I'D LIKE TO WELCOME EVERYONE TO THE 169th MEETING OF THE COUNCIL. I HOPE EVERYONE HAD A HOLIDAY SEASON. THE AFTERNOON PORTION OF THIS ME MEETING IS OPEN TO THE PUBLIC AND BROADCAST ON THE NIH VIDEOCAST NETWORK. WE'RE PLEASED TO HAVE OUR ADVISORY COUNCIL MEMBERS WITH US AND WOULD LIKE TO THANK MELISSA GILAM TO SERVE LONGER. I SEE HIM ON THE VIDEOCAST. THANK YOU FOR JOINING US REMOTELY. UNFORTUNATELY, DR. SHER AND DORNE AND COLORA ARE ABLE TO JOIN US. ALL COUNCIL MEMBERS HAVE THE OPTION TO PARTICIPATING REMOTELY FOR ONE MEETING A YEAR. PLEASE REMEMBER TO SPEAK INTO THE MICROPHONE AND STATE YOUR NAME SO THE PUBLIC WILL KNOW WHOSE SPEAKING. WE'RE HAPPY TO HAVE SEVERAL GUESTS FROM SOCIETIES AND PROFESSIONAL ORGANIZATIONS. I'D LIKE TO TAKE A MOMENT FOR EACH GUEST TO STAND AND INTRODUCE HIMSELF OR HERSELF SO WE MAY WELCOME YOU. SO KATIE. THANK YOU. WE ALSO ANTICIPATED DR. JOE LASKO FROM THE ENDOCRINE SOCIETY WOULD BE HERE AND IS THE NEW CHAIR OF A DEPARTMENT BUT THEY JUST RECEIVED THEIR FIRST BABY DAYS AGO AND IF YOU'RE WATCHING JOE, CONGRATULATIONS TO THE WHOLE FAMILY. THANK YOU FOR BEING HERE AND ALL YOU DO AND YOUR ORGANIZATIONS DO TO SUPPORT THE NICHD AND ITS MISSION. NOW I'LL TURN THE MEETING OVER TO DR. HANN. >> GOOD. GOOD AFTERNOON, EVERYONE. I'M HERE TO DO THE REVIEW CONFIDENTIALITY AND CONFLICT OF INTEREST FOR COUNCIL MEMBERS. ON THE COUNCIL WEBSITE YOU SHOULD HAVE READ AND AGREED TO AND SIGNED THE CONFIDENTIALITY OF NON DISCLOSURE RULES FOR SPECIAL GOVERNMENT EMPLOYEES. BEFORE YOU REVIEW THE GRANT APPLICATIONS. AT YOUR SEATS YOU'LL HAVE A RED FOLDER AND INSIDE THAT FOLDER SAY CONFLICT OF INTEREST -- IS A CONFLICT OF INTEREST CERTIFICATION FORM. THE CONFLICTS OF INTEREST ARE APPLIES WHEN DISCUSSING THE ISSUES PERTINENT TO CERTAIN ORGANIZATIONS. IF THERE IS A SPECIFIC ORGANIZATION TO ANY ORGANIZATION OR UNIVERSITY FOR WHICH YOU ARE A CONFLICT I IN ADDITION TO THOSE LISTS IN THE ACTION COUNCIL DOCUMENT, YOU'LL BE REQUIRED TO RECUSE YOURSELF FROM THE DISCUSSION AND LEAVE THE ROOM. PLEASE SIGNED THE ENCLOSE CONFLICT OF INTEREST CERTIFICATION PRIOR TO OUR CLOSED SESSION TOMORROW AFTERNOON WHEN WE DO THE REVIEW OF APPLICATIONS. AND YOU DO NOT NEED TO SERVE ON ANY NIH PEER REVIEW PANEL WHILE SERVING. IT IS NIH POLICY AN INDIVIDUAL CANNOT SERVE ON THE FIRST AND SECOND LEVELS OF PEER REVIEW AND COUNCIL IS CONSIDERED THE SECOND LEVEL OF PEER REVIEW. WITH THAT, I'LL NOW TURN TO THE COUNCIL MINUTES FROM THE PREVIOUS MEETING HELD ON SEPTEMBER 13, 14. THEY WERE POSTED ON THE NICHD COUNCIL INTRANET SITE. IF I MAY HAVE A MOTION WITH REGARD TO THOSE MINUTES. I HAVE ONE MOTION TO APPROVE. DO I HAVE A SECOND? ALL IN FAVOR OF APPROVAL? GREAT. THANK YOU. THOSE NOT IN FAVOR, ABSTENTIONS, TERRIFIC. THANK YOU VERY MUCH. OUR FUTURE MEETING DATES FOR THIS CALENDAR YEAR OUR NEXT MEETING WILL BE JUNE 11 WHICH IS A TUESDAY. A LITTLE DIFFERENT AND THEN SEPTEMBER 19 WHICH IS A THURSDAY. WITH THAT I WILL NOW TURN THE MEETING BACK TO DR. BIANCHI TO PRESENT THE DIRECTOR'S REPORT AND DISCUSSION. >> SO YOU'RE GOING HEAR FROM ME A LOT OF TODAY I HOPE I'M NOT GOING TO BE TOO BORING. GIVING TWO PRESENTATIONS THIS IS THE REGULAR DIRECTORS REPORT AND AFTER THE BREAK WE'LL START THE STRATEGIC PLANNING SESSION. SO ANYTHING RELATED TO THE STRATEGIC PLANNING UPDATES WILL BE IN THE LATER PRESENTATION. I'M GOING TO GIVE YOU AN UPDATE ON WHAT'S BEEN HAPPENING SINCE SEPTEMBER AND THAT INCLUDES IMPORTANT SPECIFIC WORKSHOPS AN MEETINGS. UPDATES ON NICHD RESEARCH INITIATIVES OF NOTE AND A COUPLE BRIEF STAFF UPDATES. SO IN SEPTEMBER IN THIS VERY ROOM, WE HAD A WORKSHOP ON MENSTRUATION, SCIENCE AND SOCIETY. THIS WAS ORGANIZED BY THE GYNECOLOGIC DISEASE BRANCH INVOLVING SOME PEOPLE YOU MAY SEE HERE. YOU MAY WONDER WHY DID WE HAVE THE WORKSHOP. CONDITIONS SUCH AS ENDOMETRIOSIS AFFECT 10% OF WOMEN AND ARE EXTREMELY PAINFUL AND THERE'S A CONNECTION WIT WOMEN WITH PAINFUL GYNECOLOGIC DISORDERS AND OPIOID MISUSE. IT'S A SIGNIFICANT PUBLIC HEALTH PROBLEM. NCHD IS A LEADER IN RESEARCH IN WOMEN'S HEALTH AND ONE PURPOSE WAS TO IDENTIFY SCIENTIFIC GAPS AND OPPORTUNITIES. AND MANY AREAS WERE EXPLORED WITH RESEARCH IN BIOLOGY AND MENSTRUAL BLOOD AS A BIOFLUID AND GLOBAL HEALTH IMPLICATIONS MUCH MENSTRUATION RESEARCH AND A PEER-REVIEWED PUBLICATION IN THE PROCESS OF BEING WRITTEN RIGHT NOW. ANOTHER REASON WE HAD THIS IS THERE'S A GROWING AREA KNOWN OF FEMME TECH. YOU'LL THING YOU'LL HEAR ABOUT IS THE IMPORTANCE OF INCLUDING OUR POPULATIONS IN RESEARCH. WOMEN'S NEEDS ARE NOT AS RESEARCH RESEARCHED AS MEN IN GENERAL. WE HAVE OUR EYE ON FEC TECH WHICH IS A BROAD TERM THAT RELATES TO USING DIGITAL HEALTH APPLICATIONS SUCH AS SOFTWARE, DIAGNOSTICS, PRODUCTS, SERVICES INCLUDING FERTILITY SOLUTIONS, PERIOD TRACKING SOFTWARE AND PREGNANCY TRACKING SOFTWARE, ETCETERA. WE WANT TO BE AWARE OF THE ADVANCES BECAUSE IT REPRESENTS RESEARCH. AND I IN PARTICULAR LEARNED A LOT DURING THE WORKSHOP ABOUT GLOBAL HEALTH IMPLICATIONS WITH REGARD TO MENSTRUATION AND THE DOWNSTREAM EFFECT. HERE IS AN ARTICLE CLEARLY BEFORE MEGHAN MARKLE JOINED THE ROYAL FAMILY AND WAS A SIGNATURE ISSUE FOR THE STIGMA AROUND MENSTRUATION IN LOW-RESOURCE SETTINGS AND THERE'S A DOWNSTREAM EDUCATIONAL AND ECONOMIC IMPACT BECAUSE WOMEN ARE STIGMATIZED. WE HEARD A LOT OF FROM VARIOUS ORGANIZATIONS THAT PRESENTED AT THE WORKSHOP INCLUDING ONE WAS CALLED DAYS FOR GIRLS IN WHICH THEY ARE PROVIDING BOTH EDUCATION AND REUSABLE SUPPLIES FOR WOMEN WHICH ARE IN SHORT SUPPLY IN AREAS OF LOW RESOURCES. THERE IS THIS CONCERN ABOUT POVERTY RELATED TO WOMEN HAVING PERIODS. IF YOU'RE INTERESTED IN SCIENCE AND BOLLYWOOD, I DO RECOMMEND A MOVIE THAT WAS RECOMMENDED TO ME CALLED PAD MAN. IT'S A MOVIE BASED IN INDIA WHERE IT'S ESSENTIALLY ABOUT A HUSBAND CONCERN ABOUT HIS WIFE BEING STIGMATIZED DURING HER PERIODS AND THAT LEADS HIM TO BECOME VERY ENTREPRENEURIAL. IT'S ON NETFLIX. I HAVE NO RELATIONSHIP OR CONFLICT OF INTEREST WITH THE MOVIE. IT'S NOT JUST AN ISSUE IN GLOBAL HEALTH. IT'S AN ISSUE IN THE UNITED STATES. SO WE ALSO BECAME AWARE OF THE FACT THAT THERE'S A TAMPON TAX. SO WOMEN ARE FINANCIALLY PENALIZED FOR THESE ESSENTIAL SUPPLIES AND YOU CAN SEE HERE THAT IN ORANGE ARE THE STATES WITH NO SALES TAX INCLUDING FEMININE HYGIENE PRODUCTS AND IN BLUE ARE STATES THAT EXEMPT THEM AND GRAY ARE THE MAJORITY THAT TAX THESE PRODUCTS. AND IT'S ALSO BECOME A POLITICAL ISSUE BECAUSE THERE WAS AN ARTICLE AROUND THE TIME OF THE WORKSHOP WHERE "THE NEW YORK TIMES" MENTIONED A MEMBER OF CONGRESS ASKED TO GET REIMBURSEMENT FROM THE HOUSE COMMITTEE ON ADMINISTRATION FOR PRODUCTS FOR HIS FEMALE STAFFERS BECAUSE THIS PARTICULAR COMMIT DOESN'T PAY -- DOES PAY FOR TOILET PAPER BUT DOESN'T PAY FOR THESE SUPPLIES. WE THOUGHT IT'D BE A GOOD TIME TO TALK ABOUT THIS BECAUSE THERE WERE SO MANY ENHANCES IN THE SOCIETAL IMPLICATIONS AND WE MADE UP A #CALLED NICHD MENSES SCIENCE. THERE WERE A NUMBER OF FOLKS ACTIVELY TREATING DURING THE MEETING AND RETWEET. ONE I SEE IS CHANGING THE CONVERSATION FROM SHAME TO CELEBRATION. TALKING ABOUT THE SCIENCE. TALKING ABOUT DIFFERENT COPING STRATEGIES, ETCETERA. SO THAT WAS ONE MEETING. WE HAD OUR ANNUAL PLACENTA PROJECT MEETING. THIS WAS THE FIFTH AND THAT WAS HELD IN ANOTHER LOCATION IN BETHESDA. AND WE CONTINUE TO BE AMAZED AT THE PROGRESS THAT IS BEING MADE AS A RESULT OF OUR $80 MILLION INVESTMENT INTO THE HUMAN PLACENTA PROJECT. REMEMBER THE GOALS ARE TO DETERMINE NON-INVASIVE STRATEGIES FOR MONITORING PLACENTAL HEALTH IN REAL TIME. SO THIS WAS AN OPPORTUNITY TO SEE PROGRESS FROM MANY OF OUR FUNDED INVESTIGATORS. WE ALSO HAD DEMONSTRATIONS AT THIS MEETING. SO IN THE LOWER RIGHT CORNER YOU'RE LOOKING AT A MODEL WEARING A SENSOR THAT IS ABLE TO DETECT OXYGENATION IN THE PLACENTA. ANOTHER AREA THEY DON'T THINK WE REALLY TALKED ABOUT A LOT IS OUR RELATIONSHIP AT NIN WITH THE BILL AND MELINDA GATES FOUNDATION. AS A RESULT OF DR. COLLINS AND BILL GATES HAVING A CLOSE RELATIONSHIP AND THE FACT WE HAVE THE TWO LARGEST FUNDERS OF BIOMEDICAL RESEARCH IN THE WORLD, THE THOUGHT IS IF WE WORKED TOGETHER IT WILL LEVERAGE AN EVEN GREATER IMPACT. SO THERE'S NOW AN ANNUAL MEETING HELD TO DISCUSS FUTURE AREAS OF COLLABORATION. USUALLY THE MEETING'S HELD IN JUNE. THIS YEAR IT WAS HELD IN DECEMBER. AND WE ARE INVOLVED IN TWO MAJOR WORKING GROUPS. SO WE HAVE A CONTRACEPTION GROUP THAT IS CO-CHAIRED BY DAN JOHNSTON. WE HAVE A PATERNAL NEONATAL HEALTH WORKING GROUP CO-CHAIRED BY MYSELF AND MY COUNTERPART AT BILL AND MELINDA GATES FOUND FOUNDATION AND THERE'S THE FOCUS GROUPS AREAS ADVERSE PREGNANCY OUTCOMES AND NEURODEVELOPMENT AND ONE OTHER. SO WE WERE ASKED TO TALK ABOUT WHAT WE'VE ALREADY ACCOMPLISHED AS A RESULT OF OUR COLLABORATION. SO I WILL JUST SKIP AHEAD TO DASH BECAUSE MAYBE SOME OF THE NEWER FOLKS AREN'T FAMILIAR WITH DASH BUT DASH IS AN ACRONYM FOR OUR DATA AND SPECIMEN HUB WHICH IS PUBLICLY AVAILABLE. IT'S A CENTRALIZED RESOURCE FOR RESEARCHERS TO STORE AND ACCESS DEIDENTIFIED DATA FROM STUDIES SUPPORTED BY NICHD. THE WHOLE IDEA IS TO MAKE IT EASY FOR OTHER INVESTIGATORS TO ACCESS THIS DATA AND DO SECONDARY ANALYSES AND THEREFORE TO LEVERAGE ALL OF OUR INFRASTRUCTURE INVESTMENT, COLLECTION OF SAMPLES, ETCETERA. IT WAS LAUNCHED IN AUGUST OF 2015. AND IT'S REALLY AMAZING THE IMPACT. YOU CAN SEE THE TOPICS. THE TOPICS CONDITION TO GROW. THERE'S NOW 29 STUDY TOPICS. THERE'S 111 DE-IDENTIFIED STUDIES AVAILABLE. THERE'S OVER 16,000 PEOPLE WHO'VE ACCESSED THE SITE. THERE'S BEEN 110 DATA REQUESTS AND ALREADY THERE'S BEEN 10 DAILY USE PUBLICATIONS. SO THE BILL AND MELINDA GATES FOUNDATION IS USING DASH FOR DATA SHARING AND USING THE DATA FOR SOME OF THE STUDIES FOR COLLABORATIVE MACHINE LEARNING ANALYSES TO DETERMINE ALGORITHMS FOR PREGNANCY RISK AND THERE'S A LOT OF STUDIES IN THE DASH DATABASE. WE'RE ALSO WORKING TOWARDS COLLABORATION ON A CLINICAL TRIAL USING THE INFRASTRUCTURE OF OUR NICHD GLOBAL FUNDED HEALTH NETWORK TO IMPROVE PERINATAL OUTCOMES FOR HIGH RISK AND LOW RISK INFANT AND STUDYING PRECONCEPTUAL AND PRENATAL MATERNAL NUTRITION SO THAT WORK HAS BEEN PUBLISHED. IN THE GROWTH AND NUTRITION FOCUS AREA THERE WAS A LOT OF DISCUSSION ABOUT THE OVERALL NIH PLAN FOR NUTRITION RESEARCH AND HOW THAT WOULD RELATE TO FUTURE WORK FOR THE SUBGROUP AND DISCUSSING FACTORS AFFECTING FEEDING, LACTATION PERFORMANCE, HOW WE CAN WORK TOGETHER GLOBALLY WITH REGARD TO THAT AND RESOURCE DEVELOPMENT. THEN THE FIRST WORKING GROUP WAS NEURYO DEVELOPMENT. SO AGAIN -- NEURODEVELOPMENT AGAIN A FOCUS ON DATA HARMONIZATION AND ANALYSIS. WAYS IF WE HARMONIZE THE WAY WE COLLECT DATA CAN WE THEN MAKE LARGER DATA SETS TO DO BETTER ANALYSES. WE ALSO INFORMED THEM OF THE NIH BABY TOOLBOX AND THEY'RE INTERESTED HOW THEY CAN USE THAT RESOURCE FOR THEIR STUDIES THAT ARE INVOLVED IN NEURAL DEVELOPMENTAL ASSESSMENTS OF YOUNG INFANTS AN CHILDREN AND TOLD THEM ABOUT THE HEAL BRAIN AND COGNITIVE DEVELOPMENT STUDY. YOU MAY BE FAMILIAR WITH THE ADOLESCENT BRAIN STUDY THE A.B.C.D. STUDY WHICH WE ARE CO-FUNDING IT BUT IT IS LARGELY RUN BY NIADA AND THAT STUDY STARTS AT APPROXIMATELY AGE 9 AND GOES THROUGH ADOLESCENCE. THERE'S A BIG GAP IN KNOWLEDGE REGARDING BRAIN DEVELOPMENT. SO NAIDA IS ORGANIZING AGAIN AND WE'LL BE CO-FUNDING PART OF THIS HEALTHY BRAIN AND COGNITIVE DEVELOPMENT WHICH WILL FOCUS FOR SURE ON INFANTS THROUGH EARLY CHILDHOOD AND POSSIBLY INTO FETAL LIFE AS WELL. SO THERE'S A LOT OF INFORMATION THAT FLOWS BACK AND FORTH AND THERE'S SOME CONCRETE PLANS IN WHICH WE CAN WORK TOGETHER. AND THIS IS AN AREA OF MR. GATES GREAT INTEREST AND FOCUS. TYPICALLY THOSE MEETINGS ARE MAINLY FOCUSSED ON INFECTIOUS DISEASES BUT TOPICS OF INTEREST TO OUR INTEREST INSTITUTE ARE GAINING MORE AND MORE ATTENTION FROM MR. GATES. IN TERMS OF RESEARCH UPDATES, I'VE PREVIOUSLY TOLD YOU ABOUT THE PLACENTAL ATLAS TOOL. I'M PROUD TO REPORT IT'S NOW PUBLICLY AVAILABLE AS OF OCTOBER. WHAT THIS IS IS A SHARED RESOURCE THAT ALLOWS YOU TO RETRIEVE PLACENTAL MOLECULAR DATA SETS AND ALLOWS SECONDARY ANALYSES AND ENCOURAGE THE SYSTEMS BIOLOGY TO APPROACH AND OF POTENTIAL THERAPEUTIC AGENT AND HAS SEVERAL KEY FUNCTIONALITIES INCLUDING A DATA SET EXPLORER, ANALYTICS AND IMAGE EXPLORER SO THERE'S A TEACHING FUNCTION AS WELL WHERE TRAINEES OR MORE EXPERIENCED INVESTIGATORS CAN LOOK AT PLACENTAL IMAGES EXTRACTED FROM NLM OPEN AND PATHOLOGY IMAGES AND THERE'S A TAXONOMY BROWSER AND WORK SPACE AREA. IT'S A SHARED RESOURCE FOR ALL THINGS RELATED TO THE PLACENTA. I'VE ALSO PREVIOUS MENTIONED THE TRANS-NIH RESEARCH CONSORTIUM. ABBREVIATED AS NBRC WHICH WAS DEVELOPED TO ADDRESS THE PROMOTION OF CHILD HEALTH RESEARCH ACROSS NIH. AS YOU'LL HEAR LATER WITH THE STRATEGIC PLANNING REPORT THOUGH CHILD HEALTH SIN OUR NAME AND THE -- IS IN OUR NAME AND THE EXTERNAL WORLD BELIEVES WE'RE RELATED TO HEALTH WE ONLY FUND 18% OF CHILD HEALTH RESEARCH ACROSS NIH. THERE ARE MANY OTHER PROGRAM OFFICERS FOR EXAMPLE AND PROGRAMS THAT ARE SPENDING A LOT OF MONEY ON CHILD HEALTH RESEARCH AND WE REALLY NEEDED TO WORK TOGETHER TO SPEAK WITH ONE VOICE TO EDUCATE EACH OTHER, TO LOOK AT AREAS OF OPPORTUNITY AND OVERLAP. THIS STARTED IN JUNE SO I FIRST PRESENTED TO THE I.C. DRIIRECTORS AND PEOPLE VOTE WITH THEIR FEET. WE HAVE INCREDIBLE ENGAGEMENT AND PARTICIPATION AT THESE MEETINGS. WE HAVE IDENTIFIED GAPS AND OPPORTUNITIES FOR COLLABORATION. THE FIRST ONE IS WE'VE REQUESTED OF THE OTHER INSTITUTES TO GIVE US THEIR HIGHEST PRIORITY REGARDING DEVELOPMENT OF SAFE PEDIATRIC DRUGS AND DEVICES AND TO GET LABELLING FOR DRUGS ALREADY USED IN CHILDREN BUT ARE NOT SPECIFICALLY LABELLED AS SUCH SO USING THE RESOURCES OF THE BEST PHARMACEUTICALS IN CHILDREN ACT TO HELP THE OTHER INSTITUTES. THEY ALREADY TRBT -- CONTRIBUTE TO THAT AND WANT TO GIVE THEM A RETURN ON THE INVESTMENT. WE HAD A DISCUSSION ON DATA SHARING. THERE'S BEEN A LOT OF ENTHUSIASM ACROSS THE MEMBERS OF NIH LEADERSHIP OVERALL WE'LL HOPEFULLY BE ABLE TO IDENTIFY ADDITIONAL FUNDS TO CREATE A FEDERATION INITIALLY FOR D.N.A. SEQUENCING DATA. LEVERAGING SOME OF THE SUCCESSES FROM THE GABRIELLA MILLER KIDS FIRST PROGRAM AND THE ANTICIPATED SUCCESSES OF PROJECT A S THAT ARE FUNDED IN THE INCLUDE PROGRAM BUILDING ON AN INFRASTRUCTURE TO BE ABLE TO LINK DIFFERENT PEDIATRIC SEQUENCING DATA SETS ACROSS NIH. THERE BE INCREASING THE STATISTICAL POWER OF WHAT WE CAN ANALYZE. WE'VE TALKED ABOUT THE NEED TO INCREASE THE PEDIATRIC WORKFORCE. WE ARE GETTING NUMBERS BUT HISTORICALLY NICHD HAS TAKEN THE FINANCIAL RESPONSIBILITY FOR TRAINING MOST THE DEDICATED PEDIATRIC WORKFORCE. ONE OF OUR HOPES IS THAT ONCE WE HAVE ALL THE INFORMATION IN PLACE THAT WE CAN ENCOURAGE