Elisabeth R . Silver
Rice University, Industrial and Organizational Psychology, Graduate Student
- Columbia University Medical Center, Medicine, Department MemberUniversity of Michigan, Psychology, Alumnusadd
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PurposeExisting research on social inequalities in leadership seeks to explain how perceptions of marginalized followers as deficient leaders contribute to their underrepresentation. However, research must also address how current leaders... more
PurposeExisting research on social inequalities in leadership seeks to explain how perceptions of marginalized followers as deficient leaders contribute to their underrepresentation. However, research must also address how current leaders restrict these followers' access to leadership opportunities. This conceptual paper offers the perspective that deficiencies in leaders' behaviors perpetuate social inequalities in leadership through an illustrative application to research on gender and leadership.Design/methodology/approachThe authors situate existing research on gender and leadership within broader leadership theory to highlight the importance of inclusivity in defining destructive and constructive leadership.FindingsPrevious scholarship on gender inequalities in leadership has focused on perceptions of women as deficient leaders. The authors advocate that researchers reconceptualize leaders' failures to advance women in the workplace as a form of destructive leadership that harms women and organizations. Viewing leaders' discriminatory behavior as destructive compels a broader definition of constructive leadership, in which leaders' allyship against sexism, and any other form of prejudice, is not a rare behavior to glorify, but rather a defining component of constructive leadership.Practical implicationsThis paper highlights the important role of high-status individuals in increasing diversity in leadership. The authors suggest that leader inclusivity should be used as a metric of leader effectiveness.Originality/valueThe authors refocus conversations on gender inequality in leadership by emphasizing leaders' power in making constructive or destructive behavioral choices. The authors’ perspective offers a novel approach to research on social inequalities in leadership that centers current leaders' roles (instead of marginalized followers' perceived deficits) in perpetuating inequalities.
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Treatment of early stage (T1) esophageal adenocarcinoma: Personalizing the best therapy choice
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e15517 Background: Gastric cancer is the third leading cause of cancer-related mortality, with only a 30% five-year survival rate. Patients who progress after one round of systemic therapy face an especially poor prognosis. The National... more
e15517 Background: Gastric cancer is the third leading cause of cancer-related mortality, with only a 30% five-year survival rate. Patients who progress after one round of systemic therapy face an especially poor prognosis. The National Comprehensive Cancer Network guidelines include both pembrolizumab (PEM) and ramucirumab plus paclitaxel (RAM/PAC) as second-line (2L) therapy for gastric cancer based on data from the Phase II KEYNOTE-059 and Phase III RAINBOW trials, respectively. Recently, the Phase III KEYNOTE-061 trial reported on the effectiveness of PEM for patients with programmed death-ligand 1 (PD-L1) expression and high microsatellite instability (MSI-H). Given the high prices of targeted therapies, it is important to determine if cost-effectiveness is possible using personalized treatment strategies. The aim of this study was to assess the cost-effectiveness of these regimens in both the general patient population and specific biomarker populations. Methods: A decision-analytic (Markov) model was constructed using data from the KEYNOTE-059, KEYNOTE-061, RAINBOW, and REGARD trials. The analysis compared PEM and RAM/PAC for all patients, as well as PEM for patients based on MSI status or PD-L1 expression (combined positive score of 1% or 10%) in the 2L setting. Comparators were paclitaxel monotherapy (PAC) for all patients and best supportive care (BSC) for all patients. Costs (USD) and utility values were estimated from Medicare and the literature. The primary outcome was the incremental cost-effectiveness ratio (ICER) with a willingness-to-pay (WTP) threshold of $100,000. Results: The only cost-effective strategy was PAC monotherapy for all patients, with an ICER of $53,705/QALY. PEM for MSI-H patients and RAM/PAC for microsatellite stable patients was the most effective strategy (greatest QALYs), but was not cost-effective with an ICER of $1,074,620/QALY. Conclusions: Despite their effectiveness, PEM and RAM/PAC are not cost-effective as 2L treatments for metastatic gastric cancer. Although personalizing treatment based on biomarkers improved cost-effectiveness, the ICERs surpassed the WTP threshold at current drug prices.
