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Going the Distance: Setbacks and a Meaningful Career in Science

On July 4th, me and 60,000 of my closest friends ran in the 50th Peachtree Road Race in Atlanta, Georgia. This was my first 10K run and as a relatively new runner, my inclination for training for this race was to go hard and go fast – a manta not just for running but possibly for my entire generation. But as I would eventually learn, distance running is not about just getting it done. It is about being patient, listening to (and adjusting) my body, and having a long-term mindset focused on the process as much as the goal.

nih rejectionsThroughout my training, I was struck by how similar distance running is to a career in science and to grant writing in particular. When I finished my PhD 10 years ago, I was confident in my ability to write manuscripts and proposals, secure funding, and ultimately do and disseminate the science that would leave a lasting impact on the health of vulnerable populations. This confidence continued even when, during the last few years of my K award, I submitted grant after grant to the NIH only to have them be not discussed repeatedly.  I understood that NIH success rates were low, with institutes reporting a range of success rates from ~10% to 35% in 2018. Mentors reminded me that failure was part of the process and that everyone has a string of not discussed grants in the early phase of their career. I just needed to keep listening to the reviewers, getting more preliminary data, refining my ideas, developing great teams, and above all writing, and eventually my ideas would hit. However, when my string of not discussed/not funded grants grew to 15 (Figure 1), each set of pink sheets more soul crushing than the last, I knew that statistically I was failing more than I should. And I questioned if I should even be in science or if these past few years were just wasted time.

These setbacks can be devastating – causing approximately 10-15% of early career scientists to leave the field. But what about those who stick it out? What happens to them and, more importantly, what is their long-term impact on science? These are the questions explored in a recent article by Yang Wang, Benjamin Joes, and Dashun Wang, “Early-Career Setbacks and Future Career Impact”. Through a series of pretty cool analyses they examined if early success in obtaining an R01 award from the National Institutes of Health led to more success and a higher impact (measured as highly-cited manuscripts) compared to those who almost, but just missed the funding threshold. Essentially, they wanted to figure out among early career health scientists which perspective is true: Do the “the rich get richer” or will “what doesn’t kill you makes you stronger”?

Unsurprisingly, the results were somewhat mixed but encouraging for an early career scientist who has had many misses. While those with near misses had approximately a 10% chance of leaving the NIH funding system entirely over the next 10 years; of the scientists remaining, those who had an early career funding failure wrote higher impact manuscripts, compared to those who had early funding success. This is a striking finding which needs to be carefully considered (specifically that junior scientists do not need additional roadblocks in their path in order to become “stronger scientists”). Yet, the authors do suggest that for those scientists who persevere, “early failure should not be taken as a negative signal” rather viewed as a chance for refining and improving their program of research.

Wang and colleagues start their manuscript with a quote by Robert Lefkowitz, winner of the 2012 Nobel Prize in Chemistry, “Science is 99 percent failure, and that’s an optimist view.”  While he many have been referring to failed experiments, what Wang’s  new analysis reveals is that even the process of obtaining the funding to support research is likely to be fraught with heartbreaking setbacks. But if you’re in science because you believe in its power to answer important questions which will help us to better understand and improve the human condition, perseverance is necessary.

I finished my first 10K in under 60 minutes. Not a medal-winning time but I preserved through the heat, sun, fatigue, and even a bit of pain to cross the finish line. Similarly, late last year I received the Notice of Award for my first R01 from the NIH- leading a research study that I believe in with a team that inspires me every day.  So whether you are submitting your first or 15th research grant, know that setbacks are common and despite the outcome on any one application, with a long-term mindset you can have a lasting impact on science.

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How to Get in the Room Where it Happens: A Conversation with Don Lloyd-Jones About Becoming An Influencer

We’ve all had those moments – where someone we work with, someone in a position to make decisions – big decisions, not the marginal ones – makes THE wrong decision. A new department is created with no resources undermining its long-term viability, or an entire program is eliminated for short-term cost savings. No, I’m not talking about corporations or government. I’m talking about hospitals, clinics, and universities – the places early career clinician scientists hope to work after completing what seems like endless training. Poor leadership is endemic and early career scientists are likely to confront the question, “How to I position myself to influence the issues I’m passionate about?”

To understand this issue, I spoke with Don Lloyd-Jones of Northwestern University. For the past 15 years, Dr. Lloyd-Jones has served in leadership positions on numerous American Heart Association committees including the Statistics Committee, Council on Epidemiology and Prevention (EPI), and co-Chaired the Writing Group for 2013 ACC/AHA Guidelines on the Assessment of Cardiovascular Risk. Given his background of service, it was not surprising that he enthusiastically recommended that all early career clinician scientists become involved with a professional association whose mission resonates with them.  However, it’s important to be strategic about developing your leadership experiences and he offered the following tips.

Tip #1: Be Bold, Work Hard, and if Necessary, Open Your Own Doors

Like other leaders, Don Lloyd-Jones’ mentors introduced him to professional organizations. They advocated he work on the Statistics Committee of the EPI Council, where he helped write the annual Heart Disease and Stroke Statistics Update.  This was hard work, often completed during off-hours but in a timely fashion, and through it Lloyd-Jones established a reputation as a dependable team player. In 2008, as he chaired the stats committee, the AHA was thinking about the strategic impact it wanted to have on cardiovascular health over the next several decades. Described as a “moment of serendipity,” Lloyd-Jones was asked to chair what would become The American Heart Association’s Strategic Impact Goal Through 2020 and Beyond. For him, this was a “career-defining experience where we helped to pivot the AHA from preventing death to promoting cardiovascular health.”