OUR COLLABORATING INSTITUTES AND CENTERS TO CONTRIBUTE TO EXPAND THE AVAILABLE TRAINING PROGRAMS TO ULTIMATELY INCREASE THE PEDIATRIC WORKFORCE. OTHER AREA IDENTIFIED AS A GAP AND OPPORTUNITY MOST THE INSTITUTES ARE INTERESTED IN ARE THE ISSUE OF TRANSITION FROM ADOLESCENCE TO ADULTHOOD YOU'LL HEAR MORE ABOUT IN OUR STRATEGIC PLANNING. WE ALSO ARE SPEAKING TOGETHER AND THE GOAL IS TO HAVE CERTAIN TALKING POINTS TO SPEAK WITH ONE VOICE WHETHER IT'S TO AN ADVOCACY ORGANIZATION TO THE LAY PUBLIC OR MEMBERS OF CONGRESS THAT WE ARE SPEAKING AS PEDIATRICIANS DOING CHILD HEALTH RESEARCH AT NIH. THEN RELATED IS AN OUTREACH EFFORT TO ENCOURAGE SENIOR PEDIATRIC RESEARCHERS TO SERVE ON PANELS. THE HEAD OF THE CENTER FOR SPECIFIC REVIEW, THAT POSITION IS CURRENTLY OPEN. RICHARD NAKAMURA RETIRED. THERE'S A FORMAL SEARCH GOING ON FOR THE HEAD OF CENTER FOR SCIENTIFIC REVIEW WHICH IS WHERE MANY GRANTS GO FOR THEIR INITIAL REVIEW. I WAS ASKED TO INTERVIEW ONE CANDIDATE. I DON'T KNOW IF THAT PERSON SAY FINALIST OR NOT, BUT THE BUT THE ONLY THING WE TALKED ABOUT FOR 20 MINUTES IS WE NEED MORE PEDIATRIC SCIENTISTS ON REVIEW PANELS. IT IS AN OPPORTUNITY WITH NEW LEADERSHIP TO HELP ENCOURAGE THAT OUTREACH EFFORT. SO NOW A COUPLE BIG PROJECTS THAT ARE TRANS-NIH PROJECTS. ONE IS THE NIH HEAL INITIATIVE. YOU KNOW WE LOVE OUR ACRONYMS. HEAL IS AN ACRONYM FOR HELPING TO END ADDICTION LONG TERM LAUNCHED LAST APRIL AS A TRANS-AGENCY EFFORT TO STEM THE PUBLIC HEALTH CRISIS OF OPIOID MISUSE AND ADDICTION. THE CONGRESS ACTUALLY DOUBLED FUNDING TO THE NIH FOR RESEARCH ON OPIOID MISUSE AND ADDICTION AS WELL AS DEVELOPING NEW OPPORTUNITIES TO TREAT PAIN. IT WENT FROM $600 MILLION TO $1.1 BILLION IN THE LAST FISCAL YEAR. NOW THERE'S QUITE A NUMBER OF FUNDING OPPORTUNITIES GOING OUT IN TO THE PUBLIC. HERE'S ONE OF THE WEBSITES. BUT THE EMPHASIS IS MAINLY ON PAIN AND IDENTIFYING NON-PHARMACOLOGIC APPROACHES AS WELL AS BETTER WAYS TO TREAT OPIOID MISUSE AND ADDICTION. YOU HEARD ME TALK ABOUT ACT NOW WHICH IS AN ACRONYM FOR ADVANCING CLINICAL TRIALS IN NEONATAL RESEARCH. IT TOOK YEARS BUT IS NOW PART OF THE HEAL INITIATIVE. WE'RE PLEASED THE NEEDS OF BOTH POSTPARTUM WOMEN AND NEONATES ARE ON THE SCREEN OF THE HEAL INITIATIVE. WE ALSO HAVE A SPECIFIC NICHD FUNDING ANNOUNCEMENT I THINK ON THE NEXT SLIDE AT DEVELOPING NEW BIOMARKERS AND NEW TARGETS FOR TREATMENT. HERE'S OUR HEAL INITIATIVE, NICHD FOA JUST POSTED RECENTLY. THE APPLICATIONS ARE DUE IN MARCH WHICH IS WHY I'M MENTIONING IT NOW. AND WE ARE LOOKING FOR GROUPS THAT WOULD INCLUDE A DATA COORDINATING CENTER AND TWO OR MORE CLINICAL SITES TO CONDUCT A MULTI-CENTER COHORT STUDY OF INFANT EXPOSED TO OPIOIDS IN INUTERO AND THIS IS MORE A FEASIBILITY STUDY TO UNDERSTAND HOW CAN WE RETAIN THESE FRAGILE FAMILIES IN A STUDY THAT THEN WILL ALLOW US TO DO DEVELOPMENT TESTING AS WELL AS NEUROIMAGING DURING THE FIRST TWO YEARS OF LIFE. THERE'S LITTLE INFORMATION AVAILABLE AS TO HOW EXPOSURE TO BE SYNTHETIC HIGH POTENCY OPIOIDS IN UTERO AFFECT BRAIN DEVELOPMENT. I'D LIKE TO GIVE YOU AN UPDATE ON INCLUDE. I DON'T BELIEVE I'VE SHOWN THIS CLIP BEFORE. HOW DID INCLUDE GET STARTED. THIS IS MR. FRANK STEVENS WHO HE HIMSELF HAS DOWNS SYNDROME. HE'S A VERY ARTICULATE SELF-ADVOCATE FOR MORE RESEARCH IN DOWN SYNDROME AND HAVE A CLIP FROM HIS HOUSE TESTIMONY OCTOBER 25, 2017. CAN WE MAKE IT LOUDER? HIS TESTIMONY WAS SO PERSUASIVE -- IT'S A ONE-MINUTE [INAUDIBLE] >> DID EVERYBODY HEAR THAT LAST PART? FUND THAT RESEARCH. HE'S MAKE THE ARGUMENT THAT HE'S AWARE HIS EXTRA CHROMOSOME WILL SOME DAY ROB HIM OF HIS MEMORY AND HE'S ALREADY BEGINNING TO SEE THAT IN HIS MOTHER WHO DOESN'T HAVE DOWN SYNDROME AND MADE SUCH AN EFFECTIVE CASE THE FUNDING WAS EFFECTIVELY DOUBLE. THERE ARE 6,000 INFANT BORN APPROXIMATELY IN THE UNITED STATES WITH DOWN SYNDROME AND IT'S DOUBLED. THERE ARE MORE PEOPLE LIVING LONGER NOW WITH DOWN SYNDROME. THE FUNDING WAS FAIRLY FLAT UNTIL 2014 AND BEGAN TO GO UP BETWEEN 2014 AND 2017 BUT BECAUSE MR. STEVEN'S TESTIMONY WAS SO PERSUASIVE TO THE HOUSE APPROPRIATION COMMITTEE IT START THE BALL ROLLING. EFFECTIVELY THE AMOUNT OF SUPPORT FOR RESEARCH ON DOWN SYNDROME HAS BEEN DOUBLED AND THAT LED TO STARTING IN THE SPRING NEW OPPORTUNITIES FOR A RESEARCH ON DOWN SYNDROME AND IT'S A TRANS-NIH PROJECT. HERE'S THE ACTUAL CONGRESSIONAL LEGISLATION CREATE A NEW INITIATIVE TO STUDY WITH THE AIM OF YIELDING SCIENTIFIC DISCOVERIES TO DEVELOP THE HEALTH AND NEURODEVELOPMENTS WITH THOSE WITH DOWN SYNDROME AND INDIVIDUALS AT RISK FOR ALZHEIMER'S DISEASE. SO FRANK TALKED ABOUT HE WILL HAVE DEMENTIA AND HIS MOTHER DOES NOT HAVE DOWN SYNDROME AND SHE IS DEVELOPING SIGNS OF ALZHEIMER'S DISEASE. HOW CAN WE USE CONDITIONS THAT PEOPLE WITH DOWN SYNDROME TEND TO HAVE MORE COMMONLY TO LEARN ABOUT THOSE CONDITIONS IN PEOPLE WHO DO NOT HAVE DOWN SYNDROME AND SIMILARLY, PEOPLE WITH DOWN SYNDROME DO NOT GET SOLID TUMORS, FOR EXAMPLE. SO WHAT IS IT ABOUT THEIR GENOME OR GENE EXPRESSION THAT PROTECTS THEM. THEY ALSO HAVE PROBLEMS WITH OBESITY. THEY DO NOT HAVE PROBLEMS WITH CORE NARY ARTERY DISEASE AND HAVE A LOWER THAN EXPECTED INCIDENCE OF HEART DISEASE. THERE'S A UNIQUE DOUBLE BENEFIT TO IMPROVE DOWN SYNDROME AND IMPROVE THEIR HEALTH AND ALSO UNDERSTAND THESE COMMON CONDITIONS AND HELP EVERYBODY. IT'S A TRANS-NIH INITIATIVE AND MULTIPLE CENTERS RECEIVED FUNDING AND THANKS TO PRIMARILY MELISSA PARISE AND LISA KISER THE GENESIS FOR THE INCLUDE PROGRAMS INCLUDES THREE COMPONENTS. THEY ARE NUMBER ONE TO CONDUCT TARGETED HIGH-RISK, HIGH-REWARD BASIC SCIENCE STUDIES ON CHROMOSOME 21 AND ASSEMBLE A POPULATION OF INDIVIDUALS WITH DOWN SYNDROME FOR FUTURE CLINICAL STUDIES AND THREE, TO INCLUDE INDIVIDUALS WITH DOWN SYNDROME IN EXISTING CLINICAL. FOR PEOPLE OF DOWN SYNDROME, IF THEY HAVE ASTHMA WHICH THEY CAN EASILY HAVE ASTHMA AS WELL THEY SHOULD BE STUDIED IN TERMS OF CLINICAL TRIALS EXAMINING VARIOUS TREATMENT APPROACHES TO ASTHMA. NOW, IN THE PREVIOUS FISCAL YEAR 22-PLUS MILLION IN SUPPORT WAS GIVEN FOR AWARDS IN A SHORT TIME SPAN, LESS THAN SIX MONTHS. NICHD HAS A NUMBER OF PROJECTS SO IN TERMS OF THE FIRST THEME THE HIGH-RISK, HIGH-REWARD BASIC SCIENCE WE'RE OFFERING A NOVEL APPROACH TO PATHOLOGIES OF DOWN AND GENERATION SHARED RESOURCE AND WE ARE ALSO IDENTIFYING COHORTS THAT CAN BE USED FOR NEW CLINICAL STUDIES AS WE HAVE NEW THERAPEUTIC AGENTS. BECAUSE WE HAVE THE GABRIELLA MILLER KIDS FIRST STUDY WHICH IS BASICALLY A SEQUENCING STUDY OF KIDS WITH CONGENITAL OR BIRTH DEFEFKD DEFECTS OR CANCERS WE ARE USING THE RESOURCES FROM THAT PROGRAM TO IDENTIFY TWO SPECIFIC AREAS THAT EFFECT CHILDREN WITH DOWN SYNDROME. ONE IS GENOMIC ANALYSIS OF CONGENITAL HEART DISEASE AND ACUTE LYMPHOBLASTIC LEUKEMIA IN CHILDREN WITH DOWN SYNDROME AND ONE EXAMINING MALIGNANCIES IN CHILDREN AND GAVE A SUPPLEMENT TO INTELLECTUAL AND DEVELOPMENTAL RESEARCH CENTERS AT VANDERBILT MINING THE ELECTRONIC MEDICAL RECORD RECORD AND BIOSPECIMENS TO IDENTIFY A COHORT TO DOWN SYNDROME AND WE'RE CO-FUNDING AS A THIRD AIM, AN AUTISM CENTER OF EXCELLENCE NETWORK BY ADDING A DOWN SYNDROME COHORT IN THE EARLY TREATMENT AND INTERVENTION GROUP AND ALSO INCLUDING ALL INVESTIGATORS WITHIN THE INCLUDE PROGRAM TO USE THE D.S. CONNECT PROGRAM WHICH WE FUND FOR RECRUITMENT. A COUPLE THINGS THAT MAY BE OF INTEREST TO PEOPLE WATCHING. WE HAVE A NUMBER OF FISCAL '19 FUNDING ANNOUNCEMENTS ARE COMING OUT AS WE SPEAK AND WE'LL HAVE TWO WORKSHOPS IN 2019. ONE WILL BE PLANNING A COHORT ACROSS THE LIFE SPAN AND ALSO SCIENCE FOR MEANINGFUL CLINICAL TRIALS IN DOWN SYNDROME. SO JUST BRIEFLY, ELIZABETH, COULD YOU STAND UP FOR A MOMENT. I'D LIKE TO INTRODUCE -- WE HAVE A NEW POSITION AT NICHD. OUR NEW CHIEF OF STAFF IS ELIZABETH BADEN WHO CAME TO NICHD FROM THE OFFICE OF SCIENCE POLICY IN THE OFFICE OF THE DIRECTOR. AND SHE IS ALREADY HELPING. SHE STARTED JUST AFTER THE HOLIDAYS. SHE'S ALREADY HELPING TO ENSURE COMMUNICATION ACROSS NICHD AND SERVING AS EXECUTIVE SECRETARY FOR NEW WORKING GROUPS FROM OUR ADVISORY COUNCIL SO AS WE SET UP SUBCOMMITTEES FOR COUNCIL YOU'LL BE WORKING WITH ELIZABETH AND SHE'LL SERVE AS THE EXECUTIVE SECRETARY TO THE TRANS-NIH PEDIATRIC RESEARCH GROUP. THE OTHER THING FOR PEOPLE WATCHING, WE HAVE A NUMB -- NUMBER OF POSITIONS OPEN SO WE'RE BEHIND AND WE HAVE A VACANCY IN OUR DEPUTY DIRECTOR POSITION BUT I'M PLEASED TO REPORT THE SEARCH COMMITTEE HAS MET AND THEY HAVE COMPLETED NOW THEIR FIRST ROUND OF INTERVIEWS. THEY TOLD ME THEY'RE PUTTING FORWARD A NUMBER OF PEOPLE FOR FURTHER CONSIDERATION. THEY SAID IT WAS A GREAT SEARCH AND THEY'RE VERY PLEASED WITH THE RESULTED. THE EXECUTIVE OFFICER POSITION WAS DELAYED. JOHN JARVIS THE PREVIOUS E.O., HE HAD A SENIOR EXECUTIVE POSITION AND THOSE ARE VERY HARD TO GET APPROVED IN THE CURRENT ENVIRONMENT AND WE HAD TO WAIT A YEAR TO GET APPROVED AND THE SEARCH COMMITTEE HAS BEEN CHARGED AND I'M WAITING FOR THE APPLICATION WINDOW TO OPEN. WE HAVE A NUMBER OF EXTRAMURAL BRANCH CHIEF POSITIONS TO FILL DUE TO VARIOUS REASONS AND FOR YOUR COLLEAGUES WHO ARE OUT THERE AND PEOPLE WHO ARE WATCHING ON THE VIDEOCAST, THESE ARE INCREDIBLY IMPORTANT OPPORTUNITIES TO INFLUENCE SCIENCE. PLEASE MAKE THE CONNECTION BETWEEN THIS AND WHAT DR. HANN IS GOING TO TALK ABOUT IN TERMS OF OUR OPERATIONAL PLANNING, THAT PROCESS. IT'S REALLY THE BRANCH CHIEFS THAT PLAY A MAJOR LEADERSHIP ROLE IN THAT PROCESS. AND THEN WE HAVE A NUMBER OF MEDICAL AND PROGRAM OFFICERS IN THE DIVISION OF EXTRAMURAL RESEARCH. SO WE ARE DEFINITELY HIRING. SO I'M HAPPY TO ANSWER QUESTIONS. WE ARE MORE OR LESS ON TIME. NO QUESTIONS. YOU'RE SAVING THEM FOR THE STRATEGIC PLANNING, I KNOW. GREAT. DR. HANN WILL NOW PRESENT THE DIVISION OF EXTRAMURAL RESEARCH REPORT. >> GOOD AFTERNOON, AGAIN, EVERYONE. I'M PLEASED TO BE HERE THIS AFTERNOON WITH YOU AND TO PROVIDE A SHORT OVERVIEW OF SOME THINGS IN THE EXTRAMURAL WORLD HERE AT NICHD. BASICALLY, I'M GOING TO PICK UP AND DO A LITTLE BIT MORE ON HEAL WITH YOU FEEDING DIRECTLY OFF WHAT DID I ANNA JUST REPORTED -- DIANA REPORTED TO YOU ON AND SPEND TIME TALKING ABOUT OUR IMPACT ANALYSIS. YOU MAY REMEMBER WE TALKED ABOUT THIS A COUPLE TIMES BEFORE. AND WE'VE ACTUALLY THROUGH HARD WORK AND DILIGENCE AND CREATIVITY, WE HAVE BASICALLY COMPLETED IT SO I WANT TO GIVE YOU A THUMB NAIL OVERVIEW OF THAT. FINALLY AS DIANA DID END ON STAFFING UPDATES. THIS IS HELPING TO END ADDICTION LONG TERM INITIALLY THE INITIATIVE DIANA JUST SPOKE ABOUT. IT'S A SIGNIFICANT AMOUNT OF MONEY WHICH HAS COME TO THE NIH WITH REGARD TO THE INITIATIVE. IT WAS VERY GRATIFYING THIS SUMMER WORKING WITH OUR COLLEAGUES ACROSS VIRTUALLY ALL THE INSTITUTES TRYING TO COME TOGETHER AND TO FIGURE OUT WHAT IT IS THAT NIH CAN DO TO HELP IN TERMS OF THIS TERRIBLE TERRIBLE EPIDEMIC WE'RE FACED WITH. WHAT I WANTED TO BUILD ON WAS SOME OF THE MORE DETAIL GOING INTO WHAT DIANA WAS JUST TALKING ABOUT. AS YOU WILL RECALL THERE'S BASICALLY TWO PRIMARY PRONGS TO THE HEAL INITIATIVE. ONE IS TO WORK WITH TREATMENT OPTIONS AND WORK WITH THOSE EXPOSED TO OR USING OR OVERUSING OPIOIDS. THE OTHER IS MORE OF A LONGER TERM STRATEGY IN TERMS OF WHAT DO WE DO GENERALLY WITH REGARD TO PAIN AND HOW DO WE DO A BETTER JOB OF MANAGING PAIN AND NOT NECESSARILY RELYING ON THOSE TYPE OF PHARMACEUTICAL AGENTS. WHEN THE INSTITUTES GOT TOGETHER THIS SUMMER TO DEVELOP THIS TERRITORY I DO NOT KNOW HOW MANY IDEAS WERE SUBMITTED BUT IT WAS VOLUMINOUS AND THERE WAS WORK TO PULL IT TOGETHER AND FIND COMMONALITY TO WORK TOGETHER IN A COHESIVE FASHION. IT'S RESULTED IN APPROXIMATELY 50 FUNDING OPPORTUNITIES WITH REGARD TO THE HEAL INITIATIVE. MOST ARE ALREADY ON THE STREET -- ALL ARE ON THE STREET AND SOME HAVE CLOSED AND MOVED TO PEER REVIEW BUT MANY ARE OPEN AT THIS TIME. WE'RE ON 25 OF THEM AND HATS OFF TO THE EXTRAMURAL STAFF THAT WORKED ON THESE AND THERE'S A CAST OF 12 THAT WORKED TOGETHER TIRELESSLY ON THIS. WE'RE ON 25 OF THE FUTUOAs WHICH IS REMARKABLE. OUR GOAL WAS TO MAKE SURE THE POPULATIONS ESSENTIAL TO THE INSTITUTE WERE BEING REPRESENTED. IT'S BEING SPRINKLED THROUGHOUT THE FOAs. SOME DEAL WITH BACK PAIN. THE ACT NOW INITIATIVE TO WHICH WE'RE TAKING FRONT AND CENTER, LEADERSHIP ON THAT, LOOKING AT THE NON PHARMACOLOGIC AGENT AND SO WE'RE THERE AND HATS OFF TO THE STAFF AND TO LET YOU KNOW WE'RE WELL REPRESENTED IN THE INITIATIVE AND HOPE WE'RE ABLE TO LAUNCH EXCITING RESEARCH TO SPEAK TO OUR POPULATIONS IN TERMS OF THE OPIOID SITUATION. SO NEXT I'M GOING TURN TO THE IMPACT ANALYSIS AND WILL SPEND TIME WALKING THROUGH SOME OF THE FINDINGS OF THE IMPACT ANALYSIS WITH YOU. FIRST AND FOREMOST A HUGE CREDIT TO DR. BILL DUGELE AND PAULA FRRING. WHO WERE THE PRIMARY AGENTS IN TERMS OF THE IMPACT ANALYSIS. THIS WAS A HUMONGOUS EFFORT AND THE TOPIC OF IMPACT ANALYSIS IS SOMETHING I PERSONALLY HAVE BEEN INTERESTED IN AT NIH FOR OVER 20 YEARS. I THINK IT'S THE FIRST TIME WE'VE BEEN ABLE TO HAVE THE TECHNOLOGIES AVAILABLE TO TRULY MAKE A DENT IN TRYING TO ASSESS AND FIND METRICS TO MAP OUT WHAT WE MEAN BY IMPACT. THIS WAS AN EFFORT IN OUR PART TO DEVELOP A SET OF TOOLS, STANDARDIZED METHODS AND METRICS TO USE ON VIRTUALLY ANY KIND OF PROGRAM. WE CHOSE THE 10 LARGEST IN TERM OF DOLLAR VOLUME IN OUR EXTRAMURAL PORTFOLIO TO ON AND SEE, QUOTE, THEIR IMPACT. THE 20 METRICS IS A RED HERRING. IT MUST HAVE BEEN 200 METRICS THAT WERE DEVELOPED, CULLED TOGETHER, POOLED, LOOKED AT IN DIFFERENT WAYS TO FORMULATE AND COME UP WITH ABOUT 20 THAT WERE CHOSEN AT THE END BUT IT WAS AN ITERATIVE PROCESS LIKE WE ALL GO THROUGH IN TERMS OF DOING OUR RESEARCH AND TRYING TO IDENTIFY THE BEST WAY TO CAPTURE AND TO LOOK AT THESE VARIOUS INDICATORS. WHAT I'M GOING TO FOCUS ON IS THREE THINGS WHICH IS WHERE. WHERE'S IT PUBLISH AND HOW'S IT BEING USED. WHAT IS IT IN TERMS OF THE SCIENCE AND IMPORTANTLY AND WITH THAT ARE INDICATORS OF HOW MUCH. IF WE START THINKING ABOUT IT IN TERMS OF ITS PLACEMENT WITH OUR OWN VERNACULAR IT CAN START TO MAKE MORE SENSE IN TERMS OF THE WHERE, THE WHAT AND HOW MANY. ONE OF THE PLACES HAS TO DO WITH THE CLINICAL REALM. WE DO RESEARCH AND WANT TO SEE DOES IT GET INTO CLINICAL PRACTICE. DOES ANYBODY EVER PAY ATTENTION TO IT WHEN IT COMES TO WORKING WITH LIVE PATIENTS AND SAVING LIVES. SO WITH REGARD TO THAT WE LOOKED TO PRACTICE GUIDELINES. BASICALLY FOR MUCH OF THE IMPACT ANALYSIS IT RESOLVES AROUND PUBLICATION. ONCE A PAPER'S PUBLISHED, WE CAN FOLLOW IT IN A LOT OF DATABASES TO FIGURE OUT WHO'S LOOKING AT THIS AND WHO'S USING IT AND WHERE DID IT GO AND HOW FREQUENTLY IS IT BEING USED. SAME IS TRUE FOR PRACTICE GUIDELINES ONCE YOU IDENTIFY THE FIELD YOU CAN LOOK AT THE PRACTICE