GOOD AFTERNOON AND WELCOME TO THE 99'S MEETING OF THE ADVISORY COUNCIL. IF I HAD ONLY KNOWN I WOULD HAVE MADE MY RETIREMENT LATER SO I COULD HAVE DONE THE 100th MEETING. I DIDN'T KNOW THAT! THIS IS THE 99th MEETING OF THE ADVISORY COUNCIL. I MEAN, I'LL BE EXCITED TO DOT 99th. THAT'S KIND OF COOL! SO, WE HAVE OUR NORMAL SCHEDULE. THERE WILL BE ONE BREAK IN THE AFTERNOON. CLOSED SESSION OPENS TOMORROW AT 9 A.M. AS FAR AS I KNOW, THE ONLY MISSING COUNCIL MEMBER IS DR. JEFFREY KELLY, AND I WOULD LIKE TO WELCOME THE NEW COUNCIL MEMBERS EVEN THOUGH PETER LEWIN WAS A COUNCIL MEMBER LAST TIME. THIS IS HIS FIRST OPPORTUNITY TO ATTEND. AND DR. M FROM DUKE IS HERE AS WELL. SO SHE IS IN PROCESS ON BEING BOARDED SO SHE IS NOT AN OFFICIAL COUNCIL MEMBER YET. BUT WE ARE PLEASED TO HAVE YOU BOTH HERE. NOW DR. NARA GAVINI WILL BE TELLING US SOME RULES AND REGULATIONS. >> NARA GAVINI: GOOD AFTERNOON. A COUPLE OF REMINDERS. FIRSTLY, WE ARE PLEASED TO REPORT THAT THIS MEETING IS BROADCAST LIVE AND IT WILL BE ARCHIVED. SO PLEASE MAKE SURE YOU USE MICROPHONE WHEN YOU'RE SPEAKING. SECOND, WE ARE ALSO HAPPY TO ANNOUNCE THAT AS A SPECIAL GOVERNMENT EMPLOYEE, COUNCIL MEMBERS MAY NOT ENGAGE IN LOBBYING ACTIVITIES. SO IT IS A CONFLICT OF INTEREST. COMPLETE CONFLICT OF INTEREST AND CONFIDENTIALITY STATEMENT IS SENT TO YOU AS A PDF FILE. I WILL BE GIVING SPECIFIC INSTRUCTIONS ABOUT CONFLICT OF INTEREST AT THE BEGINNING OF THE SESSION TOMORROW MORNING. AND FINALLY, AS YOU ALREADY KNOW, THE NIH CAMPUS IS SMOKE-FREE. THANK YOU. >> [ OFF MICROPHONE ] I'M NOT SURE HOW THAT HAPPENED, BUT IF YOU ARE AWARE OF SOMEONE, WE CAN TALK ABOUT THAT AND I CAN SEE IF IT CAN BE AMENDED. BUT THERE IS A SIGN-IN SHEET WE USE. >> ANN CASHION: WE'LL VOTE ON THESE AND YOU CAN ADD THAT LATER IF THERE IS SOME NAMES THAT YOU WOULD LIKE TO ADD. >> MOVE APPROVAL. >> ANN CASHION: ANY DISCUSSION? ANY OPPOSED? MOTION CARRIES. SO THE DATES FOR OUR FUTURE COUNCIL MEETINGS IN 2020 AND 21, Y'ALL CAN GET OUT YOUR CALENDARS. IN 2020, IT'S JANUARY 14 AND 15. MAY, 19 AND 20, AND SEPTEMBER 15 AND 16. WE ARE PRIMARILY BACK IN BUILDING 31 AGAIN, SO MOST OF THOSE WILL BE OVER THERE. THEN 2021 IS JANUARY 26-27, MAY 18-19 AND SEPTEMBER 14-15. AND AGAIN, IN BUILDING 31. PLEASE LET NINR KNOW IF YOU HAVE ANY KNOWN CONFLICTS WITH THESE UPCOMING COUNCIL DATES. WE WORKED VERY HARD TO MAKE SURE IT DOESN'T CONFLICT WITH ANY ONGOING MEETINGS OR HOLIDAYS AND THINGS LIKE THAT. SO PLEASE DO LET US KNOW IF WE MISSED ANYTHING. I WANT TO GO AHEAD AND INTRODUCE OUR FIRST SPEAKER. DR. MICHAEL GODDESS MAN. DR. GODDESS MAN IS A REAL FRIEND TO ME AND TO NINR. HE IS THE DEPUTY DIRECTOR FOR OUR INTRAMURAL PROGRAM HERE AT NIH FROM OUR INTRAMURAL PROGRAM AND LEARN MORE ABOUT THAT. SO DR. MICHAEL GOTTESMAN, HIS WORK IS PRIMARILY BEEN DONE IN THE AREA OF CANCER RESEARCH, AND HE IS PARTICULARLY INTERESTED IN MULTI-DRUG RESISTANCE IN HUMAN CANCER CELLS. IN HIS ROLE, HE ADVISES DR. COLLINS ON ALL THINGS THAT HAVE TO DO WITH INTRAMURAL. SO AT THIS POINT IN TIME, HE'S GOING TO BE GIVING US AN OVERVIEW OF NIH AS WELL AS HIS INSIGHTS INTO THE NINR INTRAMURAL PROGRAM. THANK YOU VERY MUCH MICHAEL, FOR COMING. >> MICHAEL GOTTESMAN: AND THANK YOU VERY MUCH FOR THIS INVITATION. I HAVE SPOKEN TO THE NINR COUNCIL IN THE PAST SO IT'S A PLEASURE TO COME BACK. AND THIS IS AN OPPORTUNITY FOR ME TO TELL YOU A LITTLE BIT ABOUT THE INTRAMURAL PROGRAM AND ABOUT HOW THE NURSING I THINK SOITUTE PROGRAM PLAYS A REALLY IMPORTANT ROLE IN THE INTRAMURAL PROGRAM AS A WHOLE. -- INSTITUTE. MY NAME IS MICHAEL GOTTESMAN. I'M THE DEPUTY DIRECTOR FOR INTRAMURAL RESEARCH. AND AS SUCH, I AM THE DIRECTOR OF THE OFFICE OF INTRAMURAL RESEARCH, WHICH HAS OVERSIGHT RESPONSIBILITY FOR ALL THE ACTIVITIES THAT OCCUR IN THE FEDERAL LABORATORIES. AND THAT INCLUDES OVERSIGHT OF PROJECTS AND POLICIES, OVERSIGHT OF INTRAMURAL TRAINING ACTIVITIES, COMPLIANCE WITH RULES AND REGULATIONS, AND I WAS IMPRESSED HOW FEW RULES AND REGULATIONS YOU REPORT. THAT INCLUDES HUMAN SUBJECTS RESEARCH, ANIMAL CARE AND USE AND SO ON. AND, TECHNOLOGY TRANSFER THAT IS CONDUCTED AT THE NIH AND THE INTRAMURAL PROGRAM. AND AS ANN JUST TOLD YOU, THE INTRAMURAL PROGRAM AS A WHOLE HAS A LITTLE MORE THAN 10% OF THE NIH BUDGET. THAT DIFFERS CONSIDERABLY FROM INSTITUTE TO INSTITUTE. NOW IN ADDITION TO OUR SITE HERE IN BETHESDA, WE HAVE PROGRAMS AT THE ROCKY MOUNTAIN LABORATORIES, LABORATORIES,NIAID HAS PROGRAMS IN MONTANA, PHOENIX A ZONA WE STUDY DIABETES IN PEOPLA INDIAN POPULATION. THERETO IS A PERINATAL IN DETROIT. THE ENVIRONMENTAL HEALTH UNIT IN NIEHS, RESEARCH TRIANGLE PARK IN NORTH CAROLINA AND WE HAVE LABORATORIES IN THIS AREA, INCLUDING FREDRICK, MARYLAND. WE HAVE OVER 1000 PRINCIPAL INVESTIGATORS OR 1000 INDEPENDENT LAPTORIES WITH MORE THAN 5000 TRAINEES AN AND A TOTAL OF MORE THAN 12,000 IN THE INTRAMURAL PROGRAM. 24 OF OUR 27 INSTITUTES HAVE INTRAMURAL PROGRAMS SO YOU CAN IMAGINE MY JOB, WHICH IS TO KEEP TRACK OF WHAT IS GOING ON AND HOPEFULLY MAKE SURE THAT PEOPLE ARE HEADING IN ROUGHLY THE RIGHT DIRECTION S A LITTLE BIT COMPLICATED. AND IT IS REWARDING, HOWEVER, TO HAVE AN OPPORTUNITY TO WORK WITH EACH INTRAMURAL PROGRAM AS THEY DEVELOP THEIR SPECIFIC KINDS OF REQUIREMENTS. AND I MUST SAY, IT IS IMPORTANT TO ME THAT THE INSTITUTES TAKE ADVANTAGE OF WHAT IS RELATIVELY LONG TERM FUNDING IN THE INTRAMURAL PROGRAM, VERY SPECIALIZED RESOURCES IN OUR CLINICAL CENTER AND IN OUR LABORATORIES, AND AMAZING OPPORTUNITIES FOR COLLABORATION THROUGHOUT THE INTRAMURAL PROGRAM. SO I WOULD SAY, WITH GREAT ENTHUSIASM THAT NINR REALLY HIT THE JACKPOT WHEN IT CAME UP WITH A GREAT IDEA OF DEVELOPING A SYMPTOM SCIENCE CENTER. I'D LIKE TO TELL BUT MY PERCEPTION OF THAT CENTER, WHICH I THINK IS REALLY A RELATIVELY UNIQUE AND IMPORTANT CONTRIBUTOR TO THE INTRAMURAL PROGRAM AS A WHOLE. SO THE IDEA IS THAT THROUGH BETTER UNDERSTANDING AND MANAGEMENT OF THE SYMPTOMS OF ILLNESS, SUCH AS PAIN, FATIGUE OR DEPRESSION, THE NURSING INSTITUTE IS POISED TO LEAD THE NIH ON ITS PATH TOWARDS PRECISION HEALTH. ONE OF THE EARLIEST DISCUSSIONS THAT I REMEMBER HAVING AT THE NIH, AND I HAVE TO SAY I HAVE BEEN IN THIS POSITION FOR 25 YEARS SO I'M ONE OF THE MORE SENIOR FOLKS AT NIH. ONE OF THE QUESTIONS THAT CAME UP AND IT WAS ASKED BY JIM WEINGARTEN, THE DIRECTOR AT THE TIME OF THE ESTABLISHMENT OF THE CENTER FOR NURSING RESEARCH, WAS, WHAT WAS NURSING RESEARCH? WHAT IS IT? MANY PEOPLE, INCLUDING THE DIRECTOR WERE NOT CONVINCED THAT THERE WAS A SPECIAL THING AS NURSING RESEARCH THAT NIH WAS MUCH MORE FOCUSED TOWARDS BASIC SCIENCE AND CURES AND DEVOTED TO RESEARCH. AND I WOULD SAY THAT THE SCIENTIFIC DIRECTORS WERE ALSO A LITTLE SKEPTICAL ABOUT NURSING. BUT, THE NURSING INSTITUTE REALLY OVER THE LAST 10 YEARS OR SO, HAS DEVELOPED A VERY CLEAR VISION FOR NURSING RESEARCH, MANIFESTED THROUGH THE SYMPTOM SCIENCE CENTER AND I THINK THAT HAS CONVINCED EVERYBODY THAT THIS IS BOTH APPROPRIATE AND A NECESSARY DIRECTION FOR MEDICAL RESEARCH AT THE NIH. SO, YOU SHOULDN'T BE SURPRISED AT THE SKEPTICISM THAT THE NURSING INSTITUTE WAS GREETED WITH IN THE BEGINNING. THINK ABOUT FLORENCE NIGHTINGALE. OR THE CREATION OF NURSING ACCREDITATION PROGRAMS. THEY WERE BORN IN WAR. THERE HAVE ALWAYS BEEN FIGHTS RELATED TO NURSES AND NURSING RESEARCH, EACH NOW THERE IS SOME DISAGREEMENT WITH CERTAIN THINGS. BUT THE NURSING INSTITUTE IS TRIUMPHANT AND I THINK HAS DEMONSTRATED BOTH GOOD JUDGMENT AND A REALLY TERRIFIC DIRECTION FOR THE INSTITUTE. TO DR. WEINGARTEN'S CREDIT, HE WAS THE NIH DIRECTOR AT THE TIME OF THE ESTABLISHMENT OF THE CENTER FOR NURSING RESEARCH. HE SAID THAT IF NIH IS GOING TO HAVE A CENTER FOR NURSING RESEARCH, IT BETTER BE A GOOD ONE. AND SO, THEY INVITED A LOT OF REALLY SMART PEOPLE TO LAUNCH THE NATIONAL CENTER FOR NURSING RESEARCH. AND I THINK HE WOULD BE REALLY IMPRESSED BY WHAT HAS OCCURRED TODAY. IT'S AABILITY HE CAN'T BE HERE, UNFORTUNATELY HE DIED JUST A FEW MONTHS AGO -- IT'S A PITY. TO ME, THE NURSING INSTITUTE HAS BEEN A CRUCIAL LINK BETWEEN THE SEARCH FOR CURES AND THE DELIVERY OF TREATMENT. FITTING IN THE MODEL OF BERCH TO BEDSIDE AND BACK AGAIN, THAT WE HOLD WITHIN THE INTRAMURAL PROGRAM. THIS MISSING LINK BECAME OBVIOUS DURING THE RISE OF AIDS. QUITE ORGANICALLY, THE NATIONAL CENTER FOR NURSING RESEARCH LEADERSHIP RECOGNIZED THE NEED TO BETTER CARE FOR AIDS PATIENTS. AIDS IS A DISEASE IN WHICH SYMPTOMS WAX AND WAYNE, UNLIKE TERMINAL CANCER WHICH TENDS TO BE A STEADY DECLINE IN PATIENT'S HEALTH. AND REQUIRED SPECIAL ATTENTION. THIS NEED TO TREAT THE AIDS PATIENTS WHO WERE HERE IN THE APPROPRIATE WAY TRANSLATED INTO COLLABORATIVE INTRAMURAL RESEARCH PROGRAM, WORKING WITH NIAID AND THE NIH CLINICAL CENTER, DEPARTMENT FOR NURSING. WHICH LED TO REALLY IMPROVED CARE FOR THE AIDS PATIENTS WHO HAVE BEEN SEEN HERE. THE NURSING -- NATIONAL CENTER FOR NURSING RESEARCH ALSO STRUCK UP COLLABRATIVE AGREEMENTS WITH THE CANCER INSTITUTE, CANCER PATIENTS OBVIOUSLY UNDERGO GRUELING TREATMENTS AND HAVE A LOT OF SYMPTOMS ASSOCIATED WITH THEIR TUMOR AND THE TREATMENTS THEY GET, AS WELL AS DEALING WITH THE ANXIETY OF SOMETIMES WHAT IS A TERMINAL DIAGNOSIS. VERY LITTLE SCIENTIFIC RESEARCH HAD BEEN DONE TO TRY TO UNDERSTAND HOW TO MITIGATE THESE PROBLEMSING. TODAY, AS A RESULT OF NURSING SCIENCE, WE HAVE FAR BETTER CARE FOR THE SIDE EFFECTS, WHICH IN TURN LED TO IMPROVED RECOVERY RATES AND PROLONGED LIFE. IT'S WELL-KNOWN THAT A PATIENT WHO FEELS WELL AND HAS A POSITIVE ATTITUDE ABOUT RECOVERING FROM THE DISEASE, DOES BETTER. IN CONTRAST TO MOST NIH INSTITUTES AND CENTERS, THE NINR'S MISSION IS NOT FOCUSED ON ANY PARTICULAR DISEASE OR ORGAN SYSTEM. AND YET, WE WOULD BE HARD-PRESSED TO NAME ANY CLINICAL PROGRAM AT THE NIH THAT DOESN'T BENEFIT FROM NURSING SCIENCE. WITH THE CREATION OF THE SYMPTOM SCIENCE CENTER, THE NURSING INSTITUTE IS YOU ESSENTIALLY MAKING IT EASIER FOR THE BROADER NIH TO TAP INTO THEIR EXPERTISE. AND WE KNOW THAT NIH CLINICAL RESEARCH FREQUENTLY SEEK EXPERTISE FROM NINR IN DEALING WITH SYMPTOMS AND SO IN 2013, THE NINR CONVENED A WORKSHOP OF EXPERTS IN THE FIELD OF SYMPTOM SCIENCE TO PROPOSE AND DISCUSS A SERIES OF RESEARCH QUESTIONS THAT COULD HELP THE NURSING INSTITUTE AND THE NIH BETTER INTEGRATE SYMPTOM SCIENCE INTO CLINICAL RESEARCH. SO THIS WAS THE RESULT OF A VERY DELIBERATE AND IMPORTANT STRATEGIC PROCESS. IN REVIEWING WHAT THOSE QUESTIONS WERE, I THINK THEY ARE QUITE ENGAGING AND I JUST LIKE TO MENTION SOME OF THEM TO YOU. FIRST IS WHAT ARE THE BIOLOGICAL AND BEHAVIORAL DYNAMICS OF SYMPTOMS? FOR EXAMPLE, DYSPNEA, FATIGUE, IMPAIRED SLEEP, INSOMNIA, DEPRESSION, THAT CAN CHANGE THE TRAJECTORY OF CHRONIC ILLNESS AND HOW CAN THE DYNAMICS BE MAINTAINED TO PREVENT SYMPTOM RELAPSE? SECOND, WHAT INNOVATIVE CARE DELIVERY MODELS RESEARCH METHODS AND TECHNOLOGIES CAN BE LEVERAGED TO IMPROVE SYMPTOM MANAGEMENT AND CHANGE THE CHRONIC ILLNESS TRAJECTORY ESPECIALLY AMONG INDIVIDUALS WHO EXPERIENCE DISPARATE HEALTH OUTCOMES. HOW DOES SYMPTOM PRECURSORS, BIOMARKERS OR CONDITIONS SUCH AS OBESITY, CONTRIBUTE TO THE PHYSIOLOGY OF SYMPTOM, RISK,Y IS VARIEDY, DURATION AND RESPONSE TO TREATMENT? SUCH BASIC QUESTION REVEAL PERHAPS SURPRISING TO SOME, HOW LITTLE WE KNOW AND HOW MUCH NURSING SCIENCE CAN CONTRIBUTE. THE KNOWLEDGE GAP HAS BEEN ASTONISHING AND NOW BEING FILLED BY THE SYMPTOM SCIENCE CENTER. CORE FUNCTIONS OF THE NINR SYMPTOM SCIENCE CENTER WOULD BE STANDARDIZED ASSESSMENT AND TREATMENT OUTCOMES AND TO PREDICT PATIENT-RELATED CLINICAL OUTCOMES. THEY HAVE QUITE A FEW TOOLS AND SOME OF THEM INDIVIDUAL CUTE ACRONYMS SO I'D LIKE TO REMIND YOU OF THOSEFUL YOU MAY BE MORE FAMILIAR WITH THESE THAN I. PATIENT REPORTED OUTCOMES ARE CALLED PROS. AS OPPOSED TO POETRY, I GUESS. WHICH HAVE GROWN OUT OF THE NINR PAIN RESEARCH PORTFOLIO. PROS INCLUDE REPORTS OF PAIN, FATIGUE, PHYSICAL FUNCTIONING, EMOTIONAL DISTRESS AND SOCIAL ROLE PARTICIPATION. THERE IS COMPUTER ADAPTIVE TESTING OR CAT, WHICH IS PART OF A FRAMEWORK FOR SYMPTOM ASSESSMENT AND COLLECTION OF PROS DEVELOPED BY NINR. THE CAT CAN IMPROVE PATIENT REPORTING AND REDUCED RESPONSE BURDEN BECAUSE FROM THE PATIENT'S POINT OF VIEW, THE DIFFICULTY OF THE QUESTIONING SEEMS TO TAILOR ITSELF TO THE ABILITY TO ANSWER. AND JUST AS AN ASIDE, WE ALL HEARD OF THERAPY DOGS. THIS IS THE FIRST TIME I HEARD OF THERAPY CATS. THERE IS ALSO THE PATIENT REPORTED OUTCOMES MEASUREMENT INFORMATION SYSTEM OR PROMISE. BORN OF THE NIH COMMON FUND. THE PROMISE OF PROMISE IS TO PROVIDE THE CLINICAL RESEARCH COMMUNITY WITH A RIGOROUSLY-TESTED PROS MEASUREMENT TOOL THAT USES RECENT ADVANCES AND INFORMATION TECHNOLOGY PSYCHOMETRICS AND QUALITATIVE, COGNITIVE AND HEALTH SURVEY RESEARCH. SO YOU CAN SEE, THIS IS A VERY SOPHISTICATED SET OF TOOLS THAT ARE USED TO ASSESS SYMPTOMS IN ORDER TO MOVE THE SCIENCE FORWARD. WITH THE SKILLFUL USE OF THESE TOOLS, THE NURSING INSTITUTE CAN HELP THE NIH INTRAMURAL PROGRAM MEET SEVERAL OF OUR LONG TERM GOALS SUCH AS TO DEVELOP AND DELIVER PERSONALIZED MEDICINE AND CELL-BASED THERAPIES AND TO OVERCOME DRUG RESISTANCE TO COMBAT INFLAMMATORY DISEASES AMONG OTHER ELEMENTS OF THE LONG-TERM PLANNING. IT'S A TALL ORDER BUT THE NURSING INSTITUTE DIVISION OF INTRAMURAL RESEARCH, AS MODEST AS IT IS, AND IT'S QUITE SMALL, COMPRISES A DREAM TEAM OF NURSE SCIENTISTS. LEADING THE SYMPTOM SCIENCE CENTER, AND I HOPE YOU MET HIM, AND LAURA SZALACHA, WH LAURAAND A SAL LEO SAL BEGAN. SALIGAN. HE IDENTIFIED MARKERS ASSOCIATED WITH INFLAMMATORY PATHWAYS IN PATIENTS WITH POST-TREATMENT FATIGUE. WOULDN'T IT BE AMAZING IF WE COULD FIND A WAY TO CURE THE FATIGUE ASSOCIATED WITH CANCER TREATMENT? SUPPORTING LEO WILL BE THE RESEARCH STAFF AND IN PULT OF FOUR NINR INTRAMURAL BRANCHES, INCLUDING BIOBEHAVIORAL BRANCH, SYMPTOMS MANAGEMENT, TISSUE INJURY BRANCH AND THE ADVANCED UTIZATION BRANCH. AS YOU CAN VISUALIZE, SYMPTOM SCIENCE HAS CLEAR RELEVANCE FOR CANCER, NEUROSCIENCE, GENETICS, IMMUNOLOGY, PAIN, ADDICTION, HEALTH DISPARITIES, BEHAVIORAL SCIENCE AND OTHER RESEARCH TOPICS IN NEARLY EVERY NIH INSTITUTE AND CENTER. NUMEROUS PROJECTS WHICH ARE COLLABORATIVE HAVE BEEN LINED UP ALREADY. SO, JUST IN CLOSING, I WANT TO MENTION OTHER WAYS IN WHICH THE NURSING INSTITUTION, IN ADDITION TO THE SYMPTOM SCIENCE CENTER, HAS CONTRIBUTED TO THE ENVIRONMENT, POSITIVE ENVIRONMENT AT THE NIH. THE NURSING INSTITUTE HAS A GRADUATE PARTNERSHIP PROGRAM AND HAS SCORES OF PH.D. STUDENTS WHO COMPLETE THEIR COURSEWORK AND ACADEMIC SETTING AND COME TO THE NIH TO DO RESEARCH. THE NINR HAS A SUMMER GENETICS INSTITUTE, A MONTH-LONG INTENSIVE PROGRAM TO TRAIN NURSE SCIENTISTS AND NURSES IN ADVANCED GENETICS SO THEY CAN BECOME GENETIC COUNCILORS AND HELP IN WHAT IS REALLY THE FUTURE OF PERSONALIZED MEDICINE IN THE UNITED STATES. NINR HAS A METHODOLOGIES BOOTCAMP WHICH IS NOW IN ITS TENTH YEAR WHICH IS INTENSIVE RESEARCH TRAINING COURSE HELD IN THE SUMMER DESIGN TO INCREASE THE RESEARCH CAPABILITY OF GRADUATE STUDENTS, FACULTY AND CLINICIANS. AS I UNDERSTAND IT, IT'S A VERY POPULAR AND COMPETITIVE PROGRAM. AND THE NINR WAS THE FIRST TO HOST CLINICAL RESEARCH SCHOLAR, A PROGRAM AT THE NIH FOR OUTSTANDING CLINICAL INVESTIGATORS TO WORK IN OUR CLINICS. AND THEY ARE ON THE TENURED TRACK WHEN THEY COME HERE. THE VERY FIRST LASKER CLINICA SCHOLAR AT THE NIH WAS JESSICA GILL WHO WAS AN INTRAMURAL SCIENTIST WITHIN THE NURSING INSTITUTE. SHE HAS SINCE BEEN TENURED IN THE INTRAMURAL PROGRAM AND HAS DONE TRULY PIONEERING WORK IN HER STUDIES ON POST-TRAUMATIC BRAIN DISORDER AND COMBAT INJURY. APPROPRIATELY, SHE'S MOVED ON TO SOME ADMINISTRATIVE TASKS, HOPEFULLY NOT AT THE EXPENSE OF HER SCIENCE, AND HAS BECOME OR RECENTLY BEEN THE DEPUTY SCIENTIFIC DIRECTOR OF NINR AND I THINK, IS IT OKAY TO SAY SHE WILL BE REPLACING ANN WHEN ANN LEAVES AS ACTING SCIENTIFIC DIRECTOR. WE ARE REALLY GRATEFUL FOR HER WILLINGNESS TO TAKE ON THE IMPORTANT ADMINISTRATIVE TASKS AS WELL AS HER SCIENCE, AND I KNOW THAT SHE WILL DO A TERRIFIC JOB. THE NINR HAS SINCE RECRUITED ANOTHER LASKAR SCHOLAR, PAULY JOSEPH STUDYING THE ROLE OF METABOLIC DISORDERS AND I SHOULD POINTED OUT THAT WE HAVE 24 TOTAL LASKER SCHOLARS AT THE NIH AND TWO OF THEM ARE IN THE NURSING INSTITUTE. DESPITE ITS SIZE, IT REALLY HAS BEEN A WONDERFUL HOME FOR CLINICIAN SCIENTISTS. AND FINALLY, BEFORE I CLOSE, I WANT TO THANK ANN CARBON. HER LEADERSHIP HAS BEEN EXTRAORDINARY. ANN CASHION SHE IS THE ACTING DIRECTOR OF NINR AND HAS DONE A TERRIFIC JOB. SHE IS A MEMBER OF THE BOARD OF SCIENTIFIC DIRECTORS AND AS SUCH, SHE REALLY IS ALWAYS THE PERSON WHO HAS A REALLY GOOD SUGGESTION, SHE IS THE VOICE OF REASON, AND I THINK A VERY EFFECTIVE REPRESENTATIVE OF THE NURSING INSTITUTE AT THE TABLE WHICH CONSISTS OF OTHER SCIENTIFIC DIRECTORS AT THE NIH. ANN WE WILL REALLY MISS YOU. THANK YOU. >> ANN CASHION THANK YOU VERY MUCH, MICHAEL. I APPRECIATE YOU PRESENTING AND I WOULD LIKE TO ALSO SAY THAT OVER THE LAST 10 YEARS, WE HAVE REALLY BEEN IMPRESSED BY HOW WELL YOU HAVE BEEN ABLE TO SPEAK ABOUT OUR SCIENCE. SO THANK YOU VERY MUCH. DO PEOPLE HAVE QUESTIONS? OR DO YOU HAVE TIME? DR. GOTTESMAN HAS A 1:00 MEETING HE HAS TO GO TO. >> MICHAEL GOTTESMAN: THE QUESTION IS HOW DOES THAT FIT IN WITH YOUR SCHEDULE? >> ANN CASHION: YOU CAN ASK IF ANYONE HAS ANY QUESTIONS. >> MICHAEL GOTTESMAN: ARE THERE QUESTIONS ABOUT THE INTRAMURAL PROGRAM? >> ANN CASHION: THANK YOU VERY MUCH. [ APPLAUSE ] IN DEFERENCE DR. GOTTESMAN'S SCHEDULE, WE CHANGED OUR SCHEDULE A LITTLE BIT SO I'M GOING TO SORT OF GO BACKWARDS AT THIS POINT AND ALSO INTRODUCE DR. TAURUS SWEATS. SHE IS SITTING HERE WITH US TODAY AS I KNOW ALL THE COUNCIL MEMBERS ARE AWARE AND NINR STAFF, DR. SWEATS IS NOW OUR ACTING DEPUTY DIRECTOR. SHE HAS BEEN HERE AT NIH FOR -- AROUND 7 OR 8 YEARS. SHE ACTUALLY HAS WORKED IN NINR AT ONE POINT IN TIME BUT HAS MOVED ON THROUGH VARIOUS POSITIONS INTO THE NIH OFFICE OF THE DIRECTOR WHERE SHE NOW IS THE DEPUTY DIRECTOR FOR DR. TABAK. SO, TARA IS HERE TO LEARN ABOUT OUR COUNCIL AND MEET OUR MEMBERS AND ALSO TO LEARN ABOUT -- TO ANSWER QUESTIONS AS WE GO FORWARD. DO YOU WANTED TO SAY ANYTHING