FOLKS ARE STILL CHECKING IN BUT
WE WANT TO STAY ON TIME BECAUSE
WE HAVE A PACKED DAY.
MY NAME IS LISA BEG THE PROGRAM
PHYSICAL FOR THE BIRCWH PROGRAM
AND IT'S MY PLEASURE TO WELCOME
ALL OF YOU AND THOSE ON
VIDEOCAST TO THE 2023 CONFERENCE
IN PERSON.
DR. CLAYTON WILL OFFICIALLY OPEN
IT AND HAS A NUMBER OF SLIDES
SHE WANTS TO UPDATE EVERYONE ON.
I WANT TO ACKNOWLEDGE SHE'S BEEN
OUR DIRECTOR SINCE 2012 AND LED
US ABLY AND NOW TAKING ON NEW
ASSIGNMENTS FOR THE NEW WHITE
HOUSE INITIATIVE WHICH SHE'LL GO
INTO.
I WELCOME DR. CLAYTON.
GOOD MORNING, EVERYONE.
WELCOME TO OUR BIRCWH P.I.
SCHOLARS ANNUAL MEETING.
WE'RE DELIGHTED TO BE WITH YOU
IN PERSON.
IT'S BEEN A CHALLENGING TIME AND
GOING TO ACKNOWLEDGE LISA BEGG.
SHE DESERVES A TOTAL ROUND OF
APPLAUSE AS WE MADE A LOT OF
EXPANSIONS, TRANSITIONS,
IMPROVEMENTS, AND LISA HAS
PLAYED A CRITICAL ROLE IN THE
BIRCWH AND OTHER PROGRAMS AT THE
OHWH.
HERE'S WHERE WE ARE NOW.
WE HAVE BIRCWH SITES AROUND THE
COUNTRY.
WE HAVE STATES WITH TWO BIRCWH
SITES.
WE NOW HAVE 19 SITES IN THE
U.S. OF WHICH HAVE 19 P.I.s AND
AFFILIATIONS WITH HBCUs.
WE HAVE TRAINED AND DEVELOPED
AND SUPPORTED THE CAREERS OF 750
WOMEN'S HEALTH RESEARCH SCHOLARS
AND THEY HAVE HAD BROAD IMPACT,
80% HAVE BEEN WOMEN AND 88% OF
THEM HAVE STAYED IN RESEARCH.
SO I THINK THAT ALSO DESERVED
DESERVEDS -- DESERVES A ROUND OF
APPLAUSE.
WE'RE ACHIEVING WITH THIS
PROGRAM WAS SET OUT TO DO.
IT'S SUCH INCREDIBLY WONDERFUL
AND ROBUST APPLICATIONS FOR THE
PODIUM TALKS AND HAVING FOUR
INSTEAD OF THE USUAL THREE AND A
FEW KEY NOTES.
WE WANT TO ACKNOWLEDGE OUR
PARTNERS, OUR ICO PART NEUTRAL
ZONE AND CURRENTLY ARE NIAID,
NIAA AND NIDA ADMINISTERING THE
GRANTS AND NIAMS IN
COLLABORATION.
I WANT TO HIGHLIGHT FEATURES OF
THE BIRCWH INNOVATION PROGRAM IS
ONE OF THEM AND THEY'RE WORKING
ON SEX DIFFERENCES IN MAJOR
DEPRESSION.
YOU HEARD HER SPEAK ABOUT THIS
ON THE IMPACT OF PRENATAL STRESS
IMMUNE AND AUTONOMIC
DYSREGULATION BUILDING AN
INNOVATION WORKFORCE NETWORK
CALLED TWIN.
THIS IS AN EXCITING NEW PATHWAY
FOR US.
WE'RE CONSIDERING SEX
DIFFERENCES ACROSS THE BRAIN AND
HEART IN THE BREAKTHROUGH AND
IT'S ALSO A COLLABORATION AMONG
OTHER SCORE INVESTIGATORS
SPECIALIZED CENTERS OF RESEARCH
EXCELLENCE ON SEX DIFFERENCES
AND THE INNOVATION CENTER IN SEX
DIFFERENCES IN MEDICINE AT
HARVARD.
SO THIS IS BUILDING A
PUBLIC-PRIVATE PARTNERSHIP TO
ALLOW THE TRAINEES TO EXPAND
THEIR SKILLS IN THAT SPACE.
LEARNING ABOUT INTELLECTUAL
PROPERTY.
TRANSLATING KNOWLEDGE TO
THERAPIES AND INVOLVING THE
PRIVATE SECTOR AND IT'S A
ONE-YEAR SUPPLEMENT.
I WANTED TO SHARE THAT NEWS WITH
THE BIRCWH COMMUNITY ABOUT OUR
PARTNERSHIPS BETWEEN OUR BIRCWH
AND SCORE PROGRAM AND OUR
MOVEMENT INTO MAKING SURE WE
HAVE AS MANY PATHWAYS TO CAREERS
IN SCIENCE FOR OUR SCHOLAR AS WE
RECOGNIZED THE RIVER WITH CREEKS
AND TRIBUTARIES AND STREAMS AND
CURRENTS IS A MORE APT ANALOGY
FOR TODAY'S CAREERS THAN THE
PREVIOUS TERM PIPELINE.
THEY'RE CREATING A MULTI-LEVEL
MENTORING GROUP TO HELP
ESTABLISH NEXT GENERATION OF
ACADEMIC INVESTIGATORS, BOTH
WOMEN AND MEN.
LISA MENTIONED SOME NEWS.
THERE'S BEEN A LOT OF ACTION AND
FOCUS AND ATTENTION ON THE
HEALTH OF WOMEN BY THIS
ADMINISTRATION AND BY THE
CONGRESS.
I WANT TO SHARE WITH YOU OUR
NEWS THAT LAST YEAR WE RECEIVED
ADDITIONAL CONGRESSIONAL SUPPORT
FOR TWO YEARS IN A ROW
SPECIFICALLY MENTIONING THE
BIRCWH PRIME MINISTER AND $10
MILLION LAST YEAR TO ESTABLISH A
NEW OFFICE OF AUTO IMMUNE
DISEASE RESEARCH WITHIN ORWH.
SO FOLLOWING A NATIONAL
ACADEMIES REPORT WHICH WAS
ENTITLED ENHANCING RESEARCH ON
AUTO IMMUNE DISEASES.
THEY AFFECT MORE WOMEN THAN MEN,
80% ARE WOMEN AND AS A RESULT OF
INCREASED ATTENTION TO THE NEED
TO HAVE ENHANCED COORDINATION
AND BUILD ON THE SUCCESSES OF
THE VARIOUS INSTITUTES AND
CENTERS THAT HAVE SUPPORT AND
CONTINUE TO SUPPORT AUTOIMMUNE
IN SCLEROSIS AND LUPUS WE'LL
PLAY A KEY COORDINATING ROLE IN
HELPING DEVELOP A
MULTI-STRATEGIC PLAN FOGSED ON
THE COLLABORATION FROM MULTIPLE
DISCIPLINES CONVERGING ON
AUTOIMMUNE DISEASES, IDENTIFYING
NEW IDEAS AND FOSTERING IDEAS
AMONG THE I.C.s, EVALUATE EGG
THE PORTFOLIO AND PROVIDING
RESOURCES FOR COLLABORATION AND
INNOVATION AND MAKING SURE
THERE'S PUBLICLY ACCESSIBLE
INFORMATION ABOUT AUTOIMMUNE
DISEASE RESEARCH EFFORTS AT NIH.
I WANTED TO SHARE THAT NEWS WITH
YOU AS WELL.
IN ADDITION, WE ESTABLISHED THE
NEW TEAM SCIENCE LEADERSHIP
SCHOLARS PROGRAM OR LSP IN
WOMEN'S HEALTH.
AUTOIMMUNE AND IMMUNE MEDIATED
DISEASES.
IT'S A PILOT PROGRAM DESIGN IT
TRAIN WOMEN'S HEALTH SCHOLARS,
MID-CAREER SCHOLARS TO HELP THEM
HONE THEIR SKILLS BECAUSE IT'S
THE WAY WE DO SCIENCE AND
PROVIDE THEM AN OPPORTUNITY IN
THE AMP-AIM PUBLIC-PRIVATE
PARTNERSHIP TO EXPAND WITH THE
MULTI-SECTOR VIEW.
IT'S AN IMMERSE CROSS-SECTORIAL
COLLABORATIVE EXPERIENCE AND THE
OPPORTUNITY IS TO WORK WITH
MULTIPLE LEADERS.
HERE ARE OUR FIRST COHORT OF LSP
SCHOLARS.
WE'RE SO EXCITED TO HAVE THEM
WITH US AND ALSO TO HAVE A
FORMER BIRCWH SCHOLAR AMONG
THEM.
A LITTLE BIT MORE ON THE AMP-AIM
LSP AND I WANT TO ACKNOWLEDGE
OUR PARTNERS.
NIAMS IN THE OFFICE OF DATA
SCIENCE STRATEGY AT NIH AS
ANOTHER CRITICAL PARTNER AND WE
ISSUED A SECOND OPPORTUNITY IN
THE PROGRAM.
WE'RE THRILLED TO BE ABLE TO DO
THAT TO BE ABLE TO EXPAND IT TO
EARLY STAGE INVESTIGATORS AND SO
WE WANT TO SHARE THE
ADMINISTRATION OF THE PROGRAM IS
MANAGED BY THE OKLAHOMA MEDICAL
RESEARCH FOUNDATION AND YOU
HEARD FROM THEIR LEADER LAST
YEAR LISA MENTIONED THE NEW
EFFORT AND A WANT TO PAUSE AND
SAY HOW DELIGHTED AND THRILLED
AND HEARTENED TO BE HERE AT THE
TIME WHEN THE PRESIDENT OF THE
UNITED STATES CREATES A WOMEN'S
HEALTH RESEARCH INITIATIVE LED
BY THE OFFICE OF THE FIRST LADY
AND THE GENDER POLICY COUNCIL AT
THE WHITE HOUSE.
STATED MISSION OF THIS EFFORT IS
TO IMPROVE WOMEN'S HEALTH
RESEARCH IN THE UNITED STATES.
AND THIS INITIATIVE INCLUDES
SEVERAL EXECUTIVE DEPARTMENTS
ACROSS THE FEDERAL GOVERNMENT
INCLUDING MEMBERS OF HHS BUT
ALSO THE DOD, VETERAN AFFAIRS
AND OTHER OFFICE OF TECHNOLOGY
SCIENCE POLICY, OMB AND OTHERS.
IT'S NOT JUST HHS, HEALTH AND
HUMAN SERVICES.
IT'S ACROSS THE U.S. GOVERNMENT
AND THE CHARGE TO THAT GROUP IS
TO DELIVERED CONCRETE
RECOMMENDATIONS TO ADVANCE
WOMEN'S HEALTH RESEARCH WITHIN
45 DAYS.
OUR DEADLINE IS DECEMBER 28.
AND WE ARE LOOKING FORWARD TO
DOING THAT.
FORMER BIRCWH P.I. IS THE CHAIR
OF THE INITIATIVE AND HERE SHE
STATES THE INITIATIVE WILL
FUNDAMENTALLY CHANGE HOW WE
APPROACH AND FUND WOMEN'S
HEALTH.
SO THIS INITIATIVE HAS BEEN
ESTABLISHED AND RECOMMENDATIONS
ARE DUE IN 45 DAYS.
IT'S PROPOSING TO TAKE A
TARGETED HIGH-IMPACT APPROACH BY
SETTING PRIORITY AREAS OF FOCUS
WHERE ADDITIONAL INVESTMENTS
COULD BE TRANSFORMATIVE.
I LOVE THAT "T" WORD.
TRANSFORMATIVE IS AN IMPORTANT
WORD BECAUSE WE'RE ALL ABOUT
MAKING A DIFFERENCE HERE.
THAT'S HOW WE DO EVERYTHING WE
DO.
THAT'S WHY WE DO EVERYTHING WE
DO.
IT ALSO DOES PROPOSE TO ENGAGE
THE SCIENTIFIC, PRIVATE AND
PHILANTHROPIC COMMUNITY TO DRIVE
INNOVATION.
THE PUBLIC-PRIVATE PARTNERSHIPS
MAY BE AN OUTCOME OF ONE OF THE
AREA.
HERE'S A COUPLE KWOETSZ I WANTED
TO SHARE FROM THE FIRST LADY AND
PRESIDENT.
I ALWAYS BELIEVED IN THE POUR OF
RESEARCH, PRESIDENT BIDEN SAYS
TO SAVE LIVES AND ENSURE
AMERICANS GET THE HIGH-QUALITY
HEALTH CARE THEY NEED TO ACHIEVE
SCIENTIFIC BREAKTHROUGHS WHICH
IS WHAT WE DO AT NIH AND
STRENGTHEN OUR ABILITY TO
PREVENT, DETECT AND TREAT
DISEASES WE HAVE TO BE BOLD.
THAT IS ANOTHER WORD.
WE HAVE "T" FOR TRANSFORMATIVE,
"B" FOR BOLD AND IT'S NOT AN
AN
ANNOGRAM I JUST DECIDED THAT NOW
THOUGH I DO LOVE THEM AND HERE'S
THE FIRST LADY.
EVERY STOREY -- WOMEN I KNOW
LEAVES A DOCTOR'S OFFICE WITH
MORE QUESTIONS THAN ANSWER.
THAT'S WHAT WE DO.
WE INTERROGATE AND UNDERSTAND
AND ASK RESEARCH QUESTIONS.
SHE SAID WE'RE CALLING ON
CONGRESSIONAL LEADERS IN THE
PRIVATE SECTOR, RESEARCH
INSTITUTIONS AND PHILANTHROPY TO
JOIN US IN TAKING URGENT ACTION
TO IMPROVE THE HEALTH AND LIVES
OF WOMEN THROUGHOUT THE NATION.
SO LOOKING FORWARD TO WORKING
ONE THE WHITE HOUSE WE HAVE LOTS
OF ONGOING DISCUSSIONS
INTERNALLY, EXTERNALLY AND I'M
LOOKING FORWARD TO BE ABLE TO
SHARE MORE WITH YOU IN THE
FUTURE.
YOU'LL HEAR IN A BIT WITH AN
INTRODUCTION THE LEGACY OF
LEADERSHIP LECTURE AND I'M GLAD
DR. CRISWELL WAS ABLE TO DO THUS
WITH US AND YOU'LL HEAR AN
INCREDIBLE TALK FROM HER IN A
BIT.
WE WANT YOU TO FOLLOW US ON
SOCIAL MEDIA AND GET ACCESS TO
OUR MONTHLY E-MAIL AND QUARTERLY
PUBLICATION IN FOCUS AND YOU
KNOW ABOUT THE E-LEARNING
MODULE.
WITH THAT I'LL MOVE ON TO
INTRODUCE OUR RUTH L.
KIRSCHSTEIN MEMORIAL LECTURE.
SHE TEACHES IN THE GRADUATE BIO
MEDICAL SCIENCE.
THE RECEIVED HER M.D. FROM
STANFORD AND MPH FROM BOSTON
UNIVERSITY SCHOOL OF PUBLIC
HEALTH.
SHE'S DOUBLE BOARDED IN INTERNAL
MEDICINE AND PREVENTIVE MEDICINE
AND COMPLETED A GENERAL RESEARCH
AND PRIOR TO THAT WAS PROFESSOR
OF MEDICINE AND EPIDEMIOLOGY AT
BOSTON UNIVERSITY SCHOOL OF
MEDICINE AND PUBLIC HEALTH,
DIRECTOR OF THE WOMEN'S HEALTH
INTERDISCIPLINARY RESEARCH
CENTER AND CHIEF OF THE WOMEN'S
HEALTH UNIT AT BOSTON MEDICAL
CAN CENTER.
SHE SERVES AS P.I. OF THE BOSTON
UNIVERSITY BIRCWH AND CONTINUES
TO MENTOR THE NEXT GENERATION OF
CLINICAL INVESTIGATORS IN
WOMEN'S HEALTH RESEARCH.
PLEASE JOIN ME IN WELCOMING,
DR. KAREN FREUND.
>> GOOD MORNING, EVERYBODY.
THANK YOU, DR. CLAY TO BE FOR
THE WONDERFUL INVITATION AND
THANK YOU TO THE OFFICE RESEARCH
OF WOMEN'S HEALTH FOR THE
WONDERFUL OPPORTUNITY.
I WANT TO TAKE A SECOND AND
PAUSE BECAUSE WE HAVEN'T DONE
THIS IN THREE OR FOUR YEARS.
I'VE LOST TRACK.
COVID YEARS KIND OF BLURRED.
WE'RE EXCITED TO MEET YOU ALL
TODAY.
PLEASE TAKE THIS OPPORTUNITY TO
GET TO KNOW PEOPLE.
THESE ARE GOING TO BE YOUR
COLLEAGUES FOR YOUR CAREERS.
THE THING I'M MOST EXCITED ABOUT
TODAY IS GETTING TO SPEND TIME
WITH ALL THE OTHER BIRCWH P.I.s.
WE HAVEN'T SEEN EACH OTHER IN SO
LONG.
THE ZOOM MEETINGS HAVEN'T BEEN
THE SAME AND THIS HAS BEEN MY
ACADEMIC HOME FOR YEARS AND I'M
THRILLED TO BE HERE.
I ALSO FEEL HONORED TO BE GIVING
THE DR. KIRSCHSTEIN MEMORIAL
LECTURE READING EVERYTHING ABOUT
HER SHE WAS A TRAILBLAZER AND
PAVED THE WAY FOR ALL OF US TO
BE HERE.
SO I WANTED TO SPEND MY TIME
TALKING ABOUT WORKING IN TEAMS
AND REALLY THINKING ABOUT TEAM
WORK IN ALL THE WORK WE DO TO
MAKE THE WORK MORE IMPACTFUL AND
MORE FUN AND EASIER.
I'M GOING TO TALK ABOUT THREE OR
FOUR AREAS FOR US TO THINK
ABOUT.
FIRST OF ALL, I WANT US TO
CONSIDER WHETHER TEAM WORK
ACTUALLY HELPS OR HURTS WOMEN'S
CAREERS AND A KNOW THIS OFTEN
GETS DISCUSSED WHEN IT COMES TO
PROMOTION AND ADVANCEMENT AND
HAVE US THINK A LITTLE BIT ABOUT
THAT ISSUE.
I'M GOING TO TALK ABOUT A TEAM
WORK EARLY IN MY CAREER AND GIVE
YOU A FEW OF THE LESSONS I'VE
LEARNED AND TALK ABOUT TEAM WORK
AND RESEARCH AND TALK ABOUT
TEAMS AND PROVIDING CLINICAL
CARE.
AND ON THE WAY YOU MAY SEE A FEW
OF YOUR OWN SLIDES FROM YOUR OWN
WORK JUST BECAUSE MANY ARE
BIRCWH P.I.s AND SCHOLARS HAVE
DONE SO MUCH WORK IN THESE
AREAS.
I THOUGHT I'D START WITH MY OWN
EARLY CAREER JOURNEY AND HOW I
WAS LUCKY IN TWO RESPECTS.
ONE IN TERMS OF FIND RESEARCH
BUDDY AND SECOND IN TERMS OF
FIND MENTORING TEAM.
I'M GOING TO TALK ABOUT HOW YOU
DEFINE SUPPORT ON THE HOME
FRONT.
SO ONE OF THE THINGS I WAS VERY
FORTUNATE IN MY EARLY CAREER
WHEN I FIRST BECAME A FACULTY
MEMBER WAS FINDING ANOTHER
FACULTY MEMBER WHO HAD THE SAME
INTERESTS AS ME AND WE DECIDED
EARLY ON WE'D DO ALL OF OUR
RESEARCH TOGETHER.
WE WERE GOING TO FIND ONE OF US
WOULD BE THE LEAD AND ONE WOULD
BE THE CO-LEAD ON THAT AND THAT
ALLOWED US TO EXPAND WHAT WE
WERE DOING.
IT MADE IT MORE FUN AND DOING IT
AT A TIME WHEN WERE STARTING
BOTH OUR CAREERS AND TRYING TO
START OUR FAMILIES AND MADE IT
EASIER TO GET TO THOSE DOCTORS
APPOINTMENTS, BOTH OF US WERE
GOING THROUGH AS MANY AND SOME
HAVE RESEARCHED ON THOSE OF US
WHO WAIT UNTIL OUR 30s TO FINISH
OUR TRAINING AND THEN START TO
BUILD OUR FAMILIES.
OFTEN TIMES FIND THERE'S MEDICAL
TECHNOLOGY INVOLVED THERE WITH A
LOT OF OFFICE VISITS.
SO WE MANAGED TO FIGURE OUT A
WAY TO JUGGLE ALL OF THAT AND
FIGURE THAT OUT AND OUR DIVISION
CHIEF COULDN'T FIGURE OUT WHY
ONLY ONE OF US WERE AT THE
MEETING AND TRIED TO GET HIS
HEAD WRAPPED AROUND THAT BUT IT
WAS A HIGHLY PRODUCTIVE TIME TO
PUBLISH AND WORK TOGETHER.
THAT RELATIONSHIP HAS CONTINUED
TO THIS DAY WHERE WE'RE AT
DIFFERENT ORGANIZATIONS AND
DON'T COLLABORATE IN TERMS OF
OUR PROFESSIONAL WORK BUT STILL
GET TOGETHER FOR LONG WALKS WITH
HER TWO FAIRLY LARGE DOGS.
THEN IN TERMS OF FINDING A
MENTORING TEAM, I WAS FORTUNATE
TO FIND A NUMBER OF MENTORS
EARLY IN MY CAREER.
ONE FROM WITHIN MY OWN DIVISION
WHICH WAS HELPFUL IN TERMS OF
GUIDING ME IN TERMS OF WHAT I
NEED TO DO FOR MY OWN ACADEMIC
PROMOTION, FOR MAKING SURE I HAD
THE SUPPORT IN THAT REALM BUT
THEN ALSO FINDING SEVERAL WOMEN
IN OTHER DEPARTMENTS WHO COULD
GIVE ME A PERSPECTIVE WHEN
THINGS WERE GOING WELL AND TELL
ME WHEN TO TURN AND GIVE ME
ADVICE WHEN I FELT I WASN'T
MAKING PROGRESS ESPECIALLY THOSE
FIRST MULTIPLE YEARS.
I THINK IT WAS THE FIRST SEVEN
OR EIGHT GRANTS THAT DIDN'T GET
FUNDED UNTIL MY FIRST GRANT
SPONSORED THROUGH THE OFFICE OF
RESEARCH IN WOMEN'S HEALTH WAS
THE FIRST GRANT I RECEIVED.
SO TALKING ABOUT THE HOME FRONT.
I'VE BEEN FORTUNATE ENOUGH TO
HAVE A PARTNER WHERE EACH OF US
BELIEVES WE DO FAR MORE THAN 50%
OF THE HOME CHORES AND ARE BOTH
OKAY WITH THAT.
IT REALLY DOES TAKE A
PARTNERSHIP AND TEAM WORK.
WE WERE ALSO LUCKY THAT WE HAD A
TEAM OF NEIGHBORS WHO WERE
INTERESTED IN GOING ON THIS
VENTURE WITH US.
SO NEITHER MY HUSBAND, WARREN OR
I, HAVE FAMILY IN THE NEW
ENGLAND AREA NEARBY BUT FOUND WE
HAD SEVERAL NEIGHBORS IN THE
SAME PLACE WITH YOUNG CHILDREN.
BOTH SINGLE MOMS WITH
PROFESSIONAL CAREERS.
ONE IS A CFO AND ONE A CEO OF A
NONPROFIT.
WE HAD AN UNWRITTEN RULE IF YOU
GOT A CALL FROM ANOTHER MOM AND
REALLY NEEDED HELP THAT DAY, YOU
FIGURED OUT A WAY, EVEN IF IT
MEANT YOU TAKE THEIR SICK KID TO
YOUR OFFICE OR CANCELED YOUR
APPOINTMENTS BECAUSE THEY ONLY
ASKED WHEN YOU REALLY, REALLY
NEEDED IT.
WE ALSO HAD ONCE A MONTH FRIDAY
DINNERS WHERE WE'D MAKE MAC AND
CHEESE FOR THE KIDS AND PUT THEM
IN FRONT OF A MOVIE WHICH GAVE
US TIME TO RELAX AND ENJOY NICE
TAKE OUT FOR OURSELVES.
ONE LESSON WE LEARNED EARLY ON
WHICH I'D LIKE TO RECOMMEND TO
ALL OF OUR SCHOLARS IS YOU CAN
LEARN TO COOK AND LEARN TO CLEAN
AND LEARN TO ENTERTAIN.
YOU SHOULD NEVER VENTURE ANY OF
THESE ON THE SAME DAY.
.
AND I THINK MY EXPERIENCE EARLY
ON WITH THE BIRCWH WAS ALSO AN
EXAMPLE OF MENTORING TEAMS.
MY FIRST BIRCWH APPLICATION WAS
A DISASTER.
IT DOESN'T GET SCORED.
I DIDN'T UNDERSTAND WHAT TABLES
WERE.
THERE WERE A LOT OF MISTAKES I
MADE AND I REACHED OUT TO
SOMEONE IN THE ORGANIZATION AND
I TALKED TO HER ABOUT THE NEXT
SUBMISSION.
WE DETERMINED SHE SHOULD BE THE
P.I. AND I SHOULD BE THE
RESEARCH DIRECTOR OF THE NEXT
SUBMISSION SINCE SHE HAD MORE
EXPERIENCE CLEARLY IN WRITING
GRANTS AND DETERMINED WITHIN
FIVE YEARS AND MENTORING ME TO
BE THE P.I. WHICH IS IS WHAT WE
DID.
SO IT WAS AN EXAMPLE OF BOTH
MENTORING WITHIN THE BIRCWH
PROGRAM AS WELL AS MENTORING AND
DEVELOPING MENTORING TEAMS FOR
OUR SCHOLARS WITH THE NOTION OF
ALWAYS A LOWING YOUR JUNIOR
FACULTY TO ADVANCE AHEAD OF US
AS THE MENTORS.
AND SO I'VE NOTICED UP OUR
BIRCWH DISCUSSION WITH THE P.I.s
LAST WEEK SEVERAL OF THE BIRCWH
PROGRAMS NOW HAVE AS THEIR
LEADERSHIP FORMER BIRCWH
SCHOLARS WHICH IS EVIDENCE OF
THIS MOVING THE CAREERS FORWARD
OF OUR SCHOLARS IN MULTIPLE
WAYS.
SO TEAM WORK I BELIEVE IS MORE
IMPORTANT THAN EVER.
I WOULD SAY THINGS HAVE NOT
GOTTEN EASIER IN ACADEMIC
CAREERS.
THE FUNDING CLIMATE IS MORE
CHALLENGING THAN EVER.
THE CLINICAL PRACTICE HAS MUCH
MORE FINANCIAL STRESS.
AND FAMILY SUPPORT FOR ALL EARLY
CAREER INVESTIGATORS I THINK IS
STILL A CHALLENGE.
WORK I DID WITH PHYLLIS CARR
SHOWED AS MUCH AS MANY OF US
TRIED TO DEVELOP GOOD AND STRONG
FAMILY LEAVE PROGRAMS AT OUR
ORGANIZATIONS, THAT MANY EARLY
CAREER FACULTY STILL ARE
NEGOTIATING THEIR FAMILY LEAVE
HAVING TO NEGOTIATE THAT ON AN
INDIVIDUAL LEVEL RATHER THAN
HAVING AN EASY PATHWAY AT THEIR
ORGANIZATION.
WE ALSO FOUND OUT THAT MANY OF
THE PLACES AND THIS WAS MY
EXPERIENCE, YOU COULD BUILD A
GREAT FAMILY LEAVE PROGRAM ONLY
TO FIND SEVERAL YEARS LATER IT
WAS DISMANTLED.
WE ALSO IDENTIFIED SOME REAL
CHALLENGES FOR PART-TIME FACULTY
AND MANY EARLY CAREER FACULTY
THINK ABOUT GOING PART-TIME
ESPECIALLY AFTER THEY START TO
BUILD AND HAVE A YOUNG FAMILY.
WE'VE NOTICED AN EXTRA TAX AND
PENALTIES IN TERMS OF LAGS IN
PROMOTION AND ADVANCEMENT FOR
THAT GROUP EVEN IF THEY TAKE
VERY SHORT PART-TIME ASSIGNMENTS
EVEN FOR LESS THAN A YEAR.
SO WHAT ARE THE LESSONS I'VE
LEARNED FROM THIS?
I ALWAYS FELT THE GROUP WE NEED
TO CONVINCE WERE THOSE MORE
SENIOR THAN US WHO HAD THE
OPPORTUNITY AND THE
RESPONSIBILITY TO SET THE AGENDA
AND SET PROGRAMS AND POLICIES.
