Bailey DeBarmore – The Early Career Voice

QCOR19 Early Career Panel

April 12, 2019June 11, 2019 Bailey DeBarmore

Moderators and participants from the #QCOR19 Early Career Panel Discussion – Tell it to Me Straight: The Truth About Early Career. From left to right: Rashmee Shah, MD MS (University of Utah), John Spertus, MD MPH (University of Missouri – Kansas City), Umesh Khot, MD (Cleveland Clinic), Paul Muntner, PhD (University of Alabama at Birmingham), Karen Joynt Maddox, MD MPH (Washington University in St. Louis), and Faraz Ahmad, MD MPH (Northwestern University)

The panelists sat at the front, ready to answer questions from the eager early career professionals (and mentors) in the audience. It’s the Early Career Panel at the Council on Quality of Care and Outcomes Research (QCOR) Scientific Sessions on Saturday April 6^th in Arlington, Virginia.

The session moderators – Dr. Rashmee Shah from the University of Utah and Dr. Faraz Ahmad from Northwestern University – welcome the audience and thank the panelists, and flip on the projector.

Against a stark white background, the moderators present simple advice they’ve received in the past – good or bad – and ask the panelists to discuss.

The first one: “You shouldn’t negotiate the salary for your first job.” This discussion prompt starts an interesting conversation – touching on topics not typically addressed in early career salary negotiation tips.

In terms of first-year faculty positions, Dr Paul Muntner, Associate Dean of Research at the School of Public Health at University of Alabama at Birmingham, points out that equity comes into play. No matter where you go, first-year faculty make similar salaries. That doesn’t mean you can’t negotiate for other things though. In fact, some other benefits may be worth more than an extra $1-2k in salary. For example – funding to covering moving expenses, protected research time, statistical support, and access to certain databases are some of many aspects of your new job (to be) are all things to consider.

Dr Umesh Khot, from the Cleveland Clinic, chimes in that drafting a “Letter of Understanding,” outlining the extras in your job packet and what your responsibilities will be, is an important document to have. For the clinicians in the room, protected time for research and covering for colleagues in clinic were two major topics. Having a supervisor who values your time in research means should you be called on to cover in clinic for someone way at a conference, that time will be made up to you. Should anything not live up to the discussion as you start your new job, you’ll have something concrete to reference.

Dr. John Spertus, from the University of Missouri – Kansas City, was the first to bring up salary gaps in the context of salary negotiation. Per Pew Research Center, race/ethnicity earning gaps are narrower in the STEM workforce than non-STEM, but more importantly to me, they still exist. Among those who work in STEM jobs, blacks earned 81% as much as whites and those of Hispanic ethnicity earn 85% as much as whites. A survey in the United Kingdom and Europe found that women working in STEM jobs earned a fifth less than their male colleagues, and that the gap between men and women increased with age and experience. In the US, an 11% difference was observed, though it’s considered a conservative estimate. Dr. Karen Joynt-Maddox touched on the idea of salary gaps, pointing out that after the K-level (referring to the early career NIH grant mechanism), salaries diverge greatly. “There is less anchoring for equity later on,” she said, “so it’s very important to negotiate.”

One of the biggest challenges in closing the wage gap on the individual level is knowing what your more-advantaged colleagues are making. In contrast to non-academic fields, we may be at an advantage. For public institutions, including universities, all salaries are published online. Prepping for your salary negotiation by doing your research first will give you an idea of the salary ceiling for your goal position. You can use resources like IBHE, The Buckeye Institute, and Chronicle to look up salaries.

What’s the best early career advice you’ve received? What do you wish you had known when you started out?

Follow the Early Career Panel moderators and participants on Twitter:

Rashmee Shah, MD MS (@RashmeeUShah)

Umesh Khot, MD (@UmeshKhotMD)

John Spertus, MD MPH (@JSpertus)

Karen Joynt Maddox, MD MPH (@KEJoynt)

Paul Muntner, PhD (@MuntnerPaul)

What to Expect at #QCOR19

April 3, 2019April 3, 2019 Bailey DeBarmore

As a new member of the Council on Quality of Care and Outcomes Research (QCOR), I’m excited to attend the annual Scientific Sessions in Arlington, Virginia on April 5-6, 2019. QCOR 2019 Scientific Sessions is put on in collaboration with the Council on Clinical Cardiology, the Council on Cardiovascular and Stroke Nursing, the Stroke Council, and of course, the Council on Quality of Care and Outcomes Research.

Apart from reviewing the programming and online resources, I’m not sure what to expect so I turned to QCOR colleagues and leadership who could give me the lowdown.

Key Takeaways

The QCOR Scientific Sessions bring together a diverse group of clinicians, researchers, and policymakers interested in healthcare quality and patient outcomes.
Both days of the conference are packed with dynamic workshops, early career lunches and panels, impactful plenary sessions, and opportunities for networking.
Early career development is a major focus of the QCOR conference, highlighted by the coveted Young Investigator Award finalist oral abstract sessions and early career panel discussions.
Follow along at #QCOR19 on Twitter with hashtags #CQOMeetingReport and #QCOR19 as we live tweet from the sessions.

Let me introduce Drs Madeline Sterling, Boback Ziaein, Collene McIlvennan, and Tracy Wang.

