1 00:00:06,155 --> 00:00:07,556 >> WELCOME, EVERYBODY TO THE 2 00:00:07,556 --> 00:00:11,527 HELPING TO END ADDICTION 3 00:00:11,527 --> 00:00:12,862 LONG-TERM OR HEAL INITIATIVE 4 00:00:12,862 --> 00:00:15,664 MULTIDISCIPLINARY WORKING GROUP 5 00:00:15,664 --> 00:00:15,998 MEETING. 6 00:00:15,998 --> 00:00:18,768 THIS MEETING AND GROUP SERVES TO 7 00:00:18,768 --> 00:00:24,340 PROVIDE INPUT TO THE VARIOUS 8 00:00:24,340 --> 00:00:25,941 ADVISORY COUNCILS THAT WORK WITH 9 00:00:25,941 --> 00:00:26,942 EACH OF THE INSTITUTES AND 10 00:00:26,942 --> 00:00:29,712 CENTERS THAT ARE PART OF THE NIH 11 00:00:29,712 --> 00:00:33,182 HELPING TO END ADDICTION 12 00:00:33,182 --> 00:00:34,283 LONG-TERM OR HEAL INITIATIVE. 13 00:00:34,283 --> 00:00:35,584 WE ARE VERY EXCITED TO HAVE 14 00:00:35,584 --> 00:00:36,585 EVERYBODY JOIN US TODAY AND WE 15 00:00:36,585 --> 00:00:40,322 ARE THRILLED TO BE ABLE TO HAVE 16 00:00:40,322 --> 00:00:41,857 THIS MEETING IN ITS REGULAR 17 00:00:41,857 --> 00:00:43,726 FORMAT AT ITS REGULARLY 18 00:00:43,726 --> 00:00:45,594 SCHEDULED TIME. 19 00:00:45,594 --> 00:00:47,429 YOU LEARN HOW TO APPRECIATE ALL 20 00:00:47,429 --> 00:00:49,131 THINGS NEW WHEN YOU REALIZE YOU 21 00:00:49,131 --> 00:00:50,466 CAN'T TAKE ANYTHING FOR GRANTED. 22 00:00:50,466 --> 00:00:53,068 SO WELCOME EVERYBODY TO TODAY'S 23 00:00:53,068 --> 00:00:53,636 MEETING. 24 00:00:53,636 --> 00:00:55,304 WE ARE USING A DIFFERENT FORMAT 25 00:00:55,304 --> 00:00:57,973 TODAY, WE ARE USING THE TEAMS 26 00:00:57,973 --> 00:00:59,341 PREMIUM ACCOUNT, SO WE'RE GOING 27 00:00:59,341 --> 00:01:01,177 TO MANAGE THINGS A LITTLE BIT 28 00:01:01,177 --> 00:01:01,510 DIFFERENTLY. 29 00:01:01,510 --> 00:01:03,078 I WANT TO TAKE A MOMENT TO TALK 30 00:01:03,078 --> 00:01:05,714 A LITTLE BIT ABOUT THAT FROM A 31 00:01:05,714 --> 00:01:06,448 HOUSEKEEPING PERSPECTIVE, WHEN 32 00:01:06,448 --> 00:01:08,284 PEOPLE WOULD LIKE TO ASK 33 00:01:08,284 --> 00:01:09,351 QUESTIONS YOU CAN RAISE YOUR 34 00:01:09,351 --> 00:01:10,686 HAND AND THE ORGANIZERS WILL 35 00:01:10,686 --> 00:01:12,655 MAKE SURE YOU ARE ABLE TO BE 36 00:01:12,655 --> 00:01:16,725 UNMUTED AND TO SPEAK. 37 00:01:16,725 --> 00:01:19,428 AND WE LOOK FORWARD TO A LIVELY 38 00:01:19,428 --> 00:01:20,329 DISCUSSION AT EVERY POINT. 39 00:01:20,329 --> 00:01:24,533 MY NAME IS AMY ADAMS, I SERVE AS 40 00:01:24,533 --> 00:01:25,534 DEPUTY DIRECTOR FOR SCIENTIFIC 41 00:01:25,534 --> 00:01:28,170 AND OPERATIONS FOR THE NATIONAL 42 00:01:28,170 --> 00:01:28,938 INSTITUTE OF NEUROLOGICAL 43 00:01:28,938 --> 00:01:30,706 DISORDERS AND STROKE AND IN THAT 44 00:01:30,706 --> 00:01:32,441 CAPACITY I HELP TO SUPPORT THE 45 00:01:32,441 --> 00:01:34,376 HEAL INITIATIVE IN A VARIETY OF 46 00:01:34,376 --> 00:01:34,844 WAYS. 47 00:01:34,844 --> 00:01:36,145 WE ARE LOOKING FORWARD TO INPUT 48 00:01:36,145 --> 00:01:38,547 FROM THIS GROUP ARE TO HELP 49 00:01:38,547 --> 00:01:40,149 ADVISE, HEAL AS WE MOVE FORWARD, 50 00:01:40,149 --> 00:01:42,084 THERE WILL BE BOTH AN OPEN 51 00:01:42,084 --> 00:01:44,119 SESSION OF THIS MEET BEING WHERE 52 00:01:44,119 --> 00:01:45,821 WE TALK ABOUT OVERARCHING 53 00:01:45,821 --> 00:01:47,790 PROGRAM AND POLICY ISSUES AROUND 54 00:01:47,790 --> 00:01:48,924 THIS INITIATIVE AND THERE WILL 55 00:01:48,924 --> 00:01:51,060 BE A BRIEF CLOSED SESSION, 56 00:01:51,060 --> 00:01:54,129 PORTION OF THIS MEETING WHERE WE 57 00:01:54,129 --> 00:01:55,998 TALK THROUGH AND GET INDIVIDUAL 58 00:01:55,998 --> 00:02:01,437 INPUT ON SOME OF OUR 59 00:02:01,437 --> 00:02:02,471 APPLICATIONS AND PORTFOLIOS. 60 00:02:02,471 --> 00:02:04,440 >> HI, AMY CAN WE ASK ATTENDEES 61 00:02:04,440 --> 00:02:07,409 ARE THERE OTHERS WHO CANNOT HEAR 62 00:02:07,409 --> 00:02:07,743 THE MEETING? 63 00:02:07,743 --> 00:02:09,712 IF YOU CAN PUT IN THE CHAT, 64 00:02:09,712 --> 00:02:15,451 LET'S SEE IF WE CAN BRING -- 65 00:02:15,451 --> 00:02:19,054 LINDE DID YOU HAVE A COMMENT? 66 00:02:19,054 --> 00:02:21,857 >> I WAS JUST GOING TO CLARIFY 67 00:02:21,857 --> 00:02:23,425 THAT STRANGELY WHEN I FIRST CAME 68 00:02:23,425 --> 00:02:25,594 IN, NO ACCESS TO THE AUDIO, IT 69 00:02:25,594 --> 00:02:28,364 SAID YOU CAN NO LONGER ACCESS 70 00:02:28,364 --> 00:02:30,299 AUDIO, SO WHEN I CAME BACK IN, I 71 00:02:30,299 --> 00:02:34,103 WAS ABLE TO HEAR, SO, JUST I 72 00:02:34,103 --> 00:02:35,404 WONDER WHETHER THAT'S SOMETHING 73 00:02:35,404 --> 00:02:36,906 YOU'RE CONTROLLING ON YOUR END, 74 00:02:36,906 --> 00:02:40,042 SO HOPE IT GETS WORKED OUT FOR 75 00:02:40,042 --> 00:02:40,476 OTHERS. 76 00:02:40,476 --> 00:02:40,843 >> THANK YOU. 77 00:02:40,843 --> 00:02:45,381 THANK YOU ERCH FOR YOUR 78 00:02:45,381 --> 00:02:46,181 PATIENCE. 79 00:02:46,181 --> 00:02:49,184 >> ONE QUESTION IS: IS ANYBODY 80 00:02:49,184 --> 00:02:53,222 USING A TEAMS APP THAT THEY GOT, 81 00:02:53,222 --> 00:02:55,224 THEY JUST USED A LINK TO COME IN 82 00:02:55,224 --> 00:03:01,063 AS OPPOSE TO A TEAMS APP ON YOUR 83 00:03:01,063 --> 00:03:01,330 COMPUTER? 84 00:03:01,330 --> 00:03:04,800 I'M WONDER FIGURE THAT'S THE 85 00:03:04,800 --> 00:03:05,334 DIFFERENCE? 86 00:03:05,334 --> 00:03:05,534 OKAY. 87 00:03:05,534 --> 00:03:07,937 >> IT SEEMS LIKE A LOT HAS BEEN 88 00:03:07,937 --> 00:03:08,504 RESOLVED. 89 00:03:08,504 --> 00:03:12,141 SO SORRY ABOUT THAT EVERYONE. 90 00:03:12,141 --> 00:03:12,408 >> OKAY. 91 00:03:12,408 --> 00:03:13,943 >> THANK YOU SO MUCH AND THIS 92 00:03:13,943 --> 00:03:17,012 REMINDS ME TO TAKE A MOMENT AND 93 00:03:17,012 --> 00:03:18,380 THANK THE TEAM THAT HELPS TO 94 00:03:18,380 --> 00:03:21,450 ORGANIZE AND SUPPORT THIS 95 00:03:21,450 --> 00:03:23,218 MEETING, BOTH THE SCIENTIFIC AND 96 00:03:23,218 --> 00:03:24,820 PROGRAM STAFF ACROSS THE MANY 97 00:03:24,820 --> 00:03:25,654 INTUITYS AND CENTERS THAT ARE 98 00:03:25,654 --> 00:03:28,123 PART OF THE HEAL INITIATIVE AND 99 00:03:28,123 --> 00:03:29,525 ALSO THE STAFF THAT HELPED TO 100 00:03:29,525 --> 00:03:31,727 MAKE SURE THAT THIS MEETING 101 00:03:31,727 --> 00:03:32,695 ITSELF MOVES FORWARD AND TODAY I 102 00:03:32,695 --> 00:03:34,730 WANT TO REEL KEEPSAKESLY 103 00:03:34,730 --> 00:03:35,998 APPRECIATE RACHEL KELLY WHO I 104 00:03:35,998 --> 00:03:38,834 THINK HAS STEPPED FORWARD AND 105 00:03:38,834 --> 00:03:40,069 DONE SOME REAL HEROICS AS WE'RE 106 00:03:40,069 --> 00:03:41,337 DEALING WITH THE SITUATION WHERE 107 00:03:41,337 --> 00:03:44,206 WE HAVE MANY FEWER STAFF THAN WE 108 00:03:44,206 --> 00:03:45,374 TYPICALLY DO SO THANK YOU RAICH 109 00:03:45,374 --> 00:03:48,344 AND HE WILL THANK YOU EVERYBODY 110 00:03:48,344 --> 00:03:48,911 ACROSS HEAL. 111 00:03:48,911 --> 00:03:50,713 SO WITH THAT I DO WANT TO 112 00:03:50,713 --> 00:03:52,348 ACKNOWLEDGE THAT WE HAD A 113 00:03:52,348 --> 00:03:53,115 SCHEDULES CONFLICT WITH THIS 114 00:03:53,115 --> 00:03:54,783 MEETING AND THE UNITED STATES OF 115 00:03:54,783 --> 00:03:56,652 ASSOCIATION FOR THE STUDY OF 116 00:03:56,652 --> 00:03:59,588 PAIN OR THE USA SP ANNUAL 117 00:03:59,588 --> 00:04:00,956 MEETING SO I JUST WANT TO 118 00:04:00,956 --> 00:04:02,891 APPRECIATE EVERYBODY WHO WAS 119 00:04:02,891 --> 00:04:05,694 STILL ABLE TO ORGANIZE THEIR 120 00:04:05,694 --> 00:04:08,163 TRAVEL SCHEDULE AND SQUEEZE IN 121 00:04:08,163 --> 00:04:09,331 PARTICIPATING IN THIS MEETING. 122 00:04:09,331 --> 00:04:10,632 WE REALLY APPRECIATE YOU AND WE 123 00:04:10,632 --> 00:04:12,368 APPRECIATE THE INPUT THAT YOU 124 00:04:12,368 --> 00:04:14,703 PROVIDE US AS YOU GUIDE THIS 125 00:04:14,703 --> 00:04:19,641 INITIATIVE AS IT MOVES FORWARD. 126 00:04:19,641 --> 00:04:23,078 SO WITH THAT, -- PLEASE? 127 00:04:23,078 --> 00:04:23,946 I'M SORRY? 128 00:04:23,946 --> 00:04:25,214 DID I MISS SOMEBODY? 129 00:04:25,214 --> 00:04:27,583 >> I THINK IT MIGHT HAVE BEEN 130 00:04:27,583 --> 00:04:28,717 BACKGROUND NOISE. 131 00:04:28,717 --> 00:04:30,252 >> OKAY, VERY GOOD BUT WITH THAT 132 00:04:30,252 --> 00:04:40,729 I'M HAPPY NOW TO HAND OFF TO 133 00:04:41,430 --> 00:04:45,200 FEARLESS LEADERS TO WALTER 134 00:04:45,200 --> 00:04:46,435 KOROSHETZ, AND DR. WILSON 135 00:04:46,435 --> 00:04:48,237 COMPTON, DEPUTY DIRECTOR OF THE 136 00:04:48,237 --> 00:04:50,105 NATIONAL INSTITUTE OF DRUG ABUSE 137 00:04:50,105 --> 00:04:54,643 WHO ARE STEPPING IN ON BEHALF OF 138 00:04:54,643 --> 00:04:58,380 DR. NORA VOLKOW, WHO THEY SERVE 139 00:04:58,380 --> 00:05:00,115 TO LEAD THE INITIATIVE, THANK 140 00:05:00,115 --> 00:05:00,382 YOU BOTH. 141 00:05:00,382 --> 00:05:02,551 >> THANK YOU AIM EXPE THANKS 142 00:05:02,551 --> 00:05:04,019 FOREM TUNING IN AND HOPE THE 143 00:05:04,019 --> 00:05:09,558 MEETING IN CHICAGO GOES WELL, 144 00:05:09,558 --> 00:05:11,293 SORRY WE CAN'T BE THERE. 145 00:05:11,293 --> 00:05:13,829 I WANTED TO JUST EMPHASIZE HOW 146 00:05:13,829 --> 00:05:19,234 IMPORTANT THIS GROUP IS AND THE 147 00:05:19,234 --> 00:05:20,536 HEAL INITIATIVE IS. 148 00:05:20,536 --> 00:05:22,504 YOU WILL HEAR FROM SOME I THINK 149 00:05:22,504 --> 00:05:26,341 REALLY HIGH IMPACT PROGRAMS, THE 150 00:05:26,341 --> 00:05:28,744 BACPAC PROGRAM WHICH IS RUN 151 00:05:28,744 --> 00:05:39,188 PRIMARILY OUT OF NIAMS AND 152 00:05:40,856 --> 00:05:45,661 DR. LINDSEY, AND WE ALSO HAVE 153 00:05:45,661 --> 00:05:47,763 DR. LANG EVINE AND DR. VOLKOW, 154 00:05:47,763 --> 00:05:49,398 AND THE HEAL INITIATIVE PUT US 155 00:05:49,398 --> 00:05:51,200 IN A SPECIAL PLACE WHERE WE CAN 156 00:05:51,200 --> 00:05:54,636 ADDRESS WHAT IS A TREMENDOUS 157 00:05:54,636 --> 00:05:58,674 TRAGIC PROBLEM OF OVERDOSE 158 00:05:58,674 --> 00:06:02,344 DEATHS IN THE U.S. AND THE KIND 159 00:06:02,344 --> 00:06:05,147 OF BOOK-IN PROBLEM OF POOR PAIN 160 00:06:05,147 --> 00:06:08,951 MANAGEMENT IN THE U.S. AND THESE 161 00:06:08,951 --> 00:06:10,385 2 THINGS FEED TO EACH OTHER AND 162 00:06:10,385 --> 00:06:11,386 BY WORKING TOGETHER, I THINK 163 00:06:11,386 --> 00:06:13,689 WE'VE BEEN ABLE TO DO SOME 164 00:06:13,689 --> 00:06:14,590 REALLY INNOVATIVE RESEARCH THAT 165 00:06:14,590 --> 00:06:17,126 WOULD NEVER HAVE BEEN POSSIBLE 166 00:06:17,126 --> 00:06:20,095 WITHOUT THE HEAL INITIATIVE. 167 00:06:20,095 --> 00:06:22,197 NOW LOOKING TO THE FUTURE, 168 00:06:22,197 --> 00:06:25,868 THINGS ARE CERTAINLY UNSETTLED 169 00:06:25,868 --> 00:06:28,770 IN MANY INSTANCES HERE AT NIH, I 170 00:06:28,770 --> 00:06:30,572 WILL REPORT OUT ON CHANGES THAT 171 00:06:30,572 --> 00:06:32,608 OCCURRED AND POTENTIAL IMPACT ON 172 00:06:32,608 --> 00:06:36,178 HEAL INITIATIVE, BUT I THINK 173 00:06:36,178 --> 00:06:40,215 THAT YOU KNOW WE'VE -- 174 00:06:40,215 --> 00:06:41,383 CONGRESSIONAL STAFFERS HAVE 175 00:06:41,383 --> 00:06:42,551 ASKED US QUESTIONS, SO HEAL IS 176 00:06:42,551 --> 00:06:44,586 STILL ON THEIR RADAR SCREEN, AND 177 00:06:44,586 --> 00:06:46,088 AND WE ARE HOPEFUL EVEN THOUGH 178 00:06:46,088 --> 00:06:47,890 WE HAVE A C. R. CURRENTLY WHICH 179 00:06:47,890 --> 00:06:49,391 MEANS WE ARE OPERATING UNDER THE 180 00:06:49,391 --> 00:06:51,326 SAME FUNDING WE HAD LAST YEAR, 181 00:06:51,326 --> 00:06:53,662 WE'RE LOOKING FORWARD TO 182 00:06:53,662 --> 00:06:57,299 CONTINUING HEAL SHOULD THE 183 00:06:57,299 --> 00:06:59,768 CONGRESS DEEM THAT FUNDING HIGH 184 00:06:59,768 --> 00:07:04,473 PRIORITY TO THEM GOING FORWARD 185 00:07:04,473 --> 00:07:05,073 INTO 2026. 186 00:07:05,073 --> 00:07:06,108 AS YOU PROBABLY HEARD IN THE 187 00:07:06,108 --> 00:07:08,844 PAPER HAS BEEN A LOT OF CHANGES 188 00:07:08,844 --> 00:07:12,047 AND UPS AND DOWNS AT NIH WITH 189 00:07:12,047 --> 00:07:16,919 REGARD TO A LOT OF THE 190 00:07:16,919 --> 00:07:17,886 COMMUNICATIONS ON HOLD, STUDY 191 00:07:17,886 --> 00:07:21,056 SECTIONS ON HOLD, BOARD OF 192 00:07:21,056 --> 00:07:22,357 SCIENTIFIC COUNSELORS MEETINGS 193 00:07:22,357 --> 00:07:24,526 AND ADVISORY COUNCIL MEETING 194 00:07:24,526 --> 00:07:27,930 WERE ON HOLD, THOSE HAVE ALL 195 00:07:27,930 --> 00:07:30,832 BEEN OPENED UP AND COUNCIL 196 00:07:30,832 --> 00:07:32,134 MEETINGS ARE OCCURRING, STUDY 197 00:07:32,134 --> 00:07:35,771 SECTIONS ARE WORKING REALLY HARD 198 00:07:35,771 --> 00:07:37,739 TO WRAP UP ALL THE REVIEWS OF 199 00:07:37,739 --> 00:07:39,441 ALL THE APPLICATIONS THAT ARE 200 00:07:39,441 --> 00:07:45,814 COMING TO THE MAY COUNCILS BUT 201 00:07:45,814 --> 00:07:47,649 THERE ARE SOME CHANGES THAT NIH 202 00:07:47,649 --> 00:07:50,118 IS CONSIDERING AND 1 OF THEM, 203 00:07:50,118 --> 00:07:53,021 THAT'S GOING TO AFFECT HEAL IS A 204 00:07:53,021 --> 00:07:56,592 MOVEMENT OF ALL REVIEW TO THE 205 00:07:56,592 --> 00:07:57,926 CENTER FOR SCIENTIFIC REVIEW AND 206 00:07:57,926 --> 00:08:01,063 OUT OF THE INSTITUTES WHO 207 00:08:01,063 --> 00:08:07,169 REVIEWED A NUMBER OF DIFFERENT 208 00:08:07,169 --> 00:08:08,804 HEAL PROJECTS. 209 00:08:08,804 --> 00:08:09,972 THE BIG CHANGES WERE AS AMY 210 00:08:09,972 --> 00:08:14,509 HINTED IN THE PERSONNEL, SO 211 00:08:14,509 --> 00:08:18,046 NINDS HAS LOST ABOUT 187 STAFF 212 00:08:18,046 --> 00:08:23,518 MEMBERS IN THE LAST COUPLE OF 213 00:08:23,518 --> 00:08:25,020 MONTHS AND SO IT'S JUST A LOT OF 214 00:08:25,020 --> 00:08:26,955 THINGS THAT WE HAVE HIGH 215 00:08:26,955 --> 00:08:28,290 EXPECTATIONS FOR OURSELVES BUT 216 00:08:28,290 --> 00:08:29,057 UNFORTUNATELY WE'RE JUST NOT 217 00:08:29,057 --> 00:08:31,660 GOING TO BE ABLE TO OPERATE AT 218 00:08:31,660 --> 00:08:35,597 THE SAME LEVEL THAT WE DID 219 00:08:35,597 --> 00:08:41,937 BEFORE AT LEAST IN THE 220 00:08:41,937 --> 00:08:42,437 SHORT-TERM. 221 00:08:42,437 --> 00:08:52,848 AND IN TERMS OF THE HEAL 222 00:08:58,287 --> 00:09:00,956 INITIATIVE -- 223 00:09:00,956 --> 00:09:02,557 >> IS WALTER MUTED? 224 00:09:02,557 --> 00:09:05,827 >> I THINK HE MUTED. 225 00:09:05,827 --> 00:09:09,464 WALTER, I THINK YOU'RE MUTED. 226 00:09:09,464 --> 00:09:10,832 >> WALTER CAN YOU UNMUTE. 227 00:09:10,832 --> 00:09:14,636 >> OKAY, CAN YOU HEAR ME NOW? 228 00:09:14,636 --> 00:09:14,903 >> YES. 229 00:09:14,903 --> 00:09:15,170 >> YES. 230 00:09:15,170 --> 00:09:20,909 >> OKAY, WHERE DID YOU LOSE ME? 231 00:09:20,909 --> 00:09:21,910 >> IT'S WHEN YOU WERE 232 00:09:21,910 --> 00:09:23,078 TRANSITIONING TO THE SLIDES. 233 00:09:23,078 --> 00:09:26,315 I DON'T THINK WE MISSED MUCH. 234 00:09:26,315 --> 00:09:28,717 >> OKAY, SO THE SLIDE HERE SHOWS 235 00:09:28,717 --> 00:09:31,853 THE PEOPLE WHO WERE IN THE 236 00:09:31,853 --> 00:09:33,288 OFFICE OF PAIN POLICY AND 237 00:09:33,288 --> 00:09:39,828 PLANNING AND ALL WERE LET GO, 238 00:09:39,828 --> 00:09:41,396 THESE FOLKS WERE REALLY 239 00:09:41,396 --> 00:09:44,333 ESSENTIAL IN BUILDING HEAL AS 240 00:09:44,333 --> 00:09:47,536 YOU REMEMBER MOST OF THE STAFF 241 00:09:47,536 --> 00:09:48,837 WERE IN THE OFFICE OF THE NIH 242 00:09:48,837 --> 00:09:50,372 DIRECTOR TO BEGIN WITH AND THEN 243 00:09:50,372 --> 00:09:57,179 WERE MOVED TO NINDS, BUT WE LOST 244 00:09:57,179 --> 00:09:59,715 ALL THEM AND SO THAT REALLY PUTS 245 00:09:59,715 --> 00:10:02,084 US AT SOME SIGNIFICANT 246 00:10:02,084 --> 00:10:04,052 DISADVANTAGE, IT'S 10 REALLY 247 00:10:04,052 --> 00:10:07,322 SURVEYS PUSH PEOPLE MOVING HEAL 248 00:10:07,322 --> 00:10:09,491 FORWARDOT PAIN SIDE. 249 00:10:09,491 --> 00:10:12,361 OF COURSE, WE HAVE YOU KNOW 250 00:10:12,361 --> 00:10:13,962 PROGRAM DIRECTORS AND PEOPLE IN 251 00:10:13,962 --> 00:10:15,464 ALL SORTS OF DIFFERENT AREAS 252 00:10:15,464 --> 00:10:19,568 THAT ARE TRYING TO PITCH IN, 253 00:10:19,568 --> 00:10:20,702 HOWEVER, BESIDES THE HEAL 254 00:10:20,702 --> 00:10:23,238 PROGRAM, WE ALL LOST ALL OUR 255 00:10:23,238 --> 00:10:27,576 COMMUNICATIONS PEOPLE, WE LOST 256 00:10:27,576 --> 00:10:29,244 ALL OUR PEOPLE WHO WORKED IN 257 00:10:29,244 --> 00:10:34,883 SCIENCE POLICY AND PLANNING AND 258 00:10:34,883 --> 00:10:40,055 1 OF THE BIGGER PROBLEMS IS 259 00:10:40,055 --> 00:10:41,723 THAT, A LOT OF THE STAFF THAT 260 00:10:41,723 --> 00:10:43,792 ARE INVOLVED IN OUR CONTRACTS 261 00:10:43,792 --> 00:10:48,630 AND NIDA AS WELL HAVE ALSO BEEN 262 00:10:48,630 --> 00:10:51,600 LOST, SO WE HAD TO REDUCE OUR 263 00:10:51,600 --> 00:10:53,034 CONTRACTS BY 35% AND OF NOTE, A 264 00:10:53,034 --> 00:10:55,303 LOT OF THE COMMUNICATIONS WE 265 00:10:55,303 --> 00:10:58,306 WERE DOING WERE DONE WITH THESE 266 00:10:58,306 --> 00:10:59,441 CONTRACTS AND IT'S NOT CLEAR HOW 267 00:10:59,441 --> 00:11:02,144 WE WILL BE ABLE TO DO THOSE, 268 00:11:02,144 --> 00:11:04,479 ALTHOUGH THE PLAN I THINK AT NIH 269 00:11:04,479 --> 00:11:06,748 IS TO CONSOLIDATE A NUMBER OF 270 00:11:06,748 --> 00:11:08,850 DIFFERENT FUNCTIONS SUCH AS 271 00:11:08,850 --> 00:11:10,085 POLICY AND COMMUNICATIONS AND 272 00:11:10,085 --> 00:11:12,421 ONCE THAT'S DONE, THEN I THINK 273 00:11:12,421 --> 00:11:14,289 WE WILL BE UP AND RUNNING AT YOU 274 00:11:14,289 --> 00:11:17,559 KNOW FULL SPEED AGAIN, BUT IN 275 00:11:17,559 --> 00:11:18,927 THE MEAN TIME, I THINK THE 276 00:11:18,927 --> 00:11:22,297 EFFECT ON HEAL IS THAT WE -- 277 00:11:22,297 --> 00:11:23,331 THERE ARE CERTAIN THINGS THAT 278 00:11:23,331 --> 00:11:26,635 ARE REALLY GOING TO BE DIFFICULT 279 00:11:26,635 --> 00:11:29,137 FOR US TO DO BECAUSE OF BAND 280 00:11:29,137 --> 00:11:30,605 WIDTH ISSUES, LOSS OF CONTRACTS 281 00:11:30,605 --> 00:11:36,278 SO WHAT WE'RE PROPOSING IS 282 00:11:36,278 --> 00:11:39,014 ACTUALLY TO DECREASE THE MDWG 283 00:11:39,014 --> 00:11:41,249 MEETINGS AT LEAST IN THE 284 00:11:41,249 --> 00:11:43,819 SHORT-TERM, YOU KNOW WE HOPE TO 285 00:11:43,819 --> 00:11:47,789 HAVE, YOU KNOW 1 OTHER MEETING 286 00:11:47,789 --> 00:11:49,624 THIS YEAR, BUT I THINK WE HAVE 287 00:11:49,624 --> 00:11:52,027 TO CUT BACK ON THE ABILITY TO DO 288 00:11:52,027 --> 00:11:53,028 MEETINGS AND THEN, ALSO, YOU 289 00:11:53,028 --> 00:11:58,533 KNOW WE WERE GOING TO TRY TO GET 290 00:11:58,533 --> 00:12:00,502 NEW MEMBERS ON THE MDWG AND WILL 291 00:12:00,502 --> 00:12:03,004 STILL BE WORKING ON THAT BUT 292 00:12:03,004 --> 00:12:07,509 THINGS HAVE REALLY SLOWED DOWP 293 00:12:07,509 --> 00:12:09,478 IN THAT SPACE, TOO THE OTHER 294 00:12:09,478 --> 00:12:13,381 PROBLEM FOR HEAL ON THE PAIN 295 00:12:13,381 --> 00:12:15,417 SIDE IS THAT THE -- WE HAD A 296 00:12:15,417 --> 00:12:20,021 CONTRACT WITH AN EDUCATIONAL 297 00:12:20,021 --> 00:12:21,990 COMPANY TO SET UP WHAT'S CALLED 298 00:12:21,990 --> 00:12:25,293 THE PURPOSE NETWORK, IT WAS 299 00:12:25,293 --> 00:12:26,261 HUGELY SUCCESSFUL AT DEVELOPING 300 00:12:26,261 --> 00:12:32,167 A PAIN COMMUNITY ACROSS THE 301 00:12:32,167 --> 00:12:33,502 COUNTRY DEVELOPING SOCIAL 302 00:12:33,502 --> 00:12:37,839 COMMUNICATIONS AMONG EARLY STAGE 303 00:12:37,839 --> 00:12:40,842 INVESTIGATORS AND DEVELOPING 304 00:12:40,842 --> 00:12:43,678 MENTORS PROGRAMS, SENDING OUT 305 00:12:43,678 --> 00:12:45,213 INFORMATION ABOUT PAIN AND 306 00:12:45,213 --> 00:12:48,583 HOLDING WHAT I THOUGHT WERE 307 00:12:48,583 --> 00:12:50,318 REALLY EXCELLENT MEETINGS OF THE 308 00:12:50,318 --> 00:12:55,557 EARLY STAGE INVESTIGATORS AND 309 00:12:55,557 --> 00:12:57,192 THEIR MENTORS, AND THAT CONTRACT 310 00:12:57,192 --> 00:13:02,030 WAS TERMINATED AND SO WE DON'T 311 00:13:02,030 --> 00:13:05,867 HAVE THE ABILITY TO KIND OF DO 312 00:13:05,867 --> 00:13:10,071 THOSE -- CARRY OUT THOSE 313 00:13:10,071 --> 00:13:10,705 FUNCTIONS ANYMORE. 