>> GOOD MORNING, EVERYONE. IF YOU'LL TAKE YOUR SEATS. WE'RE REALLY EXCITED ABOUT TODAY. I THINK WE'VE GOT -- THIS WILL PROBABLY BEGIN TO FILL A LITTLE BIT MORE AS PEOPLE WORK THEIR WAY THROUGH THE GAUNTLET THAT IS THE SECURITY OF THE NIH, SO HOPEFULLY WE'LL HAVE MORE PEOPLE COMING IN OVER THE COURSE OF THE NEXT HALF-HOUR OR SO. WE ALSO HAVE A NUMBER OF PEOPLE ON VIDEOCAST, I KNOW. WE ACTUALLY WANTED THIS DAY TO BE A DAY FOR BEHAVIORAL AND SOCIAL SCIENCES AT THE NIH TO GET TOGETHER TO HIGHLIGHT SOME OF THE RESEARCH WE'VE FUNDED OVER THE LAST YEAR TO NETWORK, TO GET TO KNOW EACH OTHER A LITTLE MORE, SO IF YOU'RE ON VIDEOCAST SITTING AT HOME IN YOUR PAJAMAS WITH A CUP OF COFFEE, GET DRESSED, COME DOWN, JOIN US IN PERSON AS MUCH AS YOU CAN. TAKE A SHOWER FIRST, THEN GET DRESSED AND COME DOWN. TO KICK OFF TODAY, IT'S MY PLEASURE TO INTRODUCE THE PERSON WHO WILL DO THE WELCOMING OPENING FOR OUR RESEARCH FESTIVAL TODAY, JIM ANDERSON. DEPUTY DIRECTOR OF NIH COORDINATION PLANNING AND STRATEGIC INITIATIVE. THIS IS THE HOME OF THE OFFICES -- THE COORDINATION OFFICES OF THE NIH, INCLUDING OBSSR, SO WE'VE WORKED VERY CLOSELY TOGETHER OVER THE I GUESS LAST COUNTING ACTING TIME ALMOST THREE YEARS THAT I'VE BEEN IN THIS ROLE, SO IT'S BEEN GREAT. WHAT PEOPLE DON'T KNOW, HE'S BEEN IN THE JOB SINCE 2010, HE'S ALSO IN INTERNAL MEDICINE AND HEPATOLOGY. ONE OF THE AUTHORITIES IN PRIMARY RESEARCH ON TIGHT JUNCTIONS AND PARACELLULAR TRANSPORT, SO I ALWAYS REMIND MYSELF WHEN I'M TRYING TO -- AT THE POINT WHERE I UNDERSTAND PARACELLULAR TRANSPORT, I'LL KNOW THAT HE'S PROBABLY READY TO UNDERSTAND MORE OF THE RESEARCH THAT WE DO. THAT SAID, JIM HAS BEEN AN AMAZING PERSON IN TERMS OF SUPPORTING THE OFFICE, SUPPORTING THE RESEARCH WE DO AT THE NIH, AN AND HAS BEEN A GREAT ADVOCATE FOR IT OVER THIS PERIOD OF TIME. SO WITH NO FURTHER ADO, JIM. [APPLAUSE] >> THANKS, BILL. IT'S ALSO BEEN A GREAT PLEASURE WORKING WITH BILL. HE'S I THINK PUMPED A LOT OF ENERGY INTO THE OFFICE, AND THEIR STRATEGIC PLAN, I THINK IS AN INCREDIBLE DOCUMENT FOR LEADING US FORWARD FOR THE NEXT FIVE YEARS. IT TAKES ADVANTAGE OF A LOT OF RESEARCH AND TECHNOLOGICAL DIGITAL DATA USE, AND ALSO MOVING BEHAVIORAL SOCIAL SCIENCE CLOSER TO HUMAN APPLICATIONS. SO I WANT TO WELCOME YOU TO TODAY'S REALLY HISTORIC EVENT. THIS IS THE INAUGURAL MEETING OF THE BEHAVIORAL AND SOCIAL SCIENCES RESEARCH FESTIVAL, AND I'M LOOKING FORWARD TO COMING AGAIN NEXT YEAR. THIS EVENT TODAY IS GOING TO PROVIDE AN OPPORTUNITY TO HIGHLIGHT AND ALSO TO CELEBRATE SOME OF THE RECENT NIH FUNDED RESEARCH ADVANCES BOTH FROM THE INTRAMURAL AND EXTRAMURAL ACTIVITIES THAT ARE VERY IMPORTANT IN CONTRIBUTING TO HUMAN HEALTH. BEYOND THE SCIENTIFIC PRESENTATIONS TODAY, I NOTICE THERE'S GOING TO BE TIME FOR DISCUSSIONS FOR PANELS TO TALK ABOUT WHERE WE ARE AND WHERE WE NEED TO GO. AND SPECIFICALLY ONE OF THE FOCI OF PANEL DISCUSSIONS THAT CAUGHT MY EYE WAS ON WHAT IT'S GOING TO TAKE TO MOVE RESEARCH TO PRACTICE. I THINK THAT GOAL IS CLOSER THAN WE SOMETIMES THINK. NOT JUST BECAUSE OF THE GROWING AWARENESS OR UNDERSTANDING OF FUNDAMENTAL INSIGHTS INTO HUMAN BEHAVIOR, BUT BECAUSE OF THE RAPIDLY ADVANCING PROGRESS IN DIGITAL CAPTURING OF BEHAVIOR AND SOCIAL DATA, FROM LITTLE TINY DEVICES THAT WE'RE WEARING, TO THE COMMERCIALIZATION OF LITTLE TINY DEVICES WE'RE WEARING, TO THE ABILITY TO USE BIG DATA PATTERNS AND RETURN THAT INFORMATION, INTERPRET IT AND RETURN IT TO INDIVIDUALS TO INFLUENCE THEIR BEHAVIOR TO IMPROVE HEALTH. I WAS AT -- WE HAVE A LARGE PROGRAM AT NIH THAT'S HELPING US PREPARE OR DEAL WITH BIG DATA ISSUES. IT'S CALLED BIG DATA TO KNOWLEDGE. IT'S A HUGE PROGRAM, IT'S $106 MILLION A YEAR FOR THIS CURRENT YEAR FOR TRAINING, TECHNOLOGY DEVELOPMENT, POLICY DEVELOPMENT FOR DATA SHARING, AND I WAS AT THEIR OPEN PRIZE SYMPOSIUM YESTERDAY, AND AGAIN, I WAS SO STRUCK WITH HOW THERE IS JUST THE EXPLODING CAPABILITY OF DEALING WITH DATA, FINDING PATTERNS IN DATA AND IT IS JUST A GOLDEN AGE FOR BEHAVIORAL SOCIAL SCIENCES. I KNOW BILL IS ON THE TOP OF THAT WAVE, RIDING HIS BOARD, AND I THINK THIS IS JUST AN AMAZING TIME FOR ALL OF US IN BEHAVIORAL SOCIAL SCIENCE. SO ONE OF MY FAVORITE PODCASTS IS THE NPR'S "THE HIDDEN BRAIN." I FOUND A QUOTE THAT REALLY RESONATED WITH ME, AND HERE IT IS: THE POINT IN COULDIN DOING ALL THAT RESEARCH IS IT ACTUALLY HAS AN EFFECT IN THE REAL WORLD." I DON'T HAVE THE EXACT -- IT'S SO MELLOW. I DON'T HAVE THE ACCENT. IN THE REAL WORLD THAT ACTUALLY CONNECTS WITH PEOPLE AND THEIR REAL LEAVES. LIVES. I THINK MANY UNIVERSITIES ARE SAYING THAT IT'S NOT ENOUGH FOR US JUST SIMPLY TO FUND GREAT RESEARCH THAT MAKES IT INTO PRESTIGIOUS JOURNALS. THAT WOULD BE TRUE OF FUNDERS TOO LIKE NIH. IT'S REALLY IMPORTANT TO COMMUNICATE THOSE IDEAS TO THE PUBLIC IN A WAY THAT MAKES SENSE TO THEM, AND IN MY WORDS, THAT THEY CAN USE TO IMPROVE THEIR HEALTH. SO I WANT TO RECOGNIZE BILL AND THE STAFF OF BEHAVIORAL SOCIAL SCIENCE OFFICE AND THE COORDINATING COMMITTEE FOR PUTTING TOGETHER WHAT LOOKS LIKE A REALLY SPECTACULAR EVENT. I'M ANXIOUS TO COME BACK NEXT YEAR, BILL. [APPLAUSE] >> THANK YOU, JIM. SO I THOUGHT TO KICK OFF THE DAY AND GET US STARTED, THIS WOULD BE A LITTLE BIT OF SORT OF THE STATE OF THE SCIENCE, WHERE WE ARE, WHERE WE'VE BEEN OVER THIS LAST YEAR, AND SOME OF THE THINGS THAT THE NIH HAS FUNDED AND FOE KUTIONED ON, YOU'LL SEE SOME RECENCY IN ALL OF THIS, OUR FOCUS FOR THINGS THAT HAVE HAPPENED IN FY16, AND I THOUGHT IT WOULD BE NICE TO SORT OF MOVE IT FORWARD AND THINK A LITTLE BIT ABOUT THE STATE OF BEHAVIORAL AND SOCIAL SCIENCE HERE AT NIH FOR FY16. SO FIRST OF ALL, SIBS W SINCE WE SPENT MOST OF OUR LIVES OVER THE LAST YEAR WORKING ON THE STRATEGIC PLAN, I CAN'T SPEAK I THINK ANYWHERE ANYMORE WITHOUT BRINGING THIS UP AND TALKING ABOUT IT LATELY. I WANTED TO DO AN OAF VIEW SO YOU HAD A PRETTY GOOD SENSE OF WHAT WE'RE TRYING TO DO THERE. AS YOU MAY KNOW, THERE HAVE BEEN TWO PRIOR STRATEGIC PLANS AT OBSSR, ONE IN '97 DURING THE DAYS OF NORM ANDERSON AND IN 2007, WHEN DAVE ABRAMS WAS DIRECTOR OF OBSSR. SO SOME OF THE EARLIER THINGS PART OF THOSE PREVIOUS PLANS. A COUPLE THINGS RESONATED WITH ME, ONE AROUND BIOBEHAVIORAL PER SPHEKTIVES OF ALL OF OUR RESEARCH AREAS, THIS IDEA OF INTEGRATING OUR WORK WITHIN THE LARGER BIOMEDICAL RESEARCH EFFORT. SOME OF THE THINGS FROM THE 2000 PLAN YOU'LL SEE CARRIED FORWARD, ESPECIALLY THINGS LIKE SYSTEM-RELATED THINKING AND INTERDISCIPLINARY RESEARCH AS PART OF THE EFFORT. THE ONE THING I'LL MENTION ABOUT THE WAY WE WENT ABOUT DOING THE STRATEGIC PLAN IS THE LAST THING ON THE SLIDE. THERE ARE THINGS THAT THE OFFICE OBSSR WAS UNIQUELY POSITIONED TO ADDRESS. SO YOU MAY NOT SEE YOUR CONTENT AREA INCLUDED, YOU MAY NOT SEE HEALTH DISPARITIES LISTED SOMEWHERE SPECIFICALLY BECAUSE THERE'S AN INSTITUTE THAT DEALS WITH HEALTH DISPARITIES. DOESN'T MEAN WHAT WE DO IS NOT SUPPORTIVE OF THAT, IT JUST MEANS WE TRY TO FOCUS THE WORK ON THE THINGS WE THOUGHT WE WERE UNIQUELY POSITIONED TO BE ABLE TO DO. THIS IS STRATEGIC PLANNING WORKING GROUP ON THE RIGHT, SO WE HAD A REALLY GOOD GROUP OF PEOPLE THAT GUIDED US FROM THE NIH THROUGHOUT THIS PROCESS ON HOW TO GET THIS DONE AND THE THINGS NA NEED TO HAPPEN. NOT JUST WITHIN OBSSR, BUT THE BROADER BEHAVIORAL AND SOCIAL SCIENCE RESEARCH COMMUNITY. THEN THE EXPERT PANEL, YOU'LL RECOGNIZE, I THINK, A NUMBER OF THE NAMES ON THIS PANEL WHO DID JUST A WONDERFUL JOB. ALAN LESHNER MANAGED IT, WE MANAGED FOLKS OUT OF SEMI-RETIREMENT TO BE ABLE TO HELP WITH THAT. SO WHAT YOU'LL SEE IN THE STRATEGIC PLAN IS SOME KEY ASPECTS OF THIS AROUND THREE SIGN TUS SCIENTIFIC PRIORITIES AND SOME FOUNDATIONAL PROCESSES FOR THEM THAT WE FEEL SORT OF THE THINGS THE OFFICE DOES DAY IN, DAY OUT OVER AND OVER AGAIN AS PART OF OUR WORK. AROUND THOSE FOUNDATIONAL PROCESSES, ONE IN COMMUNICATION, I'LL HIGHLIGHT A COUPLE OF THINGS WE'VE BEEN DOING OVER THE LAST YEAR, AND TALK ABOUT THEM A LITTLE BIT MORE AS WELL, BUT ONE OF THE EFFORTS IN COMMUNICATION HAS ALWAYS BEEN FOR A NUMBER OF YEARS NOW, OVER A DECADE, THE MATILDA WHITE RILEY EXCELLENCE LECTURE. THIS YEAR WE'VE BEEN PUTTING IN EARLY STAGE INVESTIGATOR AWARDS -- PAPER AWARDS FOR THAT. OUR COORDINATION AND INTEGRATION EFFORTS HAVING TO DO WITH BEHAVIORAL AND SOCIAL SCIENCE COORDINATING COMMITTEE, WHO HAS WORKED WITH US TIRELESSLY ON THIS EVENT BUT ALSO THROUGHOUT THE YEAR ON VARIOUS THINGS. TRAINING EFFORTS, I THINK PEOPLE WILL BE SURPRISED TO KNOW THAT THERE ARE 11 SUMMER TRAINING INSTITUTES, EIGHT R25s AND THREE THROUGH OTHER MECHANISMS AT THIS POINT. THEN EVALUATING THE IMPACT OF BEHAVIORAL AND SOCIAL SCIENCES THROUGH A NUMBER OF THINGS GOING ON THERE AS WELL. SO THE FIRST SCIENTIFIC PRY ORKTS IMPROVE THE SYNERGY OF BASIC AND APPLIED BEHAVIORAL AND SOCIAL SCIENCE RESEARCH. I THINK ALL YOU WAS RECOGNIZE THE FACT THERE'S A BIT OF A BROKEN PIPELINE BETWEEN BASIC RESEARCH AND APPLIED RESEARCH. SO THE FIRST THING I THINK WE FELT NEEDED TO BE DONE IS THAT THE BASIC BEHAVIORAL AND SOCIAL SCIENCE RESEARCH PORTFOLIO NEEDS TO BE STRENGTHENED, IDENTIFIED, AREAS WHERE WE'RE NOT DOING ENOUGH WORK, WHERE THE SILOS OF THE NIH AND TO MAKE IT DIFFICULT TO FIND WHERE THOSE GAPS ARE AND HAVE THEM ADEQUATELY FUNDED. ONE OF THE KEY THINGS THAT THE OFFICE NEEDS TO DO. THE OTHER IS TO INCREASE A FLOW BACK AND FORTH BETWEEN BASIC AND APPLIED RESEARCHERS. I PUT IN HERE THIS PRIMARY OUTCOME. I DON'T KNOW THAT EVERYBODY CAN LIVE WITH IT, BUT IT'S ONE THAT I THINK IS IMPORTANT, WHICH IS THAT WHEN INTERVENTION RESEARCHERS ARE DOING THEIR CONCEPTUAL MODELS FOR THE INTERVENTION, THEY OFTEN BASE THEM ON THEORETICAL MODELS. ALL WELL AND GOOD, ALL APPROPRIATE, AND CERTAINLY BETTER THAN THE DAYS WHEN THEY DIDN'T DO THAT. I THINK WE CAN GO A STEP FURTHER AND THEY CAN BASE IT NOT JUST ON THEORETICAL MODELS BUT THE BASIC SCIENCE FINDINGS THAT DETERMINE WHAT ARE THE MECHANISMS FOR THIS BEHAVIOR AND WHAT ARE THE TRIGGER STRATEGIES, WHAT ARE THE LEVERS THAT WE HAVE TO BE ABLE TO INFLUENCE THAT MECHANISM AND MOVE FORWARD. SO JUST BEING ABLE TO BE A LITTLE BIT MORE SORT OF TIED BETWEEN BASIC AND APPLIED. OUR SECOND PRIORITY, ENHANCE THE METHODS, MEASURES AND DATA INFRASTRUCTURES TO ENCOURAGE A MORE CUMULATIVE BEHAVIORAL AND SOCIAL SCIENCES. DATA INTEGRATION, REPLICATION IN BEHAVIORAL AND SOCIAL SCIENCES HAS BEEN AN ISSUE OF SOME IMPORTANCE. UP WITH OF THE THIRPTION I THINK GOING TO BE CRITICALLY -- THE TERMINOLOGY, TRYING TO BE MUCH MORE CONSISTENT ON THE CONSTRUCTS, HOW WE MEASURE THEM, WHAT WE'RE THINKING ABOUT WHEN WE SAY THESE THINGS. DEVELOP. NEW MEASUREMENT APPROACHES. BY THAT, WE DON'T MEAN YET ANOTHER SELF-REPORT MEASURE OF WHATEVER YOUR FAVORITE CONSTRUCT IS. BUT INSTEAD, MORE IMPORTANTLY, REALLY NEW INNOVATIVE WAYS OF MEASURING SOME OF THE THINGS THAT WE HAVE TO MEASURE IN THE BEHAVIORAL AND SOCIAL PROCESSES. AND THEN THE REPERTOIRE METHODS THAT ARE AVAILABLE WITH SOCIAL AND BEHAVIORAL RESEARCHERS. I THINK AS OUR DATA GETS LARGER, IT GETS MORTEM PORLL MORE TEMPORALLY DENSE, NEW METHODOLOGIES NEED TO BE BROUGHT TO BEAR TO BE ABLE TO DO THAT. WE NEED TO TAKE MORE ADVANTAGE OF THEM THAN WE CURRENTLY DO. THEN OUR THIRD IS TO FACILITATE THE ADOPTION OF BEHAVIORAL AND SOCIAL SCIENCE RESEARCH FINDINGS IN HEALTH RESEARCH AND PRACTICE. AS JIM ALLUDED TO AS WELL, THIS IS AN AREA OF PARTICULAR CONCERN, I THINK. WE HAVE KNOWN FOR MANY YEARS THAT THE RESOURCES ARE NOT NECESSARILY IN PLACE TO PUT BEHAVIORAL AND SOCIAL SCIENCE RESEARCH INTO PRACTICE AS EASILY EASILY. PUBLIC HEALTH CLINICS RUBBING DIMES TOGETHER TRYING TO MAKE SOME OF THESE THINGS WORK, CONSIDERABLE DIFFICULTY BEING ABLE TO GET THESE THINGS OUT INTO THE PUBLIC CONTEXT. PLUS THE PLACE WHERE WE'RE DISSEMINATING AND IMPLEMENTING TOO IS BROADER THAN JUST HEALTHCARE AND IT INCLUDES COMMUNITIES AND ORGANIZATIONS AND POLICY MAKERS AND OTHER GROUPS AS WELL THAT WE NEED TO MAKE SURE WE PAY ATTENTION TO AS WE MOVE FORWARD. SO THOSE ARE OUR SCIENTIFIC PRIORITIES AS WELL, AND THEN FRANCIS WAS ACTUALLY KIND ENOUGH TO WRITE THIS EDITORIAL WITH ME THAT CAME OUT ON THE SAME DAY WE RELEASED THE STRATEGIC PLAN ON NOVEMBER 23RD, WHICH IS A QUICK OVERVIEW NOT OF THE PLAN ITSELF BUT OF SOME OF THE SORT OF TRANSFORMATIVE DRIVERS WE THINK ARE CHANGING THE LANDSCAPE OF BEHAVIORAL AND SOCIAL SCIENCE RESEARCH MOVING FORWARD. SO LET ME SHIFT GEARS. I'LL TALK A LITTLE ABOUT BEHAVIORAL AND SOCIAL SCIENCE RESEARCH FUNDING. WE ALL GO, O THINGS ARE SO ROUGH. THEY'RE REALLY NOT AS BAD AS YOU MIGHT THINK. THIS IS THE OVERALL FUNDING IN BEHAVIORAL AND SOCIAL SCIENCE RESEARCH AND IN BASIC BEHAVIORAL AND SOCIAL SCIENCE FUNDING BY FISCAL YEAR BASED ON RCDC CRITERIA. SOME OF YOU MAY GO, WELL, SOME OF THE THINGS ARE NOT SO ORIENTED BUT IT'S A PRETTY GOOD INDICATOR AND CLEARLY ONE THAT AT THE NIH WE USE ON A REGULAR BASIS TO REPORT. WHAT YOU'LL SEE IS A GRADUAL INCREASE IN BEHAVIORAL AND SOCIAL SCIENCE OVER THE LAST FEW YEARS, ESPECIALLY FY13 AND MOVING FORWARD. I THINK WE'VE SEEN SOME NICE IMPROVEMENTS IN THAT. WE'RE APPROACHING ESSENTIALLY $4 BILLION OF GRANT FUNDING THAT HAS THE BEHAVIORAL AND SOCIAL SCIENCE COMPONENT. THAT FUNDING IS DISTRIBUTED ACROSS A NUMBER OF INSTITUTES. ALL THE WAY FROM THE INSTITUTES AS LARGE AS NIMH IN TERMS OF FUNDING FOR FY16, THIS IS NEW COMPETITIVE FUNDING, THIS IS THE FUNDING THAT WAS DONE THIS YEAR. AND ALL THE WAY THROUGH. SO IT'S AN INTERESTING PROCESS, HAVING BEEN IN THIS ROLE, LOOKING AT HOW WE COORDINATE THE EFFORT OF BEHAVIORAL AND SOCIAL SCIENCES ACROSS THE NIH, AS IT'S SCATTERED ABOUT ALL OF THESE INSTITUTES AND CENTERS IN VARIOUS WAYS. ONE OF THE THINGS I WANTED TO DO WAS NOT JUST GIVE YOU GRAPHS, I WANTED TO SHOW YOU SOME OF THE EXCITING RESTRETCH THA RESEARCH THAT WAS FUNDED THIS YEAR. WHEN I LOOKED AT ALL THIS, I SAID OKAY, I'LL HIGHLIGHT A FEW. THERE'S 2600 GRANTS FUNDED IN -- OVER 2600 GRANTS FUNDED IN 2016 BY THE VARIOUS INSTITUTES AND BEHAVIORAL AND SOCIAL SCIENCE RESEARCH. IT WAS HARD ENOUGH JUST TO READ ALL THE TITLES OF THOSE IN TIME. SO THEN I WENT, WELL, I'LL TAKE ONE FROM EACH INSTITUTE, AND I'LL DO THAT. WELL, THAT'S 27 AND I DON'T HAVE ENOUGH TIME FOR THAT EITHER. SO WHAT I DID WAS, I THOUGHT LET ME FOCUS OP THE FOLKS THAT DON'T FUND AS MUCH -- YOU MAY BE SURPRISED THAT THEY FUND BEHAVIORAL AND SOCIAL SCIENCE RESEARCH AND HIGHLIGHT SOME OF THEIR WORK. SO GOING FROM NINR AND WORKING YOUR WAY UP ON THIS CHART, A FEW OF THE EXAMPLES OF SOME OF THE RESEARCH THAT WAS FUNDED THIS YEAR ALONE. SO THIS IS FROM NURSING, THIS IS TAILORED SELF HELP -- OR TAILORED HEALTH SELF MANAGEMENT INTERVENTIONS FOR HIGHLY DISTRESSED FAMILY CAREGIVERS, CAREGIVERS FOR THOSE WITH BIPOLAR DISORDER, THERE'S VERY LITTLE INFRASTRUCTURE OTHER THAN THE ACTUAL PATIENT'S FAMILY MOST OF THE TIME TO HELP WITH MANAGING THESE PATIENTS OVER TIME. SO THINGS WE CURRENTLY DO, FAMILY AND EDUCATIONAL INTERVENTIONS HAVE HAD A MINIMAL EFFECT AND THERE REALLY IS VERY LITTLE TAILORED INTERVENTION WORK THAT'S BEEN REVIEWED AT THIS POINT. SO THIS STUDY IS ACTUALLY A FOUR-ARM STUDY. NO INTERVENTION, EDUCATION USUAL CARE, SELF MANAGEMENT TRAINING BASED ON THE NEED THAT THEY -- AS THEY UNDERSTAND IT FROM THE PATIENT, OR FROM THE CAREGIVER, AND THEN SELF MANAGEMENT TRAINING BASED ON THE PREFERENCES OF THE CAREGIVER. WHAT KIND OF ASPECTS OF THINGS DO THEY CONSIDER TO BE MOST IMPORTANT THAT THEY WANT TO PAY ATTENTION TO. WITH OUTCOMES AT 6 AND 12 MONTHS, AND OUTCOMES IN THE CAREGIVERS THEMSELVES AS WELL AS ASSOCIATION OF CAREGIVER NEEDS AND PREFERENCES WITH CONTEXTUAL FACTORS SO EVENTUALLY THEY CAN HAVE PREDICTIVE MODELS FOR WHAT THE LIKELY NEEDS AND PREFERENCES ARE OF THESE CAREGIVERS OF BUY BIPOLAR PATIENTS, PREDICT THAT AHEAD OF TIME AND GIVE THEM THE RESOURCES AND INTERVENTIONS THAT THEY NEED. THIS IS FROM NIAID, MODELING A COUPLE DYNAMICS OF INFLUENZA VACCINATION MAY HAVE YOURS. SEASONAL INFLUENZA VACCINATION DECISIONS ARE LARGELY MOTIVATED BY ATTITUDES ABOUT RISKS AND BENEFITS OF THAT. AND THAT PREVIOUS WORK THAT THIS PARTICULAR GROUP HAS DONE HAS CONFIRMED A STRONG DYNAMICAL INTERPLAY JUST ABOUT BEHAVIOR OF GETTING VACCINATED, THE EPIDEMIOLOGY AND SOCIAL NETWORK STRUCTURES. SO THIS WILL ENHANCE AND REFINE MODELS OF HETEROGENEOUS SAMPLES IN A FOUR-YEAR STUDY TO CAPTURE DECISIONS ABOUT VACCINATION, ATTITUDES AND BELIEFS ABOUT VACCINATION BEHAVIORS, SOCIAL STRUCTURES AND SOCIAL NETWORKS, AND BE ABLE TO EVENTUALLY MODEL AND EVALUATE HOW PEOPLE MAKE THESE DECISIONS A LITTLE BIT BETTER ABOUT INFLUENZA VACCINATION, HOW WE CAN IMPROVE THAT MOVING FORWARD. THIS IS WORK FROM NIGMS, SOME OF THE WORK THAT NEEDS TO BE DONE IS NOT ACTUALLY DOING THE RESELF, IT'S BUILDING THE RESEARCH INFRASTRUCTURE TO MAKE IT EASIER TO DO THE RESEARCH, AND THIS IS A PROJECT CALLED HEALTHPOP, GEOCODING, SPATIAL WORK FLOW AND CONTEXTUAL DATA INTEGRATION PLATFORM. IT'S HARD FOR MOST OF THE TYPICAL RESEARCHER, ESPECIALLY ONE WHO'S NOT COMFORTABLE WITH GIS-TYPE DATA TO BE ABLE TO PULL THAT INTO THEIR STUDY AND USE IT READILY. SO THIS PROJECT ACTUALLY WORKS ON BUILDING AN END TO END FREE TRANSPARENT WEB BASED PLATFORM THAT ALLOWS RESEARCHERS AND PRACTITIONERS TO GEOCOLD KOAD HEALTH AND SURVEY DATA IN CONSTRUCTING CONTEXTUAL VARIABLES IN THAT CONTEXT. A REALLY NICE AND HAVE INTERESTING WAY TO IMPROVE AND FACILITATE OF TYPE OF RESEARCH WE DO LOOKING AT GEOCODING AND LOCATION DATA. THIS IS A STUDY FROM NIEHS FROM ENVIRONMENTAL SCIENCES, A GRANT THAT THEY JUST FUNDED AGAIN THIS YEAR. ALL OF THESE ARE GRANTS FUNDED IN FY16. THIS IS TELL MERE DYNAMICS AS INDICATORS OF SOCIAL ADVERSITY IN ENVIRONMENTAL EPIDEMIOLOGY. I FORGOT NOW WHAT PBDE STAPPEDZ FOR BUT STANDS FOR, EARLY LIFE EXPOSURE TO STRESSORS. SO BOTH OF THOSE THINGS, SOME OF THE CHEMICAL EXPOSURES AND ALSO EARLY LIFE STRESSOR EXPOSURES DISRUPT ENDOCRINE SYSTEM HOMEOSTASIS, QUANTIFYING SOCIAL CONDITIONS, SO THEY'RE LOOKING AT TEL TELOMERES AND HOW THEY CAN ACTUALLY LOOK AT THOSE AS A POTENTIAL OBJECTIVE APPROACH OF THE BIOLOGICAL MANIFESTATIONS OF SOCIAL FACTORS AND STUDY THE RELATIONSHIP BETWEEN PRE AND POSTNATAL EXPOSURES BOTH TO PBDEs AND SOCIAL ADVERSITY, MEASURING QUESTIONNAIRE DATA, TELOMERE DYNAMICS ON COGNITIVE BEHAVIORAL PERFORMANCE USING AN EXISTING DATASET. THIS IS JUST AN R03 SO THIS IS A NICE EXAMPLE OF TAKING EXISTING DATA, USING A SMALL GRANT TO DO SORT OF NOVEL AND UNIQUE ANALYSES OF THAT IN TERMS OF EXISTING DATASETS. THIS IS FROM OUR FRIENDS AT THE NATIONAL EYE INSTITUTE. YOU GO, WELL, I'M SURPRISED EYE HAS A FAIR AMOUNT OF RESEARCH BUT THEY DO IN BEHAVIORAL AND SOCIAL SCIENCES. THIS IS A STUDY ON AT RISK DRIVING AND COMPENSATORY STRATEGIES IN OLDER ADULTS WITH GLAUCOMA, IN WHICH THEY'LL STUDY BOTH PEOPLE WITH VARYING SEVERITY OF GLAUCOMA AS WELL AS CONTROL DRIVERS USING ON-ROAD DRIVING TESTS TO ASSESS BEHAVIORAL AND DO A COMPREHENSIVE CLINICAL ASSESS. VISION AND NON-VISION TA FACTORS ASSOCIATED WITH DRIVING, THE KIND OF THINGS WHICH WE TYPICALLY MEASURE IN THE FIELD. DETERMINE VISION AND NON-VISION FACTORS ASSOCIATED WITH IT, IDENTIFY EFFECTIVE COMPENSATORY STRATEGIES FOR SAFE GLAUCOMA DRIVERS SO WE CAN IMPROVE THE WAY PEOPLE WITH GLAUCOMA ARE ABLE TO LENGTHEN THE AMOUNT OF TIME THEY'RE ABLE TO DRIVE WITH THE CONDITION AND DO THAT SAFELY. THIS IS FROM OUR FRIENDS AT NCCIH, A STUDY ON MINDFULNESS AND MIGRAINE, RANDOMIZED CONTROLLED TRIAL. MIGRAINE IS ONE OF THE LEADING CAUSES OF DISEASE BURDEN IN THE COUNTRY. INCREASINGLY SHOWN TO BE EFFECTIVE IN A NUMBER OF FUNCTIONAL DISORDERS, MIGHT BE AN ADJUNCT TO THERAPY FOR PATIENTS WITH MIGRAINE HEADACHES AS WELL. SO THEY'RE DOING A LATENT CLASS ANALYSIS TO IDENTIFY SUBGROUPS OF MIGRAINE PATIENTS DEFINED BY THEIR CO-MORBIDITY, RANDOMIZED TO MIEND FULLNESS BASED STRESS REDUCTION OR USUAL CARE AND OUTCOMES AT 4, 8 AND 12 MONTHS POST RANDOMIZATION. LOOKING PRIMARILY AT HEADACHE FREQUENCY AT THE FOUR MONTH FOR PRIMARY BUT LOOKING AT SECONDARY END POINTSZ INCLUDING PAIN, DISABILITY, QUALITY OF LIFE, MOOD AND SLEEP QUALITY. I ONLY HAVE 10, JUST SO YOU KNOW. BUT THESE ARE ALL -- I HAVE TO TELL YOU, GOING THROUGH 2600 TITLES, I WAS TRULY IMPRESSED WITH THE BREADTH, THE QUALITY, THE AMOUNT OF BEHAVIORAL AND SOCIAL SCIENCE RESEARCH THAT THE NIH FUNDS, AND THAT'S JUST THIS YEAR, JUST NEW FUNDING FOR THIS YEAR. EPIGENETIC BASIS OF PAIN VULNERABILITY, THIS IS WORK FROM ON EPIGENETIC BASIS FOR PAIN VULNERABILITY, PRIOR STRESSFUL EVENTS, WHETHER THAT LEADS TO PREFERENTIAL RESPONSES, LOOKING AT DNA METHYLATION AND HOW THAT MEDIATES GENE REPRESSION IN INDIVIDUAL VARIANTS AND VULNERABILITY FOR DEVELOPING CHRONIC PAIN. BY DOING THAT IN RAT AND MOUSE M MODELS, LOOKING AT OROFACIAL PAIN TO ESTABLISH A FUNCTIONAL LINK BETWEEN PAPER AND STRESS, DETERMINING WHETHER THE ANIMAL IS VULNERABLE TO NEGATIVE EMOTIONS OF PAIN. SOME OF THE EPIGENETIC WORK THAT AGAIN SORT OF INTEGRATES A LOT OF THE BEHAVIORAL AND SOCIAL SCIENCE WORK. THIS IS ANOTHER SORT OF RESOURCE STUDY FROM NIBIB, SENSOR DATA TO ENHANCE DATA DRIVEN PRECISION MEDICINE AND BEHAVIORAL HEALTH, STEPEN INTILLE'S WORK. A NUMBER OF PEOPLE HAVE ARGUED IT NEEDS TO STAY IN ITS RAW FORM AS IT'S BEING COLLECTED AND STORED SO WE CAN DO NEW THINGS WITH IT AS WE UNDERSTAND HOW BETTER TO SUMMARIZE IT, AGGREGATE IT AND PUT IT TOGETHER IN USEFUL WAYS. WITH YOU THAT TAKES BUT THAT TAKES A LOT OF WORK. MACHINE LEARN SOMETHING NOT MAGICAL, SO WHAT THEY'VE DONE AT NORTHEASTERN IS A PROJECT HERE IN WHICH THEY'RE GOING TO USE CROWD SOURCING TO DETERMINE THE FEASIBILITY, USABILITY IN MOBILE AND CROWD SOURCED BASED ONLINE SYSTEM FORCE CLEANING AND -- OTHER MOBILE DEVICES AND DEMONSTRATES HOW INDIVIDUALS PLAY MOBILE AND ONLINE GAMES, A CROWD, CAN COLLECTIVELY ADD IMPORTANT META DATA TO RAW SENSOR DATA THAT HAS BEEN PASSIVELY COLLECTED FROM INDIVIDUALS. I THINK THIS IS MY LAST. I THINK I GOT ONE MORE AFTER THIS. THIS IS INTEGRATION OF GENOMICS AND ENVIRONMENT THIS IS A LARGE STUDY OUT OF NHGRI, WE ALL KNOW THAT ENVIRONMENT IS A MAJOR CONTRIBUTOR OF HUMAN DISEASE BUT LARGELY IGNORED IN SOME OF THE WHOLE GENOME APPROACHES WE HAVE TO KATE. THIS WILL EVALUATE THE MECHANISM BY WHICH ENVIRONMENT INFLUENCES GENOMIC FUNCTION FOCUSING ON TWO IMPORTANT EXPOSURES: DIET AND ITS RELATIONSHIP TO METABOLIC DISEASE AN CAN SE AND STRESS RELATED TO NEUROPSYCHIATRIC DISEASE. THEN DEVELOP A NEW FOUNDATIONAL EXPERIMENTAL MOUSE MODEL FOR UNDERSTANDING GENE ENVIRONMENT INTERACTION AND BEING ABLE TO DO THAT WITH SOME NEW STATISTICAL METHODS AND NOVEL APPROACHES TO THAT AS WELL. THEN FINALLY, THIS IS FROM THE FOGARTY CENTER, INTERNATIONAL WORK. THIS IS A STUDY ON DOMESTIC VIOLENCE AND CULTURALLY APPROPRIATE PREVENTION IN PAKISTAN. LOOKING AT INTIMATE PARTNER VIOLENCE AND THE HIGH RATES PARTICULARLY -- AS DETERMINING POOR OUTCOMES AMONG CHILDREN WHO WITNESS INTIMATE PARTNER VIOLENCE OR EXPOSED IN UTERO, AND PREGNANCY IS ALSO DEMONSTRATED TO BE AN INCREASED VULNERABILITY OF PARTNER VIOLENCE. FORMTIVELY KNOWLEDGE NEEDED TO PROVIDE THE BASIS FOR EFFECTIVE IPV PREVENTION. SO JUST A SAMPLING OF 2600, BUT ONES I THOUGHT YOU SHOULD SEE AS AN EXAMPLE OF THE TYPES OF BREATH OF FUNDIN BREADTH OF FUNDING NIH HAS DONE OVER THE LAST YEAR. WAIT A MINUTE TO TALK ABOUT SOME OF THE FUNDING HIGHLIGHTS OVER 2016 AS WELL. MOST OF YOU HAVE BEEN QUITE BUSY, IT TURNS OUT, AND HAVE A NUMBER OF FUNDING ANNOUNCEMENTS THAT HAVE BEEN RELEASED, THAT ARE CURRENTLY ACTIVE IN 2016. THESE ARE JUST SOME INITIAL EXAMPLES OF SOME OF THE ONES. I PROBABLY AM NOT EXHAUSTIVE HERE. WANTED TO AT LEAST GIVE YOU SOME SENSE OF FUNDING ANNOUNCEMENTS THAT HAVE BEEN RELEASED IN THE LAST YEAR. THAT'S ONE SET. HERE'S ANOTHER SET OF THEM AND SOME OF THE WORK THAT'S GOING ON ON. I WON'T READ ALL THESE. ESPECIALLY PEOPLE WORRYING IF I WAS GOING TO BE HERE BECAUSE I WAS ON A LATE FLIGHT LAST NIGHT FROM CHICAGO SO MY READING ABILITIES ARE A LITTLE BIT ATTENUATED. AND THEN A THIRD SET OF THESE. SO A LOT OF WORK ACROSS ALL OF YOUR INSTITUTES AND CENTERS TO FUND SPECIFIC RESEARCH, IDENTIFY GAPS AND FOCUS ON THEM. NBSSOBSSR HAS DONE A NUMBER, LOOKING AT MULTIPLE CHRONIC HEALTH CONDITIONS, MEDICATION ADHERENCE, VALIDATION OF MOBILE/WIRELESS HEALTH TOOLS, BEHAVIORAL AND SOCIAL SCIENCES, EDUCATION AND HEALTH, PROCESSES IN THE MANAGEMENT OF CHRONIC CONDITIONS, METHODOLOGY AND MEASUREMENT OF THE BEHAVIORAL AND SOCIAL SIG SCIENCE, ONES THAT OBSSR HAS TAKEN A LEADING ROLE IN, BUT WE CAN'T DO IT WITHOUT THE SUPPORTING INSTITUTES AND CENTERS THAT HELP COORDINATE IT, BUY IN TO THE CONCEPTS AS WE'RE BUILDING THEM, WORKING WITH US IN BUILDING THEM AND MOVING THEM FORWARD. WE ALSO AT OBSSR, AS YOU ALL KNOW, DO A FAIR AMOUNT OF COFUNDING. THIS IS FROM OUR WORK OVER THE LAST THREE YEARS IN TERMS OF COFUNDING EFFORTS. WE TYPICALLY COFUND A LITTLE OVER 100 GRANTS PER YOUR REQUESTS AS THEY COME IN. YOU'LL SEE SOME VARIATION FROM YEAR TO YEAR. THAT'S KIND OF EXPECTED AND APPROPRIATE. THERE ARE TIMES WHERE SOME INSTITUTES HAVE FAIRLY LARGE REQUESTS AND WE'RE RESPONDING TO THOSE. SO YOU'LL SEE THAT IN 2014, WE PROBABLY SPENT OUR MOST COFUNDING MONEY AT NCI. 2015, WE SPENT MOST OWFER MONEY WITH NICHD OR A SIGNIFICANT PORTION OF IT. THIS LAST YEAR, WITH NINDS, PARTICULARLY WITH THE BRAIN INITIATIVE AROUND SOME OF THE WORK THAT WAS BEGINNING TO MOVE THE BRAIN INITIATIVE OUT INTO BEHAVIOR A LITTLE MORE, THIS WAS PARTICULARLY AROUND LANGUAGE PROCESSING AND THAT SORT OF THING. SO WE THOUGHT THOSE WERE SOME REALLY GOOD EFFORTS WE WANTED TO FUND AS WELL. A LOT OF THEMES THROUGHOUT THAT. AGAIN, I WON'T READ ALL OF THESE TO YOU, BUT THEY RUN THE GAMUT OF EVERYTHING FROM VERY BASIC NEUROSCIECE ALL THE WAY THROUGH TO SOCIAL DETERMINANTS OF HEALTH AND MANY THINGS IN BETWEEN, IN TERMS OF THE TYPES OF THINGS THAT WE'VE COFUNDED AT OBSSR OVER THE YEARS. WE'VE BEEN BUSY ON A FEW OTHER LITTLE THINGS ALONG THE WAY THAT I THOUGHT YOU WOULD LIKE TO SEE. AS I NOTED BEFORE, WE HAD, I THINK, A NICE MATILDA WHITE RILEY AWARD. THIS WAS OUR FIRST YEAR OF TAKING PEOPLE FROM EARLY STAGE INVESTIGATORS AND HIGHLIGHTING PAPERS THAT THEY HAD PUBLISHED IN THE LAST YEAR, SO THESE WERE OUR AWARDEES FOR THAT AS WELL. WE ALSO HAVE BEEN TRYING TO STAY BUSY WITH THE OBSSR COULD NECK, TCONNECTOR, HOW TO KEEP YOU INFORMED ON SOME OF THE THINGS THAT ARE GOING ON. WE'VE BEEN INVOLVED IN A NUMBER OF LARGE PROJECTS, ABCD INITIATIVE, THE PRECISION MEDICINE INITIATIVE, NOW CALLED "ALL OF US," THE BRAIN NICHE AND THE ECHO PROM, AL PROJECT, ALL THINGS WE'VE PLAY A ROLE IN AND MANY OF YOU IN THE AUDIENCE HAVE PLAYED A ROLE IN AS WELL, TO ENSURE THAT BEHAVIORAL AND SOCIAL FACTORS ARE INCLUDED IN THOSE LARGE PROJECTS MOVING FORWARD. I JUST ALSO WANT TO MENTION, BECAUSE WE REALLY DID THIS AS SORT OF AN AFTERTHOUGHT, AND IT TURNED OUT TO BE SO NICE THAT WE'RE GOING TO KEEP DOING IT. SO LINDA COLLINS AND DANNY EMEROL AND OTHERS HAD DONE A WEEK LONG TRAINING INSTITUTE IN MAY. A LOT OF PEOPLE FROM THE NIH WEREN'T ABLE TO GO TO IT BECAUSE IT FILLED UP SO QUICKLY AND WE THOUGHT IT REALLY SHOULD BE FOR EXTRAMURAL INVESTIGATORS. SO LINDA AND DANNY OFFERED TO JUST PROVIDE A ONE-DAY TRAIBING TRAINING SPECIFICALLY FOR NIH PEOPLE SO THEY COULD LEARN ABOUT A NEW METHODOLOGY, IN THIS KAI OPTIMIZATION DESIGNS AND SOME OF THE APPROACHES THERE. REALLY WELL ATTENDED, NICELY DONE, SO IT'S ONE OF THE THINGS THAT WE'LL CARRY FORWARD FROM YEAR TO YEAR, JUST A DAY-LONG TRAINING FOR NIH STAFF PARTICULARLY AROUND NEW METHODOLOGY AS WE MOVE FORWARD. I THINK IT WILL PROBABLY BE ON GIS-RELATED METHODOLOGIES FOR THIS NEXT YEAR MOVING FORWARD. WE'VE ALSO BEEN BUSY HIRING, SO THESE ARE THE NEW PEOPLE IN OUR OFFICE. DON'T THEY ALL LOOK LOVELY AND SMILING? WHAT A NICE GROUP. WE'VE BEEN REALLY FORTUNATE TO ADD SOME REALLY NICE AND VERY STRONG SCIENTISTS AND PEOPLE TO THE OFFICE OVER THE LAST YEAR. KATIE MORRIS WHO, BY THE WAY, IS THE PERSON WHO HAS PULLED THE VAST MAJORITY OF ALL OF THIS TOGETHER FOR THIS PARTICULAR RESEARCH FESTIVAL, NEW PEOPLE IN THE OFFICE, BUT I HAVE TO SAY A WORD ABOUT THE PEOPLE WHO HAVE WEATHERED THE STORM OVER THE LAST WHAT, THREE-PLUS YEARS. IT'S NOT HARD TO LOSE -- IT'S HARD TO LOSE A DIRECTOR, HAVE AN ACTING DIRECTOR FOR 16 MONTHS, THEN TRY TO FIGURE OUT WHAT THIS NEW DIRECTOR IS GOING TO DO, HAVE THEM SORT OF RESCRAMBLE EVERYTHING IN THE OFFICE AROUND AND SOMEHOW HANG IN THERE AND DO THE THINGS THAT NEED TO BE DONE, GREAT GROUP OF PEOPLE SO WANT TO THANK THEM ALL. I THINK WITH THAT, I WILL END AND WE'LL GET TO THE SCIENTISTS THAT EVERYBODY'S BEEN WAITING TO HEAR FROM TODAY. SO THANK YOU ALL. [APPLAUSE] >> GOOD MORNING, EVERYONE. OVER THE PAST 10 YEARS AT NIH, IT'S BEEN MY PRIVILEGE TO WORK WITH OUTSTANDING COLLEAGUES AND AN ARRAY OF REMARK PLI REMARKABLY TALENTED SCIENTISTS ON STRENGTHENING SUPPORT FOR BASIC AND BEHAVIORAL SCIENCES AT NIH, ALSO ON LEVERAGING THOSE BASIC SCIENCE INSIGHTS TO SUPPORT TRANSLATIONAL EFFORTS TO PROMOTE HEALTH AND PREVENT DISEASE. THIS PANEL IS AROUND THAT THEME WHICH IS REALLY EMPHASIZING THAT FIRST PILLAR OF THE NEW OBSSR STRATEGIC PLAN, STRENGTHENING THE SYNERGY BETWEEN BASIC AND APPLIED SCIENCE. ONE FLAGSHIP INITIATIVE, THE NIH SCIENCE OF BEHAVIORAL CHANGE PROGRAM, IS AN EXEMPLAR OF THIS KIND OF INTEGRATIVE WORK. THAT'S A PROGRAM THAT SEEKS TO LEVERAGE MERGING MECHANISTIC INSIGHTS FROM TRANSDISCIPLINARY DOMAINS OF BEHAVIORAL AND SOCIAL SCIENCE LIKE SOCIAL AND AFFECTIVE NEUROSCIENCE, BEHAVIOR GENETICS, BEHAVIORAL AND NEUROECONOMICS AND BEHAVIORAL MEDICINE, TO SEARCH FOR AND VALIDATE INTERVENTION TARGETS FOR BEHAVIOR CHANGE. IT ENGAGES SCIENTISTS WHO CAN IDENTIFY THE SOCIAL, INTERPERSONAL, PSYCHOLOGICAL AND BIOLOGICAL MECHANISMS THAT DRIVE BEHAVIOR. IT ENGAGES INDIVIDUALS WHO WORK IN THE LAB AND IN THE FIELD TO ELUCIDATE THE CONDITIONS UNDER WHICH THESE MECHANISMS OPERATE, AND IT ENGAGES SCIENTISTS WHO CAN APPLY THESE INSIGHTS TO DEVELOP MORE POTENT AND IMPLEMENTABLE BEHAVIORAL INTERVENTIONS. THE FUNDAMENTAL PHILOSOPHY THAT DRIVES THE SCIENCE OF BEHAVIOR CHANGE PROGRAM IS ALSO AT THE HEART OF THE WORK THAT'S BEING CONDUCTED BY THE INDIVIDUALS IN THIS MORNING'S PANEL. IT'S WORK THAT SEEKS TO OVERCOME THAT ARTIFICIAL SEPARATION BETWEEN BASIC SCIENCE, WHERE MECHANISTIC INTERVENTION TARGETS CAN BE IDENTIFIED, AND CLINICAL OR INTERVENTIONAL SCIENCE, WHICH SEEKS TO MODIFY THOSE TARGETS TO PROMOTE HEALTH, PROMOTE OPTIMAL HUMAN DEVELOPMENT AND SLOW DISEASE PROGRESSION. SO IT'S MY DISTINCT PLEASURE THIS MORNING TO INTRODUCE THE SPEAKERS ON TODAY'S PANEL. INDIVIDUALS WHOSE WORK EXEMPLIFIES THE SYNERGY, AIMED AT ELUCIDATING THE PATHWAYS LINKING SOCIAL, BEHAVIORAL AND PSYCHOLOGICAL FACTORS TO HELP ACROSS THE WHOLE LIVE COURSE. THE GOAL OF THIS RESEARCH PANEL IS TO SHOWCASE EXCITING LINES OF RESEARCH, ILLUSTRATING THE COMPLEXITIES INVOLVED IN IDENTIFYING -- ON THE CAUSAL PATHWAY TO HEALTH AND DISEASE. THESE PRESENTATIONS WILL REVEAL HOW OBSERVATIONAL AND INTERVENTIONAL STUDIES CAN SERVE TO ADVANCE OUR UNDERSTANDING OF HOW SOCIAL AND BEHAVIORAL FACTORS GET UNDER THE SKIN TO IMPACT HEALTH, AND HOW BEHAVIORAL PROCESSES CAN SERVE AS PROMISING INTERVENTION TARGETS. SO WE'LL HAVE THREE SPEAKERS IN THIS MORNING'S PANEL. EACH OF THE SPEAKERS WILL HAVE 20 MINUTES TO SPEAK, AND THEN AFTER ALL THE TALKS HAVE BEEN COMPLETED, WE'LL HAVE A 15-MINUTE Q & A WITH THE AUDIENCE. SO I'LL INTRODUCE EACH SPEAKER IN TURN AND I THINK PERHAPS YOU ALL WANT TO STAY DOWN THERE WHERE YOU CAN BEST SEE THE TALKS AND THEN COME UP FOR YOUR INDIVIDUAL PRESENTATIONS. OUR FIRST SPEAKER IS DR. GENE BRODY. DR. BRODY IS REGENTS PROFESSOR AND DIRECTOR OF THE CENTER FOR FAMILY RESEARCH AT THE UNIVERSITY OF GEORGIA. HE'S A DEVELOPMENTAL PSYCHOLOGIST AND A PREVENTION SCIENTIST INTERESTED IN THE SOCIAL AND BIOLOGICAL DETERMINANTS OF HEALTH AND WELL-BEING AMONG LOW SES YOUTH. HE'S AN INTERNATIONALLY RECOGNIZED EXPERT ON THE RISK AND PROTECTIVE MECHANISMS THAT FORECAST SUBSTANCE ABUSE AND OTHER PROBLEM BEHAVIORS AMONG RURAL AFRICAN-AMERICAN YOUTH. HE HAS TRANSLATED HIS FINDINGS INTO EFFICACIOUS INTERVENTIONS TARGETING FAMILY AND COMMUNITY FACTORS SUCH AS PARENTING STYLES AND EXTRA FAMILIAL SUPPORT SYSTEMS FOR YOUTH RANGING IN AGE FROM AGE 11 TO 19. DR. BRODY IS THE AUTHOR OF OVER MORE THAN 350 PUBLICATION, MANY OF WHICH FOCUS ON AFRICAN-AMERICAN YOUTH DEVELOPMENT OR SUBSTANCE USE PREVENTION. HIS WORK HAS BEEN SUPPORTED BY NIDA, NIAAANICHD AND RECENT WORK ON SKIN DEEP RESILIENCE CHALLENGES US TO THINK MORE CAREFULLY WITH INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS. SO IT'S MY PLEASURE TO INTRODUCE DR. BRODY, WHOSE TALK WILL BE A GLIMTION OF THE RESEARCH DONE BY THE CENTER FOR TRANSLATIONAL AND PREVENTIVE SCIENCE. [APPLAUSE] >> GOOD MORNING! >> GOOD MORNING. >> SO TODAY MY TALK IS ACTUALLY GOING TO BE A DEMONSTRATION PROJECT. THE PROJECT IS DESIGNED TO HELP YOU GET A GLIMPSE INTO THE BENEFITS OF EMBEDDING NEUROCOGNITIVE, INFLAMMATORY, IMMUNE, AND MEASURES IN THE BRAIN INTO THE KIND OF WORK THAT WE'RE ALL INTERESTED IN. LONGITUDINAL, EPIDEMIOLOGIC DESIGNS, AND IN PREVENTION DESIGNS, SO MY GOAL IS TO DEMONSTRATE THIS WITH SOME REAL LIFE DATA SO YOU CAN GET AN IDEA CONCRETELY THE KINDS OF QUESTIONS WE CAN ANSWER BY DOING THIS WORK. THIS WORK, HOWEVER, REQUIRES NOT JUST INDIVIDUAL GROUPS OF INVESTIGATORS, BUT TRANSDISCIPLINARY GROUPS FROM MULTIPLE BACKGROUNDS WHO COME TOGETHER TO ASK QUESTIONS THAT ANY INDIVIDUAL INVESTIGATOR THEMSELVES WOULD NOT BE ABLE TO ANSWER. SO TODAY, WHAT I WANT TO DO FIRST IS, IN THIS DEMONSTRATION PROJECT, TELL YOU WHO WE'RE TALKING ABOUT. OUR DATA THAT YOU'RE GOING TO SEE THAT EXEMPLIFIES WHAT I WANT TO DEMONSTRATE FOR YOU IS DRAWN FROM PEOPLE WHO ARE REPRESENTATIVE OF THE BLACK BELT THAT STRETCHES FROM SOUTH CAROLINA, GEORGIA, ALABAMA, MISSISSIPPI, AND LOUISIANA. THE 623 COUNTIES IN THIS AREA ARE SOME OF THE POOREST PARTS OF OUR COUNTRY. 