>>THANKS, EVERYONE, FOR COMING
BOTH HERE IN LIPSETT AS WELL AS
THE NIH VIDEOCAST.
MY NAME IS CAITLYN SATLER, I'M A
MEMBER OF THE ORGANIZING
COMMITTEE AND HAPPY TO HOST YOU
ALL TODAY.
JUST A FEW INSTRUCTIONS BEFORE
WE BEGIN FOR THOSE OF YOU
JOINING US VIA VIDEOCAST.
IF YOU HAVE ANY QUESTIONS,
PLEASE DIRECT THEM VIA THE LIVE
FEEDBACK BUTTON BELOW THE SCREEN
IN THE VIDEOCAST DESCRIPTION.
IF YOU NEED CLOSED CAPTIONS,
THOSE ARE AVAILABLE AS WELL.
THE QUESTIONS WILL BE ASKED AT
THE END OF EACH SPEAKER'S
PRESENTATION.
AND FOR THOSE OF YOU WITH US IN
LIPSETT, PLEASE ASK YOUR
QUESTIONS AT THE MICROPHONES
LOCATED ON EITHER SIDE OF THE
HALL HERE.
WITH THAT, WITHOUT FURTHER ADO,
I'M VERY EXCITED TO BE ABLE TO
INTRODUCE OUR SPECIAL GUEST FOR
THIS MORNING, WHO IS DR. CAROL
FEELEY OF NCI.
SHE IS A PIONEER HERE AT THE NIH
BOTH IN SCIENCE AND IN EQUITY
FOR WOMEN, AND WITHOUT FURTHER
ADO, CAROL.
>>THANK YOU.
I FEEL VERY HONORED TO BE
INVITED TO SPEAK HERE TODAY.
I WANTED TO START A LITTLE BIT
HISTORICALLY, WHEN I CAME TO THE
NIH IN 1981, IT WAS QUITE A
DIFFERENT PLACE.
CLEARLY IT WAS AN AMAZING
BIOMEDICAL ENTERPRISE, MUCH AS
IT IS TODAY.
BUT IT WAS WITHIN THE STRUCTURE
OF A QUASI MILITARY INSTITUTION
OR FACILITY THAT WAS REFERRED TO
AS "THE RESERVATION."
I CAME ON A CANCER RESEARCH
INSTITUTE AND LATER A DAMON
RUNION FELLOWSHIP BECAUSE THERE
WAS NOT REALLY A FORMAL TRAINING
PATHWAY FOR AMERICAN PH.D.
POSTDOCTORAL SCHOLARS AT THAT
TIME.
NO ERTAs OR SERTAs.
I WAS RAISED IN SORT OF THE
SOCIAL FORCES OF THE 70s AND
80s, WHERE WE PROTESTED THE
WAR, AND THEN WE LATER LOBBIED
FOR INCREASED VISIBILITY OF
WOMEN IN ALL ASPECTS OF LIFE,
AND ESPECIALLY THE JOB ARENA.
AND I THINK THE INSTITUTE ALSO
WAS INFLUENCED BY THIS.
CONGRESS AS WELL AS DHHS IN 1983
STARTED THE PHS TASK FORCE ON
THE STATUS OF WOMEN ISSUES.
AND THEN THIS LED TO THE ONLY
INSTITUTE DIRECTOR, FEMALE
INSTITUTE DIRECTOR, RUTH
KIRSCHSTEIN, BEGINNING TO
ORGANIZE THE OFFICE OF RESEARCH
ON WOMEN'S HEALTH, WHICH LATER
WAS TAKEN OVER BY THE FIRST
DIRECTOR, VIVIAN PINN.
AND THIS WAS REALLY A
GALVANIZING EVENT IN BIOMEDICAL
RESEARCH, BECAUSE AT THAT TIME,
WOMEN WERE NOT INCLUDED IN
BIOMEDICAL RESEARCH, AND THEY
WERE JUST CONSIDERED MEN WITH
HORMONES AND THEN THEY ALSO
DEPARTMENT WANT TO PUT THEM ON
HORMONES -- I MEAN ON STUDIES
BECAUSE OF THE HORMONAL
FLUCTUATIONS.
AND POST-MENOPAUSAL WOMEN WERE
NOT EVEN CONSIDERED AS WELL.
AND SO IT WAS IN THIS
ENVIRONMENT THAT REALLY, I THINK
IN 1991, GEORGE BUSH APPOINTED
BERNADINE HEALY TO BE THE FIRST
DIRECTOR OF THE NIH.
AND HER SHORT TENURE, I THINK,
WAS QUITE TRANSFORMATIVE.
TWO MAJOR ASPECTS THAT SHE DID
WAS TO EARMARK $150 MILLION FOR
THE WOMEN'S HEALTH INITIATIVE,
AND FOR THOSE OF YOU WHO KNOW,
MONEY IS REALLY WHAT POWERS THE
ABILITY OF AN INSTITUTE TO
EFFECT CHANGE, AND I THINK THIS
REALLY LED TO THE STRENGTHENING
OF WOMEN'S HEALTH ISSUES.
THE OTHER IMPORTANT THING THAT
SHE DID WAS TO START THE NIH
TASK FORCE ON THE STATUS OF
WOMEN, AND THIS, AS YOU HEARD
EARLIER, WAS LED BY THE CHAIR,
WAS HINDA KLEINMAN AND A NUMBER
OF WOMEN SCIENTISTS, AND I'VE
TAKEN THIS FROM AN OLD COPY THAT
I ACTUALLY RESURRECTED OF THAT
GROUP, AND HYNDA WAS THE CHAIR
OF THE TASK FORCE.
SHE WAS AN AMAZING SCIENTIST IN
THE DENTAL RESEARCH INSTITUTE.
SHARP-WITTED AND VERY
INSIGHTFUL.
KREE ATER OF MATRIGEL AND AS ANY
CANCER BIOLOGIST KNOWS, A REALLY
IMPORTANT COMPONENT OF THEIR
STUDIES.
AND SO HYNDA AND THE TASK FORCE
DELVED INTO THE STATUS OF WOMEN
AT NIH AND THEIR FINDINGS WERE
PRESENTED TO THE NIH IN AN
AMAZING DOCUMENT ALMOST 30 YEARS
AGO TO THE DAY.
SO THE MAJOR FINDINGS FROM THIS
WAS THE ESTABLISHMENT OF THE
WOMEN SCIENTIST ADVISORS.
AMONG THE FIRST ARE LISTED ON
THE SIDE HERE.
AND THE ISSUES THAT THEY RAISED
AS BEING IMPORTANT WERE PAY
EQUITY, VISIBILITY, LEADERSHIP,
WORK AND FAMILY ISSUES.
SUSAN BATES AND I WERE ASKED --
I WAS A NEWLY TENURED
INVESTIGATOR, AND WAS SOMEWHAT
SURPRISED AFTER A SEMINAR WHEN
BRUCE CHABNER, HEAD OF ONE OF
THE LARGEST INTRAMURAL DIVISIONS
OF THE CANCER INSTITUTE, CAME UP
TO ME AND ASKED ME TO BE THE
WOMEN SCIENTIST ADVISOR.
I KNEW THEY WERE SUPPOSE SUPPOSE
ELECTED AND HE SAID, WELL, YOU
AND SUSAN ARE THE ONLY TWO
TENURED INVESTIGATORS IN OUR
DIVISION.
SO THAT'S HOW I BEGAN TO
PARTICIPATE IN THIS EFFORT.
I'VE HIGHLIGHTED HERE JOAN
SCHWARTZ BECAUSE I THINK SHE
REALLY PLAYED A KEY ROLE IN
REALLY TRANSFORMING THE
AWARENESS OF THESE ISSUES AT NIH
INTO A REALITY, AND THAT CAME
ABOUT LATER ON WHEN MIGHT
GOTTESMAN WAS APPOINTED BY
HAROLD VARMUS TO BE THE
INTRAMURAL DIRECTOR OF NIH.
AND JOAN, ALONG WITH THE WSAs,
REALLY BEGAN TO TACKLE THESE
ISSUES ONE BY ONE.
JOAN REALLY WAS AN IMPORTANT
MENTOR TO ME THROUGHOUT MY
ENTIRE CAREER.
MY GO-TO PERSON FOR ANY
UNDERSTANDING OF HOW THE
INSTITUTION WORKED.
AND YOU KNOW, JOAN AND HER GROUP
ACTUALLY ENABLE US TO FIND A
PATH TO PAY EQUITY THROUGH A
NO-FAULT EEO MEMORANDUM OF
UNDERSTANDING.
AND THIS WAS QUITE AMAZING
BECAUSE WE WERE ABLE TO CHANGE
THE PAYS OF THE TRAINEES, BUT
EVEN MORE IMPORTANTLY, FOR THE
GOVERNMENT SCIENTISTS, THE
GS-RATED GOVERNMENT SCIENTISTS.
SO THIS WAS REALLY A FASCINA
FASCINATING -- TO ME IT WAS
LIKE, OH, YOU CAN IF YOU ARE
ACTIVE MAKE A CHANGE.
THEY LATER THEN WERE JOINED BY
ARLENE AND ROLAND, WHO THEN
BEGAN TO EFFECT ALL THE OTHER
ISSUES TO REALLY TRANSFORM THE
NIH FROM THIS QUASI MILITARY
STRUCTURE INTO A MORE ACADEMIC
ORGANIZATION WITH PROGRAMS LIKE
HOW TO BE A SUCCESSFUL P.I., HOW
TO DEVELOP MORE OF THE TRAINING
PATHWAYS, THE SERTA AND ERTA
PROGRAMS AND INTO THE OITE, AS
WELL AS REALLY TAKING TO THE
FORE AND KEEPING IN THE FORE THE
WORK/LIFE ISSUES FOR SCIENTISTS.
AND THESE ISSUES ALTHOUGH THEY
STARTED AT WOMEN'S ISSUES ARE
REALLY TRANSFORMATIVE FOR BOTH
MEN AND WOMEN, SO FOR ALL
PEOPLES.
AND I THINK THAT WE CAN BE
EXCITED THAT THE INSTITUTE NOW
IS BEING LED BY DR. NINA SCHOR.
I KNOW HER, SHE IS A
PEDIATRICIAN AND PEDIATRICIANS
ARE VERY SPECIAL PEOPLE.
SO I'M SURE THAT THE ACTIVITIES
OF THE DDIR WILL BE AS STRONG AS
EVER.
AND I WANTED TO LEAVE YOU WITH A
SAYING THAT I LEARNED FROM
BERNADINE HEALY.
SHE SAID SHORT SENTENCES BUT
STRONG VERBS.
AND I THINK THIS IS AN IMPORTANT
ASPECT TO CONSIDER, AND I'LL ADD
MY OWN MANTRA THAT HAS KEPT ME
MOVING FORWARD: ALWAYS DO WHAT
YOU'RE AFRAID TO DO, AND
ACTIONS, NOT WORDS.
THANK YOU VERY MUCH.
[APPLAUSE]
>>THANKS SO MUCH FOR THAT
FANTASTIC PERSPECTIVE.
AND IT IS MY HONOR TO BE ABLE TO
LEAD INTO OUR SCIENTIFIC
PROGRAMMING FOR TODAY WITH OUR
TWO SPEAKERS.
OUR FIRST SPEAKER OF THE DAY IS
DR. SEGRE, A SENIOR INVESTIGATOR
IN NHGRI.
SHE HAS BEEN ELECTED TO BOTH NIS
AND NAM AS A FELLOW OF BOTH AAAS
AND AAM.
DR. SEGRE IN 2013 RECEIVED THE
SERVICE TO AMERICA MEDAL FOR
LAUNCHING A REALTIME GENOMIC
STUDIES DURING MULTIDRUG
RESISTANT BACTERIA OUTBREAK AT
THE NIH CLINICAL CENTER.
WITH THAT, DR. SEGRE, WE'RE
LOOKING FORWARD TO YOUR TALK.
[APPLAUSE]
>>THANKS VERY MUCH.
AND IT IS REALLY A PLEASURE TO
BE HERE AND TO JOIN YOU ALL IN
PERSON, AND THANK YOU FOR THAT
NICE INTRODUCTION.
SO I'M GOING TO TALK ABOUT THE
RESEARCH PROGRAM THAT I
DEVELOPED HERE AT THE NIH ON THE
HUMAN SKIN MICROBIOME.
SO FIRST OF ALL, WHAT DO I MEAN
BY THE HUMAN MICROBIOME?
FOR ME, THE MICROBIOME IS THE
COLLECTION OF ALL THE
MICROORGANISMS AND THEIR DNA
LIVING IN ASSOCIATION WITH THE
HUMAN BODY.
SO THAT'S THE BACTERIA, THE
EUKARYOTES OR FUNGI, VIRUSES,
AND IN SOME CIRCUMSTANCES
ALTHOUGH NOT ACTUALLY FOUND ON
THE SKIN, THE ARCHAEA.
