TPS1120 Background: Breast radiotherapy (RT) is the standard of care for patients with early-stage breast cancer (BC) who undergo breast-conserving surgery (BCS). However, the magnitude of benefit of RT is less clear in BCS patients with low-risk disease who receive effective systemic therapy. Among patients with early-stage HER2-positive (HER2+) BC, 10-year locoregional recurrence has been reported as low as 1.5% following BCS, adjuvant chemotherapy and HER2-targeted therapy, and RT. Given these exceedingly favorable outcomes, with the addition of HER2-directed therapy, we seek to evaluate the feasibility of omitting RT among patients with early-stage HER2+ BC following BCS and appropriate systemic therapy. Methods: This is a phase III randomized trial for patients ≥18 years with early-stage, node-negative, HER2+ (IHC/FISH) BC treated with BCS with negative margins and sentinel lymph node biopsy or axillary dissection. Patients undergoing primary surgery must have pathologic T1-2 (≤3 cm) N0 disease, whereas patients receiving neoadjuvant therapy must have clinical T1-2 (with radiographically T≤5 cm) N0 disease and exhibit a pathologic complete response (ypT0N0) at surgery (residual DCIS [ypTis] spanning ≤1 cm is permitted, and surgical margins are negative for DCIS). All patients must receive cytotoxic chemotherapy and HER2-targeted therapy, either in the adjuvant or neoadjuvant setting. Stratification is by age (<60; ≥60), tumor size (≤1 cm; >1 cm), estrogen-receptor status (positive; negative), and systemic therapy sequencing (adjuvant v neoadjuvant). Patients will be randomized to standard breast RT in addition to continuation of trastuzumab to complete one year of treatment (Arm 1), or trastuzumab alone (Arm 2). Endocrine therapy will be recommended for patients with hormone-receptor-positive tumors. The primary endpoint is the recurrence-free interval (RFI). Secondary endpoints include time to ipsilateral breast recurrence, locoregional recurrence, disease-free survival, and overall survival, in addition to the 7-year ipsilateral breast recurrence rate among those not receiving RT. A health-related quality of life sub-study will assess differences in patient-reported breast pain and worry. We estimate a 7-year RFI of 97.5% with RT and allow for a clinically acceptable decrement of 3.63% without RT (7-year RFI of 93.87%; HR 2.5) to establish omission of RT as non-inferior. NRG-BR008 aims to enroll 1,300 patients over 7.25 years, yielding 80% power to detect the non-inferiority of RT omission with a one-sided α=0.05. We expect to observe the required 38 RFI events within 4.5 years of additional follow-up. The NRG-BR008/HERO trial opened to accrual in March 2023. Accrual is 64/1,300 as of 1/23/24. NCT #: NCT05705401. Support: U10 CA180868, -180822, UG1 CA189867, U24 CA196067. Clinical trial information: NCT05705401 .

ObjectivesThis study evaluates the safety and efficacy of Gamma Knife Stereotactic Radiosurgery (GKSRS) retreatment (T2) for recurrent or refractory trigeminal neuralgia (TN) following an initial SRS treatment (T1). Methods:We analyzed 53 patients who underwent T2 between 2012 and 2018 using a prospectively maintained single institution database. Baseline characteristics, treatment details, and toxicity data were assessed, with pain responses evaluated via Barrow Neurological Institute (BNI) pain intensity scores. Predictors of pain recurrence and chronic sensory toxicity were identified using univariate and multivariable analyses. Results:The median T2 maximum dose was 70 Gy, primarily targeting the cisternal segment (43 %) and retrogasserian zone (RGZ) (34 %). Following T2, 95 % experienced initial pain relief with a 1-month median time to response, and 1-, 2-, and 3-year freedom from pain recurrence of 51 %, 45 %, and 41 %, respectively. Chronic sensory deficits were observed in 62 % of patients, but motor toxicity remained rare (mastication deficit: 2.5 %; facial motor deficit: 5.1 %). RGZ targeting (HR = 3.84, p = 0.02) and single isocenter treatments (HR = 3.85, p = 0.04) were predictive of pain recurrence when compared to dorsal root entry zone (DREZ) targeting and two isocenters, respectively. Affected trigeminal nerve length <11.5 mm was associated with chronic sensory deficits (OR = 7.14, p = 0.02). Conclusion:GKSRS provides effective pain relief and manageable toxicity in retreatment for refractory/recurrent TN. Optimizing parameters, including DREZ targeting and dual-isocenter strategies, can enhance outcomes, while balancing treatment length to mitigate chronic sensory toxicity. Future research should aim at optimizing treatment parameters to maximize pain relief while minimizing toxicity for these patients.