AT THIS POINT? >> TARA: GOOD AFTERNOON AND THANK YOU FOR THE INTRODUCTION, ANN. IT'S A PLEASURE TO BE HERE TODAY. I'M EXCITED TO GO AROUND AND MEET ALL OF YOU IN PERSON. SOME OF YOU WE'VE TALKED ON THE PHONE. SO AS ANN MENTIONED, I'M TARA, THE ASSOCIATE DEPUTY DIRECTOR OF NIH AND FOR THE TIME BEING ALSO THE ACTING DEPUTY DIRECTOR OF NINR. IT'S A REAL PLEASURE TO BE BACK AT THE INSTITUTE, WHICH I STARTED MY NIH CAREER AT. I'M EXCITED TO GET REACQUAINTED WITH THE SCIENCE AND ALL THE WORK HERE THAT'S BEING SUPPORTED HERE AT NINR. AND AS I SAID, HOPEFULLY INTERACT WITH ALL OF YOU OVER THE NEXT COUPLE OF DAYS. OVER THE LAST COUPLE OF WEEKS, I'VE HAD THE GREAT PLEASURE OF WORKING VERY CLOSELY WITH ANN AND ALSO GETTING TO KNOW ALL THE STAFF HERE AT NIN R AND I WILL ECHO MICHAEL'S SENTIMENTS. WE WILL MISS ANN WHEN SHE LEAVES. WE TRIED HARD TO GET HER TO STAY. BASICALLY EVERYTHING EXCEPT FOR CHAINING HER TO THE DESK. THAT'S NOT OUT OF THE QUESTION YET. JUST KIDDING. BUT YOU GAVE ME A LITTLE BIT OF HOPE, MAYBE WITH THAT COMMENT ABOUT STAYING FOR THE 100th COUNCIL. MAYBE WE COULD CONVINCE YOU? ALL RIGHT. IT WAS WORTH A SHOT. I HAD TO TAKE IT. BUT, ALL KIDDING ASIDE, WE DO WISH YOU THE BEST OF LUCK IN YOUR NEW ADVENTURESS AND SHE HAS SOME REALLY EXCITING THINGS PLANNED AND IN STORE FOR HER. IN THE MEANTIME, WE ARE PUSHING FORWARD WITH OUR SEARCH FOR A NEW PERMANENT NINR DIRECTOR AND NIH LEADERSHIP, INCLUDING BOTH FRANCIS COLLINS AND LARRY TABAK ARE REALLY INVESTED IN AND ENGAGED IN FINDING THE RIGHT CANDIDATE FROM THE NURSING SCIENCE COMMUNITY TOW LEAD THIS REALLY IMPORTANT INSTITUTE. SO, WE ENCOURAGE FOLKS TO SHARE THE INFORMATION ABOUT THE JOB ANNOUNCEMENT, WHICH I THINK YOU HAVE SOME FLYERS AND IT WILL BE IN THE SLIDE SET. SO, PLEASE SHARE THAT WITH ANYONE THAT YOU THINK MAY BE INTERESTED AND A GOOD FIT FOR THE POSITION. AND CONSIDER APPLYING YOURSELF, MAYBE. BUT IN THE MEANTIME, THE INSTITUTE'S MISSION AND FUNCTION WILL REMAIN LARGELY UNCHANGED. AND NINR'S CAPABLE STAFF, WE ARE ALL SITTING AROUND THE TABLE AND THE OUTER EDGES OF THIS ROOM, THEY HAVE PROVEN OVER THE LAST YEAR THEY CAN STAY THE COURSE WHILE WE ARE IN THE TRANSITION PERIOD FOR LEADERSHIP SO WE APPLAUD ALL OF THEIR EFFORTS AND KNOW THEY WILL CONTINUE THE IMPORTANT WORK THAT NINR IS DOING. SO I LOOK FORWARD TO HEARING YOUR THOUGHTS AND THE DISCUSSION AND THE PRESENTATIONS TODAY AND WORKING WITH YOU ALL FURTHER OVER THIS TRANSITION PERIOD. AND I HOPE I GET TO INTERACT WITH YOU ALL OVER THE NEXT COUPLE OF DAYS. THANK YOU. >> ANN CASHION: THANK YOU, TARA. ALSO DR. LARRY TABAK, THE ACTING DIRECTOR OCTOBER 1, HE WILL BE HERE LATER TODAY AND WE CAN PARTICULARLY HAVE A DISCUSSION AT THAT POINT IN TIME. BUT IF ANYBODY HAS ANY QUESTIONS AT THIS TIME FOR TARA, WE ARE HAPPY TO ENTERTAIN THOSE AS WELL WELL. AGAIN, GOOD AFTERNOON AND WELCOME TO THE 99th MEETING OF THE NATIONAL ADVISORY COUNCIL FOR NURSING RESEARCH. LET'S SEE -- HOW DO I MOVE IT? THANK YOU VERY MUCH. SO, WE'RE GOING -- I'M PLEASED TO ANNOUNCE THAT TODAY'S MEETINGS AND ALL FUTURE COUNCIL MEETINGS WILL BE WEBCAST SO JUST KEEP THAT IN MIND. I KNOW HAVING WATCHED WEBCASTS BEFORE THAT PEOPLE AROUND THE TABLE FORGET THEY ARE BEING WEBCAST. SO YOU START DOING THINGS. SO JUST TRY TO KEEP IN MIND THAT A CAMERA IS ON YOU ALL DAY LONG. [ LAUGHS ] SO THIS IS THE WARNING. AND I WILL BE THE WORST OFFENDER OF THIS. BUT JUST PUTTING IT OUT THERE. YOU ARE BEING RECORDED AND SHOWN LIVE RIGHT NOW. SO, I'M GOING TO, AS TARA ALREADY SAID, WE ARE SEEKING APPLICATIONS FOR EXCEPTIONAL CANDIDATES. APPLICATIONS ARE DUE BY MONDAY NOVEMBER 18th, 2019. NATHAN, THERE ARE FLYERS HERE, RIGHT? NO? OKAY. THERE IS A WEB LINK THAT IS ON THIS PARTICULAR PAGE THAT SHOWS YOU WHERE YOU CAN GO AND READ ABOUT THE SEARCH AND PLEASE, ONE OF THE ADVANTAGES SOME OF YOU MAY BE AWARE THAT THERE ARE A LOT OF TWEETS OUT THERE AND THERE IS A LOT OF E-MAILS GOING AROUND. ONE OF THE ADVANTAGES OF THAT IS THAT IT IS -- PEOPLE ARE OUT THERE TALKING ABOUT THIS JOB. THIS TYPE OF PROMOTION OF THIS JOB, YOU CAN'T BUY. SO WE ARE VERY PLEASED THAT THEY ARE TWEETING NOW ABOUT THIS SEARCH AND WE DO ENCOURAGE INDIVIDUALS TO APPLY. JUST BRIEFLY, I'M RETIRING SEPTEMBER 30th. IT'S -- I SHOULD HAVE COUNTED THE DAYS. IT'S LIKE A WEEK AND A HALF FROM NOW. FOR THE PAST EIGHT YEARS, I HAVE REALLY FEEL LIKE A PRIVILEGE OF BEING HERE. IT'S BEEN A FANTASTIC EIGHT YEARS FOR ME WORKING AS THE SCIENTIFIC DIRECTOR HAS BEEN QUITE A PRIVILEGE TO START UNDERSTANDING ALL OF THE OPPORTUNITIES THAT NIH, THE RESEARCH THAT GOES ON, MAKING THE COLLABORATIONS. YOU DON'T HAVE THIS OPPORTUNITY AT ANY UNIVERSITY OR ANYWHERE ELSE, I WOULD SAY, IN THE WORLD. SO IT IS A FABULOUS JOB TO BE HERE. AND I'M VERY, VERY PLEASED THAT I HAVE THIS OPPORTUNITY TO BE THE ACTING DIRECTOR AS WELL. I DO HAVE EXTREME CONFIDENCE IN THE IN-COMING TRANSITION TEAM. I THINK THEY ARE GOING TO DO AN EXCELLENT JOB IN STEERING US OR CONTINUING THE COURSE THAT NURSE SCIENTISTS HAVE ALREADY DEFINED. AND NOT ONLY THAT, LARRY TABAK, WHO IS THE IN-COMING ACTING DIRECTOR FOR NINR, IS CURRENTLY THE PRINCIPLE DEPUTY DIRECTOR FOR NIH. SO BASICALLY HE IS THE RIGHT HAND PERSON FOR DR. FRANCIS COLLINS. FOR NURSING SCIENCE, THIS ALLOWS OUR SCIENCE TO BE KNOWN EVEN MORE ABOUT THAT AT SOME OF THOSE TABLES THAT WE HAVE ACTUALLY NOT BEEN SEATED AT IN THE PAST. SO, I THINK THAT THIS IS OUR OPPORTUNITY TO ACTUALLY MAKE SURE THAT LEADERSHIP IS VERY MUCH AWARE OF THE EXCELLENT DESIGNS WE ARE DOING, WHAT WE ARE FUNDING, AND THAT THIS WILL -- EXCELLENT SCIENCE -- THIS WILL BE A WONDERFUL OPPORTUNITY FOR US. PLEASE KEEP SOME OF THOSE POINTS IN MIND AS WE GO FORWARD. AND AS DR. GOTTESMAN ALREADY SAID, I'M VERY PLEASED THAT JESSICA GILL WILL BE THE ACTING SCIENTIFIC DIRECTOR. I THINK SHE IS WELL READY TO DO THAT. SHE IS ACTING -- EXCUSE ME, DEPUTY DIRECTOR -- DEPUTY SCIENTIFIC DIRECTOR OVER THE LAST YEAR. I MUST SAY I HAVE LEANED ON HER HEAVILY TO DO MOST OF THE WORK IN THE INTRAMURAL PROGRAM. SO, SHE'S ALREADY BEEN THERE. SHE'S BEEN DOING IT. AND I'M VERY PLEASED NOW THAT SHE IS WILLING TO CONTINUE TO DO IT, THAT WE DIDN'T BURN HER TOTALLY OUT DURING THAT YEAR. SO, THANK YOU. WE LOOK FORWARD TO -- I LOOK FORWARD TO SEEING HOW THE PROGRAM CONTINUES TO GROW AND THRIVE UNDER YOUR LEADERSHIP. SO, YOU'LL RECALL THAT IN MAY, WE INTRODUCED OUR NEWEST COUNCIL MEMBERS, DR. WOLFE, LOU IN AND LOW. DR. LIU IN IS HERE WITH US TODAY. WE WELCOME HIM AS WELL AS DR. M WHO IS HERE JOINING US TODAY AS WELL. SO NOW A LITTLE BIT ON THE BUDGET. IT'S A DAILY GUESS. BUT, THIS IS OUR RETROSPECTIVE BUDGET OVER THE LAST THREE YEARS SO 2017, 18 AND 19. THE KEY POINTS I LIKE TO ILLUSTRATE IS THAT WE AT NIH, HAS GONE UP EACH YEAR, 6.6% IN 'SEVENTEEN-4.7% IN' 19. NINR HAS GONE UP AS WELL IN THE CONSECUTIVE YEARS. I WOULD ATTRIBUTE THAT TO THE BIPARTISAN SUPPORT WE GET IN CONGRESS. A REMIND THEY'RE NINR'S BUDGET IS APPROPRIATED AND COMES DIRECTLY FROM CONGRESS SO THE AMOUNT WE GET IS NOT DETERMINED BY THE DR. COLLINS OR BY ANYONE IN THE OFFICE OF THE DIRECTOR. IT IS APPROPRIATION FROM CONGRESS. SO SOME PEOPLE WILL ASK ME, WHY IS IT 4.7% TO NIH AND NINR ONLY GOT 3.1%? IT'S BECAUSE THERE ARE PROGRAMS THAT ARE FUNDED IN THE NIH BUDGET THAT DOESN'T GO TO ANY INSTITUTE. THE ALL OF US RESEARCH PROGRAMS IS AN EXAMPLE. SOME ALZHEIMER'S FUNDS ARE EXAMPLES. SO THERE ARE FUNDS THAT ARE OUT THERE AND SO THAT IS WHY YOU SEE THE DISCREPANCY OR THE DIFFERENCE IN SOME OF THOSE NUMBERS. BUT WE ARE VERY PLEASED RIGHT NOW. CONGRESS, THE REPRESENTATIVES HAVE VOTED US TO GET MORE MONEY AGAIN THIS YEAR. THE SENATE HAS BEEN -- THERE HAS BEEN SOME CONTROVERSY IN THE SENATE AND SO, IT HAS NOT BEEN VOTED ON. SO, WHAT IS GOING TO HAPPEN -- OUR BUDGET, AS A REMINDER, OUR BUDGET ENDS AT THE END OF SEPTEMBER. SO, THERE IS A -- MAY NOT BE A COINCIDENCE I'M LEAVING ON THE DAY THE BUDGET ENDS. IT MAY BE A VERY THOUGHTFUL DECISION, OR NOT. [ LAUGHS ] BUT IT ENDS ON SEPTEMBER 30 AND EXACTLY WHAT WILL HAPPEN AFTER THAT AT THIS POINT, WE DON'T KNOW. ONE THING IS CALLED A CONTINUING RESOLUTION, A CR, AND THAT IS THE EXPECTATION THAT WE WILL GET A CR FOR SEVERAL WEEKS OR A MONTH AND THAT JUST MEANS THAT OUR BUDGET REMAINS THE SAME AND WE CONTINUE TO FUNCTION. THE OTHER WOULD BE SOMETHING THAT WE HAVE EXPERIENCED IN THE PAST AND WE KNOW HOW TO HANDLE IS THAT THE GOVERNMENT -- OR AT LEAST OUR PART OF THE GOVERNMENT WOULD SHUT DOWN AT THAT POINT IN TIME. SO BOTH THINGS OCCUR OVER TIME AND WE HAVE CERTAINLY EXPERIENCED THEM. I'M NOT WORRIED ABOUT EITHER ONE. BUT JUST TO ANSWER YOUR -- SOME QUESTIONS THAT YOU MAY HAVE ABOUT OUR BUDGET. I HOPE THAT WE ARE GOING TO SEE ULTIMATELY AN INCREASE IN OUR BUDGET AGAIN FOR THIS YEAR. SO THAT'S A HOPE. BECAUSE THAT ACTUALLY TRANSLATES TO MORE FUNDING THAT WE CAN GIVE OUR INVESTIGATORS. SO THAT IS A WONDERFUL OPPORTUNITY FOR US. SO HERE IS HOW OUR BUDGET IS THE DIVIDED UP. THE KEY POINTS HERE ARE THAT ABOUT 80% OF OUR FUNDS GO OUT TO FUND EXTRAMURAL RESEARCH PROGRAMS ACROSS THE UNITED STATES. THAT'S WHAT RPGs, RESEARCH PROGRAM GRANTS, RPGs. IT INCLUDES OUR CENTER GRANTS, WHICH YOU SEE AT 4%, FOR RP AND P30s. OTHER RESEARCH IS OUR PALLIATIVE CARE NETWORK, RMS IS SORT OF ADMINISTRATIVE COSTS. TRAINING IS VERY IMPORTANT TO US AND WE DO 5% IN THERE. AND RESEARCH AND DEVELOPMENT IS MORE ALONG THE LINES OF SOME CONTRACTS THAT WE HAVE AND THAT WE NEED TO MAINTAIN AS PART OF NIH AS AN INSTITUTE. AND THEN INTRAMURAL COMES IN AT ABOUT 8% OF THE BUDGET. SO THIS IS SHOWING YOU MORE INFORMATION ABOUT OUR COMMITMENT TO TRAINING. I LIKE TO POINT THIS OUT. WE ARE THE BLUE. YOU SEE THAT WE HAVE ABOUT 4% -- ALMOST 5% OF OUR BUDGET GOES TO TRAINING. THE ONLY OTHER INSTITUTE THAT HAS A HIGHER PERCENT ANNUAL THAT GOES TO TRAINING IS NIGMS, MEDICAL SCIENCE, AND THEIR MISSION IS PRIMARILY TRAINING. SO THAT IS WHY THEY HAVE A HIGHER PERCENTAGE. BUT IT'S ALWAYS BEEN A VERY IMPORTANT FOR US TO FUND OUR NURSING SCIENTISTS. WE ARE STILL A YOUNGER PROFESSION IN TERMS OF RESEARCH. YOUNGER SCIENTIFIC PROFESSION. SO WE FEEL LIKE THIS AMOUNT OF TRAINING IS IMPORTANT TO GIVE OUR RESEARCHERS. AND WE HAVE GOTTEN WONDERFUL RESULTS FROM THE AMOUNT OF MONEY WE SPENT WITH TRAINING. WE ARE VERY PLEASED. DR. WEINGARTEN PASSED AWAY EARLIER THIS YEAR AND AS DR. GOTTESMAN WAS SAYING, DR. WEINGARTEN WAS VERY INVOLVED IN HIV AND THE BEGINNING OF THE CARE OR THE RESEARCH IN THAT AREA AND THAT ALSO NURSE SCIENTISTS WERE VERY INVOLVED AS WELL AS WE DEVELOPED OUR CENTER AND STARTED TO GROW. SO HE HAS BEEN IMPORTANT TO NINR OVER THE YEARS. ANOTHER DEATH IN THE FAMILY IS DR. DONALD LINBURG, THE NATIONAL LIBRARY OF MEDICINE DIRECTOR. AND HE DIED ON AUGUST 16. HE WAS MORE THAN 30 YEARS AS THE DIRECTOR OF NLM. SO HE KIND OF BROUGHT NLM INTO THE CURRENT INTERNET PHASE. HE EMBRACED THE INTERNET. HE GAINED NEW AND IMPROVED ACCESS TO THE MEDICAL LITERATURE VIA PUBMED AND PUBMED CENTRAL, CLINICAL TRIALS.COM, AND CONSUMER HEALTH INFORMATION VIA MEDLINE PLUS. SO MANY OF THE THINGS THAT WE THINK ABOUT WITH THE NLM WERE BEGUN DURING HIS LEADERSHIP. ANOTHER -- THE ALL OF US PROGRAM -- I WANT TO SPEAK JUST A LITTLE BIT ABOUT THE ALL OF US PROGRAM. IT MADE SOME STRONG PROGRESS OVER THE LAST YEAR AND RECENTLY IN NEW ENGLAND JOURNAL OF MEDICINE PAPER, IT REPORTED SOME OF THE OUTCOMES SO OVER 230,000 PEOPLE HAVE BEEN ENROLLED. I THINK PARTICULARLY INTERESTING TO US AS NURSE SCIENTISTS, IS 80% OF THOSE ENROLLED ARE FROM GROUPS THAT HAVE BEEN HISTORICALLY UNDER REPRESENTED IN BIOMEDICAL RESEARCH. AND FROM WHEN I WAS NOT AS PART OF NIH AND I SAT ON SOME OF OUR STUDY REVIEW GROUPS, I KNOW THAT MANY NURSES WERE INVOLVED IN TRYING TO REALLY LOOK AT HEALTH DISPARITIES. SO THE FACT THAT THERE IS SO MANY DIFFERENT GROUPS IN THIS COHORT OF INDIVIDUALS, IT IS IMPORTANT TO US AS WE BEGAN TO THINK ABOUT THE SCIENCE THAT WE WANT TO CONDUCT USING THE DATA BEING COLLECTED BY THESE INDIVIDUALS. SO PLEASE KEEP THIS IN MIND. THE PLAN IS TO GET OVER A MILLION PEOPLE IN THIS DIVERSE COHORT AND THEY WILL HAVE LIFESTYLE DATA AS WELL AS GENETIC DATA AND A LOT OF MOBILE HEALTH DATA AS WELL. DR. GOTTESMAN SPOKE ABOUT A LOT OF THE THINGS THAT I'M TOUCHING ON TODAY AS WELL. WE WILL BE SUNSETTING THE PROMISE PROGRAM. IT'S BEEN SOMETHING AGAIN THAT NURSES HAVE USED IN THEIR RESEARCH. IT ENDS AT THE END OF FISCAL YEAR 19 WHICH MEANS IN TWO WEEKS. AND IT WILL TRANSITION FROM THE COMMON FUND. AND IT'S BEEN A TENURED PROJECT. NUMEROUS NIN R AND NIH GRANTEES UTILIZED THIS OVER THE YEARS. IN JUNE, NIH ISSUED A NOTICE ABOUT EXPANDING USAGE OF NOTICES OF SPECIAL INTEREST SO THIS IS SOMETHING NEW. NOTICES INFORM THE EXTRAMURAL COMMUNITY THAT NIH IS EXPANDING AND FORMALIZING THE USE OF NOTICES OF SPECIAL INTEREST. THEY ARE POSTED IN THE NIH GUIDE FOR GRANTS AND CONTRAST TO ANNOUNCE INTEREST IN SPECIFIC SCIENTIFIC RESEARCH TOPICS. CURRENTLY NIH IS A LARGE NUMBER OF NON-PARENT PROGRAM GRANTSs WITH STANDARD SUBMISSION AND REVIEW REQUIREMENTS THAT VARY FROM ONE ANOTHER ONLY IN THE SCIENTIFIC TOPICS HIGHLIGHTED. THESE PAs WILL BE PHASED OUT OVER TIME AND WILL BE REPLACED WITH NOTICES OF SPECIAL INTEREST THAT DIRECT APPLICANTS TO USE ONE OF THE PARENT OR OTHER EXISTING ANNOUNCEMENTS FOR SUBMISSION. THIS CHANGE DOES NOT DIMINISH THE INTEREST IN THESE SCIENTIFIC TOPICS BUT RATHER SIMPLY STREAMLINES HOW NIH INTERESTS ARE ANNOUNCED. IT'S JUST A CHANGE. NIH WILL CONTINUE TO POST FULL-FUNDING OPPORTUNITY ANNOUNCEMENTS FOR REQUEST FOR APPLICATIONS. PROGRAM ANNOUNCEMENTS WITH SPECIAL RECEIPT REFERRAL OR REVIEW CONSIDERATIONS. AND PROGRAM ANNOUNCEMENTS WITH SET ASIDE FUNDS. SO WE HAVE BEEN TALKING ABOUT THIS FOR A WHILE. WE WILL CONTINUE TO TALK ABOUT IT BECAUSE IT IS CONFUSING. AND ANY QUESTIONS THAT YOU HAVE, PLEASE DO ASK OUR INTRAMURAL PROGRAM OFFICERS OR OUR EXTRAMURAL PROGRAM OFFICERS OR LEADERSHIP. AND WE WILL MAKE SURE THAT WE COMPLETELY ANSWER QUESTIONS AS THEY ARISE. NINR FREQUENTLY PARTNERS WITH OTHER NIH ICs TO SUPPORT RESEARCH ENDEAVORS THAT CROSS TRADITIONAL BOUNDARIES. EXAMPLES OF FIVE CURRENT TRANS-NIH FUNDING OPPORTUNITIES IN WHICH NINR PARTICIPATES INCLUDE RESEARCH ON HEALTH AND TRANSGENDER AND GENDER NON-CONFORMING POPULATIONS. ENVIRONMENTAL INFLUENCES ON AGING, APPLYING A BIOPSYCHOSOCIAL PERSPECTIVE TO SELF-MANAGEMENT OF CHRONIC PAIN, DISSEMINATION AND IMPLEMENTATION RESEARCH IN HEALTH, AND MECHANISMS UNDERLYING THE CONTRIBUTION OF SLEEP DURING ANS TO PAIN. -- DISTURBANCES TO PAIN. NOW NEWS CLOSER TO HOME ABOUT NINR. IDA MOORE WE ARE VERY PLEASED THAT SHE IS NOW THE NEW DEAN FOR THE UNIVERSITY OF ARIZONA COLLEGE OF NURSING AND CONGRATULATIONS ON THAT. [ APPLAUSE ] I SAW MANY OF YOU AT TODAY'S NINR DIRECTOR'S LECTURE THAT WAS A WONDERFUL PRESENTATION BY DR. GENE McSWEENEY ON CARDIOVASCULAR SYMPTOMS IN WOMEN, PRIMARILY. OUR NEXT DIRECTOR'S LECTURE IS NOVEMBER 19th AND IT WILL BE DR. PATRICIA STONE FROM COLUMBIA UNIVERSITY. SHE IS A LEADER IN RESEARCH SEEKING TO UNDERSTAND THE COMPLICATIONS AND RIGORS CONDUCTING REAL-WORLDCOM PARATIVE AND ECONOMIC EVALUATIONS IN THE CONTEXT OF IMPROVING THE QUALITY OF CARE AND SPECIFICALLY PREVENTING HEALTH CARE-ASSOCIATED INFECTIONS. SO I'M SURE IT WILL BE A EXCELLENT PRESENTATION. I HEARD HER PRESENT NUMEROUS TIME. -- THIS YEAR'S PRESIDENTIAL EARLY CAREER AWARD SCIENTIST AND ENGINEERS. THE PK AWARD. WE ARE VERY PLEASED THAT TWO OF NINR'S SCIENTISTS WERE INCLUDED IN THIS GROUP THAT WERE AWARDED THIS YEAR. IT'S THE HIGHEST HONOR BESTOWED BY THE U.S. GOVERNMENT TO OUTSTANDING SCIENTISTS AND ENGINEERS WHO ARE BEGINNING THEIR INDEPENDENT RESEARCH CAREERS AND WHO SHOW EXCEPTIONAL PROMISE FOR LEADERSHIP IN SCIENCE AND TECHNOLOGY. DR. GOTTESMAN HAS ALREADY TALKED ABOUT THE SYMPTOM SCIENCE CENTER A LITTLE BIT EARLIER, BUT I DO WANT TO SAY WE DID HAVE A LAUNCH OF IT IN JUNE, 27, 2019. VERY -- JUST WENT SO WELL. AND A VIDEO OF THE LAUNCH SUSPECT NOW AVAILABLE ON OUR WEBSITE AND YOU'LL BE HEARING MORE ABOUT THE SYMPTOM SCIENCE CENTER FROM DR. LEO SALIGAN, LATER THIS AFTERNOON. SO, AS ACTING DIRECTOR, I WAS AN INVITED PANELIST AT THE CHICAGO TOWNHALL MEETING BY THE COMMITTEE ON FUTURE OF NURSING, 2030. JUST TO REMIND YOU THAT THE NATIONAL ACADEMY OF MEDICINE IS PUTTING OR DOING A NEW FUTURE OF NURSING REPORT. AND THEY HAD THREE TOWN HALLS OR HAVING THREE TOWN HALLS TO GATHER DATA FROM AROUND THE COUNTRY. AND EACH TOWN HALL HAS A SPECIFIC FOCUS. I WAS HAVING READ THE LAST FUTURE OF NURSING REPORT AND LOOKING AT SOME OF THE OBJECTIVES AND GOALS FOR THE 2030 REPORT, I WAS REALLY INTERESTED IN PROMOTING THE USE OF AND ROLE OF NURSING SCIENCE IN THIS REPORT, THAT IT PRIMARILY DISCUSSING HOW IT UNDERPINS OUR CLINICAL PRACTICE AND HOW WE WANT TO UTILIZE THE SCIENCE. SO I WAS SO PLEASED THAT THEY INVITED NINR AND ME TO COME TO THE TOWN HALL AND ACTUALLY GIVE OUR TALKING POINTS AND TALK ABOUT THAT. AND IT WAS VERY WELL RECEIVED. SO, STRENGTHENING, RIGHT NOW, WE ARE HAVING A WORKSHOP OL STRENGTHENINGS THE IMPACT OF COMMUNITY HEALTH WORKERS ON HIV CARE AND VIRAL SUPPRESSION IN THE U.S. AND AS FAR AS I KNOW AND REBECCA, I'M LOOKING AT YOU, IT'S STILL GOING WELL. IT'S NOT GOING WELL? IT'S DONE? OKAY! GOOD! IT'S DONE. IT WENT WELL. LET'S JUST SAY THAT. BUT YESTERDAY, I WAS THERE TO PRESENT AND REALLY TALK ABOUT -- WE ARE DOING THIS IN CONJUNCTION WITH THE OFFICE OF AIDS RESEARCH HERE ON CAMPUS, AND THEY DID SOME MONEY. WE DID A LOT OF THE LEG WORK, AND WE HAD THESE EXCELLENT PRESENTERS COME YESTERDAY AND TODAY TO TALK ABOUT COMMUNITY HEALTH WORKERS AND THEIR ROLE AND THE NEXT PHASE OF CARE. AND CLINICAL PRACTICE AND RESEARCH FOR HIV AND AIDS PATIENTS. SO IT HAS GONE WELL. WE ACTUALLY WERE VERY PLEASED THAT DR. SYLVIA TRENT ADAMS, THE HHS PRINCIPLE DEPUTY SECRETARY FOR HEALTH, COULD ACTUALLY JOIN US AND SHE PRESENTED AND IT IS ONE OF HER PASSIONS AS WELL. AND MOST IMPORTANTLY, AS I STATED YESTERDAY, SHE IS A NURSE AS WELL. SO IT'S GOOD TO HAVE THAT LEADERSHIP IN THAT POSITION. SO HOPEFULLY, THE WORK THAT WAS PUT INTO THIS WILL BRING GREAT OUTCOMES IN THE FUTURE AND REALLY IMPROVE THE HEALTH. NRSA INDIVIDUAL FELLOWSHIPS, F31s AND 