Tuesday, October 30, 2018

Alright, stop: recalibrate and listen

Though the precise wording varies a bit (aka a lot), Vanilla Ice was onto something: the power to stop - and listen.

Over the last few weeks, I've really struggled to balance doctoral studies - which is supposed be my main priority as a full-time student - and responsibilities associated with my research assistant (RA)-ship (what is paying for my school and a small stipend). Except balance isn't the right word or phrasing; adequately tackle or appropriately execute might be closer to what I'm trying to get at - except I feel like I'm miserably failing at each juncture.



(Re)learning how to be a successful student has turned out to be more painful than I expected; the added layer of (re)hurling myself into the actual nitty gritty of research has left me spinning and questioning everything. On the school front, I'm constantly forgetting to bring the right notebooks or printouts to class, and while I should be studying, reading ahead (or let's be honest, catching up on reading), or working on homework during the evenings after my RAship, my brain is fried from being in class every morning and then abruptly shifting gears to being in the office and trying to tackle some aspect of a five-year research project I'm still trying to understand. Five-to-six hours pass like a second when you're attending research team meetings, emailing with external partners about time-sensitive project needs like control patient selection (which take forever since I'm trying to double-check research protocols, site-specific data considerations, etc.), and reincarnating the scraps of mediocre coding skills I developed from 2008 to 2011 (and had essentially abandoned until this year). I come home mentally obliterated without much tangible progress to show, and disappointed in myself for not staying on top of it all, nevermind actually accomplishing much. Writing projects I hoped to chip away at are withering away in Google drives and email messages, and every other day or so I'm hit with a searing pang of guilt or worry about my colleagues or respected collaborators must increasingly loathe me, or worse, view me as irresponsible and/or someone who lets people down. I feel like the years of hard work I've put into building a reputation of reliability; a producer of high-quality research and scientific writing; and thoughtful collaborator are crumbling before me. My self-confidence has spiralled alongside a vicious feedback loop of negativity, and while I've so appreciated the friends and colleagues who have kindly listened to me, I quickly find talking about my current challenges as abhorrent as I'm feeling. It's like - so many people pursue doctorates and do so while juggling more classes, more work demands (one of my cohortmates is a practicing physician while also seeking his PhD [!!]), more family needs (a number of my cohortmates have children), etc., and here I am...a flailing lump of organs and appendages who has no patients, dependents, partner, or even dog I need to look out for. This is it, my only real responsibility, this investment in myself and my future career opportunities - and I feel like I'm blowing it. And doing so just one month in.

I broke down over the weekend, and emailed my faculty advisor, tearfully requesting a mid-quarter 1:1 to garner guidance on how to navigate, well, everything better. It was immediately scheduled for this Thursday. Today I received more valuable feedback on how I was overthinkng and thus overcomplicating everything; the ship had sailed on setting up a more perfect study design, and in the absence of more direction, I was still circling research rabbit holes. Though my comfort with calling some of the shots is unlikely to suddenly escalate, it's something I hope I can work through with my faculty advisor. That and identify tangible ways to start building back a more successful structure to my day-to-day. As it turns out - at least for me - 10 years of full-time(+) work doesn't seamlessly translate into being a decent, let alone stellar, doctoral student. And to make that transition better, I need to carve more moments to reflect on what I'm struggling with and find more productive ways to work through them. Today, after I spent three- to- four hours of studying for my biostats midterm, I went on what could barely be considered a run; it was a jog, at best. Yet those 30 minutes outside, listening to an absolutely ridiculous podcast (I broke into quite audible laughter several times) as I slogged along, was enough to brighten a few corners of my battered brain, or at least for the rest of the afternoon and now evening. I rewrote out the equations I need to memorize for tomorrow's midterm, and gained slightly more clarity on biostats concepts that were alluding me. It's far, far from perfect, but it's a start.

Stop. Recalibrate. And listen. Maybe it can get better. And maybe it will.


Today I learned...
My studying technique of writing out class slides, notes, and examples on a large sticky pad thing and posting them in my entryway might actually be working. Tomorrow will determine its true effectiveness, but under initial pilot conditions, I think I'm reviewng and learning the material with a method that works well for me.




Today I'm grateful for...
The kind, supportive words I received yesterday from a person whom, despite breaking up nearly a year ago, I still deeply love and miss.

Today's best part...
Was twofold: (1) our epidemiology class's "journal club" section led by Maayan Simckes, who is amazing; and (2) my "run"/jog out in the world. And it wasn't even raining.

Monday, October 29, 2018

Paranormal distributions

When your PhD cohortmates ask for a pun-based trivia team name for Halloween, of course you immediately offer up...

  • Edgar Allen Flu
  • BOO-bic plague
  • HELLth systems strengthening
  • Sick or Treat?
  • Hemo-goblin levels positive
  • Insulin pump-kins
  • Reeses piecewise regression

...I think some of my cohortmates still like me. Maybe.

