GOOD MORNING AND THANKS TO THOSE OF YOU WHO ARE JOINED US NOR OPEN SESSION. WE ARE GOING TO AGAIN TODAY WITH A REPORT FROM DR. TOM FRIEDMAN THE NIDCD'S ACTING SCIENTIFIC DIRECTOR AND WILL PRESENT THE NIDCD DIVISION OF INTRAMURAL ACTIVITIES REPORT TO THE COUNCIL. THANK YOU, TOM. >> THANK YOU. THIS IS A PHOTOGRAPH OF AN ALUMINUM EAR BY A SCULPT. FOR ON THE GROUNDS OF THE ARTS CENTER IN THE HUDSON VALLEY. HE SAID, THE SCULPTOR SAID AT THE TIME HE DIDN'T FIND THE EAR, THE EAR FOUND HIM AND AN IMMEDIATELY RELATED TO HIM BECAUSE THE EAR HAS FOUND MANY OF US. THIS IS A LIST OF THE INTRAMURAL INVESTIGATORS THERE ARE 10 TENURED TRACK INVESTIGATORS. [LISTING NAMES] AND BELOW THEIR THREE NAMES ARE THE TENURED FACULTY. ANDY ISN'T WITH US ANY LONGER BUT THERE'S AN ASTERISK NEXT TO KATIE'S NAME AND CAT'S NAME BECAUSE THEY'RE P.K. WINNERS. THE PRESIDENTIAL EARLY CAREER AWARD FOR SCIENTISTS AND ENGINEERS. IT'S THE HIGHEST HONOR BESTOWED BY THE U.S. GOVERNMENT ON OUTSTANDING SCIENTISTS. ANDY RECEIVED HIS AWARD IN 2002. KATIE KINDT IN 2016 AND CAT WEISZ IN 2019 AND THREE SCIENTIST EMERITUS [LISTING NAMES] AND THEY SEEMED AND WERE PLEASED THEY CANNOT REALLY SEPARATE THEM SELVES FROM THE NIDCD ENTIRELY AND THEY ARE ACTIVELY STILL PARTICIPATING WHEN AND WHERE THEY CAN. AND THERE ARE THREE SURGEON SCIENTISTS [LISTING NAMES] WHO IS THE NEWEST MEMBER OF THE SURGEON SCIENTIST PROGRAM. I MENTIONED ANDY WAS THE SCIENTIFIC DIRECTOR AND DEPARTED TO BECOME THE SENIOR ASSOCIATE DEAN AT THE UNIVERSITY OF TENNESSEE HEALTH SCIENCE CENTER WHERE HE INTEND TO CREATE A RESEARCH POWERHOUSE AND DEAL WITH THE DISPARITIES IN HEALTH CARE IN MEMPHIS, TENNESSEE. SO WE WISH HIM THE VERY BEST. I'VE BEEN COLLABORATING WITH ANDY FOR THE PAST 22 YEARS AND WILL MISS HIM. I ALSO WANT TO POINT OUT TWO VERY IMPORTANT PEOPLE IN THE OFFICE OF THE SCIENTIFIC DIRECTOR AND THAT'S THE CHIEF OF STAFF, DR. ELYSSA MONZACK AND LYNN PENN. I'M THE INEXPERIENCED ONE AND HAVE BEEN TRYING TO HELP THEM RUN THE RESEARCH PROGRAM TO BRING THE SARS COV2 PANDEMIC WHILE THEY'VE BEEN TEACHING ME THE ROPES. I WANT TO THANK THEM AND THEIR DEDICATED INDUSTRIOUS STAFF FOR THEIR SUPERB EFFORT IN KEEPING US SAFE DURING THE PANDEMIC. SO ONCE AGAIN THIS IS A LIST OF THE MEMBERS OF THE BOARD OF SCIENTIFIC COUNSELORS IN 2019. I THINK MANY OF YOU KNOW MOST OF THEM. PAUL MANIS HAS BEEN THE CHAIR. [LISTING NAMES] . THEY'RE ALL SUPERB AND VERY HELPFUL MEMBERS OF THE BOARD OF SCIENTIFIC COUNSELORS AND HAVE BEEN VERY HELPFUL TO US IN POINTING OUT STRENGTHS AND WEAKNESSES OF OUR INVESTIGATORS. SO THE NIDCD INTRAMURAL SCIENTIST PROGRAM IS A MENTORED EARLY CAREER FACULTY DEVELOPMENT. WE DON'T EXPECT ALL OR MANY OF THEM TO STAY HERE BUT TO MOVE ON TO OTHER POSITIONS. THEY HAVE AN INTEGRATED CLINICAL RESEARCH PROGRAM, A GRADUATED LEVEL OF INDEPENDENCE IN RESOURCES, A CULTURE OF SCHOLARLY INQUIRY AND SCIENTIFIC RIGOR AND OPPORTUNITIES TO MAINTAIN THEIR SURGICAL SKILLS AND THAT'S A PHOTO OF THE FOUR SURGEON SCIENTISTS BEFORE DR. CLINT ALLEN ENTERED THE NIDCD FULL TIME. IN ADDITION THE SURGEON SCIENTISTS THEY HAVE A RELATIONSHIP WITH THOSE ACROSS THE STREET FROM THE NIH. WITH JOHNS HOPKINS UNIVERSITY OF SUSH -- SUBURBAN HOSPITAL WHICH IS ACROSS THE STREET NEARBY AND GEORGETOWN UNIVERSITY WHERE WE HAVE AN ASSOCIATE PROFESSOR. I WANTED TO TELL YOU A LITTLE BIT ABOUT THE ANNUAL EAR ESSENTIALS COURSE. WE HAVE DIRECTORS OF THE COURSE AND THE SEVENTH ANNUAL COURSE THIS YEAR THOUGH IT WAS VIRTUAL. WE COVER THE CONCEPTS AND TECHNIQUES OF HEARING RESEARCH. IT'S FREE. LECTURES ARE OPEN TO ALL WHO REGISTER AND IN THE COMING YEAR WE'RE GOING TO BE ADVERTISING MUCH MORE WIDELY THAN JUST THE A.R.O. IN ORDER TO DEVELOP STRATEGY AND ALSO TO DEVELOP STRATEGIES TO REACH AN EVEN MORE DIVERSE POOL OF APPLICANTS FOR ATTENDEES WHO WOULD REGISTER FOR THE COURSE AND THEN THE NEXT SLIDE IS A LIST OF THE INSTITUTIONS WHERE THE STUDENTS IN THE 2020 COURSE OFFERED IN JULY THIS YEAR VIRTUALLY WERE FROM. YOU CAN SEE THEY'RE FROM MANY PLACES IN THE UNITED STATES BUT FROM ALL OVER THE WORLD, INDIA, CANADA, ARGENTINA, THE UNITED KINGDOM. THE COURSE WAS VIRTUAL AND DIDN'T KNOW HOW WELL IT WAS GOING TO WORK OUT BUT TURNED OUT TOBE VERY SUCCESSFUL. WE HAD LIVE LECTURERS AVAILABLE FOR QUESTIONS AND ANSWERS TO THE STUDENTS. THERE WERE MORE THAN 90 PRE-REGISTERED PARTICIPANTS FROM AROUND THE WORLD. WE ALSO HAD LIVE LABS THAT WERE BROADCAST TO 44 PARTICIPANTS. SO I WANT TO THANK YOU AND ASK IF YOU HAVE ANY QUESTIONS FOR ME OR DR. TUCCI ABOUT THE INTRAMURAL PROGRAM OR ABOUT YOUR ESSENTIALS COURSE OR ANYTHING ON YOUR MIND. . YOU CAN PUT YOUR QUESTIONS IN TO THE CHAT OR UNMUTE AND ASK THEM DIRECTLY. IF NOT, THEN I THINK DR. COOPER IS NEXT ON THE LIST. SO I'LL TURN IT BACK TO YOU, CRAIG OR DR. TUCCI. >> THANK YOU, TOM. I WILL SAY I IN FOR THE EAR ESSENTIALS COURSE THIS YEAR AND I REALLY ENJOYED IT. WE JUST MISSED THE LABORATORY PORTION. I THINK THAT'S THE PART THAT COULDN'T TAKE PLACE DURING COVID. I THINK HAVING A HYBRID MODEL IN THE FUTURE TO BRING MORE PEOPLE IN. I SAW SOMEBODY FROM INDIA WHO PARTICIPATED. THAT'S JUST FANTASTIC. AGAIN A SILVER LINING OF HAVING TO DO THINGS VIRTUALLY SO WE NOW KNOW WHAT'S POSSIBLE. THANK YOU VERY MUCH AND THANK YOU FOR YOUR LEADERSHIP OF THE INTRAMURAL PROGRAM I ENJOYED WORK WITH YOU. NOW WE'LL WELCOME DR. COOPER BACK. JUDITH WILL PROVIDE AN UPDATE ON OUR RESPONSES AND EFFORTS IN DEALING WITH THE COVID PANDEMIC. A LOT HAS BEEN GOING ON AT THE NIH AND WHEN WE LAST MELT IN MAY THE COUNCIL -- MET IN MAY THE COUNCIL PROVIDED INSIGHTS AND RECOMMENDATIONS TO THE INTRAMURAL WORLD. JUDITH, WELCOME AND LOOK FORWARD TO YOUR COMMENTS. >> THANK YOU. GOOD MORNING, EVERYONE. ONE OF MY ROLES HERE AT THE NIDCD AND SERVING AS THE DIRECTOR FOR THE DIVISION OF SCIENTIFIC PROGRAMS WHERE I AND MY COLLEAGUES WORK TOGETHER TO FACILITATE AND OVERSEE RESEARCH AND RESEARCH TRAINING IN OUR EXTRAMURAL COMMUNITY. I WANT TO BRIEFLY SHARE SOME OF MY DIVISION'S RECENT ACTIVITIES RELATED TO COVID-19 AND THEN WE'LL MOVE ON TO PRESENT TO YOU FOR YOUR APPROVAL SOME CONCEPTS WE HAVE IN MIND FOR FUTURE ACTIVITIES. I'M NOT GOING TO TALK ABOUT ALL OF THOSE BUT THIS IS JUST TO GIVE YOU A FLAVOR OF HOW MANY DIFFERENT COVID-19 ACTIVITIES WE WERE INVOLVED IN. I WILL HIGHLIGHT A FEW OF THOSE. THE FIRST WAS A NOTICE WE PUT OUT REQUESTING REVISIONS AND SUPPLEMENTS. REVISION IS THE NIH WORD FOR A SUPPLEMENT TO AN ACTIVE NIDCD GRANT. THIS WAS FOR SPRPIs. DOES ANYONE WANT TO ADDRESS PATHOLOGY, PREVENTION, DIAGNOSIS AND SEQUELAE OR TREATMENT OF COVID. WE ISSUED THAT IN EARLY APRIL. THAT SUPPLEMENT OPPORTUNITY EXPIRED IN JUNE VERY QUICKLY. WE ORGANIZED THE SUPPLEMENTS, GOT THEM REVIEWED AND MADE RECOMMENDATIONS AND FUNDED 18 OF THOSE. ACTUALLY, ONE WAS FUNDED BY THE OFFICE OF THE DIRECTOR. SO WE SPENT A LITTLE OVER $3 MILLION ON THESE COVID SUPPLEMENTS AND ALSO RECEIVED ABOUT $200,000 FROM THE OFFICE OF THE DIRECTOR. MANY THANKS GO OUT TO THE COORDINATORS OF THAT SUPPLEMENT ACTIVITY JANET AND NANCY. ONCE THE SUPPLEMENT WAS DONE WE DECIDED WE AREN'T DONE WITH OUR QUESTIONS AND NEEDS IN COVID-19. WE CREATED A NOTICE FOR THE RESEARCH ON THE IMPACT OF COVID-19 ON MISSION SPECIFIC SENSORY AND COMMUNICATION DISORDER. THIS IS REQUESTING NEW APPLICATIONS NOT SUPPLEMENTS. AND THE FIRST ONES ACTUALLY WILL BE COMING IN NEXT MONTH. THIS NOTICE REQUESTED EITHER RO1s OR R21s AND WE HOPE TO SEE IN FUTURE COUNCIL MEETINGS RESPONSES TO THIS PARTICULAR INITIATIVE. OUR THANKS TO THE COORDINATORS OF THAT THAT MADE THIS EFFICIENTLY CREATED PROCESS. THERE IS A TRANS-NIH ACTIVITY CALLED RAPID ACCELERATION OF DIAGNOSTICS, RAD X, RAD BEING RADICAL. EMERGENCY PROCESSES ON COVID-19 SCREENING. CONGRESS GAVE THE NIH EARMARKED FUNDS TO DEVELOP NEW METHODS TO SCREEN AND DIAGNOSE. PROBABLY IN ABOUT JUNE THE OFFICE OF THE DIRECTOR, FRANCIS COLLINS, TOLD THE INSTITUTES WHY DON'T YOU PUT TOGETHER A PROPOSAL FROM YOUR INSTITUTE THAT MIGHT SPEAK TO THE ISSUE OF SCREENING AND DIAGNOSIS. OUR OWN SUSAN SULLIVAN GATHERED A GROUP OF FOLKS AND THEY SUBMITTED A PROPOSAL TO USE A SENSORY TESTING AS A SCREENING. I KNOW MANY HAVE SEEN IN THE NEWS THAT PERHAPS THE LOSS OF SENSE OF SMELL IS AN EARLY INDICATOR THAT SOMEONE IS GOING TO TEST POSITIVE FOR COVID-19. SO SUSAN SUBMITTED THAT WITH HER COLLEAGUES AND HER PROPOSAL WAS ONE OF ONLY EIGHT THAT WERE SELECTED ACROSS ALL OF NIH FOR FUNDING. IN FACT, NICE FUNDING, $10 MILLION. SO SUSAN AND HER GROUP THEN PUTTING TOGETHER A REQUEST FOR APPLICATIONS, GET THAT OUT ON THE STREETS REQUESTING BOTH COOPERATIVE AGREEMENTS AND SUPPLEMENTS TO ACTIVE GRANTS. THE APPLICATIONS ARE DUE NEXT WEEK. SO KEEP IN MIND WHAT THE TIME LINE WAS. WE HEARD A REQUEST TO PUT SOMETHING TOGETHER IN MAYBE JUNE AND GET IT OUT ON THE STREETS AND THEN FOLKS HAD TO PUT THE APPLICATIONS TOGETHER. YOU'LL ALSO NOTE THE AWARDS HAD TO BE MADE BY DECEMBER. THOSE WHO HAVE NIH GRANTS KNOW USUALLY THAT TIME FROM SUBMISSION TO AWARD IS NINE MONTHS AND THIS IS NOT. SO ONCE AGAIN YOU CAN SEE WHAT A FAST TRAIN WE ARE ON FOR THIS ACTIVITY. MANY THANKS TO SUSAN SULLIVAN FOR LEADING THAT CHARGE. AS AN ASIDE, I WAS ASKED TO BE, ALONG WITH MY COLLEAGUE IN ALCOHOL AND ALCOHOL ABUSE INSTITUTE TO SERVE AS THE CO-CHAIR OF THIS ENTIRE ACTIVITY REGARDING DIAGNOSTICS. ANOTHER ACTIVITY WE HAVE INVOLVEMENT IN HAS TO DO WITH ANOTHER RAD X, RAPID ACCELERATION OF DIAGNOSTICS BUT THIS SUP AND STANDS FOR UNDER SERVED POPULATION. THERE ARE SEVERAL NOTICES OUT RIGHT NOW FOCUSSED ON COVID-19 BUT FOCUSSED ON TESTING UNDER SERVED AND/OR VULNERABLE POPULATIONS. OUR INDIVIDUALS WITH HEARING LOSS AND COMMUNICATION DISORDERS FIT WITHIN THAT VULNERABLE POPULATION FOCUS. WE HAVEN'T HAD ANY ACTIVITIES WITHIN OUR MISSION AREA YET BUT WE HAVE KELLY KING AS OUR REPRESENTATIVE AND KEEPING CLOSE TABS ON HIGHLIGHTING OUR VULNERABLE POPULATIONS FOR ALL THESE NOTICES AS THEY CAME OUT. SO THERE WAS ANOTHER NOTICE REQUESTING APPLICATIONS FOCUSSED ON SOCIAL BEHAVIORAL AND ECONOMIC HEALTH IMPACTS OF COVID-19 PARTICULARLY IN VULNERABLE AND HEALTH DISPARATE POPULATIONS. WE'RE NOT THE LEADER ON THAT BUT WE'VE BEEN INVOLVED IN TWO COMPONENTS. ONE THE INTERVENTION COMPONENT WAS ASKING FOR SUPPLEMENTS THAT WOULD USE OFFICE OF THE DIRECTOR DOLLARS NOT NIDCD DOLLARS AND THEN A REQUEST