>>WELCOME EVERYONE TO THE NATIONAL ADVISORY COUNCIL ON AGING. WE WILL BE -- I JUST HAVE A FEW HOUSEKEEPING ITEMS. SESSION IS BEING RECORDED, FIRST OFF. >> RECORDING IN PROGRESS. >> AND VIDEOCAST TO THE GENERAL PUBLIC. SO, JUST TO KEEP THAT IN MIND. AND I BELIEVE THAT'S ALL WE HAVE TO REPORT AT THE MOMENT. I'LL TURN IT OVER TO DR. HODES. RICHARD? >> THANK YOU, KEN. WELCOME. THIS IS WHERE I WALK UP TO THE PODIUM. AND THE SLIDES COME UP. I'LL GIVE YOU A BRIEF BACKGROUND. YOU'LL SEE IN ADDITION TO THE STATUS REPORT OF WHAT'S NEW, THIS TIME BECAUSE THERE'S SO MANY STAFF WHO HAVE COME ON, WE HAVEN'T HAD A CHANCE TO INTRODUCE THEM IN PERSON. ONCE I'VE GONE THROUGH A FEW ITEMS OF BACKGROUND, WE'LL HAVE DIVISION DIRECTORS INTRODUCE TO YOU SOME OF THE STAFF WHO HAVE COME ON IN THE PAST YEARS. NEXT SLIDE PLEASE. ALWAYS AN IMPORTANT ISSUE AND ALWAYS IN JANUARY, WE'RE IN THE SAME SITUATION OF NOT HAVING AN APPROPRIATION FOR THE CURRENT YEAR, IN THIS CASE FY2022. THIS IS A SUMMARY OF WHERE WE STAND. BACK IN JULY, THE HOUSE PASSED ITS APPROPRIATIONS BILL. IT CALLED FOR NEARLY $49.4 BILLION OVERALL FOR ALL OF NIH. $3 BILLION FOR THE NEW ARPA-H. UNDER THIS LANGUAGE, NIA APPROPRIATION WOULD INCREASE TO $4.3258 BILLION, $200 MILLION FOR ADRD. HERE ARPA IS LOWER, NIA TOTAL IS LOWER, HERE THE NUMBERS, $235 MILLION FOR ADRD RESEARCH, $29 MILLION FOR RESEARCH ON OPIOIDS AND PAIN. AS MANY OF YOU WILL KNOW, THE GOVERNMENT IS CURRENTLY FUNCTIONING UNDER A CONTINUING RESOLUTION TILL FEBRUARY 18 AND HOPE WE HAVE APPROPRIATION. ALTERNATIVE IS CONTINUED FURTHER RESOLUTION. UNDER THE CIRCUMSTANCES, WE'RE FORCED TO BE CONSERVATIVE AND FUNDING LINES, THE DIFFERENCE IS INCREASE $200 MILLION-PLUS FOR THE YEAR WILL MAKE A SUBSTANTIAL DIFFERENCE IN FUNDS AVAILABLE FOR GRANTS AND OTHER MECHANISMS. WITH THESE CONSERVATIVE INTERIM PAYLINES YOU'LL SEE FOR THE GENERAL PAYLINE, IT'S NOT ADRD, FOR THE MOST COMMON APPLICATIONS UNDER $500,000, THE PAYLINE AT THE EIGHTH PERCENTILE AND HOPING FOR INCREASE BUT THIS IS THE INTERIM. WE GIVE ADVANTAGE TO NEW AND EARLY-STAGE INVESTIGATORS, AT THE 11th AND 13th PERCENTILE, AS AS WE'VE BEEN DOING FOR SOME YEARS HAVE HIGHER BAR FOR FUNDING OF MORE EXPENSIVE OVER $500,000 APPLICATIONS. FOR AD ADRD, THE CIRCUMSTANCE IS BETTER. INTERIM PAYLINES 25th PERCENTILE, WITH 28th AND 30, RESPECTIVELY, FOR NEW AND EARLY-STAGE INVESTIGATORS. NEXT SLIDE PLEASE. SIMILAR PAYLINES FOR NON-PERCENTILED APPLICATIONS, A SUBSTANTIAL DIFFERENCE BETWEEN AD/ADRD, PAY LINES FOR PROGRAM PROJECTS, 37, CAREER DEVELOPMENT AT 28, BUT FOR GENERAL LINE SUBSTANTIALLY LOWER, 13th PERCENTILE FOR PROGRAM PROJECTS AND OTHER NIA REVIEWED, 25th FOR FELLOWSHIPS, WE MAKE EFFORT EVEN UNDER INTERIM CONDITIONS, RECOGNIZE THE IMPORTANCE OF OUR EARLY CAREER FELLOWSHIP AND CAREER DEVELOPMENT CATEGORIES. SOME UPDATES. I WANTED TO SHARE WITH YOU IN THE AREA OF ALZHEIMER'S-RELATED DEMENTIA, THIS UPDATED AS OF SOME 365 TRIALS IN ALL THESE CATEGORIES YOU CAN SEE. 72 TRIALS PHARMACOLOGIC INTERVENTION, 120 NON-PHARMACOLOGIC, 155 DEMENTIA CARE AND CAREGIVING. IF YOU LOOK AT WHAT IS LISTED UNDER THESE CATEGORIES, FOR EXAMPLE, IN THE PHARMACOLOGIC INTERVENTIONS NOTABLY EARLY STAGE TRIALS, THE VARIETY OF TARGETS ILLUSTRATING THE COMMITMENT AND SUCCESS IN FUNDING INNOVATIVE APPLICATIONS THAT TARGET MOST POTENTIAL COMPONENTS OF ALZHEIMER'S AND RELATED DEMENTIAS DISEASE PROCESSES. IN TERMS OF COVID-RELATED OPPORTUNITIES HERE WITH NIA PARTICIPATION CURRENTLY ACTIVE, ONE IN NEUROLOGIC SEQUELAE FROM SARS, WE'LL HEAR LET ABOUT LONG-TERM SEQUELAE OF COVID, AND PROJECTS THAT ARE UNDERWAY TO ADDRESS THESE WITH NIA INVOLVEMENT. ANOTHER ON SOCIAL, BEHAVIORAL, ECONOMIC IMPACT OF COVID-19 IN UNDERSERVED AND VULNERABLE POPULATIONS PARTICULARLY. NEXT PLEASE. JUST A COUPLE OF NOTABLE RELEASES HERE, NASEM DECADAL SURVEY, LOOKING AT EFFORTS TO REDUCE THE IMPACT OF DEMENTIA IN AMERICA, SURVEY OF BIOBEHAVIORAL AND SOCIAL SCIENCES, RECOMMENDING THIS TO YOU. LOOKS FOR EMPHASIS ON NOT JUST IDENTIFYING CAUSES BUT SOLUTIONS FOR DISPARITIES. NEXT PLEASE. IN COLLABORATION WITH OTHER AGENCIES, OUR EXTENSIVE AND CONTINUING NOTABLY WITH THE V.A. FOCUSING ON RECRUITMENT OF VETERANS INTO ALZHEIMER'S DISEASE RESEARCH BECAUSE THE IMPORTANCE OF THE POPULATION, GIVEN THE VERY LARGE MEDICAL CARE SERVICES POPULATION UNDER V.A. AEGIS, AN OPPORTUNITY TO INCREASE DIVERSITY OF STUDIES, SUCCESSFUL SO FAR ESTABLISHING THESE COLLABORATIONS WITH MORE TO COME. NEXT PLEASE. AND EACH YEAR I WANT TO REMIND YOU OF THE BUTLER-WILLIAMS COLLEGE PROGRAM, OUTSTANDING MULTI-DAY PROGRAM, ONCE AGAIN TO BE HELD VIRTUALLY THIS SUMMER 2022, APPLICATION DEADLINE SPRING OF 2022, BRINGING TOGETHER PEOPLE AT EARLY STAGES OF THEIR CAREER, TO DISCUSS THE BREADTH OF AGING RESEARCH WITH STRONG EMPHASIS ON HEALTH DISPARITIES RESEARCH. NEXT PLEASE. HAPPY TO NOTE THAT ALZHEIMER'S.GOV, YOU MAY UNDERSTAND TO BE THE DESTINATION FOR DEMENTIA RESOURCE TO BROAD POPULATIONS IS FULLY AVAILABLE. FULLY AVAILABLE IN SPANISH AND WORKING ON OTHER LANGUAGES. TO ILLUSTRATE EFFORTS DISSEMINATING INFORMATION, IN PERSON MEETINGS, WE WOULD PASS AROUND A BOOK, RESEARCH HIGHLIGHTS, BLOGS, ANNOUNCEMENTS, SUMMARY OF THE OPPORTUNITIES WE'VE HAD TO DISCUSS WITH STAKEHOLDERS AND CONGRESSIONAL BRIEFINGS OVER THE PAST MONTHS. NEXT PLEASE. NIH UPDATES, ONE, COMMON FUND INITIATIVE, VERY RELEVANT TO NIA, SEPARATE APPROPRIATION FROM CONGRESS, OVER $500 MILLION, AND IT IS TARGETING RESEARCH THAT SPANS THE INTEREST OF MULTIPLE INSTITUTES AND CENTERS, BROAD AND BOLD, HAS GOALS, AND ONE THAT'S BEEN SPONSORED BY NIA, WITH NCI, CELLULAR SENESCENCE NETWORKS, ONE OF THE MECHANISMS WHICH HAS A STRONG RELEVANCE TO AGING, AGING PROCESSES, SO AWARDS HAVE BEEN MADE TO A VARIETY OF SITES THAT ARE STUDYING CELLULAR SENESCENCE ESTABLISHING OVER MULTIPLE TISSUES IN HUMANS, AND NOW A RELEASE, SOLICITATION FOR APPLICATIONS TO DO SIMILAR IN MOUSE, THE NOTION BEING CROSS-TALK BETWEEN HUMANS ANDS INTERVENTIONS IN A MOUSE MODEL WILL BE EXTENSIVE SO A WAY WE'VE LEVERAGED ACROSS ALL OF NIH OF ONE OF THE MAJOR ASPECTS OF BASIC BIOLOGY OF AGING SUPPORTED HERE AT NIA. NEXT PLEASE. AD ADRD SUMMIT COMING UP, THEMES OF ALZHEIMER'S, RELATED DEMENTIAS, A SERIES OF THREE SUMMITS, THE ALZHEIMER'S RESEARCH SUMMIT, AD/ADRD SUMMIT ON CARE AND SERVICES, THIS IS THE ADRD SUMMIT, WILL BE ORGANIZED BY NINDS WORKING WITH NIA, ROD CORRIVEAU TAKING THE LEAD, ENCOURAGING YOU TO SIGN ON AND REGISTER. THIS WILL BE FULLY VIRTUAL IN LIGHT OF THE CONTINUING PANDEMIC CONSTRAINTS. NEXT PLEASE. A MAJOR EVENT, ANNOUNCEMENT THAT FRANCIS COLLINS STEPPED DOWN. LARRY TABAK, LONG-TERM DEPUTY DIRECTOR IS ACTING DIRECTOR NOW. THIS MEANS REASSURINGLY TO ALL OF US NIH IS FUNCTIONING AND FUNCTIONING WELL WHILE WE AWAIT THE PROCESS FROM THE WHITE HOUSE IN APPOINTING OR NOMINATING THE NEXT DIRECTOR OF NIH. NEXT PLEASE. AND NOW AS I MENTIONED STAFF UPDATES. SORRY WE HAVEN'T BEEN ABLE TO HAVE THESE PEOPLE STAND UP AND SAY A FEW WORDS OVER THE LAST SESSIONS OF OUR COUNCIL MEETINGS BUT INSTEAD GIVEN THE CIRCUMSTANCES WE'RE GOING TO HAVE THE DIVISION DIRECTORS INTRODUCE THE NEW MEMBERS WHO JOINED OUR STAFF. >> RON, DO YOU WANT TO START? >> I'M HERE. JUST A MATTER OF GETTING THE MOUSE TO COOPERATE. THANK YOU. I'D LIKE TO INTRODUCE HEALTH SCIENCE POLICY ANALYST SHOBHAN ADDIE, YOU CAN READ PARTICULARS. BACKGROUND, SHE WORKED WITH ONE OF OUR GRANTEES ON A Ph.D. THESIS ON DNA DAMAGE AND REPAIR, COMES TO US BY WAY OF NEW YORK ACADEMY OF SCIENCES AND NATIONAL ACADEMY OF SCIENCES ENGINEERING AND MEDICINE. DR. KATIYAR, HEALTH SCIENCE SPECIALIST IN SUPPORT OF THE CELLULAR SENESCENCE COMMON FUND NETWORK. AND SHE WAS AT THE NIA OFFICE OF PORTFOLIO ANALYSIS, Ph.D. IN TUMOR BIOLOGY WHICH THEN LED HER TO WORK AT NCI, EXPERIENCE IN PROGRAM FROM NHLBI. LEONIT TSAP, IMAGING AND VISUALIZATION. HIS PROGRAM IS ON EMERGING TECHNOLOGIES AND DEVELOPING TECHNOLOGIES SPECIFICALLY FOR USE IN BIOLOGY OF AGING. DR. COG LIATI COMES FROM ITALY, VIA THE U.K., AND HAS CREDENTIALS IN WORK IN VISUALIZATION, AND VISION AND THE MECHANISMS OF VISUALIZATION, PARTICULARLY IN STEM CELLS AND IN THE DEGENERATION OF THE NERVOUS SYSTEM. SHE ALSO HAS VALUABLE EXPERIENCE IN COMPLEXITIES OF BIOBANKS. JENNIFER FOX COMES TO US FROM NCI DIVISION OF CANCER PREVENTION, SHE HAS SUBSTANTIAL EXPERTISE AS WELL IN DRUG DEVELOPMENT AND APPROVAL PROCESSES. WE ARE ECSTATIC TO HAVE THESE NEW MEMBERS OF OUR DIVISION. THANK YOU. >> NEXT UP, LIZ NEILSEN, DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH. >> HI, EVERYONE. THANK YOU FOR THIS OPPORTUNITY TO INTRODUCE OUR NEW STAFF. WE RECENTLY WELCOMED DR. PETRA JACOBS TO LEAD OUR NEW OFFERS OF BEHAVIORAL AND SOCIAL CLINICAL TRIALS, DR. JACOBS COMES FROM NIDA, SHE HELD A POSITION AT CO-DIRECTOR OF NIDA CENTER FOR CLINICAL TRIALS NETWORK AND SHE HAS EXTENSIVE EXPERIENCE IN BOTH PHARMACOLOGICAL AND BEHAVIORAL TRIALS FOR DRUG ABUSE WHICH SHE NOW WILL BE APPLYING TO OVERSIGHT OF OUR PORTFOLIO OF OVER350 CLINICAL TRIALS THAT WE HAVE AND LEADING OUR CLINICAL TRIALS TEAM IN ADMINISTRATION THOSE GRANTS. WE'RE PLEASED TO WELCOME BACK DR. EMERALD NGUYEN, PROGRAM OFFICIAL, DEGREE IN SOCIALOLOGY, SHE WAS A AAAS FELLOW, HAD BEEN AT NIGMS IN ANALYTICS, SHE WILL BE TAKING OVER A PORTION OF OUR PORTFOLIO ON MACRO SOCIAL TRENDS IN AGING, LIFE COURSE HELD, AD/ADRD. NEXT SLIDE PLEASE. AS I MENTIONED IN OUR BREAKOUT GROUP, A LOT OF THE WORK WE DO IN BSR REALLY DEPENDS ON A TALENTED TEAM OF HEALTH SPECIALISTS AND SOCIAL SCIENCE ANALYSTS THAT ARE THE GLUE THAT ENABLE OUR WORK TO BE COMPLETED, CONDUCTING PORTFOLIO ANALYSES, SUPPORTING THE WORK THAT OUR MANY PROGRAM OFFICERS DO. AS THE DIVISION HAS GROWN, WE HAVE NOW BROUGHT ON BOARD NEW FOLKS TO HELP US WITH THIS REALLY LARGE WORKLOAD. WE'RE EXCITED TO WELCOME REBECCA RICKLIS IN THE INDIVIDUAL BEHAVIORAL PROCESSES BRANCH AS A HEALTH SPECIALIST, REBECCA WAS PREVIOUSLY AT JOHNS HOPKINS SCHOOL OF MEDICINE, AND HAS DONE SOME WORK IN HIV. CHARLES LE JOINED LAST WEEK IN THE POPULATION AND SOCIAL PROCESSES BRANCH, AND HE HAS AN NIH BACKGROUND AT THE CENTER OF SCIENTIFIC REVIEW WHICH WILL SERVE HIM WELL IN WORKING WITH US ON MANY ASPECTS OF INTERFACE BETWEEN PROGRAM AND REVIEW. NEXT SLIDE PLEASE. ADDING TO THE TEAM WE ALSO HAVE NICOLE KIDWILER, ASSISTING STAFF AND PROGRAM ANALYSTS SINCE JOINING FROM TOWSON UNIVERSITY, THE PATHWAYS PROGRAM IS A REALLY TERRIFIC WAY TO BRING YOUNG AND NEW FOLKS INTO THE FEDERAL WORKFORCE SO WE'RE PLEASED TO WELCOME NICOLE TO THE TEAM. AND OUR FINAL SOCIAL SCIENCE ANALYST ALLIE WALKER JOINING FROM OFFICE OF PLANNING RESEARCH AND EVALUATION AT THE ADMINISTRATION FOR CHILDREN AND FAMILIES, AND WILL BE ASSISTING WITH THE OTHER FOLKS IN SUPPORTING PROGRAM IN OUR MULTIPLE SCIENTIFIC ENDEAVORS. SO WELCOME ALL OF THEM AND THANK YOU FOR THE OPPORTUNITY TO INTRODUCE THEM. >> NEXT UP IS DR. ELEAZAR MASNIOF. >> THANK YOU FOR THE OPPORTUNITY. IT'S MY PLEASURE TO INTRODUCE THREE NEW PROGRAM DIRECTORS TO THE DIVISION OF NEUROSCIENCE. FIRST PAUL GROTHAUS. HE WILL BE INTEGRAL PART NOW OF THE TRANSLATIONAL RESEARCH BRANCH, WORKING TOGETHER WITH LARRY ON A NUMBER OF NEW VERY EXCITING TRANSLATIONAL PROGRAMS THAT HAVE BEEN DEVELOPED, AND PAUL HAS A BACKGROUND IN MEDICINAL CHEMISTRY. HE ACTUALLY ADVANCED A NUMBER OF DRUGS THROUGH THE PIPELINE AND HAS TREMENDOUS EXPERIENCE IN DRUG DEVELOPMENT AND JOINS US FROM -- HE WAS PREVIOUSLY AT NCI. NEXT ALSO ON THE TRANSLATION RESEARCH BRANCH JENNIFER ISAACS, SHE ALSO HAS A TREMENDOUS EXPERIENCE IN MOLECULAR BIOLOGY AND MOLECULAR MECHANISM, CELLULAR MOLECULAR MECHANISMS INCLUDING CHAPERONES, WILL BE ALSO SUPPORTING THE TRANSLATIONAL RESEARCH BRANCH IN RELATION TO OUR RECENT EFFORTS IN PRECISION MEDICINE, AND SHE COMES TO US VIA BARDA AS WELL AS NCI. AND FINALLY ALESSANDRA ROVESCALLI FAMILIAR TO SOME OF YOU, A NEUROPHARMACOLOGIST, AND PREVIOUSLY AT THE CENTER FOR SCIENTIFIC REVIEW, AND SHE IS JOINING THE CLINICAL INTERVENTIONS AND DIAGNOSTICS BRANCH, WHERE SHE IS GOING TO BE WORKING TOGETHER WITH LORI AND OTHERS SUPPORTING THE DIAGNOSTICS PORTFOLIO AND BIOMARKERS PORTFOLIO AMONG OTHER FUNCTIONS, REALLY VERY EXCITED TO HAVE THESE NEW MEMBERS. AND THANK YOU. >> THANKS, ELEAZAR. NEXT UP IS DR. EVAN HADLEY, DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY. >> WE'RE PLEASED THAT KATHLEEN MERCURE JOINED US AS PROJECT MANAGER, COMES FROM NCI, AND HER MAIN ACTIVITIES HAVE BEEN IN COORDINATING AMONG OUR LARGE PROJECTS ON EXCEPTIONAL LONGEVITY THAT THESE HAVE BEEN RUNNING FOR QUITE A WHILE WITH POTENTIAL FOR SYNERGY WITH COHORT STUDIES, COLLABORATION, FAMILY STUDIES COLLABORATION, NEW STUDIES ON OMICS. AND GETTING THE COMMUNICATION AND ONGOING INTERACTIONS HAS BEEN A REAL CHALLENGE FOR THESE BIG PROJECTS, AND KATHLEEN REALLY HAS A FLAIR FOR IT AND WE'RE GRATEFUL SHE'S JOINED US. >> THANK YOU, EVAN. NEXT UP AGAIN, I'M KEN SANTORA, DIRECTOR OF DIVISION OF EXTRAMURAL ACTIVITIES, IT'S MY PLEASURE TO ANNOUNCE SIX NEW MEMBERS TO OUR DIVISION. FIRST IS ASHLEY BUTTERFIELD HEALTH SPECIALIST FROM URBAN HOUSING AND DEVELOPMENT, NIH GUIDE LIAISON, WHICH IS THE PUBLICATION SYSTEM FOR ALL OUR FUNDING OPPORTUNITY ANNOUNCEMENTS HERE, SO SHE WILL BE IN CHARGE OF THAT. NEXT UP IS NEW SCIENTIFIC REVIEW OFFICER REY DOMINGUEZ FROM AUSTRALIA, HE'S GOING TO BE ORGANIZING THE INITIAL PEER REVIEW OF SPECIFIC RESEARCH APPLICATIONS THAT ARE ASSIGNED TO NIA. WE WELCOME REY. NEXT IS ANOTHER SCIENTIFIC REVIEW OFFICER, JOSHUA PARK, PREVIOUSLY WAS ASSISTANT PROFESSOR AT UNIVERSITY OF TOLEDO, COLLEGE OF MEDICINE, HE WILL BE OVERSEEING REVIEW OF THE CLINICAL SCIENCE SECTION, ONE OF OUR STANDING STUDY SECTIONS HERE AT NIA. NEXT SLIDE. NEXT IS LENIN GREENWOOD, NEW SUPERVISORY GRANTS MANAGEMENT SPECIALIST. SHE WAS PREVIOUSLY A SENIOR GRANTS MANAGEMENT SPECIALIST AT ONE OF OUR SISTER AGENCIES, NIDA. AND SHE'S GOING TO BE OVERSEEING THE BUSINESS MANAGEMENT AND OTHER NON-PROGRAMMATIC ASPECTS OF NOTICE OF AWARDS FOR NIA'S DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY. NEXT IS KENJA LEWIS, SHE IS AN EXTRAMURAL SUPPORT ASSISTANT. SHE JOINS US FROM PRIVATE INDUSTRY AND SHE'S GOING TO BE WORKING IN OUR OFFICE OF SCIENTIFIC REVIEW. AND SHE ASSISTS REVIEW OFFICERS IN ORGANIZING REVIEW MEETINGS, MAKING ARRANGEMENTS AND PREPARING SUMMARY STATEMENTS. AND FINALLY MISS REBECCA ROPER, SHE'S A HEALTH SCIENCE POLICY ANALYST. SHE IS NOW A NEW MEMBER OF OUR NEWLY CREATED OFFICE OF CLINICAL RESEARCH HERE IN THE DEA. SHE WAS PREVIOUSLY A PROGRAM OFFICER AT NHLBI, OVERSEEING THE OUTREACH TO COMMUNITY-BASED RESEARCH NETWORKS, ASSISTING WITH CROMS AND OUTREACHPRO, TWO MAJOR SYSTEMS CREATED FOR OUR CLINICAL RESEARCH OFFICE. NEXT SLIDE. NEXT UP CONSIST DR. DAWN BERNARD TO INTRODUCE THE NEXT SPEAKERS BUT I WOULD FIRST LIKE TO ANNOUNCE DR. BERNARD HAS BEEN SELECTED TO SERVE AS NEW DIRECTOR OF THE OFFICE OF LEGISLATION POLICY AND INTERNATIONAL ACTIVITIES. SO CONGRATULATIONS TO DAWN FOR THAT PROMOTION. DAWN? >> HI, KEN. CAN YOU HEAR ME OKAY? >> YES, THANKS. >> THANK YOU. GOOD MORNING, EVERYONE. IT'S NICE TO MEET YOU VIRTUALLY. I WANTED TO INTRODUCE TWO NEW MEMBERS OF THE OLPIA TEAM. DR. LINDA YANG HEALTH SCIENCE POLICY ANALYST IN OUR OFFICE, COMES FROM NIAID'S OFFICE OF PLANNING AND EVALUATION, PhD in biomedical sciences from Mount Sinai, helping NIA cover division of aging biology programs and supporting responses to Congress and other stakeholders. NEXT NEW ADDITION, WELL NEW TO US AGAIN, COURTNEY WALLIN, DR. WALLIN FROM "ALL OF US," PRIOR TO THAT OFFICE OF LEGISLATION AND POLICY. SHE HAS HER Ph.D. IN COGNITIVE NEUROSCIENCE FROM GEORGE WASHINGTON UNIVERSITY, AND WILL BE COVERING FOR THE OFFICE DIVISION OF NEUROSCIENCE CLINICAL PORTFOLIO AS WELL AS OUR SBIR PORTFOLIO AND CHALLENGES ACTIVITIES. THANKS, KEN. >> THANKS, DAWN. NEXT SLIDE. NOW WE ASK CINDY MCCONNELL, DIRECTOR OF OFFICE OF COMMUNICATIONS AND PUBLIC LIAISON. CINDY? >> GOOD MORNING. I'D LIKE TO WELCOME -- HOPEFULLY MY VIDEO IS WORKING. KATIE MURRAY AND ASHLEY NEGRO, BOTH KATIE AND ASHLEY CAME TO US FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES, CMS, AND KATIE WILL BE FOCUSED ON WRITING CONSUMER HEALTH CONTENT, SHE'S A WRITER/EDITOR, AND ASHLEY IS FOCUSED ON OUR MEDIA RELATIONS BOTH PRO-ACTIVE AND REACTIVE. A WARM WELCOME TO THEM BOTH. >> THANKS, CINDY. NEXT UP, HEAD OF OFFICE OF ADMINISTRATIVE MANAGEMENT. PATRICK? >> THANKS, KEN. AM I COMING THROUGH OKAY? >> YES. >> GREAT. THANK YOU, EVERYBODY. GOOD MORNING. WE HAVE TWO NEW ADDITIONS, NICHOLAS CAPELL, JOINING OUR FINANCIAL MANAGEMENT BRANCH FOCUSING ON OUR GRANTS TEAM. COMES FROM UNIVERSITY OF OREGON, WE'RE EXCITED TO HAVE HIM. DAYANA ALBA. >> AND DR. LUIGI FERUGGI. >> GOOD MORNING, EVERYBODY. I'M GOING TO TALK TO YOU ABOUT THE FOUR PEOPLE THAT ARE FOUR NEW ENTRIES IN THE INTRAMURAL PROGRAM, BUT I'LL GIVE YOU IN MY PRESENTATION A MUCH MORE COMPREHENSIVE VIEW OF THE INTRAMURAL PROGRAM. LINUS JOSEPH IS COMPUTER SCIENTIST. AS YOU KNOW, MOST OF THE SCIENCE WE DO PRODUCED MUCH MORE DATA THAN WE CAN CRUNCH, AND SO THAT REINFORCING, YOU KNOW, OUR I.T. DEPARTMENT HAS BEEN FUNDAMENTAL PROGRESS IN THE INTRAMURAL PROGRAM, AND LINUS IN PARTICULAR IS AN EXPERT IN PROGRAMMING IN LINUX, AND OTHER LANGUAGES, AND HIS ROLE IS REALLY TO MODERNIZE SOME OF THE PROCESS AND PROCEDURES FUNDAMENTAL, MOSTLY TO MOVE DATA, WITHIN THE DIFFERENT PARTS OF THE INTRAMURAL PROGRAM. ANNAMARIA RUDDDEROW, OFFICE OF SCIENTIFIC DIRECTOR. YOU KNOW, THE WORK IN THE SCIENTIFIC DIRECTOR OFFICE HAS EXPANDED TREMENDOUSLY, IN PART BECAUSE OF THE ALZHEIMER'S DISEASE AND RELATED DEMENTIA OPERATION, ALSO BECAUSE WE HAVE LAUNCHED MANY INTERNAL COMPETITIVE INITIATIVES FOR FUNDING. AND SO THOSE ARE, YOU KNOW, REQUIRE A LOT OF, YOU KNOW, PROCESSES. FOR EXAMPLE, YOU KNOW, THIS YEAR WE HAD 69 PROJECT PROPOSALS THAT NEEDED TO BE REVIEWED, AND SO WE HIRED ANNAMARIA RUDDEROW, TURNING OUT TO BE A FANTASTIC ADDITION TO OFFICE OF SCIENTIFIC DIRECTOR. VICTORIA DAVIS, PEOPLE COME OP SUNDAYS, EVENINGS, AVAILABLE EARLY IN THE MORNING FOR TESTING, VICTORIA HAS BEEN ALWAYS A FANTASTIC CONTRIBUTOR TO OUR PROGRAM SO SHE WAS HIRED AS A NIGHT NURSE. FINALLY DAN BENJAMINI, A RECENT ACQUISITION IN THE TENURE TRACK PROGRAM. DAN CAME TO US FROM THE FOUNDATION FOR ADVANCEMENT OF MILITARY MEDICINE, TRULY UNIQUE SKILLS. HE IS AN IMAGING PERSON, MOSTLY WORKING ON MRI, BUT NOT ONLY MRI, AND HIS GOAL IS TO PUT TOGETHER, YOU KNOW, THE RELATIONSHIP BETWEEN IMAGING AND -- (INDISCERNIBLE), HIGH FIELD MRI IN MICE AND HUMANS, IN DEMENTIA STUDY OF THE SAME SECTION WITH MRI TO SEE WHETHER THERE ARE WAYS TO RECOGNIZE CHARACTERISTICS OF THESE TISSUES, FOR EXAMPLE ANOTHER THING HE WANTS TO DO IS RECOGNIZE (INDISCERNIBLE) AND HAS DEVELOPED A PROGRAM ABLE TO DO THAT, AT LEAST IN MICE SO FAR, AND IS JOINING OUR PROGRAM WHERE THERE IS CONSIDERABLE EXPERTISE IN IMAGING, AND SHE WILL BE WORKING WITH SUSAN AND ALL THE OTHER INVESTIGATORS AT NIA. >> THANK YOU, LUIGI. I'LL TURN IT BACK OVER TO DR. HOED ES. >> THANKS FOR THE INTRODUCTIONS SHARING THE EXCITEMENT OVER THE PAST MONTHS, EVEN YEARS IN COVID. NOT ONLY HAVE WE BEEN WORKING WITH YOU IN THE RESEARCH COMMUNITY AND PUBLIC TO KEEP THINGS GOING BUT WE'VE OF WE NOW HAVE THE EXCITEMENT OF BEING JOINED BY TALENTED, COMMITTED, VIGOROUS FOLKS YOU'VE SEEN AT LEAST REMOTELY. WE LOOK FORWARD FOR THE CHANCE FOR THEM TO MEET YOU IN PERSON AND EXPERIENCE INTERACTIONS WITH THEM. HERE THE FINAL SLIDE TO HELP REMIND YOU SOME OF THE WAYS TO STAY CONNECTED WITH NEWS AS IT HAPPENS. WE HOPE YOU WILL LOOK INTO THESE SITES FOR THE BLOG IN PARTICULAR, SUBSCRIBING, COMING TO YOU PROACTIVELY, ONE WAY TO KEEP IN TOUCH WITH EVENTS AS THEY HAPPEN. KEN, BACK TO YOU. >> THANKS, RICHARD. ANY QUESTIONS NOW FOR DR. HODES REGARDING HIS DIRECTOR'S STATUS REPORT? >> I'VE GOT A QUESTION, IF I MAY. >> CERTAINLY. >> SO, THAT WAS SUCH A GREAT