Professional Experiences and Career Trajectories of Mid- to Senior-Career Women Clinician-Scientists: A Qualitative Study

Importance

Despite increasing evidence and recognition of persistent gender disparities in academic medicine, qualitative data detailing the association of gender-based experiences with career progression remain sparse, particularly at the mid- to senior-career stage.

Objective

To investigate the role gender has played in everyday professional experiences of mid- to senior-career women clinician-scientists and their perceptions of gender-related barriers experienced across their careers.

Design, Setting, and Participants

In this qualitative study, a total of 60 of 159 invited clinician-scientists who received National Institutes of Health K08 or K23 awards between 2006 and 2009 and responded to a survey in 2021 agreed to participate. Invitees were selected using random, purposive sampling to support sample heterogeneity. Semistructured in-depth interviews were conducted January to May 2022. For this study, interviews from 31 women were analyzed using the framework approach to thematic analysis. Data analyses were performed between August and October 2023.

Main Outcomes and Measures

Descriptive themes of participant experiences of gender and gender-based barriers in academic medicine.

Results

A total of 31 women clinician-scientists (8 identifying as Asian [25.8%], 14 identifying as White [45.2%], and 9 identifying as members of a minority group underrepresented in medicine [29.0%]; 14 aged 40-49 years [45.2%] and 14 aged 50-59 years [45.2%]) were included. Among them, 17 participants (54.8%) had children who required adult supervision or care, 7 participants (22.6%) had children who did not require supervision or care, and 6 participants (19.4%) did not have children. There were 4 dominant themes identified within participant experiences in academic medicine: the mental burden of gendered expectations at work and home, inequitable treatment of women in bureaucratic processes, subtle and less subtle professional exclusion of women, and value of communities built on shared identities, experiences, and solidarity.

Conclusions and Relevance

This study found that women perceived the institution of academic medicine as a male-centric system misaligned with the needs of women, with associated feelings of exclusion, disillusionment, and loss of trust in their institutions. Findings suggest that the confluence of domestic obligations and unaccommodating institutional environments may make it difficult for women clinician-scientists to achieve established timelines of career progression and productivity; these findings may have long-term implications for the well-being and retention of women in academic medicine.

Screening for atrial fibrillation in care homes using pulse palpation and the AliveCor Kardia Mobile® device: a comparative cross-sectional pilot study

BACKGROUND

Atrial fibrillation (AF) is a major cause of stroke in older people. Exacerbated by age and co-morbidities, residents of care homes are more likely to develop AF and less likely to receive oral anticoagulants.

AIM

To determine the prevalence of AF using the design and methodology of the Pharmacists Detecting Atrial Fibrillation (PDAF) study in a care home setting.

METHOD

A cross-sectional AF screening pilot study within four UK care homes, three residential and one residential/nursing. Screening followed the original PDAF protocol: a manual pulse check, followed by a single-Lead ECG (SLECG, AliveCor Kardia Mobile (KMD)) delivered by a pharmacist. All recorded SLECG were reviewed by a cardiologist and any residents requiring follow-up investigations were referred to their general practitioner.

RESULTS

Fifty-three of 112 care home residents participated. From 52 SLECGs recorded, the cardiologist interpreted 13.5% (7/52) as having possible AF of which 9.6% (5/52) were previously unknown. One resident with previously unknown AF received anticoagulation.

CONCLUSION

This study has shown a need for AF screening in care homes and that elements of the PDAF screening protocol are transferable in this setting. Early diagnosis and treatment of AF are essential to reduce the risk of stroke in this population.

The Royal College of Radiologists National Vulvar Cancer Audit

AIMS

This audit examined UK vulvar cancer practice from March 2018 to January 2019 and compared it to standards from national and international recommendations. Follow-up data collection in 2020 examined patient outcomes and toxicity.

MATERIALS AND METHODS

Audit standards were based on Royal College of Radiologists (RCR) guidance and published literature. A web-based questionnaire was sent to the audit leads at all cancer centres in the UK. Prospective data collection included patient demographics, tumour characteristics, radiotherapy indications, dosimetry, timelines, and follow-up data. The audit targets were 95% compliance with the RCR dose/fractionation schemes in definitive and adjuvant patients, 40% use of intensity modulated radiotherapy (IMRT), 100% of radical patients treated as category 1, and 95% use of gap compensation for category 1 patients.

RESULTS

34/54 UK radiotherapy centres (63%) completed data entry for 152 patients. 23 out of 34 (68%) centres submitted follow-up data for 94 patients. One indicator exceeded the audit target: 98% of radical patients received IMRT. The indicators of RCR dose/fractionation compliance for adjuvant/definitive radiotherapy were achieved by 80%/43% for the primary, 80%/86% for elective lymph nodes, and 21%/21% for pathological lymph nodes. The use of concomitant chemotherapy with radical radiotherapy in suitable patients was achieved by 71%. Other indicators demonstrated that 78% were treated as category 1 and 27% used gap compensation. Acute toxicity was mostly related to skin, gastrointestinal, and genitourinary sites. Grade 3 and Grade 4 toxicities were seen at acceptable rates within the radical and adjuvant groups. Late toxicity was mostly grade 0.

CONCLUSION

This audit provides a comprehensive picture of UK practice. IMRT is widely used in the UK, and treatment-related toxicity is moderate. The dose fractionation was very heterogeneous. The designation of vulvar cancer as category 1 was not regularly followed for radical/adjuvant patients, and there was minimal gap compensation during treatment.