Today I learned...
I need to go back to my college-days class and study habits. No computer, no email, no phone during class.

Today I'm grateful for...
Vasudha Mulakaluri, who kindly "Is there anything I can do to help?" when I was talking about studying for my biostats midterm...and she doesn't necessarily know biostats. That's because Vasudha is unthinkably kind and thoughtful, and I so appreciate the thought.

Today's best part...
Was when I asked one of my PhD cohortmates, "Andrew, did you do #2 last night?"...and without missing a beat, he replied "Nancy, I thought we talked about boundaries!" I was referring to the second biostatistics practice exam - and clearly, I nearly fell over laughing at our seminar.

Sunday, October 28, 2018

(Coding slow) on Sunday morning

I'm fairly sure this is the Sunday Morning Maroon 5 was thinking about when they wrote that song back in 2004...(wait what, 2004?!)

Nothing but regression lines, R code, and Lowess smoothers on this Sunday morning...and afternoon.


Today I learned...
I have no idea how to implement LAD regressions in R. Like at all.

Today I'm grateful for...
People. "A warm word from a friend, a joke and a moan with a colleague," as Dave Reay eloquently wrote in a Nature comment earlier this year. This piece, every time I read it, makes me cry, or at least tear up a bit if I'm in a particularly chipper place. If nothing else is taken away from this piece it should be that people, even if they don't know it at the time, absolutely can be lifelines during hard times. That and we, in general, but especially in the academic and scientific communities, should be more aware of how much of an impact each of us can have on the lives of others who are struggling to find their ways, particularly if darkness is closing in.

Today's best part...
Celebrating the one-year adoptaversary of Kacey Foreman and that fateful car-ride with Kyle to bring her home.


Saturday, October 27, 2018

'Tis the midterm season

And thus the season when my apartment apparently turns into a scene from A Beautiful Mind. 


Today I learned...
What the Greek letter pi stands for equation notation. Hurrah for products!(?)

Today I'm grateful for...
Daniel Dicker, who was willing to walk with me after the dog I was dogsitting wasn't have the best time at the dogpark. We took our respective dogs along the Greenlake walking path, where we saw...

Today's best part...
A Corgisauraus. That is all.


Friday, October 26, 2018

Punch today in the face

Today marked one month into my PhD program. Today I also nearly didn't make it to class.

I woke up to my well-intentioned 6 am alarm, once again hoping I'd finally get my rear into gear and work out before the day's activities began. After all, I had been doing so well this summer and most of September establishing a regular exercise schedule - a key contributor to feeling healthy, positive, etc. Yet despite this knowledge and experience and everything, it hasn't been enough to counter a deeper urge, need, something to keep sleeping, maybe another 15 minutes, 30, 45, 60, or do I really need to get up this morning, today, tomorrow...

The rational, removed version of myself understands what's going on. I'm overwhelmed and scared to admit that I'm in this place and I want to stay positive but the effort it takes to try to put on a shiny-happy front is draining and %&@$, rational me gives way to the irrational. The negative feedback loop, which seems like a strangely positive spin on what can deconstruct into a deeply detrimental spiral of doom, is strong with this one.

While I eventually managed to lug myself out of bed and go to an 8:30 am section and lecture, I almost cried in the middle of the latter (and I eventually did when I got back home). I knew this transition would be hard, but I don't I appreciated how much it would rattle my sense of self and thus day-to-day functionality. Today was a punch in the face, and for most of the day, it fully bowled me over.

I miss feeling like I know what I'm doing, I miss having a good sense of what I need to accomplish each day (and actually make progress toward this). I miss feeling directly connected to clear(er) objectives, I miss feeling well, un-alone. I miss knowing I'm fully capable of achieving x by y, whereas now, I don't feel any confidence in saying "of course, I can finish this by time z." I miss a lot, and until I begrudgingly reached out to a few people today, I wasn't sure how to even start to work through this. I went home, cried, slept, and cried some more before taking a deep breath, and saying "Hey...I need some help."


Today I learned...
To lean hard on your people, especially amid the PhD doldrums. Even if it feels crappy to admit you need more than what you (or they) might expect on a given day. And even if 'doldrums' sounds like a bedazzled version of how you're feeling.

Today I'm grateful for...
Sarah Wulf, my PhD buddy. Thank you, endlessly, for listening and your wise words.

Today's best part was...
Amanda Smith, who gave me today, among many things, this card now prominantly displayed on my fridge: punch today in the face. Sure, today wasn't a good day, or anything close to good, but it also won't be a day that defines me. I'm punching it in the face, rather than vice versa, and moving on - or at least trying not to.



Thursday, October 25, 2018

Statistics and seasons in Scotland

And these are a few of my favorite things...Scotland and former IHME Post-Bachelor Fellows (PBFs) teaching us what 2D summaries can bring...