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Research Interests: Psychology, Gender Studies, Heterosexuality, Sexuality, Identity (Culture), and 15 moreLanguage and Ideology, Ideology, Gender, Masculinity, Feminism, Gender Roles, Music and identity, Feminist & Womanist Movements, Feminism(s), Gender Identity, Sexual Behavior, Conformity, Feminist Identity, Public health systems and services research, and Sex Roles
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Research Interests: Gender and Sexuality, Gender, Gender and Sport, Gender Identity, Breastfeeding, and 15 moreGender Equity, Gender Diversity, Hormones, Disorders of sex development, Gender Differences, Feminist Science Studies, Gender Psychology, Feminist Science Practice, Biological Sex, Biological Sex Differences, Gender Equity and Diversity in Sport, Genitals, Birth Certificates, Gonads, and Bathrooms
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Policy debates have focused on who can participate in or access single-sex activities or services. This article describes how science of the biology of sex is relevant to three major policy areas: parenting (including leaves), sports, and... more
Policy debates have focused on who can participate in or access single-sex activities or services. This article describes how science of the biology of sex is relevant to three major policy areas: parenting (including leaves), sports, and public spaces. We focus on what scientists know about sex and gender (and gender/sex, where gender and sex are intertwined), and the role of various biological factors, including hormones such as testosterone and estradiol as well as genetics, gonads, genitals, and more. The policies under debate often use “biological sex,” but this fails to account for scientific understandings of sex and gender, misrepresents sex as single-faceted and binary, and overlooks scientific consensus about the importance of gender and identity.
Research Interests: Sex and Gender, Sexual and Reproductive Health, Transgender Studies, Reproduction, Gender and Sexuality, and 39 moreGender, Sex Hormones, Sports and Gender, Gender and Sport, Sexual Identity, Transgender Health, Gender Identity, Breastfeeding, Gender Equity, Sports, Pregnancy, Testosterone, Sex Difference, Public spaces, Parental Leave, Gender Diversity, Hormones, Gender Differences, Pregnancy and Parental Leave, Sex Differences, Sexual Diversity Studies, Reproductive Rights, Maternity Leave, Reproductive Health Policy, Paternity Leave, Feminist Science Studies, Sexual Diversity, Feminist Science Practice, Biological Sex, Biological Sex Differences, Gender Equity and Diversity in Sport, Genitals, Sexuality and Sexual Diversity, Sexuality and Public Policy, Birth Certificates, Sex testing in sports, Gonads, Public Policy, Sexual and Gender Diversity, Bathrooms, and Nonbinary Gender Identity
Research on feminist identification in men has often focused on men who identify as feminist or who assert agreement with feminist goals. For some men, however, choices surrounding feminist self-identification may be uncertain in ways... more
Research on feminist identification in men has often focused on men who identify as feminist or who assert agreement with feminist goals. For some men, however, choices surrounding feminist self-identification may be uncertain in ways that are meaningful indicators of their beliefs and values. We hypothesized that men who were uncertain about their feminist identity held beliefs that fell between their feminist and non-feminist peers, representing a unique ideological position. We tested this possibility by comparing feminist, Bunsure^, and non-feminist U. S. college (n = 533) and community (n = 277) men's masculinity stress and conformity, gender role values, and approaches to sexual relationships. Results showed that unsure men's gender role values fell between feminist and non-feminist men, but unsure men were more like feminists for some components of masculinity and more like non-feminists for others; on some constructs, feminist, unsure, and non-feminist men were similar. For sexual relationships, all men were equally invested in a sexual partner's pleasure, but unsure men and feminist men were less concerned with receiving sexual favors in exchange compared to non-feminists. We discuss how acknowledgement of men's uncertainty about their feminist identity may be useful for how researchers assess men's relationship to feminism, how instructors teach men about feminism in classroom settings, and how activists involve men in the feminist movement.
