>> I'D LIKE TO WELCOME EVERYONE TO THE 54th MEETING OF THE NATIONAL ADVISORY COUNCIL ON MINORITY HEALTH AND HEALTH DISPARITIES. DR. ELISEO PEREZ-STABLE, DIRECTOR OF NIMHD WILL STAY A FEW WORDS BEFORE WE START THE INTRODUCTIONS OF THE COUNCIL MEMBERS. >> ELISEO PEREZ-STABLE: GOOD AFTERNOON, EVERYONE WHO IS ON THIS VIDEOCAST AND GOOD MORNING FOR THOSE OF YOU FURTHER WEST. WE ARE PLEASED TO BE ABLE TO PRESENT OUR COUNCIL MEETING FULLY VIRTUALLY. I'M SITTING IN MY HOME IN COLUMBIA HEIGHTS IN THE DISTRICT OF COLUMBIA WHERE I HAVE BEEN ESSENTIALLY SINCE MARCH 17, NOT HAVING BEEN TO THE OFFICE, NOT HAVING BEEN OUTSIDE OF THE NEIGHBORHOOD, PRETTY MUCH, THIS WHOLE TIME. I'M PROUD TO SAY THAT NIH STAFF HAVE MADE A REMARKABLE PIVOT IN GOING FULL TELEWORK. IN OUR INSTITUTE IT'S BEEN UNFORM. THEY ARE JUST WORKING REALLY HARD. I CAN'T REMEMBER WORKING THIS MUCH OR THIS HARD SINCE MY EARLY DAYS AS AN ASSISTANT PROFESSOR TRYING TO GET A GRANT. SO I DO THINK THAT WE ARE ALL TRA VESSING NEW TERRITORY. THIS NEW PANDEMIC OF UNPRECEDENTED PROPORTIONS IS IMPACTING US AS WE LIVE. AND THIS IS A HISTORICAL MOMENT IN A WAY THAT, IN THE FUTURE, I HOPE MANY OF US WILL BE ABLE TO RECALL AND TELL STORIES IN HOW THIS CHANGED OUR LIVES, CHANGED OUR SOCIETY. RIGHT NOW, WE ARE VERY CONCERNED ABOUT THE IMPACT ON OUR COMMUNITIES AND WE'LL SPEND A LITTLE BIT OF TIME DISCUSSING THAT TODAY. BUT WE WILL ATTEND TO THE BUSINESS OF THE COUNCIL. I'M VERY GRATEFUL TO ALL OF THE COUNCIL MEMBERS TO BE PRESENT IN THIS VIRTUAL MEETING AND TO THE NIMHD STAFF THAT PREPARED THE PRESENTATIONS FOR DISCUSSION, AS WE CONTINUE TO CONDUCT OUR NIH BUSINESS. SO THANK YOU FOR ATTENDING. NO GAVEL TO START THE MEETING TODAY, BUT WE WILL PROCEED AS PLANNED. DR. HUNTER. >> A HINTER HINTER: I'D LIKE TODR. HUNTER: WE ASK YOU INTRODUCE YOURSELF. PLEASE TURN ON YOUR VIDEO IF IT'S WORKING AND INTRODUCE YURSELF. SO I'LL START WITH DR. BARNS. >> GOOD AFTERNOON, EVERYONE. LISA BARNS, A PROFESSOR OF NEUROLOGICAL SCIENCES AND A COGNITIVE NEUROPSYCHOLOGIST AT THE RUSH ALZHEIMER'S DISEASE CENTER, WHICH IS IN THE RUSH UNIVERSITY MEDICAL CENTER IN CHICAGO. MY EXPERTISE IS IN HEALTH DISPARITIES OF CHRONIC DISEASES OF AGING. THANK YOU. >> DR. HUNTER: DR. CALL MAN. >> MY NAME IS NEAL CALL MAN. I'M A FAMILY PHYSICIAN AND RUN THE INSTITUTE FOR FAMILY HEALTH AND I ALSO CHAIR THE DEPARTMENT OF FAMILY MEDICINE AT THE MOUNT SINAI MEDICAL CENTER. >> DR. HUNTER: DR. CHEN? >> DR. KORBY SMITH? >> GOOD AFTERNOON, EVERYONE, FOR THOSE OF YOU ALL THAT IT IS AFTERNOON, MY NAME IS JAZELL CORE BEE SMITH, I'M KEYNOTE DISTINGUISHED PROFESSOR IN THE SCHOOL OF MEDICINE AT THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL. I SERVED AS A ASSOCIATE PROVOST FOR VIRAL INITIATIVES. >> DR. HUNTER: DR. JOHNSON. >> GOOD AFTERNOON. I'M KIMBERLY JOHNSON. I'M A GERIATRICIAN AND INVESTIGATOR AT DUKE UNIVERSITY MEDICAL CENTER, ALSO IN NORTH CAROLINA AND THE DIRECTOR OF THE DUKE CENTER FOR RESEARCH HEALTH CARE EQUITY. >> DR. HUNTER: DR. CAHOLA KULA. DR. LYNNE? DR. LONG? >> HI. I'M JUDITH LONG ONE OF THE DIRECTORS OF THE VA CENTER FOR HEALTH EQUITY RESEARCH AND PROMOTION IN PHILADELPHIA, AND THE CHIEF OF GENERAL INTERNAL MEDICINE AT THE UNIVERSITY OF PENNSYLVANIA. THANK YOU. >> DR. HUNTER: THANK YOU VERY MUCH. DR. MANSON. DR. MENDOZA. >> I'M PROFESSOR OF PEDIATRICS AT STANFORD AND ASSOCIATE DEAN FOR MINORITY ADVISORY AND PROGRAMS AND MY RESEARCH HAS BEEN IN THE AREA OF MINORITY CHILD HEALTH AND DIVERSITY OF THE WORKFORCE. >> DR. HUNTER: THANK YOU. DR. MA STAN SKI. >> I'M DOCTOR BRAD MA STAN SKI. I'M THE DIRECTOR OF THE INSTITUTE FOR SEXUAL AND GENDER MINORITY HEALTH AND WELL-BEING AND THE CO-DIRECTOR OF THE THIRD COAST CENTER FOR AIDS RESEARCH AT NORTHEASTERN UNIVERSITY. >> DR. HUNTER: THANK YOU. DR. RAMIREZ. >> [ INDISCERNIBLE ] SCHOOL OF MEDICINE AT UT HEALTH SAN ANTONIO AND MY BACKGROUND IS IN LATINO HEALTH DISPARITIES AND ALSO IN HEALTH CAREER DEVELOPMENT IN THE AREA OF PREVENTION. >> DR. HUNTER: THANK YOU. DR. REID. DR. RES IN THIS CALL. >> I'M AT THE UNIVERSITY OF MICHIGAN, SCHOOL OF PUBLIC HEALTH AND OUR SCHOOL OF MEDICINE FOR OUR CANCER CENTER. I'M ASSOCIATE DIRECTOR FOR COMMUNITY ENGAGEMENT AND HEALTH DISPARITIES RESEARCH AND MOST OF MY RESEARCH FOCUSES ON HEALTH COMMUNICATION AND BEHAVIOR CHANGE INTERVENTIONS FOR MINORITY AND SPECIAL POPULATION POPULATIONS. >> DR. HUNTER: DR. RIFELY, ARE YOU WITH US? DR. SHALE. >> GOOD AFTERNOON. DONALD SHELL ACCIDENT FAMILY PHYSICIAN WITH THE DEPARTMENT OF DEFENSE IN THE OFFICE OF THE ASSISTANT SECRETARY OF HEALTH WHERE I'M IN HEALTH SERVICE POLICY OVERSIGHT AND DIRECTOR OF DISEASE MANAGEMENT AND POPULATION AND HEALTH OVERSIGHT. >> DR. HUNTER: DR. SUTHERLAND. >> I'M BILL SUTHERLAND, PROFESSOR OF BIOCHEMISTRY AND MOLECULAR BIOCHEMISTRY AT HARVARD AND ALSO THE PI OF HOWARD UNIVERSITY ROCMI PROGRAM. MY RESEARCH IS DATA SCIENCE AS RELATED TO HEALTH DISPARITY ISSUES. >> DR. HUNTER: THANK YOU. DR. TELEVARYA. >> GOOD AFTERNOON, EVERYONE. GREG TELEVARIA, PROFESSOR IN THE DEPARTMENT OF PSYCHOLOGY AT SAN DIEGO STATE UNIVERSITY WHERE I DIRECT A COMMUNITY-BASED RESEARCH CENTER CALLED, THE SOUTH BAY LATINO RESEARCH CENTER, WHICH FOCUSES ON EPIDEMIOLOGY AND INTERVENTION SCIENCE SURROUNDING CHRONIC DISEASE AMONG THE LATINO COMMUNITY IN SAN DIEGO. >> DR. HUNTER: -- DR. ZERELA? >> GOOD AFTERNOON. I'M CARMEN OBGYN PRACTICING IN SAN JUAN, PUERTO RICO. MY AREA OF EXPERTISE IS IN -- [ INAUDIBLE ] FOR THE PAST 30 YEARS AND WORKING WITH MEN AND WOMEN WITH ZIKA AND COVID-19 IN OUR COMMUNITIES -- [ INAUDIBLE ] I'M ALSO INTERIM DEAN FOR RESEARCH AT THE MEDICAL SCIENCES IN SAN JUAN, PUERTO RICO. >> DR. HUNTER: I WANT TO RUN BACK TO THE TOP REAL QUICK BECAUSE I SEE DR. CAHOLA KURLA'S NAME. DID YOU WANT TO INTRODUCE YOURSELF? WHAT I'LL DO NOW IS GO AROUND THE VIRTUAL TABLE TO HAVE NIMHD STAFF INTRODUCE THEMSELVES AND I'LL START WITH DR. HOOPER. >> DR. HOOPER: GOOD AFTERNOON AND GOOD MORNING. I AM THE DEPUTY DIRECTOR OF THE NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES, THE NEW DEPUTY DIRECTOR, AND BEFORE JOINING NIMHD I WAS A PROFESSOR OF ONCOLOGY, FAMILY MEDICINE AND COMMUNITY HEALTH AND PSYCHOLOGICAL SCIENCES AT CASE WESTERN RESERVE UNIVERSITY. AND I WAS ALSO ASSOCIATE DIRECTOR FOR CANCER DISPARITIES RESEARCH AND DIRECTOR OF THE OFFICE OF CANCER DISPARITIES RESEARCH IN THE CASE COMPREHENSIVE CANCER CENTER. AND I'M DELIGHTED TO BE HERE FOR MY FIRST COUNCIL MEETING AND DELIGHTED TO HAVE ALL OF YOU ON THE CALL AND VIRTUALLY WATCHING. I'M A TRANSLATIONAL BEHAVIORAL SCIENTIST AND CLINICAL HEALTH PSYCHOLOGIST AND I WORKED TIRELESSLY TO ADDRESS MINORITY HEALTH AND HEALTH DISPARAT ISSUES FOCUSED ON CHRONIC ILLNESS PREVENTION AND HEALTH BEAR CHANGE. THANK YOU. >> DR. HUNTER: THANK YOU VERY MUCH. DR. STINSON. >> DR. STINSON: DIRECTOR IN THE DIVISION OF SCIENTIFIC PROGRAMS AT NIMHD. >> DR. HUNTER: DR. VAL BERG? >> I'M DR. TROMBERG AND THE DIRECTOR OF THE OFFICE OF EXTRAMURAL RESEARCH ACTIVITIES AT THE NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES. >> DR. HUNTER: THANK YOU VERY MUCH. DR. ELISEO PEREZ-STABLE, DID YOU WANT TO SAY ANYTHING OR DID YOU WANT ME TO GO ON WITH A REVIEW OF THE MINTS QUICKLY AND GET OUT OF THE WAY? >> ELISEO PEREZ-STABLE: I WANTED TO MAKE SURE