Today I learned...
How to write up code to easily implement cutpoints at particular values (e.g., for quickly creating categories for A1c or blood pressure measures). One line and done - thank you egen and cut() and at()!

Today I'm grateful for...
The Hogan Lim family, for feeding my stomach with great food and my soul with greater warmth and positivity than I ever have before stepping through your door. Thank you, tonight and always, for listening, laughter, and love.

Today's best part was...
Reading to the Hogan Lim children at bedtime and then having good night hugs, otherwise known as "squeezers," requested (correction demanded). I adore them, so much. 

PSL? Try personal statement season

Yesterday I was asked to review and give feedback on someone's personal statement for a PhD application - something I'm always happy to do if I have the bandwidth, especially for current or former post-bachelor fellows (PBFs) at IHME - and it got me thinking: what did my personal statement say?

How did I talk about what drives me to work in this field, often sacrificing sleep, fitness, social life, etc. for the pursuit of better science and measurement of population health? And one month into my own PhD program, would I agree with what I said (of course, while trying to account for some level of self-promotion and/or over-the-top-edness that is essentially mandatory for an application but would rarely, if ever, creep into my everyday manner)? Well, these are questions I could easily answer.

Dated November 2016, here are two excerpts from my PhD application's personal statement; first, the second paragraph:
A recent Lancet editorial excerpt aptly captures my views on research and what motivates my work in global health: “Because what you don't measure you don't know, and what you don't know you can't act on. Good science is the start.” I came to fully appreciate the consequences of inadequate scientific knowledge and action when I worked at an inpatient and outpatient research unit at the National Institutes of Mental Health (NIMH). Our goal was to better define the diagnosis and treatment of pediatric bipolar disorder, a diagnosis children often receive despite having symptoms that markedly differed from adult typology. A bipolar diagnosis typically triggers medication restrictions for clinical care and insurance reimbursement – outcomes that left many children prescribed powerful antipsychotics which failed to improve their emotional or behavioral states. Although I arrived at NIMH planning to pursue a clinical career, my experiences fundamentally shifted my attention toward the more systemic challenges underlying effective health service provision: what gaps emerge in access to proper diagnosis and treatment; who is most affected; and which policies can result in substandard care. I realized that science alone was not the panacea, as many social, political, and cultural factors affect how people seek care and what services are available. Yet rigorous research, from better data to stronger methods, can set the foundation for advancing health outcomes of all individuals, including my patients. This belief serves as the cornerstone for my professional pursuits in population health research.
And my summary paragraph:
I view doctoral training as a critical next step toward strengthening my contributions to the global health field. The world’s most vulnerable and marginalized populations, from the United States to Uganda, deserve the best possible researchers, practitioners, and evidence-informed advocates working on their behalf. While I have wholeheartedly enjoyed my roles and work to date, I want to bolster what I can offer our field in terms of advanced study design, data collection, and analysis. I see my career path as a mixture of leading applied research and scientific advising, ideally working closely with collaborating institutions to identify key health priorities and strategies for evaluating intervention coverage and program impact. I also derive great satisfaction from working with, as well as mentoring, early-career global health professionals, and thus hope to blend my research endeavors with teaching in an academic setting. The University of Washington’s PhD program in Global Health Metrics would substantially expand my skills and research capacity in population health measurement, ultimately preparing me to work at the forefront of our discipline. I believe my interests, experience, and energy will be an asset to this program, and that together we can elevate the science of improving the world’s health.

Three immediate reactions and thoughts - and application lessons learned:
  • I wish I asked someone to copyedit my personal statement before I submitted it and the rest of my application. Copyeditors are the unsung heroes of the written word.
    • Application lesson learned: ask a pal or colleague who has some kind of formal copyediting training to check out your application materials at least a few days before you submit. And then buy them their favorite beverage and thank them endlessly.
  • The second paragraph of a PhD program personal statement - or so I've been told - is supposed to clearly demonstrate what drives you, what keeps you going when the going gets tough, and so on. Working at NIMH right after college and truly seeing the effects of research translation on health service delivery on my patients did that for me. While the work I've done over the last decade rarely resembles anything I experienced that year (the main exception was well-organized and color-coded spreadsheets for tracking patient outcomes), my time at NIMH fundamentally shaped my career trajectory. 
    • Application lesson learned: don't shy away from the life experiences that brought you to applying to a PhD program. What you'll end up writing will come off as much more genuine and reflective of why you're a great fit for the program - all pluses!
  • The summary paragraph is not only meant to bring everything together but also to provide a sense of one's future career trajectory and why PhD program xyz would support that. Honestly, I think my summary paragraph is pretty darn great, particularly since it neatly represents what I hope to do and why I think the UW program will get me there. Does it have some heavy only-found-in-applications phrasing? Of course - "the forefront of our discipline" anyone? - but overall, I think it captures me, my motivations, and future aspirations well. 
    • Application lesson learned: draft a summary paragraph that borderline feels like a call to action; silence any lingering "wait, why does this person want to be at this program?" with assertive, enthusiastic statements about how you want to contribute to the world and how University x's PhD program in yz will get you there. And then redraft it again. And again. This is the last thing the application committee will read about you (or at least that's written by you) - make it count!