While having a mentor connect you to committees and networks is an efficient way to get involved, it is not the only way to get in the room. For AHA and other professional organizations, introducing yourself to the committee’s Chair, Vice-Chair, Past-Chair and the nominating committee can get you on their radar. Then follow up with an email letting them know that you would love to work on their committee, asking how you can get more involved. When a door opens, even if it’s not exactly the one you wanted, “show up, do the work, share what drives you, create a reputation as a contributing team member, and in doing so you will have almost limitless opportunities to meaningfully effect change.”

Tip #2: Find Your Niche First

While every early career professional should plan to become involved with professional organizations, it is important to first establish a clinical niche or stabilize a successful lab before assuming a leadership position. Once that is accomplished, plan to quickly engage with professional societies because at that time, you have developed a substantive understanding of your field and will bring a voice to the table that will be respected, valued, and sought after. This inflection point often occurs mid-way to the end of one’s Career Development Award and should be planned for and strategically pursued.

Tip #3: Know What You Want

Reflecting on yourself – your goals, capabilities, and weaknesses – is a common theme in leadership books. A critical look at what you want from a leadership experience will help you select the right one and maximize its benefits. In the short-term, if you want highly-cited publications, working with the stats committee might be a great fit. Or if you have a long-term vision of assuming national leadership roles, you may want to try out different committees to see which one aligns with your preferred areas of strategic influence. However, all true leadership engagement, whether at a regional or national level, will lead to a meaningful and expanded professional network. As Dr. Lloyd-Jones stated, “Serving allows you to make connections in robust ways. These new connections can be called upon for letters of support for promotions and tenure or for grant applications. And the personal connections developed through engagement will matter far more than the name of the person who is writing because they bring a lot more color to the applicant.” And over time these professional colleagues can become friends. He shared, “The friendships that you make in AHA, perhaps due to its altruistic nature, are quite unique. AHA draws remarkable people who share a vision to promote health and many become lifelong friends. Why wouldn’t you want to be a part of that?”

Tip #4: Be Open to Change

While many people pursue leadership experiences because they want to change the outcome, oftentimes we are changed by the process of leading with others. Yes, we will have bigger networks, busier travel schedules, and fewer free hours but all of this also changes us — our empathy, perspective, time-management skills, and our ability to adapt to new and ever-changing contexts. For Lloyd-Jones, his two years working on the 2020 strategic impact goals, “Substantially changed the focus of my research, what I talk about, what my whole department is focused on, which is increasingly on children and helping them get a healthier start in life. It’s been a wonderful gift.“

In their review article, Warren and Carnell describe the non-technical skills needed for health care leadership including “creating and communicating a vision, setting clear direction, service redesign and healthcare improvement, effective negotiation, awareness of both self and others, working collaboratively and networking.” No one is born knowing how to create and clearly communicate an inspiring long-term vision for change and collaborating to turn that vision into reality. It takes time, practice, failure, courage, and continued investment. Should you choose to pursue your own leadership path, I hope the time, work, and energy you spend developing influence will be among the most fulfilling investments in your career.

Or as Lin-Manuel Miranda wrote:

“….When you got skin in the game, you stay in the game
But you don’t get a win unless you play in the game
Oh, you get love for it, you get hate for it
You get nothing if you
Wait for it.”

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Paradigms and Progress in HIV and Cardiovascular Health

 “Led by a new paradigm, scientists adopt new instruments and look in new places” – Thomas S. Kuhn

For a lot of rational (and some irrational) reasons, hearing the word HIV evokes fear, anger, and sadness. When I first heard about HIV, I was an elementary school student in late 1980’s and at that time, HIV was almost always a death sentence.  But today that is not the case.  Today, due to the hard work of scientists, patients, volunteers, advocates, and countless others, HIV is a chronic, manageable disease. An accomplishment epitomized by the oldest known person living with HIV recently turning 100 years old.

living with HIV graph

While this progress and longevity should be celebrated, the flip-side of age is that it is the primary driver of cardiovascular disease (CVD). In fact, this longevity has ushered in a new era where adults living with HIV are at exceptionally high risk of cardiovascular diseases including heart attacks, heart failure, and stroke. A recent meta-analysis by Anoop Shah, MD, from the University of Edinburgh, found that the global burden of HIV-associated cardiovascular disease has tripled in the past 20 years, especially in low and middle-income countries. Now, after more than two decades of accumulating evidence in this field, the American Heart Association released earlier this month a Scientific Statement on the characteristics, prevention and management of cardiovascular disease in people living with HIV.

Directed at all who support adults living with HIV, this statement is a general roadmap for raising awareness about the increasing burden of CVD in this population. However, it offers few new tools for providers to use, due primarily to the lack of high-quality “clinical trial data on how to prevent and treat cardiovascular diseases in people living [and aging] with HIV investigating cardiovascular endpoints” said Matthew J. Feinstein, M.D., M.Sc., chair of the writing group for the statement and assistant professor of medicine at the Feinberg School of Medicine, Northwestern University.

