>> SO, GOOD MORNING, EVERYBODY. I'D LIKE TO CALL THE 202nd MEETING OF THE NATIONAL ADVISORY DENTAL AND CRANIOFACIAL RESEARCH COUNCIL. WE WERE WAITING FOR DR. DAVID TO, TODAY IT'S ABNORMALITIES SLOTLY BEAUTIFUL HERE BUT SOMEWHAT WAS CHALLENGING TO GET HERE SO THANK YOU FOR MUCH FOR MAKING THE RIDE. SOME PEOPLE OPTED NOT TO TAKE THE PLANE BUT TOOK TRAINS AND THAT WAS INNOVATIVE AND WE APPRECIATE IT. SO WE HAVE A FULL AGENDA THIS MORNING, THIS IS ALWAYS--THE BEGINNING OF THE YEAR IS WHEN WE TALK ABOUT THE BUDGET AND THEN WE'RE GOING TO HAVE A LITTLE BIT OF ENGAGEMENT IN STRATEGIC PLANNING WITH COUNCIL AND FOLLOWED BY A 1 OF OUR WONDERFUL PORTFOLIOS IN THE PAIN, TRANSNIH INITIATIVES AS WELL AS PROJECTS HERE SO IT'S GOING TO BE A GREAT MORNING AND I WELCOME COUNCIL MEMBERS AND EVERYONE WHEREVER THEY MAY BE. AT THIS POINT I'D LIKE FOR OUR GUESTS TO INTRODUCE THEMSELVES AND MAYBE I'LL START SOMEWHERE OVER HERE AND JUST GO AROUND? I MEANT TO INTRODUCE YOU. >> [INDISCERNIBLE]. >> [INDISCERNIBLE]. [INDISCERNIBLE] >> [INDISCERNIBLE]. >> [INDISCERNIBLE]. >> ALL RIGHT, I THINK--ALL RIGHT. AND SO WE HAVE 2 OFFICIAL OR ACTUALLY 3 OFFICIAL NEW MEMBERS DR. HECTOR BALKAZAR, HE'S THE REGIONAL DEAN AT THE HOSPITAL IN EL PASO, PROMOTION OF HEALTH AND BEHAVIOR SCIENCES. UNIVERSITY OF TEXAS HOUSTON SCHOOL OF PUBLIC HEALTH EL PASO REGIONAL CAMPUS, HE SPECIALIZES IN THE STUDY OF PUBLIC HEALTH PROBLEMS OF LATINOS IN THE MEXICAN AMERICANS, HE'S BI-LINGUAL, BICULTURAL AND HE'S A PUBLIC HEALTH SCIENTIST WHO CONDUCTED NUMEROUS STUDIES OF LATINO BIRTH OUTCOMES. ACULTERATION AND HEALTH BEHAVIORIAL, HEALTH RELATED BEHAVIORS, CARDIOVASCULAR DISEASE, PREVENTION PROGRAMS IN LATINOS AND BORDER HEALTH ISSUES, WE'RE DELIGHTED TO HAVE HIM JOIN US. THANK YOU. ALSO, IVA N CAPPELAS, DIRECTOR OF GLOBAL HEALTH INITIATIVES AND PERIO DON'TICS AND ORAL MEDICINE, UNIVERSITY OF MICHIGAN SCHOOL OF DENTISTRY, HER INTERESTS INCLUDA EXTRA CELLULAR BIOLOGY OF THE CRANIOFACIAL COMPLEX WITH FOCUS ON PERIODONTAL PATHOGENS AND HEAD AND NECK CANCER. WELCOME, WE'RE DELIGHTED TO HAVE YOU HERE. IN ADDITION TO THAT, WE ALWAYS HAVE ON OUR COUNSEL A REPRESENTATIVE FROM VETERAN'S AFFAIR AND WE'RE WELCOME TO HAVE DR. PATRICIA OROLO, AND MET WITH HER THIS MORNING AND WE'LL BE HEARING MORE FROM HER, SO JUST AS WE GO ON SO WE'RE DELIGHTED TO HAVE YOU JOINING US AS WELL. IN TERMS OF STAFF ANNOUNCEMENTS, MANY OF YOU AROUND THE ROOM ALSO PERHAPS NOT ON COUNCIL, 1 OF THE FORMER ASSOCIATE DIRECTOR OF MANAGEMENT ALSO CALLED OUR EXECUTIVE OFFICER, YOU MAY NOT KNOW THAT PERSON RUNS NIDCR, NOT I, ANDLY MOVED ON TO A NEW POSITION, TOM, MURPHY AS THE OFFICE OF MANAGEMENT AT NIH, ADMINISTRATIVE SYSTEMS AND TECHNOLOGY OFFICER AND THIS IS REALLY A WIN-WIN FOR US BECAUSE HE'S A VERY WONDERFUL PEOPLE PERSON, AS WELL AS KNOWS THE INFORMATION TECHNOLOGY SIDE INSIDE AND OUT. SO HE'S GOING TO BE HELPING NIH WITH TRYING TO COORDINATE ALMOST IMON POSSIBLE PROJECT BUT HE'S EXCITED ABOUT IT ENTHUSIASTIC AND HE STARTED JANUARY 14th. AND FORTUNATELY FOR US, GEORGE KOI, WHO WAS THE FORMER BUDGET OFFICER, HE WILL BE SERVING AS THE ACTING EXECUTIVE DIRECTOR AND WE'RE BELIGHTED TO HAVE HIM IN THAT POSITION AND THERE'S GEORGE. SO WELCOME. ALSO YOU'LL SEE THE NEW INVESTIGATOR'S BOOKLET WHICH WAS DISTRIBUTED TO COUNCIL AND WE DO THIS ONCE A YEAR. AND REALLY VERY PROUD OF THE NEW INVESTIGATORS AND THE THINGS THEY HAVE ACHIEVED, SO PLEASE TAKE TIME TO EXAMINE THAT. SO MOVING FORWARD. >> ALL RIGHT, I'D LIKE TO WELCOME EVERYONE THIS MORNING AND OUR VIDEO PARTICIPANTS AS WELL FOR ANYONE SPEAKING IN THE ROOM, PLEASE RYE TO USE THE MICROPHONE SO VIDEO PARTICIPANTS CAN HEAR YOU. IF ANYONE EXPERIENCES A PROBLEM WITH OUR YOUR LAPTOP COMPUTER, YOU HAVE OUR SUPERIOR I.T. STAFF TO HELP YOU, JOHN AND LISE? JUST JOHN. WORKING IN THE BACK TODAY, THE FIRST ITEM ON THE BUSINESS AGENDA IS TO APPROVE THE MINUTES FROM THE PREVIOUS MEETING AND SO THESE, THE MINUTES FROM THE SEPTEMBER 2012 MEETING WERE MADE AVAILABLE TO COUNSEL MEMBERS FOR THEIR REVIEW PRIOR TO THE MEETING AND WE GIVE THEM THIS OPPORTUNITY TO MAKE COMMENTS OR SUGGEST CORRECTIONS AND THEN WE'LL TAKE A VOTE. SO ARE THERE ANY COMMENTS OR SUGGESTIONS OR CORRECTIONS FOR THE MINUTES? WOULD A COUNCIL MEMBER LIKE TO MAKE A MOTION TO APPROVE THE MINUTES? SECOND THE MOTION? ALL IN FAVOR? ANY OPPOSED? OKAY, SO THE MINUTES ARE NOW APPROVED AND WE'LL TURN THE MEETING BACK OVER TO MARTHA FOR THE REPORT OF THE DIRECTOR. >> THIS IS ON, RIGHT? YES? OKAY. SO AGAIN, GOOD MORNING AND IT'S TIME FOR BUDGETS. BEFORE I MOVE ON TO THE BUDGET PART, YOU'RE WONDERING, SO WHO'S RUNNING THE BUDGET NOW AT THE BUDGET OFFICE? SO CAROL LOSS, BACK THERE STEPPED UP. SHE'S BEEN IN THE BUDGET TEAM FOR A LONG TIME AND STEPPED UP INTO THIS POSITION AND WE'RE HAPPY TO HAVE HER. IN ADDITION TO THAT, HELPING ME PREPARE THIS WAS CAROL BUT ALSO BRETT DEAN AND OF COURSE GEORGE WHO AS WELL, SO I THANK YOU FOR ASSISTING IN THE PREPARATION OF THIS. BEFORE I MOVE ON TO TALK ABOUT THE BUDGET WHICH IS ALWAYS INTERESTING AND AT THIS TIME, AS YOU CAN IMAGINE HAS BEEN CHALLENGING, I WANT TO MAKE SURE YOU REALIZE THAT THE SIGNS AS MANY OF YOU ARE IN THE OUTSIDE COMMUNITY KNOW HAS JUST BEEN EXPONENTIALLY GROWING AND THE QUESTIONS WE'RE ASKING AND THE WORK WE'RE DOING IS AMAZING BOTH IN OUR INTRAMURAL PROGRAM AND OUR EXTRAMURAL PROGRAM AND I WANTED TO TAKE TIME TO JUST THANK YOU ALL AND BEFORE MOVING ON TO THE BUDGET, I WANT TO DESCRIBE THIS FIRST SLIDE BECAUSE WE HAVE A CHANGE OF A FACE. AND SO, IN THE PAST, AND YOU WILL BE NOTICING THE CHANGES THROUGHOUT THE NIH COMMUNITY. SO THIS LITTLE HANGER HERE WHICH IS THIS IS A DIRECTOR, DR. FRANCIS COLLINS CALLS THIS THE HANGER SYMBOL, IT WAS NOT 1 THAT HE ADMIRED TOO MUCH, WE LOVE OUR PUMPKIN BUT PUMPKIN IS LEAVING US. AND THIS IS THE NEW FACE FOR ALL THE INSTITUTES AND CENTERS. SO ALL OF THEM WILL WILL HAVE THE NIH SYMBOL AND THEN OUR INSTITUTE OR CENTER TO THE LEFT OF IT AND IF YOU GO AROUND CAMPUS OR IF YOU LOOK AT OUR WEB SITE, YOU'LL SEE THESE CHANGES HAPPENING. SO THAT'S ON THAT SIDE. SO IN TERMS OF 2012 AND THE YEAR THAT WAS, I'M GOING TO JUST TALK A LITTLE BIT ABOUT 2012 OR A LOT MORE ON THAT, AND THEN A LITTLE BIT ABOUT WHERE WE ARE IN 2013 AS YOU KNOW, 2013 IS UP IN THE AIR, BUT WE'LL TALK A LITTLE BIT ABOUT SOME OF THE THINGS AND TALK A LITTLE BIT AND THEN TOWARD THE END, GIVE YOU SOME UPBEAT THINGS ON SOME OF YOU NEW INITIATIVES GOING ON IN 2013. SO, IN TERMS OF TOTAL DOLLARS, WE WERE AT 410 MILLION ABOUT FLAT, FROM 2011, TO 2012 AND AS MANY OF YOU HAVE HEARD, FLAT MEANS UP THESE DAYS, IT'S A NEW TERMINOLOGY. SO IN TERMS OF OUR EXTRAMURAL PROGRAM, THAT'S ABOUT 321 MILLION, IT'S ABOUT 78% OF OUR BUDGET. AND THE EPITHELIAL RAMURAL DIVISION IS--INTRAMURAL DIVISION IS ABOUT 16% OF OUR BEST OF MY KNOWLEDGEET AND THIS IS OUR CENTRAL ASSESSMENT AND ALL OF YOU OUTSIDE OF THE COMMUNITY HAVE CENTRAL ASSESSMENT, OURS IS ABOUT 36% SO IT'S QUITE HIGH. THIS INCLUDES UTILITIES, FACILITIES, ALSO WE HAVE A TAX IN TERMS OF THE CLINIC. AND SO IT'S QUITE HIGH. IN ADDITION WE HAVE RESEARCH AND MAGMENT SUPPORT AND THIS INCLUDES THE DAILY OPERATION, OFFICE COST AS WELL AS CENTRAL ASSESSMENTS, ADDITIONAL UTILITIES, FACILITIES, STUDY SECTION, I.T. COSTS AND CAMPUS SECURITY JUST TO MENTION A FEW OF THESE OTHER THINGS THAT WE GET TAXED FOR. BRIBING THIS DOWN A LITTLE BIT MORE IN TERM--BREAKS IN DOWN A LITTLE BIT MORE IN TERMS OF PERCENT OR DETAIL, I'M GOING FROM 1998 TO 2012 BUT BREAK IT UP BECAUSE IN THE 1998 TO 2003, WAS THE TIME OF THAT RAMP UPOF DOUBLING OF YOUR BUDGETS. WE DIDN'T QUITE MAKE THE DOUBLING BUT THERE WAS A RAMP UP, IF YOU LOOK AT THE DOLLARS HERE AND IN TERMS OF PERCENTS OF WHERE WE FOCUSED OUR INCREASE IN PERCENT WISE, IT WAS IN THE RESEARCH PROJECT GRANTS AND AS YOU'LL SEE EVEN AS WE GO ALONG INTO THE 203 AND BEYOND, WE HAVE DECREASED CENTERS AND STRATEGICALLY TO INCREASE THE RESEARCH PROJECT THEN SO TO MAKE SURE THAT WE CAN CONTINUE ON RESEARCH PROJECT GRANTS. CONTRACTS FLUCTUATE, AND THESE CONTRACTS INCLUDE BIOREPOSITORYS, CLINICAL TRIAL MONITORING, NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY, AS WELL AS NATIONAL HEALTH AND NUTRITIONAL EXAMINATION, SURVEY, AND HANES, AND WE SUPPORT MANY OF THESE OTHER ACTIVITIES THROUGHOUT CONTRACTS, SOME YEARLY, SOME 5 YEARS AND THEN SOME THAT WE DON'T RENEW AND REYOU NEW OTHERS INSTEAD SO THOSE GO UP AND DOWN ALL THE TIME. AND THEN MINOR CHANGES IN OTHER PERCENTS, 1 PERCENT OR SO IN OTHER THINGS. IN TERMS OF THE OTHER CATEGORY HERE, THIS INCLUDES SUMMER SUPPORT, CONFERENCE GRANTS AND WHERE THEY REALLY DON'T HAVE ANOTHER CATEGORY SO WE PUT THEM IN THE OTHER. MOVING FORWARD TO 203, 2012, CAN YOU SEE THAT WE'RE CONTINUING TO INCREASE THE RPGs AND DECREASE CENTERS. WE MAINTAIN CENTERS BUT WE HAVE DECREASED THEM. AND THEN OUR TAX KEEPS GOING UP AND SO WHEN THAT GOES UP, WE LOSE MONEY OR NOT LOSE, BUT WE HAVE TO REDISTRIBUTE THINGS AS THEY ARE. RMS GOES UP. IN TERMS OF AWARD MECHANISM, THIS IS ANOTHER WAY OF SHOWING THE BUDGET. IN TERMS OF THE RESEARCH PROJECT GRANTS WE FUNDED A 163 OF 769 THAT WERE RECEIVED, SO OUR SUCCESS RATE WAS AT 21.2% AND YOU'LL SEE ANOTHER SLIDE ON THIS LATER, THAT'SA A SUCCESS RATE, THE NOMINAL PAY LINE WAS 16%. IN ADDITION TO FUNDING THE RPGs, WE'VE ALSO CONTINUED TO FUND SMALL BUSINESS INNOVATIVE AND SMALL BUSINESS TECH TRANSFER AS WELL AS CENTERS, RESEARCH CAREERS AND THE OTHER RELATED RESEARCHERS I MENTIONED BEFORE FOR A TOTAL OF 696 GRANTS. IN ADDITION TO THAT, WE HAVE TRAINING AS WELL AS CONTRACTS, SO THERE'S YOUR EXTRAMURAL DOLLARS GOES TO 321 AND THEN HAVE YOU YOUR INTRAMURAL AND THE RMS FOR A TOTAL OF 410 IN TERMS OF OF DOLLARS. FOCUSING JUST ON THE EXTRAMURAL BUDGET, I MENTIONED BEFORE, THE STRATEGY IS TO PUT A LOT OF EFFORT INTO THOSE INDIVIDUAL AND MULTIDISCIPLINARY RPGs. IN ADDITION TO THAT, WE CONTINUE TO FOCUS VERY SERIOUSLY ON TRAINING AND CAREERS AND WE ALSO CONTINUE TO FUND CENTERS, AS WELL AS THOSE CONTRACTS THAT VARY FROM YEAR TO YEAR. THIS SLIDE HERE IS SHOWN WHEN YOU THINK SO WHERE'S THAT RPG GOING, IS IT IN MY AREA, AND WHEN YOU CAN SEE HERE, IS WE REALLY HAVE A BREDTH TO THE MANY, MANY DIFFERENT AREAS THAT WE FUND. THIS IS NICELY COLOR COATED. I WANT YOU TO REALIZE THAT IN TERMS OF OUR CODES THAT WE USE, YOU'RE ONLY ALLOWED TO USE NOT QUITE LIKE THIS BUT YOU'RE ONLY ALLOWED TO USE 1 CODE FOR 1 AREA AND IF YOU LOOK AT THESE, THEY REALLY INTERLAP SO IN TERMS OF SAYING THAT AREA DEVELOPMENT IN BIOLOGY AND GENETIC SYSTEM YOUR BIGGEST AREA AT NIDCR, WHAT ABOUT MY TINY LITTLE AREA, THEY REALLY DO OVERLAP SO DON'T LOOK AT IT THAT WAY, MOIRE IF YOU LOOK AT IT IN TERMS OF THE MANY, MANY, DIFFERENT AREAS AND I HOPE YOU IDON'TIFY AND CAN SEE YOUR AREA--IDENTIFY AND CAN SEE YOUR AREA AS WELL AS PEOPLE LOOKING VIRTUALLY CAN SEE THEIR AREA IN HERE BECAUSE WE DO FUND QUITE A BIT OF BREDTH IN TERMS OF RESEARCH AREAS WE FIND. SO AGAIN THIS IS IN THE EXTRAMURAL PROGRAM. BREAKING IT DOWN INTO WHAT WE DO FIND, YOU CAN SEE THE MAJOR PART IS ON THE RPGs. WE ALSO CONTINUE TO FUND COOPERATIVE AGREEMENTS, THIS INCLUDES THE PRACTICE BASED NETWORKS. WE CONTINUE TO FUND THE R21S AND RO3S, THREES ARE THE EXPLORATORY RESEARCH PROJECTS AS WELL AS SMALL RESEARCH GRANTS. OF COURSE, OUR MERIT AWARDS WHICH WE'RE VERY PROUD OF, WE CONTINUE TO SUPPORT THOSE AND THEN WE HAVE SOME HIGH PRIORITY SHORT-TERM PROJECTS WHICH ARE THE R56. IN THE OTHER CATEGORY THIS IS YOUR--A LOT OF TRAINING TYPE GRANTS. THE HIGHER LEVEL OF THE TRAINING SO THE R00s ARE IN THE OTHER AS WELL AS THE--SOMETHING CALLED THE DP1S AND 2S WHICH ARE THE DIRECTORS PIONEER AND INNOVATIVE GRANTS, ALSO HERE ARE YOUR R34S, YOUR CLINICAL TRIAL PLANNING GRANTS SO THAT'S IN THE OTHER BLUE CATEGORIES AND THE RO-1S ARE PRETTY CONSISTENT OVER THE YEARS. THIS IS 1 THAT INVESTIGATORS DON'T LIKE TO SEE AND WE HOPE MAYBE IN THE NEXT 5 YEARS IT STARTS CLIMBING BACK UP IN TERMS OF THE PERCENT SUCCESS RATE BUT IT HAS GONE DOWN BUT IT'S BEEN STUDY AND STUDY I RECOGNIZE IS VERY DIFFICULT WHEN WE STILL ARE DEALING WITH INFLATION AND YOU'LL SEE ON ANOTHER SLIDE IT COSTS MUCH MORE TO DO BUSINESS. BUT IF TERMS OF 2012 AS I MENTIONED BEFORE, WE HAD A 21.2% SUCCESS RATE, WHERE THE BLUE LINE, NIH AVERAGE, AND IT'S A REALLY AVERAGE OF 17.8, PROBABLY PLUS AND MINUS 20 BECAUSE IN FACT--OR 15--IN FACT, THERE'S SOME IC INSTITUTES THAT ARE FUNDED AT ABOUT 9% AND OTHERS THAT WENT UP TO ALMOST 30%. SO THERE'S A HUGE RANGE IN TERMS OF THE DISTRIBUTION AND SUCCESS RATE. THIS IS A REALLY IMPORTANT POINT AND IT'S AN IMPORTANT POINT FOR COUNCIL. YOU CAN SEE HERE THAT WE HAVE AS YOUR OWN HOME BUDGETS THEY'RE COMMITTED TO SOMETHING, OBLIGATED MONIES, WE CAN'T DO ANYTHING ABOUT IT SO THEY'RE FIXED, THAT'S YOUR GRANTS, SBIR, SCTR, ONGOING CONTRACT OPERATING EXPENSES, SO RIGHT NOW 2012 WE HAD 18% THAT WAS FLEXIBLE AND THAT'S WHY THE COUNCIL IS SO IMPORTANT IN MAKING AND HELPING US WITH STRATEGIC DECISIONS WITH FUNDING THE BEST SCIENCE WE POSSIBLY CAN. GENERALLY OUR RANGE, I WAS LOOKING AT THIS IN THE LAST YEARS IN TERMS OF FLEXIBLE MONEY HAS BEEN SOMEWHERE BETWEEN 16 ASK 22%. SO, IN TERMS OF WHAT HAPPENED TO OUR INITIATIVES FOR 2012, SO THIS IS BEYOND THE RPGs AND MAKE THANKSGIVING CLEAR BECAUSE SOME PEOPLE GET CONFUSED, THIS ISN'T THE ONLY AREA WE CAN FOCUS ON, WE FUND MANY THINGS BUT THESE HAVE CLEARED THESE INITIATIVES, IN ADDITION TO THE OTHER AREAS THAT WE FUND. SO, 1 WAS THE NATIONAL DENTAL PRACTICE BASED RESEARCH NETWORK AND THIS WAS A LIMITED COMPETITION AND AS WE UPDATED COUNCIL LAST TIME, 1 WAS FUNDED WITH THE CENTRAL COORDINATING CENTER IN BIRMINGHAM AND THEN 6 NODES AND THIS WILL BE UPDATED, FOR THE LAST TIME. THE LABRATIVE RESEARCH ON TRANSITION FROM ACUTE TO CRANIC PAIN AND YOU WILL HEAR MORE ABOUT THIS SHORTLY AND A LITTLE BIT LATER, THERE WERE 21 PROPOSALS THAT WERE SUBMITTED, 6 WERE AWARDED. IN TERMS OF FUNCTIONAL RESTORATION OF SAFULARY GLANDS WE HAD 24, 11 RO-1S, 13 R21S, 5 RO-1S WERE FUNDED AND 4 R21S WERE FUNDED. IN TERMS OF MOLECULAR CHARACTERIZATION OF SAFULAR GLANDS WE HAD 25 RO-1S AND 26 R21S AND TOTAL OF 51 IN THIS AREA. A LOT OF EXCITEMENT, NEW INVESTIGATORS COME NOTHING IN THIS AREA AND WE FUNDED 3 RO-1S RO-1S--WE FUNDED 1 AND FUND TODAY AS A COOPERATIVE AGREEMENT AND IT'S A CLINICAL REGISTRY OF DENTAL OUTCOMES IN HEAD AND NECK CANCER PATIENTS. SO THIS IS THE SLIDE I WAS TALKING TO YOU ABOUT IN TERMS OF 2012 AND THE APPROPRIATION WHICH IS PRETTY FLAT IN TERMS OF THE BLUE LINE BUT IF YOU LOOK AT PURCHASING POWER, WE DO RECOGNIZE THAT THERE'S ACTUALLY BEEN A CUT IN TERMS OF SUPPORT WHEN YOU LOOK AT IT RELATIVE TO INFLATION. 2013, WE'RE ALL STANDING BY. SO WHERE ARE WE IN TERMS OF 2013? UP IN THE AIR AS I THINK ALL OF YOU ARE AWARE. WHAT WE DO IS REVIEW WHAT WE KNOW RIGHT NOW ABOUT 2013 AND THEN SOME RECENT CHANGES BASED ON THE ELECTIONS AND LEADERSHIP IN THE HOUSE AND THE SENATE WHICH I THINK IS IMPORTANT, VERY IMPORTANT FOR NIH AND IMPORTANT FOR ALL OF YOU TO BE AWARE OF. AND ALSO SOME--REVIEW SOME OF THE HOUSE AND SENATE BILLS RECOGNIZING THAT THESE MOVED OUT OF COMMITTEE BUT THERE'S NO, THE DOLLAR FIGURES ARE NOT REAL AND ANYTHING--THERE'S ANY GUESS IN TERMS OF WHERE IT'S GOING, BUT ON THE OTHER HAND, IT DOES SUGGEST AREAS OF FOCUS AND ATTENTION THAT WILL BE HIGHLIGHTED IN THE FUTURE PROBABLY BY BOTH THE SENATE AND THE HOUSE. SO IN TERMS OF CURRENT STATUS AND THIS MAY BE SOMETHING ALL OF YOU ARE AWARE OF, BUT WE ARE UNDER CONTINUING RESOLUTIONS THROUGH MARCH 27th. THE AMERICAN TAXPAYER RELIEF ACT PASSED ON JANUARY 1 AS WE WERE ALL BITING OUR NAILS SO THAT 8.2% CUT ACROSS THE BOARD WHICH WAS STARTING TO BECOME A SERIOUS THING TO CONSIDER WAS AVERTED. NOW IF NO RESOLUTION IS ACHIEVED, A NEW SEQUESTER WILL BE ORDERED AND THAT WILL HAPPEN MARCH FIRST AND WE'LL HAVE TO IMPLEMENT IT BY MARCH 22. WITH ALL THE VARIATIONS IN THE TAXES, THE POTENTIAL REDUCTION NOW WOULD BE APPROXIMATELY 6.4%, VERSES 8.2%. STILL NOT A VERY PRETTY PICTURE FOR US AND FOR NIH. IN ADDITION TO THAT, WE HAVE THE FEDERAL DEBT LIMIT WHICH WAS REACHED ON DECEMBER 31st, AND WE HAVE TILL APPROXIMATELY FEBRUARY 28th WHEN THE TREASURY SPECIAL MEASURES WILL RUN OUT AND CAUSE LESS CONGRESS ACTS TO EXTEND THE LIMIT SO WHAT DOES THIS MEAN. ADMINISTRATION KEEPS SAYING THAT THEY ARE CONFIDENT THAT CONGRESS WILL AGREE TO REPLACE THE SEQUESTER, WITH A BALANCED APPROACH TO ADDRESSING LONG-TERM SPENDING ISSUES AND THE BUDGET DEFICIT AND WE SURE HOPE THAT THIS WILL HAPPEN AND I THINK ALL OF US AGREE THAT'S THE BEST SOLUTION BUT ANYTHING GOES. IMPORTANTLY, WE HAVE NO INTENTION OF RAMPING DOWN ON SPENDING, DURING THIS UNKNOWN SEQUESTER BUT WE'RE GOING TO BE CAUTIOUS AS WE HAVE IN THE PAST UNTIL A FINAL FY13 FUNDING IS DETERMINED SO WHAT DOES THIS CAUTION MEAN, IT INCLUDES TO FUND THE NONCOMPETING GRANTS AT 90% OF THE APPROVAL LEVEL AND THIS IS SOMETHING WE'VE ALWAYS DONE DOING CONTINUING RESOLUTION, SO IT'S NOT ANYTHING NEW. SO IN TERMS OF THE COMMITTEES, AND THESE ARE VERY IMPORTANT NIH AND THEY HAVE A HUGE IMPACT ON HOW WE DO BUSINESS, WE HAVE TO HAVE SOME SANITY THERE, SO THE RECENT ELECTION BROUGHT ABOUT A FEW CHANGES IN LEADERSHIP THAT ARE DIRECTLY RELEVANT, SO WE START WITH THE APPROPRIATION AND THIS IS AS YOU KNOW THE COMMITTEE THAT CONTROLS THE BUDGET IN THE HOUSE WE HAVE LEADER LOWIE, WHICH IS A DEMOCRATIC FROM NEW YORK, SHE'S A LONG TIME SUPPORTER OF BIOMEDICAL RESEARCH IN WOMAN'S HEALTH ISSUE AND SHE ROSE TO A RANKING MEMBER OF THE FULL APPROPRIATIONS COMMITTEE BECAUSE OF HER LONG-TERM SERVICE AND SHE'S A VERY STRONG SUPPORTER. OUR HOUSE APPROPRIATIONS COMMITTEE HAS A NEW CHAIR AND THIS IS JACK KING STONE, HE'S REPUBLICAN FROM GEORGIA AND WHILE HE IS FISCALLY CONSERVATIVE, IN TERMS OF HIS SUPPORT FOR RESEARCH AND RECOGNIZING THE IMPORTANCE, HE HAS HAD A VERY STRONG HISTORY. SO WHEN WE LOOKED INTO IT, WE FEEL PRETTY GOOD ABOUT THIS AS WELL. AND AS YOU KNOW ON THE SENATE SIDE, BARBARA MILKOWSKY, SHE BECAME THE FIRST TO CHAIR THE APPROPRIATIONS COMMITTEE IS AND AS A CHAIR IN MARYLAND SHE'S A STRONG SUPPORTER OF RESEARCH. THESE ARE VERY POSITIVE FOR US, OR AT LEAST AT THIS POINT, WE FEEL THAT WAY. IN TERMS OF OUR SENATE SUBCOMMITTEE, IT HAS REMAINED THE SAME AND I'LL TALK A LITTLE BIT ABOUT TOM HARKIN IN THE NEXT SLIDE. SO THE AUTHORIZING COMMITTEES, SHOWN HERE, WITH CHANGES, THEY HAVE THE LEGISLATIVE AUTHORITY, THEY AUTHORIZE PROGRAMS, AND THEY CONDUCT OVERSIGHT OVER AGENCY PROGRAMS AND IN THE HOUSE, THE AUTHORIZATION COMMITTEE LEADERSHIP REMAINS THE SAME. IN THE SENATE, THERE ARE 2 POINTS I'D LIKE TO MENTION. ONE IS THAT YOU RECOGNIZE--AS YOU RECALL, A SENATOR HARKIN TURNED DOWN THE OPPORTUNITY TO CHAIR THE FULL SENATE APPROPRIATE COMMITTEE BECAUSE OF HIS COMMITMENT TO THE ISSUES ON THE CURRENT COMMITTEE THAT HE'S ON. AND THEN, I THINK IT WAS JUST ON SATURDAY THAT HE ANNOUNCE THAD HE'LL NOT BE SEEKING RE-ELECTION TO A SIXTH TERM IN 2014. THIS IS A SIGNIFICANT LOSS TO THE COMMUNITY. HE'S BEEN A STRONG ADVOCATE FOR RESEARCH, FOR HEALTH ISSUES, FOR MANY, MANY DIFFERENT ASPECTS OF RESEARCH AND OF PUBLIC HEALTH AND SO, WE ARE DISAPPOINTED AND RECOGNIZE HIS DESIRE AS WELL. ON THE SECOND IS LAMAR ALEXANDER, HE'S A NEW RANKING MEMBER, HE WAS IN ALEXANDER, HE WAS IN THE 80S PRESIDENT OF THEs UNIVERSITY OF TENNESSEE AND IN THE EARLY 90S HE SERVED AS STATE--AS THE UNITED STATES STATES SECRETARY OF EDUCATION. SO HE DOES HAVE A CLEAR UNDERSTANDING OF THE IMPORTANCE OF FEDERAL