FOR A FULL GRANT APPLICATIONS FOR NEXT FISCAL YEAR. OUR OWN KELLY KING WAS A COORDINATOR HERE. IN AN AREA THAT WAS FOCUSSED ON COMMUNITY-LEVEL AND DIGITAL HEALTH CARE INTERVENTIONS. BECAUSE OF KELLY'S ADVOCACY TWO NIDCD GRANTEES WHO SUBMITTED SUPPLEMENTS WERE FUNDED WITH OFFICE OF THE DIRECTOR DOLLARS. SO OUR THANKS GO TO KELLY FOR ADVOCATING FOR OUR MISSIONARIES. AND THEN THERE'S A DATA SCIENCE COMPONENT TO THIS PARTICULAR INITIATIVE WHERE ROGER MILLER HAS BEEN OUR COORDINATOR AND HE'S BEEN VERY INVOLVED IN REVIEWING APPLICATIONS AS THEY COME IN AND BEING INVOLVED IN FUNDING RECOMMENDATIONS. WE HAVEN'T HAD ANY APPLICATIONS YET THAT FOCUSSED ON OUR MISSIONARY BUT WE HOPE WE WILL. YESTERDAY WE TALKED A LITTLE BIT ABOUT DOWN SYNDROME. THERE'S A SUPPLEMENT OUT FOR ACTIVE GRANTS TO FOCUS ON THE CORONAVIRUS IN INDIVIDUALS WITH DOWN SYNDROME. YESTERDAY I INDICATED KELLY KING SOUR REPRESENTATIVE AND COORDINATOR FOR OUR DOWN SYNDROME RESEARCH AND SO FAR WE HAVEN'T RECEIVED ANY APPLICATIONS IN THIS AREA BUT KELLY REMAINS VIGILANT. WE STILL HAVE THE OPPORTUNITY FOR FUTURE APPLICATIONS UNTIL NEXT YEAR. THE FINAL THING I WANT TO HIGHLIGHT IS COMMUNITY ENGAGEMENT RESEARCH ALLIANCE AGAINST COVID-19 IN DIS DISPROPORTIONATELY AFFECTED COMMUNITY. THEY SENT A REQUEST FOR APPLICATIONS. THEY IDENTIFIED 11 HIGH PRIORITY STATES PARTICULARLY IMPACTED ABOUT COVID-19 AND ARE ADDRESSING RESEARCH THAT WILL HELP MAYBE RESEARCH AND UNDERSTAND THE FACTORS THAT HAVE AN IMPACT ON WHY THEY ARE DISPROPORTI DISPROPORTIONATELY BURDENED AND WANT TO BE FUNDED IN SEPTEMBER. ANOTHER FAST TRAIN. OUR REPRESENTATIVE ON THOSE ACTIVITIES IS TREN LEE. THE BOTTOM LINE WITH COVID-19 IS WE'VE BEEN ACTIVE AND WILL CONTINUE TO BE ACTIVE AND ADVOCATE FOR OUR SCIENCE AND COMMUNITY. WE APPRECIATED THE COMMENTS THAT YOU RAISED AT THE MAY COUNCIL ABOUT WHAT WE CAN BE DO AND CAN'T DO AND WHAT WE SHOULD BE DOING WITH REGARD TO HELPING OUR RESEARCHERS AND RESPONDED WITH WHAT WE ARE ABLE TO DO AND CAN'T DO AND WHAT ARE ISSUES NIH IS THE A HIGHER LEVEL NEEDS TO ADDRESS. I'M TO ANSWER QUESTIONS OR COMMENTS HAVE YOU ABOUT ANY COVID-RELATED ACTIVITIES. SHOULD YOU WANT INFORMATION ABOUT SOMETHING OF THESE INITIATIVES STILL ACTIVE, PLEASE FEEL FREE TO GET IN TOUCH WITH ME OR THE INDIVIDUALS I MENTIONED. >> THERE'S SOME DISCUSSION IN THE CHAT AND CHARLOTTE YEH ASKED A QUESTION AND KELLY ANSWERED HER. I WONDER CHARLOTTE IF YOU COULD SHARE WITH EVERYBODY WHAT YOUR QUESTION WAS AND MAYBE KELLY COULD ELABORATE SO EVERYONE CAN HEAR. I THINK IT'S AN INTERESTING DISCUSSION. >> THANKS. I APPRECIATE IT. FIRST KUDOS TO YOU FOR CO-CHAIRING THE GROUP AND ALSO FOR THE REALLY RAPID WORK THAT NIH HAS DONE. HIGH-FIVE. ON THE PROPOSAL FOR SOCIAL AND ECONOMIC IMPACT OF COVID-19 IT SEEMS LIKE AN IDEAL PLACE FOR NIDCD TO LOOK FOR RESEARCH FOR HEARING IMPAIRED AND THOSE WITH COMMUNICATION DISORDERS WHEN YOU HAVE TO WEAR MASKS. IT OBSCURES LIP READING AND FACIAL EXPRESSIONS. TWO, IT MUFFLES THE SOUND SO HOW DO WE IMPROVE THE CLARITY OF SOUND AND CAPTIONING. YOU CANNOT CAPTION WELL WHEN YOU ARE BEHIND THE MASK AND THAT'S CREATED DIFFICULTIES. THIRDLY, IN THE INCREASED BURDEN FOR HEARING IMPAIRED AND COMMUNICATION DISORDERS WITH THE SOCIAL ISOLATION AND LONELINESS THAT RESULTS FROM THE SOCIAL DANCING AND YOU CAN'T HEAR AS WELL BECAUSE YOU'RE FARTHER AWAY. IT ADDS TO HIGHLY VULNERABLE POPULATIONS AND THEN YOU THINK ABOUT CHILDREN LEARNING DISABILITIES, AUTISM, AND HOW DO WE ASSURE THAT THEY WILL NOT BE CHALLENGED AS A RESULT GOING FORWARD AS THEY GROW. >> THANK YOU, CHARLOTTE. KELLY, DID YOU HAVE A RESPONSE TO CHARLOTTE? >> THANK YOU FOR YOUR COMMENT, CHARLOTTE. THE SOCIAL BEHAVIOR AND ECONOMIC IMPACT INITIATIVE FROM COVID-19 WE WERE ABLE TO ADVOCATE AS THIS WAS BEING DEVELOPED TO INCLUDE PEOPLE WITH HEARING LOSS AND COMMUNICATION DISORDERS WHICH WAS A REALLY IMPORTANT ADDITION FOR OUR MISSION AREAS. THAT INITIATIVE HAS TWO ACTIVE AREAS OF INTEREST. ONE BEING DIGITAL HEALTH CARE AND ONE BEING COMMUNITY LEVEL INTERVENTIONS. IT'S DEFINITELY POSSIBLE SOME TOPICS YOU TOUCHED ON COULD BE RESPONSIVE BUT EVEN IF THEY'RE NOT RESPONSIVE TO THAT SPECIFIC CALL THE BROADER NOSI JUDITH TALKED ABOUT IS WHERE OTHER APPLICATIONS COULD COME IN. PEOPLE INTERESTED IN THIS AREA WE WOULD STRONGLY ENCOURAGE YOU TO BE IN TOUCH WITH US. . >> THANK YOU. THAT'S GREAT. I DO WANT TO EMPHASIZE SOMETHING WE DON'T TALK MUCH ABOUT WHICH IS THE CAPTIONING PIECE. THAT'S WHY WE'RE NOW ON VIRTUAL CALLS DOING REMOTE MEETINGS, YOU NEED A WAY TO ENHANCE AND THE CAPTIONING IN ENVIRONMENT PLATFORMS IS GOING TO IMPACT THE WORKFORCE SO THAT'S AN ECONOMIC IMPACT AS WELL. . >> THANK YOU, CHARLOTTE. AND I WOULD ADD THAT WE EVEN DID A SPECIAL SORT OF SHOUT OUT ABOUT THIS ISSUE ON OUR NIDCD WEB PAGE WITH DR. TUCCI MODELLING THE SHIELD FOR A MASK THAT DID NOT OBSCURE THE LIPS TALKING ABOUT THE CHALLENGES FOR INDIVIDUALS WITH HEARING LOSS AND THE COMMUNICATION CHALLENGES WITH MASKS. WE TRIED TO HIGHLIGHT THAT IN GENERAL ON THE WEBSITE AS WELL AS OFFERING RESEARCH OPPORTUNITIES. >> IF I CAN JUST SAY THANK YOU AND A SHOUT-OUT AND FROM A PERSONAL STORY, MY FATHER HAS PROFOUND HEARING LOSS WITH A COCHLEAR IMPLANT AND WHEN I WAS HOME SPEAKING WITH HIM AND HE COULDN'T UNDERSTAND AND I SWITCHED TO A CLEAR MASK AND HE COULD UNDERSTAND AND THIS SATURDAY WE'RE HOSTING A MEMORIAL ZOOM SERVICE FOR MY MOTHER AND GOT CLEAR MASKS FOR ALL THE SPEAKERS IN THE ZOOM SO EVERYBODY CAN SEE THE FACES AND THE EXPRESSONS AS PART OF THIS SERVICE. SO I JUST WANT TO SAY THANK YOU FOR THAT ARTICLE. IT WAS REALLY HELPFUL. >> AND THANK YOU FOR SHARING YOUR OWN PERSONAL PERSPECTIVE. >> OKAY. I THINK WE NEED TO MOVE ON, IF WE CAN. GO BACK ONE MORE BEFORE I SHOW THIS SLIDE. SO LET ME SAY A WORD ABOUT CONCEPT CLEARANCE, WHICH IS WHAT I'M GETTING READY TO TRANSITION IN TO. YOU RECALL AT THE LAST COUNCIL AND PROBABLY THE ONE BEFORE BUT FOR THE NEW COUNCIL MEMBERS THE NIH DECIDED A YEAR OR TWO AGO IF AN INSTITUTE WAS GOING TO PURSUE A PARTICULAR NEW ACTIVITY, WE NEEDED TO BRING THAT IDEA, THAT CONCEPT, TO THE COUNCIL FOR COUNCIL AWARENESS AND FOR COUNCIL REPORT. OUR PRACTICE HAS BEEN TO GIVE YOU THE CONCEPT BUT NOT REALLY TOO MUCH MORE INFORMATION THAN THE CONCEPT BECAUSE WE DON'T WANT TO MAKE YOU AS COUNCIL MEMBERS AND PRIVILEGED INFORMATION SOMEHOW IN CONFLICT AND NOT ABLE TO RESPOND SHOULD THERE BE FUTURE INITIATIVES IN AN AREA IN FAIRNESS TO PEOPLE WHO MAY NOT BE ON THE CALL. THAT BEING SAID, GINGER, LET ME PROCEED TO FIRST OF ALL SOME KEY RESEARCH PROGRAMS THAT ARE IN A SENSE RE-ISSUANCES. WE THINK IT'S IMPORTANT WE HAVE PROGRAMS FOR BEGINNING, INDEPENDENT INVESTIGATORS WITHIN SEVEN YEARS OF THEIR DOCTORAL DEGREE. HOW HAVE WE DONE THAT IN THE PAST? WE HAD THE NIDCD R21 EARLY CAREER AWARD WE THINK IT'S IMPORTANT TO TRANSLATE OUR BASIC RESEARCH FINDINGS TO DIAGNOSIS, TREATMENT AND PREVENTION OF COMMUNICATION DISORDER. WE'VE DONE THAT IN THE PAST THROUGH THE NIDCD RESEARCH GRANTS FOR TRANSLATING BASIC RESEARCH IN CLINICAL TOOLS. YOU'LL NOTICE THESE WERE P.A.R.s AND ANNOUNCEMENTS BACK IN 2018 AND THE NIH WHEN YOU ISSUE SOMETHING LIKE THESE, THEY SAY THEY CAN REMAIN ACTIVE FOR THREE YEARS BUT THEN YOU HAVE TO RE-ISSUE THEM AND WHEN WE DO WE NEED TO BRING THEM TO YOU, THE COUNCIL, FOR YOUR CONCURRENCE. SO WE HAVE THOSE TWO AND THEN WE HAVE ONE MORE, GINGER, THE NEXT SLIDE, WHICH I GUESS I'LL CATEGORIZE AS A RENEWED FOCUS. WE HAVE NOT DONE SOMETHING IN PARTICULAR IN THIS AREA BUT WE HAVE HAD A FOCUS ON THIS AND THAT IS RESEARCH OPPORTUNITIES IN HEALTH DISPARITIES IN COMMUNICATION DISORDERS. THOSE ARE THE THREE THINGS WE'D LIKE YOUR OPINION AND COMMENTS ABOUT. ARE THESE GOOD AREAS WE SHOULD PURSUE? THANK YOU. ANY COMMENTS FROM THE COUNCIL? >> I HAVE A COMMENT. IT'S ABOUT THE [INDISCERNIBLE] EARLY CAREER SUPPORT IS REALLY IMPORTANT [BACKGROUND NOISE] AND SUPPORTIVE OF THE PROGRAM. I WONDER IF YOU'VE CONSIDERED EXPANDING THE SEVEN YEARS TO 10 YEARS BECAUSE OF THE VERY LONG POST-DOCS PEOPLE IN SCIENCE ARE OFTEN [BACKGROUND NOISE] AND I WILL SAY ESPECIALLY WITH THE PEOPLE OF COVID WILL SEE EVEN LONGER POST-DOCS AND MAYBE DOUBLE POST-DOCS AS PEOPLE GET THEIR CAREER FOOTING. I KNOW IN SOME AREAS NIDCD SUPPORTS PEOPLE CAN GO STRAIGHT FROM THEIR Ph.D. TO A JOB AND START APPLYING FOR MONEY BUT THAT'S NOT TYPICAL FOR BENCH SCIENTISTS. I JUST THINK IT'S A SHAME TO HAVE THESE LIMITS. [BACKGROUND NOISE] >> THANK YOU. I WOULD LIKE TO RESPOND AND MAY ASK GRACIE WHO COORDINATES THE PROGRAM FOR US TO FOLLOW-UP ON MY COMMENTS AND I SAW A CHAT FROM RICHARD THAT SOME MICS ARE OPEN AND MAKING IT HARD FOR HIM TO HEAR. SO IF YOU'RE NOT SPEAKING, PLEASE TRY TO TURN YOUR MIC OFF. THANK YOU. SO THE REASON WE HAVE GONE WITH THE SEVEN, A WHILE BACK IT WAS 10 YEARS BUT WE WENT TO SEVEN BECAUSE WHAT WE WANT IS FOLKS TO TRY THE E.C.R. AND THEN BE ABLE TO STILL BE ELIGIBLE FOR THE E.S.I. RO1. THAT'S A DESIGNATION AND SOME OF THE [NO AUDIO] . [NO AUDIO] BUT THAT PRETTY MUCH HAS BEEN OUR MOTIVATOR OF KEEPING IT AT SEVEN TO ALLOW THEM TO NOT ONLY GET THE R21. GRAC GRACIE, WOULD YOU ADD ANYTHING TO THAT? >> ARE YOU ABLE TO HEAR IS THE >> YES. >> GREAT. AS JUDITH INDICATED WHEN THIS WAS ACTUALLY CALLED THE RO3 PROGRAM WE HAD A 10-YEAR LIMIT ON IT. WE REDUCED IT TO SEVEN YEARS FOR THE REASONS JUDITH GAVE. IN ADDITION TO THAT IF THERE ARE EXTENUATING CIRCUMSTANCES WE HAVE A MECHANISM FOR EXTENSIONS FOR INDIVIDUALS THAT HAVE AGAIN EXTENUATING CIRCUMSTANCES THAT PREVENTS THEM FROM [NO AUDIO] . >> DID WE NOT ALSO EXTEND E.S.I. ELIGIBILITY BASED ON HARDSHIPS BECAUSE OFCOVID? I THOUGHT THE NIH HAD A POLICY OF DOING THAT AS WELL. IT MAY BE EVERYTHING CAN BE PUSHED BACK A BIT. >> I CAN'T CALL THAT UP RIGHT AWAY BUT THE E.S.I. PROGRAMS ALWAYS HAD EXTENSION POSSIBILITIES BECAUSE OF FAMILY AND THAT SORT OF THING. I'M NOT SURE THEY CAME OUT. CRAIG, DO YOU KNOW THEY'VE COME OUT SPECIFICALLY WITH SOMETHING RELATED TO E.S.I. BEYOND THE CURRENT ELIGIBILITY PRACTICE? >> I HAVEN'T SEEN A SPECIFIC ANNOUNCEMENT ABOUT THAT BUT THE ABILITY TO EXTEND THE E.S.I. IS ACROSS NIH AND FAIRLY WIDE CUTTING FOR FAMILY RESPONSIBILITIES, MEDICAL ISSUES, MILITARY SERVICE. MANY THINGS. I ANTICIPATE THEY'LL ACCOMMODATE THE COVID BUT I HAVEN'T HEARD. >> THAT'S GREAT. I'M GLAD TO HEAR