THAT FOLKS WHO SHOW UP ON THE LIST ARE ON THE LIST. SO I SEE WE ARE HAVING TROUBLE WITH YOUR MIC. WE DID NOT HEAR YOU AT ALL, ALTHOUGH I SEE YOU'RE LISTED. I KNOW BILL RILEY IS ALSO IN. I DIDN'T SEE JOAN REID OR DR. MANSON. MAYBE GIVE THEM AN OPPORTUNITY TO INTRODUCE THEMSELVES AND YOU CAN TAKE IT AWAY, JOYCE. >> DR. HUNTER: OKAY. DID YOU WANT TO TRY AGAIN DR. KULA? I THINK HE MAY STILL BE HAVING PROBLEMS WITH HIS MIC. DR. MANSON JOIN US? YOU SAID YOU SAW HIS NAME. >> CAN YOU HEAR ME? >> DR. HUNTER: YES, WONDERFUL! WE CAN SEE YOU TOO. >> GREAT. I'M SORRY I HAD TO TAKE OFF MY EARPLUGS. ALOHA. I'M CLINICAL HEALTH PSYCHOLOGIST, PROFESSOR AND CHAIR OF HAWAIIAN HEALTH AT THE MEDICAL SCHOOL HERE. >> DR. HUNTER: THANK YOU VERY MUCH. >> THIS IS MARSHAL FROM THE UNIVERSITY OF CHICAGO -- [ INAUDIBLE ] >> DR. HUNTER: SOMEONE IS SPEAKING. WONDERFUL. GO AHEAD DR. CHEN, PLEASE. >> HI. MARSHAL CHEN, GENERAL INTERNIST IN THE HEALTH SERVICES RESEARCHER FROM THE UNIVERSITY OF CHICAGO. >> DR. HUNTER: DID ANYONE ELSE JOIN? >> I THINK DR. SPIRO MAN SEN. >> DR. HUNTER: DR. MANSON, WILL YOU PLEASE INTRODUCE YOURSELF. >> SPIRO MANSON FROM THE UNIVERSITY -- COMMUNITY CAMPUS IN COLORADO WHERE I DIRECT THERS AMERICAN INDIAN AND ALASKAN INDIAN HEALTH. >> DR. HUNTER: THANK YOU VERY MUCH. >> JOYCE, THIS IS BILL RILEY. I MANAGED TO MUTE MYSELF -- [ INAUDIBLE ] >> DR. HUNTER: BILL, YOU'RE BREAKING UP. YOU WANT TO TRY IT AGAIN? >> LET ME TRY THAT AGAIN. DIRECT THE OFFICE OF BEHAVIORAL AND SOCIAL SCIENCES RESEARCH AT THE NIH. >> DR. HUNTER: THANK YOU VERY MUCH. I THINK WE GOT EVERYONE, SO I'LL VERY QUICKLY GO OVER THE REVIEW OF THE MINUTES AND THESE ARE THE MINUTES FROM THE FEBRUARY 2020 COUNCIL MEETING. THEY WERE POSTED IN THE ELECTRONIC COUNCIL BOOK. HAVING REVIEWED THE MINUTES, PLEASE LET ME KNOW IF THERE ARE ANY QUESTIONS, CONCERNS OR CORRECTIONS FOR THE MINUTES. AND I'D LIKE TO ASK THAT IF YOU DO HAVE A QUESTION OR A COMMENT, PLEASE PUT IT IN THE CHAT BOX. I'M MONITORING TO SEE IF YOU -- SO I DON'T SEE ANY QUESTIONS OR COMMENTS ON THE MINUTES. AT THIS POINT, MAY I PLEASE HAVE A MOTION TO APPROVE THE MINUTES FROM THE FEBRUARY 2020 COUNCIL MEETING? >> I MOVE TO APPROVE THE MINUTES. >> SECOND. >> DR. HUNTER: IT'S BEEN MOVED AND PROPERLY SECONDED. ALL THAT ARE IN FAVOR, PLEASE PUT A Y IN THE SUBMIT CHAT IN THE CHAT BOX. ALL IN FAVOR. WONDERFUL. ANY OPPOSED, PLEASE PLACE A "NO QUALITIES IN THE CHAT BOX. SEEING NONE, IT IS MOVED AND PROPERLY SECONDED THAT THE MINUTES FROM THE FEBRUARY 2020 ADVISORY MEETING HAVE BEEN APPROVED. FUTURE MEETING DATES ARE LISTED ON THE AGENDA AND AFTER REVIEWING THEM, IF IT IS DETERMINED THAT YOU HAVE A CONFLICT, OUTSIDE CONFLICT, WITH ANY OF THE MEETINGS, PLEASE LET ME KNOW AS SOON AS POSSIBLE. IT IS OUR POLICY THAT YOU ARE ALLOWED TO MISS ONLY ONE MEETING PER CALENDAR YEAR. I ALSO WOULD LIKE TO REMIND YOU THAT IT IS THE POLICY OF THE NIH THAT AN INDIVIDUAL COUNCIL MEMBER CANNOT SERVE ON A PEER-REVIEWED PANEL WHILE BEING PART OF THE COUNCIL, NOR CAN THEY SERVE ON ANY OTHER ADVISORY COUNCIL WITHOUT A WAIVER. THAT THE POINT, I WILL NOW TURN THE MEETING BACK OVER TO DR. ELISEO PEREZ-STABLE. >> ELISEO PEREZ-STABLE: GOOD AFTERNOON AGAIN, EVERYONE. IF I COULD HAVE MY SLIDES UP. I'M GOING TO DO THE DIRECTOR'S REPORT AND THEN WE'LL PROCEED WITH OTHER BUSINESS OF THE COUNCIL. SO ONCE AGAIN, WELCOME EVERYONE AND THANK EVERYBODY FOR PARTICIPATING IN THIS VIRTUAL MEETING AS WE ARE ADAPTING TO THESE NEW CONDITIONS. I'LL START WITH GENERAL INFORMATION. APPARENTLY THE NATIONAL INSTITUTES OF HEALTH HAS SEVERAL NEW DIRECTOR POSITIONS OPEN. WE HAVE NOT FINALIZED ANY SELECTION ON THESE INSTITUTES, ALTHOUGH THERE ARE IMPORTANT MOVEMENTS IN ALL OF THEM. THE NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES, WHICH HAS BEEN OPEN SINCE DR. STEVEN KATZ PASSED AWAY SUDDENLY AND BOB CARTER HAS BEEN THE ACTING DIRECTOR NOW FOR ALMOST A YEAR AND A HALF. I BELIEVE THERE IS A FINAL LIST WITH WHOM DR. COLLINS IS TRYING TO FINALIZE ALL THE NEGOTIATIONS. ON THE NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES, I SERVED ON THAT SELECTION COMMITTEE. WE MADE OUR RECOMMENDATIONS TO DR. COLLINS AND AT THIS POINT, I ASSUME THEY STARTED OR HAVE GONE THROUGH THE SECOND LEVEL INTERVIEWS. AT THE NATIONAL INSTITUTE OF NURSING RESEARCH, I CO-CHAIRED THAT SEARCH IN ITS SECOND ITERATION WITH THE NATIONAL LIBRARY OF MEDICINE. WE MADE OUR RECOMMENDATION. I BELIEVE DR. COLLINS, AGAIN, IS FINALIZING THE NEGOTIATIONS WITH THE FINALIST. THE NATIONAL INSTITUTE OF DENTAL AND WILL CRANEO FACIAL RESEARCH IS INITIATING THE SECOND-LEVEL INTERVIEWS, WHICH I HAVE BEEN ASKED TO PARTICIPATE IN SO THAT IS PROBABLY THE FURTHEST BEHIND OF THE SEARCHES AND THE NATIONAL EYE INSTITUTE, I DID IN-PERSON INTERVIEWS THE LAST TIME I WAS ON THE NIH CAMPUS FRIDAY THE 13th OF MARCH. I WAS THERE TO INTERVIEW A CANDIDATE IN THE SECOND-LEVEL INTERVIEWS. SO I ASSUME THOSE ARE PROGRESSING AS WELL. NEXT SLIDE. LOTS OF STUFF ON COVID WE'LL PRESENT TODAY. I WANT TO TRANSMIT TO THE PUBLIC AND TO THE COUNCIL AS AWARE THE INTENSE LEVEL OF MOBILIZATION AT THE AGENCY HAS UNDERGONE AROUND THIS GLOBAL CRISIS. LOTS OF SCIENCE ACTIVITY. LOTS OF MANAGING OF COMMUNITY EDUCATION AND STAFF. SINCE MARCH 17, I HAVE BEEN PERSONALLY IN TELEWORK I BELIEVE 100% OF NIMHD STAFF IS ON FULL TELEWORK SINCE WE DO NOT HAVE A SCIENCE PROGRAM, NOR ANYBODY WHO ABSOLUTELY HAS TO BE PHYSICALLY PRESENT. SOMEWHERE OVER HALF OF THE NIH STAFF ARE FULLY TELEWORKING WITH TIER ONE WORKERS NEEDING TO BE PRESENT FOR DIFFERENT ACTIVITIES. -- LAUNCHED IN EARLY APRIL OF HYDROXY CHLOROQUINE AND HOSPITALIZED PATIENTS. THAT IS STILL ONGOING. YOU MAY BE AWARE OBSERVATIONAL DATA PUBLISHED IN THE V.A. WAS NOT SUPPORTED WITH EVIDENCE OF BENEFIT IN THE INITIAL REPORTS CAME OUT OF FRANCE WERE REALLY IN THE ANECDOTAL LEVEL SO THE EXPECTATION IS NOT HIGH BUT THERE IS ALSO A NATIONAL TRIAL ONGOING FOR HOSPITALIZED PATIENTS AT NHLBI. THERE HAS BEEN LAUNCHED A STUDY OF 10,000 RANDOMLY-SELECTED ADULTS TO LOOK AT LEVEL OF UNDETECTED VIRUS IN THE POPULATION. DR. COLLINS PERSONALLY FOCUSED ON CREATING A PUBLIC-PRIVATE PARTNERSHIP WITH SPEEDED DEVELOPMENT OF VACCINE AND TREATMENT OPTIONS WITH THE ACRONYM, ACTIV WE WERE INVITED TO JOIN AN UPDATE SESSION WITH THIS ADVISORY GROUP LAST WEEK. I LISTENED AND WE HAD A SUMMARY DISCUSSION. THE ANTI-CORONA VIRUS AGENTS THAT ARE BEING DISCUSSED RIGHT NOW ARE THINGS AROUND IMMUNOMODULATORS AND ANTICOAGULANT THERAPIES. THE ANTIVIRALS ARE NOT READY FOR PRIME-TIME IN TERMS OF LAUNCHING TRIALS, ALTHOUGH THEY ARE LIKELY TO FOLLOW. THIS IS A GROUP OF INDIVIDUALS THAT LEADING RESEARCH IS FROM PHARMA FROM FDA. THE GATES FOUNDATION, AS WELL AS NIMH. THERE ARE EXPERT PANEL RECOMMENDATIONS ON TREATMENT LIKE MANY VIRAL INFECTIONS. MOST OF IT IS SYMPTOMATIC. WE DO NOT HAVE ANTIVIRAL THERAPIES, REMDESIVIR, AS I'LL SHARE IN A MINUTE, IS A MODEST EFFECT ON SEVERE HOSPITALIZED PATIENTS. THERE ALSO IS AN EFFORT ON DEVELOPING A VACCINE THAT IS BASED IN THIS A WHY. TIV PROGRAM. THERE ARE SEVERAL PROMISING VACCINE CANDIDATES. THEY'LL PROBABLY LAUNCH CLINICAL TRIALS ON ANYWHERE FROM 3-6. IT DEPENDS ON ADDITIONAL PHASE I AND PHASE II TESTS. ALSO TRYING TO REV UP PRODUCTION ON THE MOST PROMISING