RESEARCH TO THE UNIVERSITIES ACROSS THE COUNTRY, AND WE THINK HE'S GOING TO BE A VERY STRONG SUPPORTER AS WELL. SO WHAT IS THE SENATE UP TO AND WHAT IS THE HOUSE UP TO AND AS I SAID BEFORE, THE BUDGET IS VERY MUCH UP IN THE AIR. HOWEVER, BOTH THETSENATE AND THE HOUSE DID MOVE THEIR INDIVIDUAL NIH APPROPRIATION BILLS OUT OF COMMITTEE. THEY WERE NOT PASSED, THEY JUST MOVED OUT OF COMMITTEE AND WHILE THE DOLLARS FOR SURE ARE PROBABLY--NOT PROBABLY, THEY'RE IRRELEVANT, AS I MENTIONED BEFORE, I THOUGHT IT WAS IMPORTANT TO TAKE A LOOK AT THESE, JUST SOME BRIEF HIGHLIGHTS BECAUSE THESE WILL BE BUDGET NEGOTIATIONS IN THE FUTURE. SO NORMALLY THE APPROPRIATION BILLS THEY ORIGINATE IN THE HOUSE, BUT LAST YEAR THE SENATE ACTED FIRST SO I'M GOING TO START WITH THE SENATE. THEY WERE SUPPORTIVE OF SMALL INCREASES TO NIH BUDGET. IN ADDITION TO THAT, THEY REDUCED THE NATIONAL CHILDREN'S STUDY BY 28 MILLION AND THIS IS A PART OF THE PLAN RESTRUCTURING OF THE PROGRAM AND THAT'S OKAY. THE OTHER AREA, THIS IS THE IDEA PROGRAM. IT'S CALLED THE INSTUITION DEVELOPMENT AWARD PROGRAM. AND IT'S BECOME A POINT OF CONTENTION. THIS PROGRAM WAS ESTABLISHED TO ENHANCE THE BIOMEDICAL RESEARCH ACTIVITIES IN STATES THAT HAVE HAD HISTORICALLY LOW NIH GRANT FUNDING, SUCCESS RATES. SO IF YOU RECALL IN 2012, THE PROGRAM RECEIVED 50 MILLION INCREASE, BUT WE THOUGHT ADMINISTRATION SHOUT THIS WAS A 1 TIME DEAL. --THOUGHT THIS WAS A 1 TIME DEAL. NOW THE SENATE OPTED TO CONTINUE THE FUNDING RAISING ANOTHER 50 MILLION TO A HIGHER. SO THAT WOULD BE A HIGHER LEVEL ON THE HOUSE SIDE, THIS IS A GOOD THING BECAUSE IF YOU RECALL LAST YEAR, IT--THIS IS A LOT MOVING OUT OF THE HOUSE IS A LOT BETTER THAN WE WERE LAST YEAR WHETHER IT WAS NO HEARING, AND THERE WASN'T EVEN A BUDGE THEATWAS INTRODUCED. SO THIS IS PROGRESS IF YOU WANT TO CALL IT THAT. SO AGAIN, HERE'S WHERE THE I.D. E. A. PROGRAM CONTENTION GOES. THEY WANT TO INCREASE IT 100 MILLION BEYOND FY2012. SO THAT MEANS AN ADDITIONAL HUNDRED MORE THAN THE SENATE AND A HUNDRED AND 50 MILLION MORE THAN WHAT ADMINISTRATION WAS EXPECTING. SO THIS IS AN AREA THAT I'M SURE YEAR--WE'RE GOING TO BE HAVING MORE DISCUSSIONS ABOUT. BEYOND THAT, THERE ARE OTHER PROVISIONS THEY HAVE SUGGESTED AND 1 IS TO PROHIBIT PATIENT CENTERED OUTCOMES RESEARCH AND ECONOMIC RESEARCH. IN ADDITION TO THAT, THEY WANT TO REDUCE THE MAXIMUM SALARY ALLOWED ON GRANTS AND IF YOU CALL LAST YEAR THEY REDUCED IT 20,000 NOW THEY WANT TO REDUCE IT ANOTHER 14,400. AND THEY'RE SUGGESTING TO INTRODUCE THE SIZE OF THE INTRAMURAL PROGRAM AND WHILE NONE OF THESE ARE ON TRACK TO BECOME LAW, IT DOES SIGNAL AN UNPRECEDENTED LEVEL OF INVOLVEMENT OF CONGRESS IN NIH AFFAIRS AND THIS IS SOMETHING YOU CAN IMAGINE THAT WE'RE NOT VERY PLEASED WITH AND IT'S SOMETHING THAT WE'RE KEEPING AT NIH, KEEPING A VERY CLOSE EYE ON, BUT THIS IS PROBABLY GOING TO BE IN CONVERSATION. SO ENDING ON EYEY A POSITIVE NOTE, I HAVE 2 SLIDES ON INITIATIVES FOR 2013, SOME OF THESE, ALL OF THESE WERE SHARED WIDE COUNCIL PREVIOUSLY. SO HOW ARE WE DOING WITH SOME OF THESE INITIATIVES THAT YOU APPROVED? SO THE EFFECTIVENESS OF TREATMENT IN ORAL DECS AND MEDICALLY COMPOMMIZED PATIENTS WAS REISSUED AND WE HAVE 11 PROPOSALS FOR REVIEW. IN TERMS OF SALIVARY GLAND TUMORS THIS WAS LEFT OVER FROM 2012 AND IT WAS AWARDED AS AN R21. WE'RE VERY EXCITED ABOUT THE INITIATIVE IN NOVEL DENTAL COMPOSITES AND AS YOU KNOW THIS IS ALWAYS ON THE NEWSPAPER, MOST RECENTLY IN TERMS OF MERCURY AND THAT WAS LAST WEEK IN TERMS OF DECREASING OR CLOSING DOWN THE MINES IN MERCURY, FOR MERCURY. SO WE HAD HAD 29 LETTERS OF INTENTION AT THIS POINT AND THE PROPOSAL DEADLINE IS JANUARY 31st. SO WE'RE DELIGHTED WITH THE LETTERS OF INTENT. SO WE'LL SEE WHERE THAT IS. WE RELEASED THE EPIGENOMICS OF VIRUS ASSOCIATED ORAL DISEASES AND APPLICATIONS ARE DUE FEBRUARY 21. SO WE DON'T KNOW HOW MANY WE'RE GOING TO BE RECEIVE NOTHING THAT AREA, AND THEN WE DID CONTINUE TO FUND THE BIOREPOSITORY. OTHER AREAS THAT WE'RE CLEARED BY COUNCIL IN SEPTEMBER, THANK YOU INCLUDE DEVELOPING A MULTIDISCIPLINARY ORAL RESEARCH WORKFORCE AND THIS IS THROUGH A K MECHANISM OF FACULTY DEVELOPMENT, WE'RE ALSO VERY EXCITED ABOUT THE FACE BASED 2 INITIATIVE AND WE'RE IN DISCUSSION ON HOW THAT WOULD FOLD OUT AS WELL AS DISCUSSIONS ON THE ORAL CANCER INITIATES CELL ON PROPOSALS HOW THOSE WOULD, OR FOI WOULD LOOK. THE ROLE OF CULTURABLE BACTERIA IN THE ROLE OF MICRO BI OTA, THIS IS AN AREA THAT YOU PROBABLY PICK UP THE PAPER EVERY DAY AND ARE READING SOMETHING ELSE ABOUT WHAT THE MICROBIOME MEANS OF THE 5 SITES THAT ARE INITIALLY EXAMINED IN TERMS OF THE SPECIFIC UNCULTURABLE BACTERIAIARY AND THE IMPLICATIONS IN TOTAL PHYSIOLOGY, IN TERMS OF HOW THEY COMPETE WITH NORMAL CELLS AND THEIR IMPORTANCE THERE AND THE LAST 1 IS ESTABLISHING MEASURES OF CLINICAL OUTCOMES AND MECHANISMS OF ACTIONAL BEHAVIORIAL INTERVENTIONS CLEARLY A VERY, VERY IMPORTANT AREA FOR US. SO THAT WAS THE YEAR THAT WAS. AND WE HAVE A NEW FACE TO PRESENT TO YOU AND AT THIS POINT DO WE OPEN THIS UP FOR DISCUSSION OR DO WE WAIT? IF ANYBODY HAS ANY QUESTIONS? PLEASE? >> I HAVE PROBABLY WHAT WOULD BE CONSIDERED AN IGF NORAPT QUESTION BUT I'LL ASK IT ANYWAY. WHEN YOU TALK ABOUT THE PERCENT OF GRANTS THAT ARE FUNDED, DOES THAT INCRUITED THE GRANTS THAT WERE NOT REVIEWED. SO IS THAT 20% OF ALL GRANTS SUBMITTED, THE PAY LINE? ALL GRANTS SUBMITTED, IT'S ALL GRANTS SUBMITTED, NOT JUST THE 1S WE'RE REVIEWED. >> OKAY, THANK YOU. >> GOOD QUESTION. >> SO EVERYTHING ELSE WAS PERFECT, COUNSEL UNDERSTANDS EVERYTHING. ALL RIGHT. OKAY. >> CAN YOU USE YOUR MICROPHONE PLEASE? >> CAN YOU--HOW WILL YOU BE ABLE TO COUNTERACT THIS HUNDRED MILLION DOLLARS, ADDITIONALLY GOING OUT AWARD THAT SEEMS SO POLITICALLY DRIVEN FOR STATES THAT DON'T HAVE THE SCIENTISTS THERE TO BEGIN WITH. >> YEAH, SO WE HAVE SOME--AT THE I. C. LEVEL AND 1--FRANCIS COLLINS IS THE DIRECTOR IS REALLY A WONDERFUL VOICE FOR US, WE'RE NO LONGER ALLOWED AS INDIVIDUAL ICs TO GO DOWN AND INCREDIBLY ARTICULATE, IN ADDITION TO THAT, WE'VE ADDRESSED SOME OF THIS THROUGH THE TAKING ACTIONOT WORKFORCE AND WORKFORCE DIVERSITY PROGRAMS AND SO, 1 IS THE BUILD PROGRAM, WHICH YOU'RE GOING TO SEE SOME INITIATIVES, RELATING TO FUNDING OF A--OF A SCHOOL THAT HAS LESSER FUNDING BUT THEY HAVE TO PARTNER WITH THE SCHOOL THAT HAS HIGHER RESEARCH ACTIVITIES AND SO, I THINK THAT'S 1 WAY WE'RE GOING TO COUNTERACT IT BECAUSE WE'LL HAVE--AND NA'S THROUGH THE COMMON FUND SO SOME OF THE COMMON FUND MONEY IS GOING TO ADDRESS WORKFORCE AND WORKFORCE DIVERSITY ISSUES. AND I REALLY DO FEEL WITH THAT, IN PLACE, THAT MAY HELP AVERT SOME OF THIS I.D. E. A. CONCEPT THAT WE ARE CONCERNED ABOUT. >> WITH THE ADMINISTRATION'S OPTIMISM ASIDE, IF THE CUTS DO COME THROUGH, WHAT PLANS ARE YOU ALL DOING TO ADJUST YOURSELF TO MANAGE IT BEYOND THE 10%--I THINK I SAW THE 10% CUT IN FUNDING TO SOME OF THE EXISTING GRANTS. >> SO WE ARE IN DISCUSSION AS ICs AND LOOKING FOR STRATEGICALLY AT DIFFERENT AREAS TO ADDRESS. IT DOESN'T LOOK PRETTY. IT WOULD BE DEVASTATING FOR ALL OF US, BUT THAT DOESN'T MEAN THAT WE AREN'T DISCUSSING IT. IT'S VERY DIFFICULT. TELL BE--WOULD IT BE A TRAGEDY TO THE UNITED STATES AS WELL AS ON OUR RESEARCH COMMUNITY AND THE IMPORTANT THINGS WE DO AND THE IMPACT IT HAS ON PUBLIC BUT WE'RE IN DISCUSSION. NOT HAPPY. >> JUST TO FOLLOW UP ON THAT QUESTION, SO IS IT MY UNDERSTANDING THAT YOU'RE NOT GOING TO BE FUNDING ANY NEW GRANTS OR FELLOWSHIPS UNTIL AFTER ALL OF THIS IS RESOLVED? >> NO, AS I SAID WE'RE CONTINUING WE'RE JUST BEING CONSERVATIVE DURING THIS FIRST TIME AND IN CLOSED SESSION THIS AFTERNOON WE'LL BE DISCUSSING SOME OF THOSE AND WE'RE GOING TO MOVE THEM FORWARD. SO, YES. >> I JUST WANT TO ADD 1 THING TO CLARIFY SOMETHING FOR DR. MARTINEZ QUESTION THAT THE 10% CUT WHAT WE ARE REFERRING TO AT THIS POINT WE'RE MAKING AWARDS AT THE 90% LEVEL WHICH WE DO EVERY TIME WE'RE IN A CONTINUING RESOLUTION. THAT DOESN'T MEAN THERE WILL BE A 10% CUT. USUALLY THOSE WHEN THE DECISION IS MADE, IF THERE IS GOING TO BE A REDUCTION IN GRANTS MANAGEMENT MODIFYS THAT AWARD AND THAT'S JUST STANDARD. SO I DON'T WANT TO TRANSLATE THE FACT THAT THEY'RE GOING OUT AS 90% THAT THERE'S A 10% CUT BECAUSE THERE ISN'T. >> NO, THANK YOU. >> THE SALIVA--SALIVAARY CAP ISSUE PRESENTS INTERESTING CHALLENGES TO ACADEMIC INSTITUTIONS BECAUSE WE'RE TRYING TO RETAIN THE BEST AND MOST COMPETITIVE SCIENTISTS AND AT THE SAME TIME WITH OUR BUDGET CONTAINTS THIS JUST ADDS OR COMPOUNDS THAT CHALLENGE. DO YOU HAVE ANY SENSE OF WHERE THAT WILL ULTIMATELY END UP OR IF THERE WILL BE CONTINUED PRESSURE TO DRIVE DOWN THE SALARY CAP? >> SO I HAVE NO IDEA WHERE THAT'S GOING TO END UP. IF YOU LOOK AT SOME OF THE RECOMMENDATIONS THAT HAVE COME OUT AND THESE ARE ALL POSTED OUT OF WORKFORCE AND WORKFORCE DIVERSITY, THERE IS SOME SUGGESTION OVER THE NEXT 20-30 YEARS OF REDISTRIBUTING SALARIES FOR FACULTY THAT ARE COVERED ON GRANTS AND SPENDING THE SAME AROUND OF MONEY, BUT SPENDING IT MORE ON THE RESEARCH SIDE AND ASKING UNIVERSITIES TO PICK UP MORE OF THE FACULTY SALARY, THIS IS JUST A GENERAL DISCUSSION. AND THAT'S POSTED IN THERE. HOW YOU PAL BANS THAT BECAUSE WE WANT TO HAVE MORE OF THE MONEY GOING INTO RESEARCH AND I THINK WE ALL DO AND I RECOGNIZE VERY MUCH EVEN AS OUR PUBLIC UNIVERSITIES, THESE SALARIES ARE SUPPORTED REALLY BY PRIVATE MECHANISMS, SO IT'S A--IT'S A REAL, VERY DIFFICULT SITUATION AND FOR NOW, WE'RE HOPING THAT WE DON'T SEE THIS PROPOSAL. OKAY, WELL, THANK YOU VERY MUCH AGAIN AND WE'LL MOVE FORWARD. >> OKAY OUR NEXT ITEM IS THE REVIEW OF COUNSEL OPERATING PROCEDURE AND THIS HAPPENS EVERY JANUARY WHERE WE HAVE THE COUNCIL REVIEW AND ADVISE TO ANY CHANGES TO THE OPERATION PROCEDURES. THIS YEAR WE ADDED UNDER SECTION 2, SECONDARY REVIEW OF GRANT APPLICATIONS, THE RECENT NI H POLICY CHANGE THAT REQUIRES ALL APPLICATIONS FROM INVESTIGATORS WITH MORE THAN 1 MILLION IN DIRECT COSTS IN RESEARCH SUPPORT FROM NIH TO BE GIVEN SPECIAL COUNCIL CONSIDERATION SO THAT'S BEEN ADDED AND THAT'S THE ONLY SUBSTANTIVE CHANGE TO THE COUNCIL UPGRADING PROCEDURE THIS IS YEAR. SO, I'LL OFFER THE OPPORTUNITY FOR COUNCIL MEMBERS TO ASK ANY QUESTIONS OR MAKE ANY COMMENTSOT OPERATE PROGSEEDURES. AND IF THERE ARE NONE, WOULD A COUNCIL MEMBER MAKE A MOTION TO APPROVE THE UPDATED OPERATING PROCEDURES. SECOND IN ALL IN FAVOR? ANY OPPOSED? OKAY, THE OPERATING PROCEDURES ARE APPROVED. THE NEXT ITEM ON THE AGENDA IS THE BIENNIAL REPORT TO COUNCIL ON TRACKING AND INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH. THIS IS PRESENTED EVERY 2 YEARS IN JANUARY AND THE REPORT WILL WILL BE PRESENTED BY DR. DENA, FISCHER, WHO IS A DOCTOR FOR THE CENTER FOR EPIDEMIOLOGY AND THE CENTER FOR CLINICAL RESEARCH. >> GOOD MORNING EVERYONE I'M DENA, FISCHER, I'M A PROGRAM PROVE FOR THE CENTER OF CLINICAL RESEARCH AND THIS MORNING I HAVE THE PLEASURE OF PRESENTING THE 2013 BIENNIAL REPORT CERTIFYING NIH POLICY ON INCLUSION. I INVITE TO YOU REVIEW THE FULL REPORT WHILE I GO THROUGH THIS PREV PRESENTATION. SO AS YOU MAY RECALL, THE NIH REVITALIZATION ACT OF 1993 STATES THAT NIH MUST INSURE THAT WOMEN AND MINORITIES AND THEIR SUBPOPULATIONS ARE INCLUDED IN ALL CLINICAL RESEARCH. WOMEN AND MINORITIES AND THEIR SUBPOPULATIONS MUST BE INCLUDED IN PHASE 3 CLINICAL TRIALS IN NUMBERS ADEQUATE TO ALLOW FOR VALID ANALYSIS OF DIFFERENCES IN INTERVENTION EFFECTS. COST IS NOT AN ACCEPTABLE REASON FOR EXCLUDING THESE GROUPS AND NIH MUST INITIATE PROGRAMS AND SUPPORT FOR OUTREACH EFFORTS TO RECRUIT AND RETAIN WOMEN AND MINORITIES AND THEIR SUBPOPULATIONS AS PARTICIPANTS IN CLINICAL STUDIES. SO THIS IS A BIENNIAL REPORT SO I WILL PRESENT POPULATION TRACKING DATA FROM NY2011 AND 2012. AND AS YOU MAY BE AWARE, POPULATION TRACKING OCCURS AT 2 DIFFERENT LEVELS AND 2 DIFFERENT TYPES OF TRACKING AND FIRST THIS OCCURS AT THE LEVEL OF APPLICATIONS FOR GRANT APPLICATIONS THAT COME INTO NIDCR, AND SECOND IT OCCURS AT A SUBJECT OR ENROLLMENT LEVEL FOR APPLICATIONS THAT HAVE BEEN NIDCR FUNDED OR SUPPORTED AND THIS OCCURS IN ANNUAL PROGRESS REPORTS. SO FIRST FOR GRANT APPLICATIONS REVIEWED, THE MAJORITY OF GRANT APPLICATIONS INVOLVING HUMAN SUBJECTS HAVE PRESENTED PLANNED FOR MINORITY AND SEX GENDER INCLUSION THAT WERE FOUND TO BE ACCEPTABLE BY THE INITIAL REVIEW GROUP FOR PEER REVIEW AND THIS IS DETAILED IN TABLE A OF THAT FULL REPORT. AND FOR NIDCR POLICY, APPLICATIONS DEEMED UNACCEPTABLE MUST BE RESOLVED SATISFILY PRIOR TO FUNDING THIS, IS IN TABLE B. LOOKING AT ENROLLED SUBJECTS IN FY11 AND 12, THIS IS FURTHER DETAIL INDEED TABLE 1 AND 2 OF THE FULL REPORT. SO IN FY2011 ABOUT 113 HUMAN SUBJECT IT IS WERE ENROLLED IN 142 NIDCR SPONSORED RESEARCH STUDIES WITH REPORTING REQUIREMENTS. EXAMPLES OF STUDIES THAT DO NOT HAVE REPORTING REQUIREMENTS ARE CAREER DEVELOPMENT AWARDS AND TRAINING GRANTS AND FY2012 OVER 146,000 HUMAN SUBJECTS WERE ENROLL INDEED 115 NIDCR SPONSORED RESEARCH STUDIES. IT'S OBVIOUS INCREASE THIS 2012 COMPARED TO 11 WAS PRIMARILY ATTRIBUTABLE TO 1 NEW STUDY OF DENTAL CARE, RECEIVED BY OVER 44,000 INDIVIDUALS, TREATED IN A LARGE MANAGED HEALTHCARE ORGANIZATION. AGGREGATE ENROLLMENT DATA DEMON TRAIT THAT APPROXIMATELY 56,000--56% OF SUBJECT WERE WOMEN, 41% WERE MALE AND 3% HAD UNREPORTED SEX OR GENDER IN NY2011 WITH SIMILAR TRENDS IN 2012. ALSO IN 2011, HISPANIC PARTICIPATION WAS APPROXIMATELY 12% WITH ETHNICITY BEING UNKNOWN OR NOT REPORTED FOR 8% OF SUBJECTS. IN NY2012, THIS HISPANIC PARTICIPATION WAS 10% WITH ETHNICITY NOT KNOWN OR NOT REPORTED FOR 35% OF SUBJECTS. THE MAJORITY, ABOUT 85% OF THESE SUBJECTS IN FY2012 WITH UNKNOWN OR NOT REPORTED ETHNICITY WERE ENROLLED IN 1 DATABASE STUDY WITH PARTIALLY LINKED DATA FOR WHICH ETHNICITY DATA WAS NOT REPORTED. LOOKING OVERALL AT ENROLLMENT SUBJECTS IN RACE IN FY2011 AND 12, THE MAR JORRITY OF SUBJECTS WERE WHITE WITH BLACK OR AFRICAN AMERICAN SUBJECTS COMPRISING ABOUT 1 EIGHTH OF ENROLLED SUBJECTS AND A SIGNIFICANT LOWER PROPORTION OF SUBJECTS REPORTED THEMSELVES AS BEING AMERICAN INDIAN OR ALASKA NATIVE AS WELL AS HAWAIIAN AND PACIFIC ISLANDER. IT MUST BE NOTED THAT UNKNOWN OR NOT REPORTED RACE RANGE FROM ABOUT 12 TO 18% OF SUBJECTS DURING THESE YEARS. PHASE 3 TRIAL ENROLLMENT, THIS IS FURTHER DETAIL INDEED TABLES 5 AND 6. IN FY2011, CLOSE TO 800 SUBJECTS WERE ENROLL INDEED 4 TRIALS AND IN FY2012 THIS MEMBER WAS OVER 2500 SUBJECTS WERE ENROLL INDEED 6 PHASE 3 TRIALS. THE MAJORITY IS FEMALE COMPRISING OF 60% OF ENROLLED SUBJECTS. AND UNDERREPRESENTED POPULATION PARTICIPATION WAS HIGHER IN PHASE 3 TRIALS COMPARED TO THESE AGGREGATE STUDIES WITH 20--ABOUT 24% OF SUBJECTS IDENTIFYING THEMSELVES AS HISPAN NICK FY2011 AND INDIVIDUALS IDENTIFYING THEMSELVES AS HISPANIC WAS ABOUT 43% OF ENROLLED SUBJECTS IN 2012. I DO WANT TO MENTION THAT THE PHASE 3 TRIALS IN GENERAL WERE IN SETTINGS AND WERE DESIGNED TO RECRUIT SUBJECTS IN THESE UNDERREPRESENTED POPULATIONS. AND LOOKING AT PHASE 3 TRIAL ENROLLMENT BY RACE, AGAIN THE MAJORITY OF SUBJECTS ARE WHITE WITH 1 EIGHTH OF SUBJECTS BEING AFRICAN AMERICAN OR BLACK. AND COMPARED TO AGGREGATE STUDIES A LOWER PORTION IDENTIFIEDED THEMSELVES ASAZZIAN WITH A LITTLE BIT HIGHER PROPORTION IDENTIFYING THEMSELVES AS AMERICAN INDIAN OR ALASKA NATIVE. AGAIN, THE UNKNOWN OR NOT REPORTED RACE RANGED FROM ABOUT 10-18% OF SUBJECTS. AND FINALLY INTRAMURAL ENROLLMENT, PROGRAM ENROLLMENT, THIS IS DETAILED IN FY11 AND SUBJECTS WERE ENROLL INDEED RESEARCH PROTOCOLS AND IN FY2012, THIS IS JUST OVER 5700 SUBJECTS. FEMALE PARTICIPATION WAS HIGH OVER 60% IN BOTH YEARS. HISPANIC PARTICIPATION WAS SIMILAR BOTH YEARS, JUST BELOW 7% OF ENROLLED SUBJECTS AND FINALLY, BLACK AND AFRICAN AMERICAN ENROLLMENT WAS COMPRISED OF ABOUT 12% OF THE SUBJECTS WHO WERE ENROLL INDEED THESE STUDIES IN FY2011 AND 12. OKAY, ANY QUESTIONS? THANK YOU FOR YOUR TIME. [ APPLAUSE ] OKAY, WE'RE REQUIRED TO TAKE A VOTE TO APPROVE THAT REPORT, SO IF SOMEONE ON COUNCIL WOULD LIKE TO MAKE A MOTION TO APPROVE THE REPORT. SECOND? THANK YOU. ALL IN FAVOR? ANY OPPOSED? OKAY, THE REPORT IS APPROVED AND I WILL TURN THE MEETING BACK OVER TO MARTHA FOR AN UPDATE DISCUSSION ON STRATEGIC PLANNING. F SO I'M GOING TO STAY HERE FOR THIS 1 BECAUSE I'M HOPING TO GET A LIVELY DISCUSSION GROUP FOR STRATEGE INCREASE IN BODY PLANNING, I THANK YOU VERY MUCH, YOU CAN PUT THIS UP, I THANK YOU VERY MUCH--NO, THAT'S NOT THE SLIDE. >> WELL, AS WE'RE WAITING FOR THE SLIDES TO COME, AS MANY OF YOU ARE AWARE, WE STARTED DISCUSSIONS ON THE STRATEGIC PLANNING ABOUT AUGUST OF THIS YEAR AND BOB BERREN HAS JOINED US FOR THAT AND MAY INTERJECT HERE, I DON'T KNOW IF YOU FEEL MORE COMFORTABLE COMING TO THE TABLE FOR QUESTIONS, WHY DON'T YOU COME SIT AT THE TABLE. I THINK THAT WOULD BE GOOD. AND PART OF THIS WAS--BOB HAS BEEN TALKING TO SOME OF OUR INTRAMURAL AND INTRAMURAL FOLKS AS WELL AS THE DIVISION OF EXTRAMURAL RESEARCH, EXTRAMURAL RESEARCH ACTIVITIES AND THE OD OFFICE IN MEETING WITH INDIVIDUAL GROUPS JUST POSING SOME OF THE QUESTIONS OR TYPES OF QUESTIONS THAT WE ARE POSING TO YOU TODAY AND WE'RE GOING TO BE POSTING A SIMILAR FORMAT OF THESE QUESTIONS TO THE EXTRAMURAL COMMUNITY AS WELL. SO, WE'RE ASKING COUNCIL FOR SOME ADVICE IN SEEING HOW THIS GOES WITH YOU AND I HAD ALSO POSED SOME OF THESE QUESTIONS WHEN I WAS AT A RECENT MEETING IN DECEMBER, THEY WERE TALKING ABOUT SOMETHING ELSE AND THE OPPORTUNITY TO TEST IT OUT THERE AS WELL. BUT THESE ARE VERY IMPORTANT. WE TAKE THESE VEERSLY. I KNOW FOR THE LAST TIME WHEN WE HAD SOME CONCEPT CLEARANCES AND ASKED FOR COMMENTS FROM THE PUBLIC, I READ EVERY SINGLE 1 BECAUSE IT REALLY DOES HELP. SOME ARE A LITTLE BIT OR EGOCENTRIC ABOUT THEIR OWN PROGRAM AND I KNOW YOU CAN'T HELP THAT YOU BUT WE'RE HOPING THAT YOU HAVE MORE OF A BROAD VIEW WHEN YOU LOOK AT THINGS TODAY BUT WE TAKE IT SERIOUSLY AND THERE ARE THINGS THAT MAYBE WE HAVE TO BE MISSING AND SO WE, HOPING YOU'LL HELP US TO IDENTIFY AREAS THAT WE HAVEN'T EVEN CONSIDERED BEFORE AND THAT'S REALLY THE GOAL OF THIS MORNING'S STRATEGIC PLANNING. THIS 1 IS INCREDIBLY BROAD BASED AND WE DID SHARE THESE WITH YOU BEFORE HAND TO GIVE YOU A BIT OF AN OPPORTUNITY TO THINK ABOUT SOME OF THESE THINGS. AND FEEL FREE AFTER TODAY'S MEETING AND FOR EVERYBODY ELSE HERE AND IN OUR VIRTUAL PARTICIPANTS TO BRING THIS BACK TO YOUR OWN COMMUNITIES AND ADDRESS THESE QUESTIONS. AND THE MORE INPUT WE HAVE, THE BETTER WE ARE, THE STRONGER WE ARE AS AN INSTITUTE. SO QUESTION 1: MAYBE WE SHOULD HAVE SOME MUSIC IN THE BACKGROUND AS WE GO THROUGH THESE, BUT THERE'S NO MUSIC THERE. WHICH MAJOR QUESTIONS,/ISSUES MUST BE ADDRESSED TO SIGNATURES 95 IMPROVE OW WE UNDERSTAND PREVENT, DIAGNOSE AND MANAGE DENTAL ORAL AND CRANIOFACIAL DISEASES AND DISORDERS? SO WITH THAT? YES? >> SO I THINK 1 MAJOR ISSUE HIGHLIGHTED BY THE REPORT THAT WE JUST SAW ON INCLUSION AND STUDIES, WE'RE CERTAINLY IMPROVING ON INCLUSION OF RACIAL GROUPS OUTSIDE CAUCASIAN, BUT WE STILL HAVE A WAYS TO GO. IN ADDITION TO INCLUDING UNDER REPRESENTED POPULATIONS, I THINK THAT ANOTHER GROUP THAT STILL REMAINS UNDERREPRESENTED IN OUR STUDY SYSTEM CHILDREN. THERE ARE MANY CHILDREN'S ORAL HEALTH ISSUES THAT WE CERTAINLY HAVE PROGRAMS TO ADDRESS, BUT SHOULD BE INCREASED AS ORAL HEALTH BEGINS IN CHILDHOOD AND YOUR TRAJECTORY FOR YOUR LIFETIME BEGINS AT THAT TIME. THANK YOU. >> I THINK I'M JUST FOLLOWING UP IN THE SAME VAIN. I THINK, WELL, I JUST WANT TO MAKE 2 COMMENTS. ONE I NOTICED THAT IS REALLY