The Disproportionate Effects of the COVID-19 Pandemic on the Time Allocation of Recipients of NIH Career Development Awards Who Are Women or Caregivers of Dependents

PURPOSE

To understand time allocation of a national medical faculty cohort 1.5-2 years after the COVID-19 pandemic began, compared to before.

METHOD

From August 2021-April 2022, the authors conducted a retrospective survey of 1,430 clinician-researchers who received National Institutes of Health career-development awards between 2006-2009 asking about domestic and professional time allocation pre-pandemic and at the time of surveys (TOS). Of 915 respondents (64%), the 830 who remained in academic positions constituted the analytic sample. Multivariable regression models identified demographic factors associated with each time outcome and change in time between pre-pandemic and TOS, and having experienced ≥8-hour increase of total self-reported weekly professional work hours and domestic labor hours.

RESULTS

Median self-reported weekly professional work hours were 55 hours/week pre- pandemic and 60 at TOS. On multivariable analysis, significant predictors of self-reported weekly professional work hours at TOS were having a non-child other dependent (+2.6 hours, P = .03), academic rank (associate -3.1 hours, assistant -9.0 hours; P < .001), and specialty (P < .001). Average self-reported TOS weekly domestic-labor hours were 23.1 among men and 30.2 among women (P < .001). Predictors of total self-reported TOS weekly domestic hours were being a woman (+5.6 hours; P < .001) and having children requiring supervision (+10.2 hours; P < .001). Overall, 9.3% of men (42/450) and 21.6% of women (88/407) experienced a ≥ 8 hour increase in domestic labor (P < .001). On multivariable analysis, women had higher odds of substantial domestic-labor increase (OR = 2.33, 95% CI: 1.47, 3.68), as did those with children requiring supervision (OR = 1.93, 95% CI: 1.25, 2.98) or other dependents (OR = 1.83, 95% CI: 1.13, 2.98).

CONCLUSIONS

This study illuminates demands on women and faculty with dependents during the COVID-19 pandemic and suggests increased flexibility and resources are of heightened importance.

Gender Differences in Faculty Perceptions of Mentorship and Sponsorship

This survey study examines gender differences in mid- to senior-career faculty experiences of receiving and providing mentorship and sponsorship during early career development.

Body Image Among Sexual and Gender Minorities: An Intersectional Analysis

Body image is consequential for overall well-being and has a complex relation to gender. Sexual and gender minority (SGM) individuals develop body image amid intersecting systems of oppression, such as sexism, cisnormativity, heteronormativity, and gender binary pressures. This study used an intersectionality framework to examine how various aspects of gender identification (cis/trans, binary/nonbinary, woman/man identification) related to body image differences among SGM individuals. We also assessed whether identification with conventionally masculine and feminine personality traits predicted body image. We used one-way and two-way ANOVAs and linear regressions to analyze two indicators of body image (body appreciation and drive for muscularity) in a sample of 643 SGM individuals (148 sexual minority (SM) cis women, 171 trans women, 121 SM cis men, 43 trans men, 160 nonbinary individuals). Results implicated cisnormativity as an influential and hierarchical force for body image, although woman/man and binary/nonbinary identification also played roles in group differences. With a few exceptions, masculine but not feminine trait identification significantly predicted body appreciation and drive for muscularity, indicating a complicated association with overall body image. These findings underscore the value of an intersectional lens for analyzing how broad social forces may manifest in individual-level body image for SGM individuals.

Evaluation of field-testing protocols to diagnose insulin dysregulation in ponies using a Bayesian approach

Field tests and their association with laminitis have not been evaluated in large cohorts. The objectives of this study were to evaluate the performance of basal insulin (BI), the oral sugar test (OST) and the insulin tolerance test (ITT) to diagnose ID and investigate their association with laminitis. Insulin dysregulation status was determined in 146 ponies using BI (insulin concentration >20 µIU/mL), an OST (insulin concentration >65 µIU/mL at 60 or 90 min after oral administration of 0.45 mL/kg corn syrup) and an ITT (< 50% reduction in glucose concentration 30 min after intravenous administration of 0.1 IU/kg insulin). Laminitis was identified using modified-Obel scores. A Bayesian approach was used to define the characteristics of the tests and receiver operating characteristic curves were used to assess their association with laminitis. All tests were well tolerated and laminitis was diagnosed in 9% of ponies. Insulin dysregulation was diagnosed in 15% of ponies using BI, 38% using the OST and 54% using the ITT with 11% of ponies positive for all three tests. The sensitivities and specificities of BI, the OST and the ITT to diagnose ID were 0.52 (95% confidence interval [CI], 0.35-0.79) and 0.97 (95% CI, 0.91 - 1.00), 0.84 (95% CI, 0.70 - 0.94) and 0.60 (95% CI, 0.49 - 0.71), and 0.85 (95% CI, 0.68-0.96) and 0.88 (95% CI, 0.75 - 0.97), respectively. Only BI and the OST were associated with laminitis (P = 0.003 and 0.015, respectively).