SO THE BASIC UNDERSTANDING IS
THAT AS SOMEONE WHO CAME FROM
THE HUMAN GENOME PROJECT, I
ORIGINALLY THOUGHT OF HUMANS AS
BEING THE GENETIC MATERIAL OF
THESE 23 CHROMOSOMES, BUT IN
FACT, HUMANS ARE SUPERORGANISMS.
AND OUR DNA IS ACTUALLY MADE UP
OF THE HUMAN GENOME, AS WELL AS
ALL OF THE MICROBES THAT LIVE IN
AND ON US.
AND THIS IS IMPORTANT AND CAN BE
IMPORTANT FOR DISEASE STATES
BECAUSE THESE BACTERIAL GENOMES
ARE MUCH SMALLER THAN A HUMAN
GENOME, BUT WITH THEIR CODING
POTENTIAL, THE DNA OF THE HUMAN
GENOME IS THE SAME IN EVERY
CELL, WE MIGHT HAVE
TRANSCRIPTIONAL DIFFERENCES, BUT
THE DNA OF THE BACTERIA OR THE
FUNGI CAN ACTUALLY BE QUITE
DIFFERENT.
SO YOU'VE GOT THIS OTHER GENOME
THAT'S LIVING SIMULTANEOUSLY
WITH YOU, AND THAT CAN CHANGE IN
THE CONTEXT BOTH OF DISEASE
STATES BUT ALSO HOW WE MIGHT TRY
TO AMELIORATE DISEASE.
SO IN THAT CONTEXT, THE SORT OF
THEMES THAT I WANT TO TALK ABOUT
THAT WE'RE INTERESTED IN IS SORT
OF HOW DOES THE HUMAN MICROBIOME
FUNCTION AS AN ORGAN SYSTEM OF
THE HUMAN BODY TO TUNE THE
IMMUNE SYSTEM, TO AID IN
DIGESTION, AND TO PROVIDE
PROTECTION FROM PATHOGENS.
SO AWESOME NEW FIELD, BUT HOW DO
WE ACTUALLY CHARACTERIZE THE
MICROBIOME?
SO WE'RE ALL NOW VERY
COMFORTABLE WITH THIS IDEA OF
STICKING SWABS UP OUR NOSE, BUT
HOW DO YOU ACTUALLY CHARACTERIZE
THE MICROBIOME BECAUSE THE
TRADITIONAL WAY WAS TO PUT THESE
ON TO AUGER PLATES AND SEE WHAT
GREW.
BUT THE ISSUE IS THAT MANY
BACTERIA ARE FASTIDIOUS OR THE
VIRUSES ARE IMPOSSIBLE AND THE
FUNGI ARE ALSO HARD.
SO MY SCIENTIFIC UPBRINGING WAS
WITHIN THE HUMAN GENOME PROJECT,
WHERE WE TALKED ABOUT THIS
3 BILLION BASE PAIRS AND WE
TALKED ABOUT IT IN TERMS OF
BOOKS AND CHAPTERS, BUT REALLY
WE WERE DEVELOPING THIS
TECHNOLOGY OF GENETIC MAPS AND
PHYSICAL MABS AND CONSTRUCTING
THESE SEQUENCE READS THAT WE
THEN REASSEMBLED.
BUT ALONG WITH THESE TECHNOL
TECHNOLOGIES, ALONG WITH THIS
INTELLECTUAL CONSTRUCT OF THE
HUMAN GENOME PROJECT, WE WERE
ALSO DEVELOPING THESE
TECHNOLOGIES OF MOVING FROM
SEQUENCING ON SANGER INSTRUMENTS
INTO THESE HIGH THROUGHPUT
SEQUENCING CENTERS, AND ALSO THE
COMPUTE POWER THAT GOES ALONG
WITH THAT.
AND SO WITH THAT AS A FRAMEWORK,
I REALLY AS AN INDEPENDENT
INVESTIGATOR HERE AT THE NIH
STARTED TO THINK ABOUT
SEQUENCING AS A NEW LENS TO
OBSERVE BIOLOGY.
AND WE MAY THINK ABOUT
SEQUENCING AS A WAY TO OBSERVE
THE STATE OF HUMAN CELLS IN
TERMS OF CHROMATIN STATE OR THE
TRANSCRIPTIONAL EXPRESSION, BUT
I ALSO WAS THINKING ABOUT IT IN
THE CONTEXT OF THE WORLD AROUND
US.
THAT IN THE PAST, WE'VE THOUGHT
ABOUT MICROBES AND OBSERVING
THEM USING THE LENS OF A
MICROSCOPE.
BUT WHAT NOW ABOUT USING THE
LENS OF SEQUENCING TO EXPLORE
WHAT IS THE MICROBIAL COMMUNITY.
SO WE DEVELOPED METHODS TO
SAMPLE THE HUMAN SKIN, AND THEN
CHARACTERIZED THE COMPONENTS OF
THE SKIN.
AND WE STARTED WITH SIGNATURE
MARKER GENES OF THE BACTERIA AND
THE FUNGI SO THAT WE COULD AT
LEAST CHARACTERIZE WHAT WAS
THERE, AND THEN MOVED THE ENTIRE
PIPELINE INTO A MUCH MORE
COMPLEX SYSTEM, WHERE WE'RE
DOING SHOTGUN METAGENOMIC
SEQUENCING OF TAKING THAT SAMPLE
AND DIRECTLY SEQUENCING
EVERYTHING THAT'S THERE AND THEN
PULLING THE GENOMES BACK OUT.
AND OUR INITIAL FINDING TOGETHER
WITH MY LONG-TIME COLLABORATOR
DR. HEIDI KONG, THEN IN NCI, NOW
IN NIAMS, AND A VERY TALENTED
POSTDOC WHO ELIZABETH GRIES
WHO'S NOW AT PENN, WE SET UP THE
FIRST EXPERIMENT ON THE SKIN.
THIS WILL BE KIND OF A MODEL
THAT WE USE WHERE WE
CHARACTERIZE 18 DIFFERENT BODY
SITES OF HEALTHY VOLUNTEERS AND
THEN OF PATIENTS.
AND WHAT WE FOUND HERE WITH THE
INSIGHTS BORROWED FROM DR. MARIA
TURNER, WHO WAS OUR SCIENTIFIC
GURU AT THAT POINT WAS THIS IDEA
THAT DERMATOLOGIC DISORDERS
MANIFEST AT STEREOTYPICAL SITES.
SO YOU'RE GOING TO SEE PSORIASIS
ON THE OUTSIDE OF THE ELBOW,
ECZEMA ON THE INSIDE OF THE
ELBOW, AND THAT MAYBE THERE IS
SOMETHING BIOLOGICAL ABOUT THOSE
MICROBES.
AND SO WHEN WE CHARACTERIZE THE
SCIENCE, WHAT WE FOUND WAS A
GREAT DISTINCTION BETWEEN THE
KNOW KROABS --BETWEEN THE MICROE
ON OILY SITES ENRICHED INTO THE
BACTERIUM, THE MOIST SITES THAT
WERE MORE DIVERSE, AND HAD A
GREATER AMOUNT OF PROTEOBACTERIA
AND STAPHYLOCOCCUS, AND THE DRY
SITES THAT WERE EXTREMELY
DIVERSE.
AND WE STARTED TO THING ABOUT
THIS THEN THAT HUMANS ARE THESE
ECOSYSTEMS FOR THE RESIDENT
BACTERIA, AND THAT THE MICROBES
ARE TUNING THEMSELVES TO LIVING
ON THE HUMAN BODY, SEEING THE
HUMAN SKIN AS A NUTRIENT FIELD.
AND THAT WE ARE THEIR HOMES BUT
THEY ARE THEN PROVIDING BENEFIT
TO US.
SO UNDERSTANDING THIS, WE HAD
ONE ISSUE AS WE MOVED SORT OF
FROM THE SIMPLICITY OF
CHARACTERIZING THE BACTERIAL AND
THE FUNGAL COMMUNITIES TO TRYING
TO UNDERSTAND THE FULL
COMPLEXITY OF THE HUMAN
MICROBIOME.
AND THE PROBLEM WAS THAT WE
STILL ONLY WERE SEEING THE
MICROBES THAT MATCHED A
REFERENCE.
& THE ISSUE WAS THAT THE
DATABASES WERE FILLED WITH
PATHOGENS.
SO WE HAD A TON OF SEQUENCES
FROM STAPH AUREUS THAT HAD
CAUSED AN INFECTION, BUT WE
STILL REALLY DIDN'T HAVE VERY
MANY SEQUENCES FROM THE
COMMENSAL MICROBES.
SO SARAH KASHA AL TOOK ON THIS
ISSUE.
THE ANALOGY YOU WANT YOU TO
ENVISION IS THAT YOU HAD THE
PUZZLE, RIGHT, AND YOU'VE THROWN
ALL THESE PUZZLE PIECES INTO A
BOX, AND WHAT WE SHOWED WITH THE
HUMAN GENOME IS THAT YOU CAN
TAKE THOSE PIECES, THOSE
SEQUENCES, AND YOU CAN
RECONSTRUCT THE HUMAN GENOME AS
A PUZZLE.
BUT FROM META GENOMICS, WHAT WE
HAVE IS THAT SOMEONE THREW 10
PUZZLES INTO THE SAME BOX AND
YOU ARE NOW TRYING TO
RECONSTRUCT THAT BUT YOU HAVE A
LOT OF LANDMARKS BECAUSE SOME
PUZZLES HAVE SMALLER PIECES AND
SOME HAVE BIGGER PIECES AND THEY
HAVE DIFFERENT SCENERIES ON
THEM.
SO SARA WAS TAKING THIS TO
SEQUENCING, TAKING THE SEQUENCE
READS AND ASSEMBLING THEM
BECAUSE THEY OVERLAPPED AND THEN
BINNING THEM BASED ON THE
QUALITIES OF TETRANUCLEOTIDE
FREQUENCY AND OTHER ASPECTS OF
THOSE AND BUILDING MAGS FROM
THIS.
FROM THIS, SARA WAS ABLE TO
IDENTIFY 213 NOVEL BACTERIAL
SPECIES LIVING ON THE SKIN,
WHICH INCLUDED 14 NOVEL
BACTERIAL GENERA, SOME OF WHICH
WERE ACTUALLY AS COMMON IN
RELATIVE ABUNDANCE AS MICROBES
THAT WE KNOW A LOT ABOUT LIKE
STAPHYLOCOCCUS.
TWO NOVEL SPECIES AND THOUSANDS
OF NOVEL VIRUSES INCLUDING JUMBO
PHAGE.
SO ENOUGH ABOUT OUR FRIENDS.
WHAT WILL ABOUT THESE FOES THAT
WE'RE SO CONCERNED ABOUT?
THIS IS WHERE BEING AT THE NIH
CLINICAL CENTER HAS REALLY BEEN
TRANSFORMATIVE.
I SHOW YOU A PICTURE HERE OF THE
FAMOUS OUTBREAK DETECTION BY
JOHN SNOW, WHERE HE'S TRYING TO
FIND AND THEY STILL HAVE
PRESERVED IN LONDON THE WATER
PUMP WHERE THEY'RE TRYING TO
FIND WHAT WAS THE SOURCE OF AN
OUTBREAK.
SO WITH THAT AS A MODEL, AND
THINKING NOW AGAIN ABOUT
SEQUENCING AS A NEW LENS,
TOGETHER WITH MY COLLEAGUE, TEAR
A POLMORE AND ANOTHER EXTREMELY
TALENTED POSTDOC EVAN SNICKEN IN
THE LAB, WE HAD BEEN SEQUENCING
HISTORIC SAMPLES THAT HAD COME
TO THE CLINICAL CENTER AND
CAUSED A CLUSTER OF INFECTIONS,
AND SITTING IN THE OFFICE WITH
THE THEN DIRECTOR OF THE
CLINICAL MICRO LAB, PATRICK
MURRAY, WE WERE AWARE THAT THE
FIRST PATIENT WITH CARBAPENEM
RESISTANT KLEBSIELLA PNEUMONIAE
WAS BEING ADMITTED TO THE
CLINICAL CENTER.
AND SHE WAS ADMITTED IN JUNE OF
2011, AND DISCHARGED FROM THE
CLINICAL CENTER, STILL DOING
WELL.
AND ABOUT TWO MONTHS LATER,
PATIENT -- THEY IDENTIFIED AS
SECOND PATIENT WITH A CLINICAL
CULTURE WHO HAD AN INFECTION
WITH KLEBSIELLA PNEUMONIA AND
THEN A PATIENT A WEEK AFTER THAT
ON EITHER SURVEILLANCE OR
CLINICAL CULTURES.
SO HERE'S THE QUESTION.
CARBAPENEM RESISTANT -- ARE ONE
OF THE MOST URGENT THREATS
BECAUSE WE HAVE SO FEW DRUGS
LEFT TO TREAT THEM.
THAT MAKES HOSPITAL INFECTION
CONTROL REALLY CRITICAL.
