Hayes, Sharonne N.

Background: Grand rounds and named lectureships are forums in academic medicine for sharing research, scholarly achievements, and clinical expertise. An invitation to speak at grand rounds is regarded as an honor and is part of the pathway to academic promotion. We describe gender representation relative to the national academic medical workforce among invited speakers at departmental grand rounds and annual named lectures at a large academic medical center. Materials and Methods: Lists of external speakers for grand rounds from 2015 through 2017 were obtained from 18 departments and for annual named lectures from 2007 to 2017 from 7 departments. Results: Of the 783 invited speakers to the 25 speaker series, there were 178 women (22.7%). The proportion of women speakers for departmental grand rounds ranged from 0% to 59.3%; representation of women speakers was lower than representation in their specialty in 14 of the 18 departments and significantly lower in 4 of the 18 departments. In four departments, there was a higher proportion of women than available in the specialty-specific academic medicine workforce. The proportion of women who spoke at annual named lectures was significantly lower in two of seven lecture series and ranged from 0% to 21.2%. Three departments had no women speakers. Conclusions: The underrepresentation of women as speakers is a potential target to improve gender representation and role modeling and provide equitable opportunity for academic advancement. Solutions may include formal diversity and inclusion training, intentional overrepresentation of invited female speakers, and inclusion of women on grand rounds planning committees.

Background: Deep learning algorithms derived in homogeneous populations may be poorly generalizable and have the potential to reflect, perpetuate, and even exacerbate racial/ethnic disparities in health and health care. In this study, we aimed to (1) assess whether the performance of a deep learning algorithm designed to detect low left ventricular ejection fraction using the 12-lead ECG varies by race/ethnicity and to (2) determine whether its performance is determined by the derivation population or by racial variation in the ECG. Methods: We performed a retrospective cohort analysis that included 97 829 patients with paired ECGs and echocardiograms. We tested the model performance by race/ethnicity for convolutional neural network designed to identify patients with a left ventricular ejection fraction ≤35% from the 12-lead ECG. Results: The convolutional neural network that was previously derived in a homogeneous population (derivation cohort, n=44 959; 96.2% non-Hispanic white) demonstrated consistent performance to detect low left ventricular ejection fraction across a range of racial/ethnic subgroups in a separate testing cohort (n=52 870): non-Hispanic white (n=44 524; area under the curve [AUC], 0.931), Asian (n=557; AUC, 0.961), black/African American (n=651; AUC, 0.937), Hispanic/Latino (n=331; AUC, 0.937), and American Indian/Native Alaskan (n=223; AUC, 0.938). In secondary analyses, a separate neural network was able to discern racial subgroup category (black/African American [AUC, 0.84], and white, non-Hispanic [AUC, 0.76] in a 5-class classifier), and a network trained only in non-Hispanic whites from the original derivation cohort performed similarly well across a range of racial/ethnic subgroups in the testing cohort with an AUC of at least 0.930 in all racial/ethnic subgroups. Conclusions: Our study demonstrates that while ECG characteristics vary by race, this did not impact the ability of a convolutional neural network to predict low left ventricular ejection fraction from the ECG. We recommend reporting of performance among diverse ethnic, racial, age, and sex groups for all new artificial intelligence tools to ensure responsible use of artificial intelligence in medicine.

Abstract Background Nurse leaders who are mothers are at significant risk for experiencing stress, burnout, and occupational fatigue. Authentic Connections (AC) Groups is an intervention shown to be effective for fostering resilience among at‐risk moms, including physicians; however, it has not previously been tested with nurse leaders. Aims Our aims were to test the feasibility and acceptability of the AC Groups intervention with nurse leader mothers and examine its effects on participant resilience, as measured by increased self‐compassion and decreased distress, depression, perceived stress, and burnout. Methods A randomized controlled trial design was employed for this pilot study, with 36 nurse leaders at Mayo Clinic. AC participants attended group sessions for an hour per week for 12 weeks. Control group members were provided 1 hr per week of free time over 12 weeks. Multiple self‐report psychological measures were completed at baseline, post‐intervention, and 3‐month follow‐up. Results The AC Groups intervention was feasible and well‐received by nurse leaders. Session attendance rates averaged 92%. Despite the small n ’s, repeated measures of Analysis of Variance showed significantly greater improvements ( p < .05) for participants in the AC Groups than control condition for depression, self‐compassion, and perceived stress, with large effect sizes ( 0.18–0.22). In addition, effect sizes for anxiety and feeling loved approximated the moderate range ( 0.05 and .07). Linking Evidence to Action The AC intervention shows promise as a feasible intervention for mitigating nurse leader mothers’ stress by positively impacting indices of well‐being, including depression, self‐compassion, and perceived stress. Given, the prevalence of stress and burnout among nurse leaders, the effectiveness of the AC intervention in fostering resilience in this population has significant implications for research and practice. Further research is warranted with larger numbers from multiple sites, longer follow‐up periods, and biomarker measures of stress.

