Associate editor at BMC Thrombosis Journal

source: https://goo.gl/CS2XtJ
source: https://goo.gl/CS2XtJ

In the week just before Christmas, HtC approached me by asking whether or not I would like to join the editorial board of BMC Thrombosis Journal as an Associate Editor. the aims and scope of the journal, taken from their website:

“Thrombosis Journal  is an open-access journal that publishes original articles on aspects of clinical and basic research, new methodology, case reports and reviews in the areas of thrombosis.Topics of particular interest include the diagnosis of arterial and venous thrombosis, new antithrombotic treatments, new developments in the understanding, diagnosis and treatments of atherosclerotic vessel disease, relations between haemostasis and vascular disease, hypertension, diabetes, immunology and obesity.”

I talked to HtC, someone at BMC, as well as some of my friends and colleagues whether or not this would be a wise thing to do. Here is an overview of the points that came up:

Experience: Thrombosis is the field where I grew up in as a researcher. I know the basics, and have some extensive knowledge on specific parts of the field. But with my move to Germany, I started to focus on stroke, so one might wonder why not use your time to work with a stroke related journal. My answer is that the field of thrombosis is a stroke related field and that my position in both worlds is a good opportunity to learn from both fields. Sure, there will be topics that I have less knowledge off, but here is where an associate editor should rely on expert reviewers and fellow editors.

This new position will also provide me with a bunch of new experiences in itself: for example, sitting on the other side of the table in a peer review process might help me to better understand a rejection of one of my own papers. Bottom line is that I think that I both bring and gain relevant experiences in this new position.

Time: These things cost time. A lot. Especially when you need to learn the skills needed for the job, like me. But learning these skills as an associate editor is an integral part of the science apparatus, and I am sure that the time that I invest will help me develop as a scientist. Also, the time that I need to spend is not necessary the type of time that I currently lack, i.e. writing time. For writing and doing research myself I need decent blocks of time to dive in and focus  — 4+ hours if possible. The time I need to perform my associate editor tasks is more fragmented: find peer reviewers, read their comments and make a final judgement are relative fragmented activities and I am sure that as soon as I get the hang of it I can squeeze those activities within shorter slots of time. Perhaps a nice way to fill those otherwise lost 30 minutes between two meetings?

Open science: Thrombosis journal is part of the Biomed central family. As such, it is an 100% OA journal. It is not that I am an open science fanboy or sceptic, but I am very curious how OA is developing and working with an OA journal will help me to understand what OA can and cannot deliver.

Going over these points, I am convinced that I can contribute to the journal with my experience in the fields of coagulation, stroke and research methodology. Also, I think that the time that it will take to learn the skills needed are an investment that in the end will help me to grow as a researcher. So, I replied HtC with a positive answer. Expect email requesting for a peer review report soon!

The paradox of the BMI paradox

2016-10-19-17_52_02-physbe-talk-bs-pdf-adobe-reader

I had the honor to be invited to the PHYSBE research group in Gothenburg, Sweden. I got to talk about the paradox of the BMI paradox. In the announcement abstract I wrote:

“The paradox of the BMI paradox”
Many fields have their own so-called “paradox”, where a risk factor in certain
instances suddenly seems to be protective. A good example is the BMI paradox,
where high BMI in some studies seems to be protective of mortality. I will
argue that these paradoxes can be explained by a form of selection bias. But I
will also discuss that these paradoxes have provided researchers with much
more than just an erroneous conclusion on the causal link between BMI and
mortality.

I first address the problem of BMI as an exposure. Easy stuff. But then we come to index even bias, or collider stratification bias. and how selections do matter in a recurrence research paradox -like PFO & stroke- or a health status research like BMI- and can introduce confounding into the equation.

I see that the confounding might not be enough to explain all that is observed in observational research, so I continued looking for other reasons there are these strong feelings on these paradoxes. Do they exist, or don’t they?I found that the two sides tend to “talk in two worlds”. One side talks about causal research and asks what we can learn from the biological systems that might play a role, whereas others think with their clinical  POV and start to talk about RCTs and the need for weight control programs in patients. But there is huge difference in study design, RQ and interpretation of results between the studies that they cite and interpret. Perhaps part of the paradox can be explained by this misunderstanding.