HARD TO GET DATA FOR HISPANIC POPULATION WHEN REALLY ETHNICITY SO WHEN THE HUMAN IS CONSIDERED AS WHITE, SO REALLY IT'S REALLY, IT'S REALLY HARD BECAUSE YOU CAN SEE THE PERCENTAGE, 60% IN REALITY, WHEN YOU LOOK AT YOUR DATA, IT LOOKS LIKE 20, 15% ARE HISPANIC SO IT'S REALLY KIND OF HARD HOW THAT HAS EVOLVED THROUGH THE YEARS AND WE STILL MAINTAIN THAT KIND OF CLASSIFICATION FOR MANY SYSTEMS WHICH IS REALLY A LOT OF THE TIME HURTS THAT POPULATION IN MANY WAYS. SO THAT'S SOMETHING, BUT I WOULD LIKE TO ECHO WHAT THE DOCTOR MENTIONED IN TERMS OF HOW MUCH WHEN WE THINK OF CHILDREN, ORAL HEALTH BECOMES IN THE CONTEXT OF CHRONIC ISSUES LIKE OBESITY AT THE SAME LEVEL, I THINK THIS IS THE GREAT OPPORTUNITY FOR ORAL HEALTH TO TRY TO DISENTANGLE SOME OF THE CHARACTERIZATION OF RISK FACTORS FOR CHILDREN AND TRY TO REALLY ADDRESS ORAL HEALTH AS A MAJOR COMPONENT WHICH REALLY CAN BRING UP A LOT OF TIEWPTS FOR HEALTH LITERACY FOR EXAMPLE, HOW WE BEGIN TO START DRESSING ORAL HEALTH AS A RISK FACTOR AND HOW IN OUR COMMUNITIES IN VULNERABLE COMMUNITIES WE CAN BEGIN TO START WORKING WITH INTERDISCIPLINARY GROUPS FOR THE PURPOSE OF REALLY BRINGING ORAL HEALTH INTO A NEW DIMENSION. I THINK I REALLY ABLAHED YOUR EFFORTS FOR SCIENCE AND I ENJOY SEEING SOME OF THE MEMBERS THAT ARE WORKING ON SCIENCE, I WANT TO ECHO 2 MORE POINTS SINCE I NOW HAVE MY CHANCE AND THANK YOU FOR THE OPPORTUNITY, IS TO THINK ABOUT SOME OF THE POLICY COMPONENTS OF THE SYSTEM SCIENCE. I THINK THAT SOME OF THE MULTIDISCIPLINARY WORKFORCE IN SOME OF THE WORK THAT THE [INDISCERNIBLE] ARE DOING WITH THE COMMUNITY WORKERS AND OTHER KINDS OF APPROACHES THAT TRY TO UNDERSTAND HOW WE BEST SCREEN CHILDREN, HOW WE BEST GO INTO COMMUNITIES TO REALLY UNDERSTAND ORAL HEALTH COULD BE EXCITE NOTHING ADDRESSING POLICY COULD BE VERY EXCITING IN THAT WAY. THANK YOU. --EXCITING IN THAT WAY, THANK YOU. ANYTHING GOES. SO IF I COULD FOLLOW THIS THEME AND MORE ON THE APPLIED SIDE, 1 OF THE FRUSTRATIONS IS THAT WE MIGHT DEVELOP NEW TECHNOLOGIES OR NEW PROCESSES OR NEW WAYS OF WORKING TOGETHER TO IMPROVE ORAL HEALTH AND YET IT'S EITHER NOT SUPPORTED THROUGH ALL THE INSURANCE AND OTHER PRACTICAL MECHANISMS OR IT JUST DOESN'T-OF WE DON'T SEE THE UPTAKE IN DENTAL PRACTICES SO ANY BEHAVIORIAL SCIENCE RESEARCH THAT CAN HELP US BETTER UNDERSTAND AND FACILITATE THE UPTAKE AND IMPLEMENTATION OF NEW TECHNOLOGIES AND PROCESSES AND PROCEDURES TO GET THOSE INNOVATIONS INTO PRACTICE TO REALLY HELP THE PUBLIC, I THINK THAT WOULD BE VERY BENEFICIAL. THANK YOU. IMPORTANT POINT. >> SO I'LL JUST JUMPOT BAND WAGON IN THIS AREA AND I'D LIKE TO EMPHASIZE THE AREA OF IMPLEMENTATION SCIENCE RESEARCH AS A GROWING AREA AND MANY OF THE INSTITUTES WITH THE ACCUMULATION OF MANY THINGS THAT WORK BUT PEOPLE DON'T USE, FOR KNOWLEDGE IT DOESN'T GET OUT THAT REALLY CAN MAKE THE DIFFERENCE IN PEOPLE'S LIVES, SO, THE PROBLEM IS THAT PEOPLE DON'T SYSTEMATICALLY STUDY WHAT THE BEST PRACTICES ARE, APPROACHES FOR DOING THAT AND CAN YOU APPLY GOOD SCIENTIFIC METHODOLOGY TO TEASING APART HOW WELL--THE HOW OF THE WAY YOU GO ABOUT THAT OCCURS, SO I WOULD ENCOURAGE YOU TO ESPECIALLY WORKING WITH YOUR PBRN, TO USE THAT AS A FORUM TO REALLY MAKE THAT A HOME FOR YOUR IMP EMATION SCIENCE. SORT OF LIKE THE END OF THE FOOD CHAIN RESEARCH AND I AWIVE FEEL THE NEGLECTED CHILD SO PERHAPS CAN YOU RAISE THAT 1 A LITTLE LITTLE BIT. >> I THANK YOU FOR THAT QUESTION, I'D LIKE TO EXPLORE THAT A LITTLE BIT MORE BECAUSE THIS HAS COME UP AS AN AREA OF FOCUS FOR US AND AN AREA AS WE MOVE FORWARD AND CAN YOU GIVE AN EXAMPLE MORE BROADLY THAN THAT, THAT WOULD IMPACT US. >> YEAH, I THINK THIS FALLS INTO THE CATEGORY OF HEALTH SERVICE RESEARCH, BUT, YOU CAN YOU KNOW LOOK AT DIFFERENT STRATEGIES FOR TRAINING PROCEEDERS TO USE DIFFERENT TECHNOLOGIES AND 1 MIGHT BE, YOU KNOW MY AREA, TRAIN THE TRAINER AS A COMMON TECHNIQUE USED BUT NOT NECESSARILY STUDIED TO SEE IF IN FACT PEOPLE ARE ABLE TO TRANSFER WHAT THEY LEARN AND BE ABLE TO TRAIN IT TO OTHERS. IT'S 1 OF THE MOST COMMONLY USED APPROACHES AND YET, WE REALLY DON'T KNOW WHETHER IT WORKS. IT COSTS A LOT OF MONEY AND PEOPLE HAVE JUST ACCEPTED AS THE WAY TO GO WHEN YOU EXAMINE IT, IT MAY NOT PAN OUT. SO THERE'S A LOT OF LOW HANGING FRUIT ON THEY THINGS THAT WE COMMONLY DO THAT COULD BE STUDIED MORE SYSTEMATICALLY AND ULTIMATELY IMPACT THE FIELD MORE AND GUIDE HOW TO BEST SPEND LIMITED DOLLARS IN THIS AGE. THAT WOULD JUST BE 1 OF--1 EXAMPLE. >> I ACTUALLY LIKE TO JUST ANOTHER EXAMPLE WOULD BE IF YOU THINK OF REALLY SCREENING, HOW WE CAN ENHANCE SCREENING FOR DETECTING PLACES WHERE ORAL HEALTH HAS REALLY BEEN IN THE FOREFRONT, I THINK THERE ARE A LOT OF TECHNOLOGIES AND THINGS 1 CAN DO FROM JUST ININIVATION FOR--INNOVATION FOR DIFFERENT WAYS TO START IMPROVING SCREENING AND SO, YOU CAN LOOK AT THE WORKFORCE, LOOK AT DIFFERENT STRATEGIES THAT CAN BE TESTED TO SEE WHICH WILL YIELD THE BEST WAY OF BRINGING PEOPLE TO SCREENING, TO IN DETECTING OR UNDERSTANDING ORAL HEALTH AND THE IMPORTANCE OF ORAL HEALTH AND THINGS LIKE THAT. >> GOOD MORNING, THIS IS DAVID JOHNSON, CAN YOU HEAR ME? I'M OUT IN-- >> WHERE ARE YOU? >> I'M IN IOWA, HAD TROUBLE WITH AIRPLANES GETTING OUT OF IOWA YESTERDAY, 5 CANCELS FLIGHTS. >> WELL WE'RE GRAD YOU'RE ON PHONE. >> THANKS FOR JOINING US. >> I HAVE 2 THEMES THAT COLLEAGUES HAVE ASKED ME TO AT LEAST BRING UP, 1, CAME FROM CLARK STANFORD AND HE SAID DOES NIDCR HAVE A INTEREST IN MOVING FORWARD WITH COMPARATIVE EFFECTIVENESS RESEARCH AND PRAGMATIC TRIAL DESIGN THIS IS PART OF THE NEW EMPHASIS OF THE DTSA. THAT'S 1 I'LL DO THE OTHER 1 OF THE THE OTHER 1 CAME FROM JEFF MURRAY TO TAKE ADVANTAGE OF THE HUGE ADVANCES IN DNA DEQUENCING BY INVESTIGATING THESE IN THE GERM LINE DENOME USING RNA SEQUENCE TO STUDY GENE EXPRESSION AND IT FOCUSES IN ON THE MICROBIOME AND MAKING IT SPECIFICALLY TO SPECIFIC TISSUES, IN USING DNA SEQUENCE TO LOOK AT GENE REGULATION, THEN. >> THOSE ARE MY 2 ISSUES. >> ANY OTHER COMMENTS OR ANYTHING SPECIFIC? YES? >> I'LL PITCH IN HERE IF I CAN REACH THE MIC? SO THIS THOUGHT CAME FROM AN EARLIER MEETINGS AND I THINK WE WERE TALKING ABOUT CTSAs AND I THINK IT IS IMPORTANT TO INTEGRATE THE PATIENT PERSPECT TESTIFY IMPROVE RESEARCH WHEREVER POSSIBLE. I THINK YOU KNOW IF YOU LOOK AT RESEARCH PLANNING, THERE„i ARE LOTS OF WAYS IN WHICH PATIENTS CAN EITHER HELP CLARIFY SOME OF THE OBJECTIVES, CAN HELP WITH UNDERSTANDING CONSENT FORMS, CAN TALK ABOUT THE BURDEN ON STUDY PARTICIPANTS SO I INNING RESEARCH PLANNING, WHERE POSSIBLE, IF IT'S EASY TO BRING IN A PATIENT PERSPECTIVE, I THINK THAT'S IMPORTANT, BUT NOT JUST IN THE PLANNING BUT ALSO IN MEASURING OUTCOMES, I THINK IT'S IMPORTANT TO MAKE SURE THAT THE OUTCOME BEING MEASURED OR IMPORTANT FOR PATIENTS, WHETHER IT'S PAIN WHICH WE'RE GOING TO HEAR ABOUT, TOXICITY, JUST PATIENT SATISFACTION, YOU KNOW SOMETHING WE'RE SEEING A LOT IN HEALTHCARE. YOU KNOW I THINK, SO, REPORTING OUTCOMES IS ALSO, JUST AN IMPORTANT PART, INTEGRATE ACROSS ALL TYPES OF RESEARCH AND YOU KNOW THE THIRD COMPONENT OF THAT IS ACTUALLY SOMETHING THAT VARIOUS PEOPLE WERE SAYING ALREADY WHICH WAS MAKING SURE THAT IT'S NOT A GENERIC--GENERIC PATIENT, THAT IT'S--IN ALL THE COMMUNITIES THAT ARE OUT THERE AND MAKING SURE THEY PLOT THESE APPROACHES TO IMPROVING RESEARCH ARE CARRIEDED OUT ACROSS PLOTS THROUGHOUT THE COMMUNITY. >> IMPORTANT. >> I JUST WANTED TO PERHAPS QUERY THE GROUP A LITTLE BIT ON SOME ADDITIONAL EXAMPLES OF RESEARCH NEED, THAT COULD ACTUALLY SPAN FROM THE BASIC CLINICAL TRANSLATIONAL, ALL THE WAY TO THE T4 POPULATION BASE, IMPLEMENTATION SCIENCE, SO THE PREVIOUS COMMENTS RELATED TO SCREENING AND IF I CAN JUST MODIFY THAT A LITTLE BIT AND THINK ABOUT EARLIEST DETECTION OF DISEASE. IT'S PERHAPS 1 TOPIC WHERE YOU TAKE ALL THE WAY FROM BASIC DISCOVERY TO DEVELOPMENT OF NEW TOOLS, TO THEN PERHAPS INTEGRATION OF THOSE TOOLS WITH POPULATION BASED APPROACHES, TO THEN TOUCHING ON THE WORKFORCE NEEDS AND WHO APPLIES THAT NEW TECHNOLOGY. YOU SEE WHERE I'M GETTING. JUST SORT OF TRYING TO FOLLOW THE THREAD. SO THAT SEEMS LIKE A REALLY GREAT EXAMPLE OF WHERE YOU CAN SORT OF BEGIN TO PLAN EVERYTHING THAT YOU NEED, ALL THE WAY ACROSS THE RESEARCH FACT SPECTRUM AND I'M WONDERING WHETHER THERE ARE ANY OTHER EXAMPLES SUCH AS THAT THAT COME TO MIND THAT THAT WE SHOULD BE THOUGHTFUL ABOUT OR KEEP ALIVE IN OUR CONVERSATIONS AS WE MOVE FORWARD WITH THE STRATEGIC PLAN. JUST, IF YOU THINK OF IT, NOW, OR WE CAN TOUCH BASES LATER, I THINK THAT WOULD BE A USEFUL APPROACH FOR US SO THAT WE CAN BEGIN TO SEE, HOW PIECES OF OUR PORTFOLIO TIE TOGETHER, SO THAT WE DON'T HAVE JUST A PATCH WORK OF THINGS, BUT BEGIN TO INTEGRATE THINGS ACROSS, THANKS. >> SO I'LL SUGGEST 2 THAT WERE SUGGESTED TO ME BY OUR FACULTY. ONE TIES INTO AN UPCOMING PRESENTATION ON PAIN AND PAIN RESEARCH, BUT THERE'S OPPORTUNITIES TO UNITE MOLECULAR TECHNOLOGIES WITH MECHANISTIC STUDIES ON PAIN AND THEN PAIN MANAGEMENT AND THEN PARTICULARLY IN THE AREA OF PERSONALIZED MEDICINE SO MAYBE THERE'S A WAY TO HAVE TAKEN--THEY CONTINUUM AS YOU SUGGESTED FROM SCREENING TO INTERVENTIONS AND MANAGEMENT AND THEN THE SECOND 1 THAT WAS SUGGESTED TO ME, IS UNDERSTANDING MECHANISMS BY WHICH COMMENSAL ORGANISMS EXERT BENEFICIAL INFLUENCES ON ORALTHOUGH BIOFILM TO PERHAPS INHIBIT PERIODONTAL DISEASE AND FUNGAL INFECTION WITH THE HOPE OF HAVING PROMISING AND PREVEPTIVE THERAPIES. JUST TO FOLLOW UP ON THAT, TO FOLLOW UP ON THE LATEST COMMENT, BY TERROW, I THINK IT WAS WAS FOCUSED TOO LONGOT BAD PART OF THE MICROBIOME AND WE HAVEN'T--HAVEN'T STARTED TO UNDERSTAND HOW THE GOOD PART OF THE ORAL MICROBIOME WORKS AND IN AN AREA OF EVER INCREASING POPULATIONS OF MEDICALLY COMPROMISED PEOPLE OR IMMUNO SUPPRESSED PEOPLE WHO ARE INCREASING IN THEIR LIFE SPAN IS CONSIDERABLY INCREASING, WE HAVE TO TRY TO UNDERSTAND THE GOOD PATHWAYS, THE GOOD BACTERIA, THE GOOD PART OF WHAT MAKES A HEALTHY PERSON WORK IN A BALANCED WAY IN ORDER TO BE ABLE TO PERHAPS IN LESS INTERVENTIONAL WAWAYS IMPROVE THE LIVES OF THESE INDIVIDUALS WITH LESS PHARMACOLOGICAL TYPES OF INTERVENTIONS AND I THINK THAT THAT'S AN IMPORTANT AREA WE HAVE TO EXPAND ON. >> THANK YOU. >> SO LET ME PREFASTHESE COMMENTS BY SAYING, I'M NOT SURE HOW WE CAN DO THIS FROM A REGULATORY STANDPOINT, BUT PARTICULARLY IRB AND CONSENSUS ISSUES, BUT IT TIES IN WITH WHAT TERRY SAID AND WHAT DAVE PASSED ON FROM JEFF, WE'RE IN AN ERA NOW WHERE DOING HUMAN RESEARCH HAS BECOME LESS EXPENSIVE IN TERMS OF DOING THE-OMICS, EITHER FROM THE HOST THEMSELVES OR THE MICROBIOME SO WHAT WE'RE LACKING IS LARGE ENOUGH SAMPLE SIZES AND PARTICULARLY WHEN WE WANT TO LOOK AT INTERACTION, BECAUSE ONCE YOU START LOOKING AT INTERACTIONS SAY BETWEEN THE HOST GENOME AND THE MICROBIOME, YOU NEED EVER LARGER SAMPLELE SIZES. SO, MY SUGGESTION IS SOMETHING TO THINK ABOUT IS THAT WE REALLY NEED TO LEVERAGE OUR EXISTING COHORTS THAT THE NIDCR IS SUPPORTING TO PERHAPS CONSIDER SOME SORT OF MINIMAL SAMPLING STRATEGY AND/OR MINIMAL DATA SAMPLING THAT IS DONE ANYTIME A HUMAN COHORT IS APPROVED. SO THAT WE COULD DO HYPOTHESIS TESTING ACROSS OUR LARGE COHORT. YOU KNOW 1 OF THE MAJOR EXPENSES OF HUMAN RESEARCH NOW IS GETTING THAT HUMAN IN FRONT OF YOU SO LET'S NOT WASTE THOSE OPPORTUNITIES WHEN WE HAVE COHORTS THAT ARE BEING STUDIED. SO THEN--SO THAT WOULD BE A PROSPECTIVE APPROACH AS WE MOVE TO COME UP WITH MINIMAL DATA BUT CONSIDERING THE COHORTS AND POPULATION THAT ALREADY EXIST THAT ARE SUPPORTED BY THE INSTITUTE, WE COULD USE SOME SORT OF REGISTRY OF REPOSITORIES OR REGISTRY OF DATA THAT EXIST FROM EXISTING STUDIES, YOU KNOW AGAIN SUPPORTED BY THE NIDCR BECAUSE I THINK WE HAVE A HEALTH OF EXISTING DATA THAT COULD BE MINED IN OUR ABILITY TO MINE SUCH DATA SETS IS GETTING--IS ALSO BECOMING RARE. WE HAVE, YOU KNOW STUDIES THAT--WITH MORE OF A CLINICAL FOCUS, STUDIES WITH MORE OF AN ETICSIO LOGICAL FOCUS THAT ARE COLLECTING SIMILAR DATA IN MANY CASES THAT COULD PROFITABLY BE COMBINED, YOU KNOW, OUR BUDGE SET NOT GETTING LARGER IN THE IMMEDIATE FUTURE AND IT COULD BE A WAY TO LEVERAGE EXISTING RESOURCES TOO. TO GET THE BIGGEST BANG FOR OUR BUCK. >> I UNDERSTAND NOW WHAT YOU MEAN IN TERMS OF WHETHER THE POLICY WISE WHETHER WE CAN DO IT OR NOT, BUT THERE'S A LOT OF DISCUSSION ABOUT THAT IN CONSENT FORMS AND MAKING SURE THAT WE MOVE FORWARD THAT APPROPRIATE CONSENT FORMS ARE WRITTEN SO THAT THE PATIENTS SAY YES AND THAT YOU CAN CONTINUE LOOKING AT MY SAMPLES FOR SOMETHING ELSE AND SO THAT'S IN DISCUSSION BUT VERY, VERY, IMPORTANT. YOU'RE ABSOLUTELY RIGHT. THANK YOU. >> SO AGAIN, WITH THAT COMMENT, I KNOW OTHER INSTITUTES MOVED TOWARD HARMONIZATION OF DATA AND HOW PEOPLE COLLECT WHAT INSTRUMENTATIONS THEY'RE USING AND ALL, SO I DON'T KNOW TO WHAT EXTENT NIDCR HAS GONE DOWN THAT PATHWAY, BUT THAT COULD BE HELPFUL AND IN ALLOWING PEOPLE TO KNOW WHAT'S EXPECTED OR WHAT WOULD INCREASE ONCE COMPETITIVENESS IS A BIG WORD TO CONSISTENTLY INCLUDE COMMON MEASURES FOR COMMON BATTERIES THAT WOULD ALLOW FOR COMBINING DATA SETS MORE READILY. THAT MAY BE ANOTHER AREA TO THINK ABOUT. >> VERY IMPORTANT. >> STEVE THANK YOU AGAIN FOR ANOTHER THOUGHTFUL COMMENT. WE HAVE MADE BIG STRIDES IN THIS AREA. PARTICULARLY IN THE NETWORK BECAUSE IN FACT, THEY WERE COMPLETE VOCABULARY DISCONNECT. TIME INTERVAL DISCONNECTS AND INABILITY TO LOOK ACROSS STUDIES ACTUALLY. AND SO WE HAVE MADE BIG STRIDES IN SEVERAL AREAS. THERE'S ALSO THE WORK THAT HAS BEEN DONE FACTORS THAT FOLLOWED THE GEI AND IN FACT, MARY MIGHT WANT TO ELABORATE ON THIS JUST A LITTLE BIT THAT WE WERE ABLE, WITH PHOENIX, WITH THE PHOENIX PROJECT TO GET AN ORAL HEALTH PIECE WITH DOMAINS THAT ARE SUGGESTED FOR COLLECTION ACROSS ALL CLINICAL STUDIES. AND SO MARY I DON'T KNOW IF YOU WANT TO JUST--BECAUSE MARY WAS IMPORTANT IN HELPING THAT [INDISCERNIBLE], BUT MAYBE THAT'S AN EXAMPLE OF WHAT WE SHOULD BE DOING MORE EVER. >> YEAH, NOT TOO MUCH MORE TO SAY EXCEPT IT WAS AN EFFORT SPEAR HEADED BY NHGRI WITH THE PARTICIPATION OF THE OTHER INSTITUTES INSCLUEDING NIDCR TO COME UP WITH A BATTERY OF EXISTING VALIDATED DATA COLLECTION INSTRUMENTS ACROSS MULTIPLE DOMAINS, AND WE WERE VERY GLAD TO GET AN ORAL HEALTH DOMAIN INCLUDED BECAUSE IT WAS A LOT OF THE THINGS YOU MIGHT THINK OF, YOU KNOW CANCER, HEART DISEASE, ET CETERA, ET CETERA, SO, I ENCOURAGE EVERYBODY TO GO LOOK AT THAT WEB SITE, IT'S PH ENX, AND A LOT OF FOOD FOR THOUGHT THERE IN TERMS OF ADDING OTHER MEASURES TO OUR ORAL HEALTH STUDIES AND HOPEFULLY ENCOURAGE YOUR COLLEAGUES ASTERISKS AN ORAL HEALTH INSTRUMENT THERE, TO THEIR HEART DISEASE PROJECT. >> [INDISCERNIBLE]. >> THIS ISN'T REALLY A QUESTION BUT IT'S A MAJOR ISSUE THAT WE KEEP TRYING TO UNDERSTAND AND THAT IS HOW TO BUILD TEAMS OF CLINICIANS AND SCIENTISTS THAT CAN MOVE THINGS FORWARD AND UNDERSTAND EACH OTHER AND I THINK THAT'S A CHALLENGE AND IT'S ALWAYS BEEN A CHALLENGE AND I JUST THINK IT'S SOMETHING WE NEED TO KEEP IN MIND. LOOK AT WHAT HAS BEEN WORKING AND REALLY KEEP MOVING THAT TEAM CONCEPT FORWARD AND ENCOURAGING IT. >> JUST TO FOLLOW UP ALONG THE LINES OF YIELDING FROM THE INFORMATION THAT'S OUT THERE, I HAPPEN TO BE AT STANFORD, THERE'S NO DENTAL SCHOOL BUT DOES THE NIDCR HAVE A MECHANISM TO GO TO SEE TO MAKE SURE YOU'RE CALLING THROUGH CTSA ACTIVITY AT CAMPUSES WHERE THERE'S NO SCHOOL OF DENTAL MEDICINE SUCH THAT WHEN YOU HAVE TRANSLATIONAL CENTERS THAT RELATE TO THINGS THAT ARE LIKE HEAD AND NECK TUMORS OR ORAL HEALTH OR SOMETHING WITH THE FLORA THAT MAY HAVE APPLICATIONS MRIICATIONS FOR DENTAL DISEASE THAT HAVE YOU THAT. EVEN THOUGH THEY'RE NOT TRADITIONALLY CONNECTED TO THIS INSTITUTE, THAT MAY BE A WAY TO LEVERAGE INTO OTHER AREAS, TOO. >> VERY GOOD POINT. THANK YOU. >> TO RESPOND TO THAT, THERE IS A CONSORTIUM TO THE DENTAL SCHOOL TO OUR PART OF CTSAs TO IMPROVE OUR POSITION WITHIN THE CTSAs BUT WE HADN'T THOUGHT OF THAT PARTICULAR POINT, WHAT WE COULD DO WITH INSTITUTES THAT DON'T HAVE A DENTAL SCHOOL, BUT THAT'S A GREAT IDEA. >> SO WE HAVE REPRESENTATION, STAFF, ON MANY OF THE COMMITTEES OF THE SUBCOMMITTEES OF CTSA AND THAT'S 1 OF THE 1S THAT JANEAT KIN SON WATCHES OUT FOR ACTUALLY TO SEE IF THERE ARE STUDIES GOING ON FOR SCHOOLS THAT DON'T HAVE A DENTAL SCHOOL SO WE WOULDN'T HEAR ABOUT IT DIRECTLY. IT'S A BIG UNDERTAKING TO STAY ON TOP AND I THINK WE WOULD APPRECIATE ANY SORT OF SUGGESTION ABOUT WHICH MAY BE AN EFFICIENT WAY TO GO THROUGH THAT IN SUMMATION AND GET IT. >> THE POINT--I TOTALLY AGREE AND I'LL GIVE IT THOUGHT, THAT'S FUNDED STUDIES AND COLLECTION OF DATA BY THE NIH AS A LARGE COMMUNITY BUT TRADITIONALLY OUT OF STANFORD OR M. I.T. AND PICK ANY PLACE WITHOUT DENTAL SCHOOL THAT MIGHT HAVE THAT DATA, IT'S PROBABLY NOT GOING TO BE EASY TO GET AT IT BUT IT SHOULD HAVE FUNDED MECHANISM DATA SO YOU SHOULD HAVE ACCESS TO IT. >> I THINK ON THE CTSA, THE WHOLE PRACTICE LINK NETWORKS, LINKING WITH THE CTSAs IS ON OUR MINDS AND THE SCHOOLS THAT ARE NOT AND DON'T HAVE DENTAL SCHOOLS AND MAKE SURE WE'RE INTEGRATED INTO THOSE AS WELL SO THANK YOU FOR THAT. I THINK WE'LL MOVE ON TO THE NEXT QUESTION. >> CAN I BRING UP 1--THIS IS DAVID JOHNSON, MARTHA. UNLESS YOU FLY IN, YOU CAN'T--NO--PLEASE DO, THANK YOU. >> ONE THING THAT'S STRATEGIC PLANNING, I THINK IT'S IMPORTANT NOT ONLY WHAT DOES YOUR STRATEGIC PLAN INCLUDE BUT HOW DOES IT INTERFACE WITH OTHER ENTITIES THAT ARE ALSO DOING STRATEGIC PLANNING AND 1 THING IT MAY BE HELPFUL TO INCLUDE IS HOW WELL NIDCR HAS DONE IN INTERFACING WITH OTHER GROUPS FOR EXAMPLE, AS YOU GO FROM BENCH TO BEDSIDE OR IN OUR CASE, CHAIR SIDE OR TO POPULATIONS LIKE FLOWERIDATION BUT 1 THING NIDCR HAS DONE IS TO INTERFACE WITH THE GROUPS THAT ARE TAKING IN INFORMATION AND TRANSLATING IT INTO POLICIES AND STANDARDS THAT AFFECT PATIENT CARE, LEADERSHIP GROUPS, PROFESSIONAL GROUPS, AND ALSO WITH GROUPS PARTICULARLY INSTITUTIONS THAT ARE TAKING ALL THIS INFORMATION AND LEARNING HOW DO WE GET CLINICIAN IN OUR CASE STUDENTS TO TRANSLATE ALL OF THIS INTO DIRECT PATIENT--PATIENT DECISIONS, WHAT PROCESSES ARE WE ARMING OUR CLINICIANS WITH. SO I THINK IT'S--IT COULD BE IMPORTANT EVEN THOUGH NO MONEY IS CONNECT WIDE THAT TO ALSO NOTE THAT NIDCR IS FULLY ENGAGED AND SUPPORTIVE AND INTERACTING WITH THESE OTHER GROUPS. >> EVERY IDEA ALWAYS COSTS MONEY SOMEWHERE DOWN THE LINE BUT I THINK THAT'S AN EXCELLENT SUGGESTION, SO I THANK YOU. SO NOW WILE MOVE ON TO THE NEXT QUESTION. >> SO QUEER ON TRANSFORMATION NOW. SO IN YOUR VIEW, WHAT ARE THE AREAS THAT HAVE THE GREATEST ADVANCEMENT FOR FOR DENTAL, ORAL CRANIOFACIAL RESEARCH? >> DOWN HERE AT THE END. WHEN I WAS R DING TOUGH THESE QUESTIONS, I FELT THERE WAS POTENTIALLY A LOT OF OVERLAP BETWEEN THEM. SO I'M GOING TO MAKE A COUPLE OF REALLY QUICK PASSING COMMENTS BECAUSE I THINK MY COLLEAGUES HAVE ARTICULATED SOME OF THESE VERY WELL, ALREADY. I THINK THAT THE BEHAVIORIAL COMPONENT AND THE REENFORCEMENT AND THE INTEGRATION OF THAT, INTO, YOU KNOW I WON'T SAY EVERYTHING THAT THE INSTITUTE WILL FUND BUT INTO MANY OF THE THINGS THAT THE INSTITUTE WILL FUND IS PROBABLY THE AREA THAT I FEEL WILL HAVE THE GREATEST, YOU KNOW ULTIMATE BENEFIT, FOR WHAT WE'RE TRYING TO ACCOMPLISH AND SO I THINK 1 OF THE AREAS AND IT HASN'T COME UP YET AND YOU WON'T BE SURPRISED TO HEAR THE COMMENT COME FROM ME, BUT, IS, WHAT'S THE PUBLIC PRIVATE PARTNERSHIPS MEAN TO NIDCR. AND I KNOW IN THE CURRENT STRATEGIC PLAN THAT WE'RE OPERATING UNDER, YOU KNOW THERE IS LANGUAGE TO THE EFFECT THAT YOU