Government size, composition of public expenditure, and economic development

This paper analyzes the effects of government size and of the composition of public expenditure on economic development. Using the system-GMM estimator for linear dynamic panel data models, on a sample covering up to 156 countries and 5-year periods from 1980 to 2010, we find that government size as a percentage of GDP has a quadratic (inverted U-shaped) effect on the growth rate of the Human Development Index (HDI). This effect is especially pronounced in developed and high income countries. We also find that the composition of public expenditure affects development, with the share of five subcomponents exhibiting non-linear relationships with HDI growth.COMPETE, QREN, FEDER, Fundação para a Ciência e a Tecnologia (FCT

Infections in Dupilumab Clinical Trials in Atopic Dermatitis : A Comprehensive Pooled Analysis

Background: Patients with moderate-to-severe atopic dermatitis (AD) have increased infection risk, including skin infections and systemic infections. Immunomodulators (e.g., anti-tumor necrosis factors, anti-interleukin [anti-IL]-23, anti-IL-17, Janus kinase inhibitors) increase risk of infections. Dupilumab (a monoclonal antibody blocking the shared receptor component for IL-4 and IL-13) is approved for inadequately controlled moderate-to-severe AD and for moderate-to-severe eosinophilic or oral corticosteroid-dependent asthma. Objective: The aim was to determine the impact of dupilumab on infection rates in patients with moderate-to-severe AD. Methods: This analysis pooled data from seven randomized, placebo-controlled dupilumab trials in adults with moderate-to-severe AD. Exposure-adjusted analyses assessed infection rates. Results: Of 2932 patients, 1091 received placebo, 1095 dupilumab 300 mg weekly, and 746 dupilumab 300 mg every 2 weeks. Treatment groups had similar infection rates overall per 100 patient-years (placebo, 155; dupilumab weekly, 150; dupilumab every 2 weeks, 156; dupilumab combined, 152), and similar non-skin infection rates. Serious/severe infections were reduced with dupilumab (risk ratio 0.43; p < 0.05), as were bacterial and other non-herpetic skin infections (risk ratio 0.44; p < 0.001). Although herpesviral infection rates overall were slightly higher with dupilumab than placebo, clinically important herpesviral infections (eczema herpeticum, herpes zoster) were less common with dupilumab (risk ratio 0.31; p < 0.01). Systemic anti-infective medication use was lower with dupilumab. Conclusions: Dupilumab is associated with reduced risk of serious/severe infections and non-herpetic skin infections and does not increase overall infection rates versus placebo in patients with moderate-to-severe AD. ClinicalTrials.gov Identifiers: NCT01548404, NCT02210780, NCT01859988, NCT02277743, NCT02277769, NCT02260986, and NCT02755649

Diaper dermatitis prevalence and severity : global perspective on the impact of caregiver behavior

Objectives To compare prevalence and severity of diaper dermatitis (DD) in infants and toddlers (babies) across three countries (China, USA, and Germany), including diapered skin measures and caregiver practices. Methods A cross‐sectional study of 1791 babies (~600 from each country) was recruited at each clinical site. Based on regional toilet‐training habits, exclusively diaper‐wearing infants were recruited between ages 2‐8 months in China and 2‐18 months in the USA and Germany. DD was measured, as well as skin pH, transepidermal water loss (TEWL), and relative humidity (RH) in the diapered region. Caregiver habits were collected via a questionnaire and included information on hygienic practices. Results Diaper dermatitis was highest in the perianal area, followed by the intertriginous, genital, and buttock regions. In general, DD was significantly lower in babies in China, highest in Germany, and intermediate in the USA. This rank ordering of DD by geography was also observed in baby age 2‐8 months. The lower DD observed in China was associated with lower skin pH and TEWL on diapered skin and decreased RH in the diaper. Chinese caregivers had the highest rate of prophylactic topical product usage, the most robust cleaning of the diapered area, lack of cleansing after urine‐only diaper changes, and Chinese infants spent the least time in an overnight diaper. Conclusions These data suggest caregiver behaviors including prophylactic use of topical products, thorough cleaning after stooling and reduced time in an overnight diaper are associated with less DD, lower superficial skin pH, and enhanced skin barrier

Pimecrolimus in atopic dermatitis: Consensus on safety and the need to allow use in infants