BUT ONE OF THE LESSONS I THINK I
LEARNED WAS WE ALSO HAVE TO WORK
WITH OUR CURRENT PEERS IN ALL
SETTINGS BECAUSE THOSE CURRENT
PEERS WILL BECOME THE FUTURE
LEADERS AND THEY'LL HAVE THE
OPPORTUNITY TO PROMOTE THE GAINS
WE MAKE OR SET THAT BACKWARDS.
SO IN WORKING YOU WANT TO MAKE
SURE YOU'RE WORKING WITH THE
GROUPS NOT ONLY MORE SENIOR TO
YOU AND THINKING ABOUT ISSUES
AROUND FAMILY LEAVE BUT WORKING
WITH CURRENT PEERS.
SO RESEARCH TEAMS.
CAN THIS WORK FOR THE
ADVANCEMENT OF EVERYONE?
ONE EXAMPLE EARLY ON IN THE
FIRST BIRCWH PROGRAM.
WE RECEIVED TWO BIRCWH
APPLICATIONS WITH OVERLAPPING
INTERESTS.
WE SEE THESE TWO APPLICATIONS
BOTH WERE INTERESTED IN HPV
PREVENTION.
WHEN I GOT THESE I WENT INTO A
LITTLE BIT OF A PANIC, HOW WE
WERE GOING TO DETERMINE WHOSE
CAREER WE'RE TO ADVANCE AND THE
TWO INVESTIGATORS AT THE SAME
ORGANIZATION WERE NOT COMPETING
AGAINST EACH OTHER OR ONE WAS
STIFLING THE CAREER OF ANOTHER?
IT CAUSED ME A LOT OF CONCERN AT
THE BEGINNING.
THEN WE READ THROUGH THEIR
APPLICATIONS BOTH WHICH WERE
REALLY EXCELLENT AND WANTED TO
FUND BOTH.
THEY HAD A SLIGHTLY DIFFERENT
FOCUS BUT MUCH OVERLAP IN THEIR
METHODS.
THEY HAD DIFFERENT TARGET
AUDIENCES.
ONE WAS TARGETING HPV PREVENTION
LOOKING AT THE PARENT AND ONE
LOOKING AT THE PHYSICIANS AND
ONE WORKED WITH A HISPANIC AND
ANOTHER WITH THE HAITIAN
POPULATION AND INSTEAD OF THINK
OF IT AS A PROBLEM AND MAKING
SURE THE TWO INDIVIDUALS WOULD
NOT BE A PROBLEM FOR THE TWO,
OUR INTERNAL ADVISORY COMMITTEE
SUGGESTED NOT ONLY WE FOUND BOTH
OF THEM BUT WORK WITH BOTH TO
DEVELOP A COLLABORATIVE TEAM
APPROACH TO THEIR RESEARCH.
WE MADE SURE EACH HAD THEIR OWN
MENTORING TEAMS AND MENTORS BUT
ALSO HAD OVERLAP OF THEIR
MENTORS AROUND THEIR
METHODOLOGIES WHERE BOTH WERE
DOING INITIAL QUALITATIVE WORK
TO THINK HOW TO COLLABORATE AND
WORK TOGETHER.
SINCE THEY BOTH HAD INROADS
ABOUT CERTAIN POPULATIONS AND
THEY'D BE ABLE TO EXPAND THE
POPULATIONS THEY WERE STUDYING
OPPOSED TO HAVING TO CONTRACT
THAT.
AND I'M HAPPY TO SAY THIS WORKED
ADVANCING IN THEIR CAREERS.
DR. NATALIE PEER JOSEPH AND
DR. PERKINS HAVE BEEN
COLLABORATING NOW OVER A DECADE.
I PULLED ONE OF THEIR MORE
RECENT PUBLICATIONS FROM 2020
USING THE MODEL OF WORKING
TOGETHER.
EACH TAKING A LEAD ON THE
PROJECT THAT WAS PART OF THEIR
BIRCWH PROJECT AND MOVING THAT
FOR WAR AND THEN SUPPORTING AND
COLLABORATING WITH EACH OTHER ON
THE STRENGTHS THEY HAD TO
ADVANCE THEIR PROGRAM.
THE BIRCWH HAS BEEN AN EXAMPLE
OF DEVELOPING TEAM WORK IN
RESEARCH AND THERE'S A LOT OF
GREAT PHOTOGRAPHS OF A LOT OF
YOU AND YOUR PROGRAMS.
I HOPE YOU ENJOY THESE
PHOTOGRAPHS OF YOUR TEAMS.
I'M GOING BRING UP ANOTHER
EXAMPLE AND IT'S IMPORTANT FOR
THE SCHOLARS HERE FOR THE FIRST
TIME TODAY.
WHEN YOU'RE AT THAT POSTER
SESSION AND SEE SOMEBODY ELSE'S
POSTER THAT LOOKS LIKE IT'S SORT
OF IN THE SAME AREA AS YOURS,
DON'T PANIC.
DON'T THINK OF THIS AS SOMEBODY
WHO IS GOING TO DO THE
PUBLICATION WORK AND YOUR WORK
WILL NOT GET PUBLISHED.
GO UP TO THAT PERSON AND THINK
HOW TO COLLABORATE.
OVER TEN YEARS AGO THAT HAPPENED
AT ONE OF THE MEETINGS.
EMLY MET WITH A SCHOLAR
DR. BOYNTON AND BOTH HAD AN
INTERESTING IN LOOKING AT
CHILDHOOD HARDSHIPS AND
FERTILITY ISSUES SUBSEQUENTLY.
RATHER THAN SEEING IT AS A
COMPETITIVE ISSUE THEY MET AND
SAID LET'S WRITE A GRANT
TOGETHER.
THEY'VE HAD SEVERAL FUNDING
OPPORTUNITIES THEY'VE BEEN
CO-P.I.s ON AND YOU CAN SEE FROM
THE PUBLICATION DATES HERE
THEY'VE HAD OVER A 10-YEAR
COLLABORATION OF WORKING
TOGETHER.
A COLLABORATION THAT STARTED
HERE AT ONE OF THE BIRCWH
MEETINGS.
DR. BIRCH HERE TODAY WHO HAS
LOOKED AT THE ISSUE OF
INCREASING COLLABORATIONS WITH
THE BIRCWH PROGRAM.
YOU CAN SEE FROM HER NOTE
ANALYSIS ABOUT THE IMPACT OF THE
BIRCWH PROGRAM IN ADVANCING THE
NETWORK OF SCHOLARS TO INCREASE
THEIR COLLABORATIONS AND IMPACT
OF THEIR RESEARCH.
SO GOING BACK TO THE QUESTION OF
RESEARCH AND TEAMS.
CAN THIS WORK TO ADVANCE
EVERYONE.
AND HOW CAN WE PREVENT TEAMS
FROM INTERFERING WITH ACADEMIC
PROMOTION AND RECOGNITION?
THERE'S A COUPLE WAYS WE CAN DO
THIS AND I WANT TO TALK ABOUT A
LITTLE BIT BOTH FROM THE POINT
OF VIEW OF THE EARLY SCHOLAR AND
FROM THOSE OF US WHO NOW HOLD
LEADERSHIP POSITIONS WITHIN
ORGANIZATIONS.
I THINK THE TEAM WORK DOES WORK.
I THINK THERE'S A COUPLE OF
GUARDRAILS YOU WANT TO PUT IN
PLACE FOR YOUR SCHOLARS AND FOR
YOU AS SCHOLARS AS YOU'RE
STARTING TO DEVELOP TEAMS.
I THINK AS YOU'RE WORKING WITH A
GROUP IT'S REALLY IMPORTANT FOR
EACH INDIVIDUAL, EACH SCIENTIST
WITHIN THAT GROUP TO HAVE THEIR
SPECIFIC AREA OF FOCUS THEY
BRING AND WHAT THEY'RE SC -- WH
SCHOLAR ACHIEVEMENTS WILL COME
FROM AND THAT AND DEMONSTRATE
THAT FOR THE ACADEMIC PROMOTION.
ONE THING WE CAN DO AS SENIOR
LEADERS NOW IN ORGANIZATIONS IS
TO LOOK AT OUR ADVANCEMENT AND
PROMOTION CRITERIA AND WORK TO
MAKE SURE THEY INCLUDE
RECOGNITION OF ALL ASPECTS OF
SCHOLARSHIP AND ALL
CONTRIBUTIONS TO SCHOLARSHIP AND
IT'S THE INDIVIDUAL WORK OF EACH
MEMBER OF THE TEAM.
I THINK FROM THIS APPROACH WE
CAN MAKE SURE FROM EVERYBODY
ADVANCING IN THEIR FIELD.
I WANT TO TALK ABOUT WORKING IN
TEAMS IN CLINICAL CARE.
THE LANDSCAPE IS DIFFERENT THAN
EVEN 10 YEARS AGO.
MEDICARE HAS LONG SINCE
ELIMINATE THE ACADEMIC PAYMENT
TO OUR ACADEMIC CENTERS WHICH
WAS OFTEN TIMES USED BY
INSTITUTIONS TO SUPPORT EARLY
CAREER FACULTY EARLY ON GIVING
THEM DEDICATED TIME TO RESEARCH.
THOSE DAYS HAVE LONG SINCE
PASSED.
WE NOW HAVE EPIC BASKETS WHICH
ARE FULL.
AND WE LONG TO HAVE A SYSTEM
THAT ENSURES PHYSICIANS AND
EVERYBODY IN OUR TEAM ARE
FOCUSSED AT THE TOP OF OUR
LICENSE BUT THE REALITY IS MANY
INNOVATIONS IN CARE WIND UP
PULLING PHYSICIANS BACK TO MORE
CLIFF CAL AND OTHER
RESPONSIBILITIES.
THEN THERE'S CARE TO FAMILIES
AND PATIENT WHO'S COULD NOT
ACCESS TELEHEALTH OR PORTALS TO
GET INFORMATION.
THE PATIENTS WORKING TWO OR
THREE JOBS AND LOSE A DAY'S PAY
WHEN THEY NEED TO HAVE A
DOCTOR'S APPOINTMENT.
HOW CAN WE ACHIEVE HEALTH
EQUITY, SUPPORT OUR PATIENTS AND
STILL GET HOME IN TIME FOR
DINNER?
I WANTED TO SHOW WHEN I STARTED
RESEARCHING FOR THIS TALK I
DECIDED TO GO INTO NIH REPORTER
AND LOOKING AT PROVIDING SUPPORT
TO UNDER RESOURCED COMMUNITIES
AND MANY SCHOLARS ARE WORK TO
IDENTIFY THE NEGATIVE THE IMPACT
OF POOR SOCIAL DETERMINATES OF
HEALTH AND MANY ARE LOOKING AT
THE SOCIAL NEEDS OF WOMEN.
I THOUGHT I'D INCLUDE A FEW
EXAMPLE.
I'LL START WITH ONE OF OUR
FORMER SCHOLARS WHO LOOKED AT
THE GENDER DIFFERENCES IN SOCIAL
NEEDS DURING THE LIFE COURSE.
AND FOUND WHILE MEN OVER THE
LIFE COURSE HAVE A REDUCTION IN
THEIR SOCIAL NEEDS, SHE FOUND A
U-SHAPED RELATIONSHIP WITH WOMEN
IN THE MID YEARS AND BEYOND
HAVING MORE SOCIAL NEEDS WITH
REAL IMPLICATIONS FOR THEIR
HEALTH AND THEIR HEALTH NEEDS.
I'M GOING TO MOVE ON TO DEBORAH
FROM THE UCSF BIRCWH WHO LOOKED
AT AREAS REDLINED IN THE 1940s
IN THE SAN FRANCISCO, OAKLAND
AND L.A. AREAS AND WAS ABLE TO
DEMONSTRATE THE SAME COMMUNITIES
EVEN 50 YEARS LATER CONTINUE TO
HAVE ADVERSE BIRTH OUTCOMES AND
INCREASED RATES OF PREMATURE
DELIVERY.
ANOTHER UCSF SCHOLAR, THIS IS
BRITTANY CHAMBERS WORK AND HER
COLLABORATION, LOOKED AT A
MEASURE OF STRUCTURAL RACISM.
THE INDEX OF CONCENTRATION AT
THE EXTREMES AND LOOKED TO SEE
THE ASSOCIATION OF THIS WITH
ADVERSE BIRTH OUTCOMES AND WITH
THE AREAS OF HIGHEST SEGREGATION
ON THE SLIDE THAT THOSE
COMMUNITIES AND THOSE
NEIGHBORHOODS HAD HIGHER RATES
OF PRETERM BIRTH AND INFANT
MORTALITY.
THE NEXT PAPER I HOLD UP AND I
SEEM TO HAVE LOST THE FIRST LINE
OF THAT SLIDE HERE, THIS IS WORK
FROM THE EMORY BIRCWH AND WAS
ABLE TO SHOW A DIFFERENCE
BETWEEN MEN AND WOMEN AND THE
ASSOCIATION OF SOCIAL
VULNERABILITY AND PSYCHOLOGICAL
DISTRESS.
AND FOUND FOR WOMEN IN
PARTICULAR THERE WAS GREATER
PSYCHOLOGICAL DISTRESS WITH
HIGHER RATES OF SOCIAL
VULNERABILITY COMPARED TO MEN.
JOSHUA BUNDY AT THE TULANE
BIRCWH WAS LOOKING AT WHAT WERE
SOME OF THE SOCIAL DETERMINATES
THAT EXPLAINED THE DIFFERENCE IN
BLACK AND WHITE MORTALITY AGAIN
USING SOME OF THE NHANES DATA
AND FOUND IN PARTICULAR IN THIS
BEAUTIFUL PIE CHART THERE WERE
FOUR AREAS IN PARTICULAR THAT
COULD BE HIGHLY ASSOCIATED WITH
THE DIFFERENCE WITH BLACK AND
WHITE MORTALITY, EMPLOYMENT,
POVERTY, LACK OF INSURANCE AND
NOT HAVING A PARTNER.
THIS IS TO THE WORK OF KATHERINE
McKINLEY ALSO AT THE TULANE
BIRCWH.
SOME WORK THAT SHE HAS BEEN
DOING WITH HER MENTORS LOOKED TO
DEVELOP TEAMS WITH COMMUNITY
REPRESENTATION TO SUPPORT
PREVENTIVE HEALTH WORKING WITH
INDIGENOUS COMMUNITIES.
THEN THE LAST EXAMPLE I'M GOING
TO SHOW IS KATIE.
SORRY, IF I MISPRONOUNCE HER
NAME, MINDEL WHO LOOKED AT DOULA
CARE AS AN INTERVENTION TO
ADDRESS THE SOCIAL DETERMINATES
OF HEALTH.
HOW CAN TEAM WORK ADDRESS SOCIAL
NEEDS?
I'LL TALK ABOUT SOME OF MY OWN
RESEARCH WITH MY TEAMS ON
PATIENT NAVIGATION.
THEY SERVE AS THE GO BETWEEN
BETWEEN THE PATIENT, HEALTH CARE
SYSTEM AND COMMUNITY.
THEY HAVE KNOWLEDGE HOW TO GET
OUR PATIENTS HOW TO GET THE
HEALTH CARE SYSTEMS WHICH HAVE
BECOME INCREASINGLY COMPLEX EVEN
AS THE CARE HAS GOTTEN
INCREASINGLY APPROVED AND HAVE
AN UNDERSTANDING OF THE
COMMUNITY, CULTURE AND MEDICAL
MODEL OF OUR PATIENTS AS WELL AS
SOCIAL DETERMINATES AND THE BEST
TO SCREEN FOR SOCIAL NEEDS.
SO WITHIN THE FRAMEWORK OF
PATIENT NAVIGATION WE'VE USED
AND MUCH OF THE WORK HAS BEEN
DONE IN CANCER AND IN A NUMBER
OF AREAS, WE'VE LOOKED AT
PATIENT NAVIGATION BEGINNING AT
THE TIME OF AN ABNORMAL CANCER
SCREENING WORKING THROUGH
DIAGNOSIS AND TREATMENT WITH A
GOAL OF ELIMINATING CRITICAL
DELIVERY GAPS FOR POPULATIONS
EXPERIENCING HEALTH DISPARITIES.
THE TASKS OF THE PATIENT
NAVIGATOR DEPEND ON THE LOCATION
AND NEEDS OF THAT PARTICULAR
COMMUNITY BUT INCLUDE A NUMBER
OF FACTORS SUCH AS TRANSLATING
WHAT TO EXPECT INTO LAY
LANGUAGE, PROMOTING AND
INFORMATION OF THE HEALTH CARE
SYSTEM, INCREASING ACCESS TO
CLINICAL TRIALS, COACHING AND
PROVIDING SUPPORT TO PATIENTS AS
THEY COME FOR THEIR DOCTOR'S
VISITS.
ASSISTING WITH SOCIAL NEEDS OR
BARRIERS TO CARE AND ONCE
FINDING BARRIERS TO CARE AND
SOCIAL NEEDS FACILITATING WITH
THEIR COMMUNITY RESOURCES TO
ADDRESS THOSE.
SO I WANT TO SHOW A FEW SLIDES
FROM ONE OF OUR STUDIES ON HOW
PATIENT NAVIGATION HAS BEEN
HELPFUL TO ELIMINATE HEALTH
DISPARITIES THE RESEARCH PROGRAM
WHICH IS A STUDY OF 12,000
PATIENTS WITH ABNORMAL CANCER
SCREENING FOR A NEW CANCER
DIAGNOSIS.
WHAT WAS USED WAS ACCESS TO
TIMELY CARE LOOKING AT THE TIME
IT TOOK FOR PATIENTS TO GET
DIAGNOSTIC RESOLUTION OR INTO
CANCER TREATMENT AND WE LOOKED
AT THE IMPACT OF THE NAVIGATION
INTERVENTION WHICH WAS A
CLINICAL TRIAL WITH A CONTROL
VERSUS A NAVIGATION ARM AND SEE
IF WE COULD SEE DIFFERENCES
BASED ON SELF SOCIAL NEEDS.
SO I'M GOING TO SHOW YOU THREE
SLIDES.
THE FIRST IS LOOK AGENT THE
IMPACT OF ON PATIENT NAVIGATION
IB ELIMINATING DISPARITIES BY
INCOME.
TO GIVE YOU A LITTLE BIT OF
ORIENTATION TO SHE SLIDE.
I'M SHOWING THE ADJUSTED HAZARD
RATIOS FOR THE CONTROL ARM IN
THE LEFT AND NAVIGATION ARM IN
THE RIGHT COLUMN.
THE HAZARD RATIOS ARE ADJUSTED
TIME TO EVENT AND HERE HAZARD
RUSSIA -- RATIO IS BAD AND MORE
THAN ONE IS GOOD AND THE
REFERENCE GROUP IS ONE OF THE
SUBGROUPS WESTBOUND THE CONTROL
ARMS.
HERE WITH INCOME ARE THOSE WHO
REPORTED A FAMILY INCOME OF MORE
THAN $50,000.
YOU SEE THE ADJUSTED HAZARD
RATIOS FOR ALL THE OTHER INCOME
CATEGORIES ARE LESS THAN ONE AND
THE HAZARD RATIOS ARE NOW OVER
ALL THE TREND IS INDICATING THAT
HAVING A NAVIGATOR REDUCED THE
DISPARITIES TO TIMELY CARE FOR
THOSE WHO ARE LOW INCOME.
SO HERE WE HAVE AS THE REFERENCE
GROUP THOSE WHO REPORTED BEING
EMPLOYED FULL TIME AND YOU'LL
SEE THOSE WHO RECEIVE BEING
UNEMPLOYED HAD GREATER DELAYS IN
CARE WITH AN ADJUSTED HAZARD
RATIO OF .85 BELOW ONE.
YOU LOOK AT THE COMPARISON NOW
IN THE NAVIGATED ARM AND SO
COMPARED TO THOSE WHO WERE FULLY
EMPLOYED IN THE CONTROL ARM,
THOSE WHO RECEIVE NAVIGATION HAD
MORE TIMELY CARE REGARDLESS OF
WHETHER THEY WERE EMPLOYED FULL
TIME, PART-TIME OR UNEMPLOYED.
AGAIN, INDICATING HAVING A
PATIENT NAVIGATOR ELIMINATED THE
DESPAIRS AND DELAYS IN CARE BY
EMPLOYMENT.
THEN WE LOOKED AT THE SAME ISSUE
BY HOUSING.
AGAIN, OUR CONTROL REFERENCE
POINT WERE THOSE IN THE CONTROL
GROUP WHO REPORTED OWNING THEIR
OWN HOUSE.
AND WE COMPARED THAT IN THE
CONTROL ARM YOU CAN SEE THERE
WERE GREATER DELAYS IN CARE FOR
THOSE INDIVIDUALS WHO REPORTED
RENTING AND THOSE WHO REPORTED
OTHER LESS STABLE HOUSING
ARRANGEMENTS.
THESE DELAYS IN CARE IN THE
CONTROL ARM WERE ELIMINATED IN
THE NAVIGATION ARM REGARDLESS OF
TYPE OF HOUSING WITH ALL THE
HAZARD RATIOS NO LONGER BEING
SIGNIFICANTLY LESS THAN ONE.
FINDING NAVIGATION ELIMINATED
CANCER DISPARITIES IN ACCESS TO
CARE INDEPENDENT OF ONE'S
HOUSING.
SO THERE'S A LOT OF DATA SHOWING
PATIENT NAVIGATION HAS SHOWN AN
IMPACT IN THE INTERIM OUTCOMES
SUCH AS DELAYS IN CARE.
THE QUESTION IS HAS PATIENT
NAVIGATION SHOWN AN OVER ALL
MORTALITY BENEFIT FOR UNDER
RESOURCED PATIENTS?
THE NEXT SLIDE IS DATA AROUND
BREAST CANCER IN THE CITY OF
BOSTON BUT FRANKLY WE COULD
PROBABLY RECREATE THIS SLIDE IN
ALMOST ANY AMERICAN CITY AND FOR
MANY CONDITIONS OTHER THAN
BREAST CANCER.
SO WE CONTINUE TO FIND DESPITE
ALL THESE EFFORTS THAT BLACK
WOMEN IN BOSTON ARE ALMOST TWICE
AS LIKELY TO DIE FROM BREAST
CANCER WHEN THEY DEVELOP IT
COMPARED TO WHITE WOMEN.
THIS IS DATA FROM THE BOSTON
HEALTH COMMISSION A FEW YEARS
OLD BUT THE TREND HASN'T CHANGED
THAT MUCH.
THIS IS DESPITE THE FACT THERE'S
NO GAP IN SCREENING.
WOMEN OF COLOR, BLACK WOMEN,
ASIAN WOMEN AND HISPANIC WOMEN
HAVE RATES OF BREAST CANCER
SCREENING AND MAMMOGRAPHY IN THE
BOSTON AREA AND MUCH OF THE
COUNTRY.
WE HAVE A NUMBER OF HOSPITALS IN
BOSTON AND EVERY HOSPITAL CLAIMS
THEY HAVE NO GAPS.
THEY DON'T SEE DISPARITIES IN
THEIR DATA.
AND YET WHEN WE LOOK AT THE
PUBLIC HEALTH DATA WE CONTINUE
TO SEE THESE GAPS.
SO WHAT'S THE REASON?
ONE THING WE THOUGHT ABOUT IS
MOST OF US WHEN WE MEASURE OUR
OWN INTERNAL DATA WE ONLY LOOK
AT THE PATIENTS WHO START THEIR
CARE WITH US AND CONTINUE ALL OF
THEIR TREATMENT WITH US.
USUALLY DROPPED FROM THE DATA
ARE THE PATIENTS WHO TRANSFER IN
FROM ANOTHER LOCATION AND WE
SOMEHOW DONT INCLUDE THOSE
PATIENTS THAT MAY START THEIR
CARE WITH US AND THEN LET US
KNOW THEY'RE GOING TO ANOTHER
ORGANIZATION OR INSTITUTION OR
DON'T SHOW UP FOR FOLLOW UP AND
THEY'RE LOST TO DATA.
OUR CONCERN IS THOSE ARE THE
VERY PATIENTS WE SHOULD BE MOST
CONCERNED ABOUT.
THE PATIENT WHO SAID HE OR SHE
IS GOING TO ANOTHER ORGANIZATION
FOR CARE AND SOMEHOW THE RECORDS
ARE NEVER REQUESTED AND SLIDES
NEVER SIGNED OUT AND NO EVIDENCE
THEY WENT SOME PLACE ELSE TO
RECEIVE THEIR CANCER CARE AFTER
A DIAGNOSIS.
WE EMBARKED ON ANOTHER STUDY
WHICH WE'RE JUST COMPLETING
RIGHT NOW WE CALLED TRANSLATING
RESEARCH INTO PRACTICE.
WE DIDN'T REALLY THINK WE WERE
GOING TO BE STUCK WITH THIS NAME
FOR A LONG TIME.
TRIP MAY NOT HAVE BEEN THE BEST
ACRONYM WE COULD HAVE USED BUT
THE CONCEPT WITH US OF WAS THIS,
WE SHOULD LOOK OUTSIDE OUR WALLS
AND BUILD BIGGER TEAMS.
WE WANTED TO MAKE A CASE FOR
COLLABORATIONS FOR DISPARITIES
AND POSTULATED THE ELIMINATION
OF HEALTH DISPARITIES REQUIRES A
PARADIGM SHIFT FROM THE
RESPONSIBILITY FROM THE PATIENT
OR DOCTOR OR THE INSTITUTIONAL
RESPONSIBILITY FROM THE HEALTH
CARE SYSTEM AND THE PATIENT
WHO'S WALK INTO THE HEALTH CARE
SYSTEM TO A REGIONAL
RESPONSIBILITY.
THIS REVISED FOCUS IS CRITICAL
TO ADDRESS DELIVER GAPS AND
PRESSES INSTITUTIONS TO WORK
TOGETHER COLLABORATIVELY TO TAKE
RESPONSIBILITY FOR EVENTS THAT
OCCUR OUTSIDE OUR WALLS.
SO WE'VE ENGAGED ALL THE
ACADEMIC HOSPITALS IN BOSTON IN
THE CLINICAL TRIAL.
WE'RE LOOKING TO SEE IF WE
DEVELOP A SET OF COLLABORATING
NAVIGATORS THE CITY SO IF A
PATIENT CHANGES INSURANCE OR
DECIDES SHE'S GOING SOMEWHERE
ELSE FOR CARE, THERE'S SOMEONE
AT THE RECEIVING END THAT KNOWS
ABOUT HER AND MAKES SURE THERE'S
NOT GAPS IN CARE AND GETS INTO
CARE MORE QUICKLY AND SOMEBODY
LOOKING TO SEE FOR THE PATIENT
WHO SAYS THEY'RE GOING ELSEWHERE
THEY DID GO ELSEWHERE FOR THEIR
CARE.
WE'RE JUST FINISHING THE TRIAL
AND OUR PRELIMINARY DATA DO
SUGGEST FOR THOSE PATIENTS WHO
RECEIVE NAVIGATION AND HAVE
NAVIGATORS HELPING ASSESS THEIR
SOCIAL NEEDS AND ADDRESSING THAT
THEY RESULT IN MUCH MORE TIMELY
CARE.
I WANT TO THANK YOU FOR THE
TIME.
I HOPE I'VE GIVEN YOU SOME AREAS
TO THINK BIN -- THINK ABOUT IN
TERMS OF WORKING IN TEAMS AND
OPPORTUNITIES FOR SCHOLARS AND
THINKING HOW TEAM WORK CAN
REALLY ADVANCE YOUR RESEARCH,
THE IMPACT OF YOUR RESEARCH AND
YOUR OWN CAREERS.
FOR THOSE OF US WHO ARE THE
LEADERS OF OUR BIRCWH PROGRAMS
ON HOW WE CAN USE TEAM WORK TO
PROMOTE THE WORK OF OUR SCHOLARS
AND ALSO TO THINK ABOUT HOW TEAM
WORK AND WORKING IN BIGGER TEAMS
AND REGIONAL TEAMS CAN REALLY
WORK TO SUPPORT THE CARE FOR ALL
OF OUR PATIENTS.
THANK YOU ALL SO VERY MUCH.
DO WE HAVE TIME FOR QUESTIONS?
I'M TOLD WE HAVE TIME FOR
QUESTIONS.
>> HI, THANK YOU FOR THE GREAT
PRESENTATION.
IT'S REALLY INSPIRING.
SO I HAVE A QUESTION ABOUT TRIP.
CAN YOU TELL US A LITTLE BIT
ABOUT WHAT THE PROCESS WAS
BUILDING COLLABORATIONS WITH
OTHER ACTORS IN THE BOSTON AREA.
I'M REALLY INTRIGUED BY THAT.
>> SO THE QUESTION HOW YOU GET
ALL THE COMPETING HOSPITALS IN A
REGION TO START TO COLLABORATE
TOGETHER.
IS THAT YOUR QUESTION?
>> YEAH.