Investigation of breed differences in plasma adrenocorticotropic hormone concentrations among healthy horses and ponies

Plasma adrenocorticotropic hormone (ACTH) concentration is commonly measured to diagnose pituitary pars intermedia dysfunction (PPID). Several intrinsic and extrinsic factors affect ACTH concentrations, including breed. The objective of this study was to prospectively compare plasma ACTH concentrations among different breeds of mature horses and ponies. Three breed groups comprised Thoroughbred horses (n = 127), Shetland ponies (n = 131) and ponies of non-Shetland breeds (n = 141). Enrolled animals did not show any signs of illness, lameness or clinical signs consistent with PPID. Blood samples were collected 6 months apart, around the autumn equinox and spring equinox, and plasma concentrations of ACTH were measured by chemiluminescent immunoassay. Pairwise breed comparisons within each season were performed on log transformed data using the Tukey test. Estimated mean differences in ACTH concentrations were expressed as fold difference with 95 % confidence intervals (CI). Reference intervals for each breed group per season were calculated using non-parametric methods. In autumn, higher ACTH concentrations were found among non-Shetland pony breeds compared with Thoroughbreds (1.55 fold higher; 95 % CI, 1.35-1.77; P < 0.001), and in Shetland ponies compared with Thoroughbreds (2.67 fold higher; 95 % CI, 2.33-3.08; P < 0.001) and non-Shetland pony breeds (1.73 fold higher; 95 % CI, 1.51-1.98; P < 0.001). In spring, no differences were identified among breed groups (all P > 0.05). Reference intervals were similar among breed groups in spring, but upper limits for ACTH concentrations were markedly different between Thoroughbred horses and pony breeds in autumn. These findings emphasise that breed should be accounted for when determining and interpreting reference intervals for ACTH concentrations among healthy horses and ponies in autumn.

Becoming Jane Barney: Developing a generative identity as an engaged citizen

OBJECTIVE

We propose that analysis of the life of Jane Lockwood Barney provides insight into the notion of a "generative identity"-an integrated sense of self constructed around caring for others and the world. During her 104 years, the socially prescribed roles for women grew in range; Barney's own roles included minister's wife, mother of four, theological philosopher, social work student and professional, and community activist. We outline her life, focusing on three periods defined by her time at Parishfield, a Christian 'think tank' that focused on community-engaged advocacy for structural change, based in Brighton, Michigan.

METHOD

Using thematic analysis, we identify three main themes from documents written by and about Barney, as well as interviews conducted later in her life.

RESULTS

Consistent with Erikson's notion of epigenesis, these themes-belonging, self-reliance/self-expression and generative identity-are evident throughout Barney's adult life to varying degrees. However, we show that the first two themes, belonging and self-reliance/self-expression, act as precursors to the development of her generative identity.

CONCLUSION

Barney's experience at Parishfield in midlife was pivotal to her generative identity, acting as a sort of crucible and turning point; from that time forward the focus of her activities broadened to caring and working tirelessly for the underserved in her community.

Gendered Impact of Caregiving Responsibilities on Tenure Track Faculty Parents’ Professional Lives

Navigating a career while raising a family can be challenging, especially for women in academia. In this study, we examine the ways in which professional life interruptions due to child caregiving (e.g., opportunities not offered, professional travel curtailed) affect pre- and post-tenure faculty members’ career satisfaction and retention. We also examine whether sharing caregiving responsibilities with a partner affected faculty members’ (particularly women’s) career outcomes. In a sample of 753 tenure track faculty parents employed at a large research-intensive university, results showed that as the number of professional life interruptions due to caregiving increased, faculty members experienced less career satisfaction and greater desire to leave their job. Pre-tenure women’s, but not pre-tenure men’s, career satisfaction and intention to stay were negatively affected when they experienced at least one professional life interference. Pre-tenure men’s desire to stay in their job and career satisfaction remained high, regardless of the number of professional life interferences they experienced. Sharing parenting responsibilities with a partner did not buffer the demands of caregiving on pre-tenure women’s career outcomes. Our work highlights the need to consider the varied ways in which caregiving affects faculty members’ careers, beyond markers such as publications, and how institutions can support early career stage women with family-friendly practices.

Successful treatment of a chronic oroantral fistula infected with extensively drug resistant bacteria using long-term oesophageal tube feeding and several non-conventional treatments in a horse

BACKGROUND

Chronic oroantral fistulae (OAF) with secondary sinusitis can occur following repulsion of cheek teeth in horses.

CASE REPORT

An 8-year-old Andalusian cross gelding presented with an iatrogenic clinical crown fracture of tooth 209, which underwent repulsion of its apical portion (day 0). The horse was treated with intramuscular penicillin and intravenous gentamicin (5 days), followed by oral trimethoprim-sulphonamide (10 days) and then oral doxycycline (14 days). The acute iatrogenic OAF created during the initial repulsion persisted; a chronic OAF was identified on day 24. On day 48, septic sinusitis with multidrug-resistant (MDR) Escherichia coli was confirmed. Although susceptible to enrofloxacin in vitro, 30 days of therapy was unsuccessful. Subsequent serial cultures grew multiple MDR and extensively drug-resistant (XDR) gram-negative microorganisms. Whole-genome sequencing (WGS) revealed multiple sequence types of E. coli, with a range of resistance and virulence genes. The orientation of the OAF, regional osteomyelitis and septic sinusitis were confirmed with computed tomography on day 70. On day 74, enteral nutrition was provided through a cervical oesophagostomy tube for 3 months for prevention of oral feed contamination. The OAF was treated with various alternative therapeutics, including apple cider vinegar, propolis and amikacin impregnated products, until resolution on day 116.

CONCLUSION

These non-conventional therapeutics, antimicrobials and long-term oesophagostomy contributed to the successful treatment of a complicated OAF. In the future, WGS may be useful to inform antimicrobial selection when MDR or XDR organisms are identified.

Treatment of moderate grade dog bite wounds using amoxicillin-clavulanic acid with and without enrofloxacin: a randomised non-inferiority trial

BACKGROUND

Dog-to-dog bite wounds are a common veterinary emergency presentation: despite this, there is insufficient information to guide veterinarians on appropriate empirical antimicrobial management.

