GOOD MORNING, EVERYBODY. WELCOME TO THE 216TH COUNCIL, AND TO OUR COUNCILMEMBERS, THANK YOU AGAIN AS ALWAYS FOR SERVEING, AND TO THE OUTSIDE COMMUNITY WHO HAVE JOINED US TODAY AND THE VIRTUAL COMMUNITY THAT'S HERE AS WELL. WE HAVE AN INCREDIBLY FULL AGENDA OF LOTS OF EXCITEMENT, SO I'LL JUST MOVE FORWARD WITH WHAT'S GOING ON. SO THE FIRST ORDER -- BUT I DON'T SEE THE PHOTOGRAPHER. OH, GREAT. OKAY. SO THE VERY, VERY IMPORTANT THING, AND IT GETS COMPLICATED ALSO, IS THAT WE HAVE THREE PEOPLE HERE THAT ARE DEPARTING AND I JUST WANT TO THANK THEM FOR ALL THEIR SERVICES AND ALSO BECAUSE OF LOGISTICS AND TAKING TIME TO APPOINT THE NEW PEOPLE, WHILE TWO OF THEM, AND I'LL INTRODUCE THEM LATER, HAVE JOINED US FOR TODAY, THEY HAVE YET TO BE APPROVED, SO WE HAVE YOU COMING BACK FOR THE JANUARY COUNCIL, AND WE THANK YOU FOR THAT AS WELL. SO WITH THAT, WE HAVE A TINY, TINY, TINY LITTLE GIFT AND CERTIFICATE FOR YOU, AND SO DR. OAKLANDER. COME ON OVER. YOU GET A CERTIFICATE AND A LETTER BY DR. PRICE. ALL RIGHT. [APPLAUSE] DR. TANNER, ANNE TANNER IS OUR NEXT PERSON WITH A WONDERFUL BAGGIE. THANK YOU. [APPLAUSE] DR. JAIN WEINTRAUB. [APPLAUSE] >> AGAIN, THANK YOU VERY, VERY, VERY MUCH FOR YOUR SERVICES. SO THE NEXT THING IS THE NEW MEMBERS, AND I'D LIKE TO JUST BRIEFLY INTRODUCE THEM, AND THANK YOU AGAIN FOR SERVING. FIRST IS DR. DAVID COOPER, WHO'S A CLINICAL PROFESSOR IN THE DEPARTMENT OF BIOSTATISTICS AT THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL. HE SPECIALIZES IN THE COORDINATION OF MULTICENTER OBSERVATIONAL STUDIES AND CLINICAL TRIALS. WE SO MUCH NEED THIS. HE OBTAINED HIS PH.D. FROM THE UNIVERSITY OF WASHINGTON, AND WORKED AT THE EPIDEMIOLOGY RESEARCH CENTER IN AUSTRALIA BEFORE MOVING TO UNC IN 1998. HIS FIRST INVOLVEMENT WITH DENTAL RESEARCH WAS WITH DENTAL ATHEROSCLEROSIS IN RISK COMMUNITIES, HE IS NOW COORDINATING CENTER P.I. OF THE STUDY. SUBSEQUENTLY, HE SERVED AS A BIOSTATISTICIAN IN THE DATA COORDINATING CENTER FOR PERIODONTITIS AND VASCULAR EVENTS, ALSO CALLED PAVE, WHICH IS A PILOT STUDY, AND HE'S ALSO THE DATA COORDINATING CENTER P.I. FOR MATERNAL ORAL HEALTH TO REDUCE OBSTETRIC RISK CALLED CLINICAL TRIAL. HE'S A FREQUENT AM CAUTIOUS REVIEWER AND HAS BEEN A STATISTICAL REVIEWER FOR THE JOURNAL OF PERIDONE WILLING TO AND JOURNAL OF CLINICAL PERIDONETOLOGY AS WELL AS MANY OTHER JOURNALS. PLEASE WELCOME HIM. [APPLAUSE] AND THANK YOU FOR COMING FOR THIS ONE, AND TO YOU AS WELL, DR. JOYCE DELEO, UNIVERSITY OF OKLAHOMA SCIENTIST CENTER. SHE DID HER PREDOCTORAL RESEARCH AT THE MAX PLANCK INSTITUTE OF PSYCHIATRY IN GERMANY UNDER A FULBRIGHT SCHOLAR SHIP. SHE THEN FOLLOWED THIS BY POSTDOCTORAL STUDIES AT HARVARD AND AT DARTMOUTH MEDICAL SCHOOL. SHE WAS THE IRENE HINES GIBBON GIBBON -- WITH 23 YEARS OF CONTINUAL FUNDING BY BOTH NIH AND INDUSTRY, AND A RECIPIENT OF NUMEROUS AWARDS. THE GOAL OF HER RESEARCH WAS TO DISCOVER DRUGS WITH NOVEL MECHANISMS FOR TREATMENT AND PREVENTION OF CHRONIC PAIN WITH A FOCUS ON GLIO-NEURONAL INTERACTIONS. SHE COFOUNDED SOLAS PHARMACEUTICALS, INCORPORATED, WHICH WAS DEVELOPED TO IDENTIFY NEW NON-ADDICTIVE DRUGS FOR THE TREATMENT OF CHRONIC PAIN. AND FROM 2011-15 AT EMANUEL COLLEGE IN BOSTON, MASSACHUSETTS. SHE IS NOW AN EXECUTIVE CONSULTANT IDENTIFYING LEADERSHIP SOLUTIONS FOR ORGANIZATIONS COMMITTED TO IMPROVING THE QUALITY OF LIFE, SPECIALIZING IN HEALTHCARE, ACADEMIC MEDICINE, HIGHER EDUCATION, AND PHARMA LIFE SCIENCES. PLEASE WELCOME HER. [APPLAUSE] THE THIRD PERSON WAS UNABLE TO ATTEND TODAY, AND THAT'S DR. CLARKE STANFORD. DR. STANFORD IS THE DEAN OF THE DENTAL SCHOOL AT UNIVERSITY OF ILLINOIS-CHICAGO, AND HE'S THE UIC DISTINGUISHED PROFESSOR IN THE DEPARTMENTS OF DENTAL ADMINISTRATION AND RESTORATIVE DENTISTRY, AND ALSO A PROFESSOR IN THE DEPARTMENT OF BIOENGINEERING AT THE COLLEGE OF ENGINEERING. YOU WILL HEAR MORE ABOUT HIM WHEN HE ATTENDS IN JANUARY, SO THANK YOU VERY MUCH. AND NOW WE'RE GOING ON TO NEW STAFF INTRODUCTIONS. SO FIRST PERSON IS JOHN PRU. >> HELLO, EVERYBODY. THANK YOU VERY MUCH FOR ALLOWING ME TO INTRODUCE MR. DON SEE MOHR. JOHN IS JOINING US AS OUR NEW INSTITUTE SYSTEMS SECURITY OFFICER. DON RECEIVED HIS B.A. FROM TULANE UNIVERSITY AND A J.D. FROM GEORGE WASHINGTON LAW EURT SCHOOL. DON'S PROFESSIONAL FOCUS SHIFTED INTO INFORMATION TECHNOLOGY IN 2005. HE JOINED THE NIH'S NATIONAL CANCER UNS NATIONAL CANCER INSTITUTE'S I.T. PROGRAM IN THE DESKTOP SUPPORT ROLE AND THEN MOVING INTO NETWORK ENGINEERING. IN 2009, DON BEGAN WORKING AND SPECIALIZING IN I.T. SECURITY, AND HE BECAME A MEMBER OF NCI'S HIGHLY REGARDED I.T. SECURITY TEAM. IN 2013, DON TOOK A POSITION WITH NIH'S OFFICE -- THE NIH OFFICE OF THE DIRECTOR IN THEIR INFORMATION SECURITY PROGRAM AND HELPED TO MANAGE NIH'S SECURITY OPERATIONS. FOR THREE YEARS, HE ASSUMED -- AND THREE YEARS LATER, HE ASSUMED A FEDERAL POST AT NIH'S CENTER FOR INFORMATION TECHNOLOGY AS THEIR INFORMATION SYSTEM SECURITY OFFICER, AND AT THIS POSTING, HE ALSO YOU A SEUMED THE ASSUMED THE FEDERAL LEAD FOR THREAT MITIGATION AND INCIDENT RESPONSE FOR ALL OF NIH. MOST RECENTLY, HE SERVED AS THE FEDERAL LEAD FOR VULNERABILITY MANAGEMENT, AND THE NIH LEAD FOR HHS'S CONTINUOUS DIAGNOSTICS MITIGATION PROJECT. SO WE'RE DELIGHTED TO HAVE DON JOIN NIDCR AND I LOOK FORWARD TO HIS EXPERTISE IN HELPING US KEEP OUR CUTTING EDGE SECURITY AND TECHNOLOGY PROGRAM MOVING FORWARD. SO PLEASE JOIN ME IN WELCOMING DON TO NIDCR. [APPLAUSE] >> CAROL LOOS IS OUR NEXT PERSON THAT'S GOING TO INTRODUCE SOME PEOPLE. >> GOOD MORNING. IT IS MY PLEASURE TO INTRODUCE MATTHEW SIERRA, HE'S OVER THERE WAVING. MATT JOINS NIDCR AS A BUDGET ANALYST IN THE FINANCIAL MANAGEMENT BRANCH. HE IS A RECENT GRADUATE OF THE NIH PRESIDENTIAL MANAGEMENT FELLOWS PROGRAM. DURING THIS PROGRAM, HE COMPLETED MULTIPLE ROTATIONAL ASSIGNMENTS IN DIFFERENT CAREER FIELDS, INCLUDING COMMUNICATIONS, ADMINISTRATION, GRANTS MANAGEMENT, AND BUDGET. PRIOR TO COMING TO THE NIH, MATT SERVED AS A PROGRAM SUPPORT ASSISTANT AT THE DEPARTMENT OF VETERAN AFFAIRS, WHILE ALSO SERVING IN THE NEW YORK STATE AIR FORCE NATIONAL GUARD. PRIOR TO THIS, HE SERVED SIX YEARS IN THE UNITED STATES ARMY, COMPLETING SEVERAL TOURS OF DUTY THROUGHOUT THE U.S. AND ABROAD. HE HOLDS A MASTER'S DEGREE IN BUSINESS ADMINISTRATION FROM MARIS COLLEGE AND HAS AMBITIONS OF COMPLETING HIS PH.D. IN BUSINESS. HE WAS RAISED IN DUCHESS COUNTY, NEW YORK. HIS PASSIONS INCLUDE TECHNOLOGY, ENGINEERING, TRAVEL, AND SPENDING TIME WITH HIS WIFE AND DOG. PLEASE JOIN ME IN WELCOMING MATT TO NIDCR. [APPLAUSE] >> NOW WE HAVE DR. BRUCE TO INTRODUCE A BUNCH OF PEOPLE. >> GOOD MORNING AND HAPPY FRIDAY. I HAVE FIVE PEOPLE AND I'M GOING TO BREEZE THROUGH THIS PRETTY FAST FOR YOU. FIRST OUR SPONSOR DENTAL PUBLIC HEALTH FELLOWS THIS YEAR. FIRST IS COMMANDER CATHY BUSS, CATHY IS FROM THE UNITED STATES NAVY. SHE RECEIVED HER DENTAL DEGREE FROM THE UNIVERSITY OF IOWA AND HER MPH FROM UNIFORM SERVICES UNIVERSITY ACROSS THE STREET HERE IN BETHESDA. CATHY'S INTERESTS INCLUDES MILITARY COMMUNITY HEALTH AND PATIENT SAFETY. HER PROJECT IS ON PATIENT SATISFACTION ACROSS THE ENTIRE DOD. OUR NEXT INDIVIDUAL IS MAJOR DAVID SCHINDLER FROM THE U.S. AIR FORCE. DAVID RECEIVED HIS DENTAL DEGREE FROM THE VIRGINIA COMMONWEALTH UNIVERSITY, AND HIS MPH FROM UNIFORM SERVICES UNIVERSITY ACROSS HERE IN BETHESDA AS WELL. DAVE'S INTEREST IS IN MILITARY READYINESS AND GLOBAL HEALTH. DAVE'S PROJECT IS LOOKING AT ORAL HEALTH STATUS AMONG OUR VETERANS AND NON-VETERANS IN THE UNITED STATES. OUR THIRD INDIVIDUAL IS LIEUTENANT COMMANDER JUSTIN VOSS. JUSTIN IS FROM THE U.S. PUBLIC HEALTH SERVICE. HE'S CURRENTLY ASSIGNED WITH THE BUREAU OF PRISONS. JUSTIN RECEIVED HIS DENTAL DEGREE FROM THE UNIVERSITY OF DETROIT MERCY AND HIS MPH FROM UNIVERSITY OF NORTH CAROLINA. JUSTIN'S INTEREST IS IN HEALTH ECONOMICS, HEALTH POLICY EVALUATION, AND HIS CURRENT PROJECT WILL BE LOOKING AT SUBSTANCE ABUSE AND ORAL HEALTH STATUS. MOVING ON TO OUR STIPEND AWARD FELLOWS, WE HAVE TWO THIS YEAR. OUR FIRST ONE IS DR. DAVIE WHO RECEIVED HER DENTAL DEGREE IN INDIA, MPH FROM JOHNS HOPKINS UNIVERSITY, AND HER INTEREST IS IN HEALTH SYSTEMS POLICY FOR LOW AND MIDDLE INCOME COUNTRIES AND PREVENTIVE DENTISTRY AND NUTRITION. REMEMBER RESEARCH PROJECT IS LOOKING AT NUTRITION BENEFITS SUCH AS SNAP, WIC, AND ORAL HEALTH AMONG CHILDREN IN THE UNITED STATES. FINALLY I'D LIKE TO INTRODUCE DR. CHANDRA SHANDOKARNUM. HE IS OUR FIRST FELLOW, THIS IS OUR JOINT PROGRAM WITH THE NATIONAL LIBRARY OF MEDICINE AND NIDCR. HE RECEIVED HIS DENTAL DEGREE IN INDIA, PH.D. IN EPIDEMIOLOGY AND PUBLIC HEALTH IN INDIA, AND A MASTER'S IN BIOETHICS FROM THE UNIVERSITY IN BELGIUM, AND CHANDRA'S INTERESTS INCLUDES EPIDEMIOLOGY, HEALTH SYSTEMS ANALYSES, INFORMATICS, BIOETHICS, AND HE'S CURRENTLY WORKING ON AN INFORMATICS PROJECT LOOKING AT OPIOID ABUSE AND PRESCRIPTIONS FOR OPIOIDS, THOSE RECEIVE PRESCRIPTIONS FOR ANTIBIOTICS AND OPIOIDS IN EMERGENCY ROOM DEPARTMENTS IN THE UNITED STATES. THANK YOU VERY MUCH. [APPLAUSE] >> THANK YOU FOR THAT. NOW I'D LIKE TO GO AROUND THE ROOM FOR VIS VISITORS WHO ARE HERE TODAY TO INTRODUCE THEMSELVES. WE'LL START THIS WAY AND GO AROUND. SO DO WE HAVE ANY VISITORS OUTSIDE ON THIS SIDE? YES? >> [INAUDIBLE] >> WELCOME. >> -- FROM THE AMERICAN DENTAL ASSOCIATION. >> CAROLYN BELLER [INAUDIBLE] [GUEST INTRODUCTIONS] >> ALL RIGHT. WELCOME, EVERYONE. PLEASE A REMINDER THAT WE ARE PROVIDING REMOTE ACCESS TO THE OPEN SESSION TODAY BY WEBCASTING THE PROCEEDINGS. I'D LIKE TO EXTEND AN EXTRA WELCOME TO OUR VIRTUAL PARTICIPANTS AND FOR ANYONE IN THE ROOM WHO'S SPEAKING, PLEASE TRY TO USE THE MICROPHONES SO THAT THE VIRTUAL PARTICIPANTS CAN HEAR YOU. IF ANYONE IN THE ROOM EXPERIENCES A PROBLEM WITH YOUR LAPTOP COMPUTER, WE HAVE SOME PEOPLE FROM OUR I.T. GROUP HERE TO HELP YOU OUT. JOHN, OF COURSE, UP HERE IN THE FRONT, AND ALBERT OVER HERE IN THE BACK. JUST RAISE YOUR HAND AND THEY'LL COME OVER AND GIVE YOU SOME ASSISTANCE. THE FIRST ITEM -- OR THE NEXT ITEM ON THE AGENERAL KA IS THE AGENDA IS A PPROVAL OF THE MINUTES FROM THE PREVIOUS MEETING, SO THE MINUTES FROM THE MAY MEETING ARE AVAILABLE TO THE MEMBERS FOR THEIR REVIEW. DOES ANYONE HAVE ANY COMMENTS OR CORRECTIONS FOR THE MAY COUNCIL MINUTES? IF NOT, WOULD A MEMBER OF COUNCIL LIKE TO MAKE A MOTION TO APPROVE THE MINUTES? SECOND? ALL IN FAVOR OF APPROVING THE MINUTES? ANY OPPOSED? THANK YOU. THE MINUTES ARE APPROVED. NOW I WILL PASS THE MICROPHONE BACK TO DR. SOMERMAN, WHO WILL PRESENT HER REPORT TO COUNCIL FOLLOWED BY AN UPDATE ON THE OPIOID CRISIS FROM DR. JOHN KUSIAK, ACTING DEPUTY DIRECTOR, AND DR. YOLANDA VALLEJO, PROGRAM DIRECT FOR OF NEUROSCIENCE. >> GREETINGS AGAIN, EVERYBODY. SO WE HAVE AN INCREDIBLY EXCITING AND FULL AGENDA TODAY. ONE OF THE THINGS -- WELL, WE HAVE MANY THINGS WE WANT TO ADD AND WE KEPT ADDING AND ADDING, SO WE'RE ALREADY RUNNING LATE, BUT THAT'S OKAY. WE'LL JUST KEEP YOU HERE ALL DAY. BUT IMPORTANTLY, SO ONE IS THANK YOU FOR THE VISITORS THAT HAVE TRAVELED FROM SOME VERY DIFFICULT SITUATIONS AND I HOPE YOUR FAMILIES AND YOUR FACULTY AND EVERYBODY IN YOUR VARIOUS PLACES ARE HANDLING THE SITUATION, SO REALLY THANK YOU FOR THAT. I HAVE FOUR AREAS THAT I'M GOING TO GO THROUGH VERY BRIEFLY. I DID WANT TO MENTION THE -- YOU'RE GOING TO HEAR MORE ABOUT THE DENTAL STUDENT TRAINING PROGRAM IN A BIT. BUT I JUST WANTED TO TELL YOU, WE'VE HAD LIKE TWO DAYS OF JUST WONDERFUL GATHERINGS AND ACTIVITIES WITH THE DENTAL STUDENTS, PH.D.s, AND THIS IS MORE THOSE IN THEIR FIVE, SIX, SEVEN, EIGHTH YEAR, SO THE MORE SENIOR YEARS OF THEIR CAREER, AND A LOT OF EXCHANGE AND INTERACTION, AND SPECIAL CALLOUT TO DR. LYNN KING AND DR. LESLIE AND THEIR DIRECTOR, DR. ALICIA DOM BROS CAN DOMBROSKI, FOR PUTTING AN INCREDIBLE PROGRAM TOGETHER AND THE MANY, MANY, MANY STAFF THAT WERE ENGAGED OVER THE LAST TWO DAYS. AND YOU'LL HEAR MORE ABOUT THIS. I JUST WANTED TO BRIEFLY MENTION THE NIDCR ENVISIONING THE FUTURE, AND I THINK MANY OF YOU ARE AWARE OF THIS, BUT FLASHBACK A MOMENT, OUR STRATEGIC PLAN IS ALWAYS OUR STRATEGIC PLAN. IT'S 2014 TO 2019. THE INITIATIVES YOU ARE GOING TO HEAR TODAY ARE SEPARATE FROM THE STRATEGIC PLAN. PEOPLE SOMETIMES GET CONFUSED AND SAY WAIT A SECOND, YOU DIDN'T INCLUDE THIS, YOU DIDN'T INCLUDE THAT. WE HAVE. BUT WE HAVE SOME NEW AND EXCITING INITIATIVES TO HEAR TODAY AS WELL. BUT IF YOU GO BACK TO 2030, THIS WAS ABOUT ALMOST A YEAR AGO WHEN WE SAID THREE R01s AWAY, IT'S NOW ABOUT TWO-PLUS R01s AWAY, BUT WE THOUGHT BEYOND THE STRATEGIC PLAN, BEYOND OUR INITIATIVES, THAT WE NEEDED TO TAKE SOME RISK, AND I THINK THIS IS A VERY GOOD TIME TO TAKE RISKS AND BE BOLD ABOUT WHERE WE'RE GOING. AND IMAGINING 2030, WHERE DENTAL OROCRANIAL FACIAL DISEASE ARE UNDERSTOOD IN THE CONTEXT OF THE WHOLE BODY, RESEARCH INFORMS THE STRATEGIES THAT WE USE TO PROMOTE HEALTH, PREVENT AND TREAT DISEASE AND OVERCOME DISPARITIES, AND EVERYBODY, ALL PEOPLE, HAVE THE OPPORTUNITY TO LEAD HEALTHY LIVES. WE SET FIVE DIFFERENT AREAS AND WE USE AN IDEA SCALE TO GET FEEDBACK ON THESE SPECIFIC AREAS. WE THOUGHT WE'D GET AROUND 200, AND WE REACHED OUR GOAL AND BEYOND IN TERMS OF IDEAS. WE ALSO GOT VOTES AND COMMENTS. IT WAS AN INCREDIBLY EXCITING TIME. THESE IDEAS HAVE BEEN REVIEWED, AND WE ARE GOING TO BE DISCUSSING THEM WITH COUNCIL DURING LUNCHTIME, SO WE LOOK FORWARD TO AN EXCITING INTERACTION WITH COUNCIL ON THESE TOPICS. AS WE MOVE FORWARD, WE ALSO HAVE ALREADY PUT IN PLACE AN AUTO THERAPY SYMPOSIUM AND WORKSHOP SCHEDULE FOR JANUARY 25TH AND 26TH. SO TWO THINGS I WANT TO MENTION IF I DIDN'T MENTION, COUNCIL WOULD SAY WHERE IS THIS, WHAT'S GOING ON? SO ONE, THERE'S A LOT OF BUZZ ABOUT CLINICAL TRIALS, AND THE NEXT VERSION OF THIS, AND SO WHAT IS A CLINICAL TRIAL? THERE IS A NEW DEFINITION. I STRONGLY ENCOURAGE YOU TO GO ON THE WEBSITES AND TAKE A LOOK AT THIS, BUT IT'S A RESEARCH STUDY IN WHICH ONE OR MORE HUMAN PART PARTICIPANTS ARE PROSPECTIVELY ASSIGNED TO ONE OR MORE INTERVENTIONS. AND THERE'S SOME CONCERN OF WHAT THAT MEANS, AND WE'LL GET TO THAT ON THE NEXT SLIDE, BUT I THINK IT'S IMPORTANT THAT WE REMEMBER WHAT THE AIM WAS. AND IS. AND SO THE AIM IS REALLY TO ENHANCE THE STEWARDSHIP, INCREASE ACCOUNTABILITY, TRANSPARENCY, EFFICIENCY, AND DISSEMINATION OF THE RESULTS. MANY OF THE CLINICAL TRIALS ARE NOT POSTED. MANY OF THE THINGS THAT HAVE BEEN DONE BEFORE ARE NOT KNOWN AND PEOPLE REPEATED, SO THERE'S REALLY A NEED TO INCREASE THE POSTING OF THESE CLINICAL TRIALS. IT'S JUST HOW TO DO IT AND WHEN TO DO IT AND SO THERE ARE SOME NEW GUIDELINES THAT ARE GOING TO BE FOLLOWED AS IF YOUR TRIAL IS NOW THAT YOU NEVER CONSIDERED BEFORE A CLINICAL TRIAL, AND NOW IT IS, INCLUDING GOOD CLINICAL PRACTICE TRAINING, THAT'S IMPORTANT, THERE WILL ALSO BE CLINICAL TRIAL SPECIFIC FOAs FUNDING OPPORTUNITY ANNOUNCEMENTS. THERE'S GOING TO BE, IN ADDITION TO THE FIVE USUAL CRITERIA, WE'RE GOING TO HAVE ADDITIONAL -- ONE ADDITIONAL ONE, STUDY TIMELINE AND MILESTONES AND THAT'S SOMETHING THAT WE REALLY WANT ON CURRENT GRANT PROPOSALS THAT ARE BEING SUBMITTED. THEN THERE'S GOING TO BE ADDITIONAL REPORTING MECHANISMS AND WHILE WE WANT TO REDUCE THE BURDEN TO THE OUTSIDE COMMUNITY IN TERMS OF LAYERS AND LAYERS OF ADMINISTRATION, WE'RE HOPING AS TIME GOES ON WITH THIS, THAT IT WILL BE PRETTY SMOOTHLY GOING. SO IF YOU GO ON THE WEBSITE AND TAKE A LOOK AT A CLINICAL TRIAL, IF YOU CAN SAY YES TO ALL FOUR OF THESE, DOES IT INVOLVE HUMAN SUBJECTS, ONE OR MORE INTERVENTIONS, PROSPECTIVELY ASSIGN HUMAN SUBJECTS, AND OBVIOUSLY DOES IT HAVE A HEALTH-RELATED BIOMEDICAL OR BEHAVIORAL OUTCOME. SO ONE IS GOING ON THE WEBSITE, ONE IS GOING ON OPEN MIC, THAT'S DR. LOWRY'S BLOG, BUT THE OTHER IS CALL YOUR PROGRAM OFFICERS, DON'T FORGET TO DO THAT. NO MATTER WHAT, WHETHER YOU THINK IT IS A CLINICAL TRIAL OR NOT, JUST GIVE A CALL. SO WE WILL BE MOVING FORWARD WITH THIS AND RECOGNIZE THE COMMUNITY HAS SOME ANGST ABOUT IT. THE OTHER AREA THAT HAS GOTTEN A LOT OF BUZZ IN THE NEWSPAPERS AND ELSEWHERE RELATES TO GRANT AWARDS BY CAREER STATE. IF YOU REMEMBER, THIS WAS A DIRECTIVE TO THE DIRECTOR OF NIH BASED ON THE 21ST CENTURY CURE ACT. SO IT'S SOMETHING THAT HAS TO BE DONE. MOREOVER, IT'S SOMETHING WE AT NIDCR HAVE BEEN PAYING CLOSE ATTENTION TO ALREADY, AND SO HAVE ALL THE OTHER INSTITUTES AND CENTERS. SO THE RECOGNITION AS YOU CAN SEE FROM THIS GRAPH THAT EARLY STAGE INVESTIGATORS, AS WELL AS THE EARLY ESTABLISHED INVESTIGATORS, WERE REALLY DECLINING IN THEIR SUCCESS RATE IN OBTAINING GRANTS, AND SO THE GOAL IS TO INCREASE THE NUMBER OF INVESTIGATORS BY 200 IN BOTH THE ESTABLISHED AS WELL AS THE EARLY STAGE INVESTIGATOR FOR NEXT YEAR OVER THIS YEAR. HOW DO YOU DEFINE EARLY STAGE INVESTIGATOR? THIS IS A P.I. OR P.D. WHO HAS COMPLETED THEIR TERMINAL RESEARCH DEGREE OR END OF A POSTGRADUATE CLINICAL TRAINING, WHICHEVER COMES FIRST, WITHIN THE LAST 10 YEARS, AND WHO HAS NOT PREVIOUSLY COMPETED SUCCESSFULLY FOR A SUBSTANTIAL NIH AWARD. THE ESTABLISHED PERSON IS ONE WHO IS WITHIN 10 YEARS OF RECEIVING THEIR FIRST SUBSTANTIAL INDEPENDENT COMPETING NIH R01 OR EQUIVALENT AWARD AS AN EARLY ESTABLISHED INVESTIGATOR. SO WITH THAT, WHAT HAVE WE BEEN DOING? WE ALREADY HAVE HAD EFFORTS TO EXTEND THE PAY LINES AND THIS IS SOMETHING ACROSS THE INSTITUTES AND CENTERS, AND ALSO A GREATER EMPHASIS ON THE FUNDING, ESPECIALLY THE EARLY ESTABLISHED. IN FACT, THERE ARE SEVERAL INSTITUTES THAT HAVE WORKED ON THIS AND WE HAVE SOMETHING CALLED THE SAW AWARD, WHICH IS SUSTAINING OUTSTANDING ACADEMIC -- NO, IT'S ACHIEVEMENT IN RESEARCH, ALL THESE DIFFERENT AK NISMS, BUT THAT'S THE SAR AWARD. LAST YEAR WE GAVE TWO AWARDS IN THIS AREA. THIS YEAR WE DECIDED BECAUSE OF THE IMPORTANCE ON EMPHASIZING THIS FOUR, AND WHILE WE MO MONITOR IT CAREFULLY WITH MILESTONES, THESE ARE AWARDS FOR THE EARLY ESTABLISHED INVESTIGATOR. JUST A MOMENT ON BUDGET. FINALLY SOME GOOD NEWS. ALL OF THIS IS INTERESTING AND ACTIVE, BUT THIS IS ONE WHERE OUR CONTINUING RESOLUTION WAS ACTUALLY -- CONGRESS IS MOVING CLOSING THE SESSION FOR THIS FISCAL YEAR, SO WE NOW KNOW THAT FOR 2017, THE BUDGET IS 425.75, AND THIS IS GOING TO BE THE SAME FOR FY18, TILL DECEMBER 8TH, AS