>> FIRST, IT STARTS WITH THE
FACT THAT FOR THOSE OF US THAT
WORK IN LOCATIONS WHERE THERE
ARE MULTIPLE ACADEMIC CENTERS OR
MULTIPLE UNIVERSITIES, IT TURNS
OUT THAT THOSE WITHIN ANY
PARTICULAR AREA YOU'RE LIKELY TO
KNOW YOUR COLLEAGUES AND IN FACT
WITHIN THE BOSTON AREA WE KNEW
THE COLLEAGUES THAT WERE WORKING
IN BREAST CANCER DISPARITIES
AROUND THE CITY.
THE OTHER THING THAT WAS REALLY
HELPFUL IS THE BOSTON PUBLIC
HEALTH COMMISSION AND THE
MASSACHUSETTS PUBLIC HEALTH
DEPARTMENT LOOKED AT THE SAME
DATA I SHOWED AND THEY ACTUALLY
HELPED TO CONVENE THAT GROUP TO
COME TOGETHER.
OUT OF THAT ALSO CAME AND I
DIDN'T HAVE A LOT TO TALK ABOUT
THIS A NUMBER OF COMMUNITY
ORGANIZATIONS THAT WORK
TOGETHER.
THE CHALLENGE IS YOU CAN TAKE A
GROUP OF INVESTIGATORS OR
INDIVIDUALS WITHIN THOSE
ORGANIZATIONS AND THEY CAN COME
UP WITH AN IDEA OF HOW THEY CAN
COLLABORATE BUT YOU THEN HAVE TO
EXPAND THAT SO IN FACT THE
ORGANIZATIONS BELIEVE THIS IS
WORTH DOING AND WANT TO SUPPORT
THAT.
AND WE'VE BEEN BROUGHT IN A
NUMBER OF KEY PLAYERS IN THIS.
IT INCLUDES PAYERS AND WE'VE
BEEN WORKING WITH SOME OF THE
PRIVATE PAYERS AS WELL AS THE
MASSACHUSETTS MEDICAID CHIEF
MEDICAL OFFICER IN THAT GROUP
AND REALLY BRINGING THEM
TOGETHER.
I THINK IN THE LONG RUN ONE OF
THE WAYS WE'LL BE ABLE TO MAKE
THIS PARADIGM SHIFT IS TO HAVE
PART OF OUR PAYMENT STRUCTURES
BE AROUND QUALITY OF CARE AND
NOT QUALITY OF CARE AGAIN JUST
WITHIN OUR SMALL GROUP OF
PATIENTS BUT THINKING ABOUT
QUALITY CARE ACROSS THE REGION
TO PROVIDE DOLLARS AND AR IN --
DOLLAR INCENTIVES FOR REGIONAL
GROUPS TO WANT TO WORK TOGETHER.
>> HELLO.
I'M FROM THE UNIVERSITY OF
MINNESOTA BIRCWH PROGRAM AND I
APPRECIATE THE PRESENTATION AND
YOUR FRAMING, COLLABORATION
VERSUS COMPETITION.
I WONDER HOW YOU CAN SAY YOU
FOSTER THAT APPROACH AND BUY-IN
FROM LEADERSHIP, DEPARTMENTS,
PROMOTION AND TENURE.
THERE'S THINGS YOU CAN SAY MORE
ABOUT HOW TO REALLY FOSTER THAT
FRAMEWORK AND THAT THINKING.
>> SO I'LL TALK ABOUT SOME OF
THE LOCAL THINGS I THINK HAVE
BEEN HELPFUL.
FIRST, THERE'S PROBABLY MORE
THAN A FEW PEOPLE THAT HAVE BEEN
ON THE PROMOTION COMMITTEES OF
THEIR ORGANIZATION.
OUR PROMOTION AND TENURE
COMMITTEE WAS GOING UP AND
REVIEWING OUR CRITERIA AND IT'S
ONE OF THE TIMES YOU PUT UP YOUR
HAND AND SAY I'M GOING TO JOIN
THE COMMITTEE AND MAKE A PUSH
FOR THINKING ABOUT THE MIDDLE
AUTHOR AND HOW DO WE DEFINE THAT
AND ENSURE THAT THOSE
PUBLICATIONS WHERE YOU'RE NOT
THE FIRST AUTHOR REALLY COUNT
TOWARDS YOUR PROMOTION.
THAT'S ONE OF THE THINGS I FOUND
IS HIGHLY EFFECTIVE.
THE MORE WE ALL DO THAT AND OUR
INDIVIDUAL ORGANIZATIONS AND
COMMUNICATE THAT ACROSS
ORGANIZATIONS IT HELPS THE NEXT
PLACE BECAUSE THE NEXT PLACE CAN
SAY WELL, AT UNIVERSITY X, THIS
IS IS HOW THEY'RE ADDRESSING
PROMOTION.
NOBODY WANTS TO BE TOO FAR
AFIELD FROM ANY OTHER
ORGANIZATION WHEN THEY REWRITE
THEIR PROMOTION CRITERIA BUT I
DO FEEL AS INDIVIDUAL
ORGANIZATION S HAVE WRITTEN
ABOUT THIS AND TALKED ABOUT IT
AND DONE IT, IT'S ALLOWED
ORGANIZATIONS TO MOVE FORWARD
WITH THOSE CHANGES WHICH I THINK
ARE REALLY IMPORTANT TO ENSURE
EVERYBODY'S FELLOWSHIP IS
IDENTIFIED AND RECOGNIZED.
>> THANK YOU.
>> GOOD MORNING.
I'M CHARITY WATKINS REPRESENTING
DUKE BIRCWH AND HBCU BASED IN
DURHAM, NORTH CAROLINA.
FIRST, THANK YOU FOR THE BROADER
DISCUSSION ON TEAM WORK THAT
EXPANDS BEYOND THE PROFESSIONAL
REALM BUT ALSO THINKING ABOUT
WHAT HAPPENS AT HOME AND HOW
FOLKS AT HOME CAN BE ON THE TEAM
AS WELL.
I WAS WONDERING IF YOU COULD
SPEAK A LITTLE BIT MORE ABOUT
HOW TO FORM TEAMS WHILE
NAVIGATING STRUCTURAL INEQUITIES
AND HOW OUR ARE WE ABLE TO
DEVELOP TEAMS THAT ARE EQUITABLE
WHEN WE MAY BE ENTERING THOSE
SPACES WITH INEQUITIES WHETHER
IT'S FINANCIAL RESOURCES, OTHER
RESOURCES, HOW DO WE DO THAT IN
A WAY THAT DOESN'T, I GUESS
PRODUCE EVEN MORE INEQUITIES.
>> I THINK YOUR QUESTION IS A
REALLY GOOD ONE BECAUSE THERE'S
SO MUCH DATA TO SHOW THAT EVERY
TIME WE COME UP WITH AN
INNOVATION IT OFTEN HAS THE
CONSEQUENCE OF INCREASING
INEQUITIES RATHER THAN REDUCING
THEM EVEN WITHIN THE PATIENT
NAVIGATION WORLD THIS AN
INTERVENTION WE USED TO ADDRESS
UNDER RESOURCED COMMUNITIES.
IN MANY PLACES IT'S BEING USED
AS A MECHANISM TO SUPPORT VIP
PATIENTS OR TO SUPPORT PATIENTS
IN ORDER TO ATTRACT PATIENTS TO
ORGANIZATIONS WHOSE INSURANCE IS
GOOD.
OFTEN TIMES IT'S HAD THE
UNINTENDED CONSEQUENCES OF
INCREASING DISPARITIES.
SIMILARLY WITHIN WE THINK OF OUR
ORGANIZATIONS OF DEVELOPING
RESOURCES FOR SUPPORTING EARLY
INVESTIGATORS I THINK THINKING
ABOUT HOW WE DO IT SO THAT WE
PROVIDE THOSE RESOURCES FOR
THOSE WHO MAYBE HAVE INCREASED
SOCIAL DISADVANTAGE.
PART IS MINDFULNESS AND PART IS
MAKING SURE EVERYBODY'S AT THE
TABLE THAT NEEDS TO BE AT THE
TABLE SO WE MAKE SURE EVERYBODY
THAT EQUITY.
I'M NOT SURE THAT ADDRESSES WHAT
YOU WERE ADDRESSING.
>> HI, KAREN.
I'M SORRY.
THANK YOU.
I WONDER IF YOU HAVE TIPS IN
NAVIGATING INEQUITIES ACROSS
UNIVERSITIES AND ADDRESSING
COMMUNITIES AND COMMUNITY-BASED
ORGANIZATIONS.
HOW DO WE MAKE SURE WE DON'T
CAUSE MORE HARM THAN GOOD.
>> THEY SEE WHERE WE'RE COMING
FROM AND YOU GO TO WORK WITH A
COMMUNITY ORGANIZATION THEY SEE
YOU AS PART OF A BIG MONOLITH
WHAT HAS MORE MONEY THAN THEY DO
AND MORE RESOURCES THAN THEY DO.
WE TRIED VERY HARD WHEN WE
WORKED WITH COMMUNITY
ORGANIZATIONS TO MAKE SURE THAT
WE PAY THEM FOR THEIR TIME
OPPOSED TO EXPECTING IT TO BE
VOLUNTEER WORK.
AND THAT HAS AND PUTTING THAT
INTO OUR GRANTS BUT THERE'S SUCH
A BIG INEQUITY IN TERMS OF THE
RESOURCES COMMUNITY
ORGANIZATIONS HAVE.
AT THE SAME TIME WE'RE NOW
FOCUSSED MORE AND MORE ON
SCREENING FOR SOCIAL NEEDS ALL
MEDICARE IS NOW GOING TO BE
PAYING US TO SCREEN FOR SOCIAL
NEEDS WITH THE EXPECTATION WE'RE
GOING TO TURN TO THOSE COMMUNITY
PARTNERS TO PROVIDE SUPPORT FOR
PATIENTS.
THERE'S SOME REAL NEEDS TO
ADDRESS THAT.
>> ONE OF THE CO-P.I.s OF THE
BIRCWH PROGRAM UNIVERSITY SAN
FRANCISCO AND THANK YOU FOR YOUR
WISE LESSONS AND INSIGHT AND
WISDOM AS WELL AS YOUR STELLAR
CAREER IN WOMEN'S HEALTH OVER
DECADES.
MY QUESTION IS AROUND
DISSEMINATION AND DIFFUSION OF
YOUR RESEARCH INTO POLICY AND
WHETHER YOU HAVE SPENT SOME
TIME, ENERGY, ETCETERA IN
ASSURING IT MAKES STRUCTURAL S
AND REGULATORY AND STRUCTURAL
RACISM.
>> CLAIRE, NICE TO SEE YOU IN
PERSON AND THANKS FOR THE
QUESTION.
I'LL USE THE EXAMPLE OF PATIENT
NAVIGATION AND TRYING TO FIGURE
OUT HOW TO PUT THIS INTO POLICY.
IT'S BEEN ONE OF THE BIGGER
CHALLENGES.
IF WE WERE DOING A RANDOMIZED
TRIAL AND RED BILL VERSUS BLUE
PILL AND THE RED PILL TURNED OUT
TO BE MORE EFFECTIVE THERE'S A
WHOLE MECHANISM FOR SOMEBODY TO
MAKE THE RED PILL TO GO TO THE
FDA AND GET THE RED PILL
APPROVED AND GET CMS TO PAY FOR
IT AND A STRUCTURE WHEN IT COMES
TO DEVICES AND DRUGS BUT DON'T
HAVE THAT SAME STRUCTURE WHEN IT
COMES TO INTERVENTIONS THAT HAVE
BEHAVIORAL INTERVENTIONS OR
INTERVENTIONS THAT RESULT OR
REQUIRE A CHANGE IN HOW WE
DELIVER CARE.
SO IN FACT WHEN THE NCI FUNDED
THE PATIENT NAVIGATION RESEARCH
PROGRAM THE NCI SAID HE WAS
WORRIED ABOUT FUNDING THIS
BECAUSE COMMUNITY ORGANIZATIONS
WERE GOING TO EXPECT THE NCI TO
PAY FOR PATIENT NAVIGATORS WHICH
IS AN INTERESTING COMMENT TO
MAKE BECAUSE THE NC I WOULD SAY
WE DON'T WANT TO STUDY THE DRUG
BECAUSE IF IT WORKS WE'LL EXPECT
THE NCI TO PAY FOR THE DRUG.
THAT WAS THE DILEMMA.
AND SO FOR THE LAST DECADE
THERE'S BEEN GROUP NATIONALLY
THAT'S BEEN TRYING TO THINK HOW
WE GET THIS TO THE RIGHT
STAKEHOLDERS.
ONE THING WORKING IN
MASSACHUSETTS WE'VE BEEN
FORTUNATE THE LOCAL CANCER
SOCIETY HAS DECIDED TO DO ALL
THEIR WORK WITH LEGISLATIVE
STAKEHOLDER AROUND PATIENT
NAVIGATION AND HELPED US BRING
THE PAYERS TO THE TABLE AS WELL
AS BRING LEGISLATORS TOE THE
TABLE TO THINK HOW DO WE CHANGE
POLICY SO THIS TYPE OF WORK IS
COVERED AS HEALTH CARE BENEFITS.
WE'RE STARTING TO SEE IMPACT IN
TERMS OF THE MASSACHUSETTS
MEDICAID WAIVER CURRENTLY HAS
GOT THINGS IN PLACE THAT PAY FOR
THE KINDS OF STRUCTURES WITHIN
PRACTICES.
SO THAT'S THE TACTIC WE'VE BEEN
USING BUT IT'S REALLY.
THAT PART IS REALLY UNFUNDED
WORK.
BECAUSE IT DOESN'T FIT INTO PART
OF A GRANT.
IT'S WORK WE DO LONG AFTER THE
PARTICULAR GRANT IS OVER BUT
IT'S PART OF THAT ADVOCACY WORK
THAT'S REALLY BEEN CRITICAL.
I THINK THIS IS WHERE SOME OF
THE FOUNDATIONS AND COMMUNITY
GROUPS HAVE BEEN HELPFUL AND
SUPPORTIVE.
>> THANK YOU FOR THAT BEAUTIFUL
TALK.
I'M FROM THE ORWH.
I WANT TO FOLLOW-UP ON A
QUESTION ON BEING PART OF A
TEAM.
AND YOU MENTIONED ABOUT
PUBLICATION AND THE MIDDLE
AUTHOR BEING RECOGNIZED AS WELL.
HOW DO YOU PROPOSE TO DO THAT
FOR SAY RECOGNITIONS?
YOU MENTIONED A LITTLE BIT ABOUT
PROMOTION BUT NORMALLY IF YOU
GET AN AWARD AS A MEMBER OF A
TEAM DOESN'T SEEM QUITE AS
PRESTIGIOUS AS IF WERE AN
INDIVIDUAL AWARD BUT IF YOU
PROPOSE TEAM WORK AND
COLLABORATION, HOW WOULD YOU
LIKE TO ADDRESS THAT KIND OF
SUBRECOGNITION, SO TO SPEAK?
>> I THINK WHEN THE NIH ALLOWED
FOR MULTI-P.I.s THAT WAS HUGE.
THERE WAS ALWAYS THE P.I. AND
CO-P.I. AND THE THEY NEVER
SHOWED UP ON REPORTER AND NEVER
GOT TO STATE THAT.
I THINK THE MULTI-P.I.
DESIGNATION HAS BEEN REALLY KEY
AND ALLOWED A LOT OF INDIVIDUALS
TO REALLY GET THAT RECOGNITION.
WHEN WE DID THE PATIENT
NAVIGATION RESEARCH PROGRAM IT
WAS INTERESTING.
MANY OF THE SITES IN FACT MOST
THE SITES THAT HAD MALE P.I.s
HAD FEMALE CO-P.I.s BEFORE THE
DESIGNATION AND YOU CAN GUESS
WHO WAS DOING MOST THE WORK.
THAT'S BEEN ONE THING THAT'S
BEEN HELPFUL AND HAVING
PROMOTION COMMITTEES RECOGNIZE
BEING A COLLABORATOR ON A GRANT
OPPOSED TO A P.I. ON A GRANT
DEPENDING ON WHAT ROLE YOU PLAY
IS CRITICALLY HELPFUL.
MOST METHODOLOGISTS WILL USUALLY
NOT BE THE P.I.s OF THE AWARDS
UNLESS THEY'RE DEVELOPING SOME
INNOVATION IN METHODOLOGY AND
YET WE CAN'T DO THE WORK WITHOUT
THAT GROUP.
>> MY NAME IS BETHANY I'M ONE OF
THE BIRCWH SCHOLARS.
THANK YOU FOR A GREAT TALK.
YOU USED ONE OF MY FAVORITE
WORDS, ADVOCACY.
WHICH I FEEL LIKE IS AN
ESSENTIAL PART OF DOING WORK IN
WOMEN'S HEALTH BECAUSE THERE'S
NEVER ENOUGH RESOURCES AS PEOPLE
EARLY IN OUR CAREER, DO YOU HAVE
TIPS HOW TO HAVE ADVOCACY IN OUR
WORK IN A PRACTICAL WAY.
>> IT'S A GREAT QUESTION HOW YOU
INCREASE ADVOCACY IN YOUR WORK.
ONE OF THE CHALLENGES WORKING
WITH COMMUNITIES, DOING ADVOCACY
WITH COMMUNITIES, THE WORK TAKES
LONGER TO DO AND I ALWAYS WORRY
A LITTLE BIT WITH EARLY CAREER
INVESTIGATORS THAT THE
TRAJECTORY OF GETTING WORK
PUBLISHED CAN HAPPEN MORE
SLOWLY.
ONE THING WE DID THAT WAS
EFFECTIVE WITH THE MOST RECENT
PROJECT WE KNEW WOULDN'T GET
OUTCOMES FOR FIVE YEARS IS WHAT
ARE INTERMEDIATE STEPS AND WHO
ON OUR TEAM WERE THE EARLY
CAREER PEOPLE WE COULD ASK TO
WRITE THE EARLIER PAPERS AND
SOME WEREN'T EVEN ON HOW YOU
ENGAGE THE COMMUNITY.
THERE'S A LOT OF INTEREST IN
JOURNALS IN HAVING STRUCTURED
PUBLICATIONS ESPECIALLY AROUND
THOSE STEPS AND IMPLEMENTATION
SCIENCE.
I THINK AND MAKING SURE YOU HAVE
TWO OR THREE OTHER PAPERS IN THE
PIPELINE TO THINK OF HOW OR WHY
YOU'RE DESCRIBING THE WORK WITH
METRICS ON THE PROCESSES YOU'RE
USING.
>> I'M A BIRCWH SCHOLAR FROM THE
TULANE PROGRAM AND THANK YOU FOR
YOUR WORK AND THE WORDS ABOUT
FAMILY LEAVE.
I WANTED TO ASK YOU WHAT YOU
THOUGHT WE AS BIRCWH SCHOLARS
AND SCHOLARS OF WOMEN'S HEALTH
AND SEX DIFFERENCES CAN DO TO
HELP IMPROVE AT THE EDUCATIONAL
LEVEL SO CLINICAL TRAINING AND
MEDICAL RESIDENCY AND EVEN
UNDERGRAD AS SOME OF US MAY BE
TEACHING TO IMPROVE THE WAY WE
UNDERSTAND SOCIAL NEEDS AND
STRUCTURAL FACTORS.
THINKING ABOUT THE FACT THE
LIAISON COMMUNITY ON MEDICAL
EDUCATION LISTED CULTURAL
COMPETENCY AND PART OF A WORKING
GROUP CALLED STRUCTURAL
COMPETENCY WORKING GROUP
TRAINING FOLKS FOR 10 YEARS IN
THE FRAMEWORK OF STRUCTURAL
COMPETENCY.
NOW THERE MAY BE MORE CALLS FOR
STRUCTURAL COMPETENCY WHICH
BUILDS ON OTHER COMPETENCY TO BE
BUILD ON TRAINING AND THINK HOW
FROM YOUR PERSPECTIVE WE COULD
EDUCATE CLINICIANS, CLINICIAN
RESEARCHERS BETTER ON THE SOCIAL
AND STRUCTURAL DETERMINATES OF
HATH.
>> ONE OF THE CHALLENGES I FOUND
WITH NEW AREAS WHETHER IT'S
ADVOCACY OR TRAINING ON
STRUCTURAL NEEDS OR SOCIAL NEEDS
IS THE INDIVIDUALS WHO TYPICALLY
ARE THE TRAINERS THEMSELVES MAY
NOT HAVE THE EXPERTISE AND
KNOWLEDGE TO DO THE TRAINING.
THEN WE'VE SEEN THIS IN MULTIPLE
AREAS WHERE OUR MEDICAL STUDENT
ARE ASKING FOR MORE EDUCATION ON
A NUMBER OF AREAS AND WE AS THE
EDUCATORS ARE SAYING THAT'S A
GREAT IDEA.
WE SHOULD LEARN ABOUT THAT
OURSELVES.
PART OF WHAT HAS BEEN HELPFUL IN
OTHER AREAS IB HOW WE THINK OF A
GROUP OF EARLY EDUCATORS WITH
THE EARLY EXPERTISE BE ELEVATED
TO BE THE LEADERS IN TERMS OF
DEVELOPING THE CURRICULUM AND
WITH ANY CURRICULUM FIGURING OUT
WHERE IN THE EXISTING CURRICULUM
YOU CAN TIE THAT IN BECAUSE IT
DOESN'T MATTER WHO'S EDUCATIONAL
PROGRAM THERE IS THEY WILL
ALWAYS TELL YOU THERE'S NO MORE
TIME TO ADD NEW ELEMENT.
THINKING HOW THAT GETS EMBEDDED
INTO CURRENT ELEMENTS SO IT'S
NOT SEEN AS A MANDATE BUT
TEACHING IN A MORE SYSTEMATIC
WAY.
THANK YOU AGAIN ALL VERY MUCH.
>> AS KAREN WAS TALKING, I WAS
THINKING ABOUT THE ORIGINS.
THE BIRCWH ANNUAL MEETINGS ARE
PLEASED TO BE THE HOST FOR THE
RUTH L. KIRSCHSTEIN MEMORIAL
LECTURESHIPS AND I THINK SHE
WOULD BE ESPECIALLY BROWED --
PROUD OF TODAY TALKS AND I THINK
WE HONORED HER.
MOVING ON TO THE PODIUM SESSION,
IT'S MY PLEASURE AND CAN WE HAVE
THE SLIDES.
THERE'S A NUMBER OF PICTURES.
I'LL LEAVE THAT FOR A MOMENT.
WE'RE PLEASED TO SHARE IT'S BEEN
1 24 PICTURES OF CURRENT
SCHOLARS AND IMMEDIATE PAST
SCHOLARS AND SHARING IT TO
REINFORCE OUR APPRECIATION FOR
ALL YOUR HARD WORK AND CLEARLY
YOUR MENTORING TEAMS AND STAFF
AND SO FORTH THERE'S THREE MORE
SLIDES THAT HAVE MORE DETAIL BUT
WE WANT TO ACKNOWLEDGE THE
PASSION AND DEDICATION FOR ALL
OF OUR SCHOLARS AND TODAY WE'RE
CITING FOUR PODIUM TALKS AND
WANTED TO GIVE YOU ORIENTATION.
THESE BEGAN IN 2015 AS A WAY TO
ACKNOWLEDGE WHAT WE WHY THE MOST
COMPETITIVE ABSTRACTS AND
POSTERS THAT WERE SUBMITTED.
TODAY WE HAVE FOUR AND ON YOUR
PROGRAM IS THE DETAILS.
WE'RE ASKING EACH OF THE
PRINCIPLE INVESTIGATORS FROM THE
PROGRAM TO DO A BRIEF
INTRODUCTION OF THEIR SCHOLAR
AND WE FOUND THAT TO BE
PARTICULARLY EFFECTIVE BECAUSE
THEY KNOW THEIR SCHOLARS SO
WELL.
AFTER THE INTRODUCTION WE'LL ASK
OUR PHOTOGRAPHER TO TAKE A
PICTURE OF THE P.I. AND SCHOLAR
BEHIND THE PODIUM AND THE
SCHOLAR WILL GIVE HIS OR HER
TALK AND WE -- FOR 15 MINUTES,
HOPEFULLY AND FIVE MINUTES FOR
Q&A.
SO IT'S GOING TO BE THE FOUR
SERIES AND THEN WE'LL GO ON
BREAK.
I WOULD LIKE TO INVITE
DR. BERENSON TO COME DOWN TO
START THE PROCESS FOR THE UTMB
BIRCWH.
>> IT'S VERY EXCITING TO BE BACK
IN PERSON TODAY.
FROM THE UTMB BIRCWH AND EXCITED
TO INTRODUCE DR. RICHARDSON.
THIS IS THE THIRD YEAR IN A ROW
OUR PROGRAM HAS HAD A PODIUM
SPEAKER SO WE ARE VERY HONORED
BY ORWH'S RECOGNITION OF OUR
PROGRAM.
DR. LAUREN RICHARDSON IS
DESERVING OF THIS HONOR.
SHE'S AN EXCEPTIONAL RESEARCHER
AND SCHOLAR AND IN THE DIVISION
OF BASIC AND TRANSLATIONAL
RESEARCH AT THE UNIVERSITY OF
TEXAS MEDICAL BRANCH.
SHE COMPLETED HER Ph.D. DEGREE
IN CELL BIOLOGY AND ANATOMY AT
UTMB IN 2019 WHERE SHE SERVED AS
THE T32 TRAINEE.
FOLLOWING THIS, SHE WAS
RECRUITED TO TEXAS A&M WHERE SHE
COMPLETED A POST-DOCTORAL
FELLOWSHIP IN ELECTRICAL
ENGINEERING AND THIS UNIQUE
COMBINATION OF TRAINING PLACED
HER IN A POSITION WHERE SHE
COULD DO CUTTING EDGE RESEARCH .
SHE ENTERED THE BIRCWH PROGRAM
ONE YEAR AFTER JOINING THE
FACULTY AT UTMB AND AS A BIRCWH
SCHOLAR HAS WORKED ON
DEVELOPMENT OF PLACENTA ORGAN ON
CHIP MODELS TO STUDY HEALTHY AND
DISEASED STATE OF PREGNANCY AND
EFFICACY AND DRUG SAFETY.
IN 2022 SHE RECEIVED A FIVE-YEAR
RO1 GRANT AND NEW RECIPIENT TO
CONTINUE HER WORK IN THIS AREA.
I'M THRILLED TO HEAR WHAT LAUREN
HAS TO SHARE WITH US TODAY.
>> THANK YOU FOR THAT GREAT
INTRODUCTION.
IT'S REALLY QUITE AN HONOR TO BE
ABLE TO PRESENT TO YOU ALL
TODAY.
I'M GOING TO TELL YOU ABOUT
MICROFLUIDIC ORGAN ON CHIP
TECHNOLOGY AND HOW WE CREATED A
MULTI-ORGAN FETAL MEMBRANE AND
PLACENTA ORGANOID CHIP TO
ESTABLISH PHYSIOLOGY AND
PATHOLOGICAL STATES AND EXCITING
DRUG TESTING.
TO SET THE STAGE WE'LL TALK
ABOUT THE PREGNANCY TIME LINE.
THROUGHOUT GESTATION, MULTIPLE
INTRAUTERINE ORGANS PROTECT AND
SUPPORT THE DEVELOPING FETUS.
CLOSER TO 40 WEEKS GESTATION
WHICH IS CALLED TERM IS WHEN
MATERNAL AND FETAL SIGNALS
CONTRIBUTE TO IMMUNE CELL
ACTIVATION, INFLAMMATION AND
DELIVERING OF THE BABY.
THIS PHYSIOLOGICAL SIGNALS CAN
BEING ACTIVATED PATHOLOGICALLY
AND IF THIS HAPPENS BEFORE 37
WEEKS GESTATION IS CALLED
PRE-TERM BIRTH.
IT OCCURS IN ONE OUT OF EVERY 10
PREGNANCIES.
THE RATES OF PRETERM BIRTH ARE
ON THE RISE WORLDWIDE.
NOW, INTRAUTERINE INFECTION AND
INFLAMMATION ACCOUNT FOR 40% OF
ALL PRE-TERM BIRTH CASES.
THIS OCCURS WHEN BACTERIA FROM
THE VAGINAL TRACT CROSSES THE
CERVIX IN THE FETAL MEMBRANE AND
REACHES THE AMNIOTIC CAVITY AND
THESE NEW PRE-TERM BABIES HAVE
AN INCREASED RISK FOR EARLY
ONSET ADULT DISEASES SUCH AS
NEURO OR CARDIOVASCULAR DISEASE,
EARLY ONSET ASTHMA, DIABETES AND
EVEN CERTAIN TYPES OF CANCERS.
SO WHEN WE THINK ABOUT THE
SIGNALS THAT LEAD TO TERM OR
PRE-TERM BIRTH, THEY HAVE A VERY
SIMILAR SIGNALLING CASCADE THAT
IS DEPICTED ON THE SLIDE.
AND IT ALL ACCUMULATES IN FETAL
INFLAMMATORY RESPONSES THAT
PROPAGATE BACK TO THE MOM
BUILDING UP INFLAMMATION AND
CAUSING THE PROCESS TO OCCUR.
