WELCOME TO THE MAIN MEETING AND I AM GOING TO LET DR. SOMERMAN GET THE MEETING GOING. >> WELL, WELCOME TO EVERYBODY FOR THE--THIS IS THE JANUARY MEETING IN MAY. SO REALLY THANK YOU, COUNCIL FOR PARTICIPATING IN JANUARY ON THE PHONE. THAT WAS GREAT AND AS I SAID LAST NIGHT AS YOU JOINED US FOR DINNER, THAT WE BROUGHT YOU A THUNDERSTORM. WE CREATED IT HERE AT NADCR AND BROUGHT IT OUTSIDE SO YOU CAN FEEL WHAT WE FELT IN JANUARY, BUT REALLY THANK YOU FOR THAT AND TODAY'S PRESENTATION WILL BE SORT OF JANUARY'S ON THE BUDGET AND WE'RE ALSO DELIGHTED THAT THE PEOPLE THAT WE ORIGINALLY INVITED FOR THE HEALTH DISPARITIES EVERY SINGLE PERSON WAS ABLE TO JOIN US TODAY. SO THAT WAS GREAT AS WELL AND JUST WELCOME TO EVERYBODY AND TO ALL OF YOU AROUND THE CIRCLE HERE FOR ALL THE WONDERFUL STAFF AND VISITORS FOR ALL YOUR CONTRIBUTIONS AND WHAT YOU DO FOR US AND ALSO TO THOSE ON THE PHONE, VIRTUAL PARTICIPANTS. WE WELCOME YOU AS WELL. I THINK TODAY WILL BE ABSOLUTELY INCREDIBLE AND I LOOK FORWARD TO A LIVELY CONVERSATION FROM COUNCIL AND THANK YOU FOR YOUR TIME AND EFFORT AS WELL. >> OKAY, WE'RE GOING TO START OUT WITH INTRODUCTIONS SO WE'LL START OUT BY GOING AROUND THE ROOM AND HAVING THOSE PEOPLE WHO ARE GUESTS HERE TODAY STAND UP AND INTRODUCE YOURSELF. >> [INAUDIBLE-AWAY FROM MIC ] >> [INAUDIBLE-AWAY FROM MIC ] >> OKAY, JUST KEEP GOING AROUND. >> [INAUDIBLE-AWAY FROM MIC ] WHO'S NEXT? >> [INAUDIBLE-AWAY FROM MIC ] >> [INAUDIBLE-AWAY FROM MIC ] >> [INAUDIBLE-AWAY FROM MIC ] >> I THINK WE GOT EVERYONE THE NEXT ITEM OF WAS THE NEW AND REASSIGNED STAFF MEMBERS AND VARIOUS MEMBERS OF OUR STAFF WILL INTRODUCE PEOPLE WHO ARE IN THEIR GROUP. SO WE WILL START OUT WITH DR. YAZMAN SHIRADI. >> GOOD MORNING I AM PLEASED TO INTRODUCE DR. CARTER WHO IS NOW A SCIENTIFIC REVIEW OFFICER IN THE BRANCH. PRIOR TO COMING TO NIDCR, THE DOCTOR SERVED AS A PROGRAM DIRECTOR WITHIN THE BIOREPOSITORIES AND SPECIMEN RESEARCH BRANCH OF NCI FOR NEARLY FOUR YEARS. WHILE THERE, SHE MANAGED A PORTFOLIO OF CONTRACTS TO SUPPORT LARGE TEAM SCIENCE PROJECTS SUPAS THE NIH COMMON FUND, GENO TYPE TISSUE EXPRESSION OR GTEX INITIATIVE. BEFORE JOINING NIH SHE WAS A SCIENCE AND POLICY FELLOW AT THE INSTITUTE OF MEDICINE WHERE SHE EVALUATED ETHICAL, REGULATORY AND OPERATIONAL ISSUES RELATED TO COLLECTING AND STORING HUMAN BIOSPECIMENS. SHE RECEIVED A BS IN BIOLOGY FROM SPEEL MAN COLLEGE AND A Ph.D. IN PATHOBIOLOGY AND MOLECULAR MEDICINE FROM COLUMBIA UNIVERSITY. HER DOCTORAL WORK FOCUSED ON EVALUATING FUNCTIONS OF BRACA OF CANCER PROCESSES, PLEAS WELCOME ME IN JOINING HER TO NADCR. [ APPLAUSE ] I'M ALSO EXCITED TO INTRODUCE MISS AMY PEREZ, SHE WILL SERVE AS EXTRAMURAL SUPPORT ASSISTANT IN THE BRANCH. AMY EARNED HER B. A. WHERE FROM NOTRE DAME MARYLAND USING RESEARCH EMPHASIS TRACK. WHILE THERE SHE SERVED AS A TEACHING ASSISTANT TO THE DEPARTMENT CHAIR IN EXPERIMENTAL AND STATISTICAL METHODS AND PRESIDED OVER THE LOCAL CHAPTER OF THE SCI-TI, NATIONAL HONORS SOCIETY. INTERESTINGLY SHE HELD A FELLOWSHIP IN BALTIMORE WHERE SHE TRAINED PEEK NOSED TURTLES USING CLASSICAL TRAINING FOR THE AUSTRALIA EXHIBITS. SHE SUBSEQUENTLY WORKED AT A CPA FIRM SUPPORTING 35 PROFESSIONALS AND ASSISTING NOT-FOR-PROFIT CLIENTS. PLEASE JOIN ME IN WELCOMING AMY TO THE NADCR. >> OKAY, LOOKING FOR CAROL. >> GOOD MORNING. I WOULDED LIKE TO WELCOME MR. DOE, HE HAS BEEN WITH THE NIH COMMUNITY FOR THE PAST 14 YEARS AND HOLDING POSITIONS AT THE NICCH, NHLBI AND PREVIOUSLY WITH NIDCR. MOST RECENTLY HESERVED AS THE DEPUTY BUDGET OFFICER FOR THE NHGRI PRIOR TO RETURNING TO NIDCR. PRIOR TO HIS EMPLOYMENT WITH THE NIH, HE WORKED IN PRIVATE BANKING, REAL ESTATE INVESTMENT, TRUST AND STATE AND LOCAL GOVERNMENT. MR. DOUGH RECEIVED HIS ACCIDENT AND FINANCE DEGREE FROM THE UNIVERSITY OF BALTIMORE. PLEASE WELCOME JIMMY. [ APPLAUSE ] >> GOOD MORNING, IT GIVES ME GREAT PLEASURE TO INTRODUCE DR. GANAUT WHO JOINED AS CLINICAL RESEARCH PROGRAM DIRECTOR, CLINICAL RESEARCH AND TECHNOLOGY PROGRAM IN DECEMBER OF 2015. DR. GANAUT, HOLDS A M. D., Ph.D. AND MASTERS OF FINE ARTS FROM TELAVIV IN THE RESEARCH DEPARTMENT. THE DOCTOR COMPLETED A POST DMD FELLOWSHIP AT THE NIDCR INTRAMURAL PROGRAM AND A POST DOCTORAL FELLOWSHIP AT THE NATIONAL CANCER INSTITUTE. DR. GANAUT COMES TO NIDCR AS SERVING AS PRESIDENT OF OPTICAL DIAGNOSTICS AND INVITRO DIAGNOSTICS COMPANY IN ROCKVILLE MARYLAND THAT SHE FOUNDED AND MANAGED. THANK YOU PLEASE WELCOME DR. GANAUT. >> GOOD MORNING. I'D LIKE TO INTRODUCE DR. NICOLE GARCIA KEHANO, WHO RECENTLY JOINED HEALTH INFORMATION AND PUBLIC LIAISON BRANCH IN THE OFFICE OF COMMUNICATIONS AND HEALTH EDUCATION, NICOLE WILL MANAGE NADCRs LANGUAGE, HEALTH INFORMATION AND OUTREACH ACTIVITIES. PRIOR TO JOINING NADCR, SHE ASSISTED OTHER NIH INSTITUTES WITH PUBLIC INQUERY RESPONSE AND PUBLIC INFORMATION CONTRACTORS. BEFORE THAT SHE LED HEALTH PROGRAMS FOR THE NATIONAL ALLIANCE FOR HISPANIC HEALTH IN WASHINGTON D. C. AND THE PUERTO RICO DEPARTMENT OF HEALTH. NICOLE HAS AN M. D. FROM THE UNIVERSITY OF PUERTO RICO SCHOOL OF MEDICINE IN SAN JUAN. AND AN MPh IN HEALTH COMMUNICATION FROM THE JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH. SHE IS A BOARD CERTIFIED PREVENTIVE MEDICINE SPECIALIST. PLEASE JOIN ME IN WELCOMING NICOLE. [ APPLAUSE ] >> GOOD MORNING, SO I HAVE THE NEXT FOUR MEMBERS OF THE DIVISION OF EXTRAMURAL RESEARCH AND ONE PROMOTION, AND I THINK SHE'S STUCK ON THE METRO. IN ANY CASE, HE'S A FAMILIAR FACE,--THIS APPOINTMENT WAS MADE BACK IN NOVEMBER OF 2015: NADIA JOINED US IN 2006 AS THE DIRECTOR OF TISSUE ENGINEERING AND REGENRATIVE MEDICINE RESEARCH PROGRAM, A POSITION THAT SHE STILL HOLDS RIGHT NOW. AND OVER THE YEARS, SHE HAS SHEPHERD--SHEPHERDED A PARTICULAR AREA IN BIOMEDICAL RESEARCH AND LED AND CO LED SEVERAL INITIATIVES, MOST RECENTLY SHE'S THE ARCHITECT OF THE DENTAL ORAL AND CRANIOFACIAL TISSUE REGENERATION CONSORTIUM. AND PRIOR TO JOININGLY NADCR, SHE WAS A SECTION CHIEF AT NIDDK, NADIA EARNED HER Ph.D. FROM THE NEW YORK STATE ALBANY, TRAINED AS POST DOCTORAL FELLOW AT YALE UNIVERSITY UNDER THE TUTELAGE OF NOBEL LAUREATE SYDNEY ALDMAN, AND WORKED ON MOLECULAR MECHANISMS OF CAT CATALYTIC COMPONENT OF A KINASE PIECE. SO WHEN HE COMES SHE WE ALL GO YAY! NEXT KEVIN JOINED US AS MEDICAL OFFICER. HE CAME TO US FROM NIDDK WITH WHERE HE WAS PROGRAM DIRECTOR OF THE OFFICE OF RESEARCH HEALTH ACCORD NATION SINCE 2010. PRIOR TO THAT HE WAS MEDICAL OFFICER AT THE CENTER FOR DEVICES AND RADIOLOGICAL HEALTH AT THE FDA FOR THREE YEARS. DR. MCBRIDE RECEIVED HIS UNDERGRADUATE DEGREE FROM U PENN. HE COMPLETED REZONING DONEESY TRAINING AND GENERAL PEDIATRICS AT ST. CHRISTOPHER HOSPITAL FOR CHILDREN IN PHILADELPHIA, AND PEDIATRIC NEVERROLOGY AT UNIVERSITY OF MICHIGAN ANN ARBOR, HELD FACULTY POSITIONS IN PEDIATRIC AT TERMERAL SCALE OF MEDICINE AND GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE. LET HE IS ALSO CERTIFIED IN SPORT PEDIATRIC NEVERROLOGY. PLEASE WELCOME KEVIN. I ALSO WANT TO THANK A MOMENT TO THANK DR. JANE ATKINSON. HERS WAS A LONG SEARCH AND HE WATCHED OVER ALL OUR CLINICAL STUDIES. >> NEXT IS MISS SUE LANGFORD, MISS LANGFORD JOINED US AS EXTRAMURAL SUPPORT ASSISTANT. SHE HAS OVER 10 YEARS EXPERIENCE AS ADMINISTRATIVE ASSISTANT IN VARIOUS CAPACITIES, WITH INCREASING RESPONSIBILITIES OVER THE YEARS AND INCLUDING SIX YEARS IN A MEDICAL PROVIDER SETTING AS ADMINISTRATIVE MEDICAL ASSISTANT. [ APPLAUSE ] LAST AND CERTAINLY NOT LEAST WE HAVE CHRISTOPHER SUX JR., HE HAS ADMINISTRATIVE AS EXECUTIVE ASSISTANCE EVENT MANAGER AND COORDINATOR. HE SERVED IN THE U.S. NAVY FOR 11 YEARS AS MILITARY POLICE TRAINER, EARNED MEDAL FOR HEROISM, FOR 9/11 PENTAGON TORRORRISM ATTACK. THIS MEDAL IS THE SECOND HIGHEST NONCOMBAT DECORATION AWARDED BY THE U.S. DEPARTMENT OF NAVY TO MEMBERS OF THE U.S. NAVY AND U.S. MARINE CORPS. [ APPLAUSE ] >> GOOD MORNING IT'S MY PLEASURE TO WORK GABRIELA LOPEZ TO NADCR, WITH THE HEALTH RESIDENCY PROGRAM, GABY HAS 15 YEARS OF EXPERIENCE WORKING AS STATISTICIAN DATA ANALYST AND PROGRAMMERS, GABY'S ORIGINALLY FROM ARGENTINA WHERE SHE OBTAINED A MASTERS DEGREE IN BIOSTATISTICS FROM CHILI AND SANTIAGO AT THE RANDOMIZED TRIAL GRAND YOD SCHOOL IN LOS ANGELES. RECENT WORK EXPERIENCE INCLUDES WORK AS A STATISTICIAN AT THE U.S. ARMY OF OFFICE OF SURGEON GENTLEMEN. WORKING IN THE NATIONAL CHILDREN'S RESEARCH STUDY. ALSO WORKED AT THE PEDIATRICS DEPARTMENT AT THE UNIVERSITY OF MIAMI WHERE SHE CO-AUTHORED PUBLICATIONS IN CHILD HEED OBESITY, CARDIOLOGY, AND CHILDHOOD CANCER. PLEASE WELCOME GABY TO NADCR. >> OKAY, I WOULD LIKE TO INTRODUCE MR. PAUL NEWGENT, HE WORKED AT VARIOUS BRANCHES OF THE NIH, NATIONAL INSTITUTE ON AGING AS WELL AS NATIONAL INSTITUTE OF NEUROLOGICAL--NEUROLOGY AND NEUROLOGICAL DISEASES AND STROKE. HE CAME TO US FROM THE NIH TYPE FIVE CLOSE OUT CENTER AFTER DOING A DETAILED GRANTS MANAGEMENT GROUP. HE HAS A B. S. DEGREE FROM THE UNIVERSITY OF MARYLAND COLLEGE AND ASSOCIATE'S DEGREE OF ENGINEERING AND SCIENCE FROM MONTGOMERY COLLEGE, PLEASE WELCOME ME IN JOINING MR. NEWGENT. [ APPLAUSE ] SO I -- >> SO I HAVE THE GREAT PLEASURE OF INTRODUCING ANANICHOLSON WHO JOINED THE NADCR IN JANUARY AS THE DIRECTOR OF CLINICAL TRIALS AND OPERATIONS MANAGEMENT, FINALLY CALLED OCM, AND COMES FROM NATIONAL PROGRAM FOR SKIN DISEASINGS WHERE SHE SERVED AS PROGRAM DIRECTOR. DURING HER TENURE WITH NIAMS, SHE RECEIVED SEVERAL AWARDS, DEVELOPMENT OF POLICIES AND PROCEDURES FOR THE CLINICAL TRIALS PROGRAM IN HER AREA. PRIOR TO HER FEDERAL SERVICE SHE WAS A PROJECT TEAM LEAD AT KAI, WHICH IS A CLINICAL RESEARCH ORGANIZATION. SHE RECEIVED HER MASTERS IN HEALTH SCIENCES AND CLINICAL TRIALS ADMINISTRATION FROM GEORGE WASHINGTON UNIVERSITY AND A BACHELOR OF SCIENCE--OF ARTS AND BUSINESS ADMINISTRATION GRADUATING SUMA, CUM LAU DE. AND IS THE DIRECTOR AND MANAGER OF NEXTRAMURAL RESEARCH PROGRAMS. INCLUDING CLINICAL TRIALS AND COMPLEX CLINICAL STUDIES. I WOULD ALSO LIKE TO THANK INCREDIBLY DR. YOUNG WHO OVER THE LAST YEAR HAS MANAGED HER HUGE RESPONSIBILITIES PLUS OVERSEEING THE OFFICE AS WELL. SO PLEASE SUPPORT ANNA. [ APPLAUSE ] SO I WAS SUPPOSED TO INTRODUCE SOMEBODY ELSE BUT WE'LL HAVE TO WAIT TILL NEXT TIME BECAUSE SHE'S HAD JURY DUTY. >> ALL RIGHT, WE HAVE GOTTEN THROUGH OUR LIST. JUST A COMMENT. REMEMBER WE'RE WEBCASTING THE MEETING TODAY SO IF YOU ARE SPEAKING PLEASE USE THE MICROPHONE SO THAT THE FOLKS ON THE WEBCAST CAN HEAR YOU. ALSO IF ANYONE IN THE ROOM IS EXPERIENCING DIFFICULTIES WITH YOUR LAB TOP WE HAVE TWO OF OUR I.T. FOLKS HERE TODAY, JON AND PATRICK OVER HERE IN THE FRONT SIDE AND THEY'LL BE MORE THAN HAPPY TO HELP YOU. OUR FIRST EITHER TEMOF BUSINESS WILL BE APPROVAL OF THE MINUTES FROM THE PREVIOUS MEETING. THANK YOU AGAIN FOR YOUR PATIENCE WITH THE TRAVEL CHANGES IN JANUARY BECAUSE OF THE BLIZZARD, IT WAS A WHIRL WEND OF CHAOS UNTIL WE GOT THINGS SETTLED. THE MINUTES FROM THE 2016 MEETING HAVE BEEN MADE AVAILABLE TO THE COUNCIL MEMBERS FOR THEIR REVIEW AND I'LL ASK IF ANYONE ON COUNCIL HAS ANY COMMENTS OR QUESTIONS FOR THE JANUARY MINUTES? IF NOT WOULD A COUNCIL MEMBER MAKE A MOTION TO APPROVE THE MINUTES. >> [INDISCERNIBLE] >> AND WOULD SOMEONE SECOND THAT MOTION. >> ALL IN FAVOR OF APPROVAL? ANY OPPOSED? OKAY, THANK YOU. AND NEXT, EACH YEAR TYPICALLY IN JANUARY, COUNCIL REVIEWS AND APPROVES THE COUNCIL OPERATING PROCEDURES AND MAKING RECOMMENDATIONS FOR REVISIONS AS NEEDED. BECAUSE OF THE ABBREVIATED JANUARY MEETING THIS AGENDA ITEM WAS DEFERRED TO MAY. THIS YEAR NADCR IS NOT RECOMMENDING ANY CHANGES TO THE OPERATING PROCEDURES. WE DO ASK COUNCIL IF IT THEY HAVE ANY SUGGESTED CHANGES OR COMMENTS OR QUESTIONS? IN THAT CASE WOULD SOMEONE ON THE COUNCIL MAKE A MOTION TO APPROVE. >> SO MOVED. >> AND ALL IN FAVOR? ANY OPPOSED? THANK YOU. I'LL TURN THE MEETING BACK OVER TO DR. SOMERMAN FOR HER REPORT. >> ALL RIGHT, EVERYBODY, SO AGAIN GOOD MORNING TO EVERYBODY AND THANK YOU FOR JOINING US FOR THE BUDGET WHICH SOME OF YOU PROBABLY ALREADY KNOW MUCH ABOUT AT THIS POINT SINCE WE'RE A LITTLE DELAYED ON IT BUT WE ARE GOING TO GO THROUGH THIS AND GIVE YOU A LITTLE BIT OF INFORMATION ON THE 17 JUST AS WELL, A BRIEF OVERVIEW OF THAT. BEFORE STARTING THE PRESENTATION, I DID WANT TO CALL OUT TO ALL OUR INCREDIBLE STAFF, FOR YOU HAVE NO IDEA WHAT THEY DO EVERY SINGLE DAY TO MAKE THIS MEETING AS WELL AS EVERYTHING ELSE JUST RUN SMOOTHLY. AND A WONDERFUL EXAMPLE OF THIS WAS YESTERDAY WHERE AS YOU MAY KNOW, WE HAVE THREE DENTISTS ON CONGRESS AND ONE OF THE INDIVIDUALS REPRESENTED AGASA, WAS HERE YESTERDAY WITH HIS STAFFER AND FROM THE BEGINNING OF THE DAY WHEN DR. TABAK JOINED US FOR THE FIRST HALF HOUR AND PRESENTED AN OVERVIEW OF NIH TO THE END OF THE DAY WHERE WE ENDED UP AT THE CLINICAL RESEARCH CENTER AND DR. JANICE LEE AND HER GROUP A BEAUTIFUL PRESENTATION, HAPPENED TO HAVE A FOUR YEAR-OLD PATIENT WITH MOBIUS SYNDROME THAT HE WAS ABLE FOCUSED ON GO IN AND GREET AS WELL AND ALSO OVER AT BUILDING 30 JUST BEAUTIFUL WITH DR. BOB ANGER AND KENNY MOTTA AND JUST A BEAUTIFUL PRESENTATION, SO VISUAL IT'S AMAZING. SO ONE IS IT WAS A GREAT VISIT AND THESE ARE IMPORTANT THINGS WE DO BECAUSE CONGRESS DOES MAKE A DIFFERENCE AND I KNOW COUNCIL AND ALL OF YOU AROUND THE TABLE WHAT YOU DO IN TERMS OF ADVOCACY MAKES A HUGE DIFFERENCE FOR US. SO LET'S GIVE A HUGE APPLAUSE FOR ALL OF US. SO WE'RE GOING TO TALK A LITTLE BIT ABOUT THE BUDGET. SOME OF THE FUNDING OPPORTUNITIES AND ANNOUNCEMENTS AND THEN A LITTLE BIT OF PREVIEWS. AND IT'S BUDGET TIME SO I WILL TALK ABOUT JUST ONE SLIDE ON THE BUDGET FOR HEALTH DISPARITIES WHICH YOU MAY BE SURPRISED OF IN TERMS OF THE DISTRIBUTION OF WHERE WE SPEND OUR MONEYS AND WHAT PERCENT OF THE BUDGET IS DEVOTED TO HEALTH DISPARITIES. SO IN TERMS OF OUR BUDGET FOR FY15 IT WAS JUST A LITTLE BIT UNDER 400 MILLION, 397, 672, GOING EXTRAMURAL, 78% GOES TO EXTRAMURAL. AND WE HAVE 16% THAT GOES TO INTRAMURAL BUT TAKE A LOOK AT THAT NUMBER, SO 40, IT'S ALMOST A 40% OVERHEAD. IT'S APPROPRIATE. YOU MAY OVERHEADS AT YOUR UNIVERSITIES BUT SO WHEN YOU LOOK AT THAT NUMBER, IT'S MUCH LESS IN TERMS OF WHAT WE DISTRIBUTE TO THE PIs IN THE INTRAMURAL PROGRAM. THIS GOES TO FACILITIES, UTILITIES, OUR ASSESSMENT TAX FOR THE CLINICAL RESEARCH CENTER, SO A LOT GOES INTO THE SET WE HAVE TO PAY AND THESE MAY BE INCREASING. WILL AND THEN OF COURSE, ABOUT SIX% RESEARCH MANAGEMENT AND SUPPORT AND THESE ARE FOR JOINT CENTRAL ASSESSMENTS. SECURITY, STUDY SECTIONS, I.T. SO THERE ARE MANY THINGS THAT WE DON'T THINK ABOUT DAILY THAT WE HAVE TO PAY FOR APPROPRIATELY BUT THOSE COST US MONEY AS L.- -WELL. SO DRILLING DOWN ON THE BUDGET, AND THE BUDGET FOR--THE TOTAL BUDGET IN TERMS OF COMPETING RENEWALS, THAT'S THE 171 UP THERE, WE HAD ALMOST 800 GRANT PRACTICES POTENT STATALS TO REVIEW AND FUNDED 171 WHICH IS IT ABOUT A 22% SUCCESSFUL RATE. IN ADDITION WE CONTINUED TO FUND THE SMALL BUSINESS PROGRAMS AND WE'RE DELIGHTED ABOUT THE ACTIVITIES AND INCREASED APPLICATIONS WE'VE BEEN SEEING. ONE OF THE AREAS OF FOCUS FOR US IS INCREASED VISIBILITY AND INCREASED ACTIVITY AND PROPOSALS IN IN THIS AREA AND I THINK THERE ARE HUGE OPPORTUNITIES IN THE DENTAL OROCRANIOFACIAL AREAS FOR SBIR, STTR, SO THAT TOTALS 591, ADDING TO THIS THE RESEARCH CAREERS AREA AS WELL AS RESEARCH TRAINING WHICH WE'RE INTERESTED IN BUT IN TERMS OF THE TOTAL IT WAS 655 GRANTS AND THEN ADD THE RESEARCH TRAINING AND CAREERS AND I CHECK THOSE OUT BECAUSE THIS IS ANOTHER AREA OF FOCUS FOR US IN TERMS OF WORKFORCE AND MAKING SURE THAT THE NEXT GENERATION IS THERE IN TERMS OF ALSO THE STRONG DIVERSITY OF OUR WORKFORCE. SO I WANTED TO POINT THAT OUT TO YOU AND WE WILL TALK A LITTLE BIT ABOUT A NEW AWARD COMPETITION RELATED TO RESEARCH CAREERS LATER ON. SO LOOKING AT THIS FOR THOSE THAT ARE VISUAL, THIS IS FOR THE TOTAL BUDGET. SO WHEN YOU LOOK AT THE TOTAL BUDGET, THE RESEARCH PROJECT GRANT, STILL OUR BREAD AND BUTTER, MULTIPLE ARE ABOUT 63% AND INTRAMURAL BUDGET IS ABOUT 16% AS I MENTIONED BEFORE AND THEN OUR RESEARCH MANAGEMENT SUPPORT. BUT WE ALSO HAVE FOR A HIGH% RELATIVE TO OTHER INSTITUTES IN TERMS OF TRAINING AND CAREER DEVELOPMENT AND ALSO THE SBIR PROGRAMS AS WELL. AND WE HAVE VARIOUS CONTRACTS THAT SUPPORT THE RESEARCH OF MANY OTHERS AS WELL. SPECIFICALLY FOCUSING ON EXTRAMURAL AND I THINK THIS IS IMPORTANT BECAUSE EVERYBODY, THE EXTRAMURAL COMMUNITY WONDERS WITH SOME OF THE INITIATIVES THAT WE'RE PUTTING FORWARD, THESE INITIATIVES ARE FROM EMERGING AREAS, AREAS WHERE WE DO WANT TO INCREASE AND MAKE SURE OUR PORTFOLIO HAS, BUT ON THE OTHER HAND, IT'S THE DRIVER, THE PIs AND THE IDEAS AND THE INNOVATIONS THAT YOU COME UP WITH AND THAT'S THE IMPORTANT FOCUS FOR US AND YOU CAN SEE IT'S OVER 80% OF WHAT WE FUND IN TERMS OF THE EXTRAMURAL COMMUNITY. SO THE OTHER QUESTION PEOPLE ALWAYS ASK IS, WELL, WHAT% GOES TO RO-1S, ROTHREEs AND SO LUMPED HERE AND THEN I'LL SEPARATE IT OUT IN THE BLUE, WILL--WELL, NO, IT'S NOT THIS SPOT, WE HAVE ANOTHER SPOT THAT VISUALIZES THIS AS WELL. THINGS VICTORY CHANGED MUCH IN TERMS OF THE YEARS IN TERMS OF THE MAJORITY, BREAD AND BUTTER RESEARCH PROJECTS. WE HAVE A BIT OF AN INCREASE IN YEAR IN THE Us FOR THE RELATED TO THE HEALTH DISPARITIES GRANTS WE PUT FORWARD AND IN THE OTHER RPGs AND THIS WAS BECAUSE OF DENTAL CRANIOFACIAL TISSUE REGENERATION CONSORTIUM AND THOSE WERE 10 PLANNING GRANTS IN THAT AREA. SO THERE WERE A COUPLE OTHER THINGS AS WELL, BUT YOU SEE A SLIGHT INCREASE IN THE OTHER WHICH IS THAT TOP BLUE, LIGHT BLUE AREA. SO IN TERMS OF SUCCESS RATE OVER THE LAST FEW YEARS, WE'VE BEEN STEADY BETWEEN 18 AND 22%, SLIGHTLY HIGHER THAN THE NIH BUDGET, WE WOULD LIKE TO GET IT BACK UP BUT WE ARE DELIGHTED WHERE WE ARE TODAY AND THE ABILITY TOO FUND EVEN AT THIS LEVEL IS VERY, VERY GOOD. SO THIS IS AN INTERESTING GRAPH AND YOU MAY LOOK AT THIS AND SAY WHAT'S GOING ON? SO FOR ONE WITH THE RO-1s IN TERMS OF THE SUCCESS RATE IT'S BEEN PRETTY STEADY