Madeline Sterling, MD MPH MS, (@mad_sters) is an Assistant Professor of Medicine at Weill Cornell Medicine Division of General Internal Medicine.
Boback Ziaeian, MD PhD FACC FAHA, (@boback) is an Assistant Professor at the David Geffen School of Medicine at UCLA in the Division of Cardiology.
Colleen McIlvennan, DNP MS BSN (@colleenkmac) is an Assistant Professor of Medicine-Cardiology and Lead Nurse Practitioner in advanced heart failure and transplantation at University of Colorado School of Medicine, and is also the chair of the QCOR Young Clinicians and Investigator Committee.
Tracy Wang, MD MHS MS (@TYWangMD) is an Associate Professor of Medicine, a member of the Duke Clinical Research Institute, and Director of Health Services and Outcome Research at Duke.

Dr. Colleen McIlvennan

Dr. Madeline Sterling

Dr. Tracy Wang

Dr. Boback Ziaeian

What is the QCOR council all about?

In an AHA newsletter, QCOR Council Chair, Tracy Wang, presents 3 reasons to join QCOR:

QCOR focuses on real world health care issues and practical solutions
QCOR is disease and specialty agnostic – if you study the heart, brain, disparities, health systems, or anything else, you belong in QCOR
In QCOR, you can connect with a growing community of creative, passionate, and fun people who want to influence health and healthcare delivery in a positive way

QCOR is not only a place for clinicians, researchers, and policymakers to come together for healthcare quality and patient outcomes, but is also focused particularly on early career development.

Dr Tracy Wang commented that the QCOR “council has always been proud of its diverse constituency; and [its] collaborations bring to the forefront experienced multidisciplinary teams and stakeholders who have successfully orchestrated change in our health care environment.”

Why should you attend QCOR Scientific Sessions?

Dr Madeline Sterling: There is a lot of programming geared towards early career professionals, which in my mind, makes QCOR really stand out as a ‘must attend’ conference for early investigators conducting cardiovascular outcomes research.

Dr Colleen McIlvennan: This year QCOR has six program tracks, including policy, health technology and innovation, implementation/QI/data science, cardiovascular clinical trialists forum, quality of care workshops, and Get with the Guidelines. New this year is a Design Thinking in Action workshop facilitated by Google.

Dr Tracy Wang: This year there will be a number of workshops with topics ranging from scientific publication, to advancing health care quality through collaborations with IT, to shared decision making. Plenary session topics will tackle two large and important areas for quality of care and outcomes research: the first will be on data science and health technology, the second will be on health policy and behavioral economics.

What are you looked forward to most at QCOR?

Dr Boback Ziaeian: I’m looking forward to people coming to my poster and seeing if they find the issue I report on as interesting. It’s something I’ve spent years thinking about and I’m curious how well I communicate my ideas.

Dr Ziaeian will be presenting his poster “Changes in the US Burden of Cardiovascular Mortality by Unique Weighting Methodologies” (Poster 294) at the afternoon poster session on Saturday April 6^th.

Dr Madeline Sterling: Mike Thompson, PhD, Adam Bress, PharmD, MS, and I are leading the QCOR19 Career Development Luncheon. It will take place on April 5th at 12:30-2:00pm. The topic is ‘Building Bulletproof Collaborations.’ We’ve assembled some terrific panelists and table leaders to facilitate the discussion and I hope that many attendees will join for what I hope will be a dynamic and helpful session.

Dr Sterling will also be presenting her poster “Social Determinants of Health and 90 Day Mortality after Hospitalization for Heart Failure in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study” (Poster 284) at the afternoon poster session on Saturday April 6^th.

How does QCOR focus on early career professionals?

Dr Madeline Sterling: Not only are there special abstract award presentations to highlight the top work of early investigators, but poster sessions, luncheons, and seminars with skill building exercises geared towards early career professionals. There are sessions with journal editors, as well as talks on mentoring and collaboration.

Dr Colleen McIlvennan: QCOR has always and continues to promote early career clinicians and investigators. A major focus of the conference is early career investigation with a highly coveted Young Investigator Award as well as oral abstract and moderated poster sessions. It’s a great council to join for those starting their career.

This year’s Young Investigator Award finalists are Enrico Giuseppe Ferro from the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center, Ali O Malik from Saint Luke’s Mid America Heart Institute, Sameed Ahmed M Khatana from the University of Pennsylvania, Ashwin S Nathan from the University of Pennsylvania, and Tran Nguyen from George Washington Hospital in Washington DC. These 5 final abstracts will present in a special oral abstract session Friday morning (10:45 am) with the winner announced at the early career development luncheon to follow.

Dr Boback Ziaeian commented on how QCOR focuses on early career professionals throughout the year, not just at the annual scientific sessions. As a member of the QCOR Young Clinicians & Investigators Committee, he spoke to the significant amount of planning that occurs year-round for QCOR members.

“The council gives a voice to early career investigators by evaluating abstract submissions, developing content for conferences, and starting initiatives for the council community.”

Dr. Colleen McIlvennan, chair of the Young Clinicians & Investigator Committee, shared that the committee works “throughout the year on the programming for the early career events at QCOR’s annual meeting as well as early career programming at AHA Scientific Sessions.”

What’s a unique aspect of the QCOR Scientific Sessions?

Compared to other AHA conferences, the QCOR Scientific Sessions is relatively short (2 days) and small. But it’s a small conference with a big impact.

Dr. Colleen McIlvennan: Although QCOR is a relatively small conference by many standards, it really offers an impressive group of speakers and attendees. The size also allows for great networking opportunities!