A CONTINUING RESOLUTION. SO WITH THAT, I THANK YOU, I WILL TAKE A MOMENT OF QUESTIONS IF THERE'S ANY BURNING QUESTION, OTHERWISE I'D LIKE TO MOVE ON TO OUR NEUROSCIENCE EXPERTS TO TALK ABOUT THE OPIOID CRISIS. SO ANY MAJOR QUESTIONS FROM COUNCIL? NO. OKAY, LET'S GO. LET'S MOVE ON. THANK YOU VERY MUCH. >> SO GOOD MORNING, EVERYONE. SO WHAT WE'LL BE DOING TODAY IS TO GIVE YOU JUST A BRIEF UPDATE FROM THE NIH AND FROM NIDCR ON WHAT WE ARE DOING WITH REGARD TO THE OPIOID CRISIS THAT'S PRESENT IN THE UNITED STATES RIGHT NOW. SO I JUST HAVE A COUPLE OF INTRODUCTORY SLIDES TO SHOW YOU WHERE WE ARE, AND WHAT'S GOING ON. US A KNOW, THE OPIOID OVERDOSE DEATH RATE HAS INCREASED DRAMATICALLY IN THE PAST 12 TO 15 YEARS OR SO, INCREASING ALMOST TENFOLD IN MANY PARTS OF THE UNITED STATES, AND WITH THE MAP OF THE UNITED STATES ON THE RIGHT-HAND SIDE, IT SHOWS THAT IT'S KIND OF -- IT'S UNIVERSAL, IT'S ACROSS THE ENTIRE COUNTRY, THERE ARE HOT SPOTS IN NORTHERN NEW ENGLAND, APPALACHIA, FLORIDA, AND THE DESERT SOUTHWEST, BUT IT IS TRULY A NATIONAL PROBLEM. SO THE NEXT SLIDE IS SORT OF GOOD NEWS/BAD NEWS. AND THE GOOD NEWS IS -- THE SORT OF GOOD NEWS IS THAT OPIOID PRESCRIPTIONS ARE FALLING IN THE UNITED STATES, SO SINCE 2010, THEY'VE DECREASED ABOUT 15%. HOWEVER, REGARDLESS OF HOW IT'S MEASURED, WHETHER IT'S MILLIGRAM EQUIVALENTS OF OPIOIDS OR WHETHER IT'S OPIOID PRESCRIPTIONS, IT'S STILL ABOUT THREE TO FOUR FOLD HIGHER THAN IT WAS IN THE EARLY 90s. ON THE RIGHT-HAND SIDE, OF COURSE, IS THE BAD NEWS, WHICH YOU'VE ALL BEEN READING ABOUT RECENTLY, AND THAT IS THAT THE FATALITIES FROM OVERDOSE ARE INCREASING DRAMATICALLY IN THE UNITED STATES, AND THE VALUES FOR 2015, YOU CAN SEE THEM THERE, THAT FOR ANY DRUG, THE OVERDOSES WERE ABOUT 52,000 PEOPLE, AND THOSE ATTRIBUTED TO OPIOIDS WERE AROUND 33. WE'VE JUST GOTTEN PROVISIONAL DATA FROM CDC ON 2016 AND THOSE NUMBERS ARE NOW ABOUT 64,000 FOR ANY DRUG, AND ABOUT 50,000 FOR OPIOIDS. AND OF THOSE OPIOIDS, ABOUT 20,000 REPRESENT OVERDOSES FROM FENTANYL AND THEIR DERIVATIVES, ABOUT 15,000 ARE FROM HEROIN, AND LESS FROM OPIOID DRUGS. WHAT'S KIND OF INTERESTING, IT'S NOT SHOWN HERE, IS THAT ALSO THE OVERDOSE RATES FROM COCAINE ABUSE AND ALCOHOL ARE ALSO RISING. SO WHAT'S NIH DOING ABOUT THIS? OUR RESPONSE IS PART OF A BROADER HEALTH AND HUMAN SERVICES OPIOID STRATEGY, WHICH IS A FIVE-POINT STRATEGY. OF COURSE OUR INVOLVEMENT INVOLVES SUPPORTING CUTTING EDGE RESEARCH, WHICH IS THE BOX ON THE LEFT-HAND SIDE THERE, BUT IT'S ALSO PART OF A BIGGER PROGRAM TRYING TO IMPROVE SURVEILLANCE AS WELL AS PAIN MANAGEMENT, AND ALSO TRYING TO INCREASE ACCESS TO CARE AND TREATMENT, AS WELL AS TARGETING THE AVAILABILITY AND DISTRIBUTION OF OVERDOSE-REVERSING DRUGS. WE'RE ALSO RESPONDING TO THE PRESIDENT'S COMMISSION ON COMBATING DRUG ADDICTION AND OPIOID CRISIS. THIS WAS A GROUP THAT WAS CHAIRED -- IS BEING CHAIRED BY CHRIS CHRISTIE. AND ONE OF THE RECOMMENDATIONS THAT CAME OUT OF THE INTERIM REPORT OF THIS COMMITTEE TO THE NIH WAS TO WORK WITH THE PHARMACEUTICAL INDUSTRY, SO DEVELOPING PUBLIC-PRIVATE PARTNERSHIPS WITH INDUSTRY TO DEVELOP ADDITIONAL MEDICATION-ASSISTED OPTIONS FOR OAR DOSE AS WELL AS DEVELOPING NEW NON-OPIOID NON-ADDICTIVE TREATMENTS FOR PAIN. AND OF COURSE IT'S ALL BASED ON RESEARCH THAT CLARIFIES THE BIOLOGY AND UNDERLYING MECHANISMS SURROUNDING PAIN. SO AS A RESULT OF THIS, FRANCIS COLLINS JUMPED TO THE FORE AND SCHEDULED, IN THIS PAST SUMMER, THREE WORKSHOPS THAT WERE HELD HERE AT NIH, TWO IN JUNE, ONE IN JULY, ON THESE THREE TOPIC AREAS: MEDICATIONS DEVELOPMENT FOR OPIOID USE DISORDERS, FOR BOTH OVERDOSE PREVENTION AS WELL AS REVERSAL, DEVELOPMENT OF SAFE, EVENING EFFECTIVE EFFECTIVE NON-ADDI CTIVE PAIN TREATMENTS, AND THEN A FINAL WORKSHOP IN JULY THAT WAS REALLY LOOKING AT MECHANISMS OR NOVEL MECHANISMS OF PAIN AND CHRONIC PAIN IN ORDER TO TRY TO IDENTIFY NEW TARGETS THAT MIGHT BE USEFUL FOR TREATING CHRONIC PAIN CONDITIONS. SPHORFOR EACH OF THOSE WORKSHOPS, WE'RE ATTEMPTING TO IDENTIFY RESEARCH CHALLENGES, DEVELOPED A FAIR LEA LONG FAIRLY LONG LIST OF HIGH PRIORITY ACTION ITEMS, AND MORE IMPORTANTLY, DEVELOPED A SET OF OVERARCHING ACTION ITEMS THAT I SHOW ON THE NEXT SLIDE. THERE ARE SORT OF FOUR BASIC ONES. ONE WAS TO DEVELOP BIOMARKERS, AND SOME SAY OBJECTIVE BIOMARKERS FOR PAIN, AND TREATMENT RESPONSE. TO DO A SYSTEMATIC EVALUATION OF TARGET VALIDATION STEPS TO ACCELERATE DRUG DEVELOPMENT. AND THIS -- ACTUALLY LOOKING FROM THE VERY BEGINNING, LOOKING AT THE CELLS THAT ARE USED TO DO SOME OF THE BASIC EXPLORATORY WORK, ALSO LOOKING AT THE ANIMALS, THE TYPES OF ANIMALS THAT ARE USED IN PAIN RESEARCH, AS WELL AS ANIMAL MODELS THAT ARE BEING USED. THEY'LL ALSO DEVELOP A SET OF CLINICALLY RELEVANT OUTCOME MEASURES FOR PAIN TO ENHANCE THE CLINICAL TRIALS, AND OF COURSE SORT OF THE UNIVERSAL OVERARCHING ITEM IS TO ESTABLISH INTERDISCIPLINARY RESEARCH TO ENHANCE OUR KNOWLEDGE ABOUT BASIC MECHANISMS OF PAIN, PAIN CIRCUITRY AND SO ON. SO THERE WERE THREE WORKSHOPS, IN THE PAST COUPLE WEEKS WE'VE JUST FOUND OUT THAT AS A RESULT OF THOSE, THE NATIONAL ACADEMIES WILL BE HOLDING A WORKSHOP THROUGH THE NEUROSCIENCE FORUM AT THE NATIONAL ACADEMIES ON ADVANCING THERAPEUTIC DEVELOPMENT FOR PAIN AND OPIOID USE DISORDERS THROUGH PUBLIC-PRIVATE PARTNERSHIPS. THIS IS GOING TO BE A TWO-DAY MEETING DOWNTOWN, AND WE JUST GOT THE AGENDA A COUPLE DAYS AGO, AND IT'S NICE TO NOTE THAT THERE ARE SEVERAL NIDCR GRANTEES THAT ARE ON THE PANEL AND WILL BE PRESENTING, AND ALSO ONE OF OUR -- ONE OF THE MEMBERS OF OUR BOARD OF SCIENTIFIC COUNSELORS IS ALSO ON THIS PANEL, SO THERE SHOULD BE GOOD REP 16 TAWTION REPRESENTATI ON FROM THE DENTAL COMMUNITY. NOT COINCIDENTALLY, A COUPLE OF WEEKS AGO, THERE WAS A CONCEPT THAT WAS PRESENTED TO THE COUNCIL OF COUNCILS AT NIH, NOT UNLIKE WHAT YOU'LL BE HEARING PRESENTED THIS AFTERNOON -- FURTHER ON THIS MORNING OF VARIOUS CONCEPTS ON A PROPOSAL ON PAIN. AND FOR THOSE OF YOU THAT HAVE BEEN AROUND NIH FOR A WHILE, YOU KNOW THAT WE HAVE BEEN TRYING -- PAIN CONSORTIUM AND OTHER GROUPS HAVE BEEN TRYING FOR YEARS TO GET A COMMON FUND PROPOSAL GOING ON PAIN AND WE'VE FINALLY SUCCEEDED. SO A COUPLE WEEKS AGO, THIS CONCEPT WAS APPROVED BY THE COUNCIL OF COUNCILS. IT'S CALLED ACUTE TO CHRONIC TRANSITION SIGNATURES, OR ACTS FOR PAIN. THE TITLE IS NOW CHANGED AND IT'S NOW PACT, THEY'VE JUST TAKEN THE "PAIN" AND PUT IT AT THE FRONT OF THE TITLE. I'LL JUST MENTION WHAT THE OVERALL CONCEPTS ARE, AND THAT IS TO HAVE A DISCOVERY-FOCUSED PROSPECTIVE CLINICAL STUDY TO IDENTIFY OBJECTIVE SIGNATURES, INCLUDING GENETICS IMAGING, MOLECULAR BIOCHEMICAL INFORMATION, PSYCHOLOGICAL PROFILING AND SO ON, THAT ASSOCIATE WITH THE TRANSITION FROM ACUTE TO CHRONIC PAIN. AND THAT'S REALLY HOW THE FOCUS OF THE CONCEPT. BUT ALSO LOOKING AT RESILIENCE, AND THAT IS THOSE PEOPLE -- LOOKING AT THE KRUX CHARACTERISTICS OF THOSE PEOPLE THAT DO NOT IF ON GO ON TO DEVELOP CHRONIC PAIN. ASSOCIATED WITH THAT IS GOING TO BE AN OBSERVATION STUDY FOCUSED ON IDENTIFYING OBJECTIVE SIGNATURES THAT ASSOCIATE WITH CHRONIC PAIN. AND AS PART OF MOST COMMON FUND ACTIVITIES, THERE'S INFRASTRUCTURE DEVELOPMENT, SO THERE WILL BE A DATA RESOURCE CENTER, THERE WILL BE A CLINICAL COORDINATING CENTER WHICH WILL OVERSEE THREE, FOUR OR FIVE DIFFERENT CENTERS THAT WILL BE DOING THE ACTUAL STUDIES, AND THEN A CENTER THAT WILL BE DOING A LOT OF THE ANALYSES OF THE OMICS THAT ARE A PART OF THIS. I GUESS TO MAKE THE POINT OF WHAT'S VERY INTERESTING ABOUT THIS CONCEPT IS THAT IT'S ON A LARGER SCALE, VERY, VERY SIMILAR TO A PROGRAM THAT WE HAVE BEEN SUPPORTING FOR THE PAST 12 YEARS CALLED OPERA. AND THAT'S OROFACIAL PAIN PROSPECTIVE EVALUATION AND RISK ASSESSMENT. MUCH MORE FOCUSED OBVIOUSLY ON TEMPOROMANDIBULAR JOINT DISORDER, BUT REALLY THE SAME IDEAS THAT ARE GOING ON WITH THIS COMMON FUND PROPOSAL ARE ALSO BEING -- ARE ALSO PART OF THE PROGRAM THAT WE'VE BEEN SUPPORTING FOR THE LAST 12 YEARS OR SO. THERE IS A WORK GROUP THAT IS SORT OF DEVELOPING THE DETAILS OF WHAT THE CONCEPT IS GOING TO BE, THAT'S ONGOING, THAT'S RELU ON A FAST TRACK, THIS IS LAND FOR FUNDING FOR 2018, AND YOLANDA IS A MEMBER OF THAT TEAM, AND I'LL NOW TURN IT OVER TO HER AND SHE'LL TALK A LITTLE BIT MORE ABOUT NIDCR AND ITS ROLE WITHIN NIH AND WHAT IT'S DOING WITH REGARD TO OPIOID RESEARCH. YOLANDA? >> SO GOOD MORNING, EVERYONE. AS JOHN MENTIONED, I'M THE PROGRAM DIRECTOR FOR NIDCR'S NEUROSCIENCE OF OROFACIAL PAIN AND TEMPOROMANDIBULAR JOINT DISORDERS PORTFOLIO. AND I THINK AS YOU JUST HEARD, THERE'S CLEAR RECOGNITION THAT THE MITIGATION OF THE OPIOID CRISIS WILL REQUIRE A MULTIPRONGED APPROACH THAT INCLUDES EMPHASIS ON PAIN RESEARCH TO ATTAIN A BETTER UNDERSTANDING OF THE COMPLEX PATHOPHYSIOLOGICAL MECHANISMS INVOLVED IN CHRONIC PAIN, AND IN THE DEVELOPMENT OF NON-ADDICTIVE PAIN TREATMENTS. WITH THAT IN MIND, I'D LIKE TO GIVE YOU A BRIEF OVERVIEW OF NIH AND NIDCR'S EFFORTS IN PAIN RESEARCH. AND WHAT THOSE LOOK LIKE. BUT FIRST I'D LIKE TO MAKE YOU AWARE OF WHAT JOHN MENTIONED A MINUTE AGO, WHICH IS THE PAIN -- NIH PAIN CONSORTIUM. THE NIH PAIN CONSORTIUM HAS MEMBERSHIP FROM 21 OF THE NIH IC'S CENTERS AN OFFICES. WITH NIDC BEING A MEMBER AND DR. SOMERMAN HOLDING A SEAT ON THE EXECUTIVE COMMITTEE. SO THE CONSORTIUM WAS ESTABLISHED TO ENHANCE PAIN RESEARCH AND PROMOTE COLLABORATION AMONG RESEARCHERS ACROSS THE NIH INSTITUTES AND CENTERS THAT HAVE PROGRAMS ADDRESSING PAIN. IT REPRESENTS A FOCUSED EFFORT TO DEVELOP A FORWARD-THINKING PAIN RESEARCH AGENDA, IDENTIFY KEY OPPORTUNITIES IN PAIN RESEARCH, AND INCREASE VISIBILITY FOR PAIN RESEARCH. THE NIH HAS LONG-STANDING COMMITMENT TO FUNDING PAIN RESEARCH. THIS BAR GRAPH SHOWS FUNDING ALLOCATIONS FROM FISCAL YEAR 2007 THROUGH FISCAL YEAR 2016. AND IN FISCAL YEAR '16, NIH FUNDED -- INVESTED $483 MILLION INTO PAIN RESEARCH, WITH $410 MILLION OF THOSE DOLLARS COVERING CHRONIC PAIN RESEARCH TOPICS. THAT OVERALL REPRESENTED 1.5% OF NIH'S TOTAL BUDGET IN FISCAL YEAR '16. IF WE TAKE A LOOK AT THE DISTRIBUTION OF THIS INVESTMENT IN FISCAL YEAR '16 ACROSS ALL NIH UNS TEUTS AND CENTERS, YOU CAN SEE THAT NIDCR'S SLICE OF THE PIE IS 5.4%. IF WE FOCUS IN FURTHER, WE FIND THAT'S REPRESENTATIVE OF 68 PROJECTS REFLECTING AN NIDCR INVESTMENT OF $25.9 MILLION IN FISCAL YEAR '16. THE MAJORITY OF THESE PROJECTS ADDRESS CHRONIC PAIN RESEARCH TOPICS WITH 45% CONDUCTING BASIC RESEARCH, 43% CONDUCTING CLINICAL RESEARCH, AND 12% CONDUCTING TRANSLATIONAL RESEARCH. I'D LIKE TO NOTE THAT THESE RESEARCH AREA CATEGORIES ARE GENERATED BY THE NIH'S RESEARCH CONDITION AND DISEASE CATEGORIZATION PROCESS. OTHERWISE KNOWN AS RCDC. WHICH IS A COMPUTERIZED PROCESS THAT DOES NOT CAPTURE ANY OVERLAP BETWEEN BASIC CLINICAL AND TRANSLATIONAL RESEARCH THAT MAY EXIST WITHIN A PARTICULAR -- ANY GIVEN ONE GRANT. SO IF WE LOOK AT FISCAL YEAR '16 AND HOW T HESE RESEARCH& PROJECTS FELL OUT BY FUNDING MECHANISM, WE CAN SEE THAT 73% OF THE RESEARCH PROJECTS WERE R01s, R21s OR R03s. 12% WERE INTRAMURAL, 10% WERE SMALL BUSINESS GRANTS, 5% WERE TRAINING AND CAREER DEVELOPMENT GRANTS, AND 1% WERE CONTRACTS. THE PORTFOLIO TO PARSE OUT PAIN RESEARCH BY CONDITION, WE FIND THAT NIDCR SUPPORTS RESEARCH RELEVANT TO A HETEROGENEOUS IMREUP OF OROFACIAL PAIN CONDITIONS THAT ARE QUITE COMPLEX AND HAVE A DIVERSITY OF UNDERLYING PATHOPHYSIOLOGICAL MECHANISMS. INDEED MANY OF THESE HAVE UNKNOWN ETIOLOGIES. THESE INCLUDE TEMPOROMANDIBULAR JOINT DISORDERS, NEUROPATHIC PAIN, ORAL CANCER PAIN, ORAL CAVITY CONDITIONS SUCH AS PULPITIS AND DENTAL PAIN, AND POST SURGICAL PAIN, AND ALL 16% OF THESE GRANTS ALSO ADDRESS MULTIPLE CONDITIONS WITH 7% COMPRISING BASIC RESEARCH THAT'S BROADLY APPLICABLE TO MANY OF THE CONDITIONS LISTED. I SHOULD NOTE THAT THE PERCENTAGE OF TMD PROJECTS THAT YOU SEE SHOWN HERE IS REPRESENTATIVE OF ONLY GRANTS CAPTURED BY WHAT WE CALL THE PAIN CATEGORY CAPTURED BY RCDC, AND DOESN'T REFLECT ALL TMD PROJECTS ACROSS NI DCR. SO RESEARCH ACROSS ALL OF THESE CONDITIONS IS QUITE DIVERSE AND INCLUDES INVESTIGATIONS INTO ASPECTS OF BIOPSYCHOSOCIAL AND GENETIC DETERMINANTS OF PAIN, NEUROIMMUNE INTERACTIONS, SEX DIFFERENCES, CHRONIC OVERLAPPING PAIN CONDITIONS, MODEL DEVELOPMENT, BEHAVIORAL SCIENCE APPROACHES, AND THE TRANSITION FROM ACUTE TO CHRONIC PAIN. ONE THING THAT'S IMPORTANT TO NOTE HERE IS THAT MANY OF THESE PAIN CONDITIONS HAVE IN COMMON AN UNMET NEED FOR EVIDENCE-BASED PAIN MANAGEMENT STRATEGIES, AND ANALGESICS WITH SUPERIOR EFFICACY, DIMINISHED ADVERSE SIDE EFFECTS, AND LOWER ABUSE VIABILITY THAN THOSE CURRENTLY AVAILABLE. SO THIS IS WHERE PAIN RESEARCH COMES IN, GAINING CLEAR INSIGHT INTO THE COMPLEX MECHANISMS UNDER KS LYING MANY OF THESE PAIN CONDITIONS CAN FACILITATE THE DEVELOPMENT OF SAFER AND MORE EFFECTIVE PAIN MANAGEMENT STRATEGIES THAT COULD CONTRIBUTE TO ENDING THE OPIOID CRISIS. AND SOME OF THESE STRATEGIES COULD INCLUDE NON-PHARMACOLOGICAL TREATMENTS, VACCINES OR ANTIBODIES AGAINST PAIN-PRODUCING CHEMICALS, DEVELOPMENT OF BETTER BIOMARKERS AND, OF COURSE, NON-OPIOID ANALGESICS. ALL OF THESE RESEARCH AREAS HOLD PROMISE. WITH THAT IN MIND, I'D LIKE TO HIGHLIGHT JUST A FEW OF NI. DCR-FUNDED PROJECTS THAT ARE WORKING TOWARD THIS GOAL. THE FIRST IS THE MECHANISTIC CLINICAL TRIAL BEING CONDUCTED AT THE UNIVERSITY OF MICHIGAN BY DR. ALEX DISILVA, WHERE LIST GROUP IS LOOKING AT WHETHER FAULTY MEDIATED TRANSMISSION IN THE BRAIN PLAYS A ROLE IN CHRONIC DMD AND WHETHER REPETITIVE ACTIVATION OF THIS TRANSMISSION WITH NONINVASIVE HIGH DEFINITION TRANSCRANIAL DIRECT STIMULATION CAN OFFER LASTING PAIN RELIEF. NEXT IS A PATIENT-CENTERED WEB-BASED PROGRAM BEING CONDUCTED BY DR. JAMES FRICKTON AT HEALTH PARTNERS INSTITUTE IN MINNESOTA. TO EDUCATE AND ENGAGE TMD PATIENTS IN A PERSONALIZED PROGRAM OF EXERCISE AND BEHAVIORAL CHANGES AIMED AT DECREASING AND PREVENTING PAIN. THE THIRD IS A PRE-CLINICAL STUDY BEING CONDUCTED BY DR. BRIAN SCHMIDT AT NYU, FOCUSING ON DEVELOPING NON-VIRAL GENE THERREL THERAPY FOR ORAL CANCER PAIN AND RESTORATION OF FUNCTION FUNCTION. I'D ALSO LIKE TO HIGHLIGHT NIDCR'S NATIONAL DENTAL PRACTICE BASED RESEARCH NETWORK, WHICH I BELIEVE YOU'LL HEAR A BIT MORE ABOUT LATER TODAY. THAT'S ACTIVELY ENGAGING FRAKES NERS TO GENERATE THE EVIDENCE BASE NEEDED TO IMPROVE PRECISION HEALTHCARE. IT'S COMPRISED OF THE NATIONAL COORDINATING CENTER AND SIX REGIONAL CENTERS, HAS OVER 7,000 PRACTITIONER MEMBERS, AND TO DATE, HAS ENROLLED OVER 60,000 PARTICIPANTS IN OVER 55 STUDIES THAT ARE EITHER IN PROGRESSOR COMPLETED. PROSPECTIVE OBSERVATIONAL STUDY OF PBR PRACTITIONER DENTISTS WHO TREAT TMD PATIENTS, WHERE THE GOAL IS TO IDENTIFY FACTORS CONTRIBUTING TO PRACTITIONERS' TMD TREATMENT DECISIONS AND PATIENTS' ADHERENCE, AS WELL AS THE OVERALL EFFECT OF TMD TREATMENT ON PAIN INTENSITY AND JAW FUNCTION. THE SECOND IS A STUDY FOCUSED ON DENTAL PRAK TITION NERL OPIOID PRESCRIBING PRACTICES. WHERE THE OBJECTIVES ARE TO ASSESS KNOWLEDGE AND BEHAVIOR RELATED TO DENTAL PRACTITIONERS OPIOID PRESCRIBING PRACTICES AND IDENTIFICATION OF MULTILEVEL FACTORS THAT CONTRIBUTE TO CONSERVATIVE PRESCRIBING PRACTICES. AND LASTLY BUT CERTAINLY NOT LEAST, I'D LIKE TO TELL YOU ABOUT NIDCR'S IMPLEMENTATION SCIENCE RESEARCH INITIATIVE. THIS INITIATIVE WHICH WE'RE QUITE EXCITED ABOUT AIMS TO REDUCE THE TIME BETWEEN ESTABLISHMENT OF THE EVIDENCE BASE FOR INTERVENTION, POLICIES, PRACTICES, AND THEIR WIDESPREAD ADOPTION FOR IMPROVEMENT OF DENTAL AND ORAL AND CRANIOFACIAL HEALTH. IN LINE WITH THIS, WE RECENTLY FUNDED A PROJECT LED BY DR. BRAD RINDEL AT THE HEALTH PARTNERS INSTITUTE IN MINNESOTA, AIMED AT INCREASING THE UTILIZATION OF EVIDENCE-BASED PAIN MANAGEMENT STRATEGIES THAT CALL FOR REDUCED USE OF OPIOIDS. AND INCREASED USE OF NSAIDS OR ACETAMINOPHEN FOLLOWING DENTAL EXTRACTIONS. SPECIFICALLY THE STUDY WILL USE CLINICAL DECISION SUPPORT INTEGRATED INTO ELECTRONIC HEALTH RECORDS TO COMPARE THE EFFICACY OF THREE STRATEGIES TO DEIMPLEMENT OPIOIDS, WHICH INCLUDE STANDARD PRACTICE, PROVIDER FOCUS CLINICAL DECISION SUPPORT, AND PROVIDER FOCUS CLINICAL DECISION SUPPORT WITH ENHANCED PATIENT ENGAGEMENT. AND THIS PATIENT ENGAGEMENT INCLUDES EDUCATION REGARDING ANALGESIC OPTIONS. FOR THE PATIENT PRIOR TO THE EXTRACTION VISIT AND ENHANCED SUPPORT FOR MANAGING POSTOPERATIVE SYMPTOMS. THE STUDY WILL ALSO EXAMINE PROVIDER AND PATIENT ACCEPTABILITY. THIS PROJECT HAS POTENTIAL TO DRIVE MAJOR IMPROVEMENTS IN PRESCRIBING PRACTICES AND MANAGEMENT OF POSTOPERATIVE PAIN SO I THINK WE CAN ALL AGREE THAT MAGNITUDE OF THE OPIOID CRISIS IS QUITE OVERWHELMING ON MANY FRONTS. ITS RELATIONSHIP TO PAIN MANAGEMENT QUITE COMPLEX. AND THAT ADDRESSING BOTH, AS I MENTIONED EARLIER, WILL REQUIRE A MULTIPRONGED APPROACHES THAT ARE BOTH ACCEPTSTIVE SENSITIVE AND RESPONSIVE TO THE NEEDS OF INDIVIDUALS SUFFERING FROM CHRONIC PAIN CONDITIONS. WHILE MUCH REMAINS TO BE DONE, WE HOPE THAT TODAY'S PRESENTATION HAS GIVEN YOU SOME INSIGHT INTO ONGOING NIDCR-FUNDED PAIN RESEARCH, EFFORTS THAT ARE RELEVANT TO THE DEVELOPMENT AND IMPLEMENTATION OF SAFER AND MORE EFFECTIVE PAIN MANAGEMENT TO REDUCE RELIANCE ON OPIOIDS. THANK YOU. [APPLAUSE] >> SO I THINK -- DO WE HAVE TIME FOR QUESTIONS? >> WE HAVE TIME FOR A COUPLE QUESTIONS. ANY QUESTIONS? FOR EITHER JOHN OREO LAN DA? >> THANK YOU. >> SO WE'LL MOVE ON TO THE NEXT ITEM ON THE AGENDA, WHICH IS EIGHT CONCEPT CLEARANCES. SO WE'RE REQUIRED TO DOCUMENT THE CLEARANCE OF CONCEPTS FOR GRANTS IN CONTRACT OPPORTUNITIES BY PRESENTING THE PURPOSE, SCOPE AND OBJECTIVES IN A PUBLIC FORUM. AND GIVING THE PUBLIC AN OPPORTUNITY TO COMMENT. SO TODAY, FOLLOWING EACH PRESENTATION BY NIDCR STAFF, DESIGNATED COUNCILMEMBERS WILL LEAD THE DISCUSSION, OTHER PEOPLE IN THE AUDIENCE ARE WELCOME TO JOIN IN THE DISCUSSION AS WELL, AND THEN WE'LL HAVE A VOTE FOR APPROVAL OF THE CONCEPT AS A BASIS FOR DEVELOPING A FUTURE FUNDING OPPORTUNITY ANNOUNCEMENT. DR. DENA FISCHER WILL PRESENT THE FIRST CONCEPT. COUNCILMEMBERS HART AND MCNEILL WILL LEAD THE DISCUSSION. >> GOOD MORNING, EVERYONE. I HOPE YOU ARE STRAPPED IN FOR A FUN MORNING. OF CONCEPTS. SO I'M GOING TO PRESENT -- I'M ACTUALLY SEEKING COUNCIL'S CONCURRENCE FOR THE