OBJECTIVES

Investigate the effectiveness of amoxicillin-clavulanic acid with and without enrofloxacin in the treatment of moderate grade dog bite wounds (DBW). To describe common pathogens and their antimicrobial susceptibility patterns.

MATERIALS AND METHODS

In a single-centre parallel group pragmatic trial, 50 dogs presenting with moderate grade DBW were prospectively randomised to receive amoxicillin-clavulanic acid (group A) or amoxicillin-clavulanic acid and enrofloxacin (group B). Swabs were taken for culture and susceptibility testing at admission. Stabilisation, wound care and surgical debridement were performed at the discretion of admitting clinicians. The primary outcome was complication due to infection at 10 days, with Bayesian inference used to estimate the difference in proportions between treatment groups.

RESULTS

Of the 24 dogs in treatment group A, 1 required the addition of enrofloxacin at re-examination. None of the 26 dogs in group B required alteration of antimicrobial coverage. The difference in complication rate due to infection between treatment groups was 4.2%. Twenty-one different organisms were identified: Staphylococcus pseudintermedius, Neisseria spp., Pasteurella multocida and P. canis were the most common. Over 90% of gram-negative and gram-positive isolates were susceptible to amoxicillin-clavulanic acid. Ninety-six percent of gram-negative and 86% of gram-positive isolates were susceptible to enrofloxacin.

CONCLUSION AND CLINICAL SIGNIFICANCE

Amoxicillin-clavulanic acid is an appropriate empirical antimicrobial choice for moderate DBW in South East Queensland. Reduced empirical enrofloxacin use will promote antimicrobial stewardship and potentially antimicrobial resistance.

Stereotypes in Attributions About Women's Gender-Based Mistreatment

Using an intersectional framework, we assessed how gender stereotypes applied to women with different race and class identities who experienced gender-based mistreatment. Thematic content analysis of 238 responses to a woman in a vignette, who varied in terms of race and class, revealed three themes: action or inaction, living conditions, and education. Sexual assault drew significantly more comments about the woman's actions and inaction than sexual harassment, as did a middle-class versus a working-class woman. Conversely, living conditions surfaced more for the working-class woman. Finally, education came up most in sexual harassment accounts. Qualitative features of the responses are also discussed.

Adaptive Radiotherapy in the Management of Cervical Cancer: Review of Strategies and Clinical Implementation

The complex and varied motion of the cervix-uterus target during external beam radiotherapy (EBRT) underscores the clinical benefits afforded by adaptive radiotherapy (ART) techniques. These gains have already been realised in the implementation of image-guided adaptive brachytherapy, where adapting to anatomy at each fraction has seen improvements in clinical outcomes and a reduction in treatment toxicity. With regards to EBRT, multiple adaptive strategies have been implemented, including a personalised internal target volume, offline replanning and a plan of the day approach. With technological advances, there is now the ability for real-time online ART using both magnetic resonance imaging and computed tomography-guided imaging. However, multiple challenges remain in the widespread dissemination of ART. This review investigates the ART strategies and their clinical implementation in EBRT delivery for cervical cancer.

All immigrants are not alike: Intersectionality matters in views of immigrant groups

In two studies, we investigated how intersecting social categories shape views of immigrants in the United States. In Study 1, we analyzed 310 attributes generated by 92 participants for the category of immigrant and 30 additional immigrant groups with intersecting social categories (e.g. “undocumented immigrant”) reflecting various levels of social status. Using the Meaning Extraction Method (MEM) and factor analysis to examine shared meanings, we identified five factors; further comparative analyses of immigrant groups focused on the first two factors (Vulnerable vs. Hardworking, Drain vs. Asset). The importance of legal status for judgments on these two factors was evident in comparisons of the generic immigrant with four specific legal intersections. An examination of all 31 groups of immigrants showed that higher status groups were perceived as Hardworking (less Vulnerable) and high national Assets (low Drain), while lower status groups varied in Vulnerability perceptions but were generally thought to be Drains on the nation rather than Assets. In Study 2, 270 participants evaluated intersectional immigrant social categories that differed in combinations of higher status (privileged) and lower status (marginalized) social group memberships, using scales based on the terms identified by the factors in Study 1. Participants rated immigrant groups with two privileged statuses as less vulnerable and more likely to be an asset to the nation than immigrant groups with two marginalized or mixed statuses. The utility of a bottom-up intersectional approach to assess stereotype content of immigrant groups is discussed.

Essential oil spray reduces clinical signs of insect bite hypersensitivity in horses

OBJECTIVE

To assess the efficacy of an herbal spray combining various essential oils, with a claim of mast cell stabilisation, antipruritic, anti-inflammatory, and insect repellent effects on the clinical presentation of insect bite hypersensitivity (IBH) in horses.

DESIGN

Double-blinded, placebo-controlled, randomised, cross-over clinical trial.

METHODS

Twenty adult horses with clinical IBH were treated with a daily application of herbal spray or placebo for 28 days in a randomised, cross-over fashion, separated by a>28-day washout period. Horses were examined and scored prior to and after the completion of each treatment. Histopathology was performed on four horses. Owners kept daily diaries of observations.