32s AND INSTITUTIONAL TRAINING GRANTS, T32s, ALLOW RECYPIANTS TO RECEIVE TRAINING IN CLINICAL RESEARCH. SO NINR HAS PRODUCED A SHORT GUIDANCE DOCUMENT SUMMARIZING THE SPECIFIC INSTRUCTIONS FOR APPLICANTS. SO APPLICANTS NEED TO REVIEW THE GUIDANCE DOCUMENT AND FOLLOW INSTRUCTIONS. IT'S A REVIEW. IF THEY COULDN'T FOLLOW INSTRUCTIONS, HOW COULD THEY BE A RESEARCHER? BUT FOLLOW INSTRUCTIONS FOR THIS RELEVANT FUNDING OPPORTUNITY ANNOUNCEMENT. I'M SURE WE CAN HAVE THE LINK AVAILABLE ON OUR WEBSITE AS WELL AS THE SLIDE. AND ADDITIONAL INFORMATION IS AVAILABLE FROM THE NIH INTRAMURAL NEXUS. ACTING DEPUTY DIRECTOR FOR CHIEF OF THE OFFICE OF END OF LIFE AND PALLIATIVE CARE RESEARCH. WE ARE VERY EXCITED BECAUSE SHE HAS BEEN ASKED TO BE THE NON-SPONSOR FEDERAL PARTNER OR NINR HAS BEEN ASKED TO BE THE NON-SPONSORED FEDERAL PARTNER. AND SHE IS GOING TO REPRESENT NINR IN THIS CONGRESS REQUESTED REPORT. AND THE AGENCY FOR HEALTH CARE RESEARCH AND QUALITY IS BRINGING APPROPRIATE GROUPS TOGETHER TO LOOK AT HOSPICE AND PALLIATIVE CARE AND DEVELOP AND DISSEMINATE INFORMATION FOR PATIENTS, FAMILIES AND HEALTH PROFESSIONALS ABOUT PALLIATIVE CARE. SO JERRY IS EXTREMELY KNOWLEDGEABLE ABOUT THIS. HAS BEEN WORKING WITH THIS COMMUNITY FOR MANY YEARS. AND HER EXPERTISE HAS BEEN RECOGNIZED AND SOUGHT AFTER. SO WE ARE VERY PLEASED THAT THEY HAVE INCLUDED HER AND THE WORK THAT WE ARE DOING IN DEVELOPING THIS. SO THEY ARE USING A SYSTEMATIC REVIEW PROCESS TO DEMONSTRATE BENEFIT OF PATIENT ACCESS TO PALLIATIVE CARE. AND THE INTERDISCIPLINARY SERVICES PROVIDED TO PATIENTS BY PROFESSIONALS, TRAINED IN HOSIS AND PALLIATIVE CARE. THEY PLAN TO HAVE THAT REPORT OUT LATER THIS YEAR. I'D ALSO -- WE ARE VERY PROUD OF OUR OWN PALLIATIVE CARE RESEARCH COOPERATIVE GROUP. I'D LIKE TO HIGHLIGHT SOME OF THEIR ACTIVITIES THIS YEAR. THE PALLIATIVE CARE RESEARCH COOPERATIVE GROUP COMMITTED TO SEARCHING AS A SECTION EDITOR FOR THE METHODOLOGICAL REVIEW SECTION OF THE JOURNAL OF PAIN AND SYMPTOM MANAGEMENT. THEY ARE ALSO DOING A COUPLE OF SYMPOSIUMS AT THE 2020 EUROPEAN ASSOCIATION OF PALLIATIVE CARE RESEARCH MEETING. AND THEY ARE DEVELOPING AND DISSEMINATING EVIDENCE AND CONSENSUS-BASED FAMILY CAREGIVER OUTCOME MEASURES. SO AGAIN, IT'S RECOGNITION OF WHERE WE HAVE PUT OUR EMPHASIS OVER THE LAST SEVERAL YEARS AND USING THIS EXPERTISE TO IMPROVE HEALTH OUTCOMES. IN AUGUST, NINR RELEASED TWO NEW NIH FUNDING OPPORTUNITY ANNOUNCEMENTS THAT ENCOURAGE RESEARCH TO DETERMINE THE REQUIREMENTS AND BEST PRACTICES FOR PALLIATIVE CARE IN HOME AND COMMUNITY SETTINGS. AND THESE FUNDING OPPORTUNITIES ARE PROVIDED UNDER RO1 AND R21 GRANT MECHANISMS. THEY ARE FIRST DUE IN OCTOBER OF THIS YEAR AND THEY'LL BE OPEN FOR MULTIPLE YEARS. AND NOW JUST A LITTLE BIT ABOUT FIVE FUNDED PROGRAMS WE SUPPORT. AND WHAT THEY ARE FUNDING. SO IN THE AREA OF WOMEN'S HEALTH, A SINGLE-SITE RANDOMIZED CLINICAL TRIAL TESTED WHETHER COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA IMPROVED DEPRESSIVE SYMPTOMS, MALADAPTIVE THINKING AND SOMATIC HYPERAROUSAL IN POST-MENOPAUSAL WOMEN WITH INSOMNIA. THE STUDY COMPARED THE COGNITIVE BEHAVIORAL THERAPY TO SLEEP RESTRICTION THERAPY AND ALSO HAD A CONTROL ARM THAT WAS JUST SLEEP HYGIENE EDUCATION. WHILE NO DURABLE TREATMENT EFFECTS WERE PRODUCED WITH SLEEP HYGIENE EDUCATION, THE COGNITIVE BEHAVIORAL THERAPY AND THE SLEEP RESTRICTION THERAPY REDUCED DEPRESSIVE SYMPTOMS, DYSFUNCTIONAL BELIEF ABOUT SLEEP AND PRE-SLEEP SOMATIC HYPERAROUSAL IN POST-MENOPAUSAL WOMEN WITH THE COGNITIVE BEHAVIORAL THERAPY PRODUCING SUPERIOR RESULTS. SO, WE ARE EXCITED ABOUT THAT. ANOTHER STUDY FOCUSED ON IDENTIFYING LATE SUBGROUPS OF SELF-REPORTED COGNITIVE PROBLEMS AMONG POST-MENOPAUSAL WOMEN WITH AND WITHOUT BREAST CANCER. IT EXPLORED ASSOCIATIONS BETWEEN MEMBERSHIP AND THESE SUBGROUPS AND THEIR DEMOGRAPHIC CLINICAL AND SYMPTOM CHARACTERISTICS AS WELL AS VARIATIONS IN CANDIDATE GENE POLYMORPHISMS. THREE LATENT SUBGROUPS WERE IDENTIFIED. MORE FREQUENT PERSISTENT AND ALMOST NEVER. RECEIPT OF CHEMOTHERAPY PLUS THE ANTI-CANCER HORMONE THERAPY DEPRESSION SYMPTOMS AND BASELINE NEUROPATHIC SYMPTOMS INCREASED THE ODDS OF BELONGING TO THE MORE FREQUENT SUBGROUP, ACK SIGHTY AND DEPRESSIVE SYMPTOMS INCREASED ODDS OF BELONGING TO THE PERSISTENT SUBGROP IN ADDITION. SO WHEN WE ARE LOOKING AT THE GENOTYPE ERCC5, INCREASE THE ODDS OF REPORTING MORE FREQUENT COGNITIVE PROBLEMS. SO LOOKING AT COMBINING SYMPTOMS WITH THE GENOTYPE AND SEEING IF WE CAN COME UP WITH SOME WAYS TO IDENTIFY WHO WILL RESPOND TO TREATMENT IS A VERY IMPORTANT AREA FOR NURSING SCIENCE. SO IN THE AREA OF SLEEP, A PILOT STUDY TESTED AN INTENSIVE CARE UNIT SLEEP PROMOTION PROTOCOL THAT RESTRICTED NON-URENT BEDSIDE CARE OVERNIGHT HAVING BEEN AN INTENSIVE CARE NURSE FOR FOUR YEARS OR LONGER, I KNOW I WORKED MANY NIGHT SHIFTS. I KNOW I WOKE UP MY PATIENTS A LOT AT NIGHT AND YOU DID ALWAYS WONDER WHAT WAS THE UNINTENTIONAL EFFECTS OF THAT. SO THIS PARTICULAR INTERVENTION HAD 32% FEWER ROOM ENTREES AND THEY SAW 9.1 FEWER MINUTES OF IN-ROOM ACTIVITY. SO THE INTERVENTION GROUP ALSO HAD SOUND LEVELS THAT WERE 2.5 DECIBELS LOWER. SO OVERALL, THE INTERVENTION DECREASED IN-ROOM ACTIVITY AND SOUND WHICH PROVIDES BETTER OPPORTUNITIES FOR SLEEP. AND I THINK THAT IS A GOOD THING. JUST A FEW MORE. SO YOU'LL KNOW WHAT YOUR DOLLARS ARE FUNDING OR WHAT THE DECISIONS THAT ARE MADE AROUND THIS TABLE ARE FUNDING. SO A FEW ADVANCES FROM THE AREA OF PRE-TERM INFANT CARE AND ALSO CARDIOVASCULAR HEALTH. SO IN THE PRE-TERM INFANT CARE, YOU HAVE A RANDOMIZED SINGLE CENTER CLINICAL TRIAL, THE VALUE OF MEASURING GASTRIC RESIDUALS IN PRE-TERM INFANTS WAS EXAMINED TO DETERMINE THE EFFECTS OF OMITTING THE PRE-FED GASTRIC RESIDUAL EVALUATION AND NUTRITIONAL OUTCOMES. SO BASICALLY MAKING A DECISION TO NOT DO AN EVALUATION BEFORE YOU DO THE FEEDING. AND BY COMPARING THE OMISSION OF THIS EVALUATION WITH PRE-FED GASTRIC AND RESIDUAL EVALUATION, THE STUDY FOUND THAT AMONG EXTREMELY PRE-TERM INFANTS, THE OMISSION OF GASTRIC RESIDUAL EVALUATION INCREASED THE DELIVERY OF INTERIM NUTRITION OR WHAT THEY WERE ABLE TO TAKE IN. IT IMPROVED WEIGHT GAIN AND LED TO EARLIER HOSPITAL DISCHARGE. SO ANOTHER EXAMPLE OF REALLY TRYING TO EFFECT PRACTICE. STUDY OF PRE-TERM INFANTS INVESTIGATED IMPACT OF EARLY-LIFE IMPACT OF THE TRAJECTORY OF GUT MICROBILE STRUCTURE AND THEY FOUND THAT IN NICK YOU, STRESS EXPOSURE HAD A SIGNIFICANT EFFECT ON THE TYPE OF MICROBIOME THAT THE INDIVIDUAL HAD. AND THE FINDINGS SUGGEST THAT EARLY LIFE NICU STRESS MAY SIGNIFICANTLY INFLUENCE THE DEVELOPING GUT MICROBIOME WHICH IS IMPORTANT TO THE PRACTICE THERE AS WELL AS TO FUTURE MICROBIOME RESEARCH. AND LASTLY, IN THE AREA OF CARDIOVASCULAR HEALTH, A STUDY WAS CONDUCTED TO IDENTIFY PREDICTORS OF HEALTH STATUS IN THE SAMPLE OF RACIALLY AND ETHNICALLY DIVERSE PATIENTS WITH HEART FAILURE USING A WEB-BASED MOBILE HEALTH APPLICATION. USING ACROSS SECTIONAL STUDY OF URBAN ACADEMIC CENTER, PATIENTS WITH HEART FAILURE SELF REPORTED SYMPTOMS BY WAY OF MOBILE HEALTH APPLICATION PREDICTORS OF BETTER HEALTH STATUS AND HEALTH FAILURE INCLUDED HIGHER PHYSICAL FUNCTION AND ABILITY TO PARTICIPATE IN SOCIAL ROLES AND ACTIVITIES. PREDICTORS OF POOR HEALTH STATUS WERE NEW YORK HEALTH ASSOCIATION FUNCTIONAL CLASS 4 AND DYSPNEA. PATIENT CENTERED INTERVENTIONS SHOULD FOCUS ON MODIFIABLE RISK FACTORS THAT REDUCE DYSPNEA, IMPROVE FUNCTIONAL STATUS AND ENHANCING ENGAGEMENT IN SOCIAL ROLES TO IMPROVE THE HEALTH STATUS OF PATIENTS WITH HEART FAILURE. SO THOSE WERE JUST SOME SELECT EXAMPLES. AND HERE IS SOME SELECT NINR FUNDING OPPORTUNITY ANNOUNCEMENTS INCLUDING IMPROVING INDIVIDUAL AND FAMILY OUTCOMES THROUGH CONTINUITY AND COORDINATION OF CARE AND HOSPICE. CLUSTER CHARACTERIZATIONS IN CHRONIC CONDITIONS. NEW ONSET DEPRESSIVE SYMPTOMS AND ACUTE ILLNESS. ADDRESSING CHRONIC WOUND TRAJECTORIES THROUGH SOCIAL GENOMICS RESEARCH AND END OF LIFE AND PALLIATIVE NEEDS OF ADOLESCENT AND YOUNG ADULTS. NOW, TO SWITCH JUST TO TRAINING, THE 2019 SUMMER GENETIC INSTITUTE WAS HELD IN JUNE. IT'S STILL ONE MONTH LONG. INSTITUTES DR. YVETTE IS OUR COUNCIL MEMBER AND VERY INVOLVED IN THAT PARTICULAR ACTIVITY HERE AND WE APPRECIATE ALL THAT SHE BRINGS TO THAT. THIS YEAR'S CLASS INCLUDED 26 PARTICIPANTS FROM REPRESENTING THE UNIVERSITYES FROM ACROSS THE COUNTRY AND BRINGS US TO OVER 400 GRADUATES SINCE 2000 WHO ARE MAKING A DIFFERENCE IN COMMUNITIES ACROSS THE COUNTRY. THE APPLICATION PERIOD FOR THE 2020SGI WILL OPEN MID-NOVEMBER AND CLOSES IN MARCH. NINR METHODOLOGIES BOOTCAMP THIS YEAR. YOU CAN SEE THERE WERE A LOT OF PEOPLE THERE. AND WE WERE VERY, VERY PLEASED WITH THE OUTCOMES THIS YEAR. IT ADDRESSED DIGITAL HEALTH DATA AND SMART TECHNOLOGIES AND IN ADDITION TO FEATURED SPEAKERS THIS YEAR, BOOTCAMP INCLUDED A PANEL SESSION ON THE ALL OF US INITIATIVE AND POSTER PRESENTATIONS. OUR DIVISION OF INTRAMURAL RESEARCH 2019 SUMMER TRAINEES ARE A GROUP -- ARE PICTURED HERE. THE SUMMER INTERNS CONDUCTED RESEARCH FOR EIGHT WEEKS. SOME TRAINEES WERE AT NIH TRAINING PROGRAMS AND ARE FROM NIH TRAINING PROGRAMS SUCH AS THE COMMUNITY, COLLEGE SUMMER ENRICHMENT PROGRAMS AND THE GRADUATE SUMMER OPPORTUNITY TO ADVANCE RESOURCE. EARLIER, DR. GOTTESMAN MENTIONED THE GRADUATE PARTNERSHIP PROGRAM. IT'S APPLICATION PERIOD IS OPEN NOW. THIS IS A WONDERFUL OPPORTUNITY FOR UNIVERSITIES AROUND OUR COUNTRY TO DO THE DIDACTIC TRAINING IN THEIR HOME UNIVERSITY AND THEN THE STUDENT WILL COME TO NINR TO THE DO THEIR DISSERTATION WITHIN THE LABS HERE. WHAT I HAVE SEEN IS THAT THOSE INDIVIDUALS WHO TAKE ADVANTAGE OF THIS PROGRAM ARE VERY SUCCESSFUL FOLLOWING THE PROGRAM. WE HAVE GREAT OUTCOMES FROM THIS PROGRAM. SO I HIGHLY RECOMMEND THAT PEOPLE CAN LOOK AT THIS AND CONSIDER DOING THIS. NINR WAS REPRESENTED BY 11 TRAINEES AT THE NIH POSTBAC POSTER DAY. SOME PEOPLE ASKED ME WHAT IS A POSTBAC? IT'S NOT NORMAL IN A UNIVERSITY SETTING TO HAVE POSTBACS. NIH HAS MANY POSTBACS BECAUSE NIH HAS A VERY STRONG TRAINING MISSION. A POSTBAC IS AN INDIVIDUAL WHO HAS A BACCALAUREATE DEGREE AND COMES TO NIH TO WORK IN RESEARCH LABS FOR 1-2 YEARS. IT'S LIMITED TO ONLY TWO YEARS. AT THE END OF 1-2 YEARS THEY HAVE APPLIED TO A GRADUATE PROGRAM AND WILL GO BACK TO SCHOOL AT THAT POINT. SO SOME PEOPLE IN OUR POSTBACS, WE USUALLY HIRE A NUMBER OF POSTBACS. THIS YEAR IT LOOKS LIKE WE HAVE ABOUT 10 OR SOMETHING. 11. SO SOME WILL GO TO CLINICAL PSYCHOLOGY -- PEOPLE WHO ARE INTERESTED IN CLINICAL PSYCHOLOGY, NURSING, MED SCHOOL, AND MANY OF THE BIOLOGICAL PH.D. PROGRAMS AS WELL. A LITTLE BIT ABOUT THE NINR STAFF NEWS. I'M PLEASED TO ACKNOWLEDGE FOUR OUTSTANDING STAFF FROM NINR'S DIVISION OF EXTRAMURAL PROGRAMS AND DIVISION OF INTRAMURAL RESEARCH WHO ARE RECOGNIZED AT THE 2019 NIH DIRECTOR'S AWARD CEREMONY HELD IN JULY. SO THIS IS A BIG DEAL HERE ON CAMPUS. SO WE WERE VERY PROUD OF DR. MICHELLE HAMLET WHO RECEIVED TWO AWARDS FOR HER WORK ON THE NIH-WIDE EFFORT TO RESTRUCTURE THE R15 RESEARCH ENHANCEMENT AWARD. AND ALSO FOR HER WORK WITH ALL OF US SCIENTIFIC PRIORITIES DEVELOPMENT TEAM. DR. MARTHA MA TOKA AND BRIAN WALLET EACH RECEIVED AN AWARD FOR THEIR CONTRIBUTIONS TO THE TRANS-NIH BIOLOGIC IN SELFOPATHY. -- ENCEPHALITIS -- THAT WILL DO. [ LAUGHS ] IT'S CHRONIC-FATIGUE SYNDROME IS THE OTHER MECFS WORKING GROUP. DR. REBECCA RECEIVED AN AWARD FOR HER WORK ON THE INCLUDE PROJECT LEADERSHIP TEAM TO DEVELOP AND LAUNCH A TRANS-NIH INITIATIVE ADDRESSING THE HEALTH AND QUALITY OF LIFE NEEDS FOR INDIVIDUALS WITH DOWN'S SYNDROME AND ITS CO-OCCURRING CONDITIONS. SO PLEASE HELP ME IN CONGRATULATING DOCTORS HAMLET, MA TOKA, WALLET AND RASULI. [ APPLAUSE ] VERY GOOD. NINR'S DIVISION OF SCIENCE POLICY AND PUBLIC LIASON PREPARED A HANDOUT REGARDING OUR RECENT OUTREACH EFFORTS AND THIS HANDOUT HAS BEEN PROVIDED TO COUNCIL MEMBERS AND COPIES ARE ALSO AVAILABLE AT THE TABLE ON THE FRONT DOOR. I BELIEVE I NOW SEE OUR POSTING JOB ANNOUNCEMENT FOR THE DIRECTOR. IT'S VERY -- IT'S NICE BEING THE ACTING DIRECTOR. YOU ASK FOR SOMETHING AND IT JUST -- [ LAUGHS ] IT JUST APPEARS. THANK YOU NATHAN VERY MUCH WHEREVER YOU FOUND THEM. THANK YOU FOR DOING THAT. SO, AGAIN, I WANT TO EXPRESS MY APPRECIATIONS TO ALL OF YOU FOR BEING HERE TODAY. I THINK IT'S GOING TO BE A WONDERFUL AFTERNOON. WE WILL BE GETTING STARTED SHORTLY. I'M NOT SURE IF YOU START RIGHT NOW OR IF I HAVE SOME MORE ANNOUNCEMENTS TO DO. SO I APOLOGIZE FOR THAT. OUR NEXT PRESENTER IS DR. JESSICA GILL WHO I INTRODUCED NUMEROUS TIMES. THE PART THAT I WOULD PROBABLY LIKE TO EMPHASIZE HERE IS THAT SHE IS TENURED HERE AT NIH AND HER WORK HAS INVOLVED BIOMARKERS FOR TRAUMATIC BRAIN INJURY AND THAT'S WHERE HER SCIENCE HAS REALLY BEEN BUILT. SHE IS A WONDERFUL COLLABORATOR, AND BECAUSE OF HER JOY AND EXPERIENCE WITH COLLABORATIONS, SHE HAS BEEN ABLE TO BUILD SOME OF OUR SCIENCE PROGRAM WITH OTHER INSTITUTES, WHICH REALLY DOES LEVERAGE WHAT WE -- OUR ABILITIES AND WHAT WE CAN DO, AS WELL AS WITH OTHER AGENCIES. SO AT THIS POINT IN TIME, DR. GILL, GO RIGHT AHEAD, JESSICA. >> JESSICA GILL: THANK YOU VERY MUCH, THAT MIGHT BE THE LAST TIME YOU INTRODUCE ME SO I APPRECIATE IT. SO TODAY I GET THE PLEASURE OF TALKING ABOUT WHAT IS GOING ON IN OUR INTRAMURAL PROGRAM AND SOME OF THE CHANGES AND WHERE WE ARE GOING WITH THOSE. SO IT REALLY IS THE FOCUS IS TO UNDERTAKE STUDIES AND UNDERSTAND THE MECHANISMS THAT UNDERLIE THE DEVELOPMENT OF SYMPTOMS ACUTELY AS WELL AS CHRONICALLY. HOW CAN WE UNDERSTAND THE NATURE OF INDIVIDUAL VARIATION, INCLUDING GENETICS, DIET, EXERCISE AND OTHER TYPES OF THINGS THAT CAN IMPACT AN INDIVIDUAL'S HEALTH? HOW CAN WE UNDERSTAND THE MECHANISMS AND THEN FIND MODIFIABLE FACTORS THAT WE CAN INTERVENE ON TO OVERALL IMPROVE THE HEALTH AND WELL-BEING OF THE PATIENTS WE SERVE. OUR MISSION HERE IS GREATLY ENHANCED BY THE ACTIVITIES OF THE CLINICAL DIRECTOR AND THE CLINICAL DIRECTOR OFFICE, WHICH IS IS SUE WINGATE WHO I DON'T SEE HERE TODAY. BUT HER OFFICE BASICALLY HELPS US WITH INSTRUMENTING ALL OF HER ACTIVITIES FROM THE BEGINNING OF AN IDEA OF A PROTOCOL TO IMPLEMENTATION, TO UNDERTAKING IT SAFELY TO DOING THE MOST PRODUCTIVE SCIENCE WE CAN WITH THE RESOURCES WE HAVE. INCLUDING IN HER OFFICE ARE RESEARCH NURSES WHO ARE JUST AMAZING AND MAKE OUR LIVES EASY HERE OR AT LEAST AS EASY AS CAN BE IN THE FEDERAL GOVERNMENT. AS WELL AS OVERSIGHT FOR QUALITY MANAGEMENT AND ALL COMPONENTS OF CLINICAL TRIALS. DR. PAMELA IS INSTRUMENTAL TO ALL THE WORK WE DO HERE. TRAINING IS A WIG PRIORITY. ALL THE TEAMS INTEGRATE TRAINEES FROM HIGH SCHOOL STUDENTS UP TO POSTGRADUATES INCLUDING POSTDOCTORAL FELLOWS AND RESEARCH FELLOWS. WE TAKE GREAT PRIDE AND EFFORT TO PROVIDE TRAINING ENVIRONMENT THAT IS OPTIMAL AND TO REALLY HELP INDIVIDUALS GET THE TRAINING AND TRANSLATIONAL SCIENCE TO BE ABLE TO DO THAT WORK HERE AND THEN ALSO PROMOTE IT ACROSS THE COUNTRY AND ACROSS THE WORLD. SO THE RECENT ADVANCES HAVE OUR FIRST ROBERT WOOD JOHNSON FELLOW THAT JUST STARTED SO WE ARE EXCITED TO HAVE THAT. WE ALSO TALKED ABOUT THIS AS WELL AS BOOTCAMP. I THINK IT'S NICE TO HIGHLIGHT THIS IS THE WAY THE INTRAMURAL PROGRAMS ALSO BRIDGE WITH EXTRAMURAL TO FIND WAYS TO WORK MORE TOGETHER TO MAKE THE MOST OF NURSING SCIENCE AND SO WE LOOK FORWARD IN THE FUTURE TO DEVELOP ADDITIONAL ABILITIES TO COLLABORATE AND TO BRING ADDITIONAL INDIVIDUALS HERE AND TO PARTNER WITH YOU AND TO PROVIDE SERVICE AND TRAINING TO THOSE INDIVIDUALS IN NURSING SCIENCE. WE HEARD A LOT ABOUT NEIL. WE HAD OUR KICKOFF WHICH WAS VERY SUCCESSFUL. WE HAD 300 INDIVIDUALS ATTEND IN PERSON AND THEN WE HAD ABOUT 600 INDIVIDUALS WATCH THE VIDEOCAST. SO THAT REALLY GOES TO SHOW HOW MUCH EXCITEMENT IS COMING BEHIND THIS AND I THINK HOW MUCH IT CAN REALLY CHANGE THE WAY WE LOOK AT NURSING SCIENCE. SO DR. SAL BEGAN IS THE PERFECT PERSON TO BE DESIGNING THIS AND MOVING IT FORWARD. I WORKED WITH LEO, WE STARTED POSTDOCS ON THE SAME DAY A LITTLE WHILE AGO. BUT SEEN HIM AND SEEN HIM MOVE FORWARD IN HIS SCIENTIFIC CAREER AND LEAD THIS HUGE EFFORT IS AMAZING TO SEE AND WE COULDN'T DO IT WITHOUT HIM. OVERALL, YOU'LL SEE THIS AGAIN, I BELIEVE. BUT REAL THE IS THE SYMPTOM SCIENCE MODEL, THE FOUNDATION OF WHAT WE DO HERE AT NINR. WHAT WE DO IS LOOK AT A SYMPTOM OR SET OF SYMPTOMS THAT ARE OFTEN CO-MORBID TO UNDERSTAND THE NATURE AND THE EXPERIENCE OF THAT SYMPTOM TO THE PATIENT, THEIR FAMILIES AND THEIR COMMUNITIES. WE CHARACTERIZE THAT TO REALLY LOOK AT THE SEVERITY AND THE TYPE OF SYMPTOMS TO UNDERSTAND THE IMPACT TO THE OVERALL HEALTH AND WELL-BEING OF THAT INDIVIDUAL. WE THEN UNDERTAKE STUDIES TO UNDERSTAND THE BIOMARKERS THAT CONTRIBUTE TO THE DEVELOPMENT OF IT AS WELL AS THE MAINTENANCE OF THAT SYMPTOM AND DEFICIT TO REALLY UNDERSTAND THE MECHANISMS THAT ARE UNDERLYING BOTH THE DEVELOPMENT AS WELL AS CHRONIC SYMPTOMS OVER TIME. THIS ALLOWS TO YOU IDENTIFY THERAPEUTIC TARGETS TO MODIFY OR CHANGE THE RISK FACTORS TO OVERALL IMPROVE THE HEALTH AND WELL-BEING OF THE PATIENTS WE CARE FOR. WE ARE EXCITED TO HAVE DR. PAULY JOSEPH HERE IN THE AUDIENCE. ALSO BRIDGING AND A KEY COLLABORATOR WITHIN MANY, MANY INSTITUTES HERE. SHE DOES POWERFUL RESEARCH HERE ON THE NIH CAMPUS WHICH HAS BEEN WELL RECOGNIZED. SHE IS NOW ALSO WITH THE NATIONAL INSTITUTES OF ALCOHOL AND ABUSE AND ALCOHOLISM PROVIDING A BRIDGE. THE PROGRAM SHE DESIGNED AND IS IMPLEMENTING HERE IS TO LOOK AT THE NEURAL CALL AND MOLECULAR MECHANISMS ARRANGEMENTED TO SYMPTOMS WITH SENSORY EXPERIENCE AND APPLY TO METABOLIC DISORDERS TO BETTER UNDERSTAND MECHANISMS TO RELATE TO THE DEVELOPMENT OF TYPTYPE II DIABETES AND OBESITY. ONE OF THE MANY PUBLICATION THAT IS DR. JOSEPH HAD THIS YEAR IS PICTURED HERE SHE SHOWED DIFFERENTIAL ACTIVATION IN AREAS OF THE BRAIN IN THOSE INDIVIDUALS WHO ARE MORE LIKELY TO DEVELOP OBESITY GIVING US IDEAS HOW TO CHANGE THIS AND HOW TO MAKE SENSORY FUNCTION TO CHANGES IN NEUROLOGICAL FUNCTION AND HIGHLIGHTING THE ABILITY TO DO THIS COLLABORATIVE RESEARCH HERE AT NINR. DIVERSITY IS ONE OF OUR KEY COMPONENTS HERE AND PAULY IS OUR ADVOCATE FOR DIVERSITY. TRYING TO CHALLENGE THE WAY THAT WE SEE IT AND HOW WE CAN BE THE BEST SCIENTIST