rivka

Last week and this I've been settling into my new life in the Psychiatry Department. Biggest change: people are glad to see me. In Infectious Disease I drifted through the day doing my own thing, sometimes not speaking to anyone else all day. In Psychiatry, people say "Hey, Rebecca! You should come to this meeting and possibly get involved in Thing X. And maybe we can help you with Y and Z."

Infectious Disease was probably like this for the docs and virologists, but I don't think it would ever have been that way for me. Even if there hadn't been complications related to my former supervisor, there just weren't enough points of convergence.

The other big difference is that Psychiatry has systems and resources and personnel to do all of the things I am used to doing myself or having ad hoc arrangements for. So, for example, instead of writing a position description and hiring a research assistant, I'll be meeting with the person who coordinates RA assignments and contracting with her for parts of various existing RAs who have the skill sets I need. And when I start enrolling participants, there's someone who is in charge of ensuring IRB compliance, making sure that all my consent forms are properly filled out and storing them for me in a HIPAA-compliant way. "Because the investigators really need time to write and think."

I used to do all of that stuff for my former boss, Lydia: all the day-to-day arrangements and regulatory details and organization, so that she could write and think. Then when I was promoted to faculty level and became a PI, I still did those things for myself. It'll require a huge mental shift to be able to delegate those things to other people - especially, without forgetting about them. But I can see how it gives faculty a much fairer chance to succeed.

I just got my "pink sheets," the summary statement of my grant review. Wow, it's really good.

This resubmission retains all the numerous strengths of the previous submission including: addressing a highly significant public health problem (failure to initiate or delayed initiation of ART); a clearly thought through iterative model of intervention development; well established involvement of the community; and a strong and clearly articulated research design. The revised application has been highly responsive to the previous reviewers comments and has been substantially strengthened. The team is outstanding and the choice of sites and inclusion criteria to increase generalizability have now been well justified. A few negligible issues for clarification are described in the individual critiques. In review considerable enthusiasm was expressed for this timely, highly innovative and clearly outstanding study that addresses a very serious and real public health concern.

I would like to express my particular affection for Reviewer 3, who used the phrases "superb investigative team" and "PI a very promising Early Career Investigator with demonstrated publication productivity."

Edited to add: guys, we're in clear text here. I've screened some comments.

Under the new scoring system, NIH peer reviewers assign scores ranging from 1 ("exceptionally strong with essentially no weaknesses") to 9 ("very few strengths and numerous major weaknesses"). These scores are averaged and multiplied by 10, to produce a 2-digit number between 10 and 90. The lower you score, the better. They also figure your percentile, and lower is also better there.

I got a 15. That puts me in the 2nd percentile. I am told that only one, extremely senior, researcher scored better than I did.

Holy crap, you guys!! A 15!! Right up there in "essentially no weaknesses" territory!!

I have never, ever heard of anyone getting this good of a percentile score. My professional stock has just gone way way up.

2nd percentile. 2nd percentile. 2nd percentile.

Not to be immodest, or anything, but I AM THE MOST AWESOME PERSON WHO HAS EVER BEEN AWESOME.

Current length of the research plan:14 pages. Maximum allowable length: 12 pages. Only two pages to go. Sadly, I only have two pages left to edit, and since they include my entire data analysis plan I don't think I'll be able to cut them out entirely. So I will still need to cut, cut, cut. But damn, 25 pages to 14 is a pretty good start.

Once I work through these two pages, I will have a complete draft![1] Yay me! I can send it off to my mentor and to my very kind NIMH Program Official. Maybe they'll know what else I can cut.


[1] Except for the project narrative, the Facilities and Resources section, the revised biosketches, and the appendices. Mercifully the human subjects section stays the same. And the budget. The budget is done.

Updated to add: 13! 13 pages! I am the awesomest person who has ever been awesome! I got it down to 13 pages 10 lines, and then realized that I would totally gain more space once I formatted my references as numbers rather than in-text Endnote tags. And it saved a TON! Go me!

