Farmland valuation for estate tax purposes (1993)

Inflated land values have increased the impact of the federal estate tax on heirs of family farm operations. In an effort to alleviate the added tax burden, Congress included a special provision for farmland valuation for federal estate tax purposes in the Tax Reform Act of 1976. This publication explains the current use provision and presents the changes made by the Economic Recovery Tax Act of 1981.Reviewed October 1, 1993

Marital Trust : an estate planning tool (1993)

Everybody has the right to pass property from one generation to another. However, this right is subject to federal estate and gift taxes and to Missouri estate taxes. Estate planning has two purposes: To provide for orderly distribution of property. To reduce the effect of taxes on this distribution of property. This publication discusses an estate planning tool called the marital trust. A marital trust can reduce the impact of estate taxes and provide professional management for assets passed at death. This publication emphasizes the recent federal estate and gift tax changes caused by the Economic Recovery Tax Act of 1981.Reviewed October 1, 1993

Farmland valuation for estate tax purposes

"Inflated land values have increased the impact of the federal estate tax on heirs of family farm operations. In an effort to alleviate the added tax burden, Congress included a special provision for farmland valuation for federal estate tax purposes in the Tax Reform Act of 1976. This Guide explains the current use provision and presents the changes made by the Economic Recovery Tax Act of 1981."--First page.Stephen F. Matthews, Ronald L. Plain, and John C. Banning (Department of Agricultural Economics College of Agriculture)Revised 11/82/10

Should you incorporate your farm?

"Because of estate, gift, and income taxes, many Missouri farmers are interested in forms of business organization that help decrease taxes and increase the inheritance for their children and other heirs. Three basic forms of farm business organizations are sole proprietorship, partnership, and corporation."--Page 1.Stephen F. Matthews, Ronald L. Plain and John C. Banning (Department of Agricultural Economics, College of Agriculture)Revised 1/83/12

Gifts and gift taxation

"Estate planning provides for orderly distribution of your assets during your lifetime and at death. Estate planning also minimizes the impact that federal and state transfer taxes can have on your estate. This Guide has general information on lifetime gifts as one of the various tools available to the estate planner. See your attorney for legal advice."--Page 1.Stephen F. Matthews, Ronald L. Plain, and John C. Banning (Department of Agricultural Economics, College of Agriculture)New 11/82/10

Identifying and Defining the Structures That Guide the Implementation of Participant Direction Programs and Support Program Participants: A Document Analysis

This is the author's accepted manuscript. The published version is available at http://dx.doi.org/10.1177/1044207313514112Participant direction (PD) programs offer the individual with a disability or his or her surrogate decision maker varying degrees of choice and control over the individual’s supports and services. We conducted a document analysis using grounded theory methods to identify the design elements of participant direction programs in long-term care. We analyzed 53 documents across multiple disabilities and funding sources. We identified and defined two major components of participant direction programs: policy and aid and assistance. The component of policy was represented by three structures that guide implementation of participant direction programs: (a) option to participant-direct, (b) participation stipulations, and (c) provider qualifications. The component of aid and assistance was represented by 11 structures that support program participants: (a) financial management services, (b) employer of record, (c) emergency back-up, (d) worker registry, (e) advice/counseling, (f) managerial assistance, (g) information dissemination products, (h) service quality monitoring, (i) service coordination, (j) participant training, and (k) provider training. Each structure was represented by one or more continua depicting the range of choice and control participants may have over the structure. The findings of this study have implications for improving the standardization of research on participant direction programs and the development of long-term care policy

Identifying and defining the activities of participant direction programs: A document analysis

This is the author's accepted manuscript. The published version is available at http://dx.doi.org/10.1177/1044207313502538We analyzed the design of various U.S. programs of participant direction offering participants (individual with a disability or his or her surrogate decision-maker) some level of choice and control over the individual’s long-term care supports and services. We used grounded theory methods to conduct a document analysis of 53 documents published from 2004 through 2008 representing multiple disabilities and program funding sources. In our analysis, we identified three major components (planning, budgeting, and employing) over which participants had the opportunity to exercise choice and control and the activities associated with each. Activities were represented by one or more continua illustrating the range of participant choice and control over the indicator. The component of planning consisted of the activity of care plan development. The budgeting component included the activities of (a) development, (b) individualization, and (c) authority. The employing component included the activities of (a) identifying/selecting providers, (b) hiring/employing providers, (c) scheduling providers, (d) training providers, (e) managing/directing/supervising providers, (f) disciplining/dismissing providers, (g) keeping records, (h) managing payroll, (i) locating emergency back-up, and (j) monitoring service quality. The findings of this study have implications for improving policy, practice, and research in the field of long-term care

