The Career Costs of Children

This paper analyzes the life-cycle career costs associated with child rearing and decomposes their effects into unearned wages (as women drop out of the labor market), loss of human capital, and selection into more child-friendly occupations. We estimate a dynamic life-cycle model of fertility, occupational choice, and labor supply using detailed survey and administrative data for Germany for numerous birth cohorts across different regions. We use this model to analyze both the male-female wage gap as it evolves from labor market entry onward and the effect of pro-fertility policies. We show that a substantial portion of the gender wage gap is explainable by realized and expected fertility and that the long-run effect of policies encouraging fertility are considerably lower than the short-run effects typically estimated in the literature

Empiricism and Philosophy

Though Quine's argument against the analytic-synthetic distinction is widely disputed, one of the major effects of his argument has been to popularise the belief that there is no sharp distinction between science and philosophy. This thesis begins by distinguishing reductive from holistic empiricism, showing why reductive empiricism is false, refuting the major objections to holistic empiricism and stating the limits on human knowledge it implies. Quine's arguments (and some arguments that have been mistakenly attributed to him) from holism against the analytic-synthetic are considered, and while many of them are found wanting one good argument is presented. Holism does not, however, imply that there is no sharp distinction between science and philosophy, and indeed implies that the distinction between scientific and philosophical disputes is perfectly sharp. The grounds upon which philosophical disputes may be resolved are then sought for and deliniated

Pregnancy outcomes in women with heart disease: Experience of a tertiary center in the Netherlands

Item does not contain fulltextOBJECTIVES: Clinical data of pregnant women with heart disease were obtained with the intention to provide input for local counseling and management guidelines. STUDY DESIGN: Retrospective data from all pregnant women with congenital or acquired heart disease between 2000 and 2011 in the VU University Medical Centre Amsterdam. MAIN OUTCOME MEASURES: Maternal and neonatal outcomes were evaluated. RESULTS: Data of 122 women with 160 pregnancies were obtained. The most common heart diseases were congenital heart disease (n=65, 53.3%) and arrhythmia (n=20, 16.4%). Based on the functional criteria of the New York Heart Association (NYHA), 114/122 patients (93.4%) were classified NYHA class I-II. Patients in NYHA class III-IV (n=8/122, 6.6%), mainly had a history of myocardial infarction or pulmonary hypertension. There were 156 singleton and 4 twin pregnancies. 22 (13.5%) pregnancies were complicated by hypertensive disorders. Heart failure developed in 11 women (9.0%), 37.5% in NYHA class III-IV and 6.5% in NYHA class I-II. Mean gestational age and birth weight were 270days and 3196g in NYHA class I-II compared to 237days and 1972g for NHYA class III-IV. There were two maternal deaths (1.6%) and 5 fetal deaths (3.1%). There were 29 (12.8%) preterm births, 20 (12.8%) neonates small for gestational age and 34 (21.8%) admittances on the Neonatal Intensive Care Unit (NICU). CONCLUSIONS: Pregnancy in women with pre-existing heart disease in all NYHA classes is associated with increased maternal morbidity and perinatal morbidity. Risk of structural fetal anomalies is especially high in women with congenital heart disease

[227-POS]: Thromboelastography (TEG((R))) and rotational thromboelastometry (ROTEM((R))) in pregnancy: A systematic review

Item does not contain fulltextOBJECTIVES: To evaluate the current position of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in clinical obstetric practice. METHODS: A search of the literature was performed on the following databases PubMed MEDLINE, EMBASE and the Cochrane Database of Systematic reviews. All articles published after 1990 until February 2013 and written in English, German, French, Spanish, Italian and Dutch concerning human pregnancies were eligible for inclusion. Eligible papers were subdivided in normal and complicated pregnancy outcomes and processed. RESULTS: 287 articles were found, of which 60 are included in the review. All studies with TEG/ROTEM performed in uncomplicated pregnancies, found significant changes towards a hypercoagulable state, especially in the third trimester. Hypercoagulability was found to persist till at least 3 weeks postpartum. In postpartum hemorrhage FIBTEM-ROTEM correlated well with the measured fibrinogen levels. Although, in severe preeclampsia with low platelets (<100.000/mm(3)) or in HELLP-syndrome changes in TEG/ROTEM associated with hypocoagulability are described, most studies were not able to show any significant differences between healthy pregnant women and women with mild preeclampsia. Miscarriage is associated with hypercoagulable changes in TEG/ROTEM compared to healthy non-pregnant and pregnant women. 26 case reports concerning women with specific coagulation disorders were identified and TEG/ROTEM was used for guiding therapeutic decision making. CONCLUSIONS: In individual women with coagulation disorders TEG/ROTEM can be useful to provide complementary information for "decision-making" and "therapy-guidance". The use of TEG((R)) or ROTEM((R))-analysis in the general obstetric practice, is at this time not recommended. Further research with standardized processing of data is most promising for bedside monitoring and interventions of postpartum hemorrhage. DISCLOSURES: A.C. Bolte: None. F.J. Hermans: None. L.E. Van Rheenen-Flach: None