314 00:13:10,705 --> 00:13:12,340 SO I THINK THE MAIN POINT I 315 00:13:12,340 --> 00:13:18,079 WANTED TO MAKE IS THAT WE AT 316 00:13:18,079 --> 00:13:21,683 NINDS AND THE OTHER PAIN 317 00:13:21,683 --> 00:13:23,485 INSTITUTES IS -- I'M SURE WILSON 318 00:13:23,485 --> 00:13:25,654 WILL ALSO TALK, IS USE THE STAFF 319 00:13:25,654 --> 00:13:29,925 WE HAVE REMAINING TO FOCUS ON 320 00:13:29,925 --> 00:13:32,227 THE REAL CRITICAL BUSINESS OF 321 00:13:32,227 --> 00:13:34,296 WORKING WITH INVESTIGATORS TO 322 00:13:34,296 --> 00:13:35,931 GET GRANTS IN, SYSTEMS ARE 323 00:13:35,931 --> 00:13:40,068 CHANGING THERE, SO IT'S VERY 324 00:13:40,068 --> 00:13:41,403 CONFUSING VERY IT ON THE OUTSIDE 325 00:13:41,403 --> 00:13:42,904 SO TO HAVE OUR PROGRAMS 326 00:13:42,904 --> 00:13:44,706 DIRECTORS WITH PEOPLE WHO WANT 327 00:13:44,706 --> 00:13:48,743 TO SUBMIT GRANTS AND GET THOSE 328 00:13:48,743 --> 00:13:50,278 GRANTS REVIEWED PROPERLY AND 329 00:13:50,278 --> 00:13:52,414 PRESENTED TO COUNCILS AND THEN 330 00:13:52,414 --> 00:13:54,115 WORK TO GET GRANTS FUNDED, I 331 00:13:54,115 --> 00:13:56,851 THINK THAT WE REALLY HAVE TO 332 00:13:56,851 --> 00:14:01,256 SHRINK OUR EFFORTS INTO THAT 333 00:14:01,256 --> 00:14:03,391 CORE ACTIVITY AT LEAST IN THE 334 00:14:03,391 --> 00:14:05,560 SHORT-TERM AND WITH HEAL WE WERE 335 00:14:05,560 --> 00:14:08,964 ABLE TO DO SOME REALLY 336 00:14:08,964 --> 00:14:10,565 INNOVATIVE PROJECTS THAT WE 337 00:14:10,565 --> 00:14:11,766 HAVEN'T REALLY BEEN ABLE TO DO 338 00:14:11,766 --> 00:14:14,402 FOR MANY OF OUR OTHER AREAS OF 339 00:14:14,402 --> 00:14:16,204 RESEARCH BUT I THINK THAT WE 340 00:14:16,204 --> 00:14:18,640 LOST THAT OPPORTUNITY NOW, AT 341 00:14:18,640 --> 00:14:19,608 LEAST IN THE SHORT-TERM. 342 00:14:19,608 --> 00:14:22,711 SO I HOPE YOU WILL BE PATIENT 343 00:14:22,711 --> 00:14:24,679 WITH US AS YOU KNOW PAIN AND THE 344 00:14:24,679 --> 00:14:25,780 POOR MANAGEMENT OF PAIN AND THE 345 00:14:25,780 --> 00:14:28,750 NEED TO DEVELOP BETTER EFFECTIVE 346 00:14:28,750 --> 00:14:31,353 THERAPIES ESPECIALLY FOR CHRONIC 347 00:14:31,353 --> 00:14:33,922 PAIN IS SOMETHING THAT LIVES ON 348 00:14:33,922 --> 00:14:36,491 AS A HIGH PRIORITY HERE FOR MANY 349 00:14:36,491 --> 00:14:37,392 INSTITUTES, THERE'S 14 DIFFERENT 350 00:14:37,392 --> 00:14:39,661 INSTITUTES IN THE HEAL PAIN 351 00:14:39,661 --> 00:14:42,364 GROUP AND WE WILL CONTINUE TO 352 00:14:42,364 --> 00:14:43,598 WORK, YOU KNOW WITH URIENCY AND 353 00:14:43,598 --> 00:14:48,169 AS HARD AS WE POSSIBLY CAN TO 354 00:14:48,169 --> 00:14:50,005 MOVE THAT RESEARCH FORWARD SO WE 355 00:14:50,005 --> 00:14:51,740 CAN GET BETTER MANAGEMENT FOR 356 00:14:51,740 --> 00:14:54,743 PEOPLE OUT THERE SUFFERING, BUT 357 00:14:54,743 --> 00:14:57,012 THERE ARE CERTAINLY SOME THINGS 358 00:14:57,012 --> 00:14:58,413 WE HAD DONE BEFORE IN HEAL THAT 359 00:14:58,413 --> 00:15:00,849 ARE GOING TO BE VERY TOUGH TO DO 360 00:15:00,849 --> 00:15:02,717 RIGHT NOW. 361 00:15:02,717 --> 00:15:04,085 SO HOPEFULLY WE WILL GET 362 00:15:04,085 --> 00:15:05,053 PATIENCE AND CONTINUE TO WORK 363 00:15:05,053 --> 00:15:08,957 WITH US AND KEEP THE SCIENTISTS, 364 00:15:08,957 --> 00:15:11,026 YOU KNOW, KEEP THEIR NOSE TO THE 365 00:15:11,026 --> 00:15:12,694 GRIND STONE IN TERMS OF GETTING 366 00:15:12,694 --> 00:15:15,530 THE WORK TONE BECAUSE THAT'S 367 00:15:15,530 --> 00:15:18,299 REALLY THE IMPORTANT STUFF. 368 00:15:18,299 --> 00:15:20,235 SO THOSE ARE THE KIND OF THINGS 369 00:15:20,235 --> 00:15:21,403 I WANTED TO SET OUT FOR PEOPLE 370 00:15:21,403 --> 00:15:23,972 AND I THINK I IF COULD MAKE 371 00:15:23,972 --> 00:15:29,044 TURNOVER TO WILSON NOW AND HE 372 00:15:29,044 --> 00:15:32,013 COULD A COUPLE UPDATES ON THE 373 00:15:32,013 --> 00:15:33,281 OPIOID SIDE OF HEAL AND OF 374 00:15:33,281 --> 00:15:37,686 COURSE THE CROSS CUTTING ASPECTS 375 00:15:37,686 --> 00:15:39,254 THAT WE DO TOGETHER. 376 00:15:39,254 --> 00:15:39,487 WILSON? 377 00:15:39,487 --> 00:15:44,693 NTHANK YOU VERY MUCH, WALTER: 378 00:15:44,693 --> 00:15:47,362 IT'S A PLEASURE TO BE 379 00:15:47,362 --> 00:15:48,596 REPRESENTING THE NATIONAL 380 00:15:48,596 --> 00:15:50,832 INNSITUTE ON DRUS DRUG ABUSE AND 381 00:15:50,832 --> 00:15:53,568 FOR THE INSTITUTE AND IN 382 00:15:53,568 --> 00:15:56,871 PARTICULAR NORA VOLKOW, WHO 383 00:15:56,871 --> 00:15:58,173 SENDS HER APOLOGIES FOR NOT 384 00:15:58,173 --> 00:16:00,442 BEING ABLE TO BE HERE THIS 385 00:16:00,442 --> 00:16:03,111 MORNING AND I WILL SAY THAT I AM 386 00:16:03,111 --> 00:16:05,313 GOING TO DO MY BEST ESPECIALLY 387 00:16:05,313 --> 00:16:07,849 WITH A NEW VERSION OF TEAMS AND 388 00:16:07,849 --> 00:16:09,517 HAS SOME THINGS THAT I'VE NEVER 389 00:16:09,517 --> 00:16:11,119 USED BEFORE AND A LEARNING CURVE 390 00:16:11,119 --> 00:16:15,123 FOR ALL OF US, SO THANK YOU VERY 391 00:16:15,123 --> 00:16:16,424 MUCH FOR NEW TECHNOLOGY IN ALL 392 00:16:16,424 --> 00:16:18,493 SECTORS OF THE PROGRAM. 393 00:16:18,493 --> 00:16:20,829 CLERLY THERE'S TERRIFIC WORK ON 394 00:16:20,829 --> 00:16:22,931 THE OPIOID OVERDOSE USE SECTION 395 00:16:22,931 --> 00:16:24,032 THAT WE'RE PRIMARILY RESPONSIBLE 396 00:16:24,032 --> 00:16:25,667 FOR, THE HEAL PAIN PROGRAM AND 397 00:16:25,667 --> 00:16:27,001 THE VERY INNOVATIVE SHARED 398 00:16:27,001 --> 00:16:27,602 PROGRAMS. 399 00:16:27,602 --> 00:16:30,605 AMONG THE SHARED PROGRAMS I 400 00:16:30,605 --> 00:16:34,175 CERTAINLY WANT TO HIGHLIGHT THE 401 00:16:34,175 --> 00:16:42,751 AMERICAN INDIAN PROGRAM, THE 402 00:16:42,751 --> 00:16:45,253 N CREW PROGRAM, AND HOW THE PAIN 403 00:16:45,253 --> 00:16:47,288 AND OPIOID INTERSECT WITH EACH 404 00:16:47,288 --> 00:16:47,689 OTHER. 405 00:16:47,689 --> 00:16:50,358 LIKE ALL COLLEAGUES ACROSS NIH, 406 00:16:50,358 --> 00:16:53,995 NIDA HAS HAD A NUMBER OF STAFF 407 00:16:53,995 --> 00:16:56,498 WHO HAVE DEPARTED BOTH THROUGH 408 00:16:56,498 --> 00:16:58,933 EARLY RETIREMENT AND THROUGH 409 00:16:58,933 --> 00:16:59,934 REDUCTIONS IN FORCE SO THERE 410 00:16:59,934 --> 00:17:01,503 HAVE BEEN A NUMBER OF LOSSES 411 00:17:01,503 --> 00:17:04,239 THAT HAVE AN IMPACT ON ALL OF 412 00:17:04,239 --> 00:17:05,673 OUR OPERATIONS. 413 00:17:05,673 --> 00:17:10,145 AS WALTER MENTIONED THE 414 00:17:10,145 --> 00:17:11,446 CONTRACTS OFFICE WHO MANAGE MANY 415 00:17:11,446 --> 00:17:13,648 MANY OF THE RESEARCH ACTIVITIES 416 00:17:13,648 --> 00:17:15,583 THAT ARE ESSENTIAL TO OUR 417 00:17:15,583 --> 00:17:19,721 PROGRAMS HAVE BEEN NOTIFIED THAT 418 00:17:19,721 --> 00:17:21,122 THEY'RE BASICALLY PART OF A 419 00:17:21,122 --> 00:17:23,591 REDUCTION IN FORCE, SO THEY HAVE 420 00:17:23,591 --> 00:17:25,760 A 2 MONTH ADMINISTRATIVE LEAVE 421 00:17:25,760 --> 00:17:26,961 IN WHICH CASE, THEY'RE STILL 422 00:17:26,961 --> 00:17:28,229 FOLLOWING THROUGH ON ESSENTIAL 423 00:17:28,229 --> 00:17:30,298 ACTIVITIES BUT THEY'RE PREPARING 424 00:17:30,298 --> 00:17:32,767 FOR THEIR DEPARTURE IN EARLY 425 00:17:32,767 --> 00:17:34,269 JUNE AND SO FIGURING OUT HOW WE 426 00:17:34,269 --> 00:17:35,804 WILL MANAGE OUR MYRIAD RESEARCH 427 00:17:35,804 --> 00:17:38,640 CONTRACTS THAT ARE ESSENTIAL TO 428 00:17:38,640 --> 00:17:40,975 OUR ACTIVITIES IS A MAJOR 429 00:17:40,975 --> 00:17:42,343 IMPORTANCE TO US AND WE'RE 430 00:17:42,343 --> 00:17:43,978 WORKING AS BEST WE CAN BEHIND 431 00:17:43,978 --> 00:17:46,214 THE KEENS TO FIND ALTERNATIVES 432 00:17:46,214 --> 00:17:49,417 TO KEEP THE ESSENTIAL ACTIVITIES 433 00:17:49,417 --> 00:17:49,617 GOING. 434 00:17:49,617 --> 00:17:53,388 WE'VE LOST A NUMBER OF STAFF IN 435 00:17:53,388 --> 00:17:54,355 OUR JUSTICE PROGRAM, J COIN IN 436 00:17:54,355 --> 00:17:55,523 PARTICULAR THAT I WOULD 437 00:17:55,523 --> 00:17:56,991 HIGHLIGHT FOR YOU THAT WILL 438 00:17:56,991 --> 00:17:59,060 REQUIRE US TO RETHINK HOW WE DO 439 00:17:59,060 --> 00:18:00,929 OUR BUSINESS AND COME UP WITH 440 00:18:00,929 --> 00:18:02,764 NEW WAYS THAT WILL RELY, I 441 00:18:02,764 --> 00:18:04,465 EXPECT, A LITTLE MORE ON THE 442 00:18:04,465 --> 00:18:05,533 EXTRAMURAL COMMUNITY BECAUSE WE 443 00:18:05,533 --> 00:18:07,435 JUST WON'T HAVE ALL THE INTERNAL 444 00:18:07,435 --> 00:18:09,237 STAFF TO MANAGE PROGRAM IT IS IN 445 00:18:09,237 --> 00:18:10,605 THE SAME WAY AND TO MY MIND 446 00:18:10,605 --> 00:18:12,707 THAT'S A BIT OF WHAT WALTER WAS 447 00:18:12,707 --> 00:18:15,043 HIGHLIGHTING AT THE END THAT WE 448 00:18:15,043 --> 00:18:16,744 WILL HAVE TO REALLY FOCUS ON OUR 449 00:18:16,744 --> 00:18:19,380 CORE ACTIVITIES WHICH OF COURSE 450 00:18:19,380 --> 00:18:21,216 INCLUDES GRANT MAKING AND BE 451 00:18:21,216 --> 00:18:23,117 VERY CREATIVE AND FLEXIBLE, OUR 452 00:18:23,117 --> 00:18:25,486 MAIN PRIORITIES CONTINUE TO BE 453 00:18:25,486 --> 00:18:28,022 TO ADDRESS OPIOID USE DISORDER, 454 00:18:28,022 --> 00:18:31,626 OVERDOSE AND PAIN WHICH I'M 455 00:18:31,626 --> 00:18:33,494 REALLY PLEASED WE WILL BE ABLE 456 00:18:33,494 --> 00:18:35,763 TO DO THAT AND CONTINUE TO DO 457 00:18:35,763 --> 00:18:36,030 SO. 458 00:18:36,030 --> 00:18:37,232 SOME HIGHLIGHTS THAT HAD ME 459 00:18:37,232 --> 00:18:39,434 EXCITED IN THE LAST WEEK IN 460 00:18:39,434 --> 00:18:41,703 PARTICULAR WAS THE LARGE SCALE 461 00:18:41,703 --> 00:18:42,570 PRESCRIPTION DRUG SUMMIT, THIS 462 00:18:42,570 --> 00:18:44,572 IS 1 THAT HAS TAKEN PLACE OVER 463 00:18:44,572 --> 00:18:48,009 THE LAST NUMBER OF YEARS, THAT 464 00:18:48,009 --> 00:18:50,211 WAS IMPLEMENTED BY HAL ROGERS A 465 00:18:50,211 --> 00:18:52,614 CHAIR OF THE APPROPRIATIONS 466 00:18:52,614 --> 00:18:54,215 COMMITTEE A NUMBER OF YEARS AGO 467 00:18:54,215 --> 00:18:57,318 AND ULTIMATELY SOMEBODY WHO'S 468 00:18:57,318 --> 00:18:59,787 BEEN 1 OF THOSE RESPONSIBLE FOR 469 00:18:59,787 --> 00:19:02,056 APPROPRIATIONS AND ATTENTIONS TO 470 00:19:02,056 --> 00:19:04,192 THE OPIOID CRISIS AND OPIOID USE 471 00:19:04,192 --> 00:19:06,060 DISORDER BOTH IN HIS 472 00:19:06,060 --> 00:19:07,695 CONSTITUENTS IN EASTERN KENTUCKY 473 00:19:07,695 --> 00:19:09,731 AND NATIONALLY. 474 00:19:09,731 --> 00:19:11,599 THIS MEETING HAS BEEN AN 475 00:19:11,599 --> 00:19:14,102 OPPORTUNITY TO BRING TOGETHER 476 00:19:14,102 --> 00:19:16,871 RESEARCHERS, POLICY MAKERS AND 477 00:19:16,871 --> 00:19:19,374 PRACTITIONERS IN A MAJOR WAY, 478 00:19:19,374 --> 00:19:22,577 AND THIS YEAR'S MEETING IN 479 00:19:22,577 --> 00:19:23,211 TENNESSEE WAS NO EXCEPTION. 480 00:19:23,211 --> 00:19:28,383 ARE I WAS VERY PLEASED TO SEE 481 00:19:28,383 --> 00:19:33,154 THE NEW NIH DIRECTOR THERE AND 482 00:19:33,154 --> 00:19:36,190 PRESENT, WE SAW PRESENTATIONS 483 00:19:36,190 --> 00:19:38,293 FROM THE NEW AG PAM BONDI, AND 484 00:19:38,293 --> 00:19:40,995 WE ALSO WERE ABLE TO SEE 485 00:19:40,995 --> 00:19:42,230 SECRETARY KENNED EXPE THIS 486 00:19:42,230 --> 00:19:43,431 INDICATES THAT THE CONTINUED 487 00:19:43,431 --> 00:19:46,534 ATTENTION THAT THE OVERDOSE 488 00:19:46,534 --> 00:19:47,936 CRISIS COMMANDS FOR THE 489 00:19:47,936 --> 00:19:50,338 ADMINISTRATION AND WE HOPE THAT 490 00:19:50,338 --> 00:19:52,173 IT AUGERS WELL FOR CONTINUED 491 00:19:52,173 --> 00:19:54,976 SUPPORT FOR THESE PROGRAMS AND 492 00:19:54,976 --> 00:19:55,944 WITH THAT I'M LOOKING FORWARD TO 493 00:19:55,944 --> 00:19:59,280 THE REST OF THE MEETING AND I 494 00:19:59,280 --> 00:20:02,550 WILL TURN IT BACK TO WALTER FOR 495 00:20:02,550 --> 00:20:04,819 ANY WRAP UP AND PROBABLY AMY, I 496 00:20:04,819 --> 00:20:11,426 THINK THAT'S NEXT. 497 00:20:11,426 --> 00:20:12,894 >> YEAH, BEFORE WE SHIFTED, I 498 00:20:12,894 --> 00:20:14,062 JUST WANT TO ALSO MENTION, I 499 00:20:14,062 --> 00:20:19,567 JUST PUT IN THE CHAT THAT THE 500 00:20:19,567 --> 00:20:21,836 GROUP HERE PRIOR TO THE 501 00:20:21,836 --> 00:20:26,941 REDUCTION FORCE PUT TOGETHER A 502 00:20:26,941 --> 00:20:28,242 REALLY GREAT ANNUAL REPORT ON 503 00:20:28,242 --> 00:20:30,678 THE HEAL INITIATIVE WHICH IS 504 00:20:30,678 --> 00:20:33,147 INTERESTING READING AND 505 00:20:33,147 --> 00:20:37,719 RECOMMENDED TO ALL BUT IT HAS 506 00:20:37,719 --> 00:20:39,454 REALLY SOUP TO NUTS EXPLANATION 507 00:20:39,454 --> 00:20:40,455 OF WHAT'S BEEN DONE OVER THE 508 00:20:40,455 --> 00:20:42,056 LAST YEAR AND GIVES YOU A SENSE 509 00:20:42,056 --> 00:20:45,660 OF THE VALUE THAT HEAL BRINGS TO 510 00:20:45,660 --> 00:20:49,497 THE TABLE. 511 00:20:49,497 --> 00:20:49,697 GREAT. 512 00:20:49,697 --> 00:20:51,265 SO I GUESS I WAS GOING TO PASS 513 00:20:51,265 --> 00:20:55,970 IT TO AMY NOW TO INTRODUCE ANNA. 514 00:20:55,970 --> 00:20:57,872 >> YEAH, DO YOU WANT TO TAKE A 515 00:20:57,872 --> 00:21:01,342 MOMENT AND TAKE ANY QUESTIONS? 516 00:21:01,342 --> 00:21:02,377 WALTER AND WILSON? 517 00:21:02,377 --> 00:21:06,814 WE HAVE A JUST A COUPLE MINUTES. 518 00:21:06,814 --> 00:21:12,553 >> ALWAYS FINE WITH ME. 519 00:21:12,553 --> 00:21:14,389 >> OKAY. 520 00:21:14,389 --> 00:21:15,356 >> DOES ANYONE -- ROB? 521 00:21:15,356 --> 00:21:16,457 >> THANK YOU BOTH FOR THE 522 00:21:16,457 --> 00:21:19,394 INTRODUCTION AND KIND OF UPDATE 523 00:21:19,394 --> 00:21:20,428 ON EVERYTHING THAT'S ANYTHING 524 00:21:20,428 --> 00:21:20,595 ON. 525 00:21:20,595 --> 00:21:21,662 I KNOW IT'S VERY CHALLENGING AND 526 00:21:21,662 --> 00:21:26,401 I THINK A LOT OF QUESTIONS ABOUT 527 00:21:26,401 --> 00:21:27,702 WITH THE REDUCTIONS IN FORCE, 528 00:21:27,702 --> 00:21:31,939 KIND OF THE PACE OF GETTING 529 00:21:31,939 --> 00:21:33,875 GRANTS AWARDED AND THINGS LIKE 530 00:21:33,875 --> 00:21:37,045 THAT, WHERE DO YOU PULL PEOPLE 531 00:21:37,045 --> 00:21:38,946 AND HOW IS THAT GOING TO BE 532 00:21:38,946 --> 00:21:42,216 IMPACTED BY WHAT'S GONE ON IN 533 00:21:42,216 --> 00:21:46,521 TERMS OF THE STAFFING. 534 00:21:46,521 --> 00:21:47,822 >> WELL 1 THING I'VE BEEN 535 00:21:47,822 --> 00:21:52,260 RELIEVED THAT WE HAD A MAJOR 536 00:21:52,260 --> 00:21:54,662 SLOW DOWN IN REVIEW BOTH IN 537 00:21:54,662 --> 00:21:55,396 TERMS OF THE INSTITUTE'S REVIEW 538 00:21:55,396 --> 00:21:57,732 AS WELL AS ALL THE MAJOR REVIEWS 539 00:21:57,732 --> 00:21:59,667 TAKING PLACE IN CSR AND WE 540 00:21:59,667 --> 00:22:04,205 WEREN'T SURE WE COULD HAVE 541 00:22:04,205 --> 00:22:07,308 COUNCIL MEETINGS IN MAY WITH A 542 00:22:07,308 --> 00:22:08,943 FULL RANGE OF APPLICATIONS. 543 00:22:08,943 --> 00:22:10,578 ONCE THE ADMINISTRATIVE BARRIERS 544 00:22:10,578 --> 00:22:11,846 TO THOSE MEETINGS WERE RELIEVED 545 00:22:11,846 --> 00:22:12,713 AND THEY'VE BEEN SHUT DOWN FOR 546 00:22:12,713 --> 00:22:15,149 MANY OF THE MEETINGS FOR ABOUT A 547 00:22:15,149 --> 00:22:16,751 MONTH, MONTH IN A HALF, THERE 548 00:22:16,751 --> 00:22:18,820 WAS A BACK LOG OF SOMETHING UP 549 00:22:18,820 --> 00:22:22,123 ON THE ORDER OF 20 SOMETHING 550 00:22:22,123 --> 00:22:22,890 APPLICATIONS AT NIH, THE GOOD 551 00:22:22,890 --> 00:22:25,093 NEWS IS THAT THE REVIEW GROUPS 552 00:22:25,093 --> 00:22:26,394 HAVE BEEN EXTRAORDINARILY 553 00:22:26,394 --> 00:22:27,895 COOPERATIVE AND THEY'VE 554 00:22:27,895 --> 00:22:28,963 RESCHEDULED VIRTUALLY ALL OF 555 00:22:28,963 --> 00:22:30,865 THOSE MEET EXPTION WE FULLY 556 00:22:30,865 --> 00:22:32,400 EXPECT ALL OF THOSE APPLICATIONS 557 00:22:32,400 --> 00:22:35,303 TO BE VIEWED IN TIME FOR MAY 558 00:22:35,303 --> 00:22:35,703 COUNCIL MEETINGS. 559 00:22:35,703 --> 00:22:40,241 WE HAD SOME OF THE SAME SLOW 560 00:22:40,241 --> 00:22:41,175 DOWN FOR AUGUST. 561 00:22:41,175 --> 00:22:42,910 THE AUGUST DEAD LYNNS FOR THOSE 562 00:22:42,910 --> 00:22:45,213 THAT ARE TYPICALLY END OF YEAR 563 00:22:45,213 --> 00:22:47,682 RFA TYPE APPLICATIONS AND FOR 564 00:22:47,682 --> 00:22:51,452 OCTOBER COUNCIL AND THOSE ARE 565 00:22:51,452 --> 00:22:54,288 NOW BEING SCHEDULED TO CATCH UP 566 00:22:54,288 --> 00:22:55,623 AND BE ABLE TO BE COMPLETED IN 567 00:22:55,623 --> 00:23:02,096 TIME FOR US TO DO OUR FUNDING OF 568 00:23:02,096 --> 00:23:03,664 THOSE EMPLOY THIS' AN EXAMPLE OF 569 00:23:03,664 --> 00:23:05,333 HOW PEOPLE HAVE COME TOGETHER 570 00:23:05,333 --> 00:23:07,702 AND BURN THE MIDNIGHT OIL WHERE 571 00:23:07,702 --> 00:23:08,402 POSSIBLE AND WHERE FEASIBLE. 572 00:23:08,402 --> 00:23:09,604 >> AND ROB DO YOU WANT TO SAY 573 00:23:09,604 --> 00:23:12,773 ANYTHING ABOUT THE RESEARCH 574 00:23:12,773 --> 00:23:14,408 RECOMMENDATIONS THAT I THINK WE 575 00:23:14,408 --> 00:23:16,344 SHARED WITH THE MDWG BUT ARE 576 00:23:16,344 --> 00:23:18,479 COMING TO THE COUNCIL IN MAY, 577 00:23:18,479 --> 00:23:18,880 RIGHT? 578 00:23:18,880 --> 00:23:23,618 >> YES, WE ARE -- WE ARE 579 00:23:23,618 --> 00:23:25,386 PLANNING TO PRESENT THE RESEARCH 580 00:23:25,386 --> 00:23:28,022 RECOMMENDATIONS AS PART OF THE 581 00:23:28,022 --> 00:23:28,723 STRATEGIC PLANNING PROCESS TO 582 00:23:28,723 --> 00:23:31,692 THE COUNCIL HERE IN A COUPLE OF 583 00:23:31,692 --> 00:23:32,660 WEEKS, LOOKING FORWARD TO BEING 584 00:23:32,660 --> 00:23:36,030 ABLE TO GET THAT PRODUCT PUSHED 585 00:23:36,030 --> 00:23:38,432 FORWARD. 586 00:23:38,432 --> 00:23:41,335 I KNOW TIMELINES ARE TIGHT FOR 587 00:23:41,335 --> 00:23:43,671 THE FY27 SO THESE ARE SUPPOSED 588 00:23:43,671 --> 00:23:45,306 TO INFORM THAT PROCESS, YEAH, 589 00:23:45,306 --> 00:23:49,410 AND KATHLEEN AND I WILL BE 590 00:23:49,410 --> 00:23:51,412 PRESENTING THAT AT THE NINDS 591 00:23:51,412 --> 00:23:55,449 COUNCIL AND AT NIAMS AS WELL. 592 00:23:55,449 --> 00:23:57,218 >> THANK YOU SO MUCH. 593 00:23:57,218 --> 00:23:59,754 ALAN, I SAW YOUR HAND UP, TOO? 594 00:23:59,754 --> 00:24:00,655 >> THANK YOU. 595 00:24:00,655 --> 00:24:04,992 TWO QUESTIONS, 1 VERY PRACTICAL. 596 00:24:04,992 --> 00:24:07,161 DESPITE ALL THE CUT BACKS AND 597 00:24:07,161 --> 00:24:12,567 STAFFING, DO YOU EXPECT THAT THE 598 00:24:12,567 --> 00:24:14,468 ACTUAL AMOUNT OF FUNDS GOING TO 599 00:24:14,468 --> 00:24:16,470 RESEARCH WILL STAY THE SAME OR 600 00:24:16,470 --> 00:24:17,305 WHAT YOU EXPECTED? 601 00:24:17,305 --> 00:24:19,674 OR DO YOU ANTICIPATE THAT THAT 602 00:24:19,674 --> 00:24:21,175 WILL BE CUT AS WELL? 603 00:24:21,175 --> 00:24:24,745 THE OTHER QUESTION IS I KNOW OF 604 00:24:24,745 --> 00:24:29,317 SEVERAL FOLKS WHO HAVE AN E-MAIL 605 00:24:29,317 --> 00:24:30,818 THAT SAYS PENDING, PENDING AND 606 00:24:30,818 --> 00:24:33,254 THEY'RE KIND OF CURIOUS AS TO 607 00:24:33,254 --> 00:24:36,824 WHEN THERE WILL BE A RESOLUTION 608 00:24:36,824 --> 00:24:41,662 OF THAT MESSAGE. 609 00:24:41,662 --> 00:24:43,564 >> I CAN'T SPEAK TO THE LAST 1 610 00:24:43,564 --> 00:24:46,667 BUT IN TERMS OF FUNDING AS 611 00:24:46,667 --> 00:24:48,169 WALTER HIGHLIGHTED, THIS YEAR 612 00:24:48,169 --> 00:24:49,570 WE'VE BEEN APPROPRIATED AS PART 613 00:24:49,570 --> 00:24:53,074 OF A CONTINUING RESOLUTION WHICH 614 00:24:53,074 --> 00:24:54,342 MEANS IT'S APPROXIMATELY THE 615 00:24:54,342 --> 00:24:55,676 EXACT SAME AMOUNT AS LAST YEAR 616 00:24:55,676 --> 00:24:59,614 SO THAT MEANS THAT WE HAVE, YOU 617 00:24:59,614 --> 00:25:01,282 KNOW SIMILAR AMOUNTS OF FUNDS AS 618 00:25:01,282 --> 00:25:04,085 WE HAD BEFORE, SO VERY GENEROUS 619 00:25:04,085 --> 00:25:04,318 AMOUNTS. 620 00:25:04,318 --> 00:25:05,653 WE'RE CERTAINLY -- WE'RE 621 00:25:05,653 --> 00:25:08,256 CERTAINLY READING THE MEDIA AND 622 00:25:08,256 --> 00:25:11,225 PAYING ATTENTION TO WHAT IS 623 00:25:11,225 --> 00:25:12,159 POTENTIALLY IN STORE FOR NEXT 624 00:25:12,159 --> 00:25:14,528 YEAR BUT UNTIL THE WHITE HOUSE 625 00:25:14,528 --> 00:25:17,365 RELEASES THEIR BUDGET THE HOUSE 626 00:25:17,365 --> 00:25:19,634 START HAVING HEARINGS AND MAKING 627 00:25:19,634 --> 00:25:21,769 THEIR APPROPRIATIONS AND THE 628 00:25:21,769 --> 00:25:23,604 SENATE, WE WILL JUST REMAIN 629 00:25:23,604 --> 00:25:26,407 ALERT TO WHAT IS PROPOSED. 630 00:25:26,407 --> 00:25:29,677 I DON'T KNOW, WALTER ANY OTHER 631 00:25:29,677 --> 00:25:30,044 OBSERVATIONS? 632 00:25:30,044 --> 00:25:33,347 >> NO, I THINK WE DON'T HAVE ANY 633 00:25:33,347 --> 00:25:37,151 INSIDE TRADER INFORMATION ON 634 00:25:37,151 --> 00:25:38,019 THIS 1 ALLAN. 