KNOW, THAT INSTITUTE IS WILLING TO YOU KNOW CONSIDER THESE KINDS OF RELATIONSHIPS, BUT I THINK OFFERING OR EXTENDING THE HAND VERSES, YOU KNOW BEING MORE DELIBERATE OR MORE OVERT IN HOW--YOU KNOW HOW THAT HAPPENS, I REALIZE THERE ARE THINGS, RULES WE CAN'T VIOLATE, OKAY? BUT IT'S HOW WE LEVERAGE OTHERS PERHAPS TO HEALTH IN BRINGING PEOPLE FORWARD TO THE TABLE BECAUSE YOU KNOW NOT SURPRISINGLY, THE WHOLE INDUSTRY SECTOR IS WRESTLING WITH THESE QUESTIONS, TOO, AND IT'S JUST HOW WE'RE ALL GOING TO WORK TOGETHER AND COME TOGETHER AND PROBABLY PICK THE THINGS THAT WE REALLY FEEL LIKE WE CAN MAKE THE BIGGEST DIFFERENCE IN. AND SO, I THINK THAT'S AN AREA WHEN I LOOK AT THE PREVIOUS STRATEGIC PLAN AND WHEN I THINK ABOUT THE 1 FOR THE FUTURE, I WAS HAVING CONVERSATIONS WITH AMY LAST NIGHT ABOUT THE FACT THAT I THINK THAT AS PART OF THE DATA COLLECTION THAT YOU'RE GETTING, THAT YOU--THAT YOU MORE SPECIFICALLY ASK, NOT JUST, ARE PEOPLE INTERESTED IN THESE KINDS OF RELATIONSHIPS, BUT, REALLY, REALLY, WHAT ARE THE AREAS THAT THEY THINK ARE MOST IMPORTANT? AND THEN, YOU KNOW UTILIZE THAT TO INTEGRATE INTO MORE SPECIFIC CALL OUTS, I THINK THAT WOULD ATTRACT PEOPLE AND I LOOK AT THE SDIR, AND THE STTRs AND THERE'S AN ISSUE WITH PEOPLE NOT BEING AWARE. THERE'S AN ISSUE WITH PEOPLE BEING INTIMIDATED IN WHAT DOES THAT MEAN AND OH MY GOSH, GOING TO NIH, AND WHAT DOES--YOU KNOW WHAT DOES NIH THINK ABOUT ME, BUT I THINK WE HAVE A LOT OF REALLY GREAT EXAMPLES OF THINGS, MAYBE NOT GONE ALL THE WAY TO WHERE WE WOULD LIKE THEM TO, BUT, YOU KNOW TO BE ABLE TO SHARE THOSE AND TALK ABOUT THOSE AND USE THEM AS, YOU KNOW WAYS WE CAN GET OTHERS TO ACTUALLY THINK ABOUT IT AND CONSIDER IT, SO I'M RAMBLING A LITTLE BIT BUT I REALLY THINK THAT I THINK THAT ULTIMATELY, FOR US COLLECTIVELY TO BE SUCCESSFUL AND REALLY MOVE THE NEEDLE ON A LOT OF THESE ORAL HEALTH ISSUES THAT YOU'RE TALKING ABOUT, I THINK THAT WE'RE GOING TO HAVE TO EXTEND BEYOND SORT OF THE ACADEMIC GOVERNMENT DIVIDE AND GO A LITTLE BIT BROADER. >> THANK YOU. THANK YOU FOR THOSE IMPORTANT COMMENTS AND SHOW THE PUBLIC PRIVATE PARTNERSHIP IS ON THE MINDS OF NIH AND VERY SUPPORTED BY OFFER DIRECTOR DR. FRANCIS COLLINS AND OF INTEREST TO US SO THANK YOU FOR BRING IT TO OUR ATTENTION AGAIN. I APPRECIATE IT. ANYMORE TRANSFORMATIVE? >> AS A BASIC SCIENTIST AND AS TANS FORMAATIVE, I THINK OF NEW TECHNOLOGIES AND HOW WE CAN APPLY THAT TO THE DATABASE, AND DATA TO 1 OF THE COLLEAGUES ABOUT GENOMICS [INDISCERNIBLE]--I WAS HAPPY TO SEE IN THE GRANT APPLICATION FOR 1 APPLICATION LOOKING AT EPIGENETICS OR--[LOW AUDIO ]--I'VE LEARNED OVER THE YEARS THAT YOU KNOW IT'S HARD TO UNDERSTAND HOW THESE EPIY GENETIC MARKS CAN BE APPLIEDED TO PATIENT CARE BUT IN THE FIELD OF CANCER, SOME OF THESE MARKS ARE ESTABLISHED VERY EARLY IN A PREVIOUS GENERATION AND IT COMES BACK TO YOU KNOW WHY CANCER IS RECEIVED IN THE NEXT GENERATION AND WITH ANOTHER IMPORTANT ASPECT, I THINK IS BRINGS IN THE CHILDREN'S POPULATION SO THIS WORLD IS [INDISCERNIBLE]--STEM CELLS VERY EARLY IN CHILDHOOD THAT BECOME SENSITIVE TO OTHER ENVIRONMENTAL--]LOW AUDIO ] TAKEN--THEY LEAD TO MORE SERIOUS PROBLEMS. AND IT'S A WHOLE NEW SET OF DATA THAT WE HAVE TO THINK ABOUT AND INTEGRATE THAT INTO DATABASING THAT CAN BE LOOKED AT BY CLINICIAN AND THE TRAINING AND TEACHING THEM AND SOMEONE SAID THE RESISTANCE TO CLINICIANS COMING BO THAT WAY OF THINKING, BUT YOU KNOW [LOW AUDIO ]--THEY GO INTO COMPUTERS AND REACH OUT. SO IT WILL HAPPEN AND WITH THE NEW GENERATION, OR THE NEXT GENERATION OF DENTISTS THAT RETURN, IT WILL BE VERY EASY FOR THEM TO STEP INTO THAT TO PERHAPS CHANGING THE MIND SET--[INDISCERNIBLE]. >> YEAH, YEAH. >> I THINK 1 AREA THAT IS REALLY VERY MUCH IN TRANSFORMATION IS OUR HEALTHCARE SYSTEMS. I MEAN HEALTHCARE IS TRANSFORMING, IN PEOPLE FEEL THAT MAY NOT BE TRANSFORMING, SOME PEOPLE BELIEVE THERE'S GOING TO BE TRANSFORMING BUT I THINK THE FACT THAT COMMITTEE HEALTH CENTERS, AND HOSPITALS AND CLINICS ARE TRYING TO GET TOGETHER TO TRY TO IMPROVE IN REGIONAL ELEMENTS HOW BEST GO TO CMS TO GET WAIVERS, AND ALL KINDS OF THINGS, I THINK HEALTHCARE AND ORAL HEALTH CAN BE IN THAT WAY, OF LOOKING AT HOW THAT TRANSFORMATION CAN REALLY YIELD TO BETTER TRANSFORM THE SYSTEM SO THAT THE BETTER CONNECT TO THAT ELEMENT OF THE CLINICIAN, THE RESEARCHER AND THE COMMUNITY. I THINK THAT'S THE THIRD PIECE THAT I WILL SAY, YES WHEN WE TRANSFORM AND IMPLEMENT, WE LOOK FOR THEM, THE MOLECULAR POETIC THE BEDSIDE THAT IF WE STAY IN THE BEDSIDE, IT'S NOT GOING TO DO MUCH, SWREE TO GO TO THE COMMUNITY BECAUSE A LOT OF THE IMPLEMENTATION, THAT WE DON'T REALLY GET FROM THE COMMUNITY, WE'RE NOT GOING TO CATCH SOME OF THOSE THINGS SO I THINK THAT TRANSFORMATION OF HEALTHCARE WHICH IS REALLY IN THE REALM OF HEALTH SERVICES RESEARCH IN SO MANY WAYS CAN BE VERY EXCITING. >> POINTS THAT GO ON BOTH SIDES OF THIS. >> [LAUGHTER] >> I JUST WANT TO ADD ANOTHER COMMENT THAT A LOT OF IT GOES BACK TO THE EDUCATION, A LOT OF OUR STUDENTS NEED TO BE TRAIN INDEED THAT VERY, VERY, EARLY THOUGHT FROM THE VERY BEGINNING BECAUSE SOMETIMES BY THE TIME THEY GET OUT TO BE IN CLINICAL PRACTICE, THEY'RE SORT OF NOT USED TO THAT PARADIGM SO IT'S A VERY EARLY FROM JUST THE VERY EDUCATIONAL STAGES OF MULTIDISCIPLINARY CARE. THAT'S VERY IMPORTANT. >> I WON WE'RE NOT HERE NECESSARILY ABOUT THE EDUCATIONAL MISSION BUT I THINK THAT'S REALLY IMPORTANT. WHEN WE GO BACK TO THE IDEA OF EDUCATION AT MULTIDISCIPLINARY EDUCATIONAL COMPONENTS FOR STUDENTS. >> SO MAYBE JUST THIS WHOLE CONVERSATION HERE MAY BE AN AREA THAT PERHAPS YOU CAN HELP US WITH AND I DON'T KNOW HOW, BUT IT'S BACK AT THE UNIVERSITIES AS WELL IS, I DON'T THINK THERE'S RESISTANCE, IT'S LACKAOF UNDERSTANDING, LACK OF EDUCATION AND IMPATIENCE. I HAVE A PATIENT IN FRONT OF ME AND I HAVE TO TREAT THEM TODAY AND YOU'RE TALKING--YOU'RE JUST TALKING ABOUT PERSONALIZED MEDICINE AND BIOMARKERS, BUT THEY'RE NOT GOING TO HELP ME IN MY DECISION MAKING IN MY OFFICE TODAY. SO TRYING TO GET STUDENTS AND ALSO CLINICIANS EXCITED ABOUT, IT MAY NOT BE TOMORROW, BUT IT'S COMING FOR EXAMPLE, THIS IS WHAT'S HAPPENED IN THE PAST AND NOW WE'RE DOING THIS AND HELPING TO INTEGRATE THINGS BETTER AND I DON'T KNOW HOW TO DO THIS BUT I THINK IT REALLY IS SOMETHING THAT IS A DISCUSSION AT THE UNIVERSITIES, IT'S ALSO A DISCUSSION WITH PUBLIC PRIVATE PARTNERSHIPS WITH THE EDUCATIONAL SIDE IN REACHING THE COMMUNITY SO THAT THERE ISN'T, SO I WOULDN'T CALL IT RESISTANCE, I WOULD CALL IT ALMOST--I HAVE TO TREAT MY PATIENTS AND THIS INFORMATION DOESN'T HELP ME TODAY. SO IF WE COULD HELP WITH THAT. >> OH, SORRY. SO WE'VE ALREADY TOUCHED A LITTLE BIT ON THIS 1 BUT IT CAME OUT VERY LOUD AND CLEAR AND WITH A FAVORITE SUBJECT OF WHAT ARE THE NEW EMERGING TECHNOLOGIES, CAPABLES OR TOOLS THAT HAVE POTENTIAL TO REVOLUTIONIZE OUR ORAL HEALTH RESEARCH? >> SO AT THE RISK OF SOUNDING LIKE A BROKEN RECORD, THAT IT WILL REVOLUTIONIZE RESEARCH. >> I AGREE, THE HIGH THROUGHOUT PUT IS THE WAY TO GO AND BUILD THAT INTO DATABASES AND THE--MICHAEL BROUGHT UP A GOOD POINT, YOU KNOW A LOT OF THE CENTERS THAT ARE DOING THIS IS IT'S JUST ROUTINE GOING 24/7, WE'RE NOT IN THE SCHOOL THAT HAS AN INSTITUTION THAT HAS A DENTAL SCHOOL BUT I THINK IT HAS TO BE PART NEUROLOGISTING TO BE ABLE TO ACCESS PATIENT SAMPLES. TO BUILD THAT INIAL--DENTAL SCHOOL WOULD BE GOOD. AND HAVE THE HIGH THROUGHOUT PUT INFORMATICS AND FACILITIES AND THE PERSON DOING THE CLINICAL RESEARCH AND DOG THE BASIC RESEARCH, AND THE VERY EXCITING THING WITH THE BUDGET FALLING IS THAT THE COST,--RIGHT, THE COSTS COMING DOWN AT A REMARKABLE FASHION UNBELIEVABLE HOW IT IS AVAILABLE ON THE PLATFORMS AND HOW HIGH THE THROUGH PUT IS GETTING AND THERE ARE INDUSTRY AND PHARMACEUTICAL COMPANIES THAT ARE THAT HAVE THE NEW PHILOSOPHY IN TERMS OF PROVIDING MONEY FOR THIS TYPE OF THING FOR EXAMPLE, FOR EXAMPLE PFIZER IS GIVING THESE RESEARCH AWARDS IN THE AREA OF CANCER IN THE CANCER TO DEVELOP TEASE EPIY GENETIC SIGNATURES AND CANCER STEM CELLS TO BE ABLE TO UNDERSTAND HOW DRUGS AND TREATMENTS ARE AFFECTING THE CELLS. AND SINCE YOU BROUGHT UP THE OMICS, AND JANE SINCE YOU SECONDED, TO HELP US THINK A LITTLE BIT, BEYOND THE OMIC, AND HOW TO OVERCOME THE FULL UTILIZATION OF THE DATA AND HAVING MORE AND MORE DATA IS WONDERFUL BUT HOW DO WE REALLY TRANSLATE THAT INTO BETTER RISK PROFILES FOR OUR PATIENTS? HOW DO WE TAKE ADVANTAGE OF THE OMICSS AND MARRY THAT WITH THE ELECTRONIC DENTAL RECORD. HOW DO WE MARRY THAT WITH CLINICAL DATA. YOU KNOW, WE DON'T HAVE TO DO IT NOW, I KNOW MARTHA IS PROBABLY ANXIOUS TO MOVE ON TO GET TO OTHER QUESTIONS, BUT, I THINK WE ALL RECOGNIZE HOW VITALLY IMPORTANT ALL THIS IS, BUT REALLY TRANSLATE TGF INTO ACTION BETTER PROFILES AND THINGS THAT WILL ENABLE US AND APPLY TO PATIENT AND POPULATION HEALTH. IT'S I THINK WHAT WE GRAPPLE WITH, AND SO, OF COURSE IN THIS FLAT BUDGET, FLAT IS GREAT, ENVIRONMENT, IT'S DIFFICULT TO THINK ABOUT APPROXIMATE THIS IN THESE WAYS, BUT THE STRATEGY REQUIRES THAT TO NOT BE HELD HOSTAGE BY THE BUDGET CLIMATE BUT BE REALLY PUTTING ON THE TABLE THINGS THAT WE--REALLY NEED TO BE THINKING ABOUT AND PLANNING NOT JUST FOR THE CURRENT STRATEGIC PLAN AND THE 5 YEAR HORIZON, BUT, BEYONDt( THAT, THE 10 AND 15 YEARS, SO YOU KNOW ANY HELP THAT YOU CAN GIVE US AND SORT OF MOVING THE OMICS FORWARD AND BRINGING ALL THE PIECES BECAUSE THERE'S SO MANY MOVING PIECES THAT RIGHT THAT ACCOMPANY THAT WOULD BE REALLY HELPFUL. THANK YOU. >> YOU RAISED AN EXCELLENT POINT AND THAT'S 1 OF THE REASONS WHY I HAD MENTIONED WHY IT'S SO IMPORTANT TO HAVE PARTNERSHIPS AND ACTING LEVEL OF THE GENOMICS WITH THE COMMISSION BECAUSE THEY WILL BE USING THESE THINGS IN TERMS OF DAT SITES AND THEY'LL FIND OUT SPECIFICS THAT ARE WRONG IN THE GENOME, BUT THEN, THEY'LL MAKE CORRELATIONS AND FURTHER BEYOND THAT AND THAT'S WHEN YOU NEED A CLINICIAN TO SAY, ARE THESE OUTCOMES THAT YOU DID IN BIOLOGY MEANINGFUL OR THESE ARE MEANINGFUL, AND THAT'S THE IMPORTANCE OF BRINGING THEM TOGETHER AT AN EARLY STAGE [INDISCERNIBLE]. SO I WOULD COME BACK TO THE POINTS THAT HAVE BEEN RAISED. OF COURSE WE'RE ALL GRAPPLING WITH HOW BEST TO UTILIZE THESE TOOLS AND I THINK WE'RE AT THE STAGE WHERE TO ME THE IDEAL SAYING WOULD BE FOR ANY OF OUR HUMAN STUDIES TO BE PREPARED TO JUMP INTO THE OMICS, WHENEVER A CLINICAL OR ETICSIO LOGICAL STUDY IS FUNDED. BECAUSE IT'S CERTAINLY PREMATURE TO SAY, WELL, WE GETTER GET WHOLE DENOME SEQUENCING ON EVERY SAMPLE THAT NIDCR SUPPORTS, THAT'S JUST SILLY BUT IT WE HAVE SAMPLELES IN PLACE THAT IN A CONSIDERED FASHION IS DETERMINED THAT, WOW, THIS IS A GREAT PRELIMINARY RESULT, WE NEED A BIG SAMPLE SIZE TO SEE IF THIS HOLDS UP, IDEAL LE PRIMATES LIMINARY RESULT THAT WOULD HAVE PRACTICE BASED IMP LIAISONICATIONS. --IMPLICATIONS. SO KEEPING THE CLINICIANS INVOLVE FRIDAY THE VERY BEGINNING WHAT ARE THE IMPORTANT QUESTIONS AND WHAT SHOULD BE--WHAT KIND OF PHENOTYPING SHOULD BE WE DOING AS WE'RE CONSIDERING IMPLEMENTING OMICs APPROACHES. >> [INDISCERNIBLE]. WITH THE INTEGRATION AND DIFFERENT EXISTING CENTERS THAT HAVE BEEN FUNDING FOR EXISTENCE, WITH THE METABALOMICS CENTERS THAT BEEN FUNDED SO CAN YOU USE THOSE AS LEVERERAGE AND WHAT YOU NEED IS A WAY TO MAYBE HAVE A CLEARINGHOUSE OF A LOT OF STUDIES THAT ARE SENT TO THE OMICs CENTERS AND IF HAVE YOU AN I.D. INDIVIDUAL WHO IS--I.T. INDIVIDUAL WHO IS GIFTED AND WHO CAN CAPTURE THESE DATA FREES THEE VARIOUS CENTERS CAN BE A CLEARINGHOUSE OR A WAY FOR PEOPLE TO SEARCH THROUGH AND MINE THIS INFORMATION STUDIES THAT ARE BEING DONE. BECAUSE THAT'S WHAT YOU NEED, A CENTRAL AREA WHERE EVERYONE CAN SEARCH, JUST ANOTHER IDEA. >> I DON'T REALLY HAVE THIS WELL FORMULATED BUT WHEN I THINK OF--I THINK OF THE CLINICIAN NAHAS AN INTERESTING QUESTION ASK THEY MIGHT WANT TO DO RESEARCH IN IT, BUT TO DO INITIATE RESEARCH, FIRST OF ALL IF YOU PAY YOUR CHR COMMITTEE MONEY, YOU HAVE TO PAY SUBJECTS SO TO JUST SORT OF START COLLECTING AND THEN YOU HAVE TO FIND SOME BASIC SCIENCES THAT'S INTERESTED IN WORKING WITH YOU. SO I THINK TO TRY TO COME UP WITH CREATIVE WAYS TO THOSE--FOR THOSE SMALL CLINICAL PROJECTS THAT HAVE A REALLY INTERESTING HAPPEN LINKING ICFICATION, YOU KNOW HOW DO YOU NEST WORK IN, YOU DON'T NEED A LOT OF MONEY YOU NEED STRATEGIES, MAYBE PEOPLE THAT HAVE FUNDED RESEARCH CAN GET SUPPLEMENTS TO SUPPORT CLINICAL DATA GATHERING, IF SOME CLINICIANS HAD AN AREA IS, AND $20,000 ON THAT'S JUST NOT THERE, FOCUSED ON GET THINGS START BUT TO LOOK AT CREATIVE WAYS TO HELP CLINICIANS ACCESS SOME OF THIS STUFF THAT THEY DON'T EVEN KNOW ABOUT WILL BE REALLY USEFUL. >> SO THE BI-DIRECTIONAL NETWORKS THAT ARE CLINEITIONS ASKING CLINICAL RESEARCH QUESTIONS OF HAVING THEM WHEN THEY DON'T KNOW THE ANSWER SO COME BACK TO THE UNIVERSITIES AND TO HELP IDENTIFY WHERE THEY CAN GO SO THEY DON'T SIT IN THEIR OFFICE AND SOMETIMES CALL NIDCR AND SAY I HAVE THIS PATIENT AND WE REALLY HAVE DIFFICULTY IN TERMS OF ASSIGNING THEM, BUT THEY'RE EXCITED SO HAVE YOU A LOT OF CLINICIANS OUT IN PRACTICE THAT ARE EXCITED ABOUT WHAT'S GOING ON IN TRYING TO IDENTIFY BUT NO PLACE TO GO. AND I PERSONALLY BELIEVE THERE ARE MANY OUT THERE WITH THAT ATTITUDE AND JUST DON'T HAVE A PLACE FOR IT. BUT THANK YOU. >> THIS THE RESPONSE TO THE LAST 2 ISSUES AND WITH THIS TRANSFORMATIVE AND MAYBE TOO PROVOCATIVE BUT YOU HAVE THE OMICs. YOU'VE GOT THE ELECTRONIC MEDICAL RECORDS AND DENTAL RECORDS, YOU KNOW, AS DISTINCT FROM MEDICAL RECORDS, YOU KNOW JUST AS A PATIENT WHAT WOULD BE TRULY TRANSFORMATIVE IS, TRULY INTEGRATING THE DENTAL CARE TEAM INTO THE MEDICAL HEALTHCARE TEAM. THAT'S WHAT--YOU KNOW AT CORE WHY IS THERE THAT DISTINCTION? FROM MY PERSPECTIVE IT'S UNFATHOMABLE AND A BIT INFURIATING. THIS IS SUCH A--YOU KNOW, WE'RE GOING TO HAVE THESE WONDER DATA SET WHERE IS WE LOOK AT ORAL HEALTH AND HOW IT RELATES TO DIABETES AND EVERYTHING ELSE, THERE NEEDS TO BE AN INTEGRATION OF THESE THINGS AND AND SO, I THINK THAT'S THE TRANSFORMATIVE AND TECHNOLOGICAL NEXT STEP. THE OTHER TECHNOLOGICAL ASPECT WITH THIS ADDED IS THE MEASUREMENTS. YOU KNOW BEING ABLE TO HAVE SOMEONE WITH YOUR iPHONE AND JUST SWAB IN YOUR MOUTH AND FIND WHAT YOUR CURRENT MICROBIOME IS, SO I THINK THERE'S THAT KIND OF TECHNOLOGICAL TRANSFORMATION THAT CAN HAPPEN. >> NO, THANK YOU, VERY, VERY IMPORTANT POINT. SO, BUT I--I-- >> [INDISCERNIBLE]. >> I JUST WANT TO PICK UP ON JEFF'S POINT ABOUT INTEGRATION AND TO INCLUDE WITHIN THAT INTEGRATION THE BEHAVIORIAL HEALTH TEAM. BECAUSE IN MEDICINE, THAT'S BECOME AN INCREASING AREA OF PATIENT CENTERED YOU KNOW TREATMENT TEAMS, AND OFTEN A LOT OF THE MEDICAL ISSUES ARE BEING DRIVEN BY FAILURE TO ADOPT HEALTHY BEHAVIORIAL PRACTICES AND SO, INCREASINGLY THESE INTEGRATED CARE TEAMS ARE BECOMING STANDARD PRACTICE CERTAINLY WITHIN THE VA SYSTEM, SO I WOULD SAY, LET'S BRING THEM ALL TOGETHER. >> JUST WANT TO PUSH SOMETHING FURTHER IN THE COMFORT ZONE IS THAT FOR EXAMPLE WOULDN'T IT BE EXCITING TO GO TO SCHOOLS AND GET PHOTOGRAPH OR SOMETHING TECHNOLOGY TO ALL THE KIDS, AND THEN BEGAN TO USE THAT INFORMATION TO TRY TO GET THEM TO START SENDING DATABASES THAT WILL COME FROM THE SCHOOLS THAT GO DOWN TO THE DENTALS AND TO THE PHYSICIANS AND SO BEGIN TO REALLY START GETTING, EVEN THAT COULD BE VERY INNOVATIVE BECAUSE THEY COULD BE IN SCIENCE, SHOWING SOME WAYS, I DON'T KNOW WHAT EXACTLY, SOME NEW TECHNOLOGIES CAN GO INTO DENTISTRY THAT CAN SHOW CERTAIN PARTS OF THE ORGANIZATION, THAT ACCOUNTED REPRESENT AN INTERESTING TRAJECTORY OR WHAT IS THE GENESIS OF THE CONDITION FOR THE CHILDREN? >> THIS IS GOING BACK TO PAMELAS COMMENTS. SO 1 OF THE THINGS THAT MANY ACADEMIC HEALTH CENTERS ARE DOING NOW IS LEVERAGING THEIR HEALTH RECORDS TO REGISTRIES SO THAT IF THE PATIENTS COMING IN SIGN OFFOT CONSENT FORM, THEY'RE PART OF A REGISTRY THAT CAN BE MINED AND DEIDENTIFIED FASHION AND WE'RE FINDING THAT OUR CLINICAL FACULTY, ARE PRETTY INTERESTED IN THAT BECAUSE THEY HAVE THAT IDEA THAT YOU MENTIONED, WHAT DO I DO NEXT? WELL LET'S SEE IF HOLDS UP IN OUR OWN IN. TERNAL RESEARCH REGISTRY OR POTENTIALLY ACROSS OTHER UNIVERSITIES BEFORE YOU HAVE TO AT THE CLINICAL FACT ULTIMATELYY GO TO THE BIG STEP OF ENROLLING THE COHORT OF SOME SORT. SO, I THINK THAT THERE COULD BE MORE DONE ACROSS SCHOOLS FOR EXAMPLE TO FOSTER THAT THAT RESEARCH DESIRE IN OUR MORE CLINICALLY ORIENTED FACULTY WHO COULD THEN BRING THEIR EXPERTISE TO BEAR IN WAYS THAT THE MORE BASIC PEOPLE HAVE NOT THOUGHT ABOUT. JUST STATED THE TECHNOLOGIES AND IPF IN AH TO MY KNOWLEDGE NOWS REPROGRAMMING FOR BUILDING BLOCKS TO REPAIR, REPLACE OR GENERATE IN THE ORAL CRANE CROW FACIAL REGION ARE SOMETHING THAT SHOULD BE ON THE TABLE IN TRANSFORM WAG WE DO IS SECOND THING IS WEARING A SILICONE VALLEY HAT, I ENCOURAGE THE DENTAL SCHOOLS AND AND INSTITUTIONS THAT RECEIVE FUNDING FROM NIDCR TO MAKE SURE THEY'RE COMMUNICATING WITH THE CLINICIAN ABOUT WHAT IDEALS WOULD TRANSFORM THEIR PRACTICE, SO THE IDEA OF A NEW TECHNOLOGY COMING FROM A PRACTICE RESEARCHITION WHETHER IT'S IPHONE BASED OR WHATEVER IS INTERESTING BUT DENTAL SCHOOLS LIKE MEDICAL SCHOOLS LIKE BUSINESS SCHOOL HEAT SHOCK SYSTEM HAVE THESE INNOVATION SEED GRANTS WHERE THE CLINICIAN HAS SOME PLACE TO GO WHEN HE OR SHE HAS A PROBLEM THAT THEY THINK THEY HAVE A SOLUTION FOR, WHERE DO THEY GO NOW. HOW IS THAT CAPITALIZED IN A VERY EFFICIENT WAY WITH JUST THE SMALL GRANTS BUT IT WOULD BE A WAY TO GET EMERGING TECHNOLOGIES BUT THEIR VOICES FROM THE PRACTITIONER WHICH MAY OR MAY NOT BE AN OBVIOUS CONNECTION TO DENTAL SCHOOLS RIGHT NOW BUT IN CARDIOLOGY AND THESE OTHER FIELDS WHERE THEY'RE COMING ALL THE TIME, I'M NOT SURE, THAT'S SOMETHING THEY BE COULD BE THOUGHT IN THE NEXT 10 YEARS HOW DO WE ENGAGE THE CLINICIAN FROM AN IDEA INNONAPOPTOTIC STANDPOINT. >> THAT'S GREAT. THANKS FOR BRINGING THAT UP. >> GO AHEAD. >> TO FOCUSED ON FOLLOW UP, MINING IDEA IS GREAT, YOU CAN LEARN A LOT ABOUT WHAT YOU'RE CURRENTLY DOING AND GIVING NEW TECHNOLOGIES TO DLINITIONS TO UTILIZE IS A GOOD IDEA BUT WHAT I'M TALKING ABOUT IS ACTUALLY ENCOURAGING THE OTHERS WAY AROUND WHERE CLINICIANS ARE SAYING, I THINK THIS IS REALLY INTERESTING. I'VE SEEN THIS PROBLEM, I'D REALLY LIKE TO FIND SOME BASIC SCIENTISTS THAT MIGHT BE INTERESTED TO SEE IF THERE'S SOMETHING THAT WE CAN EXPLORE FURTHER AND I'M NOT SURE HOW TO GO ABOUT IT AND I THINK THAT'S WHAT WE ARE REALLY NOT DOING. >> THANK YOU. I AGREE. >> SO, IT'S 10:20. WE HAVE 1 MORE QUESTION THEY DIDN'T THINK WE WOULD--I WAS CONCERNED, THIS IS GREAT, THIS HAS BEEN ABSOLUTELY WONDERFUL BUT WE WOULD NOT GET TO BUT I'D LIKE TO JUST ADDRESS IT SO THAT IT IS ON YOUR RADAR SCREENS AND MAYBE ANY 1 OR 2 OR 3 VERY THOUGHTS AT THIS TIME AND REALLY, DAVID I FORGOT YOU'RE ON THE PHONE, I DON'T KNOW IF YOU HAVE THOUGHTS ON THE QUESTION BEFORE, BEFORE I MOVE ON? >> NO I'M GOOD, THANK YOU. >> SO THE NEXT 1 RELATES TO THE PIPELINE AND WHAT CAN NIDCR DO TO EXPABD AND ENHANCE THE PIPELINE FOR NEW DENTAL ORAL CRANIOFACIAL RERESEARCHERS, AND THE REASON WHY THIS IS VERY IMPORTANT, IN MARCH WHEN WE GO TO THE I.D. E. A., ADR MEETING WE WILL HAVE A LOT OF FORUMS CENTERED ON THIS QUESTION, DRESS ADDRESSING FROM STUDENTS IN THE DDS Ph.D. PROGRAM TO FACULTY THAT ARE INVOLVED IN TRAINING AND OPEN SESSIONS ON THIS AS WELL. IT WILL BE POSTED ON THE WEB SITE AND COMING TO YOU BEFORE THAT AND HOPEFULLY COMING BACK AGAIN ON THIS VERY CRITICAL QUESTION FOR US AND BUT IF THERE ARE ANY SPECIFIC THINGS, YES? >> I HAVE A