CONCEPT TITLED DENTAL PRACTICE-BASED RESEARCH NETWORK TO SUPPORT THE COP DUBLGHT OF RESEARCH IN CLINICAL PRACTICES. SO THE INTENT OF THIS INITIATIVE IS TO SUPPORT A THIRD PHASE OF THE DENTAL PRACTICE BASED PRACTICE NETWORK TO CONDUCT ORAL HEALTH RESEARCH ON TOPICS OF IMPORTANCE TO DENTAL PRACTITIONERS AND THEIR PATIENTS, TO PROVIDE EVIDENCE USEFUL IN DAY LE PATIENT CARE, AND TO FACILITATE THE TRANSLATION OF RESEARCH FINDINGS INTO CLINICAL PRACTICE. NIDCR'S INVESTMENT IN PRACTICE BASED RESEARCH BEGAN IN 2005, WHEN THE INSTITUTE SUPPORTED THREE REGIONAL AND GEOGRAPHICALLY DIVERSE PBRNs. IN 2012, NIDCR FUNDED THE SECOND AND CURRENT PHASE OF THE PBRNs, WHICH IS A NATIONAL STRUCTURE WITH SIX REGIONAL HUBS OR ADMINISTRATIVE SITE. THIS NATIONAL STRUCTURE HAS ALLOWED FOR PARTICIPATION OF PRACTITIONERS FROM -- REALLY WITH NATIONAL REPRESENTATION AND THEIR PATIENTS IN DENTAL PBRN RESEARCH STUDIES. IT'S ALLOWED THE DEVELOPMENT OF A CENTRAL INSTITUTIONAL REVIEW BOARD, STANDARDIZATION OF STUDY OPERATIONS ACROSS ALL REGIONS, AND CONTINUED INVOLVEMENT OF DENTAL PRACTITIONERS IN ALL ASPECTS OF RESEARCH STUDIES. REALLY CONTRIBUTING TO THE DEVELOPMENT OF STUDIES, TO IMPLEMENTATION, COLLECTING DATA IN THEIR PRACTICES, AND ULTIMATELY DISSEMINATION OF RESEARCH FINDINGS IN LOCAL AND NATIONAL MEETINGS. SOME IMPORTANT ASPECTS OF THE PRACTICE BASED RESEARCH STRUCTURE IN THIS PARTICULAR VENUE IN WHICH TO CONDUCT RESEARCH. OF COURSE IT'S A UNIQUE VENUE. IT ALLOWS DENTAL PRACTITIONERS AND THEIR CONSENTING PATIENTS TO PARTICIPATE IN RESEARCH STUDIES. THIS IS A SCENARIO WHERE PRACTITIONERS ARE COLLECTING DATA THAT THEY -- ON INFORMATION THAT THEY TYPICALLY PURSUE IN CLINICAL PRACTICE AND THEY'RE JUST RECORDING THIS DATA IN THEIR PRACTICE, PATIENTS HAVE THE OPPORTUNITY TO -- PRACTITIONERS MAY ALSO PROPOSE RESEARCH QUESTIONS AND/OR CONTRIBUTE TO THE DEVELOPMENT OF RESEARCH STUDIES, WHICH HELPS FACILITATE THESE RESEARCH QUESTIONS BEING FRAMED BASED ON THE INSIGHTS OF DENTAL PRACTITIONERS TO EXPAND THE PROFESSION'S EVIDENCE BASE AND INFORM TREATMENT DECISIONS FOR DENTAL PRACTITIONERS IN THE DAILY CARE OF THEIR PATIENTS. IT ALLOWS THE CAPACITY TO LAUNCH STUDIES IN A TIMELY MANNER, SO EACH DENTAL PRACTITIONER MAY CONTRIBUTE A SMALL NUMBER OF PATIENTS, BUT NETWORK-WIDE, THERE'S THE ABILITY TO EFFICIENTLY ENROLL LARGE NUMBERS OF PATIENTS WITH A WIDE GEOGRAPHIC DISTRIBUTION AND FROM A VARIETY OF PRACTICE TYPES. AND A FUTURE INITIATIVE WILL BUILD ON PREVIOUS SUCCESSES AND INCORPORATE REFINEMENTS BASED ON LESSONS LEARNED. SO A FEW EXAMPLES OF POTENTIAL RESEARCH TOPICS THAT COULD INCLUDE EXPLORATION OF FACTORS THAT CONTRIBUTE TO PRACTITIONERS' DECISION-MAKING REGARDING ORAL HEALTH PREVENTION OR TREATMENT, ASSESSMENT OF ORAL DISEASE, PREVENTION OR TREATMENT OUTCOMES THROUGH LONGITUDINAL STUDIES, DETERMINATION OF BEST ORAL HEALTH TREATMENT STRATEGIES FOR PATIENTS WITH ORAL DISEASES, DISSEMINATION OF ORAL HEALTH EVIDENCE IN PBRN RESEARCH FINDINGS AND IMPLEMENTATION INTO PRACTICE. TOPICS OF EMERGING PUBLIC HEALTH INTEREST, AND QUESTIONS OF INTEREST TO DENTAL SPECIALTY ORGANIZATIONS. SO AS DR. DOMBROSKI MENTIONED, THERE ARE TWO REVIEWERS. WE'LL BEGIN WITH DR. MACNEIL. >> THANK YOU, DR. FISHER. I'M ENTHUSIASTIC ABOUT THIS CONCEPT IN THE REVIEW, I CONSIDER TWO AREAS, I CONSIDERED THE PHILOSOPHY OF THE PBRNs AND ALSO THE PRODUCTIVITY, SINCE THIS WILL BE THE THIRD ITERATION ITERATION. PHILOSOPHICALLY, I THINK THIS IS VERY IMPORTANT BECAUSE IT BRINGS TOGETHER RESEARCHERS AND CLINICIANS, IT ALLOWS US TO BRING SCIENTIFIC INVESTIGATIONS INTO THE FIELD TO WORK WITH INDIVIDUAL DENTAL PRACTICES ACROSS THE COUNTRY,, I THINK THAT ALLOWS A HIGH DEGREE OF EX-TECIAL VALIDITY IN THE WORK THAT WE DO SO I THINK PHILOSOPHICALLY, IT'S VERY IMPORTANT. IN TERMS OF PRODUCTIVITY, AS YOU SAID, THERE'S TWO PRIOR ITERATIONS, AND YOU KNOW, THE -- YOU LOOK TO THE PUBLISHED MATERIALS, THERE ARE NOW 128 PUBLICATIONS, TWO MORE EVEN SINCE THE PUBLICATION OF THE REPORT AS OF THIS MORNING. IN THE RANGE -- YOU SAW IN THE PRIOR PRESENTATION THAT CERTAINLY PAIN IS AN AREA FOCUSED AND ENDODONTIC PAIN, BUT IT ALSO RANGES FROM MATERIAL SELECTION TO DECISION-MAKING IN PATIENT AND PROVIDER SATISFACTION, SO THERE'S QUITE A RANGE OF RESEARCH THAT I THINK IS -- THE PBRN IDEAS HAVE PRODUCED. ALSO THE PAST ITERATIONS HAVE ALLOWED PUBLICATIONS IN 39 DIFFERENT JURMS, JOURNALS, INCLUDING THOSE THAT ARE MOST SELECTIVE AND MOST PRESTIGIOUS IN THE REALM OF ORAL HEALTH. I THINK THE PBRN HAS BEEN VISIBLE IN THE FIELD AND I THINK THAT'S IMPORTANT IN TERMS OF ENGAGING CLINICIANS. SO FROM BOTH THE PHILOSOPHICAL AND THE PRODUCTIVITY STANCE, I THINK THIS IS AN IMPORTANT CONCEPT AND ONE THAT I SUPPORT. >> THANK YOU, DR. MACK MCNEIL. TRACY HART ALSO WAS A REVIEWER FOR THIS CONCEPT. >> SURE. THANKS FOR ALLOWING ME TO REVIEW IT. I AGREE WITH EVERYTHING DR. MCNEIL SAID. I THINK IT'S TERRIFIC. I DIDN'T KNOW MUCH ABOUT THE PROGRAM AND IT'S FANTASTIC. FROM THE PATIENT ADVOCACY ORGANIZATION PERSPECTIVE, IT REALLY ALLOWS PATIENTS TO BE INVOLVED EARLY, WHICH IS GREAT, BECAUSE OUR PATIENTS MAKE OUR STUDIES WHAT THEY ARE. AND THEY CAN PARTICIPATE WITH THE TRUSTED PARTNER, THEIR OWN PRACTITIONER, AND I THINK THAT'S REALLY IMPORTANT BECAUSE WE GENERALLY HAVE A VERY -- SPEAKING FROM THE RARE DISEASE COMMUNITY, WE HAVE A VERY EDUCATED GROUP OF FOLKS PARTICIPATING IN STUDIES, AND JUST LASTLY, THE POTENTIAL OF HAVING ADDITIONAL PATIENT CONTACT REGISTRIES CAN BE REALLY EFFECTIVE STRATEGY IN COMPLEMENTING THINGS LIKE THE RDCRN, WHICH WE'RE A PART OF ALREADY. SO I THINK IT'S FANTASTIC, AND SOMETHING REALLY THAT I SUPPORT. >> WONDERFUL. THANK YOU. YES, OTHER COMMENTS OR QUESTIONS. FROM COUNCIL OR FROM ANYONE ELSE ELSE? IF NOT, WOULD A COUNCILMEMBER LIKE TO MAKE A MOTION TO APPROVE THIS CONCEPT? AND SECOND? ALL IN FAVOR? ANY OPPOSED? OKAY. THANK YOU. THE NEXT CONCEPT WILL BE PRESENTED BY DR. STEVE SKULLNICK, PROGRAM DIRECTOR FOR THE DEVELOPMENTAL BIOLOGY AND GENETICS PROGRAM. COUNCILMEMBERS DESILVA AND SHETE WILL LEAD THE DISCUSSION. >> THANK YOU, ALICIA, AND THANKS TO DR. SHETE AND D SILVA FOR REVIEWING THE CONCEPT. WHAT I'M GOING TO INTRODUCE TODAY IS A CONCEPT FOR COUNCIL CONCURRENCE ON THE FAITH-BASED INITIATIVE, THE NEXT ITERATION OF IT, WHICH WOULD BE -- THAT'S NOT MY LATEST SLIDES. OKAY, THESE ARE FINE. THEY ARE MY SLIDES, THEY'RE JUST AN OLD VERSION OF MY SLIDES. ANYWAY, SO THE GOAL IS -- PHASE BASED WAS STARTED IN 2009, IT WAS RECOMPETED IN 2014, AND IT'S NOW TIME, 2019 TO CONSIDER WHAT TO DO NEXT. THE GOAL OF FACE BASE HAS ALWAYS BEEN TO BUILD A RESOURCE OF UTILITY TO THE RESEARCH COMMUNITY. THE WIDER RESEARCH COMMUNITY. SO THIS REALLY IS NOT LIKE A PO1, IN THE SENSE OF RESEARCHERS WORKING ON THEIR OWN PROJECTS, IT'S RESEARCHERS COMING TOGETHER TO SUPPORT THE WIDER COMMUNITY BY PROVIDING THEM WITH DATA. SO SOME BACKGROUND. IT'S AN NIDCR-FUNDED CONSORTIUM. IT'S NORMALLY IN THE PAST CONSISTED OF A DATA COWARD NAUSEOUS HUB, AND TENSE -- PROJECTS THAT GENERATE THE DATA. IT'S INTENDED TO SERVE AS AN INCUBATOR FOR BRINGING TOGETHER PEOPLE FROM DIVERSE PARTS OF THE CRANIOFACIAL DEVELOPMENT AND DISMORPHOLOGY COMMUNITIES TO ALLOW THEM TO INTERACT IN WAYS THEY MIGHT NOT. SO TO USE POPULAR TERMINOLOGY AT NIH, TOITS IT'S TO MAKE SURE FIELDS DON'T BECOME SILOS, TO GET PEOPLE TO CROSS THOSE SILOS AND WORK TOGETHER. IT'S ALSO A WAY TO ACCELERATE RESEARCH INTO CRANIOFACIAL DEVELOPMENT AND DISMORPHOLOGY, BY DEVELOPING AND DISSEMINATEING, THE IMPORTANT PART IS DISSEMINATING, LARGE DATASETS TO THE RESEARCH COMMUNITY. SO TRADITIONALLY, IF YOU -- IT'S CHANGING A LITTLE BIT, BUT IF YOU WANTED TO PROPOSE IN, LET'S SAY, AN R01 TO DEVELOP A LARGE DATASET THAT WOULD BE USEFUL LATER, YOU WOULD NOT GET A FAVORABLE REVIEW. SO TO STICK -- ALLOW PEOPLE TO DO MORE HYPOTHESIS-DRIVEN RESEARCH, WE THROUGH FACEBASE GENERATE THOSE DATASETS AND LET OTHER INVESTIGATORS USE THEM. SO YOU CAN GO RIGHT TO HYPOTHESIS-DRIVEN STUDIES WITHOUT HAVING TO PROPOSE I WILL SPEND THE NEXT FIVE YEARS GENERATING CHIP SEQ DATABASES OR WHATEVER IT IS. IT'S ALSO BEEN BAIT. THERE ARE MANY PEOPLE WHO -- IN BIOMEDICINE IN GENERAL WHO HAVE INTERESTS IN SYSTEMS AND COMPUTATIONAL BIOLOGY, BIOINFORMATICS, NOT THAT MANY IN CRANIOFACIAL DEVELOPMENT, PEOPLE WITH -- RESEARCH SKILLS ARE ALWAYS LOOKING FOR DATASETS TO WORK ON. FACEBASE PROVIDES THOSE DATASETS. AFTER SO MANY YEARS OF FACEBASE, WE NOW HAVE OVER 705 INDIVIDUALLY DOWNLOADABLE DATASETS TO GET AT THOSE DATASETS, ALL YOU NEED TO DO IS ASK FOR A FACEBASE ACCOUNT, YOU GET THE ACCOUNT, YOU CAN DOWNLOAD ANYTHING THAT'S NOT HUMAN-RESTRICTED ACCESS DATA THAT REQUIRES APPROVAL FROM A DAC AND AN IRB. IT'S ALSO IN CURRENT NIH TERMINOLOGY SO THE FIRST PART IS A DATA REPOSITORY THAT HOLDS ALL THE DATASETS. IT'S ALSO A KNOWLEDGE BASE. SO WE HAVE THINGS LIKE DEVELOPMENTAL ATLASES, RESOURCES WHERE WE BRING INFORMATION TOGETHER IF YOU'RE READING A PAPER AND SAY I WANT TO KNOW ABOUT SO-AND-SO, YOU CAN GO TO FACEBASE AND THERE MAY BE A RESOURCE THERE WITH NICE VISUALS THAT WILL HELP EXPLAIN THE BACKGROUND TO IT. AND PROVIDE INFORMATION. SO WHAT'S THE GAPS RIGHT NOW? WELL, THE OBVIOUS GAP IS THAT THE FUNDING IS RUNNING OUT IN APRIL OF 2019, AND WE'VE ACCOMPLISHED A GREAT DEAL WITH LOTS OF PAPERS THAT HAVE COME OUT OF FACEBASE BOTH IN COLLABORATION FROM THE CONSORTIUM ITSELF AND IN COLLABORATION WITH OUTSIDE RESEARCHERS WORKING WITH THE FACEBASE RESEARCHERS, THERE ARE STILL AREAS OF CRANIOFACIAL BIOLOGY THAT WE DON'T COVER. SO WE STARTED OFF IN THE MID FACE, THEN WE EXPANDED TO OTHER PARTS OF THE CRANIUM, BUT FOR INSTANCE, WE DON'T HAVE ANY TOOTH DEVELOPMENT DATASETS, SO WE'D LIKE TO EXPAND BEYOND WHAT WE'VE GOT NOW. HOW DO WE ADDRESS THIS? WELL, THE OPPORTUNITIES ARE TO SWITCH FROM THE EXISTING HUB AND SPOKE MODEL, WHERE WE FUND THE DATA COORDINATING CENTER AND THE PROJECTS DOING THE GENERATION OF THE DATA, TO JUST A HUB MODEL. AND THAT'S BECAUSE IN THE PAST FEW YEARS, THE NUMBER OF DATASETS THAT ARE DEVELOPED OUTSIDE THE CONSORTIUM HAVE REALLY GROWN. SO TECHNIQUES LIKE RNA SEQ, CHIP SEQ, THINGS LIKE THAT WHERE YOU DO GENERATE THESE LARGE REUSABLE DATASETS ARE NOW MUCH MORE COMMONLY DEVELOPED. SO WHAT WE CAN DO IS DISPENSE WITH THE HUB SPOKE MODEL, SWITCH ONLY TO A HUB, AND WORK WITH THE COMMUNITY TO INCORPORATE THE COMMUNITY'S DATASET. SO WE'LL CONTINUE TO TAKE THE DATASETS WE HAVE, WHICH WILL BE GENERATED RIGHT THROUGH, YOU KNOW, APRIL 30TH OF 2019, CONTINUE TO INTEGRATE THOSE DATASETS, DEVISE NEW WAYS OF DISPLAYING AND DISSEMINATING THEM, BUT ALSO WORK WITH INVESTIGATORS FUNDED BY THE NIDCR AND OTHER INSTITUTES TO TAKE THEIR DATA, HELP THEM STRUCTURE IT SO IT'S USEFUL, IT'S VERY IMPORTANT TO BE ABLE TO STRUCTURE DATA PROPERLY OR NO ONE ELSE KNOWS WHAT YOU'VE DONE, AND BRUNG BRING THAT DATA INTO FACEBASE. WE ALSO WANT TO DO SOMETHING THAT OTHER SOMEWHAT SIMILAR PROJECTS LIKE GOOD MAP AND LUNG MAP HAVE DONE MORE THAN WE HAVE, AND THAT'S OUTREACH. SO WHENEVER ANY OF US INVOLVED IN FACEBASE GOES TO A CONFERENCE, WE ALWAYS ADVERTISE ITS EXISTENCE, BUT WE DON'T HAVE THE, FOR INSTANCE, TRAINING SESSIONS. WE DON'T PUT TOGETHER TUTORIALS OR HOW TO USE FACEBASE. SO FACEBASE 3, WE WOULD REQUIRE THE MUCH MUCH MORE OUTREACH TO THE WIDER COMMUNITY TO MAKE THE RESOURCE MORE USEFUL. BENEFITS OF THE NEW MODEL SHOULD BE ACCESS TO MANY MORE TYPES OF DATA THAN WE ALREADY HAVE. ACCESS TO DATASETS GENERATING œUSE FUNDS FOR OTHER ICs, ANY TIME WE CAN MAKE GOOD USE OF OTHER PEOPLE'S MONEY, THAT'S A BENEFIT. BRING THE COMMUNITY ITSELF MORE INTO THE COMMUNITY RESOURCE. WE HAVE HAD, OVER THE YEARS, MANY GROUPS OFFERING US THEIR DATASETS TO PUT ON FACEBASE, BUT BECAUSE THE HUB HAS ALWAYS BEEN VERY BUSY WITH FACEBASE-GENERATED DATA, WE REALLY HAVEN'T BEEN ABLE TO TAKE FULL ADVANTAGE OF THAT. , SO WE TRY TO PUSH THIS FOR A PREFERRED WAY FOR NIDCR FUNDED PROJECTS TO SATISFY NIH'S DATA SHARING REQUIREMENTS. IT'S IN LINE WITH THE BROAD DATA GOALS OF NIH. MOST OF YOU, I HOPE, HAVE HEARD OF BD2K, BIG DATA TO KNOWLEDGE. THERE'S A LOT OF DATA SCIENCE BEING PUSHED BY THE NIH NOW. THINGS LIKE USE OF COMMUNITY DATA STANDARDS, SO ANYBODY CAN USE YOUR DATA AND UNDERSTAND IT. THE SO CALLED FAIR PRINCIPLES, FINDABLE, ACCESSIBLE, INTEROPERABLE AND REUSABLE. SO WHEN YOU GENERATE DATA, IT'S GOOD FOR SOMETHING MORE THAN THE PAPERS YOU WROTE FROM IT, SOMEBODY ELSE CAN DOWNLOAD IT AND USE IT, AND IT WILL BE A BROADER, MORE INTEGRATED AND COMPREHENSIVE RESOURCE FOR CRANIOFACIAL DATA. AND AT THIS POINT, I THINK DR. SHETE, I THINK YOU SAID YOU'D GO FIRST. >> THANKS. I THINK I'M -- I LIKE THIS AGREEMENT AND I LIKE THIS PROPOSAL BUT I'M GOING TO GIVE SOME DISCUSSION THAT WE HAD. SO THIS IS THE THIRD -- I HAVE SOME QUESTIONS ABOUT HOW MANY OF THE USERS ARE UTILIZING THIS DATABASE WHO ARE OUTSIDE THE FACEBASE CONSORTIUM. I THINK THE NUMBERS ARE RELATIVELY SMALLER, SO I THINK THAT'S SOMETHING THAT AS IT'S MOVING FROM -- TO THE HUB-ONLY MODEL, I THINK THAT WOULD BE IMPORTANT, THAT THEY FOCUS ON DISSEMINATING TO WIDER AND -- BUT I THINK I LIKE SOME OF THE INITIATIVES THAT WE MENTIONED, INCLUDING THE TUTORIAL-TYPE THINGS THAT I THINK WILL INCREASE NUMENT NUMBERS OF USERS OF THIS DATABASE. I THINK THAT'S THE MOST IMPORTANT QUESTION I HAVE. BECAUSE I SAW THERE WERE MORE THAN 130 PUBLICATIONS BUT A LOT FEWER FROM THOSE WHO ARE OUTSIDE THIS CONSORTIA, SO THAT'S SOMETHING THAT NEEDS TO BE -- AND I THINK AS THE DATA FROM THE OTHER INVESTIGATORS WERE PUTTING THIS DATASET, THERE WILL BE MORE EPIDEMIOLOGY BEHAVIORAL DATA THAT WILL COME IN THERE AND THAT WILL ALSO INCREASE THE UTILIZATION BECAUSE -- AND THEN I THINK AS WE SPOKE WHEN I TRIED TO DO IT, IT'S KIND OF A SLOW PROCESS BECAUSE I THINK AS I UNDERSTAND IT, IT DOES A LOT OF THINGS AND AS A USER WHEN YOU CLICK ON SOMETHING, YOU TRY TO LOOK FOR SOMETHING TO SHOW UP AND NOT -- YOU DON'T KNOW WHETHER IT'S CARING OR IT'S CACHING OR NOT , SO AS YOU MOVE INTO MORE DATA, A MORE EASY WAY TO GET THAT ONE. ALSO I HAD ASKED ABOUT THE -- ARE THERE ANY RFAs SPECIFICALLY COMING OUT -- MECHANISM THAT WILL UTILIZE WITH THIS RESOURCE AS IT'S MOVING FORWARD TO BE EVEN A LARGER RESOURCE FOR RESEARCH. IT SEEMS LIKE THERE ARE ALREADY -- THAT ARE VERY GOOD, AND I THINK I HAD ONE MORE COMMENT I HAD MENTIONED WAS TO SEE -- THERE COULD BE SOME PARTNERSHIP WITH INDUSTRY ALONG THAT LINE, I THINK THAT'S SOMETHING TO THINK ABOUT IN NIDCR, AS WELL AS THE FACEBASE INVESTIGATORS TO SEE HOW TO -- AND WE TALKED ABOUT SOME OF THE POSSIBLE OPTIONS BUT I THINK THAT WOULD BE SOMETHING -- DIRECTION TO GO IN THERE. BUT I THINK OVERALL, IT'S VERY USEFUL, I THINK WITH MOVING IT TO THE HUB-ONLY MODEL, I THINK IT'S GOING TO HAVE -- THE DATA IS GOING TO EXPONENTIALLY GROW, AND I THINK THE -- PARTICULARLY I THINK HAVING A REGULAR TUTORIALS AND -- IS VERY IMPORTANT SO THAT IT GETS UTILIZED -- CRUCIALLY IMPORTANT. >> I AGREE WITH DR. SHETE, AND I THINK THIS CONCEPT IS EXTREMELY IMPORTANT AND I WAS VERY ENTHUSIASTIC ABOUT THIS. I ALSO LIKE THE IDEA OF -- THAT THE COMMON PLATFORM WILL PROVIDE LINKS TO RESOURCES DEVELOPED OUTSIDE THE CONSORTIUM, WHICH I THINK IS A VERY IMPORTANT UTILIZATION OF THESE RESOURCES. I WANT TO EMPHASIZE THE ASPECT OF THE TUTORIALS, I SUGGEST THESE ALSO BE IMEERED TO GEARED TO RESEARCHERS FOCUSING ON OTHER ASPECTS OF CRANIOFACIAL HEALTH AND DISEASE SO THEY CAN FOCUS ON ASPECTS OF THE DEVELOPMENT DATASETS THAT RELATE TO THESE DISEASES. I THINK ONE OF THE MOST EXCITING ASPECTS OF THIS CONCEPT IS THE TUTORIAL ASPECT TO AGAIN ENHANCE THE UTILIZATION OF THESE -- IT'S A TREMENDOUS RESOURCE IN THE UTILIZATION OF THESE DATASETS WILL GENERATE MORE HYPOTHESIS-DRIVEN RESEARCH. >> THANK YOU. I THINK THERE WAS -- YOU MENTIONED THAT IN THE EARLIER VERSION OF FACEBASE, THERE WERE LINKS TO SOME OF THE DB GAP DATA WHICH ALSO HAS BENEFICIAL DATA, SO I THINK -- AND THEN THAT WAS KIND OF DROPPED OUT, SO MAYBE AGAIN BRING THAT BACK. SO EVEN THOUGH IT'S NOT HOSTED IN THE FACEBASE, BUT IN THE DBGAP, WHICH IS, I THINK, RELEVANT TO THIS ONE, SO HAVING LINKS AND INFORMATION WILL BE REALLY USEFUL SO THAT ALL THE CRANIOFACIAL RESEARCH -- THIS IS ONE STOP AND THEN THEY CAN LINK -- >> SO THE FACEBASE PROJECTS THAT HAVE DEPOSITED DATA IN DBGAP HAVE THOSE LINKS THERE. WHAT WE DON'T HAVE RIGHT NOW IS A RESOURCE PAGE TO NON-FACEBASED PROJECTS THAT ARE IN DBGAP AND WE NEED TO BRING THAT BACK. THAT'S VERY USEFUL. ANY OTHER QUESTIONS? >> I JUST WANT TO MAKE A COMMENT, STEVE MENTIONED THERE ARE ALSO OTHER PROGRAMS FUNDED BY NIH. SUCH AS LONG MAP AND GOOD MAP, SO THESE ARE SORT OF IMPAIR LEL IN PARALLE L PROGRAMS, AND SOMEONE CAN CERTAINLY IMAGINE SOMEWHERE DOWN THE ROAD THAT WE CAN BUILD A HUMAN ATLAS BY INTEGRATING SOME OF THESE DATASETS, SO THAT'S ANOTHER ASPECT THAT WE'D WANT TO CONSIDER.