CANDIDATES IN ANTICIPATION OF ONE OF THEM COMING FORTH AS BEING MOST -- HAVING THE BEST EFFICACY. KEEP IN MIND, THAT PRODUCTION OF VACCINE, EVEN AT A MODEST LEVEL, THAT THE FLU VACCINE GETS 150 MILLION DOSES. IT REQUIRES ABOUT A SIX-MONTH PERIOD. AND EVEN AFTERWE KNOW WHAT THE VACCINE CONTENTS WILL BE, IT TAKES TIME TO GET ALL OF THIS LINED UP AND THERE IS A HUGE EFFORT TO TRY TO ACCELERATE THIS PROCESS AS MUCH AS POSSIBLE, ANTICIPATING EFFICACY. AND FINALLY, THERE IS A LOT OF EFFORT NOW ON INNOVATION FOR DIAGNOSTICS AND WE'LL GET MORE INTO THAT. NEXT SLIDE. DR. COLLINS TESTIFIED ON MAY 7 IN FRONT OF THE SENATE BILL COMMITTEE ON HEALTH, EDUCATION LABOR AND PENSIONS. HE QUOTED THE TERM, "SHARK TANK" TO DESCRIBE THE EFFORT LED BY NIBIB. WE WILL HEAR MORE FROM DR. TROMBERG SHORTLY ON DEVELOP DEVELOPING RAPID CARE TESTING. THE CURRENT TEST TO DETECT VIRAL NUCLEIC ACID ARE TESTS THAT REQUIRE A CERTIFIED LAB, AND ALSO HAS TO BE TRANSPORTED TO A BUILDING, A PLACE, OFTEN DISTANT FROM THE SITE OF THE PATIENT OR THE CLINIC AND THEN IT WILL TAKE AT LEAST A DAY OR MINIMUM OF SEVERAL HOURS TO GET THE RESULT BACK. AND THE NOTION HERE IS HOW POINT OF CARE TESTING THAT WILL BE READY IN AN HOUR OR LESS. PREFERABLY WITH MINIMUM INVASIVENESS AND ALSO EVENTUALLY THE -- POTENTIALLY TO HAVE HOME TEST KITS. DR. TROMBERG IS LEADING THIS EFFORT THROUGH THE GATES TECHNOLOGY CENTERS. THERE ARE SIX FUNDEDDENTS AND THEY ARE SORT OF COORDINATING THIS EFFORT. THEY HAD SEVERAL HUNDRED APPLICATIONS ALREADY AND THEY WILL USE ALLOCATED FUNDS FROM CONGRESS THAT WERE APPROPRIATEOD APRIL 24. NIH HAS LABELED THIS BRAND X WITH A BIG X, OR A SMALL X, AND AS YOU CAN SEE, THEY IT IS IN THE SLIDE. NEXT SLIDE. OTHER UPDATES. THE ADAPTIVE COVID-19 TREATMENT TRIAL THAT NIH LAUNCHED AND GLOBALLY DEPLOYED, RANDOMIZED 1000 HOSPITALIZED PATIENTS WITH SEVERE COVID-19. THEY DO NOT ACQUIRE TO BE IN THE INTENSIVE CARE OCCUPANT BUT THEY NEED TO BE VERY SICK. THIS REPRESENTS MAYBE UP TO 20% OF ALL PEOPLE INFECTED AT MOST, PROBABLY LES IF WE GET A REAL HANDLE ON THE DENOMINATOR. RANDOMIZED RECEIVED REMDESIVIR, A DRUG THAT WAS INITIALLY DEVELOPED AND TARGETED FOR EBOLA THAT DID NOT HAVE EFFICACY. REMDESIVIR-TREATED PATIENTS RECOVERED FASTER WITH A DIFFERENCE OF 4 DAYS TO FULL RECOVERY, WHICH IS BEING USED AS AN ENDPOINT IN THESE STUDIES. THAT WAS SIGNIFICANT AND A TREND TO MORTALITY BENEFIT THAT WAS NOT SIGNIFICANT BUT FURTHER ANALYSIS WILL BE DONE AFTER THE FULL SET OF PATIENT DATA ARE ANALYZED. THIS HAS LED TO REMDESIVIR NOW DEFACTO BECOMING STANDARD OF CARE. STANDARD OF THERAPY FOR A FUTURE CLINICAL TRIAL, WILL REQUIRE REMDESIVIR OR IN ADDITION TO REMDESIVIR. SO WE WILL SEE THAT IMPLEMENTED ALMOST IMMEDIATELY. THE APPROPRIATIONS ALLOCATEOD APRIL 24 AND SIGNED BY THE PRESIDENT THAT DAY, INCLUDED 300 MILLION DOLLARS IN FUNDING TO WORK ON THE SEROLOGICAL TEST FOR COVID-19. NCI, UNDER DR. SHARPLESS LEADERSHIP HAD ALREADY CONVERTED THE HPV LAB THAT IS BASED IN FREDERICKS BERG TO BECOME COVID-19 LAB. AND SO THEY ARE SORTING THROUGH THE ISSUES OF WHICH SIR LOGICAL - OAR THE BEST. EITHER IGM OR IGG-BASED. THERE HAD BEEN NO VALIDATION OR TESTING BY THE FDA PRIOR TO THIS. IT HAS BEEN PULLED BACK EVEN WITHIN 9.99% EFFICACY, THE TEST IS ONLY 99% SENSITIVE, YOU WILL MISS A NUMBER OF CASES. SO WE ARE LOOKING WHAT THE WILL BE THE OPTIMAL SEROLOGY. MIND YOU THAT IT IS NOT YET CLEAR WHETHER THERE IS ANY LEVEL OF UNITY THROUGH THIS VIRUS. THE TRAJECTORY OF CORONA VIRUS IMPLIES THAT THERE IS SOME PARTIAL IMMUNITY THAT MAY LAST SEVERAL YEARS. THAT'S THE MOST OPTIMISTIC PERSPECTIVE. IT MAY NOT BE AS POTENT IN IMMUNITY AS YOU GET LIFELONG IMMUNITY FROM HAVING A NATURAL INFECTION WITH LET'S SAY MEASLES VIRUS. IT WILL NOT BE AS TRANSIENT OR PARTIAL AS WHAT WE SEE IN THE EXPERIENCE WITH INFLUENZA. WE JUST DON'T KNOW YET. AND THIS HAS TO BE INVESTIGATED RIGOROUSLY. THERE IS ALSO FUNDING HAS BEEN MADE AVAILABLE TO THE OFFICE OF THE DIRECTOR OF A BILLION DOLLARS IN THAT BILL. THIS IS ALREADY APPROPRIATED FUNDS. AND NIH LEADERSHIP HAS MADE THE INITIAL DECISION TO ALLOCATE A SIGNIFICANT PROPORTION TO COMMUNITY-BASED INTERVENTIONS FOR DEMONSTRATION PROJECTS, PROMOTE TESTING IN UNDERSERVED COMMUNITIES AND SPECIAL ANALYSIS ON HEALTH DISPARITY AND OTHER VOLATILE POPULATIONS. I SHOULD HAVE SAID AT THE BEGINNING THAT ALL OF THIS APPROPRIATIONS FROM CONGRESS ON APRIL 24 WAS FOR TESTING. EVERYTHING AND ANYTHING NIH DOES WITH THESE FUNDINGS, THE SUPPLEMENTAL FUNDS ARE FOR TESTS ONLY. NIMHD IN A PARTNERSHIP WITH NATIONAL INSTITUTE ON AGING IN THE OFFICE OF THE DIRECTOR, WILL LEAD THIS EFFORT, COORDINATED EFFORT, FROM NIH AND SO BE ON THE LOOKOUT FOR WHAT WE WILL BE PUBLISHING ON THIS OVER THE NEXT FEW WEEKS. THERE IS ALSO FUNDING THAT WILL BE AVAILABLE FOR SUPPORTING ALTERNATIVES TESTING STRATEGIES. THIS IS BROADLY ACROSS NIH. THE IDEA HERE IS TO THINK ABOUT OTHER WAYS OF DIAGNOSING COVID-19 THAT MAY NOT REQUIRE NUCLEIC ACID TEST, FOR EXAMPLE. OR OTHER APPROACH THAT IS DON'T REQUIRE OR AREN'T FIXOD INDIVIDUALCOLOGICAL SAMPLES. AND THERE IS FUNDING THAT HAS BEEN PENCILED IN FOR THE DATA SCIENCE SUPPORT OF ALL THESE EFFORTS. NEXT SLIDE, PLEASE. THE IMPACT ON MINORITY HEALTH AND HEALTH DISPARITIES IS SOMETHING THAT EARLY ON TOOK NOTE OF FOR THE INITIAL REPORTS OF ACCESS MORTALITY WERE PUBLISHED. PART OF OUR BRAINSTORMING PROCESS OF SCIENCE AROUND COVID-19 AND NI PH.D. OTHER INSTITUTES, THINKING ABOUT BEHAVIORAL HEALTH, SOCIAL DETERMINANTS, ECONOMIC DISRUPTION, AND IMPACT ON NOT JUST HEALTH DISPARITY POPULATIONS BUT ANY OTHER VULNERABLE POPULATIONS, SUCH AS OLDER ADULTS AND PEOPLE WITH CHRONIC DISEASES AND OTHER GROUPS OR PERSONS WHO ARE FRONT-LINE WORK SITUATIONS WHERE THEY ARE HIGHER EXPOSURE. OUR SCIENTIFIC STAFF REALLY JUMPED AT THE OPPORTUNITY TO DRAFT A NOTICE OF INTEREST THAT IS PUBLISHED. THE LINK IS AT THE BOTTOM OF THE SLIDE. WE ARE SOLICITING RESEARCH WITH SPREADING POPULATIONS THAT SEEK TO REALLY UNDERSTAND HOW CURRENT POLICIES ARE AFFECTING THESE POPULATIONS. THE ROLE AT THE COMMUNITY LEVEL PROTECTIVE AND RESILIENCE FACTORS HAVE, HOW THE INTERVENTIONS TO GREAT PHYSICAL DISTANCING OR MITIGATING THE PANDEMIC HAVE AFFECTED MINORITY HEALTH AND HEALTH DISPARITY AND AS A RESULT, COVID-19 OUTBREAK OR THE DIRECT EFFECTS OF THE PANDEMIC. THESE VERY BROADLY -- VARY BROADLY ACROSS THE COUNTRY WITH SOME COMMUNITIES BEING SERIOUSLY AFFECTED AND OTHERS MODERATELY BUT ALL, THE WHOLE COUNTRY IS AFFECTED AND ALL THE POPULATIONS, HEALTH DISPARITY POPULATIONS ARE AFFECTED. AND BEHAVIORAL AND OTHER BIOLOGICAL MECHANISMS THAT MAY CONTRIBUTE TO DIFFERENT MANIFESTATIONS. NEXT SLIDE. JUST YESTERDAY, LED BY MONICA WEB COOPER AND OTHERS, WE PUBLISHED A VIEWPOINT IN JAMA TO EXPRESS OUR PERSPECTIVES ON THIS REGARDING THE IMPACT ON MINORITY HEALTH AND HEALTH DISPARITIES. IT OF COURSE IS ALREADY OUTDATED. YOU NEED TO UPDATE THESE INFORMATION ALMOST ON A DAILY BASIS, BUT WE TRY TO REPRESENT THE UNDERLYING CAUSES OF THIS BURDEN RELATED TO EITHER LONGSTANDING EXISTING DISPARITIES AND THIS PANDEMIC IS REALLY PUT A SPOTLIGHT ON THE DISPARITIES IN OUR COUNTRY. IT'S ALSO WELL RECOGNIZED HIGHER RATE OF CERTAIN CO-MORBIDITY ADDITION, OBESITY AND DIABETES ARE TWO OF THE LEADING ONES THAT LEAD TO WORSE OUTCOMES