GUIDELINES RELATIVE TO THAT FIELD OF RESEARCH. THEN YOU CAN LOOK TO SEE WHAT ARE THE CITATIONS, WHAT'S BEING CITED, ETCETERA. THAT'S WHAT THIS PARTICULAR GRAPH IS ALL ABOUT. LET ME HELP YOU ORIENT A LITTLE BIT. THESE ARE THE 10 PROGRAMS AND THOUGH THE COLOR IS NOT GREAT, THERE ARE CLINICALLY ORIENTED PROGRAMS WHICH WILL BASICALLY D THROUGH F. THEN WE HAVE SOME WE CALL INFRASTRUCTURE SO THEY ARE INFRASTRUCTURE PROGRAMS. THAT'S THIS ONE J. AND I. AND THESE TWO ARE BLUE AND THAT'S MORE TRANSLATIONAL WORK. IT MAKES SENSE OF VALIDITY AND WE'LL MORE CITATIONS AND PRACTICE GUIDELINES COMING OUT OF OUR CLINICALLY ORIENTED WORK. GOOD THING. IN ADDITION TO WHICH THE BLUE INDICATES IT WAS CITED IN MORE THAN ONE GUIDELINE AND THE MORE PENETRATION THOSE ARTICLES ARE MAKINGTOWN THE PRACTICE GUIDELINES. YOU HAVE THE AMOUNT AS WELL AS THE DEGREE OF PENETRATION AND FOR SEVERAL OF THE CLINICALLY ORIENTED INITIATIVES WE HAVE GOING ON, IT'S NOT BAD. IT'S NOT BAD AT ALL IN TERMS OF BEING PICKED UP IN CLINICAL GUIDELINES. YOU WILL SEE A DIMUNATION OVER TIME WITH REGARD TO WHO'S USING IT, IT NEEDS TO BE THERE FOR A PERIOD OF TIME. THESE ARE OUR NEWER ENDEAVORS AND THESE ARE OUR OLDER ENDEAVORS ESSENTIALLY. IT MAKES SENSE. REMEMBER THE OLD ADAGE WITH REGARD TO HOW LONG IT TAKE RESEARCH TO GET USED BY F.D.A. AND BECOME A DRUG IS LIKE 17 YEARS. THE LONGER IT'S BEEN IN EXISTENCE THE MORE LIKELY IT ENDS UP IN CITATIONS. >> IS THERE A PERCENTAGE OF PAPERS FUNDED BY THE GRANTS? SO 15% OF PAPERS FUNDED BY GRANTS IN THE D CATEGORIES WERE CITED BY -- >> MORE THAN ONE GUIDELINE. >> I'LL HAVE TO THINK ABOUT THAT. >> WHAT WAS ALSO INTERESTING IS WE APPLIED IT TO THE INFRASTRUCTURE AND TRANSLATION AND YOU SEE PAPERS FROM THOSE AREAS TOO BEING PICKED UP IN GUIDELINES. THAT WAS A PRESENT SURPRISE BECAUSE THAT WASN'T THE INTENT OF THE ENDEAVORS WAS TO REACH ALL THE WAY TO CLINICAL PRACTICE. CLEARLY, SOME OF THE PAPERS ARE SOME SUCH, AIR QUOTES, IMPACT THEY'RE PENETRATING INTO THE CLINICAL GUIDELINES AREA. >> TO FOLLOW UP ON THAT, DO YOU HAVE A SENSE OF WHAT THE AVERAGE NUMBER OF PUBLICATIONS ARE PER GRANT? >> I'M GOING LOOK AT BILL. >> I'M TRYING TO UNDERSTAND IF YOU HAD A GRANT FUNDED IN THE D CATEGORY. WHAT PERCENTAGE OF GRANTS FUNDED IN THE D CATEGORY HAD A PAPER CITED ONCE WITH A CLINICAL PRACTICE GUIDELINE AND YOU SEEM TO HAVE TO KNOW THE AVERAGE NUMBER OF PUBLICATIONS FROM ONE OF THOSE GRANTS. >> IT'S NOT JUST GRANTS. IN THE CLINICAL AREA WE'RE TALKING ABOUT OUR NETWORK. IT'S A COLLECTION OF GRANTS THAT WE'RE ASSESSING HERE. THEY'RE NOT INDIVIDUALIZED. >> I THINK ONE OF THE REASONS WHY PERCENTAGES WERE USED IS THE OLDER PROGRAMS HAD MANY MANY MORE PUBLICATIONS. I KNOW YOU'RE TRYING TO LOOK AT PUBLICATION PER GRANT BUT IT'S VERY HARD TO COMPARE SAY A NETWORK WITH THE FIVE YEAR WHICH IS WHY WE USE PERCENTAGES. I THINK WHAT WE'RE TRYING TO EXAMINE IS THE RETURN OF INVESTMENT ON LARGE PROGRAMS VERSUS A TYPICAL RO1 VERSUS EVERYTHING IN A PARTICULAR EXTRAMURAL BRANCH. YOU CAN SEE SOME OF THE PROGRAMS ARE HAVING A BIG IMPACT ON THESE CLINICAL GUIDELINES. >> RIGHT. AND THANK YOU, DIANA FOR WHAT YOU JUST SAID. WHAT'S HERE AND WHAT I FAILED TO MENTION EARLIER WHICH MAY LEAD TO CONFUSION, FOR EACH OF THE PROGRAMS WE HAVE COMPARISONS AND WE HAVE A COMPARATIVE GROUP OF RO1s SIMILAR IN TOPIC SO THE PROGRAM. SO I APOLOGIZE. I SHOULD HAVE POINTED THIS OUT. KEEP THAT IN MIND. THAT WAS PRACTICE GUIDELINES. SOME PEOPLE LOOK AT THEM, SOME DON'T. SO ONE OF THE OTHER TOOLS CLINICIANS HAVE IS UP TO DATE. THEY'RE ABLE TO CARRY IT WITH THEM AND LOOK UP THINGS, ETCETERA. WE WERE ABLE TO ACCESS THAT DATABASE AND TO SEE ARE THE PUBLICATIONS COMING FROM OUR ENDEAVORS REACHING INTO THAT PARTICULAR VENUE AND INDEED, YESSER. YOU'LL SEE HERE FOR B THERE'S A GREAT DEAL OF SATURATION IN TERMS OF BEING PICKED UP UP TO DATE. MAYBE THERE'S A CONNECTION IN TERMS OF MEMBERSHIP. THERE'S CLEARLY A LOT OF USAGE THERE AND AGAIN WITH OUR INFRASTRUCTURE PROGRAMS WE'RE SEEING THE SAME THING. THIS WAS ANOTHER WAY FOR US TO SAY, IS THIS ACTUALLY -- IS ANYBODY PAYING ATTENTION TO THIS THAT NEEDS TO PAY ATTENTION TO THIS. I THINK THE ANSWER IS YES. IT IS VARIABLE ACROSS THE PROGRAMS. PART HAS TO DO WITH THE LONGEVITY OF THE PROGRAM. ALSO CLEARLY THE INTENT OF THE PROGRAM IF THE PROGRAM NEVER INTENDED TO REACH PRACTICE GUIDELINES AND THIS SAY BONUS IN TERMS OF THE OTHER PROGRAMS AND THEY'RE BEING USED. THAT'S SORT OF THE WHERE. WE CAN ALSO BE THINKING ABOUT IT IN TERMS OF WHAT. WE'RE ALL RESEARCHERS AND INTERESTED IN OUR PUBLICATIONS AND WHO'S MAKING AN IMPACT SPECIFICALLY IN THE FIELD. SO THIS SLIDE IS GOING TO BECOME MORE COMPLICATED. I'LL TAKE IT FAIRLY SLOWLY AND WALK OUR WAY THROUGH IT. I THINK EVERYONE HOPEFULLY MANY OF YOU WILL REMEMBER WHAT I CALL AS THE SPACE GRAPH HERE. YOU CAN TAKE ANY AREA OF LITERATURE, DOESN'T HAVE TO BE SPECIFIC LITERATURE AND TAKE MULTIPLE PUBLICATIONS AN RUN IT THROUGH EYE CONTENT ANALYSIS TO GET THEMES. SOME DO THAT FOR RESEARCH PURPOSE IN TERMS OF LOOKING AT NARRATIVES. SAME PRINCIPLE. THIS IS WHAT WE WERE DOING IN TERMS OF OUR PROGRAMS AND THE COMPA COMPARITORS AND PAPERS FUNDED BY NICHD BUT NOT IN THE PROGRAM AND PAPERS PUBLISHED BY THE REST OF NIH AND PAPERS PUBLISHED BY THE FIELD NIH NEVER HAD A CONNECTION WITH AT ALL. WE PULLED IN A HUGE DATABASE IN TERMS OF LOOKING AT THE RESEARCH FOR AN AREA OF SCIENCE AND DID A THEMATIC CONTENT ANALYSIS WITH IT. IT'S PRETTY AND IT GETS TO SHOW YOU NATIONALLY WHERE THE DIFFERENT INITIATIVES OR PROJECTS WE'RE SUPPORTING ARE SATURATED AND THE KINDS OF SCIENCE AND WHAT ARE THE TOPICS THEY'RE TRYING TO DO. HOWEVER, WE CAN TAKE IT A STEP FURTHER. I THINK MANY WILL REMEMBER IN PREVIOUS CONVERSATIONS WE TALKED ABOUT A METRIC DEVELOPED AT NIH CALLED THE RELATIVE CITATION RATIO. IN A NUTSHELL WHAT IT ALLOWS YOU TO DO IS TAKE A GIVEN PAPER AND THE CITATIONS OF A GIVEN PAPER AND COMPARE IT TO THE AVERAGE FOR NIH WITHIN THAT FIELD OF STUDY BECAUSE IT'S NOT FAIR TO USE AN AVERAGE THAT WOULD BE BASED ON NEUROSCIENCE WHEN YOU HAPPEN TO BE LOOKING AT CLINICAL PEDIATRICS. THAT WOULD NOT BE APPROPRIATE. THIS TOOL ALLOWS YOU TO SAY WHAT'S THE FIELD AND YOU DEFINE THE FIELD AND TALK ABOUT THE RELATIVE CITATION RATIO OF THE PAPERS.COMPARED TO THE AVERAGE. THE AVERAGE IS ALWAYS ONE. ANYTHING IS ABOVE ONE IS GOOD. EVEN BEING AT ONE IS GOOD. YOU CAN TAKE THE SPACE IN TERMS OF THEMES AND WHAT YOU CAN DO IS LOOK AT RELATIVE CITATION RATIOS FOR THE PAPERS THAT HAVE BEEN GENERATED AND LOOKING AT IT ACROSS THE DIFFERENT COMPARISON GROUPS. YOU'VE GOT THE PROGRAM OF INTEREST RIGHT HERE THE NEXT IS THE RO 1 COMPARISON GROUP AND PAPERS PUBLISHED BY NICHD AND PAPERS PUBLISHED BY NIH AND THEN EVERYTHING ELSE. ALL TAKEN FROM THIS ONE GRAPH. IN GENERAL IT SHOWS THAT THE PROGRAM OF INTEREST HERE IS DOING VERY WELL. INDEED, THE MEDIAN BECAUSE THIS IS THE LINES WHICH I KNOW ARE DIFFICULT TO SEE, THE LINES ARE THE MEDIAN FOR THE PROGRAM IT'S ALMOST TWO. PRETTY GOOD. NOW WE CAN TAKE IT A STEP FURTHER. WE CAN LOOK AT EACH ONE OF THESE THEMATIC CLUSTERS AND CAN LOOK AT THE RELATIVE CITATION INDEXES WITHIN THE CLUSTERS AND BREAK IT OUT IN TERMS OF A COMPARITOR GROUP AND WORKING WITH THE STAFF FOR EACH OF THE PROGRAMS OF INTEREST WE IDENTIFIED SEVERAL CLUSTERS. THE FIRST WAS RESPIRATORY COMPLICATIONS AND THE MEDIAN CITATION RATIO IS HERE AND YOU CAN BREAK THEM OUT IN GROUPS AND TALK ABOUT THE PAPERS AFFILIATE WITH THE PROGRAM, THE PAPERS AFFILIATED WITH THE RO 1 GROUP AND WITH REGARD TO RES -- THE COMPLICATIONS ARE SHOWN AND THE PAPER THAT'S BEING NOTE AND TAKEN UP IN A LOT OF PLACES WITHIN THE RESEARCH REALM. IT'S HAVING AN IMPACT ON THE RESEARCH REALM. THE PROGRAM IS HIGHER THAN ANY OF THE OTHER COMPARISON GROUPS. I HAVE TO SAY MANY OTHER COMPARISON GROUPS ARE DOING QUITE WELL. ONE OF THE FRIENDS WE HAVE NOTED IN TERMS OF DOING THIS ANALYSIS IS IN GENERAL, NOT ALWAYS, PAPERS COMING OUT OF NIH ENDEAVORS WHICH ARE THESE FOUR BOX AND WHISKERS GENERALLY ARE HIGHER THAN THE REST OF THE FIELD. WE DID THE SAME FOR YET ANOTHER CLUSTER. HIPE OWE -- HYPERTHERMIA AND OTHERS AND WE DID THE GREAT METRICS. HOW'S IT GOING TO BE USED? FOR ME I FIND THE DATA TO BE INCREDIBLY HELPFUL IN WORK ING WITH THE PROGRAM STAFF IN THESE AREAS. WE HAVE MORE. I SHOWED YOU TWO AND IT'S ONLY ONE OF THE SET PROGRAMS. WE HAVE THIS FOR 10 PROGRAMS AND MULTIPLE CLUSTERS. ONE CAN USE IT AND I'M THINKING ABOUT IT IN TWO DIFFERENT KINDS OF WAYS. IT DEPENDS ON THE DIALOGUE AND DISCUSSION. IT OPENS UP A USEFUL DISCUSSION BECAUSE HAVE YOU METRICS IN WHICH TO BASE IT ON. ONE IS TO LOOK AND SEE THE AREAS IN WHICH THE SAID PROGRAM IS HAVING AN IMPACT BY DOING THIS. WHAT ARE THOSE AREAS IN COMPARISON TO OTHER AREAS. YOU CAN THINK ABOUT AND HAVE DISCUSSIONS AS TO WHETHER OR NOT THE PROGRAM, IF THIS IS THE TOUR DE FORCE FOR THE PROGRAM MAYBE THAT'S WHAT THEY NEED TO FOCUS ON. THAT WOULD BE ONE LINE OF LOGIC. THE OTHER LINE OF LOGIC IS THEY'VE MADE PHENOMENAL PROGRESS IN PARTICULAR AREAS GIVEN WHERE WE ARE IN THE STATE OF SCIENCE AND WHAT WE KNOW, THE OTHER AREAS NOT AS STRONG TRULY NEED TO BE BUILT. THERE'S A LOT OF IMPORTANT SCIENCE AND PUBLIC HEALTH ISSUES GOING ON IN THAT. MAYBE WE NEED TO DIVEST OUT OF THE AREAS AND MOVE TO ANOTHER AREA OF INTEREST IN TERMS OF BUILDING UP THE FIELD IN OTHER WAYS. THERE IS NO RIGHT OR WRONG IT'S JUST A DIALOGUE AND DISCUSSION TO RAISE IT UP A LEVEL BASED OFF THE METRICS ESSENTIALLY. THAT'S WHAT I LOOK FORWARD TO DOING IN TERMS OF WORKING WITH STAFF GOING FORWARD IN TERMS OF USING THE ANALYSIS IN SHAPING THE PROGRAMS. SO THAT'S IT FOR MY TOUR THROUGH THE IMPACT ANALYSES. THE FINAL SHORT PART I'M GOING GO THROUGH A FEW STAFFING UPDATES. SO DIANA INDICATED ALREADY WE HAVE HAD SOME RETIREMENTS AND MOVEMENTS. THE FIRST IS DR. WHITE. I THINK SEVERAL OF YOU WERE FAMILIAR IN WORKING WITH DELLA. SHE WAS PART OF OUR POPULATION DYNAMICS SINCE 2016 AND PRIOR TO THAT WORKED IN THE OFFICE OF HEALTH EQUITY AND HAS BEEN HERE A NUMBER OF YEARS. SHE'S ACCEPTED A POSITION AT THE NATIONAL INSTITUTE OF COMPLIMENTARY AND ALTERNATIVE MEDICINE. WE WISH HER ALL THE BEST IN TERMS OF HER ENDEAVORS. IN FORWARD WE'RE LOOKING FORWARD TO WORKING WITH HER IN THAT CAPACITY AND BRIDGING THAT INSTITUTE. WE SAID A FOND FAREWELL TO DR. TONSA BAREU. HE HELD HIS POSITION SINCE 2018 AND HAD COME TO THIRD IN THE EARLY 2000s AND A WELL DISTINGUISH DISTINGUISHED NEONATOLOGIST. AND DR. LISA FREUND SHE TOO ACCEPTED A POSITION IN 2013 BUT HAD BEEN AT THE INSTITUTE SINCE 1998. SHE HAD DEFINITELY MADE HER MARK IN TERMS OF HER AREA OF SCIENCE. ONE OF HER STRONG SUITS IS AND ALWAYS HAD BEEN IN TERMS OF DEVELOPMENT NEUROSCIENCE WITH COGNITION AND MADE TREMENDOUS STRIDES IN TERMS OF PURSUING AND SUPPORTING THAT AREA OF RESEARCH AT NICHD. SHE TOO WE WISH A FOND FAREWELL. I'M PLEASED TO ANNOUNCE FOUR FOLKS WHO HAVE JOINED US SINCE WE LAST MET. SHE IS IN THE DEVELOPMENT AND DISABILITIES BRANCH. SHE WAS WORKING WITH US US PREVIOUSLY IN THE BRANCH IN THE WHO'VE A CONTRACTOR AND GLAD SHE'S BECOME A FULL-PLEDGED OFFICIAL. HER AREA OF FOCUS IS DOWN SYNDROME AND WORKING WITH DR. PARISI ALL THE PROJECTS DIANA REFERRED TO IN HER TALK. I'D LIKE TO ALSO WELCOME DR. WINDCHILL ROBBINS AND SHE'S JOINING US IN OUR SCIENTIFIC REVIEW BRANCH. SHE HAS A BACKGROUND IN EPIDEMIOLOGY AND INFECTIOUS DISEASE AND TRAINING. IT'S WONDERFUL TO HAVE SOMEONE WHO UNDERSTANDS THE TRAINING MECHANISMS AND THE INS AND OUTS WITH REGARD TO PEER REVIEW. THIRD, I'D LAKE TO WELCOME DR. CHRISTOPHER LINDSAY. CHRIS IS JOINING US AS A MEDICINAL CHEMISTRY AND HIS BACKGROUND IS IN ORGANIC CHEMISTRY AND HE'LL WORK IN THE DEVELOPMENT WITH NEW THERAPEUTICS AN ISSUES WITH REGARD TO CONTRACEPTION AND DR. JAMES KULAM IS NOW IN A DIFFERENT ROLE. HE'S NOW THE NEW BRANCH CHIEF FOR THE DEVELOPMENT BIOLOGY AND STRUCTURAL VARIATIONS BRANCH. HE'S BEEN WITH US A FEW YEARS. AN AREA OF DEVELOPMENT BIOLOGY AND NEUROSCIENCE AND SYSTEMS BIOLOGY AND WE LOOK FORWARD TO HIS LEADERSHIP IN LIGHT OF WHAT WE'LL BE TALKING ABOUT IN THE STRATEGIC PLAN AND THE ROLE OF THE BASIC SCIENCES IN THAT. THOSE ARE THE ARRIVALS AND WELCOME TO ALL FOUR AND HOPEFULLY IF YOU SEE THEM YOU GIVE THEM A NICE HELLO AND WELCOME AS WELL. I'LL END THE SAME WAY IN TERMS OF DIANA DID THAT WE'RE ACTIVELY HIRING THERE'S AN ANNOUNCEMENT DAY FOR FOLKS TO APPLY TO BECOME A PROGRAM OFFICIAL OR BRANCH CHIEF WITH THE BACKGROUND IN EYE EYE -- IN A MEDICAL BACKGROUND AND THE ANNOUNCEMENT JAME -- ANNOUNCEMENT CAME AND WENT AND WITH THAT I'M DONE. THANK YOU VERY MUCH. >> DOES ANYBOD HAVE ANY QUESTIONS FOR DR. HANN. THANK YOU. WE'RE GOING TO TAKE SHORT BREAK I WOULD LIKE TO INTRODUCE A NEW MEMBER OF OUR ADVISORY COUNCIL DR. REBECCA WAN THE HEALTH CARE ECONOMIST WITH PARTICULAR EXPERTISE IN LIFE SPAN COHORTS. YOU'LL SEE WHY THAT'S IMPORTANT COMING UP BUT GLAD YOU CAN JOIN US AND THE HEALTH AND HUMAN SERVICES HAS APPROVED YOUR MEMBERSHIP ON COUNCIL. WE'LL GET STARTED WITH AN UPDATE ON STRATEGIC PLANNING. WE'RE LOOKING FORWARD TO YOUR ACTIVE ENGAGEMENT AND KNOW MANY OF YOU HAVE THINGS TO SAY AND WE WELCOME THAT. IT'S IMPORTANT TO RECOGNIZE, WHEN WE GET TO THE THEMED, THESE ARE DRAFT THEMES AND WE HAVE ALREADY GOTTEN A LOT OF COMMENTS FROM ANYBODY WHO HAS CHOSEN TO WRITE IN IN TERMS OF REQUEST FOR INFORMATION AND WE STARTED WITH THE COUNCIL IN SEPTEMBER AND THIS IS THE MIDPOINT WITH THE PROCESS AND YOU'LL END WITH THE COUNCIL AS WELL. YOU'LL BE HEARING WHERE WE END UP BUT WE'RE AT THE MIDPOINT RIGHT NOW. LET ME GET STARTED. I THINK IT'S VERY IMPORTANT AND THIS SAY MESSAGE THAT PARTICULARLY FOR OUR EXTRAMURAL STAFF MEMBERS WE WEREN'T MAYBE AS CLEAR AS WE COULD HAVE BEEN BUT THE INITIAL GOALS WERE TO IDENTI IDENTIFY SCIENTIFIC PRIORITY AREAS WHERE NICHD CAN LEAD AT NIH. ONE THING NOT CLEAR FROM PEOPLE TO THE OUTSIDE IS THERE'S A TREMENDOUS AMOUNT OF PARTNERSHIP BETWEEN DIFFERENT INSTITUTES AN CENTERS. SO WE WANT TO IDENTIFY WHEN SOMEBODY HERE'S ABOUT A PROBLEM THEY WANT TO CONNECT IT TO NICHD BUT IT DOESN'T MEAN WE'LL DROP AREAS WE CURRENTLY FUN. THERE'S MANY AREAS AND IT WASN'T ABOUT IMPLEMENTATION OR WHAT TYPES OF GRANTS YOU'RE GOING CONTINUE TO SUPPORT. WE WANTED TO IDENTIFY THE PRIORITY FIRST AND THEN GET TO TRAINING AND FUNDING AND ADDITIONAL PARTNERSHIP. WE'RE PRETTY MUCH ON THE TIME LINE RIGHT HERE. WE'RE DOWN ON THE LOWER RIGHT. SO WE'RE HERE WITH COUNCIL INPUT AND THERE'S BEEN A TREMENDOUS AMOUNT OF WORK THAT'S HAPPENED SINCE WE LAST MET IN SEPTEMBER SO THERE'S BEEN THE WORKING GROUP MEETING, INTERNAL STAFF HAVE MET. THERE'S BEEN COALESCENCE AND BEGINNINGS OF ALIGNMENT AND WORK HAS BEEN GOING ON PRETTY MUCH FOR OVER A YEAR NOW. AND I JUST WANT TO REMIND YOU BECAUSE SOME OF THE COUNCIL MEMBERS WERE NOT HERE FOR THE SEPTEMBER PRESENTATION. SO THE CORE PRINCIPLES ALL ALONG HAVE BEEN TRANSPARENCY, THE TYPE OF EVIDENCE THAT DELLA PRESENTED IN TERM OF ANALYZING THE IMPACT OF THE PROGRAMS WE FUND, STAKEHOLDER PARTICIPATION AND OTHER PRINCIPLES INCLUDING AN OVERALL GOAL OF EVENTUALLY ALIGNING INTRAMURAL AND EXTRAMURAL RESEARCH AND OUR CORE PRINCIPLE OF INCLUDING OUR CORE POPULATIONS, WOMEN, CHILDREN AND PEOPLE WITH INTELLECTUAL AND PHYSICAL DISABILITIES. SO IN TERMED OF IMPLEMENTING TRANSPARENCY, THERE WAS AN INITIAL ANNOUNCEMENT WHERE WE EXPLAINED WHY AND HOW WE WERE DOING THIS. WE GAVE OUR INITIAL TIME LINE. WE HAD OUR INITIAL PUBLIC LAUNCH. ACTUALLY, THAT SHOULD SAY SEPTEMBER OF 2018. WE TOLD YOU WE WERE GOING TO DO IT BUT WE BEGAN TO DISCUSS THINGS. WE PRESENTED DATA WITH TWO OF YOU IN SEPTEMBER. WE HAD MAINTAIN A PUBLIC FACING WEBSITE THROUGH CALENDAR YEAR 2018 AND UPDATED THAT AS NEEDED. REALLY, THERE WAS AN OVER SIX-MONTH PROCESS WHERE KEY PORTFOLIO DATA FROM THE PROJECTS THAT WE FUND WERE ANALYZED BY PUBLIC HEALTH AND SCIENTIFIC DOMAINS. YOU HEARD A LOT OF THAT IN THE SEPTEMBER COUNCIL MEETING. WE ALSO REVIEWED STRATEGIC PLANS FOR OVERALL NIH AS WELL SUBCOMPONENTS OF OUR INSTITUTE SUCH AS THE DIVISION OF INTRAMURAL RESEARCH STRATEGIC PLAN. WE LOOKED AT THE PRIOR DOCUMENTS. THE STRATEGIC PLAN FROM THE YEAR 2000 AS WELL AS THE VISIONING PROCESS AND DID OTHER IMPACT ANALYSES. THAT WAS THE EVIDENCE WE USED TO SAY WHAT IS THE IMPACT OF WHAT WE'RE ALREADY DOING. WE STARTED WITH THE LISTENING SESSION IN SEPTEMBER, THOSE WHO WERE HERE REMEMBER THAT. AND THAT LED INTO THE STRATEGIC PLANNING WORKING GROUP MEETING THAT WAS HELD IN MID OCTOBER. THAT CONSISTED OF 27 FEDERAL MEMBERS. 