Scholars in HeAlth Research Program SHARP

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1 Scholars in HeAlth Research Program SHARP SHARP Summer Certificate Master in Sciences in Health Research Capacity Building in Non-Communicable Diseases At the American University of Beirut NIH FIC Advisory Board Meeting May 9, 2017 NIH Grant Award- D43TW FIC-ODS-NHLBI

2 About the American University of Beirut The American University of Beirut is a teaching-centered research university founded to provide excellence in education, to participate in the advancement of knowledge through research, and to serve the peoples of the Middle East and beyond. Founded in 1866, chartered in New York State, AUB has around 700 faculty members and a student body of around 8,000. AUB includes six faculties and offers more than 120 programs leading to the bachelor's, master's, MD, and PhD degrees- Collaborations of this program are with Faculty of Medicine FM Faculty of Health Sciences FHS Faculty of Agriculture and Food Sciences FAFS

3 AUB s Medical Center (AUBMC), is the only medical institution in the Middle East to have earned the three international accreditations: Joint Commission International (JCI), Magnet, and the College of American Pathologists (CAP). AUBMC is 350-bed capacity medical center with plans for a 600-bed medical complex by AUBMC has several Specialty Programs and Centers of Excellence: The Calcium Metabolism and Osteoporosis Program-WHO CC for Metabolic Bone Disorders is one of them.

4 SHARP Mission To provide superior didactic education complemented with state-of-the-art interactive and practical training in health research, with a focus on Non-Communicable Diseases Research. It is intended for physicians and other health care professionals, to improve and advance the health care agenda for non-communicable diseases in Lebanon and the region.

5 SHARP Faculty American University of Beirut PI, Co-investigators, TAG American University of Beirut Principal Investigator/Program Director - Ghada El-Hajj Fuleihan, MD, MPH (FM) Co-investigators/Executive Committee - Robert, Habib, PHD (FM)- Summer Program Director - Huda Huijer, PhD (HSON) - Abla Sibai, PhD (FHS) Training Advisory Group (TAG) - Kamal Badr, MD (FM) - Ali Abu Alfa, MD (FM) - Rabih Talhouk, PhD (FAS) US Collaborators Harvard Medical School- Scholars in Clinical Sciences Program: SCIP Harvard Medical School-NIH US TAG Members - Gordon H. Williams, MD (BWH) - Ellen Seely, MD (BWH) Harvard School of Public Health Clinical Effectiveness Program: CEP Director-co-directors HSPH Consultants - Earl Fran Cook, PhD. (HSPH) - John Orav, PhD. (HSPH)

6 About SHARP Hybrid between curriculum building and training grant A unique multifaceted, novel, and collaborative interfaculty program at multiple levels The only intensive summer training program for research training in the region and one that goes beyond and spans three depths (short, intermediate and long-term training) Combines didactic teaching, interactive sessions, and with intensive hands-on research experience through laboratory sessions, and research projects including a mentored thesis project

7 About SHARP Bridges research and academia, with clinical practice, public health, health care management and health policy Addresses population-oriented and patient-oriented research needs A career path to Clinical and Translational Research, akin to similar leading programs at first tier institutions Provides an ideal vehicle for capacity building in NCDs and promotes health research, and thus health, in Lebanon and the region (for eg NIH funded Scholars in Clinical Sciences Program at Harvard Medical School, and MPH in Clinical Effectiveness Harvard School of Public Health).

8 Schema for SHARP Schedule JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Intensive Summer Program 12 credits EPI I/EPI II Biostatistics Research Ethics Library Science Required Courses - Fall Clinical/Advanced Trials Epi of NCDs Leadership in Organizations (Olayan School of Business) Spring Systematic Review & Meta-analysis Policy and Decision Making in Health Care Large Datasets I Select Research Project Longitudinal Seminar Series I-II Bioethics in clinical research, mock IRB/study section, genetics, career development, progress report Electives Research Thesis

9 SHARP Growth Over Years SHARP Summer Certificate 60 Number of applications over the years % 54% 61% 53% 20 51% 10 0 Summer 2013 Summer 2014 Summer 2015 Summer 2016 Summer 2017 Received complete applications Enrolled applicants First year 25% co-pay introduced

10 Human Capital National and Regional SHARP Trainees Summer Certificate graduates, 11 Master Students REGIONAL OUTREACH Blue dots are enrolled students from region

11 Post-doctoral Trainees After SHARP N=103 Young Faculty at AUB 3% Physicians at AUB affiliate institutions 2% Master's students at AUB (SHARP, MPH, MS) 10% Other (Research Assistants, Nurses, Clinicians in Lebanon ) 29% Research Fellows/PhD students in Europe 4% Research Fellows/Residents at AUBMC 22% Research Fellows/Residents in US institutions 32%

