>>IT IS TIME TO CALL THIS 56th MEETING OF THE NIMHD ADVISORY COUNCIL TO ORDER. I AM ELISEO PEREZ-STABLE, THE DIRECTOR OF THE NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES. THIS MORNING'S OPEN SESSION IS OPEN TO THE PUBLIC, IS BEING BROADCAST ON THE NIH VIDEOCAST NETWORK. COUNCIL MEMBERS, PLEASE SPEAK SLOWLY AND DISTINCTLY. VIDEOCASTERS AND NOTE TAKERS WILL BE LISTING TO HEAR YOUR COMMENTS. DR. VOLLBERG WILL PROMPT YOU, AFTER YOU'RE RECOGNIZED TO SPEAK. IN THE EFFORT TO CONSERVE BANDWIDTH AND MINIMIZE BACKGROUND NOISE DR. VOLLBERG WILL LEAD THE ROLL CALL. STATE YOUR NAME, ORGANIZATION, AND ANY FACTS YOU WOULD LIKE TO SHARE WITH US. DR. VOLLBERG? >> HELLO. WELCOME. THANK YOU ALL FOR BEING HERE. I WILL FIRST START ARE OUR ROSTER MEMBERS, MEN EX OFFICIO MEMBERS, AND THEN MEMBERS NIMHD STAFF NORMALLY WOULD BE SEAT AROUND THE TABLE IN PERSON. SO, FIRST, DR. BARNES COULD YOU IDENTIFY YOURSELF PLEASE? >> LISA BARNES, NURSE PSYCHOLOGIST, ENDOWED PROFESSOR OF GERONTOLOGY AND GERIATRIC MEDICINE, RUSH UNIVERSITY MEDICAL CENTER IN CHICAGO, AND MY EXPERTISE IS IN RACIAL AND ETHNIC DISPARITIES OF CHRONIC DISEASES OF AGING WITH PARTICULAR FOCUS ON ALZHEIMER'S DISEASE. HAPPY TO BE HERE. >> THANK YOU. DR. CALMAN? >> GOOD MORNING, EVERYONE. NEIL CALMAN, FAMILY PHYSICIAN, CHAIR OF THE DEPARTMENT OF FAMILY MEDICINE AND COMMUNITY HEALTH AT THE ICAHN SCHOOL OF MEDICINE, MT. SINAI, PRESIDENT OF THE INSTITUTE FOR FAMILY HEALTH, WHICH IS A NETWORK OF 32 FEDERALLY QUALIFIED COMMUNITY HEALTH CENTERS IN NEW YORK CITY AND THE HUDSON VALLEY OF NEW YORK. AND MY RESEARCH INTERESTS ARE IN STRUCTURAL RACISM. >> THANK YOU. DR. CHIN? >> MARSHAL CHIN, GENERAL INTERNIST, HEALTH SERVICES RESEARCHER UNIVERSITY OF CHICAGO, I DO MULTI-LEVEL HEALTH DISPARITIES WORK. >> THANK YOU. DR. CORBIE-SMITH. OH, SORRY, DR. CORBIE-SMITH IS NOT WITH US TODAY. BEER JOHNSON? >> GOOD MORNING, KIMBERLY JOHNSON, GERIATRICIAN AND PROFESSOR OF MEDICINE AT DUKE UNIVERSITY MEDICAL CENTER IN DURHAM, NORTH CAROLINA, AND LEAD OUR CENTER OF EXCELLENCE ON MINORITY HEALTH AND HEALTH DISPARITIES WHICH FOCUSES ON RACIAL AND ETHNIC DISPARITIES IN THE CLINICAL REALM. >> THANK YOU. DR. KAHOLOKULA? >> ALOHA, I'M KEAWE KAHOLOKULA, UNIVERSITY OF HAWAII, ENGAGE IN APPLIED AND BASIC TRANSLATIONAL RESEARCH AIMED AT ELIMINATING HEALTH DISPARITIES AMONG NATIVE AND PACIFIC ISLANDERS. DR. >> THANK YOU. DR. LIN, ARE YOU ARE? DR. LIN? I GUESS HE'S NOT WITH US THIS MORNING. DR. MANSON? HE MUST BE JOINING US LATE AS WELL. DR. MUSTANSKI? >> GOOD MORNING, DR. BRIAN MUSTANSKI, PROFESSOR AT NORTHWESTERN UNIVERSITY, WHERE I DIRECT THE INSTITUTE FOR SEXUAL AND GENDER MINORITY HEALTH AND WELL BEING, AND ALSO CO-DIRECT CENTER FOR AIDS RESEARCH, FOCUSING ON HEALTH AND WELL BEING OF LGBTQ YOUNG PEOPLE WITH PARTICULAR FOCUS ON YOUTH USE OF TECHNOLOGY FOR HIV PREVENTION. >> THANK YOU. NEXT, DR. RAMIREZ. >> THANK YOU, GOOD MORNING. AMELIE RAMIREZ, DIRECTOR OF THE INSTITUTE FOR HEALTH PROMOTION RESEARCH FOR LATINOS NATIONWIDE, UT HEALTH SCIENCE CENTER IN SAN ANTONIO. >> THANK YOU. DR. REEDE? >> JOAN REEDE, DEAN FOR COMMUNITY PARTNERSHIP HARVARD MEDICAL SCHOOL, PROFESSOR OF MEDICINE AT THE MEDICAL SCHOOL, PROFESSOR AT THE SCHOOL OF PUBLIC HEALTH. >> THANK YOU. DID I CUT YOU OFF? >> NO, YOU DIDN'T. I'M GETTING READY TO COME OUT AND COME BACK IN, I CAN BARELY HEAR. >> THANK YOU. DR. RESNIKOW? >> KEN REZNICKOW, UNIVERSITY OF MICHIGAN, ANN ARBOR, HEALTH DISPARITIES RESEARCH, PERSONAL RESEARCH ON HEALTH COMMUNICATION INCLUDING (INDISCERNIBLE) POPULATIONS (INDISCERNIBLE). >> THANK YOU. DR. SOUTHERLAND? >> GOOD MORNING, BILL SOUTHERLAND, PROFESSOR OF BIOCHEMISTRY, ALSO THE P.I. OF HOWARD'S RESEARCH CENTER FOR MINORITY INSTITUTIONS PROGRAM, AND MY RESEARCH INTERESTS CENTERS AROUND DATA SCIENCE APPROACHES TO MINORITY HEALTH AND HEALTH DISPARITIES ISSUES AND CONCERNS. THANK YOU. >> THANK YOU. DR. ZORRILLA? >> GOOD MORNING, CARMEN ZORRILLA, OB/GYN BY TRAINING, RESEARCH AT THE MEDICAL CENTERS CAMPUS, MOST OF MY RESEARCH CAREER HAD DO WITH CLINICAL RESEARCH RELATED TO HIV AND PREVENTION, AND NOW I'M INVOLVED IN RESPONSE TO THE COVID PANDEMIC IN TERMS OF TESTING SITES, VACCINE SITES, AND (INDISCERNIBLE). NICE MEETING YOU. >> THANK YOU. DR. JUDITH LONG? >> JUDITH LONG, CO-DIRECTOR OF THE CENTER FOR HEALTH EQUITY RESEARCH AND PROMOTION, ALSO THE DIVISION CHIEF OF GENERAL INTERNAL MEDICINE UNIVERSITY OF PENNSYLVANIA, AND MY RESEARCH FOCUSES ON (INDISCERNIBLE) SUPPORT BEHAVIOR CHANGE AND ADDRESS SOCIAL DETERMINANTS OF HEALTH IN VULNERABLE POPULATIONS. THANK YOU. >> THANK YOU. DR. SHELL? >> GOOD MORNING, DONALD SHELL, FAMILY PHYSICIAN BY TRAINING, EX OFFICIO MEMBER DEPARTMENT OF DEFENSE, OFFICE OF ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS, RACIAL AND HEALTH DISPARITIES, GLAD TO BE HERE TODAY. THANK YOU. >> THANK YOU. NOW WE MOVE TO NIMHD STAFF, DEPUTY DIRECTOR AND DIVISION DIRECTORS. DR. HOOPER? EXCUSE ME. BEFORE I DO THAT, I MISSED REPRESENTATIVE FROM NIH, DR. RILEY. >> THANK YOU. HELLO, I'M BILL RILEY, SOCIAL DIRECTOR FOR BEHAVIORAL AND SOCIAL SCIENCES RESEARCH AT THE NIH, NON-VOTING MEMBER. >> THANK YOU. NOW, DR. HOOPER. >> GOOD MORNING, NICE TO BE WITH EVERYONE TODAY, MONICA WEBB HOOPER, DEPUTY DIRECTOR OF NIMHD. >> THANK YOU. DR. GILASANTO, ARE YOU ON? OKAY, SHE MAY BE LISTENING IN ON VIDEOCAST. DR. SAYER, ARE YOU THERE? >> GOOD MORNING, MIKE SAYER, DIRECTOR OF INNOVATIVE BIOLOGICAL AND BEHAVIORAL SCIENCES AT NIMHD. GREAT TO SEE YOU ALL. THANKS. >> THANK YOU. DR. STINSON, ARE YOU THERE? >> GOOD MORNING, DIRECTOR OF DIVISION OF COMMUNITY HEALTH AND POPULATION SCIENCE, WELCOME, EVERYONE. >> THANK YOU. I'M TOM VOLLBERG, DIRECTOR OF THE OFFICE OF EXTRAMURAL RESEARCH ADMINISTRATION, AND I'M THE DFO FOR THIS MEETING. AT THIS POINT DR. PEREZ-STABLE IS THE OTHER STAFF MEMBER WHO HASN'T INTRODUCED HIMSELF, HE DID SORT OF WHEN WE JOINED. WOULD YOU LIKE TO SAY ANYTHING ELSE BEFORE WE MOVE TO MINUTES? >> I WANT TO JUST THANK EVERYONE FOR TAKING THE TIME TO JOIN US TODAY FROM COUNCIL, AND WE WILL PROCEED WITH MINUTES AND MY PRESENTATION. THANK YOU, TOM. >> OKAY. SO THE NEXT ITEM OF BUSINESS IS THE APPROVAL OF MINUTES FROM SEPTEMBER 2020 2020 MINUTES. I WONDER IF THERE ARE QUESTIONS, CONCERNS, DIRECTIONS, I HAVE NOT RECEIVED ANY PREVIOUSLY. IF YOU HAVE ANY PLEASE ENTER THEM IN THE CHAT NOW. I DO NOT SEE ANY. >> MOVE TO ACCEPT THE MINUTES. >> SECOND. >> OKAY. WE HAVE A MOVE AND SECOND. THANK YOU. COULD THE MEMBERS OF THE COUNCIL INDICATE YES OR NO FOR THEIR APPROVAL OF THE MINUTES? ENTER THAT IN THE CHAT. WE'LL TALLY THOSE UP. THANK YOU. THE MINUTES ARE APPROVED. I SEE DR. LIN HAS NOW JOINED US. WOULD YOU LIKE TO INTRODUCE YOURSELF AND I'M LOOKING AND I SEE OTHER MEMBERS WHO HAVE JOINED. DR. LIN IF YOU'D LIKE TO UNMUTE AND INTRODUCE YOURSELF. YOU'RE STILL MUTED, DR. LIN. >> OKAY. GOOD MORNING. THIS IS DR. LIN. I'M ALSO A SURGEON, FORMER DEPUTY ASSISTANT SECRETARY FOR MINORITY HEALTH AND HEALTH DISPARITIES IN HHS. IT'S MY HONOR TO JOIN YOU. THANK YOU. >> YOU'RE MUTED. >> DR. MANSON, I'M SORRY, I WAS MUTED. THANK YOU. DR. MANSON, IF YOU WOULD TAKE A MOMENT AND JUST INTRODUCE YOURSELF FOR THE VIDEOCAST. WE DON'T HAVE YOUR AUDIO, SPERO. SORRY. >> SPERO MANSON. (INAUDIBLE). CAN YOU HEAR ME NOW? [ DISTORTED AUDIO ]. >> THANK YOU FOR BEING PATIENT WITH US. AT THIS POINT NOW WE CAN TURN THINGS BACK -- WELL, THE NEXT ITEM OF BUSINESS IS FUTURE MEETING DATES. I WANT TO REMIND PEOPLE OF WHAT THE FUTURE MEETING DATES ARE LISTED ON THE AGENDA. AFTER REVIEWING DATES LET US KNOW IF THERE'S A DATE YOU ABSOLUTELY CANNOT MAKE. IT'S IMPORTANT WE HAVE A QUORUM OF MEMBERS FOR EACH MEETING TO CONDUCT THE BUSINESS OF THE INSTITUTE. OUR POLICY ALLOWS FOR COUNCIL MEMBER TO HAVE ONE ABSENCE PER CALENDAR YEAR, IN 2021 WE'RE SCHEDULED TO MEET ON MAY 24 AND 25, AND SEPTEMBER 9 AND 10. AND THEN IN 2022 FIRST MEETING IN 2022 IS FEBRUARY 3 AND 4, AND MAY 23 AND 24. THOSE DATES ARE -- I'M GIVING TWO DATES. ONE OF THOSE WILL LIKELY BE A CLOSED SESSION, AND THE OTHER AN OPEN SESSION, BUT IT'S NOT YET DETERMINED WHICH DAY WILL BE WHICH. SO THAT'S WHY YOU'RE PROVIDED WITH BOTH DATES. OKAY. WITH THAT, I CAN NOW TURN THINGS BACK TO DR. PEREZ-STABLE FOR THE NEXT ITEM IN THE AGENDA, THE DIRECTOR'S REMARKS. >> OKAY. SO, I'M GOING TO SHARE MY SCREEN, AND SEE IF I CAN GET MY SLIDES UP. CAN EVERYBODY SEE MY SLIDES? >> YES. >> OKAY. GOOD. SO, THANKS, ALL COUNCIL MEMBERS, FOR YOUR PRESENCE THIS MORNING. I'LL TAKE YOU THROUGH SORT OF A TOUR OF THE LAST FOUR MONTHS AT NIH, NIMHD. HOPEFULLY WE'LL FINISH IN TIME FOR QUESTIONS AND HAVE A BREAK FOR LUNCH BEFORE WE HAVE OUR SPEAKERS JOIN US AT 1:00. AND I ALSO WANT TO THANK ALL THE NIMHD STAFF REALLY FOR JUST BEING REMARKABLE IN THEIR WORK, THEIR COMMITMENT, PASSION, TO ADVANCE THE AGENDA ON MINORITY HEALTH, HEALTH DISPARITIES, WHAT WAS A HISTORICAL YEAR OF CRISIS AND OPPORTUNITY FOR US, FOR THE COUNTRY AND THE WHOLE WORLD. WE DON'T SEE AN END OF IT YET SO I THINK PERSISTENCE WILL PAY OFF WELL. SO I'LL START WITH A FEW UPDATES FROM NIH. AS YOU HEARD FROM THE NEWS, DR. FRANCIS COLLINS WILL CONTINUE HIS ROLE AS DIRECTOR OF NATIONAL INSTITUTES OF HEALTH. HE IS NOW APPROACHING HIS 12th YEAR OF CONFIRMED DIRECTOR OF NIH, WILL AT SOME POINT BE THE LONGEST ACTING NIH DIRECTOR I THINK. AND FRANCIS HAS OUR FULL SUPPORT AND HIS ENERGY, PASSION, AND SUCCESS AS AN ADVOCATE FOR SCIENCE ON A NATIONAL AND GLOBAL SCALE AS WELL AS IMPORTANTLY WITH CONGRESS HAS BEEN A BENEFIT TO ALL OF THE COMMUNITY OF RESEARCH AND ALL OF SCIENCE AND THE POPULATION. LARRY TABAK HAS CONTINUED HIS ROLE AS PRINCIPAL DEPUTY DIRECTOR, AND WE HAVE I THINK AT THIS POINT A FULL STAFF OF DIRECTORS, SO KNOW NEW DIRECTORS SEARCH IS PENDING. JUST TO GO OVER THE SCIENCE APPOINTMENTS FROM THE ADMINISTRATION, THESE ARE SOME OF THE HIGHLIGHTS. XAVIER BECERRA IS DESIGNATE FOR HEALTH AND HUMAN SERVICES SECRETARY, HAS TO UNDERGO SENATE CONFIRMATION. DAVID KESSLER DIRECTOR OF OPERATION WARP SPEED, CONFIRMED POINT AND WILL CHANGE THE NAME PRINCIPALLY FOCUSED ON VACCINE DISTRIBUTION AND NEW DEVELOPMENTS IN THERAPEUTICS. ERIC LANDER OF HUMAN GENOME PROJECT FAME WILL SERVE AS PRESIDENTIAL SCIENCE ADVISER, DIRECTOR OF OFFICE OF SCIENCE AND TECHNOLOGY POLICY, A SENATE CONFIRMED AAPPOINTMENT. ALONGDRA NELSON WILL BE DEPUTY DIRECTOR, QUITE A BALANCE AND PERSPECTIVE FOR THIS OFFICE, TRADITIONALLY FILLED BY A PHYSICAL SCIENTIST. VIVEK MURTHY APPOINTED TO SERVE AS U.S. SURGEON GENERAL AGAIN, WILL UNDERGO SENATE CONFIRMATION FOR THIS POSITION. ROCHELLE WALENSKY NEW DIRECTOR OF CDC, STARTED IN HER JOB TEN DAYS AGO, SHE CAME FROM THE MASSACHUSETTS GENERAL HOSPITAL WHERE SHE WAS CHIEF OF INFECTIOUS DISEASE. AND IS HIGHLY REGARDED BY ALL WHO KNOW HER. AND FINALLY RACHEL LEVINE, CURRENTLY THE CHIEF HEALTH OFFICER FOR STATE OF PENNSYLVANIA, IS THE DESIGNATE TO SERVE AS THE ASSISTANT SECRETARY FOR HEALTH, WHICH IS A KEY POSITION FOR NIH AND THAT IS ALSO A SENATE-CONFIRMED APPOINTMENT. MOST OF YOU KNOW THAT LAST SEPTEMBER, DR. HANNAH VALANTINE LEFT NIH AFTER SPENDING SIX YEARS AS THE INAUGURAL CHIEF OF THE OFFICER -- CHIEF OFFICER FOR THE SCIENTIFIC WORKFORCE DIVERSITY OFFICE, HANNAH CAME TO US FROM STANFORD, A CARDIOLOGIST, ON THE FACULTY OF STANFORD A LONG TIME. TURNED OUT SHE AND GARY GIBBONS BECAME ASSISTANT PROFESSORS ABOUT THE SAME TIME, AND DURING HER TIME AT NIH HANNAH WAS CHARGED WITH LEADING NIH EFFORTS TO ADDRESS THE CRISIS OF LACK OF DIVERSITY IN THE BIOMEDICAL WORKFORCE, PARTICULARLY FOCUSED ON SCIENTIFIC WORKFORCE, SHE DID I THINK A SPECTACULAR JOB OF CREATING PROGRAMS PASSIONATELY ADVOCATING FOR THIS -- FOR THESE CAUSES, AND SUPPORTING DIFFERENT PROGRAMS, BOTH ON THE INTRAMURAL AND EXTRAMURAL PROGRAM. THE FIRST PROGRAM WHICH I WILL MENTION LATER IS A LEGACY OF HER EFFORTS, AND SHE'S HAD WIDE SUPPORT. SHE HAD WIDE SUPPORT FROM A NUMBER OF INSTITUTE DIRECTORS. MARIE BERNARD, WHO IS THE CURRENT DEPUTY DIRECTOR OF THE NATIONAL INSTITUTE ON AGING, AND GERIATRICIAN BY TRAINING, IS SERVINGS A ACTING CHIEF OFFICER FOR SCIENTIFIC WORKFORCE DIVERSITY AND THERE'S AN ACTIVE SEARCH ONGOING, SO VERY HIGH LEVEL IMPORTANT SEARCH AND WE'LL SEE WHAT THE OUTCOME OF THIS IS. WE LOOK FORWARD TO WORKING WITH THE NEW DIRECTOR. NIH HAD A PLEASANT SURPRISE THIS PAST FALL WITH THE NAMING OF A NOBEL LAUREATE, HARVEY ALTER, WHO I KNEW HIS NAME, I'VE NOT MET HIM. SENIOR SCHOLAR AT THE NIH CLINICAL CENTER, WHO REALLY WAS THE MAIN -- ONE OF THE MAIN DISCOVERERS OF THE HEPATITIS C VIRUS, CLEARLY A MAJOR CONTRIBUTOR TO MORBIDITY AND MORTALITY IN THE POPULATION, CAME THROUGH CLEARLY, YOU KNOW, WAS PART OF WHAT WAS CALLED TRANSFUSION HEPATITIS, AND THAT'S HOW DR. ALTER CAME ABOUT TO HIS DISCOVERY, SCIENTIFIC DISCOVERY. HE WAS WORKING IN TRANSFUSION MEDICINE. BUT HIS RESEARCH WAS SYSTEMATIC. A GREAT EXAMPLE OF A CLINICIAN-SCIENTIST WHO WENT ABOUT ASKING IMPORTANT BASIC QUESTIONS AND GRADUALLY CONTRIBUTING TO THE ANSWERS. OF COURSE HEPATITIS C, BECAUSE IT BEING IDENTIFIED AND BEING AVAILABLE TO BE TESTED FOR, BOTH WITH ANTIBODY NOW AND VIRAL LOAD, THERE ARE NOW CURATIVE THERAPIES THAT ARE REALLY QUITE EFFECTIVE FOR THE MOST COMMON TYPE OF HEPATITIS C, AND THIS IS A DISEASE ABOUT 60% OF THE TIME ONE IS INFECTED WITHOUT SYMPTOMS, AND GOES ON TO DEVELOP CHRONIC SEQUELAE IN A SIGNIFICANT AMOUNT OF TIME. HE SHARES THE AWARD WITH MICHAEL HOUGHTON AND CHARLES RICE, A DISTANT CEREMONY ON DECEMBER 7. WE ENCOURAGE YOU TO RELY ON THESE WEBSITES AS MUCH AS NEEDED TO LOOK AT ISSUES RELATED TO COVID-19, CONSTANTLY BEING UPDATED, AND WITH THE LATEST INFORMATION AND RECOMMENDATIONS, PROVIDING TRUSTED, ACCURATE AND UP-TO-DATE INFORMATION ABOUT RESEARCH, VACCINES, TRIALS, TREATMENT. PERHAPS WE HAD THE MOST COMMITMENT OR INVESTMENT IN THE ONE THAT THE COMMUNITY ENGAGEMENT ALLIANCE AGAINST COVID-19 DISPARITIES PUT UP, THE CEAL EFFORT, WHICH DEVELOPED OVER AUGUST AND SEPTEMBER OF 2020, HAS REALLY CREATED A DYNAMIC AND BROAD PROGRAM AFFECTING LARGE SEGMENT OF THE U.S. POPULATION. OUR GOAL WAS TO RESPOND TO A NEED TO HAVE GREATER INCLUSIVE PARTICIPATION IN THE CLINICAL TRIALS THAT WERE BEING IMPLEMENTED, OR CARRIED OUT ON THE VACCINE, INITIALLY, AND ALSO THERAPEUTICS. BUT PRIMARILY FOCUSED ON THE VACCINE, TWO INITIAL CLINICAL TRIALS ON MESSENGER RNA VACCINEs, BOTH APPROVED FOR EMERGENCY USE, MODERNA AND PFIZER VACCINES, WERE TO RANDOMIZE 30,000 TO 40,000 VOLUNTEERS IN RANDOMIZED PLACEBO TRIAL. AND THE INITIAL NUMBER OF PARTICIPANTS WERE PREDOMINANTLY WHITE, THERE WAS CONCERN THAT THE POPULATION MOST BEING AFFECTED WAS NOT BEING INCLUDED IN TRIALS. WE WENT ABOUT TRYING TO BUILD AND SUSTAIN TRUSTING RELATIONSHIPS WITH THESE COMMUNITY ENGAGEMENT, APPEALING TO MANY OF YOU TRUSTED INVESTIGATORS WHO HAVE BEEN DOING THIS WORK FOR YEARS, AND TO REALLY REORIENT THE EMPHASIS ON INFORMATION ABOUT SCIENCE. THE PROGRAM HAS EMPHASIZED THE IMPORTANCE OF MOVING AT THE SPEED OF TRUST, AND I WANT TO DWELL ON THE IMPORTANT MESSAGE NOT ONLY OF TRUSTED VOICES AND TRUSTED MESSAGES BUT ALSO MESSENGERS, AT THE NATIONAL AND LOCAL LEVELS. WE KNOW THAT EVERYONE IN THE COUNTRY WANTS TO HEAR FROM DR. TONY FAUCI, AND WE DO TOO AT THE NIH DIRECTOR'S MEETING WHEN HE'S AVAILABLE. BUT WE KNOW THAT'S NOT POSSIBLE A LOT OF TIMES SO WE REALLY ENCOURAGE GROUPS AND ORGANIZATIONS TO RELY ON LOCAL TRUSTED LEADERS. YOU DON'T NEED TO BE A CELEBRITY TO TRANSMIT THIS MESSAGE. AND WE EMPHASIZE THE IDEA OF THIS FOCUS. AND WE'RE ALSO MORE THAN WILLING TO HELP IN THAT CONTEXT FROM THE NIH SIDE. NOW, CEAL HAS BEEN SET UP IN 11 DIFFERENT PROGRAMS, HIGHLIGHTED IN THE BLUE STATES, SHOWN HERE. WE FOCUS PRIMARILY IN SOUTHEAST, ALSO INCLUDED ARIZONA, CALIFORNIA, AND MICHIGAN AND TEXAS, TECHNICALLY NOT THE SOUTHEAST. THE GOAL AT THE TIME WE SET THIS UP WAS TO OVERLAP WITH THE PANDEMIC, WAS PEAKING AT THE TIME, SURGING AT THE TIME, IN THE SUN BELT, AND ALSO WHERE THEY ARE COINCIDED A HIGH PROPORTION OF COMMUNITIES OF COLOR. NOT ONLY AFRICAN AMERICANS AND LATINOS BUT ALSO AMERICAN INDIANS AND PACIFIC ISLANDERS. THE FOCUS IS NOT JUST LEVERAGING OUR ACADEMIC PARTNERS WHO HAVE FOR YEARS WORKED IN COMMUNITY ENGAGEMENT, BUT ALSO FULL PARTNERSHIP WITH COMMUNITY-BASED ORGANIZATIONS, IN ALL OF OUR GOVERNANCE SET UP THIS WAY. SO AS YOU CAN SEE THESE ARE THE DIFFERENT ORGANIZATIONS THAT WE'RE WORKING WITH. HEAVY EMPHASIS ON THE COMMUNITY-BASED ORGANIZATIONS, AS I MENTIONED, HEALTH CARE CENTERS, MEANING COMMUNITY HEALTH CENTERS, AS WELL AS CLINICIANS OUT THERE. FAITH-BASED ORGANIZATIONS, STATE AND LOCAL GOVERNMENT AGENCIES, PARTICULARLY THE PUBLIC HEALTH OFFICES AND PHARMACY NETWORKS. NEXT SLIDE. THE UNDERSERVED POPULATIONS PROGRAM, RADx, A MAJOR EFFORT BEING CO-LED BY NIMHD ALONG WITH RICHARD HODES AND TARA SCHWETZ, TO PROMOTE TESTING, FOCUSED ON PROMOTING INTERVENTION TO INCREASE TESTING IN UNDERSERVED AND VULNERABLE POPULATION, FUNDED A CONSORTIUM OF COMMUNITY-ENGAGED RESEARCH PROJECTS, 69 TO BE EXACT, INCLUDING LARGE COORDINATION AND DATA COLLECTION CENTER, STRENGTH OF DATA AVAILABLE ON INFECTION RATES, DISEASE PRE-ESSENTIAL AND OUTCOME, TO IDENTIFY STRATEGIES, OVERALL GOAL TO IDENTIFY STRATEGIES AND MECHANISMS BY WHICH WE CAN THEN INTERVENE AND REDUCE THE DISPARITIES THAT HAVE BEEN PERSISTENT IN COVID-19 THAT WE HAVE SEEN, PERSISTED OVER THE FIRST YEAR OF THE PANDEMIC. WE'RE CURRENTLY IN THE PROCESS OF PLANNING PHASE 2, AS WE JUST GET GOING WITH PHASE 1, BEGIN TO CONTINUE TO MEET REGULARLY WITH THE DIFFERENT GROUPS. NEXT SLIDE. RADx COORDINATION AND DATA COLLECTION CENTER IS FUNDED AT DUKE AND UNIVERSITY OF NORTH CAROLINA. THREE CO-PRINCIPAL INVESTIGATORS INCLUDE (INDISCERNIBLE) AND WARREN KIBB, FOUR PRIMARY TASKS, FIRST AND MOST IMPORTANT PERHAPS IS ADMINISTRATION AND COORDINATION SO SETTING UP A COMMUNICATION MECHANISM, VARIETY OF PROCESSES AND POLICIES, AND PARTNERSHIPS, ACT AS LIAISON BETWEEN NIH, PRIMARILY NIMHD, AND THE PROJECTS. WE ALSO ARE ABLE TO PROVIDE SUPPORT ON DATA SCIENCE AND BIOSTATISTICS, WARREN KIBB IS RESPONSIBLE, IN CHARGE OF THIS AREA, ON THE COVID-19 TESTING WHAT'S AVAILABLE, WHAT TESTS ARE BEST, TECHNICAL SUPPORT, AND THIS WE WILL RELY ON SOME OF OUR COLLEAGUES AT NIH IN THE NATIONAL INSTITUTE OF BIOMEDICAL ENGINEERING. AND IN COMMUNITY ENGAGEMENT, WHERE THE FOCUS, THE LEAD IS DR. GISELLE CORBIE-SMITH WHO IS ON OUR COUNCIL, AND WILL FOCUS ON HELPING SUPPORT THE COMMUNITY OF PRACTICE AND COLLABORATION WITH DIFFERENT GROUPS. THERE ARE 53 TESTING PROJECTS THAT HAVE BEEN FUNDED, AT TWO DIFFERENT SITES, AND 16 RESEARCH PROJECTS ON SOCIAL, ETHICAL AND BEHAVIOR ISSUES IN COVID AND THE COORDINATING CENTER. NEXT SLIDE. THIS IS A MAP SHOWING THE -- ALL THE AWARDS RECEIVED IN PHASE 1. I WOULD HIGHLIGHT A COUPLE OF THINGS. ONE IS WE DID FUND THE UNIVERSITY OF HAWAII WITH A PROJECT FOCUSED ON NATIVE ISLANDERS AND PACIFIC ISLANDERS, A PROJECT FOCUSED IN PUERTO RICO AND YALE, INCLUDING PUERTO RICO AND U.S. VIRGIN ISLANDS, WE HAVE A PROJECT IN MONTANA STATE, THROUGH ONE OF THE NARCH CENTERS, THE STANFORD PROJECT WHICH IS FUNDED SUPPLEMENT TO NIMHD GRANT IS ACTUALLY FOCUSED ON SOUTH DAKOTA SIOUX IN THAT PROJECT, AND THERE ARE -- I THINK FAIRLY WELL COVERED MAP, NOT THE ENTIRE COUNTRY AS YOU CAN SEE, AND ONE OF THE CHALLENGES MAY BE THAT IN THE PHASE 2 WE'LL BE LOOKING TO FILL SOME OF THOSE GAPS. I WOULD HIGHLIGHT THREE STATES THAT WERE NOT FUNDED FOR RADX-up ARE INCLUDED IN CEAL, STATE OF MISSISSIPPI, TENNESSEE AND MICHIGAN. NEXT SLIDE. THESE ARE SOME OF THE NIMHD RADX-up SUPPLEMENTS FOR YOUR AWARENESS. YOU MAY KNOW SOME OF THESE INDIVIDUALS, WASHINGTON STATE, DEDRA BUCHWALD ON URBAN INDIANS, THE ONLY PROJECT. EIDA CASTRO AS PONS SCHOOL OF MEDICINE IN FREAK. MONA FOUAD, UNIVERSITY OF ALABAMA. JERRIH HEDGES UNIVERSITY OF HAWAII. ROBERT KIRKEN, UNIVERSITY OF TEXAS, EL PASO, BOTH ARE RCMIs. DEEPAK KUMAR AT NORTH CAROLINA CENTRAL HBCU AND YVONNE MALDONADO, STANFORD FOCUSED ON SOUTH DAKOTA. THE OTHER PROGRAMS FLAVIO MARSILGI, AT ARIZONA STATE, PEARL McELFISH, UNIVERSITY OF ARKANSAS. MARCELLA NUNEZ-SMITH, SHE'S NOW OCCUPIED AS I MENTIONED WITH CHIEF COVID ADVISER FOREPRESIDENT BIDEN. NYU PROGRAM, BILL SUTHERLAND ON THE COUNCIL, AND GUANGDI WANG, AND LILLIAN WINTER FROM UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN. NEXT SLIDE. WE SWITCH TO NIMHD UPDATES. NEXT SLIDE PLEASE. I'VE ALREADY MENTIONED MARCELLA A COUPLE TIMES. SHE WILL BE SERVING ON PRESIDENT BIDEN'S COVID-19 TASK FORCE. WE MET AROUND THE TIME OF INAUGURATION AND LOOK FORWARD TO WORKING WITH HER AS SHE EMBARKS ON THIS MAJOR TASK SHE'S TAKEN ON. MARGARETA ALEGRI, HARVARD UNIVERSITY, RECEIVED REMA LAPOUSE AWARD. VICKIE MAYS FROM UNIVERSITY OF CALIFORNIA LOS ANGELES PRESENTED CARL TAUBE LIFETIME ACHIEVEMENT AWARD FOR MENTAL HEALTH RESEARCH AND SPERO MANSON UNIVERSITY OF COLORADO, CAREER ACHIEVEMENT AWARD. WE'VE HAD ACTIVITY ON THE LEGISLATIVE FRONT, IT'S ALL BEEN ON A VIRTUAL FRONT. I MENTIONED IN SEPTEMBER SEVERAL MEETINGS WE HAD WITH CONGRESSIONAL -- WITH CAUCUSES, WITH INDIVIDUAL SENATORS, AROUND THE BUILDUP OF RADX-up, THAT HAS SLOWED DOWN A LITTLE BIT BUT WE'VE BEEN ACTIVE IN SOME OF THESE. I PARTICIPATED IN A ROUNDTABLE PUT ON BY THE ATLANTIC, TO ACHIEVE HEALTH EQUITY FOR ALL, WITH AT LEAST ONE CONGRESSWOMAN PRESENT IN THAT ROUNDTABLE, AND OTHERS INCLUDING DAVID HEYS BATISTA. I ALSO PARTICIPATED IN AD HOC GROUP, COALITION FOR HEALTH FUNDING, NIMHD WORK TO ADDRESS HEALTH DISPARITIES IN SEPTEMBER. LATER IN SEPTEMBER, WITH FRANCIS COLLINS, LEADING THE WAY, A BRIEFING OF THE TRICAUCUS, QUAD CAUCUS, A LOT OF DISCUSSIONS ABOUT WHAT CEAL WAS DOING, WHAT WE COULD DO ABOUT VACCINE UPTAKE AT THE TIME, OF COURSE THE TRIALS, RESULTS OF THE TRIALS WERE NOT OUT YET, AND ALSO DISCUSSED ISSUES AROUND RADx-UP. DR. FAUCI, DR. GIBBONS AND DR. DAVID WILSON ALL PARTICIPATED IN THAT BRIEFING. NEXT SLIDE. IN OCTOBER, WE BRIEFED THE STAFF OF MEMBERS OF THE HOUSE KNELT AND COMMERCE COMMITTEE, DR. GARY GIBBONS AND I PARTICIPATED. IN NOVEMBER BRIEFED HOUSE ENERGY AND COMMERCIAL STAFF ON HOW DATA FROM COVID-19 TESTING STUDIES COULD BE USED TO EXPAND COVID-19 TESTING CAPACITY. RICHARD HODES, BRUCE TROMBERG FROM NIBIB LED THE TECHOLOGY WITH CONGRESSIONAL FUNDING SUPPORT AND DR. TARA SCHWETZ FROM NIH OFFICE OF DIRECTOR, ASSOCIATE DEPUTY DIRECTOR, WE PARTICIPATED IN THAT BRIEFING WITH STAFF WITH CONGRESSIONAL STAFF IN NOVEMBER. FINALLY, DR. MONICA WEBB HOOPER SPOKE AT A TEXAS TOWN HALL ORGANIZED BY TEXAS CEAL GROUP WITH REPRESENTATIVE SHEILA JACKSON LEE TO JUST NATIONAL EFFORTS OF THE CEAL INITIATIVE. NEXT SLIDE. AT THE END OF DECEMBER OUR BUDGET WAS APPROVED AND SIGNED BY THE PRESIDENT AT THE TIME. THIS IS AN ILLUSTRATION OF WHAT THE NIMHD BUDGET HAS DONE OVER THE LAST FIVE YEARS. YOU CAN SEE IN FISCAL YEAR 2017 WE WERE AT $289 MILLION, THAT WAS AN INCREASE OF 279 IN FISCAL 16. FISCAL 16 WAS WHEN 21ST CENTURY CURES WAS APPROVED. NIH INCREASES HAVE BEEN STEADY EVERY YEAR AND WE HAVE BENEFITED FROM THIS. USUALLY, WITH SOME DIVISION OF THE ALLOCATION OF OUR INCREASE, ABOUT HALF IS FOR TARGETED PROGRAMS, HALF HAS BEEN FOR GENERAL INCREASE, WHICH IS APPROXIMATELY WHAT HAPPENS TO THE AGENCY AS A WHOLE. IN 2021, FISCAL 21, WE HAD A SIGNIFICANT INCREASE ABOVE AND BEYOND WHAT WOULD HAVE BEEN EXPECTED FROM THE INCREASE FOR NIH AS A WHOLE, WHICH WAS A LITTLE BIT MORE MODEST THIS YEAR THAN IT HAD BEEN IN EACH OF THE LAST THREE YEARS. AND BUT MOST OF THIS WAS TARGETED, I'LL TALK ABOUT THIS LATER, RELATED TO CHRONIC DISEASE CENTERS. NEXT SLIDE. THIS IS A BREAKDOWN OF OUR BUDGET IN FISCAL YEAR 20. WE'RE ROUGHLY I THINK MORE OR LESS IN A STEADY STATE. RESEARCH PROJECTS, RESEARCH GRANTS ARE ABOUT 44% OF OUR BUDGET. NOTE INTRAMURAL IS STILL QUITE MODEST AT 2%. AGAIN EMPHASIZE THAT WE HAVE THE SMALLEST PROPORTIONATELY THE SMALLEST INTRAMURAL PROGRAM IN ALL OF NIH FOR THE CENTER, INSTITUTES AND CENTERS THAT HAVE AN INTRAMURAL PROGRAM. THE OTHER LOWEST ONE IS ABOUT 5%. SBIR/STTR 3%. CENTERS AT 9% WILL CHANGE, THESE INCLUDE NOT JUST THE EXPIRING TCCs OR MEDICINE AND CHRONIC DISEASE BUT ALSO CENTERS OF EXCELLENCE AND RECENTLY FUNDED ENVIRONMENTAL DISPARITY CENTERS FROM LAST YEAR. RESEARCH MANAGEMENT AND SUPPORT IS PICKED TO RUN THE OPERATION. WE SIT AT ABOUT THE AVERAGE FOR OUR SIZE INSTITUTE AND A VARIETY OF OTHER THINGS THAT INCLUDE. NEXT SLIDE. OTHER ASPECTS THE COMMUNITY WOULD BE INTERESTED IN ARE R01 SUBMISSIONS IN FISCAL YEAR 20, EXCEEDED 400, ALMOST APPROACHED 450, WE WERE ABLE TO FUND NOT QUITE 10% OF THESE, SUCCESS RATE IS LOW. AND THAT'S A SIGN OF THE INTEREST IN THE TOPICS, THIS IS SOMETHING THAT WE HOPE WILL EVOLVE OVER THE COMING YEAR OR TWO. THE R21 PROGRAM AGAIN WE NO LONGER ARE SUBSCRIBED TO THE PARENT PROGRAM. WE HAVE OUR OWN FUNDING OPPORTUNITY ANNOUNCEMENT, R21. SUCCESS RATE IS LOWER. WE HAVE BEEN ACTUALLY FOR R21 AND R 4, R01. AND THEN R03s ARE ALMOST AT -- ALMOST DISAPPEAR. WE DO NOT HAVE ANY R15s THIS PAST FISCAL YEAR. NEXT SLIDE. AS FAR AS THE OTHER PROGRAMS, YOU CAN SEE FOR SBIR AND STTR RELATIVELY COMPETITIVE BUT WE'RE GETTING 22% FUNDED. SIMILARLY R13s, LIMITED NUMBER AND LIMITED SUCCESS. VERY PROUD OF THE INCREASE IN K AWARDS, AND I'LL HAVE ANOTHER SLIDE ON THAT BUT WE'RE UP TO 36% SUCCESS. THIS IS A LARGE PART OF OUR FUTURE, SO I'M PLEASED TO SEE MORE APPLICATIONS COMING IN THIS. WE MAY BE REACHING A GOOD STEADY STATE IN APPLICATIONS AND SUCCESS RATES FOR K AWARDS. AND WE FUND SOMEWHERE BETWEEN AROUND 10, 15 FELLOWSHIP AWARDS A YEAR AND WE'LL CONTINUE TO DO THAT. NEXT SLIDE. THIS IS A DISTRIBUTION OF THE SCORING PROFILE FOR R01. MAKE THE POINT THAT WE ARE USING SELECT PAY, PRIMARILY FOCUSED ON WHAT WE CONSIDERED NIMHD PRIORITY TOPICS, SO NOT ALWAYS A WELL-REVIEWED WELL-WRITTEN GRANT IS THE ONE THAT WE THINK IS MOST MERITORIOUS FOR SUCCESS, ALTHOUGH WE GENERALLY SEE THAT IF YOU'RE SCORING BELOW 20 YOUR LIKELIHOOD OF SUCCESS IS EXTREMELY HIGH. ABOVE 30 IT'S LESS LIKELY YOU'LL BE FUNDED, BUT IT ISN'T NON-EXISTENT AND DEPENDS, AGAIN, ON OTHER FACTORS REGARDING PROGRAM PRIORITY. I CAN SAY PRETTY CONFIDENTLY THAT WE HAVE NO REASON OR NEED TO GO ABOVE 40 OR RARELY GO ABOVE 35 NOW FOR FUNDING AND R01. NEXT SLIDE. THIS IS ILLUSTRATION OF THE K PROGRAM. WE'VE HAD K99s, I SHOULD SAY, FOR MANY YEARS. SO THAT HAS EXISTED WITH SOME VARIABILITY AND APPLICATION, AS YOU CAN SEE BEGINNING WITH FISCAL YEAR 18 THE NUMBER OF APPLICATIONS HAVE