IT. I WAS GOING TO SUGGEST YOU CAN EXTEND E.S.I. AS WELL. IS THIS EASY FOR PEOPLE TO FIND OUT BECAUSE EXTENSIONS OR EXTENUATING CIRCUMSTANCES AREN'T WELL PUBLICIZED BUT MAYBE YOURS ARE. >> I GUESS I CAN SPEAK FOR MYSELF. I ALSO HANDLE THE LANGUAGE PORTFOLIO FOR THE INSTITUTE AND WHEN I GET INQUIRIES AND IF THEY JUST BARELY MISSED THE CUT-OFF BECAUSE I REFER THEM TO GRACIE AND IT'S A VERY EASY PROCESS. I THINK THERE IS AN ONLINE KIND OF REQUEST FOR THE E.S.I. ELIGIBILITY. THERE'S A LOT OF ADVOCATE -- INFORMATION OUT THERE AND PROGRAM OFFICERS POINT THEM TO THAT INQUIRY AND ALMOST AN AUTOMATIC AND GRACIE'S RESPONSES HAVE BEEN SUPPORTIVE. >> THANK YOU VERY MUCH. >> SURE. >> ARE THE PROGRAM OFFICERS COMMUNICATING THIS TO THE INQUIRIES BECAUSE OUR UNIVERSITY HAS A RESEARCH MANAGEMENT GROUP HAS A STRONG INTERPRETATION OF NIH RULES AND WILL NOT COMMUNICATE HOW EASY IT ACTUALLY IS AND THE POST-DOCS ARE BEING DISCOURAGED NOT BY NIH BUT BY THEIR OWN UNIVERSITY. >> I HEARD THOSE STORIES BEFORE TOO. AND I HEARD SOME UNIVERSITIES WON'T EVEN ALLOW POST-DOCS TO APPLY FOR SOME PARTICULAR GRANTS. WE CAN'T CONTROL WHAT THE UNIVERSITIES DO BUT WHAT YOU'RE SAYING IS THERE A WAY TO MAKE THIS INFORMATION AVAILABLE. WE TRY TO DO THAT WHEN WE GO OUT TO THE NATIONAL MEETINGS AND TRY TO DO THAT WHEN WE GET INQUIRIES AND DO HAVE INFORMATION ON THE WEBSITE BUT IF YOU HAVE SOME OTHER IDEAS, WE'RE OPEN. >> I THINK THE PROGRAM OFFICER SHOULD BE AWARE MAYBE ASK THE POST-DOC AND SAY ARE THERE CERTAIN WAYS OF HELPING YOU TO MAKE IT CLEAR ALSO TO UNIVERSITY MANAGEMENT OR RESEARCH MANAGEMENT HOW THEY CAN GET THROUGH AND APPLY THESE OPPORTUNITIES. >> THAT'S A GOOD IDEA. ALBERTO, I'M NOT SURE IF YOU'RE ON THE PHONE BUT HE OF COURSE COORDINATES OUR POST-DOC PROGRAM AND WHETHER WHEN YOU ARE WORKING WITH THEM, DO YOU -- ARE THERE OPPORTUNITIES WHERE THEY COULD BE INFORMED IN THE NEXT STEP IN THEIR POST-DOC? WHAT'S BEEN OUR PHILOSOPHY AND POLICY THAT WE PROVIDE ONCE THEY GET OUR AWARDS EITHER FELLOWSHIP OR POST-DOC LEVEL SO FORTH WE EXPECT THEM TO TRANSITION TO THE NEXT RESEARCH STAGE. FOR EXAMPLE THE POST-DOCS CAN GO FOR THE E.C.R. AND THEY USE TO GENERATE PRELIMINARY DATA FOR CAREER OR K AWARD OR RO1. WE WORK WITH THEM AND COMMUNICATE WITH INSTITUTIONS IN TERMS OF WHAT THEY CAN DO AND WHAT NOT. SO I THINK WE ALWAYS OPEN TO LISTEN THEM AND HELPING OUT. >> GREAT, THANK YOU VERY MUCH, ALBERTO. ANY OTHER QUESTIONS? HOW ARE WE DOING ON TIME? WE'RE ALMOST OUT OF TIME. CRAIG, I'M NOT SURE IF WE NEED A VOTE FOR APPROVAL OF CONCEPT CLEARANCE SINCE IT'S AN OPEN SESSION OR JUST THE FACT WE HAVE PRESENTED IT IS SUFFICIENT FOR NIH? >> MANY HAVE VOTED IN THE CHAT BOX BUT WE CAN MAKE IT OFFICIAL. ALL COUNCIL MEMBERS IN SUPPORT OF THE CONCEPT CLEARANCE JUDITH JUST DISCUSSED PLEASE SAY AYE OR -- [VARIOUS AYES] >> VERY GOOD. THANK YOU SO MUCH. IS THERE ANYBODY OPPOSED OR ANYBODY ABSTAINING? HEARING NONE IT WAS UNANIMOUS. THANK YOU. >> THANK YOU, JUDITH. WE'LL MOVE ON TO THE REPORT OF THE DIVISION OF EXTRAMURAL ACTIVITIES AND DR. JORDAN WILL PROVIDE AN UPDATE ON THE IMPACT OF COVID ON PEER REVIEW AND GRANT AWARDS. THANK YOU, CRAIG. >> THANK YOU. THANK YOU. PART WILL BE IN RESPONSE TO THE COVID COUNCIL IN MAY AND THAT WAS ON THE JULY 7 MEMO DR. TUCCI SENT TO THE COUNCIL AND WHILE I'LL GIVE EXAMPLES OF STAFF ACTIONS IN RESPONSE TO COVID TO THE COMMUNITY AS WELL AS THE NIH WEBSITE FOR ALL THINGS RELATED TO COVID AND SOME ANNOUNCEMENTS AND SOME ACTIONS NIH HAS BEEN TAKING BOTH IN PEER REVIEW AND THE APPLICATION PROCESS IN RESPONSE TO COVID AND THE LAST ANNOUNCEMENT I'LL SHARE WITH YOU IS AN EXTENSION OF ADMINISTRATIVE RELIEF. AND THEN I'LL CLOSE OUT WITH A SUMMARY OF THE ACT AND LOOK LIKE WE'VE JUMPED AHEAD SO WE'LL GO IN TO STAFF ACTIONS. WHAT'S HAPPENED IS PROGRAM OFFICERS WORK WITH INVESTIGATORS AND I HAVE EXAMPLES OF THE TYPES OF CONVERSATIONS THEY'VE HAD IN RESPONSE TO THE COVID SETBACKS. THERE'S BEEN REQUEST TO CONVERT FACE TO FACE TESTING OR INTERVENTIONS INTO TELEHEALTH PROCEDURES. THERE'S BEEN SOME CONVERSATIONS REGARDING REQUESTING IRB APPROVAL FOR MAJOR CHANGES. YOU CAN UNDERSTAND ACCESS TO PATIENTS RESEARCH PARTICIPANTS HAS BEEN AN ISSUE. THEY'VE ALSO HAD DISCUSSIONS PARTICULARLY WITH JUNIOR INVESTIGATORS ABOUT THE POSSIBILITIES FOR CARRY-OVER FUNDS OR NO-COST EXTENSIONS. THOSE CONVERSATIONS HAVE LED TO SOME ACTIONS THAT HAVE BEEN TAKEN BY OUR GRANTS MANAGEMENT OFFICE SO SPECIFIC EXAMPLES I'M GOING TO SITE ARE TWO REQUESTS FOR CARRY OVER OF TRAINING-RELATED EXPENSES. THOSE ARE BEEN DONE IN A COUPLE OF INSTITUTIONAL AWARDS AND T32s AND THEY'VE TAKEN A REQUEST AND RECEIVED IT THAT FOR A THIRD NO-COST EXTENSION. AND THEY'RE AUTOMATIC AND SECOND THEY'RE APPROVED ON A CASE BY CASE BASIS AND THIRD NO COST EXTENSIONS ARE EXTREMELY RARE. THIS IS THE FIRST ONE I'M AWARE OF. THE NEXT IS THE NIH'S WEBSITE FOR ALL THINGS CORONAVIRUS. ALL THINGS RELATED TO COVID-19. I PUT THE URL IN THE LOWER RIGHT HAD CORNER AND SEARCH FOR CORONAVIRUS. THIS WEBSITE HAS A LOT OF CATEGORIES AND FOUR BOX ACROSS THE MIDDLE TO LOOK AT COVID-19 TESTING. AND NIH EFFORTS ON VACCINES AND EFFORTS AND AND THE FOURTH BOX DEALS WITH TREATMENT GUIDELINES. IF WE GO TO GRANTS AND FUNDING THEY HAVE A LOT OF INFORMATION. THE ONES I'LL HIGHLIGHT ON ARE THREE EXAMPLES OF WHAT HAS CHANGED IN THE PEER-REVIEW AND/OR GRANT APPLICATION PROCESS. THE FIRST SLIDE IS TALKING ABOUT THE COUNCIL ROUND FOR AUGUST AND OCTOBER 2020. THAT IS THE CURRENT COUNCIL MEETING AND TALKED ABOUT APPLICATIONS THAT CAME THROUGH THIS PROCESS IN THE PRIOR MONTHS. THESE APPLICATIONS FIRST STARTED COMING IN IN JANUARY 25. THEY WERE REVIEWED DURING THE SUMMER AND COMING TO ADVISORY COUNCILS NOW. WHAT CHANGES WERE MADE IN THE APPLICATION REVIEW PROCESS? WELL, THESE APPLICATIONS ALREADY STARTED COMING IN BEFORE THE COVID PANDEMIC REALLY HIT. AND THEN THEY CONTINUE TO HAVE SUBMISSION DATES DURING SCHOOL AND UNIVERSITY CLOSINGS AND OTHER WORK SETBACKS. APPLICATION RECEIPT DATES WERE EXTENDED THROUGH MAY 1 AND THE POST-SUBMISSION DEADLINES WAS CUT DOWN TO 14 DAYS BEFORE STUDY SESSION MEETING. OF COURSE WE ALL REMEMBER THE PEER-REVIEWED MEETINGS ALL WENT VIRTUAL STARTING IN MID MARCH. REVIEWERS WERE GIVEN GUIDANCE TO ASSUME THE ISSUES RESULT FROM THE CORONAVIRUS PANDEMIC WILL BE CONSIDERED PRIOR TO AWARD. THEY WERE NOT SUPPOSED TO CRITICIZE APPLICATIONS FOR THOSE TYPES OF ISSUES FOR PEER REVIEWED. THE NEXT SLIDE LOOKS AT THE JANUARY 2021 COUNCIL ROUND AND THOSE APPLICATIONS STARTED COMING IN IN MAY, MAY 25. PEER-REVIEW IS HAPPENING DURING THE FALL AND THOSE APPLICATIONS WILL BE GOING TO THE JANUARY 2021 COUNCIL. AT THIS POINT GOING BACK TO STANDARD DUE DATES. OF COURSE AN INDIVIDUAL I.C. IF THEY HAVE SOME FUNDING OPPORTUNITY ANNOUNCEMENT WHERE THEY CAN ACCOMMODATE THEY CAN ACCEPT LATE APPLICATIONS. THE POST-SUBMISSION DEADLINE WENT BACK TO 40 DAYS BEFORE THE STUDY SESSION. WHAT WAS ADDED WAS THE OPPORTUNITY FOR THE INCLUSION OF PRELIMINARY DATA. I'LL TELL YOU SOME OF THE SPECIFICS OF UNDER WHAT CONDITIONS THAT'S ALLOWED BUT THAT'S RATHER UNIQUE TO ALLOW PRELIMINARY DATA AFTER THE GRANT APPLICATION WAS SUBMITTED. STILL ALL MEETINGS WERE BEING DONE VIRTUALLY AND THE GUIDANCE PEER REVIEWERS WERE TO ASSUME ISSUES RESULT FROM THE CORONAVIRUS PANDEMIC WILL BE TAKEN CARE OF PRIOR TO AWARD. THE APPLICATIONS WILL START COMING IN LATER THIS MONTH ON THE 25TH AND DONE IN SPRING AND GOING TO THE MAY 2021 COUNCIL MEETING. ALL THE ASPECTS I TALKED ABOUT PREVIOUSLY STAYED THE SAME. THE REAL CHANGE HERE IS THAT COVID-19 CONTINGENCY PLANS SHOULD NOT BE INCLUDED IN THE APPLICATIONS. THIS HAS BEEN SENT OUT TO THE COMMUNITY. THIS MAKES TOTAL SENSE IF YOU THINK ABOUT IT FOR A MINUTE. HOW CAN YOU MAKE APPROPRIATE CONTINGENCY PLANS NOW WHEN YOU DON'T KNOW WHAT THE SITUATION FOR COVID, WHAT THE SITUATION FOR SUBJECTS OR ANIMALS WILL BE NINE TO 12 MONTHS FROM NOW WHEN THE AWARDS ARE ACTUALLY MADE? PRELIMINARY DATA IS STILL BEING ALLOWED. AND THE GUIDANCE FOR REVIEWERS HAS CHANGED SLIGHTLY. IT'S REALLY FOR THEM TO JUST ASSUME THE CONTINGENCIES WILL BE RECOGNIZED AND I'LL GIVE A LITTLE BIT MORE INFORMATION ON THAT IN A MOMENT AS WELL. IF WE STAY ON THAT SAME NIH WEBSITE, IT'S GOT ADDITIONAL PIECES. SOME PIECES ARE THE POLICY OR PRACTICES AND ANNOUNCEMENTS SENT OUT TO THE COMMUNITY. THERE'S MANY OF THEM. I'LL JUST HIGHLIGHT A COUPLE. THIS ONE WAS ISSUED ON AUGUST 12 AND IT EXTENDS A PRIOR ANNOUNCEMENT EARLIER IN THE YEAR ALLOWING SPECIAL EXCEPTION TO THE POST SUBMISSION MATERIAL AND I TOLD YOU THAT MOST RECENTLY IN THE LAST TWO ROUNDS OF APPLICATIONS, PEOPLE INVESTIGATORS CAN SUBMIT A ONE-PAGE UPDATE WITH PRELIMINARY DATA IN THE POST SUBMISSION MATERIALS. IT'S LIMITED TO ONE PAGE. IT'S ONLY ALLOWED IF THE FUNDING OPPORTUNITY ANNOUNCEMENT THEY SUBMITTED TO ALLOWS PRELIMINARY DATA. AND IT IS NOT ALLOWED FOR THOSE SUBMISSIONS EMERGENCY COMPETITIVE REPETITIVE REVISIONS AND URGENT COMPETITIVE REVISIONS ARE ON FAST TRACK. YOU HAVE TO GET ALL YOUR INFORMATION TO THOSE APPLICATIONS WHEN YOU SUBMIT THEM. ON THE NEXT SLIDE THERE'S ANOTHER APPLICATION. THIS DEALT WITH GUIDANCE FOR APPLICANTS PREPARING APPLICATIONS FOR THE FALL 2020. I ALREADY ALLUDED THIS A LITTLE BIT. THIS SPECIFIES THAT CONTINGENCY PLANS SHOULD NOT BE INCLUDED IN THE APPLICATION AND ALSO REVISED REVIEWERS AND THEY'RE REMIND WILL OF THIS DURING MEETINGS TO DISREGARD SITUATIONS DUE TO THE COVID-19 PKTD PANDEMIC. THE WAY -- PANDEMIC. THE WAY THIS WILL BE HANDLED THE TIME OF AWARD OR PROCEEDING WITH THE RESEARCH NIDCD STAFF CAN REACH OUT TO THE INVESTIGATORS AND DEAL WITH CONTINGENCY PLANS AT A TIME WHEN IT'S BEING EXECUTED AND THEY KNOW THE CURRENT CONDITIONS AND THE CURRENT CONDITIONS AT THE LOCATION WHERE THE RESEARCH WILL BE DONE. THIS IS A LAST ANNOUNCEMENT FROM NIH. THIS DEALS WITH THE EXTENSION OF ADMINISTRATIVE RELIEF FOR RECIPIENTS IMPACTED BY COVID-19. THIS WAS A RE-ISSUANCE AND BASED ON O.M.B., OFFICE OF MANAGEMENT AND BUDGET GUIDANCE THAT GOES OUT TO NIH AND OTHER PARTS OF THE GOVERNMENT AND STATED RESIP RECIPIENTS ARE CONTINUED TO CHARGE SALARIES AND BENEFITS TO NIH AWARDS. THERE'S A STIPULATION THAT HAS TO HAPPEN CONSISTENT WITH THE RECIPIENTS POLICIES UNEXPECTED AND THE ANNOUNCEMENT EXTENDED THE DELAYS ALLOWED FOR SUBMISSION