IT'S GREAT TO BE HERE. I WANT TO CALL THE ORDER THE 90th MEETING OF THE NATIONAL ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES ADVISORY COUNCIL. THE MEETINGS ARE OPEN TO THE GENERAL PUBLIC. AND CLOSED TO THE PUBLIC FOR REVIEW AND DISCUSSION OF EVALUATION OF INDIVIDUAL GRANT APPLICATIONS. PLEASE READ THROUGH THE MATERIAL PROVIDED TO YOU IN THE ELECTRONIC COUNCIL BOOK REGARDING CONFIDENTIALITY AND CONFLICT OF INTEREST AND YOUR FOLDERS CONTAIN STATEMENTS REGARDING CONFLICTS OF INTEREST, WHICH YOU MUST SIGN AND RETURN TO DR. MOW EN. IF YOU JUST TAKE A MOMENT AND DO THAT, THAT WOULD BE GREAT. BEFORE WE BRO SEED WITH THE BUSINESS OF THE MEETING, WE HAVE A FEW HOUSEKEEPING ITEMS. >> GOOD MORNING EVERYONE. THANK YOU VERY MUCH FOR COMING. I WANTED TO REMIND EACH OF YOU ABOUT THE CONFLICT OF INTEREST RECORDING DATES. NEW MEMBERS, AD-HOC MEMBERS, I DON'T THINK YOU HAVE TO DO IT AGAIN ON FEBRUARY 2, BUT LIZ ELLIOT WILL TELL YOU IF YOU DO. BUT THE NEXT REQUEST IS COMING ON FEBRUARY 2 AND YOU'LL HAVE 30 DAYS TO RESPOND, AFTER WHICH IF YOU VIOLENT RESPONDED, YOU WILL BE UNABLE TO PARTICIPATE IN ANY COUNCIL BUSINESS. SO PLEASE DO RESPOND WITHIN 30 DAYS AFTER THE REMINDER. ANOTHER UPDATE WILL BE FOLLOWING IN JUNE AS USUAL. THAT WILL BE JUNE 2. AND OF COURSE, WHEN YOU GET THOSE IF YOU HAVE ANY QUESTIONS ABOUT THEM, YOU WANT TO TALK TO LIZ ELLIOT. THE OTHER THING I WANTED TO MENTION AS A SIGN UP SHEET IS GOING AROUND TO MARK YOUR ATTENDANCE AT THE COUNCIL TODAY. WHEN IT COMES TO YOU, PLEASE SIGN IT. AND JUST CIRCULATE IT. THANK YOU. >> WE PROVIDED TO YOU THE ELECTRONIC COUNCIL BOOK. IF I COULD HAVE A MOTION OF ANY ACTION YOU WISH TO TAKE ON THE MINUTES. I HAVE A MOTION, A SECOND. ALL IN FAVOR. OPPOSED? OKAY. THANK YOU VERY MUCH. WE DO LOOK AT THE MINUTES VERY CAREFUL TO MAKE SURE THAT THEY DO REFLECT WHAT WE DO HERE. FOR THOSE OF YOU WHO HAVE BEEN HERE FOR A WHILE, AND LOOKED AT THE MINUTES, WE DECIDED TO NOT ABBREVIATE THE MINUTES BUT CERTAINLY SHORTEN THE MINUTES SO THAT THEY ARE MUCH MORE READABLE AND FOCUS IN ON WHAT EACH ISSUES HAVE BEEN ADDRESSED AND ANY DECISION THAT IS HAVE BEEN MADE. YOU HAVE ALREADY SEEN THE PROPOSED FUTURE COUNCIL MEETING DATES AND THESE WERE MADE AVAILABLE TO YOU IN THE ELECTRONIC COUNCIL BOOK AND I THINK ALSO OUR NEW COUNCIL MEMBERS HAVE BEEN GIVEN THOSE DATES SO THEY COULD BE FULLY AWARE OF THE IMPORTANCE OF THOSE DATES. AND AS ALWAYS, I APPRECIATE GREATLY YOUR IDENTIFYING THOSE DATES AS - EYE SHOULDN'T SAY SACRED BUT CLOSE TO SACRED, SO YOU CAN COME JOIN US FOR THIS MEETING. I WANT TO TRANSPORTATION MY OWN REMARKS, AND I WANT TO THANK EVERYONE FOR BEING HERE. DR. SAM BORG AND DR. EP SCOTT ARE SUPPOSED TO BE ON THE PHONE FOR BOTH OF THEM, I WOULD SAY IF THEY ARE THERE, A GOOD, VERY, VERY EARLY MORNING. IF THEY ARE NOT THERE -- >> SO I DID WANT TO MENTION DR. SAM BORG AND DR. TAP SCOTT, IF YOU'RE ON THE PHONE, THERE IS A GLITCH WITH THE TELECONFERENCE SYSTEM. SO IF YOU WANT TO BE HEARD WHEN SPEAKING, PLEASE SPEAK DIRECTLY INTO YOUR RECEIVER AND SPEAK UP SO WE'LL BE ABLE TO HEAR YOU. WE UNDERSTAND YOU CAN HEAR US BUT WE MAY NOT BE ABLE TO HEAR YOU QUITE AS WELL. >> ATTENDING BY PHONE: THANK YOU. >> THAT IS STEVE. GOOD VERY, VERY EARLY MORNING. AND KRISTI THE SAME TO YOU BECAUSE THEY ARE BOTH ON THE WEST COAST. I'LL REMIND EVERYONE THE PUBLIC PORTION OF TODAY'S MEETING IS BEING VIDEO CAPACITY WILL BE ARCHIVED ON THE NIH WEBSITE. MANY DO TAP INTO THIS. IT'S OUR COMMITMENT TO OPENNESS AND TRACKS PARENTSY. I THINK WE HAVE DONE THIS NOW FOR 3-4 TIMES AND I THINK IT'S A GOOD THING. AND I HAVE GOTTEN ONE OR TWO REMARKS FROM PEOPLE WHO HAVE NOT BEEN HERE. PLEASE SHARE THE LINK WITH ANY OTHER COLLEAGUES WHO MIGHT BE INTERESTED. WE HAVE FOUR NEW MEMBERS JOINING US TODAY ON THE COUNCIL. -- TRAUMA SURGERY, HAVING BEEN IN THE AIR FORCE, ACTIVE DUTY FOR A NUMBER OF YEARS, AND THEN IN THE RESERVE AND MICHAEL AND I HAVE TALKED, I DON'T KNOW HOW MANY TIMES, BUT GETTING HIM ON TO THE COUNCIL. BUT HE IS ALWAYS BUSY WITH SOMETHING, ON SOMEBODY ELSE'S COUNCIL ET CETERA. I THINK THE LAST WAS NIBIB COUNCIL. IS THAT RIGHT? SO THE REASON I RAISE THAT IS BECAUSE, ANYTHING THAT WE CAN LEARN, ANY GOOD THINGS THAT WE CAN LEARN FROM ELSEWHERE, WE ARE LOOKING TO LEARN HERE, AS YOU'LL HEAR WHEN YOU HEAR MY COLLEGE REPORT. SO PLEASE, DON'T BE SHY ABOUT TELLING US HOW WE CAN DO THINGS BETTER. WELCOME TO ALL OF YOU AT 10:05 AND NIH PHOTOGRAPHER WILL ARRIVE TO TAKE A PICTURE OF THE NEW COUNCIL MEMBERS WITH THE NIMS LEADERSHIP DURING THE BREAK. WE WELCOME EACH OF YOU TO THE COUNCIL AND HOPE YOU'LL QUICKLY REALIZE AND THIS IS WHAT I SAID LAST NIGHT AT DINNER, HOW MUCH WE VALUE YOUR INPUT. I HAVE DECIDED TO ABBREVIATE TODAY'S OPENING REMARKS SO WE HAVE TIME TO DISCUSS WAYS WE CAN GIVE YOU THE INFORMATION THANK YOU NEED TO ADVISE US. WE ALREADY SHARED WITH YOU THE SUGGESTIONS THAT WE COLLECTED FROM CURRENT MEMBERS AND WE HOPE THAT YOU HAVE REFLECTED ON THEM AND PREPARED TO OFFER YOUR THOUGHTS ABOUT WAYS TO BETTER INFORM AND ENGAGE IN COUNCIL ABOUT NIMS AND NIH ACTIVITIES, MORE ABOUT THIS A LITTLE BIT LATER WHEN I INTRODUCE MIKE'S COMMENTS. FIRST I WANT TO APPRISE YOU OF A FEW ACTIVITIES EFFECTING THE NIH AND NIMS. I MUST MENTION THIS IS DR. MOW EN'S LAST NIMS COUNCIL MEETING AFTER BEING OUR EXECUTIVE SECRETARY FOR ABOUT EIGHT YEARS. SHE ACCEPT AID POSITION AT THE NATIONAL HEART, LUNG AND BLOOD INSTITUTE AS DIRECTOR OF THEIR DIVISION OF EXTRAMURAL RESEARCH ACTIVITIES. SINCE COMING TO THE INSTITUTE, SHE HAS DONE AN EXCELLENT JOB OVERSEEING THE SCIENTIFIC REVIEW BRANCH, GRANTS MANAGEMENT BRANCH AND THE CLINICAL OPERATIONS TEAM AS WELL AS REPRESENTING THE TRANS-NIH COMMITTEES. WHILE WE CONDUCT THE NATIONAL SEARCH TO FILL HER POSITION, WE HAVE AGAIN LEANED ON M.S. MELINDA NELSON, WHO WE LEAN ON FOR LOTS OF THINGS. MELINDA IS CURRENTLY AT THE HEAD OF THE GRANTS MANAGEMENT BRANCH. SHE'S BEEN IN THE INSTITUTE NOW, WE WORKED TOGETHER FOR 18 YEARS. SHE KNOWS THE INSTITUTE VERY WELL AND SHE HAS GRACIOUSLY AGREED TO SERVE AS THE ACTING DIRECTOR OF OUR DIVISION OF EXTRAMURAL RESEARCH ACTIVITIES AND SHE HAS A VERY ABLE BACKUP WHO HAS AGREED TO SERVE AS OUR ACTING CHIEF GRANTS MANAGEMENT OFFICER AND THAT IS ANDY JONES WHO IS RIGHT THERE. SO THANK YOU VERY MUCH, ANDY. I WANT TO PROVIDE A GENERAL OVERVIEW OF THE ADMINISTRATION TRANSITION. THE NIH BUDGET AND SOME OF OUR CONGRESSIONAL OUTREACH ACTIVITIES. SOME UPDATES FROM ACROSS THE NIH AS WELL AS WITHIN THE NIMS AND WILL OVERVIEW OF A FEW OF THE MANY RESEARCH ADVANCES THAT INSTITUTE STAFF IDENTIFIED AS PARTICULARLY NOTEWORTHY. FIRST OF ALL, FRIDAY MARKED THE BEGINNING OF -- IN CASE ANYBODY DIDN'T NOTICE, FRIDAY MARKED THE BEGINNING OF PRESIDENT TRUMP'S ADMINISTRATION. MOST OF YOU LIKELY KNOW, PRESIDENT TRUMP IS NOMINATED REPRESENTATIVE TOM PRICE TO BE THE SECRETARY OF HEALTH AND HUMAN SERVICES. AND HE IS GOING THROUGH HEARINGS RIGHT NOW. HE IS AN ORTHOPAEDIC SURGEON AND SERVED IN THE U.S. HOUSE OF REPRESENTATIVES SINCE 2005. WE RECEIVED WORD LAST WEEK THAT DR. COLLINS, OUR CURRENT NIH DIRECTOR, IS BEING HELD OVER AS NIH DIRECTOR. AT THIS TIME NO FURTHER DETAILS ARE AVAILABLE. BUT HELD OVER MEANS THAT ANY CHANGE OF ADMINISTRATION, THERE ARE MANY PEOPLE WHO AT THE TOP WHO ARE IDENTIFIED IN TERMS OF THE SECRETARIES BUT IN ORDER FOR THE GOVERNMENT TO CONTINUE TO FUNCTION, MANY PEOPLE HELD OVER. SOME ARE RE-APPOINTED. BUT SOME ARE HELD OVER UNTIL A NEW APPOINTMENT IS MADE. SO WE HAVE NO FURTHER DETAILS ON THAT. IF I COULD HAVE THAT FIRST SLIDE -- THAT S ECOND SLIDE, ACTUALLY. PLANS TO REVISIT THE FISCAL YEAR 2017 BUDGET. MUCH OF THE FEDERAL GOVERNMENT WITH THE NEW ADMINISTRATION IN PLACE, MEANWHILE WE HAVE AN OPERATING PLAN THROUGH OUR CONTINUED RESOLUTION THROUGH APRIL 28, 2017. BECAUSE WE -- IT IS REALLY IMPORTANT FOR US TO GET APPLICATIONS OUT THE DOOR, WE HAVE DEVELOPED AN INTERIM FUNDING PLAN USING A CONSERVATIVE NUMBER AS OUR BUDGET LOOKING TO A FLAT BUDGET YEAR. AND WE ARE PAYING ONLY TO THE 10 PERCENTILE AND THE 18th PERCENTILE FOR NEW AND EARLY-STAGE INVESTIGATORS. AND I MUST SAY, THE ONLY WAY TO DO THIS, AND THIS MAY BE FROM THE SCIENTIFIC COMMUNITY OR WHO HAVE GOTTEN GRANTS FROM US KNOW, THAT THE ONLY WAY WE CAN DO THIS WAS TO DO A 3% CUT TO THE NON-COMPETING GRANTS. THE ONLY WAY TO GET THIS. AND MANY TIMES I HAVE TALKED WITH COUNCIL OVER THE YEARS ABOUT WEIGHING -- THIS IS A SHOT FROM A MEETING WE HAVE HERE ON OCTOBER 5, AND THE NIMS COALITION TO GIVE OUT MORE, HOSTED A CONGRESSIONAL STAFF TOUR WITH SOME OF THE LABORATORIES IN OUR INTRAMURAL PROGRAM. DURING THE TOUR, WE HAD THE STAFFERS LEARNED ABOUT THE INTRAMURAL AND EXTRAMURAL RESEARCH PROGRAMS, TRAINING THE NEXT GENERATION OF SCIENTISTS, AND ALSO THAT ARE OUTREACH PROGRAMS. AND I DO WANT TO PUBLICLY ACKNOWLEDGE OUR INTRAMURAL SCIENTISTS WHO PARTICIPATED AND THEY CAN REALLY INTERESTING IN DOWN-TO-EARTH FOR PEOPLE WHO DON'T GO INTO -- IT IS REALLY A SECTION TO LET PEOPLE KNOW -- AND MANY PEOPLE DON'T KNOW, THAT ONLY ABOUT 10-12% OF OUR BUDGET IS SPENT ON THE BETHESDA AND NORTH CAROLINA CAMPUS. MOST OF THE MONEY GOES OUT TO NEW ACADEMIC CENTERS AROUND THE COUNTRY. AND THIS IS ONE WAY TO ONLY KATE. THESE ARE THE STAFFERS WHO ARE REALLY INFORMING OUR CONGRESS PEOPLE, OUR SENATORS, AND IT IS IMPORTANT FOR THEM TO KNOW WHAT THIS IS ALL ABOUT. WE APPRECIATE THE COALITION BRINGING THIS. WE CAN'T REALLY LEGALLY BRING THIS GROUP IN BUT THE COALITION PUTS OUT AN INVITATION AND USUALLY WE HAVE 10-12 OR 15 YOUNG PEOPLE WHO COME IN REALLY LEARNING ABOUT THE NIH. AND AS MANY KNOW, THE NIMS COALITION IS AN INDEPENDENT CONSORTIUM OF NEARLY 90 PROFESSIONAL VOLUNTEER ORGANIZATIONS THAT RAISE AWARENESS ABOUT THE NIMS-FUNDED RESEARCH AND WE GREATLY APPRECIATE THE WORK OF OUR COALITION MEMBERS PARTICULARLY THOSE WHO VOLUNTEER TIME AND TALENTS ON THE STEERING COMMITTEE. ON JANUARY 1, STEPHANIE OF THE AAOS, AMERICAN ACADEMY OF ORTHOPAEDIC SURGEON GENERAL, BEGAN HER TERM AS THE CO-CHAIR. IS SHE HERE? THE OUTGOING CO-CHAIR WILL CONTINUE TO BE INVOLVED IN THE STEERING COMMITTEE AND CERTAINLY ROBERT RIGS, ROBERT IS SOMETIMES HERE. HELLO, ROBERT. AND HELLO MARY AND STEPHANIE IF YOU'RE WATCHING. WE THANK ALL THREE OF THEM AND ALL FUTURE CO-CHAIRS FOR THEIR SERVICE I WANTED TO PROVIDE AN UPDATE ABOUT PRECISION MEDICINE INITIATIVE THAT I TALKED ABOUT EARLIER, WAS ANNOUNCED TWO YEARS AGO IN THE PRESIDENT'S STATE OF THE UNION ADDRESS. MILLION PERSON COHORT ON PRECISION MEDICINE NOW CALLED ALL OF THIS RESEARCH PROGRAM. IT INVOLVES MORE THAN 35 INSTITUTIONS DEVELOPING THE INFRASTRUCTURE AND PROCESS NEEDED TO BECOME TO ENROLL PEOPLE. YOU CAN READ MORE ABOUT THIS. BUT I WILL SAY AT OUR NEXT MEETING IN JUNE, WE WILL HAVE THE PERSON IN CHARGE OF THIS COHORT. SO THAT WILL COME OUT WHEN WE TALK ABOUT MY COLLEAGUE'S REPORT IN TERMS OF PREPARING. HOW CAN WE AS AN INSTITUTE WITH OUR ADMISSIONS, BEST TAKE ADVANTAGE? WHEN I SAY WE, OUR SCIENTISTS, BEST TAKE VALUE OF THIS VERY EXPENSIVE INITIATIVE. THERE IS A LETTER THAT Mr. AIR DISHMAN WROTE FOR THE OCTOBER NIMS UPDATE WHICH WILL GIVE YOU A TASTE OF WHAT THE MMI IS ALL ABOUT. HIS ARTICLE DESCRIBES THE PROGRAM'S EFFORTS TO ENSURE IT PROMOTES BENEFITS IN PRECISION HEALTH TO ALL POPULATIONS. WE LOOK FORWARD TO HIM BEING HERE IN JUNE. WE THOUGHT THAT WOULD GIVE HIM ENOUGH TIME TO REALLY GET SETTLED AND HAVE SOME IDEA WHERE TO GO. ALSO INTERESTINGLY, WHAT COINCIDES WITH MY COLLEGE REPORT FROM THE COUNCIL, IS THE SCIENCE OF MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH. AND THIS IS A CORE COMPONENT OF THE NIMS AND OF ALL OF THE INSTITUTES. WE HAVE INVITED DR. ELISEO STABLE, DIRECTOR OF THE NATIONAL INSTITUTE OF MINORITY HEALTH AND HEALTH DISFIGHTERS TELL US ABOUT THE INSTITUTE'S WORK AND THE NIH'S COMMITMENT TO IMPROVING MINORITY HEALTH AND REDUCING THE HEALTH DISPARITIES. AND WE'LL HEAR MORE FROM ELISEO WHEN HE COMES. HE HAS BEEN A GREAT ADDITION. HE HAS BEEN HERE PROBABLY A YEAR AND A HALF. A GREAT ADDITION TO OUR DIRECTOR'S COUNCIL. AS PART OF OUR OWN EFFORTS WE LAUNCHED A NEW COMMUNITY OUTREACH SECTION OF THE NIMS WEBSITE TO PROVIDE HEALTH PROFESSIONALS AND COMMUNITY ADVOCATES WITH EASY ACCESS FOR A LARGE COLLECTION OF INFORMATION AND RESOURCES ON BONES, JOINTS, MUSCLES AND SKIN. THE SITE PROVIDES LOTS OF PUBLICATIONS AND MOST IMPORTANTLY, IT ALSO PROVIDES THESE PUBLICATIONS IN SPANISH, CHINESE, COUNTRY AN, VIETNAMESE, AS WELL AS ENGLISH. AND I THINK VIRTUALLY EVERY ONE OF OUR PUBLICATIONS IS IN SPANISH NOW IF I'M NOT MISTAKE EN AND I THINK THE SPANISH LANGUAGE IS, AS I SAW RECENTLY IN SOME PASS, IS THE MOST POPULAR ACCESSED ITEM. SO REALLY IMPORTANT FOR US TO KEEP UP AND TO ACTUALLY BE AHEAD OF THE CURVE IN TERMS OF ADDRESSING OUR DIVERSE COMMUNITIES IN THE COUNTRY. CAN I HAVE THE NEXT SLIDE, PLEASE. THE CLINICAL RESEARCH IS THE FOUNDATION ON WHICH NIMS HEALTH INFORMATION IS BASED AND ALL CLINICAL RESEARCH REQUIRES PATIENTS OR HEALTHY VOLUNTEERS. AND I BRING THIS UP BECAUSE I TALKED ABOUT IT A FEW TIMES. BUT LAST WEEK, THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND 15 OTHER FEDERAL AGENCIES UPDATED REGULATIONS KNOWN AS, THE COMMON RULE. I CAN TELL YOU FOR A LONG TIME, I WAS DIRECTOR AND I HAD NO IDEA WHAT THE COMMON RULE WAS. I KNEW THAT IT WAS MEANT TO SIMPLIFY. BUT ALSO FOR PROTECTION. AND THESE NEW RULES ARE INTENDED TO BETTER PROTECT HUMAN SUBJECTS INVOLVED IN RESEARCH WHILE FACILITATING VALUABLE RESEARCH AND REDUCING BURDEN AND DELAY AND AMBIGUITY FOR INVESTIGATORS. MOST OF THE PROVISIONS WILL GO INTO EFFECT IN 2018. NEXT I WANT TO TALK ABOUT A MEETING WE HAVE EVERY YEAR. FOR THOSE WHO HAVE BEEN HERE FOR A FEW YEARS KNOW ABOUT THIS, AND THIS IS IN ADDITION TO OUR SUPPORTING DEPARTMENT-WIDE EFFORTS TO ENHANCE CLINICAL RESEARCH ENTERPRISE, WE CONTINUE TO FOCUS ON DEVELOPING AND SUSTAINING THE CLINICAL RESEARCH FOCUS AND THE INVESTIGATORS OF THE FUTURE. A FEW YEARS AGO, MAYBE 4 YEARS AGO, 5 YEARS AGO, WE BEGAN HOLDING A FORUM ON CLINICAL AND PATIENT-ORIENTED INVESTIGATORS IN THE THIRD YEAR OF EITHER A KOA AWARD OR K23 AWARD. PARTICULARLY FOCUSED ON CLINICIAN SCIENTISTS. AND ONE YEAR WE HAD A FEW VETERINARY SCIENTISTS AT OUR MEETING WHO WERE INTERESTED IN CLINICAL RESEARCH. WE FOCUSED ON THE THIRD-YEAR AWARDEES BECAUSE THEY ARE AT THE STAGE WHERE THEY SHOULD BE APPLYING FOR THEIR FIRST INDEPENDENT RO1. WE HAVE HEARD THE TRANSITIONS, IS A PARTICULARLY VULNERABLE PERIOD. WE ARE FROM THE GOVERNMENT AND WE ARE TRULY HERE TO HELP AND WE DO TRY TO ENHANCE CAREERS BY TALKING ABOUT WHAT THE LIMITATIONS ARE. REALLY WHAT THE CHALLENGES ARE AND HOW DIFFERENT PEOPLE ADDRESS THOSE CHALLENGES OF THE TRANSITION. AND I NOTED THAT THIS MORNING, WE PUT UP A SUMMARY OF OUR MOST RECENT CASE MEETING. THE K MEETINGS ARE VERY SIMILAR YEAR TO YEAR AND TREMENDOUS ENTHUSIASM BY THOSE WHO ATTEND. AND NOT ONLY DO WE HAVE THE ATTENDEES BUT WE ALSO HAVE MENTORS AND PEOPLE WHO RECENTLY MADE THE TRANSITION FROM K TO R, WHICH IS IT IMPORTANT. ALSO I SHOULD SAY THAT WE HAVE A NEW CLINICAL CENTER CHIEF OPERATING OFFICER. AS THE NEXT STEPS TO ENHANCE THE OPERATIONS OF THE CLINICAL CENTER, MAJOR GENERAL JAMES GILLMAN WHO WE WILL HENCEFORTH CALL DR. GILLMAN, HAS BEEN INAUGURATED AS CHIEF ECONOMIC OFFICER OF THE NIH CLINICAL CENTER. TONY FAUCI AND I LED THE SEARCH. IT WAS AN ALL-TIME FAST ONE. WE WERE HELPED A LOT BUT WE RECRUITED DR. GILLMAN WITHIN A 90-DAY PERIOD. HE IS A CARDIOLOGIST WITH RICH EXPERIENCE IN LEADING THE OPERATIONS OF NUMEROUS HOSPITAL SYSTEMS. AND I WILL BE INTERACTING WITH HIM A LOT SINCE I CHAIRED THE CLINICAL CENTER GOVERNING BOARD, WHICH DEALS WITH THE BUDGET OF THE CLINICAL CENTER. WE HAD STAFF CHANGES AT THE NIMS. I ALREADY TOLD YOU ABOUT LAURA AND MELINDA AND ANDY. WE HAVE Mr. RICK PHILLIPS WHO IS OUR DEPUTY EXECUTIVE OFFICER, WHO SHOULD BE HERE. RICK? WE HAVE M.S. SIDNEY KAUFFMAN WHO IS THE CHIEF OF OUR SCIENCE POLICY AND PLANNING BRANCH IN OUR OFFICE OF SCIENCE POLICY. AND SHE COMES TO US FROM THE NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH, NCCIH, FORMERLY KNOWN AS N CAM AND WE ALSO CONGRATULATE DR. NANCY GARRET THERE WHO HAS BEEN SERVING AS DEPUTY DIRECTOR OF THE COMMUNICATIONS AND PUBLIC LIASON BRANCH IN OUR OFFICE OF SCIENCE AND POLICY AND NOW THE BRANCH CHIEF. IN OUR EXTRAMURAL PROGRAM, I MET DR. NA KIA ONE TIME BUT SHE IS HERE SOMEWHERE IN THE BACK AND I HOPE THAT YOU WILL INTERACT WITH HER. SHE JOINED OUR SCIENTIFIC REVIEW BRANCH AND SHE HAS EXPERTISE AND THAT INCLUDES THE DESIGN IMPLEMENTATION AND ANALYSIS OF NATIONAL HEALTH RELATED PROGRAM EVALUATIONS AND HER WORK IS FOCUSED ON THE USE OF MIXED-METHOD APPROACHES AND OUTCOMES BASED RESEARCH. WE ALSO HAVE DR. CHARLOTTE PETERSON JOINING US ON A PART-TIME BASIS UNDER IPA. THE GOVERNMENTAL -- HI CHARLOTTE. SHE IS REALLY STEEPED IN THE MOTOR PACK THAT YOU'LL HEAR A LOT MORE ABOUT FROM JOAN McGOWAN. SHE JOINED US FROM OCTOBER AS THE PROJECT SCIENTIST FOR THE MOLECULAR TRANSDUCERS OF PHYSICAL ACTIVITY CONSORTIUM, WHICH PEOPLE HAVE TIMELY TURNED INTO THE TERM, MOTOR PACK, WHICH REALLY GIVES YOU A FEELING OF ENERGY IN THIS INITIATIVE. JOAN McGOWAN WHO HAS BEEN ABSOLUTELY CRITICAL IN THE DEVELOPMENT OF THIS, AND I'LL INTRODUCE HER LATER ON AND TALK MORE ABOUT MOTOR PACK LATER THIS MORNING. I ALSO WANTED TO MENTION IMPORTANT ORGANIZATIONAL CHANGE THAT IS BEING PLANNED AT THE NIMS AND WORKING WITH OUR COLLEAGUES AT THE NATIONAL CANCERRICSITUTE, WE INTEND TO TRANSFER -- CANCER INSTITUTE -- DERM TALL GEE BRANCH FROM THE NCI TO NIAMS TO THE INTRAMURAL RESEARCH PROGRAM. THIS ANNOUNCEMENT SERVICE AS THE FIRST NOTICE AS THE ATTEMPT TO REORGANIZE OF THE INTRAMURAL RESEARCH PROGRAM. PLANNED MOVE PROVIDES A GREAT OPPORTUNITY FOR SYNERGY ACROSS THE SCIENTIFIC PROGRAMS WITHIN NIMS AS WELL AS BETWEEN OUR LABS AND MANY OTHERS ACROSS THE NIH AND WE EXPECT THE PLANNED TRANSFER WILL BENEFIT THE NIH. AND THE EFFECTIVE INVESTIGATORS AND THE DERMATOLOGY COMMUNITY AS A WHOLE, SKIN BIOLOGY AND SKIN DISEASE COMMUNITY AS A WHOLE. WE MOVE FORWARD WITH OUR COMMITMENT TO PRESERVE AND ENHANCE THE LONG HISTORY OF LEADERSHIP IN THE DERMATOLOGY BRANCH IN THE SKIN RESEARCH FIELD. NOT ONLY LEVERAGING INTELLECT BUT ALSO SPACE AND OTHER RESOURCES IN THIS REGARD. I'LL TRANSITION FOR A MINUTE OR TWO ABOUT SCIENCE ADVANCES. WE HAVE A LOT OF ADVANCES BUT I DON'T WANT TO DETRACT FROM MY COLLEAGUE'S PRESENTATION. SO I'LL TELL YOU FIRST FROM OUR INTRAMURAL PROGRAM, MICHAEL UMBRELLA, WHO IS GOING TO BE A TENURED TRACK INVESTIGATOR AND INVESTIGATED AS SUCH. JUST FINISHED INTERNATIONAL CHILDHOOD ARTHRITIS GENETICS CONSORTIUM PROGRAM AND HAS IDENTIFIED SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS ON THE GENETIC BASIS AS BEING DIFFERENT THAN THE OTHER FORMS OF JIA. ANOTHER PAPER I FOUND MOST INTERESTING WAS A PAPER THAT CAME FROM COLORADO FROM MY COLLEAGUE IN BILL ROCK IN SON WHO LED THIS TEAM AND THEY ARE INTERESTED IN THE PATHOLOGIC IMMUNE RESPONSE THAT IS OCCUR BEFORE AUTOIMMUNE DISEASE IS APPARENT. WE KNOW THAT IN LUPUS, WE KNOW THAT IN OTHER OF THESE AUTOIMMUNE DISEASES BEFORE YOU SEE IT. ACTUALLY JAMES YOUR CLASSIC ARTICLE SOME YEARS AGO SHOWED THAT IN LUPUS, YOU START WITH DISEASE 5 OR 10 YEARS EARLIER AND YOU CAN SEE ANTIBODIES. WHAT MIKE MIGHT WANT TO SAY SOMETHING ABOUT THIS AFTERWARDS, BUT BASICALLY WHAT THEY DID WAS COMPARED THE ANTIBODY REPERTOIRE OF IMMATURE BLOOD CELLS, PLASMA BLASTS, FROM THREE GROUPS AND FOUND THAT THOSE THAT EXPRESS A CERTAIN TYPE OF ANTIBODY, IGA, THOSE PATIENTS WERE MORE PRONE TO DEVELOP RHEUMATOID ARTHRITIS. THE IMPORTANCE OF THIS IS