SPECIFIC QUESTION BACK, I HAD HEARD THERE ARE TALK THAT WE'RE TRAINING TOO MANY PH Ds, THERE'S NOT ENOUGH JOBS FOR EVERYBODY. YOU KNOW IT'S GREAT TO HAVE NEW PEOPLE IN THE PIPELINE, BUT YOU KNOW WHAT ARE WE GOING TO TRAIN THESE PEOPLE AND THEN BE ABLE TO DO RESEARCH SO I JUST THINK TO HAVE THIS KIND OF A REAL UNDERSTANDING OF WHO WE WANT AND THEN AFTER DOING THIS, MANY, MANY, YEARS OF TRAINING, WILL THEY ACTUALLY HAVE A CAREER OR DO WE LOOK AT TRAINING GOOD SCIENTISTS WHO THEN BECOME TEACHERS OR GO OUT INTO INDUSTRY AS A GOOD THING. SO HOWEVER IT ENDS UP, IS FINE. SO THAT'S A BIGGER QUESTION THAT CAN GO ON FOREVER BUT IF YOU GO ON THE WEB SITE AND LOOK AT THE RECOMMENDATIONS FROM THE ADVISORY COUNCIL TO THE DIRECTOR AS WELL AS THE RESPONSE TO THAT, FROM NIH IN TERMS OF THE WORKSHOP AND WORKSHOP DIVERSITY, THAT PAGES AND PAGES ON DATA THAT WERE ATTEMPTED TO BE COLLECTED IN TERMS OF ARE WE TRAINING TOO MANY? NOT ENOUGH? WHAT'S THE MODEL THAT WE SHOULD BE LOOKING AT FOR THE FUTURE? AND I THINK 1 EVER THE CONCLUSIONS IN TERMS OF--IT WAS EASIER TO CAPTURE INFORMATION ON PH Ds, BUT HPDs THAT ARE NOT ON TRAINING GRANTS, WERE NOT ABLE TO BE CAPTURED SO THEY'RE MISSING AND THERE ARE MANY THAT ARE NOT, OR COMING FROM INTERNATIONAL THAT ARE FUNDED BY OTHER MECHANISMS INCLUDING THEIR OWN GOVERNMENTS AND THOSE ARE LOST WHEN WE TRY TO CAPTURE THE INFORMATION. BUT 1 OF THE THINGS THAT WAS HIGHLIGHTED WAS THAT MANY OF THESE PH Ds ARE VERY, VERY, SUCCESSFUL BUT THEY DON'T GO INTO ACADEMIA. SOME OF THEM ARE SITTING AROUND THE TABLE HERE THAT ARE ABSOLUTELY WONDERFUL IN TERMS OF OUR DIVISION OF EXTRAMURAL RESEARCH AND DIVISION OF EXTRAMURAL ACTIVITY, THAT ADVANCE TO A VERY CRITICAL POINT FOR US AS WELL AS THOSE THAT ARE IN INDUSTRY THAT ARE OF INCREDIBLE VALUE, AND SO, HOW DO WE SAY WE'RE SUCCESSFUL IN OUR TRAINING NEEDS TO BE VERMEN INFECTED VISITED AS WELL SO THAT'S AN IMPORTANT POINT IN AN AREA OF DISCUSSION. IS AND IN TERMS OF THE CLINICAL SCIENTISTS, MEDICAL, DENTAL, VETS, THE COMMITTEE FELT THEY DIDN'T HAVE THE EXPERTISE TO RULY ADDRESS THAT SO THERE'S ANOTHER COMMITTEE THAT'S FORMED NOW THAT'S GOING TO BE ADDRESS TAG AND DRIVE TOGETHER AS MUCH INFORMATION AS WE HAVE POSSIBLE AND AVAILABLE TO ANALYZE IT SO YOU'RE ASKING A QUESTION WITH MANY THAT GED GO ON TO IT FOREVER AND THAT'S DATA AND THAT'S A VERY, VERY ACCIDENT IMPORTANT THING AND HOW DO WE HAVE THE INFORMATION OF WHERE WE ARE NOW, SO THANK YOU FOR RAISING THAT. >> I WANT TO SHARE AN OPTIMISTIC OBSERVATION, I KNOW IT HAS BEEN OUR DENTAL STUDENTS A MUCH GREATER INTEREST IN RESEARCH THAN EVER BEFORE. I MEAN I THINK THEY SEE THE WORLD DIFFERENTLY, THEY HAVE A MORE GLOBAL VIEW, NOT NECESSARILY, UNIFORMLY FOCUSED ON CLINICAL PRACTICE OR SEE CLINICAL PRACTICE THROUGH DIFFERENT LENSES AND I THINK IT'S AN OPPORTUNITY FOR US TO ENCOURAGE THAT AND PROVIDE OPPORTUNITIES AND FLEXIBILITY BECOMES IMPORTANT FOR BOTH MENTORING STUDENT AS WELL AS JUNIOR FACULTY AND PROVIDING THEM THE FACULTY DEVELOPMENT OPPORTUNITIES THROUGH Fs AND Ks AND SIMILAR AWARDS SO THAT THEY GIVE THE INTENSIVE TRAINING AND MENTORING THEY NEED IN ORDER TO BE SUCCESSFUL. SO, I THINK THAT THERE'S A LOT OF TIEWPT OUT THERE AND I'M VERY PLEASED. I DON'T THINK IT'S JUST MY INSTITUTION WHERE OUR YOUNG STUDENTS ARE ACTUALLY LOOKING AT CAREERS BEYOND TYPICAL PRIVATE PRACTICE AND DENTISTRY. NTHIS IS DAVID JOHNSON, I AGREE COMPLETELY. WE'RE GETTING OUTSTANDING STUDENTS TODAY AND I HAVE TO BELIEVE THERE'S A GREAT OPPORTUNITY TO TAKE ALL THIS TALENT AND INTELLECT AND ENGAGE IT WITH ALL THE RESEARCH THAT'S GOING ON. THANK YOU. >> WHAT HAPPENS DOWN THE ROAD WHEN THESE FOLKS EVENTUALLY ENTER ACADEMIA, THERE'S 2 SPECIFIC COMMENT SYSTEM THE LOANER PAYMENT PROGRAM, THAT'S ALWAYS BEEN AN AREA WHERE IT'S HELPFUL FOR FOLKS OBVIOUSLY HAVE BEEN IN EDUCATION GOING THROUGH DENTAL EDUCATION IN THIS AMASSED VERY LARGE SUM OF MONEY THAT THEY OWE, SO INCREASING THOSE OR ENHANCING THOSE LOAN REPAYMENT PROGRAMS IS I THINK IS A SURE WAY. OTHER THING IS ABOUT LATER ON, WHEN FACULTY BECOME JUNIOR FACULTY GETTING THOSE NEXT AWARDS AFTER THE INITIAL TRAIT TRAINING GRANTS BECOMES CHALLENGING AND ESPECIALLY IN THIS FUNDING CLIMATE, SO I THINK MAYBE USING THE EXISTING MECHANISMS THAT ARE ALREADY PRESENT SAY THE R-AWARDS WHERE THERE'S STILL A COMPONENT WHERE THERE'S MAYBE SENIOR FACULTY THAT COULD BE PARTNERS WITH UP AND COMING FACULTY WHERE INSTEAD OF JUST--IN THINKING OF WHERE THEY HAVE MULTIPLE PI TYPE GRANTS WHERE I'M JUST SAYING THAT I HAVE TO BE NEW INVESTIGATORS WHERE THEY HAVE TO BE SORT OF LONGER PARTNERED PERIOD WHERE THERE'S MENTOR COMPONE TONIGHT THOSE GRANT MECHANISMS MY BE ANOTHER ADDITION AIL WAY TO HELP CONTINUE KEEPING THOSE PEOPLE IN THE PIPELINE. >> MY COMMENT GOES BACK TO BRIDGING THE DIVIDE BETWEEN THE CLINICIANS AND THE SCIENTISTS. AND I THINK HAVING BEEN IN AN ACADEMIC ENVIRONMENT AT YUKON FOR A FEW YEARS NOW, I THINK WE GET THE BEST AND THE BRIGHTEST AND THEY SHINE DURING THE FIRST COUPLE OF YEARS OF THEIR REDICATION AND THEN THERE IS A DECLINE TOWARD THE END. THERE'S A DECLINE AND LOSS OF CURIOSITY IN THEIR DEVELOP AND WANT NOR INVESTIGATIVE TYPE OF A PROFESSIONAL AND IF WE CAN GRAB THESE STUDENTS DURING THEIR DENTAL SCHOOL AND CULTIVATE THIS NATURAL CURIOSITY THAT COME IN WITH AND PERHAPS NIDCR CAN FUND A 5 YEAR TYPE OF PROGRAM WITH A Ph ATTACHED TO THE FIFTH YEAR OR SOMETHING THAT WILL CULTIVATE THIS TYPE OF EDUCATION, TOWARD UNDERSTANDING BETTER, BETTER UNDERSTANDING OF OF RESEARCH AND TRYING TO BRIDGE THE DIVIDE BETWEEN CLINICIANS AND SCIENTISTS, I THINK IT WOULD BE VERY BENEFICIAL. >> SO, I'D LIKE TO--UNLESS THERE'S SOMETHING THAT HAS TO SAY SOMETHING, I'D LIKE TO THANK YOU VERY MUCH FOR YOUR PARTICIPATION. THIS WAS PHENOMENAL. SO I REALLY APPRECIATE IT AND I THINK WE HAVE A BREAK FOR 5 MINUTES BUT LET'S DO 10 MINUTES. SO REALLY WANT EVERYBODY BACK HERE AT 22. SO THANK YOU VERY MUCH. >> SO, THIS SESSION IS DEVOTED TO THE AREA OF PAIN VERSES BOTH TRANSNIH AS WELL AS FEATURING SOME OF OUR SPECIFIC PORT FOAL YEE AND WE'RE GLAD TO HAVE 3 GUESTS THAT ARE PRESENTING TODAY, 1 FROM ENTHUSIASM RAMURAL AND 2 FROM EXTRAMURAL. AND JUST--I THOUGHT I WOULD PRECEPT A BRIEF BACKGROUND AND WHERE I'M GOING TO FOCUS ON THE BUDGET AND THAT'S WHAT I DO THESE DAYS. AND THE RESEARCH ASPECT OF THIS WILL BE DISCUSSED SHORTLY. SO SOME OF THE TRANSNIH ACTIVITIES THAT WE AT NIDC ARE ARE INVOLVED IN AND YOU WILL WILL HEAR MUCH MORE DETAIL ABOUT ALL OF THESE INCLUDE THE NIH PAIN CONSORTIUM AND THIS WAS ESTABLISH INDEED 1996 AND AND I HEARD WAS REVITALIZED IN 2003. AND AS THE DIRECTOR I SERVE ON THE COMMUNITY, ALL OF THESE ARE VERY ACTIVE GROUPS. THE INCOME 1 IS BLUEPRINT FOR NEUROSCIENCE AND WERE THIS IS COOPERATIVE FUNDING EFFORT AMONG 15 ICASKS OFFICES THAT SUPPORT NEUROSCIENCE RESEARCH AND THIS WAS FOUNDED IN 2004. IN ADDITION TO THAT THE IRPT AGENCY RESEARCH COMMITTEE WAS ESTABLISH WIDE THE FIGHTER MEET NOTHING MARCH OF 2012 AND WE'VE HAD ANOTHER MEETING SUBSEQUENT TO THAT AND THIS WAS ESTABLISHED BY THE PATIENT'S PROTECTION AND AFFORDABLE CARE ACT. IT'S A FEDERAL ADVISORY COMMITTEE, IT INCLUDES 6 FEDERAL AGENCIES AS WELL AS EXTRAMURAL SCIENCES AND MEMBERS OF THE PUBLIC. YOU WILL HEAR MUCH MORE DETAIL ABOUT THESE FROM DR. KUSI AK IN A MOMENT. IN TERMS OF THE BUDGET HOW MUCH DOES NIH SPEND ON THIS AND THE OTHER FEDERAL AGENCIES? YOU CAN SEE THE MAJOR PART IS SO THERE'S 430 MILLION AND THE MAJOR PART OF THIS IS 90% IS NIH. IN ADDITION TO THAT THE OTHER DIVISIONS, THE DEPARTMENT OF DEFENSE, V. A. CDC AND A. R. C. HAVE A VERY SMALL% RELATIVE TO NIH AND THEY'RE ALL IMPORTANT AND THEY'RE ALL ADDRESSING VERY CRITICAL ISSUES IN THE AREA OF PAIN. AS WE BROUGHT UP TODAY, THE BASIC TO THE CLINICAL AND ALL OVER THE NIH, CAN YOU SEE THESE ARE CODE INDEED CHANGE WAYS SO YOU CAN'T TAKE THIS AS THIS IS IT. THIS IS EXACT IN THE END ZONE OF THE CLINICAL BUT THE CLINICAL RESEARCH FROM 202 FOCUSED ON 2011, CAN YOU SEE IT'S ABOUT--STAYING PRETTY CONSTANT, BASIC RESEARCH HAS GONE DOWN A LITTLE BIT AS YOU MOVE MORE INTO THE TRANSLATIONAL AND CLINICAL RESEARCH COMPONENT. HOW DOES THIS COMPARE TO NIDCR, INTERESTINGLY ENOUGH WHEN WE LOOKED AT THIS, WE HAVE ABOUT 73 GRANTS AND THERE ARE THE 2011 PIE WE SELECT O THAT, THAT'S FOR ALL OF NIH AND IN TERMS OF OUR AREA ABOUT 82% IS BASIC RESEARCH, CLINICAL IS 17% AND THE TRANSALATIONAL IS 1%. --TRANSLATIONAL IS 1%. BUT AN IMPORTANT POINT TO POINT OUT BUT WHEN YOU BREAK IT DOWN INTO DOLLARS, WE HAVE 30 MILLION WE'RE DEVOTING TO THIS AND ALTHOUGH IT'S ONLY 17% IN TERMS OF THE GRANTS, IN TERMS OF THE EXPENDITURE, SOME IT'S 25% OF PORTFOLIO WITH THE MAJORITY GOING TO BASIC SCIENCE. SO BEFORE I'D LIKE TO NOW TAKE A MEMORY CLONE TONIGHT INTRODUCE DR. JOHN KUSI K, MANY OF YOU KNOW WHO HE IS, IT'S A MODEST INDIVIDUAL AND WE DON'T TALK ABOUT HIM TOO MUCH BUT I'M GOING TO SPEND SOMETIME TALKING ABOUT HIM. SO, HE IS THE DIRECTOR OF NIDCR MOLECULAR AND CELLULAR NEUROSCIENCE PROGRAMS IN THIS CAPACITY HE DIRECTS THE NIDC'S BROAD CAN COMPLEX NEUROSCIENCE PORTFOLIO. WITH STRATEGIC INSIGHT, CREATATIVITY, LEVERAGING HIS DEEP UNDERSTANDING OF THE RESEARCH AREA, EXTERNAL COMMUNITY AND NIH FUNDING MECHANISMS TO DEVELOP A NUMBER OF EXCITING SCIENTIFIC INITTIA TIFFS THAT FILL VARY GAPS IN OUR PORTFOLIO. YOU WILL SEE EVIDENCE OF HIS EXPERT GUIDANCE IN THE EXCITING PRESENTATIONS THAT ARE LINED UP THIS MORNING. IN ADDITION HE PROVIDES CRITICAL INPUT AND DIRECTION FOR A NUMBER OF TRANSNIH RESEARCH PROGRAMS INCLUDING NEUROSCIENCE BLUEPRINT AND THE NIH PAIN CONSORTIUM. FOR EXAMPLE, HE SPEAR HEADED THE EFFORT TO DEVELOP THE NEUROSCIENCE GRANT CHALLENGE ON CHRONIC PAIN AND HE CURRENTLY ADMINISTERING THE GRANTS THAT WERE FUNDED THROUGH THE THIS INITIATIVE ON BEHALF OF AIL OF NIH. HE PLAYED A CRITICAL ORGANIZATIONAL ROLE IN THE REVITALIZATION OF THE PAIN CONSORTIUM AND IS INTEGRAL TO THE REGULAR EFFORT OF THE PAIN CONSORTIUM TO DEVELOP NIH COMMON FUND INITIATIVES FELT FURLGTDER NOR, HE INITIATED THE CREATION OF A TRANSNIH WORKING GROUP TO ADDRESS THE CONCERNS OF PATIENT ADVOCATES FOCUSED ON A GROUP OF OVERLAPPING CHRONIC PAIN CONDITIONS THAT DISPROPORTIONATELY AFFECT WOMEN AND CONTINUES TO LEAVE LEADS THIS GROUP. THE DOCTOR WAS ALSO ABLE TO LEAD A NUMBER OF PAIN REVISIONS PATIENT AFFORDABLE ACTS WITH HEALTHCARE REFORM INCLUDING THE NIH SUPPORTED IOM REPORT AS WELL AS THE ESTABLISHMENT OF--AS I MENTIONED INTERAGENCY PAIN RESEARCH COORDINATING COMMITTEE HE'S BEEN WITH NIDCR SINCE 2003. BUT HE'S BEEN WITH NIH SINCE 1980 IN TERMS OF HIS BACKGROUND. HE GRADUATED FROM COLBY COLLEGE WITH AN UNDERGRADUATE DEGREE IN CHEMISTRY AND HE RECEIVED HIS Ph.D. FROM THE LOCAL SCHOOL, GEORGE WASHINGTON, SORRY--GEORGE WASHINGTON UNIVERSITY IN MEDICAL AND BIOCHEMISTRY. HIS SCIENTIFIC EXPERTISE IS HIGHLY RECOGNIZED THROUGH THE NIH AND ACROSS THE FIELDS'VE PAIN RESEARCHERS AND HIS ABILITY TO WORK ACROSS INSTITUTE BOUNDARIES TO DEVELOP AND IMPLEMENT PROGRAMS AT BOTH THE INSTITUTION AND AGENT LEVELS IS REMARKABLE AND HE IS PLAYAD AN IMPORTANT ROLE IN PROPELLING THE FIELD FORWARD. AT NIDCR, WE ARE GRATEFUL AND INCREDIBLY FORTUNATE TO HAVE DR. KUSI AK ON OUR TEAM AND I'M DELIGHTED TO INTRODUCE HIM TODAY TO TELL YOU MORE ABOUTA@ THE PAIN RESEARCH WHICH I'M SURE YOU WANT TO HEAR RIGHT NOW SO THANK YOU AND THANK YOU FOR JOINING UTR. [ APPLAUSE ] >> THANK YOU, THANK YOU, VERY NICE INTRODUCTION, SO I'M GOING TO VERY BRIEFLY TALK TO YOU A LITTLE BIT ABOUT THE PAIN PORTFOLIO AT NIDCR AND OUR ROLE IN THE TRANSNIH EFFORTS IN PAIN RESEARCH. THE PORTFOLIO REALLY FOCUSES ON BASIC TRANSLATIONAL AND CLINICAL RESEARCH ON PAIN MECHANISM. WE HAVE A FOCUS ON CHRONIC PAIN DISORDERS OF THE TRI GEMINAL SYSTEM, OF THE--ORAL FACIAL AND THE CRANIOFACIAL REGION AND WE HAVE A SPECIFIC INTEREST IN TEMP ROMAN DIBULAR JOINT DISORDERS. WHAT I'LL BE TALKING ABOUT THIS MORNING ARE SOME OF THE RECENT FUNDING INITIATIVES THAT THE PAIN PORTFOLIO HAS INITIATED OVER THE PAST SEVERAL YEARS AS MARTHA MENTIONED, I'LL TALK A LITTLE BIT ABOUT SOME OF THE TRANSNIH ACTIVITIES THAT WE TAKE PART IN AS WELL AS THE SCIENCE POLICY ISSUES. SO OVER THE PAST, MAYBE 6 TO 8 YEARS OR SO, WE'VE HAD A NUMBER OF FUNDING OPPORTUNITY MOST RECENTLY THERE'S BEEN 1 ON ENHANCING RESEARCH CAPACITY AND THIS HAS BEEN PROVIDING MENTORED TRAINING FOR INDIVIDUALS WHO ARE EARLY ON IN THEIR CAREERS WHO WANT TO GET INTO THE FIELD OF ORAL FACIAL PAIN RESEARCH. WE JUST STARTED IT LAST YEAR. WE HAVE 1 CENTER THAT IS--THAT IS FUNDING THIS OPPORTUNITY AND WE ARE JUST COMING UP ON THE SECOND REVIEW 2 DAYS FROM NOW: PREVIOUSLY WE HAD RFAs LOOKING AT THE TRANSITION FROM ACUTE TO CHRONIC ORAL FACIAL PAIN CONDITION. THE IDEA HERE WAS TO BRING IN RESEARCHERS, WHO HAD INTERESTS IN TEMPORAL MANDIBULAR FACIAL PAIN, ORAL PAIN AS WELL AS INDIVIDUALS WHO HAD COMPLIMENTARY EXPERTISE THAT COULD ENHANCE THE RESEARCH PROGRAMS. AND I THINK MARTHA MENTIONED THOSE EARLIER AS WELL. A LITTLE BIT PRIOR TO THAT WE HAD AN RFA ON NEW MODELS AND MEASURES OF PAIN IN THE TRI GEMINAL SYSTEM WHEN I WAS FIRST HERE 1 OF THE FIRST RFAs WE HAD INVOLVED THE ROLE OF GLIAL CELLS IN INTERACTIONS WITH NEURONS IN BOTH INFLAMMATORY AS WELL AS NEUROPATHIC PAIN. PERHAPS A LITTLE BIT--PERHAPS QUITE A BIT AHEAD OF OUR TIME WE HAD AN RFA ON THE OMICs OF FACIAL PAIN, METABALOMICS, GENOME BEINGICS AND AND IMAGING OF--GENOMICS AND IMAGES OF PAIN AND RNA ON THE PATHOLOGY OF THE TEMP ROMAN DIBULAR JOINT. SO I'LL SHOW YOU A FEW EXAMPLES OF SOME OF THE RESEARCH THAT WE'RE FUNDING. WHOSE BEEN LOOKING AT THE ROLE OF STRESS IN THE TEMROW MANDIBULAR JOINT DISORDER AND HOW STRESS CAN ENHANCE NEURONAL SIGNALING OR ACTIVITY IN THE SPINAL CORD. THAT IS EXPERIENCING THE SWIM, AND INCREASED ACTIVITY IN THE BRAIN STEM REGION, TRIGEMINAL BRAIN STEM REGION THAT MAY LEAD TO HYPER SENSITIVITY THAT IS FOUND IN CHRONIC PAIN STATES. IN THE UPPER RIGHT IS A CARTOON BY F. WANG FROM DUKE UNIVERSITY WHO IS STUDYING TRIGEMINAL MECHANICAL SENSORY CIRCUITRY SO IN A WAY SHE DEVELOPED USING A TRANSSYNAPTIC TRACING, MOLECULAR GENETIC TECHNIQUES AND TRANSGENIC ANIMALS AS A WAY TO COLOR CODE SPECIFIC NEURONAL CIRCUITS INVOLVED IN MECHANICAL TOUCH IN RODENT MODELS. SHE'S NOW JUST GOTTEN--AN ADMINISTRATIVE SUPPLEMENT ON TRACING SPECIFIC PAIN PATHWAYS ON THE TRIGEMINAL SYSTEM. UNIVERSITY OF MARYLAND DENTAL SCHOOL INCLUDING RON DUBBENER, THEY HAD MAJOR INTEREST IN NEURONAL GLIAL CELL INTERACTIONS THAT IS THE IMMUNE SYSTEM INVOLVEMENT IN THIS EXACERBATION OF PAIN AND LOOKING AT CHEMOKINES, ALSO LOOKING AT LARGE PATHWAYS IN THE PAIN PATHWAY FACILATTORY AS WELL AS INHIBITORY PAIN PATHWAYS AND THE LOWER RIGHT IS STUDIES FROM FILL KRAMER FROM BAYLOR LEDGE OF DENTISTRY, A ROLE THAT ESTROGEN MAY PLAY IN ORAL FACIAL PAIN. HE IS--HE HAS STUDIED OVER 230 GENES, IN QUANTITATING THEM IN INFLAMMATORY MODELS OF PAIN AND IN HIGH AND LOW ESTROGEN IN CONTROLLING SEVERAL IMPORTANT KEY PAIN RELATED GENES. AND THESE 2 GRAFFS SHOW RESULTS FROM CHARLIE SEWARD, AND COLLABORATING WITH GI, WHO IS HEAD OF PAIN RESEARCH AT DUKE UNIVERSITY, LOOKING AT THE ROLE OF RESOLVENT, THESE ARE INTERNAL LIPID MEDIATORS OF LIPID INFORMATION. THEY'RE ANTIINFLAMMATORY AND AND THEY'VE SHOWN THAT VARIOUS CERTAIN SPECIFIC RESOLVINGS ARE ABLE TO REDUCE PAIN AND A NUMBER OF DIFFERENT INFLAMMATORY MODELS AND THEE ARE JUST SHOWN HERE AND HERE AND SO ON, AND VERY INTERESTING, VERY POSITIVE RESULTS LEAKILY THESE ARE IN TERMS OF TRANSLATING AND GETTING INTO THE CLINIC LIKELY NOT TO HAVE ANY ADDICTIVE PROPERTIES AS DO THE OPIOIDS THAT ARE USED PRIMARILY FOR PAIN NOW. SO IT'S VERY, VERY INTERESTING SET OF MOLECULES, WHICH ALSO INTERESTING IS THAT THEY DO SEEM TO HAVE SPECIFICITY IN THE SENSE THAT THEY DO NOT AFFECT BASAL MEASURES OF PAIN, BASAL SENSITIVITY TO PAIN AND ALSO THEY DO NOT INTERFERE WITH MOTOR FUNCTION AT ALL. SO THERE APPEARS TO BE SOME FEES FISCHERITY. THE CARTOON IN THE LOWER RIGHT SHOWS THAT THESE RECEPTORS FOR THE RESULTS ARE FOUND BOTH IN THE IMMUNE SYSTEM AS WELL AS IN VARIOUS PARTS OF THE CENTRAL NERVOUS SYSTEM INCLUDING THE PERIPHERAL TERMINALS IN THE SPINAL CORD AS WELL IN CELL BODIES SO THAT OPENS UP A LOT OF OPPORTUNITIES FOR DEVELOPING THERAPIES, BUT ALSO, CREATES SOME DIFFICULTIES AS WELL IN TERMS OF SPECIFICITY. WE'LL SEE HOW THAT TURNS OUT. NEXT? OKAY. ALSO WE ARE DOING SOME OTHER RESEARCH, THIS IS THE SPONSORED BY THE BEHAVIORIAL SCIENCES GROUP. BOB FROM THE UNIVERSITY OF TEXAS AT ARLINGTON, IS LOOKING AT BIOBEHAVIORIAL TREATMENTS FOR A GROUP OF PATIENTS HAVE ACUTE TEMP TEMP ROMAN DIBULAR DISORDER BUT AT ARE HIGH RISK FOR BECOMING KRONE AND I CAN HE'S DEVELOPED BEHAVIORIAL THERAPIES INCLUDING COGNITIVE BEHAVIORIAL TREATMENTS TO PREVENT THIS TRANSMISSION TO KRONEISITY. SIMILARLY, GENERATEDERER HAYTHORN AT JOHNS HOPKINS IS INVOLVED IN A STUDY LOOKING AT COGNITIVE BEHAVIORIAL THERAPY FOR PAIN KACCT TAFT ROUGH ATOMMIFIESING AND SLEEP BEHAVIOR IN TMJ PATIENTS. THERE ARE A COUPLE OF PROJECTS THAT ARE IN THE PLANNING STAGES RIGHT NOW, 1 IS KAREN RAFAEL AT NYU LOOKING AT THE ROLE OF TOX AND BOTOX, FOR MY O FACIAL TMJ D. AS YOU KNOW THE FDA APPROVED ITS USE FOR MIGRAINES, BUT THE AMOUNT OF RESEARCH THAT HAS BEEN DONE ON TMJ AND AND BOTOX TREATMENT IS VERY SPARSE AND QUITE CONTROVERSIAL. AND FINALLY THE UNIVERSITY OF NORTH CAROLINA, IS LOOKING AT THE INFLUENCE COMPED, POLYMORPHISMS AND AND DOPAMINE AND THE RESPONSE TO PROPAN OLDER PEOPLE OLDER PEOPLE IN THE TREATMENT OF TMJD. THESE LAST 2 ARE IN THE CLINICAL RESEARCH AND ARE AT THIS STAGE ARE IN THE PLANNING STAGE SO THAT'S JUST VERY BRIEFLY, SOME OF THE RESEARCH HIGHLIGHTS, I'D NOW LIKE TO TALK ABOUT THE TRANSNIH EFFORTS THAT THE NIDCR IS INVOLVED IN. AS MARTHA MENTIONED, WE WERE 1 OF THE FOUNDING MEMBERS OF THE PAIN CONSORTIUM BACK IN 96, TOGETHER WITH NATIONAL INSTITUTES OF NEUROLOGICAL DISORDERS AND STROKE, NINDS, CURRENTLY THE PAIN CONSORTIUM IS GOVERNED AND CARRIED OUT BY THE INSTITUTE DIRECTORS INCOLLIDING NIDCR, NINDS, THE NATIONAL INTUITY OF NURSING RESEARCH, NATIONAL INSTITUTE OF DRUG ABUSE AND NATIONAL CENTER FOR COMPLIMENTARY AND ALTERNATIVE MEDICINE. THERE ARE CURRENTLY 25 CENTERS THAT PARTICIPATE IN THE PAIN CONSORTIUM, AS MARTHA ALSO MENTIONED, IT'S PURPLE SOS TO ENHANCE PAIN RESEARCH PROMOTE COLLABORATION ACROSS THE NIH TO DEVELOP A PAIN RESEARCH AGENDA. TO OOH DENTIFY OPPORTUNITIES IN RESEARCH AND MAKE PAIN MORE VISIBLEOT NIH CAMPUS. AND SOME OF THE ACTIVITIES THAT WE TAKE PART IN, INCLUDE ORGANIZATION OF ANNUAL SYMPOSIUM. THAT HIGHLIGHTS RECENTLY FUNDED NIH RESEARCHERS THIS YEAR'S THEME IS GOING TO BE ON SELF-CARE FOR PAIN MANAGEMENT, AS YOU'LL SEE THAT'S PROBABLY A FAIRLY IMPORTANT THING TO BE LOOKING AT RIGHT NOW. AND WE ALSO ORGANIZED A NUMBER OF WORKSHOPS AND OTHER MEETINGS ON SPECIFIC PAIN TOPICS WHERE USUALLY A SINGLE INSTITUTE WILL TAKE THE LEAD AND HAVE AS MEMBERS OF A STEERING COMMITTEE OR A WORKING GROUP, LARGE NUMBERS OF PROGRAM STAFF FROM THE VARIOUS PAIN CONSORTIUM INSTITUTES. AND ALSO, WE HAVE BEEN TASKED BY LAW TO DEVELOP INITIATIVES FOR THE COMMON FUND. AND I'LL TALK BRIEFLY ABOUT THAT IN A MINUTE. WE ARE ALSO A MEMBER OF THE APPLICANT RESEARCH, WE WERE ESTABLISHED IN 2003/04, THAT WAS ESTABLISHED FOR ALL THAT HAVE SCIENCE OR MAJOR AS A MODERATE OR MAJOR PART OF THEIR RESEARCH PORTFOLIOS. THE IDEA WAS TO BE ABLE TO IDENTIFY AND SUPPORT LARGE SCALE CROSS CUTTING NEUROSCIENCE RESEARCH AND TRAINING THAT COULD NOT BE DONE BY 1 SINGLE INSTITUTE. AND