AND THE MAIN SIGNAL REGULATOR IS
NF CAPA B PLAYS A ROLE AT THE
FETAL INTERFACES TO INDUCE THIS
TYPE OF LABOR SIGNAL.
THERE'S TWO FETAL MATERNAL
INTERFACES.
THE PLACENTA AND THE FETAL
MEMBRANES.
NOW, WHILE THE PLACENTA IS VITAL
FOR FETAL SURVIVAL THE MEMBRANES
PLAY A UNIQUE ROLE INITIATING
THE CASCADE.
THEY'RE BOTH UNIQUE IN THEIR
CELLULAR AND COLLAGEN MAKEUP.
THEY'RE NOT THE SAME.
SO FROM THE PLACENTA SIDE, WE
HAVE THE IS SYNCYTIAL
TROPOBLAST.
WE HAVE THE TREE ON THE LEFT
MADE UP OF SYNCYTIAL AND
TROPOBLAST THAT CONNECTS IT TO
THE EPITHELIUM AND ON THE
MEMBRANE SIDE WE HAVE THE
CHORION WITH MESENCHYMAL CELLS
CREATING INTERFACES.
WHEN IT COMES TO STUDIES THESE
INTERFACES IN VITRO OR IN VIVO
THERE'S A COMMON PROGRESSION
THAT MOST PEOPLE FOLLOW WHEN
CONDUCTING PRECLINICAL TRIALS.
USUALLY YOU START OFF WITH MAYBE
A GENERIC CULTURE OF CELLS AND
MOVE ON TO A CO-CULTURE
EXPERIMENT OR AND MAYBE YOU HAVE
ACCESS TO PROFUSION STUDIES BUT
PREDOMINANTLY IT GOES OR LARGE
ANIMAL STUDIES TO TRY TO ANSWER
YOUR SCIENTIFIC QUESTIONS.
BUT THERE'S A BIG FLAW WITH
THIS.
THE FACT IS THAT THE ANATOMY AND
FUNCTION OF ANIMAL MODELS
COMPARED TO HUMANS IS SO
DIFFERENT.
SO WE NEED AN ADVANCED
HUMAN-BASED SYSTEM TO ANSWER
SOME OF THESE BIOLOGICAL
QUESTIONS.
THAT'S WHERE CHIP TECHNOLOGY AND
3-D PRINTING COME TO PLAY.
OREGONON CHIPS LIKE THE ONE I
HAVE HERE ARE THE MERGER OF WHO
DISTINCT FIELDS, ENGINEERING AND
BIOLOGY.
THIS IS WHERE ENGINEERS CREATE
PLASTIC DEVICES THAT BIOOLOGISTS
PUT THE PROPER CELL AND COLLAGEN
LAYERS TO MIMIC THE ORGAN'S
ARCHITECTURE AND YOU CAN
RECREATE ORGAN SYSTEMS THIS WAY.
I HAVE THE PRIVILEGE OF TELLING
YOU ONE OF OUR MOST ADVANCED
DEVICES YET.
IT'S A MULTI-ORGAN FETAL ORGAN
ON CHIP AND HERE'S THE SCHEMATIC
OF THE PLACENTA LAYERS
CONNECTED.
WE HAVE A CHIP DEVICE THAT
ALLOWS US TO GROW ALL THE SEVEN
CELL AND COLLAGEN LAYERS IN THE
ONE SYSTEM AND FILL THE BASEMENT
MEMBRANE COLLAGEN BETWEEN THE
AMNYON AND CHORRION WE HAVE AN
ONCHIP RESERVOIR AND THIS ALOUSZ
US TO HAVE AND ON THE PLACENTA
SIDE WE LOADED IN HUMAN DERIVED
TERM PLACENTA CELL LINES OF THE
SYNCYTIAL TROPHOBLASTS.
CYTOTROPHOBLASTS AND UMBILICAL
VESSEL CELLS AND ON THE FETAL
MEMBRANE SIDE WITHIN THE SYSTEM
WE HAVE INTERFACES WIN ONE MODEL
TO STUDY WHAT'S GOING ON.
THE FIRST AIM IS TO DEVELOP A
PHYSIOLOGICAL PLATFORM OF THE
TWO INTERFACES USING THE NOVEL
TECHNOLOGY.
7D SECOND IS LOOK AT
INFLAMMATION AS THE DISEASE
STATE AND THE LASTLY TO SEFT THE
DEVICE'S UTILITY.
WE LOOKED AT THE IMMUNE CELL
REGULATORY FACTORS AND
EXPRESSION AND THE CELLULAR
TRANSITION STATUS OF THE AMNION
THAT PLAYS A CRITICAL ROLE IF
THE MEMBRANES RUPTURE.
THE CELLS WITHIN THE MULTI-ORGAN
CHIP MAINTAINED THEIR IN UTERO
CHARACTERISTIC STATE.
NEXT WE WANTED TO DEVELOP OUR
DISEASED STATE.
WE TREATED THE MATERNAL CAVITY
AND LOOK AT THIS AND AFTER 30
MINUTES OF LPS TREATMENT WE
IDENTIFIED NF CAPPA B INCREASED
EXPRESSION IN THE MATERNAL
DECIDUA.
WE KNEW LPS WAS PROPAGATING BUT
IS THIS RESULTING IN CELL
SPECIFIC CHANGES OR CHANGE IN
THE INFLAMMATORY MILIEU.
THAT'S WHAT WE WANTED TO
INVESTIGATE NEXT.
AND LPS DID NOT AFFECT
TROPHOBLAST OR IMMUNE REGULATORY
FACTOR EXPRESSION OR AMNION
STATUS.
THIS WAS INTERESTING.
WHEN WE STARTED TO INVESTIGATE
THE INFLAMMATORY SIDE OF THINGS
WE LOOKED AT THE EXPRESSION OF
PROINFLAMMATORY CYTOKINE MARKERS
INTERLEUKIN 8 AND 6.
THE MATERNAL DECIDUA CELLS AFTER
TREATED AND THE SIGNIFICANT UP
REGULATION OF THE
PROINFLAMMATORY CYTOKINES.
THIS INFLAMMATION WAS
PROPAGATING ACROSS THE PLACENTA
PLAYERS ON THE LEFT AND FETAL
MEMBRANE LAYERS ON THE RIGHT AND
INDUCING THE SIGNIFICANT
RESPONSES OF IL8 AND 6 ACROSS
OUR SYSTEM.
TO SUMMARIZE OUR DISEASE STATE
WE DOCUMENTED INFECTIOUS AGENTS
CAN PROPAGATE ACROSS THE
MULTI-ORGAN CHIP WITHIN SIX DAYS
AND INDUCE NF CAPA B
INFLAMMATION AND INCREASE
INTERLEUKIN 6 AND 8.
AT THIS POINT WE WANTED TO TEST
THE DEVICE'S UTILITY.
WE HAVE INFLAMMATION, CAN WE USE
A THERAPEUTIC AND SEE IF THIS
ANTIINFLAMMATORY THERAPEUTIC
WILL HAVE AN EFFICACIOUS EFFECT.
WE'RE USING A NOVEL COMPOUND.
IT'S AN EXOSOMAL DERIVED
INTERLEUKIN 10.
WE TAKE EXOSOMES AND ENCOMPASS
THE IL10 TO ITS STRUCTURE.
THE EXOSOME SHAPE IS NOT
DISORGANIZED.
IT HAS PROPER MORPHOLOGY AND
WE'RE ABLE TO IDENTIFY A
SIGNIFICANT INCREASE IN
INTERLEUKIN 10 CONTENT WHILE
MAINTAINING THE CANONICAL
MARKERS.
WE ESTABLISHED AN LPS OR DISEASE
STATE PLATFORM AND TREAT THE
CHIP FOR THREE DAYS WITH LPS AND
DID A CO-TREATMENT FOR AN
ADDITIONAL THREE DAYS.
WE FLOUORESCENTLY TAGGED THE
EXOSOMES AND WHAT WE OBSERVED
SEEN HERE IN GREEN AS TAGS
EXOSOME CLUSTERS IS THE EXOSOMES
PROPAGATED FROM THE MATERNAL
DECIDUA FROM THE PLACENTAL
PLAYERS WITHIN THREE DAYS.
WHEN WE EVALUATE THE
INFLAMMATORY STATUS OF THE
ORGANS WE'RE ABLE TO SEE
EXOSOMAL IL10 TREATMENT CAUSED
SIGNIFICANT UPREGULATION IN
INTERLEUKIN 10 AND REDUCED
PROINFLAMMATORY CYTOKINE IL6 AND
8 EXPRESSION IN SPECIFIC LAYERS
SHOWING EFFICACY IN THIS DEVICE.
NOW, TO VALIDATE THESE STUDIES,
WE USED A PRETERM BIRTH MICE
MODEL SIMILAR EFFECT OF TREATING
WITH LPS AND GIVE IL10 AND THERE
WAS A SIGNIFICANT DECREASE IN
PRETERM BIRTH ONSET DELAYING
BIRTH FROM THREE DAYS IN A MOUSE
MODEL IN A SYSTEM AND REDUCED
FETAL MEMBRANE INFLAMMATION AND
SYSTEMIC INFLAMMATION IN THE
SERUM AND INCREASED PUP
SURVIVAL.
TO SUMMARIZE THIS SECTION WE'RE
ABLE TO SHOW IL10 PROPAGATION IN
THREE DAYS IS REDUCING
PROINFLAMMATORY CYTOKINE
RESPONSE SHOWING EFFICACY AND
RESTORING THE HEALTHY STATE OF
MEMBRANES AND THE CHIP STUDIES
HAVE BEEN VALIDATED WITH LIFE
STUDIES.
IN OVER ALL CONCLUSION, TODAY I
HAVE TOLD YOU ABOUT THE
MULTI-ORGAN FETAL MEMBRANE
PLACENTA ON CHIP AND USE IT TO
STUDY PHYSIOLOGICAL AND
PATHOLOGICAL STATES OF PREGNANCY
AND THE KEY THING IS BECAUSE WE
HAVE THESE CELLS THAT ARE
CHARACTERIZED GENETICALLY STABLE
AND THE CHIP ALLOWS FOR THE
INTERACTIONS TO CREATE THIS
BIOLOGICAL RESPONSE WE CAN NOW
INVESTIGATE.
THESE HEALTHY AND DISEASED STATE
CHIPS CAN BE USED FOR PRE
CLINICAL TRIAL TESTING TO
HOPEFULLY REDUCE ADVERSE
PREGNANCY OUTCOME AND BY
VALIDATING THE RESULTS ONE A
MODEL WE CAN REDUCE USE OF AN
MOL MODELS IN THE FUTURE AND
ADVANCED FOR MORE HUMAN BASED
ADVANCED CULTURE SYSTEM TO
REPLACE THAT DATA SET.
THERE ARE A FEW LIMITATIONS LIKE
FOR ANYBODY ELSE'S SYSTEM.
RIGHT NOW WE DO NOT HAVE IMMUNE
CELLS INCORPORATED INTO THE CHIP
THOUGH WE'RE ACTIVELY ADDING
IMMUNE CELLS TO THE DECIDUA TO
COMPENSATE FOR THIS AND
INVESTIGATING DYNAMIC FLOW TO
ADD A VESSEL CHAMBER AND WHAT
I'M MOST EXCITED ABOUT IS WE'RE
ABLE TO CREATE FETAL MEMBRANE
AND PLACENTA CELL LINES DERIVED
FROM FEMALE AND MALE FETUSES.
THESE CELL LINES WILL LET US
INVESTIGATE SEX-SPECIFIC EFFECTS
WHEN ITS COMES TO DOING THE
THERAPEUTIC AND I'M EXCITED TO
START THE WORK SOON.
SO WITH THAT, I WOULD LIKE TO
CONCLUDE I'D LIKE TO THANK THE
LABS AT UTMB AND A&M FOR THEIR
SUPPORT IN THE PROJECT.
REALLY HIGHLIGHTING MY BIRCWH
MENTORS AND THE UTMB BIRCWH HAVE
BEEN INSTRUMENTAL IN HELPING ME
IN MY APPLICATION AND PROVIDING
THE COLLEAGUE AND MENTOR SUPPORT
IS CRITICAL THROUGH THIS PROCESS
AND NOW I'VE BEEN GRACIOUSLY
BEEN AWARDED AN RO1 AND WITH
THAT I'LL TAKE ANY QUESTIONS AT
THIS TIME.
>> ARE YOU TRYING TO ENSURE
YOU'RE USING A MONOLAYER AND
FORM A MONOLAYER AND THEN I HAVE
A SECOND QUESTION.
>> THANK YOU FOR DIVIDING IT UP.
WE START WITH THE FIRST DAY AT
70% AND GROWS TO 100% WITHIN SIX
DAYS.
SOME CULTURES ARE IN 3-D AND
SOME IN 2-D WHEN IT COMES TO THE
TROPHOBLAST BARRIER IS IN 2-D
AND SOME ARE IN A 3-D COLLAGEN.
IT'S A MIXTURE OF 2-D AND 3-D
DEPENDING ON THE BIOLOGY.
THAT'S THE MOST IMPORTANT THING
IS TRYING TO MIMIC THE BIOLOGY.
>> AND A QUICK FOLLOW-UP.
THE EXOSOMES LOADED WITH
INTERLEUKIN 3 BUT THOSE GETTING
TO THE CELLS GET DEGRADED WHAT
HAPPENS TO THE INTERLEUKIN 10 IT
DOESN'T GET DEGRADED.
>> GREAT QUESTION.
IT'S BEEN PUBLISHED IN FRONTIERS
OF IMMUNOLOGY.
I INVITE ANYONE TO LOOK INTO
THAT TO GET MORE INFORMATION BUT
TO ANSWER THAT SPECIFIC QUESTION
WE ARE CREATE SYSTEM TO HAVE THE
EXOSOMES TAGGED IN GREEN AND
INTERLEUKIN TAG IN RED.
FROM THESE WE'RE DETERMINING
ON-CHIP HOW MANY EXOSOMES ARE
GETTING INCORPORATED INTO THE
DECIDUA AND HOW MANY ARE
PROPAGATING AND DELIVERING THE
IL10.
I HOPE TO REPORT BACK SOON.
>> THANK YOU.
>> THANKS SFORCH SO MUCH FOR THE
GREAT TALK AND COOL MODEL.
IS IT POSSIBLE TO STUDY MODELS
OF CONGENITAL VIRAL INFECTIONS
LIKE IN THIS INSTANCE YOU'RE
EXPOSING TO LPS BUT WITH A MODEL
LIKE THAT YOU THINK CAN YOU LOOK
AT THE IMPACT OF SAY CMV AND THE
TRANSMISSION ACROSS THE MATERNAL
FETAL BARRIER OR OTHER HERPES
VIRUSES OR HIV.
I'M AN HIV RESEARCHER SO THAT'S
WHERE MY MIND WENT TO.
I WONDER IF THIS ORGAN AND CHIP
MODEL CAN LOOK AT DIRECTLY
INFECTING CELLS AND LOOKING AT
CASCADE OF EVENTS FROM THESE
INFECTIONS.
>> I THINK THAT'S THE DIRECTION
OF THIS.
HAVING THIS PLATFORM AND THE
ABILITY TO TEST MULTIPLE ANGLES,
VIRAL INFECTION, OXIDATIVE
STRESS.
HOW DOES SOCIAL STRESS AFFECT
THE PLACENTA AND MEMBRANE.
NOW THAT WE HAVE A PLATFORM THAT
MODELS HUMAN WE CAN STUDY THESE
IN A MECHANISTIC WAY.
THAT WOULD BE GREAT DIRECTION TO
GO WITH SOME OF THESE STUDIES.
>> GREAT TALK.
I'M CURIOUS ABOUT YOUR PLANS TO
INCORPORATE IMMUNE PLANS IN THE
MODEL AND CAN YOU EXPAND AND IF
THERE'S CELL DIFFERENCES BETWEEN
DIFFERENT POPULATIONS AND THE
PLAN TO MIMIC THAT.
>> GREAT QUESTION AND COMPLEX
QUESTION.
>> WHEN WE DO GET THE PLACENTA
DELIVERIES WE ISOLATE PRIMARY
IMMUNE CELLS FROM THE DECIDUA.
SO THAT WOULD BE MORE OF A
PATIENT-SPECIFIC IMMUNE RESPONSE
HOWEVER, THE LIMITATION TO THAT
IS THE HALF LIFE OF THOSE
PRIMARY IMMUNE CELLS IS 24/48
HOURS.
THAT'S A CHALLENGE.
SHORT TIME POINTS BUT NOT LONG
POINTS AND THE OTHER SIDE IS TO
TAKE IMMORTALIZED IMMUNE CELLS
AND TRY TO RECREATE THE MILIEU
OF HOW MANY CELLS THERE ARE IN
THE CONDITIONS AND THAT'S
SOMETHING WE'RE CURRENTLY DOING.
WE TRIED BOTH.
WE PUBLISHED A PAPER WITH
PRIMARY IMMUNE CELLS AND SEEN
THE LIMITATIONS AND NOW WE'RE
TRYING TO USE IMMORTALIZED
IMMUNE CELLS AT THE RIGHT
CONCENTRATION TO PRIME THEM WITH
DIFFERENT STIMULANTS AND SEE HOW
THEY WOULD HAVE DIFFERENT
EFFECTS.
THE HOPE IS TO HAD TO THE
DECIDUA AND TO ADD SOME IN THE
PLACENTA STROMA AND THE MAYBE
EVEN IN THE AMNIOTIC FLUID
SECTION.
THERE'S A LOT OF ROOM TO GROW IN
THE IMMUNE CELL REGULATION OF
THE CHIP MODELS.
>> THANK YOU.
>> YEAH.
>> PAM STRATTON, ORWH.
I HAVE QUESTIONS ABOUT DIFFERENT
DIRECTIONS I'M SURE YOU'RE
THINKING ABOUT BUT WOULD LIKE
YOU TO EXPAND ON THEM.
DRIVING ON THE CONGENITAL VIRAL
INFECTION THERE'S EVIDENCE IF
YOU HAVE CONGENITAL BACTERIAL
INFECTIONS THAT COULD LEAD TO
CEREBRAL PALSY AND OTHER THINGS
LIKE THAT.
I WONDERED HOW YOU WERE THINKING
MECHANISTICALLY AND THE OTHER
PART IS INTRAUTERINE GROWTH
RESTRICTION AND PRECLAMSIA AND
HOW YOU ADDRESS THEM.
REALIZE THESE ARE PIE IN THE SKY
DECADES OF RESEARCH IDEAS BUT
OFTEN IF WE START WITH THE END
IN MIND IT INSPIRES US.
>> I APPRECIATE THAT.
THE RO1 WAS TO CREATE PLACENTA
MODELS AND EXPAND ON A MORE
SIMPLISTIC VERSION THAN
REPRESENTED HERE AND TO HAVE
WITHIN A DEVICE BE PLACENTA
VESSEL AND THE TROPHOBLASTS AND
ALL THE DIFFERENT LAYERS.
IT'S AN EIGHT TO NINE CHAMBER
CHIP.
THAT MODEL IS GOING TO BE MORE
OF A MODEL OF LOOKING AT P
PREECLAMPSIA AND RELATED MORE TO
THE VIRAL INFECTION AND HOW THAT
MAY AFFECT CEREBRAL PALSY.
>> I REMEMBER SEEING REVERSES
BECAUSE OF INFECTIOUS EXPOSURES.
>> WE WANT TO TREAT THEM AND SEE
WHAT COMES OUT THE OTHER SIDE
AND PUT THAT ON OUR FETAL BRAIN
CHIPS.
THAT'S SOMETHING WE'RE CURRENTLY
WORK ON IS THE FETAL BLOOD BRAIN
BARRIER CHIP TO INVESTIGATE IF
SOMETHING TRANS FIRSTS WHAT IS
THE FETAL RESPONSE AND THAT'S
ONGOING AND SHED LIGHTS ON
QUESTIONS GOING FORWARD.
>> THANK YOU.
>> HOW DO YOU ENSURE IMMUNE CELL
CROSS TALK WITH YOUR MODEL OF
PLACENTA AND WITHIN THE IMMUNE
CELLS LIKE ADAPTIVE AND INNATE
IMMUNE CELLS WHETHER YOU CAN
ENSURE PROPER CROSS TALKS ARE
GOING ON LIKE WHAT HAPPENS IN
VIVO.
>> WITH ANY CROSS PLATFORM WE
HAVE TO VALIDATE IT AND THIS
ALLOWS FOR DIRECT CELL TO CELL
INTERACTION WITH THE IMMUNE
CELLS AND DECIDUA AND ALLOWS
THEM TO MIGRATE IF THEY'RE
CALLED TO MIGRATE AND CAN
VISUALLY WATCH THAT.
ONCE WE HAVE THE ACTION WE HAVE
TO DO MULTI-OMIC APPROACHES AND
COMPARE THAT TO IN VIVO AND IN
UTERO TISSUE TO SEE IF WE'RE
CONNECTING AND CREATING THE
RIGHT KIND OF CROSS TALK AND THE
SIGNALS THAT WOULD BE MODELLING
PREGNANCY STATES.
THAT'S OUR STRATEGY TO
INVESTIGATE AND CURRENTLY
ONGOING.
THANK YOU VERY MUCH FOR YOUR
TIME.
>> GOOD MORNING EVERYONE.
I'M SUSAN KORNSTEIN AND
INTRODUCING DR. DIALLO.
SHE'S AN ASSISTANT PROFESSOR IN
THE SCHOOL OF NURSING AND IN THE
OFFICE OF INSTITUTIONAL EQUITY
EFFECTIVENESS AND SUCCESS.
SHE WAS BORN AND RAISED IN GIN
E, WEST AFRICA AND LIVED IN FOUR
COUNTRIES BEFORE MOVING TO THE
U.S.
IS THE GRADUATED FROM BCU WITH A
BACHELOR'S OF SCIENCE IN
NURSING, AND BACHELOR OF ARTS IN
GLOBAL HEALTH.
SHE COMPLETED A Ph.D. AND MASTER
OF PUBLIC HEALTH AT THE
UNIVERSITY OF CONNECTICUT AND
THEN WAS A CLINICAL AND
TRANSLATIONAL POSTDOC
POSTDOCTORAL FELLOW AT THE
NATIONAL INSTITUTE OF NURSING
RESEARCH.
HER RESEARCH INTEGRATES DIETARY
BEHAVIORS, CLINICAL AND GENOMIC
DATA TO DEVELOP TAILORED
NUTRITION INTERVENTIONS IN THE
MANAGEMENT OF CARDIOVASCULAR
DISEASE RISK FACTORS IN RACIAL
AND ETHNIC MINORITY GROUPS.
SHE'S PARTICULARLY INTERESTED IN
STUDYING HOW SELF AND GENDER
INFLUENCE THE AFFECT OF GENE
DIET INTERACTIONS ON CHOLESTEROL
LEVELS AND HOW TO ADDRESS THE
UNDER REPRESENTATION OF MINORITY
GROUPS.
PLEASE WELCOME DR. ANNA DIALLO.
>> THANK YOU.
IT'S AN HONOR TO REPORT THE
EARLY RESULTS OF OUR RESEARCH
PROJECT THAT LED TO THE
FOUNDATION FOR THIS CURRENT K12
I RECEIVED.
FUL -- IT WILL LOOK AT THE SEX
DIFFERENCES IN THE MANAGEMENT OF
DYSLIPIDEMIA IN A COHORT OF
BLACK AMERICANS AND JACKSON
HEART STUDY THERE'S LOW
CHOLESTEROL, TRIGLYCERIDE OR LOW
CONCENTRATION OF HIGH DENSITY
CHOLESTEROL OR TAKING ANY LIPID
MEDICATION AND IT'S A MAJOR RISK
FACTOR FOR CARDIOVASCULAR
DISEASES.
YOU CAN SEE -- YOU CAN SEE THE
GREENER THE COLOR, THE HIGHER
THE PREVALENCE OF TOTAL
CHOLESTEROL.
WE CAN SEE IN THE UNITED STATES
MORE THAN 30% OF U.S. ADULTS
HAVE ELEVATED CHOLESTEROL.
MORE THAN ONE IN EVERY THREE
ADULTS IN THE U.S. FACE ELEVATED
CHOLESTEROL OR DYSLIPIDEMIA.
IT'S MANAGED BY TWO WAYS.
PRIMARILY WE CAN LOOK AT
LIFESTYLE MODIFICATIONS.
SO FOCUSSING ON DIET RICH IN
FRUITS, VEGETABLES AND WHOLE
GRAIN AND LOOKING AT
THERAPEUTICS AND THAT'S GOING TO
BE STATINS.
THEY HAVE BEEN USED FOR DECADES
FOR THEIR EFFECTIVENESS AND
SAFETY IN DECREASING CHOLESTEROL
AND PREVENTING CARDIOVASCULAR
EVENT HOWEVER, DISPARITIES ARE
IN THE MANAGEMENT OF
DYSLIPIDEMIA AND THAT'S WHERE I
WANT TO FOCUS.
THIS DISPARITIES ARE BASED ON
RACE AND SEX DIFFERENCES AND ON
THE RIGHT THE IDEAL SCORE IS
GREEN ALMOST IN EXISTENCE AND
THE RED COLORS ON THE STAFF BAR
GRAPH REPRESENTING POOR DIET.
IT'S ESTIMATED MORE THAN 80% OF
U.S. ADULTS HAVE POOR DIET
ACCORDING TO THE AHA DIET SCORE.
AND THOSE DIFFERENCES EXIST
BASED ON RACE AND NON-HISPANIC
BLACKS SUFFER MORE COMPARED TO
OTHER GROUPS.
THAT'S ACROSS DIFFERENT GROUPS
AND THAT'S ON THE GRAPH ON THE
LEFT YOU CAN SEE COMPARED TO
WHITE WOMEN HAD LESS LIKELY TO
USE STATINS BUT MOST CHALLENGES
IN CONTROLLING FOR THEIR LDL
CHOLESTEROL WITH OR WITHOUT
STATINS.
SEEING WHAT WAS GOING ON WITH
THE MINORITY GROUPS AND SO
THAT'S WHERE MY RESEARCH FOCUS
IS ON.
WE HYPOTHESIZED THE STRATEGIES
DO WORK AND WANTED TO TEST THEM
BY FOCUSSING ON TWO PRIMARY
AIMS.
THE FIRST LOOKED AT EXAMINING
SEX AND GENDER DIFFERENCES IN
THE ASSOCIATION BETWEEN DIET
QUALITY AND DYSLIPIDEMIA AND THE
PROFILE AND LOOKING AT THE
INTERACTION BETWEEN THE TWO
STRATEGIES ON DISLIPIDEMIA AND
PROFILE.
WE LOOKED AT THE JACKSON HEART
STUDY DATA.
IT CONSISTS OF THOSE LIVING IN
JACKSON, MISSISSIPPI.
AND LEAVES US WITH A SAMPLE SIZE
OF INDIVIDUALS.
THE HIGHER THE SCORE THE
HEALTHIER THE DIET AND THE CUT
OFF WAS FIVE.
SO FIVE AND HIGHER WAS
INDICATIVE OF A HEALTHIER DIET
AND BELOW FIVE WAS INDICATIVE OF
A POORER DIET AND LOOKED AT
STATIN THERAPY AND THE ATP III
GUIDELINE AND WE CONDUCTED
SECONDARY DATA ANALYSIS FOR AIM
1 USING THE CORRELATION ANALYSIS
BETWEEN DIET SCORE AND LIPIDS IN
DYSLIPIDEMIA STRATIFIED BY SEX
AND WE LOOKED AT DIET SCORE
BETWEEN LIPIDS AND DYSLIPIDEMIA.
THE TABLE REPRESENTS THE
CHARACTERISTICS.
OF THE 257,000 PARTICIPANTS, 77%
HAD DYSLIPIDEMIA AND A LARGE
PROPORTION WERE FEMALES
REPRESENTING ALMOST 62% OF THE
STUDY SAMPLE.
IT WAS ASSOCIATED WITH
DYSLIPIDEMIA.
IT'S IMPORTANT TO NOTE WHILE BMI
WAS VATE VATED -- ELEVATED IT
HIGHER AMONG THOSE WITH
DYSLIPIDEMIA.
WHEN WE MOVE TO STATINS IT WAS
VERY INTERESTING FOR US TO SEE
THAT DATA CORROBORATED
INDIVIDUALS WITH DYSLIPIDEMIA
THOUGH LESS LIKELY TO RECEIVE
STATINS.
ONLY 8% REPORTED USE COMPARED TO
MEN WHO REPORTED STATIN USE.
WHEN WE LOOK AT DIET IT WAS POOR
FOR FEMALE AND MALE CASE AND
CONTROL.
HOWEVER, AN INTERESTING FACT IS
TO SEE THE DIET SCORE WAS ONLY
STATISTICALLY SIGNIFICANTLY
ASSOCIATED WITH DYSLIPIDEMIA IN
FEMALE NOT MALE.
IT SAYS HOW DIET CAN BE A
CONTRIBUTOR WE NEED TO LOOK AT
AMONG MALE.
