An Interview with 2 NCS Research Training
Fellowship Grant Recipients
By Shraddha Mainali, Sara Hocker, Andrew Naidech, NCS Research Operations Sub-Committee
We recently asked the NCS Research Training Fellowship Grant
recipients Dr. David Hwang (2015) and Dr. Edilberto Amorim
De Cerqueira Filho (2016) to share their experience regarding the
fellowship grant.
How did you learn about the grant?
Dr. David Hwang (DH): NCS did a great job advertising
this grant via emails.
Dr. Edilberto Amorim De Cerqueira Filho (EA): I found
out about the grant when Dr. David Hwang received the
award in 2015. I have participated in the annual NCS
meeting every year since I was a PGY-2 resident, and I
encourage all trainees to attend the pre-meeting career
development and research mentoring talks. Bring your specific
aims page with you if you can!
Please provide a brief description of your project.
DH: Discussing the options of trach/PEG versus comfort care with
families of severely brain injured patients is routine in the neuro-
ICU, yet evidence suggests that families are not satisfied with
current decision-making practices and are at risk of developing
PTSD, complicated grief etc. One of my goals is to develop
decision aids that can help families through difficult decisions in
the hopes of improving their long-term psychological outcomes.
The goal of my funded study was to characterize the general U.S.
population into various groups of decision makers when placed
in this neuro-ICU goals-of-care situation based on how they
prioritize their concerns. The idea was to use this data regarding
key decision making archetypes as high-yield targets for future
decision aid development.
Our team worked with a professional survey company to recruit
a large sample of adult respondents whose demographics
mirrored that of the U.S. population. We presented them with
a hypothetical situation of an elderly relative hospitalized with
severe ICH and needing trach/PEG to survive, although likely with
a severe functional deficit. In asking respondents whether they
would prefer a trach/PEG versus comfort measures for the patient,
we also used a survey technique known as “best-worst scaling”
to get at what each respondent’s top concerns were in making
their decision. We then used the data we collected to divide our
respondents into key groups with like-minded concerns.
EA: My goal is to develop quantitative neurophysiology
methods that can help us understand why some patients
recover from coma after hypoxic-ischemic brain injury while
others don’t. Our first steps were to build algorithms that could
efficiently process and analyze large amounts of continuous
EEG data, and then use machine learning methods to generate
early and accurate outcome predictions. We have since started
a prospective observational study using continuous EEG and
evoked potentials in comatose cardiac arrest subjects. We
hope to identify which specific neurophysiology signatures are
necessary for awakening from coma and how temperature and
sedation may affect these biomarkers.
How did this grant help you move forward in your research career?
DH: The grant made all aspects of this project possible: facilitating
mentorship, working with the survey
company, hiring a research assistant
to help with survey development
and validation, and working
with a statistical team to
perform the subsequent
analysis. We’ve presented
the results of our study
at several conferences,
including oral
presentation at AAN this
year. We are in the process
of using the data to draft
an actual decision aid for pilot
testing among families of patients
hospitalized with severe ICH.
EA: Getting protected time for
research during the fellow to faculty
transition time is one of the most
important goals for anyone invested in
research career. The NCS Fellowship Grant
allowed me to spend more time in the lab working with my
mentors and many other people with skill sets complementary
to mine. We have since been able to secure grants from other
foundations and industry, I got a part-time appointment at MIT,
and we are starting to draft an NIH K23 award proposal that I
hope to submit next year.
Did you experience any roadblocks during the grant period? If
so, how did you overcome it?
DH: The actual process of gathering and analyzing the data
has taken longer than projected, but in between phases of this
project, I have tried my best to move forward other research
projects that are thematically related. Having the time that this
grant has afforded me has allowed me to conduct research on
topics such as how physicians and nurses prognosticate ICH
outcomes, how satisfied families are with shared decisionmaking
practices in ICUs, and how variable decisions to place
PEGs in ICH patients are across different U.S. hospitals. I hope
these projects will be helpful in designing interventions to help
families of critically ill patients.
EA: 1) Recruiting for a small pilot study is not easy, so having
people who can help you enroll is very important, or you risk
under-powering your study. 2) My IRB inclusion criteria were too
strict, so making it a little broader was helpful, but it can take a
while to get reviews back, so starting broad would be my advice.
3) Having buy-in from nurses, residents, fellows and faculty (from
your division and others) is often how you are going to get a
“heads-up” about potential study candidates early on, and also
avoid any potential misunderstandings. Making sure I had a oneminute
pitch, a flyer and a short video about our study was helpful
as well. The key has been to talk to as many people as possible
about our study.
Shraddha Mainali Sara Hocker Andrew Naidech
21