35% OF OUR NATION'S POOR LIVE THERE. OVER HALF OF THE CHILDREN WHO GROW UP THERE GROW UP UNDER CONDITIONS OF ECONOMIC HARDSHIP. THE ACTUAL DATA IN MY PRESENTATION TODAY COMES FROM 38 COUNTIES IN GEORGIA WHO MIRROR PRETTY CLOSELY THE DEMOGRAPHICS OF THE BLACK BELT THAT I JUST DESCRIBED. MOST OF THE CAREGIVERS WHO PARTICIPATED IN THE RESEARCH I'M GOING TO TALK ABOUT TODAY WORK EITHER ONE OR TWO JOBS AT VERY LOW WAGES, THEY ARE BEST CHARACTERIZED AS WORKING POOR, AND THE VAST MAJORITY OF THE CAREGIVERS ARE HIGHLY COMPETENT PARENTS WHO WE REFER TO AS HEROS. SO I WANT TO GIVE YOU SOME EXAMPLES OF THE KINDS OF QUESTIONS YOU CAN ANSWER BY EMBEDDING DIFFERENT KINDS OF DATA INTO A LONGITUDINAL PREVENTION TRIAL. IN OUR FIRST EXEMPLAR, WE TOOK A SAMPLE OF 500 AFRICAN-AMERICAN YOUTH WHO BEGAN OUR STUDY AT AGE 10 WHO ARE NOW AGE 25, AND WERE TRACKED AS PART OF THAT LONGITUDINAL ANALYSIS THROUGH THE GREAT RECESSION THAT STARTED IN 2007, AND OFFICIALLY ENDED IN 2010, AND WE OBTAINED A VARIETY OF MARKERS ON EACH OF THESE 500 YOUTH. AT AGE 19, WE ATTAIN -- FROM WHICH WE GOT CORTISOL, EPINEPHRINE, NOREPINEPHRINE, WE DREW BLOD TO GET C REACTIVE PROTEIN, A MARKER OF SYSTEMIC INFLAMMATION, FROM THAT BLOOD, WE ALSO GOT MEASURES OF ACCELERATED EPIGENETIC AGING, WE TOOK THEIR BLOOD PRESSURE AND THEIR BMIs. SO THE QUESTION WE WANTED TO ASK HERE, AS AB EXEMPLAR OF SOME INSIGHTS YOU'RE ABLE TO DISCERN FROM LOOKING AT A NATURAL EXPERIMENT LIKE THIS IS AT 2007 AND 2009, SOME OF THE YOUTH DIDN'T EXPERIENCE ANY ECONOMIC DOWNTURN, EXPERIENCE NO ECONOMIC HARDSHIP, OTHERS LIVED IN ECONOMIC HARDSHIP ACROSS THE GREAT RECESSION, WHILE A THIRD GROUP EXPERIENCED DECLINE AMONG THEIR ECONOMIC WELL-BEING. WHAT WE ARE ABLE TO DISCERN BY EMBEDDING THESE MEASURES INTO THAT LONGITUDINAL DATA COLLECTION WAS THAT YOUTH WERE AT HIGHER CARDIOMETABOLIC RISK, MEANING THEY HAD HIGHER LEVELS OF CIRCULATING STRESS HORMONES, THEY HAD HIGHER BLOOD PRESSURE, THEY HAD HIGHER BMI AND HIGHER LEVELS OF INFLAMMATION IN THEIR BODIES, WHEN THEY LIVED ACROSS THAT GREAT RECESSION AT THE HIGHEST LEVELS OF ECONOMIC HARDSHIP. OF PARTICULAR INTEREST, THOUGH, AND WHAT WAS FASCINATING TO US, WAS THAT YOUTH WHO HAD DOWNWARD ECONOMIC MOBILITY DURING THAT TIME EVINCED HIGHER LEVELS OF CARDIOMETABOLIC RISK AND ACCELERATED BIOLOGICAL AGING COMPARED TO CHILDREN OR ADOLESCENTS WHO DID NOT HAVE ANY ECONOMIC HARDSHIP ACROSS THAT PERIOD OF TIME, BUT WHEN WE ASKED THEM ABOUT THEIR HEALTH, THOSE YOUTH THAT EXPERIENCED AN ECONOMIC DOWNTURN DID NOT SELF-REPORT ANY HEALTH PROBLEMS EVEN THOUGH THEIR BIOLOGY SAID OTHERWISE. THERE IS SOME LORE IN THE HEALTH DISPARITIES LITERATURE THAT MANY YOUTH GROW UP AND THEIR COMMUNITIES CHANGE AND THEY BECOME ENVELOPED IN POVERTY. WE WANTED TO TEST THIS IDEA. WE ALSO WANTED TO TEST IDEAS THAT WERE DRAWN FROM ANIMAL MODELS WHICH SAID THAT SUPPORTIVE AND SENSITIVE CAREGIVING COULD PROTECT YOUTH IN YOUR NEUROENDOCRINE SYSTEM, IN THEIR IMMUNE SYSTEMS, AND IN THEIR BRAINS, IF THEY WERE THE RECIPIENTS OF SUPPORTIVE CAREGIVING. SO ON 493 KIDS AT AGE 11, WE TOOK CENSUS DATA, WE LOOKED AT THEIR NEIGHBORHOOD LEVELS OF POVERTY AND WE LOOKED AT THEIR SAME NEIGHBORHOOD LEVELS OF POVERTY WHEN THE WHERE THEY LIVED WHEN THEY WERE 18. THERE WERE SOME YOUTH WHO OVER THAT TIME REALLY DID LIVE IN ENVIRONMENTS THAT WERE ENVELOPED BY POVERTY, AND COULD THAT BE ASCERTAINED IN THEIR BIOLOGY. SO AGAIN WE LOOKED AT THEIR CARDIOMETABOLIC RISK WITH THOSE SAME MEASURES OF CIRCULATING STRESS HORMONES, BLOOD PRESSURE, BMI, INFLAMMATORY RESPONSE, AND WE FOUND INDEED THOSE YOUTH GROWING UP IN NEIGHBORHOODS THAT BECAME ENVELOPED IN POVERTY, BELOW THEIR SKIN, THEIR BIOLOGY DISTINGUISHED THEM PARTICULARLY IF THEY DID NOT HAVE THE RECEIPT OF SPOR SUPPORTIVE CAREGIVING. WE COULD NOT HAVE ASCERTAINED THESE KINDS OF QUESTIONS WITHOUT THE EMBEDDING OF THESE MARKERS IN OUR LONGITUDINAL SAMPLE. IN THE HEALTH DISPARITIES LITERATURE, THERE IS A HYPOTHESIS THAT EXPOSURE TO RACIAL DISCRIMINATION, CHRONICALLY OVER TIME REDUCES LIFE EXPECTANCY AND BECAUSE OF ACCELERATIONS IN BIOLOGICAL AGING THAT ACCOMPANIES THE COPING THAT GOES ALONG WITH EXPOSURE TO THOSE CHRONIC STRESS STRE STORES. IN THIS STUDY, WE WANTED TO TEST THIS HYPOTHESIS. SO USING OUR MEASURE OF AK ACCELERAT ACCELERATED BIOLOGICAL AGING, EPIGENETIC AGING, WE WANTED TO SEE ACROSS THE AGES OF 16 AND 18 IN ONE SAMPLE, IF WE COULD IDENTIFY A GROUP OF ADOLESCENTS EXPOSED TO HIGH LEVELS OF RACIAL DISCRIMINATION, AND IF THREE YEARS LATER, THAT WAS ASSOCIATED WITH ACCELERATED BIOLOGICAL AGING. AND IF IT WAS, COULD WE ALSO ASCERTAIN WHETHER SUPPORTIVE CAREGIVING COULD AMELIORATE THAT THOSE BIOLOGICAL CHANGES, WHICH ACTUALLY SPEEDS UP AGING. AND WHAT WE FOUND IN THIS FIRST SAMPLE IS INDEED YOUTH WHO GREW UP EXPOSED TO HIGH LEVELS OF DISCRIMINATION, ACCELERATED BIOLOGICAL AGING, PARTICULARLY IF THEY DID NOT HAVE RECEIPT OF SUPPORTIVE CAREGIVING. WE EXAMINED THE SAME HYPOTHESIS IN ANOTHER INDEPENDENT SAMPLE WHERE FROM AGES 17 TO 19 IN 223 YOUTH FROM RURAL GEORGIA, THEY REPORT ON RACIAL DISCRIMINATION, AND ONCE AGAIN, THIS TIME AT AGE 22, WE DREW BLOOD, WE LOOKED AT THEIR BIOLOGICAL AGING, FOR YOUTH WHO HAD HIGH LEVELS OF PARENTAL SUPPORT AND SUPPORTIVE SENSITIVE CAREGIVING VERSUS THOSE WHO DID NOT AND REPLICATED ALMOST PRECISELY OUR FINDINGS IN OUR FIRST STUDY. NEUROENDOCRINE PROCESSES, INFLAMMATORY PROCESS, EPIGENETIC PROCESSES, ALONG WITH MEASURES OF BLOOD PRESSURE AND BMI, WE WERE ABLE TO ASCERTAIN THAT INDEED, THERE WAS A SIGNAL THAT INDICATED THAT EXPOSURE TO ECONOMIC HARDSHIP WAS ASSOCIATED WITH DIFFERENT KINDS OF BIOLOGICAL PROFILES UNDER THE SKIN IN YOUTH THAT CHANGES IN NEIGHBORHOODS, ALSO WAS ASSOCIATED WITH DIFFERENT KINDS OF BIOLOGICAL CONFIGURATION IN YOUTH AND FINALLY EXPOSURE TO CHRONIC LEVELS OF RACIAL DISCRIMINATION ASSOCIATED WITH ACCELERATED BIOLOGICAL AGING. I'M GOING TO SKIP OVER SOME OTHER DATA TO GET TO SOME PREVENTION DATA. IT'S IMPORTANT TO SHOW THE BENEFITS OF OUR DEMONSTRATION TODAY BY EMBEDDING BIOMARKERS INTO EFFICACIOUS PREVENTION PROGRAMS THAT WERE NOT DESIGNED THEMSELVES TO IMPACT HEALTH OUTCOMES BUT MAY HAVE HEALTH BENEFITS BECAUSE THEY ENHANCE SUPPORTIVE CAREGIVING, WHICH OUR DATA SHOW CAN AMELIORATE STRESS FROM GETTING UNDER THE SKIN. SO IN OUR CENTER, WE'VE DEVELOPED THREE PREVENTION PROGRAMS, THEY ARE DEVELOPMENTALLY APPROPRIATE DESIGNED FOR RURAL AFRICAN-AMERICAN FAMILIES. THE FIRST ONE, SAFE, WAS DESIGNED FOR PREADOLESCENTS, THE SECOND ONE WAS DESIGNED FOR ADOLESCENTS AND ADULTS IN THE MAKING WAS DESIGNED FOR YOUTH AND DELIVERED TO YOUTH DURING THEIR LAST YEAR OF HIGH SCHOOL BEFORE THEY GO OUT INTO A VERY CHALLENGING AND OFTEN UNFOR GIVING WORLD. EACH OF THESE PREVENTION PROGRAM PROGRAMS WERE TESTED IN RANDOMIZED TRIALS WITH Ns OF AT LEAST 500. WE'RE STILL FOLLOWING SOME OF THESE SAMPLES TODAY, AND IN TWO OF THE PROGRAM, WE EMBEDDED BIOMARKERS, AND I SHOULD SAY THAT EACH OF THESE PROGRAMS -- THEIR PREVENTION GOALS FOR AT LEAST TWO YEARS BEYOND PARTICIPATION IN THE PREVENTION EXPERIENCE. WE'VE TRACKED THE KIDS IN SAFE AND FIND PREVENTION EFFECTS EIGHT YEARS AFTER PARTICIPATION IN THE PREVEPTION PROGRAM. PREVENTION PROGRAM. IN THIS FIRST PAPER, THIS FIRST DEMONSTRATION, WHAT I WANT TO HIGHLIGHT HERE IS, WE DREW BLOOD FROM THE SAFE PARTICIPANTS WHEN THEY WERE 19 YEARS OLD AND THEY PARTICIPATED IN PREVENTION PROGRAMMING AT AGE 11. AND SAFE WAS KE SIGNED TO ENHANCE SUPPORTIVE CAREGIVING AND EMOTIONAL SUPPORT AS ONE OF MEN MARKERS, AND WE WANTED TO SEE IF PARTICIPATION IN SAFE AT AGE 11 CARRY FORWARD TO IMPACT ON MARKERS OF INFLAMMATORY RESPONSE, WHICH IS PARTICULARLY IMPORTANT TO THIS POPULATION BECAUSE THEY HAVE PROGNOSTIC SIGNIFICANCE FOR THE DEVELOPMENT OF CARDIOVASCULAR DISEASE, DIABETES, STROKE, AND HYPERTENSION. SECONDLY, WE WANTED TO SEE IF CHANGES IN SUPPORTIVE PARENTING DURING THE SAFE PREVENTION TRIAL WERE RESPONSIBLE FOR ANY OBTAINED EFFECTS. AND WHAT YOU CAN SEE IS THAT THOSE YOUTH WHO PARTICIPATED IN SAFE AT AGE 11, AT AGE 19, THEY EVINCED LOWER LEVELS OF CYTOKINES THAT ORCHESTRATE INFLAMMATION, AND THAT THESE EFFECTS, NOT SHOWN HERE, WERE MEDIATED BY INCREASES IN SUPPORTIVE PARENTING AND DECREASES IN HARSH PARENTING. AN EXAMPLE OF MIXING PREVENTION WITH PSYCHOSOCIAL TARGETS AND BIOLOGICAL OUTCOMES THAT ARE RELEVANT FOR HEALTH. THE SECOND STUDY ADDRESSES AN IMPORTANT CLINICAL QUESTION FOR THE POPULATIONS OF CAREGIVERS IN RURAL GEORGIA. MANY OF THESE CAREGIVERS ARE COPING WITH MULTIPLE DEMANDS, AND CHRONIC ECONOMIC HARDSHIP, AND IT KIND OF RIPS AT THEIR PSYCHOLOGICAL FABRIC AND INDUCES LEVELS OF DEPRESSION, AND WE WANTED TO ASK IN THIS PARTICULAR STUDY WHETHER GROWING UP WITH A DEPRESSED PATIENT FORECASTS ACCELERATED BIOLOGICAL AGING IN YOUTH, AND WHETHER PARTICIPATION IN SAFE COULD AMELIORATE THE LINK BETWEEN CAREGIVER DEPRESSION AND ACCELERATED BIOLOGICAL AGING, AND IF THE MECHANISM FOR THIS DECREASE WERE REDUCTIONS IN HARSH PARENTING. SO WHAT THIS SLIDE SHOWS IS THAT THOSE YOUTH WHO GREW UP WITH A DEPRESSED PARENT AND WERE RANDOMLY ASSIGNED TO A CONTROL CONDITION, THOSE YOUTH AT AGE 20 SHOWED ACCELERATE BIDE LOGICAL BIOLOGICAL AGING, AND THAT THOSE YOUTH IN THAT PARTICULAR CONDITION WHERE MOMS WERE DEPRESSED AND THEY WERE IN THE CONTROL CONDITION, SHOWED LOW DECREASES IN HARSH PARENTING, AND A SUBSEQUENT ANALYSIS SHOWED THAT THE REDUCTION IN ACCELERATED BIOLOGICAL AGING FOR THOSE YOUTH IN A CONTROLLED CONDITION WHO GREW UP WITH A DEPRESSED PARENT WAS SAFE CHANGE OR REDUCTION ON DECREASES IN HARSH PARENTING. I MISSPOKE. THOSE YOUTH IN THE SAFE CONDITION WITH A DEPRESSED CAREGIVER EVINCED LARGER DIFFERENT -- LARGER REDUCTIONS IN HARSH PARENTING AND THOSE REDUCTIONS IN HARSHNESS WERE RESPONSIBLE FOR SAFE EFFECTS ON ACCELERATED BIOLOGICAL AGING. AGAIN, ANOTHER DEMONSTRATION OF MIXING PREVENTION PROGRAMMING WITH PSYCHOSOCIAL MENTAL HEALTH OUTCOMES, AND A BIOLOGICAL END POINT, AND ACCELERATED BIOLOGICAL AGING FORECAST EARLY MORTALITY. FINALLY, WE HAD A STUDY THAT JUST CAME OUT THIS PAST WEEK WHICH IS ANOTHER DEMONSTRATION EXCEPT THIS TIME WE FOCUSED ON NEUROSCIENCE OUTCOMES IN THE BRAIN. THERE'S A LITERATURE THAT LINKS BRAIN DEVELOPMENT TO STRESS, PARTICULARLY IN TWO AREAS: THE HIPPOCAMPUS AND THE AMYGDALA, AND WE FOCUSED ON TWO AREAS OF THE HIPPOCAMPUS, WHICH HAVE IN TRANSLATIONAL STUDIES SHOWN TO BE PARTICULARLY INFLUENCED BY ADVERSITY IN STRESS. THERE'S SOME STUDIES WITH KIDS WHICH ARE PRETTY CONSISTENT WITH THOSE RESULTS, AND WE WANTED TO TAKE A LOOK AT IF KIDS LIVED IN POVERTY ACROSS ADOLESCENCE, COULD THAT BE EVINCED IN THEIR BRAIN VOLUMES IN THESE HIPPOCAMPAL AREAS OF THE BRAIN AND IN THE AMYGDALA WHEN THEY WERE 25. SO IN THIS ANALYSIS, WE PUT 115 YOUNG ADULTS WHO PARTICIPATED IN SAFE, HALF WHO PARTICIPATED IN SAFE, HALF WHO PARTICIPATED IN THE CONTROL CONDITION INTO THE SCANNER, LOOKED AT THE VOLUMES OF THESE TWO HIPPOCAMPAL AREAS AND THE AMYGDALA TO SEE IF PARTICIPATION IN SAFE 14 YEARS EARLIER WAS ASSOCIATED WITH LARGER BRAIN VOLUMES. AS THE DATA SHOW, YOUTH WHO SPENT MORE YEARS IN POVERTY AND WERE IN THE CONTROL CONDITION EVINCED SMALLER HIPPOCAMPAL AND AMYGDALA AREA. AGAIN, WE'RE TRYING TO SHOW HERE THAT THERE IS TERRIFIC BENEFIT AND CURRENCY FOR THOSE OF US WHO ARE SOCIAL AND BEHAVIORAL SCIENTISTS TO BE ABLE TO DEMONSTRATE THAT THE PROCESSES THAT WE ARE SO ABLE TO ASSESS AND ANALYZE, HAVE IMPLICATIONS FOR MARKERS OF HEALTH THAT MAY CARRY FORWARD ACROSS THE LIFESPAN. THANK YOU. [APPLAUSE] A PICTURE OF HIS GROUP OF COINVESTIGATORS THERE. OUR NEXT SPEAKER IS PETE GIANAROS, UNIVERSITY OF PITTSBURGH. HE HOLDS FACULTY APPOINTMENTS IN THE CENTER FOR THE NEURAL BASIS OF COGNITION, THE CENTER FOR NEUROSCIENCE AND DEPARTMENT OF PSYCHIATRY. PETE'S WORK HAS FOCUSED ON THE NEUROBIOLOGY OF PSYCHOSOCIAL STRESS, EMOTIONS, SOCIOECONOMIC HEALTH DISPARITIES AND CARDIOVASCULAR DISEASE RISK. THIS FOCUS HAS ENCOMPASSED STUDIES OF HOW THE BRAIN FUNCTIONALLY REGULATES IMMUNE CARDIOVASCULAR STRESS RESPONSE, HOW THE BRAIN INFLEUPSES AND IS INFLUENCED BY BIOLOGICAL AND BEHAVIORAL RISK FACTORS FOR CHRONIC ILLNESS, AND HOW THE BRAIN LINKS SOCIOECONOMIC INEQUALITIES TO HEALTH OVER THE LIFESPAN. HIS WORK HAS RESULTED IN OVER 90 PUBLICATIONS, INTEGRATING APPROACHES FOR MULTIMODAL BRAIN IMAGING, PSYCHOPHYSIOLOGY, EPIDEMIOLOGY, BEHAVIORAL AND BASIC LABORATORY APPROACHES. HE'S RECEIVED THE HERBERT WEINER EARLY CAREER AWARD FROM THE AMERICAN PSYCHOSOMATIC SOCIETY IN 2008 AND THE DISTINGUISHED SCIENTIFIC AWARD FOR EARLY CAREER CONTRIBUTIONS TO PSYCHOLOGY FROM THE AMERICAN PSYCHOLOGICAL ASSOCIATION IN 2010. THE TITLE OF PETE'S PRESENTATION IS THE NEUROBIOLOGY OF SOCIOECONOMIC HEALTH DISPARITIES. [APPLAUSE] >> THANK YOU FOR THAT KIND INTRODUCTION. IT'S REALLY AN HONOR TO BE HERE. WHAT I'M GOING TO DO TODAY IS DESCRIBE SOME EXAMPLE FINDINGS FROM A LINE OF RESEARCH THAT WE'VE BEEN CONDUCTING FOR A LITTLE OVER 10 YEARS NOW THAT IS DIRECTED AT UNDERSTANDING THE NEUROBIOLOGY OF SOCIOECONOMIC HEALTH DISPARITIES WITH A PARTICULAR FOCUS ON CARDIOVASCULAR HEALTH DISPARITIES. TO DO THAT, I'VE ORGANIZED TODAY'S TALK INTO THREE PARTS. FIRST, I'LL PROVIDE A LITTLE BIT OF A CONTEXT, A CONCEPTUAL CONTEXT FOR THE QUESTIONS THAT WE'VE BEEN ASKING, AND THEN I'LL PROVIDE AN EXAMPLE OF SOME FINDINGS FROM A RECENT STUDY THAT WE COMPLETED THAT ILLUSTRATES THE KIND OF WORK THAT WE DO AND THEN I'LL TALK A LITTLE ABOUT WHERE I HOPE TO SEE THIS WORK GOING IN THE FUTURE. SO TO PROVIDE SOME CONTEXT, WHAT WE'RE DOING, THE WORK THAT WE'RE DOING THE CONTEXT FOR IT IS SITUATED AT THE INTERFACE OF TWO BODIES OF RESEARCH THAT HAVE BEEN LARGELY INDEPENDENT FOR SOME TIME NOW. THE FIRST BODY OF RESEARCH HAS TO DO WITH SOCIOECONOMIC HEALTH DISPARITIES. WE'VE KNOWN FOR DECADES THAT LIFE EXPECTANCY, RISK FACTORS FOR CHRONIC ILLNESSES, CHRONIC ILLNESSES TRACK A SOCIOECONOMIC GRADIENT. AND THE SECOND BODY OF RESEARCH THAT'S BEEN LARGELY INDEPENDENT FROM SOCIOECONOMIC HEALTH DISPARITIES RESEARCH IS A MORE RECENT LINE OF NEUROSCIENCE RESEARCH SHOWING THAT A NUMBER OF RISK FACTORS FOR CHRONIC ILLNESS, PARTICULARLY HEART DISEASE, LIKE SYSTEMIC INFLAMMATION, COMPONENTS OF THE METABOLIC SYNDROME, BLOOD PRESSURE, INSULIN RESISTANCE AND SO FORTH, AS WELL AS DISREGULATED AUTONOMIC FUNCTION, SEDENTARY BEHAVIOR, SMOKING BEHAVIORS AND PRE-CLINICAL ATHEROSKLARSCLEROSIS, ALL OF THESE FACTORS CAN COME TO ADVERSELY AFFECT BRAIN FUNCTION AND BRAIN STRUCTURE. WE KNOW FROM THE LITERATURE I JUST MENTIONED THAT ALL OF THESE RISK FACTORS TRACK SOCIOECONOMIC GRADIENT, SO MUCH OF THE NEUROSIGH EPS RESEARCH THAT HAS BEEN FOCUSED ON THESE RISK FACTORS IN THE CONTEXT OF THEIR ADVERSE EFFECTS ON BRAIN HEALTH HAVE LARGELY IGNORED THE FACT THAT THESE RISK FACTORS TRACK A SOCIOECONOMIC GRADIENT AND YOU'RE LUCKY TO SEE A LOT OF THESE STUDIES USED SOMETHING LIKE EDUCATION -- COVARIANT AS BEST. SO IT'S IN THIS CONTEXT THAT WE'VE BEEN TRYING TO INTEGRATE THESE TWO LINES OF RESEARCH TO BETTER UNDERSTAND SOME OF THE ENVIRONMENTAL, PSYCHOSOCIAL, BEHAVIORAL AND BIOLOGICAL PATHWAYS THAT MIGHT LINK RELATIVE SOCIOECONOMIC DISADVANTAGE TO RISK FACTORS FOR DISEASE AND HOW VARIATION ALONG THESE PATHWAYS AND RISK FACTORS THAT ARE SOCIOECONOMICALLY PATTERNED MIGHT COME TO ADVERSELY AFFECT BRAIN FUNCTION AND BRAIN STRUCTURE OVER THE LIFESPAN. SO THIS IS THE BROADER CONCEPTUAL FRAMEWORK FOR THE QUESTIONS THAT WE'VE BEEN ASKING. IN OUR WORK, WE TREAT SES LIKE MANY OTHERS IN THE FIELD AS A MULTIDIMENSIONAL AND MULTILEVEL CONSTRUCT THAT MIGHT COME TO INFLUENCE HEALTH IN ADDITION TO BRAIN FUNCTION AND STRUCTURE THROUGHOUT THE LIFE COURSE. SO WE INVESTIGATE IN TERMS OF ITS MULTIDIMENSIONAL NATURE, WE INVESTIGATE SES ALONG DIMENSIONS OF WEALTH, FINANCIAL DIMENSIONS, OCCUPATIONAL PRESTIGE AND STATUS, AS WELL AS EDUCATIONAL ATTAINMENT. WE RECOGNIZE THAT YOU CAN MEASURE SES ALONG THESE LINES BOTH WITH OBJECTIVE MEASURES AND SUBJECTIVE MEASURES. IN OUR WORK, WE TREAT SES AS A MULTILEVEL CONSTRUCT AS ILLUSTRATED BY THE WORK THAT GENE JUST PRESENTED WHERE YOU CAN MEASURE SES AT THE LEVEL OF THE INDIVIDUAL, THE HOUSEHOLD, THE COMMUNITY AND AT HIGHER LEVELS OF SOCIAL ASSEMBLY. AND WE RECOGNIZE THAT SES CAN COME TO INFLUENCE HEALTH, BRAIN FUNCTION, BRAIN STRUCTURE THROUGHOUT LIFE AND THERE MIGHT BE PERIOD-SPECIFIC EFFECTS FOFER THE INFLUENCE OF SES ON THESE KINDS OF OUTCOMES. WE'VE TRIED TO INVESTIGATE A RANGE OF CORRELATES OF RISK FOR SOCIOECONOMIC STATUS IN THIS WORK AS WELL. SO NOW WHAT I'LL DO IS WALK YOU THROUGH SOME EXAMPLE FINDINGS FROM A STUDY THAT WE PREENT REENTLY COMPLETED THAT ILLUSTRATE THE KIND OF QUESTIONS THAT WE'VE BEEN TRYING TO WRESTLE WITH OVER THE YEARS. THIS WORK WAS RECENTLY REPORTED IN A PUBLICATION "CEREBRAL CORTEX." WE TRIED TO TREAT SES AS A MULTILEVEL CONSTRUCT IN ASKING THE QUESTION WHETHER COMMUNITY OR NEIGHBORHOOD SOCIOECONOMIC DISADVANTAGE MIGHT RELATE TO ASPECTS OF BRAIN MORPHOLOGY THAT HAVE BEEN LINKED TO PREMATURE COGNITIVE DECLINE, DEMENTIA RISK AND SO FORTH, AND WHETHER THERE ARE PARTICULAR PATHOLOGICAL PATHWAYS THAT MIGHT LINK THESE TO ASPECTS OF BRAIN MORPHOLOGY. SO AS MANY YOU HAVE KNOW AND AS GENE POINTED OUT, THERE'S A LARGE BODY RESEARCH LINKING AREA LEVEL SOCIOECONOMIC DISADVANTAGE SO THIS WOULD BE AT THE LEVEL OF NEIGHBORHOOD, COMMUNITIES AND SO FORTH, TO RISK FOR A NUMBER OF CHRONIC ILLNESSES. STROKE, DIABETES, CARDIOVASCULAR DISEASE, PREMATURE MORTALITY, SO FORTH. THERE'S AN EMERGING LITERATURE, NOT UNIFORMLY CONSISTENT BUT THERE ARE SOME STUDIES TO SUGGEST THAT LIVING IN SOCIOECONOMICALLY DISADVANTAGED AREA MIGHT CONFER RISK FOR PREMATURE COGNITIVE DECLINE AND PROBABLY DEMENTIA. WHAT'S INTERESTING IN THIS LITERATURE IS THAT THE AREA LEVEL RISKS THAT ARE CONFERRED FOR ADVERSE HEALTH OUTCOMES ARE OFTEN INDEPENDENT OF INDIVIDUAL LEVEL FACTORS, INCLUDING A PERSON'S OWN EDUCATIONAL ATTAINMENT, THEIR WEALTH, THEIR INCOME, THEIR OCCUPATIONAL PRESTIGE AND SO FORTH. SO THAT SUGGESTS THAT THERE'S SOMETHING UNIQUE ABOUT THE AREA THAT MIGHT BE CONFERRING RISK THAT'S INDEPENDENT OF A PERSON'S OWN SES. HOWEVER, AN OPEN QUESTION IS WHETHER THE RISK CONFERRED BY AREA LEVEL DISADVANTAGE MIGHT EXTEND TO THE BRAIN, WHETHER THESE RISKS MIGHT BE INDEPENDENT OF A PERSON'S OWN SOCIOECONOMIC STATUS AS HAS BEEN DEMONSTRATED IN EPIDEMIOLOGICAL STUDY, AND IT'S AN ENTIRELY OPEN QUESTION THAT IF AREA LEVEL DISADVANTAGE MIGHT RELATE TO ASPECTS OF BRAIN FUNCTION AND STRUCTURE, WHAT ARE THE MECHANISTIC PATHWAYS WHICH WOULD HAVE IMPLICATIONS FOR INTERVENTION, AND SO FORTH, THAT WE CAN TALK ABOUT A LITTLE BIT LATER. SO THESE WERE THE PRIMARY QUESTIONS WE SOUGHT TO ADDRESS IN THIS PARTICULAR STUDY. WE FOCUSED -- WE USED GEOCODING METHODS I'LL DESCRIBE IN A LITTLE BIT TO COMPUTE METRICS OF AREA LEVEL DISSTRANG DERIVED FROM CENSUS DATA IN THE NEIGHBORHOODS WHERE PEOPLE LIVED AND THE ASPECTS OF BRAIN MORPHOLOGY THAT HAVE BEEN LINKED TO ASPECTS OF NEUROCOGNITIVE AGING AND DEMENTIA RISK AND SO FORTH, AND THE PATHWAYS THAT WE FOCUSED ON ENCOMPASSED RISK FOR CARDIOMETABOLIC DISEASE WITH A SPECIFIC FOCUS ON COMPONENTS OF THE METABOLIC SYNDROME THAT HAVE BEEN LINKEDIN EPIDEMIOLOGICAL STUDIES TO AREA LEVEL DISADVANTAGE, THAT'S IN ONE BODY OF RESEARCH, THEN SEPARATELY, THE SAME RISK FACTORS HAVE BEEN LINKED TO ALTERATIONS IN BRAIN MORPHOLOGY IN NEUROSCIENCE STUDY, SO BASICALLY TWO BODIES OF LITERATURE THAT ESSENTIALLY AREN'T TALKING TO EACH OTHER THAT HAVE SEPARATELY LINKED CARDIOMETABOLIC RISKS. ANOTHER PATHWAY WE FOCUSED ON INVOLVED THE HYPOTHALAMIC PI TEU TERRY ADRENAL ACCESS. HERE IN METHODS OF CORTISOL, WHICH IS A STRESS HORMONE THAT HAS BEEN TIED TO SOME INDICATORS OF AREA DISADVANTAGE IN ONE LITERATURE AND THEN SEPARATELY TO ASPECTS OF BRAIN MORPHOLOGY, BRAIN AGING AND COGNITION IN SEPARATE LITERATURE. THESE ARE THE PATHWAYS THAT WE FOCUSED ON IN THIS STUDY, AND WE ALSO, AGAIN, WANTED TO ADDRESS THE QUESTION OF WHETHER AREA DISADVANTAGE MIGHT RELATE TO ASPECTS OF BRAIN MORPHOLOGY THROUGH THESE PATHWAYS AND WHETHER THESE EFFECTS MIGHT BE INDEPENDENT AFTER PERSON'S OWN EDUCATIONAL ATTAINMENT, THEIR OWN OCCUPATIONAL GRADE AS WELL AS THEIR OWN HOUSEHOLD INCOME. WE ALSO ASKED WHETHER THESE EFFECTS WERE MODERATED OR ACCOUNTED FOR SIMPLY BY A PERSON'S AGE AND THEIR GENDER. SO TO ADDRESS THESE QUESTIONS, WE STUDIED 448 PEOPLE FROM THE ADULT HEALTH AND BEHAVIOR PROJECT PHASE 2 THIS IS A COMMUNITY SAMPLE OF ADULTS FROM THE PITTSBURGH AREA FOR WHOM WE HAVE DETAILED BIOLOGICAL, NEURAL, PSYCHOSOCIAL CORRELATES OF RISK. THIS IS A MID LIFE VERY HEALTHY SAMPLE. ALL OF THEM WERE EMPLOYED AND WORKED 25 OR MORE HOURS PER WEEK. THERE WERE NO NIGHT SHIFT WORKERS WHICH COULD AFFECT THE RELEASE OF DPLEU COCORTICOIDS DURING THE DAY. THEY WERE MOSTLY CAUCASIAN, MOST HAD NEVER SMOKED, ALL OF THEM WERE SCREENED FOR THE EXISTENCE OF ANY CHRONIC ILLNESS THAT COULD IMPACT ANY OF THE PATHWAYS THAT WE'RE INTERESTED IN ALONG WITH BRAIN FUNCTION OR STRUCK TEU ANSTRUCTURE AND NONE WERE CURRENTLY ON ANY MEDICATIONS THAT COULD AFFECT OUR OUTCOMES SO AN EXTREMELY HEALTHY COMMUNITY-BASED SAMPLE. AS R. WE USEWE USED GEOCODING TO ARRIVE AT AN INDEX OF COMMUNITY DISADVANTAGE. THIS IS A ALLEGHENY COUNTY. EACH DOT REPRESENTS WHERE SOMEONE LIVED IN THE SAMPLE. SO WE LINKED STREET ADDRESSES TO CENSUS METRICS OF THE PERCENTAGE OF PEOPLE WHO WERE UNEMPLOYED IN A PERSON'S CENSUS TRACT. THE NUMBER OF -- PERCENTAGE OF HOUSEHOLDS BENEATH THE FEDERAL POVERTY LINE, THE NUMBER OF HOUSEHOLDS ON PUBLIC ASSISTANCE, SO FOR EXAMPLE, THE PERCENTAGE OF PEOPLE RECEIVING FOOD STAMPS, SUM MENTIVE NUTRITIONAL ASSISTANCE AND SO FORTH, THE PERCENTAGE OF PEOPLE 25 OR OLDER WITHOUT A HIGH SCHOOL EDUCATION, AS WELL AS THE MEDIAN HOUSEHOLD INCOME WHICH WAS REVERSE CODED. SO WE STANDARDIZED -- WE DID FACTOR ANALYSES AND STANDARDIZED ALL OF THESE TO COME UP WITH AN AGGREGATE DISADVANTAGE SCORE SO THE HIGHER THE SCORE, THE MORE DISADVANTAGE IN THAT PERSON'S COMMUNITY. WE HAD 213 DIFFERENT CENSUS TRACTS REP RESENTED IN THE AHAS BEEN SAMPLE WITH ABOUT TWO PEOPLE WERE TRACT AND THERE WERE ABOUT FEP HUNDRE 1500 HOUSEHOLDS IN THIS SAMPLE TO. COMPUTE SAMPLES OF HPA ACCESS REGULATION, WE MEASURED SALIVARY CORTISOL AT AWAKENING, 30 MINUTES AFTER AWAKENING, FOUR HOURS AFTER AWAKENING, NINE HOURS AFTER AWAKENING AND BEDTIME. THE NORMAL VARIATION IN CORTISOL OVER THE COURSE OF THE DAY LOOKED SOMETHING LIKE THIS. SO FROM THESE ASSESSMENTS, WE DERIVED THREE INDICATORS OF HPA ACCESS ACTIVITY, ONE WAS THE PERGS TAJ OF THE RISE IN CORTISOL FROM AWAKENING UNTIL 30 MINUTES AFTERWARD. ANOTHER INDICATOR WAS A SLOPE OF THE DIURNAL INCREASE OVER THE COURSE OF THE DAY ACROSS THESE ASSESS A.A FLATTER SLOPASSESSMENTS. A STEEPER SLOPE IS MORE INDICATIVE OF THE NORMATIVE DECLINE OR REGULATED RELEASE OF CORTISOL OVER THE COURSE OF THE DAY. THEN FINALLY, WE JUST LOOKED AT TOTAL GLUCOCORTICOID OUTPUT SO WE COMPUTED AN AREA UNDER THE CURVE FOR THESE CORTISOL ASSESSMENTS TAKEN OVER THE COURSE OF THE DAY. THESE ARE NOT INTERCHANGEABLE MEASURES THAT YOU CAN SEE BY THEIR MODERATE TO LOW CORRELATION BETWEEN THE MEASURES. SO THEY REPRESENT SOMETHING SLIGHTLY DIFFERENT ABOUT HPA ACCESS OVER THE COURSE OF THE DAY. WITH RESPECT TO CARDIOMETABOLIC RISK, WE ASSESS MAJOR DIMENSIONS OF THE METABOLIC SYNDROME SO WE COMPUTED MEASURES OF BLOOD PRESSURE, ADIPOSITY, DYSLIPIDEMIA, WE ASSESSED FASTING GLUCOSE AND FASTING INSULIN AS WELL, SO WE STANDARDIZE AND AVERAGE THESE METRICS TO COME UP WITH AN AGGREGATE CARDIOMETABOLIC RISK SCORE WHICH WE'VE DONE IN OUR PRIOR WORK. IN TERMS OF THE BRAIN IMAGING METRICS, WE LOOKED AT ASPECTS OF BRAIN MORPHOLOGY, WE LOOKED AT ASPECTS OF CORTICAL MORPHOLOGY. IN TODAY'S TALK, I'M GOING TO FOCUS MAINLY ON TOTAL CORTICAL GRAY MATTER VOLUME. WE ALSO LOOKED AT THINGS LIKE CORTICAL SURFACE AREA AND CORTICAL THICKNESS, WHICH I WOULD BE HAPPY TO TALK ABOUT IN THE QUESTION AND ANSWER PERIOD. THEN WE ALSO LOOKED AT SUBCORTICAL BRAIN REGION, PARTICULARLY THE AMYGDALA AND THE HIPPOCAMPUS, AS GENE MENTIONED, FOR REASONS THAT HAVE TO DO WITH THESE AREAS BEING IMPLICATED AS SENSITIVE TO STRESS, AND THEY'VE BEEN INDICTED AS CULPRITS THAT MIGHT LINK SOCIOECONOMIC ADVANTAGE -- THESE WERE THE AREAS OF THE BRAIN THAT WE WERE PARTICULARLY INTERESTED IN. TO TEST WHETHER AREA DISADVANTAGE, PREDICTED VARIATION AND BRAIN MORPHOLOGY ACROSS THE SAMPLE WITH TWO PARALLEL MEDIATORS ARE AGGREGATE INDICATORS OF CARDIOBOLG RISK AS WELL AS HPA ACCESS ACTIVITY. WE COVARIED FOR AGE, SEX, INDIVIDUAL LEVEL SES INDICATORS AS WELL AS INTRACRANIAL VOLUME. ALSO AN ANCILLARY ANALYSES, WE SCRAMBLED THE OUTCOME VARIABLES AND MEDIATORS TO TEST WHICH MODEL MIGHT FIT THE DATA BEST FOR REASONS THAT I'LL EXPLAIN IN A LITTLE BIT. SO IN TERMS OF RESULTS, WE ACTUALLY SAW NO CORRELATION, NO ASSOCIATIONS BETWEEN TOTAL SUBCORTICAL BRA TISSUE VOLUME, HIPPOCAMPAL VOLUME AND AMYGDALA VOLUME WITH AREA DISADVANTAGE, CARDIOMETOLIC RISK, ANY OF OUR CORTISOL METRICS AFTER YOU CONTROL FOR AGE, SEX, INDIVIDUAL LEVEL SES AND INTRACRANIAL LEVEL VOLUME. IN OTHER ANALYSES, WE ACTUALLY DID FIND INDIVIDUAL LEVEL SES VARIABLES DID TRACK WITH AMYGDALA AND HIPPOCAMPAL VOLUME, SO IT MIGHT BE THE CASE THAT INDIVIDUAL LEVEL FACTORS TRACK WITH THESE SUBCORTICAL METRICS BUT NOT AREA LEVEL METRICS, AND WE'RE NOT ENTIRELY CLEAR WHAT THE PATHWAYS MIGHT BE THAT WOULD CONNECT INDIVIDUAL LEVEL SES WITH THE SUBCORTICAL METRICS. IN TERMS OF CORTICAL BRAIN TISSUE VOLUME, WE SAW THAT GREATER DISADVANTAGE WAS ASSOCIATED WITH REDUCED CORTICAL GRAY MATTER VOLUME. THIS WAS ALSO TRUE FOR REDUCED WHITE MATTER VOLUME, REDUCED CORTICAL SURFACE AREA AND REDUCED CORTICAL THICKNESS, SO THERE APPEARS TO BE SORT OF THIS BLUNT INSTRUMENT ASSOCIATION BETWEEN AREA DISADVANTAGE AND GROCER GROSS REDUCTION IN CLINICAL MORPHOLOGY. WE ALSO SAW THE GREATER THE CARDIOMETABOLIC RISK, THE LOWER THE CORTICAL TISSUE VOLUME, AND THEN OF THE CORTISOL METRICS, IT WAS ONLY A FLATTER SLOPE SO MORE DISREGULATED RELEASE OF CORTISOL OVER THE COURSE OF THE DAY THAT WAS ASSOCIATED WITH A REDUCTION IN CORTICAL TISSUE VOLUME. ALL THESE ASSOCIATIONS WERE INDEPENDENT OF OUR COVARIANTS, PARTICULAR LIVID LEVEL SES, SO THERE APPEARS TO BE SOMETHING UNIQUE AS I'LL MENTION ABOUT THE COMMUNITY IN THESE ASSOCIATIONS. IN THE MULTIPLE MEDIATOR MODEL, WE FOUND EVIDENCE CONSISTENT WITH PARALLEL MEDIATION SUCH THAT AREA DISADVANTAGE RELATED TO REDUCED CORTICAL TISSUE VOLUME, AND THIS ASSOCIATION WAS ACCOUNTED FOR BOTH BY CARDIOMETABOLIC RISK AS WELL AS A FLATTER DI DIURNAL DECLINE IN CORTISOL OVER THE COURSE OF THE DAY. I SHOULD ALSO SAY THAT EVEN AFTER ACCOUNTING FOR ALL OF OUR COVARIANTS AND THESE TWO MEDIATORS, THERE WAS STILL A RESIDUAL ASSOCIATION SUCH THAT HIGHER DISADVANTAGE RELATED TO REDUCED CORTICAL VOLUME IRRESPECTIVE OF CARDIOMETABOLIC RISK AND DIURNAL SLOPE SO THAT SUGGESTS THERE MIGHT BE OTHER MEDIATORS AT PLAY. AS I MENTIONED, WE SCRAMBLED THE MEDIATORS IN THE OUT COME VARIABLE SO WE BASICALLY PUT BRAIN MORPHOLOGY MEASURES AS THE MEDIATORS, AND CARDIOMETABOLIC RISK AND DIURNAL SLOPE AND CORTISOL METRICS AS AN OUT COME. WHEN WE REVERSED THE VARIABLES IN THIS WAY, WE FOUND NO EVIDENCE CONSISTENT WITH THE BRAIN BEING THE MEDIATOR. SO IT APPEARS THAT THE BRAIN IS BEST REPRESENTED AS A TARGET OR OUTCOME VARIABLE HERE. I SHOULD SAY THE MEDIATORS WERE INDEPENDENT OF ONE ANOTHER SO THERE WAS NO RELATIONSHIP AT ALL BETWEEN THE CORTICAL SLOPE AND CARDIOMETABOLIC RISK SO THAT SUGGESTIONS THEY'RE INDEPENDENT. THEY'RE CONSISTENT ACROSS HEMISPHERES, ACROSS ALL FOUR CORTICAL LOBES. WE THINK THAT'S INCOMPATIBLE WITH AN INDIRECT SELECTION MODEL THAT WE CAN TALK ABOUT. NONE OF THESE PSYCHOSOCIAL FACTORS LIKE POSITIVE OR NEGATIVE AFFECT, SLEEP QUALITY, DIVERSITY, WHEN WE CONTROL FOR THOSE, WE STILL SAW ALL OF THESE MEDIATED EFFECTS. EVEN WHEN WE CONTROLLED FOR THE OTHER CORTISOL METRICS, WE STILL SAW THESE EFFECTS. SO THEY APPEAR TO BE QUITE ROBUST AND INDEPENDENT OF THESE. IN SEPARATE ANALYSES THAT WERE UNPUBLISHED, WE FOUND THAT GREATER AREA DISADVANTAGE WAS NEGATIVELY RELATED TO NEUROPSYCHOLOGICAL PERFORMANCE ON TESTS OF SPATIAL REASONING, SHORT TERM MEMORY AND EXECUTIVE FUNCTION. WE RECENTLY RESUBMITTED AN APPLICATION TO DO LONGITUDINAL FOLLOW-UPS IN THIS SAMPLE TO TEST WHETHER THE BRAIN -- SOME OF THESE MEDIATORS MIGHT LINK AREA DISADVANTAGE TO THESE NEUROCOGNITIVE OUTCOMES IN THIS MID LIFE AGING POPULATION. USED TO REDUCE CORTICAL GRAY MATTER VOLUME, MEDIATING