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Elective admission to the epilepsy monitoring unit (EMU) is an essential service provided by epilepsy centers, particularly for those with drug-resistant epilepsy. Given previously characterized racial and socioeconomic healthcare disparities in the management of epilepsy, we sought to understand access and utilization of this service in New Jersey (NJ). We examined epilepsy hospitalizations in NJ between 2014 and 2016 using state inpatient and emergency department (ED) databases. We stratified admissions by race/ethnicity and primary payer and used these to estimate and compare (1) admission rates per capita in NJ, as well as (2) admission rates per number of ED visits for each group. Patients without insurance underwent elective EMU admission at the lowest rates across all racial/ethnic groups and payer types studied. Black patients with Medicaid and private insurance were admitted at disproportionately low rates relative to their number of ED visits. Hispanic/Latino and Asian/Pacific Islanders with private insurance, Hispanic/Latinos with Medicaid, and Asian/Pacific Islanders with Medicare were also admitted at low rates per capita within each respective payer category. Future studies should focus on addressing causal factors driving healthcare disparities in epilepsy, particularly for patients without adequate health insurance coverage and those who have been historically underserved by the healthcare system., Competing Interests: Declaration of Competing Interest Dr. Zhang has received honorariums from Lundbeck Biopharmaceuticals, Board Vitals, and Fieve Clinical Research. He collaborates with Headache Science Incorporated without receiving financial support. He has ownership interest in Cymbeline LLC. The other authors do not have competing interests to declare., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The global financial crisis which erupted in the United States instantaneously swept across Europe. Like the United States, the European Monetary Union (EMU) was ripe for a crash. It had its own real estate bubble, specifically in Ireland and Spain, indulged in excessive deficit spending, financially deregulated, and rapidly expanded credit. Policy responses and recovery patterns for key EU members like Germany, France (within the Eurozone) and the United Kingdom (outside the Eurozone) were similar. However, after the bubble burst and the crisis began unfolding it became clear that the Eurozone plight differed from America's in one fundamental respect. There was no exact counterpart of Eurozone GIIPS (Greece, Italy, Ireland, Portugal and Spain) in the United States. The disparity is traced to the EU's and Eurozone's special form of governance called "supranationality" (a partially sovereign transnational organization) that has been largely ignored in economic treatises about the costs and benefits of customs unions, economic communities, and monetary unions. EZ members have put themselves in a monetary cage, akin to the gold standard. Member states have surrendered control over their monetary and foreign exchange rate policies to the German dominated European Central Bank (ECB), without supplementary central fiscal, private banking and political union institutions. This should be enough in general competitive theory, but too often leads to factional and societal gridlock that compounds the misery, and could cause the EU to permanently and gravely underperform relative to community's "un-caged" potential. [ABSTRACT FROM AUTHOR]

Most studies of business cycle synchronization in the EMU identify a core set of counties with high synchronization and a periphery set of countries with low synchronization. Using a structural VAR with model uncertainty, we identify spillover effects from shocks that originate in the United States, the EMU, and the rest of the world to test whether external influences can explain the existence of the core and periphery. Most countries typically found in the core respond to external spillovers in similar ways, leading to more synchronized business cycles. The response to external influences in the countries traditionally found in the periphery, on the other hand, help explain their exclusion from the core. [ABSTRACT FROM AUTHOR]

This paper analyses how fiscal adjustment comes about when both central and sub-national governments are involved in consolidation. We test sustainability of public debt with a fiscal rule for both federal and regional government. Results for the German Länder show that lower tier governments bear a relatively smaller part of the burden of debt consolidation, if they consolidate at all. Most of the fiscal adjustment occurs via central government debt. In contrast, both the US federal and state levels contribute to consolidation of public finances. [ABSTRACT FROM AUTHOR]