635 00:25:38,019 --> 00:25:43,658 AND IN TERMS OF THE GRANTS, 636 00:25:43,658 --> 00:25:45,393 AGAIN THESE DECISIONS ARE NOT 637 00:25:45,393 --> 00:25:47,194 COMING FROM NIH, BUT A NUMBER OF 638 00:25:47,194 --> 00:25:55,269 GRANTS ARE ON HOLD, MAYBE THAT'S 639 00:25:55,269 --> 00:25:56,437 WHAT YOU'RE TALKING ABOUT AND WE 640 00:25:56,437 --> 00:26:00,141 DON'T HAVE CONTROL OF THAT 641 00:26:00,141 --> 00:26:00,574 EITHER. 642 00:26:00,574 --> 00:26:02,643 SO WE CAN'T REALLY HELP PEOPLE 643 00:26:02,643 --> 00:26:05,012 VERY MUCH THERE. 644 00:26:05,012 --> 00:26:06,047 THERE WAS 1 THING, 1 TECHNICAL 645 00:26:06,047 --> 00:26:08,482 THING THAT MIGHT BE OF NOTE IS 646 00:26:08,482 --> 00:26:10,818 THAT THE PAYMENT MANAGEMENT 647 00:26:10,818 --> 00:26:12,586 SYSTEM WHICH ALLOWS GRANTEES TO 648 00:26:12,586 --> 00:26:14,422 PULL MONEY DOWN WAS CLOSED FOR A 649 00:26:14,422 --> 00:26:17,758 WHILE AS THEY WERE TRYING TO DO 650 00:26:17,758 --> 00:26:21,929 UPDATES, I THINK NO 1 COULD 651 00:26:21,929 --> 00:26:22,997 ACCESS MONEY FOR A LITTLE WHILE 652 00:26:22,997 --> 00:26:24,899 BUT THERE ARE A NUMBER OF GRANTS 653 00:26:24,899 --> 00:26:28,736 THAT ARE ON HOLD, CERTAIN 654 00:26:28,736 --> 00:26:29,904 INSTITUTIONS, PRIMARILY, THERE 655 00:26:29,904 --> 00:26:31,505 WERE A NUMBER OF GRANTS THAT 656 00:26:31,505 --> 00:26:37,611 WERE TERMINATED BY THE PURPOSE 657 00:26:37,611 --> 00:26:37,878 NETWORK -- 658 00:26:37,878 --> 00:26:42,049 >> I WAS REFERRING TO A COUPLE 659 00:26:42,049 --> 00:26:42,483 OF K99S. 660 00:26:42,483 --> 00:26:45,786 WHERE THEY GET A NOTE OF PENDING 661 00:26:45,786 --> 00:26:48,856 AND OF COURSE, THEY'RE RATHER 662 00:26:48,856 --> 00:26:49,123 CONCERNED. 663 00:26:49,123 --> 00:26:50,758 >> THEY SHOULD REACH OUST TO 664 00:26:50,758 --> 00:26:52,560 THEIR PROGRAM OFFICER WHO MAY 665 00:26:52,560 --> 00:26:53,260 HAVE INFORMATION, THAT'S ALL I 666 00:26:53,260 --> 00:26:54,061 CAN SAY. 667 00:26:54,061 --> 00:26:55,262 IF THAT'S NOT SATISFACTORY THEN 668 00:26:55,262 --> 00:26:56,664 YOU'RE WELCOME TO REACH OUT TO 669 00:26:56,664 --> 00:26:58,132 LEADERSHIP OF THE INSTITUTE 670 00:26:58,132 --> 00:27:00,000 WHERE THEY'RE ASSIGNED. 671 00:27:00,000 --> 00:27:02,770 >> YEAH, THANK YOU. 672 00:27:02,770 --> 00:27:03,904 THANK YOU. 673 00:27:03,904 --> 00:27:04,939 AND I CERTAINLY AM ANSWERING 674 00:27:04,939 --> 00:27:06,407 INTH OF THOSE QUESTIONS 675 00:27:06,407 --> 00:27:07,942 PERSONALLY AND I'M SURE WALTER, 676 00:27:07,942 --> 00:27:09,410 IS, TOO, BECAUSE EVERYBODY -- 677 00:27:09,410 --> 00:27:10,911 AND THE ANSWER MAY BE WE DON'T 678 00:27:10,911 --> 00:27:12,279 KNOW BUT WE HAVE TO LOOK AT THE 679 00:27:12,279 --> 00:27:18,486 SPECIFIC SITUATION TO BE ABLE TO 680 00:27:18,486 --> 00:27:18,786 ANSWER THAT. 681 00:27:18,786 --> 00:27:20,855 >> THANK YOU. 682 00:27:20,855 --> 00:27:28,229 >> THANK YOU. 683 00:27:28,229 --> 00:27:28,896 ERIC? 684 00:27:28,896 --> 00:27:29,530 >> THERE I AM, GREAT. 685 00:27:29,530 --> 00:27:33,968 I HAD A SIMILAR QUESTION TO 686 00:27:33,968 --> 00:27:35,336 ALLANWITH RESPECT TO THE HEAL 687 00:27:35,336 --> 00:27:38,339 FUNDING, I SEEM TO REMEMBER OVER 688 00:27:38,339 --> 00:27:39,407 THE PAST SEVERAL YEARS IT WOULD 689 00:27:39,407 --> 00:27:41,809 BE A DISCUSSION IN THESE 690 00:27:41,809 --> 00:27:43,277 MEETINGS THAT TALKED ABOUT THE 691 00:27:43,277 --> 00:27:45,279 FORWARD FUNDING COMMITMENTS OF 692 00:27:45,279 --> 00:27:46,747 HEAL THAT THERE HAD BEEN A LOT 693 00:27:46,747 --> 00:27:49,383 OF DOLLARS THAT HAD BEEN 694 00:27:49,383 --> 00:27:50,985 APPROPRIATED FOR EXISTING 695 00:27:50,985 --> 00:27:53,487 PROJECTS GOING FORWARD TO FUTURE 696 00:27:53,487 --> 00:27:59,126 YEARS, HAS THAT CHANGED AT THIS 697 00:27:59,126 --> 00:27:59,527 POINT? 698 00:27:59,527 --> 00:28:01,061 >> ARE, ERIC, SO WE ALWAYS MAKE 699 00:28:01,061 --> 00:28:02,630 PLANS, WE NEVER KNOW HOW MUCH 700 00:28:02,630 --> 00:28:07,168 MONEY WE HAVE, SO THAT'S NOT 701 00:28:07,168 --> 00:28:09,904 NEWS TO US AND I THINK IT'S JUST 702 00:28:09,904 --> 00:28:12,640 A LITTLE BIT MORE UNCERTAINTY 703 00:28:12,640 --> 00:28:13,607 THAN USUAL THIS YEAR GIVEN WHAT 704 00:28:13,607 --> 00:28:16,210 WE'VE SEEN IN THE PAPERS BUT 705 00:28:16,210 --> 00:28:24,051 AGAIN, WE DON'T HAVE ANY INSIDE 706 00:28:24,051 --> 00:28:25,419 INFORMATION ON THAT. 707 00:28:25,419 --> 00:28:27,955 IN GENERAL FROM JUST PAST 708 00:28:27,955 --> 00:28:30,891 EXPERIENCE IF HEAL -- HEAL COMES 709 00:28:30,891 --> 00:28:32,993 WITH A SPECIAL APPROPRIATION SO 710 00:28:32,993 --> 00:28:33,727 EVERYTHING REALLY DEPENDS ON 711 00:28:33,727 --> 00:28:35,229 WHAT CONGRESS WANTS TO DO IN 712 00:28:35,229 --> 00:28:36,997 THAT SPACE GOING FORWARD. 713 00:28:36,997 --> 00:28:41,168 YOU KNOW WE HAVE OPTIONS. 714 00:28:41,168 --> 00:28:43,137 IF WE GET MORE MONEY WE ARE 715 00:28:43,137 --> 00:28:44,538 USUALLY VERY GOOD AT DEVELOPING 716 00:28:44,538 --> 00:28:48,209 REALLY GOOD PROGRAMS TO MAKE 717 00:28:48,209 --> 00:28:50,110 VERY GOOD USE OF THOSE FUNDS. 718 00:28:50,110 --> 00:28:51,846 IF WE HAVE DECREASED FUNDS THEN 719 00:28:51,846 --> 00:28:53,848 WE HAVE TO LOOK TEARFULLY AT 720 00:28:53,848 --> 00:28:56,183 WHAT THE TOP PRIORITIES ARE WITH 721 00:28:56,183 --> 00:28:58,152 REGARD TO NOT JUST WHAT'S MOST 722 00:28:58,152 --> 00:29:00,321 IMPORTANT BUT TIMES YOU KNOW 723 00:29:00,321 --> 00:29:01,455 WHAT'S MOST TIME URGENT, WHAT 724 00:29:01,455 --> 00:29:07,127 THINGS CAN WE PUT OFF, CAN WE 725 00:29:07,127 --> 00:29:09,096 FUND INSTEAD OF 5 GRANTS IN A 726 00:29:09,096 --> 00:29:11,932 GROUP, CAN WE FUND MAY ONLY BE 727 00:29:11,932 --> 00:29:13,300 ABLE TO FUND 2, THOSE ARE THE 728 00:29:13,300 --> 00:29:18,572 KIND OF THINGS WE DO. 729 00:29:18,572 --> 00:29:20,307 WE DO ALSO, PARTICULARLY THIS 730 00:29:20,307 --> 00:29:22,409 YEAR WITH THE UNCERTAINTIES 731 00:29:22,409 --> 00:29:24,979 WE'RE INTERESTED IN MULTIYEAR 732 00:29:24,979 --> 00:29:27,448 FUNDING GRANTS WITH FUNDS FROM 733 00:29:27,448 --> 00:29:28,616 THIS YEAR, THAT ARE AVAILABLE 734 00:29:28,616 --> 00:29:32,152 THAT WOULD MIGHT COVER US AND 735 00:29:32,152 --> 00:29:37,057 NEXT YEAR IF IT'S -- IF THE 736 00:29:37,057 --> 00:29:37,424 BUDGET'S DOWN. 737 00:29:37,424 --> 00:29:39,226 SO WE HAVE A COUPLE OF OPGS WE 738 00:29:39,226 --> 00:29:42,596 CAN WORK WITH HERE, BUT WE'RE 739 00:29:42,596 --> 00:29:45,132 USED TO UNCERTAINTY, YEAH, 740 00:29:45,132 --> 00:29:47,535 THAT'S NOT NEWS TO US. 741 00:29:47,535 --> 00:29:48,469 >> ONE THING THAT PROVIDE A 742 00:29:48,469 --> 00:29:50,337 LITTLE BIT OF FLEXIBILITY ERIC 743 00:29:50,337 --> 00:29:52,773 IS THE DECLARATION OF A PUBLIC 744 00:29:52,773 --> 00:29:54,708 HEGHT EMERGENCY START NOTHING 745 00:29:54,708 --> 00:29:56,911 2017 ARE, THAT GIVES US A LITTLE 746 00:29:56,911 --> 00:29:57,711 BIT OF ADMINISTRATIVE 747 00:29:57,711 --> 00:29:58,646 FLEXIBILITY IN TERMS OF OUR 748 00:29:58,646 --> 00:29:59,947 GRANT MAKING AND THAT WAS 749 00:29:59,947 --> 00:30:01,515 CONTINUED IN MARCH, THE EVERY 90 750 00:30:01,515 --> 00:30:03,984 DAYS THE SECRETARY HAS TO DECIDE 751 00:30:03,984 --> 00:30:06,220 WHETHER EASE GOING TO CONTINUE 752 00:30:06,220 --> 00:30:08,822 IT AND SECRETARY KENNEDY DID 753 00:30:08,822 --> 00:30:10,758 RESIGN IT LAST MONTH. 754 00:30:10,758 --> 00:30:11,392 >> GOOD. 755 00:30:11,392 --> 00:30:11,792 THAT'S GOOD NEWS. 756 00:30:11,792 --> 00:30:13,827 WELL SINCE THIS IS A PUBLIC 757 00:30:13,827 --> 00:30:15,663 MEETING, JUST ON THE RECORD, 758 00:30:15,663 --> 00:30:17,197 THIS HEAL INITIATIVE IS VITALLY 759 00:30:17,197 --> 00:30:17,998 IMPORTANT TO ADADVANCE SCIENCE 760 00:30:17,998 --> 00:30:24,238 AND THE HEALTH OF THIS NATION. 761 00:30:24,238 --> 00:30:29,343 HAVING SEEN THE REALLY DRAMATIC 762 00:30:29,343 --> 00:30:30,978 DECREASE IN OVERDOSE DEATHS, I 763 00:30:30,978 --> 00:30:31,979 HAVE TO FEEL LIKE AT LEAST PART 764 00:30:31,979 --> 00:30:33,747 OF THAT HAD TO DO WITH THESTS 765 00:30:33,747 --> 00:30:35,683 HERE AND THE EXCELLENT WORK THAT 766 00:30:35,683 --> 00:30:38,752 THE HEAL INITIATIVE HAS DONE. 767 00:30:38,752 --> 00:30:40,588 SO I HOPE THE FEDERAL GOVERNMENT 768 00:30:40,588 --> 00:30:42,723 CONTINUES TO SUPPORT CRITICALLY 769 00:30:42,723 --> 00:30:44,091 IMPORTANT SCIENTIFIC INIAATIVE 770 00:30:44,091 --> 00:30:47,661 THAT HELPS TO ALLEVIATE HUMAN 771 00:30:47,661 --> 00:30:47,928 SUFFERING. 772 00:30:47,928 --> 00:30:50,097 >> WE ALMOST ALWAYS REMIND OUR 773 00:30:50,097 --> 00:30:51,865 EXTRAMURAL COLLEAGUES THAT YOU 774 00:30:51,865 --> 00:30:54,868 HAVE THE ABILITY TO EXPRESS 775 00:30:54,868 --> 00:30:57,037 THOSE THOUGHTS AND IDEAS TO YOUR 776 00:30:57,037 --> 00:30:59,073 ELECTED REPRESENTATIVES IN A WAY 777 00:30:59,073 --> 00:31:01,575 WE WILL PROVIDE ANSWERS TO 778 00:31:01,575 --> 00:31:02,509 QUESTIONS AND INFORMATION BUT 779 00:31:02,509 --> 00:31:05,379 YOU ALL ARE ABLE TO ADVOCATE IN 780 00:31:05,379 --> 00:31:06,947 WAYS THAT YOU'RE CERTAINLY 781 00:31:06,947 --> 00:31:17,458 WELCOME TO CONSIDER DOING SO. 782 00:31:18,492 --> 00:31:18,726 >> LYNN? 783 00:31:18,726 --> 00:31:20,561 >> I'M NOT SURE THIS IS AN 784 00:31:20,561 --> 00:31:21,895 ANSWERABLE QUESTION BUT I WAS 785 00:31:21,895 --> 00:31:22,696 JUST THINKING WALTER ABOUT WHAT 786 00:31:22,696 --> 00:31:26,500 YOU WERE SAYING ABOUT THE ROLE 787 00:31:26,500 --> 00:31:28,168 OF CSR AND GRANT REVIEW AND 788 00:31:28,168 --> 00:31:32,673 MAYBE THESE LESS SPECIALIZED 789 00:31:32,673 --> 00:31:33,741 REVIEWER GROUPS FOR THINGS LIKE 790 00:31:33,741 --> 00:31:40,447 HEAL AND I KNOW ALSO IT SEEMS AN 791 00:31:40,447 --> 00:31:42,449 EMPHASIS MORE ON GRANT 792 00:31:42,449 --> 00:31:45,052 MECHANISMS AND YOU KNOW THIS HAS 793 00:31:45,052 --> 00:31:47,721 BEEN VERY DRIVEN BY THE KINDS OF 794 00:31:47,721 --> 00:31:49,523 STRATEGIC PLANNING THAT ROB WILL 795 00:31:49,523 --> 00:31:52,526 BE TALKING ABOUT AND CONCEPTS 796 00:31:52,526 --> 00:31:54,728 RELATED TO THAT AND IS THERE ANY 797 00:31:54,728 --> 00:32:00,668 -- ARE THERE ANY UPDATES ABOUT 798 00:32:00,668 --> 00:32:09,243 HOW FEASIBLE SOME OF THAT IS IN 799 00:32:09,243 --> 00:32:10,210 THE CURRENT ENVIRONMENT? 800 00:32:10,210 --> 00:32:14,214 >> YEAH, I THINK WILSON CAN 801 00:32:14,214 --> 00:32:15,582 COMMENT, TOO, BUT WHAT WE 802 00:32:15,582 --> 00:32:20,254 USUALLY DO IS WE PUT OUT A NOFO, 803 00:32:20,254 --> 00:32:21,755 NOTICE OF FUNDING OPPORTUNITY 804 00:32:21,755 --> 00:32:23,891 AND THAT TELLS THE COMMUNITY 805 00:32:23,891 --> 00:32:25,693 WHAT WE'RE LOOK FOR IN TERMS OF 806 00:32:25,693 --> 00:32:29,396 THE TYPE OF SCIENCE AND YOU KNOW 807 00:32:29,396 --> 00:32:30,831 THE -- SOMETIMES THE MECHANISM 808 00:32:30,831 --> 00:32:33,834 BY WHICH WE'RE LOOKING TO HAVE 809 00:32:33,834 --> 00:32:37,438 THAT SCIENCE DONE, YOU KNOW, 810 00:32:37,438 --> 00:32:38,639 CLINICAL TRIALS, THERAPY 811 00:32:38,639 --> 00:32:41,308 DEVELOPMENT OFTEN PHASE TRIALS, 812 00:32:41,308 --> 00:32:46,113 PHASED AND THAT'S GOING TO BE 813 00:32:46,113 --> 00:32:46,447 HARDER TO DO. 814 00:32:46,447 --> 00:32:48,415 PRETTY CLEAR THAT THAT THE 815 00:32:48,415 --> 00:32:53,387 EMPHASIS NOW IS TO DECREASE THE 816 00:32:53,387 --> 00:32:59,660 NUMBER OF NOFOs AND THEY'RE 817 00:32:59,660 --> 00:33:01,128 ALSO GETTING APPROVAL AT 818 00:33:01,128 --> 00:33:05,299 MULTIPLE LEVELS, SO THAT IS 819 00:33:05,299 --> 00:33:09,036 GOING TO STYMIE US AND CERTAINLY 820 00:33:09,036 --> 00:33:10,738 SLOW US DOWN IN TERMS OF MOVING 821 00:33:10,738 --> 00:33:11,572 THESE THINGS FORWARD. 822 00:33:11,572 --> 00:33:13,107 I THINK THAT'S -- THAT'S THE 823 00:33:13,107 --> 00:33:17,311 MESSAGE WE'VE BEEN GETTING. 824 00:33:17,311 --> 00:33:17,778 >> THANKS. 825 00:33:17,778 --> 00:33:18,378 ULTIMATE GOAL MATERIALLY THE 826 00:33:18,378 --> 00:33:19,713 HOPE THAT THIS WILL BE MORE 827 00:33:19,713 --> 00:33:21,582 EFFICIENT IN THE LONG RUN BUT 828 00:33:21,582 --> 00:33:23,784 THE PROOF WILL BE IN THE PUDDING 829 00:33:23,784 --> 00:33:24,818 AS THEY SAY. 830 00:33:24,818 --> 00:33:26,086 SO I ENCOURAGE YOU ALL TO KEEP 831 00:33:26,086 --> 00:33:27,521 AN EYE ON THIS OVER THE NEXT 832 00:33:27,521 --> 00:33:29,223 YEAR OR 2 BECAUSE IF IT'S THAT 833 00:33:29,223 --> 00:33:34,061 LONG A LAG TIME TO SEE THESE 834 00:33:34,061 --> 00:33:35,729 BEING IMPLEMENTED BUT NIDA IN 835 00:33:35,729 --> 00:33:38,432 PARTICULAR HAS HAD A LARGE 836 00:33:38,432 --> 00:33:40,134 NUMBER OF NOTICES OF FUNDING 837 00:33:40,134 --> 00:33:43,270 OPPORTUNITY OR WHAT MANY OF US 838 00:33:43,270 --> 00:33:44,471 CALL RFAs AND WE'RE NOW QUITE 839 00:33:44,471 --> 00:33:47,908 LIMITED IN HOW MANY WE WILL BE 840 00:33:47,908 --> 00:33:49,209 PUTTING OUT THIS YEAR AND IN 841 00:33:49,209 --> 00:33:50,844 FUTURE YEARS SO WE WILL BE 842 00:33:50,844 --> 00:33:53,280 ADJUSTING AND USING THE WEB TO 843 00:33:53,280 --> 00:33:54,748 HIGHLIGHT PRIORITY AREAS AND 844 00:33:54,748 --> 00:33:56,183 ENCOURAGING YOU DR. DEBAR AND 845 00:33:56,183 --> 00:33:59,386 OTHERS TO KEEP AN EYE OUT FOR 846 00:33:59,386 --> 00:34:00,654 WHAT WE'RE HIGHLIGHTING AS 847 00:34:00,654 --> 00:34:03,557 PRIORITY AREAS AND THEN USING 848 00:34:03,557 --> 00:34:04,792 THE STANDARD GRANT MECHANISMS TO 849 00:34:04,792 --> 00:34:07,694 ADDRESS SOME OF THOSE PRIORITY 850 00:34:07,694 --> 00:34:07,895 AREAS. 851 00:34:07,895 --> 00:34:08,195 >> RIGHT. 852 00:34:08,195 --> 00:34:09,496 EXACTLY RIGHT. 853 00:34:09,496 --> 00:34:12,766 THANKS, WILSON, YEAH. 854 00:34:12,766 --> 00:34:15,669 >> WILL THOSE COME OUT AS 855 00:34:15,669 --> 00:34:16,170 PROGRAM ANNOUNCE WANTS? 856 00:34:16,170 --> 00:34:19,840 >> NO, THEY WILL BE -- STAY 857 00:34:19,840 --> 00:34:20,107 TUNED. 858 00:34:20,107 --> 00:34:22,009 WE DON'T HAVE THE FULL PROCESS 859 00:34:22,009 --> 00:34:24,711 FULLY IMPLEMENTED BUT THE ROUGH 860 00:34:24,711 --> 00:34:29,449 IDEA IS THAT THE WEBSITES WILL 861 00:34:29,449 --> 00:34:31,885 HAVE A PLACE TO INCLUDE PRIORITY 862 00:34:31,885 --> 00:34:33,220 AREAS, SO THE ONLINE VERSION OF 863 00:34:33,220 --> 00:34:36,657 SORT OF THE HIGHLIGHTS AND 864 00:34:36,657 --> 00:34:37,925 PROGRAM ANNOUNCEMENTS BUT IN 865 00:34:37,925 --> 00:34:39,259 OTHER WORDS WE WILL FIND WAYS TO 866 00:34:39,259 --> 00:34:40,661 COMMUNICATE TO YOU WHAT THE 867 00:34:40,661 --> 00:34:42,362 PRIORITIES ARE BUT IT MAY MEAN 868 00:34:42,362 --> 00:34:48,001 THERE'S A NEW PLACE YOU LOOK FOR 869 00:34:48,001 --> 00:34:48,202 THEM. 870 00:34:48,202 --> 00:34:49,469 >> GOT IT. 871 00:34:49,469 --> 00:34:49,903 THANKS. 872 00:34:49,903 --> 00:34:50,904 >> AND THESE ADVISORY GROUPS ARE 873 00:34:50,904 --> 00:34:52,873 A WONDERFUL PLACE TO DISCUSS 874 00:34:52,873 --> 00:34:53,707 THIS BECAUSE FRANKLY ONCE WE 875 00:34:53,707 --> 00:34:57,344 START THIS IF YOU ALL AREN'T 876 00:34:57,344 --> 00:34:59,112 AWARE OF, THAT MEANS WE HAVE A 877 00:34:59,112 --> 00:35:02,716 LOT MORE COMMUNICATION TO DO. 878 00:35:02,716 --> 00:35:05,219 >> JUST A QUICK QUESTION, IRENE, 879 00:35:05,219 --> 00:35:09,122 ARE THE PROGRAM DIRECTORS STILL 880 00:35:09,122 --> 00:35:15,329 AROUND, HAVE ANY BEEN ALSO ASKED 881 00:35:15,329 --> 00:35:15,662 TO LEAVE? 882 00:35:15,662 --> 00:35:18,432 >> I WAS GOING TO SAY A NUMBER 883 00:35:18,432 --> 00:35:21,802 OF PROGRAM DIRECTORS TOOK THE 884 00:35:21,802 --> 00:35:26,807 PACKAGES FOR EARLY RETIREMENT. 885 00:35:26,807 --> 00:35:27,908 >> IS IT POSSIBLE TO FIND OUT 886 00:35:27,908 --> 00:35:29,142 WHO THAT IS BECAUSE IF WE HAVE 887 00:35:29,142 --> 00:35:30,744 TO REACH OUT AND YOU DON'T GET 888 00:35:30,744 --> 00:35:33,847 AN ANSWER, YOU DON'T KNOW WHY. 889 00:35:33,847 --> 00:35:35,349 >> WELL IF YOU DON'T GET AN 890 00:35:35,349 --> 00:35:39,686 ANSWER, YEAH, JUST E-MAIL ME. 891 00:35:39,686 --> 00:35:42,556 >> OKAY, THANK YOU. 892 00:35:42,556 --> 00:35:43,156 THANK YOU. 893 00:35:43,156 --> 00:35:49,229 >> NOW GAIL, CAN YOU TALK, CAN 894 00:35:49,229 --> 00:35:50,898 YOU UNMUTE? 895 00:35:50,898 --> 00:35:54,668 GAIL IS -- 896 00:35:54,668 --> 00:35:55,669 >> CAN YOU HEAR ME NOW? 897 00:35:55,669 --> 00:35:58,538 I DON'T KNOW IF I CAN GET ON 898 00:35:58,538 --> 00:36:02,042 CAMERA, OH, GOOD, THANK YOU. 899 00:36:02,042 --> 00:36:02,743 HI. 900 00:36:02,743 --> 00:36:05,112 I JUST WANTED A COUPLE COMMENTS 901 00:36:05,112 --> 00:36:07,247 SO SOME THINGS ARE WORKING IN 902 00:36:07,247 --> 00:36:08,615 THE CTN, I WANT YOU TO KNOW WE 903 00:36:08,615 --> 00:36:10,384 GO GET OUR NOTICE OF ARK WARDS 904 00:36:10,384 --> 00:36:11,652 FOR OUR CONTINUING APPLICATION 905 00:36:11,652 --> 00:36:13,320 SO I'M VERY EXCITED ABOUT, I 906 00:36:13,320 --> 00:36:15,022 JUST WANTED TO KNOW THERE ARE 907 00:36:15,022 --> 00:36:18,225 THINGS COMING OUT AND THE ANSWER 908 00:36:18,225 --> 00:36:19,326 THOSE QUESTIONS THAT I HAVE 909 00:36:19,326 --> 00:36:20,494 GOTTEN FROM A VETERINARY 910 00:36:20,494 --> 00:36:21,395 COMMUNITY OF DIFFERENT 911 00:36:21,395 --> 00:36:23,130 INVESTIGATORS WHERE THINGS ARE 912 00:36:23,130 --> 00:36:24,264 KIND OF IN LIMBO BUT I HAVE 913 00:36:24,264 --> 00:36:27,734 REACHED OUT TO THE DIRECTORS OF 914 00:36:27,734 --> 00:36:28,635 THOSE PARTICULAR AREAS. 915 00:36:28,635 --> 00:36:30,137 LUCKILY I KNOW WHERE THEY ARE 916 00:36:30,137 --> 00:36:32,005 BECAUSE I'VE BEEN ASSOCIATE WIDE 917 00:36:32,005 --> 00:36:34,207 YOU ALL AND THEY HAVE BEEN VERY 918 00:36:34,207 --> 00:36:35,375 RESPONSIVE SO CAN YOU ALWAYS GO 919 00:36:35,375 --> 00:36:38,445 OFF AND SAY HELP ME OUT TO HELP 920 00:36:38,445 --> 00:36:38,845 THIS INVESTIGATOR. 921 00:36:38,845 --> 00:36:39,646 THE OTHER COMMENT I WANTED TO 922 00:36:39,646 --> 00:36:47,888 MAKE IT THAT WE ARE SEEING A 923 00:36:47,888 --> 00:36:48,956 NICE DECELERATION ON OVERDOSE 924 00:36:48,956 --> 00:36:51,091 DUE TO A LOT OF WORK THAT 925 00:36:51,091 --> 00:36:51,525 EVERYONE'S DOING. 926 00:36:51,525 --> 00:36:54,127 WE WANT TO MAKE SURE THAT THE 927 00:36:54,127 --> 00:36:56,530 NARCAIN IS GETTING OUT THERE BUT 928 00:36:56,530 --> 00:36:57,965 I ALSO WANT TO MAKE SURE WE 929 00:36:57,965 --> 00:36:59,232 COMMENT THAT THESE ARE NOT 930 00:36:59,232 --> 00:37:01,969 ACROSS THE BOARD, THAT WE HAVE 931 00:37:01,969 --> 00:37:04,871 FOUND GEOGRAPHICAL ISSUES, BEING 932 00:37:04,871 --> 00:37:06,940 THAT LESS IMPROVEMENTS IN THE 933 00:37:06,940 --> 00:37:08,909 WEST, LESS IMPROVEMENTS FOR 934 00:37:08,909 --> 00:37:10,911 CERTAIN ETHNIC AND RACIAL GROUPS 935 00:37:10,911 --> 00:37:13,513 SUCH AS BLACKS, LESS IMPROVEMENT 936 00:37:13,513 --> 00:37:14,948 FOR AGE CERTAINLY OF PEOPLE WHO 937 00:37:14,948 --> 00:37:16,149 ARE OLDER, SO, I JUST WANT TO 938 00:37:16,149 --> 00:37:22,756 SAY WE HAVE A LOT OF WORK TO DO 939 00:37:22,756 --> 00:37:24,291 AND WE NEED TO KEEP UP OUR 940 00:37:24,291 --> 00:37:29,129 EFFORTS TO MAKE SURE THAT WE DO 941 00:37:29,129 --> 00:37:30,630 CONTINUE THIS DECELERATION AND 942 00:37:30,630 --> 00:37:32,466 IT'S NOT GOING TO PLATEAU OFF 943 00:37:32,466 --> 00:37:38,572 AND WE ALSO KNOW IT'S DUE TO A 944 00:37:38,572 --> 00:37:41,641 LOT OF OTHER THINGS WITH IT SO 945 00:37:41,641 --> 00:37:44,978 THERE'S A LOT OF ATTENTION BEING 946 00:37:44,978 --> 00:37:46,580 PAID TO POLYSUBSTANCE USE ALONG 947 00:37:46,580 --> 00:37:47,147 WITH OPIOID. 948 00:37:47,147 --> 00:37:48,615 THAT'S ALL I WANTED TO SAY. 949 00:37:48,615 --> 00:37:50,183 KEEP UP THE GOOD WORK. 950 00:37:50,183 --> 00:37:52,119 >> THANK YOU GAIL,IME VERY 951 00:37:52,119 --> 00:37:53,653 PLEASED THAT YOUR GRANTS WENT 952 00:37:53,653 --> 00:37:55,422 OUT AS EXPECTED THAT WAS A 953 00:37:55,422 --> 00:37:58,225 RELIEF BOTH FOR YOU ALL BUT ALSO 954 00:37:58,225 --> 00:38:04,331 FOR YOUR PROGRAM STAFF AND 955 00:38:04,331 --> 00:38:04,631 LEADERSHIP. 