& >> THANK YOU. OTHER QUESTIONS? THANK YOU FOR LISTENING. >> ANYONE ELSE? WOULD A MEMBER OF COUNCIL LIKE TO MAKE A MOTION TO APPROVE THIS CONCEPT? SECOND? ALL IN FAVOR? ANY OPPOSED? OKAY, THANK YOU. THE NEXT TWO CONCEPTS WILL BE PRESENTED BY DR. EMILY HARRIS, CHIEF OF THE TRANSLATIONAL GENOMICS RESEARCH BRANCH, AND COUNCILMEMBERS CHAI, MACK KNEELED, SHETE AND COUPER WILL LEAD THE DISCUSSIONS. >> GOOD MORNING, EVERYONE. SO THE FIRST CONCEPT THAT WE'RE SEEKING COUNCIL'S CONCURRENCE FOR IS ENTITLED "UNDERSTANDING MECHANISMS OF GENE-ENVIRONMENT INTERACTION IN DENTAL, ORAL AND CRANIOFACIAL DISEASES AND CONDITIONS." I HAD TO GET IT HELP ON HOW TO MOVE FORWARD. THANK YOU, JOHN. SO THE GOAL OF THIS CONCEPT IS TO BETTER UNDERSTAND THE BIOLOGIC MECHANISMS UNDERPINNING GENE ENVIRONMENT INTERACTIONS FOR DISEASES AND CONDITIONS THAT ARE CENTRAL TO NIDCR'S MISSION. THE ETIOLOGY OF MOST DENTAL, ORAL AND CRANIOFACIAL DISEASES AND CONDITIONS INVOLVES THE INTERPLAY OF GENETIC AND ENVIRONMENTAL FACTORS. EPIDEMIOLOGIC AND FAMILY STUDIES PROVIDE EVIDENCE OF GENE ENVIRONMENT INTERACTION. THERE'S A COUPLE OF EXAMPLES HERE. FOR EXAMPLE, WITH DENTAL CARIES, THE EFFECTS OF ENAMEL MATRIX CHAINS MAY BE MODERATED BY FLUORIDE EXPOSURE, AND FOR NON-SYNDROMIC CLEFT PALATE, THERE'S EVIDENCE OF GENE ENVIRONMENT INTERACTION FOR TWO GENOMIC REGIONS ON CHROMOSOME 4 AND MATERNAL SMOKING. HOWEVER, LITTLE IS KNOWN ABOUT THE BIOLOGIC MECHANISMS UNDERPINNING THESE STATISTICAL RESULTS. NEW TICK TECHNOLOGIES SUCH AS CRISPR CASS WHICH FACILITATE GENETIC VARIANCE INTO THE GENOMES OF MODEL ORGANISMS AND NEW INFORMATION GENE REGULATORY NETWORKS MAY BE LEVERAGED THROUGH ANIMAL MODELS AND IN VITRO APPROACHES. SO WE ANTICIPATE RESEARCH IN THIS AREA WILL INCLUDE SPECIFIC GENETIC AND ENVIRONMENTAL FACTORS FOR WHICH THERE IS STRONG EVIDENCE IN HUMANS. AREAS OF INTEREST INCLUDE USING ANIMAL MODELS OR IN VITRO APPROACHES TO STUDY THE INTERPLAY BETWEEN CANDIDATE GENES IDENTIFIED IN HUMAN RESEARCH AND ENVIRONMENTAL FACTORS, INCLUDING IN UTERO AND PERSONAL FACTORS. TO GIVE A FEW EXAMPLES, THIS COULD INCLUDE EPIGENETICS OR GENETICS, AND A RANGE OF EXPOSURE SUCH AS EXOGENOUS EXPOSURES TO POLLUTANTS, EXPOSURES THROUGH BEHAVIORS SUCH AS ALCOHOL AND TOBACCO USE, DIET OR OTHER NUTRIENTS, EXPOSURES THROUGH MEDICAL CONDITIONS OR MEDICAL TREATMENTS, AND ALSO COMPOSITION OF THE ORAL MICROBIOME. THE SECOND AREA OF INTEREST IS DEVELOPING NEW ANIMAL MODELS OR ORGANOID MODELS THAT WILL INFORM THE MECHANISMS OF GENE ENVIRONMENT INTERACTION, AND JUST A NOTE THAT THIS IS NOT INTENDED TO INCLUDE HUMAN EPIDEMIOLOGIC OR FAMILY STUDIES OF GENE ENVIRONMENT INTERACTIONS, BUT TO LOOK MORE AT THE MECHANISMS. SO OUR DISCUSSANTS ARE DRS. CHAI AND MCNEIL AND I THINK DR. CHAI WAS GOING TO START. >> THANK YOU, EMILY. IT IS VERY WELL-KNOWN THAT THE BIRTH DEFECTS ARISE FROM A COMBINATION OF GENETIC AND ENVIRONMENTAL FACTORS. A MAJOR CHALLENGE FOR CLINICIANS AND ALSO BASIC SCIENTISTS IS REALLY TO FIGURE OUT HOW TO SORT OUT WHICH FACTORS ARE REALLY THE CAUSE FOR THESE CONGENITAL BIRTH DEFECTS. IF YOU LOOK INTO THE LITERATURE AS EMILY JUST SHARED WITH US, THERE ARE MANY STUDIES LOOKING AT MUTATIONS THAT ARE LINKED TO HUMAN BIRTH DEFECTS AND ALSO THERE ARE MANY ANIMAL MODELS THAT HAVE BEEN DEVELOPED THAT SHOW THESE CRANIOFACIAL BIRTH DEFECTS. AND OF COURSE THERE ARE A LOT OF ENVIRONMENTAL STUDIES ABOUT THE IMPACT ON HUMAN DEVELOPMENT. BUT THERE ARE VERY FEW STUDIES THAT ACTUALLY BRING THIS TOGETHER. SO I THINK THIS CONCEPT IS VERY TIMELY, AND IT WILL ALLOW US TO USE THE ANIMAL MODELS COMBINED WITH, FOR EXAMPLE, THE ENVIRONMENTAL FACTORS TO STUDY THE MECHANISM THAT CAUSES OR MIGHT BE RESPONSIBLE FOR CAUSING THESE CONGENITAL BIRTH DEFECTS. SO I THINK BASED ON THIS, NIDCR REALLY WANTS TO ENCOURAGE THE NEW ANIMAL MODEL DEVELOPMENT THAT REALLY ARE BASED ON THE MUTATIONS THAT HAVE BEEN IDENTIFIED IN HUMAN PATIENT POPULATION, AND THEN USE THAT TO FURTHER INVESTIGATE HOW A MUTATION IN COMBINATION WITH AN ENVIRONMENTAL FACTOR MAY BE RESPONSIBLE FOR CAUSING THESE CRANIOFACIAL BIRTH DEFECTS. I THINK THE USE OF ORGANOID MODEL WILL BE REALLY HELPFUL TO LOOK AT HOW THIS DYNAMIC MICROENVIRONMENT WITHIN THE SORT OF THE -- HOW THAT CAN BE USED TO STUDY GENE-ENVIRONMENTAL INTERACTIONS BEING RESPONSIBLE FOR CAUSING SIMILAR DEFECTS. AND ALSO THE STUDY OF GENE-ENVIRONMENTAL INTERACTION I THINK CAN HELP TO REDUCE THE HEALTH DISPARITY BETWEEN DIFFERENT POPULATIONS, AND THEN CAN INFORM BETTER EDUCATION FOR CERTAIN PRACTICE OR CERTAIN POPULATION, AND THEN FINALLY, I THINK THIS NEW STUDY WILL REALLY HELP -- CAN NEED TO SHOWCASE THE IMPACT ON HOW THEY CAN IMPROVE HUMAN HEALTH. >> I WAS BOTH THRILLED AND CHAGRINED TO KNOW THAT I'D BE SPEAKING AFTER DR. CHAI BECAUSE I KNEW HE WOULD SAY IT ALL. SO I'LL JUST ADD IT BIT. I'M SUPPORTIVE OF THIS, I THINK IT'S AN IMPORTANT AREA. I'VE DONE A BIT OF WORK IN THIS AREA BUT MORE OF MINE HAS BEEN APPLIED IN BEHAVIORAL, AND I THINK IT'S FROM THAT PERSPECTIVE, IT'S VERY IMPORTANT FOR US TO UNDERSTAND BASIC BIOLOGICAL MECHANISMS THAT WILL THEN INFORM THE WORK THAT WE DO IN APPLICATIONS. I THINK IN PARTICULAR, WITH THESE ANIMAL MODELS AND THE IN VITRO APPROACHES, I THINK IT ALLOWS FOR A MORE HIGHLY CONTROLLED VIEW OF THE INTERACTION OF DIFFERENT EXPOSURES. WE THINK ABOUT THE EXPOSURES OF MEDICAL CONDITIONS AND BEHAVIORAL ONES, AND THEN ENVIRONMENTAL TYPE OF EXPOSURES, BUT BE ABLE TO LOOK AT THE INTERACTION OF THOSE IN THESE VERY BASIC KIND OF STUDIES, I THINK WILL BE VERY IMPORTANT AND WILL HELP MOVE THINGS FORWARD IN THIS FIELD. SO I'M SUPPORTIVE OF THIS. >> OTHER COMMENTS OR QUESTIONS? WOULD A COUNCILMEMBER LIKE TO MAKE A MOTION TO APPROVE THE CONCEPT? SECOND? ALL IN FAVOR? ANY OPPOSED? OKAY. THANK YOU. EMILY, YOU'RE UP AGAIN. >> THE TWO-FER. >> SO THIS CONCEPT THAT WE'RE SEEKING COUNCIL CONCURRENCE FOR IS ENTITLED BIOINFORMATICS, COMPUTATIONAL BIOLOGY, AND DATA SCIENCE JUMP START FOR DENTAL, ORAL AND CRANIOFACIAL DISEASES AND CONDITIONS. THIS CONCEPT HAS TWO GOALS. THE FIRST IS TO ENCOURAGE DATA INTEGRATION AND DATA MINING WITH FOLLOW-UP RESEARCH AS APPROPRIATE TO ADVANCE SCIENTIFIC QUESTIONS THAT ARE CENTRAL TO NIDCR'S MISSION. AND ALSO TO ATTRACT MORE BIOINFORMATICS, COMPUTATIONAL AND DATA SCIENCE PROJECTS, AND INVESTIGATORS TO NIDCR. IN TERMS OF GAPS IN OPPORTUNITIES, WE'VE ALL HEARD A LOT ABOUT BIG DATA AND DATA SCIENCE AND APPLYING MATHEMATICAL AND COMPUTATIONAL APPROACHES TO COMPLEX AND MULTIDIMENSIONAL DATA, CAN LEAD TO A DEEPER UNDERSTANDING OF RESEARCH DATA AND ALLOW US TO ADDRESS NEW QUESTIONS, AND WE WOULD LIKE TO ENCOURAGE THESE APPROACHES TO BE LEVERAGED TO FURTHER NIDCR'S MISSION. SO OUR AREAS OF INTEREST INCLUDE BIOINFORMATICS, COMPUTATION UNTIL NAL BIOLOGY AND RESEARCH THAT ARE FACILITATE DATA MINING, INTEGRATION AND MODELING, AND ALSO VALIDATION MECHANISTIC OR TRANSLATIONAL COMPONENTS AS APPROPRIATE TO THE RESEARCH STRATEGY. SO EXAMPLES INCLUDE BUT ARE NOT LIMITED TO GENOMICS AND OTHER OMICS RESEARCH, RESEARCH INTEGRATING ELECTRONIC RECORDS OR MOBILE HEALTH DATA INTO EPIDEMIOLOGIC OR HEALTH SERVICES RESEARCH, THREE-DIMENSIONAL MODELING OF CRANIOFACIAL STRUCTURES FOR SURGICAL PLANNING. THOSE ARE JUST A FEW EXAMPLES. JUST A QUICK NOTE THAT WE HAVE SEMPLE ACTIVE SEVERAL ACTIVE FOAs THAT CAN SUPPORT. YOU MAY BE FAMILIAR WITH SOME OF BUT THEY REALLY DON'T EMPHASIZE COMPUTATIONAL BIOLOGY AND SOME IMPORTANT PROJECTS JUST CAN'T BE DONE UNDER THOSE OPPORTUNITIES BECAUSE THEY'RE BEYOND THE SCOPE OR JUST TOO LARGE AND COMPLEX, WILL TAKE TOO MUCH TIME. SO THAT'S WHY WE'RE BRINGING THIS TO YOU TODAY. THE DISCUSSANTS, DR. SHETE AND DR. COUPER, THINK DR. SHETE IS GOING TO START. >> THANK YOU, EMILY, I THINK THIS IS A REALLY EXCITING CONCEPT. I THINK I'M HIGHLY IN FAVOR BECAUSE I'VE ALWAYS BELIEVED THERE IS A LOT OF TOOLS AND TECHNIQUES COMING AND ONE CAN GENERATE A LARGE AMOUNT OF DATA. WHAT IS LACKING IS THE ONE LIKE HOW TO ANALYZE THE DATA, HOW USING THE COMPUTATIONAL TOOLS AND NEWER DATA MINING WITH MINING ALGORITHMS THAT ARE BEING DEVELOPED IN COMPUTER SCIENCE BUT THEY DON'T COME IN THIS FIELD. SO I THINK THIS WILL HAVE NOT ONLY THE ACTUAL LEADING TO ANSWER TO SOME OF THE IMPORTANT QUESTIONS FOR NIDCR, BUT ALSO BRING NEW QUANTITATIVE SCIENTISTS IN THIS FIELD, SO I THINK THIS IS REALLY AN EXCITING OPPORTUNITY, AND AS I MENTIONED IN OUR EMAIL, I THINK LIKE MAYBE IF THERE IS A WAY TO SOMEHOW LINK THEM OR EVEN TO THE FACE BASE, FOR EXAMPLE, BECAUSE IF THAT'S WHERE THE BIG DATASETS ARE GOING TO BE THERE, I THINK THAT WILL BE -- MENTIONING AND THAT WILL BE USEFUL, BUT I AM HIGHLY U.S. SUPPORTIVE AND I THINK THIS IS HIGHLY TIMELY ALSO WITH THE BD2K AND COMMON FUND AND OTHER THINGS, VERY GOOD. >> I'M SUPPORTIVE OF THIS THOUSAND I'D SAY I'M GUARDEDLY ENTHUSIASTIC ABOUT THIS. WHY THE GUARDEDLY PART COMES IN, IN TERMS OF RIGOR AND REPRODUCIBILITY. MY CONCERN HERE IS THAT A LOT OF THINGS IN DATA SCIENCE, WE NEED TO HAVE VALIDATION, AND SO IN THE GENOMIC FIELD, IT'S VERY HARD TO GET A MANUSCRIPT PUBLISHED THESE DAYS IF YOU DON'T HAVE VALIDATION COHORT AND IN FACT YOU HAVE TO DO A LOT OF COMPUTATIONAL BRYOLOGY AND BIOLOGY AND OTH ER THINGS THESE DAYS, I'M NOT SO SURE IN -- HEALTH RECORDS AND MOBILE HEALTH IS REQUIRING THE SAME LEVEL OF REPLICATION, SO I THINK WE NEED TO THINK VERY CAREFULLY, AND HAVING THE RIGHT SCIENTIFIC REVIEW OF APPLICATIONS WOULD BE GOOD, BUT WE NEED TO MAKE SURE THAT WE HAVE GOOD STUDY DESIGNS. , ANALYSIS PLAN, WE NEED TO MAKE SURE WE'RE INCLUDING THE RIGHT PEOPLE AND CAREFULLY -- WE'RE NOT EXCLUDING PEOPLE, PARTICULARLY IN TERMS OF MOBILE HEALTH OR SEGMENTS OF THE POPULATION WE'RE EXCLUDING BECAUSE OF WHERE WE'RE GETTING THE DATA FROM. SO I'M ENTHUSIASTIC, BUT THERE'S SOME GUARDEDNESS IN THE ENTHUSIASM. >> THANKS. WE ALSO THINK THAT'S AN IMPORTANT PART OF THIS CONCEPT AND IT'S ONE AREA WITH OUR CURRENT FOAs ARE RO3s, AND THERE JUST ISN'T ENOUGH TIME AND MONEY FOR SOME OF THE VALIDATION EXPERIMENT. SO WE THINK THAT'S A VERY IMPORTANT PART OF THIS. THANK YOU. >> DR. OAKLANDER. >> I'M ENTHUSIASTIC ABOUT THIS CONCEPT WHICH INDEED I THINK IS REALLY PERMEATING ALL OF HEALTHCARE, BUT I WOULD LIKE TO MAKE SURE THAT ANOTHER PART OF IT IS INCLUDED, AND THAT'S THE ARC BACK TO THE CLINIC, TO THE PROVIDER AND TO THE PATIENT. SO THERE'S A LOT OF EXCITEMENT ABOUT GETTING PATIENTS TO, YOU KNOW, GIVE US DATA FROM THEIR CELL PHONES, FROM THE FIELD, ET CETERA, SUCKING IN DATA FROM CLINICAL PRACTICES, BUT I THINK WE OWE THEM SOMETHING IN RETURN. AND WHAT WE OWE THEM IS THE ABILITY TO BE ABLE TO ACCESS THESE DATA WAREHOUSES AND PULL DOWN THE CURRENT INFORMATION THAT'S RELEVANT TO THEM AND TO THAT PATIENT THEY HAVE THERE. SO I WOULD JUST LIKE TO MAKE SURE THAT WE INCLUDE CLOSING THE LOOP BY GETTING THE DATA BACK TO THE SITE OF CLINICAL PRACTICE. >> THANK YOU. ANYONE ELSE? DO WE HAVE A MOITION TO APPROVE MOTION TO APPROVE THE CONCEPT? SECOND? ALL IN FAVOR? ANY OPPOSED? OKAY. THANK YOU. WE HAVE JUST ABOUT CAUGHT UP WITH OUR AGENDA. WE'LL TAKE A BREAK RIGHT NOW, TRY TO BE BACK AT 10:15 FOR FOUR MORE CONCEPTS. DR. JASON WAN WILL PRESENT THE NEXT CONCEPT. COUNCILMEMBERS CHAI, MESSERSMITH WILL LEAD. TITLED ENCOURAGING NOVEL -- MODELS AND EX VIVO CELL LINES DEVELOPMENT. IN ORDER TO ADD VABS OUR UNDERSTANDING OF ENAMEL DEVELOPMENT, THIS INITIATIVE WILL HAVE TWO GOALS. ONE, TO VOL DATE MODELS FOR THE STUDY OF AMELOGENESIS THAT ACCURATELY REFLECT THE DEVELOPMENTAL STAGE OR PHYSIOLOGICAL PROCESS THEY ARE MEANT TO REPRODUCE, AND TWO, TO GENERATE ANY NEW OR IMPROVED MODELS, ENSURING THEY ARE BOTH ROBUST AND REPRODUCIBLE. AMELOGENESIS, WHICH IS THE PROCESS OF ENAMEL FORMATION, IS A COMPLEX ONE THAT INVOLVES A NUMBER OF GENES AND MANY PROTEINS AND IONS THAT ARE MOVED BETWEEN THE AMELOBLAST CELL AND THE EE ENAMEL MATRIX. MUTATIONS IN ANY OF THESE GENES OR PERTURBATIONS IN ANY OF THESE ENVIRONMENTAL FACTORS CAN LEAD TO CLINICAL PRESENTATION OF A NUMBER OF ENAMEL DEFECTS. COMMON TOOLS USED BY RESEARCHERS ARE ANIMAL MODELS AND CELL LINES LINES. THE ANIMAL MODEL OF CHOICE IS A RODENT WITH ITS CONTINUOUSLY GROWING INCISOR, BUT IT HAS LIMITED PHYSIOLOGICAL RELEVANCE TO HUMANS. ANOTHER MODEL IS CELL LINES THAT ARE AVAILABLE BUT THERE'S A LIMITATION IN THE AVAILABILITY OF CELL LINES REPRESENTING VARIOUS STAGES OF AMELOGENESIS. AND THESE LINES ARE SOMETIMES NOT ALWAYS PREDICTABLE, LEADING TO REPRODUCIBILITY PROBLEMS. CURRENTLY, THERE ARE TOOLS THAT ARE AVAILABLE TO MANIPULATE GENES, INSERTIONS AND DELETIONS IN THE GENOME, AND TO CONTROL THE MICROENVIRONMENT BY ANY OF VARIOUS ENVIRONMENTAL OTHER OTHER FACTORS THAT ARE INFLUENCING THAT TISSUE MICROENVIRONMENT. AND THESE ARE ALL TO DISSECT THE MOLECULAR MECHANISMS. TO ADDRESS THESE GAPS, THERE ARE SPECIFIC AREAS OF INTEREST. TO VALIDATE CELL DEVELOPMENT, STEM CELLS OR OTHER SOURCES TO REFLECT THE CONTINUUM OF DIFFERENTIATION TO MATURATION. TO REFINE OR DEVELOP NEW AMINO BLAST CELL LINES AND SUITABLE ANIMAL MODELS, AND DEVELOP 3D CULTURES, CO-CULTURES WITH OTHER CELLS AND ENGINEERING APPROACHES TO EMULATE THE NATIVE AMELOBLAST ENVIRONMENT, AND TO STANDARDIZE THESE PROCESSES FOR DEVELOPMENT -- DEVELOPING THESE MODELS, SHARE THE INFORMATION ABOUT THESE MODELS THAT ARE DEVELOPED, AND TO TEST THE MODELS FOR UTILITY AND REPRODUCIBILITY. FOR THIS CONCEPT, DR. CHAI HAS AGREED TO LEAD THE DISCUSSION, FOLLOWED BY DR. MESSERSMITH AND THEN DR. TANNER. >> THANK YOU, JASON. WE REALLY HAVE COME A LONG WAY ON ENAMEL RESEARCH SINCE THE DAY THAT THE GENE AMELOGENIN WAS CLONED UNTIL NOW, WE HAVE LOTS OF CROSS STUDIES WITH HUMAN ENAMEL DEFECTS AND CERTAINLY ANIMAL MODELS HAVE BEEN VERY, VERY HELPFUL TO UNDERSTAND WHAT REGULATE ENAMEL FORMATION. I THINK JUST THIS CONCEPT REALLY IS VERY TIMELY. I JUST ONLY HAVE A FEW COMMENTS TO MAKE. I THINK WE SHOULD REALLY EMPHASIZE THE POINT OF DEVELOPING ANIMAL MODELS TO BETTER TESTING OR -- HAVE A BETTER UNDERSTANDING ABOUT THE ENAMEL FORMATION, AND ALSO IN TERMS OF ENAMEL REPAIR OR REGENERATION, WE SHOULD ALSO EMPHASIZE SORT OF THE IN VIVO APPROACH. THE OTHER PART ABOUT THE 3D CULTURE OR -- I THINK WILL BE USEFUL, WE HAVE TO LOOK AT WHETHER THIS IS AT AN EARLY STAGE OF THE UTILITY OF THESE MODELS TO STUDY ENAMEL FORMATION, AND THEN REALLY HAVE A BETTER UNDERSTANDING OF HOW WE CAN UTILIZE THESE NEW APPROACHES TO HAVE A BETTER UNDERSTANDING HOW ENAMEL FORMS. THE CELL CULTURE MODEL, CERTAINLY THAT'S SOMETHING WE NEED TO HAVE BETTER DEVELOPMENT IN TERMS OF UNDERSTANDING HOW THESE DIFFERENT CELLS INTERACT WITH GUIDE THE ENAMEL CRYSTAL STRUCTURE FORMATION AND THAT WILL REALLY INFORM US ABOUT POSSIBLE WAYS TO REPAIR OR REGENERATE ENAMEL IN THE FUTURE, AND ALSO FROM THESE STUDY, WE CAN PROBABLY DEVELOP SOME INFORMATION TO INFORM PREVENTIVE MEASURES FOR PATIENT CARE. FINALLY, I THINK IN OUR DISCUSSION WE ALSO TALKED ABOUT WHILE WE LOOK AT THESE ENAMEL FORM IN AN ORGANOID STRUCK TEU WE WANT TO MAKE SURE THE MATRIX STRUCTURE IS REALLY REPRESENTS WHAT THE ENAMEL MATRIX IS IN THE IN VIVO SETTING. SO THESE ARE IMPORTANT PARAMETER PARAMETERS FOR ALL OF US TO KEEP IN MIND AS WE MOVE FORWARD WITH THIS TYPE OF STUDY. THANK YOU. >> SO I ALSO LIKE THIS CONCEPT QUITE A BIT, PARTICULARLY THE THREE-DIMENSIONAL CULTURE AND CO-CULTURE ASPECT OF THIS CONCEPT. I THINK THERE'S A LOT OF INTERESTING OPPORTUNITIES ACTUALLY FOR NOVEL MATERIALS TO CONTRIBUTE TO THIS CONCEPT IN THE FORM OF, FOR EXAMPLE, 3D PRINTABLE MATERIALS, THERE'S A LOT OF EXCITING WORK GOING ON IN THAT FIELD, AND IT'S DEVELOPING VERY RAPIDLY. ALSO IN THE FORM OF THESE MICRO PHYSIOLGICAL OR ORGANOID CHIP SYSTEMS, MAYBE A SLIGHT WORD OF CAUTION THERE, WHICH IS PRESENTLY, THE VAST MAJORITY OF THE WORK IN THAT FIELD IS PERFORMED ON VERY PRIMITIVE MATERIALS, THINGS LIKE SILL CONES, THINGS THAT SILICONES, THINGS THAT REALLY ARE POOR MIMICS OF THE EXTRACELLULAR MATRIX, BUT AT THE SAME TIME, THAT'S ALSO AN OPPORTUNITY FOR PEOPLE WORKING IN THAT FIELD TO DEVELOP BETTER MATERIALS TO UNDERSTAND THE MECHANICAL BIOLOGY OF ENAMEL DEVELOPMENT. >> I WAS VERY PLEASED THAT DR. CHAI AND DR. MESSERSMITH WERE ON THIS DISCUSSION BECAUSE OF THEIR BACKGROUND IN THIS AREA, AND I VERY MUCH APPRECIATED THEIR PREMEETING DISCUSSION WHICH HAS PRETTY MUCH BEEN COVERED IN THEIR COMMENTS. FOR MYSELF, I FOUND THE BEST AREA I COULD PROBABLY CONTRIBUTE IS CONSIDERING THE SIGNIFICANCE OF THIS CONCEPT. US A KNOW, FULLYAS YOU KNOW, FULLY FORMED ENAMEL BECOMES INCREASINGLY SUSCEPTIBLE FOR A HIGHER RATE OF DENTAL CARIES, AND INDEED, WHETHER IT'S FROM CHEMICAL EXPOSURES OR POOR NUTRITION THAT MAY AFFECT OUR FORMATION, IT WOULD BE NICE TO KNOW WHAT THOSE INTERACTIONS ARE ARE. I ALSO POINT OUT IN 2012, THEY EVEN PROPOSED A NEW NAME FOR DENTAL CARIES FROM HYPERPLASTIC ENAMEL, HASE C C, WHICH IS VERY SEVERE FORMS OF DENTAL CARIES, AND IN SOME RESPECT, CONSIDERING SOME OF THE REASONS WHY THERE MAY BE GENETIC ALTERATIONS IN ENAMEL FORMATION COULD WELL OVERLAP A CONCEPT OF BIOLOGICAL FACTORS UNDERLYING ORAL CRANIOFACIAL DISPARITIES. SO FROM THAT PERSPECTIVE AND FROM WHAT I'VE HEARD IN OUR DISCUSSIONS, I VERY MUCH SUPPORT THIS CONCEPT AND THANK YOU FOR THE OPPORTUNITY TO PARTICIPATE. >> OTHER COMMENTS OR QUESTINS? IF NOT, WOULD SOMEONE LIKE TO MAKE A MOTION TO APPROVE THE CONCEPT? SECOND? ALL IN FAVOR? ANY OPPOSED? OKAY. THANK YOU. ON TO THE NEXT CONCEPT. WHICH WILL BE PRESENTED BY DR. CHIAYENG WANG FROM THE CANCER BIOLOGY PROGRAM. COUNCILMEMBERS BAKER, CHAI AND D' SILVA WILL LEAD THE DISCUSSION. >> GOOD MORNING. I'LL BE PRESENTING ON BEHALF OF MY TEAMMATE, DR. GNATT, ON OUR JOINT COP SEPTEMBER ENTITLED PRECISION IMAGING OF ORAL LESIONS. WE SEEK COUNCIL'S CONCURRENCE WITH THIS INITIATIVE. SO AS WE MOVE TOWARDS PERSONALIZED MEDICINE, WE NEED TO FOCUS ON INNOVATIVE POINT OF CARE TECHNOLOGIES FOR PRECISION HEALTH. THE PURPOSE OF THIS INITIATIVE IS TO ENCOURAGE RESEARCH THAT USES CUTTING EDGE IMAGING TECHNOLOGIES THAT CAN ENHANCE DETECTION AND DIAGNOSIS OF ORAL DISEASES AND CONDITIONS. THEREBY ENHANCING TREATMENT AND PLANNING OF PATIENTS TO IMPROVE THEIR SURVIVAL AND LIFE QUALITY. SO WE ARE -- TODAY IN TERMS OF DIAGNOSEING ORAL LESIONS. BIOPSY REMAINS TO BE THE GOLD STANDARD FOR DIAGNOSING LESIONS, AND HISTOPATHOLOGY REMAINS TO BE THE REFERENCE STANDARD TEST. IN THIS PROCESS, THERE ARE SOME INHERENT LIMITATIONS THAT INCLUDE LOOSELY DEFINED HISTOPATHOLOGICAL CHARACTERIZATIONS, AND DEFINITIONS, IN ACCURACY IN HISTOLOGICAL DE -- AND THE INTERAND THE INTRAOBSERVER VARIABILITY. SO ALL OF THESE ARE MAJOR DRAW BACKS THAT CAN LEAD TO MISDIAGNOSIS AND IMPROPER CARE. SO WE NEED TO FILL THIS INFORMATION AND CLINICAL PRACTICE GAP BY INTRODUCING MORE ANALYTICAL AND QUANTITATIVE EVALUATION PROCESS THAT CAN EITHER REPLACE OR COMPLEMENT WITH THE CURRENT STANDARD PRACTICE TO AVOID THESE UNDESIRED OUTCOMES. AND PRECISION IMAGING CAN FILL THIS VOID. SO THE MODERN IMAGING MODALITIES APPLY WITH ADVANCING IMAGING PROCESSING AND ANALYSIS TECHNOLOGIES HAVE BECOME A MAJOR SOURCE OF INFORMATION IN REBUILDING NOT ONLY THE FINE ANATOMICAL DETAILS AS WELL AS CELLULAR AND MOLECULAR MECHANISM OF BIOLOGY. SO IN THIS SPECTRUM ON PRECISION IMAGING, ON THE ONE THING WE HAVE THINGS SUCH AS RADIOMICS, THESE ARE HIGHLY SOPHISTICATED IMAGING ANALYTICS THAT PROVIDE QUANTITATIVE METRICS FROM COMPUTERIZED IMAGE FEATURE, MAKING BIOIMAGING MORE EFFECTIVE, OBJECTIVE AND REPRODUCIBLE. AND THIS IMAGING LANDMARKS CAN BE COUPLED WITH A NUMBER OF FUNCTIONAL GENOMIC SIGNATURES TO GET POWERED TO A QUICK CLINICAL TRANSLATION