AS YOU SAW FROM THE LAST SLIDE: IN TERMS OF THE RO-1S AND ROTHREES AND R21S, A LOT OF OUR INVESTIGATORS SAY I'LL GO FOR THIS BECAUSE IT'S EASIER TO GET. AND A FEW THINGS HERE, THE REASON FOR THE UPS AND DOWNS, THE WAY THEY ARE IS BECAUSE WE GET MUCH LESS GRANTS IN THIS AREA, SO YOU GET A CHANGE OF 102 AND IT CAN BOUNCE UP AND DOWN MUCH MORE READILY AS CAN YOU IMAGINE. WE'RE A SMALL INSTITUTE. WE ARE VERY SUPPORTIVE OF THESE AREAS. YOU CAN SEE THE R21S INAPPROPRIATELY SO ARE NOT AS EASY TO GET. THE R21S VERSES THE RO-1s BECAUSE THESE ARE HIGH RISK, HIGH REWARD AND ARE CHALLENGING TO GET. IT'S ALSO--IF I CAN SAY THIS, IN OUR STUDY SECTION AND REVIEWERS THEY DO AN EXCELLENT JOB BUT THE ABILITY TO THINK OUT OF THE BOX ALONG WITH THE PERSON THAT SUBMITTED THE R21 IS SOMETIMES CHALLENGING FOR THEM AS WELL. SO THEY LOOK AT THE IDEA IS SAY THIS IS IMPOSSIBLE AND SO WE HAVE TO WORK ON THE STUDY SECTIONS AS WELL IN THIS AREA. IN TERMS OF THE RO-THREES AND INCREASE, THE R O-THREES IN ADDITION TO THE INFORMATION FOR INVESTIGATORS THAT DO NOT HAVE ENOUGH PRELIMINARY DATA OR NOT ENOUGH READY FOR FOR THE RO-1 PROPOSAL TYPE, WE ALSO PROMOTE IN THE RO-THREE REALM A SECONDARY ANALYSIS. AND WE'VE HAD VERY GOOD STRONG APPLICATIONS IN THIS AREA. SO THAT'S WHERE YOU SEE THE INCREASE FROM. SO WHAT ABOUT OUR ANNOUNCEMENTS IN THE APPLICATIONS? I'M GOING TO GO THRAW THIS QUICKLY. THERE ARE A LOT OF SLIDES HERE BUT I JUST WANT TO GIVE YOU SORT OF THE BREADTH OF THE MANY DIFFERENT ACTIVITIES WE HAVE. SO IF YOU LOOK AT THE RFAs THAT WERE AWARDED, I THINK THE Us THERE, THE PLANNING GRANTS AND ALSO SMALL BUSINESS. SO THESE ARE WHERE WE TRY TO TARGET A DIFFERENT VARIETY OF DIVERSE RESEARCHERS AND APPLICATIONS, ONE AREA OF FOCUS THAT WILL CONTINUE TO BE A FOCUS IS RELATED TO THE HIV AREA AND YOU CAN SEE SEVERAL IN THAT AREA. IN ADDITION TO THE AREA OF CANCER WHERE WE HAVE MODEL CITIZEN LEAKULAR CO DEPENDENT PATHWAYS IN THE CANCER AND THE PLANNING GROUP I SAID AS I MENTIONED BEFORE AND CRANIOFACIAL REGENERATION AND OF COURSE THE MULTIDISCIPLINARY COLLABORATIVE RESEARCH TO REDUCE ALL HEALTH DISPARITIES. IN 2016 AND ONE IS GOING TO BE APPROVED HOPEFULLY, I SHOULDN'T SAY IT WILL, THE RFAs FROM COUNCIL REVIEW TODAY, YOU CAN SEE HERE, IF YOU LOOK QUICKLY, I THINK I SAW THREE RELATED TO HIV. WE'RE VERY EXCITED ABOUT THE FUNDING IN IF THE PHARMACOGENOMICS OF ALL FACIAL PAIN WHICH IS REALLY AN IMPORTANT AREA AS YOU KNOW THERE'S BEEN A LOT IN THE NEWS ON THIS AND THE NEED TO DEVELOP BETTER DRUGS AND ALSO PERSONALIZED PRECISION TO AN INDIVIDUAL. AND THAT'S WHAT THIS IS A FOCUS ON. AND THEN THE E-CIGARETTES WHERE WE HAVE, WE WERE RIGHT ON TOP OF THAT RECOGNIZING THE NEED TO DO MORE RESEARCH AND THEN THERAPIST IS TARGETED AT BASIC RESEARCH BUT IT'S ALSO HUMAN SAMPLES, ANIMALS, ANIMAL MODELS, AND INVITRO MODELS AS WELL AND WE AWARDED SEVEN IN THIS AREA: AND THEN YOU--SO I THINK THE OTHERS WERE HIV, AND THEN VERY IMPORTANTLY, WE CONTINUE TO SUPPORT THE AREA OF RESTORATIVE DENTISTRY AND DEPTAL MATERIALS WHICH IS ABSOLUTELY A NEED. AND THIS IS WITH CLASS FIVE LESIONS. SO IN TERMS OF PROGRAM ANNOUNCEMENTS AND MECHANISMS NEAR 2016, ESTABLISHING OUTCOME MEASURES FOR CLINICAL STUDIES, THIS IS REALLY IMPORTANT AND ABSOLUTE NEED AND WE'RE REALLY EXCITED ABOUT THE GRANTS PROPOSALS THAT IT'S BECOMES INNING IN THIS AREA. IMMUNE PLASTICITY IS VERY IMPORTANT AND HIGH ON EVERYBODY'S RADAR SCREEN THESE DAYS IN TERMS OF IMMUNE HOST INTERACTIONS AND IMPACT ON TOTAL HEALTH. OF COURSE THE AREA OF IMAIMINGING DIAGNOSTICS AND THIS IS THROUGH AN SBIR, CTR, I THINK THIS IS AN AREA FOR THE DENTAL OR CRANIOFACIAL WHERE WE CAN SHINE BECAUSE THIS IS AN EASY AREA TO DO THE FIRST ANALYSIS OF IMAGING THAT CAN BE TAKEN TO OTHERS FOR OTHER MODELS AS WELL, VERSES OTHER PEOPLE DOING IMAGING ON MORE COMPLEX AREAS AND THEN WE'RE USING IT FOR US, I THINK WE CAN BE A LEAD HERE. SO WHERE THE FUTURE? WELL SOME OF THESE FUTURES ARE ALREADY ALMOST HERE. THE NEXT TO THE LAST ONE IN SUSTAINING OUTSTANDING ACHIEVEMENTS IN RESEARCH, THE GRANT PROPOSALLINGS ARE ALREADY RECEIVED BUT NOT REVIEWED YET. AND THIS IS SUSTAINING ALLOT STANDING ACHIEVEMENT IN RESEARCH OR SOAR AWARD. A LOT OF YOU HAVE INITIATED STUDIES TO ADDRESS JUNIOR INVESTIGATORS. SO ONE THING THAT'S BEEN RECOGNIZED IS THE FIRST AWARD THEY GET IS THE BR-ONE AND THEN THEY DON'T GET THE IN ACCIDENT ONE. SO THIS IS FOR OUTSTANDING RESEARCHERS THAT HAVE AN RO-1, JUNIOR INVESTIGATORS AND APPLYING FOR THE NEXT ONE AND THIS IS AN EIGHT YEAR AWARD. SO THEY DON'T HAVE TO KEEP SPENDING THE TIME ADMINISTRATIVELY PUTTING THINGS TOGETHER. THE OTHER AREAS, SO THE DENTAL OROCLANNIAL DENTAL REGENERATION CONSORTIUM. THE PLANNING PHASE IS ALMOST DONE BUT THE ANNOUNCEMENTOT RESOURCE CENTERS IS OUT THERE. AND PEOPLE ARE BUSY WORKING ON THIS AT THIS POINT: THESE WILL BE TWO YEAR AWARDS FOR LOOKING AT ESTABLISHING RESEARCH CENTERS AND WILL FUND ABOUT ONE-THREE DEPENDING ON WHAT WE RECEIVE AND ALWAYS OUR BUDGET AS WELL BUT WE HAVE SET ASIDE FOR THIS. IN BUILDING, SALES AND SCAFFOLDS AND ANIMAL MODELS THAT WILL THEN NEED TO WORK WITH GROUPS THAT HAVE THESE CENTERS REALLY FUNCTIONAL SO THAT AT THE NEXT PHASE, WHICH IS PHASE THREE OF FOUR OR FIVE YEARS, THEY WILL JUMP START HAVING PRODUCTS READY FOR CLINICAL TRIALS BY THE END OF THIS WHOLE AREA AND THE GOAL HERE FROM THE BEGINNING WAS TO MOVE PRODUCTS. WE RECOGNIZE AT THE BASIC SCIENCE LEVEL THAT WE HAD EXCELLENT RESEARCH ON SIGNALING MOLECULES AND BASIC SCIENCE AREA WE WILL CONTINUE TO SUPPORT AND EXCELLENT RESEARCH IN TERMS OF SCAFFOLDS THAT WE WILL CONTINUE TO SUPPORT SOME LIMITATIONS IN ANIMAL MODELS THAT ARE DISEASE APPROPRIATE AND SOME LIMITATIONS OF SUBSTANTIAL LIMITATIONS IN NOT ASKING CLINICIANS FIRST. WHAT DO THEY NEED? SO WE DEVELOP THE PRODUCT AND THE PRODUCT THE CLINICIAN DEVELOPS AND LOOKS AT AND SAYS WHAT'S THAT. SO THE REAL IMPORTANCE OF HER GETTING INITIONS IN THE BEGENERATEDDING OF A PHASE, GETTING A MAN DATE INVOLVED IN THE SECOND PHASE IS CRITICAL SO THAT WE'RE REALLY READY TO GO AT THE END OF THIS CONSORTIUM PROJECT IN TERMS OF PRODUCT AND CLINICAL TRIALS. SO THE OTHER ONE THAT'S ALREADY OUT THERE IS TELLING DENTAL TREATMENT FOR GUIDELINES WITH SYSTEMIC DISEASES AND THIS IS AN ABSOLUTE NEED FOR THE PRACTITIONERS. AND WE DON'T HAVE A VERY CLEAR GUIDELINES IN MANY AREAS RELATED TO SYSTEMIC DISEASES AND WE'RE LOOKING FORWARD TO STRONG PROPOSALS IN THIS AREA. THE OTHERS THAT ARE ALMOST READY TO GO AND I'M EXCITED ABOUT ALL OF THESE, SO I'LL GO FROM TOP UP, YOU KNOW ONE IS IN THE DIFFERENCES IN MALE AND FEMALE PRESENTATION OF VARIOUS DISEASES AND FOR US IN THE DENTAL OR CRANIOFACIAL REGION THERE ARE QUITE A FEW. ONE RELATED TO AUTOIMMUNE DISEASES WHERE WE KNOW FEMALES ARE MORE SUSCEPTIBLE TO AUTOIMMUNE DISEASES, THAN MALES, SO WHY? WHAT'S THE REASON? SYNDROMES? CHRONIC TEMPO MANDIBULAR JOINT DISORDERS, MALE HIGHER THAN FEMALE. CERTAIN ORAL CANCERS MALE HIGHER THAN FEMALE. WHAT'S GOING ON HERE? EVERY DAY--WELL, OFTEN I WILL RECEIVE AN RESEARCHER WORKING OUTSIDE WORKING ON ANIMAL MODELS AND SAYING WE DIDN'T THINK WE WOULD SEE THIS BUT WE ARE SEEING A DIFFERENCE IN ONE GENE OR OUR MOUSE MODELS. SO THE INCREASED ATTENTION TO DIFFERENCES IS VERY, VERY IMPORTANT. IMPORTANT IN TERMS OF FUTURE PRECISION MEDICINE AND WHAT IS THE GENETICS EPIGENETICS BEHIND THIS. SO WE'RE EXCITED ABOUT THOSE PROPOSALS. THE OTHER MOVING UP IS 3D TISSUE AND MIMIC MODELS WITH ORAL HEALTH DISEASE, I'M SURE YOU HEARD A LOT ABOUT THIS WITH KNOW ARGANOMIC CHIP. ORIGINALLY WHEN THE PROPOSAL WAS PUT OUT, THERE WAS NONE IN THE DENTAL-CRANEIO AREA SO WE'RE WORKING ON THIS. WE HOPE YOU WILL SEE IT SOON AND THEN OF COURSE, THE BIOSENSORS IN THE NEUROCAVITY AND THIS IS AN EXCITING AREA FOR US AND ONE THAT REALLY FITS IN WITH PRECISION MEDICINE IN TERMS OF BEING ABLE TO MONITOR DISEASE, YOU CAN IMAGINE HAVING AN ORAL CHIP AND THEN YOU TAKE IT OUT ONCE A DAY TO MONITOR YOUR DRUG INTAKE, YOUR THERAPIES, YOUR AT-RISK AND MANY OTHER THINGS THAT ARE JUST OPPORTUNITIES THAT ARE EASY, EASY ACCESS, ABLE TO DO IN THE RURAL COMMUNITIES AND WE'RE EXCITED ABOUT MOVING AND LAUNCH THANKSGIVING FORWARD AS WELL. SO THE BUDGETS FOR 16 AND 17, YOU HEARD ABOUT THIS. IT'S NEVER OVER UNTIL IT'S OVER IN TERMS OF WHAT REAL BUDGETS ARE SO JUST A SMALL FOR INFORMATION AT THIS POINT BUT I THINK THE BUDGET FOR 2016 WITH A 6.5% SO UP TO ABOUT 413 K, AND AND APPROPRIATELY SERVED THE TIARAS SPENDS FOR OUR TREE HAS GONE UP SO ONE OF THE REQUIREMENTS WAS A TWO% INCREASE FROM FROM FY14 TO FY17, AND THIS IS NEEDED AND KEEPING WITH THE BUDGET AND READING ANYTHING ON THE DEPARTMENT OF LABOR AND THE FOSA NEW RATE THERE THAT WILL GO IN FY17 WITH OVER 447,440 SOMETHING LIKE THAT, THE PAY LINE THAT WILL BE ESTABLISHED FOR OUR POST DOCS AND THEY WILL RECEIVE THAT OVER TIME, THAT'S FOR FY17 AND FOR THE NEXT FEW YEARS IT NEEDS TO GO UP TO 50, AGAIN APPROPRIATE BUT NOT SURE HOW WILL IT BE DONE ORE HOW IT'S DONE FOR ALL, WILL NOT BE CLEAR YET, AND--WHAT DOES THAT MEAN WHEN IT SAYS NIH; EACH INSTITUTE, CENTER, BUDGET WILL HAVE A CONTRACT THAT GOES THEREUPON BEFORE IT'S DEPOSITED AND THE UNIVERSITIES WILL HAVE TO FIGURE OUT HOW TO COVER THE REST, IT'S IMPORTANT BUT I KNOW EVERYBODY'S SCRAMBLING IN TERMS OF FIGURING OUT HOW TO DO THIS. SO FY17 REALLY IS UNKNOWN. IT WAS A PROPOSED INCREASE OF 825 MILLION OVER FY16 SO THAT'S WHERE IT IS RIGHT NOW. SO AS YOU LOOK AT THE FAMOUS PURCHASING POWER, IF YOU MOVE TO 2016 AGAIN WE'RE INCREDIBLY THANKFUL TO OUR CONGRESS FOR THE INCREASE IN THE FUNDS SO ANY INCREASE WAS DIFFICULT BUT IMPORTANT TO RECEIVE BUT YOU CAN SEE FROM THE BLUE LINE WE HAVE INCREASED UP AGAIN AND IN TERMS OF THE RED LINE IN TERMS OF WHERE WE WERE IN 2003, WE'RE STILL NOT THERE YET AND A LONG WAY TO GO. SO IN TERMS OF AREAS THAT I FELT WOULD BE OF INTEREST TO YOU, THE BLUE WHICH I DON'T THINK COMES UP HERE, I THINK YOU CAN SEE IS TERMS OF APPROPRIATIONS AND OTHERS IN TERMS OF RECOMMENDATIONS, BUT AREAS I THOUGHT YOU MAY BE INTERESTED IN WHERE ARE THE BUDGET ITEMS FOR INTEREST OF CONGRESS, COST RELATED TO THE MEDICINE INITIATIVE, BRAIN INITIATIVE, ALZHEIMER'S DISEASE HAS TARGETED MONEY THERE, ANTIMICROBIAL RESISTANCE INTEREST, COMMON FUNDS FOR THE GRABRIELA PEDIATRIC RESEARCH INITIATIVE AND DELIGHTED TO SAY THAT WE HAVE RESEARCHERS FROM NIDCR THAT ARE FUNDED IN THIS AREA, THE INSTITUTIONAL DEVELOPMENT AWARD, THE IDEA PROGRAM, WE DO NOT HAVE ANYTHING FUNDED OUT OF NADCR IN THE THIS AREA, WE HAVE IN THE PAST AND FOCUSING ON THE STIPEND AND BENEFITS FOR TRAINEES, HIV/AIDS JUST TO LET YOU KNOW AND I THINK YOU'VE ALREADY NOTICED THEY'RE LOOKING AT DIFFERENT WAYS IN MECHIMISMS IN TERMS OF PRIORITIES AND GUIDELINES FOR HIV/AIDS RESEARCH. ANOTHER AREA WE'RE STILL SCRAMBLING ON IS WHO'S GOING TO PAY FOR SOME OF THIS WITH THE ZIKA VIRUS INITIATIVE AND DELIGHTED TO SAY THAT NADCR HAS STEPPED UP. WE HAVE A COMPANY THAT'S BEING FUNDED RIGHT NOW, THEY WERE FUNDED FOR ANOTHER INITIATIVE, BUT USING BLOOD AND SALIVA TO DIAGNOSE THE ZIKA VIRUS. SO IN TERMS OF HEALTH DISPARITIES LET ME SHARE WITH YOU THE BUDGET. SO THE BLUE LINE IS THE AMOUNT OF THE CONSORTIUM NOW THAT WAS CENTERED AND OUR TOTAL BUDGET IN THIS AREA, RELATIVE TO THE TOTAL BUDGET FOR NADCR IS ABOUT 13%. SO 13% OF OUR BUDGET IS SUBSTANTIAL. THIS IS VERY MUCH A COMMITMENT FOR ME AS THE DIRECTOR. THE SO IN TERMS OF THE CONSORTIUM NOW, CENTERS BEFORE, IT'S ABOUT 20-25% OF THE BUDGET. I THINK THIS IS APPROPRIATE BECAUSE AGAIN WITH PROGRAM IT SHOULD BE INDIVIDUAL DRIVEN RESEARCH. SO THE MAJORITY OF THE BUDGET IN THIS AREA COMES FROM INDIVIDUALS AND NOT--I MEAN THE CENTERS IN THE CONSORTIUMS ARE CRITICAL AND THEY DO A WONDERFUL JOB AND YOU WILL HEAR SOME OF THAT TODAY. BUT IT'S WAY BEYOND THAT IN TERMS OF WHAT WE FUND IN THIS SPACE. SO I THOUGHT THAT WAS AN IMPORTANT THING FROM THE BUDGET SIDE, AND YOU ARE GOING TO HEAR SOME MORE ABOUT THE ACTIVITIES AND THE RESEARCH IN AN OVERVIEW FROM DR. JANE AT KINSON AND SO WITH THAT, THAT'S THE YEAR THAT WAS AND I THANK YOU VERY MUCH. [ APPLAUSE ] QUESTIONS? >> ALL RIGHTY SO EVERYTHING WAS PERFECTLY CLEAR AND YOUR EYES ARE OPEN. GREAT, THANK YOU VERY MUCH. >> OKAY, WE ARE A TAD BIT AHEAD OF SCHEDULE. NEXT WE HAVE A CONCEPT CLEARANCE WE ARE REQUIRED TO DOCUMENT THE EXPERIENCE FOR GRANT AND CONTRACT OPPORTUNITIES BY PRESENTING THE PURPOSE, SCOPE AND OBJECTIVES IN A PUBLIC FORUM AND GIVING THE PUBLIC AN OPPORTUNITY TO COMMENT. FOLLOWING THE PRESENTATION, DESIGNATED COUNCIL MEMBERS WILL LEAD THE DISCUSSION FOLLOWED BY A VOTE FOR APPROVAL OF THE CONCEPT AND WE WILL USE THAT FOR A BASIS FOR FUNDING THE OPPORTUNITY ANNOUNCEMENT. TODAY DR. SUNDAR VENKATACHALAM, DIRECTOR, WILL PRESENT THE FIRST CONCEPT AND THEN DRS. CHI AND DARVO WILL LEAD THE DISCUSSION. >> GOOD MORNING I WOULD LIKE TO TRG LEAD THE DISCUSSION TARGETING HEAD AND NECK CANCERS FOR IMMUNOTHERAPY. THE GOAL IS TO AIM IDENTIFYING AND TESTING TUMOR SPECIFIC NEW ANTIGENS THAT ARISE FROM SOMATIC CANCERS THIS IS DRIP BY GAPS AND OPPORTUNITIES. SOME OF THEM ARE LISTED HERE. IF YOU LOOK AT GAINS IN SURVIVAL RATES FOR HEAD AND NECK CANCER DURING THE PAST DECADE THEY HAVE BEEN MARGINAL. FOR THE PAST FEW DECADES THE GAIN VS BEEN PRIMARILY DUE TO EARLY DETECTION RATHER THAN MAJOR CHANGES IN THERAPIES. AND MOST OF THE CURRENT THERAPIES HAVE MODERATE EFFICACY AND HIGH MORBIDITY. AND TARGETED MONOTHERAPIES WE HAVE COME A LONG WAY IN THIS AREA, WHILE SPECIFIC LIMITED BY DRUG RESISTANCE AS WELL AS CANCER RECURRENCE. HOWEVER, DURING THE PAST YEAR SOME USEFUL AND EXCITING DATA HAVE COME TO LIFE, IN TERMS OF CANCER IMMUNOTHERAPY, DATA FROM THE PAST YEAR HAVE SHOWN SOMATIC MUTATIONS AND CARCINOGEN LIKE LUNG CANCERs AS WELL AS MELANOMAS, TUMOR SPECIFIC NEW ANTIGENS THAT CAN INTRODUCE A IMMUNE RESPONSE AND HEAD AND NECK CANCERS BELONG TO THIS CATEGORY OF CARC SIN O GEN INDUCED CANCERS AND CANCER IMMUNOTHERAPY UNLIKE CONVENTIONAL THERAPIES HAVE BEEN SHOWN TO OVERCOME MANY PROBLEMS ASSOCIATED WIDE IMMUNOTHERAPIES. WE STARTED THIS WAR 45 YEARS AGO AND I REALLY BELIEVE THE TIDE IS TURNING AT LEAST FOR SOME TYPES OF CANCERS. SO SOME OF THE AREAS WE WOULD WOULD LIKE TO FOCUS ON, ARE LISTED HERE. IDENTIFY HEAD AND NECK CANCER SPECIFIC NEOANTIGENS AND VAL DAD THEIR EXPRESSION IN HEADS AND NECK TUMORS. DEVELOP MODEL SYSTEMS TO FUNCTIONALLY TEST HNC SPECIFIC NEOANTIGENS AS TARGETS FOR IMMUNOTHERAPY AND ANALYZE THE EFFICACY OF COMBINATION APPROACHES THAT WOULD COUPLE NEOANTIGEN-BASED IMMUNOTHERAPY WITH TRADITIONAL RADIO CHEMO THERAPY TARGETED THERAPY OR IMMUNE CHECK POINT INHIBITOR BLOCKADE. DRS. CHI, DRS. THAT ARE NOT ABLE TO BE HERE TODAY. >> OKAY, SO I'LL GO FIRST. SO THE HYPOTHESIS THAT THEY ARE SPECIFIC NEW ANTIGENS PRES EPT IN PATIENTS WITH HEAD AND NECK CANCER IS REALLY BASED ON THE RECENT DISCOVERY THAT CANCERS INDUCE BY CARCINOGENS USUALLY HAVE HIGH SOMATIC MUTATIONS. WHICH LEADS TO THE GENERATION OF TUMOR ANTIGEN AND OTHER EXAMPLES OF CANCER LIKE--LIKE JUST BEING PRECEPTED INCLUDING MELANOMAS AND LUNG CANCERS AND THESE CANCER ANTIGENS CAN BE TREATED AND TARGETED WITH THESE IMMUNOTHERAPIES FOR DIAGNOSIS AND ALSO FOR TREATMENT. SO THAT CLEARS ALSO TAKES ADVANTAGE OF THE FACT THAT SALIVARY GLAND CANCERS SHOW UNIQUE FOGSS AND THAT LEADS TO FUSION PROTEINS THAT HAVEONCH O GENIC ROLES, THE NADCR SUPPORT IMPORTANT DISCOVERIES THAT MAY PROVIDE SALIVARY GLAND--AND THIS ALIGNS WITH THE INSTITUTE'S MISSION, SO I SUPPORT THIS CONCEPT CLEARANCE. >> I AGREE SO WITH THAT COMMENT, JUST SAY IT HAS A SOLID BASIS IN THE LITERATURE. USING NEW TECHNOLOGY AND NEXT GENERATION SEQUENCING TO IDENTIFY THE NEW ANTIGENS AND IT DEFINITELY FITS WITHIN THE EGRESS AND CONCEPTS OF NADCR. >> DR. [INDISCERNIBLE] IS NOT WITH US HERE TODAY BUT SHE DID SEND WRITTEN COMMENTS AND I WILL READ THEM TO THE COUNCIL. SHE SAID SHE IS VERY EXCITED TO SEE THIS CONCEPT, GIVEN THE FOUR-FIVE YEAR SURVIVAL RATE FOR HEAD AND NECK CANCER IN THE LAB, THESE FACTS UNDERSCORE THE NEED FOR FURTHER ADVANCEMENT IN HEAD AND NECK CANCER, RESEARCH, THE BASIS FOR THIS CONDITION SEPTORS IS WELL SUPPORTED BY DATAA AND OTHER CANCERS SPECIALLY THOSE WITH SOMATIC MUTATIONS INCLUDES HEAD AND NECK CANCERS, THERE A GAP IN KNOWLEDGE IN THIS FIELD FOR HEAD AND NECK CANCER AND NADCR PORTED FOLIO DOES NOT HAVE STUDIES ADDRESSING THIS AREA. TIMING IS EXCELLENT, THIS INITIATIVE ALIVANCE WITH A WHITE HOUSE NATIONAL CANCER MOON SHOT INITIATIVE AND WITH THE NIH PRECISION MEDICINE INITIATIVE AND ALSO ALLIANCE FOR THE NADCR STRATEGIC PLAN, ONE IS TO CONSIDER BROADENING THIS CONCEPT CLEARANCE BEYOND HEAD AND NECK CANCERNY O ANTIGENS AND TUMOR SPECIFIC PROFUSION PROTEINS AND INCLUDE MORE BROADLY OTHER IMMUNOMODULATORY MECHANISMS FOR HEAD AND NECK CANCER. FOR EXAMPLE, NUMEROUS ADDITIONAL IMUE O MODEL MONITORETTORY INHIBITORY FACTORS EXPRESSED BY STROMAL CELLS IN THE TARGET ARE CHECK POINT BLOCKING. THE IDEA OF CANCER IMMUNOTHERAPY MIGHT BE HELPFUL CONCEPT TO INCLUDE. >> OKAY, WE CAN OPEN UP THE DISCUSSION. WOULD ANYONE ELSE LIKE TO COMMENT OR ASK ANY QUESTIONS? >> DR. MELVIN? >> JUST A QUESTION: IS IT KNOWN IF IN ANY OF THESE ARENY O ANTIGENS ARE ON THE SURFACE? >> SO MANY OF THESE WILL BE IMAGED BY CLASS ONE OR TWO OR PROTEIN COMPLEX SO THAT'S THE IDEA AT LEAST FOR MELANOMAS AS WELL AS LUNG CANCERS THEY HAVE SHOWN TO BE PRESENTED BY THE IMAGE OF ONE COMPLEX BUT THEY COULD BE FOR HNC RELATED CANCERS ESIX AND SEVEN PEPTIDE SOLUTIONS PEPTIDE IMAGES BUT MOST OF THEM ARE GOING TO BE PRESENTED THROUGH IMAGING COMPLEX. BUT ONE WOULDN'T BE SURPRISED TO SEE SOME SURFACE ANTIGENS MUTATED WHICH CAN GENERATE NEW ANTIGENS. >> OTHER QUESTIONS? OKAY IF THERE ARE NO OTHER COMMENTS O QUESTIONS WOULD COUNCIL MAKE MOTION TO APPROVE THIS CONCEPT? SECOND? ALL IN FAVOR? OPPOSED? >> THANK YOU. >> THANK YOU. WE'RE A LITTLE BIT AHEAD OF SCHEDULE BUT OUR GUEST SPEAKER HAS ARRIVED AND SO MARTHA WILL INTERVIEWS