53 EXTERNAL MEMBERS VETTED IN TERMS OF THEIR EXPERTISE. IDEALLY PEOPLE HAD EXPERTISE IN MORE THAN ONE AREA. WE ALSO IMPORTANTLY INCLUDED A THIRD OF THE WORKING GROUP WAS WHAT WE WOULD CALL YOUNG INVESTIGATORS SO WE COULD HAVE PEOPLE WHO REPRESENT THE FUTURE OF NICHD. AND THE PHOTOGRAPHS ARE THE ACTUAL PHOTOGRAPHS WERE PEOPLE DISCUSSING THINGS AND COMING UP WITH IDEAS. NOW, HOPEFULLY THIS WILL WORK. OUR COMMUNICATIONS DEPARTMENT HAS COME UP WITH FIVE ON THE WEBSITE -- GOOD, IT'S WORKING, MAGICALLY. HERE'S ONE. YOU'LL SEE TRACY. >> DIFFERENT PERSPECTIVES BASED ON CLINICAL OR TRANSLATIONAL IN WHAT DIFFERENT WORDS EVEN MEANT. WHAT DOES ENVIRONMENT MEAN. WHAT DOES DEVELOPMENT MEAN. DEVELOPMENT OF EXPECT OR THE DEVELOPMENT OR PRESENTATION OF SOMETHING? GETTING TO UNDERSTAND EACH OTHER AND COMING OUT WITH IDEAS HOW TO INTEGRATE THOSE ACROSS DIFFERENT ARENAS AND AVENUES OF RESEARCH TO HOW THAT IMPACTS REPRODUCTION, HEALTH AND CHILD DEVELOPMENT. MANY FACTORS THAT SEEM TO COME UP OVER AND OVER AGAIN WE REFER TO AS GENETIC RISK BY ENVIRONMENTAL INFLUENCES AND ACROSS THE LIFE SPAN WHERE THAT MATTERS. SOMETHING MOM OR DAD EXPERIENCE PRECONCEPTION IN THEIR ENVIRONMENT OR SOMETHING THAT HAPPENED SPECIFICALLY DURING PREGNANCY OR IN HER LIFE VERSUS SOMETHING IN PUBERTY. THOSE FACTORS INTERACT AND CAN BE UNIQUE. THERE COULD BE NEURODEVELOPMENT UNDERPINNINGS OF NEURODEGENERATE DISEASES YOU MAY NOT SEE FOR 80 YEARS. FINDING THAT COMMON POINT IN THE ROOM YESTERDAY WAS HELPFUL IN LOOKING AT HOW WE LOOK ACROSS DISEAS DISEASES AND LOOK AT COMMONALITIES AT GENETIC RISKS AND ENVIRONMENTAL LIKE STRESS, IMMUNE AND THE WINDOWS THOSE HAPPEN IN ARE MORE INFORMATIVE THAN DISEASE BY DISEASE. >> THERE'S FIVE UNDER TWO-MINUTE VIDEO SUMMARIES OF FIVE PEOPLE WITH DIFFERENT AREAS OF EXPERTISE WHO HAD DIFFERENT TAKE ON THE PROCESS. YOU ALSO HAD VISUAL SUMMARIES OF WHAT WAS DISCUSSED. THAT'S WHAT YOU WERE SEEING THERE. SO THAT WAS A VERY INVIGORATING MEETING AND THEN WE WENT FROM THERE TO ASKING THE GENERAL PUB TLOIK JOIN THE CONVERSATION. -- PUBLIC TO JOIN THE CONVERSATION. WE FROM THE BEGINNING HAD A WEBSITE IN WHICH WE ASKED PEOPLE TO COMMENT ON WHAT IS IMPORTANT AND WHAT NEEDS TO BE IN THE STRATEGIC PLAN AND WE RECEIVED 119 E-MAIL RESPONSES WITH THE R.F.I. WITH COMMENTS OR QUESTIONS ON THE STRATEGIC PLAN. AS YOU HEARD, WE HAD THE WORKING GROUP MEETING ON THE 15th OF OCTOBER. ON OCTOBER 22 AND HAD 35 PATIENT AND FAMILY ORGANIZATIONS ATTENDED. THIS INCLUDED RESEARCH ADVOCACY GROUPS AS WELL AS REPRESENTATIVES OF PROFESSIONAL SOCIETIES. WE HAD PEOPLE IN THE ROOM AT THE MEETING AND THE LOWER PICTURE IS WHAT I WOULD CALL THE WAR ROOM. WHEN WE DID OUR FIRST LIFE INTERACTIVE PUBLIC WEBINAR. WE HAD AROUND 300 PEOPLE PARTICIPATING AS WE WENT THROUGH SOME OF THE DATA THAT WE HAD COLLECTED ON OUR PORTFOLIO AND OUR THINKING SO FAR AND THEN TOOK QUESTIONS LIVE VIA THE ONLINE SYSTEM. YOU SEE VARIOUS MEMBERS OF NICHD PULLING TOGETHER THE QUESTIONS AND GIVE ME THE QUESTIONS. AS THEY WERE GROUPED WE ANSWERED THEM. I THOUGHT IT WAS TERRIFYING AT FIRST BUT IT WAS A LOT OF FUN. I THINK IT WAS EFFECTIVE. IT WAS A WAY OF COMMUNICATING WITH A NUMBER OF PEOPLE IN REAL TIME. WE'VE ALSO HAD GENERAL PUBLIC INPUT WITH REGARD TO FACEBOOK AND TWITTER PAGES. OUR HASH TAG IS NICHD STRATEGIC PLAN AND HAVE ACTIVE SOCIAL MEDIA WORK GOING ON IN THE COMMUNICATIONS ACCIDENT AND THERE'S BEEN 383 HASH TAG MENTIONS BY AUTHORS GENERATING 1.3 MILLION POTENTIAL IMPRESSIONS. THE POSTS COMING FROM NICHD STAFF ABOUT STRATEGIC PLANNING HAVE GENERATED 59,000 PLUS IMPRESSIONS, 110 SHARES OF RETWEETS AND 403 CLICKS. QUITE A LOT OF SOCIAL MEDIA ACTIVITY. IN SEPTEMBER WE GOT 39 THEMES. IT'S A GOOD TIME TO INTRODUCE SCOTT WHEELER. IF YOU HAVEN'T MET SCOTT WHEELER THE PRINCIPLE FOR STRATEGY ARTS, HE HAS BEEN LEADING OUR STRATEGIC PLANNING PROCESS AS THE FACILITATOR THE HONCHO FACILITATOR. HE WAS LISTENING DURING THE INITIAL COUNCIL MEETING THAT LED TO 39 IDEAS. THE WORKING GROUP INTERVIEWS BEFORE THE SESSION AND THEN DURING THE SESSION LED TO I BELIEVE 272 IDEAS. THOSE WERE EXAMINED FOR ALIGNMENT AND CONDENSED TO 30. THIS IS ANOTHER PICTURE DURING THE STRATEGIC PLANNING MEETING. THEN WE PRESENTED THOSE 50 THEMES TO INTERNAL STAFF CONSISTING OF THE INTRAMURAL DIVISION AS WELL AS THE EXTRAMURAL DIVISION AND THE QUESTION OPPOSED IS WHAT WAS NICHD UNIQUELY SUITED TO INVEST AND WHERE WILL WE HAVE INVESTMENTS AND ARE THEY FEASIBLE TO ACCOMPLISH WITHIN THE NEXT FIVE YEARS. THIS IS ONE OF THE GRAPHICS THAT CAME FROM THE WORKING GROUP MEETING. AGAIN, WE HAVE ALL THESE NUMBERS. WE THEN CAME DOWN TO SEVEN PRIORITIES FROM THE INTERNAL MEETINGS THAT OCCURRED BEFORE CHRISTMAS. WE HAVE CONDENSED THAT TO SIX DRAFT THEMES. THAT'S WHAT WE'LL FOCUS ON TODAY AND IT'S ALL MATERIAL THAT'S BEEN SUBMITTED PUBLICLY. THERE'S A REQUEST FOR INFORMATION THAT ANYBODY CAN ANSWER. INTERNAL STAFF, EXTERNAL STAFF, YOUR GRANDMOTHER. DOESN'T MATTER. PEOPLE ARE ALLOWED TO COMMENT. THROUGHOUT, I'VE BEEN USING THE CONCEPT OF A WOVEN DOCUMENT. I LIKE THE IDEA OF A WARP AND WENT. THE WARPS WOULD BE THE VERTICAL FIBERS. THOSE WOULD BE THE THEMES WE EVENTUALLY DECIDE UPON. THE WEFTS ARE THE THEMES EMBEDDED IN THE PRIORITY AREAS. FOR EXAMPLE, WE DIDN'T TALK SEPTEMBER COUNCIL MEETING AND IT WAS SOMETHING I BROUGHT UP AND SAID WHY DIDN'T WE SAY ANYTHING ABOUT GLOBAL HEALTH? WELL, GLOBAL HEALTH EFFECTS A LOT OF WHAT WE DO. THAT'S ONE OF OUR CROSS-CUTTING PRINCIPLES INCLUDING INCLUSION OF OUR POPULATIONS. WE HAVE MULTIPLE CHALLENGES AND OUR NAME IS IS THE EUNICE SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOP. PEOPLE ARE SURPRISED WHEN THEY HEAR WE DO THINGS THAT ARE OTHER THAN THAT AND OTHER INSTITUTIONS FUND CHILD HEALTH AND ONE OF THE REASONS WE HAVE NPERC. PREGNANCY IS THOUGHT TO BE A TIME-LIMITED CONDITION. AND I THINK THAT'S WHY CONGRESS HAS NOT HISTORICALLY BEEN THAT FOCUSSED ON PREGNANCY AND ADVERSE OUTCOMES ESPECIALLY FOR WOMEN WHO ARE PREGNANT. IT'S BECAUSE PREGNANCY LASTS NINE MONTHS AND IT'S OVER. ONE OF THE CONCEPTS WE'RE TRYING TO INCLUDE IN ALL THESE THEMES IS WE NEED TO FOCUS ON OUR POPULATIONS IN EVERYTHING WE DO AND WE DO THAT EVERY DAY WHETHER IT'S TALKING ABOUT INCLUDING CHILDREN, PREGNANT WOMEN AND PEOPLE WITH DISABILITIES IN ALL OF US, FOR EXAMPLE. IT'S AN UPHILL STRUGGLE WHEREVER WE TALK ABOUT BIG PROGRAMS AT NIH. BUT THE CONCEPTS ARE INCLUDED IN ALL THE SCIENTIFIC THEMES. INCLUDING OUR POPULATIONS. WOMEN, CHILDREN, PEOPLE WITH PHYSICAL AND INTELLECTUAL DISABILITIES. NUTRITION, HEALTH DISPARITIES AND INFECTIOUS DISEASES AND I ALREADY MENTIONED GLOBAL HEALTH. THE THEMES WHICH ARE DRAFT AND I KNOW THERE'S BEEN ENGAGEMENT AND YOU'RE ONLY SEEING THE HEADLINES HERE. SO WE HAVE DOCUMENTATION THAT SCOTT WILL PRESENT OR I CAN BACK HIM UP WITH WHAT UNDER LIES THESE THEMES. SO THE FIRST THEME IS UNDERSTANDING EARLY HUMAN DEVELOPMENT. THE SECOND IS SETTING THE FOUNDATION FOR A HEALTHY PREGNANCY AND LIFE-LONG WELLNESS. PROMOTING GINE -- GINO -- GYNECOLOGIC HEALTH AND THIS DOESN'T INCLUDE CONTRACEPTIVE HEALTH THAT IS FOR MEN AND WOMEN BUT IT'S A SIGNIFICANT INVESTMENT AND SOMETHING NOT IDENTIFIED IN OTHER INSTITUTES. WE'LL OF THE PLAIN IDENTIFYING SENSITIVE TIME PERIODS TO OPTIMIZE HEALTH INTERVENTIONS -- EXPLAIN IDENTIFYING, AND ADOLESCENCE TO ADULTHOOD AND SAFE THERAPEUTICS AN DEVICES FOR OUR POPULATIONS. AND SPECIFICALLY THE NEEDS TO DEVELOP THERAPEUTICS AND DEVICES FOR OUR POPULATIONS. SO THE GOAL OF THEME ONE IS TO AND I WANT TO MENTION, THIS IS LANGUAGE PUT TOGETHER WITH THE GOAL OF PUTTING THE R.F.I. OUT AS SOON AS POSSIBLE AFTER THE HOLIDAYS. WE HAVE HEARD THE COMMENTS ABOUT THE ABSENCE OF CERTAIN WORDS OR THE WAY SOME OF THESE THEMES ARE COMMUNICATED. THIS IS ALL UP FOR REVISION. THIS IS A DRAFT FOR YOU TO REACT TO. SO I WANT EVERYBODY TO UNDERSTAND THAT THAT IT'S EASIER TO REACT TO SOMETHING THAN TO AN ABSTRACT CONCEPT. IS EVERYBODY WITH ME ON THAT? OKAY. SO THE GOAL IS TO ENHANCE KNOWLEDGE OF GENES AND REGULATORY NETWORKS OF THE SINGLE AND MULTICELL LEVELS DURING PRECONCEPTION, CONCEPTION AND GESTATION TO UNDERSTAND HUMAN DEVELOPMENT AND FERTILITY AND REDUCE PREGNANCY LOSS. WE HAVE OPPORTUNITIES INCLUDING DEVELOPING NOVEL PLATFORMS AN TECHNIQUES TO CHARACTERIZE EARLY STAGE DEVELOPMENT AND UNDERSTAND NOVEL CELL TYPES IN HUMANS AND MODEL ORGANISMS, SIGNALLING PATHWAYS AND VERTEBRATE PATHWAYS AND OMICS IN DEVELOPMENT AND GENE DEVELOPMENT. A HEAVY BASIC SCIENCE COMPONENT TO THIS THEME. AND ON THE ENVIRONMENTAL EXPOSE EXPOSE -- EXPOSURES IN DEVELOPMENT. THIS WORK CAME FROM ALL OF YOU INCLUDING THE WORKING GROUP. THE THEMES REVIEWED AND COALESCED BUT MUCH OF THE LANGUAGE CAME FROM SOMEWHERE ALONG THE PROCESS. IN TERMS OF THEME ONE, WE WANT TO CAPITALIZE ON NEWLY-AVAILABLE TECHNOLOGY TO UNDERSTAND AND DESCRIBE THE FUNCTION OF CELL TYPES PRESENT DURING DEVELOPMENT AND WHAT CONTRIBUTE TO STILL BIRTH, DEFECTS AND AND OTHER CONGENITAL CONDITIONS. IN THEME TWO WE WERE NOT TRYING TO CALL OUT A SPECIFIC ADVERSE OUTCOME OF PREGNANCY BUT MAKE THE CONNECTION. THE DEVELOPMENTAL ORIGINS OF HEALTH AND DISEASE. THE LONG-TERM VIEW IF WE OPTIMIZE A HEALTHY PREGNANCY WE'LL HAVE A HEALTHIER ADULT POPULATION. WE WANT TO MAXIMIZE THE HEALTH OF THE PREGNANT WOMAN AS WELL AS HER CHILD OR CHILDREN. WE WANT TO MINIMIZE THREATS TO MATERNAL HEALTH AND STRESS AS A TEST FOR DISEASE AND LOOK AT THE UNDERPINNING FOR THE POTENTIAL TARGETS FOR INTERVENTION BY STUDYING PHENOTYPIC EXPOSURES AND OTHER BIOMARKERS AND LOOK AT DATA SETS TO UNDERSTAND THE COMPLICATIONS OF PREGNANCY THAT CONTRIBUTE TO HEALTH OUTCOMES FOR WOMEN AND CHILDREN THROUGHOUT ADULTHOOD AND CONDUCT STUDIES OF THE PLACENTA INCLUDING NON-INVASIVE METHODS TO DETERMINE PLACENTAL HEALTH AND UNDERSTANDING THE CONTRIBUTORS TO MORBIDITY AND MORTALITY AND PREVENTING PRE-TERM BIRTH AND OTHER ADVERSE EVENTS. SO NOW WE HAVE THEME THREE WHICH IS TO ENABLE WOMEN AND MEN TO MANAGE FERTILITY AND MINIMIZE THE ANDROELOGICAL CONDITIONS AND THERE'S BASIC SCIENCE HERE AS WELL. UTILIZE GENETIC AND PHENOTYPIC EXPOSURE DATA TO UNDERSTAND THE UNDERLYING MECHANISMS OF HEALTH CONDITIONS AND WE ADDED BECAUSE THIS IS A FOCUS FOR YVRM INTRAMURAL INTRAMURAL FOCUS FOR COMPLEX PEDIATRIC COMPLICATIONS AND UNDERSTANDING DEVELOPMENT AND ALLOWING MEN AND WOMEN TO MANAGER THEIR FERTILITY AND TO DEVELOP SOLUTIONS FOR INFERTILITY WHICH WILL PUT A HEAVY EMPHASIS ON EPIDEMIOLOGICAL DATA ON ASSISTED REPRODUCTIVE TECHNOLOGIES. IN THEME FOUR, TO THE OUTSIDE THIS IS SOMEWHAT CONFUSING BUT WE BASED ON ALL THE DISCUSSIONS HEARD THAT NOBODY HAS REALLY LOOKED AT DIFFERENCES IN TIME PERIODS. THE TIMING OF INTERVENTION IF YOU ARE RECOVERING FROM A STROKE FOR EXAMPLE OR TIMING IS IMPORTANT BECAUSE TIMING IS VERY IMPORTANT IN DEVELOPMENT AND IT MAY BE THAT TREATMENT APPROACHES IN UTERO IF YOU'RE CONCERNED ABOUT COGNITIVE DISORDERS. MAYBE PRENATAL TREATMENT IS MORE IMPORTANT THAN POST-NATAL TREATMENT. THIS THEME IS A BROAD THEME THAT WILL ENCOMPASS A NUMBER OF THINGS AND LOOKING AT THE DIFFERENCES IN TIME PERIOD A THAN B. IT IS LOOKING AT CHANGE BROUGHT ON BY NORMAL DEVELOPMENT OR INJURY OR DISEASE AND IT'S UNDERSTANDING SENSITIVE TIME PERIODS IN WHICH EXPOSURE TO A DISEASE OR EVENT OR THE USE OF PARTICULAR INTERVENTION WILL HAVE THE BIGGEST IMPACT. FOR EXAMPLE, IF YOU'RE EXPOSED TO ZIKA AND YOU'RE A FETUS IN THE WOMB, IT HAD DIFFERENT CONSEQUENCES THAN IF YOU ARE AN ADULT EXPOSED TO ZIKA. WE ARE AIMING TO IDENTIFY THE TIMING AND MECHANISMS OF PLASTICITY IN EARLY DEVELOPMENT STAGES. WE'LL THE MECHANISMS THAT DETERMINE THE INITIATION AND DETERMINATION OF THE TIME PERIODS INCLUDING DIFFERENT PERIODS DURING GESTATION BUT WE AGAIN WANT TO IDENTIFY PERIODS IN WHICH PLASTICITY IS HIGH TO INFORM TIMING OF PREVENTION AND MANAGEMENT. INCLUDING EARLY INTERVENTIONS FOR INTELLECTUAL DEVELOPMENT AND LEARNING DISABILITIES AND THERAPEUTIC APPROACHES IN CRITICAL CARE AND REHABILITATION SETTINGS. WE'LL EXPLORE FACTORS TO PROMOTE OR HINDER HEALTH DURING THESE SENSITIVE TIME PERIODS SUCH ADDS NUTRITION, WHICH I MENTIONED WAS A CROSS-CUTTING THEME OR SLEEP OR BEHAVIORAL INTERVENTIONS INCLUDING EXPOSURES TO INFECTIOUS DISEASES AND EARLY LANGUAGE INTERVENTIONS AN EXPOSURE TO DIGITAL MEDIA. THIS WOULD ALL BE EXAMINED BY LOOKING AT SOCIAL DETERMINANTS WITH BIOLOGICAL FACTOR. SO IN THEME FIVE THERE'S A GAP IN TERM OF THE TRANS NIH RESEARCH CONSORTIUM. THERE'S A MAJOR GAP IN THE TRANSITION FROM ADOLESCENCE TO ADULTHOOD ESPECIALLY FOR ADOLESCENCE WITH INTELLECTUAL DISABILITIES OR OTHER CHRONIC CONDITIONS. WE THINK IT NEEDS TO BE AN IMPORTANT AREA FOR OUR INSTITUTE AS WELL AS TRANSNIH. -- TRANS NIH. IT'S A TIME OF DEVELOPMENT CHANGES AND RISK TAKING BEHAVIOR. WE WANT TO LOOK AT THE HORMONAL AND ENDOCRINE AND OTHER FACTORS THAT CONTRIBUTE TO ADOLESCENT DEVELOPMENT AND LOOK AT