PATHS MIGHT ENCOMPASS ASPECTS OF CARDIOMETABOLIC RISK AS WELL AS NEUROENDOCRINE DISRUPTION. WE THINK OUR FINDINGS FIT WITH AREA LEVEL MODELS OF HEALTH INEU QUALITIES RIGHT NOW, AND WE EXTEND THESE MO KEL MODELS TO ENCOMPASS ASPECTS OF BRAIN MORPHOLOGY. IT'S POSSIBLE FROM THESE MODELS THAT OUR CARDIOMETABOLIC RISK MIGHT BE ASSOCIATED WITH ASPECTS OF THE ENVIRONMENT THAT FAVOR ENERGY IMBALANCE, SO FOR EXAMPLE, IN EARS OF DISADVANTAGE, THERE ARE FEWER PLACES FOR EXERCISE SAFELY, SO IT MARTHA STEWART B THIS PATHWAY MIGHT ENCOMPASS I IN THE ENVIRONMENTAL PATHWAY. IT'S SHOWN NEIGHBORHOOD VIOLENCE AND LACK OF SAFETY ARE ASSOCIATED WITH A FLATTER DIURNAL SLOPE, AND THEY'VE SHOWN THAT NEIGHBORHOOD POVERTY RELATES TO THESE NEUROENDOCRINE DISRUPTIONS VIA INCREASES IN NEIGHBORHOOD VIOLENCE. SO IT'S POSSIBLE THAT OUR HPA FINDINGS MIGHT -- A SAFETY OR STRESS RELATED PATHWAY TO INFLUENCE BRAIN HEALTH. IN TERMS OF WHERE WE'D LIKE TO SEE THIS WORK GO, WE THINK THIS WORK HAS IMPLICATIONS FOR UNDERSTANDING BRAIN BASED OUTCOMES SUCH AS COGNITIVE AGING, DEMENTIA, THAT MIGHT BE SOCIOECONOMICALLY PATTERNED. WE THINK THAT THIS WORK ILLUSTRATES HOW NEUROSCIENCE CAN PROVIDE COMPLEMENTARY EVIDENCE TO WHAT'S BEING SHOWN IN THE DISPARITIES LITERATURE WITH RESPECT TO EARLIER PRE-CLINICAL CHANGES THAT MANIFEST THEMSELVES PRIOR TO CLINICAL OUTCOMES. AND WE DO HOPE THAT MORE NEUROSCIENTISTS WILL HAVE A GREATER INTEREST IN HEALTH DISPARITIES, WE HOPE HEALTH DISPARITIES RESEARCHERS BECOME MORE INTERESTED IN APPLYING NEUROSCIENCE WORK LIKE WE'VE SHOWN HERE, AND WE ALSO THINK THIS WORK SHOULD ENCOURAGE MORE INTEGRATIVE TRAINING AS WELL AS LONGITUDINAL RESEARCH, SO TRAINING YOUNG INVESTIGATORS IN NEUROSCIENCE AND HEALTH DISPARITIES METHODS, WE THINK WILL BE PARTICULARLY FREUT FRUITFUL. THANK YOU ALL FOR YOUR TIME. [APPLAUSE] >> THE THIRD AND FINAL SPEAKER IN OUR PANEL IS BARBARA FREDRICK FREDRICKSON, DIRECTOR OF THE POSITIVE EMOTIONS AND PSYCHOPHYSICIAN LOLG LABORATORY. BARBARA IS ALSO CURRENT PRESIDENT OF THE INTERNATIONAL POSITIVE PSYCHOLOGY ASSOCIATION. BARBARA FREDERICKSON IS MOST KNOWN FOR HER BROADEN AND BUILD THEORY OF POSITIVE EMOTIONS, WHICH IS FOUNDATIONAL WITHIN POSITIVE PSYCHOLOGY FOR PROVIDE AGO BLUEPRINT FOR HOW PLEASANT EMOTIONAL STATES, AS FLEETING AS THEY ARE, CONTRIBUTE TO RESILIENCE, WELL-BEING AND HEALTH. HER WORK HAS EXPLORED THE MOMENTARY AND LONG-TERM EFFECTS OF POSITIVE EMOTIONS ON COGNITIVE PROCESSES, HEALTH BEHAVIORS, SOCIAL CONNECTIONS, AND RESILIENCE TO ADVERSITY. DR. FREDERICKSON HAS PUBLISHED APPROXIMATELY 140 PEER REVIEWED ARTICLES AND BOOK CHAPTER, AND HER TWO GENERAL AUDIENCE BOOKS, "POSITIVELY" AND "LOVE 2.0" HAVE BEEN TRANSLATED FOR MORE THAN 30 FOREIGN MARKETS. DR. FREDERICKSON HAS BEEN RECOGNIZED WITH NUMEROUS HONORS INCLUDING THE TEMPLETON PRIZE IN POSITIVE PSYCHOLOGY FROM THE AMERICAN PSYCHOLOGICAL ASSOCIATION, AND HER WORK HAS HAD INFLUENCE ON SCHOLARS AND PRACTITIONERS ACROSS THE GLOBE WITHIN EDUCATION, BUSINESS, HEALTHCARE, THE MILITARY AND BEYOND. THE TIE TEFL HER PRESENTATION IS POSITIVE AFFECTIVE PROCESSES UNDERLYING POSITIVE HEALTH BEHAVIORAL CHANGE. [APPLAUSE] >> THANK YOU FOR THE INVITATION TO JOIN YOU HERE TODAY. I JUST WANT TO GIVE A QUICK SHOUT OUT EARLY ON TO MY TEAM IN THE PEP LAB AT UNC AND ALSO TO THE VARIOUS AGENCIES OF NIH THAT HAVE FUNDED MY PAST AND CURRENT WORK. WE ALL KNOW POSITIVE HEALTH BEHAVIORS ARE GOOD FOR US. CERTAINLY STAYING PHYSICALLY ACTIVE, EATING FRUITS AND VEGETABLES, AND I ADD MEDITATION HERE BECAUSE SOME OF MY RESEARCH HAS USED THAT AS A POSITIVE HEALTH BEHAVIOR AS WELL. THE BIG QUESTION IS HOW TO STICK WITH THESE BEHAVIORS. WE KNOW THEY'RE GOOD FOR U WE START NEW HABITS AND THEN WE LOSE THEM. WE KNOW THIS IS -- PART OF THE PROBLEM IS THAT WILLPOWER FAILS. WILLPOWER IS GREAT AT BEHAVIORAL INITIATION. WILLPOWER IS NOT SO GREAT AT BEHAVIORAL MAINTENANCE OVER THE LONG TERM, AND WHAT STUDIES SHOW IS THAT FOR BEHAVIORAL MAINTENANCE, WHAT'S MUCH MORE INFLUENTIAL IS NON-CONSCIOUS PROCESSES, AND CERTAINLY HABIT, SO SORT OF A QUESTION OF HOW THOSE DEVELOP. WELL, WE ALSO KNOW THAT ENJOYMENT MOTIVATES, AND WHAT THE RESEARCH I WANT TO SHARE WITH YOU, THE THEORETICAL FRAMEWORK BEHIND IT, IS REALLY TRYING TO UNPACK, WHY DOES ENJOYMENT MOTIVATE. I DON'T THINK THIS MULE IS THINKING ABOUT IN A CONSCIOUS DELIBERATE WAY THE BENEFITS OF CARROTS, BUT HE'S DRAWN IN THAT DIRECTION, HE OR SHE. SO WHAT WE KNOW ABOUT ENJOYMENT IN POSITIVE HEALTH BEHAVIORS, THIS INCLUDES BOTH PHYSICAL ACTIVITY AND MEDITATION HERE, IS THAT POSITIVE AFFECT FROM THOSE POSITIVE HEALTH BEHAVIOR FORECASTS BEHAVIORAL ENGAGE. EVEN AT 15-MONTH FOLLOW-UP, AND ESPECIALLY FOR POSITIVE AFFECT DURING THOSE POSITIVE HEALTH BEHAVIORS. WE KNOW THINGS LIKE EXERCISE BOOSTS POSITIVE AFFECT FOR HOURS AFTER A BOUT OF EXERCISE. THAT POSITIVE AFFECT DOESN'T SEEM TO BE AS INFLUENTIAL AS THE POSITIVE AFFECT PEOPLE FEEL DURING THE ACTIVITY. AND SO WHAT I WANT TO SHARE WITH YOU IS A MODEL THAT MY TEAM AND I HAVE DEVELOPED TO TRY TO UNDERSTAND SOME OF OUR EARLY EFFECTS ABOUT HOW INFLUENTIAL THE EARLY POSITIVE AFFECTS TO BEGINNING A MEDITATION PRACTICE PREDICTED WHETHER PEOPLE STUCK WITH IT 15 MONTHS LATER. IN AN EFFORT TO UNDERSTAND THAT PHENOMENON, WE'VE DEVELOPED THIS UPWARD SPIRAL THEORY OF LIFESTYLE CHANGE AND IT'S ROOTED BOTH IN NEUROSCIENCE AND MY BROADEN AND BUILD THEORY OF POSITIVE EMOTION. I'M GOING TO GIVE YOU THE QUICKEST PRESENTATION OF THE BROADEN AND BUILD THEORY. AND THIS IS THE IDEA THAT SUBTLE MILD POSITIVE AFFECT BROADENS OUR AWARENESS IN SUBTLE WAYS BUT EXPANDS OUR AWARENESS, AND THE MORE THESE MOMENTS OF POSITIVITY AND EXPANDED AWARENESS ACCUMULATE AND COMPOUND, THE MORE THEY BUILD OUR RESOURCES LIKE OUR MENTAL HEALTH, OUR SOCIAL INTEGRATION, OUR PHYSICAL HEALTH, IN WAYS THAT ARE AKIN TO THE WAY NUTRIENTS, FRUITS AND VEGETABLE CONSUMPTION IS SOMETHING THAT WE NEED TO HAVE A DAILY DIET OF IN ORDER TO IMPROVE OUR PHYSICAL HEALTH MONTHS LATER, OUR DAILY DIET OF SUBTLE POSITIVE EMOTION EACH DAY CONTRIBUTES TO THE BUILDING OF ENDURING RESOURCES LIKE MENTAL HEALTH AND PHYSICAL HEALTH. FROM THE NEUROSCIENCE LITERATURE, I'VE DRAWN ON TWO DISTINCT BUT RELATED LITERATURES, ONE ON ADDICTION AND THE OTHER ON SICKNESS BEHAVIOR. FROM THE NEUROSCIENCE OF ADDICTION, I'M VERY INFLUENCED BY KENT BERRIDGE'S WORK, DISASSEMBLED REWARD PROCESSES INTO SEPARATE LIKING AND WANTING SYMPTOMS WITH THE IDEA THAT DOPAMINE IS PARTICULARLY RELEVANT TO THE WANTING OR INCENTIVE SALIENT SIDE THAT DRAWS US TOWARDS THINGS, BUT NOT SO MUCH TO THE ENJOYMENT SIDE. THEN I'M ALSO INFLUENCED BY NAOMI IC EISENBERGER'S WORK, AND THIS IS THAT INFLAMMATION ALONE HAS ITS OWN PSYCHOLOGY SO THAT WHEN YOU INJECT AN ENDOTOXIN IN RANDOMIZED TRIAL, PEOPLE REPORT FEELING LUKE THEY HAVE LESS ENERGY, THEY'RE A LITTLE DOWN, THEY DON'T WANT TO BE WITH PEOPLE, THEY DON'T WANT TO BE PHYSICALLY ACTIVE. THIS ISN'T ABOUT SICKNESS, PER SE, BUT THE INFLAMMATION. ALSO THIS SAME ENDOTOXIN CHALLENGE HAS BEEN SHOWN TO RECUSE THE ACTIVITY AND REWARD AREAS OF THE BRAIN THAT ARE CRITICALLY LINKED TO DOPE ANY NER JIK FUNCTION. SDOPE NER JIK FUNCTION. TURNING DOWN THE DIAL ON POSITIVE AFFECT EXPERIENCE AND KIND OF MUTING THE SYSTEM. SO FROM THAT, I WAS THINKING WE HAVE A COLLECTION OF SICKNESS BEHAVIOR, NOT WANTING TO BE WITH PEOPLE, NOT WANTING TO BE PHYSICALLY ACTIVE AND SO ON, MAYBE WE ALSO HAVE A COHERENT SET OF WELLNESS BEHAVIORS, THINGS LIKE BEING PHYSICALLY ACTIVE, BEING SOCIAL, LEARNING SOMETHING NEW, PURSUING MEANINGFUL PURSUITS, EATING WELL AND CARING FOR THE BODY. WHAT THESE HAVE IN COMMON IS THAT THEY -- UNLIKE SICKNESS MAY HAVE YOUR, SICKNESS MAY HAVE YOURS ARE ABOUT SURVIVING THE DAY AND PERHAPS ALSO NOT INFECTING OTHERS, BUT WELLNESS BEHAVIORS ARE ABOUT INVESTING IN YOUR FUTURE. THESE ARE NOT THINGS YOU DO IF YOU THINK YOU'RE NOT GOING TO LIVE THE WEEK. OR GET THROUGH THIS ILLNESS. BUT YOU'RE TAKING A PROACTIVE INVESTMENT IN THE FUTURE. AND THE INSIGHTS OR THE PRINCIPLE OF THE UPWARD SPIRAL THEE REAR, ONE BASIC PRINCIPLE, IS THAT BIOLOGICAL AND PSYCHOLOGICAL RESOURCES, WHAT I'M CALLING VANTAGE RESOURCES, CERTAIN BIOLOGICAL AND PSYCHOLOGICAL VANTAGE RESOURCES CAN AMPLIFY OR TURN UP THE VOLUME ON THE POSITIVE EMOTION SYSTEM WHICH CAN MAKE THESE BEHAVIORS MORE APPEALING BECAUSE THEY'RE MORE AFFECTTIVELY REWARDING. SO THIS UPWARD SPIRAL THEORY OF LIFESTYLE CHANGE HAS ONE OVERARCHING HYPOTHESIS, I'LL GIVE YOU THAT BEFORE I GIVE YOU THE DIAGRAM OF IT, AND THAT IS THAT POSITIVE EMOTIONS CREATE NON-CONSCIOUS AND INCREASING MOTIVES FOR VARIOUS WELLNESS BEHAVIORS. AND IT'S A SPIRAL MODEL, AN INNER AND OUTER LOOP. THE INNER LOOP IS INSPIRED BY THE WORK ESTABLISHES BETWEEN LIKING AND WANTING AND A CONCEPT IN HIS WORK HE CALLS INCENTIVE SALIENCE, HERE I'M JUST SIMPLIFYING THAT A BIT AND CALLING IT NON-CONSCIOUS MOTIVES, WIT BUT THAT TO THE EXTENT THAT HEALTH BEHAVIOR, POSITIVE HEALTH MAY HAVE YOURS, INCREASE PEOPLE'S POSITIVE EMOTIONS AND I WANT TO BE SUPER CLEAR THAT I DO NOT THINK ALL INCREASE POSITIVE EMOTIONS. SOMETIMES WE JUST DO IT, WE WILLPOWER OUR WAY TO IT. BUT TO THE EXTENT THAT THESE WELLNESS BEHAVIORS DO ELICIT POSITIVE AFFECT DURING THOSE INTERACTIONS, OR DURING THOSE BEHAVIOR, THEN THESE OTHER PROCESSES COME INTO PLAY. SO ONE OF THE DOWNSTREAM EFFECTS OF POSITIVE AFFECT EXPERIENCE DURING HEALTH BEHAVIORS IS THAT NON-CONSCIOUS MOTIVES FOR THOSE BEHAVIORS BEGIN TO DEVELOP. PEOPLE BEGIN TO HAVE THIS NON-CONSCIOUS SALIENCE FOR THAT ACTIVITY AND HAVING MORE OF THAT NON-CONSCIOUS MOTIVATION SETS UP PEOPLE TO BE MORE LIKELY TO ENGAGE IN THAT BEHAVIOR AND EXPERIENCE POSITIVE AFFECT IN THAT BEHAVIOR AGAIN AND SO ON. SO THIS IS THE INNER LOOP OF THE INNER SPIRAL. ON THE OUTER IS THE BROADEN AND BUILD LOOP OF THE THEORY. POSITIVE EMOTIONS INCREASE PEOPLE'S POSITIVE AFFECT OVER TIME, THAT INCREMENTALLY THAT SERVES TO BUILD RESOURCES, AND SOME OF THOSE RESOURCES FUNCTION AS VANTAGE RESOURCES, THAT LEVERAGE THE POSITIVE AFFECT THAT YOU GAIN OUT OF A GIVEN WELLNESS BEHAVIOR, AND I'LL GIVE YOU SOME EXAMPLES OF THIS IN A LITTLE KIND OF SPEAKER VOLUME SIGN AS MY LITTLE IMAGE FOR AMPLIFICATION. SO THIS IS A WAY THAT VANTAGE RESOURCES MODERATE HOW FAST THIS INNER SPIRAL DEVELOPS. SO I WANT TO GIVE A QUICK SHOUT OUT TO DR. PATTY VAN CAPPELLEN. THE INNER LOOP OF -- I'M GOING TO GIVE YOU TWO EXAMPLES THAT COME OUT OF MY RESEARCH LAB TO ILLUSTRATE THE INNER LOOP AND YO THE OUTER LOOP. I WANTED TO ILLUSTRATE THIS HERE HERE. HERE I'M FOCUSING ON POSITIVE SPONTANEOUS THOUGHTS, AND AS A MARKER OF THESE NON-CONSCIOUS MOTIVES FOR WELLNESS BEHAVIORS. I WANT TO GIVE A SHOUT OUT HERE TO DR. ELISE RICE, NOW A POSTDOC AT NCI. THE STUDYS THAT I'M GOING TO SHARE WITH YOU NEXT WERE ALL FROM HER DISSERTATION THAT SHE COMPLETED LAST YEAR, SO THANK YOU, ELISE. IF YOU HAVE QUESTION WIT ABOUT THIS WORK LATER, YOU CAN ASK ME OR ELISE, AND SHE'LL BE HERE LONGER. I WANT TO GIVE YOU AN EXAMPLE OF WHAT I MEAN BY POSITIVE SPONTANEOUS THOUGHTS. ONE WAY WE'VE MEASURED THIS, WE'VE MEASURED IT IN MULTIPLE WAY, BUT SOMETIMES WE SIMPLY ASK PEOPLE, HOW OFTEN DO THOUGHTS ABOUT PHYSICAL ACTIVITY SEEM TO POP INTO YOUR HEAD OR JUST COME TO YOU. SO WE MEASURE THE FREQUENCY OF THESE SPONTANEOUS THOUGHTS THAT JUST POP TO MIND. AND THEN WE ASK A SECOND QUESTION, CONSIDERING THESE THOUGHTS, WHAT PERCENTAGE OF THOSE THOUGHTS ARE POSITIVE OR PLEASANT. WE ALSO ASK WHAT PERCENTAGE ARE NEGATIVE BUT ALL THE ACTION IS WITH THE POSITIVE HERE. THESE ARE THE POSITIVE -- THAT HAVE GONE VERY MUCH UNDERSTUDIED. WE REALLY HAVE FOCUSED ON THE INTRUSIVE THOUGHTS OR UNCONTROLLABLE NEGATIVE THOUGHTS, BUT NOBODY HAS REALLY LOOKED AT, UNTIL ELISE, THIS POSITIVE SIDE. WHAT WE KNOW FROM INITIAL RESEARCH IS THAT THESE POSITIVE SPONTANEOUS THOUGHTS FUNCTION JUST LIKE INCENTIVE SALIENCE IN THAT THEY BRIDGE THE GAP BETWEEN -- OR MEDIATE THE EFFECTS OF LIKING, ENJOYING A WELLNESS BEHAVIOR AND ENJOYING AN ACTIVITY, AND THE DESIRE TO DO THAT AGAIN IN THE FUTURE. SO THIS WAS A STUDY WHERE WE HAD 103 PARTICIPANTS, RESPONDING TO SURVEY QUESTIONS ABOUT 10 DIFFERENT ACTIVITIES, THEY TOLD US HOW MUCH THEY HAVE LIKED THAT ACTIVITY I THE PAST, HOW MUCH THEY WANTED TO ENGAGE IN IT NEXT WEEK, AND THEN ALSO HOW MANY POSITIVE SPONTANEOUS THOUGHTS THEY HAD ABOUT IT YESTERDAY. SO WE TRY TO GET SOME TEMPORAL SEPARATION HERE EVEN THOUGH IT'S A SURVEY STUDY, AND WE FIND THAT THERE IS SIGNIFICANT MEDIATION BY POSITIVE SPONTANEOUS THOUGHTS. NOW, THAT HELPS US POSITION POSITIVE SPONTANEOUS THOUGHTS HERE IN -- AS A MEDIATOR BETWEEN LIKING THE TOP BOX OF THE INNER CIRCLE AND WANTING -- OR BEHAVIORAL INDEX OF WANTING ENGAGEMENT IN THAT HEALTH BEHAVIOR, AND WE ALSO HAVE A LONGITUDINAL STUDY THAT LINKS THESE CONCEPTS TOGETHER WITH DAILY REPORTS, A DAILY DIARY STUDY WHERE WE MEASURE HOW MUCH POSITIVE AFFECT DID YOU -- HOW MUCH DID YOU ENGAGE IN PHYSICAL ACTIVITY TODAY, A SEPARATE MEASURE ON A DIFFERENT DAY, WE ASKED HOW MANY THOUGHTS ABOUT PHYSICAL ACTIVITY, SPONTANEOUSLY COME TO MIND, AND THEN IN FUTURE DAYS, WE MEASURE SUBSEQUENT BEHAVIORAL ENGAGEMENT AND WE FIND THIS MEDIATION FOR PHYSICAL ACTIVITY AS WELL. BUT IN ADDITION TO THESE CORRELATIONAL -- LONGITUDINAL ANALYSES, ELISE SOUGHT TO GET A CAUSAL HANDLE ON THESE TWO SEPARATE LINKS. CAN WE SAY THAT POSITIVE AFFECT CAUSES POSITIVE SPONTANEOUS THOUGHTS AND THAT POSITIVE SPONTANEOUS THOUGHTS CAUSE BEHAVIORAL MOTIVES. SO THAT'S WHERE THESE TWO LABORATORY EXPERIMENTS OF HER DISSERTATION CAME IN AND THESE RK REVISE ARE BEING REVISED FOR EMOTION. WE HAD ALMOST 100 UNDERGRADUATE STUDENTS, THEY WERE RANDOMIZED TO EXPERIENCE CARTOONS THAT WERE EITHER ALL FUNNY OR A MIXTURE OF FUNNY AND DECIDEDLY UNFUNNY. AND THENG THEN W THEN WE LATER ASKED, HOW OFTEN DID THOUGHTS OF THESE CARTOONS SPONTANEOUSLY COME TO MIND, AND WHAT PERCENTAGE OF THOSE WERE POSITIVE, AND WE FIND LIKING THE CARTOONS WHICH WE RAM DONEL WE RANDOMLY ASSIGNED CREATES POSITIVE SPONTANEOUS THOUGHTS ABOUT THOSE CARTOONS. THEN THE NEXT EXPERIMENT ELISE SOUGHT TO -- POSITIVE SPONTANEOUS THOUGHTS. IT'S A LITTLE DIFFICULT TO DO THAT BECAUSE THEE ARE SPONTANEOUS THOUGHTS. AND SO SHE HAD A GREAT IDEA TO MANIPULATE PEOPLE'S PERCEPTION, HERE WE HAD 80 UNDERGRADUATE STUDENTS COME IN TO THE LABORATORY AND WE RANDOMIZED THEM TO RECEIVE BOGUS FEEDBACK ABOUT THEIR SPONTANEOUS THOUGHTS, ABOUT A PHYSICAL ACTIVITY, A PARTICULAR PHYSICAL ACTIVITY LIKE DANCING OR RUNNING OR HIKING THAT WAS SELECTED SPECIFICALLY BASED ON THEIR PREFERENCES TO BE SOMEWHAT NOT QUITE THEIR FAVORITE BUT -- THE TOP HALF OF THEIR FAVORITES, THOUGHT PATTERN SUGGESTED PARTICULAR POSITIVITY IN THEIR SPONTANEOUS THOUGHTS. SO THE WAY WE CONVINCED THEM OF THIS IS WE WERE ALSO MEASURING HEART RATE ACTIVITY, FACIAL EMG, WE HAD ALL KINDS OF ACTIVE PHYSIOLOGICAL SENSORS ON THEM, AND THEN AFTER THAT, WE SHOWED THEM THIS FIGURE, HALF THE PEOPLE BY RANDOM ASSIGNMENT RECEIVED A GRAPH LIKE THIS THAT SAYS YOUR DATA SUGGESTS THAT YOUR SPONTANEOUS THOUGHTS ABOUT THIS PARTICULAR PHYSICAL ACTIVITY ARE GENERALLY QUITE POSITIVE, AVERAGING ABOUT 88%. A LITTLE NOTE AT THE BOTTOM SAYS THIS ONLY PERTAINS TO SPONTANEOUS THOWTSZ. WE DON'T HAVE THE SCIENCE TO BE ABLE TO SAY YOUR DELIBERATE THOUGHTS. OF COURSE THIS IS BOGUS FEEDBACK, BUT WHAT WE FOUND IS HAVING THE PERCEPTION THAT YOUR SPONTANEOUS THOUGHTS ARE POSITIVE INFLUENCES THE PEOPLE'S BEHAVIORAL INTENTIONS TO ENGAGE IN THAT PARTICULAR ACTIVITY OVER THE COMING WEEKS. HERE WE MEASURED PEOPLE'S INTEXT TO ENGAGE IN THAT ACTIVITY IN THE NUMBER OF HOURS THEY DEVOTED TO IT IN A CALENDAR FOR THE NEXT WEEK, SO PEOPLE ARE DEVOTING A LITTLE MORE THAN TWO HOURS TO THAT ACTIVITY IF THEY THOUGHT THEIR SPONTANEOUS THOUGHTS WERE MORE POSITIVE, WHICH WAS SIGNIFICANTLY HIGHER THAN THE NO FEEDBACK CONDITION. SO THIS UPWARD SPIRAL THEORY OF LIFESTYLE CHANGE, THESE STUDIES OF SPONTANEOUS THOUGHTS HELP US TEST THIS INTERLOOP, AND THAT IS THE PLACE WHERE ENJOYING AN ACTIVITY, LIKE ENJOYING PHYSICAL ACTIVITY, LEADS TO MORE SPONTANEOUS THOUGHTS THAT ARE POSITIVE ABOUT THAT ACTIVITY AND THAT DRIVES PEOPLE'S FUTURE ENGAGEMENT IN THAT ACTIVITY. NOW I WANT TO TURN TO THE OUTER LOOP OF THE SPIRAL NOW, WHERE WE'RE LOOKING AT HOW VANTAGE RESOURCES CAN LEVERAGE THIS PHENOMENON, AND AMONG THE RESOURCES WE'VE LOOKED AT, WE'VE LOOKED AT BIOLOGICAL RESOURCES AND PARTICULARLY WE HAVE DATA ON HEART RATE VARIABILITY AS AN INDEX OF CARDIAC VAGAL CONTROL, AND WHAT WE'VE FOUND WITH THIS WORK IS THAT THE POSITIVE AFFECT PEOPLE GAIN FROM A WELLNESS BEHAVIOR HERE, MEDITATION, IS INCREASED FOR PEOPLE WHO HAVE HIGHER LEVELS OF HIGH FREQUENCY HEART RATE VARIABILITY. THEY TEND TO EXPERIENCE MORE POSITIVE EMOTIONS IN RESPONSE TO THE SAME MINUTES OF MEDITATION COMPARED TO PEOPLE WITH LOWER HEART RATE VARIABILITY. AND MORE TIME SPENT MEDITATING LEADS TO INCREASES DOCTOR OR MOR -- OR MORE ENJOYMENT, I'M SORRY, PRODUCES INCREASES IN CARDIAC VAGAL TONE, INCREASED HEART RATE VARIABILITY OVER TIME, SO WE SEE THIS BETWEEN ENJOYMENT AND THE ACTIVITY, SO JUST TO GO BACK TO THIS FIGURE FOR A SECOND, WHAT WE'RE FINDING HERE IS THAT THE BIOLOGICAL RESOURCE MODERATES THE POSITIVE AFFECT YIELD OF THE BEHAVIOR AND THAT ALSO THE POSITIVE AFFECT ACCOUNTS FOR INCREASES IN THAT BEHAVIOR OVER TIME. HEART RATE VARIABILITY HAS BEEN ONE. I JUST PUT A LITTLE SPLASH OF OXYTOCIN HERE TO REMIND ME TO TELL YOU THAT WE HAVE PRELIMINARY EVIDENCE THAT OXYTOCIN FUNCTIONS IN THE SAME WAY AS A VANTAGE RESOURCE BUT I DON'T HAVE TIME TO TALK TO YOU ABOUT THAT AT THIS TIME. WITBUT YOU CAN ASK QUESTIONS ABOUT IT. THE PSYCHOLOGICAL VAB TAJ RESOURCE WE'VE BEEN LOOKING AT IS PRIORITIZING POSITIVITY THIS IS A NEW INDIVIDUAL DIFFERENCE MEASURE THAT LANA CATALINO HAS PARTICULARLY SPEARHEADED THIS IS LANA, FORMERLY HAD FROM MY LABORATORY, THIS IS -- SOME OF THIS WORK WAS INSPIRED BY HER DISSERTATION AND SHE'S OFF TO SCRIPS COLLEGE SHORTLY, AND PRIORITIZING POSITIVITY, YOU CAN THINK OF THIS AS WHEN YOU SELECT YOUR TO-DO LIST FOR THE DAY, TO WHAT EXTENT DO YOU INCLUDE THINGS THAT ARE GOING TO FEEL GOOD. SOMETIMES WE JUST PUT ALL THE HAVE TO'S ON OUR LIST AND WE DON'T HAVE ANYTHING THAT FEELS GOOD. PRIORITIZING POSITIVITY, PEOPLE WHO SCORE HIGH ON THIS MEASURE ARE MORE LIKELY TO THINK ABOUT WHAT THEY DO OUTSIDE OF WORK IN TERMS OF HOW MUCH POSITIVE AFFECT IT YIELDS. AND WE FIND THAT THIS INDIVIDUAL DIFFERENCE ALSO INCREASES THE LIKELY HOOF LIKELIHOOD OF GAINING MORE POSITIVE AFFECT FROM MEDITATION INCREASES POSITIVITY. WE ALSO DID A FIELD EXPERIMENT WHERE WE RANDOMIZED PEOPLE TO INCREASE THEIR PRIORITIZING POSITIVITY BY HAVING THEM READ A SHORT ARTICLE THAT WE SAY IS FROM SCIENTIFIC AMERICAN MIND THAT BASICALLY VERY QUICKLY OUTLINES SOME UNEFFECTIVE STRATEGIES FOR INCREASING POSITIVE AFFECT, JUST TRYING TO WISH YOURSELF TO FEEL GOOD, VERSUS EFFECTIVE STRATEGIES, PLANNING YOUR DAY TO INCREASE MORE POSITIVE AFFECT. THAT INTERVENTION INCREASES THE POSITIVE AFFECT PEOPLE FEEL DURING MEDITATION. OUR HYPOTHESIS, AND WE HAVE A GRANT UNDER REVIEW NOW, IS THAT GETTING PEOPLE TO PRIORITIZE POSITIVITY IN PHYSICAL ACTIVITY WILL CREATE THESE NON-CONSCIOUS AND I CREASING MOTIVES FOR INCREASING PHYSICAL ACTIVITY. SO AGAIN, I HOPE THAT THE EXAMPLES HAVE HELPED YOU SEE HOW THIS INNER LOOP AND OUTER LOOP WORK TOGETHER AND I JUST WANT TO THANK YOU FOR YOUR ATTENTION. [APPLAUSE] >> SO INVITE OUR OTHER SPEAKERS UP TO THE TABLE AND WE'LL OPEN IT UP FOR A Q & A SESSION AND INVITE ALL OF YOU IN THE AUDIENCE SO PLEASE LINE UP BEHIND ONE OF THE MICROPHONES AND CONSIDER QUESTIONS FOR ALL OF THE SPEAKERS INDIVIDUALLY OR FOR THE PANEL AS A WHOLE TO TALK ABOUT SOME OF THE BROAD THEMES AND HOW THESE TALKS MIGHT BE INTERCONNECTED. SO AS YOU'RE SORT OF GATHERING YOUR THOUGHTS ABOUT THAT, I THOUGHT I WOULD JUST POINT OUT THAT ACROSS THESE TALKS, WE'VE SEEN PRESENTATIONS THAT TARGET INDIVIDUAL LEVEL FACTORS LIKE THE ABILITY TO CULTIVATE OR EXPLOIT POSITIVE EMOTIONS. WE'VE TALKED ABOUT APPROACHES THAT TARGET INTERPERSONAL PROCESSES LIKE SUPPORTIVE PARENTING, TO HELP PROMOTE POSITIVE HEALTH MAY HAVE YOUR AND PHYSICAL HEALTH IN AT-RISK TEENS, AND WE'VE HAD A TALK THAT SUGGESTS THE POTENTIAL OF TARGETING SOCIETAL STRUCTURAL FACTORS SUCH AS FEATURES OF NEIGHBORHOODS, THE LIFESTYLES THAT THEY POTENTIALLY PROMOTE THAT COULD ALSO POTENTIALLY INFORM AND PROMOTE DIFFERENT HEALTH TRAJECTORIES IF WE KNEW HOW TO INTERVENE IN THOSE AREAS. REALLY HAVE THE POTENTIAL TO PULL TOGETHER THESE THREE DIFFERENT LEVELS OF MECHANISMS THAT WE CAN TARGET IN AN INFORMATIVE WAY BY ILLUSTRATING THE LINK BETWEEN FACTORS ON THESE MANY, MANY LEVELS. SO I WAS STRUCK BY SORT OF THE CHALLENGE OF LINKING THESE THREE LEVELS IN MANY WAYS. THE FIRST TWO TALKS SPOKE QUITE A LOT ABOUT HEALTH DISPARITIES AND DISADVANTAGE, AND POTENTIAL WAYS TO INTERVENE ON FACTORS TO SORT OF BUFFER OR REDUCE THE VULNERABILITY TO THOSE EXPOSURES. THEN WE HAD A TALK ABOUT THE CULTIVATION OF POSITIVE FACTORS IN LIFE, AND I WAS REALLY SORT OF HOPING TO GET A DIALOGUE GOING ABOUT HOW TO BRIDGE WHAT WE SEE SORT OF AS THE ADVERSE INFLUENCES, HOW TO UNDO THOSE OR AMELIORATE THOSE AND THE POSITIVE FOCUS YOU'RE TAKING IN YOUR TALK, SO I'D OPEN IT UP TO ALL THREE OF TO YOU SAY A FEW IMHENTS HOW YOU SEE INTERCESSION BETWEEN THIS MORE POSITIVE CULTIVATION APPROACH AND SORT OF THE TARGETING OF THE ADVERSITY THAT THE FIRST TWO SPEAKERS SPOKE OF. >> I WAS SPECIALLY STRUCK BY THE INTERVEPTION INTERVENTIONS TO REDUCE HARSH PARENTING AND WAS WONDERING HOW MUCH THAT REDUCTION IN HARSH PARENTING VARIABLE MIGHT ALSO INCLUDE AN INCREASE IN LOVING THOUGHTFUL PARENTING, OR IS IT JUST REDUCTION -- IF YOU THINK OF THOSE AS THEY COULD BE REDUCING HARSHNESS AND BECOMING NEUTRAL, OR THEY COULD BE REDUCING HARSHNESS AND CREATING MORE POSITIVE EMOTIONS, AND THAT SEEMS TO BE A LITTLE BIT HIDDEN THERE, BUT THAT'S A PLACE WHERE I THINK THERE COULD BE THAT INTERCEPTION BETWEEN LESSENING THE NEGATIVE, BUT IT'S KIND OF HIDDEN AS TO WHETHER THAT'S INCREASING THE POSITIVE. AND THEN IT WOULD BE SCIENTIFICALLY IMPORTANT TO FIND OUT WHICH DRIVES IT, IS IT THE REDUCTION IN THE NEGATIVE OR THE INCREASE IN POSITIVE OR BOTH. >> IN THE STUDY WE SUMMARIZED WHICH TOOK A LOOK AT SIDE EFFECTS OF CYTOKINE LEVEL, THOSE PREVENTION EFFECTS, THOSE REDUCTION IN CYTOKINE LEVELS ASSOCIATED WITH PARTICIPATING IN THE INTERVENTION WERE MEDIATED COMPLETELY BY INCREASES IN SUPPORTIVE -- WHAT WE MIGHT CALL WARMTH AND DECREASES IN HARSHNESS. SO THE INCREASE IN THOSE TWO THINGS WHICH OFTEN COVARY NEGATIVELY WERE RESPONSIBLE AT LEAST UNDER THE SKIN FOR LOWER LEVELS OF INFLAMMATORY RESPONSE. >> I WAS REALLY STRUCK BY YOUR TALK AND THE POSITIVITY OF SPONTANEOUS THOUGHTS THAT MIGHT UNDERPIN LIKE WELLNESS BEHAVIORS AND PHYSICAL ACTIVITY, AND I WAS TRYING TO CONNECT IT TO MY WORK AND WONDER ABOUT WHETHER THERE'S A SOCIOECONOMIC GRADIENT IN THOSE THOUGHTS AND THE POSITIVITY ABOUT THEM, BECAUSE THERE'S SO MANY CONSTRAINTS FROM THE NEIGHBORHOOD ON JUST AVAILABILITY FOR RESOURCES TO, LIKE, ACT OUT, EVEN IF YOU HAVE THE THOUGHTS, IT COULD BOIL DOWN TO SCHOOLS AND SO FORTH, THEN WITH THINGS AT THE INDIVIDUAL LEVEL, IF YOU'RE AN ADULT WORKING MULTIPLE JOBS, IF THEY'RE JUST SORT OF LIKE CONSTRAINTS IN YOUR DAY THAT DON'T AFFORD YOU TO HAVE AN OPPORTUNITY TO HAVE THOSE, BUT IF THERE WAS SOME WAY TO EVEN LIKE WORK WITHIN THE CONSTRAINTS IN THE ENVIRONMENT AT THE INDIVIDUAL LEVEL AND TAKE ADVANTAGE OF THINGS THAT MIGHT BE THERE, PARTICULARLY LIKE IN A SOCIALLY SUPPORTIVE ATMOSPHERE, THERE'S ROOM TO DO INTERESTING WORK. BUT I THINK LIKE STEP ONE WOULD BE STL A GRADIENT -- >> I CERTAINLY DO THINK THERE WOULD BE A GRADIENT IN THOSE THOUGHTS BECAUSE DOES THOUGHTS PATTERN PASS BEHAVIOR, I DON'T THINK YOU GET TO HAVE POSITIVE SPONTANEOUS THOUGHTS ABOUT PHYSICAL ACTIVITY IF YOU DON'T HAVE A PHYSICAL ACTIVITY THAT ARE PRODUCES ENJOYMENT AND SO THE POSITIVE SPONTANEOUS THOUGHTS WOULD TRACK WHATS THAT IN THE PAST BEEN ENJOYABLE. NOW THAT MIGHT BE SOCIAL RELATIONSHIPS OR IT MIGHT BE SOCIAL INVOLVEMENT IN OTHER THINGS. SO THESE HERE WE'RE TARGETING THIS CONSTRUCT BECAUSE THAT'S OUR CONTEXT, AND WE FOUND IT IN MEASUREMENTS, IT'S NOT EASY TO ASK PEOPLE ABOUT THEIR SPONTANEOUS THOUGHTS IN GENERAL, YOU NEED TO ASK ABOUT A -- DOMAIN. SO IT WOULD BE INTERESTING TO LOOK AT THE DEMOGRAPHIC DIFFERENCES IN POSITIVE SPONTANEOUS THOUGHTS ABOUT SPECIFIC DOMAINS, BUT ALSO THEN TO TARGET CERTAIN POPULATIONS. AND FIND OUT WHERE ARE THOSE POSITIVE SPONTANEOUS THOUGHTS. >> YOU HAD ALSO -- STRUCK BY THE IDEA, THOUGHTS ABOUT WELLNESS BEHAVIOR, ENGAGING IN WELLNESS BEHAVIORS HAS THIS FUTURE ORIENTATION TO IT, MAKING AN INVESTMENT FOR THE FUTURE, AND THERE'S THIS IDEA THAT DISADVANTAGE SORT OF FOSTERS MYOPIA FOR THE PRESENT. IT'S REALLY NOT ABOUT INVESTING IN THE FUTURE, IT'S ABOUT WHAT'S GOING ON TODAY, THIS WEEK, WHAT CAN I DO TO GET BY, SO I THINK THERE'S ALSO THAT ISSUE OF TRYING TO BASICALLY BROADEN THE PERSPECTIVE TO FOCUS ON FUTURE HORIZONS RATHER THAN ON PRET, WHICH WOULD BE SORT OF ANOTHER CONCEPTUAL ISSUE. >> IF I COULD INTERJECT THEN, HERE, I THINK THIS CAUSED ME TO THINK A BIT ABOUT THE SORT OF THE APPROPRIATE TIMING OF THESE INTERVENTIONS. SO I DON'T KNOW IF ANY OF YOU WERE AROUND SOME YEARS AGO WHEN MICHAEL MARMET GAVE A PRESENTATION HERE AT NIH WHERE I THINK HE SHOWED A VIDEO OF AN OLDER GENTLEMAN LIVING -- DISADVANTAGED AREA SOMEWHERE IN THE U.K., TALKING ABOUT LENGTHENING LIFE, SOMETHING LIKE WHY WOULD ANYBODY WANT TO LIVE ANOTHER YEAR IN THIS HELL HOLE, AND I WONDERED WHETHER UNIQUELY TARGETING INDIVIDUALS IN THIS ADOLESCENT PERIOD THAT GENE IS LOOKING AT OF POTENTIAL GREATER RECEPTIVITY TO VIEWING OPPORTUNITY DIFFERENTLY OR CONCEPTUALIZING THE OPPORTUNITIES THAT YOU MIGHT HOLD THAT SORT OF SUGGEST THAT THAT'S A MORE OPTIMAL TIME POINT FOR INTERVENTION OR WHAT MIGHT BE WAYS OF THINKING ABOUT THIS WHOLE QUESTION DEVELOPMENTALLY WHEN WE WANT TO BOTH AMELIORATE THE DISADVANTAGES THAT ARE -- PEOPLE ARE STILL LIVING IN WHEN THEY'RE LATER IN LIFE, AND WE TALKED ON THAT. >> -- PREVENTION SCIENCE LITERATURE, IT'S USUALLY BUILT ON THE NOTION THAT AN INOCULATION OF PREVENTION STRATEGY WILL CARRY FORWARD OVER TIME, EVEN THOUGH WE KNOW THAT THE RISK AND PROTECTIVE FACTORS CHANGE. IT'S NOT LIKE GETTING A VACCINE WHERE MAYBE ONE INOCULATION FOR POLIO OR TUBERCULOSIS CARRIES THROUGH THROUGHOUT LIFE, AND ONE OF THE THINGS WE KNOW FROM MANY REPORTS INCLUDING THOSE COMING OUT OF INSTITUTE OF MEDICINE, FOR PREVENTION PROGRAMMING TO BE EFFICACIOUS, THIS POINT OFTEN GETS LOST, IT HAS TO BE DEVELOPMENTALLY APPROPRIATE. AND SO AN INTERVENTION THAT A YOUTH MIGHT EXPERIENCE AT AGE 11 MAY NOT PROTECT THEM AT AGE 15 AS NEW PARTICULARLY RISK FACTORS EMERGE OR DURING YOUNG ADULTHOOD, WHEN ALL SORTS OF AUTONOMY ISSUES EMERGE. SO I THINK WE HAVE TO BE COGNIZANT OF THAT PROCESS. >> GOOD MORNING. THANK YOU SO MUCH TO ALL THOSE SPEAKERS FOR THE EXCELLENT PRESENTATIONS. I WAS REALLY INTRIGUED BY THE CONCEPT OF DIFFERENTIAL IMPACTS OF AREA LEVEL VERSUS INDIVIDUAL LEVEL DISADVANTAGE. AND I WANTED TO KNOW IF THE PANELISTS HAVE ANY THOUGHTS ABOUT -- OR CAN HELP EXPLAIN FURTHER WHY THIS MIGHT BE THE CASE AND HAVE ANY THOUGHTS ABOUT HOW THIS MIGHT IMPACT OUR APPROACH TO PREVENTION. >> THAT'S A GREAT QUESTION, AND IT'S SOMETHING THAT CAN BE VERY PERPLEXING, LIKE WHEN YOU SEE SOMETHING LIKE EDUCATIONAL -- A PERSON'S EDUCATIONAL ATTAINMENT RELATING TO SOME OF KIND OF NEURAL OUTCOME BUT NOTNESS SAIR LEA SOMNOT NECESSARILY SOME FEATURE OF THEIR ENVIRONMENT. SOME OF THAT COULD BE DUE TO EXPERIENCE BASED EFFECTS ON THE BRAIN, SO THERE'S THIS IDEA THAT GREATER EDUCATIONAL EXPERIENCES, ENRICHED ENVIRONMENTS AND SO FORTH, CAN BASICALLY AFFECT HOW THE BRAIN GETS ASSEMBLED IN WAYS THAT MIGHT, YOU KNOW, THAT WILL HAVE LASTING APPEARANCES IN BRAIN, SO GREATER EDUCATIONAL ATTAINMENT, GREATER EDUCATIONAL EXPERIENCE, SCHOOLING, CAN AFFECT BRAIN MORPHOLOGY IN A WAY THAT'S VERY DIFFERENT THAN LIVING IN A COMMUNITY THAT MAY HAVE THESE SORT OF ENERGY IMBALANCE EFFECTS THAT COULD AFFECT YOU LATER IN LIFE. SO IT MIGHT BE A LITTLE CLEARER WITH MORE SPECIFIC EXAMPLES LIKE THAT, BUT OFTENTIMES WE SEE DISCONNECTS BETWEEN MEASURES OF SUBJECTIVE SOCIAL STANDING LIKE YOU ASK SOMEBODY LIKE WHERE THEY THINK THEY STAND IN SOCIETY, THOSE HAVE VERY DIFFERENT SETS OF NEURAL CORRELATES THAN WHAT YOU SEE WITH OBJECTIVE MEASURES OF SES AT THE COMMUNITY AND NEIGHBORHOOD LEVELS. SO WHEN YOU SEE THOSE DISCONNECTS, YO I THINK THEY MIGHT HAVE IMPLICATION FOR INTERVENING PATHWAY, SO WHAT WE SAW, IF THERE'S A CLEAR CONNECTION BETWEEN THE NEIGHBORHOOD ENERGY IMBALANCE, CARDIOMETABOLIC RISK AND BRAIN OR NEURAL OUTCOME, THEN IT WOULD SUGGEST THAT TARGETING THE ENERGY AND BALANCE PATHWAY MIGHT BE MOST RELEVANT, WHEREAS FOR SOMETHING ELSE, IT MIGHT BE MORE OF AN EDUCATIONAL BASE OR PSYCHOSOCIAL BASE KIND OF INTERVENTION. >> I THINK ONE OF THE CHALLENGES OF DOING MULTILEVEL PROGRAMS IS IDENTIFYING THE SKILLS YOU WANT TO ENHANCE THAT MIGHT BE PROTECTIVE FACTORS. SO IF WE PUT OURSELVES IN THE PLACE OF A YOUTH WHO LIVES IN A DANGEROUS CONTEXT, THEY'RE GOING PROBABLY -- IT WOULD BE ADAPTIVE FOR THEM TO BE HYPERVIGILANT, AND WHEN YOUTH ARE HYPERVIGILANT, THEN THEY HAVE HIGHER LEVELS OF CORTISOL, EPINEPHRINE AND NOREPINEPHRINE SURGING THROUGH THEIR BODIES, AND IN SHORT BURSTS, THAT'S GOOD AND ADAPTIVE, BUT OVER TIME, AS PETE HAS WRITTEN ABOUT THAT CAUSES WEAR AND TEAR ON MULTIPLE BODY SYSTEMS, WHICH CAN BE EVIDENCED IN THE BRAIN AS WELL AS IN ORGANS IN THE BODY. SO I'M NOT SURE I HAVE AN ANSWER TO DR. CRUMP'S QUESTION, BUT WE ACTUALLY NEED BETTER RESEARCH ON PROTECTIVE PROCESSES THAT HELP YOUTH NAVIGATE DANGEROUS ENVIRONMENTS THAT CAN BE TRANSLATED INTO PREVENTION PROGRAMMING. >> SECOND QUESTION, PLEASE? >> HI. I'M CHLOE, MEDICAL SOCIOLOGIST, AND I REALLY ENJOYED ALL THREE OF THE PRESENTATIONS, BUT I'M LEFT WONDERING TO WHAT EXTENT HAD YOU HYPOTHESIZED AND FOUND SEX AND GENDER DIFFERENCES FOR EACH OF YOU? >> FOR THE STUDIES THAT WE'VE DONE ON THE BENEFITS OF POSITIVE EMOTIONS AND THE UPWARD SPIRAL THEORY, WE HAVEN'T SEEN GENDER DIFFERENCES IN THE PROCESS OF LIKE THE BROADENING EFFECTS OR THE BUILDING EFFECTS OF POSITIVE EMOTIONS, WHERE WE DO SEE GENDER DIFFERENCES ARE IN THE ACTIVITIES PEOPLE USE TO ELICIT POSITIVE EMOTIONS AND IN OUR MEDITATION STUDY SES, W S, WE SEE HUGE GENDER DIFFERENCES ?UT DI. SO WE HAVE A LOTTERY FOR WHITE WOMEN WHO WANT TO BE IN THE STUDY AND ANYBODY ELSE GETS IN JUST BY SHOWING THEIR INTEREST. SO IT'S MORE ON THE ACTIVITY SIDE WE SEE DIFFERENCES BUT NOT HOW POSITIVE EMOTIONS FUNCTION IN THE BRAIN AND IN THE BODY. >> IN OUR OWN WORK, WE HAVEN'T SEEN A MODERATING ROLE FOR GENDER IN SOME OF OUR -- IN SOME OF THE PATHWAYS THAT I'VE PRESENTED EARLIER SO WE TYPICALLY DON'T SEE A PATHWAY SPECIFIC FOR MEN BUT NOT WOMEN, THAT SORT OF THING. SO THERE'S REALLY NOT A LOT TO REPORT ON GENDER DIFFERENCES. >> CAN I FOLLOW UP ON ONE POINT ON THAT. IN OUR WORK IN LOOKING AT NEIGHBORHOOD VERSUS INDIVIDUAL LEVEL EFFECTS USING OBJECTIVE MEASURES, WE SAW CROWDING HAVING DIFFERENT IMPACTS, WHERE FOR MEN, THERE