WHEN ONE TALKS ABOUT PREVENTIVE MEDICINE, ONE HAS TO IDENTIFY RISK FACTORS AND THAT IS A RISK FACTOR. ANOTHER STUDY THAT VERY INTERESTING WITH TOO HARD BONE BIOLOGY AND BONE DISEASE COMES FROM HENRY RONINBURG FROM MASS GENERAL AS WELL AS MARK WINE WHO IS A -- [ PHONE RINGING ] I GUESS SOMEBODY IS TELLING ME MY TIME IS UP, RIGHT? MARK WINE A K0 A LITTLE AWARDEE IDENTIFIED A ENZYME DOWNSTREAM SIGNALING MOLECULES ACTS SOMEWHAT LIKE PARATHIGH RIDE R. ROID HORMONE AND ENABLES US TO HAVE YET ANOTHER TARGET FOR THE TREATMENT OF OSTEOPOROSIS. AND FINALLY, THERE IS A SLIDE UP HERE WHICH STUDIES HAVE BEEN GOING FOR MANY, MANY YEARS IN DISTROPEIC FORM OF EPIDERMOLYSIS, TRYING TO DO EX-VIVO GENE THERAPY WHERE THEY TAKE A PIECE OF SKIN. AND THIS IS WHAT ONE CAN DO WITH A PIECE OF SKIN. TAKE A PIECE OF SKIN AND GROW IT. TAKE A PIECE OF SKIN FROM UNINFECTED AREA OF SKIN THAT LACKS A CERTAIN TYPE OF -- I DON'T HAVE A POINTER BUT YOU SEE THAT LINE ON THE RIGHT THREE PORTIONS? YOU CAN SEE THE LINE. THAT'S RIGHT. THAT SHOWS A CERTAIN TYPE OF COLLAGEN MISSING IN PATIENTS WHO HAVE THIS DISEASE AND WHAT THEY CAN DO IS TAKE SKIN AND TRANSFECT THAT SKIN WITH THE GENE THAT EXPRESSES THAT MOLECULE AND/OR THAT PROCESS AND THAT EXPRESSES THAT MOLECULE. THE PROTEIN IS THEN EXPRESSED AND THEY FOLLOWED FOUR PATIENTS IN THIS STUDY LONG-TERM STUDY OF OVER A YEAR. THE ANTIGEN IS MAINTAINED AND THE INTEGRITY OF THE SKIN IS MAINTAINED FOR UP TO A YEAR, IN FACT 50% OF THE INDIVIDUALS. SO IT IS AN ADVANCE, PARTICULARLY IN AREAS THAT ARE RESISTANT TO ANY FORM OF PALLIATIVE CARE. NOW I'D LIKE TO JUST CONCLUDE BY -- THERE ARE MANY, MANY MORE ADVANCES THAT WE HAVE GOTTEN FROM ALL ASPECTS OF OUR INSTITUTE. I WILL GO ON WITH THEM THE NEXT TIME. AS I CONCLUDE MY REMARKS I I WANT TO EMPHASIZE OUR APPRECIATION AND THE DEDICATION TO OUR MISSION. WE LISTEN CAREFUL TOW WHAT YOU SAY AND I LOOK FORWARD TO HEARING MORE ABOUT YOUR IDEAS FROM FURTHER IMPROVING OUR INTERACTIONS. I WANT TO TAKE A MINUTE AND ADDRESS ANY QUESTIONS YOU MIGHT HAVE HAD FROM MY PRESENTATION, AND THEN I WANT TO INTRODUCE MY COLLEGE PRESENTATION WHICH YOU HAVE ALREADY SEEN PART OF. SO LET ME STOP HERE AND ASK IF THERE ARE ANY QUESTIONS OR ELUCIDATIONS YOU WANT TO MAKE. >> COULD YOU GIVE US A LITTLE BIT OF BACKGROUND ABOUT THE MIX OF THE DERM BRANCH, NOT BEING AT NCI AND NOT BEING DIRECTLY WITHIN NIAMS? >> SO THE QUESTION IS, WHY WAS THE DERM BRANCH IN THE NCI FOR ALL THESE YEARS? HISTORY TELLS A LOT OF STORIES. BUT PROBABLY 50-60 YEARS AGO, IT WAS A RENOWNED DERMATOLOGIST, EUGENE VAN SCOTT, RECRUITED FROM THE UNIVERSITY OF CHICAGO, TO DEAL WITH MANY OF THE RASHES THAT CAME FROM THE NEW CHEMO THERAPEUTIC AGENTS LIKE METHOTREXATE,ET CELTRA, AND HE STARTED THE BRANCH. AND HE STARTED THE BRANCH IN THE CANCER INSTITUTE AND IT IT STAYED THERE UNTIL THIS INSTITUTE STARTED. WHEN THIS INSTITUTE STARTED ABOUT 31 YEARS AGO, WE WERE ASKED IF WE WANTED TO -- I WAS CHIEF OF THE BRANCH, ASKED IF WE WANTED TO MOVE. WE DIDN'T HAVE TO BECAUSE WE WERE WELL SETTLED IN THE CANCER INSTITUTE AND AT THAT TIME, WE DECIDED NO THE TO MOVE. NOW, IT IS A DIFFERENT STORY. THE CHIEF DERM BRANCH CHIEF, IS RETIRING. THERE IS A PROXIMITY, TREMENDOUS PROXIMITY, 6-7 YEARS AGO WHEN THE CLINICAL SEVEN. WAS RENOVATED, THEY PUT DERMATOLOGY TOGETHER WITH OUR ROOM ATTIC DISEASES BRANCH. SO THEY ARE RIGHT NOW TOGETHER. AND IT WAS FELT THAT SINCE NUMBER 1 THE CANCER INSTITUTE WAS NOT GOING TO MAINTAIN THE BRANCH AS IT HAD BEEN FOR THE LAST 30 OR 40 YEARS AS A BRANCH, THAT THE INVESTIGATORS WOULD BE WELL OFF AND THERE WOULD BE CERTAIN INTERACTIONS THAT WOULD TAKE PLACE WITH COMMON GOALS IN THE AREA OF INFORMATION, AREA OF AUTOIMMUNE DISEASE ET CETERA. SO MANY COMMONALTIES THAT WE CANCER INSTITUTE AND THE INVESTIGATORS, ALL AGREE THIS WOULD BE AND SHOULD BE DONE. WHAT HAPPENS IS, IN A TRANSFER LIKE THIS, THE FUNDS THAT ARE USED FOR THE BRANCH ARE TRANSFERRED TO OUR INSTITUTE. JOHN WILL MENTION WHAT TYPES OF REACH THESE PEOPLE ARE DOING OR AT LEAST MENTION THEIR NAMES AND WE'LL GIVE A PRESENTATION SOMETIME. BUT WE THOUGHT THIS WAS THE TIME, PARTICULARLY SINCE IT WAS GOING TO BE CONVERGENCE OF LOCATION AND A LOT OF CONVERGENCE OF EFFORTS IN TERMS OF GOALS AND RESEARCH. ANY OTHER COMMENTS? AND THE CANCER INSTITUTE WILL ANNOUNCE THIS IN A COUPLE OF WEEKS AT THEIR SESSION AS A WHOLE STRIKE OF THINGS THAT HAVE TO BE ADDRESSED. ANYTHING ELSE? SO, OUR NEXT ITEM IS MY COLLEAGUE'S PRESENTATION. I SENT YOU MY PRESENTATION AND THE BACKGROUND AND MANY PARTICIPATED IN THAT DISCUSSION. EVERY COUNCIL MEETING SINCE I HAVE BEEN HERE, I HAVE ASKED FOR SUGGESTIONS FROM COUNCIL IN TERMS OF HOW CAN WE DO THINGS BETTER? LAST TIME WE HAD A MORE EXTENSIVE DISCUSSION AND MICHAEL AGREED TO CHAIR A GROUP THAT WOULD LOOK AT THIS IN PARTICULAR. SO, NOW WE HAVE A FORMAL REPORT THAT I CAN -- THAT I AND OUR SENIOR STAFF CAN RESPOND TO. AND I APPRECIATE IT GREATLY. I HAVE SPOKEN TO MICHAEL ABOUT IT A FEW TIMES. AND I WILL WITH TIME -- NOT TODAY, BUT WITH TIME, ALSO TALK ABOUT HOW WE WILL ADDRESS SOME OF THESE ISSUES. MICHAEL, YOU HAVE THE FLOOR. >> THANK YOU, STEVE. FIRST I'D LIKE TO THANK YOU AND YOUR LEADERSHIP TEAM FOR AGREEING TO OPEN UP THIS DISCUSSION, WHICH I THINK WILL BE VERY FRUITFUL AND INFORMATIVE, TODAY AS WELL AS GOING FORWARD. ALSO LIKE TO THANK THE COUNCIL MEMBERS WHO PARTICIPATED IN A SERIES OF DISCUSSIONS LAST FALL AND INTO THE WINTER WHICH I THINK WERE VERY HELPFUL HERE. AND REALLY MY ROLE TODAY IS TO SERVE AS A SPOKESPERSON FOR THE COUNCIL TO GO THROUGH A COUPLE OF SLIDES THAT SUMMARIZE MANY OF OUR DISCUSSIONS, AND THEN HOPEFULLY TO BE ABLE TO SIT DOWN WHILE WE CONTINUE THE DISCUSSION AROUND THE TABLE WITH REGARD TO GOING FORWARD. SO, JUST TO SET THE STAGE FOR THE NEW MEMBERS AND ALSO TO INVITE THEIR PARTICIPATION IN THIS DISCUSSION. AS YOU RECALL AND IS NICELY OUTLINED IN THE SUMMARY NOTES FROM THE MEETING, DR. KAATZ AND THE GROUP HAD A ROBUST DISCUSSION ABOUT IMPROVING AND ENHANCING THE INTERACTIONS OF THE COUNCIL WITH INSTITUTE LEADERSHIP. AND DR. KAATZ SUBSEQUENTLY ASKED THAT WE GO AHEAD WITH THIS. IT WAS MY REAL PLEASURE TO ORGANIZE THE CONFERENCE CALLS AND TRY TO SUMMARIZE MANY OF THE IDEAS THAT CAME FROM COUNCIL MEMBERS AND WE WENT AHEAD AND WROTE UP COMING REVIEWED AND DISCUSSED THESE INTERESTS. PUT TOGETHER AN INITIAL DRAFT SUMMARY OF THE CONFERENCE CALLS AND E-MAILS AND DISCUSSIONS AND THEN REVIEWED THE DOCUMENT WITH DR. KAATZ. WHAT YOU HAVE IN YOUR INFORMATION TODAY IS THAT DOCUMENT. THE GROUP ALSO HAD A NUMBER OF DISCUSSIONS REGARDING SPECIFIC GRANT MECHANISMS OR SPECIFIC RESEARCH AREAS. AND FOR THE ISSUE OF THAT BEING A BIT OUT OF SCOPE WITH REGARD TO WHAT WE ARE TRYING TO DO AS A GROUP GOING FORWARD, THOSE PARTICULAR COMMENTS WERE NOT INCLUDED GOING FORWARD. AND THEN WE HAVE THIS DISCUSSION PLANNED AT THE COUNCIL MEETING. SO, THE GROUP CAME TOGETHER AROUND FOUR MAJOR TOPICS AND ONE OF THOSE OF COURSE IS THE PRECISION MEDICINE INITIATIVE, EMI. SECOND IS WORKING TO ENHANCE THE COUNCIL ORGANIZATIONAL EFFECTIVENESS AND THE IMPACT OF THE COUNCIL. THE THIRD IS TO ALIGN FUNDING MECHANISMS TO TAKE ADVANTAGE OF CHANGING RESEARCH ENVIRONMENTS AND THAT IS A PARTICULAR INTEREST TO MANY OF US WHO ARE IN THE COMMUNITY IN WATCHING THE EVOLUTION OF HEALTH CARE AND THE OPPORTUNITIES THAT CERTAINLY ARE BECOMING APPARENT IN THE LOCAL LEVEL. AND ALSO OF GREAT INTEREST TO SUSHOW WE LEVERAGE PARTNERSHIPS TO BROADEN THE IMPACT OF NYE ALPS. AND WE HAD MANY -- NIAMS -- SO TO PUT A BIT OF GRANULATER TOW THIS AND SET THE STAGE FOR THE CONVERSATION GOING FORWARD, WITH REGARD TO THE PMI, THE COUNCIL MEMBERS REALLY WANTED TO PREPARE A PROACTIVELY FOR THIS 2017 PRESENTATION IN JUNE THAT DR. KAATZ ALREADY MENTIONED. ANOTHER AREA OF INTEREST WAS HOW WE ORGANIZE OURSELVES AS A GROUP AND MANY OF THE INDIVIDUALS HAVE BEEN ON SUBCOMMITTEES AND OTHER LEADERSHIP GROUPS AND REALLY FELT THAT A WAY TO PERHAPS ENHANCE WHAT WE DO PROACTIVE SRI TO FORM A SUBCOMMITTEE OR ONE OR TWO TO ADDRESS PLANNING FOR DISCUSSIONS GOING FORWARD. AND PARTICULARLY THE PMI DISCUSSION MIGHT BE A GOOD WAY TO PRESSURE TEST OR START THAT. IS THERE ALSO GREAT INTEREST WITH REGARD TO THE PMI BROADLY ACROSS THE NIAMS PORTFOLIO AND HOW EACH ASPECT OF THE PORTFOLIO CAN UTILIZE AND IMPACT AND BE ASSISTED IF YOU WILL, BY THIS PMI. WE ALSO TALKED ABOUT SEVERAL OTHER TOPICS WHICH WE CAN CERTAINLY COME BACK TO, AFFECTIVE INTERACTIONS OF PUBLIC AND PRIVATE DATABASES AND WORKING ON THIS ISSUE OF RESEARCH SILOS AND USING THE PMI WHICH AGAINST GOES ACROSS AREAS WITHIN NIAMS AND THE NIH AND ASSURING DESIST NEPMI RESEARCH EFFORTS AND POPULATIONS -- DIVERSE. I KNOW IT HAS BEEN A STRONG INTEREST OF DR. KAATZ. WITH REGARD TO ORGANIZATIONAL EFFECTIVENESS, WE ALREADY DISCUSSED THE POSSIBILITY OF SUBCOMMITTEES TO ENHANCE OPPORTUNITIES FOR UNSTRUCTURED INTERACTION AROUND COUNCIL MEETINGS. MANY OF US FLY IN AND FLY OUT BUT THERE IS NOT THE KIND OF SOCIAL INTERACTIONS THAT SOME OTHER GROUPS HAVE THAT WE REALLY THINK HELP TO ALLOW EXPLORATION OF IDEAS IN A LESS STRUCTURED INTERACTION AND SOMETIMES COME UP WITH REALLY PRETTY COOL THINGS. ALSO WANTED TO WORK OR BREAKDOWN RESEARCH SILOS AND ALSO AGAIN TO IDENTIFY OR HELP IDENTIFY SCIENTISTS FROM UNDER REPRESENTED MINORITIES WHO CAN SERVE ON COUNCIL WITH US. WITH REGARD TO ALIGNING FUNDING MECHANISMS, AGAIN, THIS IS THE HUGE ISSUE ON WORKFORCE DEVELOPMENT. WE ALL SEE IT AT THE LOCAL LEVEL WITHIN COLLEGE OF RHEUMATOLOGY, WHICH I HAVE PERSONAL INTERACTIONS WITH. WE NOW KNOW THAT THE VAST MAJORITY OF DIVISIONS IN THE UNITED STATES ARE ACTUALLY ACTIVELY RECRUITING. THE WORKFORCE THAT ALMOST REALLY DOESN'T EXIST. SO THERE ARE ISSUES WE ALL HAVE WITH REGARD TO THAT AND THAT GOES ACROSS ALL OF THE SPECIALTIES AND DEMANDS WITHIN NIAMS. WE WANTED TO WORK ON MULTIDISCIPLINARY RESEARCH EFFORTS THAT GO ACROSS DIFFERENT BACKGROUNS TO PROMOTE COLLABORATIVE RESEARCH FUNDING EFFORTS ACROSS AREAS AS WELL AS ACROSS OTHER INSTITUTES AND THEN TO AGAIN WORK ON ENGAGING COMMUNITY POSITIONS IN RESEARCH. AND I THINK THIS IS AN OPPORTUNITY THAT WE SEE IN MANY PLACES WHERE HEALTHNET WORKS ARE EXPANDING VERY RAPIDLY. THERE IS A GREAT INTEREST IN THE DOCS OUT IN THESE DEGREES IN COMMUNICATING AND WORKING AS PART OF THE ACADEMICALLY CENTERED NETWORK AND THIS IS AN AREA THAT I THINK HAS A POTENTIAL UP SIDE AND MANY OTHERS AGREED WITH THAT. THERE WERE SOME QUESTIONS WITH REGARD TO HOW DO WE WORK ON LEVELS OF EVIDENCE FOR A NUMBER OF PRE-CLINICAL STUDIES AND AGAIN, TO ENHANCE THE ISSUES OF ACCURACY AND REPRODUCIBILITY. AND THE FORTH, AN AREA OF GREAT INTEREST IS HOW TO BROADEN THE IMPACT OF NIAMS MORE FORMERLY WITH THE COUNCIL AND THE NIAMS COALITION AND THEN TO WORK TO INCREASE RESEARCH SUPPORT FOR THE NIAMS PORTFOLIO AND THEN FINALLY TO WORK WITH INTEGRATION RESEARCH EFFORTS AND FUNDING ORGANIZATIONS THAT WORK ON THE SAME DISEASES. SO THAT IS THE SUMMARY OF BRIEF SUMMARY OF LONG SET OF DISCUSSIONS AND REALLY THANK AGAIN THE COUNCIL MEMBERS AND NYE ALPS LEADERSHIP AND I DO THINK THAT THIS IS THE BEGINNING OF POTENTIAL FOR ENHANCING OUR INTERACTIONS AND MORE EFFECTIVELY ADDRESSING PATIENTS WITH THE DISEASES THAT WE ARE INTERESTED IN THANK YOU. >> THANK YOU VERY MUCH. LET'S IT UP TO PARTICIPANTS SINCE I KNOW THEY LOOKED AT IT MORE THAN ONE TIME. AND ALSO THOSE WHO HAVE NOT PARTICIPATED, WE'LL OPEN THE FLOOR. AMY? >> I'LL JUST ADD TO THAT. THAT WAS BEAUTIFULLY PRESENTED, MIKE, THANKS. I THINK ONE OF THE THINGS WE BROUGHT UP AND I'LL JUST REITERATE IT, IS THE FACT THAT I THINK WE THOUGHT THERE WERE LOST OPPORTUNITIES, EVEN WITHIN THE SPECIALTIES OF NIAMS FOR COLLABORATING ON PROJECTS OR COMING TOGETHER WITH P50 AWARDS OR THESE TYPES OF THINGS WHERE YOU CAN BRING TOGETHER -- SO I THINK A LOT ABOUT RHEUMATOLOGY FOR EXAMPLE, AND DERMATOLOGY IN PEDIATRIC OR ADULT, AS OPPORTUNITIES TO REALLY BE, INSTEAD OF GOING IN SILOS TO BE WORKING TOGETHER AND BE SUPPORTING THESE TYPES OF OPPORTUNITIES. I KNOW IT HAPPENS MORE IN RHEUMATOLOGY AND ORTHOPAEDIC AND BONE THAN IT DOES IN TERMTOLOGY. AND WE HAVE A REAL OPPORTUNITY TO THINK ABOUT THIS AND TRY TO ENCOURAGE IT. BECAUSE WE WIN THROUGH THESE SYNERGIES AND I DON'T THINK WE ARE DOING ENOUGH TO ENCOURAGE THEM. >> OF COURSE THERE IS NOTHING THAT INHIBITS THAT BECAUSE ALL OF OUR PROGRAMS PROMOTE THE ENTER ACTION AND I FOR ONE, WE TALKED ABOUT THIS AROUND THE TABLE, NOT NECESSARILY ONE FOR FORCING COLLABORATIONS. I THINK WHAT WE COULD DO IN THAT REGARD IS TALK ABOUT THOSE THINGS THAT ARE ALLOWABLE AND EMBRACEABLE, BUT NOT TO THE DETRIMENT OF OTHER THINGS THAT MAY NOT CROSS LINES. >> I AGREE WITH THAT. >> SO INTERNALLY WE TALK A LOT ABOUT THIS, WHETHER FORCING A RFA FOR AN ENGINE TEAR WORK WITH A BONE BIOLOGIST TO WORK WITH A MECHANICAL -- WE JUST DON'T DO THOSE THINGS, AT LEAST UNDER MY LEADERSHIP. GARY? >> SO I JUST WANT TO ACTUALLY THANK MIKE FOR LEADING THISSEST AND ONE OF THE THINGS THAT I THINK WAS MOST REVEALING WAS THE LEVEL OF INTEREST OF ALL OF THE COUNCIL MEMBERS IN PUTTING TIME, NOT JUST FLYING IN AND FLYING OUT, TO HAVE THESE DISCUSSIONS. SO I THINK THAT THERE IS A PENT UP DESIRE TO BE IMPACTFUL AND TO BE ABLE TO CONTRIBUTE. ONE THING, WHICH I THOUGHT WE TALKED ABOUT BUT YOU DIDN'T -- I DIDN'T SEE IN YOUR REPORT BECAUSE THERE WERE A LOT OF THINGS WE TALKED ABOUT. BUT THAT I HOPE WE CAN DISCUSS AT SOME POINT, AND I HAVE A QUESTION FOR STEVE, AND THAT IS WHETHER OR NOT THE VARIOUS ADVISORY COUNCILS FOR THE DIFFERENT NIH INSTITUTES HAVE AN OPPORTUNITY TO INTERSECT WITH EACH OTHER? AND WHEN CANNING ABOUT WHAT AMY SAID, I DON'T THINK IT'S RESTRICTED TO WITHIN NIAMS. BUT IT'S THE MISSIONARY AS EACH OF THE INSTITUTES OVERLAP IN MANY WAYS. AND WE OPERATE AS A COUNCIL AND ADVISORY COUNCIL FOR NIAMS. ONE NOTION AND I DON'T THINK WE'LL RESOLVE THIS TODAY AND I DON'T KNOW WHAT MECHANISM TO DO THIS, IS WHETHER OR NOT THERE COULD BE A COUNCIL OF COUNCILS WHERE THE DIFFERENT NIH COUNCILS ADVISORY COUNCILS INTERSECT IN SOME WAYS SO THAT WE HEAR FROM HEART LUNG WHAT THEY ARE MOST EXCITED ABOUT AND THERE MAY BE THINGS THAT WE ARE DISCUSSING THAT ARE VERY, VERY POSSIBLE TO INTEGRATE WITH QUESTIONS THAT ARE EMERGING EXACTLY BY THAT GROUP THAT WE DON'T KNOW HOW TO DO THAT. >> SO WE ARE VERY SENSITIVE TO THAT AND WHAT -- FIRST OF ALL THERE IS A COUNCIL OF COUNCILS T DOESN'T FUNCTION THE WAY YOU'RE TALKING ABOUT. IT WAS INITIALLY MEANT TO FUNCTION THAT WAY WHEN IT STARTED PROBABLY 10 YEARS AGO. THE COUNCIL OF COUNCILS IS THE COUNCIL OF THE COMMON FUND. SO, WHEN YOU HEAR ABOUT THAT WHEN JOAN TALKS ABOUT THE MOTOR PACK, HOW MANY TIMES SHE WENT TO THE COUNCIL OF COUNCILS, OR THE PROPOSAL WENT TO THE COUNCIL OF COUNCILS. BUT IT DOESN'T DO WHAT YOU'RE TALKING ABOUT. IT DOESN'T TALK ABOUT NITTY-GRITTY THINGS THAT WE ARE DOING THAT IS SPECIFIC TO US AND ALSO TO NIAD OR NIA. AND THAT IS ONE OF THE REASONS WHY WE INVITE DIRECTORS OF OTHER INSTITUTES TO THE COUNCIL TO GIVE US A FEEL FOR -- AND I HOPE YOU'LL GET THIS FROM ELISEO WHEN HE MAKES HIS PRESENTATION; WHAT ARE THOSE OPPORTUNITIES? AND ONE THING THAT CLEARLY COMES OUT FROM YOUR INTERESTS AND OUR INTERESTS AS WELL, IS TO BETTER PREPARE FOR THESE COUNCIL MEETINGS. SO FOR EXAMPLE, TWO OF THE MAJOR SUGGESTIONS, I THINK TWO OF THE MAJOR AREAS WERE, ONE WAS TO BE OR GET SOMEBODY TO TALK ABOUT PMI, WHICH WE HAD ALREADY DONE. THE OTHER WAS TO GET SOMEBODY TO TALK ABOUT MINORITY HEALTH AND HEALTH DISPARITIES AND HOW IMPORTANT IT IS TO US AND TO THEM. AND TO THAT INSTITUTE. SO THOSE WERE TWO THINGS THAT WERE ALREADY DONE BUT I THINK HAVING SEEN THOSE SUGGESTIONS, MY TEMPTATION IS TO -- WE WORK INTERNALLY A LOT ABOUT WHAT WE SHOULD BRING TO THIS TABLE, BECAUSE WE COULD BRING TO THIS TABLE JUST A FEW SCIENTIFIC TALKS, WHICH SOME INSTITUTES DO. BUT I THINK MOST OF US HERE SCIENTIFIC TALKS ELSEWHERE. THIS IS NOT THE PLACE FOR SCIENTIFIC TALKS. THIS IS A PLACE FOR OPERATIONS, LEADERSHIP IN TERMS OF MEDICAL RESEARCH. SO THAT IS WHY I WOULD PROBABLY BE TEMPTED IN RESPONSE TO SOME OF THESE TO DO A WORK GROUP, SOME OF OUR WORK GROUPS WORKED WELL. SOME OF THEM HAVE NOT WORKED WELL. WHEN I SAY NOT WORKED WELL, NOT BECAUSE PEOPLE DIDN'T WANT THEM TO BUT BECAUSE IT JUST DIDN'T FIT. ONE WORK GROUP THAT CERTAINLY COULD BE HELPFUL IS TO IDENTIFY AREAS THANK YOU MIGHT LIKE TO HEAR FROM. AS LONG AS IT'S NOT DONE IN A PREEVENTUAL MANNER, AREAS THANK YOU MIGHT LIKE TO HEAR FROM AND PROVIDE THAT INFORMATION TO US SO THAT WE CAN ADDRESS THAT PARTICULAR ISSUE. SO WE HEARD TWO THINGS BUT WE PRE-EMPTED THE COUNCIL ON THOSE TWO THINGS AND THAT'S THE PMI. NOW IN PREPARING FOR THE COUNCIL MEETING, I THINK THAT OUR RESPONSIBILITY MIGHT BE TO LET YOU ALL KNOW, TO IDENTIFY AREAS OF THE PMI OR ALL OF US, OR THE NEW NAME, TO LET YOU KNOW ABOUT THAT A MONTH IN ADVANCE SO YOU CAN DO WHATEVER READING YOU WANT TO DO TO TALK ABOUT WITH THE DIRECTOR OF PMI, WHAT SORTS OF THINGS COULD BE DONE IN EACH OF YOUR INTEREST AREAS? AND THEN WE COULD FOLLOW-UP WITH IT. SO I THINK THAT IS AN EXCELLENT IDEA. GETTING BACK TO YOUR POINT, I THINK ONE OF THE WAYS TO DO IT IS TO INVITE MORE OF THE INSTITUTE DIRECTORS WHO ACTUALLY HAVE OVERLAPPING INTERESTS AND WE HAVE A LOT WHO HAVE OVERLAPPING INTERESTS WITH US, TO AT LEAST OPEN THAT DOOR, TO LET THEM KNOW WHAT WE CAN PROVIDE. DID THAT ANSWER YOUR QUESTION? CINDY? >> SO, I WANT TO ALSO CONGRATULATE MIKE FOR ALL OF HIS EFFORTS. ONE OF THE THINGS OF COURSE IS LEVERAGING TRANS-NIH EFFORTS TO THE ADVANTAGE OF THE NIAMS MISSION. AND YOU TALKED ABOUT A COUPLE IN THE MINORITY HEALTH DISPARITIES AND MINORITY INVESTIGATORS AND SO FORTH. THE OTHER ONE, WHICH IN THE INTEREST OF FULL DISCLOSURE, I HAVE A VESTED INTEREST IN, IS ALL OF THE EFFORTS THAT NCATS IS MAKING AND I KNOW BOB CARTER IS AWARE OF THAT. BUT FOR THOSE OF YOU THAT MAY NOT BE QUITE AWARE OF THOSE HISTORICALLY NCRR USED TO PROVIDE INFRASTRUCTURE IN TERMS OF THE GENERAL CLINICAL RESEARCH CENTER. AND WHEN NIAMS INVESTIGATORS SUBMITTED AN RO1, THE THE COST WAS GREATLY REDUCED BECAUSE THERE WAS BASICALLY FREE ACCESS TO THE INFRASTRUCTURE THAT NCRR PAID FOR. THAT'S CHANGED NOW. THAT INFRASTRUCTURE IS NO LONGER SUPPORTED. BUT IT'S BECOME CLEAR THAT DR. AUSTIN AND NCATS HAS SHIFTED A LOT OF THOSE RESOURCES TO SUPPORTING MULTI-SITE CLINICAL TRIALS SO THEY JUST UNVEILED A TRIAL IN THE NETWORK WHICH BASICALLY PROVIDES VARIOUS LEVEL OF SUPPORT FOR CLINICAL TRIALS FROM LEVERAGING SINGLE IRBs TO SERVING AS CROs AND THAT CAN CUT THE COST DOWN OF THE CLINICAL TRIALS BECAUSE THAT INFRASTRUCTURE IS BEING PAID FOR BY NCATS AND BECAUSE THEY ARE GOING TO DO THIS FOR A LIVING, I THINK IT WILL BE MORE EFFICIENT AND ENSURE ENROLLMENT AND COMPLETION OF CLINICAL TRIALS. SO I THINK EACH INSTITUTES, WHICH NIAMS CAN TAKE MORE ADVANTAGE OF. AND IT REALLY SEEMS TO BE GETTING OFF THE GROUND IN THESE NETWORKS. >> WE HAVE HAD CONSIDERABLE DISCUSSION ABOUT THAT, BOB HAS BEEN ACTIVELY INVOLVED IN THAT. TICKS ANDRIX -- [ OFF MIC ] >> BUT WE HAVE DISCUSSED THAT AND WE REALLY DON'T WANT OUR RESEARCH DIMENSIONS TO BE LIMITED TO THOSE PLACES THAT HAVE CTSAs, CLINICAL AND TRANSLATIONAL SCIENCE AWARDS OR INSTITUTES. BUT THERE IS NO REASON WHY, FOR EXAMPLE, A LOT OF THEM ARE LED BY PEOPLE FROM THE MUSCULOSKELETAL COMMUNITY. THERE IS NO REASON WHY AN APPLICATION THAT IS A MULTI-CENTER APPLICATION COULD NOT COME TO US WITH THE SUPPORT OF THOSERIX OR TICKS. IT'S SOMETHING THAT HE WAS TALKING ABOUT WITH THE CLINICAL TRIALS AND NETWORK. NO REASON AT ALL WHY THEY COULDN'T COME TO US. AND WE AS AN INSTITUTE ARE READY TO PAY OUR FAIR