Still, what the existing (mostly observational) evidence allowed the writing group to do was to develop a pragmatic approach to assessing and preventing cardiovascular disease in treated HIV (Figure above). This approach includes the following:

  • Ensure all patients living with HIV are on effective HIV treatment
  • Determine risk of cardiovascular disease using tools such as ACC/AHA 10-year ASCVD risk estimator and a family history
  • Optimize lifestyle approach to prevention (e.g., smoking cessation, physical activity, healthy diet intake)
  • If at high risk and between the ages of 40-75 years, talk with the patient about the risks and benefits of lipid-lowering therapy while exercising caution for drug-drug interactions

Yet, while the new AHA Scientific Statement will be an important catalyst for the field, in many ways it creates more questions than answers. For example, are we shifting to a new paradigm in HIV care? Do we need new tools to help reduce CVD in this population or are the general recommendations for risk stratification and lifestyle optimization sufficient?  What is the most effective way to get either existing or new clinical tools to the high-risk patients living with HIV?

Fortunately, some of these questions are starting to be answered. The REPRIEVE study is the first large scale (>8,000 people) clinical trial to test if a daily statin reduces cardiovascular disease in adults living with HIV. Results are expected in the next 3-4 years. Additionally, the PRECluDe grants at the National Heart, Lung, and Blood Institute have stimulated new implementation science research focused on understanding how to best adapt effective CVD prevention studies to the real-world settings where people living with HIV receive their health care. These initiatives, coupled with ongoing research on the discovery of mechanisms of CVD and the testing of CVD prevention interventions in people living with HIV, will eventually allow for the development of guidelines on the prevention and management of CVD in HIV—the true instrument needed to help improve cardiovascular health for all adults living with HIV.

 

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Seeing and Serving Invisible Populations

Like many of you, I chose to be a nurse because I wanted to serve people during their most vulnerable times, knowing that this work would make a difference. Working with people at their most vulnerable has taught me a lot, including that my patients can be braver, kinder, more frightened, angrier, disappointed, lovelier, and in general more surprising than I expect when I walk in the door.

A growing and perhaps surprising population at disproportionally high risk for heart attacks are individuals who identify as transgender. Transgender individuals are those whose gender identity is different from the sex they were assigned at birth. People identifying as transgender can be any age or race, from any background, and reside in all 50 states. In 2016 there were approximately 1.4 million people in the United States who identified as transgender.  Given the increase in the transgender population, new initiatives are attempting to understand the unique health needs of this population in order to provide high-quality health care. Little is known about the cardiovascular health of this population, which prompted a recent study by Dr. Alzahrani from George Washington University who found that the transgender population had a higher reported history of heart attacks compared with the cisgender (those whose gender corresponds with their birth sex) population.

This first-of-its-kind study examined approximately 720,000 U.S. adults who completed the telephone-based Behavioral Risk Factor Surveillance System survey, conducted by the Centers for Disease Control and Prevention between the years of 2014-2017. Of these, 3,055 adults identified as transgender. In gender stratified analyses, Dr. Alzahrani and colleagues found that after adjusting for known cardiovascular risk factors transgender men had (i.e. they were told by a doctor, nurse or health care professional that they had a heart attack) compared to cisgender men and women. And transgender women had a 2-fold increase in the rate of heart attacks compared with cisgender women. Importantly, the investigators also found that transgender men and women were more likely to smoke and be sedentary, and that these and other traditional risk factors were associated with increased odds of experiencing a heart attack. This suggests that while there are about the long-term cardiovascular risk of gender affirming-hormones, mitigating these traditional risk factors are important first line targets for this and all populations.

In an accompanying editorial Dr. Paul Chan evoked Ralph Ellison’s Invisible Man, citing the narrator “I am invisible, understand, simply because people refuse to see me.” Dr. Chan states that today transgender individuals are invisible. But they don’t have to be. We have to actively reject any implicit or explicit expectations we have about this population and simply see them and treat them as they present. This sentiment is echoed by Dr. Billy Carceres, Nurse and Post-Doctoral Fellow at Columbia University Program for Study of LGBT health, “There’s this perception that we can spot transgender people; but if we don’t ask the question about gender identity we might be missing out on people who are at risk. Patients want to have conversations with health care providers about things that influence their health.”

Table 1 lists several steps that can help us start to have these conversations. Adopting such steps in our clinical practice and research are critical against the backdrop of the increased social stress, poor socioeconomic status, health disparities, violence, and a perpetuating fear of mistreatment by healthcare professionals experienced by transgender populations. These steps will help us to see this invisible population, gain their trust, and ultimately help engage them in activities to improve their cardiovascular health.

Table 1. Steps to Reducing Cardiovascular Risk in Transgender Populations

  1. Assess the gender of all your patients or research participants on multiple levels
  2. Ask which pronouns they would like you to use
  3. Understand the terminology used by the trans community
  4. Recognize that transgender people may avoid seeking out health care because of fear of discrimination and create a safe and welcoming environment
  5. Assess all potential cardiovascular risk factors for transgender patients and work with them to collaboratively develop a plan to reduce their risk factors
  6. Learn more about the unique health care needs of your transgender patients. Your health care institution may have good local resources and the Center of Excellence for Transgender Health at UCSF and the World Professional Association for Transgender Health have up-to-date resources.

