Regional chemotherapy by isolated limb perfusion prior to surgery compared with surgery and post-operative radiotherapy for primary, locally advanced extremity sarcoma: a comparison of matched cohorts

Background: Induction chemotherapy by isolated limb perfusion (ILP) with melphalan and tumour necrosis factor-α is an effective strategy to facilitate limb-conserving surgery in locally advanced extremity sarcoma. In a comparison of cohorts matched for grade, size and surgical resectability, we compared the outcome of patients undergoing induction ILP prior to limb-conserving surgery and selective post-operative radiotherapy with patients undergoing limb-conserving surgery and routine post-operative radiotherapy. Methods: Patients with primary, grade 2/3 sarcomas of the lower limbs over 10 cm in size were identified from prospectively maintained databases at 3 centres. Patients treated at a UK centre underwent limb-conserving surgery and post-operative radiotherapy (Standard cohort). Patients at two German centres underwent induction ILP, limb-conserving surgery and selective post-operative radiotherapy (ILP cohort). Results: The Standard cohort comprised 80 patients and the ILP cohort 44 patients. Both cohorts were closely matched in terms of tumour size, grade, histological subtype and surgical resectability. The median age was greater in the Standard vs the ILP cohort (60.5 years vs 56 years, p = 0.033). The median size was 13 cm in both cohorts. 5-year local-recurrence (ILP 12.2%, Standard 20.1%, p = 0.375) and distant metastases-free survival rates (ILP 49.6%, Standard 46.0% p = 0.821) did not differ significantly between cohorts. Fewer patients received post-operative radiotherapy in the ILP cohort compared with the Standard cohort (27% vs 82%, p < 0.001). Conclusion: In comparative cohorts, the outcomes of patients undergoing induction ILP prior to surgery did not differ from those undergoing standard management, although induction ILP was associated with a reduced need for adjuvant radiation

What Do Unions Do for Economic Performance?

Twenty years have passed since Freeman and Medoff's What Do Unions Do? This essay assesses their analysis of how unions in the U.S. private sector affect economic performance - productivity, profitability, investment, and growth. Freeman and Medoff are clearly correct that union productivity effects vary substantially across workplaces. Their conclusion that union effects are on average positive and substantial cannot be sustained, subsequent evidence suggesting an average union productivity effect near zero. Their speculation that productivity effects are larger in more competitive environments appears to hold up, although more evidence is needed. Subsequent literature continues to find unions associated with lower profitability, as noted by Freeman and Medoff. Unions are found to tax returns stemming from market power, but industry concentration is not the source of such returns. Rather, unions capture firm quasi-rents arising from long-lived tangible and intangible capital and from firm-specific advantages. Lower profits and the union tax on asset returns leads to reduced investment and, subsequently, lower employment and productivity growth. There is little evidence that unionization leads to higher rates of business failure. Given the decline in U.S. private sector unionism, I explore avenues through which individual and collective voice might be enhanced, focusing on labor law and workplace governance defaults. Substantial enhancement of voice requires change in the nonunion sector and employer as well as worker initiatives. It is unclear whether labor unions would be revitalized or further marginalized by such an evolution

Isolated limb perfusion with biochemotherapy and oncolytic virotherapy combines with radiotherapy and surgery to overcome treatment resistance in an animal model of extremity soft tissue sarcoma.

The management of locally advanced or recurrent extremity sarcoma often necessitates multimodal therapy to preserve a limb, of which isolated limb perfusion (ILP) is a key component. However, with standard chemotherapeutic agents used in ILP, the duration of response is limited. Novel agents or treatment combinations are urgently needed to improve outcomes. Previous work in an animal model has demonstrated the efficacy of oncolytic virotherapy when delivered by ILP and, in this study, we report further improvements from combining ILP-delivered oncolytic virotherapy with radiation and surgical resection. In vitro, the combination of radiation with an oncolytic vaccinia virus (GLV-1h68) and melphalan demonstrated increased cytotoxicity in a panel of sarcoma cell lines. The effects were mediated through activation of the intrinsic apoptotic pathway. In vivo, combinations of radiation, oncolytic virotherapy and standard ILP resulted in delayed tumour growth and prolonged survival when compared with standard ILP alone. However, local disease control could only be secured when such treatment was combined with surgical resection, the timing of which was crucial in determining outcome. Combinations of oncolytic virotherapy with surgical resection and radiation have direct clinical relevance in extremity sarcoma and represent an exciting prospect for improving outcomes in this pathology