INCREASED, STEADILY, AND IN FISCAL YEAR 20 WE HAD OVER 60 APPLICATIONS COMING. WE ENDED UP FUNDING A LITTLE OVER A MILLION DOLLARS IN THE K AWARDS, AND WE WILL SEE WHAT THE BALANCE WILL BE FOR FISCAL YEAR 21. NEXT SLIDE. A COUPLE UPDATES ON LEADERSHIP AT NIMHD, TILDA FARHAT WAS SELECT THE DIRECTOR OFFICE OF SCIENCE POLICY PLANNING AND EVALUATION, HAS BEEN WITH NIMHD FOR A NUMBER OF YEARS, A BEHAVIORAL AND SOCIAL EPIDEMIOLOGIST, CAME TO US FROM THE UNIVERSITY OF NORTH CAROLINA SCHOOL OF PUBLIC HEALTH. SHE'S ORIGINALLY FROM LEBANON AND HAS BEEN JUST STEADY WONDERFUL COURSE IN THAT OFFICE. I LOOK FORWARD TO WORKING WITH HER OVER THE COMING YEARS FOR THE IMPORTANT MULTIPLE ROLES OF REPORTING, STRATEGIC PLANNING, AND ANALYTICS, THAT THE OFFICE PROVIDES. EARLIER THIS YEAR WE ALSO WERE SUCCESSFUL RECRUITING YUJING LIU, BRANCH CHIEF, OFFICE OF REVIEW IN THE OFFICE OF EXTRAMURAL RESEARCH ADMINISTRATION. HE CAME TO NIMHD FROM THE CENTER FOR SCIENTIFIC REVIEW, WHERE HE SERVED AS DEPUTY DIRECTOR FOR DIVISION OF RECEIPT AND REFERRAL, PRIOR TO THAT AT NATIONAL INSTITUTE OF NURSING RESEARCH, WE LOOK FORWARD TO HAVING HIM LEAD OUR REVIEW BRANCH AT NIMHD. HE'S A PHYSICIAN, GRADUATED FROM BEIJING MEDICAL UNIVERSITY, AND HAS ALSO A Ph.D. IN MOLECULAR GENETICS FROM SYRACUSE UNIVERSITY, AND SPENT TIME IN ACADEMICS BEFORE COMING TO NIH. NEXT SLIDE. JOYCE HUNTER RETIRED AT THE END OF CALENDAR 2020, ALL OF YOU ARE FAMILIAR WITH JOYCE, SHE HAD BEEN THE EXECUTIVE SECRETARY FOR THIS COUNCIL FOR MANY YEARS. IN FACT, BEGINNING IN 2015, BEFORE I ARRIVED, AT NIMHD. AND SHE FULFILLED THAT ROLE ADMIRABLY. SHE SERVED AS THE DEPUTY DIRECTOR FOR THE NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES, RECRUITED BY DR. JOHN RUFFIN, IN 2007, AND STEPPED AWAY FROM THAT POSITION IN 2018 AND SHE WAS A CARDIOVASCULAR PHYSIOLOGIST BY TRAINING, AFTER A FELLOW AT NIH SHE JOINED MOSTLY IN THE EXTRAMURAL WORLD, BECAME EXPERT IN EXTRAMURAL POLICIES, WENT FROM NHLBI TO NIDDK, AND CAME TO NIMHD IN 2007, RETIRING WITH MORE THAN 31 YEARS OF SERVICE AT NIH. NEXT SLIDE. COURTNEY AKLIN WAS MY CHIEF OF STAFF FROM THE TIME I STARTED IN SEPTEMBER 2015. SHE WAS RECRUITED AWAY TO THE OFFICE OF THE DIRECTOR TO WORK WITH TARA SCHWETZ IN THE OFFICE OF THE DEPUTY PRINCIPAL -- SHE'S THE DEPUTY TO THE PRINCIPAL DEPUTY. I WORK CLOSELY WITH TARA ON RADX-up PROGRAM. COURTNEY DESIGNED AND MANAGED PROGRAMS TO AUGMENT AND STRENGTHEN EMERGING NEUROSCIENCE RESEARCH PROGRAMS AT UNIVERSITIES AND MEDICAL SCHOOLS. AND SHE IS COMMITTED TO THE BIOMEDICAL WORK FORCE DIVERSITY. WE WILL MISS HER. BUT WE HAVE ADAPTED AND PERSEVERE. I TRUST OUR STAFF WILL CONTINUE TO THRIVE IN THIS NEW TIME. NEXT SLIDE PLEASE. I WANT TO SHOUT OUT RINA DAS, WE NOMINATED GROUPS AND PEOPLE, GOT ONE IN, I MADE A VIDEO PRAISING RINA BECAUSE WE DID NOT HAVE AN IN-PERSON CEREMONY LIKE WE USUALLY DO, WITH NIH DIRECTOR BEING THE MAIN HOST OF THAT, ALL THE DIRECTORS BEING THERE ON STAGE. AND SO PLEASE, IF YOU'D LIKE TO LISTEN YOU CAN FIND IT ON OUR WEBSITE I BELIEVE. THIS YEAR WE HOPE TO NOMINATE MORE AND GET MORE SUCCESSES BUT RINA IS RECOGNIZED FOR SUSTAINED EXCEPTIONAL LEADERSHIP PROMOTING INNOVATION NIMHD'S RESEARCHES, PARTICULARLY AROUND ISSUES OF SOCIAL EPIGENOMICS, LIVER DISEASE, CANCER AND LUNG CANCER, AND SHE'S REALLY PROVIDED AN EXTRA SUPPORT FOR SPEAKING UP ABOUT MENTAL HEALTH, THIS IS MY STORY ESSAY CHALLENGE, AND ALSO HAS BEEN PLANNING A SPECIAL EVENT NOW POSTPONED UNTIL MAY THAT I THINK WE'RE GOING TO FEATURE VIVEK MURTHY, LET'S SEE IF THAT WILL STILL TAKE PLACE. NEXT SLIDE. AND THEN A COUPLE DAYS AGO OUR DEPUTY, MONICA WEBB HOOPER, MADE AN INTERVIEW, DID AN INTERVIEW WITH HER FAMILY ABOUT BEING VOLUNTEERS IN ONE OF THE TRIALS. MONICA, COULD I ASK YOU TO UNMUTE AND SAY A WORD ABOUT THIS? I CAN'T DO IT JUSTICE. >> SURE. I WAS DELIGHTED THAT MY MOTHER AND FATHER-IN-LAW WERE WILLING TO SHARE THEIR EXPERIENCE, ACTUALLY BOTH PARTICIPANTS IN THE MODERNA TRIAL, AND MY CONVERSATIONS WITH THEM ABOUT THAT EXPERIENCE AND WHAT PROMPTED THEM TO VOLUNTEER, I REALIZED THEY HAD A LOT TO SHARE, I THOUGHT PERHAPS COULD BENEFIT OTHERS. THEY ARE I THINK -- THEIR REASONS CONTRACT WITH RACIAL MINORITIES, PARTICULARLY AFRICAN AMERICANS, WHERE THEY DIDN'T HAVE ANY HESITATION ABOUT PARTICIPATING AND THEY SEE IT I THINK AS A PART OF RESPONSIBILITY, I WANTED TO SHARE THE CONVERSATION THAT WE HAD WITH THEM AND I WAS DELIGHTED HOW THE PROGRAM CAME TOGETHER AND WE RELEASED IT YESTERDAY, I'M HOPEFUL IT WILL BE SHARED ACROSS NETWORKS AND RESONATE WITH OTHERS WHO MIGHT BE HESITANT NOT NECESSARILY ON THE TRIAL FRONT BUT ACCEPTING THIS OPPORTUNITY FOR VACCINATION, WE ALL KNOW IT'S CRITICAL FOR US TO MOVE FORWARD AND AWAY FROM THIS PANDEMIC. SO I'M GRATEFUL TO THEM FOR DOING THAT AND NIMHD SUPPORTING IT THIS WAY. >> THANK YOU, MONICA. AND AGAIN, JUST ENCOURAGE EVERYONE TO -- IF YOU HAVE THE OPPORTUNITY TO TAKE ADVANTAGE OF PROMOTING SCIENCE AND LEVERAGING FAMILY MEMBERS, FRIENDS, WHO ARE WILLING TO DO THIS ON A BROAD WAY, BECAUSE WE NEED TO GET THE WORD OUT. NEXT SLIDE. WE HAVE THIS SPECIAL EVENT PLANNED PRE-HEALTHER IN PLACE, TO CREATE A HEALTH EQUITY ART CHALLENGE, PART OF OUR 10, 20, 30 CELEBRATION LAST YEAR THAT DID NOT MATERIALIZE AFTER MARCH 3, DUE TO THE SHELTER IN PLACE, SO WE HAVE TO I GUESS DO SOMETHING WHEN WE'RE ABLE TO GET BACK TOGETHER. BUT THE GOALS TO RAISE NATIONAL AWARENESS ABOUT HEALTH DISPARITIES THROUGH ART. ANY KIND OF ART, PAINTINGS, DRAWINGS, PHOTOS, DIGITAL ART, THAT REPRESENT OUR VISION. I'VE PROMOTED TO THE ARTISTS I KNOW WHO SAY WE DON'T DO THIS BUT I'LL SEND IT TO PEOPLE I KNOW WHO DO THIS, AND REALLY THERE IS SOME MONEY, SOME REAL MONEY ATTACHED TO THE WINNERS, AS YOU CAN SEE HERE, WITH CATEGORIES FOR TEENS AND ADULTS THAT ARE SEPARATE. IF YOU HAVE ANY QUESTIONS OR SUGGESTIONS, GINA RUSSO IS LEADING THIS EFFORT FOR THE INSTITUTE. NEXT SLIDE. NOW LET ME HIGHLIGHT THE SCIENCE HIGHLIGHTS FROM PROGRAMS. FIRST, WE CONTINUE OUR SUCCESSFUL NIMHD DISPARITIES RESEARCH INSTITUTE HDRI, VIRTUAL THIS YEAR. WE MADE THE DECISION TO MAKE IT VIRTUAL AND NOT DELAY, IN AUGUST. IT WORKED REASONABLY WELL LAST YEAR. WE WERE ABLE TO GET MORE PARTICIPANTS BECAUSE OF THE VIRTUAL NATURE. AND I THINK THE SCHOLARS WERE VERY ENGAGED, EXTREMELY ACTIVE IN THE CHAT, SO I WAS VERY PLEASED WITH THE LECTURES AND BECAUSE IT'S VIRTUAL I THINK WE'RE MOST LIKELY GETTING PEOPLE SAYING, NO, I CAN'T DO IT. SO IT IS A GREAT ACTIVITY FOR SCHOLARS AND FOR OUR STAFF, WE'RE CONTINUING THIS ACTIVITY. IT'S OPEN FOR APPLICATIONS ALREADY, AND THROUGH THE DATE OF MARCH 8, SO THIS IS THE TIME TO ENCOURAGE SENIOR AND POSTDOCS, JUNIOR FACULTY, OR ESIs, TO APPLY. WE WILL SEE SOME EXCEPTIONS COME OUR WAY, MORE ASSOCIATE PROFESSORS WHO HAVE SORT OF RETOOLED INTO RESEARCH CAREER, BUT THIS IS REALLY THE TARGET AUDIENCE THAT WE'RE LOOKING FOR. AND, AGAIN, WE WITHOUT MAKING ANY EXPLICIT CATEGORIES ABOUT 60% OF OUR SELECTIVE SCHOLARS AND APPLICANTS ARE FROM UNDERREPRESENTED MINORITY GROUPS. NEXT SLIDE. WE DO HAVE A FUNDING OPPORTUNITY OUT ON THE STREET, ON VACCINE HESITANCY, WE'RE VERY EXCITED ABOUT THE OPPORTUNITY TO CONTINUE TO THIS TOPIC, ALTHOUGH EXTREMELY URGENT, NEEDING ANSWERS YESTERDAY, WE WILL GO ABOUT AS QUICKLY AS WE CAN THROUGH THE NIH PROCESS. WE HAVE A COMMITMENT TO WORK THROUGH THIS QUICKLY, AS LONG AS WE HAVE SUFFICIENT APPLICATIONS, BUT THAT ENDS FRIDAY, SO IF YOU HAVEN'T GOTTEN YOUR APPLICATION MOSTLY DONE, IT'S A LITTLE LATE BUT THERE WILL BE OTHER RECEIPT DATES FOR THIS FUNDING OPPORTUNITY ANNOUNCEMENT. AND THIS IS THE NIMHD EFFORT THAT IS HAPPENING ALSO MORE BROADLY THROUGH CEAL AND INDIRECTLY THROUGH RADX-up. NEXT SLIDE. THE FACULTY INSTITUTIONAL RECRUITMENT FOR SUSTAINABLE TRANSFORMATION, THE FIRST PROGRAM, HAS A DEADLINE OF MARCH 1 ALSO. THIS IS WHAT DR. VALANTINE DEVELOPED OVER THE COURSE OF THE LAST TWO YEARS OF HER TIME AT NIMHD. SHE'S AGREED -- BELIEVE A COHORT MODEL WILL WORK. THERE'S MODERATE EVIDENCE THIS IS THE CASE. THE COHORT DOES NOT HAVE TO BE IN THE SAME DISCIPLINE, UNLIKE WHEN YOU'RE BUILDING UP A UNIT, A CENTER, ON A SPECIFIC TOPIC, THE IDEA AND I DID PERSONALLY OBSERVE THIS HAPPENING AT UCSF, SO WITH BUILDING COMMUNITY AMONGST UNDERREPRESENTED SCIENTISTS DID NOT RESTRICT ITSELF TO DISCIPLINE BOTH IN THE CLINICAL POPULATION OR BASIC RESEARCH WORLD. PEOPLE FOUND A COMMON GROUND ON LIVED EXPERIENCES, MENTORSHIP, AND MANAGING THE SYSTEM. AND THIS IS THE EFFORT BEHIND IT. THE FACULTY COHORT WILL INCLUDE FUNDING FOR EITHER A HIGH RESOURCE INSTITUTION OR LOW RESOURCE INSTITUTION, AND THOSE NOT AS WELL RESOURCESSED WE DO EXPECT TO SEE TWO TIERS OF THIS, HOUSED AT THE NATIONAL CANCER INSTITUTE, THIS IS A COMMON FUND PROGRAM BUT THEY PROVIDE THE FUNDING, BUT THE INSTITUTES MANAGE. SO MANY OF YOU ARE FAULT WITH THE BOLD PROGRAM, WHICH IS MANAGED OUT OF THE NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCE, A COMMON FUND PROGRAM. THIS IS SORT OF A SEQUEL TO THAT IN A WAY. NIMHD WILL BE HANDLING COORDINATION AND EVALUATION CENTER WITHIN OUR INSTITUTE SO WE LOOK FORWARD TO THIS DEVELOPING, FUNDED LATER THIS FISCAL YEAR, AND ONGOING FOR -- WE EXPECT NINE YEARS INTO THE FUTURE. NEXT SLIDE. ON THURSDAY, DR. EBONY BOULWARE WILL BE GIVING THE NIMHD DIRECTOR SEMINAR SERIES ON VIDEOCAST. WE HAVE REENERGIZED THE EFFORTS TO DO THESE SEMINARS, COMBINING IN PART WITH THE HEALTH DISPARITIES SCIENTIFIC INTEREST GROUP AT INTRAMURAL, AND HOPE TO HAVE -- IF NOT EVERY MONTH, EVERY OTHER MONTH, INVITED VIRTUAL SPEAKER, IT'S EASIER NOW WITH VIRTUAL. BLACK HISTORY MONTH IN FEBRUARY, EBONY IS THE CHIEF OF THE DIVISION OF GENERAL INTERNAL MEDICINE AT DUKE AND ALSO DIRECTOR OF THE CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTE AND HAS A CAREER IN WORKING IN HEALTH DISPARITIES. EARLY ON PARTICULARLY FOCUSED ON KIDNEY DISEASE, ALTHOUGH I THINK HER TOPIC IS GOING TO BE SLIGHTLY DIFFERENT. WE'RE PLEASED TO HAVE HER JOIN US THIS MONTH. OR LAST ONE WAS RICARDO MUNOZ IN OCTOBER, HAD A SPECIAL LECTURE BY DAVID WILLIAMS IN DECEMBER, ON STRUCTURAL RACISM. NEXT SLIDE. LET ME FINISH UP WITH SOME HIGHLIGHTS ABOUT SCIENCE ADVANCES. NEXT SLIDE PLEASE. THESE ARE THE NEXT SEVERAL PAPERS WILL BE -- ARE SELECTED BY STAFF AND PRESENTED TO ME, SENT TO ME. THEY SEND ME MORE THAN I END UP USING PARTLY BECAUSE OF TIME, PARTLY BECAUSE OF MY OWN CRITERIA. SO JUST TO GIVE CREDIT, I WILL SHOW SOME FROM INTRAMURAL AND SOME GENERAL TOPICS. SO THIS IS A PROJECT ON LAY COUNSELORS FOR TELEHEALTH DEPRESSION TREATMENT FOR OLDER HOMEBOUND ADULTS, 277 HOME BOUND LOW INCOME ADULTS WITH DEPRESSION REFERRED THROUGH MEALS ON WHEELS PROGRAM RANDOMIZED TO RECEIVE VIDEO PROBLEM-SOLVING THERAPY WITH LICENSED CLINICIAN, VIDEO BEHAVIORAL ACTIVATION THERAPY WITH LAY COUNSELORS, OR TELEPHONE SUPPORT. MIND YOU, THIS WAS DESIGNED AND IMPLEMENTED BEFORE COVID. SO A LITTLE FORWARD THINKING ABOUT WHERE WE ARE TODAY. AND HOMEBOUND OLDER ADULTS ARE REALLY CAUGHT, IF THEY ARE WITHOUT A YOUNGER ADULT LIVING WITH THEM OR CAREGIVER I THINK IT WOULD BE CHALLENGING FOR MANY OF THESE INDIVIDUALS TO BE ABLE TO SECURE AN APPOINTMENT TO GET A VACCINE, AT LEAST THE WAY IT'S CURRENTLY SET UP, IN ADDITION TO THE FACT THAT THEY ARE MEALS ON WHEELS ELIGIBLE MEANS THEY ARE POOR, AND THEREFORE IN NEED OF MORE SERVICES THAN PERHAPS OTHERS AVERAGE OLDER ADULTS. THERE'S A GREATER RESPONSE WITH THE TELE-PST OR VIDEO PROBLEM SOLVING THERAPY WITH LICENSED CLINICIANS, AND THE TELE-BA, VIDEO BEHAVIORAL ACTIVATION THERAPY. AND REDUCTION IN DEPRESSION RATING SCALE OR SYMPTOM SCORE, COMPARED WITH FEWER TELEPHONE SUPPORT CALLS. I BELIEVE THE INVESTIGATORS CREATED A TABLET SO THEY WOULD HAVE ACCESS TO VIDEO AS OPPOSED TO DEPENDING ON YOUR OWN EQUIPMENT OR RESOURCES. AND LAY COUNSELORS CAME TO YOU TO DELIVER MENTAL HEALTH TREATMENT, SHOWN IN OTHER SETTINGS AS WELL, COMMUNITY CLINICIAN SETTINGS WITH GROUPS OF PARTICULARLY I'M FAMILIAR WITH STUDIES DONE WITH IMMIGRANTS AND WOMEN POST-PARTUM IN THAT CONTEXT. NEXT SLIDE. NO OUTCOMES HERE YET BUT I THINK THIS IS A SPECIAL IMPORTANT PROJECT ON THE NAVAJO NATION EXTENTING 2% JUNK FOOD TAX, THE ULTIMATE QUESTION IS WILL THIS IMPACT JUNK FOOD CONSUMPTION, WHICH WILL BE -- WE'LL SEE HOW THAT WORKS. THIS IS A PROJECT THAT WAS FUNDED THROUGH THE NAVAJO EPIDEMIOLOGY CENTER AND COMMUNITY OUTREACH AND PATIENT EMPOWERMENT PROJECT, INVESTIGATORS PARTNERED WITH NAVAJO TASK COMMISSION, REGION OF COMMUNITY DEVELOPMENT AND TRIBAL DELEGATES AND LOCAL CHAPTER LEADERS TO DO THIS AND REAUTHORIZE TAX DUE TO EXPIRE LAST YEAR. SINCE LATE 2015 GENERATED SIGNIFICANT FUNDS, FOR THE NAVAJO NATION, BUT I THINK ULTIMATELY WE WANT TO SEE IMPACT ON CONSUMPTION. PERHAPS ON THE MODEL OF THE SWEETENED BEVERAGES TAX THAT HAVE BEEN IMPLEMENTED IN SOME MUNICIPALITIES IN THE U.S., AND IN MEXICO. NEXT SLIDE. THIS IS AN INTERESTING STUDY ON POTENTIAL CONTRIBUTORS OF MECHANISMS, DENOMINATION OF RELIGIOUS COPING EFFECTS ON HYPERTENSION RISK IN AFRICAN AMERICAN YOUNG ADULTS. I THINK ALL OF US KNOW THAT AFRICAN AMERICANS HAVE A HIGHER RATE OF HYPERTENSION, ALSO HAVE HIGHER RATE OF UNCONTROLLED HYPERTENSION IN MOST OF THE COUNTRY. THE ISSUE WITH YOUNG ADULTS IS THAT IT'S UNCOMMON, IT USED TO BE VERY UNCOMMON TO SEE SOMEONE IN THEIR 20s PRESENT WITH HYPERTENSION, AND BUT AMONG AFRICAN AMERICANS PARTICULARLY MEN IT DID HAPPEN, EVEN WHEN I WAS TRAINING AS A RESIDENT. SO, NOW WE MAY SEE IT BECAUSE OF EXTREME OBESITY OR OTHER RISK FACTORS IN DIFFERENT POPULATIONS. REGARDLESS, THIS IS AN EVALUATION OF THE ADD HEALTH STUDY THAT STARTED WITH ADOLESCENTS AND NOW GOTTEN OLDER, NATIONAL INSTITUTE ON AGING HAD TAKEN OVER THE PRINCIPAL INSTITUTE, CHILD HEALTH, GRADUATED, AND NIMHD JOINED NIA ON THIS EFFORT. WE'RE CONTRIBUTING TO IT AND HOPEFULLY WE'LL BE ABLE TO LEVERAGE THE DATA OF THIS DIVERSE COHORT THAT INCLUDES, YOU KNOW, NOT AN INSIGNIFICANT NUMBER OF MIDDLE CLASS AFRICAN AMERICANS WHICH SUN USUAL FOR THESE COHORT STUDIES, AS WELL AS EARLY ON ASK QUESTIONS ABOUT SEXUAL GENDER, GENDER IDENTITY AND SEXUAL ORIENTATION, WHICH IS, AGAIN, UNCOMMON IN COHORT STUDIES. THIS PARTICULAR PUBLICATION FOCUSED ON RELIGIOUS AFFILIATION AND CHURCH ATTENDANCE. AND KNOWN IN THE PREVENTION WORLD FOR MANY YEARS IF YOU SAID YOU'D GO TO CHURCH, OR SERVICES OF ANY KIND, YOU'RE LIKELY TO REPORT BETTER BEHAVIOR. THIS IS THE CASE HERE IN TERMS OF OUTCOME OF HYPERTENSION RISK, PARTICULARLY FOR WOMEN. THE EFFECT WAS NOT SEEN IN MEN. AND WHETHER OR NOT WOMEN WHO ARE PENTECOSTAL HAVE HIGHER RISK OF HYPERTENSION IS UNCLEAR. ALTHOUGH IT'S AN INTERESTING OBSERVATION TO FOLLOW UP. AND THEN RELIGIOUS COPING IS ALSO ASSOCIATED WITH DECREASED RISK OF HYPERTENSION AMONG WOMEN, AGAIN THE EFFECT ONLY SEEN IN WOMEN. NEXT SLIDE PLEASE. THIS IS AN IMPORTANT FOCUS OF HIV RESEARCH, RELATED TO PREP UPTAKE AMONG ADOLESCENTS. AND, YOU KNOW, FIGURING OUT IN THIS SURVEY OF ALMOST 500 DIVERSE ADOLESCENTS, OF MEN WHO HAVE SEX WITH MEN, MALES WHO HAVE SEX WITH MALES, AGES 13-18. I HAVE TO PAUSE ABOUT ANY 13 OR 14-YEAR-OLD ENGAGING IN SEXUAL BEHAVIOR OF ANY KIND OF ORIENTATION BUT IF IT HAPPENS YOU HAVE TO MANAGE IT. THAT'S THE FIRST POINT. IF IT'S HIDDEN AND SECRETIVE IT MAKES IT MORE CHALLENGE. OVER HALF THE PARTICIPANTS HEARD PREP BUT VERY FEW HAD TAKEN IT. RATE FOR ADULT NATIONALLY IS HIGHER BUT STILL WE HAVE A LONG WAYS TO GO. AND THEN ONE OF THE COMMON REASONS THAT PREP WAS A CONCERN WAS THAT THERE THEY WOULD BE WORRIED THEIR PARENTS WOULD FIND OUT AND NOT BE SUPPORTIVE. THESE ARE THE KINDS OF CHALLENGES YOU FACE, AND I THINK IT'S AN IMPORTANT CONTRIBUTOR TO UNDERSTANDING THIS, TO ADDRESS ENDING THE HIV EPIDEMIC AND FINDING WAYS THAT YOUTH CAN BE ABLE TO ENGAGE IN SAFER BEHAVIOR BY USING PREP. NEXT SLIDE. COVID-19 AND COLORECTAL CANCER SCREENING, THE FACT THERE'S EMERGING LITERATURE ON THIS, I RECENTLY HAD SEEN A REPORT FROM THE CDC THAT CERVICAL CANCER SCREENING HAD BEEN DECREASED BY ABOUT 80% IN 2020, IN MANY AREAS. ONE COULD SAY, WELL, CERVICAL CANCERS ARE MORE CHRONIC DISEASE, RARELY YOU MISS IT, ONE YEAR YOU CAN GET IT THE NEXT OR THE NEXT. IT TAKES TEN YEARS TO GO FROM, ON AVERAGE, FROM A CIN CYTOLOGY TO INVASIVE AND EVEN IN THAT CONTEXT IT'S CURABLE. COLON CANCER IS NOT QUITE THAT SLOW, FROM ONE CENTIMETER POLYP TO INVASIVE COLON CANCER IS ABOUT SIX YEARS. AGAIN, IF YOU MISS, AN AVERAGE OF COURSE, THERE ARE AGGRESSIVE TUMORS, IF YOU MISS ONE YEAR YOU CAN PICK IT UP ANOTHER YEAR. THE OBSESSION WITH DOING COLONOSCOPY REALLY SHOULD NOT BE A QUESTION HERE. AND THE MAIN POINT OF SAYING, WELL, WE SHOULD PROTECT PEOPLE BY MAKING SURE THEY AT LEAST GET MALE FECAL IMMUNOCHEMICAL TESTS, FECAL, DO IT, MAIL IT, GET RESULTS, IT'S AN OUTSTANDING MEASURE OF SCREENING. IN MY OWN CLINICAL PRACTICE, UCSF AS A CLINICIAN, WE HAD SWITCHED TO THIS AS THE PRIMARY MODE OF SCREENING, MANY YEARS AGO, IT'S JUST EASIER TO USE AND MORE ADAPTABLE. YOU CAN ALWAYS ADAPT AND SAY YOU WANT A COLONOSCOPY, YOU CAN GET ONE BUT THESE WORK WELL AND THERE'S RANDOMIZED TRIAL WORK TO SUPPORT IT, ONE OF THE MAIN POINTS OF THIS PAPER. NEXT SLIDE PLEASE. AND THEN COVID-19 IS PREDOMINANT, I'VE NOT EMPHASIZED DATA IN THIS PRESENTATION, I HAVE A COUPLE THINGS TO SHARE. THIS IS A STUDY FROM MASSACHUSETTS, A POPULATION STUDY, MORE AFRICAN AMERICAN POPULATION WAS ASSOCIATED WITH INCREASED CASED PER 100,000. SIMILARLY FOR LATINOS. YOU CAN ADJUST THE LATINO FINDING AWAY BY ADJUSTING FOR FOOD SERVICE WORKERS AND MEAN HOUSEHOLD SIZE, THE MAIN REASONS WHY YOU SEE MORE INFECTION. IT DIDN'T QUITE DIMINISH BUT DIDN'T QUITE MAKE THE AFRICAN AMERICAN IMPACT GO AWAY. NOTICE ALSO PROPORTION OF FOREIGN BORN NON-CITIZENS AT THE BOTTOM OF THE LIST OF THE INCREASES PER 100,000 BEING THE HIGHEST OF ALL, WHEN ADJUSTED FOR. SO I THINK THESE KINDS OF RESEARCH HAS CONTINUED TO REINFORCE AND INFORM OUR KNOWLEDGE OF COVID-19, THE MAIN POINT BEING THAT THE MAIN CHALLENGE IS RISK OF INFECTION, IS GREATER, THE COMORBIDITY THAT IS HIGHER PARTICULARLY FOR DIABETES ACROSS THE BOARD IS A FACTOR IN SEVERITY BUT NOT THE MAIN REASON PEOPLE ARE DISPROPORTIONATELY AFFECTED BY THE PANDEMIC. NEXT SLIDE. POLICIES TO PROMOTE BETTER REFERRALS FOR KIDNEY TRANSPLANT ARE ILLUSTRATED IN THIS SLIDE. AND THIS IS ALONG THE WORK THAT DR. PATZER HAS BEEN DOING TO DEVELOP QUALITY METRICS TO IMPROVE REFERRALS. NEXT SLIDE PLEASE. THIS IS A LARGE STUDY LOOKING AT ENVIRONMENTAL BUILT ENVIRONMENT EXPOSURES, LOWER BIRTH WEIGHT SIGNIFICANTLY ASSOCIATED WITH LOWER GREENNESS AND HIGHER TEMPERATURE, WALKABILITY, NOISE, SEGREGATION OF HIGH INCOME. THIS IS FROM OUR INTRAMURAL PROGRAM, WORK FROM THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS, LONGITUDINAL STUDY, INCREASE IN BLACK PARTICIPANTS WHO EXPERIENCE LIFETIME DISCRIMINATION MORE LIKELY TO DEVELOP HYPERTENSION, SO OVER THE COURSE OF FOLLOW-UP IN THIS SAMPLE DETERMINED RISK OF HYPERTENSION. LATINO, FOREIGN BORN, PRIMARILY MEXICAN IN THIS STUDY, THEY REPORTED HIGH EVERYDAY DISCRIMINATION SCORES, NOT ASSOCIATED WITH INCREASED RISK OF HYPERTENSION, IN FACT ASSOCIATED WITH LOWER RISK OF HYPERTENSION, WHICH IS INTERESTING. NEXT SLIDE. THIS IS A STUDY THAT DR. SHARINO FROM THE INTRAMURAL PROGRAM DID AS A POSTDOC ACTUALLY AND FINISHED LATER, WE COLLABORATED WITH HER, ISSUE OF PORTAL ACCESS AND USE. AS YOU KNOW, THE CLINICAL WORLD HAS COMPLETELY TRANSFORMED INTO THE ELECTRONIC HEALTH RECORD. THERE HAS BEEN A BELIEF THAT RACIAL AND ETHNIC MINORITIES ARE LESS LIKELY TO USE OR ACCESS PORTAL, EXPERIENCES IN DIFFERENT SYSTEMS SHOW THERE TENDS TO BE LATER UPTAKE IN AT LEAST REGISTERING TO USE THE PORTAL. THESE ARE DATA FROM THE HEALTH INFORMATION NATIONAL TREND SURVEY, WHICH IS A CORE STUDY FUNDED BY THE NATIONAL CANCER INSTITUTE FOCUSED ON VARIETY OF FACTORS INCLUDING A NUMBER OF QUESTIONS ABOUT ELECTRONIC HEALTH RECORD USE. AND WE'RE ABLE TO EVALUATE ALMOST 6800 ADULTS, IN THE 2017-18 HINTS CYCLE, A NATIONALLY REPRESENTED SAMPLE, SELF-ADMINISTERED SURVEY, EVALUATES A VARIETY OF FACTORS INCLUDING PUBLIC PERCEPTIONS AND USE OF THE ELECTRONIC HEALTH RECORD AND PATIENT PORTALS. AT LEAST AS OF THREE OR FOUR YEARS AGO, PATIENT PORTAL ACCESS WAS NOT QUITE 50%, SO YOU WOULD THINK RELATIVELY LOW, USE WAS LOWER. THIS IS HIGHER IN SOME SYSTEMS, OBVIOUSLY, BUT THEN THERE ARE SYSTEMS THAT DON'T HAVE -- HAVEN'T TURNED ON THE PORTAL, SOME OF THE SAFETY NET CLINICS, OR LIMITED ITS USE FOR VERY LIMITED ACCESS. TURNS OUT RACE/ETHNICITY WAS NOT SIGNIFICANTLY ASSOCIATED WITH ACCESS OR USE OF THE PORTAL, WAS ASSOCIATED WITH SOCIOECONOMIC STATUS, AS MEASURED BY EDUCATIONAL ATTAINMENT. ALSO WHETHER ONE HAD AN IDENTIFIED BY SELF REPORT PRIMARY CARE CLINICIAN, AND WOMEN MORE LIKELY ALSO TO USE A PORTAL. SO, I THINK THE PERCEPTION INTERNET ACCESS, MOBILE DEVICE OWNERSHIP ASSOCIATED WITH THESE USE OF ELECTRONIC RECORDS, WE NEED MORE EMPIRICAL EVIDENCE ON HOW TO BEST MAKE THESE ACCESSIBLE. WE'VE TRANSFORMED THE SYSTEM. WE STILL HAVE BARELY TOUCHING ON THE POTENTIAL OF ALL THESE SYSTEMS IN PROVIDING BETTER HEALTH CARE. NEXT SLIDE. PROSTATE CANCER IS SOMEWHAT OF A CHRONIC DISEASE, AFTER A CERTAIN AGE SOME OF US THINK IT DOES MORE HARM THAN BENEFIT TO FIND IT. THIS IS A STUDY DONE AGAIN IN INTRAMURAL PROGRAM, SECONDARY ANALYSIS OF THE TENNESSEE DEPARTMENT OF HEALTH CANCER REGISTRY. CLASSIFIED INTO THREE DIFFERENT GROUPS, PREDOMINANTLY WHITE, OVER 70, APPALACHIAN COUNTY PUBLIC HEALTH INSURANCE, WHITE, 55 TO 69, HAVING PRIVATE HEALTH INSURANCE. CLASS 3 MOSTLY AFRICAN AMERICAN AND NON-APPALACHIAN COUNTY, AND WITH PRIVATE INSURANCE. YET THE DELAYS FOR THE AFRICAN AMERICANS WERE GREATER. NOW, IF I DELAY IN GETTING BREAST CANCER -- SORRY, PROSTATE CANCER DIAGNOSIS, OR ENGAGEMENT FOR THREE MONTHS, I WOULD SAY, WELL, IT DOESN'T SOUND TOO BAD. IT IS PROSTATE CANCER, SLOW GROWING MOST OF THE TIME. YOU START GETTING TO SIX MONTHS, I START TO WORRY. YOU GET TO MORE THAN A YEAR, AS YOU CAN SEE UP THERE, WITH SIGNIFICANTLY DIFFERENT OR MORE THAN SIX MONTHS, I THINK THAT BECOMES MORE CLINICALLY SIGNIFICANT RISK OF LOSING THE OPPORTUNITY TO HAVE LOCALIZED PROSTATE CANCER, PARTICULARLY IN MEN WHO ARE YOUNGER THAN THE AGE OF 70. NEXT SLIDE PLEASE. ON THE CANCER TOPIC, AS I WIND THIS DOWN, THE REPORT FROM THE AMERICAN CANCER SOCIETY, SORT OF ANNUAL CANCER STATISTICS, I JUST EXTRACTED THESE INCIDENTS RATES, NOT SEER, THIS IS WHAT ACS IS REPORTING. I'M SORRY ABOUT THE SEER AT THE BOTTOM THERE. ATTRIBUTION AT THE BOTTOM. A FEW POINTS. PROSTATE CANCER CONTINUES TO BE MORE COMMON AMONG AFRICAN AMERICAN MEN AS YOU CAN SEE DOUBLE ANY OTHER GROUP ALMOST. LUNG CANCER HAS DROPPED IN INCIDENCE AMONG AFRICAN AMERICANS. NOT ENTIRELY SURE WHY BUT WE'VE SEEN SIGNIFICANT DECREASE IN INCIDENCE. STILL HIGHER THAN ANY OTHER GROUP BUT HASN'T BEEN -- USED TO BE CONSIDERABLY HIGHER IN THE '90s. COLON CANCER REMAINS HIGHER AMONG AFRICAN AMERICAN. LIVER CANCER IS HIGHER AMONG ALL MINORITY GROUPS, ASIANS AND PACIFIC ISLANDERS ARE LUMPED TOGETHER IN THESE STATISTICS UNFORTUNATELY. THE BIG NEWS FROM THE CANCER STATISTICS WAS MORTALITY FOR CANCER HAS CONTINUED TO DROP, AND HAD BEEN DROPPING STEADILY NOW FOR THE LAST FIVE YEARS. BELIEVED TO BE IN LARGE PART TO BETTER THERAPIES, AS WELL AS BETTER MANAGEMENT AND DETECTION OF EARLY DISEASE. NEXT SLIDE. THIS IS AN ANALYSIS DONE BY SANDRA GALLEA AND COLLEAGUES, LOOKING AT NHANES, WORTH EMPHASIZING BECAUSE THEY LOOKED AT THE ISSUE OF CARDIOVASCULAR DISEASE AMONG PERSONS YOUNGER THAN 65, AND USED THE METRIC IN NHANES OF FAMILY INCOME TO POVERTY RATIO. REN THE POVERTY LEVEL WOULD BE ABOUT $25,000 FOR A FAMILY OF FOUR, SO FIVE TIMES THAT, YOU CAN DO THE MATH. AND THEN INDIVIDUALS WHO WERE IN THE LOWER RESOURCES CATEGORY, AND OLDER, WERE ACTUALLY OLDER, SORRY, MORE WOMEN WERE PROPORTIONATELY REPRESENTED THERE, MORE AFRICAN AMERICANS AND MORE LATINOS. THE TOP 20% OF INCOME OR HIGHER RESOURCES HAD REALLY STEADY DECREASES IN CARDIOVASCULAR DISEASE, NO MATTER HOW YOU MEASURE IT, HEART ATTACKS, HEART FAILURE AND STROKE, REMAINDER 80% HAD SLIGHT DECREASE IN HEART ATTACKS BUT SLIGHT INCREASES IN HEART FAILURE AND STROKE. SO THIS DISPROPORTIONATE LACK OF BENEFIT FOR 80% OF THE POPULATION ON A CONDITION WE HAD SEEN STEADY PROGRESS FOR THE LAST REALLY 40+ YEARS AS REMARKABLE ADVANCEMENTS WILL NEED INCREASING ATTENTION ON OUR PART FROM DISPARITIES PERSPECTIVE. NEXT SLIDE. FINALLY ABOUT COVID, THE MORTALITY EFFECTS WERE LOOKED AT, SYSTEMATIC REVIEW, PUBLISHED IN THE ANNALS END OF LAST YEAR, 37 STUDIES, AFRICAN AMERICANS AND LATINOS HAD HIGHER RATES OF INFECTION AND HOSPITALIZATION AND MORTALITY OVERALL BUT IN-HOSPITAL MORTALITY WAS NOT DIFFERENT. ONCE SOMEONE IS HOSPITALIZED, THE IN-HOSPITAL MORTALITY DID NOT DIFFER BY RACE/ETHNICITY. ASIANS IN THIS ANALYSIS WERE NOT DIFFERENT THAN WHITES. AND THERE WAS INSUFFICIENT DATA TO MAKE ANY STATEMENTS ABOUT AMERICAN INDIANS, ALASKA NATIVE OR NATIVE HAWAIIANS OR PACIFIC ISLANDER. THAT'S IT. THANK YOU FOR YOUR ATTENTION. IF WE COULD STOP THE SLIDE SHOW, I DON'T KNOW IF WE HAVE TIME FOR QUESTIONS. HOPEFULLY A FEW MINUTES, IF PEOPLE HAVE QUESTIONS OR COMMENTS. SORRY ABOUT MY PROBLEMS WITH THE TECHNOLOGY. CAN'T CONTROL THE COMPUTER. >> CAN I ASK A QUESTION? >> OF COURSE. >> I PUT IT IN THE CHAT. >> YOU NEED TO ASK QUESTIONS, NOT PUT THEM IN THE CHAT. >> TWO QUESTIONS. I WAS VERY ENCOURAGED BY THE RESULTS YOU SHOWED FOR THE K AWARDS EARLIER IN YOUR PRESENTATION. I KNOW IT MIGHT BE TOO EARLY BUT DO YOU HAVE ANY DATA SHOWING THE SUCCESS OF Ks GOING ON TO BECOME R01s? AND THEN THE SECOND QUESTION IS HAVE YOU BEGUN TO TRACK SUCCESS OF PEOPLE WHO ATTENDED HEALTH DISPARITIES AS FAR AS GETTING Ks AND R GRANTS? >> THANK YOU, LISA, FOR THAT GREAT QUESTION. IT'S TOO EARLY ON THE K. WE'VE ONLY REALLY SEEN THE INCREASE IN THE LAST THREE YEARS. ALTHOUGH WE WILL BE SETTING UP WAYS TO EVALUATE THIS AND LOOK FOR SUCCESSIVE, BUT I CAN'T SAY THAT I KNOW OF ANY SPECIAL SUCCESS RATE -- SUCCESSFUL K AWARDEE HAS ALREADY TRANSITIONED TO R01. AS FAR AS THE HDRI, YES, WE HAVE BEEN INTERESTED IN TRACKING THIS, AT LEAST PASSIVELY THROUGH THE NIH SYSTEMS, BUT ALSO RICHARD PALMER AND ALICIA ATHELAV COORDINATING EFFORTS HAVE THIS IN MIND, WE'RE CONTINUING TO MONITOR. THERE ARE A COUPLE SUCCESSES OF Ks. A NUMBER OF GRADUATES WHO HAVE APPLIED, AND AT LEAST ONE R01, MAYBE TWO, I'M NOT RECALLING RIGHT NOW, SUCCESSFUL APPLICANTS FROM THE HDRI. WE VERY MUCH WANT