Purpose To present long-term toxicity and effectiveness outcomes of three prostate high-dose-rate (HDR) brachytherapy schedules: 38 Gy in 4 fractions, 24 Gy in 2 fractions, and 27 Gy in 2 fractions for men with low- or intermediate-risk prostate cancer. Methods and Materials Patients treated with HDR brachytherapy monotherapy for prostate cancer were identified in a prospectively maintained, single institution database. Patients with AJCC T-stage ≤ T2b, Gleason score ≤ 7, prostate-specific antigen level ≤ 20 ng/mL, and ≥2 years of follow-up were included. Results 671 patients were evaluated. 310 patients received 38 Gy in 4 fractions, 129 received 24 Gy in 2 fractions, and 232 received 27 Gy in 2 fractions. Median follow-up was 12.8 years, 10.6 years, and 8.1 years (p < 0.001), respectively. 231 (74.5%), 92 (71.3%), and 81 (34.9%) patients (p < 0.001) had low-risk disease. Rates of acute grade ≥2 GU toxicity were 11.1%, 12.3%, and 25.0% (p = 0.004), while chronic grade ≥2 GU toxicity were 17.0%, 22.6%, and 26.5% (p = 0.06). For low-risk patients, 10-year overall survival (OS), freedom from biochemical failure (ffBF), local control (LC), and freedom from distant metastasis (ffDM) were 86.6%, 93.3%, 97.9%, and 99.3%. For intermediate-risk patients, 10-year OS, ffBF, LC, and ffDM were 89.5%, 82.6%, 90.5%, and 97.4%. Higher PSA, higher Gleason score, perineural invasion, and 24 Gy or 27 Gy treatment schedules were predictors of biochemical failure. Conclusions HDR brachytherapy monotherapy with 38 Gy in 4 fractions was associated with improved long-term ffBF compared with 24 Gy/27 Gy in 2 fractions, without any associated increase in GI or GU toxicity rates.

BACKGROUND:Workplace violence is a serious safety hazard in the healthcare sector and has attracted much attention worldwide, especially for nursing staff. Equipping nursing personnel with protective capabilities for workplace violence can reduce the risk they face in work settings. This study explored scenarios of common violent patient-nurse conflicts in the workplace of hospital nursing staff and their capabilities for de-escalating such conflicts. METHODS:We used a qualitative content analysis for this study. Qualitative interviews were conducted with 21 nurses in two teaching hospitals in New Taipei City, Taiwan, until data saturation was reached. The data were transcribed, encoded, and analyzed and similar concepts were grouped under the same category. RESULTS:Four categories of workplace violence scenarios common to hospital nursing staff were identified: unreasonable requests, caring for high-risk patients, long waiting times for medical consultation, and close contact when caring for patients. Two protective capabilities were recognized: communication and interpersonal capabilities and problem-solving skills. Each scenario may require a different combination of abilities. CONCLUSION:Our findings suggest that a violence-prevention training program could be designed for various workplace violence scenarios to enhance nurses' abilities to de-escalate workplace violence in hospitals.

Occupational Information Network (O*NET) is a comprehensive job analysis repository, developed and periodically updated in the U.S. The study aims to validate O*NET in the Australian context and illustrate the potential to use O*NET as a source of robust occupational research data internationally. We first link O*NET data at the occupational level with individual-level data in the Australian Workplace Barometer (AWB) database containing a sample of 3,829 individuals working in 209 occupations. We then conceptually replicate the primary hypothesized relationships from nine published studies that used O*NET ratings of four job characteristics (job hazards, emotional labour requirements, job autonomy, and task significance) to predict work-related outcomes. Specifically, we selected the same O*NET job descriptors used in the nine studies and linked them to similar but not identical employee outcomes obtained from the AWB database. Multi-level analyses showed that the hypothesized relationships were predominantly supported at the occupational level, demonstrating the criterion validity of the O*NET job characteristic profiles in the Australian context. Overall, our research highlights the potential to use O*NET in research and policy applications on a broader international scale, predicated on obtaining solid validation evidence.