OF THE AUDITS AND THE AUDITS WERE DUE BACK IN MARCH AND JUNE. THE EXTENSIONS WERE DUE IN JULY AND SEPTEMBER AND IT EXTENDED ONE TIME. WE HAVE NOT HEARD ANYTHING AT THIS POINT ABOUT IT AN ADDITIONAL EXTENSION. NEXT SLIDE PLEASE. ANOTHER PIECE OF THE SAME WEBSITE GOES TO THE OPPORTUNITY ANNOUNCEMENTS ISSUED TO COVID. YOU SAW WHERE WE WERE ABLE TO ISSUE OUR OWN ANNOUNCEMENT. YOU CAN SEE A LOT OF DETAILS AND THERE'S 53 ACTIVE ONES AND 34 THAT ARE ALREADY EXPIRED. THAT'S 90 INITIATES AND NIDCD WAS ABLE TO PARTICIPATE IN 11 OF THOSE ACTIVE ONES LET ME GO TO MY LAST SLIDE. IT'S A SUMMARY OF INTERIM ACTIONS. THOSE ARE THOSE STAFF CONTINUE TO MAKE IN THE INTERIM. THIS CAPTURES THOSE PRESENTED AT THE JANUARY COUNCIL MAY COUNCIL AND NOW OCTOBER COUNCIL. THEY GET A MORE DETAILED REPORT IN ADVANCE OF THE MEETING. THE RIGHT COLUMN IS HOW MANY ARE ACTIVE AND WERE REPORTED IN EACH COUNCIL. THE LEFT COLUMN GOES DOWN TO THE TYPE. YOU CAN SEE P.I.'S DO CHANGE INSTITUTION FROM INSTITUTION AND WE ROUTINELY PROCESS THESE AND THAT HAS DROPPED OFF PRECIPITOUSLY. LIKELY BEING DUE TO THE COVID PANDEMIC THE NEXT IS PROMOTING DIVERSITY. WE HAVE A FAIR NUMBER IN THE COUNCIL ROUNDS. THE NEXT ONE IS SUPPLEMENT RE-EN RE-ENRY -- RE-ENTRY OFTEN DUE TO FAMILY AND SECOND IS PROMOTING CLINICIAN SCIENTISTS IN RESEARCH. NOW THE FOLLOWING ARE UNIQUE SUPPLEMENTS SPECIAL ACTIVITIES AND THE YELLOW INDICATES CO-FUNDING. WE MANAGED TO GET IT IN RESEARCH SUPPLEMENTS IN HER PRESENTATION. WE HAVE ONE AWARDED ON THE IMPORTANT SEXUAL AND GENDER MINORITY POPULATIONS. WE HAD SUPPLEMENTS TO TRANSLATIONAL RESEARCH AND THE NEXT ONE IS THE NIDCD NOSI AND CO-FUNDING OBTAINED FROM THE OFFICE OF THE DIRECTOR. ONE AND A HALF OF THE AWARDS WERE CO-FUNDED BY THE DIRECTOR. THE NEXT IS ALZHEIMER'S AND RELATED DEMENTIAS. ALL THESE AWARDS FUNDED BY THE NATIONAL INSTITUTE ON AGING. WE HAVE BEEN ABLE TO TAKE ADVANTAGE OF THE PROGRAM IN PRIOR YEARS AND 18 OF THOSE WERE FUNDED RECENTLY. [NO AUDIO] AGAIN, CO-FUNDING FROM THE OFFICE OF RESEARCH. THE LAST IS A SUPPLEMENT IN THE AREA OF BETTER INTEGRATED SCIENCES FUND THE OFFICE OF BEHAVIORAL AND SOCIAL SCIENCES. THE OFFICE OF THE DIRECTOR OF NIN. WHEN SOME PROGRAMS ARE ONLY SUPPORTED. >> ARE THERE ANY QUESTIONS BEFORE WE GONE ON THE BREAK. ALL RIGHT. FEEL FREE TO SEND ANY IN THE CHAT AS WELL. SO WE'RE GOING TO TAKE A SHORT BREAK NOW. DON'T DISCONNECT BUT TURN OFF YOUR VIDEO AND MUTE IF YOU'D LIKE AND LET'S BE BACK IN 10 MINUTES AT 11:55. IT IS MY GREAT PLEASURE TO WELCOME DR. KELLY KING. DR. KING IS PROGRAM DIRECTOR OF THE DIVISION OF SCIENTIFIC PROGRAMS AND SHE AND HER COLLEAGUES WILL PRESENT A REVIEW AND DISCUSSION OF THE TOPIC DEMENTIA AND HEARING LOSS. WELCOME TO OUR SPEAKERS AND KELLY, WOULD YOU POLICE -- PLEASE INTRODUCE OUR GUEST SPEAKERS AND KICK OFF THE PRESENTATIONS. >> THANK YOU DR. TUCCI AND JORDAN. I HAVE THE PLEASURE OF MODERATING AND CONTRIBUTING TO TODAY'S SESSION FOCUS ON DEMENTIA AND HEARING LOSS. WE'LL BEGIN LOOKING AT THE NIDCD PORTFOLIO AROUND ALZHEIMER'S DISEASE AND RELATED DIM EN HAS. I WANT TO -- DEMENTIAS. I WANT TO ACKNOWLEDGE THE FOLKS WHO CONTRIBUTED. EMMA EGGERMAN WHO WILL GIVE CURRENTS STUDENTS AND OPPORTUNITY TO GAIN EXPERIENCE AND CONSIDER POSSIBLE CAREERS HERE. EMMA CAME TO US NOT KNOWING MUCH AOUT COMMUNICATION DISORDERS AND LEARNED A LOT IN A SHORT PERIOD OF TIME AND THE WORK WE'LL LOOK AT TODAY BELONGS TO HER AND WANT TO THANK DR. LISA KENNEDY THE CODING GURU. THE WAY RESEARCH IS CODED AND REPORTED ACROSS THE NIH AND IMPORTANTLY OUTSIDE THE NIH SAY SERIOUS AND COMPLICATED BUSINESS AND THE GENERATED THE WORK WE'LL LOOK AT AND CHRIS MYERS PUT TOGETHER THE SUPPLEMENT DATA WE LOOK AT. AFTER I'LL HAVE THE PLEASURE OF INTRODUCING DR. ST. DR. ST. HILLARY-CLARKE AND FROM THE INSTITUTE ON AGING. AND NAI IS A LEADER IN THIS RESEARCH AND SHE'LL WALK US THROUGH SAFE AND HAVE A SCIENTIFIC LECTURE FROM DR. LIN I'LL INTRODUCE SHORTLY. I WANT TO TAKE A MOMENT TO CALIBRATE EVERYONE TO FIRST ADDRESS WHY WE'RE TALKING ABOUT HEARING AND DEMENTIA. THE SHORT ANSWER IS BECAUSE YOU, OUR ADVISORY COUNCIL, ASKED THE QUESTION WHAT DO WE KNOW ABOUT HEARING AND DEMENTIA. THEY CAME UP THE LAST TIME WE WERE TOGETHER IN PERSON IN JANUARY AND GENERATED ENOUGH DISCUSSION AND ENTHUSIASM WE WANTED TO SPEND TIME TALKING ABOUT IT. THE REASON IT CAME UP THE REASON ISN'T MUCH OF A SURPRISE. THERE'S A GROWING RECOGNITION OF THE RELATIONSHIP BETWEEN SENSORY FUNCTION, HEARING IN PARTICULAR AND COGNITIVE DECLINE AS WE AGE. THIS RELATIONSHIP HAS NOT JUST GARNERED ATTENTION IN OTHER CIRCLES BUT SOME LEVEL OF CONSCIOUSNESS YOU CAN SEE REFLECTED IN THE MEDIA REPORTS. WE KNOW A FAIR AMOUNT RELATIVELY SPEAKING ABOUT NEUROCOGNITIVE DEVELOPMENT AND SENSORY FUNCTION. THE IMPACT TO DEVELOPMENT FOR SPEECH AND LANGUAGE IN THE CONTEXT OF HEARING LOSS. THERE'S BEEN ATTENTION PAID TO UNDERSTANDING THE RELATIONSHIP BETWEEN A GRADUAL LOSS OF HEARING AND AGING AND NEUROCOGNITIVE CHANGE. YOU CAN GO BACK DECADES IN LITERATURE AND FIND THIS IN ADULTS BUT IT'S BEEN IN THE LAST DECADE OR SO WE'VE SEEN A DRAMATIC UPTICK IN THE SIGNAL LINKING THESE TWO. THAT WITH LITERATURE CONTRIBUTED TO AN IMPORTANT LANCET COMMISSION ON DEMENTIA PREVENTION, INTERVENTION AND CARE THAT WAS PUBLISHED INITIALLY IN 2017 AND REVISITED JUST THIS YEAR WHICH FOUND THE EVIDENCE TO DATE SUGGESTS HEARING LOSS IS ONE OF THE LEADING MODIFIABLE RISK FACTORS FOR DEMENTIA. I WON'T TALK ABOUT IT FURTHER BECAUSE WE'LL HEAR MORE FROM DR. LIN WHOSE RESEARCH PLAYED AN AN IMPORTANT ROLE IN THIS DISCUSSION AND WE HAVE BETTER UNDERSTANDING THE RELATIONSHIP BETWEEN HEARING AND COGNITIVE FUNCTION AND HEARING LOSS AND THE TRANSLATIONAL QUESTIONS LIKE DOES TREATING HEARING LOSS MODIFY THE TRAJECTORY OF COGNITIVE CHANGE. SO WHAT YOU SEE HERE IS WHAT NIDCD HAS SPENT OVER THE LAST 10 YEARS IN RESEARCH INCLUDED IN ALZHEIMER'S DISEASE. THE CODING SCHEME WE USE FOR THIS ANALYSIS IS FROM A COMPUTERIZED REPORTING PROCESS CALLED RCDC WHICH STANDS FOR RESEARCH CONDITION AND DISEASE CATEGORIZATION AND NIH USES THIS TO CATEGORIZE FOR MEDICAL RESEARCH AT THE END OF EACH FISCAL YEAR AND YOU DON'T SEE IT 2020 BECAUSE WE'RE STILL IN THAT YEAR. IT HASN'T BEEN LOGGED YET. THE BENEFIT OF USING THIS KIND OF SCHEME IS AAPPLY CONSISTENT DEFINITIONS AND PROVIDES A CLEAR AND CONSISTENT REPORTING FOR NIH FUNDING. YOU'RE SEEING SPENDING PER FISCAL YEAR NIDCD HAS DONE FOR RESEARCH RELATED TO ALZHEIMER'S DISEASE. NOW, IN JANUARY 2007 PRESIDENT OBAMA SIGNED IN AN ACT WHICH REQUIRES THE HHS TO CREATE AND MAINTAIN AN INTEGRATED NATIONAL PLAN TO OVERCOME ALZHEIMER'S DISEASE. IN RESPONSE TO THAT AND TO FACILITATE THE REPORTING NIH DOES IN THE REPORTING OF ALZHEIMER'S DISEASE RESEARCH BOTH NIA AND NINDS REQUESTED A NEW CATEGORY BROADER THAN JUST ALZHEIMER'S DISEASE AND EXTENDS TO OTHER RELATED DEMENTIAS. WHAT YOU SEE PLOTTED HERE IS THE NEW CATEGORY REFLECTED IN THE ORANGE COLORING. THIS IS SCIENCE THAT COVERS BOTH ALZHEIMER'S DISEASE AND RELATED DEMENTIAS. AND YOU CAN SEE THIS REFLECTS MORE AGGRESSIVE SPENDING UNDER THE NEW CODING SCHEME. THE DEFINITIONS THEMSELVES ARE A LITTLE CLUNKY BUT RELATED DEMENTIAS INCLUDE VASCULAR COGNITIVE IMPAIRMENT AND OTHERS, ETCETERA. WHEN WE LOCK AT THE SPENDING THAT'S TAKEN PLACE THE LAST 10 YEARS AND HOW IT'S BEEN DISTRIBUTED ACROSS THE MISSION AREAS YOU SEE THE NUMBER OF GRANTS FOR EACH OF OUR MISSION AREAS. THE MAJORITY OF THESE GRANTS HAVE BEEN IN THE SPEECH AND LANGUAGE PORTFOLIO. I CAN TELL YOU THE VAST MAJORITY ARE IN THE AREA OF APHASIA FOR TRAINING AND CAREER DEVELOPMENT. STARTING IN 2018 OUR COMMUNITY GOT A REAL INFUSION OF FUNDING IN THIS AREA THANKS TO NIA. THEY BEGAN A SUPPLEMENT PROGRAM MEANT TO ENCOURAGE RESEARCHERS NOT CURRENTLY WORKING IN ALZHEIMER'S DISEASE AND RELATED DEMENTIAS TO EXPAND EFFORTS IN THAT DIRECTION. THAT'S WAS INITIALLY ONLY FOR NIH GRANT RESCIPIENTS BUT THEY'VE OPENED IT UP TO OTHER INCLUDING NIDCD AND OUR INVESTIGATORS AND SCIENCE HAS BENEFITTED. PRIOR TO THESE SUPPLEMENTS THE MOST NIDCD SPENT IN ANY AREA FOR AN GIVEN YEAR WITH US $3.5 MILLION AND WE SURPASSED THAT IN EACH YEAR OFFERED WITH OVER $10 MILLION INVESTED IN FISCAL 2018 ALONE. MANY BENEFITTED FROM THE SUPPLEMENTS WITH THE EXCEPTION OF THE BALANCE PORTFOLIO YOU'LL HEAR MORE ABOUT OUR JOINT EFFORTS IN STIMULATING THIS AREA IN PARTICULAR. MANY SUPPLEMENT PROGRAMS AT NIH ARE AIMED AT STIMULATING WORK IN A CERTAIN AREA AND PUSHING SCIENCE AND INDIVIDUALS WITH DIFFERENT EXPERTISE INTO A PLACE THEY MAY NOT HAVE BEEN PREVIOUSLY. IT'S OUR HOPE MANY SUPPLEMENTS WILL GENERATE NEW DATA AND RESEARCH QUESTIONS THAT CAN DRIVE INDEPENDENT INVESTIGATIONS INTO COMMUNICATION DISORDER DOWN THE ROAD. THIS PERHAPS UP OUR SNAPSHOT ON OUR PORTFOLIO ON ALZHEIMER'S DISEASE AND RELATED DEMENTIA AND I'M HAPPY TO TRY TO ANSWER ANY QUICK QUESTIONS BEFORE WE MOVE ON TO THE PRESENTATION FROM THE NIA. >> THIS IS RICHARD. CAN YOU GIVE AN IDEA ON THE GRANTS DONE FOR HEARING AND DEMENTIA MAY REQUIRE. A COUPLE HIGHLIGHTS OF WHAT THOSE WERE. >> LET ME PULL THAT UP BECAUSE I HAVE THE LIST IN FRONT OF ME. BUT I DON'T WANT TO TAKE UP ANY MORE TIME SO IF I CAN CIRCLE BACK AROUND TO THAT MAYBE AFTER ST. HILL -- DR. ST. HILLAIRE-CLARKE IS DONE. >> I'M SURE OTHERS WOULD BE INTERESTED TOO. >> OF COURSE. THANKS, RICHARD. NOT SEEING ANY OTHER QUESTIONS OR HEARING ANY, I AM REALLY PLEASED TO INTRODUCE TO EVERYBODY DR. ST. HILLAIRE-CLARKE IN THE DIVISION OF NEUROSCIENCE AND OVERSEES THE SENSORIMOTOR DISORDER PROGRAMS WHICH SUPPORTS RESEARCH ON NORMAL AGING AND DISEASE-RELATED CHANGES IN MOTOR, VISUAL, AUDITORY, SOMATOSENSORY FUNCTIONS AS WELL AS PAIN. SHE AS A BROAD AND IMPORTANT PORTFOLIO. AND IF IT WASN'T APPARENT BEFORE TODAY I HOPE THIS AFTERNOON'S SESSION HIGHLIGHTS THE CLOSE END FRUITFUL RELATIONSHIP WITH NIA AND DR. ST. HILAIRE-CLARKE IS A WONDERFUL IMPORTANT WITH WHOM TO WORK AND THE FLOOR IS YOURS. >> THANK YOU. KELLY, THAT WAS A FANTASTIC INTRODUCTION. BETTER THAN WHAT I WAS GOING TO DO MYSELF. SO I'M HAPPY TO BE HERE. I WANT TO THANK YOU FOR INVITING ME TODAY. OUR INSTITUTES HAVE COLLABORATED A NUMBER OF ACTIVE -- ACTIVITIES AND MADE GREAT COLLEAGUES AT NIDCD AND LOOK FORWARD TO OTHER OPPORTUNITIES TO COLLABORATE IN THE FUTURE AND WANT TO THANK OUR HEALTH SPECIALIST IN