WERE NEGATIVE EFFECTS -- I'M SORRY, THERE WERE NOT NEGATIVE EFFECTS OF LIVING IN MORE CROWDED AREAS WHEREAS FOR WOMEN, WE WERE SEEING MORE NEGATIVE EFFECTS. I DON'T KNOW IF THAT'S BECAUSE OF THE PSYCHOSOCIAL PROCESSES, IF WOMEN TAKE -- IN TAKING -- TO MORE PEOPLE, THEY ABSORB MORE NEGATIVE THINGS OUT OF THEIR NETWORK, WHEREAS MEN GOING FROM LESS TO -- BEING IN LESS VERSUS MORE HIGHLY NETWORKED AREAS OR MORE CROWDED AREAS, GOT MORE OF THE BENEFITS WOMEN GOT FROM BIGGER NETWORKS. >> WHAT WE'RE DOG AT THE COMMUNITY LEVEL WORK, IT'S A VERY CRUDE -- WHAT WE'RE TRYING TO DO IS TAKE A MORE GRANULAR APPROACH, ASKING THE QUESTION WHAT IS DISADVANTAGE SORT OF A PROXY FOR? IS IT SOMETHING ABOUT THE BUILT ENVIRONMENT, IS IT POLLUTION EXPOSURE, IS IT SORT OF THE SAFETY METRICS, SO THAT'S WHERE WE'RE TRYING TO GO NOW, AND THOSE PROBABLY PLAY OUT DIFFERENTLY IN MEN, WOMEN, MIGHT PLAY OUT DIFFERENTLY WITH RACE AND ETHNICITY AS WELL. >> WE HAVE TWO MORE QUESTIONS AND PROBABLY JUST ENOUGH TIME FOR THOSE. >> HI. RACHEL FROM THE NATIONAL CANCER INSTITUTE. I REALLY APPRECIATE THESE TALKS AND I USED TO DO MORE OF THIS TYPE OF RESEARCH ABOUT FIVE OR SIX YEARS AGO WITH ADOLESCENTS. I HAVE A QUESTION IN FOLLOW-UP TO THE COMMENTS ABOUT INTERVENING EARLY WITH ADOLESCENTS AND MAYBE THE TIMING OF INTERVENTIONS TO DECREASE THE NEGATIVE EXPERIENCE OF NEIGHBORHOOD DYSFUNCTION, ET CETERA, AND INCREASING THE POSITIVE. WHEN I WAS DOING WORK WITH TEEN AND SMOKING SESSIZATION IN AN ALTERNATIVE HIGH SCHOOL SYSTEM WHERE THEY'VE ALREADY LEFT THE REGULAR HIGH SCHOOL SYSTEM FOR, FOR INSTANCE, LIKE DRUG INFRACTIONS OR TRUANCY AND THINGS, THEY WERE REALLY INDICATING TO ME THAT WHY SHOULD THEY HAVE A FUTURE ORIENTATION OR EVEN THINK ABOUT THINGS LIKE QUITTING SMOKING OR IMPROVING THEIR HEALTH BECAUSE THEY ARE SO THREATENED ON A DAY-TO-DAY BASIS BY THEIR ENVIRONMENT AND SEEING VIOLENCE AND OTHER THINGS, SO I'M JUST CURIOUS IF YOU LOOKED AT FUTURE ORIENTATION AS A VARIABLE OR A CONSTRUCT THAT'S IMPORTANT IN ANY OF YOUR MODELS AND ANY COMMENTS ON THAT AND HOW THAT INFLUENCES YOUR WORK. >> IT MAKES ADAPTIVE SENSE THAT IF YOU'RE LIVING IN A RESOURCE-POOR ENVIRONMENT AND THERE'S POOR EDUCATIONAL AND OCCUPATIONAL OPPORTUNITIES, LIVING IN THE MOMENT KIND OF MAKES SENSE. WE DID SOME WORK TRYING TO UNDERSTAND WHEN PEOPLE DELAY GRATIFICATION, WHEN DOES IT MAKE A DIFFERENCE. WHAT WE FIND IS, FOR THE POPULATIONS WE STUDY, IT DOESN'T MAKE A DIFFERENCE UNLESS PEOPLE'S BIOLOGY, THEIR LEVEL OF CIRCULATING STRESS HORMONES, NOT WHAT THEY TELL US BUT THEIR CIRCULATING STRESS HORMONES, ONLY THEN DID DELAY OF GRATIFICATION INTERACT WITH BIOLOGICAL STRESS TO FORECAST INCREASES IN DRUG USE. SO THOSE PEOPLE WHO ARE LIVING IN THE MOMENT, IN THEIR BIOLOGY, SAID TO US, YOU'RE STRESSED, THOSE WERE THE PEOPLE WHO INCREASED THEIR DRUG USE OVER TIME DRAMATICALLY. >> I'M CONRAD, BEHAVIORAL ECONOMIST. IT'S KIND OF INTERESTING, I THINK EACH OF YOU HAVE VERY INTERESTING IDEAS, YOU OBVIOUSLY WANT TO MAKE SOME CHANGES IN NOT JUST THE RESEARCH IDEAS YOU'RE PROMULGATING BUT ALSO IN SOCIAL CONTEXT IN OUR SOCIETY. WHAT ARE YOUR THOUGHTS ABOUT HOW TO MAKE THESE THINGS MORE WIDELY KNOWN? OBVIOUSLY WE HAVE PROBLEMS WITH OBESITY, CHRONIC DISEASE, FRACTURED HEALTH SYSTEM. HOW WOULD YOU LOOK TO TRY TO GET YOUR STUFF MORE WIDELY KNOWN AND WHERE WE ARE HEALTHIER, I GUESS YOU COULD PURT IT THAT WAY? HOW DO YOU GET THIS STUFF PROMULGATED IN OUR STOW SITE GENERALLY, DISSEMINATED IMPLEMENTATION, LET ME PUT IT THAT WAY. >> I THINK SOME OF THE REEF RESEARCH WE'RE DOING, AGAIN, SOME OF THE POSITIVE AFFECT PEOPLE EXPERIENCE DURING PHYSICAL ACTIVITY FOR ONE IS KREUSHLY IMPORTANT, AND THIS ISN'T A VERY EXPENSIVE INTERVENTION AS LONG AS PEOPLE RECOGNIZE HOW TO NOT JUST DECIDE ONE TIME WHAT THEY LIKE, BUT TO ACTUALLY PAY ATTENTION THROUGH MINDFUL AWARENESS, WHETHER THAT ACTIVITY DOES, IN FACT, INCREASE A FELT SENSE OF POSITIVITY AND THEN TO KNOW WHETHER IT EVER WEARS OUT. SO WE ALL HEAR PICK SOMETHING THAT YOU ENJOY, BUT SOMETIMES WE THINK THAT'S JUST AN ON/OFF SWITCH, ENJOY IT OR NOT ENJOY T BUT YOU REALLY NEED TO LOOK AT IT IN A MORE SUBTLE WAY, SO THERE'S WAYS OF TAKING THAT THROUGH PSYCHOEDUCATION, THROUGH GAMES, THROUGH APPS, THROUGH BOOKS,, SO IT'S NOT AN EXPENSIVE IDEA TO BRING OUT TO PEOPLE, BUT TO REALLY GET PEOPLE TO KNOW WHERE TO LOOK. IF THIS DOESN'T ROUSE THAT POSITIVE AFFECT FEELING, THEN I MAY AS WELL QUIT NOW, BECAUSE I'M GOING TO QUIT EVENTUALLY, THAT POSITIVE HEALTH BEHAVIOR. >> WITH FUNDING FROM NIDA FOR OUR CENTER FOR TRANSLATION, WE HAVE AN ACTIVE OUTREACH PROGRAM, SO WE TRY TO BUNDLE THESE RESULTS AND WE'LL DO PRESS RELEASE, WE HAVE A WEBSITE THAT TURNS OUT TO GET LOTS OF HITS FROM THE COMMUNITY, WITH PREVENTION PROGRAMS THAT I BRIEFLY TALKED ABOUT IN THE TALK, WE ARE DISSEMINATING DISSEMINATE ACROSS THE NATION SO WE'RE LOOKING FOR OTHER WAYS TO GET THE WORD OUT BECAUSE PEOPLE ARE REALLY INTERESTED. >> I GUESS I HAVE MIXED REACTIONS. PART OF ME FEELS LIKE THE WORK THAT I'M DOING, AT LEAST, MIGHT NOT BE READY FOR PRIME TIME. IT JUST -- EVEN GETTING THE WORK INTO JOURNAL, YOU KNOW, IS A DIFFICULT THING BECAUSE WHEN YOU START TALKING ABOUT DISADVANTAGE IN THE BRAIN, YOU KNOW, EVERYBODY'S GOT AN OPINION ABOUT WHAT EXPLAINS WHAT YOU'RE LOOKING AT. SO YOU KNOW, IT'S SORT OF BEEN AN UPHILL BATTLE TO GET A LOT OF THIS STUFF EVEN IN JOURNAL, SO CHANGING SCIENTIFIC OPINION AND MAKING SURE THAT WE SORT OF UNDERSTAND WHAT THE PATHWAYS ARE THAT MIGHT CONNECT DISADVANTAGE TO BRAIN, I THINK IS AN IMPORTANT FIRST STEP FOR THE DISSEMINATION STEP. I MIGHT BE A LITTLE MORE CONSERVATIVE THAN OTHERS. >> I THINK THAT NICELY REFLECTS THE WORK THAT EACH OF YOU IS DOING ON THIS SORT OF DEVELOPMENTAL TRA JEK TREE FROM THE BASIEXTRA JEK TREE TO THE TRANSLATIONAL. I WANT TO THANK ALL THREE OF YOU FOR FABULOUS TALKS AND THE AUDIENCE FOR YOUR PARTICIPATION. IT'S BEEN A REALLY RICH MORNING SESSION, LOOK FORWARD TO MORE RICH DISCUSSION THROUGHOUT THE DAY. THANKS AGAIN. [APPLAUSE] >> THANK YOU, EVERYBODY. I REALLY APPRECIATE THESE SPEAKERS. IT WAS A GREAT COHESIVE TALK WHICH I WASN'T EXPECTING BECAUSE YOU ALL CAME FROM SUCH DIVERSE FEELTDZ, BUT IT WAS REALLY EXCITING. I'M KATHRYN MORRIS FROM THE OFFICE OF BEHAVIORAL SOCIAL SCIENCES RESEARCH HERE AT NIH AND YOU'VE GOTTEN A LOT OF EMAILS INTEREST ME REGARDING THIS EVENT, SO THANKS THANKS SO MUCH FOR NOT PUTTING THEM IN YOUR SPAM FILTER. I'M ALSO THE EXECUTIVE SECRETARY OF OUR BEHAVIORAL AND SOCIAL SCIENCES RESEARCH COORDINATING COMMITTEE, WHICH IS OUR COHOST IN THIS EVENT. JUST WANTED TO LET YOU KNOW THAT UP NEXT IS OUR BREAK AND THAT'S A LITTLE FUNGIBLE, SO IF YOU COULD REJOIN US AT NOON -- SORRY -- AT 11. SO FROM 11:00 TO NOON, WE'RE GOING TO DO TWO TOWN HALL SESSION AND YOU'LL SEE IN YOUR AGENDA THERE'S TWO DIFFERENT TRACTS. ONE IS FOCUSING ON HOW OUR OFFICE AND OUR COMMUNITY CAN HELP SUPPORT NIH AND FEDERAL EMPLOYEES. THOSE OF WHO YOU ARE FEDERAL EMPLOYEES, IF YOU COULD JOIN US BACK HERE IN THE AUDITORIUM FROM 11:00 TO 12:00 FOR A RICH DISCUSSION THAT'S GOING TO BE SPEARHEADED BY A RECENT ADDITION TO OUR OFFICE BUT A GREAT COLLEAGUE HERE AT NIH THAT'S GOING TO BE DR. LISBETH, AND THOSE OF WHOW ARE PART OF OUR RESEARCH COMMUNITY OR PRIVATE CITIZENS, UPSTAIRS WHERE YOU WALKED IN, THERE ARE SEVEN TABLES NEXT TO OUR POSTER PRESENTATION. WE'D LOVE TO TALK TO YOU IN THE TOWN HALL FORUM ABOUT HOW WE CAN HELP SERVE THE COMMUNITY, WHAT YOUR EXCITING IDEAS ARE OR QUESTIONS OR CONCERN, BE HAPPY TO TALK TO YOU UP THERE, THAT'S LED BY OUR ASSOCIATE DIRECTOR WENDY METZ. THERE'S ALSO A FEW POSTERS UPSTAIRS WHICH WILL BE HEADED BY OUR PROGRAM STAFF AT DIFFERENT INSTITUTES AND CENTERS HERE AT NIH WHO ARE SO EXCITED TO SHOW YOU THE WORK THEY'VE BEEN DOING. PLEASE FEEL FREE TO GO THROUGH THOSE FROM THE LUNCH BREAK, WHICH IS FROM NOON TO 1:15. AND ALSO JUST OUTSIDE THESE DOORS, OUR PARTNER OFFICE, THE OFFICE OF AIDS RESEARCH, HAS GREAT MATERIALS TOO ON THE WORK THEY'VE BEEN DOING IN BEHAVIORAL HEALTH RESEARCH. SO JOIN US FOR THE TOWN HALLS UNTIL NOON, 12 TO 1:15 IS YOUR LUNCH WHICH YOU CAN -- UP HERE THERE'S A GREAT CAFETERIA, YOU'RE ON YOUR OWN FOR THAT, AND ALSO PLEASE VISIT THE PROGRAM POSTERS. SO SEE YOU BACK HERE AT 1:15. THANKS. THIS IS OUR TOWN HALL MEETING SESSION. MY NAME IS LIZ, AND I'M THE NEWEST -- WELL, MAYBE NOT THE NEWEST BUT ONE OF THE NEWEST STAFF MEMBERS AT OBSSR NOW. I'VE BEEN WITH THE NIH FOR ABOUT 13 YEARS AS THE HEALTH SCIENCE ADMINISTRATOR FIRST AT NIADA IN THE PREVENTION RESEARCH BRANCH THERE FOR ABOUT SEVEN YEARS. THEN I SPENT SIX YEARS AT THE TOBACCO CONTROL RESEARCH BRANCH AT NCI. AND JUST JOINED OBSSR. SUPER EXCITED ABOUT THE NEW STRATEGIC PLAN. THE GOAL OF THIS TOWN HALL REALLY IS TO HAVE A DIALOGUE WITH YOU, SO I'M NOT GOING TO STAND UP HERE AT THE PODIUM, I JUST WANTED TO DO THAT TO GET YOUR ATTENTION, I'M GOING TO COME DOWN THERE AND WE'LL TALK, BUT THE FIRST THING I'D LIKE TO DO WITH THE MIC, SO THAT YOU CAN ALL HEAR, IS THIS SESSION IS FOR FEDS ONLY. IF YOU ARE NOT A FEDERAL EMPLOYEE, PARTICULARLY AT THE NIH, WE NEED TO ASK YOU TO EXIT. THE REASON FOR THAT IS, WE'RE GOING TO BE TALKING ABOUT SORT OF OUR INNER WORKINGS AND ALL THE THINGS THAT WE DO IN PROGRAM, IN EXTRAMURAL, IN INTRAMURAL, IN REVIEW, THINGS THAT ARE NOT -- MAY COME UP THAT YOU ALL BRING UP THAT MAYBE THE PUBLIC SHOULDN'T KNOW ABOUT. MAYBE YOU'RE GOING TO TELL US ABOUT NFOA IDEA THAT YOU HAVE COOKING THAT'S NOT ON THE STREET YET AND SO JUST TO MAKE IT SO THAT YOU CAN TALK ABOUT ANYTHING, WE'RE ASKING IF YOU'RE NOT A FED, TO JUST STEP OUT AND GO TO THE OTHER SESSION, WHICH IS GOING TO BE JUST AS LIVELY, I PROMISE, AND THAT'S GOING TO BE TALKING ABOUT THE RESEARCH COMMUNITY AND THAT'S OUTSIDE. >> HELLO, EVERYONE. I THINK PEOPLE ARE COMING BACK IN FROM LUNCH. HOPEFULLY YOU HAD A NICE DISCUSSION. I HEAR FROM THE GROUPS THAT THEY GOT A LOT OF GOOD FEEDBACK FROM PEOPLE ABOUT THINGS THAT THE OFFICE CAN DO MOVING FORWARD TO HELP SUPPORT BEHAVIORAL AND SOCIAL SCIENCE RESEARCH, BOTH WITHIN NIH AND ALSO OUTSIDE. SO THAT WAS GREAT TO HEAR. THE POSTERS, BY THE WAY, I THOUGHT WERE REALLY NICE. IT'S A NICE OPPORTUNITY FOR, YOU KNOW, IT'S AMAZING YOU THINK, WELL, THE KNOWS WHAT THEY ARE DOING, INTERNALLY, NOT NECESSARILY ESPECIALLY AMONG EACH OTHER. MAYBE NOT IN GENERAL EITHER, BUT CERTAINLY NOT AMONG EACH OTHER. IT'S REALLY HELPFUL TO HAVE THE INSTITUTE SORT OF PRESENT SOME THINGS THEY ARE WORKING ON AND SOME THINGS THEY ARE DOING SO WE CAN KIND OF LEARN FROM EACH OTHER ABOUT THE WORK THAT'S GOING ON. I DO WANT TO MAKE ONE QUICK ANNOUNCEMENT BEFORE I INTRODUCE RICK. IF YOU REMEMBER FROM YOUR DAYS OF PUTTING IN YOUR DISSERTATION, WANTING TO SEE IF YOUR COMMITTEE ACTUALLY READ IT AND TAKE THE $20 BILL TO PAGE 73 ON YOU PUT IN A BLANK PAGE, IF YOU READ THIS FAR, TELL ME, JUST AS A TEST, SO THE TEST TODAY DURING MY PRESENTATION WAS HOW MANY PEOPLE WOULD NOTICE THAT WE SKIPPED EVERY OTHER I.C. IN THE IDENTIFICATION? A LOT OF PEOPLE DID. SO VERY GOOD. APPARENTLY A LOT OF PEOPLE DID BECAUSE I HEARD FROM MANY PEOPLE ABOUT MY I.C. WASN'T ON YOUR SLIDE ABOUT THE FUNDING BY I.C. AND BEHAVIORAL AND SOCIAL SCIENCE RESEARCH. IN ACTUALITY, WHEN WE MOVED IT FROM BEING COLUMNS TO BEING ROWS, IT AUTOMATICALLY TOOK OUT EVERY OTHER, SO THAT I.C. WAS IN THERE, IT JUST DIDN'T HAVE A LABEL BECAUSE IT TOOK OUT EVERY OTHER ONE IN THERE. WHAT WE'LL DO, ALL OF YOU, SO YOU KNOW WHO YOU ARE, AND HOW MUCH MONEY YOU'VE SPENT IN BEHAVIORAL AND SOCIAL SCIENCE RESEARCH, WE'LL UPDATE THE SLIDES AND MAKE THEM AVAILABLE TO EVERYONE SO YOU HAVE THAT. AND THAT WILL BE UP ON THE WEBSITE PROBABLY IF NOT BY END OF TODAY, CERTAINLY BY MONDAY. SO THANK YOU. SO, WITH THAT, MY PLEASURE TO INTRODUCE THE MODERATOR FOR THE NEXT SESSION, RICK MOSER AND I HAVE WORKED TOGETHER FOR MANY YEARS. GOOD FRIEND, GOOD COLLEAGUE, WORKING PARTICULARLY IN THE SCIENCE RESEARCH AND TECHNOLOGY BRANCH AT NCI WHEN WE WERE THERE TOGETHER, SO RICK I THINK IS A REALLY GOOD PERSON TO FOCUS ON THINGS RELATED TO METHODOLOGY AND MEASUREMENT AND DATA INFRASTRUCTURE SO I'LL TURN THIS NOW OVER TO RICK. >> THANKS. GOOD AFTERNOON, EVERYONE. HOPEFULLY NOT EVERYBODY IS IN THEIR POST-LUNCH COMA AND HOPEFULLY WE'LL HAVE A STIMULATING AND INTERESTING SESSION TODAY TO KEEP YOU AWAKE. I GUESS I DO WANT TO KIND OF ACKNOWLEDGE AND APPLAUD BILL RILEY AND HIS STAFF FOR PUTTING TOGETHER SUCH A WONDERFUL SETTING LECTURES AND SEMINARS. THIS MARKS AN IMPORTANT EVENT IN THE SENSE, YEAH, WE WANT TO MAKE SURE BEHAVIORAL AND SOCIAL SCIENCE RESEARCH IS ON THE MAP SO I APPLAUD THEIR EFFORTS. I'M A PSYCHOLOGIST BY TRAINING IN THE BEHAVIORAL RESEARCH PROGRAM, HOPEFULLY THAT GIVES ME STREET CRED TO BE UP HERE. I'M EXCITED ABOUT THIS PANEL IN PARTICULAR BECAUSE I THINK IT'S SO KIND OF KEY TO THINK ABOUT HOW WE WANT TO KIND OF ADVANCE SCIENCE. SO AS I'M PROBABLY SPEAKING TO THE CHOIR IN MANY WAYS, THIS IDEA WE REALLY WANT TO ACCELERATE SCIENTIFIC DISCOVERY, SOMETHING WE THINK ABOUT AT THE NATIONAL CANCER INSTITUTE A LOT. YOU'RE FAMILIAR WITH THE CANCER MOONSHOT THAT INITIATIVE THAT WAS ANNOUNCEDDED BY PRESIDENT OBAMA BACK IN JANUARY, AND, AGAIN, THE WHOLE IDEA IS TO ACCELERATE SCIENCE ESPECIALLY IN CANCER RESEARCH, TAKE TEN YEARS OF RESEARCH AND CONDENSE IT INTO FIVE YEARS, A LOFTY BUT GREAT GOAL. THEY HAVE IDENTIFIED WHERE ARE THE PROBLEMS, HOW CAN WE ACCELERATE SCIENCE? THEY TALKED ABOUT DATA SHARING. THAT'S OBVIOUSLY VERY KEY ESPECIALLY FOR THOSE WHO ATTENDED THE OPEN DATA SCIENCE SYMPOSIUM YESTERDAY, THAT'S WHAT THE IDEA WAS ABOUT. BESIDES DATA SHARING THERE'S OTHER ISSUES THAT NEED TO BE ADDRESSED. ONE OF THEM IS THE IDEA OF ONTOLOGY DEVELOPMENT, BILL RILEY TALKED ABOUT THAT TODAY, PART OF THEIR STRATEGIC PLAN TO WORK ON CREATING A BEHAVIORAL ONTOLOGY. BESIDES THAT ALSO IT'S VERY IMPORTANT WE HAVE KIND OF BETTER METHODS, IN OTHER WORDS HOW DO WE GATHER DATA, WHAT ARE OUR RESEARCH METHODS, YOU HEAR ABOUT OPTIMIZE INTERVENTIONS, THOSE TYPES OF THINGS, JUST-IN-TIME INTERVENTION, PUSHING THE FIELD THAT WAY AGAIN TO ACCELERATE SCIENCE, AND BETTER MEASURES. I'M SEEING THINGS MORE ACCURATE, MORE PRECISE, LESS BURDENSOME, AND IT'S A GOOD WAY TO WHET YOUR APPETITE ABOUT THINGS WE'LL BE SEEING TODAY. THE LAST THING I'LL TELL YOU ABOUT MEASURES IS THAT THE IDEA OF WE NEED TO REUSE COMMON MEASURES, THE IDEA OF CREATING, SHARING MEASURES, NOT CREATING NEW ONES WHEN NOT NECESSARY TO CREATE HARMONIZED DATA, EASILY MERGED TOGETHER TO DO INTERESTING THINGS LIKE INTEGRATIVE DATA ANALYSIS, ANOTHER LITTLE -- TO WHET YOUR APPETITE, TO ACCELERATE SCIENCE ULTIMATELY AND ALLOW FASTER DISCOVERIES. THE OTHER THINGS I WANT TO MENTION, THE NIH CREATED OR SUPPORTS TOOLS AND RESOURCES TO HELP WITH THESE THINGS, CREATING AND SHARING BETTER MEASURES, CREATING BETTER METHODS. I WANT TO MENTION A COUPLE THINGS YOU'RE FAMILIAR WITH. IF YOU'RE NOT I'D BE HAPPY TO LET YOU KNOW ABOUT, MAYBE COME SEE ME AFTERWARDS. THERE'S LIKE THINKING ABOUT MEASUREMENT AND USE COMMON MEASURES, AND CREATING MORE PRECISE MEASURES, THE PROMISE INITIATIVE, PATIENT-REPORTED OUTCOME, MEASUREMENT INFORMATION SYSTEM, AGAIN TRYING TO CREATE ACCURATE PRECISE AND LESS B URDENSOME WAYS OF MEASURING THINGS, OTHER ISSUES TO CREATE OR OFFER SUGGESTED MEASURES THAT OTHER PEOPLE CAN USE SO YOU DON'T HAVE TO CREATE YOUR OWN, LIKE THE NIH TOOLBOX, THE GEM INITIATIVE THAT I RETURN, CREATE CONSENSUS AND COMMON MEASURES, WE'RE USED TO COMMON METHODS. THE LAST THING IS CREATED BY THE NATIONAL LIBRARY OF MEDICINE, THEY HAVE THIS CDE PORTAL, COMMON DATA ELEMENT PORTAL AGAIN WHICH IS A NICE REPOSITORY, YOU CAN SEE, GET INFORMATION ABOUT THESE INITIATIVES THAT I WAS TALKING ABOUT, PROMIS, TOOLBOX, AND OTHER WAYS OF FINDING MEASUREMENTS USEFUL FOR YOUR RESEARCH. YOU DON'T HAVE TO RECREATE THE WHEEL AGAIN. ONE LAST THING BEFORE I EXIT THE STAGE HERE TO TALK ABOUT FOAs, I KNOW BILL RILEY THIS MORNING MENTIONED SOME BUT I WANT TO REITERATE FOR THOSE NOT SET, WHO MIGHT INTERESTED IN FUNDING THIS TYPE OF WORK THAT MAYBE YOU'RE SEEING TODAY, SO THERE'S THE METHODOLOGY AND ISSUE MA. MEASUREMENT IN THE BEHAVIORAL AND SOCIAL SCIENCE, FOA AND RO1, CANCER-RELATED THROUGH INTEGRATING EXISTING DATA, AGAIN I KNOW I HOPE YOU MAY BE TRYING TO SCRAMBLE WRITING THIS DOWN BUT SEE ME AFTERWARDS IF I WOULD POINT YOU IN THE RIGHT DIRECTION AND DO A GOOGLE SEARCH. THOSE WILL SUPPORT IN SOME WAYS THE COOL CUTTING-EDGE RESEARCH YOU'LL SEE IN JUST A SECOND. OKAY. SO YOU DIDN'T COME TO HEAR ME SPEAK. I WANT TO GET OFF THE STAGE. AGAIN WE'LL HAVE THREE PANELISTS, EACH WILL GO FOR 20 MINUTES, AND WE'LL HAVE AT LEAST 15 MINUTES OR SO FOR Q&A, FOR QUESTIONS AND ANSWERS. AGAIN, WE'VE GOT A NICE RANGE OF THINGS TO BE PRESENTED TODAY. ALL RIGHT. OUR FIRST SPEAKER IS EY MOON, AN ASSOCIATE PROFESSOR AT THE CENTER FOR ALCOHOL STUDIES AND DEPARTMENT OF CLINICAL PSYCHOLOGY, THE GRADUATE SCHOOL AT RUTGERS, JOINED THE CENTER FOR ALCOHOL STUDIES AT RUTGERS IN 2006, AFTER FOUR YEARS ON THE FACULTY OF THE UNIVERSITY OF ALABAMA AT BIRMINGHAM, HOLDS A JOINT APPOINTMENT AT THE DEPARTMENT OF CLINICAL PSYCHOLOGY, GRADUATE FACULTY MEMBER IN THE DEPARTMENT OF PSYCHOLOGY AND STATISTICS SCHOOL OF ARTS AND SCIENCES, FOCUSED ON INTERVENTIONS FOR COLLEGE STUDENTS IN A LARGE SCALE RESEARCH SYNTHESIS USING DATA FROM 24 STUDIES, I THINK IT'S GOING TO BE A GREAT PRESENTATION. SO E.Y., YOU ARE UP. >> THANK YOU. I GO BY THE NAME OF E.Y. MOON FROM THE CENTER FOR INTEGRATIVE STUDIES. THANK YOU FOR THE LOT OFLY INTRODUCTION. IF YOU THINK EVERYBODY IN THE FUTURE HAS TO USE THE SAME SET OF MEASURES, RESEARCH SHOWS IT'S NOT NECESSARY TO HAVE THE EXACT SAME MEASURES AS LONG AS DATA CAN BE LINKED, WE CAN UTILIZE SLIGHTLY DIFFERENT MEASURES USED ACROSS DIFFERENT STUDIES, THAT WAY WE WITH MAXIMIZE DATA IN A MOST EFFICIENT WAY. I'LL BRIEFLY EXPLAIN MY BACKGROUND. I HAVE DIRECTED PROJECT INTEGRATE FOR THE PAST SIX YEARS, AND THAT STUDY COMBINES INDIVIDUAL PARTICIPANT DATA FROM 24 INDEPENDENT CLINICAL TRIALS ON COLLEGE STUDENTS, ALCOHOL USE AND RELATED HARMS. WE FOCUSED ON BRIEF MOTIVATIONAL INTERVENTIONS BECAUSE BRIEF MOTIVATIONAL INTERVENTIONS ARE PROVEN TO BE EFFICACIOUS FOR COLLEGE STUDENTS, EFFECT SIZE TENDS TO BE A LITTLE BIT SMALL, BY COMBINING DATA TOGETHER WE MAXIMIZE THE SAMPLE SIZE AND POWER AND WE ALSO STRETCH THE RANGE OF OBSERVATION SO THAT WE CAN PROVIDE A BETTER OVERALL EFFICACY ESTIMATE AS WELL AS THE MECHANISMS CHANGED BY TAKING ADVANTAGE OF THE LARGE SCALE DATA. THE BRIEF MOTIVATIONAL INTERVENTION FIELD HAS A DECENT SIZE EVIDENCE BASE. FOR EXAMPLE, THE LATEST META ANALYSIS REVIEWED BY MY COLLEAGUES SHOWS OVER 300 TRIALS, 185 INDEPENDENT SAMPLES, CURRENTLY FACED WITH NUMEROUS INCONSISTENCIES AND LACK OF CRITICAL INFORMATION ACROSS TRIALS AS WELL AS BETWEEN REVIEWS. AND I WANT TO PROVIDE SOME METHODOLOGICAL SOLUTIONS SO THAT WE CAN MAXIMALLY USE THE DATA FOR THE ANSWER THAT WE NEED SO WE CAN DEVELOP MORE INDIVIDUALIZED TREATMENT DECISIONS FOR THE COLLEGE STUDENTS AND YOUNG ADULTS. SO THE TALK OUTLINE, THE REASON WHY I PUT CLINICAL TRIALS AND META-ANALYSIS REVIEWS TOGETHER IS BECAUSE THEY ARE INTRICATELY CONNECTED AND MY RESEARCH CAN LOWER THE BARRIERS FOR BOTH TYPES OF RESEARCH, AND I ALSO WANT TO DISCUSS SOMETHING ABOUT AN INTERVIEW IN 2014, 15 AND 16 AND DISCUSS MY PROJECTS SO HOW PLAN TO TACKLE THIS PROBLEM AND HAVE CONCLUDING REMARKS. OKAY. YOU PROBABLY KNOW THESE TWO ICONIC ARTICLES, CHALLENGED US TO SHOW OUR STANDARDS FOR CLINICAL TRIALS AND MORE BROADLY CLINICAL RESEARCH. OTHER PROBLEMS FLOODED IN, THE RESPONSE HAS BEEN A NUMBER OF CHANGES. FOR EXAMPLE, IN A RECENT ARTICLE IN JAMA, PUBLISHED IN JAMA, NIH IDENTIFIED SEVERAL CHALLENGES THAT EXIST IN CLINICAL TRIALS, MANY TIMES CLINICAL TRIALS TEND TO BE OVERLY COMPLEX AND HAVE A SMALL SAMPLE SIZE, AND USE OF SURROGATE CLINICAL END POINTS WITH DUBIOUS CLINICAL RELEVANCE AND MOST IMPORTANTLY MANY OF THE TRIALS DO NOT PUBLISH THE STUDIES. FOR EXAMPLE, ABOUT A THIRD OF CLINICAL TRIALS REGISTERED AT clinicaltrials.gov DO NOT PUBLISH DATA AFTER FOUR YEARS OF THEIR STUDY COMPLETION CURRENTLY, AND ALSO WITH EACH TESTING YEAR THAT THE DISCOVERABILITY OF DATA DIMINISHED 17% WITH EACH PASSING YEAR, SO THIS IS A SERIOUS CONCERN AND THEY PROPOSE, WE DISCUSSED THIS IN OUR I GUESS BREAKOUT SESSION, THEY ARE PROPOSING A NUMBER OF CHANGES SO THEY CAN PROVIDE A BETTER STEWARDSHIP OVER CLINICAL TRIALS THROUGHOUT THE ENTIRE LIFESPAN, AND APPARENTLY NIH OVERSEES OVER $3 BILLION EACH YEAR SO THAT THEY WANT TO MINIMIZE WASTING RESOURCE AND WANT TO PROMOTE TRIALS THAT ARE MOST LIKELY TO GENERATE PROMISING RESULTS. HOWEVER, I WANT TO SAY THE LIFESPAN OF A CLINICAL TRIAL HAS BEEN ALREADY EXTENDED. IT DOESN'T END WHEN TRIAL ENDED. AGGREGATE DATA OR PUBLISHED CONCLUSIONS I REVIEWED INCLUDED IN SYSTEMATIC DEBUTS AND META-ANALYSIS, IN FACT A RECENT ARM IN 2016 ESTIMATES FOR EVERY ONE NEW EMPIRICAL ARTICLE THERE'S TEN SUBSEQUENT SECONDARY ARTICLES ASSOCIATED WITH THAT ORIGINAL ARTICLE. TRIAL DATA INCREASINGLY COMBINED TO PROVIDE OVERALL INFORMATION AS WELL AS EXAMINING NEW HYPOTHESIS, THEREFORE TO SEE THE ENTIRE FIELD MORE BROADLY BEFORE ANY TRIAL CAN BE PLANNED AND PROVIDE SOME SUPPORT WHEN TRIALS ARE BEING CONDUCTED, SO MY RESEARCH IS AIMED AT PROVIDING SOME OF THE NEW SOLUTIONS SO THAT WE CAN FULLY MAXIMIZE THE AVAILABLE DATA IN WAYS THAT WE COULD NOT DO IT BEFORE, USING INDIVIDUAL CLINICAL TRIALS OR TYPICAL STANDARD META-ANALYSIS. SO TOWARD THAT END WE NEED A MORE METHODOLOGICAL AND TECHNICAL INNOVATION AND PROVIDE END-USER APPLICATIONS AND SUPPORT FOR INNOVATIVE APPROACHES AT THE UPSTREAM OF LESSER DEVELOPMENT. SO CONCERNS. I QUESTIONS BEFORE WE TALK ABOUT CONCERNS BRIEFLY I'LL EXPLAIN THE META ANALYSIS. THE FIRST KNOWN USE OF META-ANALYSIS WAS DONE IN 1904 BY KARL PEARSON WHEN HE REQUESTED EFFECTIVE NESS OF A VACCINATION AGAINST MALARIA FOR SOLDIERS ABROAD, TUSHED -- TURNED OUT TO BE EFFECTIVE BUT IT WASN'T UNTIL 1986 THE TERM META-ANALYSIS WAS COINED BY JIM GLASS, AND ANOTHER LANDMARK EVENT IN 1993, COLLABORATION WAS FORMED TO INTEGRATE AVAILABLE EVIDENCE TO PROVIDE THE BEST EVIDENCE THUS FAR SO THAT WE CAN DECIDE BEST COURSE OF TREATMENT ACTION. IN THEORY IT PROVIDES ESTIMATE OVERALL, CONSISTENCY IN WAYS INDIVIDUAL CLINICAL TRIALS CANNOT PROVIDE, AND IN RECENT PUBLIC CRISIS, THE CONFIDENCE OF OUR CLINICAL TRIALS, IT HAS BEEN TOUTED AS A NEW KIND OF METHOD THAT CAN OVERCOME OUR DUPLICATION CRISIS. HOWEVER, A RECENT ARTICLE IOANNIDIS SHOWS META-ANALYSIS AND SYSTEMATIC REVIEWS EXPLODED IN THE LAST 30 YEARS, THE BLUE LINE IS META-ANALYSIS, DURING THE PAST 30 YEARS, AND HE SUGGESTS THAT THERE HAS BEEN OVER 2000% INCREASE IN EITHER SYSTEMATIC OR META-ANALYSIS REVIEW IN THE PAST 30 YEARS AND SOME NEGATIVE CONSEQUENCES ARE HAVING SO MANY META-ANALYSIS IS THAT THEY PRODUCE REDUNDANT OR UNHELPFUL REVIEWS. FOR EXAMPLE IN THE CASE OF ANTI-DEPRESSANTS, HE IDENTIFIED 184 META-ANALYSIS REVIEWS IN THE PAST SEVEN YEARS FROM 2007 AND 2014 ONLY. AND MANY OF THE REVIEW ARTICLE AUTHORS OF THESE REVIEWS HAVE SOME TIES WITH THE PHARMACEUTICAL INDUSTRY, IN U.S. 10% OUT OF THE POPULATION ARE ON ANTI-DEPRESSANTS, AND THESE CAST OUT ON THE CONCLUSION VALIDITY PRODUCED IN THIS TIME PERIOD. LIKEWISE, I GUESS THIS IS ANOTHER EXAMPLE FIGURE THAT SHOWS THE POPULARITY OF META-ANALYSIS, THE BOTTOM DOTTED LINE INDICATES STRUCTURE EQUATION MODELING, IT'S A VERY POPULAR METHOD, BUT IT PALES IN COMPARISON WHEN IT COMES TO META-ANALYSIS PUBLICATIONS. LIKEWISE, COCHRANE REVIEWS HAVE SEEN EXPONENTIAL GROWTH, SO IN 2015, END OF 2015 THERE WERE ALMOST 10,000 REVIEW PROTOCOLS AND MANY OF THEM ARE MORE THAN ONE REVIEWS ON THE SAME TOPIC, THE MEDIAN WAS TWO SO AT LEAST TWO PROTOCOLS FOR ONE SAME TOPIC, AND END RESULT IS THAT REVIEW SAYS SOMETHING DIFFERENT ABOUT THE EVIDENCE, BEST AVAILABLE EVIDENCE. SO META-ANALYSIS, SOME OF THE CRITICISMS AND ARGUMENT AGAINST THE TWO, GARBAGE IN AND GARBAGE OUT OR MIXING APPLES AND ORANGES, THIS CAN BE ADDRESSED SOMETIMES USING APPROPRIATE METHOD AND ALSO SOME OF IT LIKE PUBLICATION BIAS AND SELECTIVE REPORTING BIAS, IT IS A COMMON PROBLEM FOR BOTH CLINICAL TRIALS AND META-ANALYSIS. SO I WANT TO GIVE AN EXAMPLE OF FOXCROFT ET AL., WHEN IT CAME OUT IN 2014 THIS WAS QUITE WELL COVERED BY THE MEDIA OUTLETS, AND THESE TYPE OF CONCLUSION WAS CIRCULATED QUITE WIDELY LIKE THIS. SO, WHEN I READ THAT CONCLUSIONS AND THE WAY THE ARTICLE WAS CITED, I DECIDED TO TAKE A LOOK AT THE ACTUAL DATA, AND DIDN'T REALIZE ACROSS ALL STAGES OF META-ANALYSIS THERE WERE WEAKNESSES, SOME SERIOUS DATA CODING AREAS LIKE FLIPPING DATA WITH CONTROL WITH DATA WITH INTERVENTION, SOME INVOLVED FLAWS IN DESIGN IN IMPLEMENTATION OF METHOD, IN DIGS SUBSECTIV THAT I DID NOT AGREE. I DECIDED TO COMMUNICATE OBVIOUS FLAWS. AS A RESULT WE PUBLISHED THIS PAPER CRITICIZING THE FOXCROFT ET AL. REVIEW PAPER FROM START TO FINISH, AND THEN WE DIRECTLY COMMUNICATED WITH COCHRANE EDITORS AND AS A RESULT IT WAS WITHDRAWN LAST YEAR. BUT AFTERWARDS THOUGH THEY CAME OUT AND PRODUCED TWO MORE REVIEWS. BUT THE RESEARCH CONCLUSIONS ARE THE SAME. IT SAYS M.I. HAS NO SUBSTANTIVE MEANINGFUL BENEFITS, M.I. PART IS INTERCHANGEABLE, BUT METHOD HAS NO SUBSTANTIVE MEANINGFUL BENEFITS AND THE POOR QUALITY OF EVIDENCE CAN FURTHER ATTENUATE INTERVENTION EFFECTS THEY FOUND. SO WHAT DO YOU THINK WHEN YOU LOOK AT THIS? DOES IT COME ACROSS TO YOU AT FOUR MONTHS AFTER INTERVENTION THERE WERE FOUR STATISTICALLY SIGNIFICANT, OR 6 OUT OF 8 AT 3 MONTHS OR LESS, AND MOST OF THE EFFECT ACHIEVED 10% DIFFERENCE BETWEEN TREATMENT AND CONTROL, AND MANY TIMES IT'S ACTUALLY BETWEEN TWO DIFFERENT INTERVENTIONS. SO WHEN WE LOOK AT THIS DATA MORE CLOSELY, WE REALIZE THERE HAVE BEEN ON AVERAGE 3.7 DIFFERENCE BETWEEN TREATMENT AND CONTROL WITHIN FOUR MONTHS AND ABOUT 1.5 DRINKS DIFFERENCE AFTER FOUR MONTHS AND ABOVE. IT SHOWS A DIFFERENT PICTURE. THERE ARE NO KNOWN SIDE EFFECTS ASSOCIATED WITH THESE INTERVENTIONS AND THE 4-MONTH FIGURES ARE BETTER, NOT EXPENSIVE TO IMPLEMENT. IF YOU WANT CONCLUSION WILL CLINICAL MEANINGFULNESS, THEY SHOULD CONSIDER ADVANTAGES OR BENEFITS AS WELL AS HARMS ASSOCIATED WITH INTERVENTIONS BUT THEY DIDN'T HAVE A CONTENT EXPERT ON THE TEAM SO THEY END WITH UNILATERAL AND PROVOCATIVE œBACK IN THE DAYS IN 1990, WHEN COCHRANE COLLABORATION WAS FORMED, THIS WAS INNOVATIVE APPROACH TO COME UP WITH A ROBUST EVIDENCE THAT EACH INDIVIDUAL TRIAL CANNOT PROVIDE BUT NOW IT SEEMS TO ME THIS IS TYPE OF TRADITIONAL META-ANALYSIS USING AGGREGATE DATA ONLY USES A FRACTION OF A DATA IN MOST UNHELPFUL WAY, SOMETIMES, NOT ALWAYS, BUT SOMETIMES. AND ALSO THE DATABASES THEY MAINTAIN BY THE COCHRANE COLLABORATION GROUP, THOSE ARE PROPRIETARY DATABASES NOT OPEN TO THE PUBLIC, WE CAN TAKE A LOOK BUT IT'S NOT EASILY ACCESSIBLE OR RETRIEVABLE FROM THE INTERNET. SO IT SEEMS TO ME IT HAS A SUBOPTIMAL PROCESSING, OR HANDLING THE EXISTING DATA, AND SO I HAVE AN EXAMPLE OF WHY I DISLIKE THEIR CONCLUSION OF POOR QUALITY OF EVIDENCE BECAUSE ARD COULDING ACCORDING TO THEIR OWN GRADING IT WAS ONE NOTCH DOWN BUT THEY SAID QUALITY CAN FURTHER ATTENUATE THE EFFECTS THEY THINK IT IS SO I THINK IT'S GROCERY UNFAIR. I'M TRYING TO FIND A WAY TO COMMUNICATE MY FRUSTRATIONS WITH OTHER PEOPLE BUT HAVEN'T FOUND A GOOD VENUE TO DO IT. [ CHUCKLES ] SO I PROPOSE COMPLETELY DIFFERENT APPROACH TO META-ANALYSIS. LET'S USE DATA IN A MOST EFFICIENT WAY, LET'S USE ALL DATA AVAILABLE, CALLED COMPLEX META-ANALYSIS, LET'S COMBINE INDIVIDUAL PARTICIPANT DATA AS WELL AS AGGREGATE DATA, SO WHATEVER THE FLAWS THAT MAY EXIST IN AGGREGATE DATA CAN THE BY COMPENSATION. IT CAN PRODUCE PATTERNS OF BEHAVIOR CHANGE OVER TIME, BUT LONGITUDINAL DATASET IS NOT THE ONLY THING THAT UTILIZE THE LINKING DATA OR BORROWING INFORMATION INDIRECTLY FROM EXISTING DATA, AND CAN USE THE SAME APPROACH FOR DIFFERENT MEASURES, LINK THEM TOGETHER ACROSS DIFFERENT TRIALS AS WELL AS DIFFERENT INTERVENTIONS, DIFFERENT CLINICAL ENDPOINTS, RIGHT? MULTIPLE MULTIPLE OUTCOMES THAT ARE RELATED. WE CAN TAKE ADVANTAGE OF IT BECAUSE THIS IS DONE WITHIN THE SAME INDIVIDUAL, THEY ARE HIGHLY CORRELATED, AND THOSE CORRELATIONS WOULD BE HIGHLY CORRELATED ACROSS DIFFERENT STUDIES BY TAKING ADVANTAGE OF WITHIN-STUDY AND BETWEEN-STUDY CORRELATIONS, WE CAN DO MORE WITH AVAILABLE DATA. WE CAN DO SO WITH INDIVIDUAL PARTICIPANT DATA, BECAUSE IT SUFFERS THE LEAST AMOUNT OF INFORMATION LOSS, COMPARED TO AGGREGATE DATA TYPE. AGGREGATE DATA TYPE IS A FRACTION OF WHAT IS AVAILABLE OUT THERE. SO WE IPD CAN CHECK AND VALIDATE PREVIOUSLY REPORTED FINDINGS, TRACKED FOR clinicaltrials.gov, WE CAN ALSO ADOPT CONSISTENT INCLUSION/EXCLUSION CRITERIA ACROSS DIFFERENT TRIALS AND ALSO ACCOMMODATE INDIVIDUAL LEVEL MISSING DATA, ALSO DO A BETTER JOB HARMONIZING THE DATA ACROSS TRIALS USING IRT ANALYSIS AND SO ON AND ALSO ANALYZE UNPUBLISHED OUTCOMES BASED ON MY EXPERIENCE WHATEVER BEING PUBLISHED IN THE LITERATURE IS ALSO A SMALL SUBSET OF AVAILABLE DATA THAT I HAVE, THAT I GOT FROM MY COLLABORATORS. ALSO WE CAN CHECK MODEL ASSUMPTIONS FOR THE SAME SET OF COVARIATES. WHAT I WANT TO ALSO EMPHASIZE IS IT CAN PRODUCE CLINICALLY MOST RELEVANT FINDINGS AND AVOID ECOLOGICAL BIAS. THIS IS A DONE BY A GROUP OF RESEARCHERS BASED IN U.K., AND THIS JUXTAPOSED WHO TYPES MUCH DATA, ONE IS AGGREGATE DATA AND THE OTHER IS INDIVIDUAL PARTICIPANT DATA. BLUE BOXES INDICATE INDIVIDUAL PARTICIPANT DATA ANALYSIS RESULTS. THIS SHOWS GENDER DIFFERENCE IN TREATMENT ON HYPERTENSION. THE RED LINE ON THE OTHER HAND IS AGGREGATE DATA ANALYSIS, IT SHOWS THIS, IT'S TILTED, RIGHT? THE MORE MALES YOU HAVE IN YOUR TRIAL, LESS EFFECTIVE THAT INTERVENTION IS. THAT'S THE MESSAGE BASED ON AGGREGATE DATA. BUT WHEN YOU LOOK AT INDIVIDUAL DATASETS WITHIN THE TRIAL, YOU SEE THERE'S ALMOST NO DIFFERENCE BETWEEN MEN AND WOMEN. THE DOTTED LINE IS THE LINE THAT SUGGESTS GENDER DIFFERENCE IN TREATMENT EFFECT, AND IT'S ALMOST FLAT. SO THIS SHOWS WHEN WE RELY ON INFORMATION FROM AGGREGATE DATA ONLY, YOU CAN HAVE A COMPLETELY DIFFERENT CONCLUSION. ANOTHER WAY, THIS IS I WANT TO SHOW, THIS IS THE GRAPH THAT I DREW USING META-ANALYSIS TOOL, A TYPICAL META-ANALYSIS USING AGGREGATE DATA, THE TWO NODS ARE CONNECTED BY AN AN ARROW, ONE LINE IS FROM STANDARD META-ANALYSIS, UNIVARIATE META-ANALYSIS, ONE LINE AT A TIME WHAT WE SEE IN A STANDARD META-ANALYSIS. EACH META-ANALYSIS REVIEWS USES VERY LITTLE DATA AND ALSO IT WILL GRAPH TRIALS THAT HAVE THREE-ARM TRIALS, FOUR-ARM TRIALS OR FIVE WITHOUT A CONTROL BECAUSE IT CANNOT BE COMBINED USING STANDARD METHODS, IN CONTRAST WE CAN APPROACH IT DIFFERENTLY AS A NETWORK OF A CONNECTED INTERVENTION. THIS IS ALSO JUST ONE EXAMPLE OF INTERVENTION BEING CONNECTED BUT WE CAN DO MORE WITH IT, SO UNDER THE EXAMPLE, HAVING THIS TYPE MULTIVARIATE, AS A RESULT I SHOW THIS ONE, AT THE END BECAUSE COMBINED ENTIRE EQUATION COME UP WITH A MORE INDIVIDUALIZED ANSWERS. FOR EXAMPLE, WE CAN HAVE A PREDICTION, WHEN SOMEBODY'S MALE, WITH TEN DRINKS PER WEEK WHAT IS THE PERSON'S DRINKS AT A FLOP AFTER GET -- AT A FOLLOW-UP AFTER GETTING A TREMENDOUS, A PREDICTION WHEN