REPORT. TWO QUESTIONS, RICHARD. THAT IS, YOU SAID AT ONE POINT IN YOUR PRESENTATION THAT YOU HAD A NUMBER OF BRIEFINGS WITH CONGRESS, A NUMBER OF BRIEFINGS WITH CONSTITUENTS. HOW HAS THAT GONE UP OR DOWN DURING COVID, YOUR NUMBERS, ARE THEY THE SAME? >> IT'S A GOOD QUESTION, TERRY. MY SENSE IS YES, PRETTY MUCH THE SAME. >> THAT'S GREAT. >> MEETINGS WITH CONSTITUENT AND ADVOCATE GROUPS, MANY OF THEM ARE REGULARLY SCHEDULED, AND THEY HAVE CONTINUED NOW, JUST REMOTE INSTEAD OF IN PERSON. SIMILARLY FOR BRIEFINGS AND HEARINGS. >> THAT'S GREAT. AND PART 2 QUICKLY IS YOU HAVE INTRODUCED US TO AN ARRAY OF WONDERFUL NEW STAFF. ARE YOU NET POSITIVE OR NET NEGATIVE IN YOUR STAFFING NOW? >> VERY SIGNIFICANTLY POSITIVE. >> GREAT. >> SOME YEARS WE WERE AT STEADY STATE, EVEN AS OUR SCOPE AND BUDGET INCREASED. BUT WE HAVE HAD THE OKAY TO DO SUBSTANTIAL RECRUITMENT. SO WE'RE WORKING EACH YEAR ACROSS ALL THE PROGRAMS AND DIVISIONS FOR STRATEGIC PLANS, ASK WHAT'S NEEDED, SO FAR HAVE BEEN ABLE TO MEET NEEDS AND EXPAND. INCREASING STAFFING TO MEET THE DIVERSITY AND EXTENT OF OUR SCIENCE INTERACTIONS WITH ALL OF YOU. >> ABSOLUTELY WONDERFUL. THANK YOU. >> OTHER QUESTIONS? >> SALLY? >> YES, I WANT TO CONGRATULATE YOU, NIA AND STAFF FOR AMOUNT OF WORK AND QUITE A SPECTACULAR GROWTH IN NIA'S PORTFOLIO OVER THE LAST DECADE. THAT'S WONDERFUL AND ENCOURAGING. ONE FEEDBACK THAT I AND OTHERS ARE RECEIVING FROM JUNIOR COLLEAGUES IS EXTRAORDINARY AMOUNT OF PAPERWORK AND REGULATORY BURDEN THAT NEW GUIDELINES AND IMPLEMENTATION OF THE PREVIOUS GUIDELINES ARE IMPOSING ON JUNIOR COLLEAGUES. SUCH A LARGE PORTION OF THE GRANT SUBMISSION RELATES TO ADMINISTRATIVE ASPECTS, THAT THE INVESTIGATORS, INDIVIDUAL INVESTIGATORS, ESPECIALLY JUNIOR INVESTIGATORS, HAVE VERY LITTLE CONTROL OVER. AND FIND IT EXCEEDINGLY DIFFICULT TO MANAGE, EVEN THINGS LIKE THOUSAND DOLLAR TRAVEL HAS TO BE EXPLAINED MULTIPLE TIMES, IN GREAT DETAIL. AND ALTHOUGH THIS IS NOT ENTIRELY NIA'S PURVIEW, I THINK WE GET THE SAME FEEDBACK FROM VARIOUS INSTITUTES, I THINK THERE NEEDS TO BE SOME ATTENTION GIVEN TO WHAT THE REVIEWERS CAN REVIEW MEANINGFULLY AND WHAT THE INVESTIGATORS CAN MEANINGFULLY AND PRACTICALLY MANAGE IN TERMS OF THE ADMINISTRATIVE ASSURANCES AND BURDEN THAT IT IMPOSES. >> THANK YOU FOR THE THOUGHTFUL COMMENTS. WE NEED TO PAY ATTENTION. KEN, DO YOU HAVE ANY SPECIFIC RESPONSE? INCLUDING THE CHANNELS BY WHICH WE CONVEY THESE KINDS OF CONCERNS. >> YES. WE CERTAINLY RECOGNIZE THOSE CONCERNS. AND ALWAYS TAKE THAT INTO CONSIDERATION WHEN WE'RE IMPLEMENTING NEW POLICIES, ESPECIALLY. I THINK THERE'S BEEN A CONCERTED EFFORT EVER SINCE THE 21ST CENTURY CURES ACT CAME OUT DURING THE OBAMA ADMINISTRATION. ONE OF THE TENETS OF THAT WAS TO TRY TO REDUCE ADMINISTRATIVE BURDEN. AND WE REALLY RECOGNIZE HOW MUCH A BURDEN THAT IS ESPECIALLY IN OUR EARLY CAREER AWARDEES BECAUSE OF, YOU KNOW, SETTING UP LABORATORIES, ET CETERA, YOU KNOW, WRITING GRANTS, MANAGING. VERY DIFFICULT TO MANAGE ALL THOSE COMPONENTS. WE DO RECOGNIZE THAT. YOU KNOW, WE'RE TRYING TO IMPLEMENT EFFICIENCIES WHERE WE CAN, ESPECIALLY THROUGH OUR ELECTRONIC AND I.T. DEPARTMENTS. YOU KNOW, TO MAKE THINGS MUCH MORE ARE STREAMLINED AND EASIER TO MAKE ALL THOSE REQUIREMENTS. WE'RE INTEGRALLY INVOLVED ALWAYS IN THOSE REQUIREMENTS. AND WE UNDERSTAND, BECAUSE AS ADMINISTRATORS OF THOSE GRANTS THOSE TIMES TEN ARE ON US ALSO. AND WE THOROUGHLY UNDERSTAND THAT. UNFORTUNATELY, THE NECESSITY OF DOING THOSE, BECAUSE MOST OF THEM ARE BY REGULATION AND LAW THROUGH THE FEDERAL GOVERNMENT, AND SO WE DON'T HAVE A LOT OF CHOICES IN IMPLEMENTING THOSE TYPES OF THINGS. BUT WE ARE ALWAYS TRYING TO HELP OUR INVESTIGATORS, AND, AGAIN, TRYING TO COME UP WITH SOME EFFICIENCIES AS MUCH AS POSSIBLE. SO, BUT AGAIN IT'S A VERY GOOD QUESTION. AND WE'RE CONSTANTLY LOOKING FOR NEW INNOVATIVE WAYS TO ALLEVIATE THOSE ADMINISTRATIVE BURDENS WHEN POSSIBLE. >> I ONLY ADD WE APPRECIATE YOU RAISING THE QUESTIONS, AND WELCOME YOUR HELP AND AYE SIS TANS, SHALI AND COUNCIL, IF THERE'S SPECIFIC QUESTIONS WE CAN LOOK INTO AND TEST NECESSITY, WHETHER THERE'S ROOM FOR MODIFICATION. SO PLEASE CONTINUE TO CONVEY THE GENERAL CONCERNS BUT ALSO ANY SPECIFIC THOUGHTS YOU HAVE. >> I'LL SEND AN E-MAIL WITH SOME THOUGHTS ON IT BUT I'M GETTING SO MUCH FEEDBACK WITHIN OUR PEPPERER CENTER, I CAN'T TELL WHAT THE AIRFARE IS TODAY VERSUS TOMORROW AND TO EXPECT A RATIONALIZATION OF A THOUSAND DOLLARS IN TRAVEL EXPENSES SEEMS MUCH, AN EXTREME EXAMPLE, PERHAPS I HOPE AN UNCOMMON EXAMPLE. BUT 80% OF THE GRANT TODAY IS NOT RELATED TO THE SCIENCE PART OF IT. AND SO MANY OF THESE ADMINISTRATIVE ASSURANCES CAN BE ASSIGNED TO THE NIH-FUNDED INSTITUTIONS. AND IT SEEMS TO ME TO PUT THOSE 150 PAGES INTO A GRANT DOESN'T DO MUCH BECAUSE I AS A REVIEWER HAVE VERY LITTLE TIME TO READ THOSE 150 PAGES. AT ANY RATE, I RECOGNIZE THAT IT'S NOT ENTIRELY WITHIN THE INSTITUTE NIA'S PURVIEW. BUT IF IT'S NOT 27 INSTITUTES PURVIEW WHOSE IS IT AND HOW CAN WE ACCESS AND PROVIDE FEEDBACK TO TOP LEADERSHIP SETTING THESE POLICIES? >> AGAIN, THANK YOU FOR THAT, SHALI. PLEASE SEND ME AND DR. HODES SUGGESTIONS AND WE CAN FUNNEL TO LEADERSHIP AT NIH TO MAKE SURE THAT'S ALWAYS ON THE AGENDA. I CAN ALSO ASSURE YOU THESE DISCUSSIONS LIKE THIS ARE ALWAYS HIGH IN PRIORITY TO THE NIH, AT THE HIGHEST LEVELS, BECAUSE OBVIOUSLY YOU'RE NOT THE ONLY ONES THAT ARE BRINGING THIS TO OUR ATTENTION THROUGHOUT THAT, AND WE'RE WORKING THROUGH CHANNELS. BUT THE MORE EVIDENCE AND MORE WE HEAR FROM YOU, THE BETTER. AND WE CAN KEEP THAT CONVERSATION GOING ALWAYS. AND TRY TO WORK THROUGH THINGS TO MAKE IT BETTER. >> THANK YOU, KEN. THANK YOU, RICHARD. >> ANY OTHER QUESTIONS? SO OF COURSE WE'LL STAY TUNED FOR, YOU KNOW, HOPEFULLY WE'LL GET A BUDGET IN THE NEXT THREE WEEKS. WE'LL SEE. BUT LOTS DEPEND ON THAT, YOU KNOW, TOO SO STAY TUNED FOR THAT. OKAY. >> MERRILL HAD A COMMENT. >> YES, DR. HODES, I THINK ONE OF THE SLIDES THAT YOU PUT FORTH REALLY SPEAKS TO THE PRODUCTIVITY ON THE ACTIVE CLINICAL TRIALS UNDERWAY. I THINK THAT SHOULD BE USED MORE OFTEN BECAUSE IT REALLY GIVES A SNAPSHOT OF HOW EFFECTIVE THE NIA HAS BEEN AND ACROSS VARIOUS DOMAINS. MY QUESTION TO YOU IS CAN YOU GIVE US ANYPLACE INSIGHT INTO ARPA-H AND HOW ITS POTENTIAL IMPACT ON THE NIA? >> THANKS FOR THAT COMMENT AND QUESTION, MERYL. NOT MUCH CAN I SHARE BECAUSE NOT MUCH HAS BEEN DETERMINED. THE ARPA-H PROPOSAL IS NOT YET PASSED THROUGH AT THE LEVEL OF EITHER AUTHORIZATION OR APPROPRIATION. SO IN GENERAL OF COURSE THE VISUALIZATION HAS BEEN IT'S SOMETHING LIKE DARPA, WHICH MEANS IT HAS PARTICULAR MECHANISMS FOR FACILITATING PARTNERSHIPS, RAPID PROGRESS, MILESTONE-DRIVEN DETERMINATIONS OF SUCCESS OR FAILURE AT A PROJECT LEVEL. THE DECISION ABOUT WHETHER THERE WILL BE AN ARPA-H, IF THERE IS ONE WHETHER IT WILL BE WITHIN NIH OR NOT, IS STILL A MATTER OF SOME CONGRESSIONAL DISCUSSION. AGAIN, IT NEEDS AUTHORIZATION AND APPROPRIATION OF FUNDS, NEITHER OF WHICH HAS YET OCCURRED. IF THERE'S A COMMON THEME FOR DISCUSSIONS IF THIS COMES TO BE, WHETHER WITHIN NIH OR NOT, IT HAS TO BE SOMETHING QUITE DISTINCT AND INDEPENDENT AT LEVEL OF MANAGEMENT FROM NIH. NOT MORE OF THE SAME, NOT TO UNDERMINE THE VALUE OF WHAT NIH DOES BUT IF IT'S VALUE ADDED IT HAS TO HAVE A LEVEL OF AUTONOMY WHILE IT ENTER ACCOUNT A -- INTERACTS WITH NIH, VERY LITTLE IN RECENT WEEKS, CONGRESSIONAL LEVEL, AUTHORIZATION OR APPROPRIATION. WE'LL KEEP YOU INFORMED AS YOU'RE INTERESTED IN THE OUTCOME OF THIS. >> THANK YOU. >> THERE'S VERY LIMITED LANGUAGE WHEN IT CAME TO WHAT WAS BEING PROPOSED DURING ARPA-H. ONE OF THE THINGS THEY DID POINT OUT IN THAT WAS ALZHEIMER'S DISEASE. SO WE ARE IN, YOU KNOW, KEEPING THAT UNDER CONSIDERATION WHEN WE'RE THINKING OF THE FUTURE AND FUTURE PROJECTS FOR THE INSTITUTE. >> YES, THE ORIGINAL LANGUAGE FROM THE PRESIDENT, ALZHEIMER'S WAS ONE OF THREE EXAMPLES OF DISEASE ALONG WITH CANCER THAT HE CITED. >> ALL RIGHT. ANY OTHER COMMENTS OR QUESTIONS? OKAY. NOT HEARING ANY, I'D LIKE TO THEN CONTINUE. JUST TO KEEP EVERYONE INFORMED, OUR NEXT COUNCIL DATE IS ON MAY 10 AND 11, THAT IS 2022. WE AT THIS POINT DON'T KNOW IF THAT WILL BE AN IN-PERSON MEETING OR A VIRTUAL MEETING, BUT WE'RE HOPEFUL. AND WE'LL LET YOU KNOW AS SOON AS WE HEAR MORE INFORMATION. AND THEN OF COURSE YOU CAN SEE ON THE SLIDE THE OTHER FUTURE DATES FOR OUR COUNCIL MEETINGS. THE NEXT ITEM ON OUR AGENDA IS CONSIDERATION OF THE MINUTES OF THE LAST MEETING. I JUST WANTED TO GET A MOTION FROM OUR COUNCIL MEMBERS TO APPROVE THE MINUTES FROM THE LAST MEETING. >> SO MOVED. >> SECOND? >> SECOND. >> ALL IN FAVOR? >> AYE. >> AYE. >> AYE. >> ANY DISSENT? THANK YOU VERY MUCH. WE HAVE APPROVAL OF THE MINUTES FROM OUR LAST MEETING. THANK YOU. NEXT UP IS OUR REPORT FROM OUR TASK FORCE ON MINORITY AGING RESEARCH. I'LL TURN IT OVER TO DOCTORS WHITFIELD AND MANLEY. >> THANK YOU. PARTICULARLY GOOD MORNING TO THE NEW MEMBERS. I THINK THAT ONE OF THE THINGS YOU'LL SEE THE TASK FORCE KICKS OFF OUR MEETINGS ALL THE TIME. OUR GOAL IS TO BE ABLE TO HAVE SOME INTERESTING CHALLENGING CONTROVERSIAL THOUGHT-PROVOKING IDEAS THAT COME ACROSS TO BE ABLE TO THINK ABOUT HOW AS PART OF NIA'S MISSION WE CAN BE ABLE TO ADVANCE WORK ON MINORITY AGING RESEARCH. SO JUST TO GIVE A VERY QUICK RECAP, WE KICKED OFF YET WITH DR. JONES' OPENING, AND STARTING OFF BY INTRODUCING THE NEW CO-CHAIR. I WANT TO GIVE ALL THANKS AND APPRECIATION TO JENNIFER FOR STEPPING INTO THIS ROLE. I THINK THAT IT'S CRITICALLY IMPORTANT AND I THINK SHE'S GOING TO DO AN INCREDIBLE JOB. I THINK I'VE ONLY BEEN A CO-CHAIR FOR LIKE A YEAR, ON MY SECOND PERSON. MAYBE I'M JUST WEARING THEM DOWN. A SPECIAL THANKS TO CLIFF ROSEN. HIS THOUGHTFUL, MEANINGFUL, HEARTFUL APPRECIATION FOR THE CONTRIBUTION OF HEALTH DISPARITIES AND MINORITY AGING IS CRITICAL IMPORTANT. DR. JONES PROVIDED ANNOUNCEMENTS, FIRST OFF 2022 BUTLER-WILLIAMS SCHOLAR PROGRAM, MEETING AUGUST 23-25. DR. JONES HAS BEEN ABLE TO RUN THAT PROGRAM VIRTUALLY. I KNOW SOME OF YOU, LIKE ME, PARTICIPATED IN THE SUMMER INSTITUTE PROGRAM OVER THE YEARS. AND THE DYNAMIC NATURE OF IT IN PERSON IS SOMETHING THAT'S SPECIAL THAT ANYBODY WHO HAS BEEN THROUGH IT WILL RECOUNT THAT EXPERIENCE. BUT I THINK SHE'S BEEN ABLE TO FIGURE OUT A WAY VIRTUALLY TO BE ABLE TO CAPTURE THAT SAME KIND OF EXCITEMENT AND ENTHUSIASM. SO PLEASE SUGGEST TO PEOPLE THEY APPLY AGAIN THIS YEAR, AND SHE MENTIONED IT WILL BE VIRTUAL I THINK, APPLICATIONS DUE BY APRIL 15, 2022. SHE ALSO MENTIONED THE NIH OFFICE OF DIRECTOR, OFFICE OF SCIENTIFIC WORKFORCE DIVERSITY QUARTERLY LECTURE SERIES FOSTERING COHORT RECRUITMENT WILL BE A 2 1/2-DAY VIRTUE FORUM FEBRUARY 23-24, REGISTRATION ANNOUNCED HOPEFULLY SOON BECAUSE THAT'S COMING UP REAL SOON. SHE ALSO MENTIONED REISSUING OF NIH COMMON FUND, WHICH IS TRANSFORMATIVE RESEARCH TO ADDRESS HEALTH DISPARITIES AND ADVANCE HEALTH EQUITY AT MINORITY SERVING INSTITUTIONS WITH PROPOSED MARCH 25, 2022, APPLICATION DATE. I THINK -- I DON'T KNOW IF WE HAVE HBCUs OR MINORITY SERVING INSTITUTIONS REPRESENTED HERE BUT WE NEED TO REACH OUT AND MAKE SURE THEY ARE AWARE OF THIS FUNDING OPPORTUNITY. SO NEXT WE DID TWO PRESENTATIONS, I'M GOING TO PREVENT THEM OUT -- PRESENT THEM OUT OF ORDER FOR CONVENIENCE, MINE WAS SECOND, A PRESENTATION I DID WAS SECOND, AND BUT I'M GOING TO SHARE WITH YOU THAT HERE FIRST AND GIVE YOU A QUICK RECAP, HOPEFULLY MITTING MOST OF THE IMPORTANT HIGHLIGHTS. SO, THE PRESENTATION WAS ON CONTRASTING WITHIN AND BETWEEN ANALYSES IN PURSUIT OF UNDERSTANDING RACIAL DIFFERENCES IN AGING POPULATIONS. I PROVIDED WITH YOU THE IDEA THAT SOMETIMES I THINK WE THINK ABOUT AGING RESEARCH, RELATIVE TO DOING WHAT WE THINK IS MAYBE MORALLY RIGHT. BUT ACTUALLY SCIENTIFICALLY RIGHT IS AN ISSUE THAT WE NEED TO THINK ABOUT. CULTURE ACTUALLY IMPACTS EVERY STEP OF THE SCIENTIFIC PROCESS. QUESTIONS, MODELS, TO MEASUREMENT, TO ANALYSIS, EVEN INTERPRETATION. AND SO JUST TO PROVIDE A QUICK SUMMARY, I TALKED ABOUT BETWEEN GROUP QUESTIONS, I WANTED TO MAKE IT CLEAR I SPENT MY CAREER IN RESEARCH, I'M NOT AGAINST BETWEEN GROUP BUT HAVE TO BE THOUGHTFUL, WHAT FACTORS ACCOUNT FOR DIFFERENCE. I USED THE EXAMPLE OF COGNITIVE PERFORMANCE BUT APPLIES TO ANYTHING, PUT IN DIFFERENCES IN, YOU KNOW, BIOINFORMATICS OR WHATEVER AS A FACTOR. ALSO ASKING QUESTIONS LIKE ARE THERE DIFFERENCES IN COGNITIVE PERFORMANCE BY RACE. BUT THERE ARE ALSO VERY VALID AND VERY USEFUL AND VERY IMPORTANT IN-GROUP QUESTIONS. WHAT ACCOUNTS VARIABILITY IN COGNITIVE FUNCTION IN AFRICAN AMERICANS, WHAT MAKES AFRICAN AMERICANS AND CAUCASIANS DIFFERENT IN COGNITIVE FUNCTIONING AND WHY? THAT'S A BIT OF A GROUP APPROACH IN A MODIFIED SORT OF WAY BECAUSE YOU'RE TRYING TO FIGURE OUT WHAT THE EXPLANATORY FACTOR IS BETWEEN THE TWO. SO THAT'S AN IMPORTANT STEP TO MAKE AS WELL. I DID TALK ABOUT MODELS OF CULTURAL DIFFERENCES CITING A PAPER, I PROVIDED A 2008 PAPER I HAVE, AS I OFTEN DO, I ASK EVERYBODY TRY TO CITE THAT PAPER SO I CAN GET MY CITATION IN, IT'S ONE I HOPE THAT'S IMPORTANT AND THOUGHT PROVOKING, TALKS ABOUT WAYS WE AS SCIENTISTS THINK ABOUT CULTURAL DIFFERENCE. I TALK ABOUT ANALYSES AND TALK ABOUT POWER CALCULATIONS, THERE ARE POWER CURVES IN THAT PAPER. THE MOST IMPORTANT PIECE, THE LARGER THE DIFFERENCE BETWEEN THE TWO GROUPS, THE LARGER THE SAMPLE SIZES OVERALL NEED TO BE TO GET PROPER POWER ESTIMATION. ALSO MENTIONED A BIT ABOUT INTERPRETATIONS THAT DIFFERENCES CAN BE STRENGTH, TRAJECTORIES OF CHANGE MY BE DIFFERENT. SO AS IS A MAIN GOAL OF MUCH OF WHAT WE TRY TO DO IN THE SCIENCE OF AGING, TRYING TO GET LONGITUDINAL STUDIES, SO THAT WE DON'T JUST GET THE PSYCHOLOGICAL MOMENT IN ONE MOMENT IN TIME. WE GET TRAJECTORIES, PROCESSES OF CHANGE CAN BE IDENTIFIED. THOSE ARE THINGS THAT ARE VERY IMPORTANT FOR LONGITUDINAL STUDIES TO BE DONE, BOTH WITHIN AND BETWEEN. LASTLY, FOR BASIC AND APPLIES, IF YOU HAVE PHENOMENA THAT ARE IMPACTED BY SOCIAL AND PSYCHOLOGICAL FACTORS, BUT WIN-GROUP APPROACH IS VERY USEFUL TO BE ABLE -- WITHIN-GROUP APPROACH IS USEFUL TO IDENTIFY WHAT CAUSES VARIABILITY, THAT MAY CAUSE POPULATION VARIABILITY AS WE LOOK AT SUBPOPULATIONS. FUTURE RESEARCH UTILIZING MINORITIES FOR UNDERSTANDING RESEARCH AND DYSFUNCTION WILL, IN MY THOUGHT, BE ABLE TO ADVANCE SCIENCE AND AGING IN GENERAL. I GAVE THE EXAMPLE OF STUDYING LONGEVITY IN AFRICAN AMERICANS. SELF SERVING BUT IF WE LOOK AT A GROUP, ALMOST DOING EXTREMES ANALYSIS THINKING ABOUT FOLKS WHO ARE AT THE VERY EXTREMES FOR A PARTICULAR REASON FOR AFRICAN AMERICANS BECAUSE OF THE EARLY MORTALITY AND SHORTER LIFE EXPECTANCY, THOSE WHO LIVE VERY LONG LIVES REPRESENT EXTREME SITUATIONS OF AGING. SO THEY MILD PROVIDE SOME INTERESTING INSIGHTS, IF WE LEARN ABOUT THEM. LASTLY, ALTERNATIVE STRATEGIES FOR STUDYING MINORITIES, DOING BETWEEN AND WITHIN, WILL HELP ADVANCE OUR UNDERSTANDING OF MINORITIES AND PEOPLE, AND ALL PEOPLE. SO THAT WAS MY PRESENTATION, THE FIRST PRESENTATION WAS ACTUALLY BY DR. WASHINGTON AND DR. MANLY IS GOING TO PROVIDE AN OVERVIEW OF HER PRESENTATION. >> THANK YOU, DR. WHITFIELD, AND PRESIDENT WHITFIELD. I'LL GIVE A TWO OR THREE-MINUTE OVERVIEW OF OR EXCELLENT TALK BY DR. WASHINGTON. DONNA WASHINGTON IS THE DIRECTOR OF THE OFFICE OF HEALTH EQUITY, AND QUALITY ENHANCEMENT CENTER AT THE V.A. THE TALK SHE GAVE TO US WAS A REPORT ESSENTIALLY FROM THE NATIONAL VETERANS HEALTH EQUITY REPORT THEY RUN REGULARLY AT THE V.A. AND THE PURPOSE WAS OF THESE REPORTS IS TO GO OVER THE STATUS OF HEALTH EQUITY AT THE V.A. AND V.A. HEALTH SYSTEM, AND SHE GAVE A VERY USEFUL DEFINITION OF HEALTH EQUITY, WHICH IS THE ABSENCE OF UNFAIR AND AVOIDABLE OR REMEDIABLE SITUATIONS, DEFINED BY OTHER GROUP DEFINITIONS. AND THIS IS A W.H.O. DEFINITION OF HEALTH EQUITY. SO YOU CAN SEE HER REPORT ORGANIZED AROUND THIS. THE UNDERLYING PURPOSE REALLY SEEMED TO BE, OF THESE REPORTS, THAT YOU CAN ONLY CHANGE WHAT YOU MEASURE. AND THAT INCREASING KNOWLEDGE AND AWARENESS OF THE STATE OF HEALTH EQUITY AT THE V.A. PROVIDES THE EVIDENCE BASE FOR FIGURING OUT BARRIERS AND RECOMMEND ACTIONS FOR IMPROVING HEALTH EQUITY SYSTEMWIDE. DR. WASHINGTON PROVIDED SOME DEMOGRAPHICS OF THE PATIENT GROUP AT THE V.A. AND I'VE GOT A SCREEN SHOT THERE, JUST INCIDENTALLY THIS REPORT YOU CAN GOOGLE IT. IT'S ONLINE. AND YOU CAN GO THROUGH EXTREMELY DETAILED AND SEE ALL THESE TABLES AND GRAPHS I'LL FLASH BY VERY QUICKLY ON THE REPORT. THAT'S MEANT TO SAY 2021, BY THE WAY. THE FOCUS IN 2021 IN THEIR EQUITY REPORT ON PATIENT EXPERIENCES OF CARE, WITH SORT OF A PATIENT-CENTERED CARE, AND ALSO HEALTH CARE QUALITY. THEY DEFINED DISPARITIES BOTH USING AN ABSOLUTE METRIC, WHICH IS STATISTICAL SIGNIFICANCE METRIC BETWEEN TWO GROUPS. AND ALSO A RELATIVE, HAVING A RELATIVE DIFFERENCE OF AT LEAST 10%, SO THE DIAGNOSED PREVALENCE OF A CONDITION OR HEALTH CARE DIFFERENCE IN A GROUP WAS 10% OR HIGHER THAN IT IS IN THE REFERENCE GROUP, IS HOW THE RELATIVE DIFFERENCE WAS DEFINED. AND WHAT YOU CAN SEE, JUST BY SQUINTING ON THE GRAPH, OR THE FIGURE IN THIS SLIDE, IS THAT THERE WAS GREATER RACIAL AND ETHNIC DIVERSITY AMONG VETERANS YOUNGER THAN 65, AND THEY FOUND 58% OF THE PATIENTS IN THE SYSTEM HAD A SERVICE-CONNECTED DISABILITY, SO JUST TO QUICKLY SHOW YOU A FEW OF THE SLIDES THAT DR. WASHINGTON SHOWED US, THERE WAS A LOT OF DATA THERE, REALLY IMPRESSIVE, IN THE FIRST SLIDE ON THE UPPER LEFT I'M SHOWING THE DIFFERENCES IN THE PATIENTS WHO INDICATED THAT IN THE LAST SIX MONTHS THEIR PROVIDER ALWAYS SPENT ENOUGH TIME WITH THEM. SO THIS IS SOMETHING YOU WANT A LOT OF. AND THE REFERENCE IS THAT PATIENTS IN THE CORRESPONDING AGE GROUP, NON-HISPANIC WHITE VETERANS. RED BARS, THE GROUP WAS WORSE THAN REFERENCE GROUP, IN YELLOW THE SAME AS REFERENCE GROUP. WHAT YOU CAN SEE IS THAT IN ESPECIALLY MIDDLE AND OLDER AGE GROUPS MANY ETHNICITY -- ETHNIC AND RACIAL GROUPS FEWER FELT THE PROVIDER WAS SPENDING ENOUGH TIME WITH THEM. LOWER RIGHT I'M SHOWING DIFFERENCES IN THE PATIENTS WHO SAID THEIR PROVIDER ASKED THEM IF THERE WAS A PERIOD OF TIME THEY FELT SAD, EMPTY, DEPRESSED. HERE THE REFERENCE GROUP IS HIGH SES PEOPLE FINDING A DISPARITY HERE, EVEN ACROSS EACH AGE GROUP. IN GENERAL FREQUENCY OF THE PROVIDERS ASKING ABOUT DEPRESSION WAS LOWER AS PEOPLE IN THE VHA FELT HEALTH SYSTEM GOT OLDER. SO IN SUMMARY, DR. WASHINGTON SHOWED US MANY DISPARITIES IN THE V.A. HEALTH SYSTEM IN PERSON-CENTERED CARE, ACCESS TO CARE, CARE COORDINATION. DIFFERENCES BY RACE AND ETHNICITY. THERE WERE DIFFERENCES BY SES, DIFFERENCES BY SEX/GENDER, AND DIFFERENCES BY HEALTH, BY SERVICE-CONNECTED DISABILITY. THE PURPOSE OF THE ANALYSES THAT DR. WASHINGTON HELPED US UNDERSTAND IS TO IMPROVE THE CARE OF ALL VETERANS EXPERIENCING DISPARATE CARE OR OUTCOMES, AND THE REPORT REALLY WAS -- IS INTENDED TO RAISE AWARENESS, AND TO BOLSTER ACTION, IN IMPROVING THE LIVES AND HEALTH CARE OF VETERANS. I THINK THE WAY WE WERE SHOWN THESE DATA IS A REALLY NICE TEMPLATE OR EXAMPLE OF THE EXTENT OF DATA COLLECTION NEEDED TO ANALYZE, DESIGN, AND GENERATE TOOLS AND INTERVENTIONS TO NARROW DISPARITIES. WE HAD A NICE DISCUSSION, A LOT OF IT WAS ABOUT HIGH RATES OF DEPRESSION AMONG VETERANS. DR. WASHINGTON DESCRIBED, YOU KNOW, AN APPROACH THAT THIS REPORT POINTED TO, WHICH IS FOR PROVIDERS TO REALLY ASK ABOUT STRESSORS THAT THE PATIENTS ARE GOING THROUGH, AND TO -- RATHER THAN -- THERE MIGHT NOT BE SPECIFIC ACTIONS THAT PROVIDERS CAN DO BUT THEY CAN UNDERSTAND WHAT THE PATIENTS ARE EXPERIENCING. AND THAT COMMUNICATION BETWEEN PATIENTS AND PROVIDERS COULD BE A KEY FOR REDUCING DISPARITIES. WE ALSO HAD A QUESTION ABOUT HEATHER -- HETEROGENEITY AND COMBAT VETERAN STATUS THAT DR. WASHINGTON SAID IS A FUTURE GOAL FOR THE RESEARCH IN THIS AREA. AND THAT'S MY SUMMARY OF DR. WASHINGTON'S TALK. >> ANY QUESTIONS OR ANY FOLLOW-UP? >> WHILE WE'RE WAITING FOR QUESTIONS, I WANTED TO COMMENT. THE