Bonus babies? The impact of paid parental leave on fertility intentions

Paid parental leave has become an increasingly important part of family policy in OECD countries: by 2004 on average over a year of leave paid at 59% of average wages was provided. Australia’s Paid Parental Leave (PPL) scheme was introduced in 2011 and provides 18 weeks of leave paid at the full time minimum wage for the primary carer of a child. Prior to the scheme, federal and state legislation provided paid maternity leave for most state and federal employees. We estimate the effect of access to paid parental leave on women’s fertility desires and intentions by exploiting the differential impact of the scheme for women working in the public and private sectors. We find that the announcement of the scheme had no impact on fertility desires or intentions at the extensive margin but that, conditional on intending to have at least one (more) child, the number of children intended increases by 0.28, a 13% increase. This effect is driven by highly educated women who do not already have children. As it has been shown that fertility intentions predict fertility outcomes, these results suggest that even modest paid parental leave programs can increase the fertility of working women and so moderate the declines in fertility rates seen in many developed countries

Findings of the 2013 National Food Hub Survey

Food hubs are businesses or organizations that actively manage the aggregation, distribution and marketing of source-identified food products. Food hubs also operate within their own expressed value sets, and these values guide any additional activities that a food hub may undertake. In theory, food hubs may serve to provide much-needed, size-appropriate infrastructure and marketing functions for local food produced by small and midsized producers. However, the impact of food hubs has only recently been studied, and there is a lack of aggregated information on many of the characteristics of active food hubs. The 2013 National Food Hub Survey was conducted to collect this information from a broad sample of food hubs. Findings from the survey showed that food hubs across the country are growing to broaden the distribution infrastructure for local food. From the survey, 62% of food hubs began operations within the last five years, 31% of food hubs had $1,000,000 or more in annual revenue and the majority of food hubs were supporting their businesses with little or no grant assistance -- including food hubs that identified as nonprofits. Financially, the most successful food hubs tended to be for-profit and cooperative in structure, in operation for more than 10 years and working with a relatively large number of producers. The values-based nature of food hubs makes it hard to judge many of them solely on their level of financial success. The survey also revealed a number of persistent challenges and barriers to growth that even the most financially successful food hubs faced. For example, many food hubs indicated their needs for assistance in managing growth and identifying appropriate staffing levels for their hubs. They also often pointed to their need for capital and other resources to increase their trucking and warehousing capacity

Clinical outcomes following responsive neurostimulation implantation: a single center experience

BackgroundResponsive neurostimulation (RNS) is an implantable device for persons with medically refractory focal-onset epilepsy. We report a single-center experience for RNS outcomes with special focus on stereoelectroencephalography (sEEG) for seizure onset localization.MethodsWe performed retrospective review of patients with drug resistant focal epilepsy implanted with the RNS System for a minimum of six months between July 2014 and July 2019. Records were reviewed for demographic data, epilepsy duration, seizure frequency, number of prior antiepileptic drugs (AEDs), number of AEDs at RNS System implantation, prior epilepsy surgery or device use, previous seizure localization with sEEG, and RNS system information. Clinical response was defined as a 50% reduction in seizures. Differing response rates were calculated using Fisher Exact test.Results30 patients met inclusion criteria. Seventeen (57%) underwent previous sEEG. Average clinical follow up was 3.0 years. Overall response rate was 70%. Median seizure reduction was 74.5%. Response rate was 82.3% for patients with sEEG compared to 53.8% without (p = 0.08); 37.5% for prior epilepsy surgery compared to 81.8% without (p = 0.02); 70% for mesial temporal onset; 50% for previous vagal nerve stimulator compared to 77.3% without (p = 0.13).ConclusionOur response rates match or surpass outcome metrics of previous studies. Although limited by small study size, subpopulation analyses show positive response rates in patients with previous sEEG versus no sEEG and in temporal versus extratemporal pathology. Additional research is needed to evaluate efficacy of RNS in patients with previous epilepsy surgery, and utility of sEEG in this population