Dr Madeline Sterling: It’s large enough where you can network and meet new people at each meeting, but small enough where you can also have quality time to catch up with colleagues and friends. Take me for example, a few years ago I went for the first time, not knowing a single person. I left 2 days later feeling inspired with new research ideas and a whole list of contacts.

Dr Tracy Wang: The early career lunches and panel discussion provide ample opportunity for members to network, reconnect, and learn from their peers; and I’ve taken advantage of the many nice little corners in our conference venue for 1-on-1 conversations and consultations.

Dr Boback Ziaeian: The conference is much more intimate and easier to navigate than some of the larger national conferences.

What session are you most excited about at QCOR Scientific Sessions?

Dr Madeline Sterling: I always love the Young Investigator Award finalists – it’s wonderful to see exciting work across the country from really talented young investigators. I’m also looking forward to the Get with the Guidelines sessions, clinical trial track, and health IT sessions.

Dr Boback Ziaeian: I think the Google session. But like most buzz-worthy scientific concepts, I expect a lot of hype.

Dr Colleen McIlvennan: The early career sessions are always a highlight. This year offers a great lineup: Young Investigator Awards (Friday at 10:45 am), Building Bulletproof Collaborations (Friday at 12:45 pm), Tell it to Me Straight: The Truth About Early Career (Saturday at 12:45 pm), and oral abstract and moderated poster sessions specifically for early career!

Dr Tracy Wang: Two novel collaborations will be featured this year. The Get with the Guidelines (GWTG) registries have been the flagship quality improvement program for the AHA, designed to promote guideline adherence, elevate quality of care, and improve patient outcomes across many cardiovascular diseases. While research from GWTG has historically had a strong presence at the QCOR conference, this year’s conference attendees will get to enjoy a deep dive into the what and how of organizing and implementing systems of care for outcomes improvement. (emphasis added) Also exciting this year is the collaboration between QCOR and the Cardiovascular Clinical Trialists Forum. Joint sessions will explore how real-world data can be leveraged for evidence generation, something that has been aspirational over the last decade but is now very firmly part of the clinical trial research landscape.

Want to follow along at #QCOR19?

You can follow #CQOMeetingReport and #QCOR19 as we live tweet from Arlington this weekend, as well as the Circulation: Cardiovascular Quality and Outcomes journal account (@CircOutcomes).

The Social Determinants of Cardiovascular Health

March 20, 2019March 28, 2019 Bailey DeBarmore

Social epidemiology “proposes to identify societal characteristics that affect the pattern of disease and health distribution in a society and to understand its mechanisms.” [1]

At AHA EPI|Lifestyle Scientific Sessions this year, the conference theme was “Genes, Behavior, and Environment: Putting the Pieces Together,” as I discussed in my blog post in early March. [Read the post]

Both within and between the ideas of genes, behavior, and environment was the thread of health disparities and social epidemiology. Oral abstract sessions included Epidemiology of Major Cardiovascular Disease, where Dr. Ben King discussed the burden of CVD among homeless persons in Austin, Texas; Dr. Gail Daumit highlighted interventions to reduce CV risk factor burden among those with serious mental illness; and Dr. Catherine Tcheandjieu called for more inclusion of non-European descent populations in polygenic risk studies.

In the Social Determinants of Cardiometabolic Disease, social determinants of health (SDOH) came to the forefront, as would be expected. From Dr. Emily D’Agostino presenting results comparing use of different poverty measures, to Dr Marialaura Bonaccio highlighting the effect of cumulative socioeconomic disadvantage across the lifespan on heart failure hospitalizations, we in the audience learned not only how to measure and evaluate these measures of social determinants of health, but saw how they quantifiably and undeniably affect CV health and outcomes.

Caption: A key Healthy People 2020 goal is to “create social and physical environments that promote good health for all”. You can learn more [here]. Image Source: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

In the Lifecourse Epidemiology session, presenters summarized and argued for the importance of diet quality, smoking prevention, access to green spaces, and healthy diet patterns beginning in childhood to attenuate CVD risk in adulthood. Research from the Lifestyle Council naturally focuses on healthy lifestyle behaviors that are typically found in more affluent groups and likely contribute to the widening health disparities in chronic disease we’ve observed over the past decade, at least. [2]

In Dr. Leslie Lytle’s frank discussion of the lack of NIH funding towards intervention studies [3] to address not only these disparities but the lag in CV Health overall, I’m reminded of the session at #AHA17 “Closing the Gap on Disparities: Practical Strategies and Implementation,” when Dr. Michelle Albert called for epidemiologists to move from describing associations to implementing and evaluating interventions. [Read the post]

I encourage you to think of your research in the framework of social determinants of health. You can learn more about SDOHs, access data sources, and learn how to put SDOH research in action at the CDC Social Determinants page.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723602/ Social epidemiology: Definition, history, and research examples.
https://www.cdc.gov/nchs/data/hus/hus15.pdf Health, United States, 2015, With Special Feature on Racial and Ethnic Health Disparities
https://www.ncbi.nlm.nih.gov/pubmed/30458950 NIH Primary and Secondary Prevention Research in Humans During 2012-2017

Putting Together The Pieces of Genes, Behavior, and Environment

March 11, 2019March 4, 2022 Bailey DeBarmore

The theme of this year’s #EPILifestyle19 conference was “Genes, Behavior, Environment: Putting the Pieces Together.” The three speakers in the first session, Dr Eric Boerwinkle, Dr Leslie Lytle, and Dr Michael Jerrett presented a cohesive program truly reflecting putting the pieces together.