OF HIGH THROUGH PUT INFORMATION IN A PERSONALIZED MANNER. AND THE OTHER END OF THE PRECISION IMAGING SPECTRUM, WE HAVE MOLECULAR IMAGING, AND THAT CAN MAP ANATOMICAL LOCATIONS OF SPECIFIC MOLECULES OF INTEREST WITHIN LIVING TISSUES. SO IT HAS POTENTIAL POWER, I MEAN IT'S VERY POWERFUL TOOLS FOR DIAGNOSING AND MONITORING DISEASE. SO BY CHOOSING THE CORRECT IMAGE MODALITIES ALONG WITH THE ANALYSIS METHODOLOGIES WHEN VISUALIZING SPECIAL LESIONS, WITH THE CLINICAL CONTEXT IN MIND PRECISION IMAGING CAN ADD MORE TO THE VALUE NOT ONLY TO BIOLOGICAL RESEARCH BUT ALSO TO CLINICAL PRACTICE. SO SOME OF THE INTERESTING AREAS WILL BE COVERED UNDER THIS INITIATIVE BUT NOT LIMITED TO, INCLUDE INTEGRATION OF EMERGING IMAGING TECHNOLOGIES INTO CLINICAL WORK FLOW, FOR MORE EFFECTIVE SOLUTIONS IN CHARACTERIZING AND GRADING OF ORAL LESIONS AND DETERMINING THE EXTENT AND SEVERITY OF DISEASE. OPTIMIZATION OF SINGLE CELL ANALYSIS TO DEFINE PHYSIOLOGICAL STATE WITHIN HETEROGENEOUS LESIONS. DEVELOPMENT OF ROBUST METHODS TO DETECT LESIONS NOT DETECTABLE BY CONVENTIONAL EXAMINATION PROCEDURES, DEVELOPMENT AND OPTIMIZATION OF INTRAOPERATIVE IMAGE-GUIDED PROCEDURES SUCH AS BIOPSY, SURGERY AND ABLATIVE THERAPIES FOR ORAL DISEASE TREATMENT MANAGEMENT, AND DEVELOPMENT OF -- AGENTS THAT TARGET BIOLOGICAL PATHWAYS AND PROCESSES TO HELP IDENTIFY EARLY MARKERS AD ALSO FOR TREATMENT AND MOP TORING OF THERAPEUTIC EFFECTS OF ORAL DISEASES AND CONDITIONS. I THANK DRS. BAKER, CHAI AND D' SILVA FOR AGREEING TO RENEW THIS INITIATIVE. DR. D' SILVA HAS AGREED TO LEAD THE DISCUSSION. THANK YOU. >> SO I'M VERY ENTHUSIASTIC ABOUT THIS CONCEPT BECAUSE OF THE ABILITY TO ADDRESS ISSUES, CONFOUNDING ISSUES OF THE CLINICAL RADIOGRAPHIC AND HISTOPATHOLOGIC LEVEL IN TERMS OF IMAGING. INDISTINGUISHABLE LESIONS MAY BE BENIGN, REACTIVE OR MALIGNANT, AND THESE DELAYS IN DIAGNOSIS, IN FACT, NOT JUST MALIGNANCIES BUT ALSO OTHER LIFE-THREATENING CONDITIONS SUCH AS -- DISORDERS, THE RADIOGRAPHS CANNOT PROVIDE A DEFINITIVE DIAGNOSIS, AND IT IS UNCLEAR WHETHER THE BENEFITS OF ADVANCED IMAGING HAVE BEEN ASSESSED RELATIVE TO DIAGNOSTIC ACCURACY. HISTOPATHOLOGICALLY SIMILAR LESIONS HAVE BEEN -- MAY HAVE DIFFERENT CLINICAL OUTCOMES, AND THE HISTOPATHOLOGY CANNOT BE ASSESSED CHAIR SIDE CURRENTLY, AND REQUIRES INVASIVE BIOPSY PROCEDURES, THEREBY DELAYING DIAGNOSIS AND TREATMENT. ANOTHER ISSUE IS ASSESSMENT OF MARGINS AT THE TIME OF SURGERY. SO THIS INITIATIVE, THIS CONCEPT ADDRESSES A VERY IMPORTANT AREA. THE SUGGESTIONS I HAVE FOR THIS ARE TO CLARIFY THE DEFINITION OF IMAGING FOR THE CONCEPT THE INITIATIVE WILL REQUIRE BENCHMARKING AGAINST EXISTING DIAGNOSTIC TESTS AND TOOLS TO PROVE IMPROVEMENTS AND INCLUDE INVESTIGATIONS OF MOLECULAR MARKERS TO FEED INTO THE IMAGING TECHNOLOGY, AS WELL AS TO IMPROVE DATA ANALYSIS AND PROVIDE REALTIME POINT OF CARE CLARITY. SO MY VERY ENTHUSIASTIC SUPPORT. >> SO AS AN ORAL HEALTHCARE PROVIDER, I'M REALLY VERY EXCITED ABOUT THIS NEW CONCEPT. I THINK IT'S CRITICAL FOR PEOPLE WHO WORK WITH PATIENTS TO BE ABLE TO PROVIDE DIAGNOSIS FOR ORAL LESIONS AT EARLY STAGE AND REFER THEM TO THE PROPER SPECIALIST FOR CARE, AND THEN, OF COURSE, PRECISION IMAGING COUPLED WITH PRECISION DIAGNOSIS WILL HELP PATIENTS TO SEEK PROPER CARE AND THEN ALSO REDUCE UNCERTAINTY AND THEN PROBLEMS IN DIAGNOSIS. JUST A FEW COMMENTS. I THINK ONE OF THE CONSIDERATIONS THAT WE TALKED ABOUT IN OUR DISCUSSION IS TO COMBINE SOME OF THESE PRECISION IMAGING WITH SOME OF THE MORE TRADITIONAL PATHOLOGY STUDIES TO MAKE SURE THIS IS A PRECISE DIAGNOSIS, AND ALSO HOW TO GET THE CLINICIANS TO ADAPT THESE NEWLY DEVELOPED TECHNOLOGY, AND THEY USE THAT IN THEIR PRACTICE AND TO BENEFIT THEIR PATIENTS. ALSO I SAW A COMMENT FROM AADR, WHICH PROVIDED A FEEDBACK TO THIS CONCEPT, AND WHAT THEY MENTIONED HOW THIS POSITION IMAGING MAY CHANGE THE CLINICAL DECISION-MAKING. SO THAT'S SOMETHING I THINK IS ALSO VERY IMPORTANT TO CONSIDER. OVERALL, YOU THINK I THINK THIS IS A REALLY IMPORTANT CONCEPT AND I'M VERY SUPPORTIVE. >> I'M GOING TO THIRD THE OPINIONS OF DRS. D' SILVA AND DR. CHAI, BUT FROM A SLIGHTLY DIFFERENT PERSPECTIVE, FROM THE TREATMENT SIDE, HAVING TOOLS THAT WOULD ALLOW US TO LIKE MECHANISTICALLY AT MOLECULAR CHANGES WITHIN A LESION AS WELL AS CELLULAR MARKERS, WHAT TYPES OF IMMUNE CELLS ARE COMING OR GOING AT WHAT POINT IN TIME, NOT ONLY DURING BUT BEFORE THE TREATMENT AND AFTER THE TREATMENT TO SEE IF THE THINGS THAT WE ARE DEVELOPING AS INTERVENTIONS ARE DOING WHAT WE THINK THEY DO. ACROSS A WHOLE LESION OR ACROSS THE WHOLE CAVITY. SO VERY STRONGLY SUPPORT THIS AND LOOK FORWARD TO TAKING SOME OF THE TOOLS THAT ARE USED IN OTHER AREAS THAT ARE VERY POWERFUL, THREE-DIMENSIONAL, MULTIPHOTON, MULTI-LIGHT, MULTI-DETECTION SYSTEMS, AND NOT BEING AFRAID TO REACH OUT TO THOSE COMMUNITIES FOR THEIR ASSISTANCE, BECAUSE THERE'S A LOT OUT THERE AND I THINK IT WILL BE VERY POWERFUL IN HELPING IN THE PERSONALIZED MEDICINE AS WELL, SO VERY STRONGLY SE PORT SUPPORT THIS. >> OTHER COMMENTS OR QUESTIONS? DR. MCNEIL? >> I'VE GOT A QUESTION. PRECISION IMAGING AND MOLECULAR IMAGING, YOU NOTE IT'S RAPIDLY EMERGING. ONE OF THE QUESTIONS IS, HOW QUICKLY IS IT CHANGING? IS IT SOMETHING THAT IN FIVE YEARS, THE TECHNOLOGIES WE HAVE NOW ARE NOT GOING TO BE USED ANYMORE, WHAT'S HAPPENING IN THAT FIELD? >> THE IMAGING HAS BEEN IMPROVING AND ADVANCING CONTINUOUSLY, SO WHAT HAVE BEEN DEVELOPED NOW WILL REMAIN, IT WILL BE JUST HAVING TO ADD ON. SO WE HAVE REACHED A CERTAIN STAGE WHERE YOU CAN REALLY LOOK INTO DETAILED INFORMATION ANATOMICALLY AND MOLECULARLY, SO IT'S NOT SOMETHING THAT IT'S GOING TO BE PUT ON THE WAYSIDE AND THERE WILL BE ANOTHER TOTALLY DIFFERENT TECHNOLOGY TO EMERGE -- TO REPLACE IN THIS PARTICULAR AREA. SO I DON'T THINK THAT CONCERN -- YOU NEED TO HAVE TOO MUCH OF THAT CONCERNS. IT'S AN INTEGRAL PART OF MEDICAL SCIENCE THAT'S NOT GOING AWAY, BASICALLY. >> IT SEEMS LIKE THE WRITE-UP AND ALSO THE DISCUSSION IS MOSTLY FOCUSED OP SOFT TISSUE LESIONS, RIGHT? >> IT'S FOR ALL LESIONS, BUT YES, MUCH OF THE INFORMATION THAT WE HAVE PUT INTO THE WRITEUP APPLY DEFINITELY TO MORE OF SOFT TISSUE LESIONS, BUT IT CAN ALSO APPLY TO HEART TISSUE. >> THAT'S WHY IT'S -- [INAUDIBLE] >> I SEE. I'M NOT A RESEARCHER IN THIS FIELD BUT I'M JUST WONDERING HOW YOU DO GENOMIC OR TRANSCRIPT OMIC ANALYSIS ON A DENTAL HARD TISSUE THAT DOESN'T HAVE CELLS. LIKE ENAMEL. >> WELL, THE INITIATIVE IN TERMS OF APPLYING IMAGING TECHNOLOGY TO DIAGNOSE OR DETECT THE ORAL LESIONS DEFINITELY DEPENDS ON WHERE YOU'RE LOOKING AT AND WHAT IS APPLICABLE IN TERMS OF THE TYPES OF LESIONS. AS YOU SAID, TECHNOLOGIES WILL NOT BE APPLICABLE FOR SPECIFICALLY LESION TYPE OR HARD TISSUE TYPE, BUT IT WILL BE VERY USEFUL FOR ADVANCING OUR KNOWLEDGE AS WAS CLINICAL TREATMENTS FOR OTHER LESIONS, SO FOR THAT ALONE IS VERY VALUABLE WAYS TO PUSH FORWARD THE FIELD. >> ANYONE ELSE? >> THANK YOU. THIS IS -- FROM THE ADA. THE COUNCIL SCIENTIFIC CHIEF AFFAIRS WILL BE PUBLISHING GUIDELINES ON DIAGNOSIS OF EARLY LESIONS, IN OCTOBER THIS YEAR. THERE IS A CLINICAL PRACTICE DPIED LINE SYMPOSIUM MEETING. ONE OF THE RESULTS OF THE CLINICAL PRACTIC GUIDELINES ANALYSIS THE REVIEW SHOWS THAT NONE OF THE EXISTING IMAGING TOOLS THAT WE HAVE NOW FOR CLINICIANS WORK. THEY ARE NOT VALIDATED, THEY ARE SHOWING THAT THEY FAIL WHEN THEY GO TO THE NEXT LEVEL OF DIAGNOSIS, THEY ARE NOT ABLE TO DETECT LESIONS. THE OTHER THING IS I THINK WHAT DR. CHAI SAID IS IT'S VERY IMPORTANT, IT'S ALSO TO DEVELOP SOME THINGS THAT CAN BE USED IN THE CLINICAL PRACTICE. ALL THE GENOMICS, RADIOMICS IS BEAUTIFUL, BUT THE CLINICIAN WILL NOT BE ABLE TO HAVE ACCESS, NOT EVEN -- THEY'RE NOT GOING TO ASK FOR THIS SO I URGE ALSO YOU TO LOOK INTO COST-EFFECTIVE TREATMENT OR DIAGNOSIS TOOLS THAT CAN BE USED BY THE CLINICAL PRACTITIONER. THANK YOU. >> THANK YOU. >> OKAY. WOULD A MEMBER OF COUNCIL LIKE TO MAKE A MOTION TO APPROVE THE CONCEPT? SECOND? ALL IN FAVOR? ANY OPPOSED? THANK YOU. OKAY. FOR THE NEXT CONCEPT, WE HAVE ARE DR. MALAMUD ON THE PHONE AND THE CONCEPT WILL BE PRESENTED BY DPR DAGGYA GANNOT, AND THEN DOCTORS MALA PL. UD -- AND CHAI WILL LEAD THE DISCUSSION. >> GOOD MORNING. HAPPY FRIDAY. I'M ALMOST THE LAST CONCEPT SO -- SO I WOULD LIKE -- I'M VERY EXCITED TO PRESENT FOR COUNCIL CONCURRENCE BASIC AND TRANSLATIONAL RESEARCH ON HIV AND AIDS-RELATED PATHOGENS IN THE ORAL CAVITY. THE GOAL OF THIS CONCEPT IS TO ENCOURAGE INNOVATIVE BASIC AND TRANSLATIONAL RESEARCH INTO MECHANISMS OF HIV TRANSMISSION, PERSISTENCE, PATHOGENESIS, AND COMORBIDITIES IN THE ORAL CAVITY. RESEARCH RESPONSIVE TO THIS INITIATIVE WILL HELP ADDRESS GAPS IN OUR KNOWLEDGE, AND COULD ENCOURAGE DEVELOPMENT OF IMPROVED LOCAL AND SYSTEMIC THERAPIES FOR HIV-RELATED ORAL INFECTIONS AND OTHER COMPLICATIONS IN THE ERA OF COMBINATION ANTIRETROVIRAL THERAPY. SO THE SPECIFIC AREAS OF INTEREST THAT WE LISTED HERE ARE NOT ALL OF THEM, OF COURSE, SO THEY'RE NOT LIMITED TO THE FOLLOWING ONES. THAT ARE MECHANISMS OF MOTHER TO CHILD ORAL HIV TRANSMISSION, ORAL MUCOSAL DEFENSE MECHANISMS, IN THE CONTEXT OF HIV INFECTION, AND ANTIRETROVIRAL THERAPY, MECHANISMS OF ORAL HIV/AIDS OR PROPHYLACTIC AND THERAPEUTIC VACCINES, HIV AND ORAL MICROBIOME, MECHANISMS LIVING TO THE DEVELOPMENT OF CARIES AND PERIODONTITIS OF PEOPLE LIVING WITH HIV AND CO-MORBID ITS OF PEOPLE COMORBIDITIES OF PEOPLE LIVING WITH HIV. SO THESE ARE THE AREAS OUR REVIEWERS -- ON THE PHONE HOPEFULLY WITH US, HE IS LEADING THE DISCUSSION, DR., ARE YOU WITH US? >> YES, I AM. IT'S ONLY MY VOICE THAT MIGHT BE A PROBLEM. SO I AM VERY INTERESTED IN THIS AREA. WE HAVE BEEN WORKING -- >> WILL YOU SPEAK UP? IT'S VERY HARD FOR US TO HEAR YOU. THANK YOU. WE KNOW YOU HAVE LARYNGITIS. >> SO I HAVE BEEN WORKING IN THE AREA FOR PROBABLY 20 YEARS, SO WE'VE LEARNED A GREAT DEAL. INITIALLY THERE WAS FEAR ABOUT PEOPLE KISSING OR DRINKING FROM A CONTAMINATED GLASS OR IF THERE WAS A FOOD SERVICE WAITER THAT HAD AIDS, THEY THOUGHT THEY COULD CATCH IT FROM THAT INDIVIDUAL, AND ALMOST ALL OF THESE HAVE BEEN DEBUNKED OVER THE YEARS. AND THAT IS BECAUSE THERE ARE A SERIES OF MOLECULES AND CHEMICAL SITUATIONS IN THE ORAL MUCOSA AND IN THE SALIVA THAT SEEM TO INACTIVATE HIV. THE SIMPLEST ONE IS HYPOTENNIS IT. SALIVA IS HYPOTONIC. IF AN ENVELOPE VIRUS IS PUT INTO A HYPOTONIC SOLUTION, IT LYSES. THIS IS GOING BACK TO VERY EARLY STUDIES. IF YOU DID MOLECULAR TESTING, YOU FOUND VIRUS IN SALIVA, BUT IF YOU TRIED TO CULTURE THE VIRUS, YOU COULDN'T CULTURE IT. THE THOUGHT WAS IT HAD BEEN INACTIVATED BY THE HYPOTENNIS IT. TENICITY. SO IN GENERAL, MOST OF THE CONDITIONS THAT WE SEE IN THE ORAL CAVITY IN HIV INFECTED INDIVIDUALS, FOR EXAMPLE, THERE IS AN INCREASE IN GENERAL IN CARIES AND PERIODONTAL DISEASE, AND THIS COULD BE EXPLAINED SIMPLY BY THE DEFICITS IN THE IMMUNE SYSTEM. BUT MOST INTERESTINGLY, THE ONE PATHOGEN THAT SEEMS TO REMAIN IS HPV, AND WE DON'T REALLY UNDERSTAND WHY THAT IS SO, AND THAT'S AN INTERESTING QUESTION. THE OTHER THING IS, AND THIS HAS BEEN LOOKED AT A LOT, THE TRANSMISSION ORALLY DOES NOT OCCUR AFTER ORAL SEX. AND THAT, YOU WOULD EXPECT IF THERE WAS GOING TO BE SOMETHING, THAT IT WOULD -- BECAUSE THE VIRAL LOAD IN SEMEN IS QUITE HIGH, YOU'D EXPECT, BUT APPARENTLY, THE DEFENSE MECHANISMS CONTROL IT, AND THERE'S ONLY ONE OR TWO EYES LATED REPORTS OF AN INDIVIDUAL WHO MIGHT HAVE BEEN INFECTED BY ORAL SEX. IN CONTRAST, THE TRANSMISSION THROUGH BREAST FEEDING IS WELL DOCUMENTED, AND SO IT'S AN INTERESTING QUESTION, IS IT BECAUSE THAT YOU GET A BREAST FED BABY MAYBE THREE, FOUR TIMES A DAY, THEN EVERY DAY FOR MANY WEEKS, IS THAT WHAT'S DOING THE TRANSMISSION, OR IS IT THE -- SOMETHING IN THE MILK THAT COUNTERACTS THE EFFECT OF THE MUCOSAL DEFENSE MECHANISMS. I MEAN, THOSE ARE THE TWO POSSIBILITIES THAT COME TO MIND. BUT IT'S STILL A VERY INTERESTING AND IMPORTANT, VERY IMPORTANT, BECAUSE WE DO KNOW THAT THERE IS A VERY HIGH TRANSMISSION WITH BREAST FEEDING. THE OTHER INTERESTING QUESTION IS THE ORAL MICROBIOME. AGAIN, THERE'S BEEN A LOT OF REPORTS OF THE ALTERATIONS IN THE ORAL MICROBIOME, BUT TO MY KNOWLEDGE, THERE'S NONE THAT SUGGEST A DIRECT INTERACTION BETWEEN A MICROBE AND THE VIRUS THAT MIGHT BE PROTECTED. AND THAT COULD BE DONE IN SILICA OR IN TISSUE CULTURE, AND SEE IF THERE'S A CHANGE IN THE MICROBIOME, DOES THAT AFFECT IN VITRO THE ABILITY OF HIV TO INFECT CULTURED CELLS. THE OTHER ISSUE WHICH IS NOT IN THIS CONCEPT BUT I THINK NEEDS TO BE IN SOME CONCEPT IS THAT THERE IS A -- THERE IS THE ABILITY TO DETECT HIV INFECTION WITH AN ORAL TEST. SO THAT TEST MEASURES THE ANTIBODY OR THE NUCLEIC ACID. DENTISTS ARE RARELY DOING THESE TESTS, AND WE KNOW THAT THERE'S ABOUT 20 MILLION PEOPLE EVERY YEAR IN THE UNITED STATES, THAT THE ONLY HEALTH PROFESSIONAL THEY SEE IS A DENTIST. AND SO THEY MAY NOT BE GETTING TESTED FOR HIV. SO IT WOULD BE VERY USEFUL IF WE COULD FIND A MECHANISM TO ENCOURAGE DENTAL PROFESSIONALS AND USUALLY WHAT THEY SAY IS IT'S NOT IN THE SCOPE OF THE PROFESSION, AND WE COME BACK WITH NEITHER IS TAKING BLOOD PRESSURE IN THE SCOPE, AND SUPPOSEDLY DENTISTS ARE SUPPOSED TO TAKE A BLOOD PRESSURE TEST ON THEIR PATIENTS, AND THEY DON'T TREAT THEM, THEY SAY YOU JUST NEED TO SEE YOUR PHYSICIAN, AND THE SAME THING COULD BE DONE WITH HIV. IT'S A SCREENING TEST, THE ANTIBODY TEST, AND THEY COULD SAY YOU HAVE POSITIVE ANTIBODIES FOR HIV, YOU MAY NOT BE INFECTED BUT YOU NEED TO GO -- IT WOULD BE VERY NICE IF WE COULD FIND A WAY IN NOT PROBABLY THIS CONCEPT BUT ONE OF THE OTHER CONCEPTS OF A PROGRAM TO FOSTER TESTING FOR HIV IN THE DENTAL SETTING. AND I THINK THAT'S ALL I HAVE TO SAY FOR NOW. >> THANK YOU. DR. TANNER? >> I'M ALSO VERY SUPPORTIVE OF THIS CONCEPT, WHICH BASICALLY IS, AS DR. MALL MUD VERY NICE RELEE REVIEWED, A LOT OF WORK HAS BEEN DONE ON HIV IN THE ORAL CAVITY AND ITS EFFECT ON ORAL AND CRANIOFACIAL DISEASES, BUT THERE'S MORE TO DO, AND IT WOULD BE GOOD TO CONTINUE THE RESEARCH. DR. MALAMUD VERY NICELY SUMMARIZED WHAT I LEARNED IN OUR PREVIOUS DISCUSSION, BUT JUST TO PICK UP ON A COUPLE OF THINGS THAT I THOUGHT WRL PARTICULARLY INTERESTING, NAMELY, RECOGNIZING THE ASSOCIATION WITH HIV/AIDS WITH ADVANCED CARIES PERIODONTITIS AND MALIGNANCIES, SO IT'S AN IMPORTANT AREA TO TEASE OUT, AND THE OTHER ONE WE DISCUSSED OR OF PARTICULAR INTEREST AS HE POINTED OUST IS INFECTION OF INFANTS IN RELATION TO BREAST FEEDING. VERY LITTLE IS KNOWN ABOUT WHAT IS REQUIRED TO GET THE TRANSMISSION. IS IT PROLONGED BREAST FEEDING, IS IT NUMBER OF TIMES A DAY, SO THERE ARE THINGS THAT REALLY NEED TO BE CONSIDERED, AND THEN LASTLY, LISTED ON YOUR SLIDE IS THE ROLE BETWEEN VIRUSES AND BACTERIA, AND IN OUR DISCUSSION, WE CONSIDER A GOOD THING, PERHAPS, TO ADD TO THE CONCEPT WAS THE SUGGESTION OR REQUIREMENT FOR SOME MULTIDISCIPLINARY COLLABORATION, SO INTERACTION BETWEEN VIRUS AND BACTERIA FOR THE MICROBIOME COULD BE ADEQUATELY STUDIED. SO THOSE WERE THE KEY THINGS THAT I PULLED OUT. A LOT OF PEOPLE WITH THE TIME THEY'VE GOT, HIV AND AIDS MAY ALSO FIT IN WITH FOLKS WITH ORAL HEALTH DISPARITIES SO MAYBE IT CROSSES UP A LITTLE BIT WITH THAT CONCEPT WHICH IS COMING UP NOW, BUT OVERALL, I VERY MUCH SUPPORT THIS CONCEPT, PARTICULARLY IN RELATION TO INFANT -- OF HIV. >> SO I'M ALSO VERY SUPPORTIVE OF THIS CONCEPT. I THINK REALLY THE BEAUTY HERE IS THIS IS SUCH A BROAD CONCEPT THAT COVERS MECHANISTIC AND TRANSLATIONAL RESEARCH IN HIV, AND ALSO HIGHLIGHTED AREAS THAT NOT REDUCED SUCH AS SALIVARY GLAND ASSOCIATED WITH HIV AND SEVERE PERIODONTITIS, AND ALSO ORAL MALIGNANCIES IN PEOPLE LIVING WITH HIV. ALSO I THINK ONE OTHER COMMENT IS -- HAS A LOT OF THE PATIENT POPULATION DIVERSITY. THIS IS REALLY A GREAT OPPORTUNITY FOR US TO STUDY. IT'S A MECHANISM OF HIV. SO I'M VERY SUPPORTIVE. >> MORE QUESTIONS? >> OTHER COMMENTS, QUESTIONS? >> WE HAVE A MOTION TO APPROVE THE CONCEPT. SECOND? ALL IN FAVOR? ANY OPPOSED? THANK YOU. AND WE HAVE ONE MORE. THE FINAL CONCEPT WILL BE PRESENTED BY DR. JAIN ATKINSON, DIRECTOR OF THE CENTER FOR CLINICAL RESEARCH, AND COUNCILMEMBERS TANNER AND WEINTRAUB WILL LEAD THE DISCUSSION. >> THANK YOU FOR YOUR PATIENCE. I AM SEEKING COUNCIL'S CONCURRENCE FOR THE CONCEPT BIOLOGICAL FACTORS UNDERLYING ORAL AND CRANIOFACIAL HEALTH DISPARITIES. THE GOAL OF THIS CONCEPT IS TO ENCOURAGE STUDIES TO IDENTIFY AND UNDERSTAND BIOLOGICAL FACTORS. MICROBIAL, IMMUNE, GENETIC, THAT CONTRIBUTE TO DISPARITIES IN DENTAL, ORAL AND CRANIOFACIAL DISEASE ONSET, PROGRESSION, AND THE PERSISTENCE. NOW, WE KNOW THAT MULTIPLE BEHAVIORAL CULTURAL AND SOCIOECONOMIC FACTORS SUCH AS ACCESS TO AND USE OF HEALTHCARE CONTRIBUTE TO ORAL HEALTH DISPARITIES. BUT IF YOU LOOK AT THE FISCHER OWENS MODEL, ONE OF THE COMPONENTS OF THAT IS ALSO BIOLOGIC FACTORS. IN ADDITION, BIOLOGICAL FACTORS MAY PLAY A SIGNIFICANT ROLE IN WHETHER A DISEASE OCCURS, HOW IT PROGRESSES AND WHETHER TREATMENTS WORK. WE KNOW FROM CANCER REGISTRY DATA, THAT THE SURVIVAL OF -- WITH ORAL CANCER IS HIGHER THAN THAT -- A DISPARITY NOT OBSERVED ACROSS ALL CANCER TYPES AND IN FACT IN OTHER CANCER TYPES, THEY HAVE SHOWN THAT THERE ARE DIFFERENCES SOMETIMES IN TUMOR CHARACTERISTICS THAT MAY BE CONTRIBUTING TO SURVIVAL. CARIES IS MORE PREVALENT IN AFRICAN-AMERICAN, HISPANIC AND PARTICULARLY AMERICAN IND YAND AND ALASKA NATIVE CHILDREN. RACIAL ETHNIC AND MINORITY POPULATIONS IN THE UNITED STATES EXHIBIT A HIGHER PREVALENCE OF MORE -- OF AND MORE SEVERE DESTRUCTIVE PERIODONTAL DISEASE COMPARED TO U.S. WHITES. WE ARE NOW LIVING IN AN AGE OF GREAT TECH LOGIC ADVANCES AND SCIENTIFIC DISCOVERIES ABOUT THE ORAL MICROBIOME, INFLAMMATORY PROTEINS, MEDIATING ORAL DISEASES, AND GENOMICS THAT COULD FACILITATE MORE IN DEPTH RESEARCH INTO BIOLOGIC FACTORS UNDERLYING HEALTH DISPARITIES. THE SCOPE INCLUDES BUT IS NOT LIMITED TO RESEARCH ON MICROBIAL AND INFLAMMATORY MEDIATORS OF ORAL DISEASES IN DIFFERENTLY RACIAL AND ETHNIC GROUPS, AND THEIR CONTRIBUTION TO RACIAL AND ETHNIC DIFFERENCES AND DISEASE PREVALENCE AND/OR SEVERITY. TO CONVENTIONAL THERAPY FOR DENTAL, ORAL AND CRANIOFACIAL DISEASES THAT MAY EXPLAIN THE PERSISTENCE OF THESE DISEASES IN DIFFERENT RACIAL AND ETHNIC MINORITY