Increasing public expenditures: Wagner's Law in OECD countries

The paper proposes a panel cointegration analysis of the joint development of government expenditures and economic growth in 23 OECD countries. The empirical evidence provides indication of a structural positive correlation between public spending and per-capita GDP which is consistent with the so-called Wagner´s law. A long-run elasticity larger than one suggests a more than proportional increase of government expenditures with respect to economic activity. In addition, according to the spirit of the law, we found that the correlation is usually higher in countries with lower per-capita GDP, suggesting that the catching-up period is characterized by a stronger development of government activities with respect to economies in a more advanced state of development

Increasing Public Expenditures: Wagner’s Law in OECD Countries

The paper proposes a panel cointegration analysis of the joint development of government expenditures and economic growth in 23 OECD countries. The empirical evidence provides indication of a structural positive correlation between public spending and per-capita GDP which is consistent with the so-called Wagner’s law. A long-run elasticity larger than one suggests a more than proportional increase of government expenditures with respect to economic activity. In addition, according to the spirit of the law, we found that the correlation is usually higher in countries with lower per-capita GDP, suggesting that the catching-up period is characterized by a stronger development of government activities with respect to economies in a more advanced state of development.Fiscal Policy, Wagner’s Law, Panel Cointegration

Identifying fiscal shocks and policy regimes in OECD countries

JEL Classification: E62, H30Fiscal Policy, SVAR

Studio osservazionale prospettico sull’outcome clinico dei pazienti affetti da carcinoma della tiroide

Aim: To identify clinical and molecular prognostic factors in differentiated thyroid cancer (DTC) Methods: A web based longitudinal database of newly diagnosed DTC was settled down. The risk of recurrence and the response to treatment were classified according to the American Thyroid Association (ATA) guidelines. Circulating miR analysis of sera collected before surgery and about 1 months and 1-2 years after surgery was performed with TaqMan MicroRNA Assay. Results: 2730 patients had a follow-up ≥1 year. The ATA risk of recurrence was low in 1386 (50.8%), intermediate in 1168 (42.8%) and high in 176 (6.4%). The response to treatment was excellent in 1675 (61.3%), biochemical incomplete in 63 (2.3%), structural incomplete in 70 (2.6%), and indeterminate in 922 (33.8%). A significantly higher rate of structural disease was found in intermediate (2.7%, Odds ratio 4.85, 95% confidence interval 2.18 - 12.23, p<0.01) and high risk (17.1% Odds ratio 35.21, 95% confidence interval 15.41 - 90.66, p<0.01) patients compared with low risk patients (0.6%). Of the 829 patients that had a follow up of ≥3 years, only 3 (0.6%) intermediate risk patients experienced relapse. Serum samples of 44 patients with papillary thyroid cancer (PTC) were available for miR profiling. After a screening analysis, miR-146a-5p and miR-221-3p were selected for validation because of superior accuracy in PTC identification from healthy controls and benign thyroid nodules. The trend over time of miR-146a-5p and miR-221-3p was decreasing in patients with disease remission and increasing in patients with structural disease. In 3 cases miR profile was more informative than the serum thyroglobulin. Conclusion: The ATA risk stratification is an effective clinical prognostic tool for structural disease prediction in DTC. One third of the patients has an indeterminate response to treatment due to low detectable serum markers (thyroglobulin or anti thyroglobulin antibodies). miR profile may represents a promising alternative marker of disease status for these patients

ENDOCRINE TUMOURS: Imaging in the follow up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach

The clinical and epidemiological profiles of differentiated thyroid cancers (DTCs) have changed in the last three decades. Today's DTCs are more likely to be small, localized, asymptomatic papillary forms. Current practice is though moving towards more conservative approaches (e.g. lobectomy instead of total thyroidectomy, selective use of radioiodine). This evolution has been paralleled and partly driven by rapid technological advances in the field of diagnostic imaging. The challenge of contemporary DTCs follow up is to tailor a risk-of-recurrence-based management, taking into account the dynamic nature of these risks, which evolve over time, spontaneously and in response to treatments. This review provides a closer look at the evolving evidence-based views on the use and utility of imaging technology in the post-treatment staging and the short- and long-term surveillance of patients with DTCs. The studies considered range from cervical US with Doppler flow analysis to an expanding palette of increasingly sophisticated second-line studies (cross-sectional, functional, combined-modality approaches), which can be used to detect disease that has spread beyond the neck and, in some cases, shed light on its probable outcome. 