THE ENVIRONMENTAL AND BEHAVIORAL ASPECTS OF THE OPPORTUNITY AND CONSIDER THE IMPACT OF THE MEDICAL TRANSITION FROM PEDIATRIC TO ADULT CARE ESPECIALLY FOR CHILDREN WITH DISABILITIES OR OTHER CHRONIC DISEASES. AND THE LAST THEME IS ENSURING SAFE AND EFFECTIVE THERAPEUTIC DEVICES FOR OUR POPULATIONS. TASK FORCE AND AS RESULT OF THE WORK IN THE TASK FORCE WE RECOGNIZED THERE'S A HUGE GAP IN KNOWLEDGE IN TERM OF THE EFFECTS OF MEDICATIONS TAKEN BY PREGNANT OR LACTATING WOMEN. SO IN THIS AREA, IT'S TO DEVELOP AND VALIDATE SAFE AND EFFECTIVE THERAPEUTICS AND DEVICES FOR LACTATING WOMEN AND CHILDREN WITH PHYSICAL AND INTELLECTUAL DISABILITIES. WE'LL CONSIDER CURRENTLY NEEDS NOT CONSIDERED IN DRUG DEVELOPMENT AND EVALUATE MEDICATIONS INCLUDING SAFE AND EFFECTIVE DOSING FOR THESE POPULATIONS TO ESSENTIALLY IMPROVE THEIR HEALTH CARE. WE WANT TO UTILIZE REAL WORLD DATA SUCH AS ELECTRONIC HEALTH RECORDS AND EXISTING DATA SETS OR OTHER BIG DATA APPROACHES TO DISCOVER EVENT OR OUTCOMES OR COMMON COMORBIDITIES IN OUR POPULATIONS AN ENABLE IMPLEMENTATION EFFORTS IN HEALTH SYSTEMS BY SUPPORTING ACCEPTABILITY AND ADHERENCE RESEARCH TO ENSURE INTERVENTIONS CAN BE MEANINGFULLY USED IN THESE POPULATIONS. SO IN LOOKING AT THESE THEMES AND IN TALKING TO MY FELLOW I.C. DIRECTORS, THIS IS JUST BLUE SKYING THINKING ABOUT THIS ISSUE OF WHERE WE'RE GOING TO LEAD AND WHERE WE'RE GOING TO PARTNER. AND I KNOW WE HEARD THE QUESTION OF WHERE IS COGNITIVE NEUROSCIENCE. WE HAVE FOUR NEUROSCIENCE INSTITUTES AT THE NIH. THE NATIONAL INSTITUTE OF STROKE AND HEALTH AND OF DRUG ABUSE AND NATIONAL INSTITUTE OF ALCOHOLISM AND ALCOHOL ABUSE. THEY'RE ALL HEAVILY FOCUSSED ON NEUROSCIENCE. THIS DOES NOT MEAN WE ARE NOT GOING TO DO NEUROSCIENCE RESEARCH. BUT THE QUESTION I RAISE TO ALL OF YOU BECAUSE THESE ARE DRAFT THEMES IS SHOULD WE HAVE A FOCUS ON NEUROSCIENCE IF WE HAVE FOUR OTHER INSTITUTES AT NIH THAT ARE PREDOMINANTLY FOCUSSED ON NEUROSCIENCE. AND IS THERE AN AREA WITHIN NEUROSCIENCE THAT WE COULD UNIQUELY CARVE OUT AS OUR OWN AND PARTNER WITH OTHER INSTITUTES AND CENTERS. SO THIS IS TOTALLY THE THINKING AND IT'S NOT REALLY MEANT FOR ANYTHING OTHER THAN TO SHOW YOU AREAS WHERE WE ALREADY HAVE PARTNERSHIPS OR IT WOULD BE LOGICAL TO HAVE PARTNERSHIPS, FOR EXAMPLE, IN TERMS OF DRUGS AND DEVICES FOR OUR POPULATIONS. TO WORK WITH THE NATIONAL CENTER ON COMPLIMENTARY AND INTEGRATIVE HEALTH OR TO WORK WITH THE NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES. I WANT TO POINT OUT BECAUSE I KNOW PEDIATRIC VIOLENCE CAME UP IN A LOT OF THE DISCUSSIONS SO THIS IS FOR DICK AND VALERIE. JUST LAST NIGHT, JOSH GORDON WHO IS THE DIRECTOR OF THE NATIONAL INSTITUTE FOR MENTAL HEALTH CAME UP TO ME AND SAID WE REALLY WANT TO TALK TO YOU ABOUT WHETHER YOU'RE GOING TO SUPPORT PEDIATRIC VIOLENCE BECAUSE THIS IS AN AREA WHERE WE GET A LOT OF APPLICATIONS AND WE DON'T KNOW WHAT TO DO WITH THEM. I SAID FUNNY YOU SHOULD MENTION THAT BECAUSE THAT'S SOMETHING THAT HAS COME UP DURING THE CRITICAL PERIODS AND ALSO IN ADOLESCENCE AND TRANSITION TO ADULTHOOD WHEN THERE'S RISK TAKING BEHAVIOR. PEOPLE NEED TO LOOK ACROSS NIH AND HELP US WITH THE DUAL CHALLENGE OF WHAT DO WE WANT TO BE KNOWN FOR AS OUR PRIORITY WITHOUT SACRIFICING EVERYTHING ELSE. THE WAY IT IS NOW IS WE'RE SO BROAD WHEN SOMETHING COMES UP, OFTEN TIMES IT COMES TO OTHER INSTITUTES BECAUSE THEY ARE CLEARER IN ARTICULATING THEIR PRIORITIES. SO THAT IS HOW WE'VE STARTED THE STRATEGIC PLANNING PROCESS TO IDENTIFY PRIORITY AREAS FOR US. SO WE WANT TO DISCUSS WHAT'S MISSING AND WHERE WE GOT WRONG AND WHAT SHOULD WE DO, WHERE CAN WE ADD AND WE HOPE EVERYONE'S AWAKE AND READY TO COMMENT SO I'LL INTRODUCE SCOTT WHEELER WHO WILL TAKE IT FROM HERE. THANK YOU. >> WELCOME BACK. SO AS DR. BIANCHI SAID THERE'S BEEN A LOT OF THAT HAS TRANSPIRED SINCE THE LAST COUNCIL MEETING. A LOT OF PEOPLE HAVE PUT A LOT OF EFFORT TO GET TO THE POINT WE ARE AT TODAY. THERE'S A LOT OF WORK YET TO DO AND WE'RE AT A PRETTY CRITICAL POINT RIGHT NOW BECAUSE AS WE ADJUST, REFINE AND FINALIZE WHAT THE PRIORITY THERE'S MORE WORK TO DO. TO FINALIZE THE DETAILS OF WHAT NEEDS TO HAPPEN. THERE'S A NUMBER OF THINGS WE'LL BE WORKING ON TO LET YOU KNOW WHAT THOSE ARE, WE'LL BE THINKING ABOUT THE PARTNERSHIPS AND THE TRAINING NEEDED TO ADVANCE THE DIFFERENT AREAS. WE'LL BE THINKING ABOUT THE INFRASTRUCTURE AND TECHNOLOGY AND METRICS FOR HOW WE TRACK THE PROGRESS AND MANY DETAILS ABOUT WHAT COMES FIRST IN THE SCIENCE TO BE ABLE TO ACCELERATE PROGRESS AS BEST WE CAN. SO THERE'S A LOT OF DETAILS LEFT TO BE WORKED ON. BUT FIGURING OUT WHAT THESE PRIORI PRIORITIES ARE IS ESSENTIAL TO FIND OUT WHAT THE NEXT STAGE IS AND GET INTO THE DETAILS OF THE PROSECUTION. WE HAVE SIX PRIORITY THEMES OUT FOR COMMENT AND THERE'S COMMENTS COMING IN HERE. THE COMMENTS WE GET FROM YOU AS A COUNCIL, WE WILL BE TAKING PUBLIC AND STILL AN OPPORTUNITY FOR ANYBODY OPEN UNTIL FEBRUARY FOR ANYBODY LISTENING NOT PART OF THE COUNCIL AND FOR THOSE IN THE COUNCIL TO COMMENT INDIVIDUALLY AS WELL. THERE'S A LOT OF OPPORTUNITY TO CONTINUE TO PROVIDE OUTPUT. WE HAVE ABOUT AN HOUR AND A HALF FOR OUR CONVERSATION TODAY TO BE ABLE TO GET YOUR INPUT AND DISCUSS EACH OF THE INDIVIDUAL THEMES AND TO GET YOUR REACTION TO THE OVERALL POINTS OF VIEW. AS WE GO THROUGH, I WILL BE PUTTING THE TEXT THAT IS IN THE R.F.I. BEHIND ME. IF YOU DON'T HAVE A COPY OF THE R.F.I. IN FRONT OF YOU, THE TEXT THAT'S BEEN PUT OUT FOR PUBLIC COMMENT IN THE R.F.I. WILL BE BEHIND ME FOR EACH OF THE PRIORITY. WE'LL TRY TO MANAGE THIS TO A TIME BASIS. I'LL ASK YOU TO BE RELATIVELY SUCCINCT IN YOUR COMMENTS, NOT BRIEF BUT SUCCINCT IS IMPORTANT BECAUSE WE HAVE TO CUT OFF 10 TO 15 MINUTES MAXIMUM PER PRIORITY WHEN WE GET INTO THE DISCUSSIONS TO HAVE TIME TO TALK ABOUT EACH ONE. BEFORE I GO INTO THE BEGINNING ONES, LET ME PAUSE AND SEE IF THERE'S ANY QUESTIONS ABOUT THE PROCESS YOU'LL BE FOLLOWING TODAY OR IF YOU HAVE ANY REACTIONS TO THE OVERALL THEMES APPROACH THAT HAS BEEN PRESENT DR. BIANCHI? AND CAN I ASK ONE FAVOR ON THE SIDE IF YOU CAN TURN YOUR CARDS TO THE FORWARD SO I CAN SEE YOUR NAMES, THAT WOULD BE HELPFUL. >> SCOTT, CAN YOU CLARIFY ONE OF THE MYSTERIES OF STRATEGIC PLANNING IS WHAT HAPPENS AFTER INPUT SESSIONS AND DIFFERENT ORGANIZATIONS DO THEM DIFFERENTLY. TYPICALLY IF A SMALL GROUP GOES IN THE BACK AND SAYS WHAT DO WE DO WITH ALL OF THAT. >> SURE. >> AND SOMEONE MAKES DECISIONS. GIVE US CLARITY. >> WE TRIED TO BE AS INCLUSIVE FROM THE DATA OF ALL SOURCES AS POSSIBLE AS WE CAME FORWARD TO DO THE THEMES. AS YOU SAW FROM DR. BIANCHI'S PRESENTATION THERE WERE MANY SUGGESTIONS THAT CAME IN FROM MANY PLACES. WE VIEWED THEM AT DIFFERENT STREAMS COMING INTO THE PLANNIN PROCESS AND YOUR INPUT AND THE INPUT THAT CAME FROM THE WORKING THEME, ALL THAT WAS FED IN THE INTRAMURAL AND EXTRAMURAL THEMES THAT CAME FROM CANDIDATE NOMINATIONS THAT WENT TO THE STRATEGIC PLANNING COMMITTEE. IN ADDITION TO THAT, ALL THE DATA PROVIDED FROM ALL THE SOURCES WENT BACK IN THE STRATEGIC PLANNING COMMITTEE WHERE THEY THEN HELD THEIR DELIBERATIONS AN FOCUSSED ON THAT. THERE'S A NUMBER OF REPORTS STILL AVAILABLE. AFTER THIS SESSION, THIS INFORMATION AND THE R.F.I. WILL COME BACK INTO A MEETING WE'LL HAVE AT THE PLANNING COMMITTEE TO ADJUST THE THEMES. THEN THE DETAILS OF ANY OF THIS FEEDBACK PLUS INFORMATION THAT CAME IN FROM BEFORE ALL GOES INTO WORKING TEAMS TO PLANT THE DETAILS. ANYTHING THAT STAYS WITHIN THE SET OF THE PRIORITIES IS THEN FED INTO WORKING THEMES FOR EACH PRIORITY. OTHER QUESTIONS? >> SO TIM, ONE OF THE TASKS WE'LL BE ASKING INTERNAL STAFF TO HELP US WITH IS SPECIFIC OBJECTIVES. SO A LOT OF THE THINGS WE HEAR AT THIS POINT WILL POTENTIALLY RELATE TO FUTURE FUNDING ANNOUNCEMENTS OR MAJOR PROJECTS. SO IT WILL TRANSLATE INTO SPECIFIC MEASURABLE OBJECTIVES. I MIGHT HAVE SAID IT BEFORE AND WILL GIVE A QUOTE SAID FAMOUSLY STRATEGIC PLANNING WOULD IMPLEMENTATION IS JUST HALLUCINATION. SO IMPLEMENTATION IS A MAJOR GOAL. ARE THERE ANY COMMENTS WITH THE GENERAL SET AS A WHOLE OR BEFORE WE JUMP INTO EACH INDIVIDUAL PRIORITY FOR COMMENT. PLEASE. >> THANK YOU, VERY MUCH. SO I DO HAVE COMMENTS ON THE INDIVIDUAL THEMES WRITTEN BUT I'D LIKE TO MAKE A BROADER COMMENT AND I'M SPEAKING ON BEHALF OF THE DIRECTORS OF THE DEVELOPME DEVELOPMENT DISABILITIES RESEARCH CENTER ACROSS THE COUNTRY AND I HAVE COMMENTS THAT WERE PUT TOGETHER E-MAILED ACROSS THE COUNTRY AND TO SHARE THAT WITH EVERYONE. WE BELIEVE STRONGLY THAT RESEARCH INTO THE BASIC NEUROSCIENCE OF INTELLECTUAL AND DEVELOPMENT DISORDERS SHOULD BE A LEADING PRIORITY OF NICHD. AND OG TO NEUROSCIENCE INCLUDING TRANSITION TO ADOLESCENCE. WE NOTE THAT AT LEAST ONE IN SIX INDIVIDUALS IS AFFECTED BY INTELLECTUAL DEVELOPMENT DISABILITY. SO THIS SAY CRITICAL THING WE HAVE TO BE ADDRESSING FROM MANY PERSPECTIVES. SEVERAL TERMS ARE MISSING INTELLECTUAL DISABILITIES AND AUTISM AND NEUROSCIENCE. I KNOW DIANA ALREADY MENTIONED COGNITIVE NEUROSCIENCE IN THIS DISCUSSION AND IT'S TRUE IT'S SOMETHING COVERED IN OTHER INSTITUTES AN PARTNERSHIP BUT THE BASICS OF BRAIN DEVELOPMENT AND THE PROCESSES WHICH LEAD TO A WIDE RANGE OF DEVELOPMENT DISABILITIES, MANY OF WHICH OVERLAP, I BELIEVE IS CRITICAL AND WE BELIEVE AS A GROUP IS CRITICAL TO THE NIH MISSION. OTHERS AREN'T AS INTERESTED IN THESE THINGS AND WHERE HE HAD TROUBLE GETTING FUND FROM OTHER INSTITUTES IN THESE AREAS. THERE'S NOT CONSIDERED A DISORDER CONSIDERED WITH THAT DOMAIN BUT WE KNOW THERE'S A DEAL OF OVERLAP BECAUSE OF THE FUNDAMENTAL PROCESSES ACROSS DISORDERS. WE FEEL STRONGLY THAT A FOCUS ON INTELLECTUAL DEVELOPMENT DISABILITIES SHOULD BE A MAJOR THEME AND GOAL FOR NICHD. IT HAS BEEN IN THE PAST. WE MADE TREMENDOUS PROGRESS. I NOTE SOME OF THE RECENT FINDINGS FOR TREATMENT ARE EXTREMELY IMPORTANT AND SHOULD PLAY A MAJOR ROLE AND I THINK OUR INSTITUTE IS THE ONLY ONE THAT'S GOING TO BE DOING THAT AND THE NUCLEOTIDES IS AN EXCITING AREA OF RESEARCH WILL GIVE US THE ABILITY TO TREAT SINGLE-GENE DISORDERS AND RARE DISORDERS. IT'S EXCITING. IT'S THE BEGINNING OF PERSONALIZED MEDICINE AND WE'RE IN THE BEST POSITION TO DO THIS AND BELIEVE WE'RE THE ONLY INSTITUTE THAT CAN DO IT. WE CAN ADD SPECIFIC COMMENTS ABOUT SPECIFIC AREAS BUT I THINK THIS IS AN OVERALL COMMENT THE DIRECTORS WOULD LIKE TO MAKE AND FEEL STRONGLY ABOUT. >> THANK YOU. ANY MORE COMMENTS. >> IN THE INTEREST OF BEING SUCCINCT, I'D LIKE TO FOLLOW THE COMMENTS WITH AN ENDORSEMENT WITHOUT REPEATING HER POINTS, I'D JUST SAY I APPLAUD DR. BIANCHI AND THE TEAM AND THE INTERLOCKING NATURE OF THE COMPLEX HERE AT THE NIH ALL THE CENTERS AND TRYING TO INTEGRATE AND AT THE BIG PICTURE LEVEL YOU STARTED WITH THE QUESTION, WHAT SHOULD WE BE KNOWN FOR? WHEN I LOOK AT THE PLAN, WHAT I FEEL IS WHAT WE'RE ANGLING TO BE KNOWN FOR IS THE PLACE WHERE THE BEST WORK IS BEING DONE AROUND PREGNANCY FERTILITY REPRODUCTION AND MATERNAL HEALTH WHICH IS TERRIFIC. NO COMPLAINT WITH THAT WHATSOEVER. THERE SHOULD BE A SECOND WHAT WE'RE KNOWN FOR. THAT IS INTELLECTUAL DEVELOPMENT DISABILITY. I THINK TO PUT THIS ADVOCACY LENS ON IT, THE VAST ENTERPRISE OF MEDICINE IF I CAN GENERALIZE TO THE ABSURD, UNDERSTANDS OR PRIORITIZES THE DEVELOPMENTAL DISABILITY IN ITS WORK. YOU HAVE WRITTEN ON THE OVERSIGHT THROUGHOUT THE NIH WHICH PERSIST NOW WITH EXCLUSIONARY CRITERIA ROUTINELY ACCEPTED AROUND EXCLUDING PEOPLE WITH INTELLECTUAL DEVELOPMENT AND THAT'S ONE PIECE OF A COMPLEX PUZZLE BUT THIS INSTITUTES FORMATION AND MANY ACCOMPLISHMENTS HAVE CENTERED AROUND THIS ISSUE AND POPULATION. I BELIEVE THE AVERAGE SCIENTIST OUGHT TO BE ABLE TO CONCLUDE ON THE RESEARCH PRIORITY THAT THIS CENTER WITHIN THE COMPLEX HAS PLACED INTELLECTUAL DEVELOPMENT DISABILITIES AT THE CENTER OF ITS CONTRIBUTIONS TO THE VANCEME VANCEMENT -- ADVANCEMENT OF MEDICINE ABOVE TRANSLATIONAL AND SO ON. SUSAN MAY HAVE COMMENTS ON THE SPECIFICS, BUT I DO THINK AT THE MESSAGING LEVEL IT REMAINS A FIELD FOR MANY INVESTIGATORS. IT'S A DIFFICULT FIELD TO MAKE DEVELOPMENT IN AND DIFFICULT TO FIND FUNDING IN AND MOST CENTERS WILL NOT SEE THIS POPULATION OR THESE ISSUES AROUND A TYPICAL DEVELOPMENT A NON-NORMATIVE DEVELOPMENT AROUND THEIR FOCUS AROUND DEVELOPMENT DISABILITIES. AND OUGHT TO BE CLEAR, HOWEVER, WE END UP, SOMEONE LOOKING AT THIS OUGHT TO BE ABLE TO SAY TO THE NICHD CLEARLY HAS A FOCUS ON INTELLECTUAL DEVELOPMENT DISABILITY. THANK YOU. >> THANK YOU. OTHER COMMENTS BEFORE WE MOVE TO THE FIRST? PLEASE. >> I SUSPECT THERE IS PRACTICALLY NO ONE WHO'S BEEN FUNDED FOR A LONG TIME BY THIS INSTITUTE. THEY'RE NOT GOING TO LOOK AT IT FROM A NON-PERSON PERSPECTIVE. THE BUDGET HAS INCREASED AND THAT SHOULD AT LEAST PROVIDE THE ABILITY TO ADDRESS SOME OF THE AREAS THAT HAVEN'T BEEN ADDRESSED. SINCE YOU MENTIONED THE VIOLENCE THING WHICH I REMEMBER FROM THE MEETING WITH ALL THE DRAWINGS WAS A PREVALENT COMMENT. IT WOULD HELP ME UNDERSTAND JUST TAKING THAT HOW ONE PERCEIVES IT WILL BE ADDRESSED IN THE PROCESS. BECAUSE THE OUTSIDE WORLD AS THE DIRECTORS SUSAN NOTED, MINE SAID I SUSPECT YOU'VE ALL SEEN THE PLAN. IT STREETS ME OF THE SIX RESEARCH THEMES, FOUR SPECIFICALLY FOCUS ON GROUPS OTHER THAN CHILDREN AND THE OTHER TWO ARE NOT REALLY TARGETED AT CHILDREN PARTICULARLY LATE. I SUSPECT IT'S NAIVE A COMMENT WOULD GET THEM TO THINK MORE SERIOUSLY ABOUT COMMENTS. I SUGGESTED THEY COMMENT. NOT HOLD BACK WHICH IS NOT NAIVE AT ALL. THAT'S THE PHASE WE'RE AT AND IT WOULD HELP ME UNDERSTAND IF YOU WERE TO ADDRESS WHAT WOULD SEEM TO BE A BIGGER AREA AND WHERE THROUGH THAT IT WILL GO. IT WILL ALSO HELP ME NOT SAY A LOT FOR THE REST OF THE MEETING. >> I HAVE A SUMMARY OF SOME OF THESE INITIAL OBJECTIVES PUT TOGETHER AND LINING UP WITH SOME OF THE SUB THEMES. SO I THINK WHAT PEOPLE ARE REACTING TO, FOR EXAMPLE, THEME FIVE IS IMPROVING HEALTH DURING THE TRANSITION FROM ADOLESCENCE TO ADULTHOOD. THERE WAS WAYS TO PROMOTE HEALTHY BEHAVIOR AND REDUCED IMPACT OF VIOLENCE, TRAUMA AND INJURY. THEN THERE ARE SPECIFIC OBJECTIVES WITHIN THAT. PART OF THE PROBLEM IS YOU'RE SEEING THIS HIGHLY LEVEL THING THAT CONSISTS OF HEADLINES AND NOT THE DETAILED THOUGHT THAT HAS GONE INTO FLUSHING THESE THINGS OUT. >> MYFOLLOW-UP QUESTION THEN WOULD BE, DO YOU ANTICIPATE GOING FORWARD THROUGH THIS PROCESS, THE ORGANIZATIONAL STRUCTURE OF THE OFFICES AND INSTITUTE WILL CHANGE AT ALL OR JUST ADAPT TO WHATEVER THE NEW PRIORITIES ARE? >> SO, I KNOW THIS IS CAUSING A LOT OF ANXIETY IN EXTRAMURAL. WE HAVEN'T MADE ANY DECISIONS YET BECAUSE THAT IS SORT OF IMPLEMENTATION WOULD BE DOES IT MAKE SENSE TO ORGANIZE BRANCHES A LITTLE BIT MORE AROUND THEMES. TRULY, WE HAVEN'T MADE ANY DECISIONS