SO THE QUESTION WAS, DOES THE
ISOLATE FROM PATIENT 1 MATCH
PATIENTS 2, 3, 4 AND 5?
AND THE REASON THIS IS IMPORTANT
IS IF THERE IS MATCH, THEN WE
HAD POSSIBLE KNOW SEW COMB YAL
TRANSMISSIONS IN THE HOSPITAL
AND THAT WOULD MEAN THAT THE
CONTACT ISOLATION WAS
INSUFFICIENT AND THE SCREENING
OF PATIENTS WAS INSUFFICIENT,
AND WE SHOULD -- AND TEAR A
SHOULD CHANGE HOSPITAL PRACTICE.
IF THERE'S NO MATCH, AND THIS IS
A SEPARATE INTRODUCTION, THEN
THE CONTACT ISOLATION WAS
SUFFICIENT, THE SCREENING OF
PATIENTS WAS SUFFICIENT AND STAY
THE COURSE ALTHOUGH ADDRESS WHAT
HAPPENS BETWEEN PATIENTS 2, 3,
4, 5.
AT THAT POINT THE DATA WE HAD
WAS RUNNING SEQUENCE TYPE 258.
THAT DOESN'T GIVE YOU THE
RESOLUTION BECAUSE 70% OF
HEALTHCARE-ASSOCIATED ARE
SEQUENCE TYPE 258.
SO WE STARTED RAPIDLY SEQUENCING
THE ISOLETTES FROM THESE
PATIENTS.
WE HAD MULTIPLE ISOLATES FROM
PATIENT 1 WHO HAD BEEN ADMITTED
TO THE CLINICAL CENTER FOR
ACTUALLY A WHILE AND SHE CAME
ALREADY COLONIZED SO SHE HAD
BEEN COLONIZED ALREADY FOR, WE
SUSPECT, ABOUT SIX MONTHS.
WE HAD ISOLETTES FROM THE
URINARY TRACT THAT WE SEQUENCED,
THE THROAT, THE GROIN AND ACTUAL
BRONCHIAL ALVEOLAR LAVAGE.
AND WHEN WE SEQUENCED THESE
ISOLETTES FROM PATIENT 1, WE
COULD SEE THAT ACTUALLY THE
KLEBSIELLA PNEUMONIA HAD
DIVERSIFIED ALREADY ON THIS
PATIENT, SO THE URINARY TRACT IS
THE ANCESTRAL STRAIN THAT
MATCHES OTHER THINGS IN THE
DATABASE, BUT THERE WERE THREE
SNPs THAT WE FOUND IN THE
THROAT THAT HAD DIVERGED FROM
THE URINARY TRACT, SUGGESTING
THAT THOSE DIVERGED ON THE
PATIENT AND THEN ACTUALLY WERE,
YOU KNOW, DIVERSIFIED ON THE
BODY SITES.
WE FOUND THREE DIFFERENT SNPs
WHEN WE LOOKED AT THE GROIN
ISOLETTES.
SO WE WOULD SAY THAT THESE
SNPs EVOLVED IN THAT PATIENT
ON OUR SIGNATURE OF HER GENETIC
STATE.
THEN WE ISOLATED PATIENTS THAT
WE DID THE SEQUENCING ANALYSES
FOR PATIENTS 3 AND PATIENTS 2, U
3 AND 2.
AND WHAT WE SAW WAS THAT PATIENT
3'S THROAT ISOLATE WAS EXACTLY
IDENTICAL TO PATIENT 1 AND
CARRIED THOSE THREE SNPs THAT
WE BELIEVE EVOLVED ON PATIENT
1 AND WERE SIGNATURE FOR HER
ISOLATES.
PATIENT 2 HAD ONE ADDITIONAL SNP
SO WITH THE GENETIC MAPPING, WE
WOULD SAY THAT THE MOST
PARSIMONIOUS EXPLANATION IS THAT
PATIENT 1 TRANSMITTED TO PATIENT
3, WHO THEN TRANSMITTED TO
PATIENT 2.
AND IN THE CONVERSATION WE HAD
THE NEXT MORNING WITH
DR. PALMORE, SHE SAID, YES,
THAT'S EXACTLY WHAT OUR
EPIDEMIOLOGIC DATA WOULD
SUGGEST.
PATIENT 1 AND 3 OVERLAPPED IN
THE ICU AND THEN PATIENT 2 AND
PATIENT 3 OVERLAPPED IN THE ICU
AFTER PATIENT 1 WAS ALREADY
DISCHARGED.
SO FOR THE FIRST TIME WHAT WE
HAD WAS GENETIC AND
EPIDEMIOLOGIC DATA THAT WERE
BOTH CONSISTENT WITH A
TRANSMISSION AND A REALTIME
ASSESSMENT OF HOW WE NEEDED TO
CONSIDER HOSPITAL PRACTICE IN
THAT THIS WOULD SUGGEST THAT THE
TRANSMISSIONS -- THAT THE
SCREENING WAS INSUFFICIENT AND
THAT PROBABLY SUBJECT 3 WAS
COLONIZED FOR A LONGER PERIOD OF
TIME THAN WAS DETECTED.
OVER THE NEXT SIX MONTHS,
SCREENING CONTINUED AND
COLONIZATION WAS DETECTED IN AN
ADDITIONAL TOTAL OF 18 PATIENTS,
AND AS DR. PALMORE SORT OF
RUSHED THROUGH TRYING TO WORK TO
UNDERSTAND WHAT WERE THE
TRANSMISSIONS THAT WERE
OCCURRING, WE CONTINUED TO BUILD
THIS GENETIC MAP BECAUSE IF YOU
LOOK AT IT JUST WITH
EPIDEMIOLOGIC DATA, WHICH IS
WHAT YOU'D HAVE ON THE LEFT, YOU
SEE THE SORT OF PLATE OF
SPAGHETTI, AND WE KEPT HAVING
THESE QUESTIONS OF, YOU KNOW,
HOW DID PATIENT 15 BECOME -- HOW
DID PATIENT 15 BECOME INFECTED
AND WAS IT FROM THIS PERSON OR
THAT PERSON, AND THERE WERE A
LOT OF FALSE LEADS THAT WE WERE
ABLE TO -- THAT WAS ACTUALLY
ABLE TO DISCOUNT LIKE THERE
WOULD BE SOMETHING WHERE THERE
WOULD BE THE SAME BURN CART
BEING USED ON DIFFERENT SUBJECTS
AND WE COULD SAY NO, IT WASN'T
THAT PATIENT 17 TRANSMITTED TO
PATIENT 18.
WE SEE THAT THEY ARE GENETICALLY
DISTINCT, YOU KNOW, PUT YOUR
RESOURCES TO LOOK SOMEWHERE
ELSE.
SO THAT'S THE BEGINNING OF HOW
WE STARTED USING GENOMIC
INFORMATION TO TRACK
TRANSMISSION.
AND NOW I JUST WANT TO TALK
ABOUT SOME OF THE WORK WE'RE
DOING NOW, LOOKING AT CANDIDA
AURUS.
IT WAS FIRST DETECTED IN 2008,
AND EMERGED SIMULTANEOUSLY ON
DIFFERENT CONTINENTS, BUT BY
NOW, THERE ARE OUTBREAKS OF
CANDYCANDIDA AURIS, IT IS THE FT
FUNGUS TO BE RATED AS AN URGENT
THREAT.
BY THE CDC AND THE WORLD HEALTH
ORGANIZATION, BECAUSE OF ITS
EXTREMELY HIGH LEVEL OF
ANTIMICROBIAL RESISTANCE, WHICH
CAUSES DIFFICULT TO TREAT
BLOODSTREAM INFECTIONS AND THE
ISSUE IS THAT PATIENTS ARE
COLONIZED ON THEIR SKIN SO
THEY'RE INFECTED IN THE
BLOODSTREAM BUT THEY REMAIN
COLONIZED ON THE SKIN AND FROM
THE SKIN, YOU SHED INTO THE
ENVIRONMENT ABOUT A MILLION
MICROBES AN HOUR, SO YOU'RE
SHEDDING INTO THE ENVIRONMENT,
AND THAT'S REALLY DIFFICULT IF
YOU'RE IN THESE NURSING HOMES
WHERE PEOPLE LIVE FOR PROLONGED
PERIODS.
SO WORKING WITH DR. MARY HAYDEN
IN THE CHICAGO DEPARTMENT OF
HEALTH, WE ASKED WHY ARE THESE
SO INTRACTABLE.
AT THIS .1 OF THE ISSUES IS
AGAIN COMING BACK TO WHAT SITE
DO YOU DO SURVEILLANCE ON.
THE TRADITIONAL SURVEILLANCE IS
AXILLA GROIN.
WHAT WE FOUND IN THIS DOING
SURVEILLANCE OF MULTIPLE BODY
SITES OF THE 57 SUBJECTS LIVING
IN THIS NURSING HOME IS THAT
ACTUALLY THE SITE OF HIGHEST
COLONIZATION IS THE NARES, BUT
UNFORTUNATELY WHAT WE FOUND WAS
THAT WE WOULD HAVE TO DO
SURVEILLANCE ON SIX BODY SITES
IN ORDER TO IDENTIFY EVERY
PATIENT WHO WAS COLONIZED ON
THEIR SKIN.
SO THAT MAKES IT REALLY
DIFFICULT TO FIND EVERY PATIENT
AND THEN PUT THEM INTO CONTACT
ISOLATION.
AND TO DO THAT FOR EVERY PATIENT
WHO'S BEING ADMITTED INTO THE
NURSING HOME.
AND SO NOW WE'RE FACED WITH THIS
DIFFICULT SITUATION WHERE THE
OCCULT COLONIZATION MAY UNDERLIE
THIS ENDEMIC, INTRACTABLE
OUTBREAK.
WE'RE USING THIS DATA TO TRY TO
THINK ABOUT WHY -- WHAT IS THE
PREDISPOSITION TO BECOMING
COLONIZED WITH CANDIDA AURIS IN
TERMS OF IS THERE SOMETHING
PROTECTIVE IN THE SKIN
MICROBIOME THAT WE COULD
LEVERAGE.
SO THE DOMINANT FUNGI IS
MALESSEZIA FOR THE SKIN
COMMUNITIES BUT WHAT WE OBSERVED
IN THIS NURSING HOME IS THAT
THERE ARE THE BLUE DOTS, WHICH
ARE THE MALASSEZIA DOMINATED
POPULATIONS BUT EACH DOT
REPRESENTS THE BODY SITE OF A
SUBJECT.
THERE ALSO IS A CANDIDA DIVERSE
COMMUNITY ON THESE INDIVIDUALS.
AND WHEN WE LOOKED AT THE
MONTHLY SURVEYS, ON THE
RIGHT-HAND SIDE, WHAT WE COULD
SEE, THERE IS AN 80% CHANCE.
IF YOU'RE MALASSEZIA DIVERSE, A
MONTH LATER YOU WILL STILL BE AT
THAT BODY SITE.
BUT THERE IS A 9% CHANCE YOU
WOULD GO TO BEING CANDIDA
DIVERSE.
ONCE YOU'RE CANDIDA DIVERSE,
THEN THERE'S AN EQUAL CLANS THAE
THAT YOU WOULD STAY CANDIDA
DIVERSE AS THAT YOU WOULD GULF
COAST COLONIZED WITH CANDIDA
AURIS.
AND IF YOU ARE, THERE'S A
GREATER THAN 50% CHANCE THAT YOU
WILL REMAIN COLONIZED WITH
CANDIDA AURIS.
SO THIS TAKES US BACK AT LEAST
ONE STEP WHERE WE CAN THINK
ABOUT TRYING TO INTERVENE AT THE
POINT WHERE THERE IS A CANDIDA
DIVERSE COMMUNITY.
IN CONCLUSION, UNDERSTANDING THE
MICROBIOME WILL REVOLUTIONIZE
WHAT IT MEANS TO BE HUMAN, WHAT
IT MEANS TO BE HEALTHY, AND
PROVIDE NEW INSIGHTS TO FIGHT
FOR MICROBIAL FOES AND CULTIVATE
OUR MICROBIAL FRIENDS.
AND I'LL JUST SAY THAT THE
RESEARCH WORK HAS BEEN PART OF
THE U.S. GOVERNMENT AND BEING AT
NIH HAS ENABLED ME THESE GREAT
OPPORTUNITIES TO WORK ACROSS THE
U.S. GOVERNMENT INCLUDING
WORKING ON PCAST, NATIONAL
ACADEMIES REPORTS AND WORKING ON
THE NCAA DEFENSE STRATEGY.
I'LL CLOSE QUICKLY BY
ACKNOWLEDGING THE AMAZING PEOPLE
THAT I'VE HAD THE CHANCE TO WORK
WITH.