INTRODUCTION: Trigeminal neuralgia(TN) is a debilitating nerve disorder affecting approximately 4.5 per 100,000 people annually. While medical management is the first line of treatment, Gamma Knife Stereotactic Radiosurgery(GKSRS) may be used. Long-term outcomes after GKSRS retreatment are not well elucidated. METHODS: Of the 168 patients treated since 2012 at our institution, 149 had adequate follow-up data, and 53(40.4%) received 2 treatments. The Barrow Neurological Institute (BNI) pain intensity score was used to grade pain. Pain relief was defined as post-GKSRS BNI score of I-III. Treatment failure was defined as post-GKSRS score of IV-V without pain-relief. Pain-recurrence was defined as a post-GKSRS score of IV-V after achieving pain-relief. Univariable analyses were performed to examine the effects of multiple factors on outcomes. RESULTS: Median follow-up was 15(1-63) months; 136(90%) and 49(83.0%) patients achieved pain-relief after T1 and T2 respectively. Median time to pain-relief was 3 months and 1 month after T1 and T2 respectively. Median freedom from pain-recurrence was 24.0 months and 13.7 months following T1 and T2 respectively; 44 (30.0%) and 6 (12.2%) patients developed pain-recurrence following T1 and T2 respectively. High KPS score, V1+V2 pain distribution, and absence of mastication deficits reduced the risk of T1 treatment failure by 21%, 58%, and 54% respectively(p<0.05). Patients with lower BNI scores after T1 had a 39% reduced risk of T2 failure(p<0.001); 2(1.3%) and 4(6.8%) patients developed facial and/or mastication deficits following T1 and T2 respectively. Neither isocenter location nor dose affected outcomes. CONCLUSIONS: GKSRS remains an effective treatment for patients with refractory TN. Our data show that patients who fail or recur after T1 may still receive symptomatic relief following T2 with minimal toxicity. Abstract not yet presented, but accepted for presentation at ASTRO 2022

The workplace can be a major source of stress, and this can cause health problems that have a negative impact on the individuals, organizational, and society. This concise, evidence-based volume, written by a leading occupational health psychologist, explores how work conditions and organizational characteristics pose threats and harms to people’s wellbeing through the lens of occupation stress theories and models. The author then summarizes the potential adverse impacts of major job stressors across individuals, families, organizations, and nations. In a final section, several evidence-based prevention strategies targeting individuals, management, and organizations are explored, including recovery from work, job crafting, and supervisors as change agents. Practitioners can modify and tailor these actionable strategies to assist employees and organizations in managing occupational stress. This book is essential reading for clinical and occupational psychologists, managers, supervisors, and anyone interested in making the workplace a healthier place.

PURPOSE:Shorter courses of breast radiotherapy are offered as an alternative to 4 weeks of whole-breast irradiation after lumpectomy, including brachytherapy. A prospective phase 2multi-institution clinical trial to study 3-fraction accelerated partial breast irradiation delivered by brachytherapy was conducted. METHODS AND MATERIALS:The trial treated selected breast cancers after breast-conserving surgery with brachytherapy applicators that delivered 22.5 Gy in 3 fractions of 7.5 Gy. The planning treatment volume was 1 to 2 cm beyond the surgical cavity. Eligible women were age ≥45 years with unicentric invasive or in situ tumors ≤3 cm excised with negative margins and with positive estrogen or progesterone receptors and no metastases to axillary nodes. Strict dosimetric parameters were required to be met and follow up information was collected from the participating sites. RESULTS:Two hundred patients were prospectively enrolled; however, a total of 185 patients who were enrolled were followed for a median of 3.63 years. Three-fraction brachytherapy was associated with low chronic toxicity. There was excellent or good cosmesis in 94% of patients. There were no grade 4 toxicities. Grade 3 fibrosis at the treatment site was present in 1.7% and 32% percent had grades 1 or 2 fibrosis at the treatment site. There was 1 rib fracture. Other late toxicities included 7.4% grade 1 hyperpigmentation, 2% grade 1 telangiectasias, 1.7% symptomatic seromas, 1.7% abscessed cavities, and 1.1% symptomatic fat necrosis. There were 2 (1.1%) ipsilateral local recurrences, 2 (1.1%) nodal recurrences and no distant recurrences. Other incidents included one contralateral breast cancer and 2 second malignancies (lung). CONCLUSIONS:Ultra-short breast brachytherapy is feasible and has excellent toxicity and could be an alternative to standard 5-day, 10 fraction accelerated partial breast irradiation in eligible patients. Patients from this prospective trial will continue to be followed to evaluate long-term outcomes.