YOU COMBINE MORE COMPLEX MODELS THAT ARE MORE ECOLOGICALLY APPROPRIATE. SO END RESULT, SIMILAR RESULT, REGARDLESS OF WHAT METHOD WE USED, IT WAS VERY PROMISING. AND WE PLAN TO DO IT MORE BY ADDING AGGREGATE DATA AND INDIVIDUAL PARTICIPANT DATA. CONCLUDING REMARKS CLINICAL TRIAL DATA HAS BEEN UNDERUTILIZE AND MISUSED. WHEN PUBLISHED OR EXISTS SOMEWHERE, WHO IS RESPONSIBLE FOR MAKING SURE THEY ARE NOT INCORRECTLY USED, RIGHT? IF YOU WERE TO HAVE MORE OPEN ACCESS DATABASES FOR THESE EFFECTS, THEN THERE WOULD BE NO DOUBT OR THERE'S NO NEED TO CHECK WHO IS DOING A POOR JOB WITH ALL THIS META-ANALYSIS. SO CLINICAL TRIAL DATA ARE VERY VALUABLE, PRICELESS IF IT CAN CONNECT THEM TOGETHER IN A MORE INCREMENT WAY AND META-ANALYSIS USING PARTICIPANT DATA, USE CAPABILITIES AND THINK MORE PROSPECTIVELY HOW TO CONNECT THEM WITH THE IDEA THEY SHOULD BE CONNECTED DOWN THE ROAD. I WANT TO RECOGNIZE NIAAA FOR THE GENEROUS SUPPORT AND MY PROGRAM OFFICERS AND NIH CSS STAFF AND BSSR STAFF. THANK YOU. [APPLAUSE] >> THANK YOU. WE'RE GOING TO HAVE THREE PRESENTATIONS AND WE'LL DO Q&A AFTERWARDS. GREAT. SO I WANT TO INTRODUCE THE NEXT SPEAKER, ARGYRIS STRINGARIS, CHIEF OF THE MOOD BRAIN AND DEVELOPMENT UNIT, EMOTION AND DEVELOPMENT BRANCH, NATIONAL INSTITUTE OF MENTAL HEALTH. RESEARCHES AND TREATS DEPRESSION AND RELATED CONDITIONS IN YOUNG PEOPLE. HE TRAINED IN LONDON, Ph.D. FROM KINGS COLLEGE IN LONDON, INTERESTED IN MOOD AND SEEKS TO USE THIS KNOWLEDGE TO IMPROVE TREATMENT OF YOUNG PEOPLE WITH DEPRESSION AND RELATED CONDITIONS. SPECIAL HAVE INTEREST IN REWARD PROCESSING AND A CENTRAL PART OF WORK TO IMPROVE THE WAY WE MEASURE MOOD USING MULTI-METHOD MULTI-SOURCED APPROACHES AND YOU CAN SEE THE PRESENTATION IS "THE MEASUREMENT OF IRRITABILITY" WHICH WOULD COME IN HANDY WITH MY 13-YEAR-OLD DAUGHTER SO MAYBE I'LL TALK TO YOU AFTERWARDS. [LAUGHTER] >> GOOD AFTERNOON. THANK YOU VERY MUCH FOR THE VERY GENEROUS INTRODUCTION AND THANK YOU VERY MUCH FOR INVITING ME TO THIS EXCITING EVENT. SO, I FEEL I HAVE TO APOLOGIZE TO YOU FOR HAVING TO TALK ABOUT MEASUREMENT. I KNOW THAT MANY OF YOU FIND IT BORING. I HAVE DONE MY BEST TO TRY TO AVOID THAT. BUT TIME WILL SHOW WHETHER I HAVE ACHIEVED THAT. SO WHY DOES MEASUREMENT MATTER? WELL, CLINICALLY IT MATTERS IN THE SAME WAY THAT MEASURING, SAY, BLOOD PRESSURE, METASTASIZED LYMPH NODES IN CANCER WOULD MATTER. IT MATTERS TO THE PATIENT AND DECISIONS ABOUT THEIR MANAGEMENT. IT MATTERS ABOUT DIAGNOSIS AND TREATMENT DECISION AND MONITORING. SCIENTIFICALLY THE VALUE OF SCIENTIFIC CONSTRUCT IS ALSO DETERMINED BY HOW MEASURABLE IT IS. DO CLINICALLY MEASURED CONSTRUCTED RELATE AND DO NEURAL UNDERPINNINGS OR BRAIN PHENOMENA HELPERS RESHAPE AND UNDERSTAND CLINICAL PHENOMENA? I PROBABLY DON'T NEED TO REMIND YOU OF THIS, BUT PSYCHOLOGICAL CONSTRUCTS ARE TYPICALLY LATENT VARIABLES, DERIVED FROM MULTIPLE SOURCES OF INFORMATION. SO YOU CAN SEE -- LET ME MOVE THE CURSOR. OKAY. YOU CAN SEE OBSERVE THE INDICATORS, QUESTIONNAIRES, QUESTIONS, WHATEVER IT MIGHT BE, AND THEY LOAD ON WHAT SOME PEOPLE DESCRIBE AS HYPOTHETICAL WORKINGS, SOMETHING THAT ISN'T MEASURED. SUCH AS DEPRESSION OR IRRITABILITY IN THIS CASE. SO, IT IS IMPORTANT TO USE A NUMBER OF DIFFERENT METHODS TO DO THIS. SO, ASSUME THIS IS THE CHILD, AND YOU WILL ASK SIMPLE QUESTIONS, HOW DO YOU FEEL RIGHT NOW, YOU MAY DO A CLINICAL RATING AND HAVE A NUMBER OF CLINICIANS TALK TO THE CHILD. YOU WILL USE AN INTERVIEW OR CLINICAL QUESTIONNAIRE. YOU MAY ASK A SIBLING THE SAME QUESTIONS. YOU VERY WELL DO FUNCTIONAL MAGNETIC RESONANCE IMAGING, DO SOME BRAIN SCANNING, MEASURE HEART RATE, MEASURE CORTISOL RESPONSE TO STRESS, FOR EXAMPLE, WE'LL TALK MORE ABOUT THAT LATER ON. YOU CAN HAVE OTHER OBSERVERS WHO ARE OUTSIDE THE ROOM, AND WE NOW EVEN HAVE A LITTLE ROBOT, NOT ACTUAL ROBOTS THAT ROAM AROUND THE ROOM, BUT WE DO USE AND I'LL SHOW THAT LATER ON, WE DO USE MACHINE LEARNING ALGORITHMS TO DEAL WITH MEASURES OR AFFECT, FACIAL AFFECT FOR EXAMPLE. ALL THIS, HOW WE GET OUR INFORMATION, DERIVE OUR INFORMATION, I'LL TALK LATER ON WHAT THE CHALLENGES ARE IN INTEGRATING IT. THE OTHER THING THAT ONE MIGHT WANT TO REALIZE IS THAT DIFFERENT MEASURES SERVE DIFFERENT PURPOSES OFTEN. SO IN EPIDEMIOLOGY AND PUBLIC HEALTH, PEOPLE PREFER METHODS THAT ARE CONCISE, AT LEAST METHODS THAT ARE SCALABLE, RIGHT? SO IT'S VERY HARD TO SCAN ONE MILLION PEOPLE, BUT YOU CAN GIVE ONE MILLION PEOPLE A QUESTIONNAIRE OR COLLECT ROUTINE DATA ON THEM, RIGHT? AND BREADTH IS A PRIORITY OF COURSE BECAUSE FINDING KIND OF POTENT BROAD RISK FACTORS THAT ONE CAN INTERVENE ON IS OF PARTICULAR IMPORTANCE, RIGHT? CLINICAL MEASUREMENT, ON THE OTHER HAND, NEEDS TO BE DIAGNOSTIC, OR AT LEAST AID IN DIAGNOSIS. THIS MEANS HELP IN MAKING A DECISION WHETHER SOMEONE REQUIRES A TREATMENT OR NOT. YOU DON'T HAVE TO SUBSCRIBE TO A CATEGORICAL ILLNESS, BUT DECISIONS ARE BINARY, THE LEAST THEY MAY HAVE THREE CATEGORIES BUT THEY DO COME IN CATEGORIES. CLINICIANS PREFER FINE-GRAINED APPROACH. SOMETIMES IT'S JUSTIFIED, SOME LESS SO BUT I'LL SHOW YOU EXAMPLES WHERE INFORMATION ABOUT CONTEXT, ABOUT WHEN AND HOW EXACTLY SOMETHING OCCURS MAY ACTUALLY BE HELPFUL. PARTICULARLY WHEN YOU'RE DESIGNING THE TREATMENT AND YOU WANT TO INDIVIDUALIZE THIS TO THE PATIENT IN FRONT OF YOU. NOW, IN BRAIN RESEARCH YOU MAY NEED DIFFERENT OR IN RESEARCH MORE GENERALLY, DIFFERENT COMPONENTS OF ALL OF THE ABOVE, BUT ONE IMPORTANT THING IS YOU WANT SOMETHING THAT IS MANIPULABLE, AVAILS ITSELF TO EXPERIMENTAL MANIPULATION, RIGHT? THAT'S THE GENERAL STUFF ABOUT MEASUREMENT. LET MEET TALK ABOUT IRRITABILITY AND WHY IT IS IMPORTANT. SO IRRITABILITY BY ONE DEFINITION REFERS TO DIFFERENCES AND PRONE TO ANGER AND MAY REACH PATHOLOGIC EXTENT, ONE OF THE MAJOR MODES OF STRESS RESPONSE, YOU KNOW, IT IS KIND OF IF YOU THINK ABOUT FIGHT AND FLIGHT DICHOTOMY MORE ON THE FIGHT SIDE, RIGHT? YOU CAN IMAGINE THERE ARE MANY PEOPLE IN THE ROOM, I DON'T WANT TO CAST APERSIANS BUT MANY PEOPLE MAY HAVE FELT IRRITABLE IN THEIR LIVES. [LAUGHTER] IT IS SOMETHING THAT IS MODIFIED BY THE ENVIRONMENT. PARENTAL RESPONSE I'M DEALING WITH QUITE A LOT, CHILD SAID SOMETHING TO PARENT, PARENT RESPONDS, THERE MAY OR MAY NOT BE IRRITABILITY BUT IT HAPPENS IN THE WORKPLACE AND EVERYWHERE ELSE OF COURSE. IT'S A POTENT MODIFIER OF THE ENVIRONMENT. JUST THINK OF A VERY BIG MAN WHO SUDDENLY BECOMES VERY, VERY IRRITABLE AND COMES KIND OF CHARGING TOWARDS YOU. YOU BEING THE ENVIRONMENT MAY, YOU KNOW, CHANGE YOUR OWN TONE OR YOUR OWN POSITION IN THE ROOM AS A RESULT. SO IT IS SOMETHING QUITE POTENT, RIGHT? COMPARED TO OTHER TYPES OF EMOTIONS AND BEHAVIORS. IT IS AN IMPORTANT PART OF BRAIN ENVIRONMENT, WHAT I WOULD CALL BRAIN ENVIRONMENT REINFORCEMENT CYCLES, ALL OF THE PREVIOUS THINGS A LEARNING COMPONENT IS IMPLICIT. PEOPLE LEARN FOR EXAMPLE TO JUST RUN AWAY, OR THEY LEARN THAT IRRITABILITY IS ACTUALLY A GREAT CURRENCY, BUYS THEM QUITE A LOT, RIGHT? AND, YOU KNOW, IT MAKES PEOPLE GO AWAY AND THEREFORE THEY CAN JUST GET FURTHER IN LIFE, RIGHT? OTHER PEOPLE LEARN TO AVOID THOSE PEOPLE, BE SCARED OF THEM. IT'S VERY, VERY IMPORTANT FROM THAT POINT OF VIEW. AND THE OTHER GOOD THING IS THAT YOU CAN IMAGINE IT CAN BE STUDIED ACROSS A NUMBER OF SPECIES. SO HUMANS ARE HIGHER, YOU KNOW, MAMMALS AND YOU CAN, YOU KNOW, GO DOWN TO RODENTS VERY EASILY TO STUDY IT. THAT KIND OF HAS A BIG TRANSATIONAL POTENTIAL, IF YOU LIKE, THAT'S GREAT STUFF ABOUT IRRITABILITY. JUST TO GIVE YOU A BIT OF FLAVOR OF THE PHENOMENONOLY, GY, A 9-YEAR-OLD BY WITH ADHD AND LEARNING DIFFICULTIES, IT'S PROBABLY A FAMILIAR SITUATION, CAN OCCUR IN THE CONTEXT OF DEPRESSION OR AUTISM SPECTRUM AND REACH PROPORTIONS THAT ARE IMPAIRING. JUST TO GIVE YOU SOME BACKGROUND IN TERMS OF HOW PROBLEMATIC IT CAN BE, DESPITE BEING A NORMAL HUMAN EXPERIENCE, IT CAN REACH PATHOLOGIC EXTENTS. IT'S A PRESENTING COMPLAINT FOR THE MAJORITY OF REVEALS IN CHILD MENTAL HEALTH SERVICES, RIGHT? SO CAN YOU PLEASE FIX THE ANGER, CAN YOU PLEASE MAKE SURE EMOTION DYSREGULATION GOES AWAY, I CAN'T DEAL WITH IT ANYMORE, SCHOOLS SAY THAT, PARENTS SAY THAT. WHEN THE CHILD IS OLDER, THE CHILD MAY SAY THAT. IT'S ASSOCIATED WITH DOUBLE RISK OF SUICIDALITY UP TO 30 YEARS LATER, OKAY? ITS THAT EVIDENCE OF SPECIFIC ASSOCIATION WITH DEPRESSION AND ANXIETY. LEADS TO IMPAIRMENT IN EDUCATION AND INCOME, 20-YEAR FOLLOW-UP, IT IS NOT BIPOLAR DISORDER, CAN OCCUR IN BIPOLAR DISORDER BUT NOT A DIAGNOSTIC FEATURE OF BIPOLAR DISORDER. PARTICULARLY CHRONIC IRRITABILITY. SEVERE FORM AFFECTING 3% OF YOUNG PEOPLE PROBABLY DESIGNATED DISRUPTIVE MOOD DISREGULAR DISORDER, INCLUDED IN DSM-V MANUAL RECENTLY. NOW, LET ME START TALKING ABOUT MEASUREMENT, THE TOPIC OF MY TALK, START WITH VERY SIMPLE QUESTIONNAIRES. SO THERE IS A SIMPLE QUESTIONNAIRE TO MEASURE IRRITABILITY, IT IS HERE, KIND OF SEVEN QUESTIONS, 6 PLUS 1, 6 SYMPTOMS, ONE ON IMPAIRMENT, FILL IN, IT HAS SEVERAL KIND OF GOOD THINGS TO RECOMMEND. IT'S CONCISE OBVIOUSLY. IT'S BROADISH. IT HAS -- IT'S BEEN RELIABLE, BOTH INTERNALLY AND IN TERMS OF TEST, RETEST, IT'S VALID, YOU KNOW, ONE OF THE INDICATIONS IT PICKS UP THIS DMDD DIFFERENTIALLY COMPARED TO OTHER DISORDERS. SOME OF THE KIND OF PROBLEMS WITH IT, IT HAS A CROSS-INFORMANT SO -- COEFFICIENT, .4. BETTER FOR PARENT/CHILD AGREEMENT, I SHOULD SAY PARENTS CAN FILL THIS IN NICELY, DIFFERENT WORDING, CHILDREN FILL IT IN AS WELL. OBVIOUSLY, IT MAY BE TOO CONCISE. IT DOESN'T CAPTURE CONTEXT. SOMEONE TELLS YOU THEY ARE IRRITABLE. HOW? WHEN? WHAT EXACTLY IS HAPPENING DURING THAT TIME? SO AS I SAID, CLINICIANS LOVE THE FINE GRAINED, AND KIND THEY LOVE THE INTUITIVE APPROACH, GET THIS INFORMATION, GET THE FEELING, GET THE COLOR. YOU HEAR CLINICIANS ANSWER THOSE WORDS QUITE A LOT BUT WHAT'S THE FEELING YOU GET? IT'S HARD TO QUANTIFY OFTEN WHAT THAT IS. BUT PEOPLE FEEL IT IS IMPORTANT. AND IT MAY BE. SO PEOPLE WANT TO KNOW ABOUT THE INTENSITY OF TEMPER OUTBURST FREQUENCY OF TEMPER OUTBURST, DURATION OF THE IRRITABLE MOOD, FOUR OR FIVE HOURS, BELIEVE ME THAT DOES HAPPEN, YOU SEE IT PARTICULARLY IN THE MENTAL DISORDERS, FIVE HOURS NON-STOP TANTRUM OVER SOMETHING MINOR. WHAT'S THE CONTEXT AND WHAT WERE THE THINGS THAT WENT ON BEFORE IT, RIGHT? WAS IT AT HOME, WAS IT AT SCHOOL? HOW WAS IT IN TERMS OF TIMING OF MEDICATION THE CHILD MAY HAVE BEEN TAKING AT THE TIME? WHAT WERE THE CONSEQUENCES, RIGHT? DID PEOPLE START RUNNING AWAY, DID THE MOTHER CALL THE POLICE, YOU KNOW, DID THE CHILD SMASH A WINDOW, SO THESE ARE VERY IMPORTANT PIECES OF INFORMATION THE CLINICIAN MAY WANT TO HAVE. I'M NOT GOING THROUGH IT BUT THIS IS JUST TO GIVE YOU A FLAVOR OF IT, THIS IS JUST ONE QUESTION OUT OF A LONG CLINICAL INTERVIEW THAT CAN BE USED WITH IRRITABILITY, CALLED THE CLINICIAN NARRATIVE. IT GOES INTO A LOT OF DETAIL. NOW, ANOTHER APPROACH IS THE EXPERIMENTAL APPROACH WHICH IS KIND OF THE IDEA OF FINDING OUT, COLLECTING PARAMETERS OF WHAT MIGHT BE CONSIDERED MECHANISMS OF IRRITABILITY, IN THIS CASE THE BRAIN AND fMRI DATA. SO TO BE ABLE TO DO THAT, ONE NEEDS, AS I SAID, SOMETHING THAT'S EXPERIMENTALLY MANIPULABLE. IRRITABILITY CAN BE A PROBLEM OR FRUSTRATION, META-ANALYSIS DATA BEFORE, THIS IS ONE WAY OF INDUCING IT. FRUSTRATION IS A RESPONSE TO BLOCKED GOAL ATTAINMENT. FOCUS ON FRUSTRATION ENABLES EXPERIMENTAL APPROACH AND MEASUREMENT OF NEURAL UNDERPINNINGS. WE ALL AS MAMMALS OR AS ANIMALS MORE GENERALLY ARE AFTER SOME SORT OF REWARD, BE IT MONETARY OR GLORY OR SOMETHING ELSE MORE ABSTRACT, BUT WE ALSO HAVE THIS PROPERTY OF BECOMING QUITE FRUSTRATED WHEN WE DON'T GET IT. [LAUGHTER] THAT'S NICE, ISN'T IT? IT TOOK ME A WHILE TO GET THIS RIGHT. [LAUGHTER] SO AND IN CASE YOU WANT TO KIND OF AN EQUIVALENT, A ROUTINE, AND EVERYDAY EQUIVALENT, A CHILD MAKES DEMAND TO PARENT, PARENT REFUSE, CHILD THROWS A FIT, TANTRUM, PARENT GIVES IN AND CHILD, YOU KNOW, HAS BEEN REINFORCED BY THE BEHAVIOR OF THE PARENT, LEARNS THAT I CAN GET MY WAY, RIGHT? THAT'S SIMPLE REINFORCEMENT STUFF. SO ONE WAY TO DO IT IS TO CREATE A TASK OF MODIFYING EXISTING TASK, THE POSTDOC IN THE BRANCH, WORKING UNDER THE DOCTOR WHO HELPED DESIGN THIS TASK, SOME MIGHT SAY IT'S REPETITIVE OR BORING BUT THAT'S ONLY THE BEGINNING. AT SOME POINT YOU JUST HAVE TO SAY WHERE THE DOT IS ON THE PICTURE HERE IN THE MIDDLE OF THE RIGHT OR LEFT SIDE. IT'S SIMPLE. PEOPLE GET IT RIGHT ALL THE TIME, MORE OR LESS, AND YOU HAVE NON-FRUSTRATION RUNS WHERE YOU'RE JOLLY AND HAPPY, YOU WIN, YOU EARN MONEY, AND THEN YOU START LOSING HERE. BASICALLY THE TASK IS RIGGED AND CAN INDUCE FRUSTRATION, YOU'RE TOO SLOW, MATE, SORRY, NOT GETTING THE MONEY. THIS IS VERY FRUSTRATING TO PEOPLE AS YOU CAN IMAGINE, REFLECTED IN THE RATINGS, HERE. SO THESE ARE THE NON-FRUSTRATING RUNS, THESE ARE FRUSTRATING RUNS, HOW FRUSTRATED ARE YOU ON THE SCALE FROM, YOU KNOW, 1 TO WHATEVER, 10. YOU CAN SEE BEING KIND OF CONSCIENTIOUS, THIS WAS DONE TWICE, VISIT 1, VISIT 2, IT'S A SIMILAR SHAPE, SLIGHTLY ATTENUATED, HAS GOOD ICCs. NOW, WHAT ABOUT PLAUSIBLE RISE IN FRUSTRATION, RETEST RELIABILITY, SIGNIFICANT ASSOCIATION WITH TRAIT IRRITABILITY RATING. WHAT HAPPENS IN THE BRAIN? THIS IS BRAIN ACTIVITY DURING FRUSTRATION, I DON'T WANT TO TALK FOR TOO LONG BECAUSE THERE'S COMPLICATIONS, STRINGENTLY THRESHOLDED VERSION OF THE PICTURE YOU SAW BEFORE. ESSENTIALLY WE DEFINE AN ASSOCIATION BETWEEN TRAIT AND IRRITABILITY DURING FRUSTRATION RUNS, IN THE BRAIN AREA WHICH I WOULD HAVE PREDICTED WHICH ALSO SURVIVES VERY STRINGENT FOREBRAIN CORRECTION, THIS IS ONE WAY OF ACQUIRING BRAIN IMAGING DATA THROUGH AN EXPERIMENTAL TASK, AND IT IS ONE OF THE FORMS OF MANIPULABE MEASUREMENT I WAS MEASURING, YOU CAN SEE THE TRAIT IRRITABILITY AND BRAIN DATA I WAS TALKING ABOUT BEFORE. I'M HAPPY TO DISCUSS THIS IN MORE DETAIL FOR THOSE INTERESTED IN THIS ASPECT OF MEASUREMENT. SO THERE ARE SEVERAL CHALLENGES OBVIOUSLY TO MEASUREMENT, NOT JUST IRRITABILITY BUT GENERALLY. I'LL MENTION JUST A FEW ONES IN THE LAST THREE MINUTES THAT REMAIN. SO PROBABLY THE BIGGEST CHALLENGE IN MY MIND GOING AHEAD IS ALIGNING TIME SCALES. SO CLINICAL SCALES ASK ABOUT THE LAST, SAY, SIX MONTHS. fMRI AND SIMILAR EXPERIMENTS AVERAGE OVER SIX MINUTES, RIGHT? IF I WERE TO DRAW THESE ON SCALE, THE SAME SCALE, I COULDN'T. I DID TRY THAT BUT YOU WOULDN'T BE ABLE TO SEE IT. IT'S COMPLETELY DIFFERENT TIME SCALES, RIGHT? AND THAT'S A MAJOR, MAJOR CHALLENGE IN MY MIND. SO WE TRIED TO IMPROVE THIS, TO MAKE IT BETTER BY ACQUIRING DIFFERENT TYPES OF DATA, SO BY LOOKING MORE TIME COURSE ANALYSIS INCLUDING MODULATION AND INTEGRATING TYPICALLY USED fMRI SIGNALS WITH SIGNALS THAT HAVE A BETTER TEMPORAL RESOLUTION, THIS IS THIS HAS A NUMBER OF TECHNICAL CHALLENGES. ONE OF THE PEOPLE WHO IS WORKING ON THAT AT THE MOMENT IS ONE OF OUR POSTDOCS, DR. KEREN, AS YOU CAN SEE THESE ARE RESPONSES. THESE ARE TRIALS IN A REWARD TASK, SIMILAR TO WHAT I SHOWED YOU BEFORE. AND MOST PEOPLE WOULD SHOW YOU THE AVERAGE DATA OVER THOSE TRIALS. AND WHAT WE'RE AFTER IS TRYING TO DESIGN THE TASK IN SUCH A WAY THAT WILL ALLOW US TO HAVE ENOUGH POWER TO LOOK AT THE INDIVIDUAL CURVES OF PEOPLE. AND YOU CAN SEE THESE ARE PRELIMINARY DATA. YOU CAN SEE WE GET A SIGNAL DISTINGUISHING DEPRESSED AND HEALTHY AND PARTICIPANTS JUST BY THE SHAPE OF THE CURVE, WE WOULD HAVE PROBABLY MISSED A LOT OF DATA HAD WE LOOKED AT AVERAGE. THIS IS ONE OF THE PIECES OF WORK THAT WE'RE VERY KEEN TO DEVELOP FURTHER AT THE MOMENT. CLINICALLY, WE'RE VERY INTERESTED IN THINGS LIKE AUTOMATED CONTINUOUS SPATIAL AFFECT RECOGNITION I'LL SHOW IN A MINUTE AND WHAT MOST OF YOU ARE FAMILIAR WITH, ECOLOGICAL MONETARY ASSESSMENT, YOU COULD USE YOUR IPHONE OR PEN AND PAPER TO RAISE YOUR FEELINGS OR THOUGHTS EVERY HOWEVER MANY MINUTES, YOU MIGHT WANT TO DO THIS, A NICE DYNAMIC VIEW TO IT. LET ME TRY TO PLAY THIS VIDEO. THIS IS ONE WAY OF TRACKING FACIAL AFFECT. RIGHT, SO THE CHILDREN MOVE AND WE RECORD THE FACIAL EXPRESSIONS. THIS IS IN COLLABORATION WITH AFFECTIVA, A SPINOFF LAB FROM THE M.I.T. AND IT ALLOWS US TO -- WE'RE USING ALGORITHMS THAT ALLOW US TO PARS OUT EMOTIONS FROM FACIAL AFFECT AS DISPLAYED HERE. WE DO END UP WITH VERY COMPLEX MODELS LIKE THE ONE I'M PRESENTING HERE WHEN WE DEAL WITH TIME DATA. AND KIND OF MAKING SENSE OF THEM, YOU SEE OTHER COMMUNICATING TO THE REST OF HUMANS WHO DON'T HAPPEN TO SIT NEXT TO US. FINALLY I'D LIKE TO SAY THANK YOU TO EVERYONE IN MY LAB AND A SPECIAL THANK TO YOU DR. LEIBOWITZ, THE WORLD AUTHORITY ON IRRITABILITY AND FROM WHOM I'VE LEARNED MOST OF WHAT I KNOW ABOUT THE CONDITION. THANK YOU VERY MUCH TO ALL OF YOU. [APPLAUSE] >> ALL RIGHT, WONDERFUL. GREAT PRESENTATION. WE'RE GOING TO MOVE TO OUR THIRD PRESENTATION, WHICH IS RIGHT THERE. LET ME INTRODUCE THE THIRD SPEAKER, BRUCE TOMBLIN, EMERITUS PROFESSOR AT THE UNIVERSITY OF IOWA, RESEARCH HAS BEEN CONCERNED WITH CAUSES AND CONSEQUENCES OF INDIVIDUAL DIFFERENCES IN LANGUAGE DEVELOPMENT AND DISORDERS, SERVE THE AS PRINCIPAL INVESTIGATOR ON SEVERAL AWARDS FROM NIH'S NATIONAL INSTITUTE ON DEAFNESS AND AUTHORED PUBLICATIONS ON LANGUAGE DEVELOPMENT AND OUTCOMES OF CHILDREN WITH LANGUAGE IMPAIRMENT PARTICULARLY CONCERNING ACADEMIC, BEHAVIOR AND PSYCHOLOGICAL OUTCOMES INCLUDING CHILDHOOD. I'LL GET OUT OF THE WAY AND IT LOOKS LIKE YOU'RE ALL SET TO GO. >> I ALSO WOULD LIKE TO THANK YOU FOR THE KIND INVITATION TO BE HERE, AND TALK ABOUT SOME OF OUR WORK. WHAT I'LL BE TALKING ABOUT TODAY IS A RELATIVELY LARGE SCALE PROGRAM OF RESEARCH THAT I'VE DONE WITH MARY PAT MULLER, AT THE BOYS TOWN NATIONAL RESEARCH HOSPITAL IN OMAHA. AND THIS RESEARCH HAS BEEN CONCERNED WITH CHILDREN WHO ARE HARD OF HEARING. THESE ARE CHILDREN WHO HAVE REDUCED AUDITORY ACUITY, BUT I NEED TO EMPHASIZE THESE ARE CHILDREN WHO ARE NOT DEAF. SO IN CONTRAST TO A RATHER LARGE LITERATURE ON CHILDREN WHO ARE DEAF, THERE'S BEEN VERY ALSO RESEARCH CONDUCTED ON THE OUTCOMES OF CHILDREN WHO ARE HARD OF HEARING. THE SMALL AMOUNT OF LITERATURE THAT WE HAVE ON THAT IS MIXED AND IN FACT I'D SAY ABOUT HALF OF THAT RESEARCH WAS SUGGESTING IN FACT THESE CHILDREN WERE REALLY NOT AT MUCH RISK FOR ANY SUBSTANTIAL PROBLEMS IN LIFE, AS A FUNCTION OF THEIR HEARING LOSS. SO THAT IT WAS RATHER BENIGN. THE RESEARCH STUDY THAT WE DID WAS RATHER BROAD, IN PART BECAUSE THERE HAVE BEEN SO FEW STUDIES DONE WITH THESE CHILDREN. THE BASIC STRUCTURE OF THE STUDY WAS ONE THEREOF TO LOOK AT -- THEREFORE TO LOOK AT A VARIETY OF OUTCOMES IN THIS POPULATION, AND SO WE LOOKED AT OBVIOUSLY THEIR HEARING AND SPEECH PERCEPTION, SPEECH PRODUCTION ABILITY, LANGUAGE SKILLS, ACADEMIC OUTCOMES, PSYCHOSOCIAL AND BEHAVIORAL AND FAMILY OUTCOMES, AND THEN WE ALSO WANTED TO INCLUDE LOOKING AT INTERVENTIONS, AND HOW THOSE INTERVENTIONS HAD AN IMPACT ON THESE OUTCOMES, ESSENTIALLY MODERATING OR REDUCING THE IMPACT OF THE HEARING LOSS ON THESE OUTCOMES. SO I GUESS THE THEME OF TALKING ABOUT MEASUREMENT, YOU CAN SEE THEREFORE WE HAD A LOT OF MEASUREMENT THAT WENT ON, AND WE WERE OFTENTIMES CHALLENGED BY TRYING TO DEAL WITH ANY NUMBER OF THESE MEASURES TO TRY TO EMPLOY THEM TO ADDRESS THE QUESTIONS THAT WE HAD. JUST TODAY, I'M GOING TO FOCUS ACTUALLY ON JUST ONE OF THESE OUTCOMES, AND THAT IS LANGUAGE SKILLS IN THESE CHILDREN, AND SO WE'LL LOOK AT THAT AND WE'LL LOOK AT SOME OF -- ACTUALLY I GUESS I SHOULD SAY WE'LL ALSO LOOK AT ONE CLINICAL INTERVENTION, ONE OF THE PRIMARY CLINICAL INTERVENTIONS, AND THAT IS THE IMPACT OF WEARING A HEARING AID ON THE LANGUAGE OUTCOMES. JUST AS A WAY TO FRAME THIS, ALTHOUGH STILL CONTROVERSY WE IN OUR PROJECT MADE THE ASSUMPTION EXPOSURE TO LINGUISTIC EXPOSURE IS ESSENTIAL FOR LANGUAGE DEVELOPMENT, NOT AUDACIOUS BUT IN THE COMMUNITY THERE'S A LOT OF BELIEF THAT PERHAPS THERE'S ONLY A MINIMUM AMOUNT OF INPUT THAT'S NECESSARY AND THE CHILD CAN THEN ESSENTIALLY SOLVE THE PROBLEM OF LANGUAGE ACQUISITION CAN RATHER MINIMAL AND DEGRADED INPUT. AND THAT IN PART THEREFORE ALLOWED PEOPLE TO THINK THAT IN FACT MILD TO MODERATE OR MODERATELY SEVERE HEARING LOSS DIDN'T DENY THE CHILDREN ACCESS TO LANGUAGE WAS PROBABLY SUFFICIENT, IN FACT A LEARNING SYSTEM FOR LANGUAGE WERE SO ROBUST THAT BEYOND THAT MORE WASN'T NECESSARY. BUT THERE ARE DATA AND IN FACT THERE'S A STRONG MOVE IN I THINK IN THE FIELD, TO ACKNOWLEDGE THAT CHARACTERISTICS OF THE LANGUAGE INPUT TO THE CHILD ARE ASSOCIATED WITH DIFFERENCES IN LANGUAGE GROWTH, AND IN FACT THIS MORNING'S TALKS ABOUT THE IMPACT OF THE POVERTY AND HOME ENVIRONMENT ARE VERY GERMANE WITH REGARD TO THIS AS THERE ARE NOW A NUMBER OF STUDIES ATTEMPTING TO LOOK AT THE IMPACT OF PARENT INPUT TO CHILDREN AND THAT IMPACT ON LANGUAGE ACQUISITION, AS WELL INTERVENTIONS TO INCREASE THE AMOUNT OF THAT PARTICULARLY IN LOWER SES HOMES. SO WE ALSO BELIEVE LANGUAGE LEARNING DRAWS ON STATISTICAL LEARNING PROCESSES REQUIRING THE CHILDREN HAVE ACCESS TO A LOT OF THE LOW LEVEL DETAILS IN INPUT, FOR THE CHILD TO ASSEMBLE LOW LEVEL STATISTICAL STRUCTURES, THE PATTERNS THAT MAKE UP LANGUAGE, THAT THEN THE CHILD CAN BUILD A LANGUAGE KNOWLEDGE FROM. SO THEREFORE ANY KIND OF -- ACCESS TO INPUT AND QUALITY OF INTERACTION ARE GOING TO SUPPORT LANGUAGE DEVELOPMENT, AND ANYTHING THAT CONSTRAINS THAT IS GOING TO IN FACT POSSIBLY IMPAIR THE CHILD'S LANGUAGE DEVELOPMENT. SO WE'RE INTERESTED THEN IN HEARING LOSS AS A POSSIBLE CONSTRAINT IN THAT REGARD. AND WE WANT TO KNOW THEREFORE ARE THESE LIMITATIONS FROM ACCESSING THE INPUT LEADING TO PROBLEMS OF HEARING LOSS. AND SO MOVING DOWN HERE, IT'S IMPORTANT TO UNDERSTAND THAT IT COULD WELL BE FOR THESE CHILDREN, AS WELL, THAT IT'S NOT AS THOUGH THEY ARE ALWAYS UNABLE TO GET ACCESS OR NOT, BUT IT'S MORE VARIABLE IN INCONSISTENT ACCESS, SOMETIMES THEY MAY ACTUALLY BE ABLE TO HEAR WHAT IS BEING SAID AROUND THEM. IN FACT, WE'RE QUITE CERTAIN THEY ARE. BUT ANYTHING THAT EVEN LIMITS THE CONSISTENCY OR REGULARITY OF THAT ACCESS IS ALSO GOING TO HAVE A NEGATIVE IMPACT. SO, THE FOCUS CURRENTLY TODAY IS ON THAT ASPECT OF OUR QUESTIONING THAT HAD TO DO WITH WHETHER THE ENHANCED AUDIBILITY, THE ABILITY TO GET THAT INPUT THAT IS PROVIDED BY HEARING AIDS, DOES THAT IN FACT PROVIDE PROTECTION FOR POOR LANGUAGE DEVELOPMENT? ODDLY ENOUGH, NO STUDY UNTIL WE DID THIS STUDY HAD ACTUALLY LOOKED AT THAT QUESTION. A NUMBER OF STUDIES LOOKED, I SHOULDN'T SAY A NUMBER BUT A SMALL NUMBER LOOKED AT MILD HEARING LOSSES, MILD, MODERATE, UP TO SEVERE. BUT NEVER TOOK INTO ACCOUNT THE FACT THEY WORE HEARING AIDS, YET HEARING AIDS WE ASSUME WERE IMPORTANT AND PROVIDED FOR THE VERY BENEFIT OF AIDING THE CHILD IN SPEECH AND LANGUAGE DEVELOP. BUT NOBODY DEMONSTRATED OR TESTING. THAT'S WHAT WE WERE ADDRESSING HERE. THE STUDY USED A DESIGN, TALKING ABOUT METHODS AND MEASUREMENT, IN THIS CASE WE USED AN ACCELERATED LONGITUDINAL DESIGN, BECAUSE WITH NIH FUNDING, THE WAY IT IS, YOU HAVE FIVE YEARS TO DO YOUR STUDY, AND WE WERE ASKING QUESTIONS ABOUT ACADEMIC DEVELOPMENT OUT HERE SIX OR SEVEN YEARS OF AGE, ALSO INTERESTED IN EARLY CHILDHOOD EVEN INFANCY AND TODDLERHOOD. AND SO WE COULD NOT DO THAT ALL IN FIVE YEARS, PARTICULARLY SINCE IT WOULD TAKE A YEAR OR SO TO GEAR UP AND EVEN GET THE FIRST DATA POINT, SO THE SOLUTION WAS TO USE THIS ACCELERATED LONGITUDINAL DESIGN WHERE WE RECRUITED CHILDREN AT THE AGE, WHATEVER AGE THEY WERE, WE CAN ASSUME LET'S SAY A 2-YEAR-OLD, AND WE GOT BACKGROUND INFORMATION THAT WAS HISTORICAL, AND THEN OBTAINED AT LEAST THREE WAYS OF DATA COLLECTION SUBSEQUENT TO THAT. AND WE CONTINUED TO GO AS LONG AS WE COULD. SOME CHILDREN HAD FOUR AND I DON'T THINK WE HAD ANY FIVE. IF THEY CAME AT THREE WE WENT UP TO SIX, ET CETERA. AND WITH THOSE CHILDREN WE CONDUCTED COMPREHENSIVE ASSESSMENTS OF AUDIOLOGICAL HEARING AID VERIFICATION, SPEECH LANGUAGE, COGNITIVE, ABILITY TO DEAL WITH SORT OF SOUND COMPOSITION OF WORDS, AS WELL SPEECH SERVICE PROVISION. ONE OF USABLE TO THE BRAIN. WHAT WE WANT TO BE ABLE TO DO IS, THE NORMAL LISTENER HAS A HEARING THRESHOLD HERE, AND THAT ALLOWS THE PERSON TO BE ABLE TO HEAR ALL OF THE SPEECH INFORMATION THAT'S IN THIS GRAY SHADED AREA HERE. THAT'S CONSIDERED TO BE THE AREA WHERE MOST OF THE SPEECH INFORMATION IS PROVIDED. IF YOU HAVE A HEARING LOSS THAT DROPS YOUR THRESHOLD DOWN BELOW THIS GRAY AREA, YOU'RE GOING TO HAVE A REDUCED AUDIBILITY. SO THE VOWELS TEND TO HAVE A LOT OF INFORMATION DOWN HERE, NOT SO MUCH UP IN THE HIGH FREQUENCY. THIS IS A HIGH FREQUENCY TO LOW FREQUENCY, ON THE OTHER HAND A LOT OF INFORMATION IN THE HIGH FREQUENCY, THAT PERSON WITH THIS KIND OF AUDIOGRAM WOULD NOT HEAR HIGH FREQUENCY OF Ss AND CHs, THEY MIGHT HEAR THE VOWELS. THE PURPOSE OF A HEARING AID IS TO TAKE AN AUDIOGRAM THAT MIGHT BE DOWN HERE AND NOT PICKING UP ANY OF THESE THINGS AND RAISE THAT PERSON'S THRESHOLD UP INTO THAT GRAY AREA WHERE THEY COULD THEN HEAR. AND SO WE CAN REPRESENT THE DEGREE TO WHICH THE CHILD HAS ACCESS TO SPEECH INFORMATION BY THIS SII THAT ESSENTIALLY IF YOUR THRESHOLDS ARE DOWN HERE YOU WOULD HAVE A ZERO SII. IF YOU'RE UP HERE YOU WOULD HAVE AN SII OF ONE. AND SOME STYLES AND BENTLEH PROPOSED SII OF 6.5 WAS AS LOW AS YOU WOULD DARE NOT GO TO NOT HAVE EFFECT ON SPEECH AND LANGUAGE. SII IS A MEASUREMENT TECHNIQUE THAT ALLOWS US TO QUANTIFY THE DEGREE TO WHICH THE CHILD IS GETTING SPEECH INFORMATION FROM THE HEARING AID. WE CAN COME COMPUTE SII FOR THE CHILD WITHOUT A HEARING AID WE THINGS WE FIND IS THAT THERE'S A STRONG RELATION, NON-LINEAR, BETWEEN STATUS WITHOUT A HEARING AID AND INFORMATION YOU GET WITH AN AIDED AID. THAT FORCED US TO HAVE TO CONTEND WITH THIS SO THIS IS A MEASUREMENT ISSUE. WE WANTED TO KNOW EFFECT OF BENEFIT FROM HEARING AID REGARDLESS OF WHAT THE CHILD'S UNAIDED HEARING WAS LIKE. WE WANTED TO CONTROL FOR TH SEVERITY OF HEARING LOSS IN GENERAL AND IDENTIFY THEN THE BENEFIT FROM GAINS PROVIDED BY HEARING AID. WE ACCOMPLISHED THIS BY A PIECE-WISE REGRESSION THAT IDENTIFIED A JOINT IN THIS REGRESSION AND RESIDUALIZED SCORES HERE AND RESIDUALIZED SCORES HERE ON EACH SIDE OF THE JOINT TO COME UP WITH RESIDUALIZED SII, THINK OF AS ESSENTIALLY A NORMALIZED VALUE REPRESENTING THE AMOUNT OF BENEFIT THAT THE CHILD'S GETTING FROM THE HEARING AID, RELATIVE TO OTHER CHILDREN WITH A SIMILAR LEVEL OF UNAIDED HEARING. SO THIS MEASUREMENT TECHNIQUE HAD NOT BEEN USED BEFORE. AND IT ALLOWED US TO ISOLATE THE EFFECTS OF THE HEARING AID. A LOT OF THE VARIATION, INDIVIDUAL DIFFERENCES IN AUDIBILITY, SOME TO THE AGREE OF HEARING LOSS, THAT'S GOING TO INFLUENCE IT ALONE, AS YOU CAN SEE CHILDREN WITH POORER HEARING, DOWN HERE, IT'S MUCH HARDER TO GIVE THEM THE KIND OF LIFT THAT IS NEEDED TO GIVE THEM VERY HIGH LEVELS OF AUDABILITY. ANOTHER FACTOR IS THE DEGREE THEY WERE WELL FIT WITH HEARING AIDS. AUDIOLOGISTS HAVE AN ALGORITHM TO SET WHAT IN FACT GIVEN THE CHILD'S HEARING WHAT LEVEL OF HEARING THE CHILD SHOULD BE ABLE TO GET WITH A HEARING AID. YOU CAN SEE THE GRAY IS THE TARGET, THE DARK BARS REPRESENT THE ACTUAL FIT OF THESE CHILDREN'S HEARING AID. WHAT WE HAVE HERE IS SOME INDIVIDUAL DIFFERENCES THERE THAT ARE COMING FROM CLINICAL PRACTICE, AS THE AUDIOLOGISTS ARE FITTING THEM. A LOT OF AUDIOLOGISTS ARE CAREFUL OF GIVING THEM TOO MUCH AMPLIFICATION THAT THIS MIGHT CAUSE NOISE INDUCED HEARING LOSS. WE SEE A PATTERN A TENDENCY TO UNDERFIT. SO WE CAN EXPLOIT THAT DIFFERENCE, THIS IS ANOTHER MEASUREMENT THING. WE EXPLOITED THE DIFFERENCE IN VARIANCE IN INTERVENTION TO LOOK AT EFFECTS, WE COULD SEE SOME CHILDREN HAD VERY LOW AUDABILITY. SO BECAUSE WE HAD AN ACCELERATED LONGITUDINAL DESIGN COULD DO A GROWTH CURVE ANALYSIS, WE DID THIS WITH MIXED MODELING. AND ANOTHER WHOLE TALK COULD BE GIVEN ON THE FACT THAT AT THE LANGUAGE MEASURES THAT WE GOT AT THESE DIFFERENT AGES WERE DONE WITH DIFFERENT INSTRUMENTS, SO WE HAD TO DO A LOT OF FACTOR ANALYSIS AND TO EVALUATE AND SHOW THAT IN FACT WE WERE MEASURING THE SAME LANGUAGE TRAIT ACROSS THESE, EVEN THOUGH THE MEASURES THEMSELVES WERE DIFFERENT, AND IN FACT WE WERE FINDING THAT THEY WERE. SO WHAT WE FOUND WAS THAT THERE WAS -- THE KEY THING WE WERE LOOKING FOR WAS EITHER AN SII EFFECT ITSELF, MAIN EFFECT, WHICH WE DIDN'T FIND, BUT WE DID SEE AN AGE BY SII EFFECT, WHICH SAYS THAT AT 2 YEARS OF AGE, THE DIFFERENTIAL AMOUNT OF AUDABILITY THE CHILDREN WERE GETTING DIDN'T SEEM TO BE MAKING A LOT OF DIFFERENCE WITH REGARD TO THEIR LANGUAGE, BUT AS WE MOVED ON OUT, 6 YEARS OF AGE, EFFECT SEEMED TO SHOW UP AND SEEMS TO BE A CUMULATIVE EFFECT. WE START WITH NO EFFECT. AT THIS POINT WE'RE GETTING THE DIFFERENCE BETWEEN THESE SCORES AND THESE SCORES ARE ABOUT 3/4 OF THE STANDARD DEVIATION. THE CHILDREN WITH LOWEST LEVELS OF AUDIBILITY SHOWED FLAT GROWTH, WHICH MEANS THEY WERE JUST ON COURSE, STANDARD SCORES. WE'RE SEEING HERE THE CHILDREN WHO HAD HIGH LEVELS OF AUDIBILITY WERE ACTUALLY SHOWING GAINS, AND TEASE ARE GAINS RELATIVE TO HEARING CHILDREN. SO THEY ARE SHOWING INITIALLY, THEY ARE BEHIND, A LITTLE BIT BEHIND THEIR HEARING PEERS, AND OVER TIME THEY ARE ACTUALLY IMPROVING AND CATCHING UP. SO THESE DATA SHOW US THAT IN FACT THE HEARING AID ITSELF AND THE DEGREE TO WHICH THE HEARING AID IS PROVIDING GOOD LEVELS OF AUDIBILITY ARE PROVIDING A BENEFIT DURING THE PRESCHOOL YEARS TO THE CHILDREN'S LANGUAGE GROWTH. HAVING BENEFIT FROM THE HEARING AID REQUIRES THAT THE HEARING AID BE WORN. AND SO WE LOOKED AT THAT AS WELL. ANOTHER MEASUREMENT ISSUE HERE, WE WANTED TO KNOW ABOUT THE CHILD'S DAILY USE OF THE HEARING AID. THE WAY THAT'S TYPICALLY DONE IS ASK PARENTS TO REPORT ON HOW MUCH THE CHILD IS WEARING THE AID. FORTUNATELY FOR MANY OF THESE CHILDREN THEY WERE WEARING DIGITAL HEARING AIDS THAT HAVE ALGORITHMS IN THEM THAT STORE THE AMOUNT OF TIME THAT THE HEARING AID IS ON. WE CAN ASSUME IF IT'S ON THE CHILD IS PROBABLY WEARING IT. SO WE DECIDED TO LOOK AT THE VALIDITY OF THE PARENT REPORT BECAUSE THERE WAS A LOT OF QUESTION ABOUT THAT, TO THE DATA LOG, AND YOU CAN SEE THERE WAS A STRONG CORRELATION. BUT WE ALSO LEARNED THAT PARENTS TEND TO OVERESTIMATE BY TWO HOURS A DAY. SO THIS GAVE US CONFIDENCE THAT IN FACT THOUGH THE PARENT REPORT WAS ACCURATE IN SO FAR AS AT LEAST IT TOLD US THE CHILDREN -- PARENTS WOULD WERE REPORTING A LOT OF USE, THEY PROBABLY WERE, RELATIVE TO THE CHILDREN THAT WERE BEING REPORTED TO HAVE LOWER USE. SO THEN AGAIN, WE LOOKED AT A LONGITUDINAL LOOK USING MIXED MODELING TO SEE IF IN FACT THE AMOUNT OF HEARING AID USE MATTERED WITH REGARD TO THEIR LANGUAGE DEVELOPMENT, AND WHAT WE SEE HERE IS CHILDREN, THESE ARE ALL QUARTILES, WEARING MORE THAN THAN TEN HOURS A DAY, IMPROVEMENT. LESS THAN TEN HOURS, TRANSLATE WITH DATA LOGGING, LESS THAN EIGHT HOURS A DAY, THOSE CHILDREN ARE SHOWING NO EFFECT THERE. AND SO WE CAN SEE AGAIN THAT THE DEGREE TO WHICH THE CHILD WEARS THE HEARING AID IN FACT DOES MATTER. IT CONFIRMS IN FACT IT'S ANOTHER SORT OF DOSE INDICATOR THAT HEARING AIDS IN FACT ARE PROVIDING BENEFIT. SO, WE'RE ABLE TO CONCLUDE FROM THIS THAT THE DEGREE TO WHICH THE CHILD OBTAINS MORE SPEECH INFORMATION IS PROVIDED BY THE HEARING AID IS BENEFICIAL, AND FURTHERMORE, THAT THE GREATER THE DAILY USE, AT LEAST THE MORE THEY USE IT, IF THEY USE IT LESS THAN 8 HOURS A DAY IT'S DELETERIOUS, PERHAPS MORE THAN THAT IS