COMMENT IS OF COURSE THANKS TO ALL OF YOU, THE CO-CHAIRS AND MEMBERS WHO PARTICIPATED. BUT JUST TO POINT OUT TO THE COUNCIL, PARTICULARLY NEW COUNCIL MEMBERS AND OTHERS IN THE AUDIENCE WHAT AN IMPORTANT AND ARGUABLY UNIQUE PART THIS IS OF OUR COUNCIL AND COUNCIL ACTIVITIES, THIS TASK FORCE BEGAN MANY YEARS AGO WITH GIANTS LIKE JAMES JACKSON BEING SOME OF THE FUNDING CHAIRS, HAS CONTINUED TO BE CRITICALLY IMPORTANT TO MAKE SURE WE DON'T LOSE FOCUS, NOW OVER YEARS AND DECADES, ABOUT THIS IMPORTANT ASPECT. IT'S A REGULAR INTEGRAL PART OF THE COUNCIL MEETINGS, WE'RE EXCITED TO HAVE IT BE SO. THANK UP ALL -- THANK YOU ALL FOR TAKING THE LEAD IN THIS. >> SO ANY QUESTIONS FOR DOCTORS WHITFIELD AND MANLY? ALL RIGHT. AGAIN, THANKS TO THE TASK FORCE AND THANK YOU FOR THE SUMMARY OF THE TWO VERY IMPORTANT TOPICS FROM DOCTORS WHITFIELD AND WASHINGTON. APPRECIATE THE SUMMARIES. >> THANK YOU. >> NEXT UP IS OUR REPORT FROM THE WORKING GROUP ON PROGRAM. I'LL TURN THIS OVER TO DR. MONICA DRISCOLL, OUR CHAIR. >> THANKS VERY MUCH. I WANTED TO START REALLY BY CONGRATULATING AND THANKING PROGRAM FOR ALL THE REALLY HARD WORK IN DEVELOPING THESE CONCEPTS. AND TO THE COUNCIL MEMBERS FOR THEIR TIME AND CAREFUL CONSIDERATION OF WHAT HAS GONE FORWARD. WE HAVE A NUMBER OF CONCEPTS. WE'LL START WITH THOSE FROM THE DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH. THE FIRST CONCEPT WAS -- OH, AND I SHOULD -- I'M SORRY. I SHOULD REMIND YOU THAT WE HAD GREAT DISCUSSION OF THESE PROPOSALS YESTERDAY. TODAY, I'LL ANNOUNCE PRIMARY AND SECOND REVIEWER, THE PRIMARY WILL DO THE SUMMARY, EVERYONE WILL HAVE A CHANCE TO COMMENT BUT BE MORE CONCISE THAN WE WERE YESTERDAY. OKAY. SO THE FIRST CONCEPT IS POLICY IN AD/ADRD HEALTH CARE DISPARITIES, ACCESS, UTILIZATION AND QUALITY. PRIMARY WE VIEWER DR. WHITFIELD, SECONDARY WAS DR. FULLMER. DR. WHITFIELD, IF YOU COULD SUMMARIZE THE DISCUSSION YESTERDAY. >> YOU CAUGHT ME AT A LOSS. I WAS WRITING SOMETHING IN THE CHAT. THIS WAS ABOUT ADHD HEALTH CARE DISPARITIES, ACCESS AND UTILIZATION. WE WERE IN GENERAL SUPPORTIVE OF THIS, THINKING THAT IF THERE COULD BE WAYS IN WHICH POLICY COULD ADD TO THE DISCUSSION, HOW HEALTH DISPARITIES ARE TAKEN CARE OF, IT WOULD BE VERY IMPORTANT. ONE OF THE COMMENTS THAT I CAN REMEMBER THAT I HAD WAS THAT PERHAPS RATHER THAN JUST SIMPLY USING AN R01 MECHANISM, WHICH I FEEL LIKE IN POLICY THIS IS A LONG TIME, THAT ONE SUGGESTION THAT CAME FROM ME WAS THE IDEA OF USING AN R03, PERHAPS EVEN R21 MECHANISM, TO TRY TO GET TO SOME OF THE ANSWERS FOR HOW DIFFERENT HEALTH CARE SETTINGS AND HEALTH CARE ISSUES WERE AFFECTING DISPARITIES, IN A SHORTER TIME FRAME. >> OKAY. THANK YOU. WERE THERE OTHER COMMENTS FROM COUNCIL OR PROGRAM ON THIS CONCEPT? SO, HEARING NONE, ACTUALLY LET ME MAKE SURE THAT I MAKE IT MORE CLEAR TO MYSELF, BUT HEARING NONE, I WOULD LIKE US TO VOTE ON ACCEPTING THIS CONCEPT. ALL THOSE IN FAVOR? >> AYE. >> ANY OPPOSED? IF NOT, THIS CONCEPT IS APPROVED BY COUNCIL. WE'LL MOVE TO THE NEXT ONE. SO, THE NEXT COUNCIL IS UNDERSTANDING THE SUPPLY OF PROFESSIONAL DEMENTIA CARE PROVIDERS AND THEIR DECISIONS. THE PRIMARY REVIEWER WAS TERRY FULLMER. SECONDARY WAS DAVID REUBEN. TERRY, IF YOU CAN SUMMARIZE FOR US THE DISCUSSION AND YOUR RECOMMENDATION FROM YESTERDAY. >> HAPPY TO. THIS IS AN EXTREMELY IMPORTANT AREA OF CONCERN. AND THERE WAS ENORMOUS ENTHUSIASM ABOUT GETTING AN UNDERSTANDING OF THE SUPPLY FOR PROFESSIONAL DEMENTIA CARE, AMONG AND ACROSS ALL OF US WHO KNOW THAT THE CONFLUENCE OF WORKFORCE SHORTAGES IN PARTNERSHIP WITH INCREASING PERCENTAGES OF PEOPLE WITH DEMENTIA MEAN WE HAVE TO UNDERSTAND, GET OUR SCIENCE STRAIGHT, MOVE IT FORWARD. THERE WAS VERY ROBUST ENTHUSIASM FOR THIS. >> OKAY. THANK YOU. WERE THERE OTHER COMMENTS FROM COUNCIL OR FROM -- FROM COUNCIL ON THIS? NOT HEARING OR SEEING ANY, I WOULD LIKE TO SUGGEST THAT WE VOTE ON MOVING THIS, ON ACCEPTING THIS. ALL THOSE WHO ARE IN FAVOR? >> AYE. >> AYE. >> AYE. >> AYE. >> ANY OPPOSITION? NO, OKAY. NOT HEARING ANY, COUNCIL VOTES TO MOVE THIS FORWARD, THIS CONCEPT FORWARD. WE'LL MOVE TO THE NEXT ONE. SO THE NEXT ONE IS ENTITLED, MORE MOBILE MONITORING OF COGNITIVE CHANGE, CONTINUED, THE M 3C 3, SNAPPY TITLE. PRIMARY WE VIEWER WAS JENNIFER MANLY, SECONDARY WAS DAVID WEIR. DR. MANLY, IF YOU WOULD LIKE TO SUMMARIZE THE DISCUSSION FROM YESTERDAY. >> YES, SNAPPY TITLE, VERY IMPORTANT RESEARCH THAT WAS DESCRIBED IN THIS CONCEPT CLEARANCE. THERE HAVE BEEN TWO STUDIES THAT HAVE BEEN ONGOING FOR THE LAST FIVE YEARS THAT ARE DEVELOPING MOBILE ASSESSMENT ALSO OF COGNITION. THEY ARE DOING THIS BASED ON -- ONE IS BASED ON THE NIH TOOLBOX, A SET OF INSTRUMENTS THAT WERE DEVELOPED FOR -- NOW DEVELOPED FOR THE IPAD. AND THE OTHER IS A MOMENTARY COGNITIVE ASSESSMENT. AND THE POINT IS THAT EVEN IF YOU'RE NOT SITTING ACROSS THE DESK FROM A PATIENT OR RESEARCH PARTICIPANT, YOU CAN GET A SENSE OF THEIR COGNITIVE FUNCTION, NOT JUST, YOU KNOW, WHETHER THEY ARE HAVING ANY COGNITIVE IMPAIRMENT IN DOMAINS LIKE MEMORY, EXECUTIVE FUNCTION, LANGUAGE, BUT ALSO WHETHER THEIR COGNITION HAS CHANGED OVER TIME. THIS IS INCREDIBLY IMPORTANT FOR SEVERAL GOALS AND MILESTONES OF THE NIA IN THEIR AD AND ADRD RESEARCH. SO THIS CONCEPT CLEARANCE IS TO BUILD ON THE WORK THAT'S BEEN DONE IN THESE TWO COOPERATIVE AGREEMENTS. THEY NOW WANT TO INCLUDE, TO ADD NON-COGNITIVE MEASURES, BEHAVIORAL ASSESSMENTS, WIDER DISSEMINATION OF THE INSTRUMENTS TO ALLOW EACH STUDY USING THE MEASURES TO CUSTOMIZE THE APPS THAT HAVE BEEN DEVELOPED FOR THIS WORK TO INCORPORATE ELECTRONIC CONSENT FOR MOBILE COGNITIVE ASSESSMENT, AND TO WORK ON A COST MODEL THAT WILL ALLOW FOR REGULAR UPDATES. SO, THIS IS A CALL FOR APPLICATIONS TO CONTINUE THAT WORK, AND THAT THERE WAS A LOT OF ENTHUSIASM ABOUT THIS EXCITING WORK IN COUNCIL. >> OKAY. THANK YOU. ARE THERE OTHER COMMENTS OR POINTS TO ADD FROM COUNCIL? OKAY. HEARING AND SEEING NONE, I'LL INVITE THE VOTE ON THIS CONCEPT, MOVING FORWARD. ALL THOSE IN FAVOR OF THE CONCEPT? >> AYE. >> AYE. >> AYE. >> ANY OPPOSED? OKAY. THIS CONCEPT MOVES FORWARD AS APPROVED BY COUNCIL. THE NEXT CONCEPT IS MEASURES AND METHODS FOR RESEARCH ON FAMILY CAREGIVERS FOR PEOPLE LIVING WITH AD/ADRD. AND THE PRIMARY REVIEWER ON THIS WAS DAVID WEIR, SECONDARY WAS JENNIFER MANLY. DR. WEIR, IF YOU'D LIKE TO SUMMARIZE THE CONCEPT AND DISCUSSION FROM YESTERDAY. >> SURE. THIS PROPOSAL MET WITH A LOT OF ENTHUSIASM, RECOGNIZING THAT FAMILY CAREGIVERS FOR PEOPLE WITH DEMENTIA PROVIDE PROBABLY WELL MORE THAN HALF OF THE TOTAL CARE NEEDED BY PEOPLE WITH DEMENTIA. AND THAT CONCERN HERE IS THAT WHILE ESTABLISHED PROJECTS AND DBSR DO ASK AND FIND OUT INFORMATION ABOUT CAREGIVERS AND ABOUT RELATIONSHIP BETWEEN CAREGIVERS AND PEOPLE THEY CARE FOR, THE WORLD IS CHANGING. IN PARTICULAR, MOST OF THOSE UNPAID RELATIONSHIPS ARE BASED ON A FAMILY CONNECTION AND FAMILIES ARE CHANGING, FEWER CHILDREN, LESS STABLE MARRIAGES, AT LEAST GROWING RECOGNITION IF NOT GROWING REALITY OF SEXUAL AND GENDER MINORITY KINDS OF RELATIONSHIPS. SO EVEN AT THE LEVEL OF TERMINOLOGY ARE WE ASKING ABOUT PEOPLE IN THE RIGHT WAY TO CAPTURE THE DIFFERENT KINDS OF RELATIONSHIPS THAT MIGHT GIVE RISE TO A CARE-GIVING RELATIONSHIP. SO, THIS WAS TO R21s, I THOUGHT WAS A GOOD IDEA AS THEY WOULD ENCOURAGE MORE JUNIOR INVESTIGATIONS, INVESTIGATIONS OF SOME OF THE VULNERABLE POPULATIONS, R01s, TO DO MORE LARGE SCALE PROJECTS, TO DEVELOP NEW MEASURES THAT EXISTING STUDIES MIGHT ALSO THEN ADOPT, SO WE CAN GET A BETTER PICTURE LOOKING AHEAD TO WHETHER MORE BROADLY DEFINED NOTION OF FAMILY IS GOING TO BE SUFFICIENT TO PROVIDE THE CARE THAT THE BABY BOOM GENERATION IS GOING TO NEED WHEN THEY BEGIN TO DEVELOP DEMENTIA IN LARGE NUMBERS. >> OKAY. THANK YOU. ARE THERE OTHER COMMENTS FROM COUNCIL MEMBERS ON THIS CONCEPT? NOT HEARING OR SEEING ANY, I WOULD INVITE THE COUNCIL TO VOTE ON THIS CONCEPT. AL ALL THOSE IN FAVOR? >> AYE. >> AYE. >> YES. >> ALL THOSE OPPOSED? OKAY. SO THIS CONCEPT MOVES AHEAD AS APPROVED BY COUNCIL. THE NEXT ONE IS BROADENING THE SCOPE AND REACH OF NIA'S AD-ADRD RESOURCE, THE RCMAR PROGRAM. DR. WHITFIELD AND DR. APPLEBY. DR. WHITFIELD CAN YOU SUMMARIZE THE CONCEPT AND DISCUSSION FROM YESTERDAY. >> I'M READY FOR THIS ONE. THIS ONE IS ON THE RCMAR MECHANISM, AND THE RCMAR MECHANISM HAS BEEN AROUND SINCE I THINK 1997, IN ITS FIFTH ROUND MUCH SUPPORT. BY ALL METRICS A VERY SUCCESSFUL MECHANIC, INCREASING RESEARCH OF POPULATIONS. THERE'S THREE BASIC PIECES TO THIS. NOT BASIC, ACTUALLY SOPHISTICATE AND SUPPORTIVE ELEMENTS TO THIS. THE FIRST ELEMENT IS AN RFA FOR P30 APPLICATION REQUEST, AND THIS IS FOR CONTINUING RCMAR APPLICATIONS THAT FOCUS ON BEHAVIORAL AND SOCIAL SCIENCE RESEARCH RELATED TO AGING AND/OR HEALTH DISPARITIES IN OLDER ADULTS. THERE'S A P30 APPLICATION PIECE FROM INSTITUTION PROPOSING TO DEVELOP OR RENEW RCMAR THAT FOCUSES ON BEHAVIOR AND SOCIAL SCIENCE RESEARCH RELATED TO ALZHEIMER'S DISEASE AND RELATED DEMENTIA. THIRD IS A U24 TO SUPPORT A RCMAR COORDINATING CENTER FOR P30 AWARDEES. ONE NEW ELEMENT THAT IS INCLUDED IN THIS REQUEST IS THE IDEA OF BEING ABLE TO MAKE BETTER MORE EFFECTIVE AND DEEPER COLLABORATIONS WITH RESEARCHERS FROM HBCUs, HISTORICALLY BLACK COLLEGES AND UNIVERSITIES, FROM TCUs, TRIBAL COLLEGES AND UNIVERSITIES, AND FROM MSI OR MINORITY-SERVING INSTITUTION. THE SCOPE OF THE RESEARCH PROGRAM OVERALL IS ONE OF BEING ABLE TO FOSTER ESSENTIAL LEADERSHIP SKILLS AND KNOWLEDGE, IMPLEMENT TEAM SCIENCE STRATEGIES TO PROVIDE FLUBBING OF INFRASTRUCTURE TO FOSTER MULTI-DISCIPLINARY COLLABORATION AND IMPROVE DIVERSITY. THAT'S THE MEAT AND POTATOES OF THIS RFA. I HAD A COUPLE COMMENTS, SOME OF THEM WERE ADDRESSED BY PROGRAM. ONE WAS THAT WHY WEREN'T HSIs, HISPANIC-SERVING INSTITUTIONS MENTIONED, SIMPLY AN OVERSIGHT. WHO WOULD BE RESPONSIBLE FOR CONNECTIONS TO MINORITY INSTITUTIONS? AND THAT WAS PROVIDED, CLARITY WAS PROVIDED BY PROGRAMMING, THAT WOULD BE AT THE INDIVIDUAL SITE LEVEL. ALSO ARE THERE EXPECTATIONS FOR LEADERSHIP AND CAREER MANAGEMENT, AND, YES, THERE ARE. THAT'S GOING TO BE DONE AT THE SITE LEVEL. ALSO, ONE COMMENT THAT I PROVIDED WAS ABOUT WHETHER THERE WOULD BE SUPPORT FOR ADDITIONAL INTERACTIONS, OTHER THAN JUST THE GSA YEARLY MEETINGS WHICH I KNOW THE RCMAR TEAM THERE, AND THAT WILL BE SOMETHING THAT IS TAKEN INTO CONSIDERATION. AND LASTLY, I OFFERED THIS PIECE OF IT. I THINK IT'S ONE WAY WE CAN REALLY THINK ABOUT WAYS WE CAN MAKE THE KINDS OF INTERACTIONS, CONNECTIONS, AND KNOWLEDGE SHARED ACROSS THE RCMARs, TO CREATE ONLINE CONTENT, PERHAPS CREATING MICROCREDENTIALS THAT COULD BE SHARED, THE CONTENT COULD BE SHARED, MICROCREDENTIALS SHARED, RUN BY A COORDINATING CENTER. THOSE WERE MY COMMENTS AND I SUPPORTED THIS CONCEPT. >> THANK YOU. ARE THERE OTHER COMMENTS OR ADDITIONS FROM COUNCIL? OKAY. SO HEARING OR SEEING NONE, SOUND LIKE THERE'S CONSIDERABLE ENTHUSIASM FOR MOVING THIS CONCEPT FORWARD. I'D LIKE TO ASK FOR A VOTE ON APPROVAL. >> SO MOVED. >> ALL THOSE IN FAVOR? >> AYE. >> AYE. >> ALL THOSE OPPOSED? GREAT. IF NOT, WE WILL MOVE TO THE LAST APPLICATION FROM THE DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH. THE TITLE OF THIS CONCEPT IS PREDICTING EARLY ALZHEIMER'S DISEASE AND RELATED DEMENTIA IN DIVERSE POPULATIONS. THE PRIMARY REVIEWER IS ERIC REIMANN, SECOND WAS JENNIFER MANLY. DR. REIMANN, IF YOU WILL START BY SUMMARIZING THE NATURE OF THIS CONCEPT AND THE DISCUSSION. >> THANK YOU, MONICA. I'LL TAKE A LITTLE BIT MORE TIME THAN USUAL TO SUMMARIZE THE CONCEPT, AND THE DISCUSSION. THIS CONCEPT IS A GRAND CHALLENGE THAT WOULD CAPITALIZE ON THE PRIZE COMPETITION MECHANISM IN THE AMERICA COMPETES ACT TO FIND BETTER WAYS TO DETECT SUBTLE CHANGES ASSOCIATED WITH PRE-CLINICAL ALZHEIMER'S DISEASE AND RELATED DEMENTIA IN DIVERSE POPULATIONS. THE COMPETITION WOULD PROVIDE THREE SEQUENTIAL CHALLENGES THAT WOULD HAVE THE GOALS OF PROVIDING COGNITIVE CLINICAL EHR CLAIMS, BIOMARKERS, AND OTHER KINDS OF DATA FROM DIVERSE POPULATIONS, TO HELP UNDERSTAND AND ADDRESS POTENTIAL BIASES, MAKE THOSE DATA WIDELY AVAILABLE THROUGH TRUSTED REPOSITORIES, ESTABLISH ABILITY OF ARTIFICIAL INTELLIGENCE MACHINE LEARNING AND OTHER PREDICTIVE ALGORITHMS TO CHARACTERIZE THE EARLIEST MANIFESTATIONS OF ALZHEIMER'S DISEASE, EXPLAIN TO STAKEHOLDERS HOW ALGORITHMS REACH THEIR CONCLUSIONS, AND DEMONSTRATE THEIR ABILITY TO CHARACTERIZE INDIVIDUALS FREE FROM RACIAL, ETHNIC SOURCE OR ALGORITHMIC BIASES. THE GRAND CHALLENGE WAS DEVELOPED IN RESPONSE TO NACA MILESTONE 14-POINTC, RELATED RECOMMENDATION ALSO FROM THE 2019 DIVISION OF NEUROSCIENCE REVIEW COMMITTEE, WHICH SEEKS TO CAPITALIZE ON NOVEL DISRUPTIVE SCIENCE THAT WOULD INCENTIVIZE INDIVIDUALS TO ADOPT COLLABORATIVE AROACH TO RESEARCH THROUGH USE OF TARGETED SMALL FUNDING SCHEMES. COUNCIL MEMBERS EXPRESSED SUPPORT FOR THIS EXCITING CONCEPT, BUT NOTED THE DEVELOPMENT OF PREDICTIVE ALGORITHMS FOR DETECTION OF PRE-CLINICAL ALZHEIMER'S DISEASE DEPEND ON SUFFICIENT AMOUNT OF BIOMARKER DATA TO RELATE THESE ALGORITHMS TOP DIAGNOSIS OF PRE-CLINICAL ALZHEIMER'S DISEASE, AND/OR TO PREDICT -- DATA TO PREDICT SUBSEQUENT PROGRESSION TO CLINICAL STAGES OF DISEASE INDEPENDENT MUCH KNOWING WHO DOES OR DOES NOT HAVE PRE-CLINICAL ALZHEIMER'S DISEASE. IN DIVERSE POPULATIONS, INCLUDING HAVING SUFFICIENT AMOUNT OF DATA FROM UNDERREPRESENTED GROUPS. WHILE THERE MAY BE SUFFICIENT DATA TO ENABLE PREDICTIVE ALGORITHMS TO INFORM COGNITIVELY UNIMPAIRED PERSONS PROGNOSIS, WITHOUT KNOWING WHETHER OR NOT THEY HAD PRE-CLINICAL ALZHEIMER'S DISEASE, THERE MAY NOT BE SUFFICIENT BIOMARKER DATA JUST YET IN UNDERREPRESENTED GROUPS. AND INSUFFICIENT NUMBERS OF PERSONS FROM UNDERREPRESENTED GROUPS HAVE PET OR CSF BIOMARKERS TO CONFIRM PRE-CLINICAL ALZHEIMER'S DISEASE, USING THESE STANDARDS OF TRUTH. EMERGING BLOOD-BASED BIOMARKERS ONCE VALIDATED AND SHOWN TO BE GENERALIZABLE TO UNDERREPRESENTED GROUPS WHICH MAY HAPPEN IN THE NEXT ONE TO TWO YEARS, IF SHOWN TO BE ROBUST COULD ADDRESS THIS ISSUE. THERE SHOULD BE EFFORT INDEPENDENT OF CONCEPT TO ENSURE BLOOD SAMPLES ARE AVAILABLE AND THEN SUITABLE BLOOD-BASED BIOMARKERS DEPLOYED FIRST IN A SCALABLE WAY, SUCH THAT THE CONCEPT COULD PROCEED LATER, HOPEFULLY IN THE NEXT TWO YEARS, AND HAVE A GREATER CHANCE OF SUCCESS. >> THANK YOU VERY MUCH. SO, YES, THIS WAS A CONCEPT WHERE THERE WAS CONSIDERABLE DISCUSSION. DID OTHER MEMBERS OF THE COUNCIL WANT TO COMMENT ON THIS? I'M SORRY, I HAVE TO CHANGE MY VIEW. >> MY ONLY COMMENT, DR. DRISCOLL, I THINK THERE WAS A LOT OF ENTHUSIASM ABOUT THE CHALLENGE IDEA, IN THE PAST THESE CHALLENGES HAVE REALLY PROVIDED A WAY FOR TEAMS THAT WOULDN'T NORMALLY GET INVOLVED IN ALZHEIMER'S DISEASE RESEARCH TO ENGAGE, AND THAT THE TEAMS WOULD BE MULTI-DISCIPLINARY. I DO WANT TO DOUBLE DOWN ON SOMETHING THAT YOU SAID, WHICH IS THAT RIGHT NOW A LOT OF THE MULTI-LEVEL DATA THAT WOULD BE NEEDED TO DEVELOP A REALLY STRONG PREDICTIVE MODEL MAY NOT BE THERE, ESPECIALLY FOR GROUPS THAT EXPERIENCE HIGHER RISK OF DEVELOPING ALZHEIMER'S DISEASE AND DEMENTIA. AND SO, YOU KNOW, WE LOOK FORWARD TO THE CONCEPT CLEARANCE, YOU KNOW, BEING VERY CLEAR ABOUT WHERE THESE DATA WOULD COME FROM AND AT WHAT POINT THE WORK CAN ADVANCE, IF THERE ISN'T THE AMOUNT OF DATA OR THE SOPHISTICATION OF DATA THAT IS NECESSARY TO DEVELOP THESE MODELS. >> THANK YOU. ARE THERE OTHER COMMENTS? OH, MERRYL PLEASE. >> I WOULD LIKE TO SAY WITH THE CHALLENGE AND OPPORTUNITY TO HAVE CROSS-FUNCTIONAL TEAMS, WHAT THE STUDIES HAVE SHOWN IS THAT IT ALSO LEVELS THE PLAYING FIELD FOR WOMEN RESEARCHERS. SO I THINK THAT DYNAMIC SHOULD BE RECOGNIZED FOR THE YOUNGER INVESTIGATORS. >> THANK YOU. OTHER COMMENTS? I THINK, YOU KNOW, IN THIS CASE IT SOUNDS LIKE, AGAIN, AS DR. MANLY WAS SAYING, THERE'S A LOT OF ENTHUSIASM FOR THE CHALLENGE IDEA AND THE STRUCTURING OF THE APPROACH, BUT THERE'S SOME CONCERNS ABOUT WHETHER IT'S THE STARTING MATERIALS ARE THERE TO ACTUALLY MOVE FORWARD. AND SO I'M WONDERING IF THE TWO REVIEWERS WANT TO SPECIFICALLY STATE WHAT THE MOTION IS THAT WE -- OR WHAT COUNCIL'S VOTE ON THIS IS -- WHAT YOU'RE OF YOUR PERCEPTION OF THAT IS. >> I WOULD LIKE TO COMMEND NIA FOR BRINGING THIS CHALLENGE FORWARD. I WOULD LIKE TO POSTPONE THE DECISION TO A FUTURE TIME TO CONSIDER THE CHALLENGE ONCE SOME OF THE OTHER ISSUES ARE ADDRESSED, AND HOPE THAT WE WOULD BE ABLE TO SEE THE -- REVISIT THE CHALLENGE WITHIN THE NEXT TWO YEARS. SO I'D LIKE TO PROPOSE THAT WE -- THAT CONTINUED ACTION HAPPEN THAT WE ULTIMATELY SEE THIS BUT THAT WE POSTPONE APPROVAL AT THIS TIME. >> I AGREE. AND I ESPECIALLY AGREE WITH THE COMMENDING OF THE -- OF NIA PROGRAM FOR INNOVATING THIS IDEA, ALWAYS THINKING ABOUT INNOVATION, AND THE SPIRIT BEHIND THIS IS ABSOLUTELY ON POINT. AND LOOK FORWARD TO WORKING ON THE DETAILS. >> THE MOTION OTHER VOTE ON THIS PARTICULAR CONCEPT IS TO POSTPONE, I DON'T KNOW, KEN, IF THAT'S THE CORRECT TERMINOLOGY, BUT THAT WOULD BE THE RECOMMENDATION. >> I THINK DEFER IS PROBABLY CORRECT. >> DEFER, OKAY. SO THE VOTE IS WHETHER THE COUNCIL APPROVES TO DEFER THIS PARTICULAR CONCEPT. >> ONE COMMENT. >> PLEASE. >> THANK YOU. THEY COULD POSTPONE, I AGREE WITH THAT. >> JULIE, I'M HAVING A TINY BIT OF TROUBLE HEARING YOU CLEARLY. >> OH. CAN YOU HEAR ME NOW? >> MUCH BETTER, THANK YOU. >> OKAY. SO, I AGREE WITH THE WAY IT'S CURRENTLY WRITTEN THAT IT WOULD NEED TO BE POSTPONED, BUT COULD ALSO CONSIDER RESTRUCTURING THE PROPOSAL INTO -- RATHER THAN NECESSARILY PRE-CLINICAL, INTO VERY MILD CLINICAL DISEASE OR, YOU KNOW, RISK FACTORS. I DO THINK THERE COULD BE SPACE FOR THIS, IF THEY MOVE OUT OF THE PRE-CLINICAL SPACE. THERE WOULD BE SPACE SOONER FOR DOING SOME OF THESE INVESTIGATIONS. >> OKAY. THANK YOU. I THINK -- SO, AGAIN, KEN CAN COMMENT ON THE OFFICIAL THINGS WE CAN AND CAN'T DO. I THINK WE'RE PRETTY MUCH BOUND TO VOTE ON THE CONCEPT OR THE CONCEPT CONSEQUENT TO DISCUSSION WITH PROGRAM. SO, YEAH, IS THAT CORRECT, KEN? >> YES. I'VE TAKEN NOTE OF ALL THE COMMENTS AND CONSIDERATIONS. WE'LL BRING THAT BACK TO PROGRAM. AND THEN WE CAN CIRCLE BACK WITH THE COUNCIL MEMBERS AT A FUTURE TIME. >> THANK YOU. ARE THERE OTHER COMMENTS ON THIS? HEARING AND SEEING NONE, I WOULD LIKE TO JUST SUMMARIZE THAT WE'RE ABOUT TO VOTE ON WHETHER TO DEFER THIS PARTICULAR CONCEPT. SO, ALL THOSE IN FAVOR OF A DEFERRAL? >> AYE. >> AYE. >> AYE. >> AYE. >> AYE. >> ANY OPPOSED? OKAY. NOT HEARING ANY, WE ARE MOVING TO THE NEXT SET OF CONCEPTS, WE HAVE ONE FROM DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY. LET ME JUST PULL UP -- YEAH, THERE WE GO. THE TITLE IS OPTIMIZATION AND PERSONALIZATION OF DIAGNOSTIC TESTS FOR AD/ADRD IN OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS, THE PRIMARY REVIEWER WAS DAVID REUBEN, SECOND WAS JENNIFER MANLY. DR. RUBEN, IF YOU CAN SUMMARIZE THE CONCEPT AND THE DISCUSSION FROM YESTERDAY. THANKS. >> THANK YOU. IT'S VERY TIMELY SINCE THIS IS A CONCEPT CLEARANCE THAT WAS DEFERRED LAST TIME. AND THE NIA PROGRAM STAFF HAVE WORKED ON IT, AND BOTH MYSELF AND SPEAKING FOR JENNIFER, BOTH FELT IT WAS CONSIDERABLY APPROVED BY ITERATIVE PROCESS OF GETTING FEEDBACK FROM COUNCIL AND THEN REDOING IT. IN THE NEW CONCEPT, THE FOCUS IS NARROWED TO DIAGNOSTIC TESTING, IN MCC, AND ALTHOUGH DIAGNOSTIC TESTING HAS NOT BEEN AS HELPFUL AS WE WOULD HOPE, IN THE CURRENT MANAGEMENT OF ALZHEIMER'S AND RELATED DEMENTIAS, AS NEW THERAPEUTICS (INAUDIBLE) THIS MAY BE INCREASINGLY IMPORTANT, PARTICULARLY IF THOSE THERAPEUTICS TURN OUT TO BE EFFECTIVE. IT ALSO MAY HELP CLARIFY THE ROLE OF THE ALZHEIMER'S DISEASE VERSUS THE ROLE OF MCCs IN DETERMINING THE FUNCTIONAL AND OTHER IMPAIRMENTS THAT ARE ASSOCIATED WITH DEMENTIA. FINALLY, THE OTHER THING THAT WE THOUGHT WAS REALLY VALUABLE IS THIS WOULD PROVIDE TREMENDOUS INFORMATION ABOUT HELPING CMS IN POLICY DECISIONS REGARDING COVERAGE OF DIAGNOSTIC TESTING. RIGHT NOW COVERAGE IS