs decision. Methods This retrospective cohort study evaluated abortion provision at the University of Washington between January 1, 2022 and October 31, 2023. Data on patient sociodemographic and clinical characteristics were extracted from electronic medical records. We assessed differences in patient sociodemographics, clinical characteristics, and type of care (medication vs. procedural) comparing the pre-Dobbs (January 1, 2022- June 23, 2022) and post-Dobbs (June 24, 2022 – October 31, 2023) periods using chi-squared tests for categorical variables and t-tests for continuous variables. Results Among the 494 abortions performed during the study period, most were procedural (63 %) and performed in the hospital setting (68 %), over one-third (37 %) had a fetal anomaly, and 4 % were from out of state. The distribution of gestational duration was bimodal: over one-third of abortions occurred at less than 8 weeks gestation (34 %) and 38 % were 18 weeks or greater. The weekly number of abortions remained stable and there were minimal significant differences in patient characteristics or type of care comparing the pre-and-post Dobbs periods. Conclusion Academic medical centers provide comprehensive abortion services that span primary to complex specialty care. The minimal changes in abortion care following Dobbs suggests academic medical centers have important patient care and training opportunities to expand abortion access in Washington state
Factors influencing evidence-based cardiovascular disease prevention programming in rural African American communities: a community-engaged concept mapping study
Get PDFBackground African Americans experience cardiovascular disease (CVD) disparities, and the burden is greatest in the rural south. Although evidence-based CVD prevention and management programs have been tailored to this context, implementation has been limited and not sustained long-term. To understand how to implement and sustain evidence-based CVD programs at scale, we must explore the perspectives of organizations serving rural African American communities and situate findings within foundational Implementation Science frameworks. Methods This study used group concept mapping (GCM) to elicit and synthesize stakeholder perspectives into an action-focused conceptual model depicting factors influencing implementation of evidence-based CVD programs. Representatives of community-based, faith, and healthcare organizations serving African Americans in five rural North Carolina counties were recruited via purposive sampling techniques. Participants (total n = 31) completed three activities: 1) brainstorming in response to an open-ended prompt (n = 31); 2) sorting brainstorm data into wider concepts and rating each in terms of relative importance and feasibility (n = 26); and 3) collaborative interpretation and refinement of the concept map (n = 19). Multivariate statistical analysis was used to generate a concept map. Absolute pattern matches comparing ratings of the relative importance and feasibility of each factor were generated and depicted via ladder graphs. Results The final concept map included five factors: Accessibility, Community and Social Factors, Education and Training, Financial/Resource Development, and Organization Capacity and Staffing. There was high agreement (r = .98) between ratings of importance and feasibility. Education and Training, both within organizations and the wider community, was rated as the most important and feasible factor and Financial/Resource Development was the least important and feasible. Conclusions The concept map emphasizes aspects of organizations (inner setting), their surrounding community (outer setting), and individual stakeholders (participants, implementers) as influencing implementation of evidence-based CVD prevention and management programs in rural African American communities. The nature of the intervention or implementation processes were de-emphasized. Organizations in rural African American communities may feel equipped to implement a range of evidence-based programs, provided strategies address the contextual and structural barriers that impede their success. Group concept mapping helped distill and prioritize initial leverage points for action in our project catchment area by facilitating a community-engaged process of data generation and interpretation
Causal analysis for multivariate integrated clinical and environmental exposures data
Get PDFElectronic health records (EHRs) provide a rich source of observational patient data that can be explored to infer underlying causal relationships. These causal relationships can be applied to augment medical decision-making or suggest hypotheses for healthcare research. In this study, we explored a large-scale EHR dataset on patients with asthma or related conditions (N = 14,937). The dataset included integrated data on features representing demographic factors, clinical measures, and environmental exposures. The data were accessed via a service named the Integrated Clinical and Environmental Service (ICEES). We estimated underlying causal relationships from the data to identify significant predictors of asthma attacks. We also performed simulated interventions on the inferred causal network to detect the causal effects, in terms of shifts in probability distribution for asthma attacks