While Dr. Alzahrani’s new article highlights a significant disparity in an often overlooked and vulnerable population, ultimately we need a lot more data before we can develop and tailor cardiovascular treatment guidelines for transgender populations. As Dr. Sangyoon Shin, Medical Director of Co-Management Service for Gender Affirmation Surgery of Mount Sinai stated, “Its important to realize that the transgender population has specialized needs because they are more marginalized and face high rates of discrimination; But the health care practices the guidelines geared towards them need to be just as evidence-based as with any other population.“ Anything less would be a disservice.

People who seek out a health care provider – a nurse, physician, physical therapist, or pharmacist – do so because they need our help. Our job is to serve them, all of them, as they are, with high quality evidence-based health care. How we treat invisible populations, no matter how different or perplexing they are to us, is the true mark of our professionalism.

 

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A Tale of Two Heart Attacks

Differentiation between Type 1 and Type 2 heart attack according to the condition of the coronary arteries (Thygesen, et al., 2012, Circulation)

Differentiation between Type 1 and Type 2 heart attack according to the condition of the coronary arteries (Thygesen, et al., 2012, Circulation)

Crushing. Stabbing. Gut-wrenching, knock the wind right out of you sort of pain in your chest, arms, neck, jaw or back.  This is how we commonly think of heart attacks and for patients and their loved ones – it is the worst of times. But just before the pain or discomfort starts, your body is adjusting to the cause of the heart attack and those causes can be classified as either Type 1 or Type 2 heart attacks. There are actually 6 types of heart attacks, but the vast majority of heart attacks, including those experienced by people living with HIV, are either Type 1 or Type 2.

A Type 1 heart attack is when a person has a sudden block in their blood flow, usually related to a blood clot that has broken off from a plaque, resulting in reduced oxygen going to the heart and death of heart muscle cells.  Whereas a Type 2 heart attack is when the heart needs more oxygen than it gets, due a number of potential causes including a spasm of the heart vessels, critical illness (including sepsis, very low blood pressure, and respiratory failure), or those undergoing surgery.

As I’ve previously written, HIV doubles the risk of heart disease and doubles the risk of having a heart attack. But in order to understand how to reduce this risk, we need to better understand what causes heart attacks in people living with HIV.  Building on previous work demonstrating that half of the heart attacks in people living with HIV are Type 2 heart attacks, Crane and colleagues recently presented new research on the differences in types of heart attacks among people aging with HIV. In over 27,000 adults living with HIV, the investigators determined the type of heart attack, probable cause of all Type 2 heart attacks, and looked at the rates of heart attack by age.

causes of type 2 myocardial infarction among people living with HIVThey identified over 1,000 Type 1 and 2 heart attacks and found that age was a primary predictor of the incidence and type of heart attack. Younger people with HIV had 10-fold more Type 2 than Type 1 heart attacks (although rates were low – only 22 heart attacks in this age group).  Starting in their 50’s, people living with HIV experienced significantly more Type 1 heart attacks than Type 2. Most interestingly were the heterogeneous causes of the Type 2 heart attacks including sepsis, respiratory failure, pneumonia, hypertensive emergency, and GI bleeds (Figure 1).

When asked what initially prompted this work, Dr. Heidi Crane from the University of Washington Center for AIDS Research states, “As an awareness of the importance of Type 2 heart attacks has grown in the general population, we were struck that there was so little data in people living with HIV- a population which has twice the rate of heart attacks as the general population.” This new study demonstrates that younger adults living with HIV are more likely to have Type 2 heart attacks from heterogeneous causes, which change the prevention strategies needed for this group.  While prevention strategies for Type 1 and 2 heart attacks require attention to traditional risk factors, we also need to pay attention to other non-traditional causes that may put someone with HIV at risk for heart attack due to supply-demand mismatch. Ultimately, these prevention strategies will need to be as heterogeneous as the causes. Dr. Crane continues, “There’s not going to be an easy fix for Type 2 heart attacks, there’s a lot going on and we will need to dive deeper to understand how to best tailor strategies to the individual patient.”

And yet, we’re often told that we need to treat the patient, not the disease. But in order to treat the patient, we have to know them, listen to them and understand the risk factors that they face as individuals for heart attacks. Whether it is a chronic disease like HIV infection or some other inflammatory condition, we will need to avoid the temptation to apply blunt prevention strategies, and favor the more challenging personalized solutions.

What are your experiences diagnosing and treating Type 2 Heart Attacks? How can we do a better job preventing them in people living with HIV and others at high risk? Tweet at me at @AllisonWebelPhD to follow the conversation.

 

Thumbnail photo credit: Photo by Kelly Sikkema on Unsplash

Thumbnail photo credit: Photo by Kelly Sikkema on Unsplash

 

 

 

 

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A Profile in Mentorship: Dr. Thomas Pearson

Every scientist, even those who are particularly good at hiding away in their offices, will have an impact on others. Most of the time, this impact is a byproduct of our everyday work. We don’t give it much thought – it just happens. But what if that impact was not accidental, and instead was a deliberate, strategic path of choices that build up those around us – even those who disagree with us, compete with us, and threaten us? That is the path that has been trodden by Dr. Thomas Pearson who was awarded the 2019 AHA Council on Epidemiology and Prevention Mentoring Award.