SHARE FOR THAT INFRASTRUCTURE. NO FREE LUNCH BUT IF IT'S AN IMPORTANT STUDY, WE WILL SUPPORT IT. >> I'D LIKE TO ALSO THANK MIKE FOR LEADING THE EFFORTS. IT WAS VERY INFORMATIVE TO ALL OF US. WE HAVE A HUGE UPSIDE IN FIGURING WAYS ON THIS NUMBER 4 GOAL OF BILLION PARTNERSHIPS WITH OTHER ORGANIZATIONS. AND I THINK OF MY OWN CYCLE AS A VOLUNTEER STARTING OUT WITH THE ARTHRITIS FOUNDATION WHEN I WOULD GO TO MEETINGS AND HEAR PEOPLE DISCUSSING ABOUT MEDICAL RESEARCH AND NYE ALPS. THAT WAS FOR THE SCIENTIST TO WORRY ABOUT. AS I GREW AND BECAME PART OF LEADERSHIP. SO THE WHOLE ROLE OF THE LAY VOLUNTEER, I THINK, IN THIS EFFORT TO RAISE AWARENESS AND ALSO TO RAISE SOME LEVEL OF SYNERGY IN SPENDING AROUND RESEARCH. SO AGAIN WHEN I WAS A YOUNG VOLUNTEER HERE AT THE ARTHRITIS FOUNDATION I THOUGHT WE DID OUR OWN RESEARCH AND IF IT FIT INTO THE BIGGER GOAL, WHO KNEW. NOW I'M OLDER AND WISER, I GET IT IS VERY IMPORTANT WE LEVERAGE THESE THINGS. THAT THERE IS SOME SYNERGY NOT REPLICATION, SOMETIMES THERE IS A LOT OF REPLICATION BUT SOME SYNERGY TO BUILD TOWARDS A BIGGER GREATER GOOD. AND I THINK THE COUNCIL COULD SHOW SOME LEADERSHIP IN THAT BY PUSHING TO HAVE THOSE DISCUSSIONS ACROSS A LOT OF DIFFERENT VOLUNTEER ORGANIZATIONS WHO ARE ALL FUNDING RESEARCH, SOME AT VERY SIGNIFICANT LEVELS, SOME LESS SIGNIFICANT. BUT WHEN YOU ADD THE TOTALITY OF IT UP, I THINK IT WOULD HAVE A MAJOR IMPACT. SO, I THINK THAT IS A REAL OPPORTUNITY FOR THE COUNCIL TO TAKE ITS EFFORTS TO A WHOLE DIFFERENT PLACE AND REALLY BECOMING THE LEADER IN SHAPING THE DIRECTION OF SCIENTIFIC RESEARCH AND KNOWLEDGE IN BRINGING THE LAY VOLUNTEER WHO ARE HELPING TO MAKE BUDGET DECISIONS AND OTHER THINGS AT THE LOCAL LEVEL ONBOARD TO BUILD A BIGGER, STRONGER, MORE SYNERGISTIC EFFORT TOWARDS FINDING SOME SOLUTIONS. >> THANK YOU FOR THAT. THAT BRINGS UP A REALLY IMPORTANT POINT. WE DO HAVE A LONG HISTORY OF INTERACTION WITH THE VOLUNTARIY AND PROFESSIONAL LAY COMMUNITIES. WHEN YOU WERE TALKING, I THINK YOU GO BACK TO THE NARAC, NORTH AMERICAN RHEUMATOID ARTHRITIS CONSORTIUM, WHICH WAS A PARTNERSHIP BETWEEN NIAID, NIAMS, WE LED IT, SUSAN LED IT. AND NIAID. NIAMS, OFFICE OF RESEARCH ON WOMEN'S HEALTH AND THE ARTHRITIS FOUNDATION. NOW THE ARTHRITIS FOUNDATION CONTRIBUTED A SMALL AMOUNT OF MONEY BUT WHAT THEY REALLY CONTRIBUTED IS THE ENTHUSIASM -- AND YOU WERE PART OF THAT. DEBORAH WAS A PART OF THAT IN TERMS OF THE AGREEMENT TO MOVE FORWARD -- WHAT THEY REALLY CONTRIBUTED WAS EP NEWSASM FOR THE MEMBERSHIP TO PARTICIPATE. PART OF THE SUCCESS IS BASED ON THAT. SINCE THAT TIME, WE HAD MANY AGREEMENTS WITH VARIOUS ORGANIZATIONS, ASBMR, RHEUMATOLOGY RESEARCH FOUNDATION, NATIONAL PSORIASIS FOUNDATION, AND IT BRINGS TO MIND TO MAKE A LONG STORY SHORT, THAT PERHAPS WE'LL BRING THAT TO THE TABLE AS A PRESENTATION IN TERMS OF WHAT HAS BEEN DONE SO WHAT THE POSSIBILITIES ARE. BECAUSE THE POSSIBILITIES IN MY VIEW, ARE LIMITLESS. >> I AGREE WITH THAT. >> A VERY GOOD POINT. >> I AGREE WITH THAT. I THINK WHAT WE HAVE TO THINK ABOUT IS, VOLUNTEERS ARE ALL DIFFERENT LEVELS OF ENGAGEMENT AND THE MORE WE CAN GET THEM UNDERSTANDING THEIR ROLE EARLY, THE BETTER ADVOCATES THEY BECOME AS THEY GET INTO LEADERSHIP POSITIONS. I THINK IT'S JUST A HUGE UPSIZE FOR US. >> I THINK PEOPLE WHO ARE WATCHING KNOW THAT WE HAVE DONE THIS AND MIGHT BENEFIT FROM THAT AS WELL. PAUL? DID YOU HAVE A QUESTION? >> MINE WAS JUST MOVING ON. SO BACK TO A TOPIC WE TALKED ABOUT AND THEN REALLY BRIEFLY A NEW TOPIC. AND SO, I THINK THAT HAVING DIFFERENT GROUPS COME IN AND SPEAK TO US IS GREAT. BUT I THINK THAT WHAT I WAS GETTING OUT OF READING THE SLIDES WAS THAT MAYBE WHAT WE NEED TO DO IS HAVE A SUBCOMMITTEE THAT SAYS, THESE ARE SPECIFIC QUESTIONS THAT WE ARE INTERESTED IN IN THE PRECISION MEDICINE INITIATIVE AS IT RELATES TO NIAMS AND OUR MISSION. YOU'LL REMEMBER THAT THASM PARTNERSHIP THAT NIAMS IS PARTICIPATING IN, ONE OF THE FIRST THINGS PMI DID WAS TO ASK FOR OUR PROTOCOLS. WE PRESENTED AND WE DID ALL THOSE THINGS AND NOW WE WOULD LIKE TO KNOW HOW THOSE HAVE EVOLVED AND WHAT KIND OF CHANGES ARE THEY MAKING AND WHAT KIND OF QUESTIONS ARE THEY ASKING TO MAKE SURE RHEUMATOLOGY ISSUES LIKE OSTEOARTHRITIS OR OSTEOPOROSIS ARE BEING ADDRESSED. SO I THINK I WOULD BE HAPPY TO LEAD THE SUB COMMITTEE TO COME UP WITH A LIST OF QUESTIONS SO THAT WE GET INFORMATION BEFOREHAND. THEY KNOW WE ARE ALREADY THINKING ABOUT IT AND THEN MAYBE ACTION ITEMS OR FOLLOW-UP STEPS AFTER. AS OPPOSED TO JUST HAVING THEM COME AND GIVE US THE HIGHLIGHTS. WE NEED THAT INFORMATION BUT MAYBE WE CAN MAKE IT A LITTLE MORE INTERACTIVE. >> SO LET ME SAY THAT IS TERRIFIC. THE PROPOSAL IS ACCEPTED. ACTUALLY YOUR PROPOSAL IS EMBRACED. ERIC DISHMAN WHO YOU'LL HEAR IS A VERY APPLICABLE FELLOW, HE AND I HAVE HAD A FEW MEETINGS AND INITIALLY HIS IDEA WAS WELL, WE'LL TRY TO HAVE SESSIONS THAT DEAL WITH EACH OF THE INSTITUTES. MY SENSE WAS IT SHOULDN'T BE EACH OF THE INSTITUTES. IT REALLY SHOULD BE PROGRAM AREAS. AREAS OF REAL INTEREST WHETHER IT'S MUSCULOSKELETAL DISEASE, UNDER AN UMBRELLA TO BRING PEOPLE TOGETHER. WHAT CAN WE LEARN FROM A MILLION PEOPLE OR 500,000 PEOPLE THAT COULD, WITH VERY LITTLE EFFORT, BE -- NOTHING IS VERY LITTLE EFFORT. BUT AS LONG AS THEY ARE ACCUMULATING THESE PEOPLE, WHAT CAN WE DO? KNOWING FULL WELL THAT THE SCIENTIFIC APPROACH IS GOING TO BE SUPPORTED BY US. I MEAN, THAT IS WHAT WE DO. SO THIS IS A BIG RESEARCH RESOURCE. BUT WE WILL TAKE YOU UP ON THAT AND IT IS ESPECIALLY PRECIOUS BECAUSE HE IS COMING AT OUR NEXT MEETING. >> CAN I JUST ADD ONE COMMENT? I'M WONDERING WHETHER AS AN ACTION ITEM, NIAMS MIGHT CONSIDER THE FOLLOWING. THAT IS THAT IF THIS DECISION GOES WELL, SO THAT THERE IS INPUT FROM OUR DISEASE AREAS INTO HOW DATA ARE GOING TO BE COLLECTED FOR THE PM I AND WHAT THE SOPs WILL BE, THAT WE THEN IN TURN, AS WE GO FORWARD TO FUND OTHER NYE AM-SPECIFIC PROGRAMS, TO MAKE IT NOT REQUIREMENT. SO THERE ARE A MILLION PEOPLE IN PMIF THERE ARE OTHER PROGRAMS BEING ESTABLISHED, TO LOOK AT OTHER DISEASE ENTITIES, TO MAKE SURE THAT OUR INVESTIGATORS KNOW THAT IF THEY USE SIMILAR SOPs IN COLLECTING DATA AND COLLECTING SAMPLES, THAT THAT COULD THEN LEVERAGE THESE MILLION INDIVIDUALS IN THE PMI BECAUSE THEY'LL BE A COMMON SET OF PRINCIPLES WITH HOW SAMPLES ARE COLLECTED OR STORED OR ANALYZED, TO REALLY AUGMENT THE POTENTIAL IMPACT. SO, I THINK BY HAVING THAT BE A NIAMS CONTRIBUTION AND I THINK YOU MIGHT GET EVEN MORE BUY-IN BY THE PMI GUYS THAT THEY WILL LISTEN BECAUSE THEY WILL BE ABLE TO LEVERAGE THEIR MILLION INDIVIDUALS WITH FOLKS THAT ARE STUDIED THROUGH NIAMS. I DON'T KNOW IF THAT WAS CLEAR. >> I UNDERSTAND THAT. LET ME JUST ADDRESS THAT. I WOULD HOPE YOU LOOK AT THE LOWEST OF THE LOW HANGING FRUITS. THEY DON'T NEED QCTs. THEY DON'T NEED RHEUMATOID FACTOR STUDIES. THIS IS THE LOWEST OF THE LOW OF THE LOW-HANGING FRUIT. BECAUSE THEY ARE GOING TO START AT THAT LEVEL AND NOT GOING TO START -- BLOOD PRESSURE, PERHAPS OBESITY, AND SO I'D LIKE FOR YOU TO CONCENTRATE ON THAT. >> BUT IT DOES PLAY BIGGER FROM THE LOWEST OF THE LOW TO THE HIGHEST OF THE HIGH. I GAVE A PRESENTATION TO THE COUNCIL OF COUNCILS ON THE HUMAN BIOMOLECULAR ATLAS PROGRAM THAT PROBABLY WILL BE COMING BACK TO YOU. IN PUBLIC PRESENTATION, IT'S ABOUT DOING SINGLE CELL RNA-SEQ TYPE WORK WITH SPACIAL ORIENTATION PRESERVE. BUT, I THINK THAT GETS TO EXACTLY WHAT YOU WERE TALKING ABOUT, GARY, IS IF WE CAN PLUG IN THOSE KIND OF SOPs, THOSE KIND OF LARGER INITIATIVES THAT WE ACTUALLY ALREADY PLAYING IN IN SOME AREAS, COULD BE USED THROUGHOUT THE INSTITUTE. >> SO -- SORRY. MY SECOND POINT QUICK IS THE ENGAGING COMMUNITY PHYSICIANS. I THOUGHT THAT WAS A VERY INTERESTING PHRASE AND I THINK THERE IS LOTS OF OPPORTUNITIY THERE THAT RHEUMATOLOGY MAYBE HASN'T TAPPED INTO LIKE SOME OF THE OTHER COMMUNITIES HAVE. SO, I THINK OF ENGAGING COMMUNITY PHYSICIANS BUT ALSO COMMUNITIES AND PRACTICE-BASED RESEARCH NETWORKS. THERE ARE A NUMBER OF LARGE ONES THAT HAVE BEEN DIVIDES. WE HAVE ONE WITH 300 PARTICIPANTS IN OKLAHOMA. 300 DIFFERENT PRACTICES. AND THEY HAVE DONE A LOT OF THINGS BUT NOTHING IN RHEUMATOLOGY. EXTENDED PRACTICE REGISTRIES WHICH THE ACR AND OTHERS HAVE INVESTED A LOT OF RESOURCES IN AND THERE IS A LOT OF INFORMATION THERE BUT I THINK WE SHOULD THINK ABOUT WAYS WE CAN LEVERAGE THAT AS WELL AS DISSEMINATION AND IMPLEMENTATION RESEARCH, WHICH HASN'T BEEN HISTORICAL STRENGTH BUT WE ARE GETTING CLOSE TO BEING ABLE TO DO THAT ACROSS RHEUMATOLOGY. SO I THINK THAT ONE SMALL PHRASE MADE ME THINK OF A LOT OF DIFFERENT THING AND WHEN YOU HAD THOSE DISCUSSIONS, MAYBE IT WILL BE SOMETHING WE SHOULD KEEP THINKING ABOUT HOW WE CAN INTERACT. >> I WANTED TO SAY -- PUTTING ALL THESE TOGETHER. -- REALLY FOND OF THE PMI STUDY BECAUSE THE ISSUE OF DIVERSITY IS PRETTY MUCH IMPORTANT TO ME AND TO OUR COMMUNITIES, ESPECIALLY HISPANICS AND OTHER MINORITY GROUPS THAT HAVE VERY LOW, I WOULD SAY PARTIS NATION CLINICAL TRIALS. AND ALSO THE RESEARCHERS -- I MEAN IT HAS ALREADY BEEN MENTIONED. DIFFERENT PARTICIPATION OF COMMUNITY RESEARCHERS OF MINORITY RACIAL OR ETHNIC GROUPS. I ALSO THINK IT'S -- AND THIS IS A GREAT OPPORTUNITY FOR NIAMS TO REACH OUT WITH THE PROJECT. AND WE SHOULD INCLUDE OTHER MINORITIES IN THE RESEARCH. THE OTHER THING THAT I -- IMPORTANT WAS -- ESCAPING. THE INCLUSION OF PROJECT THAT ALREADY IN PLACE, PARTICULARLY THOSE THAT ARE DONE BY HISPANIC REACHERS, FOR EXAMPLE THE PROJECT THAT IS ALSO FUNDED BY NIH. [ LOW AUDIO ] AND DATA COLLECTION REALLY SIGNIFICANT AND IS ALREADY A REPORT OUT THERE THAT IT WILL BE REALLY HELPFUL TO COORDINATE AND INVOLVE THE RESEARCHERS THAT OUR COMMUNITY REACHERS INTO THE PMI. >> BUT IF THEY HAD A QUESTION THAT WAS AN IMPORTANT QUESTION TO BE ASKED IF ANY OF OUR AREAS OF INTEREST, ASKED TO PARTICIPATE AND TO TAKE VALUE OF THAT AS A RESEARCH RESOURCE. THAT SAY RESEARCH RESOURCE. I THINK WE ARE GOING TO TRY -- WE'LL TRY TO CLOSE THIS OUT IT'S BEEN A VERY GOOD DISCUSSION. GWEN? LAST COMMENTS FROM ANYBODY BESIDES GWEN. >> ONE THOUGHT. AND MIKE THANK YOU AGAIN. IT WAS VERY GOOD OF YOU TO ORGANIZE IT. I ENJOY THE INTERPLAY THAT WE HAVE ON THE CONFERENCE CALLS. ANOTHER THOUGHT ALONG THE LINE OF CULTURE IS IN THE NUMBER 2, ENHANCING ORGANIZATION. ONE OF THE THOUGHTS THAT WE DISCUSSED WAS HOW WE CAN GET MORE OF THE PRESENTERS TO COME TO INCLUDE INFORMATION ABOUT CULTURE AND DIVERSE GROUPS. AND WE ARE A DIVERSE GROUP AND PERHAPS WE CAN EMPHASIZE THAT A LITTLE MORE, SHOW THAT TO THE REST OF NIH, AND GIVE THEM SOME EMP TUS FOR INCLUDING THAT INFORMATION. WE SHOULDN'T HAVE TO ASK FOR THE INFORMATION. AND IF WE DON'T HAVE TIME BECAUSE OF, WE HAVE TO CLOSE DOWN THE DISCUSSION, THEN WE DON'T GET THE INFORMATION, OR THE INFORMATION IS SOMEWHAT SHALLOW WHEN THEY RESPOND TO US. SO, IF FOR EXAMPLE, ONE OF THE THINGS WE COULD CONSIDER DOING IS LETTING THEM KNOW AND SEND A THANK YOU LETTER AND LET THEM KNOW WE DO HAVE A DIVERSE GROUP AND VARIOUS CULTURES OF INTEREST AND THINGS OF THAT NATURE. SO THAT THEY CAN ADDRESS THAT. SOME OF IT IS THERE WHEN YOU ASK THE QUESTION BUT IT'S NOT INCLUDED. >> VERY GOOD POINT. LAST WORD, MIKE. >> THANK YOU. SO ONE THING TO ALSO JUST REFLECT ON WHICH IS A TRUE STRENGTH OF NIAMS AND I WANTED TO COME BACK TO THAT, AND THAT IS WHAT GARY POINTED OUT THAT I ONLY ALLUDED TO BUT DIDN'T ADDRESS DIRECTLY, BUT ALSO REFLECTS A BIT OF A SENSE FROM SOME OF THE LAY MEMBERS OF THIS GROUP, THAT THERE IS A SENSE THAT THE SILOS WITHIN DIFFERENT -- INSTITUTE TO INSTITUTE -- ARE ONES THAT ARE HARD TO ADDRESS FROM THE OUTSIDE OR HARD TO SEE THROUGH. AND I KNOW THAT YOU AND YOUR LEADERSHIP LIKE TO CHANGE THINGS OR MOVE THINGS FORWARD WITHIN THE NIH. AND I THINK ANYTHING THAT CAN BE DONE, AS YOU MENTIONED, TO BRING IN PERHAPS OTHER INSTITUTE DIRECTORS OR DISCUSS ISSUES THAT ARE BROAD-BASED THAT CROSSCUT THESE AREAS, WOULD BE HELPFUL TO THE COUNCIL MEMBERS AND ALSO TO ULTIMATELY TO OUR PATIENTS. I'LL LEAVE YOU THE FINAL WORD. >> SO CLEARLY SOME ACTION ITEMS COMING OUT OF THIS. I WOULD, MY PREFERENCE IS TO PUT TOGETHER A RESPONSE TO COUNCIL MEMBERS WHO HAVE PUT THIS TOGETHER AND TALK ABOUT HOW WE'RE GOING TO DO THIS MOVING FORWARD, ALONG WITH DISCUSSION WITH MY SENIOR STAFF ON WHAT RESPONSIBILITIES AND WHAT WORK GROUPS WE WOULD PUT TOGETHER. WE DON'T MEAN TO OVERBURDEN BUT THERE WAS A FEW THINGS I HEARD TODAY THAT ARE CLEARLY ACTIONABLE STRAIGHTAWAY. I HAD NOTES I WAS GOING TO SET THEM UP DURING THIS MEETING BUT I THINK TIME DOESN'T ALLOW THAT AND I THINK THE REFLECTION BY US AND PERHAPS INTERACTION WITH YOU AS THE LEADER INITIALLY AND THEN YOU ALL WILL BE HEARING FROM ME WITHIN THE NEXT MONTH TO 5 WEEKS. I'M ACTUALLY TAKING A FEW WEEKS OFF AFTER THIS HARROWING COUNCIL MEETING. [ LAUGHS ] SO, IT WON'T BE IMMEDIATE BUT IT WILL BE WITHIN THE NEXT 4-5 WEEKS AND THAT'S THE ONLY REASON FOR THE LATENESS IN TIME. SO, THANK YOU ALL VERY MUCH. I THOUGHT THIS WAS A GOOD DISCUSSION. IT MAKES US ALL BETTER AND I HOPE THAT WILL YOU GO ALONG WITH SOME OF THESE WORKING GROUPS AND SOCIAL ASPECT OF WHAT WAS BROUGHT UP. AS SOME OF YOU KNOW, I'M A BIG BELIEVER IN THAT. I THINK THAT DINNERS LIKE WE HAD LAST NIGHT WITH THE NEW MEMBERS JUST TO HELP ORIENT THEM TO THE REALITY OF WHAT THEY ARE LOOKING FOR, AND THE ORIENTATION AND THE SESSION THAT I HAVE AT MY HOUSE, IS MEANT TO ENHANCE THAT INTERACTION THAT TAKES PLACE AND EVEN AMONG SCIENTISTS ALONE IS TREMENDOUS INTERACTION THAT GOES WELL BEYOND JUST THE SCIENTIFIC INTERACTION. THAT IS THE REASON WHY WE HAVE BEEN HIND TORD A CERTAIN EXTENTUX NOW LES SO, IN TERMS OF -- HINDER ED TO A CERTAIN EXTENT. IT'S NOT JUST THE SCIENTIFIC ASPECT. IT ALSO IS THE OTHER THINGS THAT HAPPEN IN THE HALLWAYS THAT END UP WITH ACTUALLY SUBSTANTIVE RECOMMENDATIONS. AND I THINK ON THAT POINT, WE'LL STOP. JOHN, I'M VERY SORRY WE ARE STARTING LATE. BUT JOHN O'SHEA WHO MS. BEEN OUR SCIENTIFIC DIRECTOR, FOR NOW 10 YEARS AT LEAST, WHO IS A TREMENDOUS LEADER AT NIH. NOT ONLY A SCIENTIFIC LEADER, BUT ALSO A LEADER IN MANY OF THE OPERATIONS THAT GO ON AT NIH. A LEADER IN BUDGET DISCUSSION THAT IS GO ON ACROSS THE NIH. JOHN HAS -- I'M REALLY BLESSED BY HAVING JOHN AS THE SCIENTIFIC DIRECTOR AND RICHARD WHO COULDN'T BE HERE AS OUR CLINICAL DIRECTOR, BOTH OF WHOM REPORT TO ME AND JOHN WILL TALK ABOUT WHAT GOES ON IN THE INTRAMURAL PROGRAM, WHAT ADVANCES WE HAVE SEEN. AS YOU KNOW, ONCE A YEAR WE HAVE A REPORT AND THE BOARD OF SCIENTIFIC COUNCILS BUT THIS IS NOT THAT. THIS IS REALLY THE STATE OF THE IRP. SO JOHN, THE FLOOR IS YOURS. >> GRATED. THANK YOU VERY MUCH. SO, I'LL TRY TO MOVE QUICKLY SINCE I WANT TO STAY ON TIME. BUT AS YOU ARE WELL AWARE, I THINK THE INTRAMURAL RESEARCH PROGRAM IS THE SINGLE-BIGGEST INVESTMENT OF NIAMS SO I'M SURE YOU WANT TO KNOW WHETHER YOU'RE GETTING YOUR MONEY'S WORTH AND WHETHER WE ARE DELIVERING. I THINK OVER THE YEARS WE HAVE CERTAINLY HAVE STARTING WITH THE DISCOVERIES OF MY PREDECESSOR, JOSEPH, ONE OF THE FIRST PEOPLE TO USE METHOTREXATE TO TREAT ARTHRITIS, UP TO MY WORK WHERE WE HAVE BEEN FORTUNATE ENOUGH TO BE INVOLVED IN A CLASS OF NEW DRUGS USED FOR ARTHRITIS BUT ALSO DERM LONG CALL CONDITIONS ET CETERA. AND I COULD GO ON AND ON. I THINK YOU GET YOUR MONEY'S WORTH OUT OF US BUT LET ME JUST GIVE YOU A LITTLE BIT OF OVERVIEW OF THE INTRAMURAL RESEARCH PROGRAM, TELL YOU SOME OF THE THINGS THAT I'M MOST EXCITED ABOUT FOR THIS YEAR AND THEN INTRODUCING NEW FACES TO YOU. SO, TO GET BACK TO THE POINTED THAT I WAS MAKING BEFORE, WE ARE AS YOU HAD HEARD BEFORE, WE ARE EVALUATED EACH YEAR BY THE BOARD OF SCIENTIFIC COUNCILORS AND THE VARIOUS FACULTY MEMBERS BOTH BASIC SCIENCE AND CLINICAL FACULTY MEMBERS PRESENT TO THE BOARD OF SCIENTIFIC COUNCILORS AND I'LL COME TO THAT IN A LITTLE BIT MORE IN A SECOND. THERE ARE 27 FACULTY THAT WE CONSIDER AS SUCH, 11 ARE TENURED SENIOR INVESTIGATORS. 7 TENURED TRACK PIs WHICH I'LL TRY TO TOUCH ON THEIR WORK AS I GO THROUGH THIS. WE HAVE ASSISTANT CLINICAL INVESTIGATOR, A PATHWAY TO INDEPENDENCE TO IDEALLY GET TO THIS TENURED SENIOR INVESTIGATOR POSITION. STAFF SCIENTISTS AND STAFF CLINICIANS AND WE ALSO DID AN EXPERIMENT A FEW YEARS AGO. WE HAD A DIFFICULTY OVER MANY YEARS TO RECRUIT A TENURED TRACK INVESTIGATOR AS AN ORTHOPAEDIC SURGEON IN OUR GROUP SO WE HAVE A CONTRACTOR. AND HE'LL BE REVIEWED BY THE BOARD OF SCIENTIFIC COUNCILORS THIS YEAR. SO WE HAVE 26 CLINICAL FACULTY. IF YOU'RE WONDERING HOW THESE NUMBERS ADD UP. JUST POINT OUT THAT WE CONSIDER CLINICAL FACULTY ABSOLUTELY DIFFERENT THAN OUR SCIENTIFIC FACULTY IN THE SENSE THAT WE HAVE TRAINEES WHO ARE BOARD CERTIFIED, CAN SEE PATIENTS AND SERVE AS ATTENDEES SO WE INCLUDE THAT AMONG OUR CLINICAL FAMILIAR TEE SO THAT INCLUDES EIGHT CLINICAL SENIOR INVESTIGATORS, SIX TENURE-TRACK INVESTIGATORS, ET CETERA AND THESE ARE THE SCHOLARS THAT I ALLUDED TO. SO IN ADDITION TO OUR FACULTY AND CLINICAL FACULTY, WE HAVE OUR OFFICE OF SCIENCE AND TECHNOLOGY, THAT'S OUR COURSE. WE HAVE ROBERT WALKER WHO IS DOING A SPECTACULAR JOB AND OUR TRAINING AND OUTREACH BRANCH. I SHOULDN'T SAY SHE BEING EVALUATED BY THE BOC THIS SPRING BUT I THINK YOU WILL ALL AGREE WHEN YOU HEAR ABOUT THE GREAT THINGS HE IS DOING THAT HE IS DOING AN,A MAZING JOB. AGAIN TO MY POINT BEFORE, WE ARE BIG INVESTMENT AND WE UNDERSTAND THAT WE TAKE THAT VERY SERIOUSLY 10% OF THE TOTAL NIAMS BUDGET. YOU NOTICE I PUT 10.4% HERE. AND THAT IS BECAUSE I KNEW THAT IF I SAID 10%, STEVE KATZ KNOWS THAT IF YOU ROUND OFF NUMBERS THAT HE DOESN'T BELIEVE THEM. SO I THINK IT IS ACTUALLY 10.37% SO STEVE, I ROUNDED IT UP BUT IN ANY CASE, WE TAKE THIS PART VERY SERIOUSLY. AND AS I'D LIKE TO SHOW YOU -- >> YOU MENTIONED THAT IS CHANGING WITH THE COMING ON OF THE NCI. >> CORRECT. AND MAYBE WE CAN TALK ABOUT THAT A BIT LATER IT'S A BIG MOVE FOR US. IT'S A VERY SUBSTANTIAL INCREASE IN THE INTRAMURAL PROGRAM AND WE ARE WORKING VERY HARD TO MAKE SURE ALL THE MOVING PIECES FIT TOGETHER. OUR PROGRAMS, I'LL TRY TO GIVE YOU A FLAVOR OF, SPAN FROM BASIC ISSUES TO CLINICAL ISSUES. AND THE WORK IS REVIEWED EACH YEAR BY THE BOARD OF SCIENTIFIC COUNCILORS AND THE CHAIR IS ANTHONY ROSEN AND I'LL TELL YOU WHO IS GOING TO BE REVIEWED THIS YEAR COMING. >> FORMER CHAIRS WERE GARY AND ALSO JUDY. >> AND I THINK BOTH CAN SPEAK TO -- WE TAK E WHAT OUR BSE CHAIRS STAY VERY SERIOUSLY AND I HOPE YOU FELT LIKE YOU HAD A LOT TO DO WITH HOW THE PROGRAM CHANGED AND GREW. AND AGAIN, WE REALLY RELY ON THEIR WISDOM AND IN PULT. SO LET ME GIVE YOU A FEW EXAMPLES ON WHAT I'M EXCITED ABOUT STARTING FROM THE BASIC. STEVEN IS A STRUCTURAL BIOLOGIST AND THEY COLLABORATED WITH THE EYE INSTITUTE ON THIS DISEASE, MACULAR DEGENERATION, THIS PARTICULAR FORM OF MACULAR DEGENERATION OF THE PROTEIN RETINOSIS IN RS1, AND LOOKING AT THE MUTATIONS IN THIS DISEASE THAT LEAD TO BLINDNESS. AND I JUST LOVE THIS PICTURE WHEN I SAW THEM. AND THEY ARE CRYOELECTRON MICROSCOPY GAVE US THIS IMAGE OF PROTEINS THAT FORM THIS DOUBLE RING THE OCTOBER MERES THAT ARE PAIRED BACK-TO-BACK AND WHAT WAS PARTICULARLY EXCITING WHEN THEY WORKED -- WHEN THIS STRUCTURE WAS SOLVED, WAS THAT THE MUTATION THAT IS OCCURRED AND CAUSE THIS DISEASE ARE ON THE INTERFACE BETWEEN THE TWO DOUBLE-RING STRUCTURE. SO THAT REALLY GIVES A MODEL FOR HOW THIS PATHOPHYSIOLOGY EVER THIS DISEASE THAT REALLY HAVE THESE JUNCTIONS THAT REALLY CAN BE DISRUPTED BY MUTATIONS AND GOING FORWARD, ONE CAN THINK ABOUT ALL SORTS OF WAYS THAT ONE COULD THINK ABOUT THERAPEUTIC IMPLICATIONS OF THAT. AND JUST TO REALLY BEAUTIFUL EXAMPLE OF HOW YOU CAN TAKE A VERY BASIC FINDING AND THEN TRY TO RELATE