AMONG FEMALE AN INTERESTING FACT
WE SAW IN THE RESULT IS THE DIET
SCORE WAS ELEVATED AMONG CASES
IN FEMALE AND I'LL TOUCH MORE ON
THAT IN THE NEXT SLIDES.
IT SHOWS DESPITE BEING ON
STATINS ABOUT 63% OF THOSE
INDIVIDUALS STILL HAD ABNORMAL
LIPID LEVEL AND STILL UNABLE TO
CONTROL WHILE BEING ON STATINS.
MOST WERE STILL STRUGGLING WITH
THEIR LDL CHOLESTEROL.
THAT'S A RED FLAG FOR A
CLINICIAN LIKE ME.
MOVING FORWARD WITH THE DIET AND
DYSLIPIDEMIA ASSOCIATION WE CAN
REPORT THE DIET SCORE WAS
ASSOCIATED WITH LDL CHOLESTEROL
AND DYSLIPIDEMIA IN FEMALE.
THIS WAS SUPPOSED TO FOCUS ON IS
THE DYSLIPIDEMIA AND LDL EFFECT.
WHAT WE SAW IS THAT LDL WAS
POSITIVELY ASSOCIATED WITH DIET
SCORE.
A HEALTHIER THE DIET THE HIGHER
THE LDL AND HERE WHAT WE CAN
THINK ABOUT IS FIRST LOOKING AT
THE LIMITATION OF OUR STUDY
WHICH WAS A CROSS-SECTIONAL
ANALYSIS AND ONLY BASED ON THE
BASELINE DATA.
AS THE INDIVIDUALS WERE GETTING
ENROLLED IN THE STUDY, BUT
SECOND WE CAN THINK ABOUT THE
REVERSE CAUSALITY AND FOR
PATIENTS WHO ARE WOMEN, 50 AND
ORDERLY WITH A KNOWN CHRONIC
DISEASE PRIMARILY CARDIOVASCULAR
DISEASE IS WHAT I KNOW ABOUT,
THESE INDIVIDUALS TEND TO ADOPT
A HEALTHIER LIFESTYLE AS SOON AS
THEY KNOW ABOUT THEIR DIAGNOSIS.
WHAT WE CAN ASSUME HERE IS THAT
THOSE PARTICIPANTS ALREADY KNEW
ABOUT THEIR DIAGNOSIS AND HAD
ALREADY STARTED ADOPTING
HEALTHIER LIFESTYLE PRIMARILY
DIET THAT IS HEALTHIER.
WHEN WE LOOK AT THE INTERACTION
BETWEEN DIET SCORE AND STATIN IT
WAS INTERESTING TOO BECAUSE WHAT
WE OBSERVED IS STATIN AND
HEALTHY DIETS WERE SIGNIFICANTLY
ASSOCIATED WITH A DECREASE IN
LDL CHOLESTEROL BY ALMOST TWO
FOLD WITH A SLIGHT INCREASE IN
LDL AND BOTH INDICATORS OF THE
POSITIVE EFFECT OF BOTH DIET AND
STATINS ON MANAGING DYSLIPIDEMIA
EFFECTIVELY.
WHAT OUR DATA ANALYSIS REPORTS
IS FEWER FEMALE PARTICIPANTS
ABOUT 8% WERE ON STATINS WHILE
HAVING DYSLIPIDEMIA COMPARED TO
MALE PARTICIPANTS 21% OF THE
SAMPLE.
63% OF PARTICIPANTS ON STATINS
STILL HAD UNCONTROLLED LIPID
PROFILE AND WE ALSO SHOWED THAT
WHEN A HEALTHY DIET IS TAKEN
WITH STATINS IT'S EFFECTIVE IN
REDUCING LDL CHOLESTEROL AND
INCREASING LDL AND DECREASING
THE LIKELIHOOD OF HAVING
DYSLIPIDEMIA.
FIRST, WE'RE STILL STRUGGLING TO
HA
HAVE TO LOOK AT CONTRIBUTORS OF
DIET QUALITY AND LOOKING AT
SOCIAL DETERMINATES OF HEALTH
LIKE CULTURAL PREFERENCES AND
HOW DO WE MOVE FORWARD WITH THAT
WILL PRIMARILY FOCUS ON THAT
BECAUSE WHAT THIS IS SHOWING US
IS THAT WE KNOW WHAT WORKS.
A HEALTHY DIET COMBINED WITH
STATIN WORKS BETTER.
MOVING FORWARD WE HAVE TO FOCUS
ON THOSE FACTORS THAT ARE
INFLUENCING THE IMPLEMENTATION
OF THE KNOWN STRATEGIES AND THAT
IS A FOCUS OF MY RESEARCH MOVING
FORWARD WHERE WE WILL BE LOOKING
AT PRECISION NUTRITION TO
ADDRESS HEALTH EQUITY AND HOW WE
WANT TO FOCUS ON THAT IS LOOKING
AT TWO LENSES.
THE FIRST WILL BE THE BIOLOGICAL
FACTORS LOOKING AT SEX
DIFFERENCES AND THE GENETIC
RISK.
THEY ARE MORE LIKELY TO HAVE A
CONCENTRATED LDL AND LOOK AT
ENVIRONMENTAL FACTORS AND THIS
SHOWS IT DOESN'T MATTER IF WE
HAVE THE BEST DRUG IF OUR
PARTICIPANTS OR OUR PATIENTS
AREN'T TAKING THEM, SO WHAT IT
DOESN'T WORK AND LOOKING AT DIET
QUALITY AND SOCIAL DETERMINATES
OF HEALTH, LOOKING AT PATIENT
ENGAGEMENT ESPECIALLY THOSE
UNDER REPRESENTED MINORITY GROUP
WHO HAVE HISTORICALLY BEEN
NEGLECTED IN RESEARCH.
MOVING FORWARD I'LL HAVE THE TWO
LENSES INTEGRATED IN MULTI-LEVEL
INTERVENTION STUDY THAT THAT
WILL USE THE DATA WE HAVE
INCLUDING WITH WHAT I HAVE
REPORTED NOW AND SOME GENETIC
ANALYSIS WE'RE CONDUCTING AND
ALSO USING FOOD AS MEDICINE
PROMOTING ACCESS TO HEALTHY DIET
AND TAKING THAT AS AN ADVANTAGE
FOR US TO HAVE THIS CONVERSATION
TO DIG DEEPER AND WHY THEY'RE
NOT BE PRESCRIBED FOR FEMALE AND
WHY THEY'RE LESS LIKELY TO
CONTINUE TAKING STATINS WHEN
PRESCRIBED.
THE INSTITUTE INSTITUTE OF
WOMEN'S HEALTH HAVE BEEN
TREMENDOUS IN SUPPORTING ME WITH
THIS TALK AND THE SCHOOL OF
NURSING AND MY MENTORING
COMMUNITY AND THOSE EXTRAMURAL
MENTORS THAT HAVE BEEN CRITICAL
IN ACCESSING THE JACKSON HEART
DATA.
SO NIAAA AND THOSE WHO HAVE
FACILITATED ACCESS TO THE
JACKSON HEART AND HAD HELPED ME
WITH THE DATA ANALYSIS.
THANK YOU.
>> HAVE YOU CONSIDERED THE ROLE
OF PHYSICAL ACTIVITY AND ARE YOU
CONTROLLING FOR THAT AND WOMEN
ARE SIGNIFICANTLY LESS ACTIVE
THAN MEN TYPICALLY AND OF COURSE
THAT MAY PLAY A ROLE.
>> WE REPORTED THE STATISTICAL
SIGNIFICANT RESULTS AND WE DID
LOOK AT PHYSICAL ACTIVITY AND IT
WAS NOT STATISTICALLY
SIGNIFICANT ASSOCIATED WITH
DYSLIPIDEMIA IN OUR GROUP AND WE
WERE NOT SURPRISED BY THAT.
AGAIN, THESE WERE WOMEN IN THEIR
UPP
UPPER 50s AND TENDED NOT TO BE
AS PHYSICALLY ACTIVE AS WE'D
LIKE THEM TO.
>> THANK YOU FOR THAT
PRESENTATION.
IT'S VERY IMPORTANT TOPIC.
HAVE YOU ANALYZED OR DO YOU HAVE
DATA ON THE TYPE OF AND THOSE
STATINS, HIGH, MODERATE OR LOW
INTENSITY?
>> UNFORTUNATELY WE DID NOT.
AT THE BASELINE WE ARE ENGAGING
INDIVIDUALS IN WHAT I MENTIONED
THE FOOD IS MEDICINE PROGRAM.
WE HAVE A PRESCRIPTION PROGRAM
AND WE DO ASK WHETHER OR NOT
THEY'RE TAKING STATIN, WHAT TYPE
THEY'RE TAKING AND FOR HOW LONG
THEY HAVE KNOWN ABOUT THEIR
DIAGNOSIS.
>> THANK YOU INTERESTING WORK
AND LOOKING AT PREVENTION LONG
TERM.
AS A PRIMARY CARE PHYSICIAN I'M
OFTEN STRUCK BY HOW LOW THE RISK
SCORING IS FOR WOMEN WHEN I SAW
THE BASELINE AGE AND BY THE
SCORING SYSTEM MANY DON'T REACH
THE THRESHOLD WE GENERALLY
CONSIDER STATIN THERAPY.
I DON'T KNOW ENOUGH ABOUT
JACKSON HEART TO SEE IF YOU WERE
CALCULATE AN ASCVD RISK SCORE
SAYING ACCORDING TO GUIDELINES
BECAUSE WE'RE NOT USING THE LDL
LEVEL AS OUR DECISION MAKING
CRITERIA UNLESS IT'S BEYOND A
CERTAIN BOUND IF YOU WERE ABLE
TO ADD THAT INTO THE DATA YOU
HAVE AVAILABLE.
HOW MANY WOULD HAVE BEEN
INDICATED TO BE ON STATINS BASED
ON THE BASELINE DATA.
>> THAT'S A VERY GOOD POINT.
WE HAVE THE DATA ON THAT.
WE WANTED TO LOOK AT THE LIPID
AND SEEING WHAT DIET AND
EXERCISE IS INFLUENCING AND
WE'RE LOOKING AT THE K12 FOR THE
DIFFERENT LIPID PROFILES AND THE
OTHER SUBCLASSES NOT BEING
LOOKED AT WITH THE RISK SCORES
AND OTHER GUIDELINE S CURRENTLY
USED IN CLINIC.
FOR EXAMPLE, THE SMALL DENSE
LDL.
THE LARGE BUOYANT LDL I'M
DIGGING DEEPER.
THAT'S A GOOD POINT WE'LL HAVE
TO LOOK AT.
>> I LOOK FORWARD TO THAT FUTURE
RESEARCH.
>> THANK YOU.
>> GREAT PRESENTATION IT. WAS
GREAT TO HEAR INTEREST INDICT.
MY QUESTION IS ABOUT SOME DATA
THERE.
WHEN YOU SHOWED THE TABLE I WAS
WONDERING THE DIFFERENCE BETWEEN
THE MODELS.
>> GOOD POINT.
THANK YOU FOR CATCHING THAT.
IT'S BASED ON WHAT WE CONTROLLED
FOR.
IN MODEL ONE WE DIDN'T INCLUDE
THE COVARIATE INCLUDING INCOME,
EDUCATION LEVEL AS WELL AS
PHYSICAL ACTIVITY.
>> IT WAS THE WHOLE SAMPLE OF
THE DYSLIPIDEMIA SO
NONO
NN
NOT DISSEGREGATED.
>> YOU WERE SAYING THE FUTURE
PLAN WAS OF THE FUTURE PLAN IS
LOOKING AT THE SUB GROUPS.
IN WOMEN, PREMENOPAUSAL VERSUS
POST MENOPAUSAL COULD HAVE A
DIFFERENT RESPONSE.
>> ABSOLUTELY.
AND ME MAIN REASON IS THAT WE
KNOW HORMONAL CHANGES HAVE AN
INFLUENCE ON CHOLESTEROL.
ACTUALLY, AS WE MOVE INTO
MENOPAUSE SO WOMEN TEND TO HAVE
A HIGHER HDL BUT THE PROTECTIVE
EFFECT IS LOST MOVING INTO
MENOPAUSE.
LOOKING AT PRE MENOPAUSAL VERSUS
POST MENOPAUSAL WOMEN IS THE
LAST STEP IN MY RESEARCH.
>> ONE LAST SUGGESTION BECAUSE
YOU USED THE DIETARY SCORE WITH
THE SERVINGS.
IF IT'S NOT --
>> WE CONTROLLED FOR ENERGY.
ESPECIALLY WHEN YOU LOOK AT THE
BMI THAT ELEVATED WE WANTED TO
KNOW OR CONTROL FOR THE ENERGY
INTAKE AND IT WAS CONTROLLED
FOR.
>> THANK YOU.
>> WERE YOU ABLE TO DETERMINE
THE REASON WHY THESE WOMEN WERE
NOT TAKING THIS STATIN MEDICINE
WAS BECAUSE THE PHYSICIANS DID
NOT PRESCRIBE IT OR WAS IT
BECAUSE THE PATIENT WAS NOT IN
COMPLIANCE WITH THE PHYSICIAN'S
INSTRUCTIONS FOR TAKING THE
MEDICATION, OR THIRDLY REFUSAL
ON THE PART OF THE PATIENTS TO
TAKE THE STATIN?
>> BASED ON THE LITERATURE IT'S
BASED ON ALL THREE FACTORS YOU
JUST LISTED.
WE KNOW BASED ON WHAT HAS BEEN
REPORTED IN THE PAST THAT
PHYSICIANS TEND TO LESS LIKELY
BE PRESCRIBING STATINS TO FEMALE
AND STATIN AS AN EFFECTIVE LEVEL
AND ALSO KNOW WOMEN TEND NOT TO
TAKE THE MEDICATION AFTER BEING
PRESCRIBED IT.
IN CLINIC THERE'S SIDE EFFECTS
AND THAT'S ONE OF THE MAJOR
FACTORS FOR NOT TAKING THE
MEDICATION.
AND THAT'S THE MAIN REASON WHY I
WENT TO THAT RESEARCH.
THEY WERE TELLING ME IT'S NOT
WORKING FOR ME AND I DON'T KNOW
WHAT CHOLESTEROL IS.
WHEN HAVE YOU HIGH BLOOD
PRESSURE YOU CAN FEEL IT.
WHEN YOU HAVE HIGH BLOOD SUGAR
YOU CAN FEEL IT BUT CHOLESTEROL
IS NOT UNTIL THE END WHEN
THERE'S AN CARDIOVASCULAR
ACCIDENT YOU KNOW YOU HAVE AN
ELEVATED CHOLESTEROL.
MOVING FORWARD THAT'S WHAT WE
NEED TO INVESTIGATE.
WE NEED TO WHILE IT'S GREAT TO
INVESTIGATE HOW THE STRATEGIES
ARE WORKING WE NEED TO
INVESTIGATE THE IMPLEMENTATION
AND MAKE SURE PHYSICIANS ARE
PRESCRIBING AT THE RIGHT DOSE TO
THESE WOMEN AND CREATE A SUPPORT
SYSTEM IN PLACE FOR THOSE
PATIENTS TO TAKE WHAT'S
RECOMMENDED.
>> INTERESTING RESEARCH.
I'M CURIOUS ABOUT THE DIET.
WAS ANY SPECIFIC COMPONENT OF
THE MULTI-COMPONENT DIET SCORE
DRIVING SOME OF THAT AFFECT
WHETHER IT WAS SUGAR SWEETENED
BEVERAGES BEING HIGH OR
CONSUMPTION OF VEGETABLES BEING
LOW.
JUST CURIOUS.
>> THAT'S INTERESTING.
AND WHAT IS DRIVING THE CORE
DOWN?
WE NEED TO STOP AND NOT DIG
DEEPER.
WHEN WE LOOKED AT ALL THAT WE
SAW THE HIGHER INTAKE OF SUGAR
SWEETENED DIET AND RED MEAT WAS
PREVALENCE OF THE FRESH FRUIT
AND VEGETABLES AND PLAYED INTO
THE LOW DIET SCORE.
THANK YOU SO MUCH.
>> ON BEHALF OF THE MPI OF THE
TUFT BIRCWH OR OTHER BIRCWH
SCHOLARS I SEE YOU HERE TODAY,
ON BEHALF OF THE MENTORS LISTED
ON THE SLIDE IT'S OUR GREAT
PLEASURE TO INTRODUCE OUR NEXT
PRESENTATION.
DR. RAMOS JOINED TUFT'S AS A
FACULTY MEMBER IN 2022 IN THE
DEPARTMENT OF OB-GYN AND
COMPLETED HIS UNDERGRADUATE WORK
AT AMHERST AND RESIDENCY WITH
BROWN WOMEN AND INFANTS.
HE WAS BORN IN GUATEMALA AND
IMMIGRATED TO THE U.S. AT THE
AGE OF 8 DURING THE CIVIL WAR IN
198 8.
THE FIRST IN HIS FAMILY TO
GRADUATE FROM COLLEGE.
HE BEGAN HIS CAREER FIRST IN
ADVOCACY FOR MARGINALIZED
COMMUNITIES BOTH SERVING AS A
MANAGER OF A NON FOR PROFIT
ADDRESSING RESOURCES TO UNDER
REPRESENTED COMMUNITIES.
HE TOOK THAT PASSION AND
ADVOCACY INTO HIS MEDICAL CAREER
AND HAS LED A NUMBER OF DEI
EFFORTS INCLUDING STARTING THE
FIRST LOCAL CHAPTER OF THE
LATINO MEDICAL STUDENT
ORGANIZATION AT U-MASS TO
SUPPORT RECRUITMENT OF UNDER
REPRESENTED MINORITIES INTO
MEDICAL SCHOOL AND DEVELOPED THE
LBTQ PLUS IN THE AREA FOR
SUPPORT IN THE MEDICAL SCHOOL
AND SERVED ON DEVELOPING A
CURRICULUM FOR THE CARE TO
GENDER-NON-CONFORMING
INDIVIDUALS.
HIS RESEARCH NOW IT'S MY
DISTINCT PLEASURE TO WELCOME YOU
TO GIVE THE PRESENTATION.
>> I'D LIKE TO TALK ABOUT NE
ASSOCIATION BETWEEN STRUCTURAL
RACISM AND BLACK-WHITE INFACT
MORTALITY DISPARITY IN THE
UNITED STATES.
IT'S THE DEATH OF AN INFANT
WITHIN A ONE YEAR OF BIRTH AND
REFLECTS PLED MEDICAL OUTCOMES
AND USED TO ASSESS THE HEALTH OF
A SOCIETY HERE IN THE UNITED
STATES AND WORLDWIDE.
YET DESPITE BEING ONE OF THE
WEALTH NATIONS IN THE WORLD THE
UNITED STATES HAS ONE OF THE
HIGHEST INFANT MORTALITY RATES
COMPARED TO OTHER HIGH RESOURCED
COUNTRIES.
THE UNITED STATES HAD AN INFANT
MORTALITY RATE OF 5.4 PER
100,000 RANKING BELOW BULGARIA
IN THIS IMPORTANT MARKER.
UNFORTUNATELY, INFANT MORTALITY
RATE IS NOT ONLY HIGHER IN THE
UNITED STATES BUT IN 2021 THE
CDC REPORTED THE INFANT
MORTALITY WAS MORE THAN DOUBLE
FOR THE NON-HISPANIC WHITE
POPULATION OF 4.4.
WE INCREASED MEDICAL ADVANCES
THAT IS THE FOCUS OF MY
RESEARCH.
CLINICAL MEDICINE LOOKED AT LOW
BIRTH WEIGHT WITHOUT MUCH
EVIDENCE OF A BIOLOGICAL
EVIDENCE BETWEEN GROUPS.
UNFORTUNATELY, THIS PARADIGM OB
SECURES KEY PATHWAYS THAT
ADVERSE OUTCOMES AND
IMPLICATIONS OF CARE.
WE'RE MISSING OPPORTUNITIES FOR
MEANINGFUL INTERVENTIONS AND
ALLOWING RACIAL DISPARITIES TO
PERSIST.
RECENTLY, A PARADIGM SHIFT HAS
EMERGED THAT USED RACISM AS A
RISK FACTOR RATHER THAN AN
INDIVIDUAL'S RACE.
THIS EXPOSURE TO RACISM BEING
NOTED AS A RISK FACTOR ALLOWS
RESEARCH TO INVESTIGATE POSSIBLE
PHYSIOLOGIC PATHWAYS FOR ADVERSE
OUTCOMES AND FIND MITIGATING
STRATEGIES BASED ON THE RESEARCH
AT THE INSTITUTIONAL AND
SOCIETAL LEVEL TO ADDRESS THE
HEALTH DISPARITIES.
RESEARCH HAS DEMONSTRATED SOCIAL
DETERMINATES OF HEALTH ARE
SIGNIFICANT DRIVERS OF HEALTH
DISPARITIES AND THEIR MAGNITUDE
IS SOMETHING HEALTH RESEARCHERS
CONTINUE TO STUDY AND THE
CIRCUMSTANCES ARE MOSTLY
DETERMINED BY A DISTRIBUTION OF
MONEY, POWER AND RESOURCES
WITHIN RACIAL AND ETHNIC LINES.
WE HAVE BECOME MORE AWARE OF
STRUCTURAL RACISM IT'S POLICIES
AND PRACTICES AND NORM THAT
PERPETUATE CERTAIN GROUPS AND WE
SEE IT IN HOUSING AND HEALTH
CARE AND JUSTICE SYSTEM AND
THEY'RE CORRELATED WITH WORSE
OUTCOMES FOR CERTAIN GROUPS.
I'M SURE SOME HAVE DONE RESEARCH
ON THIS AND TRIED TO QUANTIFY
STRUCTURAL RACISM.
AND UNFORTUNATELY THIS
PARTICULAR APPROACH WAS LIMITED
BY THE FACT WE KNOW STRUCTURAL
RACISM IS MULTI-FACTORIAL.
RESEARCH ATTEMPT TO APROEF IT
THROUGH A MULTI-DIMENSIONAL VIEW
AND LOOKING AT THE JUSTICE
SYSTEM, EMPLOYMENT, ECONOMIC
STATUS.
HOWEVER, OTHER LIMITATIONS
INCLUDE THE DIMENSION NOT
CONSIDERED.
IN DISEASE AND SCALES HAVE BEEN
CONSTRUCTED LIKELY AT THE STATE
LEVEL AND TRIED TO ADDRESS THE
PREVIOUS LIMITATIONS HOWEVER, A
LOT OF THOSE WERE NOTE ADDRESSED
ON THEORY AND A TEAM USED THE
CONCEPTUAL THEORY THAT SOCIETY
IS INFLUENCED BY ENVIRONMENTAL
DISCRIMINATION INFLUENCING HE
HEALTH OF BLACK PEOPLE AND THIS
IS THE FRAMEWORK USED NORD
CREATE A NEW NOVEL ON STRUCTURAL
INDEX AT THE COUNTY LEVEL.
THERE ARE WITH FIVE STRUCTURAL
DOMAINS.
THE EQUATION MODEL WAS COMPARED
AND THE MODEL WITH THE BEST FIT
CHOSEN.
AND THIS BECAME THE STRUCTURAL
RACISM INDEX.
THAT WERE FIVE VARIABLES AT THE
COUNTY LEVEL AND THAT INCLUDED
INCARCERATION THE BLACK TO WHITE
PROPORTION OF POPULATIONS
JAILED, EDUCATION THE PROPORTION
WITHOUT A HIGH SCHOOL DEGREE.
ECONOMIC STATUS WHICH IS THE
RACIAL OPPORTUNITY GAP
EMPLOYMENT AND THE BLACK TO
WHITE RATIO AND SEGREGATION
WHICH IS THE SIMILARITY.
THIS IS A PARTICULAR MEASURE
THAT LOOKS AT THE DIFFERENTIAL
DISTRIBUTION OF TWO POPULATION
GROUPS.
THIS SHOWS THE SCORE FOR THE 181
COUNTIES WE WERE ABLE TO OBTAIN
SCORES FOR.
RED INDICATES HIGHER STRUCTURAL
RACISM AND GREEN LOWER LEVELS.
WE SHOULD LOOK AT OTHER
IMPORTANT HEALTH MARKERS
INCLUDING INCOME MORTALITY AND
LOOK AT STRUCTURAL RACISM INDEX
AND THE FACTOR SCORE TO THE
BLACK-WHITE DISPARITY AT THE
U.S. COUNTY LEVEL.
WE USED THE BIRTH STUDIES
RECORDS FROM 2016 TO 2019.
THESE WERE IMPORTANT SINCE WE
WERE LINK TO BIOS AND THE COUNTY
OF BIRTH.
WE CALCULATED THE RATES AND PER
THOUSAND BLACK DEATHS AND THE
BLACK TO WHITE RATIO WE EXCLUDED
COUNTIES WITH LESS THAN 20,000
DEATH AND COUNTIES WITH LESS
THAN 50,000 BLACK RESIDENTS AS
WE WANTED TO FOCUS ON LOCATIONS
WHERE THERE WAS MITIGATING
STRATEGIES THAT MAY BE MORE
IMPACTFUL.
A PREDICTIVE VARIABLE WAS
STANDARDIZED FACTOR SCORE FOR
EACH TO CLARIFY THE FACTOR SCORE
INDICATES THE NUMBER OF STANDARD
DEVIATIONS A COUNTY STRUCTURAL
RACISM SCORE IS FROM THE MEAN
SET AT ZERO.
OUR VARIABLE WAS MORTALITY FOR
EACH COUNTY AND ANALYSES WERE
PERFORMED AND ACCOUNTED FOR
EDUCATION, UNEMPLOYMENT AND
INCOME.
IT GIVES A VIEW SHOWING HOW ONE
GROUP FARES AGAINST ANOTHER IT
HIGHLIGHTS THE MAGNITUDE IN THE
DISPARITY AND WHEN THERE'S A
DIFFERENCE OF A RARE OUTCOME
THERE COULD BE A SIGNIFICANT
DISPROPORTIONATE DISPARITY AND
IT'S IMPORTANT TO CAPTURE THAT.
IT'S A HELPFUL MEASURE WHEN WE
LOOK AT INFANT MORTALITY WHERE
ONE GROUP IS DISPROPORTIONATELY
AFFECTED.
51 COUNTIES MET INCLUSION
CRITERIA AND 50% OF THE
U.S. POPULATION 27.5 MILLION OF
THE POPULATION ACCOUNTING FOR
20% OF THE U.S. TOTAL
POPULATION.
OVER THE STUDY PERIOD OF 2016 TO
2019 NON-HISPANIC WHITE INFANT
MORTALITY RATE WAS 4.9.
THAT'S COMPARED TO 13.4 FOR THE
NON-HISPANIC BLACK POPULATION
AND MORE THAN A 2 .7 POINT
DIFFERENCE.
THIS HEAT MAP SHOWS THE LOCATION
AND MAGNITUDE OF THE WHITE
INFANT MORTALITY RATE IN
COUNTIES THAT MET STUDY CRITERIA
155.
COUNTIES WITH GREATER THAN
50,000 BLACK RESIDENTS.
THIS SHOWS THE SCALE WE USE TO
GIVE YOU AN IDEA OF THE
DISPARITY OR DIFFERENCE IN THE
MORTALITY RATES IN SUBSEQUENT
SLIDES WITH GREEN INDICATING
LOWER RATES OF INFANT MORTALITY
AND RED BEING HIGHER RATES OF
INFANT MORTALITY.
THIS HEAT MAP IS THE BLACK
INFANT MORTALITY RATES IN
SIMILAR SCALES.
RED BEING HIGHER AND GREEN
LOWER.
THERE'S SIGNIFICANTLY HIGHER
LEVEL OF RED AND ORANGE IN THE
MAP.
FINALLY THE MAGNITUDE OF THE
BLACK TO WHITE STUDIES THAT MET
CRITERIA WITH DISPARITY BEING AS
HIGH AS 6 AND AS LOW AS 1.
WHEN WE LOOKED AT THE
CORRELATION FROM BLACK TO WHITE
INFANT MORTALITY RATE WE FOUND
THEY ALL HAD A POSITIVE
CORRELATION WITH THE OUTCOME AND
CONTRIBUTED TO THE EXPECTED
EFFECT ON INFANT MORTALITY RATE
DISPARITY.
A COLORATION LOOK AT THE
COUNTIES ARE HIGHLIGHTED HERE.
THE TOP FIVE COUNTRIES WITH THE
HIGHEST RACISM FACTOR SCORES ARE
NOTED ON THE COLUMN.
THE FACTOR SCORE IS HERE IN THE
RATIO OF BLACK TO WHITE OR
PRIMARY OUTCOME.
THE COUNTIES THAT HAD THE
HIGHEST STRUCTURAL RACISM FACTOR
SCORES WERE IN NEW YORK COUNTY.
THIS MANHATTAN WITH THE FACTOR
SCORE OF 4.65 AND RACIAL
DISPARITY OF 4.20.