YOU. >> SO, AGAIN GOOD MORNING EVERYBODY AND IT'S REALLY MY PLEASURE TO INTRODUCE DR. ELISEO PEREZ-STABLE. AND WITH ALL THESE--HE'S ARRIVED JUST LESS THAN A YEAR AGO AND NOT ONLY HE'S HERE, BUT A WONDERFUL TEAM PLAYER HE BRINGS VISION AND NEW INSIGHTS AND DIRECTIONS TO ALL OF US AND ACTUALLY SHOWS UP EARLY TO SOMEBODY ELSE'S COUNCIL WHICH IS PRETTY IMPRESSIVE AS WELL. HIS RESEARCH INTERESTS WHICH ARE VERY ALIGNED WITH OURS AND SO HE'S HAD SOME PARTNERS IN DENTISTRY IN THE PAST AND FUTURE ARE IN IMPROVING THE HEALTH OF POOR AND MINORITY POPULATIONS INCLUDING RESEARCH ON SMOKING CESSATION AND TOBACCO CONTROL POLICY IN LATINOS AND U.S. AND LATIN AMERICA. ADVANCING PATIENT CENTERED CARE, IMPROVING CROSS CULTURAL COMMUNICATION SKILLS AMONG HEALTHCARE PROFESSIONALS AND PROMOTING DIVERSITY IN THE BIOMEDICAL RESEARCH WORKFORCE. HE CAME TO US FROM THE UNIVERSITY OF CALIFORNIA SAN FRANCISCO, LANGUAGE PATHOLOGISTS WAY AWAY. AND THERE HE WAS THE PROFESSOR OF MEDICINE, CHIEF OF THE DIVISION OF GENERAL INTERNAL MEDICINE AND THE DIRECTOR FOR THE CENTER OF AGING AND DIVERSE COMMUNITIES. HE WAS ALSO THE DIRECTOR OF THE MEDICAL EFFECTIVENESS RESEARCH CENTER FOR DIVERSE POPULATIONS. DR. PEREZ-STABLE EARNED HIS B. A. IN CHEMIST RADIOY FROM THE UNIVERSITY OF MIAMI ALSO HIS MEDICAL DEGREE FROM THE UNIVERSITY AND COMPLETED PRIMARY CARE INTERNAL MEDICINE RESIDENCE SCHERESEARCH FELLOWSHIP AT THE UCSF AND HE WAS ELECTED INTO THE NATIONAL ACADEMY OF MEDICINE IN 2001. SO PLEASE LET'S JOIN HIM IN PROPROVIDING HIS TALK. THANK YOU SO MUCH. >> SO THANK YOU. IT'S AN HONOR TO BE HERE. ORIGE NAWILLLY THIS WAS GOING TO BE THE FIRST COUNCIL I PRESENTED TOO BACK ON MY OWN BACK IN JANUARY BUT THE WEATHER GOT IN THIS THE WAY, SO THIS PRESENTATION HAS EVOLVED SOME SINCE THEN BUT HOPEFULLY, I THINK WE HAVE A LOT OF COMMON GROUND TO SHARE. AS BACKGROUND, I WANT TO START BY REVIEWING NIMHD HISTORY. OUR INSTITUTE IS IN MANY WAYS UNIQUE AT NIH AND IT WAS BORN OUT OF A POLITICAL PROCESS AND NOT A SCIENTIFIC ONE. IT WAS ESTABLISHED AS AN OFFICE UNDER THE NIH DIRECTOR IN 1990. UNDER PRESIDENT BUSH WITH SECRETARY SULLIVAN NAMING JOHN ROUGHIN AT THAT TIME AS THE DIRECTOR IT WAS STRAINSITIONED TO THE CENTER AND MOST IMPORTANT CHANGE IN THE YEAR 2000, CHAMPIONED BY REPRESENTATIVE LEWIS STOKES AND THE CONGRESS AT BLACK CAUCUS AND PART OF THE AFFORDABLE CARE ACT IN 2010 LED BY CENTER KENNED SCHESUBSEQUENTLY CENTER AND DR. RUFFINWAS THE DIRECTOR OF ALL THESE ENTITIES UNTIL HIS RETIREMENT, YVONNE MADDOX BECAME ACTING DIRECTOR AND THEN I STARTED SEPTEMBER 1, LAST YEAR. OUR BUDGET IS 280 MILLION INCLUDING 3.2% INCREASE WE GOT IN DECEMBER. WE ARE THE SECOND SMALLEST INSTITUTE WITH BOTH COMPLIMENTARY MEDICINE AND FOLK ARTY ALSO BEING SMALLER CENTERS IN NURSING BEING THE ONLY IC THAT'S ACTUALLY SMALLER IN BUDGET. OUR MISSION REALLY IS TO FOCUS ON MINORITY AND HEALTH DISPARITIES AND I WANT TO SPEND A COUPLE MINUTES OR EMPHASIZING THE DIFFERENCE. RESEARCH AND MINORITY HEALTH IS DEFINED BY THE GROUPS IN THE CENSUS WHICH WE'LL GO OVER AND THEN CAUSES IN LEADING--IN DEVELOPING INTERVENTIONS TO REDUCE HEALTH DISPARITIES IN SPECIFIC POPULATIONS. WE'RE ALSO VERY COMMITTED TO THE SOCIETAL MANDATE TO DIVERSIFY THE SCIENTIFIC WORKFORCE AS PART OF A BROAD NIH EFFORT EVEN THOUGH WE HAVE LIMITED TRAINING PORTFOLIO IN YOUR INSTITUTE AND LIKE OTHER INSTITUTES WE ARE CONSTANTLY DEALING WITH COMMUNICATION AND COLLABORATION ISSUES. SO MINORITY HEALTH IN OUR OPERATIONAL DEFINITION IS TO LOOK AT DISTINCTIVE HEALTH CHARACTERISTICS THAT ARE ATTRIBUTED TO THE MINORITY OR RACIAL ETHNIC GROUPS IN THE U.S., THIS IS INDEPENDENT OF THE HEALTH OUTCOMES SO IF THE OUTCOMES ARE GOOD OR BETTER THAN THE MAJORITY POPULATION ARE WHITE, THAT IS STILL OF INTEREST TO US. ALL MINORITY GROUPS SHARE A SOCIAL DISADVANTAGE OF BEING SUBJECT TO DISCRIMINATION AS A COMMON THEME. THIS IS TRUE FOR ALL CURRENT GROUPS. IT IS NOT ALL EQUAL. THE HISTORICAL LEGACY OF SLAVERY IN THE UNITED STATES IS RATHER UNIQUE ON GLOBAL HISTORY AS FAR AS WE UNDERSTAND. THERE IS ALSO THE HISTORY OF THE AMERICAN INDIANS BEING SUBJECTED TO SYSTEMATIC ELIM NATION DURING A LARGE PART OF THE LAST SEVERAL CENTURIES. BUT THAT ASIDE, ALL GROUPS HAVE BEEN SUBJECT TO SOME FORM OF DISCRIMINATION AS WE SEE VERY MUCH SO IN CURRENT EVENTS. INDEPENDENT OF THAT MINORITIES HAVE BEEN UNDERREPRESENTED SYSTEMATICALLY IN ALL BIOMEDICAL RESEARCH, THIS IS TRUE OF ALL GROUPS AND MOST EVER UNDERREPRESENTED IN THE SCIENTIFIC WORKFORCE AND THESE ARE ALL IMPORTANT ISSUES AND THEY'RE DISTINCT FROM MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH. THIS IS THE OMB STANDARD. I THINK MOST OF YOU ARE FAMILIAR WITH THIS, AFRICAN--THIS IS THE TERMINOLOGY USED BY THE OFFICE OF MANAGEMENT AND BUDGET. AFRICAN AMERICAN ARE BLAY, ASIAN, HETEROGENEOUS GROUP REPRESENTED OVER 30 COUNTRIES AND DOZENS MORE LANGUAGES, AND THE AMERICAN INDIAN OR ALASKA NATIVE POPULATION, NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER AND I WOULD EMPHASIZE THIS IS DISTINCT FROM ASIAN. WE FREQUENTLY ASIAN AND PACIFIC ISLANDER LUMPED TOGETHER AND CONFUSED. THEY ARE NOT ONE GROUP AND THEY SHOULD NOT BE LUMPED TOGETHER. AND THEN LATINO OR HISPANIC, I AM LATINO IT IS TECH IN IICALLY AN ETHNICITY, REPRESENTS 20 COUNTRIES IN THE AMERICAS AND IT'S A MIXED POPULATION. I HAVE HEARD FROM FOLKS AT THE CENSUS THAT THEY ARE PLANNING TO CHANGE--PROPOTENT STATING TO CHANGES FOR 2020, ONE IS TO GO BACK TO ONE QUESTION, SOME OF YOU MAY KNOW THAT FOR LAST TWO CENSUS, THE QUESTIONS HAVE BEEN SEPARATED SO THEY'RE FIRST ASKING ARE YOU LATINO OR HISPANIC AND THEN THEY ASK, RACE. TURNS OUT THAT 40% OF LATINOS DON'T KNOW HOW TO RESPOND TO THE RACE QUESTION, THEY PUT OTHER OR LEAVE IT BLANK SO THEY DON'T REALLY GET IT. UNDERSTAND THEY SAY--WELL WE TOLD YOU WE ARE LATINOS, WHY ARE YOU ASKING ME AGAIN AND THAT KIND OF THING. SO I THINK THEY WILL ROLL IT INTO ONE ON AND SAY RACE OR ETHNICITY. THEY'RE PROPOSING ADDING ANOTHER ETHNIC GROUP OF NORTH AFRICAN MIDDLE EASTERN AS THEY FEEL LEFT OUT OF THE CURRENT CATEGORIES AND INCREASING NUMBER IN THE U.S. THE WHETHER OR NOT THESE ARE APPROVED WILL DEPEND ON THE--I THINK CONGRESSIONAL PROCESS. SO HEALTH DISPARITY POPULATIONS THEN INCLUDE THE RACE ETHNIC MINORITY GROUPS, PERSONS OF LOW SOCIOECONOMIC STATUS WHETHER WE DEFINE USING INCOME OR MORE COMMONLY IN RESEARCH USING FORMAL YEARS OF EDUCATION OR OTHER METRICS AND UNDERSERVED RESIDENTS. THESE ARE PART OF OUR MANDATE. THE THERE ARE OTHER POPULATIONS THAT MAY BE SUBJECT TO DISCRIMINATION WHO MAY HAVE AS A CONSEQUENCE OF THAT POORER HEALTH OUTCOMES, ATTRIBUTED TO THE SOCIAL DISADVANTAGE AND THEN BEING UNDERSERVED IN THE SPECTRUM OF HEALTHCARE. FELT THE GROUP THAT IS MOST IN DISCUSSION RIGHT NOW THOUGH NOT YET PROCESSED THROUGH THE DEPARTMENT I SHOULD SAY ARE SEXUAL GENDER MINORITIES AND THAT IS AN ONGOING CONVERSATION BETWEEN NIH AND WANT DEPARTMENT OF HEALTH AND HUMAN SERVICES. THE AGENCY FOR HEALTH CARE RESEARCH AND QUALITY ALSO HAS SOME CONGRESSIONAL LANGUAGE THAT REQUESTS THAT THEY PAY ATTENTION TO DISPARITY POPULATIONS IN FACT, THE DIRECTOR OF HRQ, RECENTLY NAMED ANDREW BINEMAN AND I ARE SUPPOSED TO COLLABORATE ON MAKE THANKSGIVING DECISION ALTHOUGH I'M SURE FRANCIS COLLYNNS AND THE SECRETARY WILL NOT JUST LET THAT HAPPEN SPONTANEOUSLY. BE THAT AS IT MAY, THESE ARE THE LISTS OF PRYERITY POPULATIONS BY ARC, I EMPHASIZE THE TERM PRIORITY BECAUSE THERE'S AGAIN SOME LEGISLATION THAT REQUESTS THAT THEY PAY ATTENTION TO THIS POPULATION. THEY ARE NOT IDENTIFYING THESE AS DISPARITIES SO WE'RE NOT IN KONT TRANSLATIONAL RESEARCH DICTION. IF YOU LOOK AT THE LIST OF PRIORITY POPULATIONS IT INCLUDES ALMOST EVERYONE ON IN THE COUNTRY SO IT LEAVES JUST A FEW HEALTHY WHITE MEN, I SUPPOSE WHO ARE EXCLUDED FROM THIS GROUP IF YOU INCLUDE--BUT WE CERTAINLY HAVE COMMON GOALS HERE. IN HEALTH DISPARITIES THEN, IT'S A DIFFERENCE THAT ADVERSELY EFFECTS THE DISADVANTAGED POPULATION AND IT'S BASED ON ONE OR MORE OF THE HEALTH OUTCOMES THAT I'LL GO OVER AND I EMPHASIZE THE DIFFERENCE THAT ADVERSELY EFFECTS THE DISADVANTAGED POPULATION BECAUSE FOR EXAMPLE, WHITE MEN IN THE U.S. HAVE MORE HEART ATTACKS, CONTINUE TO HAVE MORE HEART ATTACK IN 2016 YET THAT'S NOT A DISPARITY, THAT'S A DIFFERENCE AND I JUST WANT TO--THERE ARE OCCASIONALLY SITUATIONS WHERE YOU SEE THAT, THE WORST HEALTH OUTCOMES OR INCIDENCE RATES ARE NOT IN THE GROUP NA'S DISADVANTAGED. OUR SCIENCE THEN WILL BE DEVOTED TO ADVANCING KNOWLEDGE ABOUT HEALTH DETERMINEINANTS AND HOW THESE LEAD TO DISPARITIES ALSO IN RELATIONSHIP TO MINORITY HEALTH, TO MINORITY HEALTH ISSUES. NOW THE OUTCOMES I LIKE TO LIST THAT WE HAVE COME TO SOME PAUSE ON CONCLUSION ON ARE EASY ONES WE CAN COMPARE ACROSS POPULATIONS INCIDENCE AND PREVALENCE. GENERALLY THINKING THEY'RE HIGHER, PREMATURE EXCESSIVE MORTALITY AND DISEASES WHERE POPULATIONS DIFFER, OBVIOUSLY MORTALITY BEING THE ULTIMATE OUTCOME AND THEN SOME GLOBAL MEASURE OF BURDEN OF DISEASE, DISABILITY ADJUSTED TO LIFE HERE USED COMMONLY USE INDEED GLOBAL HEALTH, IT'S A USEFUL METRIC, ALLOWS US TO GET A SENSE OF THE BURDEN OF BACK PAIN FOR EXAMPLE. THAT DOESN'T LEAD TO MORTALITY OR IN THE CASE OF POORER HEALTH, THAT COULD BE A SIMILAR SITUATION. AND THEN ALL METRICS RELATED TO PERSON-PATIENT REPORTED, RELATED TO HEALTH RELATED QUALITY OF LIFE, DAILY FUNCTIONING, SYMPTOMS ET CETERA, USING STANDARDIZED MEASURES WE CAN COMPARE ACROSS GROUPS. AND AS A NOT TOO LONG AGO PRACTICE RESEARCH ITSING PRIMARY CARE PHYSICIANS, WHAT PATIENTS THINK OR FEEL MATTER AND THIS IS WHERE THIS COMES IN THIS. THESE ARE PROCESSES OR CATEGORIES OF RISKS THAT WE GENERALLY FOCUS ON. THERE'S A LOT THAT'S BEEN WRITTEN AND EMPHASIZED ABOUT LIFESTYLE AND STRESS AND ENVIRONMENT AND DEMOGRAPHIC CONDITIONS OR SOCIAL CHARACTERISTICS, ISSUES AROUND TRAUMA, CHILDHOOD TRAUMA AS WELL. THE EXPLOSION IN SCIENTIFIC INFORMATION FROM THE LABORATORY BOTH IN GENETICS AND OTHER METABOLIC PROCESSES I THINK HAVE LED TO A LOT OF NEW INFORMATION ABOUT HOW THINGS THAT WE HAVE CLASSICALLY CATEGORIZED AS SOCIAL DETERMINANTS WERE ENVIRONMENTAL EFFECTS OR BEHAVIOR ARE REFLECT INDEED PHYSIOLOGICAL AND BIOLOGICAL PROCESSES WHETHER THAT I BE EPIGENETIC METABOLIC PATHWAYS, LEADING TO FASTER PROGRESSION AND GREATER SEVERITY AND AGAIN THIS IS AN AREA OF ACTIVE INTEREST FOR OUR INSTITUTE. I'M VERY INTERESTED IN EMPHASIZING DISPARITIES AND MINORITY HEALTH IN THE HEALTHCARE SETTING. AND THAT MEANS DIFFERENTIAL TREATMENTS, COMMUNICATION BETWEEN PATIENT AND DOCTOR AND CLINICIANS AND PATIENTS, ADVERSE EVENTS AND MEDICATIONS, OTHER CONDITION THAT IS DO NOT EASILY FALL UNDER A DISEASE CATEGORY SUCH AS FALLS OR PROGRESS OF DISEASE FROM ONE STAGE TO ANOTHER. EVEN THOUGH DIAGNOSIS DOESN'T CHANGE AND THEN ALL THINGS RELATED TO UTILIZATION OF CARE WHICH LINKS US CLOSELY THEN TO THE HEALTHCARE SYSTEM AS IT IS EVOLVING QUICKLY. UNDER BOTH THE EXPANDED ACCESS TO INSURANCE OR TO HEALTHCARE FOR AMERICANS AS WELL AS THE TRANSFORMATION OF THE MEDICAL RECORD FROM PAPER TO ELECTRONIC WHICH WE'RE IN THE MIDST OF AND BEING TRAUMATIC FOR THE CLINICIANS AS WELL AS, IT'S JUST A NEW ERA AND I THINK WE NEED TO BE ON TOP OF THAT AND HOW IT EFFECTS DISPARITIES HOW WE DO RESEARCH AND THERE ARE A NUMBER OF ISSUES AROUND APPROPRIATE USE OF SERVICES, ABUSE OF SERVICES, SCREENING, HOSPITALIZATION, READMISSIONS, PRIMARY CARE, EMERGENCY ROOM AND THE ALL-IMPORTANT END OF LIFE CARE WHICH IS GENERALLY NOT EMPHASIZED IN MOST OF OUR RESEARCH TOPICS. THIS PARTICULAR CATEGORY HAS THE ADDED IMPORTANCE OF BEING LINKED TO PAIRS AND THINGS LIKE CMS, AND ALLOWS US THEN TO IMPACT HOW PEOPLE ARE CARED FOR. I LIKE TO USE A COUPLE OF SIMPLE DIAGRAMS TO ILLUSTRATE SORT OF OUR MISSION AROUND MINORITY HEALTH AND HEALTH DISPARITIES. THEY DO EXPLAIN INDEPENDENT VARIANCE BUT HAVE A SIGNIFICANT OVERLAP. SIMILARLY WITH RACE ETHNICITY AS DEMOGRAPHIC CHARACTERISTIC IN THE U.S. AND SOCIAL CLASS OR SOCIOECONOMIC STATUS AS BEING IMPORTANT, NOT ENTIRELY ONE DOMINATING THE OTHER BUT EXPLAINING OVERLAPPING VARIANTS BUT HAVING MUTUALLY INDEPENDENT VARIANTS THAT THEY EXPLAIN. OUR SCIENTIFIC STAFF DEVELOPED THIS FRAMEWORK BASED IN PART ON A FRAMEWORK THAT WE PUBLISHED OUT OF THE NIA, WITH CARL HILL MARIE BERNARD AND NORM ANDERSON LAST YEAR LOOKING AT AGING RESEARCH IN HEALTH DISPARITIES, THIS TENDED TO GRAVITATE TOWARDS THE MORE GENERIC PERSPECTIVE AND TRY TO CAPTURE THE DOMAINS OF THE HEALTH DETERMINANTS OR FACTORS IN BOTH BIOLOGICAL AND BEHAVIORIAL ASPECTS OF THE INDIVIDUAL AS WELL AS ENVIRONMENTAL INFLUENCE AND AS THESE RELATE TO THE HEALTHCARE SYSTEM AND LEAD TO DIFFERENT YALE HEALTH CARE OUTCOMES AND CAPTURE THE LEVEL OF INFLUENCE THAT INCLUDE THE INDIVIDUAL BOTH IN TERMS OF BIOLOGY AND BEHAVIOR AGAIN AND HOW WE INTERACT WITH HEALTHCARE SYSTEM IN OUR ENVIRONMENT. THE INTERPERSONAL HOW WE DEAL WITH FAMILY WHERE A VARIETY OF OTHER FACTORS COME INTO PLAY, PARTICULARLY THE FAMILY OF THE MICROBIOME, I THINK THE AREA OF GREAT INTEREST PLASTICITY OF THE BRAIN IN EARLY CHILDHOOD DEVELOPMENT AND IN ADULTS AS WELL. ADVERSE CHILD EVENTS AND HOW THIS EFFECTS ADULT DISEASE. AND THEN THE COMMUNITY IN SOCIETAL WHERE WE UNDERSTAND HOW IMPORTANT PLACE IS, IN LEADING TO HEALTH, MOST OF YOU PROBABLY HEARD ABOUT THE RECENT PUBLICATION IN JAMA THAT ILLUSTRATED THAT AMONG THE POOREST AMERICANS THOSE WHO LIVED IN THE CITY OF BIRMINGHAM LIVED THREE YEARS LONGER THAN THOSE WHO LIVE IN THE CITY OF DETROIT. AND THESE ARE ALL IN THE LOWEST GROUP OF POVERTY SO SOMETHING IS BEING DONE CORRECTLY AND SOME URBAN ENVIRONMENTS LEFT-SIDE TO BETTER LIFE SPAN FOR POOR PEOPLE AND ALTHOUGH THE GAP CONTINUES TO BE LARGE BETWEEN THE POOREST AND THE WEALTHIEST FOR BOTH MEN AND WOMEN, I THINK THE IMPORTANCE OF PLACE IS I THINK SOMETHING THAT IS REALLY DRIVEN HOME BY THAT, BY THOSE DATA. AND THEN POLICIES AND SOCIETY AND HOW THAT CHANGES AND EVOLVES AND LEADS TO CHANGES IN POPULATION OF HEALTH, SOME THINGS WILL EVOLVE WITH POLICY CHANGES AND GENERAL CHANGES, OTHERS DEPEND ON OTHER DIFFERENCES. I WANT TO EMPHASIZE THE DIFFERENCE BETWEEN WHAT WE LABEL INCLUSION AND MINORITY HEALTH. THERE HAS BEEN SOME CONFUSION AT NIH ABOUT THIS OVERTHE LAST DECADE, SO WE HOPE TO CLARIFY THIS WITH THIS OPERATIONAL DEFINITION, THERE ARE MANY CLINICAL STUDIES THAT SET THE TARGET TO SAY WE'RE GOING TO RECRUIT X NUMBER OF MINORITIES INTO OUR STUDY, AND FOR MANY YEARS THESE HAVE BEEN LABELED AS MINORITY HEALTH AND WERE THEY ARE NOT. THEY ARE ASKING GENERIC QUESTIONS THAT ARE RELEVANT TO SCIENTIFIC FIELD BUT ARE NOT SPECIFIC TO MINORITIES, MANY TIMES THE INVESTIGATORS DO NOT FULFILL THEIR GOALS OF HOW MANY MINORITIES THEY ARE RECRUITING AND THAT'S A SEPARATE ISSUE THAT INVOLVES OUR CONCERN ABOUT INCLUES OF MINORITIES IN STUDIES BUT THAT'S INCLUSION AND NOT MINORITY HEALTH. INCLUSION IS A MATTER OF GOOD SCIENCE, SOCIAL JUSTICE, COMMON SENSE REMINDING US THAT ALMOST 40% OF THE U.S. POPULATION IN TWO THIS HAPPENED 16 SELF-IDENTIFIED IN ONE OF THE MINORITY GROUPS THAT I LISTED EARLIER. RELATED BUT SEPARATE IS THE BIOMEDICAL WORKFORCE DIVERSITY, THIS IS AN URGENT SOCIETAL ISSUE FOR BOTH THE CLINICAL ARENA AND SCIENTISTS, ABOUT 10-12% OF PHYSICIANS GRADUATING IN 2015 WERE EITHER AFRICAN AMERICAN OR LATINO AND THEN THROW IN AMERICAN INDIAN AND PACIFIC ISLANDER SINCE THOAR THEY'RE SO SMALL MAY DON'T MAKE A BIG DIFFERENCE IN THE TOTAL NUMBER OF THE NUMBER. THIS EPIRESENTATION IS WORSE AMONG SCIENTISTS. FIVE% SUBMITTED GRANTS AT NIH BY BLACK OR LATINO PIs, AGAIN AMERICAN INDIAN PACIFIC ISLANDERS ADD A BIT TO THAT. ASIANS ARE NOT URPD REPRESENTED IN EITHER OF THESE AS A CATEGORICAL GROUP BUT ARE AS YOU LOOK SEPARATELY IN THE HETEROGENEITY OF THE ASIANS, FILIPINOS AND SOUTHEAST ASIANS AND. ABOUT 40% ARE LED BY LATINO OR BLACK INVESTIGATORS IN 2000--IF FISCAL 2015. I WOULD THINK THAT WE DO NOT WANT TO LET OTHER 15-20 YEARS WITH THIS GAP CONTINUING TO GROW AND THIS IS A SOCIETAL ISSUE THAT MANDATES OUR ATTENTION WITH ALL THE BARRIERS THAT EXIST. THESE ARE DATA FROM NIMHD COMPARED TO ALL OF NIH, YOU CAN SEE THAT IN OUR INSTITUTE, ABOUT, NOT QUITE 20% OF OUR PRINCIPLE INVESTIGATORS ARE AFRICAN AMERICAN OR BLACK, AND ABOUT THE LATINO ASPANNIC GROUP IS A LITTLE LESS THAN 13% COMPARED TO THE REST OF NIH WHERE IT ALSO INCLUDES OUR DATA BECAUSE SOME OF OUR PIs OF COURSE ARE PIs IN OTHER INSTITUTES AS WELL. IN THINKING ABOUT PRESENTING TO THIS COUNCIL, I THOUGHT WELL WHAT ARE ISSUES THAT WE SHARE ORAL HEALTH DISPARITIES, AND SOME OF IT WAS DONE BY JUST MY AWARENESS OF SOME OF THE TOPICS AS WELL AS LOOKING AT OUR PORTFOLIO AND TALKING TO MARFA. SO CLEARLY A HUGE ONE IS CARIES PREVENTION AND FLUORIDE VARNISH. IN IS IN THE AREA OF WE KNOW WAWE NODE TO DO, WE JUST NEED TO DO IT. OPPOSE TO RESEARCH, IMPLEMENTATION RESEARCH, WE KNOW IT'S GETTING DONE WHEN WE SEA THAT MINORITY RULE AND POOR CHILDREN HAVE DENTAL DECAY BECAUSE OF A LACK OF ACCESS, ALTHOUGH THIS HAS IMPROVE INDEED SOME REGIONS THIS IS WHERE THE DISCORDANCE IS, WE HAVE THIS DRAMATIC SITUATION OF POOR ACCESS AND DENTAL DECAY. UNTREATED PERIODONTAL DISEASE AND EXTRACTIONS WITH LOW ACCESS THIS, IS AMONG ADULTS, TWO ROOT CAPPAL TREATMENTS BECAUSE OF FINANCIAL BARRIERS AND THERE IS THE PLAUSIBLE ASSOCIATION BETWEEN PERIODONTAL DISEASE AND VASCULAR EVENTS AND POSSIBLY CKD OF WHICH ARE THERE RESEARCH GRANTS LOOKING AT THESE QUESTIONS. WE HAVE SEVERAL GRANTS THAT OVERLAP WITH ORAL HEALTH ISSUES. WHEN I LOOK AT THIS EARLIER THIS YEAR, THERE ARE A COUPLE OF OUR PROGRAMS THAT ARE FOCUSED ON TRAINING DENTISTS Ph.D. PROGRAM AT [INDISCERNIBLE], WITH FOCUS OF AFRICAN AMERICANS AT [INDISCERNIBLE]. AND PUERTO RICO THERE'S AN ENDOWMENT GRANT THERE'S RESEARCH TRAINING IN ACTIVE ENGAGEMENT BY DOCTORAL STUDENTS IN DENTISTRY. THERE ARE OTHER STUDIES THAT HAVE LOOKED AT DENTAL BIOLOGICS FOR UNDERSERVED THIS IS RELATED TO OUR SMALL BUSINESS PROGRAM AND IN THE U24 GRANT, RURAL