I WANT TO NOW CALL TO ORDER THE OPEN SESSION OF THE 80TH MEETING OF THE NATIONAL ADVISORY COUNCIL FOR COMPLEMENTARY AND INTEGRATIVE HEALTH. I NOTE FOR THE RECORD THAT THIS MEETING IS BEING HELD VIRTUALLY FOR ALL COUNCILMEMBERS, MOST NIH STAFF, AND THE PUBLIC. MY NAME IS PARTAP KHALSA AND I SERVE AS THE EXECUTIVE SECRETARY FOR THIS COUNCIL AND AS PER FEDERAL REGULATIONS, I'M THE DESIGNATED FEDERAL OFFICIAL FOR THIS MEETING OF THIS NATIONAL ADVISORY COUNCIL. THIS COUNCIL MEETING IS CONVENED AS REQUIRED BY TITLE 42 OF THE U.S. CODE OF LAWS THAT GOVERN NIH IN GENERAL AND NCCIH SPECIFICALLY, AND IN ACCORDANCE WITH THE FEDERAL ADVISORY COMMITTEE ACT THAT IS CODIFIED IN TITLE 5 OF THE U.S. CODE OF LAWS. I NOTE THAT THE CLOSED SESSION OF THIS COUNCIL WAS HELD EARLIER THIS MORNING AND WAS CLOSED TO THE PUBLIC IN ACCORDANCE WITH THE GOVERNMENT IN THE SUNSHINE ACT, AND AS CODIFIED IN TITLE 5 OF U.S. CODE, DEALING WITH ADMINISTRATIVE PROCEDURES FOR FEDERAL AGENCIES. WE WILL ENDEAVOR TO FINISH THE OPEN SESSION THIS AFTERNOON BY 4:30 P.M. EASTERN TIME. THE OPEN SESSION OF COUNCIL IS OPEN TO THE GENERAL PUBLIC TO ATTEND BY A LIVE NIH VIDEOCAST AND THIS CAN AND MAY BE VIEWED BY INDIVIDUALS ACROSS THE COUNTRY AND INDEED AROUND THE WORLD. THE OPEN SESSION WILL INCLUDE REMARKS AND A REVIEW -- EXCUSE ME, THESE REMARKS, AND THEY WILL BE FOLLOWED BY THE NCCIH DIRECTOR'S REPORT TO COUNCIL. WE WILL THEN BREAK FOR LUNCH, AND FOLLOWING LUNCH, WE WILL RECONVENE AT 1:20 P.M. EASTERN TIME AND THERE WILL BE A PRESENTATION BY DR. DSOUZA ON RESEARCH PRIORITIES FOR TEMPOROMANDIBULAR DISORDERS AND SHARED INTERESTS WITH NCCIH. FOLLOWING THAT, THERE WILL BE A MINI SYMPOSIUM ON CLINICAL TRIALS TO ADDRESS STRESS IN DIFFERENT CONTEXTS AND WHAT MAKES TRIALS IMPACTFUL. FINALLY, WE WILL HAVE THREE CONCEPT CLEARANCES WHICH WILL BE ON, FIRST, VALIDATION STUDIES OF ANALYTICAL METHODS FOR DIETARY SUPPLEMENT CONSTITUENTS. THE SECOND CONCEPT WILL BE ON RESEARCH NETWORKS TO PROMOTE INNOVATIVE MECHANISTIC AND TRANSLATIONAL STUDIES OF SICKLE CELL DISEASE PAIN, AND THE THIRD WILL BE ON BUILDING CROSS-CUTTING RESEARCH NETWORKS TO PROMOTE MULTIDISCIPLINARY MECHANISTIC STUDIES OF MUSIC AND HEALTH. COUNCILMEMBERS HAVE ALREADY RECEIVED A COPY OF THE JANUARY 2022 MEETING MINUTES IN THE ELECTRONIC COUNCIL BOOK, AND AT THIS TIME, I WOULD LIKE TO FINALIZE THE MINUTES, SPECIFICALLY ARE THERE ANY CORRECTIONS TO THE COUNCIL MEETING MINUTES? I'M GOING TO ASK COUNCILMEMBERS IF THEY HAVE ANY COMMENTS TO GO AHEAD AND RAISE THEIR DIGITAL HANDS ON THE ZOOM OR WAVE AT ME VIA THEIR VIDEO FEED. SEEING NONE, I WILL ASK FOR A MOTION FOR APPROVAL OF THE MEETING MINUTES. I NEED TO HEAR THAT AUDITOR ILY BY ONE COUNCILMEMBER. >> I MOVE. >> AND A SECOND? >> SECOND. >> AND IS THERE ANY FURTHER DISCUSSION BEFORE WE VOTE IN AND SO WHAT I'D LIKE TO HAVE IS THAT, AGAIN, THERE WILL BE A POLL QUESTION APPEARING ON YOUR SCREEN. YOU'RE VOTING TO APPROVE THE JANUARY 2022 COUNCIL MEETINGS, A VOTE OF YES MEANS YOU'RE APPROVING, A VOTE OF NO MEANS YOU'RE NOT, AND YOU CAN ABSTAIN. I SEE THE THING BUT I DON'T SEE THE NUMBER OF COUNCIL VOTES. CAN YOU TELL ME IF WE'VE GOT ALL THE VOTES? >> YES. >> SO IT'S UNANIMOUS? ALL RIGHT. SO THE COUNCIL MINUTES ARE APPROVED UNANIMOUSLY. THANK YOU. THERE WE GO. LATE TO THE PARTY. FUTURE COUNCIL MEETING DATES ARE NOTED ON THE AGENDA WHICH COUNCILMEMBERS HAVE ALREADY RECEIVED. OUR NEXT MEETING WILL BE ON AUGUST 12TH, 2022, AS CLOSED SESSION ONLY. AND THAT WILL THEN BE FOLLOWED BY A REGULAR MEETING OF COUNCIL MEETING, BOTH CLOSED AND OPEN SESSIONS, ON FRIDAY, SEPTEMBER 9TH OF THIS YEAR. IF THERE'S ANY CHANGE TO THESE DATES FOR ANY REASON, IT WILL BE ANNOUNCED IN ADVANCE. PLEASE BE SURE TO LET US KNOW AS SOON AS YOU KNOW IF YOU WILL NOT BE ABLE TO ATTEND ANY GIVEN MEETING. THE LAST AGENDA ITEM FOR THE OPEN SESSION LATER THIS AFTERNOON IS A PUBLIC COMMENT SESSION. BECAUSE THIS COUNCIL MEETING IS BEING HELD VIRTUALLY RATHER THAN IN PERSON FOR ALMOST EVERYBODY, THEN IT'S NOT POSSIBLE FOR MEMBERS OF THE PUBLIC TO MAKE IN-PERSON COMMENTS. AS SUCH, ANY MEMBER OF THE PUBLIC WHO WISHES TO MAKE A PUBLIC COMMENT MAY DO SO BY SENDING ME YOUR WRITTEN COMMENTS WITHIN 15 DAYS OF THE CON CONCLN OF THIS MEETING. THIS CAN BE DONE EITHER BY EMAIL OR HARD COPY LETTER. YOUR WRITTEN COMMENTS SHOULD BE LESS THAN 700 WORDS IN LENGTH, WHICH IS CONSISTENT WITH A FIVE-MINUTE ORAL PRESENTATION. YOUR WRITTEN COMMENT WILL BE ADDED TO THE MINUTES -- OR SHARED TO COUNCIL VIA THE ELECTRONIC COUNCIL BOOK. DR. LANGEVIN, PLEASE PROCEED. >> THANK YOU SO MUCH, DR. KHALSA. IT'S NOW MY DISTINCT PLEASURE TO SHARE MY DIRECTOR'S REPORT TO COUNCIL. ALL RIGHT. WE'RE GOING TO START WITH SOME GENERAL NIH NEWS. WE HAVE HAD RECENTLY THE ANNOUNCED IMPENDING DEPARTURE OF DR. NED SHARPLESS, WHO HAS STEPPED DOWN AS THE DIRECTOR OF THE NATIONAL CANCER INSTITUTE. DR. SHARPLESS HAS BEEN DIRECTOR OF THE NCI SINCE 2017. AND HE ALSO, DURING THAT TIME, WAS ASKED TO FILL IN AND ACT AS THE ACTING COMMISSIONER FOR FOOD AND DRUG AT THE U.S. FOOD AND DRUG ADMINISTRATION, FDA, FOR SEVEN MONTHS, IN 2019. AND THEN HE CAME BACK TO NCI, AND NOW, AFTER HIS DEPARTURE, PRINCIPAL DEPUTY DIRECTOR DOUGLAS LOWY IS SERVING AS NCI'S ACTING DIRECTOR. ANOTHER -- WE ALSO WANT TO WELCOME DR. JULIE GERBEDING, PREVIOUSLY SERVED AS DIRECTOR OF THE CDC AS WELL AS THE CHIEF PATIENT OFFICER AND EXECUTIVE VICE PRESIDENT OF MERCK. SO WE ARE VERY PLEASED THAT SHE'S NOW GOING TO BE LEADING FNIH. NOW FOR SOME STAFF UPDATES AT NCCIH. WE WOULD LIKE TO ALL PLEASE JOIN ME IN WELCOMING SEVERAL NULL PROGRAM NEW PROGRAM OFFICERS. A NEW PROGRAM DIRECTOR IN THE CLINICAL RESEARCH BRANCH AT NCCIH, DR. CHIDEYA, WHERE HER PORTFOLIO INCLUDES HEALTH DISPARITIES, POPULATION HEALTH AND DISEASE MANAGEMENT, MHEALTH INTERVENTIONS AND PRODUCTS RESEARCH. SHE IS ESPECIALLY INTERESTED IN FINDING -- EXPLORING THE UTILITY OF NATURAL PRODUCTS FOR MENTAL HEALTH AND ISSUES RELATED TO PALLIATIVE CARE. PRIOR TO JOINING NCCIH, DR. CHIDEYA WORKED FOR APPLE, WHERE SHE STRENGTHENED POPULATION HEALTH INITIATIVES AND SPEARHEADED A MULTI-PLATFORM INTERVENTION FOR GENERALIZED ANXIETY DISORDER. SHE'S A TRAINED MEDICAL EPIDEMIOLOGIST, AND WE ARE VERY, VERY PLEASED TO HAVE DR. CHIDEYA JOIN US AT NCCIH. NEXT IS A PROGRAM DIRECTOR IN THE CLINICAL RESEARCH BRANCH IN THE DIVISION OF EXTRAMURAL RESEARCH, OVERSEEING A PORTFOLIO OF CLINICAL RESEARCH INCLUDING HEALTH DISPARITIES, PEDIATRIC RESEARCH ON MENTAL AND EMOTIONAL WELL-BEING, MATERNAL MORBIDITY AND MORTALITY AND PRAGMATIC CLINICAL TRIALS. ADDITIONALLY SHE CONTRIBUTES TO THE MENTAL EMOTIONAL AND BEHAVIORAL OR MEB FLISHTIVES, AS WELL AS THE PRAGMATIC TRIALS COLLABORATORY. BEFORE JOINING NCCIH, DR. JEAN-FRANCOIS SERVED AS ADMINISTRATOR AT THE NATIONAL INSTITUTE OF MINORITY HEALTH AND HEALTH DISPARITIES, WHERE SHE CO-LED THE DATA COORDINATING CENTER FOR THE RADX INITIATIVE. WELCOME, DR. JEAN-FRANCOIS. NEXT I WOULD LIKE TO WELCOME DRM DIRECTOR IN THE BASIC AND MECHANISTIC RESEARCH BRANCH. DR. TUTTLE CURRENTLY LEADS SEVERAL TRANS-NIH INITIATIVES, INCLUDING THE HEAL MYOFASCIAL PAIN BIOMARKERS PROGRAM AND THE FORCE BASED MANIPULATION RESEARCH NETWORKS PROGRAM. HIS ADDITIONAL PROGRAMMATIC EFFORTS WILL INCLUDE DEVELOPING RESEARCH INITIATIVES INVOLVING MULTIORGAN SYSTEMS AND MULTICOMPONENT INTERVENTIONS CENTERING AROUND THE MUSCULOSKELETAL SYSTEM. PRIOR TO JOINING NCCIH, DR. TUTTLE SERVED AS ACTING CHIEF OF STAFF FOR THE NATIONAL INSTITUTES OF NEUROLOGICAL DISORDERS AND STROKE, OR NINDS. HE ALSO SERVED AS A LEAD PROGRAM ANALYST FOR THE HEAL ANALYST THINK TANK. SO WELCOME TO ALL OF THESE WONDERFUL NEW PROGRAM STAFF. I AM ALSO HAPPY TO WELCOME DR. BACKONJA AS ACTING CLINICAL DIRECTOR. OF COURSE WE ALSO WANT TO THANK DR. MARILYN POWELL, WHO HAS BEEN SERVING AS THE ACTING CLINICAL DIRECTOR AT NCCIH SINCE 2020. FLAD TO HER WORK AT NCCIH, DR. PAO HAS ALSO BEEN SERVING AT THE NATIONAL INSTITUTES OF MENTAL HEALTH. INTRAMURAL RESEARCH PROGRAM. WE TRULY APPRECIATE VERY, VERY GRATEFUL FOR DR. PAO FOR EVERYTHING SHE HAS DONE FOR US AT NCCIH, AND WE REALLY LOOK FORWARD TO CONTINUING TO WORK WITH HER IN THE FUTURE. WE ALSO NOW HAVE A NUMBER OF NEW ARRIVALS AND DEPARTURES. ONE DEPARTURE, RETIRING FROM THE OFFICE OF POLICY PLANNING AND EVALUATION, SHE'S BEEN AT NCCIH FOR MANY YEARS, AND OUR NEW ARRIVALS IN THE OFFICE OF COMMUNICATIONS AND EXTRAMURAL RESEARCH, EXTRAMURAL ACTIVITIES AND INTRAMURAL RESEARCH AS WELL. NOW OUR BUDGET. SO JUST TO KIND OF GUIDE YOU THROUGH A LITTLE BIT THIS MECHANISM TABLE THAT WE SHOWED TO SHOW TO YOU EVERY TIME, OBVIOUSLY THE NUMBERS THAT ARE HERE ARE ALWAYS A LITTLE BIT LAGGING, BUT WHAT I DO WANT TO POINT OUT IS THAT IN FY 22, WE RECEIVED A 3.4% INCREASE, SO OUR BUDGET WEN FROM $153,000,616 YOU SEE AT THE BOTTOM TO $159,000,365. NOW, THIS ALSO KIND OF RESULTED IN A GRADUAL SORT OF INCREASE IN THE AMOUNT OF MONEY THAT WE HAVE BEEN ABLE TO PUT TOWARDS RESEARCH PROJECTS. AT PREVIOUS COUNCILS WE HAD TALKED ABOUT THE POSSIBILITY IN THE FY 22 PRESIDENT'S BUDGET, THERE HAD BEEN A SUBSTANTIAL INCREASE TO NCCIH SPECIFICALLY FOR PAIN RESEARCH. THIS DID NOT COME TO FRUIT. WE DID NOT GET THIS INCREASE. HOWEVER, AS YOU CAN SEE IN THE FY 23 BUDGET, THE INCREASE IS, AGAIN, BACK IN THE PRESIDENT'S BUDGET. SO YOU CAN SEE THAT THE TOTAL AT THE BOTTOM WOULD GO UP TO $183 MILLION. $183,000,368. HOWEVER, AS WAS DEMONSTRATED LAST YEAR, THE PRESIDENT'S BUDGET DOES NOT OBVIOUSLY GUARANTEE ANYTHING. BUT THIS IS WHERE WE STAND RIGHT NOW. WE HAVE -- SO THERE IS A PROPOSED $183 MILLION, SO AN INCREASE OF $29 MILLION, SPECIFICALLY $26 MILLION OF THIS WOULD BE ALLOCATED TO EXPANDING NCCIH'S RESEARCH INTO PAIN AND PAIN MANAGEMENT. THIS REALLY IS, YOU KNOW, A REFLECTION OF THE VERY IMPORTANT RESEARCH, LEADERSHIP AND CONTRIBUTION THAT NCCIH HAS MADE IN THE AREA OF PAIN IN THE PAST, SO WE'LL JUST SEE WHAT HAPPENS WITH THIS. FOR SOME PROGRAM NEWS, AT BOTH NIH AND NCCIH, I WANT TO JUST GIVE A VERY QUICK UPDATE ON THE BRIDGE2AI PROJECT INITIATIVE THAT WE WERE HOPING TO HAVE SOME AWARDS ANNOUNCED AT THIS COUNCIL ROUND, BUT IT'S NOT GOING TO BE UNTIL MAY OR EARLY JUNE, SO WE'LL GIVE YOU AN UPDATE ON THIS IN SEPTEMBER. BUT HOWEVER, I AM DELIGHTED TO ANNOUNCE OUR AWARDEES FOR THE NEUROMECHANISMS OF FOR SPACE MANIPULATION, JOINED BY NCCIH AND THE NATIONAL INSTITUTES OF NEUROLOGICAL DISORDERS AND STROKE. THIS PROGRAM IS FOCUSING ON DEVELOPING INNOVATIVE AND IMPACTFUL RESOURCES TO ADVANCE OUR UNDERSTANDING OF BOTH NEURAL MECHANISMS AND BIOMECHANICS UNDERLYING FORCE-BASED MANIPULATION. SO YOU CAN SEE THE THREE AWARDS, SO THESE ARE THREE SEPARATE NETWORKS THAT WILL BE REALLY KIND OF ESTABLISHING GROUPS OF INVESTIGATORS TO REALLY GET THIS WHOLE FIELD KIND OF LAUNCHED. AND SOME GREAT NEWS FROM THE ALL-OF-US RESEARCH PROGRAM. THE NIH IS AWARDING $170 MILLION OVER FIVE YEARS PENDING THE AVAILABILITY OF FUNDS, OF COURSE, TO CLINICS AND CENTERS ACROSS THE COUNTRY FOR A NEW PRECISION NUTRITION STUDY THAT WILL DEVELOP ALGORITHMS TO PREDICT INDIVIDUAL RESPONSES TO FOODS AND ALSO DIETARY ROUTINES OR BEHAVIORS. SO THIS NUTRITION FOR PRECISION HEALTH IS THE FIRST EMBEDDED CLINICAL TRIAL IN THE ALL-OF-US RESEARCH PROGRAM. SO WE'VE OPINION BEEN EXPECW WITH QUITE TREPIDATION BECAUSE THE WHOLE POINT OF THE ALL-OF-US PROGRAM IS TO ENROLL LARGE NUMBERS OF HUMAN PARTICIPANTS, BUT ALSO -- AND COLLECT DATA TO ESTABLISH THIS VERY EXTENSIVE DATABASE, BUT ALSO TO ENABLE WHAT WE CALL ANCILLARY STUDIES TO THIS ENORMOUS DATABASE THAT WILL BE FUNDED SEPARATELY. AND THIS IS THE FIRST ONE OF THESE. WE ANTICIPATE A NUMBER OF U54, U24 AND UG1 PROJECTS FUNDED THROUGH THE NUTRITION FOR PRECISION HEALTH PROGRAM. NOW PRECISION NUTRITION, OF COURSE, ALIGNS VERY CLOSELY WITH NCCIH'S INTERESTS AND OUR VERY OWN CRAIG HOPP IS THE PROJECT SCIENTIST ON THE METABOLOMICS AND CLINICAL ASSAY CENTER. NOW ALSO, NEARLY 100,000 HIGHLY DIVERSE WHOLE GENOME SEQUENCES ALONG WITH A WEALTH OF ASSOCIATED PHENOTYPIC DATA FROM ELECTRONIC HEALTH RECORDS, WEARABLES, SURVEY DATA ARE AVAILABLE THROUGH THE ALL-OF-US RESEARCH PROGRAM. THIS IS OPEN TO ANYONE WHO WANTS TO ACCESS IT. 50% OF THESE DATA IS FROM -- I MEAN INVESTIGATORS -- FROM INDIVIDUALS -- 50% OF THE DATA IS FROM INDIVIDUALS WHO IDENTIFY WITH RACIAL OR ETHNIC GROUPS THAT HAVE HISTORICALLY BEEN UNDERREPRESENTED IN RESEARCH. SO YOU CAN SEE HERE THE LARGE NUMBERS OF GENOME SEQUENCES THAT WILL BE ASSOCIATED WITH EACH OF THE VARIOUS DIFFERENT TYPES OF DATA. WE ARE VERY MUCH LOOKING FORWARD TO SOME ANTICIPATED FUNDING OF OPPORTUNITY ANNOUNCEMENTS REGARDING ADDITIONAL ANCILLARY STUDIES. ANOTHER VERY, VERY IMPORTANT AREA THAT'S REALLY GETTING A LOT OF ATTENTION NIH-WIDE IS MATERNAL MORTALITY. WE KNOW ESPECIALLY THAT THERE IS TWO TO THREE TIMES MORE LIKELY -- MORTALITY IS 23 TIMES MORE LIKELY IN AMERICAN INDIAN, ALASKA NATIVE AND BLACK WOMEN, THE MORTALITY RATE FROM A PREGNANCY-RELATED CAUSE, THAN IN WHITE WOMEN. SO THIS IS A HUGE PRIORITY AT NIH AND MULTIPLE ICS HAVE INVESTED IN RESEARCH TO PREVENT MORBIDITY AND MORTALITY AND OVERALL HEALTH OF PREGNANT WOMEN. SO AT NCCIH, WE'RE WATCHING THIS SPACE VERY CLOSELY, AND WE'RE KEEPING OUR FINGER ON THE PULSE OF THESE NIH-WIDE PROJECTS AND WE'LL LET YOU KNOW WHEN FUNDING OPPORTUNITY ANNOUNCEMENTS ARE AVAILABLE FOR IMPLEMENTATION RESEARCH IN THIS VERY IMPORTANT AREA. WE'RE PARTICULARLY INTERESTED IN COMPLEMENTARY HEALTH APPROACHES FOR MANAGING THE VARIOUS DIFFERENT ASPECTS OF PREGNANCY THAT COULD LEAD TO IMPROVED HEALTH OUTCOMES FOR PREGNANT WOMEN. NOW AS I'VE PRETTY MUCH BEEN DOING FOR THE LAST TWO YEARS, GIVING YOU A LITTLE BIT OF UPDATES ON WHAT'S HAPPENING IN THE AREA OF COVID. ONE VERY IMPORTANT INITIATIVE IS THE ROSALIND TRACKER. THIS IS VERY IMPORTANT BECAUSE IT'S A REALTIME TRACKER TO SUPPORT THE RAPID GENOTYPING FOR SARS-COV-2. THE CURRENT SITUATION RIGHT NOW IS MOST OF THE PRIMARY METHOD FOR DETECTING VARIANTS IS NEXT GEN SEQUENCING. THE PROBLEM WITH THIS FIRST OF ALL IS IT'S EXPENSIVE AND IT CAN TAKE MANY WEEKS BEFORE SEQUENCING DATA IS AVAILABLE IN PUBLIC DATA REPOSITORIES. THE ROSALIND TRACKER IS VERY NOVEL AND IMPORTANT BECAUSE IT USES A PCR-BASED GENOTYPING APPROACH THAT REALLY IS VERY, VERY QUICK. IT CAN BE IMPLEMENTED IN ANY TESTING LAB THAT PERFORMS PCR, AND IT'S SIGNIFICANTLY LESS EXPENSIVE. SO YOU CAN SEE HERE FROM THE BAR GRAPH THAT OVER THE LAST 60 DAYS, THE BA2, BA3 VARIANT HAS BECOME DOMINANT OVER THE OTHER OMICRON VARIANTS, BUT HOWEVER, THERE'S SOME VARIATION BY STATE. SO IT'S REALLY IMPORTANT THAT WE HAVE METHODS THAT ARE ABLE TO REALLY DETECT THIS IN REALTIME AS THESE VARIANTS ARE SORT OF, YOU KNOW, POPPING UP AND SPREADING. SO THIS RESEARCH IS SUPPORTED WITH FUNDING FROM NIBIB AS PART OF THE RAPID ACCELERATION OF DIAGNOSTICS OR RADX INITIATIVE. NOW, IN MARCH, THE FDA AUTHORIZED A FOURTH DOSE OR THE SECOND BOOSTER OF PFIZER AND OTHER -- AND MODERNA VACCINES AND OTHER VACCINES FOR OLDER AND CERTAIN IMMUNOCOMPROMISED POPULATIONS. AND THE NEW ENGLAND JOURNAL OF MEDICINE STUDY THAT WAS PUBLISHED RECENTLY FROM A RESEARCH GROUP IN ISRAEL, VERY CONVINCINGLY SHOWED THAT A SECOND BOOSTER SIGNIFICANTLY DECREASES THE LIKELIHOOD OF HOSPITALIZATION, SEVERE INFECTION AND DEATH. YOU CAN SEE THESE CURVES, THE DIFFERENCE BETWEEN THE RED AND THE BLUE LINES ARE VERY CONVINCING. SO IF THERE WAS EVER ANY DOUBT THAT THESE BOOSTERS ARE DOING SOMETHING, REALLY THIS IS IT. NOW, A NEW NATIONWIDE TEST TO TREAT INITIATIVE, THIS IS VERY IMPORTANT, WAS ALSO LAUNCHED IN MARCH BY THE BIDEN-HARRIS ADMINISTRATION TO ALLOW INDIVIDUALS TO QUICKLY ACCESS FREE LIFE SAVING TREATMENTS FOR COVID-19. SO THIS TEST TO TREAT PROGRAM MEANS THAT IF YOU GO TO A CERTAIN AREA, PLACE TO BE TESTED, FOR EXAMPLE, AT CERTAIN PHARMACIES OR HEALTH RESOURCES SERVICE ADMINISTRATION SUPPORTED FEDERALLY QUALIFIED HEALTH CENTERS, THEN YOU CAN -- IF YOU TEST POSITIVE AND TREATMENTS ARE APPROPRIATE, YOU CAN RECEIVE A PRESCRIPTION FROM A HEALTHCARE PROVIDER RIGHT THERE ON THE SPOT AND HAVE PRESCRIPTIONS FILLED AT THAT LOCATION. THESE ARE AT PHARMACY-BASED CLINICS THAT HAVE THESE KINDS OF FACILITIES. BUT THIS IS GOING TO BE VERY IMPORTANT GOING FORWARD TO MAKE SURE THAT WE TAKE FULL ADVANTAGE OF THE KIND OF LIFE SAVING MEDICATIONS THAT WE NOW HAVE. NOW ANOTHER VERY IMPORTANT COURSE OF THIS PANDEMIC IS POST COVID, OR WHAT WE CALL PAS, POST COVID SEQUELAE OR LONG COVID. WE KNOW THAT RECOVERY FROM SARS-COV-2 INFECTION IS EXTREMELY VARIABLE. MANY PATIENTS RECOVER VERY QUICKLY AND HAVE MINIMAL SYMPTOMS, BUT OTHERS REALLY HAVE PROMINENT SYMPTOMS THAT CAN CONTINUE ON FOR QUITE A WHILE, INVOLVING MULTIPLE ORGAN SYSTEMS AND REALLY CAN SIGNIFICANTLY AFFECT QUALITY OF LIFE. SO THE MAGNITUDE OF THE PUBLIC HEALTH IMPACT OF THESE SEQUELAE IS POTENTIALLY VERY LARGE, GIVEN THE NUMBER OF INDIVIDUALS ACROSS ALL THE AGE SPECTRUMS THAT HAVE ALREADY BEEN AFFECTED AND WILL CONTINUE PROBABLY TO BE INFECTED WITH SARS-COV-2. SO THIS REQUEST FOR APPLICATIONS IS TO SOLICIT APPLICATIONS PROPOSING CLINICAL TRIAL PROTOCOLS TO BE FINALIZED AND EXECUTED RAPIDLY FOR THE IDENTIFICATION OF SAFE AND EFFECTIVE TREATMENTS AND PREVENTIVE STRATEGIES VERY IMPORTANTLY FOR PASC IN THOSE OVER 18 YEARS OF AGE. WE ANTICIPATE FURTHER OPPORTUNITIES FOR TRIALS INVOLVING CHILDREN. SO WE'RE REALLY INTERESTED OF COURSE IN THIS AREA FROM POINT OF VIEW OF CHRONIC STRESS AND STRESS MANAGEMENT AND BEHAVIORAL INTERVENTIONS THAT CAN HELP TO SORT OF STRENGTHEN OVERALL HEALTH, BECAUSE WE THINK THIS IS VERY IMPORTANT. OUR OVERALL HEALTH AND THE FUNCTION OF OUR IMMUNE SYSTEMS IS NOT JUST AN ISOLATED EVENT. IT REALLY FENDS ON A LOT OF FACTORS THAT ARE INFLUENCED BY SELF-CARE AND ATTENTION TO NUTRITIONAL, PSYCHOLOGICAL, PHYSICAL, ET CETERA, KIND OF ASPECTS OF HEALTH. SO WE THINK THIS IS GOING TO BE VERY, VERY IMPORTANT. I ALSO WANT TO HIGHLIGHT SOME RESEARCH, SOME RECENT PUBLICATIONS INCLUDING SEVERAL PAPERS FROM OUR CURRENT AND PAST INTRAMURAL RESEARCHERS, ESPECIALLY RICHARD -- AS WELL AS LAURA CASE WHO WAS PREVIOUSLY A POSTDOCTORAL FELLOW, NOW ASSISTANT PROFESSOR AT U.C. SAN DIEGO. AND SO IF YOU HAVE A CHANCE TO CHECK THESE OUT, THESE ARE ALL IN YOUR PACKET. AND I ALSO WANT TO POINT OUT THIS STUDY FROM UNIVERSITY OF WASHINGTON IN SEATTLE, WHERE RESEARCHERS LOOKED AT WHETHER OR NOT RESIDENTIAL GREEN SPACES ARE ASSOCIATED WITH A RISK OF DEMENTIA AMONG OLDER ADULTS. THIS WAS A STUDY, AN ANCILLARY STUDY FROM THE GINKGO EVALUATION OF MEMORY STUDY, THE GEM STUDY, WHERE 3,000 PARTICIPANTS 75 OR OLDER WERE ENROLLED BETWEEN 2000 AND 2008. AND THEY WERE ABLE TO GO BACK AND LOOK AT ASSOCIATIONS BETWEEN THE GREEN AREAS, GREENSPACE SURROUNDING WHERE PEOPLE LIVE AND WERE ABLE TO CONTROL FOR MULTIPLE FACTORS, INCLUDING SOCIAL -- NEIGHBORHOOD SOCIOECONOMIC STATUS. WHAT THEY FOUND IS THAT EVIDENCE FOR ASSOCIATION BETWEEN THE GREENSPACES AND ALL CAUSE DEMENTIA SUGGESTING THAT GREENSPACES MAY ACTUALLY BE PROTECTIVE. SO IT WILL BE INTERESTING TO FOLLOW HOW THIS KIND OF RESEARCH EVOLVES. THIS IS YOU A 'NOTHER ANG STUDY WHERE RESEARCHERS SHOW THAT GUT MICROBIOME, DIVERSITY AND ABUNDANCE CORRELATES WITH GREY MATTER VOLUME IN THE HIPPOCAMPUS AND NUCLEUS ACCUMBENS IN OLDER ADULTS WITH DEPRESSION. SO LOOKING ACROSS THE DIFFERENT SYSTEMS OF THE BODY, THIS TIME THE GUT AND THE BRAIN, AND ALTHOUGH THIS WAS AL SMALL STUDY, THE DATA SUGGESTS THAT THE GUT MICROBIOME MAY REFLECT AND INFLUENCE BRAIN HEALTH IN GERIATRIC DEPRESSION. THE STUDY WAS PARTIALLY FUNDED BY NCCIH AND WITH A K24 AWARD TO HELY LEF HELEN LAVRETSKY. INCREASING CONSUMPTION OF ORAL SUPPLEMENTS MADE FROM KRATOM LEAVES IS VERY MUCH ON THE RISE IN TERMS OF PEOPLE USING THESE HERBS AND HERBAL DERIVATIVES TO MANAGE OPIOID WITHDRAWAL SYMPTOMS IN THE EAST, FOR EXAMPLE, INDONESIA, VERY MUCH EVERYBODY WHO HAS A BACKYARD HAS A KRATOM TREE. AND PEOPLE PICK THE LEAVES AND DRINK IT AS TEA. IT'S VERY, VERY COMMON. AND THIS HAS BEEN USED IN THIS COUNTRY FOR WITHDRAWAL SYMPTOMS AND PAIN, BUT UNFORTUNATELY, THIS IS LEADING TO INCREASED KRATOM-LINKED OVERDOSES AND DEATH. SO WE NEED TO UNDERSTAND WHAT'S GOING ON. IN THIS STUDY FROM MARY PAINE'S GROUP, UNIVERSITY OF SEATTLE IN WASHINGTON, THE TEAM PERFORMED A COMPREHENSIVE PHARMACOKINETIC CHARACTERIZATION OF KRATOM ALKALOIDS IN SIX HEALTHY ADULTS WHO WERE ADMINISTERED A SINGLE LOW DOSE WELL CHARACTERIZED KRATOM PRODUCT AS A TEA, WHICH IS THE MOST COMMON ROUTE OF CONSUMPTION WORLDWIDE. THIS IS A REALLY IMPORTANT RESULT TO OPEN THE DOOR TO FUEL TOUR STUDIES THAT WILL ENABLE REGULATORY AGENCIES TO MAKE INFORMED DECISIONS ABOUT THE SAFE USE OF THIS INCREASINGLY POPULAR BOTANICAL PRODUCT AND ADDRESSING IMPORTANT PUBLIC HEALTH CONCERNS. THIS WAS FUNDED BY NCCIH AND ODS. I WOULD ALSO LIKE TO MENTION A VERY EXCITING STUDY FROM DR. ERIC GARLAND'S GROUP, SUCCESSFUL TREATMENT OF OPIOID MISUSE AMONG PEOPLE WITH CHRONIC PAIN WHICH IS, AS WE KNOW, VERY CHALLENGING. THIS IS A NIDA-FUNDED RANDOMIZED CONTROLLED TRIAL WHERE DR. GARLAND'S GROUP SHOWED THAT THE MINDFULNESS ORIENTED RECOVERY ENHANCEMENT OR MORE INTERVENTION LED TO SUSTAINED -- SO VERY IMPORTANT RESULTS. JUST WANT TO GO THROUGH SOME NCCIH FUNDING OPPORTUNITIES. I'M GOING TO START WITH A -- ACTUALLY IT'S NOT FUNDING BUT THIS IS A REQUEST FOR INFORMATION, OR RFI, TO IDENTIFY A SET OF DETERMINANTS FOR WHOLE PERSON HEALTH. NOW WE'RE VERY INTERESTED IN THIS, VERY EXCITED ABOUT THIS RFI, BECAUSE THIS IS REALLY A FOLLOW-UP FROM A LOT OF THE INFORMATIONS CONVERSATIONS WE'VE BEEN HAVING AT NCCIH THROUGHOUT OUR WHOLE PERSON BOTH INTERNAL AND EXTERNAL WORKING GROUPS AS WELL AS COUNCIL, INPUT THAT WE HAVE GOTTEN FROM ALL OF YOU IN TERMS OF THE IMPORTANCE OF UNDERSTANDING THE FACTORS THAT INFLUENCE WHOLE PERSON HEALTH. THIS IS NOT A SIMPLE THING. YOU CAN IMAGINE, WHAT WE'RE GOING TO BE ASKING FOR IN THIS RFI, AND I HOPE THAT ALL OF YOU EITHER HAVE BEEN OR WILL HOPEFULLY RECEIVE EMAILS ABOUT THIS. WE'VE ALSO REALLY KIND OF BEEN BLASTING THIS FOR ALL OF OUR COMMUNICATION CHANNELS. WHAT WE'RE ASKING PEOPLE IS TO GIVE A LIST OF 20 FACTORS THAT INFLUENCE WHOLE PERSON HEALTH, INCLUDING ALL OF THE DIFFERENT DOMAINS. BIOLOGICAL, BEHAVIORAL, SOCIAL AND ENVIRONMENTAL. WE PICKED THE NUMBER 20 ARBITRARILY, BASICALLY BECAUSE O MUCH, AND SO WE KIND OF SHOT SOMEWHERE IN THE MIDDLE, AND IT'S NOT GOING TO BE THE FINAL NUMBER OBVIOUSLY, WE'RE GOING TO SEE WHAT INPUT WE GET. BUT WE REALLY WANT TO TRY TO DEFINE, WHAT ARE THE MAIN FACTORS IF YOU HAD TO NAME 20 FACTORS THAT ARE REALLY MOST IMPORTANT, WHAT WOULD THEY BE? SO THIS IS AN EXPERIMENT. WE WANT TO HEAR WHAT WE GET FROM THE COMMUNITY, FROM ALL OF YOU, SO PLEASE SPREAD THE WORD ABOUT THIS. WE REALLY HOPE TO GET -- AND THE RFI IS OPEN RIGHT NOW ON OUR WEBSITE FOR RESPONSE. I WANT TO ALSO POINT OUT A NOSI AIMED AT PROMOTING CHILDREN'S MENTAL, EMOTIONAL AND BEHAVIORAL HEALTH IN SCHOOL SETTINGS. WITH A PARTICULAR FOCUS ON SCHOOLS THAT SERVE HEALTH DISPARITY POPULATIONS AND OTHER VULNERABLE POPULATIONS LIKELY TO BE UNDERRESOURCED. WE KNOW THAT MENTAL HEALTH IN SCHOOLS RIGHT NOW IS REALLY BECOMING AND ACUTE PROBLEM, REALLY AN EMERGENCY, SO WE THINK THIS NOSI IS VERY TIMELY. ACTUALLY I'M JUST GOING TO QUICKLY GO BACK TO THE RFI FOR ONE SECOND. I FORGOT TO MENTION THAT OUR ULTIMATE GOAL OF THIS RFI IS NOT SIMPLY TO IDENTIFY FACTORS, BUT TO IDENTIFY MEASURES. SO ONCE WE GET THE INPUT FROM THE FACTORS, WHAT WE'RE GOING TO DO IS WE'RE GOING TO BE TAKING EACH OF THESE FACTORS ONCE WE'VE DETERMINED THE LIST AND ASSOCIATE THESE FACTORS WITH A LIST OF DATA ELEMENTS, MEASURABLE. AND THESE COULD BE FROM QUESTIONNAIRES, FROM WEARABLE SENSORS, GEOSPATIAL DATA, HEALTH RECORDS, TO DEFINE EACH OF THESE FACTORS, AND THEN TO DEVELOP A SET OF COMMON DATA ELEMENTS THAT PEOPLE CAN USE TO REALLY IMPROVE THE RIGOR AND REPRODUCIBILITY AND GENERALIZABILITY OF THE STUDIES THAT PEOPLE DO ON WHOLE PERSON HEALTH. I WANT TO NOW ALSO POINT OUT ANOTHER NOSI, NOTICE OF SPECIAL INTEREST, THAT ENCOURAGES APPLICATIONS FOR ADMINISTRATIVE SUPPLEMENTS TO NCCIH SUPPORTED AWARDS TO SUPPORT COMPLEMENTARY HEALTH PRACTITIONERS IN AN INTENSIVE, SUPERVISED RESEARCH EXPERIENCE THAT WILL LEAD TO A BETTER UNDERSTANDING OF AND PRACTICAL EXPERIENCE IN COMPLEMENTARY AND INTEGRATIVE HEALTH RESEARCH. NOW THIS RESEARCH OPPORTUNITY SUPPORTED UNDER THIS NOSI IS INTENDED TO PROVIDE A VEHICLE FOR COMPLEMENTARY HEALTH PRACTITIONERS TO OBTAIN RESEARCH SKILLS THAT WILL BENEFIT THE COMPLEMENTARY HEALTH RESEARCH COMMUNITY, AS THESE INDIVIDUALS BRING VERY IMPORTANT IN DEPTH KNOWLEDGE OF THE DME MEN COY HEALTH RESEARCH TO THE ENTERPRISE. NOW WE ALREADY HAVE RECEIVED A NUMBER OF APPLICATIONS TO THIS VERY IMPORTANT RFA ON THE HEALTHCARE RESEARCH COLLABORATORY PRAGMATIC AND IMPLEMENTATION TRIALS OF EMBEDDED INTERVENTIONS. BUT I JUST WANT TO POINT OUT THAT THERE'S ANOTHER RECEIPT DATE ON JUNE 18TH, SO THERE'S STILL TIME TO SUBMIT APPLICATION IS FOR THIS RFA. NEXT, THIS IS AN OPPORTUNITY FOR EXISTING T32 TRAINING PROGRAMS TO APPLY FOR ADMINISTRATIVE SUPPLEMENT TO SUPPORT ADDITIONAL TRAINING SLOTS FOR PRE-DOCTORAL AND POST-DOCTORAL CANDIDATES FROM DIVERSE BACKGROUNDS, INCLUDING THOSE FROM GROUPS