THE COUNTIES WITH THE LOWEST
STRUCTURAL RACISM FACTOR SCORES
AND THEIR CORRESPONDING BLACK TO
WHITE RATIO ARE ALSO NOTED HERE.
THE LOWEST SCORE HAD A
CORRESPONDING RATIO OF 1.68.
ANOTHER REPRESENTATION THIS IS
IT THE LINEAR REGRESSION SCATTER
PLOT THAT SHOWS THE DISPARITY IN
THE STANDARDIZED FACTOR SCORE.
THE ANALYSIS INDICATED WE HAVE
AN R SQUARE OF 2.66, 27% OF THE
VARIANTS IN BLACK TO WHITE
DISPARITY IS EXPLAINED BY THE
INDEX.
THIS IS SURPRISING GIVEN THE
COMPLEXITY AND CAUSES OF INFANT
MORTALITY WE'RE AWARE OF TO SAY
OUR MODEL WAS ABLE TO PREDICT
MORE THAN A QUARTER OF THAT
DISPARITY.
I'D LIKE TO ORIENT YOU TO THE
SLIDE.
THIS PARTICULAR GRAPH SHOWS THE
PERCENT CHANGE.
WE LOOK AT DIFFERENT OUTCOMES.
THE PERCENT CHANGE HERE.
THE FIRST PART IS THE LACK OR
N
DISPARITY.
WE FOUND THE NON STATISTICALLY
DIFFERENCE OF INCREASE OF 3.2%.
NON-HISPANIC BLACK AN INCREASE
OF 3.2% AND WE FOUND A STRONG
STATISTICALLY SIGNIFICANT
DECREASE OF 6.5% IN THAT
POPULATION.
WE FOUND THE INCREASE OF 16%.
THAT MEANT THE RATE, RATIO
DISPARITY INCREASED BY 16% FOR
EVERY ONE STANDARD DEVIATION
INCREASE IN THE FACTOR SCORE.
ALL WERE ADJUSTED FOR COUNTY
LEAVE FACTORS INCLUDING
EDUCATION, UNEMPLOYMENT AND
INCOME.
SINCE WE FOUND SOME EVIDENCE TO
SHOW SIGNIFICANT PROPORTION OR
PART OF THE DISPARITY HERE MAY
ATTRIBUTE TO THE NON-HISPANIC
WHITE POPULATION.
THOSE THAT LOOKED AT COUNTIES IN
THE DISPARITY AND EXPLAIN THE
MAGNITUDE OF THE OBSERVED
DISPARITIES.
WE'RE LIMIT ED BECAUSE THERE'S
MULTIPLE COUNTIES WITH
NON-HISPANIC BLACK POPULATIONS
AND WERE UNABLE TO GAIN FACTOR
SCORES FOR ALL OF THEM AND
THERE'S NO GOLD STANDARD TO
MEASURE STANDARD RACISM SO
EXTERNAL VALIDATION IS DIFFICULT
BUT WE DID STATISTICAL ANALYSIS
TO IN TERMLY VALIDATE OUR STUDY
FINDINGS.
WE LIMIT OUR STUDY TO
POPULATIONS WHERE COUNTIES HAVE
MORE THAN 50,000 BLACK RESIDENTS
WITH GENERALIZABILITY AND WE
FEEL WE CAPTURED 70% OF THE
U.S. HISPANIC BLACK POPULATIONS.
THERE WAS NO BRIDGE DEMOGRAPHIC
DATA AND COULDN'T CAPTURE
PATIENTS WHO IDENTIFIED MORE
THAN ONE RACE.
ONLY BLACK RACE WAS NOTED FOR
THE STUDY.
WE WERE NOT ABLE TO COUNTY FOR
RISK FACTORS TO BE ABLE TO
CONTROL FOR THE COMORBIDITIES
WHICH WE KNOW ARE ALSO
ASSOCIATED WITH INFANT
MORTALITY.
POPULATION PERSPECTIVE IS
ESSENTIAL TO UNDERSTANDING
DISPARITIES AND GIVES A FULLER
PICTURE OF THE FORMS OF RACISM
DO INFLUENCE ACTUAL INFANT
HEALTH.
AND ALLOWS US TO HAVE A
CONVERSATION AND UNDERSTAND THAT
RACISM IS AN EXPOSURE LIKE
OTHERS AND CAN LEAD TO POOR
HEALTH OUTCOMES.
AND WE'RE LOOKING AT INDIVIDUAL
LEVEL INTERVENTIONS WHEN WE LOOK
AT HIGHER LEVEL DATA THAT WILL
HELP FOCUS POLICY AT THE COUNTY
STATE LEVEL AND INCREASE SUPPORT
TO LOOK AT RISK MITIGATION IN
THE TOPICS.
IN CONCLUSION, STRUCTURAL RACISM
IS SIGNIFICANTLY ASSOCIATED WITH
DIFFERENCES BETWEEN COUNTIES AND
THE MAGNITUDE OF THE DISPARITIES
IN INFANT MORTALITY AND HOPE
WE'LL PURSUE THE MECHANISMS AND
IDEOLOGIES OF THE DIFFERENCES.
I'D LIKE TO THANK MY MENTOR FOR
THEIR SUPPORT DURING THE PROCESS
SPECIFIC.
I'LL BE HAPPY TO TAKE QUESTIONS.
AMAZING PRESENTATION.
I ALWAYS LOVE PRESENTATIONS
CENTERED ON STRUCTURAL RACISM SO
THANK YOU FOR THAT.
A COUPLE QUESTIONS AND ONE MAY
BE A VERY SPECIFIC QUESTION I
WAS WONDERING IF THERE'S A PART
OF THE RACISM MODEL AND SECONDLY
WAS THERE ANY NOTE OF THE
PRESENCE OF MILITARY BASES IN
SOME OF THE COUNTIES?
I WAS LOOKING AT CUMBERLAND
COUNTY AND FORT BRAGG ONE OF THE
BIGGEST MILITARY INSTALLATIONS
IS LOCATED THERE AND WONDERING
IF THAT MAY HAVE ALTERED THE
RESULTS WHEN REPORTING
STRUCTURAL RACISM WITHIN SUCH A
NESTED ENVIRONMENT AS THE
MILITARY.
>> THOSE ARE EXCEPTIONALLY GOOD
QUESTIONS.
THANK YOU FOR THAT.
WE LOOKED AT ENVIRONMENTAL
EXPOSURE AND CLIMATE CHANGE IS
AFFECTING CERTAIN COMMUNITIES
AND DIDN'T FIND IT CORRELATED AS
WE WERE EXPECTING AND IT'S AN
EXAMPLE HOW SCIENCE AND DATA
GUIDES YOU BUT WE LOOKED AT
THAT.
.
THE FIVE VARIABLES WERE THE BEST
FIT AND WHAT WE USED FOR THE
PARTICULAR QUESTION.
FOR THE SECOND QUESTION, IT'S AN
EXCELLENT QUESTION.
WE DID NOT LOOK AT THAT GRANULAR
TYPE OF DATA LOOKING AT COUNTIES
WITH MILITARY INSTALLATIONS OR
ANY SPECIFIC MARKERS LIKE THAT
BUT THAT'S SOMETHING I MAY
INTERESTED IN LOOKING AT WHEN I
GET BACK HOME SO THANK YOU FOR
THAT IDEA.
WE FINISHED I PATHWAYS TO
PREVENTION MEETING AND PROCESS.
THE INDEPENDENT PANEL REPORT
WILL BE AVAILABLE ONLINE
DECEMBER 21.
WE'RE TRYING TO GEAR AT
PREVENTION STRATEGIES AND YOUR
STRUCTURAL RACISM MAY BE HELPFUL
WHAT RISK MITIGATION STRATEGIES
MAY BE ATTAINED AND HOW TO BEST
ASSESS THEIR IMPACT GOING
FORWARD.
THE RESEARCH SHOWING MATERNAL
CARE DESERTS ARE A HUGE
COMPONENT.
>> YOU'RE DESCRIBING THE PROBLEM
I'M ASKING YOU TO POSE A
SOLUTION?
>> OF COURSE.
IF I WAS A BILLIONAIRE.
THEY'RE GAUGING THE EXPOSURE
FROM RACISM.
WE HAVE MULTIPLE SCALES WHO HAVE
SOMEONE PERCEIVED DISCRIMINATION
BUT WHAT'S THE TOUCH POINTS THE
PATIENTS HAVE HAD WITH
STRUCTURAL RACISM TO UNDERSTAND
THE RISK FACTOR AND INVEST IN
THE COMMUNITIES.
OUR PROBLEM IS NOT GOING TO BE
SOMETHING THAT STARTS WITHIN THE
COMMUNITY AND GETS LARGER RATHER
THAN TOP DOWN APPROACH.
>> THERE'LL BE DIFFERENT
SOLUTIONS FOR DIFFERENT
OBSTETRIC DESERTS OR REGIONS AND
ENCOURAGE YOU TO USE THAT LENS
BECAUSE IT'S GREAT TO KNOW THAT
THIS IS IMPACTING THE RATES BUT
WE NEED TO GO BEYOND COUNTING
AND DO PREVENTION.
I'M TRYING TO INSPIRE TO YOU ADD
THAT INTO YOUR LENS.
>> FOR ME RIGHT NOW THE
LITERATURE AND WHAT I THINK
WE'RE MOVING TOWARDS IS SIMILAR
TO HEALTH NAVIGATORS IS DOULA
CARE AND POST NATAL CARE IN THE
FIRST YEAR AFTER AND THERE'S
GOOD DATA TO SHOW IT'S A BUFFER
FROM STRUCTURAL RACISM IN SOME
WAYS AND ADVOCATE THROUGH THE
IMPORTANT 12 MONTHS AFTER
DELIVERY AND PART OF ONGOING
RESEARCH WHERE IF I HAD A
MILLION DOLLARS THERE'D BE A
DOULA.
>> THANK YOU THFOR ENTERTAININGY
THOUGHT.
>> HAVE YOU THOUGHT ABOUT WITH
EXPLORING POTENTIALLY
MECHANISTIC APPROACHES TOWARDS
STRUCTURAL RACISM AND HOW HAVE
YOU EXPLORED THAT.
THERE'S THEORIES SUCH ASSAL OWE
STAT -- ALOE STATIC LOAD.
>>
>> FINDING OUT THE HOW.
THERE'S BEEN RESEARCH SHOWING IN
PLACENTAL MODELS THERE'S
MICRORNA MARKERS OF STRESS AND
GETTING TO POSSIBLY AN EXPOSURE
COMPONENT AND ALLO STATIC LOAD
TO MICROAGGRESSIONS IN YOUR LIFE
TIME CAN HAVE PHYSIOLOGIC
AFFECTS THAT CAN BECOME ALMOST
PERMANENT AND CAN'T EXPLAIN THE
PROTECTIVE FACTORS LIKE IN
PRETERM BIRTH HIGHER IN
NON-HISPANIC BLACK WOMEN AND
INCOME, ETCETERA.
THINGS WE ASSUME ARE PROTECTIVE
AND COULD BE RELATED TO SEE IF
WE CAN GET TO THE MECHANISTIC
APPROACH OF EXPOSURE AND LOOKS
TO THE INTERGENERATIONAL HEALTH.
>> I'M WITH UYC.
TWO THINGS, IT GOES WITH FORT
BRAGG I THINK THERE'S A HUGE
SOMALI POPULATION AND THE SLIDE
WHERE YOU SHOW THE BOTTOM FIVE
VERSUS TOP FIVE, DID YOU LOOK AT
THE INDIVIDUAL FACTORS LIKE WE
DO FOR SIX DIFFERENCES WE
STRATIFY ON THAT AND SEE WHAT
MATTERS MOST.
WE FOCUS ON THE BAD PEOPLE BUT
WHAT ARE THE THINGS WORKING AND
WHY DON'T DON'T WE SEE AN IMPACT
ON THAT AS WELL.
>> WE DIDN'T LOOK AT THE
VARIABLES PER COUNTY BUT THAT'S
AN INTERESTING APPROACH AND
PERHAPS COULD ELUCIDATE SOME
MITIGATING STRATEGIES OF THOSE
DOING BETTER.
THANK YOU FOR THAT.
>> THANK YOU FOR YOUR TALK.
I'M A BIRCWH SCHOLAR AT THE
UNIVERSITY.
MY QUESTION WAS AROUND THE
HEALTH INEQUITIES RESEARCH THAT
FOCUSES ON THE OPPRESSED PEOPLE
AND RARELY DO WE LOOK AT THE
PRIVILEGES.
I'VE BEEN IN A LOT OF THE
QUESTIONS ABOUT AND THIS IS MORE
A THEORETICAL QUESTION AND WE
OFTEN DO THIS COMPARISON TO THE
WHITE POPULATION AND SOMETIMES
IT'S THIS WHITENESS DISCOURSE
WHICH IS IMPORTANT BUT AT THE
SAME TIME AND I KNOW YOU'RE
LIMITED WITH SELF-IDENTIFIED AND
ONE RACE AND PEOPLE ARE NOW
MULTIRACIAL AND HOW DO YOU THINK
ABOUT THE WHITENESS CONCEPT AND
COMPARING THAT POPULATION ALL
THE TIME AND NEXT STEPS AND HOW
THAT CAN BE PART OF THE AGENDA?
>> THANK YOU FOR THE EXCELLENT
QUESTIONS.
I WOULD SAY ONE OF THE BARRIERS
IN LARGE DATABASE RESEARCH IS
THAT THE IDEA OF SELF-REPORTING
OF RACE AND ETHNICITY IS
SOMETHING WE STRUGGLE WITH QUITE
A BIT.
IN GENERAL VITAL STATISTICS
DATA, BIRTH CERTIFICATE DATA
SAYING THE CONCORDANCE BETWEEN
WHAT IS ON THE BIRTH CERTIFICATE
AND HOW THAT PERSON IDENTIFIES
AND IN GENERAL BELOOK AT IN A
WAY IT'S IT'S A NATURAL
COMPARISON AND SHOWING A BENEFIT
RESOURCES ARE NOT FINITE AND
WHEN YOU'RE COMPETING FOR
RESOURCES WHETHER AS THE A
CLINICIANS TIME WE SPENT MORE
TIMES AT THE BEDSIDE WITH
CERTAIN RACIAL GROUPS OR INCOME
OR ACCESS THERE'LL BE A BENEFIT
TO A PARTICULAR GROUP OVER
ANOTHER.
>> GREAT PRESENTATION.
I RESPECT THE FACT THAT THIS
HELPS IDENTIFY HOW STRUCTURAL
RACISM IMPACTS HEALTH EQUITY
WORK FROM UNDERSTANDING AND
IDENTIFYING AND UNDERSTANDING
AND THEN ALLEVIATING AND
UNDERSTANDING THE MECHANISTIC
CONTRIBUTION TO HEALTH EQUITY.
JUST WITH ANY SCIENCE WITH
HEALTH EQUITY SCIENCE WE CAN
JUST COME AND START SEEING
MITIGATION STRATEGY IT TAKES A
SCIENCE TO REALLY MOVE TOWARDS
THAT SCENARIO LIKE THE PRE TERM
LABOR.
WE DIDN'T ASK WHAT IS THE
SOLUTION TO STOP PRE TERM LABOR.
I APPRECIATE THAT YOU'RE
FEEDBACK AND DISCUSSION AND HOW
THIS HEALTH EQUITY SCIENCE TAKES
TIME AND SAYING IT'S A SOLUTION
TO STRUCTURAL RACISM THERE'S 100
YEARS OF HISTORY.
THANK YOU FOR YOUR WORK.
>> THANK YOU FOR THE COMMENT.
THE HOPE IS ENCOURAGING RESEARCH
IN THIS PARTICULAR FIELD AND
LOOKING AT RACISM AS AN EXPOSURE
LIKE SMOKING OR ANYTHING WE'RE
AWARE OF CAUSING SIGNIFICANT
DISPARITIES.
>> THANK YOU FOR YOUR WORK THAT
ADDS SO MUCH TO THE FIELD THAT'S
GROWING.
I WANT TO ASK YOU IF YOU COULD
ANALYZE YOUR DATA.
A NUMBER OF COUNTIES IN THE
SOUTH ARE DOING QUITE WELL
THOUGH THEY'D HAVE SOME OF THE
STRUCTURAL RACISM IN PLACE AND
LOOKING AT THE CONCEPT OF
POSITIVE DEVIANCE AND WHETHER
THERE WOULD BE A WAY TO UNTANGLE
THE PROTECTIVE FACTORS OCCURRING
DESPITE THE TERRIBLE ENVIRONMENT
IN TERMS OF THE STRENGTH OF THE
COMMUNITY.
THANK YOU THAT QUESTION.
WE ASSUME SERB PARTS OF THE
COUNTRY GIVEN HISTORY AND WE
FOUND NOT NECESSARILY THEY WERE
DOING BETTER NO NON-HISPANIC
BLACK BUT EVERYONE WASN'T DOING
GREAT.
EVEN THE NON-HISPANIC WHITE
POPULATION THOSE SCORES WERE
HIGHER.
WHEN WE LOOK AT THE RATIO THAT
WILL MITIGATE THE NUMBER VERSUS
IN MANHATTAN YOU WOULD ASSUME IN
A STATE WITH A GOOD SAFETY NET
YOU EXPECT SIGNIFICANTLY LOWER
DISPARITY BUT FOUND IT HIGHER
AND THE AREAS IN THE SOUTH HAD
INFANT MORTALITY RATES CLOSE TO
EACH OTHER AND WHY THE DISPARITY
DID NOT CAPTURE THAT AS CLEARLY.
THE LACK OF ACCESS IS THE REASON
WE FOUND THE FINDINGS THAT WERE
SURPRISE.
>> ONE FINAL QUESTION FOR ME,
THE DOBBS DECISION IS GOINGS TO
IMPACT OUR COUNTRY IN MANY
DIFFERENT WAYS AND I WOULD
ENCOURAGE YOU TO KEEP TRACKING
THAT OVER TIME.
>> ABSOLUTELY.
>> I WAS STRUCK BY THE BENEFIT
TO A WHITE POPULATION AND THE
CONVERSATION THAT STRUCTURAL
RACISM DISADVANTAGES SOME
POPULATIONS AND BENEFITS OTHERS.
IN RESIDENCY WE WERE TAUGHT
WHITE MALES ARE WIMPY AND
GETTING MORE INTERVENTIONS AND
ATTENTION AND WONDERING IF
THERE'S A WAY TO SEPARATE BY
GENDER OF THE INFANT IF THAT
EXISTS BECAUSE THAT WOULD BE
INTERESTING ANALYSIS.
>> THAT'S AN EXCELLENT ANALYSIS.
WE HAVE INDIVIDUAL-LEVEL DATA
AND WE'LL BE ABLE TO CONTROL FOR
INDIVIDUAL FACTORS AS WELL TO
SEE IF THIS STILL HOLDS BUT IT'S
A GREAT IDEA.
THANK YOU FOR BRINGING THAT UP.
THANK YOU.
>> THANK YOU FOR YOUR TIME.
>> A QUICK ANNOUNCEMENT.
WE NEED AN EXECUTIVE DECISION
THAT PEOPLE ARE SO EAGER TO
EXCHANGE WITH ONE ANOTHER THAT
WE'RE GOING TO CONTINUE RIGHT ON
GIVE THE UCSF GROUP THEIR TIME
AND THEN IF ANYONE NEEDS TO TAKE
A BIO BREAK, PLEASE DO SO.
THE LEGACY OF LEADERSHIP TALK
WILL BE AT 11:05 AND 11:10.
THANK YOU.
>> THESE TALKS ABOUT HAVE BEEN
FABULOUS WITH INTERACTIVE
DISCUSSION.
I FEEL MORE ENERGY IN THE ROOM.
GLAD TO BE HERE IN PERSON.
CONGRATULATIONS TO THE SCHOLARS.
I'M CYNTHIA HARPER FROM THE
UNIVERSITY OF CALIFORNIA SAN
FRANCISCO AND ALONG WITH MY
MULTI-P.I.s AND OUR SCHOLARS I'M
PLEASED TO PRESENT OUR DIVISION
OF RESEARCH PROGRAM DR. MITRO A
RESEARCH SCIENTIST AT KAISER.
SHE HAD HER FIRST EXPOSURE TO
HUMAN SUBJECTS RESEARCH WHILE
COMPLETING OUR BIOLOGY DEGREE AT
SWARTHMORE COLLEGE AND LOOKED AT
WHETHER HUMANS CAN SMELL AGE AND
BODY ODOR AND TURNS OUT THEY
CAN.
SHE TURNED TO WOMEN'S HEALTH
RESEARCH WITH THE SWAN COHART
THE STUDY OF WOMEN'S HEALTH
ACROSS THE NATION YOU'LL HEAR
HER PRESENT IN HER TALK TODAY
WITH THE SAME DATA SET AND WAS A
T32 PREDOCTORAL TRAINEE AT
HARVARD AND FOUND LEVEL OF PFAS
ARE ASSOCIATED WITH WORSE
MATERNAL HEALTH INCLUDING
POSTPARTUM AND CAME TO NIH FOR A
FELLOWSHIP STUDYING FIBROIDS IN
PREGNANCY AND THE AFFECT ON
NEONATAL HEALTH.
LAST YEAR WAS RECRUITED FOR THE
UTERINE FIBROID RISK FOR WHICH
SHE WON THE REPRODUCTIVE
SURGEONS PRICED PAPER AWARD AND
WILL HEAR HER TALK ABOUT
HYPERTENSION AND UTERINE
FIBROIDS TODAY.
>> THANK YOU FOR YOUR CONTINUED
ATTENTION FOR THE LAST TALK.
I'M SUSANNA.
I'M A BIRCWH SCOL AND SWAN STUDY
AND RECEIVED FUNDING FROM NIH
AND SOME POTENTIAL CONFLICT OF
INTERESTS FROM MY CO-AUTHORS AT
THE BOTTOM.
LET'S START WITH BACKGROUND.
WHAT'S A UTERINE FIBROID THEY'RE
TUMORS THAT OCCUR IN THE WALLS
OF THE OUTEROUS DEF
AND DEF AL THEY
>> THEY HAVE PRESSURE AND PAIN
AND FATIGUE AND FERTILITY
ISSUES.
THEY COST UP TO $19 BILLION TO
TREAT AND THE NUMBER ONE BENIGN
INDICATION FOR HYSTERECTOMY.
DESPITE THE PREVALENCE, ETIOLOGY
IS NOT COMPLETELY UNDERSTOOD.
THE GRAPH ON THE RIGHT SIDE OF
THE SLIDE ILLUSTRATES TWO OF THE
FACTORS AGE ON AND PREVALENCE.
AND THE OPEN CIRCLES REPRESENT
PREVALENCE IN WHITE WOMEN.
IT INCREASES WITH AGE AND SECOND
AT ALMOST EVERY AGE BLACK WOMEN
HAVE A HIGHER PREVALENCE OF
FIBROIDS THAN WHITE WOMEN.
THE BLACK RACE AND OLDER AGE
UNTIL MENOPAUSE ARE IDENTIFIED
FACTORS.
FAMILY HISTORY HAS BEEN
ASSOCIATED WITH GREATER RISK AS
WELL AS REPRODUCTIVE FACTORS
SUCH AS LOWER PARITY AND LONGER
TIME SINCE LAST BIRTH.
HIGHER BMI HAS BEEN ASSOCIATED
AND WHAT I'M SHOWING ON THE
RIGHT SIDE SHOWS THE
RELATIONSHIP BETWEEN BMI AND
FIBROIDS AND BMI ON THE Y AXIS
AND THIS IS FROM A
META-ANALYSIS.
YOU CAN SEE AS BMI INCREASES
FIBROID ODDS INCREASE TO A POINT
BETWEEN AROUND BMI28 AND 30 THE
RISK SEEMS TO LEVEL OUT AND
MAYBE DECLINE SO A NON-LINEAR
RELATIONSHIP WITH FIBROIDS.
AND OTHER RISK FACTORS HAVE BEEN
TESTED FOR ASSOCIATION WITH
FIBROIDS FOR MIXED FINDINGS AND
THE INCLUDE FACTORS LIKE LOW
VITAMIN D, STRESS, ENVIRONMENTAL
CHEMICAL EXPOSURES AND SMOKING.
SO WHY STUDY FIBROIDS?
FIRST, FIBROIDS ARE VERY COMMON
AND AS I SAID THEY CAN AFFECT
QUALITY OF LIFE BUT WE CURRENTLY
HAVE NO KNOWN WAY TO PREVENT
FIBROIDS.
SECOND, HORMONAL THERAPIES WHICH
ARE OFTEN THE FIRST-LINE
THERAPIES BECAUSE WE KNOW THEY
RESPOND ARE SOMETIMES
INEFFECTIVE AND OTHER TIMES
INAPPROPRIATE.
IF A PATIENT WANTS TO CONCEIVE
TREATING WITH CONTINUOUS ORAL
CONTRACEPTIVES MAY NOT BE
APPROPRIATE.
WE NEED A FERTILITY NEUTRAL WAY
TO TREAT AND CURRENT TREATMENT
EVIDENCE IS INSUFFICIENT TO
GUIDE CLINICAL CARE.
THERE'S A STOCK EXCHANGE --
SYSTEM ON THE LEFT SIDE AND THIS
IS TRANSFORMED AND LEADS TO
BLOOD PRESSURE INCREASE AND THE
ADRENAL GLAND PRODUCES
ALDOSTERONE AND THIS WORKS BY
INTERFERING WITH THE PATHWAY.
ALDOSTERONE AND ANGIOTENSION 2
CAUSE CELL PROLIFERATION AND IN
EPIDEMIOLOGY STUDIES HIGH BLOOD
PRESSURE AND HYPERTENSION HAVE
BEEN LINKED TO SURGERY IN
PROSPECTIVE SURGERY AND ACE
INHIBITOR USE HAS BEEN USED TO
REDUCE ODDS OF FIBROID DIAGNOSIS
THE CLAIMS DATA SUPPORT A
RELATIONSHIP BETWEEN HIGH BLOOD
PRESSURE AND RISK OF FIBROIDS
BUT IT HAS LIMITATIONS.
THE PROSPECTIVE EPIDEMIOLOGY
STUDIES ALL RELIED ON
SELF-REPORTED BLOOD PRESSURE
WHICH IS GOING TO BE SUBJECT TO
MEASUREMENT ERROR BECAUSE PEOPLE
AREN'T ABLE TO ACCURATELY REPORT
THEIR BLOOD PRESSURE AND THE
CLAIMS DATA WAS LIMITED BECAUSE
IT DID NOT COLLECT ON RACE OR
ETHNICITY OR BMI ASSOCIATED WITH
RISK OF FIBROIDS AND
HYPERTENSION AND HAD SHORT
FOLLOW-UP.
WE KNOW HOW TO CONTROL BLOOD
PRESSURE THROUGH LIFESTYLE AND
MEDICATION TECHNIQUES.
AND GIVE INSIDE INTO ETIOLOGY.
IS STUDIED MEASURE HYPERTENSION
ASSOCIATED WITH RISK OF FIRST
FIBROID DIAGNOSIS?
SWAN IS A MULTI-SITE STUDY OF
300 PARTICIPANTS RECRUITED IN
THE LATE 1990s AT SEVEN STUDY
SITES SHOWN ON THE SLIDE AND
THEY RECRUITED BY RACE AND
ETHNICITY TO ENSURE THE COHORT
COULD BE DIVERSE.
ELIGIBILITY CRITERIA BEING 42 TO
52 YEARS OLD WITH A UTERUS AND
HAVING A MENSTRUAL PERIOD AND
NOT USING HORMONAL MEDICATION IN
THE LAST FEW MONTHS.
IT'S A MID LIFE COHORT OF PRE
AND PERI MENOPAUSAL
PARTICIPANTS.
AFTER THE FIRST VISIT AT
BASELINE PARTICIPANTS RETURNED
FOR 13 SEMI ANNUAL FOLLOW-UP
VISITS.
AT THE FIRST VISIT THEY WERE
ASKED WHETHER THEY EVER HAD A
FIBROID AND HAS A HEALTH CARE
PROFESSIONAL TOLD YOU HAD A
FIBROID.
EACH VISIT THEY MEASURED BLOOD
PRESSURE AND COLLECTED
INFORMATION ABOUT HYPERTENSION
MEDICATION USE.
I USED SCREEN ANALYSIS WITH A
LOG LINK WHICH MEANS EXPOSURES
AND CONFOUNDERS ARE ALLOWED TO
UPDATE AT EACH STUDY VISIT AND
LOOKED AT WHEN HAVING A
HYSTERECTOMY AND ADJUSTED FOR
AGE, EDUCATION, RACE AND
ETHNICITY AND MENOPAUSAL STATUS
AND HEALTH CARE UTILIZATION.
THOUGH THIS SLIDE SHOWS THE
STUDY POPULATION AT BASELINE
AMONG THE APPROXIMATELY 2500
PARTICIPANTS WHO NEVER HAD A
FIBROID.
THE POPULATION IS DIVERSE IN
RACE AND ETHNICITY.