THE DIVISION OF NEUROSCIENCE IN OUR BRANCH. HE WAS INSTRUMENTAL IN PUTTING TOGETHER AND GENERATING LATEST THE DATA ON THE PORTFOLIO I'LL BE PRESENTING TODAY. AND WE LOOKED AT ALZHEIMER'S DISEASE AND RELATED DEMENTIAS AND NIH LEADS THAT EFFORT AND SPECIAL PROBLEMS AND NEEDS OF OLDER ADULTS. WE ALSO TRAIN AND DEVELOP RESEARCH SCIENTISTS, PROVIDE RESEARCH RESOURCES, DISSEMINATE INFORMATION ON HOW INFORMATION ADVANCES. I HAD A LONG-STANDING INTEREST IN RESEARCH ON SENSORY SYSTEMS IN GENERAL. WE HAVE TAKEN ADVANTAGE OF A NUMBER OF OPPORTUNITIES OVER THE YEARS TO ADDRESS VARIOUS AREAS AND WE OFTEN DO THOSE THROUGH INITIATIVES FORMED BY WORKSHOPS MANY TIMES. HERE'S AN EXAMPLE OF A PARTICULAR WORKSHOP WE DID IN 2013 ON AUDITORY PLASTICITY AND AGING IN CONJUNCTION WITH NIDCD. IT LATER INFORMED AN RFA ON CENTRAL MECHANISMS OF AGE-RELATED HEARING LOSS AGAIN THE NIDCD PARTICIPATED WITH US AND WE WERE ABLE TO FIND FOUR APPLICATIONS TWO THROUGH NIA AND TWO THROUGH NIDCD. HERE'S ANOTHER EXAMPLE OF TWO CONVENINGS THAT EXPLORE THE RELATIONSHIP BETWEEN SENSORY IMPAIRMENT AND AGING, COGNITIVE DECLINE AND ALZHEIMER'S DISEASE. IN BOTH CASES IT LED TO PUBLICATION OF PAPERS AND THE FIRST BEING A REVIEW AND IT ALSO INFORMED THIS FUNDING OPPORTUNITY ANNOUNCEMENT AR18519 ON SENSORY AND MOTOR SYSTEM CHANGE AS [TECHNICAL DIFFICULTIES] AND ALSO THIS ACTIVE RFAAG2111 THE DUE DATE IS OCTOBER 2 AND I REALLY ENCOURAGE YOU GUYS TO SUBMIT APPLICATIONS. WE'RE LOOKING FORWARD TO EXCITING APPLICATIONS IN THIS PARTICULAR AREA. KELLY ALSO TOUCHED ON THIS THE NATIONAL ALZHEIMER'S PROJECT ACT SIGNED IN TO LAW IN JANUARY OF 2011. IT HAS MADE QUITE AN IMPACT ON RESEARCH ON ALZHEIMER'S DISEASE AND ALZHEIMER'S DISEASE RELATED DEMENTIA AS WELL AS SENSORY RESEARCH. THIS CALLS FOR AN ANNUAL UPDATED NATIONAL PLAN ANY RECOMMENDATIONS FOR PRIORITY ACTIONS TO IMPROVE HEALTH OUTCOMES AND LOWER COST TO FAMILIES AND GOVERNMENT PROGRAMS. THERE'S ALSO AN ANNUAL EVALUATION OF ALLFUL FEDERALLY FUNDED EFFORTS AND AN ADVISORY COUNCIL WAS ALSO CREATED. SO NOT LONG AFTER THE PLAN WAS RELEASED NIA STARTED ING INCREASED APPROPRIATIONS FOR TARGETED RESEARCH ON ADADRD. YOU CAN SEE IN 2016 THAT'S ABOUT THE TIME WE STARTED SEEING EVEN GREATER LEVELS OF APPROPRIATIONS. WE ALSO RECEIVED SLIGHT INCREASES IN OUR BUDGET FOR THE NON-TARGETED RESEARCH. WE REFER TO AS OUR NIA BASE. SO NON-AD RESEARCH. FOR FY20 OUR BUDGET WAS $3.54 MILLION. YOU CAN SEE -- BILLION. THAT IS MORE THAN THREE TIMES THE AMOUNT RECEIVED IN 2013. YOU CAN IMAGINE THESE APPROPRIATIONS HAVE LED TO PRETTY GENEROUS PAY LINES AT THE NIA AND NOT ONLY THAT AFFORDED US THE OPPORTUNITY TO SPREAD THESE FUNDS ACROSS NIH AND WE'VE DONE SO BY PARTICIPATING IN JOINT INITIATIVES. ALSO BY FUNDING ADMINISTRATIVE SUPPLEMENTS KELLY ALSO MENTIONED EARLIER. YOU CAN SEE AS OUR APPROPRIATIONS INCREASED ACROSS FISCAL YEARS WE WERE ABLE TO SPREAD EVEN MORE FUNDS ACROSS NIH. THAT'S BEEN QUITE IMPACTFUL. I WON'T GO TOO MUCH IN TO THIS BECAUSE KELLY TALKED ABOUT IT, WE SEE THE ADMIN SUPPLEMENT AS BEING QUITE SUCCESSFUL. WE'VE BEEN ABLE TO INTERACT A NUMBER OF INVESTIGATORS INTO THE A.D. FIELD. THAT'S FANTASTIC. AS WELLY ALSO MENTIONED -- KELLY ALSO MENTIONED NIDCD WAS ABLE TO FUND 32 SUPPLEMENTS IN FY19. SO HERE'S A GRAPH THAT ILLUSTRATES OUR INVESTMENTS IN SENSORY RESEARCH OVER THE LAST 10 YEARS. IN 2010 TO 2019. THE FIRST THING YOU MIGHT NOTICE HERE IS THERE'S A MARKED INCREASE IN FUNDING FROM THESE PERIODS. AS YOU MIGHT RECALL, I MENTIONED THAT IN FY2016 THAT'S WHEN WE STARTED SEEING EVEN MORE INCREASES. IT ESSENTIALLY TRACKS PRETTY WELL WITH APPROPRIATIONS. THE OTHER THING I'LL MENTION HERE IS THAT FOR THE LAST FEW YEARS, 2017 TO 2019 WE'VE BEEN ABLE TO MAINTAIN ROUGHLY $10 MILLION PER YEAR IN INVESTMENT AND HEARING RESEARCH. THAT'S IN THE ORANGE BAR YOU SEE ON TOP. SO HOW DOES THIS ALL BREAK DOWN FOR AUDITORY RESEARCH IT TURNS OUT TO NUMBER OF AWARDS AND NONNO NON-AD VERSUS AD VARIATIONS. WE SEE A NUMBER OF INCREASE FOR AWARDS FOR AD. PRIOR TO 2016, BETWEEN 2010 AND 2016 WE FUNDED ONE OR TWO GRANTS ON HEARING AND A.D. SO WE HAVE SEEN AN INCREASE IN THAT AREA. I'LL ALSO POINT OUT THAT WHAT'S AS IMPORTANT, I THINK [NO AUDIO] WE REALLY DON'T WANT TO LOSE THAT COMPONENT OF THE PORTFOLIO. IN CONTRAST IF YOU LOOK AT THE CHEMO SENSORY RESEARCH IN A.D. WE SEE A LARGER INCREASE. THAT'S NOT TOO SURPRISING GIVEN THE FACT THERE'S AN ASSOCIATION BETWEEN OLFACTORY DYSFUNCTION AND ALZHEIMER'S DISEASE. THIS IS JUST TO GIVE YOU A FLAVOR OF THE TIMES OF AREAS FUNDED UNDER OUR AUDITORY RESEARCH PORTFOLIO. AND THESE APPLICATIONS INCLUDE THINGS LIKE PRESBYCUSIS, DEMENTIA AND NEURAL PLASTICITY AND UNDERSTANDING SPEECH PERCEPTION IN AGING. SO THANK YOU FOR YOUR ATTENTION. THAT'S ALL I HAVE FOR NOW. I'LL LEAVE YOU WITH WAYS TO STAY INFORMED AND CONNECTED WITH EVERYTHING WE DO AT NIA. >> THANK YOU VERY MUCH, THAT WAS GREAT. I'LL GIVE PEOPLE A MINUTE TO TYPE THEIR QUESTIONS IN TO THE CHAT OR PREPARE TO COME ONLINE. I'LL CIRCLE BACK TO RICHARD'S QUESTION AND SHARE HIGHLIGHTS OF THE NIDCD SCIENCE WE'VE SEEN COME IN. THERE'S GRANTS LOOK AT HEARING AID OUTCOMES TENTATIVE AND BASIC RESEARCH OF THE CELLULAR MECHANISMS. THERE'S WORK LOOKING AT TAO CLEARANCE IN ALZHEIMER'S DISEASE. AND ONE AND VESTIBULAR DISORDER IN ALZHEIMER'S DISEASE AND THE PUBLIC HAS BEEN ABLE TO CAPITALIZE. DOES ANYONE HAVE QUESTIONS FOR DR. ST. HILLAIRE-CLARKE? OKAY. NOT HEARING ANY RIGHT NOW, AGAIN, THANK YOU FOR THE PRESENTATION AND I'M PLEASED TO MOVE ON TO INTRODUCING OUR SPEAKER FOR THE SCIENTIFIC SEMINAR DR. FRANKLIN. DR. LIN IS THE DIRECTOR OF THE COCHLEAR CENTER FOR HEALTH AND PART OF THE BLOOMBERG SCHOOL OF PUBLIC HEALTH AND COMPLETED HIS UNDERGRADUATE DEGREE AT BRUN UNIVERSITY AND MEDICAL EDUCATION AND OAT -- AND IS A PRACTING -- AND TRAINING AND ADDRESSING THE IMPACT OF HEARING LOSS ON OLDER ADULTS AND PUBLIC HEALTH. HE WAS A PRIOR RECIPIENT OF AN NIDCD K23 CAREER DEVELOPMENT AWARDS AND HOLDS ACTIVE GRANTS FROM NIDCD AND NAI AND CURRENTLY OVERSEEING A LARGE RANDOMIZED TRIAL THAT AIMS TO DETERMINE IF TREATING HEARING LOSS REDUCE THE RISK OF COGNITIVE DECLINE IN OLDER ADULTS. WE'RE ALL INTERESTED IN HEARING MORE SO WITHOUT FURTHER ADO A WARM VIRTUAL WELCOME. >> THANK YOU. IT'S NICE TO SEE SCO MANY FAMILIAR -- SEE SO MANY FAMILIAR NAMES AND NICE TO BE HERE VIRTUALLY. AS DR. KING MENTIONED MY CLINICAL TRAINING I'M AN OAT -- O OTOLARYNGOLOGIST AND THE TALK WILL BE 45 MINUTES I KNOW THAT CAN BE LONG FOR A VIRTUAL TALK SO AS MUCH AS POSSIBLE I'LL TRY TO TAKE PAUSES AND THERE'S NATURAL BREAKS BUILT IN. I'LL HIGHLIGHT WORK IN THE LAST DECADE SPECIFICALLY AROUND HEARING LOSS AND DEMENTIA. YOU SAW THIS BEFORE FROM DR. KING, THIS SUMMARIZES FROM THE LANCET COMMISSION THE 2017 META-ANALYSIS REVIEW WHICH WAS A SURPRISE FOR A LOT OF PEOPLE WHEN THEY IDENTIFIED HEARING LOSS AS BEING ESSENTIALLY THE LEADING POTENTIALLY MODIFIABLE RISK FACTOR FOR DEMENTIA AND IT CAME UP IN MORE UPDATED REPORTS INCLUDING OTHERS WHERE HEARING LOSS CAME OUT THE MOST DOMINANT POTENTIALLY MODIFIABLE RISK FACTOR. THEY PUT IN MID LIFE IT'S MID OR LATE LAST. IT HAPPENS IN THE STUDIES THEY REVIEWED AND INCLUDED ADULTS UP TO MID 60s WHICH ARE STILL MID LIFE. AND IT'S MID LIFE TO BALANCE IT BETTER. IT'S HEARING LOSS MID TO LATE LIFE. THIS IS A GUIDING LIGHT HOW DID HEARING LOSS WIND UP ON THE MAP OF DEMENTIA WHERE FIVE AND SIX YEARS AGO IT WASN'T ON ANYONE'S RADAR SCREEN. TO THAT END I KNOW WE HAVE A DIVERSE AUDIENCE IN TERMS OF EXPERIENCE AND IT'S AN OPEN SESSION. TO BEGIN WITH DEFINITION PRINCIPLES WHAT DO I MEAN BY HEARING, COGNITION AND DEMENTIA? I'LL THEN GO BACK TO THE CONCEPTUAL FRAMEWORK FOR WHY THERE MAY BE A DINK -- DIFFERENCE AND THE SURVEYS FOR THE LANCET COMMISSION AND OTHERS AND I'LL GO OVER ALL THOSE AND TOUCH BRIEFLY ON WHAT DR. KING MENTIONED BEFORE AND I'LL END WITH BASIC RESEARCH GAPS AND OPPORTUNITIES SPECIFICALLY IN THE FIELD OF DEMENTIA. BETWEEN EACH SECTION I'LL PAUSE AND IF DR. JORDAN AND DR. TUCCI WILL ALLOW I'LL TAKE QUESTIONS OR PROCEED AHEAD. GIVEN THIS IS A RELATIVELY LONG WEBINAR WE'LL TAKE BREAKS WHENEVER WE CAN TO TAKE QUESTIONS. FROM MY POINT OF VIEW FROM A GER ONTO LOGICAL APPROACH WE HAVE CENTRAL CODING AND HEARING IS CODING AND DECODING CENTRALLY. ON THE TOP LEFT WE HAVE A CLASSIC SPEAK SPECTROGRAM OF A COMPLEX SOUND AND THE JOB OF THE COCHLEA IN THE MIDDLE IS TO TAKE IN THE ACOUSTIC VIBRATIONS TO CONVERT IT TO A SIGNAL TO THE BRAIN FOR CODING AND DECODING. THAT'S ALL HEARING IS. I KNOW THAT'S SIMPLISTIC BUT STANDS IN TERMS OF THE BIG PICTURE. AND THIS IS A BRIEF REVIEW FOR MANY IN THE AUDIENCE. WHEN WE TALK ABOUT HEARING THEN AND YOU CAN LOOK AT CONSTRUCTS AND STEPS ALONG THE AUDITORY CHAINS. AT THE MOST PERIPHERAL OF HEARING FUNCTION WE CAN MEASURE THE HAIR CELL WHETHER THEY MOVE OR NOT WHICH IS PRIMARILY A PERIPHERAL FUNCTION AND THEN A TONE PLAYED TO THE INNER HERE. THE BRAIN IS DE FUNCTIONING FOR THAT BUT THERE'S MINIMAL DECODING AND A SENSITIVITY TASK. THEN WE LOOK AT RELATIVE RUDIMENTARY TASK BUT MORE DECODING AND WHEN YOU GET TO SPEECH AND NOISE OR A DICHOTIC LISTENING TASK AND THESE PULL IN MORE AND MORE CENTRAL ASPECTS OF DECODING AS WELL AS ATTENTION. AND FINALLY THINGS LIKE SUBJECTIVE HEARING, COMMUNICATIVE FUNCTION, HOW WELL YOU CAN HEAR. YOU CAN IMAGINE IS AS MUCH AS PERIPHERALLY BASED IN TERMS OF THE AS WELL AS HOW WE CAN DECODE AND WHAT'S THE ENVIRONMENT LIKE AND THINGS LIKE THAT. THE REASON I SHOW THIS AND MAY SEEM OBVIOUS AND I'LL GO OVER IT LATER IN THE GENERAL EPIDEMIOLOGIC LITERATURE IS THEY'RE ALL LUMPED TOGETHER AS A MEASURE OF HEARING BUT IT CAN MEAN COMPLETELY DIFFERENT THINGS. I WANT TO START WITH THAT BASIC LEVEL. THERE'S DIFFERENT LEVELS OF MEASURING HEARING AND THE OTOMETRY IS TO MEASURE THE PERIPHERY. AND WHEN WE TALK ABOUT OLDER ADULTS WHICH IS A FOCUS OF MY RESEARCH AND WHEN WE TALK BROADLY ABOUT GENERICALLY AGE RELATED HEARING LOSS IT'S A CATCH-ALL TERM THAT REFLECTS MULTIPLE PROCESSES, AGING, NOISE EXPOSURE, GENETIC PREDISPOSITION AND CAN ALL DAMAGE THE COCHLEA AND THE HAIR CELLS AND IT'S PROGRESSIVE DAMAGE TO THE COCHLEA WHICH OCCURS FROM MULTIP MULTIPLE EDIOLOGIES AND A STANDARD AUDIO GRAM AND YOU SEE A CLASSIC MILD DOWN SLOPING TO SEVERE SENSORY HEARING LOSS WE'LL COMMONLY SEE IN