THAT ARE UNDERREPRESENTED IN THE BIOMEDICAL, CLINICAL, BEHAVIORAL AND SOCIAL SCIENCES. AND THE NEXT RECEIPT DATE FOR THIS IS JULY 2ND. ALSO HERE'S AN OPPORTUNITY FOR ADDITIONAL T32 -- I JUST SAID THAT. DID I DUPLICATE THIS SLIDE? YEAH. SORRY. NOW I WILL MENTION A FEW UPDATES REGARDING THE HEAL INITIATIVE, OR HEALTH ADDICTION -- TO END ADDICTION LONG TERM. NOW, AS I MENTIONED IN PREVIOUS REPORTS, WE HAVE OUR SICKLE CELL DISEASE AND PAIN INITIATIVE THAT IS PART OF THE HEAL INITIATIVE, THIS IS FUNDED BY THE HEAL INITIATIVE. WE HAD A FANTASTIC TURNOUT AT OUR WORKSHOP LAST JULY WHICH RESULTED IN A REQUEST FOR APPLICATIONS, AND WE HAVE RECEIVED APPLICATIONS, THE RECEIPT DATES ARE NOW CLOSED AND THESE APPLICATIONS ARE UNDER REVIEW AND WE LOOK FORWARD TO GIVE YOU AN UPDATE ON THIS LATER, AT A LATER DATE. I ALSO WANT TO MENTION THE MYOFASCIAL PAIN INITIATIVE, ALSO FUNDED BY THE HEAL INITIATIVE TO DEVELOP QUANTITATIVE IMAGING BIOMARKERS OF BIOFACIAL TISSUES, PREDICT OUTCOMES FOR A VARIETY OF PAIN MANAGEMENT. APPLICATIONS AGAIN ARE UNDER REVIEW AND WE WILL GIVE YOU SOME UPDATES ON THESE. I WANT TO ALSO MENTION THAT WE CONTINUE TO BE INTERESTED FOR BOTH THE MYOFASCIAL PAIN AND THE SICKLE CELL PAIN. WE CONTINUE TO BE INTERESTED IN THESE TOPICS SO WATCH OUT FOR POSSIBLE ADDITIONAL RECEIPT DATES ON THESE INITIATIVES. HERE IS ANOTHER INITIATIVE CURRENTLY UNDER REVIEW, RESTORING JOINT FUNCTION THAT REFLECTS A VERY IMPORTANT COLLABORATION BETWEEN THE NATIONAL INSTITUTES OF ARTHRITIS AND MUSCULOSKELETAL DISEASES AND SKIN DISEASES, NCCIH, NINDS, NEUROLOGICAL DISEASE AND STROKE, NIDCR, DENTAL AND CRANIOFACIAL RESEARCH, NIBIB, BIOMEDICAL ENGINEERING BIOIMAGING, AND NATIONAL INSTITUTE ON AGING. AND THE GOAL IS TO DEFINE -- OF THIS PARTICULAR INITIATIVE IS TO DEFINE THE INNERVATION OF THE DIFFERENT ARTICULAR AND PERIARTICULAR TISSUES THAT COLLECTIVELY FORM THE JOINT, INCLUDING BONE, CARTILAGE, SYNOVIUM, JOINT CAPSULES, LIGAMENTS, TENDONS, FASCIA, MUSCLE, ET CETERA. THESE COMPONENTS, AS WE TALKED ABOUT THIS AT A PREVIOUS COUNCIL DISCUSSIONS, VERY IMPORTANT TO THINK ABOUT A WHOLE JOINT APPROACH, AND WE WILL BE REALLY LOOKING AT USING THESE AS A PLATFORM FOR LOOKING AT PREVENTIVE STRATEGIES TO PREVENT THE DEVELOPMENT OF JOINT PAIN AND DYSFUNCTION. SO AGAIN, WE HAD A NUMBER OF APPLICATIONS FOR THESE AND THEY'RE CURRENTLY BEING REVIEWED. PAST ACTIVITIES AS ACTIV. ARE THEY CONVENED THE THIRD ANNUAL MEETING, FEDERAL OFFICIALS AND OTHER STAKEHOLDERS ACROSS THE COUNTRY TO IDENTIFY OPPORTUNITIES TO ADVANCE THE GOALS OF THE INITIATIVE. AND A RECORDING OF THIS EVENT CAN BE FOUND ON THE NIH VIDEOCAST WEBSITE. NOW, THIS IS ANOTHER IMPORTANT PAST EVENT, INTERNATIONALLY INTERDISCIPLINARY WORKSHOP FOCUSED ON THE THEME OF CREATIVE MOVEMENT AND THE BRAIN. IT WAS A WONDERFUL SUCCESS. THIS IN-PERSON WORKSHOP TOOK PLACE AT THE WOLF TRAP NATIONAL PARK FOR THE PERFORMING ARTS AND THE PLANNING COMMITTEE INVITED AN EXCEPTIONALLY WIDE RANGE OF SCIENTIST, ENGINEERS, CLINICIANS TO EXCHANGE IDEAS AND TO INTEGRATE KNOWLEDGE AND EXPERIENCE AMONG CREATIVE MOVEMENT PROFESSIONALS AND OTHER PERFORMING ARTISTS. AND THE PRIMARY GOAL OF THE EVENT -- GOALS WERE TO ENCOURAGE ALL PARTICIPANTS TO REACH BEYOND THE CONFINES OF THEIR EXPERTISE TO EXPLORE THE SCIENCE OF LEARNING TO MOVE. HOW THE CREATIVE PROCESS HAD MANIFESTED IN THE BRAIN AND HOW IT CAN BE HARNESSED TO ENHANCE HEALTH AND QUALITY OF LIFE. SO VERY, VERY EXCITING. THE NCCIH HOT TOPICS WEBINAR RECENTLY FEATURED A CONVERSATION BETWEEN DR. EMILY EDWARDS, MYSELF AND TWO OUTSTANDING RESEARCHERS FROM THE UNIVERSITY OF MINNESOTA. WE HAD A VERY INFORMATIVE DISCUSSION ON THE INTERSECTION OF RESEARCH ON STRUCTURAL RACISM AND DISCRIMINATION AND WHOLE PERSON HEALTH. THIS WAS VERY WELL ATTENDED. WE HAD 549 ATTENDEES AND A RECORDING CAN BE FOUND ON THE NIH VIDEOCAST SITE. NOW WE ALSO HAD A TWO-DAY STEERING COMMITTEE MEETING THAT CELEBRATED THE 10 YEARS OF THE COLLABORATORY HEALTHCARE -- PRAGMATIC TRIALS COLLABORATORY WHICH HAS RECENTLY BEEN REBRANDED. THIS IS THE PREVIOUS HEALTHCARE SYSTEMS RESEARCH COLLABORATORY WHICH NOW HAS A NEW NAME. AND THE DISCUSSIONS OF THE EVOLUTION AND CURRENT LANDSCAPE OF EMBEDDED PRAGMATIC CLINICAL TRIALS SHARED THOUGHTS ON PRIORITIES FOR THE FUTURES OF THESE CLINICAL TRIALS INCLUDING HOW TO BETTER SERVE DIVERSE POPULATIONS, AND HEAR UPDATES ON PROGRESS AND TRANSITION PLANS FROM THE UG3 DEMONSTRATION PROJECTS. IT ALSO FOCUSES ON CHALLENGES AND LE SOBS LESSONS LEARNEDE DEMONSTRATION PRACTICE AS WELL AS THE LATEST BIOETHICS ACTIVITIES OF THE NIH COLLABORATORY. DR. CHRISTOPHER MCCURDY SLIVERED AN EXCELLENT PRESENTATION ABOUT THE CONTROVERSIAL KRATOM ONCE AGAIN IN THE CONTEXT OF THE OPIOID CRISIS EVENT. HAD A GREAT TURNOUT WITH 864 TOTAL VIEWS, BOTH LIVE AND ON DEMAND. AND ANOTHER SUCCESSFUL PAST EVENT, THE PRECISIONS PROBIOTICS WORKSHOP THAT IDENTIFIES KNOWLEDGE GAPS FROM CURRENT METHOD OLS AND CHALLENGES IN PROBIOTIC RESEARCH, AS WELL AS ROAD MAPPING FUTURE DIRECTIONS OF THE PRECISION PROBIOTIC THERAPIES. THERE WERE 11 PARTICIPATING INSTITUTES AND CENTERS. NCATS, NCCIH, NCI, NHLBI, NIA, NIAAA, NIAID, NICHG, ODS AND ONR, SO YOU CAN SEE IT WAS A VERY, VERY BROAD AND TRANS-NIH INTEREST IN THIS. OUTSTANDING VIEWERSHIP. 2,118 LIVE VIEWERS ON DAY ONE AND 1500 ON DAY TWO. NOW SOME UPCOMING ACTIVITIES AND EVENTS. PLEASE SAVE THE DATE FOR MAY 18TH. DR. MICHELLE MARTINS IMLS TALK, INTEGRATIVE MEDICINE LECTURE SERIES ENTITLED "WELL-BEING AND ECONOMIC BURDEN OF DISEASE." WHAT ARE WE LEARNING FROM CANCER SURVIVORS? AND ONCE AGAIN, NCCIH WILL HAVE A SUBSTANTIAL PRESENCE AT THE ANNUAL INTEGRATIVE -- INTERNATIONAL CONSORTIUM FOR INTEGRATIVE MEDICINE AND HEALTH MEETING IN PHOENIX, ARIZONA. IN JUST 10 DAYS. LEADING A VARIETY OF WORKSHOPS AND SYMPOSIA. AND I'VE OUTLINED SOME OF THESE AT OUR LAST COUNCIL MEETING, AND I WILL HAVE THE PLEASURE OF HAVING A CONVERSATION WITH DR. SUZANNE SIMMARD, PROFESSOR OF FOREST ECOLOGY AT THE UNIVERSITY OF BRITISH COLUMBIA AND THE AUTHOR OF "FINDING THE MOTHER TREE" BOOK. WONDERFUL BOOK. SHE'S A PIONEER IN PLANT COMMUNICATION AND KNOWN FOR HER RESEARCH ON HOW TREES INTERACT. SO REALLY LOOKING FORWARD TO THIS CONVERSATION WITH HER. AND MARINE JOYCE US FOR OUR 17TH ANNUAL PAIN CONSORTIUM SYMPOSIUM FEATURING NIH SUPPORTED RESEARCHERS WHOSE WORK HAS MADE AN IMPORTANT CONTRIBUTION TO PAIN RESEARCH. AND I'M PLEASED TO SAY THAT THIS YEAR'S THEME IS PAIN MANAGEMENT THROUGH THE LENS OF WHOLE PERSON HEALTH. AND KEYNOTE SPEAKERS ARE GOING TO BE DR. TRACY GAUDET AND DR. RUTH WOLEVER. AND IN ADDITION TO SPEAKERS AND PANEL SESSIONS, THERE IS A POSTER SESSION FEATURING EARLY CAREER INVESTIGATORS. AND RESEARCHERS WITH THE BEST ABSTRACTS ARE SELECTED TO GIVE ORAL PRESENTATIONS, AND THERE WILL BE THE AWARD FOR BEST POSTER AWARDED. AND ALSO PLEASE SAVE THE DATE FOR JUNE 23RD FOR A TALK ENTITLED ADVANCING RESEARCH ON EMOTIONAL WELL-BEING AND REGULATION OF EATING BY DR. ELISSA EPEL. FINALLY ON SEPTEMBER 29TH, WE WILL BE HOLDING THE INAUGURAL ANNUAL INVESTIGATOR MEETING OF THE NIH BLUEPRINT FOR NEUROSCIENCE RESEARCH ON INTEROCEPTION THAT WILL FOCUS ON FUNCTIONING NEURAL CIRCUITS. SO IF YOU RECALL, THIS WAS AN INITIATIVE THAT WAS FUNDED THROUGH THE NEUROSCIENCE BLUEPRINT, AND IT WILL BE VERY, VERY FASCINATING TO SEEK UPDATES FROM THESE INVESTIGATORS ON HOW THINGS ARE GOING. AND I FINALLY WANT TO POINT OUT OUR NEXT MEETING, SEPTEMBER 9TH OF OUR ADVISORY COUNCIL. AND I WANT TO ALSO JUST MENTION THAT WE ARE DOING A LITTLE BIT OF AN EXPERIMENT TODAY FOR THIS COUNCIL BECAUSE WE ARE DOING A HYBRID -- A LITTLE MINI HYBRID MEETING, AS YOU CAN SEE, SOME OF US, THE NCCIH STAFF IS IN THE ROOM. MOST OF THEM -- MOST OF THE STAFF IS VIRTUAL, AND SO ARE THE COUNCILMEMBERS. BUT WHAT WE WANT TO KNOW AND WE WOULD LIKE TO HEAR FROM OUR COUNCILMEMBERS IS HOW WOULD YOU ALL FEEL ABOUT EXPANDING THIS IN SEPTEMBER AS LONG AS, YOU KNOW, COVID STATISTICS PERMIT, WE WOULD KIND OF OPEN THIS UP AND REALLY EXTEND THIS TO BE A MORE FULLY HYBRID MEETING WHERE COUNCILMEMBERS WOULD BE INVITED TO COME AND PARTICIPATE IN PERSON AND HOPEFULLY WE CAN ALSO HAVE A SOCIAL EVENT AT THIS MEETING, WHICH WE HAVEN'T HAD NOW FOR TWO YEARS. AND I WOULD BE CURIOUS TO HEAR -- I SEE SOMEBODY CHIMING IN IN THE CHAT. BUT WE'D LOVE TO HEAR WHAT ARE YOUR THOUGHTS ON THIS. SO AS WELL AS ANY OTHER MATERIALS THAT I PRESENTED. SO I'M GOING TO STOP SHARING. YOU CAN REMOVE THE SLIDES AND WE'D LOVE TO HEAR COMMENTS FROM COUNCIL ON ANY OF THESE TOPICS. >> SO AGAIN FOR COUNCILMEMBERS, IF YOU'LL RAISE YOUR DIGITAL HAND OR WAVE AT US VIA VIDEO, WE'LL CALL ON YOU IN ORDER THAT YOU SO INDICATE. AND AS YOU GATHER YOUR THOUGHTS -- >> YEAH, AS YOU GATHER YOUR THOUGHTS, I'M JUST GETTING A PING FROM OUR DIRECTOR OF OFFICE AND POLICY PLANNING EVALUATION. I WANT TO JUST MENTION ALSO THAT I RECENTLY HAD A CONGRESS FLAL HEARING, BRIEFING, WITH TWO CONGRESS MEMBERS, CONGRESSWOMAN JACKIE WILORSKY AND CONGRESSWOMAN JUDY CHU, WHO ARE BOTH CO-CHAIRS OF THE INTEGRATIVE HEALTH CAUCUS. AND SO IT WAS VERY WELL RECEIVED. WE TALKED ABOUT WHOLE PERSON HEALTH AS WELL AS THE IMPORTANCE OF CHRONIC STRESS. AND HOW CHRONIC STRESS IS REALLY REACHING ALARMING PROPORTIONS, ESPECIALLY INCREASINGLY IN THE U.S., THERE ARE SOME SURVEYS THAT ARE -- QUITE CONCLUSIVELY SHOW PEOPLE IN THE UNITED STATES HAVE LEVELS OF STRESS THAT ARE AMONG THE HIGHEST IN THE WORLD. AND WE ALSO HAVE SOME DISTURBING HEALTH STATISTICS, THAT OUR LIFE EXPECTANCY IS DECREASING, WE HAVE A LOT OF PROBLEMS WITH DIFFERENT AREAS OF HEALTH THAT CAN BE INFLAWNSED BY STRESS, INCLUDING OPIOID USAGE, DEATH, ADDICTION, PAIN, AND AS WELL AS MENTAL HEALTH, BUT ALSO VERY IMPORTANTLY, PHYSICAL HEALTH. WE HAVE RISING RATES OF CARDIOVASCULAR DISEASE, CHRONIC OBESITY AND METABOLIC DIABETES, TYPE 2 DIABETES THAT CAN -- THAT ARE WORSENED, AND HYPERTENSION WORSENED BY STRESS. AND, OF COURSE, COVID. AND WE NE OUR IMMUNE RESPONSES ARE INFLUENCED BY STRESS. SO THIS IS AN AREA WE FEEL WE REALLY WANT TO RAISE AWARENESS OF THE IMPORTANCE OF STRESS MANAGEMENT, NOT ONLY FOR PSYCHOLOGICAL REASONS THEY'RE EXTREMELY IMPORTANT BUT FOR PHYSIOLOGICAL REASONS AS WELL. AND SO WE DISCUSSED THIS AND THERE WAS A LOT OF INTEREST IN THIS TOPIC. SO THANK YOU, MARY BETH, FOR REMINDING ME TO MENTION IT. >> QUESTIONS, COMMENTS FROM COUNCIL? >> DR. CECH? >> I JUST WANTED TO SAY THANK YOU, THAT WAS A REALLY INTERESTING AND DIVERSE OVERVIEW OF SOME REALLY EXCITING INITIATIVES. I'M JUST OBSERVING THAT THERE'S SUCH A THEME HERE OF INTERCONNECTIVITY THAT NCCIH HAS REALLY BEEN MAKING AN EFFORT TO CONNECT WITH OTHER INSTITUTES AND OTHER PROJECTS ACROSS NIH REALLY IN A FORWARD-THINKING WAY EVEN BEFORE WE WERE MOVING INTO THIS SITUATION THAT WE'RE IN CURRENTLY WITH SUCH A REALIZATION OF HOW ALL THE DIFFERENT TYPES OF STRESSORS THAT WE'RE HAVING ON OUR LIVES ARE REALLY IMPACTING HEALTH IN WAYS THAT CANNOT BE ISOLATED TO A SINGLE DISEASE. AND NCCIH HAS REALLY BEEN A LEADER IN THINKING ABOUT WHOLE BODY HEALTH AND INTERCONNECTIVITY FOR A VERY LONG TIME, BUT IT'S EXCITING TO SEE SOME OF THIS COMING TO FRUITION AND SEE SOME OF THE INTEGRATED EFFORTS ACROSS NIH AND ALSO THE EFFORTS TO REACH OUT TO COMMUNITIES THAT HAVEN'T PARTICIPATED IN SOME OF THESE IN THE PAST AND REACHING OUT TO PEOPLE TO GET THEIR OPINIONS ABOUT WHAT ARE THE MOST IMPORTANT VARIABLES WE SHOULD BE LOOKING AT IN RESEARCH. I JUST THINK IT'S REALLY VERY CUTTING EDGE AND I JUST WANT TO ACKNOWLEDGE ALL OF THE EFFORT OF ALL THE PEOPLE WHO'VE CONTRIBUTED TO THAT. IT'S REALLY EXCITING TO SEE. >> WELL, THANK YOU FOR THIS COMMENT. I REALLY APPRECIATE IT. WE ALL DO. IT'S VERY INTERESTING AS YOU SAID THAT THE INTERCONNECTIVITY IS SO IMPORTANT AND SO VITAL TO HOW WE THINK, BUT ALSO REACHING OUT TO OTHER GROUPS, BY NECESSITY, RIGHT, AT NCCIH BECAUSE WE HAVE SUCH A SMALL BUDGET, WE NEED TO REACH OUT AND WE'VE BEEN ACTUALLY VERY SUCCESSFUL IN GETTING CO-FUNDING PARTICIPATION IN THESE TRANS-NIH INITIATIVES WHICH ALLOWS US TO AUGMENT THE FUNDS THAT WE HAVE. SO, SO FAR, SO GOOD I THINK, YES. BEN AND THEN JUSTIN AND THEN -- >> THANKS, DR. LANGEVIN. I JUST HAVE A QUESTION, I GUESS, WHICH IS, AS YOU DO THAT REACHING OUT ACROSS TO OTHER INSTITUTES, HOW DO YOU FIND THE RECEPTION TO THIS CONCEPT OF WHOLE PERSON HEALTH? DO YOU FIND A LOT OF OPENNESS AND WILLINGNESS TO GET ON BOARD WITH THE INITIATIVES? DO YOU FIND STILL A FAIR AMOUNT OF SKEPTICISM FROM THE OTHER INSTITUTES? I'M JUST CURIOUS, YOUR GENERAL IMPRESSION ON THAT. >> A LOT OF INTEREST. AND IN FACT, THE PROOF OF THAT WAS THE FANTASTIC COLLABORATIONS THAT WE IN OUR WHOLE PERSON RESEARCH WORKSHOP. THIS WORKSHOP WAS ORGANIZED IN COLLABORATION WITH A NUMBER OF DIFFERENT INSTITUTES, AND WE HAD PROGRAM OFFICERS FROM ALL THESE INSTITUTES COME AND HELP US SHAPE THE PROGRAM AND CONTRIBUTED THEIR INVESTIGATORS TO THIS VERY AMAZING WORKSHOP THAT OCCURRED. SO WE ON PURPOSE WANTED THAT, BECAUSE WE WANTED TO HEAR FROM OTHER FIELDS THAT ARE ALREADY THINKING IN AN INTEGRATIVE DIRECTION, WHO ARE ALREADY THINKING ACROSS SYSTEMS AND ACROSS DOMAINS. OF COURSE THE INSTITUTES THAT ARE MORE -- ALREADY HAVE, FOR EXAMPLE, ENVIRONMENTAL HEALTH, NURSING, MINORITY HEALTH, AGING, THESE ARE THE INSTITUTES THAT ARE WHAT WE CALL NON-CATEGORICAL, THOSE ALREADY THINK THIS WAY. BUT WE ALSO HAD -- WE HAVE A LOT OF INTEREST NOW FOR VERY IMPORTANTLY THE MUSCULOSKELETAL, YOU'RE GOING TO HEAR THIS AFTERNOON FROM DR. RENA DSOUZA, THEY ARE ALSO REALLY THINKING IN AN INTEGRATIVE WAY. SHE'S GOING TO BE TALKING ABOUT THIS TOO. SO THE WORD IS DEFINITELY SPREADING. IT'S GONE REALLY WELL. DR. SONNENBURG, JUSTIN? >> HELENE, THANKS FOR THE REALLY WONDERFUL OVERVIEW. FAST MOVING, THERE'S A TON GOING ON. I THINK JUST TO KIND OF ECHO SOME OF THOSE SENTIMENTS, JUST OVER THE PAST FOUR YEARS OF BEING ON COUNCIL, SEEING THIS DIFFERENT WAY OF THINKING ABOUT DOING MEDICINE AND THINKING ABOUT HEALTH, TRANSITIONING FROM BEING SOMETHING THAT IS, YOU KNOW -- I THINK FELT VERY FOREIGN, IT FELT LIKE TO A LOT OF NIH TO NOW BEING REALLY CENTRAL AND BEING AT THE LEADING EDGE, I THINK THAT'S SUPER EXCITING TO SEE THE INTEGRATION WITH ALL THE OTHER INSTITUTES AND CENTERS, ALL THE JOINT INITIATIVES AND JUST TO HIGHLIGHT ONE POINT THAT YOU TOUCHED ON, THAT TRANS-NIH WORKSHOP ON PROBIOTIC THERAPIES THAT I WAS PART OF, I THINK THAT WAS JUST A SUPER INSPIRING TWO DAYS. INCREDIBLE LINEUP OF SPEAKERS, INCREDIBLE DISCUSSION. THAT FIELD IS CLEARLY GOING IN A LOT OF INTERESTING DISCUSSIONS, INCORPORATING PROBIOTICS 2.0, MICROBES FROM THE GUT AS PROBIOTICS AND EVEN ENGINEERED MICROBES FROM THE GUT. SO I THINK THERE'S JUST SO MANY EXCITING THINGS GOING ON THERE. AND THEN JUST A FINAL THANK YOU TO THE NCCIH STAFF THAT WERE INVOLVED IN PULLING THAT OFF. IT WAS REALLY JUST A REALLY EXCELLENT WORKSHOP AND DISCUSSION. >> THANK YOU FOR THIS COMMENT. I WANT TO SAY ALSO A VERY INTERESTING THING. A COUPLE YEARS AGO, WE DID A PORTFOLIO ANALYSIS AND WE LOOKED AT THE KIND OF RESEARCH THAT WE WERE ALREADY FUNDING, LIKE IN PREVIOUS YEARS, THAT WENT ACROSS SYSTEMS. AND THE NATURAL PRODUCTS PORTFOLIO AND PROBIOTICS AND MICROBIOME WAS SOME OF THE MOST INTEGRATIVE RESEARCH THAT WE WERE ALREADY FUNDING. SO IT'S VERY INTERESTING THAT THIS FIELD HAS BEEN REALLY LEADING THE WAY IN UNDERSTANDING HOW THE BODY IS CONNECTED, SO IT'S VERY INTERESTING TO SEE THAT. SO EMILY? >> THANK YOU, HELENE. IT'S FUNNY, AS WE DO THIS ON A DAY-TO-DAY BASIS WITHOUT REALIZING HOW MANY ACTIVITIES, EXCITING ACTIVITIES THAT WE'RE INVOLVED IN. SO THANK YOU FOR THIS WONDERFUL SUMMARY. BUT I WANTED TO JUST HIGHLIGHT THE TWO INTEGRATIVE MEDICINE SERIES YOU MENTIONED, DR. MARTIN AND DR. EPEL, THEY'RE FROM THE RESEARCH NETWORKS THAT WERE FUNDED IN 2020, AND THAT GROUP -- THOSE NETWORKS ARE FULLY FUNCTIONING AND REALLY MOVING FORWARD, SO I'M REALLY HAPPY THAT WE'RE ABOUT TO FEATURE THE WORK OF SOME OF THE THOSE NETWORKS IN THE NEXT COUPLE OF MONTHS. THANKS. >> THANK YOU, EMMELINE, YES, THANK YOU, VERY IMPORTANT. THANK YOU FOR MENTIONING THAT. KAREN? >> I FIND THIS VERY, VERY EXCITING. ONE OF THE CHALLENGES, THOUGH, AS I THINK ABOUT WHAT YOU'VE SAID ABOUT STRESS, HAVING REALLY RISEN RELATIVELY RAPIDLY DURING THE COVID PERIOD, AND JUST LOOKING AT WORLD EVENTS, IT DOESN'T LOOK LIKE IT'S GOING TO COME DOWN ANY TIME SOON, BUT OUR TYPICAL, YOU KNOW, IT TAKES THREE TO FIVE YEARS TO GET RESULTS AND GET THEM OUT AND STUFF IS A LITTLE CONCERN, AND I'M JUST WONDERING IF THERE'S A WAY TO PUT TOGETHER SOMETHING FROM ALL OF US WITH MAYBE SOME ONLINE INTERVENTIONS AND SOME REALLY NOVEL, QUICK, RAPID WAYS OF GETTING THINGS OUT AND TESTING THEM, MAYBE TESTING MULTIPLE THINGS AT ONCE OR WHATEVER, TO REALLY OFFER THINGS TO PEOPLE SOON. >> RIGHT. WELL, PART OF THAT IS TO LOOK AT INTERVENTIONS THAT WE ALREADY KNOW ARE EFFECTIVE, AND THEN TO SORT OF REALLY PUSH THE IMPLEMENTATION RESEARCH. AND THIS IS AN AREA WHERE WE'RE STARTING TO REALLY KIND OF LEARN -- WE'RE DEVELOPING A PLAY BOOK AS TO HOW TO MOVE THIS KIND OF RESEARCH ALONG, SO YEAH, YOU'RE RIGHT, WE DON'T WANT TO SIT ON THIS. I MEAN, THIS IS A CRISIS. AND JUST -- OBVIOUSLY WE'VE RECOGNIZED THE OPIOID CRISIS, THE PAIN CRISIS, BUT I THINK WE HAVE A STRESS CRISIS RIGHT NOW. IT'S MANIFESTING ITSELF ACROSS A LOT OF DIFFERENT AREAS. SO YEAH, WE'RE DEFINITELY GOING TO TRY TO SEE AND LOOK FOR CREATIVE WAYS TO PUSH THIS QUICKLY. HELEN? WE CAN'T ACTUALLY SEE YOUR VIDEO. THERE WE GO. >> SO JUST TO COMMENT ON THE PREVIOUS COMMENT, YOU KNOW, THIS IS A VERY IMPORTANT AREA, ESPECIALLY WITH LONG COVID, AND THE NEED IS ACCELERATED BY THE PANDEMIC, AND WHAT WE DO, ESPECIALLY MIND/BODY INTERVENTIONS, IS PROVIDING TOOLS FOR SELF-REGULATION. THE AMOUNT OF PEOPLE NOW UNDER STRESS, IT'S JUST IMPOSSIBLE TO FIND PROVIDERS FOR EACH OF THEM, SO IT HAS TO BE A PUBLIC EDUCATIONAL CAMPAIGN ABOUT SELF-REGULATION, STRESS REDUCTION, AND I DON'T KNOW WHETHER NCCIH HAS A MISSION LIKE THIS. >> OH, YES, ABSOLUTELY. WELL, YOU KNOW, THE WHOLE -- WHAT YOU'RE CALLING SELF-REGULATION IS VERY, VERY IMPORTANT, AND WE WANT TO UNDERSTAND BETTER FROM A BASIC SCIENCE POINT OF VIEW, WE UNDERSTAND THE AUTONOMIC NERVOUS SYSTEM IS VERY IMPORTANT HERE, THE ENDOCRINE SYSTEM IS RELATED TO OUR IMMUNE RESPONSES. IT'S RELATED TO A LOT OF -- THE FIELD OF INTEROCEPTION THAT WE ARE REALLY KIND OF TRYING TO UNDERSTAND BETTER. WHAT ARE THE SENSORY QUEUES THAT YOU GET FROM YOUR BODY TO EVEN KNOW THAT YOU'RE STRESSED? YOU KNOW, DIFFERENT PEOPLE FEEL DIFFERENT WAYS, RIGHT? AND SO THAT'S IMPORTANT. THAT'S AN IMPORTANT PIECE OF IT. AND THEN WHAT ARE SOME OF THE PRACTICES THAT WE ALREADY KNOW CAN BE REALLY IMPLEMENTED THAT ARE EASY TO DO, DON'T REQUIRE EXTENSIVE TRAINING. BREATHING, FOR EXAMPLE, DEEP BREATHING, SIMPLE HEAD TO TOE RELAXATION, SIMPLE MINDFULNESS EXERCISES THAT CAN BE KIND OF SCALED DOWN SO THAT THEY'RE ACCESSIBLE TO PEOPLE. WE REALLY WANT TO TRY TO REALLY EXPLORE WHAT IS THE BEST WAY THAT THIS CAN BE PUT INTO THE HANDS OF PEOPLE SO THAT THEY CAN APPLY THIS TO THEIR DAILY LIVES. AND REALLY HELP -- WE HAVE THIS KIND OF NEW LITTLE -- WHAT DO YOU CALL IT, PRESS RESET ON STRESS. HOW DO YOU HELP PEOPLE TO PRESS RESET SEVERAL TIMES DURING THE DAY SO THAT THEIR LEVELS OF STRESS DON'T ACCUMULATE AND SORT OF REALLY SORT OF BUILD UP OVER THE COURSE OF A STRESSFUL DAY, WHICH WE ALL HAVE TO DEAL WITH. SO RIGHT, I THINK THIS ELEMENT OF SELF REGULATION IS SO IMPORTANT, WHAT YOU'RE TALKING ABOUT, WE NEED TO UNDERSTAND BETTER HOW TO GIVE PEOPLE TOOLS SO THAT THEY CAN DO THIS EASILY, OR AT LEAST, YOU KNOW -- >> WELL, YOU KNOW, SO YOU HAVE ALL THIS INFORMATION AVAILABLE ON YOUR WEBSITE FOR THE PUBLIC, FOR THE GENERAL PUBLIC ABOUT SUPPLEMENTS, BUT CAN YOU DEVELOP A SIMILAR KIND OF TOOLBOX ABOUT SELF-REGULATION TOOLS THAT WE KNOW ABOUT? >> THAT'S A GREAT IDEA. IN FACT, WE ARE WORKING WITH OUR COMMUNICATIONS TEAM ABOUT REALLY SORT OF REIMAGINING OUR STRESS INFORMATION PACKET, AND I THINK -- WE'LL TAKE YOUR RECOMMENDATION. I THINK THAT'S A FANTASTIC IDEA. THANK YOU. I THINK, RICK, YOU HAD A HAND UP? >> HE DID HAVE HIS HAND UP. >> JUST TO PIGGY BACK REAL SHORTLY, I THINK ONE REALLY OPPORTUNITY FOR THIS SELF-CARE MASS IMPLEMENTATION AND MAYBE QUICKER CLINICAL TRIALS PROBABLY WILL INVOLVE INTERNET APPROACHES, MAYBE APP APPROACHES FOR THINGS THAT ARE ALREADY OBVIOUSLY WORKING FOR US, LIKE MEDITATION IS A VERY OPTIMAL ONE, AS WOULD BE LIKE ACUPRESSURE, THAT CAN ALL BE TAUGHT VIA AN APP. AND THAT'S REALLY KIND OF THE ONLY WAY I CAN SEE MANY SITES WORKING TOGETHER TO POOL DATA QUICKLY, WOULD HAVE TO HAVE INTERVENTION THAT WOULD BE ADMINISTERED FROM LIKE A LOCAL HUB THAT WOULD BE SENT OUT VIA SMARTPHONES OR WHAT HAVE YOU. MAYBE LIKE A FUNDING OPPORTUNITY THAT WOULD STIMULATE THAT KIND OF A NETWORK WHERE THESE EFFICACIOUS THINGS THAT WE ALREADY KNOW WORK CAN BE IMPLEMENTED REALLY QUICKLY. SO ANYWAY, JUST KIND OF OBVIOUS THINGS. >> THIS IS DEFINITELY VERY GOOD THOUGHTS. >> JUST WANT TO BE MINDFUL OF TIME. WE'VE GOT LIKE 4 MINUTES LEFT AND WE'VE GOT DR. SONNENBURG AND DR. KNUTSON AND I THINK THAT WILL PROBABLY TAKE US TO THE LUNCH BREAK. >> I'LL MAKE MINE REALLY QUICK. JUST TO COMMENT ON DR. SHERMAN'S COMMENT ABOUT THE RAPIDITY RANGE OF MOTION THAT'S NEEDED, I THINK THIS IS A REALLY KEY POINT. ONE OF THE THINGS THAT I THINK ABOUT WHEN I THINK ABOUT RAPID TRIALS IS SAFETY AS WELL AS EFFICACY, AND I THINK DIET IS ONE OF THESE THINGS THAT WE HAVEN'T PAID ENOUGH ATTENTION TO. I KNOW WE TALK ABOUT IT A LOT AT NCCIH, AND THE PRECISION NUTRITION COMPONENT OF ALL-OF-US IS COMING, BUT I WORRY THAT THAT MAY NOT EXPLORE ENOUGH DIETARY DIVERSITY AND THAT IT MAY NOT BE RAPID ENOUGH TURNAROUND. SO JUST THINKING ABOUT WAYS TO -- WE'RE DELIVERING MASSIVE DOSES OF DRUG-LIKE COMPOUNDS TO OUR BODIES THREE TIMES A DAY, SOMETIMES MORE TIMES A DAY. THAT'S MANIPULATING OUR MICROBIOME AND THEN CHANGING ALL OF OUR BIOLOGY, AND WHAT AN OPPORTUNITY TO HAVE A HUGE HEALTH IMPACT IF WE COULD UNDERSTAND THAT AND LEVERAGE IT. >> EXCELLENT POINT. THANK YOU. LORI, YOU HAVE THE LAST WORD. >> ALL RIGHT. I'LL BE QUICK. IT'S REALLY RESTATING MANY OF -- MUCH OF WHAT'S BEEN SAID, BUT THE NCCIH WEBSITE HAS THE HEALTH INFORMATION COMPONENT WHICH I THINK IS FOR THE GENERAL PUBLIC, AND THERE'S GREAT INFORMATION ON THERE ABOUT STRESS, BUT I THINK THAT HOW DO WE PACKAGE THIS FOR THE GENERAL PUBLIC, AND I WOULD ALSO SAY EMPLOYERS WHO HAVE A GREAT INTEREST IN WHAT'S GOING ON HERE. HOW DO WE PACKAGE THIS AND MAKE IT PROACTIVE VERSUS PASSIVE WHERE PEOPLE HAVE TO FIND THE SITE AND SO TO GET THROUGH THE MATERIALS. SO JUST A COMMENT ABOUT MORE BROAD COMMUNICATION ABOUT THE FINDINGS AROUND STRESS. >> THAT'S GRACE. ONE OF THE GREAT. ONE OF THE AREAS I'VE PERSONALLY BEEN INTERESTED IN GETTING MORE INPUT FROM YOU ALL COUNCILMEMBERS IS, HOW EASY IS TO GET THE INFORMATION FROM OUR WEBSITE? YOU KNOW, REGARDING A LOT OF THINGS. THIS IS FOR PUBLIC BUT ALSO WE'RE VERY INTERESTED ABOUT HOW USER-FRIENDLY SOME OF OUR INFORMATION REGARDING FUNDING OPPORTUNITIES, REGARDING -- WE'VE PAID A LOT OF ATTENTION TO THAT OVER THE LAST COUPLE YEARS AND TRIED TO IMPROVE THE USABILITY AND MAKE IT EASIER FOR PEOPLE TO SEARCH TO FUNDING OPPORTUNITIES, TO SEARCH FOR DIFFERENT EVENTS. SO IF YOU HAVE ANY FEEDBACK ON THAT, WE WOULD REALLY WELCOME THAT. >> JUST A VERY QUICK ONE. I WOULD ADVOCATE FOR A BIGGER TWITTER PRESENCE. I DON'T SEE A LOT FROM YOU GUYS. BUT THAT'S THE WAY FORWARD. >> THANK YOU. WELL, I KNOW. >> THANK YOU, DR. HANEY. >> WE NEED TO DO MORE. >> SO THAT'S GOING TO BE THE LAST COMMENT BEFORE WE BREAK FOR LUNCH BUT I'M GOING TO USE THIS TO SEGUE FOR A PLUG ACTUAL LITTLE FOR THIS AFTERNOON'S MINI SYMPOSIUM, WHICH IS GOING TO BE ON CLINICAL TRIALS AND HOW THEY ADDRESS STRESS IN DIFFERENT CONTEXTS, AND PARTICULARLY HOW THOSE TRIALS CAN BE HIGHLY IMPACTFUL. WE HAVE THREE GREAT PRESENTERS WHO WILL BE COMING IN, INVESTIGATORS TALKING ABOUT THIS FROM DIFFERENT PERSPECTIVES, AND WE WILL THEN HAVE ALSO A LOT OF TIME OR AT LEAST SOME TIME FOR COUNCIL TO INTERACT WITH THE PRESENTATIONS AND WEIGH IN ON THE DISCUSSIONS AND MAKING SUGGESTIONS ON THIS VERY IMPORTANT TOPIC. SO HAVE A GOOD LUNCH. WE'LL MEET BACK HERE AGAIN PROMPTLY AT 1:20 P.M. EASTERN TIME TO START OFF, AND THAT WILL BE THE SESSION LED BY DR. D' SOUZA, AND THAT WILL BE FOLLOWED BY THE MINI SYMPOSIUM ON STRESS. SO HAVE A GREAT LUNCH. WELCOME BACK FROM LUNCH. WE ARE GOING TO BE STARTING NOW, RECONVENING THE OPEN SESSION OF THE 80 MEETING OF THE NATIONAL ADVISORY COUNCIL FOR COMPLEMENTARY AND INTEGRATIVE HEALTH. AND DR. LANGEVIN, TAKE IT AWAY. >> THANK YOU SO MUCH, DR. DR. KHALSA. IT'S MY PLEASURE TO INTRODUCE DR. RENA D'SOUZA, DIRECTOR OF THE NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH AT NIH. SHE OVERSEES NIDCR'S ANNUAL BUDGET OF MORE THAN $475 MILLION, WHICH SUPPORTS BASIC, TRANSLATIONAL AND CLINICAL RESEARCH IN AREAS OF ORAL CANCER, OROFACIAL PAIN, TOOTH DECAY, PERIODONTAL DISEASE, SALIVARY GLAND DYSFUNCTION AND ORAL COMPLICATIONS OF SYSTEMIC DISEASES. DR. D'SOUZA HAS BEEN AT NIH NOW FOR A COUPLE OF YEARS NOW. SHE WAS ONE OF THE INSTITUTE DIRECTORS THAT WAS RECRUITED AND