HIGHLY EDUCATED WITH ABOUT 40%
HAVING A COLLEGE DEGREE OR MORE
AND ABOUT 18% ALREADY HAD
DIAGNOSED HYPERTENSION AT
BASELINE.
THE REFERENCE GROUP HERE IS
PARTICIPANTS WITH NO
HYPERTENSION MEANING A NORMAL
BLOOD PRESSURE AND NO USE OF
HYPERTENSIVELY -- HYPERTENSIVE
MEDICATION.
AND COMPARED TO PARTICIPANTS
WITH NO HYPERTENSION WHO ARE
SHOWN ON THE GRAPH AS A LIGHT
BLUE DOT, THOSE WITH UNTREATED
HIGHER TENSION HAD A 19% GREATER
FIBROID DIAGNOSIS RISK AND THOSE
EN -- IN DARK BLUE ADD NO
ELEVATED RISK.
NEXT I LOOKED AT HYPERTENSION
DURATION.
THE REFERENCE GROUP IS
PARTICIPANTS WHO NEVER HAD
HYPERTENSION AT THE CURRENT OR
PRIOR STUDY VISIT AND COMPARED
THOSE TO NEW ONSET HIGHER
TENSION AT THE STUDY VISIT AND
PRE EXISTING HIGHER TENSION AND
THOSE WHO PREVIOUSLY HAD
HYPERTENSION.
COMPARED TO THE LIGHT BLUE DOT
WHICH REPRESENTS THOSE WHO NEVER
HAD HYPERTENSION, PARTICIPANTS
WITH NEW ONSET HYPERTENSION HAD
A 40% GREATER DIAGNOSIS RISK AT
THAT VISIT WITH THOSE WITH
PREEXISTING HIGHER TENSION DOES
NOT HAVE AN ELEVATED RISK OF
DIAGNOSIS.
FINALLY THE REFERENCE GROUP HERE
PATIE
PATIENTS WITH HYPERTENSION AND
COMPARED TO ANY GROUP USING
HYPERTENSIVE MEDICATION AND
USING ACE INHIBITERS.
I'M LOOKING AT ACE INHIBITORS
BECAUSE I'M INTERESTED IN
WHETHER THE ALDOSTERONE SYSTEM
COULD BE THE MECHANISM
UNDERLYING THE CONNECTION
BETWEEN HIGHER TENSION AND RISK
OF FIBROIDS.
HERE'S WHAT I FOUND.
COMPARED TO THE LIGHT BLUE DOT
REPRESENTING PATIENTS WITH
HYPERTENSION NOT USING
MEDICATION AND THOSE USING ACE
INHIBITORS HAD A 50% LESS RISK
OF FIBROID AND THIS IS OUR
ABILITY TO REPEATEDLY MEASURE
BLOOD PRESSURE AND SOME HAD TO
RELY ON BLOOD PRESSURE AND I
FOCU
FOCUSED ON PREMENNO PAUSAL WOMEN
AND I HAD GOOD CONFOUNDING
CONTROL INCLUDING CONTROL FOR
HEALTH CARE UTILIZATION WHICH IS
VERY IMPORTANT IN STUDIES
LOOKING AT ASSOCIATIONS BETWEEN
BLOOD PRESSURE AND
ANTIHYPERTENSIVE USE WITH
DIAGNOSIS.
LIMITATIONS THIS, THE MOST
IMPORTANT WOULD BE WE HAD TO ROW
LIE ON SELF-REPORTED FIBROID
DIAGNOSIS WHICH MEANS WE'RE
PROBABLY MISSING ASYMPTOMATIC
DISEASE AND FORTUNATELY
SELF-REPORT HAS HIGH SPECIFICITY
WHICH MEANS PARTICIPANTS WHO
REPORTED THEY HAD A FIBROID WERE
LIKELY TO HAVE A FIBROID AND THE
MISSED FIBROID DIAGNOSES ARE
LIKELY OCCURRING IN PEOPLE WITH
AND WITHOUT HYPERTENSION NON
DIFFERENTIALLY.
INSTEAD OF INTRODUCING NON
SPERIOUS ASSOCIATION THE
ELIGIBILITY IS THE PARTICIPANTS
COULD NOT HAVE HAD A PREVIOUS
FIBROID AND STILL HAVE THEIR
UTERUS AND THIS STUDY DOES NOT
GENERALIZE TO THOSE WHO DEVELOP
FIBROIDS BEFORE MIDLIFE.
FINALLY, IT'S POSSIBLE THAT SLOW
GROWING FIBROIDS WERE PRESENT
BEFORE HYPERTENSION ONSET AND
NOT DIAGNOSED.
BUT THE STRONG ASSOCIATION WE
SEE BETWEEN NEW ONSET
HYPERTENSION AND NEW DIAGNOSIS
SUGGESTS HYPERTENSION IS PLAYING
SOME ROLE WHETHER INITIATING
FIBROIDS OR LEADING TO THEIR
GROWTH.
NEW ONSET HYPERTENSION WERE
ASSOCIATED WEDGE GREATER RISK OF
FIBROID DIAGNOSIS AND MEDICATION
USE ESPECIALLY ACE INHIBITOR
USING IS ASSOCIATED WITH LOWER
RISK OF FIBROID DIAGNOSIS.
ACE INHIBITOR FINDINGS WHICH
WERE STRONGER THAN USING ANY
HYPERTENSIVE REPORT LEND SUPPORT
TO THE ALDOSTERONE MAY PLAY A
ROLE AND THE CLINICAL
IMPLICATIONS BLOOD PRESSURE
CONTROL COULD BE A WAY TO REDUCE
RACIAL DISPARITIES IN FIBROID
BURDEN.
THANK YOU FOR YOUR ATTENTION AND
I'M HAPPY TO TAKE QUESTIONS.
>> GOOD AFTERNOON.
MY NAME IS LORI.
I'M A STRESS MANAGEMENT
PRACTITIONER.
SO I'VE HAD THE MYOECTOMY AND
HYPERTENSION.
IS THERE A CORRELATION TO ANY OF
THIS WITH PCLS AS WELL AS YOU
TALKED ABOUT THE RACE AND PCOS
INCREASES WEIGHT AND BMI AND
THEN THINKING ABOUT THE PREVIOUS
SPEAKER WHO TALKED ABOUT THE
INFANT AND MORTALITY RATE THE
RACE DISPARITY.
HAVE YOU GUYS DONE FURTHER
RESEARCH IN THE RACE DISPARITY
THE PCOS AND HYPERTENSION AND
TYING IT ALL TOGETHER AND LASTLY
IT'S GREAT TO HEAR THIS IN THIS
ROOM BUT HOW IS IT GETTING OUT
TO THE LOCAL MEDICAL FIELD?
YOUR PRIMARY CARE DOCTOR OR YOUR
OB-GYN BECAUSE NEVER HAS A
DOCTOR TIED THE HYPERTENSION AND
MY FIBROIDS AND DOCTORS DON'T
TIE THE PCOS TO OTHER UNDERLYING
CONDITIONS ESPECIALLY WITH THE
CLIENTS I SEE THAT ARE AFRICAN
AMERICAN AND GETTING TO
SOLUTIONS?
>> THANK YOU FOR THE GREAT
QUESTIONS.
I'LL TRY TO REMEMBER EACH AND
TRY TO RESPOND BUT FEEL FREE TO
REFEET -- REPEAT AND REASK.
WE DON'T KNOW WHO HAS PCOS AND
WHO DOESN'T.
I'M STUDYING THE SAME
RELATIONSHIP AS I DESCRIBED
BETWEEN HYPERTENSION AND
FIBROIDS AND LOOKING AT
DIABETES.
THERE'S A LINK WITH PCOS.
IT LOOKS LIKE DIABETES IS
INVERSELY ASSOCIATED WITH RISK
OF FIBROIDS UNEXPECTEDLY.
THERE'S BEEN RESEARCH THAT
SUPPORTS THAT BEFORE THIS SO
IT'S CONSISTENT WITH PRIOR
RESULTS BECAUSE WE UNDERSTAND SO
LITTLE ON WHAT CAUSES FIBROIDS
TO DEVELOP AND MORE RESEARCH IS
NEEDED.
I FEEL LIKE PART OF MY MISSION
IS DESCRIBING THE FIBROID
BACKGROUND AND TRYING TO GET
OTHERS EXCITED ABOUT IT BECAUSE
WE GET MORE EVIDENCE.
RELATED TO YOUR QUESTIONS ABOUT
GETTING THIS MORE BROADLY
PUBLICIZED BEYOND THE BIRCWH
ROOM.
IT'S A GREAT QUESTION.
I'M PART OF KAISER PERMANENTE
NORTHERN CALIFORNIA AND I WORK
WITH CLINICIANS AND TRY TO
SPREAD THE WORD ABOUT FIBROIDS
AND HOW TO GET THIS KIND OF
EVIDENCE INTO CLINICAL CARE-LOTS
OF WORK LEFT TO DO AND OWNER
RESEARCH IS FIBROID
EFFECTIVENESS AND THAT IS MORE
INTERESTING TO CLINICIANS
BECAUSE IT'S DIRECTLY APPLICABLE
COMPARING UTERINE EMBOLISM LONG
TERM THE EVIDENCE IS CONCRETE.
THIS KIND OF ASSOCIATION BETWEEN
HYPERTENSION AND FIBROIDS WE'RE
WORKING ON MAKING THOSE CLINICAL
CONNECTIONS AND MAKING SURE THE
EVIDENCE IS GETTING WHERE IT'S
NEEDED.
THANK YOU.
THANK YOU FOR YOU'RE TIME.
FOLLOW ME TO THE POSTER SESSION.
>> PLEASE LET ME ASK THIS
QUESTION.
I BEG YOUR INDULGENCE FOR A
MINUTE.
I'M INSPIRED BY THIS.
I WANT YOU TO THIS IS PAM
STRATTON AT ORWH.
ONE IN FOUR WOMEN ARE
HYPERTENSIVE BY AGE 25 IF YOU
THINK OF THE PARITY AND THE
ASSOCIATION WITH BREAST CANCER
AND TAKE THE LIFE COURSE
PERSPECTIVE AN IMPORTANT LENS TO
THINK ABOUT THIS.
AND IF YOU THINK ABOUT
IDENTIFYING AND CONTROLLING
HYPERTENSION IN BLACK WOMEN IN
THEIR 20s IT WOULD BE REALLY
GREAT TO THINK ABOUT HOW TO
ADDRESS THIS OVER THE LIFE
COURSE.
THANK YOU FOR HUMORING ME.
>> THANK YOU FOR THE GREAT
COMMENT.
THANK YOU.
>> GOOD MORNING LADIES AND
GENTLEMEN I'M THE ASSOCIATE
DIRECTOR FOR THE OFFICE OF
RESEARCH ON WOMEN'S CAREER.
IT'S MY PLEASURE AND PRIVILEGE
TO INTRODUCE THIS YEAR'S LEGACY
OF LEADERSHIP SPEAKER.
BEFORE I DO I'D LIKE TO GIVE A
BRIEF HISTORY OF THE SPEAKER
SERIES FOR THOSE ATTENDING THE
FIRST TIME.
THE INAUGURAL REPRESENTATION OF
THE LEGACY OF LEADERSHIP LECTURE
WAS DELIVERED AT THE 20th
ANNIVERSARY OF THE BIRCWH.
SEPTEMBER 14, 2020.
DR. CLAYTON CREATE THE
LECTURESHIP AT THAT TIME TO
SHOWCASE OUTSTANDING WOMEN
SCIENTISTS WHO HAVE DEMONSTRATED
EXCELLENCE IN THEIR RESEARCH
CAREERS BUT REACHED INSTITUTIONS
THAT ARE FOR MOST OF US
ASPIRATIONAL.
THE FIRST SPEAKER WAS DR. BURKE
AND CANDLER PROFESSOR OF PUBLIC
HEALTH AT EMORIENCE EMORY INCID
P.I. AND BE THE WE HAD A VICE
CHANCELLOR AND DEAN OF THE
SCHOOL OF MEDICINE AT U.C. DAVIS
AND LAST YEAR'S SPEAKER WAS
DR. JUDITH JAMES CHIEF MEDICAL
OFFICER OF THE OKLAHOMA MEDICAL
RESEARCH FOUNDATION, PROFESSOR
AND PROGRAM CHAIR OF ARTHRITIS
AND CLINICAL IMMUNOLOGY AND
MEMBER OF THE NATIONAL ACADEMY
OF MEDICINE.
TODAY WE'RE HONORED TO WELCOME
ONES AGAIN ANOTHER IMMINENT
FEMALE SCIENTIST AND INSPIRATION
TO US ALL.
IN THE PERSON OF DR. CRISWELL
M.D. AND DOCTOR OF SCIENCE.
DR. CRISWELL HAS SERVED AS VICE
CHANCELLOR OF RESEARCH AT THE
UNIVERSITY OF CALIFORNIA SAN
FRANCISCO AND PROFESSOR OF
RHEUMATOLOGY AND PROFESSOR OF
SCIENCES.
HER RESEARCH FOCUSES ON THE
GENETIC AND EPIDEMIOLOGY OF
HUMAN AUTOIMMUNE DISEASE AND
LUPUS AND MENTORED MANY
FACULTIES TO INDEPENDENT
RESEARCH CAREERS.
DR. CRISWELL EARNED HER MASTER'S
FROM THE UNIVERSITY OF
CALIFORNIA IN BSHG.
BERKELEY.
A AND IN GENETIC EPIDEMIOLOGY
FROM THE NETHERLANDS INSTITUTE
FOR HEALTH SCIENCES RODDER DAM
AND M.D. FROM THE UNIVERSITY OF
UNIVERSITY SAN FRANCISCO AND IS
BOARD CERTIFIED IN RHEUMATOLOGY
AND DIRECTOR DIRECTOR OF THE
NATIONAL INSTITUTE OF ARTHRITIS
AND MUSCULOSKELETAL SKIN
DISEASES AND HAS GENOMICS AND
RHEUMATIC DISEASE SECTION
MEDICAL GENETICS BRANCH,
NATIONAL HUMAN GENOME RESEARCH
INSTITUTE.
SO PLEASE WELCOME DR. LINDSEY
CRISWELL.
>> THANK YOU FOR THE KIND
INTRODUCTION AND THANKS TO
DR. CLAYTON FOR THE INVITATION
TO DELIVER THIS LEGACY OF
LEADERSHIP LECTURE.
SORRY I'M KEEPING YOU FROM YOUR
BREAK.
DR. CLAYTON ASKED ME TO SPEAK
ABOUT MY OWN CAREER JOURNEY AND
PROVIDE ADVICE TO SCHOLARS HERE
THIS MORNING.
I'M GOING TO COVER THE FOLLOWING
TOPICS IN THE TIME I HAVE.
I'M GOING TO TELL YOU MORE ABOUT
MY BACKGROUND IN EDUCATION AND
CONCLUDE BY SHARING
OPPORTUNITIES I WANT TO MAKE
SURE YOU'RE AWARE OF.
I'M A NATIVE CALIFORNIA AND GREW
UP IN THE LOS ANGELES AREA OF
SOUTHERN CALIFORNIA.
AND HAD THE OPPORTUNITY TO
ATTEND GREAT PUBLIC SCHOOLS AND
ALMOST ALL MY TRAINING WAS AT
PUBLIC INSTITUTIONS.
I HAD THE GOOD FORTUNE TO GO TO
U.C. BERKELEY FOR MY
UNDERGRADUATE EDUCATION AND
ALWAYS BEEN EXCITED AND
INTERESTED IN THIS CONCEPT OF
NATURE VERSUS NURTURE.
I ENDED UP FOCUSSING ON THE AREA
OF GENETICS.
I HAD A LONG STANDING INTEREST
IN RESEARCH FOR MEDICAL AND KEPT
MY OPTIONS OPEN AND HAD
WONDERFUL EXPERIENCES AT THE
LABORATORY AND THE EAST COAST
AND THE LABORATORY ON THE
BERKELEY CAMPUS.
I WAS INTERESTED IN RESEARCH AND
ULTIMATELY HAD THE OPPORTUNITY
TO GO TO MEDICAL SCHOOL AT UCSF
IN SAN FRANCISCO AND I WAS ABLE
TO HEAR THE PRESENTATION FROM
THE UCSF SCHOLAR AND GRADE TO
KNOW SOME UCSF COLLEAGUES ARE
HERE.
IT WAS A FABULOUS PLACE TO TRAIN
FOR MEDICAL SCHOOL AND DOES MY
RESIDENCY AT SCRIPPS CLINIC IN
LA JOLLA AND HAD A DIFFERENT
EXPERIENCE OF MEDICINE AND
CLINICAL CARE THAN I HAD BEEN
EXPOSED TO AT UCSF.
IT WAS AT THAT INSTITUTION WHICH
ATTRACTED MANY PATIENTS WITH
MANY DISEASES AND I WAS HOOKED
ON PURSUING A CAREER IN
RHEUMATOLOGY.
A WONDERFUL EXPERIENCE.
ALSO THE CONCEPT OF
EVIDENCE-BASED MEDICINE WAS
BRAND NEW AND THOUGH MY
BACKGROUND HAD BEEN LABORATORY
BASED I FELT MOTIVATED TO PURSUE
RESEARCH TRAINING THAT WOULD
ALLOW ME TO GET CLOSER TO
PATIENT CARE SO MORE
TRANSLATIONAL RESEARCH.
THAT BROUGHT ME BACK TO THE BAY
AREA AND ACROSS THE BAY AT
U.S. BERKELEY WAS A FANTASTIC
SCHOOL TO GET A DEGREE IN PUBLIC
HEALTH BECAUSE I FELT BIO
STATISTICS WOULD BE CRITICAL FOR
MY TRAINING AS A CLINICAL
RESEARCHER.
I STARTED MY FELLOWSHIP AT UCSF
AND TRYING TO FIGURE OUT HOW TO
COMBINE MY TRAINING FULL TIME
WITH THE TRAINING OF AN MPH
PROGRAM.
I AUDITED CLASSES IN BIO
STATISTICS AT UCSF AND IN MY
THIRD YEAR OF FELLOWSHIP I WAS
ABLE TO FOCUS ON THE MPH
TRAINING AND THAT SEQUENCE WOUND
UP WORKING WELL BECAUSE I HAD
RESEARCH PROJECTS I WAS
FOCUSSING ON WHEN I DID THE MPH
TRAINING.
I FEEL FORTUNATE TO HAVE HAD THE
FOUNDATION TO SUPPORT MY
SUBSEQUENT PROGRESSIONS AS A
FACULTY MEMBER.
.
A BIT LATER I PURSUED ADDITIONAL
TRAINING AND EDUCATION OUTSIDE
THE U.S.
I WOULD STRONGLY RECOMMEND THIS
FOR ALL OF YOU WHO CAN FIND THE
OPPORTUNITY.
THANKS TO A MID YEAR DEVELOPMENT
AWARD I SPENT A YEAR AT THE
NETHERLANDS INSTITUTE OF HEALTH
SCIENCES AND I BECAME VERY
INTERESTED IN GENETIC
EPIDEMIOLOGY AND NEEDED
ADDITIONAL TRAINING.
THIS WAS A BRAND NEW RAPIDLY
EVOLVING FIELD AND A KNEW IT HAS
A FANTASTIC PROGRAM AND WAS ABLE
TO SPEND A YEAR FOCUSSING ON
THAT AREA AND IT WAS A FABULOUS
EXPERIENCE.
THAT EXPERIENCE WAS SO ENRICHING
AND REWARDING I WAS ABLE TO
ARRANGE ANOTHER YEAR TO WORK IN
EUROPE THIS TIME IN FRANCE JUST
OUTSIDE THE SOUTH OF PARIS
BECAUSE THERE WAS A WONDERFUL
SJOGREN'S DISEASE EXPERT AND
WANTED TO BE IMMERSED IN THAT
PROBLEM AND I FEEL PRIVILEGED TO
HAVE HAD THE PRIVILEGE TO WORK
OUTSIDE THE UNITED STATES FOR
MANY REASONS.
I WANT TO TALK ABOUT THE
IMPORTANCE OF MENTORS.
I'VE WORKED WITH THE SUPPORT OF
SOME FABULOUS PEOPLE THAT HAVE
MADE SUCH A DIFFERENCE IN MY
LIFE AND FOR MY CAREER.
I'M GOING TO HIGHLIGHT A COUPLE
HERE.
ON THE LEFT THERE'S DR. EPSTEIN
WHO WAS A RHEUMATOLOGIST AND
GREATLY ADMIRED FOR SEVERAL
REASONS.
HE HAD DIVERSE RESEARCH
INTERESTS AND ACTIVITIES AND WAS
ALSO A VERY INTERESTING AND WELL
ROUNDED PERSON.
THIS RESEARCH LOOKED AT
RHEUMATOID FACTOR AND CHANGED S
AND FOCUSSED ON A NEW FIELD OF
HEALTH SERVICES RESEARCH AND WAS
A WELL ROUNDED PERSON AND TOOK
UP CELLO LATER IN LIFE AND WOOD
WORKING DURING A SABBATICAL AND
THE ELDERLY GENTLEMAN TO HIS
LEFT, DR. ENGELMAN IS CONSIDERED
THE FIRST ACADEMIC
RHEUMATOLOGIST IN CALIFORNIA AND
RECRUITED WALLY AND IS A
FASCINATING AND IMPRESSIVE
PERSON AND GREAT ADVOCATE FOR
RESEARCH SUPPORT.
HE HAD INTERACTIONS WITH MEMBERS
OF CONGRESS THAT WERE PRODUCTIVE
AND A PRODIGY VIOLINIST AND
CONTINUED SEEING PATIENTS TO
OVER THE AGE OF 100.
QUITE AN IMPRESSIVE PERSON AND
INSPIRATIONAL MENTOR.
AND THIS IS WALLY AND SORRY I
DIDN'T HAVE THAT UP AT THE RIGHT
TIME I WANTED TO SHARE THIS
PICTURE OF WALLY WITH -- WITH MY
DAUGHTERS DOING A WOOD WORKING
PROJECT IN HIS HOME AND ONE OF
THE MANY WAYS HE SUPPORTED ME
AND MY FAMILY.
NOW, THANKS TO WALLY I WAS
EMBEDDED WITHIN A
MULTI-DISCIPLINARY TEAM OF
INVESTIGATORS THAT INCLUDED
RHEUMATOLOGISTS AND SOCIAL
SCIENTISTS, HEALTH ECONOMISTS.
FABULOUS ENVIRONMENT FOR A
FELLOW AND JUNIOR FACULTY MEMBER
AND I PURSUED CAREER AS A JUNIOR
FACULTY MEMBER AND RESEARCHER
AND WHAT ALLOWED THIS GROUP TO
FORM WAS A GRANT FROM THE NIH.
IT MADE ALL THE DIFFERENCE AND
THE SUPPORT AND TEAM APPROACH
MADE A DIFFERENCE FOR SO MANY
EARLY CAREER INVESTIGATORS AND I
HOPE MANY ARE BENEFITING FROM
THAT SUPPORT AND THAT
ENVIRONMENT IN YOUR HOME
INSTITUTIONS.
I WAS ABLE TO OBTAIN MY GRANT
FROM NIAMS.
IT WAS NOT AN EASY PROCESS BUT
UNFORTUNATE TO RECEIVE THE
SUPPORT ALLOWING ME TO INITIATE
SOME OF MY GENETIC STUDIES.
I RECEIVE THE MID CAREER
DEVELOPMENT AWARD THAT NOT ONLY
ALLOWED ME TO PURSUE TIME
OUTSIDE THE UNITED STATES BUT
SUPPORTED MENTORING ACTIVITIES.
THAT THE TIME THERE WERE FEW
OPPORTUNITIES AND IT'S BECOMING
MORE COMMON AND IT'S A PRIORITY
OF MINE BUT MADE A HUGE
DIFFERENCE IN ALLOWING ME TO
CONTINUE TO SPEND TIME AS A
MENTOR.
ANOTHER P60 GRANT ALLOWED ME TO
EXPAND MY OPPORTUNITIES FURTHER
AND PROVIDE LEADERSHIP
EXPERIENCE WHICH PROVED TO BE
SOMETHING I REALLY ENJOYED
THOUGH I NEVER IMAGINED I WOULD
BECOME AN ADMINISTRATOR AND I
AND THE TO EMPHASIZE THE MANY
MANY FOR THOSE WHO MAY BE
FEELING FRUSTRATED.
WE SECURED ANOTHER CENTER GRANT
THAT ALLOWED US TO LAUNCH A
PRECISION MEDICINE CENTER THAT
CONTINUES TO SUPPORT EARLY
CAREER INVESTIGATORS AND BRING
OTHER INDIVIDUALS INTO A TEAM
SCIENCE ENVIRONMENT TO SUPPORT
THEIR WORK IN THIS IMPORTANT
AREA.
I WANTED TO SHIFT GEARS TO TALK
ABOUT CRITICAL SUPPORT ONE CAN
LOOK OUTSIDE OF THE NIH FOR.
A CRITICAL PIECE OF SUPPORT THAT
ALLOWED ME TO SECURE A POSITION
WAS A SCHOLARS AWARD OFFERED BY
PFIZER.
IT MADE ALL THE DIFFERENCE IN
TERMS OF THE TRANSITION FROM
FELLOWSHIP TO FACULTY.
LATER IN MY CAREER I HEARD ABOUT
A FUNDING OPPORTUNITY FROM THE
ARTHRITIS FOUNDATION.
ANNEST TO TRY TO DEVELOP
RESOURCE FOR GENES THAT
CONTRIBUTE TO ARTHRITIS AND
BEFORE THE GWAS ERA AND
CONCURRENTLY THE NIH AND NIAMS
AND NIAID WERE TRYING TO CREATE
THE SAME RESOURCE.
I WAS ABLE TO JOIN THIS
IMPRESSIVE GROUP OF
INVESTIGATORS BARELY OUTSIDE MY
FELLOWSHIP BECAUSE OF THE
SUPPORT FROM THE ARTHRITIS
FOUNDATION.
IT HIGHLIGHT THE VALUE OF OTHER
SOURCES OF SUPPORT AND CAN
ATTEST TO THE FACT THAT ONCE
AGAIN THIS TEAM SCIENCE
ENVIRONMENT CAN BE SO VALUABLE
EVEN TO EARLY CAREER
INVESTIGATORS AND EXPERTISE TO
RESOURCES AND DATA SETS.
IT WAS A FABULOUS OPPORTUNITY
FOR ME AND HOPE YOU'LL NOT SHY
AWAY FROM PURSUING OPPORTUNITIES
TO JOIN RESEARCH EFFORTS.
LITTLE FISH IN A BIG POND AND
CAN BE A VALUABLE SOURCE OF
SUPPORT PARTICULARLY EARLY ON.
AND I ENJOYED MENTORING AND I
FOUND IT DEEPLY REWARDING AND
GRATIFYING AND I FOUND IT
INTERESTING TO MENTOR ALL AGES
OF ALL BACKGROUNDS AND HIGH
SCHOOL STUDENTS INTEREST TRYING
TO FIGURE OUT WHAT TO DO WITH
THEIR LIVES AND COLLEGE STUDENTS
AND CLINICAL COORDINATORS AND
STATISTICIANS AND PROGRAM
MANAGERS AND GETTING TO KNOW
THESE PEOPLE AND WORK WITH THEM
TO SUPPORT THEIR OWN LIFE GOALS
NOT JUST ABOUT OUR RESEARCH
EFFORTS BUT HOW TO MAKE THEM
HAPPY AND SUCCESSFUL PEOPLE.
THERE'S MANY THINGS THEY CAN DO
IN HELPING THROUGH ROUGH TIMES
AND THE INCREASINGLY FUNDING
LANDSCAPE AND HOW TO ESTABLISH
COLLABORATIONS AND HOW TO
NETWORK, WHICH MEETINGS ARE
IMPORTANT TO GO TO.
ETCETERA.
I HOPE MANY OF YOU WILL ALSO NOT
SHY AWAY FROM DOING MENTORING
YOURSELVES EVEN AS AN EARLY
STAGE INVESTIGATOR.
I WANT TO SHIFT AND TALK MORE
ABOUT COLLABORATIONS.
AS I ALLUDED TO BECAME
FASCINATED WITH COMPLEX
RHEUMATIC DISEASE AND ENDED UP
FOCUSSING ON THE GENETIC AND
INCREASINGLY THE ENVIRONMENT
TRKS OF DISORDERS AND THE
IMPORTANT THEME THROUGH MY
CAREER AND SOMETHING I'M
CONVINCED AS ESSENTIAL TO A
SUCCESS
SUCCESSFUL PROGRAM TO SUPPORT
SJOGREN'S DISEASE A
MISUNDERSTOOD AND UNDER STUDIED
CONDITION.