EXTREMELY LIMIT OF LIMITED FOR LARGE SEGMENTS OF THE POPULATION, WE THOUGHT THAT WAS VALUABLE. WE THOUGHT THE SET ASIDE AND MECHANISM OF DOING THIS R24 WAS APPROPRIATE AND GENERAL DISCUSSION WAS QUITE SUPPORTIVE OF THIS. >> FANTASTIC. ARE THERE OTHER COMMENTS FROM COUNCIL ON THIS PARTICULAR CONCEPT? OKAY. HEARING OR SEEING NONE, I WOULD LIKE FOR US TO MOVE FORWARD AND VOTE ON THIS, THE VOTE IS TO APPROVE THIS PARTICULAR CONCEPT CLEARANCE. AL THOSE IN FAVOR? >> AYE. >> AYE. >> AYE. >> ANY OPPOSED? OKAY. SO THIS CONCEPT MOVES FORWARD AS ACCEPTED BY COUNCIL. OKAY. SO THE NEXT GROUP IS FROM THE DIVISION OF NEUROSCIENCE. THE FIRST CONCEPT THAT WE'LL CONSIDER IS PRECISION MEDICINE APPROACHES IN ADDRESSING AD/ADRD MINORITY AND HEALTH AND HEALTH DISPARITIES. PRIME REVIEWER WAS JENNIFER MANLY, SECONDARY WAS KEITH WHITFIELD. DR. MANLY, IF YOU CAN SUMMARIZE THE CONCEPT AND THE DISCUSSION FROM YESTERDAY. >> YES, SO THIS IS A CONCEPT CLEARANCE FOR UH2/UH3 AWARDS, THAT WOULD ENCOURAGE DEVELOPMENT OF STUDIES CAPABLE OF INVESTIGATING PRECISION MEDICINE AND THAT IS TREATMENT, PREVENTION, AND INTERVENTION METHODS THAT ADDRESS CAUSAL PATHWAYS THAT INFLUENCE DISPARITIES IN AD AND ADRD, SO FOCUSED ON DISPARITIES IN AD AND ADRD AND HAS A PRECISION MEDICINE CONCEPT GOING THROUGH IT. THE CONCEPT CLEARANCE DESCRIPTION AND THESE AWARDS REALLY CENTER THE NIA HEALTH DISPARITIES FRAMEWORK, AS FUNDAMENTAL TO THE RATIONALE FOR THE FUNDING OPPORTUNITY. THE RESEARCH QUESTIONS PROPOSED UNDER THE MECHANISM CAN SUPPORT EMERGING AD OR ADRD STUDIES OR ESTABLISHED STUDIES NOT CURRENTLY A.D. FOCUSED BUT HAVE POTENTIAL TO ADD KNOWLEDGE ABOUT ALZHEIMER'S DISEASE. FIRST PHASE OF EACH STUDY WOULD BE PLANNING OR EXPLORATORY. THAT'S THE UH2 PHASE. AND CAN INCLUDE DEVELOPMENT OF NEW TOOLS OR METHODS, DATA COLLECTION, ENGAGEMENT OF MEANINGFUL STAKEHOLDERS WHICH IS INCREDIBLY IMPORTANT IN DISPARITIES RESEARCH. AND WHILE -- AND THE PROCESS DURING THE UH2 PERIOD OF THE AWARD IS REALLY DESCRIBED AS A COMMUNITY ENGAGED APPROACH. SO, MINORITIYIZED COMMUNITIES WOULD BE CENTERED AT EARLY STAGE IN THE PROJECTS. CONCEPT CLEARANCE DESCRIBES THE DEFINITION OF INTERSECTIONALITY, HOW THAT WOULD BE IMPLEMENTED BY RESEARCHERS AT THIS DEVELOPMENT STAGE. THE CONCEPT CLEARANCE ALSO DESCRIBES HOW THE CONCEPT OF RESILIENCE IN MINORITIZED POPULATIONS, RESEARCH IN DEVELOP DEVELOPMENTAL STAGE CAN ADDRESS ISSUES. TEAMS BEING CALLED FOR ARE DESCRIBED AS TRANSFORMATIVE, MULTI-DISCIPLINARY, AND THEY CAN INTEGRATE NEUROSCIENCE WITH GENETIC OR BIOLOGICAL, ENVIRONMENTAL, BEHAVIORAL AND SOCIAL SCIENCE TO ADVANCE UNDERSTANDING OF THESE CAUSAL PATHWAYS AT THE MULTIPLE LEVELS JUST LIKE WHAT WE ALL KNOW IS DESCRIBED IN THE NIA HEALTH DISPARITIES FRAMEWORK. HEARKENING BACK TO DR. WHITFIELD'S SUMMARY OF HIS TALK TO US, THE CONCEPT CLEARANCE STATES THAT THE PROPOSED RESEARCH CAN FOCUS ON MULTIPLE OR SINGLE MINORITIZED POPULATIONS OR SUBGROUPS WITHIN THESE POPULATIONS. THE APPLICATION STATES THAT MEMBERS OF THE INVESTIGATIVE TEAM SHOULD DEMONSTRATE BEFORE APPLYING A TRACK RECORD OF WORKING WITH COMMUNITIES IN AN ENGAGED WAY TO DEVELOP RESEARCH PRIORITIES. THE COUNCIL FELT THAT THIS WAS AN EXTREMELY TIMELY TOPIC THAT THERE WERE A NUMBER OF MILESTONES AND PRIORITIES AT NIA THAT WERE ADDRESSED BY THIS TOPIC. WE WERE ALL VERY EXCITED ABOUT IT. AND THAT THE COOPERATIVE UH2/UH3 PHASED COOPERATIVE AGREEMENT MECHANISM WAS APPROPRIATE FOR THIS CALL FOR APPLICATIONS, FIRST HAVING A FEASIBILITY STAGE, AND THEN HAVING A PILOT DATA COLLECTION PHASE. SO, THAT SUMMARIZES THE CONCEPT CLEARANCE, OUR DISCUSSION WAS THAT IT WAS REALLY EXCITING. AND THAT'S MY SUMMARY. >> GREAT. THANK YOU VERY MUCH. DOES COUNCIL HAVE ANY ADDITIONAL COMMENT ON THIS CONCEPT? >> MONICA, I WAS SECONDARY ON THAT, THE ONLY THING I WOULD ADD IS THAT I JUST ADDED A COMMENT ABOUT MAKING SURE THERE WAS APPROPRIATE ATTENTION TO SUBJECT RECRUITMENT, JUST GIVEN THE CHALLENGES THAT THAT CAN BE IN SOME MINORITY POPULATIONS, BUT I FELT CONFIDENT FROM THE RESPONSE FROM PROGRAM THAT THAT WAS GOING TO BE ADDRESSED. >> GREAT. EXCELLENT. VERY GOOD POINT. OTHER COMMENTS? OKAY. NOT HEARING ANY, I WOULD MOVE TO ACCEPT THIS CONCEPT CLEARANCE. THOSE WHO ARE IN FAVOR, AYE? >> AYE. >> AYE. >> AYE. >> ANY OPPOSED? OKAY. NOT HEARING ANY OPPOSITION, THIS CONCEPT MOVES FORWARD AS APPROVED BY COUNCIL. WE'LL MOVE TO THE NEXT APPLICATION, NEURONAL VULNERABILITY TO PROTEINOPATHIES IN ALZHEIMER'S DISEASE AND ALZHEIMER'S DISEASE-RELATED DEPARTMENTS. DR. HUANG, IF YOU WANT TO SUMMARIZE THE CONCEPT AND THE DISCUSSION FROM YESTERDAY. >> YES. SO, THIS CONCEPT CLEARANCE PROPOSED TO USE THE R01 ACTIVITY CODE TO SUPPORT SPECIFY PROJECTS, CHARACTERIZING NEURONAL AND GLIAL CELL POPULATION SELECT OR VULNERABLE TO PROTEINOPATHY, AD AND ADRD. REVIEWERS ON COUNCIL GENERALLY AGREED THIS COUNSEL CLEARANCE TARGETED ONE VERY IMPORTANT UNANSWERED QUESTION IN THIS FIELD. AND ESPECIALLY RECOGNIZED THIS IS TIMELY, ESPECIALLY DUE TO THE CURRENT ADVANCEMENT OF SINGLE CELL TRANSCRIPTOMIC EPIGENOMIC AND SPATIAL TECHNOLOGY WHICH NOW CAN USE TO CHARACTERIZE CELL TIMES AT A MOLECULAR LEVEL AND RESOLUTION. SO, THE REVIEWER AND COUNCIL ALSO RECOGNIZED VERY UNIQUE FEATURE IN THIS CONCEPT CLEARANCE THAT IS ENCOURAGE COLLABORATION WITH INVESTIGATORS WHO ARE CURRENTLY FUNDED BY THE BRIDGE INITIATIVE AND ALSO VIEWED ON EXISTING REFERENCE BRAIN ATLAS AND DATABASE AND ALSO ENCOURAGING GENERAL SHARE OF THE DATA. SO, DURING THE DISCUSSION THERE WAS ONE CLEARANCE REQUIRED, AND THE PROGRAM OFFICER ADDRESSED THAT VERY CLEARLY. THAT IS WHETHER THIS CONCEPT ONLY COVER THE TAUOPATHY OR OTHEROPATHYS, PROTEINOPATHIES, INCLUDING TGP 43 OR ALPHA-SYNUCLEIN, AND THE PROGRAM OFFICER ADDRESSED CLEARLY NOT JUST TAUOPATHY BUT OTHER PROTEINOPATHIES, SO THE SUMMARY THE COUNCIL WAS VERY SUPPORTIVE OF THE CONCEPT CLEARANCE. >> THANK YOU VERY MUCH. ARE THERE OTHER COMMENTS ON THIS CONCEPT? OKAY, NOT HEARING OR SEEING ANY, I WOULD INVITE PEOPLE TO VOTE ON THE APPROVAL OF THIS CONCEPT. ALL THOSE IN FAVOR? >> AYE. >> AYE. >> AYE. >> AYE. >> ANY OPPOSED? OKAY. SO NOT HEARING ANY, THIS CONCEPT IS APPROVED BY COUNCIL VOTE. THE NEXT APPLICATION -- THE NEXT CONCEPT IS DEMONSTRATION PROJECTS TO PROMOTE ALLS OF INTERPRACTICABLE HEALTH RECORDS IN CLINICAL RESEARCH IN OLDER ADULTS. THE PRIMARY REVIEWER WAS DAVID REUBEN, SECOND REVIEWER WAS ERIC REIMANN. DR. REUBEN IF YOU CAN SUMMARIZE THE CONCEPT AND NATURE OF DISCUSSION. >> THIS IS A VERY INTERESTING CONCEPT. IT ADDRESSES AN ISSUE THAT HAS REALLY BEEN DEFICIENCY AND PROBLEM WITH HOW ELECTRONIC HEALTH RECORDS HAVE BEEN DEVELOPED IN THE UNITED STATES. THEY ARE NOT VERY INTEROPEARABLE, NUMBER ONE. NUMBER TWO, THEY DON'T COLLECT DATA, VERY IMPORTANT DATA, USING DEFINED FIELDS THAT ARE EXPORTABLE. SO THIS ATTEMPTS TO REMEDY SOME OF THIS BY ALLOWING RESEARCH PARTICIPANTS TO DONATE THEIR ELECTRONIC HEALTH RECORD, AND THEN HAVING THE AWARDEES, GRANT AWARDEES, CREATE ESSENTIALLY A DATABASE OF THE INFORMATION PARTICULARLY RELATED TO MEDICAL HISTORY, MEDICAL CONDITIONS, SELF-REPORTED CONDITIONS, THAT WILL BE VERY USEFUL TO THE RESEARCH. ONE OF THE CAVEATS, IT HAS TO BE ABLE TO ACCOMMODATE ALL OF THESE ELECTRONIC HEALTH RECORDS. FOUR ACCOUNT FOR 77% OF ALL ELECTRONIC HEALTH RECORDS IN THE UNITED STATES. THIS WAS SUPPORTED IN GENERAL IN THE DISCUSSION, AND BY DR. REIMANN AS WELL. WE ALSO -- ANY LED TO INTERESTING QUESTION ABOUT GETTING THE EHR VENDORS INVOLVED IN THIS, AND TO DATE NONE OF THE MAJOR VENDORS HAVE ACTUALLY BEEN LEADS IN NIA GRANTS, BUT IN FACT COLLABORATION WITH THEM WOULD BE VERY VALUABLE. THAT'S ANOTHER WAY TO APPROACH THIS DEFICIENCY OF GETTING CLINICAL DATA INTO CLINICAL RESEARCH. SO OVERALL WE WERE QUITE SUPPORTIVE OF THIS. THE MECHANISM WILL BE THROUGH THE R01 ACTIVITY CODE, AND IT'S ANTICIPATED SOME OF THESE WILL BE ALZHEIMER'S AND DEMENTIA, DISORDERS RELATED, AND SOME OF THEM WON'T. >> OKAY. THANK YOU VERY MUCH. ARE THERE OTHER COMMENTS FROM COUNCIL? NOT HEARING ANY, I WOULD PROPOSE THAT WE VOTE TO ACCEPT THIS CONCEPT CLEARANCE. IN FAVOR? >> YES. >> AYE. >> AYE. >> ANY OPPOSED? OKAY. THEN THIS CONCEPT MOVES FORWARD AS APPROVED BY COUNCIL. THE FINAL CONCEPT CLEARANCE HAS A LOT OF LETTERS IN THE TITLE, AND IS NIA, AD, ADRD, SBIR, STTR REISSUE, ADVANCING RESEARCH ON AD AND ADRD. THE PRIMARY REVIEWER WAS DR. REIMANN, SECONDARY WAS DR. COMER, DR. REIMANN, SUMMARIZE THE CONCEPT AND DISCUSSION FROM YESTERDAY. >> THANKS, MONICA. THIS CONCEPT WOULD REISSUE THE SMALL BUSINESS INNOVATION RESEARCH, SMALL BUSINESS TECHNOLOGY TRANSFER PROGRAMS FOR ALZHEIMER'S DISEASE, ALZHEIMER'S DISEASE RELATED DEMENTIAS. BEFORE THEY ARE SET TO EXPIRE IN SEPTEMBER 2022. SBIR AND STTR GRANTS SUPPORT THE DEVELOPMENT OF PRODUCTS OR SERVICES IN AREAS OF ALZHEIMER'S DISEASE AND RELATED DEMENTIA TREATMENT, PREVENTION, DIAGNOSIS, CARE, RESEARCH, AND CLINICAL TOOLS. PHASE 1 GRANTS ARE INTENDED TO DEMONSTRATE TECHNICAL MERIT AND FEASIBILITY OF THE PRODUCT OR SERVICE AND QUALITY PERFORMANCE OF THE SMALL BUSINESS ITSELF, WHEREAS THE PHASE 2 AND 2B GRANTS ARE INTENDED TO FURTHER DEVELOP THE PRODUCT OR SERVICE, PROPOSED PROGRAMS WOULD CONTINUE TO USE CONGRESSIONALLY MANDATED SET-ASIDE FUNDS, AVERAGING $20 MILLION PER YEAR FOR SBIR GRANTS AND $4 MILLION PER YEAR FOR STTR GRANTS, THE GRANTS ARE CAPPED AT 500K, TOTAL COST, 2.5 MILLION FOR PHASE 2, $3 MILLION FOR PHASE 2B STUDIES. THE PROGRAM ALSO CAPITALIZES ON CONFERENCES, WORKSHOPS, NUMEROUS INDIVIDUAL INTERACTIONS TO REACH OUT TO EDUCATE AND HELP TRAIN POTENTIAL APPLICANTS, RESULTING IN IMPROVEMENT IN APPLICATION QUALITY IN THE LAST THREE YEARS. SINCE THE ORIGINAL FOAs THAT WERE ISSUED IN 2017, THERE WAS 184% INCREASE IN THE NUMBER OF THESE GRANTS. COUNCIL MEMBERS EXPRESS STRONG SUPPORT FOR THE REISSUE, AND IT WAS NOTED THAT IN THOSE INSTANCES IN WHICH BUDGETARY LIMITATIONS MIGHT PREVENT BUSINESSES FROM ACHIEVING THEIR SCIENTIFIC GOALS WITH ADEQUATE POWER, THERE WERE OTHER MECHANISMS THAT COULD BE PURSUED INDEPENDENT OF THIS. SO THERE WAS A STRONG SUPPORT FOR THE REISSUE OF THESE PROGRAMS. >> THANK YOU. IS THERE OTHER COMMENT ON THIS CONCEPT? >> IF I COULD ALSO MENTION ONE OTHER THING DURING THE DISCUSSION, MEMBERS ALSO NOTED THE OPPORTUNITY TO LEVERAGE BUSINESS-RELATED GRANTS AND OTHER MECHANISMS, TO FOSTER INNOVATION, ALSO THE INCLUSION OF FEMALE INVESTIGATORS AND INVESTIGATORS FROM UNDERREPRESENTED GROUPS. AND IT WAS -- WE HAD A NICE DISCUSSION ABOUT WHAT NIA HAS BEEN DOING IN THAT REGARD. >> THANK YOU. MERYL? >> YES, JUST RESPECTFULLY, I CANNOT CLAIM TO BE A DOCTOR OR Ph.D., SO FOR THE RECORD, BUT THANK YOU. >> YES, YOU CERTAINLY IN OUR EYES ARE ABOVE DOCTOR LEVEL. SO THANK YOU. OTHER COMMENTS OR QUESTIONS? IF NOT, I WOULD LIKE TO INVITE A VOTE ON THIS CONCEPT FOR WHICH THERE WAS CONSIDERABLE POSITIVE ENTHUSIASM. ALL THOSE WHO ARE IN FAVOR OF ACCEPTING THIS CONCEPT? >> AYE. >> AYE. >> AYE. >> AYE. >> OKAY. ANY OPPOSED? >> AYE. >> OKAY. I'M NOT SURE IF THAT NEEDS TO BE NOTED. BUT IT SEEMS, KEN, THAT THE MAJORITY VOTE IS IN FAVOR OF ACCEPTING THIS CONCEPT. >> OKAY. >> YEAH. AND THEN I THINK WE ARE DONE WITH THE CONCEPTS. THANK YOU ALL, REVIEWERS, AND PANEL MEMBERS, FOR REALLY INTERESTING AND I THINK CONSTRUCTIVE DISCUSSION. >> YES, I WOULD LIKE TO THANK MONICA FOR HER LEADERSHIP ON WORKING GROUP AND THANK ALL THE MEMBERS FOR THEIR REVIEWS OF THESE CONCEPTS. I WANT TO REMIND EVERYONE THAT THESE CONCEPTS THAT ARE APPROVED BY COUNCIL WILL BE PUBLISHED ON OUR WEBSITE, SO IF YOU JUST GOOGLE NIA CONCEPTS, HOPEFULLY WITHIN THE WEEK THEY WILL BE UP, WITH MORE LENGTHY SUMMARY OF THE CONCEPTS THEMSELVES AND A PROGRAMMATIC CONTACT FOR EACH OF THEM SO IF YOU'D LIKE TO HAVE FURTHER DISCUSSION WITH PROGRAM ON ANY OF THESE PLEASE CONTACT THEM SO THEY WILL BE PUBLISHED ON OUR WEBSITE. YOU CAN GET AN EARLY START THINKING ABOUT PERHAPS PROPOSALS IN A -- THAT YOU WOULD LIKE TO START INITIATING. ALL RIGHT. SO, NEXT IN OUR AGENDA IS OUR NEXT THREE SPEAKERS, BUT BEFORE WE DO THAT I'D LIKE TO GIVE EVERYONE A FIVE-MINUTE BREAK TO STRETCH YOUR LEGS, SO IT IS NOW 11:50 EASTERN TIME. I'D LIKE TO GIVE EVERYONE FIVE MINUTES. WE'LL RECONVENE AT 11:55, AND WE WILL START WITH OUR NEXT SPEAKER >> WELCOME BACK. WE'LL CONTINUE WITH OUR OPEN SESSION. I'D LIKE TO TURN THIS OVER TO DR. HODES TO INTRODUCE OUR FIRST SPEAKER. RICHARD? >> YES, IT'S A PLEASURE TO INTRODUCE DR. CLINTON WRIGHT FROM NINDS, A VERY IMPORTANT TOPIC AS WE'RE COPING WITH ACUTE IMPACT OF SARS-COV-2 INFECTIONS, IT'S CLEAR SEQUELAE INFECTION HAVE BEEN PROMINENT, PREDOMINANT, A SOURCE OF ONGOING RESEARCH, CLINT HAS BEEN ONE OF THE CO-LEADS IN THIS INITIATIVE, NIH RECOVER INITIATIVE AND WILL SPEAK TO US TODAY. >> IT'S A PLEASURE TO BE HERE. CAN YOU HEAR ME? >> LOUD AND CLEAR. >> FANTASTIC. YES, THANK YOU FOR INVITING ME TO TALK TO YOU TODAY ABOUT POST-ACUTE SEQUELAE OF COVID AND RECOVER INITIATIVE, FIRST TALKING ABOUT THE DEFINITION BECAUSE THERE ARE A NUMBER OF DEFINITIONS OUT THERE AND I THINK A LOT OF PEOPLE HEARD THE TERM LONG COVID USED BUT THE NIH IS USING POST-ACUTE SEQUELAE OF COVID TO INCLUDE DIFFERENT CONCEPTS LIKE MULTI-INFLAMMATORY SYNDROME IN ADULTS AND CHILDREN, AS WELL AS VERY INTERESTING PROBLEM OF CONDITIONS THAT MAY ARISE AS A CONSEQUENCE OF SARS-COV-2 INFECTION THAT MIGHT BE DIABETES OR MIGHT BE SOME OTHER RISK FACTOR THAT MAY LEAD TO OTHER ORGAN DAMAGE. CLEARLY SYMPTOMS CAN RANGE FROM MILD TO SEVERE, AND SO THAT REALLY NEEDS TO BE UNDERSTOOD MUCH BETTER, AND A BROADER TERM I THINK IS GOING TO BE HELPFUL WITH THAT. AND AGAIN MANY SYMPTOMS HAVE BEEN DESCRIBED OVER THE YEARS. SORRY, OVER THIS ACUTE PANDEMIC. YOU COULD SEE SOME THEM LISTED HERE, THIS IS ONLY REALLY A SHORT LIST. AND THE UNDERSTANDING IS QUITE LIMITED BECAUSE OF THE VERY SHORTENED TIME FRAME THAT WE'VE HAD TO STUDY THIS PROBLEM. >> I'M SORRY, DR. WRIGHT, IF I COULD INTERRUPT. WE DON'T HAVE YOUR SLIDES UP AT THE MOMENT. >> OH, THANKS FOR LETTING ME KNOW. >> YES. ARE YOU SHARING YOUR SCREEN? >> I PRESSED THE BUTTON BUT I THOUGHT -- SORRY ABOUT THAT. I ASKED IF YOU COULD HEAR ME BUT DIDN'T IF YOU COULD SEE WHAT I WAS PRESENTING. DO YOU SEE NOW? >> YES, WE CAN SEE YOUR SLIDES. >> MY APOLOGIES. WELL, ANYWAY, I WILL SKIP THROUGH WHAT I ALREADY SAID BUT ESSENTIALLY THIS IS WHAT I SAID ABOUT THE DEFINITION OF PAST, I WAS TALKING ABOUT THE VARIED SYMPTOMS AND THE NEED TO CHARACTERIZE THAT. THE EPIDEMIOLOGY PIECE HAS BEEN A CHALLENGE. WE NEED MORE ROBUST DATA IN THIS AREA, AND THAT'S REALLY THE MAIN PURPOSE OF RECOVER, BUT THE STUDIES TO DATE AS MANY PEOPLE ON THIS CALL ARE AWARE, HAVE BEEN VERY HETEROGENEOUS, AND MANY OF THEM HAVE HAD SIGNIFICANT LIMITATIONS, EITHER BECAUSE THE SAMPLE ADVISES HAVE BEEN SMALL OR WORK HAS BEEN DONE QUITE QUICKLY, PUBLISHED IN PRE-PRINT FORM, AND MAY THE NEW HAVE BEEN PEER REVIEWED, SO WE'RE NOT SURE IF THOSE FINDINGS WILL HOLD UP. EPIDEMIOLOGY WILL DEPEND ON DEFINITION USED. THERE ARE A NUMBER OF DEFINITIONS, LIKE I SAID, THAT HAVE BEEN USED ACROSS ORGANIZATIONS AND EVEN AGENCIES, AND SO WE NEED TO BE MORE HARMONIZED IN THE USE OF THOSE DEFINITIONS OR BE CLEAR ABOUT THEM. AND THEN WE WANT TO RECOGNIZE THAT PASC DOES OCCUR IN CHILDREN, MAY BE LESS FREQUENT BUT MAY BE QUITE DIFFERENT. WE WANTED TO MAKE SURE THAT THAT WAS STUDIED IN ITS OWN RIGHT. THIS STUDY I THINK IS AN INTERESTING ONE THAT INCLUDED ABOUT A QUARTER OF A MILLION COVID-19 SURVIVORS THAT WERE ASSESSED FOR PASC AFTER 30 DAYS FROM INFECTION, AND 57 STUDIES IF YOU LOOK AT THE PANELS ON THE SLIDE YOU SEE THE ENORMOUS VARIABILITY IN THE DIFFERENT SYMPTOMS AND PROBLEMS THAT HAVE COME OUT IN THE STUDY. AND SO IT JUST HIGHLIGHTS THE IMPORTANCE OF GETTING ALL OF OUR HEADS TOGETHER, AND STUDYING THIS IN AN ORGANIZED AND HARMONIZED WAY. WHAT IS THE PREVALENCE OF PASC? THAT IS OBVIOUSLY SOMETHING THAT IS REALLY AN ITERATIVE PROCESS OF TRYING TO UNDERSTAND, THIS STUDY OUT OF THE U.K. THAT INVOLVED MORE THAN 300,000 PEOPLE THAT ANSWERED A SURVEY, YOU CAN SEE THAT IN THE BEGINNING ABOUT 30 DAYS OUT FROM INFECTION, ALMOST A FIFTH OF THE POPULATION THAT HAS BEEN INFECTED COMPLAINS OF SYMPTOMS THAT HAVE LASTED THAT LONG, AND THEN OVER THE NEXT COUPLE OF MONTHS THAT DROPS DOWN, AND SEEMS LIKE IT LEVELS ON OF, ENDS UP AT 12% IN THIS ONE STUDY, BUT ONE OF THE THINGS THAT IS VERY INTERESTING ABOUT IT, AND ALSO MAKES IT A CHALLENGE TO STUDY, IS THAT IT SEEMS TO VARY BY THE SEVERITY OF THE ILLNESS, SO YOU CAN SEE THAT THE SYMPTOMS CONSISTENTLY GREATER IN PEOPLE WITH POOR BASELINE HEALTH AND MORE SEVERE ACUTE INFECTION, AND THE LITTLE PANEL TO THE RIGHT WITH THE COLOR-CODED BARS SHOW YOU THAT IF PEOPLE WERE NOT HOSPITALIZED, THE RATES WERE MUCH LOWER THAN THOSE WHO WERE EITHER HOSPITALIZED OR PUT IN INTENSIVE CARE BECAUSE OF THE COVID-19. SO IT COMPLICATES THE UNDERSTANDING OF PASC. AND THIS SLIDE, ALTHOUGH YOU DON'T NEED TO READ EACH EVERY ROW, WHAT IT SHOWS IS ACROSS THE NON-HOSPITALIZED/HOSPITALIZED AT ICU, DARKER RED AND PURPLE SHOW MORE HEAVY BURDEN OF THE SYMPTOMS, YOU CAN SEE THEY GENERALLY KIND OF GO UP WITH SEVERITY OF THE ILLNESS. BUT I ALSO PUT THESE PANELS HERE BECAUSE THEY ACTUALLY HIGHLIGHT THE AGE GROUPS THAT I THOUGHT THE NIA WOULD BE INTERESTED IN BECAUSE THIS TABLE'S MUCH LARGER, THIS LOOKS AT PEOPLE LESS THAN 60, 60 TO 70, GREATER THAN 70. WHAT I THOUGHT WAS INTERESTING ABOUT THIS IS THAT IN SOME OF THE CASES, THE SYMPTOMS SEEM TO GET WORSE AS PEOPLE GET OLDER. BUT IN SOME CASES THEY SEEM TO BE WORSE IN YOUNGER GROUPS. AND SO THAT'S ALSO SOMETHING THAT NEEDS TO BE REALLY UNDERSTOOD A LOT BETTER. SO, THE PERSISTENCE OF SYMPTOMS HAS BEEN STUDIED IN RANDOM SORT OF COMMUNITY-BASED SAMPLES LIKE I MENTIONED EARLIER, AND THIS ONE ALSO FROM THE U.K., MORE THAN HALF A MILLION PEOPLE, THE PREVALENCE OF SELF-REPORTED COVID WAS 19%, BUT OF THOSE ABOUT 40% REPORTED AT LEAST HAVING ONE SYMPTOM, 12 WEEKS, LASTING 12 WEEKS OR MORE AFTER INFECTION, WHICH IS QUITE HIGH. AND THEY IDENTIFIED IN THIS STUDY TWO DISTINCT CLUSTERS, TIREDNESS CLUSTER, WHERE TIREDNESS CO-OCCURRED WITH MUSCLE ACHES AND DIFFICULTY SLEEPING AND SHORTNESS OF BREATH AND RESPIRATORY THAT INCLUDED SHORTNESS OF BREATH BUT TIGHTNESS OF THE CHEST AND CHEST PAIN, AND UNDERSTANDING HOW CLUSTERS, MAYBE PHENOTYPES ARE REALLY GOING TO BE HELPFUL IN UNDERSTANDING PASC AND HOW TO TARGET THE TREATMENTS. YOU CAN SEE HERE SORT OF GETTING BACK AMOUNT WHAT I MENTIONED EARLIER A HIGHER PERCENTAGE OF PEOPLE IN THE RESPIRATORY CLUSTER REPORTED SEVERE CLUSTERS THAN TIREDNESS BUT THAT MAY HAVE TO DO WITH SEVERITY OF THE ILLNESS THAT THEY HAD. SOME GREAT AND VERY IMPORTANT DATA HAVE COME OUT OF THE U.S. DEPARTMENT OF VETERANS AFFAIRS HEALTH DATABASE, WHERE PEOPLE HAVE BEEN -- THEY HAVE HAD 75,000 PEOPLE THAT THEY HAVE IDENTIFIED WITH A COVID DIAGNOSIS, AND THEY WERE ABLE TO COMPARE THAT TO ROUGHLY 5 MILLION PEOPLE WHO USE THE HEALTH CARE SYSTEM AND WERE FOUND -- NOT FOUND TO HAVE A COVID INFECTION DURING THE STUDY PERIOD. BEYOND THE FIRST 30 DAYS, PEOPLE WITH COVID-19 DID HAVE A GREATER RISK OF DEATH AND USE OF HEALTH CARE RESOURCES, MEANING THAT PEOPLE ARE AT RISK OF DEATH EVEN BEYOND THAT, YOU KNOW, EARLY INFECTION STAGE. SO THIS IS SOMETHING THAT REALLY NEEDS TO BE DELVED INTO FURTHER. AND THERE WERE MANY DIFFERENT SYSTEMS INVOLVED, INCLUDING RESPIRATORY, NERVOUS SYSTEM INCLUDED NEUROCOGNITIVE DISORDERS AND MENTAL HEALTH, OTHER SYSTEMS AS WELL, ALSO AN INCIDENT USE OF MANY DIFFERENT MEDICATION TYPES, INCLUDING PAIN MEDICATIONS, ANTI-DEPRESSIVE, ANXIOLYTIC, ORAL HYPOGLYCEMICS AS I REFERRED TO AT THE BEGINNING OF THE TALK, THERE'S AN INTEREST IN HOW SARS-COV-2 MAY ACTUALLY CREATE A RISK FOR DEVELOPING SOME OTHER RISK FACTORS FOR WELL KNOWN DISEASES. SO IT SEEMS THERE'S A RISK GRADIENT ACCORDING TO THE SEVERITY THAT WE REALLY NEED TO FURTHER UNDERSTAND. BUT NOW WE ARE IN A