STARTED I BELIEVE RIGHT AT THE BEGINNING OF THE PANDEMIC, IF I'M CORRECT. AND IT'S BEEN WONDERFUL TO HAVE DR. D'SOUZA JOIN OUR NIH FAMILY, AND WE'VE HAD MANY CONVERSATIONS WHERE IT'S VERY CLEAR THAT HER INTERESTS REALLY INCLUDE THE RELATIONSHIP OF ORAL HEALTH TO WHOLE PERSON HEALTH AS WELL AS PREVENTION, AND WE ALSO SHARE A LOT OF INTERESTS IN THE AREAS OF PAIN. DR. D'SOUZA HAS BEEN INSTRUMENTAL IN REALLY FOSTERING A LOT OF COLLABORATIONS THAT WE'VE HAD ACROSS MANY INSTITUTES, INCLUDING MYOFASCIAL PAIN INITIATIVE, INCLUDING THE REJOIN INITIATIVE, AND SO WE'RE SO EXCITED TO HAVE HER COME IN AND SPEAK TO OUR COUNCIL TO TELL US ABOUT THE PRIORITIES OF NIDCR AND ALSO MANY DIFFERENT AREAS WHERE WE CAN COLLABORATE. ON A PERSONAL LEVEL, MY OWN LAB AT NIDCR IN THE INTRAMURAL RESEARCH DIVISION AT NIDCR, AND IT'S WONDERFUL THAT THERE ARE SUCH A DIVERSE ARRAY OF INVESTIGATORS AND INTRAMURAL RESEARCHERS THAT REALLY SPAN ACROSS SO VARIED AREAS OF HEALTH. SO DR. D'SOUZA'S OWN RESEARCH INTERESTS FOCUS ON CRANIOFACIAL DEVELOPMENT, GENETICS, TOOTH DEVELOPMENT, AND REGENERATIVE DENTAL MEDICINE. SHE AND HER TEAM HAVE MADE IMPORTANT ADVANCES IN THE FIELD OF TISSUE ENGINEERING IN THE CONTEXT OF DENTAL CARE. PRIOR TO JOINING NIH, DR. D'SOUZA WAS THE ASSISTANT VICE PRESIDENT FOR ACADEMIC AFFAIRS AND EDUCATION FOR HEALTH SCIENCES AT THE UNIVERSITY OF UTAH IN SALT LAKE CITY, WHERE SHE ALSO SERVED AS PROFESSOR OF DENTISTRY AND THE CHAIR OF THE SCHOOL OF DENTISTRY AND PROFESSOR OF NEUROBIOLOGY AND ANATOMY AND PATHOLOGY AND SURGERY IN THE SCHOOL OF MEDICINE AND THE DEPARTMENT OF BIOMEDICAL ENGINEERING. IF THAT WASN'T ENOUGH, IN 2002, SHE WAS SELECTED TO BE INAUGURAL DEAN AT THE UNIVERSITY OF UTAH SCHOOL OF DENTISTRY. IN ADDITION TO BEING A HIGHLY PRODUCTIVE RESEARCHER AND LEADER, DR. D'SOUZA IS ALSO A DEVOTED MENTOR AND CHAMPION OF DIVERSITY IN THE BIOMEDICAL RESEARCH WORKFORCE. SHE HAS SERVED AS A VOLUNTEER DENTIST FOR WOMEN IN NEED AND PEOPLE STRUGGLING WITH HOMELESSNESS IN SALT LAKE CITY, DALLAS AND HOUSTON SINCE 1985. DR. D'SOUZA RECEIVED HER BACHELOR'S DEGREE IN DENTAL SURGERY FROM THE UNIVERSITY OF BOMBAY, INDIA AND EARNED A DDS AS WELL AS PH.D. IN PATHOLOGY, BIOMEDICAL SCIENCES FROM THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER IN HOUSTON. SO WELCOME, DR. D'SOUZA. THANK YOU SO MUCH FOR COMING AND SPEAKING TO OUR COUNCIL. >> THANK YOU. THANK YOU, HELENE. I WOULD SAY AS A NEW DIRECTOR, I WAS ACTUALLY SWORN IN OCTOBER OF 2020 VIRTUALLY. IT BEEN VIRTUAL REALITY SINCE. BUT THAT REALITY HAS BEEN MADE A WHOLE LOT MORE PLEASANT BECAUSE OF FELLOW COLLEAGUES LIKE HELENE LANGEVIN, IT'S BEEN SUCH A PLEASURE KNOWING YOU AND SEEING YOU AS A REAL ADVOCATE AND SHARING THE VALUES THAT WE AT NIDCR UPHOLD VERY DEARLY. SO I WANT TO BRING TO ALL OF YOU MANY DPREETINGS FROM GRR INSTITUTE. WE HAVE A VERY IMPORTANT PARTNERSHIP WITH NCCIH AND WE INTEND TO ACTUALLY STRENGTHEN THAT IN THE MONTHS AND YEARS TO COME. AND I WANT TO SAY THAT -- LET ME GO INTO THE SLIDE HERE. SO THE TITLE IS FAIRLY EXPLANATORY. I WANT TO STRESS THAT THROUGHOUT THE PRESENTATION, AS I DESCRIBE WHAT'S IN OUR PORTFOLIO, I'M HOPING THAT YOU ALLOW YOURSELF THE FREEDOM TO MAKE THE CONNECTIONS BECAUSE THAT'S HOW IDEAS ARE BORN. SO EVEN THOUGH I'M NOT GOING TO SPECIFY WHICH ONES UNTIL THE VERY END, I DO HOPE THAT WE CAN GAIN FROM THIS CONNECTIONS FROM THIS TALK. AND THERE'S NO OTHER TIME ACTUALLY TO KNOW AND LEARN AND FEEL THAT IMPORTANCE OF HUMAN CONNECTIONS AS THE PANDEMIC HAS TAUGHT US THESE LESSONS. I LOVE THAT "TIME" MAGAZINE COVER BECAUSE IT ACTUALLY TELLS US THAT LIFE HAS CHANGED AND WILL NEVER BE THE SAME, AND HOW WE REDEFINE THE FUTURE IS REALLY UP TO US. WE LEARNED THAT NIMBLENESS AND BEING FLEXIBLE WAS SO KEY, AND THAT PARTNERSHIPS AND TEAM WORK WERE ACTUALLY CRITICAL FOR HEALTH-RELATED MATTERS. I SWITCHED THE IIIs THAT WE IN SCIENCE WOULD LABEL AS IMMUNOLOGY, INFECTION AND IMMUNITY. INTEGRATION DOESN'T MEAN WE LOSE OUR IDENTITY OR OUR ECOSYSTEM NATURES. IT MEANS WE CONNECT THE DOTS SO THAT WE IMPROVE HEALTH FOR THE INDIVIDUAL IN A HOLISTIC MANNER. BUT SHARK TANK APPROACHES WORK, THAT, IN FACT, WE LEARNED THAT THERE WERE MANY DEFICIENCIES IN OUR HEALTHCARE SYSTEM AND THEY CONTINUE TO PERSIST. IT WAS PRETTY OBVIOUS, AND THAT INDIVIDUALS MOST DISADVANTAGED ARE ACTUALLY THE ONES THAT SUCCUMBED TO THE PANDEMIC EARLY ON, AND THAT THE SOCIAL DETERMINANTS REMAIN I THINK A DETERRENT TO US ACHIEVING IDEAL OPTIMUM HEALTH FOR INDIVIDUALS. IN THE FIELD OF ORAL HEALTH, TELEDENTISTRY ACTUALLY DID IMPROVE ACCESS TO CARE, SO THAT WAS WONDERFUL LESSONS LEARNED THAT WE COULD ACTUALLY USE THESE NEW TECHNOLOGIES AND TOOLS TO TO GET THE HELP THEY NEEDED. AND OF COURSE IT WAS SO OBVIOUS THAT SCIENCE AND TECHNOLOGY COUNTS AND THAT LEADERSHIP MATTERS. SO I'M VERY GRATEFUL THAT HELENE IS AT THE HELM OF LEADING THE CENTER OF INTEGRATIVE HEALTH AND COMPLEMENTARY MEDICINE, REALLY, WITH COLLABORATIONS IN MIND. SO TO INTRODUCE TO YOU THE HUMAN FACE, EACH ONE OF YOU ON THIS PANEL HAS THIS UNIQUE IDENTITY, THE SENSE OF SELF WORTH AND WELL-BEING, AND IT COMES FROM THAT UNIQUE FACE, RIGHT, THAT WE SOMETIMES TAKE FOLKS FOR GRANTED. YOU JUST HAVE TO TALK TO A HOMELESS INDIVIDUAL THAT'S MISSING FRONT TEETH AND YOU PUT THEM BACK ON AND LIFE CHANGES FOR THAT INDIVIDUAL. AND THERE'S SO MANY EXAMPLES THAT I'LL COME TO THROUGHOUT THE TALK. NOW WHAT WE ARE VERY, VERY PROUD TO OWN ARE THE BIOLOGICAL SYSTEMS THAT, IN FACT, ARE PARADIGMS FOR BIOLOGY, REALLY, AND MEDICINE. WE HAVE ENAMEL WHICH IS IRREPLACEABLE, THE HARDEST TISSUE IN MAMMALIAN SYSTEMS, WE HAVE THE DISTINCT PATTERNING OF THE CRANIOFACIAL COMPLEX WHICH MEANS THAT SUTURES AND TEETH AND THEIR ERUPTION AND SHEDDING ARE VERY STRICTLY TIMED, WHICH MEANS STRICT GENETIC CONTROL. WE HAVE THE UNIQUE TONGUE AND TASTE BUDS, SALIVA, WE HAVE MICROBIOME UNIQUE FOR THE ORAL CAVITY. SO WE OWN THESE SYSTEMS THAT WE'RE VERY PROUD OF BUT WITH THEM COME A HOST OF CHALLENGES BECAUSE THEY ALL IMPACT SMALL SPACES THAT WE WORK IN AND SMALL TISSUES, RIGHT? SO FOR ALL OF THESE AMAZING SYSTEMS, WE HAVE A SET OF CHALLENGES THAT WE HAVE TO STEP UP TO MEET. THE ORAL CAVITY, MORE THAN ANYTHING ELSE, IS THE PORT OF ENTRY FOR THE COMMON RISK FACTORS THAT IN FACT PREDISPOSE IF NOT CONTRIBUTE TO CARDIOVASCULAR DISEASE AND METABOLIC SYNDROME. WE CAN SEE CERTAIN SYSTEMIC DISEASES MANIFESTED VERY EARLY IN THE MOUTH AND SARS-COV-2 WAS NO EXCEPTION. THE FIRST THING TO GO TYPICALLY IS THE LOSS OF TASTE. AND THEN YOU LAND UP WITH DRY MOUTH AND OTHER SCE SEQUELAE F COVID-19. WE ALSO CAN MONITOR HEALING AND COMPLIANCE BY LOOKING AT THE ORAL CAVITY, WE CAN LOOK AT A PATIENT AND KNOW ABOUT AS LONG AS LONG TERM DRUG USE, MENTAL ILLNESS, CAN BE CONTROLLED WITH COMPLIANCE AS WELL AS SIMPLY MONITORING THE PROGRESS TREATMENT THROUGH ORAL TISSUES, SO THERE'S A LOT THERE WE NEED TO KNOW. NOW WHEN I READ THROUGH YOUR WEBSITE AND WENT THROUGH YOUR STRATEGIC PLAN AND I LOOKED AT YOUR PRINCIPLE CORE MISSIONS, THERE WAS SUCH AN OVERLAP WITH WHAT WE AT NIDCR ACTUALLY CARE ABOUT. SO I HOPE THIS IS JUST THE BEGINNING OF CONTINUING THE JOURNEY SET UP BETWEEN MARTHA SOMERMAN AND HELENE YEARS AGO. SO JUST AN OVERVIEW, WHAT MAKES US TICK, SO TO SPEAK, WHAT OUR CHARGES ARE, WHAT WE ACTUALLY TAKE ON BEYOND THE SCIENCE, WHAT IS ACTUALLY HAPPENING TO ORAL HEALTH AND THE STATUS IN THIS COUNTRY? VERY IMPORTANT TO KNOW WHAT THAT IS. IT POINTS TO SO MANY CHALLENGES, LESSONS AND OPPORTUNITIES FOR THE FUTURE, HOW WE ORGANIZE AND OF COURSE OUR RESEARCH HIGHLIGHTS JUST TO PICK A FEW. ALL OF THESE ARE LEAD TO OUR COLLABORATIONS RIGHT NOW ACROSS CAMPUS, ACROSS INSTITUTES AND OF COURSE OUR EXTRAMURAL INVESTMENTS, SO THAT WE CAN MAKE MORE CONNECTIONS WITH NCCIH. SO WE'RE ONE OF 20 INSTITUTES. WE'RE I THINK ON THE SMALLER END, OUR BUDGET ACTUALLY, HELENE, MOVED UP TO 500 MILLION AND 200 ODD THOUSAND DOLLARS SO WE MOVED BEYOND THE 500 MARK, WHICH IS WONDERFUL, BUT WHAT MAKES US DISTINCT IN MANY WAYS WAS OUR ACTUAL HISTORY. WE WERE CREATED 48 YEARS AGO. SO WE CELEBRATED CELEBRATT YEAR ALONG WITH NEI AND GARY GIBBONS, NHLBI. WE WERE CREATED WITH A PUBLIC HEALTH MISSION. HARRY TRUMAN WAS CONCERNED WITH THOSE BEING ENLISTED IN THE WAR COULDN'T BECAUSE THEY HAD VERY BAD ORAL HEALTH. A LOT OF DECAY AT THAT TIE. PRIOR TO THE INTRODUCTION OF FLUORIDE IN COMMUNITY WATER SYSTEMS. SO WE CHANGED OUR NAME TO NIDCR TO INCLUDE THE CRANIOFACIAL COMPLEX FOR THE REASONS I MENTIONED JUST EARLIER. AND WE STAY TRUE TO THAT MISSION TODAY, WHICH IS TO REALLY ADVANCE HEALTH THROUGH KNOWLEDGE, THROUGH DISCOVERIES, THROUGH PARTNERSHIPS. BECAUSE WE CAN'T TO TO DO IT R OWN. WHEN I CAME ON BOARD, LITTLE DID I KNOW THAT WE WOULD HAVE TO TAKE ON THE RESPONSIBILITY OF STEERING THIS REPORT WHICH WAS ON THE ORAL HEALTH STATUS OF THE COUNTRY, THE PREVIOUS SURGEON GENERAL, JEROME ADAMS, WAS REALLY STRUCK BY THE DEMANDS OF COVID AND WAS UNABLE TO SHEPPARD THE TRUTH FURTHER, AND THE NEW SURGEON GENERAL HAD THE BORDER CRISIS, MENTAL HEALTH AND OTHER RESPONSIBILITIES SO WE KIND OF FELL IN THE CRACK THERE. AND NIH STEPPED UP WITH NIDCR TO GUIDE IT THROUGH. IT'S A 790-PAGE DOCUMENT. THE EXECUTIVE SUMMARY IS ONLY 25 PAGES SO I URGE YOU TO READ THAT. I'VE PLACED THE LINK HERE AND I WILL LEAVE THE POWERPOINT WITH YOU. THE WAY WE PROCEEDED WAS TO ORGANIZE ACROSS THE LIFESPAN LOOKING AT DISEASES AND DISORDERS THAT REALLY CHARACTERIZE EACH AGE GROUP AND ALSO PICKED ON WHAT I CONSIDERED THE CROSS-CUTTING THEMES OF PAIN IMAGINAGEMENT, OPIOID, SUBSTANCE USE DISORDERS, ADDICTIONS OF DIFFERENT KINDS. SO WE'RE HOPING THAT IT WILL STAY AS A LIVING DOCUMENT AND HELP US GUIDE OUR THINKING AND OUR STRATEGIES FOR THE FUTURE. AND IT WAS GOOD WITH THE HELP OF LARRY TABAK, WE WERE ABLE TO STRIKE UP A COLLABORATION WITH DR. VIVEK MURTHY, WHO'S THE CURRENT SURGEON GENERAL, AND WE WROTE THIS SHORT PERSPECTIVE ARTICLE PUBLISHED IN THE NEW ENGLAND JOURNAL, AND THIS IS A QUOTE FROM THERE THAT BASICALLY STRIKES AT THE VERY CORE OF WHAT WE ACTUALLY REPORTED ON. AND IT WAS IN MANY WAYS AN UPLIFTING EXPERIENCE BECAUSE WE ACKNOWLEDGED ALL THE GOOD SCIENCE AND DISCOVERIES THAT CAME ABOUT IN THE LAST 20 YEARS, SO THE FIRST SURGEON GENERAL REPORT WAS PUBLISHED IN 2000. AND THAT WAS A REPORT THAT STRESSED THE CONNECTION BETWEEN THE ORAL SYSTEMS AND SYSTEMIC -- GENERAL SYSTEMS. BUT DESPITE ALL OF THE PROGRESS WE'VE MADE, WE STILL HAVE THIS HUGE PROBLEM WHERE INDIVIDUALS AND POPULATIONS IN THIS COUNTRY EXPERIENCE ORAL HEALTH DIFFERENTLY. AND THAT WE CANNOT LOOK AT HEALTH AND WELL-BEING WITHOUT CONSIDERING ORAL HEALTHCARE AS BEING ABSOLUTELY INEXTRICABLY LINKED TO GENERAL HEALTH. SO OVER THE LAST 20 YEARS WE ALL KNOW THE DEMOGRAPHICS HAVE CHANGED SIGNIFICANTLY. WE'VE MOVED ESPECIALLY IN ORAL HEALTH TO A VERY DIGITAL ERA. WE'RE LOOKING NOW AT DATA SCIENCE AND BIG DATA, THE DELIVERY OF SYSTEMS AND OUR DELIVERABLES HAVE CHANGED, WHAT PATIENTS EXPECT THE KINDS AND SCOPES OF PRACTICES HAVE CHANGED, OUR DISEASE TRENDS HAVE CHANGED TO WHERE HBV POSITIVE OROPHARYNGEAL CANCERS ARE NOW MORE DOMINANT THAN CERVICAL CANCERS OF HBV ORIGIN. OUR DISCOVERIES HAVE BEEN FANTASTIC BUT WE HAVE THE DIVIDES AND BARRIERS AND DETERMINANTS OF HEALTH THAT HOLD US BACK, ALONG WITH UNEXPECTED PANDEMICS THAT WE'RE NOT QUITE PREPARED FOR. AND THIS IS WHAT THE REPORT SAYS. THAT THE BURDEN OF ORAL DISEASE IS HUGE AND IT'S FELT GLOBALLY. CRANIOFACIAL DEFECTS OUT OF ALL THE INHERITED DISORDERS, 50% OF THEM INVOLVE THE CRANIOFACIAL COMPLEX. I BRING THAT UP, I KNOW I HAVE IN THE PAST TO HELENE THAT THAT'S AN AREA THAT IS HARDLY UNDERSTOOD. LITTLE BABIES HAVE TO ENDURE LONG HOURS OF SURGERY AND THEN LIFELONG MANAGEMENT INVOLVING A LOT OF FACIAL TISSUES AND A LOT OF MUSCULATURE AND THEY FALL INTO THIS KIND OF CRACK OF NOT BEING ATTENDED TO FULLY WELL. DENTAL DECAY OR CARE EAST, WHICH IS REALLY THE MOST PREVALENT OF ALL CHILDHOOD DISEASE, THE COMMON REASON WHY CHILDREN MISS SCHOOL AND ARE TAKEN TO THE E.R. YOU'RE SUPPOSED TO ACCESS A DENTIST WHERE OFTENTIMES YOU CAN'T. SEVERE PERIODONTITIS REMAINS AN ADULT DISEASE, VERY COMMON, ONE OF THE MOST COMMON OF ALL INFECTIOUS DISEASES. AND THEN, OF COURSE, WE HAVE THE CANCERS, VERY HARD TO DETECT, ALWAYS DETECTED TOO LATE, TREATMENT IS SURGICAL RESECTION WHERE HALF THE TONGUE IS REMOVED AND THEN YOU HAVE THIS VERY PAINFUL RECOVERY PROCESS FOR WHICH THERE ISN'T ANY -- REALLY NO MEDICATIONS THAT CAN ALLEVIATE SOME OF THIS PAIN AND DISCOMFORT. AND OF COURSE HPV RISING TO CERVICAL CANCER, HIGHER THAN THAT. THIS IS JUST AN EXAMPLE WHAT CHILDHOOD CARE EAST CAN DO TO INDIVIDUALS. YOU START A CHILD WITH THAT -- A MOUTHFUL OF DECAY, THAT CHILD IS SET FOR LIFE FROM THEN ON. TYPICALLY THEY GO INTO SURGERY, EITHER HAVING TO HAVE LOTS OF EXTRACTIONS OR STAINLESS STEEL CROWNS, AND IT'S VERY PREVALENT IN THIS COUNTRY. AND YOU CAN SEE TO THE VERY FAR RIGHT, ONE WHO WAS NEGLECTED, IT SPREAD TO HIS BRAIN, UNFORTUNATELY HE DIED BECAUSE THERE WAS NO CARE. HE WASN'T GIVEN THE CARE HE NEEDED. SO I KNOW I'M EMPHASIZING PUBLIC HEALTH HERE BUT IT'S ALL GUIDED BY OUR SCIENCE OR OUR NEED TO LOOK AT A DIFFERENT WAY TO HANDLE OUR DISEASES AND PROBLEMS. RISING AND ALSO VERY NE NEGLED ARE THE TRIBAL NATIONS, WHERE A COMBINATION OF ACCESS TO ONLY WELL WATER THAT HAS A LOT OF ENVIRONMENTAL STRESSES AND TOXINS WITH PHENOLS AND FAIL S CONTRIBUTE TO ORAL HEALTH, DECAY IS SO HIGH AMONGST THESE POPULATIONS AS IT IS AMONGST HISPANICS AND AFRICAN AMERICANS WHO HAVE NO ACCESS TO CARE, AND THAT'S EXACTLY WHAT A TYPICAL MOUTH LOOKS LIKE. AND I'VE BEEN THERE AND TREATED THESE PATIENTS. SO WE'VE REALIZED THROUGH SOUL SEARCHING, WHICH WASN'T WHAT WE WERE THINKING 20 YEARS AGO AND IS SO CENTRAL TO NCCIH IS THAT WE LOOK AT A PATIENT AS A WHOLE. AND AS WE TREAT INDIVIDUAL CONDITIONS, THAT WE PUT THAT PATIENT IN THE CONTEXT OF THEIR FAMILY SETTINGS AND THEIR COMMUNITY LEVEL INFLUENCES AND YOU LOOK AT BEST WAYS TO MITIGATE THESE NEGATIVE UPSTREAM DETERMINANTS THAT REALLY IN THE END PUSH SOMEONE INTO THE DISEASE PATH. THAT HAS BECOME AN ISSUE FOR GLOBAL HEALTH CONCERN ABSOLUTELY SO AND STRESSED BY WHO ACTUALLY PASSING A RESOLUTION THAT ORAL HEALTHCARE SHOULD BE PART OF UNIVERSAL HEALTH COVERAGE, SO SAYING IT IS ABSOLUTELY ESSENTIAL FOR OVERALL HEALTH AND WELL-BEING. IT IS SO NICE WHEN THE OLDEST OF WORLD CLASS JOURNALS PUT AN EMPHASIS ON ORAL HEALTH BY PUBLISHING A SPECIAL SERIES IN 2019 THAT EMPHASIZED THE IMPORTANCE OF EVIDENCE OF ADDRESSING THE DETERMINANTS, TACKLING INEQUALITIES AND ACTUALLY CHANGING THE WAY WE DELIVER CARE. AND SO IT WAS GOOD AND THEY ARE ACTUALLY NOW IN THE PROCESS OF DELIVERING A COMMISSION AND OUR OWN REPORT THAT NIH ACTUALLY IS GOING TO BE PART OF THE REPORT ON GLOBAL ORAL HEALTH STATUS. BUT WHAT'S VERY CHALLENGING FOR NIDCR IS WE ALSO ARE STEWARDS OF THE PROFESSION OF DENTISTRY. BECAUSE OUR STAKEHOLDER GROUPS, OUR DENTIST SCIENTIST, OUR CLINICIAN SCIENTISTS, OUR PHTs M COULD FROM THAT PH.D.s COME FROM THAT EDUCATION POOL SO WE FEEL OUR MISSIONS ARE VERY INTERTWINED WITH CLINICAL PRACTICE OF DENTISTRY AND A ADA'S OWN POLIY AND OF COURSE SUCH THAT EVERY MISSION, IF SUCCEEDING, STRENGTHENS THE OTHER MISSIONS. THAT'S A UNIQUE CHARGE THAT OUR INSTITUTE FACES. MAYBE NURSING HAS THE SAME RESPONSIBILITIES. SO WE STRUGGLE AGAINST BIASES, WE STRUGGLE THAT IN FACT ORAL HEALTH IS NOT SEEN AS A CRITICAL DETERMINE NAPT OF HEALTH. DETERMINANT OF HEALTH AND THAT EVEN PERSISTS WITHIN NIH. WE HAVE PROFESSIONAL ORGANIZATION AND EDUCATION UNITS WHO DO NOT PRIORITIZE THE IMPORTANCE OF RESEARCH BECAUSE DEPTH INDUSTRY IS A VERY -- IT'S A VERY LIKELIHOOD DRIVEN PROFESSION AND THERE'S A LOT OF EMPHASIS ON FEE FOR SERVICE AND PROVIDER CODES, ET CETERA. THE EVIDENCE BASE, THE ANECDOTAL REVERENCES THAT WE WORRY ABOUT. SOL WE HAVE TO ACTUALLY THINK OF ENGAGING ALL THESE CONSTITUENTS AT THE SAME TIME. NOW WE ALSO HAVE OVER US A VERY BIG CHALLENGE BECAUSE THE FIELD OF ORAL HEALTHCARE HAS VERY, VERY FEW MINORITY REPRESENTATIVES SUCH THAT IT'S NOT EVEN CLOSE TO REPRESENT THE DEMOGRAPHICS OF THIS NATION. AS YOU CAN SEE ON THE LEFT, IT'S CHANGING. WE HAVE THE DISEASE BURDEN THAT SEEMS TO -- NOT SEEMS BUT DOES AFFECT DISADVANTAGED POPULATIONS, BUT WE DON'T HAVE THE WORKFORCE TO ACTUALLY CARE. SO WE'RE TAKING THAT VERY SERIOUSLY AS NIH BUILDS ITS OWN CAMPUS-WIDE INITIATIVE, UNITE, ALONG WITH ALL OUR OTHER PROGRAMS. AND NIDCR'S OWN PORTFOLIO REFLECTS THAT DEFICIENCY. AND YOU CAN SEE THAT FOR EACH ONE OF OUR GRANT MECHANISMS. WE HAVE VERY FEW AFRICAN AMERICANS, VERY FEW HISPANICS, AND VERY, VERY FEW NATIVE AMERICANS. SO IN THINKING OF IT, KNOWING WE COULDN'T DO THIS ON OUR OWN, KNOWING THAT WE COULDN'T JUST RELY ON UNITE TO MAKE THE DIFFERENCE, WE ARE FORGING A PUBLIC/PRIVATE PARTNERSHIP WITH KEY ORGANIZATIONS AND REALLY EVERY STAKEHOLDER GROUP TO THE TABLE SO WE CAN ADDRESS MISSION CRITERIA, PIPELINE DEVELOPMENT, RETENTION AND NURTURING INDIVIDUALS FOR THE FIELD WITH SUPPORT FROM INDUSTRY WHO WOULDN'T SUPPORT US DIRECTLY BUT WOULD HELP IN FINANCING SCO SCHOLARSHIPS. DEP DENTAL EDUCATION, BY THE WS VERY EXPENSIVE. GRADUATING AFTER FOUR YEARS WITH A DDS AND HAVING DEBTS BETWEEN 400 AND $500,000, DEPENDING ON WHICH PART OF THE NORTHEAST YOU'RE IN, SO THAT'S SIGNIFICANT. SO WE WERE THINKING OF ALL OF THIS INDEPENDENTLY CAME THE CHARGE OR THE RESPONSIBILITY FOR ME TO CONTINUE DEVELOPING OUR STRATEGIC PLAN THAT MARTHA SOMERMAN HAD INITIATED. AND IT WAS HARD TO DO THAT BY JUST CONDITIONING ON THAT PATH JUST CONTINUING ON THAT PATH, THE PANDEMIC CHANGED OUR WORLD. WE HAD TO THINK OF TRANSLATION, WE HAD TO THINK OF DIVERSIFYING AND USING METRICS TO MEASURE THE OUTCOMES. SO I WAS VERY DISEASE-AGNOSTIC, EVEN THOUGH I HAVE MY INTEREST AREA, I DECIDED NOT TO BE FOCUSED ON ONE DISEASE OR THE OTHER, BUT TO THINK OF THE OVERARCHING THEMES OF TRANSLATION DIVERSE FIGHTING D OUTCOME ASSESSMENTS. WE THIS HAD THESE FIVE VERY C GOALS, STRESSING TRANSLATION RESEARCH INVOLVES ALL OF THESE DOMAINS OF RESEARCH, THERE'S NOT ONE THAT STANDS OUT AND IS MORE IMPORTANT THAN THE OTHER. BECAUSE ENGAGING WITH THE COMMUNITY NORMALLY GIVES RISE TO A FINDING OR OBSERVATION THAT CAN BE TESTED IN A HYPOTHESIS-DRIVEN WAY. SO IN THE PAST WE WOULD THINK BASIC ON ONE END, CLINICAL ON THE OTHER AND TRANSLATION IN THE MIDDLE, VERY LINEAR, BUT IT REALLY IS A CIRCULAR CONTINUUM AND I WANTED TO EMPHASIZE THAT OBVIOUS LIP FOR THIS GROUP. OBVIOUSLY FOR THIS GROUP. THE FIRST PRIORITY IS TO REALLY PUT MEAT ON THE BONES, TO ACTUALLY FIND THE UNDERPINNINGS OF WHAT THAT MEANS. UNIQUENESS AND SHARED PROPERTIES OR QUALITIES OF PROGRESS OF THE DISEASE. THEN TAKE THAT INFORMATION AND DRAW FROM ALL OF US AND THESE AMAZING PROGRAMS THAT EXIST TO COME UP WITH INDIVIDUALIZED APPROACHES FOR PERSONALIZED DENTAL MEDICINE, TRANSLATING IN IMPLEMENTATION SCIENCES IS SO IMPORTANT FOR OUR COMMUNITY AS IS NURTURING THE DIVERSE NEW GENERATION AND EXPANDING OUR PARTNERSHIPS, INCLUDING THOSE WITH OTHER INSTITUTES. SO IF YOU LOOKED AT THE EXTRAMURAL PROGRAM AND MOST OF OUR FUNDING GOES OVER $350 MILLION OF OUR BUDGET IS SPENT ON THE EXTRAMURAL COMMUNITY. WE FUND PRACTICALLY EVERY AREA OF SCIENCE. THE ONES ON THE FAR RIGHT ARE ONES WE'RE PUTTING EXTRA EMPHASIS ON, BUT REALLY THERE'S SOMETHING HERE FOR EVERYONE. YOU CAN GO THROUGH THE LIST AND THERE ARE CERTAINLY OPPORTUNITIES FOR COLLABORATION IN EACH OF THESE DOMAINS, WHETHER IT'S DISEASE OR DISCIPLINE. LILLIAN SHUM IS REALLY AN EXPERT DIRECTOR OF OUR PROGRAM. WE HAVE BUILT UP OUR TRAINING PROGRAM SO WE ADDRESS ALL THE LEAKS IN THE PIPELINE, WHICH AS I'VE MENTIONED BEFORE IS NARROW AND NOT YIELDING OF THE CRITICAL MASS THAT WE NEED AS AN INSTITUTE AND AS A PROFESSION TO FORGE SCIENCE FORWARD. BUT WE'RE TRYING VERY HARD, AND WHAT YOU SEE IN THE PINK OR RED BOXES IS WHAT THE INTRAMURAL PROGRAM OFFERS, AND EXTRAMURAL PROGRAMS HAVE THESE AND ALL OF THESE TERMS ARE VERY FAMILIAR TO YOU. WE'VE REALLY ADDED ON A HUGE MOUNT OF DIVERSITY SUPPLEMENTS AND MECHANISMS TO ENCOURAGE AS EARLY AS POSSIBLE A PIPELINE DEVELOPMENT THROUGH CEPA, WHICH IS N IGMS'S PROGRAM, SO WE'VE DOVETAILED TO ACTUALLY MOVE THE NEEDLE IN THIS AREA. YOU KNOW, WHEN I CAME ON BOARD, THE PUBLIC HEALTH RESIDENCY PROGRAM THAT HAD EXISTED FOR YEARS WAS ACTUALLY SLATED FOR CLOSURE. IT WAS, IN FACT, SHUT DOWN. BUT THE PANDEMIC SHOWED US THAT THERE WAS A NEED FOR THIS IN OUR PROFESSION AS IT WOULD BE FOR THE GENERAL FIELD, RIGHT, PUBLIC HEALTH WAS ALWAYS SEEN AS A SIDELINE THING, BUT NOW I THINK EVERYONE GETS IT, THAT IT IS ACTUALLY IMPORTANT FOR US TO HAVE A MOBILIZABLE UNIT OF -- UNITS ALL OVER THE COUNTRY THAT CAN ACTUALLY ENGAGE AND MITIGATE PANDEMIC OR ANYTHING LIKE THAT. SO WE ARE NOW LAUNCHING A THREE-YEAR PROGRAM A LITTLE DIFFERENT, IT USED TO BE JUST ONE YEAR, WE'RE ADDING ON A TWO-YEAR POSTDOC EXPERIENCE, SO THAT OUR FELLOWS IN TRAINING WHO ARE TYPICALLY DDAs WITH MPHs CAN AUTOIMMUNE TACH TO T HAS INTEREST IN ORAL CANCERS. SO THAT WOULD BE A GREAT CANCER. PROJECT. WE HAVE NATIONAL INSTITUTE OF AGING, COGNITIVE DECLINE, SO WITH AT LEAST TWO OR THREE TRAINEES A YEAR, WE CAN MAKE A LITTLE BIT OF A DENT IN PRODUCING A PUBLIC HEALTH -- PUBLIC HEALTH DENTISTS WHO ARE WELL INFORMED, WHO ARE KNOWLEDGE CREATE TORES, NOT KREE CREATORS. WE OFFER A TWO YEAR RESEARCH IF FELLOWSHIP WHERE THEY ACTUALLY LOOK AT WHERE AN UNDIAGNOSED CONDITION, I'LL GIVE YOU EXAMPLES OF THE SEARCH GOING ON THERE, VERY NICE PROGRAM THAT HAS GROWN IN ITS NATIONAL STATURE LED BY JANICE LI, WHO YOU SEE HERE ON THE RIGHT. YOU KNOW, I THINK IF I LOOKED AT THE BLESSINGS THAT WE HAVE ACCUMULATED OVER THESE 75 YEARS, OUR INTRAMURAL PROGRAM STANDS OUT BECAUSE WE HAVE THE MOST OUTSTANDING GROUP OF INVESTIGATORS WHO ARE CUTTING EDGE SCIENTISTS, VERY SERIOUS ABOUT WHAT THEY DO, AND WE'RE GROWING TO WHERE 7 OUT OF THE 26 -- SORRY -- ACTUALLY ARE CLINICIAN SCIENTISTS, AND THEY WORK IN BUILDING 10 PRIMARILY, AND SOME OF THEM ARE SCATTERED ACROSS CAMPUS. AND THE FOCUS IS IN THESE AREAS. THERE'S A HUGE SECTION ON SKELETAL MATRIX AND MECHANO-BIOLOGY. THESE ARE THE PIs HERE. IT'S GREAT BECAUSE THEY ACTUALLY SEE PATIENTS AND THEY'RE TESTING VARIOUS INTERVENTIONS AND PHARMACOLOGICAL INTERVENTIONS ACTUALLY FOR VERY RARE AND UNDIAGNOSED CONDITIONS. YOU CAN SEE THAT RIGHT HERE IN THE CENTER OF OUR CAMPUS. WE HAVE A SJOGREN'S CENTER THAT ACTUALLY DIAGNOSES AND TREATS PATIENTS LED BY BLAKE WARNER AND HIS TEAM. SO THAT'S A BLESSING TO HAVE THAT AVAILABLE, AND WE DO HAVE REFERRALS FROM ALL OVER THE WORLD ACTUALLY AND HAVE A PATIENT REPOSITORY. ABOUT 4,000 CASES OF SJOGREN'S, WHERE WE'VE COLLECTED SAMPLES AND HAVE KIND OF A LARGE BIOREPOSITORY TO MOVE FORWARD. I BROUGHT THIS UP AS JACKIE'S PROJECT LOOKING AT GRAFT-VERSUS-HOST DISEASE BECAUSE THERE ARE LOTS OF ORAL MANIFESTATIONS AND JACKIE IS ACTUALLY LOOKING AT AN INTERVENTION THAT'S PROVEN TO BE QUITE SUCCESSFUL. AS YOU CAN SEE THE SEVERE REACTIONS IN GRAFT-VERSUS-HOST DISEASE AFFECTS SO MANY TISSUES IN THE ORAL CAVITY, SCLEROSIS, HYPERKERATOSIS AND LOTS OF OTHER LESIONS THAT AFFECT SALIVARY GLAND FUNCTION AND OTHER BODY FUNCTIONS. INTERESTING FOR MY INTRAMURAL WORLD AND FIBROSIS IS THIS FAC INHIBITOR THAT'S ACTUALLY BEING USED TO PREVENT SCAR TISSUE FORMATION. JUST THOUGHT I WOULD BRING THAT UP AS AN OPPORTUNITY FOR NCCIH AND US TO COLLABORATE ON SPINOFF STUDIES THAT WOULD COME FROM WOUND HEALING, AND BEING ABLE TO CONTROL EXCESSIVE FIBROBLAST FUNCTION REALLY. IF THERE'S NOT ENOUGH REMODELING, THAT'S WHAT IT IS. SO LIKE EVERY OTHER INSTITUTE, WE ON A SMALLER SCALE INVEST IN LARGER INITIATIVES ACROSS THE COUNTRY. THESE COST A LITTLE BIT MORE. AND WE HAVE THREE OF THEM THAT HAVE BEEN RUNNING FOR YEARS NOW INTO THEIR SECOND AND THIRD CYCLES, AND I'M GOING TO DESCRIBE THEM VERY BRIEFLY. THE NATIONAL PRACTICE-BASED NETWORK, THE REGENERATIVE MEDICINE ONE THAT MARTHA WAS VERY INSTRUMENTAL IN SETTING UP, FACEBASE, WHICH IS A REPOSITORY OF GENOMIC INFORMATION AND PHENOTYPE INFORMATION ON CRANIOFACIAL DISORDERS, AND THEN WHAT'S COMING UP VERY SOON IS THE TEMPOROMANDIBULAR JOINT OR DYSFUNCTION CENTER. SO IN THIS PARTICULAR EFFORT OF CREATING A NETWORK ACROSS THE COUNTRY OF PRACTITIONERS WHO ARE CALIBRATED AND TRAINED TO ACTUALLY ANSWER QUESTIONS THAT ARE COMMON CLINICAL QUESTIONS, EVERYDAY PROBLEMS THAT DENTISTS AND ORAL HEALTH PROFESSIONALS, AND THEY'VE GOT A GOOD BASE OF 7,000 PRACTITIONERS, AND THEY'RE GOING TO BE MORPHED BECAUSE THE PANDEMIC TAUGHT US THEY OUGHT TO BE CONNECTING THIS AND BE READY TO ACTIVATE THIS GROUP TO LOOK AT OPERATORY CONDITIONS AND THINGS THREATENING TO THE PRACTICE OF DENTISTRY. SO THIS IS IN THE PROCESS OF ACTUALLY SHAPING UP TO BE MUCH MORE DIVERSE AND INCLUSIVE. BUT WHAT'S INTERESTING IS, WE'RE GOING TO START UP A PRACTICE BASED RESEARCH -- WITHIN DENTAL SCHOOLS BECAUSE SCHOOLS ARE SAFETY NET PROVIDERS AND SEE THE ENTIRE SPECTRUM OF PATIENTS FROM VERY SIMPLE TO VERY COMPLEX TO THE MEDICALLY COMPROMISED AND SPECIAL NEEDS PATIENTS. THAT REQUIRE VERY SPECIAL CARE AS YOU KNOW. SOMEONE WITH SPINA BIFIDA OR MULTIPLE SCLEROSIS, THEY DON'T HAVE A DENTIST THAT HAVE THE OPERATORIES AND EVEN ARE TRAINED FOR SPECIAL NEEDS