Dr. Pearson has an impeccable academic pedigree and an enviable career. After an early start at the University of Wisconsin, he earned his Bachelor of Arts, MD, MPH, and PhD all from the Johns Hopkins University. He has achieved the goal of every early career scientist – over 35 years of continuous NIH support and is a Fellow of the American Heart Association, American College of Cardiology, the American College of Preventive Medicine, and the American College of Physicians. But the degrees, grants, and accolades are a byproduct of a man driven to service for the love of science.

Dr. Pearson’s own mentors reflected his insatiable curiosity. As a student, he drew from a broad mentoring team that left lifelong impressions of the qualities of good mentor. While excellent teaching was important, more so was the “utterly frank” assessment and advice they provided him. He states, “from them I learned that the primary role of a mentor is to provide an honest, encouraging perspective on the mentee’s ideas, plans and experiences. While some mentors may be tempted to acquiesce or tell mentees what they want to hear- that is abrogation of their responsibility of a mentor.” Such frankness can be tough in today’s academic environment, so to help cultivate this skill, Dr. Pearson’s University of Florida developed the Mentorship Academy. Equally important to learning how to deliver a frank assessment of the mentee is helping the mentee learn how to receive and act upon such advice without taking umbrage to it.

Additionally, Dr. Pearson offered this advice on how early stage professionals can intentionally become effective mentors, including:

  • Be a good communicator. Communication is the basis of mentoring. Good communication should include developing shared expectations of the goals, responsibilities, and processes of the mentor-mentee relationship. Many of the problems that occur in the mentoring relationship result from a misalignment of expectations and reality. An honest conversation, with both parties being active listeners, about the mentor and mentee’s strengths, weaknesses and goals early on in the relationship can set both parties up for success.
  • Broaden your network. Every day we hear about new grants, interesting conferences, and visiting professors. Yet because they are just starting their career, mentees may not hear about the same opportunities. Part of being a good mentor, Dr. Pearson suggests, “is to continually be looking out for opportunities for your mentee and actively encouraging them to pursue them”. This includes inviting a mentee to a lecture and offering to introduce her to the speaker. Opening this door can help a mentee broaden her professional network and embolden her to pursue new opportunities.
  1. Focus on the mentee. The mentor must recognize the mentee is not “hers.” Rather the mentor should focus on the mentee’s needs and goals and, if she finds another investigator can provide a better opportunity for the mentee, help to arrange it. Dr. Pearson states, “Mentoring and selfishness are like oil and water- they don’t mix.”
  2. Stay curious. In his acceptance speech, Dr. Pearson talked about how much he learned from each of his mentees. They taught and inspired him as much as he did them. But that can only happen by accepting that mentoring is a partnership in which each person has a lot to offer. Good mentors need to be curious about their mentees and excited about learning from them.

Dr. Pearson has mentored over 60 people during his career. Many have gone to have equally enviable careers where their impact reverberates into every corner of our profession. He told me, “You never really stop mentoring a mentee. People I mentored still call me and talk about their career, their family. At some point, they start being friends.”

Mentors – true mentors – view their work not as a requisite service but as a thread that weaves together the knowledge of the current and past generations to the next. Mentors are the foundation upon which scientific progress is made; and their impact is the greatest when their mentoring is done with humility, enthusiasm, compassion, curiosity, and an infallible sense of optimism. These are the traits Dr. Pearson embodies; and are the ones that all who seek to see further should strive to emulate.

 

 

 

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Engaging in the Conversation of Science: Its Time for You to Take an Active Role

Every day, headlines scream about cures, causes of disease, and questionable scientific advances. While many health reporters work hard to get the science right and translate it into something digestible for the public, they are still subject to pressures that can lead to less than precise articles. And once a scientific paper or abstract finds its way on to social media, the “facts” can be distorted into something barely resembling the original results, leaving scientists and the authors of the paper cringing. Given the speed of information-sharing today and the resulting imprecision, NOW is the time for all scientists (including early career scientists) to actively engage the lay public in the conversation of science through all means possible – even social media.

This was the topic of the early morning, early career presentation Bailey DeBarmore and I gave at the 2019 AHA EPI Lifestyle Scientific Sessions. To be honest, using social media to disseminate my science was definitely not something I learned in graduate school. In fact, my first exposure to blogging was through the TV character Barney Stinson, and for most of the past 15 years, I thought blogging was typically superficial and shameless. However, recently I have seen (and used) its immense power to share my own science. These experiences convinced me that social media may be one of the powerful tools we have to actively engaging and shaping in the conversation of science.

https://unsplash.com/photos/0gkw_9fy0eQWhether or not scientists should blog has been hotly debated. In 2018, Eryn Brown and Chris Woolston published a persuasive article on why science blogging matters in Nature. They list a number of benefits to blogging including furthering one’s career, recruiting more bright minds to science, creating a new community of scientists, and it can further the reach and understanding of science (by both the public and often by the scientist herself). Those are significant reasons to write a science blog. But, if you’re someone like me and didn’t really understand what blogging was, you may be wondering how to start.  There are several ways to get started writing science blogs:

