Women continue to remain underrepresented in STEM, and this gender disparity is particularly pronounced in leadership positions. Through in-depth, qualitative interviews of 39 women leaders in STEM, ...we identify common gender microaggressions they experience, and explore how these microaggressions affect their leadership experience and outcomes in the workplace. Our findings highlight five types of gender microaggressions women most often encounter, and how and when these microaggressions occur. We explore the negative impact that microaggressions can have on women’s work identities and how they can trigger a cycle of rumination and self-doubt that may ultimately result in women choosing to leave STEM. Importantly, we surface the interventional and empowering role that allies play in triggering a redemptive sensemaking process that can support women leaders to build resilience and counter the negative effects of microaggressions.
We explore the different types of racial violence encountered by Asian American and Asian Canadians (whom we refer to as Asians) in the workplace during COVID‐19 and how they respond. Using a ...grounded theory approach, we found that during the COVID‐19 pandemic, Asians experienced different types of workplace racial violence, most of which manifested as microaggressions, including a revival of the yellow peril trope, physical manifestations of bordering behaviour, and identity denial. In some cases, manifestations of physical violence also emerged. The data revealed that Asians demonstrated various types of agentic responses to challenge and counter unwanted and incorrect identities conveyed by the racial microaggressions. We enhance theory by shedding light on the experiences of Asians whose voice has largely been ignored in the organizational literature. Our study draws together and contributes to the theory on racial violence and racialized identity by highlighting the different types of racial violence faced by Asians and exploring the challenges they encounter in the face of racial microaggressions. Finally, we discuss practical implications of our study results and offer insight into how organizations can help support their Asian employees.
Polypharmacy in older adults is a global problem that has recently worsened. Approximately 30% of adults aged 65 years and older in developed countries take 5 or more medications. Although prescribed ...and over-the-counter medications may improve a wide range of health problems, they also may cause or contribute to harm, especially in older adults. Polypharmacy in older adults is associated with worsening of geriatric syndromes and adverse drug events. Given the risks and burdens of polypharmacy and potentially inappropriate medications, nurses must use patient-centered approaches and nonpharmacologic strategies to treat common symptoms and to optimize patient function and quality of life.
Background Although studies of oral immunotherapy (OIT) for food allergy have shown promise, treatment is frequently complicated by adverse reactions and, even when successful, has limited long-term ...efficacy because benefits usually diminish when treatment is discontinued. Objective We sought to examine whether the addition of omalizumab to milk OIT reduces treatment-related reactions, improves outcomes, or both. Methods This was a double-blind, placebo-controlled trial with subjects randomized to omalizumab or placebo. Open-label milk OIT was initiated after 4 months of omalizumab/placebo with escalation to maintenance over 22 to 40 weeks, followed by daily maintenance dosing through month 28. At month 28, omalizumab was discontinued, and subjects passing an oral food challenge (OFC) continued OIT for 8 weeks, after which OIT was discontinued with rechallenge at month 32 to assess sustained unresponsiveness (SU). Results Fifty-seven subjects (7-32 years) were randomized, with no significant baseline differences in age, milk-specific IgE levels, skin test results, or OFC results. At month 28, 24 (88.9%) omalizumab-treated subjects and 20 (71.4%) placebo-treated subjects passed the 10-g “desensitization” OFC ( P = .18). At month 32, SU was demonstrated in 48.1% in the omalizumab group and 35.7% in the placebo group ( P = .42). Adverse reactions were markedly reduced during OIT escalation in omalizumab-treated subjects for percentages of doses per subject provoking symptoms (2.1% vs 16.1%, P = .0005), dose-related reactions requiring treatment (0.0% vs 3.8%, P = .0008), and doses required to achieve maintenance (198 vs 225, P = .008). Conclusions In this first randomized, double-blind, placebo-controlled trial of omalizumab in combination with food OIT, we found significant improvements in measurements of safety but not in outcomes of efficacy (desensitization and SU).
The immunosuppressive effects of chemotherapy present a challenge for designing effective cancer immunotherapy strategies. We hypothesized that although systemic chemotherapy (SC) exhibits negative ...immunologic effects, local chemotherapy (LC) can potentiate an antitumor immune response. We show that LC combined with anti-programmed cell death protein 1 (PD-1) facilitates an antitumor immune response and improves survival (P < 0.001) in glioblastoma. LC-treated mice had increased infiltration of tumor-associated dendritic cells and clonal expansion of antigen-specific T effector cells. In comparison, SC resulted in systemic and intratumoral lymphodepletion, with decreased immune memory in long-term survivors. Furthermore, adoptive transfer of CD8
cells from LC-treated mice partially rescued SC-treated mice after tumor rechallenge. Last, the timing of chemo- and immunotherapy had differential effects on anti-PD-1 efficacy. This study suggests that both mode of delivery and timing have distinct effects on the efficacy of anti-PD-1. The results of this work could help guide the selection and scheduling of combination treatment for patients with glioblastoma and other tumor types.
Background The majority (approximately 75%) of children with cow’s milk allergy tolerate extensively heated (baked) milk products. Long-term effects of inclusion of dietary baked milk have not been ...reported. Objective We report on the outcomes of children who incorporated baked milk products into their diets. Methods Children evaluated for tolerance to baked milk (muffin) underwent sequential food challenges to baked cheese (pizza) followed by unheated milk. Immunologic parameters were measured at challenge visits. The comparison group was matched to active subjects (by using age, sex, and baseline milk-specific IgE levels) to evaluate the natural history of development of tolerance. Results Over a median of 37 months (range, 8-75 months), 88 children underwent challenges at varying intervals (range, 6-54 months). Among 65 subjects initially tolerant to baked milk, 39 (60%) now tolerate unheated milk, 18 (28%) tolerate baked milk/baked cheese, and 8 (12%) chose to avoid milk strictly. Among the baked milk–reactive subgroup (n = 23), 2 (9%) tolerate unheated milk, and 3 (13%) tolerate baked milk/baked cheese, whereas the majority (78%) avoid milk strictly. Subjects who were initially tolerant to baked milk were 28 times more likely to become unheated milk tolerant compared with baked milk–reactive subjects ( P < .001). Subjects who incorporated dietary baked milk were 16 times more likely than the comparison group to become unheated milk tolerant ( P < .001). Median casein IgG4 levels in the baked milk–tolerant group increased significantly ( P < .001); median milk IgE values did not change significantly. Conclusions Tolerance of baked milk is a marker of transient IgE-mediated cow’s milk allergy, whereas reactivity to baked milk portends a more persistent phenotype. The addition of baked milk to the diet of children tolerating such foods appears to accelerate the development of unheated milk tolerance compared with strict avoidance.
Efforts to promote the completion of advance directives implicitly assume that completion rates of these documents, which help ensure care consistent with people's preferences in the event of ...incapacity, are undesirably low. However, data regarding completion of advance directives in the United States are inconsistent and of variable quality. We systematically reviewed studies published in the period 2011-16 to determine the proportion of US adults with a completed living will, health care power of attorney, or both. Among the 795,909 people in the 150 studies we analyzed, 36.7 percent had completed an advance directive, including 29.3 percent with living wills. These proportions were similar across the years reviewed. Similar proportions of patients with chronic illnesses (38.2 percent) and healthy adults (32.7 percent) had completed advance directives. The findings provide benchmarks for gauging future policies and practices designed to motivate completion of advance directives, particularly among those people most likely to benefit from having these documents on record.
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