PATIENTS, AND SO WE'RE GOING TO SET THIS UP WITHIN SCHOOLS TO ENGAGE CLINICIANS AND FACULTY, ADMINISTRATORS AS WELL AS PATIENTS AND CREATING THIS SENSE OF CURIOSITY AND DRIVE TO ACTUALLY CREATING KNOWLEDGE CHAIRSIDE THAT THEY CAN TAKE THEN INTO THEIR PRACTICE EXPERIENCES OR WHEN THEY COME BACK AS FACULTY. THE REGENERATIVE MEDICINE CONSORTIUM WHICH IS BASED IN CALIFORNIA, WE HAVE TWO GROUPS AND THE MICHIGAN HARVARD PITTSBURGH ONE, NORTHEAST, SO TO SPEAK, IS DOING VERY WELL. THERE'S MANY FDA PRODUCTS RIGHT NOW THAT ARE IN THE PROCESS OF BEING APPROVED, AND THEY DEAL WITH VARIOUS ASPECTS OF PERIODONTAL DISEASE AND FRACTURE HEALING AND DIFFERENT KINDS OF REGENERATIVE -- SO THAT'S ACTUALLY BEEN A HIGHLY SUCCESSFUL INFRASTRUCTURE AND CAPACITY BUILDING CONSORTIUM. VERY PLEASED WITH IT. FINALLY THE FACEBASE, A PROGRAM THAT I TALKED ABOUT, HAS GATHERED QUITE A REPOSITORY OF GENOMIC INFORMATION AND -- IN THIS DATABASE THAT IS ACCESSIBLE TO ALL, AND THEY'RE HOPING THAT THE DATA SCIENCE INITIATIVE, NIH IS ACTUALLY INVESTING IN IT NOW, THAT WE CAN ACTUALLY MAKE ALL OF THIS TRANSFERABLE AND INTERRELATABLE, BECAUSE THAT IS THE CHALLENGE. YOU CAN SEE THAT IT'S ACROSS EVOLUTION WITH DIFFERENT MODEL SYSTEMS AND MAKING A DIFFERENCE TO PATIENTS. AND THIS IS WHAT I MEAN BY CRANIOFACIAL DISORDERS. SO HERE IS A CHILD THAT HAS CLEFT, CORRECTED SURGICALLY, CHILD IS ABOUT 6 MONTHS OLD, COMES BACK IN FOR SECOND INTERVENTION. THE MID FACE IS GROWING AT THAT TIME SO THERE'S ALWAYS A MID FACE KIND OF DEPRESSION BECAUSE YOU'RE BRINGING ABOUT CLOSURE BEFORE THAT ACTUALLY HAPPENS. IN AN UNNATURAL WAY. AND THAT CHILD UNDERGOES A SERIES OF CARE -- MULTIDISCIPLINARY CARE THROUGHOUT LIFE. WHEN YOU LOOK AT HIM, GOD BLESS HIM, HE ACTUALLY PASSED HIM AWAY BUT I TREATED HIM WHEN HE WAS IN AFRICA, HE HAD SURGERY THAT INVOLVED REPLACING HIS -- REALLY RESHAPING HIS SKULL AND HIS BRAIN. LOOK AT THE EFFECTS ON HIS ORBITS AND ALL THE SEQUELAE OF THAT SURGERY THAT HE HAD TO DEAL WITH AND THE SAME WITH PUZANS. SO WE HAVE A NEED TO BE LOOKING AT THAT GROUP OF PATIENTS AND THEN TAKING ADVANTAGE OF THIS DATABASE TO SEE HOW BEST WE CAN TRANSFER THIS TO MAKE IT REALLY USER-FRIENDLY FOR CLINICIANS WHO HAVE A HARD TIME DIFFERENTIATING BECAUSE THESE SYMPTOMS -- SYNDROMIC CONDITIONS ARE VERY SUBTLE SOMETIMES AND CAN BE MISSED. VERY OFTEN THE DENTAL PHENOTYPE IS NOT TAKEN AS SERIOUSLY. SO AS I LOOKED AT THE MOVING FRONTS AND HPV RISING EVEN WITH THE VACCINES THAT ARE EFFECTIVE, THAT IT'S RISING TO WHERE MALES ARE GETTING FAR MORE AFFECTED THAN FEMALES. INITIALLY THE VACCINE WAS AVAILABLE FOR TEENAGE GIRLS, IF YOU REMEMBER. WELL, NOW IT'S SEEMING TO BE THAT YOUNG MALES ARE AFFECTED FIVE OR SIX FOLD TIMES MORE. SO WE BROUGHT TOGETHER A THINK TANK, NED SHARPLESS WAS ON BOARD TO LOOK AT HOW WE CAN ADVANCE EARLY DIAGNOSIS, AND YOU KNOW THAT WITH NCCIH, THAT THE EMPHASIS ON BEHAVIORAL CONDITIONING OF MAKING SURE THAT HABITS THAT BECOME HABITS ARE NICKED EARLY IN THE BUD ARE VERY, VERY IMPORTANT FOR THIS KIND OF CANCER, SO AS FOR ORAL CANCERS IN GENERAL. I WAS VERY PLEASED SO SEE FROM OUR VERY INNOVATIVE PARTNERSHIP INITIATIVE THAT FRANCIS COLLINS WAS RESPONSIBLE FOR SETTING UP SEVEN YEARS AGO, BRINGING TO THE TABLE INDUSTRY PARTNERS, GOVERNMENT, ACADEMIA AND NIH, TO REALLY SOLVING THE MOST DIFFICULT ISSUES, THE MOST COMPOUND DISEASES LOOKED AT SERIOUSLY: DIABETES, PARKINSON'S, ALZHEIMER'S. SO THEY'VE MADE GOOD PROGRESS IN AUTOIMMUNE DISORDERS, ON SYSTEMIC LUPUS AND RHEUMATOID ARTHRITIS, TO WHERE FRANCIS FELT THAT SHOW GRINS SJOGREN'SF THIS, AND WE JUMPED AT THE OPPORTUNITY. WE NOW HAVE A GRANT THAT INVOLVES ACADEMIC PARTNERS AT OKLAHOMA AND JOHNS HOPKINS WITH OTHER INSTITUTES HERE INVOLVED, ALONG WITH OUR INTRAMURAL PROGRAM THAT HAS A VERY RICH HISTORY IN SALIVARY GLAND BIOLOGY AND RECONSTRUCTION. TO LOOK AT THIS DISEASE FROM START OH TO FINISH, WELL CHARACTERIZED, WE'VE ALREADY GOT A LARGE COLLECTION OF BIOSPECIMENS AND TAKE IT UP FROM THE DEACON STRUCKTIVE MODE F SINGLE CELL ANALYSIS, PUTTING T BACK TOGETHER AND COMING UP WITH THERAPEUTIC PRODUCTS THAT WOULD HALT THE PROGRESS OF THIS QUITE DEVASTATING DISEASE. HELENE AND I WOULD BOTH AGREE THAT THE TRANS-NIH ACTIVITIES ARE TRULY EXCITING, AND WE HAVE TO BE AT THE TABLE TO INTEGRATE AS BEST AS WE CAN. I THINK WE SHARE SOME OF THE STRUGGLES AND SOME OF THE GREAT SUCCESS STORIES HERE IN THIS EFFORT, AND YOU CAN SEE THAT RANGE FROM THE CANCER MOONSHOT TO BRAIN IMAGING TECHNOLOGIES, THAT THERE IS AN APPLICATION FOR US IN ORAL HEALTH AS IT MUST BE HERE. SO I JUST ACTUALLY HAVE DONE AN IN DEPTH INTERVIEW WITH REBECCA BAKER WHO ACTUALLY RUNS IT SO EFFICIENTLY. IT'S DIVIDED INTO PAIN MANAGEMENT AND SUBSTANCE USE DISORDERS. DENTISTS AND ORAL HEALTH -- ARE VERY INVOLVED INITIALLY FOR OVERPRESCRIBING. THAT TREND HAS ACTUALLY DECLINED OVER THE YEARS. SO WE HAVE TWO MAJOR INITIATIVES. THE FIRST ONE WAS INITIATED BY NCCIH ON MYOFASCIAL TISSUES AND CLINICAL PAIN MANAGEMENT. AND VERY RECENTLY DRIVEN REALLY BY THE LEADERSHIP OF HELENE, WE HAVE THIS MULTI-INSTITUTE PARTNERSHIP ON RE-JOIN, WHICH IS FOCUSED ON UNDERSTANDING THE NEURAL PATHWAYS IN JOIN, SUCH AS THE KNEE JOINT AND TEMPOROMANDIBULAR JOINT. THEY HAVE DIFFERENT CHALLENGES AND I'LL SHOW YOU WHY. BECAUSE HERE YOU HAVE THE JOINT. LET ME SEE IF I CAN POSSIBLY -- THE HEAD OF THE CONDYLE ARTICULATES IN THIS LITTLE FOSSA AND THERE'S THIS FIBER CARTILAGE HERE, NOT THE SAME AS YOU SEE IN THE KNEE JOINT. FIBER CARTILAGE DEGENERATES FAST AND CANNOT GENERATE EASILY. IT'S AVASCULAR, IT'S NOT INNERVATED EITHER. SO IT'S VERY PRONE TO DESTRUCTION AND CAN'T REPAIR ITSELF EASILY. SO WE START OFF THERE, PERIARTICULAR TISSUES AROUND THE JOINT ARE REALLY WHAT SETS THE JOINT UP FOR A DISEASE PROCESS. BECAUSE IT'S A VERY FINALLY CONNECTED NEUROMUSCULAR TISSUE WHERE FASCIA PLAYS A HUGE ROLE, SO IF YOU LOOK AT THE DYSFUNCTION ITSELF, THEY NO LONGER CALL IT TEMPOROMANDIBULAR JOINT. IT'S TEMPOROMANDIBULAR DYSFUNCTION BECAUSE IT'S NOT JUST THE JOINT ITSELF. IT INVOLVES THE JOINT PRINCIPALLY BUT ALSO THE MUSCLES AND THE FASCIA AND EVERYTHING THAT GOES WITH IT. THE ATTACHMENTS, THE TENDONS, THE LIGAMENTS. AND VERY OFTEN THE SYMPTOMS ARE ALSO VERY, VERY COMPLEX AND INDICATIVE AT THE START OF THE DISEASE. SO THIS IS MY ASK FOR YOU, IS THAT WE REALLY WANT YOU AT THE TABLE AS A PARTNER, BECAUSE WE CANNOT DO THIS IN A UNIDIRECTIONAL MANNER. IT HAS TO BE A PARTNERSHIP WITH NCCIH AND SOME OTHER INSTITUTES. SO FAR, I LOOKED UP EVERYTHING THAT WE WERE INVOLVED WITH, WITH NCCIH, AND THESE ARE THE INITIATIVES THAT WE HAVE A COMMON INTEREST IN AND WE HAVE PARTNERSHIP ON. YOU CAN SEE IT VARIES FROM LOOKING AT OMEGA 6 DIETS, PAPER MANAGEMENT AND SO PN MANAGEMENT AND CONTROL OF PAIN, MUSIC. IT'S A PORTFOLIO THAT LENDS ITSELF TO EXPANSION IN EVERY AREA. NOW WHERE I SEE OURSELVES MOVING, IF I CAN PROJECT A BIT FOR THE FUTURE, IT WOULD BE IN THE AREA OF PAIN FOR SURE. WE STRUGGLE AND WITH VERY DISTINCT OROFACIAL PAIN PHENOMENA THAT ARE HARD TO CALIBRATE SOMETIMES AND EVEN STRATIFY. WE NEED DO THAT, WITH A BETTER THESAURUS. WE NEED HEALTH APPROACHES AND INTEGRATIVE TREATMENTS FOR EVERY ONE OF OUR DISEASES AND DISORDERS. WE HAVE TO, I THINK, INSTITUTE MUCH MORE OF A PREVENTIVE AIF PROACH TO EVERYTHING WE DO, AND TO PROBE INTERCEPTOR PROCESS IN THE CONTEXT OF ORAL DISEASE, BECAUSE IT IS, IN FACT, AFFECTING GENERAL HEALTH AND WELL-BEING. SO THIS IS WHERE I WOULD END, WHICH IS I'VE SPECIFIED THE PROBLEMS, I'VE ENVISIONED A PLAN THAT I'M HOPING THE INSTITUTE WILL MOVE ALONG IN A VERY, VERY INTENTIONAL WAY, AND I'M HOPING THAT THE RESULTS WILL ACTUALLY BE ORAL HEALTH FOR ALL. THROUGH INTEGRATION, THROUGH INNOVATION AND BY INSPIRING THOSE THAT WE MENTOR. I WANT TO THANK MY STAFF WHO ARE EXTREMELY SUPPORTIVE AND TALENTED, DEDICATED GROUP. IT'S REALLY A PRIVILEGE AND AN HONOR TO BE HERE EVEN IF IT'S VIRTUAL. THANK YOU. ANY QUESTIONS AND COMMENTS? I'M HAPPY TO TAKE THAT. >> THANK YOU SO MUCH. RENA, THIS WAS SO OUTSTANDING. IT'S SO IMPRESSIVE TO SEE IN THE SHORT AMOUNT OF TIME THAT YOU'VE BEEN AT NIH AND THE LEADERSHIP THAT YOU'RE SHOWING AND THIS WONDERFUL SPIRIT OF COLLABORATION. I REALLY -- I'M JUST SO IMPRESSED AND IT'S WONDERFUL TO HAVE YOU AS A COLLEAGUE. WE HAVE A FEW MINUTES FOR QUESTIONS. I HAVE A QUESTION BUT I'LL LET OTHERS JUMP IN FIRST. RICK AND THEN NADJA. >> THANK YOU VERY MUCH FOR THAT WONDERFUL TALK. I REALLY, REALLY ENJOYED LISTENING TO IT. I WAS WONDERING IF THERE MIGHT BE SOME OVERLAPS BETWEEN YOUR INSTITUTE AND NCCIH, PARTICULARLILY WITH THE TURNG. TONGUE. IN TRADITIONAL CHINESE MEDICINE, THERE'S DIFFERENT THEORIES ABOUT WHAT THE TONGUE LOOKS LIKE, COLOR, EVERYTHING ABOUT THE TONGUE CAN BE IMPORTANT IN DIAGNOSES, AND I WAS WONDERING IF THERE'S ANY OVERLAB THERE. >> HUGE AMOUNT, RICK. HUGE. EVEN WITH COVID AND THE TASTE BEING SO AFFECTED AND SO EARLY ON, WE HAVE A POCKET OF RESEARCHERS LOOKING AT THE PHYSIOLOGY OF TASTE AND SENSATIONS, LOOKING AT THE TURNG IN ITS NEUROMUSCULAR CAPACITY, AS AN INDICATOR OF VITAMIN DEFICIENCY, IS IT OFTENTIMES EVALUATED IN THE CLINICAL EXAM? >> IN TRADITIONAL CLIE NIECE MED SIGN, MANY TIMES THE TONGUE IS LOOKED AT AS AN INDICATOR OF WHAT THE INTERNAL ORGANS MIGHT BE DOING AND HOW THE HOMEOSTASIS OF THE INTERNAL BODY SYSTEM IS, SO IT'S KIND OF A WINDOW TO THE INSIDE THAT'S MANY TIMES USED IN INITIAL DIAGNOSIS. THE COLOR, SHAPE, COATING, LOTS OF THINGS YOU CAN JUST TELL BY LOOKING. >> YES. AND WE HAVE A HOST OF DISEASES ALL OF WHICH AFFECT THE TONGUE, THOSE ARE ACTUAL PATHOLOGIES BUT YOU CAN ALSO GET A FIRM INDICATION OF OVERALL HEALTH BY LOOKING AT THE TONGUE. NADJA? >> THANK YOU SO MUCH. YOU JUST REALLY JUST REAR PRESENTATION AND I'M REALLY INSPIRED BY THE WORK THAT YOU'VE DONE TRANSITIONING FROM BEING ON THE GROUND AND SEEING PATIENTS AND THEN MOVING TOWARDS BEING MORE INVOLVED IN POLICY AND HAVING THAT REALLY INFORMED BY YOUR ON THE GROUND EXPERIENCE. IN THAT REGARD, I JUST WONDERED, I KNOW SOME OF THE POPULATIONS THAT YOU'VE WORKED WITH IN THE PAST WHEN YOU WERE IN PRACTICE, ARE SOME OF THE SAME POPULATIONS THAT DO USE ALTERNATIVE THERAPIES, COMPLEMENTARY APPROACHES A GREAT DEAL, WHETHER THAT'S APPROACHES FOR PAIN MANAGEMENT OR ORAL HYGIENE OR THINGS LIKE THIS BASED ON BOW TAN YAL KALES OR THINGS LIKE THAT AND I WONDERED IF YOU HAD ANY PERSONAL EXPERIENCE WITH THAT OR ANY PERSONAL INTEREST IN THAT CONNECTION BETWEEN IT SEEMS LIKE THERE'S A NEED FOR OFTEN SURGICAL INTERVENTION BUT THEN SOME OF THESE SRP APPROACHES MIGHT BE USED FOR PAIN MANAGEMENT, RECOVERY, OVERALL PAIN MANAGEMENT, THAT HAS HAPPENED. I JUST WONDERED IF YOU HAD ANY PERSONAL THOUGHTS ABOUT THAT. >> SUMP A GREAT POINT. >> RELATED TO, SAY, THE EFFECTIVE ENVIRONMENTAL STRESSES ON TOOTH DEVELOPMENT. BECAUSE TEETH DEVELOP IN UTERO, THEY LAND UP AS BEING VERY IMPORTANT BIOLOGIC HARDWARE FOR RECORDING THE INSULTS THAT ACTUALLY HAPPEN DURING PREGNANCY. I KNOW PEOPLE DON'T REALIZE THAT, BUT YOU GET THESE LITTLE ENAMEL DEFECTS THEY CALL HYPERMINERALIZATION DEFECTS ON BABY TEETH AS WELL AS PERMANENT FIRST MOLARS THAT REFLECT THAT THE MOTHER WAS EXPOSED TO SOME VIECIALT TALL VERY ENVIRONMENTAL STRESSOR, IT'S RECORDED IN YOUR TEETH. ALTERNATIVE APPROACHES, DENTISTRY AND ORAL HEALTH PRACTICE IN THE U.S. IS VERY, VERY TRADITIONAL. VERY CONSERVATIVE, VERY PROCEDURE-DEPENDENT, INTERVENTION-DEPENDENT RATHER THAN PREVENTION, AND THAT MOST OF THE PRACTICES THAT INVOLVE HOMEOPATHY, AYURVEDICS ARE OCCURRING OUTSIDE THE COUNTRY IN DIFFERENT PARTS OF WORLD. IN CHINESE MEDICINE IN INDIA, FOR SURE ALL OF THAT IS HAPPENING, AND EXCEPT FOR THE TEMPOROMANDIBULAR JOINT WHERE IT'S GONE INTO THE GREY AREA OF -- I WOULDN'T CALL IT VOODOO DENTISTRY BUT IT'S IN THE PSYCHOSOMATIC RANGE ONLY BECAUSE YOU WALK INTO AN OFFICE WITH FLASHY LIGHTS AND THINGS THAT YOU JUST CAN'T PUT YOUR FINGER ON BECAUSE PEOPLE DON'T UNDERSTAND THE DISEASE. SO I THINK IN THAT AREA, THERE ARE ALTERNATIVE APPROACHES BUT NOT THE KIND THAT YOU'RE THINKING. BUT NOT IN GENERAL, NO, I WOULDN'T SAY UNLESS I'M NOT KEEPING ON TOP OF WHAT'S HAPPENING IN THE FIELD. I WILL TAKE A LOOK AT THAT AND SEE IF THERE ARE ANY -- YOU CAN PUT ON A TOOTH THAT'S THROBING WITH PAIN. TYPICALLY IT'S ZINC OXIDE EUGENOL, WHICH IS CLOVE OIL. WE STILL USE THAT. AND THAT IN A SENSE IS A BIOLOGICAL DERIVATIVE. IT'S A GOOD THING, BECAUSE WE CERTAINLY NEED THE BEHAVIORAL CONDITIONING ASPECTS OF MUCH MORE REINFORCED IN OUR PRACTICE AND OUR PRINCIPLES OF PRACTICE. SO THANK YOU FOR THAT. >> THANK YOU. >> SO I HAVE ONE QUESTION IF THERE'S NO OTHER QUESTIONS OR COMMENTS, BECAUSE I WANTED TO FOLLOW UP ON RICK'S QUESTION ABOUT TRADITIONAL CHINESE MEDICINE. ONE OF THE REASONS IS THAT IN OUR STRATEGIC PLAN, ONE OF THE THINGS THAT WE'VE PUT IN ONE OF OUR FIRST STRATEGIC AIM IS TO LOOK AT WHAT WE CALL DIAGNOSTIC SYSTEMS AND THERAPEUTIC SYSTEMS, BUT PRIMARILY DIAGNOSTIC, THAT ARE DIFFERENT FROM THOSE OF CONVENTIONAL MEDICINE. SO AIR VAI DA, YOU MENTIONED COULD BE ONE OF THEM, TRADITIONAL CHINESE MEDICINE WHERE THE PRACTITIONER INTERPRETS THE PERSON'S SIGNS AN SYMPTOMS IN A WAY THAT IS A DIFFERENT FRAMEWORK, SIGNS AND SYMPTOMS ARE LOOKED AT DIFFERENTLY IN ORDER TO COME TO A DIAGNOSIS. A LOT OF THESE DIAGNOSES ARE VERY, VERY -- THEY DON'T OVERLAP REALLY WITH OUR DIAGNOSES. SO ONE OF THE THINGS WE WANT TO DO IS TO HAVE SOME INITIATIVES TO VALIDATE ESSENTIALLY THESE DIAGNOSES AND DO INTERRATER RELIABILITY, FOR EXAMPLE. ONE OF THE THINGS THAT RICK WAS MENTIONING, SAY TAKE 10 DIFFERENT PRACTITIONERS OF TRADITIONAL CHINESE MEDICINE AND SHOW THEM 10 DIFFERENT TONGUES AND SEE WHETHER THEY, FIRST OF ALL, AGREEL ON WHAT THE SIGNS AND SYMPTOMS ARE, AND HOW DO THEY INTERPRET IT, WHAT DO THEY DIAGNOSE BASED ON THAT. THIS MIGHT BE A REALLY INTERESTING -- AND THEN USE THE PRACTITIONERS WHO ARE TRAINED, YOU KNOW, IN THIS PARTICULAR METHOD, DIAGNOSTIC METHOD TO INFORM THE RESEARCH QUESTION. SO I THOUGHT THIS MIGHT BE AN AREA WHERE WE COULD COLLABORATE. IT WOULD BE VERY INTERESTING, WOULDN'T IT? >> YES. ESPECIALLY NOW IN THE AGE OF DIGITAL IMAGING WHERE INTRAORAL PHOTOGRAPHY IS SO WELL DEFINE AND WELL REFINED SO WE CAN HAVE AI AND MACHINE LEARNING TOOLS THAT WOULD ACTUALLY BE PREDICTIVE AND DIAGNOSTIC. I THINK THAT WOULD BE ONE AREA WE COULD INTEGRATE DATA SCIENCE, ABSOLUTELY. >> I TOTALLY AGREE. SO LET'S PUT THAT DOWN. >> AND THERE'S LOTS TO TALK ABOUT, HELENE, AS YOU KNOW. >> GOSH. IT HAS BEEN LOVELY TO HAVE YOU, RENA. WE'RE ACTUALLY OUT OF TIME SO WE'RE GOING TO MOVE ON IN OUR PROGRAM, BUT WE CANNOT THANK YOU ENOUGH FOR TAKING THE TIME TO COME AND SPEAK WITH OUR COUNCIL AND LOOKING FORWARD TO FOLLOWING UP ON ALL THESE IDEAS THAT WE'RE DISCUSSING. >> THANK YOU. AND THANK YOU, DR. KHALSA, FOR MAKING ALL OF US WORK ON TIME. THANK YOU. BYE-BYE. >> THANK YOU. BYE-BYE. >> OKAY. WE ARE NOW GOING TO MOVE TO THE MINI SYMPOSIUM THAT WE HAVE TALKED ABOUT EARLIER, AND I'M GOING TO TURN THE MICROPHONE OVER TO DR. EDWARDS, WHO WILL INTRODUCE DR. WEBER, WHO WILL INTRODUCE THE SPEAKERS. >> THANKS, PARTAP. SO I THINK AS WE CONCEPTUALIZE THIS LITTLE MINI SYMPOSIUM, WE ACTUALLY DREW BACK FROM OUR STRATEGIC PLAN WHERE AT THE END OF THE PLAN, YOU CAN FIND OUR TOP 10 SCIENTIFIC PRIORITIES. ONE OF THEM IS ACTUALLY SUPPORTING IMPACTFUL CLINICAL TRIALS. SO AS WE DISCUSS PUTTING THIS SYMPOSIUM TOGETHER, WE ACTUALLY COMBINE TWO AREAS OF INTEREST AS YOU HEARD EARLIER, WE'RE VERY MUCH INTERESTED IN DEVELOPING NEW PROGRAM FOR REDUCTION OF STRESS, SO WE THOUGHT WE'D PUT THE DISCUSSION OF IMPACTFUL TRIAL IN THE CONTEXT OF STRESS RESEARCH, BUT WE ARE GOING TO HAVE WENDY ACTUALLY SET THE STAGE, AND WE ALSO INVITED THREE OF OUR INVESTIGATORS THAT ARE GOING TO ILLUSTRATE THE VARIOUS ASPECTS OF WHAT WE CONSIDER AS IMPACTFUL TRIAL FROM THE PERSPECTIVE OF THE SCIENCE THAT'S BEING TARGETED, THE APPROACH, THE POPULATIONS THAT ARE BEING TARGETED AND ALSO THE PROCESS THAT WE FOLLOW. SO WITHOUT FURTHER ADO, I'M GOING TO TURN IT OVER TO WENDY, WHO'S GOING TO SET THE STAGE FOR THE REST OF THE PRESENTATION. WENDY? >> GREAT. THANK YOU SO MUCH, EMMELINE. LET ME JUST MAKE SURE THAT EVERYONE CAN SEE MY SLIDES OKAY. AND LET'S SEE IF I CAN GET THEM TO GO TO THE CORRECT MODE. CAN EVERYBODY SEE THAT? GREAT. SO IT'S MY PLEASURE TO TALK WITH YOU ALL THIS AFTERNOON AND TALK TO YOU ABOUT THIS IDEA OF CLINICAL TRIALS TO ADDRESS STRESS IN DIFFERENT CONTEXTS AND WHAT REALLY MAKES TRIALS IMPACTFUL. SO LET ME START OFF WITH JUST DOING A FEW INTRODUCTIONS AND OVERVIEW OF WHAT WE'RE GOING TO TALK ABOUT THIS AFTERNOON. SO I'M GOING TO GIVE A LITTLE BIT OF AN INTRODUCTION AND TALK A LITTLE BIT ABOUT OUR FRAMEWORK FOR CLINICAL TRIAL RESEARCH AND WHAT WE THINK SUCCESS WOULD LOOK LIKE FOR IMPACTFUL CLINICAL TRIALS AND THEN I'M GOING TO TURN THINGS OVER TO OUR DIFFERENT SPEAKERS. DR. MICHAEL CHRISTOPHER IS GOING TO TALK ABOUT ADAPTATION AND FEASIBILITY OF INTERVENTIONS IN A WORKPLACE SETTING, AND DR. CHRISTOPHER IS A PROFESSOR AT PACIFIC UNIVERSITY AND THE DIRECTOR OF MINDFUL HEALTH AND RESILIENCE LABORATORY. HIS PRIMARY RESEARCH IS FOCUSED ON THE IMPACT OF MINDFULNESS AND ITS RELATED CONTEMPLATED PRACTICES ENHANCING RESILIENCE AND IMPROVING STRESS REACTIVITY IN HIGH RISK AND DIVERSE GROUPS. HE'S DEVELOPED THE MINDFULNESS AND RESILIENCE TRAINING DESIGNED TO PREVENT STRESS REACTIVITY AND HEALTH OUTCOMES AMONG HIGH STRESS COHORTS. THEN WE'RE GOING TO TURN THINGS OVER TO DR. ZEV ZEV SCHUMAN-OLIVIER WHO'S GOING TO TELL US ABOUT POPULATION-BASED SCREENINGS HE'S DOING IN A HEALTHCARE SETTING AND SOME RESEARCH HE'S DOING IN THAT SPACE. CAMBRIDGE HEALTH ALLIANCE AS WELL AS AN ASSISTANT PROFESSOR IN THE DEPARTMENT OF PSYCHIATRY AT HARVARD MEDICAL SCHOOL. HE'S THE FOUNDING DIRECTOR OF -H SUBSTANCE USE, MENTAL HEALTH DISORDERS AND CHRONIC PAIN IN BOTH MENTAL HEALTH AND PRIMARY CARE SETTINGS. OUR FINAL SPEAKER WILL BE DR. JUDITH MOSKOWITZ. DR. MOSKOWITZ IS A PROFESSOR OF MEDICAL SOCIAL SCIENCES AT NORTHWESTERN UNIVERSITY FEINBERG SCHOOL OF MEDICINE. SHE'S THE DIRECT DIRECTOR OH AT THE CENTER FOR INTEGRATIVE HEALTH AND HER CURRENT RESEARCH IS FOCUSED ON UNIQUE ADAPTIVE ROLE OF POSITIVE EMOTION IN THE PROCESS OF COPING WITH VARIOUS TYPES OF HEALTH RELATED AND OTHER LIFE STRESSORS. SO WE'VE GOT A STAR STUDDED PANEL FOR YOU TODAY. SO I WANT TO JUST GIVE A VERY BRIEF CONTEXT, THINK WE'VE TALKED THIS MORNING A LITTLE BIT ABOUT STRESS AND HOW CHALLENGING THE SITUATION IS GETTING AROUND THE WORLD AND HOW MANY STRESSORS WE'RE DEALING WITH BUT JUGS TO PUT THIS IN CONTEXT, EVEN BEFORE THE PANDEMIC THIS IS SOMETHING WE WERE TALKING ABOUT. OUR STEVEN STRAUSS DISTINGUISHED LECTURE FOR COMPLEMENTARY THERAPIES WE DO ANNUALLY, ABOUT A NATION UNDER PRESSURE AND THE PUBLIC HEALTH CONSEQUENCES OF STRESS IN AMERICA. AND AS WE ARE ALL WELL AWARE, THIS HAS JUST GOTTEN WORSE WITH THE PANDEMIC, SO MUCH SO THAT DR. MURTHY AS SURGEON GENERAL HAS JUST ISSUED IN THE LAST FEW MONTHS AN ADVISORY ON THE YOUTH MENTAL HEALTH CRISIS THAT WE HAVE, WHICH HAS BEEN FURTHER EXPOSED BY THE COVID-19 PANDEMIC. SO THIS IS JUST A MAJOR ISSUE FOR ALL OF US, BUT PARTICULARLY THE CHILDREN IN OUR -- IN THE U.S. AS WELL AS INTERNATIONALLY. MANY OF YOU ARE PROBABLY FAMILIAR WITH THESE STATISTICS. EARLY ON IN THE PANDEMIC, SURVEYS REPORTED THAT 70% OF AMERICANS SURVEYED FELT THAT THE COVID PANDEMIC WAS AN EXTREME OR SEVERE CRISIS AND NEARLY TWO THIRDS SAID THEY HAD REPORTED INCREASED STRESS, ANXIETY OR DEPRESSION, AND THAT COVID-RELATED STRESSORS WERE INTERFERING MODERATELY, SEVERELY OR OVERWHELMINGLY IN THEIR LIVES. TWO YEARS LATER, WE HAVEN'T GOTTEN MUCH BETTER. IN MARCH OF 2022, THE AMERICAN PSYCHOLOGICAL ASSOCIATION RELEASED A SERIES OF DATA AND STATISTICS LOOKING AT STRESS IN AMERICA, MONEY, INFLATION AND THE WAR THAT'S GOING ON IN THE UKRAINE PILE ON TO A NATION THAT'S STUCK IN SORT OF THIS CONTINUED SURVIVAL MODE. A FEW GRAPHICS FROM THEIR INFORMATION THAT THE DIFFERENT SOURCES OF STRESS, 87% OF AMERICANS SAY THAT THE RISING COST OF INFLATION IS A MAJOR STRESSOR. GLOBAL UNCERTAINTY, THE WAR IN RUSSIA AND POTENTIAL RETALIATION ARE ALL MAJOR STRESSORS WITH MORE THAN 80% OF INDIVIDUALS REPORTING THESE AS STRESSORS. OVER TWO THIRDS HERE AGAIN REPORT THAT THEIR LIVES HAVE BEEN FOREVER CHANGED BY THE PANDEMIC. AND THAT THEY CONSTANTLY FEAR THE NEXT VARIANT THAT MAY BE COMING. AND WHEN YOU LOOK AT THE DIFFERENT ECONOMIC STRESSORS BY RAISE AND ETHNICITY, YOU SEE THAT THEY DO VARY SOMEWHAT. I THINK WHAT'S VERY INTERESTING HERE IS HOUSING IN PARTICULAR, AND HOW MUCH HOUSING AS A STRESSOR AND WHERE YOU'RE GOING TO LIVE DIFFERS BY SOMEONE'S BACKGROUND IN TERMS OF THEIR RACE AND ETHNICITY WITH ONLY 45% OF WHITE ADULTS REPORTING THIS AS A STRESSOR VERSUS 57 TO 62% OF BLACK AND LATINO ADULTS. SO THIS CONTINUES TO BE A MAJOR ISSUE AND SO THE QUESTION IS, WHAT DO WE DO ABOUT IT AND HOW DO WE ADDRESS THIS? SO THIS IS WHERE SORT OF OUR FRAMEWORK IN THINKING ABOUT HOW DO WE FUND RESEARCH IN CLINICAL RESEARCH TO BE ABLE TO ADDRESS SOME OF THESE STRESSORS. AND WHAT I'M GOING TO SHARE WITH YOU IS OUR FRAMEWORK IN HOW WE THINK ABOUT THIS, BUT THIS IS BEING ADDRESSED IN A NUMBER OF DIFFERENT WAYS. FOR EXAMPLE, THE CDC EVEN RELEASED ON THE LEFT HERE A GENERAL WAY OF HOW TO CARE FOR YOURSELF DURING THE PANDEMIC. THINGS TO DO TO KEEP SOCIALLY CONNECTED AND KEEP YOURSELF HEALTHY. AND THEN IF YOU GO ON THEIR WEBSITE, THEY HAVE ONE SPECIFICALLY FOR OLDER ADULTS, SPECIFICALLY FOR FIRST LINE WORKERS AND FOR STUDENTS AND FOR YOUNG PEOPLE, WHERE THEY'VE TARGETED THESE MESSAGES TO TRY TO REALLY HELP PEOPLE THINK ABOUT HOWL DO YOU TAKE CARE OF YOURSELF DURING THESE TIMES. AND OUR ROLE HERE AT NCCIH IS, HOW DO WE FUND THE RESEARCH TO GIVE YOU THE EVIDENCE THAT DOING THESE THINGS WILL ACTUALLY REDUCE YOUR STRESS? AND THAT'S WHERE SORT OF OUR FRAMEWORK COMES INTO MIND. NOT ONLY MECHANISTICALLY HOW DO THESE INTERVENTIONS IMPACT STRESS IN OUR LIFETIME, BUT AS WE THINK ABOUT DEVELOPING THESE INTERVENTIONS, HOW DO WE REFINE THEM, HOW DO WE OPTIMIZE THEM, LOW DO WE TEST WHETHER THEY WORK, HOW DO WE THEN GET THEM OUT INTO CLINICAL PRACTICE, INTO EITHER HEALTHCARE SETTINGS, COMMUNITY-BASED SETTINGS, OR EVEN EMPLOYER-BASED SETTINGS. I THINK WE'VE SHARED WITH COUNCIL AT PREVIOUS MEETINGS THAT WE DO HAVE FUNDING OPPORTUNITIES FOR THIS WHOLE RANGE OF RESEARCH QUESTIONS FROM THE VERY EARLY FEASIBILITY WORK TO THE EFFICACY STUDIES AND EVENTUALLY INTO THOSE DISSEMINATION AND IMPLEMENTATION SCIENCE FRAMEWORKS, BOTH FOR THE INTERVENTIONS THAT HAVE PSYCHOLOGICAL, BEHAVIORAL AND PHYSICAL UNDER PINNINGS TO THEM WITH MIND AND BODY INTERVENTIONS BUT ALSO FOR OUR NATURAL PRODUCTS, WE HAVE FUNDING MECHANISMS ACROSS THE SPECTRUM, AND CERTAINLY WE'RE WELL AWARE OF DIFFERENT NATURAL PRODUCTS USED IN DIFFERENT COMMUNITIES TO HELP MANAGE STRESS, SO THERE ARE OPPORTUNITIES FOR THESE AS WELL, LOOKING AT THE IMPACT IN BUY BIOLOGICAL SIGNATURES AND EVENTUALLY MOVING INTO EFFICACY STUDIES. AS WE'VE GONE ALONG OVER TIME IN DEVELOPING OUR FUNDING OPPORTUNITIES, WE'VE TRIED TO STREAMLINE THESE SO THAT WE CAN GET TO THOSE EFFICACY AND EFFECTIVENESS STUDIES AS QUICKLY AS POSSIBLE, BUT WE UNDERSTAND SOMETIMES THE PRELIMINARY DATA MAY NOT BE THERE YET TO ACTUALLY JUSTIFY DOING THAT FULL SCALE TRIAL. THAT'S WHY WE PROVIDE A VARIETY OF LITTLE ENTRY POINTS INTO THAT FRAMEWORK FOR DOING THESE TYPES OF CLINICAL TRIALS. WE WANT TO MOVE PAST THE FEASIBILITY WORK AND WE'VE ADDRESSED THE PRELIMINARY DATA REQUIREMENTS AND ENCOURAGING OUR INVESTIGATORS TO LEVERAGE THE PUBLISHED LITERATURE AND MOVE ON TO THE NEXT STAGE OF RESEARCH. AND I'M GOING TO SHOW YOU IN JUST A MINUTE HOW WE HAVE FUNDING OPPORTUNITIES ACROSS THE ENTIRE FRAMEWORK FOR YOU TO CONSIDER. AND HERE'S AN EXAMPLE OF THAT. WHERE WE'VE PLUGGED IN ALL OF THE VARIOUS FUNDING OPPORTUNITIES, AND YOU CAN FIND THESE ON OUR WEBSITE IF YOU JUST SEARCH ON OUR WEBSITE FOR CLINICAL RESEARCH FUNDING OPPORTUNITIES, THERE'S A LIST OF ALL OF THESE VARIOUS FUNDING OPPORTUNITIES AND SORT OF WHERE THEY FIT IN AND WHAT STAGE OF RESEARCH THEY'RE APPROPRIATE FOR. I DO WANT TO MENTION ONE THING THAT WAS PRESENTED IN A PREVIOUS CONFERENCE WE HAD BACK IN SEPTEMBER BY DR. LINDA COLLINS, WHO'S AT NYU. SHE'S DONE A LOT OF WORK IN THINKING ABOUT HOW DO WE OPTIMIZE INTERVENTIONS AND USING SOME ADAPTIVE DESIGNS TO DO THAT, AND SHE JUST RECENTLY HAS SORT OF STARTED TALKING ABOUT A NEW ACRONYM THAT SHE'S USING CALLED EASE, WHICH IS, AS WE THINK ABOUT DESIGNING AND EVENTUALLY TESTING INTERVENTIONS, IT'S A BALANCING ACT BETWEEN HOW EFFECTIVE ARE THOSE INTERVENTIONS, WHICH IS WHAT WE ALWAYS TRY TO MAXIMIZE, BUT THAT WE ALSO -- I OFTEN THINK OF THE SCALABILITY ELEMENT IN BEING -- CAN IT BE USED IN DIFFERENT PLACES, CAN YOU SHIFT IT OR CHANGE IT OR HAVE SOME FLEXIBILITY IN IT SO THAT IT CAN BE CUSTOMIZED OR TAILORED TO SPECIFIC POPULATIONS OR MAYBE LESS RESOURCE INTENSIVE ENVIRONMENTS, OR MAYBE THEY DON'T HAVE THE SAME INFRASTRUCTURE. SO THINKING ABOUT THAT UP FRONT AS WE DESIGN AND OPTIMIZE AND REFINE OUR INTERVENTIONS IS REALLY IMPORTANT SO THAT AS WE TEST INTERVENTIONS AND KNOW WHETHER THEY WORK, THAT THEY ACTUALLY CAN