IN PARTICULAR, TEAM SCIENCE HAS
REALLY BEEN AT THE FOREFRONT OF
ALL OF THIS WORK, WORKING WITH
DR. CONGRESS, DR. PALMORE,
DR. BELKAID AND MY FABULOUS LAB,
THE 2011 GROUP WHO STARTED ALL
OF THIS WORK AND THE CHERRY
BLOSSOMS IN 2023, AND MY
ADVISORS AND FAMILY.
THANK YOU.
[APPLAUSE]
>>IF WE VL ANY QUESTIONS FROM
OUR AUDIENCE HERE IN LIPSETT,
WE'LL START THERE.
>>BEAUTIFUL TALK.
IS THIS ON?
OKAY.
CAN YOU COMMENT ON SOME OF THE
THINGS THAT YOU THINK HELPED TO
MAINTAIN THE STABILITY OF THE
MICROBIOME, LIKE LOCAL RESIDENT
IMMUNE CELLS AND HOW THAT MIGHT
CHANGE IN CONDITIONS OF
AUTOIMMUNITY AND THE FEEDBACK
BETWEEN THOSE TWO THINGS?
>>YEAH.
THANKS, KELLY.
SO THE STABILITY OF THE SKIN
MICROBIOME IS SOMETHING WE
LOOKED AT A LOT IN COMMENSALS,
BECAUSE THAT HELPS US POWER OUR
CLINICAL STUDIES WHERE WE LOOK
AT -- THERE'S A FAIR AMOUNT OF
VARIATION BETWEEN INDIVIDUALS,
BUT WE NOW POWER OUR CLINICAL
STUDIES BY USING SOMEONE AS
THEIR OWN CONTROL.
SO IT'S IMPORTANT FOR US TO
UNDERSTAND ON A WEEKLY, MONTHLY
BASIS, WHAT KIND OF STABILITY
THERE IS.
AND WE SEE THE STABILITY AT THE
MICROBIAL COMMUNITY LEVEL AND AT
THE STRAIN LEVEL.
AND WE ATTRIBUTE THAT TO THE
FACT THAT THE MICROBES AREN'T
JUST LIVING ON THE SURFACE OF
YOUR SKIN.
THEY'RE ACTUALLY LIVING MUCH
DEEPER IN YOUR SKIN, SO THEY'RE
LIVING INSIDE THE HAIR FOLLICLES
AND THE SEBACEOUS GLANDS, AND
THAT MEANS THAT WHEN YOU WASH
YOUR SKIN, YOU'RE NOT ACTUAL
ACTUALLY -- YOU'RE REMOVING THE
RESIDENT MICROBES BUT YOU
ACTUALLY HAVE AN UNDERLYING
POPULATION THAT CAN MAINTAIN
THAT COMMUNITY AT THE STRAIN
LEVEL.
AND I'M SURE THERE ARE ALSO
THINGS, WE'RE LOOKING AT
TRANSMISSIONS WITHIN FAMILIES
AND THINKING ABOUT THE
INHERITANCE OF THE MICROBIAL
COMMUNITY.
YEAH.
>>JULIE, THANK YOU.
THAT WAS GREAT.
I HAVE A QUESTION ABOUT THE
CANDIDA EXPERIMENTS.
SO YOU SAID THAT SOME PEOPLE ARE
COLONIZED WITH MALASSEZIA, AND
THEN THERE'S A CONVERSION RATE
TO CANDIDA, DIVERSE CANDIDA
SPECIES.
DOES ONE PRECLUDE THE OTHER?
IN OTHIN OTHER WORDS, COULD YOU
COLONIZE PEOPLE WITH MALASSEZIA
TO PREVENT THEM FROM BEING
COLONIZED WITH CANDIDA?
YEAH, UM, SO WITH A LOT OF THESE
EXPERIMENTS AND THE SORT OF
CONCEPT OF MICROBIAL THERAPIES,
YOU COULD IMAGINE USING
BENEFICIAL MICROBES.
AND BUT I WOULD SAY THAT I HAVE
THOUGHT MORE ABOUT IT IN THE
CONCEPT OF THE PREBIOTIC,
PROBIOTIC, SYMBIOTIC, THAT
PERHAPS WHAT WE WANT TO DO IS TO
CULTIVATE THE HEALTHY MICROBES
AND USE SKINCARE PRODUCTS THAT
WILL HELP PROMOTE THE GROWTH OF
THE BENEFICIAL MICROBES, THE
MALASSEZIA, BECAUSE ADDING AN
EXOGENOUS MICROBE HAS OTHER
ISSUES.
SO, YES, WE PROBABLY DO WANT TO
USE OUR BENEFICIAL MICROBES
TO -- YOU KNOW, TO -- AND IT
COULD BE ACTUALLY BACTERIA.
THERE'S A LOT OF BACTERIAL
FUNGAL INTERACTION, SO WE COULD
ALSO FIND BACTERIA THAT HELP TO
PREVENT THE COLONIZATION WITH
CANDIDA AURIS.
I KNOW OF STUDIES LIKE THAT.
BUT SOMETIMES YOU ALSO HAVE THIS
CONCEPT WHICH IS TRUE DURING
TRANSPLANT, IS TRUE FOR NURSING
HOME PATIENTS, YOU'RE TRYING TO
ALSO REDUCE THE MICROBIAL
BURDEN.
SO I THINK THAT MIGHT BE ANOTHER
CASE WHERE YOU DON'T WANT TO
JUST ADD ON LOTS OF MICROBES
BECAUSE WE HAVE THIS CONCEPT OF
SORT OF, YOU KNOW, COMMENSALS
CAN BECOME PATHOGENS.
>>OKAY, THANKS.
[APPLAUSE]
>>WONDERFUL.
>>THANKS AGAIN, DR. SEGRE, FOR
YOUR TALK.
AND LOOKING AROUND, THERE ARE
SOME AMAZING WOMEN HERE AT THE
NIH THAT HAVE NOT ONLY DONE
AMAZING RESEARCH, BUT HAVE ALSO
DONE AMAZING WORK FOR EQUITY,
BOTH FOR THEMSELVES AND THE
WOMEN THAT COME AFTER THEM.
AS MENTIONED, I AM A TENURE
TRACK INVESTIGATOR AND ALONG
WITH DR. PAULIE JOSEPH WHO WILL
BE PRESENTING AT THE NEXT
SESSION, THE JUNIOR
REPRESENTATIVES FOR THE
ORGANIZING COMMITTEE.
AS MENTIONED AT THE BEGINNING OF
THIS SESSION, WSA WAS
ESTABLISHED IN 1993, ABOUT 30
YEARS AGO.
AND FROM THE JUNIOR WOMEN OF
NIH, THANK YOU TO THOSE THAT
CAME BEFORE US TO START THIS
LONG JOURNEY.
IT IS REALLY, REALLY
APPRECIATED.
IT MIGHT NOT SEEM TOO LONG AGO
FOR THOSE WHO HAVE BEEN AT THE
NIH FOR A WHILE, BUT FOR JUST A
BIT OF CONTEXT FOR HOW LONG AND
HARD THESE WOMEN HAVE BEEN
WORKING FOR EQUITY, IN 1993,
THIS IS WHAT I LOOKED LIKE.
[LAUGHTER]
I WAS 3 YEARS OLD.
I AM THE VISIBLE REPRESENTATION
OF THE TIME THAT THESE WOMEN
HAVE TAKEN NOT ONLY TO DO
AMAZING RESEARCH, BUT ALSO BRING
WOMEN CLOSER TO EQUITY.
NOW THAT LITTLE GIRL IS STARTING
TO GET SOME GREY HAIRS, AND IN
2019, I BECAME THE FIRST FEMALE
P.I. AT NIBIB AND IN 2021, I
BECAME THE FIRST WSA
REPRESENTATIVE FOR OUR
INSTITUTE.
SO WE'VE COME VERY FAR SINCE
1993, BUT THERE ARE STILL
BARRIERS THAT WOMEN FACE.
SO JUNIOR WOMEN AS WE COME IN TO
DIFFERENT ENVIRONMENTS, THIS IS
TRUE FOR A NUMBER OF
INSTITUTIONS, WE DO LOOK TO
LEADERSHIP AND WE DO NOTICE WHEN
WOMEN ARE ABSENT.
WOMEN -- WE CAN SEE WHEN WOMEN
ARE IN LEADERSHIP ROLES THAT
INVOLVE A LOT OF RESPONSIBILITY,
BUT NOT NECESSARILY A LOT OF
AUTHORITY.
AND OF COURSE THERE ARE INFORMAL
GROUPS -- STILL PRESENT ACROSS
MANY INSTITUTES.
WOMEN IN GENERAL CAN RECEIVE
LESS CREDIT IN SCIENCE AND
THEY'RE A LARGER BURDEN OF
NON-PROMOTABLE TASK.
THIS IS A NON-PROMOTABLE TASK.
[LAUGHTER]
AND WHEN WOMEN DO RECEIVE
CREDIT, IT'S SEEN BY SOME AS NOT
RIGHTFULLY EARNED.
SO RECENTLY THERE WAS AN
INTERVIEW BY THE OUTGOING PRIME
MINISTER OF NEW ZEALAND AND SHE
MENTIONED THAT ONE DAY ALL THAT
WILL BE LEFT OF HER IS A PHOTO
IN PARLIAMENT, AND HOW SHE MADE
PEOPLE FEEL.
THE REPORTER THEN ASKED HER, HOW
DID YOU MAKE YOURSELF FEEL?
AND SHE SAID, TIRED.
SO IT'S NOT JUST THE WSA AND
THESE SENIOR WOMEN THAT HAVE
BEEN PUSHING FOR YEARS THAT CAN
SUPPORT NEW WOMEN AT THE NIH.
OF COURSE WE HAVE WSA BUT ALSO
SUPERVISORS OF WOMEN SCIENTISTS,
I'M VERY THANKFUL TO HAVE A
SUPPORTIVE MENTOR HERE AT THE
NIH, OUR SCIENTIFIC DIRECTOR,
DR. RICHARD LEETMAN, VERY
THANKFUL FOR HIM.
OUR MALE COLLEAGUES, IF YOU SEE
SOMETHING, SAY SOMETHING, SPEAK
OUT AGAINST SOMETHING IF IT
LOOKS LIKE IT'S WRONG, STAND UP
FOR PEOPLE WHO MIGHT NOT BE ABLE
TO STAND UP FOR THEMSELVES.
AND OF COURSE OTHER WOMEN
SUPPORTING OUR INTERSECTIONAL
COLLEAGUES.
WOMEN OF COLOR, DISABLED WOMEN
IN SCIENCE, AND THE LGBTQ
COMMUNITY.
WE HAVE TO MAKE SURE THAT WE'RE
THERE FOR EACH OTHER.
AND OF COURSE, WE KNOW THAT
DIVERSE LABS COME WITH DIFFERENT
IDEAS AND ARE MORE INNOVATIVE.
THEY HELP AVOID GROUP THINK AND
THAT IS SOMETHING THAT CAN HAVE
SEVERE CONSEQUENCES.
AND HOW SEVERE?
THE NIGHT BEFORE LAUNCH, A GROUP
OF INDIVIDUALS FLAGGED A PROBLEM
WITH O-RINGS IN THE SPACE
SHUTTLE CHAL ENJER.
THEY DECIDED IT WAS OKAY.
THE FOLLOWING DAY, 74 SECONDS
AFTER LIFTOFF, SEVEN LIVES WERE
LOST.
AND NOW OUR DAY TO DAY MIGHT NOT
INVOLVE LAUNCHING PEOPLE ON
ROCKETS INTO SPACE, BUT THINK OF
THE DISCOVERIES OR THE DIFFERENT
IDEAS THAT MAY BE QUASHED
BECAUSE A ROOM DOES NOT INCLUDE
A DIVERSE SET OF MINDS.
GOOD WITH DISAGREEING WITH EACH
OTHER, FINDING HOLES IN OUR
ASSUMPTIONS, AND TO REALLY PUSH
FORWARD AND BREAK SCIENTIFIC
PARADIGMS.
AND SO HOW DO WE DO THAT?
HOW DO WE AVOID THIS GROUP
THINK?
WE LISTEN TO PEOPLE THAT ARE
UNDERREPRESENTED AND WE LISTEN
TO NEW EMERGING LEADERS W THAT
THOUGHT, I'M VERY HAPPY TO
INTRODUCE OUR NEXT SPEAKER
TODAY, DR. EMILY RICOTTA.
DR. RICOTTA IS AN INDEPENDENT
RESEARCH SCHOLAR AND CHIEF OF
THE EPIDEMIOLOGY AND DATA
MANAGEMENT UNIT IN NIAID.
IN 2019, SHE WAS ELECTED AS AN
EMERGING LEADER IN BIOSECURITY
INITIATIVE FELLOWSHIP PROGRAM.
AND WAS RECENTLY AWARDED A GRANT
TO ANALYZE DATA MANAGEMENT IN
REGIONS AT HIGH RISK FOR
INFECTIOUS DISEASE SPILLOVER.
WITH THAT, EMILY, PODIUM IS
YOURS.