POSSIBLE. MY AREA IS THE TISSUE INJURY BRANCH. WHAT I LOOK AT ARE CONCUSSIONS AND TRAUMATIC BRAIN INJURIES. WHAT WE KNOW IS THAT THESE ARE COMMON INJURIES IN THE LIVES OF AMERICANS AS WELL AS PEOPLE AROUND THE WORLD. BUT WHAT WE DON'T KNOW IS WHY SOME INDIVIDUALS WILL HAVE SIMILAR INJURIES AND BE FINE WHEREAS, HAVE LASTING SYMPTOMS. THE FOCUS OF MY LAB IS UNDERSTANDING THAT NATURE OF INDIVIDUAL VARIATION SO WE CAN IDENTIFY THOSE INDIVIDUALS EARLY WHO WE NEED TO INTERVENE WITH. WHO WE CAN FOLLOW OVER TIME AND THEN PREVENT ADDITIONAL EXPOSURES IF NEEDED. SO THIS IS A HIGHLIGHT FROM ONE OF OUR STUDIES THAT WE JUST COMPLETED. THIS IS WITHIN NCAA CARE CONSORTIUM, THE LARGEST CONCUSSION STUDY TO DATE. WE HAD ABOUT 40,000 INDIVIDUALS WITHIN THIS STUDY. WE ARE NOW GOING ON TO THE SECOND PHASE OF THE STUDY WHERE WE FOLLOW THESE INDIVIDUALS AS THEY GO INTO THE WORKPLACE AND BEGIN FAMILIES. THIS FIRST PHASE WAS DURING COLLEGIATE PLAY. WHAT IS UNIQUE IS WE GET A SAMPLE BEFORE THEY ARE EXPOSED TO ANY TYPE OF COLLEGIATE EXPOSURE TO SPORTS-REALITY CONCUSSION AND THEN FOLLOW THEM OVER THEIR FOUR YEARS IN COLLEGIATE PLAY. WE FOUND OVERALL USING ULTRASENSITIVE TECHNOLOGY IS TAU IS SIGNIFICANTLY INCREASED IN ATHLETES WHO REQUIRED PROLONGED RETURN TO PLAY. SO IT GIVES US AN IDENTIFICATION AND REPLICATION OF THIS FINDING. IN ADDITION TO THAT, WE ALSO FIND THAT THOSE ATHLETES WHO MADE THAT PROLONGED RETURN TO PLAY ALSO HAVE DIFFERENTIAL ACIVITY OF APROTEIN CALLED G FAB, ONE OF THE PROTEINS IDENTIFIED TO ALLOW FOR THE IDENTIFICATION OR DIAGNOSIS OF CONCUSSION IN EMERGENCY ROOMS. SO AGAIN WE EXPAND ON THAT. WHAT IS REALLY IMPORTANT ABOUT THESE RETURN PLAY DECISIONS IS THAT WHAT WE KNOW IS THAT AN ATHLETE HAS A CONCUSSION AND GOES BACK TO PLAY TOO SOON, SEVEN TIMES MORE LIKELY TO HAVE ANOTHER CONCUSSION IN THE NEXT MONTH. IF THEY DO HAVE THAT CONCUSSION, THEY ARE MUCH MORE LIKELY TO HAVE NON OPTIMAL RECOVERY AND THOSE ATHLETES ARE COMPROMISED. SO HAVING OBJECTIVE BIOMARKERS HELP TO INFORM THIS DIST DECISION INCREASES SAFETY OF ATHLETES AS OF RIGHT NOW WE ARE RELIANT ON SUPPORT FROM THEM AND THE COACH AND THE TRAINER. MOST PEOPLE WANT TO GET BACK TO PLAY. BUT WE. THE LAST BRANCH IS ADVANCED VISUALIZATION BRANCH. PATTY BRENNAN IS THE NATIONAL DIRECTOR OF THE NATIONAL LIBRARY OF MEDICINE. I THINK EVERYBODY HERE AT THE NIH HAS AT LEAST TWO JOBS. SHE IS ADDING DEPTH TO WHAT WE CAN DO HERE. SHE HAS A LAB THAT IS BEING ABLE TO ENGAGE PATIENTS AND ADD TO WHAT WE CAN DO. OVERALL, HER FOCUS TO IMPROVE PATIENT SAFETY THROUGH THE MANAGEMENT OF ENGAGING PRESENTATION OF HEALTH INFORMATION. THIS IS SOMETHING THAT IS NOT BEING DONE RIGHT NOW AT NIH SO REALLY ADDS A DIFFERENT COMPONENT ABOUT WHAT WE CAN DO. WE HAVE ALSO HAD EXCITING DEVELOPMENT IN OUR LAB OVER THE LAST YEAR. DR. KIM WHO OVERALL SEES THIS AND NEVER COMES TO ANY OF THESE MEETINGS BUT WE REALLY APPRECIATE ALL OF THE EFFORT HE PUTS IN. HE IS HERE. THE ONE TIME I SAID HE WASN'T HERE. [ LAUGHS ] WE APPRECIATE ALL HE DOES. HE COMES IN ON SATURDAYS WITH THE FREEZERS GO DOWN AND IS REALLY THE HALLMARK, THE FOUNDATION OF DEVELOPING A VERY NOVEL LAB. WHAT IS NOVEL ABOUT OUR LAB IS WE DON'T FUNCTION ON ONE TYPE OF BIOMARKER BUT WE HAVE A COMPREHENSIVE ABILITY TO GO ACROSS ALL THE FUNCTIONS OF BIOMARKERS TO LOOK AT ANYTHING FROM GENETIC PRE DISPOSITION TO EXOSOMES THAT ALLOW US TO GET TO CENTRAL FUNCTIONS USING PERIPHERAL BLOOD. WE CHALLENGE OURSELVES TO GET THE MOST WE CAN OUT OF BIOMARKERS WE LOOK AT WITHIN THE FLUIDS WE COLLECT. AND SO IT'S CHALLENGING THE PARADIGM TO DO THAT. THIS YEAR WE ADDED RNA SEQUENCES IN SINGLE CELL AS WELL AS ADVANCES IN EXOSOMES. AND WE ENCOURAGE YOU TO REACH OUT TO US. WE ARE HAPPY TO SHARE THE DATA WE ARE GENERATING AS WELL AS METHS AND TO HELP PEOPLE PARTNER TOGETHER. LASTLY, WE ALSO HAVE CHELSEA WAGNER WHO JOINED US AND I SEE HER OVER THERE. SHE IS A MAJOR ADDITION TO OUR LAB. SHE COME IN WITH AMAZING AMOUNT OF ENTHUSIASM AND CLEANED UP THE LAB AND ORGANIZED ALL OUR FREEZERS AND ALL THE THINGS WE NEGLECTED. SO WE ARE HAPPY TO HAVE HER HERE. SO AS WE CHANGE AND EVOLVE AND WE SAY FAREWELL TO DR. CARBON, WE ARE EXCITED ON WHAT WE ARE DOING THROUGH SYMPTOM SCIENCE WITH INNOVATIVE CLINICAL INFRASTRUCTURE AS WELL AS LAB TO LOOK TO THE FORWARD OF NURSING AND DO THE BEST SCIENCE WE CAN. WE LOOK FORWARD TO PARTNERING TO BUILD THIS PROGRAM AND TO DO TRAINING AS WELL AS RESEARCH TO REALLY MOVE NURSING SCIENCE FORWARD. THANK YOU. [ APPLAUSE ] >> ANN CASHION THANK YOU VERY MUCH, JESSICA. GREAT JOB. SO NOW, THE ONLY THING THAT IS KEEPING YOU FROM YOUR BREAK AND THE POSTER SESSIONS IS, WE'LL READ A LIST OF WHO IS VISITING TODAY. I HAVE TO READ THEM, RIGHT? OKAY. [ LAUGHS ] SO VALERIEEDDLE SON, NICK, CATHY, LISA, EMILY, KARIN, MIO, KEN, MAY, CHRISTINE, NADA -- I HAVE NEVER BEEN ABLE TO SAY YOUR LAST NAME, NADA [ INAUDIBLE ] [ READING ] THEY ARE ALL FROM DIFFERENT ORGANIZATIONS, INCLUDING ONCOLOGY, NURSING SOCIETY TO UNIVERSITY IN TURKEY. WE HAVE SOME VISITING US FROM CEDAR SINAI AS WELL AS COLUMBIA, UNIVERSITY OF MARYLAND, JOHNS HOPKINS, AND KENTUCKY AND NOVA RESEARCH COMPANY AS WELL. AND THE JOHN MAY LOU FOUNDATION. SO THANK YOU VERY MUCH FOR BEING HERE. WE WILL NOW TAKE A BREAK AND DO THE POSTERS. WE WILL START UP AGAIN AT 2:30. STATE OF THE SCIENCE METHODOLOGIES TO UNDERSTAND THE PATHOBIOLOGY OF COMPLEXES. HE IS A SOUGHT-AFTER SPEAKER NATIONALLY AND INTERNATIONALLY AS WELL AS ONE OF OUR BEST MENTORS. SO HE JUST DOES AN EXCELLENT JOB, AND WE ARE VERY PROUD OF WHAT HE IS DOING. SO DR. SALIGAN. IT'S ALL UP TO YOU NOW. >> DR. SALAGAN: THANK YOU. I APPRECIATE EVERYTHING, YOUR MENTORSHIP AND LEADERSHIP AND THE KIND INTRODUCTION. VERY TOUCHING. GOOD AFTERNOON, EVERYONE. SO, MY ROLE IS TO -- SOME OF YOU HAVE ATTENDED OUR JUNE LAUNCH WHICH WAS REALLY VERY SUCCESSFUL AND HAPPY ABOUT IT. THIS WOULD BE TO REVISIT THE OVERVIEW OF THE CENTER BUT AT THE SAME TIME I WILL GIVE YOU SOME UPDATES OF OUR RECENT ACTIVITIES. ONE OF THE THEMES THAT IS DRIVING OUR STRATEGIC PLAN IS FOCUSING ON SYMPTOM SCIENCE. SPECIFICALLY VERY DEDICATED TO CONDUCTING RESEARCH IN MOLECULAR AND BEHAVIORAL MECHANISMS UNDERLYING SYMPTOMS. THROUGH THIS PROCESS, WITE LIES DIFFERENT APPROACHES TO EXPLORE INDIVIDUAL VULNERABILITIES FROM SYMPTOMS AFFECTED FUNCTION, QUALITY OF LIFE AND PERFORMS. SO WE USE OUR DISCOVERIES TO DEVELOP CLINICAL INTERVENTION THAT INFORMS SYMPTOM ETIOLOGY AND SYMPTOM MANAGEMENT. YOU HAVE SEEN THIS SLIDE A FEW HOURS BACK. BUT THIS IS THE SYMPTOM SCIENCE MODEL AND I'M REALLY EXCITED THAT A LOT OF OUR PH.D. STUDENTS THAT I HAVE TALKED TO AND HAVE MENTORED, UTILIZED THIS MODEL IN THEIR ACTIVITIES. SO OUR FOCUS IN THE DIVISION OF INTRAMURAL RESEARCH IS GUIDED BY THE SYMPTOM SCIENCE MODEL WHICH STARTS OUT BY OUR AWARENESS OF A COMPLEX SYMPTOM AND OUR ATTEMPT TO CHARACTERIZE THE PHENOTYPE AND MOST OF THE TIME, DIFFERENT PHENOTYPES OF SYMPTOMS. AND USE THIS CHARACTERIZATION TO EXPLORE BIOLOGIC MARKERS ASSOCIATED WITH THE SYMPTOM PHENOTYPE. AND THEN USE PRE-CLINICAL OR SOMETIMES CLINICAL APPROACHES. OFTENTIMES PROOF-OF-CONCEPT INTERVENTIONS TO VALIDATE FUNCTIONALLY VALIDATE, THE RELATIONSHIP OF THE BIOMARKERS TO THE SYMPTOM OF INTEREST. WE PROPOSE TO INTEGRATE THE SYMPTOM SCIENCE MODEL INTO THE ACTIVITIES OF THE CENTER. WE ENVISION IT WILL SERVE AS A HUB TO ADVANCE SCIENCE AND PHYSICIAN HEALTH. SO, WE AT THE CENTER SEE IT AS A TRANS-NIH RESOURCE WHERE INTERDISCIPLINARY RESEARCH TEAMS ASSEMBLE AROUND COMMON SYMPTOMS OR A COMMON SYMPTOM THAT AFFECT THE PERSON'S QUALITY OF LIFE. WE ALSO ENVISION THAT THIS CAN BRIDGE AND FURTHER ADVANCE COLLABORATION BETWEEN INTRAMURAL AND EXTRAMURAL SCIENTISTS TO TACKLE SYMPTOM RESEARCH CHALLENGES. WHAT ARE SOME OF THESE EXAMPLES OF THE SYMPTOM SCIENCE RESEARCH CHALLENGES? ONE IS THE CAPACITY TO INVESTIGATE SYMPTOM CLUSTERS. AND TO UNDERSTAND THE SYNERGY TO LINK BIOLOGIC MARKERS WITH SUBJECTIVE SYMPTOM EXPERIENCES OF PATIENTS. SO HOW WE ALL STARTED. WE STARTED BY BRINGING IN DR. MARGARET GRAY. MARGARET GRAY ASKED AROUND THE COUNTRY AMONG INTRAMURAL AND EXTRAMURAL SYMPTOM SCIENTISTS EXPERTS AS WELL AS THOSE THAT HAVE STARTED DIFFERENT CENTERS OR PROGRAMS SIMILAR TO THIS. SO DURING 2015, DR. GRAY DID THAT, WENT AROUND AND ASKED FOR INPUT AND ADVICE AND RECOMMENDATION ABOUT THE FEASIBILITY OF CREATING A CENTER WITHIN THE NIH INTRAMURAL PROGRAM. THERE WAS A GREAT DEAL OF ENTHUSIASM TO DEVELOP A CENTER. BY THE SAME TIME, THERE WAS CAUTION THERE NEEDS TO BE A CLEAR MISSION AND VISION OF THE CENTER. SO ON AUGUST 15, WE GATHERED EXPERTS BOTH THROUGH EXTRAMURAL AND INTRAMURAL, TO A ROUNDTABLE AND TASKED THESE EXPERTS TO ESTABLISH THE MISSION, THE VISION AS WELL AS LAY OUT SPECIFIC OBJECTIVES FOR THE SSC. SO IT WAS CONCLUDED THAT THE MISSION OF THE SYMPTOM SCIENCE CENTER SHOULD BE TO PROMOTE UNDERSTANDING OF THE BIOLOGICAL AND BIOBEHAVIORAL MECHANISMS OF SYMPTOMS TO IMPROVE PATIENT OUTCOMES. ALSO ENVISION THAT THE SYMPTOM SCIENCE CENTER SHOULD PROVIDE AN INTEGRATED AND FOUNDATIONAL NEXUS FOR BOTH COMMUNITIES, FOR BOTH THE SCIENTIFIC AND CLINICAL COMMUNITIES TO UNDERSTAND AND QUANTIFY SYMPTOM EXPERIENCES ACROSS THE LIFESPAN. IT WAS LAID OUT THAT ACTIVITIES OF THE SYMPTOM SCIENCE CENTER SHOULD TOKE US ON PROMOTING DISCOVERY AS WELL AS CREATING COLLABORATIVE AND INTERDISCIPLINARY TEAMS. IT WAS ALSO ADVISED THAT THE SYMPTOM SCIENCE CENTER NEEDS TO DEVELOP AND CONTRIBUTE TO THE SYMPTOM SCIENCE DATA REPOSITORY. AND ONCE THAT IS ESTABLISHED, WE NEED TO DEVELOP PREDICTIVE TREATMENT MODELS TO HELP WITH RISK ASSESSMENT AS WELL AS OPT MICE SYMPTOM MANAGEMENT. -- OPTIMIZE -- THE CORE AND THE HEART OF THE SCIENCE CENTER NEEDS TO BE EXPANDING SYMPTOM EXPERTISE THROUGH MENTORSHIP. SO, IN ORDER TO ADDRESS AND MEET THIS MISSION, THE VISION AND OBJECTIVES, WE THOUGHT WE NEED TO BUILD THREE PILLARS OF THE SYMPTOM SCIENCE CENTER. ONE, IT NEEDS TO BE PATIENT-CENTERED. IT ALSO NEEDS TO UTILIZE INNOVATIVE TECHNOLOGY AS WELL AS EMBRACE THIS TRANSLATIONAL SCIENCE THAT SERVES AS A CULTURE OF THE NIH INTRAMURAL PROGRAM. IN ORDER TO LEVERAGE THE EXISTING RESOURCES AND SYSTEMS OF NIH, PARTICULARLY IN THE NIH CLINICAL CENTER WHERE COLLECTING SYMPTOMS DATA THROUGH ACROSS NIH, IT WAS LOGICAL STRATEGY FOR US TO STRENGTHEN OUR COLLABORATION WITH THE NIH CLINICAL CENTER NURSING DEPARTMENT. SO THROUGH THAT AND THROUGH OUR CHIEF NURSE. SO THROUGH OUR COLLABORATION, WE UTILIZED EXISTING ADVANCEMENTS THAT ARE ALREADY PRESENT AND BEING USED IN THE NIH INTRAMURAL PROGRAM. BUT WE PUSHED OURSELVES AND LOOKED INTO OTHER AND EXPLORED OTHER INNOVATIVE TECHNOLOGICAL PLATFORMS TO BE ABLE TO CREATE ANALYSIS TO STANDARDIZE ASSESSMENT OF SYMPTOMS, NOT JUST WITHIN OUR STUDIES IN THE CLINICAL CENTER BUT SERVE AS A CHAMPION AS EXPERTS ACROSS NIH. HOW DO YOU ASSESS HEALTH OUTCOMES? THAT'S A GREAT PLACE TO START FOR THE SYMPTOM SCIENCE CENTER. TECHNOLOGY IS TO CONTRIBUTE TO THE EXISTING COMMON DATA ELEMENT INITIATIVE OF NNR, A LOT OF US KNOW, THIS INITIATIVE WAS BROUGHT ABOUT BY THE 2015 REPORT WHICH EMERGED FROM THE CENTER DIRECTOR'S MEETING AND RECOMMENDED THE NEED FOR DATA COLLECTED FROM NINR-FUNDED STUDIES TO BE IN A REPOSITORY. SO BACK IN AUGUST, 2016, NINR APPROVED THE CREATION OF A COMMON DATA REPOSITORY AND NAMED THIS THE COMMON DATA REPOSITORY FOR NURSING SCIENCE OR CDRNS. IT WAS SPEARHEADED BY THE NINR EXTRAMURAL DIVISION. SO, WE COLLABORATED WITH OUR COLLEAGUES IN THE NINR EXTRAMURAL TO PROVIDE A SPACE FOR THE NINR INTRAMURAL TO CONTRIBUTE TO THE INITIATIVE AND EXPAND THE LIBRARY. WITH THE STAFF OF THE SYMPTOM SCIENCE CENTER, THEY EXPANDED THAT AND WE HAVE MORE THAN 3500 COMMON DATA ELEMENTS IN OUR NINR LIBRARY. TRANSLATIONAL SCIENCE. THE OTHER PILLAR, IS TO UTILIZE AND OPTIMIZE THE EXPERTISE BUT ALSO THE RESOURCES OF NINR LAB. THE NINR LAB SPACE, AS SOME OF YOU HAVE VISITED, AND IF YOU HAVEN'T, PLEASE REACH OUT TO US AND WE CAN DO A LAB TOUR OF OUR SPACE AT NINR LABS. THE NINR LAB HAS EXPERTISE TO CONDUCT INNOVATIVE APPROACHES AND HAVE THE ABILITY TO DO MUCH MORE FUNCTIONAL VALIDATION USING IN-VITRO EXPERIMENTS. THESE EFFORTS ARE ALSO COMPLIMENTED THROUGH OUR TRANS-NIH COLLABORATIONS THROUGH VALUABLE ACCESS TO NINR CORE LABS ACROSS CAMPUS. IN FACT, ONE OF THE EXAMPLES OF THESE TRANS-NIH COLLABORATION IS OUR PARTNERSHIP WITH ESTABLISHED ANIMAL CORE LABS IN NHLBI, FOR EXAMPLE, WITH A LOT OF METABOLIC EXPERIMENTS OF SYMPTOMS, AND NIMH HAS A HUGE BEHAVIORAL CORE FACILITY JUST TO PHENOTYPE SYMPTOMS. AND THESE COLLABORATIONS HAVE HELPED US TO DEVELOP ANIMAL SIMPLE MODEL IN ORDER FOR US TO ADVANCE OUR INVESTIGATION TO UNDERSTAND CENTRAL AND PERIPHERAL UNDERPINNINGS OF SYMPTOMS. OF COURSE, ONE OF THE VALUABLE PIECES OF SYMPTOM SCIENCE IS THE PATIENT-CENTERED CLINIC. WE OPENED AND HAPPY TO REPORT THAT WE OPENED OUR CLINIC DOORS LAST WEEK WHEN WE ENROLLED OUR FIRST PATIENT FOR OUR STUDY, WHICH IS PATIENT-CENTERED ASSESSMENT OF SYMPTOMS AND OUTCOMES. WE CALL IT SIMPLY THE PICASSO STUDY. AND ALSO, WE ARE HAPPY TO REPORT THAT A LOT OF STUDIES ARE IN THE PIPELINE IN DIFFERENT LEVELS OF REVIEW AT THE MOMENT. SO THE CLINIC, SYMPTOM SCIENCE CENTER CLINIC SERVES AS A HUB FOR PHENOTYPING AND MANAGEMENT OFTEN REFERRED FROM OTHER STUDIES. WE HAVE A LIST OF PEOPLE AND COLLABORATORS THAT ARE REALLY EXCITED TO SEND THEIR PATIENTS JUST TO REFER TO OUR PATIENTS TO BE ABLE TO PHENOTYPE THE DIFFERENT SYMPTOMS, PARTICULARLY FATIGUE, MY SYMPTOM OF INTEREST. SO IT'S A GREAT OPPORTUNITY FOR US TO HAVE THESE RESOURCE IN ORDER TO DIG DEEPER INTO THE BIOLOGY OF SYMPTOMS BUT AT THE SAME TIME, CHAMPION ACROSS NIH, BE AN EXPERT ON HOW TO OPTIMIZE OUR SYMPTOM ASSESSMENT AS WELL& AS EVENTUALLY THE SECOND PHASE IS MANAGED SYMPTOMS. SO, THE CLINIC ALSO FUNCTIONS AS A VENUE FOR COLLABORATIVE STUDIES. FOR EXAMPLE, IN PAIN, IN SLEEP, AND REHAB MEDICINE, AS WELL AS TRAINING AND BUILDING OUR DATA REPOSITORY. IN TERMS OF EXPANDING PARTNERSHIP CURRENTLY SYMPTOM SCIENCE CENTER TO EXPAND PARTNERSHIP WITH OTHER INSTITUTES. FOR EXAMPLE, WE HAD HIGH LEVEL OF DISCUSSIONS WITH NATIONAL CENTER FOR COMPLEMENTARY INTEGRATIVE HEALTH. THEY HAVE THE WHOLE ESTABLISH OF THE PAIN CENTERS. IT'S LOGICAL FOR US TO JOIN TOGETHER AND JOIN FORCES TO BE ABLE TO PHENOTYPE BOTH SYMPTOMS IN PAIN AND FATIGUE. WE ALSO PARTNER WITH OTHER ONGOING NIH INITIATIVES SUCH AS THE ALL OF US INITIATIVE. AND CURRENTLY, JUST THIS MONTH OF SEPTEMBER, THE SCHEDULE TO HAVE HIGH-LEVEL MEETINGS WITH OTHER SENIOR LEADERSHIP OF SEVERAL ORGANIZATIONS WHO ARE INTERESTED TO PARTNER WITH US IN THE SYMPTOM SCIENCE CENTER. FOR EXAMPLE, THE ONCOLOGY NURSING SOCIETY WE HAVE A MEETING NEXT MONDAY TO DISCUSS ON HOW WE CAN PARTNER AND ESPECIALLY IN TRAINING. WE ALSO HAVE MEETINGS SOMETIME AT THE END OF SEPTEMBER WITH ISOL LEADERSHIP TO BRING IN MORE NURSE TRAINEES INTO SYMPTOM SCIENCE CENTER AND EXPOSE TO ALL THESE DIFFERENT OPPORTUNITIES. THE CORE OF THE CENTER IS COMMITTED TO TRAINING, PARTICULARLY TO DEVELOP THE NEXT GENERATION OF NURSE SCIENTISTS. SO THE MOST COMMON THAT HAS BEEN MENTIONED A LOT THIS AFTERNOON, THE MOST COMMON ESTABLISHED TRAINING OF NINR, DIVISION OF INTRAMURAL RESEARCH, ARE THE SGI, WHICH IS COMING TO 20th YEAR. REALLY VERY EXCITING. OF COURSE THE MOSTLY POPULAR METHODOLOGIST BOOTCAMP WHICH OFTENTIMES CLOSED WITHIN SECONDS AFTER REGISTRATION OPENS. SO PLEASE TAKE NOTE OF WHEN THE NEXT REGISTRATION IS OPEN. AND OF COURSE, WE HAVE A LOT OF REALLY TALENTED STUDENTS THAT ARE COMING THROUGH OUR GRADUATE PARTNERSHIP PROGRAM AT THE MOMENT. WE ALSO HAVE DIFFERENT OPPORTUNITIES. FOR EXAMPLE POSTBAC LAUREATE FELLOWSHIP AND THE POSTDOCTORAL FELLOWSHIP. AND WILL WE ARE HAPPY TO WELCOME, WE STARTED TWO WEEKS AGO, DR. LATISHA GRAY, OUR FIRST POSTDOCTORAL FELLOW WHO STARTED THROUGH THE SYSTEM SCIENCE CENTER, THIS IS OUR PARTNERSHIP WITH THE ROBERT WOOD JOHNSON FOUNDATION FOR EARLY CAREER INVESTIGATOR WHO WILL BE MENTORED NOT ONLY EXPOSED TO DIFFERENT CORE LABS IN NINR AS WELL AS OTHER NIH PARTNERS, BUT ALSO WILL BE MENTORED IN GRANT WRITING AND DIFFERENT ON-CAMPUS TRAININGS. SO, IN THIS PARTICULAR OPPORTUNITY AND TIME, WE HAVE REALLY REMANAGED HOW WE MOVE FORWARD IN OUR TRAINING -- REMANAGED -- WE LOOKED AT OUR CURRICULUM AND HOW TO USE THE SYSTEM SCIENCE CENTER AND THE TRAINING OPPORTUNITIES FOR ALL NURSE SCIENTISTS THAT WILL BE GOING THROUGH NINR. HOPING TO IMPROVE THE RIGOR OF THEIR INVESTIGATIONS. SO WHAT CAN ONE EXPECT TO GAIN AFTER TRAINING IN THE SYMPTOM SCIENCE CENTER? OF COURSE, TRAINING WILL BE TAILORED. THIS WILL BE DRIVEN SPECIFICALLY BY THE TRAINEE, ESPECIALLY THE POSTDOCTORAL TRAINEE. SO, IT WILL BE TAILORED DEPENDING ON THE TRAINEE OF INTEREST BUT AS WELL AS THE LENGTH OF ROTATION, ESPECIALLY NOW THAT WE ARE HAVING THIS DISCUSSION WITH DIFFERENT FOUNDATIONS SUCH AS THE ONS AND I SAW SOME OF THEM CAN COMMIT TO SHORT PERIODS FOR TRAINING. OUR CURRICULUM WILL BE BUILT BASED ON THOSE DEMANDS. THERE IS ALSO OPPORTUNITIES THAT ONLY IN TRAINING AND ALSO TO REACH AND BUILD THEIR OWN MATRIX OF MENTORS AS THEY ROTATE IN THE DIFFERENT LABS AT NINR AND ALSO POTENTIAL COLLABORATORS. THIS THE IS AN OPPORTUNITY FOR OUR TRAINEES TO DEVELOP THAT. AND OF COURSE HIGHLIGHT THE TRANSLATIONAL NATURE OF SYMPTOM INVESTIGATION. SO THOSE ARE THE DIFFERENT OPPORTUNITIES THAT WE HAVE IN THE NINR SYMPTOM SCIENCE CENTER AND WE ARE REALLY LOOKING FORWARD TO EACH ONE OF YOU TO BE EXPOSED AND ALSO TO COLLABORATE WITH THE FUTURE ACTIVITIES OF THE SYMPTOM SCIENCE CENTER. THANK YOU VERY MUCH. [ APPLAUS ] >> ANN CASHION: THANK YOU LEO. WE WILL HAVE A PANEL PRESENTATION AFTER THE NEXT THREE PRESENTERS. BUT LEO, I SEE, IS NOT ON THE PANEL. DO YOU HAVE ANY SPECIFIC QUESTIONS ABOUT THE SYMPTOM SCIENCE CENTER THAT YOU WOULD LIKE TO ASK AT THIS POINT? SHIRLEY? >> [ OFF MICROPHONE ] SO WHAT ARE THE PLANS? WHAT IS THE SUNSETTING? WILL THAT AFFECT OUR ABILITY TO ACCESS THOSE TOOLS? THE COST OF THEM? THE SCORING OF THEM? THAT SORT OF THING? >> LEO: THANK YOU. SO IT WILL NOT AFFECT AS FAR AS MOST OF THE COMMON DATA ELEMENTS INITIATIVE AND THEY ARE UTILIZED THE PROMISE MEASURES FOR THE NINRCEs AND THOSE ARE AVAILABLE