Recent advances in managing differentiated thyroid cancer

The main clinical challenge in the management of thyroid cancer is to avoid over-treatment and over-diagnosis in patients with lower-risk disease while promptly identifying those patients with more advanced or high-risk disease requiring aggressive treatment. In recent years, novel clinical and molecular data have emerged, allowing the development of new staging systems, predictive and prognostic tools, and treatment approaches. There has been a notable shift toward more conservative management of low- and intermediate-risk patients, characterized by less extensive surgery, more selective use of radioisotopes (for both diagnostic and therapeutic purposes), and less intensive follow-up. Furthermore, the histologic classification; tumor, node, and metastasis (TNM) staging; and American Thyroid Association risk stratification systems have been refined, and this has increased the number of patients in the low- and intermediate-risk categories. There is now a need for new, prospective data to clarify how these changing practices will impact long-term outcomes of patients with thyroid cancer, and new follow-up strategies and biomarkers are still under investigation. On the other hand, patients with more advanced or high-risk disease have a broader portfolio of options in terms of treatments and therapeutic agents, including multitarget tyrosine kinase inhibitors, more selective BRAF or MEK inhibitors, combination therapies, and immunotherapy

Microbial Ecology of Urban Sewers

Municipal sewage provides a glimpse into the health and activities of a human society. For more than a century, sewage exploration has helped expose the sources of disease outbreaks and track disease progression over time. Recent advancements in wastewater surveillance born from the COVID-19 pandemic have potential to enhance mitigation efforts against the decades-long global health crisis of microbial antibiotic resistance. However, critical knowledge gaps exist in wastewater surveillance, stemming from a lack of understanding in sewer microbial ecology. Ecology reveals trends in how communities respond and adapt to change, which has far-reaching implications for identifying effective strategies for disease control. However, with little knowledge about sewer microbial communities, including its residents, community dynamics, and functions, no baseline picture of the sewer microbiome exists. The goal of this dissertation was to characterize the sewer microbiome using an ecological approach. The specific aims were to determine if (1) microbial communities in urban wastewater exhibit seasonal patterns in assembly; (2) if seasonal community assembly is driven by environmental bacteria responding to changes in water temperature; and (3) if temperature-driven communities modulate the composition and abundance of antibiotic resistance genes in wastewater. Results show that microbes in sewers have seasonal community dynamics akin to other natural environments, and they have adapted to this stressful environment by acquiring and maintaining mechanisms of antibiotic resistance. Using only well-established methods in DNA sequencing and analyzing a wastewater dataset covering expansive temporal and spatial scales, this dissertation builds the foundation of a baseline sewer microbiome in the United States. All data collected and analyses used were made publicly available to aid standardizing methods in global strategy plans. Together, standardizing methods and sharing data related to the sewer microbiome will improve predictive models, guide interventions, and make other public health breakthroughs in wastewater surveillance

Prone single-position extreme lateral interbody fusion (Pro-XLIF): preliminary results.

Abstract Background Single-position options for combined anterior and posterior fusion in the lumbar spine have been suggested to reduce the surgical time and improve the efficiency of operating room. Previous reports have focused on lateral decubitus single-position surgery. The goal of this study is to describe and evaluate the feasibility and safety of prone single-position extreme lateral interbody fusion (XLIF) with posterior fixation. Methods Design Pilot prospective non-randomized controlled study. Seven patients who underwent prone single-position XLIF and posterior fixation were evaluated (Pro-XLIF). A control group (Std-XLIF) was composed of ten patients who underwent XLIF in lateral decubitus and posterior fixation in prone position. All patients underwent interbody XLIF fusion at one level and posterior procedures at one or more levels. Duration of surgery, blood loss, complications, X-ray use and clinical outcomes were recorded. Results No major complications were observed in either group. Oswestry Disability Index, back pain and leg pain were improved in the Pro-XLIF group from 48.5, 7.7 and 8.5 to 14.5, 1.71 and 2.71, respectively, and in the Std-XLIF group from 50.8, 5.7 and 7.2 to 22.5, 3.7 and 2.5. The Pro-XLIF group had a longer time of preparation before incision (39 vs 26 min, ns), equal duration of the anterior procedure (65 vs 59 min, ns), shorter duration of surgery (133 vs 182 min, ns) and longer X-ray exposure time (102 vs 92 s, ns). The surgical technique is described. Conclusions Prone single-position XLIF is feasible and safe. In this preliminary report, the results are comparable to the standard technique. Graphic abstract These slides can be retrieved under Electronic Supplementary Material