POPULATIONS. NOT ON THIS SLIDE. BIOLOGICAL RESPONSES TO SOCIAL BEHAVIORAL AND CULTURAL AND SEEK SOCIOECONOMIC FACTORS THAT CONTRIBUTE AND MEDIATE ORAL HEALTH DISPARITIES, AND FINALLY, GENETIC AND GENOMIC RISK OR PROTECTIVE FACTORS THAT MIGHT CONTRIBUTE TO RACIAL AND ETHNIC DIFFERENCES IN DENTAL, ORAL AND CRANIOFACIAL DISEASES, AND THE INTERPLAY WITH OTHER FACTORS. SO I INVITE DR. WEINTRAUB TO FIRST DISCUSS THIS CONCEPT. >> THANK YOU. I SUPPORT THIS CONCEPT FOR THIS IMPORTANT PHASE OF RESEARCH TO UNDERSTAND ORAL HEALTH DISPARITIES. HEALTH DISPARITIES ALSO CALLED HEALTH INEQUITIES IN OTHER COUNTRIES ARE DEFINED BY DIFFERENCES IN HEALTH STATUS OR HEALTHCARE BETWEEN IMREUPS THAT ARE UNNECESSARY AND AVOIDABLE, BUT ALSO CONSIDERED UNFAIR AND UNJUST. SO THESE ASPECTS OF THE DEFINITION PROVIDES A CONTEXT FOR THIS CONCEPT. MUCH OF THE EARLY DISPARITY IS FOCUS OND SOCIOECONOMIC AND OCCUPATIONAL STATUS, HOW DOES SOCIOECONOMIC STATUS GET UNDER THE SKIN? THERE HAVE BEEN A FOCUS ON SOME POSSIBLE MECHANISMS, STRESS EXPOSURE, STRESS RESPONSE AND ALLOSTATIC LOAD, AND THEIR INFLUENCE ON BIOLOGIC PATHWAYS, INCLUDING TELL MERE LENGTHS HAVE BEEN STUDIED. AND MORE COMPLEX MOTTLES HAVE BEEN MODELS HAVE BEEN DISCOVERED FROM THE MOLECULAR TO MACRO SYSTEM LEVEL FACTORS, AND EVERYTHING IN BETWEEN. RISK AND PREVENTIVE FACTORS CHANGE OVER THE LIFE COURSE IMPACT PRENATAL AND EARLY CHILDHOOD DEVELOPMENTAL STAGES AND AGING PROCESSES DIFFERENTLY, AND THEY CAN BE CUMULATIVE. HEALTH OUTCOMES ARE ALSO DPENTD DEPEND DENT ON ACCESS TO AND TYPE OF HEALTHCARE RECEIVED. THUS LONGITUDINAL STUDIES ARE IMPORTANT FOR STUDIES THESE INCIDENTS, CHANGES OVER TIME AND SURVIVAL RATES. STUDYING THE DENTAL ECOLOGY OF THE MOUTH AND ORAL DISEASE INITIATION AND PROGRESSION IS A COMPLEX TASK THAT REQUIRES TEAM SCIENCE, CONSIDERATION SHOULD BE GIVEN TO THINGS SUCH AS INTERACTIONS OF HUMANS AND THEIR MICROBIOMES, HUNDREDS OF ACTIVE AND INACTIVE SPECIES IN THE BIOFILM, NOT JUST -- THE ROLES OF SALIVA, DENTAL ANATOMY, HUMAN AND MICROBIAL GENETIC FACTORS, DIET DRUGS, CO-MORBID OTHER INDIVIDUAL ENVIRONMENTAL AND SYSTEM LEVEL FACTORS. AT THE START WE FOCUSED ON -- MEU TANS BECAUSE THEY CAN BE -- TO STUDY THE MANY HUNDREDS MORE ORGANISMS IN THE ORAL ENVIRONMENT. THIS CONCEPT FOCUS HEAVILY ON RACIAL AND ETHNIC DIFFERENCES. THEY'RE IMPORTANT TO UNDERSTAND BUT ETHNIC AND RACIAL POPULATIONS ARE NOT HOMOGENEOUS AND OTHER INHERENT POPULATION DIFFERENCES SUCH AS AGE, GENDER AND DIFFERENCES IN SUSCEPTIBILITY ALSO RESULT IN ORAL HEALTH DISPARITIES. PRECISE MOLECULAR MEASUREMENT TOOLS ARE NOW AVAILABLE TO STUDY THESE DIFFERENCES. UNDERSTAND HEALTH DISPARITIES, WE CLEARLY NEED TO UNDERSTAND BIOLOGIC PATHWAYS AND HOW THEY DIFFER BETWEEN ADVANTAGE AND DISADVANTAGE POPULATIONS. NOT JUST IN ISOLATION, BUT IN SOCIAL CONTEXT AND IN RESPONSE TO PREVENTION AND THERAPY. GLAD YOU ADDED THAT ADDITIONAL BULLET TO THE SLIDE. AS BIOLOGISTS, EPIDEMIOLOGISTS, HEALTH SERVICES RESEARCHERS, BIOINFORMATICS EXPERTS, BIOSTATISTICIANS SHOULD BE ENCOURAGED TO WORK CLOSELY TOGETER TO SORT OUT THE COMPLEX ARRAY OF BIOLOGIC AND SOCIAL DETERMINANTS THAT RESULT IN ORAL AND CRANIOFACIAL DISEASES AND DISPARITIES IN DIFFERENT POPULATIONS. OTHERWISE THIS CONCEPT IS ABOUT BIOLOGIC PATHWAYS AND RACIAL DURCHESES, BUT WILL NOT GO AS FAR AS IT COULD TO HELP ELUCIDATE HEALTH DISPARITIES. I WANT TO ACKNOWLEDGE MY UNC COLLEAGUE DEVARIS WHOSE RESEARCH IS LISTED IN THE PORTFOLIO AND WHOSE WORK HAS INFORMED SOME OF THESE COMMENTS. THANK YOU. >> WELL, THAT WAS VERY ELOQUENTLY PUT, JAIN. I'D LIKE TO NOW -- ANY COMMENTS? DR. TANNER. >> YES, INDEED. VERY ELOQUENTLY PUT. THANK YOU. I ALSO SUPPORT THIS CONCEPT. AS YOU KNOW, IT'S LONG BEEN RECOGNIZED, THERE ARE DIFFERENCES IN DISEASE EXPERIENCE BASED ON WHAT AS DR. WEINTRAUB OUTLINED, CONSIDERED TO BE BASED ON RACIAL ETHNIC INCOME DISPARITIES. WHAT WAS INTERESTING IN THE CONCEPT AND AS YOU HAD ON YOUR SLIDE, THE BEGINNING OF SOME BIOLOGICAL REASONS WHY THERE MAY BE DURCHESES AND THAT WAS VERY HELPFUL, THE BACKGROUND, PARTICULARLY IN TUMORS. ONE AREA THAT I WILL PICK UP ON BASED A LITTLE ON MY BACKGROUND IS THE RECOGNITION THAT SOME OF THE POPULATIONS OF DISPARITIES AND VERY HIGH RATES OF CHILDHOOD CARIES, IN SOME EXTENT STRONGLY ASSOCIATE WITH ACQUISITION OF THE CAR IOGENIC MICROBIOTA, AND AS OUTLINED IN THE CONCEPT, THERE'S EMERGING INFORMATION THAT SOME SAL SALIVARY FACTORS, IN FACT, COMBINATIONS OF SALIVARY FACTORS MAY BE WORKING WITH INCREASED COLONIZATION OF CAR IOGENIC BACTERIA. IN THINKING ABOUT THIS, I SUSPECT IN MANY OF THESE CASES, WE'RE NOT GOING TO FIND A SINGLE SILVER BULLET. INSTEAD OF TRYING TO SAY THIS IS ONE THING AND THIS IS THE OTHER THING, WE'LL VERY LIKELY HAVE TO LOOK AT COMBINATIONS OF THINGS IN ORDER TO TEASE IT OUT, SO WHAT MAY BE A RISK FACTOR IN ONE POPULATION MAY NOT BE SO IMPORTANT IN ANOTHER, BUT IT'S STILL IMPORTANT TO SORT OUT WHAT THEY ARE, SO THAT RISK CAN BE ADEQUATELY ASSESSED. SO AS I INDICATED, I THINK IT'S IMPORTANT TO SUPPORT THIS CONCEPT TO TEASE OUT UNDERLYING FACTORS FOR ORAL AND CRANIOFACIAL DISEASES WHICH HAVE BEEN SOMEWHAT BURIED IF YOU'D LIKE UNDER RACE, ETHNICITY AND HIGH RISK POPULATIONS. >> THANK YOU. ANY OTHER COMMENTS? CAN WE HAVE A MOTION TO APPROVE THE CONCEPT? SECOND? ALL IN FAVOR? ANY OPPOSED? OKAY. THANK YOU. AGAIN I'D LIKE TO THANK EVERYONE WHO WORKED ON DEVELOPING AND DISCUSSING THE CONCEPTS TODAY. THIS WAS A BIG JOB. NEXT, FOR THE OPEN SESSION, WE'LL WRAP THIS UP WITH A SPECIAL SESSION ON NIDCR RESEARCH TRAINING FOR DENTIST SCIENTISTS. BEGINNING WITH DR. LYNN KING, CHIEF OF THE RESEARCH TRAINING CAREER DEVELOPMENT BRANCH, FOLLOWED BY THREE OF OUR CURRENTLY SUPPORTED NIDCR TRAINEES. LYN. >> THANK YOU, ALICIA. GOOD MORNING. SO AS MARTHA, DR. SOMERMAN, MENTIONED, THIS SESSION IS A FOLLOW-ON FROM A WORKSHOP THAT WE HELD ON WEDNESDAY AND THURSDAY FOR DUAL DEGREE NIDCR SUPPORTED PREDOCTORAL STUDENTS WHO ARE PURSUING BOTH A DENTAL DEGREE AND A PH.D. IN A COMBINED AND INTEGRATED PROGRAM WHICH WE CALL A DENTIST SCIENTIST TRAINING PROGRAM OR A DSTP. MEMBERS OF THE COMMUNITY, INCLUDING COUNCILMEMBERS, I THINK IT'S REALLY IMPORTANT TO JUST PAUSE HERE A MOMENT AND SAY THANK YOU AGAIN, IT WAS SO TRE AMERICAN DUS TREMENDOUS THAT EVERYONE PARTICIPATED. I'VE HEARD FROM BOTH THE PARTICIPANTS AND STAFF THAT IT WAS A VERY EXCITING, ENGAGING AND WONDERFUL EXPERIENCE, SO DOCTOR LESLIE FREIDEN DID MUCH OF THE LEGWORK, TREMENDOUS AMOUNT OF ADMINISTRATIVE WORK, COORDINATING EVERYONE, AND WE REALLY NEED TO SHOUT OUT TO HER FOR ALL OF HER EFFORTS, AND A HUGE THANK YOU TO EVERYONE. [APPLAUSE] THE GOALS OF THE WORKSHOP WERE TO -- A PRIMARY ONE WAS TO PROVIDE NETWORKING EXPERIENCES FOR THIS COHORT OF DUAL DEGREE TRAINEES. IT'S A SMALL AND PRECIOUS COMPONENT OF OUR NIDCR WORKFORCE. WE PROVIDED WORKSHOPS ON GRANT-WRITING, CAREER DEVELOPMENT ACTIVITIES, THEY GAVE A WONDERFUL POSTER SESSION, MENTORING EXPERIENCES, AND JUST A SUITE OF OPPORTUNITIES WHERE THEY COULD INTERACT WITH STAFF AND AMONG THEMSELVES, AND REALLY TO FOSTER MAYBE SOME PEER TO PEER RELATIONSHIPS TOO. SO AMONG THOSE 26 INDIVIDUALS, WE'VE INVITED THREE OF THOSE TRAINEES BECAUSE WE WANT TO HEAR FROM THEM, WE WANT TO HEAR ABOUT THEIR EXPERIENCES. SO THE PURPOSE OF THIS SPECIAL SESSION IS REALLY TO PROVIDE AN OPPORTUNITY TO HEAR FROM THEM ABOUT THEIR EXPERIENCES IN PURSUING THIS DUAL DEGREE PATHWAY, PERHAPS WHY THEY CHOSE IT AND WHAT ARE THE CHALLENGES THEY FACE. AND THEN HOPEFULLY, THEY WILL BE ABLE TO INFORM US ON HOW NIDCR CAN CONTINUE TO SUPPORT OR PROVIDE THE BEST TYPE OF TRAINING OPPORTUNITIES FOR THEM, AND FOR THE COMMUNITY, HOW CAN YOU HELP THEM, AND THE MENTORS AND THE WHOLE NIDCR DENTAL ORAL AND CRANIOFACIAL RESEARCH COMMUNITY, HOW CAN WE HELP SUPPORT THESE FUTURE LEADERS IN DENTAL, ORAL AND CRANIOFACIAL RESEARCH. I'M GOING TO BEGIN BY A VERY BRIEF AND HIGH LEVEL OVERVIEW OF NIDCR RESEARCH TRAINING CAREER DEVELOPMENT PROGRAMS, SO THESE INDIVIDUALS ARE SUPPORTED ON NATIONAL RESEARCH SERVICE AWARDS. THEY'RE SUPPORTED UNDER INSTITUTIONAL TRAINING GRANTS AND INDIVIDUAL FELLOWSHIPS. TRAINING GRANTS IN OUR NIDCR FELLOWSHIP SUPPORT INDIVIDUALS AT THE DUAL DEGREE LEVEL, PREDOCTORAL LEVEL, PH.D., AND POSTDOCTORAL LEVEL. THE AWARDS THEMSELVES, THE INDIVIDUALS HAVE TO BE A U.S. SIT ACCEPT, NON-CITIZEN NATIONAL OR PERMANENT RESIDENT. 100% RESEARCH ERT EFFORT IS REQUIRED, NIH DEFINES THIS AS 40 HOURS A WEEK. IT PROVIDES A STIPEND TO OFFSET LIVING COSTS, TUITION AND FEES, AND INSTITUTIONAL ALLOWANCE OR TRAINING-RELATED EXPENSES. DUAL DEGREE STUDENTS ARE SUPPORTED FOR UP TO SIX YEARS OF SUPPORT. FOR THIS INTEGRATED CLINICAL AND PH.D. RESEARCH TRAINING. THIS IS THE LOCATION OF 17 -- THE SLIDE SHOWS THE LOCATION OF 17 OF THE -- THE LOCATION OF 17 TRAINING PROGRAMS THAT ARE SUPPORTED BY NIDCR. PROGRAMS CAN SUPPORT ANY OF THOSE THREE LEVELS THAT I MENTIONED, DUAL DEGREE, PREDOC 12 OF THEM SUPPORT THE DUAL DEGREE PROGRAMS WHICH ARE HIGHLIGHTED IN THE DARKER PURPLE ACROSS THE U.S. THESE INDIVIDUALS -- THESE PROGRAMS ARE THE PRIMARY SOURCE OF THE F30, SO INDIVIDUALS -- TRAINEES TRANSITION -- TEND TO TRANSITION FROM A TRAINING GRANT TO AN INDIVIDUAL F30 AWARD, WHICH WE STRONGLY ENCOURAGE AS IT PROVIDES A CAREER DEVELOPMENT OPPORTUNITY IN TERMS OF FOCUSING AND DEFINING THEIR RESEARCH AREA, AND FUTURE, AND ALSO IT PROVIDES THE ESSENTIAL NIH GRANT-WRITING EXPERIENCE. PROGRAMS ARE DEVELOPED IN THESE SCHOOLS OTHER THAN THESE 17 SO IT CAN AUGMENT THE POOL OF UNIVERSITIES AND PROGRAMS IN DENTAL SCHOOLS THAT PARTICIPATE IN THIS TYPE OF TRAINING. WHAT'S UNIQUE ABOUT THE NIDCR-SUPPORTED DSTP PROGRAMS IS THAT EVERY INSTITUTION DEVELOPS THEIR OWN INTEGRATED PROGRAM OF CLINICAL AND RESEARCH TRAINING. WHAT I'VE TRIED TO ILLUSTRATE HERE IS TO CONSOLIDATE ALL OF THOSE 12 DIFFERENT PROGRAMS INTO SOME SORT OF SCHEMATIC, SO THE DARKER RED IS THOSE THAT ILLUSTRATE THE YEARS THAT ARE DDS FOCUS, DARKER PURPLE IS WHERE IT HAS MORE OF A PH.D. FOCUS OR WHERE I COULDN'T REALLY DETERMINE, THEY MANAGED TO PULL OFF BOTH AT THE SAME TIME. YOU CAN SEE IT'S ABOUT 50/50 IN TERMS OF WHETHER OR NOT THEY BEGIN WITH A PH.D. OR THE DENTAL COMPONENT, AND THERE'S ALWAYS SOME TYPE OF INTEGRATION. OFTEN IT OCCURS WITH THE GRADUATE WITH THE DIDACTIC COURSES WHICH THERE MAY BE OVERLAP, AND FURTHER ON IN THE CLINICAL ARE SUMMERS WHICH CAN BE DEVOTED TO PH.D. RESEARCH, AND I'M SURE THE STUDENTS THEMSELVES, WHEN YOU HEAR FROM THEM, CAN TELL YOU MUCH MORE IN DETAIL ABOUT HOW THIS WORKS FOR THEM. THIS IS A VERY HIGH LEVEL VIEW OF THE RESEARCH TRAINING AND CAREER DEVELOPMENT PROGRAMS THAT NIDCR OFFERS, BOTH IN THE INTRAMURAL PROGRAM AND EXTRAMURAL PROGRAM. THIS IS WHERE THE DUAL DEGREE TRAINEES SIT. AT THE WORKSHOP, THE PAST TWO DAYS, INDIVIDUALS HEARD ABOUT ALL OF THESE OPPORTUNITIES AND, OF COURSE, WE'RE ALWAYS AVAILABLE TO TALK ABOUT OUR EXTRAMURAL FUNDING OPPORTUNITIES. BECAUSE OF THIS LARGE SUITE OF POTENTIAL PROGRAMS AND FUNDING OPPORTUNITIES THAT AN INDIVIDUAL CAN NAVIGATE THROUGH, DR. FRIEDMAN AND I HAVE DEVELOPED THESE PATHWAYS WHICH WE CAN USE TO ILLUSTRATE TO INDIVIDUALS, HOW DO YOU NAVIGATE FROM EITHER A PREDOCTORAL DENTIST PH.D. OR IF YOU'RE A DENTIST AND WANTING TO PURSUE A RESEARCH CAREER, HOW DO I NAVIGATE ALL OF THESE FUNDING OPPORTUNITIES TO ACHIEVE THIS GOAL OF BECOMING AN INDEPENDENT INVESTIGATOR. SO WE WORK WITH -- VERY CLOSELY WITH INDIVIDUAL AND BASED ON THEIR PREVIOUS RESEARCH EXPERIENCE, THEIR PREVIOUS CLINICAL TRAINING EXPERIENCE, WHERE THEY ARE, WHAT THEY ARE TRYING TO ACHIEVE BOTH IN TERMS OF THEIR CAREER GOALS AND THEIR RESEARCH TRAINING GOALS, WE CAN HELP THEM MAP OUT WHAT WOULD BE A GOOD OPPORTUNITY OR PATHWAY FOR THEM TO FOLLOW IN IN ULTIMATELY ACHIEVING THAT INDEPENDENT RESEARCH CAREER STATUS. THIS SLIDE IS TO SHOW YOU OF THE DUAL DEGREE TRAINEES THAT WE'VE HAD OVER THE PAST 17 YEARS OR SO, JUST THE RESEARCH AREAS, IT'S ABOUT 166 INDIVIDUALS ARE REPRESENTED HERE. THAT MAP ON TO THE VERY HIGH LEVEL OVERVIEW OF RESEARCH PROGRAMS THAT ARE SUPPORTED BY NIDCR. SO THAT'S JUST SOME DESCRIPTIVE INFORMATION. AND OF COURSE IF ANYBODY IS LOOKING FOR WHAT KINDS OF PROGRAMS THAT WE HAVE TO SUPPORT RESEARCH TRAINING, WE HAVE A WEBSITE DEVOTED TO CAREERS IN TRAINING AND THERE ARE SEVERAL WAYS TO LOOK AT THE INFORMATION. THE PROGRAMS BY CAREER STAGE CAN BE VERY HELPFUL FOR WHERE YOU ARE, AND WE HAVE ALL OF OUR CONTACT INFORMATION, DR. FRIEDEN AND I AND ALSO DR. DEP DEBRA PHILIP WHO MANAGES THE PROGRAMS AND WE'RE ALWAYS HAPPY TO HAVE THOSE INDIVIDUALS REACH OUT. SO JUST TO TURN IT OVER NOW TO OUR TRAINEES, THE PURPOSE OF, AS I MENTIONED. OUR GOAL IS REALLY AT THIS POINT, WE FED A LOT OF INFORMATION TO THEM, WE HEARD FROM THEM, THEY ASKED A LOT OF QUESTIONS, WE NOW WANT TO HEAR FROM THEM WHAT THEIR TRAINING EXPERIENCE HAS BEEN LIKE. AND WHAT THEY CAN OFFER OUR R., HOW WE CAN DEVELOP OUR PROGRAM, YOU AND FUTURE CLAB TRAITORS AND INVESTIGATORS CAN HELP THEM ESTABLISH THEIR OWN INDEPENDENT CRANIOFACIAL RESEARCH CAREERS, SO ALL THREE OF YOU, I THINK YOU CAN COME UP TO THE FRONT, BUT THEN WE CAN JUST BEGIN IN ORDER WITH MR. DONNELLY. IF THERE ARE ANY QUESTIONS ABOUT MINE, WE CAN HOLD THOSE BECAUSE I THINK THEY'RE THE ONES WE REALLY WANT TO HEAR FROM. >> I WANT TO START OUT BY SAYING THANK YOU FOR THE LAST TWO DAYS AND THE WORKSHOP AND INVITING ME TO COME AND SPEAK TO YOU. I THINK NOBODY HAS HAD A HARDER JOB THAN LESLIE AND LYN OVER THE LAST TWO DAYS TO KEEP 26 GRADUATE STUDENTS CAFFEINATED, AND YOU SAID I HAD ABOUT AN HOUR? [LAUGHTER] SO I'M A SEVENTH YEAR STUDENT AT THE UNIVERSITY OF MICHIGAN. RIGHT NOW WE'RE ONE OF THE PROGRAMS THAT BEGINS WITH THE PH.D. IN THE FIRST THREE YEARS AND PROGRESSES INTO THE DENTAL TRAINING PROGRAM AFTERWARDS. AT MICHIGAN, THERE REALLY IS NO TIME WHERE YOU'RE JUST DOING ONE THING. SO WE BEGIN WITH THE PH.D. BUT WE TAKE SOME DIDACTIC COURSES ALONG THE WAY. IN THE LAST FOUR YEARS, I'VE BEEN DOING DENTAL SCHOOL BUT ALSO IN THE LAB, NIGHTS AND WEEKENDS AND ANY TIME A PATIENT CANCELS ON ME. I REALLY LIKE MY PROGRAM, I DON'T HAVE A WHOLE LOT OF THINGS TO SAY ABOUT IT. I THINK THERE ARE THINGS WE COULD BE DOING A LITTLE BIT BETTER AND THINGS THAT WE'RE DOING REALLY, REALLY WELL ALREADY. SO MY BACKGROUND, I'M A MICHIGAN NATIVE, GREW UP IN KIND OF A BLUE COLLAR CITY IN MICHIGAN, PONTIAC, REALLY KIND OF A NON-ACADEMIC ENVIRONMENT. AND I KIND OF -- I KIND OF IDENTIFY WITH ONE OF THE SPEAKERS WE HAD YESTERDAY. I WAS NOT YOUR MODEL DENTAL PATIENT. SO I DID NOT BEGIN WITH AN INTEREST IN DENTISTRY. BUT I WAS KIND OF SCIENTIFICALLY INCLINED, YOU KNOW, I WAS ALWAYS THE KID KIND OF CHECKING OUT BOOKS ON DINOSAURS INSTEAD OF, I DON'T KNOW, CLIFFORD OR WHATEVER ELSE PEOPLE WERE DOING. AND THAT WAS KIND OF MY INTEREST GOING INTO COLLEGE, SO I WENT TO OAKLAND UNIVERSITY, A SMALL SCHOOL IN KIND OF THE METRO DETROIT AREA, AND IT WAS A REALLY GREAT PLACE FOR ME TO BE, BECAUSE I GOT TO HAVE THIS KIND OF BIG FISH-SMALL POND KIND OF EXPERIENCE. WHERE WE HAD A REALLY STRONG BIOLOGICAL SCIENCES DEPARTMENT AND A REALLY DIVERSE GROUP OF INVESTIGATORS THAT I COULD GET INVOLVED IN. AND SO I HAD THIS INTEREST IN GETTING INTO RESEARCH AND IT WAS REALLY -- IT WAS A BROAD INTEREST. I KNEW I LIKED SCIENCE, SO I REALLY WENT THROUGH A LITANY OF DIFFERENT KINDS OF RESEARCH EXPERIENCES. I WORKED WITH WASPS IN A BEHAVIORAL BIOLOGY RESEARCH LAB, THAT WAS A FUN THING TO DO BUT I'D RATHER BE MORE KIND OF ENTRANCHED IN THE BIOMEDICAL SCIENCES SO I GOT INVOLVED IN A STEM CELL BIOLOGY LABORATORY AND I KIND OF ENDED MY UNDERGRADUATE WITH A YEAR-LONG PROJECT IN CANCER BIOLOGY. SO IT WAS A REALLY FUN AND DIVERSE SET OF EXPERIENCES THAT INITIATED AND THEN KIND OF PROPAGATED MY INTERESTS IN SIGH EPS IN THE FIRST PLACE. I BEGAN WITH THIS INTENTION TO DO KIND OF AN M.D., EVERYBODY ENTERS COLLEGE WITH INTERESTS OF PRE-MED. SO IT WAS FUELED BY LOVE OF SCIENCE BECAUSE THAT'S WHAT SO MANY PEOPLE DO, AND AGAIN, I WASN'T A MODEL DENTAL PATIENT AND MY FAMILY WASN'T -- I HAVE NO DENTISTS IN MY FAMILY. SO I JUST HADN'T REALLY CONSIDERED DENTISTRY AS A PROFESSION. ONCE I GOT INVOLVED IN RESEARCH, I KIND OF DEVELOPED THIS IDEA THAT I'D LIKE TO PURSUE AN MD PH.D. IN PURSUIT OF KIND OF THAT GOAL, I BEGAN LOOKING INTO DIFFERENT HEALTH PROFESSION, SHADOWING DIFFERENT KINDS OF PHYSICIANS AND DENTISTS AS WELL. I ENDED UP LANDING IN DENTISTRY BECAUSE THE PATIENT-CENTERED COMMUNITY FEEL OF DENTISTRY WHERE YOU GET TO SEE THE SAME PEOPLE OVER AND OVER AGAIN AND YOU GET TO SEE PEOPLE WHO REALLY, REALLY LIKE THEIR DENTISTS. SO THAT WAS A FUN THING FOR ME. I LIKE TO BE INVOLVED IN ENHANCED SKILLS AND DOING THINGS ACTIVELY, SO I KIND OF SHIFTED AWAY AND DECIDED MAYBE I'LL GO TO DENTAL SCHOOL. I DIDN'T KNOW AT THAT TIME THAT THERE WAS SUCH A THING AS A DES PH.D., AND THAT'S SOMETHING I'D LIKE TO COME BACK TO, JUST BECAUSE I THINK IT'S SOMETHING THAT I HEAR FROM SO MANY PEOPLE YEAR AFTER YEAR WHEN WE'RE DOING INTERVIEWS, IS PEOPLE DON'T FIND OUT THAT THERE EVEN IS A DUAL DEGREE PROGRAM UNTIL THE DAY OF THEIR DENTAL SCHOOL INTERVIEW, AND I THINK IT'S SOMETHING WE COULD IMPROVE ON TO GET THE BEST TALENT GOING INTO THIS FIELD. SO ONCE I GOT INTO THIS INTEREST AND DEVELOPED THIS INTEREST, I WAS LOOKING AT SEVERAL DIFFERENT SCHOOLS, AND I ULTIMATELY LANDED AT MICHIGAN BECAUSE I HAD THIS INTEREST IN SENSORY NEUROBIOLOGY. I HAVE FAMILY MEMBERS THAT HAVE PERIPHERAL NEUROPATHIES, AND MY FATHER ACTUALLY HAS TRIGEMINAL NEURALGIA, SO IT WAS KIND OF FOSTERED IN THIS KIND OF VERY PERSONAL EXPERIENCE WITH OROFACIAL PAIN. AND KIND OF ENHANCED BY MY COLLEGE COURSES. CHOOSING MICHIGAN WAS ONE OF THE BEST DECISIONS I'VE EVER MADE. THE RESEARCH ENVIRONMENT IS JUST PHENOMENAL, AND ESPECIALLY THE NEUROSCIENCE COMMUNITY. GREAT TRACK RECORD AND IDEAL FUNDING. THOSE WERE KIND OF THE THINGS THAT WENT IN TO MY DECISION-MAKING PROCESS. ONCE I STARTED, I WORKED IN A COUPLE DIFFERENT NEUROSCIENCE LABORATORIES AND ULTIMATELY DECIDED TO WORK WITH PIERCHALA. SO MY RESEARCH SO FAR, I'M REALLY NOT GOING TO GO INTO IT A WHOLE LOT, HAS BEEN ON THE GROWTH FACTOR SIGNALING MECHANISMS IN PERIPHERAL NERVOUS SYSTEM