Dr Eric Boerwinkle genetic researcher, dean, and chair of public health at the UTHealth School of Public Health, kicked things off with a hearty welcome to Houston, and applauding the audience for braving the city during the annual Houston Rodeo. Dr. Boerwinkle’s talk was marked by sincerity and focused passion for precision health and precision prevention – terms to replace “precision medicine” – that mirrors the AHA’s focus on cardiovascular health over cardiovascular disease.

He highlighted that genetics, environment, and lifestyle behaviors can be envisioned in several ways, depending on perspective and discipline. A key challenge in producing science focused on fitting these pieces together is measurement. Variables are often measured separately and differently across disciplines, and no matter the metaphor, Boerwinkle encouraged the audience to step out of their silos and begin measuring key variables together. Dr Leslie Lytle of UNC Chapel Hill Gillings School of Public Health provided a concrete example with the ADOPT project for obesity treatment, which identified high-priority measures to measure across biology, behavior, psychosocial, and environmental processes.

Transitioning from genetics to lifestyle behaviors, Boerwinkle highlighted research finding that even in genetically high-risk patients, modifying environmental factors and lifestyle behaviors can lower risk.

Dr. Leslie Lytle, professor in the department of Health Behavior at UNC Chapel Hill, situated her talk in the puzzle piece landscape by contrasting the NIH’s position on the importance of intervention research with the dismal percent of funding dollars that actually go towards intervention research.

unsplash by yusuf evli

After emphasizing the importance of intervention research to address the lifestyle and behavioral challenges of poor cardiovascular health, particularly obesity, Dr. Lytle showed us what intervention research should look like and what it can accomplish. Combining environment-level interventions based on socioecological models with individual level education can effect change, like in in the CATCH intervention, which involved child-level education, positive social modeling, and healthy changes in physical activity and school meals.

Over the past few years, the “exposome” concept has only gained popularity, along with the “-omics” trend. Wrapping up the themed session with environmental factors, Dr Michael Jerrett of UCLA School of Public Health taught us about characterizing the exposome by incorporating hyper-spatiotemporal components into research to assign exposure. What are hyper-spatiotemporal components? These components measure where people go during the day, what the pollution level is there, what they are doing and how it affects their exposure (walking in a park, biking behind a diesel truck, sitting in a car).

unsplash by adrian williams

Jerrett highlighted several studies examining these concepts, comparing the inhaled pollutants when biking, walking, or commuting by car to work in various areas of a city. How can we measure these spatiotemporal components in a “ubicomp” (ubiquitous computing) environment? Jerrett broke down the inside of our smart phones, calling attention to the numerous sensors present in nearly every smart phone and the research possibilities to harness these.

3 Tips for Live Tweeting a Conference

February 7, 2019March 28, 2019 Bailey DeBarmore

What is Live Tweeting?

Live tweeting is when you tweet about an event while you’re there.

You can harness conference hashtags, like #EpiLifestyle19 for the upcoming Epi | Lifestyle Scientific Sessions in Houston, or this past year’s #AHA18 Scientific Sessions in Chicago, to group your tweets with others and help people follow along.

Live tweeting doesn’t mean typing out every word a speaker is saying.

Tweet the name of the presentation and the speaker, the energy of the room, or your big takeaway.

What’s the “so what?” behind the presentation? What did you find most interesting?

You also don’t have to tweet in the moment.

Write down some of your thoughts, and after the session, write up your summary tweet.

Why Live Tweet?

Tweeting short comments at a conference presentation or seminar let’s your followers tune in, like they’re sitting there with you.

In an article for PLOS Blogs, Atif Kukaswadia (@DrEpid) shares an impressive example from the 2011 2^nd National Obesity Summit in Montreal.

The conference had 800 attendees, and only a handful of people tweeted.

But those handful of people produced 500 tweets with the conference hashtag, and those 500 tweets reached 80,000 people.

80,000 people.

Can you imagine how many people we’d reach at a bigger AHA conference with meeting reporters live tweeting from nearly every session?

Not only does live tweeting make followers feel like they’re there, but it stimulates discussion as people comment, asking questions, offering their own thoughts, and connecting to other science resources.

In his article “The Challenges of Conference Blogging”, Daniel MacArthur reminded us of the purpose of presenting science at conferences.

Why do we do it?

To promote discussion about our science.

To expand our own influence for future job opportunities and collaborations.

Live tweeting at conferences achieves these things – with the added benefit of concise science communication that expands both the reach of the science but also the understanding.

Tips for Live Tweeting

Live tweeting doesn’t have to be a play-by-play of the talk. Don’t worry about tweeting every single word. Instead, think about what theme or finding resonates the most with you. Tweet about that!
Visuals make any tweet that much more engaging. Use high quality, free stock photos from unsplash.com or www.rawpixel.com along with your post, or search online for a corresponding paper or faculty webpage to link in. Many people snap a pic of the slides or the speaker on stage – just be sure to check with conference policies before posting photos.
Search for the speaker on Twitter so you can tag them with their handle (preceded by @). One of the best ways to do this is to use a search engine with their full name, and “Twitter”. If nothing comes up, try tagging their institution. Many schools of medicine, hospital departments, and universities have Twitter accounts. If you know you’ll be reporting on a session in advance, you can look up these handles beforehand.