But the cool thing about the paradox is that through complicated topics, new hypothesis , interesting findings and strong feelings about the existence of paradoxes, I think that the we can all agree: the field of obesity research has won in the end. and with winning i mean that the methods are now better described, better discussed and better applied. New hypothesis are being generated and confirmed or refuted. All in all, the field makes progress not despite, but because the paradox. A paradox that doesn’t even exist. How is that for a paradox?

All in all an interesting day, and i think i made some friends in Gothenburg. Perhaps we can do some cool science together!

Slides can be found here.

How to set up a research group

A couple of weeks ago I wrote down some thoughts I had while writing a paper for the JTH series on Early Career Researchers. I was asked to write how one sets up a research group, and the four points I described in my previous post can be recognised in the final paper.

But I also added some reading tips in the paper. reading on a particular topic helps me not only to learn what is written in the books, but also to get my mind in a certain mindset. So, when i knew that i was going to take over a research group in Berlin I read a couple of books, both fiction and non fiction. Some where about Berlin (e.g. Cees Nootebooms Berlijn 1989/2009), some were focussed on academic life (e.g. Porterhouse Blue). They help to get my mind in a certain gear to help me prepare of what is going on. In that sense, my bookcase says a lot about myself.

The number one on the list of recommended reads are the standard management best sellers, as I wrote in the text box:

// Management books There are many titles that I can mention here; whether it the best-seller Seven Habits of Highly Effective People or any of the smaller booklets by Ken Blanchard, I am convinced that reading some of these texts can help you in your own development as a group leader. Perhaps you will like some of the techniques and approaches that are proposed and decide to adopt them. Or, like me, you may initially find yourself irritated because you cannot envision the approaches working in the academic setting. If this happens, I encourage you to keep reading because even in these cases, I learned something about how academia works and what my role as a group leader could be through this process of reflection. My absolute top recommendation in this category is Leadership and Self-Deception: a text that initially got on my nerves but in the end taught me a lot.

I really think that is true. You should not only read books that you agree with, or which story you enjoy. Sometimes you can like a book not for its content but the way it makes you question your own preexisting beliefs and habits. But it is true that this sometimes makes it difficult to actually finnish such a book.

Next to books, I am quite into podcasts so I also wrote

// Start up. Not a book, but a podcast from Gimlet media about “what it’s really like to get a business off the ground.” It is mostly about tech start-ups, but the issues that arise when setting up a business are in many ways similar to those you encounter when you are starting up a research group. I especially enjoyed seasons 1 and 3.

I thought about including the sponsored podcast “open for business” from Gimlet Creative, as it touches upon some very relevant aspects of starting something new. But for me the jury is still out on the “sponsored podcast” concept  – it is branded content from amazon, and I am not sure to what extent I like that. For now, i do not like it enough to include it in the least in my JTH-paper.

The paper is not online due to the summer break,but I will provide a link asap.

– update 11.10.2016 – here is a link to the paper. 

 

 

 

 

Does d-dimer really improve DVT prediction in stroke?

369
elsevier.com

Good question, and even though thromboprofylaxis is already given according to guidelines in some countries, I can see the added value of a good discriminating prediction rule. Especially finding those patients with low DVT risk might be useful. But using d-dimer is a whole other question. To answer this, a thorough prediction model needs to be set up both with and without the information of d-dimer and only a direct comparison of these two models will provide the information we need.

In our view, that is not what the paper by Balogun et al did. And after critical appraisal of the tables and text, we found some inconsistencies that prohibits the reader from understanding what exactly was done and which results were obtained. In the end, we decided to write a letter to the editor, especially to prevent that other readers to mistakenly take over the conclusion of the authors. This conclusion, being that “D-dimer concentration with in 48 h of acute stroke is independently associated with development of DVT.This observation would require confirmation in a large study.” Our opinion is that the data from this study needs to be analysed properly to justify such an conclusion. One of the key elements in our letter is that the authors never compare the AUC of the model with and without d-dimer. This is needed as that would provide the bulk of the answer whether or not d-dimer should be measured. The only clue we have are the ORs of d-dimer, which range between 3-4, which is not really impressive when it comes to diagnosis and prediction. For more information on this, please check this paper on the misuse of the OR as a measure of interest for diagnosis/prediction by Pepe et al.

A final thing I want to mention is that our letter was the result of a mini-internship of one of the students at the Master programme of the CSB and was drafted in collaboration with our Virchow scholar HGdH from the Netherlands. Great team work!

The letter can be found on the website of Thrombosis Research as well as on my Mendeley profile.