Influence of Psychological Safety and Safety Climate Perceptions on Nurses’ Infection Prevention and Occupational Safety Practices and Environment
Get PDFBackground/Objectives: The aim of this study was to describe and examine the relationships among elements of infection prevention practices, the care environment, psychological safety, and safety climate in adult medical surgical units in the wake of the COVID-19 pandemic. Methods: Nurses in adult inpatient medical surgical units in the northeast were surveyed electronically. Each self-rated their infection prevention practices and elements of the care environment in their primary work unit. They were also asked to rate a series of questions regarding how psychologically safe they felt on their units as well as the overall patient safety climate. Results: A total of 259 nurses responded (52% response rate) to the survey. Overall psychological safety was rated neutrally among respondents, with a rating of 3.5 (1 being the lowest and 5 being the highest). Respondents reported better ratings of the safety climate on their unit (4.0) but also identified areas for improvement. Eight of twelve infection prevention practices were correlated with higher safety climate scores and ten were correlated with higher psychological safety scores. Nine of ten environmental factors were correlated with higher safety climate and higher psychological safety scores. Conclusions: Both psychological safety and patient safety climate are related to nurse self-ratings of performance of infection prevention practices. Similarly, the care environment nurses work in has important implications for psychological safety and patient safety. It is essential for nursing leadership to act as a steward in these areas to build a higher quality care environment for nurses and patients alike
Peak OD Phenotypes and Infographic for Overdose Deaths by State, January 2020 to August 2024
No full textOverdose deaths have quietly declined in nearly all states for years, and 19 have returned close to pre-pandemic baseline. But improvements have been uneven. Too many people we love are still dying. To understand what’s working and who is left behind, we must understand when and where declines started.
When did overdose declines start? This infographic from the Opioid Data Lab displays sparklines showing that overdoses started declining in 2022-23. There is a distinct east-to-west pattern across the Untied States.
This blogpost and newsletter published on opioiddatalab.ghost.io is a deep dive into the methods of smoothing that influence when and where we first detect declines in overdose.
For the infographic, Python code for recreating the analysis, and Adobe Illustrator file for layout are provided. All files are licensed for reuse.
Measurement: 12-month cumulative (smoothed) predicted values, z-score normalized. Ordered roughly east to west.
Data pedigree: Local medical examiners & coroners > state health departments > CDC public API > UNC Opioid Data Lab
Data source: CDC Provisional Drug Overdose Death Counts, accessed January 10, 2025.
Associations of prenatal urinary melamine, melamine analogues, and aromatic amines with gestational duration and fetal growth in the ECHO Cohort
Get PDFMelamine, its analogues, and aromatic amines (AAs) were commonly detected in a previous study of pregnant women in the Environmental influences on Child Health Outcomes (ECHO) Cohort. While these chemicals have identified toxicities, little is known about their influences on fetal development. We measured these chemicals in gestational urine samples in 3 ECHO cohort sites to assess associations with birth outcomes (n = 1,231). We estimated beta coefficients and 95% confidence intervals (CIs) using adjusted linear mixed models with continuous dilution-standardized concentrations (log2 transformed and scaled by interquartile range, IQR) or binary indicators for detection. As secondary analyses, we repeated analyses using categorical outcomes. Forty-one of 45 analytes were detected in at least one sample, with > 95 % detection of melamine, cyanuric acid, ammelide, and aniline. Higher melamine concentration was associated with longer gestational age (β^ per IQR increase of log2-transformed: 0.082 [95 % CI: −0.012, 0.177]; 2nd vs 1st tertile: 0.173 [-0.048, 0.394]; 3rd vs 1st tertile: 0.186 [-0.035, 0.407]). Similarly in secondary analyses using categorical outcomes, an IQR increase in log2(melamine) was associated with 1.22 [0.99, 1.50] higher odds of post-term (>40 & ≤42 weeks) as compared to full-term (≥38 & ≤40 weeks). Several AAs were associated with birthweight and gestational length, with the direction of associations varying by AA. Some stronger associations were observed in females. Our findings suggest melamine and its analogs and AAs may influence gestational length and birthweight
Changes in the critical nutrient content of packaged foods and beverages after the full implementation of the Chilean Food Labelling and Advertising Law: a repeated cross-sectional study
