Correlation between the Perfusion Index and Intraoperative Hypothermia: A Prospective Observational Pilot Study

Background and Objectives: We examined the association between the baseline perfusion index (PI) and changes in intraoperative body temperature during general anesthesia. The PI reflects the peripheral perfusion state. The PI may be associated with changes in body temperature during general anesthesia because the degree of redistribution of body heat from the central to the peripheral compartment varies depending on the peripheral perfusion state. Materials and Methods: Thirty-eight patients who underwent brain surgery were enrolled in this study. The baseline PI and body temperature of the patients were measured on entering the operating room. Body temperature was recorded every 15 min after induction of anesthesia using an esophageal temperature probe. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for intraoperative hypothermia. Results: Eighteen patients (47 %) developed hypothermia intraoperatively. The baseline PI was significantly lower among patients in the hypothermia group (1.8 ± 0.7) than among those in the normothermia group (3.0 ± 1.2) (P < 0.001). The baseline PI and body temperature were independently associated with intraoperative hypothermia (PI: odds ratio [OR], 0.270; 95% confidence interval [CI], 0.105–0.697; P = 0.007, baseline body temperature: OR, 0.061; 95% CI, 0.005–0.743; P = 0.028). Conclusions: This study showed that low baseline PI was the factor most related to the development of intraoperative hypothermia. Future studies should consider the PI as a predictor of intraoperative hypothermia.

INTER-NATION EQUITY REVISITED

States are on the verge of a new form of global competition. Some have taken unilateral measures to tax multinational profits that they would typically not be able to tax, at least not according to conventional international tax concepts and rules. Others have threatened to retaliate with economic countermeasures to protect their tax base and corporate residents. The recent attempt of the OECD to build consensus for a global tax compact has so far proven unsuccessful due to broad disagreement about how taxing rights should be equitably distributed between countries. As policymakers and tax scholars increasingly call into question long-standing theories of international taxation, the concept of inter-nation equity plays a pivotal role as a guiding principle in determining how to divide the international tax base among states. Inter-nation equity is one of the most ubiquitous concepts appearing in international tax policy discussions and yet one of the most understudied in tax scholarship. This Article introduces a comprehensive normative analysis of inter-nation equity by discussing how the concept should reconcile the two primary goals of international allocation of taxing rights: on the one hand, the concern of states to preserve their tax sovereignty and, on the other hand, the need to promote some degree of redistribution to address the challenges of global poverty and inequality. This Article further explains how a similar notion of inter-nation equity has developed in other areas of international law and discusses some practical implications for tax policy design.

Labor Supply, Taxation, and the Use of Tax Revenues: A Real-Effort Experiment in Canada, France, and Germany

We experimentally investigated three variants of a real-effort game with taxation that differed in the degree of redistribution of tax revenue. Concretely, we compared a Leviathan scenario, where no tax is redistributed, with a situation where tax revenues are used to finance a public good involving neither a direct nor immediate monetary transfer to participants and with a scenario where direct transfer payments are made to each participant. Our results confirm previous findings of a nonlinear decreasing relationship between tax rate and work effort. We found that, for tax rates above 50 percent, the level of effort was highest under direct redistribution, followed by the public-good scenario, and by the Leviathan case. Conducting the experiment in Canada, France, and Germany, we observed average effort (and thus tax revenues) to be higher in France than in Canada and Germany.

Life-threatening bleeding due to persistent dabigatran effect in a patient with sepsis despite idarucizumab therapy and haemodialysis

A 58-year-old man presented with necrotising fasciitis and septic shock requiring urgent surgical debridement. Idarucizumab was used preoperatively to reverse the effects of dabigatran, which he was taking for chronic atrial fibrillation. He developed multiorgan failure including an oliguric acute kidney injury and was given continuous venovenous haemodiafiltration. Adjunctive intravenous immunoglobulin therapy was used in addition to his antibiotic therapy for necrotising fasciitis. Significant clinical and laboratory coagulopathy continued for over 12 days with evidence of a persistent dabigatran effect. Here, we discuss the potential impact of the immunoglobulin therapy, the patient’s weight on the degree of redistribution of dabigatran seen and the oliguria in the context of an acute kidney injury on the apparent lack of the effectiveness of idarucizumab.