 

Starting a research group: some thoughts for a new paper

isth-logo

It has been 18 months since I started in Berlin to start at the CSB to take over the lead of the clinical epidemiology research group. Recently, the ISTH early career taskforce  have contacted me whether I would be willing to write something about my experiences over the last 18 months as a rookie group leader. The idea is that these experiences, combined with a couple of other papers on similar useful topics for early career researchers, will be published in JTH.

I was a bit reluctant at first, as I believe that how people handle new situations that one encounters as a new group leader is quite dependent on personality and the individual circumstances. But then again, the new situations that i encountered might be more generalizable to other people. So I decided to go ahead and focus more on the description of the new situations I found myself in while trying to keep the personal experiences limited and only for illustrations only.

While writing, I have discerned that there are basically 4 new things about my new situations that I would have loved to realise a bit earlier.

  1. A new research group is never without context; get to know the academic landscape of your research group as this is where you find people for new collaboration etc
  2. You either start a new research group from scratch, or your inherit a research group; be aware that both have very different consequences and require different approaches.
  3. Try to find training and mentoring to help you cope with your new roles that group leaders have; it is not only the role of group leader that you need to get adjusted to. HR manager, accountant, mentor, researcher, project initiator, project manager, consultant are just a couple of roles that I also need to fulfill on a regular basis.
  4. New projects; it is tempting to put all your power, attention time and money behind a project. but sometimes new projects fail. Perhaps start a couple of small side projects as a contingency?

As said, the stuff I describe in the paper might be very specific for my situation and as such not likely to be applicable for everyone. Nonetheless, I hope that reading the paper might help other young researchers to help them prepare for the transition from post-doc to group leader. I will report back when the paper is finished and available online.

 

Causal Inference in Law: An Epidemiological Perspective

source:ejrr

Finally, it is here. The article I wrote together with WdH, MZ and RM was published in the European Journal of Risk and Regulation last week. And boy, did it take time! This whole project, an interdisciplinary project where epidemiological thinking was applied to questions of causal inference in tort law, took > 3 years – with only a couple of months writing… the rest was waiting and waiting and waiting and some peer review. but more on this later.

First some content. in the article we discuss the idea of proportional liability that adheres to the epidemiological concept of multi-causality. But the article is more: as this is a journal for non epidemiologist, we also provide a short and condensed overview of study design, bias and other epidemiological concepts such as counterfactual thinking. You might have recognised the theme from my visits to the Leiden Law school for some workshops. The EJRR editorial describes it asas: “(…) discuss the problem of causal inference in law, by providing an epidemiological viewpoint. More specifically, by scrutinizing the concept of the so-called “proportional liability”, which embraces the epidemiological notion of multi-causality, they demonstrate how the former can be made more proportional to a defendant’s relative contribution in the known causal mechanism underlying a particular damage.”

Getting this thing published was tough: the quality of the peer review was low (dare I say zero?),communication was difficult, submission system flawed etc. But most of all the editorial office was slow – first submission was June 2013! This could be a non-medical journal thing, i do not know, but still almost three years. And this all for an invited article that was planned to be part of a special edition on the link between epi and law, which never came. Due several delays (surprise!) of the other articles for this edition, it was decided that our article is not waiting for this special edition anymore. Therefore, our cool little insight into epidemiology now seems to be lost between all those legal and risk regulation articles. A shame if you ask me, but I am glad that we are not waiting any longer!

Although i do love interdisciplinary projects, and I think the result is a nice one, I do not want to go through this process again. No more EJRR for me.

Ow, one more thing… the article is behind a pay wall and i do not have access through my university, nor did the editorial office provide me with a link to a pdf of the final version. So, to be honest, I don’t have the final article myself! Feels weird. I hope EJRR will provide me with a pdf quite soon. In the meantime, anybody with access to this article, please feel free to send me a copy!

Changing stroke incidence and prevalence

changing stroke population

Lower changing incidences of disease over time do not necessarily mean that the number of patients in care also goes down, as the prevalence of the disease is a function of incidence and mortality. “Death Cures”. Combine this notion with the fact that both the incidence and mortality rates of the different stroke subtypes change different over time, and you will see that the group of patients that suffer from stroke will be quite different from the current one.

I made this picture to accompany a small text on declining stroke incidences which I have written for the newsletter of the Kompetenznetz Schlaganfall. which can be found in this pdf.