For examples of live tweets, search previous conference hashtags on Twitter, like #AHA18, #EpiLifestyle18, #QCOR18, or your council’s Scientific Sessions hashtag.

To learn more about using social media for science communication, with more tips for tweeting and blogging, be sure to come to the Epi Early Career session on Friday March 8^th, 7 – 8:30 am in the Galleria Ballroom, Westin Galleria, Houston, TX at Epi | Lifestyles Scientific Sessions 2019.

3 Tips for Incorporating Coauthor Feedback

January 18, 2019March 28, 2019 Bailey DeBarmore

When we review a paper, we often forget how we feel in the role of author. Along the same lines, when we read over drafts coauthors’ send us, we forget how we act in the role of editor.

Suggested changes seem personal.

Tip #1: Get your head right

We often have coauthors at different institutions and finalize manuscripts via email. Receiving criticism, constructive or otherwise, is never pleasant but receiving criticism over email opens the situation up to miscommunication.

Why?

When we write or read an email, our current mood influences how we perceive it.

Incorporating coauthor feedback is a key step in the science writing process, and seeing it as an integral part of the final product and not a burden to be borne can help you orient yourself. Approach the process constructively and with an open mind.

“You cannot grow if you are not willing to change, to accept new perspectives on life or to change your habits.” – Steven Aitchison

Tip #2: Consider the type of feedback

So, you’ve taken a deep breath and opened up the document with coauthor feedback. Plan to make several sweeps through the document. If you have comments from several people in one document, consider isolating each author. If you’re using Microsoft Word, you can do this by going to the Review pane, selecting “Show Markup”,
and then “Specific People”.

As you read through feedback, I’d like you to think about them as 4 types of feedback.

Clarifying content
Modifying style elements
Correcting grammar
Changing wording

Simplifying wording often leads to clarifying content. Modifying style elements, such as use of “First,…” “Second,…”, “…; however…”, or by changing passive to active voice, often modify writing style but may also increase or decrease writing clarity.

Kristin Sainini teaches the online Coursera course “Writing in the Sciences” and uses assignments like “Give a short word that means the same thing as “utilize””. Here’s a table of words that can be simplified.

Instead of…	Use…
Accordingly,	So
Address	Discuss
Afford the opportunity	Allow
Advantageous	Helpful
Due to the fact that	Due to, since
Determine	Decide, figure, find
Demonstrate	Show
Evident	Clear
Evidenced	Showed
In lieu of	Instead
In regard to	About, concerning
Magnitude	Size
Notwithstanding	In spite of, still
Numerous	Many
Preclude	Prevent
Provided that	If
Provides guidance for	Guides
Represents	Is
Similar to	Like
Subsequent	Next
Subsequently	Then
Sufficient	Enough
Therefore	So
Utilize	Use
Viable	Practical
Warrant	Call for

CAPTION: Not all of them involve fewer words. Some are just more common in spoken language, and so better understood. [Source]

Correcting grammar is often straight forward, but may be stylistic. Double check with a style guide or online grammar guru like Grammarly. If you’re both right, feel free to keep your own. Consistency throughout the manuscript – both in writing style and grammar choices – is important.

If they are suggesting a change in wording, think about why. Is it a simpler word? Is it more correct?

If you write with the same coauthors frequently, you may find certain people predominantly provide a certain type of feedback.

Then, think about the purpose of an edit. Why do you think the coauthor made that suggestion?

If the suggestion is a stylistic change that doesn’t clarify content or simplify wording, then it’s an edit that shifts your writing style towards their own. These are edits that, in my opinion, you are not “required” to make. But if you know your writing could benefit from some streamlining, look at what these edits are. Are they moving the main subject from the end to the beginning of the sentence? Adding transitions? Cutting out unnecessary words? These are changes you can make in your own writing style to improve communication.

However, keep in mind when you are providing feedback on someone else’s writing that these comments aren’t always helpful. Instead of trying to mold someone’s words into your own, assess writing for clarity and purpose.

If a coauthor changes a word that changes the meaning of a sentence – that’s a big problem. Definitely don’t change anything that results in a false statement, but acknowledge that if someone on the project didn’t understand what you were trying to say, a reader definitely won’t. That sentence needs to be clarified. Spend time on these edits to make sure what you’re trying to say is coming across.

Tip #3: Stand up for yourself

Hopefully you have a great group of mentors, and at least one is in your coauthor group.

Don’t hesitate to have a frank conversation with your mentor about manuscript editing. They have much more experience than you, and have encountered many different frustrating situations. Some of the best advice I’ve gotten is to “choose your battles”. Not only does that mean to let some things go, but think about what you’d like to stand up for.

Being able to edit someone’s writing without replacing their writing style is difficult. Not all coauthors, no matter how senior, are able to do so.

Recently, a colleague in my lab group asked for advice on how to handle conflicting coauthor feedback. My mentor brought up a good point: many times, in academia we don’t feel like we are “doing our job” if we don’t come up with a suggestion. As the “commenter”, we feel satisfied with ourselves for contributing. But as the recipient, we consider all feedback and suggestions as changes to make.

Having straight forward discussions about what changes benefit the paper as a whole not only improve your communication skills, but your independence.

What challenges have you encountered in this area?

5 Tips for Science Writing

January 7, 2019March 28, 2019 Bailey DeBarmore

Among the many responsibilities you have, writing is probably the one that gets pushed to the bottom of your to-do list again and again.