RESULTS

The herbal spray significantly reduced the severity of all assessed parameters (pruritus, excoriations, lichenification and alopecia; P < 0.05) compared with baseline values (pretreatment) and with placebo. Owners reported improvement of pruritus in 19/20 horses (95%) with complete resolution in 17 horses (85%) following treatment. Skin biopsies showed resolution of orthokeratosis in 4/4 horses, reduced thickness of the stratum spinosum in 2/4 horses and complete resolution of histopathological abnormalities in 1/4 horses after treatment, compared with either no change or deterioration of histopathologic lesions after placebo. No side effects were observed.

CONCLUSIONS

The tested herbal spray may be an effective treatment for the management of equine IBH.

P6145Atrial fibrillation screening in care homes by clinical pharmacists using pulse palpation and single-lead ECG: a feasibility study

Background

The prevalence of atrial fibrillation (AF) amongst care home residents ranges from 7–19% with the number of undiagnosed cases five-fold above that of the general population. Clinical pharmacists providing services to care homes may offer opportunistic AF screening, improving residents' access to timely diagnosis and treatment.

Purpose

The aim of this feasibility study was to determine the prevalence of AF in UK care homes and to evaluate the feasibility of clinical pharmacist-led AF screening in this setting. It also aimed to ascertain the proportion of residents who could be screened using pulse palpation and single-lead electrocardiogram (ECG) and those with new AF who qualified for anticoagulant therapy.

Methods

This screening initiative was delivered in 4 care homes linked to 2 general practices in Kent (UK). The clinical pharmacist providing AF screening was trained by a cardiologist to pulse palpate and record a mobile ECG. A designated general practitioner (GP) assessed each resident's mental capacity to consent. Any residents with mental capacity and no pacemaker were offered a free heart rhythm check with the pharmacist. After written consent, each participant underwent a pulse palpation (1 min), followed by ECG (30 sec) and a provisional diagnosis. All ECGs were overread by a cardiologist within 72 hrs, and any residents requiring further investigation were referred to their GP.

Results

Fifty-three eligible individuals (mean age 90 years, 76% female) were screened between October 2018 and January 2019. Fifty-eight residents (52%) could not be screened due to lack of mental capacity. One participant with a regular pulse could not be tested with the ECG device due to severe hand tremor. The quality of 14 ECGs (27%) was determined as poor. Following the cardiologist's interpretation, 17 residents (33%) required a 12-lead ECG: 7 (14%) with possible AF and 10 (19%) with an inconclusive result. Amongst those with suspected AF, 5 had hypertension, 3 - chronic kidney disease and 2 - diabetes mellitus or peripheral vascular disease. Five had not been previously diagnosed with AF and all qualified for anticoagulant therapy (CHA2DS2-VASc ≥2). The device's algorithm displayed low sensitivity for AF (57%) despite greater agreement with the cardiologist's interpretation (Cohen's κ 0.70) than either the pharmacist's interpretation (0.56) or pulse palpation (0.44).

Conclusion(s)

This research was the first of its kind in UK care homes and identified a suspected AF prevalence >5 times higher than in the general population. Several barriers to AF screening in this setting, including mental incapacity and physical comorbidities, led to poor ECG quality, low diagnostic accuracy and 1 in 5 inconclusive diagnoses potentially limiting the economic viability of the intervention proposed. Future studies will explore the feasibility of using alternative strategies which may circumvent these barriers to AF screening in care homes.

Acknowledgement/Funding

This work was supported by Kent Surrey and Sussex Community Education Providers Network and Faculty of Science Research Funding, University of Kent.

The Role of Biomarkers for the Prediction of Response to Checkpoint Immunotherapy and the Rationale for the Use of Checkpoint Immunotherapy in Cervical Cancer

Checkpoint immunotherapy has revolutionised the way that melanoma is treated and has also shown significant effectiveness in lung, bladder, renal, and head and neck cancers. At the present time, trials of checkpoint immunotherapy in cervical cancer are at early phases, but there is very good rationale for pursuing this as a treatment option, especially as cervical cancer is a virally driven cancer and therefore should be recognised by the immune system as being foreign. This review explores the biomarkers for the selection of patients for immunotherapy in other cancers, such as programmed death ligand 1 (PD-L1) expression, tumour infiltrating lymphocytes and total mutational burden, and relates these biomarkers to cervical cancer. A PubMed search was carried out for publications published in English with the terms 'immunotherapy' OR 'cervical cancer' OR 'checkpoint blockade' OR 'tumour infiltrating lymphocytes' OR 'total mutational burden'. Articles that met these criteria and were available on PubMed before 8 October 2018 were included. The results showed that PD-L1 is positive in up to 90% of cervical cancers and that the total mutational burden is moderately high, with 5-6 mutations per megabase. In addition, the tumour microenvironment in cervical cancer has an impact on prognosis, with higher ratios of CD8+ tumour infiltrating lymphocytes to CD4+ T regulatory cells being associated with improved survival. Clinical studies to date have shown the response rate of cervical cancer to checkpoint immunotherapy to be in the region to 10-25%. Cervical cancer exhibits many of the features that have been shown to be correlated with response to checkpoint immunotherapy in other tumour sites. However, response rates to date are in the region of 10-25%. Therefore, combinations of immunotherapeutic agents or checkpoint inhibitors with radiotherapy may be required to maximise the therapeutic benefit of harnessing the host immune system to fight cancer.