12 SHARP Graduates-Positions Now!!! Research Fellows Residents Brigham and Women s Hospital Baylor College of Medicine Case Western Reserve University Johns Hopkins School of Medicine Duke University Medical Center Mayo Clinic Henry Ford Health System Oregon Health & Science University Johns Hopkins School of Medicine Saint Louis University MD Anderson Cancer Center University of Maryland University of Chicago University of Maryland University of Pittsburgh University of Pennsylvania Washington University

13 The Global Approach to NCDs from a Program as Nucleus to the Region & the World Collaborating with Other Major Programs at AUB GLOBAL MENA Lebanon AUB SHARP

14 Funded NCD Related NIH Programs at AUB Funding Agency Project Title Project Type Amt Approved New England Research Institutes, Inc / NIH Randomized, Double-Blind, Placebo Controlled Trial Comparing The Effect of Deferoxamine with or without Oral Deferiprone(L1) on Cardiac Left Ventricular Function Assessed by MRI in Adults with Transfusion-Dependent Beta-Thalassemia (TCRN) Clinical Trial $ 90,762 Virginia Commonwealth University (VCU) / NIH Water pipe Tobacco Smoke: Toxicant Exposure and Effects Research and Development $ 1,156,265 Medical University of South Carolina (MUSC) / NIH Kallikrein and Vascular Disease Risk in Diabetes Research and Development $ 124,576 Medical University of South Carolina (MUSC) / NIH Lipoproteins, CTGF and Diabetic Vascular and Renal Disease Research and Development $ 157,735 Virginia Commonwealth University (VCU) / NIH National Institutes of Health (NIH) National Institutes of Health (NIH) University of Texas / NIH REALTIME Water pipe Tobacco Smoke Toxicant Sampling in the Natural Environment Prevalence of Dementia in Lebanon: A Nationwide Community-Based Cohort Study Capacity Building in Chronic Non-communicable Diseases and Disorders Among Multidisciplinary Curriculum Based Interfaculty Approaches Radiotherapy Outcomes for Children in Developing vs. Developed Countries Research and Development Research and Development $ 839,069 $ 243,815 Training $ 1,107,182 Research and Development Florida International University (FIU) / NIH Tobacco Control Research and Capacity Building Research, Training, Conference/ Workshop Virginia Commonwealth University (VCU) / NIH Virginia Commonwealth University (VCU) / NIH Virginia Commonwealth University (VCU) / NIH Tobacco Centers of Regulatory Science for Research Relevant to the Family Center for the Study of Tobacco Products: Comparison of Methods of Measurement of Electronic Cigarette Topography Pilot Project - Nicotine Detection using Novel Substrate Nanostructures Research and Development Research and Development Research and Development $ 1,000 $ 571,603 $ 1,089,162 $ 26,631 $ 49,910

15

16 SHARP Students Awards Knowledge Is Power (KIP) Grant and MPP Grant: Eman Sbaity, SHARP MS student- April 2017 Outstanding AUB Research day poster presentation: Marlene Chakhtoura, SHARP MS graduate-february Alpha Omega Alpha Honor Medical Society (AΩA): Ziad Al Addas, Khairat Al Habbal, and Michael Raad, SHARP 2016 Summer graduates-january Intern of the year award, Best junior resident teaching award, and highest Absite score award: Rami Kantar, SHARP Summer 2013 graduate-july ASBMR Phoebe Leboy Professional Development Award: Marlene Chakhtoura, SHARP MS graduate-october Lebanese Association for the Advancement of Science Award: Victor Nauffal, Abdul Karim Sleiman, Maroun Yammine, Mohamad El Zein, SHARP Summer 2013 graduates-april 2014.

17 SHARP Students Presentations Resident oral presentation at the American College of Radiation Oncology meeting: Karine Al Feghali, SHARP MS graduate- March Poster presentation at the American Society of Parenteral and Enteral Nutrition (ASPEN) annual conference: Jana Jabbour, SHARP Summer 2015 graduate- January Oral presentation at the American Public Health Association (APHA) Annual Meeting: Fatima Ghaddar, SHARP Summer 2014 graduate- November, Poster presentation at the Annual Meeting of the American Society of Bone and Mineral Research: Marlene Chakhtoura, SHARP MS graduate- September US Ten day Cardiovascular Epidemiology Seminar: Victor Nauffal, SHARP Summer 2013 graduate-may 2014.