WITH SEVERE COVID AND THOSE ARE BOTH MORE COMMON IN ALMOST EVERY MINORITY GROUP THAT HAS BEEN EXAMINED IN POOR PEOPLE EVERYWHERE AND IN RURAL POPULATIONS AS WELL. SO THIS IS A CONSISTENT FACTOR IN MANY OF THESE CO-MORBIDITIES. HYPERTENSION, OR CARDIOVASCULAR CONDITIONS, CHRONIC LUNG DISEASE, AND THEN OTHER IMMUNE MODIFYING CONDITIONS RELATED TO CANCER. INFLAMMATORY CONDITIONS OR HIV. THERE IS AN IMPERATIVE NEED FOR PREVENTION AND HEALTH CARE STRATEGIES ALIGN WITH THESE COMMUNITIES AND TO ADDRESS THIS PANDEMIC AND THE MITIGATION THEATERS HAVE REALLY ALSO UNCOVERED INEQUALITIES. THE HIGHEST RATE OF UNEMPLOYMENT SINCE THE GREAT DEPRESSION HAVE BEEN REPORTED AS OF FRIDAY. LATINOS ARE NUMBER 1 IN UNEMPLOYMENT OF THE GROUPS THAT ARE REPORTED BY RACE, ETHNICITY. LIGHTS AND AFRICAN-AMERICANS ARE ALSO UP 14% AND THIS WILL ONLY GET WORSE IN THE NEXT MONTH. THIS IS A RAPIDLY-EVOLVING SITUATION MANAGING INTERNALLY. WE HAVE PUT A NUMBER OF RESOURCES ON THE NIMHD INTRANET. NIH IS ALSO MAINTAINING AN UP-TO-DATE INTERNET WITH ADVICE,RIA SOURCES, HOW TO DEAL WITH SYMPTOMS OR HOW TO GET TESTED. YOU ARE AN NIH STAFF MEMBER AND CONSIDER TO BE TESTED IN WHO YOU CALL AND ALSO A PULSE ON THE CASES AT NIH AND WHAT THE POLICIES ARE. EVERYONE IS WORKING HARD AND THE ISSUE OF RETURNING TO THE PHYSICAL WORKSPACE IS PARTICULARLY RELEVANT FOR PARTS OF THE NIH STAFF. AND ON THE EXTRAMURAL SIDE, WE ARE ALSO AWAITING FOR FURTHER GUIDANCE OTHER THAN WHAT HAS ALREADY BEEN PUBLISHED THROUGH THE LINK. WE DO NOT HAVE ANY NEW INFORMATION ON THIS TOPIC TODAY. NEXT SLIDE. NEXT SLIDE. SO LET ME TURN TO A NON-COVID ISSUE FOR A FEW MINUTES. I WANT TO CELEBRATE THE ARRIVAL OF OUR NEW DEPUTY DIRECTOR, MONICA WEBER. I ANNOUNCED THIS EARLIER IN THE FEBRUARY COUNCIL WHEN ERVING WAS ALREADY SET. LITTLE DID WE KNOW -- EVERYTHING WAS ALREADY SET -- HER FIRST TWO MONTHS AT NIH WOULD BE IN CLEVELAND, WHICH WE WERE EXPECTING, BUT IT WOULD ALL BE VIRTUAL. IT HAS BEEN UNUSUAL TO SAY THE LEAST, BUT I'M EXTREMELY PLEASED THAT MONICA HAS JOINED US AS A LEADER AND A SCIENTIST TO HELP WITH NUMEROUS TESTS THAT NEED OVERSEEING AND ROLL UP YOUR SLEEVES AND GET TO WORK AND SHE HAS BEEN COMPLETELY IN THAT SPIRIT. SO WE DID A NICE, SMALL, TOURING CEREMONYO MARCH 16. WE PROMISE WHEN WE WOULD BE ABLE TO HAVE A GROUP GET-TOGETHER AND IN-PERSON, WE WOULD DO SOMETHING ELSE AGAIN WITH A LARGER GROUP. AND WE HAVEN'T FORGOTTEN, MONICA. SO WE'LL GET TO THAT. NEXT SLIDE. WE SUCCESSFULLY ONBOARDED -- A WEEK OR SOING WHAT HAD A BABY. SO I'M NOT SURE THAT SHE IS GOING TO BE ABLE TO LISTEN? TODAY. WE ARE DELIGHTED SHE JOINED US. SHE CAME OVER FROM HRSA AND OUR ADMINISTRATIVE STAFF DID A WONDERFUL JOB IN GETTING HER ONBOARDED AND BADGED. SHE HAD TO PHYSICALLY COME TO CAMPUS TO GET HER BADGE. AND ONE OF THE IMPORTANT POINTS WAS THAT I SAID, PARK IN MY PARKING SPOT IT'S THE FIRST ONE IN BUILDING 31. AND OUR EXECUTIVE OFFICER MADE THE ARRANGEMENTS FOR HER TO BE SEEN THAT FIRST MORNING. SO, WE WANT TO WELCOME DEBORAH AND HOPEFULLY YOU'LL MEET HER AT OUR NEXT COUNCIL MEETING. I'M ALSO SAD TO ANNOUNCE THAT NANCY DAVIS LEFT TO GO TO NIDA, A BIGGER JOB. SHE WAS A WONDERFUL BUDGET OFFICER. -- HE LEFT THE OFFICE IN GOOD HANDS WITH KEN SERVING AS ACTING BUDGET OFFICER AS WE HAVE PURSUED OUR SEARCH AND HOPEFULLY WILL BE ABLE TO MAKE A DECISION. I HAVE THE SELECTION IN THE NEXT 12 WEEKS OR SO. WE CONTINUE TO SEARCH FOR STAFF IN THE CLINICAL HEALTH SERVICES RESEARCH DIVISION MEDICAL OFFICERS, HEALTH SCIENCE ADMINISTRATORS AND POPULATION SCIENCE AND HEALTH SERVICES RESEARCH AS WELL AS A DIRECTOR OF THE REVIEW OFFICE AS DR. TOM MOVED TO BECOME DIRECTOR OF EXTRAMURAL ADMINISTRATION. NEXT SLIDE. WE ALSO CELEBRATED ON MARCH 3, OUR 10th ANNIVERSARY. IT MAY HAVE BEEN JUST IN THE NICK OF TIME FOR THAT KIND OF ACTIVITY. I WANT TO ESPECIALLY THANK GREG TOL VARIA FOR COMING FROM THE WEST COAST AND PHIL FOR DRIVING UP, OR DOWN, TO COME AND SPEND THE DAY WITH US AND DR. MANSON PRESENTED AND I THINK DR. STAN SKI'S GROUP. THE UNIVERSITY WAS GREAT. IT WAS A BIT ON THE LONG SIDE FOR THE DAY BUT IT WAS PACKED WITH GREAT SCIENCE, GREAT QUESTIONS. DR. COLLINS MADE AN INTRODUCTION, COMMENTS AND DR. SULLIVAN WAS ORIGINALLY GOING TO DO A KEY-NOTE OPENING SPEECH. WAS NOT ABLE TO ATTEND DUE TO AN ILLNESS, ALTHOUGH WE SUBSEQUENTLY LEARNED HE WAS FINE AND WELL. HE RECOVERED. I GAVE A KEYNOTE TALK AND MADE SOME VERY GOOD COMMENTS ABOUT NIMHD AND MOVING FORWARD. SO, WE HAD MANDATORY TELEWORK START ON MARCH 16 AND 17. SO IN REALITY, THIS WAS OUR LAST BIG EVENT AND WE HAVE SUSPENDED OUR TENTH ANNIVERSARY ACTIVITIES FOR THE YEAR, ESSENTIALLY, GIVEN THE UNCERTAINTY OF WHAT WILL PROGRESS OR WHAT WOULD HAVE BEEN MINORITY HEALTH MONTH OR WAS MINORITY HEALTH MONTH. WE NORMALLY HAVE A 5K AND ALL KINDS OF ACTIVITIES THAT HAVE BEEN SET ASIDE AND WILL HAVE TO COVER OR RECOUP AT ANOTHER POINT. THESE ARE PHOTOS FROM THE EVENT. YOU CAN SEE THE DIFFERENT ASPECTS OF THE EVENT THE SCIENCE PANELS ORGANIZED AROUND OUR THEMES INCLUDING INTRAMURAL RESEARCHERS. THERE WERE ATTENDEES AND ACTIVE SOCIAL MEDIA. NEXT SLIDE. OVER THE COURSE OF THESE MONTHS HAVE BEEN ACTIVE IN A VARIETY OF THINGS. WE HAVE DONE A FEW INTERVIEWS, NATIONAL GEOGRAPHIC, VOICE OF AMERICA, THE ZOOM INTERVIEW TOPIC. I WATCHED THAT T CAME OUT PRETTY WELL. DEB GRANT AND I DID A CLASS, STATISTICS IN AN UNDERSERVED HIGH SCHOOL IN GEORGIA. DON'T ASK ME HOW THEY FOUND ME BUT THEY DID AND I THOUGHT IT WAS PRETTY COOL THING TO DO. FOCUS ON STATISTICS WAS HOW DO YOU MAKE DECISIONS FOR POLICY BASED ON STATISTICS? WE HAD GREAT QUESTIONS. I ENJOYED IT. AND WE DID IT THROUGH ZOOM. AND I SALUTE THOSE TEACHERS WHO WERE ENTREPRENEURIAL IN SEEKING US OUT AND GETTING US ENGAGED IN THAT ACTIVITY. THERE ARE A COUPLE OF OTHER INTERVIEWS PENDING. FRANCIS COLLINS ASKED ME TO DO ONE OF HIS HOME VIDEOS. SO FRANCIS HAS BEEN DOING WEEKLY E-MAILS TO ALL NIH STAFF RADIO HE SUMMARIZES THEP DATES AND SHARES CONCERNS, ACKNOWLEDGES ISSUES WE ARE ALL EXPERIENCING AND HAS HAD A VIDEO TO SHARE WITH STAFF, INITIALLY IT WAS SORT OF UPDATE ON COVID-19. HE HAD ISSUES ON WORKPLACE, CLINICAL CENTER ISSUES, HR ISSUES. JOSH GORDON TALKED ABOUT STRESS AND MANAGING STRESS AND THEN HE ASKED ME TO DO ONE ON MINORITY HEALTH HEALTH DISPARITIES AND HOW THIS IS AFFECTED COVID-19 AFFECTED OUTER COMMUNITIES. SO THAT WAS OCCUPY FRIDAY. I THOUGHT IT WAS INTERNAL NIH. I GUESS IT IS ACCESSIBLE TO THE GENERAL COMMUNITY. MY LAST TRICK WAS TO THE LATINO CANCER SCIENCE CONFERENCE. WHEN I WAS THERE ON FEBRUARY 27. -- ALSO ATTENDED AND PRESENTED A NUMBER OF -- IN THE CANCER DISPARITIES WORLD MY POST LACK HAD A POSTER AND DOUG LOWY AND BOB CROW FROM NCI WERE ALSO THERE. I THINK THAT WAS IT FOR ME, ALTHOUGH THE FOLLOWING WEEK NIH STAFF WERE STILL TRAVELING. AND I ALSO DID A WEBINAR FOR THE NATIONAL HEALTH IT FOR THE UNDERSERVED ON APRIL 8. NEXT SLIDE. THIS IS OUR BUDGET. JUST TO REMIND THE COMMUNITY OF WHERE WE ARE. IT'S ABOUT 20% INCREASE OVER THESE FIVE YEARS, PARALLEL TO WHAT THE ENOUGH HAS BEEN RECEIVING IN INCREASING -- NIH -- INCREASING ALLOCATIONS IN CONGRESS. IN FISCAL YEAR 20 WE GOT EXTRA FUNDING FOR RCMI SO OUR INCREASE WAS GREATER THAN THE AVERAGE NIH INSTITUTE INCREASE. ABOUT 50% OF THE INCREASES NIH HAS BEEN GETTING