TO MONITOR THIS AND HOPEFULLY BE ABLE TO REPORT ON SUCCESS BUT AS YOU KNOW TAKES TIME FOR PEOPLE TO PROGRESS. THANK YOU. >> ELISEO, THIS IS BILL SUTHERLAND. AS FAR AS DATA WITH THE AFRICAN AMERICAN MEN AND PROSTATE CANCER, THE DELAYED TREATMENT, DO YOU THINK THAT MAY BE BASED ON THEIR PARTICIPATION IN VARIOUS ACTIVE SURVEILLANCE PROGRAMS WHERE THEY ARE MONITORED AND WATCHED UNTIL IT'S TIME FOR TREATMENT? >> YEAH, GOOD QUESTION, BILL. BECAUSE OF THE NATURE OF THAT KIND OF STUDY, SORT OF LARGE REGISTRY OF CANCER PATIENTS YOU CAN'T REALLY COME UP WITH EXPLANATIONS SO WE NEED OTHER KIND OF DATA OR STUDIES TO BE ABLE TO EVALUATE. I SUSPECT MUCH OF IT IS RELATING TO ACCESS, MAYBE COMFORT WITH PHYSICIANS, MAYBE BIAS THAT, DELAYS. PEOPLE ARE SAYING, WELL, PATIENT DELAYS, YOU KNOW, THEY ARE NOT REPORTING SYMPTOMS. BUT I DON'T THINK THAT THAT'S THE CASE. YOU KNOW, IT IS CONTROVERSIAL WHETHER ONE SHOULD SCREEN FOR PROSTATE CANCER, PERIOD. I DON'T THINK ONE SHOULD GO DOGMATIC, ESPECIALLY IN MEN OVER 70 THERE'S A REASONABLE CASE TO BE MADE WITH INFORMED SHARED DECISION MAKING ABOUT THE RISKS AND BENEFITS ABOUT DOING IT. MY OWN EXPERIENCE AS A CLINICIAN WAS MOST MEN ALREADY HAVE MADE UP THEIR MIND ALTHOUGH THEY WOULD LISTEN TO WHATEVER I'D SAY, AND I TENDED TO FAVOR SCREENING IN MEN YOUNGER THAN 70, ALTHOUGH NOT EVERY YEAR. WE WOULD PROBABLY TEST EVERY THREE YEARS WAS MY PRACTICE. SO IT DEPEND. I WOULD SAY THERE'S BEEN SIGNIFICANT OUTREACH TO THE AFRICAN COMMUNITIES TO SCREEN FOR PSAs, AT LEAST THAT'S WHAT I SAW. SO I DON'T KNOW. BUT TENNESSEE IS NOT CALIFORNIA. SO IT COULD BE DIFFERENT THERE. BUT I DO THINK THE IMPORTANT POINT IS YOU DON'T NEED TO RUSH. THIS ISN'T, YOU KNOW, LUNG CANCER, WHERE YOU LOSE A LOT SOMETIMES BY DELAYING A MONTH OR SO, OR EVEN BREAST CANCER WHERE WE KNOW THAT THE DOUBLING TIME OF THE CANCER IS BETWEEN 6 AND 9 MONTHS. AND IF YOU HAVE A VERY ABNORMAL MAMMOGRAM YOU SHOULD BE GETTING TO A CONCLUSION DIAGNOSIS WITHIN, YOU KNOW, A MONTH, SORT OF THE STANDARD OF QUALITY OF CARE. PROSTATE CANCER, THE DELAY CAN BE A LITTLE BIT LONGER BUT YOU DON'T WANT TO BE MORE THAN SIX MONTHS. I THINK THAT'S BEYOND WHAT YOU WOULD WANT BECAUSE THE EVALUATION AND OFFER OF MANAGEMENT IS IMPORTANT. >> THANK YOU. >> I HAVE A QUESTION. >> GO AHEAD, NEIL. >> DO YOU SEE SOMETHING LIKE THE RADX-up, DO YOU SEE SOMETHING LIKE THAT EVOLVING LIKE A MAJOR KIND OF EFFORT THAT WOULD COORDINATE ALL OF THE WORK AROUND THE VACCINE THE SAME WAY IT WAS AROUND TESTING? I MEAN, ALL OF THE SAME ISSUES SORT OF COME UP AGAIN, RIGHT? IT'S ABOUT DATA. IT'S ALSO GOING TO BE ABOUT, YOU KNOW, THE EFFECTIVENESS OF THE VACCINES, NOT ONLY JUST ON THE ACCEPTANCE OF THE VACCINES BUT ALL OF THE SAME ISSUES SEEM TO BE RELEVANT. >> GREAT QUESTION. AND, YES, YOU'RE CORRECT, THAT THAT WOULD BE LOGICAL SEQUENCE. THE CHALLENGE IS THAT THE CONGRESS APPROPRIATED THE FUND FOR TESTING, SO WE NEED TO CONTINUE TO LINK IT TO TESTING. I THINK WE COUNTED ABOUT A DOZEN OR SO OF THE CURRENT RADX-up PROJECTS WE FUNDED ALREADY HAVE SOME EMPHASIS ON VACCINE HESITANCY UPTAKE, AS PART OF THEIR AIM. SO IT WASN'T ABSENT IN OUR PORTFOLIO. BUT YES WE'RE DISCUSSING POSSIBILITIES THE NOT ONLY PIVOTING IN THAT DIRECTION ON LENGTH OF TESTING BUT ALSO WITH REGARDS TO HOW WE CAN COLLABORATE WITH CEAL AND SO THAT'S AN ONGOING DISCUSSION. IT'S HARD TO BE SO COMPARTMENTALIZED, SO FREQUENT AND SEQUENTIAL TESTING WE ALL THINK IS AN IMPORTANT PART OF CONTROLLING THE PANDEMIC. OBVIOUSLY VACCINE DISTRIBUTION AND UPTAKE NEEDLES IN ARMS IS ALSO AN IMPORTANT PART OF THE CONTROLLING OF PANDEMIC. AND ALL OF IT IS UNDERLIED BY THE IMPORTANCE OF MAINTAINING MASK AND PHYSICAL DISTANCING AND AVOIDING INDOOR GATHERINGS. AND HAND WASHING. SO THAT'S NOT GOING TO GO AWAY, THE LATTER. WHEN WILL CONTACT TRACING BECOME MORE USEFUL, PARTICULARLY WHEN YOU DON'T HAVE 150,000 CASES IN A DAY, SO I THINK ALL OF THESE ARE QUESTIONS -- THE IMPORTANCE OF HAVING THE COORDINATION AND DATA COLLECTION CENTER SET UP, THE IMPORTANCE OF HAVING THESE FUNDED INTERVENTION PROJECTS I THINK DOES GIVE US AN OPPORTUNITY TO LEVERAGE EXISTING INFRASTRUCTURE. EVERYTHING'S HAPPENING QUICKLY, THINGS ARE CHANGING. SO WHAT WE SAW WERE MAIN ISSUES IN MAY AND JUNE OF LAST YEAR HAVE CHANGED. AND I WOULDN'T PREDICT THE SAME THINGS ARE WORTH THINKING ABOUT NOW WILL BE TRUE IN JUNE OR JULY OF THIS YEAR. STAY TUNED. >> YEAH, I WANTED TO ALSO LINK THAT BACK TO THE PROSTATE CANCER PIECE. YOU KNOW, IT'S NOT SO MUCH THAT THE DELAY IN THE TREATMENT OF PROSTATE CANCER IS GOING TO HAVE CLINICAL IMPLICATIONS BUT THE REASONS FOR THE DELAY MAY BE VERY SIMILAR. YOU KNOW, AROUND PEOPLE NOT TRUSTING THE KINDS OF THINGS THAT GET DONE TO PEOPLE AND ESPECIALLY, YOU KNOW, NOT TRUSTING THE KINDS OF RECOMMENDATIONS, YOU KNOW, HEARING A LOT OF CONFLICTING EVIDENCE, THE SAME KINDS OF THINGS, A LOT OF CONFLICTING EVIDENCE AROUND PROSTATE CANCER AND TREATMENT AND STUFF LIKE THAT, ALSO JUST, YOU KNOW, THE ACCESS TO TRUSTED SOURCES FOR INFORMATION. SO THE REASONS FOR THE DELAY MAY NOT BE THAT DIFFERENT EVEN THOUGH THEY MAY NOT HAVE THE SAME CLINICAL IMPLICATIONS, UNDERSTANDS MAY TURN OUT TO BE SIMILAR WITH WHAT WE'RE SEEING WITH THE VACCINE. >> THANK YOU, NEIL. WE'LL NOW TURN TO A PRESENTATION BY ONE OF MY COLLEAGUES, DEBARA TUCCI IS DIRECTOR OF THE NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS AT THE NIH, A POSITION SHE'S HAD SINCE SEPTEMBER OF 2019. PRIOR TO BEING AT NIH DR. TUCCI WAS A LONGTIME FACULTY MEMBER AT DUKE UNIVERSITY, IN THE DEPARTMENT OF HEAD AND NECK SURGERY, COMMUNICATION SCIENCES. HER RESEARCH FOCUSED ON UNDERSTANDING BIOLOGICAL EFFECTS OF HEARING LOSS USING ANIMAL MODELS AS WELL AS ON TREATMENT AUTOLOGIC DISEASE, WITH COCHLEAR IMPLANTATION, PARTNERED WITH A RESEARCH TEAM THAT STUDIED OUTCOMES AND COST-BENEFIT OF ADULT HEARING SCREENING IN PRIMARY CARE CLINICS AT DUKE, TRAINED AND MENTORED MANY RESIDENT PHYSICIANS, JUNIOR FACULTY AND GRADUATE STUDENTS INFORMALLY AND FORMALLY. HAVING DEBRA AT THE TABLE HAS BEEN REFRESHING AND CONTINUES TO ADVANCE DIVERSITY OF OUR INSTITUTION DIRECTORS, I LIKE TO SAY I'M THE ONLY PRIMARY CARE PHYSICIAN AT THE TABLE OF THE NIH RESEARCHERS, AND DEBARA IS THE ONLY SURGEON. DELIGHTED TO HAVE HER AS A COLLEAGUE. >> I KNOW A COUPLE COUNCIL MEMBERS, IT'S NICE TO SEE THEM AND TO HAVE THIS OPPORTUNITY TO TALK WITH YOU ALL. SO TODAY I WANTED TO FOCUS ON THREE MAIN TOPICS. ONE IS JUST TO SHARE A LITTLE BIT ABOUT OUR INSTITUTE AND ITS MISSION, I'M GOING TO SHARE EXAMPLES OF RESEARCH PROGRAMS AND EXTRAMURAL PORTFOLIO THAT ADDRESS HEALTH DISPARITIES IN THESE MISSION AREAS. AND LAST, I WANTED TO HAVE SOME DISCUSSION, I'M GOING TO PRESENT SOME INFORMATION ABOUT OUR PAST AND CURRENT EFFORTS TO DIVERSIFY WORKFORCE, SUPPORT SCIENTISTS FROM DIVERSE BACKGROUNDS, AND INCREASE OUR RESEARCH PORTFOLIO IN HEALTH DISPARITIES RESEARCH SO I HOPE WE CAN GET SOME DISCUSSION GOING ABOUT THAT. NEXT SLIDE PLEASE. SO, THE MISSION OF THE NIDCD IS TO CONDUCT AND SUPPORT RESEARCH AND RESEARCH TRAINING IN THE NORMAL AND DISORDER PROCESSES OF HEARING, BALANCE, TASTE, SMELL, VOICE, SPEECH AND LANGUAGE. I'M GOING TO TELL YOU A LITTLE BIT ABOUT RESEARCH IN EACH OF THESE AREAS. NEXT SLIDE. FIRST I'LL TELL YOU ABOUT THE U.S. HEALTH IMPACT OF THESE DISORDERS. YOU CAN SEE HERE ARE SOME STATISTICS, MOST OF THE CONDITIONS IN OUR MISSION AREAS AFFECT BETWEEN 15 AND 25% OF THE U.S. POPULATION, AND ALL CAN HAVE A VERY SIGNIFICANT ON QUALITY OF LIFE. HEARING LOSS IS PARTICULARLY COMMON ESPECIALLY ASSOCIATED WITH AGING, SO BY THE TIME WE HIT AGE 75, ALMOST HALF OF PEOPLE IN THE U.S. WILL HAVE HEARING LOSS. IT'S A BURDEN WORLDWIDE, I'VE BECOME FAMILIAR WITH STATISTICIAN FROM GLOBAL BURDEN OF DISEASE STUDIES, HEARING LOSS IS THE THIRD MOST IMPACTFUL DISABILITY WORLDWIDE. IT FOLLOWS ONLY BACK PAIN AND MIGRAINE, A VERY BIG PROBLEM ON AN INTERNATIONAL SCALE AS WELL. CONGENITAL HEARING LOSS IS PRESENT IN TWO TO THREE OUT OF EVERY THOUSAND CHILDREN BORN IN THE U.S., MOST CONGENITAL HEARING LOSS IS GENETIC IN ORIGIN. BALANCE PROBLEMS ARE COMMON, THE ESTIMATED MEDICAL COST OF FALLS IN THE ELDERLY ACCORDING TO THE CDC CROSSES $50 BILLION ELDERLY YET THERE'S SIGNIFICANT GAPS IN OUR UNDERSTANDING OF WHAT CAUSES THESE BALANCE DISORDERS, SO LIMITED ABILITY TO TREAT THEM. SMELL AND TASTE HAS BEEN IN THE NEWS LATELY WITH COVID-19, THERE WAS A PARTICULARLY GOOD ARTICLE IN THE "NEW YORK TIMES" MAGAZINE THIS PAST SUNDAY TALKING ABOUT THE IMPACT OF TASTE AND SMELL DISORDERS, IN THAT DISEASE. TASTE AND SMELLS CONTRIBUTE TO NUTRITION AND OVERALL HEALTH STATUS, IMPORTANT FROM THAT STANDPOINT. THERE IS GENETIC AND CULTURAL VARIABILITY IN OUR FOOD PREFERENCES. AND THESE HAVE SIGNIFICANT ASSOCIATIONS WITH A VARIETY OF HEALTH RISK FACTORS, INCLUDING OBESITY, HIGH BLOOD PRESSURE, AND CARDIOVASCULAR DISEASE. VOICE, SPEECH AND LANGUAGE DISORDERS AFFECT A PERSON'S EMOTIONAL SOCIAL LIFE, AND CAN COMPROMISE EDUCATIONAL AND JOB OPPORTUNITIES. NEXT SLIDE PLEASE. UNADDRESSED HEARING LOSS HAS SIGNIFICANT PUBLIC HEALTH RAMIFICATIONS, AND SOME OF THESE ARE SHOWN IN THE LEFT-HAND SIDE OF THE SLIDE. ACCORDING TO THE LANCET COMMISSION ON DEMENTIA HEARING LOSS IN MID-LIFE IS THE MAJOR MODIFIABLE RISK FACTOR FOR DEMENTIA. HEARING LOSS IS ALSO ASSOCIATED WITH HIGHER RISK OF DEPRESSION, ANXIETY, AND SOCIAL ISOLATION IN ADULTS, AND THERE'S ASSOCIATED HIGHER COST OF HEALTH CARE AS WELL, SO THERE'S A HIGHER RATE OF FALLS, HIGHER RISK OF HOSPITALIZATION. ALL OF THIS POINTS TO THE IMPACT OF HEARING LOSS, PARTICULARLY IN PEOPLE AS THEY AGE. OUR INSTITUTE HAS BEEN VERY INTERESTED IN FUNDING RESEARCH THAT REDUCES THE COST AND INCREASES ACCESSIBILITY OF HEARING HEALTH CARE FOR ADULTS. BARRIERS TO HEARING HEALTH CARE INCLUDE HIGH COST OF DEVICES SUCH AS HEARING AIDS, COMPLEXITY AND DIFFICULTY IN ACCESSING HEARING HEALTH SERVICES, LACK OF INSURANCE COVERAGE FOR HEARING HEALTH SERVICES, FOR TRADITIONAL MEDICARE PROGRAMS, FOR EXAMPLE, DO NOT COVER THE COST OF HEARING AIDS OR THE COST OF AURAL REHABILITATION, ALTHOUGH SOME MEDICARE ADVANTAGE PROGRAMS ARE STARTING TO INCORPORATE THIS MORE AND MORE INTO THEIR PLANS. ALSO REALLY IMPORTANT IS THE STIGMA ASSOCIATED WITH HEARING LOSS. SO WE KNOW THAT OF THE ADULTS WHO COULD BENEFIT FROM USE OF HEARING AIDS IN THE UNITED STATES, ONLY ABOUT 20% OF THEM ACTUALLY USE THEM. AND SO THERE ARE MANY FACTORS THAT YOU MIGHT THINK COME INTO THIS LACK OF USE, ONE OF THEM BEING HIGH COST, ONE BEING I THINK THAT PEOPLE HAVE A PERCEPTION THAT HEARING AIDS MAY NOT BE THAT EFFECTIVE FOR THEM. THERE'S A LOT OF STIGMA, AND ASSOCIATION WITH AGEISM THAT COMES ACROSS WITH USE OF HEARING AIDS, BUT IF YOU LOOK AT EUROPE WHERE HEARING AIDS ARE ACTUALLY PAID FOR THROUGH THEIR PUBLIC HEALTH SYSTEMS, THE UPTAKE OF HEARING AIDS IS STILL ONLY ABOUT 40%. SO IT'S NOT JUST COST. BUT I THINK STIGMA AND PERCEPTION OF INEFFECTIVENESS OF THE HEARING AIDS MIGHT BE MAJOR FACTORS AS WELL. SO THE NIDCD WAS A MAJOR SPONSOR OF THE NATIONAL ACADEMY STUDY ON AFFORDABILITY AND ACCESSIBILITY OF HEARING HEALTH CARE, AND IN 2016 THIS GROUP RELEASED A REPORT THAT WAS IMPACTFUL THAT RECOMMENDED OVER THE OVER THE COUNT AVAILABILITY, A COMPANY BY A P-CASS REPORT MADE THE STAKE SOLUTION. THE WARREN GRASSLEY BILL MANDATED A REGULATORY STRUCTURE FOR OVER THE COUNTER SALES OF HEARING DEVICES. THEY WERE GIVEN THREE YEARS TO DO THAT, AND THAT DEADLINE PASSED THIS PAST SUMMER, BUT WE'RE HOPEFUL THAT THEY WILL BE ABLE TO RELEASE THOSE GUIDELINES LATER THIS YEAR. NEXT SLIDE. SO NOW I'LL TALK ABOUT SEVERAL STUDIES IN OUR PORTFOLIO THAT ADDRESS IN VARIOUS WAYS MINORITY HEALTH AND HEALTH DISPARITIES. NEXT SLIDE. SO I'LL START BY TALKING ABOUT AN EPIDEMIOLOGIC STUDY, HEALTHY PEOPLE, A NATIONAL PROGRAM SPONSORED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, THAT EVERY TEN YEARS SETS NEW GOALS TO IMPROVE THE HEALTH AND WELL BEING OF PEOPLE IN THE UNITED STATES. FOR HEALTHY PEOPLE 2020, THE NIDCD PARTICIPATED ON HEARINGS OR SENSORY COMMUNICATION DISORDERS AND SPECIFIC TOPICS ARE LISTED IN THE SLIDE. TRACKING THESE OBJECTIVES, THE NIDCD NOTED DISPARITIES IN SYMPTOMS REPORTED TO HEALTH CARE PROVIDERS, I'LL READ SOME. FOR EXAMPLE AMERICAN INDIAN AND ALASKA NATIVE POPULATIONS HAVE THE HIGHEST RATE FOR ADULTS BOTHERED BY TINNITUS DURING THE PAST YEAR. ASIANS AN HISPANIC/LATINO POPULATIONS HAD THE HIGHEST RATE FOR ADULTS SEEN FOR EVALUATION OF PROBLEMS WITH BALANCE OR DIS DIZZINESS. BLACK AFRICAN AMERICANS HAD THE HIGHEST RATE FOR YOUNG CHILDREN WITH PHONEOLOGICAL DISORDERS, LANGUAGE DELAY, OR OTHER DEVELOPMENTAL LANGUAGE PROBLEMS WHO PARTICIPATED IN SPEECH AND LANGUAGE THERAPY. SO NEXT I'D LIKE TO TELL YOU ABOUT SOME OF THE PROGRAMS THAT HAVE BEEN DEVELOPED BY NIDCD EXTRAMURAL INVESTIGATORS TO ADDRESS SOME OF THESE DISPARITIES AND STARTING OFF WITH HEARING HEALTH CARE. NEXT SLIDE PLEASE. SO I'LL TALK ABOUT SEVERAL PROGRAMS THAT HAVE BEEN DEVELOPED ACROSS THE U.S. TO ADDRESS THE LACK OF ACCESSIBILITY TO HEARING HEALTH CARE AND THESE PROGRAMS ALL HAVE SOME FEATURES IN COMMON, SERVING UNDERSERVED OR RURAL POPULATION, SECOND INVOLVE THE COMMUNITY TO DEVELOP INTERVENTIONS THAT ARE IMPORTANT TO THE COMMUNITY, PARTICIPATORY COMMUNITY-BASED RESEARCH, AND THIRD THEY ALL USE CARE DELIVERY MODELS THAT RELY ON TRAINED COMMUNITY HEALTH WORKERS WHO ARE SUPERVISED BY HEARING HEALTH PROFESSIONALS. FOR THE FIRST SLIDE SHOWS A PROGRAM CALLED OYENDO BIEN, HEARING WELL, A PILOT STUDY DEVELOPED IN THE STATE OF ARIZONA. SO, FIRST OF ALL THE RESEARCHERS STUDIED ACCESS TO CARE IN THAT STATE, AND THAT'S SHOWN ON THE MAP ON THE LIFE-THREATENING HERE. THE DOTS SHOW HEARING PROFESSIONALS. IN THIS CASE, THEY ARE AUDIOLOGISTS AND HEARING INSTRUMENT SPECIALISTS OR HEARING AID DEALERS, AND THE POPULATION IS SHOWN BY THE INTENSITY OF THE COLOR CODING. YOU CAN TELL THAT MOST OF THE AUDIOLOGISTS IN THE STATE ARE CONCENTRATED IN PHOENIX, THERE'S SOME IN TUCSON, BUT THERE ARE MANY, MANY PEOPLE WHO DO NOT HAVE A PROVIDER ANYWHERE NEAR THEM. AND SO THE ANALYSIS SHOWED THAT PEOPLE MAY TRAVEL UP TO 100 MILES TO SEE AN AUDIOLOGIST, AND THERE'S SIX METRO COUNTIES IN ARIZONA WITH NO AUDIOLOGISTS AT ALL. SO, THE STUDY TEAM DECIDED TO FOCUS THEIR RESEARCH AND THEIR PILOT PROGRAM IN SANTA CRUZ COUNTY NEAR THE MEXICAN BORDER. THERE ARE NO HEALTH CARE PROVIDERS AT ALL IN THAT COUNTY. THE INTERVENTION WAS DEVELOPED WITH INPUT OF THE COMMUNITY, AND THE FIRST PART OF THE STUDY WAS NEEDS ASSESSMENT TO DETERMINE WHAT THE BARRIERS TO CARE WERE, AND A PROGRAM WAS DEVELOPED AND THAT IS DESCRIBED AS A FIVE-WEEK SPANISH LANGUAGE CULTURALLY RELEVANT HEARING HEALTH OUTREACH PROGRAM FOR OLDER ADULTS WITH HEARING LOSS, FACILITATED BY COMMUNITY HEALTH WORKERS SUPERVISED BY AN AUDIOLOGIST. AFTER THE PROGRAM THEY CONDUCTED FOCUS GROUPS, AND THE COMMENTS IN THE FOCUS GROUPS REVEALED INCREASED SELF EFFICACY AND DECREASED STIGMA AS A RESULT OF THE PROGRAM. AND A FOLLOW-UP AFTER ONE YEAR SHOWED THAT MOST PARTICIPANTS HAD SOUGHT SOME SORT OF HEARING HEALTH CARE INTERVENTION. NEXT PROGRAM WAS DEVELOPED BY TWO INVESTIGATORS AT JOHNS HOPKINS IN INNER CITY BALTIMORE. SO THESE INVESTIGATORS ARE FRANK AND CARRIE, AND THEY WERE INTERESTED IN DEVELOPING A PROGRAM THAT COULD BE IMPLEMENTED IN THE INNER CITY, IN UNDERSERVED POPULATIONS. BEFORE THEY STARTED THEIR INTERVENTION, THEY ACTUALLY DID SOME RESEARCH, AND ON THE RIGHT IS SHOWN FROM AN NHANES DATABASE WHAT THE DISPARITIES ARE IN HEARING AID USE BETWEEN WHITE, BLACK, AND MEXICAN-AMERICAN POPULATIONS IN THE UNITED STATES. SO AS I MENTIONED PREVIOUSLY ADULTS 70 AND UP WITH HEARING LOSS IF WHITE UPTAKE IS 20%, IN BLACK AND MEXICAN AMERICAN POPULATIONS IT'S ONLY 10% SO HALF THAT. SO THE INVESTIGATORS DEVELOPED HEARING CARE INTERVENTION PROGRAM DELIVERED AGAIN BY COMMUNITY HEALTH WORKERS IN LOW INCOME POPULATION, SO SUCCESSFUL THAT DR. NEMAN RECEIVED THE CATALYST AWARD, AWARDED THROUGH AN INTERNATIONAL COMPETITION TO INVESTIGATORS WHO ARE MAKING BREAKTHROUGH INNOVATIONS TO IMPROVE THE PHYSICAL, MENTAL AND SOCIAL WELL BEING OF PEOPLE AS THEY AGE, AND THIS PROGRAM IS STILL ONGOING. NEXT SLIDE PLEASE. ANOTHER COMMUNITY-BASED PARTICIPATORY RESEARCH STUDY WAS RECENTLY FUNDED SO THIS IS NOT YET STARTED, BUT THIS IS ENDEAVORING TO ADDRESS LACK OF SERVICES IN RURAL ALABAMA. SO IT'S VERY SIMILAR. THIS STUDY TARGETS THOSE WHO HAVE MILD TO MODERATE HEARING LOSS AND NO ACCESS TO HEARING HEALTH CARE. AND THEY ARE USING A STATE-OF-THE-ART MOBIL AUDIOLOGY CLINIC TO MITIGATE NEGATIVE EFFECTS OF HEARING LOSS. SO THE GOALS OF THE PROGRAM ARE FIRST TO CONDUCT A COMMUNITY-BASED PARTICIPATORY RESEARCH NEEDS ASSESSMENT, THEN DEVELOP EFFECTIVE COMMUNITY HEALTH WORKER-LED REHABILITATION TRAINING PROGRAM. NEXT IDENTIFY EFFECTIVENESS OF PERSONAL SOUND AMPLIFICATION PRODUCTS FOR DECREASING HEARING HANDICAP AND IMPROVING SPEECH PERCEPTION AND HOPEFULLY OVER THE COUNTER DEVICES WILL BE AVAILABLE BY THE TIME THEY DO THAT. AND IMPLEMENT AURAL REHABILITATION PROGRAM. SO WE ARE LOOKING FORWARD TO SEEING THE RESULTS OF THAT STUDY. NEXT SLIDE. SO ALL OF THE STUDIES I'VE TOLD YOU ABOUT ARE ENDEAVORING TO MITIGATE THE EFFECTS OF HEARING LOSS IN PEOPLE AS THEY AGE, AND THESE STUDIES COMING UP THAT I'LL TALK ABOUT HAVE TO DO WITH INFANTS AND CHILDREN. AND THE FIRST IS A STUDY DONE OUT OF THE UNIVERSITY OF KENTUCKY BY MATT BUSCH AND COLLEAGUES, AND THESE CHILDREN THAT ARE BEING TARGETED ARE IN RULE APPALACHIA IN KENTUCKY, RURAL APPALACHIA, FOLLOW-UP FOR CHILDREN WHO FAILED NEWBORN SCREENING. UNIVERSAL NEWBORN SCREENING IS INCREDIBLY SUCCESSFUL PROGRAM IN THE UNITED STATES. IT WAS MANDATED BY LAW IN 1999, AND AT THIS POINT IN TIME 98% OF NEWBORNS IN THE U.S. ARE SCREENED WITHIN THREE MONTHS OF LIFE, MOST OF THEM WHILE IN THE HOSPITAL. HOWEVER, IT'S NOT ENTIRELY A SUCCESS STORY BECAUSE 36% OF CHILDREN ARE LOST TO FOLLOW-UP, SO WHEN CHILDREN ARE INITIALLY SCREENED, THEY ARE IDENTIFIED AS HAVING POSSIBLE HEARING LOSS, THEY ARE GENERALLY GIVEN APPOINTMENT TO COME BACK AND SEE THE AUDIOLOGIST FOR DEFINITIVE TESTING, AND INTERVENTION IF WARRANTED, AND THAT PROCESS SHOULD TAKE PLACE WITHIN SIX TO THREE MONTHS, AND SO FOR MORE THAN A THIRD OF THESE CHILDREN PARTICULARLY CHILDREN IN UNDERSERVED AREAS, THIS IS NOT HAPPENING. BEFORE WE HAD NEWBORN HEARING SCREENING THE AGE, AVERAGE AGE OF IDENTIFICATION OF HEARING LOSS IN CHILDREN WAS AGE 3. SO BY AGE 3, THERE'S BEEN MUCH OPPORTUNITY TO LEARN LANGUAGE AND DEVELOP THAT'S BEEN LOST, SO WE'RE VERY INTERESTED IN IMPROVING UPTAKE OF FOLLOW-UP IN THESE HEARING SCREENING PROGRAMS. THIS PROGRAM IN PARTICULAR IS STUDYING THE USE OF A PATIENT NAVIGATOR WITH DECREASED NON-ADHERENCE TO FOLLOW-UP BY PARENTS, WE'RE HOPEFUL THIS WILL BE SUCCESSFUL. I WANTED TO MENTION ON THE LEFT THE INVESTIGATORS PROVIDED DATA ON PREDICTORS OF HEARING LOSS, IN THESE NEWBORNS, AND YOU CAN SEE THE FACTORS THEY LOOKED AT ON THE LEFT, AND THE FURTHER THE SYMBOL TO THE RIGHT, THE MORE IMPACTFUL THE PREDICTOR WAS AND YOU CAN SEE FOR MINORITY RACE THAT THIS IS THE HIGHEST PREDICTOR OF HEARING LOSS AMONG THE FACTORS SHOWN. AND NEXT SLIDE PLEASE. SO NEXT IS A REALLY INTERESTING PROGRAM THAT WAS DEVELOPED BY DR. SUSAN EMMITT, A COLLEAGUE OF MINE AT DUKE, SO I'M VERY FAMILIAR WITH THIS PROGRAM. AND I THOUGHT THIS MIGHT BE OF PARTICULAR INTEREST TO ALL OF YOU AND ALSO TO DR. MANSON, WHO I THINK MIGHT HAVE JOINED PRIOR TO HIS TALK WHICH WILL FOLLOW THIS ONE, BUT THIS IS A PROGRAM, I'M CHEATING BECAUSE IT WAS FUNDED BY PCORI, PARTICIPATED IN CENTERED OUTCOMES RESEARCH INSTITUTE AND NOT THE NIDCD BUT THIS INVESTIGATOR IS FUNDED BY US AND SUBSEQUENT PROGRAMS HAVE UTILIZED THIS INFRASTRUCTURE SO I WANTED TO TELL YOU ABOUT IT. SO, YOU CAN SEE ON THE MAP ON THE RIGHT, THIS AREA OF ALASKA THAT SHE'S FOCUSED ON IS PARTICULARLY REMOTE. IT IS ANCHORED AROUND THE CITY OF NOME, ON THE COAST THERE. AS IS TRUE OF 75% OF ALASKAN COMMUNITIES THIS REGION IS REACHED ONLY BY BOAT OR PLANE, DUE TO LACK OF ROADS AND EXTREME WEATHER CONDITIONS. IT'S QUITE CHALLENGING TO DEVELOP THIS PROGRAM. AND THE PROBLEM THAT THE INVESTIGATORS ARE TRYING TO DEAL WITH IS SHOWN IN THE CARTOON ON THE LEFT, AT THE TIME THAT THE PROGRAM WAS STARTED, EVEN IF CHILDREN WERE SCREENED THEY WEREN'T SEEN FOR FOLLOW-UP FOR MANY MONTHS OR EVEN A YEAR LATER. AND THEY ARE ATTEMPTING TO IMPROVE AGAIN THE FOLLOW-UP OF THESE CHILDREN ONCE THEY ARE IDENTIFIED AS HAVING HEARING LOSS. ONE ALL MARK OF THIS WORK IN DEVELOPING THE PROGRAM THE INVESTIGATORS WORKED CLOSELY WITH A NATIVE ALASKAN COMMUNITY TO CREATE INTERVENTIONS MEANINGFUL TO THE COMMUNITY. COMMUNITY MEMBER GUIDANCE SHAPES RESEARCH QUESTIONS, THE OUTCOMES TO BE MEASURED, PROCEDURES FOR COMPLETING THE PROJECT, SUCH AS PARTICIPANT RECRUITMENT. SO IT WAS TRULY A TEAM EFFORT. SO THE STUDIES INCLUDED HEARING SCREENING OF SCHOOL-AGE CHILDREN WITH MOBILE HEALTH REFERRAL PROCESS FOR EARLY CHILDHOOD INTERVENTION, AND CELL PHONE-BASED SCREENING PROCESS FOR ADULTS. THERE'S ALSO A VERY STRONG NEED AS YOU CAN IMAGINE FOR TELEMEDICINE OPTIONS IN ALASKA IN GENERAL AND THEY DO HAVE A STRONG SYSTEM WHICH WAS STRENGTHENED FOR TREATMENT OF HEARING LOSS AND EAR DISEASE BY THIS STUDY THE NEXT SLIDE, STUDY ALSO BY DR. EMMITT, A REALLY INTERESTING STUDY THAT LEVERAGES THE ONGOING STUDY OF A COHORT OF ALASKA NATIVE CHILDREN THAT'S FUNDED BY THE NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT. THE PURPOSE OF THAT STUDY IS TO INVESTIGATE THE POSSIBLE ROLE OF A GENETIC VARIANT AND THIS IS CALLED THE ARCTIC VARIANT, IT'S IN THE CPT 1A GENE AS CAUSE OF HIGH RATES OF INFECTIOUS DISEASE AND INFANT MORTALITY IN THIS POPULATION. SO THE HIGH PREVALENCE OF THIS GENETIC VARIANT IS THOUGHT TO RESULT FROM POSITIVE GENETIC SELECTION, ORIGINAL BENEFICIAL EFFECTS TO PEOPLE IN A COLD ENVIRONMENT AND CONSUME TRADITIONAL FISH-BASED DIET. HOWEVER, DUE TO CHANGES IN THE DIET AND EXPOSURE TO ENVIRONMENTAL RISK SUCH AS OVERCROWDED LIVING CONDITIONS AND POLLUTANTS IN THE HOME SUCH AS FROM FIRES, IT'S THOUGHT THIS GENETIC VARIANT MAY CONVEY ACTUALLY INCREASED HEALTH RISK. SO, DR. EMMITT IS ACTUALLY LOOKING AT RATES OF OTITIS MEDIA IN CHILDREN WITH THESE GENETIC VARIANTS, AND A LITTLE BIT ABOUT OTITIS MEDIA, SO OTITIS MEDIA IS THE MOST COMMON CAUSE FOR ACUTE CARE PHYSICIAN VISITS BY CHILDREN, AS A COST OF $5 BILLION ANNUALLY. IT'S ASSOCIATED WITH HEARING LOSS AND WITH CONSEQUENCE SPEECH AND LANGUAGE DELAYS. IT HAS LONG BEEN RECOGNIZED THAT THIS DISORDER OCCURS DISPROPORTIONATELY RATE AMONG NATIVE AMERICAN AND ALASKA NATIVE CHILDREN, 31% COMPARED TO 1.7 TO 5% IN THE GENERAL U.S. POPULATION, SO THIS IS A HUGE, HUGE PROBLEM. SECOND OUTPATIENT VISITS RELATED TO EAR INFECTIONS FROM OTITIS MEDIA FOR AMERICAN INDIAN AND ALASKA NATIVE CHILDREN UNDER 1 YEAR OF AGE ALMOST THREE TIMES GREATER THAN FOR OTHER U.S. INFANTS. SO THIS STUDY ADDS TO OUR KNOWLEDGE OF THE INCIDENCE OF OTITIS MEDIA AND HOPEFULLY HELP US DEVELOP FUTURE INTERVENTION TO REDUCE THIS IMPORTANT HEALTH DISPARITY IN ALASKA NATIVE CHILDREN. NEXT SLIDE PLEASE. I'M GOING TO SWITCH NOW FROM HEARING AND TALK ABOUT TASTE. SO, TASTE, MENTHOL IS A FLAVOR ADDITIVE WITH A MINTY TASTE AND AROMA, I'LL DRAW YOUR ATTENTION TO THE RIGHT SIDE OF THE SLIDE WHICH PRESENTS CDC DATA ON MENTHOL CIGARETTES AND TOBACCO USE. SO TOBACCO COMPANIES ADD MENTHOL TO MAKE CIGARETTES SEEM LESS HARSH AND MORE APPEALING ESPECIALLY TO NEW SMOKERS AND YOUNG PEOPLE. 