956 00:38:04,631 --> 00:38:07,934 I WOULD POINT OUT THAT SOME OF 957 00:38:07,934 --> 00:38:10,270 THE ADVANCES, IN YOUR AREA, 958 00:38:10,270 --> 00:38:11,805 WE'VE SEEN 9 IMPROVEMENTS IN 959 00:38:11,805 --> 00:38:13,373 EMERGENCY DEPARTMENT STEPPING UP 960 00:38:13,373 --> 00:38:16,076 TO ADDRESS OPIOID USE DISORDER 961 00:38:16,076 --> 00:38:16,843 WITH STARTING MEDICATIONS ONSITE 962 00:38:16,843 --> 00:38:18,345 AND AT THE TIME OF TREATMENT 963 00:38:18,345 --> 00:38:19,479 WITHOUT JUST REFERRING PEOPLE TO 964 00:38:19,479 --> 00:38:21,214 TREATMENT BUT STARTING IT. 965 00:38:21,214 --> 00:38:23,650 BASED ON IMROWR SEMINOLE WORK 10 966 00:38:23,650 --> 00:38:25,218 YEARS AGO THAT'S NOW REALLY 967 00:38:25,218 --> 00:38:27,554 TAKEN HOLD IN SO MANY SIGHTS 968 00:38:27,554 --> 00:38:29,322 AROUND THE COUNTRY AND 969 00:38:29,322 --> 00:38:30,924 WITNESSING THAT ENGAGEMENT HAS 970 00:38:30,924 --> 00:38:31,825 BEEN AWESOME. 971 00:38:31,825 --> 00:38:32,325 >> GREAT. 972 00:38:32,325 --> 00:38:34,628 AND A PLUG, TOO, IN THAT WE'RE 973 00:38:34,628 --> 00:38:35,996 DOING IT PREHOSPITAL NOW. 974 00:38:35,996 --> 00:38:39,032 WE HAVE BEEN WORKING DILIGENTLY 975 00:38:39,032 --> 00:38:40,067 WITH SEVERAL SYSTEMS THROUGHOUT 976 00:38:40,067 --> 00:38:43,003 THE COUNTRY AND PRESENTING, OUR 977 00:38:43,003 --> 00:38:47,941 PRELIMINARY DATA THAT WE HAVE ON 978 00:38:47,941 --> 00:38:48,608 PARAMEDICS, PREHOSPITAL 979 00:38:48,608 --> 00:38:49,709 PERSONNEL WHO ARE WORKING WITH 980 00:38:49,709 --> 00:38:51,878 PEOPLE WHO HAVE JUST OVERDOSED 981 00:38:51,878 --> 00:38:52,279 AND BEEN REVERSED. 982 00:38:52,279 --> 00:38:55,315 WE FOUND THAT WE COULD GIVE 983 00:38:55,315 --> 00:38:57,017 BUPRENORPH THEN AND AS WELL AS 984 00:38:57,017 --> 00:39:00,454 PEOPLE WHO ARE STOPPING THEM 985 00:39:00,454 --> 00:39:01,688 BECAUSE THEY'RE IN WITHDRAWAL. 986 00:39:01,688 --> 00:39:03,256 WE KNOW NOT EVERYONE WANTS TO 987 00:39:03,256 --> 00:39:04,858 SEEK TREATMENT AND SO WE'RE 988 00:39:04,858 --> 00:39:06,460 OPENING A WHOLE OTHER AVENUE. 989 00:39:06,460 --> 00:39:11,898 SO WE'RE EXCITED ABOUT IT. 990 00:39:11,898 --> 00:39:13,834 >> OKAY, WELL, THANKS A LOT 991 00:39:13,834 --> 00:39:20,440 FOLKS AND LET'S NOW MOVE OVER TO 992 00:39:20,440 --> 00:39:21,708 ANNA MAZZUCCO, WE WILL TALK TO 993 00:39:21,708 --> 00:39:23,643 US ABOUT THE BACPAC PROGRAM, 994 00:39:23,643 --> 00:39:27,647 SHE'S THE DEPUTY DIRECTOR AT 995 00:39:27,647 --> 00:39:28,915 NIAMS WHERE SHE MANAGES THE 996 00:39:28,915 --> 00:39:34,855 DAILY OPERATIONS FOR THE 997 00:39:34,855 --> 00:39:35,455 EN--STRATEGIESITUTE, OVERSEES 998 00:39:35,455 --> 00:39:43,096 NIAMS PARTICIPATION AND 999 00:39:43,096 --> 00:39:43,497 PROJECTS. 1000 00:39:43,497 --> 00:39:45,799 SHE SERVED AS DEPUTY DIRECTOR OF 1001 00:39:45,799 --> 00:39:47,100 THE HEAL INITIATIVE BUILDING 1 1002 00:39:47,100 --> 00:39:50,670 AND SHE ALSO KRIEWBED TO THE NIH 1003 00:39:50,670 --> 00:39:51,438 INVESTIGATOR CO-OCCURRING 1004 00:39:51,438 --> 00:39:52,606 CONDITIONS OF COURSE THE LIFE 1005 00:39:52,606 --> 00:39:57,043 SPAN IN DOWN SYNDROME AND IN THE 1006 00:39:57,043 --> 00:40:03,316 RAD X PROGRAM AROWNT COVID-19 1007 00:40:03,316 --> 00:40:03,550 TESTING. 1008 00:40:03,550 --> 00:40:05,585 ANNA, YOU WANT TO TALK TO US 1009 00:40:05,585 --> 00:40:10,457 ABOUT THIS GREAT PROJECT BACPAC. 1010 00:40:10,457 --> 00:40:11,758 >> THANK YOU WALTER FOR THE KIND 1011 00:40:11,758 --> 00:40:15,028 INTRODUCTION, CAN YOU HEAR ME? 1012 00:40:15,028 --> 00:40:15,295 >> YEAH. 1013 00:40:15,295 --> 00:40:16,363 >> OKAY, THANK YOU SO MUCH AND I 1014 00:40:16,363 --> 00:40:21,635 DO MY BEST TO KEEP US ON TIME 1015 00:40:21,635 --> 00:40:23,336 ALTHOUGH LINDE TOLD ME WOO HAVE 1016 00:40:23,336 --> 00:40:24,938 ALET BIT OF ROOM TOWARD THE END 1017 00:40:24,938 --> 00:40:26,506 OF THE MEETING SO WE WILL TRY TO 1018 00:40:26,506 --> 00:40:28,642 HIT THE RIGHT BALANCE BUT THAT 1019 00:40:28,642 --> 00:40:29,843 WAS A VERY IMPORTANT DISCUSSION 1020 00:40:29,843 --> 00:40:33,246 WE WERE ALL HAVING SO THANK FUR 1021 00:40:33,246 --> 00:40:33,680 THAT. 1022 00:40:33,680 --> 00:40:35,315 SO I WILL JUMP RIGHT IN HERE AND 1023 00:40:35,315 --> 00:40:38,051 I WANTED TO SAY BRIEFLY THAT TO 1024 00:40:38,051 --> 00:40:40,620 BE HONEST WE WEREN'T ORIGINALLY 1025 00:40:40,620 --> 00:40:44,558 PLANNING TO PRESENT ON BACPAC 1026 00:40:44,558 --> 00:40:45,792 TODAY BUT SOME OF OUR COLLEAGUES 1027 00:40:45,792 --> 00:40:48,995 WHO ARE NO LONGER HERE, WERE 1028 00:40:48,995 --> 00:40:50,597 PLANNING TO PRESENT ON THE HEAL 1029 00:40:50,597 --> 00:40:54,601 DATA ECOSYSTEM AND SO WE'VE DONE 1030 00:40:54,601 --> 00:40:56,703 HERE WHAT I THINK IS HOPEFULLY 1031 00:40:56,703 --> 00:40:59,639 KIND OF A HELPFUL HYBRID 1032 00:40:59,639 --> 00:41:02,075 PRESENTATION, HIGHLIGHTING THE 1033 00:41:02,075 --> 00:41:03,677 ACCOMPLISHMENTS OF BACPAC BUT 1034 00:41:03,677 --> 00:41:04,844 ALSO IN HIGHLIGHTING SOME OF THE 1035 00:41:04,844 --> 00:41:07,414 INTERPLAY WITH THE HEAL DATA 1036 00:41:07,414 --> 00:41:09,249 ECOSYSTEM BECAUSE WE WANTED TO 1037 00:41:09,249 --> 00:41:12,185 EMPHASIZE THAT IMPORTANT WORK OF 1038 00:41:12,185 --> 00:41:15,689 OUR COLLEAGUES AND HOW OWL THE 1039 00:41:15,689 --> 00:41:17,424 HEAL PROGRAMS INCLUDING 1040 00:41:17,424 --> 00:41:18,458 BACPAC'RE LEVERAGING AND 1041 00:41:18,458 --> 00:41:19,426 BUILDING INTO THAT RESOURCE. 1042 00:41:19,426 --> 00:41:22,195 SO WITH THEY WILL TRY TO INCLUDE 1043 00:41:22,195 --> 00:41:24,197 HIGHLIGHTS ON THE HEAL DATA 1044 00:41:24,197 --> 00:41:24,831 ECOSYSTEM TOWARD THE END. 1045 00:41:24,831 --> 00:41:29,202 SO YOU CAN MOVE RIGHT ON AHEAD 1046 00:41:29,202 --> 00:41:31,905 LYNDIE INTO THE NEXT SLIDE. 1047 00:41:31,905 --> 00:41:34,274 BEFORE MENTIONING THE VISION FOR 1048 00:41:34,274 --> 00:41:36,876 BACPAC, I WANT TO MENTION ALSO 1049 00:41:36,876 --> 00:41:38,745 MA BACPAC IS REALLY ALSO 1050 00:41:38,745 --> 00:41:41,715 INSPIRED BY OUR STAKEHOLDER 1051 00:41:41,715 --> 00:41:44,384 BOARD, WHICH WE FEEL VERY 1052 00:41:44,384 --> 00:41:47,254 IMPORTANT TO MENTION THAT'S 1053 00:41:47,254 --> 00:41:48,855 COMPRISED OF PATIENTS, 1054 00:41:48,855 --> 00:41:49,756 PROVIDERS, PROFESSIONAL 1055 00:41:49,756 --> 00:41:51,091 SOCIETIES, GOVERNMENT SPONSORED 1056 00:41:51,091 --> 00:41:52,559 ORGANIZATION AND OTHERS WHO HAVE 1057 00:41:52,559 --> 00:41:53,560 GIVEN US IMPORTANT FEEDBACK ON 1058 00:41:53,560 --> 00:41:56,096 THIS PROGRAM OVER THE YEARS AND 1059 00:41:56,096 --> 00:41:58,465 I ALSO JUST WANTED TO MENTION MY 1060 00:41:58,465 --> 00:42:04,004 2 COLLEAGUES AT NIAMS, 1061 00:42:04,004 --> 00:42:04,537 DR. ARE--ADMINISTRATIVEIN 1062 00:42:04,537 --> 00:42:05,839 MARQUES WHO IS AT AN ALL DAY 1063 00:42:05,839 --> 00:42:09,309 MEETING AND DR. REBECCA LINDSAY 1064 00:42:09,309 --> 00:42:10,910 WHO HAS BEEN INVOLVED IN BACPAC 1065 00:42:10,910 --> 00:42:12,979 OVER THE YEARS AND YOU WILL HEAR 1066 00:42:12,979 --> 00:42:13,713 FROM REBECCA LATE THERAPY AND 1067 00:42:13,713 --> 00:42:16,249 AFTERNOON BUT I WILL PRESENT ON 1068 00:42:16,249 --> 00:42:20,920 BACPAC ON THEIR BEHALF. 1069 00:42:20,920 --> 00:42:23,056 SO THE BACPAC VISION TO PROVIDE 1070 00:42:23,056 --> 00:42:24,557 TARGETED AND MORE EFFECTIVE 1071 00:42:24,557 --> 00:42:25,625 TREATMENT FOR INDIVIDUALS WITH 1072 00:42:25,625 --> 00:42:26,926 CHRONIC LOW BACK PAIN AND REALLY 1073 00:42:26,926 --> 00:42:33,266 THE GOAL HERE IS TO DEVELOP A 1074 00:42:33,266 --> 00:42:34,601 STATE-OF-THE-ART MODEL FOR 1075 00:42:34,601 --> 00:42:36,503 CHRONIC LOWER BACK PAIN, AND TO 1076 00:42:36,503 --> 00:42:38,571 IDENTIFY FACTORS THAT PREDICTIVE 1077 00:42:38,571 --> 00:42:41,508 OF TREATMENT EFFECTIVENESS FOR 1078 00:42:41,508 --> 00:42:42,876 WELL DEFINED PATIENT 1079 00:42:42,876 --> 00:42:43,910 SUBPOPULATIONS AND LASTLY TO 1080 00:42:43,910 --> 00:42:45,912 DEVELOP AN AG GOR ITG 1081 00:42:45,912 --> 00:42:47,347 IMPEDIMENTS FOR MULTIMODAL 1082 00:42:47,347 --> 00:42:48,715 INTERVENTIONS FOR INDIVIDUALS 1083 00:42:48,715 --> 00:42:49,916 WITH DIFFERENT PHENOTYPES OF 1084 00:42:49,916 --> 00:42:54,020 CHRONIC LO BACK PAIN AND REALLY 1085 00:42:54,020 --> 00:42:56,089 THE IDEA THAT THOSE ALGORITHMS 1086 00:42:56,089 --> 00:42:57,824 COULD BE EXTENDED AND FUTURE 1087 00:42:57,824 --> 00:43:01,394 WORK FOR FURTHER TESTING AND 1088 00:43:01,394 --> 00:43:03,196 FURTHER IMPROVING OUR ABILITY TO 1089 00:43:03,196 --> 00:43:06,900 TREAT DIFFERENT PATIENT SUBTYPES 1090 00:43:06,900 --> 00:43:08,401 WITH CHRONIC LOWER BACK PAIN. 1091 00:43:08,401 --> 00:43:12,672 SO WITH THAT, ON THE NEXT SLIDE, 1092 00:43:12,672 --> 00:43:14,908 I WILL JUST TRY TO GO QUICKLY 1093 00:43:14,908 --> 00:43:17,077 BUT JUST HIGHLIGHT THE BACPAC 1094 00:43:17,077 --> 00:43:22,549 CONSORT JUMP WHOOPS AND -- 1095 00:43:22,549 --> 00:43:23,416 CONSORTIUM AND THIS RESEARCH 1096 00:43:23,416 --> 00:43:24,984 TEAM THAT CONTRIBUTED TO THIS 1097 00:43:24,984 --> 00:43:25,852 EFFORT OVER THE LAST SEVERAL 1098 00:43:25,852 --> 00:43:30,657 YEARS AND I KNOW THAT ERIIN AND 1099 00:43:30,657 --> 00:43:32,392 REBECCA WOULD WANT ME TO 1100 00:43:32,392 --> 00:43:35,495 HIGHLIGHT JUST THE VERY 1101 00:43:35,495 --> 00:43:36,196 INTERDISCIPLINARY NATURE OF THIS 1102 00:43:36,196 --> 00:43:43,570 CONSORTIUM AND JUST THE CRUCIATE 1103 00:43:43,570 --> 00:43:43,837 UNIQUE 1104 00:43:43,837 --> 00:43:44,504 COLLABORATIONS WE'VE BEEN ABLE 1105 00:43:44,504 --> 00:43:46,606 TO BE A PART OF FOR THE LAST 1106 00:43:46,606 --> 00:43:47,474 SEVERAL YEARS WITH THIS GROUP. 1107 00:43:47,474 --> 00:43:49,642 AND I HOPE YOU WILL SEE THAT 1108 00:43:49,642 --> 00:43:51,644 REFLECTED IN OUR KIND OF MODEL 1109 00:43:51,644 --> 00:43:54,013 OF CHRONIC LOWER BACK PAIN AND 1110 00:43:54,013 --> 00:43:55,215 HOW THIS INTERDISCIPLINARY 1111 00:43:55,215 --> 00:43:56,483 APPROACH WE FELT WAS REALLY 1112 00:43:56,483 --> 00:44:00,320 IMPORTANT FOR THIS PROJECT. 1113 00:44:00,320 --> 00:44:03,223 SO ON THE NEXT SLIDE, I THINK I 1114 00:44:03,223 --> 00:44:06,226 WILL BRIEFLY SHOW OUR 1115 00:44:06,226 --> 00:44:07,994 DISTRIBUTION OF BACKPACK 1116 00:44:07,994 --> 00:44:08,561 RESEARCH SIGHTS ACROSS THE 1117 00:44:08,561 --> 00:44:09,963 UNITED STATES AND DIFFERENT 1118 00:44:09,963 --> 00:44:12,732 ASPECTS OF THE MECHANISTIC 1119 00:44:12,732 --> 00:44:15,034 RESEARCH CENTERS OR MRCs AS WE 1120 00:44:15,034 --> 00:44:16,269 REFER TO THEM LATER IN THE 1121 00:44:16,269 --> 00:44:17,437 PRESENTATION AND SITES OF OUR 1122 00:44:17,437 --> 00:44:19,272 CLINICAL TRIALS AS WELL, IN THE 1123 00:44:19,272 --> 00:44:20,974 NATIONAL INSTITUTES OF HEALTH, 1124 00:44:20,974 --> 00:44:22,108 OUR TECHNOLOGY RESEARCH SITES 1125 00:44:22,108 --> 00:44:24,677 AND ALSO OUR DATA INTEGRATION, 1126 00:44:24,677 --> 00:44:27,280 AND OPERATIONS MANAGEMENT CENTER 1127 00:44:27,280 --> 00:44:27,747 OR OUR DAC. 1128 00:44:27,747 --> 00:44:31,484 AND THEN ON THE NEXT SLIDE, I 1129 00:44:31,484 --> 00:44:33,219 WILL JUST TO HIGHLIGHT FOR YOU 1130 00:44:33,219 --> 00:44:34,687 TODAY AND HOPEFULLY WILL COME 1131 00:44:34,687 --> 00:44:37,457 THROUGH IN SOME OF THE DETAILS 1132 00:44:37,457 --> 00:44:39,426 OF THE PRESENTATION, THE SCALE 1133 00:44:39,426 --> 00:44:40,794 OF DATA GENERATED THROUGH BACK 1134 00:44:40,794 --> 00:44:44,330 PACK AND TO HOPEFULLY TIE-IN 1135 00:44:44,330 --> 00:44:47,033 LATER ON THE AVAILABILITY OF 1136 00:44:47,033 --> 00:44:49,135 THIS DATA IN OUR HEAL DATA 1137 00:44:49,135 --> 00:44:52,005 ECOSYSTEM AND HOW WE REALLY LOOK 1138 00:44:52,005 --> 00:44:53,373 FORWARD TO CONTINUED ANALYSIS OF 1139 00:44:53,373 --> 00:44:57,977 THIS DATA IN FUTURE WORK AND HOW 1140 00:44:57,977 --> 00:45:00,180 WE THINK THIS DATA WILL ALSO ADD 1141 00:45:00,180 --> 00:45:03,650 AND CAN BE UTILIZED BY OTHER 1142 00:45:03,650 --> 00:45:04,984 ACTIVITIES WITHIN HEAL INCLUDING 1143 00:45:04,984 --> 00:45:07,654 OTHER PAIN TYPES AND SO I'LL 1144 00:45:07,654 --> 00:45:09,155 JUST MENTION THAT WE FEEL THE 1145 00:45:09,155 --> 00:45:10,657 MAJOR SUCCESS IS THE HIGH 1146 00:45:10,657 --> 00:45:13,393 QUALITY OF THIS DATA AND THE 1147 00:45:13,393 --> 00:45:14,761 COMPREHENSIVE DATA THAT WE'RE 1148 00:45:14,761 --> 00:45:17,664 REALLY JUST BEGINNING TO SCRATCH 1149 00:45:17,664 --> 00:45:18,164 THE SURFACE OF. 1150 00:45:18,164 --> 00:45:19,599 ON THE NEXT SLIDE, I THINK WHAT 1151 00:45:19,599 --> 00:45:22,001 I WILL BRIEFLY MENTIONED BUT 1152 00:45:22,001 --> 00:45:26,139 JUST TO MAKE CLEAR THAT ONLY 1 1153 00:45:26,139 --> 00:45:28,708 OF 10 TREATMENTS FOR CHRONIC LOW 1154 00:45:28,708 --> 00:45:30,577 BACK PAIN ARE CURRENTLY 1155 00:45:30,577 --> 00:45:32,378 EFFECTIVE AND THAT WAS HIGHLIGHT 1156 00:45:32,378 --> 00:45:33,446 INDEED A LITERATURE REVIEW THAT 1157 00:45:33,446 --> 00:45:42,188 WAS PUBLISHED IN 301 TRIALS 1158 00:45:42,188 --> 00:45:43,423 INCLUDING PHARMACOLOGICAL AND 1159 00:45:43,423 --> 00:45:45,825 NONINTERVENTIONAL TREATMENTS AND 1160 00:45:45,825 --> 00:45:46,493 THESE HAVE INCONCLUSIVE EVIDENCE 1161 00:45:46,493 --> 00:45:47,727 AND THAT FUTURE WO, IS NEEDED 1162 00:45:47,727 --> 00:45:51,164 AND SO ON THE NEXT SLIDE, JUST 1163 00:45:51,164 --> 00:45:53,299 TO MAKE MORE EXPLICIT THAT 1164 00:45:53,299 --> 00:45:54,634 REALLY 1 OF THE ISSUES HERE IS 1165 00:45:54,634 --> 00:45:57,504 THAT ONLY A SMALL SUBSET OF 1166 00:45:57,504 --> 00:45:59,439 PATIENTS WITH CHRONIC LOWER BACK 1167 00:45:59,439 --> 00:46:03,409 PAIN RESPOND TO ANY GIVEN 1168 00:46:03,409 --> 00:46:03,676 TREATMENT. 1169 00:46:03,676 --> 00:46:06,713 SOME MAY FAIL TREATMENT AND SOME 1170 00:46:06,713 --> 00:46:08,748 TREATMENTS CAN MAKE PAIN 1171 00:46:08,748 --> 00:46:10,116 SIGNIFICANTLY WORSE AND SO THE 1172 00:46:10,116 --> 00:46:11,851 MAJOR CHALLENGE HERE IS TO 1173 00:46:11,851 --> 00:46:14,821 REALLY HAVE ENOUGH DATA OF THESE 1174 00:46:14,821 --> 00:46:16,322 DIFFERENT TREATMENT OPTIONS AND 1175 00:46:16,322 --> 00:46:18,858 BE ABLE TO HAVE BIOMARKERS OF 1176 00:46:18,858 --> 00:46:26,065 THOSE PATIENT POPULATIONS TO BE 1177 00:46:26,065 --> 00:46:27,634 ABLE TO DEEVOLVE THOSE 1178 00:46:27,634 --> 00:46:28,902 TREATMENTS AND UNDERSTAND WHICH 1179 00:46:28,902 --> 00:46:30,336 TREATMENTS WILL WORK AND WHICH 1180 00:46:30,336 --> 00:46:31,471 SUBTYPES AND PREDICT THAT IN 1181 00:46:31,471 --> 00:46:32,472 FUTURE STUDIES SO THAT WAS 1182 00:46:32,472 --> 00:46:34,574 REALLY THE GOAL OF BACPAC. 1183 00:46:34,574 --> 00:46:38,111 OT NEXT SLIDE, I WILL JUST 1184 00:46:38,111 --> 00:46:40,413 BRIEFLY MENTION 1 OF THOSE 1185 00:46:40,413 --> 00:46:42,348 TRIALS WHICH WAS LAUNCHED 1186 00:46:42,348 --> 00:46:44,117 THROUGH THE BACPAC CONSORTIUM, 1187 00:46:44,117 --> 00:46:46,019 THE PURPOSE OF WHICH WAS TO DO 1188 00:46:46,019 --> 00:46:47,687 EXACTLY THAT, TO IDENTIFY LINKS 1189 00:46:47,687 --> 00:46:49,088 BETWEEN BIOMARKERS AND THE 1190 00:46:49,088 --> 00:46:53,092 EFFECTIVENESS OF IN THIS CASE, 1191 00:46:53,092 --> 00:46:55,495 FOR ALREADY PROVEN KNOWN TO BE 1192 00:46:55,495 --> 00:46:56,262 EFFICACIOUS TREEPTS FOR LOWER 1193 00:46:56,262 --> 00:46:58,798 BACK PAIN AND THIS WAS DONE 1194 00:46:58,798 --> 00:46:59,799 THROUGH THE BEST TRIAL. 1195 00:46:59,799 --> 00:47:04,337 ON THE NEXT SLIDE, I WILL JUST 1196 00:47:04,337 --> 00:47:07,340 HIGHLIGHT, THERE WE GO, THANK 1197 00:47:07,340 --> 00:47:09,976 YOU LYNDIE, AS I SAID THESE 4 1198 00:47:09,976 --> 00:47:19,452 TREATMENTS, SO HERE YOU CAN SEE 1199 00:47:19,452 --> 00:47:20,653 THE SMART TRIAL DESIGN SCHEMATIC 1200 00:47:20,653 --> 00:47:22,889 AND THIS IS JUST TO MENTION 1201 00:47:22,889 --> 00:47:25,625 HERE, NOT AN EFFICACY TRIAL AS I 1202 00:47:25,625 --> 00:47:26,492 SAID BUT 4 INTERVENTIONS THAT 1203 00:47:26,492 --> 00:47:28,194 ARE KNOWN TO HAVE EFERACY AND I 1204 00:47:28,194 --> 00:47:29,963 WILL HIGHLIGHT THAT OVER A 1205 00:47:29,963 --> 00:47:31,664 THOUSAND PEOPLE WERE ENROLLED IN 1206 00:47:31,664 --> 00:47:34,467 THE BEST TRIAL AND OVER 800 WERE 1207 00:47:34,467 --> 00:47:39,672 RANDOMIZED TO 1 OF THESE 4 1208 00:47:39,672 --> 00:47:40,039 TREATMENT ARMS. 1209 00:47:40,039 --> 00:47:42,075 AND ON THE NEXT SLIDE SHOW A BIT 1210 00:47:42,075 --> 00:47:44,844 MORE DETAIL ABOUT THIS 2 STAGE 1211 00:47:44,844 --> 00:47:48,514 OF RANDOMIZATION DESIGN AND 1212 00:47:48,514 --> 00:47:50,350 WHAT'S, I THINK PRETTY REMARKAC 1213 00:47:50,350 --> 00:47:51,818 OF THIS TRIAL DESIGN IS THAT 1214 00:47:51,818 --> 00:47:53,753 THERE ARE ACTUALLY OVER 200 1215 00:47:53,753 --> 00:47:56,155 INTERVENTIONS IN TERMS OF 1216 00:47:56,155 --> 00:47:59,192 DIFFERENT OPTIONS FOR TREATMENT 1217 00:47:59,192 --> 00:48:02,028 BASED ON THIS 2 STAGE 1218 00:48:02,028 --> 00:48:03,830 RANDOMIZATION DESIGN AND JUST TO 1219 00:48:03,830 --> 00:48:06,733 MENTION THAT THE GOAL OF THAT 1220 00:48:06,733 --> 00:48:09,202 RANDOMIZATION SCHEME WAS REALLY 1221 00:48:09,202 --> 00:48:12,472 TO MIMIC REAL WORLD PRACTICES, 1222 00:48:12,472 --> 00:48:15,041 TO CONTINUE EITHER TO AN 1223 00:48:15,041 --> 00:48:16,476 EFFECTIVE TREATMENT OR TO 1224 00:48:16,476 --> 00:48:17,310 AUGMENT WITH A DIFFERENT 1225 00:48:17,310 --> 00:48:19,646 TREATMENT OR SWITCH TO A NEW 1226 00:48:19,646 --> 00:48:22,115 TREATMENT BASED ON THE FIRST 1227 00:48:22,115 --> 00:48:25,084 RESULTS OF THE FIRST STAGE, ALL 1228 00:48:25,084 --> 00:48:27,754 THE PARTICIPANTS ARE NOW OFF 1229 00:48:27,754 --> 00:48:30,523 PROTOCOL AND 617 PATIENTS HAVE 1230 00:48:30,523 --> 00:48:31,557 COMPLETED THE TRIAL AND SO WE 1231 00:48:31,557 --> 00:48:38,831 CAN THINK OF THIS AS TESTING 200 1232 00:48:38,831 --> 00:48:39,999 INTERVENTIONS BASED ON THIS 1233 00:48:39,999 --> 00:48:40,233 DESIGN. 1234 00:48:40,233 --> 00:48:41,934 AND SO ON THE NEXT SLIDE I WILL 1235 00:48:41,934 --> 00:48:43,736 BRIEFLY SHOW THE VISIT 1236 00:48:43,736 --> 00:48:44,237 ACTIVITIES. 1237 00:48:44,237 --> 00:48:47,273 THERE WAS BOTH THE OPTION FOR 1238 00:48:47,273 --> 00:48:49,509 LIGHT PHENOTYPING OR DEEP 1239 00:48:49,509 --> 00:48:50,677 PHENOTYPING, THE LIGHT BEING 1240 00:48:50,677 --> 00:48:53,680 REQUIRED AND THE DEEP 1241 00:48:53,680 --> 00:48:54,313 PHENOTYPING BEING OPTIONAL BUT 1242 00:48:54,313 --> 00:48:57,717 JUST TO NOTE HERE THAT EVEN WITH 1243 00:48:57,717 --> 00:48:59,686 LIGHT PHENOTYPING, A LARGE AND 1244 00:48:59,686 --> 00:49:01,821 VARIED AMOUNT OF INFORMATION WAS 1245 00:49:01,821 --> 00:49:05,825 COLLECTED ABOUT EACH PARTICIPANT 1246 00:49:05,825 --> 00:49:08,094 AND ON THE -- I SEE YOUR 1247 00:49:08,094 --> 00:49:12,665 QUESTION ALAN, I WILL PROBABLY 1248 00:49:12,665 --> 00:49:16,669 TRY TO ARE REABOUTECCA LINDSEY 1249 00:49:16,669 --> 00:49:19,172 MAY BE ABLE TO ADDRESS THAT IN 1250 00:49:19,172 --> 00:49:20,339 THE CHAT. 1251 00:49:20,339 --> 00:49:23,042 I AM COGNIZANT OF TIME SO I WILL 1252 00:49:23,042 --> 00:49:24,911 TRY TO MAKE SURE I MOVE QUICKLY. 1253 00:49:24,911 --> 00:49:26,279 BUT HERE AGAIN ARE THE TRIAL 1254 00:49:26,279 --> 00:49:31,384 SITES ACROSS THE U.S., AND THEN 1255 00:49:31,384 --> 00:49:33,853 ON THE NEXT SLIDE JUST TO 1256 00:49:33,853 --> 00:49:35,588 HIGHLIGHT ALSO AS WAS SHOWN 1257 00:49:35,588 --> 00:49:38,591 BRIEFLY IN THE DESIGN THAT THIS 1258 00:49:38,591 --> 00:49:42,395 TRIAL ALSO USES BIOMECHANIC 1259 00:49:42,395 --> 00:49:42,929 TECHNOLOGIES IN DIFFERENT 1260 00:49:42,929 --> 00:49:45,598 ASPECTS OF THE DESIGN AND THAT 1261 00:49:45,598 --> 00:49:47,500 INCLUDED 5 DEFINITE 1262 00:49:47,500 --> 00:49:48,267 BIOMECHANICAL TECHNOLOGY WHICH 1263 00:49:48,267 --> 00:49:50,269 WERE COMPARED IN THE BEST TRIAL. 