The Impact of Paid Parental Leave on Fertility Intentions

Paid parental leave is an important part of family policy in OECD countries. Australia's Paid Parental Leave (PPL) scheme was introduced in 2011 and provides 18 weeks of leave paid at the full time minimum wage for the primary carer of a child. We estimate the effect of access to paid parental leave on women's fertility intentions by exploiting the differential impact of the scheme for women working in the public and private sectors. We find that the scheme's announcement had no impact on fertility intentions at the extensive margin but that, conditional on intending to have at least one (more) child, the number of children intended increases by 0.34, a 16% increase. This effect is concentrated among highly educated women. As it has been shown that fertility intentions predict fertility outcomes, these results suggest that even modest paid parental leave programs can increase the fertility of working women and so moderate the declines in fertility rates seen in many developed countries

Table_1_Clinical outcomes following responsive neurostimulation implantation: a single center experience.DOCX

BackgroundResponsive neurostimulation (RNS) is an implantable device for persons with medically refractory focal-onset epilepsy. We report a single-center experience for RNS outcomes with special focus on stereoelectroencephalography (sEEG) for seizure onset localization.MethodsWe performed retrospective review of patients with drug resistant focal epilepsy implanted with the RNS System for a minimum of six months between July 2014 and July 2019. Records were reviewed for demographic data, epilepsy duration, seizure frequency, number of prior antiepileptic drugs (AEDs), number of AEDs at RNS System implantation, prior epilepsy surgery or device use, previous seizure localization with sEEG, and RNS system information. Clinical response was defined as a 50% reduction in seizures. Differing response rates were calculated using Fisher Exact test.Results30 patients met inclusion criteria. Seventeen (57%) underwent previous sEEG. Average clinical follow up was 3.0 years. Overall response rate was 70%. Median seizure reduction was 74.5%. Response rate was 82.3% for patients with sEEG compared to 53.8% without (p = 0.08); 37.5% for prior epilepsy surgery compared to 81.8% without (p = 0.02); 70% for mesial temporal onset; 50% for previous vagal nerve stimulator compared to 77.3% without (p = 0.13).ConclusionOur response rates match or surpass outcome metrics of previous studies. Although limited by small study size, subpopulation analyses show positive response rates in patients with previous sEEG versus no sEEG and in temporal versus extratemporal pathology. Additional research is needed to evaluate efficacy of RNS in patients with previous epilepsy surgery, and utility of sEEG in this population.</p

Crossover and rechallenge with pembrolizumab in recurrent patients from the EORTC 1325-MG/Keynote-054 phase III trial, pembrolizumab versus placebo after complete resection of high-risk stage III melanoma

Publisher Copyright: © 2021 The AuthorsBackground: In the phase III double-blind European Organisation for Research and Treatment of Cancer 1325/KEYNOTE-054 trial, pembrolizumab improved recurrence-free and distant metastasis-free survival in patients with stage III cutaneous melanoma with complete resection of lymph nodes. In the pembrolizumab group, the incidence of grade I–V and of grade III–V immune-related adverse events (irAEs) was 37% and 7%, respectively. Methods: Patients were randomised to receive intravenous (i.v.) pembrolizumab 200 mg (N = 514) or placebo (N = 505) every 3 weeks, up to 1 year. On recurrence, patients could enter part 2 of the study: pembrolizumab 200 mg i.v. every 3 weeks up to 2 years, for crossover (those who received placebo) or rechallenge (those who had recurrence ≥6 months after completing 1-year adjuvant pembrolizumab therapy). For these patients, we present the safety profile and efficacy outcomes. Results: At the clinical cut-off (16-Oct-2020), in the placebo group, 298 patients had a disease recurrence, in which 155 (52%) crossed over (‘crossover’). In the pembrolizumab group, 297 patients completed the 1-year treatment period; 47 had a recurrence ≥6 months later, in which 20 (43%) entered the rechallenge part 2 (‘rechallenge’). In the crossover group, the median progression-free survival (PFS) was 8.5 months (95% confidence interval [CI] 5.7–15.2) and the 3-year PFS rate was 32% (95% CI 25–40%). Among 80 patients with stage IV evaluable disease, 31 (39%) had an objective response: 14 (18%) patients with complete response (CR) and 17 (21%) patients with partial response. The 2-year PFS rate from response was 69% (95% CI 48–83%). In the rechallenge group, the median PFS was 4.1 months (95% CI 2.6–NE). Among 9 patients with stage IV evaluable disease, 1 had an objective response (CR). Among the 175 patients, 51 (29%) had a grade I–IV irAE and 11 (6%) had a grade III–IV irAE. Conclusions: Pembrolizumab treatment after crossover yielded an overall 3-year PFS rate of 32% and a 39% ORR in evaluable patients, but the efficacy (11% ORR) was lower in those rechallenged.Peer reviewe