18 SHARP Students Achievements Hopkins Osler Internal Medicine residency: Tarek Zghaib, SHARP Summer 2015 graduate, and Victor Nauffal, SHARP Summer 2013 graduate. Nephrology Fellowship at Mayo Clinic: Khaled Shawwa, SHARP Summer 2013 graduate. Emergency Medicine Chief Resident at Johns Hopkins Medicine: Nour Al Jalbout, SHARP Summer 2014 graduate. Integrated Vascular Surgery program at the University of Pittsburgh Medical Center (UPMC): Adham Abou Ali, SHARP Summer 2015 graduate.

19 Productivity of SHARP Trainees Methodology We carried out individual author searches in Scopus to identify publication records of all students who enrolled in and have completed the program. For each author, we recorded the number of journal articles they have published. We additionally recorded whether the journal articles of each student (if any) were published before or after completing their program. We thought that anything published before or during the year the program was completed had little or nothing to do with the program whereas anything published afterwards may have been partly or largely an outcome of completing the program. To verify our findings, we asked all students to confirm whether what they have published after completing the program was a direct influence (or a result of) completing the program and whether any papers were indirectly influenced by it. Scenario: Student x enrolled in the program in Interpretation: Anything published before 2016 is considered before enrollment. Anything published after 2016 is considered after enrollment in the program.

20 Productivity of SHARP Trainees 214 Publications Total 10 Direct (4.6%) 109 Indirect (51%) Direct publications are those which are based on SHARP Summer Projects Indirect publications are those which were made possible due to skills acquired during SHARP 24 students published their first paper ever the year after enrolling in the program. 20 of these students published their first paper in the year immediately after completing the program. 4 students published their first paper 2-3 years after completing the program.

21 Publications by Type: NCD Research 50 Cardiology Oncology Nutrition/GI Metabolism/Diabetes 10 5 Pediatrics 0 Smoking Public Health Trauma/Emergency Medicine Other

22 Publications by Order of Authorship SHARP Trainee as 1st author SHARP Trainee as 2nd author 30 SHARP Trainee as 3rd author Other 0 SHARP Trainee as 1st author SHARP Trainee as 2nd author SHARP Trainee as 3rd author Other

23 Capacity Building in Non-Communicable Diseases American University of Beirut-FM-FHS Center for Population Health (FHS) Calcium Metabolism and Osteoporosis Program/WHO Collaborating Center for Metabolic Bone Disorders (FM-1997) Outcomes Research Unit (ORU, FM-2010) Scholars in HeAlth Research Program (SHARP-2012) Vascular Medicine Program (VMP, FM -2012) Center for Systematic Reviews on Health Policy and Systems Research (SPARK, FHS-2013) Centers of Excellence at AUBMC including Cancer Centers (FM)

24 Scholars in HeAlth Research SHARP A Graduate Journey Clinical fellowship -SHARP summer certificate -Enrollment in research fellowship at CMOP 1 -SHARP MS -Junior faculty at AUB-MC (Instructor of Clinical Medicine) 1 CMOP: Calcium Metabolism and Osteoporosis Program WHO CC for Metabolic Bone Disorders Junior Faculty Responsibilities Department Clinical duties Medical weight management program SHARP Advisor for fellows Assistant Director of SHARP summer course Clinical Research Institute Research Fellows Program Research Assistants Program

25 Project SHARP MS Research fellowship at CMOP 1 Outcome/Implication Vitamin D -Vitamin D replacement in the Middle East and North Africa: a systematic review -Vitamin D replacement in pregnant women: a randomized controlled trial (ongoing) -Vitamin D replacement in bariatric surgery: systematic reviews Vitamin D replacement guidelines in the general population in our region Vitamin D replacement guidelines in pregnant women in our region Inform international vitamin D replacement guidelines in obese patient undergoing bariatric surgery 1 CMOP: Calcium Metabolism and Osteoporosis Program

26 Project SHARP MS Research fellowship at CMOP 1 Outcome/Implication Osteoporosis -Lebanese Osteoporosis Guidelines -Gaps in Osteoporosis diagnosis and treatment in Lebanon: Policy brief Health policy and guidelines on osteoporosis diagnosis and treatment 1 CMOP: Calcium Metabolism and Osteoporosis Program

27 Advancing the Osteoporosis Health Care Agenda USA 1986 NOF founded 1994 WHO BMD Dx OP 1998 NOF Guidelines 2004 Surgeon General OP Report 2008 NOF FRAX Guidelines 2008 FRAX launched 2009 National Action Plan for Bone Health 2010 National Bone Health Alliance Lebanon FRAX based guidelines 1997 CaMOP Establish National Priorities and Agenda 2002 Lebanese Guidelines 2006 OSTEOS founded st Update on Guidelines 2009 FRAX Lebanon launched 2010 National Task Force for Osteoporosis 2011 Associated Research UNIT for Osteoporosis 2010 ME-Africa OP Audit WHO CC for Osteoporosis