1264 00:49:50,269 --> 00:49:52,004 THESE ENCLUEDED 2 TECHNOLOGIES 1265 00:49:52,004 --> 00:49:54,707 THAT TRACK WHOLE BODY MOVEMENT 1266 00:49:54,707 --> 00:49:56,776 AND 3 WEARABLE SENSORS AND THIS 1267 00:49:56,776 --> 00:49:58,311 PROVIDED AN ADDITIONAL 1268 00:49:58,311 --> 00:49:59,579 OPPORTUNITY TO EVALUATE WHAT 1269 00:49:59,579 --> 00:50:01,414 TYPES OF ASSESSMENTS MIGHT BE 1270 00:50:01,414 --> 00:50:02,849 MOST USEFUL IN EVALUATING 1271 00:50:02,849 --> 00:50:04,450 PATIENTS WITH CHRONIC LOWER BACK 1272 00:50:04,450 --> 00:50:04,917 PAIN. 1273 00:50:04,917 --> 00:50:06,619 SO WE WERE REALLY POLICED TO BE 1274 00:50:06,619 --> 00:50:07,954 ABLE TO INCORPORATE THIS AS PART 1275 00:50:07,954 --> 00:50:11,090 OF THE BEST DESEEN AND ON THE 1276 00:50:11,090 --> 00:50:12,792 NEXT SLIDE, JUST A BIT MORE 1277 00:50:12,792 --> 00:50:16,462 INFORMATION ABOUT THE PRIMARY 1278 00:50:16,462 --> 00:50:18,431 ANALYSIS WHICH IS CURRENTLY 1279 00:50:18,431 --> 00:50:18,664 ONGOING. 1280 00:50:18,664 --> 00:50:20,900 THE BEST TRIAL WAS FULLY 1281 00:50:20,900 --> 00:50:22,635 ENROLLED, THE DATA IS NOW LOCKED 1282 00:50:22,635 --> 00:50:23,836 AND BEING ANALYZED AND OUR PLAN 1283 00:50:23,836 --> 00:50:25,638 AT THIS POINT IS TO COMPLETE 1284 00:50:25,638 --> 00:50:27,673 WITH A PROJECT TEAM THE PRIMARY 1285 00:50:27,673 --> 00:50:29,976 OUTCOME ANALYSIS BI THIS SUMMER 1286 00:50:29,976 --> 00:50:34,380 AND SUBMIT PRIMARY OUTCOME 1287 00:50:34,380 --> 00:50:34,847 MANUSCRIPTS THIS FALL. 1288 00:50:34,847 --> 00:50:36,182 AND THE HOPE HERE IS REALLY TO 1289 00:50:36,182 --> 00:50:40,586 BE ABLE TO ADDRESS THESE 2 1290 00:50:40,586 --> 00:50:42,288 FUNDAMENTAL QUESTIONS: WHICH 1291 00:50:42,288 --> 00:50:44,157 PHENOTYPIC MARKERS BEST PREDICT 1292 00:50:44,157 --> 00:50:45,792 TREATMENT RESPONSE TO EACH 1293 00:50:45,792 --> 00:50:47,026 TREATMENTS IN THE TRIAL IN AND 1294 00:50:47,026 --> 00:50:48,995 BASED ON A GIVEN SET OF 1295 00:50:48,995 --> 00:50:51,397 PHENOTYPIC MARKERS CAN WE ASSIGN 1296 00:50:51,397 --> 00:50:52,498 A RECOMMENDED FIRST TREATMENT 1297 00:50:52,498 --> 00:50:56,435 AND A RECOMMENDED FOLLOW ON 1298 00:50:56,435 --> 00:50:57,170 TREATMENT IF NECESSARY? 1299 00:50:57,170 --> 00:50:58,004 AND WITH THAT WITH THE NEXT 1300 00:50:58,004 --> 00:51:00,807 SLIDE I WOULD LIKE TO SHOW 1 1301 00:51:00,807 --> 00:51:02,642 EXAMPLE OF SOME OF THE WAYS THAT 1302 00:51:02,642 --> 00:51:05,545 THIS DATA IS NOW BEING ANALYZED 1303 00:51:05,545 --> 00:51:08,447 AND WHAT WE LOOK FORWARD TO 1304 00:51:08,447 --> 00:51:11,117 CONTINUING TO ASSESS IN THE 1305 00:51:11,117 --> 00:51:11,450 FUTURE. 1306 00:51:11,450 --> 00:51:12,718 THIS IS AN EXAMPLE OF 1 OF THE 1307 00:51:12,718 --> 00:51:17,456 TYPES OF DATA THAT WAS COLLECTED 1308 00:51:17,456 --> 00:51:21,093 DURING THE STUDY ON IMMUNE SELL 1309 00:51:21,093 --> 00:51:27,900 QUANTIFICATION, THIS WAS DONE 1310 00:51:27,900 --> 00:51:31,204 VIA CYTOF, WHICH IS A FEW 1311 00:51:31,204 --> 00:51:33,940 TECHNOLOGY THAT USES MASS SPEC 1312 00:51:33,940 --> 00:51:34,874 FOR CELLS AND WHAT'S SHOWN HERE 1313 00:51:34,874 --> 00:51:37,343 IS THAT A HIGHER NUTRIFILL 1314 00:51:37,343 --> 00:51:38,244 PROPORTION WAS ASSOCIATE WIDE 1315 00:51:38,244 --> 00:51:41,080 GREATER PAIN AND REDUCED 1316 00:51:41,080 --> 00:51:41,914 PHYSICAL FUNCTION. 1317 00:51:41,914 --> 00:51:44,617 SO I'LL NOTE THAT BLOCKING 1318 00:51:44,617 --> 00:51:45,451 NUTRIFILL ACTIVITY HAS BEEN 1319 00:51:45,451 --> 00:51:47,553 LINKED TO THE TRANSITION FROM 1320 00:51:47,553 --> 00:51:49,555 ACUTE TO CHRONIC PAIN IN A 1321 00:51:49,555 --> 00:51:51,657 RECENT PUBLICATION, AND SO THIS 1322 00:51:51,657 --> 00:51:54,427 IS JUST 1 EXAMPLE OF SOME OF THE 1323 00:51:54,427 --> 00:51:56,963 ASSESSMENTS THAT WE LOOK FORWARD 1324 00:51:56,963 --> 00:51:58,531 TO DIGGING INTO FURTHER IN THIS 1325 00:51:58,531 --> 00:52:00,099 DATA SET, ON THE NEXT SLIDE, I 1326 00:52:00,099 --> 00:52:02,869 WOULD LIKE TO JUST PREVLY TALK 1327 00:52:02,869 --> 00:52:04,770 ABOUT 1 OF THE OTHER MRC STUDIES 1328 00:52:04,770 --> 00:52:06,772 THAT WAS ALSO DONE THROUGH 1329 00:52:06,772 --> 00:52:07,206 BACPAC. 1330 00:52:07,206 --> 00:52:09,542 THIS WAS ALSO ANOTHER CLINICAL 1331 00:52:09,542 --> 00:52:11,277 TRIAL LAUNCHED BY THE CONSORTIUM 1332 00:52:11,277 --> 00:52:14,680 TO TEST FOR INTERVENTIONS SHOWN 1333 00:52:14,680 --> 00:52:18,484 HERE KNOWN TO HAVE POSITIVE FOR 1334 00:52:18,484 --> 00:52:20,786 LOWER BACK PAIN AND THE 4 ISHT 1335 00:52:20,786 --> 00:52:23,456 VENTIONS ARE MEANT TO ARE VERIED 1336 00:52:23,456 --> 00:52:24,490 AND A CLASS OF INTERVENTIONS 1337 00:52:24,490 --> 00:52:27,426 WHICH ARE COMMONLY USED AND ON 1338 00:52:27,426 --> 00:52:29,195 THE NEXT SLIDE JUST A BIT OF THE 1339 00:52:29,195 --> 00:52:30,830 EARLY DATA ANALYSIS FROM THIS 1340 00:52:30,830 --> 00:52:32,632 STUDY SHOWING THAT THE 1341 00:52:32,632 --> 00:52:33,966 PERCENTAGE OF PARTICIPANTS WHO 1342 00:52:33,966 --> 00:52:37,236 SHOWED A STRONG BENEFIT, EACH OF 1343 00:52:37,236 --> 00:52:38,471 THE 4 TREATMENTS IN THE TRIAL 1344 00:52:38,471 --> 00:52:41,040 ALL 4 TREATMENTS HAD SOME 1345 00:52:41,040 --> 00:52:43,075 PARTICIPANTS WHO IMPROVED TO THE 1346 00:52:43,075 --> 00:52:45,578 PROPORTIONS WERE NOT THE SAME 1347 00:52:45,578 --> 00:52:47,580 AND EXCITINGLY A LOT OF EARLY 1348 00:52:47,580 --> 00:52:49,982 ANALYSIS, FOR EACH OF THE 4 1349 00:52:49,982 --> 00:52:51,717 TREATMENTS THE INVESTIGATORS CAN 1350 00:52:51,717 --> 00:52:54,887 FIND SIMPLE DEMOGRAPHICS OR 1351 00:52:54,887 --> 00:52:58,457 PEASHT REPORTED OUTCOMES THAT 1352 00:52:58,457 --> 00:53:02,261 WERE PREDICTIVE OF DIFFERENTIAL 1353 00:53:02,261 --> 00:53:04,196 RESPONSE SUGGESTING THIS WILL BE 1354 00:53:04,196 --> 00:53:05,298 POSSIBLE USING THIS DATA SET AND 1355 00:53:05,298 --> 00:53:07,033 ON THE NEXT 2 SLIDES I WOULD 1356 00:53:07,033 --> 00:53:08,801 BRIEFLY LIKE TO SHOW ADDITIONAL 1357 00:53:08,801 --> 00:53:11,270 WORK FROM THE CONSORTIUM. 1358 00:53:11,270 --> 00:53:13,072 THIS ANALYSIS SHOWN HERE IS NOT 1359 00:53:13,072 --> 00:53:15,341 ACTUALLY A CLINICAL TRIAL BUT A 1360 00:53:15,341 --> 00:53:17,677 PHENOTYPIC CLUSTERING THAT WAS 1361 00:53:17,677 --> 00:53:18,978 CONDUCTED ON SOME OF THE LARGE 1362 00:53:18,978 --> 00:53:21,080 DATA THAT WAS COLLECTED VIA THE 1363 00:53:21,080 --> 00:53:28,454 PARTICIPANT ANDS THIS WAS 1364 00:53:28,454 --> 00:53:29,388 ACTUALLY DONE BY THE UNIVERSITY 1365 00:53:29,388 --> 00:53:31,490 OF PITTSBURGH AND THE UCSF 1366 00:53:31,490 --> 00:53:31,757 TEAMS. 1367 00:53:31,757 --> 00:53:33,926 SO I WOULD LIKE TO HIGHLIGHT THE 1368 00:53:33,926 --> 00:53:37,229 CLUSTERING AND THIS ANALYSIS 1369 00:53:37,229 --> 00:53:38,497 SHOWED THAT DISTINCT CHRONIC 1370 00:53:38,497 --> 00:53:41,701 LOWER BACK PHENOTYPES CAN HELP 1371 00:53:41,701 --> 00:53:43,035 UNDERSTAND MECHANISMS AND ALSO 1372 00:53:43,035 --> 00:53:46,138 IMPROVE TAYLORING OF NEW OR 1373 00:53:46,138 --> 00:53:47,073 EXISTING TREATMENTS AND ON THE 1374 00:53:47,073 --> 00:53:49,442 NEXT SLIDE I WOULD LIKE TO SHOW 1375 00:53:49,442 --> 00:53:50,276 1 REALLY INTERESTING EXTENSION 1376 00:53:50,276 --> 00:53:52,678 OF THIS WORK WHICH ACTUALLY 1377 00:53:52,678 --> 00:53:54,280 SHOWS CROSS VALIDATION OF THIS 1378 00:53:54,280 --> 00:53:58,918 PATTERN THAT WAS DONE BY THE PIT 1379 00:53:58,918 --> 00:54:01,487 AND UCSF TEAMS AND THEY ARE 1380 00:54:01,487 --> 00:54:02,788 WORKING COLLABORATIVELY TO TEST 1381 00:54:02,788 --> 00:54:05,825 MODELS BY SWAPPING THE DATA 1382 00:54:05,825 --> 00:54:07,293 COHORTS AND THIS WAS MADE 1383 00:54:07,293 --> 00:54:09,662 POSSIBLE REALLY BY THE EXTENSIVE 1384 00:54:09,662 --> 00:54:12,365 HARMONIZATION OF THE DATA 1385 00:54:12,365 --> 00:54:12,898 COLLECTED THROUGHOUT THIS 1386 00:54:12,898 --> 00:54:16,102 CONSORTIUM WHICH WAS AN EARLY 1387 00:54:16,102 --> 00:54:17,870 FEATURE OF THE PROGRAM, SO ON 1388 00:54:17,870 --> 00:54:20,306 THE NEXT SLIDE, I WOULD LIKE TO 1389 00:54:20,306 --> 00:54:25,211 BRIEFLY SHOW, REALLY A SUMMARY 1390 00:54:25,211 --> 00:54:28,114 OF BACPAC'S WORK SO FAR BUILDING 1391 00:54:28,114 --> 00:54:29,382 TOWARDS THIS THEY--THE RETINAL 1392 00:54:29,382 --> 00:54:31,550 LOCATIONERAL MODEL WHICH EVOLVED 1393 00:54:31,550 --> 00:54:34,220 OVER THE TIME OF THE CONSORTIUM 1394 00:54:34,220 --> 00:54:35,454 AND BROUGHT TOGETHER DESPERATE 1395 00:54:35,454 --> 00:54:36,889 DISCIPLINES TO THINK ABOUT BACK 1396 00:54:36,889 --> 00:54:39,859 PAIN FROM DIFFERENT ASSPEBTS AND 1397 00:54:39,859 --> 00:54:43,329 JUST TO HIGHLIGHT AGAIN THAT THE 1398 00:54:43,329 --> 00:54:45,064 BACPAC CONSORTIUM HAD EXPERTISE 1399 00:54:45,064 --> 00:54:47,566 IN EVERIES PECT OF THIS MODEL 1400 00:54:47,566 --> 00:54:49,535 WHICH -- EVERY ASPECT OF THIS 1401 00:54:49,535 --> 00:54:50,970 MODEL WHICH LED TO COLLECTIVE 1402 00:54:50,970 --> 00:54:51,937 SHARING OF INFORMATION AND 1403 00:54:51,937 --> 00:54:53,539 UNDERSTANDING ASK WHAT WE'RE 1404 00:54:53,539 --> 00:54:55,474 REALLY EXCITED ABOUT IS THAT 1405 00:54:55,474 --> 00:54:56,976 SOME ASPECTS OF THIS MODEL CAN 1406 00:54:56,976 --> 00:54:58,277 INFORM OTHER TYPES OF PAIN AND 1407 00:54:58,277 --> 00:55:00,112 WE HOPE TO TEST THAT IN FUTURE 1408 00:55:00,112 --> 00:55:04,450 EXTENSIONS OF THIS WORK. 1409 00:55:04,450 --> 00:55:06,485 SO ON THE LAST FEW SLIDES I 1410 00:55:06,485 --> 00:55:08,454 WOULD LIKE TO HIGHLIGHT A FEW 1411 00:55:08,454 --> 00:55:09,455 OTHER EXTENSIONS ON THIS 1412 00:55:09,455 --> 00:55:10,156 THEY--THE RETINAL LOCATIONERAL 1413 00:55:10,156 --> 00:55:14,360 MODEL AND WHAT'S SHOWN HERE IS 1414 00:55:14,360 --> 00:55:15,494 OTHER EXCITING POSSIBILITIES FOR 1415 00:55:15,494 --> 00:55:17,663 THE APPLICATION OF AI AND LARGE 1416 00:55:17,663 --> 00:55:23,402 LANGUAGE MODELS TO REALLY EXTEND 1417 00:55:23,402 --> 00:55:24,503 THIS BACPAC THEY--THE RETINAL 1418 00:55:24,503 --> 00:55:26,005 LOCATIONERAL MODEL WHERE THIS 1419 00:55:26,005 --> 00:55:27,773 CAN BE ANALYZED BY VARIOUS AI 1420 00:55:27,773 --> 00:55:29,175 APPROACHES WHICH WILL FURTHER 1421 00:55:29,175 --> 00:55:31,310 HELP USE THE DATA TO REFINE THE 1422 00:55:31,310 --> 00:55:32,845 THEY--THE RETINAL LOCATIONERAL 1423 00:55:32,845 --> 00:55:36,082 MODEL SPECIFICALLY LARGE 1424 00:55:36,082 --> 00:55:38,284 LANGUAGE MODEL TOOLS FOR 1425 00:55:38,284 --> 00:55:38,984 SCOEVERRING CAUSAL ASSOCIATIONS 1426 00:55:38,984 --> 00:55:42,254 WITHIN THE DATA WHICH WILL HELP 1427 00:55:42,254 --> 00:55:44,123 REALLY BRING THE THEORETICAL 1428 00:55:44,123 --> 00:55:45,458 MODEL TO BEING MORE ACTIONABLE 1429 00:55:45,458 --> 00:55:47,693 AND TESTED IN FUTURE WORK AND 1430 00:55:47,693 --> 00:55:48,694 IMPORTANTLY, THE LARGE LANGUAGE 1431 00:55:48,694 --> 00:55:51,964 MODELS CAN ALSO BE USED TO 1432 00:55:51,964 --> 00:55:53,099 INCORPORATE PATIENT NARRATIVES 1433 00:55:53,099 --> 00:55:55,201 AND LIVED EXPERIENCE INTO THE 1434 00:55:55,201 --> 00:55:57,636 OVERALL PHENOTYPE. 1435 00:55:57,636 --> 00:56:00,306 SO ON THIS NEXT SLIDE JUST TO 1436 00:56:00,306 --> 00:56:01,273 HIGHLIGHT A LITTLE BIT MORE 1437 00:56:01,273 --> 00:56:02,842 ABOUT THE OTHER THEME WE WANT TO 1438 00:56:02,842 --> 00:56:04,410 EMPHASIZE IN TERMS OF 1439 00:56:04,410 --> 00:56:05,044 COLLABORATION, ACROSS HEAL, AND 1440 00:56:05,044 --> 00:56:08,280 THE IMPORTANCE OF THE HEAL DATA 1441 00:56:08,280 --> 00:56:09,782 ECOSYSTEM, IS REALLY JUST THIS 1442 00:56:09,782 --> 00:56:10,983 GRAPHIC SHOWN HERE OF ALL THE 1443 00:56:10,983 --> 00:56:15,020 DATA COLLECTED BY THE BACPAC 1444 00:56:15,020 --> 00:56:16,689 STUDIES AND THE EXAMPLES WE'VE 1445 00:56:16,689 --> 00:56:19,925 SHOWN IN THE PRESENTATION SO FAR 1446 00:56:19,925 --> 00:56:21,427 WE THINK DON'T EVEN BEGIN TO 1447 00:56:21,427 --> 00:56:23,896 TOUCH ON ALL THE DATA SETS THAT 1448 00:56:23,896 --> 00:56:26,031 ARE COLLECTED THROUGH BACPAC AND 1449 00:56:26,031 --> 00:56:27,500 IMPORTANTLY THAT THE DATA HAS 1450 00:56:27,500 --> 00:56:29,635 BEEN HARMONIZED TO THE MAXIMUM 1451 00:56:29,635 --> 00:56:30,736 EXTENT POSSIBLE SINCE THE 1452 00:56:30,736 --> 00:56:31,670 BEGINNING OF THE PROGRAM AND ALL 1453 00:56:31,670 --> 00:56:34,507 OF THIS DATA WILL BE AVAILABLE 1454 00:56:34,507 --> 00:56:36,275 ON THE HEAL DATA ECOSYSTEM WHICH 1455 00:56:36,275 --> 00:56:39,645 WE HOPE WILL YOU KNOW PROVIDE 1456 00:56:39,645 --> 00:56:40,746 ADDITIONAL OPPORTUNITIES FOR 1457 00:56:40,746 --> 00:56:44,850 SECONDARY DATA ANALYSIS FOR PAIN 1458 00:56:44,850 --> 00:56:46,785 RESEARCHERS AND SO ON THE NEXT 1459 00:56:46,785 --> 00:56:49,622 SLIDE, JUST AS 1 KIND OF FINAL 1460 00:56:49,622 --> 00:56:50,623 EXAMPLE OF THE DIVERSITY OF THIS 1461 00:56:50,623 --> 00:56:56,395 DATA AND I THINK THE STRENGTH OF 1462 00:56:56,395 --> 00:57:03,169 BEING ABLE TO DO CROSS 1463 00:57:03,169 --> 00:57:04,703 COMPARISONS, EXAMPLE SHOWN HERE 1464 00:57:04,703 --> 00:57:06,005 OF THE BIOSPECIMEN ANALYSIS 1465 00:57:06,005 --> 00:57:07,573 URNTD WAY FROM THE BACPAC AND 1466 00:57:07,573 --> 00:57:09,742 THE BEST TRIAL IN EACH OF THESE 1467 00:57:09,742 --> 00:57:11,644 DOMAINS ACROSS THE SITES. 1468 00:57:11,644 --> 00:57:14,079 YOU CAN SEE THE TYPE OF DATA 1469 00:57:14,079 --> 00:57:19,985 THAT'S BEEN COLLECTED INCLUDING 1470 00:57:19,985 --> 00:57:21,086 VARIOUS MULTIOMICS ANALYSIS THAT 1471 00:57:21,086 --> 00:57:22,454 HAVE BEEN PERFORMED TO DATE ON 1472 00:57:22,454 --> 00:57:24,256 THESE SAMPLES AND IMPORTANTLY WE 1473 00:57:24,256 --> 00:57:25,257 THINK THE WORK REALLY 1474 00:57:25,257 --> 00:57:26,425 DEMONSTRATES THE ABILITY TO 1475 00:57:26,425 --> 00:57:27,660 COMPARE ACROSS DATA SETS THROUGH 1476 00:57:27,660 --> 00:57:29,728 THE USE OF THE HARMONIZED DATA 1477 00:57:29,728 --> 00:57:31,764 WHICH WAS AN IMPORTANT PART OF 1478 00:57:31,764 --> 00:57:34,567 THE BACPAC APPROACH AND SO 1479 00:57:34,567 --> 00:57:40,472 LASTLY I WILL JUST SAY WITH A 1480 00:57:40,472 --> 00:57:42,741 NOD TO OUR ECOSYSTEMS COLLEAGUES 1481 00:57:42,741 --> 00:57:49,081 WHO LAID THE GROUND WORK FOR 1482 00:57:49,081 --> 00:57:49,982 THIS ECOSYSTEM STRUCTURE WHICH 1483 00:57:49,982 --> 00:57:51,383 WAS METABOLICALLY TO SPEED THE 1484 00:57:51,383 --> 00:57:53,185 INTEGRATION AND DATA COLLECTION 1485 00:57:53,185 --> 00:57:54,453 OF ACROSS HEAL AND ACCELERATE 1486 00:57:54,453 --> 00:57:57,323 THE SHARING OF DATA AND RESULTS 1487 00:57:57,323 --> 00:57:59,792 GENERATED BY HEAL TO RESEARCHERS 1488 00:57:59,792 --> 00:58:01,393 AND OTHERS BY THE COMMUNITY AND 1489 00:58:01,393 --> 00:58:04,630 ENABLE THIS DATA TO BE ANALYZED 1490 00:58:04,630 --> 00:58:05,898 AND CONFIGURED AND COMBINED AND 1491 00:58:05,898 --> 00:58:07,900 SO WE'RE EXCITED TO HAVE BACK 1492 00:58:07,900 --> 00:58:10,569 PACK, TO BE ABLE TO CONTINUE TO 1493 00:58:10,569 --> 00:58:11,537 CONTRIBUTE TO THAT RESEARCH 1494 00:58:11,537 --> 00:58:12,304 INFRASTRUCTURE AND SO WHAT I 1495 00:58:12,304 --> 00:58:13,672 WOULD LIKE TO LEAVE YOU WITH AND 1496 00:58:13,672 --> 00:58:18,410 JUST KIND OF OUR BROADER 1497 00:58:18,410 --> 00:58:19,645 THINKING ABOUT WHERE MANY OF 1498 00:58:19,645 --> 00:58:20,346 THESE ACTIVITIES MIGHT CONTINUE 1499 00:58:20,346 --> 00:58:22,581 TO WORK TOGETHER IN THE FUTURE 1500 00:58:22,581 --> 00:58:24,883 THAT WE FEEL BACPAC HAS REALLY 1501 00:58:24,883 --> 00:58:26,819 BEGUN TO LAY THE FOUNDATION FOR 1502 00:58:26,819 --> 00:58:28,787 THINKING AT A SYSTEMS LEVEL 1503 00:58:28,787 --> 00:58:31,156 ABOUT CHRONIC LOWER BACK PAIN 1504 00:58:31,156 --> 00:58:32,491 AND THAT WE ARE LOOKING FORWARD 1505 00:58:32,491 --> 00:58:38,364 TO IN THE FUTURE IN VARIOUS WAYS 1506 00:58:38,364 --> 00:58:40,633 CONTINUING TO SUPPORT 1507 00:58:40,633 --> 00:58:43,102 COMPREHENSIVE COMPARISON OF 1508 00:58:43,102 --> 00:58:45,704 PHENOTYPES ACROSS VARIOUS PAIN 1509 00:58:45,704 --> 00:58:48,040 CONDITIONS SO YOU WILL SEE OTHER 1510 00:58:48,040 --> 00:58:54,613 HEAL PROGRAMS OF NOTE HERE WHERE 1511 00:58:54,613 --> 00:58:56,115 THERE'S BEEN CONNECTIONS WITHIN 1512 00:58:56,115 --> 00:58:57,316 BACPAC AND WE HOPE TO CONTINUE 1513 00:58:57,316 --> 00:58:59,018 TO SUPPORT THAT INTERPLAY IN THE 1514 00:58:59,018 --> 00:59:04,590 FUTURE WITH A FOCUS ON REALLY 1515 00:59:04,590 --> 00:59:05,724 DEVELOPING MORE WHOLISTIC 1516 00:59:05,724 --> 00:59:07,593 MODELS, UNDERSTANDING INTERPLAY 1517 00:59:07,593 --> 00:59:08,727 AND CONNECTIONS BETWEEN LOWER 1518 00:59:08,727 --> 00:59:11,997 BACK PAIN, KNEE PAIN, TMJ, 1519 00:59:11,997 --> 00:59:12,831 INTEGRATING DATA AND RESEARCH 1520 00:59:12,831 --> 00:59:14,700 METHODOLOGY IT IS FROM THE 1521 00:59:14,700 --> 00:59:17,836 BACPAC COMMUNITY, THE REGIONAL 1522 00:59:17,836 --> 00:59:20,806 COMMUNITY, MY O FACIAL PAIN 1523 00:59:20,806 --> 00:59:21,640 COMMUNITY, ANOTHER HEAL PROGRAM 1524 00:59:21,640 --> 00:59:24,476 AND OTHERS AND I WILL LEAVE YOU 1525 00:59:24,476 --> 00:59:25,678 WITH 1 LAST LOOK INTO THE FUTURE 1526 00:59:25,678 --> 00:59:29,815 AND WHAT WE'RE HOPING TO MOVE 1527 00:59:29,815 --> 00:59:31,784 FORWARD, THE NEXT PHASE OF 1528 00:59:31,784 --> 00:59:34,586 BACPAC IS ENVISIONED AS 1529 00:59:34,586 --> 00:59:36,755 INTERACT, INTEGRATIVE PACK PAIN 1530 00:59:36,755 --> 00:59:37,990 LONGITUDINAL COHORT TEAMS WHICH 1531 00:59:37,990 --> 00:59:42,328 WE LOOK FORWARD TO EXPANDING OR 1532 00:59:42,328 --> 00:59:43,429 ENHANCING LONGITUDINAL DATA 1533 00:59:43,429 --> 00:59:45,798 COLLECTION AND ANALYSIS OF 1534 00:59:45,798 --> 00:59:48,734 EXISTING LARGE SCALE CHRONIC 1535 00:59:48,734 --> 00:59:51,837 PAIN COHORTS AND BUILDING ON THE 1536 00:59:51,837 --> 00:59:54,440 SUCCESS OF BACPAC, FORMING AN 1537 00:59:54,440 --> 00:59:54,973 INTERACTIVE COLLABORATIVE 1538 00:59:54,973 --> 01:00:00,846 NETWORK WHERE WE HOPE TO 1539 01:00:00,846 --> 01:00:01,647 CONTINUE TO INTEGRATE ACROSS 1540 01:00:01,647 --> 01:00:03,716 HEAL PROGRAM WHERE IS THERE MAY 1541 01:00:03,716 --> 01:00:05,517 BE BIOLOGICAL SHARED MECHANISMS 1542 01:00:05,517 --> 01:00:06,985 AND CONTINUE TO HAVE AN 1543 01:00:06,985 --> 01:00:08,220 INTEGRATED DATA APPROACH AS WELL 1544 01:00:08,220 --> 01:00:09,588 TO UNDERSCORE ALL OF THESE 1545 01:00:09,588 --> 01:00:10,589 EFFORTS. 1546 01:00:10,589 --> 01:00:14,159 SO WITH THAT I WILL TAKE ANY 1547 01:00:14,159 --> 01:00:17,429 QUESTIONS AND ALSO THANK MY 1548 01:00:17,429 --> 01:00:18,731 COLLEAGUE REBECCA LINDSAY WHO IS 1549 01:00:18,731 --> 01:00:29,274 HERE AND CAN ANSWER QUESTIONS AS 1550 01:00:31,310 --> 01:00:31,443 WELL. 1551 01:00:31,443 --> 01:00:33,312 AND I KNOW REBECCA ALREADY 1552 01:00:33,312 --> 01:00:35,714 ANSWERED SOME QUESTIONS IN THE 1553 01:00:35,714 --> 01:00:35,948 CHAT. 1554 01:00:35,948 --> 01:00:44,957 ALAN ARE YOU TRYING TO UNMUTE? 1555 01:00:44,957 --> 01:00:46,892 >> I'M ALWAYS TRYING TO UNMUTE. 1556 01:00:46,892 --> 01:00:55,134 >> THERE I HEAR YOU NOW. 1557 01:00:55,134 --> 01:00:56,802 >> BUT OKAY, SO THERE WAS SOME 1558 01:00:56,802 --> 01:01:02,908 EFFORT TO ANSWER THE QUESTION. 1559 01:01:02,908 --> 01:01:03,876 THAT'S GREAT. 1560 01:01:03,876 --> 01:01:05,477 THE REAL ISSUE AND IT'S SO KEY 1561 01:01:05,477 --> 01:01:08,180 AND OF COURSE JANE VALENTINE AND 1562 01:01:08,180 --> 01:01:08,914 I HAVE DISCUSSIONTHIS ALL THE 1563 01:01:08,914 --> 01:01:13,018 TIME IS WHETHER THERE'S A SENSE 1564 01:01:13,018 --> 01:01:15,587 FROM THE BACPAC FOLKS THAT IN 1565 01:01:15,587 --> 01:01:18,590 THE CASE OF BACK PAIN THAT THERE 1566 01:01:18,590 --> 01:01:26,799 IS A FOCUS OF INJURY IN THE BACK 1567 01:01:26,799 --> 01:01:27,533 SOMEWHERE THAT IF 1 COULD 1568 01:01:27,533 --> 01:01:31,136 IDENTIFY IT AND TREAT IT THAT 1 1569 01:01:31,136 --> 01:01:35,607 WOULD NOT NEED TO GO INTO THE 1570 01:01:35,607 --> 01:01:36,775 BRAIN AND THAT'S THE QUESTION 1571 01:01:36,775 --> 01:01:38,844 THAT I ALWAYS ASK BECAUSE I'M A 1572 01:01:38,844 --> 01:01:39,978 BIG BELIEVER I THINK AS YOU MAY 1573 01:01:39,978 --> 01:01:41,747 KNOW THAT I THINK IN MOST 1574 01:01:41,747 --> 01:01:44,616 CHRONIC PAIN CONDITIONS THERE IS 1575 01:01:44,616 --> 01:01:45,350 A PERIPHERAL DRIVER. 