THAT QUICKLY TO HUMAN DISEASE. ANOTHER EXAMPLE HERE, THIS IS A FEW YEARS AGO WE DECIDED TO INVEST FAIRLY HEAVILY FOR A MODERATE SIZEIPSITUTE, IN GENOMICS. AND -- INSTITUTE -- AND NEXT GENERATION SEQUENCING. AND THIS IS WORK OF RAFAEL CASELLAS. WE KNEW WHEN PEOPLE FIRST BEGAN TO DO HIGH SEQ TECHNOLOGY LOOKING AT THE ASPECTS OF THE GENOME INTERACTED THAT IT TURNS OUT THE HUMAN GENOME IS PLAID. FAIRLY PROFOUND CONCEPT I GUESS. BUT WHAT PLAID MEANS IS THESE TOPE LONG CALL ASSOCIATED DOMAINS AND YOU CAN SEE PARTS OF THE CHROMATIN THAT WERE INTERACTING AND SO RAFAEL HAS IMPROVED THIS WITH THIS WORKING WITH PEOPLE WHO FIRST DID HIGH SEQ TECHNOLOGY AND WHAT WAS PARTICULARLY EXCITING IS THIS IS CONCEPT WITHIN THE GENOME OF SUPER ENHANCERS. AND OUR BOSS FRANCIS COLLINS, HAS POPULARIZED THIS ALONG WITH RICK YOUNG AND WE ARE FORTUNATE ENOUGH TO COLLABORATE WITH FRANCIS TO UNDERSTAND SUPER ENHANCER STRUCTURE WITHIN T-CELLS. RAFAEL HAS GONE TO THE NEXT LEVEL AND REALLY BEGUN TO SEE THAT THE HUMAN GENOME REALLY CONSISTED PLAID AND ALSO HAS STRIPES. SO YOU HAVE THIS PLAID STRUCTURE THAT WAS RECOGNIZED PREVIOUSLY BUT WITHIN THE PLAID STRUCTURE, YOU SEE THESE STRIPES AND THESE STRIPES REALLY REPRESENT THESE SUPER ENHANCER STRUCTURES OF ALL OF THESE INTERACTIONS OF CHROMATIN THAT REALLY ULTIMATELY LEAD TO THE WAY THAT WE TRIBE GENES. SO THERE IS A NUMBER OF US WITHIN THE INSTITUTE THAT REALLY ARE INTERESTED IN THAT PROBLEM OF HOW YOU TAKE CELLS THAT HAVE THE SAME DNA IN ALL OF THE DIFFERENT CELLS AND HOW YOU ULT LIE GENERATE A PROGRAM THAT LEADS TO SELECTIVE GENE EXPRESSION IN A VERY SPECIFIC CELL SPECIFIC AND TIME SPECIFIC DEVELOPMENTALLY SPECIFIC MANNER. SO WE THINK THIS NOTION OF SUPER ENHANCER STRUCTURES IN THESE STRIPES ARE VERY IMPORTANT TO UNDERSTANDING THE SWITCHES THAT ULTIMATELY ARE LAID DOWN THAT ALLOW YOU TO CONTROL GENE EXPRESSION. SO I HEARD A LITTLE BIT BEFORE ABOUT SINGLE-CELL RNA-SEQ. SO WE INVESTED IN THIS OURSELVES. WE HAVE TWO PLATFORMS BUT WE ARE PARTICULARLY INTERESTED IN THIS 10X GENOMICS PLATFORM SHOWN HERE THAT PROVIDES A PLATFORM TO GIVE YOU SINGLE CELLS AND THEN TO SEQUENCE THEM. AND I'LL JUST SHOW YOU TWO EXAMPLES HERE. SO THIS IS A CORE AND HE HAS BEEN LOOKING AT TRANSCRIPTIONAL PROFILE OF MUSCLE STEM CELLS. AND IT REALLY IS NICE HOW YOU CAN SEE THE REALLY MORE HETEROGENEITY THAN WE PREVIOUSLY UNDERSTOOD WITHIN THESE POPULATIONS OF CELLS. AND WE HAVE DONE THE SAME SORT OF THING LOOKING AT LYMPHOCYTES, INNATE AND ADAPTIVE AND SEEING HOW THEY ARE SIMILAR AND DIFFERENT. AND THIS JUST GIVES AN EXAMPLE OF HOW I DIDN'T THINK WE WOULD GET THIS SORT OF RESOLUTION OF DIFFERENT TYPES OF INNATE LYMPHOID CELLS, ILC3s IN THIS CASE IS TWO CLASSES WHICH WE HAD PREVIOUSLY IDENTIFIED BY EXPRESSION OF TRANSCRIPTION FACTOR AND THEN IN FACT THEY REALLY DO APPEAR TO BE SEPARATE CELLS, ILC2s HERE AND T-CELLS OVER HERE. SO AGAIN WE ARE VERY EXCITED ABOUT THIS AND ACTUALLY WE ARE PARTICULARLY EXCITED BECAUSE OUR BOSS, FRANCIS COLLINS, KNEW WE GOT THIS MACHINE AND HE ASKED WHETHER HE COULD DO A RUN ON OUR MACHINE. AND WE GENEROUSLY ALLOWED HIM TO DO THAT. THIS IS WORK OF RICHARD SIEGEL. RICHARD AND HIS COLLEAGUES HAVE BEEN STUDYING THIS DISEASE FOR A LONG TIME. AUTOIMMUNE LIPO PROLIFERATIVE SYNDROME. THERE IS A NOTION THAT FAS INDUCES CELL DEATH AND THIS IS THE WAY IT CONTROLLED AUTOIMMUNITY. BUT RICHARD IN GETTING INTO THIS, MADE AN INTERESTING MUTANT WHERE HE -- THIS PARTICULAR MUTATION THAT REGULATES LOCALIZATION AND THIS FAILS TO INDUCE CELL DEATH AND THE PREDICTION WOULD HAVE BEEN THAT THIS WOULD ALSO FAIL TO LIMIT AUTOIMMUNITY BUT IT STILL INDUCED AUTOIMMUNITY. SO RICHARD HAS IDENTIFIED ANOTHER PATHWAY BY THIS IMPORTANT MOLECULE CAN LIMIT AUTOIMMUNITY THAT IS INDEPENDENT OF THIS MECHANISM THAT PEOPLE HAVE ASSUMED FOR A LONG TIME. A FEW YEARS AGO WE RECRUITED MARE ANNA KAPLAN FROM THE UNIVERSITY OF MICHIGAN BECAUSE WE WANTED TO REVITALIZE OUR WORK ON LUPUS. AGAIN I ALLUDED TO THAT BEFORE THAT THE NIH MADE VERY, VERY IMPORTANT CONTRIBUTIONS YEARS AGO. BUT WE REALLY THOUGHT IT WAS TIME TO REBUILD THESE EFFORTS. SO VERY EXCITED TO HAVE HER COME HERE. SHE IS ALREADY HIT THE GROUND RUNNING DOING ALL SORTS OF INTERESTING STUFF BUT I'LL SHOW YOU ONE RECENT DISCOVERY OF HERS. IT HAD BEEN KNOWN THAT MUTATIONS OF CD11B ALSO KNOWN BY GENE NAME ITGAM, IS ASSOCIATED WITH LUPUS AND THAT AS RELATED TO PRODUCTION OF INTERFERONS. IN THIS PAPER, MARY ANN HAS SHOWN SHE CAN LIMIT INTERFERON PRODUCTION BY INTEGRIN ACTIVATION WITH A SMALL MOLECULE, CDL BENCH AGONIST. AND IN FACT -- CD11B. AND CAN LIMIT KIDNEY DAMAGE IN THIS MODEL OF LUPUS IN MICE. AND IT DOES SO BY LIMITING TLR SIGNALING AND THIS IS A PAPER THAT IS IMPRESSIVE. SO WE ARE EXCITED ABOUT HAVING HER HERE NOT JUST FOR THESE KIND OF EXPERIMENTS BUT THEN MARY ANNA HELPED US THINKING ABOUT USING THE DRUG I ALLUDED TO BEFORE, A KINASE INHIBITOR. AND MARY ANNA HELPED US DO EXPERIMENTS IN OUR CORE USING THIS TO AGAIN INHIBIT DAMAGE TO KIDNEYS IN THE SAME LUPUS MODEL. AND THAT REALLY SPURRED US TO DO A CLINICAL TRIAL, PHASE I CLINICAL TRIAL, WHICH IS BEING DONE BY US AND WE HAVE ENROLLED 19 OF THE 30 PATIENTS THAT WE WANTED TO ENROLL. AND WHAT WE ARE CALLING A PHASE I B STUDY, AGAIN I CAN TALK ABOUT THAT IN SOME DETAIL, MAYBE NOT AT THE MOMENT, BUT ONE COULD IMAGINE LOTS OF WAYS WHY THE JACK INHIBITORS COULD HELP WITH LUPUS. EQUALLY, YOU COULD MANAGE A NUMBER OF WAYS IT IS MIGHT EXACERBATE THE DISEASE. WE HAVE A LUPUS NATURAL HISTORY PROTOCOL AS YOU MIGHT IMAGINE. WE HAVE BEEN STUDYING THIS FOR A NUMBER OF YEARS. WITH MARY ANNA, WE ENROLLED 80 NEW PATIENTS THIS YEAR AND SO WE HAVE MORE THAN 1000 OUTPATIENT VISITS. THAT IS VERY HELPFUL BECAUSE SHE REALLY WAS INTERESTED IN PATIENTS AND ALSO THE CLINICAL MATERIAL FOR MARY ANNA TO CONTINUE TO STUDY. AND IN PARTICULAR, SHE IS VERY INTERESTED IN THE VASCULAR ASPECTS OF LUPUS AND SO THAT HAS BEEN A VERY ACTIVE PART OF HER WORK. SHE ALSO IS INTERESTED IN PR GAMMA IN LUPUS AND SHE HAS A TRIAL RELATED TO THAT AND 36 PATIENTS HAVE BEEN ENROLLED. SO WE ARE EXCITED ABOUT EVERYTHING SHE HAS DONE. MY WAY OF THINKING IN A RELATIVELY SPORT PERIOD OF TIME. SO THIS IS THE SCORECARD FOR OUR TENURE-TRACK AND ASSISTANT CLINICAL INVESTIGATORS. I'M NOT GOING THROUGH DETAIL FOR EACH OF THEM. MARCUS HAVNER, TO BE HONEST WHAT I WAS THINKING ESPECIALLY WHEN I WAS LOOKING AT ALL THIS INFORMATION WE HAD ON THE HUMAN GENOME AND REALIZING THAT GENES ARE A REALLY MINUSCULE PART OF THE GENOME, THREAT AROUND 2% OR LESS. AND THINKING ABOUT A LOT OF THE GENOME WAS TRANSCRIBED EVEN THOUGH IT WASN'T TYPICAL GENES THINKING WE NEED TO BUILD OUR SORT OF INFRASTRUCTURE THINKING ABOUT RNAs. SO MARCUS IS AN RNA BIOLOGIST AND REALLY SPECTACULAR FROM MY PERSPECTIVE. I'LL TELL YOU MORE ABOUT HIM IN A MOMENT. ANDY IS A NEUROLOGIST FROM HOPKINS WHO WORKS ON MYOCYTEIS AND SORT OF AN EXPERIMENT. ANDY SPENDS A DAY EVERY OTHER WEEK OR SO AT HOPKINS STILL SEEING PATIENTS. AND SO, WE THINK THIS IS A GREAT WAY TO ENHANCE CLINICAL RESEARCH AND ENHANCE INTERACTIONS AND RECRUIT PATIENTS TO THE CLINICAL CENTER. I'LL GO THROUGH THE REST OF THE INDIVIDUALS AS I GO ALONG. THIS IS MARCUS AGAIN. AND I'LL TELL YOU ABOUT A PAPER OF HIS COMING OUT IN NATURE SOON. AND IT RELATES TO A PROTEIN CNBP, WHICH MUTATIONS IN WHICH UNDERLIE A FORM OF MUSCULAR DYSTROPHY. SO, WHAT MARCUS HAS SHOWN IS THAT THE FUNCTION OF CNBC THAT IT BINDS TO MATURE RNAs IN SEQUENCE-SPECIFIC MANNER. IT IS REQUIRED FOR TRANSLATION AND SO THIS REALLY IS THE FIRST SEQUENCE-SPECIFIC RNA BINDING PROTEIN THAT IN HIS MODEL, RELIEVES SECONDARY STRUCTURE OF RNA TO PROMOTE TRANSLATION. SO WE ARE VERY EXCITED ABOUT THIS BOTH AS A BASIC DISCOVERY BUT ALSO FOR THE POTENTIAL IMPLICATIONS OF MUSCULAR DYSTROPHY. SO THIS IS BRIAN. THIS IS ANOTHER EXPERIMENT. SO BRIAN ACTUALLY WAS RECRUITED TO NHLBI. BRIAN WORKS ON MUSCLE, MOSTLY CARDIAC MUSSEL. AND BRIAN HAD A PAPER IN NATURE IN 2015. WHEN I HEARD HIS TALK, I COULDN'T BELIEVE IT BECAUSE I THOUGHT, I HAVE SEEN OVER THE YEARS SINCE MEDICAL SCHOOL, I HAVE SEEN LOTS OF PICTURES OF MITOCHONDRIA AND I NEVER SEEN MITOCHONDRIA THAT LOOK LIKE MITOCHONDRIA THAT BRIAN SHOWED IN THIS PAPER. SO HE HAS THESE UNBELIEVABLY EXCITING IMAGING TECHNOLOGIES THAT NHLBI HAS INVESTED IN AND IT IS SHOWING US THINGS ABOUT MITOCHONDRIA THAT I GUESS I NEVER THOUGHT WE WOULD SEE. I MEAN AGAIN, THIS IS NOT LIKE THOSE ELECTRON MICROSCOPY IMAGES THAT YOU ALL SEEN IN YOUR TEXTBOOKS. SO WE ARE VERY EXCITED ABOUT THIS AND WE ARE EXCITED ABOUT THIS AS AN EXPERIMENT. WE HAVE A RELATIVELY SMALL INVESTMENT IN BRIAN'S LAB, NHLBI IS THE LEAD, BUT WE ARE OBVIOUSLY INTERESTED IN MUSCLE AND WE ARE INTERESTED IN THIS PROBLEM OF MUSCLE ENERGETICS AND HOW AN ORGANELLE SUCH AS MITOCHONDRIA, I GUESS WE'LL LEARN ALL SORTS OF NEW THINGS ABOUT THIS. SO WE ARE QUITE EXCITED ABOUT THAT. THIS IS PETER, A VERY DIFFERENT THAN BRIAN. PETER IS REALLY VERY CLINICAL AND IS INTERESTED IN AN OLD PROBLEM. SO I CAME TO THE NIH MANY YEARS AGO IN A DIFFERENT MILLENNIUM TO STUDY THIS DISEASE, VASCULITIS. BUT AT THE TIME, IT WAS MOSTLY DONE BY TONY FAUCI IN NIAID. TONY GOT DISTRACTED BY A FEW OTHER THINGS LIKE HIV, NOW ZIKA ET CETERA. BUT THAT LEFT AN OPPORTUNITY FOR US TO SORT OF GO BACK TO WHAT WE THINK IS AN IMPORTANT DISEASE AND HAS IMPORTANT IMPLICATIONS JUSTS IN AS A RARE DISEASE BUT OBVIOUSLY AS LOTS OF IMPORTANT IMPLICATIONS IN TERMS OF GARDEN VARIETY ARTHROSCLEROSIS AND THEN AGAIN, I HAD THESE CONVERSATIONS WITH PETER AND IT'S LIKE, YOU KNOW, THE MORE WE LEARN ABOUT ARTHROSCLEROSIS? REALIZE THE IMMUNOLOGICAL ASPECTS OF REACTION TO APOE AND T-CELL RESPONSES AND THIS STUFF, WHAT IS THE OVERLAP BETWEEN VASCULITIS AND ARTHROSCLEROSIS IS AN INTERESTING AND EXCITING WAY MOVING FORWARD. AND WE REALLY LIKE THE IDEA OF THE SYNERGY BETWEEN PETER GRAYSON'S INTEREST IN MARY ANNA'S INTEREST. SO THEY ARE IN THE SAME BRANCH. SO PETER HAS BEEN VERY ACT ENOUGH RECRUITING AS YOU CAN SEE, OVER A FAIRLY SHORT PERIOD OF TIME, LARGE NUMBER OF PATIENTS WITH A RARE DECIDE. AND THE OTHER THING THAT SPIRIT VERY, VERY GOOD AT IS USING THE RESOURCES IN CLINICAL CENTER TO GET THIS BEAUTIFUL IMAGING OF DISEASES AND OF COURSE THAT HAS IMPLICATIONS AS WE THINK ABOUT USING DIFFERENT TREATMENTS THAT ARE COMING ONLINE. PETER CAN SORT OF MORE EFFECTIVELY MONITOR THE EFFECTS OF THE TREATMENTS. YOU HEARD ABOUT MIKE OM BRELO. THIS IS A GOOD EXAMPLE OF MIKE'S SKILL IN TAKING A FAIRLY RARE DISEASE AND GETTING PEOPLE ALL AROUND THE WORLD TO WORK TOGETHER TO SOLVE THIS PROBLEM. SO, I GIVE HIM CREDIT FOR THAT AND ACTUALLY IF HE SUCCEEDS BRINGING SCIENCE TOGETHER, SCIENTIST TOGETHER, I'M THINKING WHY DON'T WE HAVE HIM DO OTHER THINGS AROUND THE WORLD LIKE WORLD PEACE OR SOMETHING? I DON'T KNOW. BUT MAYBE FOR THE TIME BEING DURING HIS TENURE-TRACK HE'LL FOCUS ON THESE DISEASES. AND THIS IS JUST A PICTURE TO SHOW A VERY UNEXPECTED FINDING THAT SJIA, I THINK EVERYONE EXPECTED WHEN THEY DID A GWAS STUDY THAT THEY WOULD GET ALL SORTS OF GENES SORT OF DRIVING YOU TO THINK ABOUT THIS DISEASE AS AN AUTO-INFLAMMATORY DISEASE. BUT AGAIN, THIS CLEARLY PUTS THIS IN THE REALM OF A T-CELL MEDIATED ADAPTIVE IMMUNE MEDIATED DISEASE WITH MUTATIONS IN MHC. BUT MAYBE NOT WORKING THE WAY WE EXPECT TODAY TO WORK BUT AGAIN, VERY EXCITED FINDING FOR MIKE AND IMPRESSIVE ACCOMPLISHMENT FOR A YOUNG INVESTIGATOR WHICH LED US TO RECRUIT HIM IN THE TEPPIER TRACK. SO THIS IS KEITH. HE IS COMPETED FOR A POSITION AS ASSISTANT CLINICAL INVESTIGATOR. FROM CINCINNATI AND HE HEARD ABOUT THIS PATIENT FROM CINCINNATI WITH THIS ARTHRITIS SHOWN HERE. AND AGAIN, THIS IS AN EXAMPLE OF SOME OF THE OPPORTUNITIES WE HAVE WITH A PATIENT LIKE THIS WHO OBVIOUSLY HAS ARTHRITIS BUT AN ODD FORM OF ARTHRITIS. SO KEITH SEQUENCED THIS PATIENT AND FOUND MUTATIONS IN A GENE THAT AT LEAST SOME OF THE AUDIENCE WILL BE VERY FAMILIAR WITH. MYD88. AND THE MUTATION IS GAIN OF FUNCTION MUTATION AND AMAZINGLY THIS MUTATION HAS BEEN FOUND IN CANCER. SO, WHAT THIS MUTATION DOES IS IT MIMICS TOLL RECEPTOR SIGNALING AND IL1 SIGNALING SO YOU CAN THINK ABOUT HOW THIS MUTATION IN THIS PATIENT COULD BE GENERATING DISEASE AND IT ALSO GIVES YOU THE EXAMPLE OF A PERSONALIZED MEDICINE, HOW IN THIS PATIENT WHAT YOU MIGHT BE THINKING OF TO TREAT THIS PATIENT. SO WE ARE VERY EXCITED ABOUT HIS WORK. IT'S A GOOD EXAMPLE OF PEDIATRIC RHEUMATOLOGISTS WHO CAN THINK ABOUT PATIENTS, THINK ABOUT GENETICS AND THEN DOT BIOCHEMISTRY AND PATHOPHYSIOLOGY EXPERIMENTS. SO AGAIN WE THOUGHT FOR ALL THOSE REASONS, HE WOULD BE A GOOD PERSON TO INVEST IN IN TERMS OF THIS POSITION. SO STEVE REFERRED TO THE DERM BRANCH BEFORE. I'M NOT GOING TO GO THROUGH IN DETAIL. MAYBE FOR THE NEXT TIME YOU HAVE ME BACK HERE IN A YEAR OR SO. I'LL TELL YOU ABOUT ALL THESE PEOPLE. THIS IS ISSAC INTERESTED IN MERKEL CELL CANCER. THIS IS HEIDI WORKING ON THE MICROBIOME. THIS IS CHRIS AND SHE VERY INTERESTED IN SKIN IMMUNOLOGY AND MOST RECENTLY WORKING ON THE WAY THAT HAIR FOLLICLES REALLY CAN DRIVE ADAPTIVE IMMUNE RESPONSES BY PRODUCTION OF CYTOKINES AND CHEMOKINES. ED COWAN IS THE STAFF SCIENTIST WORKING WITH DOMINIQUE WHO IS WORKING -- HERE TWICE. FOR NO PARTICULARLY GOOD REASON. >> VERY PLEASED ABOUT THAT, JOHN. >> I NOTICE THAT. I'LL POINT THAT OUT TO HER. SO SHE IS WORKING VERY HARD, TWICE AS HARD AS ED. ON GBHD. AND AGAIN, ANOTHER DISEASE THAT WE ARE VERY INTERESTED IN AND THEY ARE ACTUALLY GOING TO USE JACK INHIBITORS IN THIS SETTING. SO, AS I MENTIONED BEFORE, WE ARE EVALUATED EACH YEAR BY THE BOARD OF SCIENTIFIC COUNCILORS AND YOU CAN DISCUSS MORE WHAT THAT MEANS. ROBERT WALKER WILL BE EVALUATED FOR HIS ROLE IN DIRECTING THE TRAINING BRANCH. MIKE WARD IN THE CLINICAL TRIALS AND OUTCOMES BRANCH. TIM, I MENTIONED HIS WORK AS A CONTRACTOR IN OUR SMALL BUT EXCITING ORTHOPAEDICS UNIT. BOB IS CHIEF OF THE PEDIATRIC TRANSLATIONAL RESEARCH BRANCH. HIS WORK IS GOING TO BE EVALUATED. I HAVE TOREIO, I MENTIONED -- VITORIO, AND SARFARAZ IS RESPONSIBLE FOR RECRUITING PATIENTS AND OVERSEEING CLINICAL TRIALS IN LUPUS. WE HAVE A RETREAT EACH YEAR. WE HAVE REALLY EXCITING PEOPLE COME. LAST YEAR I THOUGHT WAS REALLY JUST AMAZING. ONCE AGAIN, WE HAVE A LOT OF REALLY TERRIFIC SCIENTISTS COMING HERE COMING FROM SCIENCE, BASIC SCIENTISTS DOING WORK ON MUSCLE, SKIN, BONES, AMY PAIN, VERY INTERESTED IN HER WORK ON USING CARS TO TREAT AUTOIMMUNITY. DEBORAH IS ONE OF THE EDITORS OF STEM CELL AND WE HAVE DONE THAT OVER THE YEARS. VERY HELPFUL FOR OUR TRAINEES TO TALK TO PEOPLE WHO ARE ACTUALLY THE ONES WHO HOPEFULLY IDEALLY WILL BE PUBLISHING OUR WORK ON GETTING SOME OF THOSE INSIGHTS AND AGAIN TWO INVESTIGATORS FROM EUROPE TO BROADEN THE SCOPE AND TELL US HOW THEY DO THINGS. SO I'M GOING TO STOP RIGHT THERE. I'LL TAKE QUESTIONS. THANK YOU VERY MUCH. >> THANK YOU VERY MUCH FOR THAT TREMENDOUS OVERVIEW. AND PEOPLE GET AN IDEA OF THE SCOPE OF WHAT GOES ON IN THE INTRAMURAL PROGRAM. I'M GOING TO OPEN THIS UP FOR SOME QUESTIONS SINCE OUR NEXT SPEAKER WILL INDULGE US A LITTLE WHILE. WE'LL TAKE A BREAK AFTER WE HAVE THIS DISCUSSION. SO PLEASE, MIKE. >> PARDON ME FOR NOT LOOKING AT YOU WHILE I ASK SO I CAN TALK INTO THE MIC. I'LL STATE THE QUESTION AND THEN WHY I ASK IT. WHAT IS THE COMPOSITION OF THE BOARD OF SCIENTIFICKIC DIRECTORS? THE REASON I ASK THAT IS YOU MENTIONED YOU HAD TROUBLE GETTING AN ORTHOPAEDICS SO YOU GOT THE DOCTOR AS A CONTRACT ORTHOPEDIST. DO YOU HAVE REPRESENTATION ON THE BOARD OF COUNCILORS FROM ALL THE CLINICAL DISCIPLINES? RHEUMATOLOGISTS, ORTHOPEDISTS, PHYSICAL MEDICINE REHABILITATION, DERMATOLOGIST. ARE THEY ALL INCLUDED IN THAT BOARD OF SCIENTIFIC DIRECTORS? >> IT'S A GOOD QUESTION. SO I SHOULD SAY THAT WE HAVE THE BS SCOMM POSED OF TWO GROUPS, PERMANENT MORE BUSINESS AND AD-HOCS. SO CERTAINLY WE HAVE JOSH JACOBS AS PART OF THE BSC A FEW YEARS AGO. WE HAD ANOTHER EXPERIMENT A FEW YEARS AGO WITH ANOTHER ORTHOPAEDIC SURGEON AND IN THE END THAT DIDN'T WORK OUT AS WELL AS WE HOPED FOR A VARIETY OF REASONS. BUT YES, WE HAD JOSH JACOBS AND I'M TRYING TO REMEMBER -- SO YES, I THINK WE MAKE EVERY EFFORT THAT WE CAN TO HAVE THE BSC BE INCLUSIVE OF ALL OF OUR INTERESTS. WE ARE CERTAINLY EXCITED NOW THAT DERMATOLOGY HAS RETURNED TO NIAMS. I ALWAYS HAD TO EXPLAIN WHAT THE S WAS DOING ON THE EXTRAMURAL PROGRAM. IT'S OBVIOUS BUT IN THE INTRAMURAL PROGRAM IT WAS LESS CLEAR. SO, YES. IF YOU WANT TO DISCUSS THE CHALLENGES OF HAVING AN ORTHOPAEDIC SURGEON IN THE INTRAMURAL PROGRAM, WE SHOULD DO THAT OVER A BEER. THAT WOULD TAKE A LONG TIME. ONE OF THE ISSUES -- >> IF I COULD JUST HELP OUT A LITTLE BIT HERE. I THINK MIKE, THE BOARD OF SCIENTIFIC COUNCILORS, THE MEMBERSHIP IS DRIVEN BY THE SCIENCE THAT WE DO. SO BASICALLY, WE HAVE AS MANY INSTITUTES OR RELATIVELY SMALL GROUP ON THE BOARD OF SCIENTIFIC COUNCILORS. THEY ARE -- THEIR KNOWLEDGE BASE IS ENHANCED BY A CONSIDERABLE NUMBER OF AD-HOC MEMBERS AS YOU WILL HEAR WHEN YOU HEAR REPORTS FROM OUR BOARD OF SCIENTIFIC COUNCILORS. SO THE BOARD OF SCIENTIFIC COUNCILORS DOES NOT DESIGN THE INTRAMURAL PROGRAM. WE DO INTERACT IN TERMS OF WHAT MAY BE NEEDED AND WHAT MAY BE AN OPPORTUNITY IN TERMS OF RECRUITMENT. ORTHOPEDISTS GO BACK TO THE EARLY 1970s WHEN I WANTED TO COME HERE AFTER MY ARMY TIME AND THEY TOLD ME NO ORTHOPAEDICS IS OUR TOP PRIORITY. SO EVEN THE AMY PAIN WHO IS NOW A MEMBER OF OUR BOARD OF SCIENTIFIC COUNCILORS, WAS NOT PUT ON UNTIL WE KNEW THAT THERE WAS GOING TO BE A SWITCH IN TERMS OF THE DERMATOLOGY BRANCH. SO THE BOARD IS DRIVEN AS OPPOSED TO THIS BOARD, THAT BOARD IS DRIVEN BY WHAT SCIENCE IS BEING DONE IN THE INTRAMURAL PROGRAM. >> SO STEVE, I MIGHT JUST MAKE A COMMENT FOR THE BOARD FOR THE COUNCIL TO APPRECIATE BASED ON MY EXPERIENCE ON THE BOARD OF SCIENTIFIC COUNCILORS. AND I JUST THINK IN WORKING WITH STEVE AND WITH JOHN, THE BEST WAY I CAN DESCRIBE THE BOARD OF SCIENTIFIC COUNCILORS IS REALLY AS AN INDEPENDENT PARTNER. SO THAT WE KNOW WHAT THE VISION OF THE PROGRAM IS, OUR CHARGE IS TO EVALUATE THE SCIENCE AND GIVE ADVICE TOWARDS THAT VISION. BUT WE ARE VERY INDEPENDENT THAT WE MAKE OUR DETERMINATIONS AND WE DELIBERATE WITHOUT STEVE AND JOHN PRESENT AND I'M SURE THAT THAT TRADITION HAS CONTINUED. AND IT IS A REAL I THINK ACTIVE AND VERY -- IT'S GREAT TO SEE THE EVOLUTION OF THE INTRAMURAL PROGRAM THAT IT CHANGED DRAMATICALLY SINCE THE DAYS WHEN I WAS FIRST ON THE BOARD OF SCIENTIFIC COUNCILORS. SO, IT'S TRYING TO HELP THAT VISION AND GIVE REVIEW TO THE SCIENCE ONGOING IN THE INTRAMURAL PROGRAM AND THE RESPONSE OF THE LEADERSHIP OF NIAMS TO THE CONCERNS AND QUESTIONS AND COMMENTS OF THE BOARD HAS ALWAYS BEEN TERRIFIC. >> I CAN TELL YOU FROM -- THANK YOU FOR THOSE COMMENTS, GARY. FROM ACROSS-THE-BOARD AT THE NIH, HAVING BEEN INTRAMURAL SCIENTIST FOR 40 YEARS, THAT HAS CHANGED ACROSS THE BOARDS I THINK THAT YOU REALLY CHANGE THE INTENSITY OF CRITIQUE AND WE CAN FUNCTION BETTER WITH INDEPENDENT INPUT BECAUSE WE HAVE PERSONNEL DECISIONS BEING MADE ALL THE TIME. THOSE DECISIONS HEAVILY INFLUENCE BY WHAT YOUR INDEPENDENT GROUP, THAT'S WHY JOHN AND I AND RICHARD, THEY HAVE BECAUSE THAT IS THE DRIVER FOR US IN TERMS OF THE HIGH LEVEL OF RESEARCH. SO I THANK YOU FOR THOSE COMMENTS. JOHN THANK YOU FOR YOUR COMMENTS. >> SO WE ARE ONLY RUNNING A FEW MINUTES BEHIND TIME. WE ARE GOING TO TAKE A 10 MINUTE BREAK AND THEN WE'RE GOING TO HEAR FROM DR. ELISEO STABLE. HE TRIED TO GET HERE FOR A WHILE BUT HE ALWAYS HAS HIS COUNCIL MEETING THE SAME DAY WE HAVE OURS. SO LET'S REALLY AGGREGATE IN 10 MINUTES. >>> AS WE ARE GATHERING, I HOPE EVERYBODY GATHERED NOW. IT'S