[APPLAUSE]
>>THANK YOU SO MUCH TO THE
ORGANIZING COMMITTEE FOR
INVITING ME TO SPEAK TODAY, TO
DR. SAIDLER FOR THAT
INTRODUCTION, AND THANKS TO
DR. SEGRE FORGIVE AGO WONDERFUL
TALK BEFORE ME.
ONE OF THE THINGS I LOVE MOST
ABOUT WORKING AT NIH IS THE
COMMUNITY WE HAVE AND WE GET TO
WORK WITH AND FIGURING OUT HOW
WE GET TO COME TOGETHER AND WORK
ACROSS DIFFERENT DOMAINS AND
DIFFERENT FIELDS, FOR EXAMPLE,
DR. SEGRE STUDIES THE MICROBIOME
AND ALL THE DIFFERENT ORGANISMS
THAT ARE FOUND ALL OVER PEOPLE'S
BODIES AND CAROL IS SITTING HERE
BEING A LITTLE GROSSED OUT AND
IT'S MY JOB AS AN EPIDEMIOLOGIST
TO STUDY THE GROUPS OF PEOPLE
THAT ARE COVERED IN THOSE
MICROBES THAT RIN FECTED WITH
THEM OR HAVE THEM STUFFED ALL
OVER THEIR BODIES.
AND SO THERE'S ALWAYS A WAY TO
FIND THAT CROSS COMMUNICATION
AND IT'S A REALLY EXCELLENT
OPPORTUNITY TO GET TO DO THAT.
SO TODAY I'M GOING TO TALK TO
YOU ABOUT HOW WE TURN DATA INTO
SCIENCE.
I WANT TO START WITH POINTING
OUT SO I AM AN INDEPENDENT
RESEARCH SCHOLAR.
THIS IS A PROGRAM THAT HAS
CROSSED NIH AND IT IS WITH THE
GOAL OF IMPROVING WORKFORCE
DIVERSITY, TO BUILD A DIVERSE
INTRAMURAL RESEARCH PROGRAM.
SO INDIVIDUALS WHO ARE REALLY
DEDICATED TO HIRING A DIVERSE
WORKFORCE, TRAINING A DIVERSE
WORKFORCE SCHOLARS ARE
INDEPENDENT, WE ARE PRETENURE
TRACK, HOPEFULLY WE'LL BECOME
TENURE TRACK WHEN WE'RE DONE
WITH THE PROGRAM AND WE ARE
SCIENTIFICALLY INDEPENDENT OF
OUR PREVIOUS MENTORS.
IT'S A THREE-YEAR PERIOD, AND SO
IT GIVES US THE OPPORTUNITY TO
REALLY TRANSITION FROM THAT
POSTDOCTORAL WORK THROUGH TO
BEING AN INDEPENDENT
INVESTIGATOR, WHILE STILL
MAINTAINING THE MENTORSHIP OF
ALL THE WONDERFUL INVESTIGATORS
WE HAVE AT NIH.
SO BECAUSE OF THAT, MY LAB IS
VERY NEW.
WE ARE IN NIAID'S DIVISION OF
INTRAMURAL RESEARCH IN THE
LABORATORY OF CLINICAL
IMMUNOLOGY AND MICROBIOLOGY.
PHYSICALLY, WE ARE LOCATED IN
29B, WHICH MOST PEOPLE DON'T
KNOW WHERE IT IS, BUT FUN FACT,
IT FORMERLY HAS THE FDA CENTER
FOR BIOLOGICS AND RESEARCH AND
WE ARE STILL THERE.
I'M VERY PROUD OF OUR NEW OFFICE
AS WE JUST GOT IT A MONTH AGO,
SO STOP BY!
AND I JUST WANT TO GIVE A QUICK
SHOUT OUT TO MY WONDERFUL,
WONDERFUL UNIT.
WE HAVE EPIDEMIOLOGISTS, NURSE
PRACTITIONERS, CLINICAL STUDY
COORDINATORS AND WE ALSO LOVE
HAVING TRAINEES.
WE CURRENTLY HAVE A POSTBAC
TRAINEE IN THE UNIT, AND WE ALSO
WORK WITH DATA SCIENCE FELLOWS,
PRESIDENTIAL MANAGEMENT FELLOWS,
ALL VARIETIES.
SO WE'RE REALLY BIG ON TRAINING
IN THE UNIT IN THAT GROUP.
SO WHAT EXACTLY IS EPIDEMIOLOGY?
DR. SEGRE GAVE A BIT OF AN
INTRODUCTION TO THAT, BUT IT IS
THE STUDY OF THE DISTRIBUTION
AND DETERMINANTS OF DISEASE, AND
HEALTH-RELATED STATES IN
SPECIFIC POPULATIONS.
IT ALSO IS THE APPLICATION OF
THIS STUDY TO THE CONTROL OF
HEALTH PROBLEMS.
WHAT IS EPIDEMIOLOGY NOT?
REAL FAST, WE'RE NOT
BIOSTATISTICIANS.
THERE'S A DIFFERENCE.
SO IF YOU HAVE QUESTIONS, I'LL
TAKE THEM LATER.
[LAUGHTER]
YOU KNOW, EPIDEMIOLOGIST, WE DO
OUR OWN RESEARCH STUDIES, WE
DESIGN POPULATION LEVEL STUDIES
THAT ARE MEANT TO UNDERSTAND
DISEASE I PHENOMENON.
THESE INCLUDE NON-EXPERIMENTAL
STUDIES, THINGS THAT ARE JUST
DESCRIPTIVE, WE'RE JUST TRYING
TO UNDERSTAND THE OCCURRENCE OF
A DISEASE OR WHAT A POPULATION
WITH A CERTAIN ILLNESS MIGHT
LOOK LIKE.
WE DO ANALYTIC STUDIES,
OBSERVATIONAL STUDIES WHERE THE
INVESTIGATORS ARE NOT IN CONTROL
OF THE INTERVENTION OR THE
TREATMENT OR THINGS THAT ARE
IMPACTING THE OUTCOME.
AND WE ALSO DO EXPERIMENTAL
STUDIES.
WE CAN RUN OUR CTs IN CLINICAL
TRIALS, WE CAN GIVE A GROUP OF
PEOPLE A TREATMENT,
EPIDEMIOLOGISTS WILL STUDY WHAT
HAPPENS IF WE GIVE A GROUP OF
PEOPLE AN INTERVENTION.
SO THERE'S A LOT THAT WE DO AS
EEPIDEMIOLOGISTS TO REALLY DO OR
OWN RESEARCH AND CONDUCT
RESEARCH, AS WELL AS
COLLABORATING WITH OTHER PEOPLE.
WE ALSO GET DATA FROM A LOT OF
DIFFERENT PLACES.
SO LIKE I SAID, WE'VE GOTTEN ON
RANDOMIZED STUDIES, WE'LL DO
SURVEYS AND GET OPINIONS FROM
PEOPLE THAT WAY.
WE USE GEOGRAPHIC INFORMATION
SERVICES, SATELLITE DATA, TO
STUDY HOW DISEASE AND THE
ENVIRONMENTS ARE ASSOCIATED.
WE USE OMICS DATA OF ALL
DIFFERENT VARIETIES TO STUDY
LIKE DR. SEGRE GAVE THAT GREAT
EXAMPLE, YOU KNOW, TO STUDY HOW
THE GENOMICS MIGHT BE HELPFUL IN
UNDERSTANDING DISEASE IN A
POPULATION.
RECENTLY WE'VE BEEN USING A LOT
OF SOCIAL MEDIA TO UNDERSTAND
WHO HAS DISEASE TO SEE WHAT
PEOPLE ARE INTERESTED IN, HOW
THEY RESPOND TO DIFFERENT PUBLIC
HEALTH MEASURES, THINGS LIKE
THAT.
WE USE GOOGLE SEARCH TRENDS.
WHO IS INTERESTED IN THESE
DIFFERENT OUTCOMES?
WHO'S INTERESTED IN DIFFERENT
HEALTH PROBLEMS?
AND WE USE ELECTRONIC HEALTH
RECORDS A LOT TO REALLY GET AT
THESE LARGE POPULATIONS OF
PEOPLE ACROSS THE UNITED STATES
WHO HAVE ILLNESSES THAT WE MAY
NOT BE ABLE TO OBSERVE IN
REALTIME.
AND THE GREAT THING IS THAT WE
CAN ACTUALLY LINK THIS DATA
TOGETHER IN CERTAIN INSTANCES TO
BUILD UNIQUE DATASETS TO ANSWER
QUESTIONS WE MAY NOT BE ABLE TO
GET AT, USING JUST ONE DATASET
OR JUST ONE STUDY ALONE.
BUT ALL OF THIS CREATES A LOT OF
DATA.
WE HAVE A LOT OF DATA.
AND IT NEEDS TO BE MANAGED.
AND WHAT DOES THAT ACTUALLY
MEAN?
EVERYONE HEARS DATA MANAGEMENT,
ESPECIALLY NOW WITH THE DATA
MANAGEMENT AND SHARING PLANS AND
GOES -- I KNOW.
IT'S NOT THE MOST FLASHY OF
TOPICS.
BUT IT'S REALLY IMPORTANT.
SO DATA MANAGEMENT IS ACTUALLY
THE PROCESS OF MOVING DATA FROM
COLLECTION ALL THE WAY THROUGH
TO PUBLICATION AND SHARING.
IT IS THE ENTIRE PROCESS OF DATA
ACQUISITION, CLEANING, QUALITY
ASSURANCE, STORAGE, AND DATA
SHARING, AND ITS MAINTENANCE
OVER TIME.
NOTICE I DID NOT SAY THAT DATA
ANALYSIS WAS PART OF THE DATA
MANAGEMENT PATHWAY.
DATA ANALYSIS REALLY REQUIRES
ITS OWN TOOLS AND SKILLS AND
IT'S MORE BEFORE ANSWERING THE
SCIENTIFIC QUESTIONS WHEREAS
DATA MANAGEMENT IS ABOUT THE
DATA ITSELF.
THIS FIGURE HERE REALLY
REPRESENTS THE FACT THAT DATA
MANAGEMENT OCCURS THROUGHOUT THE
ENTIRE LIFETIME OF A STUDY.
FROM STUDY DESIGN ALL THE WAY
THROUGH UNTIL THE END OF STUDY
COLLECTION, DATA COLLECTION AND
PUBLICATION.
SO WHY DID I TALK ABOUT ALL THIS
IF I'M A RESEARCH UNIT, RIGHT?
WE'RE INTERESTED IN THE RESEARCH
THAT GOES ON.
SO NOW I'M GOING TO TALK A BUILT
ABOUT MY UNIT'S MISSIONS AND
GOALS.
THE FIRST IS TO IDENTIFY AREAS
FOR IMPROVEMENT FOR INFECTIOUS
DISEASE STUDY DESIGN AND DATA
MANAGEMENT.
WE'RE SPECIFICALLY INTERESTED IN
NON-RANDOMIZED STUDIES.
WE'RE ALSO INTERESTED IN
DEVELOPING STANDARDIZED TOOLS
THAT ENHANCE EFFICIENCY AND
REPRODUCIBILITY OF INFECTIOUS
DISEASE RESEARCH.
AND YOU MAY ASK WHY.
WHY ARE WE INTERESTED IN LOOKING
AT NON-RANDOMIZED STUDIES.
AREN'T RANDOMIZED STUDIES THE
GOLD STANDARD?
THEY HAVE THEIR PLACE BUT
NON-RANDOMIZED STUDIES ARE ALSO
REALLY IMPORTANT.
THEY'RE GREAT FOR QUI QUICKLY
EVALUATING HEALTH OUTCOMES AFTER
EXPOSURES OF INTEREST.
WE'RE IN AN EPIDEMIC SETTING.
WE DON'T NECESSARILY HAVE THE
TIME TO SET UP A RANDOMIZED
CONTROL TRIAL, YET WE NEED TO
FIND OUT INFORMATION ABOUT HOW A
DISEASE GETS TRANSMITTED, WHAT
IS THE DISEASE, WHAT'S CAUSING
IT, WHAT DO THE SYMPTOMS LOOK
LIKE, WHO'S GOING TO GET THIS
DISEASE?
AND YOU CAN'T ALWAYS DO THAT
THROUGH A RANDOMIZED CONTROL
TRIAL.
YOU NEED OBSERVATIONAL STUDIES,
AND YOU NEED TO BE ABLE TO DO
THEM WELL.
WHY ELSE?
WELL, WELL DESIGNED AND WELL
EXECUTED, NON-RANDOMIZED STUDIES
CAN ACTUALLY BE MORE
REPRESENTATIVE OF THE POPULATION
THAN POPULATION INVOLVED IN AN
RCT.
WE HAVE VERY STRINGENT INCLUSION
AND EXCLUSION CRITERIA FOR
CLINICAL TRIALS, WITH GOOD
REASON.
