2013 was a big year for public health. We were thrust to the forefront again with disease outbreaks, and have had to deal with increased skepticism of the nature of what we do from the public. Meanwhile, within the establishment, rifts have been growing between groups, as different professional organizations vie for power and control. Here are my top five public health stories for 2013, presented in no particular order, but I’d love to hear yours in the comments.
1. Polio in Syria
Polio is a crippling disease that has been covered on the blog before. It’s been almost completely eradicated, but is still endemic to certain parts of the word. However, following civil unrest in Syria, polio has started to spread again and has, to date, crippled 17 children. Before the March 2011 uprising, vaccination rates were estimated to be above 90%. However, since then, estimates for vaccination rates hover around 68% – enough to prevent the benefits of herd immunity from kicking in. In order to increase immunization rates, the UN is trying to mobilize a vaccine drive. However, due to political and safety concerns, they are having a hard time ensuring that all children are vaccinated. To quote NPR:
Polio does not stop at borders or military checkpoints. Without a comprehensive response to stop the virus, aid workers fear that the outbreak could become a public health catastrophe.
William Sealy Gosset, statistician and rebel | Picture from Wikimedia Commons
Let me tell you a story about William Sealy Gosset. William was a Chemistry and Math grad from Oxford University in the class of 1899 (they were partying like it was 1899 back then). After graduating, he took a job with the brewery of Arthur Guinness and Son, where he worked as a mathematician, trying to find the best yields of barley.
But this is where he ran into problems.
One of the most important assumptions in (most) statistical tests is that you have a large enough sample size to create inferences about your data. You can’t make many comments if you only have 1 data point. 3? Maybe. 5? Possibly. Ideally, we want at least 20-30 observations, if not more. It’s why when a goalie in hockey, or a batter in baseball, has a great game, you chalk it up to being a fluke, rather than indicative of their skill. Small sample sizes are much more likely to be affected by chance and thus may not be accurate of the underlying phenomena you’re trying to measure. Gosset, on the other hand, couldn’t create 30+ batches of Guinness in order to do the statistics on them. He had a much smaller sample size, and thus “normal” statistical methods wouldn’t work.
Gosset wouldn’t take this for an answer. He started writing up his thoughts, and examining the error associated with his estimates. However, he ran into problems. His mentor, Karl Pearson, of Pearson Product Moment Correlation Coefficient fame, while supportive, didn’t really appreciate how important the findings were. In addition, Guiness had very strict policies on what their employees could publish, as they were worried about their competitors discovering their trade secrets. So Gosset did what any normal mathematician would.
He published under a pseudonym. In a startlingly rebellious gesture, Gosset published his work in Biometrika titled “The Probable Error of a Mean.” (See, statisticians can be badasses too). The name he used? Student. His paper for the Guinness company became one of the most important statistical discoveries of the day, and the Student’s T-distribution is now an essential part of any introductory statistics course.
Movember is one of, if not the biggest, charity aimed at raising awareness about men’s health (Click image for more)
In Canada, the top three causes of death for men are cancer (31.1%), heart disease (21.6%) and unintentional injuries (5.0%). The top two are the same for women, although with slightly different percentages: cancer and heart disease account for 28.5% and 19.7% of all deaths among women, with stroke (7.0%) coming in third. In the US, men die at an overall rate 1.4-times higher than women, of heart disease 1.6-times more, and are twice as likely to die from an unintentional injury.
In fact, women outlive men by 4.5 years on average worldwide – 66.5 years vs 71.0 years. This difference increase to 7 years in the developed world. Not only are men more likely to die from the causes above, men are also more likely to commit suicide than women. This gender difference increased following the recession. A time trend analysis from the UK found that approximately 850 more men, and 155 more women committed suicide than would have been expected based on historical trends following the 2008 economic downturn, with the highest increases in those regions that were most affected by rising unemployment.