OBJECTIVES: Cardiovascular (CV) disease is the top cause of mortality in patients with nonalcoholic fatty liver disease (NAFLD). Female sex is protective against CV disease. We aimed to determine whether female sex remains a protective factor against CV disease (myocardial infarction, angina, and stroke) in NAFLD. METHODS: We identified all adults diagnosed with NAFLD in Olmsted County, Minnesota, between 1997 and 2014 and selected an age- and sex-matched (1:4) referent cohort from the general population. NAFLD was ascertained using a code-based algorithm with high validity tested by medical record review. The impact of female sex on incident CV events was examined using Cox proportional hazards regression analysis stratified by standard clinical risk factors. RESULTS: A total of 3,869 NAFLD and 15,209 age- and sex-matched referent subjects were identified. After a median follow-up time of 7 (range 1–20) years, 3,851 CV events were recorded. Female sex was protective for ischemic CV events in the general population (hazard ratio = 0.71, 95% confidence interval 0.62–0.80, P < 0.001), but the impact was significantly diminished among those with NAFLD (hazard ratio = 0.90, 95% confidence interval 0.74–1.08, P = 0.25), even after stratification by time-dependent CV risk factors and control for diagnostic testing (liver enzymes and ultrasound) during routine medical evaluations, as a surrogate of access to care. Among those with NAFLD, excess events were higher in women than in men: CV disease (18% vs 9%) and mortality (9% vs 6%). DISCUSSION: Women with NAFLD lose the CV protection conferred by the female sex, and their risk is underestimated by current estimating methods in clinical practice.

Background An increasing number of residents and fellows have children during training. However, little is known about the specific experience of cardiology fellows who become parents during training. Methods and Results A 66‐question Internet‐based survey about experiences of pregnancy during graduate medical training was administered between May 1 and July 15, 2013, to all trainees (N=1516) in the Mayo School of Graduate Medical Education across 3 academic sites. Questions explored the experiences of new mothers, fathers, and their fellow trainees. There were 644 survey respondents overall (response rate, 42%), and of 73 cardiovascular trainees, 29 (10 women [35%]) completed the survey. Of those surveyed, 59% reported having children. All trainee mothers reported making alterations to their training schedule due to pregnancy and maternity leave. Twenty percent of trainee fathers also reported changing their training because of their partner's pregnancy. Of trainees with children, 41% reported difficulty completing research because of pregnancy and childcare obligations. Nontrainee mothers were significantly more likely to breastfeed beyond 6 months compared with trainee mothers ( P =0.018). A perceived stigma attached to pregnancy was reported by 62% of trainees. Both male and female trainees felt that their programs did not promote pregnancy‐related schedule flexibility. Conclusions Our study shows that both men and women entering parenthood during cardiology training often have to change their schedule, research, and career path. Cardiology training programs should focus on curriculum design and supportive parenthood policies to both avoid negative stigma and optimize fellowship training during this time period.

Background: Spontaneous coronary artery dissection (SCAD) is an uncommon idiopathic disorder predominantly affecting young, otherwise healthy women. Rare familial cases reveal a genetic predisposition to disease. The aim of this study was to identify a novel susceptibility gene for SCAD. Methods: Whole-exome sequencing was performed in a family comprised of 3 affected individuals and filtered to identify rare, predicted deleterious, segregating variants. Immunohistochemical staining was used to evaluate protein expression of the identified candidate gene. The prevalence and spectrum of rare (<0.1%) variants within binding domains was determined by next-generation sequencing or denaturing high-performance liquid chromatography in a sporadic SCAD cohort of 675 unrelated individuals. Results: We identified a rare heterozygous missense variant within a highly conserved β-integrin–binding domain of TLN1 segregating with familial SCAD. TLN1 encodes talin 1—a large cytoplasmic protein of the integrin adhesion complex that links the actin cytoskeleton and extracellular matrix. Consistent with high mRNA expression in arterial tissues, robust immunohistochemical staining of talin 1 was demonstrated in coronary arteries. Nine additional rare heterozygous missense variants in TLN1 were identified in 10 sporadic cases. Incomplete penetrance, suggesting genetic or environmental modifiers of this episodic disorder, was evident in the familial case and 5 individuals with sporadic SCAD from whom parental DNA was available. Conclusions: Our findings reveal TLN1 as a disease-associated gene in familial and sporadic SCAD and, together with abnormal vascular phenotypes reported in animal models of talin 1 disruption, implicate impaired structural integrity of the coronary artery cytoskeleton in SCAD susceptibility.