OVER THIS PERIOD OF TIME PRE ALLOCATED TO SPECIFIC PROGRAMS AND THE VEST SORT OF GENERALIZE INCREASE FOR THE AGENCY THAT IS DISTRIBUTED PROPORTIONAL TO YOUR BUDGET AS AN INSTITUTE OR CENTER. NEXT SLIDE. THIS IS OUR EXTRAMURAL FUNDING TREND. SO WHAT DIFFERENT TIMES A YEAR WE FUND COMPETING RESEARCH GRANTS. NEXT SLIDE. THIS IS A GRAPHIC TO ILLUSTRATE GROWTH AREAS IN OUR INSTITUTE. RCMI WAS SPECIFIC WITH CONGRESSIONAL INCREASES. OUR RESEARCH RO1 POOL BEING INCREASED IN OTHER RPGs AND THEN INTRAMURAL AS WELL. AND THEN OUR CONTRACTS HAVE ALSO INCREASED SLIGHTLY. NEXT SLIDE. SOME PHOTOS ABOUT NIMHD. THIS WAS THE CHILDREN'S IN THE CONGRESSIONAL NETWORKING RECEPTION ON FEBRUARY 11. IT'S A VERY NICE EVENT THAT NIH PARTICIPATES IN. A NUMBER OF DIRECTORS ATTEND IN THE UPPER RIGHT IN THE LAST ROW NEXT TO THE TALLER BRUCE TROMBERG WHO YOU'LL MEET SHORTLY, AND A NUMBER OF OTHER DIRECTORS ARE PRESENT. IT'S GENERALLY A GOOD ACTIVITY. IT GIVES US AN OPPORTUNITY TO INTERACTIN FORMERLY WITH CONGRSSIONAL STAFF AND REPRESENTATIVES AND SENATORS IF THEY ATTEND. SOME WERE PRESENT, PARTICULARLY I APPROACHED THE KEYNOTE SPEAKER WHO ERAN RAMSEY, HAD BEEN A PATIENT IN THE CLINICAL CENTER AT THE CHILDREN'S INN. HE RECEIVED A BONE MARROW TRANSPLANT FOR SICKLE CELL AND HE IS ORIGINALLY FROM SO HE GAVE A VERY INSPIRING TALK ABOUT HIS PERSONAL TRAJECTORY AND I WENT AHEAD AND TALKED TO HIM A LITTLE BIT AFTER WE WERE MORE SOCIALLY INTERACTING WHEN WE COULD DO THAT. NEXT SLIDE. ON MARCH 5, I MET WITH REPRESENTATIVE BRIAN HIGGINS FROM THE BUFFALO AREA IN UPSTATE NEW YORK. THIS WAS A MEETING ORCHESTRATED BY THE STATE UNIVERSITY OF NEW YORK CTSA, LED BY DR. TIMOTHY MURPHY AND HE IS PICTURED THERE NEXT TO ME. HE BROUGHT ALONG HIS COMMUNITY ENGAGEMENT PASTOR KINSER POINTER FROM BUFFALO. WE SPENT OVER AN HOUR IN THE REPRESENTATIVE'S OFFICE. IT WAS ACTUALLY A VERY FLUID CONVERSATION ABOUT ISSUES, BOTH NIMHD PRIORITIES AND FUNDING, WHAT OUR CENTERS DO, TYPICAL KIND OF THING ONE MIGHT EXPECT. YOU CAN ALSO DISCUSS THE REALITY OF MINORITIES IN BUFFALO AND WHAT WERE THE MAIN CONCERNS OF THIS CONGRESSIONAL MEMBER. HE SEEMED TO HAVE A FAIRLY NUANCED UNDERSTANDING OF THESE ISSUES THAT WOULD BE AN ADVOCATE FOR THE ISSUES, THE TOPICS THAT NIMHD IS MOST CONCERNED ABOUT. NEXT SLIDE. OTHER UPDATES ON THE LEGISLATIVE FRONT ON THE DAY OF THE CHILDREN'S INN I MET WITH A REPRESENTATIVE WHO IS ALSO AN INTERNIST AND REPRESENTATIVE FROM THE SACRAMENTO AREA NOW FOR A LITTLE OVER 10 YEARS TO TALK ABOUT NIMHD. AND EXPANSION OF OUR CLINICAL AND HEALTH SERVICES RESEARCH AS WELL AS WE TALKED ABOUT INTERNAL MORTALITY ISSUES. ON FEBRUARY 21, I MET WITH THE SENATE APPROPRIATIONS SUB-COMMITTEE ON LABOR HHS EDGATION AND RELATED AGENCIES. THESE WERE THE STAFF OF THE CLERK. THEY VISITED NIH, ASKED TO MEET WITH CERTAIN NUMBER OF INSTITUTE DIRECTORS AND WE WERE FORTUNATE, I ASSUME, TO BE ON THAT LIST. WE TALKED ABOUT -- MET WITH THEM TWO YEARS EARLIER. IT WAS A VERY POSITIVE MEETING. THIS ALSO WAS A VERY POSITIVE MEETING. THEY HAD SOME QUESTIONS. WANTED CLARIFICATIONS ON IT AND WE WERE ABLE TO UPDATE THEM ON OUR PROGRAMS OF GREATEST INTEREST TO THEM AS WELL AS THOSE THAT WE HAD ABOUT. ON MARCH 5, I MET WITH REPRESENTATIVE JUDY CHU'S STAFF TO DISCUSS HEALTH DISPARITIES AND THEN ON MAY ONE, JUST 10 DAYS AGO, DR. COLLINS AND DR. TABAK HAD A BRIEFING WITH THE CONGRESSIONAL BLACK CAUCUS ON THEIR REQUEST. IT WAS LATE ON A FRIDAY AFTERNOON. FRANCIS REALLY CARRIED THIS BUT HE DID ASK ME TO SAY A FEW WORDS AT THE BEGINNING AND THEN I SUBMITTED IN ANSWERING QUESTIONS AND DR. TABAK ALSO JOINED IN AND RESPONDED TO QUESTIONS. THERE WERE FIVE CONGRESSIONAL MEMBERS FROM THE CAUCUS PRESENT. ROBIN KELLIE WAS THE CHAIR OF THE HEALTH BRAIN TRUST AND MODERATED THE MEETING. IT WAS VERY, VERY SUPPORTIVE OF NIH AND ACKNOWLEDGING ALL OF OUR EFFORTS IN TRYING TO ADDRESS THE ISSUES OF MINORITY HEALTH AND HEALTH DISPARITIES IN THIS EFFORT. NEXT SLIDE. THIS WAS ABOUT DIABETES IN AMERICA. PUBLIC BROADCASTING STATION SPECIAL ABOUT THE RISE OF DIABETES IN THE U.S. EPIDEMIC WE HAVE BEEN TRACKING, IN THIS CASE, FOR ALMOST 40 YEARS AS OPPOSED TO FOUR MONTHS IN THE COVID EXAMPLE T FEATURED AN NIMHD-FUNDED RESEARCHER WHO POINTS TO THE LOSS OF CULTURES AS A CONTRIBUTOR, THE HIGH RATE OF DIABETES AMONG AMERICAN INDIANS AND ALASKA NATIVES AND IT PREMIERED ON APRIL 15. NEXT SLIDE. OUR NATIONAL MINORITY HEALTH MONTH ACTIVITIES WERE PUT TO THE SIDE BUT VIRTUAL PLATFORMS ARE THERE SO WE LAUNCHED A HEALTHY BINGO CHALLENGE, WHICH WAS VERY POPULAR CONSIDERING ALL 3500 BUSINESSES TO THE WEB PAGE AND ALMOST 1500 BINGO CARDS WERE DOWNLOADED. AND ALMOST TWO MILLION POTENTIAL IMPRESSIONS FOR SOCIAL MEDIA. SO, I THINK OUR COMMUNICATION STAFF ARE CREATIVELY LOOKING FOR WAYS TO CONTINUE TO CONNECT US WITH OUR COMMUNITY. NEXT SLIDE. MATERNAL MORTALITY AND MORBIDITY IS EMBARRASSINGLY A BIG PROBLEM IN THE UNITED STATES. TO PUT IT IN CONTEXT, U.S. LOSES 13,000 WITHIN A YEAR OF DELIVERY DELIVERY. COUNTRIES SUCH AS GREECE OR FINLAND IN EUROPE, HAVE A CASE FATALITY RATE OF 300,000. THERE MAY BE SOME REASON WHY OURS MAY BE A BIT HIGHER BUT BEING FOUR TIMES HIGHER IS INEXCUSABLE. IN THE UNITED STATES YOU LOOK AT THE MORTALITY RATE FOR AFRICAN-AMERICAN WOMEN AND AMERICAN INDIAN ALASKA NATIVE WOMEN, THEY VARY FROM TWO TO 4 TIMES HIGHER. AND ALL MINORITY WOMEN THAT WE HAVE DATA FOR HAVE HIGHER SEVERE MORBIDITY RELATED TO GIVING BIRTH. SO THIS IS A TOPIC THAT NIMHD HAS EMBRACED WITH BIGGER AND INTELLECTUAL ENERGY AND PASSION. WE HAVE AN RFA OUT, APPLICATIONS ARE DUE TOWARDS THE END OF THIS MONTH, AND WE LOOK FORWAR TO BEGINNING TO INVEST MORE IN ADDRESSING NOT JUST WHAT THE FACTORS ARE THAT CONTRIBUTE TO THIS, BUT ALSO TO INTERVENE TO REDUCE AND ELIMINATE DISPARITIES WHERE POSSIBLE. NEXT SLIDE. THERE ARE ALSO INTERESTED IN DEVELOPING MORE EMPHASIS ON RURAL HEALTH. RURAL POPULATIONS IN THE U.S. CONSTITUTE ABOUT 18% OF THE TOTAL POPULATION AND ABOUT 6% OF AMERICANS LIVE IN VERY, VERY RURAL ENVIRONMENTS. AS DEFINED BY THE DEPARTMENT OF CULTURE AND ADAPTED BY THE CDC, 18% OF THE U.S. POPULATION THAT IS NOT IN URBAN OR SUBURBAN OR EXURBAN SETTING. WE HAVE LAUNCHED THIS REQUEST FOR SUPPLEMENTS TO OUR CURRENT CENTER TO CREATE HUBS FOR RESEARCH AS WE BEGIN TO DEVELOP MORE CAPACITY IN RURAL HEALTH. THIS WAS ALL DONE BEFORE COVID-19 BECAME DOMINANT ISSUE OF THE DAY. BUT WE EXPECT THAT THIS IS A BEGINNING OF A PROGRAM THAT CAN SERVE A LARGER INITIATIVE AND WE HAVE BEEN IN COMMUNICATION WITH THE HHS AS WELL ON THIS TOPIC. NEXT SLIDE. THERE WAS A WORKSHOP ON THE CONSEQUENCES OF SLEEP HEALTH DISPARITIES THAT WAS WRITTEN UP AS A PAPER. FIRST OFF IT WAS -- NIMHD INVESTIGATOR ENVIRONMENTAL HEALTH. NANCY JONES AND RENA DOSS WORKED DILIGENTLY TO WRITE THIS UP, PACKAGE IT UP AND SUBMIT IT. IT IS NOW ACCEPTED FOR PUBLICATION. AND THIS IS A SUMMARY OF THE WORKSHOP OF PROCEEDINGS. SO VERY PROUD OF THAT EFFORT AS THEY CONTINUE TO HAVE A PROGRAM IN RESEARCH ON THIS TOPIC AS WE EXPECT NEW APPLICATIONS TO COME IN OVER THE NEXT THREE YEARS. NEXT SLIDE. THE COMMON DATA ELEMENTS FOR SOCIAL DETERMINANTS OF HEALTH HAS COMPLETED ITS FIRST [ INAUDIBLE ] WE ARE JUST COMPLETING THE FIRST PHASE. IT'S A TOOLBOX MEASUREMENT OF SOCIAL DETERMINANTS. IT HAS BEEN WELL