DURING THE FIRST 4 OR 5 YEARS DURING THE EXISTENCE OF THE BLUEPRINT, THE FOCUS ON WAS ON DEVELOPING TOOLS AND RESOURCES THAT COULD BE USED BY THE NEUROSCIENCE COMMUNITY. AND AFTER A WHILE THIS GOT A LITTLE BORING BECAUSE ALL OF THE REQUESTS FOR TOOLS AND RESOURCES TURNED OUT TO BE THE SAME WHETHER IT WAS FOR NEURODEGENERATION, NEURODEVELOPMENT, OR NEUROPLASTICKITY. SO IN 2009, WE DEVELOPED THE BLUEPRINT GRAND CHALLENGES WHICH WAS TO CATALYZE RESEARCH THAT WOULD TRANSFORM BASIC UNDERSTANDING OF THE BRAIN AND TREATMENT OF OF BRAIN DISORDERS. THIS WAS A COMPETITIVE PROCESS, THE INSTITUTES SUBMITTED ABOUT 12 PROPOSALS. THREE OF THEM WERE SELECTED TO GO FORWARD WITH FUNDING AND 1 OF THOSE WAS THE BLUEPRINTICAL ORANGE PAIN. THIS IS 1 THAT NIDCR WAS THE LEAD ON. IT SUPPORTS MULTIINVESTIGATOR RESEARCH THAT PARTNERS A PAIN RESEARCHER TOGETHER WITH ANOTHER NEUROSCIENTIST WITH EXPERTISE IN NEUROPLASTICKITY NOT RELATED TO PAIN AT ALL, TO REALLY TRY TO BRING IN NEW TECHNIQUES AND NEW IDEAS FOR THE PAIN FIELD AND THIS IS NOW IN ITS SECOND YEAR AND WE HAVE FUNDED ABOUT 10 GRANTS IN THIS AREA. WE ALSO TAKE PART IN THE COMMON FUND. THE COMMON FUND TAKES CROSS CUTTING AREAS THAT HAVE--THAT NIH PROGRAMS THAT ADDRESS KEY ROAD BLOCKS THAT IMPEDE SCIENTIFIC DISCOVERY AND THEIR TRANSLATION INTO IMPROVED HEALTH. ONE OF THOSE PROGRAMS WAS THE METABALOMICS PROGRAM SEVERAL YEARS AGO WHICH WAS ESTABLISHED TO INCREASE THE DEVELOPMENT OF NEW TECHNOLOGIES AND METABALOMICS THAT INCREASED SENSITIVITY AND SPEED OF DETECTION OF MOLECULES. AND 1 OF THE INITIATIVES THAT CAME OUT OF THAT WAS AN RFA ON USING METABALOMICS TO INVESTIGATE BIOLOGICAL PATHWAYS AND NETWORKS WE ENDED UP FUNDING 1 OF THOSE PROJECTS, THE NEUROMETABALOMA, THE SENSORY NETWORK FOR JONATHAN SWEETLER FROM THE UNIVERSITY OF ILLINOIS. HAD THERAPIST IS A PROJECT WHERE HE IS LOOKING AT THE METABALOME OF INDIVIDUAL RECEPTORS, THAT IS THAT PAIN NEURONS THAT ARE FOUND IN DORSAL ROOT GANGLIA AS WELL AS TRIGEMINAL GANGLIA AND LOOKING AT THE CHANGES IN THAT METABALOME UNDER CONTROLLED CONDITIONS AND UNDER INFLAMMATORY PAIN CONDITIONS. AND GETTING TO POETIC POLICY A LITTLE BIT, WE ALSO NOW PARTICIPATE IN THE INSTITUTE OF MEDICINE WE WERE SORT OF PRIMARY INSTITUTE FOR ESTABLISHING THE INSTITUTE OF MEDICINE REPORT ON PAIN. THIS WAS THE PROVISION OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, IN 2011, HEALTH AND HUMAN SERVICES TOGETHER, THROUGH THE NIH, REREQUESTED THAT THE IOM CONDUCT A STUDY TO ADES THE STATE OF SCIENCE REGARDING PAIN MANAGEMENT, PAIN RESEARCH, PAIN CARE, PAIN EDUCATION AND MAKE SIGNIFY SET OF RECOMMENDATIONS. DR. TABAK, FORMER DIRECTOR OF THE INSTITUTE AND NOW PRINCIPLE DEPRIVATIONUTE I DIRECTOR AT NIH DELIVERED--DEPUTY DIRECTOR AT NIH DELIVERED THE CHARGE TO THE ABOUT HOW TO PROCEED. HE WAS ALSO ABLE TO DELIVER THE FUNDING TO MAKE THIS HAPPEN AS WELL. SO WE WERE QUITE GRATEFUL FOR THAT. AND AMY ADAMS WAS THE PROJECT OFFICER ON THAT PROJECT. AS PART OF THIS REPORT, THE IOMHELD SEVERAL PUBLIC MEETINGS ACROSS THE COUNTRY AND I WAS 1 OF THOSE INDIVIDUALS ATTENDED THE MEETINGS IN REPRESENTING THE NIH AND TRYING TO ANSWER QUESTIONS AND COMMENTS THAT WERE PERINENT. THE OUTCOME WAS A BOOK OF ABOUT 350 PAGES AND I SORT OF WHISTLED DOWN TO 4 LINES HERE ON THIS SLIDE. BUT THE BASIC IDEA WAS THAT THERE WERE A NUMBER OF FINDINGS AND RECOMMENDATIONS THAT CAME OUT OF IT. THE FOCUS WAS ON PAIN AS A PUBLIC HEALTH CHALLENGE. ANOTHER RECOMMENDATION WAS TRYING TO DEVELOP BETTER DATA. THAT IS--THAT IS DATA ON COSTS OF PAIN, TREATMENTS, DISEASE BURDEN, THINGS LIKE THAT. THERE WAS AN EMPHASIS ON SELF-MANAGEMENT FOR PAIN. EDUCATION PROGRAMS FOR BOTH PATIENTS AS WELL AS FOR HEALTHCARE PROVIDERS AND OBVIOUSLY 1 OF THE RECOMMENDATIONS WAS POLICE EFFORTS IN TRYING TO ESTABLISH PUBLIC PRIVATE PARTNERSSHIPS AS WELL AND FOCUSING ON NEW AGENTS THAT IS DRUG THERAPIES FOR PAIN CONTROL AS WELL AS INCREASES IN INTERDISCIPLINEAR SCHELONGITUDINAL PAIN RESEARCH AND TRAINING. AND FINALLY AS MARTHA MENTIONED WE WERE INVOLVED IN THE ESTABLISHING THE INTERAGENCY PAIN RESEARCH COORDINATING COMMITTEE WHICH IS A FEDERAL ADVISORY COMMITTEE THAT WAS ESTABLISH TED TO ENHANCE PAIN RESEARCH EFFORTS AND PROMOTE COLLABORATION ACROSS THE FEDERAL GOVERNMENT. THE IDEA WAS TO PROMOTE TREATMENT STRATEGIES, CURRENTLY THE COOK COMMITTEE IS CHAIRED BY STORY LANDIS, THE DIRECTOR OF NINDS, AND AS MARTHA SAID, THERE ARE A NUMBER OF OTHER FEDERAL MEMBERS AND MARTHA IS ALSO A MEMBER OF THIS COMMITTEE BUT IT INCLUDES REPRESENTATION FROM AGENCY FOR HEALTHCARE RESEARCH AND QUALITY. CENTER FOR DISEASE CONTROL AND PREVENTION, FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF DEFENSE AND DEPARTMENT OF VETERAN'S AFFAIRS. THERE ARE EQUAL NUMBERS OF SCIENTIFIC STAFF TAKEN--THEY ARE ON THIS COMMITTEE AS WELL AS PUCK LICK MEMBERS THAT HAVE AN INTERESTING CONDITIONS, SOME OF THE FIRST ACTIVITIES THAT THIS GROUP IS HAS UNDERTAKE KNOW IS A SUMMARY OF ADVANCE PACES IN ADVANCES IN THE LAST COUPLE OF YEARS AND WE'VE DONE A WIDE PORTFOLIO ANALYSIS OF EVER PAIN RESEARCH TO IDENTIFY GAPS, OVERLAPS AND OPPORTUNITIES THAT WE AS THE FEDERAL GOVERNMENT COULD TAKE IN TREATING AND IMPROVING PAIN CARE. AND RECENTLY MEETING HOWARD COE FROM THE DEPARTMENT OF HEALTH AND HUMAN SERVICES GAVE US A NEW CHARGE WHICH WAS TO CREATE A POPULATION HEALTH STRATEGIC PLAN KNOWLEDGEY FOR PAIN, PREVENTION, TREATMENT, MANAGEMENT AND RESEARCH. THIS WAS SOMEWHAT OUT OF THE SCOPE OF THE NIH, BUT WE ARE BEGINNING TO WORK ON THAT TRYING TO BRING IN AD HOC MEMBERS OF A COMMITTEE TO DEVELOP THAT PROGRAM. SO THAT'S VERY BRIEFLY A SUMMARY OF WHAT NIH--NIDCR DOES IN THE PAIN FIELD. I'M HAPPY TO ENTERTAIN COMMENTS OR QUESTIONS AT THIS TIME BEFORE MOVING ON TO A MORE IMPORTANT AND INTERESTING PART OF THIS SESSION. IF THERE ARE NO COMMENTS, THAT'S FINE. SO TODAY WE HAVE--WE HAVE 3 SPEAKER WHO IS WILL TALK ABOUT THE EFFORTS THAT ARE INVOLVED THIS IN TRANSNIH PAIN RESEARCH AS WELL AS SPECIFIC RESEARCH PROJECTS GOING ON IN NIDCR, I'LL JUST GO THROUGH THE 3 SPEAKERS WE HAVE RIGHT NOW AND THEN AS THEY PRECEPT I'LL INTRODUCE THEM VERY BRIEFLY. SO THE FIRST SPEAKER IS DAVE THOMAS WHO IS A PROGRAM DIRECTOR AT NATIONAL INTUITY OF DRUG ABUSE. HE IS IN THE BEHAVIORIAL AND COGNITIVE SCIENCE RESEARCH BRANCH. HE IS GOING TO BE TALKING ABOUT A NIDA INITIATED PROJECT WITH THE PAIN CONSORTIUM ON ESTABLISHING CENTERS OF EXCELLENCE AND PAIN EDUCATION. THE NEXT SPEAKER IS BIG MAXNER, FROM THE UNIVERSITY OF NORTH CAROLINA CHAPEL HILL. HE'S PROFESSOR OF ENDODONTICS AND MILLI FLAGLER BING HAM DISTINGUISHED PROFESSOR, DID I GET THE NAMES? AND DIRECTOR FOR REGIONAL SENSORY NEURAL DISORDERS AT THE UNC SCHOOL OF DENTISTRY. WE WILL TALK ABOUT O. P. E. R. A. CHRKS ISOR O FACIAL PAIN EVALUATION AND PERSPECTIVE ASSESSMENT WHICH IS BETWEEN NORTH CAROLINA AND NIDCR, AND BRIAN SCHMIDTFROM THE NEW YORK COLLEGE OF DENTISTRY, PROFESSOR, ORAL AND MAXIAL FACIAL SURGERY AND ALSO AS YOU HEARD, HE'S DIRECTOR OF THE BLUE STONE CENTER FOR CLINICAL RESEARCH AT NYU COLLEGE OF DENTISTRY AND HE'LL BE TALKING ABOUT THE NEUROBIOLOGY OF CANCER PAIN. FIRST UP IS DAVE THOMAS. >> GOOD MORNING I'M DAVE THOMAS, WITH THE NATIONAL DRUG ADD MINISTRATION, AS WAS SAID, HE MADE IT THROUGH THESE MARATHON MEETS AND DOING STUFF AT HOME AND HE ALSO HELPED GET DENTAL--THE DENTAL INSTITUTE INVOLVED WITH THIS PROJECT. I'D LIKE TO THANK MART HA BECAUSE SHE WAS--SHE WAS ALLOWED US TO SEE THIS TO FUND THIS AND SHE ALSO JUST ROLLED UPPER SLEEVES WHEN WE WERE OVERWHELM WIDE CONTRACT APPLICATIONS SHE WAS 1 OF THE REVIEWERS, SHE WENT LATE INTO THE NIGHT WE COULD LOG ON TO A COLLABORATION SITE WORKING AWAY, SO THANK AND YOU I'D LIKE TO SAY THIS IS COMING HOME TO ME IN SOME WAYS THAT WORK FOR THE DENTAL INSTITUTE FOR 10 YEARS AND WORKED WITH BILL MAXENER WHEN WE WERE IN THE BASEMENT OF BUILDING 30 SO IT'S NICE TO BE BACK AND HAIR SAY PROJECT I'M EXCITED ABOUT THAT WE'VE DONE THROUGH THE PAIN CONSORTIUM. I'M GOING TO PRESENT ON IS THE CENTERS FOR EXCELLENCE AND COMING UP WITH COLD SO I APOLOGIZE FOR MY VOICE. BUT THE CENTERS OF EXCELLENCE FOR PAIN EDUCATION. >> I JUST WANT TO SET UP THE PROBLEM FIRST. I HAVE A SHORT AMOUNT OF TIME SO I WILL ZIP THROUGH THIS. BUT THE PROBLEM IS THAT IN MOST PRIMARY EDUCATION OF MEDICAL PROFESSIONALS, THEY DON'T GET MUCH ATTENTION TO LEARNING ABOUT PAIN. I HAVE WROTE A PAPER ON THIS, A LOT OF DIFFERENT SLIDES, I WILL SHOW YOU 1 ON PAIN AND MEDICAL SCHOOLS, AND WHAT THIS SHOW SYSTEM HOW MANY HOURS, IS DEVOTED TO PAIN OVER THE COURSE OF A 4 YEAR CURRICULUM IN MEDICAL SCHOOLS AT THE UNITED STATES, I'M NOT GOING TO RUN THROUGH THE SLIDE, BUT THE PROGRAM LINE IS THE MEDIAN IS 8 HOURS, SO, 8 HOURS ON PAIN THROUGH 4 YEARS, PAIN IS A HUGE PROBLEM. IT GETS 8 HOURS OF EDUCATION, COMPARE WIDE CANADA THEY GET ABOUT MEDIAN OF 14 HOURS OF PAIN EDUCATION BUT IT'S A COMPARATIVE VETERINARY SCHOOLS AT LEAST IN CANADA THEY GET 87 HOURS. SO SOMETHING--SOMETHING SEEMS AMISS. THIS WAS THE FIRST SIGN WE HAVE A PROBLEM HERE. I HAVE DATA FOR DENTAL SCHOOLS, NURSING PHARMACEUTICALS, AND I HAVE TO BE BRIEF TODAY. NOW I'M FROM NIDA, AND ANOTHER CONCERN ABOUT PAIN TREATMENT AND CERTAINLY FOR NIDA BUT FOR PAIN, PAIN IN GENERAL PRESCRIPTION DRUG ABUSE OR MEDICATION EPIDEMIC, OPIATES ARE ABUSED LEFT AND RIGHT. THIS SLIDE AND I WON'T GO THROUGH IT, BUT THE PRESCRIPTIONS OF OPIATES OVER THE LAST 10 YEARS HAS QUADRUPLED. THE NUMBER OF DEATHS HAS QUADRUPLES BUT RIGHT NOW ABOUT 15,000 DIE EACH YEAR FROM A OVERDOSE OF PRESCRIPTION OPIATES. THAT'S A LOT OF PEOPLE, MORE THAN DIE FROM HEROINE AND COCAINE COMBINED AND BY THAT I MEAN HEROINE AND COCAINE DEATHS, NOT WHEN YOU PUT THEM TOGETHER. I THINK IT'S ABOUT 36, 37 STATES MORE PEOPLE DIED FROM PRESCRIPTION OPIATES THAT CAR ACCIDENTS AND IT'S THE SECOND LEADING KILLER OF AXAL DEATHS IN THE UNITED STATES BEHIND CAR ACCIDENTS. SO WE HAVE A SITUATION HERE EMPLOY WE HAVE, THE PEOPLE THAT TREAT PAIN, NOT GETTING THAT MUCH IN GENERAL IN GENERAL ABOUT HOW TO TREAT PAIN, HOW TO USE THE THINGS LIKE OPIATES TO TREAT PAIN AND YOU HAVE--THEY'RE DANGEROUS, IF YOU DON'T USE THEM CORRECTLY, YOU CAN CAUSE A LOT OF PROBLEMS. SO THE IDEA WAS TO FIND A WAY TO INCREASE PAIN EDUCATION IN THE PRIMARY EDUCATION OF HEALTHCARE PROVIDERS. WE DIDN'T KNOW HOW TO DO THIS, WE HAD A WORKSHOP, I WON'T GO THROUGH THE WHOLE WORKSHOP, BUT WE WENT THROUGH THERE A FEW YEARS. BUT BOTTOM LINE WE WENT OUT THERE AND GO OUT AS THE GOVERNMENT AND SAY YOU MUST DO THIS, TEACH IT NOBODY'S GOING TO DO IT. AMERICAN DENTAL ASSOCIATION, AMERICAN PAIN SOCIETY. IF YOU BUILD IT, THEY WON'T COME BUT THERE ARE PEOPLE SCATTERED AROUND THE COUNTRY IN THESE INSTYPINGSES THAT WANT TO MAKE THIS HAPPEN. THEY KNOW THERE'S A PROBLEM WE'RE CALLING THEM PAIN CHAMPIONS AND IN FACT, AS IT TURNS OUT THEY LIKE TO BE CALLED THAT. AND SO OUR PLAN WAS TO EMPOWER THEM, TO GIVE THEM MONEY, LODGISTICAL SUPPORT TO ALLOW THEM TO LOBBY WITHIN THEIR DEPARTMENTS WITHIN THE SCHOOLS TO MAKE MORE PAIN EDUCATION WITHIN THEIR ENVIRONMENT. THEN IT WAS A MATTER OF THIS IS MY--IT'S A JOKE BUT I TALK TO EVERYBODY. I ACTUALLY WENT TO EUROPE AND MET WITH N. A. T.O. WHICH WAS VERY UNUSUAL AND WE KIND OF AND OTHERS IN THE PAIN CONSORTIUM TOORKS WE WERE GATHERING INFORMATION ABOUT WHAT THING WOULD BE. WE LEARNED SOMETHING. FIRST, INTERPROFESSIONAL EDUCATION IS THE WAVE OF THE FUTURE WHERE DIFFERENT STUDENTS LEARN TOGETHER, NURSING FARM SEES, DENTAL AND MEDICAL STUDENTS LEARN TOGETHER BECAUSE IN THEORY THEY'RE SUPPOSE TOTED WORK TOGETHER. WE LEARNED THAT THE DIDACTIC SPEECHES, INTERACTIVE TEACHING IS GOOD, ORIGINALLY WE DIDN'T INCLUDE PHARMACY SCHOOLS BUT WE LEARNED THEY WERE AN IMPORTANT PART OF THE EQUATION, AT THE END OF 2011 WE PUT OUT A CONTRACT FOR THE CENTERS OF EXCELLENCE. GOT A HUGE RESPONSE FROM THE NIH, IT WAS FEATURED ON THE NIH WEB SITE PAGE IN TERMS OF THE NUMBER OF APPLICATIONS WE GOT 56 APPLICATION WHICH IS IS A GREAT THING BUT WE'RE OVERWHELMED. IT ALSO GOT FEATURED BY FORMER DENTAL DIRECTOR LARRY TABAK, ON THE HEALTH COMMITTEE EARLIER THIS YEAR, AND HE ENTERED INTO THIS AND SENATOR HARKIN WAS INTERESTED IN EDUCATION AT THAT MEETING SO IT SEEMED LIKE WE WERE ON THE RIGHT TRACK, THIS IS THE ORGANIZATION THAT WE NOW HAVE CREATED. AND AND PROJECT OF OTHERS AT THE PAIN CONSORTIUM HELP BUT WE HAVE FUNDING WHICH IS REMARKABLE, IT'S A LOT OF PEOPLE PUTTING IN MONEY FROM A LOT OF DIFFERENT PLACES ON SOMETHING WE'VE NEVER ATTEMPTED BEFORE. THE TOP RIGHT IS THE NIDA TEAM AND THEN IN THE MIDDLE IS A COMPANY WE HIRED, PALLADDIAN PARTNERS, THEY COORDINATE THE WHOLE THING AND THEN WE FUNDED 12 COPE'S, CENTERS FOR EXCELLENCE AND THE PART THE AT BOTTOM IS VERY CRITICAL. I WANT TO NOTE THAT SHE ALSO WORKS AT DENTAL AND MURAL PROGRAM FOR YEARS AND THEN SHE WENT ON WORKING FOR HOWARD HUGHES FOR EDUCATIONAL PROGRAM. THIS IS HER COMPANY, PERFECT FIT FOR THIS AND THEY'RE DOING A GREAT JOB. WE HAD A TIER REVIEW PROCESS, I WON'T GO THROUGH IT IN DETAIL, WE HAD OUTSIDE REVIEWERS, INSIDE REVIEWERS LIKE JOHN AND MARGTSA AND THEN WE HAD REVIEWERS LOOKING AT THE FIRST 2 SETS OF REVIEWS COMING UP WITH A FINAL SCORE AND THEN WE HAD THE FUNDERS MAKING FUNDING BASED ON THE REVIEWS PROGRAM PRIORITIES. THESE ARE THE 12 CENTERS WE FUNDED. THEY ARE PRETTY WELL SPREAD ACROSS THE UNITED STATES. THEY'RE GREAT. THEY REALLY ARE PAYING CHAMPIONS, VERY ENTHUSIASTIC ABOUT WHAT THEY'RE DOING, WE'VE HAD A KICKOFF MEETING LAST SUMMER HERE'S THE COPES, PEOPLE FROM COPES PLUS OUR CONTRACTORS AND I JUST SHOW THIS NOT BECAUSE THEY'RE PRETTY BUT BECAUSE THERE WAS SUCH ENTHUSIASM ABOUT THIS. THESE PEOPLE REALLY WANT TO BE PART OF THIS PROJECT. THEY--NOT A TON OF MONEY, THEY GOT ABOUT 275,000 OVER 3 YEARS WHICH BY NIH TERMS IS NOT ENORMOUS, BUT IT--THEY WERE EXCITED TO BE PART OF THIS PROCESS. THEE PLAIN GOALS THEY HAVE, THESE THINGS ARE GOING TO HAPPEN. THEY'RE UNDER CONTRACTUAL RELATIONSHIPS, THEY WANT TO DO THESE THINGS, BUT YOU HAVE TO PUT THESE COURSES IN THEIR SCHOOLS, THEY HAVE TO FIND PLACES TO TEACH ABOUT PAIN. THEY'RE GOING TO HELP US DEVELOP A CURRICULUM RESOURCE WHERE WE HAVE MATERIALS AVAILABLE FOR OTHER SCHOOLS TO FOLLOW BECAUSE OUR REAL POINT HERE IS NOT JUST TO FUND THESE SCHOOLS, WE WANT IT TO SPREAD, WE WANT IT TO BE THE NORM THAT PAIN EDUCATION IS PART OF--PART OF THE HEALTHCARE PROVIDERS EDUCATION AND THEN DISSEMINATION, AGAIN TRYING TO SPREAD THE WORDS. IN TERMS OF THESE EFFORTS, GETTING COURSES IN, WE HAVE 12 COPES BUT THEY REALLY REPRESENT OVER A HUNDRED DIFFERENT TEACHING UNITS, HOSPITALS, DEPARTMENTS, SO THESE COURSES RIGHT NOW, THIS IS HAPPENING, THE COPES ARE ALIVE, THEY'RE STARTING TO TEACH ACROSS THE UNITED STATES IN ABOUT A HUNDRED DIFFERENT PLACES. SO THAT'S GOOD. THERE'S ABOUT 250 PARTICIPANTS INVOLVED IN TERMS OF EDUCATIONAL PER TAS PANTS ACROSS THE CENTERS SO THESE ARE NOT JUST FOR SCHOOL, THEY'RE CONGLOMERATIONS OF SCHOOLS WITH AFFILIATES AND MORE. THE SECOND PART IS BEING DEVELOPED AS WE SPEAK WE'VE REVIEWED THE OVERALL CONTENT OF OUR RESOURCE AND THEY ARE DEVELOPING THE CORE OF THIS INTERACTIVE CASE BASED MODULES FOR SOMEBODY IN ATTENDANCE TALKING ABOUT THEIR EAR PAIN. THIS IS JUST A MOCK UP BUT THERE'S GOING TO BE 60 INTERACTIVE CASE BASED SCENARIOS WHERE SOMEBODY COMES IN FOR PAIN AND THE STUDENT VS TO FIGURE OUT WHAT THEIR PAIN IS AND THEY'RE LIKE MYSTERY NOVELS, THEY'RE FASCINATING AND THE LAST THING IS DISSEMINATION GOING AROUND TALKING ABOUT THIS AND TOPIC WILL BE APS THIS YEAR THE THING THAT UNDER THE CONTRACT 3 THINGS THEY JUST SHOWED YOU, THEY'RE GOING TO HAPPEN, WE LEGALLY LIKE THE CULTURAL SHIFT, BUT IN THE NEXT 18 MONTHS WE'RE GOING TO NUDGE AND WE'RE HOPING THAT THAT LEADS TO MORE. THANKS. -- >> THIS IS SLIGHTLY OFFCENTER BUT HOW IS THAT BROUGHT INTO THE CURRICULUM AND HOW CAN OTHERS HELP BE PART OF THIS? >> RIGHT. WE TRY NOT TO MAKE THE MISTAKE OF SOMEBODY THAT SUBMITS THE GRANT FOR THE FIRST TIME PROPOSED EVERYTHING UNDER THE SUN AND SO MANY TIME WEES STAY FOCUS HERE BUT WE'RE AWARE THAT OTHER PEOPLE EMTASKS FIRE MEN AND COLLEGES AND AND PART OF THAT MIGHT BE A SECOND BASE, AND THEN WE BRANCH OUT FROM THERE, ANOTHER PART OF IT IS A LOT OF THOSE CENTERS THAT APPLY BUT DIDN'T GET FUNDED, WE WANT TO INCLUDE THEM, SO WHAT WE'RE SETTING UP IS A PORTAL WHERE WE HAVE AN INTERACTIVE SITE WHERE WE TALK ON TOPICS ONLINE, WE WILL SET UP A LITTLE SECTION OF THAT THAT ALLOWS OTHERS TO DISCUSS HOW THEY CAN BE INVOLVED AND INVOLVED IN--BECAUSE WE KNOW THERE'S A LOT MORE PEOPLE OUT THERE, AND WE DID NOT DO THIS TO BE EXCLUSIVE CLUB. HEY, WE'RE THE CENTERS FORGET ABOUT THOSE, WE WANT YOU TO BE A CORE AND GROW OUT IN TERMS OF MEDICAL SCHOOLS AND PROFESSIONS AND DENTAL SCHOOLS, SO, AND THIS WHOLE THING, GIVING TOO LONG OF AN ANSWER, THIS WHOLE THING HAS BEEN ORGANIC AND INVOLVE NOTHING GOOD DIRECTION AND WE'RE JUST KIND OF NUDGING AND ENCOURAGING IT TO HAPPEN IN CERTAINLY GOING BEYOND AND IT'S A GOOD THING. >> THIS IS AN OUTSTANDING PRESENTATION. THANK YOU. AS YOU GET INTO DEBTAL SCHOOLS, 1 THING THAT IS HELPFUL FOR ANY EDUCATIONAL SCHOOL IS TO EXCHRISITLY ARTICCULE WHAT ARE THE EDUCATIONAL OUTCOMES AND HOW YOU INTEND TO GID LEARN SUGGEST AND ASSESS PERFORMANCE, THANK YOU. AND IF THEY CAN WORK TOGETHER AND FIND COMMON BASES OF EVALUATION, THAT WOULD BE GREAT AND THOSE METRICS SHOULD BE BASED ON THE OBJECTIVES THAT WE WANT TO ACCOMPLISH FOR EXAMPLE, WE'RE TRYING TO COME UP WITH WAYS TO ASSESS THAT ACROSS THE FIELD AND IF THIS IS SUCCESSFUL, IF PEOPLE THAT USE THESE COURSES CAN CHANGE THOSE METRICS THEN WE THINK THAT COULD ENCOURAGE OTHERS TO JOIN. >> NEXT IS BILL MEXLER FROM THE UNIVERSITY OF NORTH CAROLINA. >> GOOD MORNING LADIES AND GENTLEMEN, I KNOW WE'RE A BIT PRESSED FOR TIME, I WILL DO MY BEST TO BRING US TOWARDS WHERE I THINK WE SHOULD BE IN TIME, SOMETIMES A VERY DIFFICULT TASK FOR ME. SO, I WANT TO THANK JOHN AND MARTHA AND NIDCR FOR THE VERY KIND OPPORTUNITY TO PRESENT TO YOU TODAY, I HAVE BEEN ASKED TO SPEAK ABOUT A COOPERATIVE AGREEMENT, THE OUTCOMES ABOUT VERY UNIQUE COOPERATIVE AGREEMENT FOR NOT ONLY NIDCR, BUT FOR THE FIELD, AND THE OUTCOMES THAT WE HAVE FOR PROBABLY THE LARGEST PROSPECTIVE TEAM COHORT, IT'S CONDUCTED TO DATE, I THINK WORLD WIDE. AND I'M GOING TO PREDICT IF WE CONTINUE AT THE PACE WE'VE GONE WITH WHAT I CALL OPERA 1 AND 2, THAT WE ARE POISED WELL TO BECOME THE FRAMINGHAM OF THE POPULATION STUDY I SAY THAT WITH PRIDE AND GREAT THINGS AND DENTAL INSTITUTE AND FOR THE SUPPORT WE'VE GATHERED NOT ONLY FROM THE INSTITUTE BUT THE GOOD WILL PATIENTS PROVIDED TO US UP FRONT. BEFORE GOING INTO THE ACTUAL DATA AND HOW WE HAVE AND CONDUCTED OPERA, I WOULD WOULD LIKE TO DISCLOSE I AM A CONFOUNDER AND EQUITY SHARE HOLDER OF A SMALL BIOTECH THAT FOCUSES ON PAIN THERAPEUTICS CALLED [INDISCERNIBLE]. THE FOCUS IS ON TEMPOROMANDIBULAR DISORDERS, I THINK YOU'LL RECOGNIZE IT IS A COMPLEX CONDITION, MUCH MORE THAN A SIMPLE CHRONIC ORAL FACIAL PAIN CONDITION, IT IS A HETEROGENEOUS CONDITION HIGHLY PREVALENT IN THE U.S. POPULATION AND WE KNOW THAT ABOUT 30-40% OF PATIENTS WHO DEVELOP PAINFUL TMD WILL GO ON TO DEVELOP CHRONIC TMD WHICH WE SHOULD VIEW BASED ON IOM REPORT AS A DISEASE, A CHRONIC DISEASE WHICH IS IN FACT POTENTIALLY LIFETIME IN DURATION AND HAS TREMENDOUS MAGNITUDEOT INDIVIDUAL, BUT NEGATIVE IMPACT ON THE INDIVIDUAL, THE ETIOLOGY IS MULTIFACTORIAL WHICH WE'LL DISCUSS OR MEDICAL NEED, AND DIAGNOSIS AND TREATMENT FOR THESE CONDITIONS. THERE