Wednesday, October 24, 2018

Celebrate good times...

...like 18 or 81 or the Forecasting team's feats!




Today I learned...
It's not quite academic in nature, but I'm still floored by this discovery: apparently most of what Trader Joe's sells is actually from another company and those companies license or sell those products under a white label(?) to Trader Joe's.  Also, you can print a sugar-based photo from an actual printer at QFC and put it on a cake (?!?). This world never ceases to amaze and baffle.

Today I'm grateful for...
My 686 crew: Kelly Bienhoff, Sofia Redford, and Faye Ziegeweid. These women are simply the best. We're each pretty different and pretty different things led us to our little office at IHME. Yet the smarts, laughter, and support these three brought to 686 each day was unrivaled; I can't imagine how I would have made it through last year's ups and downs without them, and I'm so glad I still get to have these stellar people in my life (though far less frequently in-person, which is definiitely not preferred, not at all). 

Today's best part...
Was the long-anticipated, frequently-rescheduled 686 office happy hour. How I miss my former officemates - and how wonderful it was to spend that time with them.

Tuesday, October 23, 2018

Straight As: attributable, avoidable, avertable, amenable

At our epidemiology class today, I definitely had a flashback to the Global Burden of Disease (GBD) 2015 Healthcare Access and Quality paper and when I had to write a table describing the differences between amenable v. avertable v. avoidable v. attributable mortality or burden...and now we're onto measures of excess risk in class!

Our epi professors, who are phenomenal, like "making" us fill online polls in real-time to test our (hopefully) new-found knowledge...apparently some of us will be studying up on the differences between odds ratios and attributable risks this weekend.



Today I learned...
Well, since I was one of the people who incorrectly said odds ratio instead of attributable risk percentage to the above question, I'm not sure if it quite counts as truly learned yet. With that said, I look forward to digging through the text and studying up on these topics this weekend!

Today I'm grateful for...
Molly Biehl, as she's endlessly thoughtful of others and truly, truly cares about people, dogs, and what's happening out in this crazy world. Plus, her stellar organization always makes me smile (and appreciate how she's thought of everything). She's getting a two-pher today, but that just demonstrates how wonderful she is.

Today's best part...
Was joining the Postcards to Voters gathering Molly Biehl organized at Teku Tavern. We each wrote at least 6 postcards to registered Democrat voters in Georgia, and it truly was the highlight of my day.


An incomplete yet potentially still useful resource for aspiring, entry-level, and early-career global health professionals

Every few weeks or so, I get an email from my alma mater, encouraging donations from alumni to support the college's x initiative, y program, and z future. While I'm grateful for everything I learned and gained during my college years, I don't feel like my few dollars a month can do much, or at least as much as other types of contributions could. 

So, for the last few years, I send a list of entry-level and early-career global health jobs I've found over the last month or so to Middlebury's global health program leadership and the school's career center. The list is far from comprehensive and the jobs are definitely biased toward more public sector opportunities, but it's something (and hopefuly better than nothing); feel free to share among aspiring, entry-level, and early-career global health professionals! http://sites.middlebury.edu/cci/uncategorized/the-news/global-health-opportunities-for-midd-grads/ 



Monday, October 22, 2018

Fireside chats - the best part of today in 2014


The following picture showed up on Facebook's "On this day" feed this morning...
...oh the days (aka 2014-2015) of "fireside chats" at the office and having this spectacular human as my officemate. 



Today I learned...
Coarsened exact matching (CEM), a method of matching I used for my MPH thesis (and thus I naturally dug up that old code for this weekend - wowser!), does not work with string variables. I was running cem on a dataset today and was momentarily floored when it seemed like perfect exact matching had worked (!??!)...and then that second passed and I donned my skeptic hat, dug into the data and code documentation, and alas...

Today I'm grateful for...
Annie Haakenstad, former officemate (see above), current/forever friend, and one of the few people I can go to about literally anything: one gchat conversation can cover some pretty in-depth career and life trajectory discussions, while the next is about how to properly implement /ponystream in said gchat window. I'm constantly inspired by her killer combination of non-sensense bad-assery (likely misspelled) and kindness, and well, I'm pretty darn thankful that I get to call her one of my people.