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PurposeExisting research on social inequalities in leadership seeks to explain how perceptions of marginalized followers as deficient leaders contribute to their underrepresentation. However, research must also address how current leaders... more
PurposeExisting research on social inequalities in leadership seeks to explain how perceptions of marginalized followers as deficient leaders contribute to their underrepresentation. However, research must also address how current leaders restrict these followers' access to leadership opportunities. This conceptual paper offers the perspective that deficiencies in leaders' behaviors perpetuate social inequalities in leadership through an illustrative application to research on gender and leadership.Design/methodology/approachThe authors situate existing research on gender and leadership within broader leadership theory to highlight the importance of inclusivity in defining destructive and constructive leadership.FindingsPrevious scholarship on gender inequalities in leadership has focused on perceptions of women as deficient leaders. The authors advocate that researchers reconceptualize leaders' failures to advance women in the workplace as a form of destructive leadersh...
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ObjectiveTo examine associations between sociodemographic and mental health characteristics with household food insecurity as a result of the COVID-19 outbreak.DesignCross-sectional online survey analyzed using univariable tests and a... more
ObjectiveTo examine associations between sociodemographic and mental health characteristics with household food insecurity as a result of the COVID-19 outbreak.DesignCross-sectional online survey analyzed using univariable tests and a multivariable logistic regression model.SettingThe United States during the week of March 30, 2020.ParticipantsConvenience sample of 1,965 American adults using Amazon’s Mechanical Turk (MTurk) platform. Participants reporting household food insecurity prior to the pandemic were excluded from analyses.Results1,517 participants reported household food security before the COVID-19 outbreak. Among this subset, 30% reported food insecurity after the COVID-19 outbreak, 53% were women and 72% were white. On multivariable analysis, race, income, relationship status, anxiety, and depression were significantly associated with incident household food insecurity. Black respondents, Hispanic/Latino respondents, and respondents with annual income less than $100,000...
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Background. The 5-year survival rate of patients with metastatic gastric cancer (GC) is only 5%. However, trials have demonstrated promising antitumor activity for targeted therapies/immunotherapies among chemorefractory metastatic GC... more
Background. The 5-year survival rate of patients with metastatic gastric cancer (GC) is only 5%. However, trials have demonstrated promising antitumor activity for targeted therapies/immunotherapies among chemorefractory metastatic GC patients. Pembrolizumab has shown particular efficacy among patients with programmed death ligand-1 (PD-L1) expression and high microsatellite instability (MSI-H). The aim of this study was to assess the effectiveness and cost-effectiveness of biomarker-guided second-line GC treatment. Methods. We constructed a Markov decision-analytic model using clinical trial data. Our model compared pembrolizumab monotherapy and ramucirumab/paclitaxel combination therapy for all patients and pembrolizumab for patients based on MSI status or PD-L1 expression. Paclitaxel monotherapy and best supportive care for all patients were additional comparators. Costs of drugs, treatment administration, follow-up, and management of adverse events were estimated from a US payer...
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Treatment of early stage (T1) esophageal adenocarcinoma: Personalizing the best therapy choice
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The majority of research on gender and the opioid epidemic focuses on women as patients, caregivers, or expectant mothers. However, little research approaches men as gendered subjects, despite their dramatically increased risk of opioid... more
The majority of research on gender and the opioid epidemic focuses on women as patients, caregivers, or expectant mothers. However, little research approaches men as gendered subjects, despite their dramatically increased risk of opioid overdose. Accordingly, we examined gender differences in prescription opioid use and misuse with specific attention to implications for men using data from the 2017 National Survey on Drug Use and Health. We used design-adjusted, weighted Wald tests and multivariate logistic regression to compare gender differences in rates of prescription opioid use and misuse, prescription opioid sources, primary motivation for misuse, and prescription opioid dependence. We found that although men were significantly less likely than women to report opioid use, they were significantly more likely to report opioid misuse and to misuse prescription opioids primarily to feel good or get high. Among past-year opioid users, men were significantly more likely than women to meet DSM-IV criteria for opioid dependence. Results are consistent with past work on the intersection of masculinity norms and health behaviors. Although gender-specific interventions are typically synonymous with interventions tailored to women, our results suggest that such interventions could alleviate the burden of the opioid epidemic for men as well. Further research studying possible mechanisms that explain men's increased vulnerability to the opioid epidemic is urgently needed to address this growing public health crisis.