READILY THROUGH THE CDRNE. AND A LOT OF OUR CENTERS THAT ARE ABLE TO USE THAT. COLLABORATION WAS IN THE INTRAMURAL PARTICULARLY, THOSE COMMON DATA ELEMENTS THAT WE'VE EXPANDED, USED IN EXPANDING THE CDL LIBRARY CAN READILY BE USED THROUGH THE PROMISE MEASURES AND WE CAN USE THAT THROUGH SPECIFIC COLLABORATIONS. >> MY QUESTION IS WITH THE SUNSETTING OF THE PROMISE. I MEAN, I'M JUST WONDERING WILL WE NOW BE CHARGED? NOW WE GO FREE TO A WEBSITE. WE ACCESS THE TOOLS. WE DO THE SCORING AND EVERYTHING. BUT I'M ASSUMING THERE IS SOMEBODY BEHIND THAT, FUNDING ALL OF THAT. AND THAT THAT WILL NOW END. SO I WAS WONDERING -- I THOUGHT MAYBE YOU WOULD HAVE AN INSIDE TRACK INTO WHAT IT MEANS FOR US. >> LEO: I CAN ONLY SPEAK FROM THE INTRAMURAL. WE HAVE COLLABORATIONS, FOR EXAMPLE, AT THE MOMENT, THAT THROUGH MTAs OR DIFFERENT FORMS OF MOUs THAT OUR COLLABORATORS CAN UTILIZE THE LIBRARY THROUGH THE INTRAMURAL SPACE FOR FREE WITHOUT CHARGE. I KNOW THAT THERE ARE AREAS THAT YOU NEED TO UTILIZE THE COMMERCIAL PROMISE, BUT THROUGH COLLABORATION WITH INTRAMURAL INVESTIGATORS, THOSE ARE AVAILABLE FOR FREE. >> ANN CASHION: WE'LL HAVE TO GET THE OTHER ANSWERS TO THAT. >> AS WE MOVE -- WE DON'T WANT INTRA-- [ MULTIPLE SPEAKERS ] >> ANN CASHION: I HAVE NOT BEEN TOLD ANYTHING OTHERWISE BUT WE NEED TO ASK THE QUESTION AND MAKE SURE. >> I'LL JUST SAY ONE THING. SO THE PROMISE MEASURES WILL REMAIN AS FAR AS I'M AWARE, WILL REMAIN FREE AND PUBLICLY AVAILABLE. JUST ONE NOTE IS THAT THIS WAS A COMMON FUND FUNDED PROGRAM THAT IS FUNDED FROM THE OFFICE OF THE DIRECTOR AND THIS IS TYPICAL FOR ALL COMMON FUND PROGRAMS THAT SUNSET AFTER A SET AMOUNT OF TIME. SO THIS IS JUST PART OF A NORMAL THING. SO JUST WANTED TO POINT THAT OUT THAT IT'S NOT LIKE THERE WAS ANY DECISION MADE TO SUNSET THESE. THE PLAN IS NORMALLY, IF THE ICs THAT ARE INVOLVED IN THE COMMON FUND PROGRAMS ARE INTERESTED AND MAINTAINING OR CONTINUING OR EXPANDING THE PROGRAMS THAT THE ICs COME TOGETHER AND DO THAT INDEPENDENT INDEPENDENTLY. >> RITA D YOU HAVE A QUESTION? >> RITA: I DO, BUT I'M NOT SURE I CAN ARTICULATE IT CLEARLY. SO IT HAS TO DO WITH THE BIOLOGIC MECHANISM PART OF THE SYMPTOM SCIENCE FRAMEWORK. SO, WHAT WORK IS THERE -- I'M NOT SURE IT'S CLEAR TO ME WHAT ALL THE BIOLOGIC MECHANISM ACTIVITY IS? IS IT GENETIC? METABOLOMICS? >> ANN CASHION: FROM THE FRAMEWORK ITSELF? WHEN IT WAS CREATED 3-4 YEARS AGO OR MAYBE LONGER NOW, IT WAS BIOMARKERS WERE THE THING IN VOGUE SO WHEN I CREATED IT, I THINK I HAVE REGRETTED USING THAT WORDING BECAUSE TO US, IT'S MORE BIOLOGIC MECHANISMS. SO IT'S SORT OF WHATEVER IF IT'S THE MICROBIOME, IF IT'S THE RNA EXPRESSION DATA. WHATEVER IS THAT PIECE THAT HELPS MOVE THE SCIENCE, A MORE BIOLOGIC PIECE FOR THE SCIENCE. THAT'S MY PERSONAL RESPONSE TO YOU ON THAT. >> SORT OF IN LINE WITH WHAT SHIRLEY BROUGHT UP, THERE IS AN EXTRAMURAL COMMUNITY THEY LOOKS AT THAT MODEL. AND MAYBE IS USING IT. SO THEN MY FOLLOW-UP QUESTION WOULD BE, ARE YOU ALL WORKING ON UPDATING OR REVISING THAT MODEL? THERE MAY ALSO BE BEHAVIORAL MECHANISMS THAT ARE NOT AT ALL BIOLOGIC AND I WONDER WHAT SORT OF EXPLORATION THAT THE NEW SYMPTOM SCIENCE CENTER MIGHT BE ENGAGED IN THAT WOULD BE DOING THAT SORT OF WORK AS WELL. AND I THINK THE EXTRAMURAL COMMUNITY WOULD BE INTERESTED IN A REVISED MODEL SHOULD THAT BE -- >> ANN CASHION: FROM AN EDITOR OF A JOURNAL IT'S NICE TO HAVE THOSE TYPES OF QUESTIONS POSED. [ LAUGHS ] >> A NEW MODEL HAS BEEN PROPOSED BUILDING ON THAT, IN THE CENTERS PAPER THAT WAS RECENTLY PUT OUT ON VISION HEALTH, I BELIEVE. THAT ONE. WHERE WE TOOK THAT MODEL AND MADE -- I DON'T WANT TO SAY MASSIVE CHANGES TO IT, BUT ADDED A LOT TO IT. IT DIDN'T CHANGE. IT JUST ADDED A LOT TO IT. AND CREATED DEFINITIONS THAT ARE MORE INCLUSIVE MORE THAN JUST GENETIC MARKERS AND THAT SORT OF THING. >> ANN CASHION: SO IN THE UNDERSTANDING THAT WE ARE ON A TIMEFRAME NOW AND I REALLY LOVE THE DISCUSSION, I THINK IT IS ALSO A CHALLENGE THAT LEO, YOU AND YOUR TEAM NEED TO LOOK AT THAT MODEL AND OVER TIME, OR WHEREVER, BUT SOMEWHERE THINK ABOUT WHAT YOU WANT TO DO WITH THE MODEL AND MAKE OF THE MODEL AND ITERATIONS AS THEY GO FORWARD. ED. >> LEO: ABSOLUTELY. THAT IS OUR NUMBER 1 ITEM FOR MONDAY'S MEETING. >> ANN CASHION: I'M HERE FOR TWO WEEKS. HE'S LISTENING TO ME FOR THE NEXT TWO WEEKS. OKAY. LET ME INTRODUCE OUR NEXT SPEAKER THEN. OUR NEXT SPEAKER IS DR. DAVID BRODIE AND HIS PRESENTATION IS GOING TO BE AN EXAMPLE OF SOME OF THE COLLABORATIONS THAT WE WE ARE VERY PLEASED HE'S COME. HE IS THE DIRECTOR FOR THE CENTER FOR NEUROSCIENCE AND REGENERATIVE MEDICINE AND A PROFESSOR OF NEUROLOGY AT THE UNIFORM SERVICES UNIVERSITY OF THE HEALTH SCIENCES IN BETHESDA, MARYLAND. HE IS RIGHT ACROSS THE STREET FROM HERE. SO HIS RESEARCH FOCUSES ON ACCELERATING BETTER OUTCOMES IN THE MILITARY TRAUMATIC BRAIN INJURY PATIENTS, TBI PATIENTS. HE HAS DEVELOPED AND AUTHENTICATED ADVANCED IMAGING TECHNOLOGIES TO THE INJURED BRAIN'S WHITE MATTER AND SHOWED FOR THE FIRST TIME HOW TO PREDICT NEUROLOGICAL FUNCTION BY MEASURING AMYLOID AND ABNORMAL PROTEIN IN THE BRAIN. HE ALSO HELPED DISCOVER THAT THE FUSION IMAGING AND ADVANCED MAGNETIC IMAGING TECHNIQUE CAN REVEAL BLAST-RELATED DAMAGE. HE HAS PREVIOUSLY LED A TEAM THAT WORKED IN PARTNERSHIP WITH THE U.S. DEPARTMENT OF DEFENSE IN GERMANY AND IN TWO SITES IN AFGHANISTAN. TREATING U.S. MILITARY PERSONNEL WITH TBI. HIS ACHIEVEMENTS HAVE BEEN RECOGNIZED WITH SEVERAL AWARDS INCLUDING A CAREER DEVELOPMENT AWARD FROM THE NATIONAL INSTITUTED OF NEUROLOGICAL DISORDERS AND STROKE, NINDS AND THE BOROUGH'S WELCOME CAREER AWARD IN THE BIOMEDICAL SCIENCES. SO WE HAVE CERTAINLY ENJOYED WORKING WITH DR. BRODIE AND WE LOOK FORWARD TO HEARING YOUR PRESENTATION. THANK YOU. >> DR. BRODIE: THANK YOU, EVERYBODY. GOOD AFTERNOON. TERRIFIC. CAN YOU ALL HEAR ME? IS THAT BETTER IF I USE THE MICROPHONES? ARE THERE PEOPLE ON LINE? TERRIFIC. SO FIRST OF ALL, ALL SYMPTOMS EXIST IN THE BRAIN. THERE IS NOWHERE ELSE THEY ARE. THAT IS WHERE SYMPTOMS ARE, IN THE BRAIN. THERE MAY HAVE OTHER MECHANISMS BUT EVENTUALLY FINAL COMMON PATHWAY IS IN THE BRAIN. SO I THINK IT'S APPROPRIATE TO TALK ABOUT SYMPTOM SCIENCE FOCUSING FOR A MOMENT ON THE BRAIN. SO, MY WORK IS ENTIRELY FOCUSED ON TRAUMATIC BRAIN INJURY. THE LESSONS I'M GOING TO HOPEFULLY TALK ABOUT A LITTLE BIT TODAY ARE BROADLY APPLICABLE TO A WIDE VARIETY OF OTHER CONDITIONS, BRAIN AND OTHER CONDITIONS THROUGHOUT THE BODY, AND I'VE HAD A REALLY GREAT OPPORTUNITY TO COLLABORATE WITH DR. GILL AND JESSICA GILL OVER MANY YEARS NOW AND WE REALLY SEE EYE-TO-EYE. SO I'M HONORED THAT YOU INVITED ME TO COME SPEAK HERE TODAY BECAUSE I THINK OUR VIEWS OF THE WORLD ARE FUNDAMENTALLY CONCORDANT. SO, THE TITLE OF MY TALK TODAY IS ONE BITE AT A TIME. CLINICAL TRIALS FOR INDIVIDUAL SYMPTOMS OF TRAUMATIC BRAIN INJURY. THESE ARE MY MANDATORY DISCLOSURES. I DON'T IS ANY CONFLICTS OF INTEREST AND THESE ARE JUST MY VIEWS NOT THOSE OF THE DEPARTMENT OF DEFENSE OR ANY OF THE OTHER ORGANIZATIONS. FIRST, IN OUR CENTER, IN THE CENTER FOR NEUROSCIENCE AND NEUROGENITIVE MEDICINE, WE ISSUED A CALL FOR ACTION FOR TBI RESEARCH. AND THAT IS THAT WE ARE NOT DOING A GREAT JOB. WE HAVE DONE A LOT OF WORK, A LOT OF SCIENCE. WE HAVE DISCOVERED A LOT OF THINGS ABOUT TRAUMATIC BRAIN INJURY, BUT THEY HAVE NOT REALLY LED TO IMPROVED OUTCOMES FOR PATIENTS WITH TRAUMATIC BRAIN INJURY. SO, WE CALLED FOR OUTCOMES OR ACTION. LET'S DO SOMETHING THAT REALLY MAKES A DIFFERENCE. IN ORDER TO DO THAT, I'M GOING TO REVIEW AND IDENTIFY THE PITFALLS OF THE THINGS THAT HAVE NOT WORKED AND PRESENT AN OVERALL FRAMEWORK FOR WHAT WE WOULD LIKE TO DO IN THE FUTURE WITH REGARD TO TRAUMATIC BRAIN INJURY RESEARCH. I'M GOING TO PRESENT AN EXEMPLAR, ONE OF MANY EXEMPLARS THAT ONE COULD PRESENT BUT I'LL PRESENT ONE PARTICULAR EXAMPLE OF A SYMPTOM-FOCUSED TRIAL THAT ALSO USES PRETTY ADVANCED TECHNOLOGY TO TREAT THE SYMPTOM OF DEPRESSION, DEPRESSED MOOD FOLLOWING TRAUMATIC BRAIN INJURY BUT USING AGAIN AS I MENTIONED, PRETTY ADVANCED INDIVIDUAL PERSONALIZED MEDICINE APPROACHES. SO, THE BOTTOM LINE, TRAUMATIC BRAIN INJURY IS A HARD PROBLEM. THE WE ALL WORK ON HARD PROBLEMS. THIS IS WHY WE ARE HERE. WE WORK ON HARD PROBLEMS. SO THE ADVICE FROM GENERAL ADAMS WAS WHEN EATING AN ELEPHANT, TAKE ONE BITE AT A TIME. AND SO THAT'S WHAT WE PROPOSE TO DO. SO, HERE IS OUR CALL FOR ACTION. THERE HAS BEEN OVER 30 LATE-PHASE CLINICAL TRIALS THAT FAILED TO TRANSLATE INTO A THERAPEUTIC AND TRAUMATIC BRAIN INJURY. OTHER FIELDS HAVE SIMILAR LESION FAILURES, LIMITATIONS OF THE ANIMAL MODELS THAT HAVE BEEN USED TO MODEL ANIMAL MODEL TBI. PRE-CLINICAL STUDIES ARE NOT VERY WELL DESIGNED. THERE HAS BEEN A LOT OF HETEROGENEITY IN HUMAN TRAUMATIC BRAIN INJURY SUCH THAT IF YOU HAVE A ONE-SIZE-FITS-ALL, YOU THINK IT WILL WORK ON ALL TRAUMATIC BRAIN INJURY. IT REALLY MAY MISS THE MARK BECAUSE OF THE SO MUCH HETEROGENEITY IN THE FIELD. SAMPLE SIZES HAVE BEEN RELATIVELY SMALL. TRIAL DESIGNS AND PATIENT SELECTION, OUTCOME ISSUES, ALL SERIOUS PROBLEMS IN THE FIELD OF TBI. FOR THIS AUDIENCE I WON'T GET INTO TOO MUCH BECAUSE THAT IS MORE THAN THE MINUTIA OF MY PARTICULAR FIELD OF TBI. BUT I THINK MANY OF YOU WILL PROBABLY RECOGNIZE SIMILAR CHALLENGES IN YOUR OWN FIELDS. IN THE END, WE HAVE VERY FEW SOLUTIONS. I'M A CLINICIAN AND I TAKE CARE OF PATIENTS WITH TBI. I STARTED THE CLINIC IN WASHINGTON UNIVERSITY IN ST. LOUIS. NOW THERE ARE LOTS OF THEM. AND I WORK AT THE TBI CLINIC AT THE WALTER REED HOSPITAL WHERE WE SEE A LOT OF SERVICE MEMBERS. BUT THE LIST OF EVIDENCE-BASED TREATMENTS FOR TRAUMATIC BRAIN INJURY IS WOEFULLY SHORT. SO MOST OF WHAT WE DO IS BASED ON CLINICAL EXPERIENCE, DEFINED AS MAKING THE SAME MISTAKE OVER AND OVER AGAIN AS YOU GET OLDER, WHICH IS MY EXPERIENCE. SO, HERE WHAT ARE SOME POTENTIAL SOLUTIONS? WELL, WE COULD DO ADDITIONAL LARGE TRIALS IN MODERATE TO SEVERE TBI LIKE THE PAST AND THIS IS NOT BEEN SUCCESSFUL DESPITE SUBSTANTIAL EFFORTS. I GUESS THAT IS THE DEFINITION OF OPTIMISM IS TRYING TO DOT SAME THING OVER AND OVER AGAIN TRYING TO GET A DIFFERENT RESULT. BUT THAT'S ONE POSSIBILITY. WE COULD FOCUS ON PREVENTION AND THAT'S TERRIFIC. WE HAVE MADE REALLY TERRIFIC STRIDES ON PREVENTION WITH AIRBAGS AND HELMET SAFETY AND REDUCED CONTACT IN PROFESSIONAL SPORTS AND BALANCE TRAINING AND BETTER FOR ELDERLY INDIVIDUALS AND BETTER MILITARY SERVICE MEMBERS AND I'M ALL IN FAVOR OF PREVENTION. IN NO WAY DO I WANT TO TAKE AWAY FROM PREVENTION. THAT'S NOT ENOUGH. BECAUSE THAT WOULD LEAVE OUR PATIENTS THAT HAVE TBI IN THE LURCH. SO PREVENTION IS GOOD BUT INSUFFICIENT. AND THEN OF COURSE THERE IS THE OPTION OF THE DENIALISM AS ADVOCATED BY ONE OF OUR PREVIOUS NINDS DIRECTORS, WHICH SHE SAID, SEE THAT? THAT'S A SQUASHED BUG. THAT IS TRAUMATIC BRAIN INJURY. YOU GOING TO FIX THAT? [ LAUGHS ] SO NO, THAT'S NOT REALLY FOR US. THAT'S THE OPPOSITE OF OPTIMISM. FOR US THAT'S NOT AN OPTION. OUR PATIENTS DESERVE BETTERTHAN THAT. SO, THEY ARE NOT SQUASHED BUG. THEY ARE WONDERFUL PEOPLE AND DESERVE THE BEST CARE WE CAN PROVIDE FOR THEM. WE CAN DOUBLE DOWN ON BASIC SCIENCE RESEARCH AND I'M NOT IN ANY WAY DISMISSING THAT. I THINK IT'S VERY IMPORTANT TO DOUBLE DOWN ON BASIC SCIENCE RESEARCH AND FIND THE MAGIC BULLET IN THE LABORATORY THAT WILL INTERVENE IN THE SPECIFIC PATHOPHYSIOLOGICAL PROCESSES THAT UNDERLIE THE IMPORTANT SEQUEL I AND TBI AND OTHER SYMPTOMS AND THAT'S REALLY IMPORTANT. BUT AND THAT'S A LONG VIEW BECAUSE THE PATH FROM DISCOVERING A SPECIFIC MECHANISM OR MOLECULAR TARGET THROUGH A CLINICAL THERAPEUTIC IS IN THE MANY DECADES. SO EVEN WHEN THINGS GO WELL, THAT'S A LONG PATH. SO LIKE A GREAT EXAMPLE IN THE FIELD OF NEUROLOGY, WE HAVE GENE RELATED PEPTIDE MONOCLONAL ANTIBODIES TO TREAT MY GRAIN HEADACHE. THAT'S A MAGIC BULLET. IT'S A SPECIFIC PEPTIDE THAT UNDERLIES THE PATHOPHYSIOLOGY OF A SYMPTOM, HEADACHE, A SPECIFIC TYPE OF HEADACHE, MY GRAIN. AND THEY REALLY WORK. THAT'S ABOUT 25 YEARS FROM DISCOVERY TO FDA APPROVAL. AND THAT WAS WHEN THINGS WENT REALLY, REALLY WELL AND THAT WAS WITH THE DRUG COMPANIES POURING GAZILLIONS OF DOLLARS INTO GETTING IT DONE. THAT'S YOUR BEST CASE SCENARIO GOING FROM THAT TO SYMPTOM MANAGEMENT IN 25 YEARS. AND THEN FINALLY, WE COME TO THE PATH THAT I PERSONALLY FAVOR, WHICH IS CLINICAL TRIALS FOCUSED ON ONE SYMPTOM OR ISSUE OR SUBDOMAIN AT A TIME AND THAT'S THE ONE BITE AT A TIME APPROACH AND THAT'S WHAT I'M GOING TO SPEND THE REST OF THE TIME TALKING ABOUT IN TERMS OF BRINGING THINGS THAT ARE USEFUL TO OUR PATIENTS SOONER RATHER THAN LATER. DOES THAT MAKE SENSE SO FAR? TERMS OF FRAMEWORK? ANY QUESTIONS SO FAR? >> [ OFF MICROPHONE ] >> SO THE PATH FORWARD IS TO IDENTIFY CANDIDATES AND TREATMENTS AND EACH ONE FOCUS OF A CLINICAL TRIAL. WE HAVE A FEW SUCCESS STORIES FOR EARLY SEIZURES AND RECOVERY OF CONSCIOUSNESS AFTER VERY SEVERE TBI AND POST-TRAUMATIC ATTENTION DEFICIT DISORDER AND FA TEAL, REPEDDATIVE TRANSCRANIAL MAGNETIC STIMULATION FOLLOWING CONCUSSIVE TBI, MELATONIN FOR INSOMNIA. THESE ARE SPECIFIC SYMPTOMS. NOT FOR CLONALLY FOR TBI. THESE ARE EXAMPLES OF ONE BITE WHERE WE HAVE TAKEN SMALL BITES OUT OF THE ELEPHANT OF TRAUMATIC BRAIN INJURY. BUT IN ORDER TO DO THIS IN A MORE REGULAR AND CONSISTENT FASHION, WE NEED SOME INFRASTRUCTURE, WE NEED A NETWORK OF CLINICAL TRIAL SITES, A SINGLE IRB IDEALLY. KEY DESIGN FEATURES. WE CAN MOVE FASTER WITH CLINICAL TRIAL DESIGN. I'LL TELL YOU ABOUT THE ADAPTIVE DESIGNS WE ARE ENGAGED IN RIGHT NOW. IDENTIFYING SPECIFIC SUBSETS OF PATIENTS THAT ARE MOST LIKELY TO BENEFIT FROM SPECIFIC TREATMENTS. SO IT'S NICE TO TAKE A BITE BUT IT'S ESPECILLY GOOD IF YOU CAN TAKE A BITE OF SOMETHING YOU CAN CHEW ON ANDA SWALLOW AS OPPOSED TO TAKING A BITE OF SOMETHING THAT IS TOO BIG OR TOO TOUGH TO CHEW AND SWALLOW. IT DOESN'T WORK. SO PICKING THE RIGHT BITES TO TAKE IS A KEY THING. WHAT I MEAN IS PICKING SUBSETS OF PATIENTS YOU CAN MAKE A DIFFERENCE IN NOW WITH THE SPECIFIC TREATMENTS YOU HAVE IN YOUR POCKET. OR REASONABLY DEVELOP. AND DOMAIN-SPECIFIC PRIMARY AND SECONDARY OUTCOMES MEASURES. THIS IS WHERE YOU ESPECIALLY CAN BE OF GREAT HELP TO US, I HOPE, AND THAT IS TO FIND THE RIGHT OUTCOME MEASURES. CLINICAL TRIALS ARE ONLY AS GOOD AS PRIMARY OUTCOME MEASURES. IF YOU HAVE THE WRONG ONE, FORGET IT, YOU'RE OUT OF LUCK BEFORE YOU START. SO WE ARE FOCUSING ON SINGLE SYMPTOMS, PATIENT-RELATED, PATIENT REPORTED SYMPTOMS, IT'S CRITICALLY IMPORTANT TO HAVE THE RIGHT OUTCOME MEASURES AND THAT'S AN OPEN DISCUSSION. WE DON'T HAVE ANY STANDARDS IN OUR FIELD ABOUT WHAT THE RIGHT OUTCOME MEASURES ARE. AND SO THIS IS AN OPPORTUNITY FOR US TO ALL COLLABORATE AND WORK ON THIS TOGETHER. SO OVERALL, OUR VIEW IS THAT THIS APPROACH WILL TRANSFORM, REDUCE ITS TIMES, COST ASSOCIATED WITH INDIVIDUAL TRIALS SUCH THAT OUR CENTER IS OUR GOAL IS TO DO 30 TRIALS OVER THE NEXT 10 YEARS FOR ABOUT THE SAME COST AS 10 STAND ALONE TRIALS USING THIS INTEGRATED APPROACH. SO, THAT'S OUR PLAN. YOU'LL SEE ME HERE FOR THE NEXT& DECADE HAMMERING AWAY AT THIS. SO WHAT DO WE MEAN BY ONE BITE AT A TIME? I'M GOING TO BREAK IT DOWN. NOW WE ARE GOING TO GET INTO THE WEEDS A LITTLE BIT AND I'LL BREAK IT DOWN IN TERMS OF WHAT DO WE MEAN BY ONE BITE AT A TIME? SO THE BIG THREE IN TRAUMATIC BRAIN INJURY ARE SLEEP AND FATIGUE WHICH ARE REALLY CLOSELY LINKED. MOST COMPLAINTS OF FATIGUE ARE RELATED TO SLEEP AND SLEEP DISORDERS THE MAIN COMPLAINT IS FATIGUE. AND THAT'S A BIG ONE. MOOD DISORDERS, DEPRESSION AND ANXIETY AND POST-TRAUMATIC STRESS ARE MIXED INTO -- MOST PEOPLE HAVE COMBINATIONS OF THOSE THREE DISORDERS. SO MOOD DISORDERS ARE A MAJOR PROBLEM FOLLOWING TRAUMATIC BRAIN INJURY. POST-TRAUMATIC HEADACHE. I TALKED ABOUT MY GRAIN AND THE FATHO PHYSIOLOGY OF MY GRAIN. THAT'S THE MOST COMMON PERSISTENT SYMPTOM IS THE HEADACHE. AND THEN COGNITIVE DISORDERS, COGNITIVE DYSFUNCTION AFTER TRAUMATIC BRAIN INJURY. THE BIG FOUR SYMPTOM DOMAINS WITHIN TRAUMATIC BRAIN INJURY. THESE HAVE BEEN PRETTY WELL VALIDATED ACROSS A WIDE VARIETY OF POPULATIONS INCLUDING MILITARY SERVICE MEMBERS OF THESE FOUR CLUSTERS. HOW CAN WE TAKE BITES OUT OF THESE? WE HAVE THERAPIES. NEUROMODULATION. PHARMACOLOGICAL INTERVENTIONS. LIFESTYLE MODIFICATIONS AND SOME COMBINATION, HIGH BRAID APPROACHES. LIKE FOR EXAMPLE, IN THE DOMAIN OF MOOD DISORDERS, COGNITIVE BEHAVIORAL THERAPY IS TERRIFIC. IT WORKS FOR MOOD DISORDERS, BUT WE CAN'T BRING IT TO NEARLY LARGE ENOUGH POPULATION. WE HAVE ENOUGH COGNITIVE THERAPISTS WELL-TRAINED THERAPISTS TO DELIVER THE THERAPY TO 5% OF THE PEOPLE WHO NEED IT. THAT IS WOEFULLY INADEQUATE. WE ARE NOT GOING TO HIRE 20 TIMES THE NUMBER OF THERAPISTS. I WISH WE COULD BUT I DON'T THINK THAT IS GOING TO HAPPEN. ONE OF THE THINGS OUR GROUP IS DOING IS WE ARE DEVELOPING SMARTPHONE APPS THAT WILL DELIVER THE BASIC PRINCIPLES OF COGNITIVE BEHAVIORAL THERAPY SPECIFICALLY TAILORED TO MILITARY SERVICE MEMBERS WITH TRAUMATIC BRAIN INJURY. THESE YOUNG MEN AND WOMEN WOULD RATHER INTERACT WITH THEIR SMARTPHONE THAN THEY WOULD WITH A THERAPIST. SO IF ANY OF YOU KNOW A LOT OF 18-24-YEAR-OLDS, YOU WON'T BE SURPRISED BY THAT BUT THAT IS IN FACT THE CASE. SO, SMARTPHONE APPS DELIVER COGNITIVE BEHAVIORAL THERAPY IS A BIG AREA AND VERY SPECIFIC FOCUS COGNITIVE BEHAVIORAL THERAPY IN ONE DOMAIN, NOT BROADLY WHATEVER YOU NEED, BUT REALLY FOCUSED ON DEPRESSION OR REALLY FOCUSED ON ONE SYMPTOM CLUSTER. SO, THAT'S AN EXAMPLE OF A TRIAL THAT WE ARE DOING. WE ARE DEVELOPING THE APP AND THEN A RANDOMIZED CONTROL TRIAL IN THAT DOMAIN. IN THE DOMAIN OF MOOD DISORDERS STILL TRANSCRANIAL MAGNETIC STIMULATION IS A BIG TREATMENT FOR DEPRESSION AND HAS THE OPPORTUNITY TO BE PERSONALIZED IN THE SENSE THAT YOU CAN USE RESTING STATE FUNCTIONAL ACTIVITY, MRI, HIGH-TECH BRAIN MAPPING APPROACH TO MAP THE SPECIFIC MOOD REGULATION CIRCUITRY IN THE INDIVIDUAL PERSON AND DELIVER THE TRANSCRANIAL MAGNETIC STIMULATION TO THE SPOT THAT IS APPROPRIATE FOR THAT INDIVIDUAL PERSON. AND SO I'M GOING TOY SHOULD YOU SOME EXAMPLES OF THAT IN THE NEXT FEW SLIDES BECAUSE THAT'S AN AREA THAT IS ONGOING. IN PHARMACOLOGY, MOSTLY WHAT WE DO IS FOCUS