28 Student Name Marlene Chakhtoura Date Enrolled Date Graduated Fall Fall Time to Degree 2.5 years Maya Barake Fall Spring years Karine Al Feghali Fall Summer SHARP MS Trainees Eman Sbaity Fall Fall (Expected) N/A Nancy Nakhoul Fall Fall (Expected) N/A 2.5 years (Took 1 year leave of absence for completing residency in the States) Fatima Saad Fall N/A Completed courses but not thesis, travelled to the US prior to completing degree Elias Ghossoub Fall Spring years Mohammad Nasser Fall Fall (Expected) N/A Sanaa Badour Fall Fall (Expected) N/A Dayane Daou Fall Michel Daher Fall Spring (Expected) Spring (Expected) N/A N/A

29 SHARP MS Graduates Thesis Projects Marlene Chakhtoura Optimal Dose of Vitamin D Replacement: A systematic Review and Meta-analysis of Randomized Controlled Trials from the Middle East and North Africa Graduated in Summer 2015 Maya Barake Effects of growth hormone therapy on bone in adults with osteopenia or osteoporosis and without growth hormone deficiency: a systematic review and meta-analysis. Graduated in Fall 2016 Karine Al-Feghali Prophylactic cranial irradiation in patients with non-small-cell lung cancer: a systematic review and meta-analysis of randomized controlled trials. Graduated in Spring 2016 Elias Ghossoub Impact of alcohol and substance use disorders on self- and other-directed violence: an integrated model approach. Graduated in Spring 2017

30 Testimonials "From SHARP student to sharper clinician" Elias Ghossoub, MS 2017 SHARP propelled me into the world of research and academics Hadi Ramadan, Summer 2015 SHARP was a phenomenal opportunity for me to master the art of epidemiologic and population based research. It allowed me to hit the ground running. I am grateful to SHARP and can sincerely say that this was a pivotal experience in my short medical career so far Victor Nauffal, Summer 2013 SHARP was the basis for a fundamental paradigm shift in the way I practice medicine Elie Ramly, Summer 2013 "SHARP has changed my career path from a physician, interested only in clinical care, into a scientist, identifying questions and knowledge gaps, and conducting studies and systematic reviews, to try to answer these questions, and eventually improve patients care" Marlene Chakhtoura, MS 2015 SHARP is not only an educational title, SHARP is a life and career promoting experience. After running away from research, SHARP made me look forward to every Journal Club" Mohammad Nasser, MS student

31 Highlights from SHARP Post-evaluations 2013: 2014: I leave SHARP as a different person with a different perspective on research. I am proud to have attended this program and I acknowledge this will be a landmark in my professional research career. It built the foundation of my academic career. I now understand the meaning of Acquire, Engage, Advance ONCE IN A LIFETIME EXPERIENCE!! Big Big Big Thank you It was a wonderful experience. I learnt more than I expected to learn and after SHARP I am a different person in terms of research. It s a step forward to advance in my career, I'm much more confident now about what I know in research, my life now has 2 main chapters (life before SHARP and life after SHARP). It is a significant push to my future career It was a career turning point. I believe now that I will integrate research in my career much more now. A great professional push forward SHARP makes me a physician with broader horizon, capable of understanding from where and how do we get many of the information present in the literature.

32 Challenges to Advancing NCD Agenda in MENA Challenges to the Conduct NCD Research Difficulty balancing patient care and research responsibilities Expensive and long training time Limited mentoring capacity Burdensome regulations and paperwork Limited funding agencies and low success rate for funding Engagement with national national agenda for health care priorities difficult due to limited MOH resources Limited National Infrastructure and Resources Human and Financial Inadequate structured research training- now addressed by SHARP Lack of national registries and databases for major outcomes Unavailable financial data on health outcomes Limited resources for health care

33 Capitalize on Unique Opportunities Little known or published on many NCDs in MENA: open fields for research Consanguinity enhances unique genetic and epigenetic research in NCDs Establish New Curriculae: genetics modules, survival analysis. Establish new platform for program delivery: e-learning, blended learning Train the future Leaders in NCD research New leadership and interest in creating new and larger funding opportunities in MENA Kotchen et al. (2006) J. Investigative Medicine; Murillo et al. (2006) Academic Medicine; Sung et al. (2003) JAMA. Address Challenges & Capitalize on Opportunities Addressing Challenges Secure capacity building grants and career development awards Ensure Protected time for research and secure effective mentoring Streamline, standardize, and simplify regulatory requirements Engage and support National Health Authorities Enhance physician knowledge and patient knowledge Establish Networks to enhance collaborations, nationally, regionally and internationally Establish outcome databases and prospective cohorts

34 Acknowledgement Thank You NIH and ODS Thank you FIC Dr Roger Glass Dr Kathleen Michels

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