During the #EpiWritingChallenge last November, many public health researchers, trainees, scientists, and clinicians shared their biggest barriers to achieving their writing goals.

My next few posts will summarize some of the discussions and writing tips that emerged from the 20 day writing challenge. Each post will be dedicated to one topic: writing, editing, and incorporating coauthor feedback.

Tip 1: Make time and space for writing

If you’re like me, you’re juggling several research projects among other work duties, and while you think about working on your manuscripts often, it seems like you never get to them. Unless there is an abstract deadline, it seems like the writing process stretches on and on.

Many #EpiWritingChallenge participants set goals aimed at writing more often, with daily or weekly goals.

Hopefully you’ve heard of SMART goals, but if you haven’t, they stand for specific, measurable, achievable, relevant, and time-bound.

First, if you want to change your writing habits, telling yourself to “write more” likely won’t cut it. It takes at least a month to form a new habit, and to maximize your success I suggest breaking down your overarching goal into manageable chunks (that are also SMART).

Second, reflect on when and where you write best. Are you a morning person or a night owl? Do you need complete silence or the bustle of a busy café? Thinking about these aspects of writing and how an ideal writing session can fit into your schedule will set you up for success. You might block off time on your work calendar as busy (to avoid meetings being scheduled during that time), and shut your office door. You might wake up an hour or two earlier to enjoy the quiet of your office as you type away. If you work best in a group, you might organize a Writing Accountability Group for even better accountability.

Tip 2: Focus on writing clearly

Writing clearly is something we all strive for (hopefully) but is harder than it sounds. As Ernest Hemingway said, “prose is architecture, not interior decoration.”

Two rules of thumb are 1) write shorter sentences and 2) choose simpler words if it doesn’t change the meaning.

Dallas Murphy, a book author and writing workshop instructor, gave a great example of typical scientific writing transformed into clear scientific writing, in “How to write a first-class paper” published on the Nature blog last year.

ORIGINAL: “Though not inclusive, this paper provides a useful review of the well-known methods of physical oceanography using as examples various research that illustrates the methodological challenges that give rise to successful solutions to the difficulties inherent in oceanographic research.”

This writing is defensive and scared to make confident statements. The language is ornate, and lists caveats, fending off criticism that hasn’t yet been made.

REWRITE: “We review methods of oceanographic research with examples that reveal specific challenges and solutions.”

Much better!

You might even explore voice-to-text apps for clear writing. We often express ideas more clearly in speech than in writing. In that same Nature article, Stacy Konkiel of Altmetric encouraged readers to make their point “in non-specialist language” if possible. “If you write in a way that is accessible to non-specialists, you…open yourself up to citations by experts in other fields and make your writing available to laypeople.”

Tip 3: Keep a “great writing” folder

What we read strongly influences how we write. In other words, “you write what you read”. Keeping up with the literature is a whole other blog post in itself, but reading other science writing not only expands your content knowledge but your writing abilities.

Whenever you come across a paper that makes you think “wow, that is great writing” tuck it away in a “Great Writing Folder”. When you sit down to write, marinate your brain in that concise science writing before putting pen to paper.

Tip 4: Create an elevator pitch for your paper

We typically talk about elevator pitches in relation to networking and job interviews. In fact, at last year’s AHA EPI | Lifestyles Scientific Sessions, one of the Connection Corners was focused on crafting an effective elevator pitch. Just as you summarize the key parts of what you do and why, and what you research, you can adapt that to a specific paper or project.

Create different ways of explaining your project in terms of what you did and why. Keep that list nearby when you write to help you stay on point and stay clear throughout your paper. Every main point should be coming back to that elevator pitch. That list is great to review at the beginning of each writing session to get you in the right mindset, too.

Tip 5: Prioritize topic sentences

Topic sentences are just as important now, in your science writing, as they were in your high school English class. Make sure you have topic sentences for each section of your manuscript. If you create an outline beforehand, those main ideas should morph into your topic sentence. After the topic sentence, every bit of that paragraph should connect back or move the argument forward. If it doesn’t contribute, cut it or move it.

In the tips for editing post we’ll be talking about using a Reverse Outline, a method with topic sentences as its backbone, to strengthen your argument.

In sum, science writing is a complex task for us to tackle. Whether a clinician-scientist, full-time researcher, trainee, or professor, it’s something on all of our to-do lists.

What is your biggest writing challenge?

Any Physical Activity is Enough

November 30, 2018March 28, 2019 Bailey DeBarmore

When I was a nutrition intern in 2014, I would excitedly tell patients that walking 30 minutes a day, 5 days a week doesn’t have to be a daunting goal. In fact, research showed that accumulating bouts of 10 minutes conferred cardiac benefits.

Under the often cited “150 minutes/week moderate activity or 75 minutes/week vigorous activity” was the implication that if you couldn’t meet that goal, then why bother?

Did the research specifically say that? Nope. And over the years research on the so-called “Weekend Warriors” has flourished. Is it regular physical activity, or the cumulative amount, that reduces risk?

And then in 2016, the catchy phrase “Sitting is the new smoking” highlighted the birth of a newly emphasized term – physical inactivity – and the distinction between physical activity and exercise.

Earlier this month in Chicago, navigating the bustling 2018 AHA Scientific Sessions, the new Physical Activity Guidelines were revealed. Lo and behold, the news is even better – even a little bit of physical activity is worth it.