7 OUT OF 10 AFRICAN AMERICAN YOUTH AGES 12-17 WHO USE CIGARETTES USE MENTHOL CIGARETTES. ALMOST 80% OF NON-HISPANIC BLACK ADULTS WHO SMOKED USUALLY USED MENTHOL CIGARETTES COMPARED TO 35% OF HISPANIC ADULTS AND 25% OF WHITE ADULTS. AND SOME STUDIES SHOW PEOPLE WHO SMOKE MENTHOL CIGARETTES HAVE A HARDER TIME QUITTING SMOKING THAN THOSE WHO SMOKE NON-MENTHOL CIGARETTES. SO NOW I'LL TELL YOU ABOUT SOME STUDIES THAT HAVE BEEN DONE IN OUR NIDCD INTRAMURAL PROGRAM LED BY DR. DENNIS DRAINA, CONDUCTING THE FIRST MULTI-ETHNIC STUDY TO LOOK ACROSS ALL GENES TO IDENTIFY GENETIC VULNERABILITY TO MENTHOL CIGARETTES. THEY FOUND SIGNIFICANT ASSOCIATION BETWEEN MENTHOL CIGARETTE USE AND CODING VAIRANTS IN THE GENE MRGPRX4, FOUND ONLY IN PEOPLE WITH AFRICAN DESCENT, RESULTS IN 5 TO 8-FOLD INCREASE IN ODDS OF MENTHOL CIGARETTE SMOKING, SO I THINK THAT'S A VERY HIGH IMPACT FINDING AND CAN BE VERY USEFUL IN PUBLIC HEALTH MESSAGING AND REGULATIONS, AND ACTUALLY THE FDA HAS NOW SOUGHT PUBLIC COMMENTARY AND SCIENTIFIC INFORMATION ON THE USE OF MENTHOL IN TOBACCO PRODUCTS WITH PLANS TO PROPOSE A BAN ON MENTHOL-FLAVORED CIGARETTES AND CIGARS. SO I THINK THAT'S A SUCCESS. NEXT SLIDE, MY LAST SLIDE, STUDIES IN THE AREA OF VOICE SPEECH AND LANGUAGE. THERE'S A NEED FOR RELIABLE USER-FRIENDLY TOOLS TO HELP PARENTS DETERMINE IF THEIR BABY MAY HAVE A COMMUNICATION DISORDERS. INFANTS FROM LOW INCOME, AFRICAN AMERICAN AND RURAL FAMILIES MAY RECEIVE DIAGNOSIS UP TO 1 1/2 YEARS LATER THAN CHILDREN FROM OTHER GROUPS. THIS RESULTS IN DELAYED DIAGNOSIS AND DELAYED INTERVENTION WITH EFFECTIVE INTERVENTION STRATEGIES. IN ADDITION, BLACK AND HISPANIC CHILDREN CONTINUE TO BE LESS LIKELY TO BE IDENTIFIED WITH AUTISM SPECTRUM DISORDER. THESE DIFFERENCES SUGGEST BLACK AND HISPANIC CHILDREN MAY FACE SOCIOECONOMIC OR OTHER BARRIERS THAT LEAD TO A LACK OF OR DELAYED ACCESS TO EVALUATION DIAGNOSIS AND SERVICES. HERE ARE TWO EXAMPLES, THE BABY NAVIGATOR AND AUTISM NAVIGATOR, THAT ARE WEB-BASED PLATFORMS HIGHLY INTERACTIVE THAT SHOW EXTENSIVE VIDEO FOOTAGE TO ILLUSTRATE EARLY MILESTONES AND RESPONSIVE PARENTING. THEY MAXIMIZE THE USE OF MOBILE TECHNOLOGY FOR COMMUNITY IMPLEMENTATION AND SCIENTIFIC ADVANCES THAT CAN RAPIDLY SCALE UP TO REACH CHILDREN AND FAMILIES ANYWHERE. THEY CAN REACH FAMILIES WHO PARTICIPATE IN RESEARCH WITHOUT COMING TO A RESEARCH LAB, ALLOWING ACCESS AS NEEDED AS A YOUNGER AGE AND THEY HAVE THE POTENTIAL TO REACH FAMILIES WHO ARE UNDERSERVED, AND UNDERREPRESENTED IN RESEARCH. SO, NEXT SLIDE, SO I'M GOING TO SWITCH NOW FROM TALKING ABOUT OUR NIDCD-SUPPORTED RESEARCH AND DISCUSS INITIATIVES AND PROGRAMS THAT NIDCD IS CURRENTLY PARTICIPATING IN OR PLANNING, IN ORDER TO PROMOTE DIVERSITY AND INCLUSIVENESS WITHIN THE SCIENTIFIC WORKFORCE, AND A MORE INCLUSIVE ENVIRONMENT WITHIN OUR OWN INSTITUTE AT THE NIH. AND NEXT SLIDE. SO WE ALL AGREE THAT FOR THE U.S. TO REMAIN A GLOBAL LEADER IN SCIENTIFIC DISCOVERY AND INNOVATION, IT'S DEPENDENT UPON A POOL OF HIGHLY TALENTED SCIENTISTS FROM DIVERSE BACKGROUNDS. THE NIDCD PARTICIPATES IN TRANS-NIH PROGRAMS THAT PROMOTE DIVERSITY AS WELL AS HEALTH DISPARITIES RESEARCH, INCLUDING AS SHOWN HERE THE DIVERSITY SUPPLEMENT PROGRAM AND F31 DIVERSITY FELLOWSHIP. THE F31 DIVERSITY FELLOWSHIP PROGRAM IS INTENDED TO INCREASE THE NUMBER OF SCIENTISTS FROM DIVERSE POPULATION GROUPS, WHO DO RESEARCH IN OUR MISSION AREAS. AND THE NIDCD SCIENTIFIC REVIEW PLAN AS WELL AS REVIEW COMMITTEES AND NIH CENTER FOR SCIENTIFIC REVIEW CONDUCT THE INITIAL PEER REVIEW OF APPLICATIONS FOR THE FELLOWSHIP PROGRAM, BUT THE NIDCD ACTUALLY STRIVES TO EXPEDITE THE PEER REVIEW PROCESS AND THE AWARD QUICKLY AFTER THE REVIEW THE SUMMARY STATEMENTS SO THAT THESE CAN BE REVISED AND RESUBMITTED ON THE NEXT ROUND AND APPLICANTS DON'T HAVE TO WAIT FOR ANOTHER TWO ROUNDS TO GET THEIR APPLICATION BACK IN. IN ADDITION, WE CONSIDER WORKFORCE DIVERSITY AND R01 AWARDS USING A HIGH PROGRAM PRIORITY PROCESS TO AWARD R01 APPLICATIONS THAT FALL OUTSIDE OF OUR AUTOMATIC PAY LINE, AND SO WE DO THAT WITH EACH COUNCIL, CAREFULLY GOING THROUGH THESE APPLICATIONS, WE ALSO USE AN R56 HIGH PRIORITY SHORT-TERM PROJECT AWARD TO PROVIDE FUNDS TO ALLOW INVESTIGATORS TO CONTINUE PROMISING LINES OF RESEARCH WHILE REVISING AND RESUBMITTING AN INITIALLY UNSUCCESSFUL R01 APPLICATION. NEXT SLIDE. THE NIDCD PUBLISHED A FUNDING OPPORTUNITY ANNOUNCEMENT FOR SUPPORTING COOPERATIVE AGREEMENTS FOR CLINICAL TRIALS IN COMMUNICATION DISORDERS, WE'VE ADDED NEW LANGUAGE. IN ADDITION TO STATING THE DEMOGRAPHIC BREAKDOWN OF THE GEOGRAPHIC AREA IN WHICH THE SCIENCE WILL BE CONDUCTED, A RECRUITMENT PLAN FOCUSED SPECIFICALLY ON ENGAGING UNDERREPRESENTED MINORITY POPULATIONS MUST BE INCLUDED IN THE APPLICATION. NEXT SLIDE. WE'VE BEGUN TO EXPLORE WITH MEMBERS OF OUR NIDCD COUNCIL AND OTHER STAKEHOLDERS HOW WE CAN MOST EFFECTIVELY ENGAGE UNDERREPRESENTED MINORITY SCIENTISTS THROUGHOUT THEIR CAREERS, AND SUPPORT TRAINING, MENTORING AND LEADERSHIP DEVELOPMENT PROGRAMS TO ENSURE ROBUST WORKFORCE. ELISEO SPOKE WITH OUR COUNCIL LAST WEEK AND HE CAME ON A LITTLE BIT EARLY SO HE HEARD A PART OF THIS DISCUSSION. AS SOON AS THE INITIAL CONSIDERATIONS ARE SHOWN HERE, THEY ARE PLANNING ON PRESENTING THEIR FINAL REPORT AT OUR MAY COUNCIL MEETING. INITIALLY THEY ARE DEVELOPING SOME RECOMMENDATIONS AROUND TRAINING AND ENGAGEMENT OF SCIENTISTS INCLUDING THOSE FROM DIVERSE BACKGROUNDS, IDENTIFYING AND SUPPORTING RESEARCH RELATED TO HEALTH DISPARITIES AND INEQUITIES, WITHIN THE NIDCD MISSION AREAS, AND FINALLY CREATING OPPORTUNITIES FOR SCIENTISTS WITH DISABILITIES, IN OUR INSTITUTE IT'S OF PARTICULAR INTEREST TO US TO SUPPORT INVESTIGATORS WHO ARE DEAF AND HARD OF HEARING OR HAVE OTHER COMMUNICATION DISORDERS. NEXT THE NIDCD HAS PLANS TO DEVELOP FURTHER PROGRAMMING WE HOPE WILL BE HELPFUL IN PROMOTING A DIVERSE WORKFORCE, ONE IS TO DEVELOP A TWO-DAY MENTORING EXPERIENCE FOR CANDIDATES AT VARIOUS CAREER STAGES WHO SUBMITTED UNSUCCESSFUL APPLICATIONS. WE FUND EXTRAMURAL PROGRAM IN ONE OF OUR PROFESSIONAL SOCIETIES, VERY WELL FOR A NUMBER OF YEARS, WE'RE WORKING TO BRING AN IN-HOUSE PROGRAM TO BEING AS WELL. WE'RE ALSO LOOKING AT DEVELOPING NEW APPROACHES AND MECHANISMS TO BETTER SUPPORT THE TRAINING, MENTORING LEADERSHIP AND ENGAGEMENT OF UNDERREPRESENTED MINORITY SCIENTISTS AND LOOKING AT WAYS TO BE ABLE TO DO THAT AS WELL. NEXT. LOOKING INTERNALLY WE'VE DEVELOPED INTERNAL NIDCD DIVERSITY WORKING GROUP TO HELP ENSURE OUR OWN FEDERAL WORKPLACE IS DIVERSE, RESPECTFUL AND INCLUSIVE. I'M VERY HAPPY TO SAY THIS OPPORTUNITY ON SERVE ON THE COMMITTEE WAS MADE WITH GREAT ENTHUSIASM AND COMPRISED OF STAFF VOLUNTEER REPRESENTATIVE FROM EVERY LEVEL SPANNING ALL NIDCD DIVISIONS, AND NOW HOLD MONTHLY MEETINGS AND ARE WELL ON THEIR WAY TO DEVELOPING RECOMMENDATIONS THEY WILL EXPLORE AND IMPLEMENT OPPORTUNITIES TO IMPROVE INCLUSION, EQUITY AND RESPECT WITHIN THE INSTITUTE, AND FOSTER INFORMED COMMUNITY WELCOMING TO EVERYONE. I PLAN TO RECRUIT A CHIEF DIVERSITY OFFICER TO FOCUS EFFORTS AND STRENGTHEN ACCOUNTABILITY IN THIS AREA BOTH INTERNALLY AND IN OUR EXTRAMURALLY DIRECTED PROGRAMS. AND NEXT. FINALLY THE NIDCD CONTINUES TO CO-SPONSOR AND PARTICIPATE IN TRANS-NIH INITIATIVES SUCH AS MOSAIC, THE FIRST PROGRAM, SCORE, AND RADX-up THAT YOU'RE VERY FAMILIAR WITH. AND WE'RE VERY COMMITTED TO PROMOTING RESEARCH AND RESEARCH TRAINING THROUGH THESE PROGRAMS. THE FIRST PROGRAM WE'RE ACTUALLY LOOKING AT POTENTIALLY BEING ABLE TO AWARD SUPPLEMENTS TO THIS PROGRAM. I'VE BEEN TOLD THAT'S POSSIBLE. WE'RE WAITING UNTIL THESE INITIAL AWARDS WERE MADE TO SEE IF WE CAN OFFER SUPPLEMENT FUNDING IN ORDER TO HAVE EVEN MORE HIGHER IN OUR MISSION AREAS. NEXT SLIDE. NOW THAT YOU'VE HEARD SOME EXAMPLES OF WHAT WE'RE DOING I'D LOVE TO GET YOUR INPUT ON WHAT ELSE YOU THINK WE MIGHT BE ABLE TO DO. SO LOOK FORWARD TO HAVING SOME DISCUSSION AND THE NEXT SLIDE SHOWS A COUPLE OF QUESTIONS FOR CONSIDERATION. FIRST WHAT RESEARCH OR WORKFORCE OPPORTUNITIES MIGHT WE HAVE MISSED? SECOND, HOW CAN THE NIDCD BETTER LEVERAGE CLINICIAN SCIENTISTS SUCH AS OTOLARNING OTOLARYNGOLOGIEST, AND AUDIOLOGISTS AND SPEECH-LANGUAGE PATHOLOGISTS, WHAT PROGRAMS MIGHT RENOT HAVE THOUGHT OF AND WHAT MIGHT BE AREAS OF COLLABORATION BETWEEN OUR INSTITUTES THAT WE COULD EXPLORE. I WILL TURN THE FLOOR OVER TO YOU, ELISEO. >> THANK YOU, DEBARA. THAT WAS A WONDERFUL TOUR OF YOUR INSTITUTE. AM I OKAY? I HEAR BACKGROUND NOISE. I'LL LET COUNCIL MEMBERS DECIDE BUT I CAN PROBABLY TAKE THOSE AND THINK ABOUT THEM AND GET BACK TO YOU ON SOME ISSUES. I THINK THAT APPRECIATION FOR THE NIDCD SPECTRUM OF INTEREST BEYOND HEARING I THINK IS REALLY RELEVANT, AS A GENERAL INTERNIST I HAVE AN APPRECIATION FOR THE CLINICAL SPECTRUM AMONG ADULTS, AND ALMOST RESIGNED TO SAY THAT, YOU KNOW, HEARING LOSS HAPPENS WITH AGING, SO NORMALLY WE SEE SOME LOSS, HIGH FREQUENCY OF COURSE, BUT CLEARLY AS YOU POINT OUT THE INTERVENTIONS, THE UPTAKE IS REALLY NOT AS GOOD AS IT SHOULD BE OR AS IT COULD BE, SOME IS ACCESSING COST, SOME IS ACCEPTANCE AND STIGMA. AND I DO REMEMBER HOW MY FATHER STRUGGLED WITH DIFFERENT KINDS OF HEARING AIDS BEFORE SETTLING ON ONE TO HIS LIKING AND CERTAINLY WOULD HELP QUALITY OF LIFE FOR MANY. I HAD A SPECIFIC QUESTION ON NOISE EXPOSURE. WHERE ARE WE WITH THAT? AND IS THAT ONE OF THE POTENTIAL EXPLANATIONS FOR DIFFERENCES IN TERMS OF HEARING LOSS AMONG ADULTS BY EITHER RACE/ETHNICITY OR SOCIOECONOMIC STATUS? >> NOISE IS A HUGE CONTRIBUTOR TO AGE-RELATED HEARING LOSS. IF YOU LOOK AT AGED POPULATIONS IN ISOLATED COMMUNITIES, THEY LOOKED AT SOME ISLAND COMMUNITIES, FOR EXAMPLE, THAT HAVE BEEN ISOLATED OVER THE YEARS, AND THEIR LEVEL OF HEARING LOSS WITH AGING IS NOT AS GREAT AS IT IS IN INDUSTRIALIZED COUNTRIES. I THINK THIS IS A HUGE PROBLEM IN DEVELOPING COUNTRIES, IN THE U.S. AND OTHER HIGH INCOME COUNTRIES WE HAVE LAWS THAT LIMIT NOISE EXPOSURE. THEY ARE NOT AS PROBABLY AS COMPREHENSIVE AS I THINK THEY SHOULD BE BUT IF YOU GO TO AFRICA, FOR EXAMPLE, AND WALK DOWN THE STREET YOU'RE WALKING NEXT TO SOMEBODY WITH A JACKHAMMER IN THE MIDDLE OF THE ROAD AND NOBODY IS PAYING ATTENTION. WE'RE BEGINNING TO UNDERSTAND GENETIC COMPONENTS OF AGE-RELATED HEARING LOSS AND HOW NOISE MAY INTERACT WITH GENETIC CAUSES AS WELL. >> ALL RIGHT. QUESTIONS FROM THE COUNCIL MEMBERS. KEAWE WAS FIRST. >> ALOHA. FIRST OF ALL, MAHALA FOR YOUR PRESENTATION, I APPRECIATE WHAT YOUR INSTITUTE IS DOING ESPECIALLY AROUND HEALTH DISPARITIES. I OFTEN FEEL LIKE HEARING PROBLEMS WITH SLEEP DISORDERS ARE UNDERAPPRECIATED TRADITIONALLY ALTHOUGH THEY ARE EMERGING AS A RESEARCH AREA FOCUS, ESPECIALLY HAS TO DO WITH HEALTH DISPARITIES. I WANT TO GET YOUR THOUGHTS AND MAYBE POSSIBLE COLLABORATIONS BETWEEN OUR INSTITUTIONS LOOKING AT PATHWAY OR MECHANISM WITH PROBLEMS EARLY IN LIFE LEAD TO DISPARITIES LATER IN LIFE. WE KNOW HEARING PROBLEMS LEAD TO ACADEMIC PERFORMANCE ISSUES, OF COURSE THAT LEADS TO PROBLEMS ARE SECURING HIGHER EDUCATION AND JOBS WITH ADEQUATE -- PROVIDES ADEQUATE LIVING, YOU SEE WHERE I'M GOING WITH THIS, RELATED TO THAT. WHERE DO YOU SEE THOSE OPPORTUNITIES AND TO BETTER IDENTIFY THE PATHWAYS AND MECHANISMS BY WHICH THESE EARLY LIFE HEARING PROBLEMS LEAD TO LATER LIFE CHRONIC DISEASES, FOR EXAMPLE? >> YEAH, I THINK THAT'S AN EXCELLENT QUESTION. THERE ARE A LOT OF WAYS YOU COULD GO WITH THAT. ONE IS THAT WE HAVE SPONSORED SOME LONGITUDINAL STUDIES THAT LOOK OVER THE LIFESPAN AT THE EFFECTS OF HEARING LOSS EARLY IN LIFE. I THINK THE DEMENTIA COMMISSION, THE LANCET IDENTIFY HEARING LOSS IS A MAJOR MOD MODIFIABLE RISK FACTOR FOR DEMENTIA, STARTING IN MIDDLE AGE, NOT JUST LATER AGE. THERE'S SOME INFORMATION ON THAT FRONT. AND THEN YOU KNOW I THINK THAT IN UNDERSERVED COMMUNITIES, THIS IS A HUGE, HUGE ISSUE. AND I THINK SOME OF THE PROGRAMS THAT I TALKED ABOUT PROVIDE SOME WAY TO SOLVE THE PROBLEM OF UNDERSERVED AREAS IN TRAINING COMMUNITY HEALTH WORKERS, BUT I THINK THAT LIKE MANY OF THESE ISSUES IT REQUIRES LONG-TERM LOOK AT THESE POPULATIONS TO SEE WHAT THE FACTORS ARE THAT REALLY DETERMINE THE OUTCOMES, AND I THINK THAT I'VE BEEN MORE INTERESTED NOT IN LEARNING WHAT THE MECHANISMS ARE BUT LEARNING HOW WE CAN REVERSE THOSE TRENDS, JUST BECAUSE LONGITUDINAL STUDIES ARE SO EXPENSIVE AND WE HAVE TO RELY ON THE STUDIES THAT ARE ALREADY ONGOING. >> THANK YOU. >> OKAY. SPERO WAS NEXT. >> SPERO, YOU'RE NEXT. >> CAN YOU HEAR ME? >> WE HEAR YOU. >> THANK YOU. THANK YOU FOR YOUR REMARKS. SEVERAL THINGS. I'M AWARE OF DR. EMMITT'S WORK IN ALASKA. (INDISCERNIBLE) DEEPLY ROOTED COMMUNITY BASED PARTICIPATORY RESEARCH, AND THAT EVOLVED INTO WHAT YOU DESCRIBED SUBSEQUENTLY. ACTIVE DISCUSSIONS BETWEEN DR. EMMITT AND HER WORK AND UNIVERSITY OF ALASKA FAIRBANKS BUILD PROGRAM DISCUSSING REGARD TO DIVERSITY SUPPLEMENTS, WE HAVE SEVERAL ALASKA NATIVES, PhDs WORKING IN THIS AREA, AN AREA WITH EXTENSION OF THE KIND OF WORKFORCE DEVELOPMENT YOU'VE BEEN DESCRIBING. OUR OTHER POINT I WANTED TO MAKE WAS BROUGHT TO MIND BY ELISEO'S NOTE ABOUT NOISE EXPOSURE. I ALSO DIRECT THE TRIBAL INJURY PREVENTION AND CONTROL CENTER FOR INDIAN HEALTH SERVICES CDC AND IT'S BECOME EVIDENT IN THE LAST THREE OR FOUR YEARS NOISE EXPOSURE IN EARLY CHILDHOOD, MOSTLY FROM SNOWMOBILE AND OUTBOARD ENGINES FROM BOAT COMPROMISE HEARING (INDISCERNIBLE) IN YOUNG ALASKA NATIVE CHILDREN ALREADY COMPROMISED BY OTITIS MEDIA (INDISCERNIBLE) DEVELOPMENT AND NOISE EXPOSURE, THE LATTER IS NOT (INDISCERNIBLE) EARLY CHILDHOOD. >> I'VE NOT HEARD THAT BEFORE. THANK YOU. THAT'S VERY INTERESTING. >> OKAY. KIMBERLY JOHNSON, DR. JOHNSON? >> HELLO. THANK YOU. HI, DR. TUCCI. SO GLAD TO SEE YOU. GREETINGS FROM YOUR FORMER HOMETOWN IN NORTH CAROLINA AT DUKE. I'LL HAVE TO TELL EVERYBODY THEY MISSED YOUR PRESENTATION. EXCELLENT PRESENTATION. >> THANK YOU. >> I THINK THIS IS GREAT. IT'S CERTAINLY A DISPARITY WE DON'T THINK ABOUT ENOUGH. BUT I HAD A QUESTION ABOUT SOME OF THE THINGS THAT YOU PRESENTED AS INITIATIVES TO INCREASE (INDISCERNIBLE) RACIAL ANDET ETHNIC MINORITIES IN RESEARCH, A RECENT E-MAIL FROM CONGRESSMAN BUTTERFIELD INTERESTED IN LEGISLATIVE ACTION WHICH MIGHT PUSH -- LEAD TO PUSH FOR CLINICAL TRIALS AND YOU MENTIONED SOME, WE ALL HAD SUGGESTED, HOW DO WE ACTUALLY INCLUDE A RECRUITMENT PLAN FROM THE VERY BEGINNING THAT SETS SPECIFIC TARGETS BEFORE WHICH CERTAINLY MAY BE REPRESENTATION IN THE GENERAL POPULATION, ALTHOUGH WHEN MINORITIES ARE DISPROPORTIONATELY REPRESENTED THAT'S STILL TOO LOW FOR DISEASE BEING STUDIED. HOW DO YOU THINK THAT MIGHT BE CONSIDERED IN REVIEW AND, TWO, FOLLOWED LONGITUDINALLY TO SUPPORT INVESTIGATORS AND ENSURE THEY ARE DOING THE WORK THAT IT TAKES TO ENGAGE THOSE COMMUNITIES. >> YEAH, GREAT POINTS. THAT'S GOTTEN SOME ATTENTION AT NIH. WE'RE TALKING ABOUT WAYS TO MAKE SURE THAT INVESTIGATORS ARE ACCOUNTABLE THROUGHOUT THE PROCESS. SO THERE ARE WAYS TO DO THAT, AND IF IT'S WRITTEN INTO THE LANGUAGE OF THE REQUEST FOR APPLICATIONS, THEN IT HAS TO BE ADDRESSED. THAT'S ONE THING. HAS TO BE PART OF THE REVIEW, REVIEWERS HAVE TO COMMENT OUT. AFTER THE STUDY STARTED, THE ANNUAL REPORTS COME IN, IT'S ON THE SHOULDERS OF THE PROGRAM OFFICERS TO MAKE SURE THAT THE RECRUITMENT IS GOING AS PLANNED. SO I THINK THAT WE'RE ALL VERY COGNIZANT OF THIS. WE MAYBE WERE NOTING A COGNIZANT AS THEY SHOULD HAVE BEEN PREVIOUSLY AND DIDN'T HOLD TO PROMISES MADE BUT THERE'S TALK NOW ABOUT MAKING THAT HAPPEN. AND NOT ALLOWING STUDIES TO GO FORWARD WITHOUT MEETING THOSE RECRUITMENT TARGETS, WE'VE TALKED ABOUT THAT, FOR EXAMPLE, IN R13s, CONFERENCE GRANTS. I THINK WE'LL HAVE MORE OBLIGATION TO MAKE SURE THAT THE AUDIENCES ARE DIVERSE AND DIVERSE PERSPECTIVES ARE REPRESENTED AND THERE ARE WAYS TO HOLD THEM ACCOUNTABLE FOR THEM. >> WE HAVE MORE QUESTIONS. DR. CHIN? >> MARSHAL CHIN, UNIVERSITY OF CHICAGO. A SUGGEST REGARDING QUESTIONS WHAT CAN YOUR INSTITUTE DUE COLLABORATING WITH NIMHD, THAT ONE OF THE GEMS IS CONCEPTUAL MODEL, WHEN YOU SAY MULTI-LEVEL MODELS IT TALKS ABOUT PATIENT FACTORS, PROVIDE FACTORS, POLICY AND COMMUNITY FACTORS ACROSS GENETICS, HEALTH FACTORS, ACROSS SOCIAL FACTORS, AND I WAS IMPRESSED BY THE RAGE OF TOPICS, HOW THEY SPANNED DIFFERENT DOMAINS. ONE STEP MIGHT BE CONVENING THEM FOR YOUR FIELD, THAT WOULD TRY TO IDENTIFY THEM, WHAT ARE THE MECHANISMS, PATHWAYS ALONG SORT OF LIKE TABLES OF MULTI-LEVEL DIMENSIONS, I'VE YET TO SEE A FIELD NOT EXCITED TO BE TALKING ABOUT EQUITY, ENERGIZED BY SOLUTIONS. GREAT FOR YOUR FIELD IN AND POTENTIALLY DEFINE RICH AGENDA. REGARDING NIMHD, ONE OF THE STRENGTHS OF THE INSTITUTE IS FOREFRONT FOR SOCIAL DETERMINANTS OF HEALTH, STRUCTURAL RACISM, A LOT OF SYNERGIES IN CONJUNCTION WITH YOUR FIELDS, WITH GENERAL LESSONS AS NIMHD GRAPPLES CAN GENERIC ISSUES RELEVANT FOR ALL THE INSTITUTES. >> THANK YOU. GREAT COMMENTS. >> MAKE SURE YOU GET THE RESEARCH FRAMEWORK. WE HAVE DR. MUSTANSKI? >> I JUST WANTED TO COMMENT, I CONDUCT RESEARCH ON SEXUAL AND GENDER MINORITY HEALTH, AND USUALLY WHEN WE HAVE A (INDISCERNIBLE) LIKE TO LOOK AT THEIR PORTFOLIO AS RELATES TO SEXUAL AND GENDER MINORITY, WHAT DATA WE HAVE ON THIS POPULATION. OBVIOUSLY AS I WAS LOOKING FOR YOUR VISIT IT'S CLEAR THERE'S VERY LITTLE DATA ON THE SEXUAL AND GENDER MINORITY POPULATIONS, IN THE DISEASE AREAS YOU FOCUS ON. I KNOW THAT YOUR INSTITUTE -- BOTH OF THE PROGRAM ANNOUNCEMENT FOR SEXUAL AND GENDER MINORITY HEALTH AND RECENTLY TRANS HEALTH WONDERING IF YOU WERE ABLE TO SHARE THOUGHTS ABOUT ISSUES IN THE SEXUAL AND GENDER MINORITY POPULATIONS. WE HAVE (INDISCERNIBLE) THAT PROVIDE ADULT AND CHILD TRANSGENDER SERVICES, THEY ARE REALLY IMPORTANT IN HELPING INDIVIDUALS ACHIEVE VOCAL PRESENTATION THAT'S IMPORTANT FOR THEM AS WELL AS PROVIDE IMPORTANT QUALITY OF LIFE AND VOCAL HEALTH SERVICES, AND SO JUST CURIOUS IF THIS IS AN AREA YOU'RE LOOKING INTO OR WHAT OBSERVATIONS YOU HAVE ABOUT OUR COMMUNITY. >> YOU KNOW, THAT'S A GREAT POINT. AND YOUR QUESTION WILL PROMPT ME TO LOOK INTO THAT BECAUSE I ACTUALLY HAVE NOT HEARD OF THOSE STUDIES IN OUR PORTFOLIO BUT I WILL FIND OUT. AND THANK YOU FOR BRINGING THAT UP. >> FINALLY JUDITH LONG HAD A COMMENT BECAUSE IT'S IN THE CHAT, IT DOESN'T GO ANYWHERE. DO YOU WANT TO SAY WHAT YOUR COMMENT WAS, DR. LONG? >> SURE. THAT WAS A GREAT PRESENTATION. I AM THE V.A. REPRESENTATIVE ON COUNCIL. SO AS YOU CAN IMAGINE, VETERANS DEAL A LOT WITH BOTH TINNITUS AND HEARING LOSS. A LOT OF VETERANS ACCESS THE V.A. JUST FOR HIGH QUALITY HEARING AIDS AND HEARING SERVICES, IT'S ONE OF THE SERVICES THE V.A. PROVIDES. I DID A PubMed SEARCH AND DIDN'T FIND DISPARITIES. ARE THERE DISPARITIES TO JOBS ASSIGNED ASSOCIATED WITH HEARING LOSS, IS THERE A HIGH PREVALENCE OF HEARING LOSS IN MINORITY VETERANS, SOMETHING TO BRING BACK TO THE V.A.? ALSO PARTNERSHIP OR THINKING OF A LARGE BURDEN OF DISEASE IN VETERAN POPULATIONS. >> UH-HUH, YEAH, THAT'S A GREAT POINT. WE THOUGHT A LOT ABOUT HEARING HEALTH CARE AND THE V.A. THE V V.A. WAS A RESPONSIBLE TORE OF THE NATIONAL ACADEMY STUDY, DO AN EXCELLENT JOB OF DELIVERING HEALTH HEALTH CARE, LARGEST PURCHASER OF HEARING AIDS IN THE UNITED STATES SO THEY GET A DECREASED COST FOR HEARING AIDS BECAUSE OF VOLUME. I DO NOT KNOW OF ANY RESEARCH GOING ON IN THE V.A. THAT WOULD LOOK AT DISPARITIES IN THE WAY YOU MENTIONED, THAT'S A REALLY INTERESTING QUESTION AS WELL. >> WELL, THANK YOU VERY MUCH FOR A WONDERFUL PRESENTATION BY THE NATURE OF THE QUESTIONS YOU GOT, YOU SAW A LOT OF INTEREST AND OPPORTUNITY POTENTIAL, SO I'LL GET BACK TO YOU ABOUT YOUR QUESTIONS AT THE END. THANK YOU FOR DOING THAT. IT'S THE FIRST TIME I SEE THAT FROM ANOTHER I.C. DIRECTOR, SO I AGAIN I APPRECIATE YOUR TIME FOR PRESENTING AND PUTTING THE EFFORT INTO THE PRESENTATION. THANK YOU VERY MUCH. >> THANK YOU VERY MUCH, ELISEO. THANK YOU ALL. >> THANKS. WE SHOULD MOVE ON. SECOND SPEAKER FOR TODAY IS DR. SPEAR OMAN SON, AND SPERO DOESN'T NEED A LOT OF INTRODUCTION, I WANT TO SAY A FEW THINGS ABOUT HIM. DISTINGUISHED PROFESSOR OF PUBLIC HEALTH AND PSYCHIATRY, DIRECTS OFFICERS FOR AMERICAN INDIAN AND ALASKA NATIVE, CHIPPEWA HIMSELF, HE OCCUPIES A TRUST CHAIR IN AMERICAN INDIAN HEALTH, COLORADO SCHOOL OF PUBLIC HEALTH AND UNIVERSITY OF COLORADO DENVER ANSCHUTZ MEDICAL CENTER. HIS PROGRAMS INCLUDE TEN NATIONAL CENTERS WHICH PURSUIT RESEARCH PROGRAM DEVELOPMENT TRAINING AND COLLABORATION WITH 225 NATIVE COMMUNITIES SPANNING RURAL RESERVATION, URBAN AND VILLAGE SETTINGS ACROSS THE COUNTRY INCLUDING ALASKA. SPERO HAS ACQUIRED $268 MILLION IN SPONSOR RESEARCH, PRETTY SOON MORE THAN NIMHD, AT LEAST IN HIS LIFETIME, PUBLISHED 280 ARTICLES ON ASSESSMENT EPIDEMIOLOGY AND TREATMENT PREVENTION OF PHYSICAL ALCOHOL. SPERO HAS BEEN RECIPIENT OF NUMEROUS AWARDS, HE WAS ELECTED TO NATIONAL ACADEMY OF MEDICINE IN 2002, RECEIVED AAMC AWARD IN 2006, RECOGNIZED NUMEROUS TIMES FOR WORK, A MEMBER OF THE ADVISORY COUNCIL FOR DIRECTOR OF THE NIH, AND AGREED TO STAY ON AS NIMHD AFTER A SPECIAL WAIVER WAS MADE, DR. MANSON IS A FRIEND THAT WE GOT TO KNOW TRUE THE RESEARCHERS IS FOR MINORITY AGING RESEARCH, BOTH FUNDED ORIGINALLY IN 1997 IF I GOT THAT RIGHT. AND OVER THE YEARS BONDED IN OUR MEETINGS AND COLLABORATED, AND REALLY SHARED BEST PRACTICES IN NUMEROUS WAYS, AND SINCE THE BEING NIMHD DIRECTOR INFORMAL ADVISER, IT'S A PLEASURE TO HAVE YOU PRESENT ON THE SBIRT PROGRAM IN NATIVE HEALTH CARE. >> I TRUST YOU CAN HEAR ME ALL RIGHT. AM I AUDIBLE? >> YOU'RE GOOD. >> GREAT. THANK YOU. FIRST I WANT TO SPEND FIVE MINUTES OR SO ASKING YOU TO JOIN ME IN A JOURNEY THAT BEGAN 20 AREAS AGO WITH THE FIRST AWARD FROM CENTERS OF EXCELLENCE NIMHD DURING THAT TIME WE BEGAN TO EXAMINE RIGOROUSLY THE INTEGRATION OF THE BEHAVIORAL HEALTH INTO PRIMARY CARE. THE STORY I'M HERE TO SHARE WITH YOU TODAY IS THE CONTEXT INITIALLY A SUICIDE, MOST RECENT EXAMPLE OF THIS JOURNEY BUT BEGAN FOCUSING ON ALCOHOL, SUBSTANCE ABUSE AND EVOLVED INTO TRAUMA MORE RECENTLY. FOCUSING ON SUICIDE, IT DISPROPORTIONATELY AFFECTED NATIVE PEOPLE. YOU CAN SEE RANKING OF THE TOP NINE LEADING CAUSES OF DEBT BY RACE/ETHNICITY IN 2017, RANKS NUMBER 8, HIGHER THAN ANY OTHER SEGMENT OF OUR POPULATION. NEXT SLIDE PLEASE. WHEN WE LOOK AT WHAT SEGMENTS OF DEVELOPMENTAL LIFESPAN IN VARIOUS POPULATIONS, WE SEE THAT IT'S EXTRAORDINARILY AFFECTING AMERICAN INDIAN AND LEAKS NATIVES, IN TERMS OF THE GOLD CURVE YOU CAN SEE IT BEGINS TO ESCALATE PARTICULARLY 15 TO 19 YEARS OF AGE RANGE, PEAKS JUST UNDER 40, AND CONTINUES TO BE WELL ABOVE ANY OTHER SEGMENT OF THE POPULATION UNTIL NEARLY 40 YEARS OF AGE. NEXT SLIDE PLEASE. SUICIDE ITSELF IS THE TIP OF THE ICEBERG WITH RESPECT TO BURDEN THAT SUICIDAL BEHAVIORS BROADLY INTRODUCE INTO THE LIVES OF AMERICAN INDIAN AND ALASKA NATIVES. IN 2016 INCIDENCE OF DEATHS DUE TO SUICIDE VERSUS ALL SUICIDES, YOU CAN SEE HOSPITALIZATION DUE TO SUICIDE ATTEMPTS, SUICIDE ATTEMPTS AND INDIVIDUAL SUICIDE REPRESENTATIVE A GROWING PLATFORM WITH REGARD TO THIS SET OF BEHAVIORS AND EMOTIONAL AND PSYCHOLOGICAL CHALLENGES. NEXT SLIDE PLEASE. WE'VE SEEN WHAT THIS REPRESENTS BETWEEN 1999 AND 2017, GOLD LINE REPRESENTS AMERICAN INDIANS AND ALASKA NATIVES, SINCE 2003 EXCEEDED ALL OTHER SEGMENTS, INCREASES SUBSTANTIALLY OVER TIME. AND IN RECENT LAST FIVE TO SEVEN YEARS INCREASED EVEN MORE DRAMATICALLY THAN PREVIOUSLY. NEXT SLIDE PLEASE. BUT OUR WORK SUGGESTS THERE HAS BEEN AND REMAINS LARGE PART CONSPIRACY OF SILENCE THAT SURROUNDS SUICIDE. WHAT DO I MEAN BY THAT AND WHAT'S THE EVIDENCE? I HAVE THE PRIVILEGE OF CONDUCT OF LARGER PSYCHIATRIC EPIDEMIOLOGIC STUDY OF AMERICAN INDIANS AND ALASKA NATIVES IN THREE OF THE LARGEST COMMUNITY IN THE COUNTRIES IN THE LATE 90s AND EARLY 2000s, AND IN THE CONTEXT OF THIS STUDY WE ASKED QUESTIONS ABOUT STIGMA AND HOW STIGMA IS ASSOCIATED WITH VARIETY OF CONDITIONS. YOU CAN SEE HERE ON THE RIGHT-HAND SIDE OF THIS PARTICULAR SLIDE IN RESPONSE TO THE QUESTION NOTED AT THE BASE, HOW ASHAMED OR EMBARRASSED WOULD YOU FEEL IF IT BECAME KNOWN TO OTHERS YOU HAD OR WERE -- (INDISCERNIBLE) THE CONDITION OF CONCERN. ATTEMPTED SUICIDE SECOND ONLY TO HIV/AIDS ABOVE ALL OTHER IN TERMS OF HOW IT WAS RANKED. MENTAL ILLNESS FOLLOWED ALONG WITH SEXUAL ASSAULT AND ALCOHOLISM. SO, WHAT THAT CLEARLY TELLS US, AS A FUNCTION OF THIS STIGMA, SUICIDE IS A RELATIVELY COARSER EXPERIENCE SELDOM CONVERSATION AMONG PEOPLE IN OUR COMMUNITIES UNTIL RECENTLY. AND THERE ARE A VARIETY OF MYTHS THAT SURROUND EXPERIENCE OF SUICIDE AND EXPRESSION AND WHAT WE AS FAMILY, FRIENDS AND NEIGHBORS CAN DO OR NOT DO WITH THIS. AND AMONG THE MOST FREQUENT MYTHS IS THAT IF YOU TALK TO SOMEBODY ABOUT YOUR SUSPICIONS OF THEIR POTENTIAL SUICIDALITY YOU MAY ENCOURAGE LIKELIHOOD THAT OCCURS. WHICH IS ONE OF THE CLASSIC MYTHS (INDISCERNIBLE) IN THE LITERATURE AVAILABLE TO US. WHAT WE DO SEE THOUGH AS ELISEO WOULD BE QUICK TO POINT OUT AS OTHER PHYSICIANS AMONG US, IS THE WHITE CLOAK PHENOMENON. IN CLINICAL ENCOUNTER, PRIMARY CARE PARTICULARLY, ONE OF THE FEW SETTINGS WHERE PATIENTS, AMERICAN AMERICAN AND ALASKA NATIVES FEEL SECURE OF CONFIDENTIALITY TO BE OPEN TO DISCLOSE SUICIDAL IDEATION AND INTENT. NEXT SLIDE PLEASE. THAT OBSERVATION LED TO THE GULF OF EVIDENCE-BASED PRACTICE THAT REPRESENTATIVE FORMALIZATION OF MANY OF THE DETECTION AND MANAGEMENT PROCEDURES LONG BEEN A PART OF SCREENING IN PRIMARY CARE, IN THIS INSTANCE FOCUS ON BEHAVIORAL, HEALTH DISORDERS, INITIALLY ALCOHOL, AND SUBSTANCE ABUSE, MORE RECENTLY WITH RESPECT TO SUICIDE. SO IN THIS EVIDENCE-BASED PRACTICE WAS INITIALLY INTRODUCED, PROMOTED, AND HEAVILY FUNDED BY SUBSTANCE USE AND MENTAL HEALTH SERVICES ADMINISTRATION, WHERE I HAD THE OPPORTUNITY TO JOIN WITH THEM THROUGH HOW THIS PARTICULAR EVIDENCE-BASED PRACTICE MIGHT BE ADAPTED FOR USE IN NATIVE COMMUNITIES. WHAT IS SBIRT? IT'S HAVING AN EFFICIENT AND SIMPLE YET CULTURALLY RELEVANT MEANS OF IDENTIFYING AT-RISK, AND BY CO-LOCATION OF BACCALAUREATE OR MASTER'S LEVEL CLINICIAN AMONG THE PRIMARY CARE MEMBERS TO ENCOURAGE ONE GREATER UNDERSTANDING OF THE NATURE AND EXTENT OF SUICIDALITY OF THE KINDS THAT IT'S NOT INEVITABLE, THAT IT IS SUBJECT TO CHANGE AND (INDISCERNIBLE) PROVIDE INDIVIDUALS AS SUCH RISK WITH TOOLS TO ENGAGE IN SUCH CHANGE. NOTABLY IN NATIONAL STRATEGIES GOALS AND PREVENTION WHICH I HAVE OPPORTUNITY TO CONTRIBUTE TO, WE IDENTIFIED SBIRT AS EVIDENCE-BASED PRACTICE AS A HIGHLY LIKELY TOOL TO BE ABLE TO USE IN EARLY DETECTION, TRIAGE AND MANAGEMENT OF YOUNG PEOPLE AT HIGH RISK OF SUICIDE. NEXT SLIDE PLEASE. WE KNOW GENERALLY AND NOW IN THE CONTEXT OF INDIAN HEALTH CARE THAT SUICIDE WORKS WELL IN PRIMARY CARE SETTINGS. THE PERFECT VEHICLE TO BE PARTNERING WITH PRIMARY CARE PRACTITIONERS IN THESE PARTICULAR SETTINGS. WE KNOW THAT STIGMATIZING CONDITIONS SUCH AS SUICIDALITY ARE MORE READILY DISCUSSED BY PATIENTS IN PRIMARY CARE THAN VIRTUALLY ANY OTHER SETTINGS, IN SCHOOL, SOCIAL SERVICES, ET CETERA. WE KNOW CO-LOCATING A BEHAVIORAL HEALTH CLINICIAN IN THE PRIMARY CARE TEAM WHETHER IT BE A BACCALAUREATE OR MASTER'S LEVEL IF POSSIBLE, IT TAKES CHANGE IN TERMS OF ORGANIZATIONAL CLIMATE AND CULTURE, IN TERMS OF PRIMARY CARE PROVIDER TEAMS, TO EMBRACE THE INCLUSION OF SUCH INDIVIDUALS BUT WE KNOW AND HAVE EVIDENCE IT'S POSSIBLE TO DO. WE KNOW THAT THE INCLUSION OF CO-LOCATING INDIVIDUALS IN PRIMARY CARE TEAMS AFFORDS MORE TIMELY INTERVENTION BY TRAINED PROFESSIONAL TO INTERCEDE AMONG THESE INDIVIDUALS AT HIGHEST RISK AND BEGIN TO REDUCE INCIDENT SUICIDE AS WELL AS RELATED BEHAVIORS. IT RELIEVES THE PRIMARY CARE PROVIDER WHO WE KNOW IS ALREADY SUBSTANTIALLY BURDENED BY ADDRESSING SUICIDALITY ALL THE OTHER COMORBID CONDITIONS WHO ARE LESS LIKELY TO DO SO BECAUSE OF WHAT THEY PERCEIVE IS THE PRIMARY CAUSES FOR THE CLINICAL ENCOUNTER FROM THE POINT OF VIEW OF THE PATIENT AND THE COMPETING DEMANDS IN THE EVERY-INCREASING -- DECREASING AMOUNT OF TIME TO SPEND WITH PATIENTS IN THE PRIMARY CARE SETTING. NEXT SLIDE PLEASE. OUR WORK, AGAIN I UNDERSCORE LAUNCHED BY NIMHD, NEARLY TWO DECADES AGO, HAS REALLY UNDERSCORED THE FOLLOWING. THAT IN SUBSEQUENT FOLLOW-UP BY THE SBIRT CLINICIAN THERE IS MORE TIME TO UNDERSTAND THE PATIENT RISK BY INCLUSION OF THE CO-LOCATION OF THIS BACCALAUREATE OR MASTER'S LEVEL CLINICIAN IN THE TEAM. DOING SO RAISES PATIENT AWARENESS OF SUICIDE AS A PLAUSIBLE CONCERN RATHER THAN DENYING IT. ENHANCES THOSE INDIVIDUALS READINESS TO CHANGE ACCELERATED BY USE OF INTERVIEWING IN FIRST EXCHANGE BETWEEN THE CO-LOCATED CLINICIAN AND THE PATIENT AT RISK. IT ALSO TYPICALLY INCLUDES DEVELOPMENT OF CONTRACT BETWEEN PATIENT AND CO-LOCATED CLINICIAN TO PURSUE THE NEXT STEPS IN ADDRESSING THIS RISK. TO ENSURE THAT THE PATIENT KNOWS NOT ONLY THAT HIS OR HER CONCERNS REGARDING CONFIDENTIALITY AND STIGMATIZATION WILL BE RESPECTED BUT ALSO THE FACT CLINICIAN IS IDENTIFYING SOME CONCRETE STEPS BY WHICH HE OR SHE CAN ENGAGE AND COMMIT TO THIS CONTRACTUAL RELATIONSHIP OF BEGINNING WITH EDUCATION AND MOTIVATION. OUR WORK CLEARLY INDICATED THESE CAN BE READILY ADAPTED TO PATIENT ORGANIZATION CULTURE, PARTICULARLY SUIT FOR EARLY IDENTIFICATION AND TREATMENT, NOT ONLY RISK OF SUICIDE BUT OFTEN MANY COMORBID CONDITIONS SUCH AS ALCOHOL. NEXT SLIDE PLEASE. I WANT TO SHARE THE CONTEXT MUCH OF THIS WORK HAS EMERGED IN THE LAST 20 YEARS. WE TALK ABOUT AMERICAN AND