AGING. FROM A CLINICAL PERSPECTIVE AND RESEARCH PERSPECTIVE A LOT OF TIMES WE'LL SUMMARIZE AUDIO GRAMS. WE HAVE SIX POINTS. WE'LL SUMMARIZE IT AS A PURE AVERAGE IN THE YELLOW BAR OF THE MAIN FREQUENCIES AND THRESHOLDS AND YOU HAVE ONE DEAF EAR AND ONE GOOD EAR YOUR NOT DEF PER SE AND SOME STUDIES HAVE LOOK AT THE AVERAGE IN THE BETTER HEARING EAR CONSERVED AS REPRESENTATION OF HOW SOMEONE'S HEARING IS IN DAILY LIFE. NOW, MANY KNOW THIS AROUND CERTAINLY NIDCD KNOWS THIS WHEN WE LOOK AT THE PREVALENCE OF HEARING LOSS, BASICALLY PURE TONE AVERAGE IN THE GREATER YEAR GREATER THAN 25 THE PREVALENCE OF HEARING LOSS INCREASES ACROSS THE LIFE SPAN. IT ALMOST DOUBLES EVERY DECADE SO BY THE TIME OF 70 TWO-THIRDS HAVE A MEANINGFUL HEARING IMPEDIMENT WHICH WE CONSIDER CLINICALLY SIGNIFICANT. SO TRANSITION. THAT'S ONE DEFINITION AROUND HEARING. MOST SIMPLISTIC BUT TRUE IN ITS FRAMEWORK. WHEN WE TALK ABOUT COGNITION IT'S PRICED OF DIFFERENT DOMAINS OF FUNCTION. WE HAVE MEMORY THAT'S INTUITIVE AND EXECUTIVE FUNCTION. CAN YOU PAY ATTENTION TO ONE TASK WHILE DOING ANOTHER, FOR INSTANCE. PROCESS IS INTUITIVE. THERE'S VISUAL OR MOTOR PROCESSING SPEEDS AND THERE'S VERBAL AND THINGS LIKE THAT. YOU CAN CHARACTERIZE EACH AND VERBAL FUNCTION AND NUMERACY DON'T CHANGE THAT MUCH AND COGNITIVE TESTS CAN BE DOMAIN SPECIFIC OR REFER TO MINI MENTAL STATUS THE MODULE COGNITIVE ASSESSMENT. THERE'S ALWAYS A TRADE-OFF BETWEEN PRECISION AND TIME SIMPLISTIC. NOW ON THE HEARING SIDE PEOPLE STUDY COGNITION THEY'LL SAY THROW IN A MEASURE OF MMSE AND THAT'S COGNITION. YES, IN A WAY BUT YOU'RE JUST GETTING ONE BRIEF FACET MUCH LIKE A COGNITIVE SCIENCE LET'S INCLUDE A MEASURE OF HEARING. YES, IT'S NOT QUITE PRECISE. THAT MATTERS AND HAS FORGOTTEN ON BOTH SIDES OF THE FIELD WHICH ASPECT YOU'RE COMING FROM. IF YOU'RE DOING COGNITIVE TESTING WELL IT WILL BE DONE BY NOT JUST A RESEARCH KOOFCOORDINATOR OR ASSISTANT BUT SOMEONE TRAINED AND FACE TO FACE IN A QUIET ROOM WITHOUT DISTRACTIONS CONSECUTIVE TESTING FACE TO FACE IN A QUIET ROOM WITH A TRAINED EXAMINER AND HEARING LOSS EXCEPT FOR SEVERE LOSS DOES NOT DIRECTLY CONFOUND IN FACE TO FACE ENVIRONMENTS. WE SAW MODERATE HEARING LOSS AND SPEECH UNDERSTANDING IS NOT COMPROMISIZED. IN A BUSY ROOM IT WOULD BE BUT NOT FACE TO FACE. AND THE CONCERN IS COGNITIVE TESTING CONFOUNDED BY HEARING LOSS? IF IT'S FACE TO FACE QUIET ROOM IT'S NOT AND YOU CAN EM PER AUTOMATICALLY FEST FOR THAT I'LL TALK ABOUT LATER. A LOT OF THE COGNITIVE TESTS WE USE IN THE DEMENTIA LITERATURE AND ELSEWHERE DON'T HAVE AUDITORY STIMULI. THERE'S VISUAL BUT IT'S NOT AUDITORY OR WORDS BEING SPOKEN LESS SUBJECT TO CONFOUND BY HEARING LOSS, FOR INSTANCE. WHEN WE PROGRESS TO DEMENTIA PER DEFINITION AND CLINICALLY IT REFLECTS THE STATE WHEN YOUR COGNITIVE IMPAIRMENT GETS SO BAD IT STARTS INTERFERING WITH YOUR ABILITY TO DO YOUR NORMAL ACTIVITIES INDEPENDENTLY. THE MOST COMMON CAUSE ALZHEIMER'S AND VASCULAR DISEASE AND PEOPLE IN THEIR 80s AND 90s IS USUALLY A MIXED BAG THE VAST MAJORITY ARE LATE LIFE, 70s, 80s AND 90s AND OTHER FORMS WE'LL GO OVER BUT THESE ARE THE TWO MAIN CAUSES AND YOU DON'T WAKE UP ONE DAY WITH DEMENTIA YOU CAN HAVE A BI-DIRECTIONAL STATE AND FINALLY DEMENTIA. WHEN I TALK ABOUT DIAGNOSING DEMENTIA THERE'S THREE MAJOR ONES. IF YOU'RE IN A RIGOROUS DATA IT'S BASED ON A PANEL OF DIFFERENT RESEARCHERS, EXAMINERS, COMPLNGSS -- CLINICIANS AND THEY RATE WHETHER SOMEONE DEMENTIA. AND IT CAN BE A CLINICAL ASSESSMENT A GERIATRICIAN OR INTERVIEW WITH A PATIENT AND FINALLY IN SOME STUDIES RATHER THAN HAVING AN ADJUDICATE DEFINITION MAY BASE IT ON A CUT-OFF CHANGE OR THRESHOLD CHANGE. ALL THREE ARE COMMONLY USED IN THE LITERATURE. THERE'S A CONTINUUM OF DEMENTIA. ON THE X IS A FIGURE YOU'LL SEE IF YOU GO TO A DEMENTIA MEETING YOU'LL SEE THIS FIGURE OVER AND OVER AGAIN. IT'S A VERY GOOD FIGURE. THE X AXIS SHOWS COGNITIVELY NORMAL AND YOU CAN SEE PATH PATHOLOGIC CONDITIONS AND YOU CAN SEE THE CHANGES BEFORE SOMEONE IS CLINICALLY ASYMPTOMATIC AND IT BECOMES NOTICEABLE IN TERMS OF MEMORY FUNCTION IN THE PURPLE AND LATER ON IN THE CLINICAL FUNCTION GETS DETERIORATED AS WELL. THE REASON I SHOW THIS IS THERE IS AND WE'VE KNOWN MANY YEARS THERE IS NOT A DIRECT CORRELATION BETWEEN THE AMOUNT OF PATHOLOGY IN THE BRAIN AND CLINICAL PRESENTATION, CLINICAL SYMPTOMS AND PHENOTYPE. THERE'S NOT A ONE TO ONE. THEY'RE VARIOUS THINGS THAT MAY BUFFER WE'RE JUST BEGINNING TO STUDY NOW. AND IT'S INCREASING THOUGH THE RISK OF DEMENTIA MAY BE GOING DOWN NOW DAYS FOR VARIOUS REASONS, THE NUMBERS ARE GOING UP BY VIRTUE OF AGING OF THE WORLD'S POPULATION. THE NEXT 30 YEARS THESE ARE THE NUMBERS YOU SEE. A FIGURE LIKE THIS IS HARD TO FATHOM. THE FIGURE I LIKE TO SAY IS WHAT IT MEANS IS FOR THE UNITED STATES AT LEAST IN 2050 THAT RELATIVELY CONSERVATIVELY ONE IN THREE OF EVERY AMERICAN WILL BE LIVING WITH DEMENTIA AND THAT'S A REFLECTION OF THOSE AGING AND THE NUMBER AT RISK THIS IS A STAGGERING NUMBER WHEN YOU LOOK AT ONE IN THREE HAVING DEMENTIA IN 30 YEARS FROM NOW. I'M GOING TO PAUSE BRIEFLY TO SEE IF THERE'S QUESTIONS OR COMMENTS. THE NEXT THOUGHT THEN IS HOW ARE THESE PHENOMENA LINKED. HOW IS HEARING WITH THIS MEASURE OF THE SENSITIVITY OF THE INNER HERE AND RELATED TO COGNITION. YOU HAVE THE LEFT EAR WITH HEARING LOSS THAT'S A MEASURE OF AUDIO METRIC FUNCTION AND ON THE LEFT TO COGNITIVE IMPAIRMENT ON THE RIGHT INTUITIVELY YOU THINK OF COURSE THEY'RE RELATED BUT DRIVEN BY A COMMON PATHOLOGICAL PROCESS. METABOLIC IMAGE OR VARIOUS THINGS WHAT AGING MEANS OR SMALL BLOOD VESSELS THAT AFFECT THE BRAIN AFFECT THE INNER EAR OR GENERAL FACTORS LIKE DIABETES. CLEARLY IF IT'S A COMMON CAUSE THAT LEADS TO HEARING LOSS AND DEMENTIA IT'S NOT NECESSARILY THAT INTERESTING FROM A PUBLIC HEALTH STANDPOINT TO ADDRESS AND TREAT HEARING LOSS WILL MAKE A DIFFERENCE. THE REAL QUESTION IS ARE THERE MECHANISTIC PATHWAYS TO HEARING LOSS CAN CONTRIBUTE TO COGNITIVE IMPAIRMENT DEMENTIA. THIS IS COVERING A LOT OF GROUNDS FROM COGNITIVE NEUROSCIENCE AND PSYCHOLOGY AND SUMMARIZE THE PATHWAYS THAT HAVE SORT OF BEEN BANDIED ABOUT MANY YEARS BUT HAVEN'T PULLED TOGETHER OVER THE LAST 10 YEARS IN TERMS OF THINKING ABOUT THIS. YOU HAVE SEEN THE CODING AND WE TALKED ABOUT AGE RELATED HEARING LOSS AND DAMAGE USUALLY TO THE INNER EAR WELL DESCRIBED BY MANY PEOPLE AND WE KNOW WHAT HAPPENS IS A DECREASE SENSITIVITY OF SOFT SOUNDS AND IT'S A CLARITY ISSUE BECAUSE THERE'S BEEN DAMAGE TO THE COCHLEA IS RATHER THAN THAT SOUND BEING PRE CIVIL AND CRISPLY ENCODE AND A SIGNAL STILL GOES TO THE BRAIN BUT A MUCH MORE DISTORTED SIGNAL. PEOPLE SAY THIS ALL THE TIME IT'S NOT THAT WE CAN'T HEAR YOU BUT WE CAN'T UNDERSTAND YOU. THAT'S HARDER TO UNDERSTAND AND TAKES MORE EFFORT TO PROCESS WHAT IS BEING SAID. ONE MECHANISM THROUGH WHICH HEARING LOSS HAS BEEN HYPOTHESIZED TO BE LINKED WITH COGNITIVE IMPAIRMENT DEMENTIA IS THE LOAD. THE BRAIN HAS TO CONSTANTLY RE-ALLOCATE BRAIN RESOURCES TO DEAL WITH A MORE BGARBLED AUDITORY SIGNAL AT THE EXPENSE OF COGNITION AND THIS IS A NEW IDEA. THE PERSON WHO WON THE NOBEL PRIZE BROUGHT UP THE IDEA THAT THERE'S A POOL OF COGNITIVE RESOURCES OR THINK, MEMORY, PLANNING. OVER TIME WE NOW WE KNOW WE CAN LOSE RESOURCES. THE THOUGHT IS DOES A HEARING LOSS, DOES IT HAVE A LOAD OF HEARING LOSS IN THE BRAIN DOES IT TAX AND TAP INTO THE AVAILABLE POOL OF COGNITIVE RESOURCES. SOUND IS ONE YOU CAN'T TURN OFF. YOU'RE PROCESSING SOUND. IT DOESN'T COME ON AND OFF WHEN IT WANTS TO AND IT'S ALWAYS THERE AND YOUR BRAIN IS ALWAYS PROCESSING SOUND. THIS GOES BEYOND THE CONSTRUCT FROM HIS WORK AND NICE WORK DONE BY OTHERS AROUND THE WORLD HAVE LOOKED AT FUNCTIONAL IMAGING. THIS IS A FUNCTIONAL M.R.I. AND SHOWED NICE WORK. AND IF YOU LOOK AT TWO GROUPS OF PEOPLE ONE GROUP HAS HEARING LOSS AND ONE DOESN'T AGE AND OTHER PARAMETERS, YOU SEE CONSISTENT OF PEOPLE WITH POOR HEARING HAVE REDUCED LANGUAGE DRIVEN ACTIVITY IN THE PRIMARY AUDITORY CORTEX. IT MAKES SENSE TO HAVE IMPOVERISHED SENDING YOU GET POOR SIGNALS IN THOSE AUDITORY AREAS. THIS IS GOING BACK MANY YEARS AND REPLICATED MANY TIMES SINCE USING AN OLDER FIGURE FROM U-PEN FROM ALMOST SO 20 YEARS AGO NOW WE CONSISTENTLY SEE AN INCREASED ACTIVITY FROM THE PREFRONTAL CORTEX AND UG WE'RE SEEING SOME DEGREE OF FUNCTIONAL REACTIVATION IN OTHER AREAS FOR PROCESSING SOUND SPEECH WHAT YOU DON'T SEE IN PEOPLE WITH NORMAL HEARING. THIS IS NICE WORK FUNDED BY NIDCD LOOKING AT HIGH DENSITY IMAGES AND ROUGHLY THE SAME CONVERSION OF IDEAS. THE IDEA IS HEARING LOSS CONSTANTLY IMPOSES A LOAD IN THE SYSTEM AND LEADS TO EARLIER UNMASKING OF COGNITIVE IMPAIRMENT DEMENTIA NOT THAT HEARING LOSS CAUSES DEMENTIA BUT LEADS TO EARLIER UNMASKING USING UP CORTICORESOURCES THAT COULD HAVE OTHERWISE BEEN USED TO BUFFER AGAINST THE PATHOLOGY OF ALZHEIMER'S AND VASCULAR DISEASE. A SECOND IDEA WHICH IS QUITE DIFFERENT IS THE IDEA IT'S NOT JUST A LOAD ISSUE, HEARING LOSS IN OF ITSELF DOES CONTRIBUTE TO BRAIN STRUCTURAL CHANGES WHICH THEN LEADS TO FUNCTIONAL CONSEQUENC CONSEQUENCES FOR THE BRAIN. THIS IS A CRUDE SUMMARY FIGURE OF THIS. TWO MAIN DOMINANT EAT -- ET ETTIOLONGIC DISEASE AND CAUSES FUNCTIONAL CONSEQUENCES. [NO AUDIO] YOU CAN SEE CHANGES IN RESPECT TO HEARING LOSS. THE NEWER RESEARCH IN THE LAST SEVERAL YEARS NOW HAS LOOKED AT MORE HUMAN STUDIES. LONGITU LONGITUDINAL STUDIES AND WE FOLLOW THE BASELINE FOR MANY YEARS AND SEE ACROSS THE STUDIES ACCELERATED ATROPHY OVER THE TEMPORAL LOBE AND MID LIFE HEARING 50s AND 60s GREATER RATES OF THES STRUCK STRUCTURE AND THERE APPEARS TO BE INTRIGUING IDEAS OF LATTERALITY. LOOKING AT THE RIGHT VERSUS LEFT YEAR AND YOU SEE IN GENERAL STRONGER ASSOCIATED WITH THE RIGHT EAR HEARING AND SEEING DIFFERENCES IN THE ATROPHY IN THE SIDES OF BRAIN AS WELL. IT SUGGESTS THERE'S A STRONG LATERALIZATION OF HOW IT WORKS AND COULD SUGGEST SPECIFICITY OF AFFECTING HEARING THE BRAIN AS TO AGING IN HEARING LOSS AND BRAIN AND TISSUE LOSS FOR INSTANCE. SO THIS IS THE SECOND HIGH BOTH THIS MECHANISM. THE THIRD BEARS MENTIONING BUT ALMOST UNTUITIVE THE IDEA -- INTUITIVE AND HEARING LOSS CAN LEAD TO SOME DEGREE OF SOCIAL ISOLATION OR LONELILINESS. -- LONELINESS. WE HAVE LOOK AT COGNITIVE IMPAIRMENT AND THE MECHANISMS ARE BROAD AND VARIED AND LOOKS AT THE PSYCHO PATH LOGIC PATHWAYS