OVER A YEAR PROCESS OF WORK WITH AN EXTERNAL EXPERTS. INTERNAL NIH-WIDE COMMITTEE AND CONTINUED LEADERSHIP FROM NIMHD STAFF. WE HAVE AGREED ON THE SET OF BASIC MEASURES THAT ARE FOCUSED PRIMARILY, INITIALLY ON THE BASIC STANDARDIZED MEASURES OF DETERMINANTS BUT ALSO ON SOCIAL DETERMINANTS AND THEN INDIVIDUAL AS WELL AS STRUCTURAL DETERMINANTS OF HEALTH. AND WE WILL NOW BE CONTINUING TO WORK ON THIS. THERE ARE AT LEAST A DOZEN CONSTRUCTS THAT DO NOT GET CAPTURED. THERE ARE OTHERS THAT HAD NUMEROUS MEASURES ON THAT HAVE NOT BEEN SUBMITTED THROUGH THIS PROCESS THAT REQUIRE MORE OF A SPECIALTY FOCUS. WE WILL BE LINKING OUR FUNDING OPPORTUNITY ANNOUNCEMENTS ENCOURAGING OUR GRANTEES AT NIMHD TO USE THESE MEASURES AS WELL AS WORKING WITH OTHERS AT NIH TO ACHIEVE SOME LEVEL OF HARMONIZATION ON SELF-REPORTED MEASURES THAT WE ARE MOST FOCUSED ON RELATED TO THE FACTORS THAT INFLUENCE HEALTH FROM A MINORITY HEALTH HEALTH DISPARITIES PERSPECTIVE, AS WELL AS MEASURING THE STRUCTURAL DETERMINANTS OF HEALTH. SO I ENCOURAGE YOU TO VISIT OUR WEBSITE. CERTAINLY PROVIDE US FEEDBACK. THIS IS GOING TO BE A LIVING DOCUMENT AND WE EXPECT TO CONTINUE TO WORK ON THIS AS WE HAVE FORMED AN INTERNAL NIMHD WORK GROUP TO CARE THE WORK ON IN COLLABORATION WITH THE NIH-WIDE GROUP. NEXT SLIDE. THE PRECISION MEDICINE OR HEALTH DISPARITIES CENTERS PUBLISHED A SPECIAL ISSUE ON ETHNICITY AND DISEASE. WE PUBLISHED A FORWARD AND, ASKED ME TO CO-AUTHOR IT WITH THEM AND THERE ARE A NUMBER OF INTERESTING AND IMPORTANT ARTICLES THERE FROM THE FIVE CENTERS THAT ARE CURRENTLY FUNDED. NEXT SLIDE. SO A FEW HIGHLIGHTS OF SCIENCE FROM OUR GRANTEES AND INTRAMURAL. I'LL SHARE WITH YOU HERE. THIS IS A STUDY HEALTH SERVICES RESEARCH ON FOCUS ON EMERGENCY DEPARTMENTAL -- EMERGENCY DEPARTMENT DENTAL VISITS AFTER MEDICAID EXPANSION AND GET INCREASING EVIDENCE OF THE BENEFIT IN ADDRESSING ISSUES IN MINORITY HEALTH AND IN DECREASING HEALTH DISPARITIES AS A CONSEQUENCE OF THE MEDICAID EXPANSION THAT BEGAN I IN 2013 AND CONTINUED, TO THIS DAY AS NOW TOTAL 38 STATES HAVE APPROVED IF NOT ALREADY IMPLEMENTED MEDICAID EXPANSION. THIS WAS BESIDES ANALYSIS BEFORE 2012 AND THEN AFTER 2014, USED 33 STATES AS THE DENOMINATOR AND SIGNIFICANTLY INCREASED MEDICAID COVERAGE AND DECREASED A RATE FOR SEVERAL PAY FOR ED DENTAL VISITS. AS PHYSICIANS OR AS A PHYSICIAN, I OFTEN FORGET ABOUT DENTAL CARE AND HOW THAT IS NOT COVERED BY REGULAR INSURANCE. IT WAS IN THE ORIGINAL MEDICARE PROPOSAL, INCLUDING, BUT DENTIST DID NOT WANT TO BE PART OF MEDICARE. THAT GOES BACK TO THE BEGINNING OF 1967-1968 WHEN MEDICARE AND MEDICAID WERE CRAFTED IN CONGRESSIONAL LEGISLATION. MANY EMPLOYERS OR SOME EMPLOYERS PROVIDE DENTAL INSURANCE. AND PREVENTIVE CARE IS CRITICAL IN DENTAL CARE. THERAPEUTIC CARE OR REPLACEMENT CARE IS MORE EXPENSIVE AND NOT WELL COVERED BY EVEN THE BEST INSURANCES BUT BE THAT AS IT MAY, IT IS A CRITICALLY-IMPORTANT PARTNER OF QUALITY OF LIFE AND IN PEOPLES OF AGE IS WHERE WE SEE THE BIGGEST IMPACTS. SO IN CHILDREN WITH POOR CARE, MULTIPLE CARRIES AND IN OLDER ADULTS, WHERE THEIR ABILITY TO CHEW AND GET ADEQUATE NUTRITION IS LIMITED. NEXT SLIDE. ACCESS TO EQUITABLE KIDNEY TRANSPLANTATION IS A PRODUCTIVE FOCUS OF THIS RESEARCH GROUP WE FUNDED FOR SOME TIME. THE ISSUE OF ESRD PATIENTS AND WHAT TRANSPLANT MEANS, THERE ARE A LOT OF CRITICAL ISSUES IN THIS CLINICAL AREA. THE UNITED STATES HAS A PREDOMINATELY DOING DIALYSIS THROUGH CENTERS AS OPPOSED TO HOME DIALYSIS. FOR A NUMBER OF REASONS AND OF COURSE THE COVID PANDEMIC HAS MADE THAT MORE IMPORTANT GIVEN THAT YOU HAVE BEEN TO A DIALYSIS CENTER, YOU SEE HOW PATIENTS ARE LINED UP IN A NON-PHYSICALLY DISTANT SPACE TO SPEND 3-5 HOURS BEING DIALYZED. ON A CHRONIC BASIS, USUALLY THREE TIMES A WEEK. THE NUMBER WHO MAKE IT TO TRANSPLANT ARE CERTAINLY SIGNIFICANT BUT NOT ENOUGH THOSE WHO ARE POOR, HAVE POORER ACCESS TO TRANSPLANTATION AND THERE ARE A NUMBER OF STEPS THAT HAVE TO BE TAKEN TO GET TO A TRANSPLANT. THEY HAVE TO BE REFERRED BY A DIALYSIS DOCTOR AND YOU HAVE TO COMPLETE A BUNCH OF FORMS AND GO TO MULTIPLISTS AND GET MULTIPLE TESTS. OFTEN THROUGH A TRANSPLANT CENTER. SO IF YOU'RE NOT IN A TRANSPLANT CENTER TO BEGIN WITH, THAT MEANS TRAVEL AND DISTANCE. SO LOTS OF BARRIERS. AND WE DO NOT DO ANYTHING CLOSE TO FACILITATING THAT FOR THE MOST PART. AND SO, ESTABLISHING AFRICAN-AMERICANS WHO HAVE HIGHER RATE OF CHRONIC KIDNEY DISEASE, HIGHER RAID OF END-STAGE RENAL DISEASE, 37% LESS LIKELY TO BE REFERRED AND 24% LESS LIKELY TO RECEIVE A KIDNEY TRANSPLANT. THIS IS DERIVED FROM DIALYSIS FACILITY DATA THAT WAS IN 2014-2017, USING A SIGNIFICANT NUMBER OF THESE FACILITIES. NEXT SLIDE. GYNECOLOGICAL SURGERY IN WOMEN WITH BREAST CANCER HAS BEEN RECOMMENDED FOR PRE-MENOPAUSAL WOMEN AS BEING ASSOCIATED WITH SURVIVAL. THIS HAS NOT BEEN AS WELL STUDIED IN AFRICAN-AMERICAN WOMEN WHO WE KNOW HAVE A HIGHER RATE OF HYSTERECTOMY GLOBALLY, BUT ALSO HAVE MORE AGGRESSIVE AND TRIPLE NEGATIVE BREAST CANCER IN WOMEN AT A YOUNGER AGE. SO UNDER 50 IN THEIR PRE MENOPAUSAL AGE. IN THIS ANALYSIS, THE STUDY POPULATION, WOMEN DIAGNOSED WITH BREAST CANCER BETWEEN 20-74, WHO PARTICIPATED IN THE CAROLINA BREAST CANCER STUDY, AND WOMEN WHO HAD A HYSTERECTOMY WITH BILATERALO EFFECT ME WASN'T ASSOCIATED WITH SIMILAR REDUCTION AND YOU CAN SEE IN THE YELLOW HIGHLIGHT IN THE SLIDE PERHAPS, AFRICAN-AMERICAN WOMEN WERE MORE LIKELY TO HAVE BENEFIT IN THE ADJUSTED ANALYSIS FROM HAVING HYSTERECTOMY WITH OVARIAN CONSERVATION. YOU CAN ALSO FROM HAVING HYSTERECTOMY WITH BILATERAL OOPHORECTOMY COMPARED TO THEIR COUNTERPARTS IN A FAIRLY LARGE STUDY. NEXT SLIDE. THIS IS ON THE PA RENNIAL TOPIC OF -- THERE MAY BE SOME SIDE WAY COMPONENT I'D LIKE TO USE NOW IN ADAPTING UNDER VENTION BUT OFTEN IN ADAPTING AND CULTURALLY ADAPTING IT, IT DOES CHANGE. AND I THINK IT DOES HAVE IMPACT ON IMPLEMENTATION AND WILL IT BE RECEIVED. WE HAVE A VERY EFFICACIOUS INTERVENTION THAT PEOPLE DON'T RECEIVE AT ALL SO THE EFFECTIVENESS IS ZERO IN A SO THIS IS A CRITICAL STEP. OUR GRANTEES ARE VERY FAMILIAR WITH THIS. TO ADDRESS DIABETES IN NATIVE HAWAIIAN AND PACIFIC ISLANDER POPULATION HAVE GONES. HAV.ONE POPULATION IDENTIFIES AS THIS CONCENTRATION IN THE COUNTRY IN ADDITION TO HAWAII. BUT BEING A SMALL PROPORTION OFTEN FORGOTTEN AND WHEN WE TALK ABOUT HEALTH DISPARITIES AND PROFILES OF POPULATION HEALTH. CULTURALLY-ADAPTED DIABETES INTERVENTION DO SHOW A PROMISE IN ADDRESSING THESE DISPARITIES RELATED TO COMMUNITY-BASED PARTICIPATORY APPROACH. SPECIFIC SOCIAL DETERMINANTS OF HEALTH RELEVANT TO LOCAL POPULATIONS SUCH AS TRANSPORTATION AND ACCESS RECOGNIZING THE COLLECTIVIST CULTURE OF NATIVE AND PACIFIC ISLANDERS WHICH RESONATES WITH OTHER GROUPS AS WELL. AGAIN A THEME HERE BUT THEN THE SPECIFICS OF CONTENT THAT WILL MAKE THE BIGGEST DIFFERENCE. NEXT SLIDE. PSYCHOLOGICAL DISTRESS FROM PEOPLE WITH ALZHEIMER'S DISEASE RELATED DEMENTIAS AND LOOKING AT RACIAL ETHNIC DIFFERENCES, THIS IS A PAPER THAT LOOKED AT THE MEDICAL EXPENDITURE PANEL SURVEY IN 2007 TO EXAMINE THE ASSOCIATION BETWEEN THESE SELF-REPORTED SERIOUS DISTRESS IN RACE ETHNICITY IN ADULTS WITH ALZHEIMER'S DISEASE OR RELATED DEMENTIAS 65 YEARS OF AGE OR OLDER. LATINOS AND AFRICAN-AMERICANS AT HIGHER LEVELS OF STRESS COMPARED