ALASKA NATIVE PEOPLE, THE COMMUNITY WHICH WE'RE PART. PEOPLE OFTEN IMMEDIATELY THINK OF RESERVATION-BASED COMMUNITIES OR PERHAPS ADJACENT RURAL COMMUNITIES NEARBY THOSE TRIBAL RESERVATIONS. BUT THE FACT IS THAT OVER 72% OF ALL AMERICAN INDIANS AND ALASKA NATIVES ACROSS DEVELOPMENTAL LIFESPAN LIVE IN TODAY'S CITIES IN AMERICA, URBAN OR SUBURBAN AREAS. THAT POSES A SERIES OF CHALLENGES. THAT'S WHY IT'S BECOME CALLED (INDISCERNIBLE) TRIBE. THERE'S TRAVEL TO AND FRO, CITY TO HOMELAND, BACK AGAIN DICTATED BY SEASONALITY, DICTATED BY AGE WITH OLDER ADULTS RETREATING IN LATER YEARS BECAUSE OF THE SECURITY OF THOSE SETTINGS AND READY ACCESS AND AVAILABLE TO PRIMARY CARE AND OTHER SOURCES OF SERVICES RELEVANT TO THEIR NEEDS. WE HAVE BY AND LARGE IGNORED THAT, THE VAST PROPORTION OF AMERICAN INDIANS AND ALASKA NATIVES LIVE IN THESE SETTINGS. AGENCIES RESPONSIBLE FOR PROVIDING FOR THE CARE, ONLY 1% OF THE ENTIRE BUDGET IS DIRECTED TO CARE OF URBAN INDIAN AND NATIVE PEOPLE. AND THAT CARE IS NOT (INDISCERNIBLE) I'LL BRIEFLY INTRODUCE YOU TO THAT. NOW, THE CHALLENGES OF URBAN AMERICAN YOUTH AND YOUNG ADULTS EXPERIENCED IN THIS PARTICULAR SETTING ARE SIMILAR IN MANY CASE TO THOSE OF THE RURAL RESERVATION COUNTERPARTS. WE KNOW THAT IN FACT THE PREVALENCE OF ATTEMPTED SUICIDE AMONG URBAN NATIVE YOUTH ARE NEARLY COMPARABLE TO THEIR NATIVE COUNTERPARTS IN THE RURAL RESERVATION AREAS AND EXCEED THREE TIMES RISK OF NON-NATIVE COUNTERPARTS IN URBAN AMERICA. SOME OF THE RISK FACTORS ASSOCIATED WITH THIS ARE HELD IN COMMON, OTHERS CONTRIBUTE TO GREATER DEGREE OR PERHAPS UNIQUELY TO SUICIDE AMONG URBAN AMERICAN INDIANS AND ALASKA NATIVE YOUTH GANG ACTIVITY, TEEN PREGNANCY, INTERPERSONAL ABUSE, GREATER THAN RURAL AND RESERVATION COUNTERPARTS. NOW, YOU MAY NOT BE AWARE THESE YOUTH, MORE THAN A THIRD OF THEM ARE SERVED BY WHAT WE CALL 34 URBAN INDIAN HEALTH ORGANIZATIONS WHICH ARE LOCATED IN 19 STATES, BUT THEY ARE POORLY EQUIPPED TO ADDRESS THESE CONCERNS IN TERMS OF FINANCIAL RESOURCES AS WELL AS ADEQUATE PREPARATION OF THE PROVIDERS IN THOSE AGENCIES. NEXT SLIDE PLEASE. FIRST OFF HOW DID SO MANY AMERICAN INDIANS AND ALASKA NATIVES FIND THEIR WAYS TO CITIES IN THE UNITED STATES? A CONSEQUENCE OF A MAJOR POLICY THAT WAS PROMOTED IN THE '50s AND '60s IN THE UNITED STATES, THAT WAS DEEPLY ROOTED IN ATTEMPT TO ASSIMILATE AMERICAN INDIANS AND ALASKA NATIVES INTO THE GENERAL SOCIETY AND SHARED CULTURE. THAT WAS SOMETHING CALLED THE JOB RELOCATION ACT, IN WHICH JOB TRAINING AND EMPLOYMENT OPPORTUNITIES FOR THOSE IN RURAL RESERVATION IF THEY WOULD MIGRATE TO UPWARDS OF 32 TO 34 CITIES WOULD BE PROVIDED WITH TRAINING AND EMPLOYMENT OPPORTUNITIES. SO WE HAD LITERALLY TENS OF THOUSANDS OF AMERICAN INDIANS AND ALASKA NATIVES RELOCATE FROM RURAL AND RESERVATION AREAS INTO TODAY'S CITIES. THE PROBLEMS IS THOSE PROMISES OF VOCATIONAL REHABILITATION AND TRAINING AND SUBSEQUENT EMPLOYMENT RARELY MATERIALIZED. NONETHELESS IT WAS IN THE RECOGNITION AND MID TO LATE '60s THAT THERE WAS SUCH A LARGE NUMBER OF NATIVE PEOPLE LIVING IN OUR CITIES, AND WHO HAD LITTLE TO NO ACCESS TO HEALTH CARE RESOURCES AS A CONSEQUENCE OF THE DISPROPORTIONATE FUNDING BY THE FEDERAL GOVERNMENT AND RURAL AND RESERVATION COMMUNITIES THIS NOTION OF URBAN INDIAN HEALTH PROGRAMS EMERGED. TO DATE THERE ARE 34 OF THOSE URBAN INDIAN HEALTH PROGRAMS SUPPORTED ACROSS THE COUNTRY, AND THEY SPAN, THE MAJORITY, CLINICS PROVIDE DIRECT CARE FOR AT LEAST 40 HOURS PER WEEK, DOWN TO SIMPLY OUTREACH AND REFERRAL PROGRAMS THAT SEEK TO IDENTIFY AND COORDINATE REFERRAL OF INDIVIDUALS IN THE OTHER HEALTH CARE ORGANIZATIONS AND AGENCIES SUCH AS OUR COUNTY HOSPITALS OR FEDERALLY QUALIFIED HEALTH CENTERS. AND WE'RE PRESENTLY IN OUR WORK WORKING WITH 12 INDIAN HEALTH PROGRAMS ACROSS THE COUNTRY. LET ME PROVIDE A SENSE OF THE NATURE OF THE WORK IN THE CONTEXT OF SBIRT. NEXT SLIDE PLEASE. THE FIRST IS WITH SOUTHCENTRAL FOUNDATION LOCATED IN ANCHORAGE ALASKA, ONE OF MY EARLY MENTEES, NOW A TREASURED COLLABORATOR COLLEAGUE DR. DENICE DILLARD WHO WENT TO DIRECT THE DEPARTMENT AT THE SOUTH SOUTHCENTRAL FOUNDATION IN 1999, HOW WE COULD TAKE EVIDENCE-BASED PRACTICE OF EXPERTS AND INTRODUCE IT INTO THIS EXTREMELY LARGE PRIMARY CARE CENTER, HOSTED, OPERATED AND SUPPORTED BY THE SOUTHCENTRAL FOUNDATION. WHAT YOU SEE HERE IS SOME OF THE KEY FEATURES OF THIS PARTICULAR EFFORT. THE ALASKA NATIVE MEDICAL CENTER, PARTICULARLY THE PRIMARY CARE CENTER, IN THE MEDICAL HOME FOR 65,000 ALASKA NATIVE/AMERICAN INDIANS IN SOUTH CENTRAL ALASKA, 36 PRIMARY CARE TEAMS THAT TREAT PATIENTS THERE. IN THE EARLY WORK IN 2000, 2001, WE BEGAN SCREENING THOSE PATIENTS WITH THIS SBIRT MODEL INITIALLY WITH RESPECT TO FOCUSING ON DEPRESSION AND ALCOHOL USE AND SUBSTANCE USE, NOW FOR EIGHT YEARS SUICIDALITY. AND THE WORK FOCUSED ON SUPPORT FROM SAMHSA TO IDENTIFY HIGHER AND INTEGRATE THREE MASTER LEVEL CLINICIANS, AND CO-LOCATE THEM WITH THE PRIMARY CARE TEAMS, EACH RESPONSIBLE FOR COORDINATING WITH 36 PRIMARY CARE TEAMS. AND AS NOTED HERE YOU CAN SEE THE SCREENING. SINCE 2001, WHEN WE LAUNCHED THIS, (INDISCERNIBLE) 15,000 UNIQUE PATIENTS SEEN IN PRIMARY CARE CENTERS, 27% DEEMED AT HIGH RISK AND FOLLOWED UP IN THIS TRIAGE AND MANAGEMENT PROCESS. OPPORTUNITIES FOR TRIAGE AND MANAGEMENT INCLUDE BEHAVIORAL HEALTH, TRADITIONAL HEALING RESOURCES AS WELL AS THE INTEGRATION INTO OTHER ANCILLARY RECOVERY PROGRAMS AVAILABLE AND SUPPORTED THROUGH AND SUPPORTED BY THE SOUTHCENTRAL FOUNDATION. NEXT SLIDE PLEASE. THE SECOND PROGRAM THAT WE ROLL OUT IS SBIRT INITIATIVE AFTER OUR EXPERIENCE AT SOUTHCENTRAL FOUNDATION I MIGHT NOTE BEFORE TALKING ABOUT THE (INDISCERNIBLE) CENTER IN 2004 WITH THE RESEARCH SUPPORTED BY NIMHD AND CENTERS OF EXCELLENCE WERE ABLE TO DEMONSTRATE THAT NOT ONLY 27% OF THOSE INDIVIDUALS SCREENED, THREE-YEAR PERIOD AT HIGH RISK, WE WERE ABLE TO REFER THEM SUCCESSFULLY IN HOUSE, OVER 72% OF THEM TO APPROPRIATE FOLLOW-UP SERVICES AND WERE ABLE TO -- TOOK COST OF CARE ANALYSES THAT SHOWED THAT IT REDUCED THE OVERUTILIZATION OF PRIMARY CARE SERVICES, SUBSTANTIALLY SAVINGS IN DOLLARS AND CENTS, AND THE STATE MEDICAID FUNDING SYSTEM, AND ALSO ABLE TO AS I'LL SHARE IN A FEW MOMENTS TO IDENTIFY BARRIERS OF FACILITATORS TO DETECTION MANAGEMENT PROCESS ITSELF. FINDINGS LED IN 2004 TO THE STATE OF ALASKA REVISING CODES SO THAT FROM THAT POINT ON THEY NOW REIMBURSED SOUTHCENTRAL FOUNDATION FOR PROVISION OF SBIRT-RELATED SERVICE, WENT FROM THREE MASTER LEVEL CLINICIANS IN THAT CONTEXT, NOW HAVE 36 MASTER LEVEL CLINICIAN, ONE ASSIGNED TO EACH TEAM FULLY FUNDED SUSTAINED BY MEDICAID REIMBURSEMENT OF THE TYPE THAT WAS WARRANTED AND JUSTIFIED ON THE BASIS OF THIS EARLY RESEARCH. WE THEN TRANSLATED THIS WORK INTO YET ANOTHER LARGE PRIMARY CARE SETTING, THIS TIME IN THE INTERIOR OF ALASKA, CHIEF TANANA HEALTH CENTER IN FAIRBANKS, SIMILAR SETTING AND ORGANIZATION MISSION, MEDICAL HOME FOR SUBSTANTIALLY SMALLER NUMBER BUT FOR GEOGRAPHIC AREA THAT COVERS 37% OF THE TOTAL LAND MASS OF THE STATE OF ALASKA, RESIDES AT THE (INDISCERNIBLE) AND YUKON RIVERS, CAN YOU SEE WITH RESPECT TO INTRODUCTION, IMPLEMENTATION AND ULTIMATELY EVALUATION AND SUSTAINING SBIRT MODEL OF THIS PARTICULAR SETTING. AGAIN, WE IDENTIFIED SIMILARLY AS WE DID WITH SOUTHCENTRAL FOUNDATION OVER 40 INDIVIDUALS WHO PARTICIPATED IN THE SCREENING PROCESS DEEMED AT HIGH RISK, FOCUS OF SUBSEQUENT TRIAGE AND MANAGEMENT. NEXT SLIDE PLEASE. 48 STATES ON THE LOWER HALF, BEGAN TO WORK WITH TWO OTHER MAJOR URBAN INDIAN HEALTH PROGRAMS, THE LARGEST ONE, IN ALBUQUERQUE, NEW MEXICO, WE'LL SEE IN A MOMENT, AGAIN STATE FUNDS STRUCTURED PROCESS, YOU CAN SEE HERE THE FIRST NATION RESOURCE IN ALBUQUERQUE, NEW MEXICO, SERVES NEARLY 57,000 AMERICAN INDIAN, AND OTHER HISPANIC RESIDENTS, THREE DISTINCT CLINIC LOCATIONS, I'LL ILLUSTRATE IN A MOMENT, THEY HAVE PHYSICIAN-LED PRIMARY CARE TEAMS THAT HAVE BEEN INTEGRATED WITHIN THAT CONTINUUM OF CARE WHICH WE CO-LOCATED CLINICIANS. THEY TOO HAVE BEEN SCREENING SUBSTANTIAL NUMBER OF UNIQUE PATIENTS IN SERVICE POPULATION, AND THEY BASED UPON THE EVIDENCE FROM OUR WORK IN PARTNERSHIP WITH THEM WERE ABLE TO GRADUATE TO THE STATE OF NEW MEXICO SBIRT PROGRAM AND WERE CERTIFIED AND SBIRT SERVICES FULLY FUNDED BY THE STATE OF NEW MEXICO THROUGH THE MEDICAID EXPANSION. NEXT SLIDE PLEASE. THE FOURTH AND LAST PROGRAM I'VE CHOSEN TO SHARE TO ILLUSTRATE SALTS INDIAN HEALTH BOARD IN SEATTLE, WASHINGTON. SIMILAR ALARMING NUMBER OF UNIQUE PATIENT IT SERVES EACH YEAR, COMPREHENSIVE IN CLINICAL FOCUS AND PRIMARY CARE, IT PROVIDES WIDE RANGE OF COMPREHENSIVE SERVICES NOT ONLY THOSE BIOMEDICAL IN RECOVERY IN NATURE BUT ALSO INCLUDE TRADITIONAL HEALING RESOURCES. THEY TOO INITIATED THEIR SBIRT PROGRAM, ALTHOUGH MORE RECENTLY THAN THE OTHER THREE, AND FOCUSING ALCOHOL ABUSE, DEPENDENCE, EXPANDED TO INCLUDE SUBSTANCE USE AND SUICIDE RISK, WERE ABLE TO MARSHAL SUPPORT OF THE IMPACT ON SERVICES OF REDUCING COST UTILIZATION AND EFFECTIVENESS WITH THESE SERVICES. THEY HAVE A FAMILY MEDICAL RESIDENCY PROGRAM THAT'S INTEGRATED INTO THEIR CLINIC AND WE'VE BEEN ABLE TO BRING THE FAMILY MEDICINE RESIDENTS INTO THE PROCESS, HOW TO INTEGRATE BEHAVIORAL HEALTH CARE INTO PRIMARY CARE. NEXT SLIDE PLEASE. SOME OF THE THINGS TO SHARE WITH YOU WE'VE DEVELOPED QUARTERLY DASHBOARDS THAT WE MAINTAIN AND POPULATE FOR EACH OF THESE PROGRAMS, DASHBOARDS PROVIDE ONGOING SORT OF REALTIME UPDATES IN TERMS OF RATES OF SCREENING, RATES OF POSITIVE ENDORSEMENT AND ASSOCIATED RISK. ONE OF THE CHALLENGES REPRESENTED HERE IN SOME DATA ALLOW YOU TO LOOK AT BRIEFLY I'M DESCRIBING THAT IN THE CONTEXT OF THE DETENTION MANAGEMENT INITIATIVES OF THIS NATURE OUR FIRST MAJOR CHALLENGE IS HOW TO INTRODUCE THESE KINDS OF PROCEDURES INTO THE CLINICAL WORK FLOW, THAT REQUIRES OFTEN MAJOR REWORKING OF THE STRUCTURE AND PROCESS OF PATIENT CARE, EQUALLY IMPORTANT OFTEN REQUIRES THE TRANSFORMATION OF THE ORGANIZATIONAL CLIMATE AND CULTURE THAT TYPICALLY CHARACTERIZES TO SUPPORT AND ENGAGE ADDITIONAL RESOURCES THAT ARE NOT HISTORICALLY TYPICAL IN SUCH SETTINGS. SO YOU CAN SEE HERE THAT WE HAVE SATURATION AND COVERAGE RATES BY CLINICS RANGING FROM 66% COVERAGE UP TO 82% COVERAGE, THERE'S A LOT OF EFFORT INVESTED IN HOW TO DEVELOP CONTINUOUS QUALITY IMPROVEMENT PROCEDURES, TO ENGAGE PRIMARY CARE PROVIDERS ACROSS THE TEAM, ACROSS LOCATIONS, AND WITH RECEPTION PERSONNEL HOW TO ENSURE THAT WE DO A VARIETY OF MECHANISMS, WHETHER ELECTRONIC, WHETHER IT BE AS THE PATIENT COMES INTO THE CLINIC SETTINGS ENGAGED AT THE TIME OF HIS OR HER APPOINTMENT, AND FULLY INCORPORATED INTO THE IDENTIFICATION OF MANAGEMENT PROCESS. WE'RE ABLE TO SPEAK TO THE RISKS THAT ARE ASSOCIATED WITH THE ENDORSEMENT OF RISK OF SUICIDE AND YOU CAN SEE IN THE LOWER LEFT-HAND SIDE CORNER OF THE SLIDE THERE WERE A NUMBER OF CLASSIC RISKS THAT WE MONITOR AND ASSOCIATE WITH THAT. THE OTHER THING, HOW THIS SBIRT PROCESS, WHICH PARTICULAR ANSWER TREATMENT RESOURCES ARE THEY REFERRED TO, EITHER INDIVIDUALLY OR COMBINATION OF REDUCING RISK OF SUICIDE AND THAT PARTICULAR INDIVIDUAL'S CASE, WE SAW A LOT OF THOSE KINDS OF 6 AND 12 MONTH TIME SCALES. I MENTIONED DR. DENICE DILLARD. WE'VE DONE STUDIES OF THE PROCESS WHICH WE HAD LARGE NUMBER OF PATIENTS FOR EXAMPLE WHICH WE'VE REPLICATED THESE STUDIES IN OTHER SETTINGS WHICH WE LONGED AT AFTER IMPLEMENTATION AND PROGRAM FACTORS WITH RESPECT TO PATIENT HEALTH QUESTIONNAIRE, ENDORSEMENT. WE FOUND, FOR EXAMPLE, 47% OF PATIENTS WERE SCREENED DURING THE YEAR IN QUESTION, WE KNEW THEY NEEDED TO WORK PARTICULARLY HARD AND INCREASING COVERAGE AND SATURATION LEVELS, KNEW IT WAS SLIGHTLY MORE SUCCESSFUL IN SCREENING AMONG WOMEN THAN MEN, INFORMED OUR EFFORTS TO IMPROVE THESE COVERAGE AND SATURATION PROCESSES. WE'LL LOOK AT INCREASED ODDS OF BEING SCREENED WITH OLDER AGE, AND WE FOUND STRONG ASSOCIATIONS WITH OLDER AGE, YOU CAN SEE FROM HERE WE GATHERED INFORMATION ABOUT A VARIETY OF PATIENT PROVIDER PROGRAMS THAT DIRECTLY INFLUENCE SCREENING PROCESS, TARGET INTERVENTIONS AROUND IMPROVING COVERAGE AND SATURATION AS INFORMED BY THESE FINDINGS. WE'RE WORKING CONSCIOUSLY AND DELIBERATELY. WE HAVE FOCUSED ON HOW TO ENGAGE ELIGIBLE PATIENTS, MINIMIZE STIGMA, ENSURE CONFIDENTIALITY, AND INCREASE RECRUITMENT INTO AND RETENTION IN THIS DETECTION AND MANAGEMENT ISSUE. WE WORK HARD ON IMPLEMENTING FIDELITY WITHIN THE CLINICAL WORK FLOW AND OFTEN COMPROMISED BY MULTIPLE CARE PROVIDERS AND WORK HARD HOW TO ENSURE PATIENT TRANSITION THROUGH THIS PROCESS OF CARE AND MAXIMIZING TRANSITION. WE DO THIS IN A FASHION THAT IS RIGOROUS AND EMPIRICALLY FORMED WITH FEEDBACK LOOP BACK TO THE PROGRAM, WE'RE SERIOUSLY COMMITTED TO PUBLISHING LITERATURE SO OTHERS CAN BENEFIT FROM LESSONS LEARNED. NEXT SLIDE PLEASE. I JUST WANT TO FEATURE THE TEAM-BASED APPROACH, EXAMPLE OF THE COMMUNITY-BASED PARTICIPATORY EFFORT I BELIEVE THE INSTITUTE HAS ADVOCATED FOR, FOR THIS OUTSET, THAT STANDS ABOVE ALL OTHERS. NEXT SLIDE PLEASE. THESE KINDS OF DEEPLY ROOTED COMMUNITY AND ACADEMIC PARTNERSHIPS WOULDN'T BE POSSIBLE WITHOUT THIS KIND OF COMMITMENT. NEXT SLIDE PLEASE. ALL THE WAY FROM THE LOWER 48 UP TO OUR PARTNERS IN ALASKA, NEXT SLIDE PLEASE. MANY OF THE PEOPLE IN OUR OWN PROGRAMS IN COLORADO DEEPLY COMMITTED TO THIS. LAST SLIDE PLEASE. THANK YOU VERY MUCH. IT WAS A WELCOME OPPORTUNITY TO SHARE. I WANT TO UNDERSCORE THE SEMINAL ROLE THAT NIMHD HAD IN LAUNCHING AND CONTINUING TO SUPPORT THIS JOURNEY ON SCIENCE, SIDE OF SCIENCE AND PRACTICE. THANK YOU. >> THANK YOU SO MUCH, SPERO. THAT WAS A WONDERFUL PRESENTATION AND HAS GENERAL INTERNIST FORMER PRIMARY CARE DOC APPRECIATE EMPHASIS IN THAT REGARD. I REMEMBER THE SBIR PROGRAM AS IT BECAME INTRODUCED IN OUR PRACTICE THROUGH GRANTS FUNDED TO ONE OF OUR FACULTY THROUGH NIDA, FOCUSED ON ALCOHOL. WE ALREADY DID TOBACCO. COINCIDED WITH STUDY TO DO CONCERNS ABOUT OPIOID OVERUSE, SO WE STARTED A PROGRAM ON OUR OWN TO SCREEN PATIENTS, AND I THINK I SAW THE IMPACT AT THE MOST -- AT ALL LEVELS, NOT JUST WITH TRAINEES. ONCE YOU QUANTIFY WHETHER THEY CONSUMING, INTERESTING TO SEE THE RESULTS, ASTOUNDING THAT PEOPLE WERE ABLE TO DO THAT. ON THE SCREENING ON SUICIDE, I ASSUME IT STARTS WITH ASKING ABOUT DEPRESSION FIRST, SINCE IT FIGURES TO BE SORT OF THE CUE FOR US, SOMEBODY COMMENTS IN AND COMPLAINS AND MAKES A POINT, BUT USUALLY WAS, YOU KNOW, WE ROUTINELY SCREENED FOR DEPRESSION, AND IF THERE WAS ANY KIND OF SIGNAL OF POSITIVITY YOU GO ON AND DO A MORE DIAGNOSTIC QUESTION, WHETHER PHQ9 OR SOMETHING SIMILAR, SO APPRECIATE YOUR CONTINUES ABOUT THAT. >> YES. >> GO AHEAD. >> WITH THE INTERESTING THING, THE WORK SUPPORTED BY NIMHD EARLY ON, WE GET CAREFUL AND LARGE SCALE PSYCHOMETRIC ANALYSES OF THE MEASURES AVAILABLE TO US, SO THE QUESTION, LIKELY WORKED IN THIS CLASSIFICATION, AND WE ALSO FOUND THAT THINGS LIKE WHEN ASK YOU ABOUT DEPRESSION, WHETHER YOU ABOUT BLUE OR SADNESS OR IDIOMS PART OF SUCH MEASURES WE FUND THAT SYSTEMATIC INQUIRY COULD AMPLIFY MEASURES TO INCLUDE LOCAL CULTURAL IDIOMS, ASK ONE OR TWO QUESTIONS THAT RESONATED MORE FULLY WITH LOCAL LIVED EXPERIENCE OF DEPRESSION, OR RISK OF SUICIDE, AS THE CASE MAY BE, AMONG THESE INDIVIDUAL PATIENT POPULATIONS SO YES. AND YOU'RE RIGHT, BUILDING IT INTO THE VARIOUS LEVELS OF PREPARATION FOR HEALTH CARE PROFESSIONALS, I THINK REALLY CRITICAL. I FOUND REALLY ONCE YOU'RE ABLE TO DEMONSTRATE POTENTIAL EFFECT AND IMPACT OF THESE PROCEDURES. >> IT DOESN'T TRANSLATE TO SPANISH VERY WELL. YOU'RE RIGHT. I HAVE A COUPLE QUESTIONS FROM COUNCIL MEMBERS. I THINK KEN RESNICOW WAS FIRST. >> THANKS FOR THE TOUR DE FORCE OF A WONDERFUL CAREER. I'VE HAD THE PLEASURE OF WORKING ON FOUR PROJECTS AND WE NEVER SHARED THIS, TOBACCO USE AND (INDISCERNIBLE) USE, STATEWIDE, THE WEXLER WHO I THINK YOU KNOW, YOU MAY NOT KNOW WHAT WE'RE DOING, I WANT TO QUICKLY TELL YOU AND ASK A QUESTION. MOTIVATIONAL INTERVIEWING TO IMPROVE SAFE GUN STORAGE PARTICULARLY HOMES THAT HAVE HIGH RISK ADOLESCENTS, SOMETHING NEAR AND DEAR TO YOUR HEART. HERE IS THE QUESTION. I DID SEVERAL M.I. TRAININGS IN BETHEL AND DELTA REGION, AND I RAN INTO SOMETHING THAT WE'VE NEVER RUN INTO BEFORE IN ANY CULTURAL GROUP AND WORKED IN 20 COUNTRIES. AFTER THE M.I. TRAINING, THREE COMMUNITY REPS SAID THIS IDEA OF GUESSING PEOPLE'S EMOTIONS AND INTENSIFYING THEIR EMOTIONS IS VERY (INDISCERNIBLE) AND WE'RE NOT GOING TO DO THIS. IT'S NOT REJECTING M.I. LOCK STOCK AND BARREL BUT DEEPER REFLECTIONS THEY WERE COMMENTING ON, I WONDER IF YOU HEARD THIS BEFORE OR DID WE RUN INTO A QUIRKY OUTLIER AND SHOULDN'T OVERREACT TO IT? >> WELL, FIRST OFF, IF YOU DON'T MAKE PERFECT THE ENEMY OF THE -- I MEAN -- OF THE GOOD, I HAVE HEARD THOSE REACTIONS TO MOTIVATION, I WILL GLADLY LINK YOU, KEN. WE DIRECT INDIAN HEALTH SERVICES TRIBAL INJURY AND PREVENTION CENTER, AND WE WORK IN ALASKA ON GUN CONTROL, AND THEY USE MOTIVATIONAL INTERVIEWING IN BOTH UPPER ALASKA AND MAINLAND TO GOOD EFFECT, THEY MAKE IT THEIR OWN, IT WOULD BE INTERESTING AND INSTRUCTIVE PERHAPS TO UNDERSTAND HOW THEY HAVE RENDERED IT COMFORTABLE IN THEIR OWN TERMS. >> THANK YOU. >> DR. LISA BARNES? >> THANK YOU, SPERO, FOR THAT REALLY WONDERFUL PRESENTATION. I HAVE ADMIRED YOUR CAREER FROM AFAR, SINCE MY EARLY DAYS, YOUR WORK WITH THE NATIVE POPULATION HAS HELPED ME WORKING WITH AFRICAN AMERICANS. I HAD A COUPLE QUESTIONS. YOUR BEHAVIORAL HEALTH CLINICIAN YOU CO-LOCATED WITH PRIMARY CARE TEAM, HAD YOU LOOKED AT HOW IMPORTANT IT IS TO HAVE A CULTURAL CONGRUENCE OR CONCORDANCE WITH THE POPULATION OR DOES IT NOT MATTER? SECOND QUESTION IS GIVEN HOW MUCH SUICIDE, A HUGE PROBLEM IN YOUNG AGE, ARE THERE AGING COHORTS THAT HAVE LOOKED AT RESILIENCE AMONG THE NATIVE POPULATIONS? >> THANK YOU, LISA, FOR THE QUESTIONS. THEY ARE WONDERFUL. FIRST OFF, WE DID LOOK AT BASICALLY RACIAL AND ETHNIC DISPARITIES IN THE CONTEXT OF MANAGEMENT ISSUE PARTICULARLY IN TERMS OF BOTH (INDISCERNIBLE) AND ADHERENCE ON THE PART OF CO-LOCATED CLINICIANS. CO-LOCATE CLINICIAN DOES EDUCATIONAL SESSION FIVE TO SEVEN MINUTES, FOLLOWED IMMEDIATELY BY MOTIVATIONAL INTERVIEW, AND TO A BEHAVIORAL CONTRACT THEY AGREE THEY WILL HAVE ANYWHERE FROM DEPENDING UPON LEVELS ONE TO FIVE FOLLOW-UP SESSIONS, INCREASINGLY TELEPHONIC, OR TAILORED TO WHEN THE PATIENT RETURNS TO HEALTH CARE SESSION. AND SO WE WERE LOOKING AT THE AGREEMENT ON THE PART OF THE PATIENT TO ENGAGE THAT CO-LOCATED CLINICIAN ON THE AGREEMENT TO CONTRACT, ON THE NUMBER OF SESSIONS THAT THE PATIENTS SUBSEQUENTLY COMPLETED, OF THE NUMBER CONTRACTED BY RACE/ETHNICITY, WE FOUND NO DIFFERENCE. DEPENDING UPON THE RACE/ETHNICITY OF THE COUNSELOR. ALL OF THESE PARTICULAR HEALTH PROGRAMS ARE ABSOLUTELY DEDICATED TO CULTURALLY COMPETENT HEALTH SETTINGS, ENORMOUS EMPHASIS AT EVERY STAGE OF THE PROCESS OF CARE IN TERMS OF THE INTERPERSONAL INTERACTIONS AS WELL AS PHYSICALITY OF THE SETTING TO MAXIMIZE THAT SENSE OF COMFORT IN ALIGNMENT WITH THE NATURE OF THE SERVICES THAT ORIENTATION. I GUESS I WASN'T SURPRISED THAT WOULD BE THE CASE. THE OTHER THING, LISA, JUST THE REALITY OF THE NUMBER OF AMERICAN INDIAN AND ALASKA NATIVE PEOPLE ALREADY TRAINED AT THESE LEVELS OF CLINICAL PREPARATION, JUST ABSOLUTELY INDICATES THERE WILL ALWAYS BE NON-NATIVE PEOPLE POPULATING THESE POSITIONS AND WE NEED TO THINK ABOUT TRAINING INDIVIDUALS AND THE FACILITY OR ORGANIZATION TO ENSURE SKILLS ARE ESSENTIAL AND ENACTED APPROPRIATELY. I FORGOT THE FIRST QUESTION, THE SECONDE. >> THE SECOND QUESTION WAS ABOUT RESILIENCE. ARE THERE AGING COHORTS THAT HAVE LOOKED AT RESILIENCE IN THIS POPULATION? >> WONDERFUL QUESTION. THANK YOU BECAUSE WE'RE FUNDED RIGHT NOW BY NIMH AND NIMHD IN A TWO-PART INTERVENTION WITH RANDOMIZED CONTROLLED TRIAL, SEATTLE INDIAN HEALTH CLINIC AND THE ONE IN ALBUQUERQUE WHETHER WE IDENTIFY YOUTH AND YOUNG ADULTS AT RISK THROUGH THE SBIRT PROCESS AND RANDOMIZE THOSE MEALS ON -- TWO AGREE TO PARTICIPATE, THE CONTROLLED CONTROLLED CONDITION IS SBIRT-RELATED, TEXT INTERVENTION CONTROL-PHONE BASED, 12 MONTHS OF TIME, STAGGERED, MEASURING STRENGTH AND RESILIENCE TO PROMOTE COMMUNITY CONNECTEDNESS AND INCLUSION. THAT'S AN RCT UNDERWAY RIGHT NOW. WE BELIEVE WE NEED TO IDENTIFY ASSETS AND SOURCES OF RESILIENCE AND SENDING THEM TO OUR YOUNG PEOPLE. >> THANK YOU. >> THANK YOU, AGAIN, SPERO. >> YOU'RE WELCOME. >> I APPRECIATE YOUR HIGHLIGHTING THE PRESENCE OF URBAN INDIANS, FREQUENTLY NOT PAID ATTENTION, ENOUGH ATTENTION TO AT NIH. SO I WILL TURN IT BACK OVER TO TOM FOR THE NEXT PRESENTATION. THANK YOU. >> HELLO. NEXT PRESENTATION IS FROM THE WORKING GROUP THAT EXAMINED THE SMALL BUSINESS INNOVATION RESEARCH PROGRAM AT NIMHD, AND I'M GOING TO ASK DR. MICHAEL SAYRE TO INTRODUCE OUR SPEAKER. >> THANKS, TOM. COULDN'T GET MY VIDEO RUNNING HERE. IT'S MY PLEASURE TO INTRODUCE DR. WILLIAM SOUTHERLAND, PROFESSOR OF BIOCHEMISTRY, HOWARD UNIVERSITY, WASHINGTON, D.C., LONGSTANDING DIRECTOR OF THE RESEARCH CENTER RESPECT MINORITY INSTITUTION PROGRAM AT HOWARD, P.I. OF THE U 54 CENTER AT HOWARD. HE WILL BE PRESENTING THE NIMHD ADVISORY COUNCIL WORKING GROUP REPORT ON NIMHD'S SMALL BUSINESS RESEARCH PROGRAM. DR. SOUTHERLAND, THANK YOU. >> THANK YOU, MIKE. I APPRECIATE THE INTRODUCTION. FIRST I WANT TO SAY THAT THE WORK GROUP WAS ESTABLISHED IN OCTOBER OF 2019, AND WE HAD A CHARGE, OUR CHARGE WAS TO REVIEW THE NIMHD SBIR/STTR PROGRAM, AND TO MAKE RECOMMENDATIONS TO THE NIMHD DIRECTOR ON WAYS TO MAXIMIZE THE PROGRAM'S POTENTIAL, TO ADVANCE MINORITY HEALTH AND REDUCE HEALTH DISPARITIES. AND THEY CONSIST OF THREE CURRENT NIMHD MEMBERS, THREE SCIENTISTS FROM THE EXTRAMURAL COMMUNITY, AND NIMHD STAFF AS WELL. AND OUR REVIEW OF THE NIMHD SBIR/STTR WAS FOCUSED ON USING SCIENTIFIC INNOVATION AND DISSEMINATION, LEVERAGING FURTHER OPPORTUNITIES TO ADVANCE THE NIMHD AGENDA, AND ADVANCING OUTREACH EFFORTS. NEXT SLIDE. I THINK I'VE COVERED THAT. NEXT ONE PLEASE. AND THIS IS THE MEMBERSHIP OF THE WORKING GROUP, AND YOU SEE THE MEMBERS THERE, I WON'T HAVE TO READ THE NAMES NECESSARILY. YOU ALSO SEE THE CATEGORIES OF HOW EACH PERSON PARTICIPATED. AND THE WORK GROUP. NEXT SLIDE. SO, THE FIRST PART OF OUR EFFORT WAS TO REVIEW THE OVERALL SBIR/STTR PROGRAM OF THE NIH OVERALL. AND JUST WANT TO SAY TO START WITH THERE ARE SOME DIFFERENCES IN THE SBIR AND STTR PROGRAM. I'LL TOUCH ON THE HIGH LEVEL DIFFERENCES THAT SEEM TO BE MOST PROMINENT, NOT THE ONLY DIFFERENCES. THE SMALL BUSINESS BUSINESS AND INNOVATION PROGRAM PERMITS PARTNERING WITH NON-PROFIT RESEARCH INSTITUTIONS, WHILE THE SMALL BUSINESS TECHNOLOGY AND TRANSFER PROGRAM, STTR PROGRAM, REQUIRES PARTNERING WITH NON-PROFIT RESEARCH INSTITUTIONS. THERE ARE SOME OTHER DIFFERENCES I THINK, THIS IS ONE OF THE HIGH MAJOR LEVEL DIFFERENCES BETWEEN THE PROGRAMS. SO, HOW ARE THESE PROGRAMS FUNDED? THOSE FEDERAL AGENCIES, EXCEEDING PARTICULARRAL CONGRESSIONAL THRESHOLDS, ARE REQUIRED TO ALLOCATE 3.2% OF THEIR EXTRAMURAL ANNUAL BUDGETS TO THE SBIR PROGRAM, AND 0.45% OF ANNUAL EXTRAMURAL R&D BUDGETS TO STTR ACTIVITIES. NEXT SLIDE. NOW, A REVIEW OF THE SBIR/STTR PROGRAM ELIGIBILITY IS THAT ONLY AS YOU KNOW ALREADY I'M SURE ONLY U.S. SMALL BUSINESSES CONCERNS ARE ELIGIBLE TO APPLY AND THOSE BUSINESSES MUST MEET CERTAIN CRITERIA. THEY MUST BE ORGANIZED FOR PROFIT WITH PLACE OF BUSINESS LOCATED IN THE UNITED STATES. AND REGARDLESS OF THE LEGAL FORM OF BUSINESS IT MUST HAVE LESS THAN 50% PARTICIPATION BY FOREIGN BUSINESS ENTITIES. AND IT MUST BE MORE THAN 50% DIRECTLY OWNED AND CONTROLLED BY ONE OR MORE INDIVIDUALS WHO ARE U.S. CITIZENS OR PERMANENT RESIDENTS. OR THEY CAN BE CONTROLLED BY OTHER BUSINESSES THAT ARE 50% DIRECTLY OWNED AND CONTROLLED BY INDIVIDUALS OR WHO ARE U.S. CITIZENS, PERMANENT RESIDENTS, INDIAN TRIBES, ALASKA NATIVE CORPORATIONS, OR NATIVE HAWAIIAN ORGANIZATIONS. AND OF COURSE THEY HAVE NO MORE THAN 500 EMPLOYEES. NEXT SLIDE PLEASE. SO THE SBIR/STTR PROGRAM AWARDS CONSIST OF DIFFERENT PHASES. PHASE 1, STTR AWARDS ARE MADE VIA R 41 MECHANISM FOR 1 MONTHS, AND IN PHASE 1 THE SBIR AWARDS ARE MADE VIA R 43 MECHANISM AND FOR SIX MONTHS. AND OBJECTIVES OF THE PHASE 1 IS TO ESTABLISH TECHNICAL MERIT, FEASIBILITY, AND COMMERCIAL POTENTIAL OF THE PROPOSED WORK. ALSO IN PHASE 1 OBJECTIVE IS TO DETERMINE EQUALITY OF PERFORMANCE OF THE SBC AWARDEE, PRIOR TO GIVING OR PROVIDING FURTHER SUPPORT THAT COULD COME IN PHASE 2. NOW IN PHASE 2, PRIMARILY CONTINUES THE R&D EFFORTS THAT'S INITIATED IN PHASE 1, AND IN PHASE 2 THE STTR AWARDS ARE MADE VIA R42 MECHANISMS, AND FOR 24 MONTHS. AND IN PHASE 2 SBIR AWARDS ARE MADE VIA R 44 MECHANISM, AND THAT IS FOR 24 MONTHS. PHASE 2 FUNDING IS BASED ON RESULTS ACHIEVED IN PHASE 1. ALSO BASED ON SCIENTIFIC AND TECHNICAL MERIT AND POTENTIAL COMMERCIAL -- THE COMMERCIAL POTENTIAL OF THE PHASE 2 PROJECT. THESE PROGRAMS ALSO HAVE A PHASE 3, WHICH FOCUSES ON COMMERCIALIZATION OBJECTIVES. HOWEVER, NIH PROGRAMS TYPICALLY DO NOT FUND PHASE 2 ACTIVITIES. NEXT SLIDE PLEASE. SO THE NEXT PHASE WAS TO REVIEW THE NIMHD'S SBIR/STTR PROGRAM. AND WE LEARNED THAT IN FISCAL YEAR 2019, NIMHD ALLOCATED $9.3 MILLION FOR THE SBIR AWARDS AND $1.3 MILLION FOR THE STTR AWARDS. AND THESE AWARDS WERE PRIMARILY FOCUSED ON PRIORITIZING R&D ACTIVITIES, DESIGNED TO EMPOWER COMMUNITIES TO ACHIEVE HEALTH EQUITIES THROUGH EDUCATION, DISEASE PREVENTION, AND PARTNERING AND COMMUNITY-BASED PROBLEM-BASED RESEARCH. AND THE KEY GOALS OF THE NIMHD PROGRAM WERE TO STIMULATE TECHNOLOGICAL INNOVATION, STRENGTHEN ROLE OF SMALL BUSINESS IN MEETING FEDERAL R&D OBJECTIVES, AND INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DEVELOPED THROUGH FEDERALLY FUNDED R&D. AND TO FOCUS AND ENCOURAGE PARTICIPATION IN THE SBIR/STTR PROGRAM BY SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESSES AND AS WELL AS WOMEN-OWNED BUSINESSES AS WELL. NEXT SLIDE PLEASE. SO, THIS SLIDE SHOWS THE NIMHD SBIR/STTR AWARDS FROM 2003 THROUGH 2019. AND AS YOU CAN SEE THERE WERE 194 AWARDS MADE, GIVEN TO 104 DIFFERENT SMALL BUSINESSES, BASED IN 28 STATES, AND PUERTO RICO. AWARDED PRODUCTS COVERED A BROAD RANGE OF TOPICS AND DISEASES AND CONDITIONS, YOU WILL COLLECTIVELY INCLUDED ALL NIH DESIGNATED U.S. POPULATIONS WITH HEALTH DISPARITIES. AND ONE FINAL NOTE ABOUT THIS TABLE IS THAT THE TOTAL AMOUNTS, TOTAL DOLLAR AMOUNT OF THE AWARD FOR THIS PERIOD UNDER $51.5 MILLION. NEXT SLIDE. SO, THEN WE LOOKED DEEPER AT