1576 01:01:45,350 --> 01:01:47,186 SO I'M CURIOUS TO KNOW WHETHER 1577 01:01:47,186 --> 01:01:48,387 THE BACK PACK FOLKS BELIEVE 1578 01:01:48,387 --> 01:01:52,758 THERE IS A SOURCE, THEY JUST 1579 01:01:52,758 --> 01:01:53,459 CAN'T IDENTIFY IT. 1580 01:01:53,459 --> 01:01:55,594 >> YEAH, I THINK I CERTAINLY 1581 01:01:55,594 --> 01:01:57,396 THINK THAT'S LIKELY TRUE, BUT 1582 01:01:57,396 --> 01:02:00,899 I'M GOING TO ASK REBECCA WHO'S 1583 01:02:00,899 --> 01:02:02,034 BEEN MORE DEEPLY INVOLVED WITH 1584 01:02:02,034 --> 01:02:03,602 THAT TEEM IF SHE WOULD LIKE TO 1585 01:02:03,602 --> 01:02:04,403 COMMENT ON THAT. 1586 01:02:04,403 --> 01:02:12,311 OBVIOUSLY VERY INTERESTING 1587 01:02:12,311 --> 01:02:12,578 QUESTION. 1588 01:02:12,578 --> 01:02:13,545 >> CAN YOU HEAR ME? 1589 01:02:13,545 --> 01:02:15,347 I THINK I PUT IN THE CHAT, I 1590 01:02:15,347 --> 01:02:17,249 BELIEVE THIS IS AN ISHT 1591 01:02:17,249 --> 01:02:17,749 DISCIPLINARY TEAM THAT 1592 01:02:17,749 --> 01:02:19,618 RECOGNIZES THERE IS A LOT OF 1593 01:02:19,618 --> 01:02:24,189 INPUT AND IS NOT NECESSARILY 1594 01:02:24,189 --> 01:02:25,591 ASCRIBING A SINGLE CAUSE 1595 01:02:25,591 --> 01:02:28,393 MECHANISM AND TRYING TO 1596 01:02:28,393 --> 01:02:29,127 UNDERSTAND THE INTERPLAY FROM 1597 01:02:29,127 --> 01:02:30,429 EVERYTHING SO I WOULD SAY IT'S 1598 01:02:30,429 --> 01:02:40,772 PART OF THE PROCESS. 1599 01:02:50,916 --> 01:02:56,321 >> THEY COULD BE A TARGET. 1600 01:02:56,321 --> 01:02:59,024 BUT IT IS INTERESTING THAT THERE 1601 01:02:59,024 --> 01:03:04,696 IS INCLUSION OF DULOXETINE BUT 1602 01:03:04,696 --> 01:03:05,564 IS GABBA PENTINE REGIMENIN NOT 1603 01:03:05,564 --> 01:03:08,767 PART OF THE EFFORT? 1604 01:03:08,767 --> 01:03:11,603 WHICH MADE ME THINK THAT THE 1605 01:03:11,603 --> 01:03:13,472 ADDER NERNLGIC COMPONENT HAD A 1606 01:03:13,472 --> 01:03:16,875 SPECIFIC REASON FOR GOING AFTER 1607 01:03:16,875 --> 01:03:17,042 IT? 1608 01:03:17,042 --> 01:03:18,810 >> SURE, GABBA PENTINE REGIMENIN 1609 01:03:18,810 --> 01:03:20,012 WAS NOT INVOLVED IN ANY OF THE 1610 01:03:20,012 --> 01:03:21,780 STUDIES I SHOWED BUT REBECCA I 1611 01:03:21,780 --> 01:03:23,181 DON'T KNOW IF THAT WAS ENCLUED 1612 01:03:23,181 --> 01:03:24,816 INDEED ANY OF THE OTHERS? 1613 01:03:24,816 --> 01:03:26,952 >> I DON'T KNOW IF THAT WAS A 1614 01:03:26,952 --> 01:03:30,088 SPECIFIC INCLUSION OR EXCLUSION 1615 01:03:30,088 --> 01:03:31,723 CRITERIA IN THE COHORT STUDIES 1616 01:03:31,723 --> 01:03:42,100 BUT I CAN FOLLOW UP. 1617 01:03:46,171 --> 01:03:46,538 >> THANK YOU. 1618 01:03:46,538 --> 01:03:50,943 >> SO I HAVE A QUESTION WHICH IS 1619 01:03:50,943 --> 01:03:53,111 WHAT PAIN MANAGEMENT SPESHTISTS 1620 01:03:53,111 --> 01:03:55,347 ARE OFTEN DOING TARGETED 1621 01:03:55,347 --> 01:03:58,884 PROCEDURES WHICH MAY RELATE TO 1622 01:03:58,884 --> 01:04:01,019 ALLAN'S QUESTION ABOUT IS THERE 1623 01:04:01,019 --> 01:04:04,222 A SPECIFIC LESION SOMEWHERE, 1624 01:04:04,222 --> 01:04:06,825 INJECTING STEROIDS, INJECTING 1625 01:04:06,825 --> 01:04:08,126 LOCAL ANESTHETIC, IMPLANTING 1626 01:04:08,126 --> 01:04:09,561 STIMULATORS, THIS SORT OF THING, 1627 01:04:09,561 --> 01:04:18,637 WHERE DOES THAT FIT IN? 1628 01:04:18,637 --> 01:04:21,540 >> SO AGAIN, I MEAN THERE'S 1629 01:04:21,540 --> 01:04:23,041 THESE LARGE COHORTS AND SOME OF 1630 01:04:23,041 --> 01:04:25,477 THAT DATA IS BEING CAPTURED SO 1631 01:04:25,477 --> 01:04:27,446 FOR EXAMPLE, PAST SURGERIES, 1632 01:04:27,446 --> 01:04:28,981 PAST INJECTIONS, SO, THAT'S SORT 1633 01:04:28,981 --> 01:04:31,883 OF SOME OF THE DATA THAT'S GOING 1634 01:04:31,883 --> 01:04:34,286 TO BE IMPORTANT TO ASSESS THE 1635 01:04:34,286 --> 01:04:38,890 ROLE IN THE PAIN MANAGEMENT. 1636 01:04:38,890 --> 01:04:40,158 >> YEAH, YEAH. 1637 01:04:40,158 --> 01:04:41,893 >> BUT THERE'S NOT SPECIFIC DATA 1638 01:04:41,893 --> 01:04:44,229 ON THAT RIGHT NOW WITHIN THE 1639 01:04:44,229 --> 01:04:46,365 CONSORTIUM IS WHAT I'M TRYING TO 1640 01:04:46,365 --> 01:04:46,531 SAY. 1641 01:04:46,531 --> 01:04:47,299 >> RIGHT, RIGHT. 1642 01:04:47,299 --> 01:04:48,767 >> IT'S A REALLY IMPORTANT 1643 01:04:48,767 --> 01:04:53,338 QUESTION IS OBVIOUSLY STEROIDS 1644 01:04:53,338 --> 01:04:55,307 ARE USED LOCAL ANESTHETICS ARE 1645 01:04:55,307 --> 01:04:56,742 USED AND THE LOCAL AREA OF 1646 01:04:56,742 --> 01:04:57,776 ASSUMPTION THAT THERE IS A 1647 01:04:57,776 --> 01:04:59,911 TARGET CAN YOU GO AFTER AND IN 1648 01:04:59,911 --> 01:05:01,179 MANY INSTANCES WILL BE EFFECTIVE 1649 01:05:01,179 --> 01:05:03,382 BUT OF COURSE TELL BE EFFECTIVE 1650 01:05:03,382 --> 01:05:06,218 FOR A SHORT PERIOD OF TIME AND 1651 01:05:06,218 --> 01:05:07,886 MAYBE NOT ABLE TO REPEAT IT, SO 1652 01:05:07,886 --> 01:05:10,589 THE REAL QUESTION IS, WHAT IS 1653 01:05:10,589 --> 01:05:12,424 THE -- WHAT DO YOU CONCLUDE FROM 1654 01:05:12,424 --> 01:05:15,160 THAT RESULT THAT THERE WAS A 1655 01:05:15,160 --> 01:05:18,664 RESPONSE BUT THAT YOU COULDN'T 1656 01:05:18,664 --> 01:05:19,231 REPEAT IT. 1657 01:05:19,231 --> 01:05:23,268 DID THE CNS BECOME THE DOMINANT 1658 01:05:23,268 --> 01:05:24,970 AND MAYBE EVEN INDEPENDENT 1659 01:05:24,970 --> 01:05:26,338 ELEMENT WHICH THE NOSI PLASTIC 1660 01:05:26,338 --> 01:05:36,148 VIEW WOULD ACCEPT OR ARE WE 1661 01:05:36,148 --> 01:05:36,782 MISSING SOMETHING? 1662 01:05:36,782 --> 01:05:39,718 >> MAYBE TO JUST ADD TO THE 1663 01:05:39,718 --> 01:05:41,453 DISCUSSION, COULD YOU GO BACK TO 1664 01:05:41,453 --> 01:05:42,854 THE LAST SLIDE YOU JUST HAD 1665 01:05:42,854 --> 01:05:44,056 BECAUSE THE EFFORTS TO BRING IN 1666 01:05:44,056 --> 01:05:45,390 THE EFFORTS OF MY O FACIAL AND 1667 01:05:45,390 --> 01:05:47,392 THE HOME JOINT EFFORT TO THE 1668 01:05:47,392 --> 01:05:49,995 POINT, WE'RE TRYING TO FIND OUT 1669 01:05:49,995 --> 01:05:50,562 PERIPHERAL MECHANISMS THAT 1670 01:05:50,562 --> 01:05:55,067 CONTRIBUTE TO PAIN AT LEAST 1671 01:05:55,067 --> 01:05:59,671 INITIALLY THAT MAY LEAD TO 1672 01:05:59,671 --> 01:06:00,405 NEUROPLASTICKITY IN THE BRAIN 1673 01:06:00,405 --> 01:06:03,375 BUT THIS SLIDE I THINK CAPTURES 1674 01:06:03,375 --> 01:06:04,643 THE INTEGRATIVE APPROACH THAT 1675 01:06:04,643 --> 01:06:06,778 THE PROGRAM IS PROPOSING MOVING 1676 01:06:06,778 --> 01:06:08,080 FORWARD, THAT INVOLVES BOTHER 1677 01:06:08,080 --> 01:06:13,118 55ERAL MECHANISMS AND THE 1678 01:06:13,118 --> 01:06:14,753 MYOFACIAL PAIN REJOIN BACPAC IN 1679 01:06:14,753 --> 01:06:16,655 GENERAL AS AN INTEGRATIVE 1680 01:06:16,655 --> 01:06:21,193 APPROACH TO LOOK FOR THOSE 1681 01:06:21,193 --> 01:06:23,562 TARGETS PERIPHERALLY, MUSK LO 1682 01:06:23,562 --> 01:06:25,697 SKELETAL MARKERS, ALL THIS WILL 1683 01:06:25,697 --> 01:06:28,734 THEN BE PART OF A WHOLISTIC 1684 01:06:28,734 --> 01:06:29,568 APPROACH, RIGHT? 1685 01:06:29,568 --> 01:06:34,206 INVOLVING PERIPHERY AND BRAIN 1686 01:06:34,206 --> 01:06:36,708 AND AND PHARMAICOLOGGIC AND 1687 01:06:36,708 --> 01:06:37,309 NONPHARMAICOLOGGIC TREATMENTS 1688 01:06:37,309 --> 01:06:39,811 MOVING FORWARD, SO THIS SLIDE 1689 01:06:39,811 --> 01:06:41,379 MAYBE HELPS CAPTURE WHERE THIS 1690 01:06:41,379 --> 01:06:45,350 PROGRAM IS GOING WITH ALL THE 1691 01:06:45,350 --> 01:06:47,552 VARIOUS ELEMENTS. 1692 01:06:47,552 --> 01:06:48,186 >> EXACTLY. 1693 01:06:48,186 --> 01:06:48,687 THANK YOU, DAVID. 1694 01:06:48,687 --> 01:06:50,989 >> THIS IS NOT A RHETORICAL 1695 01:06:50,989 --> 01:06:52,924 QUESTION BUT IS DRG STIMULATION 1696 01:06:52,924 --> 01:07:00,198 USED TO ANY GREAT EXTENT FOR 1697 01:07:00,198 --> 01:07:04,102 BACK PAIN. 1698 01:07:04,102 --> 01:07:08,039 >> NOT THAT I KNOW OF BUT IT'S 1699 01:07:08,039 --> 01:07:13,712 ACTUALLY STIMULATION OF THE 1700 01:07:13,712 --> 01:07:15,480 NERVE ROOTS THAT INFILL STRAIGHT 1701 01:07:15,480 --> 01:07:17,182 THE BONY PLATE THAT PEOPLE ARE 1702 01:07:17,182 --> 01:07:25,457 CLAIMING IS EFFECTIVE NOW. 1703 01:07:25,457 --> 01:07:29,494 >> OKAY, WELL I THINK WE SHOULD 1704 01:07:29,494 --> 01:07:30,762 KEEP MOVING. 1705 01:07:30,762 --> 01:07:32,430 >> WELL I WILL HAND IT BACK TO 1706 01:07:32,430 --> 01:07:34,366 AMY I THINK AND SHE WILL 1707 01:07:34,366 --> 01:07:35,967 INTRODUCE THE NEXT SPEAKER AND 1708 01:07:35,967 --> 01:07:37,769 HOPEFULLY I HAVEN'T STOLEN TOO 1709 01:07:37,769 --> 01:07:38,870 MUCH OF THEIR TIME. 1710 01:07:38,870 --> 01:07:40,305 THANK YOU VERY MUCH. 1711 01:07:40,305 --> 01:07:41,740 >> NO, NO, THANK YOU AMY THAT 1712 01:07:41,740 --> 01:07:43,441 WAS A HELPFUL OVERVIEW. 1713 01:07:43,441 --> 01:07:46,878 SO I'M REALLY DELIGHTED TO 1714 01:07:46,878 --> 01:07:50,816 INTRODUCE PRESENTERS FOR THE 1715 01:07:50,816 --> 01:07:52,584 HEAL RESEARCH ADDRESSINGNYONATAL 1716 01:07:52,584 --> 01:07:56,988 OPIOID WITHDRAWAL SYNDROME SO 1717 01:07:56,988 --> 01:07:59,658 THIS INCLUDING TONSE RAJU, AND 1718 01:07:59,658 --> 01:08:03,395 STEPHANIE ARCHER, TONSE IS 1719 01:08:03,395 --> 01:08:04,963 ANYONATOLOGYIST AND A PROGRAM 1720 01:08:04,963 --> 01:08:07,332 OFFICER FOR THE IDEA STATES 1721 01:08:07,332 --> 01:08:08,433 PEDIATRIC CLINICAL TRIALS, AND 1722 01:08:08,433 --> 01:08:10,836 HE ALSO WORKS ON THE ECHO 1723 01:08:10,836 --> 01:08:15,440 PROGRAM, SHE PREVIOUSLY SERVED 1724 01:08:15,440 --> 01:08:19,678 AS CHIEF OF PREGNANCY AND 1725 01:08:19,678 --> 01:08:22,180 PERINATOLOGY BRANCH AT NICHD AND 1726 01:08:22,180 --> 01:08:26,084 HE HAS BOOK 2 BOOKSOT SUBJECT. 1727 01:08:26,084 --> 01:08:28,153 STEPHANIE ARCHER IS THE PROGRAM 1728 01:08:28,153 --> 01:08:32,390 ANALYST AND PROGEC MANAGER ARE 1729 01:08:32,390 --> 01:08:33,925 THE EEUNICE KENNEDY SHRIVER 1730 01:08:33,925 --> 01:08:35,060 NATIONAL INTUITY FOR CHILD 1731 01:08:35,060 --> 01:08:45,604 HEALTH AND HUMAN DEVELOPMENT AND 1732 01:08:48,707 --> 01:08:49,808 ALSO THE PEDIATRIC CLINICAL 1733 01:08:49,808 --> 01:08:50,642 TRIALS PROGRAM. 1734 01:08:50,642 --> 01:08:51,710 SO WE LOOK FORWARD TO HEARING 1735 01:08:51,710 --> 01:08:53,044 FROM YOU BOTH AND THANK YOU SO 1736 01:08:53,044 --> 01:08:54,646 MUCH FOR COMING TOGETHER. 1737 01:08:54,646 --> 01:08:55,480 >> YEAH, THANK YOU VERY MUCH. 1738 01:08:55,480 --> 01:08:58,583 CAN YOU HEAR ME WELL, I SUPPOSE. 1739 01:08:58,583 --> 01:09:00,819 >> YEAH, IT'S LOW SO YOU COULD 1740 01:09:00,819 --> 01:09:02,387 TALK A LITTLE LOUDER. 1741 01:09:02,387 --> 01:09:12,430 >> LET ME INCREASE THE VOLUME 1742 01:09:12,430 --> 01:09:13,765 HERE. 1743 01:09:13,765 --> 01:09:17,736 MAYBE BETTER NOW? 1744 01:09:17,736 --> 01:09:18,036 >> BETTER. 1745 01:09:18,036 --> 01:09:20,138 >> OKAY, SO AS YOU SAY, NOW FOR 1746 01:09:20,138 --> 01:09:20,972 SOMETHING COMPLETELY DIFFERENT 1747 01:09:20,972 --> 01:09:23,141 THAN WHAT WE HAVE SO FAR. 1748 01:09:23,141 --> 01:09:26,711 SO HERE WE ARE ADDRESSING 1749 01:09:26,711 --> 01:09:30,815 NEONATAL OPIOID WITHDRAWAL 1750 01:09:30,815 --> 01:09:31,082 SYNDROME. 1751 01:09:31,082 --> 01:09:31,483 NEXT SLIDE. 1752 01:09:31,483 --> 01:09:33,551 WHAT I AM PLANNING TO DO IN THIS 1753 01:09:33,551 --> 01:09:35,453 TALK WILL BE TO PROVIDE A BRIEF 1754 01:09:35,453 --> 01:09:38,556 OUTLINE OF WHAT ISNYONATAL 1755 01:09:38,556 --> 01:09:40,058 OPIOID DRUG SYNDROME WITH DUE 1756 01:09:40,058 --> 01:09:41,359 APOLOGIES TO ALL THE EXPERTS 1757 01:09:41,359 --> 01:09:42,394 HERE AND THEN WHAT SORTS OF 1758 01:09:42,394 --> 01:09:44,763 STUDY SAYS WE HAVE, YOU KNOW 1759 01:09:44,763 --> 01:09:46,831 BEEN ABLE TO DO THUS FAR, THE 1760 01:09:46,831 --> 01:09:49,534 VERY FIRST 1 WAS CURRENT 1761 01:09:49,534 --> 01:09:51,436 EXPERIENCE, THAT IS TO LOOK AT 1762 01:09:51,436 --> 01:09:53,071 HOW PEOPLE ARE TREATING 1763 01:09:53,071 --> 01:09:58,710 CHILDREN, NEW BORN BABIES WHO 1764 01:09:58,710 --> 01:10:01,646 ARE WITHDRAWING FROM OPIOID USE 1765 01:10:01,646 --> 01:10:02,914 DURING PREGNANCY AND THEN 2 1766 01:10:02,914 --> 01:10:05,150 STUDIES FUNDED BY HEAL, THE 1767 01:10:05,150 --> 01:10:07,719 CURRENT EXPERIENCE STUDY WAS 1768 01:10:07,719 --> 01:10:10,322 FUNDED BY THE ECHO, 1769 01:10:10,322 --> 01:10:11,156 ENVIRONMENTAL CONSEQUENCES OF 1770 01:10:11,156 --> 01:10:17,162 HEALTH EEIVETS ON CHILDREN. 1771 01:10:17,162 --> 01:10:17,829 NEXT SLIDE. 1772 01:10:17,829 --> 01:10:28,306 SO THE ACT NOW TRIALS STANDS 1773 01:10:35,747 --> 01:10:40,785 FORNYONATAL OPIOID WITHDRAWAL 1774 01:10:40,785 --> 01:10:44,489 SYNDROME, AND IN THE BLUE THIS 1775 01:10:44,489 --> 01:10:45,857 IS THE COLLABORATOR STUDIES I 1776 01:10:45,857 --> 01:10:48,326 WANT TO EMPHASIZE, MULTIPLE 1777 01:10:48,326 --> 01:10:51,663 SITES COLLABORATED TO DEVELOP AT 1778 01:10:51,663 --> 01:10:53,365 LEAST TBO MAJOR STUDIES FOR 1779 01:10:53,365 --> 01:10:55,033 CHILDREN AND THE 1S ON THE 1780 01:10:55,033 --> 01:10:57,135 RIGHT, YOUR RIGHT SIDE AS 1781 01:10:57,135 --> 01:11:00,705 NEONATAL RESEARCH AND NICHD, WE 1782 01:11:00,705 --> 01:11:05,844 START INDEED 1986, CURRENTLY 15 1783 01:11:05,844 --> 01:11:14,719 SITES AND MOST ARE AND MANY ARE 1784 01:11:14,719 --> 01:11:16,755 REGISTERING LOW NEONATAL OPILOT 1785 01:11:16,755 --> 01:11:19,991 PROJECTIE SYNDROME. 1786 01:11:19,991 --> 01:11:21,526 THERE'S RED, ON THE OTHER SIDE, 1787 01:11:21,526 --> 01:11:26,231 THERE IS NO REASON FOR THE COLOR 1788 01:11:26,231 --> 01:11:26,598 OF THE STATES. 1789 01:11:26,598 --> 01:11:34,239 THE ISPC TN AND IT START INDEED 1790 01:11:34,239 --> 01:11:35,740 2016 AND THAT IS IN THE OFFICE 1791 01:11:35,740 --> 01:11:39,944 OF THE DIRECTOR, IN THE PROGRAM, 1792 01:11:39,944 --> 01:11:41,312 PROGRAM, IDSTPROGRAM, AND IN 1793 01:11:41,312 --> 01:11:42,881 THAT WE HAD 18 CLINICAL SCIENCE 1794 01:11:42,881 --> 01:11:44,416 THAT PARTICIPATED IN THE ACT NOW 1795 01:11:44,416 --> 01:11:48,086 TRIALS, AND MANY OF THESE SITES 1796 01:11:48,086 --> 01:11:50,989 HAVE RELATIVELY SPEAKS MUCH 1797 01:11:50,989 --> 01:11:52,690 HIGHER PREVALENCE OFNYONATAL 1798 01:11:52,690 --> 01:11:56,728 OPIOID WITHDRAWAL SYNDROME, NEXT 1799 01:11:56,728 --> 01:11:56,928 SLIDE. 1800 01:11:56,928 --> 01:12:01,066 YOU CAN SEE OVER THE TIME PERIOD 1801 01:12:01,066 --> 01:12:02,267 THERE'S TREMENDOUS INCREASE IN 1802 01:12:02,267 --> 01:12:05,570 THE USER OPIOID USER DURING 1803 01:12:05,570 --> 01:12:05,837 PREGNANCY. 1804 01:12:05,837 --> 01:12:09,441 IT USED TO BE 1 AND HALF TO 2 OR 1805 01:12:09,441 --> 01:12:11,109 1000 DELIVERY HOSPITAL 1806 01:12:11,109 --> 01:12:11,843 ADMINISTRATION, RELATIVELY LOW, 1807 01:12:11,843 --> 01:12:14,779 AND WENT ALL THE WAY UP TO THE 1808 01:12:14,779 --> 01:12:18,183 2014 DATA UP TO 6.5 WOMEN HAVE 1809 01:12:18,183 --> 01:12:19,517 AT LEAST REPORTED AND IN THE 1810 01:12:19,517 --> 01:12:22,287 NEXT SLIDE, I WILL SHOW YOU, 1811 01:12:22,287 --> 01:12:26,124 NEXT SLIDE, GONE EVEN FROM 2014, 1812 01:12:26,124 --> 01:12:28,159 TO 2017, IT WAS 14.6 PER 1000 1813 01:12:28,159 --> 01:12:29,294 DELIVERIES. 1814 01:12:29,294 --> 01:12:30,962 SO THE OPIOID USE AMONG WOMEN, 1815 01:12:30,962 --> 01:12:33,331 SO YOU MIGHT THINK IT IS NOT A 1816 01:12:33,331 --> 01:12:36,835 LARGE NUMBER BUT CONSIDERING 1817 01:12:36,835 --> 01:12:42,307 THERE ARE 3.8 MILLION WOMEN WHO 1818 01:12:42,307 --> 01:12:46,211 DELIVER EACH YEAR, BETWEEN 1819 01:12:46,211 --> 01:12:47,545 3.8 MILLION DELIVERIES ANNUALLY, 1820 01:12:47,545 --> 01:12:49,747 IT BECOMES OPIOID USE DISORDER 1821 01:12:49,747 --> 01:12:53,451 HERE, AND YOU CAN SEE IT'S 1822 01:12:53,451 --> 01:12:54,052 56,000. 1823 01:12:54,052 --> 01:12:55,286 LIKEWISE THE NUMBER OF CHILDREN 1824 01:12:55,286 --> 01:12:59,624 ADMITTED TO THE HOSPITAL BECAUSE 1825 01:12:59,624 --> 01:13:02,026 OF MATERNAL USE OF OPIOID DURING 1826 01:13:02,026 --> 01:13:03,995 PREGNANCIES AND THE CHILDREN 1827 01:13:03,995 --> 01:13:10,835 HAVE WITHDRAWAL SYNDROMES AND 1828 01:13:10,835 --> 01:13:13,705 THEY HAVE 7 PER 1000 INFANT 1829 01:13:13,705 --> 01:13:14,272 HOSPITALIZATIONS. 1830 01:13:14,272 --> 01:13:14,572 NEXT SLIDE. 1831 01:13:14,572 --> 01:13:15,840 AND FOR THOSE WHO MIGHT NOT 1832 01:13:15,840 --> 01:13:19,544 REMEMBER, ALL THE ASPECTS OF 1833 01:13:19,544 --> 01:13:24,182 THENYONATAL OPIOID USE DISDROAM, 1834 01:13:24,182 --> 01:13:27,986 IT IS A MULTIORGAN AFFECTING 1835 01:13:27,986 --> 01:13:29,120 SYNDROME, THE CHILDREN HAVE HIGH 1836 01:13:29,120 --> 01:13:32,190 PITCHED CRY, THEY ARE HYPER 1837 01:13:32,190 --> 01:13:34,826 IRRITABLE, THEY HAVE SEIZURES, 1838 01:13:34,826 --> 01:13:38,096 SLEEP DEPRIVED, SLEEP 1839 01:13:38,096 --> 01:13:40,365 FRAGMENTATION, YOU CAN TAKE 1840 01:13:40,365 --> 01:13:45,803 CARDIAC ISSUES, THEY HAVE 1841 01:13:45,803 --> 01:13:47,906 TACHYPNOEA, HYPERTENSION, 1842 01:13:47,906 --> 01:13:49,607 TACHYCARDIA, DIARRHEA, EXCESSIVE 1843 01:13:49,607 --> 01:13:50,875 WEIGHT LOSS, VOMITING, THEY 1844 01:13:50,875 --> 01:13:54,245 DON'T FEEL WELL, THERE'S 1845 01:13:54,245 --> 01:13:56,414 SWEATING, HYPOTHERMIA, HYPER 1846 01:13:56,414 --> 01:13:57,682 TONIA, SO SO MANY SYMPTOMS ARE 1847 01:13:57,682 --> 01:14:00,051 THERE AND THEY ARE REALLY 1848 01:14:00,051 --> 01:14:02,120 EXTREMELY DIFFICULT TO TAKE CARE 1849 01:14:02,120 --> 01:14:03,021 OF. 1850 01:14:03,021 --> 01:14:04,822 YOU CAN HEAR 1 CHILD IN 1 ROOM, 1851 01:14:04,822 --> 01:14:06,558 AND THE ENTIRE NURSELY YOU CAN 1852 01:14:06,558 --> 01:14:08,726 HEAR THEM CRYING AND VERY, VERY 1853 01:14:08,726 --> 01:14:13,464 DIFFICULT TO CONSOLE. 1854 01:14:13,464 --> 01:14:14,465 NEXT SLIDE. 1855 01:14:14,465 --> 01:14:15,967 SO INITIALLY BEFORE WE LAUNCH 1856 01:14:15,967 --> 01:14:17,235 ANY OF THE CLINICAL TRIALS WE 1857 01:14:17,235 --> 01:14:19,037 WANT TO SEE WHAT KIND OF 1858 01:14:19,037 --> 01:14:20,438 MANAGEMENT STRATEGIES ARE BEING 1859 01:14:20,438 --> 01:14:22,040 USED ACROSS THE COUNTRY, SO 1 1860 01:14:22,040 --> 01:14:23,841 STUDY WAS DONE, CURRENT 1861 01:14:23,841 --> 01:14:25,143 EXPERIENCE STUDY, OBJECTIVE WAS 1862 01:14:25,143 --> 01:14:27,745 TO SEE IT, BOTH MATERNAL AND 1863 01:14:27,745 --> 01:14:29,047 INFANT CHARACTERISTICS AND WHAT 1864 01:14:29,047 --> 01:14:30,882 SORT OF VARIATION IN THEIR 1865 01:14:30,882 --> 01:14:32,417 MANAGEMENT, AND THE STUDY HAS 1866 01:14:32,417 --> 01:14:35,353 BEEN PUBLISHED NOW, I WILL 1867 01:14:35,353 --> 01:14:38,223 PRESENT BRIEF RESULTS OF THOSE 1868 01:14:38,223 --> 01:14:43,595 STUDY. 1869 01:14:43,595 --> 01:14:44,662 NEXT SLIDE. 1870 01:14:44,662 --> 01:14:50,401 SO THERE ARE ISPTN FUNDED 1871 01:14:50,401 --> 01:14:55,273 STUDIES, THEY WERE BETWEEN 1872 01:14:55,273 --> 01:14:58,843 2016-2017, AND WE HAD 1377 1873 01:14:58,843 --> 01:15:01,412 INFANT-MOTHER DIADS AND WE HAD 1874 01:15:01,412 --> 01:15:03,248 THE STUDY HELP US LAUNCH 2 1875 01:15:03,248 --> 01:15:04,716 CLINICAL TRIALS THAT I WILL 1876 01:15:04,716 --> 01:15:05,383 DESCRIBE IN DETAIL. 1877 01:15:05,383 --> 01:15:06,284 NEXT SLIDE. 1878 01:15:06,284 --> 01:15:08,353 SO WHAT DID WE FIND? 1879 01:15:08,353 --> 01:15:10,154 THE LARGE SITE TO SITE 1880 01:15:10,154 --> 01:15:14,659 VARIATION, WHEN THE MOTHERS HAVE 1881 01:15:14,659 --> 01:15:16,527 A PRENATAL COUNSELING WAS DONE 1882 01:15:16,527 --> 01:15:19,864 AS FEW AS ONLY 2% OF THEM TO AS 1883 01:15:19,864 --> 01:15:22,800 MANY AS 76% OF THEM. 1884 01:15:22,800 --> 01:15:25,436 PRENATAL CARE, FOLLOW THEM AND 1885 01:15:25,436 --> 01:15:27,572 NEARLY A HUNDRED% OF THOSE IN 1886 01:15:27,572 --> 01:15:35,380 SOME OTHER SITES, SIMILARLY 1887 01:15:35,380 --> 01:15:36,180 MEDICATION ASSISTED TREATMENT 1888 01:15:36,180 --> 01:15:38,116 FOR THE MOTHER WAS VERY, VERY 1889 01:15:38,116 --> 01:15:40,852 LIKELY AND THOSE RECEIVING 1890 01:15:40,852 --> 01:15:41,586 PHARMAICOLOGGIC THERAPY OR 1891 01:15:41,586 --> 01:15:44,355 RECEIVING ANY OTHER MEDICATIONS, 1892 01:15:44,355 --> 01:15:45,790 AND ALL THE VARIABLES THAT WE'RE 1893 01:15:45,790 --> 01:15:54,832 LOOKING AT. 1894 01:15:54,832 --> 01:15:55,933 NEXT SLIDE. 