BE SCALED UP AND SCALED OUT. SO AS WE THINK HERE AT NCCIH ABOUT IMPACTFUL CLINICAL TRIALS, THERE'S A FEW THINGS THAT WE THINK ABOUT. AS WE MOVE TOWARDS EFFICACY AND DOING EFFICACY STUDIES ON NATURAL PRODUCTS, WE WANT TO KNOW THAT WE HAVE AN ACTIVE BIOLOGICAL SIGNATURE THAT THE NATURAL PRODUCT CAN REPRODUCIBLY AFFECT A POTENTIAL MECHANISM AND THAT HELPS US KNOW THAT WE'VE GOT AN ACTIVE COMPOUND AND WE'RE READY TO MOVE INTO EFFICACY STUDIES. SIMILARLY ON THE MIND AND BODY SIDE OF THINGS AND OUR INTERVENTIONS ON THAT SIDE, WE WANT TO MAKE SURE WE HAVE INTERVENTIONS THAT ARE FEASIBLE, PEOPLE CAN DO THEM, AND THAT THEY CAN BE DELIVERED WITH FIDELITY ACROSS SITES SO THAT WHEN WE GO TO THAT MULTISITE TRIAL, WE KNOW THAT EVERYBODY IS GETTING THE SAME OR VERY CLOSE TO THE SAME INTERVENTION, WE KNOW WHAT ARE THE CORE COMPONENTS AND WHAT CAN MAYBE BE ALTERED BY SITE. AND THEN WE'RE READY TO MOVE INTO THOSE EFFICACY IN EFFECTIVENESS STUDIES. AND ONCE WE KNOW WHETHER INTERVENTIONS WORK OR NOT, WHETHER THEY HAVE EFFICACY OR EFFECTIVENESS, THEN WE'RE READY TO DO THOSE PRAGMATIC TRIALS. HOW DO WE GET THEM INTO THE HEALTHCARE SETTING OR COMMUNITY-BASED APPROACHES, COMMUNITY SETTINGS, THE WORKPLACE SETTINGS OR OTHER PLACES LIKE THAT. AND SO IN REALITY, TRIALS ALL ALONG THIS CONTINUUM CAN BE IMPACTFUL BECAUSE KNOWING WHETHER WE HAVE A REPRODUCIBLE, BIOLOGICAL SIGNATURE TELLS US WHEN WE'RE READY TO MOVE TO THAT NEXT STUDY, SO THAT'S A REALLY IMPORTANT STEP. DETERMINING THE FEASIBILITY AND THE FIDELITY OF THESE INTERVENTIONS CAN BE REALLY IMPACTFUL, BECAUSE IT CAN SHIFT AND CHANGE HOW THE INTERVENTION IS DELIVERED AND HOW IT'S DESIGNED SO IT HAS THE OPPORTUNITY TO BE TESTED AS WELL AS SCALED UP EVENTUALLY. SO WHAT WILL SUCCESS LOOK LIKE FOR US? THAT WE'LL HAVE A RANGE OF TRIALS ACROSS THE FRAMEWORK IN ALL OF THESE DIFFERENT APPROACHES. THAT THINGS MOVE ALONG THAT FRAMEWORK SUCH THAT WHEN WE KNOW THAT THEY'RE FEASIBLE, THAT WE KNOW THAT THEY'RE EFFECTIVE, THEY MOVE INTO CLINICAL PRACTICE OR INTO COMMUNITY OR WORKPLACE SETTINGS. AND THAT EVENTUALLY, THE TRIALS THAT WE'RE SUPPORTING ARE ACTUALLY INCORPORATED INTO GUIDELINES THAT THEY SET HEALTHCARE POLICY DECISIONS, THEY INFORM PAYORS ABOUT WHAT INTERVENTIONS SHOULD BE COVERED AND MADE AVAILABLE TO THE BROADER COMMUNITY. SO I THINK THAT IS MY LAST SLIDE, AND I THINK WHAT I'M GOING TO DO NOW IS TURN THINGS OVER TO DR. MICHAEL CHRISTOPHER TO TELL US A LITTLE BIT ABOUT SOME OF THE EXCITING WORK THAT HE IS DOING UP AT PACIFIC UNIVERSITY. >> THANK YOU, VERY MUCH, DR. WEBER. THANK YOU VERY MUCH TO THE COUNCIL FOR HAVING ME HERE TODAY. IT AN HONOR FOR ME TO . SO I'M GOING TO START OFF WITH A QUICK STORY, I PROMISE I'LL KEEP IT VERY QUICK. THIS IS A DETECTIVE FROM THE HILLSBOROUGH POLICE DEPARTMENT. BEFORE HE WAS SHINY, HAPPY SMILING ON THE COVER OF "LIFE" MAGAZINE, HE WAS IN HILLSBOROUGH, OREGON, AND -- BURNED OUT AND STRESSED, I DON'T WANT TO BE A POLICE OFFICER ANYMORE, I'M DEPRESSED AND MY COLLEAGUES ARE JUST LIKE ME, WE'RE ALL BURNED OUT, WE'RE STRESSED, WE JUST CAN'T DO THIS WORK ANYMORE. HE HAD READ A LITTLE BIT OF MY WORK WE WERE DOING IN MINDFULNESS. HE SAID I TRIED MEDITATION MAYBE LIKE 20 YEARS AGO. I DON'T KNOW IF THIS MINDFULNESS STUFF IS SORT OF THAT SAME THING, BUT I NEED SOMETHING. I JUST NEED -- SOMETHING HAS TO CHANGE. SO WE ENROLLED HIM IN OUR 8-WEEK PROGRAM AND TO USE RICH'S LANGUAGE, HE DRANK THE KOOL-AID. HE CALLED IT LIFE CHANGING. RICH IS A VERY DYNAMIC GUY, SO FOR HIM, IT WAS NOT ONLY LIFE CHANGING FOR HIM. IN HIS PERSPECTIVE, LIKE EVERY POLICE OFFICER IN THE WORLD NEEDED TO DO MINDFULNESS. THEY NEEDED TO GET INVOLVED IN A MINDFULNESS TRAINING. SO THAT'S A QUICK BACK STORY OF HOW THIS PROGRAM AND RESEARCH GOT STARTED, WITH RICH'S PARTNERSHIP. SO THIS IS RICH AND I SITTING DOWN, KIND OF FIGURING OUT FROM THE BEGINNING, WHAT DO WE REALLY WANT TO ACCOMPLISH HERE? SO AGAIN FOR RICH, IT WAS THAT THIS IS REALLY IMPROVING MENTAL HEALTH, PHYSICAL HEALTH, THE THINGS THAT HE EXPERIENCED. WE KNEW A GOOD DEAL OF RESEARCH ON THAT. I KIND OF CAME TO THIS AS NOT A LAW ENFORCEMENT OFFICER BUT A SCIENTIST IN A BACKGROUND OF C VPR AND COMMUNITY METHODS, ALSO REALLY INTERESTED IN THE IMPACT THIS CAN HAVE ON OUR COMMUNITIES AND COMMUNITY POLICING. IT WAS AROUND THIS TIME THAT UNFORTUNATELY MICHAEL BROWN OF FERGUSON WAS KILLED BY POLICE THERE, AND WE THOUGHT MAYBE THIS WAS ALSO NOT ONLY A WAY TO IMPROVE POLICING IN GENERAL BUT TO LOOK AT SOME OF THOSE VIOLENT OUTCOMES THAT ARE OFTEN THE RESULT OF STRESS BASED OR OFFICERS BEING OVERLY STRESS AND MAKING POOR DECISIONS. SO WE ENGAGED BOTH OF US IN THIS CULTURAL IMMERSION. FOR ME AND MY LAB IT WAS DOING THINGS LIKE RIDE-ALONGS, GOING TO BRIEFINGS, GETTING A BETTER SENSE OF THAT CULTURE, AND FOR RICH AND SOME OF THESE COLLEAGUES IN THE PROGRAM AND THIS RESEARCH, THEY JOINED OUR LAB ESSENTIALLY AS EQUAL CO-PARTNERS IN THE LAB, CONTRIBUTING TO PAPERS, THINGS LIKE THAT. SO ONCE WE HAD THE BACKGROUND AND THIS THEORY, WHAT WE WANTED TO DO, WE DECIDED TO GO FOR IT AND DO A GROUP FOR LAW ENFORCEMENT OFFICERS. WE GOT A SMALL PILOT GRANT. THERE'S ONE OF MY CO-FACILITATORS LEADING FOLKS THROUGH AN EXERCISE. WE HAD SOME PRETTY GOOD DATA, WE FOUND SOME SIGNAL CHANGE ON THINGS LIKE STRESS, RESILIENCE, BURNOUT, THINGS LIKE THAT. THROUGH SOME FOCUS GROUPS AND THEN LEARNING AS WE WERE GOING, WE LEARNED THAT MB -- IT NEEDED CHANGES, IT NEEDED ADAPTATION. A SIMPLE EXAMPLE IS A LOT OF OFFICERS WERE RELUCK AT THAT PARTICULAR TIME TO DO THE TRADITIONAL BODY SCAN OF LYING DOWN ON THE BACK. SORT OF TALKING WITH THEM ABOUT THAT, WHAT'S THE PROBLEM THAT WAS GOING ON, IT WAS THAT YOU HAD A ROOM FULL OF POLICE OFFICERS, LYING DOWN ON THEIR BACK WITHOUT THEIR WEAPONS AND THEY FELT VERY VULNERABLE. AT ANY POINT SOMEONE COULD COME IN WITH A GUN, FOR EXAMPLE, SO WE HAD THIS AGREEMENT THAT THE DOOR STAYS LOCKED. SO THE DOOR WAS LOCKED SO NO ONE ELSE COULD COME IN THAT WASN'T SUPPOSED TO BE THERE. SO LITTLE THINGS LIKE THAT, ONE OF THE THINGS WE REALLY FOCUSED ON IN DISCUSSING THIS AND GOING BACK TO THE LITERATURE WAS RESILIENCE ENHANCEMENT. THIS IS SOMETHING THAT THE LITERATURE WAS TAKING OFF AT THIS TIME AND WE FELT THAT WAS SUCH AN IMPORTANT SKILLSET FOR LAW ENFORCEMENT, IS IT'S INEVITABLY A STRESSFUL JOB, THERE ARE GOING TO BE TRAUMAS, AND WE THOUGHT IS THERE A WAY WE CAN CULTIVATE USING MINDFULNESS FOR LAW ENFORCEMENT. SO WE DEVELOPED MINDFULNESS BASED RESILIENCE TRAINING. SO WE GOT SOME FUNDING FROM NCCIH FOR AT THE TIME WAS -- IT WAS MORE OF A HIGH RISK HIGH REWARD AS YOU ALL KNOW BUT WE SORT OF SHAPED THIS WORK TO A FEASIBILITY TRIAL. SO FOR STARTERS, THIS WAS A SINGLE -- A RELATIVELY SMALL TRIAL HERE IN PORTLAND, OREGON. AND WE ALSO WERE JUST LOOKING AGAIN FOR SOME PRELIMINARY SINGLE CHANGE. IT WAS A SINGLE ARM -- AN RCT SO WE WERE LOOKING AT STRESSOR ACTIVITY, WANTED TO LOOK AT BIOMARKER, WE LOOKED AT CORTISOL AWAKENING RESPONSE. WAS REAL INTERESTED TO SEE, COULD WE MAKE A CHANGE IN IMPLICIT RACE BIAS ACTIVATION BY TRAINING IN MINDFULNESS, AND LASTLY PSYCHOLOGICAL HEALTH AND RISK. SO IN TERMS OF OUR FEASIBILITY MARKER, WE SET SOME BENCHMARKS. SO JUST COULD WE RECRUIT, COULD WE GET 60 OFFICERS IN THE PORTLAND METRO AREA WILLING TO DO THIS, WITH 90% OF THEM ACCEPT BEING EITHER RANDOMIZED MBRP OR THE RANDOMIZED CONTROL GROUP. WOULD ABOUT THREE QUARTERS ATTEND THE CLASSES AND MAKE ALL THE CLASSES, AND COULD WE DO THIS WITH 20% ATTRITION. AND LUCKILY WE MET ALL THOSE BENCHMARKS. SO WE HAD THE PARTICIPANTS, PEOPLE STUCK AROUND AND THEY ACCEPTED THE RANDOMIZATION. SIMILARLY FOR OUR ACCEPTABILITY GOAL, WE JUST USED A FAIRLY STRAIGHTFORWARD THREE-ITEM MEASURE OF ACCEPTABILITY. WE WERE JUST LOOKING FOR RESPONSES IN A LIKELY OR REASONABLE RANGE. AND WHAT WE FOUND AGAIN, PRETTY SIMILARLY, IS THAT MOST OFFICERS WOULD RECOMMEND THIS TO A FRIEND. THEY'D DO IT AGAIN IF IT WERE OFFERED AGAIN BUT THEY DID FIND THE WHOLE PRACTICE A LITTLE UNREASONABLE. THAT WAS AGAIN PART OF OUR ADAPTATION PROCESS. MAYBE 45 MINUTE A DAY OF MEDITATION HOMEWORK JUST MIGHT NOT BE FEASIBLE FOR THIS POPULATION. IN TERMS OF OUR OUTCOMES, AGAIN WE WERE REALLY MORE INTERESTED IN JUST LOOKING AT WERE THEY FEASIBLE. SO WE FOUND WITH CORTISOL AWAKENING RESPONSES, AGAIN, WE HAD OFFICERS DOING THIS THREE DAYS PREINTERVENTION AND THREE DAYS POST, SO THOSE WHO HAVE ACTUALLY DONE THIS, IT'S QUITE A CHALLENGE FIRST THING IN THE MORNING TO COLLECT SALIVA THREE TIMES, DO NOT EAT, DRINK, DO ANYTHING ELSE, SO WE WE ARE WERY PLEASANTLY SUR PLIED WE HAD ABOUT A 95% COMPLETION RATE. THIS IS CALLED THE SHOOTER BIAS TASK. WHAT IT DOES VERY BRIEFLY IS LOOK AT IMPLICIT BIAS IN DECISION SHOOT OR NO SHOOT. WE WERE CONCERNED THAT POLICE OFFICERS WOULD REFUSE AT HIGH NUMBERS TO DO THIS BECAUSE, AGAIN, WE WERE COLLECTING THIS DATA AND ALTHOUGH, AGAIN, OBVIOUSLY IT WAS CONFIDENTIAL AND NOMINALIZED, AFTER WE HAD A CERTIFICATE OF CONFIDENTIALITY, WE THOUGHT WE WOULD HAVE SOME OFFICERS WHO WOULD FLAT OUT REFUSE DO THIS. SO AGAIN YOU'RE PROVIDED WITH IMAGES OF EITHER A WHITE OR BLACK MALE HOLDING SOMETHING LIKE EITHER A CELL PHONE OR A GUN, AND YOU HAVE TO MAKE THAT QUICK WITHIN A FEW MILLISECONDS DECISION OF WHETHER TO SAY THAT THEY'RE HOLDING A WEAPON OR THEY'RE HOLDING SOMETHING LIKE A CELL PHONE. SO WE HAD 100% COMPLIANCE HERE, WE DIDN'T HAVE A SINGLE OFFICER REFUSE TO DO IT. AND THEN OUR LAST TWO SORT OF OUTCOMES, AGAIN, WE HAD SOME SELF-REPORT MEASURES, 100% COMPLETION RATE, AND WE'VE BEEN -- WE OBVIOUSLY WERE PLEASANTLY SURPRISE HEERD AS WELL, ABOUT 322 MINUTES OF HOME PRACTICE. IT WASN'T EXACTLY THAT 45 MINUTES A DAY THAT WE HAD HOPED BUT WE LEARNED PRETTY QUICKLY THAT'S JUST NOT REALISTIC, AS IT'S NOT IN MOST SAMPLES. SO FELT PRETTY GOOD ABOUT THAT. I JUST WANT TO READ A COUPLE QUOTES HERE. I KNOW I'M SORT OF RUNNING SHORT ON TIME BUT WE ALSO DID SOME INTERVIEWS AND GOT SOME REALLY NICE QUOTES FROM OFFICERS. I USED TO FLY OFF THE HANDLE, I DON'T SO MUCH ANYMORE, WHICH IS REALLY NICE. RM "PUN TIME MY WIFE TOLD ME, I CAN ACTUALLY SEE THE CLASS KICK IN WHILE WE WERE TALKING. AND SHE'S JUST LIKE -- HELPED ME NOT ESCALATE. SO IT WAS REALLY NICE AGAIN TO HEAR FROM THE OFFICERS, SORT OF THEIR LIVED EXPERIENCE WITH THIS COURSE. SO LESSONS LEARNED SORT OF QUICKLY IS, AS WITH ANY COLLABORATIVE RESEARCH PROJECT, IT WAS REALLY IMPORTANT FOR US TO ENGAGE POLICE LEADERSHIP EARLY ON THROUGHOUT THE PROJECT. ALTHOUGH WE HAD A LOW DROPOUT RATE T OCCURRED MOSTLY AFTER THAT FIRST GROUP. SO WE LOST THREE OR FOUR PARTICIPANTS AFTER JUST OUR NORMAL TWO-HOUR SESSIONS, SO WE THOUGHT MAYBE WE NEED TO DO SOMETHING TO GET BETTER BUY-IN AT THE BEGINNING. THE POLICE OFFICER DILEMMA, WHICH WE SHOWED YOU, ALTHOUGH WE HAD 100% OF OFFICERS DO IT, THEY DID REALLY WELL ON IT, ALMOST TOO WELL. AND WE KNEELED -- REALLY NEEDED A MORE SOPHISTICATED DESIGN FOR A PAPILLATION THAT'S VERY WELL TRAINED IN POPULATION THAD AT -- -- THAT WAS REALLY DISHEARTEN, WE NEEDED TO DO MORE TO KEEP THEM -- ALTHOUGH IT IS PRIMARILY A MALE PROFESSION, WE HAD 90% MALE AND 80% WHITE SAMPLE SO WE WANT TO DO BETTER IN OUR NEXT ROUND. SO BASED OFF OF THE R21, WE APPLIED AND RECEIVED A U01 FOR A MULTISITE FEASIBILITY TRIAL. SO HERE WE WERE TAKING WHAT WE LEARNED FROM THIS TRIAL AND NOW WE WERE EXPANDING THAT OUT TO DISTANT SITES, SO HERE AGAIN IN PORTLAND, COLLEAGUES, AGAIN THE GOAL HERE WAS A MULTISITE FEASIBILITY TRIAL. CAN WE REPLICATE WHAT WE'VE DONE AND CAN WE DO THAT IN PREPARATION FOR A FULL SCALE EFFICACY TRIAL. SO NEXT STEPS JUST REAL QUICKLY HERE, SOME OF YOU MIGHT RECOGNIZE THESE FACES. WE RECRUITED SARAH TO COME JOIN US AT PACIFIC A FEW YEARS AGO. HER BACKGROUND IS REALLY MORE IN MBRP AND ADICKS. BUT AFTER A LOT OF A CAJOLING D PUSHING WE GOT HER EXCITE TODAY JOIN ME ON THIS PROJECT. MANY OF YOU PROBABLY KNOW, THESE TWO ARE REALLY SORT OF THE CORE DEVELOPERS ALONG WITH ALLAN, OF COURSE, OF -- PREVENTION. AND THEIR INFLUENCE WAS SORT OF WHERE WE WENT THE NEXT DIRECTION OF MBRT WAS REALLY IMPORTANT. WE SORT OF SHIFTED AWAY A LITTLE BIT FROM MBSR ALTHOUGH IT WAS A QUICK COUSIN -- ONE OF THE IMPORTANT DISTINCTIONS WE'VE MADE HERE IS THAT REACTIVITY IS REALLY ONE OF THE CORE TARGETS WITHIN MBRP, SORT OF LOOKING AT AGAIN PREDICTIONS BUT IT REALLY FIT WITH WHAT WE WERE KIND OF THINKING WAS OUR PRIMARY MECHANISM, BOTH FROM THE PRELIMINARY DATA WE HAD BUT JUST ANECDOTALLY SO SOME OF THE QUOTES THAT WE CAPTURED EARLIER, DECREASING THAT REACTIVITY DURING TIMES OF STRESS LEADING TO BAD OUTCOMES ESSENTIALLY IN POLICING. OBVIOUSLY A HIGH TRAUMA POPULATION, SO WE INTEGRATED THAT MORE INTO THIS NEXT PHASE OF MBRT. WE ALSO BASED ON THE PILOT WORK WE HAD DONE REALIZED THAT -- WERE GETTING LOTS OF MOVEMENT, LOTS OF SIGNAL CHANGE, LOTS OF BODY WORK WITH THE OFFICERS RESPONDED WELL TO. SO WE DECIDED TO MOVE TO A SIX-HOUR IMMERSION IN WEEK ONE TO GET MORE BUY-IN, AND THEN ON THE END, ADD BOOSTER SESSIONS TO HOPEFULLY FOSTER MORE PRACTICE. AND THEN LASTLY, WE SHIFTED MORE TO AN ACUTE STRESS CHALLENGE. WE WANTED TO SEE HOW OFFICERS RESPONDED TO A STRESS PATH IN THE LAB, MEASURING THESE PARAMETERS AND LOOKING AT THAT AGAIN AFTER AND SEEING IF WE WOULD HAVE NOT AT HIGH AS A PEAK BUT ALSO A QUICKER RETURN BACK TO BASELINE. AND THIS NEXT STEP TOO, WE INCLUDED AN ACTIVE CONTROL CONDITION, STRESS MANAGEMENT EDUCATION. AND LASTLY, BECAUSE IT WAS MORE OF A FEASIBILITY TRIAL, WE REALLY WANTED TO MOVE FROM -- IT WAS STILL INCLUDING SORT OF SELF-REPORT AND OTHER MEASURES OF AGGRESSION AND USE OF FORCE TO ACTUALLY COLLECTING BEHAVIORAL DATA, ACTUALLY USE SOME FORCE. TO SEE IF A IT WAS FEASIBLE TO COLLECT AND B IF WE COULD DETECT ANY SLOT CHANGES. MOVING TO MORE OF THAT ACUTE PHYSIOLOGICAL ACTIVITY. SO WE PARTNERED WITH OUR THREE AGENCIES IN THE THREE CITIES, AND OUR STUDY STARTED WITH AN ENTIRELY IN-PERSON PROTOCOL. OFFICERS WERE COMING TO THE LAB, WE WERE STRESSING THEM OUT, AND GROUPS ENTEARLY IN PERSON. WE STARTED OFF IN ALBUQUERQUE, FIRST PARTICIPANT JANUARY 5TH, 2020, WE HAD 24 AND WE COMPLETED OUR FIRST GROUP, WE WERE SO EXCITED, ON MARCH 11, 2020. AND THE NEXT DAY, COVID ESSENTIALLY HIT AND SHUT US DOWN. SO IT WAS 3/12, OUR SITES WENT INTO LOCKDOWN. WE WERE SORT OF IN A HOLDING PATTERN, NOT SURE WHAT TO DO FOR A WHILE AND AS YOU ALL KNOW, TWO MONTHS AFTER THAT, GEORGE FLOYD WAS MURDERED IN MINNEAPOLIS, AND IT WAS REALLY A TOUGH TIME FRANKLY. BETWEEN COVID AND NOT SURE WHAT TO DO, BUT GEORGE FLOYD'S MURDER AND THEN THE SOCIAL PROTESTS FOR SOCIAL JUSTICE AFTER THAT, AS A TEAM, WE REALLY SPENT A LOT OF TIME TO SORT OF FIGURE OUT THIS WAS THE RESEARCH WE WANTED TO KEEP DOING, DO YOU WANT TO SHIFT, DO YOU WANT TO DO SOMETHING DIFFERENT. SO WE TOOK A SIX MONTH PAUSE AND I WANT TO MENTION HOW HELPFUL -- WAS DURING THIS TIME, KEEPING US ON TRACK, COMING BACK TOGETHER, AND AT THE END, CONSULTING WITH COMMUNITY MEMBERS AND OTHER PEOPLE, OKAY, WE REALLY NEED TO GET BACK TO WORK HERE, TO MOVE FORWARD WITH THIS. SO WE SHIFTED GEARS, TAKE TWO HERE, AND SWITCHED FROM ENTIRELY IN PERSON TO AN ENTIRELY VIRTUALLY PROTOCOL, WHICH AS YOU CAN IMAGINE WAS QUITE AN UNDERTAKING. WE WERE THEN SHIFTED OVER TO INFLAMMATORY MARKER, WHICH WAS AGAIN MORE OF A CHRONIC MEASURE BUT WE THOUGHT AT LEAST IT KEEPS SOME BIOMARKERS WE COULD LOOK FOR THAT CHANGE AND AGAIN, ALL DATA THAT THAT WERE NOW COLL, DELIVERED VIA ZOOM. SO WE ENROLLED OUR FIRST PARTICIPANT IN MID DECEMBER OF 2020. AND THE -- AGAIN VIRTUALLY AND STRESS -- AP DAP TAITION IN OUR THREE SITES. VERY RECENTLY WE JUST FINISHED OR SIX MONTH FOLLOW-UP DATA COLLECTION. WE MANAGED TO DO IT ALL VIRTUALLY. THIS WAS ABOUT A COUPLE, TWO MONTHS AGO THAT WE FINISHED DATA COLLECTION. SO I'LL JUST QUICKLY GO THROUGH SORT OF OUR BENCHMARKS THAT WE FOUND AND LUCKILY WE FOUND THAT MULTISITE TRIAL, DESPITE SOME OF THE ISSUES THAT WE DEALT WITH, THAT WE HIT OUR ENROLLMENT TARGETS. WE WERE VERY HAPPY TO SEE THAT WE REALLY MADE A STRONG EFFORT TO RECRUIT A DIVERSE SAMPLE IN ALL THREE OF OUR SITES, AND WE ACTUALLY EXCEEDED OUR DIVERSITY TARGETS. WE HAD ALMOST WERE FEMALE. LARGELY ACCEPTED RANDOMIZATION. WE WERE REALLY HAPPY WITH OUR RETENTION EFFORTS THAT, WE KEPT 86% OF OUR OFFICERS AT SIX MONTHS OUT. REALLY HIGH RATES OF COMPLETION WITH DATA. THOUGH ONE THAT WE DIDN'T MEET WAS OUR DRY BLOODSPOTS. SO WE WERE MAILING THEM OUT TO PARTICIPANTS HAVING TO DO IT AT HOME WHILE WE WERE WALKING THROUGH IT ON ZOOM. FEDEX UNFORTUNATELY LOST A BATCH OF THEM SO I WON'T CLAIM FULL RESPONSIBILITY UNFORTUNATELY FOR NOT MEETING THIS BENCHMARK. AND WE HAD OUR T GROUP, WHICH WAS GREAT, THE VAST MAJORITY DID ATTEND, R. AT LEAST FIVE E SESSIONS. AND THEN LASTLY, OUR PARTICIPANTS FOUND IT ACCEPTABLE. AND THEN TO SUMMARIZE, THIS IS REALLY THE PART WE'RE WORKING ON AS WE SPEAK. SO WIRE LOOKING WE'RE LOY AGAIN, FIDELITY ACROSS SITES, SO WE'RE LOOKING VERY CAREFULLY TO SEE HOW WELL OUR INTERVENTIONISTS -- IN EACH OF THE THREE SITES. AGAIN OUR ANALYSIS HERE, WE'RE NOT LOOKING AT GROUP DIFFERENTS. WE'RE REALLY LOOKING AT MORE EFFICIENCY OF MEASURES AND SENSITIVITY TO CHANGE. BUT LUCKILY -- NON-REACTIVITY, INTERNAL INTERROW ACCEPTIVE AWARENESS ARE EFFICIENT AND SENSITIVE TO CHANGE. EXCESSIVE USE OF FORCE DATA, THIS IS CALLED BLUE TEAM, SO WE HAVE REAMS OF DATA OF USE OF FORCE. WE WERE UNABLE TO GET THIS IN ALBUQUERQUE, BUT AT LEAST WE HAVE ONE THERE, THEAND WE'RE WORKING ON OUR INFLAMMATION BIOMARKER TATA NOW. DATA NOW. WE'VE GOT 47 INTERVIEW, SO LOTS OF RICH THEMES COMING OUT OF THIS ACROSS ALL PHASES OF THE STUDY. NOT JUST THE -- AND ALL THE DIFFERENT ASPECTS. LASTLY AGAIN, PRETTY -- WE DON'T HAVE MINUTES -- AT LEAST 95% DID IT. SO VERY QUICKLY, SOME NEXT STEPS, AGAIN WE'RE GOING TO ANALYZE THIS DATA AND THEN OUR FINAL STEP HOPEFULLY IF ALL GOES WELL ONCE WE PUBLISH SOME OF THE PAPERS FROM THIS IS TO SUBMIT APPLICATIONS IN OCTOBER SO WE'VE MET MOST OF OUR BENCHMARKS AND WE'LL FIND OUT AGAIN HOW WE DO ON THE OTHER MEASURES. JUST LASTLY, WE'RE OPENING AGAIN TO MOVE IN THIS LAST STUDY BACK TO INCLUDE RACE BASED BIAS IN SHOOTING. WE'VE BEEN WORKING WITH A LAB IN UNIVERSITY OF WASHINGTON WHO'S DOING THIS WITH MUCH MORE HIGH SOPHISTICATED EQUIPMENT AND -- K THINGS TO LIKE A COMMUNITY ADVISORY BOARD. VERY LASTLY HUGE THANKS TO ALL THE OFFICERS WHO PARTICIPATED IN THIS, AND AGAIN TO ALL THE PEOPLE, I'M JUST A SPOKESPERSON REALLY FOR ALL THE WONDERFUL PEOPLE WHO DID THIS WORK. SO THANK YOU AGAIN. I'LL TURN THIS BACK OVER. >> THANK YOU SO MUCH, MIKE. THAT WAS WONDERFUL. I THINK WHAT WE'RE GOING TO DO IS HOLD QUESTIONS UNTIL THE END, JUST SO WE CAN GET THROUGH ALL THE PRESENTATIONS. SO PLEASE, ANYONE, ON THE CHAT OR VIDEOCAST, PLEASE GO AHEAD AND SUBMIT QUESTIONS IF YOU HAVE THEM, ON ZOOM YOU CAN DO THAT THROUGH CHAT AND I BELIEVE WE HAVE A Q & A BOX OR AN EMAIL UNDER THE VIDEOCAST WHERE YOU CAN SUBMIT QUESTIONS. BUT THANK YOU SO MUCH, MIKE, AND I AM GOING TO TURN THINGS OVER NOW TO OUR NEXT SPEAKER, WHO IS ZEV SCHUMAN-OLIVIER. SO ZEV, YOU'RE UP NEXT AND JUST TELL ME "NEXT SLIDE" AND I'LL GO AHEAD AND CLICK THROUGH FOR YOU. >> GREAT. THANK YOU. AND MICHAEL, WHAT AN EXCITING STUDY TO GET TO HEAR ABOUT. I FEEL LUCKY TO BE ABLE TO HEAR ABOUT IT SO EARLY HERE. I'M ZEV SCHUMAN-OLIVIER, CENTER FOR MINDFULNESS AND COMPASSION. I'M GOING TO TELL YOU ABOUT A PROJECT THAT REALLY IS MUCH BIGGER THAN ME AND EVEN OUR CENTER AND OUR ENTIRE HEALTHCARE SYSTEM. I WANT TO JUST THANK, BEFORE WE GET STARTED, MANY OF OUR TEAM MEMBERS WHO HELPED TO PUT TOGETHER SOME OF THESE SLIDES AND FIGURES FOR US AND I WANT TO POINT OUT THAT IT REALLY HAS TAKEN AN ENTIRE TEAM. THIS IS OUR CURRENT TEAM RIGHT HERE, AND CARL FULYILER IS WITH ME ON THIS PROJECT, AND REALLY WANT TO THANK THE OTHERS FOR HELPING TO PUT TOGETHER. SO LET'S KEEP GOING. SO THIS PROJECT STARTED RIGHT AT THE VERY BEGINNING OF COVID, COVID-19, IN MARCH 2020. AND WHAT WE PREDICTED MIGHT HAPPEN IS WHAT HAPPENED, AND THAT IS THAT THE PANDEMIC HAS REALLY CAUSED A TSUNAMI OF MENTAL HEALTH NEEDS. SO STRESS, ANXIETY, DEPRESSION, TRAUMA, GRIEF IS ABUNDANT, AND NOT EVEN JUST FROM THE -- FROM COVID ITSELF BUT ALL THE CHANGES THAT RELATED TO IT, THE JOB CHANGES, HOUSING CHANGES THAT WENDY TALKED ABOUT BEFORE, SOCIAL ISOLATION, CONTRACTING COVID AND THE IMPACT OF THAT, THE DELAY IN ROUTINE MEDICAL PROCEDURES, THE IMPACT OF PEOPLE'S HEALTH PROBLEMS, DEATH OF LOVED ONES, THE RACIAL STRESS AS MICHAEL POINTED OUT AND THEN THE LOSS OF IDENTITY. PEOPLE LEAVING JOBS TO CARE FOR CHILDREN AT HOME, PEOPLE WORKING FROM HOME, PEOPLE HAVING TO RETURN HOME FROM SCHOOL AND FROM AN ENVIRONMENT THEY WERE COMFORTABLE IN TO NEEDING TO HIDE THEIR IDENTITIES. PEOPLE LAID OFF FROM WORK OR HAVING TO TRANSITION. A LOT OF STRESS ALL AROUND. SO WE STARTED A PROJECT CALLED CHA MINDWELL. I JUST WANT TO SAY I'M REALLY APPRECIATIVE TO THE CAMBRIDGE HEALTH ALLIANCE EXECUTIVE TEAM AND OUR PARTNER PSYCHIATRY LEADERSHIP FOR REALLY KIND OF GREEN LIGHTING SOMETHING IN THE MIDST OF THE ACTIVE CHAOS AS THE ENTIRE HOSPITAL WAS GOING INTO EMERGENCY MODE TO BE ABLE TO ALSO HAVE SOME FORESIGHT TO HAVE SOMETHING TO BE ABLE TO WORK ON THE MENTAL HEALTH CONSEQUENCES. SO WE STARTED A FREE MENTAL HEALTH WELLNESS PROGRAM TO CONNECT THEM WITH SERVICES AND AN ONLINE COMMUNITY. BASICALLY PEOPLE GO ONLINE AND THEY WERE USING COMPUTERIZED ADAPTIVE TESTING FOR MENTAL HEALTH AND COMPUTERIZED ADAPTIVE TESTING FOR SOCIAL DETERMINANT OF HEALTH. AND WITH USING SEVEN DIFFERENT MODULES, ASSESSING THEIR MENTAL HEALTH, ANXIETY, DEPRESSION, PTSD, ADHD, MANIA/HYPOMANIA, JUST AS AN EXAMPLE OF SOME OF THE MODULES. WE DO THAT AT BASELINE WHEN THEY REGISTER AT ENROLLMENT, WE DO IT AT ONE MONTH, TWO MONTHS, THREE MONTHS, FOUR MONTHS, SIX AND NINE MONTHS AND 12 MONTHS. WE'RE AND WHEN PEOPLE'S DATA , WE THEN HAVE A PROCESS AND ALGORITHM FOR TIERING PEOPLE. SO TIER ONE, PEOPLE WITH NO OR MINIMAL SYMPTOMS, TIER TWO WITH MILD OR MODERATE SYMPTOMS, AND THEN TIER THREE WAS SEVERE SYMPTOMS. SO IF YOU THINK ABOUT IT THIS WAY, BASED ON WHAT PEOPLE'S TIER WAS WE COULD GIVE THEM PERSONALIZED RECOMMENDATIONS FOR WHAT THEY NEED NEEDED. SO EVERYONE HAD ACCESS TO A MONTHLY NEWSLETTER ON MENTAL HEALTH TOPICS. WE GAVE MENTAL ILLNESS PROGRAMMING WITH A COORDINATOR, GIVE THEM ADVICE ON SELF-HELP MOBILE APPS, ESPECIALLY FOR THE TIER 1 FOLKS THAT WERE IN TIER 1. THEN PEOPLE WOULD ALSO GET EMAIL OR PHONE COACHING AROUND ACTIVATING AND USING THE RESOURCES THAT WERE IN THE PROGRAM. WE TRAINED ALL OF OUR STAFF IN MOTIVATIONAL INTERVIEWING BY A CERTIFIED MOTIVATIONAL TRAININGER SO ALL TRAININGER SO OUR COORDINATORS KNEW HOW TO TALK TO PEOPLE ABOUT ACTIVATING AND MAKING BEHAVIOR CHANGE IN ENGAGING WITH THE SELF HELP APPS, LIVE ONLINE, MINDFULNESS PROGRAMS, AND WE MADE IT AVAILABLE FOR ANYONE IN THE PROGRAM TO JOIN A FREE MINDFULNESS COURSE THAT WAS AVAILABLE. WE HAD THINGS LIKE MBSR, STRESS REDUCTION, COGNITIVE THERAPY FOR RESILIENCE, MINDFULNESS TRAINING FOR LIVING WELL, AND FOR SELF COMPASSION GROUPS. FOR THOSE WHO WERE IN TIER IT OR TIER 3, THERE WAS AN OPPORTUNITY TO MEET AND DO A PHONE OR VIDEO CHECK-IN WITH A MENTAL WELLNESS SPECIALIST WHO WAS A CLINICIAN, CLINICALLY TRAINED CLINICIAN WHO COULD DO A BRIEF TRIAGE AND ASSESSMENT AND EVALUATE WHETHER OR NOT PEOPLE NEEDED A HIGHER LEVEL OF CARE OR NOT. AND SO THEY WERE ABLE TO THEN MAKE REFERRALS TO ADDITIONAL CLINICAL CARE AS NEEDED. IT IMPORTANT TO SAY THAT DURING THIS TIME OVER COVID, OUR WAIT LIST OUTPATIENT CARE WAS IN THE THOUSANDS. AS FAR AS PEOPLE SEEKING MENTAL HEALTHCARE. SO THE IDEA THAT PEOPLE COULD BE ABLE TO ASSESS RAPIDLY IN THIS AUTOMATED WAY AND BE ABLE TO GET TRIAGE TO PEOPLE THAT REALLY NEED SUPPORT RIGHT AWAY WAS REALLY A GREAT PART OF THIS PROGRAM. SO NEXT SLIDE, PLEASE. THIS BASELINE STARTED IN APRIL, SO ABOUT THREE WEEKS AFTER THE COVID LOCK DOWNS STARTED HERE IN BOSTON. WE MOVED QUICKLY, IN ABOUT 10 DAYS, AND STARTED A QUALITY IMPROVEMENT PROJECT WHERE WE STARTED MINDWELL WITH CAT-MH AND WE GOT ANXIETY AND DEPRESSION SCORES FOR EIGHT WEEKS IN A ROW AND EVERYBODY IN THIS CASE WAS ENROLLED OR OFFERED TO ENROLL IN THE MINDFULNESS BASED COGNITIVE THERAPY PROGRAM. AND YOU CAN SEE HERE THAT EVEN IN THAT VERY FIRST ITERATION, WE SAW A 41% REDUCTION IN ANXIE%Y AND 34% REDUCTION IN DEPRESSIVE SYMPTOMS DURING THIS HEART OF THE COVID LOCKDOWN. WHICH SUGGESTED THAT WE WERE ON TO SOMETHING AND WE REALLY SHOULD PURSUE THIS FURTHER. WHAT WE BUILT, WE HAD THIS IDEA IN ORDER FOR TO BE REALLY IMPACTFUL FOR US AND OTHER HEALTHCARE SYSTEMS EVENTUALLY, WE WANTED TO BE ABLE TO INTEGRATE THIS TESTING DEVELOPED BY ADAPTIVE TESTING TECHNOLOGIES THROUGH AN FBR GRANT WITH NIMH. WE WANTED TO BE ABLE TO INTEGRATE THIS INTO RED CAP. THERE WAS BEGINNING TO BE CODE AROUND AN EXTERNAL MODULE THAT WAS DEVELOPED AT VANDERBILT IN A PROGRAM WITH CARL REID, SO WE STARTED WORKING WITH CARL TO GIVE US HIGH LEVELS OF PROCESSING TO BE ABLE TO GET PEOPLE'S SEVERITY, RESPONSES TO BE ABLE TO SEE WHAT CATEGORY THEY'RE IN AND THEN BE ABLE TO TIER THEM AND THEN SCHEDULE THEM FOR APPOINTMENTS IF NEEDED OR MOVE THEM ALONG. YOU CAN SEE HERE THIS IS JUST AN EXAMPLE TEST HOW FOR