ABOUT THAT. WE'LL SEE WHETHER THE STRUCTURE MAKES SENSE BUT IT REQUIRES APPROVAL FROM HEALTH AND HUMAN SERVICES. >> I WAS GOING TO ENCOURAGE YOU TO DO IT UNTIL I HEARD THE LAST SENTENCE. >> DO I WANT TO JUST MAKE A COMMENT. THIS IS ONE OF THE THINGS WE HAVE STRUGGLED AS WE TRIED TO PUT THIS TOGETHER. I THINK DR. BIANCHI HAS BEEN DOING A GOOD JOB WITH THE STRATEGY AND THERE'S SO MANY DIFFERENT THINGS THAT WE COULD CALL OUT INDIVIDUALLY AND SO WHAT WE'VE BEEN TRYING TO FIGURE OUT IS HOW DO WE WEAVE THE CONSTITUENT COMMUNITIES INTO ALL THE THEMES. I DON'T KNOW WE HAVE IT RIGHT YET BUT THAT'S A CHALLENGE HOW WE EXPLAIN THE PRIORITY AND WHERE TO HAVE THE GREATEST ADVANCES IN THE MOST AREA FOR THE MOST PEOPLE WHILE AT THE SAME TIME NOT BEING SO SPECIFIC PEOPLE FEEL EXCLUSIVE OR LEFT OUT AND THAT'S ONE OF THE CHALLENGES AS WE GO THROUGH ALL OF THIS. WAVING, COMMITTING, NEEDLE POINTING, I DON'T KNOW. THERE ARE CERTAINLY SOME CROSS-CUTTING CONSIDERATIONS. AND ONE THAT'S POINTED OUT HERE AND SOMETHING THAT APPEARS CERTAINLY RELEVANT TO ALL THE THEMES AND APPEARS AND SPECIFICALLY IN SEVERAL OF THEM IS THE CONCEPT OF PREVENTION WHICH OBVIOUSLY IS IMPORTANT IN ADDITION TO THERAPY AND INTERVENTIONS. BUT ANOTHER CONSIDERATION SHOULD BE DISPARITIES. AND THEIR SOLUTION TO IT IN THE INTRODUCTION BUT IT DOESN'T APPEAR ANYWHERE IN ANY OF THE THEMES UNLIKE PREVENTION. I WORRY YOU NEED TO BE INTENTIONAL WHEN YOU TALK ABOUT DISPARITIES BECAUSE THERE'S THE RISK OF MISSING MAJOR OPPORTUNITIES WHEN YOU FOCUS ON THE COMPOSITE AND NOT HOW SPECIFIC SUBGROUPS ARE EFFECTS. IT NEEDS TO BE INSERTED. >> WE HAVE TIME FOR ONE MORE GENERAL AND THEN MOVE TO THE SPECIFIC. >> ONE OF THE CROSS-CUTTING THEMES ALREADY MENTIONED BY DR. BIANCHI WHICH KEEPS COMING UP IN MY MIND AS I READ THROUGH THE DOCUMENT AND HEAR THE CONVERSATION IS ABOUT OUR POPULATIONS AND WHO THEY ARE WHETHER THEY'RE CHILDREN OR ADOLESCENTS OR YOUNG ADULTS WITH INTELLECTUAL DISABILITY OR CHILDREN IF THEY'RE NOT COVERED TO THE EXTENT MENTIONED. THOUGH NICHD COVERS 18% OF PEDIATRIC CATEGORY RESEARCH, IN SOME OF THOSE INSTITUTES, CERTAINLY THEY'LL BE THE FOCUS. BUT IN SOME INSTITUTES WILL CHILDREN BEING AN AFTERTHOUGHT AND GROUPED INTO A LONGITUDINAL COHORT WITH A FEW KIDS VERSUS THIS INSTITUTE WHERE WE SAY THEY'RE THE FOCUS AND WE SHOULD BE IN THE LEAD AND WE PARTNER AND I COME BACK TO THE NEUROSCIENCE. THE DEVELOPING BRAIN FROM CONCEPTION THROUGH TO ADOLESCENCE SO ME IS VERY IMPORTANT AND PART OF ALL THE DECISIONS. ALL THE RISK BEHAVIORS THAT PEOPLE TAKE. ALL THE EXPOSURES AND THEIR CONSEQUENCES. IT'S HARD TO FULLY SEPARATE THESE OUT GIVEN OUR KEY POPULATIONS AND WANTING TO MAKE SURE THAT AS WE SEPARATE THESE THINGS WE DON'T FORGET THAT WE ARE THE ADVOCATES FOR THE POPULATIONS ACROSS NIH. THANK YOU. >> I THINK MY COMMENT I HAD FROM THE BEGINNING IN READING THE DOCUMENT AND WATCHING IT PRESENTED WERE TWO DIFFERENT EXPERIENCES BECAUSE THE WEAVE IS NOT SOMETHIN THAT COMES FROM THE DOCUMENT. AND I THINK IT HITS ON SO MANY POINTS IF WE WERE ABLE TO UNDERSTAND THE CRITICAL CONSTITUENTS WE UNIQUELY REPRESENT IT WOULD GREATLY HELP. I THINK IT'S A CHALLENGING TASK. THAT WAS A GREAT THING TO BE ABLE TO SEE. >> I KNOW WE'RE TIGHT ON TIME. SO I APPRECIATE EVERYTHING THAT'S BEEN SAID I THINK THERE ARE OTHER INSTITUTES, 25% OF MENTAL HEALTH'S BUDGET IS CHILD HEALTH RESEARCH. 25% OF DENTAL'S BUDGET IS MENTAL HEALTH RESEARCH. THE PERCEPTION -- IT'S 55% OF OUR BUDGET AND IT'S WHY WE FORMED THE NPERC TO LEVERAGE THAT BECAUSE WE HAVE THE CHALLENGE OF BEING CHILD HEALTH IN NAME BUT IN REALITY WE'RE 55% PEDIATRICS, APPROXIMATELY 30% REPRODUCTIVE AND OBSTETRIC AND GYNOCOLOGICAL DISABILITIES. SO THAT'S THE CHALLENGE IS HOW DO WE NAVIGATE THAT WHILE SIMULTANEO SIMULTANEOUSLY PROMOTING CHILD HEALTH. AD THERE'S PROGRAMS ON THE ADOLESCENT BRAIN AND COGNITIVE DEVELOPMENT PROGRAM AND NOW THE BABY VERSION. THERE'S TENS OF MILLIONS OF DOLLARS WE CONTRIBUTE BUT BEING RUN BY NAIDAD. AUTISM IS A MAJOR FOCUS FOR NICHD. WE PARTNER WITH THEM BECAUSE IT'S CLEAR CUT. I'M MENTIONING THIS SO YOU UNDERSTAND IT'S COMPLEX. HOW DO WE LEVERAGE OUR UNIQUE BUDGET TO PUT OUR MONEY WHERE OUR PRIORITY ARE? WE GET FUNDING FOR THE RESEARCH BUT NEVERTHELESS THE INTELLECTUAL DEVELOPMENT DISABILITIES AND THE EARLY NEUROSCIENCE THAT GOES WITH THAT IS NOT THE PROVINCE OF THE OTHER INSTITUTES. WE'RE FINDING THERE'S SO MANY CROSS TALK BETWEEN THE DISORDERS AND WE'RE LEARNING THEIR COMMON GENES AND MECHANISMS. NIH IS FUNDING PRIMARILY ADOLESCENT AND ADULT WORK IN AUTISM, MOST THE WORK RELATED TO THE ANIMAL MODELS, ETCETERA OF THE DISORDERS SPECIFICALLY AU AUTISM IS DONE AT NICHD AND OTHER ORGANIZATIONS AREN'T EQUIPPED TO AND DO THEY WANT TO AND THERE'S A DECLINE OF DOING THE GENE RESEARCH AND I THINK JOSH TALKED ABOUT IT AT THE LAST MEETING. THIS IS A BIG PROBLEM FOR I.D.D. RESEARCH. WE CAN ONLY DO THAT HERE. I'D LIKE TO REITERATE, THOUGH WE KNOW THE DISORDERS ARE HANDLED AT OTHER INSTITUTES, THIS IS WHERE THE FOUNDATION COMES FROM. >> I'D LIKE TONED THIS PART OF THE DISCUSSION -- I'D LIKE TO END THIS PART OF THE DISCUSSION BY SAYING THIS PART IS TERRIFIC BECAUSE YOU'RE IDENTIFYING A SPECIFIC AREA IN WHICH WE CAN LEAD. THAT'S VERY IMPORTANT AND WE WELCOME THAT AND ARE DEFINITELY HEAR IT AND WILL INCORPORATE IT. >> SO THANK YOU VERY MUCH. I DO WANT TO ADD ONE COMMENT. I THINK YOUR COMMENT ABOUT THE EXPLANATION OF THE WEFT IS PRETTY IMPORTANT AND WHEN WE GET TO THE FINAL PUBLICATION. AS WE REFINE AFTER THE PRIORITY ARE FINALIZED HOW IT'S COMMUNICATED IN THE PLAN HAVE YOU AN IMPORTANT ROLE TO HELP US CALL OUT THE RIGHT THINGS AS WELL. LET'S MOVE ON TO THE INDIVIDUAL THEMES AS WRITTEN SO FAR IN THE R.F.I. WE'LL TAKE YOUR COMMENTS. WE'LL START WITH UNDERSTANDING EARLY HUMAN DEVELOPMENT. THE COPY BEHIND ME HAS BEEN PUT OUT IN THE R.F.I. SO IT'S THE COPY OUT FOR PUBLIC COMMENT. I'M GOING TRY TO TIME OUR PUBLIC COMMENT TO GET TO THE LAST ONE BEFORE WE RUN OUT OF TIME TODAY. SO I'LL OPEN THE FLOOR TO COMMENTS. >> FIRST, RELATING TO THE CONVERSATION SUSAN LED OFF PREVIOUSLY, I THINK THE PLACE WE CAN LEAD IN NEUROSCIENCE SIN DEVELOPMENT NEUROSCIENCE. THAT'S SOMETHING NO OTHER INSTITUTE COVERS AND BASIC DEVELOPMENT MECHANISMS OF NEUROBIOLOGY ARE A FOUNDATION FOR THE TYPE OF INFORMATION YOU NEED TO ADDRESS THE ISSUES BEING PRESENTED. I SAY THAT IN THE CONTEXT OF THIS RATHER THAN THE PREVIOUS CONVERSATION BECAUSE SPEAKING AS A BASIC SCIENTIST BASIC SCIENCE PERCOLATES THROUGH THIS BUT IS NOT A FOCUS. THERE'S REAL ABSENCE OF SAYING THIS INSTITUTE IS GOING TO FUND RESEARCH THAT'S GOING TO LAY THE FOUNDATION FOR FUTURE KNOWLEDGE THAT WILL BENEFIT CHILD HEALTH. AND MOUSE MODELS FOR LOOKING AT GENES THAT ARE INVOLVED IN AUTISM OR FUNDAMENTAL PROPERTIES STICKING WITH NEUROBIOLOGY OF HOW NEURONS GET THEIR SHAPE AND INTERACT WITH EACH OTHER IN WORMS OR FLIES IS THE TYPE OF INFORMATION TO BE FUNDAMENTAL TO MAKE THE ADVANCES TO ADDRESS THE CONCERNS. IN THE ABSENCE OF SAYING SOMETHING REALLY FOCUSSED IN OPPORTUNITY IS THE OPPORTUNITY TO DOES EXPLOIT A DIVERSE SET OF ORGANISMS AN LEVELS TO LEAD TO INSIGHTS TO LEAD TO HUMAN HEALTH, CHILD HEALTH. I THINK YOU'LL GET A LOT OF IF IT'S A FINAL VERSION AND I REALIZE THIS IS PUT UP FOR COMMENT, BUT IF THIS WERE TO HAVE THE FINAL VERSION IT'D HAVE A CHILLING EFFECT ON THE SCIENCE COMMUNITY FUNDED BY NICHD BECAUSE IT LOOKS LIKE IT'S IN THERE BUT NOT A FOCUS FOR THE FUTURE. IT HAS TO BE A FOCUS FOR THE FUTURE AS THE PAST IF WE'RE GOING TO BUILD MORE SCIENTIFIC KNOWLEDGE AS A PLATFORM TO MOVING FORWARD IN THE DIFFERENT DISORDERS OR ANY OTHER TOPICS. NOT JUST FOR DEVELOPMENT BIOLOGY BUT UNDERSTANDING PREGNANCY OR REPRODUCTIVE HEALTH AND THE DIFFERENT THEMES. UNDERSTANDING BASIC SCIENTIFIC PRINCIPLES AND SHOULD STAND. >> THANK YOU. OTHER COMMENTS? >> THANK YOU I APPRECIATE THE COMMENTS VERY MUCH AND SUSPECT A LOT OF THESE DETAILS ARE IN THE DETAILS THAT AREN'T PRESENTED HERE BUT IN THE INTEREST OF MAKING THEM MORE EXPLICIT THIS IS WRITTEN AS IF THERE'S A STRONG EMPHASIS ON CELLS AND THEY'RE GREAT BUT THERE'S MULTIPLE LEVELS OF UNDERSTANDING CELLS AND ORGANOIDS AND NETWORKS AND GENE EXPRESSION AND WE HAVE NEW TECHNIQUES FOR NETWORK ANALYSIS. I THINK MAYBE THIS COULD BE WORDED IN A BROADER WAY TO INCORPORATE MULTIPLE LEVELS OF GENES TO CELLS TO ORGANOIDS TO NETWORK SO IT'S CLEAR. >> THANK YOU. OTHER COMMENTS? LAST CHANCE? WE'LL MOVE TO PRIORITY NUMBER TWO. FOUNDATIO FOUNDATIONS AND HEALTHY PREGNANCY AND LIFE. WE'LL OPEN THE FLOOR UP FOR COMMENTS. >> I'D LIKE TO MAKE A COMMENT ON THIS ONE. I THINK ONE THING WE SHOULD DO TRY TO BLEND OUR THEMES AS MUCH AS POSSIBLE AND THIS TALKS ABOUT PREGNANCY IN WOMEN. I THINK TEEN PREGNANCY GETS LOST AND THERE'S WAYS TO SPEND THAT AND ON THE OUTCOMES AND ALSO AN OPPORTUNITY FOR PREVENTION. I KNOW WE'RE NOT WORDSMITHING BUT THINKING ABOUT PREGNANCY IN A WOMAN AND ADOLESCENT AND IDEAS AMONG THE OPPORTUNITIES AS WELL. >> THANK YOU. OTHER COMMENTS? OKAY. >> SO I THINK THIS IS ONE OF THE PLACES WHERE I HAD MY ROW HAB HAT ON AND ONCE AGAIN I THINK THE THEME THAT WOULD BE HELPFUL. IT DOESN'T COME UP MUCH IN THE DIFFERENT PRIORITY AREAS. THIS SEEMED LIKE A UNIQUE OPPORTUNITY TO BRING UP LIFE LONG WELLNESS IN POPULATIONS OF PEOPLE WITH DISABILITIES. AND IT STRUCK ME WHEN I READ IT. I DID THE WORD SEARCH AGAIN AND IT SEEMS LIKE A LOST OPPORTUNITY IN THE LIFE LONG WELLNESS AFTER AN OCCURRENCE OR WITH A CONGENITAL DISABILITY. I'D LIKE TO INCLUDE THOSE PEOPLE WHO ACQUIRE A DISABILITY THROUGH WHATEVER MEANS HAS PART OF THIS. >> DOCTOR? >> I'D WOULD JUST LIKE TO ADVOCATE FOR THE PARENTHESES SUCH AS WEIGHTS AN SUBSTANCE ABUSE AND OTHER EXAMPLES. PERIODICALLY SPECIFICALLY THE WORDS VIOLENCE OR SEXUAL ABUSE ACTUALLY APPEAR AS AN ANTECEDANT BECAUSE NOBODY TALKS ABOUT IT AND UNLESS IT'S EXPRESSLY SPOKEN, IT DOESN'T EXIST. >> OTHER COMMENTS. THIS MAYBE A GOOD PLACE TO MENTION THE INEQUITY RELATED ISSUES. I THINK IT'S IMPLIED. I DON'T THINK IT'S OVERLOOKED GIVEN THE WAY THIS IS WRITTEN OR THE POTENTIAL EMPHASIS ON TEEN PRAEG -- PREGNANCY AND OTHER RELATED RISK AND LOOK AT DISTINCT FACTORS WHO AFFECT PEOPLE WHO HAVE BEEN SUPPOSED TO INEQUITABLE CONDITIONS. WE HAVE HAD MANY CONVERSATIONS ABOUT EQUITY AND INCLUSION IN ALL THESE CONVERSATIONS AND IT'S BEEN A DEBATE HOW WE MAKE SURE IT COMES TO THE FRONT. MORE TO THINK ABOUT AS WELL. THANK YOU. >> SO I WONDERED IF WE SHOULD MENTION HERE I WAS HOPING TO SEE SOMETHING ON MODELS OF PREGNANCY AS WELL. THERE'S IMPORTANT ANIMAL MODELS OF MATERNAL HEALTH. MATERNAL INFLAMMATION IS AN ANIMAL MODEL REPLICATED IN HUMANS. THIS IS ALL FOCUSSED ON HUMAN BUT I THINK BASIC RESEARCH IN MATERNAL HEALTH WOULD BE IMPORTANT. >> I JUST WANTED TO ADD THAT IN TERMS OF THE HEALTH EQUITY ISSUE, THAT WAS A MAJOR THING THAT WAS DISCUSSED IN THE WORKING GROUP SO I KNOW IT'S CAPTURED BECAUSE IT KEPT COMING UP OVER AND OVER AGAIN IN THE THEMES. THAT'S ONE OF THE REASONS WHY IT'S A CROSS-CUTTING THEME. >> I WAS GLAD TO SEE NUTRITION WAS WOVEN INTO ALL THE SIX THEMES BUT WHEN YOU GET PREGNANT WOMEN BECAUSE THAT'S THE POPULATION I WORK WITH IT'S IMPORTANT. AND DR. GORDAN MENTIONED BEFORE ABOUT NUTRITION IN TEENS AND GOING BACK TO HOW IMPORTANT NUTRITION IS GOING BACK TO GRANDMA AND GREAT GRANDMA AND HOW THAT AFFECTS THE LIVES OF THEIR GRANDCHILDREN AND GREAT GRANDCHILDREN. SO FIGHTING THE FAST FOOD INDUSTRY AND MAKING STRIDES IN THAT. SO I JUST DON'T WANT NUTRITION TO JUST BE ACROSS THE THEMES AND NOT SPECIFICALLY RESEARCH IN THAT AREA. >> ALL RIGHT. >> I WANTED TO MAKE A NOTE ABOUT PHARMACO VIGILANCE DURING PREGNANCY AND THINGS DOCTORS PRESCRIBE TO THEIR PATIENTS AND WHEN GIVEN TO LARGE POPULATIONS OF WOMEN EITHER U.S. OR GLOBALLY END UP ASSOCIATED WITH BIRTH DEFECT OR ADVERSE EVENTS TO THE WOMAN OR HER BABY. THANK YOU. >> OTHER COMMENTS? DR. GORDON. >> ADDING TO THAT SUPPLEMENTS, NOT ONLY MEDICATIONS BUT SUPPLEMENTS THAT ARE SEEMINGLY BENIGN. >> OTHERS. YOU GUYS ARE DOING WELL. LAST CHANCE ON PRIORITY NUMBER TWO. ALL RIGHT. READY FOR PRIORITY THREE. >> THE ROLE OF IMAGING. NON-INVASIVE TESTING AND IMAGING. >> THANK YOU. ALL RIGHT. WE'LL MOVE TO NUMBER THREE. SO PROMOTING GYNECOLOGICAL AND PRODUCTIVE HEALTH. >> I THINK THIS IS FANTASTIC AND A MONUMENTAL EFFORT AND WE'RE GRATEFUL FOR THIS. THIS IS JUST A THOUGHT. I DID NOT SEE THE POTENTIAL EFFECT OF FERTILITY TREATMENT ON THE CHILD IN THE SECTION AND I THINK THAT'S VERY IMPORTANT. WE ARE VERY CONCERNED ABOUT FERTILITY TREATMENTS THAT RESULT IN MULTIPLE BIRTH AND CONSEQUENCES FOR COGNITIVE DEVELOPMENT AND DEVELOPMENT DISABILITIES NOT JUST SHORT TERM BUT LONG TERM. >> OKAY. OTHER COMMENTS? >> IN ENDMETRIOSIS MAKING SURE THE ADOLESCENT AND ADULT ARE DIFFERENTIATED ENDOMETRIOSIS WE THINK IS DIFFERENT IN ADOLESCENTS THAN ADULTS AND LIKE THERE'S A SHOUT-OUT TO PEDIATRIC GYNECOLOGY BECAUSE I FEEL IT'S ANOTHER DOMAIN THAT WOULD BE OURS. >> OKAY. OTHER COMMENTS? YOU GUYS ARE SUPER EFFICIENT. LAST CHANCE ON PRIORITY THREE BEFORE WE MOVE TO FOUR. >> THIS MAY BE MORE OF A GENERAL COMMENT BUT MAYBE I'M UNIQUE HERE IN THAT I'M NOT A BASIC MEDICAL DOCTOR BUT ONE OF THE VALUES OF A STRATEGIC PLAN AND THE WORK YOU'RE DOING SUGGESTS WE'LL GET TO ONE IS A COMMUNICATION TOOL AND NOT JUST AS A PLANNING OR OPERATIONAL TOOL. AS I READ THESE WHAT DOESN'T JUMP OUT TO ME AND IF IT DOES TO OTHERS, IGNORE THE COMMENT, BUT IT DOESN'T JUMP OUT THERE'S NEW EMERGING SCIENCE THAT'S LED US TO THIS POINT THAT THERE'S A MOMENT WHERE THIS INITIATIVE OR FOCUS IS PARTICULARLY IMPORTANT OR ACUTE. I READ THESE LAST TWO IN PARTICULAR IN CONTINUING THE STUDY OF PREGNANCY AND FERTILITY, IT DOESN'T READ TO ME LIKE WOW, WE HAVE A BIG OPPORTUNITY. THERE'S A MOMENT WHERE THE STRATEGIC PLAN'S MESSAGE IS PARTICULARLY FOCUSSED. FORGET THAT IF IT'S NOTICED BY EVERYBODY ELSE IF THEY SUGGEST CRITICAL TIPPING POINTS WE'RE TRYING TO MOVE IN TO. I DON'T GET THAT IN MY READ. IT'S MORE OF A GENERAL POINT. >> SO THANK YOU FOR THAT COMMENT. THAT WAS ONE OF MY CONCERNS AT THE END OF THE WORKING GROUP MEETING AND WHY WE SURPRISED EVERYONE WITH THE REQUEST FOR A BIG IDEAS SESSION. THIS IS ALSO NOT ONLY A MOMENT FOR COMMUNITY BUT A MOMENT TO THINK BIG AND BE ASPIRATIONAL. THAT'S PART OF THE REQUEST FOR INFORMATION. WE WANT BIG IDEAS. IN FACT, DR. COLLINS HAS TOLD ME THAT HE EXPECTS TO SEE AT THE END OF THE STRATEGIC PLAN SOME ASPIRATIONAL GOALS SOME PEOPLE WILL SAY WOW, IF NICHD CAN ACHIEVE THIS IN FIVE YEARS, WOULDN'T THAT BE AMAZING? I AGREE. >> FROM THE BASIC SCIENCE YOU'D WANT TO FRAME IT NOT JUST WHAT ARE THE BREAKTHROUGHS WE CAN JUMP ON AND BUILD ON BUT WHERE WILL THERE BE BREAKTHROUGHS