1895 01:15:55,933 --> 01:15:58,002 SO THE CONCLUSION WAS THERE WERE 1896 01:15:58,002 --> 01:16:02,473 STRATEGIES THAT VARIED A LOT. 1897 01:16:02,473 --> 01:16:04,008 AND THEREFORE, RESULTS INDICATE 1898 01:16:04,008 --> 01:16:08,046 THAD MANY OTHERS WITH OPIOID USE 1899 01:16:08,046 --> 01:16:10,181 DISORDERS, NOW, MAYBE HERE IN 1900 01:16:10,181 --> 01:16:11,215 OPTIMAL CARE AND MYSTERY 1901 01:16:11,215 --> 01:16:16,821 THEREFORE HELPED US TO DESIGN 2 1902 01:16:16,821 --> 01:16:18,489 ACT NOW ISHT VENTION TRIALS. 1903 01:16:18,489 --> 01:16:22,393 THE FIRST 1 WAS CALLED EAT, 1904 01:16:22,393 --> 01:16:23,394 SLEEP, CONSOLE FORNYONATAL 1905 01:16:23,394 --> 01:16:25,596 WITHDRAWAL SYNDROME, IT WAS 1906 01:16:25,596 --> 01:16:27,532 RANDOMIZED CONTROL TRIALS WHERE 1907 01:16:27,532 --> 01:16:29,434 26 HOSPITALS WERE INVOLVED AND 1908 01:16:29,434 --> 01:16:35,506 18 STATES. 1909 01:16:35,506 --> 01:16:36,708 NEXT SLIDE. 1910 01:16:36,708 --> 01:16:39,243 AND BEHIND IT IS TYPICAL 1911 01:16:39,243 --> 01:16:41,813 MANAGEMENT OF A NEW BORN BABY 1912 01:16:41,813 --> 01:16:43,548 WHO HAS NOW SYNDROME, IS USING 1913 01:16:43,548 --> 01:16:46,217 THE SYSTEM TO SEE HOW SERIOUS 1914 01:16:46,217 --> 01:16:47,785 ARE THE SYMPTOMS AND THEN 1915 01:16:47,785 --> 01:16:49,587 DEPENDING ON SOME SITE, USE A 1916 01:16:49,587 --> 01:16:50,254 LARGE NUMBER OF SYMPTOMS AND 1917 01:16:50,254 --> 01:16:52,223 THEN THEY WILL TREAT THEM WITH 1918 01:16:52,223 --> 01:16:55,259 EITHER OPIOID OR SOMETIMES 1919 01:16:55,259 --> 01:16:56,761 PHENOBARBIT OLDER PEOPLE, OR 1920 01:16:56,761 --> 01:17:00,231 SOMETIMES THEY USE MORPHINE AND 1921 01:17:00,231 --> 01:17:01,833 SOMETIMES PHENOBARBIT OLDER 1922 01:17:01,833 --> 01:17:02,066 PEOPLE. 1923 01:17:02,066 --> 01:17:03,568 BUT 15 YEARS AGO THERE WAS A NEW 1924 01:17:03,568 --> 01:17:07,372 APPROACH THAT CAME IN INSTEAD OF 1925 01:17:07,372 --> 01:17:08,406 IMMEDIATELY GOING INTO 1926 01:17:08,406 --> 01:17:09,474 PHARMAICOLOGICAL THERAPY WHY 1927 01:17:09,474 --> 01:17:12,910 DON'T THEY USE A SIMPLER, A 1928 01:17:12,910 --> 01:17:14,178 HUMAN KIND OF TREATMENT, HELP 1929 01:17:14,178 --> 01:17:16,514 THEM TO EAT PROPERLY, HELP THE 1930 01:17:16,514 --> 01:17:18,950 BABIES TO SLEEP PROPERLY AND 1931 01:17:18,950 --> 01:17:20,451 CONSOLE THEM, SWADDLE THEM, ROCK 1932 01:17:20,451 --> 01:17:22,954 THEM, SO CARE TAKER ESPECIALLY 1933 01:17:22,954 --> 01:17:24,589 MOM AND NURSES CAN BE MORE IN 1934 01:17:24,589 --> 01:17:26,724 THIS SO IT'S CALLED EAT, SLEEP, 1935 01:17:26,724 --> 01:17:28,025 CONSOLE APPROACH AND THERE WAS 1936 01:17:28,025 --> 01:17:29,193 NOT ENOUGH EVIDENCE TO SUPPORT 1937 01:17:29,193 --> 01:17:32,697 WHETHER THAT IS BETTER THAN 1938 01:17:32,697 --> 01:17:33,464 PHARMAICOLOGICAL THERAPY, REALLY 1939 01:17:33,464 --> 01:17:35,299 DO MAKE ANY DIFFERENCE, SO THAT 1940 01:17:35,299 --> 01:17:39,003 IS WHY THE STUDY WAS LAUNCHED. 1941 01:17:39,003 --> 01:17:39,537 NEXT SLIDE. 1942 01:17:39,537 --> 01:17:44,041 AND HERE, THE STUDY DESIGN WAS A 1943 01:17:44,041 --> 01:17:52,383 RABD ORDER OF MICRONSIZE -- 1944 01:17:52,383 --> 01:17:53,718 RANDOMIZED TRIAL, FROM USUAL 1945 01:17:53,718 --> 01:17:56,454 CARE TO EAT SLEEP AND CONSOLE 1946 01:17:56,454 --> 01:17:59,657 CARE, AND THE WHOLE PRACTICE OF 1947 01:17:59,657 --> 01:18:02,560 CHANGE TRAINED 5000 NURSES AND 1948 01:18:02,560 --> 01:18:05,163 LED BY 3 EARLY STAGE 1949 01:18:05,163 --> 01:18:06,497 INVESTIGATORS AND THE RESULTS 1950 01:18:06,497 --> 01:18:08,065 WERE PUBLISHED 2 YEARS AGO IN 1951 01:18:08,065 --> 01:18:09,467 THE NEW ENGLAND JOURNAL OF 1952 01:18:09,467 --> 01:18:11,002 MEDICINE AND IT WAS AN BRAGZAL 1953 01:18:11,002 --> 01:18:12,336 HIT WHETHER THE PAPER CAME OUT. 1954 01:18:12,336 --> 01:18:13,838 NEXT SLIDE. 1955 01:18:13,838 --> 01:18:15,673 THIS IS THE MAIN MEET OF THE 1956 01:18:15,673 --> 01:18:19,110 STUDY, AND WILL SEE THAT MEAN 1957 01:18:19,110 --> 01:18:21,245 TIME UNTIL THE INFANT WAS 1958 01:18:21,245 --> 01:18:24,949 RELEASED OR DISCHARGED IN THE 1959 01:18:24,949 --> 01:18:25,483 USUAL CAR, ABOUT 15 DAYS, 1960 01:18:25,483 --> 01:18:28,019 WHEREAS IN THE BABIES HAD EAT 1961 01:18:28,019 --> 01:18:30,054 AND SLEEP AND CONSOLE APPROACH, 1962 01:18:30,054 --> 01:18:32,957 FIRST AND ONLY 8 DAYS OF THIS, 1963 01:18:32,957 --> 01:18:34,992 SO THERE WAS ACTUALLY 6 TO 7 1964 01:18:34,992 --> 01:18:36,394 DAYS ABSOLUTE DIFFERENCE WHEN 1965 01:18:36,394 --> 01:18:39,530 THE CHILDREN WAS READY TO BE 1966 01:18:39,530 --> 01:18:42,533 DISCHARGED AND THE PERCENT WHO 1967 01:18:42,533 --> 01:18:43,501 RECEIVED PHARMAICOLOGGIC 1968 01:18:43,501 --> 01:18:45,803 THERAPY, YOU CAN SEE 52% IN THE 1969 01:18:45,803 --> 01:18:48,739 USUAL CAR AND 20% IN THE EAT, 1970 01:18:48,739 --> 01:18:49,874 SLEEP, CONSOLE. 1971 01:18:49,874 --> 01:18:51,509 SO IT'S SIGNIFICANT. 1972 01:18:51,509 --> 01:18:56,547 YOU WOULD EXPOSE THE BABIES TO 1973 01:18:56,547 --> 01:18:57,181 FAR FEWER PHARMAICOLOGICAL 1974 01:18:57,181 --> 01:18:57,982 INTERVENTION EMPLOY NEXT SLIDE. 1975 01:18:57,982 --> 01:18:59,884 AND THIS STUDY HAD A LOT OF 1976 01:18:59,884 --> 01:19:05,056 IMPACT AND IT IT'S SUMMARIZING 1977 01:19:05,056 --> 01:19:06,390 THE DATA I JUST MENTIONED HERE, 1978 01:19:06,390 --> 01:19:08,526 YOU CAN TALK ABOUT NEXT SLIDE, 1979 01:19:08,526 --> 01:19:11,329 THERE IT IS, WASHINGTON STATE, 1980 01:19:11,329 --> 01:19:13,898 FORMALLY RECOGNIZED THAT ESC, 1981 01:19:13,898 --> 01:19:16,067 EAT, SLEEP AND CONSOLE SHOULD BE 1982 01:19:16,067 --> 01:19:18,803 THE PRIMARY APPROACH FOR ALL 1983 01:19:18,803 --> 01:19:19,971 CHILDREN WHO ARE IN HOSPITALS 1984 01:19:19,971 --> 01:19:26,711 TAKING CARE OF CHILDREN WHO HAVE 1985 01:19:26,711 --> 01:19:27,044 THIS SYNDROME. 1986 01:19:27,044 --> 01:19:28,646 SO BEFORE THE PAPER WAS 1987 01:19:28,646 --> 01:19:31,616 PUBLISHED, BETWEEN 6 MONTHS, 1988 01:19:31,616 --> 01:19:32,283 STATE OF WASHINGTON ACCEPTED 1989 01:19:32,283 --> 01:19:34,151 THIS AS STANDARD OF CARE, SO 1990 01:19:34,151 --> 01:19:36,921 IT'S VERY, VERY INTERESTING FOR 1991 01:19:36,921 --> 01:19:38,389 US. 1992 01:19:38,389 --> 01:19:38,956 NEXT SLIDE. 1993 01:19:38,956 --> 01:19:41,592 AND THE BABIES ARE BEING 1994 01:19:41,592 --> 01:19:42,226 FOLLOWED, JUST ABOUT COMPLETE 1995 01:19:42,226 --> 01:19:43,995 NOW, AND THE FOLLOW UP VISITS 1996 01:19:43,995 --> 01:19:45,663 ARE BEING ANALYZED AND SHOULD BE 1997 01:19:45,663 --> 01:19:51,402 PUBLISHED WITHIN THE NEXT 6 1998 01:19:51,402 --> 01:19:51,669 MONTHS. 1999 01:19:51,669 --> 01:19:52,069 NEXT SLIDE. 2000 01:19:52,069 --> 01:19:55,506 THE NEXT TRIAL WE DID WAS ACT 2001 01:19:55,506 --> 01:19:57,341 NOW TRIAL AND THE BACKGROUND FOR 2002 01:19:57,341 --> 01:19:59,810 THAT IS IN SPITE OF LOTS OF 2003 01:19:59,810 --> 01:20:01,913 PEOPLE USING OUR FARM 2004 01:20:01,913 --> 01:20:02,880 KACCTICOLOGICAL THERAPY THERE IS 2005 01:20:02,880 --> 01:20:04,415 NO STANDARD AS TO HOW YOU SHOULD 2006 01:20:04,415 --> 01:20:07,485 WEAN THOSE CHILDREN FROM THOSE 2007 01:20:07,485 --> 01:20:07,752 THERAPIES. 2008 01:20:07,752 --> 01:20:09,020 MORPHIN OR METHON DONE BEING 2009 01:20:09,020 --> 01:20:11,055 USED BUT MOW FAST TO WEAN THEM, 2010 01:20:11,055 --> 01:20:13,958 WEAN THEM 1 HALFA AT A TIME, 10% 2011 01:20:13,958 --> 01:20:14,392 AT A TIME. 2012 01:20:14,392 --> 01:20:16,427 HOW QUICK IN WHAT ARE THE 2013 01:20:16,427 --> 01:20:16,994 MONITORS? 2014 01:20:16,994 --> 01:20:19,664 HOW DO WE HANDLE THAT. 2015 01:20:19,664 --> 01:20:19,964 NEXT SLIDE. 2016 01:20:19,964 --> 01:20:21,232 SO THIS WAS DEVELOPED THEREFORE 2017 01:20:21,232 --> 01:20:25,002 SO THAT WE WOULD HAVE 2 2018 01:20:25,002 --> 01:20:26,737 STRATEGIES, IN 1 GROUP WE HAD 2019 01:20:26,737 --> 01:20:28,940 THEM FAST, THE OTHER 1 WE WEAN 2020 01:20:28,940 --> 01:20:31,475 THEM SLOWLY AND DEPENDING UPON 2021 01:20:31,475 --> 01:20:32,877 MEANING RAPIDLY, DID NOT MAKE A 2022 01:20:32,877 --> 01:20:35,079 WHOLE LOT OF DRVES COMPARED TO 2023 01:20:35,079 --> 01:20:38,082 READING STORY, RAPID WEANING IS 2024 01:20:38,082 --> 01:20:39,817 BETTER BECAUSE IN EXPOSING THESE 2025 01:20:39,817 --> 01:20:43,187 BABIES TO SMALLER AMOUNT OF 2026 01:20:43,187 --> 01:20:44,121 PHARMAICOLOGICAL THERAPIES. 2027 01:20:44,121 --> 01:20:44,655 NEXT SLIDE. 2028 01:20:44,655 --> 01:20:47,491 SO THIS STUDY THEN, THIS JUST 2029 01:20:47,491 --> 01:20:49,327 COMPLETED SO I'M SUMMARIZING THE 2030 01:20:49,327 --> 01:20:51,562 RESULTS FROM THE STUDY THAT 2031 01:20:51,562 --> 01:20:52,964 SHOWED THE PRIMARY NUMBER OF 2032 01:20:52,964 --> 01:20:55,666 DAYS OF OPIOID TREATMENT, 2033 01:20:55,666 --> 01:20:58,569 MORPHINE OR METHADONE, INCLUDING 2034 01:20:58,569 --> 01:21:00,938 ESCALATION, FROM THE FIRST TO 2035 01:21:00,938 --> 01:21:03,107 THE CESSATION, THERE WAS A 2036 01:21:03,107 --> 01:21:04,775 PRIMARY OUTQUM AND THE IN THE 2037 01:21:04,775 --> 01:21:06,644 SECONDARY OUTCOME WE LOOK AT 2038 01:21:06,644 --> 01:21:08,446 DAYS OF OPIOID DEALING WITH 2039 01:21:08,446 --> 01:21:13,584 MORPHINE, THIS YEARS DAYS OF 2040 01:21:13,584 --> 01:21:18,189 OPIOID WITH METHADONE EXCEPT ALL 2041 01:21:18,189 --> 01:21:18,689 SECONDARY OUTCOMES. 2042 01:21:18,689 --> 01:21:19,557 NEXT SLIDE, THE IN THE MIDDLE OF 2043 01:21:19,557 --> 01:21:23,294 THE STUDY WE HAD TO RECALCULATE 2044 01:21:23,294 --> 01:21:24,528 THE SAMPLE SIZE BECAUSE IT 2045 01:21:24,528 --> 01:21:26,330 TURNED OUT AT ANY CASE, I WAS 2046 01:21:26,330 --> 01:21:28,299 JUST MAKING IT SIMPLE, THE IDEA 2047 01:21:28,299 --> 01:21:30,868 WAS TO SEE RAPID WEANING, AT 2048 01:21:30,868 --> 01:21:34,038 LEAST WE HAVE 2 FEWER DAYS OF 2049 01:21:34,038 --> 01:21:35,973 OPIOID THERAPY, NOW YOU MAY 2050 01:21:35,973 --> 01:21:37,174 STILL THINK 2 DAYS WAS THE BIG 2051 01:21:37,174 --> 01:21:38,809 DEAL BUT IF YOU TRANSLATE THAT 2052 01:21:38,809 --> 01:21:43,080 INTO THE ENTIRE NATION, IT WILL 2053 01:21:43,080 --> 01:21:45,683 BE A SIGNIFICANT COST SAVINGS IN 2054 01:21:45,683 --> 01:21:46,917 THE DAYS OF THERAPY. 2055 01:21:46,917 --> 01:21:50,121 IN ANY CASE BECAUSE OF THE 2056 01:21:50,121 --> 01:21:50,921 DIFFICULTY OF ENROLLING NUMBERS 2057 01:21:50,921 --> 01:21:52,556 THERE WAS A SAMPLE SIZE ON THE 2058 01:21:52,556 --> 01:21:55,526 BOTTOM LINE HERE, SLOW 2059 01:21:55,526 --> 01:21:56,994 RECRUITMENT AND RISK OPPORTUNITY 2060 01:21:56,994 --> 01:21:58,429 THIS WAS RECALIBRATED AND THEN 2061 01:21:58,429 --> 01:22:01,465 RECOMMENDED THAT ARE WE SHOULD 2062 01:22:01,465 --> 01:22:04,935 ENROLL 151 INFANTS PER EACH ARM, 2063 01:22:04,935 --> 01:22:09,073 FOR 80% POWER IN THE STUDY 2064 01:22:09,073 --> 01:22:09,306 . 2065 01:22:09,306 --> 01:22:09,974 NEXT SLIDE. 2066 01:22:09,974 --> 01:22:10,975 SO THIS IS THE INTERVENTION 2067 01:22:10,975 --> 01:22:13,711 DONE, ON THAT SIDE, YOU START 2068 01:22:13,711 --> 01:22:16,047 OFF AT HUNDRED PERCENT AND THEN 2069 01:22:16,047 --> 01:22:17,581 YOU DROP OFF 15% EVERY SECOND 2070 01:22:17,581 --> 01:22:18,816 LEVEL DEPENDING ON THE SYMPTOM 2071 01:22:18,816 --> 01:22:22,853 OF THE BABY, AND THEN IN THE 2072 01:22:22,853 --> 01:22:26,657 SLOW, YOU DROP BY 10% EACH DAY, 2073 01:22:26,657 --> 01:22:28,893 SO THAT'S THE DEVELOPED APPROACH 2074 01:22:28,893 --> 01:22:30,061 FOR INTERVENTION. 2075 01:22:30,061 --> 01:22:33,297 NEXT SLIDE. 2076 01:22:33,297 --> 01:22:35,599 ANYWAY, THIS IS A SLIDE I DO NOT 2077 01:22:35,599 --> 01:22:36,600 WANT TO SPEND MUCH TIME ON. 2078 01:22:36,600 --> 01:22:40,337 IF YOU LOOK AT ALL IT, WE HAD 19 2079 01:22:40,337 --> 01:22:43,674 -- I'M SORRY IN ALL THE MEANING 2080 01:22:43,674 --> 01:22:46,777 THERE WERE 91 BABIES, RAPID 2081 01:22:46,777 --> 01:22:49,747 WEANING IN 98 BABIES, WE HAD 2082 01:22:49,747 --> 01:22:50,347 FOLLOW UP ABOUT COMPARABLE 2083 01:22:50,347 --> 01:22:56,353 NUMBER ON THE GROUPS. 2084 01:22:56,353 --> 01:22:56,854 NEXT SLIDE. 2085 01:22:56,854 --> 01:22:59,190 SO THESE INFANTS ARE BEING 2086 01:22:59,190 --> 01:23:00,591 FOLLOWED UP AT 24 MONTHS WE WILL 2087 01:23:00,591 --> 01:23:03,661 FOLLOW AND WE WILL FINISH BY 2088 01:23:03,661 --> 01:23:04,995 NEXT YEAR. 2089 01:23:04,995 --> 01:23:05,830 NEXT SLIDE. 2090 01:23:05,830 --> 01:23:07,565 SO THE OUTCOME, ALLIANCE HAD 2091 01:23:07,565 --> 01:23:09,233 BEEN COMPLETED SINCE THEY HAD 2092 01:23:09,233 --> 01:23:10,868 NOT BEEN PUBLISHED, I'M NOT ABLE 2093 01:23:10,868 --> 01:23:14,004 TO SHARE WITH YOU THE RESULTS OF 2094 01:23:14,004 --> 01:23:16,440 THE WEANING TRIAL BUT WE EXPECT 2095 01:23:16,440 --> 01:23:19,610 THAT TO COME OUT IN 3-4 MONTHS. 2096 01:23:19,610 --> 01:23:23,981 SO RIGHT NOW THEY'RE BEING 2097 01:23:23,981 --> 01:23:26,450 REVIEWED BY 1 OF THE SUBJECTS. 2098 01:23:26,450 --> 01:23:28,986 THE NEXT SET OF SLIDES MY 2099 01:23:28,986 --> 01:23:31,622 COLLEAGUE FROM NICHD, STEPHANIE 2100 01:23:31,622 --> 01:23:34,158 ARCHER WILL BE PRESENTING. 2101 01:23:34,158 --> 01:23:35,659 >> THANK YOU TONSE, AND THANK 2102 01:23:35,659 --> 01:23:37,628 YOU EVERYBODY FOR LETTING US 2103 01:23:37,628 --> 01:23:37,995 PRESENT TODAY. 2104 01:23:37,995 --> 01:23:40,264 SO THE OUTCOME OF BABIES WITH 2105 01:23:40,264 --> 01:23:42,566 THE OPIOID EXPOSURE, IT'S CALLED 2106 01:23:42,566 --> 01:23:47,538 THE COHORT STUDY, NEXT SLIDE. 2107 01:23:47,538 --> 01:23:49,039 SO IT'S TRYING TO ANSWER THE 2108 01:23:49,039 --> 01:23:55,780 QUESTION, TO WHAT EXTEND IS IT 2109 01:23:55,780 --> 01:23:57,047 ASSOCIATE WIDE ATYPICAL 2110 01:23:57,047 --> 01:23:57,948 NEURODEVELOPMENTAL OUTCOMES AND 2111 01:23:57,948 --> 01:24:02,086 TO DO THAT, IT'S LOOKING AT A 2112 01:24:02,086 --> 01:24:07,625 SERIES OF TIME POINTS AFTER 2113 01:24:07,625 --> 01:24:10,394 BIRTH IN BOTH EXPOSED INFANTS 2114 01:24:10,394 --> 01:24:12,463 AND UNEXPOSED INFANTS THAT WERE 2115 01:24:12,463 --> 01:24:14,632 EXPOSED TO OPIOIDS WELL, A 2116 01:24:14,632 --> 01:24:16,567 FETUS, THEY'RE COLLECTING MRIs 2117 01:24:16,567 --> 01:24:19,570 AT 1 MONTH, 6 MONTH AND 24 2118 01:24:19,570 --> 01:24:23,040 MONTHS OF AGE AND DO BEING A 2119 01:24:23,040 --> 01:24:25,409 VARIETY OF ASSESSMENTS AT 1, 6, 2120 01:24:25,409 --> 01:24:29,380 12, AND 18, AND 24 MONTHS. 2121 01:24:29,380 --> 01:24:34,385 IT COMPLETED ENROLLMENT IN 2122 01:24:34,385 --> 01:24:35,786 DECEMBER OF 2023, WITH 237 2123 01:24:35,786 --> 01:24:36,453 INFANTS. 2124 01:24:36,453 --> 01:24:38,556 155 OF THEM WERE OPIOID EXPOSED 2125 01:24:38,556 --> 01:24:41,025 AND 82 OF THEM WERE UNEXPOSED 2126 01:24:41,025 --> 01:24:43,093 AND THE FOLLOW UP VISITINGILATES 2127 01:24:43,093 --> 01:24:44,862 ARE ONGOING PARTICULARLY FOR THE 2128 01:24:44,862 --> 01:24:51,101 18 AND 24 MONTH AGE VISITS. 2129 01:24:51,101 --> 01:24:51,402 NEXT SLIDE. 2130 01:24:51,402 --> 01:24:55,539 AND BECAUSE OF THAT WE DON'T 2131 01:24:55,539 --> 01:24:58,142 HAVE SET PAPERS OUT YET ON THE 2132 01:24:58,142 --> 01:24:59,176 RESULTS. 2133 01:24:59,176 --> 01:25:04,148 WE DO HAVE PRELIMINARY PAPERS 2134 01:25:04,148 --> 01:25:07,885 OUT ON SOME OF THE METHODS 2135 01:25:07,885 --> 01:25:18,362 INCLUDING A PERCEIVED STIGMA 2136 01:25:26,337 --> 01:25:28,672 OUTCOME MEASURE, IT IS DOING 2 2137 01:25:28,672 --> 01:25:31,375 DIFFERENT STUDIES, OPTIMIZE NOW 2138 01:25:31,375 --> 01:25:41,652 AND INFORM NOWS. 2139 01:25:43,320 --> 01:25:43,988 NEXT SLIDE. 2140 01:25:43,988 --> 01:25:45,122 AND LOOKING AT BASE LINE DATA 2141 01:25:45,122 --> 01:25:47,791 THIS WAS STARTED AFTER THE ESC 2142 01:25:47,791 --> 01:25:58,302 TRIAL RESULTS WERE OUT, SO WE 2143 01:26:00,704 --> 01:26:02,239 WANTED TO SEE WHAT CHANGED SIN 2144 01:26:02,239 --> 01:26:04,808 THEN SO WE KNOW WHAT THE TRIALS 2145 01:26:04,808 --> 01:26:08,812 WOULD HOPE TO DO WOULD CHANGE 2146 01:26:08,812 --> 01:26:09,880 FURTHER, CHANGE PRACTICE. 2147 01:26:09,880 --> 01:26:11,515 SO IT SHOWS LITTLE EVIDENCE 2148 01:26:11,515 --> 01:26:14,418 EXISTS ON THE BEST APPROACHES TO 2149 01:26:14,418 --> 01:26:16,687 IESHES DENTIFYING MONITORING AND 2150 01:26:16,687 --> 01:26:20,324 TREATING NOWS LIKE NONSE SAID, 2151 01:26:20,324 --> 01:26:28,232 IT WAS COLLECTING PATIENT LEVEL. 2152 01:26:28,232 --> 01:26:28,999 >> THE DATA COLLECTION IS 2153 01:26:28,999 --> 01:26:32,269 COMPLETED AND THE ANALYSIS ARE 2154 01:26:32,269 --> 01:26:33,637 ONGOING AND THE FIRST MANUSCRIPT 2155 01:26:33,637 --> 01:26:35,005 SHOULD BE PUBLISHED IN THE NEXT 2156 01:26:35,005 --> 01:26:45,282 3 MONTHS OR SO. 2157 01:26:46,383 --> 01:26:46,617 NEXT SLIDE. 2158 01:26:46,617 --> 01:26:47,017 NEXT SLIDE. 2159 01:26:47,017 --> 01:26:51,288 SO THIS 1 IS LOOKING AT HOW TO 2160 01:26:51,288 --> 01:26:52,222 OPTIMIZE THE PHARMACOTHERAPYS 2161 01:26:52,222 --> 01:26:54,992 THAT THE BABIES RECEIVE IF THEY 2162 01:26:54,992 --> 01:26:56,827 NEED THEM AND WHAT IS THE BEST 2163 01:26:56,827 --> 01:26:59,229 METHOD OF PROVOIDING THAT 2164 01:26:59,229 --> 01:26:59,663 MEDICINE. 2165 01:26:59,663 --> 01:27:05,102 SO THE IDEA IS FOR NEW BORNING 2166 01:27:05,102 --> 01:27:07,271 THAT NEED MORE BUPRENORPH OR 2167 01:27:07,271 --> 01:27:10,574 METHADONE FOR NOWS CAN SYMPTOM 2168 01:27:10,574 --> 01:27:13,243 BASED DOSING WEANING REGIMEN 2169 01:27:13,243 --> 01:27:15,112 REDUCE THE NUMBER OF HOSPITAL 2170 01:27:15,112 --> 01:27:19,316 DAYS COMPARED TO A MORE 2171 01:27:19,316 --> 01:27:26,423 TRADITIONAL SCHEDULED TAPERING 2172 01:27:26,423 --> 01:27:26,690 APPROACH. 2173 01:27:26,690 --> 01:27:31,295 SO AT THE SCHEDULING APPROACH 2174 01:27:31,295 --> 01:27:33,297 THE INFANTS GET SCHEDULED 2175 01:27:33,297 --> 01:27:34,465 APPROACH AND IT DECREASES OVER 2176 01:27:34,465 --> 01:27:36,967 TIME UNTIL THEY NO LONGER NEED 2177 01:27:36,967 --> 01:27:37,468 THE MEDICATIONS. 2178 01:27:37,468 --> 01:27:39,737 THE -- WE WERE TESTING THE 2179 01:27:39,737 --> 01:27:41,338 SYMPTOM BASED APPROACH WHERE THE 2180 01:27:41,338 --> 01:27:42,339 INFANTS WOULD ONLY GET THE 2181 01:27:42,339 --> 01:27:45,909 MEDICINE IF THEY SHOWED SIGNS OF 2182 01:27:45,909 --> 01:27:49,413 NOWS THAT NEEDED TO BE TREATED. 2183 01:27:49,413 --> 01:27:55,285 THEY WERE DOING THIS IN A 2-STEP 2184 01:27:55,285 --> 01:27:56,353 PROCESS, 1 HAS A 5 MONTH 2185 01:27:56,353 --> 01:27:59,790 APPROACH BASED ON THE SCHEDULED 2186 01:27:59,790 --> 01:28:02,559 BASED APPROACH, HAD A 2 MONTH 2187 01:28:02,559 --> 01:28:03,594 WASH OUT PERIOD BETWEEN THE 2 2188 01:28:03,594 --> 01:28:06,263 AND THEN WE STARTED THE SYMPTOM 2189 01:28:06,263 --> 01:28:11,101 BASED APPROACH IN ALL OF THE 2190 01:28:11,101 --> 01:28:11,802 CENTERS, THE SECOND PERIOD OF 2191 01:28:11,802 --> 01:28:15,372 THE TRIAL WAS JUST COMPLETED 2192 01:28:15,372 --> 01:28:19,209 APRIL 11th, SO WE'RE HOPING TO 2193 01:28:19,209 --> 01:28:21,045 GET ALL OF THE HOSPITAL 2194 01:28:21,045 --> 01:28:22,813 DISCHARGE DATA SHORTLY AND DO 2195 01:28:22,813 --> 01:28:27,651 DATA CLEANING AND ANALYSIS FOR 2196 01:28:27,651 --> 01:28:27,951 THAT. 2197 01:28:27,951 --> 01:28:30,921 NEXT SLIDE. 2198 01:28:30,921 --> 01:28:32,856 AND THE CONCLUSIONS. 2199 01:28:32,856 --> 01:28:35,659 SO AS TONSE SAID THE ACT NOW 2200 01:28:35,659 --> 01:28:37,628 CURRENT EXPERIENCE SHOWED LARGE 2201 01:28:37,628 --> 01:28:38,529 PRACTICE VARIATIONS AND HELPED 2202 01:28:38,529 --> 01:28:42,099 PLAN ALL OF OUR OTHER TRIALS. 