I just got off the phone with my Program Officer at NIMH. He doesn't think my grant is going to be funded this time around. He says that I got a great score for the first submission... but I should prepare to resubmit. I more or less expected that to happen, so I'm not crushed.

The part of the discussion I didn't expect had to do with when I should resubmit. There are three deadlines per year for AIDS-related applications: January 7, May 7, September 7. The review cycle is such that the earliest possible start date is about six months in the future; for my January submission, I proposed a start date of July 1.

My PO said that, given the level of the critiques I need to respond to, he would normally encourage me to reapply at the next deadline: May 7. That is totally what I had expected to do. However, as I've mentioned before, NIH has completely revamped their application structure. I'll need to substantially modify my application - including cutting the length in half. And, my PO suggested, that might take me more than a month.

We talked about the pros and cons for a while. He does say that May is "not out of reach." Advantages of trying for May: (1) I know myself to be a fast and good writer. (2) It might be politically difficult for me here at work to let a deadline go by without a submission. (3) The sooner I resubmit, the more likely it is that I'll get the same primary reviewers - who basically liked my idea, and who saw my longer more-detailed initial application and will know that any areas that I have to skim over to meet the new page limits did at one point exist in more fleshed-out form.

Advantages of waiting: (1) These days you only get two chances to submit a grant. (It used to be three.) If I don't get funded this time around, I can never resubmit this application or anything "substantively identical" to it. So it might make sense to take more time to get this submission perfect. (2) The new application format is going to shake things up, and it would probably be safer to not be one of the first people reviewed under the new system, by peer reviewers who are suddenly getting half as much detail as they expected. (3) My work pace preparing the resubmission would be substantially more humane.

I have written to my external mentor, and am drafting a letter to my collaborators on the grant to get their input.

They posted my grant score this afternoon.

I got a priority score of 27. Under the new system, a priority of 20 is "Outstanding. Extremely strong with negligible weaknesses." 30 is "Excellent. Very strong with only some minor weaknesses." I'm somewhere in the middle there. (The lower middle.) That's pretty good for a first submission.

My percentile score is 20. (NIH does this weird thing where lower percentile = better.) The percentile score is the best indicator of whether a grant is likely to be funded. And mine tells me... not much.

Some NIH institutes have a "payline," a percentile above which virtually everything is funded and below which virtually nothing is funded. NIMH doesn't. That would be too easy. Here's what they say about their payline:

In general, NIMH assumes that research applications that fall below the 20th percentile are scientifically meritorious and that sufficient funds are available to support up to 80 percent of these new and competing research applications. Council and program staff may selectively recommend payment of grants that fall in this range, as well as beyond, based on: 1) Institute and division priorities; 2) balance in the existing research portfolio; 3) early stage new investigator status (see below); and 4) availability of funds. [...]

Early Stage Investigators: NIMH is committed to supporting new investigators and facilitating the independence of emerging scientists. The Institute considers early stage new investigator status--new Investigators who are within 10 years of completing their terminal research degree or within 10 years of completing their medical residency at the time they apply for R01 grants—as a priority in funding decisions. This means that a research grant from a newand/or early stage investigator may be funded out of order and at percentile scores the same or higher than grants not selected for payment from established investigators.

So I'm juuuust on the edge of the potentially fundable range. I do have Early Stage Investigator status, which should help, but my guess is: probably not quite enough. It could be funded this time around, but I am not in the hold-your-breath range.

A score this high does bode well for my chances of a successful resubmission. But here's the sad thing: NIH radically changed their applications just after I submitted my grant. So I won't be able to just polish what was already a very good application, working in carefully-crafted responses to the reviewers' criticisms. I'll have to rewrite the whole damn thing. AND SHORTEN IT FROM 25 PAGES TO 12. *cries*

I actually feel pretty good about my score. It's a frustrating score, almost more so than something in the definitely-not-gonna-get-in range would have been. But it's a good score for a first submission. Most grants don't get funded the first time around. It would've been nice to defy the odds and get a fantabulous, immediately-fundable score. But the score I got says "really good grant, just needs a tiny bit of work." I'll take that.