In a gchat today (Annie is based in Boston right now, hence the preponderance of gchat-based communication), Annie told me about a ritual she and her partner would do each evening: share what was the best part of each of their days. Sometimes it was something big ("Oh my gosh, I received this grant!"), sometimes it was something comparatively small ("I finally debugged this piece of code!"), sometimes it was completely unrelated to work or school ("My brother got engaged!"), sometimes it was work-based but had a less direct relation to work ("Our office got Uber Puppies today!"...for the record, this did not happen, but I'd like to imagine such an event would qualify for a day's "best part"). I really liked the idea, and decided then and there to add that to "Today I learned" and "Today I'm grateful for" bits. And so...[drum roll]

Today's best part...
Was talking for an hour plus with my mom after school/work. She had just come back from spending 11 days in Maine with my brother, sister-in-law, and still-pretty-new nephew (!!!)  the incredible saint that she is  and was willing to stay up past 10 pm EST catching up with me. I rarely, if ever, take a call past 8:30 pm, and bless my mother's heart (and delayed bedtime stamina), she was totally game to chat at a time that was most convenient for me. By the time I left the office today, I had begun to feel less like a Positive Polly (I have no idea if that's a thing) and more like a Negative Nancy (yes, I know that's a thing, thank you very much), and honestly, I wasn't looking forward to tackling what I needed to accomplish this evening. Yet after hearing about my mom's time in Maine and my nephew and catching up on various life things, I couldn't help but smile. Thanks mom, for being the best part of my today.

Sunday, October 21, 2018

Back to life, back to reality


Beyond the wonderment that is Soul II Soul's 1989 hit, this weekend was definitely a reality check about how much I need to stay on top of my class readings and assignments - and then make sure I follow-up at office hours when I'm unclear about something.

I spent about 10 hours on two assignments, an efficiency rate I'm not pleased with, but even worse, my grasp on some of the key aspects covered in those assignments felt pretty tenuous (e.g., properly redistributing censored data and corresponding weights for survival; confidently determining when/if relative risks v. odds ratios should be calculated based on the study design and data provided). With midterms right around the corner, I better get my nonsensically-studious Nancy cap on.

Today I learned...
A really annoying R quirk that cost me time and a sliver of sanity - it turns out that installing the library plyr overules the command group_by (even if you reinstall dplyr), continously leaving me only one row of summary statistics instead of said measures by group. I got so frustated I switched over to Stata to complete a portion of my biostatistics homework, rebooted my computer, and eventually Googled the error...which of course immediately gave me the answer (i.e., detach the plyr library).

Perhaps should be an addendum: shockingly, despite ~3.5 weeks of graduate school, today I learned Google's debugging capacities remain superior to mine.


Today I'm grateful for...
Sleeping in until 8:30 am with a sweet yellow lab spoon by my side. Apparently I needed the ~11 hours of sleep - and well, a warm snuggle body is always a bonus. 

Saturday, October 20, 2018

Carrot and stick


In my book, as well as Stark's, carrots always win over the stick...




Today I learned...
The extent to which my country's "national" (and theoretically "unbiased") health statistics are skewed by sociocultural biases. Of course I've known about and, to some extent, understood the magnitude to which science is subjective, but seeing this in print was weirdly shocking. Seriously, as recent as 1989, the US was only willing to view the race of a newborn as the race of the mother - and not any compilation of the mother and father's racial identification, let alone history?! (And the clearly, the conditionals for pre-1989 are even more appalling). Let this be a good reminder of how science is never devoid of subjective and sociocultural factors - never.


Today I'm grateful for...
My Wallingford/Fremont family, aka my PhD (and overall life) support team outside of my immediate field. These ladies not only keep me sane and grounded, but oh so importantly, remind me of the world outside of academia. I easily get wrapped up in the research cycle and what is considered normal within the academic system: a 'normal' that often equates with 60+ hour weeks for months on end, weekends of non-stop work, and taking on roles or responsibilities well outside one's alleged job description. I'm happily pursing an academic career trajectory, and honestly, I view myself as pretty lucky to have this as even an option to pursue. Nonetheless, I've found it to be so important to have my people - the equivalent of a chosen family - as a straight-shooting yet supportive support system over the years. I'm pretty sure I can't ever fully express my gratitude for you and everything you do; perhaps this blog-based shout-out can provide an inkling.

Friday, October 19, 2018

Scottish statistics segues

When your biostatistics professor is Scottish (he's actually from Fife, which is the 'kingdom' wherein I studied abroad during college), lecture slides naturally segue between measuring covariance and "line fitting" for microdata with the Jacobite steam train chugging along the Glenfinnan viaduct...


(aka the Harry Potter train, aka the train to Hogwarts in the movies, 
aka one of the best things I did the last time I was in Scotland [i.e., summer 2015])


Today I learned...
Lowess and Loess, while seemingly related approaches or methods for generating smoothed curves and fitting non-linear "lines" to data, are technically different (or so we'll likely learn later in my biostatistics series). And this apparently is the case, even though they sound. exactly. the. same. 