TO WHITES AND GIVEN POTENTIAL UNDER TREATMENT OF PSYCHIATRIC DISORDERS. I EMPHASIZE UNDER-TREATMENT ALTHOUGH THERE ARE SOME SUBTLE DIFFERENCES PERHAPS IN PREVALENCE OF DEPRESSION IN DIFFERENT RACE ETHNIC GROUPS BY-AND-LARGE MAJOR MENTAL HEALTH DISORDERS OR SEVERE DISORDERS, PREVALENCE RATES IN WELL-DONE CITIES HAVE NOT BEEN DIFFERED BY RACE ETHNICITY BUT THE ACCESS AND TREATMENT OF ANY KIND, NOT JUST BEHAVIORAL TREATMENT OR THERAPY BUT ALSO PHARMACOTHERAPY, ARE GROSSLY WORSE FOR ALL MINORITY GROUPS THAT HAVE BEEN STUDIED FOR A NUMBER OF OF FACTORS INCLUDING HEALTH INSURANCE AND PAY AS WELL AS LANGUAGE AND CULTURE. SO THIS IS AN AREA THAT I THINK HAS NOT -- RECEIVED SOME ATTENTION IN THE LITERATURE BUT IT CERTAINLY IS NOT AN AREA THAT WE HAVE RESOLVED BY ANY STRETCH OF THE IMAGINATION. SO NEED FOR BETTER TOOLS AND BETER WAYS TO MEASURE THIS ARE NEEDED AND IN THIS PARTICULAR CASE, WOO ALZHEIMER'S DISEASE, AN EPIDEMIC WE ARE ALL LIVING THROUGH AS WELL, AND FORGOTTEN THAT ACTUALLY PATIENTS WITH ALZHEIMER'S DISEASE PRESENT WITH OR APPEAR TO BE PRIMARILY PSYCHIATRIC SYMPTOMS. IN MY FORMER LIFE AS A CLINICIAN, I WAS REMINDED ONE TIME I REMEMBER BY ONE OF MY FRIENDLY CONSULTANTS THAT ALZHEIMER'S WAS A PSYCHIATRIST AND THAT HIS FIRST CASE WHEN HE DESCRIBED THE DISORDER, IT PRESENTED WITH PRIMARILY PSYCHIATRIC SYMPTOMS PREDOMINANTLY PARANOIA. SO NOT TO BE FORGOTTEN IN THIS INCREDIBLY IMPORTANT PROBLEM AFFECTING OUR COMMUNITIES. NEXT SLIDE. THIS STUDY FROM THE HISPANIC COMMUNITY HEALTH STUDY, STUDY OF LATINOS ON DIETARY PATTERNS AND ASTHMA. AND LOOKING MORE MECHANISTICALLY AT PRO-INFLAMMATORY DIET IN USING A DIETARY INFLAMMATORY INDEX RELATED TO QUALITY AND ALTERNATIVE HEALTHY EATING INDEX ASSOCIATE WITH THE ASTHMA. ISSUES OF BIOLOGICAL PLAUSIBILITY WOULD COME UP IN THESE KINDS OF OBSERVATIONAL STUDIES, PROBABLY MECHANISTICALLY THEY MAY SPECULATE RELATED TO CHANGES IN THE MICROBIOME AND OTHERS AFFECTING INFLAMMATION. ASTHMA IS A CHRONIC INFLAMMATORY LUNG DISEASE THAT HAS ACUTE EXACERBATIONS. THE GLAD ASTHMA IS JUST EPISODIC INTERMITTENT DISEASE IS INCORRECT, ALTHOUGH LIKE ANY OF THESE CHRONIC DISEASES, SEVERITY SPECTRUM IS QUITE BROAD FROM VERY MILD TO VERY SEVERE. IN THIS CASE, THE PARTICIPANTS OF PUERTO RICAN BACKGROUND HAVE SIGNIFICANTLY HIGHER INDEX OF DIETARY INFLAMMATORY INDEX AND LOWER MEAN ALTERNATIVE HEALTHY EATING INDEX IS ALSO WELL DESCRIBED FROM OTHER STUDIES THAT PUERTO RICANS AND LATINO BACKGROUND POPULATIONS HAVE HIGHER RATES OF ASTHMA COMPARED TO OTHERS. NEXT SLIDE. VITAMIN D AND CALCIUM AND SUN EXPOSURE, POTENTIALLY ASSOCIATED WITH RISK OF BREAST CANCER AMONG AFRICAN-AMERICAN WOMEN. LOTS OF LITERATURE ON VITAMIN D. SOME STUDIES POINTING ATTENTION TO POTENTIAL ANTI-TUMORGENIC PROPERTIES. MAINLY IN WHITE WOMEN. THIS STUDY INCLUDED A SIGNIFICANT SAMPLE OF AFRICAN-AMERICAN CASES, CONTROLS IN THE WOMEN'S CIRCLE OF HEALTH STUDY. DO I TERRY IN TAKE WAS ASSESSED USING THE STANDARD -- DIETARY INTAKE -- AND IN-PERSON INTERVIEWS AND SUPPLEMENTAL IMTAKE OF CALCIUM AND VITAMIN D AND SUNLIGHT. THIS MAY BE AN IMPORTANT OBSERVATION ALTHOUGH I THINK NEEDS TO BE SUBMITTED TO MORE RIGOROUS CLINICAL TRIAL-TYPE OF EVIDENCE GEFFEN THAT WE HAVE BEEN DOWN THIS PATH WITH VITAMIN D IN THE PAST ON SEVERAL OCCASIONS. AND NOT FOUND NECESSARILY IMPACTFUL CLINICAL OUTCOME EVENTS HAVE BEEN DECREASED, WEATHER CARDIOVASCULAR OR CANCER. NEXT SLIDE. THIS IS NOT NIMHD FUNDED. OUT OF MMWR JUST PUBLISHED A COUPLE OF MONTHS AGO. AND IT JUST TOOK A HIGHLIGHT OF COLORECTAL CANCER SCREENING TO REMIND US THAT COLORECTAL CANCER SCREENING IS ULTIMATELY PREVENTABLE. COLORECTAL CANCER IS PREVENTIBLE. THE STANDARD RECOMMENDATIONS OF ANNUAL FECAL BLOOD TESTING OR SOME SORT OF ENDOSCOPY EVERY 10 YEARS S PROVEN TO DECREASE THE MORTALITY FROM COLORECTAL CANCER FROM 20-30% BASED ON RANDOMIZED CLINICAL TRIALS. AND ENDED WITH VERY LIMITED DIVERSITY BUT I THINK THAT OBSERVATION HAS BEEN CONSISTENT IN OBSERVATIONAL STUDIES IN A NUMBER OF OTHER COUNTRIES. AND THE ISSUE TO REMEMBR IS, YOU DON'T NEED TO GET A COLONOSCOPY TO DO THIS. YOU CAN DO THIS WITH A TAKE HOME FECAL BLOOD TEST. Y RECEIVE IT IN THE MAIL, SEND IT BACK IN THE MAIL AND THEN GET YOUR RESULT AND YOU THEN SLEEKED OF UPON SELECT WHETHER YOU WANT DO A COLONOSCOPY. IT IS RECOMMENDED FOR ADULTS 50 50-75 BY THE TASK FORCE. THAT THE RATES ARE HIGHER FOR OLDER ADULTS SO 65, THAT MAY HAVE SOMETHING TO DO WITH MEDICARE. I ASSUME. WE CAN SEE THAT FOR WHITES AND BLACKS IN THAT AGE GROUP AND FOR YOUNGER AGE GROUP OF 50-64, THERE ARE NO DIFFERENCES. WE HAVE ESSENTIAL ELIMINATED THAT DISPARITY OF SCREENING. WE ARE NOT AT GOAL YET. WE WANT TO SEE EVERYBODY OVER 80% AS A GOAL, BUT IT IS REASSURING TO SEE THAT OVER YEARS, WE CAN MAKE PROGRESS IN SOME THINGS. LATINOS ARE LAGGING BEHIND AND PARTLY RELATED, TO ACCESS. THEY ARE THE MOST POORLY INSURED POPULATION GROUP IN THE UNITED STATES. THATEE WE HAVE DATA FOR. ASIANS AND PACIFIC ISLANDERS ARE LUMPED TOGETHER HERE UNFORTUNATELY AND YOU CAN SEE THE RATES FOR AMERICAN INDIAN AND ALASKA NATIVE LAG WAY BEHIND BEHIND. WELL BEHIND THE OTHER GROUPS EXCEPT FOR LATINOS. HOWEVER, THE MOST IMPORTANT FACTOR IS INSURANCE. SO IF YOU'RE NOT INSURED, YOU DON'T GET SCREENED. FOR THE MOST PART. AND THAT IS TRUE FOR 50-64 OR FOR THOSE WHO ARE 65 AND OVER. NEXT SLIDE. I'LL SPEND A FEW MINUTES TALKING ABOUT THE ACCOMPLISHMENTS OF THE DIVISION OF INTRAMURAL RESEARCH. FIRST NIH HAS A LARGE TRAINING PROGRAM FOR POSTBACS AND STUDENTS. IT'S REALLY A WONDERFUL PROGRAM. EVERY YEAR THERE IS A SESSION USUALLY HELD AT THE NATCHER CENTER WHERE ALL OF THE POSTBACS HAVE POSTERS AND IT'S REALLY REMARKABLE ENERGY THERE. THIS YEAR WAS CANCELED. THE SUMMER INTERNSHIP PROGRAM WAS CANCELED, DISAPPOINTING MANY, MANY YOUNG PEOPLE LOOKING FORWARD TO SPENDING A COUPLE OF MONTHS ON THE NIH CAMPUS OR IN NIH LABS. BUT THIS WAS DONE VIRTUALLY. I WAS ABLE TO SEE THE POSTBAC IN MY LAB PRESENT ON THAT TUESDAY. UNFORTUNATELY, I COULDN'T ATTEND THE NIMHD POSTBAC BUT I UNDERSTAND THEY DID A GREAT JOB PRESENTING T WORKED WELL WITH STRUCTURED TIME FOR PRESENTATION AND THEN QUESTIONS FROM THE PANEL THAT WAS LISTENING AS WELL AS IN THE AUDIENCE COULD CHIME IN AND SEND QUESTIONS VIA CHAT. SO BEING ABLE TO SUSTAIN THE CAREER DEVELOPMENT FOR THE YOUNG SCIENTISTS OF THE FUTURE IS CRITICAL FOR US. NEXT SLIDE. THIS IS A STUDY THAT CAME OUT OF CALVIN TROY'S LAB ON SECOND-HAND SMOKE EXPOSE AND YOU ARE SUBSEQUENT ACADEMIC PERFORMANCE IN U.S. YOUTH IN THE AMERICAN JOURNAL OF PREVENTIVE MEDICINE AND HOW THE LONGITUDINAL DATA FROM THE STUDY SHOWED THAT MEASURING ACTIVITY AND PERFORMS USING A 9 POINT SCALE, SECOND-HAND SMOKE EXPOSURE EXHIBITED A DOSE RESPONSE RELATIONSHIP WITH LOWER ACADEMIC PERFORMANCE. THIS IS LEVERAGING THE LONGITUDINAL NATURE OF THIS TEST AND SO I THINK IT CONTRIBUTES TO POTENTIAL CAUSAL PATHWAY POSSIBILITIES IN TERMS OF SMOKERS INFLUENCE THEIR SUBSEQUENT EDUCATIONAL ATTAINMENT AND LEADING THEM TO MORE ADVERSE SITUATIONS, PARTICULARLY TRUE FOR AFRICAN-AMERICAN OR YOUTH WHO CAME FROM LOW-INCOME FAMILIES. NEXT SLIDE. THIS IS WORK OUT OF ANNAPOLIS'S LAB. IT IS COMPLETING WORK SHE STARTED AT UCSF AND STRATEGIES TO OVERCOME BARRIERS TO BIOSPECIMEN DONATION IN ROLE LA TEEN'S BREAST CANCER