WE WANT TO BE ABLE TO MAKE SURE
THAT THE CONCLUSIONS WE'RE
DRAWING ARE ACCURATE, BUT THAT
CAN EXCLUDE A WHOLE LOT OF THE
POPULATION.
AS WAS SAID EARLIER, WOMEN WERE
NOT INCLUDED IN CLINICAL STUDIES
FOR A LONG TIME.
WE'RE STILL FIGHTING TO GET
PREGNANT WOMEN INCLUDED IN MANY
STUDIES.
SO BY DOING OBSERVATIONAL
STUDIES OUT IN THE COMMUNITY, WE
CAN TEND TO GET A MORE
REPRESENTATIVE IDEA OF WHAT'S
HAPPENING IN TERMS OF A DISEASE
PROCESS OR AN INTERVENTION.
NON-RANDOMIZED STUDIES ARE ALSO
GREAT FOR MULTISITE DATA
COLLECTION AND DATA POOLING.
SO IF YOU HAVE SOMETHING, SAY, A
PANDEMIC THAT'S HAPPENING ACROSS
MULTIPLE GEOGRAPHIC REGIONS OR A
DIFFERENT TIME POINTS OR
COMMUNITIES, HAVE A WELL
STANDARDIZED AND WELL RUN
NON-RANDOMIZED STUDY CAN
ACTUALLY HELP YOU GET A LOT OF
INFORMATION FROM A LOT OF
DIFFERENT PLACES VERY QUICKLY.
AND FINALLY, HAVING BAD DATA
MANAGEMENT AND POORLY RUN
STUDIES CAN ACTUALLY CONTRIBUTE
TO INCREASED DISEASE
TRANSMISSION OR WORSE DISEASE
OUTCOMES.
IF YOU DON'T KNOW WHERE A
DISEASE MAY BE EMERGING, HOW ARE
YOU GOING TO RESPOND TO IT?
IF YOU DON'T HAVE GOOD DATA AND
YOU CAN'T UNDERSTAND WHERE
DISEASES MIGHT ARISE, HOW DO YOU
PREPARE FOR IT?
AND IF YOU HAVE BAD DATA THAT
COMES FROM POORLY DONE CLINICAL
STUDIES, YOU END UP WITH THINGS
LIKE HYDROXYCHLOROQUINE TAKING
OVER THE MEDIA AS THE TREATMENT
OF CHOICE FOR COVID-19, ONLY TO
FIND OUT, OOPS, THIS ISN'T
ACTUALLY WORKING.
SO THIS IS WHY WE WANT TO
UNDERSTAND HOW TO IMPRO IMPROVE
NON-RANDOMIZED STUDIES.
WE'RE GOING TO START BY STUDYING
THE FIELD.
WE'RE GOING TO TRY TO UNDERSTAND
THE CURRENT STATE OF
OBSERVATIONAL DATA COLLECTION,
DATA MANAGEMENT METHODS, SEE
WHAT DATA AVAILABILITY LOOKS
LIKE, TO SEE WHAT THE
LIMITATIONS FOR DOING RESEARCH
ARE.
DURING MY IRS PERIOD, I'M
FOCUSING SPECIFICALLY ON LOOKING
AT THIS IN EPIDEMIC SETTINGS,
BECAUSE AS MUCH AS I WOULD LIKE
TO CHANGE THE WORLD AND MAKE ALL
OBSERVATIONAL STUDIES BETTER
FOREVER, I SADLY ONLY HAVE A
CONFINED TIME PERIOD TO DO SO.
SO WE'RE CONCENTRATING ON
EPIDEMICS, BUT KNOW THAT THIS IS
ALL APPLICABLE TO NATURAL
HISTORY STUDIES, LONGITUDAL
COHORT STUDIES, THINGS LIKE
THAT.
SO HOW ARE WE ACTUALLY GOING TO
DO THIS?
WE'RE GOING TO CONDUCT -- WE'RE
STARTING WITH A SCOPING REVIEW
OF HISTORIC OUTBREAKS TO
UNDERSTAND OBSERVATIONAL DATA
COLLECTION METHODS,
AVAILABILITY, AND LIMITATIONS.
TAKE FOR EXAMPLE EBOLA.
WHAT DID THE LITERATURE LOOK
LIKE EARLY ON DURING THE EBOLA
OUTBREAK?
HOW THRO LONG DID IT TAKE FOR
OBSERVATIONAL STUDIES TO GET
REPORTED?
HOW LONG DID THAT DELAY CLINICAL
TRIALS BEING ABLE TO GO TO
FIELD?
NEXT WE'RE GOING TO EVALUATE
DATA MANAGEMENT CAPACITY IN
REGIONS WITH HIGH PREDICTED
OUTBREAK POTENTIAL.
THIS IS THE TOPIC OF MY
INTRAMURAL TARGETED CLIMATE
CHANGE AND HEALTH GRANT THAT I
RECENTLY RECEIVED FROM NIEHS.
SO WE'RE GOING TO BE TRYING TO
ACTUALLY EXPLICITLY DEFINE DATA
MANAGEMENT CAPACITY AS AN
INDICATOR FOR INFECTIOUS
DISEASES.
THERE ARE MANY OTHER INDICATORS
THAT ARE OUT THERE, BUT NONE OF
THEM EXPLICITLY ADDRESS DATA
MANAGEMENT TO CAPACITY.
AND WE WANT TO QUANTIFY THOSE
GAPS AND SEE WHAT MAY BE THE
IDENTIFYING CAUSES ARE CAUSING
THIS LACK OF DATA MANAGEMENT
CAPACITY.
IS IT THAT THERE'S JUST NO
INFRASTRUCTURE, NO TRAINING, OR
IS THERE MAYBE A POLITICAL
PROBLEM IN A CERTAIN COUNTRY
THAT DOESN'T WANT TO SHARE THEIR
DATA BECAUSE THEY'RE WORRIED
ABOUT FINANCIAL IMPLICATIONS?
WE ALSO THEN ARE GOING TO
ACTUALLY MODEL THIS, WE'RE ABLE
TO USE THIS AS AN INDICATOR
VARIABLE THAT WE INCLUDE INTO
MODELS TO UNDERSTAND AND
QUANTIFY HOW MUCH DATA
MANAGEMENT CAPACITY CAN ACTUALLY
IMPACT PREDICTED HOT SPOTS OF
DISEASE AND PREDICTED RISK OF
SPILLOVER.
FINALLY, WE'RE GOING TO BE
CONDUCTING A PARTICIPATORY
ASSESSMENT OF GLOBAL DATA
MANAGEMENT CAPACITY BY RUNNING
AN INTERACTIVE PANDEMIC SCENARIO
WITH DATA END USERS.
SO THE PLAN IS TO BRING DATA END
USERS FROM AROUND THE WORLD,
FOLKS WHO ARE ACTUALLY IN
COUNTRY WHO DEAL WITH PANDEMICS
AND OUTBREAKS ON A REGULAR
BASIS, BRING THEM IN, AND GIVE
THEM DIFFERENT SCENARIOS TO SAY
HERE'S WHAT YOUR DATA MANAGEMENT
LOOKS LIKE IN COUNTRY.
LET'S SEE HOW YOU DO.
AND THEN WE'LL CHANGE IT AND
WE'LL SAY, YOU HAVE A PERFECT
SYSTEM.
YOU HAVE THIS WONDERFUL DATA
MANAGEMENT SYSTEM.
WHAT DO YOU DO NOW?
AND LOOK TO SEE HOW THEIR
RESPONSES ARE GOING TO CHANGE
AND HOW THEIR FEELINGS ABOUT
THAT ARE GOING TO CHANGE GIVEN
BETTER ACCESS TO BETTER DATA
MANAGEMENT CAPACITY.
THE SECOND RESEARCH GOAL IS TO
REALLY IDENTIFY OPPORTUNITIES
FOR IMPROVEMENT AND SPECIFICALLY
WE WANT TO IDENTIFY AND DEVELOP
METHODS FOR STANDARDIZING AND
IMPROVING DATA MANAGEMENT.
FIRST, WE'RE GOING TO START BY
HOLDING A STAKEHOLDER ENGAGEMENT
WORKSHOP.
THIS IS SCHEDULED FOR SEPTEMBER
OF THIS YEAR.
WE HAVE SOME REALLY EXCELLENT
PEOPLE COMING FROM ALL OVER TO
COME AND SPEAK.
AND TELL US WHAT THEY BELIEVE
THE GAPS IN DATA MANAGEMENT AND
DATA COLLECTION DURING EPIDEMICS
ARE AND HOW THOSE CAN BE
IMPROVED.
WITH THE GOAL OF DEVELOPING
CONSENSUS RECOMMENDATIONS FOR
HOW THE FIELD SHOULD MOVE
FORWARD.
WE ARE GOING TO BE CONDUCTING AN
ENVIRONMENTAL SCAN TO IDENTIFY
EXISTING METHODS FOR
STANDARDIZATION.
I DON'T WANT TO REINVENT THE
WHEEL.
THE MORE STANDARD WE CAN BE, THE
BETTER OFF WE'RE ALL GOING TO
BE.
AND SO WE WANT TO LOOK AND SEE,
YOU KNOW, WHAT LESSONS HAVE BEEN
LEARNED FROM STANDARDIZING
RANDOMIZED CONTROL TRIALS?
WHAT LESSONS CAN WE LEARN FROM
SURVEILLANCE DATA THAT MAYBE
DOESN'T GET USE FORD RESEARCH,
BUT WE HAVE THESE GREAT
SURVEILLANCE SYSTEMS.
HOW CAN WE LEVERAGE THEM MAYBE
HOW DO WE IMPROVE THAT?
WE CAN ALSO LEARN FROM THE
DISASTER RESPONSE DOMAIN.
THESE PEOPLE GO AND THEY RESPOND
AND DO RESEARCH DURING -- AFTER
HURRICANE KATRINA AND AFTER
TSUNAMIS AROUND THE GLOBE.
HOW DO THEY DO THAT, HOW DO THEY
STANDARDIZE THAT RESEARCH AND
HOW CAN WE ADOPT THAT AS
INFECTIOUS DISEASE
PRACTITIONERS.
FINALLY WE'RE GOING TO EVALUATE
ANY TOOLS WE FIND AND, IF
NECESSARY, DEVELOP NEW TOOLS
WITH THE GLOBAL RESEARCH
COMMUNITY.
AND TRYING TO REALLY CREATE
RESOURCES FOR PEOPLE TO USE.
SO IF ANYONE -- IF WE RESPOND AT
NIH TO A GLOBAL OUTBREAK, AS WE
DO, YOU'LL HAVE TOOLS THAT YOU
CAN TAKE WITH YOU SO YOU DON'T
HAVE TO TRY TO DESIGN AN
OBSERVATIONAL STUDY FROM
SCRATCH.
YOU DON'T HAVE TO QUICKLY
UNDERSTAND WHO'S GOING TO HELP
WHAT VARIABLES ARE WE GOING TO
CHECK.
WE'LL HAVE THOSE TOOLS THAT CAN
HELP YOU AND WE'LL HAVE
RESOURCES TO HELP YOU USE THAT.
SO BECAUSE EVERYBODY LOVES
SEEING DATA, I'M GOING TO CLOSE
WITH SOME EXAMPLES OF WHY MAYBE
AN EPIDEMIOLOGIST WOULD BE
INVOLVED IN SOME OF THESE
STUDIES.
SO THE FIRST STUDY WE DID WAS
EARLY, EARLY IN THE PANDEMIC, WE
PUBLISHED THIS IN JANUARY OF
2021.
IT WAS A RETROSPECTIVE COHORT
STUDY.
WE ENROLLED -- WE HAD
175 PATIENTS WHO WERE
HOSPITALIZED WITH COVID-19
BETWEEN APRIL -- EXCUSE ME --
END OF FEBRUARY, END OF
MAY 2020, BUT WHAT WE DID WAS,
THESE FOLKS WERE HOSPITALIZED
AND THEY HAD BLOOD DRAWN FOR
CLINICAL PAIR AND THEN WE
RANDOMLY OBTAINED WHATEVER
SAMPLES THAT WE COULD FROM
DISCARDED BLOOD, AND WE SAID
OKAY, WE'RE GOING TO TEST THOSE.
THE QUESTIONS THAT WE WERE
TRYING TO ANSWER WERE, IS THERE
AN ASSOCIATION BETWEEN
BIOMARKERS AND SEVERITY OF
ILLNESS AND DEATH, AND CAN THESE
BIOMARKERS BE PREDICTIVE?
AND WHAT WE DID WAS, WE LINED UP
SAMPLES FROM THE TIME SINCE
ADMISSION, AND THEN LOOKED
FORWARD OVER TIME.
NOW, IDEALLY, WE WOULD HAVE
LOOKED AT TIME FROM SYMPTOM
ONSET, BECAUSE WE'RE LOOKING AT
A BIOLOGICAL PHENOMENON, RIGHT?