PROBABLY VERY -- VARIANCE IS NOT TOO IMPORTANT. HEARING AIDS, ALTHOUGH PROSTHESES FOR HEARING, ARE ALSO FOR SPEECH AND LANGUAGE DEVELOPMENT AS WELL IN CHILDREN. SO AND THESE ARE ALL OF MY COLLEAGUES THAT HELPED PULL THIS OFF. SO THANK YOU. >> COME UP TO THE STATE. WE'RE GETTING CLOSE TO THE END OF THE SESSION BUT WE WANT TO TAKE AT LEAST A COUPLE MINUTES TO GET SOME QUESTIONS AND ANSWERS, PLEASE START THINKING OF THOSE. WE DO HAVE TO USE THE MICROPHONES IF YOU CAN. DON'T MAKE ME ASK A QUESTION. I HAVE QUESTIONS BUT I'D RATHER HEAR FROM THE AUDIENCE. AWESOME, THANK YOU. >> I'M AT NYU SCHOOL OF MEDICINE. GREAT PRESENTATIONS. THE QUESTION IS FOR E Y. I WAS CURIOUS HOW WE COULD LEARN MORE ABOUT YOUR METHODS AND IF IT YOU DO ANY TRAININGS, AND THEN KIND OF SINCE YOU DID HAVE A SERIES OF PAPERS, CRITIQUING THE FOXCRAFT PAPERS, IF YOU HAD RESERVATIONS CRITIQUING OTHER RESEARCHERS AND LESSONS LEARNED ABOUT THAT SINCE PEOPLE CAN BE TENTATIVE ABOUT CRITIQUING PEERS. >> YES. ACTUALLY, ONE OF MY CO-AUTHOR'S DATA WAS SERIOUSLY MISREPRESENTED IN THE FOXCROFT ET AL. REVIEW PAPER. I WAS USING HIS DATA AS PART OF THE LARGER STUDY, AS I WAS DISCUSSING HE GOT INCREASINGLY UNHAPPY AND HE THOUGHT IT'S IMPORTANT TO DISCUSS WITH A WIDER RANGE OF I GUESS PEOPLE WORKING IN THE FIELD. AND THAT'S WHAT WE DID. AND I ACTUALLY RECEIVED A LOT OF COMPLIMENTS AFTER THE PAPER THAT CAME OUT BUT THE PROBLEM NOW IS THIS. IN THE 2015 ONE THEY SAID, LOOK, YOU ALSO HAVE SIMILAR CONCLUSIONS AS WHAT WE HAVE, SO WHY DO YOU CRITICIZE OUR WORK, IN A WAY, SO MY APPROACH TO THIS IS THIS. CONCLUSION MAY BE SIMILAR, BUT THE WAY YOU REACHED THESE TWO CONCLUSIONS ARE DRASTICALLY DIFFERENT, AND THAT'S ALL THE IMPORTANT THINGS ABOUT I GUESS SCIENTIFIC RIGOR AND ROBUSTNESS OF THE METHOD THAT WE'RE USING, SO I THINK IT MAKES A DIFFERENCE, NUMBER ONE. NUMBER TWO, WHEN WE CONCLUDED THAT MOTIVATIONAL INTERVENTION MAY NOT BE AS POWERFUL AS PEOPLE THINK, I WAS TRYING TO TELL VERY EXUBERANT AND VERY ENTHUSIASTIC DISSEMINATION FOLKS TO CURB OUR ENTHUSIASM SO THAT MAYBE WE CAN SEE WHAT WE'RE MISSING SO WE CAN IMPROVE IT BETTER. BUT WITH THEIR CONCLUSION, THEY WERE ACTUALLY MAKING A CONCLUSION THAT CANNOT BE BACKED BY EVIDENCE THEY GENERATED. FIRST OF ALL, WE CANNOT REALLY TRUST THE EVIDENCE IS CORRECT, BUT EVEN IF WE SAID IT'S CORRECT THAT'S OVERREACHING, IN MY VIEW. AND I GUESS I WAS DISCUSSING HOW TO SOLVE THIS PROBLEM, I WAS DISCUSSING WHETHER WE SHOULD TALK ABOUT IT AT RSA, SOME PEOPLE SAID, NO, BECAUSE IT'S PREACHING TO THE CHOIR, SHOULD I TALK ABOUT IT IN ANOTHER JOURNAL, NO, IT'S THE SAME THING. A CAMP WAS SKEPTICAL, ENTHUSIASTIC FOLKS WHO THINK EVERYTHING GOES, SO A LITTLE BIT OF DILEMMA HERE. HOW TO ACTUALLY USE THIS KIND OF METHOD, YOU MAY HAVE TO WAIT BECAUSE RIGHT NOW THERE ARE NO SOFTWARE THAT YOU CAN USE TO LINK THEM TOGETHER, WE'RE ACTUALLY DEVELOPING STATISTICAL THEORY, APPLIED IN BIOSTATISTICS, DO A LOT OF SIMULATION, WE WRITE THE PROCESS FOR STAGES, FOR THEM TO BE TRANSLATING TO APPLICATION SITE IT MAY TAKE A WHILE BUT THAT'S THE ULTIMATE GOAL. >> THANK YOU. >> AND JUST AS A FOLLOW-UP, THE PRISSMA TOOL IS CHECK LIST OR GUIDELINE TO WHAT A GOOD QUALITY SYSTEMATIC REVIEW OR META-ANALYSIS IS, SO IN YOUR OPINION THEN THAT MEASURE IS NOT -- IS IT NOT SUFFICIENT, IT'S NOT CAPTURING ENOUGH? SOUNDS LIKE ONE OF THE BIGGEST ISSUES IS THAT THE METHODS USED ARE NOT RIGOROUS IN THIS EXAMPLE THAT YOU'VE IDENTIFIED. IS THE PRISMA TOOL NOT ENOUGH OR THEY WERE NOT USING THE RULES. >> LAST TIME THEY DIDN'T FOLLOW VERY WELL. THIS TIME I THINK THEY DID IT BETTER FOR 2016, BUT IT'S MET FOLLOWING THE GUIDELINES, NUMBER ONE, AND NUMBER TWO IS HOW BADLY DO YOU EXECUTE AT STEPS, RIGHT? THE FIRST TIME AROUND I THINK -- OKAY. WE POINT OUT, YOUR TEAM DOESN'T HAVE CONTENT EXPERTS, SO YOU CANNOT POSSIBLY -- I MEAN, THAT'S WHY YOU HAVE A LOT OF ERRORS, OMITTING A STUDY, INCLUDING A STUDY, YOU SHOULDN'T HAVE -- THINGS OF THAT NATURE. AND THEY COME BACK AND SAID, COCHRANE REVIEW GUIDELINES TO NOT REQUIRE CONTENT EXPERTS TO BE INCLUDED. BUT THERE ARE OTHER GUIDELINES, LET'S SAY APA GUIDELINES, DIFFERENT FROM THE OTHER GUIDELINES SO I THINK LACK OF CONTENT EXPERT ON THEIR TEAM IS A SERIOUS PROBLEM WHEN THEY ARE MAKING VERY UNILATERAL PROVOCATIVE CONCLUSIONS ABOUT USEFULNESS OF AN INTERVENTION. >> ALL RIGHT. ANYBODY ELSE? I'LL ASK ONE QUESTION. HOPING THIS WILL BE INTERESTING TO THE WHOLE GROUP AND THIS COULD BE TO ANYBODY ON THE PANEL. SOME OF YOU MENTIONED -- FIRST LET ME SAY THERE'S A LOT OF, YOU KNOW, TELLING PEOPLE SCIENTISTS, YOU HAVE TO USE THE SAME MEASURE, COMBINE DATA. SOME SAID, WELL, WE USED A SIMILAR MEASURE, WEREN'T THE SAME ONES, WE HAD TO FIGURE OUT HOW TO COMBINE THEM. TALK MORE ABOUT THAT AND MAYBE WHAT IS THE MINIMAL CHARACTERISTICS OF A MEASURE TO COMBINE THEM, THAT WOULD BE HELPFUL FOR PEOPLE HERE. >> OKAY. MATHEMATICALLY, ONE ITEM ACROSS TWO DIFFERENT TRIAL, AND THAT CONSTRUCT IS UNIDIMENSIONAL IN NATURE, YOU CAN ACTUALLY LINK THEM TOGETHER. A LOT OF EDUCATIONAL TESTING EXPERTS DO, BUT WHEN YOU HAVE ONLY ONE COMMON ITEM, THE LINK CAN BE TENUOUS AND WE CANNOT POSSIBLY HAVE A VERY GOOD TRUST IN THE LINKED ESTIMATE, SO I GUESS IN IDEAL SITUATION YOU WANT A LITTLE BIT MORE ITEMS THAT ARE COMMON ACROSS, AND WHEN IT BECOMES BIDIMENSIONAL, OR MULTI-DIMENSIONAL, THE REQUIREMENT WILL GET A LITTLE BIT MORE. BUT IN MY EXPERIENCE, LET SAY I CORRELATE A PROBLEM, A SET USING NUMBER OF QUESTIONNAIRES IN EACH STUDY, SO THERE WAS A NICE LINK, SO THEY WERE LIKE 60, 70 ITEMS, SO THEY ARE NATURALLY -- NOT NATURALLY, THERE WERE VERY MANY NUMBER OF ITEMS THAT COULD BE LINKED. >> GREAT. THANK YOU. >> I WOULD AGREE, IT SEEMS TO ME THOUGH THE REAL SOLUTION IS TO LOOK AT THE DIMENSIONALITY OF THE MEASURES. AND EVEN THOUGH THE MANIFEST MEASURES MAY APPEAR TO LOOK DIFFERENT, IF THE LATENT CONSTRUCTS IN FACT ARGUE THAT IN FACT THEY ARE ALL REFLECTIVE OF THE SAME LATENT TRAIT, THEN COMBINE THEM, MY AREA OF LANGUAGE THERE'S A GREAT DEAL OF STRUGGLE OVER THAT BECAUSE WE HAVE MANY DIFFERENT LANGUAGE MEASURES, AND A GENERAL BELIEF THAT IF WE CALL IT SOMETHING DIFFERENT, IT IS DIFFERENT. AND YET I'VE SPENT A LOT OF TIME LOOKING AT THE ITEM LEVEL, THE TEST LEVEL IN TERMS OF DIMENSIONALITY, AND I'VE BEEN SHOCKED TO FIND HOW LOW THE DIMENSIONALITY IS FOR SOMETHING AS COMPLEX AS LANGUAGE. AT LEAST IN CHILDREN. IT COULD BE THAT OUR MEASURES ARE THE BOTTLENECK, BUT THERE'S JUST VERY LITTLE DIMENSIONALITY THAT I CAN GET OUT OF IT, AND WHICH I SEE AS AN ADVANTAGE FOR SOME THINGS, BECAUSE THEN THE CROSS-RESEARCH PROJECTS I DO WORK IN THE AREA OF GENETICS AND LANGUAGE, AND THERE ARE NOW -- THERE'S A LOT OF PRESSURE TO COMBINE DATASETS TO GET 10,000 SUBJECTS AND VERY FEW OF THOSE HAVE ALL USED THE SAME MEASURES, AND SO BUT MY DATA WOULD SAY YOU'RE PROBABLY ALL THINKING YOU'RE LOOKING AT THE SAME THING WITH SOMEWHAT DIFFERENT THINGS. SO I GUESS IT'S JUST THE -- YOU NEED TO DO THE MEASUREMENT RESEARCH TO SUPPORT THAT, AND IF IT DOES, THEN YOU SHOULD BE OKAY. >> GREAT. OKAY. ON THAT OPTIMISTIC NOTE WE'LL STOP HERE. PLEASE JOIN ME IN CONGRATULATING THE PANEL AND THANKING THEM. THEY DID A GREAT JOB. [APPLAUSE] I'M GOING TO GET OFF THE STAGE AND LET SOMEBODY ELSE COME ON. >> WE COULD GET EVERYBODY TOGETHER AFTER THE BREAK. WHAT A NICE PANEL, THE LAST PANEL WAS GREAT. OUR LAST PANEL IS RESEARCH AND PRACTICE, WE'RE PLEASED TO HAVE GILA NETA MODERATE. WE'VE MADE NICE STRIDES, THANK YOU. LIFE STRIDES AND DISSEMINATION RESEARCH. IT'S BEEN PEOPLE LIKE GILA WHO HAVE DONE A NICE JOB, HER MOVING THAT FORWARD AT THE NIH MAKING SURE WE GET THAT KIND OF WORK DONE. GILA, THANK YOU. >> THANKS, BILL. THANKS, EVERYONE. SO THAT SLIDE HAS ALREADY BEEN COVERED. SOME OF YOU MAY HAVE SEEN THIS, BUT I THOUGHT THIS WAS A GOOD CARTOON, ILLUSTRATING THE CHARGE OF THIS PANEL, AND YOU ALL HAVE HEARD A LOT OF GREAT TALKS ABOUT RESEARCH AND RESEARCH INFRASTRUCTURE BUT I THINK SORT OF THE ULTIMATE QUESTION IS, YOU KNOW, WHAT SHOULD WE REALLY DO WITH ALL OF THIS RESEARCH, AND THAT'S PART OF WHAT WE THINK ABOUT IN IMPLEMENTATION SCIENCE, AND THIS GRAPHIC ILLUSTRATES WHAT HAPPENS IF WE AREN'T THINKING ABOUT WHAT WE SHOULD DO WITH OUR RESEARCH AND WE JUST SIT BACK AND PUBLISH, WHICH IS THE USUAL THING, AND YOU KNOW MORE. HERE YOU CAN SEE IN THIS SO-CALLED PUBLICATION PATHWAY, ON THE -- ON YOUR LEFT SIDE THOSE ARE SORT OF THE LEAKS IN THE PIPE, THE NEGATIVE RESULTS, GOING FROM RESEARCH TO SUBMISSION, ACCEPTANCE, PUBLICATION, AND LACK OF NUMBERS AND LACK OF CONSISTENT INDEX, FROM RESEARCH TO IMPLEMENTATION OF WHATEVER THE FINDINGS ARE. ON THE RIGHT SIDE YOU SEE RATE OF FLOW, SO TO SPEAK. SO WHAT THESE RESEARCHERS FOUND WHEN THEY REVIEWED, THEY REVIEWED SIX AREAS, SIX LARGE AREAS OF RESEARCH, AND ESTIMATEDDED IT TAKES 17 YEARS TO TURN 14% OF ORIGINAL SEARCH TO THE BENEFIT OF PATIENT CARE. WE NEED TO DO A BETTER JOB. PART OF THE PROBLEM IS WE ASSUME IF YOU BUILD IT, JUST BECAUSE WE GENERATE EVIDENCE DOESN'T NECESSARILY MEAN ANYBODY WANTS TO USE IT OR NEEDS IT. AND SO THINKING ABOUT BEYOND THE EVIDENCE, EVIDENCE IS ONLY AS GOOD AS HOW AND WHETHER PEOPLE ARE GOING TO ADOPT IT. WHETHER PRACTITIONERS ARE TRAINED TO USE IT, AND OF THOSE PRACTITIONE TRAINED TO USE IT WHETHER THEY ACTUALLY CHOOSE TO USE IT. AND WHETHER OF THOSE WHO CHOOSE TO USE IT, WHETHER THEIR PATIENT POPULATIONS ACTUALLY BENEFIT FROM IT. SO IF YOU ASSUME 50% THRESHOLD FOR EACH STEP, WHICH AS I UNDERSTAND IN BEHAVIORAL AND SOCIAL SERVICES RESEARCH IS QUITE A LARGE THRESHOLD ACTUALLY AND IN IMPLEMENTATION SCIENCE EVEN, AND YOU ASSUME PERFECT ACCESS, ADHERENCE, DOSAGE AND MAINTENANCE, YOU STILL ONLY SEE A 6% BENEFIT. SO WE REALLY NEED TO DO A BETTER JOB OF REALLY THINKING ABOUT THESE THINGS, AND THINKING ABOUT THE REACH. THIS IS THE REAIM FRAMEWORK WHICH YOU MAY BE FAMILIAR WITH, ORIGINALLY DEVELOPED AS EVALUATION FRAMEWORK BUT OFTEN USED BY MANY RESEARCHERS TO THINK THROUGH WHAT THE -- THE SO-WHAT OF RESEARCH AND IF THEY ARE THINKING ABOUT IMPLEMENTATION, WHAT ARE THE DIMENSIONS THAT THEY NEED TO BE THINKING ABOUT, THE REACH, EFFECTIVENESS, ADOPTION, ION, IMPLEMENTATION AND MAINTENANCE. THIS IS SORT OF TRANSLATIONAL RESEARCH SPECTRUM FROM BASIC SCIENCE TO DISSEMINATION AND IMPLEMENTATION STUDIES, AND BASICALLY THE POINT I WANTED TO HIGHLIGHT HERE, AND I THINK PART OF THE CHARGE OF THE PANEL, WHATEVER STAGE YOU'RE AT, AND I WOULD HAVE ADDED ANOTHER CIRCLE AROUND THAT VERY FIRST ORANGE CIRCLE, BUT THESE ARE THE KINDS OF THINGS THAT WE CAN BE THINKING ABOUT EARLIER ON, AND WHAT YOU'LL BE HEARING FROM THE PANELISTS IS NOT ONLY ABOUT THEIR RESEARCH BUT WAYS IN WHICH THEY ARE THINKING ABOUT ADOPTION AND SOME QUESTIONS TO CONSIDER. SO WITH THAT, I'D LIKE TO INTRODUCE THE PANELISTS. WE'LL FIRST BE HEARING FROM DR. SARAH GEHLERT, WHO IS PROFESSOR OF RACIAL AND ETHNIC DIVERSITY BROWN SCHOOL, PROFESSOR IN DEPARTMENT OF SURGERY OF THE SCHOOL OF MEDICINE AND SCHOLAR IN WASHINGTON UNIVERSITY'S INSTITUTE OF PUBLIC HEALTH. DR. GEHLERT IS PRO PROGRAM LEADERS OF PREVENTION AND CONTROL PROGRAM OF ALVIN J. SITEMAN CANCER CENTER AND ALSO CO-DIRECTOR OF TRANSDISCIPLINARY CENTER ON ENERGETICS AND CANCER, AT NCI WE KNOW AS TREC. SO WELCOME, SARAH, AND THANK YOU. [APPLAUSE] >> GOOD AFTERNOON. I'M GOING TO TALK ABOUT THE EFFORTS WE'VE TAKEN TO SPEED TRANSLATION. IN MY 20 MINUTES I'M GOING TO DESCRIBE THE TREC INITIATIVE, WE'VE ALREADY HEARD WHAT IT'S CALLED, WE REFER TO IT AS TREC, THE TREC AT WASHINGTON UNIVERSITY LINKS TRANSDISCIPLINARY TEAM SCIENCE TO TRANSLATION IN THE WASHINGTON UNIVERSITY TREC, OUTLINE A LONGITUDINAL SURVEY OF THE GROWTH OF TREC AND TIES AND RESULTS AND SUGGEST MECHANISMS FOR INCREASING RESEARCH CAPACITY TO MOVE TOWARD TRANSLATION, AND ARTICULATE SOME OF THE LESSONS WE'VE LEARNED. SO, TREC IS AT NCI USE OF D 4 MECHANISM WITH THE MISSION OF INTEGRATING DIVERSE DISCIPLINE TO FIND EFFECTIVE INTERVENTIONS ACROSS THE LIFESPAN TO REDUCE BURDEN OF OBESITY IN CANCER AND IMPROVE POPULATION HEALTH. I WANT TO SHOW YOU THE STRUCTURE. FOUR RESEARCH PROJECTS UNIVERSITY OF CALIFORNIA SAN DIEGO, HAR PARDON, SAN DIEGO, WASHINGTON UNIVERSITY AND A FIFTH SITE AT THE HUTCH CANCER CENTER. THERE ARE OVER 116 INVESTIGATORS FROM 30 DISCIPLINES. I'VE SHOWN YOU 17 OF THE 30 DISCIPLINES BECAUSE THEY WOULDN'T ALL FIT ON THE SLIDE. WE'RE REALLY TALKING ABOUT THE SECOND FUNDING CYCLE OF TREC. SO I'VE GOT TOO MANY DEVICES HERE. SO WASH-U TREC WE'LL TALK ABOUT FIRST. WASH-U TREK IS TO ACCELERATE THE MARCH FROM DISCOVERY TO POPULATION CHANGE, NOT REAL TOO AMBITIOUS, IS IT? AND IT'S TRANSITIONAL RESEARCH, MAY INVOLVE DIRECT INTERACTION BETWEEN PROJECTS AND THE FEEDBACK OF RESULTS, I'M GOING TO ILLUSTRATE THAT IN A SECOND. IT MIGHT PRODUCE DISTINCT SCIENTIFIC FINDINGS THAT ACCELERATE BY CAPITAL CAPITALIZING ON RESULTS FROM INDIVIDUAL PROJECTS. THIS IS BIDDY. I REDUCED TO TWO PROJECTS INSTEAD OF FOUR TO MAKE A POINT. AND YOU'VE GOT FOUR RESOURCES, AND THEN HERE WE'VE GOT BOTH PROJECTS INTERACTIONS BETWEEN THE PROJECTS YOU'VE GOT INTERACTIONS BETWEEN THE PROJECTS BUT YOU'VE GOT THE FEEDBACK OF RESULTS FROM ONE PROJECT TO THE OTHER PROJECT. AND THEN WE THINK FROM THE INTERACTIONS AND FEEDBACK YOU'VE GOT TRANSLATION OF INDIVIDUAL PROJECTS BUT YOU'VE ALSO GOT SOMETHING GREATSER, THE TRANSLATION OF RESULTS FROM THE CENTER AS A WHOLE. THAT'S WHAT I'M TALKING ABOUT TODAY. THIS IS ANOTHER WAY OF LOOKING AT IT. SOMETHING I PUBLISHED A FEW YEARS AGO. EPISTUDIES, REALLY THE KNOWLEDGE WAS DISSEMINATED TO THOSE DISCIPLINESR WHAT WE'VE DONE IS CREATE AN INCUBATOR, FOSTERING TRANSLATION BY FOCUSING ON APPLICATIONS, AND INCREASING LIKELIHOOD OF PUBLISHING IN JOURNALS THAT CROSS-CUT DISCIPLINES AND HAVE A BROADER LEADERSHIP, THAT'S THE DISSEMINATION BEAUTY OF THE EFFORT. AND THIS IS THE WASH U TREC, IF WE LOOK HERE PROJECT ONE WAS PRETTY MUCH BASIC SCIENCE, PROSTATE PROLIFERATION FROM PUPS FROM A HIGH FAT DIET DURING MATERNAL PREGNANCY. PROJECT TWO WAS PROSTATE OUTCOMES, IT WAS INTERESTING BEFORE WE BEGAN WHEN WE MET AND WERE WRITING THE APPLICATION, KELLY MOLEY, WHO WAS THE LEADER OF THE FIRST PROJECT, PLANNED ON USING FEMALE PUPS. AND LOOKING AT BREAST CANCER, BUT BECAUSE SHE MET THE PEOPLE FROM PROJECT, SHE SWITCHED TO MALE PUPS. SHE'S AN OB/GYN AND HADN'T WORKED WITH MALE PUPS. PROJECT 3, DETERMINING THE ROLE OF WORKPLACE POLICY IN SHAPING OBESEOGENIC BEHAVIORS. PROJECT 4 IS RUN BY OUR SYSTEMS MODELING LAB, AND IT'S MODEL BUILDING OF THE SOCIAL DETERMINANTS OF OBESITY IN NON-HODGKIN LYMPHOMA THROUGH STAKEHOLDER ENGAGEMENT. THESE ARE THE THINGS THAT WERE GOING ON, AND AS I TOLD YOU, THERE WAS SOME INTERACTION, BUT REALLY THERE WERE SEPARATE ENTITIES AT THAT POINT. SO WHAT WE DID TO TRY TO FOSTER COMMUNICATION AND COLLABORATION AMONG ALL THE INVESTIGATORS AND ALL THE PROJECTS, WHEN YOU THINK ABOUT IT, THE CHALLENGE OF COLLABORATION OCCURS AT THREE LEVELS, THE FIRST IS WITH INVESTIGATORS WITH ANY ONE PROJECT, THEN YOU'VE GOT PROJECTS WITHIN A CENTER, SECOND CHALLENGE, AND THEN COLLABORATION BETWEEN THE CENTERS IN THE INITIATIVE. YOU'RE TRYING TO COORDINATE ALL THAT MAXIMIZE COMMUNICATION, SO ONE THING THAT WE DID TO FOSTER COMMUNICATION AND COLLABORATION WAS BRING IN EXPERTS FROM OUTSIDE. WE THOUGHT THEY WERE GOING TO GIVE FEEDBACK BUT WHAT HAPPENED WAS THAT THEY REALLY KEPT US FOCUSING ON THE BIGGER PICTURE BECAUSE WHEN YOU'RE WORKING IN A PROJECT, YOU'RE TRYING TO DEAL WITH DAY TO DAY ISSUES AND TRYING TO GET YOUR SPECIFIC AIMS MET. AND WHEN WE WOULD BRING IN THESE EXPERTS FROM AROUND THE COUNTRY, THEY WOULD SAY, OH, LOOK AT THE POSSIBILITIES OF COLLABORATION. THAT WAS INVALUABLE. THEY WEREN'T -- THEY DIDN'T HAVE TO DEAL WITH DAY-TO-DAY OPERATIONS OR SPECIFIC AIMS. WE ALSO INCLUDED ON THAT ADVISORY PANEL THE DIRECTOR OF THE ST. LOUIS COUNTY DEPARTMENT OF HEALTH, BECAUSE WE WANTED HER TO KEEP OUR FEET TO THE FIRE IN TERMS OF CLINICAL APPLICATIONS, AND SHE DID. SO ONE OF THE THINGS WE DID AT THE VERY BEGINNING WAS TO BRING ALL THE INVESTIGATORS INTO THE SAME ROOM AND BASICALLY LOCK THE DOOR FOR ABOUT 6 HOURS, AND WE HAD A ROOM WHERE YOU WOULD WRITE ON THE WALLS, WE BROUGHT IN AN EXTERNAL FACILITATOR, CANCER RESEARCHER, SHE HELPED US UNDERSTAND HOW EACH PROJECT AND EACH PERSON'S INTERESTS FIT INTO A LARGER HOLE WHICH ALSO IS INVALUABLE. SO WE CAME UP WITH A SHARED MODEL. AND WHAT WE FIRST CAME UP WITH WAS EXPOSURE AT THE MULTIPLE LEVEL OF INFLUENCE ACROSS THE LIFE COURSE LEAD TO INEFFICIENCY IN CANCER PREVENTION DIAGNOSIS AND TREATMENT WHICH LEADS TO INCREASED BURDEN OF CANCER IN MISSOURI. AND EACH INVESTIGATOR SITUATED HERSELF OR HIMSELF IN THE MODEL, SO WE'VE GOT EPIGENETICS HERE, WE'VE GOT MEDICAL ONCOLOGY HERE, WE'VE GOT UROLOGY HERE, WE'VE GOT POPULATION EPIHERE, AND THAT WAS REALLY VALUABLE, BECAUSE WE SAW THE BIGGER HOLE AND EVERY PERSON KNEW WHERE THEY FIT INTO THE PICTURE. AND WE TURNED IT A LITTLE BIT TO IDENTIFY EXPOSURES, PRODUCE EFFICIENCY IN CANCER PREVENTION AND TREATMENT AND DECREASE BURDEN OF CANCER IN MISSOURI. AND YOU SEE I'VE ADDED THE FOUR PROJECTS HERE. AND AGAIN, EVERYBODY BEGAN TO SEE WHERE THEY FIT IN, AND THE THING IS YOU KNEW THAT FOR US TO ANSWER THE BIGGER QUESTIONS, AND REALLY TO GET TO WHERE WE WANTED TO BE, WHICH IS AT THE BOTTOM, WE HAD TO WORK TOGETHER. EVERYBODY'S WORK WAS IMPORTANT. SO, WE DECIDED TO INVESTIGATE THE TREC TIES ACROSS THE FIVE SITES. THE FOUR RESEARCH SITES AND COORDINATION CENTER, AND THIS KIND OF FELL TO ME, WHICH WAS A GOOD THING. WHAT WE DID WAS DEVELOP A SURVEY AND WE SURVEYED ONE YEAR INTO THE TREC INITIATIVE AND THEN EVERY YEAR AFTER SO WE HAD FOUR SURVEYS OF THE 116+ INVESTIGATORS, IT SAYS 2011-2013, WHICH JOURNAL REVIEWERS WERE QUICK TO POINT OUT WITH MORE THAN A YEAR, BUT IT WAS 13 MONTHS. AND WHAT EVERY INVESTIGATOR GOT A LIST OF EVERY OTHER INVESTIGATOR AT THE SITES, SO ALL 116 STARTING OUT, AND WE ASKED THEM TO INDICATE IF THEY WERE CURRENTLY WORKING WITH THAT PERSON AND I'M GOING TO GIVE YOU IN WHAT AREAS AND IF THEY EVER WORKED WITH THEM. WE WANTED TO SEE IF THEY HAD TIES BEFORE OR DEVELOPED TIES THROUGH TRECs. WE ASKED THEM ABOUT WHETHER THEY HAD WORKED WITH THAT PERSON IN A STUDY OR GRANT. CO-AUTHORED PUBLICATIONS. CO-AUTHORED PRESENTATIONS. MENTORING OR TRAINING. SUBCOMMITTEE OR GROUP WORK, AND OTHER WE USED SOCIAL NETWORK ANALYSIS TO UNDERSTAND WHAT WAS GOING ON. SOCIAL NETWORK ANALYSIS HOLDS DENSER NETWORKS SUGGEST FASTER PROPAGATION OF IDEAS AND INFORMATION. AND SO WE DEFINE DENSITY AS ACTUAL TIES OVER THE NUMBER OF POSSIBLE TIES. HERE THAT'S NOT THE POINTER. EACH OF THESE CIRCLES OR DOTS IS AN INVESTIGATOR. AND THE LINES BETWEEN THEM ARE TIES. AND HERE WE HAVE A PRETTY DENSE NETWORK, EVERY INVESTIGATOR IS PRETTY MUCH -- WE CALL THOSE NODES. COMMUNICATING WITH EVERY OTHER INVESTIGATOR. HERE IS A LESS DENSE NETWORK, BECAUSE THE COMMUNICATION IS HAPPENING REALLY THROUGH TWO INDIVIDUALS. THAT'S LESS DESIRABLE. AND WHEN WE -- THIS IS JUST ONE SCHEME. YOU CAN SEE WE HAVE CATEGORIES OF DISCIPLINES HERE. WE PUT THE 30-SOME INTO CATEGORIES. YOU CAN SEE HOW MANY INVESTIGATORS THERE WERE OF EACH TYPE OVER TIME. IT DIDN'T CHANGE THAT MUCH. WE SORT OF INCREASED I THINK IN EPI AND BROUGHT ON MORE STATISTICIANS, NOT SURPRISING. THE NETWORK SIZE VARIED, GREW A LITTLE BIT. WE HAD BY THE WAY AT LEAST AN 85% RATE EACH TIME. AND SURPRISINGLY PERHAPS YOU SEE THE DENSITY DIDN'T CHANGE THAT MUCH, SO WE'RE GOING TO GET BACK TO THAT. BUT I WANT TO SHOW YOU FIRST THE WASH U TREK. 13 MONTHS LATER IN 2013, AND AGAIN WE'VE COLOR-CODED THE NODES, EACH NODE IS AN INVESTIGATOR, AND YOU CAN SEE THIS, I'LL MAKE IT BIGGER IN THE NEXT SLIDES. AND THE NUMBER IS THE NUMBER OF THE INVESTIGATOR. AND A BIGGER NODE HERE MEANS THAT THAT PERSON HAD MORE CONNECTIONS, THEY WERE CONNECTING MORE INDIVIDUALS. THEY WERE BRINGING TOGETHER TWO INDIVIDUALS. IN TERMS OF SELF DISCLOSURE, THE BIG GREEN DOT IS ME. THE BIG BLUE DOT IS GRANT. A -- GRAHAM. MOST WERE BEING MADE BY ME AND GRAHAM, DIRECTOR AND CO-DIRECTOR. YOU SAW A NODE, IN A MEDICINE DOC, THE LEADER OF THE ANIMAL MODEL PROJECT. AND BY 13 MONTHS LATER, THE NICE THING WAS THAT MORE PEOPLE WERE EMERGING AS LEADERS. THEY WERE CONNECTING PEOPLE. SO YOU WANT TO BE DENSE. YOU WORRY ABOUT PEOPLE OUT ON THE PERIPHERY, ESPECIALLY THIS PERSON ONLY HAS ONE TIE. AND OTHER PEOPLE HAVE -- THIS ONE HAS ONE TIE. SO WE WERE ABLE THROUGH THIS ANALYSIS TO FIGURE OUT WHO WAS LESSEN LESS -- LESS ENGAGED, CLINICIANS OFF SIGHTSEEING PATIENTS. THIS IS KELLY MOLEY, LEADER OF PROJECT 1, AND WE WERE ABLE TO CHANGE THINGS AROUND SO THAT KELLY REALLY TRANSMITTED INFORMATION TO THESE PEOPLE THAT WERE ON SITE LESS OFTEN, SO THAT WORKED. THIS WAS NICE BECAUSE IT GAVE US A WAY OF CHANGING THINGS, CORRECTING MID-COURSE. GETTING BACK TO TREC AS A WHOLE, WE DIDN'T SEE CHANGE IN DENSITY, BUT WHEN WE LOOKED AT A WHOLE, WHAT WAS GOING ON BETWEEN THE SITES WE SAW SOMETHING DIFFERENT. HERE THE RATIO ACROSS THE PERCENTAGE OF CROSS-SITE TIES WAS ABOUT 15.66%, AND YOU CAN STILL SEE THE FIVE SITES. YOU CAN SORT OF FIGURE OUT THE COORDINATION CENTER WHERE IT SHOULD BE IN THE MIDDLE COORDINATING, HERE ARE THE SITES. WE'RE SITE C SO IT LOOKS LIKE WHAT YOU SAW ON THE LAST SLIDE. AND THE DISCIPLINE CATEGORIES ARE COLOR-CODED. THINGS WERE OPERATING -- OH, THE TIES WERE THROUGH GRANT'S PUBLICATIONS, MENTORSHIP, COMMITTEES AND AWARDS GROUPS ACROSS SITES. AS YOU GO THROUGH TIME IN 13 MONTHS LATER, THE PERCENTAGE OF CROSS-SITE TIES DOUBLED, WHICH SURPRISED US. YOU'RE LESS ABLE TO SEE WHAT IS WHICH SIDE UNLESS YOU LOOK AT LITTLE LETTERS. YOU BEGAN TO SEE STILL AT SOME SITES THESE INVESTIGATORS OPERATING ON THEIR OWN, SO THAT'S 13 MONTHS LATER. THIS IS 12 MONTHS AFTER THAT, CONTINUING TO GO UP AND YOU REALLY CAN'T TELL ONE SITE FROM ANOTHER. WE WORRIED ABOUT ONE SITE, WHICH MOST OF THE COMMUNICATION WAS THROUGH THE DIRECTOR, WHICH WAS AGAIN SUBOPTIMAL. BY 2015 YOU HAD TROUBLE TELLING ONE SITE FROM ANOTHER SO CROSS-SITE TIES WERE GOING UP, GROWING AGAIN. CROSS CITE TIEs WENT FROM 15% TO 40%, WITHIN SITE TIES WENT DOWN A BIT, INVESTIGATORS WERE BEGINNING TO LEVERAGE EXPERTISE AND RESOURCES ACROSS SITES OVER TIME. TWO OF THE SITES, HARVARD AND WASH U HAD HIGH SPEED GENE SEQUENCER AND WE BEGAN TO WORK ACROSS SITES. THE COLLABORATION OTHER TIME IS INTERESTING, SO YOU'VE GOT THE YEARS HERE AND YOU'VE GOT SOME GRANTS, AND THAT WENT UP. PUBLICATIONS DOUBLED, MORE THAN DOUBLED. PRESENTATIONS DOUBLED. MENTORSHIP WENT UP BUT INTERESTINGLY, COMMITTEES DIDN'T CHANGE MUCH. THEY WENT DOWN IF ANYTHING, WHICH MADE ME HAPPY, PERSONALLY. AND THE LESSONS, COMMITTEES SERVE AS SPRINGBOARDS FOR GRANT SUBMISSION AND MENTORSHIP, ONCE THE TIES ARE SET UP IT'S REALLY YOU DON'T NEED MEETINGS AS MUCH. SO DECIDED TO COMPARE TREC WITH ANOTHER INITIATIVE FUNDED BY MCI AND OTHER INSTITUTES AIMED AT BEING TRANSDISCIPLINARY TOO. I WAS SURPRISED WHEN I SAW THIS BECAUSE THEY ONLY HAD ONE WAVE OF DATA, WE'RE THE ONLY -- IT WAS DIFFICULT, WE'RE LUCKY TO HAVE FOUR WAVES OF DATA BUT WHEN YOU LOOK AT THE CROSS SITE TIES, ONE YEAR IN, SO REALLY THIS IS ONE YEAR IN AND THIS IS ONE YEAR IN, WE HAD TWICE AS MANY CROSS-SITE TIES. THEY HAD MORE WITHIN-SITE TIES, SO TRYING TO FIGURE THAT OUT WE FINALLY DISCOVERED THAT THE CENTERS FOR POPULATION HEALTH AND HEALTH DISPARITIES INVOLVED COMMUNITY-BASED PAICIPATORY RESEARCH. IT WAS A TARGET, WHICH MAY HAVE FOCUSED THEM MORE LOCALLY, RATHER THAN OUTWARDLY, FROM CENTERS WHILE TREC REALLY FOCUSED OUTWARD TO SHARE RESOURCES, RESOURCE US OF VARIOUS UNIVERSITIES. ANOTHER DIFFERENCE WAS THAT TREC HAD A COORDINATION CENTER WHILE HEALTH DISPARITIES DIDN'T, AND THAT TOOK OVER PLANNING OF SCIENTIFIC MEETINGS, IT ESTABLISHED WORK GROUPS, AND PROBABLY MOST IMPORTANTLY, IT HELPED DEVELOP CROSS-SITE DEVELOPMENTAL AWARDS, AND THOSE AWARDS REALLY INCENTIVIZED THE WORK ACROSS SITES. SO I THINK THAT WAS WHAT WAS GOING ON. THIS IS SOMETHING THAT KARA HALL DID, I THINK WHO IS IN THE BACK OF THE ROOM. BUT SHE WAS SHOWING THE FIRST FIVE YEARS OF TREC, IT WAS FOUR DIFFERENT RESEARCH SITES, AND THE TOBACCO RESEARCH RESEARCH CENTERS AND COMPARING THEM TO RO1 MECHANISMS, AND THEY NOTED A REAL LAG IN THE FIRST TWO TO THREE YEARS OF THE PROJECT, WHILE THINGS WERE -- THE TEAM SCIENCE WAS FINDING ITSELF. WE DIDN'T HAVE THE SAME LAG. SO THEY HAD FEWER THAN 10 PUBLICATIONS AFTER ONE YEAR. WE HAD 16. AND THEN WE ALSO LOOKED AT THE NUMBER OF PUBLICATIONS THAT WERE MULTI-DISCIPLINE AND THE NUMBER THAT WERE MULTI--- THAT INVOLVED MORE THAN ONE SITE. AND THE NUMBER THAT INVOLVED MORE THAN ONE SITE REALLY WENT UP. THESE ARE THE DATA FOR 2015, THEY ARE INCOMPLETE, DON'T EVEN LOOK AT THAT I'D SAY. SO THIS WAS SORT OF SURPRISING AND HEARTENING. AGAIN, WE'RE THINKING THAT IN MULTI-SITE MULTI-DISCIPLINARY PROBABLY GOING TO BE IN JOURNALS THAT HAVE A WIDER READERSHIP, WE'RE LOOKING INTO THAT NOW. SO, TO CONCLUDE, I WANTED TO SHOW YOU WHAT I THINK THE MECHANISMS WERE THAT MADE IT TURN OUT THE WAY IT DID. SO ONE THING THAT REALLY HELPED US TO MAXIMIZE THIS COLLABORATION COMMUNICATION WAS THE JOINT CONSTRUCTION OF THE UNIFIED MODEL BY ALL INVESTIGATORS, THAT WAS WORTH THE SIX HOURS. THEN WE REALLY HAD A CONTINUED DIALOGUE BETWEEN PROJECTS WITH ADJUSTMENT AND DESIGN AND MEASUREMENT AS NEEDED. WE TALKED CONSTANTLY. WE HAD INTERNAL AND EXTERNAL ADVISORY BOARDS, WHICH REALLY MADE A DIFFERENCE AS I TOLD YOU BEFORE, THEY COULD LOOK AT -- THEY COULD BROADEN OUR LENS WHEN WE TENDED TO SORT OF REGRESS TO THE MEAN OF LOOKING AT OUR OWN DISCIPLINES. ALSO IT WAS REALLY IMPORTANT TO TRACK THE COLLABORATION AND MAKE MID-COURSE CORRECTIONS. WE SPENT TIME COMMUNICATING WITH ADMINISTRATORS TO CHANGE OUR CULTURE, SOMETHING EXTERNAL ADVISORY BOARD BOB HYATT ACTUALLY URGED US TO DO SO I MARCHED TO THE CHANCELLOR'S OFFICE AND PROVOST'S OFFICE AND WE GOT SOME CHANGES MADE IN TENURE AND PROMOTION POLICY, AND IT ALLOWED US TO SUSTAIN CHANGES WE MADE IN THE CAMPUS CULTURE, ALSO THE INCENTIVES FOR KNOWLEDGE TRANSMISSION BETWEEN INVESTIGATORS, PROJECTS AND SIDES THROUGH THE DEVELOPMENTAL AWARDS REALLY MADE A DIFFERENCE. LESSONS LEARNED, WE LEARNED THAT GOOD EPIDEMIOLOGICAL METHODS NEED TO BE TIED TO MECHANISTIC BASIC SCIENCE STUDIES. NOT TO MENTION SOCIAL AND BEHAVIORAL. WE NEEDED TO ENGAGE MORE BASIC SCIENTISTS AND UNDERSTAND CANCER-RELATED CHANGES WHICH THEY DIDN'T, AND TO MAKE THE INTERVENTION RESEARCH ACCOUNTABLE TO CHANGE, TO CHANGE POPULATION HEALTH. SO AS WE HEARD, MANY INTERVENTION RESEARCHERS HAVE A SHELF FULL OF INTERVENTIONS, PUBLISHED IN JOURNALS, BUT NOT USED IN PRACTICE. SO DISSEMINATION AND IMPLEMENTATION RESEARCH CAN HELP US UNDERSTAND AND BRING ABOUT POPULATION HEALTH CHANGES. MAKING -- HELPING THEM TO ADAPT EVIDENCE-BASED INTERVENTION IN REAL WORLD SETTINGS, THAT MATTERED IN MISSOURI ESPECIALLY. SO I WOULD CONCLUDE THAT FUNDING TRANSDISCIPLINARY TEAM SCIENTIST INCREASES TRANSLATION TO IMPROVE POPULATION HEALTH, FOR A GIVEN LEVEL OF SUPPORT. OCCURS BY INCREASING COMMUNICATION, BY INCREASING COLLABORATION, BY GENERATING NEW RESEARCH QUESTIONS, METHODS AND ANALYSES. COMING TOGETHER THE BASIC OF THE ANIMAL MODEL IN PEOPLE AND POLITICAL SCIENTIST ADAPTED BAYESIAN STATISTICS TO COMPARE SMALL GROUPS OF RODENTS. SO WE CONSIDERED IT A SUCCESS IF WE CAME UP WITH NEW RESEARCH QUESTIONS AND THAT HADN'T EXISTED BEFORE IN NEW METHODS AND NEW ANALYSES, AND IT ALSO EXTENDED THE REACH OF PUBLICATIONS AND PRESENTATION. SO, I'D LIKE TO ACKNOWLEDGE THESE PEOPLE THAT CONTRIBUTED TO THE WORK. AND THANK YOU VERY MUCH. [APPLAUSE] >> I'D LIKE TO INTRODUCE OUR SECOND SPEAKER, DR. MARTY WOLDORFF, PROFESSOR AT DUKE UNIVERSITY, WITH APPOINTMENTS IN DEPARTMENTS OF PSYCHIATRY, PSYCHOLOGY, NEUROSCIENCE. AND NEUROBIOLOGY. AND WITH LABORATORY BASED AT THE DUKE CENTER FOR COGNITIVE NEUROSCIENCE. DR. WOLDORFF'S MAIN RESEARCH INTERESTS HAVE BEEN IN ADVANCING UNDERSTANDING OF NEURAL MECHANISMS OF ATTENTION, AND HE WILL BE PRESENTING ON HIS WORK FUNDED BY NINDS, INVESTIGATING INTERACTIVE RELATIONSHIP BETWEEN ATTENTION AND REWARD INCLUDING DISCUSSING SOME POTENTIAL TRANSLATIONAL APPLICATIONS OF SUCH RESEARCH. SO THANK YOU, DR. WOLDORFF. >> GOOD AFTERNOON, EVERYONE. I'M GOING TO -- RELATIVE TO PREVIOUS TALK I'LL TALK MORE ABOUT BASIC COGNITIVE NEUROSCIENCE FIRST BEFORE GOING INTO TRANSLATIONAL POSSIBILITIES. SO, I'M GOING TO FIRST TALK ABOUT ATTENTION. WHAT IS ATTENTION? AT EACH MOMENT OF OUR LIVES, WE'RE BOMBARDED BY STIMULI AND INFORMATION COMING AT US FROM MYRIAD OF DIRECTIONS TO OUR SENSORY MODALITIES, MUCH MORE INFORMATION, MUCH MORE STIMULUS INPUTS THAN WE CAN POSSIBLY -- THAN WE CAN FULLY PROCESS. OR EVEN ADEQUATELY PROCESS. SO WHAT WE NEED TO DO IS TO SELECT AND PRIORITIZE THOSE INPUTS, THE MOST IMPORTANT OR CRITICAL OR INTERESTING AND WE DO THAT ALL THE TIME AT EVERY POINT IN OUR DAY. SO ATTENTION IS A FUNDAMENTAL COGNITIVE FUNCTION, THAT'S CRITICAL TO OUR NAVIGATION IN THE WORLD. SO LET'S TAKE A LOOK AT SOME FINDINGS THAT WE UNDERSTAND ABOUT ATTENTION AND CONTROL. IT'S BEEN KNOWN FOR A LONG TIME FROM BEHAVIORAL WORK, FROM POSNER, IF YOU CUE SOMEBODY TO ATTEND TO A PARTICULAR SIDE OF THE VISUAL FIELD, LET'S SAY TO ATTEND TO THE RIGHT BECAUSE YOU'RE LIKELY TO GIVE A TARGET THERE, IF IT ACTUALLY OCCURS THERE VERSUS SOMETIMES IT OCCURS IN THE INVALIDLY CUED LOCATION, YOU'RE FASTER TO RESPOND TO THE VALIDLY CUED TARGET, RESPONSE TIME. AND THE IDEA THERE IS THAT THE REASON YOU'RE FASTER, BETTER AT DISCRIMINATING THAT TARGET IS BECAUSE YOUR ATTENTION HAS BEEN SHIFTED, FOCUSED ON THAT PLACE IN THE VISUAL FIELD. WELL, WE CAN ALSO STUDY WHAT GOES ON IN THE BRAIN, DURING THESE SORTS OF TASKS, THAT UNDERLIE THESE COGNITIVE PERFORMANCE ENHANCEMENTS. SO FOR INSTANCE WE CAN -- WE CAN DO THIS IN A COUPLE WAYS, PROBABLY THE MAIN TWO WAYS IN HUMANS IS RECORD ELECTRICAL ACTIVITY FROM THE SKULL, FROM THE SCALP, E EG OR EVENT-RELATED POTENTIALS, OR TO PUT SOMEBODY IN THE SCANNER AND STUDY THEM WITH FUNCTIONAL MRI. EEG HAS HIGH TEMPER RESOLUTION, IT'S ELECTRICAL BUT RATHER COURSE SPATIAL RESOLUTION, fMRI IS GREAT FOR SPATIAL RESOLUTION BUT RATHER LOW TEMPORAL RESOLUTION. WHEN WE DO THAT AND LOOK AT THE EFFECTS OF SPATIAL ATTENTION ON, SAY, BILATERALLY PRESENTED DISPLAY, WHAT WE SEE IS THAT WHEN YOU'RE ATTENDING TO THE LEFT YOU HAVE ENHANCED ACTIVITY OVER THE RIGHT OCCIPITAL CORTEX CONTRALATERAL TO THE DIRECTION OF ATTENTION, THIS OCCURS AT A PARTICULAR POINT IN TIME AT ABOUT 100 MILLISECONDS AFTER THE PRESENTATION OF THE BILATERAL STIMULUS, LOOK AT FUNCTIONAL MRI AND WE GET A SIMILAR PATTERN FOR A CONTRALATERAL ACTIVITY BUT HERE WE KNOW VERY WELL, WITH HIGH RESOLUTION, WHERE IT HAPPENS IN THE BRAIN, BUT REALLY VERY LITTLE INFORMATION ABOUT WHEN. THESE ARE ENHANCEMENTS, BUT THERE'S A WHOLE BRAIN INVOLVED. THERE ARE OTHER -- HOW IS THIS BROUGHT ABOUT? HOW ARE THESE SENSORY ENHANCEMENTS BROUGHT ABOUT? IN GENERAL, THE GENERAL MODEL THAT MOST PEOPLE IN THE FIELD WOULD AGREE WITH IS THAT THERE IS AN ATTENTIONAL CONTROL NETWORK, A SET OF REGIONS IN FRONTAL AND PRY PARIETAL CORTEX THAT CONTROL THE ALLOCATION AND DIRECTION OF ATTENTION BY SENDING MODULATORY SIGNALS DOWN