THE NIMHD SBIR/STTR RESULTS BY FOA TYPE. AND SINCE 2003, NIMHD FUNDED SBIR AND STTR THROUGH THE PHS OMNIBUS SOLICITATIONS, APPLICATIONS REVIEWED VIA THE NIH CENTER FOR SCIENTIFIC REVIEW, BUT IN 2014 NIMHD BEGAN USING ITS OWN RFAs ON TOPICS RELEVANT TO NIMHD. AND THESE APPLICATIONS WERE REVIEWED BY NIMHD'S SPECIAL EMPHASIS PANELS. AND THE WORK GROUP COMPARED MEMBERS AND SCORING PATTERNS OF APPLICATIONS AND AWARDS MADE UNDER THE NIMHD RFAs, AS WELL AS PHS OMNIBUS SOLICITATIONS, AND THE DATA ARE SHOWN ON THIS SLIDE. AND YOU CAN SEE ON NUMBERS ON THE TABLE, ONE OBSERVATION I WANT TO POINT OUT TO YOU, AND THAT IS THAT THE PERCENTAGE OF SCORED APPLICATIONS WAS HIGHER FOR THOSE IN NIMHD REVIEW PANEL, RATHER THAN STUDY SECTIONS. ALSO TO THE CHARGE TO REVIEWERS TO ADDRESS SPECIAL REVIEW CRITERIA IN THE NIMHD RFAs. IN OTHER WORDS, THE WORK GROUP FELT BOTH THE -- BOTH THE RFAs AND REVIEW INSTRUCTIONS WERE MORE FOCUSED TO GOALS AND INITIATIVES, IN THE NIMHD-ISSUED RFAs. NEXT SLIDE PLEASE. AND ADDITIONAL OBSERVATION FROM THE PREVIOUS TABLE IS THAT FEW APPLICATION SCORED IN THE HIGH IMPACT RANGE, AND THE REASON CAN BE GROUPED INTO TWO GROUPS, ONE APPLICATION QUALITY, AND THE OTHER IS REVIEW PANEL COMPOSITION AND ORIENTATION. NOW, UNDER APPLICATION QUALITY, WE FELT THAT SIGNIFICANCE OR IMPACT ON THE FIELD AND SCIENTIFIC RIGOR OR FEASIBILITY OF APPROACH SEEMED TO BE AREAS THAT MERIT POTENTIAL IMPROVEMENT. UNDER THE REVIEW PANEL COMPOSITION ORIENTATION, WE FELT THAT ENHANCED REPRESENTATION OF OF BEHAVIORAL AND SOCIAL SCIENCES COULD BE IMPORTANT, AS WELL AS NEED TO ENSURE EXPERTISE IN MIXED METHODS APPROACHES AN COMMUNITY ENGAGED RESEARCH AND FINALLY THE WORK GROUP RECOGNIZED NEED TO EMPHASIZE OR HIGHLIGHT THE IMPORTANCE OF THE SOCIAL RETURN ON INVESTMENT, OR SOCIAL ENTREPRENEURSHIP INSTRUCTIONS TO THE REVIEW PANEL AS WELL. SO, WHAT I'VE COVERED THUS FOR HIGHLIGHTS REVIEW OF THE BOTH NIH-WIDE AND THE NIMHD STTR PROGRAMS. BUT OUR CHARGE ALSO INCLUDED MAKING SPECIFIC RECOMMENDATIONS TO THE DIRECTOR, AND WE DID THAT, RECOMMENDATIONS FALL INTO SCIENTIFIC GAPS AND OPPORTUNITIES, PROGRAM OUTREACH, TECHNICAL ASSISTANCE FOR APPLICANTS AND REVIEWERS, AND IMPLEMENTATION STRATEGIES. NEXT SLIDE. WHAT I WOULD DO IS DISCUSS OUR RECOMMENDATIONS IN EACH ONE OF THESE CATEGORIES. UNDER SCIENTIFIC GAPS AND OPPORTUNITIES THE FIRST RECOMMENDATION IS TO IDENTIFY OPPORTUNITIES FOR PRODUCT DEVELOPMENT AND SUSTAINABLE SOCIAL VENTURES TO BENEFIT COMMUNITIES. IN INHERENT IS TO ENCOURAGE SBCs TO CONSIDER THE DOUBLE BOTTOM LINE, THAT IS TO CONSIDER BOTH FISCAL BOTTOM LINE OR PROFIT AND LOSS AS WELL AS THE SOCIAL IMPACT BOTTOM LINE AS WEVMENT . WE'RE REARING TO EQUAL FISCAL RETURN ON INVESTMENT PLUS SOCIAL RETURN ON INVESTMENT. THE NEXT RECOMMENDATION IS NIMHD ISSUE SBIR/STTR FOAs ALIGNED WITH NIMHD FRAMEWORK. NOW, THIS WOULD REQUIRE ASSISTING SBCs TO BECOME FAMILIAR WITH THE FRAME WORK AS THEY CONSIDER INTERCONNECTED FACTORS OPERATING WITHIN AND ACROSS THE DOMAIN AND LEVEL OF INFLUENCE THAT ARE IDENTIFIED WITHIN THE FRAMEWORK. WE ALSO BELIEVE THAT THE SBIR AND STTR NOTICES OF SPECIAL INTEREST ON SELECT OR EMERGENT TOPICS COULD BE IMPORTANT AS WELL. FOR EXAMPLE, MINORITY-OWNED SBCs COULD ADDRESS COVID-19 IMPACT IN DISADVANTAGED AND VULNERABLE POPULATIONS. IT'S BEEN SUGGESTED NIMHD COULD CONSIDER UTILIZATION OF CONTRACTS TO ADDRESS SPECIFIC NEEDS AS WELL. AND BEFORE I LEAVE THIS SLIDE I WANT TO SAY THAT WE WISH TO EMPHASIZE POSITIVE IMPACT OF POSITIVE SOCIAL IMPACT OR SOCIAL RETURN ON INVESTMENT CAN BE CRITICAL FOR MOTIVATING BROAD COMMUNITY UPTAKE OF NEW TECHNOLOGIES AND PRODUCTS. NEXT SLIDE. PROGRAM OUTREACH, IN THE AREA OF PROGRAM OUTREACH, RECOMMENDATIONS ARE TO CULTIVATE CONNECTIONS BETWEEN SMALL BUSINESSES AND NIMHD-FUNDED CENTERS AND INVESTIGATORS. THIS COULD INVOLVE ASSISTING AND INCENTIVIZING RESEARCHERS TO PARTNER WITH SBCs, TO TRANSLATE NIMHD-FUNDED RESEARCH FINDINGS INTO PRODUCTS AND SERVICES THAT BENEFIT THE COMMUNITIES WE SERVE. ANOTHER RECOMMENDATION IS TO OFFER WORKSHOPS AND LINKS TO OTHER RESOURCES TO HELP WITH BUSINESS BASICS. WHICH WOULD INCLUDE PROMOTING SOCIAL MEDIA EVENTS, BLOGS, WEBINARS, VIRTUAL WORKSHOPS AND SO FORTH FOR ACADEMIC INVESTIGATORS, SBCs AND COMMUNITY GROUPS AS WELL. AND ALSO WE THOUGHT IT WAS IMPORTANT TO IDENTIFY SUCCESSFUL INVESTIGATORS WHO WERE WILLING TO SERVE AS MENTORS AND ROLE MODELS FOR NEW OR POTENTIAL SBIR/STTR P.I.s. NEXT SLIDE PLEASE. IN THE AREA OF TECHNICAL ASSISTANCE FOR APPLICANTS AND REVIEWERS, WE FEEL THAT WEBINARS, WORKSHOPS AND LINKS TO GRANT WRITING RESOURCES COULD BE VERY HELPFUL. AND ASSOCIATED WITH THIS WOULD BE LEVERAGING MENTORSHIP PROGRAMS LIKE THE NATIONAL RESEARCH MENTORING NETWORK TO HELP NEW P.I.s THROUGH APPLICATION PROCESS AND PROVIDE ACCESS TO TECHNICAL RESOURCES AND CONSULTANTS. ADDITIONALLY, ORIENTATION PEER REVIEWERS COULD BE HELPFUL AS WELL, AND THIS COULD BE AN OPPORTUNITY TO PROMOTE CONCEPT -- THE CONCEPT OF SOCIAL RETURN ON INVESTMENT, AND ITS VALUE TO THE COMMUNITY. ALSO AWARDEES SHOULD BE ENCOURAGED TO TAKE ADVANTAGE OF NIH'S POST-AWARD COMMERCIALIZATION STRATEGIES AND RESOURCES WHICH ARE THE NIH NISH AND CAP PROGRAM MARKETING MARKET INSIGHT AND DATA TO HELP SMALL BUSINESSES STRATEGICALLY POSITION TECHNOLOGY IN THE MARKETPLACE. AND THE CAP PROGRAM ENABLES PARTICIPANTS TO ESTABLISH MARKET AND CUSTOMER RELEVANCE, BUILD COMMERCIAL RELATIONSHIPS AND FOCUS ON REVENUE OPPORTUNITIES. THERE WAS ALSO ADDITIONAL SUGGESTION THAT MAYBE NIMHD COULD HAVE THEIR APPLICANTS WORK MORE CLOSELY WITH THE EDUCATIONAL OPPORTUNITIES THAT EXIST AT THE NIH THROUGH THE EXISTING SBIR/STTR PROGRAM AS WELL. NEXT SLIDE. SO IMPLEMENTATION STRATEGIES, THE WORK GROUP SAID THERE WERE THREE AREAS FOR SPECIFIC STRATEGIES COULD BE HELPFUL IN IMPLEMENTING RECOMMENDATIONS, LISTED AS FOLLOWS. ONE IS ADMINISTRATIVE INFRASTRUCTURE, UNDER ADMINISTRATIVE INFRASTRUCTURE IT WAS RECOMMENDED THAT A PROGRAM MANAGER RECOMMENDED, COULD COORDINATE AND OVERSEE SBIR/STTR PROGRAM PROMOTION OUTREACH AND TECHNICAL ASSISTANCE. AND THE WORK GROUP ENVISIONS THIS PERSON TO BE A READILY IDENTIFIABLE GO-TO SOURCE FOR INFORMATION ABOUT NIH COMMERCIALIZATION, ASSISTANCE PROGRAMS, SMALL BUSINESS ADMINISTRATION RESOURCES AND STATE-RUN SMALL BUSINESS DEVELOPMENT AGENCIES AS WELL JUST TO NAME A FEW. AND THE NEXT RECOMMENDATION INVOLVES NIMHD WEBSITE AND SOCIAL MEDIA ENHANCEMENTS WHICH COULD INCLUDE BLOG, YouTube VIDEOS, THAT FOCUS ON THE ROLE OF SMALL BUSINESSES IN IMPROVING MINORITY HEALTH AND REDUCING HEALTH DISPARITIES. AND LASTLY, WE RECOMMEND PERIODIC CONVENING OF SMALL BUSINESS CONCERNS WITH MINORITY AND HEALTH DISPARITIES RESEARCHERS, WHICH COULD INVOLVE MEETING -- CONVENINGS OF THE SMALL BUSINESS CONCERNS WITH CENTER OF EXCELLENCE ANNUAL MEETINGS, ANNUAL GRANTEE MEETINGS AS WELL. AND WORKSHOP -- WORK GROUP WAS CONVINCED IF MEETING RECOMMENDATION WOULD REQUIRE ROBUST PROGRAM MANAGEMENT COORDINATION AND CONSULTATION, COUPLED WITH ADMINISTRATIVE SUPPORT, AND SO BY SAYING THAT I WANT TO END BY JUST EMPHASIZING THAT WORK GROUP BELIEVES DEDICATED PROGRAM MANAGER COULD BE INSTRUMENTAL IN MAKING ALL OF THIS HAPPEN. NEXT SLIDE. SO, THAT IS OUR REPORT. AND I WISH TO THANK ALL OF THE WORK GROUP MEMBERS WHO MET FREQUENTLY AND DISCUSSED THOROUGHLY AND GENERALLY WORKED VERY HARD ON THIS EARTH. I WOULD LIKE TO ESPECIALLY THANK JOYCE HUNTER, MIKE SAYRE AND DEREK TABER WHO HELPED US UNDERSTAND THE DETAILS AND SUBTLETIES OF THE SBIR AND STTR PROGRAMS, NIH-WIDE AND AT NIMHD. WITH THAT I WILL STOP AND ANSWER QUESTIONS ALONG WITH ANY OTHER MEMBERS OF THE WORK GROUP HERE AS WELL. WE'LL ALL TRY TO ANSWER YOUR QUESTIONS. THANK YOU. >> THANK YOU. OTHER MEMBERS OF THE WORK GROUP ARE HERE INCLUDING BRIAN RIVERS AND CHUCK LEE, LINDA BURNS-STEPANOFF, ARE YOU THERE? NO? OKAY. I DON'T SIGH ANY -- SEE ANY QUESTIONS. IS THERE ANYONE WHO WANTS TO BRING ANYTHING UP? >> YES. I'D LIKE TO RAISE A COMMENT AND A QUESTION, BILL. THANK YOU FOR THAT REALLY COMPREHENSIVE REPORT AND PRESENTATION. THANK YOU TO ALL THE COMMITTEE MEMBERS WHO WORKED ON THIS. I TOTALLY AGREE WITH YOU ABOUT THE SOCIAL IMPACT OF THE BOTTOM LINES FOR THESE APPLICATIONS, AND I THINK THAT THESE APPLICATIONS NEED TO HAVE SOME TYPE OF EVALUATION COMPONENT RELATED TO THAT, I DON'T KNOW HOW EASY THAT IS TO DO, BUT I THINK UNLESS PEOPLE ARE EVALUATING, UNLESS IT'S REQUIRED IT MAY NOT BE INCORPORATED, AND FOR COMMUNITIES OBVIOUSLY THE BOTTOM LINE OF SOCIAL IMPACT IS VITALLY IMPORTANT. SO I DON'T KNOW IF THAT COULD BE INCLUDED AS A RECOMMENDATION BUT THAT WOULD BE ONE SUGGESTION. THE OTHER SUGGESTION I HAVE, OR QUESTION I HAVE FOR YOU, I KNOW YOU HAD A CHARGE TO JUST FOCUS ON THIS MECHANISM. THESE TWO MECHANISMS. BUT THE RESULT THAT YOU SHOWED FOR THE SUCCESS WHEN THESE APPLICATIONS CAME TO NIMHD, VERSUS REGULAR CSR I THINK HAS BROAD IMPLICATIONS FOR ALL OTHER MECHANISMS. AS YOU KNOW, YOU KNOW, MINORITIES OR SCHOLARS WHO FOCUS ON HEALTH DISPARITIES CONCERNS TEND NOT TO BE FUNDED AT THE SAME RATE AS WHITE INVESTIGATORS. DO YOU THINK YOUR RECOMMENDATIONS THAT CAME OUT OF THIS COULD BE SHARED WITH CSR TO HELP ENHANCE REVIEW OF APPLICATIONS FOR OTHER MECHANISMS? >> I'LL RESPOND QUICKLY AND MAKE ROOM FOR THE OTHER WORK GROUP MEMBERS AS WELL. I THINK OUR CHARGE WAS TO MAKE RECOMMENDATION -- YOU RAISE A VERY GOOD POINT. I THINK THERE MAY BE SOME VALUABLE INSIGHTS HERE THAT COULD BE BENEFITED OUTSIDE OF NIMHD. SO I AGREE WITH YOU THERE. WE MADE OUR REPORT TO THE DIRECTOR, AND SO I GUESS WHAT I WANT TO SAY IS THAT IT'S UP TO -- I MEAN -- WHAT WAS YOUR FIRST QUESTION AGAIN? I'M SORRY. >> I WAS SUGGESTING THAT THERE WOULD BE SOME KIND OF EVALUATION REQUIREMENT FOR SOCIAL IMPACT, APPLICATIONS INCLUDE THAT THEY HAVE TO BE ABLE TO SHOW OR TO MEASURE THE SOCIAL IMPACT OF THEIR BUSINESSES IN THE COMMUNITY. >> YES, THINK THAT'S A GOOD IDEA AS WELL. AND I DON'T RECALL DISCUSSING ANY REQUIREMENT FOR EVALUATION BUT I THINK IT'S A GOOD IDEA. I DON'T THINK - I'LL STOP RIGHT THERE AND LET THE OTHER MEMBERS OF THE WORK GROUP PARTICIPATE AND RESPOND. >> IN THE APPLICATION ITSELF IT INCLUDES A STRONG EVALUATION COMPONENT, AND WE HAVE FIVE SBIRs AND ALL HAVE INCLUDED SECTIONS ON BENEFITS TO THE COMMUNITY, HOWEVER REVIEWERS WERE VERY DENIGRATING ABOUT THOSE EVALUATIONS. >> OKAY. YEAH, THE COMMENTS ABOUT REVIEWERS, ONE THING I LEARNED IN THIS PROCESS IS THAT THE ORIENTATION AND THE INSTRUCTIONS GIVEN TO REVIEWERS IS VERY IMPORTANT. IT'S VERY IMPORTANT TO THE OVERALL SUCCESS OF THE PROGRAM AND WHAT COULD BE ACCOMPLISHED BY THE AWARDEES AS WELL. THAT'S VERY IMPORTANT. AND WHEN YOU COMPARE THE FOAs FUNDED BY THE OMNIBUS VERSUS NIMHD SOLICITATIONS. >> AND ONE OF OUR PROJECTS WE WANTED TO HIRE A VILLAGE IN ALASKA THAT JUST LOST A CANNING CONTRACT AND NEEDED WORK, WE WANTED THEM -- (INDISCERNIBLE) FOR PHASE 2 APPLICATION, REVIEWERS RIPPED IT, SAID YOU'LL NEVER BE A SUCCESS HIRING OUT WORK LIKE THAT. REALLY DO THINK THAT THE REVIEWERS FOR NIMHD ARE MUCH MORE UNDERSTANDING ABOUT THE IMPACT BRINGING JOBS INTO COMMUNITIES AND OTHER BENEFITS OF BEING INVOLVED WITH THIS. I THINK THE NIMHD IS MUCH MORE INCLUSIVE THAN THE OTHERS HAVE HAVE BEEN MORE TOP-DOWN, KIND OF. >> I THINK LESSONS LEARNED FROM THIS CAN BE SHARED WITH CSR BECAUSE OTHERWISE WE'RE NOT GOING TO CHANGE ANYTHING IN THE SYSTEM. NIMHD CANNOT POSSIBLY REVIEW ALL OF THE HEALTH DISPARITIES WORK THAT'S OUT THERE. YOU KNOW, WE NEED TO BE ABLE TO HELP THESE OTHER STUDY SECTIONS AND, YOU KNOW, LEARN FROM WHAT YOU'VE SHOWN US HERE. >> YEAH. YOU MAKE A VERY GOOD POINT, VERY GOOD POINT. >> PARTICULARLY IF YOU'RE TRYING TO GET THE COMMUNITY INVOLVES WHO MAY BE FIRST-TIME APPLICANTS WITH GREAT IDEAS, THEY ARE AT, YOU KNOW, A DISADVANTAGE IN TERMS OF THE KIND OF INFORMATION THAT'S GETTING REVIEWED BY REVIEW COMMITTEES, LIKE LINDA SAID, GETTING DENIGRATED WITH THEIR IDEAS AND CONCEPTS TOO. >> I JUST WANT TO IDENTIFY THAT WAS DR. CHUCK LEE, A MEMBER OF THE WORK GROUP WHO WAS JUST SPEAKING. >> THANK YOU. I CAN'T ANSWER THIS DIRECTLY BUT I WILL STATE FOR PROJECTS THAT COME TO NIMHD FOR REVIEW OFTEN THEY ARE FUNDING OPPORTUNITIES WHICH ARE DEVELOPED WITH SOMEWHAT SPECIAL REVIEW CRITERIA, SPECIFIC TO THIS FUNDING OPPORTUNITY QUERIES THAT ALLOW REVIEWERS TO LOOK IN THE DIRECTION OF CERTAIN AREAS. SO IN THAT SENSE, THAT WOULD BE ONE DIFFERENCE FOR THOSE REVIEWERS VERSUS THOSE AT CSR, REVIEWING BASED ON REVIEW CRITERIA WHICH ARE DESIGNED FOR GENERIC SENSE OF SMALL BUSINESS APPLICATIONS THAT MIGHT COME IN. >> THERE WAS ANOTHER ISSUE THAT HAD TO DO WITH THE REVIEWERS, THAT IN OUR COMMITTEE WE WERE ALL KIND OF SURPRISED BUT AGAIN I CAN QUOTE SOME OF THE REVIEW SHEETS AND THIS IS FROM PHASE 1 TO PHASE 2, AND WE HAVE, AGAIN, (INDISCERNIBLE) GENETIC EXECUTION FOR NATIVE AMERICANS AND FOR TRIBAL COMMUNITIES AND PROGRAMS AT THAT POINT THESE WERE DVDs, A GRAND FROM 12 OR 13 YEARS AGO, AND WE'RE GOING TO (INDISCERNIBLE) CHARGE A DOLLAR FOR A DVD, IF IT WAS LARGER SYSTEM OR SCHOOL DISTRICT OR SOMETHING THEY WOULD BE CHARGED $20 OR $100, (INDISCERNIBLE) REVIEWERS THAT (INDISCERNIBLE) VERY STERN RESPONSES WHETHER IT BE (INDISCERNIBLE) A LOT OF MONEY. AND OUR COMMITTEE'S REACTION WAS THE (INDISCERNIBLE) BENEFIT FROM LOW COST PRODUCTS CUSTOM TAILORED TO THEM, AND THAT WAS TOTALLY (INDISCERNIBLE) BY THOSE REVIEWERS. AGAIN, THAT'S WHY I THINK THE COMMENT MADE IN SLIDES REVIEWERS NEED TO BE EDUCATED ON SOCIAL RETURN ON INVESTMENT, THAT'S VERY IMPORTANT. >> OKAY. DID I MISS ANYONE ELSE IN THE COMMENT BOX WITH A QUESTION? I DON'T SEE ANYTHING. IF NOT, I'LL ASK, SINCE THIS IS A REPORT, AND THERE ARE RECOMMENDATIONS IF THERE'S SOMEONE ON THE -- IF THERE'S A MOTION TO ACCEPT THESE RECOMMENDATIONS AND THE REPORT FROM THE WORKING GROUP. >> I MOVE TO ACCEPT THE RECOMMENDATIONS AND THE REPORT FROM THE WORKING GROUP. >> I SECOND. AMELIE. >> IF YOU COULD PLEASE ENTER YOUR VOTES IN THE CHAT BOX, YES TO ACCEPT THE MOTION, NO TO REJECT IT. I THANK EVERYONE FOR VOTING. THE MOTION PASSES. ALL YESES, AND IT WAS YOUR UNANIMOUS, NO DISSENSIONS. ALL RIGHT. DR. PEREZ-STABLE, IS THERE ANYTHING YOU WOULD LIKE TO ADDRESS BEFORE WE MOVE TO THE NEXT ITEM, A BREAK? >> NO, WE SHOULD TAKE A BREAK AND RECONVENE FOR THE CONCEPTS. >> LET'S RECONVENE AT 3:25, TO TAKE UP THE APPROVAL OF CONCEPTS. I WANT TO THANK THE WORKING GROUP FOR THE SBIR PROGRAM REPORT AND ESPECIALLY DR. SOUTHERLAND FOR PRESENTING THAT ON THEIR BEHALF. TO ALL THE MEMBERS, THANK YOU FOR ALL YOUR WORK THROUGHOUT THE LONG YEAR AND A HALF I GUESS IT WAS PROVIDING THAT REPORT. WE TURN IN OUR PROGRAM AT THIS POINT TO THE APPROVAL OF CONCEPTS, CONCEPTS ARE NOT IN THEMSELVES FUNDING TUNE BUT ARE SCIENTIFIC IDEAS THE INSTITUTE INTENDS TO DEVELOP INTO FUNDING OPPORTUNITIES. WE SEEK YOUR APPROVAL FOR THESE. THERE ARE FOUR FORMAL CONCEPTS, AND WE'LL HAVE A PRESENTATION FROM EACH OF THE AUTHORS OF THOSE CONCEPTS. THESE AUTHORS PROVIDED TWO-PAGE REPORT WHICH WAS PROVIDED TO THE COUNCIL MEMBER IN ADVANCE, TWO ASSIGNED COUNCIL MEMBERS FOR EACH CONCEPT, IN AN EFFORT TO MAKE THE BEST USE OF TIME THE DOCUMENTS WERE AVAILABLE TO OTHER MEMBERS, ALL THE MEMBERS OF THE COUNCIL, AND THE MEMBERS WERE ASKED TO SHARE ANY COMMENTS THEY HAD ABOUT A CONCEPT WITH ASSIGNED REVIEWER SO ASSIGNED REVIEWERS COULD BRING THOUGHTS INTO THEIR COMMENTS HERE IN THE OPEN SESSION. PLEASE KNOW THAT IF ANY PERSON WHO SHARED A COMMENT OR THOUGHT, ANY MEMBER, YOU MAY SPEAK UP DURING THE DISCUSSION TO EMPHASIZE OR AMEND ANYTHING THAT'S SAID ABOUT YOUR IDEA. AND WE ALSO WELCOME NEW IDEAS WITHIN THE DISCUSSION PERIOD. SO FIRST WE'LL HAVE A PRESENTATION FROM THE PROGRAM OFFICIAL WHO IS ASSOCIATED WITH THE CONCEPT AND WE'LL HEAR FROM THE ASSIGNED COUNCIL REVIEWERS AND CALL UPON ALL COUNCIL MEMBERS TO SPEAK. WHEN IT'S DETERMINED IT'S TIME TO CLOSE THE SESSION, WE'LL HAVE A MOTION, WHETHER TO APPROVE THE CONCEPT OR DISAPPROVE, AND THEN WE'LL HAVE A VOTE OF THE COUNCIL IN EACH CONCEPT. FIRST PRESENTER IS DR. DERRICK TABOR, PRESENTING SMALL BUSINESS INNOVATION RESEARCH AND SMALL BUSINESS TECHNOLOGY TRANSFER. I CALL ON JUAN ROMERO TO SORT THE SLIDES. DERRICK, PLEASE GO AHEAD WHEN YOU'RE READY. >> GOOD AFTERNOON. TWO CONCEPTS, THE CONCEPT THAT I'M PRESENTING TODAY IS HERE ON THIS FIRST SLIDE, NOTE THAT THERE ARE TWO DIFFERENT OR DIFFERENT MECHANISMS ASSOCIATED WITH THE CONCEPTS, R 43-44 AND TECHNOLOGY TRANSFER USES R 41 AND R R42. DR. SOUTHERLAND GAVE US A THOROUGH INSTRUCTION TO THE PROGRAM, I WILL SAY SOMETHING ABOUT THE OBJECTIVE OF THE SMALL BUSINESS RESEARCH APPLICATIONS, SO IF I COULD HAVE THE NEXT SLIDE PLEASE. SO HERE'S THE OBJECTIVE FOR OUR PROGRAM, TO SUPPORT SMALL BUSINESS INNOVATION RESEARCH APPLICATIONS PROPOSING A PRODUCT, PROCESS OR SERVICE FOR COMMERCIALIZATION TO IMPROVE MINORITY HEALTH, REDUCE ULTIMATELY ELIMINATE HEALTH DISPARITIES, ALSO TO SOLICIT APPLICATIONS THAT WE CONSIDER APPROPRIATE. THAT IS, THEY WILL BE EFFECTIVE, THEY WILL BE ACCESSIBLE BY THE COMMUNITIES THAT WE DESIRE TO USE THEM, THEY WILL ALSO BE AFFORDABLE BY THE SAME COMMUNITIES, AND ALSO CULTURALLY ACCEPTABLE. SO I WOULD LIKE NOW TO GO TO THE NEXT SLIDE. THIS TALKS ABOUT OUR DESCRIPTION. SMALL BUSINESS CONCERNS WILL BE ENGAGED IN DEVELOPING TECHNOLOGIES AND PRODUCTS TO ENGAGE, EMPOWER AND MOTIVATE INDIVIDUALS, AND COMMUNITIES, INCLUDING PROVIDER AND HEALTH CARE INSTITUTIONS. WE ALSO WANT THEM -- WE WANT TO DEVELOP TECHNOLOGIES THAT WILL SUSTAIN HEALTH-PROMOTING ACTIVITIES, AND THEN ALSO INTERVENTIONS LEADING TO IMPROVED HEALTH AND HEALTH CARE DELIVERY. NEXT SLIDE PLEASE. SO THE NEXT THREE SLIDES I'LL COVER SOME OF THE TECHNOLOGIES THAT ARE INTERESTING. THESE ARE EXAMPLES. THERE ARE OTHER POSSIBILITIES, THAT WE WOULD EXPECT PEOPLE TO BRING FORWARD. PATIENT-CENTERED TECHNOLOGIES FOR IDENTIFYING AND LEVERAGING RACIAL AND ETHNIC PROTECTIVE FACTORS IN AREAS OF RESILIENCY, FOR EXAMPLE COMMUNITY SUPPORT. TECHNOLOGIES FOR DISRUPTING OR PREVENTING THE IMPACT OF DISCRIMINATION, BIAS AND INDIFFERENCE ON MORTALITY AND MORBIDITY OUTCOMES FOR RACIAL AND ETHNIC MINORITIES AND POPULATIONS EXPERIENCING HEALTH DISPARITIES ACROSS SYSTEMS OF CARE AND LEVELS OF INFLUENCE. REFERENCE HERE TO SYSTEMS OF CARE AND LEVELS OF INFLUENCE AND INTERPERSONAL AND STRUCTURAL ARE DIRECTLY RELATED TO THE NIMHD FRAMEWORK WHICH LOOKS AT BOTH DOMAINS AND LEVELS OF INFLUENCE. WE WILL BE ASKING APPLICANTS TO SHOW AND HAVE THEIR WORK BE INFORMED BY THE NIMHD RESEARCH FRAMEWORK. TECHNOLOGIES LEVERAGING MULTIPLE DIGITAL TECHNOLOGIES, FOR EXAMPLE FAST HEALTHCARE INTEROPERABILITY PHENX AND TOOLKIT. NEXT SLIDE PLEASE. WE'RE INTERESTED IN TECHNOLOGIES FOR PREDICTING MORTALITY AND MORBIDITY RISK, AND FOR IDENTIFYING PREVENTIVE INTERVENTIONS. TECHNOLOGY LEADING TO EQUAL ACCESS, IMPROVING ACCESS, EFFECTIVE CONTINUITY OF CARE AND PROVISION OF QUALITY CARE THROUGH DISRUPTION OF LIMITATIONS AND/OR BARRIERS RESULTING FROM FACTORS LIKE INSURANCE COVERAGE, SOCIAL ECONOMIC STATUS, ACCESS TO COMMUNITY RESOURCES, AND SITE OF CARE. IN THIS BULLET WE DISRUPTION AND EARLIER ONE WE MENTION DISRUPTION, AND WE ARE INTERESTED IN TECHNOLOGIES THAT MIGHT DISRUPT SOME OF THE FACTORS OR PROCESSES OR PATHWAYS THAT LEAD TO HEALTH DISPARITIES. I WANT TO SHARE WITH YOU ONE EXAMPLE OF A TECHNOLOGY THAT WAS DEVELOPED FROM A BRANCH STEMMING IN 2005, AN SBIR TO IMPROVE ADHERENCE OF MEDICATION WITH LIMITED ENGLISH PROFICIENCY, IN CALIFORNIA ALONE POTENTIAL OF 6 MILLION INDIVIDUALS, AND THIS TECHNOLOGY HAS GONE ON TO BE QUITE SUCCESSFUL AN LED TO LAWS WITH REGARD TO PRESCRIPTION LABELING IN CALIFORNIA, AN EXAMPLE OF A TECHNOLOGY THAT HAS DISRUPTED PATHWAYS THAT NORMALLY WOULD BE TO LACK OF ADHERENCE TO NOW PROMOTE ADHERENCE. ANOTHER ONE IS THE -- MOBILE INTERNET DIRECTLY OBSERVED THERAPY, AND THIS HAD TO TO WITH DELIVERY OF TUBERCULOSIS THERAPY. THIS IS NOW CALLED VIDEO DIRECTLY OBSERVED THERAPY AND THIS THERAPY HAS BEEN OR APPROACH HAS BEEN VERY, VERY SUCCESSFUL AND HAS BEEN TAKEN UP ACROSS THE COUNTRY, QUITE SUCCESSFUL, LEAD LEADING TO IMPROVED ADHERENCE. WE'RE LOOKING FOR TECHNOLOGIES THAT CAN INTERRUPT OR INTERVENE ON THESE PATHWAYS. ANOTHER PRODUCT WOULD BE INNOVATIVE PRODUCTS OR SERVICES THAT FACILITATE SELF MANAGEMENT, TO PROMOTE COORDINATION BETWEEN PRIMARY CARE PROVIDERS, DENTAL HEALTH PROFESSIONS, PROFESSIONALS, NURSE PRACTITIONERS, PROVIDERS OF MEDICAL HEALTH AND BEHAVIORAL HEALTH SERVICES OR PATIENT NAVIGATORS AND MEDICALLY UNDERSERVED COMMUNITIES AND REGIONS ARE OF INTEREST AS WELL. NEXT SLIDE PLEASE. RECENTLY NIMHD PUT OUT AN RFA OR FOA FOR ADDRESSING DISASTERS, AND THIS IS KIND OF A FOLLOW-UP AND RELATED ONE, THIS PARTICULAR BULLET, SO HERE WE'RE INTERESTED IN TECHNOLOGIES FOR PREVENTING AND MINIMIZING ADVERSE EXPOSURES AND HEALTH RISK, OR FOR PROMOTING HEALTH, WELL-BEING RESILIENCE AND RECOVERY RESULTING FROM DISASTERS OR THE THREAT OF DISASTER. INCLUDING PUBLIC HEALTH RISK SUCH AS COVID-19 OR SIMILAR PANDEMIC, INCLUDING NEW TOOLS, APPS, EDUCATION, CURRICULA, OR OTHER TECHNOLOGIES TO DETECT, SCREEN, TREAT OR PREVENT OR OTHERWISE MITIGATE ADVERSE HEALTH OUTCOMES, OR TO LEVERAGE COMMUNITY AND/OR POPULATION RESILIENCE AND PREVENTION EFFORTS. THERE'S ONE THING I DID WANT TO REITERATE, SOMETHING THAT WAS MENTIONED DURING DR. SOUTHERLAND'S PRESENTATION ON THE WORK GROUP REPORT, THAT IS THAT THE -- I'M SORRY, THAT IS THE DIFFERENCE BETWEEN THE SBIR AND STTR PROGRAMS IS THAT THE STTR REQUIRES A PARTNERSHIP WITH A NOT-FOR-PROFIT ENTITY LIKE AN ACADEMIC RESEARCH INSTITUTION. IT'S NOT REQUIRED FOR THE SBIR BUT THESE CAN BE -- THESE ARE ENCOURAGED AND FOR BOTH THE SBIR AND THE STTR, WE DO ENCOURAGE PARTNERSHIP WITH THE COMMUNITIES FOR WHICH THE TECHNOLOGY WILL BE ULTIMATELY USED BY. AT THIS TIME, TOM, I'D LIKE TO TURN IT BACK OVER TO YOU. THANK YOU. >> TRYING TO SWITCH BETWEEN SCREENS, MISSING MY MUTE BUTTON. HERE YOU GO. OUR COUNCIL REVIEWERS ARE DOCTORS JOHNSON AND -- HOLD ON HERE. I APOLOGIZE. DR. SOUTHERLAND AND DR. RAMIREZ. DR. SOUTHERLAND WOULD YOU CARE TO SHARE YOUR RECOMMENDATIONS WITH REGARD TO THIS CONCEPT? >> SURE, SURE, BE HAPPY TO. FIRST OF ALL, I WANT TO START BY SAYING AN IMPORTANT ASPECT OF ADDRESSING HEALTH CARE ISSUES DESIGNED TO ADJUST SPECIFIC HEALTH CONCERNS, AND HOWEVER DEVELOPMENT OF TECHNOLOGIES HAS PRIMARILY FOCUSED ON DISEASES AND POPULATIONS THAT COULD YIELD GREATER IMPACT OR RETURN ON INVESTMENT FOR THE DEVELOPER, SMALL BUSINESS CONCERN. AND AS A RESULT, BELIEVE THE MINORITY POPULATIONS HAVE NOT OCCUPIED SUFFICIENT SPACE IN THE HEALTH CARE TECHNOLOGY AND DEVELOPMENT WORLD. AND THAT CREATED A GAP BETWEEN TECHNOLOGY PLAYS AND ROLE OF MINORITY AND MAJORITY POPULATIONS. THIS CONCEPT ADDRESSES THAT GAP IN A VERY DIRECT MANNER BY FOCUSING ON DIRECTING OR ENCOURAGING TECHNOLOGY DEVELOPMENT SPECIFICALLY TO ADDRESS ISSUES OF MINORITY HEALTH AND HEALTH DISPARITIES. THAT'S VERY IMPORTANT TO ME. WHAT I REALLY LIKE IS THAT IT HOLDS POTENTIAL TO ENSURE THE NEEDS OF MINORITY HEALTH POPULATIONS ARE CONSIDERED AND INCLUDED IN THE PUSH TO ADVANCE NEW TECHNOLOGIES IN ADDRESSING HEALTH CARE NEEDS OF THE NATION. SO IT MAKES INVESTORS OF SMALL BUSINESS CONCERN THINK ABOUT HEALTH CARE NEEDS OF MINORITY POPULATIONS IN A CENTRAL WAY, AND SO ONE THING THAT THIS CONCEPT, THREE PROOFS OF OBJECTIVES CAN BE IDENTIFIED. ONE IS LEVERAGING THE SBIR/STTR PROGRAMS TO BETTER ALIGN WITH THE NIMHD MISSION, AND THEN EDUCATING SMALL BUSINESS CONCERNS ON THE VALUE IN USING THE NIMHD FRAMEWORK TO IDENTIFY NOVEL OPPORTUNITIES, AND ALSO PROMOTING SOCIAL ENTREPRENEURSHIP. AND I BELIEVE IF THESE THREE ARE EXECUTED, IT WILL INTRINSIC INCLUDE IN ALL LEVELS OF MINORITY AND HEALTH AND DISPARITIES, CONSISTENT WITH NIMHD INTERESTS. AND TWO OTHER POINTS I WOULD LIKE TO MAKE REGARDING THESE THREE PILLARS IS, ONE, THEY WILL DRIVE SBCs TO CONSIDER FRAMEWORK IN THE RECRUITING PROCESS, AND HOPEFULLY THIS WILL CAUSE SBCs TO REALIZE THAT INVESTING IN MINORITY POPULATIONS CAN BE A VIABLE PIECE OF THEIR PORTFOLIO INSTEAD OF A FRINGE BUSINESS. ANOTHER VERY IMPORTANT POINT IS THAT THE CONCEPT INCLUDES THE IDEA OF SOCIAL ENTREPRENEURSHIP, WHICH IS SOMETHING THE WORKSHOP RECOMMENDS ALSO, AS DR. TABOR POINTED OUT, EMBRACES THE NOTION OF DOUBLE TIME LINE, TECHNOLOGICAL ADVANCES, HA IS FINANCIAL RETURN ON INVESTMENT AND SOCIAL RETURN ON INVESTMENT. SOCIAL RETURN ON INVESTMENTS SHOULD ENCOURAGE POTENTIAL INVESTORS TO BE COGNIZANT AND SEEK ADVANCEMENT OPPORTUNITIES THAT WILL HAVE A POSITIVE IMPACT ON SOCIETY. THE CONCEPT SEEKS TO CORRELATE NEEDS OF THE SBC AND MINORITY COMMUNITIES BY PRIORITIZING THOSE PROJECTS THAT PROMISE TO RESULT IN THE COMMERCIALIZABLE AND AFFORDABLE AND ACCESSIBLE CULTURALLY ACCEPTABLE TECHNOLOGIES AND/OR PRODUCTS. I'M PLEASED WITH THE CONCEPTS. I BELIEVE IT SHOULD ADVANCE NIMHD AGENDA IN ADDRESSING HEALTH NEEDS OF MINORITY POPULATIONS AND AS INDICATED EARLIER CONCEPT ADDRESSES WORK GROUP RECOMMENDATIONS, I BELIEVE THE FRAMEWORK AND ALSO OF EMPHASIZING SOCIAL RETURN ON INVESTMENT. WHILE PARTNERING WITH THE NON-PROFIT RESEARCH INSTITUTIONS, INHERENT IN THE SBIR/STTR PROGRAM, I THINK SOME EXPLICIT LANGUAGE THAT ENCOURAGES SUCH PARTNERSHIP WILL ONLY IMPROVE THE CONCEPT. NOW, WHILE IT'S ALSO IMPLICIT NIMHD GOALS MAY BE HELPFUL TO ENCOURAGE INVOLVEMENT OF WOMEN AND MINORITY-OWNED SBCs, TO FURTHER THIS KIND OF OPPORTUNITY, MAY HELP ALSO TO EXPLICITLY ENCOURAGE THE PARTICIPATION OF THOSE KINDS OF SMALL BUSINESS CONCERNS. SO IN SUMMARY, I'M VERY ENTHUSIASTIC ABOUT THIS CONCEPT, AND I WHOLEHEARTEDLY SUPPORT IT. THANK YOU VERY MUCH. >> THANK YOU. DR. RAMIREZ, DO YOU HAVE HAVE SOME COMMENTS TO ADD TO WHAT'S ALREADY BEEN SAID? >> THANK YOU VERY MUCH. I'M IN CONCURRENCE WITH THE COMMENTS MADE BY DR. SOUTHERLAND. I JUST WANTED TO INDICATE THAT, YOU KNOW, COVID-19 REALLY SHINED A LIGHT ON MANY OF THE TECHNOLOGY DIFFICULTIES, MANY UNDERSERVED COMMUNITIES HAVE THAT WE'RE NOT PREPARED TO DEAL WITH THE NEW TECHNOLOGY, SO I THINK THIS CONCEPT IS VERY TIMELY AND LOOK FORWARD TO SEEING IT GO TO FURTHER DEVELOPMENT. AND WE CERTAINLY ALSO ENCOURAGE EMPHASIS THEY INCLUDE MORE HOW-TOs AND INDIVIDUALS OF HOW INDIVIDUALS CAN APPLY FOR THIS MECHANISM SO WE CAN ENCOURAGE BOTH THE SOCIAL AND BUSINESS ASPECTS OF THIS ENDEAVOR. THANK YOU. ARE THE OTHERS ON THE PANELS WITH THOUGHTS THEY WANT TO BRING FORWARD NOW? NOT SEEING ANYTHING IN THE CHAT BOX. ONE LAST OPPORTUNITY. WITH