But what leads to these outcomes? Given we live in a world where people can get help when they need it, why should men be dying at a rate that is that much higher than women for (almost) the same diseases? And why are they dying younger than women?
Last time I spoke about how to deal with negative feedback, and how you can cope with it. However, as you transition from undergrad, to graduate student, to senior graduate student (to life afterwards), you’ll be placed more and more into positions of responsibility. When that happens, it will be your responsibility to give feedback, and at this point, you realize that it’s really difficult to give good, constructive feedback that doesn’t come off as harsh.
Depending on the person, this feedback could be to a student, a colleague, or even a senior student. My research group has had a lot of success with practice run-throughs of presentations for conferences and defences, and once the person has presented, giving them useful and constructive comments is something we strive for. The easy route out is to give them “soft” feedback and avoid major problems. However, that doesn’t help them as, if you don’t point out major points they can work on, someone else will. The goal of this post is to help you frame that feedback.
And, in honour of Thor: The Dark World, coming out this week, I’ll be recruiting my good friend and gym buddy Chris Hemsworth* to help me with this post.
This just makes me laugh. I’m not even sure why.
1. Real life or email? The first question is how to give feedback – face to face, or via e-mail. As we move more towards an electronic presence, sometimes it’s not only easier to give feedback electronically (such as when you’re in different cities), sometimes you have to (such as when you’re using track changes in word). People disagree over which is best, with this article falling on the email side, and this article falling on the face to face side. Frankly, I think both can be done well, and both can be done poorly. Finally, if you do choose to provide feedback in real life, keep it respectful, and, if necessary, private. Do not publicly shame someone.
A car is not a good place to give feedback.
2. Follow up This relates to the point above, as one of the major benefits of face-to-face feedback is that you can provide instant feedback and clarify concerns on the spot. Email does not allow for quick clarification the way a face to face meeting does. One option is to send the email and then follow up on the phone or in-person soon afterwards, or meet first, and then provide written feedback. Similarly, once the feedback has been given, that’s not the end of the process. Improving oneself and developing skills takes time and effort, and small “course corrections” may be required, especially if the person has a hard time interpreting what you’re asking them to do. If they want more help or clarification later on, that should be available to them.
Don’t worry Thor, we’ll be specific!
3. Be specific If you have an issue with something, say that. Don’t be vague as that can lead to further confusion. For example, some people when they present, never make eye contact. So when providing feedback, say “you need to make more eye contact.” Don’t say “you need to engage the audience.” The latter is not helpful, and can mean a number of different things, ranging from more eye contact, to more audience participation, to revamping your slide deck. Providing specific comments bypasses this concern.
We’re not attacking you Thor! We’re just providing feedback!
4. Present facts, not opinions Avoid subjective words and emotional descriptions of events. Rather than saying “you didn’t care about this project” you want to focus on the specifics “your introduction needed more detail about X.” Continuing in the same vein, remove emotion and wait if things are too charged. Waiting for people to process their own feelings following an experience allows for everyone to think logically and productively, and at that point, feedback (may) be welcomed. This is as much for you as it is for them:
“The exception to this is if the situation involved is highly emotional. Here, wait until everyone has calmed down before you engage in feedback. You can’t risk letting yourself get worked up and risk saying something you will regret later.”
That is good, positive, specific feedback! Way to go Thor!
5. Positivity! We often dwell on the negative, and only provide feedback about areas of improvement. However, also consider providing positive feedback! If someone does a really good job of explaining a concept, or writes a very clear article, then tell them that! One of the tricks is learning not only what you need to improve, but capitalizing on what you do well and putting that front and centre, and stating that can help boost a person’s morale, confidence and make the whole process a lot more enjoyable and positive for all involved.
*Note: I’m not actually friends with Chris Hemsworth, and I’m not getting anything from Marvel Studios/Walt Disney Studios Motion Pictures to include these GIFs.
A quick update for all our readers – Cristina and I (Atif) will be in beautiful Gainesville, Florida this week for the National Association of Science Writers/Council for the Advancement of Science Writers annual conference!