“I Became a Lioness”

Feminist identity is a powerful predictor of activism on behalf of women. However, little is known about how feminist identity develops worldwide, either in terms of social identity theory or the stage model of feminist identity development. Moreover, some women’s movement advocates view feminism with suspicion, as focused only on concerns of a narrow group of women. For this study, 45 women’s movement activists from China, India, Nicaragua, Poland, and the United States were interviewed as part of the Global Feminisms Project. Participants’ personal narratives were examined to identify themes activists used to describe their own feminist identity development. The six themes that emerged were education, social relationships, gender-based injustice, violence, activism, and emotion. Alternating least squares analysis of the concurrence of these themes revealed four pathways to feminist identity: (1) education, (2) social relationships and gender-based injustice, (3) violence, and (4) activism and emotion. These findings suggest that individuals come to feminist identity in different ways. Instructors aiming to encourage understanding of women’s movement activism should point to these different pathways, and feminist activists seeking to promote feminist identity development should consider different approaches to successfully engaging people. Online slides and a podcast for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/page/pwq/suppl/index

Level of choice in older women's decisions to retire or continue working and associated well-being

Retirement is a complex life transition. Women's retirement, like their work lives, may be further complicated, for example, by family or financial obligations; they may feel forced to retire or to continue working or feel they have the choice to do so. This study examines the role of voluntary versus involuntary retirement or continued work participation among retirement-age women; specifically, the relationships between choice, work status, and well-being. Compared to women forced to retire, women who chose retirement or continuing to work had higher levels of life satisfaction. Findings highlight the importance of examining retirement within the life course context.

Disposition of levetiracetam in healthy adult horses

Nine horses received 20 mg/kg of intravenous (LEV_IV ); 30 mg/kg of intragastric, crushed immediate release (LEV_CIR ); and 30 mg/kg of intragastric, crushed extended release (LEV_CER ) levetiracetam, in a three-way randomized crossover design. Crushed tablets were dissolved in water and administered by nasogastric tube. Serum samples were collected over 48 hr, and levetiracetam concentrations were determined by immunoassay. Mean ± SD peak concentrations for LEV_CIR and LEV_CER were 50.72 ± 10.60 and 53.58 ± 15.94 μg/ml, respectively. The y-intercept for IV administration was 64.54 ± 24.99 μg/ml. The terminal half-life was 6.38 ± 1.97, 7.07 ± 1.93 and 6.22 ± 1.35 hr for LEV_CIR , LEV_CER, and LEV_IV , respectively. Volume of distribution at steady-state was 630 ± 73.4 ml/kg. Total body clearance after IV administration was 74.40 ± 19.20 ml kg^-1  hr^-1 . Bioavailability was 96 ± 10, and 98 ± 13% for LEV_CIR and LEV_CER , respectively. A single dose of Levetiracetam (LEV) was well tolerated. Based on this study, a recommended dosing regimen of intravenous or oral LEV of 32 mg/kg every 12 hr is likely to achieve and maintain plasma concentrations within the therapeutic range suggested for humans, with optimal kinetics throughout the dosing interval in healthy adult horses. Repeated dosing and pharmacodynamic studies are warranted.

Voice Matters: Buffering the Impact of a Negative Climate for Women in Science

The current study examined whether women scientists' perceptions of voice moderate the impact of poor workplace climates on job satisfaction and whether effective leadership and mentoring promote women's voice. Survey data were collected from 135 faculty women in the natural sciences. The results from multiple regression analyses indicated that negative (e.g., sexist, hostile) departmental climates were related to lower job satisfaction. However, voice interacted with climate, such that women who perceived that they had more voice in departmental matters showed higher levels of job satisfaction than those who perceived having less voice. An additional regression indicated that mentoring by other women (but not men) in academia and effective departmental leadership were positively related to women's sense of voice. Theoretical and practical implications for the retention and success of women in male-dominated fields are discussed.

The Climate for Women in Academic Science: The Good, the Bad, and the Changeable

Deficits theory posits that women scientists have not yet achieved parity with men scientists because of structural aspects of the scientific environment that provide them with fewer opportunities and more obstacles than men. The current study of 208 faculty women scientists tested this theory by examining the effect of personal negative experiences and perceptions of the workplace climate on job satisfaction, felt influence, and productivity. Hierarchical multiple regression results indicated that women scientists experiencing more sexual harassment and gender discrimination reported poorer job outcomes. Additionally, perceptions of a generally positive, nonsexist climate, as well as effective leadership, were related to positive job outcomes after controlling for harassment and discrimination. We discuss implications for the retention and career success of women in academic science.

Growing Up and Growing Older: Feminism as a Context for Women's Lives

Social science research shows that contemporary women endorse feminist goals at rates similar to women in the 1970s. However, generations may differ in some aspects of their relationship to feminism. This study of 333 university alumnae examined expressions of feminism across three generations. We provide the first empirical evidence to support Stewart and Healy's (1989 ) prediction about the impact of social events experienced in childhood; only the youngest cohort recalled holding feminist beliefs as children. Additionally, each cohort identified feminist influences from the period coinciding with their own identity-forming adolescence as most important, although feminism was related to other beliefs in a similar way for each cohort. The Women's Movement appears to be internalized differently depending on developmental life stage.

Midlife Women's Political Consciousness: Case Studies of Psychosocial Development and Political Commitment

Midlife women's political consciousness may be importantly influenced by a preoccupation with generativity. Analysis of three case studies suggests the importance of several elements for a developmental perspective on women's (and perhaps men's) midlife political activity: childhood family political ideology; earlier adolescent and adult political activity; influences of particular social and historical events at different developmental stages; a desire to be generative or to “make a contribution”; experiences as a parent; and access at midlife to time, energy, and personal resources. In addition, the importance of defining “political activity” broadly, and in the terms meaningful to women themselves, is underlined. Finally, the satisfaction associated with recognizing the continuity in one's life commitments must be appreciated as one element of women's midlife political consciousness.