The peer review committee meets to review my grant application in 22 days.

*hyperventilates*

I had the opportunity to take part in a mock review through my Cyber Mentors program. It was a harrowing yet fantastic experience. I am assured that the process was very much like a real grant review - certainly, the people conducting it regularly serve on peer review committees for NIMH - except that my mentor and I got to listen in by conference call.

So I have a much better idea of what is happening to my grant right now than I did the last time through.

Peer review happens like this: Your grant is assigned to a "study section," a group of scientists drafted by NIH to review applications of a certain broad type, topic, or speciality. I am lucky in this regard, because NIMH has a speciality subsection for grants of my exact type (R34s proposing AIDS-related interventions), which means that my grant is not going up against projects with bigger scopes and/or more completed preliminary work. Within the study section, two or three people are assigned to review your grant.

The primary reviewers decide whether your grant falls within the upper half of applications. If it doesn't, that's the end of the road. They write up some comments for you and your grant is "unscored" - it never makes it to a full study section meeting.

If the primary reviewers agree that your grant is in the top half of the pile, it gets presented at the study section meeting. All the peer reviewers meet at NIMH, and the primary reviewers take turns presenting the grants they've read. There is some general discussion and a time for questions, and then everyone assigns your grant a score.[1] The primary reviewers write up comments, plus the NIH staff member assigned to the study section summarizes the group discussion.

This is the part I didn't really grasp before I participated in the mock review. It is absolutely harrowing to listen to someone with only a vague understanding of your grant application pitch it to a group and answer questions about it, potentially mangling it in a way you have no control over. The other study section members have the opportunity to read all the grants, but realistically speaking they are only likely to read the abstract and perhaps the Specific Aims section, which outlines the purpose and goals of the study. So what the review committee thinks of your grant is pretty much entirely dependent on what is conveyed by the primary reviewer.

Many of the grantsmanship strategies I learned from my mentor during this process had to do with spelling things out for the reviewers, making it easy for them to fill out their review forms, and making sure they don't miss any of the important stuff. At first I kind of rolled my eyes about some of her suggestions, but after the mock review it became clear why she wanted me to do things like briefly recap the entire grant application in the Aims section, use bolded topic sentences in the Background & Significance section so that someone who is quickly scanning will get the gist of my argument, and include homework-helper sections like the paragraph that begins "This proposal is innovative because..."

I "know," in the professional way that you know people in your field, two of the thirteen people assigned to the study section. They're both very good. I don't know anything about the other eleven. I will never know who the primary reviewers of my grant are.

Sometime after March 23rd, I'll log on to the NIH eRA Commons and click on my grant application, and there will be a score and a percentile. A few days after that, there will also be a written review available.

*nailbiting commences*



[1] They've changed the scoring system since the last time I had a grant reviewed. Now grants are ranked on a scale from 1-9 (1=exceptional, 9=poor), and the mean score is multiplied by 10 to produce an "impact score" from 10-90. You can see the criteria I'll be reviewed on here.

My first research job was right out of college. When my boss submitted an NIH grant that year, I spent a few hours sitting on the floor by the copier with scissors, tape, and a ruler, shrinking down graphs and trying to fit them all on one page by literally copying and pasting. We were on the west coast, so the drop-dead date for proposal submission was 11pm the night before the due date. Then someone would drive the grant to the airport and get it on the midnight plane to DC.

When I first started working at the IHV, submitting an NIH grant meant making eleven copies of some forms and five copies of others. Everything had to be carefully collated and organized. The research plan would be photocopied onto "NIH continuation pages" and at the very end every page would be hand-numbered, and you'd fill out a table of contents by hand. Then you'd pack it up in a box and a courier would take it to NIH. About a week before that happened, you'd "route" the grant by circulating the budget, a little bit of the research plan, and some forms and things, and having someone walk it around to various offices on campus to have all the right people sign off on it.

When I submitted my first independent grant in 2007, there were no more printed copies couriered to NIH. Instead you uploaded to grants.gov. But you still routed the proposal by walking it around. Someone in the university Office of Research and Development checked all your signatures and then pressed a button on grants.gov to submit your grant.