DEVELOPMENT. THAT'S VERY BROAD BECAUSE I GET BORED EASILY AND I'VE HAD FOUR OR FIVE DIFFERENT PROJECTS AND FOUR OR FIVE DIFFERENT CELL TYPES. SO I'VE WORKED BROADLY ON TASTE AND PAIN, AND I'VE WORKED ON PAIN IN THE CONTEXT OF THE TRIGEMINAL GANGLION AND THE NEURONS THAT INNERVATE TEETH AS WELL AS THE DORSAL ROOT GANGLION AND THE NEURONS THAT UNDERLIE PAIN IN RESPONSE TO THERMAL AND INFLAMMATORY STIMULI. IT'S BEEN A GREAT COLLECTION OF PROJECTS BECAUSE IT'S SPANNED FROM TRANSGENIC ANIMAL EXPERIENCE AND MOLECULAR BIOLOGY TECHNIQUES AND PROTEIN WORK AND JUST ALL THE DIRN THINGS THAT I THINK WILL BE REALLY IMPORTANT GOING FORWARD IN SETTING UP A LABORATORY IN THE FUTURE. SO THEY ASKED US TO KIND OF SPEAK ON BRIEFLY OPPORTUNITIES AND CHALLENGES THAT HAVE FACED DDS/PH.D. OR DMD/PH.D. TRAINEES ALONG THE WAY. I THINK LIKE SO MANY PEOPLE IN THIS ROOM, SPEAKING AS A CLINICIAN, IT GIVES US AN INTERESTING NICHE TO IDENTIFY THE ISSUES THAT ARE MOST PERTINENT, THE ISSUES THAT ARE THE MOST IMPORTANT TO TACKLE IN DENTISTRY. I CAN'T TELL YOU HOW MANY TIMES I TELL A PATIENT THAT I'M IN A PH.D. PROGRAM AT DENTAL SCHOOL OR WORKING IN A RESEARCH LAB AT DENTAL SCHOOL AND THEY DON'T EVEN KNOW THAT DENTAL RESEARCH EXISTS. OR IF I GO TO THE GROCERY STORE AND I TELL SOMEBODY WHAT I'M DOING, COMES UP OR SOMETHING, I DON'T KNOW WHY IT COMES UP AT THE GROCERY STORE, YOU KNOW, IT'S ALWAYS AN ODD CONVERSATION, AND IT JUST BLOWS MY MIND HOW PEOPLE NEVER EVEN CONSIDER THAT DENTISTRY IS AS A FIELD NEEDS TO EVOLVE IN THE SAME WAY THAT MEDICINE DOES. AND SO HAVING PEOPLE THAT CAN DO BOTH IS JUST SO IMPORTANT. AND THEN SPEAKING AS A SCIENTIST, AND SOMEBODY TRAINING IN NEUROSCIENCE, THE COMMUNITY AS A WHOLE IN MY FIELD, AT LEAST, HAS KIND OF NEGLECTED CRANIOFACIAL BIOLOGY AND CRANIOFACIAL NEURON DEVELOPMENT. IT'S SOMETHING THAT I FEEL WELL POSITIONED FOR IN THE FUTURE, AND KIND OF A NICHE AREA THAT I CAN GO INTO. PEOPLE ARE NOT DOING OROSENSORY BIOLOGY IN THE NUMBERS THAT THEY'RE DOING OTHER KINDS OF NEUROSCIENCE RESEARCH. SO I FEEL VERY BLESSED TO BE IN THAT POSITION. THEN SPEAKING AS A FUTURE JOBS SEEKER, THE DENTAL SCHOOL NICHE IS REALLY IMPORTANT, AND I FEEL JUST BASED ON PEOPLE THAT I'VE SEEN GRADUATE AND GO INTO ACADEMIC POSITIONS THAT WE'RE REALLY AT AN ADVANTAGE COMPARED TO SO MANY OF OUR COLLEAGUES IN PH.D. TRAINING PROGRAMS AND EVEN MD/PH.D. PROGRAMS. BECAUSE THERE'S JUST SUCH AP UNMET NEED ACROSS THE COUNTRY FOR PEOPLE WITH THE DUAL TRAINING. CHALLENGES FACING DDS/PH.D. TRAINEES, I WOULD SAY GETTING THE WORD OUT TO PEOPLE THAT MAY BE INTERESTED IN THESE PROGRAMS AND JUST DON'T KNOW THEY EXIST. I THINK THAT'S RELEREALLY IMPORTANT. IT'S SOMETHING AT MICHIGAN THAT THE TRAINEES GET HEAVILY INVOLVED IN. WE'VE GOT PEOPLE THAT GO ON THE STUDENT DOCTOR FORUMS AND POST HEAVILY THAT WAY, AND EVEN SOMETHING SILLY AND INFORMAL LIKE THAT, YOU WOULDN'T BELIEVE OW EFFECTIVE IT IS IN ACTUALLY LANDING APPLICATIONS. AND THEN JUST GOING OUT AND TALKING TO PEOPLE, COLLEAGUES IN PH.D. PROGRAMS ARE PLAPPING TO OR PLANNING TO PURSUE PH.D. PROGRAMS AND JUST EXPLAINING TO THEM HOW THAT NICHE COULD BENEFIT THEIR CAREER. DURING THE DENTAL SCHOOL COMPONENT, I THINK IS WHERE THE MOST CHALLENGES COME TO LIGHT. I THINK THE VARYING DENTAL CURRICULA, DEPENDING ON WHO YOU TALK TO, YOU SAW DR. KIG'S SLIDE ON ALL THE DIFFERENT MODELS, AND I THINK -- I'M NOT SAYING THAT WE SHOULD HAVE A ONE SIZE FITS ALL MODEL, BUT DEFINITELY THERE ARE DIFFERENT TRAINEES HAVING DIFFERENT EXPERIENCES, JUST BASED ON HOW VARIABLE THE CURRICULA ARE, AND AT MICHIGAN, WE'VE EVOLVED TWO OR THREE TIMES IN THE WAY WE DO THINGS, JUST TRYING TO FIND THE RIGHT WAY TO DO THIS SO THAT TRAINEES ARE SUFFERING MINIMALLY. I WOULD SAY ANOTHER BIG ISSUE, AND THIS WAS AN ISSUE THAT AS A GROUP YESTERDAY, WE DISCUSSED AT LENGTH, IS THAT THERE'S A VARYING DEGREE OF BUY-IN FROM THE DENTAL SCHOOL CURRICULA. AND THAT'S THE BIGGEST THING. THE PH.D. CURRICULA AT MICHIGAN AND BEYOND IS VERY, VERY FLEXIBLE. THEY'RE TRYING TO GET US THE BEST TRAINING POSSIBLE, AND I FEEL THAT THE DDS AND DMD CURRICULA AROUND THE COUNTRY COULD BE DOING A BETTER JOB AT BUDGING BUDGETING WHERE WOULD BE REASONABLE. AN EXAMPLE OF THIS WOULD BE, I TOOK A YEAR-LONG COURSE SEQUENCE IN GRADUATE LEVEL NEUROSCIENCE TRAINING BUT I STILL HAD TO TAKE SEVERAL DENTAL SCHOOL NEUROSCIENCE COURSES, WHICH AS YOU CAN IMAGINE, ARE TAUGHT AT A VERY DIFFERENT LEVEL. SO JUST LITTLE THINGS THAT CREATE EXTRA TIME WINDOWS TO GET PEOPLE TO A POINT WHERE THEY CAN SPEND MORE TIME IN THE LAB AS OPPOSED TO WASTING TIME ON THINGS THAT REALLY ARE NOT GOING TO BENEFIT ANYONE. JUST LIKE EVERYONE IN THIS ROOM, I MEAN, TIME IS THE MOST CHALLENGING ISSUE, AND I THINK TIME MANAGEMENT IN THE PROGRAM COULD BE DONE BETTER AND SPECIFICALLY DURING THE DENTAL SCHOOL TRAINING PROGRAM. FOLLOWING GRADUATION, I THINK A LOT OF PEOPLE ARE CONFUSED ABOUT THE ISSUE AND THIS WAS ANOTHER THING THAT CAME UP AT OUR MEETING YESTERDAY. THE ISSUE OF WHETHER OR NOT A SPECIALTY IS SOMETHING THAT WOULD BENEFIT OUR CAREERS AND TO WHAT EXTENT THAT'S REQUIRED IN THE FUTURE. AND SO CLEARLY, IF YOU HAVE A DEEP CLINICAL INTEREST IN A FIELD, YOU KNOW, YOU SHOULD FOLLOW YOUR CLINICAL INTERESTS, BUT FOR A LOT OF US, WE DO HAVE CLINICAL INTERESTS, BUT WE'RE SO DRAWN TO SCIENCE THAT WE DON'T KNOW WHICH WAY TO GO. WE DON'T KNOW -- SHOULD WE FOREGO THE RESIDENCY TRAINING OR IS THAT PUTTING US IN A WORSE POSITION LATER ON, SAY, WHEN YOU'RE GOING THROUGH THE ACADEMIC RINGS. THIS IS SOMETHING THAT I WOULD SAY IS CAUSING A LOT OF ANXIETY AMONG THE DSTP TRAINING GROUP. I WOULD SAY EVEN JUST TRYING TO MAKE THIS WORK FOR INDIVIDUALS THAT ARE COMBINING THE POSTDOC AND THE RESIDENCY, CREATING THESE FUNDING -- CREATING THESE PROGRAMS WITH THE RESIDENCY PROGRAMS, IT SHOULDN'T BE AN EASY ENDEAVOR, BUT IT'S AND I'LL KIND OF GO INTO MY FUTURE PLANS. SO I'M PLANNING TO FINISH UP THIS YEAR, IF THEY DECIDE TO RELEASE ME, AND I HAVE A SHORTLIST OF LABORATORIES THAT I WOULD LIKE TO PURSUE MY POSTDOC TRAINING IN, AND I'M DEFINITELY GOING TO DO A POSTDOC. I FEEL VERY STRONGLY THAT ALL OF THE DSTP TRAINEES SHOULD DO A POSTDOC. AND I PLAN TO PURSUE SENSORY NEUROBIOLOGY, BUT I ALSO HAVE AN INTEREST IN ORAL AND MAXILLOFACIAL PATHOLOGY, AND I DO PLAN TO PURSUE RESIDENCY TRAINING THERE. AND SO FOR MY PERSONAL EXPERIENCE, I WENT TO TWO MEETINGS WITH ORAL PATHOLOGISTS AND I MET WITH EVERY SINGLE PROGRAM DIRECTOR, AND I JUST HAD A SIT-DOWN AND SAID, OKAY, HOW MUCH RESEARCH WOULD I BE ABLE TO DO IN YOUR PROGRAM? CAN YOU GUARANTEE THAT I'M ABLE TO DEVOTE X AMOUNT OF TIME TO RESEARCH, HOW MUCH AM I GOIN TO BE ON CALL, AND THESE SORTS OF THINGS, AND I ACTUALLY WAS ABLE TO IDENTIFY A FEW PROGRAMS THAT WERE WILLING TO LET ME COMBINE THE TWO. MAYBE BEGRUDGINGLY, I'M NOT SURE. SO IN MY CURRENT PLAN, THE WAY I'D LIKE TO SET IT UP IS TO DO SOME DATA COLLECTION DURING YEARS ONE AND TWO OF MY RESIDENCY AND PREPARE A K99R00 DURING THAT FINAL YEAR AND KIND OF KEEP THE CAREER PROGRESSION GOING. BUT A LOT OF PEOPLE ARE HAVING DIFFICULTIES, I THINK, WITH THIS IDEA OF SHOULD I PURSUE A RESIDENCY AND HOW DO I GO ABOUT DOING THAT. SO MANY PEOPLE TO THANK. MY P.I., BRIAN, HE'S BEEN VERY SUPPORTIVE OF MY WORK, I COULDN'T THANK HIM ENOUGH, AND MY PROGRAM DIRECTOR, JAN YU AT MICHIGAN, JUST A GREAT GROUP OF PEOPLE. I HAVE MANY MENTORS CLINICALLY, THE ORAL PATHOLOGISTS AT MICHIGAN HAVE PUT ME -- HAVE MADE A BIG DIFFERENCE IN MY CAREER PROGRESSION AND HELPED ME IDENTIFY MY INTERESTS, AND JUST SO MANY OTHER PEOPLE, AND OF COURSE THANK YOU ALL FOR HAVING ME COME OUT AND BEARING WITH ME FOR 16 MINUTES. SO THANK YOU. [APPLAUSE] >> HI, EVERYONE. I'M MARY BETH FRANCIS, FROM UNIVERSITY OF ILLINOIS AT CHICAGO. AGAIN, I'D LIKE TO ECHO WHAT CHRIS SAID AND THANK YOU SO MUCH FOR HAVING US. THIS IS A GREAT OPPORTUNITY, IT'S BEEN A REALLY VALUABLE WEEK. I'M FROM WISCONSIN. I GREW UP IN MILWAUKEE AND THEN DID MY UNDERGRADUATE AT UW-MADISON. I THOUGHT KIND OF SIMILAR TO CHRIS THAT I WAS GOING TO DO PRE-MED, ALSO WAS THINKING PREDENTAL AT THE TIME. I STARTED WORKING IN A RESEARCH LAB AND THAT'S WHEN I KIND OF GOT THE ITCH THAT MAYBE I WANT TO DO RESEARCH TOO. SO NEEDLESS TO SAY AT THE END OF MY UNDERGRADUATE CAREER, I WAS NOT READY TO GRADUATE OR MAKE A CAREER MOVE. I WAS OFFERED A JOB IN INDUSTRY AT COVANCE LABORATORIES IN THE TOXICOLOGY DEPARTMENT, SO DOING A LOT OF DRUG DEVELOPMENT WORK. AND AT THAT TIME, I WAS ALSO OFFERED THE OPPORTUNITY TO PURSUE A MASTER'S IN BIOTECHNOLOGY AT THE UNIVERSITY OF WISCONSIN-MADISON. SO THIS PROGRAM CONSISTED OF REALLY FOCUSING ON WHAT IT TAKES TO BRING A DRUG OR DEVICE FROM THE BENCH TO THE BEDSIDE. I USE THIS OPPORTUNITY DURING A CAPSTONE PROJECT TO EXPLORE WRITING A PROJECT MANAGEMENT PLAN TO BRING A HYPOTHETICAL BIOTECH COMPANY'S DENTAL STEM CELL TECHNOLOGY FROM THE BENCH TO -- LIKE THROUGH PHASE ONE CLINICAL TRIALS. AND AT THAT POINT IS WHEN I REALLY WANTED TO GO BACK TO DENTAL SCHOOL. I WANTED TO BE ABLE TO PURSUE SOME SORT OF RESEARCH AT THE SAME TIME, BUT I HAD NO IDEA THERE WAS A DMD/PH.D. PROGRAM. SO I WAS ONE OF THESE PEOPLE THAT DURING MY INTERVIEW, I HEARD ABOUT THE DMD/PH.D. PROGRAM, AND I WAS TELLING MY MENTOR THAT I'M REALLY EXCITED ABOUT GOING TO DENTAL SCHOOL, HOWEVER, I'M ALSO INTERESTED IN PURSUING RESEARCH ON THE SIDE, AND SHE THOUGHT THAT I'D BE A GREAT FIT FOR THE DMD/PH.D. PROGRAM. SO I'M VERY LUCKY THAT SHE WAS MY INTERVIEWER. AND OUR PROGRAM IS A LITTLE DIFFERENT. SO WE DO THE FIRST YEAR AS PH.D. COURSE WORK, THE SECOND YEAR WE GO TO DENTAL SCHOOL, AND THE THIRD AND FOURTH YEAR, WE GO BACK TO THE PH.D. CURRICULUM. THEN THE LAST THREE YEARS, WE ARE IN DENTAL SCHOOL. SO FOR ME THE FIRST YEAR I DID MOST OF MY COURSE WORK, I ALSO COMPLETED LAB ROTATIONS, I PICKED DR. LUAN AS MY MENTOR AND THEN I ALSO WROTE MY F AWARD THAT SAME YEAR, SO IT WAS FUNDED NEXT YEAR, THANKS TO THE NIDCR. SO MY RESEARCH IS REALLY LOOKING AT WHY PEOPLE WITH DIABETES HAVE THIS EXACERBATED PERIODONTITIS, AND WE'RE SPECIFICALLY LOOKING AT THE NFKAPPAB PATHWAY BECAUSE IT'S STIMULATED IN BOTH DISEASES. SO WE ALSO KNOW IT RECRUITS HISTONE METHYLATION ENZYMES AND THESE ENZYMES PLACE MARKS ON THE CHROMATIN TO EITHER ACTIVATE OR SUPPRESS TRANSCRIPTION. AND IN OUR STUDY, WE'VE SEEN IN BOTH DISEASE MODELS THAT PRO INFLAMMATORY CYTOKINE PROMOTOR REGIONS HAVE THIS H3K4 TRI-METHYLATION MARK, SO OUR HYPOTHESIS IS IF WE CAN INHIBIT THIS ENZYME THAT IS PLACING THIS MARK ON THOSE PROMOTOR REGIONS, CAN WE REDUCE INFLAMMATION THAT WAY. AND HERE'S A PICTURE OF OUR ANIMAL MODELS, OUR PERIODONTITIS ANIMAL MODEL AND DIABETES IN BOTH THE DIABETIC AND PERIODONTITIS MODELS, SO MICRO CT IMAGING DEMONSTRATES INCREASED BONE LOSS, AS WELL AS AS -- DEMONSTRATES TISSUE DESTRUCTION IN OUR DISEASE MODELS. SO THAT'S A VERY BRIEF OVERVIEW. SO BEING IN THIS PROGRAM, I'M IN YEAR 6 OF 7, SO I'VE REALLY SEEN BOTH, LIKE THE GRADUATE SCHOOL PORTION AND THE DENTAL SCHOOL, AND NOW BEING IN DENTAL SCHOOL, I REALLY AM ABLE TO APPRECIATE WHAT I WAS DOING IN LAB. SO MAYBE STARTING IN DENTAL SCHOOL FIRST, MAYBE COMING UP WITH YOUR OWN PROBLEM THAT YOU SEE IN YOUR PATIENTS TO TRY TO COME UP WITH A RESEARCH PROJECT AFTER THAT. MY SEQUENCE WORKED, I'M JUST THINKING OF IDEAS. SO ALSO THE COLLEAGUES I'VE MET THROUGH JUST SEIZING OPPORTUNITIES AS FAR AS LEADERSHIP OPPORTUNITIES IN THE PROGRAM, SO BEING THE LEADER OF STUDENT RESEARCH GROUP REALLY GETTING TO KNOW FACULTY MEMBERS AT SCHOOL THROUGH ORGANIZING DIFFERENT EVENTS AND SEMINARS, AND NOW I REALLY HAVE THAT RELATIONSHIP THAT I CAN TALK TO THEM ABOUT MY SCIENCE, THEIR SCIENCE, AND WHAT ARE THEIR THOUGHTS ABOUT WHAT I COULD DO IN THE FUTURE. THEN SOME OF THE CHALLENGES. I DO ALSO AGREE WITH WHAT CHRIS SAID, THE TRANSITION BETWEEN THE CURRICULUMS CAN BE REALLY CHALLENGING, ESPECIALLY WHEN YOU'RE TAKING BIOCHEMISTRY, FOR EXAMPLE, AT THE PH.D. LEVEL AND THEN WE'RE STILL REQUIRED TO TAKE THAT AT THE DMD LEVEL. ONE, WE COULD BE DOING EXPERIMENTS IN LAB OR SOMETHING MAYBE MORE PRODUCTIVE. ALSO WE START SCHOOL WITH TWO DIFFERENT GROUPS OF CLASSMATES, SO WE START AND THEN THE CLASSMATES I STARTED WITH GRADUATED LAST YEAR, WHICH I'LL ADMIT THAT WAS KIND OF HARD TO SEE THEM LEAVE, BUT IT'S ALSO AN OPPORTUNITY TO GET TO KNOW A WHOLE NEW GROUP OF PEOPLE, AND IT'S DEMANDING. THESE ARE INTENSE PROGRAMS, AND THAT WAS ANOTHER CHALLENGE ONE WHEN YOUR DENTAL SCHOOL FRIENDS ARE GOING TO CANCUN FOR SPRING BREAK. BUT THAT'S -- WHEN I THINK OF MY LONG TERM GOALS, THIS IS WHAT I WANT TO DO, AND IT MAKES IT WORTHWHILE. SO MY NEXT STEPS, I KNOW MY LONG TERM GOAL, I WANT TO BECOME A LEADER AT A DENTAL SCHOOL, AND TO GET THERE, I THINK I WANT TO START DOING THE CLINICAL RESEARCH FELLOWSHIP. WE'VE HEARD A LOT ABOUT THAT THIS WEEK, AND I WAS KIND OF INSPIRED TO PURSUE THAT. I KIND OF FOLLOW THE STEPS THAT WE HEARD ABOUT BEFORE, YOU HAVE THIS 7 YEAR ITCH AND YOU KIND OF MOVE ON, SO I DID UNDERGRAD, HIGH -- THE NEXT SEVEN YEARS WILL BE JUST AS EXCITING. AND THEN THIS IS MY MOST IMPORTANT SLIDE. I'D REALLY LIKE TO THANK NIDCR AGAIN FOR THE SUPPORT FOR MY F AWARD. AND MY MENTORS, DR. DIEKWISCH, DR. LUAN AND THE PEOPLE IN MY LAP THAT HAVE TAUGHT ME HOW TO DO CHIP EXPERIMENTS, DO MICRO CT IMAGING, AND LEARN HOW TO WORK WITH MOUSE MODELS, BECAUSE WITHOUT THEIR SUPPORT AND THEIR HELP AND JUST ALONG THE WAY, I DON'T THINK I WOULD BE HERE TODAY. SO THAT'S ALL I HAVE. [APPLAUSE] >> GOOD MORNING, EVERYONE. I HAVE TO START OUT AND SAY HOW HONORED I AM TO HAVE THE OPPORTUNITY TO SPEAK TO YOU TODAY AND TALK ABOUT MY PATH AND MY JOURNEY AND CHOOSING TO ENTER INTO THE DDS PH.D. PROGRAM AT USCF, AND TALK ABOUT MY EXPERIENCE AND JUST HIGHLIGHT SOME SNAPSHOTS INTO MY THESIS RESEARCH, HIGHLIGHTING A NEW ROLE FOR PRIMARY CILIA IN REGULATING MID FACIAL DEVELOPMENT. I HAVE TO SAY, IT'S BEEN SUCH AN INCREDIBLES PAST FEW DAYS AND I CAN'T WAIT TO GET BACK TO UCSF AND SHARE WHAT I'VE LEARNED WITH MY CLASSMATES SO IT'S REALLY BEEN AN AMAZING EXPERIENCE. SO THE OUTLINE OF MY TALK TODAY, SO I'LL JUST GIVE YOU A LITTLE BACKGROUND ON MY PATH TO CHOOSING TO APPLY TO THE DDS PH.D. PROGRAM. I'LL TALK ABOUT MY EXPERIENCE IN THE DDS/PH.D. PROGRAM AT UCSF AND TOUCH ON A LITTLE BIT OF MY THESIS RESEARCH, AND THEN SOME OF THE CAREER OBJECTIVES, WHAT MY FUTURE PLANS ARE FOLLOWING COMPLETION OF THIS PROGRAM. SO I AM A NEW YORKER, I'M FROM BROOKLYN, NEW YORK, AND I GRADUATED FROM THE CITY UNIVERSITY OF NEW YORK IN 2006. THIS IS A SMALL HISTORICALLY BLACK COLLEGE AND UNIVERSITY IN HBCU, AND WHEN I WAS IN UNDERGRAD, I WAS SET ON GOING INTO DENTISTRY, SO MY MOM WAS A DENTIST AND SO BECAUSE OF THAT, I HAD A GREAT RELATIONSHIP WITH MY DENTIST GROWING UP. [LAUGHTER] I LOVED SHADOWING HER, IT WAS REALLY AN AMAZING EXPERIENCE TO WORK ALONGSIDE HER AND WATCH THE TREMENDOUS JOY THAT HER AND HER PATIENTS GOT IN THAT RELATIONSHIP THAT THEY FORGED. SO I KNEW DENTISTRY REALLY BIT ME EARLY ON, BUT THE RESEARCH SIDE KIND OF CAME UNEXPECTEDLY. BECAUSE AFTER FIN URBANNING FINISHING UNDERGRAD, I WAS SET ON APPLYING TO DENTAL SCHOOL, I WAS GOING TO GET THROUGH DENTAL SCHOOL AND TAKE OVER MY MOM'S PRACTICE, BUT MY JOURNEY IS REALLY A TESTAMENT TO THE POWER OF HAVING GREAT MENTORS, AND BEING OPEN TO THE POSSIBILITIES OF, YOU KNOW, BEING FLEXIBLE WITH YOUR CAREER PLANS. SO AT MEDGAR EVERS COLLEGE, IT'S ONE OF THE SMALLER CITY OF UNIVERSITY OF NEW YORK CAMPUSES, AND UP WITH OF THE ONE OF THE CHALLENGES I HAD WAS THERE WERE REALLY LIMITED RESEARCH OPPORTUNITIES AT THAT INSTITUTION SO I DIDN'T REALLY HAVE AN OPPORTUNITY TO DO RESEARCH IN UNDERGRAD. I HAD A MENTOR THAT TOLD ME, HE SAID, DENTAL SCHOOL IS NOT GOING AWAY, DON'T BE SO -- DON'T HAVE SUCH TUNNEL VISION AND BE SO FOCUSED ON JUST STARTING DENTAL SCHOOL AND GETTING THROUGH IT. I WANT YOU TO, YOU KNOW, JUST TRY RESEARCH. YOU KNOW, I'VE SAW HOW YOU WERE SO ENGAGED IN YOUR UPPER LEVEL BIOLOGY CLASSES AND I FORGED THESE CLOSE RELATIONSHIPS WITH BOTH THE CHAIR OF THE BIOLOGY DEPARTMENT AND THE DEAN, AND THEY REALLY SAW SOMETHING IN ME AND THEY REALLY PUSHED ME TO JUST TRY RESEARCH BEFORE I STARTED DENTAL SCHOOL. I DECIDED TO APPLY FOR A POSTBAC LORE YACHT RESEARCH EDUCATION PROGRAM. THIS IS THE PREP SCHOLARS PROGRAM DESIGN TODAY INCREASE THE NUMBER OF UNDERREPRESENTED MINORITY STUDENTS THAT RENTERRING BIOMEDICAL RESEARCH, AND IT PROVIDED ME TWO YEARS OF TIME WHERE I CAN JUST FOCUS IN THE LAB, JUST START TO BUILD MY RESEARCH TALKS AND SEE IF RESEARCH WAS FOR ME. AND THAT'S WHERE THE SPARC KIND OF WAS LIT. THAT EXPERIENCE, I GOT TO WORK WITH INCREDIBLE MENTORS THAT REALLY LOOKED OUT FOR ME AND I REALLY STARTED TO DEVELOP MY SCIENTIFIC INDEPENDENCE AND STARTED LEARNING HOW TO ASK THE RIGHT QUESTIONS, I WAS REALLY ENGAGED AT THAT POINT. I WAS SO EXCITED AND I WAS SO THANKFUL THAT FROM ARE PROGRAMS LIKE THIS FUNDED BY THE NIH, THE NIGMS, TO INSTITUTIONS TO REALLY GIVE UNDERREPRESENTED MINORITIES THE EXPOSURE TO GAIN REALLY QUALITY RESEARCH EXPERIENCE. THROUGH THAT EXPERIENCE, I WAS ABLE TO AUTHOR MY FIRST PUBLICATION, WHICH WAS A REALLY VALUABLE EXPERIENCE, AND GREAT EX-ARE SEISE SIZE TO HAVE BEFORE STARTING GRADUATE SCHOOL. BUT THAT WASN'T ENOUGH FOR ME. I REALLY WANTED TO KNOW WHAT DENTAL RESEARCH LOOKED LIKE. I WAS WORKING IN A PHARMACOLOGY LAB AND WHILE IT WAS REALLY EXCITING, I DIDN'T REALLY KNOW WHAT DENTAL RESEARCH LOOKED LIKE. AND I REMEMBERED GOING TO A CONFERENCE AND PRESENTING MY WORK, I MET DR. DEBRA PHILIP FROM NIDCR AND SHE TALKED ABOUT NIDCR AND WHAT AN AMAZING PLACE IT WAS. I KNEW THAT I REALLY WANTED TO TRAIN AT NIDCR BEFORE I STARTED DENTAL SCHOOL. SO THAT LED ME TO A SECOND POSTBAC LORE YACHT TRAINING PROGRAM. I APPLIED SUCCESSFULLY FOR THE NIDCR TECHNICAL INTRAMURAL RESEARCH TRAINING AWARD AND FELLOWSHIP AND I HAD AN OPPORTUNITY THROUGH THAT FELLOWSHIP TO WORK AT NIDCR FOR THREE YEARS, AND THAT WAS REALLY LIKE BEING A KID IN THE CANDY STORE. I THINK BACK ON THAT EXPERIENCE THAT I HAD AT NIDCR AND I FEEL SO FORTUNATE THAT I HAD SUCH GREAT MENTORSHIP WORKING IN MATT HOFFMAN'S LAB, I GOT TO MEET SO MANY DDS/PH.D. SCIENTIST, I GOT INCREDIBLE EXPOSURE TO ALL THE DIFFERENT