SCHOOL BASED PREVENTION PROGRAM EFFECTIVENESS OF THAT AND THEN AS MENTIONED THE REGARDS STUDY A LARGE COHORT BEING CONDUCTED IN APPROXIMATE THE DEEP SOUTH AS A ANCILLARY RO-ONE EFFECTIVE TREATING PERIO DON'TAL DISEASE ON MEDIATING VARIABLES OF STROKES--IN STROKE SURVIVORS OF ABNORMAL GLUCOSE TOLERANCELER O CHLOROTIC DISEASE, AND LOOKING AT THICKENING OF THE CAROTID AS WELL AS BLOOD PRESSURE, LIPID AND C-REACTIVE PROTEIN IN STROKE SURVIVORS. SO JUST TO SUMMARIZE THEN OUR PRIORITY IS TO EMPHASIZE THE SCIENCE OF HEALTH DISPARITIES IN MINORITY HEALTH. CREATING DISTINCTION BETWEEN THE TWO. THE METHODS WILL BE THE SAME. THE FRAMEWORK ASPECT WE PRESENTED PER THE SAME. WE'RE INTERESTED IN THIS GOOD OUTCOMES, RESILIENCE, WHY DO CERTAIN GROUPS DO BETTER EVEN THOUGH THE PUBLIC HEALTH PARADIGM OR SOCIAL PARADIGM SAYS THEY SHOULD DO WORSE, THEY HAVE WORSE EDUCATION, LESS INCOME, SOCIAL CONDITIONS ARE LESS, YET THEY HAVE LOWER RATES OF VASCULAR DISEASE AND CANCER. AND I THINK THIS IS IMPORTANT FOR ADVANCING KNOWLEDGE. ESTABLISHING WITHIN OUR IC, A HEALTH SERVICES RESEARCH AND RESEARCH IN CLINICAL SETTINGS PROGRAM AND WE HAVE ORGANIZED IN THE THREE BRANCHES WHERE THIS IS ONE OF THEM. WE WANT TO EMPHASIZE POPULATION AND CONTINUE TO EMPHASIZE COMMUNITY HEALTH WHICH HAS BEEN A STRONG ASPECT OF NIMHD. WE WANT TO BALANCE OUR PORTFOLIO OF A HEAVY EMPHASIS ON CENTERS, OVER THE FIRST 15 YEARS OF THE CENTER AND INSTITUTE EXISTENCE TO HAVE A GREATER PROPORTION OF RO-1 INVESTIGATOR INITIATED RESEARCH, AND WE CONTINUE TO PROMOTE DIVERSITY IN THE WORKFORCE. WE'VE REORGANIZED OUR SCIENTIFIC DIVISION INTO THREE BRANCHES. IT'S STILL AN EVOLUTION, AS WE'RE RECRUITING PROGRAM OFFICERS AND A BRANCH CHIEF AND AS WE GO FORWARD, I THINK OVER THE NEXT ONE-TWO YEARS THIS WILL TAKE MORE HOLD IN A PATTERN MORE SIMILAR TO OTHER INSTITUTES. WE HAVE CLEARED A NUMBER OF NEW RESEARCH AREAS. FIRST, THE HIV CARE IN THE TREATMENT CASCADE OF CHILDREN AND/OR YOUTH IN YOUNG ADULTS. THIS WILL BE RO-1S AND R21S, NOT CENTERS. THESE HAVE BEEN CLEARED BY FEBRUARY COUNCILOT FOAs ARE IN PROCESS OF BEING FINALIZED. WE WILL HAVE AN ANNOUNCEMENT ON HEALTH DISPARITIES AMONG IMMIGRANT POPULATIONS BOTH FROM AN ETIOLOGIC MECHANISM TO INTERVENTIONS AND FOCUSING ON EVERYTHING FROM BIOLOGY TO COMMUNITY: A PROGRAM ANNOUNCEMENT ON DISPARITIES AND SURGICAL CARE AND OUTCOMES WHICH IS ALREADY BEEN SUBSCRIBED BY A COUPLE OF OTHER INSTITUTES AND THE AMERICAN COLLEGE OF SURGERY HAD BEEN VERY ENTHUSIASTIC ABOUT THIS IS A PRODUCT OF A WORKSHOP THAT WAS HELD ABOUT A YEAR AGO, IN CONJUNCTION WITH THE AMERICAN COLLEGE OF SURGERY AND LED AT THAT TIME BY YVONNE MADDOX AS ACTING DIRECTOR AND IRENE NOLAN, AGAIN SOCIAL EPIGENERATED ORDER OF MICRONSICS FOR MINORITY HEALTH AND HEALTH DISPARITIES, AGAIN LOOKING AT THING AS A RESULT OF STRESS, ENVIRONMENTAL OR BEHAVIORIAL FACTORS AND WE HAVE PUBLISHED A HEALTH RESEARCH FOA ON MINORITY HEALTH AND HEALTH DISPARITIES. THIS WAS PREVENTIVE ONIOUSLY A RFA, ABOUT SIX RO-1S WERE FUNDED BY I WOULD LIKE TO CONTINUE TO STIMULATE THE INVESTIGATORS TO SUBMIT THIS KIND OF GRANT. SO WE REISSUED IT AS A PROGRAM ANNOUNCEMENT AND TOOK SORT OF SOME OF THE LANGUAGE OUT OF IT TO FOCUS IT MORE ON HEALTH SERVICES RESEARCH. WE'RE ALSO UNDERGOING A SERIES OF WORKSHOPS. WE COMPLETED AS OF LASTS WEEK OUR VISIONING WORKSHOPS, I THINK THEY WERE SUCCESSFUL, WE HAVE TO BRING THIS TO CONCLUSION WITH PRODUCTS. WE HAD A MEETING IN ONE OF THESE ROOMS IN APRIL ON MEASUREMENT AND METHODS, AND LAST WEEK ON ETIOLOGIES AND INTERVENTIONS, WE BROUGHT IN EXTRAMURAL SCIENTISTS, A LOT OF NIH PARTNERS PARTICIPATED TO REVISIT ISSUES THAT WERE RELATED TO THE SCIENTIFIC VISIONING. THIS IS A PROCESS THAT AGAIN DR. MADDOX LAUNCHED TWO YEARS AGO WHEN SHE BECAME ACTING DIRECTOR AND WE WANT TO SEE IT COME TO A CONCLUSION AS WE MOVE FORWARD. AND THAT PROPOSED THREE ADDITIONAL SCIENTIFIC WORKSHOPS THAT ARE AT DIFFERENT STAGES OF DEVELOPMENT, ONE IS ON INFORMATION TECHNOLOGY AND MINORITY HEALTH AND HEALTH DISPARITIES AGAIN TO REVIEW THE ISSUES ON WHAT WE SHOULD BE FOCUSED ON IN THE HEALTHCARE SETTING AS WE HAVE TRANSFORMED 90% OF HOSPITALS, OVER 90% ON ELECTRONIC MEDICAL HEALTH RECORD, THOSE WHO GO SEE A PHYSICIAN OR CLINICIAN NOT A DENTIST WILL FIND THAT SOMETHING LIKE 85% OF MEDICAL PRACTICE IN THE U.S. HAVE TRANSFORMED TO ELECTRONIC RECORDS, SO THIS IS A CHANGE THAT HAS HAPPENS AND WHAT DOES THIS MEAN TO HEALTH DISPARITIES AND MINORITY HEALTH? THIS IS AN AREA THAT DESERVES ATTENTION BUT I'M NOT SURE WHAT THE QUESTIONS ARE. AND ARRIVING HERE I FOUND THAT THERE'S DEBATE ABOUT THE PHENOTYPE GENO TYPE ISSUE I GATHER THAT THERE WAS 10 OR 11 YEARS AGO THAT THERE WAS A WORKSHOP THAT WAS BIOLOGICAL IN ITS PERSPECTIVE AND WE WANT TO PARTNER WITH GENOME ON THIS AND HAVE A SESSION IN OCTOBER AND TENTATIVE DATE, SOMETIME IN OCTOBER OF THE CONCEPT OF SELF-IDENTIFIED RACE ETHNICITY AND THE USE OF ANCESTRAL MARKERS IN GENOMIC AND BIOMEDICAL RESEARCH AND BRINGING SOCIAL SCIENCE OF DEMOGRAPHERS AS WELL AS GENETICIST AND TO THE TABLE TO HAVE THIS CONVERSATION ABOUT THIS AND SEE WHERE WE CAN TAKE SEE IF WE CAN TAKE ANAL IS AND POSITION ON IT. AND ONE OF OUR SCIENTISTS WANTED TO BRING UP THE ISSUE OF STRUCTURAL RACISM I THINK THIS IS WORTH LOOKING AT SCIENTIFIC EVIDENCE ABOUT THIS. ALSO IN THE REVERSE OF THIS WHICH IS CULTURAL COMPETENCE IN THE HEALTHCARE SETTING, I'VE CONSIDERED THESE MORE SYSTEM CONSTRUCTS AS OPPOSE TO OPERATION AT RESEARCH CONSTRUCTS BUT I THINK IT'S TIME THAT WE COULD LOOK AT THIS SYSTEMATICALLY AND THE OFFICE OF MINORITY HEALTH IS VERY INTERESTED IN THIS PARTICULAR TOPIC SO I THINK WE CAN PARTNER WITH THEM ON THIS ONE. , FINALLY WE HAVE PLANNED, WE HAVE SCHEDULED AND APPLICATIONS OPEN FOR A HEALTH DISPARITIES RESEARCH INSTITUTE. THIS IS IT A CHANGE FROM THE RECENT TIME IN THE LAST FIVE YEARS NIMHC HAS SPONSORED A COURSE THAT IS OPEN ALTHOUGH YOU HAVE TO APPLY FOR IT. IT WAS TWO WEEKS AND IT WAS ESSENTIALLY HEALTH DISPARITIES 101 THROUGH WHATEVER. AND THE FOCUS HERE IS GOING TO BE ON SENIOR POST DOCS AND EARLY STAGE INVESTIGATORS, ASSISTANT PROFESSORS TO GIVE THEM MORE INDEPTH PERSPECTIVE ON SELECTED TOPICS, NOT A COMPREHENSIVE AND OPPORTUNITY TO NETWORK WITH OUR SCIENTISTS AS WELL AS OTHERS AT NIH. WE'RE INTERESTED IN DISPARITIES BOTH FROM INTRAMURAL PROGRAM AS WELL AS EXTRAMURAL SCIENTISTS. AND IT'LL BE ONE WEEK AND WE WILL PROVIDE SOME FINANCIAL SUPPORT FOR THE APPLICANTS. MY GOAL IS TO HAVE NO MORE THAN 50 ABOUT I'LL BE FINE WITH FEWER IN THE PAST WE HAD ABOUT A HUNDRED PEOPLE COME TO OUR COURSE AND I THINK THAT THIS WILL BE A SLIGHTLY DIFFERENT FLAVOR. SO I HAVE ONE MORE SLIDE, SO NHHC HAS TWO% ALGO LOCATED INTRAMURAL AND AS MARFA CAN RELATE TO YOU, A LOT GOES INTO TAXES, WE CALL IT TAPS AROUND HERE. I DISCOVERED ALL THIS AS I GOT HERE BUT THAT SAID I AM EXCITED ABOUT DEVELOPING AN INTRAMURAL PROGRAM AS AN OPPORTUNITY BECAUSE OF THE WAY THINGS DEVELOPED. WE HAVE SPACE WHICH IS ALWAYS IMPORTANT CURRENCY ANYWHERE, NIH AS WELL AS ACADEMICS AND TED GOAL WILL BE TO DEVELOP A POPULATION SCIENCE PROGRAM AND I'M CURRENTLY RECRUITING FOR SCIENTIFIC DIRECTOR AND IMMEDIATELY THEREAFTER SENIOR SCIENTIST, THE APPLICATION ACTUALLY THE ANNOUNCEMENT IS OUT, THERE'S A--GREAT SEARCH COMMITTEE PUT TOGETHER FOR THIS AND THIS IS SORT OF THE KIND OF PHENOTYPE SCIENTISTS THAT I'M LOOKING FOR. WE'RE NOT GOING TO DO BASIC SCIENCE IN THE INTRAMURAL PROGRAM BUT WE WILL OBVIOUSLY COLLABORATE WITH OTHERS. AND THEN WHAT THE NEW--WHAT WHAT WE WILL WILL DEPENDOT SCIENTIFIC DIRECTOR IS A NEW COHORT OF SOME SORT. WE'VE ALSO BEEN WORKING WITH OTHER INSTITUTES WITH SIMILAR INTEREST, WE HAVE ESTABLISHED AFFILIATION WITH NIDDK, IN, CI, THE ACTING DIRECTOR OF SCIENTIFIC PROGRAM NOW IS ACTING SCIENTIFIC DIRECTOR IS AN NCI INVESTIGATOR. NATIONAL INSTITUTE ON AGING AS WELL AS CHILD HEALTH BY SUPPORTING EITHER A JUNIOR PERSON WE RECRUITED THROUGH RESOURCES OF THE OTHER INSITUDES OR THE STEDMAN OR AFFILIATING WITH ESTABLISHED INTRAMURAL SCIENTISTS IN THOSE INSTITUTESS. AND I SORT OF CREATE A NETWORK OF DISPARITIES ORIENTED INTRAMURAL SCIENTISTS, HOLD A MONTHLY SEMINAR AND GET TRACTION ON THIS TOPIC IN THE INTRAMURAL PROGRAM WHICH WILL ALSO I THINK HELP WITH DIVERSIFICATION OF SCIENTISTS. SO WITH THAT I'LL STOP AND BE HAPPY TO ANSWER QUESTIONS OR YOUR COMMENTS. THANK YOU. [ APPLAUSE ] >> SO WE DO OPEN IT UP FOR QUESTIONS BUT YOU CAN SEE IT'S VERY APPROPRIATE THAT YOU'RE HERE AT THE NINE MONTHS BECAUSE YOU'VE JUST GIVEN BIRTH TO A WONDERFUL BUNCH OF NEW ACTIVITIES SO I'M SURE THERE'S ACTIVE DISCUSSION, SO PLEASE ASK QUESTIONS. COUNCIL FIRST? >> HI, TRACEY WITH THE [INDISCERNIBLE] FOUNDATION. QUICK QUESTION: WHERE DO YOU SEE PEOPLE LIVING WITH RARE DISEASES IN THE DISPARITY? LANDSCAPE? IS IT THE MEDICALLY UNDERSERVED OR WHERE DO YOU SEE THAT? >> THAT'S A GREAT QUESTION. AS A CLINICIAN GENERAL INTERNIST WHICH IS MY TRAINING I CERTAINLY HAVE GREAT APPRECIATION FOR ALL KINDS OF ISSUES RELATED TO THAT. I THINK THAT MOST OF WHAT WE FOCUSED ON WITH HEALTH DISPARITIES HA BEEN AROUND SOCIAL DEMOGRAPHIC FACTORS SO, RACE, ETHNICITY AND SOCIOECONOMIC STATUS. HOWEVER, WITHIN--WITH THOSE TWO DRIVERS, THEN THERE'S CLEARLY MANY OTHER CATEGORIES WHERE PEOPLE MAY HAVE BARRIERS AND I THINK, YOU KNOW WOULD BE A MISTAKE TO SAY, WELL, THAT'S NOT A DISEASE THAT THIS GROUPS GETS OR WE DON'T CARE ABOUT IT BUT PEOPLE WITH THIS DISEASE, WE DON'T--WE DO CARE ABOUT IT ONLY IF CHARACTERISTICS A OR B ARE PRESENT. I THINK THAT, YOU KNOW IN A MORE GENERIC WAY, YOU KNOW SOME OF THE ISSUES WE ADDRESS WITH A DISPARITY LENS WILL APPLY TO ANY PATIENT BOTH IN TERMS OF ACCESS, COMMUNICATION WITH YOUR PHYSICIAN, WORSE OR BETTER OUTCOMES DEPENDING ON THEIR CONDITION, BUT OUR LENS IS DRIVEN BY THOSE FIRST TWO FACTORS WITH OTHER VARIATIONS AT LEAST IN DISCUSSION. I THINK THINK IT WOULD OFTEN LEAD BUT NOT ALWAYS, BUT SOMETIMES LEAD TO SOME DISABILITY AND THAT'S ANOTHER GROUP THAT GETS IN THE CONVERSATION ABOUT A DISPARITY POPULATION IN THAT REGARDS IT'S UNDER OUR RADAR. IT'S IN OUR RADAR, I SHOULD SAY. >> THANKS. >> DR.? >> DR. CHAI FROM THE UNIVERSITY OF SOUTHERN CALIFORNIA. AS SOMEONE WHO LIVES IN THE GREATER LOS ANGELES AREA, YOU HEAR A LOT OF DISCUSSION, THERE IS A LACK OF FOCUS ON MINORITY AGING POPULATION IN TERMS OF STUDIES AND ALSO THE TYPE OF NEW APPROACHES THAT CAN HELP THE POPULATION AND IN THE OTHER AREAS OF IMMIGRANT HEALTH, I WONDER IF YOU HAVE NEW PROGRAMS YOU ARE ABOUT TO START THAT ADDRESS THOSE TWO AREAS. >> THE FIRST ONE YOU SAID AGING OR ASIAN. >> MINORITY AGING? >> WELL YOU ASK ABOUT TWO TOPICS VERY CLOSE TO MY OWN RESEARCH. THE NIAA, THE NATIONAL EN--STRATEGIESITUTE ON AGING HAS HAD A PROGRAM FOR THE LAST 20 YEARS ALMOST THAT'S CALLED A RESOURCE CENTERS FOR MINORITY AGING RESEARCH ARE TWO FUNDED IN LOS ANGELES, ONE AT USC, AND ONE AT UCLA, OUR GOAL IN THOSE GRAPT SYSTEM REAL TO DEVELOP INVESTIGATORS FOCUSED ON MINORITY AGING AND TO HELP DIVERSIFY SCIENTIFIC WORKFORCE BY FOCUSING ON MINORITY INVESTIGATORS ALTHOUGH IT'S NOT EXCLUSIVELY THAT. FOR EXAMPLE, THERE ARE--THE INCREASE PROPORTION OF OLDER ADULTS WHO WILL BE MINORITIES, IS PART OF THE REASON FOCUSED ON FOCUS ON IT, AND THE ASSUMPTION THAT EVERYTHING THAT CAN--HAS BEEN LEARNED ABOUT AGING IN THE MAJORITY OR WHOAT POPULATIONS CAN BE APPLICABLE TO ALL THESE GROUPS IS NOT NECESSARILY CORRECT. IN CALIFORNIA ASIAN AMERICANS OR ASIANS ARE ACTUALLY PROPORTIONALLY RIGHT UP THERE IN TERMS OF NUMBER OF ELDERLY IN SAN FRANCISCO, BY EXAMPLE, BY FAR THE MOST COMMON, THE LARGEST GROUP OF OLDER ADULTS ARE ASIAN, PARTICULARLY CHINESE. AMONG LATINOS IT'S NOT THE CASE. IT TENDS STILL TO BE A YOUNG POPULATION THAT IS SLOWLY AGING BUT WE'RE NOT PROPORTIONALLY AS WELL REPRESENTED PEOPLE OVER 65. SO THERE'S A LOT OF INTEREST THE IN THE CULTURAL ISSUES OF FAMILY, SOCIAL NETWORKS, KEEPING PEOPLE AT HOME OR NOT. IF YOU ARE AT HOME, THEN HOW DO THE MULTIPLE GENERATIONS DEAL WITH THAT. AMONG ASIANS IN PARTICULAR, THE CONCEPT OF FILIAL PIETY, AND HOW THAT INFLUENCES THE OLDER GENERATION, YOUNGER GENERATION. PEOPLE HAVE DONE RESEARCH ON THIS. IT HAS BEEN SHOWN THAT FOR LATINOS AND I DON'T KNOW THE DATA FOR OTHER GROUPS THAT THE OLDER ADULTS WHO ARE AT HOME TEND TO HAVE MORE CHRONIC DISEASE BURDEN THAN WHITES, BECAUSE THE ONES WHO END UP GOING TO THE NURSING HOME TEND TO BE SICKER AND THAT'S ALSO OFTEN THE CASE FOR AFRICAN AMERICANS AS WELL. SO THE NUMBER OF INTERSECT OF HEALTHCARE SYSTEM AND SOCIAL, CULTURAL PARADIGMS WILL INTERACT IN A DIFFERENT WAY THAN AMONG THE MAJORITY POPULATION. LET DEAF AND DYING AND PALLIATIVE CARE ARE DIFFERENT. ACCEPTANCE OF DISCUSSING END OF LIFE CARE VARIES ACROSS THE POPULATIONS WHETHER ONE SAYS--ONE IS WILLING TO SAY, DO NOT RESUSCITATE, THESE ARE ALL ISSUES THAT CONCERN FAMILY AND INDIVIDUAL THAT NEED AGAIN MORE IMPERICAL DATA IN A CLINICAL SETTING. THERE ARE SOME AVAILABLE DATA BUT NOT AS MUCH AS WE WOULD LIKE. AND FINALLY THERE ARE DIFFERENCES IN BIOLOGY THERE'S INTRIGUING DATA THAT I'VE BEEN PART OF, ANALYSIS FROM ALZHEIMER'S DISEASE RESEARCH CENTER THAT SHOWED THAT THERE'S NOT ENOUGH ASIANS IN THAT DATA SET THAT LATINOS AND AFRICAN AMERICANS AFTER DIAGNOSIS OF ALZHEIMER'S DISEASE ACTUALLY LIVE LONGER AND YOU COULD NONAPOPTOTIC THE ADJUST IT AWITH HOW LONG HAVE THEY HAD SYMPTOMS. IT'S A CLINICAL DATA SET, 30 DIFFERENT CENTERS BUT ONE COULD SAY, WELL, AND THE FINDINGS WERE MOST ROBUST FOR LATINOS IN BLACK WOMEN AND NOT AS STRONG FOR BLACK MEN AND YET UNPUBLISHED DATA FROM KISER NORTHERN CALIFORNIA SHOWED THAT THE INCIDENCE OF ALZHEIMER'S DISEASE WAS ACTUALLY HIGHER AMONG SOME MINORITY GROUPS AND LOWER AMONG OTHERS IN THE LOWER KISER SET COMPARED TO WHITES BUT AGAIN THERE WAS AN APPARENT MORTALITY ADVANTAGE IN ALL OF THE MINORITY GROUPS. NOW AFRICAN AMERICAN, INDIAN, PACIFIC ISLANDERS ASIANS AND LATINOS COMPARED TO WHITES OVER ABOUT A 15 YEAR PERIOD IN A RETROSPECTIVE COHORT DESIGN WITHIN KISER. NOW AGAIN POTENTIAL FOR ERROR, FOR MYTH CATEGORIZATION, ALL OF WHICH USUALLY BIAS TOWARDS IT IS THE NULL, THE FACT IT THERE'S A FIND THANKSGIVING IS--THAT PAPER IS STILL UNDER REVIEW LED BY ONE OF THE SCHOLARS, ONE OF THEM AT UCSF, AND THE BIG CHALLENGE IN HEALTH IS THE PARADIGM. SO YOU SLEEP APNEA AND OBESITYY THIS WITH LATINOS VERY CHOIRLY AND LESS DATA AGAIN, ASIANS APPEAR TO BE THE CASE. LESS DATA STILL, WHAT ABOUT CARIBBEAN BLACK IMMIGRANTS, WE DON'T KNOW AS MUCH. THEY DO BETTER AND THE REASON IS PROBABLY THAT PEOPLE WHO MIGRATE VOLUNTARILY USUALLY DO SO. THEY HAVE SOME AMOUNT OF RESOURCES AND CERTAIN AMOUNT OF RESILIENCE AND ENERGY THAT PEOPLE WHO STAY BEHIND DON'T. THE REALLY WEALTHY DON'T MIGRATE UNLESS THEY'RE FORCED TO AND THE POOR DISADVANTAGED POPULATIONS DON'T MIGRATE SO SOMETHING ABOUT THE LOWER OR MIDDLE WORKING CLASS AND THANTHROPOLOGYST DESCRIBE THIS IN THE 19th CENTURY WITH EUROPEAN IMMIGRANTS AS WELL. NOW IN THE U.S., LATINA WOMEN, HISPANIC WOMEN HAVE THE LONGEST LIFE EXPECTANCY. NOW HOW DO WE EXPLAIN THAT BECAUSE THE AVERAGE EDUCATIONAL, FORMAL YEARS OF EDUCATION IS LOWER, INCOME IS LOWER, ACCESS TO CARE IS LOWER. IS IT BEHAVIOR? SOME OF IT IS BUT NOT ALL OF IT SO AGAIN THERE'S MORE OBESITY, MORE DIABETES, SO I THINK THAT THERE'S A LOT OF SCIENTIFIC QUESTIONS TO BE ASKED THERE, AND THE ASSUMPTION IS THAT FACTOR A AND FACTOR B ALWAYS LEAD TO C IS NOT ALWAYS THE CASE, IN JUST OF THE SIMPLE CATEGORY OF RACE AND ETHNICITY. SMOKING AND LUNG CANCER IS ANOTHER ONE. WE KNOW THAT BLACKS, AFRICAN AMERICANS HAVE THE HIGHEST RATE OF LUNG CANCER, YET COMPARED TO THE AMOUNT OF SMOKE, INTENSITY OF SMOKING, WHITES, LATINOS, NATIVE--SORRY NOT NATIVE HAWAIIANS JAPANESE AMERICANS ALL HAVE LOWER RATES OF LUNG CANCER FROM THE SAME EXPOSURE. SO KNOWN CARC SIN O GENERATED, KNOWN BAD OUT COME AND THEN THE CONSTRUCT OF WHAT MY RACE ETHNICITY, IS CHANGES THE RISK, RELATIVE RISK IN DATA COLLECTED FROM THE ETHNIC STUDY IN CALIFORNIA AND HAWAII SHOW BIG DIFFERENCES. SO I THINK THERE'S A LOT OF INTERESTING BIOLOGICAL QUESTIONS TO ASK USING THESE POPULATIONS AND THAT WOULD ONLY BE POSSIBLE TO ASK IF YOU REALLY VERTICALLY ENGAGE GROUPS AND SEARCH FOR ANSWERS OR ADDRESS QUESTIONS WITHIN CERTAIN POPULATIONS AND I THINK IMMIGRANTS OFFER A TREMENDOUS OPPORTUNITY TO LOOK AT THE ISSUES OF INDIVIDUAL BEHAVIOR AND BIOLOGY COMPARED TO SOCIAL DETERMINANTS WHEN HAVE YOU HAD POPULATIONS SEPARATED BY, YOU KNOW BECAUSE OF SOME GROUPS WHO MIGRATE AND SOME WHO DIDN'T. SO I THINK--SORRY FOR THE LONG WINDED ANSWER. >> [INDISCERNIBLE]. >> DR. DARVO. >> THANK YOU FOR THE LONG WINDED ANSWER. I WANT TO SEE IF I GOT IT RIGHT, YOU SAID STRUCTURAL RACISM AND CULTURAL COMPETENCE, SO CULTURAL COMPETENCE IS THAT RELATED TO THE AGING THING YOU TALKED ABOUT OR THE WAY CULTURES DO DIFFERENT THINGS WHAT DO YOU MEAN BY THOSE TWO TERMS? >> THANK YOU FOR THAT QUESTION. CULTURAL COMPETENCE IS A COIN THE TERM, SOME PEOPLE ALSO PREFER TO USE THE TERM CULTURAL HUMILITY. THAT THE IDEA IS WHEN SOMEONE WALKS INANCE INSTITUTION, THEY FEEL THAT THEY ARE WELCOME THERE. I THINK IT'S A SYSTEM ISSUE MORE THAN A RESEARCH OPERATIONAL CONSTRUCT OR VARIABLE. SO HAVING LANGUAGE IN--OR SIGNAGE IN MORE THAN ONE LANGUAGE WHEN A SIGNIFICANT NUMBER OF YOUR POPULATION DOESN'T SPEAK ENGLISH, IF YOU COULD WALK INTO THE CLINICAL CENTER FOR EXAMPLE, ALL THE SIGNS ARE IN SPANISH AS WELL AS ENGLISH. IN SAN FRANCISCO THEY TEND TO BE IN MORE THAN TWO LANGUAGES, THEY TEND TO HAVE CHINESE AS WELL. IN SAN FRANCISCO, GENERAL WOULD HAVE SEVERAL. THE COHORT ESTABLISHED IN 2008--BUT THEY WERE REQUIRED TO CONDUCT MAJOR INTERVENTIONAL STUDIES WITH MULTIDISCIPLINARY RESEARCH TEAMS TO SEE IF THIS COULD BE DONE SUCCESSFULLY. WE ALSO ASK THE THREE CENTERS THAT WERE FOCUSED ON EARLY CHILDHOOD CARRIES WITH WORK TOGETHER WITH A COMMON COORDINATING DATA CENTER AND THESE THREE CENTERS AGREED TO DO THIS. THE THEY WERE AT BOSTON