ON EXISTING MEDICATIONS APPLIED TO NEW THERAPEUTICS. SO A DRUG THAT WE USE A LOT FOR MOOD STABILITY. WE DON'T HAVE RANDOMIZED CONTROL DATA ABOUT WHETHER IT WORKS FOR MOOD STABILITY. IT WORKS IN BIPOLAR DISORDER. WE'LL SEE IF IT WORKS IN TBI PATIENTS WITH MOOD INSTABILITY. WE DON'T KNOW. TENSE DAILY CARDIOVASCULAR EXERCISE, ALSO SOMETHING THAT WORKS WELL FOR THE SYMPTOM OF MOOD INSTABILITY IN TRAUMATIC BRAIN INJURY PATIENTS. WE DON'T HAVE RANDOMIZED CONTROL TRIAL DATA. YOU SEE WHAT I'M GETTING AT THE IDEA OF SOME OF THE ONE BITES AT A TIME. AND YOU CAN READ SOME OF THE OTHER ONES. SOME OF THE OTHER ONES ARE IN HERE INCLUDING LIKE NERVE STIMULATION AND GENE RELATEED PEPTIDE FOR ACUTE POST-TRAUMATIC HEADACHE, AND LONG ACTING STIMULANTS FOR COGNITIVE ENDURANCE. ET CETERA. NERVE STIMULATION PARDON WITH COGNITIVE REHABILITATION AS A HYBRID COMBINATION EXAMPLES -- STIMULATION PAIRED WITH -- AS ONE OF THE EXAMPLES. THAT'S THIS ONE HERE. THAT'S AN EXAMPLE OF A HYBRID OR COMBINATION MEASURE. SO, HOPEFULLY THAT MAKES SENSE AND SOME EXAMPLES TO TELL YOU WHAT WE MEAN BY ONE BITE AT A TIME. THIS IS NOT MEANT TO BE ALL-INCLUSIVE LIST OR A PARTICULARLY WELL VALIDATED LIST. IT'S JUST SOME EXEMPLARS AND WE WROTE A REVIEW OR AN OPINION PAPER IN ANNULS OF NEUROLOGY TO EXEMPLIFY WHAT WE MEAN BY THIS APPROACH. SO, NOW JUST FOR FUN, I'M GOING TO DIVE INTO A SPECIFIC EXAMPLE. SO, THIS IS THE DOMAIN OF MOOD DISORDERS AND IT'S A DEPRESSION POPULATION OF CONCUSSIVE AND MODERATE BRAIN INJURY WITH DEPRESSIVE SYMPTOMS. ULTIMATELY DEPRESSIVE SYMPTOMS ARE IN OUR HANDS, IN OUR POPULATION, THE LARGEST DETERMINANT OF QUALITY OF LIFE. VERY STRONG CORRELATE, STRONGEST CORRELATE OF QUALITY OF LIFE MEASURES IS THE SEVERITY OF DEPRESSIVE SYMPTOMS. NO SURPRISE. THAT IS TRUE IN MANY, MANY DISEASES. SO THIS IS ONE OF THE FIRST THINGS WE WENT AFTER. PLUS, THE FACT THAT MILITARY SERVICE MEMBERS ARE COMMITTING SUICIDE AT A RATE OF TWO A WEEK IN THE UNITED STATES. WHICH IS SHOCKING AND AWFUL. IT USED TO BE THAT MILITARY SERVICE MEMBERS HAD A MUCH LOWER SUICIDE RATE THAN THE GENERAL POPULATION AND NOW IT IS EQUAL TO OR SLIGHTLY GREATER THAN THE RATE IN THE GENERAL POPULATION. A LOT OF IT IS DRIVEN BY DEPRESSION, NOT ALL OF IT. I CERTAINLY WOULD NOT SAY SUICIDE EQUALS DEPRESSION BUT DEPRESSION IS A BIG CHUNK OF SUICIDE. SO OUR PRIMARY OUTCOME IS A RATING SCALE WHICH IS A PRETTY WELL-VALIDATED SYMPTOM CLUSTER REPORT. THIS IS THE CASE WHERE WE DO HAVE A PRETTY GOOD IDEA WHAT THE RIGHT PRIMARY OUTCOME IS BECAUSE THIS MONTGOMERY AS BURGER DEPRESSION SCALE HAS BEEN USED IN A LOT OF TREATMENT TRIALS. SO IT IS PRETTY WELL ESTABLISHED. IN SOME OF THE OTHER DOMAINS WE DON'T HAVE IT. THIS IS SOLID GROUND. THIS IS WHAT TMS LOOKS LIKE. MANY HAVE SEEN THIS. NOT EVERYDAY. TMS INVOLVES A FIGURE 8 COIL THERE THAT PRODUCES A VERY STRONG MAGNETIC FIELD THAT MOVES VERY FAST. IT'S A FAST PULSE OF MAGNETIC FIELD AND INDUCES ELECTRICAL CURRENTS IN THE BRAIN. NON-INVASIVE AND SITS ON THE TOP OF THE HEAD AS YOU CAN SEE FROM THE PICTURE HERE. IT'S ON THE TOP OF THE HEAD. IT'S STEREO TACTICALLY NAVIGATED IN A VERY PRECISE COORDINANT FOCUSING ON A SPECIFIC AREA, ABOUT A TWO CENTIMETER AREA OF STIMULATION AND INDUCES A PRETTY STRONG ELECTRIC CURRENT IN THE SUPERFICIAL AREA TO THE BRAIN. STRONG ENOUGH THAT IF YOU STIMULATE OVER THE LEFT MOTOR CORTEX YOU'LL GET A TWITCH IN THE RIGHT THUMB. IT'S REALLY DIRECT STIMULATION. THERE ARE OTHER METHODS OF STIMULATING THE BRAIN THAT ARE MUCH WEAKER THAT WOULD BE CALLED MODULATORY RATHER THAN DIRECTLY STIMULATING. BUT THIS IS A DIRECT STIMULATION EFFECT. AND WE FIGURE OUT HOW HARD TO STIMULATE BASED ON HOW MUCH YOU GET A TWITCH IN THE CONTRALATERAL THUMB. SO THAT'S WHAT THIS IS -- >> ANN CASHION: WE HAVE ABOUT 4-5 MORE MINUTES FOR YOU. >> I HAVE ABOUT 4-5 MORE SLIDES. [ LAUGHS ] [ LAUGHS ] TERRIFIC. SO HERE IS HOW WE DO IT. WE TAKE A RESTING STATE FMRI OF EACH INDIVIDUAL SUBJECT AND WE MAP THEIR BRAINS AND WE GET AN INDIVIDUAL MAP. THESE ARE EXAMPLES OF INDIVIDUAL SUBJECTS AND THEY ARE DIFFERENT. EACH PERSON IS DIFFERENT. MOOD REGULATION CIRCUITRY IN EVERY PERSON IS DIFFERENT AND TRAUMATIC BRAIN INJURY IS DIFFERENT AND SO THE TARGET LOCATION IS DIFFERENT IN EACH INDIVIDUAL SUBJECT. SO HERE IS AN EXAMPLE OF WE FOUND THE HOTSPOT IN THIS ONE PARTICULAR PERSON. THIS IS A RETIRED NATIONAL FOOTBALL LEAGUE PLAYER WHO HAD SEVERAL HUNDREDS OF CONCUSSIONS IN HIS LIFE AND WAS LIVING IN HIS MOTHER'S BASEMENT, DIVORCED, UNEMPLOYED, COULDN'T EXERCISE, JUST ABSOLUTELY MISERABLE, TOTALLY APATHETIC AND WE FOUND THE HOTSPOT IN HIM THAT WAS DIFFERENT FROM WHAT YOU WOULD GET IF YOU HAD A TEAM -- HE FAILED COGNITIVE BEHAVIORAL THERAPY AND MULTIPLE MEDICATIONS AND NOTHING WORKED FOR HIM. FOUND A SPECIFIC HOTSPOT IN HIM. HE WAS PART OF RANDOMIZED CONTROL TRIAL THAT HAS THE FLOW THAT LOOKED LIKE THIS, IT WAS A SMALL PILOT TRIAL. AND WE GAVE 20 SESSIONS, 20, ONE HOUR DAILY SESSIONS AND THIS IS THE RESULT. THE SYMPTOM IS ON THE LEFT ACTIONIS, AND YOU CAN SEE WHAT HAPPENED IN THE ACTIVE PATIENTS, MANY GOT BETTER NOT ALL. AND THE PLACEBO PATIENTS, CONTROL PATIENTS, THEY ALSO GOT BETTER BUT SUBSTANTIALLY LESS. THIS HAS A GREAT PLACEBO EFFECT. YOU GET SOME CARING PHYSICIANS, THAT HAVE A HIGH-TECH APPARATUS AND A FANCY SCAN AND YOU GET SOMEBODY PAYING ATTENTION TO YOU FOR 20 DAYS AND THE PLACEBO PATIENTS GOT BETTER TOO BUT NOT AS MUCH AS THE ACTUAL PATIENTS. AND SO THIS IS WHAT HAPPENED TO THE VARIOUS INDIVIDUALS SYMPTOMS. INTERESTINGLY, THE THING THAT GOT BETTER THE MOST WAS APATHY. SO APATHY AGAIN RELATED TO FATIGUE, WAS THE SPECIFIC SUBSCALE IN THIS THAT HAD THE BIGGEST BENEFIT. SO WE WERE PRETTY EXCITED ABOUT THAT. AND IT WAS FOR EXAMPLE IN THIS INDIVIDUAL, HE WAS ABLE TO START GETTING BACK TO THE GYM WHICH HE NEVER WAS ABLE TO DO BECAUSE HE WAS SO APATHETIC AND HE WAS ABLE TO START GOING TO THERAPY WHICH HE COULDN'T DO BEFORE BECAUSE HE WAS SO FATIGUED, LOW ENERGY, NO MOTIVATION, NOTHING. SO, THAT WAS GOOD. THIS IS A VERY SUCCESSFUL DAY. SO, WE ARE IN THE PROCESS -- A LOT OF UNKNOWN QUESTIONS ABOUT TRANSCRANIAL MAGNETIC STIMULATION INCLUDING WHETHER PERFORMIDES MEDICINE MAKES SENSE, WHETHER YOU CAN DO BOTH SIDES, OR FASTER, SO WE ARE DOING WHAT IS CALLED A BAYESIAN ADAPTIVE DESIGN TRIAL WHERE WE HAVE 12 DIFFERENT VARIETIES OF TRANSCRANIAL MAGNETIC STIMULATION AND WE'LL TEST THEM OUT IN A MULTI-CENTER TRIAL AND DEPENDING ON HOW THINGS GO IN THE FIRST 10 PATIENTS PER ARM, WE WILL THEN INCREASE THE RANDOMIZATION PROBABILITIES IN THE THINGS THAT ARE WORKING WELL AND DECREASE THE RANDOMIZATION PROBABILITIES IN THE THINGS NOT WORKING SO WELL AND LOOP IT AGAIN. AND WE WILL QUICKLY CONVERGE ON WHICH SUBSET OF TRANSCRANIAL MAGNETIC STIMULATION IS THE MOST EFFECTIVE USING THIS ADAPTIVE APPROACH. THIS IS AN EFFICIENTS WAY TO SORT THROUGH A VARIETY OF POTENTIAL TREATMENTS WHEN YOU HAVE A FAST FEEDBACK MECHANISM. WHEN YOU HAVE SOMETHING WHERE YOU HAVE SOME INFORMATION THAT YOU CAN USE TO ADAPT. SO, ANYWAY, THAT'S WHAT WE ARE DOING. WE ARE DOING LATE PHASE STAGES, ALL LATE-PHASE CLINICAL TRIALS FOCUSED ON SPECIFIC SYMPTOMS RELATED TO TRAUMATIC BRAIN INJURY AND USING THIS ONE BITE AT A TIME APPROACH AND INCORPORATING ADAPTIVE DESIGN TO MAKE IT MORE EFFICIENT. WE HOPE THAT THIS WILL DRAMATICALLY REDUCE THE TIME AND EFFORTEE ACQUIRED TO BRING IMPROVEMENTS IN QUALITY OF LIFE TO OUR PATIENTS IRRESPECTIVE OF WHETHER WE REALLY DISCOVER LIKE THE MAGIC BULLET OR NOT. WE STILL THINK WE CAN TAKE SOME SOLID BITES OUT OF THE ELEPHANT OF TRAUMATIC BRAIN INJURY. THIS IS OUR RESEARCH GROUP AND THANK YOU FOR YOUR ATTENTION. [ APPLAUSE ] THANK YOU VERY MUCH. AND IF YOU COULD STICK AROUND FOR OUR PANEL DISCUSSION. IT WILL BE ABOUT 30 MINUTES. IS THAT OKAY? GREAT. OUR NEXT SPEAKER TODAY IS DR. REBECCA FANG. SHE IS A RESEARCH FELLOW IN THE SYMPTOMS BIOLOGY UNIT IN THE SYMPTOMS SCIENCE CENTER. SHE RECEIVED HER DOCTORATE FROM GEORGETOWN UNIVERSITY MEDICAL CENTER WITH THE FOCUS ON THE NUKE LANPLAYS IN PARK SONS DISEASE. SHE DID HER POST DARK RESEARCH AT MAX PLANCK INSTITUTE IN MUNICH, GERMANY WHERE SHE WAS PASTER OF A TEAM THAT DISCOVERED A POSSIBLE COMMON MECHANISM OF MULTIPLE NEURODEGENERATIVE DISEASES INCLUDING ALZHEIMER'S, PARKINSON'S DISEASE AND OTHERS. JOINING NINR IN 2015, SHE DEVOTED HER EFFORTS INTO UNCOVERING MECHANISMS OF PATHOGENIC PROCESS OF CANCER-RELATED FATIGUE. ALSO AN ACTIVE RESEARCHER WITHIN THE CHRONIC-FATIGUE SYNDROME THAT IS GOING ON HERE -- STUDY -- AT NIH. AND THAT IS A CONDITION THAT IS POORLY UNDERSTOOD AND CURRENTLY HAS NO CURE. THANK YOU VERY MUCH FOR PRESENTING. >> DR. FANG: THANK YOU. THAT WAS A TOUGH ACT TO FOLLOW, DR. BRODIE. SO IF YOU GUYS ARE STILL DOING WELL - EYE KNOW MOST OF YOU. I'M A RESEARCH FELLOW WITH THE INTRAMURAL DIVISION OF NINR AND I HAVE TO TELL YOU ABOUT SOME OF THE WORK THAT WE HAVE BEEN DOING WITHIN THE SYMPTOMS FELLOW UNIT AND THE SYMPTOMS SCIENCE CENTER. SO, BEFORE WE DIVE AND TALK ABOUT THE MECHANISMS OF FATIGUE, WE HAVE TO FIRST DEFINE FATIGUE. SO WHAT IS FATIGUE? FATIGUE IS THE SUBJECTIVE AREA THAT IS CHARACTERIZED BY A LACK OF ENERGY BOTH IN THE PHYSICAL AND COGNITIVE DOMAIN. SO WHAT DIFFERENTIATES PATHOLOGICAL FATIGUE FROM THE NORMAL TIREDNESS WE FEEL IS THAT ONE, IT'S NOT PROPORTIONAL TO RECENT ACTIVITY AND TWO, IT'S NOT RELIEVED BY SLEEP. IT'S FAIRLY COMMON AND OBSERVED IN SLEEP WAKE DISORDERS, MULTIPLE SCLEROSIS, STROKE, CANCER AND THE SYNDROME WE WILL BE TALKING ABOUT A LITTLE BIT. SO OUR GROUP FOCUSES ON CANCER-RELATED FATIGUE AND IT'S A VERY COMMON DEBILITATING SYMPTOM THAT IS REPORTED BY UP TO 80% OF ALL CANCER PATIENTS. THE CURRENT ISSUE WITH CANCER-RELATED FATIGUE IS THAT IT TENDS TO BE UNDERDIAGNOSED AND UNDERTREATED. SO RIGHT NOW, IT IS ALMOST ENTIRELY DIAGNOSE SELF REPORT QUESTIONNAIRES. SO HERE IS AN EXAMPLE OF A QUESTION THEY'RE OUR GROUP AND A LOT OF ONCOLOGY GROUPS LIKE TO USE. THE PROMISE IS ANOTHER POPULAR ONE WITHIN ONCOLOGY GROUPS. DUE TO THE SUBJECTIVE NATURE OF SELF REPORT QUESTIONNAIRES, THE SPECIFIC QUESTIONNAIRE YOU USE AND ALSO CUTOFF SCORES USED TO DEFINE FATIGUE MATTERS A GREAT DEAL WHEN IT COMES TO STUDIES OF FATIGUE. IN A PAPER WE PUBLISHED IN 2016 -- HERE IS A -- IT WILL REQUIRE MOTOR ADAPTATION. [ LAUGHS ] NOT ONLY DO WE OBSERVED DIFFERENT FATIGUE SYMPTOM TRAJECTORIES, AS YOU CAN SEE, I'M LEARNING MY MOTOR CORTEX IS SLOWLY ADAPTING. IT'S NOT THAT EASY TO USE. ALSO THE MOUSE POINTER DOESN'T WORK. ANYWAY, SO NOT ONLY DO WE SEE A DIFFERENCE -- THEN THE MIC DOESN'T WORK. WE ALSO SEE A DIFFERENT GENE EXPRESSION PATTERNS ASSOCIATED WITH FATIGUE. SO, OBVIOUSLY USING SELF REPORT QUESTIONNAIRES HAS LIMITATIONS. AND IF YOU WANT TO STUDY WHETHER FATIGUE IS CENTRAL OR PERIPHERAL, BRAIN OR MUSCULAR, YOU HAVE TO USE OBJECTIVE MEASURES. SO IN THE PAPER WE JUST PUBLISHED A MONTH AGO, WE FOUND THAT THE STATIC FATIGUE INDEX CALCULATED SHOWING IN FIGURE B, WE FOUND THAT THE STATIC FATIGUE INDEX CALCULATED USING THE HANDGRIP DEVICE CORRELATED SIGNIFICANTLY WITH SELF REPORTED FATIGUE SYMPTOMS. BUT INTERESTINGLY, THOUGH, IT'S NOT THAT THESE PATIENTS ARE ANY WEAKER THAN NON FATIGUE PATIENTS BECAUSE WE DIDN'T SEE ANY DIFFERENCE IN MAXIMAL STRENGTH BUT IT'S TOTAL WORK PERFORMED OVER TIME THAT DIFFERENTIATES FATIGUE PATIENTS FROM NON-FATIGUE PATIENTS. SIMILARLY, IN THE COGNITIVE DOMAIN, WE DIDN'T SEE ANY DIFFERENCE IN THEIR PEAK PERFORMS ACCURACY USING THE COMMONLY-USED TEST. BUT WE DID SEE A DIFFERENCE IN THE COGNITIVE INTERFERENCE SCORE WHICH IS CALCULATED AS THE DIFFERENT IN REACTION TIME BETWEEN THE IN CONGRUENT AND CONGRUENT PLUS NEUTRAL CONDITIONS. THIS SUGGESTS THAT FATIGUE BOTH IN THE CENTRAL AND PERIPHERAL DOMAINS IS REALLY RELATED NOT TO PEAK PERFORMS BUT RATHER PERFORMS AS A FUNCTION OF TIME. AND ANOTHER THING THAT IS WORTH POINTING OUT IS THAT BECAUSE OF THE INCREASED COGNITIVE INTERFERENCE, WE THOUGHT THAT MAYBE IT'S DUE TO IMPAIRMENT IN THE EXECUTIVE FUNCTION DOMAIN AND THAT IS CONSISTENT WITH OUR EARLIER PUBLICATION LAST YEAR SHOWING THERE WAS IMPAIRMENT IN THE EXECUTIVE FUNCTIONING. SO, WHAT CAUSES FATIGUE? THAT'S THE MILLION DOLLAR QUESTION. SO WE THINK THAT IT MAY BE DUE TO MITOCHONDRIAL -- YOU KNOW WHEN YOU'RE SICK WITH THE FLU OR COLD, I'M RECOVERING FROM A COLD, HENCE THE WATER BOTTLE. YOU FEEL TIRED AND LETHARGIC. SO WHAT THIS TELLS US IS THAT THERE IS AN IMMUNE COMPONENT TO FATIGUE PATHOGENESIS. IN FACT, YOU CAN INJECT LPS SYSTEMICALLY INTO ANIMAL TO MIMIC BACTERIAL INFECTION AND INDUCE FATIGUE. YOU CAN ALSO PUT IL ONE BETA OR TNF ALPHA IN THE LATERAL VENTRICALS OF A MOUSE OR RAT AND INDUCE FE TEAGUE. AND IN A STUDY THAT WAS PUBLISHED THIS YEAR THAT RECEIVED A LOT OF MEDIA ATTENTION, THEY MADE IT INTO THE POPULAR NINR DAILY NEWS BRIEFS. RUSSEL AND COLLEAGUES SHOWED THAT INTERFERON ALPHA TREATMENT IN HUMANS FOR HEPATITIS C CAUSED IMMEDIATE AND PERSISTENT FATIGUE. SO THAT IS CONSISTENT WITH OUR OWN FINDING IN A PAPER WE PUBLISHED IN 2017 WHICH SHOWED THAT SERUM LEVELS OF TRIM WAS UPREGULATED IN FATIGUE PATIENTS AND THE LEVELS CORRELATED WITH SELF-REPORTEDS FATIGUE SYMPTOMS. AND THIS IS REALLY EXCITING. WE JUST GOT THE DATA LAST WEEK. WE ARE COLLABORATING WITH HARVARD LOOKING AT A TOTAL OF 570 PATIENTS AND GUESS WHAT? TRAIL REPEATED. THAT IS VERY EXCITING.& AND IN A DIFFERENT EXPERIMENT USING WHOLE GENOME TRANSCRIPTOME ARRAY ANALYSIS, WE SAW AN UPREGULATION OF THE TRAIL DECOY RECEPTOR. SO THIS IS INTERESTING. SO TRAIL STANDS FOR TNF APOPTOSE INDUCING LIGANDS. IN HUMANSIT HAS FOUR DIFFERENT RECEPTORS. LET'S TRY THIS POINTER AGAIN. SO TRAIL -- [ OFF MICROPHONE ] AGO UPREGULATED A COMPENSATORY MECHANISM. SO WHEN YOUR BODY CREATES A TRAIL, MOST OF YOUR CELLS DON'T DIE. SO TRAIL JUST DOES WHATEVER IT NEEDS. NEURONS, INTERESTINGLY, ONLY EXPRESS THE TRAIL RECEPTORS WITH THE INTRACELLULAR BINDING DOMAIN DOMAIN. EVEN AT A LOW DOSE OVER A LONG PERIOD OF TIME, WHEN NEURONS ARE SUPPOSED TO TRAIL, YOU CAN GET NEUROTOXICITY AND THAT'S EXACTLY WHAT WE SAW WHEN WE TREATED NEURONS WITH EXTRACELLULAR TRAIL, WE SEE THIS DOSE DEPENDENT CELL DEATH. THEN THE QUESTION IS, YOU PROBABLY HEARD FROM LEO'S TALK, THESE ARE PATIENTS THAT RECEIVED EXTERNAL B RADIATION THERAPY. WHY IS IT THAT WHEN THEY HAVE THE SAME KIND OF CANCER AND THEY RECEIVE THE SAME KIND OF TREATMENT, WHY DO SOME PEOPLE DEVELOP PERSISTENT FATIGUE AND SOME DON'T? WE THINK THE ANSWER LIES IN INTRINSIC GENETIC VULNERABILITY. SO, IN A PAPER WE PUBLISHED LAST YEAR IN NATURE TRANSLATION PSYCHIATRY, WE FOUND THAT TRAIL 5 AT BASELINE CAN PREDICT THE FATIGUE OUTCOME ONE YEAR AFTER RADIATION THERAPY. SO YOU GUYS ARE NEUROSCIENTISTS. YOU KNOW IT PLAYS A IMPORTANT ROLE IN TRANSMISSION. WHAT IS LESS KNOWN ABOUT THIS IS THAT IT ALSO PLAYS AN IMPORTANT ROLE IN IMMUNE SYNAPSES. SO THESE ARE STRUCTURALLY AND FUNCTIONALLY SIMILAR TO NEURONAL SYNAPSES. SO WE FOUND THAT THE ACTIVITY ITSELF DOESN'T EFFECT T CELL BEHAVIOR. INTERESTINGLY, IF YOU PRE TREAT OR ACTIVATE 5 BY TREATING T CELLS WITH AN UNGLORIFIED AGONIST 20 MINUTES BEFORE YOU ERADIATE THE CELLS, YOU SEE THAT UNYORIFIED ACTIVITY ENHANCES AFFECT OF RADIATION IN TERMS OF APOPTOSIS AND RECEPTOR CLUSTER CLUSTERING AND ALSO -- WHEREAS IF YOU BLOCK THE RECEPTOR BEFORE YOU ERADIATE THIS, YOU CAN REVERSE THE AFFECT. WHAT THIS TELLS US IS THAT PERHAPS INTRINSIC VULNERABILITIES CAN MODULATE THE THRESHOLD BEYOND WHICH INFLAMMATION BECOMES CHRONIC INFLAMMATION. AND FATIGUE SYMPTOMS APPEAR. HOW DOES INFLAMMATION CAUSE FATIGUE? SO PERHAPS IF YOU HAVE MITOCHONDRIAL DYSFUNCTION THAT MAY EXPLAIN FATIGUE BEHAVIORS BOTH IN THE COGNITIVE DOMAIN AND THE PHYSICAL DOMAIN BECAUSE AFTER ALL, EVERY CELL NEEDS MITOCHONDRIA. SO, INTERESTINGLY, MITOCHONDRIA ARE PARTICULARLY VULNERABLE TO CIRCULATING CYTOKINES. SO, INFLAMMATION CAN INDUCE MITOCHONDRIAL DYSFUNCTION AND MITOCHONDRIAL DYSFUNCTION CAN CAUSE DAMP SIGNALS SUCH AS MITODNA AND OTHER SIGNALS THAT CAN BE RELEASED FROM DYSFUNCTIONAL MITOCHONDRIA CAN THEN LEAD TO INFLAMMATION BECAUSE OF THE TLR SIGNAL AND TRANSCRIPTIONAL ACTIVITY. SO THEN THAT LED US TO LOOK AT MITOCHONDRIA AND ITS ROLE IN FATIGUE. WE KNOW THAT MITOCHONDRIA ARE THE MAIN SUPPLIER FOR ATP WITHIN A CELL. MITOCHONDRIA ALSO PLAY IMPORTANT ROLE IN CALCIUM REGULATION, APOPTOSIS AND REDOX SIGNALING. A COOL FACT ABOUT NEURONAL MITOCHONDRIA THAT NOT EVERYONENESSES, THEY ARE ALWAYS ON THE GO. THEY ARE ALWAYS BEING SHUTTLED. SOMETIMES UP TO SEVERAL FEET TO REACH THEIR DESTINATION. BECAUSE OF THE IMPORTANT ROLE THAT MITOCHONDRIA PLAYS, IT'S BEEN IMPLICATED IN A VARIETY OF PSYCHIATRIC DISORDERS. IN TERMS OF MITOCHONDRIAL DYSFUNCTION AND FATIGUE, IT'S THE FIELD FAIRLY NEW. BUT -- >> A ASH ASH: 3 MINUTES OR LESS. >> THREE MINUTES? OR LESS? [ LAUGHS ] THIS WILL BE INTERESTING. OKAY. SO BACKGROUND LITERATURE SUGGESTING THAT THERE IS SOME EVIDENCE SUGGESTING THAT MITOCHONDRIAL DYSFUNCTION MAY PLAY A ROLE IN FATIGUE AND THEN WE CAN TALK MORE ABOUT THIS IF YOU WANT. IN FACT WE PUBLISHED A VERY DETAILED PROTOCOL PAPER. SO THIS IS WHAT WE USED TO STUDY MITOCHONDRIAL DYSFUNCTION AND FUNCTIONAL TASK WE MEASURE ALL THESE VARIABLES BUT I WOULD LOVE TO TELL YOU -- [ LAUGHS ] SO THIS I WANT TO TALK ABOUT. YOU MAY BE THINKING, THESE ARE PBMC MITOCHONDRIAL FUNCTION THAT WE ARE MEASURING. SO HOW MUCH DOES PBMC MITOCHONDRIAL FUNCTION TELL US ABOUT THE REST OF THE BODY? LIKE NEURONAL MITOCHONDRIA AND MUSCLE MITOCHONDRIA? SO THERE WAS A STUDY PUBLISHED IN 2014 THAT SHOWED THE PROTEIN EXPRESSION LEVELS OF COMPLEX 5 CORRELATED SIGNIFICANTLY WITH BASAL OXYGEN CONSUMPTION RATE MEASURED USE THE TECHNOLOGY I WAS GOING TO TELL YOU ABOUT. AND THEN ANOTHER STUDY, SHOWED A SIGNIFICANT CORRELATION BETWEEN MONOCYTE MAXIMAL RESPIRATION AND ALSO SKELETAL CELL MUSCLE RESPIRATION SUGGESTING THAT EVEN PBMCs ARE NOT PERFECT, THEY ARE AN INNERDIRECT AND VALID MARKER FOR OVERALL MITOCHONDRIAL HEALTH IN THE BODY. WE FOUND DECREASE COUPLING EFFICIENCY IN THE FATIGUED PATIENTS WHICH IS VERY COOL AND IF YOU LIKE TO LEARN ABOUT HOW EFFICIENCY, I WOULD BE HAPPY TO TELL YOU ABOUT IT DURING OUR PANEL DISCUSSION. AND ALSO WE ARE PART OF THE TRANS-NIH CFS PROTOCOL LED