After EGFR-TKI resistance, chemotherapy has very limited efficacy for EGFR+ NSCLC patients. However, the IMpower150 study subgroup analyses shows Atezolizumab (PD-L1) plus bevacizumab and chemotherapy improved overall survival in EGFR TKI treated NSCLC. TQ-B2450 (PD-L1) plus Anlotinib had demonstrated encouraging anti-tumor activity and favorable safety profile in EGFR+ advanced NSCLC patients (Pts) failed to prior EGFR TKI therapies in previously reported phase I Results (Jifeng. Feng, et al. 2021 ELCC 150P).

Worldwide adverse impacts of occupational stressors are timeless concerns to humanity. These impacts not only disrupt mental and health well-being of workers and their families but also impede growth and prosperity of organizations, societies, and nations. In this chapter, we first reviewed to what extent occupational stressors have created burdens on organizations and nations in terms of economic costs (e.g., productivity loss and health care cost) and health outcomes (e.g., morbidity and mortality). After that, we reviewed work-related legislations enacted to address five occupational stressors (i.e., age discrimination, racial discrimination, sex discrimination, sexual harassment, and workplace bullying). To conduct the review, we surveyed these legislations across each continent/ geopolitical region, including Australia, Canada, China, France, Germany, Russia, Singapore, Slovakia, South Africa, South Korea, the UK, and the US. Finally, we summarized the progress of occupational stress research and offered ways of advancing preventive organizational stress management.

The Job Demands-Resources (JD-R) model is a well-recognized theoretical framework assessing the impact of job demands and resources on well-being. Though the model conceptualises job demands and resources in terms of how jobs are both objectively designed and subjectively experienced, most studies have relied only on subjective self-reported data. In a comprehensive test of the model, our study investigates how objective job characteristics at the occupation level are associated with employees’ perceptions of job demands and resources in their role, and examines the indirect effect of objective characteristics on employee outcomes via perceived characteristics. Multilevel analyses of multisource and lagged data from 2,049 employees in 97 jobs indicated that perceived job characteristics mediate the effects of objective job characteristics on employee outcomes. Specifically, the objective requirement for positive emotional displays is positively related to exhaustion through perceived emotional demands. Second, objective job hazard exposure is positively related to physical health problems through perceived physical demands. Finally, objective job complexity has a significant positive indirect relationship with work engagement through perceived skill discretion. The results suggest that risk identification and enrichment processes should consider the nature of the job itself instead of merely focusing on employees’ cognitive appraisals.

Though workplace bullying is conceptualized as an organizational problem, there remains a gap in understanding the contexts in which bullying manifests-knowledge vital for addressing bullying in practice. In three studies, we leverage the rich content contained within workplace bullying complaint records to explore this issue then, based on our discoveries, investigate people management practices linked to bullying. First, through content analysis of 342 official complaints lodged with a state health and safety regulator (over 5,500 pages), we discovered that the risk of bullying primarily arises from ineffective people management in 11 different contexts (e.g., managing underperformance, coordinating working hours, and entitlements). Next, we developed a behaviorally anchored rating scale to measure people management practices within a refined set of nine risk contexts. Effective and ineffective behavioral indicators were identified through content analysis of the complaints data and data from 44 critical incident interviews with subject matter experts; indicators were then sorted and rated by two independent samples to form a risk audit tool. Finally, data from a multilevel multisource study of 145 clinical healthcare staff nested in 25 hospital wards showed that the effectiveness of people management practices predicts concurrent exposure to workplace bullying at individual level beyond established organizational antecedents, and at the team level beyond leading indicator psychosocial safety climate. Overall, our findings highlight where the greatest risk of bullying lies within organizational systems and identifies effective ways of managing people within those contexts to reduce the risk, opening new avenues for bullying intervention research and practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background:Impacts of exposure are generally monitored and recorded after injuries or illness occur. Yet, absence of conventional after-the-effect impacts (i.e., lagging indicators), tend to focus on physical health and injuries, and fail to inform if workers are not exposed to safety and health hazards. In contrast to lagging indicators, leading indicators are proactive, preventive, and predictive indexes that offer insights how effective safety and health. The present study is to validate an extended Voluntary Protection Programs (VPP) that consists of six leading indicators.Methods:Questionnaires were distributed to 13 organizations (response rate = 93.1%, 1,439 responses) in Taiwan. Cronbach α, multiple linear regression and canonical correlation were used to test the reliability of the extended Voluntary Protection Programs (VPP) which consists of six leading indicators (safe climate, transformational leadership, organizational justice, organizational support, hazard prevention and control, and training). Criteria-related validation strategy was applied to examine relationships of six leading indicators with six criteria (perceived health, burnout, depression, job satisfaction, job performance, and life satisfaction).Results:The results showed that the Cronbach's α of six leading indicators ranged from 0.87 to 0.92. The canonical correlation analysis indicated a positive correlation between the six leading indicators and criteria (1st canonical function: correlation = 0.647, square correlation = 0.419, p < 0.001).Conclusions:The present study validates the extended VPP framework that focuses on promoting safety and physical and mental health. Results further provides applications of the extended VPP framework to promote workers' safety and health.