UNIVERSITY, UNIVERSITY OF COLORADO DENVER AND UNIVERSITY OF CALIFORNIA SAN FRANCISCO. THEY WERE SUPPORTED BY ONE DATA COORDINATING CENTER AT UCSF AND THEY WERE ASKED TO WORK USING A COMMON DATA ELEMENT SO THAT THEIR RESULTS COULD BE COMPARED EASILY AND BE A DATA SOURCE FOR FUTURE RESEARCH. HOWEVER, WE ALSO HAD A VERY ROBUST RESPONSE FROM OUR RO-1 INVESTIGATOR INITIATED COMMUNITY: THEY HAVE NOT BEEN THE ONLY GROUP TRYING TO COME UP WITH WAYS TO REDUCE ORAL HEALTH DISPARITIES IN THE UNITED STATES AND DR. SOMERE MAN POINTED THIS OUT IN THE HER REVIEW OF THE BUDGET. THIS SLIDE PROVIDES A PATE LIST OF INVESTIGATORS WHO'S BEEN STUDYING THE INFLUENCE OF THINGS LIKE HEALTH LITERACY, GENETICS BURST STATUS AND THE BENEFITS OF INVOLVING THE BROADER MEDICAL COMMUNITY IN ADDRESSING ORAL HEALTH DISPARITIES. AND YOU WILL HEAR FROM ONE OF THESE INVESTIGATORS DR. MARGARITA FONTANA, SO WHAT ARE THESE FINDINGS? SO WE'VE HAD ADVANCES IN CARE SUCH AS FLUORIDE VARNISH, BENEFITS OF PROVISION OF PREVENTATIVE ORAL HEALTHCARE BY MEDICAL PROVIDERS AND BENEFITS OF HAVING PATIENTS RECEIVE ASSISTANCE TO NAVIGATE THE COMPLEX HEALTHCARE SYSTEM AND BOOK,A POINTMENTS. WE ALSO HAD INVESTIGATORS IDENTIFY RISK FACTORS FOR AND MECHANISMS OF DISEASE INCLUDING GENETIC FACTORS, HEALTH LITERACY OF PARENTS, THE ORAL HEALTH BEHAVIOR OF PARENTS, GEOGRAPHIC LOCATION AND ACCESS TO PROVIDERS, DEPRESSION, MICRO BIOTA OF EARLY CHILDHOOD CARRY CARIES, USING THE COHORT THAT DR. GARCIA ESTABLISHED. EATING HABITS OF CHILDREN INCLUDING SNACKING FREQUENCY AND THE TYPES OF SNACKS. HOWEVER, ONE'S HEALTH STATUS IS DETERMINED BY VERY MANY COMPLEX FACTORS AND THIS SLIDE RUTH GAVE ME THAT CAME FROM HEALTHY PEOPLE 2010 AND IT REALLY SHOWS THAT YOU HAVE SEVERAL THINGS INVOLVED IN THE OVERALL HEALTH STATUS OF AN INDIVIDUAL. THE PERSON NOT ONLY HAS TO HAVE THE RIGHT BEHAVIORS AND IN THE CASE OF ORAL HEALTH BUT THERE ARE BIOLOGICAL AND GENETIC FACTORS AND SOCIAL AND ENVIRONMENTAL AND PHYSICAL FACTORS THAT INFLUENCE ONE'S HEALTH STATUS. BUT THEY ALSO HAVE TO HAVE ACCESS TO HEALTH QUALITY OR QUALITY HEALTHCARE. AND SO I WOULD SAY THAT MOST OF NIDCR AND MOST OF NIH GRANTS OR INVESTIGATORS HAVE PRIMARILY FOCUSED ON FACTORS IN THIS YELLOW BOX. INDIVIDUAL FACTORS, BEHAVIOR, GENETICS, OR EVEN AN RCT IS USUALLY DELIVERING A TREATMENT TO A SELECT POPULATION. SO WE CHALLENGE THE COMMUNITY AND WE ASK THEM TO RESPOND TO AN RFA THAT WAS ASKED TO SUPPORT MULTILEVEL RESEARCH AND WITH THAT IN 2015 WE ESTABLISHED THE MULTIDISCIPLINARY COLLABORATIVE RESEARCH CONSORTIUM TO REDUCE ORAL HEALTH DISPARITIES IN CHILDREN. BIG TITLE. THE OVERALL GOAL OF THIS INITIATIVE IS TO ESTABLISH EFFECTIVE INTERVENTIONS OR PROGRAMS TO REDUCE OR ELIMINATE ORAL HEALTH DISPARITIES IN INEQUALITIES IN VULNERABLE U.S. CHILDREN WHO ARE BETWEEN THE AGES OF ZERO AND 21 YEARS OF AGE. THE CONSORTIUM WILL SUPPORT PROJECTS THAT TESTED INTERVENTION OR EVALUATE OUTCOMES OF AN EXISTING PROGRAM, SORT OF A NATURAL EXPERIMENT AND TENDED TO REDUCE ORAL HEALTH DISPARITIES AND INEQUALITIES. EACH PROJECT MUST HAVE A MULTILEVEL INTERVENTION OR ASSESS THE IMPACT OF AN INTERVENTION OR CURRENT PROGRAM ON THREE LEVELS THAT WE KNOW INFLUENCES THE CHILDREN'S ORAL HEALTH. SUCH AS THE INDIVIDUAL LEVEL, THE FAMILY LEVEL, THE HEALTHCARE SYSTEM LEVEL. THE PROJECT VS A DEVELOPMENTAL PHASE, FOLLOWED BY IMPLEMENTATION PHASE AND THE PROJECTS ARE SUPPORTED BY DATA COORDINATING CENTER AND THEY WILL USE COMMON DATA ELEMENTS WHEN POSSIBLE IN THEIR STUDIES. SO I'M NOT GOING TO READ ALL THE INFORMATION ON THIS MAP BUT CERTAINLY, THIS IS THE DISTRIBUTION OF THE PROJECTS THAT HAVE BEEN FUNDED TO DATE. THEY ARE ALL SUPPORTED BY A COMMON COORDINATING CENTER AT UCSF AND YOU WILL HEAR FROM THREE OF THE INVESTIGATORS IN IN NEW CONSORTIUM DR. GARCIA, DR. MICHELLE HENSHAW, AND DR. MOLLY MARTIN IN THIS SESSION. SO WITH THAT OUR FIRST SPEAKER WILL BE DR. MARGHERITA FONTANA, WHO EARNED HER DE. Q. FROM THE SCHOOL OF VENEZUELA AND Ph.D.. SHE CURRENTLY RESIDESSA THE UNIVERSITY OF MICHIGAN SCHOOL OF DENTISTRY, SHE IS THE FIRST PRESIDENT FOR THE HISPANIC DENTAL ASSOCIATION AND HELD MANY POSITIONS IN PROFESSIONAL SOCIETIES. IN 2012 SHE RECEIVED THE PRESIDENTIAL EARLY CAREER AWARD FOR SCIENTISTS IN ENGINEERING THE PC AS,A WARD FOR HER WORK ON CARIES RISK ASSESSMENT AND CHILDREN. HER TOPIC WILL INTERPROFESSIONAL RESEARCH AND PRACTICE ISSUES THE ROLE IN REDUCING DISPARITIES IN CARIES EXPERIENCE. OUR SECOND PRESENTATION WILL COME FROM DOCTORS HENSHAW AND GARCIA, DR. HENSHAW EARNED HER DEGREE FROM THE UNIVERSITY OF CALIFORNIA SAN FRANCISCO AND MASTERS IN HEALTH HEALTH FROM BOSTON UNIVERSITY. SHE IS CURRENTLY A PROFESSOR OF BOSTON UNIVERSITY, HENRY GOLDMAN SCHOOL OF MEDICINE WHERE SHE SERVES AS ASSOCIATE DEAN FOR GLOBAL AND POPULATION HEALTH AND IS THE CO-DIRECTOR OF THE NORTHEAST CENTER FOR RESEARCH TO EVALUATE ELIMINATE DENTAL DISPARITIES. SHE IS A WILLIAM J. GUISE, AWARD NOTIFICATION AND WIDELY RECOGNIZED LEDDER IN DENTAL EDUCATION, SERVICE LEADING AND INTERPROFESSIONAL EDUCATION. DR. GAR A IS AND PROFESSIONAL CHAIR, DEPARTMENT OF HEALTH SCIENCES RESEARCH AND DIRECTOR OF THE NORTHEAST CENTER FOR RESEARCH TO EVALUATE AND ELIMINATE DENTAL DISPARITIES KNOWN AS CREED. BOSTON UNIVERSITY HENRY M. GOLDMAN SCHOOL OF UNIVERSITY, GAR SARSEA HOLDS AER--GARCIA HOLDS A DEGREE IN MEDICAL SCIENCE AND BIOLOGY AND HARVARD SCHOOL OF DENTAL MEDICINE, EARNED NUMEROUS AWARDS AND HONOR THROUGHOUT HIS CAREER INCLUDING RECENT IDEA GUISE AWARD FOR OUTSTANDING DENTAL VISION AND EDUCATION. HIS MAJOR RESEARCH INTEREST FOCUS ON HEALTH SERVICES RESEARCH AND ORAL EPIDEMIOLOGY. WILL AND DR. GARCIA IS ALSO THE CURRENT PRESIDENT-ELECT FOR ASSOCIATION FOR DENTAL RESEARCH AND THEY WILL BE GETTING US A PRESENTATIONOT BOSTON UNIVERSITY CENTER FOR RESEARCH TO EVALUATE AND ELIMINATE DENTAL DISPARITIES AND FINALLY, DR. MOLLY MARTIN WHO IS NEW TO OUR RESEARCH COMMUNITY AS AN NIDCR RECIPIENT. SHE IS AN ASSOCIATE PROFESSOR OF MEDIATE RICKS AND A FELLOW IN THE INSTITUTE FOR HEALTH RESEARCH AND POLICY OF THE UNIVERSITY OF IMPEDIMENTS ELIMINATED CHICAGO. DR. MARTIN IS AN ESTABLISHED LEADER IN THE FIELDS OF BEHAVIORIAL INTERVENTION DESIGN AND TESTING. ESPECIALLY AS THEY RELATE TO COMMUNITY HEALTH WORKERS. SHE IS ALSO ACTIVE IN LOCAL AND NATIONAL POLICY EFFORTS THAT TARGET HEALTH DISPARITIES. AND HER PRESENTATION IS COMMUNITY HEALTH WORKERS IN THE UNITED STATES, PAST, PRESENT AND FUTURE. SO THANK YOU. I WOULD LIKE TO WELCOME DR. FONTACIN, A TO THE PODIUM. [ APPLAUSE ] >> GOOD MORNING. THANK YOU VERY MUCH FOR THE INVITATION TO BE HERE WITH YOU, SHARING THE RESEARCH THAT WE HAVE BEEN DOING WITH NIDCR FUNDING. I CHOSE TO TAKEN--THEYUC TO BUT THE ROLE OF IRPT PROFESSIONAL AT PRACTICE AND RESEARCH AND REDUCING HEALTH DISPARITIES BECAUSE THIS IS AN AREA WE HAVE BEEN VERY INTENSELY WORKING IN THE LAST DECADE. IT FITS NICELY WITH NIDCs CURRENT TRANSLATIONAL RESEARCH STIGIC PLAN, I PUT BOTH GOALS TWO AND THREE OF YOUR CURRENT PLAN AND HIGHLIGHT INDEED BLUE THE AREAS THAT FIT THE PROPOSAL THAT I'M GOING TO DESCRIBE TO YOU WHERE WE'RE LOOKING AT HOW PRECISE AND PERSONALIZE THE HEALTHCARE BY ENGAGING PRIMARY CARE PROVIDER CANS REALLY REDUCE THE HEALTH DISPARITIES WITH THE FUTURE GOALS OF REAL ENGAGING THEN AND RISK BASED MULTIDISCIPLINARY AND MULTILEVEL RESEARCH TO PROMOTE TRANSLATION OF BEST RESEARCH AND TO IMPROVING CLINICAL CARE. SO I'M HOPING BY THE END OF MY 25 MINUTES, I AM HOME TO BE CONVINCE YOU THAT WE'RE IN THE PATH TO ACHIEVE THESE GOALS. SO TARGETED HEALTHCARE WHETHER YOU TALK ABOUT IT OR YOUR FAVORITE WORD PRECISE HEALTHCARE, RISK BASED HEALTHCARE, PERSONALIZED HEALTH CARE IS PARAMOUND IN THE TODAY'S HEALTHCARE SYSTEM BECAUSE OF INCREASING HEALTHCARE COST, RECOURSE CONSTRAINTS BOTH HUMAN AND FINANCIAL, AND THE REALLY THE NEED AND THE DESIRE TO IMPROVE THE QUALITY OF THE CARE THAT WE PROVIDE TO OUR COMMUNITIES. AND THIS IS SPECIALLY TRUE IN THE CASE OF DENTAL CARIES, BECAUSE AS YOU HEARD WITH THE PREVIOUS FABULOUS PRESENTATIONS, THE EXTREMELY LARGE AND PERSISTENT DISPARITIES THAT EXIST IN CARIES DISTRIBUTION AND ACCESS TO CARE IN THIS COUNTRY. PARTICULARLY GROUPS ARE MORE CHALLENGED THAN OTHERS IF YOU THINK ABOUT VERY YOUNG CHILDREN THIS IS A GROUP THAT HAS LARGE ADVANCES PREGARDLESS OF WHAT WE HAVE DONE IN THE MANY LAST DECADE. AND E EXPANDED PARTNERSHIPS WITH THE GROUP THAT I'M FOCUS INDEED BUT CERTAINLY OTHER GROUPS PLAY A RELEVANT ROLE IN THIS. IT'S A PROMISING AND I WOULD ARGUE WITH YOU ABSOLUTELY NECESSARY STRATEGY FOR REDUCING DISPARITIES FOR CARIES, AND THERE'S MANY REASONS FOR THAT AND ONE OF THE MOST OBVIOUS REASONS IF YOU THINK ABOUT YOUNG CHILDREN IN THIS COUNTRY IS THAT CHILDREN HAVE BY FAR, GREATER ACCESS TO MEDICAL CARE AND THE FIRST FEW YEARS OF LIFE THAT THEY WILL EVER HAVE WITH DENTAL CARE, NO MATTER MOW MANY OF OUR DENTAL WORKFORCE WE CAN TRAIN DENTIST AND PEDIATRIC DENTISTS THERE WILL NEVER BE ENOUGH TO COVER AND GIVE ADEQUATE COVERAGE IN THE EARLY YEARS OF LIFE FOR THIS POPULATION GROUP AND IN FACT, WE ARE VERY LUCKY IN IN COUNTRY THAT WE HAVE POLICIES THAT HAVE BEEN PUT IN PLACE, WHERE PHYSICIANS, FAMILY PHYSICIANS, NURSES, ET CETERA, HAVE BEEN CALLED TO BE PARTNERS IN ORAL HEALTH STRATEGIC PLAN KNOWLEDGEYS AND HELPING ESTABLISH A DENTAL HOME WHETHER THAT DENTAL HOME IS SEPARATE OR EMBEDDED WITHIN A MEDICAL HOME ARE PARTS THAT I THINK WE HAVE TO BE LOOKING AT IN THE RESEARCH FIELD AS TIME MOVES ON. THERE IS DATA THAT EXISTS IN THE LITERATURE BECAUSE OF THE EXISTING POLICIES IN PLACE AND PRACTICE IS IN PLACE WHERE YOU IF YOU LOOK AT SURVEILLANCE DATA FOR CARIES, AND LOOK AT PREVENTIVE CLAIMS DATA FOR ORAL HEALTH SERVICE IN THE MEDICAL FIELD YOU WILL SEE AS THE NUMBER OF PREVENTIST SERVICES IN THE MEDICAL FIELD, THE EXPERIENCE OF CARE IS DECREASING AND THIS IS WITHOUT IMPLEMENTING STRATEGIES TO IMPROVE THE EFFECTIVENESS OF THOSE TRANSLATION MODELS. SO THERE ARE MANY OPPORTUNITIES IN PLACE IN THIS LINE OF RESEARCH, AS I SAID THERE'S THE UNITED STATES PREVENTATIVE SERVICES TASK FORCE, TO ENDLIEWD PROVIDERS AMERICAN ACADEMY OF PEDIATRICS, AND FAMILY PHYSICIANS AND SO ON. WE HAVE SOMETHING RARE WHEN YOU TRANSLATE RESEARCH FINDINGS AND IN THIS CASE WE HAVE REIMBURSEMENT AS WELL, TO BE ABLE TO ENGAGE THIS DIVERSE WORKFORCE AND IN MICHIGAN WHERE I COME FROM FOR EXAMPLE, PEDIATRICIANS THEN, FAMILY PHYSICIANS CAN GET PAID AN ADDITIONAL $23 BY MEDICAID PER WELL CHILD VISIT PER RISK ASSESSMENT AND INITIAL FLUORIDE APPLICATION. RESOURCES ARE ALREADY AVAILABLE STOCK EXCHANGE DO THIS AND I AM SHOWING YOU HERE A PICTURE OF THIS MOUSE FOR THAT LIVE CURRICULUM AND THE APP AND IN THIS CASE YOU CAN DOWNLOAD IF TAR FREE ON THE PHONE AND IT'S A FABULOUS RESOURCE TO TRAIN NONDENTAL PROVIDERS AND BEING AWARE OF RISK FACTORS TO EVALUATE FOR ORAL HEALTHCARE AND IN THE EDUCATION REALM THOSE OF US INVOLVED IN ACADEMIA KNOW THAT PROFESSIONAL ACCREDITATION, IN MOST HEALTHCARE FIELDS INCLUDING DENTISTRY, MEDICINE, NURSING, ET CETERA. IN THE CASE OF YOUNG CHILDREN ACTUALLY, BECAUSE THEY HAVEN'T HAD TEETH LONG ENOUGH, CARIES EXPERIENCE DOES NOT WEIGH AS STRONGLY AS IT DOES IN ADUTS AS A RISK FACTOR. AND DAT HAS SHOWN HIGH SENSITIVITIES AND SPECIFICITIES, HIGHER THAN 80%. SO THERE'S A LOT OF PROMULGATE AND I GUESS FOLK US IN THIS AREA. THERE'S MANY PROBLEMS THAT NEED TO BE ADDRESSED RISK TOOLS, THOSE TARGETING THE MEDICAL FIELD NEED TO BE DEVELOPED. MOST RISK ASSESSMENT COOLS FOR CARIES, THAT EXIST ARE DEVELOPED FOR THE DENTAL FIELD AND HAVE BEEN ADAPTED BY EXPERT GROUP TO BE USE INDEED MEDICAL FIELDS BUT WITHOUT A LOT OF RESEARCH BEHIND THEM. EVEN WITHIN THE DENTAL FIELD, I THINK MANY OF US WILL ACSANDWICH THAT THE LEVEL OF EVIDENCE BEHIND THE EXISTING CARRIES RISK TOOL FROM A VALIDATION PERSPECTIVE IS EXTREMELY LIMITED. AND THERE'S CERTAINLY NO CONSENSUS OF WHICH TOOL IS MORE EFFECTIVE BASED ON LONGITUDINAL DATA AND SO, IF YOU EXTRAPOLATE THAT TO THE FACT THAT WE WOULD LIKE TO PROVIDE RISK BASED CARE, WE NEED A RISK ASSESSMENT TOOL THAT IS VALIDATED TO BE ABLE TO TEST RISK BASED STRATEGIC PLAN KNOWLEDGEYS WHETHER IT'S IN DENTAL AND MEDICAL SETTINGS. SO RIGHT NOW, THE STRATEGIES AT LEAST IN THE MEDICAL FIELD HAVE BEEN TO ENGAGE THE MEDICAL PROVIDER BUT IT'S NOT RISK BASED. BASICALLY THE PREMISE IS THAT EVERY CHILD WILL RECEIVE AN ORAL HEALTH SCREENING--SHOULD RECEIVE AN ORGANIZATIONS AT HEALTH SCREENING IN THE MEDICAL SETTING AND APPLY FLUORIDE APPLICATIONS AND THE FREQUENCY, OR DETAILS ON RECOMMENDATIONS ARE NOT TARGETED BASED ON RISK OR ANY OTHER FACTORS. AND AS CAN YOU IMAGINE, THESE RAISES ISSUES OF WHETHER THIS IS THE MOST COST EFFECTIVE WAY OF DELIVERING PREVENTIVE AND BEHAVIORIAL STRATEGIES TO THESE COMMUNITIES. SO THE OBJECTIVE OF THE PROPOSAL I WILL DESCRIBE WITH YOU TODAY IN A FEW MINUTES WAS TO DEVELOP A SELF-ADMINISTERED SIMPLE TO SCORE CARIES RISK TOOL THAT DELIVERS TO PRIMARY HEALTHCARE SETTINGS. s AS CAN YOU IMAGINE, THIS IS HAD HAS THE POTENTIAL OF LARGE IMPACT BECAUSE IT CAN IMPACT MET POLICIES AND PRACTICES. AND TRANSLATE INTO RISK BASED INTERVENTION THAT COULD BE PROVIDED THROUGH THOSE AND OTHER SETTINGS. WE'RE VERY GRATEFUL TO NIDCR FOR FUNDING PRELIMINARY WORK THAT LED TO THE URL ONE SO AN R21 PROPOSAL. WE SPENT A LOT OF TIME DURING THAT PRELIMINARY GRANT PERIOD AS WELL AS INITIAL YEAR OF THE UL-ONE AND DEVELOPING A VALID QUESTIONNAIRE. WE DEVELOPED CONCEPTUAL MAPS OF EARLY CHILDHOOD CARRIES AROUND BIOLODGEICAL AND SOCIAL DETERMINANTS OF HEALTH WE DID ITEMS OF RELIABILITY AND QUESTIONNAIRE CHECKING. WE SPENT A LOT OF TIME LOOKING AT REDUNDANCY AND POI LOT THINK ALOUDS WITH TARGET POPULATION AND THIS FOR SPANISH AND ENGLISH VERSIONS OF THE QUESTIONNAIRE. THE CURRENT ULONE IS A TRULY MULTIDISCIPLINARY AND MOLTEDY DISCIPLINEAR EFFORT AND I HAVE TO PUT THIS YEAR BECAUSE ALL THE GOOD THINGS I WILL SHARE WITH YOU ARE THE RESULT OF THE WONDERFUL ARE THE RESULT OF THE WONDERFUL PEOPLE I HAVE TO WORK WITH ON THE DAILY BASIS. WE HAVE PHYSICIANS, FAMILY PEDIATRICIANS, NURSES, DENTIST, HIGENERATEDDISTS, PSYCHOLOGISTS, SURVEY DESIGN SPECIALISTS AND A VARIETY OF MEDICAL AND DENTAL EN--STRATEGIES TUITIONS AROUND THE COUNTRY. SO THE INSTITUTIONS INVOLVED ARE THE AT UNIVERSITY OFFISH HIRSCH, UNIVERSITY OF IOWA, DUKE UNIVERSITY AND IN UNIVERSITY, GEORGE MASON UNIVERSITY AND HAVE TWO FABULOUS CONSULTANTS FROM THE UNIVERSITY OF NORTH CAROLINA, CHAPEL HILL IS THE UNIVERSITY OF ROCHESTER. IN ADDITION WE WERE ABLE TO SEE CURE FUND FREE RADICALS GENERATED THIRD PARTY PAYORS AND INDUSTRY TO COLLECT ADDITIONAL RISK DATA ON SALIVA AND BIOFILM SAMPLES FROM THIS POPULATION AND TEMP A. AND QUALITY OF LIFE DATA BECAUSE WE'RE VERY GRATEFUL FOR THE PK AWARD THAT WE RECEIVE, WE WILL BE ABLE TO ANALYZE THAT DATA AND COMBINE IT WITH THE ORIGINAL ULONE DATA THAT WE HOPE TO. HAVE. SO IN THIS GRANT, THE PREMISE WAS WE ARE GOING TO RECRUIT THE CHILDREN PRIMARILY THROUGH THE MEDICAL HOME, THROW USING MEDIATRIC OR USING PEDIATRIC OR MEDICAL RESEARCH AND THE DIFFERENT PLACE AND STATES THAT I MENTIONED WITH THE CONCEPT THAT BY FOLLOWING CHILDREN THROUGH THIS MEDICAL NETWORK, WE WERE GOING TO BE ABLE TO INCREASE RETENTION OVER TIME OF POPULATIONS THAT TRADITIONALLY ARE VERY HARD TO FOLLOW O, IF YOU THINK ABOUT A PERCENTAGE OF MEDICATE KIDS. SO THEY WERE RECRUITED AT ONE AND FOLLOWED UNTIL FOUR. WE ARE IN THE MIDDLE OF THIS PROJECT SO I CAN SHARE WITH YOU PRELIMINARY DATA. THERE'S THREE CLINICAL EXAMS. ONE AT BASELINE, ONE OF THE CHILD AT 2.5 YEARS OF AGE AND ONE THAT WE JUST STARTED WHEN THE CHILD TURNS FOUR AND BETWEEN THOSE EXAMS WHEN ARE SEPARATED BY 18 MONTHS THERE'S INTERMEDIATE CONTEXT BY THE PRIMEAR I CAREGIVER EVERY FOUR MONTHS. BUT THE PRIMARY CARE DATA WE COLLECT IS WITHIN THE DETECTION SYSTEM, CRITERIA, WHICH IS A VERY DETAILED CRITERIA THAT STAGES THE SEVERITY OF CARIES LESIONS THROUGHOUT SEVEN OF THESE INDEXES. WE HAVE A PRIMARY EXAMINER THAT CAN BE A HIGENERATEDDIST OR DENTIST DEPENDING ON THE STATE WE'RE WORK NOTHING COLLECTING THIS DAT OVER TIME AND WE CALIBRATE THEM OVER EVERY TIME PERIOD. IT'S A SELF-ADMINISTERED QUESTIONNAIRE, THERE'S QUESTIONS WITHIN FOUR CONS STRUCTURALLY DOM DOMAINS THAT DO WITH SOCIAL DETERMINANTS THAT COULD EFFECT THE INTERACTION BETWEEN THE BIOLOGICAL VACIABLES AND THE QUESTIONS THAT ARE DECIPED AND EFFECTING THE PRIMARY CAREGIVER AS WELL AS THE CHILD. THE PRIMARY OUTCOME OF THIS STUDY IS IDENTIFYING CHILDREN WHO WILL DEVELOP CARIES AT THE KAF TAGS LEVEL. WE'RE DEFINING KAFITATION AT THIS LEVEL. AND OUR PREMISE WAS IF THAT'S ARE DEVELOPING LESIONS IN THE NONMEDICAL SETTING, THERE'S A RANGE OF EXISTING AND NONLEVEL TESTING WE COULD DEPLOY LET LATER IN THE MEDICAL SESSION, BUT ONE KAFITATION OCCURS, THE CHILD NEEDS TO BE REFERRED TO A DENTAL SETTING FOR MUCH MORE INTENSIVE AND RANGE OF OPTIONS. THAT WE CAN PROVIDE IN A NONDENTAL SETTING. SO THE ABILITY TO BE ABLE TO IDENTIFY EARLY ON CHILDREN THAT WERE GOING TO PROGRESS RAPIDLY TOWARD KAFITATION TO REFER TO THEM TO CARE EARLY ON TO PREVENT KAFITATION FROM OCCURRING IS THE INITIAL PREMISE OF THIS STUDY. WE ARE VERY HAPPY THAT OUR GOAL WAS TO APPROACH 2000 KIDS PAIRS TO ENROLL 1326 AND WE WERE ALMOST ON TARGET WITH THE 1.6 APPROACH TO ENROLLED RATIO. WE HAVE LOOKED CAREFULLY AT STRATEGIES THAT HELP WITH RECRUITMENT BECAUSE WHEN YOU HAVE LARGE CLINICAL TRIALS AND CLINICAL STUDIES SUCH AS THIS, WHERE YOU HAVE SUCH DIVERSE GROUPS, RECRUITMENT IS ALWAYS VERY, VERY DIFFICULT. AND WHAT WE HAVE FOUND, THIS IS THAT DATA FROM OUR IOWA SITE THAT WAS RECENTLY PUBLISHED AND IT'S SHOWING YOU DIFFERENT METHODS OF RECRUITMENT FROM A VARIETY OF DIFFERENT SETTINGS INCLUDING E-MAILS, MASS MAILINGS, FACE-TO-FACE CONTEXT, ET CETERA AND YOU SEE, HIGHLIGHTED IN BLUE, THE ARROW OF THE PERCENTAGE YIELD PER CONTACT METHOD AND WE'RE FINDING IS IS THAT UNFORTUNATELY, STILL, THE FACE-TO-FACE METHOD YIELD HAVE THE HIGHEST PERCENTAGE YIELD ALTHOUGH THIS IS THE MOST EXPENSIVE ONE. SO E-MAILS AND MASS MAILINGS ARE VERY, VERY CHEAP BUT THE REELED FOR RECRUITMENT IS VERY, VERY LOW IN THIS TYPE OF POPULATION. OUT OF THE CHILDREN AND AND REPAIRS, IF WE FOCUS ON KIDS AND HALF WERE MALE AND FEMALE, 37% WHITE, 13% PLOOK AND OTHER MULTIRACIAL. 