Despite increasing parity in the infectious disease workforce, gender inequity persists in our clinical specialty. Inadequate accommodations for young parents at national conferences like IDWeek contribute to these inequities by disproportionately excluding young women from career advancement opportunities. We propose the CARING framework (Childcare options, Accommodations, Responsible resources, Inclusion of parents in decision-making, Network creation, and data-driven Guidelines) to improve equitable access to major academic conferences.
Background Previous work has demonstrated letters of recommendation for women in academic medicine are shorter and emphasize communal traits over grindstone or agentic traits. Objective To determine if there are sex-based differences in letters of recommendation written for applicants applying to pulmonary critical care medicine fellowships and if the sex of the letter writer impacts these differences. Methods All fellowship applications submitted to a pulmonary critical care medicine fellowship program in 2020 were included in this study. The applicant demographics and self-reported accomplishments were extracted from their application. The sex of letter writers was identified through public online searches. Word count and language differences in the letters of recommendation were analyzed for each applicant using the Linguistic Inquiry and Word Count (LIWC2015) program. Multivariable linear regressions were performed controlling for applicant characteristics to identify if applicant sex was associated with total word counts and total agentic word counts. Results Of the 529 complete applications, 2,024 letters of recommendation were reviewed. A majority of the applicants (70%, n = 370/530) and letter writers (75%, n = 1,515/2,024) were male. When adjusting for applicant demographic and accomplishments, female applicants had longer letters of recommendation (30.91 words longer, 95% confidence interval [CI], 1.53–60.29; P = 0.04) and more supportive letters (3.27 words longer, 95% CI, 1.59–4.95; P < 0.01) as compared with male applicants. Female letter writers wrote longer and more supportive letters than male letter writers, and this difference was greatest for female applicants. Conclusion Female applicants received longer and more supportive letters of recommendation. Further work is needed to understand if this finding is the beginning of a change in the letters of recommendation for female applicants.
This single-center retrospective study of invasive fungal disease (IFD) enrolled 251 adult patients undergoing induction chemotherapy for newly diagnosed acute myeloid leukemia (AML) from 2014–2019. Patients had primary AML (n = 148, 59%); antecedent myelodysplastic syndrome (n = 76, 30%), or secondary AML (n = 27, 11%). Seventy-five patients (30%) received an allogeneic hematopoietic cell transplant within the first year after induction chemotherapy. Proven/probable IFD occurred in 17 patients (7%). Twelve of the 17 (71%) were mold infections, including aspergillosis (n = 6), fusariosis (n = 3), and mucomycosis (n = 3). Eight breakthrough IFD (B-IFD), seven of which were due to molds, occurred in patients taking antifungal prophylaxis. Patients with proven/probable IFD had a significantly greater number of cumulative neutropenic days than those without an IFD, HR = 1.038 (95% CI 1.018–1.059), p = 0.0001. By cause-specific proportional hazards regression, the risk for IFD increased by 3.8% for each day of neutropenia per 100 days of follow up. Relapsed/refractory AML significantly increased the risk for IFD, HR = 7.562 (2.585–22.123), p = 0.0002, and Kaplan-Meier analysis showed significantly higher mortality at 1 year in patients who developed a proven/probable IFD, p = 0.02. IFD remains an important problem among patients with AML despite the use of antifungal prophylaxis, and development of IFD is associated with increased mortality in these patients.
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