I WAS ABLE TO JOIN AS A
COLLABORATOR AND RHEUMATOLOGIST
EARLY ON IN THE EFFORT AND ENDED
UP ASSUMING A LEADERSHIP
POSITION ESTABLISHED
COLLABORATIONS AROUND THE WORLD,
LEARNED HOW TO DEVELOP
PROTOCOLS, BIO SPECIMEN
PROCESSES THAT COULD BE
IMPLEMENTED AT SERIOUS SITES
AROUND THE WORLD AND CREATED
NINE SITES IN SEVEN COUNTRIES
AND VISITED THEM ALL AND
CONDUCTED SITE VISITS WAS
AMAZING AND SOMETHING AN
INDIVIDUAL INVESTIGATOR OR TEAM
OR INSTITUTION COULD NOT HAVE
DONE ON THEIR OWN.
THE PICTURE ON THE RIGHT IS OF
THE BIGGEST EYE HOSPITAL IN THE
WORLD A RESEARCH SITE AND I SAW
SO MUCH AND LEARNED SO MUCH AND
WOULD LOVE TO TALK ABOUT IT
MORE.
I'LL MOVE ON AND AMAZING
OPPORTUNITIES.
I'M GOING TO SHIFT GEARS AND
TALK ABOUT ADMINISTRATIVE AND
LEADERSHIP POSITION.
THE FIRST I HAD TO PURSUE AS A
DIVISION CHIEF AS OF
RHEUMATOLOGY DIVISION OF UCSF.
IT'S AN AMAZING GROUP OF PEOPLE
AND WHAT AN EDUCATION AND
PLEASURE IT WAS TO HELP EACH
ONE- AND WE LOOKED AT HOW TO
DEVELOP THE MOST IMPACTFUL
CLINICAL PROGRAM.
HOW DO WE SUPPORT EARLY CAREER
INVESTIGATORS?
HOW CAN WE MAKE OUR PROGRAMS AND
PEOPLE RUNNING THEM SUSTAINABLE
CAREERS.
WITH THE INCREASING CHALLENGES
OF FUNDING, HOW CAN WE ENSURE
SUPPORT TO ENSURE THE DIVISION
CONTINUES TO BE STRONG AND GROW
AND BE DIVERSE.
IT'S A FANTASTIC EXPERIENCE.
I LEARNED THE IMPORTANCE OF
WORK-LIFE BALANCE AND I TRIED TO
HIGHLIGHT THAT WITH MY OWN ROLE
AS A LEADER TALKING ABOUT MY
INTERESTS OUTSIDE OF WORK.
SENDING A MESSAGE THAT I EXPECT
FOLKS TO HAVE OTHER PRIORITIES
THAT THEY WILL BALANCE.
THOSE DON'T HAVE TO BE LEFT FOR
OUTSIDE OF WORK HOURS.
ONE THING I DID TO SERVE AS A
MODEL WAS TO GO ON FUND RAISING
HIKES FOR OUR PROGRAM TO SHOW
YOU CAN DO OTHER THINGS AND IT'S
PART OF NOT ONLY BEING A
WELL-ROUND PERSON BUT BEING THE
BEST PHYSICIAN AND RESEARCHER
YOU CAN BE IS TO HAVE BALANCE IN
YOUR LIFE.
I'VE ENJOYED TRYING TO SERVE AS
A MODEL IN THAT FRONT.
I SERVED AS VICE CHANCELLOR OF
RESEARCH AT UCSF.
IT WAS A HIGHER LEVEL OF
RESPONSE AND ALLOWED ME TO GET A
BROADER SENSE OF THE CHALLENGES
AND WE TACKLED MANY PROBLEMS
INCLUDING CLINICAL TRIALS BIO
BANKING, EQUITY AND ANTIRACISM
IN RESEARCH AND MY TERM AS THE
VICE CHANCELLOR OF RESEARCH
COINCIDING WITH THE PANDEMIC WAS
A GREAT CHALLENGE AND I LEARNED
SO MUCH.
WHEN THE OPPORTUNITY AROSE TO
SERVE AT THE NIH, I ENDED UP
FEELING PRETTY WELL PREPARED
THANKS TO THE EXPERIENCE I HAD
RECEIVED IN THAT VICE CHANCELLOR
ROLE.
I WANT TO SAY AGAIN I NEVER AS
PERIOD TO BE A LEADER BUT IF YOU
FIND THAT LEADING PEOPLE AND
TEAMS IS GRATIFYING I'D
ENCOURAGE YOU NOT TO SHY AWAY
FROM THAT.
THIS IS AN OPPORTUNITY FROM THE
SWEARING IN CEREMONY ON FEBRUARY
OF 2021.
IT'S BEEN A PRIVILEGE AND HONOR
AND SERVED NEW CHALLENGES AND
MORE GROWTH FOR WHICH I'M GRATE
FUL LASTLY AND I'M NOT SURE HOW
WE'RE DOING ON TIME -- AM I OKAY
ON TIME?
THANKS.
I WANTED TO SHIFT GEARS AND TALK
ABOUT THE OPPORTUNITIES
AVAILABLE TO OUR BIRCWH SCHOLARS
TO MAKE SURE YOU'RE THINKING
BROADLY ABOUT OPPORTUNITIES AND
RESOURCES FOR YOUR CAREER.
NIAMS IS ONLY ONE OF 27
INSTITUTES AND CENTERS AND IF
YOU WERE TO THINK ABOUT THESE
INDIVIDUAL CENTERS WOULD FIND
ONE THAT MOST CLOSELY ALIGNS
WITH YOUR RESEARCH INTEREST BUT
ENCOURAGE TO YOU THINK MORE
BROADLY.
ANY ONE OF US CAN IDENTIFY THREE
OR FOUR OR FIVE OR SIX
INSTITUTES WITH RELEVANCE.
THEY'RE BROADLY OVERLAPPING
AREAS AND THEY OFFER DIFFERENT
OPPORTUNITIES.
DON'T BE NARROW AND THEY OFFER
DIFFERENT OPPORTUNITIES AND
BUDGET AND OPPORTUNITIES.
KEEP AN OPEN MIND WHEN YOU START
LOOKING AT THE NIH AND BEYOND OF
COURSE OUTSIDE THE NIH AS I'VE
MENTIONED.
I WANTED TO SHARE THE RO1
GRANTS.
THEY'RE TYPICALLY A COMMON
MECHANISM TO SUPPORT A PROJECT
INVESTIGATOR INITIATED OPPOSED
TO A RESPONSE TO SPECIFIC
FUNDING OPPORTUNITY.
INCREASINGLY THEY CAN BE
MULTI-P.I. THAT CREATES THE TEAM
ENVIRONMENT THAT COULD BE SO
IMPACTFUL AND HELPFUL.
THE BUDGET IS PRETTY GENEROUS
AND THERE'S A PROCESS FOR
REQUESTING HIGHER BUDGET
PROJECTS WHEN THAT IS
APPROPRIATE AND WELL JUSTIFIED.
TYPICALLY THE PROJECT PERIOD MAY
BE UP TO FIVE YEARS WHICH IS
REALLY NICE IN TERMS OF TRYING
TO ESTABLISH STABLE FUNDING FOR
RESEARCH PROGRAM AND IMPORTANTLY
I HOPE YOU'RE ALL AWARE THAT
MOST INSTITUTES AT THE NIH HAVE
WHAT'S CALLED A MORE GENEROUS
PAY LINE.
THAT IS A THRESHOLD FOR FUNDING
BASED ON A SCORE FOR EARLY STAGE
INVESTIGATORS.
SO IF YOU HAVEN'T HEARD ABOUT
THAT, MAKE SURE YOU UNDERSTAND
WHAT THE CRITERIA ARE FOR BEING
CONSIDERED AN EARLY STAGE
INVESTIGATOR SO YOU CAN TAKE
ADVANTAGE OF THAT AS YOU START
TO APPLY FOR INDEPENDENT
RESEARCH FUNDING AT THE NIH.
REALLY AN IMPORTANT OPPORTUNITY
YOU DON'T WANT TO MISS.
FOR EARLY STAGE INVESTIGATORS
THERE'S A RELATIVELY NEW PROGRAM
NAMED AFTER THE PREVIOUS
DIRECTOR OF NIAMS BECAUSE HE WAS
COMMITTED TO EARLY STAGE
INVESTIGATORS.
THIS RO1 TYPE GRANT IS MEANT FOR
HIGH RISK PROJECTS IN THE SENSE
THAT NO PRELIMINARY DATA ARE
REQUIRED.
IN FACT, YOU'RE NOT EVEN ALLOWED
TO INCLUDE PRELIMINARY DATA WITH
YOUR APPLICATION.
IT WILL BE SENT BACK.
THIS ALLOWS SOMEONE TO PURSUE AN
AREA OF RESEARCH COMPLETELY
DIFFERENT FROM ANYTHING THEY'VE
DONE OR LOOK AT THE VALUABLE
OPPORTUNITY.
I WANT TO MAKE SURE YOU'RE ALSO
AWARE, AS I WAS NOT, WHAT
RESOURCES YOU HAVE IN THE PEOPLE
THAT WORK AT THE INSTITUTES AT
THE NIH.
I NEVER REALLY REACHED OUT TO MY
PROGRAM OFFICER AND THAT'S THE
BEST PART OF THEIR JOB RUNNING
IDEAS BY THEM.
DO YOU THINK MY AIMS ARE
APPROPRIATE FOR YOUR INSTITUTE.
WHAT DO YOU RECOMMEND?
DO YOU THINK IT'S FAR ENOUGH
LONG.
THE PROGRAM OFFICER IS A
CRITICAL RESOURCE PARTICULARLY
FOR EARLY CAREER INVESTIGATORS.
SCIENTIFIC REVIEW OFFICERS CAN
ANSWER QUESTIONS ABOUT THE
PROCESSES AND THE GRANTS
MANAGEMENT SPECIALIST CAN HELP
WITH THE BUDGETARY ASPECTS.
SO DON'T BE SHY ABOUT REACHING
OUT AND REACH OUT TO PROGRAM
OFFICERS ACROSS DIFFERENT
INSTITUTES WHO YOU THINK MIGHT
BE INTERESTED GIVEN YOUR
RESEARCH INTERESTS.
MANY INSTITUTIONS OFFER
INTRAMURAL GRANTS AND GRANTS ARE
VALUABLE FOR THE TEAM
ENVIRONMENT THAT'S CREATED.
PROFESSIONAL SOCIETY
INCREASINGLY OFFER NOT ONLY
GRANTS BUT GRANT WRITING
WORKSHOPS.
IT'S AN A CRITICALLY IMPORTANT
SKILL.
THERE'S PATIENT REGISTRIES
INCREASINGLY AVAILABLE FOR
LEVERAGING LARGE DATA SETS AND
WITH THE NEW EXPECTATIONS FOR
DATA SHARING.
THESE WILL INCREASINGLY BE A
VALUABLE FOR THE RESEARCH
COMMUNITY.
AND DON'T OVERLOOK THE REVIEW
PROCESS AND MAKE SURE YOU'RE
AWARE OF AN EARLY CAREER
REVIEWER PROGRAM OPEN TO PEOPLE
WHO HAVE HAD LAST ONE YEAR OF
EXPERIENCE AS A FULL-TIME
ASSISTANT PROFESSOR AND HAVE TO
HAVE AN ACTIVE INDEPENDENT
RESEARCH PROGRAM BUT HAVEN'T YET
SECURED RO1 FUNDING SO EARLY
UPON IT'S AN OPPORTUNITY TO GET
AN INSIDER'S VIEW AND
PARTICIPATE IN A REVIEW PROCESS.
IT'S EXTREMELY ENLIGHTENING AND
INFORMATIVE.
I WISH I HAD THIS OPPORTUNITY AT
THAT STAGE AND ENCOURAGE ALL OF
YOU TO TAKE ADVANTAGE OF THESE
IF YOU MEET THE CRITERIA.
PLEASE CHECK THIS OUT.
I'M ASSUMING MY SLIDES WILL BE
SHARED FOR LINKS.
NOTHING CONFIDENTIAL HERE.
GIVEN THE TIMING, IF YOU CHOOSE
TOE APPLY FOR THE RO1 GRANT YOU
MAY BE SUBMITTING AT A TIME WHEN
THE NEW CRITERIA HAVE BEEN
MRIM
IMPLEMENTED.
JUST FOR YOUR AWARENESS
TRADITIONALLY AND STILL TODAY
THERE'S BEEN FIVE FACTORS
CONSIDERED TO ASSESS THE MERIT
OF APPLICATIONS.
THESE INCLUDE THE AREAS OF
SIGNIFICANCE, INNOVATION,
APPROACH, INVESTIGATOR AND
ENVIRONMENT.
THE NEW CRITERIA FOR
APPLICATIONS RECEIVED STARTING
JANUARY, 2025 HAVE THREE GOALS
IN MIND.
FIRST, THEY REALLY WANT TO FOCUS
THE REVIEW ON THE IMPORTANT
PROJECTS, QUESTIONS SHOULD THE
PROPOSED RESEARCH BE CONDUCT AND
CAN IT BE CONDUCTED.
THEY ALSO WANT TO MITIGATE THE
EFFECT OF REPUTATIONAL BIAS.
LET'S THINK ABOUT THE
INVESTIGATOR AND THE PROJECT NOT
ABOUT THE MENTOR OR PRESTIGE OF
THE INSTITUTION.
AN IMPORTANT GOAL.
AND THIRD REDUCE REVIEWER BURDEN
FOCUSSING ON THE QUESTIONS NOT
THE REGULATORY COMPLIANCE
ISSUES.
TO ACHIEVE THESE GOALS AND
THERE'S A SCORE FROM ONE TO NINE
FOR THE IMPORTANCE OF THE
RESEARCH AND SIMILARLY A SCORE
FROM ONE TO NINE FOR RIGOR AND
FEASIBILITY.
THE INVESTIGATOR AND ENVIRONMENT
ARE EVALUATED AS SUFFICIENT OR
NOT.
I THINK THESE ARE GREAT CHANGES
AND MANY WILL BECOME FAMILIAR
WITH THESE AND THESE ARE CHANGES
THAT AFFECT THE REVIEW OF THE
APPLICATIONS.
NOT WHAT HAS TO BE SUBMITTED.
YOU'LL STILL BE SUBMIT THE SAME
MATERIAL.
ONE LAST SUMMARY SLIDE AND THEN
I'M HAPPY TO TAKE A FEW
QUESTIONS BEFORE YOUR OVERDUE
BREAK.
A FEW THINGS I WANT YOU TO
TAKEAWAY.
REVIEW PRIORITIES AND GOALS.
IF YOU'RE CONTEMPLATING TRYING
TO SECURE NIH FUNDING.
LEARN THE APPLICATION REVIEW
PROCESS.
I'VE TALKED ABOUT CLUES HOW TO
DO THAT.
IDENTIFY GRANT PROGRAMS OFFERED
BY EACH INSTITUTE AND CENTER.
MAKE EARLY CONTACT WITH PROGRAM
OFFICERS AND OF COURSE MAKE SURE
YOU'RE LOOKING OUTSIDE THE NIH
FOR FUNDING OPPORTUNITIES
LOCALLY, REGIONALLY AND
PROFESSIONAL ORGANIZATIONS.
AND FIND INNOVATIVE WELL
RESPECTED MENTORS.
I FAILED TO MENTION EARLIER BUT
INCREASINGLY YOU SHOULD THINK
ABOUT A TEAM OF MENTORS.
NO ONE PERSON CAN POSSIBLY
PROVIDE EVERYTHING YOU NEED TO
SUPPORT YOUR CAREER THROUGHOUT
YOUR CAREER.
YOU SHOULD BE THINKING ABOUT A
CAREER MENTOR AND SCIENTIFIC
MENTOR AND MAYBE ALSO A
TECHNICAL MENTOR AND YOU'RE
CHOICE OF MENTORS MAY EVOLVE
OVER TIME.
THAT'S OKAY.
YOU DON'T HAVE TO KEEP THE SAME
MENTORS THE REST OF YOUR CAREER.
THE NEEDS WILL CHANGE AND
OPPORTUNITIES WILL CHANGE.
YOU SHOULD ALWAYS THINK ABOUT
YOUR MENTORS AS A DYNAMIC
PROCESS.
AND SPEAKING OF YOUR MENTORS,
ASK TO READ THEIR SUCCESSFUL
GRANT APPLICATIONS.
DON'T BE SHY TO LEARN FROM
OTHERS' SUCCESSES AND BEHAVIORS
AND BE PREPARED TO PROPOSE YOUR
BEST AND MOST CREATIVE IDEAS.
.
DON'T BE SHY.
THERE'S HIGH RISK GRANT PROGRAMS
OUT THERE.
DON'T BE TOO CONSERVATIVE IN
THINKING ABOUT THE IDEA YOU WANT
TO PURSUE.
LAST BUT NOT LEAST, PERSEVERE.
I MENTIONED BRIEFLY THE NUMEROUS
ATTEMPTS IT TOOK FOR ME TO GET A
P30 GRANT BUT I HAVE CERTAINLY
APPLIED FOR MORE GRANTS THAN I
RECEIVED AND YOU'LL FIND THAT
TRUE SO PERSEVERANCE IS
IMPORTANT.
ON THAT NOTE, I'M HAPPY TO TAKE
ANY QUESTIONS IF WE HAVE TIME.
>> THANK YOU FOR THAT INSPIRING
PRESENTATION.
I'M FROM THE UIC BIRCWH.
IT'S VERY FREQUENT WE GUIDE
SCHOLARS AND WHAT OPPORTUNITIES
DID YOU SAY NO TO AND SOMETIMES
WE TELL THEM YOU SHOULDN'T DO
THIS OR THAT AND IT COULD BE A
GREAT TUPT.
-- OPPORTUNITY.
>> I GAVE WHAT TURNED OUT TO BE
A CONTROVERSIAL PRESENTATION AND
THE TITLE WAS JUST SAY NO.
THIS OCCURRED AT A TIME WHEN I
HAD TWINS AND HAD TO BALANCE ALL
THESE DIFFERENT RESPONSIBILITIES
BUT IT'S REALLY IMPORTANT TO BE
SELECTIVE ABOUT THE THINGS YOU
AGREE TO DO FOR MANY REASONS.
YOU ONLY HAVE SO MUCH TIME IN
THE DAY AND YEARS IN YOUR LIFE.
YOU HAVE TO FOCUS ON THINGS
WHERE YOU FEEL YOU CAN MAKE A
DIFFERENCE.
IT'S ALIGNED WITH YOUR
INTERESTS.
THERE'S SO MANY ASPECTS TO THIS.
ALONG THOSE LINES I TRIED TO
TELL PEOPLE DON'T TRY TO ACHIEVE
THIS STATUS OF A TRIPLE THREAT,
TEACHER, CLINICIAN, RESEARCHER,
I DON'T THINK IT'S FEASIBLE.
I DON'T THINK IT'S REALISTIC.
AT A CERTAIN POINT IN MY CAREER
I DECIDED I COULDN'T CONTINUE TO
BE THE TYPE OF CLINICIAN MY
PATIENTS NEED AND STILL PUT IN
THE TIME AND EFFORT AND DECIDED
WHAT I FELT MOST PASSIONATE
ABOUT WAS MY RESEARCH PROGRAM
AND BACKED AWAY FROM SOME OF
THOSE ACTIVITY.
THAT'S OKAY.
IF YOU COMMIT TO TOO MANY THINGS
YOU'LL ALWAYS BE LETTING PEOPLE
DOWN AND FEELING FRUSTRATED WITH
YOURSELF.
YOU'LL BE BURNED OUT AND I TRY
TO ALWAYS TALK ABOUT GETTING
INTO A SUSTAINABLE MODE.
IF YOU'RE NOT IN A SUSTAINABLE
SITUATION SOMETHING HAS TO
CHANGE.
I ALSO TALK ABOUT EVERYBODY
NEEDING TO TAKE A MATERNITY
LEAVE ONCE EVERY 10 YEARS TO GET
ACROSS THE NOTION YOU NEED TO
HELLO AND TAKE A STEP BACK AND
THERE'S A LOT ON YOUR PLATE AND
CONTRIBUTE THE MOST.
ALSO WHEN IT COMES TO
ADMINISTRATIVE AND LEADERSHIP
POSITIONS THINK ABOUT WHETHER
THERE'S ANY COMPENSATION
ASSOCIATED WITH THE ACTIVITY.
THAT'S A REALLY IMPORTANT
CONSIDERATION AS WELL.
YOU DON'T WANT TO SPREAD
YOURSELF TOO THIN.
I COULD GO ON AN ON THE TOPIC
BUT I WANT TO TAKE A COUPLE
OTHER QUESTIONS OVER HERE.
>> EXCELLENT TALK.
I'M A SCHOLAR FROM DUKE.
MY QUESTION CENTERS ON THE NEW
GREETING MODEL WHERE FEASIBILITY
IS ONE OF THE ELEMENTS AND HOW
DOES THAT GET EVALUATED AT THE
CONTEXT OF THE INDIVIDUAL AND
INSTITUTION?
WILL THAT STILL FACTOR IN IN THE
NEW MODEL YOU THINK?
>> WHAT THE REVIEWERS ARE GOING
TO BE ASKED IS CAN THIS PERSON
DO THIS PROJECT?
DO THEY HAVE THE RESOURCES AND
EXPERTISE TO DO IT?
WHAT THEY'RE NOT IF IT'S TRYING
TO AVOID A SITUATION WHERE THE
APPLICATION COMES IN AND THIS
PERSON IS FROM HARVARD.
OF COURSE, THAT MEANS SUCH AND
SUCH AND ANOTHER APPLICATION
COMES FROM ANOTHER INSTITUTION
THAT IS NOT AS GENEROUSLY
RESOURCED AND CREATES A BIAS IN
THE REVIEWER'S MIND.
IT'S REALLY SUPPOSED TO BE
NARROWLY FOCUSSED ON CAN THAT
PERSON WITH THEIR BACKGROUND AND
EXPERTISE DO THAT PROJECT AT
THAT PLACE?
DO THEY HAVE THE RESOURCES
ACCESSIBLE?
THE OTHER RESOURCES OF THE AT
THE INSTITUTION THE REPUTATION
OF THE INSTITUTION.
THE REPUTATION OF THE MENTORS
NOT SUPPOSED TO BE CONSIDERED
THE WAY SOME HAVE TENDED TO.
THIS IS THE WAY IT'S SUPPOSED TO
BE NOW BUT TO MAKE THAT POINT
CRYSTAL CLEAR, THEY'VE REVISED
THE CRITERIA AND TURNED THAT
PART THE FEASIBILITY PART INTO
INSUFFICIENT OR NOT INSTEAD OF A
ONE TO NINE SCALE.
I THINK IT WILL MAKE A BIG
IMPACT.
>> ON THE SAME NOTE WOULD YOU
CONSIDER BLINDED REVIEWS SINCE
IT'S NO LONGER A SCORABLE ITEM?
IS IT A POSSIBILITY?
>> I MISSED THE FIRST PART.
>> A BLINDED REVIEW SO YOU DON'T
KNOW THE PERSON'S NAME OR
INSTITUTION.
>> THERE'S BEEN EXPERIMENTS WITH
ANONYMOUS REAND THERE -- AND
THERE WERE OTHER EFFORTS THE
FIRST INSTITUTIONAL FUNDING
PROGRAM THEY REVIEW THE WELL
RESOURCES AND LESS RESOURCED
INSTITUTIONS.
THERE'S QUITE A LOT OF WORK FOR
CERTAIN REASONS TO THINK WHEN
NON ANONYMIZED REVIEW BE
APPROPRIATE.
IT'S MEANT TO ADDRESS A SIMILAR
PROBLEM.
>> DAWN VOGEL BETHESDA.
A COMMON AND QUICK QUESTION.
THANK YOU FOR ENCOURAGING PEOPLE
ESPECIALLY EARLY CAREER
INVESTIGATORS TO CONTACT PROGRAM
OFFICERS.
I'D LIKE TO REMIND EVERYBODY
PROGRAM OFFICERS ARE NOT
FACELESS BUREAUCRATS.
THEY'RE SCIENTISTS LIKE YOUR IS
SELF AND LOVE TO TALK SCIENCE SO
YOU CAN GET INTO A GOOD
CONVERSATION WITH THEM ABOUT
YOUR PROJECT.
THE QUESTION THE STEVE KATZ RO1
LOOKS LIKE AN EXCITING
OPPORTUNITY AND HOW MANY OF
THOSE ARE BEING MADE?
>> I DON'T HAVE THOSE NUMBERS.
IT WAS POPULAR AND COMPETITIVE.
OUR INSTITUTE FUNDED A COUPLE
AND I KNOW MANY OTHER
INSTITUTIONS HAVE FUNDED MORE.
I DON'T HAVE THE STATISTICS.
I COULD FIND OUT IF YOU'D BE
INTERESTED.
LIKE ALL NEW FUNDING PROGRAM
IT'S BEEN A LITTLE TRICKY FOR
THE FIRST COUPLE YEARS BECAUSE
THE REVIEWERS HAVEN'T REVIEWED
THEM BEFORE AND THE APPLICANTS
HADN'T WRITTEN THEM BEFORE.
WHAT DO YOU MEAN BY NO
COMPLI
PRELIMINARY DATA.
I THINK IT WILL BE EVOLVING BUT
I THINK IT'S A GREAT OPPORTUNITY
FOR EARLY CAREER INVESTIGATORS
WHO HAVE AN IDEA FOR WHICH A
TYPICAL RO1 IS NOT APPROPRIATE.
>> I'M FROM DUKE.
SINCE YOU'RE UP THERE, WOULD YOU
PUT IN A WORD FOR ENCOURAGE TO
APPLY FOR AN EXTENSION FOR
INVESTIGATOR STATUS.
THERE'S SO MANY OPPORTUNITIES TO
EXTEND THAT AFTER COVID AND WITH
MATERNITY LEAVE AND I FELL LIKE
IT NEEDS TO BE BETTER UTILIZED.
>> THANK YOU.
MAKE SURE THERE'S SITUATION IN
WHICH AN EXTENSION IS GRANTED
FOR ONE REASON OR ANOTHER.
REGARDING THE EARLY STAGE
INVESTIGATOR STATUS ONE THING
THAT'S NOT WELL KNOWN FOR
EXAMPLE IS IF YOU SUBMIT THE
INITIAL APPLICATION AND IT'S NOT
FUNDED EVEN IF YOU WOULD
TECHNICALLY USE THE EARLY CAREER
INVESTIGATOR STATUS THE
RESUBMISSION STILL COUNTS AS AN
EARLY STAGE INVESTIGATOR STATUS.
THE STATUS STAYS WITH THE
APPLICATION EVEN IF YOU ARE NO
LONGER ELIGIBLE FOR A NEW
APPLICATION.
A NUANCE ANOTHER EXAMPLE OF
DEVELOP A RELATIONSHIP WITH SOME
PROGRAM OFFICERS SO AS QUESTIONS
COME UP YOU'RE AWARE OF THE
PROGRAMS YOU MIGHT BENEFIT OR
FLEXIBILITIES.
THERE'S FLEXIBILITIES RELATED TO
FAMILY RESPONSIBILITIES AND
TAKING A LEAVE, ETCETERA.
GOOD RESOURCES.
ANY OTHER QUESTIONS?
HOPEFULLY MY E-MAIL ADDRESS WAS
SHARED WITH THIS GROUP SO PLEASE
REACH OUT TO QUESTIONS AND
THANKS AGAIN FOR THE OPPORTUNITY
TO SPEAK QUITE A PRIVILEGE.
THANK YOU VERY MUCH.
>>
>> SO WE'RE ABOUT READY TO LET
YOU GO TO LUNCH.
JUST A FEW CLOSING COMMENTS
HERE.
WE'RE CONCLUDE THE PLENARY
SESSION AND VIDEOCAST AND MOVING
TO LUNCH AND THE AFTERNOON
SESSIONS.
I WANT TO THANK ALL OF YOU FOR
YOUR PARTICIPATION AND
FLEXIBILITY AS WE HAD SOME
ADJUSTMENTS THIS MORNING.
CAFETERIA IS NOW OPEN TO 1:30.
HOPEFULLY THE SCHOLARS AND
POSTDOCS WILL HURRY UP AS
THEY'RE YOUNGER THAN US AND BE
DOWN HERE E1G2 AND I WANTED TO
THANK OUR ORWH COLLEAGUES.
IT HIT WAS CLEARLY A TEAM EFFORT
AND HAD A MEETING YESTERDAY AS
WELL AND THE ICO MENTORS FOR
THEIR HELP AND WANTED TO THANK
OUR DEVOTED COLLEAGUE AND SHOWS
UP FOR THE MEETINGS THE
CAFETERIA SEATING WILL REMAIN
OPEN ALL AFTERNOON FOR ATTENDEES
NOT SCHOLARS OR POSTDOCS YOU'RE
WELCOME TO SIT AND ENJOY
CONVERSATION.
POSTERS ARE 3:00 TO 5:00 IN THE
ATRIUM AND HAVE 84 ABSTRACTS AND
EXCITE ABOUT THAT TOO.
WITH THAT WE'LL CONCLUDE AND
EVERYONE ENJOY YOUR WELL
DESERVED LUNCH.