OBJECTIVE:To review practical, evidence-based strategies that may be implemented to promote teleworker safety, health, and well-being during and after the coronavirus pandemic of 2019 (COVID-19).BACKGROUND:The prevalence of telework has increased due to COVID-19. The upsurge brings with it challenges, including limited face-to-face interaction with colleagues and supervisors, reduced access to ergonomics information and resources, increased social isolation, and blurred role definitions, which may adversely affect teleworker safety, health, and well-being.METHOD:Evidence-based strategies for improving occupational safety, health, and well-being among teleworkers were synthesized in a narrative-based review to address common challenges associated with telework considering circumstances unique to the COVID-19 pandemic.RESULTS:Interventions aimed at increasing worker motivation to engage in safe and healthy behaviors via enhanced safety leadership, managing role boundaries to reduce occupational safety and health risks, and redesigning work to strengthen interpersonal interactions, interdependence, as well as workers' initiation have been supported in the literature.APPLICATION:This review provides practical guidance for group-level supervisors, occupational safety and health managers, and organizational leaders responsible for promoting health and safety among employees despite challenges associated with an increase in telework.

Purpose: Adoption of hypofractionated whole breast irradiation (HWBI) for patients with early-stage, biologically high-risk breast cancer remains relatively low. We compared clinical outcomes of conventionally fractionated whole breast irradiation (CWBI) versus moderate HWBI in this patient population. Methods and Materials: We queried a prospectively maintained database for patients with early-stage (T1-2, N0, M0) breast cancer who received whole breast irradiation with either CWBI or moderate HWBI at a single institution. We included only patients with biologically high-risk tumors (defined as either estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2 negative, human epidermal growth factor receptor 2 amplified, and/or patients with a high-risk multigene assay) who received systemic chemotherapy. Inverse probability of treatment weighting was used to compare treatment cohorts and to estimate 5-year time to event endpoints. Hazard ratios (HR) and 95% confidence interval (CI) were determined based on Cox proportional hazards model. Results: We identified 300 patients, of whom 171 received CWBI and 129 received HWBI. There was a statistically significant difference in median age at diagnosis, 59 years for CWBI versus 63 years for HWBI (P = .004), and in median follow-up time, 97 months for CWBI versus 55 months for HWBI (P < .001). After accounting for differences in patient and tumor characteristics with inverse probability of treatment weighting, we found similar 5-year freedom from local recurrence (HR, 0.76; 95% CI, 0.14-4.1), freedom from regional recurrence (HR, 3.395% CI 0.15-69), freedom from distant metastasis (HR 3.9, 95% CI 0.86-17), and disease-free survival (HR 0.84; 95% CI, 0.3-2.4), between those treated with CWBI and those treated with HWBI. Results were similar among each of the 3 high-risk subtypes. Conclusions: Our data support the use of moderate HWBI in patients with early-stage, biologically high-risk breast cancer. (c) 2022 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Objective: To evaluate the relationship between fundal fluid and hearing outcomes after treatment of vestibular schwannoma (VS) with Gamma Knife radiosurgery (GKRS). Study Design: Retrospective case series. Setting: Tertiary neurotology referral center. Patients: Patients treated with GKRS for vestibular schwannoma between March 2007 and March 2017 were considered for this study. Exclusion criteria included pretreatment pure-tone average (PTA) >90 dB, neurofibromatosis type II, history of previous surgical resection, and follow-up less than 1 year. Main Outcome Measure(s): Hearing function was assessed both by preservation of serviceable hearing and by preservation of baseline hearing (≤20 dB change in PTA) after GKRS. Hearing preservation comparisons were made between groups of patients with and without a fundal fluid cap. Results: Patients with a fundal cap had significantly higher rates of baseline hearing preservation (≤20 dB change in PTA) according to Kaplan–Meier survival analysis of all 106 patients (p = 0.006). By the 3rd year posttreatment, 70.9% of patients with a fundal cap had maintained a ≤20 dB change in PTA, while only 43.6% of patients without a fundal fluid cap achieved this outcome (p = 0.004). Conclusions: Fundal fluid present on pretreatment magnetic resonance imaging is predictive of improved baseline hearing preservation rates in patients undergoing GKRS for vestibular schwannoma when considering all patients with PTA ≤90 dB. Fundal fluid cap presence may serve as a favorable prognostic indicator to help set hearing expectations and guide patient selection efforts.