BY NINDS. SO WE ALSO LOOKED AT MITOCHONDRIAL FUNCTION BEFORE AND AFTER EXERCISE AND LOW AND BEHOLD WE FOUND THAT IN THE HEALTHY CONTROLS, THERE WAS AN INCREASE IN BOTH MAXIMAL RESPIRATON AND SPARE RESPIRATORY CAPACITY AFTER EXERCISE FROM BASE LAIN TO 24 HOURS AFTER EXERCISE -- BASELINE BASELINE. IN THE FATIGUED PATIENTS THEY STAYED FLAT OR WENT DOWN. THIS SUGGESTS THAT THERE MAY BE A DIFFERENCE IN THE WAY THAT MITOCHONDRIAL RESPOND TO STRESSORS THAT IS DIFFERENT. THIS I PROBABLY DON'T HAVE TIME TO GO INTO. WE ALSO LOOKED AT BRAIN MITOCHONDRIA BUT TO DO THAT WE HAVE TO USE ANIMAL MODEL AND I WOULD LOVE TO TELL YOU ABOUT THE ANIMAL MODEL TOO LATER IF YOU WANT. BASICALLY WE SAW A DECREASE IN THE MITOCHONDRIAL TRANSCRIPTION FACTOR AND DECREASE IN THE GLUCOSE TRANSPORTER AND IN THE BRAIN. SO THIS SUGGESTS THAT PERIPHERAL INFLAMMATION CAN EFFECT BRAIN MITOCHONDRIAL FUNCTION. DO I HAVE TIME FOR THIS? TWO MINUTES? OKAY. SO, WITHIN 90 SECONDS I HOPE TO TELL YOU ABOUT AN ONGOING PROJECT WE ARE REALLY EXCITED ABOUT. AS YOU CAN SEE, LATER ON, IF YOU REMEMBER FROM MY EARLIER SLIDES, MITOCHONDRIA ARE ALWAYS BEING SHUTTLED. MOST MITOCHONDRIA REMOVE EXCESSIVE CALCIUM FROM THE SYNAPTIC TERMINAL THAT HELPS PREVENT EXCITEO TOXICITY THAT IS PREVALENT IN ALZHEIMER'S DISEASE AND TRAUMATIC BRAIN INJURY. MOBILE MITOCHONDRIA ALSO HELP MOVE SYNAPTIC FROM THE RESERVE POOL TO THE READILY RELEASABLE POOL. SO, MITOCHONDRIA TRAFFICKING IS VERY IMPORTANT FOR OVERALL NEUROTRANSMISSION. SO RECENTLY, WE FOUND SINGLE NUCLEOTIDE VARIANTS IN THE BDNF GENE THAT IS VERY SIGNIFICANTLY CORRELATED WITH THE SELF-REPORTY FATIGUE SYMPTOM SEVERITY OF P-VALUE OF .002 WHICH IS PRETTY AMAZING CLINICAL STUDIES. SO BDNF TURNS OUT DIRECTLY EFFECTS MITOCHONDRIAL MOBILITY AND SYNAPTIC PLASTICITY. SO WE WON'T BE USING LIFESTYLE IMAGING TO TRACK MITOCHONDRIA IN A LIFESTYLE. SO THIS IS A DIFFERENTIATED NEURONAL MODEL THAT WE DEVELOPED. LET'S SEE IF THAT WILL WORK. SO, YOU CAN SEE MITOCHONDRIA IN THE HERE. SO THE 3D MOVE TO GIVE YOU A SENSE OF THE 3D STRUCTURE. AND OVER HERE, ON THE RIGHT, RED IS STAYING SYNAPTIC VESICLES. SO THESE RED DROUGHTS ARE SYNAPTIC TRIALS SO WITH THE STATE-OF-THE-ART HIGH SPEED INSTANCE STRUCTUREIL ILLUMINATION MICROSCOPY, WE CAN NOW TRACK SUBCELLULAR ORGANELLES AT HIGH SPEED AND RESOLUTION. SO HERE WE HAVE BKNF IN THE CELL BODY AND ALSO IN THE SYNAPTIC TERMINALS AND NEURONS WE CAN USE MITOTRACKER TO -- MITOTRACK SER A DYE THAT GOES INTO A MEMBRANE SPACE THAT HAS POTENTIAL TO DIFFERENTIAL. IT'S BOTH A STRUCTURED DYE AND ALSO A FUNCTIONAL DYE. SO WE CAN NOW TRACK MITOCHONDRIA. I DON'T KNOW IF YOU CAN SEE THE 3D-LIKE MORPHOLOGY OF THESE STRUCTURES. SO IT'S VERY COOL. SO THE GOAL IS TO TRANSDUCE THESE NEURONS WITH THE BDNF WILDTYPE AND COMPARE THAT TO THE VARIANT FORM THAT WE FOUND THAT IS SIGNIFICANTLY CORRELATED WITH FATIGUE SYMPTOMS. JUST TO SUMMARIZE, WE FOUND THE FATIGUE IS BOTH CENTRAL AND PERIPHERAL AND WE THINK THAT IT'S A RESULT OF INTRINSIC GENETIC VULNERABILITY COMBINED WITH EXTERNAL STRESSORS THAT EVENTUALLY LEADS TO FATIGUE. AND WE THINK THAT EVERYTHING THEN PRECIPITATES INTO MITOCHONDRIAL DYSFUNCTION. THAT'S WHAT IS CAUSING FATIGUE. AND HERE YOU CAN GAZE UPON THE LOVELY FACES OF OUR GROUP. IS THAT TIME OKAY? [ APPLAUSE ] I'D BE HAPPY TO ANSWER ANY QUESTIONS DURING THE PANEL DISCUSSION. >> ANN CASHION SHE IS VERY ENTHUSIASTIC AND SHE IS -- AND NOT FATIGUED. >> I'M ACTUALLY FATIGUED TODAY. >> ANN CASHION: SHE IS VERY, VERY SMART AND WE ARE FORTUNATE TO HAVE HER WITH US IN OUR LAB. SO THANK YOU, REBECCA. OUR NEXT SPEAKER IS DR. VIVIAN AND SHE IS A RESEARCH FELLOW IN THE LAB OF DR. JESSICA GILL WHERE SHE EXAMINES THE BIOLOGIC SYMPTOMS UNDERLYING TRAUMATIC BRAIN INJURY AND RELATED CO-MORBIDITIES INCLUDING POST-CONCUSSIVE SYNDROME, DEPRESSION AND POST-TRAUMATIC STRESS DISORDERS. SHE IS INTERESTED IN NEUROSCIENCE AND ALSO COGNIZANT OF THE MASSIVE BURDEN ASSOCIATED WITH NEUROLOGICAL DISORDERS AND STILL LIMITED UNDERSTANDING OF THE BRAIN DISORDERS. SHE PURSUED HER PH.D. AT THE UNIVERSITY OF SOUTH PAUL OH, BRAZIL AND DURING HER POSTDOCTORAL FELLOWSHIP IN THE CENTER FOR EXCELLENCE FOR AGING AND BRAIN REPAIR, AT THE UNIVERSITY OF SOUTH FLORIDA, SHE FOCUSED ON TBI-INDUCED NEURODEGENERATIVE PROCESSES AND THEIR LINKS TO NEUROPSYCHIATRIC ILLNESSES AS WELL AS DEVELOPMENT OF A NOVEL THERAPEUTIC STRATEGIES FOR TBI. SHE IS PERFECT FOR DR. GILL'S LAB AND THANK YOU. >> THANK YOU VERY MUCH. AND I HAD TWO WONDERFUL TALKS BEFORE ME BUT I'M VERY HAPPY THAT I JUST MADE IT HERE TODAY. I CAME IN LIKE DROVE INSANELY FROM WASHINGTON, DOWNTOWN TODAY. WITH OTHER 1000 PEOPLE FROM 117 COUNTRIES. I GOT MY U.S. CITIZENSHIP TODAY. [ APPLAUSE ] THANK YOU. THANK YOU VERY MUCH. AND I WILL TRY TO CONSIDER THE TIME TRYING TO SHORTER VERSION OF THE PRESENTATION. I'LL BE HAPPY TO DISCUSS IN DETAILS IN THE PANEL SECTION. OBVIOUSLY YOU CAN REACH ME THROUGH E-MAIL. A SHORTER VERSION. SO, WE WORK WITH TRAUMATIC BRAIN INJURY. TBI, THE FIELD NA DR. BRODIE DID AN AMAZING JOB TALKING ABOUT BUT I JUSTER WANT TO HIGHLIGHT HOW HETEROGENOUS TBI IS. TBI IS -- [ OFF MICROPHONE ] MOSTLY MILD TBI IS MOST COMMON. BUT WE STUDY -- SO IT IS HETEROGENOUS, NOT ONLY ACCORDING TO SEVERITY BUT -- SO THERE IS HIGH DIVERSE SYMPTOMS ASSOCIATED WITH TBI. MANY OF THEM MIGHT BE CHRONIC. AND TWO OF THEM I'M GOING TO BE THE TOPIC OF OUR TALK TODAY. -- [ OFF MICROPHONE ] NOT ONLY SUBJECTIVE BUT OBJECTIVE EFFECTS OR DIFFERENCES WHEN YOU COMPARE THE TBI AND THOSE FROM -- OBJECTIVE TYPE OF MEASURES. SO, JUST TO REMEMBER THE FATIGUE IS A CHALLENGING SUBJECT. IN THIS CASE, TRAUMATIC BRAIN INJURY WE CAN CONSIDER BEFORE DIVISION AND DURING DIVISION AND THE FATIGUE REPORTED BY THE PATIENTS. SO ALL THAT MAKES MORE COMPLICATED MECHANISMS AND RISK FACTORS AND THE RELATIONSHIPS BETWEEN THE TWO. SO, THE DISORDERS IS ALSO NOT A SINGLE SIMPLE COMPONENT OF THE PATHOLOGY POST TBI. HERE IS THE RESULTS OF METANALYSIS. JUST TO ILLUSTRATE THERE MAY BE SYMPTOMS OF THE DISORDERS APPEAR FREQUENTLY AFTER TBI [ INAUDIBLE ] [ OFF MICROPHONE ] IMPORTANT BECAUSE PHYSICAL HEALTH, MENTAL HEALTH, EMOTIONAL HEALTH. HARD TO THINK WHAT IS REALLY THE TWO. OF COURSE THERE IS HORMONAL ALTERATIONS THAT I WILL DISCUSS LATER IF YOU'RE INTERESTED. METABOLISM CAN CONTRIBUTE TO THE CLEANING OF THE -- [ OFF MICROPHONE ] [ OFF MICROPHONE ] GAYO MARKERS CAN HELP TO IMPROVE TBI AT MULTIPLE LEVELS AND HOPEFULLY THEY CAN USE ALSO TO IMPROVE PATIENT OUTCOME ULTIMATELY. NOT ADDS COMPLICATED. I JUST WANT TO SAY THAT FROM THE GENETIC ENVIRONMENT A LOT OF THINGS CAN BE UNDERLINED TO A RESPONSE, TBI BUT ALSO GIVE YOU A LOT OF OPPORTUNITY IN DIFFERENT TYPE OF BIOMARKERS THAT WE CAN EXPLORE. RNA PROTEIN MY FAVORITE EXOSOMES. WE CAN USE ANY OF THOSE AS A CANDIDATE BIOMARKER IN DIFFERENT PROJECTS. SO, TO JUST EXAMPLE OF THE TYPE OF PROJECT WE ARE DOING, THIS IS A STUDY DONE IN THE -- SO THE GOAL OF THE STUDY WAS TO DO THAT. SO THE ENTIRE POPULATION AND WE WANTED TO SEE ALTERATIONS AND GENE EXPRESSION USING RNA SEQUENCING. SO HERE I'M SHOWING THREE DIFFERENT COMPARISONS THAT IT IS. PTSD, WITH THE CONTROL. PTS VERSUS CONTROL AND PTSD WITH AND WITHOUT. SO EVERYBODY HERE HAS A TBI. EVERYBODY IN HAS PTSD. SOME HAVE PTSD IN THE SICKNESS AND SOME DON'T. I'M HIGHLIGHTING IT BECAUSE WE HAVE A MASSIVE GENE REGULATION WHEN THE PTS DOES. COMBINED WITH THE DATA. WHAT TYPE OF GENE REGULATION ALTERATIONS YOU MIGHT ASK? THERE IS A FEW EXAMPLES OF THE PATHWAYS WE GENERATED USING IPA AND METABOLISM. ALSO THERE IS A RELATION IN MITOCHONDRIAL ACTIVITY IN INFLAMMATION-RELATED PATHWAY THAT GIVE US CLUE OF WHAT IT MIGHT BE UNDERLYING WE COMPARE THOSE WITH FATIGUE TO WEARED TO THOSE WITH NO SYMPTOMS. AND PROTEINS INSIDE EXOSOMESES AND MEASURE THE PROTEINS THAT WERE INSIDE. WHAT I OBSERVED FOR OAKSOSOMEAL, WE HAD HIGH DEPTH IN PEOPLE WITH NOT FATIGUE COMPARED WITH PEOPLE WITH FATIGUE. AND IF THERE WAS A NEURONAL INJURY MARKER, WE USUALLY OBSERVE THE OPPOSITE. SO WE SHOULD PLAY WITH THE DATA BUT IT'S EXAMPLE OF THINGS WE CAN DO IN THE FIELD OF BIOMARKERS AND SLEEP PROBLEMS AND DISTURBANCES. THAT IS MY LAST SLIDE. SO I GAVE EXAMPLES OF EXPLORING THE SYMPTOMS POST TBI. EXAMPLES OF FATIGUE USING GENE EXPRESSION OR PROTEINS COLLECTING FROM THE BLOOD AS BIOMARKERS. WHAT ABOUT BOTH? WHAT ABOUT COMPARE BOTH AND THEN EVALUATE IN THE SAME POPULATION? SO I STUDY TO START AND GOING TO BE DONE AND THE IDEA IS TO EVALUATE TBI PATIENTS WITH FATIGUE AND WITHOUT FATIGUE. AND THEY ARE GOING TO BE TWO VISITS. SCREENING VISITS OR GOING TO ANSWER TO SELF REPORTED QUESTIONNAIRES ABOUT TBI SYMPTOMS AND FATIGUE AND PTSD AND DEPRESSION. GOING TO SPEND TWO NIGHTS IN A HOSPITAL. DURING THE TIME, THEY ARE GOING TO RECEIVE ACTO GRAPH AND THEY ARE GOING TO RECEIVE THE DIARY SO YOU WANT TO COLLECT DATA REGARDING ACTIVITY, DAYTIME ACTIVITY OF THE PEOPLE WHEN THEY SLEEP AND WHEN THEY WAKE UP AND LIGHT. WE ARE GOING TO PERFORM SONOGRAPHY AND HAVE SERIAL COLLECTION OF BLOOD THROUGH THE NIGHT. WE WANTED TO COLLECT BLOOD THAT YOU MEASURE MITOCHONDRIAL ACTIVITY TO MEASURE DIFFERENT HORMONES INCLUDING THOSE LIKE FROM THE BEGINNING RELATED TO PERFORM NEUROCOGNITIVE TESTS AND THEY ARE GOING TO BE -- PERFORM RISK FACTO RS AND MECHANISM UNDERLYING IN THE TBI, POST-TBI FATIGUE. AND HOPEFULLY THIS IS GOING TO SOMEHOW HELP US TO IMPROVE PATIENT OUTCOME REFLECTING PATIENTS LIFE AND GENERATE IMPROVED QUALITY OF LIFE. >> ANN CASHION: THANK YOU. >> THANK YOU VERY MUCH. [ APPLAUSE ] WE ARE SETTING UP FOR THE PANEL FOR 15-20 MINUTES. SO I DID WANT TO PULL IT TOGETHER WITH WHAT VIVIAN SAID AT THE END OF THE SHE IS TALKING ABOUT A CLINICAL TRIAL WE ARE GETTING READY TO START AT THE CLINICAL CENTER AND IT'S VERY EXCITING TO SEE HOW YOUR BRINGING A LOT OF THE BIOLOGIC DATA THAT YOU HAVE ALREADY COLLECTED AND REALLY GETTING A LOT OF BEHAVIORAL DATA FROM THE PATIENTS FROM THE CLINICAL SETTING AS WELL AS AT HOME. SO WHILE WE DON'T ALWAYS PRESENT ON SOME OF THE ACTIVITIES AND BEHAVIORAL DATA, WE PUBLISH ON IT AND IT IS EXCITING TO SEE TO MAYBE MAKE A DIFFERENCE IN REAL OUTCOMES ON PEOPLE. SO THANK YOU FOR BRINGING THAT FULL CIRCLE FOR US. AT THIS POINT IN TIME, WE HAVE AN OPPORTUNITY TO FOLLOW-UP ON SOME OF THE PRESENTATIONS TODAY AND THE TYPE OF SCIENCE THAT WE ARE DOING IN THE INTRAMURAL PROGRAM. CAN I OPEN THIS UP TO QUESTIONS? DEBORAH? >> DEBORAH: I'M IMPRESSED WITH ALL OF YOUR STUDIES. IT'S JUST VERY, VERY INTERESTING INTERESTING. BUT GIVEN THAT THE TOPIC LOOKING AT SLEEP AND FATIGUE, I'M WONDERING IF CONSIDERATION HAS BEEN GIVEN TO SOME OF THE SOCIAL DETERMINANTS OF HEALTH LIKE THE ENVIRONMENT THAT SOMEONE IS SLEEPING IN, INTERRUPTION THAT IS MIGHT BE OCCURRING AND IF NOT NOW, IS THAT PART OF THE PLAN FOR FUTURE RESEARCH? >> [ OFF MICROPHONE ] >> PUSH THE BUTTON. >> [ OFF MICROPHONE ] I SEE. SO I SEE. I THOUGHT IT WAS LIKE. THE MRI WHEN YOU KEEP TO PRESS. SO I THINK I'M WITH A PATIENT RIGHT NOW. [ LAUGHS ] IT IS REALLY SIMILAR. SO IT'S A VERY VALID POINT. IT'S TRUE. I FEEL LIKE IT IS VERY HARD TO ASSESS THAT. IT'S HARD. SOME OF THE SCALES THEY DO, AT LEAST A LITTLE BIT INCORPORATE ENVIRONMENT TO PEOPLE BUT WHAT WE ARE USING ALSO CAN COLLECT LIGHT INFORMATION. AT LEAST A LITTLE BIT TALK ABOUT ENVIRONMENT. SO LET'S SEE THE AMOUNT OF LIGHT THAT PEOPLE ARE EXPOSED TO. I AGREE. I FEEL LIKE THE MEASUREMENTS WE HAVE, OTHER ENVIRONMENTAL FACTORS, RELATIONSHIP WITH FAMILY AND THIS KIND OF THING, IT IS VERY LIMITED AND I FEEL LIKE IN THAT I AGREE THAT COULD BE IMPORTANT TO KNOW, ESPECIALLY IN PATIENTS WITH CHRONIC SYMPTOMS. I'M SURE THE SUPPORT AT HOME, FOR EXAMPLE, WILL EFFECT THE SYMPTOMS. >> IN THE DOMAIN OF COGNITIVE BEHAVIORAL THERAPY FOR TRAUMATIC BRAIN INJURY PATIENTS WITH INSOMNIA, THAT'S THE MAIN DOMAIN OF INTERVENTION IS IN THE ENVIRONMENT. AND SO, LIKE FOR EXAMPLE, SMARTPHONE APPS THAT PROVIDE REALLY HIGH-QUALITY COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA FOR MILITARY SERVICE MEMBERS TAILORED TO THE SPECIFIC ENVIRONMENTS THAT ARE RELEVANT TO MILITARY SERVICE MEMBERS ARE REALLY IMPORTANT. SOME OF THE EXISTING COGNITIVE BEHAVIORAL THERAPY APPROACHES ARE VERY RELEVANT TO UPPER MIDDLE-CLASS PROFESSIONALS BUT ARE NOT RELEVANT AT ALL AND CRINGE WORTHY WHEN APPLIED TO MILITARY SERVICE MEMBERS. SO, TAILORING THE THERAPEUTIC APPROACH TO THE SPECIFIC POPULATION OF INTEREST IS CRITICAL FOR EFFICACY. >> JUST WANT TO BRING UP ONE POINT. SO IN TERMS OF SLEEP, IT'S REALLY INTERESTING. SO WE DEFINE FATIGUE AS ONE ENTITY BUT IT MAY NOT BE. WE PUBLISHED TWO DIFFERENT PAPERS SHOWING THAT FATIGUE RADIATION THERAPY IS MORE RELATED TO ANEMIA AND THAT SYMPTOM CLUSTERS WITH SLEEP DISTURBANCE. ONE YEAR AFTER RADIATION THERAPY, IT'S JUST INFLAMMATION AND ANEMIA AND SLEEP DISTURBANCE NO LONGER PLAY A ROLE. SO I THINK IN TERMS OF PRECISION MEDICINE AND MAYBE ADVANTAGEOUS TO TREAT FATIGUE WITH DIFFERENT MECHANISMS PATHOGENIC ORIGINS DIFFERENTLY. >> THANK YOU FOR THE GREAT PRESENTATIONS. I THINK I WANT TO MAYBE STEP BACK EARLIER THAN THE TRAUMATIC BRAIN INJURY AND ASK, IS THERE INTEREST AT THE SYMPTOM SCIENCE CENTER TO LOOK AT WHAT IS HAPPENING WITH, ESPECIALLY WITH MY POPULATION, THOSE ACCUMULATIVE AND HISTORICAL TRAUMA ISSUES? AND EXPERIENCES? SO THAT PRECISION HEALTH CAN BE OR HELP US TO DETERMINE WHAT WE NEED TO DO IN ORDER -- >> I CAN STRESS THAT. SO THAT IS DEFINITELY A FOCUS. SO ANY TIME WE LOOK AT TRAUMATIC BRAIN INJURY, WE ALSO THINK ABOUT STRESS. SO FOR A LOT OF THE STUDIES THAT DR. BRODIE HAS DONE AS WELL AS ME IS HAVING A TBI WITHIN COMBAT WITH THAT PSYCHOSOCIAL STRESS IS DIFFERENT THAN HAVING AN ISOLATED TBI. ALL OF OUR STUDIES WE LOOK AT ACCUMULATIVE IMPACT STARTING FROM CHILDHOOD ABOUT 25% OF THE MILITARY GOES INTO COMBAT WITH PTSD OR BRAIN INJURY ALREADY. SO WE LOOK AT THE ACCUMULATIVE IMPACT OF THAT TRAUMA AND SO WE LOOKED AT IT IN THAT POPULATION AS WELL AS IN THE ATHLETES AND NOW WE WANT TO GO INTO DIFFERENT POPULATIONS AT RISK FOR MULTIPLE HEAD INJURIES. THAT WILL BE A BIG FOCUS AND UNDERSTANDING HOW MUCH HEAD INJURY REALLY MAKES IT MORE PRONOUNCED IN THAT INDIVIDUAL AND THAT VARIABILITY THAT CONTRIBUTES TO THE LONG TERM SYMPTOMS. THAT WILL BE A BIG FOCUS OF WHAT WE DO OVER THE NEXT COUPLE EVER YEARS. >> IN ADDITION IN THE SYMPTOM SCIENCE CENTER KNOWN FOR CURRENT STUDY PICASSO STUDY, WE HIRED A CLINICAL PSYCHOLOGIST AND PART OF THE PROCEDURE OF THE STUDY IS TO HAVE A REALLY COMPREHENSIVE PSYCHOTRAUMATIC HISTORY TAKING. AND THAT WOULD REALLY CAPTURE THAT PART. >> SO I HAVE A QUESTION ABOUT ARTICULATION WITH EXTERNAL AND INTERNAL RESEARCH. I GUESS I THINK WHEN I'M STUDYING INNER CITY FAMILIES WITH ENVIRONMENTS THAT WOULD HIGHLY AFFECT POSSIBLY SLEEP AND STRESS AND FATIGUE, AND OFTEN USING THAT FOR SLEEP AND TAKING GOOD SLEEP HISTORIES AND OTHER HISTORIES, IT SEEMS THAT IF I'M BANKING BLOOD THAT IT COULD BE USEFUL TO YOU GUYS. BUT WE HAVE NO -- I NEVER HEAR YOU GUYS CALL FOR OUR BLOOD. I NEVER HEAR YOU WHEN MY GRANDKIDS SAY, GEEZ, COULD YOU ADD THIS PROTOCOL TO YOUR NEW GRANTS AND THEN WE CAN -- SO I FEEL LIKE THERE IS A DISCONNECT BETWEEN US GETTING A GRANT AND STARTING A PROTOCOL AND HOW SOME SLIGHT ALTERATION IN THAT PROTOCOL OR COMMUNICATION COULD AID BOTH OF US. >> I CAN ADDRESS THAT ONE TOO. SO WHAT WE ARE TRYING TO DO IN A PROGRAM IS TO CREATE PARTNERSHIPS. SOMETIMES THEY ARE INDIVIDUALIZED AND BASED ON OUR SCIENCE BUT WE WANT TO EXPAND THAT. I CAN GIVE YOU A TOUR OF THE LAB AND CREATE PARTNERSHIPS. WE HAVE AN AMAZING LAB TO LOOK AT SO MANY DIFFERENT THINGS. WE ARE TRYING TO FIND WAYS TO DO THAT SO WE LOVE YOUR INPUT ON THAT. >> SO I WOULD ALSO ADD SHARING AMONG ALL OUR SCIENTISTS. SO I'LL PUT A PLUG OUT FOR THE OMICS AND THE SCIENCE AND EDUCATION NETWORK WHERE YOU CAN ACTUALLY GO TO THAT WEBSITE AND FILL OUT THE FORM AND SAY, HEY, I HAVE DATA. I HAVE SAMPLES. WOULD LOVE TO COLLABORATE AND LOVE TO MENTOR. WOULD LOVE TO MAKE THESE RESOURCES AVAILABLE TO TRAINEES. I WOULD REALLY ADVOCATE THAT EVERYONE GO AND TAKE A LOOK AT THAT WEBSITE AND CONTRIBUTE WHAT CAN YOU TO THE CAUSE OF SHARING AND TRYING TO GET MORE BANG FOR OUR BUCK OUT OF ALL OF THE HARD WORK THAT WE HAVE DONE TO COLLECT DATA, DO DEEP PHENOTYPING AS WELL AS BANK SAMPLES ALONG THE WAY. AFTER THE COUNCIL MEETING, WE WILL FOLLOW INFORMATION TO EACH OF YOU ABOUT THE WEBSITE AND THE LINK TO THAT SO YOU CAN GO AND LOOK AT IT BECAUSE THAT IS SOMETHING THAT CAUSES INTRAMURAL AND EXTRAMURAL AND ALLOWS FOR THOSE PARTNERSHIPS THAT YOU'RE TALKING ABOUT, SHIRLEY, FOR US TO KNOW ABOUT THE POTENTIAL FOR THOSE PARTNERSHIPS. AND IT'S FUNDED BY NINR. >> AND PART OF THAT IS THE RE-IMAGINING OF OUR TRAINING CURRICULUM THROUGH OUR ROBERT WOOD FOUNDATION SCHOLAR AND SO PART OF THE GOAL IS TO REALLY FOR THESE FELLOWS TO COME IN AND START EVEN LEARNING HOW TO DO MATERIAL TRANSFER AGREEMENTS, INTELLECTUAL PRETTY, BECAUSE THEY ARE BRINGING IN THEIR SAMPLES THAT THEY CAN STUDY HERE. SO THAT IS GOING TO BE HOW WE BRING IN OUR FELLOWSHIP. >> ANY PLAN FOR COLLABORATORS EFFORTS WITH NINR FUNDING CENTERS LIKE P20, P32 PROGRAMS? >> SO THOSE ARE ALL THINGS THAT WE WANT TO TALK ABOUT OVER THE NEXT YEAR. AND SO WHAT WE WANT TO DO IS REALLY HAVE THAT COMMUNICATION TO START. SO WE'LL REACH OUT TO YOU GOOIS AND GET SOME IDEAS ABOUT THAT AND MAYBE WE CAN FOLLOW-UP AND FIND A WAY TO CONNECT MORE. >> AND I'D LIKE TO ADD A FOLLOW-UP POINT IN TRYING TO DO THAT WITH SOME SAMPLE SHARING. IF THE IRB ISSUE IF YOU HAVEN'T GOTTEN PERMISSION UPFRONT TO DO THAT, IT CAN BE DIFFICULT RETROSPECTIVELY TO GO BACK SO I'D LIKE TO ADD TO THE CONVERSATION BEING PROACTIVE ABOUT CONSENTING. SO YOU'RE NOT MISSING THE OPPORTUNITY. >> UNRELATED TO THE TRAUMATIC BRAIN INJURY, I WAS VERY INTERESTED IN THE SYMPTOM OF THE SLEEP/WAKE AND THE THING BECAUSE I THINK THAT HAS A LOT OF IMPLICATIONS FOR THE LIFE WE LIVE IN. FOR CHILDREN. I WONDER IF THERE IS -- IF YOU'RE LOOKING AT SOME OF THOSE RELATED TO FATIGUE AND TO OTHER THINGS THAT WOULD HAVE A MAJOR IMPACT IN THOSE POPULATIONS? AND JUST TO -- >> I CAN SPEAK TO THAT AND I THINK WHAT VIVIAN WAS TRYING TO DESCRIBE, WE HAVE A STUDY THAT WE ARE STARTING