13% HISPANIC 87%, 61% ON MEDICAID, THE MAJORITY OF THE CAREGIVERS WITH THEIR MOTHERS APPROXIMATELY 29 YEARS OF AGE. WE HAD SAMPLE SIZED THIS STUDY ON OUR 21 DATA TO EXPECT ABOUT A 25% ATTRITION RATE BETWEEN EXAM VISIT IN OUR URBAN SITES AND ABOUT 30% IN OUR RURAL SITES. WE TRIED TO PUT STRATEGISTS IN PLACE TO SIGNIFICANTLY REDUCE THAT TO NO MORE THAN 20% BETWEEN EXAM PERIODS AND I AM SHOWING YOU OUR RETENTION TO DATE. YOU WILL SEE THE HIGH YIELD WE HAVE BEEN SUCCESSFUL WITH IN INTERMEDIATE CONTEXT AND HOW THOSE CONTEXT YEAR-OLDS TRANALATE WHEN IT COMES TO CLINICAL VISIT SO WE'RE VERY, VERY HAPPY WITH THE EFFORTS OF OUR FABULOUS GROUP. AND IT'S REALLY THE KUDO KUDOS IS UP TO THEM. SO I WILL SHOW YOU ANALYSISOT BASELINE DATA WE COLLECTED AND WHEN WE LOOK AT THE BASELINE RESPONSES TO THIS QUESTION AIR AND WE LOOK AT DIFFERENCES BETWEEN MEDICATE AND NONMEDICAID AND ENROLLED KIDDINGS AND BY RACE AND ETHNICITY AND I'M SHOWING EXAMPLES OF SOME OF THE RESPONSES THAT ARE SIGNIFICANTLY DIFFERENT IN THE MEDICAID AND MEDICAID ENROLLED GROUP AFTER ADJUSTING FOR RACE AND ETHNICITY DIFFERENCES AND THESE ARE JUST EXAMPLES OF QUESTIONS, THE QUESTIONS IN WHITE ON THIS TABLE ALL FALL WITHIN THAT DIETARY CONSTRUCT DOMAIN, WHETHER IT'S QUESTIONS ASSOCIATED WITH THE CHILD OR CAREGIVER. I WILL JUST CHOOSE THE THIRD ONE DOWN THE LINE, HOW OFTEN DO YOU GIVE YOUR CHILD SUGARY DRINKS AND WE LIST EXAMPLES OF SUGARY DRINKS ON BASED ON PILOT DATA BETWEEN MEALS AND YOU FIND THAT THE MEDICAID GROUP HAS A RESPONSE RATE COMPARED TO 40% COMPARED TO 12% IN THE NONMEDICAID GROUP WHICH WILL EXPLAIN THE DIFFERENCE IN CARIES CHILDREN AS THING PROGRESS OVER TIME. VERY INTERESTING DATA COMING UP FROM THE STUDY. CAN YOU DO THE SAME THING AFTER ADJUSTING FOR MEDICAID ENROLLED STATUS AND HERE'S THREE EXAMPLES OF QUESTIONS AGAIN WITH THE DIETARY CONSTRUCT DOMAIN AND THE QUESTIONS WHETHER THE PREVALENCE AND RESPONSES WERE SIGNIFICANTLY HIGHER IN THE BLACK GROUP AND I'VE SEPARATED HERE THAT BLACK AND WHITE REFERS TO NONHISPANIC BLACK AND WHITES AND I WILL CLUMP TOGETHER THE HISPANIC GROUPS BECAUSE OF EXPLANATIONS THAT DR. PEREZ-STABLE WAS ABLE TO EXPLAIN SO CLEARLY TO YOU OF THE DIFFICULTIES IN THE HISPANIC COMMUNITY TO ASSOCIATE WITH A PARTICULAR RACE. SO WHAT YOU WILL SEE HERE AND AGAIN LET'S CHOOSE THE FIRST ONE. HOW OFTEN AND IN THIS CASE WE ARE ASKING THE PRIMARY CAREGIVER DO YOU EAT SUGARY SNACKS BETWEEN MEALS YOU WILL FIND FOR RESPONSES OF THREE OR MORE TIMES A DAY, 24% IN THE BLACK, NONHISPANIC GROUP. 13% IN THE HISPANIC GROUP, AND FOUR% IN THE WHITE NONHISPANIC GROUP. MY EXPLAIN SOME DIFFERENCE IN CARIES AND THE CAREGIVERS. INTERESTINGLY WE HAVE TWO QUESTIONS THAT RATED HIGHLY DURING THE R21 INITIAL DATA THAT HAD TO DO WITH APPEARANCE PERCEPTION OF TAKING CARE OF THE CHILD'S MEDICAL HEALTH AND DENTAL HEALTH AND THIS COMMUNITY BASED ON THE BASELINE DATA PARENT PERCEIVE THAT THEY TAKE CARE OF THEIR INFANTS MEDICAL CARE OF THE HEALTH THAN THEY DO OF THE ENTHUSIASMAL HEALTH AND IF WE LOOK AT FACTORS THAT ARE RATING OF DOING A GOOD JOB TAKING CARE OF YOUR KID'S TEETH, YOU SEE QUESTIONS ON THE TABLE THAT YOU WOULD WILL EXPECT. BRUSHING, FREQUENCY OF BRUSHING OR BRUSHING WITH TOOTH PASTE DAILY OR CLEANING INSIDE THE MOUTH OR PARENTS THAT GET TENTAL CHECK UPS YEARLY AND HAVING DENTAL INSURANCE THAT MIGHT FACILITATE THIS KIND OF BEHAVIOR. I WILL SHARE THE DATA FROM STEM, AGE 2.5 YEARS OF AGE, THE SEVEN% OF THE CHILDREN HAD KAFITATED LESIONS OF THIS EXAM AND HAD IS IN LINE WITH THE CURRENT--MOST CURRENT DATA THAT WAS PUBLISHED LAST YEAR AND THEY'RE STILL PERSIST IN LARGE DISPARITIES BY RACE AND ETHNICITY YOU CAN SEE HERE BY MEDICATE STATUS AND BY RESIDENCE. SO RURAL CHILDREN HAVING SIGNIFICANTLY HIGHER EXPERIENCES THAN URBAN CHILDREN, MEDICAID ENROLLED CHILDREN, SIGNIFICANTLY HIGHER THAN ENROLLED CHILDREN, BLACKS SIGNIFICANTLY HIRER THAN WHITE, HISPANICS SIGNIFICANTLY HIGHER THAN WHITE, OTHER VERY INTERESTING, VERY HIGH COMPARED TO WHITE. SO, I WANT TO MENTION THAT ALTHOUGH, THE MAJORITY OF KIDS THAT ARE GETTING CARIES ARE ON MEDICAID, I WANT TO WARN YOU WHEN YOU LOOK AT THE STUDY AS A WHOLE, THE MAJORITY OF KIDS ON MEDICAID ARE NOT GETTING THIS LEVEL OF DISEASE. SO IF YOU JUST USE MEDICAID STATUS AND THE RISK ASSESSMENT TOOL, YOU WILL OVERHEST MATE THE RISK OF CARRIES IN THAT POPULATION, WHEN WE LIST THE CARRIES IN IN COMMUNITY AND WE LOOK AT DIFFERENT PATTERNS THIS IS THE OVERALL DATA PATTERN, YOU ARE SEEING THE CHILDHOOD PATTERN WHERE YOU HAVE CARRIES IN THE ANTERIOR WHICH IS A GOOD THING FROM THE INTERPROFESSIONAL POINT OF VIEW BECAUSE THIS ARE TEETH THAT ARE EASILY ACCEPTABLE TO NONDENTAL TRAINED PERSONNEL AND THEN EFFECTUALLY WILL PROGRESSION TO THE POSTERIOR OCCLUSEAVE SERVICES. THERE'S MANY QUESTION WHEN IS WE LOOK AT UNIVARIED ANALYSIS, THERE ARE RESPONSES TO CARRIES OF AGE 2.5. I WILL SHOW YOU VARIABLES THAT RELATE TO THE CHILD IN HAVING CARIES AT KAF TAILLIGHTED LEVEL AT AGE 2.5. I WANT TO HIGHLIGHT BLUE LINE THAT SHOWS SIGNIFICANTLY HIGHER THAN ONE BELOW THE BLUE LINE AND BELOW ARE THE RATIOS THAT ARE LOWER THAN ONE. BUT IF YOU LOOK ABOVE THE BLUE LINE YOU WILL SEE TWO VERY HIGH ODDS RATIOS THAT HAVE TO DO WITH FLOORIDE EXPOSURE, HOW IS THIS POSSIBLE TO OBLIGATIONS DANE DENTAL CARE, WE BELIEVE YOU'RE SEEING A MEASURE FOR MAYBE THE RESPONSE RATE OF THE OF THE HEALTHCARE PROVIDER TO AN INCREASED RISK WHERE THEY'RE REACTING TO THAT RISK BY RECOMMENDING SOME OF THIS STRATEGY MUCH MORE FREQUENTLY AND WE'RE DIGGING INTO THE DATA TO CLARIFY THAT. WE SEE SIMILAR PATTERN WHEN IS YOU SEE THE RESPONSE BY A PRIMARY CAREGIVER, IF YOU LOOK AT THE FIRST TWO VARIABLES THAT HAVE TO DO WITH CARIES EXPERIENCE OF THAT CAREGIVER, HAVE STRONG ASSOCIATES WITH THAT CHILD HAVING KAFIDATED LESIONS AT AGENT 2.5. WE HAVE COMBINED OUR DATA SET WITH THAT OF ANOTHER NIEKS H FUBBEDDED STUDY, LOOKING AT NORTH PLAINS AND AMERICAN INDIAN. SO AS YOU ARE AWARE. AMERICAN INDIANS IN THIS COUNTRY HAVE A DISPROPORTIONALLY HIGH NUMBER IN THIS AREA, THERE HAVE BEEN A NUMBER THAT ARE EXPLORED AND ARE BEING EXPLORED TO EXPLAIN THE DIFFERENCES AND YET ONE OF THE HYPOTHESIS WAS THAT MAYBE THE CHILDREN AT LEAST BASED ON ANECDOTAL OBSERVATIONS WERE GETTING THEIR TEETH EARLIER THAN OTHER COHORTS WHICH WOULD MEAN THAT WHEN YOU'RE COMPARING THEM AT A SIMILAR AGE, YOU WILL SEE A MUCH MORE INCREASED PREVALENCE OF DISEASE AND BY COMBINING OUR DATA SET WITH THE DATA SET FROM THIS STUDY, WE SHOWED THAT THE SIMILAR AGE RANGE NATIVE AMERICAN KEYEDS HAVE ALMOST DOUBLE AMOUNT OF TEETH PRESENT IN THE MOUTH THAN OUR NONHISPANIC WHITE AND BLACK COHORTS, AND THIS WAS PUBLISHED WITH JOHN WARREN WITH THE UPI, MAIN FIRST AUTHOR. SO WE HAVE MANY NEXT STEPS AS WE COMPLETE THIS STUDY, DO ALL OF OUR MULTIVARIANT ANALYSIS, THEN END UP WITH HOPEFULLY A PREDICTIVE RISK TOOL. WE WILL LOOK LIKE I TOLD YOU AT OUR SALIVA AND PLAQUE SAMPLES, TEMPERAMENT AND QUALITY OF LIFE DATA AND INCORPORATING THAT INTO OUR DATA SET. WE WILL EVENTUALLY HAVE TO VALIDATE SOURCE TOOL IN OTHER COMMUNITIES. WE WOULD LIKE TO CONTINUE TO FOLLOW THESE KIDS INTO THE NEXT DENTISTITION BECAUSE THERE ARE DIFFERENT PATTERNS OF CONSIDER THE OCCLUSAL AND PROXIMAL LESIONS AND WE EXPLAINED DIFFERENT PATTERNS YOU MIGHT SEE WITHIN THE MIXED DENTITION AS PERMANENT TEETH ARE ERUPTING AND WE HOPE TO USE THAT INITIALLY THROUGH ECONOMIC MODELING STUDY TO DELIVER A RISK BASED INTERVENTION AND THERE SIS TICK MODEL, IF THAT PANS OUTS WE WILL LOOK AT IMP ELEMENTATION RESEARCH STRATEGIES LOOKING AT COMPOI SAN FOR EXISTING AND NOVEL ENTERVENTION SAYS AND THE MEDICAL HEALTH CARE SETTING. I WANT TO END BY TELLING YOU WE HAVE BEEN VERY LUCKY BY OBTAINING ALSO CMS HEALTHCARE BOARD ROUND TWO LOOKING AT IMPLEMENTATION OF SOME OF THIS CURRENT EXISTING POLICIES AND STRATEGIES WITHIN THE MICHIGAN COMMUNITY TO INCREASE THE PROPORTION OF LOW INCOME CHILDREN THAT RECEIVE PREVENTIVE SERVICES AND THE ONLY REASON I'M MENTIONING THIS, THIS IS NOT A RESEARCH PROJECT THIS, IS AN IMPLEMENTATION PROJECT BUT IT SPEARED A LOT OF INTERESTING DATA THAT HAS OPENED UP RESEARCH OPPORTUNITIES AS WE LOOKED AT OUR NIH DATA AND TWO OF OUR COMMUNITY SITES ARE IN FLINT AND ANN ARBOR AND AS CAN YOU IMAGINE WITH FLINT, THE UNIVERSITY OF MICHIGAN IS COMMITTED TO HELPING THE FLINT COMMUNITY WITH THE DISASTERS THAT ARE OCCURRING NOT ONLY WITH THE LEAD EXPLOWSURE BUT THE LACK OF FLUORIDE WATER AND CHANGES AND BEHAVIORS THAT ARE ASSOCIATED WITH NOT CONSUMING WATER. BUT FLIPT HAS BEEN COMMITTED TO TRYING TO TRAINING FEEDIA PRIGSS TO INVOLVED IN ORAL HEALTH. THERE ARE MANY, MANY BARRIERS WITH THE RECORD ET CETERA THAT EXPLAIN WHY WE HAVE POLICIES AND REIMBURSEMENTS THEY HAVE NOT BEEN ENACTED AROUND THE COUNTRY AS MUCH THAT IS THEY COULD. BUT ONE OF THE OBSERVATIONS HAS BEEN THAT THE CULTURAL, CLINICAL CULTURE, CLINE IPGZS BELIEVES AND PERSONAL VALUES TEEM TO BE ABLE TO OVERCOME ALL STRUCTURAL BARRIERS, AND HAVING AN ORAL HEALTH ADVOCATE SEEMS TO BE CRUCIAL AND AS YOU CAN IMAGINE THIS OPENS VERY INTERESTING RESEARCH QUESTION. SO I WANT TO END UP BY TELLING YOU YOU'RE IN AN ERA AT LEAST WHEN YOU LOOK AT THE UPPER PART OF THIS DIAGRAM OF PERSONALIZED CARIES MANAGEMENT AND DENTAL TEACHING AND PRACTICE RESEARCH I GUESS THAT'S WHAT WE'RE TRYING TO ENACT. WE NEED BETTER RESEARCH TO UNDERSTAND RISK ASSESSMENT TOOLS THAT COULD LEAD TO RISK BASED INTERVENTIONS THAT ARE HOPEFULLY FOCUS ON PREVENTION AND REMINERRALLIZATION AND WILL LEAD TO BETTER HEALTH BENEFITS BUT IN THE AREA OF PROFESSIONALIZATION AND CARE, BY ENABLING AND INTERACTING WITH MEDICAL PROVIDERS, SOCIAL WORKERS NURSES, PHARMACIST, TEACHERS, ET CETERA. IT'S CRUCIAL. THEY CAN BE A VERY HELPFUL IN RISK ASSESSMENT, PREVENTIVE CARE, EDUCATION AND REFERRAL BUT WE NEED MUCH BETTER RESEARCH TO BE ABLE TO IMPLEMENT THIS AND TO PRACTICE. AND WITH THAT I WANT TO THANK YOU VERY MUCH FOR YOUR ATTENTION AND I HOPE I STAYED WITHIN MY ALLOTTED 25 MINUTES. THANK YOU. [ APPLAUSE ] >> LOOKS LIKE ONE QUICK QUESTION AND THEN MORE DISCUSSION AT THE END OF THE SESSION? OKAY, I GUESS THERE WERE NOT ANY QUESTIONS. >> THANK YOU. NEXT DRS. GARCIA AND HENSHAW. >> GOOD MORNING. THANK YOU FOR INVITING US TO BE HERE TODAY AND I ALSO WANT TO GIVE OUT A SHOUT OUT TO DR. RUTH WHO WAS LONG TIME DIRECTOR OF THE PROGRAM HERE AT NIDCR AND WAS INSTRUMENTAL IN WHATEVER SUCCESS DR. HENSHAW AND I HAVE HAD TO DATE OVER THE PAST 15 YEARS SO THANK YOU RUTH FOR ALL YOUR HELP. SO, MY TASK WAS TO SORT OF GIVE YOU A HISTORRIAL OVERVIEW OF THE PAST 15 YEARS OF WORK AND I WILL TAG TEAM WITH DR. HENSHAW, AND I WILL BE THE PAST, WHEN IS METAPHORICALLY, SHE IS THE PRESENT AND THE FUTURE, AGAIN, QUITE ACCURATE MPLET SEVERAL THREADS HAVE RUN THROUGH OUR WORK OVER THE PAST 15 YEARS THAT SORT OF TIED THINGS TOGETHER. ONE THEME IS COMMUNITY ENGAGEMENT. BROADLY CONSTRUED NOT JUST ENGAGING THOSE COMMUNITIES THAT WE WISH TO HELP THROUGH OUR SCIENCE TO IMPROVE THEIR HEALTH BUT ALSO THE COMMUNITY OF COLLEAGUES BOTH PROFESSIONAL CAREGIVERS AT DIFFERENT LEVELS OF CARE WHETHER SOCIAL WORKERS, SCHOOL TEACHERS, NURSES, PHYSICIANS, NURSES AND LITTLERS LIKE THAT AS WELL AS COMMUNITY AROUND US AS ACADEMICS WERE INVOLVED IN RESEARCH THEIR VARIOUS TYPES AND IN THAT REGARD WE THOUGHT A GOAL WAS TO BUILD AND SUCCEED IN MANY WAYS BUILD A COMMUNITY OF SCHOLARS IN THIS THE ORAL HEALTH DISPARITIES RESEARCH AND I WOULD SAY THAT THE FIRST TWO ITERATIONS OF U54 CENTER FUNDING REALLY HELPED TO CATALYZE THAT PROCESS IN THE UNITED STATES LEADING TO THE POINT WHERE THE CENTERS BECAME IRRELEVANT AS AN ENTITY. SUCCESS HAD BEEN ACHIEVED. WE COULD INVEST FULL OR MORE IN INVESTIGATOR LED PROJECTS OF THE TYPE. SO THESE ARE THE THREADS THAT RUN THROUGH AND WILL CONTINUE TO RUN THROUGH OUR CURRENT UHTWO CONSORTIUM PHASE AS WELL. SOT SO THE OTHER THEMES HAVE BEEN A SHIFT OVER TIME AS DR.AT KIN SON DESCRIBED, OBSERVATION, DESCRIPTION AND INTERVENTION, AND A CONTINUING THEME IN THE CYST U54 ROUND UP, WE HAD A TREMENDOUS SUCCESS, AT THE CANDU CENTER IN UCSF, DID A LANDMARK PROJECT IN THE TRIAL USING HEART CLINICAL OUTCOME, REALLY DEMONSTRATING FOR THE FIRST TIME CLEARLY THAT FLOYD WAS A ANTIEFFECTIVE INTERVENTION IN YOUNG CHILDREN IN OUR OWN WORK, WE DID A SMALLER SCALE ON TWO SIDE STUDY, NONRANDOMMIZED INTERVENTION STUDY TO SEE WHETHER INGAUGING MEDICAL PROVIDERS PEDIATRICIAN IN THE WELL CHILD VISIT COULD IN FACT REDUCE DENTAL CARRIES BUT IS IN THIS OBSERVATION TO INTERVENTION AND PROJECTEDS WITHIN ONE CENTER TO MULTILE CENTERS AND ENTITIES AND U54 TO WHAT WAS THEN CALLED THE EARLY CHILDHOOD CARIES COLLABORATIVE CENTER TO NOW THE UHTWO AND UCFOUR OF AND THAT IS AS DR. ATKINSON HAS NOTED THAT THEY WERE TRYING TO WORK MORE EQUISHTLY AS WELL AS USING A COMMON COORDINATING CENTER FOR THIS RESEARCH. AS WAS EARLIER NOTED THIS WAS NOT NOTHING THAT HAPPENED IN THE A VACUUM. IF IT WAS FRAME INDEED A CENTRAL EVENT IN ORAL HEALTH IN AMERICA, THE REPORT BY THE SURGEON GENERAL, THE CLASSIFICATION, FOCUS ON HEALTH DISPARITIES. NOW THIS INSTITUTE AND THE NIH HAD LONG BEEN FOCUSED EARLIER ON MINORITY HEALTH AND THAT'S A SOMEWHAT DIFFERENT BUT RELATED CONSTRUCT TO HEALTH DISPARITIES, BUT IT WAS REALLY THE CERTAIN PORT NAIN THE ORAL HEALTH UNIVERSE MADE IT LOOK HARD AT WHAT HEALTH DISPARITIES REALLY MEANT AND WHAT THEY MEAN TO ME IN REGARDS TO MY OWN DEFINITION, IT'S THE SHORTEST AND SIMPLEST ONE I FOUND AND IT'S AN OLD ONE FROM THE WORLD HEALTH ORGANIZATION AND DISPARITIES ARE IN DIFFERENCES IN HEALTH STATUS THAT ARE UNNECESSARY AND AVOIDABLE BUT IN ADDITION TO ARE UNFAIR AND UNJUST. IN ADDITION TO SURGEON GENERAL REPORT THAT WAS A CALL FOR ACTION THAT BUILT ON WHAT THE NIDCR WAS DOING IN REGARDING TO RESEARCH IN THIS AREA, BUT THIS CALLED FOR ACTIONS THAT THE NATION COULD TAKE AND A CLEAR ONE WAS TO BUILD THE SCIENCE BASE AND ACCELERATE SCIENCE TRANCE FER IN THIS AREA. SO TO OUR FIRST ROUND OF FUNDING, THIS WAS PART OF THE FOUR CENTERS FOR RESEARCH TO REDUCE ORAL HEALTH DISPARITIES AS I CALL TODAY THE CRROHD, NOW THE DOCTOR HAD BEAT EVERYBODY AS FAR AS HAVING THE CLEVERST ACRONYM FOR HER CENTER, THE CAN-DO SYMBOL AND THE LOGO OF ROSIE THE RIVETER WITH THE EARLY CHILDHOOD CARRIES, THE CRETED WAS A RESULT OF A COMMITTEE AND IN OUR CASE THE SCIENTIFIC ADVISORY COMMITTEE LED BY THE LATE DR. LOWRY WHO INVESTED WE COULD NOT BE LEFT BEHIND AS A CENTER, THE WE HAD THE CAP CAN-DO CENTER, WE NEED TO HAVE A CLEVER ACRONYM OURSELVES APPROXIMATE SO THE CREED DEVELOPED AFTER MANY LIBERATIONS ON THE COMMUNITY BASED ON THE FACT THAT WE HAD A BELIEF THAT RESEARCH COULD CREATE KNOWLEDGE TO IMPROVE HEALTH AND A BELIEF THAT RESEARCH WAS NEEDED AND ESSENTIAL TO ACTUALLY ELIMINATE ORAL HEALTH DISPARITIES. THAT ITERATION WAS REALLY A VERY TRADITIONAL KIND OF CENTER, WASN'T LIKE THE SPECIALIZED P50 CENTERS OF MINORITY HEALTH, IT HAD RO-1 TYPE SIZE PROJECTS, ONE OF WHICH WAS LED BY DOCTOR ANN TANNER NOTED EARLIER ABOUT UNDERSTAND THINK THE MICRO BIOTA OF THE HEALTH DISPARITIES AND THE SUCCESSFUL PROJECT WAS ONE TO LED TO DEVELOP A SUITE OF INSTRUMENTS TO MEASURE QUALITY OF LIFE. THIS LED TO TRIEWMENT THAT WAS BOTH ENGLISH AND SPANISH WERE IDENTIFIED AS AGE APPROPRIATE DEVELOPMENTALLY FOR DIFFERENT AGES OF CHILDREN IN TERM THAS COULD BE ADMINISTER BIDE INTRAMURAL OR SELF-ADMENSTRUATION FOR BOTH THE CHILD, AGE APPROPRIATE, CHILD'S PRIMARY CAREGIVER, AND ALSO SOLICITING REPORTS ON THE PRIMARY CAREGIVERS ASSESS OF THE CHILD'S ORAL QUALITY OF LIFE. AN TRIEWMENT THAT WE DEVELOPED AND TESTED AND VALIDATED IN OUR STUDIES AND WERE USED BY US IN BOSTON FOR OUR SECOND ROUND OF THE FUNDING PROG ELECTRIC LIGHTING BUT USED BY THE UNIVERSITY OF COLORADO PROJECTS TO MEASURE QUALITY OF LIFE IN THEIR TRIAL AND CONSIDERED FOR THE UH-TWO COLLABORATIVE AS ONE OF THE VALIDATED ORAL HEALTH OF QUALITY OF LIFE INSTRUMENTS AND THEY MAY BE USED TO THE ONGOING PROJECTS. SO AS WE NOTED EARLIER, COLLABORATION WAS ESSENTIAL AND THE PART WE HAD WERE DIVERSE IN THE EARLY ITERATION OF THE U54 CENTER, WE CONSIDER SOMETHING NORTHEAST BECAUSE OUR PROJECT ENCOMPASSED IN THE BOOSTOON AREA AND OLOGIST HERE IN DC, AT CHILDREN'S NATIONAL MEDICAL CENTER, AND IT'S MULTIPLE WORK IN HIGH HIGHWAY, AND AT OHIO STATE. BUT STILLING PRETTY MUCH A BOOSTOON BASED ACTIVITY, WE HAD INVESTIGATORS BOTH AT BU AND IN THE GREATER COMMUNITY, THE BOSTON MEDICAL CENTER, BOSTON HEALTH OF COMMUNITY ELGT CENTERS AND HEALTH COMMISSION OUR NATION'S PUBLIC HEALTH AGENCY, THAT WAS INVOLVED IN MANY OUTREACH ACTIVITY, INCLUDING ORAL OUTREACH RELATED ONES AND THE FORSYTH INSTITUTE THAT LED THE WAY AND OUR PARTNERS THE NIDCR AND NCMHD, WAS ONE OF THE CO-FUNDERS OF THAT FIRST ROUND OF THE CENTERS AND AFTER HEARING, THE VERY ELOQUENT TALK THIS MORNING, I AM HOPING THERE WILL BE MORE PRODUCTIVE COLLABORATIONS WITH THE NCMHD. THE THEMES OF THOSE FIRST CONSIDERATIONS CARRIED OVER INTO THE NOW SOON TO BE ENDING SECOND ROUND OF U54 FUNDING AND IT HAD TO DO WITH HOW TO PROMOTE ORAL HEALTH AND PREVENTERRAL DISEASE IN NONDENTAL SETTINGS WHETHER IT'S IN MEDICAL CARE SETTINGS OR SCHOOLS OR OTHER LOCALES, AND THAT CARE OR THOSE INTERVENTIONS ARE BEING PROVIDED BY A NONDENTIST, INCLUDING NONDENTAL PERSONNEL AND NONHIGENERATEDDIST FACILITIES AND HEAD START INSTRUCTORS, ET CETERA AND THAT'S BEEN REALLY CARRIED THROUGH, TO WHERE IN OUR SECOND ROUND OF THIS, WE HAD IMPORTANT WORK BEING DONE IN AGAIN THE WELL CHILD VISIT BUT NOW IN COMMUNITY HEALTH CENTERS AND THEN THE LANDMARK FOR DR. HENSHAW LED AND ORAL HEALTH PROMOTION USING LAY MOTIVATIONAL INTERVIEW ERS IN PUBLIC HOUSING LOCALES IN THE CITY OF BOSTON AND THE ENVIRONMENTS