A GREAT PLEASURE FOR ME TO INTRODUCE ELISEO STABLE WHO HAS BEEN AT THE NIH FOR A YEAR AND A HALF. IS THAT RIGHT? ABOUT A YEAR AND A HALF? AND HE IS THE WITH US. >> THANK YOU, STEVE FOR THE OPPORTUNITY. I THINK THIS WAS THE THIRD DATE THAT WE FINALLY SETTLED ON. SO THIRD IS THE RIGHT ONE. YOU'RE RIGHT, WE HAD CONFLICTS ON THE OTHER TWO IN JUNE AND SEPTEMBER. SO IT'S A REAL PLEASURE TO BE HERE AND SPEAK WITH YOU. STEVE HAS BEEN A WONDERFUL COLLEAGUE AND HELP TO ME AS A UNOFFICIAL MENTOR AND FRIEND OF THE SO NIH DIRECTORS HAVE BEEN VERY WELCOMING. SO, LET ME START BY REVIEWING A LITTLE BIT OF OUR HISTORY. NINHD WAS STARTED IN 1990, AND STARTED AS A OFFICE UNDER THE PRESIDENT GEORGE H.W. BUSH AND SECRETARY LEWIS SULLIVAN AT THAT TIME. IT WAS AN OFFICE OF MINORITY HEALTH IN THE NIH DIRECTOR'S OFFICE AND LATER CHANGED TO MINORITY HEALTH REACH. IT WAS TRANSITIONED TO A CENTER IN THE YEAR 2000 THROUGH LEGISLATION THAT WAS CHAMPIONED BY REPRESENTATIVE STOKES, WHO JUST PASSED AWAY IN 2015. AND THAT WAS PROBABLY THE CRITICAL TRANSITION AND THAT GAVE THE CENTER NOW GRANT-MAKING CAPACITY AND IT WOULD HAVE A BUDGET TO SHARE WITH OTHER INSTITUTES. AND THEN AS PART OF THE AFFORDABLE CARE ACT IN 2010, ONE OF THE ITEMS THAT WAS IN THE LEGISLATION WAS TO TRANSFORM THE CENTER TO AN INSTITUTE. AND SENATOR CARD EN CHAMPIONED THAT WITH SENATOR KENNEDY BEING TOO ILL TO DO THE WORK HE HAD INSPIRED. SO SINCE 2010, WE HAVE BEEN AN INSTITUTE. JOHN RUFFIN WAS THE LEADER OF ALL THESE ENTITIES SO FOR 24 YEARS HE WAS AT THE FOREFRONT OF THESE TOPICS AT NIH. HE RETIRED IN MARCH OF 2014. YVONNE MADDOX MOVED FROM CHILD HEALTH TO BECOME ACTING DIRECTOR AND THEN THE NATIONAL SEARCH ENDED UP WITH ME AND I STARTED IN SEPTEMBER OF 2015 OF THE SO NOT QUITE A YEAR AND A HALF. OUR BUDGET AFTER THE BUMP IN 2016 IS ABOUT 280 AND SO WE ARE THE SECOND SMALLEST INSTITUTE AFTER NURSING AND THEN FOGARTY AND COMPLEMENTARY MEDICINE ARE ALSO 13458ER. OUR SUBMISSION TO REALLY FOCUS ON MINORITY HEALTH AS DEFINED BY THE U.S. SEPSES US RACELING NICK GROUPS AND I'LL GO OVER THAT. -- SEPSIS AND RACE AND ETHNIC GROUPS -- AND HOW TO REDUCE HEALTH DISPARITIES IN SPECIFIC POPULATIONS. WHAT IS THE SCIENCE OF THESE TROPICS? DEFINING AND SETTLING ON THAT HAS BECOME OUR MAIN GOAL IN ESTABLISHING A VISION OVER THIS PAST COUPLE OF YEARS. INITIALLY LAUNCHED BY YVONNE MADDOX. WE ARE ALSO VERY INTERESTED IN DIVERSITY OF THE WORKFORCE AND TRAINING AND DEVELOPING THE SCIENTIFIC WORKFORCE TO DO THIS WORK ACROSS ALL DISCIPLINES, ALTHOUGH WE HAVE A VERY MODEST TRAINING PROGRAM IN OUR OWN INSTITUTE AND WORK CLOSELY WITH OTHER INSTITUTES AND VALENTINE ON THESE TOPICS ACROSS THE NIH. SO MINORITY HEALTH, OUR OPERATIONAL DEFINITION IS TO LOOK AT WITHIN A MINORITY GROUP OR COMPARATIVELY, ALL HEALTH CHARACTERISTICS AND ATTRIBUTES OF THAT PARTICULAR RACE ETHNIC GROUP. AND FOR US, THAT IS FAIR TERRITORY FOR RESEARCH. WHETHER THE OUTCOME THAT THE GROUP HAS IS ACTUALLY BETTER OR WORSE THAN THE AVERAGE OR IN THE COMPARISON POPULATION OF WHITES. WE BELIEVE THAT EVERY MINORITY GROUP IN THE UNITED STATES HAS HAD SOME LEVEL OF SOCIAL DISADVANTAGE AS A CONSEQUENCE OF BEING TO OBJECT SOME LEVEL OF DISCRIMINATION. EVEN THOUGH THIS IS QUITE VARIABLE IN INTENSITY AS WE KNOW, THE LEGACY OF SLAVERY IS ONE THING AND THE WAR AGAINST THE AMERICAN INDIAN NATIONS THAT PRECEDED INDEPENDENCE AND FOLLOWED INDEPENDENCE IS ANOTHER. BUT WE DO THINK THAT THIS SUBJECT OF DISCRIMINATION IS A COMMON THEME. AND THEN ALL THE RESEARCH ON FACTORS THAT LEAD TO SPECIFIC OUTCOMES WITHIN MINORITY GROUPS IS FAIR GAME FOR US. THAT IS OUR FIRST PART OF OUR NAME IN OUR MANDATE. AND ABOUT HALF OF THE SCIENCE WE HAVE NOW ESTIMATED THAT IS DONE AT NIH THAT PEOPLE CALL MINORITY HEALTH, HEALTH DISPARITIES, IS IN THIS CATEGORY OF MINORITY HEALTH. IT'S FOCUSED ON A MINORITY GROUP AND NOT ON ISSUES RELATED TO HEALTH DISPARITIES. TO REMIND YOU, THESE ARE THE OMB RACE ETHNIC CLASSIFICATIONS. THESE IS THE NOMENCLATURE USED BY THE GOVERNMENT, AFRICAN-AMERICAN OR BLACK. ASIAN WHICH IS PROBLEMATIC IN THAT IT IS VERY HETEROGENOUS WITH DOZENS OF LANGUAGE BUT IT IS WHAT IT IS. IT INCLUDES INDIAN ASIAN WHO ARE TECHNICALLY NOT REALLY SIMILAR TO EAST ASIANS FROM A RACE GENETIC PERSPECTIVE BUT THAT'S A PROBLEM THAT DOESN'T HAVE A SOLUTION IN THE NEAR FUTURE. AMERICAN INDIAN OR ALASKA NATIVE. NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER THAT IS DIFFERENT FROM ASIAN EVEN THOUGH THEY ARE LUMPED TOGETHER AND WE SHOULD DISCOURAGING THIS FROM GOING ON. THEY ARE A VERY SMALL GROUP IN MOST PARTS OF THE UNITED STATES COMMENT HA WASKI TO SOME EXCEPT IN CALIFORNIA. AND THEN LATINO OR HISPANIC WHICH IS HETEROGENOUS. 20 COUNTRIES BONDED BY OTHER COMMON FACTORS. AND REALLY A MIXED GROUP OF WHITES, AMERICAN INDIGENOUS POPULATIONS AND IN MEMBERSHIP AREAS A STRONG AFRICAN ANCESTRAL INFLUENCE AS WELL. AND WHITES, WHICH HAVE INCLUDEDS MIDDLE EASTERN NORTH AFRICANS. THERE IS A PROPOSAL FOR THE 2020 SINCE US AS YOU MAY HAVE CAUGHT -- CENSUS -- IT WAS IN THE FEDERAL REGISTER ASKING FOR COMMENT FROM THE CENSUS TO ADD ANOTHER GROUP CALLED MIDDLE EASTERN NORTH AFRICAN, SO THIS WOULD BE ANOTHER ETHNIC GROUP AND TO ELIMINATE THE TWO-STEP QUESTION THE CENSUS USED SINCE I THINK 2000 OR MAYBE EARLIER WHERE THEY ASKED YOUR ETHNICITY, ARE YOU HISPANIC OR LATINO, YES OR NO AND THEN ASKED RACE. 40% OF WILL TOPOS JUST MISINTERPRETED THAT OR DIDN'T ANSWER CORRECTLY -- LATINOS -- THEY WANT IT COMBINED INTO A SINGLE QUESTION. HEALTH DISPARITY POPULATIONS IMPLIES A POPULATIONS THAT HAS WORSE HEALTH OUTCOMES N PART, ATTRIBUTED TO THIS SOCIAL DISADVANTAGE AND OUR MANDATED LIST INCLUDES ALL RACE, ETHNIC MINORITY GROUPS. SO WE LOOK AT THOSE GROUPS A HEALTH DISPARITY LENSE WHEN THE OUTCOME IS WORSE AND WE SAY, IT'S MINORITY HEALTH AND HEALTH DISPARTIES AND LOOK AT THE REDUCED -- NOT IN EVERY CASE THAT IS TRUE. CRITICALLY AND SIMILARLY IMPORTANT FACTOR IS WE ARE ALSO INTERESTED IN POOR PEOPLE. SO THOSE WITH LESS PRIVILEGED SOCIOECONOMIC STATUS. OF ANY RACE ETHNIC GROUP IN THE U.S. AND THIS IS PARTICULARLY RELEVANT IN CERTAIN CONDITIONS AS WE HAVE LEARNED. IN RURAL AREAS AND THE OPIATE EPIDEMIC AND IF YOU LOOK ACROSS THE SUSPECT RUM OF HEALTH OUTCOMES, USUALLY PEOPLE WITH LESS FORMAL EDUCATION AND POOR PEOPLE DO WORSE. TO THEE THIS IS THE SECOND CRITICAL PILLAR OF OUR INSTITUTE. THIS IS LANGUAGE IN OUR LEGISLATION THAT MANDATES RURAL RESIDENCE AS FOCUS. WE BELIEVE MOST OF THESE ARE EITHER POOR OR MINORITY BUT IT IS INCLUDED AND THERE ARE MORE DATA NOW ON LOOKING ON DIFFERENCES IN MORBIDITY AND MORTALITY IN RURAL URBAN AND RECENT REPORTS FROM THE CDC HIGHLIGHTS THIS. AND THEN LAST OCTOBER, WE MADE A DECLARATION THAT SEXUAL GENDER MINORITIES ARE ALSO A DISPARITY POPULATION. I'M THE ONE EMPOWERED TO DO THIS ALTHOUGH LARRY TABAK LED THE CHARGE ON THIS PRECEDED BY MY ARULE OF LAW BY A NUMBER OF YEARS, THIS EFFORT. -- BY A NUMBER OF YEARS. A DISPARITY POPULATION FOR NIH RESEARCH PURPOSES. SO IT DID NOT INCLUDE OTHER ASPECTS AND I CAN ADDRESS THAT IF PEOPLE ARE INTERESTED IN THE DISCUSSION. SO OUR HEALTH DISPARITY DEFINITION IS THE DIFFERENCE THAT ADVERSELY EFFECTS ONE OF THESE DISADVANTAGED POPULATIONS BESIDES ONE OR MORE HEALTH OUTCOMES. A DIFFERENCE THAT IS WORSE. JUST TO CLARIFY, YOUR UPPER MIDDLE CLASS AND WHITE AND YOU HAVE MORE HEART ATTACKS, PARTICULARLY MEN, THAT IS NOT A DISPARITY. IT'S A DIFFERENCE. AND WE MAY WANT TO SEE WHY THAT IS AND UNDERSTAND WHY. AND THAT IS INTERESTING SCIENTIFICALLY BUT IT'S NOT WHAT THE FOCUS OF AIRINESSESITUTE IS. AND WE NEED TO THEN DEVOTE OUR SCIENCE TO UNDERSTANDING HOW THESE MECHANISMS LEAD TO THESE OUTCOMES. AND HOW THIS KNOWLEDGE THEN CAN BE TRANSLATED INTO INTERVENTIONS TO REDUCE DISPARITIES. ONE MIGHT THINK THAT INITIALLY ALL OF OUR EFFORTS WERE RELATED TO SOCIAL DISADVANTAGED BUT I'LL COME BACK TO HOW I THINK THE EXPLOSION OF INFORMATION HAS MADE THIS MUCH MORE INTERESTING AND COMPLEX. NOW, IN TALKING TO OUR PROGRAM STAFF, HOW DO WE DEFINE OUTCOMES WE CAN COMPARE? I COULDN'T STAND HAVING DIFFERENTIAL OUTCOMES DISPARITIES. SO WE SAID LET'S TALK ABOUT THINGS WE CAN COMPARE ACROSS POPULATIONS. SO INCIDENCE OR PREVALENCE AND SOME GLOBAL MEASURE OF BURDEN OF DISEASE. THIS IS RESONATING AS MOST PEOPLE OR PATIENTS DON'T DIE FROM THE DISEASES YOU'RE FOCUSED ON BUT THEY SUMMERY HAVE A TREMENDOUS AMOUNT OF IMPACT ON QUALITY OF LIFE AND DISABILITY. THERE ARE RECENT REPORTS SHOWING THAT CHRONIC BACK AND NECK PAIN IS A THIRD LARGEST EXPENSE ON THE U.S. HEALTH CARE BUDGET ALSO. PREMATURE OR EXCESSIVE MORTALITY. THE ULTIMATE OUTCOME. POPULATIONS DIFFER AND SOMETIMES IT IS MORE IN THE EARLIER MORTALITY AS OPPOSED TO EXCESS AND THEN ANYTHING AND EVERYTHING THAT RELATES TO PATIENT OR PEOPLE REPORTED OUTCOMES, QUALITY OF LIFE, DAILY FUNCTIONING, ANY OF THE STANDARDIZED MEASURES USED FOR SYMPTOMS IN PARTICULAR DISEASES AND RHEUMATIC DISEASES IN MANY WAYS LED THIS EFFORT FROM BOTH THE SECOND METRIC AND CLINICAL UTILITY IN USING SELF REPORTED MEASURES TO DEFINE OUTCOMES. THIS IS A VERY IMPORTANT -- OPPRESSION IS ANOTHER ONE WHERE WE HAVE LOTS OF GOOD RESEARCH ON THIS TOPIC. SO, COMPLICATIONS OF -- WHERE DOES THE SCIENCE COME IN HERE? THESE ARE FOUR BIG BUCKETS THAT I WILL EMPHASIZE. MUCH OF WHAT THE RESEARCH HAS WITHIN IS FOCUSED ON BEHAVIOR, LIFESTYLE. AND LOOKING AT THOSE DIFFERENCES. THAT IS PROBABLY HOW WHY STARTED IN OUR WORK IN THE 1980S. I THINK IT WAS AN APPROPRIATE STARTING POINT. WE LOOKED AT BELIZE AND BEHAVIORS AND HOW THAT EFFECTED OUTCOMES. BUT THIS EVOLVED TREMENDOUSLY. FOR EXAMPLE, THE KNOWLEDGE THAT RESPONSE TO STRESS IS IMPORTANT. NOT JUST IN ACUTE CONDITIONS PARTICULARLY AROUND MENTAL HEALTH SUBSTANCE USE, BUT ALSO IN CHRONIC DISEASE AND DEVELOPMENT OF CHRONIC DISEASE. I THINK IT IS REALLY A CRITICAL UNDERSTANDING OF WHY WE MAY SEE DIFFERENCE SYSTEM FROM ADVERSE CONDITIONS IN I RECALLY LIFE LEADING TO MORE -- IN EARLY LIFE LIKELY TO LEADING TO CANCER OR CARDIOVASCULAR DISEASE AS ADULTS. SOMETHING THAT IS A CHALLENGE IN HOW TO STUDY IN A POPULATION OR CLINICALLY, BUT CLEARLY FROM A MODEL PERSPECTIVE AND FROM WHAT WE OBSERVE, THIS CONNECTION IS VERY, VERY PLAUSIBLE. AND A NUMBER OF DIFFERENT STRESSORS THAT 30 YEARS AGO SOCIAL SCIENTISTS WOULD MEASURE SOME SORT OF STRESS OR SOME MENTAL HEALTH SYMPTOM OR SOME OTHER WITH A QUESTIONNAIRE AND THERE WOULD BE NO WAY TO SAY WHAT DOES THAT MEAN TO THE PATIENT OR TO THE PERSON CLINICALLY? NOW WE HAVE CHANGE THAT IS HAVE BEEN DOCUMENTED THAT OCCUR WHETHER IT BE IN TELEMERE LENSE OR ALLOSTATIC LOAD AS A BIOLOGICAL MEASURE OF METABOLISM, EPIGENETIC CHANGES. SO UNDERSTANDING OF HOW THESE THINGS ARE INTERCONNECTED AND POTENTIALLY LEAD TO DIFFERENTIAL OUTCOMES BASED ON CONDITIONS THAT WE ALL ACKNOWLEDGE WERE SIGNIFICANT BUT WE DEPENDENT KNOW QUITE WHAT THE LINK WAS TO THE BIOLOGY. I THINK WE ARE IN A JUNCTION IN SCIENCE WHERE WE CAN BEGIN TO ENHANCE OUR UNDERSTANDING OF ALL OF THESE PROCESSES AND MECHANISMS IN A MUCH MORE COMPREHENSIVE WAY. LOTS OF OTHER DIFFERENT KINDS OF CONDITIONS. AND THE GENETIC WORLD HAS USED RACE AND ETHNICITY AS A LABORATORY TOW LOOK FOR DIFFERENCES. AND IF IT HAD NOT BEEN DONE THAT WAY, THERE WOULD BE THINGS TO BE DISCOVERED. ONE IS THE APOE1 GENE IN THE AFRICAN ANCESTRAL POPULATION THAT SYNERGIES OR IS A MAJOR RISK FACTOR FOR DEVELOPMENT OF RENAL DISEASE IN AFRICAN ANCESTRAL POPULATIONS. ANOTHER EXAMPLE WORK I WAS INVOLVED WITH WAS THE DISCOVERY OF EYE GENE IN LATINA WOMEN THAT IS ONLY PRESENT IN THOSE WHERE AMERICAN IN INDIGENOUS BACKGROUND OR MIXTURE. AND IT'S A 15% PREVALENCE OF THAT GENE AND THAT GENE PROTECTS AGAINST BREAST CANCER. SO IT SUPPORTS THE OBSERVATIONAL EPIDEMIOLOGY THAT BREAST CANCER WAS LESS COMMON AND WE FIND POTENTIAL MECHANISM AS TO WHY. WHETHER THAT LEADS TO SOMETHING MORE RELEVANT LIKE MEDICATIONS AND RECENTLY, THE NEW CHOLESTEROL LOWERING DRUG IS DISCOVERED THROUGH A VERY LOW LDL FAMILY THAT WAS FOUND IN THE DALLAS HEART STUDY AND THESE WERE AFRICAN-AMERICANS. SO NOT ONLY IN AFRICAN-AMERICANS BUT THAT'S HOW THE DISCOVERY HAPPENED. SO, I THINK THESE ARE -- THERE IS A LOT OF POTENTIAL AND A LOT OF LOSS BY NOT INCLUDING THIS POPULATIONS. NOW, PARALLEL TO THE EXPLOSION IN INFORMATION IN BIOLOGICAL MECHANISMS WE HAVE SEEN PROBABLY STARTING WITH THE HUMAN GENOMIC PROJECT WHERE WE SEEN THIS INCREASES IN KNOWLEDGE, AND ALSO EXPONENTIAL INCREASE IN UNDERSTANDING WHAT THE PHYSICAL ENVIRONMENT IS, THE BUILDUP ENVIRONMENT. THIS STARTED IN THE LATE 1990 AND IT LEADS TO THE QUOTE OF YOUR ZIP CODE MORE IMPORTANT TO YOUR HEALTH THAN YOUR GENETIC CODE TO WHICH SOME EXTENT IS TRUE, ALTHOUGH CLEARLY THEY INTERACT. AND ALSO THE IMPORTANCE AND THE POWER OF SOCIAL INTERACTIONS. SO IT TURNS OUT THAT TALKING TO PEOPLE IS GOD FOR YOU. AND KNOWING YOUR NEIGHBOR AND HAVING COMMUNITIES. SO THERE ARE POOR COMMUNITIES THAT DO WELL. JUST BECAUSE YOU'RE POOR DOESN'T MEAN YOU'RE GOING TO HAVE BAD HEALTH. AND SOMETIMES COHESION IN COMMUNITIES REALLY IS SOMETHING THAT IS MORE IMPORTANT OR AS IMPORTANT LOTS SAY, NOT MORE, AS THINGS THAT WE HAVE BEEN ACCUSTOMED TO DOING ACCIDENT ACCESS TO SCHOOLS, EDUCATION -- ACCESS TO SCHOOLS -- I THINK THAT THE VALUE OF THESE DIFFERENT PER SUSPECT I WAS -- AND FINALLY THE WHOLE CLINICAL SETTING IS -- I'M A GENERAL INTERNIST BY TRAINING SO WE SHARE A LOT WITH OUR COLLEAGUES IN CLINICAL RHEUMATOLOGY, A LITTLE BIT OF DERMATOLOGY, NOT SO MUCH. BUT, A CLINICAL SETTING IS A GREAT LABORATORY TO STUDY MINORITY HEALTH AND HEALTH DISPARITIES. THERE WAS A RECENT CDC REPORT THAT SAID SOMETHING LIKE OVER 70% OF ADULTS OVER 18 HAVE AT LEAST ONE CONTACT WITH A HEALTH CARE CLINICIAN IN THE PREVIOUS YEAR. AND THE CONTACT EITHER FACE BY PHONE. SO, I THINK THAT CLEARLY PEOPLE SEE US, SEE CLINICIANS AND IS IT A SETTING WHERE WE CAN PROMOTE OR DIMINISH DISPARITIES. SO I WANT TO PROMOTE THAT WITHIN OUR INSTITUTE. JUST TO THINK THESE THINGS DON'T REPLACE EACH OTHER. THEY HAVE OVERLAPPING VARIANTS BUT EXPLAIN DIFFERENT THINGS OUTCOMES BECAUSE THE TRADITIONAL PUBLIC HEALTH PARADIGM IS ALL ABOUT SOCIAL CLASS. AND OUR CASE, WE THINK THAT WE DO BELIEVE THAT THERE ARE DISTINCT CATEGORIES. OUR PROGRAM SCIENTIST PARTICULARLY JENNIFER AND OTHERS, DEVELOPED THIS FRAMEWORK JUST TO PRESENT WHAT OUR RESEARCH FRAMEWORK WOULD LOOK LIKE. WE ARE GOING TO PUT THIS ON OUR WEBSITE IF WE HAVEN'T ALREADY. IT IS NOT INTENDED TO BE A CAUSEDAL PATHWAY BUT JUST TO UNDERSTAND PARTICULARLY FOR OUR SCIENTISTS TO SEE WHERE IS THERE RESEARCH? AND THESE ARE NOT COMPREHENSIVE LIST UNDER EACH CATEGORY. I EXPECT IN DIFFERENT AREAS WE'LL SEE GROWTH AND CHANGES CHANGES AND HOPEFULLY THROUGH SOME TECHNOLOGY WE'LL BE ABLE TO GET THE LENGTHIEST TWO ACTIVITIES THAT ARE GOING ON WITHIN INSTITUTE AND PUBLISHED PAPERS TO ILLUSTRATE THESE POINTS. LET ME COMMENT ABOUT INCLUSION. AGAIN DIVERSE PARTICIPANTS. I THINK THIS IS A CRITICAL IMPORTANT TOPIC. THE OFFICE OF THE DIRECTOR HAD A PRESENTATION WHERE IT WAS STATED THAT 30% OF ALL CLINICAL STUDIES AT NIH FUNDED BY NIH, HAVE MINORITIES ENROLLED. THESE ARE NOT JUST TRIALS BUT ALL CLIP CALL STUDIES. IF WE ARE AT 30%, THEN WE MADE A LOT OF PROGRESS IN THIS AREA. IT'S BEEN STABLE IN THE LAST 5 YEARS AND THERE IS SOME VARIATION BUT I THINK THIS IS IMPORTANT IN SEPARATE DOMAINS. INCLUSION IS NOT HEALTH MINORITY RESEARCH. INCLUDES MINORITY OFTEN BECAUSE IT'S 40% OF THE U.S. POPULATION. SO IT'S COMMON SENSE BURR IT CAN BE IMPORTANT IN GOOD SCIENCE IF YOUR OBSERVATIONAL STUDIES INDTHAT THERE MIGHT BE BIG DIFFERENCES IN THE GROUP. SO IF YOU DO A STUDY ON LUPUS AND YOU'RE NOT REALLY POWERING IT TO LOOK AT WHAT HAPPENS TO AFRICAN-AMERICAN AND LATINO WOMEN WITH LUPUS, THEN YOU'RE IGNORING THE SCIENCE IN A CLINICAL STUDY WITH THAT GROUP. THERE YOU WANT TO POWER TO INCLUDE THAT AND THAT'S MINORITY HEALTH RESEARCH. IF YOU'RE JUST DOING A GENERAL STUDY ON HEART ATTACKS, 15-20% MINORITY IS BETTER THAN NONE BUT YOU'RE NOT EXACTLY LOOKING AT DIFFERENCES BY MINORITY GROUPS. AND THIS IS A DISCUSSION THAT WE ARE STILL IN THE PROCESS OF SORTING OUT WITH THE GROUPS THAT MANAGE THIS. WE HAVE TO BE AT THE TABLE. THE SAYING IS IF YOU YOU'RE NOT AT THE TABLE YOU MIGHT BE ON THE MENU. THAT IS IMPORTANT. IT IS HARDER TO RECRUIT MINORITIES IN GENERAL. IT TAKES MORE RESOURCES. SOMEWHAT DIFFERENT SCHOOLS. PEOPLE DON'T NECESSARILY RESPOND TO THE -- SKILLS -- WAY THAT IS WE TRADITIONALLY RECRUITED PARTICIPANTS. HARD TO SAY WHAT THE SCIENCE OF THIS IS. I THINK MORE FACE TIME AND MORE PERSONALIZED MESSAGES SEEM TO BE A CONSISTENT PATTERN THAT INVESTIGATORS WHO ARE SUCCESSFUL AT DOING THIS HAVE CONFIRMED. THIS IS GENERAL SENSE THAT MINORITY SCIENTISTS MAY BE BETTER TAT BUT ALSO MAY BE MORE MOTIVATED TO DO RESEARCH. SO THAT COULD BE A COMPANION THERE. I DO THINK THAT NIH NEEDS TO IMPLEMENT AND ACCOUNTABILITY AND I THINK WE ARE MOVING IN THAT AREA WHERE IF YOU SUBMIT A RO1 AND IT GETS FUNDED YOU WILL HAVE 30% MINORITIES IN YOUR STUDY. UP UNTIL NOW THERE HAS BEEN NO ONE WHO CHECKED. WHAT DID YOU DO IN FIVE YEARS? AND USUALLY THE INVESTIGATOR WORRIED ABOUT GETTING SAMPLE SIZE SO THEY ARE HAVING TROUBLE GETTING MINORITIES. THEY JUST WANT TO GET THE SAMPLE SIZE. I HAVE BEEN THERE AND I KNOW WHAT IT IS LIKE. AND THERE HAS BEEN NO ACCOUNTABILITY. IN MY FOUR YEARS ON THE NIH COUNCIL, I NEVER SAW ANYONE DO ANYTHING'S BUT CHECK THE BOX ON MINORITY INCLUSION. IT'S WOMEN AND MINORITY INCLUSION IN THEIR GRANTS. AND SO, I THINK THAT THERE IS SOME MOMENTUM, AT LEAST IN LOOKING AT THIS AND GETTING MORE ACCOUNTABILITYO THIS TOPIC. AND I REALLY THINK WE OUGHT TO INDTHE MYTH THAT THESE BARRIERS ARE INSURMOUNTABLE. IT'S JUST TOO HARD. NOW ON THE DIVERSITY OF THE WORKFORCE, WE FACE A MUCH MORE URGENT AND CRITICAL CRISIS. ONLY 5% OF NIH RO1 GRANTS ARE AWARDED TO PLAQUE OR LATINO PRINCIPAL INVESTIGATORS. THERE IS SOME BIAS IN FUNDING. IT WAS BROUGHT OUT IN A PAPER IN SCIENCE AND WE HAVE BEEN TRYING TO LOOK AT THIS COMPREHENSIVELY THROUGH MIKE FLOWERS OFFICE. LOTS OF REASONS WHY THIS MAY BE LESS RESUBMISSION IS AN EASILY FIXED ONE SO HALF AS LIKELY TO RESUBMIT. AND SO, AND THEN WHEN YOU RESUBMIT YOUR CHANCES OF GETTING FUNDING GO UP AS LONG AS YOU MODIFY THE GRANT. POOR MENTORING, LOW SUCCESS TOPICS IS ANOTHER ONE CITED. IN OUR CLINICAL WORLD, MEDICAL SCHOOL GRADUATES IN 2014 ABOUT 12% WERE UNDER REPRESENTED MINORITIES. SO WE HAVE A WAY TO GO THERE AS WELL. AND WE DO KNOW FROM THE CLINICAL LITERATURE THAT IF YOU'RE UNDER REPRESENTED MINORITY, YOU'RE MORE LIKELY TO TAKE CAKE OF UNINSURED PATIENTS AND TAKE CARE OF MEDICAID PATIENTS AND IN A SURVEY THAT A FORMER STUDENT DID THAT I WAS INVOLVED WITH THAT IS NOT YET ACCEPTED, GREATER INTENT TO WORK IN UNDERSERVED AREAS EVEN THOUGH THEY HAVE AN AVERAGE DEBT FINISHING SCHOOL OF 200,000 DOLLARS. AND SO AND ADJUSTING FOR WHETHER THEY ARE GOING INTO PRIMARY CARE AND MORE LIKELY TO WORK IN UNDERSERVED AREAS. SO I THINK THAT THERE IS VALUE AND INTERVENTION THAT WORKS FOR CLINICAL WORLD TO HAVE MORE DIVERSE PHYSICIANS. THERE IS NOTHING ON SCIENCE. SO WE DON'T KNOW WHAT IS MORE DIVERSE IN THE SCIENTIFIC WORKFORCE WILL DO AND IT'S AN AREA WE OUGHT TO LOOK AT. LAST YEAR WE DID LOOK AT THE FISCAL 15. THIS IS ALL GRANTS. NOT JUST RO1S AND NIMHD, DOES HAVE A HIGHER PROPORTION OF MINORITY PRINCIPAL INVESTIGATORS AND AS WE EXPAND OUR RO1 POOL, WHICH IS HAPPENING ALREADY THIS YEAR, WE'LL SEE HOW WE DO WITH GETTING RO1s FUNDED TO AFRICAN-AMERICAN OR LATINO PIs. ASIANS ARE NOT UNDER REPRESENTED AT NIH IN TERMS OF BEING PIS AND NO APPARENT BIAS IN THE FUNDING OF LATINO HISPANIC PRINCIPAL INVESTIGATORS