Risk Factors for Delirium after Vascular Surgery:A Systematic Review and Meta-Analysis

Background: Vascular surgery is considered a risk factor for the development of postoperative delirium (POD). In this systematic review we provide a report on the incidence and risk-factors of POD after vascular surgery. Methods: A systematic literature search was conducted using Pubmed with the MeSH terms and key words "delirium" or "confusion", "vascular surgery procedures" and "risk factors or "risk assessment". Studies were selected for review after meeting the following inclusion cr iter ia: vascular surgery, POD diagnosed using validated screening tools, and DSM-derived criteria to assess delirium. A meta-analysis was performed for each endpoint if at least two studies could be combined. Results: Sixteen articles met the abovementioned cr iter ia. The incidence of delir ium ranged from 5% to 39%. Various preoperative risk factors were identified that is, age (Random MD 3.96, CI 2.57-5.35), hypertension (Fixed OR 1.30, CI 1.05-1.59), diabetes mellitus (Random OR 2.15, CI 1.30-3.56), hearing impairment (Fixed OR 1.89, CI 1.28-2.81), history of cerebrovascular incident or transient ischemic attack (Fixed OR 2.20, CI 1.68-2.88), renal failure (Fixed OR 1.61, CI 1.19-2.17), and pre-operative low haemoglobin level (fixed MD-0.76, CI-1.04 to-0.47). Intra-operative risk factors were duration of surgery (Random MD 15.68; CI 2.79-28.57), open aneurysm repair (Fixed OR 4.99, CI 3.10-8.03), aortic cross clamping time (fixed MD 7.99, CI 2.56-13.42), amputation surgery (random OR 3.77, CI 2.13-6.67), emergency surgery (Fixed OR 4.84, CI 2.81-8.32) and total blood loss (Random MD 496.5, CI 84.51-908.44) and need for blood transfusion (Random OR 3.72, CI 1.57-8.80). Regional anesthesia on the other hand, had a protective effect. Delirium was associated with longer ICU and hospital length of stay, and more frequent discharge to a care facility. Conclusions: POD after vascular surgery is a frequent complication and effect-size pooling supports the concept that delirium is a heterogeneous disorder. The risk factors identified can be used to either design a validated risk factor model or individual preventive strategies for high-risk patients

Transition in Frailty State Among Elderly Patients After Vascular Surgery

BACKGROUND: Frailty in the vascular surgical ward is common and predicts poor surgical outcomes. The aim of this study was to analyze transitions in frailty state in elderly patients after vascular surgery and to evaluate influence of patient characteristics on this transition. METHODS: Between 2014 and 2018, 310 patients, ≥65 years and scheduled for elective vascular surgery, were included in this cohort study. Transition in frailty state between preoperative and follow-up measurement was determined using the Groningen Frailty Indicator (GFI), a validated tool to measure frailty in vascular surgery patients. Frailty is defined as a GFI score ≥4. Patient characteristics leading to a transition in frailty state were analyzed using multivariable Cox regression analysis. RESULTS: Mean age was 72.7 ± 5.2 years, and 74.5% were male. Mean follow-up time was 22.7 ± 9.5 months. At baseline measurement, 79 patients (25.5%) were considered frail. In total, 64 non-frail patients (20.6%) shifted to frail and 29 frail patients (9.4%) to non-frail. Frail patients with a high Charlson Comorbidity Index (HR = 0.329 (CI: 0.133-0.812), p = 0.016) and that underwent a major vascular intervention (HR = 0.365 (CI: 0.154-0.865), p = 0.022) had a significantly higher risk to remain frail after the intervention. CONCLUSIONS: The results of this study, showing that after vascular surgery almost 21% of the non-frail patients become frail, may lead to a more effective shared decision-making process when considering treatment options, by providing more insight in the postoperative frailty course of patients