The neuroanatomical model of post-stroke depression: towards a change of focus?

One third of all stroke survivors develop post-stroke depression (PSD). Depressive symptoms adversely affect rehabilitation and significantly increase risk of death in the post-stroke period. One of the theoretical views on the determinants of PSD focuses on psychosocial factors like disability and social support. Others emphasize biologic mechanisms such as disruption of biogenic amine neurotransmission and release of proinflammatory cytokines. The "lesion location" perspective attempts to establish a relationship between localization of stroke and occurrence of depression, but empirical results remain contradictory. These divergences are partly related to the fact that neuroimaging methods, unlike neuropathology, are not able to assess precisely the full extent of stroke-affected areas and do not specify the different types of vascular lesions. We provide here an overview of the known phenomenological profile and current pathogenic hypotheses of PSD and present neuropathological data challenging the classic "single-stroke"-based neuroanatomical model of PSD. We suggest that vascular burden due to the chronic accumulation of small macrovascular and microvascular lesions may be a crucial determinant of the development and evolution of PSD

Anti-spasmogenic activity of isoenzyme-selective phosphodiesterase inhibitors in guinea-pig trachealis

1. The anti-spasmogenic potential of SK&F 94120 (PDE3-selective), rolipram (PDE4-selective), zaprinast (PDE5-selective), zardaverine (dual PDE3/4 inhibitor) and theophylline (non-selective) was evaluated in guinea-pig trachealis. 2. SK&F 94120 or rolipram (10 and 100 μM) antagonized histamine-induced tension generation in a concentration-dependent and non-competitive manner whereas ACh-induced contractions were unaffected. Similarly, SK&F 94120 and rolipram in combination were anti-spasmogenic with respect to both contractile agonists to an extent that was greater than the effect of either drug alone. Identical results were obtained with zardaverine (1, 10 and 100 μM) and theophylline (100 μM and 1 mM). 3. Zaprinast protected guinea-pig trachealis against histamine-, but not ACh-induced contractile responses in a manner that was indistinguishable from the results obtained with SK&F 94120. However, in contrast to the interaction between SK&F 94120 and rolipram, no further antagonism was seen when zaprinast and rolipram were used in combination. 4. Pre-treatment of tissues with SNP (10 and 100 μM) antagonized histamine-induced tension generation in a concentration-dependent and non-competitive manner. However, no further antagonism was produced when SNP and rolipram were used concurrently. Likewise, the protection afforded by a combination SNP and SK&F 94120 was no greater than that produced by SNP alone. 5. These results demonstrate that an inhibitor of PDE3 enhances the anti-spasmogenic activity of rolipram but not drugs that elevate cyclic GMP mass. Moreover, the ability of SNP and zaprinast to protect guinea-pig trachealis against histamine-induced contractions apparently is not due to the inhibition of PDE3