Educational Experiences and Shifts in Group Consciousness: Studying Women

This study takes a multifaceted approach to group consciousness. The authors assessed changes in women’s feminist consciousness due to their exposure to feminism through women’s studies. Feminist consciousness was measured at the beginning and end of a semester during which some research participants were enrolled in an introductory women’s studies course. Women’s studies students were compared with students who were interested, but not enrolled, in women’s studies. As expected, women’s studies students showed an increase on several aspects of feminist consciousness, whereas non-women’s studies students did not. Non-women’s studies students became less sensitive to sexism. It is also noteworthy that, although they became more feminist, women’s studies students did not become more negative toward men.

The Role of Self-Blame in Children's Adjustment to Parental Separation

A longitudinal study of a nonclinical sample of 6- to 12-year-old children of divorcing parents examined the incidence, antecedents, and correlates of feelings of self-blame about parental separation during the first 18 months after the breakup. About one third of the children reported some feelings of self-blame at 6 months after the separation; I year later this figure had dropped to 20%. Being caught in triadic relations with the two parents was associated with self-blame, but parental disagreement over child rearing and a history of physical, mental, or school problems were not. The consequences of self-blame for children's adjustment to the separation were primarily negative, according to self-, mother, and teacher ratings. Children who reported feelings of self-blame had lower perceived competence, more psychological symptoms, and more behavior problems.

Still Bringing the Vietnam War Home: Sources of Contemporary Student Activism

This study examined student activism concerning the Persian Gulf War. Results showed that students' reports of their parents' activities during the Vietnam War were strongly associated with students' Gulf War-related activism. Other correlates of activism included attitudes toward war, political consciousness, authoritarianism, and gender-role ideology. After the authors controlled for student attitudes, path analyses confirmed the direct role of parental modeling for children's activism in opposition to and in support of the Gulf War. In addition, parents' antiwar activism indirectly influenced students' antiwar activism through authoritarianism scores and antiwar attitudes. Parents' war-support activism had no such indirect effect on students' war-support activism; however, gender-role ideology, authoritarianism, and prowar attitudes influenced students' war-support activism. The findings support the frequently hypothesized but seldom-studied link between parents' activism and children's later activism.

Gender, Social Class, and the Subjective Experience of Aging: Self-Perceived Personality Change From Early Adulthood to Late Midlife

This study explored the applicability of previous research (obtained with groups of college-educated women) about the subjective experience of aging in midlife to men and less-educated people. Two-hundred fifty-nine men and women who graduated from a public high school in 1955-1957 retrospectively assessed their feelings of identity certainty, confident power, generativity, and concern about aging for their 60s, 40s, and 20s. Participants reported higher levels of identity certainty, confident power, and concern about aging at each age, and a leveling off of generativity in their 60s. There were some gender and social class differences. Although men and women recalled the same trajectory of these feelings, men reported higher levels of identity certainty and confident power across age. Non-college-educated men recalled the highest levels of concern about aging across age. We discuss how these findings add to our understanding of the experience of aging in these domains.

Low-radio-frequency eclipses of the redback pulsar J2215+5135 observed in the image plane with LOFAR

The eclipses of certain types of binary millisecond pulsars (i.e. 'black widows' and 'redbacks') are often studied using high-time-resolution, 'beamformed' radio observations. However, they may also be detected in images generated from interferometric data. As part of a larger imaging project to characterize the variable and transient sky at radio frequencies <200 MHz, we have blindly detected the redback system PSR J2215+5135 as a variable source of interest with the Low-Frequency Array (LOFAR). Using observations with cadences of two weeks - six months, we find preliminary evidence that the eclipse duration is frequency dependent (∝ν^-0.4), such that the pulsar is eclipsed for longer at lower frequencies, in broad agreement with beamformed studies of other similar sources. Furthermore, the detection of the eclipses in imaging data suggests an eclipsing medium that absorbs the pulsed emission, rather than scattering it. Our study is also a demonstration of the prospects of finding pulsars in wide-field imaging surveys with the current generation of low-frequency radio telescopes.

New methods to constrain the radio transient rate: results from a survey of four fields with LOFAR

We report on the results of a search for radio transients between 115 and 190 MHz with the LOw-Frequency ARray (LOFAR). Four fields have been monitored with cadences between 15 min and several months. A total of 151 images were obtained, giving a total survey area of 2275 deg². We analysed our data using standard LOFAR tools and searched for radio transients using the LOFAR Transients Pipeline. No credible radio transient candidate has been detected; however, we are able to set upper limits on the surface density of radio transient sources at low radio frequencies. We also show that low-frequency radio surveys are more sensitive to steep-spectrum coherent transient sources than GHz radio surveys. We used two new statistical methods to determine the upper limits on the transient surface density. One is free of assumptions on the flux distribution of the sources, while the other assumes a power-law distribution in flux and sets more stringent constraints on the transient surface density. Both of these methods provide better constraints than the approach used in previous works. The best value for the upper limit we can set for the transient surface density, using the method assuming a power-law flux distribution, is 1.3 × 10^-3 deg^-2 for transients brighter than 0.3 Jy with a time-scale of 15 min, at a frequency of 150 MHz. We also calculated for the first time upper limits for the transient surface density for transients of different time-scales. We find that the results can differ by orders of magnitude from previously reported, simplified estimates.