Now my university has something called COEUS. I don't know what it stands for. But over the past few days I've been sending bits and pieces of grant to my grant administrator and she's been uploading them to COEUS. Last night I checked everything over online from home. She did the same this morning and e-mailed me about a correction or two. And then I pushed a little button that said "submit for approval."

COEUS checked everything to make sure it was in the proper formats for the university and for grants.gov. Then my grant started routing. COEUS displays a chain of eight separate "stops" at which someone will click a button to approve my grant. At the end of the chain, once the Office of Research and Development signs off on it, COEUS will automatically upload my grant to grants.gov, all its sections slotting neatly into the right places. Then grants.gov will relay my grant to NIH. I can sit at my desk and watch the approvals go through one by one.

No paper copy of my grant exists, and it's possible that no paper copy will ever exist. The Center for Scientific Review at NIH will electronically accept it and assign it to a study section. The Program Officer will assign it to reviewers, who can log in to the NIH Electronic Research Administration commons and read it there. That's also where I'll go to find out where my grant is in the process, what score it is eventually assigned, and whether I receive an award.

Oh hey, did I mention? I FINISHED MY GRANT.

I am exhausted and burned out.

Yesterday was a lousy day. I expected to finally get the H1N1 vaccine at work - they'd sent out an e-mail saying that all faculty and residents in the department of medicine should come to grand rounds to be vaccinated. Even if you thought you'd already had H1N1, unless you could produce proof of typing. So I showed up, only to discover that they didn't really mean faculty - they meant MDs. "I have direct patient contact with immunocompromised people," I said. "Sorry," they said. "What do you suggest that I do?" "Find the vaccine somewhere else." Gee, thanks.

Worked late. Found out some things that, although not surprising, were tiring and discouraging. Came home to discover that I had forgotten that Michael would be spending the evening at a church meeting (including the dinner hour, so I'd be feeding myself and the kids on my own), that Colin was STARVING ZOMG NO ONE FED ME ALL DAY, and that Alex was STARVING FOR ATTENTION ZOMG NO ONE PAID ATTENTION TO ME ALL DAY. Tried to get Colin down for a nap and failed. Tried to get Alex to be quiet for ten minutes so that I could nurse the baby down and failed. Lather, rinse, and repeat for the rest of the evening. Colin did a lot of extraneous crying. Alex did a lot of extraneous loud neediness.

I honestly was ready to go to bed when Alex did. But a couple of friends called who are in very stressful situations themselves and instead I was up kind of late.

Colin woke me at five this morning. I got him back to sleep, but not myself. He was up for the day at six.

I am trying to write a grant in difficult circumstances, and I also have a lot of extra burdens at home because everyone keeps being sick, and "everyone" includes our nanny and our nanny's daughter which means that my childcare has been extremely shaky. I am stretched very, very thin.

Also: I have somehow managed to lose my Prozac. I can't find the whole bottle. Both Michael and I have looked. No idea how that happened, because it's supposed to live on my desk right next to my keyboard so that it's impossible for me to forget to take it. I've been without it for... maybe a week? I can't really remember when I took it last. Somewhere in the middle of everyone-is-sick-but-me hell.

I am, unsurprisingly, symptomatic: anxious and also very short-fused. When I'm off the Prozac I get absolutely furious about things not going my way, because the consequences seem so dire. Like, the only way the world won't fall apart is if everything is under my perfect control. Fun times.

Yes, I have e-mailed my psychiatrist to ask her to call in a replacement prescription.

Not loving my life right now.

I need some digital images that I can use in presentations about my research. We have a medical graphics department that could probably do them for me, but if possible I'd rather hire someone from my friends list.

( Here's what I need )

If you might be interested in doing this for me, leave a comment with a price quote. Or ask any questions you'd need answers to before you could bid. Comments are screened.

Time frame on turning this around is about ten days. If you can help, that would be awesome.

Edited to add: I found someone, thanks!