TO THE SENSORY PATHWAYS TO ENHANCE THE PROCESSING OF THOSE INPUTS, THAT ARE THE MOST IMPORTANT OR INTERESTING OR CRITICAL, AND RELATIVELY ATTENUATING OR SUPPRESSING PROCESSING OF THOSE THAT ARE IRRELEVANT FOR THE TASK AT HAND. SO, THE WAY THAT WOULD BE IMPLEMENTED SAY IN A CUEING PARADIGM IS THAT AFTER THE CUE, YOU GET ACTIVATION OF THE FRONTAL PARIETAL NETWORK, THIS IS THE fMRI, EEG, DATA FROM MY LABORATORY, OTHER LABORATORIES FOUND THESE RESULTS AS WELL. AND FOLLOWING THIS ACTIVATION OF FRONT PARIETAL CONTROL NETWORK WE SEE A BIASING IN THE SENSORY REGIONS IN THIS CASE VISUAL CORTEX THAT HAPPENS EVEN BEFORE THE TARGET COMES. AND BY WAY OF OTHER EVIDENCE, THIS IS BY WAY OF DESCENDING PATHWAYS. AND SO THIS BIASING OF THE VISUAL REGIONS THAT ARE GOING TO PROCESS THE UPCOMING TARGET, THEY BIAS THEM SO THAT WHEN THE TARGET COMES THROUGH, IT'S ENHANCED. IT'S PROCESSING IS ENHANCED WHICH EXPLAINS THE OTHER FIGURES THAT I WAS SHOWING WITH ENHANCED PROCESSING OF ATTENDED SENSORY STIMULI. ALSO THEN EXPLAINS THE ENHANCED PERFORMANCE, DISCRIMINATION PERFORMANCE FOR THOSE STIMULI. SO, THIS WAS WHAT WOULD BE CALLED PRO-ACTIVE ATTENTIONAL CONTROL BECAUSE YOU'RE TOLD AHEAD OF TIME TO ATTEND TO A PARTICULAR LOCATION IN THE VISUAL FIELD OR PARTICULAR COLOR OR WHATEVER IT MIGHT BE. IN THE REAL WORLD, THAT SOMETIMES HAPPENS, BUT OFTEN WHAT HAPPENS IS THAT YOU RESPOND REACTIVELY WITH ATTENTIONAL SHIFTS DUE TO THINGS THAT OCCUR IN YOUR ENVIRONMENT. A BRIGHT LOUD SOUND, FLASH OF LIGHT, THE COLOR RED BECAUSE YOU'RE LOOKING FOR YOUR FRIEND WITH A RED SWEATER, AND SO IN THOSE CASES YOU'RE NOT CUED AHEAD OF TIME, YOU GET THE STIMULUS YOU NEED TO RESPOND TO AND THAT TRIGGERS A RAPID ORIENTATION OF ATTENTION. SO, ONE CAN STUDY THOSE THINGS WITH, SAY, VISUAL SEARCH PARADIGM WHERE YOU GET A DISPLAY OF A BUNCH OF ITEMS, IN THIS CASE ELLIPSES, ONE IS DIFFERENT, A POP-OUT, YOUR TASK IS TO SHIFTINGS TO TO THE POPOUT, TWO POPOUTS, ONE RELEVANT AND ONE NOT. SHIFT YOUR ATTENTION TO THE RELEVANT ONE TO DO A DISCRIMINATION. AND WHAT WAS FOUND, THIS IS WITH ERPs, VERY RAPIDLY AFTER THE PRESENTATION OF THIS ARRAY, YOUR ATTENTION IS SHIFTED TO THAT. IN THIS CASE BLUE INDICATES THAT YOUR ATTENTION IS SHIFTED TO THE LEFT. AND THIS ERP COMPONENT, N2PC REFLECTS RAPID ATTENTIONAL SHIFTING OF ATTENTION. OKAY. THAT'S ATTENTION. WHAT ABOUT A REWARD? HOW DOES REWARD WORK AND HOW FOLKS STUDY IT? PEOPLE HAVE ALSO STUDIED CUED REWARD, WHAT IS REWARD CUEING SET UP IN PREPARATION FOR UPCOMING TASK. CLASSIC TASK IN REWARD RESEARCH, PROBABLY ONE OF THE MOST COMMON, IS THE MONETARY INCENTIVE DELAY PATH. YOU GET A CUE THAT TELLS YOU'RE GOING TO GET REWARDED ON THAT TRIAL OR YOU'RE NOT OR GET A HIGH REWARD OR LOW REWARD, SOMETHING YOU HAVE TO DO SOMETHING WITH, AND THEN YOU GET FEEDBACK THAT IF YOU DID IT WELL ENOUGH THEN YOU GET REWARD UNDER THE REWARD CONDITION VERSUS NOT-REWARD CONDITION. AND UNDER THOSE CONDITIONS, YOU GET FASTER REACTION TIMES AS WELL. BETTER PERFORMANCE ON THAT TASK. BUT THE FOCUS ON THESE SORTS OF STUDIES IS THAT THE DIFFERENCE BETWEEN REWARDED AND NOT REWARDED CUES AND YOU SEE ACTIVITY CHANGES IN SUBCORTICAL REGIONS, IN THE MID-BRAIN AND VENTRAL STRIATUM THAT HAVE BEEN TALKED ABOUT, GENERALLY TALKED ABOUT AS PART OF THE SUBCORTICAL REWARD PROCESSING CIRCUITS. THAT'S BEEN ONE OF THE MAIN ASPECTS OF BRAIN FOCUSED ON THIS BY SORT OF RESEARCH. WELL, YOU CAN NOTICE THAT THAT PARADIGM, YOU GET A CUE FOLLOWED BY A TASK OR TARGET, THE VERY SIMILAR TO ATTENTION PARADIGMS BUT THEY HAVE BEEN DONE VERY SEPARATELY. SO LET'S SAY YOU HAVE ATTENTION, REWARD, THEY BOTH IMPROVE PERFORMANCE AT LEAST TYPICALLY, I'LL SHOW YOU EXAMPLES WHERE THAT DOESN'T ALWAYS HAPPEN, BUT MOSTLY STUDIED IN SEPARATE EXPERIMENTS APPROACHES AND LITERATURES BUT THEY HAD SOMETIMES STRIKINGLY SIMILAR PARADIGMS. AND IN ATTENTION THE FOCUS IS ON CORTICAL FRONTAL PARIETAL NETWORKS THAT SEND DESCENDING SIGNALS DOWN MODULATE SENSORY PATHWAYS, FOCUS IN REWARD ON SUBCORTICAL AREAS, FOLKS LOOKING AT LOOPS PARTICULARLY WITH FRONTAL CORTEX. WELL, ARE THESE THE SAME? OR IF NOT, WE PRESUME THEY ARE NOT EXACTLY THE SAME, HOW DO THEY OVERLAP AND INTERACT? NUMBERS OF LABS IN RECENT YEARS, INCLUDING MINE, HAVE FOCUSED ON THIS INTERACTIVE RELATIONSHIP OR THE POSSIBILITY OF INTERACTIVE RELATIONSHIP BETWEEN ATTENTION AND REWARD. SO I'M GOING TO SHOW YOU A FEW STUDIES IN THAT REGARD. SO LET'S JUST TAKE A BROADER LOOK AT A MOMENT, KEY PROCESSING POINTS THAT YOU COULD HAVE INTERACTIONS BETWEEN ATTENTION CONTROL AND REWARD. YOU CAN HAVE THIS PRO-ACTIVE PREPARATORY CUEING FOR ATTENTION OR REWARD, TO SET UP THESE PRO-ACTIVE PREPARATORY MECHANISMS OR YOU CAN HAVE AN ITEM THAT OCCURS, PARTICULARLY SALIENT, SAY PHYSICALLY SALIENT LIKE A BRIGHT POPOUT, OR COULD HAVE REWARD ASSOCIATED WITH IT. THAT COULD CAUSE SOME SORT OF REACTIVE VERY RAPID WITHIN-TRIAL MODULATION FOR THAT STIMULUS. YOU HAVE YOUR RESPONSE AND THEN YOU GET FEEDBACK THAT TELLS YOU YOU DID WELL, MAYBE GIVES YOU SOME MONEY, AND THAT FEEDBACK HAS TO COME BACK TO THE SYSTEM TO -- AND THAT FEEDBACK THEN HELPS UPDATE THESE REWARD ASSOCIATIONS. SO LET'S TAKE A LOOK AT THESE SEVERAL FACETS OF THESE INTERACTIVE RELATIONSHIPS. FIRST LET'S TAKE AN ATTENTION REWARD. WHAT IF WE CUED ATTENTION AND REWARD? AND COMPARED THEM? SO THIS IS AN EEG STUDY WHERE THE CUE NOW IS A SYMBOL THAT TELLS YOU THE -- THE AMPERSTAND TELLS YOU YOU'RE GOING TO GET A STIMULUS IN A MOMENT, A PARTICULAR TASK IS NOT IMPORTANT NOW, OR A CUE THAT'S A DOLLAR SIGN THAT SAYS YOU HAVE TO ATTEND BUT YOU'RE GOING TO GET REWARDED. THERE ARE CONTROL CUES TO COMPARE TO. IF WE LOOK AT WHAT HAPPENS UNDER THOSE CIRCUMSTANCES, THIS IS NOW THE RESPONSE TO THE CUE, BEFORE THE TARGET EVER COMES, WHEN YOU ATTEND SO THE CUE HAPPENED OUT HERE, THIS IS 400 MILLISECONDS AFTERWARDS, TARGET COULD COME SOMEWHERE OUT HERE, SO IF YOU ATTEND WITH NO REWARD YOU SEE THIS ACTIVATION IN THE FRONTAL PARIETAL CORTEX THAT WE LOOKED AT BEFORE THAT PEOPLE HAVE BEEN REPORTING WITH ATTENTION WORK. WHAT HAPPENS WHEN YOU CAN ALSO GET REWARDED? HOW DOES THIS CHANGE? WHAT'S THE DIFFERENCE WHEN YOU ATTEND WITH AND WITHOUT REWARD? YOU CAN SEE ADDITIONAL ACTIVITY THAT'S ADDED THAT LOOKS A LOT LIKE THIS. SO IT'S THIS SAME ACTIVITY BUT LARGER. THIS IS ADDED TO THIS WHEN YOU'RE ATTENDING WITH REWARD. THIS IS A CONTRAST, ATTEND WITH REWARD VERSUS NO REWARD SUGGESTING REWARD PROSPECT ACCOMPLISHES PERFORMANCE ENHANCEMENTS IN PART BY CONTROL CIRCUITS TO DO WHAT IT DOES TO ENHANCE PERFORMANCE. THAT'S FOR THE EEG. WE CAN LOOK AT fMRI, AGAIN CUEING FOR ATTENTION AND/OR REWARD, YOU GET A CUE, IT'S A DOUBLE CUE, DETAILS DON'T MATTER, THE COLOR TELLS YOU WHETHER YOU'RE GOING TO GET REWARDED OR NOTHING, SOMETHING ELSE ABOUT THE CUE TELLS YOU IT'S GOING TO BE A DIFFICULT TASK SO YOU BETTER ATTEND MORE VERSUS YOU DON'T NEED TO ATTEND AS MUCH. WHEN YOU DO THAT WE FOUND THAT REWARD ACTIVATES THE SUBCORTICAL REWARD CIRCUITS AS THEY ALWAYS HAVE BEEN FOUND TO DO, BUT THEY ALSO ACTIVATE THE FRONTAL PARIETAL ATTENTIONAL CONTROL NETWORK, AGAIN CONSISTENT WITH THE VIEW THAT REWARD PROSPECT MARSHALS ATTENTION CONTROL CIRCUITS TO HELP AT LEAST IN PART TO HELP ACCOMPLISH ITS PERFORMANCE ENHANCEMENTS. SO WE HAVE TO ADD SOMETHING TO THIS DIAGRAM NOW IF WE'RE GOING TO PUT THE REWARD AND ATTENTION INTERACTIONS IN HERE, IN PARTICULAR ADD THE SUBCORTICAL REWARD CIRCUITS THAT SEEM TO RECRUIT OR MARSHAL ATTENTIONAL CONTROL NETWORKS TO HAVE THEM SEND THEIR MODULATORY SIGNALS DOWN TO ENHANCE SENSORY PROCESSING. THERE'S OTHER DATA THAT SHOWED THIS CASCADE FURTHER ON, BUT I DIDN'T HAVE TIME TO SHOW THAT HERE. SO OF COURSE THE STIMULUS INFORMATION THAT COMES IN, YOU PROBABLY ALSO HAVE TO GET SOMETHING TO THE SUBCORTICAL REWARD CIRCUITS TO START THIS PROCESS. OKAY. SO THAT WAS, SAY, ADVANCED CUEING, LOOKING AT RELATIONSHIPS BETWEEN ATTEMPTS AND REWARD FOR PREPARATORY MECHANISM. WHAT ABOUT TARGET REWARD ASSOCIATIONS? SO WE CAN LOOK AT THAT AS WELL AND WHAT WE DID IN THIS PARTICULAR CASE WAS LOOK AT ONE OF THE PARTICULARLY CLASSIC PARADIGMS IN COGNITIVE PSYCHOLOGY, PERHAPS ONE OF THE MOST WELL KNOWN, THE STROOP TASK, WHERE THE TASK IS PRESENTED WITH A NUMBER OF COLOR AWARDS AND LIKE RED AND BLUE, AND YOUR TASK IS TO SAY WHAT IS THE FRONT COLOR OF THAT WORD? SO IN THIS CASE THE ANSWER IS RED, IN THIS CASE THE ANSWER IS GREEN. WHEN THE SEMANTIC MEANING AND FONT COLOR MATCH AND IS CONGRUENT VERSUS DON'T MATCH SUCH AS HERE BECAUSE YOU HAVE THE WORD BLUE IN GREEN FRONT, YOU'RE SLOWER WHEN IT'S INCONGRUENT. THE IDEA IS THIS IS BECAUSE THIS IRRELEVANT DIMENSION, FEATURE, HAS DISTRACTED YOU, PULLED SOME OF YOUR ATTENTION AWAY, COGNITIVE CONTROL AWAY TO SLOW YOU UP. WHAT HAPPENS IF WE ADD -- DO THE STROOP TEST WITH EMBEDDED OBSERVATION? THE FIRST WAS A BEHAVIORAL STUDY, WHAT HAPPENS WHEN THE FONT COLOR MIGHT BE REWARDED? CERTAIN FONT COLORS WERE REWARDED, CERTAIN FONT COLORS WERE NOT. WHAT HAPPENS IS THAT YOU GET -- THAT HELPS PERFORMANCE. IN TWO DIFFERENT WAYS. ONE IS THAT WHEN THE FONT COLOR IS REWARDED ONE, YOU'RE FASTER FOR INCONGRUENT AND CONGRUENT STIMULI. WHEN THE RELEVANT FEATURE IS REWARDED, IT SPEEDS YOU UP BUT IT ALSO DECREASES INCONGRUENCY EFFECT, FROM HERE TO HERE. SO WHEN YOU GET REWARD FOR THE RELEVANT FEATURE, IT REDUCES DISTRACTIBILITY OF OTHER IRRELEVANT FEATURES OR ITEMS OR DISTRACTERS IN THE ENVIRONMENT. THAT'S ONE WAY THINGS CAN WORK. THAT'S WHERE WE REWARD HELPS IN YOUR PERFORMANCE. THERE'S A FLIP SIDE TO THIS. IN PARTICULAR, WHAT HAPPENS WHEN THE IRRELEVANT FEATURE, THE COLOR WORD MEANING IS INDIRECTLY ASSOCIATED WITH REWARD. WHAT IF THE BLUE FONT IS REWARDED? THE FACT THAT -- YOU GET THIS STIMULUS. THE FACT THAT IT'S THE WORD BLUE IS IRRELEVANT. THAT'S IRRELEVANT FEATURE YOU'RE SUPPOSED TO BE IGNORING. BUT YOU'RE SUPPOSED TO SAY GREEN HERE, BUT THE WORD BLUE IS THERE. SO WHAT HAPPENS UNDER THOSE CIRCUMSTANCES? WE COMPARED WHEN THE INCONGRUENT STIMULUS WAS NOT REWARD ASSOCIATED, VERSUS WHEN IT WAS REWARD ASSOCIATED. WHAT THAT DID, IT SLOWED YOU UP EVEN MORE. SO THIS SHOWS IF YOU ATTACH REWARD, IF REWARD IS ASSOCIATED WITH IRRELEVANT ITEM IN THE ENVIRONMENT OR IRRELEVANT FEATURE IT DISTRACTS YOU MORE. THAT'S THE FLIP SIDE OF WHAT REWARD CAN DO, IN TERMS OF PUSH AND PULL ON ATTENTION. SO IN THIS CASE IT MISGUIDES ATTENTION AND IMPAIRS PERFORMANCE. WE DID SERIES OF fMRI AND EMP EXPERIMENTS LOOKING AT REWARD PROCESSING CIRCUITS AND ATTENTION CONTROL CIRCUITS AND HOW THEY INTERACT TO LEAD TO THIS BEHAVIORAL RESULT. SO WHAT ABOUT THIS END HERE WHERE YOU GET FEEDBACK THAT HAS TO SOMEHOW LEARN WHAT'S ASSOCIATED WITH REWARD IN YOUR LIFE, WHAT'S GOING TO PREDICT GOOD THINGS FOR YOU. SO WE DID A COUPLE STUDIES IN THAT REGARD, AND THIS ONE IS A LITTLE BIT MORE COMPLICATED, MAYBE THEY ARE ALL COMPLICATED, BUT IN THIS CASE YOU'RE PRESENTED WITH STIMULI, YOU HAVE TO MAKE A BET. SO IT'S A NEUROECONOMIC TASK, YOU HAVE TO MAKE A WAGER ABOUT WHETHER YOU'RE LIKELY TO WIN OR LOSE ON THIS TRIAL. SO IF YOU THINK YOU'RE LIKELY TO WIN YOU BET HIGH, 8, IF YOU'RE LIKELY TO LOSE YOU BET 2 AND GET FEEDBACK. THE KICKER WAS THE DIFFERENT STIMULI, ODD CHARACTERS, ARE ASSOCIATED WITH PREDICT -- SOME HAD A HIGHER PROBABILITY OF PREDICTING WINNING ON THAT TRIALS, VERSUS A LOWER PROBABILITY. AND YOU DON'T KNOW ANYTHING ABOUT THY THESE AHEAD OF TIME, YOU HAVE TO LEARN THEM. YOU GO THROUGH A NUMBER AND EVENTUALLY LEARN THAT THESE SAY PREDICT YOU'RE LIKELY TO WIN, THESE PREDICT YOU'RE NOT LIKELY TO WIN SO WHEN YOU'RE LIKELY TO WIN YOU BET HIGH AND NOT LIKELY TO WIN YOU BET LOW. PEOPLE LEARN THIS ACROSS THE TIME. HOW DO THEY DO THIS? WE CAN LOOK FIRST OF ALL AT RESPONSE TO THE FEEDBACK STIMULUS, WHEN YOU FIND OUT WHETHER YOU WON OR LOST. WHAT WE CAN SEE, THE NUMBER OF RESULTS FROM THE STUDY, ONE RESULT IS THERE'S A BIG WAVE HERE, P 300 WAVE OR P 3 WAVE AND IF YOU GO BACK AND FIND OUT WHEN THE NEXT TIME THEY ENCOUNTER THAT CUE TYPE DO THEY CHANGE THAT CHOICE OR DO THEY NOT CHANGE THAT CHOICE, REFLECTING THEY ARE LEARNING ABOUT REWARD ASSOCIATION WITH THIS. IF THEY ARE LIKELY TO SWITCH THEIR CHOICE, IF THEY WILL SWITCH LATER, IT'S BIGGER THAN IF THEY DON'T SWITCH THEIR CHOICE LATER. WHICH WE INFER LIKELY REFLECTS MARSHALING OF INTENTIONAL RESOURCES AS PART OF THE PROCESS FOR UPDATING THE STIMULUS REWARD ASSOCIATIONS. OKAY. SO THEN WHAT? WHAT DOES THAT DO WITH ATTENTION IN THE FUTURE? WE LOOKED AT THE FEEDBACK STIMULUS, WHAT HAPPENS WHEN YOU HIT CUE STIMULI AGAIN AND CERTAIN ONES PREDICT YOU'RE MORE LIKELY TO WIN? LET'S SAY YOU GET THIS ONE, THIS ONE IS HIGH PROBABILITY OF WINNING, THIS IS LOW ONE. OR NEUTRAL. WHAT HAPPENS? WE CAN LOOK AT THIS COMPONENT THAT SHOWS ONCE YOU LEARN THAT THIS IS THE HIGH PREDICTOR, YOU HAVE AN ATTENTIONAL SHIFT, BLUE REFLECTS YOUR INTENTIONAL SHIFT AND YOU LEARN THIS ACROSS THE SESSION. ALSO, THIS AND THE OTHER WAYS VARY AS ACROSS SUBJECTS, INDIVIDUAL VARIATIONS, AND THIS IS STRONGER FOR THOSE THAT DO WELL ON THIS TASK AND LEARN WELL VERSUS THOSE WHO DON'T. OKAY. SO THAT'S HOW ARE SOME OF THESE FINDINGS IN COGNITIVE NEUROSCIENCE TRANSLATED INTO SOCIETY? FIRST ONE MAIN WAY IS EDUCATIONAL SETTINGS AND MATERIALS. WE KNOW FROM ELEMENTARY SCHOOL YOU GET GOLD STARS FOR DOING WELL, GIVES YOU MOTIVATION, WE CAN DO BETTER AND SELECTIVELY ASSOCIATE WITH REWARD WITH CERTAIN ITEMS AND IN SAY AN EDUCATIONAL MATERIALS, AS KIDS OR ANYBODY LEARN STUFF. THIS CAN BE USED ALSO IN TRAINING PROTOCOLS, SAY WITH PILOTS WHO HAVE A COMPLICATED VISUAL DISPLAY IN THE COCKPIT, YOU COULD -- PEOPLE DO STUDIES WITH VISUAL SEARCH WHERE YOU HAVE CERTAIN SALIENT ITEMS OR CERTAIN REWARD-ASSOCIATED ITEMS THAT CAN HELP YOU LEARN HOW TO DO THIS BETTER. AND THIS CAN ALSO BE CUSTOM TAILORED TO THOSE INDIVIDUALS WHO NEED TO DO REHABILITATION FOR VARIOUS NEUROLOGICAL DISORDERS OR STROKE OR MENTAL DISORDERS, TO HELP THEM LEARN OR RELEARN THOSE FACETS OF PROCESSING THAT THEY HAVE BECOME IMPAIRED AT. ANOTHER WAY WE TALKED ABOUT DISSEMINATION MAKING, CHOOSING BETTING HIGH, BETTING LOW, THIS ITEM OR ANOTHER. MARKETING IS USING THIS, COKE OR PEPSI, DIFFERENT BOTTLES, DIFFERENT WRAPPERS, ESPECIALLY AFTER SEEING ADVERTISEMENTS. THIS IS ALREADY BEING DONE BY MARKETERS AROUND THE WORLD. YOU COULD ALSO DO THIS IN A MORE ALTRUISTIC WAY TO INFLUENCE PEOPLE TO MAKE BETTER CHOICES, SAY KIDS WHO ARE IF THEY ARE GIVEN A TASK, FIND A CERTAIN COLOR, LET'S SAY GRAY, IF AN APPLE IS LAYING ON THE GRAY, VERSUS A KIT KAT BAR, YOU COULD INFLUENCE THEIR ASSOCIATION POSITIVE REWARD WITH THE APPLE. ADDICTS HAVE THEIR ATTENTION DRAWN BY ADDICTION-RELATED MATERIALS. SUCH AS CIGARETTE PACKAGE. AND YOU COULD ALSO DO A SIMILAR THING, RETRAIN TENDENCY TO HAVE ATTENTION DRAWN TO ITEMS. LASTLY THIS IDEA OF REWARD AND YOU'RE MARSHALING POTENTIAL RESOURCES BECAUSE YOU CARE ABOUT CERTAIN THINGS MORE OR LESS, WHAT WE FOUND IN A RECENT STUDY BY RENEE SAN MARTIN THAT IF YOU -- THIS SAME POSITIVE WAVE THAT REFLECTED THESE MARSHALING OF POTENTIAL RESOURCES, THE SIZE OF THAT WAVE PREDICTED YOUR LIKELIHOOD OF GIVING TO CHARITY IN EVERYDAY LIFE AND HOW MUCH YOU WOULD GIVE. SO I WOULD LIKE TO END BY THANKING ALL THE COLLABORATORS THAT HELPED, THAT CONTRIBUTED TO ALL THESE STUDIES AND TO ACKNOWLEDGE THE FINANCIAL SUPPORT FROM NINDS AS AS NIMH AND NSF AND I THANK YOU ALL FOR YOUR ATTENTION. [APPUSE] >> NEXT SPEAKER IS DR. LYNN GRATTAN, UNIVERSITY OF MARYLAND MEDICAL CELL MEDICAL CENTER SPEAKING ABOUT RESILIENCE AND MENTAL HEALTH OUTCOMES. WELCOME, DR. GRATTAN. >> THANK YOU. LET ME SAY WHAT A PLEASURE AND HONOR IT IS TO BE INVITED TO SPEAK HERE TODAY REPRESENTING THE NATIONAL INSTITUTE OF ENVIRONMENT AND HEALTH SCIENCES. I'M JUST ONE OF MANY, MANY BEHAVIORAL SOCIAL SCIENTISTS FUNDED BY THAT ORGANIZATION, AND THERE'S A LOT OF AWESOME WORK COMING OUT OF THAT GROUP. TODAY I'M GOING TO TALK ABOUT INITIALLY -- I'M GOING TO TELL A STORY ABOUT RESILIENCE AND DISASTER TO PROVIDE A CONTEXT FOR OUR IMPORTANT WORK AFTER THE OIL SPILL DISASTER WHICH THEN EVOLVED INTO INFLUENCING A RESILIENCE, CONCEPTUAL RESILIENCE MODEL FOR RAPID RESPONSE AND INTERVENTION, AND FURTHER RESEARCH ASSOCIATED WITH DISASTER. AND THEN FINALLY GET DOWN TO THE NITTY-GRITTY OF THE INTERVENTIONS THAT CAME OUT OF OUR WORK AND OUR MODEL. THE REVIEW OF THE RESEARCH IS GOING TO BE BROAD BRUSH, IN ORDER TO GET IN ALL OF THE ARCHITECTURAL INFORMATION RELATED AS WE HAVE TIME TO DISCUSS IMPORTANTLY OUR INTERVENTIONS. OKAY. SCHOLARS AND PHILOSOPHERS FOR MANY YEARS HAVE BEEN FASCINATED AND INTERESTED IN THE SUBJECT OF RESILIENCE. I'M SURE EVERY NOW AND THEN EVEN ONE OF US REPEATS ONE OF THESE LITTLE SAYINGS TO OUR SELF. WHAT IS RESILIENCE? FROM A BROAD PERSPECTIVE, RESILIENCE IS QUALITIES THAT ENABLE AN INDIVIDUAL TO THRIVE, DESPITE ADVERSITY. IT'S THOUGHT TO BE PROTECTIVE AGAINST THE DEVELOPMENT OF MENTAL HEALTH PROBLEMS. AND AFTER DISASTER, IT'S IMPORTANT TO TAKE INTO ACCOUNT BOTH TIME AND CONTEXT. THAT'S IMPORTANT BECAUSE IT CAN CAUSE CHAOS, CALAMITY, DISCOMFORT TO MANY PEOPLE, ALL OF A SUDDEN AT ONCE. THERE ARE FOUR TYPES OF DISASTERS, LET ME GO BACK WITHOUT DISTRACTING YOU WITH THESE HORRIBLE PICTURES ON A FRIDAY AFTERNOON. NATURAL, TECHNOLOGICAL, TERRORIST AND RESPONSIBLE PARTY DISASTERS, THE OIL SPILL WOULD BE CONSIDERED A RESPONSIBLE PARTY DISASTER BECAUSE BRITISH PETROLEUM WAS RESPONSIBLE FOR IT. DISASTER RESEARCH IS VERY IMPORTANT. LET ME TELL YOU WHY. I'M NOT GOING TO BE AN EXPERT IN IT BECAUSE I'M CERTAINLY NOT. BUT BECAUSE NUMEROUS AUTHORS WOULD AGREE THERE'S A DISASTER A DAY SOMEWHERE IN THE WORLD. OKAY? DISASTERS TOUCH A LOT OF PEOPLE THROUGH PRIMARY OR SECONDARY IMPACT. THROUGH LOSING LOVED ONES, ECONOMIC IMPACT, DISRUPTION OF WORK AND THINGS LIKE THAT. DISASTERS ARE IMPORTANT TO STUDY AND AS I SAID, PEOPLE SAY THERE'S ONE A DAY, I ALMOST DIDN'T BELIEVE IT. EVERY NOW AND THEN I TAKE A LOOK IN THE NEWS. AND BETWEEN THIS PAGE AND THIS PAGE, THESE ALL HAPPENED JUST IN THE MONTH OF NOVEMBER ALONE. OKAY. IN RESPONSE TO THE HIGH NUMBER OF DISASTERS THAT OCCUR IN THE WORLD, AND IN THE UNITED STATES IN PARTICULAR, THERE HAVE BEEN A LOT OF NATIONAL, INTERNATIONAL POLICY DIRECTIVES, ORGANIZING AND TELLING FOLKS HOW YOU SHOULD BE RESPONDING TO DISASTERS. COMMAND AND CONTROL IS COMMONLY PART OF THAT. AS PART OF ALL OF THAT THERE ARE POLITICAL CALLS TO ENHANCE RESILIENCE OF INDIVIDUALS AND COMMUNITIES AND COUNTER-BALANCE INDIVIDUAL AND SOCIAL VULNERABILITIES. LOTS OF AGENCIES AND FEDERAL SECTORS SAYING HOW ARE WE GOING TO CULTIVATE RESILIENCY? THE TERM, THE CONSTRUCT OF RESILIENCE, HAS ALMOST BECOME A BUZZ WORD WHICH HAS BEEN AROUND IN PSYCHOLOGICAL LITERATURE IN THE 70'S AND ENGINEERING LITERATURE BEFORE THAT. THE POINT IS THAT THERE ARE A LOT OF POLITICAL CALLS TO ACTION. HOWEVER, THE RHETORIC OUTPACES THE SCIENCE. SOMEONE CALLS YOU UP AND SAYS THERE'S A MAJOR CATASTROPHE AND DISASTER HERE, WHAT ARE YOU GOING TO DO TO HELP THE PEOPLE BEHAVIORALLY RESPOND BETTER? WE DON'T HAVE A WHOLE LOT OF SCIENCE RELATED TO DISASTER. LET ALONE DISASTERS OF DIFFERENT CONTEXT. OIL SPILL DISASTER, KIND OF AS A LABORATORY TO BEGIN TO LOOK AT FORMALLY WITH STANDARDIZED MEASURES AND SYSTEMATIC FASHION THE MENTAL HEALTH AND BEHAVIORAL IMPACTS OF THE OIL SPILL. THE OIL SPILL AS MANY OF YOU MAY REMEMBER FROM THE NEWS OCCURRED IN APRIL 20, 2010, 11 PEOPLE WERE SKILLED ON SITE, IT WAS AN OIL SPILL FOR NINE MONTHS, 206 MILLION GALLONS OF OIL, TO BE CLOSE OR ALMOST IMPACT, COVERED 88,522 MILES OF THE GULF, 950 MILES OF GULF COAST SHORELINE HAD BLACK OIL. THE ENVIRONMENTAL IMPACTS WERE GREAT, MANY IMAGES ESPECIALLY THIS SLIDE. THIS ICONIC TIME-LIFE IMAGE OF SOME ENVIRONMENTAL IMPACTS GOING ON FOR CLOSE TO 900 MILES OF SHORELINE. THE HUMAN HEALTH IMPACTS, THEY WERE AS GREAT, IF NOT GREATER, THAN THE ENVIRONMENTAL IMPACT. HERE WE HAVE A DOCK AT APALACHICOLA, FLORIDA, USUALLY FULL OF OYSTERS. FULL. THERE SHOULD BE BOATS LINED UP BRINGING IN OYSTERS. OIL WAS NOT THERE BUT THEY HAD TO CLOSE THE COASTLINE FOR FEAR OIL WOULD COME. IT CAME WITHIN A FEW MILES. THEY HAD BOOMS. THEY STARRED FISHING, TOURISM CHARTERS, NO ONE COULD GET IN AND OUT OF THE BAY. AND SEAFOOD PROCESSING PLANTS WERE CLOSED DOWN WITH A T RICKLEDOWN EFFECT, PEOPLE THAT TRANSPORTED DIDN'T HAVE JOBS, RESTAURANTS DIDN'T HAVE JOBS, ET CETERA. YOU CAN SEE A NUMBER OF THINGS THAT HAPPENED. IN THIS PICTURE I SEE A PET FOOD PANTRY COLLECTION, EVEN THE PETS WERE INVOLVED. IN MOST DISASTERS PETS DO GET INVOLVED. ONE YEAR POST-OIL SPILL, THE BP RESPONSE WAS BASICALLY TO GIVE THEM MONEY, AND RESPONSIBLE PARTY DISASTERS THAT OFTEN IS AN INITIAL RESPONSE. I MUST SAY THOUGH AT THE TIME OF THE SPILL BP DID HAVE COUNSELORS OUT ON THE DOCKS AVAILABLE TO COUNSEL ANY UPSET WATER MEN OR FISHERMAN. YOU CAN IMAGINE HOW MANY FISHERMEN WENT TO A COUNSELOR TO TALK TO ONE BUT THEY WERE THERE. DIDN'T STOP THE FACT THERE WERE SIX SUICIDES ASSOCIATED DIRECTLY WITH THE SPILL. ONE YEAR POST OIL SPILL BP HANDED OUT MONEY IN A DISORGANIZED FASHION WHICH DISTRESSED PEOPLE. PEOPLE WERE GETTING LARGE SUMS, THIRTY, FIFTY, 75, WAS $100,000 LOSSES BUT SPENT IT BEFORE THE TAX TIME WAS DUE THE FOLLOWING APRIL, BECAUSE WHEN THE PEOPLE THAT -- THE FISHERMAN GOT A BIG FLOOD OF MONEY THERE WERE BOATS AND BIG TVs, I'M SORRY A LOT OF NEW TRUCKS AND BIG TVs PURCHASED AND THEY DID NOT SAVE MONEY BACK, SO ONE OF OUR INTERVENTIONS IS FINANCIAL COUNSELING WITH BIG PAYOUTS BECAUSE THE FOLKS WERE BROKE AGAIN IN THE YEAR AND OWED A LOT OF MONEY IN TAXES. TWO YEARS POST-SPILL IN ALABAMA, A TOURIST COMMUNITY, WHILE YOU WERE ADVERTISING OPPORTUNITY FOR SLIM FIRM BODY, YOU COULD ALSO CALL A LAWYER IF YOU THOUGHT YOU HAD ANY BREATHING DIFFICULTIES, SKIN, EYE IRRITATION OR HEALTH ISSUES, ANYTHING HEALTH-WISE THAT YOU THINK COULD BE ASSOCIATED WITH THE SPILL BECAUSE YOU HAPPEN TO LIVE IN THE SPILL COMMUNITY, CALL THESE FOLKS AND THEY WILL HELP GET YOU MONEY. I MEAN, THERE WAS TWO YEARS LATER A BIG PUSH, A LEGAL PUSH FROM ATTORNEYS TRYING TO HELP PEOPLE. OKAY. DURING THE SPILL, ACTUALLY IMMEDIATELY DURING THE SPILL, OIL WAS STILL FLOWING, WE SET UP TWO FIELD SITES, ONE IN BALDWIN COUNTY, ALABAMA, ONE IN FRANKLIN COUNTY, FLORIDA. THE OIL CAME RIGHT TO HERE, JUST LIKE IT GOT THROUGH PENSACOLA AND STOPPED. SO THIS COUNTY NEVER HAD OIL ON ITS SHORES BUT WAS COMPLETELY SHUT DOWN BECAUSE THE ENTIRE GULF WAS SHUT DOWN TO FISHING AND SEAFOOD PROCESSING WAS CLOSED. THIS COUNTY HAD OIL RIGHT ON ITS SHORES. THE STUDY AIMS AS WE SET UP, MY PART OF THE PROJECT, A VERY LARGE PROJECT, WAS TO LOOK AT HOW THE STRESSORS ASSOCIATED WITH THE SPILL IMPACTED MENTAL HEALTH IN FRANKLIN AND BALDWIN COUNTY, EXAMINED 300 ADULTS TO DEFINE DOCUMENT DISTRESS RECOVERY, DURING THE SPILL 2010 THROUGH THE SPRING OF 2016. WE'RE TRYING TO IDENTIFY CHARACTERISTICS AND PREDICTORS OF RESILIENCE, WHAT'S GOING ON, MAKE THEM ADAPT, MAYBE WE CAN USE IT AGAIN. WE IMPLEMENTED COMMUNITY-BASED PARTICIPATORY MODEL TO FACILITATE IMPLEMENTATION OF OUR FINDINGS. AS YOU ALL KNOW, THAT'S USUALLY A GOOD MODEL TO USE IF YOU WANT TO IMPLEMENT YOUR RESEARCH FINDINGS IN A COMMUNITY. COHORT DEMOGRAPHICS, WE WERE FOCUSING ON SEAFOOD WORKERS, SEAFOOD PROCESSING WORKERS, FULL-TIME SHRIMPERS, OYSTERERS, A LOT OF PEOPLE OUT OF WORK BECAUSE THEY COULDN'T GO OUT AND FISH. FISH, OYSTER OR PROCESSED SEAFOOD. DURING THE SPILL, THESE FINDINGS HAVE BEEN PREVIOUSLY PUBLISHED BUT I'LL RUN THROUGH FOR YOU. WE FOUND A WHOLE WIDE RANGE OF PSYCHOLOGICAL REACTIVITY, SOME FINE, SIX SUICIDES THROUGH GUNSHOT AND DRUG OR ALCOHOL OVERDOSES. DEPRESSION AND ANXIETY WERE THE PREDOMINANT MENTAL HEALTH SYMPTOMS, ACTUALLY 33 TO 40% OF THE PEOPLE SAMPLED HAVING SYMPTOMS CONSISTENT WITH CLINICALLY SIGNIFICANT DEPRESSION. INCOME LOSS, ASSOCIATION WITH MENTAL HEALTH STATUS THAN ACTUAL EXPOSURE TO THE OIL. IF THEY LOST A LOT OF MONEY, THEY LOST MONEY BECAUSE OF IT, IT HAD A GREATER ASSOCIATION WITH POOR MENTAL HEALTH. LET'S LOOK AT THIS OVER TIME. WE'RE JUST LOOKING AT DEPRESSION. ANXIETY AND ANGER WERE ALSO STUDIED AND THEY FOLLOWED THE SAME PLOT. WE HAD CLOSE TO 2010, 40% OF THE SAMPLE WAS ELEVATED, AND WITH RESPECT TO DEPRESSIVE SYMPTOMS, STARTED TO DROP DOWN. REMEMBER BASE RATES SHOULD BE AROUND 9-12%. THEY DROPPED DOWN TO CLOSE TO 20 AND KICKED UP AGAIN AND THAT'S BECAUSE WHAT HAPPENED THROUGH SOME ENVIRONMENTAL CHANGES OVER TIME, THE BAY WAS OFFICIALLY SHUT DOWN TO OYSTERING, OYSTERS COULD NO LONGER BE COLLECTED, NO OYSTERS WERE THERE OR THEY WERE TOO SMALL AND THE NATURAL RESOURCES OR STATE RESOURCES GROUP HAD TO SHUT IT DOWN. ONCE AGAIN, BECAUSE OF ENVIRONMENTAL DEGRADATION, THEY LOST SOME INCOME AND WE HAD ANOTHER INCREASE IN DEPRESSION. LET'S LOOK AT THE TWO COMMUNITIES. ACTUALLY LET ME GO BACK. WHEN WE LOOK AT RIGHT NOW, LINEAR REGRESSION FROM THE BEGINNING OF 2011 TO 2015. WE FOUND AFTER -- TO BUILD THIS WE WENT THROUGH PRE-ANALYSIS. WE FOUND COPING DISENGAGEMENT, DISENGAGEMENT FROM YOUR ACTIVITIES, CHOOSING THAT AS MESSAGE OF COPING WAS THE STRONGEST PREDICTOR OF DEPRESSION SCORE IN WAVE 5 OR 2015. DISENGAGEMENT, WHAT IS IT? IF I'M SPEAKING TO SCIENTISTS HERE, ACCORDING TO THE MEASURE WE USE, COPING MEASURE, BASICALLY IT'S A PSYCHOLOGICAL DISENGAGEMENT FROM PROBLEM SOLVING, DAY DREAMING, SLEEPING, DISTRACTION, GIVING UP, USE OF ALCOHOL OR OTHER DRUGS, HUMAN, MAKING JOKES ABOUT THE STRESSOR, WHILE THERE IS CERTAINLY NOTHING WRONG WITH DISENGAGEMENT AS YOU ALL KNOW DURING BRIEF PERIODS OF STRESS TO HELP YOU GET THROUGH, IF IT'S CHRONIC LONG TERM, OBVIOUSLY IT'S CAUSING A PROBLEM IN THIS GROUP. SO WE FOUND DISENGAGEMENT WAS PREDICTIVE OF DEPRESSION 2-5 YEARS AFTER CORRELATED WITH SOCIAL SUPPORT. SOCIAL SUPPORT ALSO DECLINED OVER TIME. WHICH IS PROBABLY NOT SURPRISING. AND ONCE AGAIN WAS REFLECTED IN CORRELATIONS WITH DEPRESSION. THEN WE SAID LET'S LOOK AT THE TWO COMMUNITIES. ONE THAT WAS EXPOSED PHYSICALLY TO OIL, THE OTHER THAT HAD THE STRONGER ECONOMIC IMPACT WITH THE BIG SEAFOOD PROCESSING PLANTS. FLORIDA IS THE ONE OIL DIDN'T REACH, ALABAMA OIL DID REACH SHORES. COMPARING BOTH COMMUNITIES, 2010 OR 2014, THERE'S STILL A DIFFERENCE. IT IS A SIGNIFICANT DECLINE OVER TIME AND SIGNIFICANT DIFFERENCE BETWEEN THE TWO GROUPS. SO FOR SOME REASON, THE ALABAMA COMMUNITY WAS RECOVERING BETTER AND FASTER. WE START INTERACTING WITH SOCIAL SCIENTISTS AND USING SOCIAL NETWORKS MAPPING WHICH WE HAD VERY WELL EXPLAINED TO US A FEW MOMENTS AGO, BASICALLY WE FOUND ALABAMA COMMUNITY IS TIGHT, ANOTHER COMMUNITY SOCIAL NETWORKS WERE NOT SO TIGHT AND HAD POORER OUTCOMES. THAT BRINGS US TO WITH COMMUNITY DIFFERENCES, WE LOOKED AT VARIABLES, WE NEEDED TO BEGIN TO APPRECIATE THE INDIVIDUAL AND COMMUNITY LEVEL VARIABLES GOING INTO RECOVERY FROM DISASTER. WE'VE HEARD ABOUT INDIVIDUALS AND COMMUNITIES, A LEVEL VARIABLES ALL DAY, PRETTY MUCH CONSISTENT WITH THAT. WHAT WE DO HAVE AN ASSUMPTION IN THE MODEL THAT WE BUILD, MOST PEOPLE HAVE THE LATENT CAPACITY TO BE RESILIENT. MOST PEOPLE HAVE IT IN THEM, JUST HAVE TO FIGURE OUT HOW TO ACTIVATE IT. THAT'S THE BASIS OF OUR MODEL. THEY'VE GOT IT. WE HAVE TO SOMEHOW HELP THEM TRIGGER OR ACTIVATE IT SO THEY CAN RESPOND BETTER. SOME SAMPLE INDIVIDUAL ATTRIBUTES THAT WE BELIEVE COULD BE USED TO FACILITATE, AND THIS IS ALL LISTED RIGHT HERE, ALCOHOL USE, COMMUNITY VARIABLES OUR SOCIOLOGISTS WAS MEASURING, THIS IS THE ACTUAL MODEL AND RATHER THAN DISTRACT YOUR ATTENTION TOO MUCH, WE'VE GOT COMMUNITY RESILIENCY ATTRIBUTES, INDIVIDUAL RESILIENCE ATTRIBUTES, ATTRIBUTES COME FROM AREAS OF THE FOURTH MAIN CAPITALS, HUMAN, ECONOMIC, SOCIAL AND POLITICAL. REPROPOSE RESILIENCE ACTIVATION IS VIA ENGAGEMENT MUCH SOCIAL SUPPORT. IN WORKING WITH A NUMBER OF OTHER INVESTIGATIVE GROUPS CAM OUT AS STRONG PREDICTOR OF BETTER OUTCOME. ACTIVATING, WHAT CAN HELP ACTIVATE SOCIAL SUPPORT, WE IN OUR STEPS TOWARDS RECOVERY FACILITATE AND HAVE BETTER MENTAL HEALTH. THEN WE SET OUT TO TEST THEORETICAL MODEL. ONCE AGAIN, WE HAVE A NUMBER OF INDIVIDUAL ATTRIBUTES, NUMBER OF COMMUNITY ATTRIBUTES. ANYONE HAVE ANY THOUGHTS ON OUT OF ALL THE INDIVIDUAL ATTRIBUTES WHICH ONE WOULD MODERATE SOCIAL SUPPORT THE MOST AFTER A DISASTER? I HEAR A LOT OF DIFFERENT THINGS. I CHEATED A BIT. WE MUST HAVE ENTERED 50 VARIABLES, SO MUCH FOR HYPOTHESIS DRIVEN RESEARCH, NONE CAME OUT. I ASKED THE RESEARCH ASSISTANT DOES ANYTHING -- DOES OUR WHOLE MODEL THROW IT OUT WITH THREE TRACKS OF PAPER? WE MOVE FORWARD AND WE FOUND ALCOHOL USE HAD A SIGNIFICANT INTERACTION OR MODERATED SOCIAL SUPPORT IN ITS EFFECTIVENESS IN BEING ABLE TO HAVE A BETTER MENTAL HEALTH OUTCOME. I THINK I HEARD SOME PEOPLE OUT HERE ALCOHOL TOO. IN TERMS OF COMMUNITY VARIABLES A NUMBER WERE ALSO ASSOCIATED WITH BETTER OUTCOMES ACROSS TIME. MORE SPECIFICALLY, ALCOHOL USE SIGNIFICANTLY MODERATED ASSOCIATION. LOW ALCOHOL CONSUMERS BENEFITED FROM THE PRESENCE OF SOCIAL SUPPORT. INDIVIDUAL BEHAVIORS SUCH AS PROBLEM ALCOHOL USE PROBLEMATIC ALCOHOL USE MAY NOT FACILITATE GOOD ACTIVATION OF SOCIAL SUPPORT AND MENTAL HEALTH OUTCOMES AND OPTIMAL MENTAL HEALTH OUTCOMES. IMPLICATIONS FOR INTERVENTIONS, I HAVE THIS SLIDE, IMPLICATIONS AND THE PRACTICAL SLIDE OF WHAT WE WERE ABLE TO DO. IN TERMS OF IMPLICATIONS FROM OUR MODELS AND DISCUSSIONS WITH COMMUNITY LEADERS, WE THINK IN THE FUTURE -- MOVING FORWARD, DISASTER PREVENTION, IDENTIFYING VULNERABLE COMMUNITIES AND ENHANCING BEHAVIORAL MENTAL HEALTH SERVICES IN THOSE COMMUNITIES, IMPROVING ACCESS TO SOCIAL SUPPORT IN THESE COMMUNITIES, MANY OF WHICH ARE ISOLATED. AT LEAST THE COASTAL COMMUNITIES OFTEN INVOLVED IN DISASTERS LIKE HURRICANES AND FLOODS. INCREASED PROBLEM SOLVING CAPACITY OF INDIVIDUALS AND FAMILIES AND CREATE INFRASTRUCTURE TO ACTIVATE SOCIAL SUPPORT IF AND WHEN IT'S NEEDED. EARLY INTERVENTION, TANGIBLE FINANCIAL PRACTICAL SUPPORT IS NECESSARY, WITH FINANCIAL COUNSELING. CRISIS INTERVENTION IS OFTEN NEEDED ESPECIALLY PEOPLE THAT GET INTO ACUTE DISTRESS BECAUSE OF IT. SOCIAL SUPPORT NETWORKS AND SYSTEMS IDENTIFYING AT-RISK PEOPLE AND PROVIDING REASSURANCE THAT THEY WILL GET THROUGH THIS MAY BE HELPFUL OR MAY BE ALL SOME PEOPLE NEED. MOST PEOPLE ARE INHERENTLY RESILIENT, NOT EVERYBODY IS GOING TO FALL APART IN A DISASTER. POST ACUTE INTERVENTIONS WE THINK IT'S IMPORTANT TO MONITOR PROGRESS, IDENTIFY PEOPLE WHO HAVE BECOME DISENGAGED, WE WORRY THEY ARE GOING TO GET IN A PATTERN AND HAVE MORE TROUBLE RECOVERING LATER, IF THEY HAVE PERSISTENT PROBLEMS THAT COULD BE PROBLEMATIC, PEOPLE ISOLATING SHOULD BE REACHED OUT TO. ALSO FOR SUSTAINED INTERVENTION OBVIOUSLY ONGOING TRACKING MONITORING INTERVENTION WITH VULNERABLE PEOPLE AND COMMUNITIES. SOME ARE MORE VULNERABLE THAN OTHERS AND BEYOND THE SCOPE OF MY DISCUSSION TODAY TO DISCUSS DETAILS OF THAT. OUR OWN PRACTICAL INTERVENTIONS WE PROVIDE PRACTICAL AND EMOTIONAL SUPPORT OURSELVES DURING THE OIL SPILL AND THERE HAS BEEN PUBLISHED RESEARCH TO SHOW SOMETIMES THE RESEARCHERS HAVING RESEARCHERS IN THE ENVIRONMENT IS SEEN AS SUPPORTIVE BY MAKING PEOPLE FEEL IMPORTANT, CARED FOR AND VALUED. SO WHILE WE WERE DEVELOPING THE CBPR MODELS WE WERE TALKING TO PEOPLE, WE WERE HELPING THEM FILL OUT CLAIMS FORMS, WE WERE BABY-SITTING