It’s not all about aerobic activity, either. We know that resistance training improves insulin sensitivity and helps maintain muscle mass as the human body ages. The result? Less frailty. “Healthy aging”. Fewer injuries from falls, and fewer falls overall.

The new Physical Activity Guidelines didn’t leave that goody out. Upper body weight training even once a week is beneficial – for your heart! Just when you thought you had to huff and puff to beef up your heart health.

With the new Hypertension Guidelines released at Scientific Sessions last year in Anaheim, a renewed effort surfaced for clinicians to encourage lifestyle behavior changes. Not enough time with the patient isn’t an excuse. Research showing that physicians who exercise are more likely to prescribe exercise hit headlines, and the simple fact that clinicians can utilize their position of authority to impart importance upon a topic.

“As a health care provider, you know it’s important to help your patients get more physical activity. But it can be challenging to motivate patients in the short time you spend together.” – Move Your Way, Physical Activity Guidelines 2^nd Ed., Health Care Provider Fact Sheet

While not everyone feels comfortable taking on a counseling role with patients, there are key phrases and questions you can use to start the conversation. Check out this short Motivational Interviewing primer, which includes example wording to build rapport with your patient, empower them to make change, and establish a collaborative relationship.

Help them set goals. “Are there activities you’d like to be able to do?” We’ve all heard “I want to be able to pick up my grandkids”. Knowing your patients’ motivations means you can work together to set goals that are important to them.
Meet your patient where they are. Find out what they know, what they perceive as important and as barriers, and suggest small changes. Being able to walk a long driveway to get the mail is a better place to start than jumping from the couch to a 5K.
Let them know what to look for. Instead of “aim for moderate intensity activity”, translate it to perceived exertion. A lazy walk is “I’m comfortable and could maintain this pace all day.” Encourage them to reach a Level 3 to 5 – “Comfortable but breathing harder – sweating a little but feel good and can carry on a conversation – just above comfortable, sweating more, and can still talk easily”. Everyone should start slow and build up to longer durations and higher intensities – take a look at the exertion table below to see what exertion level your patient should start in.

The new guidelines come with Move Your Way tools and resources to get the message out to your friends and family, your patients, and your community. Interactive tools and widgets, fact sheets and poster, and even videos, can help teach all Americans how they can move their way to move more.

Forming new habits is hard, and lifestyle change is no exception. We know the research, and we have the responsibility to translate that data into actionable information for our patients.

I had the opportunity to recap Scientific Sessions over dinner with my parents. What did I share? Just because you can’t run a marathon doesn’t mean you can’t reap the benefits of physical activity. A little bit goes a long way.

Highlights of the 1st Annual Sex and Gender Conference at AHA18

November 10, 2018March 28, 2019 Bailey DeBarmore

Walking into the Palmer House Hotel, the longest continuously operating hotel in the United States, you can’t help but pause in awe at the intricate décor and take in the most photographed ceiling in the world. I make my way to the Honoré Ballroom, named after Bertha Honoré Palmer, the wife of Palmer and an astute businesswoman and well-known Chicago socialite of her time, not knowing what to expect for the 1^st annual Sex and Gender Influence on Cardiovascular Disease (CVD) conference.

Annabelle Volgman, medical director of the Rush Heart Center for Women, kicks off the evening by thanking the speakers and planning members, and encouraging photography and social media sharing. The many photos of the evening include Bertha Honoré’s portrait adjacent to the colorful and modern logo that, I think, will become a recognized image at future AHA Scientific Session meetings.

Dr. Annabelle Volgman welcomes attendees to the 1st Annual Sex and Gender Influences on Cardiovascular Disease at the Palmer Hotel in Chicago, IL (November 11, 2018).

Dr. Nanette Wenger of the Emory Women’s Heart Center starts the conversation with her presentation titled “Why is Mortality from Cardiovascular Disease Rising in Men and Women?” She flashes a graph of CVD mortality on the screen, highlighting the steep decline in the past decades, but the leveling off and reversal in recent years, particularly in women under the age of 55 years. The parallel rise in obesity and diabetes, as well as “non-traditional” CVD risk factors such as depression and perceived stress disproportionally affect women, she explains, and may be responsible for this reversal in CVD death rates. Summarizing the recent paper, “Defining the New Normal in Cardiovascular Risk Factors” by Dr. Donald Lloyd-Jones and Dr. Philip Greenland she points to a combination of health behaviors and ideal levels of total cholesterol, blood pressure, and fasting blood glucose, as key factors in achieving cardiovascular health.

“Behavior change,” she says, “is the ‘Holy Grail’ of heart health” and as “health professionals take back the role [of health educator] and address lifestyle behaviors” we will see favorable trends in biomarker targets we’re so interested in.

Later during the Q+A panel, when asked about the best way to approach behavior change with patients, she advises to first, “Give information – if your patient does not have the information, they can’t make a change. Then, let them start with what they would like to start with. Don’t give them 8-10 [health behaviors] to change – they will tune you out.” Dr. Gina Lundberg, co-director of the Emory Women’s Heart Center, chimes in that the clinician’s “approach to weight loss is similar to smoking cessation. Identify the obstacles in the patient’s way – money, time, desire – and often just identifying those hurdles will lead to improvement.”

Dr. Laxmi Mehta, director of the Women’s Cardiovascular Health Program at the Ohio State University Wexner Medical Center, adds that she includes an emotional appeal – “Where is the patient going and what do they want?” Seeing a child’s wedding or playing with their grandkids, developing rapport with patients and fitting your recommendations to their goals can start the health behavior change process, even in a 5 minute clinician-patient discussion.