Radiation therapy plays an important role in the multidisciplinary management of breast cancer. Recent years have seen improvements in breast cancer survival and a greater appreciation of potential long-term morbidity associated with the dose and volume of irradiated organs. Proton therapy reduces the dose to nontarget structures while optimizing target coverage. However, there remain additional financial costs associated with proton therapy, despite reductions over time, and studies have yet to demonstrate that protons improve upon the treatment outcomes achieved with photon radiation therapy. There remains considerable heterogeneity in proton patient selection and techniques, and the rapid technological advances in the field have the potential to affect evidence evaluation, given the long latency period for breast cancer radiation therapy recurrence and late effects. In this consensus statement, we assess the data available to the radiation oncology community of proton therapy for breast cancer, provide expert consensus recommendations on indications and technique, and highlight ongoing trials' cost-effectiveness analyses and key areas for future research.

The patient is a 61-year-old woman who originally presented with abnormal results on screening mammogram, with no other symptoms. Her past medical history was significant for amyopathic dermatomyositis with Gottron's papules and heliotrope rash. She was found to have a clinical stage IIB (cT3 cN0 cM0) grade 2 invasive ductal carcinoma of the upper outer quadrant of the left breast, estrogen receptor positive, progesterone receptor negative, HER-2 positive. She underwent neoadjuvant chemotherapy with docetaxel, carboplatin, trastuzumab, and pertuzumab for 6 cycles; however, the pertuzumab was held after cycle 1 owing to grade 3 gastrointestinal toxicity. She underwent a simple mastectomy with sentinel lymph node biopsy and then axillary lymph node dissection owing to failure of sentinel node mapping, with immediate tissue expander reconstruction of the left breast. The patient was found to have at least a 4-cm tumor bed with 40% viable tumor remaining. She had 3 lymph nodes removed, which were all positive for carcinoma. The largest metastatic focus was 20 mm, with extranodal extension. The extranodal extension was described as grossly infiltrative into the surrounding fat. The patient had a flare of her dermatomyositis after her surgery, which required methotrexate treatment. She was started on her expander fills but developed a wound dehiscence (Fig. 1).

With an increase in gender equality policies and gender balance targets within traditionally male professions, organisations such as the police service are experiencing changing demographics. How these shifts influence the construction of professional identity is unclear. Drawing on focus group data, this study aimed to explore identity construction of police officers across gender using a thematic analysis method. Two themes related to identity construction were found to be common to both male and female police officers: 'Working within a blue family' and 'Being a copper is a job for life'. However, the way in which these themes were articulated differed between male and female officers, with male officers experiencing more difficulty than female officers in terms of positioning their identity within the evolving police culture. The findings from this study have implications for gender policies in the workforce as they suggest that men may experience more difficulty than women in adjusting to a gender-diverse workforce, and that professional identity within traditionally male professions is more complex and nuanced than what was previously assumed.