Negative Effects of Paternal Age on Children's Neurocognitive Outcomes Can Be Explained by Maternal Education and Number of Siblings

Background: Recent findings suggest advanced paternal age may be associated with impaired child outcomes, in particular, neurocognitive skills. Such patterns are worrisome given relatively universal trends in advanced countries toward delayed nuptiality and fertility. But nature and nurture are both important for child outcomes, and it is important to control for both when drawing inferences about either pathway. Methods and Findings: We examined cross-sectional patterns in six developmental outcome measures among children in the U.S. Collaborative Perinatal Project (n = 31,346). Many of these outcomes at 8 mo, 4 y, and 7 y of age (Bayley scales, Stanford Binet Intelligence Scale, Graham-Ernhart Block Sort Test, Wechsler Intelligence Scale for Children, Wide Range Achievement Test) are negatively correlated with paternal age when important family characteristics such as maternal education and number of siblings are not included as covariates. But controlling for family characteristics in general and mother’s education in particular renders the effect of paternal age statistically insignificant for most developmental measures. Conclusions: Assortative mating produces interesting relationships between maternal and paternal characteristics that can inject spurious correlation into observational studies via omitted variable bias. Controlling for both nature and nurture reveals little residual evidence of a link between child neurocognitive outcomes and paternal age in these data. Result

Flexible Prices, Labor Market Frictions, and the Response of Employment to Technology Shocks

Recent empirical evidence establishes that a positive technology shock leads to a decline in labor inputs. Can a flexible price model enriched with labor market frictions replicate this stylized fact? We develop and estimate a standard flexible price model using Bayesian methods that allows, but does not require, labor market frictions to generate a negative response of employment to a technology shock. We find that labor market frictions account for the fall in labor inputs

The Intensive and Extensive Margin of European Labour Supply

Labour supply is determined by two factors: the participation of workers in the labour market (extensive margin), and the number of hours supplied by those working (intensive margin). Based on the European Union Labour Force Survey (EU-LFS), we analyse which margin is more decisive in determining overall labour supply in 24 Member States. The results reveal large diff erences between countries, even after controlling for composition eff ects in terms of socio-demographic and household characteristics. In addition to individual labour supply, our focus is on diff erences between EU Member States concerning household labour supply. Joint determination of the number of hours worked between spouses can be observed for dual-income couples in Austria, the Netherlands and Spain.Das Arbeitsangebot wird grundsätzlich durch zwei Faktoren bestimmt: Die Partizipation am Arbeitsmarkt (extensives Arbeitsangebot) und die Anzahl der gearbeiteten Stunden der Beschäftigten (intensives Arbeitsangebot). Auf Basis der Arbeitskräfteerhebung der Europäischen Union (EU-LFS) analysieren wir für 24 Mitgliedstaaten, welcher der beiden Faktoren bestimmend für das gesamte Arbeitsangebot ist. Die Ergebnisse deuten auf signifikante Unterschiede im Arbeitsangebot zwischen den Ländern hin, auch nachdem für Kompositionseffekte aufgrund sozio-demographischer und haushaltsspezifischer Charakteristika kontrolliert wird. Neben dem individuellen Arbeitsangebot liegt ein weiterer Schwerpunkt auf Unterschieden zwischen den EU Mitgliedsstaaten in Hinblick auf das Arbeitsangebot von Haushalten. In Österreich, den Niederlanden und Spanien kann im Gegensatz zu den anderen Ländern eine gemeinsame, simultane Entscheidung bezüglich des Arbeitsangebots bei Doppelverdienern mit kleinen Kindern im Vorschulalter beobachtet werden

Female Labor Supply Differences by Sexual Orientation: A Semi-Parametric Decomposition Approach

Using 2000 U.S. Census data we illustrate the importance of accounting for household specialization in lesbian couples when examining the sexual orientation gap in female labor supply. Specifically, we find the labor supply gap is substantially larger between married women and partnered lesbian women who specialize in market production (primary earners) than between married women and partnered lesbian women who specialize in household production (secondary earners). Using a semi-parametric decomposition approach, we further show that the role of children in explaining the mean labor supply gap by sexual orientation is greatly understated if the household division of labor between household and market production is not taken into account. Finally, we illustrate that controlling for children significantly reduces differences between married women and secondary lesbian earners both in terms of the decision to remain attached to the labor market (the extensive margin), as well as in terms of annual hours of work conditional on working (the intensive margin). Further, the effect of controlling for children is not uniform across the distribution of conditional annual hours; instead it primarily reduces the percentage of secondary lesbian earners working extremely high annual hours