Scientists know science. And they’re good at getting science news. Know who’s not? Non-scientists. Yet non-scientists outnumber scientists, and their attitudes, believes, intellects (or not) and their votes help determine science policies, from funding for stem cells to what’s taught in school. The near-extinction of science reporters at local news outlets has created a gap in a steady stream of legitimate, dependable science news. Yet today there are more ways than ever to reach the general public. This session is about expanding your audience beyond the science in crowd. We’ll talk with two young scientists who are passionate about finding new ways to reach new audiences and we’ll explore ideas for how PIOs, freelancers, staff reporters and even scientists themselves can take a lesson from the universe and expand.
If you see either of us around, be sure to say hi! We’ll be at most of the events, and would love to meet you!
You’ve spent the last month working on a manuscript/paper, have fleshed out your ideas, spent countless late nights editing and making things sound *just* right, and you’ve finally sent it in to your supervisor. This will be the draft. This will be the one that they read and go “Wow! Good job! Submit this to Nature immediately!” And it’ll be accepted within a week, and you’ll be flown to Washington to present the paper to President Barack Obama himself, and, while you’re there, BB King will show up and you’ll jam together in the oval office, and, just when you think you’re about to finish your Epic Blues Jam Session, Bill Clinton will come by and play the saxophone.
But then, your supervisor sends you your paper back, and it’s either covered in red ink or there are 714 comments in Microsoft’s Track Changes.
This is *literally* the most appropriate GIF I could find.
One of the major reasons you’re in grad school is to learn from these experiences. There is a reason your supervisor is the Canada Research Chair of Awesomeness, or is internationally known for their work. It’s because they’re very good at what they do, and part of what they do is write, and write well. Your goal is to learn everything you can from them, and in that process, improve your skills. And writing is just one part of this process – your ideas will need refinement, your writing will need work, your teaching will need improvement, all of these are skills you can work on during your graduate education. However, in order to improve, you need to deal with feedback, which can come from a wide range of sources including your supervisor, your students (via TA/TF evaluations) and people at conferences.
1: Take a break.
The first thing I tell all the students I work with when they get back corrections is to read it, then leave it. Skim over the comments, get that initial “THIS IS THE WORST NEWS EVAR!” feeling out, and then go for a walk. Once that initial visceral response has passed, you can start dealing with the comments themselves. As this 99u article says:
Don’t react defensively – or aggressively – no matter how hurt, disappointed, or annoyed you feel. Start by taking a deep breath and reminding yourself of your goal.
2: Remove emotion from the equation.
As silly as it sounds, you do get emotionally attached to your writing over time. You’ve spent countless hours tweaking everything, making it sound *just right* before sending it in. You’ve read and reread sentences again and again to make sure they’re clear. Your supervisor then rewrites many of those sentences, and may suggest that some are unclear and need work. At a conference, someone might be less diplomatic, and call your work all kinds of names. You need to take emotion out of the equation as you hear those comments, and decide what comments have merit and require further thought. One thing you should not do is take criticism of you to be a personal attack. Negative feedback isn’t personal. By removing any emotional responses from the comments, you can evaluate comments on their own merit, and decide how to deal with them.
This may be extreme, but you get the idea.
3: Triage comments
In an emergency room, patients are triaged. Those with life-threatening conditions are identified as high priorities, while those who do not need immediate attention will be waiting for beds to open up. Similarly, you need to identify which comments are important, and need to be addressed immediately, and which are stylistic and you can let slide. Pick your battles.
4: Identify constructive criticism
We’re now thinking of comments outside of those that your supervisor would give you – we’re into the realm of feedback from students, audience members at presentations, and others. Listen to the comments, and understand why the feedback is being given and what you can do to improve. What you really need to do here is identify what is constructive and helpful, and where the comment is coming from so you know how to fix it. Use the comments to help you, and be objective about whether or not it is useful – even if you don’t like the comment.