EVEN THOUGH THE NUMBER APPLYING AND THE NUMBER FUNDED IS QUITE LOW. NOW, I THOUGHT THAT WE SHOULD LOOK AT THE TOPICS WHERE WE HAVE MUTUAL INTEREST. LUPUS I ALREADY MENTIONED IS ONE. THE DISEASE THAT WE KNOW EFFECTS WOMEN PREDOMINANTLY AFRICAN-AMERICAN AND LATINO WOMEN. NOT ONLY HAVE MORE LUPUS BUT MORE SEVERE MANIFESTATIONS OF LUPUS AND THIS IS AGAIN NOT A COMMON DISEASE BUT COMMON ENOUGH FOR ALL IN TERNALLISTS TO KNOW ABOUT IT AND SEE IT. AND I THINK -- INTERNISTS -- IT'S A GREAT OPPORTUNITY FROM A SCIENTIFIC PERSPECTIVE TO SEE WHAT IS DIFFERENT USING RACE ETHNICITY AS YOUR LABORATORY AS TO EXPLORE WHAT THE MECHANISMS ARE. WE DON'T THINK IT IS ACCESS OR EARLY DETECTION. NATURAL HISTORY IS STILL A VARIABLE. THE OTHER DISEASES HAVE BEEN MENTIONED. OSTEOARTHRITIS I THINK MERITS BECAUSE IT'S THE MOST COMMON. AND IT'S A BURDEN ON QUALITY OF LIFE. AND THERE WAS A REPORT LAST YEAR THAT AFTER AGE 65, AFRICAN-AMERICANS ACTUALLY HAVE FEWER -- THEIR QUALITY OF LIFE SO THE LIFE EXPECTANCY AFTER 65 WHICH MAY BE THE SAME OR BETTER THAN WHITES, BUT THE QUALITY OF LIFE IS WORSE. AND A LOT OF THIS BURDEN PROBABLY RELATED TO OSTEOARTHRITIS. SO I NOTICED THIS IS AN AREA OF PRIORITY FOR THISIPS DISPUTES IMPORTANT. IT HAS NOT BEEN ONE THAT FASCINATES SCIENTISTS OR CLINICIANS FOR THAT MATTER IN THE PAST BUT I THINK IT IS CRIT CAM. AND EFFORTS IN THIS AREA ARE IMPORTANT. AND STEVE MENTIONED TO ME, VITILIGO WHICH NEVER CROSSED MY MIND. BUT IF YOU HAVE VITILIGO AND YOU'RE DARK SKINNED IT HAS IMPACT ON YOUR QUALITY OF LIFE. IF THE PREVALENCE OF THE CONDITION MAY BE LESS, I THINK THIS IS ALSO SOMETHING WORTH LOOKING AT. >> WHAT IF YOU HAVE PSORIASIS? >> IT WAS ON THE CROSS TOPICS COMING FROM NIAID. AREAS OF INTEREST TO YOU. >> THANK YOU. >> FOR AFRICAN-AMERICANS. AND RHEUMATOID ARTHRITIS THE MOST COMMON INFLAMMATORY CONDITION. AGAIN, NOT AS MUCH AS LUPUS IN TERMS OF RACIAL ETHNIC DIFFERENCES BUT CLEARLY ALSO MORE PREVALENT. NOW FALLS AND FRACTURES A TOPIC I DEALT WITH MORE AS A GENERAL INTERNIST AND HERE YOU CAN SEE THAT A REPORT FROM THE RISK FACTORS SURVEYED THAT PERCENTS OF FALLS IS HIGHEST AMONG AMERICAN INDIANS AND HIGHEST PER SENT WAS INJURY-RELATED TO FALL. AND PERCENT FALLS ARE SLIGHTLY LOWER IN THE OTHER RACE ETHNIC GROUPS PARTICULARLY ASIAN WITH LOWER INJURY OR NO DIFFERENT INJURY RATES AMONG LATINO AND WHITES AND BLACKS ARE SLIGHTLY LOWER. THESE ARE ALL ADULTS. NOT JUST WOMEN. AND THEN BY EDUCATION, YOU SEE THERE IS NO GRADIENT. SO THERE ARE SOME CONDITIONS THAT ARE NOT DRIVEN NECESSARILY MUCH BY SOCIAL ECONOMIC STATUS OR BY RACE. SO THESE ARE WORTHWHILE TO NOTE AND TO LOOK AT. NOW, BACK TO NIMHD. SO I HOPE I HAVE TRANSMITTED THE IMPORTANCE AND ENTHUSIASM WE HAVE ABOUT DEFINING WHAT OUR SCIENCE IS AND BECAUSE WE INTERACT AND OVERLAP WITH EVERY SINGLE OTHER INSTITUTE AT NIH, I THINK IT IS REALLY IMPORTANT. WE DON'T WANT THE LEFTOVERS. WE DON'T WANT JUST THE THINGS THAT, THEY LOOK LIKE MULTIPLE MECHANISMS SO WE'LL SEND IT TO NIMHD. WE WANT THE BEST SKIES WE CAN GET FROM OUR COMMUNITY. JUST LIKE YOU. -- THE BEST SCIENCE. SO WE JUST REDID OUR REFERRAL GUIDELINES AND I WENT THROUGH THEM ON THE OVERLAP FOR EACH OF THESE, IT'S STILL BEING REVIEWED, TO MAKE SURE IT'S NOT -- NCI GETS THE MAIN COURSE AND YOU GET THE SIDE COURSE, BECAUSE WE DO THE REAL WORK. YOU GUYS DOT OBJECTION WE DON'T KNOW WHERE IT FITS. SO -- DO THE ONES WHERE -- AND THIS YEAR IT WILL BE IMPORTANT FOR ME. WE WANT TO GET THE EXTRAMURAL SCIENTIFIC COMMUNITY AS A PLACES TO SEND RO1 GRANTS AND SIGNED UP FOR THE PARENT RO1 AFTER RETIREMENT, WE SEEN AN UPTICK. I HAVEN'T YET SEEN THE OUTCOMES SO I DON'T KNOW YET IT IT WILL LEAD TO MORE QUALITY. AT LEAST WE HAVE INCREASED AMOUNT OF GRANTS ASTOUND US THIS CURRENT YEAR, FISCAL YEAR AS OPPOSED TO LAST YEAR. WE ESTABLISHED HEALTH SERVICES RESEARCH AND CLINICAL SETTINGS PROGRAM AND WORKING ON DIVERSITY. THE SCIENTIFIC PROGRAMS AT NIMHD ARE NOT ORGANIZED IN A CLASSICAL INSTITUTE WAY, ALTHOUGH WE ARE MOVING IN THAT DIRECTION. WE HAVE TO REORGANIZE. THESE ARE THE 3 AREAS WE HAVE CREATED AS FUNCTIONAL BRANCHINGS, CLINICAL HEALTH SERVICES I MENTIONED, INTEGRATED BEETLEY AND BEHAVIORAL SCIENCES NA REALLY LOOKS AT MECHANISMS -- BIOLOGY AND BEHAVIORAL -- AND THEN WE HAD A TRADITION OF COMMUNITY-BASED PARTICIPATORY RESEARCH AND COMMUNITY HEALTH AND POPULATION HEALTH SCIENCE TO LOOK AT BIG DATA AND PUBLIC HEALTH PERSPECTIVE EPIDEMIOLOGY. AND MOVING FORWARD. WE DO NOT HAVE A BASIC SCIENCE PROGRAM AND I DON'T THINK THERE IS NO -- I CAN'T DEFINE WHAT THAT BASIC SCIENCE PROGRAM WOULD BE SO I LOOKED AT EVERY OTHER INSTITUTE TO THE DO THAT AND THEN TO INFORM US HOW TO USE THOSE TOOLS IN AND AROUND INTEGRATIVE BIOLOGY. WE HAVE A NUMBER OF PROGRAM ANNOUNCEMENTS THAT WE WORKED ON IN THE LAST YEAR AND THAT ARE COMING. AIDES WORK AND HIV INFECTED YOUTH AND YOUNG ADULTS OUT. THIS IS FOR INFECTED YOUTH AND YOUNG ADULTS AND WHAT HAPPENS IN TREATMENT. ONLY 10% OF THE MINORITY HIV INFECTED YOUTH IN THIS POPULATION ARE SUPPRESSED VIRALLY SUPPRESSED. THIS IS NOTPABLY THESE DICE. WE HAVE PROGRAM ANNOUNCEMENTS ON IMMIGRANTS -- THIS IS NOT ACCEPTABLE THESE DAYS. WE HAVE ONE ON DISSPARENTS AND SURGICAL CARE AND OUTCOMES. I EVAPORATE SEEN THE RESULTED ON THAT AND NIAMS IS ONE OF THE INSTITUTES THAT SIGNED ON TO THAT. ONE OF THE SOCIAL EPIGENOMICS TRYING TO LOOK AT MORE MECHANISTIC INTERACTIONS AND WE HAVE ONE COMING STILL IN THE PIPELINE ON THE CARIBBEAN INITIATIVE. SO TO FUND SOME GRANTS IN THE CARIBBEAN TO LOOK AT POPULATIONS THERE SOY WE CAN COM PARITY TO IMMIGRANT POPULATIONS HERE -- COMPARE -- IN THE BLACK CARIBBEAN AND SPANISH SPEAKING CARIBBEAN. SLEEP DISPARITIES IS BEING DEVELOPED. ONE ON LIVER, CHRONIC LIVER DISEASE AND LIVER CANCER WE HAVE DONE WITH NCI IS AND ALCOHOL. AND THAT ONE IS ALREADY PUT INTO THE GUIDE AND HOPEFULLY WILL BE OUT IN A COUPLE OF MONTHS AND THEN WE HAVE DEVELOPING A PLAN TO DO RESEARCH WITH THE TRIBAL EPIDEMIOLOGY CENTERS WHICH WE FUNDED FOR A LONG TIME, CONTRIBUTED TO FUNDING MOST HE FUNDED BY THE INDIAN MENTAL HEALTH SERVICE SPREAD AROUND THE COUNTRY. THERE IS 12 OF THEM. THEY COVER MOST TRIBAL NATIONS AS WELL AS URBAN INDIANS AND TO CREATE A PARTNERSHIP SO THAT THEY WILL PARTNER WITH SOME SORT OF ACADEMIC INSTITUTION OR RESEARCH INSTITUTION THAT WOULD THEN USE THEIR DATA IN THEIR AREAS. SO, THAT IS STILL BEING DEVELOPED ALTHOUGH WE PLAN TO FRIEND AT OUR COUNCIL MEETING NEXT MONTH. WE HAD THREE PLANNED SCIENTIFIC WORKSHOPS, THE ONE WE ALREADY DID WAS ON SELF-IDENTIFIED RACE ETHNICITIES WITH GENOMIC MARKERS. THIS WAS FELD OCTOBER WITH NHGRI AS A PARTNER AND WE HAVE TWO PLANNED FOR MID TO LATE SPRING, ONE ON WHAT THE ROLE OF INFORMATION TECHNOLOGY IS IN MINORITY HEALTH AND HEALTH DISPARITIES. IN IN THE HEALTH CARE SETTING FROM HOW YOU ENTER THE DATA TO WHAT KIND OF DATA TO WHAT IS THE UPTAKE OF USING WHAT THAT PATIENT PORTAL AND ET CETERA. SO A NUMBER OF ISSUE THAT IS COULD BE ADDRESSED THERE. AND THE LAST ONE IS ON STRUCTURAL RACISM AND THEN COUPLED IT WITH CULTURAL COMPETENCE OR STRUCTURAL COMPETENCY. AND HOW THAT IMPACTS ON MINORITY HEALTH AND THE OFFICE OF MINORITY HEALTH AND THE DEPARTMENT HAS BEEN PARTNERING WITH US ON THAT. I'M NOT SURE STRUCTURAL RACESSISM IS A RESEARCH CONSTRUCT. 10 YEARS AGO WHEN WE THOUGHT ABOUT THIS, I PUT TO THE SIDE AND SAY IT'S AN ORGANIZATIONAL CONSTRUCT. A SYSTEMS CONSTRUCT. I DON'T KNOW HOW TO MEASURE IT. SEE IT CAME UP LAST YEAR. I SAID LET'S CONVENE EXPERTS AND SEE WHAT PEOPLE SAY. SO, I'M CURIOUS TO SEE HOW THAT TURNS OUT. THE OTHER ONES I THINK IT WAS MORE CLEAR. JUST A NICE PHOTO OF OUR RESEARCH INSTITUTE AND WE SPONSORED A ONE-WEEK BOOTCAMP FOR ASSISTANT PROFESSORS AND POSTDOCS. IT WAS LINKED TO SELECTED LECTURES ON CUTTING-EDGE ISSUES WE SELECTED THE SPEAKERS FOR AS WELL AS MOCKERY VIEW AND OPPORTUNITIES TO MEET WITH PROGRAM SCIENTISTS FROM ALL THE DIFFERENT INSTITUTES OF COURSE WE CAN'T PRESELECT OR MAKE ANY CRITERIA BUT 80% PLUS OF OUR PARTICIPANTS WERE FROM A MINORITY GROUP. WE HAD ABOUT 12 OR 13 PHYSICIANS, ABOUT 5-6 NURSES, ONE PHARMACIST. AND THE REST ARE PH.D.s OF DIFFERENT FLAVORS. LAST, BUT NOT LEAST IS INTRAMURAL PROGRAM. PRETTY MUCH -- I'M NOT THERE YET BUT WE HAVE AN OFFER OUT FOR SCIENTIFIC DIRECTOR BEFORE JANUARY 20. SO, HOPEFULLY THAT WILL DEVELOP SOMETIME IN THE NEXT FEW MONTHS. AND THEN BUILD AN INTRAMURAL PROGRAM ON THE BASIS OF A POPULATION SCIENCE IDEA AS WELL AS POTENTIALLY A CLINICAL COMPONENT AND I HAVE ACTUALLY LIKED THE NIAMS PROGRAM OF THE COHORT OF INFLAMMATORY ARTHRITIS THAT I LEARNED ABOUT FROM STEVE AND OTHERS HERE. BECAUSE I THINK IT'S A GOOD MODEL FOR US AND SO I HAD SOME IDEAS THAT MAYBE WE CAN DO SOMETHING SIMILAR. AROUND SOME THEME WHERE WE WOULD STUDY DIFFERENT PROCESSES AS WELL AS ONE OR MORE CHRONIC DISEASES. WE CURRENTLY HAVE ENGAGED INTERESTED SCIENTIST AT CANCER AGING, DIABETES, CHILD HEALTH, ENVIRONMENTAL HEALTH AND HEART, LUNG AND BLOOD. WE CREATED A SMALL NETWORK OF LIKE-MINDED SCIENTISTS. SOME OF IT HAS BEEN THROUGH HELPING TO FUND NEW FACULTY, NEW STEM INVESTIGATORS IN ENVIRONMENTAL HEALTH AND IN CHILD HEALTH AND THEN HOPEFULLY IN NHLBI. MY OWN LAB IS IN NHLBI SO I HAVE A STAFF SCIENTIST WORKING WITH ME NOW THAT I RECRUITED. SO, I THINK THAT IS IT. AND HOPEFULLY I DIDN'T TAKE TOO MUCH TIME AND WE HAVE THE OPPORTUNITY FOR QUESTIONS. THANK YOU. [ APPLAUSE ] >> YOU COVERED A LOT OF GROUND THERE. THE FLOOR IS NOW OPEN FOR QUESTIONS OR COMMENTS. DO YOU WANT TO SAY ANYTHING ABOUT THE -- >> YES, AND SO -- >> INTRODUCE YOURSELF. >> WE WERE TALKING ABOUT THIS. YOU HAVE SEVERAL PROGRAMS IN YOUR PORTFOLIO INCLUDING THE RCMIs AND CENTERS OF EXCELLENCE THAT REAL HE LOTS OF TOPICAL RELEVANCE TO DIABETES AND CARDIOVASCULAR DISEASE WHEN WE WERE TALKING ABOUT HOW TO MAKE A LOT OF SENSE TO START THINKING ABOUT THE POTENTIAL COLLABORATIONS AND OVERLAP. DO YOU HAVE ANY SUGGESTIONS FOR THAT? >> YOU HAVE UNTIL MARCH 7 FOR THE RCMI BUT IT'S VERY STRICT CRITERIA. WE SET A CEILING OF 50 MILLION DOLLARS OF NIH FUNDING AVERAGE OVER THE LAST 3 YEARS AS WELL AS A DOCUMENTED COMMITMENT TO TRAINING AND RECRUITING AND WORKING WITH UNDER REPRESENTED POPULATIONS. IT'S BEEN A PROGRAM IN EXISTENCE FOR OVER 30 YEARS. PREDOMINANTLY 18 INSTITUTIONS. IT'S OPEN FOR COMPETITION. ABOUT 10 ARE GOING TO BE AWARDED BECAUSE THAT IS HOW MANY ARE RUNNING OUT. AND WE'LL SEE HOW IT PLAYS OUT. IT COULD BE BASIC SCIENCE BECAUSE IT IS TRADITIONALLY STARTED AS A BASIC SCIENCE LABORATORY SCIENCE UNRELATED TO MINORITY HEALTH DISPARITIES. CLINICAL POPULATION SCIENCE OR BEHAVIORAL SOCIAL SCIENCE AND THERE IS INCREMENTAL AMOUNTS. THAT DOESN'T REQUIRE A THEME. SO IT COULD BE YOUR BEST ATHLETES SO TO SPEAK. THE CENTERS OF EXCELLENCE PROGRAM, WE ARE GOING TO PUBLISH A NEW FUNDING OPPORTUNITY ANNOUNCEMENT PROBABLY AFTER SOME TIME AFTER OUR COUNCIL REVIEWS THE CONCEPT REQUIRED TO BE REVIEWED AGAIN. WE HAD A YEAR-LONG PROCESS OF REVIEWING IT AND HOW WE RETOOL IT. WE ARE -- THESE ARE SMALLER GRANTS BUT THEY ARE PROBABLY GOING TO BE ABOUT A MILLION DOLLARS AND THE FOCUS IS GOING TO BE SCIENCE SO WILL HAVE SOME SORT OF A RFG-TYPE OF PROJECT EMBEDDED IN IT. AND THEN DEVELOPMENT OF INVESTIGATORS. THOSE ARE THE TWO. SO, SIMILAR TO WHAT WE DID WITH THE RCMI, BUT LESS, NO INFRASTRUCTURE AND NO BASIC SCIENCE. SO A LITTLE BIT LESS IN TERMS OF RESOURCES. AND WE WANT TO INTENTIONALLY NOT HAVE TWO TIERS SO IT WOULD BE OPEN COMPETITION BUT THEN WE WILLMENT TO LOOK FOR DIVERSITY OF INSTITUTIONS. SOY IT'S NOT GOING TO BE JUST THE TOP 20 INSTITUTION THAT IS PUT TOGETHER GREAT GRANTS. WE REALLY WANT TO SEE THIS SPREAD OUT. DOES THAT HELP. >> AND IF WE GO BACK TO THE PROGRAM T STARTED IN NIH. AND THEN MOVED TO NIGMS. ARE THERE INTERACTIONED BETWEEN NIMH AND THE PROGRAM? >> YOU CATCH ME IN NOT UPONNING DETAILS IN WHAT GOES ON. WE ARE DESIGNED UP TO IT. I THINK IT'S AN OPPORTUNITY THAT DIFFERENT STATUTES CAN WORK FROM. IT'S A FRAMEWORK -- INSTITUTES. SO YES, WE ARE CONNECTED TO THE PROGRAM AND WE ARE HOPING THAT -- >> THEY DON'T NEED IT BUT THEY ARE CONNECTED. >> AND WE ARE HOPING THAT THIS TRIBAL EPIDEMIOLOGY CENTERS EVOLVES IN THAT DIRECTION OVER TIME SO THAT IF WE DO SOME GOOD THINGS WITH IT AND MAYBE A COUPLE OF THE OTHERRENCEITUTES MIGHT SAY IT MIGHT BE A GOOD PLACE TO GET -- THE OTHER INSTITUTES -- TO DO RESEARCH ON TOPICS THAT ARE RELEVANT TO THEIR INSTITUTE AND EFFECTS AMERICAN INDIANS. >> I HAVE TO ASK SINCE YOU AND I HAVE BEEN TO MANY MEETINGS CONCERNING CHARACTER OF THE APPLICATIONS COMING FROM MINORITY GROUPS. YOU ARE NOW REALLY OPENING UP AN RO1 PROGRAM THAT YOU HOPE WILL BE EMBRACED AND WILL BE AT A VERY HIGH LEVEL. DO YOU ANTICIPATE SEEING THIS SORT OF ADVERSITY AND FOR THE GROUP TO REMEMBER THAT MINORITY APPLICATIONS NOT ONLY ARE -- OR GET A LOWER SCORE IN TERMS OF LOWER SCORE BEING NOT ADDS GOOD BUT ALSO THE SUBJECT MATTER THAT FALLS OFF IN TERMS OF SUPPORTED THROUGH NIH. SO WHAT I'M ASKING YOU IS, WHAT DO YOU ANTICIPATE THE CHARACTER OF THOSE RO1s TO BE IN TERMS OF YOUR -- I ASSUME IT'S COMING OUT OF A FOA. WHAT ABOUT THE OPPORTUNITIES FOR CO-FUNDING. THE FIRST QUESTION IS, WHAT IS THE CHARACTER OF THE APPLICATIONS THANK YOU ANTICIPATE SEEING? I KNOW THAT YOU'RE TRYING TO HAVE A ROBUST PROGRAM IN THAT AREA. >> WELL, I CAN'T PREDICT. AND I CAN'T FORESEE THE FUTURE. BUT MY HOPE IS THAT -- I KNOW THAT THERE IS TALENT OUT THERE. AND I THINK THERE IS A PERCEPTION AMONG THE COMMUNITY I OR AMONG OUR SCIENTISTS, OUR STAFF, THAT SOME OF THESE APPLICATIONS ARE NOT MAKING IT WELL THROUGH REVIEW BECAUSE PEOPLE ARE SAYING, THIS IS NOT REAL. THIS IS NOT A NARROW FOCUS AREA ON THE TOPIC OF THE REVIEW. AND SO MANY ARE USING MULTIPLE METHODS. THEY ARE NOT PURE GENETICS, NOT PURE CLINICAL SCIENCE. SO, THEY ARE GETTING -- SUFFERING IN REVIEW. I HAVEN'T SEEN ENOUGH DATA TO SAY THAT I AGREE WITH THAT BUT THAT IS CERTAINLY A PERCEPTION THAT PEOPLE HAVE. THE TOPICS THAT ARE HIGHLY VALUED AT NIH ARE MORE LABORATORY SCIENCE. AND LOW SUCCESS TOPICS INCLUDE CRITICALLY IMPORTANT PUBLIC HEALTH PROBLEMS LIKE HYPERTENSION AND MINORITY HEALTH AND COMMUNITY HEALTH. SO I THINK SOME OF IT IS VALUE DRIVEN BY WHAT HAS BEEN VALUED. SO WE RANK AT THE LOW SUCCESS TOPICS, MAYBE BECAUSE THEY ARE NOT AS GOOD APPLICATIONS OR BECAUSE REVIEWERS DON'T CONSIDER THEM AS GOOD SCIENCE. >> YOU CAN HAVE YOUR OWN REVIEW GROUP ORGANIZED AS WE DID FOR OUR CLINICAL STUDIES, WHICH WE THOUGHT WAS REALLY IMPORTANT, PARTICULARLY FOR OUR CLINICAL TRIALS? >> I THINK CSR NEEDS TO SEE MORE OF OUR VOLUME COME OUT. AND I'M NOT SURE HOW WE WILL -- THAT IS WONG OF THE THINGS I HAVE DISCUSSED WITH RICHARD AND THERE IS ONE COMMITTEDY NOW THAT IS MORE ON THE SOCIAL BEHAVIORAL ASPECTS OF DISPARITIES. BUT NOT -- ONE REVIEW COMMITTEE. SO FOR SOME OF THESE WE DO OUR OWN REVIEW. ALL THE CENTERS ARE REVIEWED BY US AND SOME OF THE SET ASIDES WE WILL REVIEW OURSELVES. THEY DO IT THANK YOU A PAR MECHANISMS. OTHERS WE'LL SEE. IT'S A GRADUAL PROCESS. SOME OF IT IS NOT DISPLACING ANYTHING BUT CHANGING THE CULTURE ABOUT WHAT IS CONSIDERED TO BE HIGHER QUALITY. AND I DO THINK THAT THE CLINICAL SETTING IS ANOTHER PLACE WHERE WE OBVIOUSLY HAVE MUTUAL INTERESTS WHERE OFTEN THE SCIENCE IS NOT AS RIGOROUS AND BUT WE NEED TO DO THIS KIND OF RESEARCH. BECAUSE NIH IS CERTAINLY WITHIN OUR REALM AND THE NUMBER OFINS TRUST ARE INTERESTED IN THAT. >> I WAS DELIGHTED THAT YOUR LAST SLIDE TALKED ABOUT YOUR INTRAMURAL PROGRAM BECAUSE THERE IS A LOT OF POTENTIAL PARTICULARLY SIPS OUR FOCUS HAS TO HAVE A MAJOR FOCUS ON LUPUS IN OUR INTRAMURAL PROGRAM AS YOU PROBABLE HEARD AT THE END OF JOHN'S TALK. THAT IS A RYLE OPPORTUNITY FOR COLLABORATION. AND -- A REAL OPPORTUNITY FOR COLLABORATION. ANY OTHER COMMENTS? JOAN? >> I JUST WONDERED IF YOU COULD TALK A LITTLE BIT ABOUT EFFORTS FOR PIPELINE DEVELOPMENT TO BRING PEOPLE INTO THIS FIELD? >> SO, WE DON'T FUND MUCH IN THAT SPACE BECAUSE OUR BUDGET IS LIMITED. BUT I AND OTHERS WORK CLOSELY WITH HANNAH VALENTINE ON SOME OF THESE PROGRAMS. NIH BIG INVESTMENT RECENTLY WAS ON THE BUILD PROGRAM AND THE INTERIM MENTORING NETWORK IT'S AN EXPERIMENT THAT IS - GOING AND I HAVEN'T HEARD ANY PRELIMINARY RESULTS AS OF YET. SHE CALLED ME IN ALONG WITH A COUPLE OTHER DIRECTORS WHEN THERE ARE ISSUES FOR ROUTINE STUFF. SO WE'LL SEE. THAT IS A 10-INSTITUTION PAYER OF LOW RESEARCH INTERNSIVE PAIRED WITH A MORE RESEARCH ORIENTATION INSTITUTION TO GET STUDENTS ENGAGED IN REACH EARLY SO THEY HAVE 50-70% MINORITY STUDENTS AND THEN GET INVOLVED IN RESEARCH TO SEE IF WE CHANGE THE NUMBER THAT END UP GOING INTO RESEARCH. AND THE MENTORING NETWORK IS WORKING AT THE OTHER END OF THE PIPELINE WHICH IS WHERE I HAVE MORE PERSONAL EXPERIENCE. TO TAKE POSTDOCS AND ASSISTANT PROFESSORS AND PROVIDE MENTORING FOR THEM INTO ANYTHING, EACH VIRTUALLY, MUCH OF IT IS DONE VIRTUALLY BECAUSE THERE IS NO CONCENTRATION AT MOST INSTITUTIONS AND BY DISCIPLINE. AND THERE ARE 5 SITES ACTIVE IN THIS. ONE IS BASIC SCIENCE FOCUSED. I KNOW THAT MANSON HAS ONE OF THE SITES FOCUSED ON AMERICAN INDIANS. THERE IS ANOTHER ONE IN MINNESOTA AND ONE IN BOSTON AND I THINK IN TEXAS IS ANOTHER ONE. SO I THINK WHERE THEY GO WITH THAT, I THINK WE'LL HEAR. BUT IT'S FAIRLY NOVEL IN ITS APPROACH AND WE'LL SEE HOW -- AND I THINK THAT'S A WAY FOR FUTURES TO DO MORE. I MENTOR AN ASSISTANT PROFESSOR IN TEXAS WHO WAS A POSTDOC AT UCSF. I NEVER WORKED WITH HIM. I'M TRYING TO WORK WITH HIM AND MEET WITH HIM ON THE PHONE ONCE A MONTH AND SO ON. >> ONGOING EXPERIMENT. >> YES. I WILL SAY, THOUGH, THAT THERE ARE MANY MORE MINORITIES IN SCHOOL AND IN GRADUATE SCHOOL AND FINISHING PH.D.s. SO THE PIPELINE IS NOT 5%. WE ARE NOW BARRIERS GOING FROM GOT YOUR PH.D., DO YOU GO TO A RESEARCH POSITION? AND IF YOU'RE IN A RESEARCH POSITION POSTDOC, USUALLY, COULD GET A FACULTY EQUIVALENT POSITION ORB A SCIENTIST POSITION. SO I'M NOT AS FAMILIAR WITH THE DETAILS ON THAT DATA BUT THE PIPELINE IS NOT AS EMPTY AS IT -- I USED TO THINK IT WAS. >> IN CLOSING, I WANT TO GIVE AN OPPORTUNITY TO STEVE OR KRISTI TO MAKE ANY COMMENTS IF THEY WISH. I KNOW THEY ARE ON MUTE SO I WANT TO GIVE THEM A SECOND TO RESPOND. IF NOT, ON BEHALF OF ALL OF US, THANK YOU VERY MUCH. REALLY INTERESTING. YOU UNDERSCORED WHAT I SAID IN THE BEGINNING. IT'S ALL OF OUR RESPONSIBILITIES. >> THANK YOU, STEVE. THANK YOU TO EVERYBODY. [ APPLAUSE ] >> NOW AN UPDATE ON THE MOLECULAR TRANSDUCERS OF PHYSICAL ACTIVITY IN HUMAN PROGRAMMING OTHERWISE KNOWN AS THE MOTOR PACK. AND I CAN SAY THAT SINCE I WAS THERE, JOAN McGOWAN HAS BEEN LEADING THIS EFFORT FOR -- I GUESS IT MUST BE 3-4 YEARS, AND HAS MADE PRESENTATION UPON PRESENTATION ON THIS WHOLE CONCEPT SHE IS GOING TO TALK ABOUT, THAT HAS FINALLY COME. IT'S NOT COME TO FRUITION. IT'S COME TO INITIATION. AND INITIATION IS THAT THE NIH IS INVESTIGATING THIS. THIS IS NOT SOMETHING THAT WAS DONE OVERNIGHT. THIS HAS BEEN SOMETHING IN THE MILL FOR 3-4 YEARS. IT IS STILL VERY CONTEMPANUSLY, VERY IMPORTANT IN TERMS OF THE FUTURE. SO, WITH THAT, JOAN, THREE INSTITUTES ARE INVOLVED. JOAN HAS REALLY BEEN THE MAJOR ONE IN TERMS OF LEADING THISSEST. >> THANK YOU, STEVE AND THANK YOU FOR ASKING ME TO UPDATE THE COUNCIL AGAIN. I WOULD SAY THAT PROBABLY A LOT HAS HAPPENED SINCE I SPOKE IN SEPTEMBER, I THINK OF 2015. SOME OF YOU MAY REMEMBER IT. I CAN SAY, TO EVERYONE, IT REALLY HAS A LONG HISTORY AND IT TAKES A LONG TIME TO DEVELOP SOMETHING LIKE THIS. AND I'M REALLY GLAD WE ARE STILL CONTEMPORARY STATE-OF-THE-ART. I THINK THERE WAS A PERFECTED STORM THAT ENABLED THIS PARTICULAR PROJECT TO MOVE FORWARD AND TO LAUNCH. AND THAT EN