Today I'm grateful for...
Amanda Smith, who amid our mutually shared love for dry humor and the occasional snarky comment, pushes me to have more patience, and thus helps me to be a better person. 

Thursday, October 18, 2018

Non-student homework? Job/career "assignments" for your future

Before I tuck into homework of the school variety, I wanted to share some job/career "homework assignments" I recently resent to a number of people.

What - job homework? These "assignments" were given to me in ~2015 when I was trying to make some tough job decisions and thus potential career trajectories. I was massively struggling to pin down what I really wanted, and well, these homework assignments came in. The people who gave me these assignments knew that (1) I'd take doing this "homework" seriously since I like completing tasks; and (2) this format could help me drill down to what was most important to me, individually, versus what I was perceiving as important to a lot of other people. I now have people I mentor or friends who are trying to figure out their next steps complete these job/career "homework assignments," so they're truly the gifts that keep on giving.

Job homework #1
a) I love my job because...
b) I want my job to be...
c) I don't want my job to be...
d) I wish my job was...
e) If I had my dream job, I would put up with...
f) What are your dealbreaks: what I have to do, what I won't do...

Job/career homework #2
Identify 5-7 jobs that currently exist and I would want to have in 5-10 years, and then detail why I wanted them/what skills I could bring today to the positions; what I needed to gain skill or experience-wise to be qualified for those jobs in the next 5-10 years; and any other information that's pertinent. I completed this assignment by filling out a spreadsheet with the following columns: Timing; Position; Organization; Why I'd be good at it; What I'm currently lacking/I need; Pros; Cons; Any other notes; Link to position or current person who has it.

Feel free to take either of these "homeworks" or share them with your colleagues, friends, and/or mentees!




Today I learned...
The difference between odds (counts of events/counts of non-events) and probability (counts of events/all counts) - EPI512 is so enlightening! (Seriously!)

Today I'm grateful for...
Falko, a wonderful friend/colleague IHME who always puts a smile on my face (and/or a very loud burst of laughter amid all of the cubicles). He truly make me ful(l) of grate.

Wednesday, October 17, 2018

Be on time or early, they said

When you go to class and it's 8:28 am and you't figure out why no one is here two minutes before it's supposed to start...



...it's a 9:30 am class. Oops.

Today I learned...
(Double) checking my Outlook calendar  where I've carefully mapped out class and work times, travel times to and from said class and work, meetings, follow-up email flags, and so on  when I lake up is probably a good idea.

Today I'm grateful for...
Being a morning person, or at least being a fairly functional morning person conditional upon getting somewhat regular sleep. And coffee. All the coffee. So maybe I'm actually more grateful for coffee.

Tuesday, October 16, 2018

Forecasting fun with Foreman and friends

After many years of incredibly hard work by equally incredible people, Kyle Foreman and friends (fine colleagues, but I love those alliterations) published their forecasting paper in The Lancet today! It was truly an honor to work with the team and to help bring their results to life (though with their innovative figures and visualization tools, they really didn't need the help).




Today I learned...
How to actually read cohort graphs/results! Thanks to Slide 44 in my epidemiology class (see below) and Ali Rowhani-Rahbar's phenomenal teaching, it makes so much more sense to me now.



Good thing I was able to "fake it until you make it" with Marissa Reitsma and colleagues when I was helping to write the GBD 2015 smoking paper and we were drafting results about that multicolor cohort graph...though the more likely situation was that Marissa immediately sensed I wasn't sure how to properly interpret the graph and quietly fixed anything amiss before the paper was submitted. Because that's how lovely Marissa Reitsma is.

Today I'm grateful for...
The thoughtful, brilliant, and inspirational people in my PhD cohort. For instance, Elizabeth Irungu and I try to sit together at our epidemiology discussion sections and lectures, which I so appreciate this since our lives don't overlap too frequently with our different class and work schedules. Today Elizabeth kindly listened to me talk about how I was struggling to balance everything and figure out how to prioritize my (comparably light) class demands with work and studying and so on, providing me the space I needed to vent. We then started talking about other things, and while I don't remember now how exactly it came up, she mentioned how her family was back home in Kenya and she wanted to make sure she didn't miss too much of her boys growing up while she was pursuing her PhD, and that she was also trying to figure out the right balance of school, work, and life too. It was a moment that (1) my admiration for Elizabeth soared even higher; and (2) put a lot in perspective, especially in terms of how far so many people came for this program and what (hopefully) short-term sacrifices are being made for these long-term investments in ourselves.