5: Ignore personal attacks
One of the best pieces of advice I got as a Masters student was to listen to all comments and evaluate them all, even the ones you don’t agree with, but to always ignore personal attacks. And you will get personal attacks – students will write mean comments in TA evaluations, people will attack you at conferences, and, especially if you put your ideas out on the internet, you will get called all kinds of names. It’s very easy to dwell on those comments: don’t. You know you’re good at what you do, and don’t let anyone tell you otherwise.
This GIF always makes me laugh. I don’t know why.
6: Don’t listen to everyone
And thus we get to the final point: don’t listen to everyone. Everyone will have advice, everyone will have an opinion. Take the points that you like, synthesize them, and use your own judgement to decide what works for you and fits your project/worldview (that includes this article). Don’t accept everything blindly. Decide what you stand for, and if someone is arguing with you about it, plant your feet firmly and don’t budge.
Do those words scare you? If they do, you’re in good company. Mathematical anxiety is a well studied phenomenon that manifests for a number of different reasons. It’s an issue I’ve talked about before at length, and something that frustrates me no end. In my opinion though, one of the biggest culprits behind this is how math alienates people. Lets try an example:
If the average of three distinct positive integers is 22, what is the largest possible value of these three integers?
A: 64
B: 63
C: 33
D: 42
E: 48
Too easy? How about this one:
The average of the integers 24, 6, 12, x and y is 11. What is the value of the sum x + y?
A: 11
B: 17
C: 13
D: 15
I do statistics regularly, and I find these tricky. Not because the underlying math is hard, or that they’re fundamentally “difficult,” but because you have to read the question 3 or 4 times just to figure out what they’re asking. This is exacerbated at higher levels, where you need to first understand the problem, and then understand the math.*
One of my main objectives as a statistics instructor is to take “fear” out of the equation (math joke!), and make my students comfortable with the underlying mathematical concepts. I’m not looking for everyone to become a statistician, but I do want them to be able to understand statistics in everyday life. Once they have mastered the underlying concepts, we can then apply them to new and novel situations. Given most of my students are athletically minded or have a basic understanding of sports, this is a logical and reasonable place to start.
Friend of the blog Sharday Mosurinjohn recently interviewed me for a profile on the Queen’s University School of Graduate Studies website. The first paragraph of her (very flattering) interview is below, and follow the link provided for the whole thing.
Kukaswadia moved to Canada in 2002 with his family from the UK. He started his undergraduate degree in Biology at Carleton University, where he focused on ecology and studied caterpillars, butterflies and mud shrimp. The thing Kukaswadia most enjoyed about ecology was how “everything was interconnected – you never study one squirrel in isolation. You study the whole environment and how elements of the environment interact.”
While he enjoyed Ecology, he realized that studying butterflies and caterpillars wasn’t for him. So he started a second degree in Health Psychology. Using his background in ecology, he began looking at humans the same way he had been trained to look at non-human animals and, specifically, at how the environment affects humans. This combination of interests led him to Queen’s, and the Department of Public Health Sciences.
Today, the APHA is encouraging you to be prepared with their annual Get Ready Day! Across the country, people will be preparing for disasters, and encouraging people to consider how they are ready for any disasters that might happen.
The typical image that comes to mind when people think of getting ready for natural disasters is the “Y2K bunker,” where people have months of canned goods, water jugs, and matches, preparing for an apocalypse where we live in a Walking Dead or Mad Max style wasteland, struggling for survival. These individuals may or may not be sporting a beard and wearing camouflage gear in the middle of suburbia.
But that’s not what we’re talking about (although similar principles apply). A disaster could be anything ranging from a fire, a flood, a terrorist attack, or something more localized such as a storm taking out power in your neighbourhood, or a tree falling down on your house. These sorts of events will happen, and being prepared can help you and your family stay safe throughout.
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Mr Epidemiology 