Get PDFBackground Chile’s Food Labelling Law was implemented in three phases with increasingly stricter limits. After initial implementation, sugars and sodium decreased in packaged foods, with no significant changes for saturated fats. It is unclear whether full implementation is linked with further reformulation or if producers reversed changes due to consumers’ preferences. This study examines changes in the proportion of “high in” products and the nutrient content of packaged foods during the Law’s three phases. Methods This repeated cross-sectional study included the best-selling packaged foods and beverages during 2015–2020. We analyzed the proportion of products classified as “high in” critical nutrients using the final phase cutoffs and examined changes in the content of calories, sugars, sodium, and saturated fats in the three phases. To assess the changes in proportions, we used Firth’s bias-reduced logistic regression models and the Cochran-Armitage test for trends. Quantile regression was used to evaluate changes in nutrient content. Results The proportion of “high in” products decreased from 70.8 to 52.5% after the final phase (p < 0.001). The proportion of “high in” sugars products decreased across all sweet food and beverage groups (p < 0.001), except for candies (− 4.5 percentage points (pp), p = 0.09). The largest reductions occurred in sweet spreads and breakfast cereals (− 44.3 and − 40.4 pp, respectively, p < 0.001). For the proportion of “high in” sodium, reductions occurred in all savory food groups (p < 0.001), except cheeses and ready-to-eat meals (p < 0.24), with the largest decreases in savory baked products and non-sausage meat products (− 40.4 and − 38.9 pp, respectively, p < 0.001). Reductions in “high in” saturated fats and energy were less consistent, with the largest decreases in nuts and snacks and savory spreads (− 22.2 and − 20.0 pp, respectively, p < 0.001) and savory baked products and breakfast cereals (− 32.8 and − 25.7 pp, respectively, p < 0.001), respectively. After full implementation, most sweet categories showed left shifts in sugars distribution, except for candies. Similarly, most savory categories showed left shifts for sodium, except savory spreads and ready-to-eat meals. Changes increased as regulation limits tightened (p for trend < 0.001). Conclusions After fully implementing Chile’s law, the proportion of “high in” products and the content of critical nutrients decreased in all food and beverage categories. The largest changes occurred for sodium in savory foods and sugars in sweet foods/beverages. Stricter regulatory limits were associated with decreases in critical nutrient content over time. Supplementary Information The online version contains supplementary material available at 10.1186/s12916-025-03878-6
Association of glycemic control with Long COVID in patients with type 2 diabetes: findings from the National COVID Cohort Collaborative (N3C)
Get PDFINTRODUCTION: Elevated glycosylated hemoglobin (HbA1c) in individuals with type 2 diabetes is associated with increased risk of hospitalization and death after acute COVID-19, however the effect of HbA1c on Long COVID is unclear. OBJECTIVE: Evaluate the association of glycemic control with the development of Long COVID in patients with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: We conducted a retrospective cohort study using electronic health record data from the National COVID Cohort Collaborative. Our cohort included individuals with T2D from eight sites with longitudinal natural language processing (NLP) data. The primary outcome was death or new-onset recurrent Long COVID symptoms within 30-180 days after COVID-19. Symptoms were identified as keywords from clinical notes using NLP in respiratory, brain fog, fatigue, loss of smell/taste, cough, cardiovascular and musculoskeletal symptom categories. Logistic regression was used to evaluate the risk of Long COVID by HbA1c range, adjusting for demographics, body mass index, comorbidities, and diabetes medication. A COVID-negative group was used as a control. RESULTS: Among 7430 COVID-positive patients, 1491 (20.1%) developed symptomatic Long COVID, and 380 (5.1%) died. The primary outcome of death or Long COVID was increased in patients with HbA1c 8% to <10% (OR 1.20, 95% CI 1.02 to 1.41) and ≥10% (OR 1.40, 95% CI 1.14 to 1.72) compared with those with HbA1c 6.5% to <8%. This association was not seen in the COVID-negative group. Higher HbA1c levels were associated with increased risk of Long COVID symptoms, especially respiratory and brain fog. There was no association between HbA1c levels and risk of death within 30-180 days following COVID-19. NLP identified more patients with Long COVID symptoms compared with diagnosis codes. CONCLUSION: Poor glycemic control (HbA1c≥8%) in people with T2D was associated with higher risk of Long COVID symptoms 30-180 days following COVID-19. Notably, this risk increased as HbA1c levels rose. However, this association was not observed in patients with T2D without a history of COVID-19. An NLP-based definition of Long COVID identified more patients than diagnosis codes and should be considered in future studies