WAS--I THINK IT HITS ON SOME OF THE POINTS ADDRESSED BY COUNCIL THIS MORNING ABOUT HOW TO DEVELOP STRATEGIC INITIATIVES AND HOW WE STRATEGIZE TO PRODUCE STRATEGIC INITIATIVES BUT IT REALLY STARTED WITH A TOP DOWN APPROACH WHICH I AM NOT NECESSARILY 1 TO HEAVILY ENDORSE BUT IN THIS CASE, I WILL SAY THERE'S VISION FOR THE NEED TO DEVELOP A LARGE PROSPECTIVE STUDY FOR THE PAIN FIELD ON THE DAY THAT RFA WAS PRESENTED, MY GOOD COLLEAGUE AT THE UNIVERSITY OF FLORIDA, DR. ROGER [INDISCERNIBLE] WITH ME PRIOR TO THE UNIVERSITY OF NORTH CAROLINA CALLED AND SAID WE HAVE TO DO SOMETHING ABOUT THIS R FA BECAUSE WE HAD JUST FINISHED A PREOPPERA STUDY THAT POISED US WELL TO COMPETE FOR THIS APPLICATION. WE STRATEGIC PLAN JIZ AND IMPLEMENTED YOU SEE ON THE SLIDE COMPOSED OF REALLY FORESIGHT UNIVERSITY OF FLORIDA, UNIVERSITY OF NORTH CAROLINA UNIVERSITY OF MARYLAND, GREENSPAN AND RON DUBBENER AND THE UNIVERSITY OF BUFFALO WITH RICHARD ORBACH. WE DEVELOPED CORES AN EPIDEMIOLOGY DISEASE MODELING CORE HEADED BY GARY SLAYED AND ERIC BEAR, THE BIOSTATISTICIAN AND STATISTICAL GENETICIST, CRACKY JACK EPIDEMIOLOGIST. THIS CORE WAS I THINK SUPPLEMENTED WITH ALL THE OTHER PIs TO DEVELOP CONTENT EXPERTISE AS WELL AS MEMBERS OF OUR NEUROGENOMICS CORE, A WORLD CLASS FUNCTIONAL GENOME CYST WHO CAN TAKE A SNP AND LOOK AT FUNCTIONALITY AND CELL IN HUMAN SYSTEMS TO DETERMINE WHETHER THERE'S BIOLOGICAL MEANING TO WHAT WE FIND IN A DEN GENETIC REALM AND WORKING WITH BRUCE WHO'S THE CHAIR OF BIOSTATS AND DIRECTOR OF STATISTICAL GENETICS AT THE UNIVERSITY OF WASHINGTON. WHO WILL BE HELPING US WITH FUTURE SEQUENCING STUDIES. WE CONTRACT WIDE A VERY GOOD DATA SHARINGA COORDINATING CENTER AND PATEL INCORPORATED WHICH WHEN WE'RE WORKING THROUGH THIS PROJECT IS HANDLING WELL OVER 10,000 DATA POINTS A WEEK AND A HALF MILLION GENETIC VARIABLES A WEEK FOR US AND WE'VE ALSO BROUGHT TOGETHER AN EXTERNAL ADVISORY TEAM, FROM THE U. K. PUTTING TOGETHER AN INTERNATIONAL TEAM, SO THIS IS A--U-AWARD THAT HAS GONE BEYOND BORDERS TO CREATE WE THINK SOME OF THE BEST MINDS TO BRING TO BEAR TO THIS PROBLEM AND IN CONJUNCTION WITH THAT, WE'VE EMBRACED WITH THE NIDCR STAFF, EMILY HARRIS AND AMANDA AND MICHELLE RECENTLY, AND BRUCE, EARLY ON WHEN WE STARTED THIS PROCESS. BUT I GIVE THIS AS AN EXTENSION OF AN EXAMPLE HOW WE HAVE STRATEGIC PLAN JIZZED TO BRING TOGETHER A MULTIDISCIPLINARY PROGRAM TO A VERY COMPLEX PROBLEM. IN ORDER TO BE SUCCESSFUL WE FIRST AND FOREMOST HAD TO COME UP WITH A REALISTIC MODEL THAT WE CAN DO APART AND THIS IS THE MODEL, I'M GOING THROUGH 4 MAJOR COMPONENTS, WE PROPOSED AT CERTAIN PSYCHOSOCIAL, PSYCHOLOG CALVARIABLES WOULD IMPACT THE, AND INVOLVED IN PAIN PROCESSING AND ALSO AND LIKELIHOOD OF BEING A PRODUCT PATIENT. EACH OF THESE DOMAINS IS ASSOCIATED AND THESE ENDOPHENOTYPES AND ASSOCIATE DOMAINS ARE INFLUENCED BY PROTEIN PATHWAYS WHICH OBVIOUSLY ARE CODED FOR AN INFLUENCE BY GENETIC POLYMORPHISMS IN SEVERAL GENES. AND ENVIRONMENTAL FACTOR WHICH IS INFLUENCE GENETIC POLYMORPHISMS ASSOCIATED EXPRESSION TO PRODUCE SIGNS AND SYMPTOMS WE SEE IN PATIENT POPULATIONS BEFORE LEAVING THE SLIDE, I WOULD JUST LIKE TO EMPHASIZE THAT THERE ARE SEVERAL MANIFESTATIONS MANY POPULATIONS THAT I WILL TRY TO CONVINCE YOU OF IN JUST A LITTLE BIT. AND TESTED AS SHOWING HERE, WE HAD OBLIGATION TO RECRUIT 232 INCEPTION INDIVIDUALS PARTICIPANTS WITHOUT THE COHORT ACROSS THE CORE SIGHTS THEY WERE FOLLOWED PROSPECTIVELY FOR ALMOST 3 YEARS AT EVERY 3 MONTHS AT 3 MONTH INTERVALS THEY'RE QUERIED BY QUESTION AIR AND TMD AND CERTAIN POSITIVE RESPONSES WERE NOTED DURING THIS ASSESSMENT PERIOD, THEY WERE BROUGHT BACK INTO THE CLINIC, WHERE THEY WERE EXAMINED AND DETERMINED WHETHER THEY MET CASE DEFINITION TOWARD TMB ONSET, AT INCEPTION THEY WERE DEEPLY PHENOTYPED IN SEVERAL DOMAINS WHICH I'LL SHOW YOU AND MOLECULAR PROFILES ON ALL OF THESE INDIVIDUALS AS WELL, AS WELL AS VERY DEEP AUTONOMIC PROFILES AS WELL, THIS IS PROBABLY THE RICHEST DATA SET IN THE AUTONOMIC AS WELL AS IN THE PAIN DOMAIN THAT WE HAVE. NESTED WITHIN THIS PERSPECTIVE STUDY WHICH YIELDED 260 INDIVIDUALS WITH ANNUAL INCIDENCE RATE OF 3.9% ACROSS THE OBSERVATIONAL PERIOD. WE HAD NESTED WITH THEM, THE CASE CONTROL STUDY WHERE WE WERE ABLE TO CONTRAST DIFFERENT PUNITIVE RISK FACTORS THAT WE COLLECTED AT BASELINE WITH THESE FACTORS OR VARIABLES THAT WE ASSESSED IN CHRONIC CASES IN THE POPULATION AS WELL. WE USE ONLY 50% OF THE INCEPTION COHORT IN ORDER TO RESERVE THE OTHER HALF OR OTHER GENOMIC TESTS THAT WE'RE GOING TO PURSUE IN OPPERA 2. I'D LIKE TO SHARE WITH YOU JUST SOME OF THE OUTCOMES, THE TIP OF THE ICEBERG THAT WE'RE NOW SEEING FROM THIS STUDY. STARTING FIRST, DEMOGRAPHIC HEALTH STATUS AND CLINICAL OR ORAL FACIAL OBSERVATIONS, AND THERE ARE SURPRISES THAT HAVE COME OUT OF OPPERA RELATED TO AGE, GENDER RACE ASSOCIATIONS, AND ACTUALLY TOO OUR SURPRISE WHEN WE CONTRASTED, THE PARTICIPANTS, THE ONSET OR INCEPTION COHORT THAT WAS FREE OF TMZ WITH THOSE WHO HAD CHRONIC TMZ, WE FOUND INCREASED OWEDS OF CASE BASED ON AGE SO THE OLDER YOU WERE WITHIN THE POPULATION, THE MORE LIKELY YOU WERE TO EXPRESS CHRONIC TMD, WHICH IS A BIT OF A SURPRISE GIVEN THAT HISTORICALLY WE VIEWED TMZ TO BE MORE OF A CONDITION OF YOUNGER FEMALE AND WE'RE FINDING THAT IN FACT AS 1 AGES AT LEAST THROUGH THE FOURTH, FIRST DECADE OF LIFE, THERE SEEMS TO BE INCREASE PREVALENCE AND LIKELIHOOD IN DEVELOPING THIS CONDITION IN THE POPULATION. FEMALE GENDER WHERE WE CAN CONTRAST IT AGAIN THE CONTROLS, THE CHANGES WE FOUND INCREASED ODDS BASED ON FETAL FEMALE GENDER WITH RELATIVE TO MALE AND WHEN WE LOOKED AT RACE, WE FOUND THAT THERE WAS AGAIN CONTRAST IN THE CHRONIC CASES TO CONTROL CASES. WE FIND THERE'S INCREASED ODDS OF TMD IN CAUCASIAN TO AFRICAN AMERICAN. RELATIVE TO ONSET WHICH IS THE PRIMARY GOAL OF OPPERA, WHEN WE LOOK AT RELATIVE RATE OF THE ONSETS OF TMD BASED ON AGE WE FOUND THAT IN FACT AGE AS 1 AGE TO THE 35 TO 45 YEARS OF AGE THERE WAS A GREATER HAZARDS RATIO FOR THE ONSET OF T MD RELATIVE TO THE YOUNGER POPULATION AND WE FOUND MARGINAL ASSOCIATIONS FOR FEMALE GENDER FOR BOTH ONSET ON HAZARDS RATIO AND ON A RACE AS WELL. SO INTERESTING AS WE WOULD EXPECT FROM THE CLINIC THERE'S A GREATER FEMALE PREVALENCE, GREATER ODDS OF CASENESS AND FEMALE, BUT SURPRISINGLY THE ONSET WAS ALMOST EQUIVALENT BETWEEN MALES AND FEMALES. IF WE BEGIN TO LOOK AT SOME OF THE FACTORS, THAT ARE ASSOCIATED WITH THE RATE OF ONSET, WE FIND THAT INDIVIDUALS WHO NOTE BY SELF-REPORT OTHER PAIN CONDITIONS WHETHER IT'S IBS, GENERAL PAIN, HEADACHE, AND WE HAD A MEASURE OF SELF-REPORTED PAIN ACROSS 20 DIFFERENT MODALITIES OR CO MORBIT IDS WE FIND THAT THE RATE OF ONSET IN THOSED INDIVIDUAL WHO IS REPORT OTHER CHRONIC PAIN CONDITIONS RELATIVE TO THE UNAFFECTED INDIVIDUALS. IF WE LOOK AT THE ODDS, THAT IS THE ABILITY OF THE PRESENCE OF THESE CONDITIONS TO DISCRIMINATE CASES FROM CONTROLS WE AGAIN FIND THAT THE PRESENCE OF AIL PAIN CONDITION OR SELF-REPORT OF A HUMAN PAIN CONDITION INCREASES THE ODDS OF THE CASE AS WELL. SUGGESTING THERE MAY BE SOME RELATIONSHIP BETWEEN OTHER PAIN CONDITIONS AND MMD. AND IF WE LOOK AT OUR CASES, OUR CHRONIC CASES THAT WERE IN THE NESTED DESIGN, WE FIND THAT ONLY 14% OF THESE CHRONIC TMD CASES REPORTED ONLY TMD. 36% HAD AT LEAST 1 CONDITION, 35% 2 OTHER PAIN CONDITIONS. 13% 3 OTHERS AND 2% 4 AND IF YOU REPORTED 1 CONDITION, YOU WERE 6 TIMES GREATER ODDS FOR HAVING TMD, IF YOU HAD 2 CONDITIONS, 26 TIMES, ET CETERA SO IT WAS VERY CLEAR THAT TMD IS NOT THE LOCALIZED ENVISION, ONLY A VERY SMALL PERCENTAGE OF PATIENTS MEET CASE DEFINITION FOR LOCALIZED TMD. IF WE LOOK AT CERTAIN PARAMETERS SUCH AS HISTORY OF INJURY, WHETHER IT BE AUTOMOBILE ACCIDENT, EXTERNAL INJURY TO THE JAW OR INJURY OR I THINK NO SUSEPTIVE INPUT TO SAY ORTHODONTIC TREATMENT, WE SEE A SPECTRUM OF RESPONSES RELATIVE TO THE RATE OF ONSET OF TMD RELATIVE TO THE UNAFFECTED GROUP, EXTERNAL INJURY IS PROLONGED OPENING AND CERTAIN TIMES OF ORAL BEHAVIORS THAT WERE RELATED TO INJURY SHOW INCREASE HAZARDS RATIOS AND IF WE LOOK THROUGH THE TYPE OF SOCIAL DOMAIN, WE FIND THAT THERE'S SEVERAL VERY INTERESTING OUTCOMES IN THE PSYCHOSOCIAL DOMAIN. AND IN OUR COHORTS, WE COLLECTED SEVERAL DIFFERENT METRICS IN THE PSYCHOSOCIAL DOMAIN. GLOBAL MEASURES OF PSYCHOSOCIAL, MOOD, AFFECTS STRESS, SOMATIC AWARENESS, COPING, WERE ALL ASSESSED USING A VARIETY OF QUESTIONNAIRES. AND WHEN WE LOOK AT PREDICTORS OF ONSET AGAIN EXPRESSING OUR DATA AS HAZARDS RATIOS LOOKING AT THE RATE OF ONSET, OF TMZ IN THE AFFECTED INDIVIDUALS VERSES NONAFFECTED, WE FIND THAT MEASURES IN SOMATIC AWARENESS, A VERY INTERESTING CONSTRUCT, THE INDIVIDUALS WHO SENSE EXTERNAL AND INTERNAL MELUE THAT THESE MEASURES ARE HIGHLY ASSOCIATED WITH THE ONSET OF TMD AS WELL AS MANY OF THE OTHER PSYCHOLOG CALVARIABLES THAT WE ASSESSED IN OPERA AND IN FACT, ALMOST EVERY CONTRUCK THAT WE LOOKED AT SHOWED ELEVATED HAZARDS RATIOS IN TMD. IF WE LOOK AT ODDS RATIO AGAIN CONTRASTING THE INDIVIDUALS WITH CHRONIC TMD FOR THE INDIVIDUALS FREE OF TMD WE FIND THAT A NUMBER OF OF VARIABLES DISCRIMINATE BETWEEN CASES AND THE CONTROLS. AGAIN THE MOST POWERFUL PREDICTERS ARE IN THE AREA OF SOMATIC AWARENESS, AND IN CONTRAST TO WHAT WE'VE SEEN WITH ONSET, MEASURES OF POST-TRAUMATIC STRESS DISORDER FAIL TO SHOW THIS DISCRIMINATION OF CHRONIC AND DO PREDICT ONSET OF TMD AND I THINK YOU'RE GETTING A FLAVOR FOR THE COMPLEXITY OF THIS DATA SET AND THE NUMBER OF VARIABLES THAT WE'RE HAVING TO DEAL WITH AND I'LL TALK TO YOU IN JUST A MINUTE ABOUT HOW WE'RE DEALING WITH THESE VERY COMPLEX DATA SETS TO GO THROUGH ITEM REDUCTION AND BEGIN TO DEVELOP MODELS, NEW MODELS THAT CAN BEGIN TO INTEGRATE SOME OF THIS INFORMATION. THE OTHER DO PAIN IN AMERICA WAS THE PAIN AMPPLIFICATION DOMAIN AND OUR COHORT STUDY AND IN OUR CASE CONTROL, EVERY INDIVIDUAL WENT THROUGH A BATTERY OF ASSESSMENTS, PAIN ASSESSMENTS USING QUANTITATIVE ASSESSMENTS USING PRESSURE PAIN, MECHANICAL PAIN, KEY PAIN AND SOMEWHAT TO OUR SURPRISE WHEN WE LOOK AT THE RATE OF ONSET FOR TMD RELATIVE TO THE NONAFFECTED INDIVIDUALS BEGIN USING HAZARDS RATIOS AS OUR METRIC, WE DIDN'T SEE A PROFOUND EFFECT, WE SAW MARGINAL EFFECTS, BUT MAYBE MORE PROFOUND HERE AND PRESSURE MAIN SENSITIVITY. MORE SO THAN MECHANICAL. WE HAD PROPOSED BASED ON PRELIMINARY DATA THE PAIN SENSITIVITY, BASAL PAIN SENSITIVITY WILL BE A HIGH PROTECTOR AND RATHER PROFOUND RISK PREDICTOR FOR THE ONSET AND ACTUALLY TO OUR SURPRISE, PRESENT, WE WENT IN THE PSYCHOSOCIAL VARIABLES THAT I JUST SHOWED. AND IF WE LOOK--AT THE ABILITY OF THESE SENSORY STIMULI IN THE SPAISHT'S RESPONSE TO THESE SENSORY STIMULI, TO DISCRIMINATE CASES CONTROL AND WE FIND PRESSURE PAIN IN THE CASES OF VERY LARGE DISCRIMINATOR BETWEEN CASES AND CONTROLS, MORE SO THAN THE OTHER MODALITIES AND THIS MAY BE THAT THIS DEVICE AND THE PROCEDURE TAP INTO'S THE MUSCLE PAIN MORE SO THAN THE OTHER METHODS SO THIS IS MORE CLOSELY ALIGNED TO THE INTERMEDIATE PATHWAYS OF RISK FOR THESE POPULATIONS THAN THE OTHER TYPES OF MODALITIES. SO JUST FROM THE QUANTITATIVE CENTURY DATA, 29 OF THE 35 VARIABLES THAT I JUST SHOWED WERE RELATED TO CASE STATUS, AND IN CONTRAST WITH ONSET, ONLY 9 OF 35 OF THE QST MEASURES SHOWED RATHER MARGINAL OR WEAK ASSOCIATIONS WITH ONSET OF THE CONDITION PROVIDING A GENERAL SUMMARY THAT THE PSYCHOSOCIAL VARIABLES APPEAR TO PROFOUNDLY RISK AND KRONEISITY AND WITHIN THE AMPPLIFICATION REALM WE DO SEE EFFECTS ESPECIALLY CHRONICS FROM CONTROLS, BUT SEEM TO PLAY LESS OF A ROLE FOR THE MANIFESTATION OF ONSET, AND THERE ARE A NUMBER OF REASONS IF WE HAVE TIME KIDISCUSS OUR THOUGHTS ON THAT. MOVING TO THE GENETICS DOMAIN, I LIKE TO FIRST START WITH, WITHIN THE DISCUSSION OF THE GENETIC DOMAIN IS WE REALLY FOUND LITTLE ASSOCIATION BETWEEN ONSET OF TMZS AND GENETIC POLYMORPHISMS PREDICTING ONSET. IN CONTRAST IF WE LOOK AT CERTAIN INTERMEDIATE PHENOTYPES IN THE PSYCHOSOCIAL DOMAIN AND IN THE PAIN DOMAIN, WE DO FIND THAT CERTAIN INTERMEDIATE PHENOTYPES DO DIFFERENTIATE AND DO PREDICT ONSET AND THE PLOTS WHERE THEY PLOTTED THE SMPs WHERE THEY'RE OVER [INDISCERNIBLE] AND WHEN THERE'S LINE OF IMMUNITY SUGGESTING THERE IS A LINE OF ASSOCIATION WITH THIS SNP WITH THE OBSERVED PHENOTYPE OF INTEREST AND WHEN WE LOOK AT BASICALLY NONSPECIFIC ORAL FACIAL SYMPTOMS SUCH AS TIGHTNESS, LIMITATION OF MOUTH OPENING, VARIETY OF WHAT WE CALL SURROGATE MARKERS, OF EARLY ONSET TMD, WE FIND THAT CONVERTING ENZYMES, SODIUM CHANNEL ARE ASSOCIATED WITH ONSET IN THIS POPULATION AND IF WE LOOK AT GLOBAL MEASURES OF THE PSYCHOLOGICAL STRESS, TOCK 1 APPEAR FIST WE LOOK AT A STRESS FACTOR THAT'S BEEN GENERATED BY PRINCIPLE COMPONENT ANALYSIS ON PSYCHOLOGICAL DATA, WE FIND APOE PRECURIOUSOR PROTEIN POPS UP IF WE LOOK AT CERTAIN MEASURES OF PAIN AMPPLIFICATION THE PAIN, MP DC Z IS INVOLVED IN G PROTEIN COUPLING AND MAINLY INVOLVED IN A NUMBER OF GENE PROTEIN EFFECTS ON PAIN AND TRANSMISSION. SO WE ARE SEEING EVIDENCE IN INTERMEDIATE PHENOTYPES WHICH ARE CLOSE TO THE ACTUAL POSITION OF MEETING ASSOCIATED WITH TMD ONSET, IF WE LOOK AT CONTRASTS OF THE PATIENTS TO CONTROL PATIENTS, WE ALREADY RECORDED IN PREVIOUS PUBLICATION SEVERAL GENES WHICH SEEM TO DISCRIMINATE CASES FROM CONTROLS AND CLASSIC CASE CONTROL ANALYSIS. SO THE GLUCOCORTICOID RECEPTOR GENE AND ASSOCIATED STRESS AXIS FOR 2 WAY, CALCIUM MODULAR, MUSCULAR RECEPTOR, GENE INVOLVED IN GROWTH FACTOR PRODUCTIONS AND GENE INVOLVED WITH BETTSA 2 AMERGIC EFFECTS AND THE GENE INVOLVED IN THE CATACOAL MINE METHYLTRANSFERASE WHICH WE MENTIONED EARLIER IS A GENE WE LOOKED AT FOR PREDICTIVE PATHWAY INVOLVED IN DETERMINING EFFICACY OF THE THIS AND THE TMD PATIENTS AND MANY OTHER GENES AND SO WE ARE NOW BEGINNING TO STRAP THE SURFACE, IDENTIFYING GENES RELATIVE TO SMALL EFFECT SIZE OF THESE GENES IN CASE CONTROL AND WE ARE IDENTIFYING COMPUTATIVE PATHWAYS. WE'RE GOING TO ROUND OUT THE DIETS CUSHION TALKING ABOUT HOW WE WILL BEGINNING OUT THE INTEGRIN, HOW INTEGRATING THE SOAK O SOCIAL, PAIN AMPPLIFICATION DATA WHERE WE HAD THOUSANDS OF VARIABLES HOW WE BEGIN TO NOW PUT THIS IN DIFFERENT MODELS AND WE'RE TAKING MULTIPLE APPROACHES, 1 I HAVE PROVIDED TO YOU IN THE EXTENDED DATA PATH ACCESS TO FOREST PLOT MODELS WE'RE USING BUT I WANT TO FOCUS MOSTLY ON CLUSTER ANALYSIS WE'VE BEEN USING RECENTLY AND WE'RE USING A METHOD CALLED SUPERVISED CLUSTER PROCEDURE THAT WAS DEVELOPED BY ERIC BARRETT IN OUR PROGRAM WHEN HE WAS A GRADUATE STUDENT AT STANFORD AND THE BASIC IDEA IS TO APRIORI, IS IDEBTIFY CASE THAT WILL DISCRIMINATE FROM CONTROLS. SO IT DOES BIAS THE NATURE OF THE CLUSTER BUT ALLOWS THE NATURE OF THE GAP STATISTICS, SEPARATION AND WHICH SO GOOD SPECIFICITY WHEN WE GO THROUGH THE RIGORS OF SHOWING THAT AND WE IDENTIFIED 15 VARIABLES OF INTEREST TO CREATE OUR CLUSTER ANALYSIS, AND WE BELIEVE THESE VARIABLES THAT WE IDENTIFIED CAN BE PUT FORWARD IN QUESTION AIRS, SIMPLE TESTS THAT WILL ALLOW THIS TO MOVE RAPIDLY TO THE CLINIC TO ALLOW SUBDIAGNOSIS OF PATIENTS BASED ON SOME OF OUR [INDISCERNIBLE]. WE'VE IDENTIFIED 3 CLUSTERS, CLUSTER 1 IS WHAT WE CALL A RELATIVELY NORMAL CLUSTER, PSYCHOSOCIAL PROFILES OR PAIN PROFILES AND AUTONOMIC PROFILES. WE FIND CLUSTERS COMPOSED MORE SO OF MEN THAN WOMEN AND THAT THERE ARE FEWER CHRONIC CASES THAT CLUSTER INTO THIS POPULATION. CLUSTER 2 IS A RELATIVELY NORMAL POPULATION FROM PSYCHOSOCIAL AND AUTONOMIC PERSPECTIVE, THEY SHOW GREATER MUSCLE SENSITIVITY AND WE FIND THAT THERE'S ABOUT AN EQUAL DISTRIBUTION OR EQUAL NUMBER OF MALE AND FEMALE PERCENTAGE WISE IN THIS CLUSTER, AND THAT THERE'S ALSO ABOUT AN EQUAL NUMBER OF CHRONIC CASES AND NONCASES BY PERCENTAGE IN THIS CLUSTER. AND THE CHRONIC CASES SHOW MODERATE SYMPTOMOLOGY, AND CO-MORBIDITY. AND THE CONTRAST IS THE 3, EFFECTIVE, HIGHLY EFFECTIVE CLUSTER IN THESE INDIVIDUALS ARE STRESSED, THEY HAVE GREAT PAIN SENSITIVITY AND THEY HAVE ABNORMAL AUTONOMIC PROFILES SHIFTED TOWARD THE NERVOUS SYSTEM AND WE FIND IT'S COMPOSED MORE FEMALES AND MALES AND MORE CHRONIC CASES, NONCASES IN HAD CLUSTER, AND THESE INDIVIDUALS ARE VERY SYMPTOMATIC AND SHOW MULTIPLE PAIN CONDITIONS. AND I JUST WANT TO SHOW YOU SOME OF THE SYMPTOMOLOGY WE SEE CLINICALLY IN THESE 3 CLUSTERS, CLUSTERUS 1, 2, AND 3. CLUSTER 1, NORMAL CLUSTER, I'M NOT GOING--AND THESE ARE DATA TAKEN FROM PMD--TMD PATIENT WHO IS FELL INTO THESE CLUFORTERS. SO THEY ALL REPORT SOME LEVEL OF FACIAL PAIN. WHAT YOU CAN SEE IS THAT IN FACT, THESE INDIVIDUALS IN CLUSTER 1 AND 2, DO REPORT DIFFERENT METRICS OF FACIAL PAIN AND AS YOU LOOK AT CLUSTER 3 SEVERITY OF THEIR FACIAL PAIN IS REGARDLESS OF HOW YOU MEASURE IT. IF YOU LOOK AT INTENSITY OF PAIN AND SAME PICTURE EMERGES, THERE'S PAIN PRESENT IN THESE 2 CLUSTERS BUT CLUSTER 3 IS MORE DISSTRESSED IF YOU LOOK AT THE NUMBER OF OVERLAPPING PAIN CONDITIONS, CLUSTER 3, REPORTS ALMOST 5 COMORBID PAIN CONDITIONS COMPARED TO CLUSTERS ON 1 AND 2. FINALLY I WANT TO SHOW YOU THESE 3 CLUSTERS AND IF WE LOOK AT THE OPPERKS ERA COHORT, WHAT ARE THE RATE FOR DEVELOPING TMD OVER THIS 3 YEAR OBSERVATIONAL PERIOD DEPENDING UPON YOUR INITIAL CLUSTER SITE OF THE BASELINE. AS YOU CAN SEE, IF 1 LOOKS AT THE RATE, THE HAZARDS RATE OF DEVELOPING TMD, IT'S EXPRESSED IN ALL 3 CLUSTERS, BUT DEFINITELY THERE'S A PROFOUND EFFECT BEING ASSIGNED TO CLUSTER 3 IN YOUR LIKELIHOOD IN DEVELOPING TMD AND IF YOU LOOK AT THE HAZARDS RATIO COMPARING THE RATE TO CLUSTER 1 TO CLUSTER 3, THE HAZARD RATE IS ALMOST 3 TIMES GREATER IF YOU'RE IN CLUSTER 3 RELATIVE TO CLUSTER 1. SO I THINK WE IDENTIFIED FUNDAMENTAL PROPERTIES OF CLUSTERS 1, 2, AND 3. AND WE'RE ALSO BEGINNING TO SEE GENETIC CLUSTER 1, 2, AND 3, AND THIS IS SIMPLY A CONTRAST OF THE 350 GENES IN THE OVER 3000 SNPs AND CONTRASTING INDIVIDUAL AND CLUSTER 1 TO 3 AND WE GET, A FRY INTERESTING SNPs, THE GABBA SIB UNIT AND THE CORTICOID RECEPTOR AND SEVERAL OTHERS SNPs AND WHEN WE APPLY A PATHWAY ANALYSIS TO THESE DATA SETS, WE IDENTIFIED A VERY I THINK IMPORTANT AND UNIQUE PATHWAY THAT REPRESENTS THERAPEUTIC TARGETS FOR TREATMENT OF THESE CONDITIONS ESPECIALLY INDIVIDUALS APPLYING TO NUMBER 3, SO USING PROTEIN AND PATHWAY ANALYSIS, WE WERE ABLE TO REVEAL THE CAPPA B PATHWAY WHICH IS HIGHLY SIGNIFICANTLY ENRICHED IN CLUSTER 3, RELATIVE TO CLUSTERS 1 AND 2, AND IF WE LOOK AT SPECIFIC GENES OR PROTEINS THAT ARE IN THIS SPECIFIC CLUSTER, THIS NF-kappaB PATHWAY, WE FIND 4--RELATIVELY HIGHLY SIGNIFICANT HIT, THESE PROTEIN HUBS WITHIN THE PATHWAY, WHICH POTENTIALLY REPRESENT THERAPEUTIC INTERVENTION TARGETS TOWARD PATIENTS IN CLUSTER 3 IN PARTICULAR. AND WE'RE FOLLOWING UP ON THIS FINDING EGFR AND WE'RE ALREADY IN PRECLINICAL STUDIES SHOWING EGFR ANTAGONISTS ARE HIGHLY ANALGESIC WITH THE LOW SEDATION EFFECTS AND WE HAVE MANY OTHER SAMPLES WHERE WE MADE THESE TYPES OF OBSERVATIONS THAT ARE MOVING TO PRECLINICAL OR CMT FINDINGS ARE LEADING TO THE STUDIES IN THE CLINIC BASED ON THIS. SO GENERAL FINDINGS AND DISCOVERIES, VERY CLEAR THAT THERE ARE MULTIPLE WAYS OF PATHS HERE, MULTIPLE GENETIC RISKS AND FACTORS THAT CREATE A MOSAIC THAT WE CALL SIGNS AND SYMPTOMS. ONLY SOME OF THESE FACTORS PREDICT ONSET THAT ARE ASSOCIATED WITH KRONEISITY. THE BASIC ELEMENTS OF OUR HERISTIC MODEL HAVE BEEN EXTENDED AND IT'S IMPORTANT TO RECOGNIZE THIS IS NOT A LOCALIZED OROFACIAL CONDITION. IT'S HETEROGENEOUS ROW GENIUS AND CLUSTERED IN INTO HOMOGEANOUS SUBGROUPS AND IT'S CLUSTERED TOGETHER FOR DIAGNOSING THESE PATIENTS AND DEVELOPING NOVEL TREATMENT