EACH DIFFERENT TYPE OF ASPECT OF MENTAL WELLNESS, DEPRESSION, ANXIETY, MANIA, SUBSTANCE USE, PSYCHOSIS, ADD AND SOCIAL DETERMINANTS OF HEALTH, WE WERE ABLE TO GET A HIGH PRECISION SCORE AND ASSESS THEIR TIER LEVEL. THIS EXTERNAL MODULE ACTUALLY IS AVAILABLE ON GITHUB IF YOU WANT TO BRING THIS INTO YOUR OWN RED CAP DATABASE. SO WE GOT READY, WE DID FOCUS GROUPS WITH THE NEW SYSTEM THAT WAS MORE AUTOMATED USING RED CAP IN THE SUMMER AND FALL OF 2020 , AND THEN WE SUBMITTED NIH SUPPLEMENT TO ANOTHER R33 GRANT, AND WE WERE WAITING FOR THAT AND I WANT TO EXPRESS MY GRATITUDE TOLY TO LENNAE, ROBYN AND WEN DEEP THROUGH CHAOTIC TIMES TO HELPING MOVE THIS PROJECT ALONG. SO FINALLY IT WAS APPROVED FOR -- IN EARLY FALL. UNFORTUNATELY -- WE WANTED TO PUT AN RTC TO LOOK AT THE DIFFERENCES OF HOW RANDOMIZED PEOPLE TO DIFFERENT ARMS AND INTERVENTIONS WOULD WORK AND THERE WERE SUBSTANTIAL COVID DELAYS. THE MINDWELL-READ CAP STARTED IN 2020, AND IN DECEMBER AND I HAVE TO SAY IT WAS AN INCREDIBLY DIFFICULT TIME WITH THESE BUILDING LEVELS, RACIAL STRESS, POLITICAL POLARIZATION. SO IN EARLY JANUARY, WE ACTUALLY HAD TO STOP OUR IMPLEMENTATION FOCUS ON MAINTAINING STAFF AND THE STAFF'S MENTAL WELLNESS DURING THE COLLECTIVE DIFFICULTIES THAT ARE HAPPENING IN EARLY JANUARY, AND THROUGH MID MARCH AND FINALLY WE'RE ABLE TO GET IRB APPROVALS AND CHANGE IN STAFF ON THE IRB SO WE MOVE FORWARD. I THINK OF THIS AS REALLY PUTTING OUR MASKS ON FIRST TO DEAL WITH ALL THE INTERNAL IMPACTS, EVERYTHING THAT WAS GOING ON AND STABILIZE THEIR SYSTEM. SO EVEN TAKING THAT TIME TO STABILIZE OURSELVES DIDN'T REALLY PREPARE US FOR WHAT WASSING WHAT WHAT WAS ABOUT TO COME. WHEN WE FINALLY REALLY OPENED THE GATES WIDE TO BE ABLE TO ALLOW PEOPLE TO START ENROLLING FOR CHAMINDWELL, WE GOT 200 ENROLLMENTS LITERALLY IN 24 HOURS. AND OUR SYSTEM WAS DESIGNED TO HAVE 20 TO 30 A WEEK. SO WE NEED LE HAD TO SHUT DOWN T DOWN THE PROGRAM AGAIN AND SHUT THE DOOR BECAUSE THE NEEDS WERE SO INTENSE. AFTER A MONTH OR TWO OF REORGANIZING, WE OPENED AGAIN AND YOU CAN SEE AGAIN JUNE THROUGH SEPTEMBER, VERY QUICKLY THE POPULATION STRESS EVEN AFTER THE COVID WAVE HAD PASSED IN JANUARY AND FEBRUARY WAS STILL VERY MUCH THERE FOR THE SUMMER. AND WE ACTUALLY HAD TO CLOSE AND LIMIT ENROLLMENT AGAIN BECAUSE OF THE INTENSITY. WE OPENED UP AGAIN IN OCTOBER AND WE'VE BEEN ABLE TO MAINTAIN A PRETTY STEADY FLOW SINCE THEN. SO WE WERE FUNDED TO RUN A RCT WITHIN THE CONTEXT OF THE CHAMINDWELL IMPLEMENTATION PROJECT. AND IT WAS COMPARATIVE EFFECTIVENESS RCT COMPARING COGNITIVE BASED THERAPY PLUS THE MINDWELL MONITORING AND COACHING VERSUS INTERNET CBT WHERE WE USED THE SIX WEEK ASYNCHRONOUS MOOD GYM CURRICULUM AS OUR ACTIVE CONTROL GROUP, AND THEN WE ALSO HAD AS ANOTHER CONTROL ARM JUST CHAMINDWELL ALONE. SPECIFICALLY WE WERE LOOKING AT THE PRIMARY OUTCOMES, LEVELS OF DEPRESSIVE SYMPTOMS, AT 24 WEEKS, SUBSTANCE USE, AND UTILIZATION OF TELEVISITS DURING THIS TIME. THIS WAS THE STUDY FORMAT, RANDOMIZING TO THREE DIFFERENT ARMS. WE CONTINUE TO DO CAT-MH EVERY FOUR WEEKS THROUGHOUT THE STUDY. WE ALSO HAD A SALIVARY SUBSTUDY WHERE WE WANTED TO LOOK AT THE RELATIONSHIP BETWEEN DAILY STRESS AND AFFECT AS RECORDED ON AFFECT DIARIES THAT WERE DEVELOPED AT PENN STATE UNIVERSITY. AND WE WERE LOOKING AT DIFFERENT TYPES OF STRESS INCLUDING STRESS RELATED TO COVID-19. AND THEN TO LOOK AT THE RELATIONSHIP BETWEEN STRESS AND POSITIVE AND NEGATIVE AFFECT DAYS WITH ESPECIALLY IL-6, INTERLEUKIN-6, WHICH HAS BEEN DEMONSTRATED TO BE LINKED -- OR ASSOCIATED WITH DEPRESSION AND THERE'S SOME PRELIMINARY DATA SUGGESTING THAT IT MAY BE NEGATIVELY ASSOCIATED WITH POSITIVE AFFECT. SO WE'RE PLANNING TO GATHER THAT'S DATA BEFORE AND AFTER THE INTERVENTION PERIOD OF THE FIRST EIGHT WEEKS. UNFORTUNATELY SALIVA BECAME CLASSIFIED AS A CATEGORY B SUBSTANCE DUE TO COVID-19 AS WE WERE GETTING READY TO LAUNCH THE STUDY, SO WE ACTUALLY HAD TO GO THROUGH MULTIPLE LAYERS OF SAFETY REVIEW SO WE WEREN'T ABLE TO IMPLEMENT THE SALIVARY STUDY UNTIL HALFWAY THROUGH THE STUDY. SO IT'S ONGOING NOW BUT THAT WAS A LIMITATION OF WORKING IN THIS CON CONTEXT. SO I WANT TO SHARE SOME OF OUR DATA FROM THE MINDWELL PROJECT WHICH IS THIS POPULATION MENTAL WELLNESS PROJECT. WE REALLY ARE FIGHTING AGAINST THE TIDE HERE. IF YOU LOOK AT THOSE YELLOW LINES ON THE LEFT, THOSE ARE THE LEVELS IN 2019 OF ANXIETY DISORDER, DEPRESSIVE DISORDER OR ANXIETY AND DEPRESSION, AND YOU CAN SEE THAT ALTHOUGH THE BIGGEST INCREASE IN ANXIETY AND DEPRESSION HAPPENED BETWEEN JUNE AND DECEMBER 2020, THAT IT HAS NOT GONE BACK TO BASELINE AND, IN FACT, WE STILL ARE ABOUT THREE TIMES THE LEVEL OF ANXIETY/DEPRESSION THAT WE WERE SEEING PRE-PANDEMIC. SO I JUST WANT TO KEEP THAT IN MIND. OUR GOAL WAS JUST TO HOPE THAT WE WERE KEEPING PEOPLE THAT WERE ENROLLED IN OUR POPULATION WELLNESS PROGRAM WITHOUT CHANGE, WITHOUT THIS MASSIVE INCREASE, BUT THE REST OF THE COUNTRY IS EXPERIENCING. THIS IS DATA FROM OUR FIRST 921 R 921 PATIENTS THAT ENROLLED IN THE PROGRAM. ONE OF THE GOALS WAS THAT WE WOULD HAVE PEOPLE ENROLL IN A WAY THAT WOULD NOT CREATE ANY EQUITY ISSUES OR DISPARITIES. THAT WAS A REALLY IMPORTANT PART OF TESTING OUT THE FEASIBILITY APPROACH GIVEN THAT IT IS INTEGRATING WITH TECHNOLOGY AND WHEN WE STARTED IN THE FIRST YEAR, WE WERE PRIMARILY USING ENGLISH BASED PROGRAMS, ALTHOUGH WE ARE GETTING READY TO LAUNCH A SPANISH BASED PROGRAM AS WELL. AS YOU CAN SEE, THE RACIAL AND ETHNIC BREAKDOWN OF OUR SERVICE AREA IS BASICALLY REFLECTED IN THE PEOPLE WHO COMPLETED MINDWELL. SO THERE WAS NO DISPARITY IN ENROLLMENT AND WHEN WE DO HIGH SCORE ANALYSIS, THERE WAS NO STATISTICALLY SIGNIFICANT DIFFERENCE IN THOSE WHO ALSO COMPLETED. >> ZEV, WE'VE PROBABLY GOT ABOUT TWO OR THREE MINUTES. >> I'LL GO THROUGH THESE LAST ONES PRETTY FAST. IT WAS PRIMARILY MORE FEMALE ENROLLING IN THIS PROGRAM. YOU CAN SEE ANXIETY ON RIGHT ARE PEOPLE WHO HAD TIER TWO OR TIER THREE LEVEL SCORES, AND YOU CAN SEE THAT WE DID HAVE SIGNIFICANT REDUCTION IN ANXIETY SCORES AT BASELINE COMPARED TO THE FOLLOW-UP TIME POINT. IN ANXIETY. IF YOU LOOK AT THE RIGHT AS WELL, YOU CAN SEE FOR ALL PTSD SCORES ESPECIALLY THOSE THAT REACHED A TIER 2 OR TIER 3 LEVEL, WE HAD SIGNIFICANT REDUCTIONS IN PTSD SCORES OVER TIME AND SYMPTOMS, AND -- I'M SORRY, THIS IS DEPRESSION. WE SEE THE SAME THING WITH DEPRESSION. SO SAME PATTERN ACROSS ALL OF THOSE. AND FINALLY WE HAVE -- WE ALSO ARE LOOKING AT MANIA/HYPOMANIA SCORES AND YOU CAN SEE REDUCTIONS ON THE RIGHT AS WELL OVER TIME IN THOSE SCORES. IN ALL FOUR OF THE CATEGORIES THAT WE WERE LOOKING AT, WE TEAD OF THE INCREASES YOU WERE SEEING IN THE REST OF THE POPULATION WE ACTUALLY SAW SIGNIFICANT DEYEASTS, AND DECREASES AND PEOPLE HAD BASICALLY HALF THE ODDS OF STILL BEING IN TIER TWO OR THREE AFTER A THREE TO SIX-MONTH FOLLOW-UP. SO WE DID SEE A LOT OF PEOPLE COMING DOWN IN TIER BECAUSE OF THE INTERVENTION. NEXT SLIDE. I JUST WANT TO SHOW THAT AS I SAID, WE HAD A REAL BACKUP IN OUR INDIVIDUAL THERAPY AND INDIVIDUAL TREATMENT IN OUR SYSTEM, AND SO ONE OF THE THINGS WE LOOKED AT IS WHERE ARE THE REFERRALS GOING TO OUR PROGRAM, AND WE ACTUALLY FOUND THAT MORE THAN MORE THAN HALF WENT TO GROUP-BASED PROGRAMS, WHICH WAS A REALLY GOOD FINDING FOR US FROM A FEASIBILITY STANDPOINT AND BEING ABLE TO DEAL WITH THE MASSIVE MENTAL HEALTH NEEDS OF OUR SYSTEM AND ACTUALLY ONLY 8% OF THE 95 PEOPLE ACTUALLY NEEDED THAT THERAPY, SO THIS PROGRAM IS REALLY HELPING US TO BE ABLE TO GET SOME TREATMENT AND OPPORTUNITIES TO PEOPLE TO TAKE CARE OF THEMSELVES. AND NOT OVERBURDENING THE MENTAL HEALTH SYSTEM. THIS IS OUR CURRENT RESILIENCE STUDY. WE ARE ALMOST AT OUR GOAL OF 120 PEEP 120 PEOPLE ENROLLED. WE HAVE 104 RIGHT NOW AND WE HOPE TO FINISH WITHIN SEVERAL MONTHS OF ENROLLMENT. I THINK JUST GIVEN TIME, I'M GOING TO KEEP GOING BUT WE HAVE ONE TO TWO MORE COHORTS OR GROUPS. I WANT TO SAY THANK YOU, IT REALLY DID TAKE AN ENTIRE TEAM TO BE ABLE TO DO A PROJECT LIKE THIS AT THE POPULATION LEVEL, AND TO BE ABLE TO WORK WITH NOW MORE THAN 100,000 PATIENTS INVOLVED IN THE POPULATION MENTAL WELLNESS PROGRAM. SO I WANT TO THANK EVERYBODY FOR THEIR EFFORTS, AND I WANT TO THANK YOU ALL FOR INVITING ME TO SHARE OUR WORK WITH YOU. >> GREAT. THROUGH SO MUCH, ZEV. THAT'S JUST AN INCREDIBLE AMOUNT OF WORK. AND LIKE YOU SAID, TO LAUNCH THAT IN SEVEN DAYS AND GET THAT UP AND MOVING FOR SUPPORT IS JUST AN AMAZING -- I'M ALREADY STARTING TO SEE QUESTIONS COME THROUGH IN THE CHAT. I ENCOURAGE THAT TO KEEP GOING. I'LL TURN IT OVER TO OUR LAST SPEAKER AND THEN WE'LL OPEN IT UP FOR DISCUSSION. SO OUR NEXT SPEAKER IS DR. JUDY MOSKOWITZ AND SHE'S GOING TO TELL US ABOUT THE FOREST STUDY. >> GREAT. THANK YOU. YES, SO THANK YOU FOR HAVING ME. I'M HAPPY DOING HERE TO TALK ABOUT FOREST, WHICH IS NOT ABOUT NATURE BATHING OR PLANT COMMUNICATION. IT'S A FUNCTION OF -- WE NAME MOST OF OUR STUDIES USING SORT OF BOTANICAL OR PLANT OR FLOWER ACRONYMS. SO FOREST ACTUALLY STANDS FOR FOSTERING OPTIMAL REGULATION OF EMOTION TO PREVENT SECONDARY TRAUMA. SO OUR PROGRAM OF RESEARCH HAS REALLY CENTERED ON THIS MULTICOMPONENT INTERVENTION THAT TEACHES PEOPLE HOW TO HAVE MORE POSITIVE EMOTION ON A DAILY BASIS TO COPE WITH WHATEVER TYPE OF STRESS THEY'RE COPING WITH. SO WE'VE DONE A NUMBER OF TRIALS IN MOSTLY PEOPLE COPING WITH HEALTH-RELATED STRESS, HIGH SCHOOL STUDENTS, SO -- SORT OF RUN THE GAMUT IN SEEING WHETHER WE CAN -- WHEN WE TEACH PEOPLE THESE SKILLS, IF THEY HAVE IMPROVEMENTS AND TR THEIR PSYCHOLOGICAL WELL-BEING AS A RESULT. SO AROUND THE END OF 2019, I GUESS IT WAS SUMMER OF 2019, WE COULD HAVE CONTINUED WITH RANDOMIZED TRIAL AFTER RANDOMIZED TRIAL, EFFICACY TRIAL, EFFECTIVENESS TRIAL. BUT WE WERE REALLY STARTING TO THINK HOW COULD WE -- WE'VE GOT GOOD EVIDENCE THAT THIS WORKS. FOR THE PEOPLE WHO DO IT. SO HOW CAN WE HAVE MORE OF AN IMPACT WITH THIS WORK? AND IN AUGUST OF 2019, I WAS AT THE AMERICAN PSYCHOLOGICAL ASSOCIATION CONFERENCE IN CHICAGO, AND WATCHING ONE OF THEIR MAIN STAGE EVENTS. IT WAS ON GUN VIOLENCE. AND ONE OF THE SPEAKERS WAS EDDIE BOCANEGRA, WHO AT THE TIME WAS THE SENIOR DIRECTOR FOR A PROGRAM CALLED READY CHICAGO. WHICH IS A GUN VIOLENCE PREVENTION AND INTERVENTION PROGRAM WHERE THEY REACH OUT TO MEN AT HIGHEST RISK OF BEING INVOLVED IN GUN VIOLENCE AND BRING THEM IN FOR A 12-MONTH PROGRAM OF COGNITIVE BEHAVIORAL SKILLS, JOB TRAINING, TRANSITIONAL SKILLS, OTHER SORT OF WRAP-AROUND SERVICES. SO I SAW EDDIE SPEAK AND HAD THE OPPORTUNITY TO MEET HIM BACK STAGE, AND I WAS -- YOU KNOW, THAT POINT I WASN'T THINKING ABOUT OUR PROGRAM. I WAS JUST -- I'M A PSYCHOLOGIST, I REALLY THINK WHAT YOU'RE DOING IS AMAZING, HOW CAN I HELP? I'M HERE IN CHICAGO. AND HIS FIRST THOUGHT WAS, WELL, WE'RE DOING THESE COGNITIVE BEHAVIORAL SKILLS, WE COULD USE A PSYCHOLOGIST TO HELP US WITH FIDELITY TO THOSE SKILLS. I WAS LIKE, OH, I'M NOT THAT KIND OF PSYCHOLOGIST. BECAUSE I'M A SOCIAL PSYCHOLOGIST. SO I WAS LIKE, BUT I KNOW PEOPLE, I COULD PROBABLY FIND SOMEONE TO HELP YOU WITH THIS. AND THEN HE SAID WHAT DO YOU DO? AND I WAS LIKE, WELL, I DO THIS POSITIVE EMOTION THING TO HELP PEOPLE COPE WITH STRESS. AND I PROBABLY SAID IT JUST LIKE THAT TOO, BECAUSE I'M ALWAYS VERY WARY OF COMING OFF AS, UR KNOW, JUST BE HAPPY AND IT WILL FIX EVERYTHING NO MATTER HOW SEVERE YOUR STRESS IS. BUT AS SOON AS I DESCRIBED TO HIM A LITTLE BIT, HE IMMEDIATELY SAID, CAN YOU HELP OUR STAFF? THIS IS REALLY CHALLENGING WORK, THERE'S HIGH RATES OF BURNOUT, SECONDARY TRAUMA, REALLY HIGH TURNOVER. COULD THIS PROGRAM POSSIBLY HELP OUR STAFF COPE BETTER WITH THE STRESS OF BEING A FRONT LINE GUN VIOLENCE PREVENTION WORKER? SO WITH MY COLLEAGUES, WE STARTED TALKING WITH -- AT THE DIFFERENT SITES OF READY. READY HAS THREE SITES LOCATED IN SORT OF THE SOUTH AND WEST SIDE OF CHICAGO. SO WE WENT TO SOME OF THEIR MEETINGS, WE PRESENTED SORT OF AN OVERVIEW OF THE PROGRAM, HAD THEM PRACTICE SOME OF THE SKILLS, JUST IN SORT OF A GROUP FORMAT, AND ASKED PEOPLE WHO WAS INTERESTED IN LEARNING MORE ABOUT THIS PROGRAM. SO WE WERE ABLE TO GET SOME -- A SMALL POT OF MONEY TO RUN A PILOT TEST OF THE PROGRAM WHERE WE DO SORT OF A TRAIN THE TRAINERS. BECAUSE THAT WAS OUR FIRST THOUGHT OF A WAY FOR US TO BE ABLE TO IMPLEMENT THIS PROGRAM ACROSS THE REA DI SITES. SO WE CALLED IT PEAs, WHICH IS SORT OF A PLANT, FOR POSITIVE EMOTION AMBASSADORS. WE WORKED WITH ABOUT 15 STAFF MEMBERS FROM ACROSS THE THREE READI SITES AND WENT THROUGH THE PROGRAM WEEK BY WEEK. SO WE GROUPED THE SKILLS INTO FIVE WEEKS OF CONTENT AND A SIXTH WEEK WE RAN SORT OF AS A FOCUS GROUP TO GET FEEDBACK. AND EACH SESSION, WE WOULD TEACH A SKILL OR TWO AND THEN WE WOULD -- THEN THEY WOULD PRACTICE IT DURING THE WEEK, AND WE WOULD ALSO TALK ABOUT ALONG THE WAY HOW MIGHT THIS BE IMPLEMENTED AT READI. BECAUSE IT WAS PRETTY CLEAR TO US WE WEREN'T JUST GOING TO GO IN THERE, DO A PRESENTATION AND SAY GO AHEAD, NOW YOU DO IT. SO WE WALKED THEM THROUGH THE SKILLS. THIS WAS IN THE FALL OF 2020 SO IT WAS ALL ON ZOOM. A LOT OF THINGS GOING ON IN THE WORLD AS WE'VE ALREADY DISCUSSED DURING THE SIX WEEKS WE WERE RUNNING THIS WITH THEM, THE TRIAL FOR THE POLICE WHO SHOT BREONNA TAYLOR, THE VERDICT CAME DOWN FOR THAT. SO WE HAD A LOT OF SORT OF PROCESSING OF THAT AS PART OF THE CLASS BECAUSE YOU CAN'T JUST TALK ABOUT POSITIVE EMOTION, WE HAVE TO TALK ABOUT THE STRESS AND THE NEGATIVE EMOTIONS THAT ARE GOING ON AS WELL. SO WE GOT SOME REALLY GREAT FEEDBACK TO THAT PROGRAM AND TO THE SKILLS, AND HERE ARE TWO OF MY FAVORITES. THE FIRST ONE, I THINK FOR STAFF IT'S ABSOLUTELY NECESSARY AND IMPORTANT BECAUSE YOU CAN HAVE BURNOUT. YOU'RE DEALING WITH NOT JUST THE EMOTIONS OF YOURSELF, BUT OF AN ENTIRE GROUP OF OTHER PEOPLE THAT HAVE A LOT OF THINGS GOING ON WITH THEM. AND YOU HAVE TO TACKLE THAT ON A CONSISTENT BASIS. PEAs, AGAIN IS FLES SAIR . THE QUOTE ON THE RIGHT, WE LIKED IT SO MUCH, WE PUT IT ON THE BACK OF THE JOURNALS WE GAVE THEM AS A THANK YOU FOR PARTICIPATING IN THE GROUP. ONE OF THE PARTICIPANTS SAID, THE USE OF POSITIVE EMOTIONS, IT FEELS ALMOST LIKE GOING OUTSIDE WITH A RAINCOAT. IF YOU GO OUT WITH A SWEATER, YOU GET RAINED ON AND YOUR SHIRT GETS HEAVY, YOU HAVE TO CARRY THAT BURDEN. THE RAINCOAT ALLOWS THAT STUFF TO WASH OFF OF YOU. OFTENTIMES AT READI, WE'RE STANDING IN THE RAIN ALL THE TIME. I FEEL LIKE WE'RE OFTEN THE PEOPLE WHO NEED TO REMEMBER WHY WE'RE HERE AND REMINDING US AND GIVING US TOOLS TO NOT LET THOSE THINGS WEIGH US DOWN. SO WE WERE JUST WRAPPING UP THIS GETTING FEEDBACK AND DOING SOME FOLLOW-UP INTERVIEWS WITH THE POSITIVE EMOTION AMBASSADORS WHEN THIS CALL CAME OUT, THIS R21 R33 FOR FIREARM INJURY AND MORTALITY PREVENTION RESEARCH. WORKING WITH READI CHICAGO, IS NOT SOMETHING I WOULD HAVE EVEN NOTICED BUT IT WAS REALLY CLEAR TO US THAT THIS WAS A GREAT FIT FOR THE WORK THAT WE WERE DOING AND THAT WE WANTED TO CONTINUE TO DO. SO OUR GOAL FORM THIS WAS WE AIM TO ADAPT, IMPLEMENT AND MANUALIZE THE FOREST PROGRAM AND BUILD CAPACITY FOR READI CHICAGO TO SUSTAINABLY ENHANCE RESILIENCE, PREVENT BURNOUT AND REDUCE TURNOVER AMONG FRONT-LINE STAFF WORKING TO PREVENT FIREARM INJURY AND MORTALITY. SO THIS IS A PHASED AWARD. WE ARE ABOUT 8 MONTHS INTO THE R21 PHASE, 8 MONTHS OF THE TWO YEARS. WHERE OUR GOALS ARE TO ADAPT AND FINALIZE THE CONTENT OF THE INTERVENTION. SO WE DON'T REALLY ANTICIPATE THAT THE CORE SKILLS ARE GOING TO CHANGE A LOT. WE DID HAVE FEEDBACK THAT THEY WANTED TO BE MORE TRAUMA-INFORMED AND WE ARE INCORPORATING THAT PERSPECTIVE. SOME OTHER SORT OF CULTURAL TAILORING AND SOME OTHER NEEDED ADAPTATIONS, AND WE'RE GOING TO BE GETTING FEEDBACK THROUGH THIS FIRST TWO YEARS ON WAYS WE CAN IMPROVE THE CONTENT. AND THEN WE'RE ALSO LOOKING TO INFORM STRATEGIES TO IMPLEMENT FOREST AT THE THREE READI SITES BASED OP SYSTEM, ORGANIZATION AND STAFF FACTORS. SO OUR PLAN WAS TO DO SURVEYS, REALLY IMPLEMENTATION SCIENCE KIND OF SURVEYS LOOKING AT THESE CONTEXTUAL FACTORS. WITH THE STAFF, WITH LEADERSHIP AND OTHER KEY STAKEHOLDERS, AND THEN FOLLOWING THAT WE'RE GOING TO DESIGN THE STUDY WE WANT TO DO IN THE THREE-YEAR FOLLOW-UP PHASE IF WE NEED OUR BENCHMARKS. FOR THE FIRST TWO, INCLUDING HOW ARE WE GOING TO EVALUATE IT. AS A PSYCHOLOGIST, WE WANT TO LOOK AT THE WELL-BEING OF THE FRONT LINE WORKERS, WE WANT TO LOOK AT THEIR LEVELS OF BURNOUT. THE LEADERSHIP AT READI IS GOING TO HAVE OTHER THINGS THAT THEY MIGHT BE INTERESTED IN, IN ADDITION TO JUST INDIVIDUAL WELL-BEING. SO WE'RE GOING TO DO SOME INTERVIEWS WITH THOSE KEY STAKEHOLDERS TO FIND OUT WHAT THEY WOULD LIKE TO SEE OUT OF THIS PROGRAM AND HOW WE CAN BEST EVALUATE IT. AND THEN IN THE R33 PHASE, IF WE'RE -- IF WE DO A GOOD JOB IN THE FIRST PART AND WE GET THIS SECOND PHASE, WE WILL DO A LONGITUDINAL STUDY WHERE WE IMPLEMENT THE PROGRAM AT READI, AND THEN WE WANT TO TRY TO FIGURE OUT HOW WE CAN MAKE IT SUSTAINABLE, HOW WE CAN BUILD READI CAPACITY SO THEY CAN CONTINUE WITH IT ONCE THE RESEARCHERS PULL OUT. AND THEN POSSIBLY TO DISSEMINATE TO OTHER GUN VIOLENCE PREVENTION PROGRAMS IN CHICAGO AND OTHER LARGE CITIES. SO WHEN WE RECEIVED OUR FUNDING, THE NORTHWESTERN COMMUNICATIONS OFFICE GOT A CALL FROM SENATOR DICK DURBIN, FROM HIS TEAM, AND THEY WANTED TO -- AND SENATOR DURBIN WAS VERY EXCITED ABOUT THIS, BECAUSE HE'S BEEN A LONG TIME ADVOCATE FOR INCREASING FUNDING FOR GUN VIOLENCE RESEARCH. SO HE WAS VERY EXCITED THAT NORTHWESTERN AND ACTUALLY THE UNIVERSITY OF CHICAGO BOTH RECEIVED A GRANT AT THE SAME TIME TO WORK WITH READI CHICAGO IN DIFFERENT CAPACITIES. SO HERE WE ARE IN OUR PRESS CONFERENCE WITH SENATOR DURBIN. SO IT WAS KIND OF EXCITING. SO THIS IS A TRUE PARTNERSHIP BETWEEN THE RESEARCHERS AT NORTHWESTERN AND THE READI CHICAGO TEAM. WE MEET WEEKLY TO TALK THROUGH VARIOUS ASPECTS OF THE PROGRAM AND TO UNDERSTAND WHAT WE'RE SEEING IN THE DATA. SO I'LL JUST GIVE YOU A LITTLE INSIGHT, WE'RE EIGHT MONTHS IN SO WE'VE JUST COMPLETED THIS FIRST ROUND OF FOCUS GROUPS. INITIALLY WE PLANNED ON DOING SURVEYS, BUT IT WAS REALLY CLEAR TO US AS WE LOOKED AT SOME OF THE IMPLEMENTATION SCIENCE SURVEYS THAT WE NEEDED TO OPEN IT UP MORE AND REALLY LOOK MORE BROADLY AND DO THESE FOCUS GROUPS TO REALLY LOOK AT SORT OF THINGS LIKE WHAT WORKS IN NEW PROGRAMS THAT ARE ROLLED OUT, WHAT DOESN'T WORK, WHAT SHOULD WE AVOID DOING, WHAT WE MIGHT WANT TO DO, AND TO GET VIEWS OF WELLNESS AND HOW READI COULD SUPPORT WELLNESS THROUGH THIS PROGRAM. SO WE DID FIVE FOCUS GROUPS. TWO WITH OUTREACH WORKERS, ONE WITH CREW CHIEFS, ONE WITH COACHES AND MANAGERS SO TO GET A RANGE OF ROLES AND GET THEIR INPUT, AND THE GROUPS WERE VERY DIFFERENT IN THE KINDS OF THINGS THAT THEY WERE TELLING US. SO WE'RE GOING TO AN OPEN CODING PROCESS, THIS IS REALLY MESSY. SO BE GENTLE ON ME. WE'RE NOT THERE YET FIGURING EVERYTHING WE HAVE, BUT I WANTED TO GIVE YOU SOME INSIGHT INTO WHAT WE'RE SEEING. SO GENERALLY, FACILITATORS, BARRIERS, SOME CONTEXTUAL THINGS, AND THEN WE'RE ALSO COLLECTING SUGGESTIONS FOR IMPLEMENTATION. SO IN TERMS OF FACILITATORS, THERE ARE A LOT OF THINGS ABOUT THE CULTURE OF READI THAT REALLY MAKES IT READY TO HAVE A PROGRAM LIKE THIS. SO THEY REALLY HAVE AN ACCEPTANCE OF NEGATIVE EMOTIONS AND THE STRESS OF THE PROGRAM, SO THEY ARE VERY MUCH IN LINE WITH OUR POINT ABOUT OUR PROGRAM IS NOT ABOUT IGNORING THE STRESS OR PRETENDING LIKE NEGATIVE EMOTIONS DON'T EXIST. SO THEY ARE VERY GOOD AT BEING AWARE OF NEGATIVE EMOTIONS. AND THEIR CULTURE REALLY SUPPORTS WELLNESS AND SELF-CARE. I'LL GIVE YOU AN EXAMPLE. SO AS AN EXAMPLE, THE CULTURE SUPPORT, READI WANTS YOU TO BE AT YOUR BEST IN ORDER TO GIVE YOUR BEST. SO SELF-CARE, IN ESSENCE, IS PUSHED TO SAY, HEY, WE'RE SERVING BUT WE DON'T WANT TO SERVE FROM AN EMPTY PLACE. THEN IN TERMS OF BARRIERS, WE GOT A LOT MORE ABOUT BARRIERS BECAUSE WE WERE REALLY ASKING WHEN A PROGRAM DOESN'T WORK, WHY DOESN'T IT WORK? SO WE GOT A LOT OF INFORMATION ON THIS. FACTORS RELATED TO CULTURE, 208 IS THE ADDRESS OF THE LEADERSHIP. SO WE HEARD A LOT ABOUT 208 AND A DISCONNECT BETWEEN 208 AND WHAT'S REALLY GOING ON AT THE SITE, AND THEN BARRIERS ASSOCIATED WITH THE NATURE OF THE WORK. AN EXAMPLE OF THE DISCONNECT BETWEEN THE LEADERSHIP AND THE STAFF. SO WE NEED TO BE AT THE TABLE WHEN PROGRAMMATIC CHANGES ARE BEING MADE SO OUR VOICES CAN BE HEARD. AS OPPOSED TO 208 MAKING THOSE DESIXES AND ROLLING IT DOWN TO US, AT THAT POINT IT'S NOT A SUGGESTION, IT'S SOMETHING THEY'RE GOING TO DO. AND THEN AN EXAMPLE OF SORT OF THE NATURE OF THE WORK AND THE BARRIERS HERE. AND THIS IS ABOUT PERSONAL EXPERIENCES WITH TRAUMA AND HOW THAT PLAYS OUT WHEN YOU'RE DOING THIS KIND OF WORK. SO EVERY DAY WE'RE DEALING WITH TRAUMA, IT'S DIFFERENT FROM YOU GOING TO A CORPORATE JOB AND YOU'RE JUST GOING TO FOCUS ON THAT JOB BUT IF YOU'RE DEALING WITH TRAUMA AT HOME AND THEN YOU HAVE TO COME IN AND TEACH OTHERS HOWL OTHERS HOW TO DEAL WITH TRAUMA, IT CAN WEIGH HEAVILY, AND BLEED INTO WHAT YOU'RE TRYING TO DO. THEN IN TERMS OF CONTEXT, WE CODED EVERY TIME WE SAW SOMETHING ABOUT COVID, THE NATURE OF STRESS AT READI AND THE MEANING AND PURPOSE IN THEIR WORK. I KNOW THIS YEAR ALONE, I THINK WE MAY HAVE LOST TWO OR THREE PARTICIPANTS. WHEN I SAY LOST, I MEAN DIED. OF COURSE IT'S TRAUMATIC AND YOU ATTEND THE FUNERAL BUT BY THE SECOND OR THIRD TIME, IT'S HARD TO HAVE THE STOMACH TO ATTEND SOME OF THOSE FUNERALS ANYMORE. YOUR SPIRIT IS KIND OF A BURNOUT AND PEOPLE START TO DRAW BOUNDARIES, THAT'S START REALLY GETTING TO YOU, YOU CAN SEE THEY'RE DRAWING MORE AND MORE BOUNDARIES TO SOME OF THE THINGS THEY'RE EXPERIENCING THROUGH THE JOB OR EXPERIENCING VICARIOUSLY. AND THEN WE HEARD A LOT ABOUT THE SENSE OF MEANING AND PURPOSE BEHIND THIS WORK. I HAVE ONE JOB AT READI AND THAT'S TO KEEP THESE GUYS ALIVE. THAT'S THE ONLY JOB I HAVE. EVERYTHING ELSE IS WORK. YOU STAND WHAT I THERE IT READI THAT I'VE COME ACROSS THAT IS NOT THERE TO KEEP THESE YOUNG BROTHERS ALIVE. IT'S EXTREMELY DIFFICULT. SO WE'RE IN THE PROCESS OF REFINING AND FINALIZING THESE CODES AND REVISING THE CONTENT OF THE INTERVENTION. WE'RE GOING TO FOLLOW UP WITH MORE IN DEPTH INTERVIEWS ABOUT THE INTERVIEWS AND POSSIBLE IMPLEMENTATION AND WE'RE ALSO GOING TO BE IDENTIFYING AND TRAINING PERSONNEL IF WE'RE GOING TO GO THIS TRAIN THE TRAINERS ROUTE. AND I THINK THAT'S IT. >> YES. WONDERFUL. WELL, THANK YOU ALL SO MUCH. I'M GOING TO STOP SHARING AND BRING US BACK TO OUR SQUARES WHERE WE CAN SEE EVERYBODY. I'M SEEING SOME CLAPS AND SOME APPLAUSE. THE WORK THAT YOU ARE ALL DOING IS JUST REALLY AMAZING, AND SO I'LL OPEN IT UP IF PEOPLE WANT TO ASK QUESTIONS. I DID SEE A COUPLE OF THINGS IN THE CHAT. BUT I DON'T KNOW IF DR. LANGEVIN OR IF YOU WANT TO START OFF, IF YOU'VE GOT QUESTIONS AS WE'RE WAITING FOR OTHERS TO USE THEIR -- RAISE THEIR HAND FUNCTION TO START THE CONVERSATION. >> THANK YOU, WENDY. WOW, THIS WAS REALLY GREAT. I HAD A QUESTION I ASKED IN THE CHAT AND IT GOT ANSWERED, BUT MAYBE I CAN JUST RAISE IT MORE GENERALLY. I'M REALLY CURIOUS ABOUT THIS THING ABOUT HOW -- IS LESS MORE. YOU KNOW, IF YOU SET THE EXPECTATION THAT SOMEBODY IS GOING TO DO A CERTAIN AMOUNT OF PRACTICE EACH DAY OR THEY'RE GOING TO HAVE A CERTAIN -- A GOAL TO SET IN TERMS OF THEIR PRACTICE, IS SETTING A SHORTER, SMALLER, MORE PERHAPS ACHIEVABLE GOAL BOTH MORE REALISTIC BUT ALSO MAYBE EVEN BETTER IN TERMS OF EMPOWERING THE INDIVIDUAL TO DO SOMETHING, IF YOU SET THE GOAL TOO HIGH OR LIKE SAY PRACTICING FOR 30 OR 45 MINUTES A DAY, IS THAT COUNTERPRODUCTIVE? I'M JUST WONDERING, I THINK THIS IS A VERY INTERESTING QUESTION AND I WAS JUST WONDERING IF ANY OF YOU HAVE SORT OF EXAMINED THAT SPECIFICALLY. >> I DON'T KNOW, MICHAEL OR ZEV OR JUDY IF YOU GUYS HAVE THOUGHTS ON THAT? MIKE, WHY DON'T YOU START. >> I'LL KEEP MINE SHORT. AS I MENTIONED IN THE CHAT, I THINK THAT'S EXACTLY RIGHT. I THINK THAT'S SORT OF WHAT WE FOUND IN OUR STUDY. WE NICHE INITIALLY BASED THI- INITIAL 30, 45 MINUTES A DAY OF PRACTICE AND I THINK YOU HIT IT RIGHT ON THE HEAD, A LOT OF FOLKS SAID I CAN'T DO THAT SO I JUST WON'T DO ANYTHING. WE HAVE SOME OF THAT IN OUR DATA WHERE WE HAVE THEM SAY YOU'RE ASKING US TO DO TOO MUCH. SO WE DID DECREASE THAT REQUEST AND WE REVIEWED IT A LITTLE MORE CAREFULLY AT THE BEGINNING OF EACH GROUP. WE HAD THEM SET THEIR OWN PERSONAL GOALS SO INSTEAD OF US TELLING THEM YOU HAVE TO DO THIS AMOUNT, LIKE WHAT'S RIGHT FOR YOU, AND WE ADAPTED THAT THROUGHOUT TREATMENT. AND AGAIN, WE'RE JUST STARTING TO LOOK AT THE DATA. BUT SO FAR WE SUGGESTED WE HAD A MUCH BETTER CONTINUE TO PRACTICE AT SIX MONTHS OUT. >> FUNNY BECAUSE WE USUALLY THINK OF A DOSING EFFECT AS BEING LINEAR, THE MORE YOU DO, THE BETTER IT IS. THIS MAY APPLY TO MORE THAN MINDFULNESS. >> IF I COULD SAY, THERE IS A DOSING EFFECT, AND THE MORE YOU PRACTICE, OFTEN WE SEE CHANGES IN SYMPTOMS AND EVEN IN BRAIN MECHANISMS. BUT, IF IT'S TOO MUCH WHEN YOU'RE STARTING AND YOU'RE OVERWHELMED AND THAT LEADS YOU TO FEEL LIKE YOU'RE SOMEONE WHO CAN'T DO IT, OR TO FEEL BAD ABOUT YOURSELF LIKE SOMETHING IS WRONG WITH YOU, THEN THAT'S TOO MUCH AND THERE WILL BE NO PRACTICE. SO SOME IS GOING TO BE BETTER THAN NONE IN THAT CASE. IN OUR PRIMARY CARE MINDFULNESS STUDY, WE -- WE FOUND THAT WITHIN EIGHT WEEKS, THE EIGHT-WEEK PROGRAM HAD SUBSTANTIAL REDUCTIONS IN ANXIETY, DEPRESSION AND STRESS, BUT BY 24 WEEKS, THE PEOPLE THAT HAD ONE HOUR AND THEN REFERRAL TO COMMUNITY PROGRAMS CAUGHT UP AT LEAST WITHIN THE CONTEXT OF STRESS. WHAT WE DIDN'T SEE WAS THAT THE PEOPLE THAT WENT TO THE 8-WEEK GROUP WERE 2 1/2, 4 TIMES AS LIKELY TO INITIATE A BEHAVIOR CHANGE WITHIN TWO WEEKS, WHICH WASN'T A PRIMARY OUT COME OF THE STUDY. 