THAT, COULD WE HAVE A MOTION WITH REGARD TO THIS CONCEPT? >> SO MOVED. >> I SECOND. AMELIE. >> TO BE CLEAR, IT'S A MOTION TO APPROVE? >> MOTION TO APPROVE. >> THANK YOU. AND WE HAVE THE SECOND. SO IF THE COUNCIL MEMBERS WILL ENTER A VOTE, IN THE CHAT BOX, YES OR NO, I'LL POP THIS UP. THANK YOU. THE VOTE IS UNANIMOUS, CONCEPT APPROVED. NOW TO OUR NEXT CONCEPT, WHICH OUR PRESENTER IS DR. RINA DAS, REVIEWERS DR. REED AND KAHOLOKULA, CLINICAL RESEARCH EDUCATION AND CAREER DEVELOPMENT PROGRAM. WHEN YOU'RE READY PLEASE BEGIN. >> I'M RINA DAS, PRESENTING ON THIS CONCEPT ON CLINICAL RESEARCH EDUCATION AND CAREER DEVELOPMENT AWARD CRECD, R25 RESEARCH EDUCATION PROGRAM, I'D LIKE TO ACKNOWLEDGE THE HELP BY THE TWO WHO HELPED ANALYZING DATA AND DR. MIKE SAYRE . SO, THE PURPOSE OF THIS PROGRAM IS TO SUPPORT RESEARCH EDUCATIONAL ACTIVITIES TO ENHANCE DIVERSITY OF RESEARCH WORKFORCE IN CLINICAL AND TRANSLATIONAL RESEARCH, AND RESOURCE INSTITUTIONS THAT OFFER DOCTORAL DEGREES IN HEALTH PROFESSIONS, OR IN HEALTH-RELATED SCIENCES. WE DEFINE THOSE WHO HAVE RECEIVED LESS THAN $50 MILLION OF NIH FUNDING PER YEAR ON AVERAGE IN THE LAST THREE YEARS. NEXT SLIDE PLEASE. TO GIVE A LITTLE BIT OF BACKGROUND REGARDING THE NEED FOR DIVERSITY OF THE WORKFORCE WE HAVE SEEN A LOT OF DATA PRESENTED BY THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES, NATIONAL ACADEMY OF SCIENCES, WHO INDICATED THAT THERE'S A NEED FOR SENSE OF DIVERSITY, ESPECIALLY CLINICAL SCIENTIST, SMALL NUMBERS ARE INSUFFICIENT TO MEET NEED FOR CLINICAL RESEARCH. WE ALSO SEE THERE'S A NEED TO DEVELOP A CADRE OF WELL-TRAINED CLINICAL SCIENTISTS FROM UNDERREPRESENTED GROUPS. SO TO HELP MEET THIS NEED NIMHD HAS SUPPORTED THIS CRECD PROGRAM SINCE 2011, THROUGH THIS R25 MECHANISM, SINCE INCEPTION IN 2002 WHICH WAS IN THE FORMER INSTITUTE NCRR, THE PROGRAM EVOLVED FROM BEING DIDACTIC EDUCATION PROGRAM ALONE, DEFINED DIDACTIC EDUCATION AND MENTORED EXPERIENCE. INITIALLY AWARDS MADE TO INSTITUTIONS THAT WERE FUNDED BY THE RESEARCH CENTER IN MINORITY RCMI PROGRAM, SUBSEQUENTLY EXPANDED IN 2017 TO OTHER LOWER RESOURCE (INDISCERNIBLE). I WANT TO POINT OUT THE BUDGET OF THESE PROGRAMS AROUND ( INDISCERNIBLE) DIRECT COSTS (INDISCERNIBLE). SO, A LITTLE BIT ABOUT THE PROGRAM, THESE R25 AWARDS ARE INTENDED TO SUPPORT EDUCATIONAL ACTIVITIES TO REALLY DEVELOP SKILLS FOR POSTDOCTORAL CANDIDATES, WITH CLINICAL DEGREES. AND ALSO TO DEVELOP THESE RESEARCHERS WHO CAN CONDUCT MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH. THE CRECD PROGRAM IS UNIQUE, CONSISTS OF PHASE 1 AND PHASE 2. PHASE 1 OFFERS DIDACTIC PARTICULAR TO COMPLEMENT EXISTING PROGRAMS LEADING TO MASTER'S DEGREE, PROVIDES MENTORED RESEARCH EXPERIENCES AS IT WAS REALIZED THAT CANDIDATES WHO COMPLETE THE PHASE 1 OF THE PROGRAM WOULD BENEFIT FROM THESE ADDITIONAL MENTORED CLINICAL RESEARCH TRAINING, PROTECT THE TIME BEFORE THEY CAN SUCCESSFULLY COMPETE FOR EXTERNAL GRANT SUPPORT. THE CURRENT FUNDED CRECD AWARDEES ARE LISTED HERE, FUNDED IN 2017, MOREHOUSE SCHOOL OF MEDICINE, UNIVERSITY PUERTO RICO, CHARLES DREW UNIVERSITY OF MEDICINE AND SCIENCE, UNIVERSITY OF OKLAHOMA MELT SCIENCE CENTER. NEXT SLIDE PLEASE. THE PROGRAM HAS ENABLED THESE FUNDED INSTITUTIONS TO ESTABLISH ACCREDITED MASTER'S LEVEL PROGRAM FOR CLINICAL RESEARCHERS, THEY HAVE ESTABLISHED CURRICULUM TO ENHANCE THEIR KNOWLEDGE AND SKILLS IN MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH, SOME OF THE COURSES THAT THEY INCLUDE ARE LIKE IMPLEMENTATION SCIENCE, QUALITY METHODOLOGY, ALL TOOLS I THINK WE NEED THESE CLINICIANS TO BE EMPOWERED WITH TO CONDUCT HEALTH DISPARITIES RESEARCH. SO THEY HAVE ENROLLED OVER 200 SCHOLARS TO DATE, IN PHASE 1 AND PHASE 2, FROM VARIOUS HEALTH PROFESSIONS. AND OVER 90% OF THESE SCHOLARS ARE FROM UNDERREPRESENTED MINORITIES. SO ONCE THESE SCHOLARS FINISH THEIR CRECD SUPPORT THEY CONTINUE TO DO RESEARCH AND COMPLETE CAREERS RECEIVING GRANT FUNDING FROM NIH THROUGH A VARIETY OF MECHANISMS SUCH AS LOAN REPAYMENT PROGRAMS, K GRANTS, AS WELL AS OTHER FEDERAL AGENCIES, AHRQ, DEPARTMENT OF JUSTICE, FROM STATES, LOCAL AGENCIES AND OTHER FOUNDATIONS. AND THEY ALSO MADE SIGNIFICANT CONTRIBUTIONS IN AREA OF CLINICAL AND TRANSLATIONAL RESEARCH, THROUGH PUBLISHING OVER 400 PAPERS IN PEER-REVIEWED JOURNALS AND THESE INSTITUTES HAVE ALSO PARTNERED WITH MANY OTHER EXISTING NIH-FUNDED PROGRAMS SUCH AS CTSA, NRM, PARTNERED WITH OTHER ACADEMIC INSTITUTIONS TO ENHANCE CAPACITY TO SUPPORT THESE SCHOLARS AND PROVIDE THE NECESSARY MENTORSHIP NEEDED. ONE NOTE I WANTED TO ADD THAT CRECD SCHOLARS COME TO NIH, WE ORGANIZE ANNUAL SCHOLAR MEETINGS WHERE WE INVITE SOME OF THESE PHASE 1 AND PHASE 2 SCHOLARS TO COME AND PRESENT THEIR WORK AND INTERACT WITH NIH STAFF, PROGRAM STAFF, AND THIS HAS BEEN VERY SUCCESSFUL, AND WE DO THIS IN CONJUNCTION WITH THE ASSOCIATION FOR CLINICAL AND TRANSLATIONAL SCIENCES ANNUAL MEETING, SO THEY GET TO PRESENT THEIR WORK IN THAT MEETING AS WELL. NEXT SLIDE PLEASE. AS I MENTIONED, THIS PROGRAM HAS BEEN VERY SUCCESSFUL IN RECRUITING PARTICIPANTS FROM DIVERSE GROUPS, SO REGARDING THE DEGREES AS YOU CAN SEE MAJORITY OF THEM HAVE M.D. DEGREES, A FEW ARE PhDs IN PSYCHOLOGY, NURSING, AND THEN WE HAVE OTHER MEDICAL DEGREES FROM DENTAL AND OTHER AREAS. FOR DIVERSITY OF THE PROGRAM, THIS PROGRAM HAS BEEN VERY SUCCESSFUL, OVER 94% OF THE SCHOLARS ARE FROM UNDERREPRESENTED MINORITIES, AND THEY ARE LATINOS, AFRICAN AMERICANS, AMERICAN INDIANS, SO THE PROGRAM IS DOING QUITE WELL IN TERMS OF MEETING DIVERSITY GOALS, IN TERMS OF GENDER DISTRIBUTION WE HAVE ABOUT 75% OF THE SCHOLARS ARE FEMALE, AND 25% OF THE SCHOLARS ARE MALE. REGARDING RESEARCH AREAS, THERE ARE A VARIETY OF DIFFERENT TOPIC AREAS THAT THEY ARE ENGAGED IN, AND MAJORITY OF THEM ARE RELATED TO MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH, THESE INCLUDE LIKE CANCER DISPARITIES, HIV AND PROMOTING PREP USE AMONG LATINO MEN, DIABETES, CARDIOVASCULAR DISEASE, ORAL HEALTH AND MENTAL HEALTH DISPARITIES. SO, THIS PROGRAM HAS BEEN REALLY PRODUCTIVE IN BRINGING CLINICIANS TO RESEARCH AND THESE INSTITUTIONS HAVE REALLY SUPPORTED SCHOLARS AND HAVE RETAINED THESE SCHOLARS. SCHOLARS HAVE ACHIEVED LEADERSHIP POSITIONS, DIRECTLY RELATED TO THEIR RESEARCH AREAS, I JUST WANTED TO GIVE YOU SOME EXAMPLES LIKE DR. CAMPBELL IS A PEDIATRICIAN, NOW A PROFESSOR AND DIRECTS CENTER FOR COMMUNITY OUTREACH FOR HEALTH IN UNIVERSITY OF PUERTO RICO. SHE'S FUNDED THROUGH THE RCMI RESEARCH PROJECT AND R21. WE HAVE DR. MARTINNA GONZALEZ, ASSOCIATE PROFESSOR, UNIVERSITY OF PUERTO RICO, DIRECTS THE CENTER FOR STUDY AND TREATMENT OF FEAR AND ANXIETY, ALSO RECEIVED NRP AND R21 GRANTS TO PURSUE RESEARCH CAREERS AND SHE'S CURRENTLY THE P.I. OF THE CURRENT R25 GRANT. WE HAVE DR. PIMU FROM MOREHOUSE, SHE'S CURRENTLY THE VICE CHAIR OF THE DEPARTMENT OF INTERNAL MEDICINE, AND FULL PROFESSOR AT MOREHOUSE, HER RESEARCH HAS BEEN SUCCESSFUL IN OBTAINING GRANTS FROM SEVERAL INSTITUTES. SHE'S ALSO CURRENTLY CICD PROGRAM FOR MOREHOUSE, TO GIVE A FLAVOR THAT THESE SCHOLARS HAVE BEEN VERY SUCCESSFUL AND HAVE BEEN PURSUING THEIR CAREER IN RESEARCH. NEXT SLIDE PLEASE. SO, TO EMPHASIZE THE NEED FOR THIS PROGRAM THE NIH HAS SEVERAL R25 PROGRAMS, BUT THEY ARE USUALLY SHORT-TERM AND MAYBE FOR ONE YEAR AT THE MOST, AND PRE-DOCTORAL LEVELS, AND THEY LACK THE FOCUS ON MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH. NIMHD DOES SUPPORT SOME OF THE K MECHANISMS THAT YOU HEARD TODAY BUT THESE ARE AGAIN INDIVIDUAL AWARDS, AND DO NOT REALLY SUPPORT CURRICULUM DEVELOPMENT LOW RESOURCE MINORITY SERVING INSTITUTIONS, THIS CRECD IS UNIQUE AND COMBINES BOTH DIDACTIC COURSES AND THROUGH THESE EDUCATIONAL ACTIVITIES IT WOULD COMPLEMENT AND ENHANCE SOME OF THE OTHER TRAINING PROGRAMS THAT EXIST THROUGH NIH -- OTHER NIH-FUNDED MECHANISMS. SO THERE'S STILL A GAP IN THE DIVERSITY OF CLINICAL RESEARCHERS, ESPECIALLY IN HEALTH AREAS RELATED TO MINORITY HEALTH, AND HEALTH DISPARITIES. NEXT SLIDE PLEASE. SO THE PURPOSE OF THIS INITIATIVE IS TO RENEW THE CRECD PROGRAM, PR 16-330, TO CONTINUE TO PROMOTE SUPPORT RESEARCH EDUCATIONAL ACTIVITIES, TO ENHANCE DIVERSITY OF THE RESEARCH, WHO CAN CONDUCT CLINICAL AND TRANSLATIONAL RESEARCH, IN THE FIELD OF MINORITY HEALTH AND HEALTH DISPARITIES, THESE R25 AWARDS WILL BE FOR FIVE YEARS, AND CONSIST OF THE SAME TWO COMPONENTS, PHASE 1 AND PHASE 2, PHASE 1 WILL SUPPORT DIDACTIC COURSES IMPROVING EXISTING COURSES, ULTIMATELY ENHANCE KNOWLEDGE AND RESOURCE SKILLS, RESULTING IN MASTER'S DEGREE, PHASE 2 WILL PROVIDE MENTORED RESEARCH EXPERIENCE, PROTECTED TIMES FOR UP TO THREE YEARS, ALLOW PARTICIPANTS CONTINUE WORKING TO ESTABLISHING INDEPENDENT RESEARCH PROGRAMS, AS CLINICAL RESEARCH SCIENTISTS. SO WE WOULD LIKE TO SUGGEST ON A FEW CHANGES. WE THINK THIS NEEDS EVALUATION OF THE PROGRAM AND THESE EVALUATIONS SHOULD INCLUDE SOME OF THE MEASURES FOR MEASURING THE ACCOMPLISHMENTS, HOW WELL THE PROGRAM IS MEETING ITS GOAL, TRACK THE SCHOLARS PROGRESS AND ALSO LIKE THEM TO EVALUATE HOW MANY OF THESE SCHOLARS ARE RETAINED, AND HOW DOES IT IMPACT THE OVERALL CAPACITY AT THE INSTITUTION LEVEL. IN TERMS OF OTHER CHANGES WE WANT TO KEEP THESE PHASE 2 OPTIONS FLEXIBLE AND NON-DEPENDENT ON COMPLETING MASTER'S DEGREE IN PHASE 1, AS LONG AS THEY HAVE THE NECESSARY SKILLS TO CONDUCT RESEARCH, AND ALSO WE WOULD ALLOW FLEXIBILITY IN TERMS OF THE REQUIREMENT OF 75% PROTECTED TIME AS WE KNOW THAT IT'S HARD FOR CLINICIANS TO COMMIT TO AND WOULD LIKE TO COMMAND TO OTHER LOW RESOURCE INSTITUTIONS BESIDES THE RCMI-FUNDED INSTITUTIONS. WITH THAT, I WILL STOP AND TAKE ANY QUESTIONS OR COMMENTS. THANK YOU. >> DR. REEDE WOULD YOU LIKE TO SPEAK FIRST WITH YOUR COMMENTS ON THIS CONCEPT? >> SURE. THANK YOU VERY MUCH. THANK YOU FOR THAT PRESENTATION OF THE CONCEPT. THE SIGNIFICANCE OF THE CRECD PROGRAM IS FOCUS ON CLINICIAN SCIENTISTS, PARTICULARLY IDENTIFICATION AND SUPPORT OF YOUR PHYSICIAN-SCIENTISTS, IMPORTANT FOR NOT ONLY CONDUCTING CLINICAL TRIALS AND CLINICAL RESEARCH BROADLY BUT ALSO NECESSARY PART OF THE TRANSLATIONAL CONTINUUM FROM BENCH TO BEDSIDE AND INFLUENCING HEALTH CARE POLICIES. THE CRECD PROGRAM HAD GOOD SUCCESS SHOWING US THEY PROVIDED SUPPORT FOR MORE THAN 200 SCHOLARS, PHYSICIAN-SCIENTISTS ARE IN MASTER'S DEGREES GOING TO RECEIVE NIH FUNDING. OF NOTE, EACH FUNDED INSTITUTION RECEIVES FUNDING TO SUPPORT DIDACTIC PROGRAMMING IN PHASE 1, BUT THE NUMBER OF SCHOLARS SUPPORTED FOR PHASE 2, CLINICAL RESEARCH EXPERIENCE, TWO TO THREE INDIVIDUALS PER AWARD CYCLE, ALL A BACK DROP OF SOME SUGGESTIONS FOR CONSIDERATION INVOLVE FOUR AREAS. ONE INCREASING INTERACTION AMONG SCHOLARS EXPANDING OPPORTUNITIES FOR NETWORKING, INCREASING NUMBER OF SCHOLARS WHO PARTICIPATE IN ASSOCIATION OF CLINICAL AND TRANSLATIONAL SCIENTISTS ANNUAL MEETING HELD IN WASHINGTON. CURRENT SCHOLARS ACROSS INSTITUTIONS VIRTUAL (INDISCERNIBLE) VERY ACCUSTOM TO, VIRTUAL FORMS FOR CURRENT AND ALUMNI SCHOLARS TO CONNECT, EXPAND NETWORKS, PROVIDE OPPORTUNITIES FOR COLLABORATION, INTRODUCE NEW ROLE MODELS AND POTENTIAL MENTORS, MAKE AVAILABLE ADDITIONAL AVENUES FOR OBTAINING AND SHARING INFORMATION. SECONDARY CONSIDERATION RELATES TO EVALUATION, AND THIS WOULD BE AN IMPORTANT ELEMENT IN MOVING FORWARD, ADDITIONAL CONSIDERATIONS WOULD BE ESTABLISHING COORDINATED CENTER TO ENSURE ROBUST EVALUATION WITHIN AND ACROSS PROGRAMS, SUCH A CENTER COULD COORDINATE LEARNING AND TRAINING ACROSS PROGRAMS. AND YOU RAISE THE IDEA EVALUATION PROVIDES THIS OPPORTUNITY TO BETTER EXPLORE THE IMPACT OF THE PROGRAM ON INDIVIDUAL SCHOLARS, PARTICULARLY LOOKING AT THOSE SCHOLARS WHO PARTICIPATE IN PHASE 1, DIDACTIC PROGRAMMING AND OUTCOMES, AS WELL AS SCHOLARS WHO PARTICIPATE IN PHASE 1 AND PHASE 2, THERE'S A LOT TO BE ABLE TO LEARN FROM THAT, SHARED WITH THE BROADER COMMUNITY. AND THIS EVALUATION HAVING OPPORTUNITY TO UNDERSTAND IMPACT OF THE SPONSORING PROGRAM WITH REGARD TO RETENTION AND BUILDING A COMMUNITY, HOW DOES THAT IMPACT OTHERS IN TRAINING AND OTHERS COMING ON THROUGH CONSIDERATION OF CAREERS AS CLINICIAN SCIENTISTS. ANOTHER ASPECT OF THIS IS THE TRACKING OF SCHOLARS BEYOND THE PERIOD OF THEIR PROGRAMMING, INSIGHTS THAT COULD BE SHARED BEYOND THE CRECD COMMUNITY FOR THE LARGER NEED LOOKING AT DIVERSITY IN THE WORKFORCE. THIRD AREA FOR CONSIDERATION IS CLINICIAN SCIENTISTS NEED TO BALANCE CLINICAL OBLIGATIONS ENGAGING RESEARCH TRAINING WHICH CAN BE CHALLENGING FOR UNDERREPRESENTED MINORITIES, THOSE WHO MAY HAVE CLINICAL SERVICE PAYBACK TO COMPLETE. IT'S OFTEN DAUNTING FOR CLINICIANS WANTING TO ENGAGE IF RESEARCH BECAUSE OF RACIAL AND ETHNIC DISCRIMINATION BIAS, ISOLATION AND LACK OF MENTORING, CLINICAL AND COMMUNITY OBLIGATIONS. IN PHASE 1 AND PHASE 2 HAVING SUPPORT STRATEGIES BUILT IN TO MITIGATE CHALLENGES INCREASING LIKELIHOOD OF SUCCESS FOR TRAINEES AND TOPIC INCLUDE NAVIGATING BARRIERS TO SUCCESS, BALANCING CLINICAL AND RESEARCH CAREERS. FOURTH AREA FOR CONSIDERATION INVOLVES LOOKING AT ALTERNATIVE VEHICLES OR OPPORTUNITIES FOR TRAINING TO SUPPORT SCHOLARS, WHO DO NOT RECEIVE PHASE 2 SUPPORT AND LINKING TO EXTERNAL RESOURCES, THAT GO BEYOND CRECD RESOURCES SUCH AS CTSA, TRAINING PROGRAMS AND KL2s, I WANT TO THANK DR. KAHOLOKULA FOR HIS INPUT HELPING PULL TOGETHER THESE COMMENTS. AND WANT TO SAY THAT MY ENTHUSIASTIC SUPPORT FOR CLINICAL RESEARCH EDUCATION AND CAREER DEVELOPMENT PROGRAM, A VERY IMPORTANT PROGRAM. >> THANK YOU. DR. KAHOLOKULA IS HERE, WE'LL ASK HIM IF EVERYTHING HAS BEEN SAID OR IF THERE'S SOMETHING MORE HE WOULD LIKE TO ADD. >> NOTHING MORE TO ADD. MAHALA FOR THE EXCELLENT RECOMMENDATIONS. I ALREADY WORKED WITH DR. REEDE IN ADVANCE AND HAVE NOTHING MORE TO ADD. >> OKAY. IS THERE ANYONE ELSE ON THE COUNCIL WHO WOULD LIKE TO MAKE A COMMENT ABOUT THIS CONCEPT? >> I JUST WANT TO SAY THANK YOU FOR THE COMMENTS AND WE'LL TAKE THAT INTO CONSIDERATION. >> WE'LL ENTERTAIN A MOTION. >> MOVE TO ACCEPT. >> SECOND. >> OKAY. MOTION MOVED AND ACCEPTED -- AN SECONDED, CAN WE HAVE A VOTE IN THE CHAT BOX PLEASE? CONCEPT APPROVED UNANIMOUSLY. THANK YOU FOR PLACING YOUR VOTE IN THE CHAT BOX. WE CAN MOVE NOW TO OUR NEXT CONCEPT. OUR PRESENTER IS DR. JENNIFER AVLIDREZ. DR. CORBIE-SMITH HAS BEEN COMING IN AND OUT, SHE HAD CONFLICTS, MAY OR MAY NOT BE HERE. DR. MANSON'S PREPARED IF SHE'S NOT. THE CONCEPT IS INTERVENTIONS TO IMPROVE MINORITY HEALTH AND REDUCE HEALTH DISPARITIES. SO WITH THAT, WHEN YOU'RE READY PLEASE TAKE IT AWAY. >> THANK YOU. SO YOU CAN SEE THE TITLE OF THIS INITIATIVE. THIS IS REISSUE, THE LAST CYCLE WAS FROM 2015 SO THIS IS THE NEXT ROUND, THE KINDS OF COMMUNITY INTERVENTION RESEARCH WE WANT TO SEE MORE OF. THAT COMMUNITY ENGAGED APPROACHES ARE IDEALLY SUITED TO CARRY OUT IN PARTICULAR COMMUNITY LEVEL INTERVENTIONS. COMMUNITY LEVEL INTERVENTION REPRESENT UNIDENTIFIED PRIORITY FOR NIMHD TO SHIFT FROM INDIVIDUAL LEVEL FOCUSING ON CHANGING KNOWLEDGE AS BEHAVIORS OF INDIVIDUALS, TO THOSE THAT ADDRESS SOCIAL AND STRUCTURAL ENVIRONMENTS IN WHICH PEOPLE LIVE, LEARN, WORK AND PLAY THAT MAY TAMPA SILL AT THIS TIME -- FACILITATE OR SERVE AS BARRIERS OR ADDRESS HEALTH DISPARITIES. NEXT SLIDE PLEASE. THERE ARE VIRTUAL COMMUNITIES FOR THOSE GEOGRAPHICALLY DISPERSED BUT SHARE COMMON CHARACTERISTICS OR IDENTITIES BUT WE'RE FOCUSING ON PLACE BASED HERE. EXAMPLES INCLUDE BUT NOT LIMITED TO NEIGHBORHOODS, CITIES, COUNTIES, SCHOOL DISTRICTS, RESERVATIONS, TRIBAL COMMUNITIES, MILITARY BASES, COLLEGE CAMPUSES, AND THIS DEFINITION OF COMMUNITY IS SOMEWHAT FLUID AS THERE CAN BE VARIABILITY IN COMMUNITIES ACCORDING TO WHAT PARAMETERS OR BOUNDARIES ONE IS USING. THE COMMUNITY LEVEL INTERVENTION IS DEFINED AS INTERVENTION THAT MODIFIES COMMUNITY CHARACTERISTICS, NORMS OR BEHAVIORS SO MODIFIES COMMUNITY DETERMINANTS IN THE COMMUNITY AS A WHOLE. NEXT SLIDE PLEASE. LOOKING AT RESEARCH FRAMEWORK WE CAN LOOK AT THE COMMUNITY LEVEL OF INFLUENCE, SO EXAMPLES OF COMMUNITY LEVEL DETERMINANTS INCLUDE COMMUNITY COHESION, SOCIAL CAPITAL, VIOLENCE THAT IS OCCURRING IN THE COMMUNITY, THERE'S PHYSICAL BUILT ENVIRONMENT, WHICH REFLECTS -- COULD BE THE NATURAL ENVIRONMENT, GREEN SPACE, AND CLIMATE, OR THE BUILT ENVIRONMENT LIKE RESIDENTIAL SEGREGATION, PROXIMITY TO TOXICS WASTE DUMPS OR INDUSTRIAL PLANTS, COMMUNITY RESOURCES LIKE ACCESS TO HEALTHY FOOD OPTIONS, OR EDUCATIONAL OR EMPLOYMENT OPPORTUNITIES, TRANSPORTATION SYSTEMS, AND THEN SOCIAL CULTURAL ENVIRONMENT ABOUT COMMUNITY NORMS AND TRADITIONS, SOCIAL CLIMATE OF A COMMUNITY, THE LOCAL DISCRIMINATION THAT MAY BE OCCURRING WITHIN A COMMUNITY, AND THEN THE AVAILABILITY AND QUALITY OF HEALTH CARE SERVICES. AND COMMUNITY LEVEL REFERS TO NOT JUST DETERMINANTS OF HEALTH BUT ALSO HEALTH OUTCOMES THAT PROVIDES OPPORTUNITY TO LOOK AT HEALTH OUTCOMES OF COMMUNITIES AS A WHOLE IN AGGREGATE, IN ADDITION TO JUST INDIVIDUAL HEALTH OUTCOMES THAT WE TYPICALLY SEE IN HEALTH RESEARCH. NEXT SLIDE PLEASE. SO, THIS INITIATIVE, THE PURPOSE IS TO SUPPORT RESEARCH AND DEVELOPMENT TESTS, COMMUNITY LEVEL INTERVENTION TO IMPROVE MINORITY HEALTH AND REDUCE HEALTH DISPARITIES. SOME FEATURES THAT WE ARE EXPECTING TO SEE OF COMMUNITY LEVEL INTERVENTION PROJECTS THAT ARE LED BY OR CONDUCTED IN COLLABORATION WITH COMMUNITY PARTNERS, AND WE DO ENCOURAGE MULTI-SECTORIAL, PARKS AND RECREATION, HOUSING, WHATEVER SECTORS ARE RELEVANT. OF COURSE, THE FOCUS NEEDS TO BE ON HEALTH DISPARITY POPULATION IN THE U.S., THE INTERVENTIONS CAN CAN FOCUS ON CHANGING FOOD OPTIONS THAT ARE AVAILABLE, OR MAY TARGET A SPECIFIC SUBGROUP OF A POPULATION BASED ON SOCIAL IDENTITY, HEALTH CONDITION, AGE GROUP, ET CETERA. WE WOULD EXPECT PROJECTS TO REALLY LOOK AT COMMUNITY AT THE LEVEL OF ANALYSIS, SO LOOKING AT USING EITHER CLUSTER RANDOMIZED DESIGNS, RIGOROUS QUASI-EXPERIMENTAL DESIGNS TO TELL US IF THE COMMUNITY LEVEL INTERVENTIONS ARE AFFECTING THE COMMUNITY AS A WHOLE, TARGETED MEMBERS OF THE COMMUNITY. WE DON'T -- WE DO ENCOURAGE MULTI-LEVEL INTERVENTION AS WELL SO THOSE THAT TARGET COMMUNITY LEVEL DETERMINANTS AS WELL AS INDIVIDUAL LEVEL FAMILY ORGANIZATIONAL DETERMINANTS. OUTCOMES, ALONG THOSE LINES OUTCOMES CAN INCLUDE INDIVIDUAL HEALTH OUTCOMES LIKE DEPRESSION OR ANXIETY SYSTEMS AMONG RESIDENTS OF A COMMUNITY, OUTCOMES CAN BE AT THE INTERPERSONAL OR ORGANIZATIONAL LEVEL, SAY THE FAMILY LEVEL, NUMBER OF FAMILIES, LIVING IN HOUSEHOLDS SMOKE FREE IN A COMMUNITY, FOR EXAMPLE, THE PROPORTION OF STUDENTS WITHIN THE SCHOOL SYSTEM MEETING FITNESS GOALS, OR AT THE COMMUNITY LEVEL, LIKE COMMUNITY RATES OF VACCINE UPTAKE FOR FLU OR COVID OR HPV OR CHANGE IN THE FOOD PURCHASING PRACTICES AT LOCAL SUPERVISOR ENACTORS OR FOOD OUTLETS, WITHIN THE COMMUNITY. SOME THINGS NOT CONSIDERED COMMUNITY LEVEL, THESE ARE EXAMPLES THAT I HAVE SEEN AS INTERVENTIONS OR INTERVENTION PROJECTS THAT HAVE BEEN LABELED AS COMMUNITY LEVEL BUT WOULDN'T BE CONSIDERED FOR THIS INITIATIVE, INTERVENTIONS THAT ARE COMMUNITY BASED, BUT DO NOT TARGET COMMUNITY LEVEL DETERMINANTS OF HEALTH. SO, JUST OFFERING INTERVENTION OUTSIDE OF HOSPITAL SET DOESN'T MAKE IT COMMUNITY LEVEL. INTERVENTIONS THAT ADDRESS COMMUNITY LEVEL DETERMINANTS BY ACTING ON THE INDIVIDUAL, SO HELPING INDIVIDUALS COPE WITH LIVING IN A FOOD DESERT BY GIVING THEM REFERRAL TO A FOOD BANK, HELPING PEOPLE COPE WITH PTSD SYMPTOMS THEY MAY HAVE BECAUSE OF LOCAL POLICE VIOLENCE, WITHOUT DIRECTLY CHANGING THOSE CHARACTERISTICS OF THE COMMUNITIES. INTERVENTIONS THAT INCLUDE COMMUNITY ELEMENTS TESTED AT INDIVIDUAL OR OTHER LEVEL, SO COMMUNITY, LET'S SAY THERE'S A COMMUNITY-WIDE PUBLIC AWARENESS CAMPAIGN BUT THEN INDIVIDUALS, EVERYONE GETS THAT, AND SOME PEOPLE ARE RANDOMIZED TO ONE INDIVIDUAL LEVEL, INTERVENTION OR ANOTHER. YOU CAN'T REALLY TEST THE IMPACT OF THE COMMUNITY-WIDE ELEMENTS OF THAT INTERVENTION. OUTREACH AND RECRUITMENT INTO INTERVENTIONS THAT ARE NOT COMMUNITY LEVEL. NEXT SLIDE PLEASE. SOME TOPICS OF SPECIAL INTEREST FOR COMMUNITY LEVEL INTERVENTION WOULD INCLUDE INCREASING HEALTHY FOOD OPTIONS, OPPORTUNITIES FOR PHYSICAL ACTIVITY, CHANGING COMMUNITY NORMS AND ADDRESSING STRUCTURAL BARRIERS RELATED TO HEALTH PROMOTION LIKE VACCINATION, HEALTH SCREENING, INDIVIDUALS WITH DISABILITIES TO LIVE INDEPENDENTLY AND MAINTAIN HEALTH AND WELL BEING, PROMOTING COMMUNITY REINTEGRATION OF INDIVIDUALS, INTO THE COMMUNITY AFTER ABSENCE DUE TO INCARCERATION OR HOSPITALIZATION OR OTHER FACTORS. THAT'S MY LAST SLIDE. THANK YOU VERY MUCH. >> OKAY. I THINK DR. MANSON, DO YOU WANT TO TAKE THIS FIRST? >> I WILL. I DON'T THINK DR. CORBIE-SMITH JOINED US BACK AGAIN. THANK YOU. COMBINED OUR REMARKS, THIS IS A VITALLY IMPORTANT INITIATIVE WHICH MOVES BEYOND FOCUS OF INDIVIDUAL BEHAVIOR TO ADDRESS STRUCTURAL INEQUALITY THAT DRIVES HEALTH DISPARITIES. CONCEPT CLEARANCE DOCUMENT ITSELF REPRESENTS A TIMELY AND WELL-ARGUED ENHANCEMENT OF FOA. IT UNDERSCORES CORRECTLY IN DR. CORBY-SMITH AND MY VIEWS SINCE IT HAS MOVES FROM BEING SELF-ESSENTIAL FOCUS TO WELL ESTABLISHED CRITICAL METHOD NOW INCLUDED IN OUR TOOLKIT. HENCE, THIS IS SEEN AS IN SERVICE OF ARTICULATING DESIGNING, CARRYING OUT, INTERPRETING COMMUNITY LEVEL INTERVENTION SCIENCE, WE ESPECIALLY APPLY CONTINUED EMPHASIS ON PUBLIC PARTNERSHIPS, AND DEEP EQUITY INVOLVEMENT OF ALL RELEVANT PARTNERS AT EVERY TURN IN WORK PROPOSED IN RESPONSE TO THE FOA OR CONCEPT. WE WOULD LIKE TO SEE IN THIS REGARD EXPECTATION THIS WORK IS CARRIED OUT BY LONG-TERM PARTNERSHIPS, NOT OPPORTUNITIES (INDISCERNIBLE) HISTORY OF COLLABORATION OR LONG-TERM PROBLEMS. SECONDLY, EVIDENCE THE COMMUNITY LEVEL INTERVENTION IS AT LEAST CO-DESIGNED WITH THE COMMUNITY IF NOT CONCEPTUALIZED IN TANDEM WITH THE COMMUNITY. WE EXPECT THERE SHOULD BE DEMONSTRATION OF FIDELITY TO COMMUNITY BASED PARTICIPATORY RESEARCH PRACTICES RELATIVE TO AND APPLY IN ALL ASPECTS OF CONCEPTUALIZING THE INTERVENTION, DESIGN, IMPLEMENTATION AND INTERPRETATION OF RESULTS AND DISSEMINATION. WE ALSO BELIEVE THAT THERE SHOULD BE A CLEAR THEORY OF CHANGE THAT UNDERGIRDS THE COMMUNITY LEVEL INTERVENTION. SO THAT WE CAN LOCATE THE NATURE OF THIS WORK BACK INTO THE HEALTH DISPARITIES RESEARCH FRAMEWORK THAT WAS JUST POINTED OUT OR SOME OTHER CONCEPTUAL FRAMEWORK CONSISTENT WITH THAT. AND WE BELIEVE THAT THERE NEEDS TO BE A (INDISCERNIBLE) IN THE INTERVENTION INCLUDED IN DESIGN, OBVIOUSLY (INDISCERNIBLE) AT LEAST THE DESCRIPTION OF STRATEGY BY WHICH THAT MIGHT BE ACCOMPLISHED AND ARGUED WITHIN THE APPLICATION. NOW, THE WHY FOR FOCUSING ON COMMUNITY-BASED INTERVENTIONS ACTUALLY COMMUNITY LEVEL INTERVENTIONS DESERVES GREATER EXPLANATION, HIGHLIGHTING THIS IN HER PRESENTATION, IT'S CLEARLY IN THE CONCEPT AND WARRANTS A CENTRAL ROLE IN FRAMING THE BASIS FOR THIS CONCEPT. AFTER ALL, A PERSON'S ABILITY TO LEAD A HEALTHY LIFE CONSTRAINED BY WHAT IS AVAILABLE, HOW SHE OR HE INTERACTS WITH THE WORLD AROUND US, PHYSICAL, SOCIAL, EMOTIONAL AND SPIRITUAL, ENVIRONMENT IS A PRODUCT OF POLICIES, PRACTICES AND NORMS THAT MANAGE (INDISCERNIBLE) BASED ON IMPLICIT HIERARCHY OF HUMAN VALUE. NIMHD RESEARCH FRAMEWORK, CONCEPT CAN BE SEEN AS ENCOMPASSING COMMUNITY AND SOCIETAL LEVELS OF INFLUENCE, DR. ALVIDREZ SHOWED RESEARCH FRAMEWORK AND CIRCLED THE COMMUNITY LEVEL BUT AS EXAMPLES WITHIN THE CONCEPT PAPER ITSELF ILLUSTRATE AND BY HER OWN REMARKS, THERE'S NOT A CLEAN LINE, WE ARGUE THERE NEEDS TO BE, BETWEEN COMMUNITY AND SOCIETAL LEVELS. SO WE LEVEL THERE NEEDS TO BE GREATER CLARITY ABOUT DISTINCTION, OPENING UP UNDERSTANDING AND OPERATIONAL DEFINITION OF COMMUNITY LEVEL INTERVENTIONS TO INDEED FOCUS NOT JUST ON COMMUNITY LEVEL OF INFLUENCE BUT CERTAIN ASPECTS OF SOCIETAL LEVEL OF INFLUENCE. LOCATING LEVEL OR LEVELS OF INTERVENTION WITHIN THE COMMUNITY AND SOCIETAL DIMENSION SUGGESTS POLICY LEVEL INTERVENTIONS MAY BE APPROPRIATE. IN FACT MOST OF THESE EXAMPLES PROVIDED DID NOT IN FACT INCLUDE POLICY LEVEL INTERVENTIONS. WE WOULD ENCOURAGE IN THE ENHANCEMENT OF THIS CONCEPT PAPER MOVING IT FORWARD COUNCIL AGREES IT TAKES THIS IN AND BEARS SPECIAL MENTION IN THE PAPER SINCE IT DOESN'T AT PRESENT AND WE BELIEVE THERE'S A SERIES OF METHODOLOGICAL ISSUES WITH RESPECT TO DESIGN, SAMPLING, ANALYTIC APPROACH. RANDOMIZED CONTROL APPROACH POSES CHALLENGE IN TERMS OF DEFINING LEVEL OF INTERVENTION, REPRESENTATIVE ELEMENTS OF COMMUNITY, UNIT OF ANALYSIS, POWER CALCULATION, WE BELIEVE THIS WARRANTS SPECIAL ATTENTION AND ACKNOWLEDGES STRENGTHS AND WEAKNESSES OF THE DIFFERENT KINDS OF METHODOLOGICAL APPROACHES AND FRAMEWORK THAT MAY BE MOBILIZED IN ADDRESSING THIS PARTICULAR CONCEPT. BUT IN CLOSING, WE BOTH FEEL STRONGLY ABOUT THE IMPORTANCE OF THIS CONCEPT PAPER THAT BUILDS FROM PREVIOUS FOA, AND IMPORTANTLY ACKNOWLEDGES SOME OF THE UNEXPECTED SHORT FALLS IN APPLICATION AND FUNDING THAT OCCURRED, IN RESPONSE TO PREVIOUS FOA, AND WE BELIEVE THIS REPRESENTS A NATURAL EXTENSION THAT CAPTURES GAPS THAT EMERGE FROM THE PRIOR INITIATIVE. >> OKAY. I DON'T SEE THAT ANYONE HAS MADE ANY ENTRY IN THE CHAT BOX. IF THERE ARE OTHERS ON THE PANEL WHO WISH TO SPEAK, NOW IS THE TIME. YOU CAN ENTER IN THE CHAT BOX THAT YOU HAVE A COMMENT. SEEING NONE OR HEARING NONE, I GUESS DR. MANSON, YOU DID A GOOD JOB. IN THAT CASE I'LL ASK THERE THERE'S SOMEONE OTHER THAN DR. MANSON WILL MAKE A MOTION. >> MAKE A MOTION TO APPROVE. NEIL CALMAN. >> SECOND. >> CONCEPT MOVED AND READY FOR VOTING. ENTER YOUR VOTES INTO THE CHAT BOX. THANK YOU ALL. THE MOTION IS APPROVED UNANIMOUSLY. WITH THAT, LET'S MOVE TO OUR FOURTH AND LAST CONCEPT. IT'S GOING LONGER BUT I HAVE GOOD NEWS FOR YOU, ONE OF THE ITEMS ON THE AGENDA IS GOING TO BE SHORTER. SO LET'S SEE NOW. THE NEXT PRESENTATION IS FROM DR. RADA DAGHER, REVIEWERS ARE DR. CHIN AND RESNICOW, HEALTH DISPARITIES IN THE U.S. IF YOU'RE READY, UNMUTE AND GET US STARTED. >> THANK YOU. THE PURPOSE TO MAKE THE CASE FOR FUNDING ANNOUNCEMENT ON THE ROLE OF WORK IN HEALTH DISPARITIES IN THE U.S. WE WOULD LIKE TO ACKNOWLEDGE (INDISCERNIBLE) WITH HER HELP IN PORTFOLIO ANALYSIS AND THANK OUR SUPERVISORS FOR THEIR SUPPORT OF THIS CONCEPT AS WELL. NEXT SLIDE PLEASE. THE PURPOSE OF THE PROPOSED ANNOUNCEMENT TO SUPPORT RESEARCH THAT GENERATES NEW KNOWLEDGE TO UNDERSTAND AND ADDRESS THE ROLE OF WORK, SOCIAL DETERMINANTS THAT CONTRIBUTES TO HEALTH DISPARITIES, IN OTHER WORDS WE WOULD LIKE TO KNOW THE EXTENT TO WHICH WORK AS A SOCIAL DETERMINANT OF HEALTH CAN EXPLAIN THE DISPARITIES, HEALTH DISPARITIES FOR RACIAL