OPPORTUNITIES WITHIN THE FIELD OF DENTAL RESEARCH, AND THAT WAS WHERE MY DESIRE WAS CEMENTED TO DO THE DUAL DEGREE. I KNEW THAT I WOULDN'T BE FULFILLED JUST DOING A STRAIGHT DDS. I REALLY WAS SO EP GAUGED IN THA RESEARCH SIDE AND I REALLY KNEW I WANTED THAT TO BE A MAJOR PART OF MY ACADEMIC CAREER IN DENTISTRY. ALSO FROM THAT, I ALSO WAS FORTUNATE TO ALSO PUBLISH -- OBTAIN A PUBLICATION FROM THAT EXPERIENCE AS WELL. SO THAT LED ME TO UCSF. AT UCSF, THE WAY THAT OUR PROGRAM IS STRUCTURED, THERE'S SOME FLEXIBILITY ALLOWED. ALL STUDENTS START WITH THE PH.D. PHASE OF THE PROGRAM AT THE BEGINNING, SO FOR THE FIRST TWO YEARS OF THE PROGRAM, YOU'RE TAKING YOUR PH.D. COURSE WORK, YOU'RE DOING YOUR LAB ROTATION, YOU CHOOSE YOUR THESIS LAB AND AT THE END OF YOUR SECOND YEAR, YOU TAKE YOUR QUALIFYING EXAM TO BECOME A PH.D. CANDIDATE. AT THAT POINT IN THE PROGRAM, THERE'S SOME FLEXIBILITY, AND YOU HAVE THE OPTION TO EITHER START THE DENTAL PHASE OF THE TRAINING AFTER TWO YEARS OR IN MY CASE, YOU HAVE THE OPTION TO CONTINUE AND TRY TO FINISH THE PH.D. TRAINING BEFORE STARTING THE DENTAL CURRICULUM. AND WITH THE NATURE OF THE MY PROJECT WITH A LOT OF MOUSE GENETICS AND A LOT OF TOOL BUILDING EARLY ON, IT MADE SENSE TO COULD A FOUR DO A FOUR PLUS FOUR MODEL. FOR THE FIRST FOUR YEARS I DID THE P HFLT D TRAINING FOLLOWED BY THE DDS TRAINING YEARS FIVE THROUGH EIGHT. I'M CURRENTLY ENTERING THE SIXTH YEAR OF MY TRAINING, SO I FINISHED MY PH.D. RESEARCH AND OFFICIALLY FINISHED THAT PROGRAM, AND NOW I JUST FINISHED THE FIRST YEAR OF DENTAL SCHOOL, SO I'M ENTERING INTO MY SECOND YEAR OF DENTAL SCHOOL. AND HOW DID I CHOOSE MY THESIS MENTOR? THE GREAT THING ABOUT UCSF IS THAT THEY ALLOW TO YOU REACH ACROSS THE WHOLE UCSF CAMPUS TO CHOOSE YOUR THESIS ADVISER, AND THERE'S SUCH AMAZING SCIENTISTS AT THE UCSF CAMPUS, IT WAS SUCH A TOUGH DECISION TO CHOOSE JUST THREE LABS I WANTED TO ROTATE IN BECAUSE THERE WERE SO MANY AMAZING LABS, BOTH WITHIN AND OUTSIDE OF THE SCHOOL OF DENTISTRY. AND SOME OF THE THINGS THAT I THOUGHT ABOUT WHEN I WAS CHOOSING MY THESIS MENTOR WAS I KNEW THAT I WANTED TO STUDY CRANIOFACIAL DEVELOPMENT. THAT INTEREST WAS REALLY HONED DURING MY TIME WORK WORKING AS A POSTBACK AT NIDCR. I WANTED THE LAB ENVIRONMENT TO BE REALLY SCIENTIFICALLY ENRICHING. I WANTED A LAB ENVIRONMENT THAT WAS GOING TO REALLY PUSH ME TO BECOME AN INDEPENDENT SCIENTIST AS@AN ACCELERATED PACE, BECAUSE OF THE FACT WE ONLY HAVE A FOUR-YEAR PERIOD TO COMPLETE THE PH.D., AND I REALLY WANTED TO MAXIMIZE MY SCIENTIFIC INDEPENDENCE THROUGH MY THESIS MENTOR. AND THAT LED ME TO THE LAB OF JEREMY RIDER, REITER, I KNOW WHEN I EMAILED HIM, HE HAD NO IDEA WHAT A DDS/PH.D. WAS, BUT I REMEMBER READING ABOUT HIS WORK, THE PRIMARY -- CILIA IN DEVELOPMENT OF DISEASE, AND I STARTED LEARNING ABOUT CILIA AND IMPLICATIONS WITH CRANIOFACIAL DEVELOPMENT AND I WAS LIKE, WOW, THIS IS A GREAT NICHE THAT I COULD CARVE FOR MYSELF WITHIN HIS LAB, AND IT WAS A WONDERFUL PARTNERSHIP WORKING WITH JEREMY REITER FOR MY THESIS. SO AS I SAID, FOR MY THESIS PROJECT, I WORKED ON CILIA, AND I HAD NO IDEA THAT I WOULD BE WORKING ON CILIA FOR MY PH.D., I THOUGHT THE CILIA WERE THESE LITTLE TINY FINGER LIKE ORGANELLES THAT MICROORGANISMS USE TO MOVE AROUND, BUT I QUICKLY LEARNED THAT CILIA ARE REALLY CRITICAL FOR HUMAN DEVELOPMENT, SO MUCH SO THAT THERE'S ACTUALLY A WHOLE CLASS OF HUMAN DISORDERS THAT ARE CAUSED BY DEFECTS IN CILIA. THESE ARE CALLED CILIOPATHIES. THIS IS ATTRIBUTED TO THE FACT THAT ALMOST EVERY CELL TYPE IN OUR BODY HAS A SINGLE IMMOTILE CILIA, AND THEY'RE CRITICAL FOR REGULATING DEVELOPMENT AND GROWTH OF DIFFERENT TISSUES AND ORGANS. SO THESE PATIENTS THAT ARE AFFECTED WITH THESE HAVE A SPECTRUM OF DISORDERS STARTING FROM COGNITIVE IMPAIRMENT TO LOSS OF SIGHT, RETINAL DEGENERATION, THEY CAN HAVE CRANIOFACIAL ABNORMALITIES, LOSS OF SMELL, AS WELL AS LUNG DEFECTS, KIDNEY CYSTS, BUT THE CRANIOFACIAL ABNORMALITIES WHICH ARE SEEN IN ABOUT A THIRD OF ALL PATIENTS AFFECTED ARE SOME OF THE MOST POORLY UNDERSTOOD OF THESE CILIOPATHY PHENOTYPES. SO IT SEEMED LIKE IT WOULD BE A GREAT PLACE FOR ME TO CARVE OUT MY NICHE AND REALLY IMPROVE OUR UNDERSTANDING INTO THE CRANIOFACIAL CILIOPATHY PHENOTYPES. SO SOME OF THESE PHENOTYPES THAT ARE PRESENT IN THESE PATIENTS ARE MID FACE DYSPLASIAS, DEFECTS THAT AFFECT OW NARROW OR HOW WIDE THE MID FACE IS, JAW DISORDERS SUCH AS MICROGNATHIA. TONGUE ABNORMALITIES, PALATE DEFECTS, AS WELL AS ABNORMAL DENTITION. FOR MY THESIS, I REALLY FOCUSED ON THE MID FACE DYSPLASIA THAT ARE ASSOCIATED WITH THESE CRANIOFACIAL KRIL YOP THEES. SO AS I SAID, THESE CILIA ARE DISTINCT CELLULAR SIGNALING ORGANELLES, AND IN OUR LAB, A MAJOR QUESTION WAS HOW IS THE CILIA MAINTAINED AS A DISTINCT ORGANELLE. SO HOW ARE PROTEINS THAT NEED TO GO TO THE CILIA RECRUITED TO THE CILIA AND OTHER PROTEINS THAT ARE NOT SUPPOSED TO BE THERE, HOW ARE THOSE RESTRICTED FROM THE CILIA. AND THE LAB DISCOVERED THIS COMPLEX OF PROTEINS THAT SITS AT THE BASE OF CILIA CALLED THE TRANSITION ZONE COMPLEX, AND IT'S MADE UP OF ABOUT 20 DIFFERENT PROTEINS, AND IT BASICALLY ACTS AS LIKE THE BOUNCER OF THE CILIA, BASICALLY SAYS WHO CAN GET IN AND WHO STAYS OUT OF THE CILIA. AND THIS WAS THE REALLY NICE WORK BY A POSTDOC IN OUR LAB THAT SHOWED THIS FUNCTION OF THE CILIA. SO THIS IS ONE COMPONENT REQUIRED TO FORM THIS TRANSITION ZONE COMPLEX. THESE ARE FOUR DIFFERENT KRIL YAIR EE MEMBRANE PROTEINS IN RED RED, YOU CAN SEE IT NICELY ALONG THE CILIA WHICH IS IN BLUE. WHEN YOU LOSE THIS COMPONENT, YOU HAVE A DRAMATIC REDUCTION IN THE KRIL YAIR EE LOCALIZATION, REALLY CONFIRMING THAT THAT KIND OF BOUNCER FUNCTION OF THE TRANSITION ZONE. ALL OF THESE PROTEINS THAT LOCALIZE HERE HAVE BEEN FOUND TO BE MUTATED IN A HUMAN PATIENTS THAT ARE AFFECTED BY CILIOPATHYS. BUT THE MOLECULAR ETIOLOGY IS POORLY UNDERSTOOD. SO WHEN I GOT TO THE LAB, I LOOKED AT SOME OF THE MOUSE MODELS THAT WE HAVE FOR THESE PROTEIN, AND WHEN I LOOKED AT THE MID FACE OF THESE MUTANTS, AT E10.5, YOU CAN SEE A DRAMATIC NARROWING OF THE FACIAL MIDLINE WHICH PURR CYSTS ONE DAY LATER AT E11.5. I SAW THIS IN A NUMBER OF DIFFERENT TRANSITION ZONE -- SO MY TRANSITION REALLY FEE CUSSED ON WHAT WAS THE MOLECULAR MECHANISM REALLY DRIVING THE MECHANISM OF THIS PHENOTYPE. SO MY FOCUS TURNED TO THE HEDGE HOG SIGNALNG PATHWAY, WHICH WE KNOW IS CRITICAL FOR FACIAL DEVELOPMENT AND LEVELS OF ACTIVATION OF THIS PATHWAY HAVE TO BE FINALLY TUNED TO ENSURE -- IF YOU HAVE TOO LITTLE SIGNALING OVER THE PATHWAY, YOU HAVE NARROWING OF THE MID FACE, WHICH CAN IN SEVERE CASES LEAD TO SIGH CLOAP YA OR COMPLETE COLLAPSE OF THE MIDLINE, OR IN THE OPPOSITE CONVERSE EFFECT, IF YOU HAVE TOO MUCH SIGNALING, THIS CAN LEAD TO AN EXPANSION OF THE MID FACE OR HYPER TEE LERRISM. THE PRIMARY CILIA IS ACTUALLY THE SITE OF VERTEBRATE HEDGE HOG SIGNALING. THIS IS THE WAY THE PATHWAY WORKS. WHEN THE PATHWAY IS OFF, THERE'S A NEGATIVE REGULATOR PATCH THAT GOES TO THE KRIL YUM AND KEEPS THE ACTOR OUT OF THE KRIL YUM SO THE GLEE TRANSCRIPTION FACTORS ARE CONVERTED TO A REPRE SER FORM TO TURN OFF HEDGE HOG TARGET GENES. WHEN THE PATHWAY IS ON AND THE LIE AGAINST -- IS PRESENT, THIS BINDS TO THE NEGATIVE REGULATOR PATCH, PULLING IT OUT OF THE KRIL YUM SO THE ACTIVATOR SMOOTH CAN ENTER -- TO TURN ON HEDGE HOG TARGET GENES. SO THAT'S WHAT I WANTED TO LOOK AT. SO FIRST I LOOKED AT EXPRESSION OF THE LIE AGAINST ON THE HEDGE HOG AND MICE -- DAY 8.5, YOU CAN SEE IN NORMAL EMBRYOS, YOU HAVE A NICE RICH EXPRESSION DOMAIN IN THE BASAL FOREBRAIN AT E8.5 AND E9.5. IN OUR MUTANTS, THIS EXPRESSION DOMAIN IS DRAMATICALLY REDUCED. AND THIS IS QUANTIFIED HERE. NEXT LOOKING AT MARKERS OF IF THE PATHWAY IS ON, WE LOOK AT TWO TRANSCRIPTIONAL TARGETS, PATCHED 1 AND GLEE 1 AT E NOINT .0. IN THE BASAL FOREBRAIN, YOU CAN SEE RICH EXPRESSION OF BOTH OF THESE SHOWING ROBUST ACTIVATION OF THE PATHWAY WHICH IS REDUCED IN OUR MUTANTS. SO NEXT I WANTED TO REALLY ANSWER WHAT'S KRIEFING THE MID FACIAL PHENOTYPE? ARE CELLS NOT PROLIFERATING OR ARE THEY DYING OR IS THERE A COMBINATION OF BOTH? TO KIND OF FAST FORWARD TO THE ANSWER, IT TURNS OUT IF YOU TAKE A SECTION THROUGH THESE EMBRYOS AND LOOK AT CELL DEATH THROUGH A TUNNEL ASSAY, YOU CAN SEE THAT THERE'S A MASSIVE INCREASE IN THE AMOUNT OF CELL DEATH IN A NUMBER OF THE CRANIOFACIAL TISSUES, SPECIFICALLY IN THE FOREBRAIN, THE HIND BRAIN AND THE NON-NEURAL OR FACIAL ECTODETERMINE, BUT NOT SO MUCH THE ME CAN KIEM, MESENCHYME. FINALLY, I WANTED TO KNOW, YOU KNOW, IF IT'S REALLY THE HEDGE HOG PATHWAY, CAN WE USE WHAT WE KNOW ABOUT THE PATHWAY TO RESCUE THE MID FACE PHENOTYPE BY MODULATING THE PATHWAY. YOU'D THINK WE COULD DO THIS BY INCREASING A POSITIVE REGULATOR OF THE PATHWAY, OR DECREASING THE AMOUNTS OF NEGATIVE REGULATORS. I FOCUSED ON THE SECOND CHOICE BY MODULATING PATCH 1 LEVELS. AND WHEN I DID THAT, THIS IS JUST REMINDING YOU, THIS IS A NORMAL EMBRYO, WE CAN SEE THIS IS THE NORMAL MID FACIAL WIDTH, THIS IS OUR COLLAPSED MID FACE AND OUR TRANSITION ZONE MUTANT. IF WE TAKE THIS MUTANT AND JUST REMOVE ONE COPY OF THE PATCHED RECEPTOR, WHICH IS THAT BREAK ON THE PATHWAY, IF I JUST TAKE OFF THE BREAK A LITTLE BIT, I'M ABLE TO RESTORE NORMAL MID FACIAL WIDTH. WHICH IS REALLY EXCITING. AND THAT'S QUANTIFIED HERE. SO THAT GIVES US A MODEL WHERE IN THE NORMAL EMBRYO, WE HAVE SO NICK HEDGE HOG AND ACTIVATION OF THE HEDGE HOG PATHWAY IN THE BASAL FOREBRAIN, ALLOWING CELL SURVIVAL IN NORMAL MID FACIAL DEVELOPMENT. IN TRANSITION ZONE MUTANTS, WE HAVE DECREASED LEVELS OF HEDGE HOG EXPRESSION AS WELL AS HEDGE HOG PATHWAY ACTIVATION, LEADING TO MASSIVE CELL DEATH AND MID FACE COLLAPSE, AND IN OUR RESCUE EMBRYOS, WE'VE SHOWN THAT WE HAVE ROW DUED CELL DEATH THAT ALLOWS US TO RESTORE NORMAL MID FACIAL DEVELOPMENT. SO SOME CHALLENGES THAT I'VE INCURRED SPECIFICALLY DURING MY PH.D./DDS PROGRAM, SO THE REITER LAB WAS AN INCREDIBLE LAB FOR STUDYING CILIARY BIOLOGY, BUT JEREMY IS NOT REALLY A LEADER IN CRANIOFACIAL DEVELOPMENT AND I KNEW THAT I WOULD NEED THAT GUIDANCE AND THAT EXPERTISE TO REALLY DEVELOP INTO A LEADER IN THE CRANIOFACIAL BIOLOGY COMMUNITY. SO I HAD TO REACH OUTSIDE AND OBTAIN A SECONDARY MENTOR IN THE FIELD OF CRANIOFACIAL DEVELOP DEVELOPMENT WHICH NICELY SUPPLEMENTED JEREMY'S EXPERTISE IN PRIMARY KRIL YAIR BIOLOGY, SO THAT'S BEEN A GREAT PARTNERSHIP. SINCE I COMPLETED THE PH.D. TRAINING, A MAIN CHALLENGE IS REMAINING ENGAGED IN THE LAB AND KEEPING MY PRODUCTIVITY GOING WHILE I'M IN THE DD S-PHASE OF MY PROGRAM, AND THAT'S REALLY A CHALLENGE THAT I'VE ENCOUNTERED BECAUSE THERE ISN'T A LOT OF TIME IN THE DD S-PHASE, WITHIN THE DDS CRICK COLUMN CURRICULUM SO I'VE HA D TO BE RESOURCEFUL TO FIND TIME TO KEEP MY RESEARCH MOVING FORWARD. ALSO THERE'S BEEN A LACK OF COMMUNICATION AND INTEGRATION BETWEEN THE DDS SIDE AND THE PH.D., THE GRADUATE SIDE OF THE PROGRAM. MY FUTURE CAREER PLANS, I'M REALLY COMMITTED TO A CAREER IN AM DEEM ACADEMIA, I'M REALLY RESEARCH FOCUSED BUT I'D LOVE TO HAVE A HAND IN CLINICAL CARE AS WELL. I'D LOVE THE OPPORTUNITY TO DO SPECIALTY TRAINING COMBINED WITH POSTDOCTORAL RESEARCH, I'M REALLY STARTING TO THINK ABOUT CRANIOFACIAL ORTHODONTICS BECAUSE THAT WOULD NICELY FIT WITH MY RESEARCH INTERESTS, WITH MY ULTIMATE GOAL OF OBTAINING A FACULTY POSITION AT A RESEARCH INTENSIVE DENTAL SCHOOL. FINALLY, I'D JUST LIKE TO ACKNOWLEDGE EVERYONE IN THE REITER LAB, THE MEMBERS OF MY THESIS COMMITTEE AS WELL AS MY FUNDING SOURCES. THANK YOU. [APPLAUSE] >> OKAY. NOW WE HAVE SOME TIME FOR A LITTLE DISCUSSION, QUESTIONS. PR >> HI. THIS IS MATT. I WAS INTERESTED IN TALKING WITH ALL OF YOU OVER THE PAST COUPLE OF DAYS ABOUT THIS ISSUE AS YOU MOVE FORWARD WITH YOUR CAREERS WHERE YOU COME FROM THE PROGRAMS WHERE THE DIRECTORS OF ALL YOUR RESIDENCY PROGRAMS DON'T KNOW ABOUT YOUR PROGRAM, SO YOU'RE LOOKING TO TRY TO COMBINE YOUR RESEARCH EXPERIENCE INTO A RES DEB SEE RESIDENCY PROGRAM BUT NOT WANTING TO DO A MASTER'S, GET ON WITH THE POSTDOC PROGRAM. SO I GUESS CHRIS, I KNOW YOU MENTIONED YOU HAD EXPERIENCED -- YOU TALKED TO THESE, AND I'D LIKE TO HEAR FROM YOU WHETHER YOU'VE GOT SUGGESTIONS FOR OTHERS OR DO YOU SEE A PATH FORWARD, COMMUNICATION WITH OTHER STUDENT RESEARCH GROUPS, POTENTIALLY WITH THE IADR, OTHER RESEARCH GROUPS? HOW DO YOU SEE THIS MOVING FORWARD? >> SO FOR ME, I THINK WHAT WAS MOST HELPFUL WAS GETTING INVOLVED IN THE COMMUNITY OF SPECIALISTS THAT I WAS GOING INTO. SO FOR ME, I WENT TO THE ACADEMY OF ORAL AND MAXILLOFACIAL PATHOLOGISTS MEETING AND I WENT TWICE. IT WAS THROUGH ATTENDING THAT MEETING THAT I MADE EVERYOE AWARE OF MY RESEARCH BACKGROUND AND MY FUTURE GOALS, AND I LITERALLY HAD LUNCH WITH EVERY SINGLE PROGRAM DIRECTOR JUST TO COVER ALL MY BASES. SO THE IMPORTANT THING IS PUTTING YOURSELF IN A UNIVERSITY AND A PROGRAM THAT'S WILLING TO GIVE YOU THESE ACCOMMODATIONS BECAUSE I'VE TALKED TO PEOPLE WHO HAVE ENTERED INTO SPECIALTY PROGRAMS THAT DON'T HAVE THESE PRIOR AGREEMENTS, AND IT JUST DOESN'T GO VERY WELL. SO I THINK IT'S CHALLENGING THAT PROBABLY SHOULD BE CHALLENGING BECAUSE WE'RE TRYING TO DO VERY SPECIFIC THINGS, BUT ONE THING THAT WE'VE TALKED ABOUT YESTERDAY AS A GROUP WAS POTENTIALLY WOULD THERE BE AN OPPORTUNITY TO CREATE SLOTS ON AN INSTITUTIONAL TRAINING GRANT FOR THESE TYPES OF PEOPLE TO SUPPORT THEM ALONG THE WAY. BUT I WOULD SAY THE BIGGEST THING IS JUST KIND OF GETTING INVOLVED IN A COMMUNITY OF PEOPLE, THE ENDODONTICS ASSOCIATION OR WHATEVER IT IS THAT YOU'RE PURSUING, MAKING IT KNOWN TO THOSE PEOPLE WHAT YOUR INTENTIONS ARE AND WHAT YOUR BACKGROUND IS. I JUST LAID MY CARDS ON THE TABLE. THERE ARE A LOT OF PROGRAM DIRECTORS THAT KNOW THAT I BASICALLY JUST SAID THANK YOU, NOT INTERESTED, AND YOU KNOW, I THINK THAT'S IN MY BEST INTEREST. >> OTHER QUESTIONS, COMMENTS? >> I HAVE ANOTHER ONE. SHAWN, YOU'VE GOT THREE MORE YEARS OF DENTAL SCHOOL. HOW ARE YOU GOING TO MAINTAIN THIS RESEARCH INTEREST? HOW ARE YOU ACTUALLY GOING TO DO IT? >> YEAH, THAT'S -- I STRUGGLE WITH THAT QUESTION A LOT ACTUALLY. SO I'M FORTUNATE THAT RIGHT NOW I'M BETWEEN THE FIRST AND SECOND YEARS OF DENTAL SCHOOL, AND LUCKILY AT UCSF, WE HAVE THREE MONTHS OFF DURING THAT PERIOD TO DO -- IF WE HAVE RESEARCH INTERESTS, WE CAN PURSUE THOSE, SO I'VE BEEN BACK IN THE LAB FOR THREE MONTHS WHICH HAS BEEN REALLY BENEFICIAL TO KEEP MY PRODUCTIVITY GOING. IT'S GOING TO BE REALLY CRITICAL FOR ME TO FORGE SOME CONNECTIONS WITH MAYBE GRADUATE STUDENTS AND TECHNICIANS IN THE LAB THAT CAN HELP KIND OF MOVE SOME OF MY RESEARCH FORWARD WHILE I'M AWAY BACK IN 10 TALL SCHOOL SO I CAN HELP GUIDE SOME RESEARCH THERE, SO IF I HAVE SOME PERSONNEL WITHIN THE LAB THAT CAN HELP MOVE SOME THINGS FORWARD, THAT WILL BE A GREAT HELP. MAYBE I'M A LITTLE TOO OPTIMISTIC, BUT I'M HOPING THAT DURING MY CLINICAL YEARS, I'LL HAVE SOME TIME TO BE ABLE TO GO BACK INTO THE LAB AND TRY TO CONTINUE SOME EXPERIMENTS, SO THAT'S HOPEFUL OPTIMISM. >> DO YOU HAVE A PLAN TO PUBLISH NUG FROM THIS? >> YES, I'M CURRENTLY IN THE PROCESS OF SUBMITTING MY THESIS WORK MY FIRST AUTHOR PUBLICATION, SO THAT SHOULD BE -- HELP ME OUT NEXT YEAR. >> MARY BETH, YOUR EXPERIENCE IN BIOTECH BEFORE YOU WENT TO DENTAL SCHOOL, IS THAT INFLUENCING AT ALL ANY OF YOUR INTERESTS MOVING FORWARD? >> YES, THAT'S ACTUALLY SOMETHING I WAS ABLE TO TALK TO SOME PEOPLE AT THE WORKSHOP THIS WEEK ABOUT, JUST PURSUING EVEN POSTDOCTORAL TRAINING IN INDUSTRY-TYPESETTING. IT'S HARD BECAUSE NOT -- I DIDN'T GET A LOT OF FEEDBACK ABOUT CERTAIN OPPORTUNITIES THAT THERE WOULD BE DOING THAT, ALSO TALKED TO A FEW ABOUT THE SMALL BUSINESS GRANTS, SO I THINK THERE'S A LOT, AND I THINK WHAT OTHER PEOPLE HAVE MENTIONED AT THAT POINT WHEN I'M READY TO GRADUATE, I NEED TO BE PROACTIVE ABOUT SEEKING OUT THOSE OPPORTUNITIES. >> I HAD ONE MORE COMMENT. I THINK FROM THIS WORKSHOP, ONE OF THE MOST IMPORTANT THINGS THAT HAVE HAPPENED OVER THE LAST TWO DAYS IS THE ABILITY FOR US TO CONNECT WITH EACH OTHER. AND I'M IN MY SEVENTH YEAR AND FOR MOST OF THESE PEOPLE, THIS WAS MY FIRST TIME MEETING THEM, AND THESE WERE PEOPLE WHO HAVE ALSO BEEN IN THE PROGRAM FIVE, SIX, SEVEN YEARS, AND WE'RE ALL ATTENDING AAD R AND IIDR CONFERENCES, AND IT WAS JUST KIND OF SURPRISING TO ME THAT WE HADN'T MET EACH OTHER BEFORE. SO I THINK ONE THING GOING FORWARD THAT WE'VE ALL KIND OF LANDED ON AND RESOLVED TO CONSIDER IN THE FUTURE IS MAYBE WE CAN SET UP SOME SORT OF WORKSHOP AT IDR WHERE WE CAN ALL GET TOGETHER AND KIND OF TALK ABOUT THESE SAME ISSUES AND SET SOMETHING MORE FORMAL UP FOR IT. >> DID YOU DISCUSS SOCIAL NETWORKING MEDIA OPPORTUNITIES THAT I'M SURE YOU'RE ALL FAMILIAR WITH? BECAUSE I GOT THE SENSE YESTERDAY, YOU WERE ALL REALLY ENJOYING THE INTERACTION AND IT SEEMED A SHAME YOU HADN'T MET EACH OTHER BEFORE IN EARLIER STAGES OF YOUR CAREERS AND THE DECISIONS YOU'RE MAKING. >> I WOULD ALSO LIKE TO ADD THAT WE BROUGHT UP A POTENTIAL LIST OF GRADUATES FROM THIS PROGRAM, AND WHAT THEY'RE DOING. AND SORT OF USING THEM AS OUR MEN MENTORS, WHAT HAS BEEN THEIR STRUGGLES IN THE PROGRAM, WHAT THEY THINK THAT WE COULD DO AFTER GRADUATION. >> I'M NOT ASKING ANY QUESTIONS BECAUSE I THINK I POSED SOME QUESTIONS TO YOU AND IT SOUNDS LIKE YOU'VE BEEN ADDRESSING THEM AND THAT YOU HAD A GOOD SESSION AFTER I SORT OF LEFT YOU, BUT IT HAS BEEN AN INCREDIBLE TWO DAYS, AND THE ISSUES YOU BRING UP ARE ONES THAT I DON'T KNOW IF YOU EVER HAVE ANSWERS TO, BUT YOU'RE SUCH INCREDIBLE PEOPLE AND HARD WORKERS AND SO COMMITTED, YOU'LL FIGURE IT OUT IS MY FEELING. BUT IT'S JUST BEEN A PLEASURE TO HAVE YOU AROUND FOR THE LAST TWO DAYS, IT ENERGIZES US, SO WE THANK YOU FOR THAT AS WELL. SO THANK YOU SO MUCH FOR YOUR TIME. [APPLAUSE] >> OKAY. THANK YOU, EVERYONE. THE OPEN SESSION OF THE MEETING IS NOW CLOSING. COUNCILCOUNCILMEMBERS WILL MEET DOWN THE HALL, KEEP GOING DOWN PAST THE LOBBY AREA TO ROOM 7 FOR LUNCH. THE AFTERNOON SESSION, WHICH IS CLOSED TO THE PUBLIC, WILL START AT ABOUT 1:40. >> I JUST WANT TO THANK EVERYBODY AROUND THE ROOM HERE. THIS IS OUR INCREDIBLE STAFF THAT HAVE PUT EVERYTHING TOGETHER EVERY DAY AND EVERY MOMENT FOR 24/7, SO LET'S GIVE AN APPLAUSE FOR THEM AS WELL.