STRATEGIES FOR CAMICOLOGICAL OR NONPHARMACOLOGICAL IN NATURE BASED ON PROFILES. THAT'S NOW POISED WELL FOR COMPARATIVE EFFECTIVENESS. WHAT WE HAVE DONE IS CREATED METHODS THAT NOW ALLOW VAILEDDATION AND COMPARATIVE EFFECT OF THESE TO BE CONDUCTED. WE HAVE BEEN SUCCESSFUL IN OUR PUBLICATIONS, I THINK IT HAS--TO DATE WE HAVE 30 PUBLICATIONS OUT, SO THE MOST COMPREHENSIVE SET CAME IN A SUPPLEMENT TO THE JOURNAL OF PAIN AND THE NOVEMBER 2011 ISSUE, WE HAVE MANY OTHER INDIVIDUAL MANUSCRIPTS AND WE ARE IN THE PROCESS WITH PRODUCING ACT 2 OF OUR OPPE RA FINDINGS AND THESE ARE UNDER REVIEW NOW WITH THE JOURNAL OF PAIN AND IT WAS RESULT IN OTHER SUPPLEMENT TO THE JOURNAL OF PAIN. FINALLY I'D LIKE TO THANK NOT ONLY THE PATIENTS AND OUR STAFFS WHO PUT IN A YOMAN'S EFFORT ON THESE INITTAATIVES BUT THE SUBSTANTIAL SUPPORT THAT WE EARNED FROM NIDCR AND NINDS AS WELL, THANK YOU VERY MUCH D. [ APPLAUSE ] A FEW QUICK QUESTIONS WE HAVE A LITTLE BIT OF TIME. YES? >> I'M CURIOUS WHAT YOU'RE DOING IN TERMS OF TRYING TO DISSEMINATE THE FINDINGS THAT YOU HAVE OUTSIDE WHAT I WOULD CONSIDER SORT OF THE SEMINOLE PUBLICATIONS BECAUSE CERTAINLY THIS IS A HETEROGENEOUSIO GENIUS PATIENT POPULATION IN MANY CASES QUITE VOCAL AND I'M JUST CURIOUS WHAT KIND OF EFFORT YOU MIGHT HAVE GOING ON THERE. >> WE'RE TRYING TO TAKE EVERY AVENUE POSSIBLE TO US. I THINK WE PARTICIPATE IN MANY NATIONAL/INTERNATIONAL MEETINGS NOT ONLY IN THE OROFACIAL AREA BUT IN MANY OF THE AREAS OF PAIN. MY CO-PIs HAVE FREE LATITUDE TO GO OUT AND PRESENT AND DO SO. I HAVE SPOKEN AT ALMOST EVERY NIH WORKSHOP ON PAIN AND PAIN WITH INTERAGENCY DEVELOPS, I THINK OPPERA IS LOOKED TO AS A MODEL WITH THE MAP PROJECT. SO I THINK WITHIN THE PAIN FIELD, WITHIN THE RESEARCH FIELD WE ARE GETTING OUT THERE ANY WOE ARE MAKING A PATH, A FIRST MAJOR SET OF PUBLICATIONS ONLY CAME OUT IN 2011. WE HAVE JUST FINISHED OPPERAC1 AND WE HAVE BIG PLAN FOR OPPERA 2. WHICH WE HAVE BEEN FUNDED FOR AND NACR AND COUNCIL AND I THINK WE WILL WILL HAVE MANY, MANY, MORE STORIES TO TELL. SO WE ARE TRYING TO DISSEMINATE AS RAPIDLY AND EFFICIENT FICIENTLY AS PUBLICATION OF PRESENTATION AS WE CAN. DEPUTY. >> I WAS CURIOUS ABOUT YOUR FINDING ABOUT POSITIVE EFFECT, ALMOST THE PROTECTIVE MECHANISM AND WAS CURIOUS IF THAT INNATE OR IMMUNABLE OR COMMENT ON THAT. >> WELL YOU KNOW IT'S QUITE INTERESTING. WE HAVE DISCUSSIONS WITHIN OUR DISEASE MODELING GROUP ABOUT RESILIENCE AND SHOULD WE REALLY BE THINKING ABOUT, YOU KNOW DISEASE VECTORS THAT WE HAVE LITTLE OPPORTUNITY TO CHANGE THE RESILIENCE FACTOR BUT MOOD, POSITIVE MOOD IS AN AREA OF INTEREST WITH MANY OF THE INVESTIGATORS IN THE TEAM FIELD SEE NOW. SO IDENTIFYING INDIVIDUALS AT RISK, WE HAVE A NUMBER OF INTERVENTIONS, I THINK, THEY ALL REQUIRE TIME AND EFFORT, THE BEHAVIORIAL AND MOVEMENT EXERCISE IS A BIG FACTOR THAT WILL CREATE RESILIENCE. I THINK WE'RE GOING TO SEE COMMONNALLITY OF CARDIOVASCULAR DISEASE, DIABETES, EXERCISE, SLEEP, THESE FUNDMENTAL PROCESSES THAT WE NEED TO SURVIVE AND THAT WE SOMETIMES VIEWS ARE THE PATHWAY TO RESILIENCE TO CORRECT THOSE I THINK WILL HAVE TREMENDOUS IMPACT NOT ONLY ON PAIN BUT ON MANY, MANY OTHER CONDITIONS. I THINK THAT'S 1 OF OUR GOAL SYSTEM TO FIND RESILIENT FACTORS WE CAN USE BEHAVIORIAL INTERVENTIONS TO IMPACT THE LIKELIHOOD OF EITHER DEVELOPING OR ONCE DEVELOPED TRYING TO AMELIORATE THE SYMPTOMS. THANK YOU VERY MUCH. >> AND NOW BRIAN SHCMIDT. >> I'M HOPING TO SAY GOOD MORNING TO YOU, I HAVE TO SAY GOOD AFTERNOON AND GIVEN THAT I'LL KEEP IT RELATIVELY BRIEF. I WANT TO THANK THE COUNCIL FOR GIVING ME THE OPPORTUNITY TO SPEAK TO THIS GROUP AND WHAT I'M GOING TO PRESENT TO YOU REPRESENTS A PARTNERSHIP BETWEEN PATIENT, TALENTENTED GROUP OF RESEARCHERS TO WORK WITH AND NIDCR, MY INTEREST IN CANCER PAIN GOES BACK TO 2 DECADES BUT IT WAS ABOUT 2 YEARS AGO IN 2002 WHEN I STARTED SEEING THIS PATIENT THAT I SAY FIRST HAND WITH THE CLINICAL PROBLEM WAS, AND IF YOU OPENED UP A TEXTBOOK IN 2002 AND READ THE SECTION ON CANCER PAIN. IT SAID A NUMBER OF OF CAUSES THAT WERE NOT IN LINE INNAMATORY PAIN--SMALL CANCERS THAT WERE VERY PAINFUL. SO WE STARTED THIS QUEST TO UNDERSTAND WHY ORAL CANCER IN CANCER IN GENERAL IS SO PAINFUL, THIS IS A COLLAGE OF ORAL CANCER PATIENTS FOR MY OWN PRACTICE, NOT ALL OF THEM WILL HAVE PAIN BUT ABOUT 80% OF THEM WILL SAY THAT OUTSIDE OF WANTING TO SURVIVE THEIR BIGGEST CONCERN IS PAIN AND RELATED DRUGS AND THE PROBLEM I HAVE WITH MY PATIENTS IS NOT BEING ABLE TO GET THOSE DRUGS TO THE PATIENT OR GET THEM ENOUGH DRUG TO MAKE THEM COMFORTABLE. NSAIDs AND ASPIRIN DON'T TOUCH THE PAIN IN PATIENTS WITH CANCER. THE SYMPTOMS THESE PATIENTS HAVE AFFECT EVERYTHING THEY DO, SO EACH TIME THEY TRUE TO TALK OTHERS EITHER DRINK THEY HAVE EXCRUCIATING PAIN WHICH IS IMPORTANT TO UNDERSTAND FROM A PAIN MECHANISM. WHAT WE STARTED TO DO IS LOOK VERY CAREFULLY AT WHAT THESE PATIENTS WERE REPORTING. COLLECT THEIR SAMPLES AND START TO UNDERSTAND HOW IT IS THAT THESE CANCERS PRODUCE SUCH HIGH LEVELS OF PAIN. I WON'T SPEND MUCH TIME ON TALKING TO YOU ABOUT THE PREVALENCE OF CANCER PAIN BUT THIS IS A LARGE META-ANALYSIS THAT WAS DONE OVER THE LAST 40 YEARS, WHAT YOU MIGHT NOTICE IS THAT IN TERMS OF REFULENCE HEAD AND NECK IS AT THE TOP. IF YOU HAVE A DIAGNOSIS THROUGHOUT THE WORLD OF OTHER TYPES OF CANCER PAIN, HAVE YOU A GREATER THAN 50% CHANCE OF SAYING THAT PAIN IS MY BIGGEST PROBLEM THAT I'M DEALING WITH; THE FIRST THING WE STARTED TO UNDERSTAND IS THAT CANCER PAIN DEPENDSOT TYPE OF CANCER, SO THESE FIRST SERIES OF PHOTOS I SHARED YOU WERE PATES WITH SQUEAMISH CELL CARCINOMA, THE MAR JORRITY OF THE PATIENTS HAVE THE SCHEMISH CELL CARCINOMA, THEY HAVE WHAT'S CALLED ACUTE FUNCTIONAL PAIN. VERY HIGH LEVEL. IF THEY'RE NOT DOING ANY ACTIVITY, IF THEY'RE NOT TALKING EEATING OR DRINKING, THEY GENERALLY DON'T HAVE PAIN. AS SOON AS THEY GO TO SWALLOW OR TALK, THEY HAVE EXCRUCIATING PAIN. IT'S SIMILAR TO PATIENTS THAT HAVE METASTATIC BREAST CANCER WHERE IF THEY'RE LYING SUPINE, THEY HAVE NO PAIN. IF THEY THROW THEIR LEG OVER THE SIDE OF THE BED, THEY HAVE EXCRUCIATING PAIN FROM THE METASTASIS. THIS CAUSES CHRONIC AND THAT HAPPEN ALL THE TIME OR SPONTANEOUS, THIS CANCER THIS HAS A PROPENSITY FOR GETTING INTO THE NERVE, THIS IS THE LARGE NERVE, IT INNERIVATES THE PALLET AND THE CANCER AND THE NERVE DEVELOPPINGS THIS RELATIONSHIP FOR THE CANCER FIGURES OUT IT CAN MAKE THAT NERVE GIVE IT A PROLIFERATIVE ADVANTAGE, AND THEY STARTED TO BED THAT OVER THE LAST 2 OR 3 YEARS. WHEN I FIRST STARTED SUBMITTING GRANT APPLICATIONS AND MANUSCRIPT REVIEWS, I WAS TOLD THAT CANCER PAIN IS UNDERSTOOD, IT'S DUE TO DESCRIPTION OF TISSUE, WELL THIS IS A 52 YEAR-OLD MAN REFERRED TO ME FROM HAWAII, WITH A LARGE BLASTOMA, DUE TONY O PLASTIC PROLIFERATION OF THE EPITHELIUM, HE'S HAD IT 15 YEARS AND NO COMPLAINT OF PAIN. LOOKING AT THE PAN O RAMMIC RADIO GRAPH, ON THE UNAFFECTED SIZE OF COURSE INFERIOR NERVE WHICH IS THE LARGEST CENTURY BRANCH OF THE TRI GENERATEDERAL NERVE RUNS THROUGH THE CANALOT EFFECTIVE SIDE, THE NERVE HAS BEEN PUSHED INFERIORLY, THERE'S SIGNIFICANT DESTRUCTION OF THE TISSUE BUT THE PATIENT HAS NO PAIN. HE HAS NORMAL FORMAL NEUROSENSORY TESTING. MEANING THE NERVES IMPACT BUT NO PAIN. THE FIRST TIME HE HAS PAIN IS DURING THE POST OPERATIVE PERIOD, HE GETS A SHORT COURSE OF OPIOID AND THEN NO PAIN. COMPARE THAT TO ANOTHER 1 OF 54 YEAR-OLD WOMAN CEREBELLUMS PERT IN THE HEALTHCARE SYSTEM FOR HEALTH STATE WHO WAS REFERRED TO ME FOR RAPIDLY GROWING MASS IN THE LEFT ANGLE OF THE MANDATORY INCREASE IN BODILE THAT CAUSED PAIN. A PAN O RAMMIC RAD ROW GRAFF ASK WHERE THE ARTERY RUNS OVER THE MANDATORY INCREASE IN BODILE, SHE HAS A LESION, I'M CONCERNED FOR A NUMBER OF REASONS THAT THE PAIN IS WHAT CATCHES MY ATTENTION. THE SAME DAY I GET A CT SCAN AND IT TURNS OUT THAT SHE HAS A NONSMALL SMALL CELL LUNG CANCER WHICH IS ASYMPTOMATIC AT THE PRIMARY SITE AND THIS IS WHAT'S SO INTERESTING ABOUT CANCER PAIN AND ORAL CANCER PAIN. HAVE SEVERE PAIN AT THAT PRIMARY SET. THE FIRST STEP WE HAD TO TAKE WAS TO CHARACTERIZE THE PHENOTIME OF WORLD CANCER PAIN IF YOU WERE TO LOOK AT HEAD AND NECK CANCER QUALITY OF LIFE QUESTIONNAIRES AND 2 PRIMARY 1S USED HAVE SINGLE ITEMS THAT ASK ABOUT THE CANCER PAIN. AND AS I MENTIONED TO YOU AWIVE TIME FIST I ASKED ME PATIENT IF THEY'RE SIT NOTHING THE EXAMINATION ROOM, DO YOU HAVE PAIN? THEY'LL SEA SAY NO OR SHAKE THEIR HEAD NO, BUT AS SOON AS THEY GO TO DO SOME ACTIVITY, THEY HAVE EXCRUCIATE BE PAIN. WE DEVELOPED AN 8IME TEMQUESTIONNAIRE THAT CHARACTERIZE THAT PHENOTYPE. THIS WAS VERY HELPFUL IN UNDERSTANDING THE MECHANISM OF CANCER PAIN. WHAT I'M SHOWING YOU HERE ON THE Y AXIS ARE SIMPLY THE QUESTION, ITEM IT GOES BETWEEN SPONTANEOUS PAIN, DESCRIPTOR OF PAIN THAT'S VALIDATED, FUNCTIONAL. AND THEN HAVE YOU THIS ITEM SENSITIVITY TO TOUCH. THESE PATIENTS COMPLAIN OF MECHANICAL WHAT WE CALL ALOE DINNIA OR HYPER SENSITIVITY. IN THE BLACK BAR I'M SHOWING THE PATIENTS BEFORE SURGERY AND IN THE GRAY BAR, THE SAME PATIENTS AFTER SURGERY. WHAT YOU'LL NOTICE IS THAT BY REMOVING THE CANCER, THE PAIN GOES AWAY. IN CLINIC IF THE LOCAL HAVE CANCER THE PATIENTS ARE RELIEVED FOR 3 TO 4 HOURS AND THAT'S HELPFUL IN UNDERSTANDING THE MECHANISM OF PAIN. AND TRANSFORMS WHEN THERE'S SOMETHING ABOUT THAT MALIGNANT TRANSFORMATION PROCESS THAT MAKES IT PANGFUL. TO DISPEL ISSUE OF INFLAMMATION ASK CANCER PAIN, THIS GROUP OUT OF JAPAN WHO ALSO STUDIES ORAL CANCER, THERE'S FEW GROUPS AROUND THE WORLD DISCRIMINATED BETWEEN INFLAMMATORY PAIN AND CANCER PAIN. YOU COULD TAKE CANCER, PUT IT IN A STERILE ENVIRONMENT AND IT WILL STILL PRODUCE PAIN. THE HYPOTHESIS WE DEVELOPED ABOUT 5 YEARS AGO WAS THAT WE SHOULD BE LOOKING AT THE CANCER MICROENVIRONMENT AND WITHIN THAT CANCER MICROENVIRONMENT, WE HAD THE GROWING CANCER, YOU WILL GET RECRUITMENT OF INNAMATORY CELLS AND YOU HAVE WHAT'S CALLED THE PRIMARY NOSE SUSEPTER AND OUR GOAL WAS TO CHARACTERIZE THE MEDIATORS THAT ARE BEING SECRETED BY THE CANCER THAT'S SENSITIZING THE NERVES AND THE WORK WE DID WOULD RESECT THE CANCER, SOMEONE FROM THE LABORATORY WOULD COME TO THE OPERATING ROOM AND WE WOULD SNAP FREEZE IT, SEND IT BACK TO THE LAB BUT WE WOULD END UP WITH THOUSANDS OF PROTEINS THAT WE WERE LOOKING FOR. THE REMEMBER, NONE OF THE TRADITIONAL MEDIATORS THAT ARE KNOCKED DOWN BY THE STEROIDAL CONTRIBUTE TO PAIN, BUT WE HAVE TO DISCOVER THESE MEDIATORS PRODUCED BY THE CANCER LEADING TO PAIN. AND SO I STARTED TO WORK ON A TECHNIQUE ON THE MICRODIALYSIS WHERE I COULD PUT A MICRODIALYSIS CATHETER DIRECTLY INTO THE CANCER. AND COLLECT THOSE EXTRA CELLULAR SECRETIONS AND FOR HEAD AND NECK CANCER IT TURNS OUT THAT THESE PATIENTS OFTEN NEED A NECK DISSECTION BEFORE ORAL CANCER RESECTION. HAVE YOU A 3 TO 4 HOUR WINDOW WHERE YOU PUT THE PROBE INTO THE CANCER AND COLLECT EXTRA CELLULAR SECRETION. THE PERSON I DID THIS WORK WITH WAS A PROTEIN BUOY CHEMIST BY THE NAME OF MARTHA, EARLY ON WE OOH PLIED TO THE CTSI A PROGRAM AT UCSF AND $40,000 WORTH OF FUNDING AND WE USE THAT PILOT DAT TO SUBMIT AN RO-1 AND HE AND I ARE CO-PIs ON THAT RO-1 THROUGH NIDCR TO USE THIS APPROACH. WHAT WE DO AT THE TIME OF OPERATION AT THE SITE OF CANCER I PUT A MICRODIALYSIS PROBE INTO THE CANCER IN A CONTRA LATERAL MATCHED SITEOT OTHER SIDE OF THE ORAL CAVITY I PUT ANOTHER CATHETER, IT'S ALL COMPUTER CONTROLLED, THE PATIENT CAN THEN BE PREPPED AND DRAPED AND THROUGHOUT THAT OPERATION BEFORE THE CANCER IS RESECTED WE'RE DOING IN VIVO REALTIME MICRO DIALYSIS OF THE CANCER. THIS IS VERY HELPFUL BECAUSE AS I MENTIONED BEFORE WHAT WOULD HAPPEN IS WHEN YOU RESECT THE CANCER, YOU LOSE A LOT OF THOSE EXTRA CELLULAR PROTEINS AND PEPTIDES THAT WE KNEW WERE IMPORTANT. ONCE I HAVE THAT AVAILABLE, I SHIP IT OFF TO MART'S HART AT FORESIGHT WHERE HE DOES MASS SPECTROMETRY TO IDENTIFY THOSE PROTEINS AND PEPTIDES. HE ALWAYS USES A TECHNIQUE WHERE WE CAN TAKE THE PROTEIN THAT COMES OFF THE TUMOR FROM THE PATIENT AND FEED THEM O-18 LABELED WATER AND UNDERSTAND EXACTLY WHAT THOSE PROTEIN ACES ARE DOING IN THE EXTRA CELLULAR MICROENVIRONMENT TO PRODUCE MEDIATORS THAT COULD SENSITIZING OR ACTIVATE NERVES. AND THEN WE CONFIRM OR VAILEDIDATE THE CHEMISTRY. THE WAY OUR PROGRAM WAS SET UP, IS THAT I WOULD START WITH PATIENT SAMPLES. MARCUS WOULD DO THE DISCOVERY APPROACH AND I WOULD GET A LIST OF CANDIDATES AND TAKE THEM BACK TO THE LAB WHERE I WORK WITH A NUMBER OF PEOPLE IN THE LAB THAT DO PRECLINICAL STUDIES. THE TRY TO IDENTIFY THOSE MEDIATORS RESPONSIBLE. THE REAL CHALLENGE WE WERE HAVING IS THAT MARCUS WOULD SEND BACK TO ME A LIST OF 20 OR 30 AND THEN I WOULD BE LEFT WITH USING THOSE KEY WORDS ON PUB MED TRYING TO FIGURE OUT WHAT ARE THE HIGH TARGETS. AND SO THIS RFA CAPE OUT LAST YEAR, 12-1-58 WHERE IT COMBINED INDIVIDUALS WITH INFORMATIONISTS WHO WERE DOING DISCOVERY APPROACH AND APPLIED AND RECEIVED AN ADMINISTRATIVE SUPPLEMENT WHICH HELPS US BECAUSE WE HAVE 3 INFORMATIONISTS THAT THEY GET, I CAN TAKE THOSE HIGH PRIORITY TIPS BACK TO A LABORATORY. THAT TAKES ME TO PRECLINICAL TESTING AND 1 MUCH THE REAL CHALLENGES WE'VE HAD WITH PAIN RESEARCH, PARTICULARLY IN THE ORAL FACIAL REGION IS TO DO PRECLINICAL TESTING, TO UNDERSTAND WHAT MEDIATORS CAUSE ORAL FACIAL PAIN AND WHAT DRUGS RELIEF ORAL FACIAL PAIN AND EARLY ON, WE STARTED LOOKING FOR WAYS THAT WE COULD MEASURE ORAL FACIAL PAIN, AND WE ENDED UP DEVELOPING AND INVENTING A DEVICE WHICH IS BASED ON A RODENT'S NATURAL PROCLIVITY TO GNAW THROUGH OBSTRUCTION WHEN OUGHTS COMBINEDDED. SO RODENT COMES FROM RODIIR, AND THEY GNAW, THEY DO IT NONSTOP WHEN THEY'RE CONFINED, NOT REY RESTRAINED BUT CONFINED. WE ENDED UP USING THIS DEVICE AND BUILT IT AND USED FUNDS FROM AN R21, FUNDED THROUGH THE RFA THAT JOHN MENTIONED ON MODELS FOR PAIN MECHANISM IN THE TRI GENERAL REGION AND WE VALIDATED IT FOR 3 DIFFERENT TYPES OF OROFACIAL PAIN MODELS. THE WAY IT WORKS IF YOU SIMPLY LOAD THE RODENT INTO THE DEVICE AND IT APPROACHES THE BARRIER AND IT HAS TO GNAW THROUGH THE BARRIER TO ESCAPE AND THEY DO THIS NATURALLY AND THIS WAS THE FIRST BEHAVIOR THAT MATCHED WHAT I WAS SEE NOTHING MY PATIENTS. I WILL SHOW YOU A VIDEO WHICH IS SIMPLY A MOCK UP OF THE DEVICE THAT WE USE, THE BLUE BARRIERS ARE REPRESENTATIVE OF THE BARRIER THAT THE ANIMAL HAS TO GET THROUGH, AND WE USE THE TIME THAT IT TAKES TO GET THROUGH THAT BARRIER AS A PROCESS FOR NO SUSCEPTION FOR PAIN AND THEN WE HOOK IT TO SPRINGS THAT CAN CAPTURE THE AMOUNT OF TIME THAT IT TAKES TO GET THROUGH. THE AMOUNT APPROACHES THE BARRIER GETS THROUGH IT, AND THE FIRST TIME GOES OFF AND THE SECOND TIMER STARTS AND WHEN IT GETS YOU THAT SECOND TIMER IT GOES ON. AND WE CAN USE THAT AS AN INDEX OF OF NO SUSCEPTION AND WE'VE BEEN ABLE TO LOOK AT A PATHOLOGIC CONDITION IN A MOUSE AND REVERSE IT WITH ANALGESICS. THE NICE THING ABOUT THE DEVICE IS THAT IT'S OBJECTIVE, IT'S FUNCTIONAL AND IT'S NONINVEIGHSIVE. ALSO, THE MOUSE IS ABLE TO CONTROL ITS ACCESS TO THE STIMULI WHICH IS IMPORTANT FOR ETHICAL REASONS, I'M SHOWING AN INFRANCIS COLLINS READ VIDEO AT THE END OF THE TUBE, YOU CAN SEE, THIS IS THE RODENT CHEWING THROUGH THE BARRIER. THERE ARE A COUPLE OF KEY FEATURES, IT USES ALL THE MUSCLES AND THE STRUCTURES THAT ARE USED BY PATIENTS ALSO IT'S NOT CONSUMING TO TRY THIS WHICH IS THE POLYMER DOWN, AS A MOUSE CHEWS IT DOES THE SAME THING THAT HUMANS DO CHRKS IS CONSTANTLY PROTRUDE THE TONGUE SO THAT ONLY CERTAIN FLUID OR FOOD MATERIAL GOES DOWN THE ESOPHAGUS SO IT'S A VERY GOOD WAY THAT WE CAN USE TO MEASURE MEDIATORS THAT ARE CAUSING CANCER PAIN. WE NOW DO THIS ON A HIGH THROUGH PUT BASIS WHERE WE NOT ONLY MEASURE THESE MEDIATORS BUT ALSOAN TAGANISTS FOR DRUGS THAT BLOCK THOSE MEDIATORS. THIS LAST YEAR WE PUBLISH INDEED THE JOURNAL OF NEUROSCIENCE THE ACUTE TO CHRONIC PANSER PAIN MODELS WHERE WE LOOKED AT 3 DIFFERENT MOUSE MODELS THAT HAVE COONSER AND WERE ABLE TO MEASURE THE IMPACT OF THE CANCER ON NORMAL OROFACIAL FUNCTION. I DON'T CONSIDER CANCER PAIN CHRONIC WHAT I CONSIDER IT IS JUST ACUTE PAIN THAT GOES ON AND ON AND ON. IF YOU REMOVE THE CANCER, THE PAIN GOES AWAY, BUT NOW TODAY, CHEMO THERAPEUTIC DRUGS ARE SO GOOD, THAT MANY PATIENTS ARE LIVING YEARS WITH THE CANCER VIABLE AND HAVING TO DEAL WITH THE PAIN. I'M JUST FINISHING UP ON A COUPLE OF DIFFERENT DIRECTIONS THAT WE'RE HEADING, WE'RE STARTING TO UNDERSTAND THE SPECIFIC FIBERS THAT INTERACT THE FIBERS AND 1 OF THE INTERESTING THINGS ABOUT YOUR SKIN IS THAT IT HAS AN ENDOGENOUS OR INBUILT ANALGESIC MECHANISM SO IF YOU CUT YOURSELF, THERE'S A LOCAL RELEASE OF OPIOIDS, CARCINOMAS ARE DERIVE FRIDAY CAR O TIN O SIGHTS THAT WE TRY TO CAPTURE THIS TO GET THE CANCERS TO RELEASE LARGE DOSES OF OPIOIDS LOCALLY, ENDOGENOUS OPIOIDS LOCALLY WHERE THE CANCER IS AND I JUST SHOWED THIS WORK BY CHI VI ET, WHO GOT IT APPROVED THROUGH THE NIDCR AND WE SLOWLY FIGURED OUT THAT WE'RE NOT JUST DEALING WITH CANCER PAIN BUT WE'RE ADDRESSING CANCER PROGRESSION. AS I MENTIONED TO YOU IN THE BEGINNING WE UNDERSTAND THAT CANCERS RECRUIT THE NERVOUS SYSTEM, SENSORY NERVOUS SYSTEM, SIGNATURES THIEF CANT PROLIF, VERY IMMATURE NERVE FIBERS IN THE CANCER MICROENVIRONMENT. IT TURNS OUT THAT THIS IS AN ORAL CANCER PRODUCING VERY HIGH LEVELS OF NERVE GROWTH FACTOR. NOT ONLY--NOT ONLY CONTRIBUTES TO CANCER PAIN BUT ALSO ALLOWS THE CANCER TO GROW BUT BY A DIRECT CANCER PAIN WE REDUCE THE MORBIDITY ASSOCIATE WIDE CANCER AND IN SOME CASES ALMOST CERTAINLY MIGHT BE IMPACTS ON PROGRESSION. I JUST WANT TO THANK THE NIDCR FOR SUPPORT AND MOST IMPORTANTLY, YOUR PATIENT. THANK YOU. [ APPLAUSE ] >> QUESTIONS FOR BRIAN? >> [INDISCERNIBLE]. >> WE THINK IT'S THE SITE, THE REACCEPTIENT SITE. WE THINK IT HAS TO DO WITH INNERVATION WITH BONE AND PERIODONTIST. >> [INDISCERNIBLE]. >> DOESN'T CAUSE PAIN IN THE LUNG, THAT'S CORRECT. >> [INDISCERNIBLE]. >> RIGHT SO WE TRY TO STAY FOCUSED AND WHAT WE'RE FOCUSED ON ARE PROTEASES, THEY TEND TO BE SMALLER MOLECULES AND MICRODIALYSIS PROBE HAS A 50 KD CUT OFF, LARGE GROWTH FACTORS DON'T SEEM UP IN THAT DISCIPLINARIAL SIGHT SO WE'VE NOT LOOKED AT GROWTH FACTORS. ALMOST CERTAINLY CONTRIBUTING. >> [INDISCERNIBLE]. >> SO I BELIEVE THE QUESTION, FOR BONE METASTASIS DOES PAIN PROCEED? SO PAIN IS A COMMON PRESENTING SYMPTOM FOR METASTATIC CANCER, ESPECIALLY FOR CERTAIN TYPES OF CANCER, GI CANCERS PANCREATIC CANCER AND PATIENT SHOWS UP WITH LOW BACK PAIN OR HIP PAIN AND SURE ENOUGH THEY DO A WORK UP AND IT'S A PRIMARY CANCER SOMEWHERE. FOR PATIENTS WITH ORAL CANCER, PAIN IS THE PRIMARY SYMPTOM, FOR INITIAL CANCER AND RECURRENT. >> [INDISCERNIBLE]. RIGHT. ONE OF THE REAL ADVANCEMENTS WE MADE WITH THE CANCER PAIN FIELD AND THE INTRODUCTION OF THIS ARE FOR PATIENTS WITH METASTATIC AND BREAST AND PROSTATE CANCER, MULTIPLE MYELOMA, THOSE DRUGS WORK VERY WELL FOR CONTROL OF PAIN. >> OKAY I'D LIKE TO THANK DAVE, BILL, AND BRIAN FOR THE INTERESTING TALKS AND--[ APPLAUSE ] -- TURN IT BACK TO ALEASHA. >> OKAY WE'RE GOING TO HAVE A BIT OF A SHORT LUNCH TODAY SO LET'S TRY TO BE BACK AT 1 FOR THE COUNCIL MEMBERS, STAFF, BE READY TO BE BACK AT 1:30 WE THINK THE BSC REPORT WILL BE A HALF HOUR OR LESS, AND THERE IS FOR CAFETERIA ON THE FIRST FLOOR AND WE WILL HAVE THE CONFERENCE ROOM ADJAC TONIGHT THIS ROOM OPEN FOR PEOPLE WHO IF THEY WANT TO BRING THEIR LUNCH BACK UP HERE AND EAT. >> DAVEED ARE YOU ON THE PHONE? --DAVID ARE YOU STILL ON THE PHONE? WE'LL GET YOU BACK ON THE PHONE AT 1. >> YES I'M READY TO GO. >> YEAH.