Cross-subsidization of teacher pension benefits: the impact of the discount rate

This paper builds on previous work (Costrell and McGee, 2017a, Education Finance and Policy) on the redistribution of teacher pension benefits, as measured by the wide variation in individual normal cost rates by age of entry and exit, and the associated cross-subsidies. The further steps taken here are: (i) to examine the impact of the discount rate on the degree of redistribution, and the analytics behind it; and (ii) to identify the distribution of the market value of the pension guarantee. Using the example of the California State Teachers’ Retirement System, I find that: (i) high-assumed returns substantially understate the extent to which costs are redistributed for back-loaded plans; and (ii) the market value of the pension guarantee is highly concentrated among long-term teachers.

Wealth Redistribution after Exchange Rate Devaluations

We document that the likelihood of having assets in foreign currency is increasing in households' income within many emerging economies. This pattern leads to heterogeneous exposures of wealth to exchange rate movements. We analyze the redistribution of liquid wealth across households after nominal exchange rate devaluations due to the revaluation of nominal net wealth denominated in different currencies. We find that there is an important degree of redistribution from households with low income to those with high income.

The sociological imagination of rich and poor citizens

Overall, the general public tend to oppose excessive inequality and support a degree of redistribution as a matter of principle. However, differences in welfare attitudes are clearly observable between institutional regimes, ideological systems and socio-demographic groups. Drawing on analysis of the British Social Attitudes survey, this chapter begins by outlining how rich and poor citizens differ in terms of their attitudes towards welfare, inequality and social citizenship. It then turns to demonstrate how this attitudinal divergence is mediated by material position and the knowledge accumulated through lived experiences of inequality. The main body of the chapter pivots on a series of vignettes that are used as a heuristic to explore tacit and explicit intuitions about the structural determinants of agency and outcome. These vignettes were presented to those interviewed for this study to explore operational notions of justice, responsibility and fairness. The vignettes draw upon caricatures of individuals commonly (mis-) represented in policy discourse and the media: ‘the deserving workless poor’, ‘the undeserving workless poor’, ‘the deserving working poor’ and ‘the undeserving working rich’. The chapter demonstrates that affluence and deprivation engender distinct understandings, and explanations of social stratification that, in turn, affect attitudes towards welfare, rights and responsibilities.

Redistributive efficiency in 28 developed economies

This article analyses the redistributive efficiency of social transfers and direct taxation in a panel of 28 developed economies during the period 1995–2010. In order to explore how redistribution is achieved through these fiscal policies, a two-stage approach is applied. First, we evaluate their redistributive efficiency – the degree of redistribution attained for a given level of transfers and taxes – using data envelopment analysis (DEA). We find lower redistributive efficiency in Southern Europe and the United States and higher efficiency levels in the Nordic and Central European countries and Australia. Second, we use panel regression analysis to identify the determinants of efficiency differences and reveal the crucial role of government quality as well as factors affecting the redistributive profile of fiscal policies.

The Objections against Workfare Revised

Opponents of work obligations in return for transfer payments argue that workfare can crowd out private sector work, that workfare harms the welfare of the poor and thereby reduces a society’s welfare in general. This paper analyzes these objections against workfare in a discrete optimal income tax model. Workfare productivity emerges to be the crucial determinant. We identify a productivity threshold. If workfare productivity exceeds this threshold, then crowding out indeed happens, but it is second-best. Crowding out occurs entirely in the sense that workfare and private sector employment are mutually exclusive. Welfare increases due to the fact that out of the three effects workfare entails, beyond the detected threshold, the output effect and the incentive effect dominate the negative utility effect. Numerical simulations calibrated on the distribution of gross hourly wages in Germany reveal that on an individual level, the poor may even be better off under a tax-transfer scheme with workfare rather than without workfare. This is due to the fact that a higher degree of redistribution can be achieved.

Constituencies and Public Opinion

Public opinion alone cannot explain the trajectory of American social policy, but it is crucial in explaining the nature of social provision. Although most Americans are not highly knowledgeable about or interested in politics, and although their opinions are often shaped by misinformation, misperception, and framing effects, public opinion can offer broad guidance to politicians. Indeed, American social policy reflects majority preferences in a variety of ways: in the differential generosity of programs for "deserving" and "undeserving" target populations; in the extensive use of hidden and obscured modes of social provision such as tax expenditures; and in the modest degree of redistribution the American welfare state achieves. In addition, attentive and well-resourced members of the public, who receive the largest benefits from the system, have successfully prevented retrenchment attempts. Public opinion typically operates in conjunction with other factors, such as interest group influence or the institutional structure of the American system, to shape social policy outcomes.