IF WE'RE INTERESTED IN SEEING
HOW IL2 CHANGES OVER TIME AND
MIGHT BE RELATED TO AN ILLNESS,
ADMISSION DOES NOT TELL YOU A
WHOLE LOT BECAUSE THAT'S NOT
WHEN PEOPLE STARTED GETTING
SICK.
WHAT YOU CAN SEE IN THIS FIGURE
IS WE LOOKED THROUGH A WHOLE
SLEW OF BIOMARKERS AND THEY VARY
FROM TIME OVER COURSE OF A
PERSON'S ADMISSION, WHETHER THEY
WERE SURVIVORS OR WHETHER THEY
DIED.
SO WE DIDN'T KNOW WHAT THE
EXPOSURE PATTERN LOOKED LIKE, WE
DIDN'T KNOW WHAT OR WHEN OR HOW
MUCH TO BE MEASURING.
DO WE LOOK AT TOTAL EXPOSURE TO
A BIOMARKER?
DO WE LOOK AT HOW HIGH IT GOES?
DO WE LOOK AT WHAT IT IS THE DAY
BEFORE YOU DIED?
WE DON'T KNOW.
AND THIS REALLY HIGHLIGHTS THE
NEED FOR APPROPRIATE SAMPLE
TIMING AND SAMPLE NUMBER, AND
THIS REQUIRES VERY THOUGHTFUL
STUDY DESIGN UP FRONT.
MY SECOND EXAMPLE IS AN ONGOING
PROSPECTIVE OBSERVATIONAL COHORT
STUDY.
THIS IS MY UNIT STUDY, THE
PERSIST STUDY, WITH WHERE WE ARE
EVALUATING THE IMMUNE RESPONSE
TO COVID VACCINES IN PEOPLE WITH
IMMUNE DISORDERS.
WE HAVE ENROLLED 300
PARTICIPANTS SINCE APRIL OF
2021.
WE JUST CLOSED ENROLLMENT AT THE
END OF LAST YEAR, AND WE'VE BEEN
OBTAINING SAMPLES FOLLOWING THIS
VERY SPECIFIC SCHEDULE.
WE ARE INTERESTED IN LOOKING AT
THE POST VACCINE IGG RESPONSE IN
PEOPLE WITH IMMUNE DISORDERS AS
WELL AS WHAT THE RATE OF
BREAKTHROUGH INFECTIONS MIGHT
BE.
AND THIS
Q.JUST AN EXA
WE HAVE THESE SAMPLE WINDOWS
CHOSEN FOR RELEVANCY, ONE MONTH,
SIX MONTHS, 12 MONTHS AFTER
VACCINATION TO SEE WHAT THAT
RESPONSE LOOKS LIKE AND HOW IT
WANES TO INSTRUCT ONGOING
VACCINATION ADVICE AND
RECOMMENDATION IN THIS
POPULATION.
AND HAVING THESE BIOLOGICAL
WINDOWS REDUCES VARIATION IN
OUTCOME MEASURES DUAL TO TIME,
WHICH WAS A PROBLEM WE HAD IN
THAT FIRST STUDY.
WITH THIS STUDY, WE HAVE THESE
WINDOWS AND WE'RE ABLE TO REALLY
SAY HERE'S WHAT THIS LOOKS LIKE
AT THE ONE MONTH TIME POINT, AT
THE SIX MONTH TIME POINT.
BUT AS WITH ALL OBSERVATIONAL
DATA, LIFE WILL FIND A WAY,
WHICH IS WHY WE SEE THIS
VARIATION AROUND THOSE LINES.
UNFORTUNATELY IT'S NEVER
PERFECT, NO MATTER WHAT YOU DO.
BECAUSE EVERYBODY LOVES SEEING
DATA, I'M SHARING MY VERY
FAVORITE PLOT, WE CALL IT THE
CONFETTI PLOT, BUT HAVING THIS
RIGID DATA COLLECTION STRUCTURE
HAS ALLOWED US TO REALLY MAKE
THESE GREAT COMPARISONS LOOKING
AT ANTI-S IGG OVER TIME, THESE
DIFFERENT TIME POINTS, COMPARING
BETWEEN DIFFERENT IMMUNE
SUBGROUPS.
WE WERE ALSO ABLE TO LOOK AT
VIRUS NEUTRALIZATION TITERS AND
SEE WHAT THAT CORRELATION MIGHT
HAVE BEEN OVER TIME AND BY
DIFFERENT COVID VARIANTS SO WE
COULD SAY JUST LOOKING AT YOUR
ANTIBODY TITERS IN THIS COHORT
ISN'T NECESSARILY GOING TO TELL
YOU HOW WELL YOU CAN NEUTRALIZE
VIRUS.
WITHOUT HAVING THAT PARTICULAR
DATA SAMPLING TIME FRAME, WE
WOULDN'T HAVE BEEN ABLE TO LOOK
AT SOMETHING LIKE THIS TO
THE DEGREE THAT WE WERE ABLE.
SO OBVIOUSLY WE CAN'T DO THESE
STUDIES IN ISOLATION.
MY UNIT WORKS IN VERY CLOSE
COORDINATION WITH A WHOLE LOT OF
PEOPLE.
WE WORK A LOT WITHIN NIAID, THE
DIVISION OF CLINICAL RESEARCH,
ROCKY MOUNTAIN LABS.
WE WORK WITH FOLKS IN THE
CLINICAL CENTER.
WE HAVE A GOOD RELATIONSHIP WITH
THE BIOETHICS OFFICE, THE
DIVISION OF LABORATORY MEDICINE,
CRITICAL CARE MEDICINE, BOTH
THEY HELP US WITH OUR RESEARCH,
WE HELP THEM WITH THEIR RESEA
RESEARCH.
DR. SADLER AND DR. KAYLISH FROM
THE NIBIB HAVE REALLY DONE ALL
OF OUR LAB WORK FOR US.
WE WOULD NEVER HAVE BEEN ABLE TO
DO THIS STUDY WITHOUT THEM AND
THEIR GREAT ASSISTANCE.
I HAVE MY ICH TEAM, THAT'S A
HORRIBLE NAME, NOT MY AK NISM, ,
BUT WE'RE WORKING WITH FOLKS
FROM GEORGETOWN UNIVERSITY IN
THE COUNCIL ON STRATEGIC RISKS
AS WELL TO HIGHLIGHT HOW CLIMATE
CHANGE IMPACTS INFECTIOUS
DISEASES AND HOW THAT IS A
BIOLOGICAL AND HEALTH SECURITY
AND SAFETY RISK.
AND FINALLY, I'VE GOT A BUNCH OF
EXTRAMURAL COLLABORATORS.
I WOULD LIKE TO POINT OUT WE ARE
WORKING WITH THE CLINICAL DATA
INTERCHANGE STANDARDS
CONSORTIUM, AN INTERNATIONAL
ORGANIZATION TRYING TO AIM TO
MAKE CLINICAL STANDARDS THAT CAN
BE USED AND ADOPTED BY ANYONE IN
THE COMMUNITY.
AS WELL AS THE COMPUTATIONAL
EPIDEMIOLOGY DISTRIBUTED
VOLUNTEER NETWORK, WHICH IS A
REALLY INTERESTING GROUP OF
VOLUNTEERS FROM AROUND THE WORLD
DOING VERY COOL RESEARCH LOOKING
AT GOOGLE SEARCH TRENDS, SOCIAL
MEDIA, AND OTHER THINGS AND HOW
THAT IMPACTS EPIDEMIOLOGY
STUDIES.
SO WITH THAT, I'M HAPPY TO TAKE
ANY QUESTIONS.
[APPLAUSE]
>>THANK YOU.
THIS WAS REALLY FUN FOR ME TO
THINK ABOUT SOMETHING I DON'T
USUALLY THINK ABOUT.
I WONDER HOW MUCH THE FACTOR OF
THE COST OF MAINTAINING THE
DATA, ACCESSING THE DATA,
FACTORS INTO YOUR MODELS.
ESPECIALLY SORT OF FOR WORLDWIDE
PANDEMICS.
>>YEAH, ABSOLUTELY.
YOU KNOW, COST IS DEFINITELY A
BIG THING TO THINK ABOUT.
BUT INVESTING IN -- THIS IS
WHERE WE GET THAT SAYING, AN
OUNCE OF PREVENTION IS WORTH A
POUND OF CURE.
IT APPLIES TO HAVING DATA TOO.
SO WE ACTUALLY INVEST IN DATA
SYSTEMS AND HAVING ACCESS TO
GOOD DATA, THEN THAT'S GOING TO
PAY OFF WHEN WE DON'T HAVE A
HUGE GLOBAL PANDEMIC THAT BREAKS
OUT AND CRASHES THE ECONOMY,
RIGHT?
SO WHILE YES, IT IS ABSOLUTELY
EXPENSIVE AND IT'S A BIG
INVESTMENT UP FRONT TO DO, IT
SHOULD SAVE MONEY OVER THE LONG
TERM BY GIVING US ACCESS TO DATA
TO HELP ANSWER THESE QUESTIONS
AHEAD OF TIME, HELP PREPARE FOR,
YOU KNOW, OUTBREAKS THAT WE MAY
HAVE, THINGS LIKE THAT.
>>SO I GUESS ANOTHER TWIST TO
THAT IS THEN YOU'RE ALSO HAVING
TO DEAL WITH POLITICAL
SITUATIONS AND POLITICAL WILL
AND SORT OF, I GUESS, THE HOPE
IS BY PRESENTING DATA, THEN YOU
CAN CONVINCE PEOPLE.
>>AGAIN, YES.
SO IDEALLY WE WOULD HAVE DATA
AHEAD OF TIME TO SAY LOOK, ISN'T
PREVENTING A PANDEMIC A GREAT
IDEA, EVERYBODY?
BUT THIS IS THE PROBLEM THAT WE
HAVE WITH VACCINES.
VACCINE-PREVENTABLE ILLNESSES
HAVE ALL BUT DISAPPEARED IN THE
UNITED STATES, AND SO FOLKS SAY
WELL, WHY DO I NEED TO VACCINATE
MY KIDS?
NOW WE'RE SEEING A RE-EMERGENCE
OF MEASLES, OF POLIO, LIKE, WHY
ARE WE SEEING THIS COME BACK
INTO THE U.S.?
WE HAVE VACCINES TO PREVENT
THESE.
AND IT'S THE SAME THING WITH
PREVENTION OF INFECTIOUS DISEASE
OUTBREAKS.
IT IS SOMETHING THAT WE ALL KNOW
LOGICALLY WE SHOULD DO.
BUT TRYING TO MOTIVATE PEOPLE TO
SPEND THEIR MONEY AND TO PUT
TIME AND INVESTMENT INTO THAT,
WHEN IT -- IF IT WORKS, YOU SEE
NOTHING, YOU SEE NO RESULTS.
IT IS REALLY HARD.
>>I'M JUST WONDERING IF YOU CAN
SPEAK TO SOME OF THE CHALLENGES
OF DATA COLLECTION AND
MANAGEMENT IN CASES WHERE THERE
IS LIKE A HUGE DISASTER
RESPONSE, PARTICULARLY IN MAYBE
ANOTHER COUNTRY WHERE THAT IS,
YOU KNOW, MAYBE DOESN'T HAVE THE
RESOURCES THAT WE DO.
WHAT ARE SOME OF THE MAJOR
PROBLEMS IN TERMS OF DEALING
WITH BOTH THE WHOLE DISASTER
SITUATION AND STILL MAINTAINING
YOUR ABILITY TO COLLECT DATA?
>>GREAT QUESTION.
SO THERE ARE A COUPLE FACTORS
THAT PLAY INTO THAT.
SO THE FIRST IS THAT IF THERE'S
NO INFRASTRUCTURE TO COLLECT
DATA, ESPECIALLY IN COUNTRY,
THEN IT'S GOING TO BE REALLY
HARD TO START DOING THAT DURING
THE MIDDLE OF A DISASTER.
IF YOU HAVE INFRASTRUCTURE THERE
BEFOREHAND, THEN IT'S NOT QUITE
AS DIFFICULT TO COME IN, YOU
HAVE PEOPLE.
WE CAN SEND IN PEOPLE FROM
AROUND THE WORLD TO GO AND
COLLECT DATA, BUT THEN WE HAVE
PROBLEMS WITH, YOU KNOW, THE
ETHICS OF DOING THAT, OF SENDING
IN PEOPLE FROM, YOU KNOW, SAY
THE GLOBAL NORTH INTO THE GLOBAL
SOUTH AND COLLECTING DATA AND
NOT SHARING THAT WITH THE FOLKS
IN THAT COMMUNITY, NOT RETURNING
ANYTHING THAT WE LEARN ABOUT
THAT DATA.
WE ALSO HAVE TROUBLE, AND THIS
IS WHY I'M WORKING WITH
ETHICISTS AND LAWYERS, IS WHEN
WE GO INTO A COUNTRY THAT'S
HAVING, LET'S SAY, AN OUTBREAK
AND WE WANT TO COLLECT DATA
QUICKLY, WE HAVE TO -- IN ORDER
TO DO RESEARCH, WE HAVE TO WORK
WITHIN THE CONFINES OF THE
INSTITUTIONAL REVIEW BOARD OF
THE NIH, OF THAT COUNTRY.