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e15517 Background: Gastric cancer is the third leading cause of cancer-related mortality, with only a 30% five-year survival rate. Patients who progress after one round of systemic therapy face an especially poor prognosis. The National... more
e15517 Background: Gastric cancer is the third leading cause of cancer-related mortality, with only a 30% five-year survival rate. Patients who progress after one round of systemic therapy face an especially poor prognosis. The National Comprehensive Cancer Network guidelines include both pembrolizumab (PEM) and ramucirumab plus paclitaxel (RAM/PAC) as second-line (2L) therapy for gastric cancer based on data from the Phase II KEYNOTE-059 and Phase III RAINBOW trials, respectively. Recently, the Phase III KEYNOTE-061 trial reported on the effectiveness of PEM for patients with programmed death-ligand 1 (PD-L1) expression and high microsatellite instability (MSI-H). Given the high prices of targeted therapies, it is important to determine if cost-effectiveness is possible using personalized treatment strategies. The aim of this study was to assess the cost-effectiveness of these regimens in both the general patient population and specific biomarker populations. Methods: A decision-an...
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Objectives The Coronavirus disease 2019 (COVID-19) pandemic disrupted medical student education, particularly in New York City (NYC). We aimed to assess the impact of the COVID-19 pandemic on medical students’ residency choices. Methods... more
Objectives The Coronavirus disease 2019 (COVID-19) pandemic disrupted medical student education, particularly in New York City (NYC). We aimed to assess the impact of the COVID-19 pandemic on medical students’ residency choices. Methods The authors conducted a cross-sectional survey of medical students in all years of study at four NYC medical schools (Columbia, Cornell, NYU, and SUNY Downstate). The survey was fielded from 19 Aug 2020 to 21 Sep 2020. Survey questions included items assessing COVID-19 impact on residency choices, personal impact of COVID-19, residency/specialty choices, and factors influencing these choices. Results A total of 2310 students received the survey, with 547 (23.7%) providing partial responses and 212 (9.2%) providing valid responses for our primary analysis. 59.0% of participants thought that COVID-19 influenced their choice of residency/specialty, with 0.9% saying the influence was to a great extent, 22.2% to some extent, and 35.8% very little. On mult...
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Esophageal adenocarcinoma (EAC) is a rare but lethal cancer with rising incidence in several global hotspots including the United States. The five-year survival rate for patients diagnosed with advanced disease can be as low as 5% in EAC,... more
Esophageal adenocarcinoma (EAC) is a rare but lethal cancer with rising incidence in several global hotspots including the United States. The five-year survival rate for patients diagnosed with advanced disease can be as low as 5% in EAC, making early detection and preventive intervention crucial. The current standard of care for EAC targets patients with Barrett’s esophagus (BE), the main precursor to EAC and a relatively common condition in adults with chronic acid reflux disease. Preventive care for EAC requires repeated surveillance endoscopies of BE patients with biopsy sampling, and can be intrusive, error-prone, and costly. The integration of minimally-invasive subsurface tissue imaging in the current standard of care can reduce the need for exhaustive tissue sampling and improve the quality of life in BE patients. Effective adoption of subsurface imaging in EAC care can be facilitated by computer-aided detection (CAD) systems based on deep learning. Despite their recent succ...
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Objective:To examine associations between sociodemographic and mental health characteristics with household risk for food insecurity during the COVID-19 outbreak.Design:Cross-sectional online survey analysed using univariable tests and a... more
Objective:To examine associations between sociodemographic and mental health characteristics with household risk for food insecurity during the COVID-19 outbreak.Design:Cross-sectional online survey analysed using univariable tests and a multivariable logistic regression model.Setting:The United States during the week of 30 March 2020.Participants:A convenience sample of 1965 American adults using Amazon’s Mechanical Turk platform. Participants reporting household food insecurity prior to the pandemic were excluded from analyses.Results:One thousand two hundred and fifty participants reported household food security before the COVID-19 outbreak. Among this subset, 41 % were identified as at risk for food insecurity after COVID-19, 55 % were women and 73 % were white. On a multivariable analysis, race, income, relationship status, living situation, anxiety and depression were significantly associated with an incident risk for food insecurity. Black, Asian and Hispanic/Latino responde...