SITUATION WHERE MANY PEOPLE ARE BECOMING VACCINATED, WE HOPE. AND THERE ARE PEOPLE THAT HAVE BEEN VACCINATED, PEOPLE THAT HAVE BEEN BOOSTED, AND SO THE QUESTION IS HOW DOES THAT RELATE TO PASC? AND THIS ONE STUDY HERE FOUND THAT FULLY VACCINATED PEOPLE WHO DEVELOPED BREAKTHROUGH INFECTIONS WERE ABOUT HALF AS LIKELY AS UNVACCINATED PEOPLE TO REPORT SYMPTOMS OF LONG COVID THAT LASTED AT LEAST FOUR WEEKS AFTER INFECTION. AND THE DEPARTMENT OF VETERANS AFFAIRS DATABASE HAS ALSO YIELDED SOME IMPORTANT RESULTS HERE AS WELL, WHERE IT FOUND, A STUDY FROM HERE FOUND THAT PEOPLE WITH COVID-19 AND BREAKTHROUGH HAD A GREATER RISK OF DEATH AND BROAD ARRAY OF POST-ACUTE SEQUELAE BEYOND THE FIRST 30 DAYS, COMPARED TO PEOPLE WITH NO EVIDENCE OF COVID-19, BUT A LOWER RISK COMPARED TO PEOPLE WHO ARE UNVACCINATED, AND YOU COULD SEE THAT ALSO SEEMS TO DIFFER BY HOSPITALIZATION STATUS, WHICH IS WHAT IS SHOWN IN THE PANEL ON THE RIGHT SIDE. SO WE REALLY NEED MORE ROBUST DATA, EPIDEMIOLOGIC DATA. WE THINK IT'S VERY IMPORTANT TO UNDERSTAND PHENOTYPES AND CLINICAL SPECTRUM OF PASC IN ORDER TO BE ABLE TO APPROACH IT PROPERLY. WE NEED TO UNDERSTAND THE DURATION OF PASC, THOSE OF YOU WHO REMEMBER THE -- WELL, YOU WOULDN'T REMEMBER THE INFLUENZA PANDEMIC FROM A HUNDRED YEARS AGO BUT YOU REMEMBER READING ABOUT IT. AND YOU REMEMBER THAT TEN YEARS LATER PEOPLE DEVELOPED -- SOME PEOPLE DEVELOPED PARKINSON'S, RIGHT? SO, HOW LONG DOES IT TAKE FOR SOME OF THESE SYMPTOMS TO SHOW UP AND SIGNS TO SHOW UP? THIS NEEDS TO REALLY BE UNDERSTOOD. WHAT ARE THE RISK FACTORS FOR THE DEVELOPMENT OF PASC? THE IMPACT OF VACCINATION, EFFECT OF DIFFERENT VARIANTS, NOW WE ARE OF COURSE HOPEFULLY ON THE TAIL END IN SOME PLACES OF OMICRON, OF COURSE IN OTHER PLACES WE'RE NOT. WE NEED TO UNDERSTAND GIVEN THAT OMICRON BEHAVES DIFFERENTLY THAN DELTA DID, FOR EXAMPLE, DOES THAT HAVE AN EFFECT ON HOW THE TYPES OF SYMPTOMS DEVELOPED POST INFECTION AND SYNDROMES, PHENOTYPES, IF YOU WILL. WHAT IS THE UNDERLYING PATHOBIOLOGY? AND THEN OF COURSE IDENTIFYING THERAPEUTIC TARGETS. SO, WHAT DO WE KNOW ABOUT THE CAUSES? WELL, IT'S VERY MUCH AN EARLY STAGE IN UNDERSTANDING THIS. BUT THERE'S CERTAINLY CERTAIN TISSUES THAT SEEM TO STIMULATE -- THAT HAVE ONGOING DYSFUNCTIONAL IMMUNE RESPONSES AND TISSUE DAMAGE. DYSREGULATED IMMUNE REACTIONS THAT RESULT IN INFLAMMATION, THAT MAY ALSO BE INVOLVED. THERE'S EVIDENCE OF ABNORMAL PROFILES IN IMMUNE CELLS AND INFLAMMATORY MOLECULES THAT NEED TO BE FURTHER UNDERSTOOD. AND THEN THERE'S THE ASPECT OF AUTOIMMUNITY, PERSISTENCE OF VIRAL PARTICLES, VIRAL INFECTION, THAT MAY SET UP AN AUTOIMMUNE REACTION. AND THEN THE DAMAGE TO SPECIFIC ORGANS AND TISSUES THAT RESULT IN DIFFERENT SYSTEMS BEING DYSFUNCTIONAL. THAT'S VERY DIFFICULT AND VERY CHALLENGING TO STUDY IN PATIENTS BECAUSE IT'S HARD TO SEPARATE THE WHEAT FROM THE CHAFF IN TERMS OF WHAT HAPPENED WHEN THEY HAD ACUTE ILLNESS VERSUS LATER EFFECTS. SO WE HAVE THIS POTPOURRI OF SYMPTOMS THAT YOU SEE HERE ON THE LEFT, AND MANY DIFFERENT ORGAN SYSTEMS, AND CONDITIONS, INVOLVED ON THE RIGHT. SORT OF SEPARATING THESE OUT AND THEN UNDERSTANDING, YOU KNOW, HOW THEY RELATE TO EACH OTHER REALLY REQUIRES A VERY MULTI-PRONGED APPROACH, ESPECIALLY IF WE'RE GOING TO HOPE TO DEVELOP TREATMENTS. SO IN TERMS OF POTENTIAL TREATMENTS, RIGHT NOW THERE ARE THREE MAIN AREAS. THE IDEA OF PERSISTENT SARS-COV-2 VIRUS THAT WOULD BE AMENABLE TO ANTI-VIRALS, THE POTENTIAL FOR DYSREGULATED IMMUNE RESPONSE TO RESPOND TO IMMUNE MODULATORS, AND THEN SOME VERY ORGAN AND TISSUE-SPECIFIC INTERVENTIONS THAT MAY EITHER BE MEDICATIONS OR NON-PHARMACOLOGICAL INTERVENTIONS THAT COULD HELP WITH TARGETING SPECIFIC AREAS, LUNG, HEART, BLOOD VESSELS. THERE ARE A NUMBER OF NEUROCOGNITIVE AND OTHER REHABILITATIVE STRATEGIES THAT MAY BE HELPFUL, AND COGNITIVE BEHAVIORAL THERAPIES, AND ON AND ON. SO ALL OF THESE THINGS NEED TO BE PUT IN THE PERSPECTIVE AS WE GAIN MORE INFORMATION. BUT I THINK THE TAKEHOME MESSAGE FROM ALL OF THIS IS THAT WE REALLY NEED TO CHARACTERIZE WHAT'S GOING ON FIRST BEFORE WE CAN REALLY HOPE TO TREAT IT. SO THE NIH RECOVER INITIATIVE, THE MAIN GOAL BEING TO RAPIDLY IMPROVE UNDERSTANDING, HAS KEY SCIENTIFIC AIMS HERE, MOST OF WHICH I HAVE ALREADY KIND OF RUN THROUGH. I WANT TO EMPHASIZE THE GUIDING PRINCIPLE OF THIS EFFORT HAS BEEN TO CREATE A PATIENT-CENTERED APPROACH BUT THIS HAS A NATIONAL SCALE. IT'S VERY MULTI-DISCIPLINARY, AS I ALREADY MENTIONED. IT HAS TO BE ADAPTIVE BECAUSE, YOU KNOW, NOW WE'RE IN OMICRON, HOPEFULLY THERE WON'T BE ANOTHER VARIANT, BUT THERE ARE WAVES AND WAVES OF THESE VARIANTS THAT HAVE CAUSED MAYBE DIFFERENT SEQUELAE THAT WE DON'T EVEN KNOW ABOUT. THERE ARE A NUMBER OF STAKEHOLDERS THAT I'VE LISTED HERE, ON THE RIGHT-HAND SIDE, THAT ARE WORKING TOGETHER AND COLLABORATING. AND SO THE RECOVER CORES INCLUDE A SCIENCE CORE, DATA CORE, BIOREPOSITORY THAT SUPPORT THE DIFFERENT STUDIES. THE THREE MAIN STUDIES ARE RECOVER SET OF COHORTS THAT ARE GOING TO ACTUALLY ENROLL PEOPLE, I'LL TELL YOU A LITTLE BIT THAT IN A SECONDS. A VERY ROBUST ELECTRONIC HEALTH RECORD SYSTEM METHOD THAT WILL INCLUDE 40 MILLION RECORDS AND ABOUT 4 MILLION CASES PLUMBED AND ALWAYS-BASED STUDY TO LOOK AT MORE THAN 50 TISSUE TYPES. AND THERE ARE MANY RESOURCES THAT SUPPORT THIS. AND SO IN TERMS OF THE COHORTS, THERE'S AN ACUTE INFECTION COHORT WHERE WE HAVE THE OPPORTUNITY TO BRING PEOPLE IN AND FOLLOW THEM, AND SEE WHO DEVELOPS PASC. WE ALSO HAVE A POST-ACUTE INFECTION COHORT WHERE PEOPLE HAVE ALREADY BEEN INFECTED, WE CAN TEST THEM FOR DIFFERENT ANTIBODIES AND FIND OUT IF THEY WERE INFECTED, AND THEN RETRO S PECTIVE STUDIES, ABILITY TO STUDY PREGNANT WOMEN, AND CHILDREN, IN THE COHORTS, INCLUDING 40,000 PEOPLE FROM 200 SITES ACROSS ALL 50 STATES. AND THEN THE PEOPLE THAT ARE IN THE COHORT STUDIES WILL BE SCREENED AND THEY WILL UNDERGO WHAT WE CALL THE TIER 1 LEVEL ASSESSMENTS THAT WILL INCLUDE MANY QUESTIONNAIRES AND CLINICAL ASSESSMENTS AND SOCIAL DETERMINANTS OF HEALTH AND PSYCHOSOCIAL FACTORS, AND THEN DEPENDING ON HOW THEY RESPOND TO THOSE QUESTIONNAIRES AND INSTRUMENTS, A RANDOM SAMPLE WILL BE SELECTED TO UNDERGO TIER 2, SO 40,000 PEOPLE AS I MENTIONED ALREADY IN TIER 1, ABOUT 10,000 IN TIER 2, AND ABOUT 5,000 WILL GO EVEN DEEPER, UNDERGO EVEN DEEPER PHENOTYPING, THAT YOU CAN SEE LISTED HERE INCLUDING DEEP IMAGING AND SO ON. ONE OF THE MOST IMPORTANT THINGS ABOUT COVID THAT HAS BEEN VERY INSTRUCTIVE HAS BEEN THE DISPARITIES IN COVID AND THE DISPARITIES IN PASC. AND SO WHEN RECOVER WAS DESIGNED, THE IDEA WAS TO TARGET THE POPULATIONS THAT WERE MOST AFFECTED BY COVID, RATHER THAN SIMPLY REPRESENT THE U.S. POPULATION. SO YOU CAN SEE THE TARGET ENROLLMENT FOR THE DIFFERENT -- SOME DIFFERENT RACIAL AND ETHNIC GROUPS HERE, THEY ARE SOMEWHAT OVERSAMPLED IN ORDER TO TRY AND ACCOMPLISH THAT. SO IN TERMS OF WHAT NIA MAY BE INTERESTED IN, I CREATED A FEW SLIDES JUST LOOKING A LITTLE DEEPER AT THE TIER LEVEL ASSESSMENTS THAT MAY BE SPECIFICALLY RELEVANT TO NIA, SO YOU CAN SEE THE DISABILITY SCREENS, COMORBIDITY, PHYSICAL FUNCTION ASSESSMENTS, LABORATORY TESTS DONE IN DIFFERENT TIERS COLOR CODED TO TIER 1, TIER 2, TIER 3 ON THE BOTTOM OF THE SLIDE. NEUROFILAMENT LIGHT AND TAU, FOR EXAMPLE, WILL BE IN TIER 3, THAT THE SIX-MINUTE WALK TEST, GRIP STRENGTH, QUADRICEP STRENGTH AND TIMED UP AND GO WILL BE IN TIER 2. AND THEN ON THIS SLIDE YOU CAN SEE THAT MRI AND LUMBAR PUNCTURE TIER 3 IN-DEPTH TESTING, OTHER NEUROPSYCH TESTING AS PART OF TIER 2. SOME OF THESE ARE INTERESTING, I THINK, IN TERMS OF AGING AND ADRDs. I WANTED TO MENTION ALSO THAT THE AUTOPSY COHORT WILL INCLUDE COMPREHENSIVE EXAM OF THE CENTRAL NERVOUS SYSTEM, AS WELL AS SPECIFIC SAMPLING, POSTMORTEMCS BRAIN MRI. THIS IS MORE OPEN FOR YOUR DISCUSSION. WHAT IS THE PREVALENCE AND INCIDENCE OF PASC IN AGING POPULATIONS COMPARED WITH YOUNGER ADULTS? WHAT DIFFERS BY AGE, THE CLINICAL COURSE, THE SUBPHENOTYPES, UNDERLYING MECHANISMS. AND DOES THE PATHOPHYSIOLOGY OF COVID AND/OR PASC DIFFER BY AGE AT INFECTION OR AGE AT DEATH. AND UNDERSTANDING THE PASC FEATURES THAT AFFECT AGING, THE NEUROLOGICAL CONSEQUENCES, COGNITIVE CONSEQUENCES, VARIABILITY ACROSS SEQUELAE IN POPULATION DEMOGRAPHICS, RELATIVE RELATIVE TO AGE, SEX, ETHNICITY. WE NEED TO UNDERSTAND PHYSIOLOGIC AND ENVIRONMENTAL AND BEHAVIORAL FACTORS THAT MAY CONTRIBUTE TO THE SUSCEPTIBILITY OF OLDER ADULTS TO SEQUELAE OF SARS-COV-2 AND EFFECT OF SYMPTOMS AND SEQUELAE ON IMPORTANT OUTCOMES TO THE AGING POPULATION. AND THEN OTHER QUESTIONS HAVING TO DO SPECIFICALLY WITH AD AND ADRD ARE WHAT DOES SARS-COV-2 INFECTION AND/OR PASC HAVE TO DO WITH PROGRESSION, DEVELOPMENT AND PROGRESSION OF AD AND ADRDs, AND WHAT DOES UNDERLYING SUBCLINICAL OR EARLY ADRDs, WHAT AFFECT DUGS THAT HAVE ON THE COMORBIDITY OF THE SARS-COV-2 AND HOW THAT PLAYS OUT. AND WHAT ARE INTERACTIONS AND INCIDENTS AND PROGRESSION OF DIFFERENT OVERLAPPING MIXED ETIOLOGIES. SO THAT'S ALL I HAVE FOR YOU AT THIS TIME. I HOPE IT'S BEEN HELPFUL. IT'S KIND OF A BROAD OVERVIEW. IT GIVES YOU A PERSPECTIVE ON WHERE RECOVER IS HEADED. I WANTED TO JUST MENTION THAT THE SENIOR OVERSIGHT COMMITTEE IS LED BY DOCTORS FAUCI, GIBBONS AND KOROSHETZ, AND I'M PREPARED TO TAKE ANY QUESTIONS THAT YOU MAY HAVE. THANK YOU. >> TERRIFIC. THANK YOU VERY MUCH, DR. WRIGHT. REALLY GREAT OVERVIEW OF THE RECOVER INITIATIVE. QUESTIONS FROM OUR COUNCIL MEMBERS? YES, AMY? >> YEAH, THANK YOU VERY MUCH FOR YOUR VERY CLEAR PRESENTATION. I WANTED TO ASK A QUESTION ABOUT HOW UNIQUE PASC IS IN THE CONTEXT OF OTHER RESPIRATORY VIRUSES, AND IF THAT IS A COMPONENT OF UNDERSTANDING THAT THE RECOVER MISSION ENTAILS INCLUDES. >> GREAT QUESTION. FROM THE STANDPOINT OF DATA OUT THERE, IT DOES SEEM AS IF THAT SARS-COV-2 HAS MORE SEVERE OR AT LEAST THE EARLIER FORMS HAD A MORE SEVERE SET OF OUTCOMES THAN LET'S SAY INFLUENZA. OF COURSE, THERE'S A LOT OF DIFFERENT PATHOGENS OUT THERE, AND SOME ARE RARER THAN OTHERS. SO, IT'S A LOT EASIER TO STUDY THE MORE PREVALENT SUCH AS INFLUENZA. NOW THAT WE'RE IN OMICRON THOUGH, IT'S INTERESTING BECAUSE IT'S A LITTLE BIT HARDER TO PARSE THAT OUT BECAUSE MANY TIMES LET'S SAY A COLD VIRUS MIGHT NOT BE REPORTED AND IT'S HARD TO REALLY STUDY THAT. SO I THINK IT'S A REALLY INTERESTING QUESTION. ONE OF THE THINGS THAT'S REALLY EXCITING ABOUT THE EHR DATA AND REAL WORLD DATA, AND BY THE WAY, YOU KNOW, I THINK IT'S BEEN A TREMENDOUS OPPORTUNITY, YOU KNOW, BECAUSE OF THE PANDEMIC TO REALLY GET THIS HUGE DATA TOGETHER, AND IT WILL I THINK LIFT ALL BOATS IN TERMS OF UNDERSTANDING MANY DIFFERENT PROCESSES. BUT BEING ABLE TO LOOK AT MILLIONS AND MILLIONS OF RECORDS WILL HELP US TO UNDERSTAND SOME OF THOSE THINGS YOU JUST ASKED ABOUT. >> GREAT. THANK YOU. >> CLIFF? >> YEAH, HI. CLIFF ROSEN. I JUST FINISHED ON COUNCIL. THANK YOU FOR YOUR EFFORTS. THIS IS A COMPLEX AND MULTI-LAYER PROCESS. I THINK THE NIH HAS DONE AN AMAZING JOB WITH, QUOTE, THE SYNDROME TRYING TO UNDERSTAND HOW TO MEASURE IT AND ALSO MOVING FORWARD THE PATHOBIOLOGY. WE JUST ISSUED THE OTA FOR PATHOBIOLOGY GRANTS. I WANT TO SAY THANK YOU AGAIN FOR BEING SO INCLUSIVE ABOUT TRYING TO DISCOVER WHAT REALLY IS BEHIND COVID-19'S LONG COVID. >> THANK YOU. >> WE HAVE TWO OTHER QUESTIONS. YADONG AND SHALI. >> THANK YOU FOR THE CLEAR TALK. QUICK QUESTION, GENDER DIFFERENCE IN TERMS OF THIS RECOVERY? >> YES, SO WHAT WE KNOW FROM THE SELF-REPORTED SYMPTOMS IS THAT WOMEN SEEM TO HAVE MORE SYMPTOMS THAN MEN, SO FAR, SIGNIFICANTLY GREATER NUMBER OF SYMPTOMS AND A BROADER ARRAY OF SYMPTOMS. IT'S A VERY, VERY INTERESTING AREA THAT WE DON'T REALLY UNDERSTAND BECAUSE I THINK WHAT RECOVER WILL ALLOW US TO DO WHEN WE REALLY GET INTO THE MORE IN-DEPTH PHENOTYPING IS UNDERSTAND, YOU KNOW, WHAT ARE THE UNDERLYING REASONS FOR DIFFERENCES. RIGHT NOW WE SORT OF SEE SORT OF THE BIG PICTURE OF PEOPLE'S EXPERIENCE, BUT WHAT WE NEED TO DO IS DELVE INTO THE PATHOBIOLOGY AND DELVE INTO SOME OF THESE OTHER UNDERLYING RISK FACTORS, FOR EXAMPLE, DIFFERENT STAGES OF LIFE, AND SO WE -- AS WAS JUST POINTED OUT BY THE LAST COUNCIL MEMBER, IT'S INCREDIBLY COMPLEX AND DIFFICULT TO STUDY AND SO WE'VE REALLY TRIED TO INCLUDE ALL THE DIFFERENT GROUPS THAT WE THOUGHT WERE GOING TO BE AT THE HIGHEST RISK. >> SO WHAT IS THE BALANCE, THREE DIFFERENT TIERS, ABOUT THE RECRUITMENT? >> WHAT IS THE BALANCE? >> YEAH, I MEAN THE GENDER BALANCE THERE. HALF/HALF OR -- >> YES, YES, I THINK RIGHT NOW IT'S HALF/HALF. BUT AS WE -- AS I THINK THE OPPORTUNITY THAT WE HAVE, BECAUSE IT'S AN ITERATIVE PROCESS, IS WE'RE ONLY BEGINNING WITH THE INITIAL RECRUITMENT, IF WE START, WE CAN SORT OF TURN THE BOAT, IF YOU WILL, AS WE DISCOVER THAT WE WANT TO GO IN A PARTICULAR DIRECTION, WE CAN OVERSAMPLE PARTICULAR AREAS. THAT'S ONE OF THE BEAUTIES OF THE TIERS, AND I EXPECT WE'LL BE ABLE TO DO THAT. >> THANK YOU. >> SHALI, GO AHEAD. >> YEAH, THANK YOU, DR. WRIGHT, FOR THE VERY LUCID COMPREHENSIVE OVERVIEW OF THE COMPLEX SYNDROME. GIVEN THE EXTRAORDINARY SUCCESS THAT NIH HAD IN INITIAL INITIATIVES RELATED TO COVID, PARTICULARLY THE VACCINE DEVELOPMENT OPERATION WARP SPEED, ARE THERE SIMILAR PLANS ALREADY IN PLACE, PLANS TO EXPEDITIOUSLY FUND AND IMPLEMENT INTERVENTION TRIALS FOR THE VARIOUS POSTULATED MECHANISMS FOR THIS PARTICULAR -- >> YES. YES, ACTUALLY WE'RE LEVERAGING THE MECHANISMS THAT WERE USED IN THE DIFFERENT COVID, YOU KNOW, VACCINE SPACE, THE ACTIV PROGRAM, AS WELL AS SOME OF THE OTHER ONES, TO RESOURCE THAT PIECE, THE INTERVENTIONAL PIECE. SO, YOU KNOW, THE EARLIER WE CAN START WITH SYMPTOMATIC TREATMENTS, OBVIOUSLY THAT WILL START FIRST, AS WE UNDERSTAND PATHOPHYSIOLOGY, AS I MENTIONED IN ONE OF THE SLIDES, THEN WE CAN START TO SELECT TARGETS TO GO AFTER IN DIFFERENT REALMS, WHETHER THEY BE ANTI-VIRAL, IMMUNE MODULATOR, ANTI-INFLAMMATORY, SO ON. YES, WE ARE VERY MUCH LEVERAGING THE RESOURCES THAT WERE BROUGHT TO BEAR ON THE INITIAL COVID PANDEMIC. >> GREAT. IN THE INTEREST OF TIME I THINK WE'RE GOING TO HAVE TO MOVE TO OUR NEXT SPEAKER, BUT AGAIN I WANTED TO THANK DR. WRIGHT FOR HIS VERY INFORMATIVE TALK AND APPRECIATE YOU TAKING THE TIME OUT AND GIVING THE UP THE ON THE RECOVER INITIATIVE. >> THANK YOU FOR HAVING ME. THANK YOU VERY MUCH. BYE-BYE. >> ALL RIGHT. NEXT I'D LIKE TO ASK DR. LIZ NEESON TO INTRODUCE THE NEXT SPEAKER. >> IT'S MY PLEASURE TO INTRODUCE DR. ELENA FAZIO, SOCIOLOGIST AND PROGRAM OFFICIAL IN THE POPULATION AND SOCIAL PROCESSES BRANCH OF DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH AT NIA WHERE SHE MANAGES A PORTFOLIO OF RESEARCH ON LONG-TERM SERVICES AND SUPPORTS FOR OLDER ADULTS, WITH FOCUS ON DEMENTIA CARE AND DEMENTIA CARE WORKFORCE. IN ADDITION, DR. FAZIO PLAYS A LEADING ROLE IN COORDINATING ALZHEIMER'S DISEASE APROJECTS ACROSS OUR DIVISION INCLUDING COORDINATION OF OUR DEMENTIA CARE SUMMITS AND SERVING AS LIAISON TO NATIONAL ACADEMY ALSO ON THIS NIA COMMISSION DECADAL SURVEY, THE ROLE OF BEHAVIORAL AND SOCIAL SCIENCES CAN PLAY IN ADDRESSING THE CHALLENGE OF A.D. WHICH SHE WILL BE TALKING TO US ABOUT TODAY. ELENA, OVER TO YOU. >> THANK YOU SO MUCH, LIZ. GOOD AFTERNOON, I'M ELENA FAZIO FROM NIA DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH, BSR FOR SHORT. TODAY I WILL BE TALKING ABOUT NATIONAL ACADEMIES OF SCIENCE, ENGINEERING AND MEDICINE REPORT REDUCING IMPACT OF DEMENTIA IN AMERICA, DECADAL SURVEY. NEXT SLIDE. I WILL PROVIDE BACKGROUND ON WHAT IS A DECADAL SURVEY AND TURN TO REPORT RECOMMENDATIONS COUPLED WITH RESEARCH INITIATIVES IN PROJECT AND LOOK TOWARD THE FUTURE. NEXT SLIDE. WHAT IS A DECADAL SURVEY? A METHOD TO ENGAGE MEMBERS OF THE RESEARCH COMMUNITY TO IDENTIFY LINES OF RESEARCH WITH GREATEST POTENTIAL FOR IMPACT OVER A TEN-YEAR PERIOD IN THE PURSUIT OF A PARTICULAR GOAL. IT IS A SURVEY OF THE FIELD, SO TO SPEAK. NATIONAL ACADEMIES PIONEERED THIS APPROACH IN 1964, HIGHLY REGARDED BUT SPARINGLY USED. FEWER THAN TWODOZEN SURVEYS CONDUCTED, TEN YEAR RESEARCH AGENDA FOR BEHAVIORAL AND SOCIAL SCIENCE RESEARCH ON DEMENTIAS. SO AGAIN THE GOAL IS IN FACT THIS TEN-YEAR AGENDA. THE WHO IS AN AD HOC COMMITTEE AND ADVISORY PANEL. THE PROCESS INCLUDED INFORMATION GATHERING, REALLY CAREFUL DELIBERATION IN THE SERVICE OF REPORT CREATION. COMMITTEE MEMBERS REPORT A BROAD SET OF DISCIPLINES FROM ECONOMICS TO BIOETHICS HEALTH SERVICES, AND BEYOND. THE THE STAFF RELATED TO DECADAL SURVEY TO ENSURE THAT PERSPECTIVES FROM THE COMMUNITY OF INDIVIDUALS DIRECTLY AFFECTED BY DEMENTIA WERE INCLUDED IN THE INFORMATION GATHERED TO ADDRESS THE STUDY CHARGE. THEY ALSO PROPOSED REPORT THAT COALESCED AROUND FOUR THEMES, INCLUDING DIFFICULTY IN OBTAINING ACCURATE AND TIMELY DEMENTIA DIAGNOSIS, PROBLEMS IN OBTAINING SUPPORTS AND SERVICES, COMMUNICATION CHALLENGES, FEAR AND LOSS. TWO CURRENT COUNCIL MEMBERS PLAYED KEY ROLES IN THIS PROCESS. WE'D LIKE TO THANK IN PARTICULAR CYNTHIA HUMMEL AND DAVID REUBEN. NEXT SLIDE. DECADAL REPORT >> SOCIAL AS WELL AS THE V.A. THE OFFICE OF THE ASSISTANT SECRETARY OF PLANNING AND EVALUATION, AARP, ALZHEIMER'S ASSOCIATION AND THE AMERICAN PSYCHOLOGICAL ASSOCIATION, JPB AND THE JOHN H. HARTFORD FOUNDATION. WHY DID NIA INVEST IN THE SURVEY? ALZHEIMER'S DISEASE AND RELATED DEMENTIA EXPANDS MANY TOPICS AND WE FUNDED THIS WORK TO CREATE A BROAD 10-YEAR RESEARCH AGENDA WITH GREATEST POTENTIAL IMPACT. THE AD HOC COMMITTEE WAS CHARGED WITH DEVELOPING THIS AGENDA IN THE FOLLOWING AREAS, POPULATION EPIDEMIOLOGY, BEHAVIORAL AND SOCIAL RISK FACTORS AND UNDERLYING CAUSAL PATHWAYS TOWARDS DEMENTIA, PRIMARY AND SECONDARY DEMENTIA PREVENTION, FINANCING AND LIVING WITH DEMENTIA AND THE WORK FORCE AND INTERVENTIONS WITH PEOPLE LIVING WITH DEMENTIA AND HIGH RISK POPULATIONS AND METHODOLOGICAL APPROACHES. THE COMMITTEE IDENTIFIED FIVE PRIORITIES TO ENSURE THE BEHAVIORAL AND SOCIAL SCIENCE WILL HAVE A MAXIMUM IMPACT IN REDUCING THE NEGATIVE IMPACTS OF DEMENTIA AND THE GREATER FOCUS ON THE LIVED EXPERIENCE OF DEMENTIA AND DESIGNING STUDIES WITH POTENTIAL TO RECTIFY INEQUITIES AND DISPARITIES, THIRD, THE NEED FOR INNOVATIVE METHODOLOGIES AND MEASUREMENT, FOURTH, GREATER ATTENTION TO COST AND ECONOMIC ANALYSES AND FIFTH, STRENGTHENING RESEARCH INFRASTRUCTURE INCLUDING RESOURCES. THE EIGHT CHAPTERS OFFER RECOMMENDATIONS FOR ADVANCING RESEARCH ON RISK FACTORS AND PREVENTION, IMPROVING FACTORS AND ADDRESSING THE DIVERSE NEEDS OF CAREGIVERS, ENHANCING OUR INFORMATION OF HOW COMMUNITY RESOURCES CAN BE MOBILIZED, IMPROVING MODELS OF CARE ACROSS THE WHOLE DISEASE DISEASE CONTINUUM, GETTING ON THE HANDLE OF COSTS AND STUDY FINANCIAL INCENTIVES AND FINALLY PROMOTING RIGOR AND MEASUREMENT OF ENVIRONMENTAL AND SOCIAL EXPOSURES AND COGNITIVE OUTCOMES. SEVERAL RESEARCH PRIORITIES ARE ALIGNED WITH THE SRs INITIATIVES. THIS MEANS OUR SCAN OF LITERATURE AND OTHER EXPERT INPUTS ARE ALIGNED IN TERMS OF FUTURE PRIORITIES. THE REPORT PROVIDES 150 RECOMMENDATIONS. WILL NOT TEAMED TO COVER THEM ALL SINCE THEY'RE BROAD AND DEEP. I'LL HIGHLIGHT A FEW EXAMPLES. RESEARCH TOPICS WERE SIGNIFICANT PROGRESS HAS BEEN MADE, RESEARCH AREAS THAT ARE AND THOSE TOPICS THAT CAN CATEGORIZED AS EARLY STAGES AND I'LL DISCUSS PROGRESS MADE AND RESEARCH OPPORTUNITIES THAT SPEAK TO AND ADD TO THE 10-YEAR RESEARCH AGENDA. FIRST THE COMMITTEE IDENTIFIED CAUSAL AFFECTS OF SOCIAL FACTORS OF HEALTH RELATED BEHAVIORALS AS A KEY RECOMMENDATIONATION AREA. THIS CAN MEAN MANY THINGS INCLUDING HOW SOCIAL FACTORS MIGHT IMPACT THE INCIDENTS AND RATE OF PROGRESSION OF DEMENTIA AND HEALTH RELATED BEHAVIORS AND THEIR MANAGEMENT OVER THE LIFE COURSE. IN ADDITION, MODIFIABLE DRIVERS OF RACIAL AND ETHNIC INEQUITY AND OTHER DIMENSIONS OF INEQUALITY AND THERE'S AN RFA ON THE RELATIONSHIP BETWEEN EDUCATION AND COGNITION AND THE HIGH SCHOOL AND BEYOND RESOURCES AND A NEW CENTER ON EMOTIONAL WELL BEING AND BRAIN AGING. AS PREVIOUSLY MENTIONED, IT'S AN NIA