Monday, October 15, 2018

Just another m(academic?) Monday

If these chairs could talk...[fill in the blank]

(as taken from my biostats lecture this morning)

In other news, I submitted my first-ever quiz as a PhD student (hurrah!).
Naturally, it took me exactly four times longer to complete than what the professor said it should take.
Now, relative to other decision-making units (i.e., students), I wonder how poor my efficiency score would be...perhaps by the end of my PhD, I'll figure out how to adopt the models developed by DiGiorgio and colleagues to answer this question...


Today I learned...
There are seemingly endless ways to measure blood pressure in a patient survey: if there are three measures, take the average of the first two or take the average of all three; round to the nearest integer or take the floor of averages; use both systolic and diastolic measures to classify patients into different categories (e.g., low, normal, borderline, high, severe) or just rely on systolic or more heavily weight systolic if systolic and diastolic measures do not neatly bin a patient into the aforementioned categories...and of course each of these decisions could have differential effects into how many patients are considered (1) hypertensive; and then (2) effectively controlled or uncontrolled with xyz interventions.

As someone relatively (aka very) new to the non-communicable disease (NCD) research arena, I started to go down a data/measurement rabbit hole this afternoon...


Today I'm grateful for...
Emmanuela Gakidou, my current PhD faculty advisor and career/life mentor for the last ~10 years, as she briskly pulled me out of said data/measurement rabbit hole and helped me see the forest for the trees in this particular analysis and project.

Emm's combination of thoughtful yet no-nonsense research oversight and insights, fierce support, and tough love works really well for me as a researcher and professional; the caveat, of course, is that it took me a few years to learn how to effectively receive and act on feedback, from Emm or anyone for that matter. Perhaps this skillset comes naturally for some people if this resonates with you, well congratulations, awesome, mad props (or whatever the youths are saying these days). I was not such a person, and it's something I actively, deliberately work on to this day. Receive feedback, check. Process feedback, detaching emotional ties or similar mental weeds that can ruin otherwise very meaningful, important guidance. Ch....ch....ok, phew, check (and high-five for getting all up in your head!). Act on feedback, including clearly expressing appreciation for the person's willingness to give you thoughtful, candid feedback.

I can probably still pull up the email where, at the time, a faculty member called my writing "half-baked" and that it seemed like I didn't care about a particular project. I remember it so clearly, feeling as if I was literally sucker-punched, as these were things I always viewed as 'signature strengths,' as the positive psychologists call it: (1) being a good writer; and (2) being invested in whatever project I was working on. And who knows, it's totally possible that particular piece of feedback wasn't about me at all nonetheless, that moment stands out to me because, while tough to hear, it also showed that this individual was invested in me.

Maybe this sounds a little odd, or perhaps a bit...masochistic? counterproductive? some negative-undertoned-adjective? I'm sure an endless debate could ensue. My two cents? While you should never be purposefully mean or nasty to someone (especially if you are in a position of authority), the opportunities for growth are often far and few between if you aren't open to receiving (and/or giving) candid, meaningful feedback. While I can't know the counterfactual, what I can say is that I am among the strongest scientific writers at the Institute for Health Metrics and Evaluation (IHME), and I happen to be very good at mentoring/supervising early career research professionals. #AppropriatelyConfident, per Dr. Jennifer Gunter

So thank you, to everyone who has invested me over the years, and for caring enough to give me the candid, thoughtful feedback I've usually, if not always, benefited from in one way or another.

Sunday, October 14, 2018

PhD portal (aka my working-from-home-landing-pad)

This is where the magic happens.

Amendment: this is where I hope the magic happens.

Another amendment: this is where (and where I hope) the SCIENCE happens.




Today I learned...
That the correct term is "randomized controlled trial," not "randomized control trial." How I've worked in research for so long without this knowledge is beyond me. The more you know huh. [insert colorful shooting star from the 1980s/90s]

Today I'm grateful for...
Kelly Bienhoff, a Sunday work buddy extraordinaire who always both grounds and lifts you up.

The struggle is real

After approximately 2.5 weeks into my PhD program, I think it's worth saying it out loud  I'm struggling.

This kind of  "struggle" isn't something I've experienced in awhile, or at least in terms of what I can remember well. Since starting class, I've struggled to establish a meaningful, effective schedule for myself and what I need to get done (i.e., attend classes, learn new content, contribute efficiently at my research assistant [RA]ship), want to do (i.e., work out regularly, see friends, get enough sleep), and when these things get done (i.e., before or after class, during the weekdays or weekends).

Just writing this out makes it all seem so trivial, especially since many many people are overcoming much more challenging and high-stakes hurdles every minute of every day. Yet here I am, feeling oddly overwhelmed by not having a settled schedule. I'm physically exhausted by it (e.g., I've gone to bed well before 9 pm the last few nights in an effort to combat this strain of tiredness) and psychologically, well, I feel like such a loser. I was pulling off insanely busy, complicated work demands and deliverables only a few months ago – why is juggling two classes and an RAship throwing me for such a loop? This should be child's play, a cake walk, all of the metaphors for easy-peasy, yadda yadda yadda. Speaking of loops, my mind keeps whirring through the very productive cycle of "Why can't I...why haven't I..." as I try to logically break down what I need to do to get myself back on track.