AND WORK DONE LOOKING AT ALTERED INFLAMMATORY STATUS AND AX AXIS ACTIVATION AND LONELINESS CAN HAVE A DETRIMENTAL AFFECT ON HEALTH AND WE SEE THAT ACROSS MANY STUDIES NOW. WE LOOKED AT THOSE SOCIALLY ISOLATED OR INTEGRITY AND YOU SEE UP REGULATION PRO IN PROGRAM PROGRAM -- INFLAMMATORY GOON AND LOOKING AT THE -- GENES AND LOOKING AT THE PATHWAY. AND I MENTIONED COGNITIVE LOAD. THE OLDER TERM WAS SOMETHING PROPOSED BACK IN 20 YEARS AGO AND BY VIRTUE OF PROVIDING GARBLING TO THE BRAIN PUTS A LOAD IN THE SYSTEM THAT COULD HAVE BUFFERED AGAINST OTHER PATHOLOGICAL CONTRIBUTORS OF DEMENTIA AND HEARING LOSS COULD AFFECT OR TAPS IN TO THAT BUFFER. AND WE HAVE A TERM CALLED SENSORY DEPRIVATION PROCESS AND MAY CONTRIBUTE FROM DIMINISHED AUDITORY INPUT TO BRAIN CHANGES AND LONELINESS AND THERE'S WAYS IT CAN AFFECT DEMENTIA AND RISK OF COGNITIVE DECLINE. THAT'S THE SECTION I WANTED TO TOUCH BASE ON THEORETICAL FRAMEWORK. QUESTIONS, THOUGHTS OR COMMENTS? >> THERE WAS A QUESTION. >> MOST STUDIES HAVE LOOKED AT HEARING AND DEM S DEMENTIA HAVE YOU'D AUDITORY PERIPHERY. IF YOU LOOK AT SPEECH UNDERSTANDING AND NOISE PERFORMANCE AND PEOPLE WITH DEMENTIA VERSUS COGNITION AND NOISE TAPS INTO COGNITIVE RESOURCES AND THEY HAVE A HEARING LOSS AND LESS COGNITIVE RESOURCES TO DECODE SPEECH. MOST STUDIES HAVE FOCUSSED MORE ON A PERIPHERAL MEASURE OF HEARING VERSUS POOR SPEECH PERFORMANCE AND DEMENTIA. >> WE HAD A QUESTION. >> THANKS, FRANK. THIS IS TERRIFIC. I HAVE A QUESTION AND I DON'T KNOW IF YOU'LL KNOW THE ANSWER BUT SOCIAL ISOLATION AND LONELINESS ARE TWO DIFFERENT CONSTRUCTS. ISOLATION BEING OBJECTIVE AND LONELINESS IS HOW YOU FEEL ABOUT IT. IS THERE A SENSE WHICH ONE OF THESE IS MORE IMPACTFUL OR RISK IMPAIRMENT OR CAUSES THE INFLAMMATORY RESPONSE SO WHEN WE THINK OF INTERVENTIONS AND SOLUTIONS DO WE GO FOR INCREASED ACCESS TO NETWORKS VERSUS DO WE REALLY DEAL WITH SKILLS IN FRIENDSHIP DEVELOPMENT, FOR EXAMPLE. >> GREAT QUESTION. ANY UNDERSTANDING OF THE ALL RIGHT THEY'RE LOOKING -- LITERATURE THEY'RE LOOKING AT LONELINESS AND PHYSIOLOGICAL OUTCOMES AND LONELINESS IS MORE TO THE SOCIAL NETWORK SIDE. YOU MAY HAVE PLENTY OF SOCIAL CONTACTS BUT IF YOU CAN'T TALK TO THEM YOU'RE NOT ENGAGING. QUALITY VERSUS QUANT PER SE. AN THERE WAS MORE ON THE IDEA OF THE LONELINESS THE SUBJECTIVE COMPONENT OF LONELINESS COMPARED TO [NO AUDIO] >> THAT'S A GATE QUESTION THERE'S GOOD GREAT QUESTION. THERE'S WORK DONE AT UCLA AND OTHER PLACES. PRIMARY CLASSIC AMYLOID TANGLES THE STUDIES HAVE NEVER BEEN FOUND IN THE PERIPHERAL AUDITORY SYSTEM. THERE'S NEVER BEEN BETA AMYLOID FOUND IN THE COCHLEA AND CENTRAL STRUCTURES ABS OUT LIE LICK THE REST OF THE BRAIN -- ABSOLUTELY IN THE REST OF THE BRAIN AND THERE'S BEEN NO EVIDENCE FOUND. >> THANK YOU. >> FRRCHK, THANK YOU FOR YOUR -- >> FRANK, THANK YOU FOR THE TALK. WE KNOW THERE'S DIFFERENCES IN DEGREE OF HEARING LOSS BY GENDER AND CONFIGURATION AND LONGITUDINAL CHANGES IN WOMEN AS THEY GET OLDER. I WONDER IF THERE'S DIFFERENCE OF GENDER DIFFERENCES IN THAT HEARING LOSS, AGE-RELATED DYSFUNCTION IN THE TEMPORAL LOBE FROM THE IMAGING STUDIES LOOKING AT FUNCTIONAL CONNECTIVITY OR SOMETHING LIKE THAT. >> YOU BRING UP A GREAT POINT. I'LL BE HONEST OFF THE TOP OF MY HEAD I REMEMBER A COUPLE STUDIES WITH THE BRAIN AND HEARING LOSS M.R.I., I DON'T RECALL WHETHER WE LOOKED AT STRATIFIED ANALYSIS BY MEN AND WOMEN. I THINK WE WILL. I DON'T THINK WE DID OR MAYBE WE DID AND THERE WASN'T A DIFFERENCE. DON'T FORGET THE STUDIES ARE RELATIVELY LARGE FOR SEVERAL HUNDREDS OF PEOPLE FOLLOWED FOR YEARS AND YEARS AND THAT'S RELATIVELY SMALL IF YOU'RE TRYING TO DISCERN FOR DIFFERENCES. I HONESTLY DON'T RECALL IF WE DID OR IF WE DID THERE WASN'T ANYTHING THERE IF WE MADE THE SAMPLE SIZES TOO SMALL AND SOMETHING WE COULD INVESTIGATE MORE. >> OKAY. THANKS. >> THANK YOU. >> A QUESTION. THERE'S TWO VARIABLES, AGE AND HEARING LOSS. HOW ARE THESE FINDINGS SIMILAR OR DIFFERENCE THAN THOSE WITH UNTREATED HEARING LOSS IN YOUNGER SUBJECTS IS THERE A TRADE-OFF BETWEEN HEARING LOSS AND THE AMOUNT DAMAGING. >> A COUPLE THOUGHTS. AGE IS BY FAR ONE THE CONFOUNDERS THAT HAS TO BE ADJUSTED FOR IN THE ANALYSES. WE NEED A BIG ENOUGH SAMPLE SIZE TO EDUCATE -- ADJUST FOR AGE. AS THE WHAT'S BEEN DONE AND WE CAN ADJUST FOR AGE WE'RE STILL SEEING A ROBUST ASSOCIATION. THE SECOND POINT WAS THE IDEA OF HEARING LOSS AND MAYBE OCCURS IN EARLIER LIFE PER SE SAY EARLY MID LIFE OR A KID. IT'S A GREAT QUESTION. WE DON'T KNOW HOW THAT AFFECTS DEMENTIA AND ONE IT'S HARDER TO STUDY WE NEED A LOT OF PEOPLE AND NOT THAT MANY PEOPLE HAVE EARLY CONGENITAL HEARING LOSS. THE SECOND FROM A THEORETICAL STANDPOINT I'D ARGUE THE MECHANISMS OF HOW HEARING LOSS IS LINKED WITH DEMENTIA ARE LIKELY VERY DIFFERENT IN SOMEONE WITH CONGENITAL DEAFNESS AND MAY NEVER BE SOCIALLY DISTANCED AND HOW HEARING LOSS AFFECT THE BRAIN AT A 1 Y-YEAR-OLD IS DIFFERENT THAN 70 YEARS OLD WITH A LIFE TIME OF HEARING. WE CAN ADDRESS IT LATER AGAIN TOO. SHOULD I MOVE ON TO THE NEXT SECTION? >> YES, LET'S GET THROUGH THE PRESENTATION. >> I'M HAPPY TO STAY LATER BUT TRYING TO BE MINDFUL OF OTHER PEOPLE'S TIME. SO WHAT IS THE SCIENTIFIC EVIDENCE? IMPORTANTLY HERE WHAT I'LL SAY IS WHEN YOU STUDY THIS THERE'S MANY WAYS OF DOING SCIENCE BUT I THINK IF YOU'RE LOOKING AT HEARING LOSS DEMENTIA IT ARGUES FOR ONE DOMINANT APPROACH OF THE INITIAL REVIEW AND LARGE STUDIES OF OLDER ADULTS IN THE COMMUNITY NOT CLINICAL SAMPLES AND MAINLY BECAUSE IT ALLOWS FOR CAREFUL AND PRECISE MEASURES OF WHAT BY HEARING WHAT YOU MEAN BY COGNITION AND OTHER VARIABLES YOU NEED TO ADJUST FOR. THAT'S ONE BIG THING. CLEARLY, YOU WANT TO GENERALIZE A STUDY COHORT AND AT HOPKINS WOULD NOT BE GENERALIZABLE AND WITH A LARGE ENOUGH SIZE YOU CAN HAVE METHODS TO ADJUST TO LEAD TO AGE AND OTHER THINGS AND YOU NEED A SAMPLE SIZE. OTHERS ARE MORE COMMON IN THE HEARING AUDITORY SCIENCE AND CLINICAL RESEARCH AND ANIMALS AND PSYCHOLOGICAL BASED RESEARCH ARE VALID AND HELPFUL BUT YOU CAN'T GET AT SOME THINGS THAT ARE CONFOUNDING IN GENERALIZABILITY. THERE WAS A PAPER THAT CAME OUT IN 1989 PUBLISHED IN JAMA 21 YEARS AGO NOW. SORRY, 31 YEARS AGO NOW THE FIRST PROPOSED A LINK BETWEEN HEARING LOSS AND DEMENTIA. A CASE CONTROL STUDY THAT LOOKED AT 100 PEOPLE WITH A.D. AND EDUCATION MATCHED AND ON THE RIGHT YOU SEE THERE WAS ABOUT A TWO AND A HALF TIMES LOSS OF DEMENTIA WITH HEARING LOSS. THE GREATER THE HEARING LOSS THE GREATER THE ODDS OF SOMEONE HAVING DEMENTIA. THIS WAS DONE BY ERIC LARSSON. HE'S STILL ACTIVE AT THE UNIVERSITY OF WASHINGTON. THIS SORT OF GOT BURIED. OVER THE NEXT 20 YEARS YOU LOOKED AT IT AND A CUED MEASUREMENT -- CRUDE MEASUREMENT OF COGNITION AND THEN THEY'RE LIKE LET'S JUST ASK SOMEONE HOW THEIR HEARING IS RATHER THAN PRECISELY MEASURING IT AND A LOT OF SHOWED THE MEASURES OF BOTH TRYING TO GET A REAL ASSOCIATION. IT WAS AN ABOUT 20 YEAR GAP AND NOT MUCH WAS DONE DESPITE THIS BEING PUBLISHED 20 YEARS AGO. THIS IS A PAPER THAT INSPIRED US A LITTLE BIT AND THE FIRST PAPER THAT CONFIRMED IT IN A RIGOROUS LONGITUDINAL FASHION AND COLLABORATION BETWEEN US AND HOPKINS AND INTRAMURAL RESEARCH STUDY AT NAI THE LONGEST STUDY OF ADULTS IN THE U.S. BY FAR. AND WE'RE CLASOLLABORATED BUT WE LOOKED AT HEARING TESTING AND WE GOT HEARING MEASURES AND IF YOU LOOK AT THE 640 PEOPLE IN THE EARLY '90s AND FOLLOW THEM THE FIGURE ON THE LEFT IS ADJUSTED AND THERE'S A CLEAR BREAKDOWN OF HEARING LOSS AT BASELINE AND THE RISK OF DEMENTIA OVER TIME AND YOU APPLY STATISTICAL MODELS AND ADJUST FOR AGE, RACE, DIABETES, THINGS LIKE THAT WE SAW ON AVERAGE COMPARED TO PEOPLE WITH NORMAL HEARING, AND THERE'S A TO TWOFOLD AND FIVE- -- FIVEFOLD INCREASE OF DEMENTIA AND WE'RE SEEING THE SAME ORDER OF MAGNITUDE OF ASSOCIATION. WHEN WE PUBLISHED THIS YEARS AGO WE WERE HESITANT BECAUSE THESE ARE INCREDIBLY STRONG RISK RATIOS FOR DEMENTIA YOU DON'T TYPICALLY SEE. THE HALLMARK OF SCIENCE REPLICATION THIS WAS DONE A YEAR LATER AT OXFORD AND THERE WAS A STUDY THAT FOLLOWED A BUNCH OF MEN OVER 1,000 MEN OVER YEARS AND LOOKING AT THE PUROTONE AVERAGE AND THE FULLY ADJUSTED MODEL FOR EVERY INCREASING 10 DECIBELS OF HEARING LOSS A TWO AND A HALF INCREASED ODDS OF DEMENTIA OVER TIME AND THE DEGREE OF MAGNITUDE WITH WHAT WE GET FROM THE BCA. AND I'LL MENTION A SITE FROM HOPKINS LOOKING AT A DATA SET AND A STUDY OF 2,000 OLDER ADULTS RECRUITED FROM MEMPHIS AND PITTSBURGH WERE FOLLOWED FOR 15 YEARS. WHAT YOU SEE ON THE RIGHT IS THE X AXIS IS THE PUROTONE AVERAGE AND THE Y AXIS IS THE HAZARD OF RISK OF BEING DIAGNOSED WITH DEMENTIA OVER TIME AND NOT A ROBUST METHOD OF DIAGNOSING AND YOU SEE THE LEVEL AROUND 50. THERE WEREN'T THAT MANY PEOPLE IN THE CATEGORY OF HEARING LOSS. WE SEE MORE UNCERTAINTY GOING TO HIGHER LEVELS OF HEARING LOSS. I WANTED TO SUMMARIZE THOSE THREE BECAUSE THOSE ARE THE THREE THE MOST ROBUST IN TERMS OF METHODOLOGY AND HOW HEARING IS MEASURED AND THINGS LIKE THAT. AND THOSE ARE THE THREE STUDIES WHICH SERVED AS THE DIRECT BASIS OF THE FIGURE. THE META-ANALYSIS FOR HEARING LOSS AND DEMENTIA WAS BASED ON THOSE THREE STUDIES ALONE. THERE ARE PLENTY OF OTHER STUDIES. AND THERE'S INCLUSION CRITERIA OF THE LANCET COMMISSION AND OTHERS ARE QUITE GOOD TOO. THEY ALL CONVERGE ON THE SAME IDEA BUT THOSE WERE INCLUDED IN THE META-ANALYSIS BECAUSE OF THEIR INCLUSION CRITERIA. NOW, IMPORTANTLY, AS DR. KING MENTIONED IT'S THE LARGEST POTENTIALLY MODIFIABLE RISK FACTOR FOR DEMENTIA AND KEY OPERATIVE WORD. W THINK IT'S RELATED, WE THINK IT'S ASSOCIATED BUT IS IT IN FACT ASSOCIATED SO IF YOU TREAT IT, IS IT MODIFIABLE. THIS QUESTION REMAINS UNKNOWN. WE DON'T KNOW IF YOU TREAT HEARING LOSS WOULD IT DELAY DEMENTIA. WE DON'T KNOW. THE REASON IS AS MUCH AS YOU WANT TO IN SOME STUDIES SUGGEST YOU CAN'T ANSWER WITH OBSERVATIONAL DATA. DO THOSE WITH HEARING AIDS DO BETTER? THEY DO BUT WE NEVER SHOW THE DATA BECAUSE YOU CONSENT QUITE BELIEVE IT BECAUSE YOU HAVE TWO GROUPS OF PEOPLE BOTH WITH HEARING LOSS AND ONE GROUP WITH A HEARING AID AND ONE DOESN'T AND ONE IS MORE EDUCATED OR AFFLUENT OR CONSCIOUS AND IS IT THOSE MEASURES. IT'S ALMOST IMPOSSIBLE TO DISENTANGLE THE DATA. IN THE HISTORY OF OUR FIELD THERE'S NEVER BEEN A RANDOMIZED CONTROL TRIAL OF TREATING HEARING LOSS SO THE EFFECTS OF LARGER OUTCOMES. AND PART OF THE REASON WHY IT'S IMPORTANT IS IF YOU BELIEVE THE MECHANISMS MAY IN FACT BE IN PLAY THAT LINK DEMENTIA THERE'S EVERY REASON CONCEPTUALLY TO BELIEVE BASED ON PROOF OF PRINCIPLE TREATING HEARING LOSS COULD CAUSE LESS COGNITIVE DECLINE AND YOU REDUCE COGNITIVE LOAD AND THE WHOLE REASON WE TREAT HEARING LOSS IS TRY TO IMPROVE SOCIAL ENGAGEMENT AND REDUCE LONELINESS IT BRINGS UP THE IDEA OF TREATING LOSS IN MODIFIABLE LATE LIFE RISK FACTORS FOR CONSECUTIVE DEMENTIA. IF YOU GO BACK TO THE LANCET LITERATURE THE RISK FACTOR EARLY LIFE EDUCATION AND MIDLIFE CARDIOVASCULAR DISEASE AND IF YOU'RE SEEING AN OLDER WOMAN YOU CAN'T SAY YOU HAVE CARDIOVASCULAR DISEASE AND IT MAY BE TOO LATE TO TREAT BUT HEARING LOSS MAY BE MODIFIABLE FOR SOMEONE IN THEIR 50s AND 60s AND 70s. AND THIS IS A CLINICAL TRIAL OUT BEING ACTIVELY FUNDED AND DONE ACROSS THE UNITED STATES CALLED THE ACHIEVE STUDY. THE AGING AND CONSECUTIVE HEALTH EVALUATION ELDER STUDY SEEING A THOUSAND OLDER ADULTS RANDOMIZED TO BEST PRACTICE HEARING TREATMENT OR GET FIT WITH HEARING AIDS AND THE OTHER GETS DIFFERENT METHODS AND WE'RE LOOKING AT RATES OF COGNITIVE DECLINE OVER THE THREE-YEAR PERIOD AND A HOST OF OUTCOME MEASURES LOOKING AT THINGS LIKE INSTANT DEMENTIA AND BRAIN M.R.I. SCANS AND SPONSORED BY THE NIDCD INITIATIVE AND OUTCOME MEASURES. THE UNIQUE THING ABOUT THE STUDY IS THIS TRIAL'S NESTED WIN AN ONGOING VERY LONG TERM OBSERVATIONAL STUDY CALLED THE ARIC STUDY FUNDED BY NHLBI. 