2 1/2 TO 4 TIMES AS LIKELY AS THE GROUP THAT ONLY GOT AN HOUR OF MINDFULNESS. AND THE CHANGES IN MECHANISMS LIKE EMOTION REGULATION, INTERCEPTIVE AWARENESS AND SELF COMPASSION WERE MUCH LARGER EFFECTS IN THE EIGHT-WEEK GROUP COMPARED TO THE ONE HOUR GROUP. SO I THINK THAT THERE IS A DOSE EFFECT AND IF YOU DON'T TEACH IT IN A MOTIVATIONALLY SALIENT WAY AND YOU DON'T PAY ATTENTION TO WHERE PEOPLE ARE AT, THEN YOU WILL TURN A LOT OF PEOPLE OFF. AND THE WORK WE'VE BEEN DOING WITH ADICKS, WITH OPIATE USE DISORDER, ADDIF MINDFULNESS AND USE WHAT WE CALL AN ASCENDING PRACTICE DOSE LADDER SO WHEN PEOPLE CONSOLIDATE IN THAT 10 MINUTES, THEN THEY CAN GO TO 15 AND THEN WHEN THEY GET TO 15 THEY CAN GO TO 20. BECAUSE THE RISKS IN OPIATE USE DISORDER OF SOMEONE FEELING LIKE THIS WON'T WORK FOR THEM OR I'M NOT GOING TO BE GOOD ENOUGH, AND THEN DROPPING OUT OF TREATMENT, ARE REALLY HIGH. SO WE WANT TO START SLOW AND KIND OF GO WITH THEM. BUT THAT COULD BE SAID FOR NEARLY ANY POPULATION WHERE MINDFULNESS IS NOT SOMETHING THAT THEY'RE ACTIVELY COMING TO AND WHERE MAYBE THERE WAS IMPULSIVITY OR INTENTIONAL CHALLENGES OR JUST REALLY INTENSE STRESS FOR TRAUMA, THAT PEOPLE NEED TO BE ABLE TO GET COACHING AROUND HOW TO BE WITH AND HOW TO BE KIND TO THEMSELVES AROUND, BEFORE THEY ACTUALLY CAN MOVE ON AND DO THE PRACTICE. THIS IS WHY WE'VE BEEN WORKING A LOT AROUND THIS IDEA OF WARM MINDFULNESS OR INTEGRATING SELF COMPASSION AND MINDFULNESS MORE EXPLICITLY BECAUSE ESPECIALLY IN THE U.S., I THINK PEOPLE NEED TO -- NEED TO KNOW HOW TO BE KIND TO THEMSELVES IN ORDER TO THEN BE ABLE TO TOLERATE THAT MAYBE THEY CAN'T DO 30 MINUTES RIGHT AWAY. MAYBE THIS IS HARD. MAYBE I CAN BE OKAY WITH THAT. MAIBL I'M OKAY HOW I AM AND I CAN BE KIND TO MYSELF AND THAT ACTUALLY CAN ALLOW PEOPLE TO THEN STICK WITH THE PRACTICE IN THE LONG TERM. I WON'T SAY ANY MORE. THOSE ARE MY THOUGHTS ON IT. >> WONDERFUL. SO I SEE WE'VE GOT A SEER EAVES HANDS UP. SERIES OF HANDS UP. RICK, I'LL START WITH YOU. >> I'LL JUST CHIME IN. I LOVE THAT QUESTION THAT DR. LANGEVIN POSED ABOUT THE DOSE. WE'VE DONE A CLASS HERE AT THE UNIVERSITY OF MICHIGAN WHERE WE TEACH GRADUATE STUDENTS MINDFULNESS-BASED MEDITATION AS A COURSE FOR JUST ONE SEMESTER, AND WE HAVE THEM MEDITATE FOR JUST FIVE MINUTES A DAY, AND THEN TO DO A SHORT JOURNALING DAILY. THAT'S THE ONLY THING THAT WE REALLY REQUIRE OF THEM, OF THE CLASS. WE HAD THEM THROW AWAY THEIR READING, DON'T THINK ABOUT MAKING A PRESENTATION. WE JUST WANT YOU TO WORK WITH YOUR MIND DURING THE COURSE. AND WE HAD -- WE'VE DONE THIS NOW FOR FOUR SEMESTERS, AND WE HAVE 35 TO 40% REDUCTION IN ANXIETY AND DEPRESSION IN THESE GRADUATE STUDENTS THAT'S CLINICALLY AS WELL AS STATISTICALLY REALLY SIGNIFICANT. SO I DO AGREE THAT A SHORTER DOSE OR LIKE A SHORTER TIME OF MEDITATION CAN REALLY BE EFFECTIVE, ESPECIALLY WHEN YOU'RE LEARNING THE TECHNIQUE & GETTING IT GOING. SO I DO THINK A SMALL DOSE CAN BE HELPFUL. >> KAREN? >> THE ISSUE I WANTED TO RAISE IS SORT OF THE NEXT STEP AFTER THAT. AFTER YOU HAVE ENOUGH OF EXPERIENCE WITH, SAY, MINDFULNESS, THAT YOU RECOGNIZE YOU'RE NOT GOING TO FALL APART, THAT YOUR THOUGHTS DON'T OWN YOU AND ALL THAT SORT OF STUFF, THEN THE QUESTION BECOMES HOW TO TAKE THAT FROM YOUR FIVE MINUTE OR YOUR 10 MINUTE OR YOUR 30 MINUTE EXPERIENCE EVERY MORNING OR WHENEVER YOU DO TO THROUGHOUT THE DAY. IN MY PERSONAL EXPERIENCE AS WELL AS AS A RESEARCHER, THAT PIECE HAS BEEN MUCH HARDER TO FIGURE OUT. I FINALLY JUST STARTED PROGRAMMING MY CELL PHONE TO GO OFF EVERY SO OFTEN AND BEEP AT ME AND IT'S, OH, YES, I PRESENCE MYSELF. BUT I HAVEN'T REALLY READ MUCH ABOUT THAT IN SORT OF A SPECIFIC PROBLEM-SOLVING WAY IN THE RESEARCH LITERATURE, AND I THINK IT WOULD BE FUN TO HEAR YOU GUYS ALL COMMENT ON THAT. >> I CAN SPEAK TO MY THOUGHTS ON THAT. WHEN I WAS DOING SOME WORK WITH THE DEFAULT NETWORK AND THINKING ABOUT INTENTIONAL PATHWAYS AND IT SEEMED TO ME THAT WE TEND TO MIND WANDER WITHIN 6 TO 8 SECONDS OF ANY MOMENT THAT WE ARE ACTUALLY PAYING ATTENTION TO SOMETHING. AND SO I DID A BACK OF THE ENVELOPE KIND OF CALCULATION AT SOME POINT WHERE I THOUGHT ABOUT THAT AND THOUGHT ABOUT HOW MANY MINUTES OF SITTING AND LETTING YOUR MIND WANDER AND COMING BACK AGAIN WOULD TAKE TO BE ABLE TO -- UNTIL THIS KIND OF BECOMES MORE AUTOMATED, AND IN THESE EIGHT-WEEK PROGRAMS, THAT 30 MINUTES A DAY, YOU WOULD DO THAT ABOUT 10,000 TIMES AROUND WEEK SIX. THAT'S A BACK OF THE ENVELOPE KIND OF DISCUSSION, NOT SCIENTIFIC, SO I WANT TO ACKNOWLEDGE THAT AND I'M BRINGING THAT EVEN HERE INTO THAT ADVISORY COUNCIL, BUT I DO THINK THAT THERE IS THIS WHAT'S CALLED CULTIVATION OF MINDFULNESS SO THAT IT'S NOT JUST EFFORTFUL TO TRY TO PAY ATTENTION IN THE MOMENT, WHERE YOU'RE CONSTANTLY REMINDING YOURSELF, BUT WHERE ACTUALLY, I HEAR THIS ALL THE TIME FROM PEOPLE I'VE WORKED WITH, I'M WALKING ACROSS THE STREET AND SLOWLY -- MY BREATH. SOMEWHERE AROUND FOUR, FIVE, SIX WEEKS, THAT'S WHERE I THINK A LOT OF THE EASE STARTS COMING, WHEN PEOPLE ACTUALLY START TO PAY ATTENTION TO THE PRESENT MOMENT, TO THEIR BODY, AND SOMETIMES IT TAKES EVEN LONGER THAN THAT. THAT MAY DEPEND ON MANY DIFFERENT THINGS, BUT THAT'S HOW HE I SEE THESE, WHERE IT CAN START TO COME ON AUTOMATICALLY AND THEN YOU CAN CULTIVATE AND KEEP THAT GOING. BUT IT MAY HAPPEN MORE EASILY, QUICKER, FOR OTHER PEOPLE WITH OTHER TRAINING PATHWAYS. >> JUDY OR MIKE? >> I'D LIKE TO ADD TO THAT. >> I'LL BRIEFLY ADD THAT WE'VE BEEN VERY INTERESTED IN THE DISTINCTION, I GUESS WHAT WE CALL FORMAL VERSUS INFORMAL. WE TEACH THAT IN OUR COURSE OF THE FOUNDATION FIRST AND BUILDING THROUGHOUT THE DAY. I DIDN'T MENTION IN THE TALK, WE HAVE SOME DATA WE LOOKED AT AS WELL OF -- WE -- TO GET A SENSE OF WHEN THEY WERE ENGAGING AND HOW OFTEN IN INFORMAL PRACTICE. SO WE PLAN TO LOOK AT THAT ACTUALLY AS ONE OF OUR GOALS, TO LOOK AT SECONDARY ANALYSIS, WHAT ACCOUNTED FOR MORE POTENTIAL AND MORE LINKS WITH THEIR OUTCOMES, WAS IT FORMAL, INFORMAL OR BOTH. WE'VE DONE THIS IN PREVIOUS STUDIES. IT'S BEEN ABOUT EQUAL, SO THAT INFORMAL PRACTICE, KAREN, BACK TO YOUR QUESTION IS CERTAINLY -- IS SOMETHING BUILDING ON THE FOR MALPRACTICE, WE'VE DONE SOME OF THIS WORK WITH ER PHYSICIANS TO SUGGEST THAT THOSE INFORMAL MOMENTS OF MEDITATION ARE AS IMPORTANT AS GETTING ON THE CUSHION. BUT IT SEEMS LIKE THAT NEEDS TO PRECEDE SORT OF THEN DOING THAT. >> GREAT. THANKS. RONI? >> I JUST WANT TO THANK THE PRESENTERS FOR THESE GREAT PRESENTATIONS AND PROVOKING SO MUCH INTEREST. IT'S EXCITING TO HEAR YOUR WORK. I COMMEND YOU FOR GETTING THROUGH THOSE HARD TIMES AT THE BEGINNING OF THE PAN PANDEMIC. TRYING TO DO THE SAME THINGS IN MINNEAPOLIS, AT THE TIME OF GEORGE FLOOD'S MURDER AS , IT'S JUST INCREDIBLE WHAT YOU WERE ABLE TO ACCOMPLISH. AS WE MOVE FORWARD, A LOT OF PEOPLE CAN FORGET THAT. SO JUST CONGRATULATIONS. I THINK THESE CONVERSATIONS ABOUT DOSE AND HOW IT RELATE TO ADHERENCE AND ENGAGEMENT ARE SO IMPORTANT. I'D LOVE TO SEE ANOTHER SERIES OF PRESENTATIONS ON THAT AT MAYBE THE NEXT COUNCIL MEETING, BECAUSE I THINK IT'S SO CRITICAL. AND I GUESS I HAVE A QUESTION TO THE PRESENTERS. BACK TO THIS DEALING WITH THE TIME OF COVID, FOR THOSE OF YOU THAT WERE CAUGHT MIDSTREAM, HOW DO YOU DEAL WITH THIS IN THE ANALYSIS AND HOW DO YOU -- WHAT DO WE HAVE TO LOOK FORWARD TO IN OUR STATISTICAL ANALYSIS? BECAUSE WE'RE NOT DONE YET. NOT ONLY DID COVID JUST APPEAR, BUT THIS INCREASING STRESS THAT WE'RE SEEING, HOW IS THAT GOING TO AFFECT THINGS? SO I JUST WONDER IF YOU GUYS ARE THINKING ABOUT THAT LOOKING FORWARD, BECAUSE THAT'S SOMETHING THAT'S ON MY MIND A LOT. >> I CAN SPEAK TO THAT A LITTLE BIT WITH OUR OTHER TRIALS. I GUESS THE BLESSING IS THAT WE'RE ALL GOING THROUGH THIS. SO YOUR CONTROL GROUP AND YOUR INTERVENTION ARE GOING THROUGH THIS SAME STRESS AT LEAST WRIT LARGE, AND THEN THERE WILL BE THE NORMAL INDIVIDUAL DIFFERENCE VARIATION AROUND THEIR REACTIONS TO IT. THAT SHOULD WASH OUT ACROSS THE GROUPS. LIKE I SHOWED YOU IN OUR FOCUS GROUPS, WE'RE CODING THE COVID PIECE BECAUSE LIKELY THAT'S STILL GOING TO BE THERE GOING FORWARD AND WE NEED TO KEEP THAT IN MIND IF THEY'RE GOING BACK AND FORTH BETWEEN BEING IN PERSON AND BEING VIRTUAL AND TRYING TO DO THEIR PROGRAM VIRTUALLY AND THE DIFFERENT SITES ARE DOING IT DIFFERENTLY, WHICH IS WHAT WE WERE HEARING, WE NEED TO TAKE THAT INTO ACCOUNT AND AS WE'RE TRYING TO DESIGN A PROGRAM THAT IS GOING TO BE ROLLED OUT DURING COVID, THERE'S JUST NO -- YOU NE OH. UNLESS WE WAIT A DECADE, IT'S STILL GOING TO BE AN ISSUE. >> I THINK, JUDY, YOU BRING UP A REALLY GOOD POINT. I KNOW THIS IS SOMETHING, EARLIER TODAY WE'VE BEEN TALKING ABOUT SOME OF OUR PRAGMATIC TRIALS WE'RE DOING, SOME OF THE COLLABORATORY PROGRAMS, AND BOTH IN THE NIH DOD PAIN MANAGEMENT COLLABORATORY AND IN THE PRAGMATIC TRIALS COLLABORATORY, THEY'RE WORKING WITH A LOT OF THOSE TRIALS TO TRY TO FIND SOME LESSONS AND LOOK AT HOW THEY'RE GOING TO MANAGE THAT STATISTICALLY, SO I DO ANTICIPATE SOME PUBLICATIONS COMING FORWARD AND I'LL LOOK AND SEE IF THERE'S ANYTHING I'LL PUT IN THE CHAT FOR OTHER PUBLICATIONS ABOUT HOW TO HANDLE THIS, AND THE TRIALS THAT WERE MOST DISRUPTED HONESTLY WERE THE STEPPED WEDGE DESIGNS, THOSE RANDOMIZING THE ORDER OF ROLLOUT BECAUSE THE BASE WAS DIFFERENT FOR EVERYBODY. BUT IF YOU HAVE A PARALLEL GROUP DESIGN, YOU SORT OF HAVE A PRE AND A POST OR A PRE AND MID AND POST, DEPENDING ON HOW THINGS WENT, AND SO I THINK A LOT OF OUR BIOSTATISTICIANS ARE LOOKING AT THESE ISSUES AND MAKING SOME RECOMMENDATIONS ACROSS THE TRIAL, SO HOPEFULLY WE'LL GET SOME MORE INFORMATION OUT TO THE BROADER COMMUNITY ABOUT HOW SOME OF THE STUDIES ARE APPROACHING IT. I DON'T KNOW THAT WE HAVE THE ANSWERS, BUT HOW DIFFERENT GROUPS ARE LOOKING AT IT. GREAT QUESTION, RONI. HELEN. >> YES. SO I HAD A COUPLE OF COMMENTS ON THE GRAVITY OF THE INTERVENTIONS. IT'S BEEN STUDIED AND BRIEF INTERVENTIONS DO -- MY STUDY SHOWED THE 11 MINUTE MEDITATION RESULTED IN PROFOUND BIOLOGICAL CHANGES. SO WHAT I'M STRUGGLING WITH IS PATIENT PREFERENCES, AND THOSE ARE RARELY INCLUDED IN THE DESIGNS, AND WE KNOW IF PATIENTS DON'T LIKE AN INTERVENTION, THEY WILL NOT DO IT. SO ADD SHEERNS ENTIRELY DEPENDS ON PATIENT PREFERENCES. AND I THINK THAT'S SOMETHING THAT NEEDS TO BE INTEGRATED INTO THE FUTURE TRIALS. >> I WANT TO SPEAK TO THAT. ONE OF THE THINGS WE'RE TRYING TO DO IS WHEN MINDFULNESS IS ONE OF THE INTERVENTIONS, WE DON'T MENTION IT ANYWHERE IN THE CONSENT OR IN THE MARKETING. WE TRY TO CALL THEM STRESS REDUCTION PROGRAMS OR BEHAVIORAL TRAINING PROGRAMS. WHAT WE'VE FOUND IS THAT IF WE SPECIFICALLY RECRUIT FOR A STUDY SAYING MINDFULNESS IS ONE OF THE THINGS THAT'S BEING TRAINED, IT HAS THE POTENTIAL OF BIASING THE STUDY BECAUSE AS HELEN SAID, PEOPLE ARE COMING AND THEY MAY WANT THAT. SO THAT PRIMARY CARE STUDY THAT I WAS TELLING YOU ABOUT, WHERE THERE WAS A DIFFERENCE BETWEEN ONE HOUR AND 8 WEEKS, THAT WAS A STUDY WHERE PEOPLE KNEW THAT MINDFULNESS WAS WHAT WAS BEING OFFERED. SO IN THAT CONTEXT, WE SAW A CERTAIN AMOUNT OF DROPOUT AND DYSPHORIA AMONG THE FOLKS THAT DIDN'T GET THE 8 WEEK PROGRAM AND ONLY GOT AN HOUR. IN OTHER PROGRAMS THAT WE'RE RUNNING WHERE WE ARE KEEPING IT -- WHERE IT'S A STRESS PROGRAM OR RESILIENCE PROGRAM, I THINK OFTEN PEOPLE SEEM -- WHEN THEY GET RANDOMIZED TO A MINDFULNESS CONDITION OF EIGHT WEEKS AND TWO HOURS A WEEK, SOME PEOPLE KIND OF FEEL OVERWHELMED, I THINK, BY THE IDEA OF IT. AND DIDN'T FEEL LIKE THEY WANTED TO BE DOING THAT KIND OF INTENSIVE TURN TOWARDS THEMSELVES AND THEIR EXPERIENCE. SO JUST SPEAKING TO WHAT HELEN SAID, DIFFERENT PEOPLE WANT DIFFERENT THINGS, AND A SHORT INTERVENTION COULD BE VERY APPROPRIATE IF THAT'S WHAT SOMEBODY WANTS, AND FOR DIFFERENT POPULATIONS, AN INFORMAL PRACTICE, THERE ARE SEVERAL STUDIES SHOWING THAT -- ESPECIALLY WITH ADDICTION, WHERE -- THAT THE INFORMAL PRACTICE SEEMS TO BE CORRELATING WITH OUTCOMES, WHEREAS OTHER POPULATIONS, THE LONGER -- THE LARGER DOSE OF FOR MALPRACTICE MIGHT BE WHAT CORRELATES. SO THAT MAY BE ALSO DIFFERENT PEOPLE AND DIFFERENT POPULATIONS MAY NEED DIFFERENT APPROACHES. >> ABSOLUTELY. WELL, I JUST WANT TO THANK ALL THE SPEAKERS AND HOPEFULLY WE'VE GIVEN YOU AS COUNCIL AN IDEA OF SORT OF DIFFERENT KINDS OF STUDIES CAN BE IMPACTFUL FOR DIFFERENT REASONS. THE REALLY IMPORTANT THINGS THAT, MIKE, YOU LEARNED IN THE FEASIBILITY WORK OF HOW DO WE DO THIS, AND WE NEED TO SHIFT THIS INTERVENTION AROUND AND TAILOR IT, WE NEED TO LOCK THAT DOOR SO PEOPLE FEEL SAFE, YOU KNOW, IS COMPLETELY DIFFERENT THAN A DIFFERENT POPULATION THAT SAYS NEVER LOCK THE DOOR, I NEED TO BE ABLE TO GET OUT. AND SORT OF CUSTOMIZING THAT IS SO IMPORTANT AND HOW WHAT YOU'RE LEARNING HAS INFORMED AND WILL HELP YOU DESIGN THAT FUTURE TRIAL, AND THEN THE IMPORTANCE OF DOING THOSE EFFICACY TESTS YOU'RE DOING, ZEV, AND ACTUALLY UNDERSTANDING WHAT'S THE IMPACT AND THE DIFFERENTIAL IMPACT OF DIFFERENT KINDS OF PROGRAMS, ABSOLUTELY WILL SET US IN, HELP TO INFORM POLICY DECISIONS AND WHAT KINDS OF PROGRAMS DIFFERENT PAYORS WILL MAKE AVAILABLE, IS A COMPLETELY ASYNCHRONOUS CBT PROGRAM, SOMETHING THAT WORKS JUST AS WELL AS AN IN-PERSON DELIVERED SORT OF MBSR TYPE OF PROGRAM THAT'S DONE VIRTUALLY. THOSE QUESTIONS ARE REALLY IMPORTANT TO PAYORS, AND WHO NEEDS WHAT INTERVENTION, I THINK ARE SOME REALLY INTERESTING FUTURE QUESTIONS THAT WE CAN LOOK AT. AND I THINK, JUDY, YOU'RE DOING ALL THIS PREIMPLEMENTATION WORK TO FIGURE OUT HOW DO WE MAKE SURE THAT THIS PROGRAM WE KNOW WORKS IN ONE SETTING, WILL IT WORK FOR THIS PARTICULAR POPULATION, AND MAKE IT SUSTAINABLE, MAKE IT SOMETHING THAT COULD BE SCALED TO DIFFERENT PLACES AND SO IT'S NOT JUST THE EFFICACY STUDY THAT CAN HAVE IMPACT. IT'S ALL OF THESE DIFFERENT STUDIES THAT CAN BE IMPACTFUL AND I THINK THOUGHTFUL DESIGN IN THESE STUDIES AND THINKING THROUGH HOW WAS IT -- WHAT WILL I LEARN FROM THE STUDY AND WHERE WILL IT TAKE ME NEXT AND WHAT WILL BE THE NEXT STEP AFTER THAT, THAT'S OFTEN THE ADVICE I'M GIVEN TO ALL OF YOU AS APPLICANTS, IS THINKING THROUGH, YOU KNOW, DESCRIBING YOUR STUDY FOR THE REVIEWERS IS NOT ONLY WHAT AM I GOING TO DO BUT WHAT WILL I LEARN AND HOW WILL IT INFORM WHAT I WOULD DO NEXT. AND THAT IS REALLY, REALLY HELPFUL IN PUTTING TOGETHER COMPELLING APPLICATIONS AND FOR US AS FUNDERS, COMPELLING APPLICATIONS WHERE WE CAN SEE WHERE THE SCIENCE IS GOING TO LEAD. SO EMILY, I DON'T KNOW IF, R HELENE, IF YOU HAVE ANY CLOSING COMMENTS AS WE WRAP UP. >> I WOULD JUST SAY THE SESSION REALLY MET OUR OBJECTIVE MORE THAN WE EXPECTED. THANK YOU SO MUCH FOR THE WONDERFUL DISCUSSION, AND I'M SURE WE WILL FOLLOW UP WITH ALL OF YOU. THANK YOU. >> OKAY. WE'RE GOING TO MOVE ON TO THE LAST FORMAL PART OF THE OPEN SESSION OF COUNCIL, WHICH IS THREE CONCEPT CLEARANCES THAT WE'RE GOING TO PRESENT. I JUST WANT TO REMIND COUNCIL THAT CONCEPT CLEARANCES ARE SOMETHING THAT PRECEDES THE POSSIBILITY OF DEVELOPING FUNDING OPPORTUNITY ANNOUNCEMENTS, ONE OR MORE, FROM A GIVEN CONCEPT CLEARANCE. SO WE PRESENT THESE QUITE BROADLY, WITHOUT A LOT OF SPECIFICS, BUT IT IS REALLY ABOUT THE CONCEPT ITSELF, AS YOU'LL SEE. SO UP FIRST IS DR. ADAM KUSZAK FROM THE OFFICE OF DIETARY SUPPLEMENTS, AND ADAM, ARE YOU READY TO GO? >> YES, I AM. CAN YOU HEAR ME? >> YES, WE CAN HEAR YOU, AND KELLY IS GETTING YOUR SLIDES READY. >> OKAY. SO YOU'RE GOING TO ADVANCE THEM, KELLY? SO ADAM, WHEN YOU'RE READY FOR THE NEXT SLIDE, JUST SAY NEXT SLIDE, PLEASE. >> PERFECT. GOOD AFTERNOON, EVERYBODY. AS INTRODUCED, EYE ADAM KUSZAK FROM THE OFFICE OF DIETARY SUM. I WANT TO THANK MY COLLEAGUES AT NCCIH FOR THE OPPORTUNITY TO SPEAK WITH YOU TODAY. AND WITH THIS PRESENTATION, THE OFFICE OF DIETARY SUPPLEMENTS IS REQUESTING CONCEPT CLEARANCE FOR REISSUE ANS OF AN ADMINISTRATIVE SUPPLEMENT FUNDING OPPORTUNITY ANNOUNCEMENTS. AND THIS ADMINISTRATIVE SUPPLEMENT FUNDING OPPORTUNITY IS FOR FORMAL VALIDATION STUDIES OF ANALYTICAL METHODS THAT CHARACTERIZE DIETARY SUPPLEMENTS AND NATURAL PRODUCTS. SORE THE OFFICE OF DIETARY SUPPLEMENT AT NIH COORDINATES SEVERAL PROGRAMS AND ACTIVITIES TO FULFILL ITS MISSION TO SUPPORT SCIENTIFIC RESEARCH TO STRENGTHEN OUR UNDERSTANDING OF THE HEALTH EFFECTS OF DIETARY SUPPLEMENTS. THIS FOA IS A COMPONENT OF THE ANALYTICAL METHODS AND REFERENCE MATERIALS PROGRAM WHICH PROMOTES RESOURCE DEVELOPMENT FOR CHEMICAL ANALYSES FOR NATURAL PRODUCTS. AS SUCH, THIS FOA TIES TOGETHER WITH SHARED STRATEGIC GOALS OF NCCIH AND ODS TO ADVANCE RESEARCH RIGOR AND FACILITATE RELIABLE ANALYTICAL METHODS FOR NATURAL PRODUCT RESEARCH. NEXT SLIDE, PLEASE. I'M SORRY. THANK YOU. SO FOR A LITTLE BACKGROUND TO THE FOA, REPLICABLE CHARACTERIZATION OF KEY EXPERIMENTAL RESOURCES AND INTERVENTIONS IS AN IMPORTANT COMPONENT OF EXPERIMENTAL RIGOR AND REPRODUCIBLE RESEARCH. AND ONE OF O DS'S RESPONSES TO THIS NEED IS AN INITIATIVE THAT SUPPORTS VALIDATION STUDIES ON METHODS THAT CHARACTERIZE THE COMPLEX CHEMICAL COMPOSITION OF SUPPLEMENTS AND NATURAL PRODUCTS. THESE FORMAL VALIDATION STUDIES, WHAT THEY DO IS THOROUGHLY DETERMINE AN ANALYTICAL METHODS MEASUREMENT PARAMETERS, SUCH AS ITS ACCURACY, PREVISION, APPLICABILITY, REPEATABILITY, THOSE TYPES OF THINGS. AND THAT CAN BE CRITICAL TO ASSESS METHODS PERFORMANCE PARAMETERS WHEN USING IT TO QUANTIFY THE CHEMICAL CONSTITUENTS, METABOLITES, OR CONTAMINANTS THAT MIGHT BE FOUND IN SUPPLEMENTS OR NATURAL PRODUCT RESEARCH, INTERVENTIONS OR CLINICAL SPECIMENS. SO THE FOA'S CORE PURPOSE IS, THEREFORE, THE PROMOTION OF EXPERIMENTAL REPLICABILITY AND COMPARABILITY, THE ADVANCEMENT OF TOOLS THAT ENABLE NATURAL PRODUCT REAGENT STANDARDIZATION, AND ULTIMATELY INCREASED RESEARCH REPRODUCIBILITY THAT SUPPORTS RESEARCH'S TRANSLATION TO CLINICAL TRIAL INVESTIGATIONS. I'LL BRIEFLY SUMMARIZE HERE SOME OF THE HISTORY AND OUTCOMES OF THE FOA TO DATE, THE PRIOR ISSUANCES. NCCIH HAS BEEN A STRONG PARTNER THROUGHOUT THE HISTORY. IMPORTANTLY, ODS IS NOT REQUESTING FUNDING CONTRIBUTIONS FROM NCCIH OR OUR OTHER IC PARTNERS. FLEURN THE METHOD VALIDATION IS COMPARATIVELY A NICHE AREA FOR RESEARCHERS, AND THIS IS A SMALLER SCALE FUNDING INITIATIVE. BUT 12 OF THE 17 TOTAL AWARDS HAVE BEEN TO NCCIH-FUNDED INVESTIGATORS. THREE OF THE METHODS THAT WERE UNDERGOING VALIDATION, ACTUALLY THAT VALIDATION WAS DONE IN DIRECT SUPPORT OF A CLINICAL TRIAL, AND THERE HAVE BEEN EIGHT FORMAL VALIDATION STUDIES PUBLISHED. I THINK TWO CLICKS OF THE NEXT, ONE MORE, PLEASE. THANK YOU. AS I SAID, THE MAJORITY OF ADMINISTRATIVE SUPPLEMENT AWARDS HAVE BEEN TO NCCIH INVESTIGATORS FOR A TOTAL OF JUST OVER A MILLION IN FUNDING SO FAR, AND THE METHODS THAT WERE SUBJECT TO VALIDATION REALLY THEY'VE BEEN APPLICABLE TO A MIXTURE OF MECHANISTIC AND CLINICAL FOCUSED RESEARCH STUDIES. ALSO NOTABLE IS THAT A MAJORITY OF THE METHODS WERE FOR QUANTIFICATION OF NATURAL PRODUCT METABOLITES IN BIOLOGICAL SAMPLES. SHOWN HERE ARE SOME OF THE SPECIFIC PUBLICATIONS THAT ILLUSTRATE REALLY HOW THIS ADMINISTRATIVE SUPPLEMENT FUNDING HAS HELPED INVESTIGATORS DEMONSTRATE THE PERFORMANCE OF THEIR STATE OF THE ART METHODS. SO FOR EXAMPLE, THERE'S BIGGER CHROMATOGRAPHY MASS SPEC QUANTIFICATION UNDER INVESTIGATION FOR INTERACTION WITH CYTOCHROME 450s, THERE'S GAS CHROMATOGRAPHY MASS SPEC CHARACTERIZATION OF A COMPLEX MIXTURE OF GRAPE SEED FLAVENOLS STUDIES IN MODELS OF STRESS RESILIENCE. THERE ARE OTHER EXAMPLES BUT THE POINT I WANT TO MAKE IS THAT THE FORMAL METHOD VALIDATION STUDIES HERE, THEY HELPED ADD CONFIDENCE TO THE BIOMEDICAL RESEARCH ON THE LINKS BETWEEN THE DIETARY INGREDIENTS, THEIR METABOLITES, MECHANISMS OF ACTION, AND ULTIMATELY HEALTH OUTCOMES. THE LATEST FOA ISSUANCE, THAT ACTUALLY ENDED UP BEING TIME WISE CONCURRENT WITH THAT PERIOD WHERE THE PANDEMIC HAD THE MOST SIGNIFICANT NEGATIVE EFFECTS ON RESEARCH AT THE LAB BENCH, SO WITH CLOSURES AND LIMITED OCCUPANCY. BUT WE HAVE SEEN INTEREST FROM PIs START TO PICK UP AGAIN THIS YEAR. SO THEREFORE, ODS REMAINS COMMITTED TO SUPPORTING THIS APPROACH TO ENHANCING RESEARCH RIGOR AND ADDRESSING STRATEGIC GOALS THAT OVERLAP WITH NCCIH AND OTHER PARTNER ICs AND WE'RE REQUESTING CONCEPT CLEARANCE FOR A REISSUANCE. THE REISSUED FOA IS INTENDED TO CONTINUE ITS FOCUS AND PURPOSE, ALSO LOOKING TO MORE CLEARLY DELINEATE CONSIDERATION OF METABOLOMICS METHODS AND QUALITATIVE APPROACHES FOR IDENTIFICATION AND AUTHENTICATION OF COMPLEX NATURAL PRODUCT PREPARATIONS. AGAIN, THERE CONTINUES TO BE NO BUDGET REQUEST TO NCCIH OR OTHER IC PARTNERS. ODS IS COMMITTED TO FUND THE TOTAL COST OF THESE ADMINISTRATIVE SUPPLEMENTS. AND WITH THAT, I WANT TO SAY THANK YOU TO THE COUNCIL FOR YOUR CONSIDERATION, AND I'M HAPPY TO TAKE ANY QUESTIONS. >> THANK YOU, DR. KUSZAK. ANY QUESTIONS FROM COUNCIL? >> THIS WAS GREAT TO SEE. AS YOU KNOW, I'VE BENEFITED FROM THIS PROGRAM AT THE PAST AND REALLY APPRECIATE ALL YOU'RE DOING ON THE STANDARDIZATION WORK MAKING SURE PEOPLE ARE DOING EFFECTIVE STANDARDIZATION. I WONDERED IF YOU HAVE ANY PARTICULAR FOCUSES MOVING FORWARD ON SPECIFIC BOTANICALS THAT HAVEN'T BEEN LOOKED AT AS MUCH BUT SEEM TO BE IMPORTANT OR IF YOU'RE LEAVING THAT ENTIRELY UP TO THE INVESTIGATORS TO CHOOSE WHAT'S RELEVANT TO THEIR STUDIES? >> YEAH, THANKS, NADJA, FOR THE QUESTION. AND THANK YOU, WE'RE MUCH APPRECIATIVE OF ALL YOUR WORK IN THE AREA. THERE IS NOT A FOCUS ON A PARTICULAR BOTANICAL WITH THE PROGRAM. WE WANT TO HAVE THAT BE OPEN TO THE INVESTIGATOR INITIATED FOCUS AREAS, SO THERE HAVE BEEN, IN THE PAST, EXAMPLES OF THINGS THAT ARE VERY PROMINENT IN TERMS OF USAGE AND THINGS THAT ARE MUCH LOWER IN USE. SO WE WANT TO KEEP THAT OPEN FOR LETTING THE INVESTIGATOR DRIVE THE FOCUS. >> MAKES SENSE. >> ANY OTHER QUESTIONS OR COMMENTS FROM COUNCIL? SEEING AND HEARING NONE, WE'LL GO AHEAD AND VOTE ON THE CONCEPT CLEARANCE. YOU'LL SEE IT ON YOUR SCREEN MOMENTARILY. A POLL QUESTION ASKING YOU TO VOTE. IF YOU VOTE YES, YOU'RE IN CONCURRENCE WITH THE CONCEPT CLEARANCE. IF NO, THEN UROPOSING IT AND YOU CAN ABSTAIN. COUNSELING MEMBERS WHO ARE ELIGIBLE TO VOTE WILL DO SO NOW. AND WE HAVE UNANIMOUS VOTE FOR IN FAVOR OF THIS CONCEPT CLEARANCE. THANK YOU VERY MUCH. DR. KUSZAK. THANK YOU VERY MUCH. FOR YOUR PRESENTATION. >> THANK YOU. THANK YOU, EVERYONE. HAVE A GOOD DAY. >> THANK YOU. WE'LL NOW MOVE TO THE SECOND CONCEPT CLEARANCE, WHICH IS GOING TO BE PRESENTED BY DR. INNA BELFER ON RESEARCH NETWORKS TO PROMOTE INNOVATIVE MECHANISTIC AND TRANSLATIONAL STUDIES OF SICKLE CELL DISEASE PAIN. DR. BELFER? >> THANK YOU, PARTAP. GOOD AFTERNOON, EVERYONE. TODAY I'M VERY EXCITED TO TELL YOU ABOUT THIS NEW INITIATIVE ON INNOVATIVE NETWORKS TO PROMOTE BASIC AND TRANSLATIONAL RESEARCH FOR SICKLE CELL DISEASE. SO WHAT IS THE SICKLE CELL DISEASE PAIN? JUST TO REMIND THAT SICKLE CELL DISEASE IS AN UNDERSTUDIED LIFELONG DISEASE -- MINORITY POPULATIONS IN THE UNITED STATES. THERE IS ABOUT 100,000 OF AFRICAN AMERICANS AND HISPANICS AFFECTED BY SICKLE CELL DISEASE. PAIN IS THE MOST COMMON CLINICAL COMPLICATION OF SICKLE CELL DISEASE. IT IS CHARACTERIZED BY SEVERE ACUTE PAIN EPISODES, ALSO -- PAIN, CHRONIC -- PAIN, IT SPANS FROM CHILDHOOD TO ADULTHOOD AND EVEN AFTER -- FOR SICKLE CELL DISEASE. SEVERE CHRONIC PAIN CONTINUES IN ABOUT 40% OF INDIVIDUALS. IT HAS -- IN INDIVIDUALS WITH SICKLE CELL DISEASE, HIGH RATE OF HOSPITALIZATIONS AND MISSED SCHOOL AND WORK DAYS AND POOR FUNCTIONAL AND PSYCHOSOCIAL OUTCOMES, AS WELL AS INCREASED RATE OF MORTALITY. THE MANAGEMENT OF SICKLE CELL DISEASE PAIN IS COMPLEX AND OFTEN DOESN'T ADDRESS MULTIPLE COMORBIDITIES SUCH AS ANXIETY, STRESS -- AND ORGAN DAMAGE, AND ADDED COMPLICATIONS OF THE SICKLE CELL DISEASE. TO BETTER UNDERSTAND CURRENT STATUS AND POTENTIAL FUTURE DIRECTION OF SICKLE CELL DISEASE PAIN RESEARCH AND PAIN MANAGEMENT, NCCIH IN COLLABORATION WITH HEART LUNG AND BLOOD INSTITUTE, CO-LED -- VIRTUAL WORKSHOP LAST YEAR. -- SUBJECTS INCLUDING EXPLORING CRITICAL GAPS, RESEARCH CHALLENGES AND BRAINSTORMING OF POTENTIAL SOLUTIONS FOR THIS IMROASLY UNDER DID GROSSLY UNDERSTUDIED CONDITION IN A HIGHLY UNDERSERVED POPULATION. WE KNOW MUCH ABOUT SICKLE CELL DISEASE AS A GENETIC DISEASE WITH WELL-KNOWN GENETIC MUTATION S BOTH IN VARIOUS LEVELS OF RED BLOOD CELL AND CELL SICKLING, ESTABLISH UNDERSTANDING OF UNDERLYING -- HOWEVER, WE DON'T HAVE THIS EXTENT OF KNOWLEDGE ABOUT SICKLE CELL DISEASE CLEANING MECHANISM OF WHICH IT IS STILL POORLY UNDERSTOOD. PATIENTS WITH SICKLE CELL DISEASE DESCRIBE PAIN OFTEN AS DEEP, STABBING, ELECTRICAL, THROBBING, BEATING, SPREADING, OR LIKE BROKEN GLASS IN THEIR VEINS. THERE IS ENORMOUS HETEROGENEITY IN SICKLE CELL DISEASE PAIN POPULATIONS, AS WELL AS WITHIN INDIVIDUAL VARIABILITY. IN ADDITION PAIN TRAJECTORY IN SICKLE CELL DISEASE IS