Collaborative Studies: Data Harmonization and Meta-Data Visualization

August 8, 2018March 28, 2019 Bailey DeBarmore

Welcome to part 2 of the collaborative studies series. In my last post, titled “Collaborative Studies: Are They Worth It?” I discussed what collaborative studies are, how they come about, and the pros and cons of conducting them. In this post, I’ll dive deeper into analytical strategies for harmonizing data in collaborative studies and in the next post, I’ll recap some advice on how to conduct a successful collaborative study.

Note: This series is based on a pre-conference workshop session at the 51st annual Society for Epidemiologic Research meeting in Baltimore, MD in June 2018. Dr. Bryan Lau, Dr. Keri Althoff, Dr. Josef Coresh, Dr. Jessie Buckley, and Dr. Lisa Jacobson of Johns Hopkins Bloomberg School of Public Health, shared their knowledge, advice, and experience on working with collaborative studies.

Recap: What are Collaborative Studies?

Collaborative studies are a collection of multiple independent studies collaborating together for a scientific goal. This broad definition groups together many different types of collaborative studies, from multi-site randomized trials with standardized protocols to pooled data from several different cohort studies. What these different examples have in common, however, is at least some overlapping data elements and buy-in from leaders of each participating study. (Learn more in Part I of the series)

Harmonizing Data from Heterogenous Studies

In Part I, I alluded to analysis methods for harmonizing data, and brought up important considerations such as unbalanced confounders and non-overlapping data elements. Like with any research project, one of the first steps is to get to know your data – look at missing data, check derived variables, etc. The importance of this step when working with collaborative studies is magnified – are some of your data elements missing from certain studies? Were similar variables derived differently?

To combine datasets, you need individual level data to harmonize, generate estimates at the cohort and meta analysis estimates, and evaluate your inclusion and exclusion criteria

To combine datasets, you need individual level data to harmonize. In getting to know your data, you’ll generate estimates at the contributing study level, and at the meta-analysis level, with all studies contributing. You also need to develop inclusion and exclusion criteria at the study level and do basic validity checks, like checking for strange values and looking at trends by year.

Meta-Data Visualization

Looking at each contributing study alone, at the cohort-level, is called meta-data visualization. The idea is to examine core data elements in each cohort – when did the study start collecting it? How did they measure it? – and check ascertainment assumptions to construct observation windows. Observation windows are constructed from calendar time points ine ach cohort where there is nearly complete ascertainment of a data element. You’ll compare these observation windows for all contributing studies later to look for overlap.

Why are observation windows important? To avoid immortal person time bias, just like at the individual level in a study. If Study A didn’t start collecting fasting blood glucose until 2002, none of study A participants can contribute that data element to the meta-analysis. you would not to include any contributing time prior to that. Since there is usually a 6-12 month delay in receiving data, you’ll also need to trim observation windows at the proximal end.

Dr. Keri Althoff presented a handy “spreadsheet histogram” having data elements across the top row, calendar year down the first column, and the number of observations for each year for the corresponding data element (example below). Shading values green for good ascertainment allows you to visualize observation windows and examine overlap of related values, like blood pressure, comorbidities, and lab values. Each contributing cohort would have their own spreadsheet.

To apply these observation windows, each participant’s time at risk becomes a complex algorithm incorporating their respective study’s start and end dates, a data element’s observation window, or other interested window, and other factors you may want to include. But a complex algorithm is just that – an algorithm! Understanding your data and methodologically setting up this system to minimize bias in your data is well worth the time.

Example “spreadsheet histogram” showing observation windows for various data elements in hypothetical Study A and Study B. You can see that they have different study start and end times, and Study B has a larger proportion of the study with lab values.

Caption: Example “spreadsheet histogram” showing observation windows for various data elements in hypothetical Study A and Study B. You can see that they have different study start and end times, and Study B has a larger proportion of the study with lab values.

Lumping and Splitting

Once you have your dataset, you’ll want to lump and split. What’s that, you say? Lumping is when you combine all contributing studies, run your analyses, and examine the findings. You should think about – what does this new study population represent? Is it an interesting population? Who do they generalize to? Does it generalize to your target population, or perhaps is it your target population?

Then split off one, or two, or more contributing studies and compare the findings. Splitting is a key step to make sure one study isn’t dominating the analyses. You’ll know from your spreadsheet histogram if only one study is contributing a data element, and hopefully you carefully check that assumption and consider the implications of allowing that one study to stand in for all others in that variable.

Hope you enjoyed part 2 of this collaborative studies blog series. In the next post, we’ll talk about some practical tips for conducting a successful collaborative study, like getting buy-in from investigators, keeping everyone invested, and smoothing the way for everyone to get along.

Upcoming Posts:

How to conduct a successful collaborative study: the nitty gritty
Interested in something else specific? Leave a comment or tweet us @BaileyDeBarmore and @AHAMeetings to let us know!

Follow Drs. Althoff and Lau on Twitter for great EPI methods tweets

Keri Althoff – @KeriNAlthoff
Bryan Lau – @BL4PublicHealth

Bailey DeBarmore is a cardiovascular epidemiology PhD student at the University of North Carolina at Chapel Hill. Her research focuses on diabetes, stroke, and heart failure. She tweets @BaileyDeBarmore and blogs at baileydebarmore.com. Find her on LinkedIn and Facebook.