TALED MANY OF THENCEITUTES, IF NOT ALL, A LONGSTANDING INTEREST IN EXERCISE AND PHYSICAL ACTIVITY AND THE RELATIONSHIP TO THEIR PARTICULAR DISEASES AND TO HEALTH IN GENERAL. LOTS EVER OBSERVATIONAL STUDIES SHOWING THAT PEOPLE WHO EXERCISE LIVE LONGER, MORE PHYSICAL ACTIVITY YOU DO THE LOWER YOUR RISK OF NAME IT. SO MANY DISEASES. THE SECOND MAJOR THING WE ARE STANDING ON TOP OF A DECADE OF RESEARCH DEVELOPMENTS IN ALL OF THE OMIC TOOLS AND TECHNOLOGIES THAT NOW ENABLE US TO DO SOMETHING LIKE MOTOR PACK. AND THE THIRD THING IS THE TREMENDOUS PUBLIC INTEREST. AS YOU KNOW, YOU SEE IN THE NEWSPAPER ALL THE TIME, THE PUBLIC IS TREMENDOUSLY INTERESTED IN HOW TO USE EXERCISE AND PHYSICIANS AND PUBLIC HEALTH PEOPLE ARE INTERESTED IN HOW TO GET PEOPLE TO EXERCISE. SO WE ARE COMING ALONG IN THE CONTEXT OF THAT ASKING A SOMEWHAT DIFFERENT QUESTION THAN HOW TO GET PEOPLE TO EXERCISE OR WHAT IS THE BEST EXERCISE FOR YOU. WE ARE ASKING HOW DOES IT WORK? AND OUR BIGGEST MILESTONE WAS PROBABLY THE PRESS RELEASE IN JUNE OF 2015 THAT ANNOUNCED THAT NIH WAS GOING FORWARD WITH THIS AND WAS GOING TO PUT 170 MILLION DOLLARS INTO FIRST SIX YEARS OF THE PROJECT. SO WE HAD A CELEBRATION. THEN I HAD THE NIMS COUNCIL MEETING AND SOON AFTER THAT, IN OCTOBER OF 15, WE RELEASED SIX FUNDING OPPORTUNITY I ANNOUNCEMENTS AND THEN IN MARCH, WE RECEIVED APPLICATIONS AND OVER THE SUMMER, THEY WERE REVIEWED LAST SUMMER OF 2016. FINALLY, IN DECEMBER, WE WERE ABLE TO MAKE SOME AWARDS AND QUITE SOON AFTER MAKING THE AWARDS, WE HAD OUR FIRST STEERING COMMITTEE IN JANUARY 9 AND 10. AND WE HAD 80 OR SO PEOPLE AND ONE OF THE CONFERENCE ROOMS, LIKE THIS, MEETING FOR THE FIRST TIME SO NOW ALL OF US AT NIH HAVE ABOUT 100 NEW FRIENDS, THE ONES WHO WERE THERE AND THE ONES BACK IN THEIR INSTITUTIONS AND WE ARE JUST THRILLED BECAUSE THIS GROUP, THIS IS OUR BRIAN TRUST. JUST TO REMIND YOU, THE GOAL OF THIS IS TO DISCOVER THE MOLECULES AND THE PATHWAYS THAT ARE RESPONSIBLE FOR PHYSICAL ACTIVITY BENEFITS AND THIS WAS THE COVER OF CELL METABOLISM JOURNAL THAT PREFACED AIR MEETING THEY HAD ON THE TOPIC AND NIH SUBMITTED THE COVER. IN ADDITION, GOING BACK TO PUBLIC INTEREST, "TIME" MAGAZINE HAD A COVER STORY ON THE EXERCISE CURE. I WOULD ARGUE THE U.S. NATIONAL INSTITUTES OF HEALTH IS ON THE BANDWAGON TOO, THEY MENTIONED THAT NIH WOULD LAUNCH THIS STUDY AND I THINK THEY GOT THE DESCRIPTION OF IT PRETTY ACCURATELY. AND THE PROJECT OVERVIEW ALSO SOME ANIMAL, NON VOLUNTEERS, WE NOW KNOW THAT THE ANIMAL MODEL IS THE RAT. WOULD BE EXERCISED ACCORDING TO A RIG RUSSLY-CONTROLLED PROGRAM OF EXERCISE -- RIGOROUSLY-CONTROLLED -- COLLECTING THE PARTICIPANT CHARACTERISTICS, AGE, SEX, FITNESS, ETHNIC, BACKGROUND, HOPE TO GET A VERY DIVERSE POPULATION. AND THAT BOTH FROM THE ANIMALS AND THE HUMANS WE WOULD COLLECT TISSUE SAMPLES. BLOOD, MUSSEL, ADIPOSE FROM THE HUMANS, FROM THE ANIMALS WE COULD LET A BIT MORE, HEART, LUNG, LIVER, BRAIN. TREMENDOUS INTEREST IN THE BRAIN. AND IT WOULD ALLOW US TO BOTH IDENTIFY, DISCOVER SOME MOLECULES AND THEN BEGIN TO LOOK AT THE PATHWAYS AND THE SYSTEMS BIOLOGY THAT CONNECT IT ALL. THIS TAKES A VILLAGE. SO THIS IS ONLY A PARTIAL PART OF THE NIH LEADERSHIP VILLAGE. AND WE HAVE FOUR INSTITUTES NOW IN A LEADERSHIP ROLE HERE. NIAMS, DR. KAATZ, NIDDK, DR. ROGERS, NIA, DR. HOSED AND WE HAVE JOINED BY NIBIB, DR. ROB PETTIGREW. WE REALIZED WHAT A TREMENDOUS BIO INFORMATICS PROJECT THIS IS GOING TO BE. SO SUPPORTING THOSE LEADERS AND ALSO THEIR VERY INVOLVED STAFF, IS A TRANS-NIH WORKING GROUP THAT HAS REPRESENTATIVES FROM 16 OR MORE -- IT KEEPS GROWING, INSTITUTES AND OFFICES LIKE THE OFFICE OF BEHAVIORAL HEALTH. THE NIH DIRECTOR'S OFFICE THAT RUNS THE COMMON FUND IS INTEGRAL TO THIS AND HAS BEEN INTEGRAL TO MOVING THIS FORWARD. AND WHEN WE DID A PRESS RELEASE IN DECEMBER ANNOUNCING AWARDS, DR. POLLACK WAS KIND ENOUGH TO DO A VIDEO FOR US ABOUT -- [ VIDEO PLAYING ] >> I REALLY TRANSCONGRESS UPON ANY SPEAKERS -- TRANSGRESS -- BY PUTTING DR. COLLINS IN THE MIDDLE OF MY TALK. BUT TO SEE THE REST OF THIS, YOU CAN SEE IT EMBEDDED IN THE PRESS RELEASE. AND DR. COLIPS WAS ALSO THERE AT THE STEERING COMMITTEE TO LAUNCH FOLKS. SO WE ARE VERY, VERY HAPPY TO HAVE THE EXERCISER -- OH, DEAR. [ VIDEO PLAYING ] NOT TO CUT OFF DR. COLIPS BUT IT'S A YouTube VIDEO AND WE WOULD GET INTO SOME STUFF I SHOULDN'T SHOW IF WE WENT TO THE END OF DR. COLLINS REMARKS. BUT, HE ALWAYS MAKES A POINT FOR ANY PROJECT HE GETS BEHIND. AND SO I DON'T HAVE TO ANSWER THE QUESTION ABOUT THE RELATIONSHIP TO THE PMI. CAN SAY THAT HE IS MAKING THAT RELATIONSHIP. SO WHAT HAVE WE DONE? THE PROGRESS IS WE MADE 19 AWARDS. AND WE HAVE BEEN ABLE TO ORGANIZE A TRANS-NIH INFRASTRUCTURE TO MANAGE THE PROJECT THAT IS INCREDIBLY IMPORTANT. WE FORMED A STEERING COMMITTEE FROM THOSE 19 AWARDS AND ALSO A SMALLER EXECUTIVE COMMITTEE TO FEED INTO THE STEERING COMMITTEE WITH REPRESENTATIVES FROM EACH OF THE MAJOR AREAS. WE APPOINT SOMEDAY PROGRAM CONSULTANTS THAT ARE EXTERNAL SCIENTISTS WHO WILL ALSO HELP NIH TO OVERSEE THE PROGRAM. THEY'LL MAKE RECOMMENDATIONS TO US ABOUT POTENTIAL CHANGES OR OPPORTUNITIES WE MAY BE MISSING. IT'S A SMALL GROUP NOW JUST FIVE SCIENTIST BUT WE COULD BE ADDING TO THAT IN THE FUTURE. AND WE ALSO HAVE FORMED AND APPOINTED LEADERSHIP FOR THE CRITICAL SUBCOMMITTEES THAT WILL BE DOING THE WORK OF PUTTING TOGETHER THE STRINGENT EXERCISE PROTOCOLS AND DECIDING ON THE TIMELINE IN WHICH OMIC TOOLS ARE GOING TO BE APPLIED TO THE SAMPLES AND ALL OF THE IMPORTANT OTHER THINGS THAT THIS PROJECT IS GOING TO HAVE TO DECIDE. SO, IT'S IMPORTANT THAT WE HAVE A CONSORTIUM COORDINATING CENTER, WHICH THAT STEERING COMMITTEE, WE TURNED OVER FROM THIS ALL BEING ON NIH TO HAVING A TRUST OF PEOPLE SITTING AROUND THE TABLE AND THAT WAS A GREAT JOY TO ME TO FINALLY HAVE ALL OF THESE OTHER BRAINS NOW INVOLVED. WE HAVE A FANTASTIC BIO INFORMATICS CENTER. 7 CLINICAL CENTERS TO ENROLL PARTICIPANTS, INCLUDING ONE PEDIATRIC CENTER. 7 OF THE CHEMICAL ANALYSIS SITES AND 3 PRE-CLINICAL ANIMAL SITES. AND ONE NEVER COMPLIMENTARY COVERS THE COUNTRY BUT THEY ARE ALL OVER THE PLACE. THEY ARE COLOR-CODED. YOU HAVE TO MEMORIZE THE COLOR-CODE BAUDS I MAY USE IT AGAIN AND NOT TELL YOU WHO IS WHO. BUT THE DOTTED LINEUPS INDICATE THAT MANY CAME IN MULTI-PI AWARDS. SO EACH THE COORDINATING CENTER HAS THREE SEPARATE SITES. SO WE GOT REALLY A LOT OF BRAINPOWER FOR OUR INVESTMENT AND THAT WILL BE TREMENDOUSLY USEFUL. PART OF THE INFRASTRUCTURE AT NIH IS PUTTING TOGETHER A MANAGEMENT TEAM. AND WE HAVE ALL FOUR OF THOSE INSTITUTES INVOLVED IN THE MANAGEMENT TOO. THE NIDDK IS INVOLVED WITH MANAGING THE CHEMICAL ANALYSIS CENTERS AS YOU MIGHT MANUAL IN. THE BIO INFORMATICS CENTER -- MANAGINE - IS MANAGED BY NIBIB WITH A PROGRAM DIRECTOR AND SCIENTIST FROM NIDDK. THEY ARE A MIXED SET. PRE-CLINICAL ANIMAL SITES ARE MANAGED BY THE NIA. AND THE CLINICAL CENTERS ARE MANAGED BY AMANDA AND LEE WITH CHARLOTTE PETERSON WORKING AS THE PROJECT SCIENTIST ON THESE AGREEMENTS. AND NOTHING HAPPENS WITHOUT PEOPLE. AND THESE ARE THE NIAMS STARS OF THIS PROJECT WHO WORK INCREDIBLY HARD WITH THE OTHER INSTITUTE STAFF. AMANDA IS THE PROGRAM DIRECTOR FOR THE COORDINATING CENTER AND LEE FOR THE CLINICAL CENTERS. AND LEE AND AMANDA WERE ALSO INVOLVED IN WRITING THE FUNDING OPPORTUNITY ANNOUNCEMENTS. CHARLOTTE PETERSON IS THE PROJECT SCIENTIST FOR BOTH OF THOSE AND I HAVE TO SAY THAT ANITA AND HER GROUP HAVE BEEN INCREDIBLY GENEROUS IN SUPPORTING US IN NOT JUST SUPPORT SERVICES BUT INTELLECTUAL AND JOE NEL, THE SCIENCE POLICY ANALYST, IS THE ORGANIZATIONAL GENIUS. AND ALL OF THEIPSITUTE STAFF ARE ABSOLUTELY -- INSTITUTE STAFF ARE IN AWE OF JOE NEL. WE WOULDN'T BE WHERE WE ARE WITHOUT THE GRANTS MANAGEMENT TEAM OF MELINDA NELSON AND KATY. TRISH REYNOLDS WHO IS IN THE OTHER ROOM LIFT EPING TO THIS. TRISH IS OUR -- LISTENING TO THIS. SHE IS OUR COMMUNICATIONS LEADER. WITH THE MULTIPLE INSTITUTES INVOLVED IN THIS, MELINDA AND TRISH HAVE BEEN LEADING THE OTHER INSTITUTES IN THESE EFFORTS. AND KRISTI NIX HAVE BEEN SUPPORTING AMANDA AND LEE WHILE THEY PURSUE THEIR HOB NEMOTOR PACK. SO THE STEERING COMMITTEE CONSISTS OF 35 PRINCIPLE INVESTIGATORS WITH 19 VOTES. EACH AWARD HAS ONE VOTE. AND THE FOUR MOTOR PACK COORDINATORS FROM THE FURRINESSESITUTES ARE ON THIS COMMITTEE AND WE HAVE ONE VOTE ON THE STEERING COMMITTEE. SO THERE IS 20 VOTES ON THE STEERING COMMITTEE. THAT COMMITTEE HAS ALREADY BROKEN DOWN INTO SOME SUBCOMMITTEE STRUCTURES THAT WILL ACTUALLY ENABLE ALL THE WORK THAT HAS TO BE DONE TO PUT TOGETHER ALL THE DOCUMENTATION, DECIDE ON PROTOCOLS, ARGUE OUT WHAT EXERCISE AND RESIST OPENS OR AEROBIC OR BOTH ACTUALLY, THAT WORK WILL BE DONE IN THE SUB COMMITTEES AND WE HAVE AN EXECUTIVE COMMITTEE ALSO THAT HAS A REPRESENTATIVE FROM EACH OF THOSE COMPONENTS, CLINICAL, ANIMAL AND BIO INFORMATICS, ET CETERA. IN ADDITION, WE HAVE THOSE PROGRAM CONSULTANTS, THE EXTERNAL ADVISORS, AND WE WILL HAVE A DATA SAFETY AND MONITORING BOARD AND WE HAVE A LARGE GROUP OF NIH WORKING GROUP REPRESENTING MOST OF THE INSTITUTES AT NIH. WE ARE WORKING TOWARDS A SINGLE IRB AND WORKING WITH NCATS. YES, WE KNOW HOW TO SPELL NCATS. THEY ARE RIGHT UPSTAIRS FROM US. AND WE ARE TALKING ABOUT WORKING WITH THE DUKE TICK. TRIAL UP OVATION NETWORK. IT'S BEEN ENORMOUSLY HELPFUL BECAUSE WE HAVE SO MANY REPRESENTATIVES ON THE WORKING GROUP, IF ANYTHING COMES FOLLOW-UP WE HAVE A PROBLEM, WE HAVE A GO-TO PERSON THAT WILL HELP US FROM THE WORKING GROUP. SO WE HAVE ONE FROM NCATS WHO IS HELPING US. THE LEADERSHIP TEAM IS FANTASTIC. WENDY FROM THE UNIVERSITY OF COLORADO IS THE CHAIR OF THE STEERING COMMITTEE. MARCO IS THE LEAD SCIENTIST OF THE COORDINATING CENTER AND THOSE TWO PROVIDED US WITH A TERRIFIC STEERING COMMITTEE MEETING. MARCUS FROM THE UNIVERSITY OF ALABAMA REPRESENTING CLINICAL SITES, KARIN FROM THE UNIVERSITY OF FLORIDA MUSCLE RESEARCHER WELL-KNOWN TO US, IS THE EXECUTIVE GROUP REPRESENTATIVE FROM THE ANIMALS. AND EUAN FROM STANFORD REPRESENTED BIO INFORMATICSENT AND CHARLES THE UNIVERSITY OF MICHIGAN, THE CHEMICAL ANALYSIS SITES. AND THAT HAS BEEN A WONDERFUL TEAM. WE STARTED WORKING WITH THEM AS SOON AS WE MADE THE AWARDS IN DECEMBER GETTING READY FOR WHAT WAS A VERY FERTILE FIRST STEERING COMMITTEE MEETING. AND ONE OF THE FIRST VOTES OF THE STEERING COMMITTEE WAS TO DECIDE ON THE COMMITTEES AND TO NOMINATE AND THEN VOTE ON CHAIRS AND CO-CHAIRS OF THOSE LEAD COMITIES. THOSE COMMITTEES WILL BREAKDOWN INTO WORKING GROUPS TO DO SOME SPECIFIC THINGS. BUT YOU GET TO SEE WHAT A LARGE AND COMPLICATED THING THIS IS GOING TO BE. ONE OF THE THINGS WE WORRIED ABOUT WAS THE INTERGRATION OF FIELDS. WE HAVE ANIMAL PHYSIOLOGISTS, WE HAVE HUMAN EXERCISE PHYSIOLOGISTS. WE HAVE METABOLOMICS EXPERTS. WE HAVE BIO INFORMATICS EXPERTS. AND THIS IS GOING TO BE A CONTINUING INTEGRATION PROBLEM BUT IT HAS WORKED WONDERFULLY SO FAR. EVERYONE WAS SO EXCITED TO BE PART OF THIS. EVERYONE IS PLAYING NICE IN THE SAND BOX SO FAR. SO, WHAT DO WE THINK WE CAN COMP SPLISH LET'S TAKE A LONG VIEW AFTER WE ANALYZE ALL OF THOSE SAMPLES AND MAKE SENSE OF THEM. WE THINK WE CAN ENABLE AND ENCOURAGE RESEARCH TO DEFINE THE MECHANISMS FOR THE HEALTH BENEFITED OF PHYSICAL ACTIVITY. PROVIDE SOME MEASURABLE OUTCOMES THAT WILL ENABLE THE USE OF PHYSICAL ACTIVITY INTERVENTION IN BASIC AND CLINICAL STUDIES OF HEALTH AND DISEASE. ONE CLINICAL TRIALS WE HAVE THAT WE ALL LIKE TO POINT TO IS THE DIABETES PREVENTION TRIAL THAT PITTED LIFESTYLE, EXERCISE AND DIET AGAINST METFORMIN. AND LIFESTYLE WON. SO, I THINK THIS IS SOMETHING THAT YOU WOULD LIKE TO SEE MORE OF. WE WOULD LIKE TO SEE PHYSICAL ACTIVITY AT THE HEAT AND PERHAPS DIET, INTEGRATED INTO STUDIES OF PHARMACOLOGIC ACTION OF DRUGS TO SEE WHETHER THEY CAN BE BETTER THAN OR AT LEAST ADJUNCTIVE TO THE KIND OF PHARMACEUTICAL TOOLS WE HAVE. WE ALSO LIKE TO PROVIDE NOVEL MOLECULAR DEFINITIONS FOR FITNESS AND EXERCISE RESPONSE AND WE REALIZE NOT EVERYBODY RESPONDS IN THE SAME WAY TO EXERCISE EVEN IF WE COULD FORCE EVERY PERSON TO DO THE EXERCISE THEY WOULDN'T RESPOND THE SAME WAY. TO PROVIDE SOME PREDICTORS FOR THE HEALTH RESPONSES TO PHYSICAL ACTIVITY AND TO GENERATE NOVEL, TESTABLE MECHANISTIC HYPOTHESES REGARDING NORMAL PHYSIOLOGY AND DISEASE. AND AS THE FURTHER WE GET DOWN HERE, THE MORE IT'S GOING TO BE OUTSIDE OF THIS COB SORT YUM WITH YOU RATHER THE USER -- CONSORTIUM -- ALL OVER THE WORLD WHO WILL DOT REAL ACCOMPLISHMENTS OF THIS. SO AND FINALLY, BACK TO THE PUBLIC. HOPEFULLY TO ANSWER SOME OF THESE QUESTIONS FOR THEM LIKE, HOW DOES PHYSICAL ACTIVITY LOWER MY RISK OF DIABETES OR MY RISK OF CARDIOVASCULAR SKIIS? OR PREVENT FALLS? -- CARDIOVASCULAR DISEASE. WE HOPE THERE WILL BE A GIANT SCIENTIFIC EFFORT BUT ALSO A CONTINUED PUBLIC INTEREST AND SOME BENEFIT TO THE PUBLIC. SOMETHING THAT HELPS US TO REAP WHAT SEEMS TO BE THE POLYPILL FOR HEALTH. SO THANK YOU VERY MUCH. IF STEVE ALLOWS, I'LL TAKE QUESTIONS NOW OR THROUGH LUNCH. >> ANYONE WANT TO KNOW ABOUT THE POLYPILL? WE HAVE HEARD THAT BEFORE. BUT I THINK THIS IS -- I HOPE YOU GOT IT FROM THIS, IT'S A MAJOR, MAJOR EFFORT THAT IS TO GET ANSWERS TO THESE IMPORTANT QUESTIONS THAT JOAN HAD ON HER LAST FEW SLIDES BUT ALSO TO BUILD A RESEARCH RESOURCE THAT CAN BE USED FOR SOMETIME IN TERMS OF BOTH ANIMAL RESOURCES AND HUMAN RESOURCES. SO LET'S START WITH ALEX. >> THANK YOU, STEVE. THIS WAS FASCINATING. I HAD ONE SPECIFIC QUESTION WHICH IS, YOU'RE COLLECTING DATA ON 3000 PEOPLE IN THIS STUDY. HOW ARE YOU THINKING ABOUT THE RANGE OF DATA ARE COLLECTING? I ASK IT FROM A POSITION OF NOT THE SPECIFICITY OF WHAT ARE YOU DOING FOR THESE 3 THOUSAND PEOPLE, BUT GIVEN THE CHANCE TO OBSERVE 3000 PEOPLE, HOW ARE YOU THINKING BEYOND THE IMMEDIATE NEEDS AND WHEN YOU CAN USE THIS FOR IN THE FUTURE. MAW MAY BE ABLE TO COLLECT DATA THAT MAY NOT BE HELPFUL TOMORROW BUT MAYBE 5-10-15 YEARS FROM NOW AS OTHER STUDIES COME ALONG. >> THAT'S A VERY IMPORTANT QUESTION AND IT'S THE SAME ONE THAT TROUBLES OR CHALLENGES PMI. IN FACT, I HAD A CHALLENGE SLIDE THAT I LEFT OUT. THE CHALLENGE IS THAT WE CAN'T DO EVERYTHING IN THE LIMITED TIME THAT WE EXPECTED TO HAVE WITH THESE FOLKS. SO, THAT IS SOMETHING THAT THE SUB COMMITTEES ARE LOOKING AT RIGHT NOW. AND THEY HAVE ACTUALLY GOTTEN SO EXCITED, THERE A SCHEDULED ANOTHER FACE-TO-FACE FEBRUARY 4 AND 5 OVER THE WEEKEND. AND NIH WILL BE THERE TO DISCUSS ISSUES LIKE, WHAT KIND OF QUESTIONNAIRES? IT DEPENDS. THE NIH FOLKS IN LEADERSHIP WE PRESENTED TO, WERE VERY ADAMANT THAT WE CAN'T JUST GO DISCOVER MOLECULES. WE HAVE TO CONNECT THEM TO SOMETHING. SO, PART OF YOUR QUESTION IS, WHAT OUTCOMES ARE WE GOING TO LOOK AT TO SAY, IT'S MADE A DIFFERENCE AFTER A 12-WEEK EXERCISE PERIOD? SO THERE IS A TREMENDOUS INTEREST IN COLLECTING SOME KIND OF COGNITIVE BEHAVIORAL, OUTCOMES, OBVIOUSLY VO2 MAX TO IMPROVE YOUR VO2 MAX, WHICH IS A GREAT HEALTH BENEFIT. SO, THEY ARE CONNECTED BUT LIMITED. AND WE WON'T, LIKE THE PMI, ARE ALL ABOUT US, KEEP FOLLOWING THESE PEOPLE. IT COULD HAPPEN BUT THE INTENT IS NOT TO FOLLOW THEM FOR A REALLY LONG TIME. SO THAT IS A VERY CHALLENGING QUESTION. WHAT ARE YOU GOING TO COLLECT? BESIDES THE OBVIOUS THINGS THANK YOU CAN. AND ANOTHER PART OF THAT, THAT I THINK PMI ITEMELS WITH IS THAT WE DID AT THE FIRST STEERING COMMITTEE, WHAT ARE YOU GOING TO GIVE THEM IN TERMS OF FEEDBACK? TIME WISE YOU COULD HAVE A PARTICIPANT GIVE THEM A CHOLESTEROL VALUE AND THEY ARE LIKE, I KNOW MY NUMBER. BUT NOW WE NEED TO GIVE THEM BETTER FEEDBACK THAN THAT. SO WE ARE THINKING ABOUT THOSE ISSUES. >> HOW ARE YOU RECRUITING THESE HOME. >> ARE THEY VOLUNTEERS OR SOME OTHER INDUCEMENTS? I WAS WONDERING ARE YOU SELECTING FOR PEOPLE WHO ARE MOTIVATED TO EXERCISES AND MIGHT THERE BE PEOPLE WHO ARE NOT MOTIVATED LIKE THE COUCH POTATOES? >> THAT IS A VERY CHALLENGING QUESTION TOO. THE THOUGHT IS THAT MOST OF THE PEOPLE WE RECRUIT ARE GOING TO BE SEDENTARY, OF COURSE VOLUNTEERS. AND REALLY DON'T HAVE A WAY TO COERCE PEOPLE INTO DOING THIS. BECAUSE OF THE SAMPLES THAT ARE TAKEN, THEY'LL PROBABLY BE PAID VOLUNTEERS. BUT, TO SEE BIGGEST DIFFERENCE, THEY'LL LARGELY BE SEDENTARY VOLUNTEERS AND WE HAD INCREDIBLE CLINICAL SITES THAT THINK THEY HAVE DEPUTY BEFORE ON A SMALL SCALE, AND THEY BELIEVE THEY CAN GO OUT INTO THEIR COMMUNITIES, AND NOT ALL OF THEM HAVE A REALLY DIVERSE COMMUNITY BUT THERE ARE SEVERAL THAT CAN TAP IN, IN TEXAS TO HISPANIC POPULATIONS, IN LOUISIANA TO AFRICAN-AMERICAN POPULATIONS. THEY HAVE RECRUITED BEFORE FOR EXERCISE STUDIES AND THEY THINK THEY CAN DO IT AGAIN. SO, ULTIMATELY, OF COURSE VOLUNTEERS BUT THEY'LL BE A TREMENDOUS OUTREACH AND THERE IS -- >> IT SHOULD BE MENTIONED THERE IS A PEDIATRIC COMPONENT HERE IN TERMS OF AGE GROUP. >> SO ONE SITE AT UCAL IRVINE IS GOING TO RECRUIT CHILDREN FROM 10-18. THEY WON'T BE DOING AS MUCH AS THE OTHER. >> PROBABLY NO MUSSEL BIOPSIES. >> NO MUSCLE BIOPSIES. >> LET'S MOVE ON WITH THE QUESTIONS. >> THIS IS TREMENDOUS. JUST WOLF SEE IT MOVING ON. I THINK IT WILL BE REALLY IMPORTANT -- WONDERFUL. -- I'M WONDERING AND MAYBE THIS IS PREMATURE BUT PART OF THIS YOU TALKED ABOUT WAS GENERATING HYPOTHESES AND THOSE KINDS OF THINGS. ARE THERE WAYS THAT WE CAN START TO PREPARE THE COMMUNITY THAT MIGHT BE PERFORMING THOSE STUDIES ABOUT WHAT IS COMING UP IN IT'S SORT OF RELATED TO WHAT WE TALKED ABOUT BEFORE. >> WE HAVE A TRAVELING ROAD SHOW. WE WILL SEND PEOPLE TO YOUR MEETINGS AND WE ARE GOING TO ANOTHER CELL METABOLISM MEETING AND WE'LL BE ABLE TO DO A POSTER THAT BASICALLY SHOWS WHERE THIS IS GOING. AND THE COMMUNICATIONS OFFICE IN THE OFFICE OF THE DIRECTOR WILL DO A LOT OF OUTREACH LETTING PEOPLE KNOW WHAT IS GOING ON. >> JOAN, THIS IS FASCINATING. JUST A QUESTION FOR MY CURIOSITY IN TERMS OF EXERCISE PROTOCOLS. THERE IS INCREASING EVIDENCE THAT DIFFERENT PEOPLE ARE GOING TO RESPOND DIFFERENTLY TO MAYBE DIFFERENT EXERCISE REGIMENS AND JUST AS AN EXAMPLE WHETHER YOU DO HIGH INTENSATED TRAINING VERSUS JUST REGULAR EN DURANCE TRAINING AND SO FORTH. AND QUESTIONS FOR THOSE KINDS -- THE ANSWERS TO THOSE QUESTIONS ARE POTENTIALLY QUITE INTERESTING. HOW DOES THE GROUP DESIGN THESE EXERCISE INTERVENTIONS TO TRY TO LOOK AT PERHAPS AT THE END OF THE STUDY BEING ABLE TO TAILER SPECIFIC EXERCISE REGIMENS TO WHAT THEY MIGHT RESPOND TO BEST? >> THAT'S ANOTHER VERY CHALLENGING QUESTION. AND THE STUDY ITSELF IS NOT GOING TO BE ABLE TO DETERMINE WHETHER ONE TYPE OF EXERCISE IS BETTER THAN THE OTHER. THE GROUP MEETING IN A WEEK OR SO IN -- ORLANDO, ARE GOING TO BE FINDING OUT DIFFERENT PROTOCOLS. 