IN THE FUTURE TO LEAD TO THAT. I THINK WE WANT BOTH SIDES OF THAT. >> DOCTOR. >> AS I LOOK AT THIS I I'M NOT CLEAR, ARE WE TALKING ABOUT HEALTHY PAIN AND HEALTHY ORGAN DYSFUNCTION AND HOW THAT RELATES TO FERTILITY OR GENERALLY. ? >> IT'S GENERALLY. I CATHERINE'S POINT IS WELL TAKEN WE HAVE TO ADDRESS THE ADOLESCENT AND ADULT POPULATION. >> I SEE POLY CYSTIC SYNDROME MAKING A HUGE IMPACT ON ADOLESCENCE. IF IT'S A CONDITION HUGELY IMPORTANT WITH FERTILITY AND IF IT COULD BE PICKED UP IN PEDIATRIC POPULATION IT WOULD BE A BIG DEAL. >> I'D LIKE TO SECOND THAT. IT'S 6% TO 10% OF PRE-MENOPAUSAL WOMEN AND TO LIST THAT AS WELL AS ENDOMETRIOSIS. >> CAN YOU FRAME THAT IN TERMS OF AN ASPIRATIONAL BIG IDEA GOAL? LIKE IDENTIFY BIOMARKERS IN GIRLS THAT WILL PREDICT THE ONSET? >> BETTER UNDERSTAND BIOMARKERS THAT PREDICT OUTCOMES AND FERTILITY, GUE -- GLUE CO -- GLUCOSE TOLERANCE. >> I THINK ONE REASON IT'S NOT TREATED IN THAT YOUNG POPULATION ONE IS FAT PREJUDICE. YOU'RE JUST OVERWEIGHT, YOU WATCH TOO MUCH TV AND DON'T DO ANYTHING. THE OTHER IS JUST A LACK OF A BIOMARKER THAT SAYS YOU HAVE FAT. AND LACK OF WHAT I CAN TELL THE LACK OF RESEARCH IN LOOKING IN TO THAT. THERE MAY BE SOMETHING AVAILABLE THAT'S SIMPLE. I DO A LOT OF HDL AND HDL2 EVALUATIONS ON YOUNG KIDS AND THEY SEEM TO HAVE LOWER VALUES. THAT'S ANECDOTAL. I DON'T HAVE ANY BIG RESEARCH. BUT IF WE HAD A BIG BIOMARKER WHERE DOCTORS SAID THEY HAVE THIS, THEY NED TO BE TREATED, THAT WOULD BE HUGE. >> A BETTER UNDERSTANDING OF THE CONDITION EARLIER IN THE LIFE SPAN THAN IMPROVE DETECTION AND EARLIER TREATMENT, ETCETERA. I SHOULD POINT OUT THERE'S NOT MANY DISEASES CALLED OUT BY NAME. WE DID MENTION ENDOMETRIOSIS. IF YOU LOOK AT THE THEMES, THEY'RE MORE BROAD AND GENERAL. CLEARLY POLYCYSTIC OVARY DISEASE WOULD BE COVERED UNDER THEME THREE. >> I TELL PEOPLE I'D RATHER TREAT YOU AT 9 THAN 29. AND IF WE INTERVENED SOONER WE'D SEE LESS FERTILITY ISSUES LATER ON AS WELL. >> OKAY. OTHER COMMENTS ON THEME THREE. MOVING ON TO THEME FOUR. OPTIMIZING INTERVENTION. >> I WAS GLAD TO SEE THIS IN THE STRATEGIC PLAN. IT WENT CLEAR TO ME IF IT WAS MEANT TO INCLUDE PRENATAL AND POST-NATAL CRITICAL PERIODS BUT I THINK THEY'RE IMPORTANT. I THINK WITHIN THE THEME THIS IS REALLY THE PLACE WHERE NEUROSCIENCE PLAYS OUT AND I LIKE TO SEE IT PLAY OUT BECAUSE THERE'S CLEARLY CRITICAL PERIODS. WE HAVE GREAT GENE EXPRESSION TO VALIDATE THAT. IT WOULD BE NICE IF THAT WERE WOVEN IN. I THINK THIS IS SO IMPORTANT AND BLOOD SEE THIS AS A MAJOR FOCUS ON THE INSTITUTE. >> THANK YOU. OTHER COMMENTS. DOCTOR. >> I WAS SURPRISED NOT TO SEE ADOLESCENCE IN THIS AND FOCUSSED ON A CRITICAL TIME PERIOD WHEN YOU TALK ABOUT CHILDREN AS BEING YOUNG CHILDREN IN EARLY DEVELOPMENT AND EARLY INTERVENTIONS, LANGUAGE. IN FACT, ADOLESCENCE THE TIME PERIOD IS WHEN SO MUCH GRAY MATURATION THAT WILL STAY WITH THAT HUMAN BEING DURING THE REST OF THEIR LIFE CYCLE TAKE PLACE AND IT'S NOT REALLY IDENTIFIED. COMING BACK TO THE EARLY DISCUSSION IS THIS ALSO AN AREA WHERE WE CAN TAKE A BIGGER LEAD IN TERMS OF MATURATION AND DEVELOPMENT THAT OCCURS DURING THE PERIOD OF ADOLESCENCE. >> I WASN'T SURE IF ADOLESCENCE GOT THROWN IN WHICH IS NOT BAD TO HAVE ONE THEME OF ADOLESCENCE SO I'M APPRECIATIVE BUT THERE'S THE CONCEPT OF SENSITIVE TIME PERIOD WHERE IT WOULD BE WOVEN INTO FIVE OR NOTED INTO FOUR OR FOUR IS SPECIFICALLY TARGETED TOWARDS THE REHABILITATION ISSUE AS WELL AS FOR EARLY CHILDHOOD DEVELOPMENT AND IF THAT'S CLEAR, THEN THAT'S UNDERSTANDABLE. >> THANK YOU. >> DR. SHRIVER. I WAS STRUCK WHEN I READ THIS BY THE MENTION OF NORMAL DEVELOPMENT OR DEVELOPMENT INTERRUPTED BY INJURY OR DISEASE. I WONDER ABOUT THE LANGUAGE. I'M NOT SURE IN THIS DAY AND AGE PEOPLE WITH GENETIC DISORDERS SEE THEMSELVES AS PEOPLE WITH DISEASE. AND MAYBE IT'S A DISTINCTION WITHOUT A DIFFERENCE AND MAYBE IT'S MORE OF A POP EYE THAN A SCIENTIFIC EYE. I THINK THERE'S A SENSE IN WHICH PEOPLE WITH CONDITIONS THAT ARE LIFE LONG DISABLING CONDITIONS MAY NOT SEE THEMSELVES AS PEOPLE WITH DISEASES. THERE MAY BE SOME VALUE IN THINKING THROUGH HOW THIS IS FRAMED TO ADAPT AND MAYBE SENSE TIES PEOPLE -- SENSITIZE HOW WE SEE THESE THINGS MEDICALLY AND SOCIALLY. >> THANK YOU. OTHERS? >> I NOTICE THAT IN YOUR PRESENTATION YOU USE THE WORD CRITICAL INSTEAD OF SENSITIVE. AND LIKE CRITICAL A LOT BETTER. I FELT IT'S USED IN THE LIFE CYCLE WHEN WE TALK ABOUT CRITICAL PERIODS AND DURATION OF EXPOSURES AND SO ON BUT ANYWAY JUST A COMMENT. >> I THINK YOU CORRECTLY PICKED UP ON THE GROUP'S AMBIGUITY VERSUS USING THE WORD SENSITIVE AND CRITICAL. IN DIFFERENT DOCUMENTS IT'S ONE VERSUS THE OTHER BUT WE CERTAINLY WOULD APPRECIATE EVERYONE'S ADVICE WHICH WOULD BE BETTER TO USE. >> WE HAD CRITICAL ON A CHART AND PUT INSENSITIVE AND THE OTHER WAY AROUND. THE MORE GUIDANCE YOU CAN GIVE US THE BETTER. pMAKING SURE ADOLESCENCE ISN'T D MISSED BECAUSE IT WAS VERY MUCH A TRANSITION WHICH SAY HOT TOPIC BUT I DO WORRY ADOLESCENCE WOULD BE MISSED IN FOUR SO THINKING ABOUT THE CONTINUUM IN EXPOSURES AND ALL TYPES OF EXPOSURES. IT'S A WONDERFUL PLACE TO BRING IN VIOLENCE. AS ANOTHER PEDIATRICIAN AROUND THE TABLE FEEL IT WILL BE IN OUR DOMAIN. >> YOU HAD A QUESTION OR COMMENT? >> I LIKE IT AND WORRY THERE'LL BE MORE DESCRIPTIVE RATHER THAN INTERVENTIONAL STUDIES BECAUSE INTERVENTIONS HERE WILL TAKE A LONGER TIME TO ASSESS SO WONDER IF THERE'S A ROLE FOR BIOMARKERS AND UNDERSTAND THERE'S A ROLE THAN JUST WAITING TO SEE A DIFFERENCE. SOCIETAL AND INDIVIDUAL BIOMARKERS. I THINK WE'LL NEED INTERVENTIONS TO WORK SOONER THAN WAITING THE LIFE COURSE. >> THANK YOU. >> OTHER POINTS OF INPUT OR COMMENT. >> I'M LOOKING AT A DOCUMENT WITH THEMED CALLED OUT. UNDER THEME FOUR MAXIMIZE PLASTICITY TO TAKE ADVANTAGE OF SENSITIVE PERIODS FOR TREATMENT AND REHABILITATION. ONE THEME SAYS IDENTIFY THE TIMING AND MECHANISMS OF NEUROPLASTICITY IN EARLY DEVELOPMENT PERIODS INCLUDING FETAL DEVELOPMENT. >> LAST CHANCE ON THEME FOUR. ALL RIGHT. WE'LL MOVE ON THOUGHT FIFTH THEME. THIS IS IMPROVING HEALTH DURING THE TRANSITION OF ADOLESCENCE TO ADULTHOOD. DR. SHRIVER. >> I HAD A BRIEF DISCUSSION WITH DR. BIANCHI BEFORE THIS AND HEAR WHAT YOU'RE SAYING WHICH IS THERE'S A SIGNIFICANT INTEREST IN UNDERSTANDING THIS TRANSITION FOR PEOPLE WITH INTELLECTUAL DEVELOPMENT DISABILITIES OR MAYBE IT CAME FROM THAT INTEREST WHICH IS GREAT EXCEPT I DON'T SEE IT IN THE WORDS. MAYBE IT'S IMPLIED IN WAYS I DON'T NECESSARILY NOTICE. IT FEELS IT'S A GOOD OPPORTUNITY TO CLARIFY THE TRANSITIONS EFFECT DIFFERENT POPULATIONS DIFFERENTLY. AND THERE'S SIGNIFICANT STRESSORS FOR PEOPLE IN THIS TRANSITION. FROM A NON-CLINICAL PERSPECTIVE IS BECOMING THE MOST STRESSFUL AND DIFFICULT TRANSITION FOR THIS POPULATION THESE DAYS. IT WOULD BE HELPFUL TO ELEVATE THE PROMINENCE OF THE MESSAGE. >> THANK YOU. OTHER COMMENTS? DOCTOR? >> I THINK I SPOKE ABOUT THE IMPORTANCE OF BRINGING BRAIN NEUROSCIENCE AND COGNITION INTO THIS AS WELL AS PARTNERING WITH OTHER GROUPS THAT PERHAPS HAVE MORE EXPERIENCE OR OTHER NICHE AREAS THEY WOULD LIKE TO LOOK AT. ADOLESCENCE BY DEFINITION IS SUCH A MULTI-DISCIPLINARY AREA OF LIFE AND SO MANY EXPOSURES AND RISKS OF PREGNANCY AND THE CHRONIC DISEASES AS WELL AS PEOPLE TREATED WITH DRUGS THEIR WHOLE LIVES WHETHER IT'S HIV OR CYSTIC FIBROSIS. WHAT THEY'LL LOOK AT AS THEY TRANSITION HAS DIFFERENT THEMES IN TERMS OF INDEPENDENCE VERSUS CAREGIVER VERSUS TREATMENT. SO THANK YOU FOR INCLUDING THIS THOUGH. IT IS A TOPIC OF GREAT INTEREST CERTAINLY IN THE HIV WORLD GLOBALLY. THANK YOU. >> DOCTOR. >> I HAVE A QUESTION WITHOUT HAVING READ THE WHOLE DOCUMENT BUT IN THIS PARTICULAR THEME, IT STRIKES ME THE WORD SEX IS NOT THERE. AND I WONDER IF IT WAS THERE IN THE DISCUSSION AND IMPLICIT OPPOSED TO EXPLICIT AND WHEN THEY'RE TRYING TO FIND SEXUAL IDENTITY AND CONFUSED ON WHAT IT MEANS AND WHAT TO DO IS NOT THERE. I'M WONDERING IF IT'S THERE. >> IT HASN'T BEEN CALLED OUT A LOT THROUGH THIS. IT'S A GOOD POINT TO BRING. OTHER COMMENTS? OKAY. >> I'D REITERATE THE BIOMARKER THING HERE. THE SOONER YOU CAN RECOGNIZE AND DIAGNOSE THINGS THE SOONER YOU CAN INTERVENE. WHEREVER AWARE AS POSSIBLE. >> I THINK RECOGNIZING BIOMARKERS, BIOMARKERS IN THE PATIENT AND FAMILY ARE THE CAREGIVER. THE PATIENTS WITH INTELLECTUAL DISABILITY AND IT'S HARD ON THEM AND THEIR FAMILIES. WE REALLY DON'T DO IT WELL AND UNDERSTANDING THE ONES WHO TRANSITION WELL VERSUS NOT. OKAY. >> LAST CHANCE ON NUMBER FIVE. >> MOVING TO SIX SAFE AND EFFECTIVE THERAPEUTICS AND DEVICES. PLEASE, DOCTOR. >> I'D LIKE TO TAKE THE OPPORTUNITY TO SAY NUMBER FIVE TOO. I WASN'T GOING TO CHIME IN BUT SINCE I AM, I ALSO LIKE NUMBER SIX. THE ONE THING I'D LIKE TO SEE INCLUDED IN SIX AND WONDER IF IT'S PART OF THE DISCUSSION IS THERE'S SO MANY TRANSFORMATIVE TECHNOLOGIES ON THE COMMERCIAL MARKETPLACE NOT BEING EFFECTIVELY UTILIZED FOR THE POPULATIONS IN FOCUS FOR NICHD AS MUCH AS THEY SHOULD BE OR AND I THINK A CONSTANT EFFORT IN THAT AREA IS WHERE WE'RE UNIQUELY SUITED TO WORK. I'D LIKE TO SEE A SENTENCE ADDED TO THAT AND SEE NODS LIKE IT WAS DISCUSSED. >> OTHER COMMENTS? >> I WAS HAPPY TO SEE THE THEME. IT'S EXTREMELY IMPORTANT. I FEEL THE TITLE COULD HAVE DEVELOPMENT OF NOVEL THERAPEUTICS BECAUSE I THINK THAT'S EXTREMELY IMPORTANT. THIS SEEMS TO FOCUS MORE ON ALREADY DEVELOPED TREATMENTS AND THEIR EFFECTS. I WOULD HAVE HOPED AND PERHAPS IT CAME UP IN CONVERSATION EARLY IT BE BROADER AND FOCUS ON DEVELOPING THE NOVEL THERAPEUTICS WITHIN NEW TECHNOLOGIES. >> SO NOVEL NOT JUST EXISTING. >> YEAH. >> OTHER COMMENTS? >> I THINK BIOMARKERS OF COURSE BUT HERE IT WOULD BE GRET -- GREAT TO HAVE A MODEL AND LOOKING AT THE CHALLENGES. >> OKAY. THANK YOU. >> I WAS CURIOUS ON THE DISCUSSION OF PUBLIC-PRIVATE PARTNERSHIPS AROUND THE THEME. I'M ASSUMING IT WAS DISCUSSED. >> WE'VE HAD A LOT OF DISCUSSION AND INPUT ON THAT. THE NEXT STEP IN THAT DISCUSSION IS AFTER WE REFINE THESE. WE HAVE A WHOLE PART OF OUR PLANNING PROCESS THAT WILL TALK ABOUT PARTNERSHIPS AND AND COLLABORATIONS IN PARTNERSHIPS. >> MAYBE THIS CAME UP WITH THE GATES FOUNDATION BUT THE ESTABLISHMENT OF THE MEDICAL STUDENT-ATHLETE IN BOSTON LOOKING -- BOSTON INSTITUTE AND THEY'RE LOOKING AT VACCINES WITH THE INTENT TO SAVE LIVES. THEY'RE ALREADY A PARTNER OF NICHD. THEY HAVE A LOT OF OVERLAPPING COMMON INTERESTS AND ALSO A NONPROFIT. THE RELATIONSHIP WEN NICHD AND GATES IN THE AREA THE M.R.I.s ARE PLANNING TO WORK IN ARE DIFFERENT THAN US ASKING FOR GRANT PROPOSALS AND ASKING OTHER COMPANIES TO UTILIZE FUND TO PROMOTE OR DEVELOP THEIR EXISTING TECHNOLOGIES. PERHAPS A VARIETY OR MULTIPLE TYPES OF THESE PARTNERSHIPS. >> THIS IS AN AREA WHERE I THINK THERE MAY BE BENEFIT TO IDENTIFYING NEWBORNS SPECIFICALLY. THERE'S REFERRING TO CHILDREN HISTORY IN THERAPEUTICS AN DRUG DEVELOPMENT WHERE THE BEST PHARMACEUTICALS FOR CHILDREN ACT BUT NEWBORNS WERE ALMOST TOTALLY EXCLUDED FROM THAT. AS THE A SMALL POPULATION AND THERE'S HIGH RISK AND THE NODE FOR BIOMARKERS AND TO MAKE AN IMPACT AND THERE MAY BE AN BENEFIT OF IDENTIFYING THEM SPECIFICALLY IN THE REALM OF CHILDREN. >> OTHER COMMENTS? IF THERE ARE NO OTHER COMMENTS YOU HAVE MADE IT THROUGH ALL SIX. LET ME CLOSE BY SAYING -- >> WE HAVE ANOTHER 35 MINUTES. I REALLY WANT TO CHALLENGE YOU IF WE HAD A POT OF MONEY FOR SOME ASPIRATIONAL GOALS. THIS IS YOUR OPPORTUNITY. WHAT SHOULD WE TRY TO ACCOMPLISH? BE OUTRAGEOUS. WE HAVEN'T HEARD ANYTHING OUTRAGEOUS YET. PUT CHILDREN ON THE MOON. >> ONE OF THE THINGS WE COULD THINK ABOUT IF WE WERE TO GIVE YOU A COUPLE MINUTES AS YOU WERE ASKING QUESTIONS YOU DIDN'T SEE A BIG BREAKTHROUGH AND I THINK AS WE GET MORE SPECIFIC AND REFINED AREAS WE MIGHT HAVE A CHANCE OF THINKING WHAT THE BIG THINGS WE COULD ACCOMPLISH IN THE AREAS. IF WE WANT IN THE TIME WE HAVE MAYBE WE CAN DO A RAPID FIRE AND GO THROUGH THESE AND ASK YOU FOR A COUPLE IDEAS BASED ON WHAT YOU THINK, IF YOU HAD A POT OF MONEY AND WANTED TO THINK ABOUT ACCELERATING THE FAST PROGRESS WHAT WOULD BE THE BIG THINGS TO FOCUS ON. THE NEXT STEP AFTER THESE IS WE DO NEED TO FIGURE OUT WHAT ARE THE BIG THINGS WE DO UNDER THE BIG THEMES. SO WHAT ARE THEY? >> SO AN EXAMPLE WOULD BE THE ARTIFICIAL WOMB. THAT'S RESEARCH THAT'S OH, MY GOD. I COULDN'T GET FUNDED AT NIH BECAUSE IT'S OUT THERE AND THERE'S ANIMAL MODEL SHEEP DATA WHERE INVESTIGATORS CREATED AN ARTIFICIAL WOMB AND ALLOWED SHEEP TO DEVELOP AND MATURE FOR A PERIOD OF WHAT WOULD BE THE EQUIVALENT OF 22 WEEKS IN A HUMAN GUESTATION A -- GESTATION AND THEY WERE CUT OUT OF THE ARTIFICIAL PLACENTA AND WENT SKIPPING DOWN THE HALL. THAT'S WHAT WE'RE LOOKING FOR. >> EXCEPT FOR THAT, RIGHT? LET ME ASK YOU THIS, IF WE GIVE YOU FIVE MINUTES TO WRITE THESE AND POLLED YOU INDIVIDUALLY WOULD YOU BE ABLE TO GIVE US ONE OR TWO? GIVE IT A SHOT. ON ANY TOPIC YOU WANT YOU CAN PICK MULTIPLE WINDS THAT'S -- ONES THAT'S FINE. WE'LL GIVE YOU UNTIL FIVE PAST 4:00. >> SO HERE'S THE RULES WHEN I CALL ON YOU YOU'LL TELL ALL YOUR IDEAS AT THE SAME TIME AND HOPEFULLY IT APPLIES TO THE SAME THEME AND HOPEFULLY THE NOTE TAKERS CAN GET IT BECAUSE I'M SURE I CAN'T KEEP UP. WHO WANTS TO START? THERE'S NO BAD ANSWERS. >> ALL RIGHT. IF I HAD A BILLION DOLLARS I'D WANT NIH TO FUND THE DISK AND EVALUATED AND ETHICALLY FOUND, AFFORDABLE SYSTEM FOR GENETIC EDITING AND PROCURING GENETIC DISEASES. >> ANYTHING ELSE? >> OKAY. >> I THINK MINE IS A GOOD SEGUE FROM THAT. AS SOMEONE THAT THINK WE'LL NEVER BE ABLE TO CURE ALL DISEASES, IF I HAD I DON'T REMEMBER HOW MUCH MONEY IT IS I THINK TECHNOLOGY THAT MAKES DISABILITIES COGNITIVE AND PHYSICAL DISABILITIES INVISIBLE IN SOME WAY. IN OTHER WORDS, THERE ARE PROSTHETICS WHETHER THEY BE COGNITIVE OR PHYSICAL PROSTHETICS THAT PEOPLE DON'T RECOGNIZE [INDISCERNIBLE] IS A PERFECT EXAMPLE THAT AMELIORATE THE CONDITIONS THAT THIS ORGANIZATION WORKS FOR. IT WOULD BE THAT WORK. I DID HAVE A SECOND ONE BECAUSE THAT FITS FAIRLY WELL WITHIN THEME SIX I THINK. I THINK THERE'S WAYS TO ARTICULATE BIG WINS ON SMALLER SCALED IF YOU TACKLE PARTICULAR PARTS OF THE DISABILITY. THE OTHER PART OF THIS ORGANIZATION THAT HAS STRUCK ME AS I'VE ATTENDED THESE MEETINGS IS THE GROUP WE CARE FOR ARE UNIQUELY DISCRIM NATED AGAINST AND I WROTE DOWN ADVOCACY SCIENCE. I KNOW IT EXISTS IN SOME FORM OR ANOTHER BUT I THINK THAT FOR US TO WORK AND HAVE PART OF OUR BILLION DOLLARS BE SPENT ON STUDIES THAT WORK IN A SCIENTIFIC WAY ELIMINATE DISPARITY AND SPECIFICALLY FOCUSSED ON OUR POPULATION AND IF YOU'RE DISABLED YOUR LIKELY TO BE POOR, THEY ALL RAMP IN WITH EACH OTHER SO THOSE WOULD BE MY TWO AREAS. >> THANK YOU. >> ALL RIGHT. WHO WANTS TO GO NEXT? >> WE KNOW THAT MILLIONS OF