Introduction: African American women are 5 times less likely than white women to meet at least 5 or more ideal cardiovascular health metrics as defined by the American Heart Association Life’s Simple 7 (LS7) components (smoking, diet, physical activity, BMI, blood pressure, total cholesterol, and glucose). There are few studies probing the influence of sociocultural factors, such as body image dissatisfaction (BID), on these disparities. A better understanding of the impact of BID on cardiovascular health could assist in the design of more effective behavior change interventions for African American women. Hypothesis: We hypothesized that BID would have a negative association with cardiovascular health in overweight and obese African American women. Methods: We enrolled 32 women (mean age 49 years [SD 12.9]), from 5 predominantly African American churches participating in a larger community-based participatory study (FAITH! App Pilot Study) of a mobile health lifestyle intervention among African American women and men. We conducted a cross-sectional analysis of baseline data to evaluate the association between BID and both cardiovascular health and select psychosocial factors (e.g. motivation for healthy eating, diet self-regulation). A LS7 composite score was calculated as a measure of overall cardiovascular health (range 0-14). The Pulvers scale, consisting of images of women across the BMI spectrum, was used to measure perceived current and goal body size (rating of figures, 1-9; underweight to very obese). A BID score was calculated as the difference between perceived current and desired body image (range -8-8; BID < 0 [desire to be heavier], BID > 0 [desire to be thinner], BID = 0 [no dissatisfaction]). The BID score range for our cohort was 0-4. Thus, we categorized BID as no/low BID (BID score 0-1) or high BID (BID score 2-4). Results: Twenty-two percent (7/32) of women were overweight (BMI 25-29.9) and 78% (25/32) were obese (BMI (≥ 30). Forty-four percent (14/32) had no/low BID and 56% (18/32) had high BID. Those with high BID were more likely to be obese as compared to no/low BID (94% (17/18) versus 57% (8/14), p=0.03). Although not statistically significant, the mean LS7 composite score was 1 point higher among those with no/low BID, versus high BID (8.83 versus 7.76, p=0.25). Compared to women with high BID, those with no/low BID were more likely to have greater: intrinsic motivation (P=0.01) and integrated regulation for healthy eating (P=0.007), and self-regulation to reduce fat and caloric intake (P=0.01). Conclusion: Ultimately, although small, our study suggests that African-American women with obesity are more likely to have high BID. High BID was associated with lower motivation and self-regulation, which predict cardiovascular health. BID and other psychosocial factors for behavior change are potential targets for culturally-tailored lifestyle interventions in this group.

Background Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome predominantly in women without usual cardiovascular risk factors. Many have a history of migraine headaches, but this association is poorly understood. This study aimed to determine migraine prevalence among SCAD patients and assess differences in clinical factors based on migraine history. Methods and Results A cohort study was conducted using the Mayo Clinic SCAD “Virtual” Multi‐Center Registry composed of patients with SCAD as confirmed on coronary angiography. Participant‐provided data and records were reviewed for migraine history, risk factors, SCAD details, therapies, and outcomes. Among 585 patients (96% women), 236 had migraine history; the lifetime and 1‐year prevalence of migraine were 40% and 26%, respectively. Migraine was more common in SCAD women than comparable literature‐reported female populations (42% versus 24%, P <0.0001; 42% versus 33%, P <0.0001). Among all SCAD patients, those with migraine history were more likely to be female (99.6% versus 94%; P =0.0002); have SCAD at a younger age (45.2±9.0 years versus 47.6±9.9 years; P =0.0027); have depression (27% versus 17%; P =0.025); have recurrent post‐SCAD chest pain at 1 month (50% versus 39%; P =0.035); and, among those assessed, have aneurysms, pseudoaneurysms, or dissections (28% versus 18%; P =0.018). There was no difference in recurrent SCAD at 5 years for those with versus without migraine (15% versus 19%; P =0.39). Conclusions Many SCAD patients have a history of migraine. SCAD patients with migraine are younger at the time of SCAD; have more aneurysms, pseudoaneurysms, and dissections among those imaged; and more often report a history of depression and post‐SCAD chest pain. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01429727, NCT01427179.