2002 Carolyn Sherif Award Address: Gender, Race, and Generation in a Midwest High School: Using Ethnographically Informed Methods in Psychology

Abigail Stewart Sherif Award Citation. For your exceptional contributions to feminist psychology, the Society for the Psychology of Women presents to you the Carolyn Wood Sherif Award. Your entire career has been marked by distinction; you have been as prolific in publishing as you have been in mentoring. You have illuminated women's lives, their personalities, their development, and their adaptation to change. You have advanced feminist theory, and your academic leadership has created the opportunity for students to do graduate work in feminist psychology. We honor you and your work with gratitude.

In this essay I make two arguments. First, I argue for the value of ethnographically informed methods in psychology in general and particularly for the psychology of women. Second, I argue for the importance of the role of generation in psychology, perhaps particularly in the study of values and social identities. In advancing these arguments, I draw on evidence from an ongoing, ethnographically informed study of the graduates of a Midwestern high school in the mid-1950s and late 1960s. The two generations of graduates have distinctive accounts of their experiences, with the older generation's accounts consistent across gender and race, and the younger generation's accounts inflected by both race and gender. Differences in the form of generational identity in the two cohorts are discussed.

Social Class, Social Change, and Gender

This article explores the implications of social class background in the lives of women who attended Radcliffe College in the late 1940s and in the early 1960s. Viewing social classes as “cultures” with implications for how individuals understand their worlds, we examined social class background and cohort differences in women's experiences at Radcliffe, their adult life patterns, their constructions of women's roles, and the influence of the women's movement in their lives. Results indicated that women from working-class backgrounds in both cohorts felt alienated at Radcliffe. Cohort differences, across social class, reflected broad social changes in women's roles in terms of the rates of divorce, childbearing, level of education, and career activity. There were few social class-specific social changes, but there were a number of social class differences among the women in the Class of 1964. These differences suggested that women from working-class backgrounds viewed women's marital role with some suspicion, whereas women from middle- and upper-class backgrounds had a more positive view. Perhaps for this reason, working-class women reported that the women's movement confirmed and supported their skeptical view of middle-class gender norms.

Linking Femininity, Weight Concern, and Mental Health Among Latina, Black, and White Women

Studies examining women's appearance ideals and weight concern have predominantly relied on samples of White women. This study addresses this oversight, examining the different relations among embodied femininity, weight concern, and depressive symptomatology that exist for different groups of women. Using a nationally representative sample of women between the ages of 18 and 45, bivariate analyses were conducted using three samples of Latina, Black, and White women. When sample size allowed, a multivariate model was tested (i.e., for Black and White respondents). Results confirm, as hypothesized, different patterns of relations between embodied femininity, weight concern, and depressive symptomatology for each of the samples. At the bivariate level, embodied femininity, weight concern, and depressive symptomatology were positively intercorrelated among Latina respondents. Whereas weight concern fully mediated the relation between embodied femininity and depressive symptomatology for the White respondents, the mediational model was not borne out for the Black respondents. For the latter, although embodied femininity and weight concern were related, weight concern was unrelated to depressive symptoms. Both of these patterns are discussed, as well as the need for greater empirical sensitivity to various constructions of femininity among women of different ethnicities.

Evaluating the Feminist Challenge to Research in Personality and Social Psychology: 1963–1983

Multiple indices for evaluating the feminist challenge in psychology are identified, and provide a context for discussing selected aspects of research in personality and social psychology that reflect the impact of feminism on psychology. Women's involvement in the research process, the types of research methods used, and substantive concerns were examined in selected issues of the Journal of Personality and Social Psychology between 1963 and 1983. Despite a significant increase in the proportion of articles with female authors, there were no clear changes in any of the methodological variables we assessed. Comparisons of these studies and those published in the Psychology of Women Quarterly suggest that the impact of the feminist challenge is far more noticeable in this more explicitly feminist journal. Evidence pertaining to the relative impact of publishing in explicitly feminist versus “mainstream” journals, derived from analyses of citation frequency of several feminist studies, was examined. Overall, results suggest that feminist values may have affected research topics more than research methods within personality and social psychology. Several implications of this gatekeeping function of methodology are discussed.

Making Commitments, Creating Lives

This study examined the midlife personality implications of different long-term patterns of commitment to work1 and family in a sample of educated women. Women with different work commitment patterns differed on both observer and self-report of instrumentality, and on observer report of interpersonal orientation and valuation of social norms. Women with different family-role commitment patterns differed only on self-report of valuation of social norms. Multivariate analyses also indicated that interpersonal orientation and instrumentality may not represent bipolar ends of the same personality continuum, and that interpersonal orientation as a broad personality domain may be comprised of distinct qualities (i.e., warmth vs. dependence). Taken together, these findings imply that when variations in the nature of women's work and family commitments are taken into account, a more comprehensive understanding of the similarities and differences in their personalities can result.

A Generational Analysis of Women's Rights Activists

This article addresses the important issue of intergenerational similarities and differences among women's rights activists. We examined the attitudes, emotions, and experiences of three generations of reproductive rights activists, born between 1925 and 1975. Across generations, the participants were strongly pro-choice and identified as feminists. Despite these similarities, there were several differences that could be explained by considering the sociohistorical circumstances faced by each cohort. For example, the Civil Rights generation activists came of age during the boycotts and marches of the 1950s and showed the highest level of civil rights activism. Reflecting the coincidence of their young adulthood with the 1970s women's movement, the Protest generation activists identified the most with the label “feminist.” Finally, the Postwomen's movement activists, raised in the 1970s and 1980s, were the most likely to have taken college-level women's studies classes.