  • Write your own. Brown and Woolston mention a several blogs started by scientists including Small Pond Science. This is a viable option, and there are a number of books and companies ready to help anyone start to blog for a fee. However, it can be a lot of work. Not only will you have to create the content, you will need to create and maintain the website, as well. Depending on your experience with website creation, you may not want this to be your first foray into science blogging.
  • Work with your professional organization. Many professional organizations including the American Heart Association, The American College of Sports Medicine, and the American Society for Nutrition have active blogs. And all blogs need one thing to stay relevant – content. As professional organizations have recognized the power of social media and blogging to advance their noble goals, they have increasingly worked with their members to help develop and promote accurate, timely, and engaging blogs. Some, like the American Heart Association and the American Society for Nutrition, have formal programs that provide both the blogging platform and training to help improve the quality and reach of the blog. (See links above to learn more about these great programs)
  • Collaborate with your journal editors. Increasingly, journals are offering authors the opportunity to create video abstracts, blogs, and podcasts on their accepted manuscripts. While it may seem like one more tedious or abstract thing to do, these can be highly engaging mediums on which to share your work. After all, if you’ve just spent years working on a research study that has somehow been condensed to 8 single-spaced pages, don’t you want that paper to have the maximal amount of impact?

Hopefully by now you’re convinced that that science blogging can be a helpful tool and want to see how you can test it out yourself. But science bloggers are [often] not paid, and if something is going to take away from your teaching, patient care, grant writing and manuscript writing time, then there needs to be a way to derive academic benefit from it. We need metrics – specifically metrics that your promotion and tenure committee can appreciate. So I’ll conclude with a couple of tips for benefiting from blog writing.

  • Put your blogs on your CV. Edge for Scholars has great advice for how to cite a blog post on your CV (note they also publish some great early career academic blogs, as well).
  • Get your analytics (page views, geographic reach of your blog, number of times shared) and use them. You can include your analytics in your CV and also use them to highlight the reach of your science and your national and international impact on your 3- and 5- reviews.

 

If you like this blog or have any questions, let me know. I’d also love for you to share some of your science blogs with me on twitter at @AllisonWebelPhD and tell me how they helped you better engage in the conversation of science. Happy Writing!

 

 

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Red Dresses & Red Ribbons: What Every Health Care Provider Needs to Know about Cardiovascular Disease and HIV in Women

Lead Image (created by Cynthia Rentrope):

Lead Image (created by Cynthia Rentrope):

Each February, we celebrate Go Red for Women – a time for healthcare providers to reacquaint ourselves with the shocking fact that on average one woman dies from cardiovascular disease (CVD) every minute – and recommit to doing better. In the United States and the around the globe, women living with HIV are at higher risk for developing cardiovascular disease, yet not all women are affected equally. There are disparities in the quality of cardiovascular care in women, especially younger women, compared to men. Simultaneously, women living with HIV are at increased risk for cardiovascular disease than HIV uninfected women and receive less guideline-based cardiovascular care. In order to provide better preventative, diagnostic, and curative care we have to understand why women living with HIV are at higher risk for cardiovascular disease and stroke and what we can do about it.

Women living with HIV are at higher risk for CVD and stroke

The reasons why women living with HIV are at higher risk for CVD and stroke are not entirely understood. However, scientists have described several likely reasons. HIV is an inflammatory disease and women infected with HIV have higher levels of inflammatory cytokines and markers of immune activation. In turn, this inflammation may increase the risk of CVD by accelerating development of atherosclerotic plaques and making these plaques more ‘vulnerable’ to rupture, causing more heart attacks and strokes. Additionally, we recently reported that inflammation was also associated with reduced cardiorespiratory fitness in adults living with HIV, which may help explain this increased risk. Women living with HIV have elevated rates of depression, obesity, stigma, and homelessness, also associated with increased CVD.

However, there are also unique biological factors that increase the risk for CVD in women living with HIV, particularly with aging. According to Dr. Sara Looby RN, PhD, Assistant Professor of Medicine at Harvard Medical School and Massachusetts General Hospital, hormone changes experienced during menopause such as estrogen loss and reduced ovarian reserve may negatively influence immune activation and the development of subclinical CVD in women living with HIV.  Her current study funded by the National Institute of Allergy and Infectious Disease is exploring this and the results are expected in the next 4 years.

Strategies to Reduce the risk of CVD in Women Living with HIV

Yet it is not enough to know there is a risk and even to partially understand why; health care providers- cardiologists, nurses, primary care providers, and HIV and emergency room physicians -chose their profession because they wanted to improve health. And all of us have an important role in helping women living with HIV accomplish this goal. There are several evidence-based strategies we can use to improve cardiovascular health in this population.