7 PEOPLE PRESENTED 7 DIFFERENT EXERCISE PROTOCOLS FOR US TO USE. THE GOAL OF THE EXERCISE PROTOCOL IS THE DISCOVERY OF MOLECULES. SO, WE WON'T BE ABLE IN THAT, TO SAY YOU SHOULD HIT JUST ADDS GOOD AS 30 MINUTES OF AEROBIC EXERCISE OR -- WE WILL COMPARE RESISTANCE AND AEROBIC EXERCISE. BUT I THINK THE WAY DR. COLLINS PUT IT, WE WOULD KNOW SOMETHING MORE ABOUT AN EXERCISE PRESCRIPTION, THAT DEPENDS ON THE DISCOVERY OF THE MOLECULAR TRANSDUCERS BECAUSE LOOKING AT THE PATTERN OF TRAPS DEUCERS IS THEN GOING TO ENABLE US -- TRANSDUCERS -- TO LOOK AT THE RESPONSIVENESS OF INDIVIDUALS TO DIFFERENT TYPES OF EXERCISES AND DIFFERENT AMOUNTS OF EXERCISE. >> I THINK WHAT JOAN JUST SAID IS REALLY THE CRUX OF THIS. IT'S A DISCOVERY INITIATIVE. THERE WILL BE MANY TWICE DRIVE THE DISCOVERY. MAG DELENA? >> THERE ARE MANY DIFFERENCES BETWEEN HISPANIC GROUPS. ARE YOU INTENDING TO ALSO REACH -- [ INDISCERNIBLE ] OR JUST WANT TO FOCUS ON MEXICAN-AMERICAN? >> WE ARE LIMITED AS MOST STUDIES THAT ARE COLLECTING 3000 PEOPLE IN 7 SITES. WE RECOGNIZE THE DIFFERENT PARTS OF THE COUNTRY WILL DIFFER, FOR EXAMPLE, IN HISPANIC SUBGROUPS. AND PROBABLY WE'LL HAVE THE LARGEST PROPORTION OF HISPANIC IN THE HISPANIC-RICH TEXAS, MAYBE SOME OTHER AREAS. LEE KNOWS WHAT THEY HAVE PROPOSED. BUT, THE INTENT IS TO BE DIVERSE AND BEING DIVERSE, WE CAN'T DRILL DOWN TOO MUCH BELOW THE LARGER CATEGORIES THAT ARE EASIER TO GET. WE HOPE EVERYONE WILL COME IN. >> SO IT'S MORE OF A STATEMENT THAN A QUESTION. FIRST THANK YOU AND NIH FOR TAKING THIS. AS A PERSONAL TESTIMONY, I WAS DIAGNOSED WHEN I WAS 25, ALMOST 45 YEARS AGO NEXT MONTH WITH RHEUMATOID ARTHRITIS AND COULD BARELY WALK AFTER A COUPLE OF YEARS. I WAS ON METHOTREXATE ET CETERA. I DECIDED TO WEAN MYSELF OFF AND EXERCISE EVERY DAY RELIGIOUSLY. AND I GIVE THAT IN MY OWN HEALTH I GIVE THAT ALL THE CREDIT IN THE WORLD. THAT MADE A DIFFERENCE FOR ME. SO I HAVE BEEN PREACHING THIS FOR 40 YEARS THAT I BELIEVE THIS IS A VERY IMPORTANT TOPIC AND THE MORE WE CAN DO THE BETTER. >> SPOKESPERSON! [ LAUGHS ] >> HE IS A GREAT SPOKESPERSON. I THINK THAT WHAT WE'D LIKE TO KNOW IS, WHY, THAT HAPPENS. NOT TO FIND THE PILL BUT WHY IT HAPPENS. WE KNOW SOMETHING ABOUT AT THE ASB MEETING A FEW YEARS AGO, IT WAS A SESSION ON BONE, MUSCLE INTERACTIONS,. BUT I THINK WE WERE THWARTED IN THIS INITIATIVE LONG AGO BECAUSE WE COULDN'T GET ALL OF THE ORGAN SYSTEMS INTERESTED. AND I THINK JOAN AND HER COM PATRIOTS FROM DDK -- NIDD. AND ALSO FROM AGING, REALLY GARNERED SUPPORT BECAUSE FROM OTHER INSTITUTES BECAUSE THAT IS THE ONLY WAY TO GET A PROJECT LIKE THIS. SO, THANK YOU VERY MUCH. THANK YOU AGAIN JOAN FOR YOUR PRESENTATION. NEXT AN UPDATE ON THE NIMS CENTERS PROGRAM. IT WAS GOING TO BE GIVEN BY SUE SANA STEIN WHO IS OUT TODAY UNFORTUNATELY BUT -- THAT'S THE BAD NEWS. THE GOOD NEWS IS WE HAVE KARL BAKER WHO IS ALSO IN THE DIVISION OF SKIN AND RHEUMATIC DISEASES AND WHO KNOWS A LOT ABOUT THIS AND WILL BE PRESENTING THIS UPDATE. >> OKAY. SO, TODAY THIS TOPIC WILL BE PRESENTING TO THE MEMBERS OF THE NIAMS COUNCIL AN UPDATE ON HOW WE HAVE IMPLEMENTED NEW CENTERS THAT DESIGN SUPPORT, SYNERGISTIC GROUPS OF INVESTIGATORS. I'M FIRST GOING TO GO THROUGH A LITTLE BIT ABOUT CENTERS EVALUATION WORKINGS GROUP THAT WAS CONVENED IN 2013 AND TALK ABOUT WHAT THEIR RECOMMENDATIONS WERE AND THEN TO DESCRIBE THE CHANGES WE MADE IN THE CENTERS PROGRAM AND SHOW YOU A FEW OF THE RESULTS OF RECENT CENTERS SOLICITATIONS. SO IN 2013, THIS IS WHAT SOUTHERN PROGRAM LOOKED LIKE. WE HAD OUR RESEARCH CORE CENTER THAT OFFERED CORE SERVICES. THESE WERE USUALLY HAB TORY-BASED SERVICES, CELL CULTURE AND ANIMAL WORK, HISTOLOGIY, ET CETERA. AND THEN WE HAD AP50 CENTERS OF RESEARCH TRANSLATION PROGRAM, WHICH FUNDED GROUPS OF RELATED PROJECTS THAT WERE FOCUSED ON DISEASE-FOCUSED TRANSLATIONAL PROJECTS AND THEN THE P60 PROGRAM WHICH IS THE MULTIDISCIPLINARY CLINICAL RESEARCH CENTERS, OFFERED CLINICAL METHODOLOGY COURSE AND ALSO SUPPORTED CLINICAL RESEARCH PROJECTS. NOW THE CENTER EVALUATION WORKING GROUP THAT I MENTIONED PREVIOUSLY WAS CONVENED IN 2013. THESE ARE THE OUTSIDE MEMBERS OF THAT GROUP AND I BELIEVE BOB CARTER WAS INVOLVED IN THIS PROCESS INTERNALLY AS WELL AS SOME OTHER MEMBERS OF OUR STAFF. >> AS WELL AS A CHAIR. >> YES. SO, THE CEWG REALIZED THERE WERE A SET OF COMMON VALUABLE GOALS THAT WERE SHARED ACROSS ALL OF THE TYPES OF CENTERS AND THAT BECAUSE OF THAT, THEY CHOSE TO REVIEW ALL THE CENTERS TOGETHER AND OFFER A COMMON SET OF RECOMMENDATIONS. THE GOALS I'M REFERRING TO ARE MENTIONED HERE. IT'S FOSTERING INTERDISCIPLINEIARY SCIENCE AND PROMOTING INNOVATION AND FACILITATING SHARING OF RESEARCH AND COUPLING WITH THAT, INCREASING THE COMMUNITY AWARENESS OF THOSE RESOURCES TO ENHANCE THEIR USE. THERE WAS ALSO A NEED AND THE RESEARCH COMMUNITY FOR SHARED CLINICAL METHODOLOGIES AND FINALLY, THE CENTERS CAN FOSTER MENTORSHIP AND TRAINING. SO, SOME OF THE RECOMMENDATIONS FROM THE CEWG ARE SHOWN HERE. ONE IS THAT NIAMS SHOULD ALLOW FLEXIBILITY AND DIE NAMISM IN THE DESIGN STRUCTURE AND CONDUCT OF THE CENTERS. AND THE SECOND IS THAT -- [ READING ] SO AS WE WERE REWORKING OUR CENTERS PROGRAMS, WE REALLY EMPHASIZED INNOVATION, FLEXIBILITY, SHARING OF RESOURCES AND OUTREACH EFFORTS TO PROMOTE THE SHARING OF RESOURCES AND WE MADE SOME CHANGES TO THE RESEARCH BASE AND I'LL TALK ABOUT THAT AS I GO FORWARD. SO, WHAT CAN YOU SEE HERE ON THE LEFT ARE THE CENTERS PROGRAMS AS WE HAVE THEM IN 2013 AND THEN THIS IS THE NEW GROUP OF CENTERS FUNDING OPPORTUNITIES THAT WE NOW HAVE THE RESEARCH CORE CENTERS AS BECOME RESOURCE-BASED CENTERS. THE CORE IS STILL THE CENTER OF RESEARCH TRANSPOLICE STATION THE MULTIDISCIPLINARY RESEARCH -- TRANSLATION MULTIDISCIPLINARY RESEARCH CENTERS. SO THE FIRST PROGRAM IS THE RESOURCE-BASED CENTER WHICH IS OUR ORIGINAL P30. THE MEAT OF THESE CENTERS ARE THE RESOURCE CORES. ONE CHANGE WE MADE WAS TO REQUIRE ONLY A SINGLE RESOURCE CORE SO THAT AN INSTITUTION OR PI THAT HAD VERY VALUABLE RESOURCE THAT THEY WANTED TO SHARE PERHAPS OVER A LARGER RESEARCH COMMUNITY, COULD DO SO. ALSO, WE EXPLICITLY ALLOWED CORES TO INCLUDE THE PROVISION OF A CRITICAL INFRASTRUCTURE TO SUPPORT BROAD SHARING OF ACCESSIBLE PRE-EXISTING PATIENT COHORTS AND REGISTRIES AND THE BASE WOULD BE CONTAINED IN PATIENT SAMPLES AND ASSOCIATED CLINICAL DAYLIGHT A SO THERE WERE P30s IN THE PAST THAT DID -- DATE. BUT WE WERE EXPLICITLY ALLOWING THAT TYPE OF A CORE. WE MANDATED ADMINISTRATIVE CORE IN A CENTER-RICH PROGRAM. ONE OF THE GOALS IS TO CARRY OUT THAT OUTREACH THAT WE TALKED ABOUT BEFORE. ADVERTISING THE AVAILABILITY WHERE SERVICES AND RESOURCES TO A LARGER SCIENTIFIC COMMUNITY. THESE ADMINISTRATIVE CORES CAN BE DESIGNED TO ENHANCE THE RESEARCH COMMUNITY, FOR EXAMPLE BY BRINGING IN NEW INVESTIGATORS OR ESTABLISHED INVESTIGATORS FROM OTHER FIELDS AND/OR TO PROMOTE UP OVATION AND RESEARCH ON THE TOPIC OF THE FOCUS OF THE CENTER. ONE OF THE WAYS THEY CAN DO THAT IS THROUGH A PILOT AND FEASIBILITY PROGRAM, WHICH IS CURRENTLY OPTIONAL. NOW WE ALSO ALLOWED FLEXIBILITY BY ADJUSTING THE FOCUS OF THESE CENTERS AND BE BROAD FOR EXAMPLE. ALL OF SKIN BIOLOGY AND DISEASES OR THEY CAN BE NARROWLY FOCUSED ON A SINGLE OR GROUP OF DISEASES OR EVEN AN AREA OF BIOLOGY. SO A LOT OF FLEXIBILITY THERE AND WE ARE ALLOWING THAT FOCUS TO ENCOMPASS BASIC TRANSLATIONAL AND/OR CLINICAL RESEARCH. NOW WE ALSO REVISED WHAT HAD BEEN CALLED THE RESEARCH BASE AND ARE NOW CALLING IT THE RESEARCH COMMUNITY. WHICH IN ESSENCE SILENT CORE SERVICES DOING RESEARCH WITHIN THE FOCUS OF THE CENTER. THE RESEARCH COMMUNITY IS EXPLICITLY ALLOWED TO BE DEFINED AT A NATIONAL, REGIONAL OR LOCAL INSTITUTIONAL LEVEL AND ONE OF THE THINGS WE ARE TRYING TO ACCOMPLISH WAS TO GET AWAY FROM THE IDEA OF THE RESEARCH BASE SIMPLY BEING A GROUP OF INVESTIGATORS THAT WERE HEAVILY FUNDED BY THE NIH. AND RECOGNIZING THAT FUNNING CAN CAN COME FROM A -- FUNDING CAN COME FROM A NUMBER OF SOURCES AND FINALLY, WE ADJUSTED THE BUDGET. SO THAT WAS THE RESEWERS BASIS CENTER RENEEDS IN 2015 AND FUNDED IN 2016. THREE DIFFERENT SOLICITATIONS. ONE IN RHEUMATIC AND ONE FOR SKIN BIOLOGY AND DISEASES AND ONE FOR MUSCULOSKELETAL BIOLOGY AND MEDICINE. AND YOU CAN SEE THE NUMBER OF AWARDS WE MADE SO FAR FOR THIS PROGRAM. SO THE NEXT PROGRAM IS THE CENTERS FOR REACH TRANSLATION. THIS USES P50 MECHANISM. THE FOCUS COULD BE OVER ARCHING TRANSLATIONAL THEME WITH MULTIPLE RELATED SYNERGISTIC PROJECTS. THIS IS THE ORIGINAL MODEL FOR THE P -- THAT WE HAVE BEEN USING. WHAT WE ADDED IN HERE IS ALLOWING A FOCUS ON A SINGLE CRITICAL FOCUS QUESTION OR CHALLENGE. SO WITH THIS STRUCTURE, YOU MIGHT HAVE A SINGLE RESEARCH PROJECT THAT IS CARRIED OUT BY MULTIPLE TECHNICAL TEAMS OR RESEARCH CORES THAT ARE ALL SHARING THE SAME SET OF VAINS BUT WITH DIFFERENT SUBVEINS. NOW TO ADD FLEXIBILITY, WE ARE ALSO STATING THAT THE RESEARCH CORES CAN BE ADJUSTED IN THEIR TECHNICAL FOCUS OVER THE COURSE OF THE GRANT. THIS ALLOWS THEM TO TAKE ADVANTAGE OF NEW AREAS OR NEW TECHNOLOGIES AND TO ADJUST TO THE NEEDS OF THE PROJECT. FINALLY HERE, THE MAIN OUTCOMES OF A P50 ARE TO IMPROVE UNDERSTANDING OF DISEASE AND HUMAN PHYSIOLOGY AND POTENTIALLY IDENTIFY TARGETS FOR THERAPIES. BUT THE P50 MAY ALSO PRODUCE VERY SPECIFIC TANGIBLE PRODUCTS OR DELIVERABLES. SO NOW, THE STRUCTURE OF A COURT, THE OLD IS ON THE LEFT AND THE NEW IS ON THE RIGHT. THE NEW VERSION OF THE CORT, WE REQUIRE AT LEAST THREE RESEARCH COMPONENTS WHICH CAN BE EITHER RESEARCH PROJECTS. AT EAST BON OF THOSE AND RESEARCH CORES -- AT LEAST ONE OF THOSE AND THEY HAVE TO ADD UP TO 3. IN THAT SECOND CONCEPT I SHOWED ON THE PREVIOUS SLIDE, IF THERE IS A SINGLE OVERARCHING QUESTION THAT IS BEING ADDRESSED, THERE MIGHT BE ONE RESEARCH PROJECT WITH MULTIPLE THAT LEADS TO RESEARCH CORES. THERE ARE SAUCE AN ADMINISTRATIVE CORE WITH A REQUIRED PILOT AND FEASIBILITY PROGRAM. IT USED TO BE OPTIONAL. AND THEN THE CORE DIRECTORS AND ADVISORY COMMITTEE ARE THE SAME. SO NOW THERE ARE TWO FUNDING OPPORTUNITIES THAT ARE RELEASED. ONE IN 2015 AND THE OTHER IN 2016. THE FIRST ONE LED TO FOUR AWARDS IN FISCAL YEAR 16. THE SECOND ONE OF THESE IS TO BE REVIEWED IN MARCH. AND FINALLY JUST ON THE BUDGET, THE MAXIMUM BUDGET IS STILL ONE MILLION DOLLARS. DIRECT COST PER JEER THAT INCLUDES THE PILOT AND FEASIBILITY PROGRAM. SO THE LAST PROGRAM I'M GOING TO TALK ABOUT IS THE CORE CENTERS FOR CLINICAL RESEARCH. SO THIS PROGRAM HAS MAIN GOAL THE DEVELOPING AND FOSTERING AND IMPLEMENTATION OF NOVEL METHODS, METRICS AND OUTCOME MEASURES THAT ADDRESS CRITICAL EXISTING AND THE EMERGING CLINICAL RESEARCH NEEDS. THE OVERALL GOAL OF ADVANCING PREVENTION DIAGNOSIS AND TREATMENT WITHIN THE DISEASES WITHIN THE NIAMS MISSION. THE SUCCESS OF THE CCCR WILL BE MEASURED BY WHETHER THESE METRICS AND METHODOLOGIES THAT ARE DEVELOPED IN THE CCCR ARE ADOPTED INTO NEW CLINICAL RESEARCH PROJECTS POST CLINICAL TRIALS AND -- PROPOSED CLIP CALL TRIALS AND ULTIMATELY USED IN PATIENT CARE. OR TO ADVANCE PATIENT CARE. SO THE CHANGE HERE. ONE IS IN RESEARCH ACTIVITY CODE WHERE IT IS CHANGING FROM THE P60 TO P30. AND THAT REFLECTS THE FACT THAT THE MAJOR COMPONENT NOW IN A CCCR IS THE METHODOLOGY OF CORES WHICH HAVE TO BE MISSION FOCUSED. AND IN ADDITION, ONE OTHER COMMENT ON THE METHODOLOGY CORES, IS THEY CAN HAVE A TRADITIONAL DISEASE FOCUS, WHICH IS MORE WHAT WE USED TO SEE, BUT THEY CAN ALSO BE THEME FOCUSED, FOR EXAMPLE, ON SOMETHING LIKE PHARMACOEPIDEMIOLOGY, ALTERNATIVE CLINICAL TRIAL DESIGNS, AND BIG DATA ANALYSIS. AND NOW AGAIN, WE ARE TRYING TO ALLOW A LOT OF FLEXIBILITY ON THIS NEW STRUCTURE. IN ADDITION WE ARE TRYING TO ALLOW THESE CENTERS TO BE ADAPTABLE AND DYNAMIC OVER TIME TO ADAPT TO THE NEEDS OF THE RESEARCH COMMUNITY. IN ADDITION TO THESE METHODOLOGY CORES, THERE ARE OPTIONAL RESOURCE CORES, WHICH WE DO ENCOURAGE. WHAT WE NO LONGER INCLUDE WITHIN THE CCCR ARE RESEARCH PROJECTS. BUT THE CENTERS ARE ALLOWED TO HAVE ANG OPTIONAL PILOT AND FEASIBILITY STUDY. ONE OTHER POINT I WANT TO MAKE HERE ON THE DESIGN AND FOCUS IS THAT THESE CENTERS SHOULD INCLUDE AT ALL LEVELS, EFFORTS TO ADDRESS PATIENT PREFERENCES AND NEEDS. SO THE FIRST FUNDING OPPORTUNITY ANNOUNCEMENT WAS RELEASED IN SEPTEMBER OF 2016. APPLICATIONS ARE NOW IN AND WILL BE REVIEWED THIS SPRING. FINALLY, THE BUDGET FOR THE CCCR IS AT 500K DIRECT COST PER YEAR, WHICH IS LESS THAN FOR THE PREVIOUS P60 AND THE PROJECTS AREN'T INCLUDED IN THE CCCR. SO, WHERE ARE WE GOING? NEXT YEAR, WE DO HAVE UPCOMING REVIEWS FOR THE COS. AND THE CCCRs. -- CORTs. WHEN THE EXISTING CENTER COME UP FOR COMPETITION, WE WILL BE ISSUING RELEVANT FUNDING OPPORTUNITY ANNOUNCEMENTS. AND ONE THING WE NEED TO DO IN THE IMMEDIATE FUTURE IS TO DEVELOP METRICS AND EVALUATION PLAN FOR THE CENTERS PROGRAM THAT WILL HELP NEXT TIME THERE IS AN EVALUATION OF OUR CENTERS. AND I THINK THAT IS IT. >> KARL, THANK YOU VERY MUCH FOR THAT PARTICULARLY THE SIDE-BY-SIDE CHANGES. I KNOW A LOT OF WORK WENT DO IT AND I WOULD SAY THAT THIS HAS BEEN AN ONGOING ACTIVITY OF OUR PROGRAMS FOR A LONG TIME IN TERMS OF CENTERS PROGRAM. THOSE WHO ARE ON THE COUNCIL FOR YEARS HEARD RAY LOT ABOUT THIS -- HEARD A LOT ABOUT THIS. A LOT OF THE PROGRESS HAS TO BE GIVEN TO BOB CARTER WHO LED MANY SESSIONS AT DIFFERENT -- MANY. NOT MINI. IT SOUNDED LIKE MINI. BUT MANY SPECIALTY GROUPS AND OPEN DISCUSSION TO GET INPUT. SO, THIS IS NOT SOMETHING WE MADE UP. THIS IS SOMETHING THAT WAS AN AGGREGATE. WE REALIZED THE DIFFERENT SPECIALTY AREAS AND DIFFERENT NEEDS AND THIS WAS ALL MEANT TO MEET THE NEEDS OF THE MANY COMMUNITIES AND TO SOLICIT BEST SCIENCE THAT WE CAN IN TERMS OF TEAM SCIENCE. ANY QUESTIONS FOR KARL? YOU WANTED TO ADD ANYTHING BOB? MIKE? >> SO I'M OPENING THE FLOOR TO STEVE AND KRISTI IF YOU WOULD LIKE. >> AND KARL, ONCE AGAIN I'LL ASK HERE -- LOOKING AWAY FROM YOU WHILE I'M TALKING. SO THANK YOU. VERY CLEAR DESCRIPTION. THERE ARE THREE PROGRAMS. WHAT IS THE LONG TERM VIEW? WHAT IS THE TOTAL NUMBERS OF EACH THREE THINGS YOU PLAN SUBSEQUENT 2018, 19, 20 ET CETERA SOLICITATIONS IN. >> YOU WANT TO ADDRESS THAT OR SHOULD I? >> WE DON'T KNOW. >> WE DON'T KNOW. >> A LOT DEPENDS ON OUR BUDGET. SO WE CANNOT PREDICT. AND WE CAN'T PREDICT OR -- TELL YOU HOW MANY EXACTLY WE ARE GOING TO FUND BECAUSE A LOT OF IT DEPENDS ON HOW GOOD THEY ARE, NUMBER 1, AND ALSO HOTCH MONEY WE HAVE. >> THE NATURE OF THE QUESTION WAS BASED ON THE PRESIDENT OBAMA'S BIOMANUFACTURING PROGRAM, WHICH SAID OVER TEP YEARS WE LOOK TO MAKE 45 OF THEM. THERE WAS A LONG TERM, HERE IS WHAT WE WOULD LIKE TO HAVE AT THE END OF THIS PENDING FUNDING OF COURSE. >> THESE NUMBERS WILL NOT BE SO DIFFERENT THAN WHAT WE ALREADY HAVE. WE ACTUALLY DIVIDES THESIS PROGRAMS WITH OUR CENTERS PROGRAM BEING ABOUT 8% OF THE TOTAL OF OUR NIAMS BUDGET. WHEN I STARTED IT WAS 11.3% WHICH I THOUGHT WAS HIGH. AND THE DISTRIBUTION WILL BE CHANGED NOW BECAUSE THESE CCCRs ARE GOING TO BE QUITE DIFFERENT THAN THE -- AND SMALLER THAN THE MULTIDISCIPLINARY P60 CENTERS WE HAD BEFORE. SO WE PROBABLY WILL BE ABLE TO SUPPORT MORE OF THEM BUT WE CAN'T GIVE YOU EXACT NUMBERS. >> SO, THANK YOU VERY MUCH FOR THAT PRESENTATION AND THE SUMMARY. SO, YOUR LAST POINT I THINK IS ACTUALLY ONE OF THE ABSOLUTE MOST CRITICAL ONES AND THAT IS ESTABLISHING METRICS THAT YOU'LL USE. AND ONE OF THE THINGS THAT I THINK TO JUST COMMENT ON IS, I THINK IT WOULD BE GOOD TO SET UP SOME SHORT-TERM BUT ALSO LONG TERM METRICS. BECAUSE THESE ARE PROGRAMS AND CENTERS THAT HOPEFULLY WILL MAKE DISCOVERIES THAT YOU MIGHT BE ABLE TO SEE INITIALLY BUT YOU MAY NOT APPRECIATE FOR A WHILE. AND I THINK NIAMS IS GOING TO BE AROUND FOR A LONG TIME, I HOPE. AND SO HAVING THAT FORMALIZED AT THE OUTSET BECOMES REALLY IMPORTANT BOTH FOR THE SHORT-TERM LONG-TERM RETROSPECTIVE BECAUSE IT WILL BE INCREDIBLY USEFUL AS WE PLAN FOR THE FUTURE. >> THAT'S WHY WE ARE -- >> I AGREE. AS WE DISCUSSED AT OUR LAST MEETING, I THINK IT WAS ON ONE OF THE AWARDS. IT MAY HAVE BEEN IN CLOSED SESSION. WE TALKED ABOUT HOW IMPORTANT IT IS TO HAVE METRICS IN TERMS OF SUCCESS OR STOPPING CERTAIN PROGRAMS OR ENHANCING CERTAIN PROGRAMS. WE COULD ONLY DO THAT WITH METRICS. THANK YOU. OTHER COMMENTS? MICHAEL? >> THANK YOU. IT'S GREAT TO SEE THAT THE HARD WORK THAT BOB CARTER DID IN LEADING THIS GROUP EARLY ON. HAS REALLY COME TO FRUITION. I THINK THAT IS REALLY GREAT AND REALLY NICE JOB IN BRINGING THAT FORWARD. SO, THE QUESTION MAYBE FOR BOB OR KARL OR SUSANA, WHEN WE WERE DISCUSSING BROAD EPING THE SCOPE, THERE WAS -- BROADENING THE SCOPE, THERE WAS A WORRY IF YOU GOT TOO BROAD THE REVIEWERS MIGHT HAVE DIFFICULTY IN TERMS OF PRIORITIZING AND RANKING THE VARIOUS PROPOSALS. HAS THAT COME TO BE A PROBLEM? OR IS THAT SOMETHING THAT IS NOT -- >> LET ME ANSWER HALF OF THAT. AND THEN ISLE TURN THE HARDER PART OVER TO KARL. WE CAME UP WITH AN IDEA, YOU ALL CAME UP WITH THE IDEA, THE COMMUNITY ALTHOUGH THE COMMUNITIES ARE DIFFERENT PLACES, THE THEMES ARE REMARKABLY COHERENT ACROSS COMMUNITIES AND THAT MADE THE WORKING GROUP'S JOB A LOT EASIER BECAUSE IT WAS COMMONALTIES. AND THE COMMON THEMES ARE THE ONES THAT KARL MENTIONED WHICH WAS INCREASES THE SHARING OF RESOURCES BEYOND JUST WHAT A LOCAL GROUP OF PEOPLE CAN USE. AND PROVIDING IMPROVED WAYS THAT PEOPLE DID NOT MULTIDISCIPLINARY PROJECTS DEFINED AS DIFFERENT PEOPLE WORKING SEPARATELY ON DIFFERENT COMPONENTS OF A PROBLEM WITH INTERDISCIPLINARY TO MEAN ALL THE PEOPLE ON ONE TEAM FOCUSED ON ONE PROBLEM. AND I THINK THAT WAS ACCEPTED. BUT DIDN'T WANT TO THROW THE BABY OUT WITH THE BATHWATER. SO THERE WERE SOME COMPROMISES. SO AS KARL MENTIONED, PARTICULARLY ON THE P50, THAT WAS ALLOWED. BUT SO WAS THE OLD MODEL OF A VARIETY OF DIFFERENT PROJECTS WITHIN ONE LARGER THEME. SO THAT DOES MAKE A LITTLE MORE CHALLENGING THERE. AT THE END OF THE DAY, I STILL THINK THE BOTTOM LINE IS FAIRLY SIMPLE FOR THESE, WHICH IS WHAT IS THE DIFFERENCE THE CENTER WILL BE ABLE TO MAKE? AND HOW CAN IT DO SOMETHING THAT YOU CAN NOT DO THROUGH OTHER MEANS? AND I THINK THAT GOT TAKEN UP BOY REVIEW FAIRLY WELL. FOR EXAMPLE FOR THE RESOURCE CORES, THE EQUATION WAS, YOU DEFINE THE RESOURCE, YOU DEFINE THE COMMUNITY, AND X TIMES Y EQUALS WHAT? THAT WAS THE JOB OF THE REVIEW GROUP. EASIER SAID THAN DONE. KARL OR CATHY OR -- >> CATHY THE HEAD OF OUR REVIEW GROUP TO COMMENT ON THAT. THERE IS THE CHALLENGES OF REVIEW. >> AND I'M RESPONDING THROUGH THE PERSPECTIVE OF REVIEW HAVING A RANGE OF TOPICS OR AREAS COVERED IN A MEETING, AIL SINGLE MEETING, ISN'T UNUSUAL FOR US. IT IS OFTEN THE NORMAL PRACTICE. SO, A RANGE OF EXMERRITIES IS RECRUITED AND SIGNED BASED ON THE NEEDS OF EACH APPLICATION. SO WE FELT COMFORTABLE WITH IT. >> WAS THERE A QUESTION FROM STEVE ON THE PHONE? STEVE OR KRISTI? >> I'M HERE. I DID NOT HAVE A QUESTION. I JUST WANTED TO APPRECIATE THE DISCUSSION. >> OKAY. GOOD. ANY OTHER QUESTIONS OR COMMENTS? IF NOT, WE WILL GO ON TO THE LAST PIECE OF BUSINESS IN OUR OPEN SESSION IS THE COUNCIL OPERATING PROCEDURES. AND THEN WHAT WE ARE GOING TO DO IS WE ARE GOING TO TAKE A BREAK AND RECONVENE AT 1:15. SO FOR THOSE OF YOU WHO THE PHONE, 10:15, I HOPE YOU WILL HAVE HAD YOUR BREAKFAST BY THEN, KRISTI AND STEVE. SO THANK YOU FOR BEING THERE. WE PARTICULARLY WANT YOUR INPUTS LATER ON IN THE SESSION. >> OKAY. EVERY YEAR, WE BRING OUR STATEMENT OF UNDERSTANDING BETWEEN THE INSTITUTE AND THE MEMBERS ABOUT WHAT OUR OPERATING PROCEDURES WILL BE FOR THE YEAR. AND I HOPE THAT THIS SLIDE LOOKS FAMILIAR TO MANY OF YOU. I KNOW OUR NEW MEMBERS GOT TO SEE IT YESTERDAY FOR THE FIRST TIME. AND THOSE OF YOU WHO ARE CURRENT MEMBERS HAVESTEIN AT LEAST ONCE BEFORE. NOTHING HAS BEEN CHANGED. AND I'M PRESENTING IT TO YOU TO SAY THAT WE DON'T INTEND TO MAKE ANY MODIFICATIONS. DOES ANYBODY HAVE ANY QUESTIONS OR COMMENTS ABOUT THE OPERATING PROCEDURES? AS PRESENTED? >> JUST SO YOU KNOW, THESE ARE THE GUIDELINES UNDER WHICH WE WORK AND YOU KNOW IT AND WE KNOW IT. AND THIS IS THE AGREEMENT. ALL INSTITUTES HAVE THIS AGREEMENT WITH THE COUNCIL IN TERMS OF WHAT -- WHAT MEASURES THAT WILL WORK ON. >> AND THERE IS A DISCRETIONARY ITEM WHICH CITIES IF THE INSTITUTE DIRECTOR HAS SOMETHING IS THAT HE REALLY WANTS VIS, HE'LL BRING IT TO YOU. SO EVERYTHING IS PRETTY MUCH COVERED. HEARING NO DISCUSSION, DR. TAP SCOTT, DID YOU HAVE ANYTHING YOU WANTED TO BRING UP OR DR. SAN BORG? HEARING NO DISCUSSION, I THINK WE WILL JUST MARK THESE IN THE MINUTES AS HAVING BEEN UNANIMOUSLY ADOPTED. THANK YOU. >> OKAY. THANK YOU. AND WITH THAT, WE WILL CLOSE THE OPEN SESSION AND WE ARE GOING TO HAVE A LUNCH BREAK AND RECONVENE AT 1:15.