16,000 PEOPLE BACK THEN AND THE GOAL WHEN IT STARTED 35 YEARS AGO WAS TO LOOK AT MIDLIFE CARDIOVASCULAR DISEASE AND EVENTS. THE COHORT HAS BEEN FOLLOWED TO PRESENT DAY. THE STUDY IS NESTED WITHIN ARIC. THAT OFFERS A BUNCH OF SYNERGY AND WE'RE USING THE SAME STAFF AND PROTOCOLS. THE ARIC STUDY HAS BEEN A STUDY WITH THE SAME PROTOCOLS IN PLACE AND THERE'S TREMENDOUS OPERATIONAL EFFICIENCY ACROSS MANY LEVELS AND THE SCIENTIFIC POWER IS INTERESTING TOO. MOST CLINICAL TRIALS ARE PREDICATED ON FOLLOWING SOMEONE AT BASELINE AND SEEING COGNITIVE DECLINE OR IT STAYS FLAT BUT YOU'RE PREDICATED ON CHANGE FROM BASELINE. THE ADVANTAGE OF ARIC SINCE A THIRD ARE COMING FROM ARIC, WE HAD THE PREVIOUS AMOUNT FROM TRAJECTORIES TO MODEL AT THE END DOES TREATING HEARING LOSS CHANGE THE LIFE COURSE TRAJECTORY OVER TIME AND THAT'S IMPORTANT ACTUALLY. YOU SEE IT INVOLVES MANY CENTERS ACROSS THE UNITED STATES. MANY ARE SHARED BETWEEN ACHIEVE AND ARIC AND COORDINATES ARE SHARED ACROSS. THE SITES THAT MODULIZE THE HEARING IS A SEPARATE COURSE AND WE SHARE THE SAME AS THE CLIFF JACKS GRUP AT THE MAYO CLINIC. BRIEFLY THE INTERVENTIONS WE'RE TALKING ABOUT OPERATIONALIZED BY THE UNIVERSITY OF SOUTH FLORIDA IS BEST PRACTICES AS GOOD AS YOU CAN GET IT, FACE TO FACE SESSIONS WITH AN OTOLARYNG OL GISTS. AND THE OTHER GROUP GETS RANDOMIZED TO SUCCESSFUL CONTROL GROUPS. THIS IS AN ESTABLISHED PROGRAM FUND THE CDC AND GOES OVER CRITICAL HEALTHY AGING TOPICS, NUTRITION, DIET, THINGS LIKE THAT. THE KEEPING IS PARTICIPANTS ARE ALL MATCHED IN TERMS OF EXPOSURE TO STUDY PERSONNEL. THAT IN AND OF ITSELF MAY BE USEFUL. GENERAL INCLUSION CRITERIA WITH ADULTS WITH MODERATE HEARING LOSS AND NO COGNITION AND SEMIANNUAL VISITS AND THEY HAVE A 45 MINUTE NEUROCOGNITIVE BATTERY. WE MAKE SURE THEY UNDERSTAND WORDS SPOKEN TO THEM TO MAKE SURE IT'S NOT BEING CONFOUNDED BY ANY DEGREE OF SPEECH ISSUES. THERE'S A HOST OF OUTCOMES THERE'S THERE'S BEEN A 30% PRODUCTION IN GLOBAL COGNITIVE DECLINE. WE BEGAN RECRUITMENT AND TRYING TO GET TO 850 ON TIME AND ON BUDGET OF JULY OF LAST YEAR. BECAUSE IT WAS GOING SO WELL AT THE RECOMMENDATION OF ADVISORS WE KEPT IT GOING WELL AND THE TRIAL WOULD PROBABLY NEVER BE REPEATED AGAIN AND EXTENDED AND WE ALMOST GOT TO 1,000 PEOPLE. THE BLUE LINE IS PROJECTED RECRUITMENT AND OVER SHOT IT WITH THE SUPPORT OF NIA. A TRIAL OF THIS MAGNITUDE IS DIFFICULT TO GET TO 1,000 PEOPLE IN THE BLACK INVOLVED ALMOST 3,000 VISIT TO JUST GET TO THAT POINT. THERE'S A LOT OF EFFORT. IN TERMS OF THE TIME LINE THE FOUNDATION FOR WHY WE SHOULD DO THE STUDIES LAID THE FOUNDATION AND THIS TWO-YEAR PERIOD THERE WAS A FUNDING TO SUPPORT THE DEVELOPMENT OF THE FULL TRIAL. TAKING YOU THROUGH THE OPERATION, MANUALIZATION AND WE DID A PILOT STUDY SUPPORTED BY IN THE R34 BUT OTHER MECHANISMS AND FUNDING STARTED AT THE END OF 2017 AND SEASON FUNDED A YEAR LATER. RECRUITMENT ON TRACK AND ON TIME CLOSED LAST YEAR IN OCTOBER. AND SINCE HAS BEEN SEMIANNUAL FOLLOW-UP. WE WERE FORTUNATE, WHEN COVID HIT WE HAD FULLY RECRUITED AND EVERYONE GOT THEIR HEARING INTERVENTION AND WE'RE IN THE FOLLOW-UP PHASE WHICH IS EASIER TO HANDLE THE COVID DISRUPTIONS OR VISITS AND WE CAN SWITCH TO TELEVISITS AND WE'RE USING VIDEO CONFERENCING AND WE'RE IF IN THE MIDDLE OF RECRUITMENT NOT GOOD BUT BY LUCK OF TIMING WE WERE ABLE TO ASH -- ABSORB THE CHANGES WITH COVID. AND THE DIVISION OF NEUROSCIENCE TOOK THIS ON THE MANTLE MANY YEARS AGO AND STARTED WITH WEN CHEN AND OTHERS. THAT IS THE SECOND TO LAST SLOOID -- SLIDE AND I HAVE ONE MORE AND BE HAPPY TO TAKE QUESTIONS. IN TERMS OF RESEARCH GAPS AND OPPORTUNITIES THERE'S A ROLE TO UNDERSTAND THE BROADER ROLE FOR PERIPHERAL AND CENTRAL AS BIOMARKERS VERSUS ETIOLOGICAL CONTRIBUTORS. HOW DOES IT AFFECT THE BRAIN OR HOW DOES A BRAIN CHANGE AFFECT CENTRAL AUDITORY MEASURES. THERE'S MANY LEVELS TO LOOK AT AND SCIENCE COULD BE DIFFERENT DEPENDING ON WHAT YOU ARE SEEING AND THERE'S CLEARLY A ROLE TO STUDY THE ROLE OF DIFFERENT HEARING INTERVENTIONS. THIS COULD BE A PRIMARY, SECONDARY AND TERTIARY INTERVENTIONS AND PEOPLE WITH NORMAL COGNITION AND REDUCE COGNITIVE DECLINE AND SOMEONE ALREADY AT RISK OF DEMENTIA CAN YOU REDUCE PROGRESSIVE DEMENTIA AND SOMEONE WHO HAS DEMENTIA NOW YOU CAN'T REVERSE IT ANYMORE BUT WE KNOW HEARING LOSS CAN ADD ANOTHER LATER OF COMPLEX TO CARE BECAUSE THEY'RE STRUGGLING TO COMMUNICATE, THEIR SCORES ARE HIGHER AND PEOPLE WITH DEMENTIA AND HEARIN LOSS ARE WORSE OFF IN TERMS OF THEIR SYMPTOMO TOLGY AND CAN YOU LOOK AT OTHER THINGS AND ANOTHER OPEN RESEARCH QUESTION THAT REQUIRES SYNERGY ACROSS THE FIELD AND WHAT WILL HELP WITH SCIENCE FOR 21 YEARS IN 1989 TO 2010 THERE'S NEVER BEEN RESEARCHERS TO SPAN BOTH FIELD, BASIC SCIENCE AND PUBLIC HEALTH AND IN TALKING ABOUT SPAN THE KEY IS UNDERSTANDING THE LANGUAGE UNDERLYING BOTH FIELD TO MAKE PROGRESS. THAT'S WHERE IT'S BEEN HINDERED IN THE PAST. THAT'S MY LAST SLIDE. THANK YOU AND I'LL BE HAPPY TO TAKE QUESTIONS. >> THANK YOU, FRANK. WE HAVE A FEW MINUTES FOR QUESTIONS AND THERE'S A COUPLE IN THE CHAT ALREADY. ONE GOES BACK TO PRIOR TO TALKING ABOUT THE ACHIEVE STUDY AND YOUR CONVERSATION ABOUT HARG AND DEMENTIA. THE QUESTION IS IF THERE'S STUDIES TRACKING COCHLEA IMPLANT USERS AS THEY AGE AND IS IT MORE ABOUT THE AGING BRAIN AND WHAT DO WE KNOW ABOUT THAT GROUP OF FOLKS. >> THERE'S BEEN TOUGH. AND THERE'S BEEN WORK IN PARIS WHERE THEY HAVE A NICE STUDY LOOKING AT MEASURING LONGITUDINALLY OTHER OUTCOMES BEFORE AND AFTER COCHLEAR IMPLANTATION WHICH SEEMS TO HAVE A BIG DIFFERENCE IN MAINTAINING AND IMPROVING FUNCTION. THERE'S NEVER BEEN A RANDOMIZED TRIAL. IT'S HARD. AND THIS IS OBSERVATIONAL DATA AND SOME OF THE BEST THINGS HAVE COME OUT OF PARIS AND AUSTRALIA ROBERT BRIGGS IS DOING NICE WORK LOOKING AT THAT POPULATION. IT'S A SMALLER SAMPLE SIZE AND CLINICALLY SPECIFIC POPULATION. >> THERE'S ANOTHER QUESTION ABOUT MIDDLE EAR CONDITIONS LIKE FOR EXAMPLE OTOSCLEROSIS WHICH IS AN ATTENUATION ISSUE WHICH IS DITCH THAN THE CENTRAL DISTORTION THAT COMES WITH SENSORINEURAL HEARING LOSS. HAS THERE BEEN A DIFFERENCE BETWEEN TYPES OF HEARING LOSSES AND DEMENTIA RATE AND SEVERITY? HAVE PEOPLE LOOKED AT THAT? >> GREAT QUESTION. TO BE HONEST, NO YOU IN CAN ANYTHING OTO SCLEROSIS AFFECTS A FEW AMOUNT OF PEOPLE AND WE DON'T HAVE BONE CONDUCTION. ONE WEAKNESS OF ALL THESE TYPES OF STUDIES. THE KEY THING IS WE DON'T HAVE ROBUST MEASURES TO CHARACTERIZE THAT ETIOLOGY. AND WE CAN LOOK AT HOW THAT CAN AFFECT THE BRAIN THAN TRUE SENSORINEURAL LOSS. >> THIS QUESTION IS ABOUT ANALYZING THE INTERACTION OF HEARING LOSS AND DEMENTIA. HOW IS HEARING LOSS OF THE VESTIBULAR INNER EAR FUNCTION ACCOUNTED FOR? >> GREAT QUESTION. NOT DIRECTLY USUALLY AT ALL. THEY'RE DIFFICULT TO GET. IT'S NOT CONTROLLED FOR AT ALL. IT COULD CONTRIBUTE. I WOULD SAY SOME CLINICIANS AT JOHNS HOPKINS ARE ACTIVE IN THIS AREA AND THERE COULD BE RECOMBINANT INTERACTION WITH ALL SENSES IMPACT THE BRAIN BUT WE'RE NOT ABLE TO CONTROL BECAUSE WE DON'T HAVE MEASURES OF SIMILAR FUNCTIONS IN STUDIES. >> CAN YOU CONTROL FOR VISION? >> IT'S AUNSATISFYING AND USUALLY EXCLUDED. YOU HAVE A PERFORMANCE CRITERIA OF VISION TO ENTER THE STUDY. THEY'RE USUALLY EXCLUDED. A LOT OF TIMES THEY'RE EXCLUDED FROM THE STUDIES VISION CAN BE THE COGNITIVE TEST, FOR INSTANCE. >> YOU POINTED OUT THERE'S BEEN SHOWN FOR CO-OCCURRENCE OF INNER EAR IN THE COCHLEA AND VESTIBULAR AREAS SO THAT'S OF PARTICULAR INTEREST. DO YOU KNOW OF ANY EFFORTS TO BRING THOSE TWO TOGETHER? TO DO A CO-CONSIDERATION OF THOSE TWO INTERACTING FACTORS? >> WE ACTUALLY HAVE COURTESY OF NIA HAVE AN NIA SPONSORED TRIAL WITH COLLEAGUES WHICH LOOKS AT THE DATA. THEY HAVE ROBUST MEASURES OF PERCEPTION AND IN TERMS OF MODELING THE CO-OCCURRENCES AND THE TRIPLE SENSORY IMPAIRMENTS HOW IT AFFECTS THE BRAIN AND FUNCTIONING IS AN ACTIVE RO1 WE'RE WORKING ON. >> GREAT TO HEAR. THANK YOU SO MUCH. >> I THINK WE HAVE TIME FOR MAYBE ANOTHER SHORT QUESTION. WELL, THIS IS GREAT, FRANK. REALLY STIMULATING. I WANT IT THANK YOU BOTH YOU AND DR. ST. HILLAIRE-CLARKE FOR YOUR CONTRIBUTIONS AND FOR YOUR OFFER IF PEOPLE HAVE INTERESTED OR HAVE FOLLOW-UP QUESTIONS TO REACH OUT TO YOU WHICH WOULD BE GREAT. I THINK THAT CONCLUDES THIS SESSION. I'M HAPPY TO HAND IT OVER TO DR. TUCCI. >> THANK YOU SO MUCH. THAT WAS ABSOLUTELY FASCINATING. REALLY ENJOYABLE AND APPRECIATE IT VERY MUCH. SO I DON'T HAVE ANYTHING ELSE TO END TODAY'S SESSION. DOES ANYBODY HAVE ANYTHING ELSE THEY WANTED TO SHARE OR ASK ABOUT? SO WE KNOW OUR NEXT MEETING WILL BE VIRTUAL IN JANUARY AND WE'LL BE COMMUNICATING IN THE MEANTIME. I THINK WE HAVE A LOT OF THINGS TO DISCUSS IN TERMS OF THE OPEN SESSION WE CONDUCTED YESTERDAY. AND LOOK FORWARD TO INTERACTING WITH ALL OF YOU IN BETWEEN NOW AND JANUARY. STAY SAFE, STAY WELL AND TAKE CARE.