  • Take HIV medications. This strategy is well known among HIV nurses and physicians but those not trained in HIV may not realize the significance of HIV medications to reducing CVD in this population. Having a suppressed HIV viral load, obtained through adherence to effective HIV medicines, is consistently associated with reduced CVD.
  • Recognize and treat the cluster of traditional cardiovascular risk factors in HIV. Increased traditional cardiovascular risk factors in women living with HIV, including hypertension, dyslipidemia, diabetes, and obesity, need to be effectively addressed using guideline-based care. For a good resource on how to do this, check out the American Heart Association’s Life Simple 7
  • Assess sex-specific risk factors in women including menopause history. This may not be routine for HIV, cardiovascular or family health providers but it is important for understanding cardiovascular risk. Increasing evidence indicates we should use a woman’s menopause history to improve understanding of her risk of CVD and provide good cardiovascular treatment. Other health conditions unique to women, such as a history of pre-eclampsia, can also influence risk and are recommended as “risk enhancers” in the most recent AHA Cholesterol Practice Guidelines.
  • Engage women in their cardiovascular health. While this may be the hardest strategy to implement, it is the most important because for so long, women living with HIV have focused on surviving HIV that they do not perceive they are at elevated CVD risk. Dr. Looby acknowledges, “It can be difficult to find time to do this given the competing demands of clinical care, but education is essential to empowering women living with HIV to become active participants in their care. Delivering education in plain language that is easily understood by patients. Asking patients basic questions like, “Do you know what heart disease is?” or “Do you know your cholesterol levels and what they mean?” can provide simple snap shots of important information that can be built upon at subsequent visits, or followed up by providing supplemental educational materials.” Through this patient-focused engagement women living with HIV will be able to take charge and reduce their blood pressure, cholesterol, weight, and smoking resulting in improved cardiovascular health.

Almost every minute a woman dies from heart disease. But they don’t have to. We are privileged to serve in a profession dedicated to improving the health of our fellow humans. But human health is complex and, for women living with HIV, we cannot just treat their HIV or their CVD or their depression or their symptoms of menopause- we have to treat these intertwining conditions together. There are countless barriers to doing this well, and as new models of delivering cardiovascular care in HIV are under investigation, I am confident we will learn how to do this better. In the meantime, we have start today and commit to implementing strategies in our own practice to improve the heart health of women living with HIV.

 

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A New Year, A New Story: Tips for a Healthy Lifestyle in 2019

A new year presents a new opportunity for improvement. Each year, thousands of advertisements beckon us to join or buy the most recent fitness and wellness craze – wearable technologies, personal coaching, pea protein and oat milk. However, if trends are not your thing, you may find it reassuring that “traditional” fitness and wellness strategies (e.g., training for a 5K walk/run, taking the stairs instead of the elevator, and reducing your sugar intake) can also be re-imagined and integrated into your daily routine leading to a healthier, and likely happier you.

Perhaps contrary to the many images trying to sell wellness products, adopting fitness and wellness strategies are equally if not more important for those who are living with a chronic disease. In November 2018 at the American Heart Association Scientific Sessions, the Physical Activity Guidelines were updated and, for the first time, specified that physical activity can help to manage chronic conditions including decreasing pain, reducing the rate of progression for high blood pressure and diabetes, reducing anxiety and depression, and improving cognition in those with chronic comorbidities. These critical health outcomes symptoms are particularly important for adults living with HIV, who tend to experience worse symptoms than many living with other chronic illnesses – and consequently, they may stand to benefit the most from increased and improved physical activity.

Figure 1 Photo by Christine Schmitt via flickr (http://bit.ly/2LZufoz)

However, in addition to physical activity, nutritional intake is a critical part of improving health and wellness among adults living with HIV. A recent practice paper of the Academy of Nutrition and Dietetics found that nutritional status affects the overall health and longevity of this population. They suggest that improved diet can lead to reduced blood pressure, obesity, and diabetes, which will result in improved cardiovascular health. Lead author of the report, Amanda Willig, RD, PhD, from the University of Alabama at Birmingham, suggests that when anyone (especially someone with a chronic disease such as HIV) is starting to adopt a new diet to “Remember, the enemy of good is perfect. A perfect diet is not needed to see big changes in your health.”

So what are the good diet changes needed to improve health? Regardless of one’s HIV status, Dr. Willig’s recommendations on healthier eating are the same: “Watch your portion sizes, try to eat vegetables every day / fill ½ of your plate with vegetables at meals, limit the amount of sugar in your diet, and choose water over sugar sweetened beverages like soda, sports drinks or sweet tea.”

However, for those with HIV, there are some special considerations. While the evidence is still emerging, Dr. Willig indicated that those with HIV may need more Vitamin D than they did prior to their HIV infection for their overall health.  And if one’s CD4+ T-cell count is less than 250, they may want to avoid eating raw or undercooked meat and seafood, as they be at higher risk for food poisoning. Additionally, for the growing number of people living with HIV who are over 50, they may need to increase their protein intake from 0.8 grams per kg per day to 1.2 grams per kg per day. This will help with maintaining muscle mass and preventing bone loss.

Yet whether you are decreasing your portion size or increasing your daily protein intake, changing behavior can be hard and as we age, it can seem complicated and sometimes discouraging. In addition to seeking help from registered dietitian or a Physician Nutrition Specialist who can help you decide which lifestyle nutrition plan is best suited to you, Dr. Willig also suggested several tips for adopting a healthy diet in 2019 (see insert).