2203 01:28:42,099 --> 01:28:44,234 THE ESC SHOWED THAT BY USING 2204 01:28:44,234 --> 01:28:47,805 THIS EAT, SLEEP, AND CONSOLE, 2205 01:28:47,805 --> 01:28:52,643 CARRYING METHOD, THEY WERE ABLE 2206 01:28:52,643 --> 01:28:54,511 TO REDUCE THE NUMBER OF HOSPITAL 2207 01:28:54,511 --> 01:28:56,413 DAYS UNTIL THE INFANTS WERE 2208 01:28:56,413 --> 01:28:58,115 READY FOR DISCHARGE AND REDUCE 2209 01:28:58,115 --> 01:29:01,919 THE NEED FOR APILOT PROJECTOID 2210 01:29:01,919 --> 01:29:02,252 MEDICATIONS. 2211 01:29:02,252 --> 01:29:02,686 NEXT. 2212 01:29:02,686 --> 01:29:09,059 SO THE ACT NOW WEANING TRIAL, 2213 01:29:09,059 --> 01:29:10,961 THE ELBOW STUDY, INFORM NOW, AND 2214 01:29:10,961 --> 01:29:21,405 THE OPTIMIZED STUDY, HAVE 2215 01:29:24,641 --> 01:29:25,175 RESULTS. 2216 01:29:25,175 --> 01:29:27,377 AND OBOE, AND INFORM NOWS AND 2217 01:29:27,377 --> 01:29:32,950 OPTIMIZE NOWS, IS HELPING TO 2218 01:29:32,950 --> 01:29:33,851 ASSESS NEURODEVELOPMENT AMILLIO 2219 01:29:33,851 --> 01:29:40,624 OUTCOME AND HEALTH STATUS. 2220 01:29:40,624 --> 01:29:41,091 NEXT SLIDE. 2221 01:29:41,091 --> 01:29:51,535 AND WE CAN TAKE QUESTIONS. 2222 01:29:53,637 --> 01:29:54,004 >> DR. NUNES. 2223 01:29:54,004 --> 01:29:57,508 I'M CURIOUS, I'M SURE THERE'S A 2224 01:29:57,508 --> 01:29:59,810 REASON BUT BUPRENORPHINE IS NOT 2225 01:29:59,810 --> 01:30:01,745 BEING USED IN NEW BORN INFANTS 2226 01:30:01,745 --> 01:30:08,452 IS THAT OUT OF CONCERN FOR 2227 01:30:08,452 --> 01:30:09,653 PRECIPITATING WITHDRAWAL EVEN 2228 01:30:09,653 --> 01:30:11,488 WHEN THERE'S WITHDRAWAL SYMPTOMS 2229 01:30:11,488 --> 01:30:12,222 PRESENT. 2230 01:30:12,222 --> 01:30:15,492 IT'S SO EFFECTIVE IN ADULTS 2231 01:30:15,492 --> 01:30:16,126 BECAUSE IT SELF-TAPERS. 2232 01:30:16,126 --> 01:30:19,263 >> MAB I CAN ANSWER, SO 2233 01:30:19,263 --> 01:30:21,165 BUPRENORPHINE HAS NOT BEEN 2234 01:30:21,165 --> 01:30:22,266 SYSTEMATICALLY STUDY INDEED NEW 2235 01:30:22,266 --> 01:30:23,667 BORN BABIES. 2236 01:30:23,667 --> 01:30:26,069 I DON'T KNOW WHETHER THEY THE 2237 01:30:26,069 --> 01:30:27,671 FOLLOW UP HAS BEEN STUDIED FIRST 2238 01:30:27,671 --> 01:30:29,473 OF ALL IN NEW BORN BABIES, ALSO 2239 01:30:29,473 --> 01:30:31,175 VERY IMPORTANT, SOME OF THESE 2240 01:30:31,175 --> 01:30:32,943 BABIES ARE PREMOO TOUR WHICH 2241 01:30:32,943 --> 01:30:35,312 ADDS MORE COMPLEXITY FOR THAT, 2242 01:30:35,312 --> 01:30:41,118 SO, THEREFORE, WHAT HAS BEEN 2243 01:30:41,118 --> 01:30:43,520 ONLY USED MOST OF THE TIME, I 2244 01:30:43,520 --> 01:30:45,689 THINK NICH IS PLANNING A 2245 01:30:45,689 --> 01:30:46,890 BUPRENORPH TODAY AND STEPHANIE 2246 01:30:46,890 --> 01:30:47,591 CAN ANSWER THAT. 2247 01:30:47,591 --> 01:30:50,727 >> THE HELP FOR NOWS CONSORTIUM 2248 01:30:50,727 --> 01:30:53,063 WAS ORIGINALLY SET UP TO LOOK AT 2249 01:30:53,063 --> 01:30:55,332 THAT ALSO AND IF THEY END UP 2250 01:30:55,332 --> 01:30:56,567 WITH ANOTHER TIME LEFT, THEY 2251 01:30:56,567 --> 01:30:57,935 WILL BE TURNING TO THAT ONCE 2252 01:30:57,935 --> 01:31:01,138 THEY KNOW HOW TO DO THE 2253 01:31:01,138 --> 01:31:05,008 SCHEDULE, THE SCHEDULED VERSUS 2254 01:31:05,008 --> 01:31:05,509 SYMPTOM BASED TAPERING. 2255 01:31:05,509 --> 01:31:10,414 ONE OF THE ISSUES WITH THE 2256 01:31:10,414 --> 01:31:11,682 BUPRENORPHINE IS THAT IT TENDS 2257 01:31:11,682 --> 01:31:13,784 TO BE MIXED WITH ALCOHOL IN THE 2258 01:31:13,784 --> 01:31:15,852 FORMULATION AND THE FDA HAS BEEN 2259 01:31:15,852 --> 01:31:17,921 RETICENT IN ALLOWING THAT TO BE 2260 01:31:17,921 --> 01:31:21,592 USED IN TRIALS FOR BABIES. 2261 01:31:21,592 --> 01:31:25,495 SO WE ARE IN THE PROCESS OF THE 2262 01:31:25,495 --> 01:31:27,531 HELP FOR NOWS TEAM IS IF THE 2263 01:31:27,531 --> 01:31:29,766 PROCESS OF DEVELOPING A AN 2264 01:31:29,766 --> 01:31:30,467 ALCOHOL-FREE FORMULATION THAT 2265 01:31:30,467 --> 01:31:31,835 THEN WE COULD TEST. 2266 01:31:31,835 --> 01:31:34,004 IT IS USED IN SOME HOSPITALS BUT 2267 01:31:34,004 --> 01:31:37,074 IT HAS NOT BEEN ABLE TO BE USED 2268 01:31:37,074 --> 01:31:39,676 IN TRIALS YET. 2269 01:31:39,676 --> 01:31:40,377 >> RIGHT. 2270 01:31:40,377 --> 01:31:50,587 THANK YOU. 2271 01:31:51,588 --> 01:31:51,922 >> DR. JONES? 2272 01:31:51,922 --> 01:31:52,789 >> YOU'RE MUTED. 2273 01:31:52,789 --> 01:31:54,157 >> SHE CAN'T UNMUTE HERSELF. 2274 01:31:54,157 --> 01:31:56,460 >> I CAN'T, IT WON'T LET ME 2275 01:31:56,460 --> 01:31:58,228 NTHERE WE GO. 2276 01:31:58,228 --> 01:31:58,629 OKAY. 2277 01:31:58,629 --> 01:32:00,797 >> NOW THEY FIGURED OUT THE 2278 01:32:00,797 --> 01:32:03,667 TECHNOLOGY FIRST, I JUST WANT TO 2279 01:32:03,667 --> 01:32:05,002 ACKNOWLEDGE HOW INCREDIBLE 2280 01:32:05,002 --> 01:32:07,437 LOAMACYY IMPORTANT THESE SETS OF 2281 01:32:07,437 --> 01:32:11,975 STUDIES ARE AND HOW THE UNITED 2282 01:32:11,975 --> 01:32:13,710 STATES HAS BEEN SUCH A WORLD 2283 01:32:13,710 --> 01:32:18,548 LEADER IN BRINGING THIS TYPE OF 2284 01:32:18,548 --> 01:32:19,616 DESPERATELY NEEDED RESEARCH THAT 2285 01:32:19,616 --> 01:32:22,019 HAS REAL WORLD CLINICAL 2286 01:32:22,019 --> 01:32:22,619 APPLICATIONS AND IMPLICATIONS 2287 01:32:22,619 --> 01:32:24,655 FOR A LIFETIME, RIGHT? 2288 01:32:24,655 --> 01:32:26,490 BECAUSE WE'RE TALKING ABOUT 2289 01:32:26,490 --> 01:32:28,358 PREGNANT PATIENT ANDS THEIR 2290 01:32:28,358 --> 01:32:31,194 BABIES THAT ARE BEING TREATED 2291 01:32:31,194 --> 01:32:32,529 FOR THIS MEDICAL CONDITION THAT 2292 01:32:32,529 --> 01:32:34,097 IS TREATABLE AS YOU ALL ARE 2293 01:32:34,097 --> 01:32:36,066 SHOWING, SO FIRST I JUST WANT TO 2294 01:32:36,066 --> 01:32:37,134 UNDERSCORE HOW IMPORTANT THIS IS 2295 01:32:37,134 --> 01:32:38,402 AND TO THANK YOU FOR ALL OF THE 2296 01:32:38,402 --> 01:32:42,572 WORK THAT YOU HAVE BEEN DOING. 2297 01:32:42,572 --> 01:32:43,540 SECOND, I WANTED TO ASK A 2298 01:32:43,540 --> 01:32:46,710 QUESTION AND THAT IS ABOUT THE 2299 01:32:46,710 --> 01:32:48,412 FIRST STUDY THAT WAS SHOWN AND 2300 01:32:48,412 --> 01:32:51,948 IN THAT YOU NOTE THAD 5000 2301 01:32:51,948 --> 01:32:54,751 NURSES WERE TRAINED ON THE ESC 2302 01:32:54,751 --> 01:32:56,019 PROCEDURE, AND I WONDERED IF YOU 2303 01:32:56,019 --> 01:32:59,690 ALL LOOKED AT FOLLOW UP, HOW 2304 01:32:59,690 --> 01:33:01,325 MANY HOSPITALS CONTINUED WITH 2305 01:33:01,325 --> 01:33:04,194 ESC, AFTER THE STUDY WAS 2306 01:33:04,194 --> 01:33:09,099 COMPLETED AND THEN THE FOLLOW UP 2307 01:33:09,099 --> 01:33:11,301 TO THAT -- TO WHAT EXTENT DID 2308 01:33:11,301 --> 01:33:14,504 YOU SEE PUSH BACK FROM 2309 01:33:14,504 --> 01:33:16,173 THENYONATAL INFANT CARE UNITS 2310 01:33:16,173 --> 01:33:17,541 BECAUSE WHAT I'VE HEARD IN THE 2311 01:33:17,541 --> 01:33:18,575 RESEARCH IECH DONE AND TRAINING 2312 01:33:18,575 --> 01:33:20,310 I'VE DONE IS THAT SOMETIMES OUR 2313 01:33:20,310 --> 01:33:22,612 HOSPITALS DON'T WANT TO EMPLOY 2314 01:33:22,612 --> 01:33:24,481 OR UTILIZE ESC BECAUSE IT GETS 2315 01:33:24,481 --> 01:33:26,316 BABIES OUT OF THE HOSPITAL 2316 01:33:26,316 --> 01:33:28,652 FASTER, WHICH IS A COST SAVINGS 2317 01:33:28,652 --> 01:33:30,053 TO OUR SOCIETY, BUT YET THAT IS 2318 01:33:30,053 --> 01:33:32,356 HOW THE HOSPITALS ARE GENERATING 2319 01:33:32,356 --> 01:33:32,689 MONEY. 2320 01:33:32,689 --> 01:33:34,291 SO I WANTED TO HEAR YOUR 2321 01:33:34,291 --> 01:33:36,293 THOUGHTS AND PERSPECTIVES ON 2322 01:33:36,293 --> 01:33:37,194 THAT. 2323 01:33:37,194 --> 01:33:39,429 >> WELL, YOU HAVE VERY 2324 01:33:39,429 --> 01:33:40,364 INTERESTING QUESTION, ANSWER TO 2325 01:33:40,364 --> 01:33:44,968 THAT I CAN ONLY SPECULATE. 2326 01:33:44,968 --> 01:33:46,536 I'M ANYONATOLOGYIST BY TRAINING, 2327 01:33:46,536 --> 01:33:49,005 ALL MY CAREER, I TREATED NEW 2328 01:33:49,005 --> 01:33:51,208 BORN BABIES UNTIL I JOIN WITH 2329 01:33:51,208 --> 01:33:54,277 NIH, BEFORE THEY WAS PROFESSOR 2330 01:33:54,277 --> 01:33:55,078 OF PEDIATRICS ANDNYONATOLOGY, 2331 01:33:55,078 --> 01:33:56,146 YOU'RE RIGHT. 2332 01:33:56,146 --> 01:33:56,980 THE ESC REQUIRES TRAINING, THERE 2333 01:33:56,980 --> 01:33:58,482 IS NO DOUBT ABOUT THAT. 2334 01:33:58,482 --> 01:34:01,017 AND RIGHT NOW, THERE ARE SOME 2335 01:34:01,017 --> 01:34:03,653 DATA BEING DEVELOPED AND IT 2336 01:34:03,653 --> 01:34:05,622 LOOKS LIKE PROBABLY AT LEAST 2337 01:34:05,622 --> 01:34:07,891 50-60% OF THE HOSPITALS ARE 2338 01:34:07,891 --> 01:34:09,960 TRYING ESC, ALTHOUGH WE DON'T 2339 01:34:09,960 --> 01:34:11,461 HAVE ANY DIFFERENT DATA BECAUSE 2340 01:34:11,461 --> 01:34:13,964 SOMETIMES IT IS MUCH EASIER TO 2341 01:34:13,964 --> 01:34:16,566 PRESCRIBE MEDICATION THAN TO 2342 01:34:16,566 --> 01:34:19,403 SAY, WELL, YOU KNOW SPEND 2343 01:34:19,403 --> 01:34:21,104 SOMETIME AND BE PATIENT AND HOLD 2344 01:34:21,104 --> 01:34:22,105 THE BABY, ET CETERA. 2345 01:34:22,105 --> 01:34:24,708 WE ARE ALL QUICK ON WRITING THE 2346 01:34:24,708 --> 01:34:25,842 PRESCRIPTION RATHER THAN USING A 2347 01:34:25,842 --> 01:34:27,878 HUMAN APPROACH THAT TAKES MORE 2348 01:34:27,878 --> 01:34:31,715 TIME, MORE PATIENCE AND THAT 2349 01:34:31,715 --> 01:34:36,720 NEEDS LEADERSHIP IN THE UNIT. 2350 01:34:36,720 --> 01:34:38,688 THAT'S WHAT IS STRONGLY BEING 2351 01:34:38,688 --> 01:34:38,989 RECOMMENDED. 2352 01:34:38,989 --> 01:34:40,757 NOW THE HOSPITAL IS KIND OF A 2353 01:34:40,757 --> 01:34:41,658 MIXTURE IN THAT QUESTION. 2354 01:34:41,658 --> 01:34:44,127 IT IS TRUE THAT HOSPITALSED LIKE 2355 01:34:44,127 --> 01:34:46,596 TO KEEP THE BABIES LONGER BUT ON 2356 01:34:46,596 --> 01:34:47,898 THE OTHER HAND REMEMBER MOST OF 2357 01:34:47,898 --> 01:34:50,200 THESE CHILDREN WHO ARE WITH 2358 01:34:50,200 --> 01:34:50,634 WITHDRAWAL SYNDROME, 2359 01:34:50,634 --> 01:34:52,302 UNFORTUNATELY THEY DON'T HAVE 2360 01:34:52,302 --> 01:34:54,337 INSURANCE, THEY HAVE MEDICAID OR 2361 01:34:54,337 --> 01:34:55,872 BUT THEY DON'T HAVE COMMERCIAL 2362 01:34:55,872 --> 01:34:57,974 INSURANCE, THEY MAY NOT 2363 01:34:57,974 --> 01:34:59,209 NECESSARILY BE HIGH INCOME 2364 01:34:59,209 --> 01:35:00,110 COMMERCIAL INSURANCE PEOPLE, SO 2365 01:35:00,110 --> 01:35:02,279 THERE MAY NOT BE PAYING 2366 01:35:02,279 --> 01:35:03,480 PATIENTS, SO HOSPITALS REALLY 2367 01:35:03,480 --> 01:35:08,351 DON'T WANT TO KEEP SUCH PATIENTS 2368 01:35:08,351 --> 01:35:09,119 FOR LONGER PERIOD. 2369 01:35:09,119 --> 01:35:10,921 SO IT GOES BOTH WAYS WHETHER OR 2370 01:35:10,921 --> 01:35:11,955 NOT THEY ARE INTERESTED. 2371 01:35:11,955 --> 01:35:13,690 I THINK THE MOST DIFFICULT PART 2372 01:35:13,690 --> 01:35:14,624 IS THE TRAINING PART. 2373 01:35:14,624 --> 01:35:16,660 THAT IS WHERE THEY HAD TO -- 2374 01:35:16,660 --> 01:35:18,695 THEY HAD TO BE SOMEONE ADON 2375 01:35:18,695 --> 01:35:20,530 VOCATING THIS TO MAKE SURE A FEW 2376 01:35:20,530 --> 01:35:22,199 PEOPLE ARE TRAINED AND IT 2377 01:35:22,199 --> 01:35:24,267 DOESN'T TAKE MUCH TIME, MUCH TO 2378 01:35:24,267 --> 01:35:28,104 TRAIN THE MOMS AND WE HAVE HAD 2379 01:35:28,104 --> 01:35:29,406 SOME FOLLOW UP INFORMATION, 2380 01:35:29,406 --> 01:35:32,042 THOSE BABIES WHO ARE ESC ARM, 2381 01:35:32,042 --> 01:35:33,844 THEY ARE HPV HEALTHIER IN THE 2382 01:35:33,844 --> 01:35:34,845 FIRST 2 YEARS. 2383 01:35:34,845 --> 01:35:36,780 RECENTLY WE JUST LOOKEDDA THE 2384 01:35:36,780 --> 01:35:38,815 DATA, THEY ARE NOT PUBLISHED YET 2385 01:35:38,815 --> 01:35:40,617 AND THE MOTHERS ARE HAPPIER AND 2386 01:35:40,617 --> 01:35:41,985 LOOKS LIKE THE BABIES AT 2 YEARS 2387 01:35:41,985 --> 01:35:45,088 EVEN THOUGH LESS OF THEM GOT THE 2388 01:35:45,088 --> 01:35:46,189 PHARMAICOLOGICAL THERAPY THEY 2389 01:35:46,189 --> 01:35:47,023 DID MUCH BETTER OVERALL. 2390 01:35:47,023 --> 01:35:48,925 I THINK WE HAD PUBLISHED THAT, 2391 01:35:48,925 --> 01:35:51,194 SO THAT'S WHY I CAN'T FORMALLY 2392 01:35:51,194 --> 01:35:52,629 ANNOUNCE THE RESULTS BUT THOSE 2393 01:35:52,629 --> 01:35:56,800 ARE ALL VERY, VERY HELPFUL IN 2394 01:35:56,800 --> 01:35:57,801 FURTHER ENHANCING ESC AT FIRST 2395 01:35:57,801 --> 01:36:02,172 APPROACH. 2396 01:36:02,172 --> 01:36:03,039 THANK YOU. 2397 01:36:03,039 --> 01:36:04,674 >> YEAH, I WOULD ALSO ADD THAT 2398 01:36:04,674 --> 01:36:15,085 WE DID HAVE SOME ISSUES 2399 01:36:16,052 --> 01:36:17,888 CONTINUING TO FIND METHODS THAT 2400 01:36:17,888 --> 01:36:20,357 WERE STILL USING THE FIN GANNA 2401 01:36:20,357 --> 01:36:22,025 METHODS BECAUSE THEY'RE TRYING 2402 01:36:22,025 --> 01:36:25,362 TO CHANGE OVER TO ESC, AND CAN 2403 01:36:25,362 --> 01:36:27,864 YOU BEGIN OUR STUDY AND CAN WE 2404 01:36:27,864 --> 01:36:31,434 TELL YOU TO WAIT UNTIL WE SWITCH 2405 01:36:31,434 --> 01:36:33,537 IT. 2406 01:36:33,537 --> 01:36:38,675 >> YEAH. 2407 01:36:38,675 --> 01:36:39,209 >> ANY OTHER QUESTIONS? 2408 01:36:39,209 --> 01:36:40,677 IF NOT I THINK WE CAN TURN IT 2409 01:36:40,677 --> 01:36:45,649 BACK TO AMY AND RACHEL. 2410 01:36:45,649 --> 01:36:46,483 >> I HAVE 1 QUICK QUESTION WHICH 2411 01:36:46,483 --> 01:36:51,321 IS A SORT OF DESIGN WONKY 2412 01:36:51,321 --> 01:36:53,189 QUESTION, BUT STEP WEDGE 2413 01:36:53,189 --> 01:36:56,626 DESIGNS, I LOVE THE DESIGN, I 2414 01:36:56,626 --> 01:36:58,061 THINK IT'S REALLY TERRIFIC FOR 2415 01:36:58,061 --> 01:37:01,665 MANY REASONS BUT IT'S BEEN 2416 01:37:01,665 --> 01:37:04,401 CRITICIZED THAT IF THERE IS SOME 2417 01:37:04,401 --> 01:37:07,637 SECULAR TREND THAT CREATES A 2418 01:37:07,637 --> 01:37:10,807 DISRUPTION IN THE OUTCOME THAT 2419 01:37:10,807 --> 01:37:12,442 THAT CAN BIAS THE TRIAL, DID YOU 2420 01:37:12,442 --> 01:37:18,448 GET ANY KIND OF CRITICISM FOR 2421 01:37:18,448 --> 01:37:18,782 THAT? 2422 01:37:18,782 --> 01:37:20,884 >> I HAD TO SHOW HOW -- THE WAY 2423 01:37:20,884 --> 01:37:23,820 WE DID, IT WAS RANDOMIZED, THE 2424 01:37:23,820 --> 01:37:26,890 SITES, SO THE WAY WE PICKED UP 2425 01:37:26,890 --> 01:37:29,793 ON THE SITES BEGIN WITH A 2426 01:37:29,793 --> 01:37:31,528 SPECIFIC DURATION OF THE USUAL 2427 01:37:31,528 --> 01:37:31,895 CARE FIRST. 2428 01:37:31,895 --> 01:37:34,230 ALL OF THE TRIALS, ALL OF THE 2429 01:37:34,230 --> 01:37:35,899 SITES BEGAN USUAL CARE, BECAUSE 2430 01:37:35,899 --> 01:37:38,535 WE DID NOT WANT CONTAMINATION, 2431 01:37:38,535 --> 01:37:40,737 WE DID NOT WANT SOME SITES TO 2432 01:37:40,737 --> 01:37:42,005 START WITH ESC AND THEN SWITCH 2433 01:37:42,005 --> 01:37:45,241 TO USUAL CARE BECAUSE THEY SAY I 2434 01:37:45,241 --> 01:37:46,910 LIKE ESC AND I DON'T WANT TO 2435 01:37:46,910 --> 01:37:48,578 SWITCH BACK TO THE USUAL CARE, 2436 01:37:48,578 --> 01:37:51,147 SO ALL SITES HAVE USUAL CARE AND 2437 01:37:51,147 --> 01:37:52,349 THEN VARYING DURATIONS, AND THEN 2438 01:37:52,349 --> 01:37:56,252 THERE ARE WAS A PERIOD FOR 8 2439 01:37:56,252 --> 01:37:58,088 WEEKS OR SOMETHING IN BETWEEN 2440 01:37:58,088 --> 01:37:59,723 WHERE WE ARE NOT ENROLLING THOSE 2441 01:37:59,723 --> 01:38:02,058 PATIENTS SO IT'S A WASH OUT 2442 01:38:02,058 --> 01:38:02,525 PERIOD. 2443 01:38:02,525 --> 01:38:04,394 AND THEN THERE WAS THE -- WE 2444 01:38:04,394 --> 01:38:06,096 INTRODUCE THE ESC CARE, SO IN 2445 01:38:06,096 --> 01:38:07,197 THAT SENSE, I THINK WE TRY TO 2446 01:38:07,197 --> 01:38:09,265 MAKE IT AS CLEAN AS POSSIBLE, 2447 01:38:09,265 --> 01:38:12,402 BUT YOUR POINTS ARE WELL TAKEN. 2448 01:38:12,402 --> 01:38:12,669 >> YEAH. 2449 01:38:12,669 --> 01:38:13,703 >> I THINK TOO IN A TRIAL LIKE 2450 01:38:13,703 --> 01:38:18,208 THAT WHERE IT'S MORE OF A 2451 01:38:18,208 --> 01:38:19,342 BEHAVIOR CHANGE, BUT IT'S -- 2452 01:38:19,342 --> 01:38:21,211 THERE'S REALLY NO WAY TO 2453 01:38:21,211 --> 01:38:23,346 INDIVIDUALLY RANDOMIZE THE KIDS. 2454 01:38:23,346 --> 01:38:23,847 >> NO, NO. 2455 01:38:23,847 --> 01:38:24,581 I UNDERSTAND. 2456 01:38:24,581 --> 01:38:27,217 IT'S A GREAT, I WAS JUST CURIOUS 2457 01:38:27,217 --> 01:38:35,058 IF YOU HAD ENCOUNTERED THAT 2458 01:38:35,058 --> 01:38:35,659 CRITICISM? 2459 01:38:35,659 --> 01:38:39,062 I THINK IT'S GREAT. 2460 01:38:39,062 --> 01:38:41,131 THE CONCERN IS IF ANY EXTERNAL 2461 01:38:41,131 --> 01:38:43,266 THING HAPPENS WHERE SUDDENLY THE 2462 01:38:43,266 --> 01:38:44,868 OUTCOME OF INFANT SYSTEM VERY 2463 01:38:44,868 --> 01:38:46,136 DIFFERENT FOR SOME REASON THAT 2464 01:38:46,136 --> 01:38:48,171 WAS UNANTICIPATED THAT CAN BIAS 2465 01:38:48,171 --> 01:38:51,975 THE TRIALY DEPENDING ON WHERE IT 2466 01:38:51,975 --> 01:38:52,208 OCCURS. 2467 01:38:52,208 --> 01:38:53,710 BUT I THINK TO HAVE SOMETHING 2468 01:38:53,710 --> 01:38:55,311 LIKE THAT HAPPEN IS PRETTY 2469 01:38:55,311 --> 01:38:56,546 UNLIKELY AND IT'S SUCH A GREAT 2470 01:38:56,546 --> 01:39:00,583 DESIGN FOR MANY REASONS, EVERY 2471 01:39:00,583 --> 01:39:02,485 SITE GETS TRAIN INDEED THE NEW 2472 01:39:02,485 --> 01:39:03,653 INTERVENTION, SO, YOU DON'T HAVE 2473 01:39:03,653 --> 01:39:06,589 SITES THAT GET IT, DON'T GET 2474 01:39:06,589 --> 01:39:08,058 IT,. 2475 01:39:08,058 --> 01:39:08,358 >> RIGHT. 2476 01:39:08,358 --> 01:39:09,225 >> YEAH. 2477 01:39:09,225 --> 01:39:09,993 >> AND FROM THE CURRENT 2478 01:39:09,993 --> 01:39:11,094 EXPERIENCE WE COULD TELL THERE 2479 01:39:11,094 --> 01:39:18,635 WAS A LOT OF SITE VARIATIONS, 2480 01:39:18,635 --> 01:39:20,203 SO, HAVING TO MANAGE THAT AS 2481 01:39:20,203 --> 01:39:22,138 WELL AS OKAY, YOU CAN'T LOOK AT 2482 01:39:22,138 --> 01:39:23,606 1 SITE VERSUS ANOTHER WHEN THERE 2483 01:39:23,606 --> 01:39:25,508 WAS SO MUCH DIFFERENCE TO BEGIN 2484 01:39:25,508 --> 01:39:26,042 WITH. 2485 01:39:26,042 --> 01:39:27,610 >> AND IT SEEMED INTERESTING 2486 01:39:27,610 --> 01:39:30,714 THAT IN THE ESC TRIAL, SITE 2487 01:39:30,714 --> 01:39:32,282 EFFECTS WERE NOT BAD, VERY GOOD 2488 01:39:32,282 --> 01:39:37,420 FOR US, THAT AFTER CONTROL 2489 01:39:37,420 --> 01:39:39,589 SITES, IT WAS FOLLOWED IN ALL 2490 01:39:39,589 --> 01:39:41,891 SITES IT WAS VERY TELLING THAT 2491 01:39:41,891 --> 01:39:43,893 ESC WAS A PREFERRED WAY FOR 2492 01:39:43,893 --> 01:39:46,362 TREATING THESE BABIES. 2493 01:39:46,362 --> 01:39:48,565 >> AND WE ARE USING THAT STEP 2494 01:39:48,565 --> 01:39:50,500 WEDGE APPROACH FOR THE OPTIMIZE 2495 01:39:50,500 --> 01:39:51,601 NOW STUDY WITH THE 2 DIFFERENT 2496 01:39:51,601 --> 01:39:52,302 PERIODS AS WELL. 2497 01:39:52,302 --> 01:39:57,774 AGAIN, IT'S MORE OF A BEHAVIOR 2498 01:39:57,774 --> 01:39:59,142 THING YOU KNOW FOR THE 2499 01:39:59,142 --> 01:40:06,916 HEALTHCARE TEAM TO BE DOING. 2500 01:40:06,916 --> 01:40:08,184 >> OKAY, WELL, THANK YOU BOTH 2501 01:40:08,184 --> 01:40:09,352 VERY, VERY MUCH AND WE 2502 01:40:09,352 --> 01:40:11,755 APPRECIATE THAT AND WE 2503 01:40:11,755 --> 01:40:15,658 APPRECIATE ALL THE QUESTIONS AND 2504 01:40:15,658 --> 01:40:16,526 THE VERY PRODUCTIVE DISCUSSIONS 2505 01:40:16,526 --> 01:40:17,527 WE HAVE HAD TODAY. 2506 01:40:17,527 --> 01:40:20,597 THIS BRINGS US TO THE END OF THE 2507 01:40:20,597 --> 01:40:23,299 OPEN SESSION OF THE DISCIPLINARY 2508 01:40:23,299 --> 01:40:23,733 WORKING GROUP. 2509 01:40:23,733 --> 01:40:25,435 SO THANKS TO EVERYBODY WHO HAS 2510 01:40:25,435 --> 01:40:29,773 JOINED US, THROUGH THE 2511 01:40:29,773 --> 01:40:30,073 VIDEOCAST. 2512 01:40:30,073 --> 01:40:31,174 WE WILL NOW TAKE A BREAK, I 2513 01:40:31,174 --> 01:40:32,842 THINK WE WILL TAKE A 15 MINUTE 2514 01:40:32,842 --> 01:40:36,479 BREAK WHICH WILL TAKE US TO 2515 01:40:36,479 --> 01:40:36,679 4:00. 2516 01:40:36,679 --> 01:40:43,653 AND THEN, WE WILL BEGIN THE 2517 01:40:43,653 --> 01:40:44,587 CLOSED SESSION PORTION OF █THE 2518 01:40:44,587 --> 01:40:47,090 MEETING, SO THANK YOU ALL. 2519 01:40:47,090 --> 01:40:53,463 AND WE WILL NOW MOVE TO A BREAK. 2520 01:40:53,463 --> 01:40:55,131 >> VIDEOCAST CAN YOU CONFIRM 2521 01:40:55,131 --> 01:41:05,675 WE'RE DISCONNECTED INCONNECTED?