SUPPORTED DATA SOURCE AND HAS RICH EARLY LIFE COURSE MEASURES, DATA FOR SOME PARTICIPANTS STARTS AS EARLY AS AS ADOLESCENCE AND HAS A DIVERSE SAMPLE. EDUCATIONAL EXPERIENCES OF AAD HEALTH MEMBERS AND THE SCHOOLS THEY ATTENDED ARE INCLUDED FOR SOME INCLUDING ALL THE WAY TO MIDDLE SCHOOL AND GRADES RECEIVED, WHAT CLASSES PEOPLE TOOK AND WHAT THEIR SCHOOLS LOOKED LIKE. IT SUPPORTED UNIVERSITY OF VERMONT FOR RISK. THE COMMITTEE SUGGESTS SEVERAL AREAS FOR EXPLORATION AND MODIFIABLE DRIVERS OF RACIAL AND ETHNIC IN EQUALITY AND IDENTIFYING RISK FACTORS THAT CAN BE THE BASIS FOR PRECISE RECOMMENDATIONS FOR INDIVIDUALS ABOUT DECISION MAKING AND POPULATION LEVEL POLICIES TO PROMOTE BRAIN HEALTH AND CONDUCTING LONGITUDINAL HEALTH AND CHANGE AND DEMENTIA OUTCOMES IS ALSO NEEDED. THE REPORT S ADVANCED IN DATA COLLECTION AND RESEARCH METHODOLOGY ARE NEEDED TO SUPPORT PROGRESS IN VIRTUALLY EVERY DOMAIN. NIH'S DIVISION OF BEHAVIORAL AND SOCIAL SCIENCES INVESTED IN THIS TYPE OF DATA INFRASTRUCTURE WITH EMPHASIS ON SEVERAL FLAGSHIP STUDIES LIKE THE HEALTH AND RETIREMENT STUDY AS WELL AS SUPPORT FOR TECHNOLOGY FOCUSSED RESEARCH AND INFRASTRUCTURE. IT'S A LONGITUDINAL PANEL STUDY THAT SURVEYS A REPRESENTATIVE SAMPLE OF APPROXIMATELY 20,000 PEOPLE IN AMERICA 50 YEARS AND OLDER. IT PROVIDES AN INVALUABLE BODY OF RESEARCH DATA RESEARCHERS CAN USE TO ADDRESS IMPORTANT QUESTION THE CHALLENGES AND OPPORTUNITIES OF AGING. THIS MAP YOU SEE ON THE SCREEN ILLUSTRATE THE VARIOUS PLACES AROUND THE WORLD INTERNATIONAL STUDIES ARE CONDUCTED INCLUDING LOW AND MIDDLE INCOME COUNTRIES LIKE CHINA, MEXICO AND INDIA AND THIS CAN HELP INFORM THE U.S. AND BEYOND AND THE PROTOCOL IS AN ONGOING INTERNATIONAL MEASURE TO UNDERSTAND DEMENTIA RISK WITHIN LONGITUDINAL STUDIES AROUND THE WORLD TO FACILITATE ACROSS NATIONAL COMPARISONS. IT'S ASSOCIATED WITH A GROWING NUMBER OF HRS SISTER STUDIES AND WILL CONTINUE TO ADDRESS A NUMBER OF THE TODAY REPORT RECOMMENDS. AS EXPRESSED BY THE COMMITTEE INCLUDES TOUGHERSES FOR NEW AND INNOVATIVE SOURCES AND NEW DATA SETS AND THE EVALUATION OF BIASES AND SELECTION OF PARTICIPANTS AND BIASES AND MEASUREMENT DEVELOPMENT. THE TOPIC OF INCLUSIVE RESEARCH PARTICIPATION CAN SPEAK TO THE INCLUSION OF THOSE WITH AND WITHOUT COGNITIVE IMPAIRMENT AND DIVERSITY OF PARTICIPANTS BY RACE, GENDER AND GEOGRAPHY AND BEYOND. TURNING TO ANOTHER AREA WE NODE THE DIVISION OF BEHAVIORAL RESEARCH FOCUSSED ON NON-PHARMACOLOGICAL APPROACHES TO PREVENTION MUCH AD/ADRD AND ADDRESSED THE DIFFERENT ASPECT OF INTERVENTION AND DEVELOPMENT. A FEW TAKEAWAYS FROM THE WORKSHOP INCLUDE THE NEED TO IDENTIFY BIOMARKERS THAT WOULD SHOW EARLY EVIDENCE OF DISEASE MODIFICATION AND THE IMPORTANCE OF MEASURING COGNITIVE OUTCOMES USING METHODS WITH LARGE SCALE TRIALS OF DIVERSE POPULATIONS, NEED TO DESIGN THE MOST INFORMATIVE TRIALS AND THE NEED TO GENERATE CAUSAL EVIDENCE FROM OBSERVAL STUDIES TO NEAR RANDOMIZED CONTROL STUDY OR RCTs. RESEARCH OPPORTUNITIES INCLUDE INTERVENTIONS TO MODIFY RISK FACTORS TO REDUCE INCIDENTS MUCH DEMENTIA AND ASSESS HOW INTERVENTIONS DELAY OR PREVENT DEMENTIA MAY HAVE EFFECTS ON HEALTH AND HEALTH CARE DISPARITIES. THE COMMITTEE IDENTIFIED NEEDS RELATED TO TO DISCLOSURE OF DIAGNOSTIC INFORMATION AND THE USE OF BIESHL BIOMARKERS AND THE IN THECATIONS THECATION -- THE INDICATIONS FOR PEOPLE SHOWING BIOMARKERS AND USE DIAGNOSTIC TOOLS AND APPROACHES AND QUALITATIVE RESEARCH ON THE IMPACT OF PERSONS RECEIVING A DEMENTIA DIAGNOSES AND UNDER SCORE THE DIGNITY WITH THE PEOPLE WITH DEMENTIA. NOTABLE PROGRESS INCLUDES THE NIH MOBILE TOOLBOX AND MOBILE MONITORING FOR COGNITIVE CHANGE, ADVANCES IN COGNITIVE SCREENING TOOLS IN ELECTRONIC HEALTH RECORDS AND PRE-CLINICAL OR PRE-SYMPTOMATIC CHANGES THAT MAY POINT TO FUTURE DIAGNOSIS. THE WORKSHOP SHOWED A PRECLINICAL APPROACH TO AD DIAGNOSES AND CAN WE AFFORD THE COST OF AD/ADRD DIAGNOSTIC APPROACHES IF WHEN THEY ENTER CLINICAL PRACTICE AND HOW PRE-CLINICAL DIAGNOSTIC INFORMATION SHOULD BE DISCLOSED TO STAKEHOLDERS? KEY WORKSHOP TAKEAWAYS INCLUDE MOST THE DATA ON RISK OF DECLINE AND MARKER EXPOSURE IS ACQUIRED IN NON-REPRESENTED POPULATIONS PRIMARILY IN HIGHLY EDUCATED PEOPLE WILLING TO UNDER GO TESTING IN ACADEMIC CENTERS AND THERE'S LET DATA AVAILABLE IN DIVERSE POPULATIONS IN TERMS OF RACE AND EDGE NICHT. -- ETHNICITY. THERE'S THE DIFFERENCE SCREEN APPROACHES AND RESEARCH ON WHOM AND WHEN TO SCREEN AND IMPROVED ACCURACY AND SCREENING APPROACHES ACROSS POPULATIONS AND COORDINATION OF RESOURCES FOR PATIENTS ONCE DIAGNOSED. THERE'S ALSO A NEED FOR THE REPORT FOR RESEARCH ON THE EVALUATION OF DEMENTIA EDUCATION PROGRAMS FOR HEALTH CARE PROVIDERS. IN THE REPORTS CHAPTER FOR END OF LIFE CARE AND THOSE LIVING WITH DEMENTIA THERE'S A DISCUSSION HOW THOSE LIVING BIG DEMENTIA AND EMPHASIS ON THOSE RECEIVING CARE END OF LIFE. THE NATIONAL INSTITUTE OF AGING ON BEHAVIORAL AND SOCIAL SCIENCE FUNDS A CENTER ON PALLIATIVE CARE IN DEMENTIA. IT PROVIDES RESEARCH INFRASTRUCTURE AND DEVELOPS TESTS AND IMPLEMENT PALLIATIVE CARE INTERVENTIONS FOR THOSE WITH DEMENTIA AND CAREGIVERS USING ECONOMICS AND DATA SCIENCE STRATEGY. ANOTHER INFRASTRUCTURE PROJECT FUNDED BY THE DIVISION OF GERIATRICS AND GERONTOLOGY ARE THE INDEPENDENCE CENTER THE ONE AT THE SCHOOL OF MEDICINE AT MOUNT SINAI WHICH CONDUCTS RESEARCH ON PALLIATIVE CARE. MORE RESEARCH IS NEEDED. END OF LIFE RESEARCH RECOMMENDATIONS FROM THE REPORT INCLUDE THE NEED FOR STUDIES OF THE IMPACT OF ADVANCED CARE PLANNING AT ALL STAGES OF DEMENTIA AND ASSESSMENT OF PREFERENCES. THE NEED FOR RESEARCH ON THE EFFECTS OF DIFFERENT TYPES OF DEMENTIA CARE PROGRAMS AND THE TIMING OF HOSPICE REFERRALS AND THE EVALUATION OF THE FEASIBILITY FOR FAMILIES FOREGOING AGGRESSIVE PROCEDURES. THE NEXT RECOMMENDATION FOCUSES ON PLATFORMS TO FACILITATE THE FIELDING OF PRAGMATIC AND HEALTH CARE SYSTEMS. AND THESE ARE DESIGNED TO EVALUATE WHETHER AN INTERVENTION CAN IMPROVE HEALTH OUTCOMES UNDER IDEAL HIGHLY CONTROLLED CONDITIONS. IN CONTRAST PRAGMATIC CLINICAL TRIALS ARE EMBEDDED IN FUNCTIONING HEALTH CARE SYSTEMS AND DESIGNED TO EVALUATE THE EFFECTIVENESS OF REAL WORLD CONDITIONS. THE IMPACT IS TO CONDUCT PRAGMATIC TRIALS OF INTERVENTIONS FOR THOSE LIVING WITH DEMENTIA AND CARE PARTNERS. THE IMPACT COLLABORATORY HAS A NEW FUNCTIONING PILOT PROGRAM. A COUPLE EXAMPLES OF RECENTLY FUNDED PILOTS INCLUDE ONE WORKING TO IMPROVE ALZHEIMER'S AND RELATED DEMENTIA CARE MANAGEMENT ACROSS IN THE DISCIPLINARY TEAMS AND A SECOND THAT FOCUSES ON DESIGNING MOBILE APPS TO HELP ADULT DAY SERVICE CENTERS PREVENT MINOR HEALTH ISSUES FROM ESCALATING. THE COLLABORATORY MADE GREAT STRIDES BUT MORE OPPORTUNITIES ARE AVAILABLE. THE RECOMMENDATIONS IN THIS AREA INCLUDE A FOCUS ON THE EFFECTIVENESS OF PATIENT AND CAREGIVER SUPPORT AND MANAGEMENT SYSTEMS EMBEDDED IN HEALTH CARE SYMPTOMS AND SYSTEM CAPACITY FOR MULTI-FACETED INTERVENTIONS AND THE NEXT ARE RECOMMENDATIONS IN THE EARLY STAGES OF SCIENTIFIC DEVELOPMENT. FIRST AREA IS APPROACHES FOR INTEGRATING AND COORDINATING CARE. IDENTIFICATION OF THE EFFECTIVE APPROACHES FOR INTEGRATING CARE SERVICES ACROSS HEALTH CARE DELIVERY AND COMMUNITY-BASED ORGANIZATIONS. A SIMILAR TOPIC IS CAPTURED BY APP RESEARCH IMPLEMENTATION MILESTONE MANY ARE FAMILIAR WITH THE RESEARCH IMPLEMENTATION MILESTONES ON THE INTEGRATION OF LONG-TERM SERVICES AND SUPPORTS, HOME BASED CARE AND MEDICAL CARE WITH PARTICULAR ATTENTION PAID TO CARE TRANSITIONS. RESEARCH OPPORTUNITIES IN THIS AREA INCLUDE THE NEED TO DEVELOP AND EVALUATE COMPREHENSIVE CARE MODELS THAT EXPAND HEALTH CARE AND COMMUNITY-BASED ORGANIZATIONS AND STUDY EVIDENCE-BASED MODELS OF DEMENTIA CARE IN RURAL AREAS IN DEMOGRAPHICALLY DIVERSE AREAS. PER THE REPORT, MANY GROUPS ARE DEVELOPING INITIATIVES THAT FALL UNDER THE UMBRELLA OF DEMENTIA FRIENDLY COMMUNITIES AND FOCUS ON ASSETS THEY BRING AND WAYS OF ENGAGING CAREGIVERS IN CARE AND OTHER ISSUES. THEY GENERALLY OFFER EDUCATION AND TRAINING FOR MEMBERS OF THE COMMUNITY AND ALSO INCLUDE RESPITE CARE AND OTHER SERVICES. RESEARCH OPPORTUNITIES IN THIS AREA INCLUDE DEVELOPING MEASURES FOR COMMUNITY-LEVEL OUTCOMES, GENERATING RESEARCH-BASED MODELS FOR COLLABORATION AMONG ORGANIZATIONS AND RESOURCES, EVALUATING INNOVATIVE HOUSING ARRANGEMENTS AND MODELLING APPROACHES ON HOW COMMUNITY FACTORS WITHIN A SYSTEM TO IMPLEMENT DEMENTIA RISK AND THE LIVED EXPERIENCE OF DEMENTIA. FINANCING STRUCTURES IS ANOTHER EARLY STAGE RECOMMENDATION. DEVELOPMENT AND TESTING APPROACHES TO INTEGRATIVE FINANCIAL AND SOCIAL SERVICES IS KEY TO PURSUE. A NEW AD RESEARCH MILESTONE 13P IS IN ALIGN WITH THIS RECOMMENDATION ACCORDING TO THE COMMITTEE HERE INCLUDE STUDIES OF HOW MEDICARE ADVANTAGE PLANS AND ALTERNATIVE PAYMENT MODELS BEST PROVIDE INCENTIVES TO IMPLEMENT ACTIVE CARE AND LOOKING AT THE EFFECTS OF CHANGES OR DIFFERENCES IN MEDICAID PAYMENT MODELS ON THE QUALITY OF NURSING HOME AND COMMUNITY-BASED SERVICES FOR THOSE LIVING WITH DEMENTIA. A FINANCIAL EARLIER STAGE RECOMMENDATION IS TO FURTHER ADDRESS THE CHALLENGE OF MEASURING EXPOSURES AND COGNITIVE OUTCOMES FOR THOSE LIVING WITH DEMENTIA. IT'S MER -- MORE RESILIENT AS GROUPS ARE INCLUDED IN RESEARCH AND SELECTION AND RELEVANT EXPOSURES FOR IMPROVEMENT OF QUALITY OF LIFE FOR THOSE LIVING WITH DEMENTIA AND CAREGIVERS ARE SIMILAR IMPORTANT AND EVOLVING. SOCIAL AND BEHAVIORAL RESEARCHERS WILL NEED TO BE FULLY ENGAGED TO CHALLENGE NARROW CONCEPTUALIZATIONS AND RELEVANT RISK FACTORS AND CONSIDER THE IMPLICATIONS OF ALTERNATIVE MEASUREMENT APPROACH. THE CHALLENGES OF AMERICA FAMILY CENTERED OUTCOMES IN DEMENTIA RESEARCH IS RELEVANT TO NEARLY EVERY TOPIC IN THE REPORT. RESEARCH OPPORTUNITIES IN THIS AREA INCLUDE THE DEVELOPMENT OF STANDARDIZED DEFINITIONS AND TOOLS FOR IDENTIFYING DEMENTIA AND CAPTURING STAGES OF DISEASE. IMPROVING MEASUREMENT VALIDITY, DEVELOPING SCHOOLS TO SUPPORT CROSSWALKS FROM SPECIMENS FROM DIFFERENT MODALITIES AND MEASUREMENTS FOR DIVERSE POPULATIONS INCLUDING HETEROGENEOUS SETTINGS AND LINGUISTIC BACKGROUNDS. THE RECOMMENDATIONS AND THE SUBJECT PROVIDE AN IMPORTANT PATH FORWARD AND INASMUCH AS THE PROGRAMS IN AD/SCIENCE AND WE THANK ALL THOSE WHO CONTRIBUTED TO THIS REPORT LAYING OUT A RICH AND ACTIONABLE 10-YEAR AGENDA. WE HOPE THE RECOMMENDATIONS WILL BE TAKEN UP BY THE FIELD ACROSS MANY DISCIPLINES AND ORGANIZERS WITHIN AND BEYOND NIH. VISIT OUR WEB PAGES ON AD RESEARCH AND KWON ME MAKT ME OR OTHER STAFF AND CONTACT US. >> THANK YOU FOR THE OVERVIEW OF THE PUBLICATION AND IT'S IMPLEMENTATION BY NIA. DO WE HAVE QUESTIONS FOR ELENA? >> THAT WAS TERRIFIC AND WHAT A RICH AGENDA. REALLY IMPRESSIVE. I HAVE TWO QUESTIONS. ONE, ON YOUR END DO YOU HAVE TO ASSESS THE ETHICS REVEALING PEOPLE'S TEST RESULTS AND I WAS WONDERING HOW THOSE DECISIONS GET MADE AND WHO MAKES THOSE DECISIONS ABOUT THE ETHICS OF THAT AND ON THE SECOND QUESTION, WE TALKED ABOUT MEASURES AND COMMUNITY LEVEL OUTCOMES AND WONDERED IF YOU CAN GIVE EXAMPLES OF THAT. >> THE FIRST QUESTION, I THINK THIS IS BEST SUITED FOR OUR INVESTIGATORS PREPARING FOR AND PROPOSING THEIR STUDIES. THIS IS A TREMENDOUSLY IMPORTANT TOPIC. WE DON'T HAVE -- I DON'T HAVE THE ANSWER TO YOUR QUESTION DIRECTLY IN TERMS OF HOW WE WOULD DEAL WITH THE ETHICAL CONSIDERATIONS BUT IT IS SOMETHING THAT WE WHERE INTERESTED IN STUDY AND THE WORKSHOP ON PRE-SYMPTOMATIC DIAGNOSIS DEALT WITH ETHICAL QUESTIONS BEFO S BROADLY AND THAT DID TOPIC COME UP AND I'D LIKE TO DISCUSS WHAT WAS DISCUSSED AROUND ETHICS BUT I DON'T HAVE A SPECIFIC ANSWER OTHER THAN TO SAY WE'RE INTERESTED IN THAT TOPIC AND IT DID COME UP IN THE WORKSHOP AND THIS MAY HAVE SOMETHING TO ADD TO THAT AS WELL. >> ON THAT POINT, I THINK PART OF THE STIMULUS FOR THE WORKSHOP THE MORE TARGETED WORKSHOP WAS THE TENSION THAT ARISES BETWEEN THE DESIRE TO GET EVIDENCE OF EARLIER FUNCTIONAL OR PSYCHOLOGICAL CHANGES OR EARLY BIOLOGICAL CHANGES FOR RESEARCH PURPOSES AND POTENTIALLY FOR DIAGNOSTIC PURPOSES IN CLINICAL CONTEXT AND THE QUESTION OF WHAT ARE THE IMPLICATION FOR RESEARCH PARTICIPANTS OR PATIENTS THANE CASE. WE'RE ALL INTERESTED IN MOVING EARLIER TO POTENTIALLY OFFER BENEFIT BUT THE DECISION FOR WHETHER ONE REVEALS THAT IS DIFFERENT FROM THE DECISION IN A CLINICAL CONTEXT WHERE I THINK THE MEDICAL COMMUNITY ENDS UP COMING UP WITH RECOMMENDATIONS THERE. SO WE WERE GRAPPLING WITH THE ISSUE OPPOSED TO COMING UP WITH AN ANSWER FOR IT, IF YOU WILL. >> AROUND ANN, TO YOUR SECOND QUESTION IF I HEARD YOU CORRECTLY I THINK I WERE INTERESTED IN COMMUNITY-LEVEL OUTCOMES. THERE'S MANY WAYS TO APPROACH THIS. ONE WAY THAT COMES TO MIND IS WHEN I THINK OF ACCESS TO SERVICES AS THE COMMUNITY LEVEL. THE AVAILABILITY OF SERVICES AND HOW WE WHO GETS THEM AND WHO DOESN'T. HOW WELL YOUR COMMUNITY ALLOWS YOU ACCESS AND YOU AND QUALITY OF VERY DIFFERENT SERVICES DEPENDING ON THE NEEDS OF THE PERSON WITH DEMENTIA AND CAREGIVER. THERE'S OTHER INFRASTRUCTURE OUTCOMES TO THINK ABOUT AS MENG FROM THE REPORT AND THE DEMENTIA FRIENDLY COMMUNITIES BRINGS TO MIND QUESTIONS HOW THE BROADER COMMUNITY IS AVAILABLE TO HELP WITH NOT ONLY SERVICE PROVISION BUT THE PHYSICAL ENVIRONMENT FOR THOSE WITH DEMENTIA. THOSE ARE TWO EXAMPLES THAT COME TO MIND. >> THANK YOU, ELENA. ANY OTHER QUESTIONS? >> THAT WAS A FANTASTIC PRESENTATION. THERE'S A STRUCTURAL DETERMINATE OF HEALTH IN GENERAL AND VERY IMPORTANT FOR PEOPLE LIVING WITH DEMENTIA. I THINK IT HAS AN IMPACT ON DETECTION AS WELL THE COMMUNITIES PEOPLE ARE LIVING IN. THE KIND OF INFRASTRUCTURE THAT THEY HAVE IN THEIR HOME. SO HOW WOULD YOU -- GIVEN WHAT YOU KNOW ABOUT WHAT GRANTEES ARE DOING OR WHAT THE VSRs DOING, WHAT ARE THE NEXT STEPS FOR ADDRESSING HOUSING AS IT'S A BIG TOPIC AND SOMETHING THAT OFTEN TIMES, I'M AT COLOMBIA UNIVERSITY, WHAT INDIVIDUAL INVESTIGATORS CAN DO TO CHANGE THE HOUSING CONDITIONS. >> GREAT QUESTION, JENNIFER. FROM MY PERSPECTIVE WHEN WE TALK ABOUT HOUSING WE MEAN MANY THINGS AND ISSUES WITH HOUSING STOCK AND DISPARITIES AND AVAILABILITY OF NOT ONLY QUALITY BUT FINANCIALLY VIABLE HOUSING. THERE'S THE FINANCIAL PERSPECTIVE WHICH WE KNOW PLAYS A ROLE IN HEALTH AND HEALTH CARE AS WELL. THERE'S A LOT OF INTERCONNECTION BUT THE HOUSING PART COULD BE ABOUT FINANCING AND STOCK AND THE TYPE OF HOUSING FOR OLDER ADULTS AND PERSONS LIVING WITH DEMENTIA THEY MAY NEED CERTAIN TYPES OF SUPPORTIVE SERVICES CONSIDERED UNDER THE HOUSING UMBRELLA, IF YOU WILL. THERE'S MANY WAYS TO THINK OF HOUSING. TO YOUR POINT IN TERMS OF NEXT STEPS, I THINK THERE'S WAYS TO ADDRESS THIS PERHAPS UNDER THE RECOMMENDATION OF DEMENTIA FRIENDLY COMMUNITIES THINKING OF THE PHYSICAL ENVIRONMENT AND THE EXPERIENCE OF LIVING IN SOMEBODY'S OWN HOME. I KNOW SOME OF OUR INVESTIGATORS LOOK INTO THOSE WHO LIVE ALONE SO THEY'RE HOME ENVIRONMENT IS VERY DIFFERENT THAN OTHERS AND I THINK THAT CONTINUES TO BE A CONCERN IN TERMS OF NOT ONLY THE PROVISION OF SERVICES BUT THE THAT WE'RE ABLE TO CONDUCT WITH AND ON THOSE LIVING ALONE WITH DEMENTIA IN THEIR HOME AND THERE'S A MEETING THAT TALKED ABOUT ENVIRONMENTAL FACTORS IN HOUSING. YOU MAY HAVE BEEN A PART OF THAT DISCUSSION. THERE'S A LOT OF THERE AND I WOULD SAY VSR IS POISED TO THINK ABOUT HOUSING IN A NUMBER OF DIFFERENT CONTEXTS INCLUDING THE ONES I'VE MENTIONED. >> GREAT, THANK YOU. AND THANK YOU AGAIN FOR YOUR PRESENTATION TODAY. I THINK WE'RE GOING MOVE ON THEN TO OUR NEXT SPEAKER. I'D LIKE TO INVITE RON COHANSKI TO INTRODUCE OUR NEXT SPEAKER. >> I THINK WE SWITCHED IT UP ON YOU A LITTLE BIT. HI, EVERYBODY. I'M CANDACE KERR A PROGRAM OFFICER IN THE DIVISION OF AGING BIOLOGY AND PLEASED TO ANNOUNCE DR. WEN WALSH IS A LOCKHART McGUIRE PROFESSOR AT THE UNIVERSITY OF VIRGINIA HIS RESEARCH IS IMPACTING THE AGE OF CARDIOVASCULAR BIOLOGY AND LOOK AT INTERTISSUE COMMUNICATION TO UNDERSTAND BETTER THE INTEGRATED PHYSIOLOGICAL REASONS TO IMPACT AGING AND HE'S RECEIVED NUMEROUS AND AWARDS FROM NHLBI AND THE COUNSEL OF ARTERIOSCLEROSIS THAT NAMED HIM AS THE AMERICAN HEART ASSOCIATION DISTINGUISHED SCIENTIST MANY YEARS AGO. WHAT BETTER WAY TO STUDY THE INTEGRATIVE THE PATHOPHYSIOLOGY OF AGING AND THIS IS INVESTIGATING HEMATOPOIESIS AND WE LOOK FORWARD TO HEARING MORE ABOUT THIS TODAY. I'M GOING TO TELL YOU ABOUT CLONAL HEMATO-POESE -- HEMATO HEMATOPOIES HEMATOPOIESIS. I'LL START WITH A TEXTBOOK DEFINITION. IT'S A CONDITION IN WHICH A SUBSTANTIAL PROPORTION OF MATURE BLOOD CELLS ARE DEVISED FROM A SINGLE HEMATOPOIETIC STEM CELL AND THERE WAS AN EMERGING VIEW IT'S THOUGHT TO BE A CAUSAL RICK FACTOR FOR CARDIOVASCULAR AS PREVALENT FOR THE RISK FACTORS STUDIED FOR RISK FACTORS AND THE THINGS THE PRIMARY CARE PHYSICIAN TELLS YOU ABOUT, HYPER CHOLESTEROL, DIABETES, SMOKING AND YOUR FAMILY HISTORY. YOUR INHERITANCE. ADVANCED AGE IS THE GREATEST CARDIOVASCULAR DISEASE FACTOR AND ADVANCED STAGE IS A RISK FACTOR FOR MANY DISEASES, CANCER, ARTHRITIS, ALZHEIMER'S DISEASE AND OTHERS. THE ASPECT OF AGING THAT HAS ME PARTICULARLY INTERESTED IN THE LAST FIVE OR SIX YEARS IS REFERRED TO AS SOMATIC MOAISISM IN DEVELOPS. IT'S ESTIMATED FROM ULTRA DREAM SEQUENCING THAT PROBABLY BY AGE 50 EVERY CELL IN OUR BODY ARETIRED BETWEEN 1,000 AND 10,000 SOMATIC MUTATIONS. AND THE THING I WANT TO POINT OUT IS THAT BECAUSE CELLS ARE IN CONSTANT COMPETITION WITH ONE ANOTHER, IT CAN GIVE RISE TO CLONAL EVENTS. THEY EXIST AS A PASSENGER AND SOMETIMES IT HITS AN ESSENTIAL GENE AND THE CELL WILL BE LOST BUT THEY HAPPEN IN GENES THAT ARE CALLED DRIVER GENES THAT GIVE THE SELECTIVE TO THE CELL AND THERE'LL BE A CLONAL EXPANSION AND WHAT WE'VE COME TO RECOGNIZE THROUGH MANY STUDIES AS WE AGE, WE BASICALLY BECOME A MOSAIC OF PATCH WORK OF THOUSAND OF CLONES IN MULTIPLE TISSUES. THIS IS SORT OF LISTED HERE. THESE ARE JUST SOME OF THE RECENT CELL NATURE SCIENCE PAPERS ON SOMATIC MOSAICIC IN COL COLON, BLOOD, ENDOMETRIUM AND BLOOD. AND FIRST OF ALL I WOULD SAY CLONAL HEMATOPOIESIS IF YOU THINK ABOUT IT THE WHITE CELLS ARE MULTI-TASKERS AND TRAVEL THROUGHOUT THE BODY AND COMMUNICATE AND ELIMINATE DAMAGED CELLS AND ENABLE US TO COPE WITH THE ENVIRONMENTAL STRESS AND WHEN THEY GET OUT OF CONTROL THEY PARTICIPATE IN MULTIPLE CHRONIC DISEASES SUCH AS CARDIOVASCULAR DISEASE. THERE'S BEEN PAPERS ASSOCIATED MUTANT BLOOD CELLS OR MUTATIONS WITH AGING AND IN PAPER THEY ABLATED A DNA REPAIR PROTEIN IN THE HEMATOPOIETIC CELLS AND THE ANIMALS DISPLAYED PREMATURE SENESCENCE AND IMPACTING SUCH THE SYSTEM AFFECT THE HEART, KIDNEYS, BRAIN, METABOLIC SYSTEM, ALL SYSTEMS. LED TO SYSTEMIC TISSUE DAMAGE AND DECREASE IN LIFE SPAN. THE OTHER ISSUE I WANT TO POINT OUT ABOUT THE HEMATOPOIETIC SYSTEM IS UNDER SELECTIVE PRESSURES. BLOOD CELLS ARE TINY AND GET TURNED OVER RAPIDLY. THEY'RE LIFE SPANS ARE ON THE ORDER OF 3 TO 120 DAYS AND REPRESENTED 90% OF THE CELLULAR TURNOVER IN THE BODY 370 MILLION CELLS A DAY AND FAT AND MUSCLE HAVE LIFE SPANS BETWEEN 12 AND 50 YEARS. IF THEY GET MUTATED BY A DRIVER GENE, THEY ACQUIRE A MUTATED DRIVER GENE THEY WON'T HAVE THE ABILITY TO UNDER GO THE CLONAL EXPANSION LIKE WHAT WE SEE IN THE HEMATOPOIETIC SYSTEM. TO MAKE THIS BITE SIZED THIS IS MY RESEARCH. WITHIN THE HEMATOPOIETIC SYSTEM OCCASIONALLY ONE OF THESE MUTATIONS WILL HAPPEN IN A DRIVER GENE THAT HAS A CLONAL EXPANSION AND IT'S A TWO-STAGE PROCESS AND THE CELLS GIVE RISE TO LEUKOCYTES THAT HAVE BEEN GENETICALLY CORRUPTED BECAUSE THEY ALSO HARBOR THE SAME DRIVER GENE MUTATION AND THAT COULD IMPACT THEIR PHENOTYPE AND THEREBY IMPACT PROCESSES AND IT'S RELATIVELY EASY TO DETECT THIS. YOU BASICALLY DO DEEP SEQUENCING OF THE MUTANT ALLELE. THERE'S AN EASE OF SAMPLE COLLECTION AND WE HAVE ACCESS TO MANY BIOBANKS. WHAT ARE SOME OF THE MUTATIONS THAT GIVE RISE TO CLONAL HEMATOPOIESIS? THERE'S A WHOLE SPECTRUM. WHAT WE MOSTLY FOCUS ON THE CHIP DRIV GENES AND THESE ARE DRIVER GENES. SOME OF THESE ARE RECURRENTLY MUTATED IN BLOOD