AND THEN IN REGARD TO THE NONDENTIST DELIVERING THE CARE IMPORTANTLY CONTINUING OUR WORK IN THE MEDICAL CARE, ACES SPECT OF ORAL HEALTH PROMOTION AND PREVENTION AND THE LAY PERSON COMMITTEE PERSON ASPECT OF HEALTH IN THEIR OWN COMMUNITIES WITH THEIR OWN PEERS. COMMUNITY ENGAGEMENT AGAIN ANDA CAPACITY BUILDING WAS EARLIER AND SPECIFICALLY RESEARCH AND INTERIOR DEVELOPMENT, IT WAS ONE OF THOSE UNFUNDED MANDATES, THAT AS DR. ATKINs SON'S SLIDE SHOWED BUT IT WAS NOT REQUIRED BUT IT WAS FUNDED. WE WERE AS ALL OTHER CENTERS WERE CHARGED WITH THIS TASK, AND WAS SOMETHING WE SUCCEEDED WELL IN AND WE WERE OVER THAT PERIOD OF TIME, SUCCESSFUL LEAVE RECEIVED THREE DIFFERENT SUPPLEMENTS, SO CALLED MINORITY HEALTH SUPPLEMENTS BUT THEY WERE AT THAT TIME SUPPLEMENTS TO INCREASE THOSE FROM UNDER REPRESENTED GROUPS IN THE RESEARCH WORKFORCE, I THINK IT'S A LONG NAME. BUT THOSE INDIVIDUALS WHO OF WHOM ARE STILL INVOLVED IN RESEARCH RELATED ACTIVITIES, VERY SUCCESSFULLY SO. THAT WAS ONE OF OUR PISHESs AT THAT POINT IN TIME ALSO DEVELOPED ENOUGH OF A TRACK RECORD TO GET ONE OF THOSE K-AWARDS WHICH WAS FOR MIDCAREER RESEARCH PROMOTION THAT ALLOWED HER, DR. JUDY JONES TO MENTOR OTHERS IN THE AREA OF DEVELOPING THESE QUALITY OF LIFE INSTRUMENTS. THOSE VARIETY OF OTHER INDIVIDUALS IN OUR TEAM THAT SIMILARLY HAVE ADVANCED RESEARCH CAREERS, ONE NOTABLE ONE IS DR. HENSHAW HERSELF WHO BEGAN THAT WERE AT THAT TIME AND THE JUNIOR FACULTY MEMBER, AND THE K23 AWARD AND THEN OVERTIME ROSE FROM THE RANKS FROM ASSISTANT PROFESSOR IS NOW THE PI OF ONE OF HER OWN MAJOR SIGNIFICANT PROJECTS YOU WILL HEAR ABOUT MORE LATER. SO THE OUTCOMES FROM THAT FIRST ROUND OF FUNDING ARE THINGS THAT ARE TRADITIONAL MANUSCRIPTS THAT WERE IMPORTANT IN REGARD TO THIS PEDIATRICIAN DELIVERED INTERVENTION TO PREMOTE ORAL HEALTH IN THE POPULATIONS BEING TACKERETTED AS WELL AS IDENTIFY MICROBIAL RISK FACTORS IN THESE POPULATIONS AND FOCUS ON THE NUCLEOTIDES TRICIANAL RISK FACTOR IN REGARD TO THE CARRIES. PEDIATRIC ORAL HEALTH INSTRUMENTS WAS AS I NOTED EARLIER WAS A MAJOR OUTCOME WE HAD AS A TOOL TO BE USED RESEARCH, AND MONITOR THE HEALTH OF POPULATION, AND WANTED TO BE SENSITIVE TO CHANGE IN ORAL HEALTH STATUS BASED ON INTERVENTIONED TO TREAT EACH OTHER AND IT WAS PUBLISHED IN JOURNAL DENTISTRY OF CHILDREN. SO SO SWITCHING OVER TO THE EARLY COLLABORATIVE CENTERS, THAT HAS BEEN AN INTERESTING AND EXCITING EXPERIENCE, ABLE TO WORK WITH THREE INSTITUTIONS WITH B. U. WITH THREE OTHER INSTITUTIONS OF THE UNIVERSITY OF COLORADO DENVER, UNIVERSITY OF COLORADO SAN (ASSESSING COOF THE CANDU CENTER AND THE THEN THE DATA COORDINATING CENTER AND I THINK THAT LED TO GREAT EFFICIENCIES IN THIS THE AND WERE IT IS STILL CONTRIBUTED TO THE SUCCESS OF THE OVERALL COLLABORATIVE EFFORT MPLET THOSE WORKING GROUPS WERE SUCH THAT IT WAS A LONG PROCESS, NOW HAVING LEARNED FROM THAT, THE UHTWO HAVE BECOME CONDENSED MUCH MORE EFFICIENT, WE LEARNED NOT TO DRAG THINGS OUTED FOR TOO LONG. BUT STANDARDIZED PROCESSES, GOLD STANDARD EXAMINER AND PROCEDURES AND PROTOCOLS AND COMMON QUESTIONNAIRE AT ONE POINT THE BEHAVIORIAL RISK FACTOR, QUESTIONNAIRE, BECAME THE BASIC RESEARCH FACTORS QUESTIONNAIRE. IT GREW TO BE A BEHEMOTH OF AN INSTRUMENT AND DOIZEN OTHER VERY LONGS THAT REQUESTED THE USE, THE PUBLICATION COMING OUT SOON THAT WILL BROADEN THE USE OR OTHER INVESTIGATORS IN IN FIELD AND THEN OTHER SORTS OF APPROACHES TO MAKE THINGS HAPPEN. AND ON THAT NOTE, I WILL TURN TO DR. HENSHAW, HAVING TAKEN UP MOST OF HER TIME. [ APPLAUSE ] >> SO I WILL GIVE AN OVERVIEW OF THE CURRENT PROJECTS AND THE CREED PHASE TWO. BOTH OF WHICH BUILT UPON THE FOUNDATION WORK THAT DR. GARCIA ALREADY DESCRIBED IN OUR CREED ONE. SOCIETY FESTER IS PARTNERING WITH COMMUNITY HEALTH CENTERS TO PREVENT ECC. THIS BUILDING UPON THE WORK OF NANCY CRESCENT WHERE SHE SHOWED THAT WE COULD INFACT INTEGRATE OR HOLD PROMOTION WITHIN PEDIATRIC [INDISCERNIBLE] VISITS BUT IN A SPECIFIC SETTING AND TERTIARY CARE TEACHING HOSPITAL AND THE WORK DONE IN CREE TOO TWO WAS SEE FIGURE WE COULD TRANSLATE THAT WORK INTO COMMUNITY HEALTHCARE IS CENTER SETTINGS. AND THEN THE WORK THAT DR. BORRELLI, AND MYSELF LEAD, WITH THE PUBLIC HOUSING TAKING THE SAME IDEA OF COUNSELING BUT MOVING IT OUT OF THE HEALTHCARE DELIVERY SYSTEM AND ACTUALLY DOING A RANDOMIZED CLINICAL TRIAL WHERE THE INTERVENTIONISTS WERE LAY PROVIDERS, INDIVIDUAL WHO IS HAD JUST A HIGH SCHOOL EDUCATION, TRAINING THEM NOT ONLY ON ECC PREVENTION BUT REALLY USE MOTIVATIONAL INTERVIEWING COUNSELING TECHNIQUES WITH GREAT FIDELITY AND TO DO THAT WITHIN A PUBLIC HOUSING SETTING. SO REALLY MOVING IT COMPLETELY OUT OF A CLINICAL ENCOUNTER AND ALL THE WHILE, KEEPING WAS OUR OUTCOME A HARD CLINICAL 24 MONTH CARRIES INCIDENCE RATE. AND SO, WE ARE--IT IS A CLINICAL TRIAL. SO I DON'T HAVE ANY RESULTS TO SHARE YET BECAUSE WE'RE STILL COLLECTING OUR FINAL DATA POINTS BUT WE HAVE ENOUGH OUTCOMES FROM BOTH PROJECTS THAT REALLY HELP TO INFORM OUR NEXT ROUND OF WORK WHICH I WANTED TO SHARE WITH YOU. SO SOME OF THIS WILL REALLY ECHO WHAT DR. FONATNA HAS SAID. SO YES WE WERE ABLE TO IN BOTH SETTINGS, DEASHIARY CARE HOSPITAL SETTINGS AND COMMUNITY HEALTH CENTERS INTEGRATE ORAL HEALTH WITHIN THE MEDICAL SETTING BUT THE BARRIERS THAT WE ENCOUNTERED WERE PRETTY MUCH THE SAME, THE CHAMPIONS WERE IMPORTANT, BUT REALLY A RESTRICTIVE FACTOR IS THAT VERY LIMITED TIME ENCOUNTER, THAT YOU HAVE WITH PATIENTS SO YES, WE CAN DO FLUORIDE VARNISH, WE CAN DO LIMITED TRADING GUIDANCE BUT YOU'RE LIMITED TO THOSE SMALLER ENCOUNTERS. AND THEN YES, WE WERE ABLE TO TRANSLATE THIS INTO A NONCLINICAL SETTING SO USING THAT WOULD SORT OF ELIMINATE THE PROBLEM SO YOU DON'T HAVE THAT TIME CONSTRAINT IN OUR PUBLIC HOUSING WORK AND THAT'S TRUE. BUT WE RAN INTO OTHER BARRIERS THAT IT'S VERY RESOURCE INTENSIVE TO DO THIS, WITHOUT THAT SORT OF INFRASTRUCTURE OF A CLINICAL SETTING. SO, YES WE HOPE THAT IT WORKS. IT'S FEASIBLE WE CAN DO IT, WE EXPECT WHEN WE GET OUR DATA THAT WE WILL SHOW THAT IT WORKS. BUT IT'S PROBABLY NOT THE END OF STORY EITHER. AND YOU KNOW THROUGH ALL OF OUR WORK INCREASINGLY OVER THE LIFE OF THE SECOND CENTER WE'VE SEEN A REAL SHIFT IN OUR PATIENT PATIENT POPULATION THAT WHILE I AGREE THAT RECRUITMENT FACE-TO-FACE IS THE ONLY EFFECTIVE WAY, ONCE YOU GET ENGAGED WITH FOLKS THAT FACE-TO-FACE ENCOUNTER WHILE IT'S VALUABLE, THEY WANT TO COMMUNICATE ELECTRONICALLY, THEY'RE JUST LIKE YOU KNOW, EVERYONE ELSE, MY TEENAGE DAUGHTER THEY WANT TO E-MAIL--THEY WANT TO TEXT YOU. SO REALLY TAKING THOSE LESSONS LEARNED REALLY BUILT UPON WHAT WE PROPOSED IN OUR CURRENTLY ENGAGING IN THIS THE CONSORTIUM PROJECTS. YOU SEE THEM LISTED HERE. AND I'M GOING THROUGH EACH ONE PREVLY. SO THE FIRST--I'M NOT EVEN GOING TO READ THIS VERY LONG NAME, THIS WAS AGAIN DESIGN BY COMMITTEE. YOU WILL SEE THE COMMITTEE IN A SECOND, BUT OUR NEW NAME IS iPI LIKE iPHONE SOPHISTICATED THAT'S NEWLY DONE BY THE ADVISORY BOARD. WE TRULY HAVE BOT TOGETHER AGAIN A MULTIDISCIPLINARY TEAM, FAMILY MEDICINE, PEDIATRICIANS INNORMATTICS, TEST GUY, PLATFORM AND ALL THESE PEOPLE COMING TOGETHER AGAIN TO EXPAND THE CADRE OF ORAL HEALTH DISPARITIES RESEARCHERS, BUILDING UP ON WHAT DR. GARCIA MENTIONED FOR OUR SUCCESSES. SO WE'RE WORKING WITH COMMUNITY HEALTH CENTERS AND WHY COMMUNITY HEALTH CENTERS? WELL, THAT'S SORT OF--IT MAKES SENSE BECAUSE THAT'S REALLILY WHERE THE MOST VULNERABLE CHILDREN ARE RECEIVING THE BULK OF THEIR MEDICAL CARE. SO TO GO TO WHERE THE KIDS ARE IS REALLY--MAKES THE MOST SENSE TO US. AND ALSO TO HELP, TO REALLY INCORPORATE AN INTERVENTION THAT'S NOT JUST WILL STAND ALONE FOR THE CHILD AND THEIR FAMILY, BUT TO REALLY--TO MAKE IMPROVEMENTS AND BUILD CAPACITY WITHIN THE COMMUNITY HEALTH CENTER ITSELF, TO HELP THEM TO REALLY INTEGRATE THOSE BEST PRACTICES THAT DR. FONTACIN THIS, A TALKED ABOUT IN SO WHY TEXT MESSAGING IN OUR PROGRAM, IT IS PERVASIVE IN OUR CULTURE, IT ISs BECOME SADLY FROM MY PERSPECTIVE, BUT ONE OF THE MOST COMMON FORMS OF COMMUNICATION BUT REALLY IT ALIGNS WITH THE POPULATIONS THAT ARE MOST AT RISK. IF YOU SEE THE SLIDES HERE THAT IT'S ACTUALLY THOSE THAT ARE EIGHT GREATEST RISK FOR DISEASE THAT ACTUALLY TEXT THE MOST. THEY DO THE MOST TEXT AND THEY ARE ACTUALLY MOST LIKELY TO USE THEIR PHONES TO GATHER HEALTH INFORMATION. SO IT IS A PERFECT ALIGNMENT SO REALLY USING TEXT MESSAGING WHAT WE'RE CONSIDERING A PROVIDER EXTENDER SO YES WE DON'T WANT TO CHANGE WHAT HAPPENS IN IF THE PATIENT ENCOUNTER, STILL DO THE FLUOREDUCATIONAL VARNISH, ANTICIPATEATORY GUIDANCE BUT STILL DO MORE IN THE CLINIC VISIT THAT'S WHERE WE SEE THE TEXT MESSAGING HAVING THE IMPACT. I AM NOT GOING TO GO OVER ALL OF THESE. YOU CAN READ THEM. I WILL HEIGHT LIGHT A COUPLE, THE AVAILABILITY TO TAYLOR CONTENT, SO, OUR PROGRAM HAS THE ABILITY TO TAKE THE INFORMATION THAT OUR PARTICIPANTS GIVE US IN OUR BASELINE QUESTIONNAIRES AND THEN POLLS ON THEIR PHONES AND TRACK CHANGES TO TAYLOR THE TEXT MESSAGING IN TERMS OF WHERE THEY ARE, THEIR RISK FACTORS AND BEHAVIORS, THROUGHOUT THE PROJECT SO IT TRULY IS CUSTOMIZABLE. AND THEN, YES IT IS RESOURCE INTENSIVE IN TERMS OF DEVELOPING THE INTERVENTION AND IT IS PLATFORM, BUT, THE GENERALIZABILITY AND THE ABILITY TO DISSEMINATE THIS VERY BROADLY AT VERY LOW COST IS AS OPPOSE TO THESE FACE-TO-FACE ENCOUNTERS IS REALLY HUGE. SO WHERE WE ARE NOW. WE'RE IN OUR DEVELOPMENTAL PHASE, THE UHTWO, WORKING WITH ALL OF OUR STAKEHOLDERS IN A VERY ITERATIVE PROCESS TO REFINE THE MESSAGES THAT WE'VE ALREADY DEVELOPED AS PART OF THE PUBLIC HOUSING WORK AND THEN DEVELOPING THE TEXT MESSAGING PLATFORM DELIVERY IN THIS HAVING VERY THOUGHTFUL PILOT TESTING THROUGHOUT SO THAT IT REALLY IS USER FRIENDLY, AND ACCESSIBLE TO SOUR POPULATION. AND REALLY WITH THE ULTIMATE GOAL OF USING THIS IN THE UH-THREE AS INTERVENTION AND EXTENDER WHICH WILL THEN AGAIN HAVE A HARD CARRIES OUT COME OF ECC INCIDENTS OVER TWO YEARS. BUT ALSO LOOKING AT OTHER THINGS YOU SLEEP APNEA AND OBESITYY AS THE SCREEN AS OUR OUTCOMES. AND JUST FOR THOSE OF YOU WHO--OOPS, SORRY ARE INTO THEORY. WE ARE GROUNDED IN THEORY. AND I DON'T EXPECT YOU TO READ THIS YOU BI WANT TO GIVE YOU A SENSE OF HOW COMPLICATED THIS ALL IS, SO WE HAVE CHILD LEVEL, FAMILY LEVEL, PROVIDER COMMUNITY HEALTH CENTER LEVEL, AND THEN HAVE YOU ALL OF THE CONSTRUCTS IN OUR THEORY AND WITHIN EACH OF THOSE CELLS WE HAVE MULTIPLE MEASURES THAT WE NEED TO COLLECT. SO DOING THIS WORK IS VERY COMPLICATED. IT'S VERY CHALLENGING. OBVIOUSLY, THE PEOPLE HERE IN THIS ROOM THINK AND MYSELF INCLUDED, THE MOST REWARDING. SO OUR SECOND PROJECT USING SOCIAL NETWORKING TO IMPROVE ORAL HEALTH DR. GARCIA IS THE PIOO, HE'S THE INVESTIGATOR DOING WORK WITH NEW ADDITIONS. AND THE IDEA HERE IS TO REALLY UNDERSTAND SOCIAL NETWORKS, HOW PEOPLE RECEIVE AND GIVE INFORMATION TO ACTUALLY VERY THOUGHTFULLY AND SYSTEMATICALLY USE THOSE NETWORKS AS DELIVERY POINTS FOR INFORMATION, COUNSELING THAT WILL HELPFULLY LEAD TO CHANGES IN KNOWLEDGE, CHANGES IN BEHAVIOR AND ULTIMATE GOAL MAILLOTLY, CHANGES IN HEALTH STAT US. AND BUILDING UPON OUR PREVIOUS WORK, WORKS AND EXTENDING WHAT WE'VE DONE IN PUBLIC HOUSING, BECAUSE AGAINST HAVE YOU THIS CONCENTRATED GROUP OF UNDERSERVED VULNERABLE POPULATIONS FOR HIGH RISK DISEASE, A PERFECT NETWORK TO REALLYY ANALYZE AND WE HAVE A LONG STANDING PARTNER THISSHIP THIS--PARTNERSHIP IN THIS AND THEN ALSO THE ABILITY OF ASSESSING SOCIAL NETWORKS IN PUBLIC HOUSING. SO THEY'RE NOW IN THE MIDST OF THEIR DEVELOPMENTAL PHASE, GETTING READY TO ENROLL THE PILOT SO TO TEST MEASURES, DEVELOP ACCIDENT THE MESSAGING SIMILAR TO WHAT WE'RE DOING IN A TEXT MESSAGING PROCESS AND THEN UNDERSTANDING THE CONTEXT AND ASSESSING THOSE MEASURES. SO THAT WE CAN REALLY UNDERSTAND THE IMPACT OF CONTEXT IN SOCIAL NETWORKS AND PUBLIC HOUSING. AND THEN DR. GARCIA TALKED A LOT ABOUT THE SCHOLARS AND REALLY--THE CAPACITY WITHIN ORAL HEALTH DISPARITIES RESEARCH FIELD BUT I ALTS WANTED TO JUST EMPHASIZE HERE THE OTHER PART OF THE SLIDE, THE COMMUNITY ENGAGEMENT AND REALLY THE IMPORTANCE THAT ALL THE RESEARCHERS HAVE PLACED IN THIS THE ORAL HEALTH DISPARITIES FIELD ON USING TWO COMMUNITY BASED PARTICIPATORY RESEARCH BY ENGAGING THE COMMUNITIES IN ALL LEVELS, BUILDING CAPACITY WITHIN THOSE COMMUNITIES, HAVING INTERVENTIONISTS BE FROM THE COMMUNITIES, HAVE THEM WORK WITH US ON DESIGNING AND REVIEWING OR INSTRUMENTS TO MAKE SURE THAT, YOU KNOW THE LANGUAGE THAT WE'RE USING MAKES SENSE AND THAT WE'RE COLLECTING GOOD DATA. MENT AND YOU KNOW WORKING WITH THE COMMUNITY HEALTH CENTERS TO REALLY BUILD THAT CAPACITY, BECAUSE THAT IS REALLY WHAT WE BELIEVE IS THE STANDARD OF CARE. YOU KNOW ANYTHING THAT WE DO OVERAND ABOVE IS THE PROVIDER EXTENDER, WE EXPECT TO BE DONE WITHIN THE FIELD OF YOU KNOW THE CHILDREN GETTING THE BEST SERVICES BY THE COMMUNITY HEALTH INTERN MEDICAL TEAM AS POSSIBLE. SO THANK YOU. WE WILL TAKE ANY QUESTIONS YOU MIGHT HAVE. [ APPLAUSE ] >> ONE QUESTION. >> I GUESS I WOULD LIKE TO MAKE A COMMENT. IF YOU MAKE TRAINING TO THE COMMUNITY, BUT TRAINING GOES LOTS OF DIFFERENT WAYS. >> THANK YOU. >> OKAY WE WILL MOVE ON TO OUR FINAL TALK FOR THE MORNING SESSION. DR. MARTIN. >> HOW DO I GET TO THE FINAL--THANK YOU. WELL, THANKS AGAIN IF THIS OPPORTUNITY TO BE HERE SPEAKING WITH YOU ALL, MY TALK IS DIFFERENT THAN THE OTHER TWO. I'M GOING TO DO COMMUNITY HEALTH WORKS 101 BASICALLY IN 20 MINUTES. SO WE'LL--WE'LL SEE HOW FAR WE GET. I WILL TRY NOT TO TALK TOO FAST BUT I WILL TALK ABOUT BRIEFLY ABOUT COMMUNITY LEVEL HEALTHCARE AND COMMUNITY HEALTH WORKER BASICS, EVIDENCE, POLICY, SOME QUESTIONS AT RESEARCH AND POLICY TO DIRECTORS AND THEN A BRIEF GRIPGZ OF OUR PROJECT THAT'S FUNDED THROUGH THIS COLLABORATIVE. SO THIS IS THE FAMILIAR KIND OF SLIDE THAT MANY OF HAVE YOU SEEN. WE SPEND MORE ON HEALTHCARE THAN ANYONE ELSE IN THIS COUNTRY AND YET WE HAVE WORSE OUTCOMES, RIGHT? SO NOTHING NEW. I'M NOT SURE IF YOU THOUGHT IT THIS WAY BEFORE. NOW PAUL FARMER SHARED WITH US AT ONE POINT, BUT THINKING ABOUT THE U.S. HEALTHCARE SYSTEM, WE HAVE A VERY STRONG TERTIARY CARE SYSTEM, RIGHT? SO HOSPITALS OR HOSPITALS ARE FANTASTIC, CUTTING EDGE TECHNOLOGY, TREATMENTS FOR DISEASES HERE IN THE UNITED STATES, WE HAVE A PRETTY GOOD OUTPATIENT CLINICAL CARE SYSTEM, AS WELL IN THE UNITED STATES BUT WE HAVE ALMOST NO COMMUNITY LEVEL CARE AND THIS IS IN CONTRAST TO DEVELOPING NATIONS MANY OF WHICH HAVE VERY STRONG COMMUNITY LEVEL CARE SYSTEMS WITH ALMOST NO TERTIARY CARE AT ALL. AND THE WAY THAT THEY ACHIEVE THAT IS OFTEN THROUGH COMMUNITY HEALTH WORKERS SO THIS IS AN OPPORTUNITY HERE FOR US IN THE UNITED STATES TO THINK ABOUT WAYS THAT WE CAN BUILD OUR COMMUNITY LEVEL CARE AND USING EVIDENCE AND RESOURCES AND MODELS THAT HAVE BEEN DEVELOPED AND BUILT UP IN OTHER AREAS. SO THIS IS THE AMERICAN HEALTH PUBLIC ASSOCIATION DEFINITION OF COMMUNITY HEALTH WORKERS, FRONT LINE PUBLIC HEALTH WORKERS WHO ARE TRUSTED MEMBERS OF AND HAVE AN UNUSUALLY CLOSE UNDERSTANDING OF THE COMMUNITY SERVED SO COMMUNITY HEALTH WORKERS BUILD INDIVIDUAL AND COMMUNITY CAPACITY BY INCREASING HEALTH KNOWLEDGE AND SELF-SUFFICIENCY THROUGH A RANGE OF ACTIVITIES SUCH AS OUTREACH, EDUCATION, COUNSELING, SOCIAL SUPPORT AND ADVOCACY. HOW DO THEY WORK, IT'S REALLY THROUGH EMPOWERING, THROUGH EMPOWERING COMMUNITY MEMBERS TO IDENTIFY NEEDS AND SOLUTIONS. THIS IS A QUOTE THAT CAPTURES BETTER THAN ANY DEFINITIONS: IT MAY BE THE VERY FACT THAT COMMUNITY HEALTH WORKERS ARE NOT EXPERTS THAT THEY MOST LIKELY DO NOT DIFFER IN TERMS OF EDUCATION, POWER, SOCIAL CAPITAL THAT MAKES THEM MOST EFFECTIVE WITH THEIR CLIENTS. THERE'S A LOT OF NAMES FOR COMMUNITY HEALTH WORKERS. IT'S IMPORTANT TO THINK ABOUT THE CLASSIFICATION, ISM A WORKFORCE, I'M ALSO A PEDIATRICIAN, THERE'S SUBCATEGORIES UNDER THE TOP CATEGORY SOW YOU WILL HEAR COMMUNITY HEALTH WORKERS IN MANY WAY, THE BOSTON PROJECT, HAS COMMUNITY HEALTH WORKERS, IENT KNOW IF YOU DO, BUT YOU DO RIGHT SHRKS THERE'S MANY TERMS AND ONE BIG CHALLENGE IS IN THE FIELD TRYING TO GET ALL THE PEOPLE TALKING THE SAME LANGUAGE, AND YOU DON'T HAVE TO CALL THEM THAT BUT THEY DO FALL INTO THAT CLASSIFICATION. SOMETIMES THAT IS ALL IT IS IS THE SPANS INCREASE IN BODY TRANSLATION OF WHAT IS A COMMUNITY HEALTH WORKER BUT PROMOTORSs ARE WORKING IN A COMMUNITY BUT THEY'RE WORKING UNDER A DIFFERENT THEORY AND MODEL THAN WHAT COMMUNITY HEALTH WORK E-PRESCRIBINGS DO SO IT'S IMPORTANT WHEN YOU'RE WORKING WITH A GROUP THAT CALLS THEMSELVES PROMOTORES, RECOGNIZE THAT THEY'RE USING THE LATIN SOCIAL THEORY MOT MODEL OR THE MORE STANDARD U.S. COMMUNITY HEALTH MODEL. COCHRAN DID A REVIEW AND ANOTHER IN 2010 ON COMMUNITY HEALTH WORKERS, POSITIVE ASSOCIATIONS AROUND IMMUNIZATION, INFECTIOUS DISEASE, TB, MATERNAL CHILD HEALTH, THINGS AHRQ DID A REVIEW ABOUT THEREY'S MIXED EVIDENCE AROUND THE EFFECTIVENESS. THE STRONGEST EVIDENCE WERE IN THE AREAS OF CARDIOVASCULAR DISEASE AND THEN AREAS OF PEDIATRIC ASTHMA. THERE'S A LOT MORE REFERENCES I COULD INCLUDE HERE BUT TO BRIEFLY SUM UP, THE EVIDENCE IN DIABETES ARE GETTING THERE, THEY ARE PRETTY STRONG, THERE'S REALLY GOOD EFFICACY STUDIES NOW SHOWING REDUCTIONS IN HEMOGLOBIN ACONE CNO, SIR POPULATIONS THAT RECEIVE COMMUNITY HEALTH WORKERS COMPARED TO CONTROLS, HOWEVER THESE HAVE NOT MOVED INTO THE EFFECTIVENESS STAGE YET, IN ASTHMA THE DATA ARE ALREADY TO THE POINT WHERE PEOPLE ARE DOING COST ANALYSIS ON THESE, BUT YET, STILL MORE WORK NEEDS TO BE DONE ON EFFECTIVENESS AND MORE WORK NEEDS TO BE DONE IN ADULT ASTHMA, MOST OF THIS HAS BEEN DONE IN THE AREA OF PEDIATRIC ASTHMA. CANCER SORT OF ACROSS THE BOARD, SO MANY KINDS OF CANCERS RIGHT, SO THERE'S A LOT OF COMMUNITY HEALTH WORKER EVIDENCE COMING OUT OF THE CANCER FIELDS. IT'S HARD IN, YOU KNOW 25 PRINUTE TALK TO SUMMARY THE EVIDENCE AROUND THAT BUT IT'S DEFINITELY BUILDING AND THEN FOR HYPER ATTENTION AND STROKE THERE'S GOOD EFFICACY AND MOVING INTO