THEIR CHILDREN SO THEY COULD DO WHAT THEY NEEDED TO DO TO GET PAPERWORK TO FILL OUT THEIR CLAIMS FORMS, AND WE EVEN RESCUED A CAT. WHATEVER NEEDS TO BE DONE DURING THE CRISIS NEEDS TO BE DONE. IT'S VERY IMPORTANT, RESEARCH DOES NOT GET IN THE WAY. YOU GOT A COMMUNITY THAT NEEDS TO SOLVE PRACTICAL PROBLEMS FIRST. NIEHS DEVELOPED A VERY SOPHISTICATED JOB RETRAINING PROGRAM. IT IS AMAZING. BECAUSE MANY OF FISHERMEN COME FROM GENERATIONS OF PEOPLE THAT WERE FISHING AND OYSTERING THEY DIDN'T HAVE ANYTHING ELSE TO DO AND LOST RESOURCES SO THEY WERE GETTING OPPORTUNITIES TO GO TO COLLEGE AND GET OTHER KINDS OF TECHNICAL RETRAINING. WE INCREASED PSYCHOLOGICAL SUBSTANCE USE AND DOMESTIC VIOLENCE SERVICES, AS SOON AS WE SAW THE RISES IN SUBSTANCE USE AND DOMESTIC VIOLENCE WE NOTIFIED THE COMMUNITY IT WAS IN AND HELPED THEM INCREASE THEIR RESOURCES. HOW DO WE HELP THEM? WE HAD AN AMAZING COMMUNITY OUTREACH CORE, A TEAM OF FOLKS THAT WENT OUT AND HELPED A WHOLE COMMUNITY COALITION WITH GRANT WRITING FOR THESE NEEDED SERVICES. I MEAN, YOU CAN HAVE PEOPLE OFFERING THE SERVICE BUT IF YOU DON'T KNOW HOW TO WRITE THE GRANT, THE PROPOSAL PROPERLY, YOU'RE PROBABLY NOT GOING TO GET IT. AND OBVIOUSLY OUR BEHAVIORAL HEALTH TEAM DID ANNUAL PRESENTATIONS TO SERVICE PROVIDERS AND LEADERSHIP INCLUDING MINISTERS, SCHOOL PSYCHOLOGISTS, AREA COUNSELORS, WELFARE WORKERS, ET CETERA. WE DON'T KNOW IF THESE COMMUNITIES ARE BACK TO THE NEW NORMAL YET. AND EVERY HURRICANE SEASON, YOU WONDER IF SOMETHING ISN'T GOING TO HAPPEN TO DISRUPT THEIR LIVES AGAIN AND HOW THEY ARE GOING TO REACT, BUT FOR NOW THEY HAVE BEEN SOMEWHAT ADJUSTED AND BEFORE I CLOSE I WANT TO THANK ALL THESE SAMHSA, NIEHS, AND OTHER INSTITUTIONS THAT WORKED WITH US ON THESE RESILIENCE PROJECTS. [APPLAUSE] >> THANK YOU FOR THE TIMELY TOPIC. I'D LIKE TO INTRODUCE OUR FINAL SPEAKER, DR. ALAN MENDELSOHN, DEVELOPMENTAL BEHAVIORAL PEDIATRICS, ASSOCIATE PROFESSOR OF PEDIATRICS AND POPULATION HEALTH AT NEW YORK UNIVERSITY SCHOOL OF MEDICINE AND BELLEVUE HOSPITAL CENTER, RESEARCH FOCUSED ON POVERTY-RELATED DISPARITIES AND CRITICAL CHILD OUTCOMES INCLUDING CHILD DEVELOPMENT, OBESITY AND CHRONIC DISEASE. AND HE WILL BE PRESENTING HIS WORK FUNDED BY NICHED AROUND ADDRESSING DISPARITIES AND SCHOOL READINESS THROUGH PROMOTE OF PARENTING AND WELL CHILD CARE. THANK YOU. >> GOOD AFTERNOON. IT'S A PLEASURE TO BE HERE. I'M HONORED BY THE OPPORTUNITY TO TALK TO YOU ABOUT THE WORK THAT I'VE DONE. OKAY. SO THIS IS THE PROBLEM THAT WE HAVE SOUGHT TO ADDRESS, WHICH IS POVERTY-RELATED DISPARITIES ACROSS DEVELOPMENTAL DOMAINS BEGIN IN EARLIEST OF CHILDHOOD AND IMPACT EDUCATIONAL, ECONOMIC AND HEALTH OUTCOMES THROUGHOUT LIFE. TO GIVE YOU AN IDEA OF THE KIND OF STATISTICS THAT UNDERSCORES HOW SIGNIFICANT THIS ISSUE IS, IF ONE LOOKS AT DISPARITIES IN READING ACHIEVEMENT IN FOURTH GRADERS AS THE U.S. DEPARTMENT OF EDUCATION DOES AND ONE COMPARES POOR TO NON-POOR CHILDREN GROWING UP IN POOR VERSUS NON-POOR FAMILIES, THE PERCENTAGE WITH READING DIFFICULTIES IN FOURTH GRADE AMONG POOR FAMILIES IS 44% COMPARED TO 17% IN NON-POOR FAMILIES. WE'LL MENTION THE DEFINITION OF POVERTY HERE WAS ELIGIBILITY FOR SCHOOL LUNCH, SO ABOUT TWICE THE POVERTY LINE. THIS IS A SHOCKING STATISTIC. MY BACKGROUND IS AS A GENERAL PEDIATRICIAN AND DEVELOPMENTAL BEHAVIORAL PRINCIPAL PEDIATRICIAN AND INVESTIGATEDDOR. POSITIVE PREDICTIVE VALUE OF POVERTY, PREDICTING IMPLICATIONS THROUGH LIFE, THIS IS A VERY SIGNIFICANT NUMBER. THE GUIDING PRINCIPLES OF OUR WORK HAS BEEN NEED FOR PRIMARY PREVENTION BEGIN IN EARLY CHILDHOOD WHERE PRIMARY, PRIOR TO EMERGENCE OF PROBLEMS, THAT PARENT-CHILD INTERACTION CAN BE A KEY TARGET AND PEDIATRIC PRIMARY CARE CAN BE A POPULATION SCALABLE PLATFORM FOR PROMOTION OF PARENTING AND SCHOOL READINESS. SO WHAT WE MEAN, WHY PEDIATRIC PRIMARY CARE? THERE'S THREE REASONS, ONE IS POPULATION LEVEL ACCESSIBILITY. THERE ARE A LOT OF VISITS IN THOSE FIRST COUPLE OF -- THE CRITICAL FIRST COUPLE YEARS. WE'RE INVENTING MORE VISITS. COMING AS A RESULT OF RESEARCH DONE BY NIH IN FACT. AND OPPORTUNITY TO BUILD ON PARENTS' EXISTING GOALS, EXISTING RELATIONSHIPS, IF YOU ASK WHAT THEY CARE ABOUT AFTER ACUTE OR CHRONIC ILLNESS, THEY CARE ABOUT THEIR CHILD'S DEVELOPMENTS AND BEHAVIOR. FINALLY THE OPPORTUNITY TO WORK AT LOW COST BUILDING ON EXISTING TRAFFIC IS INFRASTRUCTURE AND VISITS. THE MOST STUDIED AND PROVEN PRIMARY CARE INTERVENTION OUT THERE IS CALLED REACH OUT AND READ. THIS PROGRAM INCLUDES A COUPLE DIFFERENT COMPONENTS. IT'S A SIMPLE PROGRAM, WAITING ROOM VOLUNTEERS AND STAFF MODEL READING ACTIVITIES AND HEALTH CARE PROVIDERS WHO COUNSEL PARENTS ABOUT IMPORTANCE OF READING AND DISTRIBUTE PRE-CHILDREN'S BOOKS OVER FIVE YEARS. WHAT'S INTERESTING IS THAT THE EXPERIENCE WITH REACH OUT AND READ HAS PROVEN THAT PEDIATRIC PRIMARY CARE CAN BE EFFECTIVELY UTILIZED FOR POPULATION LEVEL ACCESS AND DELIVERY OF LOW COST PREVENTION. ERE ARE NOW MORE THAN 15 STUDIES INCLUDING ON READING ALOUD AND VOCABULARY, REACH OUT AND READ NOW REACHES 4.5 MILLION CHILDREN PER YEAR IN THE UNITED STATES, DEPENDING ON HOW YOU COUNT IT WOULD REPRESENT MORE THAN 25% OF ALL LOW INCOME CHILDREN BELOW AGE 5. IT DOES SO AT ESTIMATED COST OF $25 PER CHILD PER YEAR, BY CONTRAST PROGRAMS THAT ARE MORE INTENSIVE AND HIGHLY EFFECTIVE SUCH AS HOME VISITING PROGRAMS MIGHT COST FROM $1000 TO $2500 PER YEAR, OPERATING AT 1/100th OF THAT COST, AN IMPORTANT ROLE AS ADJUNCT. WE BEGAN TO THINK WAYS WE MIGHT BUILD ON THAT MODEL TO INCREASE IMPACTS. AND WHAT WE DID IS WE ADDED AN INTERVENTIONIST OR COACH WORKING ONE ON ONE WITH FAMILIES, PROMOTING PLAY AND READING ALOUD, AND IN WHICH THE CORE ACTIVITY IS VIDEO RECORDING OF PARENT-CHILD INTERACTION USING TOY OR BOOK PROVIDED BY THE PROGRAM, FOLLOWED BY REVIEW OF THE VIDEO TO PROMOTE SELF REFLECTION, AND THIS IS AN INTERMEDIATE COST, MAYBE $170 PER CHILD PER YOU'RE, MAYBE 1/10 THAT OF HOME VISITING. AN IDEA OF WHAT THIS PROGRAM LOOKS LIKE, WE DEVELOPED INTERACTIVE PAMPHLETS BUILDING ON PARENTS' GOALS AND STRUCTURE VISIT TO SUPPORT FIDELITY, AND I'M JUST SHOWING THIS TO YOU TO SHOW KIND OF WHAT THE STRUCTURE OF THE VISIT LOOKS LIKE, BUT TO NOTE THAT THE FORMS CONTAIN A LOT OF EXCITE SPACE. THE REASON THEY DO IS BECAUSE A LOT OF WHAT WE'RE DOING IS WE'RE ENCOURAGING PARENTS TO BECOME ACTIVE OBSERVERS OF THEMSELVES AS PARENTS AND THEN BECOME ACTIVE PARTICIPANTS IN THEIR CHILD'S DEVELOPMENT. SO WE'LL ASK THEM WHAT THEY HAVE OBSERVED ABOUT THE CHILD, MAYBE TRYING TO BRING THAT IN THE CONTEXT OF, YOU KNOW, THE CHILD'S DEVELOPMENTAL LEVEL, AND THEN PROVIDE A TOY OR BOOK, MAKE PLANS FOR THE VIDEO TOGETHER, THIS IS ABOUT THE PARENTS' PLANS. WE FILM AND REVIEW THE VIDEO TOGETHER WITH THE INTERVENTIONIST, AND SET GOALS FOR HOME, AND JUST VERY BRIEFLY, I WILL SHOW YOU A QUICK CLIP. >> WE INTRODUCE A NEW BOOK OR TOY, OUR TOY FOR TODAY IS A BOOK. YOU SEE THAT? IT'S REALLY WONDERFUL BECAUSE IT GIVES YOU A LOT TO TALK ABOUT, IT MAKES YOUR INTERACTION EVEN EASIER BECAUSE IT GIVES YOU LOTS OF COLORS, YOU CAN TALK ABOUT THE SOUNDS. WE MAKE A PLAN TOGETHER FOR VIDEOTAPING. HOW WOULD YOU INTRODUCE THE TOY TO HER, WHAT WOULD YOU SAY? >> WELL, A NEW BOOK! VERY COLORFUL! AND THEN I'D SHOW HER THE SUN. NOSE, EYES, RIGHT? >> THIS IS A VIDEO FOR YOU AND HER, IT'S YOUR TIME TOGETHER. JUST PLAY AND ENJOY YOURSELF. >> WE CREATE A 3-5 MINUTE VIDEO OF THE PARENT AND CHILD INTERACTING TOGETHER. >> HERE'S A FISHY! WHAT COLOR IS THE FISHY? IT'S PINK! RIGHT? YOUR FAVORITE COLOR, JUST LIKE PURPLE? >> WE REVIEW THE VIDEO TOGETHER HIGHLIGHTINGND REINFORCING STRENGTH IN THE INTERACTION. YOU'RE CONSTANTLY TALKING TO HER THROUGHOUT THE BOOK. SHARING THE BOOK. YOU SAID LOOK, LET'S OPEN UP. YOU'RE SHARING ACTION WORDS. YOU'RE DESCRIBING WHAT YOU'RE GOING TO BE DOING. I LOVE THIS PART! YOU RELATED BACK TO SOMETHING THAT'S VERY MUCH FOR HER. YOU LIKE PINK, YOUR FAVORITE COLOR, BESIDES PURPLE. >> PURPLE! >> WHAT WAS YOUR FAVORITE PART OF THE VIDEO? >> MY FAVORITE PART, SHE WAS SO EXCITED TO SEE THE BOOK, SO INTO IT! >> SHE'S EXCITED ABOUT WHAT YOU'RE SAYING TO HER, THE FACT THAT YOU'RE SPEAKING TO HER THAT WAY. >> INDICATING WHAT YOU DO, FASCINATING, MOVING YOUR MOUTH, SOUNDS ARE COMING OUT. THE VISIT ENDS WITH A PLAN FOR READING, PLAYING AND TALKING TOGETHER AT HOME. WHAT WOULD YOU LIKE TO CONTINUE DOING WITH HER AT HOME WITH THE BOOK? WHAT WOULD YOU DO? >> THE SAME THING. >> PLAY WITH HER, THE COLORS. >> ALSO THE STORIES. >> ABSOLUTELY. >> SO WITH FUNDING FROM NIH AND NICHD BEGINNING IN 2005, WE ENGAGED IN A RANDOMIZED CONTROL TRIAL, COMPARING THIS PROGRAM TO ROUTINE CARE AND TO A THIRD PROGRAM CALLED BUILDING BLOCKS WHICH I'M NOT GOING TO GO INTO TODAY. AND AS PART OF THE ORIGINAL STUDY DESIGN, PERFORMED SINGLE BLINDED ASSESSMENT THROUGH AGE 36 MONTHS, WE ENROLLED 675 FAMILIES OVER A 3-YEAR PERIOD AND FOLLOWED CHILDREN AT LEAST THROUGH AGE 3 IN THE FIRST PHASE. WE -- THIS SLIDE SHOWS OUR PUBLISHED FINDINGS, WHICH INCLUDE INCREASED PARENT CHILD INTERACTIONS INCLUDING ENHANCED READING, PLAY, TALKING AND REDEUCED SCREEN TIME AND PHYSICAL PUNISHMENT, COPING WITH PSYCHOSOCIAL STRESSORS, MATERNAL DEPRESSIVE SYMPTOMS, REDUCE PARENTING STRESS AND ENHANCE DEVELOPMENT, INCLUDING LANGUAGE AND COGNITIVE DEVELOPMENT. OUR MOST ROBUST FINDINGS THUS FAR RELATE TO SOCIAL AND EMOTIONAL DEVELOPMENT. FIRST PARENT-CHILD INTERACTIONS, WE PUBLISHED FINDINGS THAT FUNCTIONAL FOLLOW 6 MONTHS, USING THE STIM-Q, DEVELOPED AND REVALIDATED, AVAILABLE FOR FREE DOWNLOAD ON OUR WEBSITE AT NYU, ANYBODY CAN USE IT. TO ASSESS PLAY WITH TOYS, READING, TEACHING, VERBAL RESPONSIVITY. SIZES WERE LARGE, AROUND THE .5 STANDARD DEVIATION LEVEL, PRETTY BIG FOR INTERVENTION LIKE THIS. NOW, WE DIDN'T SEEK TO REDUCE SCREEN TIME. THIS IS KIND OF INTERESTING. THIS IS NOT PART OF OUR ORIGINAL THOUGHT PROCESS. IT IS NOW BUT IT WASN'T THEN. AND SO WHAT WE FOUND WAS THAT WE DID REDUCE SCREEN TIME. WHAT SEEMS TO BE HAPPENING IS THAT ALTHOUGH CERTAINLY THERE'S MUCH DATA TO SUPPORT HOW SCREEN TIME DISPLACED POSITIVE INTERACTION PARTICULARLY IN LOW INCOME HOUSEHOLDS, WHAT WE BELIEVE IS HAPPENING THROUGH MEDIATION MODELS IS THAT SOME EXTENT, INCREASED IN INTERACTION TAKING PLACE MAY BE REDUCING SOME OF THE SCREEN TIME. IN ADDITIONAL THOUGH WE DIDN'T FOCUS ON PHYSICAL PUNISHMENT WE FOUND THAT PRESUMABLY IN THE CONTEXT OF THE ENHANCED PARENT-CHILD RELATIONSHIP TAKING PLACE, THERE WAS SOME REDUCTION IN PHYSICAL PUNISHMENT WHICH WE PUBLISHED LAST YEAR. SECOND, WE'LL NOTE FINDINGS RELATED TO COPING WITH PSYCHOSOCIAL STRESSORS AND THIS IS REALLY INTERESTING. AGAIN, SOMETHING WE WEREN'T EXACTLY LOOKING FOR BUT WHAT WE FOUND WAS THAT THERE IS SUSTAINED REDUCTION IN PARENTING STRESS, AGAIN WHICH WE THINK IS SORT OF RELATED TO ENHANCEMENT IN THE PARENT-CHILD RELATIONSHIP. THIS IS A BIG DEAL, AND THE REASON IT'S A BIG DEAL, PARENTING STRESS PREDICTS EVERYTHING BUT IN PARTICULAR CHILD MALTREATMENT. THIS IS AN IMPORTANT FINDING. THIRD, WE FOUND SOME REDUCTIONS IN MATERNAL DEPRESSIVE SYMPTOMS AND AGAIN THIS ISN'T SOMETHING WE WERE NECESSARILY LOOKING FOR BUT WHICH WE DID FIND AND IN TERMS OF MILD SYMPTOMS, REDUCTION FROM 30% TO 20% APPROXIMATELY AND MODERATE SYMPTOMS FROM 10 TO 5. THIRD, WE WILL DESCRIBE BRIEFLY SOME OF OUR FINDINGS RELATED TO CHILD DEVELOPMENT, AND HERE I'M GOING TO FOCUS ON THE SOCIAL EMOTIONAL DEVELOPMENTAL FINDINGS WE PUBLISHED AND ARE WRITING UP. USING THE BASC SUBSCALE, STANDARDIZED INSTRUMENT AND WELL VALIDATED BASED ON PARENT REPORT WE FOUND REDUCTIONS IN HYPERACTIVITY, AGGRESSION AND MANY OVERALL EXTERNALIZING BEHAVIOR. EFFECT SIZE WAS .2, AROUND A QUARTER OF A STANDARD DEVIATION, WHICH IS AGAIN A PRETTY SUBSTANTIAL EFFECT. NOW, WHERE IT GETS MORE INTERESTING, YOU START TO LOOK AT FAMILIES WHO HAVE SPECIFIC SOCIAL RISKS, SO WHAT I PROBABLY NEGLECTED TO MENTION IS THAT THIS WAS ENTIRELY A SAMPLE OF LOW INCOME FAMILIES. ALL FAMILIES WERE AT RISK. THAT BEING SAID, SOME PERCENTAGE ARE ADDITIONAL IDENTIFIABLE RISKS INCLUDING PRIOR HISTORY OF MENTAL ILLNESS, HOMELESSNESS OR SUBSTANCE USE, AND THOSE FAMILIES CONSTITUTED ABOUT A THIRD OF THE SAMPLE. WHEN YOU LOOK AT THAT THIRD OF THE SAMPLE, REDUCTIONS IN RATE OF CLINICALLY SIGNIFICANT BEHAVIOR PROBLEMS IS QUITE LARGE. AN EXAMPLE IF ONE LOOKS AT HYPERACTIVITY, THE RATE OF CHILDREN MEETING THE FIRST THRESHOLD IS 41, COMPARED TO 15% AMONG FAMILIES ASSIGNED TO VIP, BASED ON INTENT TO TREAT. THAT REPRESENTS A RELATIVE RISK REDUCTION OF 63%, BUT PERHAPS EVEN MORE RELEVANT TO POLICY IS NUMBER NEEDED TO TREATMENT SO THE NUMBER NEEDED TO TREAT, I'M SURE MANY OF YOU KNOW, RELATED TO A -- CALCULATED BASED ON REDUCTION, THE ABSOLUTE RISK REDUCTION, SO THE ABSOLUTE RISK REDUCTION WAS 15 TO 41%, 25% REDUCTION, TRANSLATES TO NUMBER TO TREAT IS 4 FOR HYPERACTIVITY MEASURES, ONE WOULD NEED TO DELIVER THIS PROGRAM TO 4 FAMILIES TO ACTUALLY HAVE A REDUCTION OF ONE FAMILY WHO WOULD HAVE A CHILD WHO MET A CLINICAL THRESHOLD FOR HYPERACTIVITY. SO AS YOU MIGHT IMAGINE, THIS HAS THE -- THIS HAS DIRECT IMPLICATION FOR THE WAY ONE THINKS ABOUT POLICY, DIRECT MONETIZING, IF YOU HAVE A PROGRAM THAT RUNS AT $170 PER CHILD, PER YEAR FOR THREE YEARS, THAT'S ABOUT $500 PER FAMILY, AND YOU DELIVER TO FOUR FAMILIES, THAT'S $2000 THAT YOU'VE GIVEN, AND FOR $2000 YOU REDUCED ONE CASE OF CLINICAL LEVEL HYPERACTIVITY, THAT WOULD BE A REALLY, REALLY BIG DEAL. THERE ARE NO TWO WAYS ABOUT IT. THE IMPLICATIONS ACROSS HEALTH AND ACROSS THE LIFESPAN. NOW, THAT BEING SAID, THIS IS A 3-YEAR MEASURE BUT AS YOU'LL SEE WE ACTUALLY HAVE FOLLOW-UP FINDINGS THAT ACTUALLY SUGGEST THAT THIS CONTINUES TO SOME EXTENT AS WE FOLLOW FAMILIES. ANOTHER BIG DEAL FINDING, I WANT TO HIGHLIGHT THIS, THAT, YOU KNOW, HERE WE'RE SORT OF LOOKING AT, YOU KNOW, THE WAY IN WHICH -- ONE REALLY NEW AND NOVEL FINDING HAS BEEN TO REALLY BEGIN TO DISENTANGLE THE WAYS IN WHICH THE DIFFERENT KINDS OF ACTIVITIES AND EXPERIENCES THAT TAKE PLACE IN FAMILIES ULTIMATELY AFFECT OUTCOMES, AND WHAT'S REALLY INTERESTING IS THAT BY INCREASING COGNITIVE INTERACTIONS, WE'RE ACTUALLY -- THERE'S AN INTERPLAY BETWEEN POSITIVE ACTIVITIES TAKING PLACE TO RESULT IN REDUCTION IN PARENTING STRESS THAT THEN CARRIES OVER TO REDUCTION IN EXTERNALIZING PROBLEMS, AND THIS IS A BIG DEAL BECAUSE THIS SUGGESTS THAT AS WE LOOK AT WAYS TO INTERVENE WITH FAMILIES, IT'S NOT KIND OF ONE OR THE OTHER, NOT THAT WE PROMOTE PLAY AND READING ON THE ONE HAND OR DO THINGS ABOUT TOXIC STRESS ON THE OTHER. THINKING ABOUT BOTH IS PROBABLY THE WAY TO GO. I'LL QUICKLY MENTION THAT WE RECEIVED A COMPETING CONTINUATION FROM NICHD IN 2010, RERANDOMIZED FAMILIES AT AGE 3 TO GET A SECOND COMPONENT, VIP 3-5, FAMILIES THEN RECEIVED FROM 3-5 YEARS OR NOT. THIS ENABLES US TO BEGIN TO LOOK AT FAMILIES WHO RECEIVED PROGRAM EARLY, LATE, BOTH OR NEITHER. AND BE ABLE TO BEGIN TO SAY SOMETHING ABOUT SORT OF TIMING AND DOSE OF INTERVENTION. JUST TO BEGIN TO SHOW YOU SOME OF THE FINDINGS THAT ARE HERE AND WE'RE VERY MUCH IN PROGRESS WORKING ON THESE FINDINGS, THESE ANALYSES FOR THE BEHAVIOR OUTCOME, WE'RE FINDING SUSTAINED IMPACTS OF VIP 0-3, 0-3 COMPONENT AT 4 1/2 TO 5 YEARS, 2 YEARS AFTER COMPLETION OF THE STUDY AND SO WE'RE FINDING A CONTINUATION OF THAT QUARTER OF A STANDARD DEVIATION IMPACT. IN ADDITION, WE'RE FINDING AN ADDITIVE IMPACT OF VIP 3-5, ADDITIONAL INDEPENDENT IMPACT AROUND QUARTER OF STANDARD DEVIATION ALSO AND SO TOGETHER THAT'S ACTUALLY GIVING US A VERY BIG DIFFERENCE AT AGE 54 MONTHS, OF ABOUT .5 STANDARD DEVIATIONS. SO IN THE LAST COUPLE OF SLIDES I WANT TO TELL A LITTLE BIT ABOUT WORK IN PROGRESS. FIRST, I WILL JUST KIND OF NOTE THAT WE'RE CONTINUING TO FOLLOW THE COHORT TO LEARN LONG-TERM VIP IMPACTS, WE'VE ACTUALLY BEEN DOING SCHOOL-BASED ASSESSMENTS OF THE COHORT IN SECOND GRADE, AND THAT IS CONSISTENT OF IN-SCHOOL OBSERVATION OF CLASSROOM ENGAGEMENT AND TEACHER REPORTS OF CHILDREN'S ACHIEVEMENTS AND WE HOPE TO GET NEW YORK STATE TEST SCORES. WE HAD TO GET INDIVIDUAL IRB APPROVAL FROM EVERY SCHOOL, EVERY PRINCIPAL AND TEACHER, WE MADE IT INTO -- I FORGET THE NUMBER, I WANT TO SAY 130 OR 140 SCHOOLS. SO IT'S PRETTY COOL. AND SORRY, I JUST MENTIONED IN ADDITION, IT'S ON THE PREVIOUS SLIDE, WE HAVE COLLECTED HAIR SAMPLES TO ASSESS CORTISOL AS PART OF ACADEMIC PEDIATRIC ASSOCIATION, YOUNG INVESTIGATOR AWARD THAT WAS AN ADD-ON TO BEGIN TO LOOK MORE TO UNDERSTAND PATHWAYS OF STRESS AND RESILIENCY IN FAMILIES. SECOND I WANT TO COMMENT ON WORK IN PROGRESS RELATED TO DISSEMINATION AND IMPLEMENTATION. WE'VE PUT IN A GREAT DEAL OF WORK THINKING ABOUT THIS ISSUE. WE'VE FULLY MANUALIZED THE PROGRAM, THIS HAPPENED IN THE LAST TWO YEARS. WE PUT TOGETHER A THREE-DAY TRAINING COURSE, DESIGNED NEW MATERIALS TO SUPPORT FIDELITY. WE'VE DEVELOPED A BLUEPRINTED FOR A CENTER OF EXCELLENCE TO SUPPORT IMPLEMENTATION WITH NON-PROFIT BUSINESS PLAN AND ORGANIZATIONAL STRUCTURE, AND WE HAVE A LOT OF PROJECTS UNDERWAY, SIMULTANEOUSLY. ONE OF THEM IS THAT THE NEW YORK CITY CITY COUNCIL HAS AN INITIATIVE TO THINK ABOUT PROMOTING EARLY LITERACY ACTIVITY, CITY'S FIRST READERS, VIP AND REACH OUT AND READ ARE LINKED TO LIBRARIES. SECOND, WE'RE ENGAGED IN EXPANSION IN THE NEW YORK CITY PUBLIC HOSPITAL SYSTEM THROUGH NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE AND EXPECT TO BE IMPLEMENTING AT ELMHURST THIS YEAR. THIRD WE HAVE A NEW NICHD RO1 IN WHICH WE'RE CALLED SMART BEGINNINGS, IN WHICH WE HAVE AN INTEGRATED TIERED MODEL LINKING VIP AND PRIMARY CARE AS PRIMARY PREVENTION TO SECONDARY AND TERTIARY PREVENTION WITH MORE INTENSIVE SERVICES THROUGH FAMILY CHECKUP IN THE HOMES OF FAMILIES AND INCREASED RISK IN PITTSBURGH. FOURTH WE'RE ABOUT TO ENGAGE IN IMPLEMENTATION OF VIP AT HURLEY MEDICAL CENTER IN FLINT, MICHIGAN. AND FINALLY WE'RE ACTUALLY THINKING ABOUT INTERNATIONAL ADAPTATIONS AND HAVE DONE WORK IN BRAZIL. I SEE MY RED LIGHT BLINKING. MY FINAL SLIDE, POLICY IMPLICATIONS. JUST TO CONCLUDE OUR FINDINGS UNDERSCORE THE NEED FOR PRIMARY PREVENTION EFFORTS FOR ALL FAMILIES IN POVERTY. POVERTY ALONE IS A SIGNIFICANT RISK AND PREVENTIVE EFFORTS ARE IMPORTANT REGARDLESS OF ADDITIONAL FACTORS. SECOND OUR FINDINGS SUPPORT INITIATIVES TO BUILD ON THE INTERRELATIONSHIPS BETWEEN THE COGNITIVE AND SOCIAL EMOTIONAL PATHWAYS OF DEVELOPMENTAL DISPARITIES, AND FINALLY OUR FINDINGS SUPPORT ROLE FOR PEDIATRIC PRIMARY HEALTH CARE AS ONE COMPONENT OF A BROAD PUBLIC HEALTH STRATEGY FOR PRIMARY PREVENTION. AND I JUST WANT TO THANK NIH AND NICHD FOR MAKING THIS WORK HAPPEN. I WANT TO THANK THE MEMBERS OF MY PROJECT TEAM. THANK YOU FOR YOUR ATTENTION. >> THANK YOU SO MUCH. WE STILL HAVE A COUPLE MINUTES FOR QUESTIONS SO I'D LIKE TO INVITE OUR SPEAKERS UP TO THE FRONT. THANK YOU, WENDY, FOR LENDING MIDGES OF YOUR CLOSING TIME FOR A FEW QUESTIONS. IF ANYONE HAS QUESTIONS WE HAVE MICROPHONES IN THE AISLE. AUGIE, LET'S START WITH YOU. >> EVERYBODY GET COMFORTABLE. SO THE TALKS WERE EXCELLENT. PROJECTS ARE EXCELLENT. RESEARCH SOUNDS TERRIFIC. I WAS HAVING A HARD TIME TEASING OUT HOW MUCH TRANSLATION IS HAPPENING AND HOW IT'S HAPPENING FOR THE MOST PART. FOR EXAMPLE, THE NICHD, YOU SAID YOU'RE IN A WHOLE BUNCH OF SCHOOLS. I DON'T KNOW IF THAT MEANS THE PROJECT ACTUALLY EXISTS AS AN ENTITY THAT CAN BE IMPLEMENTED, A SIMILAR TYPE OF QUESTION WITH THE -- SORRY, I DON'T REMEMBER THE NAMES. ONE OF THE OTHERS. THE ONE THAT SOUNDED LIKE THERE ARE SPECIFIC STRATEGIES BEING IMPLEMENTED WITH THE NIEHS PROJECT, I WANT TO TARGET THAT FOR A SECOND, BECAUSE YOU SAID THAT YOU'VE GOT SPECIFIC SERVICES THAT ARE BEING OFFERED TO PEOPLE, I THINK YOU SAID FINANCIAL COUNSELING OR OTHER KINDS OF THINGS. IF THAT'S TRUE, WHO ON YOUR TEAM IS DOING WHAT, AS A COMMUNITY-BASED PARTICIPATORY RESEARCH PROJECT YOU HAVE COMMUNITY MEMBERS, ORGANIZATIONS, ET CETERA, AND WHAT TYPE OF SKILL SETS DO THEY HAVE TO BE OFFERING THESE SERVICES, AND I WOULD LIKE TO HEAR HOW YOU ARE BUILDING THAT INTO YOUR PREVENTION MODEL FOR RISK SITES. >> THERE WAS NO FINANCIAL COUNSELING OFFERED AT THE TIME. I THINK IN THE FUTURE THAT WAS A RECOMMENDATION FOR THE FUTURE. AT THIS POINT, PEOPLE WHO ARE IMPLEMENTING THE RECOMMENDATIONS THUS FAR ARE PASTORS, SCHOOL SOCIAL WORKERS, LOCAL PSYCHOLOGIST, AND OTHER SOCIAL SERVICE AGENCIES, SOCIAL WORKERS THAT WOULD FALL WITHIN THE PURVIEW UNDER THE UMBRELLA AGENCY OF WHAT'S CALLED THE FRANKLIN PROMISE COALITION. >> THOSE ARE ALL PEOPLE WHO WERE INVOLVED IN THE RESEARCH PROJECT ON THE TEAM IN SOME WAY? OR DID YOU TAKE THE LEARNING AND THEN FIND AGENCIES TO PRESENT THESE SERVICES? >> THEY WERE INVOLVED IN THE PROJECT ALL ALONG BUT NOT IN THE DATA COLLECTION PHASE. THEY WERE INVOLVED HELPING GENERATE QUESTIONS, HYPOTHESES, AND BASICALLY THEY WANTED TO KNOW ABOUT COPING SO THAT'S WHY WE HAD COPING MEASURES IN THERE. OUR ASSESSMENTS WERE LARGELY BASED UPON THINGS THEY WANTED US TO FIND OUT AND WE WOULD GIVE THE INFORMATION BACK AND THEY WOULD PROVIDE IT IN A COUNSELING SETTING IN THEIR COMMUNITIES. THE WAY TO HELP THEM DO THAT WAS OUR EDUCATION AND OUTREACH COMPONENT FOLKS, AS I MENTIONED BEFORE, WENT DOWN AND HELPED COALITIONS AND AGENCIES WRITE GRANTS SO THAT THEY COULD IN THE FUTURE CONTINUE TO SUSTAIN THEMSELVES FOR PROGRAM PROJECTS, OR, YEAH, FOR PROJECTS THEY WOULD NEED, APPLIED PROJECTS. >> AND I'M SORRY, ONE FINAL QUESTION, SO THAT PREVENTION SIDE OF IT, HOW ARE YOU IDENTIFYING HIGH RISK AREAS AND PLANNING AROUND THOSE? ARE YOU MEETING WITH COMMUNITIES AND TALKING ABOUT THESE TYPES OF AGENCIES THAT WILL HAVE A ROLE OR WHAT RESOURCES ARE AVAILABLE? >> THAT WAS ON THE SECOND TO LAST SLIDE WHICH IS THE IDEAL INTERVENTION. >> OKAY. >> WE HAVEN'T DONE THAT YET. >> OKAY. THANK YOU. >> I JUST WANTED TO COMMENT, TO CLARIFY WHAT YOU ASKED ABOUT VIDEO INTERACTION PROJECT. SO WE'RE NOT AT THE MOMENT IMPLEMENTING VIDEO INTERACTION PROJECT IN SCHOOLS. WE'VE DESIGNED THIS TO TAKE PLACE IN PRIMARY CARE SETTINGS. I MENTIONED GOING INTO SCHOOLS, THAT WAS ABOUT DOING A FOLLOW-UP ASSESSMENT OF CHILDREN'S ENGAGEMENT IN CLASSROOMS. TRANSLATION, HOWEVER, WE'RE ENGAGED IN SIGNIFICANT LEVELS OF TRANSLATION IN MANY DIFFERENT WAYS. SO A LOT OF THAT IS TAKING PLACE IN NEW YORK CITY SO WE'RE PRESENTLY WORKING AS I SAID THROUGH THE NEW YORK CITY COUNCIL TO THINK ABOUT EXPANSION ACROSS SITES IN NEW YORK CITY, WORKING WITH NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE, IMPLEMENTING A NEW SITE AT NEW PUBLIC HOSPITAL IN NEW YORK CITY TO BE A MODEL IN FACT FOR DISSEMINATION ACROSS THE IMPLEMENTATION ACROSS THE PUBLIC HOSPITAL SYSTEM. AND THAT'S PROBABLY SUFFICIENT FOR THE MOMENT, BUT THE ANSWER IS YES, WE'RE ACTUALLY ENGAGED IN ACTIVE TRANSLATION. >> HI. TWO QUESTIONS FOR TWO DIFFERENT SPEAKERS. FIRST, DR. GEHLERT, YOU TALKED ABOUT MAKING CHANGES IN THE UNIVERSITY, TALKING TO THE PROVOST, WHAT WERE THOSE CHANGES AND HOW DID YOU CONVINCE THEM? >> BY WEARING THEM DOWN BASICALLY. WE WANTED MORE JUNIOR ACADEMIC INVESTIGATORS TO FEEL COMFORTABLE, FEEL SAFE DOING THIS KIND OF RESEARCH, SO WE MODIFIED A PROMOTION AND TENURE SYSTEM USED AT THE UNIVERSITY OF NORTH CAROLINA WHEREBY YOU GET YOUR REGULAR INTERNAL LETTERS, REVIEWS, OF REVIEW AND EXTERNAL LETTERS OF REVIEW FOR TENURE, BUT WE ALSO PUT TOGETHER A COMMITTEE OF SCHOLARS ON THE CAMPUS WHO DID MORE TEAM SCIENCE, MY RESEARCH, IF SOMEONE DECLARED THEMSELVES TRANSDISCIPLINARY COULD HAVE WORK REVIEWED BY THAT GROUP WHICH WOULD ADD TO THEIR TENURE PACKET AND DID THINGS LIKE ASK PEOPLE IN THEIR -- WHEN THEY ARE LISTING PUBLICATIONS AND IT'S MULTI-AUTHORED, TO REALLY BE CAREFUL TO TALK ABOUT THEIR UNIQUE -- TO ANNOTATE WITH UNIQUE CONTRIBUTIONS, THAT'S ONE THING. WE ALSO GOT THE PROVOST AND CHANCELLOR TO PUT TOGETHER AWARDS ON CAMPUS TO INCENTIVIZE CO-TEACHING ACROSS DISCIPLINES AND ALSO TO DEVELOPMENTAL AWARDS FOR RESEARCH. >> AND DR. MENDELSOHN, FOLLOWING UP ON THE LAST QUESTION, SO YOU TALKED ABOUT DEVELOPING THESE MANUALS AND TRAININGS AND THINGS LIKE THAT. HOW DOES YOUR TEAM WORK? WHO DO YOU HAVE INVOLVED THAT'S DOING THAT? BECAUSE I WAS TALKING TO SOME PEOPLE DURING LUNCH ABOUT, YOU KNOW, IT'S A DIFFERENT SKILL SET OFTEN, THE PEOPLE WHO DO THE RESEARCH AND KIND OF HAVE A DIFFERENT PERSONALITY AND SKILL SET THAN THE PEOPLE WHO DO IMPLEMENTATION. I JUST WONDER DO YOU HAVE DIFFERENT PEOPLE WORKING ON THESE DIFFERENT ASPECTS. >> THAT'S A GREAT QUESTION. AND ONE COMMENT THAT I WANT TO MAKE, THIS IS REALLY SET UP AS A PARENT EDUCATION PROGRAM SO THAT THE ACTUAL INTERVENTIONISTS THEMSELVES ARE NOT CLINICIANS, THEY ARE REALLY PARENT EDUCATORS, THEIR LEVEL OF TRAINING IS TYPICALLY BACHELOR'S LEVEL AND WE'VE THROUGH SORT OF OUR KIND OF COURSE AND THEN KIND OF SUPERVISED, OBSERVED, EXPERIENCE OVER TIME TRAINED THOSE INTERVENTIONISTS TO IMPLEMENT. THAT IS ONE OF THE WAYS -- AND OVER TIME WE'RE ACTUALLY WONDERING WHETHER WE MIGHT EVEN BE ABLE TO DO THIS WITH COMMUNITY HEALTH WORKERS, ALTHOUGH WE'RE NOT QUITE THERE YET. BUT THAT MAY BE AN OPPORTUNITY FOR THE FUTURE. IN ITEMS OF PEOPLE -- TERMS OF PEOPLE WHO LEAD TRAINING, THE GOAL IS TO HAVE THE MOST EXPERIENCED INTERVENTIONISTS BE THE PEOPLE WHO LEAD THE TRAINING. HOUR, TO DATE THE PEOPLE WHO LED THE TRAINING HAVE BEEN PEOPLE WHO HAVE BEEN INVOLVED IN THE RESEARCH AND THEY HAVE BEEN PEOPLE WITH PSYCHOLOGIST BACKGROUNDS PARTICULARLY IN DEVELOPMENTAL PSYCHOLOGY. >> YEAH, THAT'S WHAT I WAS THINKING, MORE OF A PSYCHOLOGY I'M A PSYCHOLOGIST AND KNOW A LOT OF RESEARCH. YOU'RE KIND OF DOING BOTH, OLD-FASHIONED MODEL WHERE YOU'RE DOING CLINICAL WORK AND RESEARCH BUT I'M WONDERING FOR OTHER SOCIAL SCIENCE RESEARCHERS IN THE ROOM HOW THEY MIGHT SET THAT UP, IF THEY ARE NOT -- IF THERE'S NOT ONE PERSON WHO HAS GOT BOTH HATS, HOW DOES THE TEAM WORK TO DO BOTH THE RESEARCH AND THE IMPLEMENTATION SIDE OF THINGS. >> I'LL JUST ADD TO THAT, THAT IS SORT OF LIKE THE CRITICAL QUESTION FACING US AT THIS MOMENT BECAUSE, YOU KNOW, I HAVE BEEN AS THE P.I. OF A PROJECT, RIGHT, SUPERVISING IN A WAY ALL THE DIFFERENT COMPONENTS OF IT, WITH A GREAT DEAL OF, YOU KNOW, COLLABORATION ACROSS THE MANY PEOPLE WHO I WORKED TOGETHER WITH. BUT IN FACT, AS ONE BEGINS TO THINK OF, YOU KNOW, DISSEMINATION AND IMPLEMENTATION OF SOMETHING LIKE THIS AND THE GOAL, RIGHT, BEING TO SORT OF HAVE SCIENCE CONTINUE, AND HAVE SCIENCE CONTINUE TO INFORM, YOU KNOW, REFINEMENT OF WHAT WE'RE DOING, INCLUDING AS WE, YOU KNOW, WORK WITH, YOU KNOW, NEW POPULATIONS, WITH POPULATIONS WITH DIFFERING RISKS, ET CETERA, HAVING THE SCIENCE INFORM THE DELIVERY AND THEN HAVING THE DELIVERY GO BACK TO -- AND IMPLEMENTATION AND INFORM THE SCIENCE, HOW TO STRUCTURE THAT IS SOMETHING I DIDN'T RECEIVE ANY TRAINING IN HOW TO DO BUT I'M TRYING TO LEARN HOW TO DO IT, AND WE'VE BEEN GETTING -- WE'VE HAD CONSULTATIONS TO HELPING YOU THINK ABOUT IT. >> THERE MIGHT BE SOME SIMILAR GOING ON IN PUBLIC HEALTH DISCIPLINES, YOU'VE GOT PUBLIC HEALTH EDUCATOR SIDE OF PUBLIC HEALTH AND THE RESEARCHER SIDE OF PUBLIC HEALTH, BUT I'M NOT A PUBLIC HEALTH RESEARCHER, BUT THANK YOU. >> I KNOW I'M STANDING HERE BETWEEN YOU AND THE WEEKEND, SO I'M HESITANT TO ASK A QUESTION OF ALL FOUR PANELISTS, ALTHOUGH THE LAST POINT YOU JUST MADE, ALAN, WAS THE ACT QUESTION I HAD, WHAT ARE WAYS YOU CAN SEE TO EFFECTIVELY HAVE THE IMPLEMENTATION SCIENCE AND PROCESSES INFORM YOUR RESEARCH AND HOW YOUR RESEARCH, HOW YOU MAY OR MAY NOT BE WORKING WITH INTERVENTIONISTS OR IMPLEMENTATION SCIENTISTS TO HELP INFORM THEIR INTERVENTIONS AND THEIR STRATEGIES TO IMPLEMENT. I DON'T KNOW IF WE HAVE TIME FOR YOU ALL TO ANSWER THAT QUESTION. I THINK MAYBE TRY TO DO A VERY BRIEF 30-SECOND, EACH OF YOU, WHOEVER HAS SOMETHING TO SAY ABOUT THAT. >> WE BROUGHT IN DISSEMINATION AND APPLICATION CORE THE FIRST DAY. ONE THING WE'RE DOING IS TRYING TO PUT THE PROJECTS TOGETHER AND NOT ONLY DO WORK SITE WELLNESS PROGRAMS WORKING WITH EMPLOYERS, AND EMPLOYER COUNCILS AND WORK YOU ARE COUNCILS, BUT FOCUSING ON PREGNANT WORKERS AND WEIGHT REDUCTION DURING PREGNANCY, ONE SMALL THING. >> I CAN SAY A LITTLE BIT ABOUT MY TAKE ON THIS, IT'S VERY INTERESTING TO BE HERE TO HEAR THESE DIFFERENT PROJECTS THAT SEEM TO BE BUILDING INTO THEM THE TRANSLATIONAL ASPECTS. MY CASE, RESEARCH WAS AIMED AS BEING COGNITIVE BASIC NEUROSCIENCE, AND I THINK I WAS ASKED, INVITED HERE, BECAUSE A LOT OF WHAT WE DO DOES HAVE TRANSLATIONAL IMPLICATIONS, AS I TRIED TO SHOW NEAR THE END THERE, HOW IT'S BEING USED AND HOW IT COULD BE USED. BUT THOSE WERE INCORPORATED SPECIFICALLY AS BEING FUNDED BY MY PROJECTS, THEY COULD BE IN THE FUTURE. IT'S INTERESTING TO THINK ABOUT HOW THAT COULD COME ABOUT BECAUSE IT'S A DIFFERENT WAY OF DOING THINGS RATHER THAN HAVING RESEARCH BEING USED BY OTHER PEOPLE WHO DO INTERVENTIONS AND DO TRANSLATIONAL WORK THROUGHOUT SOCIETY, TO TRY TO INCORPORATE PARTICULARLY IN FUNDED PROJECTS. AND THAT'S SOMETHING THAT I THINK IT IS GOOD FOR US TO BE THINKING ABOUT THAT ALONG THE WAY, AND TO HAVE WAYS THAT THAT COULD LINK, RATHER THAN -- AND MAYBE BY BEING FUNDED BY THESE NATIONAL INSTITUTES, RATHER THAN FINDING BUSINESS PARTNERS, ANOTHER WAY PEOPLE GO, DEVELOPING PORTABLE EEG DEVICES TO TRACK ATTENTIVENESS OR HAVING MARKERS COME IN AND WANT TO LEARN HOW TO FIGURE OUT HOW -- WHAT ADS ARE BETTER OR WORSE, OR TRAINING PROGRAMS BUT THIS IS LIKE A DIFFERENT DIRECTION WITH DIFFERENT SKILL SETS THAT I THINK IT'S A GOOD THING TO BE THINKING ABOUT AND SOME OF THESE SEEM TO BE MORE DEVELOPED IN THAT REGARD, BUILT INTO THE PROJECT. >> GREAT, THANK YOU. I SEE OUR RED LIGHT IS FLASHING. I'LL HAVE TO CUT LYNN AND ALAN OFF ADDING TO THE PANEL. OF GOOD GIVE OUR SPEAKERS A WARM ROUND OF APPLAUSE, AND THANKS FOR THE AUDIENCE FOR STAYING UNTIL ALMOST 5:00 ON A FRIDAY. FASCINATING CONVERSATION. THANK YOU. >> THANK YOU. I'M WENDY SMITH, ASSOCIATE DIRECTOR OF OBSSR, VERY BRIEF COMMENTS AND A COUPLE ANNOUNCEMENTS AS WE WRAP UP TODAY. ONE OF OUR GOALS WAS TO CREATE AN OPPORTUNITY TO HIGHLIGHT EXCELLENCE IN RESEARCH AND BEHAVIORAL AND SOCIAL SCIENCES ACROSS THE NIH INSTITUTES AND CENTERS. WHEN WE ASKED FOR NOMINATIONS OF RESEARCHERS AND RESEARCH FINDINGS TO HIGHLIGHT, WE GOT WELL OVER 50 NOMINATIONS. WE CLEARLY COULDN'T DO THAT ALL TODAY. SO I WANT TO LET YOU KNOW WE'LL BE CREATING A SUMMARY BOOK THAT WILL HAVE MORE DETAILS ABOUT OUR PRESENTERS AND THEIR PRESENTATIONS TODAY, AS WELL AS INFORMATION OF ALL THE NOMINEES WE HAD FOR THIS. WE WILL BE MAKING THAT PUBLIC THROUGH OUR WEBSITE. I ALSO WANT TO SAY AS CHAIR OF THE PLANNING COMMITTEE FOR THIS EVENT, I WANT TO PUBLICLY THANK ALL THE MEMBERS OF THE PLANNING COMMITTEE. I THINK AUGIE, DIANE IS HERE, THE OTHER MEMBERS, THE FULL LIST IN THE SUMMARY BOOK SO YOU CAN SEE THE INDIVIDUALS AND THE INSTITUTES THAT WERE REPRESENTED. I WANT TO THANK DR. ANDERSON FOR HIS REMARKS THIS MORNING. DR. RILEY WHO PROVIDED A COMPREHENSIVE OVERVIEW OF BEHAVIORAL AND SOCIAL SCIENCE AT NIH, OUR PRESENTERS, OUR MODERATORS, OUR PARTICIPANTS, BOTH HERE IN THE ROOM AND ONLINE, WE CERTAINLY APPRECIATE THAT. WE LOOK FORWARD TO NEXT YEAR, SO ON BEHALF OF OBSSR AND THE NIH COORDINATING COMMITTEE, THANK YOU FOR COMING AND WE'LL SEE YOU NEXT YEAR. [APPLAUSE]