Well, here's the thing (as it turns out): most of this isn't logical, and to keep hammering at it as if these reactions and feelings are supposed to be logical is unlikely to suddenly propel them into a realm of rationality. Instead, by a taking few beats and allowing those thoughts to happen and then move along their merry ways rather than dwell on them, I can be less of a Negative Nancy and more of a no-nonsense, lets-get-'er-done Nancy.

Naturally, none of this is new for me, nor is it rocket (brain) science for anyone. My default settings are not being stellar with transitions, and holding myself to very, if not impossibly, high standards. I can't rewire my innards, but I can revise the lens through I view and react to them. Amid all of the hooplah of starting school and everything, I forgot how much of a transition this actually is – and thus I forgot to give myself more grace about it all. Oops.

:: A big thanks goes to Dr. Ellie Somers, who potentially unbeknownst to her (though likely less so now), helped me come to this realization with her lovely follow-up text about our physical therapy work and how my hip nerve issue was coming along. It was a good reminder not to have shame in such ups and downs, and that allowing oneself to heal is a massive gift (not to mention investment in one's health) ::

Here's to taking a beat, allowing oneself a moment or two to cry (and/or beat a Dammit doll over the counter - this I highly recommend), and moving toward slighty better things...like coding in R!

Today I learned...
How to make pdfs come out of R! And I think they're even vectorized...?



Also, having useDingbats as a command in the pdf function makes me giggle a little. I'm fairly sure I've used the term "dingbat" with some frequency in the recent past.


Today I'm grateful for...
Google searches, and more specifically, what Google is able return when I input seemingly incomprehensible help requests about R commands ("help R device null pdf").

Of course, such Google searches wouldn't produce anything without the prolific resources provided by R users throughout the world; my gratitude for you all is second to none.

Thursday, October 11, 2018

Of learning and gratitude

Today I want to share a little thing that reminded me of a bigger things and then things I want to incorporate into my everyday life (PhD or otherwise).

After a long day of class and work, I was marching down Stone Way Ave with a very full backpack, looking forward to being home as much as my backpack was full. I received a text from a friend  – "Come to Fremont [Brewing] for a fresh hop before you get home" – to which I resisted for about 30 seconds. (That should provide adequate insights into my priortization of my people and/or fresh hops, and particularly fresh hops at Fremont Brewing)

Upon joining everyone at Fremont, we cheered Caitlyn Steiner for her well-deserved promotion (Assistant Director, wahoo!) and chit-chatted for a bit. Then Caitlyn asked: "Nancy, what did you learn at school today?"

Huh, what a great question. Like a really great question.

After spending about a decade in global health (and in particular, population health measurement and related endeavors), I know a decent amount of things. Like if my former 686 officemates turned around in their seats and asked "Hey Nancy, do you know about xyz?" there was a good chance (p < 0.05, so take that as you will) I generally could answer it (or at minimum, tell you who to ask to get the answer). Yet there's essentially no limit to what I don't know, and one of the things I've loved about working at the Institute for Health Metrics and Evaluation (IHME) and now grad school is being in a state of always learning. My greatest fears are (1) being bored; and relatedly (2) no longer learning, both of which are easily remedied by the combination of doctoral studies and continued IHME employment. This question, in combination with practice from another phenomenal colleague (more below), has inspired me to (try to) document what I learn over the course of my PhD.

Aubrey Levine, another friend-colleague from IHME, introduced me to the concept of writing down what you're grateful for each day. While potentially blasphemous in theory (you've never thought of doing this – what are you, a selfish heathen?!), in application, it takes a level of conscientiousness that I rarely find at the end of the day. Yet taking that step back, and truly thinking about all of things for which I have immense gratitude, is so, so important – especially in my field, and especially all I have to be grateful for.

So here's what I'm going to do: whenever I post something, I will include (1) what I learned; and (2) what I'm grateful for today. This kind of regular exercise  reflecting and documenting what I'm learning and grateful for in an ongoing manner –  may seem like a small thing, but in totality, these are the small things that amount to big, important things.

Today I learned...
Washington State has (or at least had in one point in time) among the highest levels of epidemiologists per capita in the US.

The map below was featured in my epidemiology class, and  warning, not-so-humble brag  as a fellow classmate can attest, I guessed what measure the map was meant to reflet within a few seconds of it being on the screen. Hurrah for deductive (or is it inferential) reasoning?



Today I'm grateful for...
Badass women, in general and specifically today, Aubrey Levine and Caitlyn Steiner. I'm grateful for everything you do for your people, in and outside of work, in all the discernible and less obvious ways you do them.