UNIQUE AND COMPLICATED. IT ALWAYS STARTS WITH ACUTE PAIN EPISODES AND THE TYPE OF PAIN MAY CHANGE ACROSS LIFESPAN. IT'S CHARACTERIZE BID MULTIPLE -- PAIN CRISES. MOST PATIENTS DEVELOP CHRONIC PAIN WITH SUDDEN ACUTE PAIN EPISODES AND -- CRISIS ON TOP OF CHRONIC PERSIST AT THE PRESENT TIME PAIN. ON CLINICAL LEVELS, BOTH ACUTE AND CHRONIC IT IS A MULTIORGAN PROBLEM. DUE TO OR DPAN DAMAGE CAUSED BY SICKLE CELL DISEASE, MANY PATIENTS REPORT ACUTE PAIN IN THEIR LIVER, SPLEEN, KIDNEY, INTESTINE, CHEST, -- AND GENERAL TELLS. ALSO THEY HAVE SEVERE HEADACHES AND -- PAIN DUE TO THE STROKE, ACUTE PAIN EPISODES -- VASOOCCLUSIVE CRIES I, BONY INFARCTION AND MULTIORGAN FAILURE. AVASCULAR NECROSIS AND BONY INFARCTION. RECENTLY, SEVERAL STUDIES POINTED MUSCULOSKELETAL PAIN IN PATIENTS WITH SICKLE CELL DISEASE. THIS PAIN IS BELIEVED TO REFLECT ACUTE AND CHRONIC INJURIES TO -- AND BONES. ONE OF THE BIGGEST PROBLEMS DISCUSSED AT THE WORKSHOP IS THAT CLINICAL STATUS OF ORGAN DAMAGE IN SICKLE CELL DISEASE DO NOT -- AND MOST ANIMAL IS IT DUS OF SICKLE CELL PAIN FOCUS ON SKIN, NOT ORGAN IMPACTED IN SICKLE CELL DISEASE PATIENTS. SO FOR EXAMPLE -- ON MUSCLE ACTIVATION CAUSES SICKLE CELL DISEASE PAIN -- THAT IS FOCUSING ON SENSITIZATION OF -- IN SKIN OF -- INTERVENTION STUDY OF THE SICKLE CELL MICE -- WERE ALSO DONE IN SKIN. -- INCLUDE LIMITED OPPORTUNITIES TO INTEGRATE RESEARCH ACROSS MULTIPLE DISCIPLINES, OPPORTUNITIES TO CONNECT SICKLE CELL DISEASE PAIN -- ACCESS FROM OTHER PAIN FIELDS. -- DISSEMINATION OF KNOWLEDGE ON SICKLE CELL DISEASE RESOURCES AND BETWEEN -- CLINICIANS AND PATIENTS, DIVERSION IT AND INCLUSION OF UNDERREPRESENTED --. TO OVERCOME THESE FAILURES -- DEVELOPMENT OF THREE SUCH NETWORKS WITH THE FOLLOWING OBJECTIVES. ONE OBJECTIVE IS TO DEVELOP FRAMEWORK TO ENABLE TRANSLATIONAL AND -- STUDIES. ALSO TO SUPPORT NOVEL TECHNOLOGY SUCH AS HUMANIZE ANIMAL MODELS, NOVEL MUSCLE BONE JOINT -- PAIN MODEL, MECHANISM-BASED PAIN PHENOTYPING, ACCESS TO -- SUCH AS DRGs, LARGE OR MIXED MICROBIOME AND IMAGING STUDY WITH LONGITUDINAL DESIGN TO STUDY DEVELOPMENT AND PROGRESSION OF PAIN. THESE NETWORKS WILL ALSO SUPPORT THE DEVELOPMENT OF INTERVENTIONS SUCH AS NON-ADDICTIVE PHARMACOLOGICAL THERAPIES, COMPLEMENTARY INTERVENTIONS AND -- BECAUSE SICKLE CELL DISEASE IS DEFINITELY A -- FUNCTION PROBLEM. ALSO THESE NETWORKS WILL BRING TOGETHER PEOPLE OF DIFFERENT EXPERTISE SUCH AS HEMATOLOGISTS, ORGAN BIOLOGISTS, PAIN EXPERTS, NEUROSCIENTISTS, PSYCHOLOGISTS, GENETICISTS, MICRO BIOLOGISTS, BEHAVIORAL SCIENTISTS AND CLINICIANS. SPECIFICALLY, THE INITIATIVE WILL ENCOURAGE THOSE GROUPS TO GET TOGETHER FROM VARIOUS DISPLIPS AND DISCIPLINES AND THEY WILL DEVELOP THE PAIN RESEARCH NETWORKS. THIS WILL INVOLVE TRAINING SUCH AS INTENSIVE WORKSHOPS AND SUMMER INSTITUTES OR VISITING SCHOLAR PROGRAMS. MEETING AND CONFERENCES, ALSO SMALL SCALE RESEARCH THAT WOULD SUPPORT, ENABLE AND LAY THE GROUND WORK FOR POTENTIAL TARGETED PROJECTS TO ADDRESS THE PRIORITY AREAS SUCH AS POTENTIAL THERAPEUTIC TARGETS, REVERSE TRANSLATION, BIOMARKERS, MULTIMODAL INTERVENTIONS, AND WHOLE PERSON HEALTH. THIS INITIATIVE IS THE SAME APPROACH THAT WAS SUCCESSFUL WITH OTHER -- PROGRAMS SUCH AS EMOTIONAL WELL-BEING AND FORCE BASE MANIPULATION. THIS APPROACH WOULD AIM TO BRING TOGETHER SCIENTISTS AND SPECIALISTS THAT CURRENTLY DO NOT COLLABORATE AND THE TOPIC OF THE -- JOIN FORCES. AS WITH OTHER SIMILAR INITIATIVES, WE'D HOPE THAT THIS PROGRAM WILL BE SUPPORTED BY OUR NIH PARTNERS, INCLUDING HEART AND LUNG AND BLOOD INSTITUTE, CHILD HEALTH AND DISEASE INSTITUTE, NIDA, NATIONAL INSTITUTE OF MINORITY HEALTH AND HEALTH DISPARITIES AND OTHERS. WITH THIS, I THANK YOU FOR YOUR ATTENTION AND SEEK YOUR APPROVAL AND SUPPORT OF THIS NEW INITIATIVE. AND HAPPY TO ANSWER ANY QUESTIONS. >> THANK YOU, DR. BELFER. QUESTIONS FROM COUNCIL? IF YOU COULD GO BACK TO THE "HOLLYWOOD SQUARES" HERE. THANK YOU. QUESTIONS FROM COUNCIL. OKAY. >> I THINK MAYBE MORE OF A COMMENT RATHER THAN A QUESTION. I THINK SICKLE CELL IS SOMETHING THAT IS WOEFULLY UNDERSTOOD AND WOEFULLY UNDERRESEARCHED. AND I THINK GETTING LARGE GROUPS OF PEOPLE TOGETHER TO COLLABORATE ACROSS MULTIPLE DISCIPLINES IS REALLY, REALLY GREAT. SO I THINK THIS IS A REALLY EXCITING PROPOSAL. >> THANK YOU, DR. COGHILL. OTHER COMMENTS OR QUESTIONS? DR. HARRIS? >> I WOULD SECOND THAT COMMENT FROM DR. COGHILL. I'M ALSO WONDERING IF THERE'S A WAY TO FACILITATE RECRUITMENT OF PATIENTS INTO THESE NETWORKS BECAUSE IT'S VERY DIFFICULT FOR A SINGLE SITE TO BE ABLE TO RECRUIT ENOUGH SICKLE CELL PATIENTS TO WARRANT STUDY, SO A KEY FACTOR IS GOING TO BE RECRUITMENT ACROSS MULTIPLE SITES AND I'M WONDERING HOW MUCH OF THIS INITIATIVE IS GOING TO BE GOING TOWARDS THAT SPECIFICALLY. >> THE PATIENT ENGAGEMENT WILL BE A BIG ASPECT OF THE NETWORKS, AND DEFINITELY NEEDS TO BE ADDRESSED BY THE GROUPS THAT WILL PARTICIPATE IN THIS INITIATIVE. PATIENT ENGAGEMENT AND THE EXPERIENCE WITH WORKING OF THE PATIENTS DEVELOP -- THIS IS DEFINITELY THE EXPERTISE WE'RE LOOKING FOR IN THESE NETWORKS. >> DR. COGHILL, DID YOU HAVE ANOTHER QUESTION? >> YEAH, I'LL JUST SECOND RICK'S THOUGHTS ON THAT IS, I THINK RESEARCH OPPORTUNITIES FOR UNDERREPRESENTED MINORITIES ARE, AGAIN, IT IS CHALLENGING TO REACH OUT, IT'S CHALLENGING TO CONNECT WITH THEM IN AN APPROPRIATE WAY AND THEN HAVING THAT BAKED INTO THE SYSTEM, I THINK IS A REALLY POWERFUL FEATURE, SO I'M REALLY GLAD THAT THAT'S THERE AS WELL. >> THANK YOU, DR. COGHILL. DR. SHERMAN? >> SO I JUST WANT TO OFFER TWO COMMENTS. FIRST, I LOVE THE IDEA OF BUILDING A NETWORK LIKE THIS FOR SUCH A COMPLEX CONDITION AND TRYING TO BRING PEOPLE TOGETHER. I THINK THAT'S FANTASTIC. I ALSO WONDER IF YOU CAN USE THIS AS A MODEL FOR OTHER KINDS OF CONDITIONS THAT MIGHT REQUIRE BRINGING DIFFERENT PEOPLE TOGETHER THAT ARE COMPLICATED LIKE THIS SO THAT WE CAN REALLY FIGURE OUT HOW, AS EFFICIENTLY AS POSSIBLE, TO BUILD THE NETWORKS FOR THESE KINDS OF THINGS, SO I THINK THAT JUST MIGHT BE A POTENTIAL ANCILLARY CONSEQUENCE IF WE'RE PAYING ATTENTION. >> THANK YOU, DR. SHERMAN. DR. EDWARDS, DID YOU WANT TO COMMENT ON DR. SHERMAN'S POINT? >> DID YOU CALL ON ME FOR THAT? >> YES, I JUST WONDERING IF YOU WANTED TO COMMENT ON WHAT DR. SHERMAN WAS SAYING. >> SURE, I'LL JUST SAY, KAREN, WE'VE BEEN REALLY EXPERIMENTING WITH THIS MODEL. THIS IS GOING TO BE -- IF YOU CONCUR, THIS WOULD BE THE THIRD SET OF NETWORKS THAT NCCIH WOULD BE SPONSORING. AS YOU RECALL, WE STARTED OUT WITH EMOTIONAL WELL-BEING NETWORKS, AND BRINGING TOGETHER INVESTIGATORS FROM VARIOUS DISCIPLINES TRYING TO UNDERSTAND THE MECHANISM OF WELL-BEING. AND THEN WE MOVE TO THE FORCE BASE MANIPULATION, WHERE WE'RE BRINGING TOGETHER NEUROSCIENTISTS TO WORK WITH INVESTIGATORS THAT WERE IN THE MANUAL THERAPY FIELD. AND SO WE SEE THIS AS ACTUALLY A FAIRLY ECONOMICAL WAY TO JUMP START THE FIELD. AND THIS PROGRAM THAT RENA IS PRESENTED TO YOU IS CONTINUING THAT PRACTICE. AND I THINK WE'LL HAVE ONE MORE LATER ON THIS AFTERNOON AS WELL. SO WE ARE REALLY SATISFIED AND PLEASED WITH THE PROGRESS THAT THE CURRENT NETWORKS ARE DOING, AND VERY HOPEFUL THAT THIS IS A GOOD MODEL FOR US TO -- >> SURE. THIS IS A LITTLE BIT DIFFERENT BECAUSE IT FOCUSES ON SORT OF MORE OF A DISEASE CONDITION THAT'S ACTUALLY VERY COMPLICATED, SO I THINK THAT WAS THE ANGLE I WAS PICKING THIS UP FROM, BUT YOUR POINT, OF COURSE, IS VERY WELL TAKEN. >> THANKS. >> DR. MEHLING, I SAW YOU POSTED A COMMENT IN THE CHAS. DID YOU WANT CHAT. DID YOU WANT TO FOLLOW UP ON THAT? >> I JUST REVIEWED RECENTLY A GRANT WHERE I LEARNED THERE IS SUPPOSEDLY SOMETHING LIKE A CLINICAL RESEARCH NETWORK ALREADY FOR SICKLE CELL DISEASE. -- INCLUDE NEUROSCIENTISTS BUT I THINK THERE IS A NETWORK OF CLINICS ALREADY NATIONWIDE. >> THANK YOU. >> SICKLE CELL DISEASE FOCUSED NETWORKS. HOWEVER, THEY'RE FOCUSED ON THE DIFFERENT ASPECTS. THE NETWORKS THAT THIS INITIATIVE WOULD SUPPORT WOULD HAVE MULTICOMPONENT WHICH WILL HAVE A CENTER THAT WOULD COORDINATE DIFFERENT CRITICAL -- AND DIFFERENT RESEARCH PROCESS AND DIFFERENT TRAINING PROGRAMS. THESE WOULD BE THE UNIQUE COMPONENTS THAT OTHER SICKLE CELL DISEASE PROGRAMS THAT ARE MORE FOCUSED ON PARTICULAR THERAPIES, AND THEY WOULD BE MISSING THIS COMPONENT OF CROSS DISCIPLINE -- THAT IS ONE OF THE -- OF THIS INITIATIVE. PRIORITIES OF THIS INITIATIVE. >> ANY NICHE QUESTIONS OR COMMENTS, ANYTHING TO ADD BEFORE WE VOTE? OKAY. SEEING NO HANDS UP OR HEARING ANYTHING, I'D LIKE TO GO AHEAD AND LET'S CALL THE VOTE ON THIS. YOU'LL SEE ON YOUR SCREENS THE USUAL THING, IF YOU'RE VOTING YES, YOU'RE FOR APPROVING THE CONCEPT CLEARANCE, NO WOULD BE FOR NOT, OR YOU MAY ABSTAIN. 13 IN FAVOR, ONE ABSTENTION. THANK YOU VERY MUCH, DR. BELFER. FOR THE THIRD CONCEPT FOR TODAY, THIRD AND LAST GOING TO BE PRESENTED BY DR. WEN CHEN, BUILDING CROSS-CUTTING RESEARCH NETWORKS TO PROMOTE MULTIDISCIPLINARY MECHANISTIC STUDIES OF MUSIC AND HEALTH. AND IN THIS CASE, WEN, YOU'RE GOING TO BE SHARING YOUR SCREEN AND PRESENTING YOUR OWN SLIDES. >> ARE YOU LOOKING AT THE RIGHT SLIDE, I HOPE? >> WE GOT THE RIGHT SLIDE BUT YOU'VE GOT YOUR -- YOU'RE NOT IN PRESENTATION MODE. >> OKAY. LET ME TRY TO SWAP THE DISPLAY. IS THIS CORRECT NOW? >> YES, THAT'S PERFECT. >> EXCELLENT. THANK YOU. WELL, GOOD AFTERNOON, EVERYONE. AS A FINAL ACT TODAY, I AM THE CHIEF OF MECHANISTIC RESEARCH BRANCH WITHIN THE DIVISION OF EXTRA RESEARCH AT NCCIH. TODAY I AM PRESENTING A NOVEL CONCEPT RELATED TO BUILDING CROSS-CUTTING RESEARCH NETWORKS TO PROMOTE MULTIDISCIPLINARY MECHANISTIC STUDIES OF MUSIC AND HEALTH. SO TO BEGIN THIS PRESENTATION, I'D LIKE TO HAVE A QUICK REFRESHER ON HISTORY OF THIS TRANS-NIH THANK MUSIC AND HEH INITIATIVES. IT STARTED WITH TWO MUSIC LOVERS, THE FAMOUS U.S. SOPRANO MRS. RENE -- AND OUR BELOVED NIH DIRECTOR FRANCIS COLLINS MANY YEARS AGO IN A SOCIAL EVENT THAT EXPLORED THE IDEA OF MUSIC AND MEDICINE TOGETHER. THE INITIAL CONVERSATION EVENTUALLY LED TO THE FIRST EVER NIH WORKSHOP ON MUSIC AND THE BRAIN, RESEARCH ACROSS THE LIFESPAN, IN JANUARY OF 2017, SLIGHTLY OVER FIVE YEARS AGO. THE KENNEDY CENTER FOR PERFORMING ARTS, NATIONAL ENDOWMENT FOR THE ARTS WHICH IS PART OF THE DEPARTMENT OF EDUCATION AND MUSIC THERAPY PROFESSIONAL AND ADVOCACY GROUPS TO THE NIH TO DISCUSS BASIC MECHANISTIC WAYS THAT MUSIC CAN AFFECT THE BRAIN AS WELL AS MUSIC AND HEALING. THAT WORKSHOP ALSO RESULTED IN A LANDMARK REVIEW ARTICLE PUBLISHED IN NEURON IN 2018 ON MUSIC AND THE BRAIN. MOST IMPORTANTLY THIS NEURON PAPER SUMMARIZES RESEARCH MUSIC IN THE BRAIN SPECIFICALLY IN AREAS OF BASIC MECHANISTIC RESEARCH, TRANSLATIONAL AND CLINICAL RESEARCH METHODS AND OUTCOME AS WELL AS CAPACITY BUILDING AND INFRASTRUCTURE. TO TACKLE THOSE RECOMMENDATIONS, NIH IMMEDIATELY FORMED A TRANS-NIH WORKING GROUP ON MUSIC AND HEALTH. THE GROUP FIRST FOCUSED ON THE TOP TWO TOPICS FROM THE WORKSHOP RECOMMENDATIONS, SUPPORTING BASIC MECHANISTIC RESEARCH AS WELL AS TRANSLATIONAL AND CLINICAL RESEARCH THROUGH A SET OF THREE RFAs UTILIZING THE R61R33, R21 AND R01 FUNDING MECHANISMS. A TOTAL OF 15 AWARDS WERE MADE PHYSICALLY IN 2019 WITH OVER 5 MILLION PER YEAR IN AWARDS. FOR SOME OF YOU WHO WERE AT COUNCIL AT THAT TIME, YOU MAY HAVE ACTUALLY REVIEWED THOSE CONCEPTS AS WELL AS THE FUNDING PLAN FOR THOSE INITIATIVES. AND IN FISCAL YEAR 2020, WE FOLLOWED UP THE INITIAL RFAs WITH ACTUALLY MULTIPLE PROGRAM ANNOUNCEMENTS TO CONTINUE OUR SUPPORT FOR MUSIC AND HEALTH RESEARCH. IN 2021, THE WORKING GROUP LED BY NCCIH -- ORGANIZED THREE HALF DAY WORKSHOPS TO TACKLE THE RECOMMENDATIONS ON METHODS AND OUTCOMES. THE FIRST WORKSHOP LAID THE FOUNDATION BY DEFINING THE BUILDING BLOCKS OF THE MUSIC-BASED INTERVENTIONS. THE SECOND WORKSHOP FOCUSED ON ASSESSING AND MEASURING TARGET ENGAGEMENT, SPECIFICALLY ON MECHANISTIC AND -- OUT COME MEASURES FOR BRAIN DISORDERS OF AGING, AND THE THIRD WORKSHOP WORKED ON RELATING TARGET ENGAGEMENT TO CLINICAL BENEFITS. THE SERIES OF EFFORTS IS SUMMARIZED IN THE MANUSCRIPT CURRENTLY UNDER CONSIDERATION ENTITLED NIH MUSIC-BASED INTERVENTIONS TOOLKIT. THE ONLY CATEGORY OF THE 2017 WORKSHOP RECOMMENDATIONS YET TO BE ADDRESSED IS THE CAPACITY BUILDING AND INFRASTRUCTURE. MORE SPECIFICALLY THROUGH NETWORKS AND COLLABORATIVE STUDIES INVOLVING NEUROSCIENTISTS, MUSIC THERAPISTS, MUSICIANS, BIOMEDICAL, BEHAVIORAL OR SOCIAL SIGH TISES SCIENTISTS AND -- EVIDENCE-BASED BEST PRACTICE. AS YOU HEARD FROM DR. BELFER'S PRESENTATION AS WELL AS DISCUSSION ON A NUMBER OF PRIOR MODELS OF RESEARCH NETWORKS, WE FELT THAT A COLLECTION OF RESEARCH NETWORKS FOCUS ON MUSIC AND HEALTH MAY BE THE BEST APPROACH TO ADDRESS THE SPECIFIC RECOMMENDATION ALIGNED IN THAT NEURON PAPER. CONCEPTUALLY, WE CAN HAVE EACH NETWORK MAY FOCUS ON A SPECIFIC CONDITION SUCH AS PAIN OR ALZHEIMER'S DISEASE OR STROKE OR PARKINSON'S DISEASE OR COULD BE EVEN MENTAL HEALTH DISORDERS, AND TOGETHER THEY WILL ADDRESS SOME COMMON TOPICS RELATED TO MUSIC-BASED INTERVENTIONS AS WELL, ESPECIALLY REGARDING TERMINOLOGIES AND TAXONOMY, FOR EXAMPLE. THIS RESEARCH NETWORKS CAN ACCOMPLISH OBJECTIVES THROUGH MEETINGS, WORKSHOPS, CONFERENCES BOTH VIRTUAL AND IN PERSON, AS WELL AS COLLABORATIVE DISCUSSIONS IN EXCHANGE FOR VISITING SCIENTIST ARRANGEMENTS AS WELL AS TRAINING OPPORTUNITIES, FOR EXA FOR . THE NETWORKS MAY ALSO FUND PILOT RESEARCH PROJECTS THAT WILL FILL UNIQUE GAPS IDENTIFIED TO PREPARE FOR THE NECESSARY PRELIMINARY DATA THAT WILL BE HELPFUL TO THE INVESTIGATORS TO PREPARE COMPETITIVE NIH APPLICATIONS THROUGH THE EXISTING MUSIC AND HEALTH PUBLIC HEALTH ANNOUNCEMENTS AND OTHER FUNDING OPPORTUNITIES. ALSO THE NETWORKS MAY SUSTAIN THE SCIENTIFIC IMPACTS THROUGH PUBLICATIONS OF RESEARCH FRAMEWORK, COMMON TERMINOLOGIES, REVIEWS, AND OTHER BEST PRACTICE, AS WELL AS THE OTHER DISSEMINATION AND OUTREACH STRATEGIES. BUT NETWORK ACTIVITIES AND PILOT PROJECTS TO BE SUPPORTED, WE HOPE, HIGH PRIORITY TOPICS IN THREE GENERAL AREAS, INCLUDING MUSIC INTERVENTION, MECHANISMS AND BIOMARKERS, TECHNOLOGY TOOLS AND MODELS. FOR MUSIC INTERVENTION, WE WILL ENCOURAGE THE RESEARCH NETWORKS TO HELP DEFINE DIFFERENTIATE DIFFERENT TYPES OF MUSIC-BASED INTERVENTIONS, PASSIVE LISTENING OR ACTIVE ENGAGEMENT, TO DEFINE VARIOUS COMPONENTS OF MUSIC AND MUSIC-BASED INTERVENTIONS. THAT'S JUST SOME EXAMPLES. AND FOR THE MECHANISMS AND BIOMARKERS CATEGORY, WE HOPE THE RESEARCH NETWORKS WILL HELP TO SUPPORT EXPLORATION OF INOH HE VAITIVE NEUROMECHANISTIC INSIGHTS RELEVANT TO MUSIC AND THE SPECIFIC HEALTH CONDITION. THAT MAY HELP TO -- AND NOVEL MEASURES TO MUSIC-BASED INTERVENTION AND THE SPECIFIC HEALTH CONDITION OR HELP TO DISCOVERY SPONS OF PREDICTIVE BIOMARKERS, SIGNATURES, PROFILES FOR THIS TYPE OF INTERVENTIONS. AND FOR TECHNOLOGY TOOLS AND MODELS, WE HOPE THEY WILL HELP TO SUPPORT THE DEVELOPMENT OF NOVEL TECHNOLOGIES TO MEASURE MUSIC-BASED INTERVENTIONS OR MONITOR DISEASE-BASED RESPONSES TO MUSIC-BASED INTERVENTIONS THAT MAY HELP TO DEVELOP OR TEST INNOVATIVE ANIMAL MODELS TO STUDY MECHANISMS AND BIOMARKERS OF THOSE TYPE OF INTERVENTIONS OR HELP TO DEVELOP NOVEL COMPUTATIONAL MODELS TO STUDY THE MECHANISMS OF MUSIC OR MUSIC INTERVENTIONS ON SPECIFIC HEALTH CONDITIONS. SO WE HOPE THAT THE RESEARCH NETWORK INITIATIVE WILL BE ABLE TO COMPLETE THE FINAL RECOMMENDATION FROM THAT 2018 NEURON PAPER, IN PARTICULAR, TO OVERCOME IDENTIFIED RESEARCH BARRIERS TO BUILD THE NETWORK AND INFRASTRUCTURE TO ADVANCE THIS VERY IMPORTANT AREA OF SCIENCE. I'M GOING TO PAUSE HERE AND THANK YOU FOR YOUR ATTENTION AND I CERTAINLY HOPE THAT YOU FIND THIS CONCEPT COMPELLING AND WE'RE LOOKING FOR YOUR COMMENTS AND HOPEFULLY YOUR SUPPORT FOR THIS CONCEPT PROPOSAL. THANK YOU, I'M GOING TO PAUSE RIGHT HERE AND MOVE ON TO THE NEXT SLIDE ABOUT QUESTIONS. >> THANK YOU, DR. CHEN. COMMENTS OR QUESTIONS FROM COUNCIL? THERE WE GO. DR. LEF RETS LEF LAVRETS. >> THIS >> THAT'S A VERY GOOD QUESTION, DR. LAVRETSKY. THIS IS SORT OF A RESEARCH NETWORK BUILDING THAT WILL BRING DIFFERENT -- INVESTIGATORS FROM DIFFERENT DISCIPLINES TOGETHER, AND BUILD -- THREE PROJECTS SO THEY CAN GENERATE THE PRELIMINARY DATA THAT WILL HELP THEM TO BE COMPETITIVE FOR R21s, R01s OR EVEN R -- 33. SO WE HAVE THE PREVIOUS INITIATIVE EFFORTS, WE STILL REALIZE THAT THAT'S A VERY CHALLENGING GAP THAT HAS NOT YET TO BE OVERCOME AND THIS SL SORT OF THE FINAL PIECE OF THE PUZZLE WE'RE HOPING TO ADVANCE THE FIELD, SO REALLY SEEDING THOSE PILOT PROJECTS. IT'S NOT QUITE -- WE DON'T REALLY -- NIH OTHERWISE DON'T REALLY QUITE HAVE FUNDING MECHANISMS EXCEPT TO R03, WHICH IS ALSO A SOMEWHAT PROBLEMATIC ON ITS OWN. SO WE FELT THIS WAY, WE CAN REALLY -- THIS KIND OF RESEARCH NETWORKS, WE CAN HELP TO BUILD THAT KIND OF COLLABORATION RESEARCH NETWORKS FOR THE INVESTIGATORS. >> SO WOULDN'T IT BE CRITERIA FOR INVESTIGATORS JOINING THIS NETWORK? IF THEY'RE NOT PROPOSING RESEARCH PROJECTS INITIALLY, HOW WOULD YOU SELECT THEM? >> I HAVE TO BE CAREFUL OF WHAT I'M SAYING HERE. SO LET ME THINK ABOUT HOW TO ANSWER THAT QUESTION. THE PILOT PROJECT COMPONENTS IN THE RESEARCH NETWORKS WHERE I THINK IF THEY CAN DEFINE IN MY LAST SLIDE, THE PRIORITY TOPICS, FOR EXAMPLE, AND THEN REALLY TYPICAL WOULD DO PRETTY BROAD CALL TO -- BEYOND THE ACTUAL INSTITUTIONS THAT'S RECEIVING SUPPORT, SO REALLY PUBLIC CALL FOR COMPETITION TO SUBMIT IDEAS. SO THOSE IDEAS CAN BE FUNDED THROUGH THE RESEARCH NETWORK TO DO THOSE PILOT PROJECTS. DOES THAT ANSWER YOUR QUESTION, I HOPE? >> MORE OR LESS, YES. THANK YOU. >> WEN, LET ME JUST ADD, WHEN WE PULL OUT THOSE CALLS FOR -- YOU KNOW, THOSE MULTIDISCIPLINARY NETWORK, WE ALWAYS HAVE THE SET OF HIGH PRIORITY TOPIC, AND REALLY THE INVESTIGATORS THAT ACTUALLY ARE SUCCESSFUL ARE GROUPS THAT CAN FULLY DEMONSTRATE THE EXPERTISE THAT THEY'RE BRINGING TOGETHER WOULD BE ABLE TO ADDRESS ONE TO THREE OF THOSE HIGH PRIORITY TOPICS. SO IT'S NOT ONLY THROUGH THE PILOT PROJECT, IT'S REALLY THROUGH BRINGING THOSE PARTICIPANTS TOGETHER TO BE ABLE TO CONCEPTUALIZE MORE SCIENTIFIC PROJECT THAT WOULD MOVE THE FIELD FORWARD. AND THAT'S ONE OF THE CRITERIA THAT WE HAVE TO EVALUATE, SUCCESSFUL APPLICATIONS AND SUCH, THE PROPOSAL. >> DR. MEHLING? >> JUST A BRIEF CURIOSITY QUESTION. LIKE MUSIC FOR PARKINSONISM, A MOVEMENT DISEASE, SO MY QUESTION WOULD BE, IS DANCE INCLUDED OR IS IT EXCLUDED FROM THIS KIND OF TOPIC? >> IT DEPENDS. IF DANCE -- WE DO DANCE TO MUSIC SO YES, IT WOULD BE CONSIDERED A MUSIC-BASED INTERVENTION. UNLESS THERE'S NO -- I DON'T KNOW -- THAT WOULDN'T BE CALLED DANCE, I GUESS. >> YOU COULD USE A MET TROA NOME. >> ACTUALLY THAT'S STILL RHYTHM. >> TRUE. THAT'S TRUE. >> IS DRUMMING MUSIC? >> YEAH. >> YES? >> RHYTHM IS A COMPONENT OF MUSIC, AND THAT'S HOW WE HAVE ACTUALLY -- THUS FAR WE WOULD INCLUDE THOSE AS PART OF MUSIC-BASED INTERVENTIONS. >> OKAY. UNLESS THERE ARE ANY OTHER CRITICAL QUESTIONS TO POSE, THEN LET'S GO AHEAD AND VOTE ON THIS CONCEPT CLEARANCE. ON YOUR SCREEN YOU'LL SEE A POLL. VOTING FOR YES MEANS YOU'RE VOTING IN FAVOR OF THE CONCEPT, NO MEANS YOU'RE IN OPPOSITION, AND YOU MAY ABSTAIN. SO IT IS UNANIMOUS VOTE IN FAVOR OF THIS CONCEPT. SO IT CARRIES. THANKS VERY MUCH. THANKS, DR. CHEN. >> THANK YOU. >> SO THE LAST THING ON THE AGENDA IS JUST A REMINDER FOR THE PUBLIC, IF YOU WISH TO MAKE A PUBLIC COMMENT AGAIN, BECAUSE WE'RE DOING THIS VIRTUALLY, PLEASE YOU MAY SUBMIT THOSE COMMENTS IN WRITING, EITHER BY EMAIL OR A HARD COPY WHICH COULD BE MAILED. AGAIN, IT NEEDS TO BE RECEIVED WITHIN 15 DAYS OF THIS MEETING. AND THEN THESE WILL BE SHARED WITH COUNCIL BY OUR ELECTRONIC COUNCIL BOOK. DR. LA VETS KEY, LAVRETS? >> I WAS TRYING TO SUBMIT RFI FOR WHOLE HEALTH AND THE WEBSITE REJECTED MY SUBMISSION. CAN YOU PLEASE CHECK THAT IT'S WORKING? >> WE WILL CHECK THAT. THANK YOU VERY MUCH FOR LETTING US KNOW. YOU'RE IN THE . IN THE ROOM IS DIRECTOR OF THAT WEBSITE SO IT WILL BE TAKEN CARE OF VERY PROMPTLY. THANK YOU VERY MUCH. LET ME JUST ASK IF THERE ARE ANY FINAL COMMENTS BY DRS. EDWARD, SHIRTLIVE OR DR. LANGEVIN? EMMELINE, ANY FINAL COMMENTS FOR COUNCIL? >> I WANT TO THANK EVERYBODY FOR A VERY, VERY EXCITING DAY, AND WE HEARD SOME REALLY GREAT DISCUSSION AND WE'RE VERY GRATEFUL THAT THE HYBRID MEETING ACTUALLY WORKED PRETTY WELL. SO THAT WAS GOOD. THANK YOU. >> THANK YOU, DR. EDWARDS. >> AND I'LL JUST ADD, THANK YOU TO COUNCIL FOR ALL YOUR ENTHUSIASM AND CONSTRUCTIVE FEEDBACK. REALLY I THINK FOR US, VALIDATING WHAT WE'RE DOING AS A CENTER IS REALLY GRATIFYING, SO WITH MUCH GRATITUDE WITH YOU, COUNCILMEMBERS, FOR YOUR ADVICE. I JUST WANT TO PUT A SHOUT OUT TO ALL OUR STAFF WHO REALLY MAKE ALL THIS HAPPEN. IT'S VERY EXCITING TO BE PART OF THIS GROUP AND WORKING WITH BOTH COUNCIL AND WITH OUR STAFF AND WITH THE EXTRAMURAL COMMUNITY, SO THANK YOU SO MUCH. >> THANK YOU. DR. LANGEVIN. >> SO I REALLY LIKED THE COMMENT THAT LORI JUST PUT IN THE CHAT ABOUT WITNESSING THE WHOLE THREAD OF WHOLE PERSON RESEARCH THROUGHOUT THE DAY. YOU KNOW, THE THING THAT AMAZES ME AT EVERY ONE OF THESE COUNCIL SESSIONS IS REALLY A CROSS-SECTIONAL SNAPSHOT AT ONE POINT IN TIME. WHAT YOU'RE SEEING IS THIS ENTIRE ARC WHICH IABLE ONLY NOW BEGINNING TO EXPERIENCE AFTER DURING MY TIME AS NCCIH DIRECTOR. BETWEEN FORMULATING A CONCEPT -- IDENTIFYING THE GAP FIRST OF ALL,, THEN FORMULATING THE CONCEPT AS YOU SAW SOME OF TODAY, AND ISSUING THE FUNDING OPPORTUNITY, WHICH -- THAT'S A LOT OF WORK TOO, THEN RECEIVING AND REVIEWING THE APPLICATION, AND THEN EVENTUALLY ISSUING THE AWARDS. THIS IS A CYCLE THAT LASTS WAY MORE THAN A YEAR ACTUALLY. AND SO IT TAKES A LONG TIME BEFORE YOU CAN THIS CYCLE MANY TIMES. THAT'S WHY WE TRY TO EMBRICATE LOTS OF DIFFERENT THINGS THAT ARE GOING TO FEED ON EACH OTHER SO YOU DON'T HAVE TO WAIT UNTIL ONE CYCLE IS COMPLETELY OVER BEFORE YOU START THE NEXT ONE. SO THIS IS REALLY COMPLICATED AND IT REQUIRES -- I CANNOT SAY ENOUGH ABOUT A FABULOUS TEAM WE HAVE, SO, SO IMPRESSIVE. WHAT YOU WITNESS AS COUNCILMEMBERS, MOSTLY PEOPLE WHO TALK HERE ARE MOSTLY REPRESENTING A PROGRAM, BUT THERE'S ALSO BEHIND ALL OF THAT OBVIOUSLY REVIEW, THERE'S ALL EXTRAMURAL ACTIVITY, THERE'S GRANTS MANAGEMENT, THERE'S OFFICE OF ADMINISTRATIVE OPERATIONS, THERE'S COMMUNICATION, I.T., POLICY, PLANNING EVALUATION. ALL OF THESE PEOPLE ARE REALLY KIND OF WORKING TOGETHER TO MAKE THIS A SMOOTH RUNNING MACHINE. I CAN'T TELL YOU, YOU KNOW, HOW GRATEFUL I AM FOR ALL OF THE HARD WORK THAT EVERYBODY AT NCCIH PUTS TO MAKE ALL OF THIS HAPPEN. AND ESPECIALLY TO OUR IT TEAM TODAY THAT REALLY WENT THROUGH MANY DIFFERENT REHEARSALS TO MAKE SURE THAT -- AND DID PUT A LOT OF THOUGHT AND EFFORT INTO MAKING THIS HYBRID MEETING. AS FAR AS I CAN TELL, WE WOULD LOVE TO HEAR YOUR FEEDBACK FROM WHAT IT WAS LIKE FROM THE ZOOM END OF THINGS. I CAN SAY THAT FROM THE ROOM SIDE, I REALLY FELT DIFFERENT, AND ACTUALLY REALLY NICE COMPARED TO BEING ON -- FOR ME PERSONALLY, I REALLY -- SO I'M REALLY HOPING THAT IF WE DO HAVE AN OPPORTUNITY TO GET TOGETHER IN THE FALL, THAT MANY OF YOU WILL TAKE THE OPPORTUNITY TO DO SO. I REALLY, REALLY WOULD LOVE TO MEET IN PERSON THOSE COUNCILMEMBERS WHO HAVE JOINED US WHILE WE WERE VIRTUAL, AND OF COURSE ALL OUR OLD FRIENDS WE HAD FROM BEFORE. I LOVED BEN'S COMMENTS, ONE OF THE BEST RUN HYBRID MEETINGS. I HAVE TO SAY, I AGREE. I'VE ATTENDED SOME NOT SO GOOD HYBRID MEETINGS RECENTLY, AND I THINK THIS ONE ACTUALLY WENT PRETTY WELL. SO GRATEFUL TO ALL OF YOU, AND YOU'LL BE HEARING, OF COURSE, UPDATES FROM US AS TO WHAT WE'RE GOING TO DO WITH FUTURE MEETINGS. BUT WE WOULD LOVE YOUR INPUT ABOUT HOW YOU FEEL ABOUT THIS, WHETHER YOU WOULD BE EXCITED IN COMING BACK IN PERSON AND WE'LL TRY TO MAKE IT FUN. SO GREAT. ANYWAY, THANK YOU VERY MUCH, EVERYONE. AND I GUESS THAT'S IT. >> SO I'D ALSO JUST LIKE TO EXTEND MY PERSONAL THANKS TO ALL OUR STAFF WHO HAVE MADE THIS MEETING HAPPEN. IT'S AN HONOR TO WORK WITH THEM. AND WE WILL -- IN TERMS OF THE SEPTEMBER MEETING, AGAIN, THE AUGUST MEETING AT COUNCIL, THE CLOSED SESSION ONLY MEETING, THAT WILL BE HELD VIRTUALLY. IT'S THE SEPTEMBER MEETING WHICH WE'RE CONSIDERING HOLDING AS A HYBRID MEETING IN WHICH COUNCILMEMBERS COULD ALSO COME OPTIONALLY. IT WAS NOT A REQUIREMENT THAT COUNCIL WOULD HAVE TO HAVE COME IN PERSON TO THE CONTRARY, BUT IT WOULD BE AB OPTION. NOW THIS OF COURSE IS GOING TO BE CONTINGENT UPON WHETHER IT'S SAFE TO TRAVEL AND ALL THOSE THINGS AND ALL THE THINGS WE KNOW TOO WELL AT THIS POINT AFTER TWO YEARS PLUS OF LIVING WITH COVID. BUT WE WILL COMMUNICATE WITH YOU THIS SUMMER ABOUT OUR BEST 'FESS AS TO WHETHER WE WILL BE ABLE TO HOLD THIS TO IN-PERSON OPTION FOR COUNCILMEMBERS AND IF SO, WE'LL ACTIVATE THE USUAL MACHINERY THAT THOSE OF YOU WHO HAVE BEEN AROUND FOR A FEW YEARS ANYWAY KNOW ABOUT HOW WE MAKE PLANE RESERVATIONS AND HOTEL RESERVATIONS AND GET YOU FED AND FROM THE HOTEL TO HERE AND ALL THOSE KINDS OF THINGS. SO STAY TUNED, AND WE'RE VERY EXCITED ABOUT THE POSSIBILITY AS WELL. AND WITH THAT, THEN I'LL GO AHEAD, WE'LL CONCLUDE THIS MEETING, THE 80TH MEETING OF THE NATIONAL ADVISORY COUNCIL FOR COMPLEMENTARY AND INTEGRATIVE HEALTH. THANK YOU VERY MUCH. IT'S BEEN GREAT BEING WITH YOU ALL DAY, AND I HOPE YOU ALL HAVE A GREAT WEEKEND AS WELL.