CHILDREN ANNUALLY WITNESS OR EXPERIENCE ONE OR MANY FORMS OF VIOLENCE, ABUSE AND/OR NEGLECT WHETHER IT'S PHYSICAL OR EMOTIONAL ABUSE OR NEGLECT WITHIN THE FAMILY OR OUTSIDE THE FAMILY. WE KNOW SOME OF THESE CHILDREN WILL TAKE A PATH THAT WILL LEAD THEM TO BE VIOLATE OR PREDATORS IN THEIR ADULTHOOD BUT MANY MORE WON'T AND JUST HAVE LIVED WITH THEIR OWN PAST TRAUMA. MANY OF THESE DEVELOP MENTAL HEALTH ISSUES SUCH AS DEPRESSION AND SUICIDAL IDEATION AND OTHER WITH EATING DISORDERS AND SOME OR MANY OF THOSE WILL SURVIVE AND WE HAVE NO IDEA WHAT THE NATURAL HISTORY OF THE IMPACT OF THESE PROCESSES ARE ON YOUNG CHILDREN OR OLDER ADOLESCENTS OR ADULTS AND WHERE I'D SPEND A BILLION OR TWO. OKAY. >> LET ME, IF YOU GAVE ME A BILLION DOLLARS TO SPEND I THINK WE COULD GET TO THE POINT WHERE WE COULD REGROW LENS. I THINK REGENERATIVE BIOLOGY IS NOT NECESSARILY NICHD BECAUSE IT TENDS TO BE AGING AND NIDDK AND SO ON BUT THE PLATFORM FOR REGENERATIVE MEDICINE IS FUNDAMENTAL BIOLOGY. EVERY ONE OF US KNEW HOW TO MAKE A LIMB ONCE. WE KNOW ENOUGH ABOUT STEM CELLS TO GET STEM CELLS TO BE LIMB PROGENITORS. IT SHOULD BE PASSABLE TO THINK HOW TO MAKE IT IN THE FIRST PLACE TO REAGREE THEM FOR PEOPLE WITH -- REGROW THEM FOR PEOPLE WITH DISABILITIES. I HAPPEN TO DO SOME OF MY LAB WORK IN LENS AND SPEAKING MORE BROADLY, I THINK IF YOU WANT TO TALK ABOUT SOMETHING MAJOR WITH DEVELOPMENT AND BIOLOGY IS A PLATFORM FOR REGENERATIVE MEDICINE IN A WAY THAT HASN'T BEEN DONE IN A FOCUSSED WAY. AND ANOTHER PROBLEM WITH THE WHOLE FIELD IS THE STEM CELL BIOLOGISTS AN TISSUE ENGINEERS AND DEVELOPMENT BIOLOGISTS DON'T SPEAK TO EACH OTHER. THEY GO TO DIFFERENT CONFERENCES AN JOURNALS. ONE COULD USE NICHD AS A CONVENING BODY TO BRING BIOLOGISTS BACK FOR THAT PURPOSE. >> THAT'S INTERESTING BECAUSE FOR NCMRR A BIG FOCUS IS THEIR LIMB ROSS REGISTRY. IS -- LIMB ROSS REGISTRY. IS THERE A WAY TO THINK OF COMBINING THE COLLECTION OF PEOPLE WHO HAVE EXPERIENCED LIMB LOSS WITH SOME OF THE PERHAPS THEMES THAT ARE DIRECTED TOWARDS THEMES AND DEVICES IN THEME SIX AND A BIOLOGY APPROACH. THAT WOULD BE NOVEL. >> AND ALSO INCLUDING UNDERSTANDING BASIC EM EMBRYOLOGICAL APPROACH. >> YOU CAN IMAGINE THAT TRANSLATION. I KNOW THAT CAME UP WITH OTHER TOPICS BUT GOING FROM BASIC CELLULAR BIOLOGY OF HOW DO YOU MAKE A LIMB TO IF THE LIMB IS NOT DEVELOPING PROPERLY, WHAT'S THAT IMPLY TO STUDYING IT IN HUMAN BEINGS. >> THERE IS THE OPPORTUNITY TO BE A CONVENING BODY AND INTEGRATE IT AS LONG AS AND ONE LAST PITCH THAT REQUIRES HAVING THE FUNDAMENTAL KNOWLEDGE TO BEGIN WITH. IT HAS TO BE A KEY AND LAID OUT ASPECT OF IT. >> WHO'S NEXT? >> DOCK FOR? -- DOCTOR? >> I HAVE TWO. THE FIRST IS TO HAVE UNIVERSAL PRENATAL SCREENING AND WITH THE NEW TECHNOLOGIES. THAT'S WORTH BILLIONS BUT WHAT THE HELL. MY MORE PRACTICAL ONE IS TO USE A TRANSLATIVE AND INTEGRATAL RESEARCH METHOD TO FIND A COMMON PATHWAY IN AUTISM. I THINK THERE'S PROBABLY MORE THAN ONE. BUT THE WAY IT'S TYPICALLY DONE NOW IS PEOPLE WILL LOOK AT ONE SYNDROME ASSOCIATED WITH AUTISM AND ONE MOUSE MODEL ED WITH THAT AND COME UP WITH AN ANSWER THAT MAY BE TRUE FOR THAT ONE MODEL BUT I'D LIKE TO SEE A STUDY OF MANY GEN ET ANGD NON-GENETIC MODELS LIKE MATERNAL INFLAMMATION TO LOOK AT COMMON BIOMARKERS TO FIND A COMMON PATHWAY. >> THANK YOU. WHOSE NEXT? >> I HAVE THREE AND THEN A QUESTION. MY FIRST ONE IS HOW NON-HEALTHY EATING PATTERNS AFFECT NOT ONLY THE FETUS BUT SUBSEQUENTLY LONG-TERM HEALTH OF THE CHILD AND THE ADULT AND IT WOULD BE TURNING THE FETAL ORIGINS OF CHRONIC DISEASES FROM THEORY TO FACT. THAT'S NUMBER ONE. NUMBER TWO, COME UP WITH EFFECTIVE METHODS SO TEENAGERS CHOOSE HEALTHY FOODS OVER FAST FOODS AND NUMBER THREE IS, WHAT IS THE IDEAL DIET FOR WOMEN WITH GESTATIONAL DIABETES. I GET ASKED THAT QUESTION A LOT. AND MY QUESTION IS DURING THE DISCUSSION OF THE STRATEGIC PLAN, WAS THERE ANY DISCUSSIONS TO CHANGE THE NAME OF THE NICHHD BECAUSE OF OUR DISCUSSION TODAY AND WHAT YOU SAID, DR. BIANCHI ABOUT CONGRESS NOT PAYING ATTENTION TO PREGNANT WOMEN. >> THAT HAS COME UP SEVERAL TIMES PRIOR TO MY DECISION AS DIRECTOR. AND I KNOW THE OBSTETRIC AND GYNECO LOGICAL COMMUNITIES HAVE HISTORY AND IT INVOLVES CONGRESSIONAL APPROVAL AND IT'S A COMPLICATED QUESTION AND ISSUE. WE ALSO HAVE TO HAVE A NAME THAT IS SHORT ENOUGH THAT PEOPLE WILL BE ABLE TO PRONOUNCE IT. AND SO WE'RE CERTAINLY OPEN TO NAMES THAT WOULD REPRESENT THE POPULATIONS THAT WE SERVE BUT IT'S HARD TO THINK OF SOMETHING SHORT. SO WHILE IT'S NOT COMPLETELY OFF THE TABLE, IT'S COMPLICATED. SO IF SOMEONE COMES UP WITH A NAME THAT SEEMS TO ADDRESS ALL THE THINGS THAT WE REPRESENT, THEN WE CERTAINLY WOULD CONSIDER IT AT LEAST BUT IT'S NOT THE TOP BATTLE THAT WE HAVE TO FIGHT. >> IT'S NO SHOCK MINE WOULD BE TO COME UP WITH A BIOMARKER EVERY KID WAS TREATED AT 9 INSTEAD OF 29. I DON'T KNOW THAT WOULD MAKE HUGE AMOUNT OF MONEY BUT GETTING THAT IMPLEMENTED INTO THE MEDICAL SYSTEM MAY BE MORE DIFFICULT THAN FINDING IT. I THINK THAT WOULD BE JUST WHEN YOU THINK ABOUT THE AMOUNT OF DISEASE THAT IS CORRELATED WITH MED BOLLIC SYNDROME AND OBESITY AND THINGS THAT COME FROM P.C.O.S. WOULD BE HUGE AND I ALSO WOULD LIKE TO KNOW WHAT THE DIET IS FOR GESTATIONAL DIABETES IS TOO SO I'LL SECOND THAT ONE. >> OKAY. HODE -- WHO WOULD LIKE TO GO NEXT? >> I'M A SOCIAL BEHAVIORAL RESEARCHER AND THINKING ABOUT THE RESEARCH AMONG CHILDREN AND IN PARTICULAR YOU RUN OUT TO FAST FOOD AND HEALTHY DIETS VERSUS UNHEALTHY DIETS BUT THINKING ABOUT INTERVENTIONS OR EXPERIMENTS AMONG CHILDREN TO HELP US COUNTERACT THE NEGATIVE EFFECTS OF ADDICTION TO CONSTANT DEPENDENCE ON DEVICES AND SOCIAL MEDIA. THAT'S GOING HELP US FOR THE REST OF US LATER IN LIFE AND THE LIFE CYCLE BUT I THINK IF WE START WITH CHILDREN I THINK IT WILL BE A GREAT BREAKTHROUGH. >> NEXT. >> TWO THINGS, ONE IS USING MODELS OF BRAIN DEVELOPMENT TO MODIFY ADOLESCENT RISK-TAKING BOW -- BEHAVIORS WHICH RELATES TO WHAT YOU WERE SAYING ON MEDIA BUT COULD BE RELATED TO ADDICTION, TOBACCO, ALCOHOL AND TO GUIDE THE TIMING OF THE INTERVENTION AND THE NATURE OF THE INTERVENTION. AND BEING PART OF THE COUNCIL GIVEN I WORK ALMOST ENTIRELY IN INTERNATIONAL SETTINGS I'M BEEN IMPRESSED HEARING MORE AND MORE ABOUT THE DASH PROGRAM HERE AND WHETHER NICHD WOULD BE IN A POSITION TO HELP TRANSFER THE STRUCTUR STRUCTURES AND TECHNOLOGIES AND ETHICAL TOOLS TO OTHER COUNTRIES TO DEVELOP DASH DATA REPOSITORIES ON THEIR OWN. IN THE HIV WORLD IT'S KNOW NOTORIOUSLY DIFFICULT TO SEND OUT HIV SAMPLES AND SOME COUNTRIES CAN'T SHARE THAT BUT IF THERE'S A WAY TO LEARN WHAT HAS BEEN DONE IN DASH AND SHARE DATA ON PREGNANCY BIRTH DEFECTS OR PHARMACO KNOWLEDGE IT'S A GREAT WAY TO SHARE INFORMATION. >> WHO HASN'T GONE YET? >> I'LL GO. SO I HAVE NO IDEA WHETHER THIS IS REALISTIC OR NOT BUT I HAVE A SENSE WE'RE NOT TERRIBLY FAR AWAY FROM UNDERSTANDING THE DEVELOPMENT TRIGGERS THAT LEAD TO BOTH THE ONSET OF AUTISM AND SCHIZOPHRENIA. AND IT SEEMS TO ME THAT IF I'M RIGHT AND MAY VERY WELL NOT BE, BUT IF I AM AND IF WE ARE THREE, FIVE, SEVEN, 10 YEARS WEIGH -- AWAY FROM UNDERSTANDING WHAT HAPPENS THAT TRIGGERS DISEASES AND WE COULD PREVENT THAT, WE MAY NOT PREVENT THE UNDERLYING NEUROLOGICAL VULNERABILITY FOR THE PEOPLE WHO DEVELOP THOSE DISEASES ABOUT THE MAY STOP THEM FROM OCCURRING WHICH WOULD BE MONUMENTAL FOR THE WORLD. IT SEEMS TO ME I READ A LOT OF ABOUT IT. THE SECOND IDEA IS WHAT IS THE GOAL OF HUMAN DEVELOPMENT? IT SEEMS TO BE ON THE POSITIVE PSYCH SIDE AND HAPPINESS AND PURPOSE AND POSITIVE RELATIONSHIPS. WE KNOW ALMOST NOTHING OF THE BIOLOGY OR EPI GENETICS OF THOSE. AND WE DON'T KNOW ANYTHING ABOUT WHY SOME PEOPLE ARE SO CAPABLE OF RESPONDING RESILIENTLY TO TRAUMAS LIKE VIOLENCE AND DISEASE EVEN. I SEE IT WITHIN PEOPLE OF INTELLECTUAL DISABILITIES WE SEE RESILIENCE AND WE DON'T KNOW WHY AND DON'T KNOW THE DISTINGUISHING FEATURES OR COULD HELP SOMEBODY FROM A BIOLOGICAL POINT OF VIEW OR EPIGENETIC POINT OF VIEW TO BECOME RESILIENT AND I'M SURE THERE'S WORK AT NIH AT THE POSITIVE PSYCH SIDE BUT IT SEEMS IF WE COULD EMBARK ON AN EFFORT TO UNDERSTAND RESILIENCE IN CHILDREN WE WOULD BE DOING THE WORLD A TREMENDOUS SERVICE IN TRYING TO HELP PARENTS GROW POSITIVELY BUT HAVE PRECIOUS LITTLE INFORMATION WHAT THAT LOOKS LIKE BECAUSE WE SPEND SO MUCH TIME ON DISEASE AND SO LITTLE TIME ON HEALTHY DEVELOPMENT. THOSE ARE TWO THOUGHTS. HAPPINESS WOULD BE THE HEADING. >> I'LL LOOK AT THE CONTRIBUTION DEFINING THE MECHANISMS BY WHICH SOCIAL FACTORS ARE TRANSED IN THE BIOLOGICAL OUTCOMES. I DON'T HAVE CONFIDENCE THERE'S A PUBLIC QUELL TO DEAL WITH THE SOCIAL FACTORS. SOCIAL ECONOMIC ISSUES AND TO MY KNOWLEDGE THERE'S BEEN SUBSTANTIVE PROGRESS IN IDENTIFYING GENETIC OR EPIGENETIC CONTRIBUTIONS. I HAVE MORE CONFIDENCE IN PEDIATRICIANS ADDRESSING THE ISSUES AND UNDERSTOOD THE MECHANISMS AND THERE WERE WAYS TO MITIGATE THE FACTORS. >> DEVELOP A DEVICE OR METH OPTED TO -- METHOD TO ELIMINATE BIRTH DEFECTS AND DEATH RELATED TO OXYGEN DEPRIVATION. >> OKAY.& THANK YOU. >> I'LL BE BRIEF BUT IF MINE WERE SET BY SOMEONE ELSE WHICH IS INTERESTING. SO EARLY BIOMARKER FOR P.C.M.S. AND IT'S A COMMON CONDITION AND DAZE NOT COMMONLY DIAGNOSED BECAUSE WE CAN'T AGREE ON WHAT IT IS AND THERE WAS A CONFERENCE CONSIDERED A LACK OF CONSENSUS AND WE DON'T NOW HOW TO DIAGNOSE IT AND THERE'S TO MANY MORBIDITY THAT CAN LEAD TO MORTALITY WITH THAT DIAGNOSE AND THIS COULD BE A REAL SOUND BITE FOR THE INSTITUTE, IF WE COULD UNDERSTAND BETTER THE ADDICTION TO THESE DEVICES AND I CAN'T GET TEENAGERS TO LOOK AT ME. I CAN'T GET MY OWN CHILDREN TO LOOK AT ME AND I WORRY WHAT THAT WILL DO TO THEIR LONG TERM HEALTH AND I THINK EVERY PARENT AND GRANDPARENT WANTS TO KNOW THAT. >> DID WE MISS ANYBODY? DR. BIANCHI DO YOU HAVE ANY RESPONSES? >> THIS IS GREAT. I ENCOURAGE YOU ALL TONIGHT IN MORE RELAXED SETTINGS TO CONTINUE THE BLUE SKY DISCUSSION. THE FEEDBACK HAS BEEN ENORMOUSLY HELPFUL AND A WANT TO EMPHASIZE WE'RE LISTENING AND THIS IS A DRAFT DOCUMENT AND WE'LL INCORPORATE MANY OF THE THINGS YOU SAID. THE ONE THING I WAS A LITTLE BIT UNCLEAR ABOUT AND MAYBE IF WE CAN JUST USE THE LAST FIVE MINUTES, IF YOU HAVE COMMENTS ON THIS, IT SOUNDED LIKE THERE WAS A LITTLE BIT OF CONFUSION BETWEEN ADOLESCENCE AND THE TRANSITION TO ADULTHOOD AND THEN THE IDENTIFICATION OF CRITICAL TIME PERIODS. SO WOULD YOU RECOMMEND THAT ISSUES RELATED TO MORE TYPICAL ADOLESCENT DEVELOPMENT, FOR EXAMPLE, SHOULD REALLY GO INTO THEME FOUR THE CRITICAL TIME PERIODS AND FOCUS THEME FIVE MORE ON ISSUES RELATED TO TRANSITION TO ADULTHOOD OR AM I JUST SPLITTING HAIRS? PLEASE COMMENT. >> I THINK WHAT YOU JUST SAID DIANA IS PERFECT. YOU CAN BRING THE WHOLE SPECTRUM OF EXPOSURE IF YOU LOOKED AT THE FETAL PERIOD AND INFANTS AND CHILDREN, ADOLESCENTS. I THINK TRANSITION IS SUCH A HUGE ISSUE IN ITSELF. I THINK NUMEROUS PEOPLE AROUND THE TABLE HAVE TALKED ABOUT THAT THAT THAT DESERVES TO BE THE THEME FIVE ABOUT ITSELF. I'D APPRECIATE OTHER'S THOUGHTS. >> ANY OTHER THOUGHTS ON THAT? >> JUST TO REITERATE WHAT MICHAEL HAS MENTIONED BEFORE, I THINK YOU EXPLAIN BEFORE THE THEMES COME, ONE DOESN'T FEEL LIKE I HAVE TO TELL YOU THIS AND THAT. IT'S WHAT YOU CALL IT, THE ORE -- HORIZONTAL. YOU GAVE US THE SIXTH VERTICAL AND YOU DIDN'T GIVE THE HORIZONTAL AND YOU'RE SAYING THAT IS CROSS-CUTTING. SO YOU TELL US AHEAD OF TIME OR FIRST THAT THIS IS THE WAY YOU THOUGHT ABOUT IT AND HERE THE SIX. >> YOU'RE GOING TO HERE TOMORROW DELLA WILL GIVE A PRESENTATION ON THE OPERATIONAL PLANNING PROCESS WHICH OUR INTERNAL STAFF KNOW BECAUSE WE SPENT A LOT OF TIME ON THIS EVERY YEAR AND THAT'S THE WHOLE PROCESS BY WHICH WE CREATE THE FUNDING OPPORTUNITY ANNOUNCEMENTS. WHICH MEANS IT'S A PRIORITY AREA STAFF ARE BRINGING FORWARD AND WE ARE COMMITTING MONEY TO AND THAT IS WHAT YOUR DISCUSSING IN THE COMPLEX PART OF COUNCIL. SO ONE OF THE THINGS WE CAN DO WITH THESE WEFT THEMES IS ONCE WE DECIDE WHAT THE VERTICAL SCIENTIFIC AREAS OF FOCUS ARE AS A PROGRAM STAFF MEMBER BRINGS FORWARD A CONCEPT. THEN WE COULD SPECIFICALLY ASK WHERE'S THE ASPECT OF NUTRITION ON THIS? IS THERE A GLOBAL HEALTH COMPONENT AND ASK THIS ADDRESS DISPARITIES AND BEFORE THIS GOES OUT TO THE WORLD WE CAN SAY WE WANT A SPECIFIC BULLET OR CALL OUT ON ADDRESSING HEALTH DISPARITIES. THAT'S HOW I SEE THE WEFTS MOVING IN. >> I THINK IT'S GOOD FEEDBACK. IF WE COULD BE MORE EXPLICIT ON WHAT THEYRY THINK IT WILL GO A LONG WAY IN TELLING THE STORY. >> HAVE YOU A MATRIX AND LABELLED ONE AXIS AND NOT THE OTHER AND WANT TO DO A SPELL OUT OF BOTH AXES AND THEN HAVE YOUR STAFF LOOK FOR THE INTERSECTIONS. >> ONE OTHER WAY TO LOOK AT THAT -- I THINK THAT'S A GREAT IDEA AND IF YOU CAN SEE BOTH IT'S EASIER TO KNOW AND LOCATE. THE OTHER TO THIS BIG IDEA QUESTION WHICH I THINK WAS A GOOD EXERCISE AND I THINK IT'S HELPFUL, IT MIGHT JUST BE TO THINK ABOUT AND THIS MAY NOT END UP IN THE DOCUMENT BUT MAY END UP IN THE DISCUSSION ITEM, WHEN YOU LOOK AT GOAL SIX, WHAT'S A PICTURE OF SUCCESS? NOT A PICTURE OF INQUIRY WHICH IS WHAT WE HAVE HERE BUT A PICTURE OF SUCCESS AND MAY GET INSPIRED TO SEE THE TWO ELEMENTS COMING TOGETHER WITH THE WEB AND THE WEFT AND WHATEVER IT IS. THE WEAVE AND THE WEFT. ANYWAY, IF ENERGY CATEGORY WERE THERE SO YOU COULD SEE THE HOPE MIGHT BE SOME OF THE THINGS THAT WERE MENTIONED OF THE BIG IDEA GENERATION AREA AND MAJOR PROGRESS OR Y OFFER X OR CHANGE IN Z IT MAY HELP PULL OUT HOW THOSE WORK TOGETHER.FFER X OR CHANGE IN Z IT MAY HELP PULL OUT HOW THOSE WORK TOGETHER.ER X OR CHANGE IN Z IT MAY HELP PULL OUT HOW THOSE WORK TOGETHER.ER X OR CHANGE IN Z IT MAY HELP PULL OUT HOW THOSE WORK TOGETHER.R X OR CHANGE IN Z IT MAY HELP PULL OUT HOW THOSE WORK TOGETHER.OR X OR CHANGE IN Z IT MAY HELP PULL OUT HOW THOSE WORK TOGETHER. >> I'M THINKING WE'LL NEVER BE ABLE TO GET RID OF THE ANALOGY WEAVE AND WEFT. WE'LL PUT IT ON THE COVER. SO WE'RE AT 4:30. I THINK IT'S TIME TO WRAP UP FOR THE DAY. I DO WANT TO THANK ALL OF YOU FOR BOTH BEING SUCH STRONG ADVOCATES FOR WHY YOU'RE PASSIONATE ABOUT AND SO CONSIDER CONSIDERATE IN YOUR FEEDBACK. DR. BIANCHI DID YOU WANT TO WRAP ANYTHING UP? >> YES. I WANT TO MENTION A SHUTTLE BUS HAS BEEN ARRANGED FOR OUR COUNCIL MEMBERS TO GET YOU BACK TO YOUR HOTEL. THANK YOU AGAIN FOR YOUR INPUT AND I WANT TO THANK STAFF AND EVERYONE WHO HAS BEEN INVOLVED IN THIS ENORMOUS EFFORT INCLUDING SCOTT'S STAFF AND ALL THE EXTERNAL WORKING GROUP MEMBERS. IT'S A VERY RICH DISCUSSION AND I THINK ULTIMATELY I THINK IT'S GOING TO RESULT IN A VERY EXCITING AND TRANSFORMATIVE STRATEGIC PLAN. THANK YOU AND ON THAT THOUGHT YOU'LL GET A LITTLE WHILE TO RELAX AND WE'LL SEE SOME OF YOU AT DINNER.