STS 2019 Workforce Report: Ad Hoc Analysis of Women in Cardiothoracic Surgery

The Society of Thoracic Surgeons (STS) is the world’s largest cardiothoracic surgical organization, representing more than 7500 surgeons, researchers, and allied health care professionals worldwide. In response to the ever-changing working environment of cardiothoracic surgery, STS conducts a workforce survey approximately every 5 years. The 2019 Practice Survey was performed in the fall of 2019, the results of which were discussed at the STS 2020 annual meeting and were published by Ikonomidis and associates. 1 Because women remain an extremely small subset of the cardiothoracic workforce, Women in Thoracic Surgery, in conjunction with STS, reviewed the 2019 workforce survey results with a focus on female respondents

Evaluating the Quality of Research into a Single Prognostic Biomarker: A Systematic Review and Meta-analysis of 83 Studies of C-Reactive Protein in Stable Coronary Artery Disease

Background Systematic evaluations of the quality of research on a single prognostic biomarker are rare. We sought to evaluate the quality of prognostic research evidence for the association of C-reactive protein (CRP) with fatal and nonfatal events among patients with stable coronary disease. Methods and Findings We searched MEDLINE (1966 to 2009) and EMBASE (1980 to 2009) and selected prospective studies of patients with stable coronary disease, reporting a relative risk for the association of CRP with death and nonfatal cardiovascular events. We included 83 studies, reporting 61,684 patients and 6,485 outcome events. No study reported a prespecified statistical analysis protocol; only two studies reported the time elapsed (in months or years) between initial presentation of symptomatic coronary disease and inclusion in the study. Studies reported a median of seven items (of 17) from the REMARK reporting guidelines, with no evidence of change over time. The pooled relative risk for the top versus bottom third of CRP distribution was 1.97 (95% confidence interval [CI] 1.78–2.17), with substantial heterogeneity (I2 = 79.5). Only 13 studies adjusted for conventional risk factors (age, sex, smoking, obesity, diabetes, and low-density lipoprotein [LDL] cholesterol) and these had a relative risk of 1.65 (95% CI 1.39–1.96), I2 = 33.7. Studies reported ten different ways of comparing CRP values, with weaker relative risks for those based on continuous measures. Adjusting for publication bias (for which there was strong evidence, Egger's p<0.001) using a validated method reduced the relative risk to 1.19 (95% CI 1.13–1.25). Only two studies reported a measure of discrimination (c-statistic). In 20 studies the detection rate for subsequent events could be calculated and was 31% for a 10% false positive rate, and the calculated pooled c-statistic was 0.61 (0.57–0.66). Conclusion Multiple types of reporting bias, and publication bias, make the magnitude of any independent association between CRP and prognosis among patients with stable coronary disease sufficiently uncertain that no clinical practice recommendations can be made. Publication of prespecified statistical analytic protocols and prospective registration of studies, among other measures, might help improve the quality of prognostic biomarker research

FAIR Data Pipeline: provenance-driven data management for traceable scientific workflows

Modern epidemiological analyses to understand and combat the spread of disease depend critically on access to, and use of, data. Rapidly evolving data, such as data streams changing during a disease outbreak, are particularly challenging. Data management is further complicated by data being imprecisely identified when used. Public trust in policy decisions resulting from such analyses is easily damaged and is often low, with cynicism arising where claims of "following the science" are made without accompanying evidence. Tracing the provenance of such decisions back through open software to primary data would clarify this evidence, enhancing the transparency of the decision-making process. Here, we demonstrate a Findable, Accessible, Interoperable and Reusable (FAIR) data pipeline developed during the COVID-19 pandemic that allows easy annotation of data as they are consumed by analyses, while tracing the provenance of scientific outputs back through the analytical source code to data sources. Such a tool provides a mechanism for the public, and fellow scientists, to better assess the trust that should be placed in scientific evidence, while allowing scientists to support policy-makers in openly justifying their decisions. We believe that tools such as this should be promoted for use across all areas of policy-facing research

Sexual Harassment and Cardiothoracic Surgery: #UsToo?

Background Fifty-eight percent of women in science, engineering, and medicine report being affected by sexual harassment (SH). This study sought to determine the extent of SH in cardiothoracic surgery. Methods The study developed a survey that was based on the Sexual Experience Questionnaire-Workplace, physician wellness, and burnout surveys. The survey was open to responses for 45 days and was disseminated through The Society of Thoracic Surgeons, Women in Thoracic Surgery, and Thoracic Surgery Residents Association listservs. A reminder email was issued at 28 days. Student t tests, Fisher exact tests, and χ2 tests were used to compare results. Results Of 790 respondents, 75% were male and 82% were attending surgeons. A total of 81% of female surgeons vs 46% of male attending surgeons experienced SH (P < .001). SH also was reported by trainees (90% female vs 32% male; P < .001). According to women, the most common offenders were supervising leaders and colleagues; for men, it was ancillary staff and colleagues. Respondents reported SH at all levels of training. A total of 75% of women surgeons vs 51% of men surgeons witnessed a colleague be subjected to SH; 89% of respondents reported the victim as female (male 2%, both 9%; P < .001). A total of 49% of female witnesses (50% of male witnesses) reported no intervention; less than 5% of respondents reported the offender to a governing board. SH was positively associated with burnout. Conclusions SH is present in cardiothoracic surgery among faculty and trainees. Although women surgeons are more commonly affected, male surgeons also are subjected to SH. Despite witnessed events, intervention currently is limited. Policies, safeguards, and bystander training should be instituted to decrease these events

Multiple metabolic risk factors and mammographic breast density

PURPOSE: We examined whether obesity and a history of diabetes, hypertension, and elevated cholesterol, individually and in combination, are associated with breast density, a strong risk factor for breast cancer. METHODS: We measured percent density and dense area using a computer-assisted method (n=191; age range=40-61 years). We used linear regression models to examine the associations of each metabolic condition and the number of metabolic conditions (0, 1, 2, and 3 or 4 conditions) with breast density. RESULTS: Among individual metabolic conditions, only high blood cholesterol was inversely associated with percent density (β=-5.4, 95% CI: -8.5, -2.2) and dense area (β= -6.7, 95% CI=-11.1, -2.4). Having multiple metabolic conditions was also associated with lower breast density, with 2 conditions and 3 or 4 conditions vs. 0 conditions associated with 6.4% (95% CI:-11.2, -1.6) and 7.4% (95% CI:-12.9, -1.9) reduction in percent density and with 6.5 cm(2) (95% CI: -13.1, -0.1) and 9.5 cm(2) (95% CI: -17.1, -1.9) smaller dense area. CONCLUSIONS: A history of high blood cholesterol and multiple metabolic conditions were associated with lower relative and absolute measures of breast density. The positive association between metabolic abnormalities and breast cancer risk may be driven by pathways unrelated to mammographic breast density