 

Dr. Willig’s Tips for Adopting a Healthy Diet in 2019

  • Keep a food diary for 3-4 days to learn not just what you are eating but why.
  • Start with the small steps that can produce big changes, such as cutting out sugary drinks or not eating during the night.
  • Regardless of the nutrition plan, portion sizes still matter. One can eat too many of the “right” foods, so learn what a portion of the foods you eat actually looks like.
  • Make sure your nutrition plan fits your lifestyle. If you want to cook, you can to experiment with baking and sautéing instead of frying foods. If you travel often, learn to read nutrition labels and restaurant nutrition information to avoid eating too many calories.

 

Additional strategies can be found on the American Heart Association’s Healthy Living Website.

As you start to navigate how to start the year committed to becoming healthier you, there will undoubtedly be challenges – busy schedules, competing demands, mood, weather and so on. But you can overcome them and take small steps to become a healthier you in 2019. As you start this journey, consider the words of writer Alex Morritt, “New year — a new chapter, new verse, or just the same old story? Ultimately we write it. The choice is ours.” The new year has just begun, and regardless of your age, sex, health status, or neighborhood in 2019 you get to write your own story – one in which you relentlessly pursue a healthier you.

 

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Feel Like An Imposter? Strategies For Dealing With Early Career Self-Doubt

As we were wrapping up our first editorial meeting for the AHA Early Career Bloggers on Saturday at Scientific Sessions 2018, the new bloggers were given this advice: “Over the next three days, do something [at Scientific Sessions] outside of your comfort zone.” This year’s Scientific Sessions offered some novel experiences –  augmented reality in the Cath Lab, network analysis for high throughput data, and machine learning for dummies. But the thing that made me the most uncomfortable was having my research recognized by my council.

If you have read my World AIDS Day blog, you know that most of my research and clinical work has been in the field of HIV. I came to the cardiovascular space out of necessity because my patients living with HIV were developing cardiovascular disease at higher rates than those without HIV. I never worked as a CICU nurse or in cardiac rehabilitation, and I still get confused about the many different types of antihypertensive medications. I could reasonably be considered a cardiovascular carpetbagger. Yet I work hard to understand cardiovascular science and practice guidelines because I know it is important to helping people living with HIV enjoy the healthiest life possible. Knowing this, about five years ago, my mentors pushed me to get more involved with the American Heart Association which has led me attend various AHA conferences, review abstracts, and apply for (and receive) AHA Research funding.

This year at Scientific Sessions, I was honored with the Council on Cardiovascular and Stroke Nursing (CVSN) Research Article of the Year Award. It is an incredible honor recognizing work that I am proud of. And while I am grateful to the CVSN and the sponsor for this award, my first thoughts after receiving the notification of award  were, “Wow, this is amazing,” quickly followed by, “Why me? Why an article on improving cardiovascular health in people living with HIV? Maybe they didn’t get other nominations.”  I felt undeserving and uncomfortable being honored for work I invested the last three years of my life in and I could not understand why.

Imposter Phenomenon, or Imposter Syndrome, first defined in 1979 by Clance and Imes, are feelings of fraudulence by high achievers who “do not attribute their success to their own abilities despite their many achievements and accolades.”  Recent research suggests most professionals can relate to these feelings, but it can be especially prevalent as new roles are taken on, especially in first jobs or new challenges. While Impostor Syndrome is associated with academic success, it is also associated with poor mental health outcomes including anxiety, depression, psychological distress, and minority student status stress.  There is also  evidence that Imposter Syndrome can make one reluctant to seek out new professional opportunities. Thus, Imposter Syndrome may be especially stunting to early career scientists and clinicians.

Strategies for Managing Imposter Syndrome

  • Recognize that many people have the same feelings of self-doubt at some point in their career
  • Talk about it and ask your trusted mentors and colleagues about their own feelings of being an imposter
  • Write down your strengths and how those led to your accomplishments
  • Develop a strong, safe social support network to share your feelings of self-doubt
  • Read about/listen to others talking about imposter syndrome, there are many great resources available which can help you contextualize your experiences
  • Be present for others who are going through similar experiences

The strategies for managing Imposter Syndrome are timeless but seem hard to achieve. A recent paper by Dr. LaDonna and colleagues in Academic Medicine suggests that having senior colleagues speak openly about their own experiences with self-doubt can have a positive effect. In addition to open discussion about self-doubt, is the importance of a strong support network the importance of perspective and reflection on their own strengths in order to expel “negative views of their own flaws”.

While such strategies may seem contradictory to social media which often highlights success but rarely failures, a recent twitter discussion on Imposter Syndrome (hosted by Emma Clayton of NHS Women Leaders) did just that. This discussion reveled many useful strategies and resources and created a space for people to share their experiences with imposter syndrome with others who had similar struggles. Emma is currently building a website designed to serve as a hub for women to come together and mentor each other as they seek new leadership roles, which should be up later this month.  In reading through her thread, I realized that my feelings of unworthiness can be a double-edged sword and that in the end I just need own it. I need to let my discomfort with my success drive me, not distress or diminish me; motivate, not isolate, me; and above all else,  never let it hold me back from confidently, passionately,  pursuing my goals.

As you reflect back upon your accomplishments in 2018, I hope that you have not feelings of being an imposter stop you from enjoying those successes or thwart progress toward your own goals. But if you are one of the many of us who have, this new year resolve to lessen the negative impact of the imposter and advance confidently in the direction of your dreams.

Photo by Paul Joyce on flikr