TO LOOK AT FATIGUE, BRAIN INJURY AND SLEEP. THEY COME TO OUR SLEEP UNIT. WE HAVE THE UNIQUE CAPACITY TO DRAW BLOOD WHILE THE PATIENT IS STILL SLEEPING SO WE CAN LOOK AT THE SLEEP WAKE DYSREGULATIONS IN RELATION TO HORMONES AND BIOMARKERS. THAT IS ONE OF THE WAYS WE ARE TRYING TO UNTANGLE THAT. THE OTHER THING WE ARE TRYING TO DO IS DEVELOP A SWEAT PATCH THAT WE PILOTED. WE CAN HAVE A PARTICIPANT WEAR THAT IN THEIR HOME ENVIRONMENT WITH A WATCH AND FROM THAT SWEAT PATCH THEY SWEAT INTO NA AND WE CAN EXTRACT AND IT PUT IT ON ANY PLATFORM AND LOOK AT microRNA, PROTEINS, ANYTHING THAT WOULD BE DYSREGULATED REGULATED TO SLEEP. WHEN WE BRING THEM INTO THE HOSPITAL, IT WILL BE VERY DIFFERENT ESPECIALLY WITH CHILDREN. AND SO THAT IS ONE OF THE COLLABORATIVE OPPORTUNITIES THAT WE ARE TRYING TO OPEN UP. FOR OTHER INDIVIDUALS TO BE ABLE TO USE THIS TECHNOLOGY WE PILOTED OUT SO THAT WAY SOMEBODY COULD WEAR THE PATCH, PUT IT IN THE MAIL AND SEND IT TO US SO WE CAN PUT IT ON OUR PLATFORMS. THAT'S HOW WE ARE TRYING TO COLLABORATE AND CONNECT WITH ALL OF YOU GUYS. >> I GUESS I'M THINKING OF SOMETHING MORE SYSTEMATIC THAN YOU CALL US AND WE'RE TRYING TO REACH LITTLE POCKETS. I GUESS DOES NINR HAVE A COMMUNICATION PATH TO ALL THE DEANS OF RESEARCH IN THE SCHOOLS OF NURSINGS? A NEWSLETTER THAT GOES OUT, COPY OF THE ARTICLE ON THE PATCH FOR EVERYONE -- TO MOVE FASTER. I KNOW I'M IMPATIENT. BUT, IT JUST SEEMS THAT A COUPLE HOURS OF GOOD THINKING WE COULD DEVELOP A SYSTEM TO MOVE A LOT OF THIS FASTER. >> AND SO THAT'S WHAT WE ARE LOOKING TO DO. WE HAVE BEEN WAITING FOR OUR NEW DIRECTOR. WE HAVE OUR TWO NEW PEOPLE IN PLACE. SO THAT MIGHT BE SOMETHING WE CAN START TALKING ABOUT OVER THE NEXT COUPLE OF MONTHS. REALLY HOW TO DO THIS TYPE OF WORK AND MOVE NURSING SCIENCE FORWARD. WE ARE REALLY EXCITED TO COLLABORATE AND MOVE IT FORWARD. WE ARE LOOKING TO YOU TO MAKE THOSE WAYS COME TO FRUITION. >> I'M WONDERING IF YOU'RE BRINGING IN ANYTHING ABOUT FAMILY SYSTEMS AND RELATIONSHIPS AND CAREGIVERS, FAMILY MEMBERS INTO ANY OF THIS WORK? >> NOT DIRECTLY. BUT YES, THAT IS SOMETHING TO KEEP IN MIND FOR FUTURE STUDIES. IT'S JUST THERE ARE SO MANY ELEMENTS AND MOVING PARTS. BUT YES, THAT IS AN ISSUE. I FEEL LIKE IT IS -- YES. I FEEL LIKE THERE IS INTUITIVE FEELING LIKE ALL ARE GOING TO CONTRIBUTE TOWARDS THE SYMPTOMS POST TBI AND TO IMPROVE RECOVERY BUT I'M NOT AWARE OF OBJECTISM EVALUATION OF IT. >> ONE OF THE KEY CHARACTERISTICS OF THE NATIONAL INTREPID CENTER FOR EXCELLENCE INTENSIVE OUTPATIENT PROGRAM FOR TBI PATIENTS ACROSS THE STREET THERE, IS COGNITIVE BEHAVIORAL THERAPY FOR FAMILIES AND CAREGIVERS OF INJURED SERVICE MEMBERS. AND THERE IS YOGA STRAINING AND MEDTATION TRAINING AND EDUCATION ABOUT TRAUMATIC BRAIN INJURY AND SYMPTOMS AND GROUP AND INDIVIDUAL COUNSELING SESSIONS ON FAMILY DYNAMICS IN THIS EXTREMELY COMPLEX ENVIRONMENT. SO THE FAMILIES OFTEN COME AND SPEND FOUR WEEKS HERE AS WELL AS THE SERVICE MEMBERS. >> ACTUALLY VERY GOOD POINT AND I FORGOT ABOUT THAT. WE JUST PROCESSED THOSE SAMPLES NOW. IT'S PART OF THE [ INAUDIBLE ] SO WE ARE HOPING TO WRITE THE ABSTRACT PAPER SOON SO IT WILL BE OUT THERE. BLOOD SAMPLES COLLECTED FROM GROUPS FROM THERE. >> ANN CASHION: ANY OTHER QUESTIONS RELATED TO THE SPEAKERS OR PANELS? IF NOT, I'D LIKE TO INTRODUCE DR. LARRY TABAK. DR. TABAK IS, AS WE HAVE ALREADY SAID TODAY, HE WILL BE THE ACTING DIRECTOR FOR NINR AS OF HE CURRENTLY IS HIS DAY JOB RIGHT NOW IS AS PRINCIPLE DEPUTY DIRECTOR FOR NIH. AND I'M VERY CONFIDENT THAT HE IS HERE TO ANSWER QUESTIONS THAT YOU HAVE FOR US TODAY. AS WELL AS TARA. SO IF ANYBODY HAS ANY QUESTIONS THAT WE WOULD LIKE TO BRING UP AT THIS TIME? >> GOOD AFTERNOON. GOOD TO SEE YOU. RITA PICKLER. DO YOU -- ARE YOU ABLE TO TELL US NOW WHO IS ON THE NEW RECONSTITUTED SEARCH COMMITTEE? >> KIM TAYLORA DR. TABAK, THAT INFORMATION IS AVAILABLE. WE'LL POST IT PUBLICLY, YES. THE COMMITTEE HAS NOW BEEN CONSTITUTED. THEY HAVE BEEN CHARGED BY DR. COLLINS AND SO, YES, THAT WILL BE AVAILABLE. >> TALKING ABOUT THE CREB CYCLE -- [ LAUGHS ] YOU KNOW, I TAUGHT INTIMATE METABOLISM FOR 10 YEARS SO I GOT REALLY EXCITED WHEN I SAW THOSE MITOCHONDRIA. [ LAUGHS ] MAYBE I WON'T. THANKS, ANN. SO LET ME SAY JUST A FEW THINGS BECAUSE IT'S BEEN AN INTERESTING FEW WEEKS HERE FOR DR. SWEATS AND FOR ME. SO FIRST, I WANT TO PUBLICLY THANK ANN FOR THE EXTRAORDINARY WORK SHE'S DONE NOT ONLY ON BEHALF OF NINR BUT FOR NIH. AND IT IS NOT EASY TO BE ACTING ANYTHING. SO ANN THANK YOU, AGAIN, BECAUSE WE CAN'T THANK YOU ENOUGH FOR ALL THE SERVICE THAT YOU HAVE PROVIDED TO US. [ APPLAUSE ] I GUESS THE SECOND THING I'LL SAY IS, MAYBE IT WILL EXPLAIN TO YOU WHY I CARE ABOUT NINR. I CARE ABOUT ALL OF THE INSTITUTES AND CENTERS OF NIH. I HAVE TO. IT'S MY JOB. AS THE PRINCIPLE DEPUTY DIRECTOR OF THE AGENCY. BUT AS -- AND I'M GOING TO SAY THE D WORD NOW. SO EVERYBODY HOLD ON TO YOUR SEATS. AS A DENTIST, I UNDERSTAND HOW CRITICALLY IMPORTANT NINR IS TO NURSING. JUST AS HOW CRITICALLY IMPORTANT NIDCV TO DENTISTRY. NINR IS THE UNDERPINNING OF THE PROFESSION. IF A DENTIST DOESN'T GET THAT, WHO IS GOING TO GET IT? SO THAT IS THE SECOND POINT. THIRD POINT I'D LIKE TO MAKE IS, DURING AN INTERIM PERIOD, THERE IS NO INTENT TO CHANGE THE COURSE OR DIRECTION OF THE RESEARCH AGENDA. TARA IS A BIOPHYSICIST. I'M AN ENSMOLOGIST. I HAPPEN TO HAVE A DENTAL DEGREE BUT IF ANYBODY BOTHERED TO LOOK UP MY PUBLICATION, YOU'LL SEE I'M AN ENSMOLOGIST. NEITHER OF US ARE CONTENT EXPERTS IN NURSING SCIENCE. WE DON'T PRETEND TO BE. WE ARE SURROUNDED BY EXPERTS. WE ARE NOT GOING TO CHANGE THE COURSE AND DIRECTION OF NINR DURING THIS INTERIM PERIOD. WE WILL LISTEN VERY CAREFULLY TO YOUR WISE COUNCIL AS MEMBERS OF THE COUNCIL. WE WILL LISTEN VERY CAREFULLY TO ALL THE GREAT STAFF WHO HAVE BEEN IN SUPPORT OF THE INSTITUTE DURING THIS TIME. SO WHAT WILL WE BE DOING? WE WILL BUILD ON THE GREAT WORK THAT ANN BEGAN TO STRENGTHEN FURTHER THE INFRASTRUCTURE OF THE INSTITUTE SO THAT IT CAN FUNCTION EVEN BETTER THAN IT IS NOW. BECAUSE THAT IS SOMETHING THE TWO OF US REALLY ARE EXPERTS AT. BECAUSE WE DO IT FOR THE WHOLE NIH. THAT IS WHAT WE ARE GOING TO BE DOING. WE WILL BE LOOKING AT WAYS TO ENHANCE AND STRENGTHEN PROCESSES AND INFRASTRUCTURE, THOSE THINGS THAT ANN BEGAN AND WE WILL BUILD UPON THEM. IT'S NOT REALLY COMPLICATED. BUT THE AGENDA THAT IS LAID OUT AND THE STRATEGIC PLAN STANDS. NOW, IF SOME REMARKABLE NEW DISCOVERY IS FOUND TOMORROW, AND THE EXPERTS THAT ARE SURROUNDING US HERE COME TO US AND SAY, YOU KNOW, WE REALLY OUGHT TO JUMP ON THIS. IT'S NOT A STRATEGIC PLAN BUT WE HAVE TO JUMP ON THIS. WELL, OF COURSE WE WILL HAVE THAT CONVERSATION. RIGHT? BECAUSE WE ARE ALL SCIENTISTS. BUT, THERE IS NO INTENT TO CHANGE ANY DIRECTIONALITY HERE. NOW, YOU GET A NEW PERMANENT DIRECTOR, THAT'S ANOTHER CONVERSATION. AND WHAT THE STAFF WILL BE DOING AND IT WILL HAVE ALREADY BEGUN AT SOME LEVEL, AND THE STAFF WILL CONTINUE TO DO IS TO BEGIN TO BUILD THEIR BEST CASE FOR WHERE THE DIRECTION LIES GOING FORWARD IN THE FUTURE. BECAUSE TRANSITION -- TRANSITION IS HARD. NO MATTER WHAT THE SCENE, TRANSITION IS HARD. BUT TO EASE THE TRANSITION OF A NEW PERMANENT DIRECTOR, THE BEST WAY TO DO THAT IS FOR THE STAFF TO BEGIN TO DEVELOP THE ARGUMENTS, THE DATA, THE EVIDENCE, HERE IS WHY WE THINK WE NEED TO GO IN WHATEVER THE DIRECTION IS THAT THEY FEEL IS IMPORTANT. NOW, WILL THERE BE UNINIMITY? PROBABLY NOT. BUT THAT'S OKAY. BECAUSE WE ARE SCIENTISTS. AND YOU HAVE LAB MEETINGS AND HAVE YOU CONVERSATIONS. DARE I SAY YOU HAVE ARGUMENTS. IT'S OKAY. AND THAT'S HOW YOU APPROACH THIS. SO, I HOPE YOU WILL FEEL COMFORTABLE ENOUGH TO EITHER ASK QUESTIONS HERE TODAY OR IF YOU PREFER OFF LINE. WE WANT TO MAINTAIN THE DIALOGUE. TARA AND I ARE REACHING OUT WITH ANN'S COUNCIL TO VARIOUS STAKEHOLDER GROUPS AND I GUESS THERE IS A SERIES OF MEETINGS THAT WE WILL BE ABLE TO TAKE ADVANTAGE OF IN OCTOBER, BUT I'M SURE THAT THERE WILL BE OTHER OPPORTUNITIES AS WELL. WE NEED TO HAVE THESE CONVERSATIONS BECAUSE THE GOAL HERE IS TO EVEN STRENGTHEN WHAT IS ALREADY A WONDERFUL INSTITUTE, ONE THAT IS THE UNDERPINNING INTELLECTUALLY OF A PROFESSION THAT IS OBVIOUSLY CRUCIALLY IMPORTANT. SO I HOPE YOU WILL TAKE THAT INVITATION AND WILL TAKE ADVANTAGE OF IT AND SO I WILL STOP THERE AND SEE NOW IF THERE ARE ANY OTHER QUESTIONS THAT YOU MAY HAVE BEFORE YOU ARE RUNNING FOR PLANES, TRAINS AND OTHER FORMS OF TRANSPOREITATION. >> DINNER. [ LAUGHS ] >> YOU HAVE A SECOND DATE. DINNER. EVEN MORE DIFFICULT. >> SO WE WILL BE GUIN. AGAIN, WE APPRECIATE VERY MUCH YOUR REASSURANCES TODAY AS WELL AS LAST MONDAY. I DON'T BELIEVE EVERYBODY WAS ON THE PHONE WITH US LAST MONDAY WHEN WE HAD THE CALL WITH COUNCIL.& AND I THINK, AGAIN, I SAID THIS LAST MONDAY, ONE OF THE EFFORTS WE ARE TRYING TO MAKE IN THE SAME SPIRIT IN WHICH YOU HAVE SAID WE ARE TRYING TO CONTINUE TO STRENGTHEN THE NINR, WOULD BE SOME GUIDANCE, IF YOU WILL, ON HOW WE HELP GET OUR NEXT PERMANENT DIRECTOR. WHO CAN WE LOOK FOR? WHAT SHOULD WE LOOK FOR? HOW DO WE -- HOW CAN WE HELP IN THAT PROCESS? >> DR. TABAK: THANK YOU FOR REASKING THE QUESTION BECAUSE I APPRECIATE THAT NOT ALL OF YOUR COLLEAGUES COULD BE ON THE PHONE WHEN WE LAST SPOKE. WE WANT A BROAD SEARCH. THE MOST IMPORTANT THING IS YOU WANT A LEADER WHO CAN SIT AT THE TABLE OF INSTITUTE AND CENTER DIRECTORS AND BE HEARD. SO AS THE INSTITUTE AND CENTER DIRECTOR, DR. COLLINS SITS HERE, I SIT HERE AND DR. FAUCI SITS THERE. FORGET ABOUT ME, THAT'S WHO THEY HAVE TO SIT AT THE TABLE WITH, DR. COLLINS AND DR. FAUCI AND ALL THE IC DIRECTOR COLLEAGUES. THAT IS WHO YOU WANT BECAUSE YOU WANT THE NURSING COMPLEX, THE NURSING PROFESSION, THE RESEARCH THAT YOU ALL HOLD SO DEAR TO BE PART OF THE CONVERSATION. SO THAT'S THE FIRST THING. NOW, WHAT ARE THE PHENOTYPES? CUTTING-EDGE RESEARCH. DISCIPLINE? YOU HAVE A VERY WIDE BREATH OF SCIENCE YOU SUPPORT IN THE 20 MINUTES OR SO THAT I WAS HERE, WE WENT ALL THE WAY FROM MITOCHONDRIA TO SLEEP DEPRIVATION OF MEMBERS OF THE SERVICE. SO, ANY AND ALL OF THOSE COULD VERY WELL BE CUTTING-EDGE WORK BUT YOU WANT IT TO BE CUTTING-EDGE. AND YOU KNOW THIS. OMICS. BIG DATA. BEHAVIORAL SOCIAL SCIENCE RESEARCH ENTERED A NEW ERA BECAUSE OF BIG DATA, BECAUSE OF WEARABLE DEVICES. BECAUSE OF ALL THE OTHER THINGS WE HAVE AT OUR DISPOSAL NOW. SO YOU WANT A CUTTING-EDGE SCIENTIST WHO CAN REALLY SHOW THE VERY BEST AND MOST EXCITING ASPECTS OF THE FIELDS THAT THE INDIVIDUAL WILL REPRESENT. THE PERSON NEED NOT LOOK LIKE ME IN THE SENSE THAT THEY DO NOT NEED TO HAVE A LOT OF GRAY HAIR. OKAY? I THINK THERE WAS A MISPERCEPTION DURING THE FIRST ROUND THAT YOU NEEDED TO HAVE MANY YEARS OF ADMINISTRATIVE EXPERIENCE TO DO A JOB OF THIS TYPE. WHEN I WAS RECRUITED TO NIH TO BE THE DIRECTOR OF I'M GOING TO SAY THE WORD AGAIN, THE DEPUTYAL INSTITUTE, I WAS LIKE -- DENTAL INSTITUTE -- I WAS LIKE 47 YEARS OLD. YOU DON'T NEED A LOT OF GRAY HAIR. WHAT YOU NEED, IS YOU NEED A WILLINGNESS TO LEARN HOW TO RUN A COMPLEX ORGANIZATION IN A FEDERAL ENVIRONMENT BECAUSE THIS IS NOT LIKE RUNNING A DEPARTMENT. INDEED, THIS IS NOT LIKE RUNNING A SCHOOL AS A DEAN. IT'S A MORE COMPLEX ENVIRONMENT. BUT IT IS A LEARNED EXPERIENCE. CURRENTLY, AT THE TABLE OF INSTITUTE AND CENTER DIRECTORS, I THINK THIS IS RIGHT. I BELIEVE THERE IS ONLY ONE FORMER DEAN OF THE SCHOOL. EVERYBODY ELSE WAS DEPARTMENT CHAIR OR THE CHIEF OF A DIVISION OR -- SO THERE IS NO NEED TO HAVE RUN BIG COMPLEX -- NOW IF SOMEBODY WITH GRAY HAIR DOES SHOW UP, THAT'S FINE. SO I'M NOT BEING AGEIST HERE, BUT I DO WANT TO EMPHASIZE THAT ADMINISTRATIVE EXPERIENCE CAN BE A LEARNED ART IF YOU'RE WILLING TO LISTEN. AND I THINK THAT AS WE WORK TOWARDS THIS, THESE ARE -- THE PERSON WE WANT IS NOT LOOKING FOR A JOB. I CAN ASSURE YOU THAT. THEY ARE NOT SEARCHING THE WANT ADS. THEY ARE NOT LOOKING AT THE CHRONICAL OF HIGHER EDUCATION OR PROFESSIONAL JOURNALS. THEY ARE NOT. OKAY? THEY ARE ABSOLUTELY DELIGHTED TO BE IN THEIR CURRENT POSITION. THEY LOVE THEIR CURRENT JOB. EVERYBODY LOVES THEM. THEY COULDN'T IMAGINE LEAVING THEIR POSITION. THAT'S WHO WE WANT. [ LAUGHS ] AND FOR THAT PRIVILEGE, I WAS GETTING THERE. [ LAUGHS ] THANK YOU. AND FOR THAT PRIVILEGE, THERE IS A REASON WHY WE CALL IT GOVERNMENT SERVICE. SO, I'LL TELL YOU A QUICK PERSONAL STORY NOT THAT IT MATTERS BUT WHAT THE HECK. SO, WHEN WE MOVED DOWN HERE IN THE YEAR 2000, I TOOK A 25% PAY CUT WITH TWO KIDS IN PRIVATE COLLEGE BECAUSE IT MADE PERFECT SENSE WHEN I WAS EARNING 25% MORE IN MY FORMER LIFE AT THE UNIVERSITY OF ROCHESTER AS THE SENIOR ASSOCIATE DEAN FOR RESEARCH OF THE MEDICAL CENTER. CAREER WISE, FANTASTIC MOVE. FINANCIAL-WISE, NOT SO MUCH. BUT IT'S OKAY. YOU RECOVER. BUT THAT'S THE POINT. IS THAT THOSE CANDIDATES WHO PUT THEIR NAME IN, THEY NEED TO UNDERSTAND THAT YES, WE DO HAVE A CERTAIN SALARY RANGES, NOT NEARLY AS DRACONIAN AS IT USED TO BE. BECAUSE IT USED TO BE REALLY DRACONIAN. BUT, FORTUNATELY, SALARIES, PARTICULARLY FOR DEANS HAVE GROWN TO I THINK NICE REASONABLE LEVELS AND THEY ARE IN GENERAL SEEM TO BE MUCH HIGHER THAN WHAT WE CAN PAY. SO AND IT IS WHAT IT IS. THAT'S SOMETHING I CAN'T CONTROL. BUT THE INDIVIDUAL CAN MAINTAIN THEIR RESEARCH PROGRAM. THEY WOULD NOT HAVE A RESEARCH PROGRAM WITHIN NINR. BUT RATHER IN A PARTNER INSTITUTE. BUT DEFINITELY THEY CAN MAINTAIN A RESEARCH PROGRAM IF THEY WISH TO. SO THERE ARE LOTS OF OPPORTUNITIES, LOTS OF PERKS IF YOU WILL. SALARY MAY NOT BE THE BIGGEST PERK. BUT I DO THINK WE ARE MUCH MORE COMPETITIVE THAN WE USED TO BE. SO, AND IT'S MUCH BETTER TO HAVE THE CONVERSATION THAN TO ASSUME. THEY CAN NEVER AFFORD ME. MAYBE WE CAN'T BUT AT LEAST LET'S HAVE THE CONVERSATION. THOSE ARE THE THINGS THAT I WOULD KEEP IN MIND. >> I DON'T MEAN TO MONOPOLIZE BUT I DO HAVE IN MY HEAD SORT OF AN IDEA THAT THE DIRECTOR IS SOMEBODY WHO I GUESS REPRESENTS US WELL BOTH INSIDE THE NIH AS WELL AS TO THE EXTERNAL WORLD IN SOME WAYS THERE IS A BIT OF A CHEERLEADER IF YOU WILL, NOT EXACTLY, BUT YES, AN ENTHUSIASTIC SCIENTIST WHO IS WILLING TO LISTEN TO THE COMMUNITY OF SCIENTISTS WITHIN AND WITHOUT ABOUT DIRECTION AND HOW ONE MOLDS THAT AND SORT OF REALLY THAT SEEMS TO ME, THAT'S THAT KIND OF THINKING. >> DR. TABAK: YOU'RE ABSOLUTELY CORRECT BUT NOT TOO MANY PEOPLE IN THEIR CURRENT ROLES HAVE THE EXPERIENCE TO DEMONSTRATE THAT. YOU SEE? SO WHAT THE SEARCH COMMITTEE AND WHAT FRANCIS ULTIMATELY NEEDS TO DECIDE IS, DOES THE INDIVIDUAL HAVE THE POTENTIAL TO DO THAT? IF IN FACT THEY HAVEN'T YET HAD THAT OPPORTUNITY? SO, LOOK, PEOPLE COME IN DIFFERENT FLAVORS. SOME ARE VERY GREGAIRUOUS AND OUTGOING AND SOME ARE PRETTY CIRCUMSPECT. BUT IT'S A LEARNED EXPERIENCE. AND JUST BECAUSE IT'S NOT SOMETHING THAT YOU LIKE TO DO, YOU CAN LEARN TO DO IT. OKAY? IF YOU WANT TO. IF YOU'RE WILLING TO. AND SO, MEDIA TRAINING. COACHING. CERTIFICATE OF GOING WITH A MENTOR THE FIRST FEW TIMES TO MAKE SURE THAT THINGS GO SMOOTHLY. OBSERVATION BY PEOPLE WHO HAVE BEEN DOING IT FOR MANY YEARS. ALL OF THIS IS A LEARNED EXPERIENCE. IT'S A LOT OF FUN. BUT WHEN YOU'RE FIRST STARTING, IT'S A LITTLE STRESSFUL BECAUSE YOU MAY BE NEVER HAVE DONE IT BEFORE. SO YES, IT IS ABSOLUTELY TRUE THAT ULTIMATELY YOU WANT THAT PERSON TO REPRESENT YOU BEFORE CONGRESS, BEFORE DIFFERENT STAKEHOLDER GROUPS, BEFORE STAKEHOLDER GROUPS THAT YOU WOULD LIKE TO ENGAGE WITH, THAT YOU WOULD LIKE TO ACCURATELY A SONS WITH, THAT YOU WANT TO SPREAD. BUT NOT TOO MANY FOLKS HAVE THAT OPPORTUNITY. SOME PEOPLE IN THEIR CURRENT POSITIONS MIGHT. BUT DON'T EXCLUDE SOMEBODY WHO YOU THINK HAS THE POTENTIAL TO DO THAT EVEN THOUGH THEY MAY NOT HAVE DONE IT YET. NOW, WHEN YOU SPEAK TO THE PERSON AND YOU SAY, WELL, DO YOU ENVISION YOURSELF BEING ABLE TO SIT BEFORE THE CONGRESS AND TESTIFY? AND THEY LOOK AT YOU AS IF THEY HAVE JUST HEARD SOME CRAZY TALK. MAYBE THEY ARE NOT THE RIGHT PERSON. BUT MOST PEOPLE RISE TO THAT CHALLENGE. MOST PEOPLE -- BECAUSE THEY ARE PASSIONATE ABOUT WHAT YOU ALL DO. WHEN I SAY YOU ALL, I MEAN LITERALLY ALL OF YOU BECAUSE YOU HAVE SUCH A BREATH OF SCIENCE. AND THAT PERSON HAS TO BE ABLE TO DISPLAY THAT PASSION, THAT EXCITEMENT, NOT ONLY FOR THEIR OWN WORK, NOT ONLY FOR MITOCHONDRIA WHICH YOU WERE REALLY PASSIONATE ABOUT -- [ LAUGHS ] BUT SO TAKE A BOX THERE. BUT YOU GOT TO BE PASSIONATE ABOUT THE ENTIRE BREATH OF THE FIELD. THAT'S VERY, VERY IMPORTANT. AND I KNOW THOSE PEOPLE ARE OUT THERE. I'M POSITIVE OF IT. BECAUSE I HAVE ENCOUNTERED THEM IN SCIENTIFIC MEETINGS. I HAVE ENCOUNTERED THEM IN THE NATIONAL ACADEMY. œI KNOW THEY ARE OUT THERE. >> AND I JUST WANT TO ADD AFTER DOING THIS FOR A YEAR, I FOUND THE JOB TO BE EXTREMELY FUN. YOU ARE ACTUALLY SITTING AT THE TABLE AS LARRY WAS SAYING WITH TONY BUT WITH ALL THE OTHER 27, 26 INSTITUTES. AND A LOT OF WHAT GOES ON AT THAT TABLE IS SOME TYPE OF, NOT NECESSARILY AT THE TABLE BUT SHORTLY THEREAFTER IS NEGOTIATIONS AND COLLABORATION THAT IS ARE FORMED BETWEEN& INSTITUTES. AND I THINK NINR NEEDS TO BE VERY STRONG IN THAT AREA. WE HAVE SO MUCH TO OFFER OTHER INSTITUTES BUT A LOT OF PEOPLE DON'T KNOW WHAT NURSING -- A LOT OF INSTITUTES STILL DON'T KNOW WHAT NURSING SCIENCE IS. SO IT NEEDS TO BE A VERY PATIENT INDIVIDUAL TO BE THE DIRECTOR SO THEY CAN SAY OVER AND OVER AND OVER AGAIN, WITH A SMILE, OR WHATEVER, NOT A CRANKY SMILE, A NICE SMILE. THAT YES, LET ME TALK TO YOU ABOUT THIS SCIENCE AND HOW THE DATA WE ARE GENERATING WORKS WITH THE DATA YOU'RE GENERATING AND WE ARE INTERESTED IN HEALTH OUTCOMES SO THAT YOU CAN DO THAT. SO, IT'S A GREAT JOB. IT'S VERY, VERY FUN AND I CERTAINLY HAVE HAD A COUPLE OF PEOPLE COME TO ME AND SAY, SHOULD I BE INTERESTED IN IT? YES. JUST PUT YOUR NAME FORWARD. AT LEAST INTERVIEW. GET THAT EXPERIENCE. AT THIS LEVEL, IT'S ALL ABOUT EXPERIENCE AND YOUR NEXT STEPS AND FOR THOSE THAT YOU'RE TALKING TO, OR FOR THOSE ON THE VIDEOCAST. >> DR. TABAK: I THINK THE GLUCOSE LEVELS ARE DROPPING. AND THERE IS A NEED TO QUICKLY ELEVATE THEM. SO THANK YOU ALL FOR GIVING ME THE OPPORTUNITY TO SPEAK WITH YOU. AND WE LOOK FORWARD TO WORKING WITH YOU GOING FORWARD. >> AND WE WILL SEE Y'ALL TOMORROW AT 9 A.M. HERE IN THIS ROOM.