AND ETHNIC MINORITIES, DISADVANTAGED POPULATIONS AND UNDERSERVED RURAL RESIDENTS. SO TO CONTEXTUALIZE WORK AS SOCIAL DETERMINANTS OF HEALTH, NOT ONLY AS A SOURCE OF EXPOSURE AND RISK FACTOR. NEXT SLIDE PLEASE. SO WHY IS IT IMPORTANT TO EXAMINE THE IMPACT OF WORK ON HEALTH DISPARITIES? WELL, THERE'S A VAST LITERATURE THAT RELATES TO HEALTH OUTCOMES. SECOND, WORK IS A SOURCE OF HEALTH INSURANCE AND ACCESS TO HEALTH SERVICES. IN ADDITION MEDICAL CARE OR WORKERS CAN GET MEDICAL CARE FOR WORK-RELATED INJURIES AND ILLNESS THROUGH THE WORKERS' COMPENSATION SYSTEM. NOW, ALSO THE EXPERIENCE OF WORK IS PATTERNED WHEN WE STUDY HEALTH DISPARITIES, RACE AND ETHNICITY, IMMIGRANT STATUS, AMONG OTHERS. IF WE LOOK AT LITERATURE STUDIES DONE IN THE UNITED STATES WE FIND LARGE DIFFERENCES IN WORKPLACE EXPOSURES AND WORKPLACE BENEFITS BY THOSE SOCIAL IDENTITIES WE JUST MENTIONED. WE SEE LARGE DIFFERENCE IN TRAJECTORY BASED ON SOMEONE'S WORK. THESE INCLUDE DIFFERENCES IN ACCESS OR ACHIEVING SOCIAL STATUS, DIFFERENCE IN ACCESS TO RESOURCES, AND DIFFERENCE IN ACCESS TO SOCIAL NETWORKS. HOWEVER, WE DON'T HAVE MUCH LITERATURE OR RESOURCE THAT LOOKS TO HOW THIS AFFECTS HEALTH DISPARITIES BUT RACISM MAY EXPLAIN PATTERNS AND EXTENT OF OCCUPATIONAL AND WORKPLACE SEGREGATION. IN OTHER WORDS, WE THINK THAT RACISM AND DISCRIMINATION MAY EXPLAIN THE UNEQUAL DISTRIBUTION OF WORKPLACE EXPOSURES AND RESOURCES ACROSS OCCUPATIONS AND WITHIN WORKPLACES BY SOCIAL IDENTITIES. AND WE ALSO KNOW WORK CAN BE MODIFIED. WE CAN INTERVENE. THAT'S ANOTHER REASON IT'S IMPORTANT TO LOOK AT WORK, YOU KNOW, AND ITS IMPACT ON HEALTH DISPARITIES. NEXT SLIDE PLEASE. WHAT ARE THE GAPS IN RESEARCH ON WORK AND HEALTH DISPARITIES? BASICALLY WHAT WE KNOW NOW IS OCCUPATIONAL HEALTH DISPARITIES RESEARCH HAS MAINLY FOCUSED ON WORK AS A SOURCE OF HAZARDOUS EXPOSURES, ON THE OTHER HAND POPULATION-BASED HEALTH DISPARITIES RESEARCH HAS RARELY CONSIDERED WORK AS EXPLANATORY FACTOR FOR HEALTH DISPARITIES IN THE UNITED STATES. SO, BASICALLY THIS TELLS US THAT, YOU KNOW, IF WE WANT TO DO HEALTH DISPARITIES RESEARCH, YOU KNOW, THAT IS MORE COMPREHENSIVE WORK HAS TO BE PART OF IT. AND NEITHER LINES OF RESEARCH HAVE LOOKED AT IMPACT OF WORK ON HEALTH CARE DISPARITIES. IF YOU LOOK AT THIS SLIDE YOU CAN SEE A FEW STUDIES THAT BASICALLY SHOW THAT WORK, YOU KNOW, WORK -- UNEQUAL DISTRIBUTION OF WORK EXPOSURES BY RACE AND ETHNICITY MAY EXPLAIN DISPARITIES IN CERTAIN HEALTH OUTCOMES SUCH AS ALL CAUSE MORTALITY RATES, AND COGNITIVE FUNCTION. HOWEVER, WHAT WE STILL DON'T KNOW IS EXTENT TO WHICH WORK AS A SOCIAL CLASS MARKER AND WORK AS SOURCE OF BENEFICIAL ECONOMIC AND SOCIAL RESOURCES EXTENT TO WHICH THAT CONTRIBUTES TO HEALTH. NEXT SLIDE PLEASE. SO, ON SEPTEMBER 28 AND SEPTEMBER 29, 2020, DR. NANCY JONES AND I CHAIRED A WORKSHOP ON THE ROLE OF WORK IN HEALTH DISPARITIES, WHICH BROUGHT TOGETHER 17 INTERDISCIPLINARY SPEAKERS TO UNDERSTAND WORK AS A SOCIAL DETERMINANTS THAT CONTRIBUTES TO HEALTH DISPARITIES AND THE WORKSHOP COVERS THEORETICAL AND CONCEPTUAL FOUNDATIONS FOR WORK AS A SOCIAL DETERMINANT OF HEALTH AND ALSO MEASURES INDICATORS AND APPROACHES AND KEY MECHANISMS AND PATHWAYS THROUGH WHICH WORK CONTRIBUTES TO HEALTH DISPARITIES. AND IF YOU SEE THE LINK BELOW, THIS IS THE LINK TO THE WORKSHOP WHERE YOU CAN ACTUALLY SEE ALL THE SESSIONS AND WATCH ALL THE SESSIONS THAT WERE IN THE WORKSHOP AND SOON WE'LL HAVE THE SLIDES FOR THAT WORKSHOP, SO STAY TUNED. NEXT PLEASE. SO, WHAT ARE THE RESEARCH OBJECTIVES FOR THIS PROPOSED FUNDING ANNOUNCEMENT? FIRST, WE NEED TO DETERMINE THE EXTENT TO WHICH WORK AS A SOCIAL DETERMINANT OF HEALTH EXPLAINS HEALTH AND HEALTH DISPARITIES. IN FACT WE NEED WORK AS A SOCIAL CLASS MARKER, WORK AS SOURCE OF HAZARDOUS EXPOSURES AND SOURCE OF BENEFICIAL RESOURCES AND, YOU KNOW, BENEFICIAL ECONOMIC AND SOCIAL RESOURCES, I MEAN. AND TO THE EXTENT TO WHICH EACH CONTRIBUTES TO HEALTH DISPARITIES. WE ALSO NEED TO DETERMINE THE MODIFIABLE MECHANISMS AND PATHWAYS BY WHICH WORK CONTRIBUTES TO DISPARITIES, LOOK AT MECHANISMS INFLUENCED BY RACISM. UNEQUAL DISTRIBUTION OF EXPOSURES AND RESOURCES, AND WITHIN WORKPLACES BY SOCIAL IDENTITIES, AND WE ALSO NEED TO LOOK AT PATHWAYS SUCH AS LIFE COURSE AND INTERGENERATIONAL TRANSMISSION, PARENTS SUBMIT FROM WORKPLACE TO KIDS, AND SYSTEM LEVEL INFLUENCE. NEXT WE NEED TO ADDRESS DISEASES, CONDITIONS AND OVERALL HEALTH QUALITY WHERE WORK AS A SOCIAL DETERMINANT CONTRIBUTES TO THE HEALTH DISPARITIES THAT WE SEE. SO WE CAN EXAMINE SPECIFIC DISEASES INCLUDING COVID-19, INFANT MORTALITY, CARDIOVASCULAR DISEASE, AMONG OTHERS. WE CAN ALSO EXAMINE MORE GENERAL INDICATORS OF HEALTH AND HEALTH CARE THAT MAY NOT BE CONDITION SPECIFIC LIKE LIFE EXPECTANCY AND OTHERS. WE NEED TO EVALUATE UPSTREAM POLICIES, REGULATIONS, SYSTEM LEVEL TRENDS, THAT EXACERBATE OR MITIGATE WORK CONTRIBUTION TO HEALTH AND HEALTH CARE DISPARITIES. NEXT SLIDE PLEASE. THANK YOU. AND I LOOK FORWARD TO FEEDBACK FROM COUNCIL. >> DR. CHIN, WOULD YOU LIKE TO GIVE YOUR REMARKS? >> THANKS, TOM. CONGRATULATIONS, RADA AND NANCY, ON A TERRIFIC CONCEPT PAPER. VERY EXCITING. A LOT TO TALK ABOUT. NOWHERE NEAR THE DEPTH FOR WORK AS A GREAT EXAMPLE. SOME WAYS THIS IDEA BEYOND WORK, A NICE EXAMPLE HOW YOU CAN TAKE A SOCIAL FACTOR AND THEN THINK ABOUT IT IN ALL ITS COMPLEXITY REGARDING WEB OF RELATIONSHIPS. CONGRATULATIONS ON THE CONCEPT CLEARANCE PAPER. I HAVE TWO SUGGESTIONS, RATHER THAN TALKING ABOUT THE GREAT THINGS ABOUT IT, ONE IS THIS IS COMPLEX, SO IT'S GOING TO BE CRITICAL IN THE MATERIALS THAT COME OUT ABOUT THIS, COMMUNICATION TO BE CRYSTAL CLEAR, THE VISUALS VERY GOOD, BUILDING UPON THE SLIDE, THE MODEL WILL BE IMPORTANT. AND THEN THE TEXT THAT DESCRIBES THEN THE RICHNESS OF THE MULTI-LEVEL FACTORS. FOR EXAMPLE, THE DANGER HERE IS THAT PEOPLE WILL GO FOR THE LOW-HANGING FRUIT AND REPEAT EXISTING LITERATURE ON STUFF LIKE EXPOSURES, THE THIRD OF YOUR BOXES ON ONE OF THE SLIDES. AS OPPOSED TO MECHANISMS SUCH AS SOCIAL NETWORKS OR STRESS OR SOCIAL POSITION, SO THE MORE THAT WE'RE CLEAR ABOUT LIKE THE RANGE OF POSSIBILITIES, MORE LIKELY TO GET INNOVATIVE RESEARCH. MY SECOND SUGGESTION IS THERE IS ONE MAJOR AREA THAT YOU JUST TOUCHED A LITTLE BIT UPON BUT SHOULD BE SPENT MORE. ONE SLIDE, VERY BOTTOM YOU TALK ABOUT UPSTREAM FACTORS, REGULATIONS, POLICIES. THAT'S AN EXAMPLE OF A BROADER SET OF IMPLEMENTATION ISSUES OF WHAT ARE THE BARRIERS TO IMPLEMENTING INTERVENTIONS AND WHY ARE THINGS THE WAY THEY ARE? MY GUESS IN SOME WAYS BUILDING UPON THINGS WE ALREADY KNOW REGARDING SOME MECHANISMS. WHY ARE THINGS STICKY? ULTIMATELY DOWN TO ISSUES OF RACISM, CLASSISM, ECONOMICS, BUSINESS CASE, WHO HAS THE POWER. AND THEN NOWHERE CAN YOU PUT ETHICS IN THE CONCEPT PAPER. THIS WILL BE A PART OF ISSUES RAISED, SO A LOT OF ISSUES THAT BASICALLY SOCIAL JUSTICE, INDIVIDUALISM, FREE MARKET, SEPARATE ISSUES. SO ALSO GREAT CONCEPT, INITIAL POINTS, CLEAR ABOUT COMMUNICATION, EXPAND IN MORE DETAIL IMPLEMENTATION ISSUES AND ETHICS ISSUES THAT ARE RAISED BY YOUR LAST BULLET ABOUT OVERARCHING ENVIRONMENT AND POLICIES AND REGULATIONS. >> THANK YOU. DR. RESNICOW? >> I SHARE THE ENTHUSIASM OF MY COLLEAGUE FROM CHICAGO, THERE'S A LOT OF WONDERFUL SCIENCE THAT I THINK WILL EMANATE FROM THIS INITIATIVE. I THINK FUNDAMENTALLY WHAT YOU'RE DOING, ALTHOUGH I'M TAKING POETIC LICENSE, THESE ARE NOT THE WORDS IN THE DOCUMENT, THAT RATHER THAN INCOME AND OCCUPATION AND CONTRASTING THEM AS CATEGORICAL VARIABLES, YOU'RE LOOKING AT EMPLOYED PEOPLE, NUANCE OF (INDISCERNIBLE) SPECIFICALLY LOOKING AT PHYSICAL AND COGNITIVE DEMANDS OF VARIOUS OCCUPATIONS, LOOKING AT THE PHYSICAL ENVIRONMENT AND LOOKING AT SOCIAL ENVIRONMENT. THOSE ARE FAR MORE NUANCED THAN THE WAY YOU TYPICALLY ADJUST FOR INCOME AND OCCUPATION AS VARIABLES SO I THINK YOU'RE GREATLY MOVING THE FIELD. JUST A FEW THINGS TO SUGGEST, WE HEARD ABOUT HAVING THEORETICAL FRAMEWORK. ONE WONDERFUL THEORETICAL FRAMEWORK USED TO EXPLAIN JOB SATISFACTION (INDISCERNIBLE) THOSE NEEDS ARE MET PEOPLE ARE BOTH HAPPY AT WORK AND PRODUCTIVE. NOW I'D LIKE TO TIE THAT FOR A SECOND INTO A DISPARITY IDEA. I THINK SOMETHING THAT YOU MAY WANT TO FOCUS ON IS UNDEREMPLOYMENT, PEOPLE HAVE A FAR GREATER SET OF SKILLS OR DEGREE BECAUSE OF IMMIGRATION STATUS OR LICENSURE THAT DOESN'T ALLOW THEM TO FUNCTION AT THAT LEVEL THEY FEEL THEY ARE NOT IN OPTIMALLY CHALLENGED, THAT'S SEVERE PSYCHOLOGIC CONSEQUENCE. SO I THINK THAT'S A CONCEPTUAL AREA THAT HAS TREMENDOUS APPLICABILITY TO DISPARITY LITERATURE THAT YOU SHARED WITH US. NUMBER TWO, I THINK YOU MAY WANT TO TALK MORE ABOUT THE EFFECT OF IMMIGRATION STATUS DOCUMENTATION AND HOW THAT IMPACTS SOCIAL SECURITY AT WORK AND OTHER ASPECTS OF INTERACTING WITH PEOPLE, WORK RELATED (INDISCERNIBLE) SO THAT CAN BE FLESHED OUT AS WELL. FINALLY ONE LAST THING, YOU MENTIONED POLICY AND INTERVENTIONS AT THE INDIVIDUAL -- THE WORK SITE AND POLICY LEVEL, ONE AREA TO FOCUS ON MIGHT BE THE EFFECTS OF DEI POLICY, ARE DELETERIOUS OUTCOMES IMPACTED WHEN SITES IMPLEMENT AND ENFORCE THROUGH POLICY DO WE SEE SEGREGATION, UNFAIRNESS THRIVE, PEOPLE BEING PROMOTED IN INEQUITABLE WAY, DO WE SEE PEOPLE RECEIVING MORE SATISFACTION IN THE WORKPLACE, EXAMINING HOW DEI POLICIES ARE IMPLEMENTED AND ENFORCED, HOW THAT IMPACTS THOSE MEDIATORS AND EVENTUALLY PEOPLE'S HEALTH STATUS, I THINK THAT WILL BE A RICH POTENTIAL AVENUE THAT YOU MIGHT WANT TO OFFER AS A SUGGESTED RESEARCH FOCUS AS THIS BECOMES AN ANNOUNCEMENT FOA. >> THANK YOU BOTH. GREAT SUGGESTIONS. >> OKAY. IS THERE ANYONE ELSE ON THE PANEL THAT HAS A COMMENT TO ADD? I SEE NOTHING IN THE CHAT BOX, NOBODY'S UNMUTING. I THANK YOU ALL FOR BOTH REVIEWERS FOR YOUR COMMENTS AND FOR CAPTURING THOUGHTS OF OTHERS. AT THIS POINT I'LL ASK IF THERE'S A MOTION WITH REGARD TO THIS CONCEPT. >> I MOVE TO APPROVE. >> SECOND. >> OKAY. MOVED AND SECONDED. SO WITH THAT, CAN WE HAVE A VOTE? THE CONCEPT IS APPROVED UNANIMOUSLY. >> THANK YOU. >> AT THIS POINT IN THE PROGRAM I HAD ON THE AGENDA FOR PUBLIC COMMENT. I WILL NOTE THAT THERE WAS ANNOUNCEMENT THAT WENT OUT THAT ASKED MEMBERS OF THE PUBLIC IF THEY WANTED TO INCLUDE A STATEMENT TO PROVIDE A FULL NAME, ADDRESS, TELEPHONE NUMBER. AND WHEN APPLICABLE, BUSINESS OR PROFESSIONAL AFFILIATION. IF THERE ARE PERSONS IN THE PUBLIC HEARING THIS NOW, WE COULD STILL ACCEPT YOUR COMMENT FOR THE RECORD FOR A SHORT TIME, UP UNTIL THE CLOSE OF THIS MEETING. HOWEVER, WE WON'T BE ABLE TO READ IT DURING THE MEETING. WE DID NOT RECEIVE ANY COMMENTS THAT MET THE CHARACTERISTICS THAT INCLUDED FULL INFORMATION. SO THERE ARE NO PUBLIC COMMENTS. I TURN IT BACK TO DR. PEREZ-STABLE WHO HAS A SHORT PRESENTATION AND WILL GO TO THE FINAL ITEM ON THE AGENDA. YOU HAVE YOUR SHORT PRESENTATION. >> THANK YOU, TOM. I DON'T WANT TO FAIL AGAIN. WILL YOU DO THIS, JUAN? I DON'T WANT TO FAIL WITH MY EFFORT. >> DO YOU NEED ASSISTANCE, JUAN? >> MAYBE I CAN TRY. THERE ARE ONLY TWO SLIDES. LET ME DO THAT. OKAY. IF I CAN SHARE BEFORE IT'S TOO LATE. ARE YOU ABLE TO SEE THIS? >> YES, WE DO. >> OKAY. SO, YES OR NO? >> YES. >> OKAY. SO, I WANTED TO BRIEFLY TELL YOU ABOUT THE MULTIPLE CHRONIC DISEASES CENTERS AND HEALTH DISPARITIES. THIS WAS THE CONSEQUENCE OF THE BUDGET THAT WAS APPROVED AND SIGNED IN LATE DECEMBER OF 2020. SO A LITTLE OVER A MONTH AGO. IN FISCAL YEAR 2020, NIH LAUNCHED INITIATIVES TO ADDRESS CHRONIC DISEASE AND HEALTH DISEASE, KIDNEY DISEASE AND OBESITY, BASICALLY PARAPHRASING LEGISLATIVE LANGUAGE AND I'LL FILL IN EXTRA COMMENTS. THESE WERE TARGETED TO NIDDK, NHLBI AND NCI, NOT SO MUCH NIMHD-FUNDED, THE YEAR BEFORE FISCAL YEAR 2019 SOME AT THAT COUNCIL REMEMBER THAT DR. NATHAN STINSON PRINTED A SPECIAL CLEARANCE OF SPECIAL ACTION ON THESE CHRONIC DISEASE CENTERS THE CONSEQUENCE OF A SPECIAL ACTION OF THE OFFICE OF THE DIRECTOR. AND SO THIS IS ALSO IN THAT VEIN OF CONVERSATION. THE CONGRESSIONAL LANGUAGE THOUGH FOR FISCAL 21 CAME BACK WITH THE INTEREST IN HAVING A MORE COMPREHENSIVE AND HOLISTIC EFFORT NEEDED TO ADDRESS HEALTH DISPARITIES AND COMORBIDITY IN DISPARATE COMMUNITIES. THIS IS THEIR LANGUAGE, NOT MINE. FUNDING IN FISCAL YEAR 2021 BUDGET FOR NIMHD WAS ALLOCATED FOR THIS PURPOSE. WORK IN CONCERT WITH NIDDK, NHLBI, NCI AND NCATS TO ESTABLISH A COMPREHENSIVE CENTER INITIATIVE AIMED AT WIDE VARIETY OF CHRONIC DISEASES AND LINKS TO HEALTH DISPARITIES. NIMHD WAS ENCOURAGED TO CONSIDER FUNDING MECHANISMS TO SUPPORT REGIONAL MULTI-INSTITUTIONAL CONSORTIUMS THAT PRODUCE COLLABORATION, RESEARCH AND TRANSLATIONAL SCIENCE ON A WIDE SCALE. AND $45 MILLION WAS ADDED TO THE NIMHD BASE FOR THIS TARGETED INITIATIVE. WE HAVE BEGUN TO WORK ON THIS. IT IS COMPLICATED, AND WE HAVE LIMITED TIME TO ACT. WE DID NOT HAVE A REQUIREMENT TO PRESENT THIS AS A FORMAL CONCEPT FOR CLEARANCE BUT DID WANT TO INFORM THE COUNCIL AND STAKEHOLDERS ABOUT THIS OPPORTUNITY. SO WE'RE DEVELOPING REQUEST FOR APPLICATIONS TO SUPPORT NEW CENTERS, I WILL INCLUDE INTEGRATION OF PREVENTION, INTERVENTION, TESTING, AND MANAGEMENT STRATEGIES FOR CHRONIC CO-OCCURRING CONDITIONS AND CO-OCCURRING RISK FACTORS FOR CHRONIC DISEASE THAT LEAD TO HEALTH DISPARITIES. THE APPLICATIONS MUST HAVE A REGIONAL FOCUS AND INCLUDE PARTNERSHIP OF AT LEAST TWO INSTITUTIONS. AND THEY WILL REQUIRE WHAT WE HAVE REQUIRED OF ALL OUR CENTERS, WHICH IS TO HAVE A COMMUNITY ENGAGEMENT CORE, AND INVESTIGATOR DEVELOPMENT CORE WITH ALLOCATED SUPPORT FOR PILOT GRANTS FOR ESI OR SENIOR POSTDOC LEVEL INVESTIGATORS. WE WILL USE P 50 MECHANIC MECHANISM ALMOST CERTAINLILY. WE'RE IN ACTIVE MODE OF DEVELOPING, THAT'S THE END OF PRESENTATION, HAPPY TO ANSWER ANY QUESTIONS. >> THIS IS BILL. DO YOU EXPECT CENTERS -- HOW FOCUSED DO YOU EXPECT CENTERS TO BE? IS IT MULTIPLE INSTITUTIONS FOCUSING ON ONE DISEASE OR A COUPLE DISEASES OR DISEASE INTERSECTIONS? ALONG THOSE LINES. >> DR. SOUTHERLAND, I CAN'T TELL YOU WHAT TO WRITE THE GRANT ABOUT. THE REQUIREMENT IS WE'RE SEEING IT, WHAT YOU WILL SEE WHEN THE FUNDING OPPORTUNITY ANNOUNCEMENT COMES OUT, I THINK YOU NEED AT LEAST TWO, RIGHT, TO BE MORE THAN ONE, RIGHT? CHRONIC DISEASES. AND I THINK THAT THE IDEA IS THEY HAVE TO BE LINKED TO HEALTH DISPARITIES, SO THE SPIRIT OF THIS IN THE LAST YEAR OR TWO HAS BEEN ON DIABETES, KIDNEY DISEASE, CARDIOVASCULAR DISEASE AND MANIFESTATIONS AND CANCER WITH RELATED ISSUES AROUND SEVERE OBESITY AND OTHER RISK FACTORS THAT ARE COMMON RISK FACTORS FOR THESE CONDITIONS. I DON'T INTERPRET THIS DISEASE OUR ONLY PARTICULAR AREA BUT WE'RE STILL IN DEVELOPING THIS. I WOULD ADD THAT WE WANT TO SEE INTERVENTIONS. WE WANT TO SEE CLINICAL IMPLEMENTATION HERE. I'M NOT -- THIS IS NOT ABOUT BASIC DISCOVERY SCIENCE. TRANSLATIONAL SCIENCE, PREVENTION I MENTIONED AND ACTUAL INTERVENTIONS THAT MAKE A DIFFERENCE THAT WILL HOPEFULLY LEAD TO DECREASING DISPARITIES IN THESE CONDITIONS. >> THANK YOU. >> I HAVE A QUESTION. HOW MANY ARE YOU EXPECTING TO FUND? >> WE'RE STILL IN THAT -- WE'RE STILL DISCUSSING AMONGST OURSELVES THE EXACT MECHANISM SO THIS IS NOT A MATURE CONCEPT YET. SO I JUST WANTED TO INFORM YOU THAT'S WHAT'S AVAILABLE. IT IS A PROGRAM THAT WILL PRESUMABLY CONTINUE SO IT'S NOT A ONE-TIME EFFORT. SO IF THAT HELPS. >> ELISEO, DO YOU EXPECT TO DO THIS AS A LIMITED COMPETITION? THERE WAS DISCUSSION WITH OTHER CENTERS MECHANISMS. >> I DO NOT. ALTHOUGH I DON'T THINK WE'VE TALKED ABOUT THAT. I DON'T LIKE TO RESTRICT APPLICANTS FOR ANY OF THIS -- THIS IS OPEN TO ALL INSTITUTIONS THAT CAN ADDRESS THE TOPIC THAT WE'RE INTERESTED IN WHICH OF COURSE ARE COMMON, I WOULD ASSUME MOST ARE. THE FOCUS ON HEALTH DISPARITY POPULATIONS, POPULATIONS WITH HEALTH DISPARITY AS YOU'RE WELL FAMILIAR WITH THE DEFINITIONS, AND WHO CAN COORDINATE A MORE THAN, YOU KNOW, PRESUMABLY MORE THAN ONE INSTITUTION, MORE THAN ONE TOPIC, AND IT'S GOING TO BE I THINK A REQUEST OR DESIRE TO LOOK FOR COLLABORATION FROM EXISTING CENTERS THAT ARE FUNDED BY OUR INSTITUTES AND HAVE BEEN NAMED IN THE LANGUAGE. >> ELISEO, QUICK QUESTION. >> YES, KEN. >> UNDERSTANDING IT'S EMERGING, YOU CAN APPLY FOR THE BIG ENCHILADA, WHAT ABOUT THE P21 TO PUT IN A BABY EMERGING VERSION LIKE NCI HAS DONE WITH DISPARITY CENTERS AT UNIVERSITY OF HOUSTON THAT I THINK AMELIE AND I ARE ON. ANY THOUGHTS ABOUT HAVING A STARTER VERSION OF IT VERSUS JUST THE FOLD? >> WE DISCUSSED THAT FOR THIS FISCAL YEAR EFFORT, PROBABLY STAY WITH THE FULL. THAT'S A CONSIDERATION. NIMHD HAD THOSE IN THE PAST. THE THINK THE NCI PROGRAM WHICH IS UNDER THE CENTER FOR CANCER AND HEALTH DISPARITIES HAS GOT A PARTICULAR FLAVOR TO IT, AND SO, YOU KNOW, THERE ARE I THINK SUCCESSFUL MODELS OF THAT PROGRAM AS WELL AS THOSE THAT HAVE MAYBE LESS SUCCESSFUL, HAPPENS WITH EVERYTHING. >> ELISEO, SPERO. WHAT WERE YOU THINKING ABOUT -- HOW WERE YOU THINKING ABOUT OPERATIONALLY DEFINED (INDISCERNIBLE) CAN YOU HEAR ME? >> YOU'RE IN AND OUT. GO AHEAD. >> SORRY. HOW IS THE TEAM THINKING ABOUT OPERATIONALLY DEFINING REGIONAL? >> THAT'S A GREAT QUESTION. YOU DON'T HAVE TO COVER THE ENTIRE COUNTRY LIKE YOU OFTEN DO BUT I THINK IT DOESN'T HAVE TO BE MULTI-STATE. THERE ARE NATURAL GEOGRAPHIC REGIONS. I MEAN, WHERE I'VE LIVED IN THE LAST TEN YEARS, SAN FRANCISCO BAY AREA IS DEFINITELY A REGION. 8 MILLION PEOPLE, 7 COUNTIES, DEFINED ENTITY IN AND OF ITSELF AND YOU CAN EXPAND A LITTLE BUT NOT MUCH. DMV AS PEOPLE CALL THIS AREA, THE DISTRICT, MARYLAND AND VIRGINIA ARE SORT OF A REGION ALTHOUGH I WOULDN'T INCLUDE THE ENTIRE STATES OF MARYLAND AND VIRGINIA BUT YOU COULD EXTEND AT LEAST TO BALTIMORE AND DEFINITELY TO NORTHERN VIRGINIA COUNTIES. SOMETHING THAT IS A NATURAL GEOGRAPHIC AREA MAKES SENSE, DOESN'T HAVE TO BE LIMITED BY STATE LINE. SO THE BRONX, I DON'T KNOW. >> THIS IS KEAWE. WILL TERRITORIES BE CONSIDERED? >> YES, U.S. TERRITORIES ARE ABSOLUTELY ELIGIBLE TO APPLY, TO BE INCLUDED IN ALL OF OUR APPLICATIONS, SO THE ISLANDS OF PUERTO RICO AND U.S. VIRGIN ISLANDS. >> THAT INCLUDE U.S. AFFILIATED PACIFIC ISLANDS, SOME ARE NOT TERRITORIES. >> WE'LL FIND OUT. I DON'T KNOW THE ANSWER TO THAT SPECIFIC QUESTION. >> THANK YOU. >> IT IS A U.S.-BASED PROGRAM, SO THIS IS NOT A -- LIKE BORDER, CROSS-BORDER, OTHER KIND OF COUNTRIES, THAT'S NOT THE (INDISCERNIBLE) OF THE LANGUAGE THAT WE HAVE. >> YEAH. U.S.-AFFILIATED PACIFIC NATIONS THROUGH THE COMPACT OF FREE ASSOCIATION, A LOT OF PACIFIC ISLANDER MIGRANTS IN THE U.S. ENTER THE U.S. WITHOUT THE NEED FOR PASSPORT OR ANYTHING ELSE, THEY CAN WORK IN THE U.S. BUT THEY ARE NOT ALL INCORPORATED TERRITORIES LIKE AMERICAN SAMOA OR GUAM. >> NO, I'M FAMILIAR WITH THAT ALTHOUGH I MUST SAY I DIDN'T KNOW THAT UNTIL I WAS IN THIS JOB. BUT I JUST DON'T KNOW THE ANSWER TO YOUR QUESTION. IT WOULD MAKE SENSE BUT -- >> THANK YOU. >> SO ONE OTHER QUESTION, ELISEO. YOU GAVE THE OVERALL BUDGET, OVERALL INCREASE IN BUDGET, $45 MILLION FOR THIS, HOW DO YOU ENVISION THE BUDGET PER CENTER? >> THAT'S A LEVEL OF DETAIL THAT WE'RE NOT YET READY TO DISCLOSE. WE'RE TOO EARLY IN OUR DISCUSSIONS ABOUT THE PROCESS FOR THIS. BUT BECAUSE AS YOU UNDERSTAND, THIS WAS CHARGED TO NIMHD, IT IS A CONGRESSIONAL PROGRAM, IT DOES HAVE SOME ISSUES WITH OUR DIRECTOR, IN TERMS OF THE -- BECAUSE IT CAME FROM CONGRESS, THE OFFICE OF DIRECTOR IS VERY INTERESTED IN WHAT WE DO AND HOW WE MANAGE IT. WE NEEDED TO MAKE SURE THERE WAS A PUBLIC FORUM TO TALK ABOUT IT SO COUNCIL IS COMING UP, WE DECIDED TO DO THIS. BUT WE HAVE NOT GOT INTO THE NITTY-GRITTY DETAILS OF WHAT TO DO. YOU KNOW THE SIZE OF OUR CENTERS, AND I DON'T THINK THEY WILL BE BIGGER THAN THE CURRENT LARGEST CENTERS THAT WE FUND, WHICH ARE OUR CMI, I'M NOT COUNTING THE RADX-up, CDCC, A SEPARATE SPECIAL PROGRAM. BUT, YOU KNOW, OUR CENTERS OF EXCELLENCE ARE GENERALLY ABOUT A MILLION DOLLARS IN DIRECT COSTS, AND UP TO $3 MILLION SO I THINK IT WILL BE IN THAT RANGE. >> OKAY. THANK YOU. >> I SHOULD MENTION WE ALSO HAVE THE TCCs ON CHRONIC DISEASE AND PHYSICIAN MEDICINE IN THEIR FINAL YEAR AND THEY WERE A LITTLE BIT LARGER THAN THE CENTERS OF EXCELLENCE, A MILLION AND A HALF EACH. ANY OTHER COMMENTS OR QUESTIONS? >> SOUNDS LIKE A VERY INTERESTING INITIATIVE. >> IT'S -- WELL, YOU KNOW, THE INCREASE IN THE BUDGET WAS GOOD. THE FACT THAT IT'S TARGETED IS SOMETHING WE MANAGE, BUT I THINK THE THEME IS ALIGNED WITH OUR GOALS, AND WE'VE BEEN PUT IN CHARGE OF IT SO I THINK THAT'S A GOOD SIGN. AND SO WE'LL SEE HOW WE RESPOND. >> ARE YOU THINKING WITH THE P50 THAT PEOPLE WILL BE PROPOSING SPECIFIC PROJECTS TO ADDRESS, YOU KNOW, THESE DISPARITIES, TEST INTERVENTION OR PROGRAMS WITHIN THE CONTEXT OF THE P50 OR MORE LIKE RESOURCE INFRASTRUCTURE FOR PEOPLE TO DEVELOP PROGRAMS WITH WORK AND STRENGTHEN THE CAPACITY WITHIN THOSE PARTICULAR AREAS? THE P MECHANISM SOMETIMES GOES IN EITHER WAY. >> NO, I WOULDN'T WANT TO HAVE THIS SIZE OF A PROGRAM, THE IMPORTANCE OF THIS PROGRAM WITHOUT HAVING SCIENCE INCORPORATED INTO IT SO I FORESEE, YOU KNOW, SOME -- YOU NEED ALWAYS SOME RESOURCES AND I MENTIONED COMMUNITY ENGAGEMENT, IF YOU DON'T CALL IT OUT IT DOESN'T HAPPEN. WE'VE LEARNED THAT OVER THE YEARS. AND I THINK WE'VE LEARNED THE VALUE OF HAVING IT. ESPECIALLY THIS PAST YEAR. BUT I'M VERY COMMITTED TO THE INVESTIGATOR DEVELOPMENT MODEL TO BE USED BY JUNIOR PEOPLE AND SO THOSE ARE NOT BIG TICKET ITEMS, I WOULD SEE THE MAJORITY OF THE BUDGET TO BE DEDICATED TO SCIENCE. >> OKAY. WE'RE BUMPING UP AGAINST THE TIME WHICH I THOUGHT EVERYBODY WOULD HAVE TO BE HERE FOR. I LED PEOPLE TO BELIEVE. IF THERE'S MORE TO GO ON WE CAN BUT I WANTED TO REMIND YOU OF THAT. >> WE HAVEN'T DISCUSSED IT, WE MAY HAVE INFORMATIONAL WEBINAR ONCE WE HAVE THE FOA WORKED OUT. SO THERE WILL BE OTHER OPPORTUNITIES TO ASK QUESTIONS OF PEOPLE WHO KNOW MORE THAN I DO, CLEARLY IT SPARKED YOUR INTEREST SO I'M GLAD. GOT EVERYBODY'S ATTENTION. >> I MISSED THE FACT WE DON'T HAVE WARM ROUND OF APPLAUSE FOR SPEAKERS, WE HAVE A PRESENTER HERE, I'LL GIVE HIM A ROUND OF APPLAUSE. [APPLAUSE] ALSO TO OUR PRESENTERS FOR THE CONCEPTS. [APPLAUSE] AND FOR ALL OF YOU FOR HANGING IN THERE. [APPLAUSE] OKAY. WITH THAT, ELISEO, LAST REMARKS. >> YEAH, FIRST I WANT TO THANK ALL OF YOU FOR TAKING THE TIME TO SPEND WITH US. YESTERDAY AND TODAY. I REALLY DO APPRECIATE ALL OF YOUR TALENTS AND ADVICE. IT HELPS ME IN THINKING ABOUT THE DIRECTION TO GO. I WOULD SAY THAT IF YOU GO TO EACH COUNCIL, EACH DIRECTOR, KIND OF USES THEIR COUNCILS DIFFERENTLY, I'M NOT SURE THAT ANY TWO ARE EXACTLY ALIKE. WE DO SOME THINGS THE SAME. WE ALL HAVE TO DO A CERTAIN AMOUNT OF WORK BUT I ENJOY THE EXCHANGES, THE DISCUSSIONS, AND THE PRESENTATIONS. I THINK YOU AS COUNCIL MEMBERS WILL APPRECIATE THE VALUE OF THIS AND IT'S CERTAINLY A LOT LESS WORK THAN BEING ON A REVIEW COMMITTEE, YOU CAN AGREE ON THAT. I ALSO WANT TO THANK ALL OF OUR STAFF, IT'S BEEN AN EXTRAORDINARY YEAR. THERE'S BEEN NON-STOP CHALLENGES, NON-STOP NEW WAYS OF DOING THINGS. YOU KNOW, BEGINNING LAST MARCH AS WE ALL KNOW, WITH THE EPIDEMIC, WE'RE APPROACHING HALF A MILLION AMERICANS WHO HAVE DIED, YOU KNOW, AS I HATE TO SAY BUT IT'S TRUE, THERE'S A 9/11 STILL HAPPENING EVERY DAY IN THIS COUNTRY, NOBODY SEEMS TO TAKE THAT MUCH NOTICE. WE'RE GOING TO GET THROUGH IT. IT'S GOING TO GET BETTER. WE'RE GOING TO ARRIVE AT SOME SORT OF EQUILIBRIUM BUT OUR STAFF WILL LOOK BACK AT THIS AS BEING CHALLENGING. I CAN ONLY PROJECT WHAT THE CHILDREN ARE THINKING OR ADOLESCENTS OR MY YOUNG ADULT SONS ARE THINKING IN TERMS OF WHAT THEIR LIVES HAVE BECOME AS A CONSEQUENCE OF WHAT'S GOING ON. BUT OUR STAFF HAVE RESPONDED IN A REMARKABLE WAY. THEY ARE ALL WORKING EXTREMELY HARD. I WOULD SAY THAT THE VIRTUAL WORLD HAS NOT BEEN ONE WHERE PEOPLE HAVE STOPPED DILIGENTLY RESPONDING AND ADDRESSING ISSUES THAT WE TAKE CARE OF SO I GREATLY APPRECIATE THEM. THE INTENSITY OF THE WORK, FOR ME, HAS INCREASED TO LEVEL THAT I DON'T THINK I EXPERIENCED SINCE I WAS ASSISTANT PROFESSOR TRYING TO WRITE MY FIRST TWO R01s AT THE SAME TIME. AND SO I CAN'T COUNT RESIDENCY BECAUSE THAT WAS A DIFFERENT KIND OF A STRESS, PHYSICAL STRESS THAT I DIDN'T HAVE AS A FACULTY. AND YET STAFF RESPONDED TO THE COVID PANDEMIC WITH SUPPLEMENTS, RADx-UP IN A WAY THAT'S REMARKABLE, AND THEY RESPONDED TO THE CEAL INITIATIVE AND WE'RE NOW MOBILIZING SUPPORT FOR THE STRUCTURAL RACISM EFFORT IN THIS YEAR. SO I'M VERY, VERY APPRECIATIVE OF ALL THEIR WORK. NOTHING THAT NIMHD DOES OR THAT I DO OR GET SOME CREDIT FOR WOULD BE POSSIBLE WITHOUT THEIR EFFORTS. I DO THINK THAT AS I MENTIONED HOPEFULLY DURING MY TALK IF NOT YESTERDAY WHEN WE MET THE TIME OF CRISIS IS AN INCREDIBLE TIME OF OPPORTUNITY. THE AWARENESS ABOUT WHAT HAS HAPPENED IN TERMS OF STRUCTURAL INEQUITY IN OUR COUNTRY HAS LED TO PERSISTENCE IN HEALTH DISPARITIES, AND UNDERSTANDING AND APPRECIATING THAT WE CANNOT, YOU KNOW, SOLVE OR BEGIN TO ADDRESS THIS THROUGH INTERVENTIONS OR PROGRAMS THAT FOCUS ONLY ON THE HEALTH CARE SIDE OF THINGS, BUT WE HAVE TO WORK ON ALL ASPECTS OF THE PLAYING FIELD SO TO SPEAK, THE BEHAVIOR, THE ECONOMIC OPPORTUNITIES, THE EDUCATIONAL OPPORTUNITIES AND COMMUNITIES, ALL THE THINGS THAT WE ARE ALL FAMILIAR WITH. I'M ESPECIALLY THANKFUL FOR THE CONTINUOUS ENDORSEMENT AND COMMENTS ABOUT THE HEALTH DISPARITIES RESEARCH FRAMEWORK, WHAT IT WAS INTENDED TO BE, A ROADMAP, A GUIDE FOR RESEARCHERS TO BE ABLE TO THINK ABOUT WHAT THEY ARE DOING AND TO REMIND US THAT WE'RE NOT ALL ABOUT ONE PARTICULAR BOX OR ANOTHER, BUT IT ALL BLENDS TOGETHER. FINALLY I WILL ADD THAT THE URGENCY FOR ADDRESSING THE BIOMEDICAL WORKFORCE DIVERSITY ISSUES THAT WE HAD DISCUSSED AT COUNCIL THAT NIMHD IS VERY INVOLVED WITH AT NIH ALTHOUGH WE DON'T HAVE PROGRAMS IN THIS, YOU HEARD AT LEAST ONE TODAY, AND SOME OF THE COMMENTS I MADE IN THE REPORT ARE REALLY AGAIN CRITICAL. THEY COINCIDE WITH THE REST OF THE ISSUES OF HEALTH DISPARITIES. I DO FIRMLY BELIEVE IT IS INTERVENTION THAT COULD HELP DECREASE DISPARITIES, AS WELL AS PROMOTE BETTER SCIENCE. AND THAT'S SOMETHING I THINK WHERE PEOPLE ARE BEGINNING TO UNDERSTAND OR TO REALIZE WE HAVE TO KEEP THE SORT OF THE EMPHASIS ON OUR GOALS AND KEEP MOVING SO THAT WITH INCREMENTAL PROGRESS AND TAKE ADVANTAGE OF THIS WINDOW OF OPPORTUNITY THAT WE HAVE OPEN TO US AND OPEN TO OUR COMMUNITIES AND OUR STAKEHOLDERS. THANK YOU AGAIN FOR ALL YOUR ATTENTION. DON'T GET LOST BEFORE MAY. STAY IN TOUCH. DON'T HESITATE TO REACH OUT IF YOU HAVE ANY ISSUES OR QUESTIONS TO ME. THANK YOU VERY MUCH. >> WE'RE ADJOURNED.