AND THAT IS NEVER A QUICK
PROCESS, RIGHT?
YOU KNOW, IRB CAN TAKE ITS TIME.
AND THAT'S NOT GREAT IF YOU'RE
TRYING TO RESPOND TO AN
EMERGENCY SITUATION.
AND SO THE WAY WE GET AROUND
THAT IS BY SAYING WELL, WE'RE
DOING THIS IN -- UNDER THE GUISE
OF PUBLIC HEALTH RESPONSE.
BUT THERE ARE STIP LAYINGS IN
THAT YOU WILL NOT BE USING THAT
DATA FOR RESEARCH PURPOSES.
SO HOW DO WE GET AROUND THAT?
DON'T KNOW YET.
THAT'S WHAT WE'RE TRYING TO BE
WORKING ON.
AND THIS IS WHY WE'RE BRINGING
IN, YOU KNOW, THESE OTHER
PEOPLE, THESE LAWYERS AND
EXPERTS AND FOLKS FROM IN
COUNTRY TO REALLY SAY, HOW DO WE
MAKE THIS WORK SO THAT WE CAN
STILL GET GOOD QUALITY DATA THAT
WE KNOW WE'RE GOING TO USE FOR
RESEARCH LATER ON, WITHOUT MAYBE
HAVING TO DEAL WITH THE TIME
REQUIRED TO GO THROUGH A FULL
IRB.
AND SO YEAH, IT'S TRICKY.
AND AGAIN, THERE'S THE MONEY AND
THE POLITICAL WILL, TRYING TO
GET INTO A COUNTRY AND COLLECT
DATA DURING AN EMERGENCY
SITUATION, TRYING TO REROUTE
FUNDS.
IT CAN BE REALLY HARD TO DO.
AND THAT'S WHAT COMPOUNDS THESE
PROBLEMS, ESPECIALLY IN OUTBREAK
SETTINGS.
YOU KNOW, IS THAT YOU'RE NOT
GETTING THE DATA THAT YOU NEED,
AND THEN IT JUST -- IT COMPOUNDS
AND IT MAKES THINGS WORSE AND SO
IF WE COULD PREVENT THAT FROM
HAPPENING IN THE FIRST PLACE, OR
AT LEAST HAVE THAT
INFRASTRUCTURE IN PLACE SO THAT
WHEN SOMETHING DOES OCCUR, WE'D
BE ABLE TO RESPOND A LOT MORE
AGILELY TO THAT, AND I THINK IT
WOULD BE -- YOU KNOW, IT COULD
PAY DIVIDENDS.
GOT TO GET A WORKOUT TO GET YOUR
QUESTIONS IN.
>>REALLY.
SO I WAS WONDERING IF YOU COULD
SPEAK TO WHETHER DATA COLLECTION
IN COUNTRIES THAT HAVE A WELL
CONTROLLED HEALTHCARE SYSTEM IS
EASIER THAN THOSE THAT HAVE KIND
OF -- LIKE THE UNITED STATES,
YOU KNOW.
>>YEAH, ACTUALLY, I AM VERY
JEALOUS OF A LOT OF
EPIDEMIOLOGISTS WHO GET TO WORK
WITH A LOT OF EUROPEAN DATA.
YOU KNOW, THE UK IS A GOOD
EXAMPLE, BUT EVEN BETTER IS LIKE
THE NETHERLANDS AND DENMARK,
THEY HAVE CENTRALIZED HEALTHCARE
SYSTEMS SO ALL OF THEIR DATA IS
THERE AND IT JUST THIS
BEAUTIFULLY ROBUST DATA SYSTEM,
WHEREAS IN THE UNITED STATES,
THINGS ARE FRACTURED, SO
EVERYTHING IS RUN AT THE STATE
LEVEL, OR YOU HAVE PEOPLE WHO
BUY INTO COMMERCIAL ELECTRONIC
HEALTHCARE RECORDS, LIKE EPIC,
AND EPIC DOESN'T ACTUALLY SELL
THEIR DATA FOR RESEARCH
PURPOSES.
YOU CAN GET DATA FROM OTHER
COMPANIES AND IT COSTS A TON OF
MONEY.
AND THEN IT'S NOT NECESSARILY
REPRESENTATIVE OF THE WHOLE
COUNTRY BECAUSE NOT EVERYBODY IS
USING THAT SYSTEM.
>>RIGHT.
>>AND SO, YEAH, IT MAKES IT
VERY CHALLENGING, AND WE DID, WE
SAW THAT DURING THE COVID
PANDEMIC.
WE SAW THAT THIS FRAGMENTATION
REALLY DIDN'T PERMIT US TO GET
THE INFORMATION WE NEEDED OP
WHERE OUTBREAKS WERE OCCURRING,
WHO WAS GETTING INFECTED, TRYING
TO GET ANY DATA ON TREATMENTS.
USUALLY IF YOU PURCHASE AN
ELECTRONIC HEALTH RECORD DATA
SYSTEM, YOU DON'T GET ANY OF THE
PHARMACY RECORDS.
LIKE GET MY PRESCRIPTIONS FILLD
AT CVS AND NONE OF THAT IS IN
THOSE SYSTEMS.
SO HOW DO YOU ACCURATELY ASSESS
TREATMENT FOR A PERSON?
IT'S A MAJOR PROBLEM.
AND ACTUALLY IN THE NATIONAL
BIODEFENSE PLAN, IT DOES TALK
ABOUT DATA WITHIN THE UNITED
STATES AND TRYING TO -- THE NEED
TO BUILD BETTER DATA
INFRASTRUCTURE FOR RESPONDING TO
HEALTH PROBLEMS.
BUT HOW WE'RE GOING TO TACKLE
THAT IS -- I'LL BE INTERESTED TO
SEE HOW THAT GOES.
>>YEAH.
THANKS.
>>GREAT QUESTION.
>>OKAY.
I THINK WE'VE GOT QUESTIONS FROM
THE VIDEOCAST SO WE'RE GOING TO
GO AHEAD AND BUMP TO MARY
KEARNEY, THE CHAIR OF WSA, TO
FIELD THOSE.
>>HI.
CAN YOU SEE ME?
SO ACTUALLY THE QUESTIONS ARE
RIGHT IN LINE WITH WHAT CAROL
JUST ASKED ACTUALLY, SO -- BUT
CAN YOU HEAR ME?
>>YES.
>>OKAY.
BECAUSE I'M HAVING TROUBLE
HEARING YOU.
BUT SO ONE OF THE QUESTIONS IS
ABOUT -- WHICH I THINK YOU JUST
ADDRESSED IN THE LAST QUESTION,
BUT -- SO THE WHO HAS, IN MANY
COUNTRIES, SET UP LOCAL AND
REGIONAL AND NATIONAL LABS SO
THAT THEY CAN MEASURE INCIDENCE
RATES AND DO GENETIC
SURVEILLANCE.
AND CDCs WITHIN MANY COUNTRIES
DO THE SAME, SET UP LOCAL AND
REGIONAL LABS AND ALL THE DATA
GET SENT TO THE CDC AND THAT
REALLY OBVIOUSLY HELPS WITH LIKE
YOU JUST MENTIONED, IT'S CLEAR
THAT IN THE UNITED STATES, WE
HAVE VERY POOR SURVEILLANCE IN
THE COVID PANDEMIC, AND THIS IS
TRUE, OF COURSE, WITH OTHER
VIRUSES LIKE HIV.
AND SO WHAT CAN WE DO AS
CITIZENS, NOT JUST AS SCIENTISTS
BECAUSE THE SCIENTISTS, OF
COURSE, WE CAN ENROLL IN
CLINICAL TRIALS AND
EPIDEMIOLOGISTS LIKE YOU CAN DO
THE BEST YOU CAN TO COLLECT DATA
AND DO ANALYSIS IN THE UNITED
STATES THAT WOULD BE THE
EQUIVALENT TO WHAT'S DONE IN
MANY OTHER COUNTRIES.
BUT AS CITIZENS, WHAT CAN BE
DONE TO -- I DON'T KNOW -- PUT
PRESSURE ON CONGRESS OR TO MAKE
SOME KIND OF CHANGES WHERE THE
CDC WOULD HAVE SOME KIND OF
POWER TO HAVE LOCAL AND REGIONAL
LABS SET UP TO MEASURE INCIDENCE
RATES AND GENETIC DIVERSITY OF
DIFFERENT PATHOGENS.
>>YEAH, GREAT QUESTION.
SO THE CDC ACTUALLY DOES IN THE
UNITED STATES HAVE SENTINEL
SURVEILLANCE PROGRAMS, AND WE
HAVE MANDATORY REPORTING OF
CERTAIN PATHOGENS THAT STATES
HAVE TO DO, SO IF WE HAVE
INCIDENCE OF, SAY, EXTREMELY
DRUG RESISTANCE TO TUBERCULOSIS,
THAT HAS TO GET REPORTED TO THE
CDC.
I USED TO WORK FOR THE
FOOD-BORNE DISEASE NETWORK WHEN
I WORKED AT THE MARYLAND STATE
HEALTH DEPARTMENT, WHICH WAS
HILARIOUS WITH THE LAST NAME
RICOTTA, HA HA.
BUT FOR THAT, IN MARYLAND, IN
THE STATE OF MARYLAND, IF THERE
WAS A CASE OF SALMONELLA OR CAM
FLOW BACTER THAT GOT REPORTED,
SHOWED UP TO THE CLINIC AND THEN
THOSE SAMPLES WOULD GET SENT TO
THE STATE LAB, WE'D REPORT THAT
TO THE CDC, BUT THAT WAS JUST
FOR MARYLAND AND THAT WAS JUST
IF PEOPLE WENT TO THE CLINIC.
SO HOW CAN REGULAR EVERYDAY
PEOPLE HELP?
WELL, THEY CAN, YOU KNOW, IF
YOU'RE SICK, YOU CAN GO TO YOUR
DOCTOR, CALL YOUR DOCTOR.
THE CDC DOES HAVE SOME PROGRAMS
WHERE YOU CAN REPORT YOUR
VACCINE AND ANY ADVERSE EVENTS.
CDC HAS VSAFE FOR THE COVID
VACCINES.
CHECK OUT WHAT PROGRAMS YOUR
LOCAL PUBLIC HEALTH DEPARTMENTS
MAY HAVE.
THEY MAY HAVE OPTIONS FOR THE
COMMUNITY TO HELP.
THE OTHER THING IS ABSOLUTELY
TALKING TO YOUR CONGRESSPEOPLE
AND SAYING, THIS IS SOMETHING
THAT WE WANT OUR MONEY DEDICATED
TO.
I WOULD LOVE TO KNOW WHERE COVID
OUTBREAKS ARE SO I DON'T GET
COVID.
I MEAN, I'M FINE, LIKE, PUT SOME
MONEY TOWARDS THAT, AND MAYBE
FIX THIS ROAD WHILE YOU'RE AT
IT.
BUT WHATEVER.
SO YEAH, IT'S -- YOU KNOW, JUST
MAKING SURE THAT THE GOVERNMENT
KNOWS THIS IS SOMETHING THAT WE
WANT TO HAVE OUR MONEY SPENT ON,
BECAUSE IT IS FOR THE GOOD OF
EVERYONE IS DEFINITELY SO, SO
VERY IMPORTANT.
>>THANK YOU.
>>THANK YOU SO MUCH.
[APPLAUSE]
>>THANK YOU SO MUCH,
DR. RICOTTA, DR. SEGRE,
DR. THIELE, FOR YOUR
PARTICIPATION TODAY AND A HUGE
THANKS TO THE OTHER MEMBERS OF
THE ORGANIZING COMMITTEE, AS
WELL AS THOSE IN EVENTS
MANAGEMENT AND I.T. THAT HELPED
PUT THIS ON TODAY.
JUST A QUICK ANNOUNCEMENT BEFORE
WE LET YOU ALL GO.
WE HAVE ANOTHER EVENT COMING UP
ON MAY 12TH AT 11:00 A.M. AGAIN
HERE IN LIPSETT FEATURING DRS.
CANDACE TANNER AND PAULI JOSEPH
ON THEIR RESEARCH, AND THERE
WILL ALSO BE A NETWORKING EVENT
DIRECTLY AFTERWARD THAT'S
SPONSORED BY FAES, SO IF YOU'D
LIKE TO MEET MORE WOMEN HERE AND
OTHER PEOPLE THAT SUPPORT WOMEN
IN SCIENCE, PLEASE DO COME, SO
WE HOPE TO SEE YOU IN MAY, AND
THANKS, EVERYBODY, FOR JOINING
US ON VIDEOCAST, AND WITH THAT,
OUR SESSION TODAY IS CONCLUDED.
SO THANK YOU VERY MUCH.
[APPLAUSE]