Atopic dermatitis (AD) is a distressing dermatological disease, which is highly prevalent during infancy, can persist into later life and requires long-term management with anti-inflammatory compounds. The introduction of the topical calcineurin inhibitors (TCIs), tacrolimus and pimecrolimus, more than 10 yr ago was a major breakthrough for the topical anti-inflammatory treatment of AD. Pimecrolimus 1% is approved for second-line use in children (≥2 yr old) and adults with mild-to-moderate AD. The age restriction was emphasized in a boxed warning added by the FDA in January 2006, which also highlights the lack of long-term safety data and the theoretical risk of skin malignancy and lymphoma. Since then, pimecrolimus has been extensively investigated in short- and long-term studies including over 4000 infants (<2 yr old). These studies showed that pimecrolimus effectively treats AD in infants, with sustained improvement with long-term intermittent use. Unlike topical corticosteroids, long-term TCI use does not carry the risks of skin atrophy, impaired epidermal barrier function or enhanced percutaneous absorption, and so is suitable for AD treatment especially in sensitive skin areas. Most importantly, the studies of pimecrolimus in infants provided no evidence for systemic immunosuppression, and a comprehensive body of evidence from clinical studies, post-marketing surveillance and epidemiological investigations does not support potential safety concerns. In conclusion, the authors consider that the labelling restrictions regarding the use of pimecrolimus in infants are no longer justified and recommend that the validity of the boxed warning for TCIs should be reconsidered

Regional assessment of the current extent of acidification of surface waters in Europe and North America

The current status of surface water acidification related to air pollution in Europe and North America has been assessed using country reports, monitoring data, critical loads and exceedance data, acid sensitivity and deposition maps, and data reported under the European Commission’s Water Framework Directive (WFD). Acidification is still observed in many countries, but the extent and severity vary. Maps of acid sensitivity and deposition suggest that surface water acidification is present in regions and countries for which no data or reports were delivered for the current assessment. Existing national monitoring varies in the ability to assess the spatial extent of acidification and the recovery responses of acidified sites. The monitoring requirements under the European Union’s National Emission Ceilings Directive are expected to reverse the recent decline in the number of monitoring sites observed in some countries. The information reported under the WFD is currently of limited value in assessing the extent of acidification of surface waters in Europe. Chemical recovery in response to reductions in acid deposition can be slow, and biological recovery can lag severely behind. Despite large and effective efforts across Europe and North America to reduce surface water acidification, air pollution still constitutes a threat to freshwater ecosystems

High elevation watersheds in the southern Appalachians: Indicators of sensitivity to acidic deposition and the potential for restoration through liming

Southern Appalachian high elevation watersheds have deep rocky soils with high organic matter content, different vegetation communities, and receive greater inputs of acidic deposition compared to low elevation sites within the region. Since the implementation of the Clean Air Act Amendment in the 1990s, concentrations of acidic anions in rainfall have declined. However, some high elevation streams continue to show signs of chronic to episodic acidity, where acid neutralizing capacity (ANC) ranges from 0 to 20 µeq L-1. We studied three 3rd order watersheds (North River in Cherokee National Forest, Santeetlah Creek in Nantahala National Forest, and North Fork of the French Broad in Pisgah National Forest) and selected four to six 1st order catchments within each watershed to represent a gradient in elevation (849–1526 m) and a range in acidic stream ANC values (11–50 leq L-1). Our objectives were to (1) identify biotic, physical and chemical catchment parameters that could be used as indices of stream ANC, pH and Ca:Al molar ratios and (2) estimate the lime required to restore catchments from the effects of excess acidity and increase base cation availability. We quantified each catchment’s biotic, physical, and chemical characteristics and collected stream, O-horizon, and mineral soil samples for chemical analysis seasonally for one year. Using repeated measures analysis, we examined variability in stream chemistry and catchment characteristics; we used a nested split-plot design to identify catchment characteristics that were correlated with stream chemistry. Watersheds differed significantly and the catchments sampled provided a wide range of stream chemical, biotic, physical and chemical characteristics. Variability in stream ANC, pH, and Ca:Al molar ratio were significantly correlated with catchment vegetation characteristics (basal area, tree height, and tree diameter) as well as O-horizon nitrogen and aluminum concentrations. Total soil carbon and calcium (an indicator of parent material), were significant covariates for stream ANC, pH and Ca:Al molar ratios. Lime requirement estimates did not differ among watersheds but this data will help select catchments for future restoration and lime application studies. Not surprisingly, this work found many vegetation and chemical characteristics that were useful indicators of stream acidity. However, some expected relationships such as concentrations of mineral soil extractable Ca and SO4 were not significant. This suggests that an extensive test of these indicators across the southern Appalachians will be required to identify high elevation forested catchments that would benefit from restoration activities