CANCER. IT MAKES SENSE THEY WOULD BE A DRIVER GENE. HOWEVER, YOU CAN HAVE MOSAIC CHROMOSOMAL ALTERATIONS WHERE YOU HAVE LOGS OF HETEROZYGOSITY AND WHAT HAPPENED WHAT LED TO THIS RESURGENT INTEREST IN THIS FIELD IS THAT THERE WERE TWO PAPERS PUBLISHED BACK TO BACK IN 2014 IN THE NEW ENGLAND JOURNAL OF MEDICINE AND BASICALLY SHOWED CLONAL HEMATOPOIESIS WAS PROBABLY MORE PREVALENT THAN WE PREVIOUSLY UNDERSTOOD. IN A PAPER THERE WAS A CLEAR INCREASE WITH AGE, THE ABILITY FOR THEM TO DETECT CLONAL HEMATOPOIESIS AND WERE USING RELATIVELY INCENSENSITIVE METHODS BACK THEN AND BUT WHEN INDIVIDUALS REACHED 70, 10% EXHIBITED CLONAL HEMATOPOIESIS AND IT INCREASED GREATER FROM THERE. THE THING THAT CAUGHT EVERYBODY'S ATTENTION AT THE TIME WAS IT WAS FOUND THAT INDIVIDUALS THAT HAD CLONAL HEMATOPOIESIS HAD AN INCREASE IN MORTALITY. THERE WAS ABOUT A 40% IN MORTALITY ON THE FOLLOW-UP PERIOD ON BOTH STUDIES. THE QUESTION BECAME, WHAT IS THIS MORTALITY ASSOCIATED WITH AND YOU WOULD THINK WELL, HEMATOLOGIC CANCER PROBABLY BECAUSE WE'RE LOOKING AT THE FIRST STEP IN A LONG PATH DEVELOPING A BLOOD CANCER. HOWEVER, THE ISSUE HERE IS THAT BLOOD CANCERS RELATIVELY SPEAKING ARE KIND OF RARE IN THE POPULATION AND REALLY CANNOT REALLY ACCOUNT FOR THE BIG INCREASE IN MORTALITY OBSERVED IN THE STUDY. IT TURNED OUT THE FIRST CLUES WERE PROVIDED IN THE SUPPLEMENTARY DATA SECTION OF THE PAPER. THERE WAS A SECONDARY ANALYSIS AND BASICALLY FOUND THAT CLONAL HEMATOPOIESIS WAS ASSOCIATED WITH INCREASED CORONARY HEART DISEASE AND STROKE WHICH WAS BIG CONSIDERING THE PREVALENCE IN THE POPULATION. IT WAS A STRIKING FINDING AND PEOPLE DIDN'T REALLY PAY ATTENTION UNTIL THIS ASPECT. PEOPLE PAID ATTENTION TO THE MORTALITY BUT NOT TO THE CARDIOVASCULAR DISEASE. MANY STUDIES ASSOCIATED HEMATOPOIESIS WITH THE STUDY AND WITH CARDIOVASCULAR DISEASE. BURY -- I WANT TO POINT OUT IT'S BEEN ASSOCIATED WITH CHRONIC KIDNEY DISEASE AND ACCELERATED AGING, OSTEOPOROSIS, PREMATURE MENOPAUSE, DIABETES, ETCETERA. WITH THE STUDIES IT'S EPIDEMIOLOGY AND WE DON'T KNOW WHAT'S CAUSAL AND DIRECTIONAL AND HAVE NO IDEA ABOUT MECHANISM. IT COULD BE FOR EXAMPLE, AS WE AGE WE DEVELOP CLONAL HEMATOPOIESIS AND DEVELOP CARDIOVASCULAR DISEASE AND THEY'RE A PHENOMENON OF THE AGING PROCESS AND WE WANTED TO LOOK AT EXPERIMENTAL SYSTEMS AND TEST WHETHER CLONAL HEMATOPOIESIS IS DIRECTLY UPSTREAM FROM CARDIOVASCULAR DISEASE. WE BASICALLY BUILT MOUSE MODELS AND HAVE DONE THIS WITH A NUMBER OF CLONAL HEMATOPOIESIS OR CHIP DRIVER GENES AND OTHERS AND WHAT I'LL SHARE QUICKLY SOME OF THESE EARLY DATA IN OUR FIRST WE DID A BONE MARROW TRANSPLANT AND WANTED TO LOOK AT THE AMOUNT OF MUTANT HEMATOPOIETIC CELLS AND TAKE CELLS AND COMBINE THEM WITH 90% BONE MARROW CELLS IN RECIPIENT MICE IRRADIATED. THE MICE THAT RECEIVED THE KNOCKOUT BONE MARROW CELLS WE COULD LABEL. WILD TYPE STAYS AT 10% AND YOU SEE THEY INCREASED STRIKINGLY. HAVE TO DO DNA SEQUENCING AND ONE FINDS AN AMPLIFICATION OF THE MUTANT DRIVER GENE AT THE EXPENSE OF WILD TYPE CELLS BECAUSE THE CELLS BASICALLY HAVE A SELECTIVE ADVANTAGE AND THAT'S CONSISTENT WITH THE CLINICAL PARADIGM OF CLONAL HEMATOPOIESIS AND WHEN A MOUSE DEVELOPS HEART FAILURE THEY FIND THE CLONAL HEMATOPOIESIS WILL LEAD TO INCREASE IN CARDIOVASCULAR DISEASE. WE'RE SEEING ABOUT A 60% INCREASE IN ATHEROSCLEROTIC PLAQUE SIZE PROVIDING THE FIRST EVIDENCE THAT CLONAL HEMATOPOIESIS COULD BE A DRIVER OF CARDIOVASCULAR DISEASE. TO SUMMARIZE ALL THIS, THERE'S A PREVALENT PRE-CANCEROUS STATE IN THE BLOOD THAT PROMOTE S CARDIOVASCULAR DISEASE AND CELLS WILL GET PEPPERED WITH MUTATIONS, WHEN THAT HAPPENS THE SUBJECT WILL UNDER GO CLONAL HEMATOPOIESIS AND THAT'S UP STREAM OF ATHEROSCLEROSIS OUR HEART FAILURE OR OTHER DISEASES WE MODEL. THE QUESTION IS WHAT'S THE MECHANISM AND IF WE UNDERSTAND THE MECHANISM WOULD THAT PROVIDE NEW INSIGHTS ABOUT POTENTIAL THERAPIES? IT TURNED OUT -- I ALWAYS THOUGHT IT WOULD IN MORE COMPLEX BUT IT SEEMS THE PARADIGM IS DEVELOPING MANY DRIVER GENES SEEM TO BE WORKING THROUGH THE IL BETA, IL6 PATHWAY IN MYELOID CELLS AND THIS IS FIRST DATA AND MORE ON THE BETA PRODUCTION AND TAKE CELLS THE MICE AND WHEN STIMULATED MAKE MORE IL6 AND CAN SHOW IN EARLY STUDIES TO TAKE AN INHIBITER BLOCK AND BASICALLY RESERVE THE PATHOLOGICAL PHENOTYPE CONFERRED BY THIS MODEL OF CLONAL HEMATOPOIESIS AND THERE'S CLINICAL EVIDENCE. IF YOU LOOK AT THE TOP MED COHORT USING HEMATOPOIESIS IS ASSOCIATED WITH IL6 AND IL1 BETA AND THERE WAS A STUDY IN THE U.K. DEMONSTRATING A COMMON IL6 RECEPTOR POLYMORPHISM SERVING AS A PROXY AND IN THOSE INDIVIDUALS THAT HAVE CLONAL HEMATOPOIESIS IT ELIMINATES THE ASSOCIATION BETWEEN THAT CONDITION AND INCIDENT CARDIOVASCULAR DISEASE. FINALLY IN THE CANTOS TRIAL TESTING A NEUTRALIZING ANTIBODY AND THE INDIVIDUALS ENROLLED IN THE TRIAL EXHIBITED A SUPERIOR RESPONSE AND IF YOU LOOK AT THE STUDY POPULATION THERE WAS A 15% REDUCTION IN MAJOR CARDIOVASCULAR EVENTS BUT INDIVIDUALS WITH HEMATOPOIESIS THERE WAS A 60% REDUCTION SUGGESTING IF YOU EVALUATE AN INDIVIDUAL'S CLONAL HEMATOPOIESIS IT MAY PROVIDE PERSONALIZED INFORMATION OR FIND PEOPLE TO BETTER RESPOND TO DISEASE PROCESS. I HAVE 10 MINUTES. LET ME TELL BUT ONE OF THE THINGS THAT BOTHERED ME SINCE THE BEGINNING ABOUT THE FIELD OR SINCE 2017 WHEN THIS WAS PUBLISHED. THE CHIP DRIVER GENES RECURRENTLY MUTATED IN CANCER PROBABLY ONLY ACCOUNT FOR THE MINORITY OF CLONAL EVENTS IN THE BLOOD AND POINTED OUT WHEN THEY DID A NON-BIASSED WHOLE GENOME SEQUENCE ANALYSIS AND 13% OF THE CLONAL EVENTS THEY COULD DETECT WERE ASSOCIATED WITH MUTATIONS IN KNOWN DRIVER GENES, YET THE BIG GROUP OF UNKNOWN HERE STILL EXHIBITED MORTALITY AND THIS IS THE FIRST DISCLOSURE AND OF A FUND STUDY AND BECAUSE IT'S AN NIA MEETING I THOUGHT IT WOULD BE APPROPRIATE BUT WE'RE RERESPONDING -- RESPONDING TO COMMENTS RIGHT NOW AND FEMALES 81 YEARS AND MALES 76 YEARS FEMALES LIVING LONGER IS BAKED IN OUR CULTURE AND THERE'S MANY MEN IN THE UNITED STATES IT'S MANY MILLIONS OF YEARS OF LIFE LOST. WE DON'T UNDERSTAND THIS. MOST OF YOU PROBABLY ASSUME THAT MEN WE HAVE TESTOSTERONE AND MAKES OUT -- US STUPID AND THE GENETIC COMPONENT MEN WILL LOSE THE Y CHROMOSOME. IT'S THE GENE THAT CONFERS MALENESS AND IT'S THE MOST DIAG ZYGOTIC GENE AND MOST MEN LOSE THIS AND THERE'S A NUMBER OF SOMATIC MUTATIONS TO THE CHIP GENE SO IT'S A BIG DEAL ABOUT 4.5 TIMES IF YOU LOOK AT MALES 2.25 TIMES IF YOU LOOK AT FEMALES. AND STRIKINGLY, MOSAIC LOSS OF Y IS INCREASED IN CANCER MORTALITY AND DIAGNOSIS OF ALZHEIMER'S DISEASE. OUR COLLABORATOR IN THIS STUDY MADE THIS FIRST ASSOCIATION WITH MORTALITY WAS QUOTED AS SAYING IT SPEAKS TO THE LOSS OF MORTALITY FOR MEN COMPARED TO WOMEN. IT'S A SMALL CHROMOSOME AND CHARACTERIZED AS A GENETIC WASTE LAND AND HAS 71 GENES AND MANY ARE DUPLICATED SO ONLY ENCODES FOR 27 UNIQUE PROTEINS AND 9 ARE UBIQUITOUS AND IT COMES DOWN TO THE SAME QUESTION AS WITH CHIP, IS MOSAIC LOSS OF Y CAUSALLY ASSOCIATED WITH MORBIDITY AND MORTALITY AND NO STUDIES HAVE ADDRESSED THIS. WE CREATED A MODEL OF MOSAIC LOSS OF Y AND WE TOOK BONE MARROW CELLS AND INFECT THEM WITH A VIRUS THAT EXPRESSES A GUIDE RNA THAT TARGETS THE Y CHROMOSOME AND EFFECTIVE AT ELIMINATING THE Y CHROMOSOME. WE CAN ELIMINATE WITH OUR BEST GUIDE RNA 90% OF THE Y CHROMOSOME. HERE YOU SEE IN THE FISH ANALYSIS THE Y CHROMOSOME IS GONE AND IF YOU LOOK AT THE CELLS LABELLED WITH THE VIRUS GFP YOU CAN SEE IF YOU LOOK AT Y EXPRESSED GENES, WHY CHROMOSOME EXPRESSED GENES IN BLOOD CELLS IT KNOCKS DOWN THE DETECTABLE EXPRESSION OF THESE GENES. WE DID THIS BONE MARROW TRANSPLANTATION AND SAID WHAT DO WE DO WITH THE MICE. THEY SHARE FEATURED WITH MEN AND THIS IS DONE IN MALE MICE. THEY EXHIBITED DIMINISHED SURVIVAL AND DEVELOPED AN AGE RELATED CARDIO MYOPATHY. THEY HAD MORE PULMONARY AND RENAL FIBROSIS AND COULD DETECT A COGNITIVE DECLINE. THIS IS INTERESTING. WITH THAT DATA WE WENT TO QUERY THE BIOBANK BECAUSE THERE WASN'T GOOD PROSPECTIVE DATA TO SUGGEST MOSAIC LOSS OF Y WAS RELATED TO CARDIOVASCULAR DISEASE MORTALITY AND FOUND A DOSE RESPONSE RELATIONSHIP WITH DISEASES OF THE CIRCULATORY SYSTEM AND MEN WHO LOST MORE OF THEIR Y CHROMOSOME EXHIBITED MORE CARDIOVASCULAR DISEASE AND HYPERTENSIVE HEART DISEASE AND WHATEVER. WE BECAME INTERESTED IN THE HEART FAILURE PHENOTYPE. THIS IS WHAT THE DATA LOOKS LIKE IF YOU LOOK AT THE SNIPS. HERE'S THE XY AND AS MEN LOSE THE Y CHROMOSOME THIS COULD BE TURNER SYNDROME INTERESTINGLY YOU HAVE PEOPLE SELF-IDENTIFIED AS MALES AND INDIVIDUALS WITH XYY AND MEN WHO HAVE TWO Y CHROMOSOMES AND XYY. BASICALLY INSTEAD OF CONTINUING TO DO THE AGING EXPERIMENTS WE ALSO CREATED AN ACUTE MODEL OF NON ISCHEMIC HEART MODEL WIN TRANS VERSION AORTIC CONSTRICTION AND ACERBATED WHEN THE MICE HAVE BEEN ENGINEERED TO HAVE MOSAIC LOSS OF Y AND THERE'S AGAIN MORE OF THIS FIBROSIS AND INCREASE IN FIBROTIC AREA. IF YOU DO RNA SEQ ANALYSIS THERE'S AN INCREASE OF TGA BETA SIGNALLING IN THE MYELOID CELLS AND THIS IS STRIKING AND TOOK A WHILE TO FIGURE OUT THERE'S IN INCREASE IN INFLAMMATION IN THE MICE. WE'RE GOOD AT LOOKING AT INFLAMMATION AND COULDN'T FIND IT. WE THOUGHT Y CHROMOSOME WOULD BE LIKE CHIP AND IT'S NOT. IT'S BASICALLY PROMOTING FIBROSIS. FINALLY, WE WERE ABLE TO SHOW THE TGF BETA NEUTRALIZATION WITH A BLOCKING ANTIBODY CAN REVERSE THE ALSO OF THE WILD TYPE IN THE HEART. TO ESSENTIALLY WRAP THIS UP HERE, ORGAN FIBROSIS INCREASES WIN AGE AND CONTRIBUTE TO 45% OF LESS IN INDUSTRIALIZED COUNTRIES AND ASSOCIATED WITH MORBIDITY AND MORTALITY. WE CONSTRUCTED A Y PROMOTES TGF BETA SIGNALLING. THANK YOU AND I FINISHED ONE MINUTE EARLYMINUTE EARLYMINUTE EARLYYMINUT E EARLYMINUTE EARLY. >> I WONDER ABOUT THE COMPARISON ON THE GENES ON THE MOUSE AND IF THAT GIVES YOU INSIGHT TO THE HUMAN Y CHROMOSOME. IF THERE'S TIME I'LL ASK ANOTHER QUESTION TOO. >> THAT'S RIGHT. SO WE CAN RULE OUT A FEW, RIGHT? SO IT'S AN IMPERFECT ANALYSIS BECAUSE LIKE MAYBE THERE'S SOMETHING BEING LOST ON THE HUMAN Y CHROMOSOME WE CANNOT REPLICATE OR FIND IN A MOUSE. BUT WE TAKE THAT SHORT LIST OF GENES. THAT'S WHAT WE'RE DOING RIGHT NOW USING THE CRISPR TO GO OUT AND TARGET THE INDIVIDUAL CODING LOCI AND BECAUSE WE KNOW THIS IS AN IMMUNE EFFECT WE'RE LOOKING AT Y CHROMOSOME GENES EXPRESSED IN THE HEMATOPOIETIC SYSTEM TO NARROW IT DOWN FURTHER. IT'S NO SO MAYBE HARD TO FIND WHAT THE GONE MIGHT BE. WE'LL SEE. THANK YOU FOR THE QUESTION. >> RICHARD AND THEN FRANK AND MAYBE THEN WE CAN CIRCLE BACK TO PEGGY. >> WHEN YOU DESCRIBED THE U.K. BIOBANK THE CORRELATION OF LOSS OF Y WITH CARDIOVASCULAR DISEASE, A PRESUME THAT WAS NOT THE CORRELATION WITH AGE? >> THE EPIDEMIOLOGY WAS DONE BY LARS FORSBERG AND I THINK HE TOOK IT INTO ACCOUNT WHEN HE WAS DOING HIS ANALYSIS. THE CONFOUNDERS. WE DIDN'T DO THAT ASPECT. WE GAVE IT TO THE EXPERTS. GOOD POINT >> FRANK. KEN, IMPRESSIVE WORK. I WAS WONDERING, AS YOU LOOK AT YOUR MODELS SAY THE CLONAL HEMATOPOIESIS MANIPULATION AND SEE THESE CYTOKINE AND IMMUNE CHANGES, WHAT IS YOUR STRATEGY THEN FOR COMPARING THEM TO THE MODELS OF AGING AND I'M BIAS BY FOLLOWING THE WORK HERE AT STANFORD AND WATCHING THE IMMUNE CHANGES WITH AGING AND THERE'S SO MANY WAYS TO LOOK AT THAT WITH LARGE-SCALE DATA AND RNA SEQ. >> NOT AS MUCH AS WE SHOULD. IT'S A NEW FIELD AND WE'RE ALL KIND OF RUSHING TO FIND WHAT ARE THE MAJOR SIGNALS AND MECHANISM. TYPICALLY WE TAKE A YOUNG MOUSE AND FORCE A DISEASE ON IT IN A CLONAL HEMATOPOIESIS MODEL AND I THINK IT WOULD BE GOOD TO COMPARE SOME OF THE CLONAL HEMATOPOIESIS WITH SOME OF THE MORE STANDARD MODELS OF AGING. A COUPLE TIMES WE'VE DONE EXTENSIVE MODELLING AND GOT ANOTHER MODEL OF CLONAL HEMATOPOIESIS WHERE WE DON'T IRRADIATE A MOUSE AND LET THE MOUSE LIVE TO 15 TO 18 MONTHS AND FIND THEY BASICALLY ALSO EXHIBIT WHAT APPEARS TO BE ACCELERATED AGING TO THE EXTENT IT'S BEEN LOOKED AT. WE SEE MORE AGE-RELATED CARDIO MYOPATHY AND BECOME METABOLICALLY DYSFUNCTIONAL AND INFLAMED. >> WE HAVE SO MANY WAYS OF MEASURING AGE. LOOK FOR WARD TO SEEING THAT, THANK YOU. >> THAT WAS A FABULOUS TALK EXTREMELY INTERESTING. FROM A GRAIN STANDPOINT, YOU SAID THE MOUSE MODEL DID SHOW COGNITIVE DECLINE WITH THE MOSAIC LOSS OF Y. GIVEN YOU'RE SPEAKING OF FIBROSIS, WHAT DO YOU THINK THE MECHANISM IS FOR THE LOSS OF COGNITIVE FUNCTION GIVEN THE BRAIN DOESN'T HAVE FIBROSIS. >> YEAH, I FL KNOW, I DON'T KNOW. I'M LUCKY TO HAVE A GOOD STROKE INVESTIGATOR IN MY LABORATORY AND SHE'S INTERESTED IN A LOT OF THESE TYPES OF ISSUES AND SHE'S BEEN BASICALLY DOING THE STROKE MODELS WHICH ARE HARD FOR CLONAL HEMATOPOIESIS BECAUSE YOU SET OFF A BOMB IN THE BRAIN AND THE IDEA YOU'LL SEE AN AFFECT IS TOUGH. SHE'S THE ONE THAT SET UP THE MODELS BUT WE FOUND THIS COGNITIVE DECLINE AND WANTS TO INVESTIGATE THAT FURTHER. NOW THAT WE'VE ESTABLISHED THIS MODEL WE CAN LOOK AT A LOT OF DIFFERENT DISEASE PROCESSES. I AGREE, THERE'S NO LITERATURE OUT THERE ON FIBROSIS AND COGNITIVE DECLINE. I DON'T KNOW. YOU LET A MOUSE AGE AND WE SEE A LOT OF THING AND WE CLEAVED OUT THE HEART FAILURE AND TAKE IT INTO WHAT WE DO HERE, BASICALLY. >> AND I THINK FINAL QUESTION, PEGGY, DO YOU WANT TO CIRCLE BACK? >> THAT WOULD BE GREAT, THANK YOU. SO YOUR WORK WITH THE TET 2 AND IL6 AND IL BETA IS WONDERFUL AND SET THE STANDARD FOR THE FIELD. THERE'S ABOUT 20 GENES THAT PLAY A ROLE IN CLONAL HEMATOPOIESIS AND TO WHAT PARADIGM A DO YOU THINK IT WILL FULFILL THE OTHER GENES AND B, BE RELEVANT FOR OWE OTHER DISEASE PROCESSES THAT HAVEN'T BEEN STUDIED YET. >> I THOUGHT, PEGGY, WHEN ALL THE GENES WORKED THROUGH DIFFERENT TYPES OF MECHANISMS THEY'RE ALL GOING TO BE WORKING THROUGH A DIFFERENT PATHWAY AND DIDN'T HAVE TO BE A PRO-INFLAMMATORY PATHWAY BUT WE LOOKED AT FOUR OR FIVE GENES AND SEE AN IL1 BETA AND AS YOU CAN APPRECIATE PEOPLE THINK MAYBE ONE OF THE THINGS THAT LEADS ONE OF THE INTRINSIC FACTORS THAT'S OCCURRING IN THE BONE MAYOREE THAT -- MARROW TO EXPAND IS LIKE A FEEDBACK MECHANISM AND MAYBE YOU CAN EXPLAINING IT BETTER THAN I CAN TO THE AUDIENCE, AS WE AGE THE BONE MARROW BECOMES MORE INFLAMED AND CREATES A SELECTIVE DISADVANTAGE FOR THE WILD TYPE HEMATOPOIETIC CELLS AND THE CELLS WITH MUTATIONS AN DRIVER GENES ARE PROTECTED FROM THE CHRONIC INFLAMMATORY STATE AND IT'S A FEEDBACK TYPE OF A THING. THAT'S POPULAR. THERE'S BEEN RELATIVELY FEW STUDIES THAT LOOKED AT AND I'M SURE PEGGY KNOWS THIS, EVERYBODY HAS SMALL TINY MUTATIONS WHEN WE'RE YOUNG WE ALREADY DEVELOPED A LOT OF THEM BUT THEY GROW IN SOME PEOPLE AND NOT IN OTHERS AND THAT'S ANOTHER CHALLENGE OUT THERE TO TRY TO UNDERSTAND WHAT'S GOING ON IN THE ENVIRONMENT OF THE HEMATOPOIETIC STEM CELL ALLOWING THE MUTANT CLONES TO SUDDENLY HAVE THE ADVANTAGE. >> GREAT. THANK YOU VERY MUCH. AGAIN, I JUST WANT TO THANK YOU, DR. WALSH FOR YOUR REALLY EXCITING TALK AND SHARING WITH US THE CURRENT DATA. AND WISH YOU ALL THE BEST SO THANK YOU VERY MUCH. AND I THINK AT THIS POINT WE HAVE ONE MORE SECTION LEFT IN OUR OPEN SESSION. FIRST, I THINK WE'LL TAKE A SHORT BREAK AGAIN. SINCE WE'RE RUNNING A LITTLE BIT LATE I THINK WE'LL JUST TAKE A 10-MINUTE BREAK AND THEN RECONVENE TO HEAR FROM OUR INTRAMURAL PROGRAM. SO IT IS NOW 1:31, SO LET'S TAKE TO 1:40 AND WE'LL COME BACK IN A SHORT TIME, 10 MINUTES. LATE JUST BREAK FOR 10 MINUTES. 1:42 WE'LL RETURN. THANKS VERY MUCH. NEXT UP WE'LL HEAR FROM DR. LUIGI FERRUCCI FIRST REGARDING OUR INTRAMURAL PROGRAM REPORT. I'LL TURN IT OVER TO LUIGI AND HIS COLLEAGUES. >> IT'S MY PLEASURE TO PRESENT SOMETHING ABOUT THE INTRAMURAL PROGRAM AT NIA AND OUR PRESENTATION WILL BE DIVIDED IN TWO PARTS. THE FIRST PART IS OPEN TO THE PUBLIC AND WE'LL HAVE SOME OF MY COLLEAGUES TO PRESENT THEIR SCIENCE, IN PARTICULAR, I'LL HAVE SUSAN RESNICK FROM THE LABORATORY OF NEUROSCIENCE PRESENTING AND THEN FROM THE POPULATION SCIENCE LABORATORY AND THE GERONTOLOGY BRANCH. THEY'LL PRESENT A HIGHLIGHT S S OF THE GROUP OF THE SCIENCE THEY'RE DOING AND IN THE CLOSED SESSION I'LL TELL YOU MORE ABOUT THE MORE SALIENT EVENT AND AS WE SAW EACH OTHER LAST TIME WITHOUT WASTING TIME I INVITE SUSAN RESNICK TO PRESENT. >> THE CHALLENGES STILL REMAIN. I'VE BEEN ASKED TO PRESENT FOR THE LABORATORY OF BEHAVIORAL NEUROSCIENCE. AND THE GOAL OF OUR PROGRAM IS TO UNDERSTAND MECHANISMS OF INDIVIDUAL DIFFERENCES AND AGE ASSOCIATED COGNITIVE VARIATION. FROM ANIMAL TO HUMAN MODELS WITH THE GOAL TO PROMOTE SUCCESSFUL OUTCOMES. THE LABORATORY OF BEHAVIORAL NEUROSCIENCE HAS FIVE PRINCIPLE INVESTIGATORS NOW. I LEAD THE LABORATORY AND SERVE AS CHIEF AND WE'RE JOINED BY BY THESE PEOPLE AND LAST MONTH DR. BENJAMINI JOINED AND WILL WORK ON INTEGRATIVE BIOPHYSICS. I'D LIKE TO START WITH SOME OF THE PROGRESS THAT WE'VE MADE OVER THE LAST YEAR DESPITE THE PANDEMIC AND THERE'S ONLY ONE GROUP REGULARLY AT THE CENTER OTHER THAN A FEW TEST PARTICIPANTS THE REST OF US HAVE WORKED REMOTELY. THERE'S A PROGRAM CALL STARRRS, SUCCESSFUL TRAJECTORY OF AGING AND THIS RESERVE AND RESILIENCE IN RATS. THE IDEA OF RESERVE AND RESILIENCE IS A THEME THAT CUTS THROUGH THE LABORATORY AS WE TRY TO LOOK FOR FACTORS THAT PROMOTE SUCCESSFUL AGING. THE GOAL OF STARS IS TO ESTABLISH AN OPEN RESOURCE FOR THE LONGITUDINAL STUDY OF COGNITIVE IN MALE AND FEMALE RATS AND RECOGNIZE AGE AND RESILIENCE AGAINST ALZHEIMER'S DISEASE AND RELATED DISORDERS. WHAT THIS PROJECT ENTAIL IS FULL LONGITUDINAL DATA SETS FROM MORE THAN 700 RATS AND THE STUDY WILL BE POWERED TO LOOK AT SEX DIFFERENCES IN THE ANIMAL MODEL. THEY EXPECT TO COLLECT MORE THAN 2,000 MRI DATA SETS AND BIOSPECIMENS. AGAIN, DUE TO COVID, THERE WERE A NUMBER OF PROGRAM RELATED DELAYS BUT I'M HAPPY TO REPORT THAT THE ANIMAL MAGNET WAS INSTALLED IN THE BRC IN LATE OCTOBER AND THIS IS A PICTURE OF THE INSTALLATION. AND DR. RAFF HAS USED THE TIME TO LOOK AT THE PHENOTYPING STRUCTURE AND MONITORING AND OPTIMIZATION OF THE OTHER METHODS AND THIS IS ILLUSTRATED IN THIS COLLAGE MUCH PICTURES. IN THE NEXT PHASE, HIS PLAN IS TO BEGIN THE LARGE-SCALE DATA COLLECTION AND ESTABLISH A WEB-BASED COORDINATION AND DIGITAL DATA CENTER AS WELL AS A BIOSPECIMEN REPOSITORY AND THE SPECIMENS WILL BE DISTRIBUTED THROUGHOUT THE EXTRAMURAL PROGRAM AS WELL AS THE INTRAMURAL PROGRAM. IN MY OWN PROGRAM, WE'VE ALSO BEEN CHALLENGED BY COVID. OUR PET SCAN STUDIES BASICALLY CAME TO A STOP OVER A YEAR. WE HAVE RESTARTED SCANNING BLSA PARTICIPANTS WIH PARTICIPANTS BUT AT A MUCH REDUCED RATE. SO WE TOOK THE OPPORTUNITY TO COMPLETE PLASMA BIOMARKERS ON ONE HAS BEEN COMPLETED IN COLLABORATION WITH JOHNS HOPKINS WHO RUNS THE SAMPLE IN DUPLICATE AND OUR TAO SAMPLES ARE PENDING AND HOPE TO GET THEM SOON. WE HAD A CROSS-SECTIONAL DATA SET BASED ON THE FIRST THREE TMRI VISITS PARTICIPANTS HAD AND THAT WAS ABOUT 700 PARTICIPANTS ACROSS THE FULL AGE RANGE. THEN WE TOOK ALL OF THE PARTICIPANT VISITS WHERE WE HAD THE MEASUREMENTS AND THAT CONSTITUTES OUR SPECIMEN AND THAT WAS OVER 600 PEOPLE FOR 200 VISITS FOR THE INDIVIDUALS. I HAVE THE RATIOS AND GFAP AND THE RATIO DECLINES WITH AGE CONSISTENT WITH A DECLINE IN THE PRESENCE OF ALZHEIMER'S DISEASE, GFAP INCREASES AND YOU CAN SEE THESE ARE PRETTY NOISY. DESPITE THAT NOISE WE GET GOOD COEFFICIENTS FOR STABILITY OVER TIME BETWEEN AROUND .7 TO .75 THOUGH THE INDIVIDUAL MEASURES ARE QUITE A BIT LOWER. SO WHAT DO WE SEE IN THE BLSA WHEN WE LOOK AT PLASMA BIOMARKERS AND PIB AT THE LAST VISIT AND THERE ARE DIFFERENCES BETWEEN PEOPLE WHO ARE POSITIVE OR HAVE AMYLOID IN THEIR BRAIN VERSUS NEGATIVE. I WANT TO POINT OUT WE USED A LOW LEVEL OF DETECTABLE PIB TO CALL SOMEBODY POSITIVE IN THE ANALYSES. DESPITE THE LOW LEVEL, WE SEE DIFFERENCES IN A BETA RATIO IN GFAP AND NFL. AS YOU'D EXPECT, GIVEN PIB SAY MEASURE OF AMYLOID. WHEN YOU LOOK AT HOW WELL THE RATIO PREDICTS POSITIVITY, THE AREA UNDER THE CURVE IS ABOUT .7 AND NOT GREAT BUT PROBABLY THE WAY THEY'LL BE USED AS OTHERS HAVE SUGGESTED IS TO DECREASE