EFFECTIVENESS DAT AROUND BLOOD PRESSURE AND CARDIOVASCULAR DISEASE WITH HEALTH WORKER INTERVENTIONS. ORAL HEALTH JUST GETTING STARTED. SO SEARCHING THE LITERATURE FOR COMMUNITY HEALTH WORKER INTERVENTIONS THERE ARE NO TRIALS THAT COULD BE FOUND ON-GOING WITHIN THE UNITED STATES THERE ARE SOME WORKED ON WITH BRAZIL WITH HOME NUTRITION VISITS WITH SUPPORT, IN NEW ENGLAND WITH EDUCATORS WITH AUSTRALIA WITH HOME VISIT AND IT IS TELEPHONE CONTEXT BY WHAT THEY CALL ORAL HEALTH THERAPISTS ALL OF THESE SHOWED REDUCED INCIDENT AND THESE ARE ALL SHOWING THE TREND IN THE DIRECTION WE WANT TO GO BUT WE'RE THE MOST ROBUST STUDIES AS WE WOULD NEED IN ORDER TO BE CONFIDENT IN THIS. IN THE UNITED STATES THERE IS A PROGRAM OF COMMUNICATED DENTAL HEALTH COORDINATORS WORKING IN UNDER SERVED NATAL AND RURAL AMERICAN COMMUNITIES AND THEY DON'T HAVE OUTCOME DATA YET BUT THE PROCESS DATA ARE PROMISING AND INDIAN HEALTH SERVICES AS WELL AS WORK NOTHING THE AREA OF ORAL HEALTH. I'M GOING TO JUMP INTO POLICY FOR A MINUTE. THERE'S A LOT ON THIS SLIDE BUT BASICALLY COMMUNITY HEALTH WORKERS WERE FORMALLY RECOGNIZED IN 1962 AS PART OF THE FEDERAL MIGRANT HEALTH ACT AND ECONOMIC STUDENTS ACT AGAIN IN 1964. INDIAN HEALTH SERVICES TRAINED AND DEPLOYED THE FIRST FEDERALLY FUNDED COMMUNITY HEALTH WORKERS WHICH THEY CALL COMMUNITY HEALTH REPRESENTATIVES AND THEY ARE CALLED CHRs TODAY. IN 2002, THE IOM REPORT ON UNEQUAL TREATMENT CALLED FOR SUPPORT AND EVALUATION OF COMMUNITY HEALTH WORKER AND INTEGRATION AND MEDICAL TEAMS AND IN 2007, THE AMERICAN PUBLIC HEALTH ASSOCIATION CREATED THE COMMON DEFINITION WHICH I SHARED WITH YOU WHICH IS THE MOST USED DEFINITION AND IN 2009 THE U.S. DEPARTMENT OF LABOR CREATED A STANDARD OCCUPATIONAL CLASSIFICATION FOR COMMUNITY HEALTH WORKERS. THE AFFORDABLE CARE ACT DOES SPECIFICALLY ADDRESS COMMUNITY HEALTH WORKERS AND IF YOU WANT TO FIND IT, SECTION 5313. AND THEN IN JULY OF 2013 CMS ALSO ISSUED A FINAL RULE. NOW WHAT THIS DOES IS THIS IT PAVES THE WAY FOR YOU TO BILL MEDICAID FOR COMMUNITY HEALTH WORK SERVICES, SO IT'S THERE, IT'S WRITTEN. IS IT BEING USED? I'M NOT AWARE THAT MOST PEOPLE MOST STATES ARE UNABLE TO ACTUALIZE THIS. A LITTLE BIT IN DIABETES. WE HAVEN'T BEEN ABLE TO DO IT AT ALL IN ASTHMA OR SOME OF THE OTHER AREAS, SO ACCIDENT EVEN THOUGH THIS DOES EXIST AS AN OPPORTUNITY, IT'S ABILITY TO BE REALIZED IS STILL LIMITED. THE NATIONAL ACADEMY FOR STATE HEALTH POLICY, HOW THE WEBINAR LAST YEAR FOR HOSPITAL ADMINISTRATORS, ACROSS THE COUNTRY AND THEY TELL ME THIS WAS THE--ONE OF THE HIGHEST ATTENDED WEBINARS THEY EVER HAD AND THEY ASKED A LIVE POLE DURING THE WEBINAR WHAT IS YOUR BIGGESTCHALLENGE OR HURDLE, AND HEALTHCARE SYSTEMS AND NUMBER ONE WAS FINANCING. NUMBER TWO WAS DEFINING ROLES AND SCOPES OF PRACTICE AND IN THE FIELD FEEL IT'S ACTUALLY DEFINE THE ROLES AND SCOPES OF PRACTICE SO THAT CAN YOU GET THE FINANCE LINGS FIGURED OUT, SO EVERYTHING'S CONNECTED. AND THIS IS HAPPENING, SO IF YOU GO TO EITHER THESE TWO WEB SITES, WELL, IF YOU GO TO THE STATE ONES CAN YOU SEE WHAT'S GOING ON IN YOUR STATE SO ALMOST EVERY STATE HAS SOME EFFORTS TOWARDS COMMUNITY HEALTH WORKER LEGISLATION THAT'S HAPPENING RIGHT NOW. THERE'S ALSO A NATIONAL MOVEMENT, THEY JUST RELEASED THEIR GUIDELINES COUPLE WEEKS AGO IF YOU GO TO THE C-THREE PROJECT THIS WEB SITE HERE YOU WILL SEE THE RECOMMENDATION SO THESE ARE OPPORTUNITIES FOR STATES TO AND GOALS FOR FINANCING AND HOW THEY'RE GOING TO MOVE FORWARD. LET SO THEIR EVIDENCE IS--I DON'T KNOW STRONG MAYBE THAT MIGHT BE OVERSTATING IT BUT THERE'S PROMISING EVIDENCE IN MANY CHRONIC DISEASE AREAS ALTHOUGH A LOT OF HOLD UPS AROUND THE EFFECTIVENESS DATA AND THE ORAL HEALTH FIELD IS WEAK BUT BUILDING. THE IMPLEMENTATION OF COMMUNITY HEALTH WORKER SYSTEM MOVING FORWARD REGARDLESS OF EVIDENCE. SO THERE'S A LOT OF WORKFORCE AND FUNDING ISSUES THAT NEED TO BE FIGURED OUT AND NATIONAL AND STATE LEGISLATION IS IN PROGRESS. THERE'S BIG QUESTIONS OUTSTANDING. THESE ARE CAN BE ANSWERED THROUGH RESEARCH AND POLICY. I WILL HIT SOME BIG ONES BUT WHAT DOES IT MEAN TO BE FROM THE COMMUNITY? BECAUSE COMMUNITY HEALTH WORKERS ARE SUPPOSED TO BE FROM THE COMMUNITY? THAT DOES MEAN YOU MATCH THE TARGET POPULATION IN YOUR RACE OR ETHNICITY? IN YOUR SOCIOECONOMIC STATUS IN? YOUR DISEASE? YOU HAVE TO HAVE HAD CHILDREN TO BE AN ORAL HEALTH COMMUNITY HEALTH WORKER FOR PEOPLE--FOR FAMILIES WITH YOUNG CHILDREN? DO YOU HAVE TO HAVE ASTHMA TO BE A COMMUNITY HEALTH WORKER? THESE ARE ALL QUESTIONS EVERYONE'S ASKING, IS A COLLEGE DEGREE REQUIRED? COLLEGE DEGREE, DOES THAT SEPARATE YOU TOO FAR FROM WHAT YOU'RE TALKING ABOUT. WHERE DO COMMUNITY HEALTH WORKERS BELONG? DO THEY BELONG IN THE HOSPITALS, DO THEY BELONG IN THE COMMUNITIES OR WHERE ARE THEY FALLING WITHIN THE SPECTRUM OF WHERE PEOPLE LIVE AND WHERE PEOPLE CONNECT TO THE SYSTEMS. AND ANOTHER WAY OF THINKING, ARE WE ADAPTING COMMUNITY MEMBERS TO THE HEALTHCARE DELIVERY SYSTEM, IS THAT WHAT THE GOAL OF THIS IS, OR THAT WE'RE ADAPTING THE HEALTHCARE SYSTEM TO THE COMMUNITY ENVIRONMENT SO IT DEPENDS WHICH LENS YOU TAKE THAT DICTATES HOW COMMUNITY HEALTH WORKER ARE GOING TO BE OPERATIONALLIZED AND IMPLEMENTED. SHOULD COMMUNITY HEALTH WORKERS DO GROUP VERSUS INDIVIDUAL? HOW MANY SESSIONS ARE NEEDED? HOW MANY NEEDED IN ORDER TO MAINTAIN BEHAVIOR OVERTIME? SAME FOR EVERYONE? THESE ARE HUGE QUESTIONS PEOPLE ARE STRUGGLING WITH? HOW YOU YOU ENGAGE COMMUNITY HEALTH WORKERS INTO CLINICAL TEAMS, COMMUNICATION, ROLES IN TEAMS? WHAT ABOUT EFFECTIVENESS? HOW DO WE MAINTAIN THESE EFFECTS AS A NUMBER OF CLINICAL TARGETS INCREASE? THOSE WORKING WITH PEOPLE WITH DIABETES AND WITH HEART DISEASE AND WITH FORM OF CANCER AND YOU HAVE A COMMUNITY HEALTH RISK THAT'S HELPING THE FAMILY WITH ALL OF THESE THINGS. HOW DO WE WRAP OUR HEADS AROUND THE OUTCOMES WE ARE SEEING THERE. WHO SHOULD BE TRAINING THEM, SHOULD THEY BE CERTIFIED, LICENSED? AND WHO PAYS? SO I'M GOING TO PREVLY THEN TALK ABOUT HOW WE OPERATIONALLIZED THESE QUESTIONS INTO OUR STUDY THAT'S FUNDED BY NIDCR IN CHICAGO. SO WE CALL OURSELVES CO-OP CHICAGO AND WE'RE IT'S FUNDED THROUGH THE COLLABORATIVE THAT WAS ALREADY DESCRIBED. WE'RE IN THE UH-TWO PHASE RIGHT NOW. OUR AIM IS A BIT BEESY OUR UH-TWO PHASE IS FOCUSED ON FORMALIZE THE ABILITY TO TEST A COMMUNITY OF HEALTH WORKER INTERVEKS FAR ORAL HEALTH FOR YOUNG CHILDREN LOOKING AT UNDER THE AGE OF THREE TO IMPROVE ORAL CHILD HEALTH BEHAVIORS AND HOW DOES THAT WORK BEST. DOES IT WORK BEST OR WORK AT ALL. FIRST OF ALL AND DOES IT WORK BEST IN A CLINIC BASED AND I'M TALKING ABOUT A PEDIATRIC CLINIC BASED MEDICAL CLINIC BASED SYSTEM WHICH IS A W. I. C. SO WOMEN, INFANTS AND CHILDREN WHERE PEOPLE GO FOR COUPONS OR MILK OR FOR HOME AND/OR IN A COMBINATION OF ALL OF THAT: AND YOU PROBABLY, MOST YOU CAN'T READ THIS BECAUSE IT'S PROBABLY REALLY, REALLY SMALL BUT THIS IS HOW--THIS IS HOW WE'RE GOING TO DO THIS. UPON IS WE'RE GOING TO START WITH A GROUP OF CLINICS, ABOUT 10 OF THEM. THEY WILL BE CLUSTER RANDOMIZED SO HALF OF THE CLINICS ARE GOING TO BE USUAL CARE CLINICS WHICH MEANS THEY OPERATE AS USUAL. HALF OF THEM WILL BE ENHANCED AND THEY HAVE AN ORAL HEALTH COMMUNITY HEALTH WORKER ASSIGNED TO THE CLINIC AND WITHIN THOSE CLINICS BOTH THE EUROPE CARE AND ENHANCED THEY RECRUIT PARTICIPANTS FOR THE STUDY, THOSE PARTICIPANTS ARE RANDOMIZED TO RECEIVE WORK FROM HEALTHCARE WORKERS AS WELL OR USUAL CARE. SO THEN HAVE YOU A CELL AND LET'S SEE IF IT I CAN MAKE THIS WORK. SO HAVE YOU A CELL WHERE THERE'S ONE GROUP THERE AND THEY'RE IN A USUAL CARE CLINIC SO THERE'S NO COMMUNITY HEALTH WORKER IN THE CLINIC BUT THEY'RE GETTING VISITS IN THE HOME. THEN THERE'S A CELL WHERE THEY GET JUST USUAL CARE, EVERYTHING, ONE CELL IS GETTING COMMUNITY HEALTH WORKER VISITS IN THE HOME AND IN THE CLINIC SO THEY'RE GETTING A DOUBLE DOSE BUT IN TWO DIFFERENT SETTINGS. SO WE'RE TRYING TO SEE WHAT HAPPEN WHEN IS YOU BRING CONTINUITY ACROSS THE HOME AND INTO THE CLINIC AND BACK AND THEN ONE GROUP THAT'S GETTING ONLY CLINIC COMMUNITY HEALTH WORKER VISITS AND THEN THE SAME THING IN THE WICs. SO WHAT ABOUT WHEN YOU TAKE IT OUT OF THE MEDICAL SETTING AND YOU PUT IT IN A COMMUNITY SETTING AND YOU STILL HAVE THE SAME QUESTION. SO DELIVERING ORAL HEALTH EDUCATION FROM A COMMUNITY HEALTH WORKER IN A COMMUNITY SETTING WHERE YOU'RE ALTS GOING TO GET NUTRITION COUNSELING AND THINGS LIKE THAT, VERSES SOMEONE WHO COMES INTO YOUR HOME AND DRYING TO UNDERSTAND THE DIFFERENCES THAT MAY OR MAY NOT RESULT IN THAT. AND YOU CAN HOPEFUL LOAMACYY SEE HOW IT TIES BACK TO A LOT OF QUESTIONS WE RAISED ABOUT THE WHERE AND THE HOW AND THE WHO. AND WE'RE TRYING TO CHIP AWAY AT THOSE QUESTIONS AT LEAST AS IT RELATES TO ORAL HEALTH BEHAVIORS. WE'RE USING AN IMPLEMENTATION AIM WORK SO WE'RE USING THE STRATEGY WE WANT TO UNDERSTAND THE REACH OF THIS INTERVENTION, EFFICACY WHICH WILL BE ORAL HEALTH BEHAVIORS, THE ADOPTION THROUGH THE CLINICS AND THE W. I. C. SITES, IMPLEMENTATION AND MAINTENANCE. SO MAYBE IT DOES IMPROVE ORAL HEALTH BEHAVIOR BUS THE CLINICS AND THE W. I. C. FEEL LIKE OH MY GOD IT'S AWFUL. WE CAN'T STAND IT. IT DOESN'T WORK WITHIN OUR SYSTEM, WE NEED TO UNDERSTAND THAT. OR THEY SAY WE LOVE IT BUT WE DON'T KNOW HOW TO SUSTAIN IT. SO WE'RE LOOKING AT ALL OF THOSE THINGS IN THIS STUDY TO UNDERSTAND THE FUTURE OF THIS INTERVENTION. WE'RE ALSO LOOKING AT ORAL HEALTH QUALITY OF LIFE, BEHAVIOR FOR THE ACCESS, CHILD AND CAREGIVER, FAMILY ORAL HEALTH ACCESS, CO MORID BITS, CAREGIVER PSYCHOLOGICAL FUNCTIONING SOCIAL SUPPORT AND FAMILY FUNCTIONS BUT I DON'T HAVE A SLIDE IN HERE BUT THIS IS HOW THE CHW SHOULD WORK THROUGH SOCIAL SUPPORT AND FUNCTIONING AND THEN OF COURSE COST. AND THAT'S IT. [ APPLAUSE ] >> OKAY, QUESTIONS FOR DR. MARTIN? >> ONE SLIDE ON THE AFFORDABLE CARE ACT AND THE FAILURE TO IMPLEMENT--YEAH, FANTASTIC, THANK YOU: SO WHY IS THAT, YOU KNOW THE COMMUNITY HEALTH WORKFORCE NOT REALLY--THEY PUT IT IN THE LEGISLATION, IT'S NOT BEING DONE. THIS REMINDING ME OF MEDICAID COVERAGE NOT IN COMMUNITY HEALTH, MEDICAID DOESN'T COVER A LOT OF DEPTAL CARE WHAT APPROACHES OR ARE YOU USING APPROACHES TO TRY TO CHANGE THAT SO THAT CAN YOU GET IT COVERED? OR YOU CAN GET IT IMPLEMENTED? , I KNOW MY QUESTION'S NOT CLEAR. I APOLOGIZE FOR THAT. >> WELL THERE'S EFFORTS ON A LOT OF DIFFERENT LEVELS AND IT VARIES STATE BY STATE CAN RIGHT? WHICH ONE OF THE BIGGEST CHALLENGES BECAUSE NATIONALLY THOSE OF US WHO WHEN RHYME SAYING US WITH THIS HAT, I'M TALKING ABOUT GROUPS LIKE THE AMERICAN HEALTH PUBLIC HEALTH ASSOCIATION AND ALSO THE GROUP THAT PUT OUT THE NATIONAL RECOMMENDATIONS SO THE CTHREE CONSORTIUM ARE TRYING TO PROVIDE GUIDELINES FOR STATE TO USE TO DWEAP WITHIN THE THEIR STATEMENT SYSTEM THAT SHOULD WORK. RIGHT? WE'RE TRYING TO USE THE BEST KIND OF DESIGNS THAT HAVE WORKED IN OTHER STATES AND RECOMMEND HOW OTHER STATES CAN USE THIS. BUT WHEN IT REALLY COMES DOWN TO IT, MEDICAID VARIES BY STATE. IMPEDIMENTS ELIMINATED IS A DISASTER, OKAY? IN ILLINOIS WE HAVEN'T HAD A BUDGET. WE ARE GOING ON MONTH 11 WITHOUT A BUDGET IN OUR STATE. SO WE ARE--NO ONE'S PAYING FOR OUR VARNISH, NOTHING IS GETTING PAID FOR EXCEPT FOR THE BARE MINIMUM SO THERE'S NO WAY THAT WE CAN OPERATIONALLIZE SOMETHING LIKE THIS IN OUR STATE WHEN WE CAN'T PAY OUR BASIC BILLS, RIGHT. BUT THERE'S EFFORTS THROUGH ADVOCACY GROUPS AND OTHERS TO TRY TO EDUCATE US TO HOW THIS WORKS AND THEN ALSO TO JUST MOVE IT FORWARD SO THAT STATES THAT ARE MORE STABLE IN THIS BUDGET AND THEIR OPERATIONS COULD ACTUALIZE THIS AND THIS IS WHERE THE DISEASE AREAS HAVE TO LEARN FROM EACH OTHER SO DIABETES ONE OF THE RULES IS THAT YOU HAVE TO BE--THE COMMUNITY HEALTH WORKERS ARE NOT CLINICAL PROVIDERS. I THINK I MADE THAT CLEAR BUT THEY DON'T HAVE ANY ARE THE SORT OF--THEY'RE NOT NURSES, DOCTORS, THEY DON'T HAVE A LICENSE OR ANYTHING, WE CAN'T BE BILLING FOR HEALTH SERVICES BUT IF THEY'RE SUPERVISED BY DIABETES EDUCATOR BUT THEY'RE RUNNING A DIABETES CLASS, THE DIABETES EDUCATOR CAN BUILD FOR THE CLASS AND SO THE WAY THAT'S DESIGNED IS THE COMMUNITY HEALTH WORKER DELIVERS THE CLASS UNDER THE SUPERVISION OF A DIABETES EDUCATOR THAT CAN BE BUILT. SO THIS IS WHAT THE MODEL IS TRYING TO BE SUPPORTED THROUGHOUT THE DIFFERENT DISEASE STATE AND DIABETES AS FAR AS I CAN UNDERSTAND, THE FILE GOES ON AND THE NAVIGATION TO HAVE SOME SUPPORT FOR CANCER SO IT'S JUST LITTLE BABY STEPS IT DEPENDS ON THE STAGE AND WHERE THEY'RE AT. >> DOCTOR? >> JUST A QUICK QUESTION, THOSE COMMUNITY HEALTH WORKERS AND THE VARIOUS SITES ARE THEY GOING TO BE ABLE TO GET TOGETHER AND SHARE THEIR EXPERIENCES? >> OKAY, SO A REGULAR BASIS. >> SURE, THEY WILL ALL BE EMPLOYED BY ME, BY UIC, RIGHT, SO EVEN THOUGH THEY'RE IN THESE SITES, THE HOME BASE WILL BE THE UNIVERSITY SITE AND THIS IS A DIFFERENT MODEL THAN WHAT WE'RE DOING IN THIS SOME OTHER AREAS WHERE WE HAVE GROUPS OF COMMUNITY HEALTH WORKERS THAT ARE EMPLOYED BY DIFFERENT INSTITUTIONS SO FOR INSTANCE THIS HAS BT BEEN DEMONSTRATED YET SO FOR A FEASIBILITY POINT, IT'S TREME LINE LIKE IF WE'RE GOING TO HOLD THE WORKERS AND THE SITES, IF WE SHARE THEM AMONGST THE SITE BUT I CAN SAY IN OTHER WORK THAT WE DO, WE DO EMPLOY COMMUNITY WORKERS IN DIFFERENT INSTITUTIONS AND THERE'S COORDINATING CENTER THAT COORDINATES THEM AND TRIES TO KEEP THE FIDELITY AND IT'S MESSY, I'LL TELL YOU, IT'S MESSY, BUT IT'S VERY IMPORTANT. ONE OF THE THICK THING THAT GETS MISSED IS THE RECOGNITION THAT THERE'S ONLY A GOOD AS THEIR SUPER VISOR, SO IN ORDER TO HAVE AN EFFECTIVE TRAPPING AND IMPLEMENTATION PROGRAM FOR COMMUNICATION, YOU HAVE TO HAVE EFFECTIVE AND CLEARLY DEFINED SUPERVISION PROTOCOL AND THAT ENCLOUDS SOMEONE WHO'S GOING TO HAVE SOMEONE WHO WILL HELP THEM THROUGH THE BASIC ACCORD NATIONS THEY'RE EXPECTED TO DO AND ALSO THE BURRED OWNS THAT THEY WILL TAKE ON WHICH ARE HUGE AND HOW THEY MANAGEMENT AND THEIR OWN KIND OF LIFE STRUCTURING BECAUSE YOU KNOW YOU PAY THEM 35,000 A YEAR. THEY'RE NOT NECESSARILY COMING WITH A LOT OF RESOURCES OR SKILLS OTHER THAN INTERPERSONAL THEMSELVES. SO IT'S IMPORTANT TO HAVE ROUTINE STRUCTURED SUPERVISION AND SUPPORT. A LOT OF TIMES WE HAVE THESE TEAMS RUN BY PSYCHOLOGIST BECAUSE THEY NEED THAT LEVEL OF SUPPORT. IN ORDER TO LEARN HOW TO BE SUCCESSFUL IN THEIR JOB. >> THANK YOU. INTRIGUED BY YOUR QUESTIONS BUT WHAT DOES IT MEAN TO BE FROM THE COMMUNITY AND WHAT QUALIFICATIONS ARE IMPORTANT? DO THEY HAVE TO BE A PARENT, WHAT TYPES OF QUALIFICATIONS ARE YOU SELECTING FOR YOUR COMMUNITY HEALTH WORKERS OR THE DIFFERENT SITES AND THE W. I. C. SITES GOING TO BE CHOOSING WHO THEY WANT TO BE THE COMMUNITY HEALTH WORKERS. >> AGAIN THEY ARE GOING TO BE HIRED BY MY TEAM SO WE GET TO SET THE BAR ON THEM, SO OF COURSE, IN COLLABORATION, JUST LOOK WEEK, THEY CHALLENGED ME AT ONE OF THE WICs AND SAID, WELL, WE WON'T HIRE PURE LACTATION CONSULTANTS UNLESS THEY'VE HAD A BABY SO HOW ARE YOU GOING TO HIRE COMMUNITY HEALTH WORKER FIST YOU HAVEN'T HAD A BABY AND I WAS LIKE--I I'LL GET BACK TO YOU ON THAT. WE HAVE A YEAR TO GO BEFORE WE HIRE THEM. SO WE HAVE TIME TO WORK IT OUT. I DIDN'T SAY YES OR NO. I DON'T KNOW. WILL I DON'T KNOW WHAT THE RIGHT THING IS AND WE STRUGGLE WITH THIS IN THE COMMUNITY HEALTH WORKER FIELD, YOU KNOW A COMMUNITY HEALTH WORKER WHEN YOU SEE ONE, RIGHT? SO ONE THING A LOT OF THESE WORKFORCEST GROUPS IF YOU LOOK AT THE--WHAT THE STATES ARE PUTTING FORWARD. THEY'RE LISTING ROLES, SKILLS THEY'RE ALSO LISTING QUALITY AND THESE ARE THE THINGS YOU LOOK FOR, I DON'T REALLY CARE WHAT YOUR DEGREE IS AS LONG AS CAN YOU SATISFY THE QUALITIES THAT I NEED YOU TO HAVE AND YOU UNDERSTAND KIND OF THE ROLE THAT I'M ASKING OF YOU, THE GROUPS THAT I PARTICIPATE IN WE HAVE THEM ROLL PLAY AND DO ENGAGEMENT ACTIVITIES BEFORE WE HIRE THIS UNDERSTAND THEIR INTERPERSONAL SKILLS BECAUSE IT'S REALLY A KEY IN TERMS OF WHO GETS TIRED ON THAT, WE'RE EDUCATING THE CLINICS AND THE W. I. C.s IN THIS PROJECT AS TO WHAT IS THE COMMUNITY HEALTH WORKER THEY HAVE PURE CONSULTANTS WITH THE WORKER BUT THEY DON'T HAVER ALTHOUGH HEALTH COMMUNITY HEALTH WORKERS THEY'RE WORKING UNDER THE SAME MODEL AND THAT'S WHAT WE MODEL THIS MEDIATE RICKS CLINIC INTERVENTION--PEDIATRIC INTERVENTION AFTER, IN THERE SHE DARTS IN THERE AND TALK ABOUT CHILD DEVELOPMENT. WE'RE HOPING THEY CAN WORK WITH THE FAMILIES AROUND THEIR VISIT WITH THE FOCUS, SO IT'S A PROCESS OF GETTING THEM REALLY TO BED AND IT'S A REAIM FOCUS ON OUR EVALUATION TO UNDERSTAND WHAT THEY WANT OUT OF THIS AND IF THEY GET WHAT THEY NEED AND IF THIS IS SOMETHING USEFUL BECAUSE IF WE DON'T JUST THROW IT AT THEM AND HIRE COMMUNITY HEALTH WORKERS THAT THEY WOULD WOULD HAVE ANY IDEA WHAT TO DO. >> WE WILL OPEN UP THE DISCUSSION TO ANY OF THE SPEAKERS AND ANY OTHER QUESTIONS OR COMMENTS. >> QUICKLY. I THOUGHT ULTIMATELIA THE PRESENTATIONS WERE FABULOUS. THANK YOU REALLY GREAT. I QUESTION, I THINK FOR DR. HENSHAW, WHEN YOU WERE TALKING ABOUT COMMUNITY ENGAGEMENT IS THAT ALSO CORPORATE SPONSORS PRODUCT, ALL THIS THAT THING, TO ALL OF YOU IS THAT SOMETHING THAT YOU DO. >> I THINK [INDISCERNIBLE] >> TRY TO USE THE MICROPHONE, PLEASE. >> ESPECIALLY FOR THIS LAST TWO ROUNDS OF FUNDING IT HAS FOCUSED ONLY ON THE COMMUNITY AS OUR TARGET OR CORPORATE SPONSORSHIP AND CREATE ONE WHERE WE HAD MANY MORE SMALLER PROJECTS, AND RESOURCE COLLABORATIONS AND HAD MORE SPINOFFS BUT RIGHT NOW, NO. >> [INDISCERNIBLE]. OF THE. >> YEAH AND ONCE WE HAVE OUR RESULTS, WE WILL BE KNOCKING ON YOUR DOOR AND TO HELP WITH THAT DISSEMINATION AND IMPLEMENTATION. >> OTHERS? OKAY, THEN LET'S THANK ALL OF OUR SPEAKERS AGAIN. THE OPEN SESSION IS NOW CONCLUDED. COUNCIL MEMBERS NOW PLEASE MEET FOR LUNCH IN ROOM SEVEN DOWN PAST THE LOBBY ON THE RIGHT HAND SIDE. THE AFTERNOON SESSION WILL START AT 1:30 FOR THE BFC REPORT, STAFF SHOULD BE READY TO RETURN AROUND TWO. WE HOPEFULLY THE BSC SESSION WON'T TAKE TOO LONG. [ APPLAUSE ] THANK YOU.