THE NUMBER OF PEOPLE THAT GO FOR PIB SCANS OR FOR AMYLOID SCANS IN GENERAL FOR SELECTION INTO CLINICAL TRIALS RATHER THAN AS A STAND ALONE MEASURE RIGHT NOW. DR. WALKER JOINED IN 2020 AND HAS BEEN ENTIRELY REMOTE SINCE JOINING AND DESPITE THAT HE'S BEEN REMARKABLY PRODUCTIVE AND DEVELOPED A SUCCESSFUL INTRAMURAL LAB PROPOSAL WHICH WAS SUPPLEMENTED BY THE DISTINGUISHED SCHOLARS FUNDING TO PERFORM PROTEOMICS AND ADDITIONAL PLASMA P TAO AND OTHER MEASURES USING THE LONGITUDINAL MRI EXAMPLE. AND HE ALSO WITH HIS GROUP QUICKLY JUMPED INTO THE EXISTING BLSA DATA AND DR. WALKER IS INTERESTED IN INFLAMMATION. THEY WERE ABLE TO IDENTIFY A SAMPLE THAT REPORTED IN THE BLSA HERPES VIRUS AND COMPARED THOSE INDIVIDUALS WHO DID NOT REPORT PRIOR HERPES VIRUS INFECTION AND FOUND THERE WAS GREATER LONGITUDINAL WHITE MATTER VOLUME LOSS AS ILLUSTRATED IN THE BOTTOM HERE THAN THOSE WHO HAD PREVIOUSLY REPORTED A HERPES INFECTION AND IT WAS MOST PRONOUNCED IN THE TEMPORAL WHITE MATTER LOSS. AND THERE'S BEEN A STUDY DREAM, DRUG REPURPOSING FOR EFFECTIVE ALZHEIMER'S MEDICINE. THIS IS A TWO-YEAR MULTI-CENTER STUDY IDENTIFY NOVEL REPURPOSING CANDIDATES FOR ALZHEIMER'S DISEASE WHERE HE LEVERAGES BOTH DEEP MOLECULAR PHENOTYPING OF HUMAN BRAIN AND BLOOD AND BIG DATA ANALYSIS OF REAL WORLD OUTCOMES IN COLLABORATION WITH EXTRAMURAL INVESTIGATORS, THEY'VE IDENTIFIED TWO CLINICAL DATA SETS WITH OVER 20 MILLION OLDER INDIVIDUALS WITH CLINICAL DIAGNOSES DATA AND USE THE DATA SETS TO IDENTIFY TARGETS THAT BEAR FURTHER INVESTIGATION POSSIBLY IN RANDOMIZED CLINICAL TRIALS AS CANDIDATE AB TREATMENT FUTURE. WITH HIS PROGRAM AND THE DREAM STUDY BUT THEY'VE BEEN SUCCESSFUL AT USING DRUG DISCOVERY IN ALZHEIMER'S DISEASE USING OMICS TO IDENTIFY PLAUSIBLE TARGETS IN A RECENT PAPER THEY IDENTIFIED THE JAK-STAT MODULATION AS IMPORTANT IN ALZHEIMER'S DISEASE AND NOW TAKEN THAT WHERE THEY'RE PROPOSING THREE DIFFERENT COMPARISONS IN THE REAL WORLD CLINICAL DATA SETS TO TEST WHETHER OR NOT DRUGS THAT MODULATE THAT PATHWAY HAVE EFFECTS ON ALZHEIMER'S DISEASE RISK IN THE REAL WORLD CLINICAL DATA SETS. IN THE LAST EXAMPLE, I'D LIKE TO SHOW YOU PROGRESS MADE IN THE WOMEN'S HEALTH INITIATIVE MEMORY STUDY WE'RE ALL WORKING ON TOGETHER WITH OTHER INDIVIDUALS IN THE INTRAMURAL RESEARCH PROGRAM AND AT WAKE FOREST TO UNDERSTAND THE COGNITIVE RESILIENCE IN APOE4 ESCAPEES AND MAKE IT TO AGE 80 AND OLDER WITHOUT COGNITIVE IMPAIRMENT. SO WE WENT BACK TO THE BAG AND PULLED SAMPLES FROM THE WOMEN'S HEALTH INITIATIVE BASELINE FROM THE MID 1990s AND THEN LOOKED AT SELECTED PLASMID BIOMARKERS AND METABOLOMICS AND WITH THE LIMIT THE TIME I WANTED TO SHARE THE PLASMA BIOMARKER THE REST OF THIS IS IN PROGRESS IN TERMS OF ANALYSIS. WHAT WE HAVE ARE PEOPLE WHO ARE LESS THAN AGE 80 AND IMPAIRED IN THE RED DOTS. PEOPLE WHO BECAME IMPAIRED AFTER AGE 80 AND THEN RESILIENT INDIVIDUALS. AND THOSE ARE THE PEOPLE WHO MAKE IT TO AGE 80 WITHOUT COGNITIVE IMPAIRMENT. YOU CAN START WITH THE RATIO ON THE LEFT. THERE'S A COUPLE THINGS THAT ARE OBVIOUS. ONE IS WHEN WE STRATIFY BY E4 GENOTYPE FOR ALL OF THE GROUPS, THE E4 GENOTYPE GROUPS HAVE LOWER ABETA RATIO AND IT'S HIGHER IN A4 POSITIVE INDIVIDUALS. THAT'S ONE ASPECT. THE SECOND IS THAT IF YOU LOOK AT THE E4 INDIVIDUALS, YOU CAN SEE THERE IS NOT MUCH OF A DIFFERENCE BETWEEN THE TWO GROUPS IMPAIRED AND BY CONTRAST IN THE E3 INDIVIDUALS THEY'RE IMPAIRED AFTER AGE 80, ARE SOMEWHAT ELEVATED RELATIVE TO THE PEOPLE WHO DEVELOPED IMPAIRMENT BEFORE AGE 80. AND I THINK WHAT THAT SUGGESTS IS THAT THE E4 GROUP IS MORE HETEROGENEOUS AND THERE'S MANY FACTORS THAT MAY BE RELATED. THEY MAY NOT BE AS DRIVEN BY THE A BETA PATHWAY. IF WE LOOK AT NFL WE CAN SEE IN THE IMPAIRED AND RESILIENT GROUPS AFTER 80 THEY'RE SIMILAR FOR THE E3 AND E4 BUT THE PEOPLE YOUNGER DEVELOPED IMPAIRMENT AT YOUNGER AGES, THEY SHOW THE ELEVATION IN THE NFL AND THEY'RE CLOSER TO THE WHI BASELINE AND FIVE YEARS ON AVERAGE FROM THE BASELINE AND 80 PLUS IMPAIRED ARE CLOSER TO 12 TO 14 YEARS FROM THE WHI BASELINE. SO THESE ARE JUST A FEW SNIPPETS OF THE PROGRESS SINCE THE LAST REVIEW AND HAPPY TO TAKE QUESTIONS AND THANK YOU FOR LISTENING. >> THANK YOU, SUSAN. WE HAVE TIME FOR A QUESTION. IF THERE ARE NOT ANY, WE CAN MOVE ON. >> I HAVE A QUESTION. THANK YOU FOR YOUR PRESENTATION, SUSAN. NICE TO SEE THAT WORK, AS ALWAYS. ARE YOU GOING TO BE USING PLASMA BIOMARKERS TO FURTHER INFORM THE EFFECTS OF ESTROGEN REPLACEMENT THERAPY? >> THERE'S A MORE SAMPLE WE'RE LOOKING TO. >> THANK YOU. >> GOOD AFTERNOON, EVERYONE. I'M LENORE LAUNER THE CHIEF OF EPIDEMIOLOGY AND POPULATION SCIENCES AND PLEASED TO PRESENT A BRIEF OVERVIEW OF LEPS HISTORY AS WELL AS FUTURE PLANS. THE LABORATORY AIMS FOCUSES ON RESEARCH TO FULFILL THE NIH/IRP MISSION OF CONDUCTING HIGH QUALITY GROUNDBREAKING RESEARCH ADVANCING HUMAN HEALTH THROUGH EARLY DETECTION, DIAGNOSIS AND TREATMENT AND USING INTEGRATIVE AND TRANSLATIONAL MODEL. WE TAKE A WHOLE PERSON APPROACH TO STUDY THE SYSTEMS RELATED TO HEALTH DISPARITIES, CHRONIC DISEASE AND BRAIN AGING AND IDENTIFY INTERACTIONS AMONG SOCIO ECONOMIC AND ENVIRONMENTAL FACTORS IN RELATION TO HEALTH OUTCOMES AND MAP OUT TRAJECTORIES OF RISK AND DISEASE AND INVESTIGATE SIGNATURES OF RISK AND PROGNOSIS. I'LL GIVE YOU A BRIEF OVERVIEW OF WHAT OUR MOST CURRENT RESEARCH FINDINGS ARE. IN THE LAST DECADE THERE'S BEEN A LOT OF CHANGES IN OUR INFORMATION OF AGING AND POPULATION LEVEL IN PARTICULAR. THERE'S SOME WORKING PREMISES THAT LEPS HAS CONTRIBUTED TO CHANGING. THE MOST OBVIOUS BEING BETWEEN GENES AND AGE, THERE WAS AN INEVITABLE DECLINE IN HEALTH WITH FEW MEANS TO PREVENT THE DECLINE AND AGE HAD A CHRONOLOGIC TRAJECTORY STARTING AT AGE 65. SO BRIEFLY I'LL SHOW YOU SOME OF THE CURRENT RESEARCH THAT HAS HELPED CHALLENGE THE OLDER PREMISES. THEY'VE LOOKED AT THE RELATIONSHIP BETWEEN EPIGENETIC CHANGES ON AGE ACCELERATION AND THE AFFECT OF AGE ON COGNITIVE DECLINE. WE HAVE ALSO EXAMINED BIOMARKERS OF AGING IN THE POPULATION AND THERE WAS AN ASSOCIATION BETWEEN GENES AND PROTEIN NETWORKS AND THEY PREDICT DISEASE SUGGESTING THE USE OF SUCH NETWORKS IN DEFINING DISEASE RISK MAY BE USEFUL. AND TESTS LOOKING AT TELOMERE LENGTH AND PROTEINS HAVE SHOWN THE MARKERS CAN VARY IN COMPOSITION AND DEGREE OF ASSOCIATION BY THE DIVERSITY OF THE SAMPLE THAT IS BEING EXAMINED. AND SOCIAL FACTORS SUCH AS DISCRIMINATION AND LOWER SOCIO ECONOMIC STATUS CAN AFFECT BRAIN DISEASE. WE ALSO PARTICIPATED IN THE PROJECT OF DR. DE CABOS TO INVESTIGATE INTERSPECIES DIFFERENCES IN METABOLISM AND DIFFERENCES IN LIFE COURSE TRA TRAJECTORIES IN GLUCOSE IN MEN, MONKEYS AND MAN. WE HAVE BEEN TAKE LIFE COURSE APPROACH AS WE DO OUR SCIENCE. WE WORK TO MEET THE AIMS OF OUR STUDY. WE DEVELOPED COHORTS AND THEY'VE BEEN DESIGNED WITH SPECIFIC SOURCE POPULATIONS IN MIND THAT COULD PROVIDE INSIGHT INTO ASPECTS OF AGING ON A POPULATION LEVEL. THE COHORTS ARE LARGE, DIVERSE AND COMMUNITY BASED AND FOLLOWED OVER TIME AND DEEPLY PHENOTYPED WITH A WIDE RANGE OF SOCIO ECONOMIC STATUS AND COMORBIDITIES AND FUNCTIONAL IMPAIRMENT AND REPRESENT OVER THE YEARS INDIVIDUALS BORN IN DIFFERENT BIRTH COHORTS AND INDIVIDUALS THAT HAVE BEEN FOLLOWED FOR MANY MANY YEARS. THESE RESOURCES ARE ALLOWING A WIDE RANGE OF QUESTIONS RELATED TO MULTIPLE PHYSIOLOGIC AND DISEASE PROCESSES AND AGING TO BE ADDRESSED AND DISENTANGLE TRENDS AND INTERACTIONS AMONG DIFFERENT BODY SYSTEMS AT THE SAME TIME. OBVIOUSLY, THE RESOURCES AND AS A FEDERAL INSTITUTION WE ALWAYS WORKED COLLABORATIVELY IN THE DESIGN AND EXECUTION OF INTERPRETATION OF FINDINGS. IN ADDITION AND IMPORTANTLY, THE COHORT SCIENTISTS AND CLINICIANS WITH A WIDE RANGE OF SKILLS HAVE TAPPED INTO THE RESOURCES AND HAVE ALSO CONTRIBUTED THROUGH GRANTS AND CONTRACTS TO ENRICH THE COHORTS THAT WE HAVE DEVELOPED. THERE'S OBVIOUSLY WE HAVE AN AMAZING NETWORK OF COLLABORATION NOT ONLY ACROSS NIH BUT NATIONALLY AND INTERNATIONALLY AND MADE MAJOR CONTRIBUTIONS TO MULTIPLE CONSORTIA WHICH EFFECTIVELY INCREASES OUR COLLABORATION WORLDWIDE. SO I WOULD LIKE NOW TO GIVE YOU A BIT HISTORY OF LEPS. WE STARTED ABOUT 15 YEARS AGO, THERE WAS ATTRITION IN THE LAB DUE TO RETIREMENT. SO BY THE 2020 BSC ONLY DR. EVANS RUNNING THE HEATH DISPARITIES SECTION AND ME RUNNING DIVISIONS HAVE HELPED AND WE MADE SEVERAL RECOMMENDATIONS HOW TO MOVE FORWARD. THEY ADVISED THE INSTITUTE TO EXPAND AND STRENGTHEN LEPS WITH A NEW LAB CHIEF WE HAVE BEEN WORKING UNDER AN ACTING LAB CHIEF MANY YEARS AND DEVELOP A STRATEGIC PLAN AND ASSEMBLE THE FULL TEAM OF NEW TENURE TRACK INVESTIGATORS. SPECIFIC AREAS THAT THEY RECOMMENDED TO FOCUS ON CONTINUE TO DO RESEARCH ON HEALTH DISPARITIES RESEARCH, DEVELOP OR FORMALIZE NEW RESEARCH AREAS RELATING TO NEW CHALLENGES TO HEALTH, TO DEVELOP NEW RESEARCH RESOURCES SUCH AS COHORTS, TRAINING OPPORTUNITIES AND AN EPIDEMIOLOGIC CORPS AND CONTINUE BRIDGING THE GAP BETWEEN THE BASIC AND POPULATION SCIENCES. SO NOW THESE DAYS CURRENTLY OBVIOUSLY THERE ARE MANY CHALLENGES TO REBUILDING AN EPIDEMIOLOGIC PROGRAM. THE CURRENT LANDSCAPE IN UNDERSTANDING WHEN DISEASE HAS BECOME MORE COMPLICATED. THERE'S THE AVAILABILITY OF DIGITAL TECHNOLOGY HAS CREATED A HUGE AMOUNT OF DATA AVAILABLE FOR US TO GAIN INSIGHT INTO HEALTH AND ALSO LEARNING THERE ARE MANY FACTORS BEYOND PHYSIOLOGIC INFLUENCES THAT INFLUENCE AN INDIVIDUAL'S OUTCOMES AND THEY NECESSITATE TAKING A WHOLE PERSON'S APPROACH TO RESEARCH AS WELL AS SYSTEMS BIOLOGY RESEARCH. AND INCLUDE NOW IN OUR RESEARCH LOCAL ENVIRONMENT BEHAVIOR, SOCIO CULTURAL CONTEXT AND BASICALLY THE OUTDOORS ENVIRONMENT. BASED ON THE BSC RECOMMENDATIONS, I APPLIED FOR THE CHIEF'S POSITION AND WAS APPOINTED LAST YEAR. THERE WILL BE AN INVESTMENT IN TENURE TRACK POSITIONS WHICH WE ARE CURRENTLY RECRUITING FOR NOW AND I ENVISION THE LAB TO CONCLUDE AT LEAST FOUR SECTIONS A LITTLE BIT PROBABLY NOT PRECISELY LABELLED BUT I ENVISION A DATA SCIENCE SECTION WHERE THE INVESTIGATORS WOULD USE A WIDE RANGE OF LARGE DATABASES TO ADDRESS INTERSECTIONS AMONG SOCIAL, BIOLOGIC AND CLIMATE AND ENVIRONMENTAL FACTORS. THERE WOULD BE BIOMARKER SECTION FOCUSSED ON DEVELOPING BIOMARKERS BASED ON OMICS DATA TESTED FOR RISK ASSESSMENT IN THE POPULATION AND EXOSOME SECTION WHICH WOULD BE DEVOTED TO TRANSLATIONAL RESEARCH WHERE WE CAN ACTUALLY FOCUS ON ONE OR TWO CORE MECHANISMS AND LOOK AT HOW THE MECHANISMS AFFECT THE WHOLE PERSON AS WELL AS PROVIDE INFORMATION FOR TRANSLATIONAL RESEARCH AND THEN FINALLY CONTINUE WITH THE HEALTH DISPARITIES RESEARCH CONDUCTED BY DR. EVANS WHERE SHE'S TRYING TO DISENTANGLE THE RELATIONSHIPS AMONG RACE, SOCIO ECONOMIC STATUS AND HEALTH OUTCOMES. I WOULD ALSO LIKE TO EMPHASIZE THAT THE HEALTH DISPARITIES AS WELL AS METHODS DEVELOPMENT WOULD BE THEMES RUN THROUGH THE WHOLE RESEARCH CONDUCTED IN EACH OF THE SECTIONS THAT WE ARE TRYING TO DEVELOP. THE WORK WOULD BE BASED ON THE LEGACY COHORT S THAT WE HAVE AND OVER TIME WE HOPE TO BE ABLE IT PLAN NEW STUDIES. WITHIN THE INTRAMURAL RESEARCH ENVIRONMENT, I PERCEIVE LEPS TO BE THE CORE OF METHODS EXPERTISE AS WELL AS COHORTS THAT WE'VE DEVELOPED THAT WOULD ALLOW COLLABORATION WITH MANY OF THE DIFFERENT LABORATORIES IN THE IRP. AS WELL AS PROVIDING OPPORTUNITY TO DEVELOP TRAIN JEZ AND ACROSS DISCIPLINARY RESEARCH AND WE WOULD ALSO STRENGTHEN OUR CONNECTS WITH OTHER NIH INSTITUTES AS WELL AS NATIONALLY AND INTERNATIONALLY AND CONTINUE TO CONTRIBUTE TO THE CONSORTIUM WHICH ARE ESSENTIAL FOR RESEARCH IN GENTICS. -- GENETICS. I'D LIKE TO END WITH ONE IDEA WE'VE BEEN DEVELOPING AND FUTURE DIRECTION FOR THE LAB. THIS WOULD BE STUDY IN LINE WITH THE BSC RECOMMENDATION. THE NEW RESOURCE IS STUDY THE EFFECT OF DISASTERS AND CLIMATE CHANGE ON OLDER PERSONS BROADLY WE SEE THREE PHASES TO THE TRAJECTORY OF THE DISASTER THE BASELINE, THE INTERIM PERIOD OR PERIOD TO SEE THE SEQUELAE OF THE DISASTER ON HEALTH AND LOOK AT SOMEBODY'S CURRENT HEALTH. FOR THIS KIND OF STUDY WE WOULD RELY ON MULTIPLE DATA STREAMS OF HISTORICALLY PUBLICLY AVAILABLE HEALTH, ENVIRONMENT, SOCIO ECONOMIC RECORDS AND PERHAPS ALSO CONDUCT A FACE TO FACE EXAMINE ON A PREVIOUSLY EXPOSED COHORT. WE ARE LOOKING AT THE QUESTIONS TO OLD ER PERSONS THAT NEED TO BE ADDRESSED AND THE MEASUREMENTS AND RESOURCES AVAILABLE TO EVALUATE THE AFFECTS OF THE OLDER PERSONS AND IS THERE A SPECIFIC PERSON ONE DUE TO WILDFIRE OR FLOODING OR DAMAGE WE SHOULD BE STUDYING IN PARTICULAR. AND ONE OF THE BIOMARKERS THAT WOULD CHANGE AND HEALTH PARAMETERS THAT MIGHT REFLECT THE EFFECT THE DISASTER HAS ON HEALTH AND WHAT THE FEASIBILITY AND FUNDING TO MOUNT SUCH A STUDY. THE STUDY COULD PROVIDE A PLATFORM FOR MANY DIFFERENT QUESTIONS RELATED TO SOCIAL AND PHYSIOLOGIC PROCESSES AND PROVIDE A MEANS FOR MORE TRANSLATIONAL AND MULTI-DISCIPLINARY RESEARCH AND WITH THAT I WILL END. >> THANK YOU. IF THERE IS ONE BRIEF QUESTION. >> CAN YOU STOP SHARING? >> SORRY. >> CAN YOU SEE MY SCREEN? >> THE TRANSLATIONAL GERONTOLOGY BRANCH LOOKS TO SEE WHAT'S RESPONSIBLE FOR THE RELATED AGE DECLINE IN SPECIES AND DELAY THE PROCESS IN USING MULTIPLE SPECIES. WE TRY TO DESIGN AND EVALUATE NOVEL THERAPEUTICS IN NOVEL OF AGE AND IMPLICATIONS AND FOCUS ON FUNCTIONAL OUTCOMES IN TERMS OF MUSCLE FUNCTION AND TRIED TO MAKE THE DATA AVAILABLE AND RECRUIT AND DEVELOP THE NEXT GENERATION OF SCIENTISTS AND AND GET TO PLACES WHERE THEY WANT TO BE. THE T THIS WAS OUR SECOND EVALUATION AS A GROUP. AT THAT TIME, THE EVALUATION IN 2020 WE HAD NIGEL GRIG AND JULIE MADISON AND MYSELF AND IT WAS A SUCCESSFUL VACCINATION OF THE BRANCH AS A WHOLE. IN JANUARY 2022 I CAN REPORT THE BRANCH HAS GROWN SUBSTANTIALLY AND WE HAD A TENURE TRACK INVESTIGATOR HITTING THE GROUND RUNNING. WE HAVE AND THERE ARE SOME THAT BECAME THE ACTING CODIRECTOR OF THE STUDIO OF AGING AND THE MOVE FROM THE LABORATORY ON MOLECULAR GERONTOLOGY TO THE TRANSLATIONAL GERONTOLOGY BRANCH. WE TRIED TO INTEGRATE THE INFORMATION FROM THE ENVIRONMENT AND HOW THESE THINGS INTERACT AT THE LEVEL OF THE ORGANISM AND THE CELLULAR LEVEL. AT THE CELLULAR LEVEL, WE KNOW ALL THE INFORMATION THAT COMES IN IS READ AT THE LEVEL OF THE BRAIN AND HOW WE TRIED TO UNDERSTAND HOW THIS INFORMATION GOES DOWN. FROM THE PLASMA MEMBRANE THERE'S CELLULAR MARKERS AND RESPOND TO THESE SIGNALS BY ACTIVATING THE SIGNALLING PATHWAYS. THESE THEN AND IT'S CONNECT HEAD TO HALLMARKS OF AGING AND WHAT WE'RE TRYING TO DO UNDERSTAND IS HOW THESE MECHANISM OF HALLMARKS THAT UNDER LIE THE PROCESS HAVE A DIRECT EFFECT ON THE PHENOTYPES AND UTILIZE ENERGY AND HOW WE LOOK AT THE SYSTEMS AND HOW THESE LEAD TO CHANGES IN NEURODEGENERATION AND FUNCTIONAL DECLINE AS A WHOLE AND BY ALTERING THE ENVIRONMENT AND HOW CAN WE DEVELOP INTERVENTIONS THAT LEAD TO CHANGES IN RESILIENCE AND LONGEVITY? IN THE REPORT ON THE SLIDE DECK YOU'LL HAVE A REPRESENTATION OF EVERY UNIT AND THE HITS WE'RE HAVING AND MAKE SURE YOU GET INSIGHT ON WHAT THE NEW TRAINEES AND RECRUITS ARE GETTING AND WHAT OTHERS ARE DOING NOW. THERE'S NOW A PROTEOMICS UNIT WITHIN THE STUDY SECTION AND HIS RECENT DIRECTIONS ARE IN THE DEVELOPMENT OF THE NEXT GENERATION OF AGING BIOMARKERS WITH A FOCUS ON PROTEOMICS AND SPECIFICALLY STUDYING SENESCENT IN VIVO AND IN VITRO AND INTEGRATED WITH THE NIH FAMILY AND THE STUDY OF AGING IS INTEGRATED WITH THE PROJECT WITHIN MY UNIT, MY SECTION AND LOOKING AT THE NON-HUMAN PRIMATE. HE'S ALSO LOOKING AT HOW PROTEIN TURNOVER CHANGES OVER TIME IN LONGITUDINAL STUDIES OF AGING AND WHAT ARE THE DIFFERENT WAYS HE CAN DEVELOP AND EVALUATE NOVEL MARKERS OF SENESCENCE AND BIOMARKERS ACROSS THE LIFE SPAN. HE HAS BEEN ALREADY BEEN ABLE TO IDENTIFY AND HIRE SEVERAL TRAINEES AND HAS HIT THE GROUND RUNNING IN TERMS OF GRANTS. HE WAS ALREADY AWARDED TO STUDY A COMPOUND IN TERMS OF THE GRANT THAT WILL GIVE HIM FOR OVER FOUR YEARS FOCUSSED ON SENESCENCE. ONE OF THE THINGS IS HE'S A LEADER IN THE DEVELOPMENT OF NEW PROTEOMICS MARKERS AND AUTHORED THE PAPER IN 2020 HE DEVELOPED THE ASSOCIATE D SYMPTOMS AND HE'S LOOKING AT THE ASSOCIATION BETWEEN THE MARKERS IN ASSOCIATION WITH MORTALITY MARKERS AND THE OUTCOMES OF HEALTH AND SURVIVAL AND LOOKING AT HOW THE AGING PROCESS CHANGES THE PROTEINS AT THE LEVEL OF THE PLASMA MEMBRANE AND ALL THIS IN THE CONTEXT OF SENESCENT CELLS. FLOU WE HAVE -- NOW WE HAVE THE PAPERS LINED UP AND STARTING TO GET PUBLISHED. SHE HAS RECENTLY HIRED TWO NEW TRAINEES AND HAS BEEN GETTING AWARDS AS A PERSON AND ALSO MOST OF HER TRAINEES HAVE BEEN EXTREMELY SUCCESSFUL GETTING AWARDS AS WELL AS GRANTS FROM BOTH SCIENTIFIC DIRECTOR OF AWARDS AND THE RFA WITH NIA AND NIEHS AND IN A PAPER PUBLISHED WITH THE MECHANISM OF DISEASE WAS THE POTENTIAL OF ATM NEGATIVE KNOCKOUT AND BASICALLY IF YOU SUPPLEMENT MICE AND LOOK AT THE BALANCED LINEAGE YOU SEE IT DOESN'T REALLY PRODUCE ANY CHANGES BUT WHEN YOU DO THIS WITH OLD WILD TYPE ANIMALS CAN SEE THERE'S AN OVERLOAD AND SUPPLEMENT THE ANIMALS WITH THE LONG-TERM AFFECTS TO SEE WHAT THE OUTCOMES WOULD BE WITH LONG-TERM TREATMENTS. LAST ON THE LIST, THE CHIVE OF THE GENOMIC SECTION MOVING TO THE TRANSLATIONAL GERONTOLOGY BRANCH HAS BEEN ABLE TO RECRUIT OR INHERIT SOME PEOPLE TO HIS NEW GROUP AND CONTINUES TO BE EXTREMELY ACTIVE WITH THE GENOMIC INTEGRATE AND PUBLISHED A PAPER IN NATURE COMMUNICATIONS LOOKING AT TCOMBATTING CANCER AND USED AN APPROACH OF TARGETING THE CELLS AND YOU CAN SEE WHEN HE USED BRCA 2 DEFICIENT MICE THEY EXHIBIT AN INCREASED GROWTH INHIBITION WHEN TREATED WITH THE INHIBITOR. THIS S A NEW LINE OF INVESTIGATIONS HE'LL BE LOOKING AT THE DIFFERENT METERS AND HOW THEY INTERACT IN TUMOR CANCER GROWTH. THE TRANSLATIONAL GERONTOLOGY BRANCH IS CONNECTED TO DIFFERENT UNIVERSITIES THE U.S. AND THE WORLD. WE REMAIN A CORE CENTER OF INTERACTION WITH HUGE INTEGRATIVE PROJECTS AND THIS IS ONE OF THEM AND ALL THE INVESTIGATORS WITHIN THE INVESTIGATIONAL GERONTOLOGY BRANCH HAVE CONNECTIONS WITH MULTIPLE UNIVERSITIES ACROSS THE U.S. INCREASING THE WE DO HERE. THIS IS THE GOAL FROM 2017 TO 2019. THIS IS WHAT WAS PRESENTED TO THE BOARD OF SCIENTIFIC COUNSELORS IN 2020. IN THE SPAN OF YEARS WE PUBLISHED 276 ARTICLES AND LOTS OF THEM WERE IN THE TOP 20% ARTICLES OF OUR RESEARCH. RIGHT NOW THE OTHER DAY WITH THE IMPACT OF THE 2020 IN THIS TWO YEARS WE HAVE ALREADY PUBLISHED 242 PAPERS AND THIS IS MORE THAN 10,000 CITATIONS AND YET TOO EARLY TO SAY HOW MANY PAPERS WILL END UP TOP FOUR CITATIONS. IT REMAINS PRODUCTIVE AND CONNECTED AND CONTINUE TO INCREASE THE NUMBER OF INTERACTION BETWEEN INTRAMURAL AND EXTRAMURAL RESEARCHERS REMAINING ACCESS AND THE DATA WE HAVE PRODUCING. YOU SEE THE PAPER AND GRANTS AND AWARDS AND FELLOWSHIPS WE'RE ALL GETTING AND THIS IS ALL OF US NOT JUST A FEW OF US WITHIN AND BENEATH THE SURFACE THERE'S A LOT OF THINGS THAT GO UNSEEN. THERE'S MULTIPLE PEOPLE THAT CONTRIBUTE TO THE SUCCESS OF THE TRANSLATIONAL GERONTOLOGY BRANCH AND A PICTURE OF THE CURRENT MEMBERS AND WE CANNOT BE TOGETHER THANKS TO COVID BUT I HOPE VERY SOON WE'LL ABLE TO GET A CELEBRATION TO THE SUCCESS TGB2020 TO PREPARE FOR THE NEXT ONE COMING UP IN 2024. I'M HAPPY TO ACHE ANY QUESTIONS YOU MAY HAVE. >> ARE YOU INTERACTING WITH THE COMMON FUND INITIATIVE AND IF SO, HOW? >> THAT'S A FANTASTIC QUESTION. WE JUST SUBMITTED A U54 PROPOSAL THAT WAS AN RFA FROM THE SUNMET DEDICATED TO THE MOUSE WE HAVE A CON -- CONSORTIA FROM THE MAYO CLINIC AND WE WELCOME THE PEOPLE THAT WERE SUCCESSFUL IN SECURING THE HUMAN SENESCENCE. WE'RE INTEGRATING OR TRYING TO BE INTEGRATED AS MUCH AS POSSIBLE. >> LUIGI, ANY FINAL REMARKS BEFORE WE END THE CLOSED SESSION. >> THANK YOU FOR TRE PRESENTATION. YOU CAN SEE WHAT A GOOD POSITION I AM WORKING WITH FANTASTIC, PRODUCTIVE CREATIVE SCIENTISTS. I COULDN'T ASK FOR MORE. THANK YOU VERY MUCH. >> THANK YOU TO OUR SPEAKERS IN THE INTERMURAL PROGRAM. THIS THEN CONCLUDES THE OPEN SESSION OF OUR NATIONAL ADVISORY COUNCIL ON AGING.