SURVIVORS. AND ONE -- RURAL LATINA. ONE OF MANY IMPORTANT CONTRIBUTIONS IN TEARING DOWN THE IDEA THAT MINORITIES DON'T WANT TO PARTICIPATE IN THESE STUDIES. THEY DON'T WANT TO PROVIDE US WITH SAMPLES. THERE ARE ISSUES AND THERE ARE ISSUES IN SOME COMMUNITIES THAT ARE PARTICULAR TO THAT PARTICULAR COMMUNITY. I'M NOT SAYING THESE THINGS DON'T EXIST. BUT THE MAIN REASON THAT MINORITIES DON'T GET RECRUITED AND BECAUSE NOBODY ASKS. AND SO WHEN ONE GETS A GROUP THAT GOES OUT, ASKS, AND APPROPRIATELY COMMUNICATES WITH THE -- IN THIS CASE, PATIENTS, LATINA BREAST CANCER SURVIVORS, ONE IS ABLE TO DO THIS THROUGH THE TRUST THAT DEVELOPS WITH COMMUNITY HEALTH WORKERS AND INVESTIGATORS IN AN APPROPRIATE LANGUAGE CONCORDANCE. NEXT SLIDE. ELEVATED CORTISOL LEVELS AND ABNORMAL STRESS REACTIVITY IN THE SAME STUDY LOOKING AT THE EFFECTS OF STRESS AND CORTISOL. THIS IS AN AREA OF INCREASING EMPHASIS BY SCIENTISTS IN MINORITY HEALTH HEALTH DISPARITIES LOOKING AT THESE ADRENAL PITUITARY ACCESSORY SPONSOR OTHER MEASURES OF BIOLOGICAL REFLECTION OF CHRONIC STRESS, ACCUMULATIVE CHRONIC STRESS, AS WE LIKE TO EMPHASIZE RELATED TO EITHER ADVERSE EVENTS OCCURRING EITHER EARLY IN LIFE OR DURING ADULT AND INCLUDING THE CONCEPT OF CHRONIC DISCRIMINATION OR RACISM. NEXT SLIDE. AND THIS IS A STUDY FROM NIMHD INTRAMURAL INITIATED BY KEVIN WHEN HE WAS AT THE ACTING SCIENTIFIC DIRECTOR AND NABLUS TOOK IT OVER. IT'S LOOKING AT REGULAR GENE EXPRESSION LEVELS IN BREAST CANCER SURVIVAL BY RACE. NIMHD EMBARKED ON A INTRAMURAL PROJECT OF GENOTYPING TUMORS FROM PRIMARILY EITHER LATINO OR AFRICAN-AMERICAN CANCER PATIENTS FROM EXTRAMURAL INVESTIGATORS. WE CONTINUE TO WORK IN THAT AREA. IT IS -- WE PROVIDE THE WHOLE GENOME SEQUENCE IN THE MUTATIONS AND WE HAVE BEEN WORKING WITH THIS GROUP FOR ONE BUT ALSO OTHER COLLABORATORS ON THIS TOPIC, AND THIS WORK WILL CONTINUE AS AN AREA OF INTEREST FOR US TO DO THE DISCOVERY THROUGH THAT METHOD, GIVEN THAT LEFT TO THE COMMUNITY, THE SCIENTIFIC COMMUNITY THEY HAD NOT REALLY MET EXPECTATIONS OF WHAT WAS AVAILABLE FROM MINORITY CANCER PATIENTS IN DATABASE THAT IS WILL BE ACCESSIBLE TO INVESTIGATORS. SO, WE WILL CONTINUE THIS WORK. NEXT SLIDE. FINALLY, JUST SHARE WITH YOU THIS ANALYSIS, THIS CAME OUT OF SHERRINE'S LAB. I PARTICIPATED AND I'M NOT GOING TO GO INTO DETAIL OF ALL THE COMPLICATED METHODDED. YOU CAN LOOK AT THE AMERICAN JOURNAL OF PREVENTIVE MEDICINE. I BELIEVE IT'S ON LINE NOW. TWO MAKE TWO POINTS. THIS IS LOOKING AT THE NATIONAL YOUTH TOBACCO SURVEY FROM 1999 AND EVERY YEAR SINCE THEN TO 2019. AND I'LL SHOW THESE TWO SNIPPETS OF THE TWO YEARS. SO WHAT HAPPENED TO SMOKING AMONG YOUTH? AND TO ADD ANOTHER PERSPECTIVE, WHEN I STARTED DOING SMOKING WORK IN 1980S, 70% OF YOUTH EXPERIMENTED WITH SMOKING. SO ONLY ABOUT 30% WERE NEVER-SMOKERS. WE HAVE GONE FROM 30% TO 50% IN 1999 IN GENERAL, AND LOOK AT THE RACE DIFFERENCES IN A SECOND. BUT 80% IN 2018. SO THAT'S REMARKABLE PROGRESS. YOU CAN SAY THEY ARE ALL VAPING NOW BUT THAT IS SEPARATE AND IMPORTANT. NOT ALL BUT MANY ARE USING NICOTINE AND OTHER METHODS AND THE PROPORTION WHO EXPERIMENTED INCREASES YOUR EXPANSE OF BECOMING A CURRENT SMOKER. -- YOUR CHANCE. AND YOU CAN SEE SOME SUBTLE DIFFERENCES BY RACE ETHNICITY BUT NOT THAT MUCH AND THERE ARE MINIMAL GENDER DIFFERENCES AS WELL. WE ARE NOT SHOWING BY GENDER. WE ALWAYS SHOW SMOKING BEHAVIOR BY GENDER. FEWER ASIANS ARE TRYING SMOKING. SLIGHTLY MORE WHITES COMPARED TO LATINOS OR BLACKS AND HIGHER PROPORTION OF AMERICAN INDIANS THAT ARE ABLE TO BE SAMPLED IN THIS SURVEY. NEXT SLIDE. AND THE MESS ANNUAL IS THAT AMONG THOSE WHO HAVE NEVER SMOKED, A PROPORTION WHO ARE SUSCEPTIBLE TO SMOKE, WHEN THEY ASK WOULD YOU CONSIDER SMOKING IN THE FUTURE? WOULD YOU SMOKE IF A FRIEND OFFERED YOU A SIGNIFICANT RELATE? THESE ARE ITEMS THAT WERE DEVELOPED AND VALIDATED BY A GROUP IN CALIFORNIA IN THE 19 -- EARLY 1990S. HAD HASN'T CHANGED F ANYTHING, IT'S GONE UP. AND THIS IS A SIGNIFICANT ISSUE THAT ALL TO GET THE ATTENTION OF PUBLIC HEALTH PROGRAMS AND SCIENTISTS AS TO HOW YOUTH WHO HAVE NEVER SMOKED, AND THESE ARE YOUTH, THE AVERAGE IS THE AGE RANGE 12-17 THAT YOU SEE ARE STILL SUSCEPTIBLE TO MARKETING EFFORTS OR TO SOCIAL PRESSURES OR JUST IT'S AVAILABLE, THEY TRIED IT. AND THE WHOLE NOTION THAT THE RISK OF SMOKING IS GREAT NEST ADOLESCENTS, ALTHOUGH CONTINUES TO BE TRUE, IT REALLY HAS SHIFTED TO YOUNG ADULTHOOD AS IS EQUALLY IMPORTANT AREA OF BEING SUSCEPTIBLE TO SMOKING. NEXT SLIDE. THAT'S THE END OF MY FORMAL PRESENTATION. I KNOW I WENT OVER THE TIME BUT I THINK IF THERE ARE SOME QUESTIONS, I'M NOT SURE IF YOU HAVE BEEN LOOKING AT THE CHAT BOX AND YOU CAN CALL ON PEOPLE, JOYCE? >> DR. HUNTER: YES, I'M MONITORING THE CHAT BOX. PUT YOUR QUESTIONS OR COMMENTS IN THE CHAT BOX, PLEASE:: A COMMENT? >> CAN YOU HEAR ME NOW? >> DR. HUNTER: YES. >> I CAN'T HEAR. [ INAUDIBLE ] [ DISTORTED AUDIO ] >> LOTS OF INTERFERENCE AND LOTS OF NOISE. [ DISTORTED AUDIO ] [ INAUDIBLE ] >> STABLE STABLE: THANK YOU FOR DISAGREEING WITH ME. DR. BARNS HAS A QUESTION. LISA? >> DR. BARNS: YES, I WANTED TO ASK ABOUT YOU THE DATA YOU SHOWED ABOUT ACCESS TO KIDNEY TRANSPLANTATION. I WAS SURPRISED TO HEAR THAT WOMEN ARE LESS LIKELY OR HAVE POORER ACCESS TO THE TRANSPLANTATION. I WAS WONDERING DID YOU KNOW WHY THAT IS? >> ELISEO PEREZ-STABLE: I DO NOT. I CAN'T SAY I REMEMBER ALL THE DETAILS OF THE ANALYSIS FROM THAT GROUP. THERE WAS A SERIES OF ARTICLES, I THINK MOST HAD BEEN FOCUSED ON THE DISPARITIES FOR AFRICAN-AMERICANS. THE WHOLE -- END-STAGE RENAL DISEASE TOPIC IS A GOOD EXAMPLE LABORATORY TO STUDY A VARIETY OF ISSUES AROUND THIS AND MINORITY HEALTH. BLACKS WHO ACTUALLY GET INTO DIALYSIS HAVE BETTER OUTCOMES THAN WHITES. BUT OF COURSE THE NUMBER THEY GET TO DIALYSIS ARE MUCH GREATER. THERE IS A NUMBER OF SPECULATIONS AS TO WHY THEY DO BETTER IN TERMS OF SURVIVAL. BUT THEN THE ACCESS TO TRANSPLANT DOES REQUIRE SKILLED MANAGING SYSTEMS. AND ARE THERE GO BIASES INVOLVED? I DON'T THINK THAT THIS HAS BEEN STUDIED. THIS WAS A VERY HIGH-LEVEL SYSTEMS ANALYSIS OF DATASET, NOT A PRIMARY DATA COLLECTION. MANY, MANY YEARS AGO ONE OF OUR FELLOWS OR INVESTIGATORS FROM OUR PROGRAM LOOKED AT HEALTH LITERACY AS A FACTOR. AND SHE FOUND THAT THAT WAS AN IMPORTANT BARRIER FOR AFRICAN-AMERICANS COMPARED TO WHITES. THE THING THAT I LEARNED FROM HER WORK, THIS IS DONE BACK 15 YEARS AGO, WAS THAT THE NUMBER OF HOOPS THAT PATIENTS HAD TO GO THROUGH TO GET A TRANSPLANT ARE HUGE. SO, EVEN IF YOU HAVE GOOD INSURANCE, BECAUSE PEOPLE ON DIALYSIS GET MEDICARE FOR THE MOST PART -- YOU HAVE TO FILL OUT FORMS. HAVE YOU TO GO HERE AND THERE AND GET TESTS AND IF YOU MISS, YOU DON'T -- YOU LOSE YOUR PLACE IN THE TRANSPLANT QUEUE. SO THERE MIGHT BE SOMETHING RELATED TO ONE OF THOSE FACTORS THAT LEADS TO A GENDER DIFFERENCE. I DON'T KNOW. BUT I CAN'T SAY. >> DR. HUNTER: YOU HAVE A QUESTION FROM DR. MILL SAP AND DR. BARNS COULD YOU MUTE YOUR MIC? >> REALLY A FANTASTIC PRESENTATION AND I WANT TO SAY YOUNG OR GROWING GROUP OF INVESTIGATORS THAT CAN ADVANCE MINORITY HEALTH. I GUESS MY QUESTION TO YOU WOULD BE, AS WE LOOK AT POPULATIONS IN PARTICULAR THE LATINO POPULATIONS, WHICH VERY DIVERSIFIED WITH SOME BEING PUERTO RICAN GROUPS AND U.S. CITIZENS, SOME HAVING MORE REFUGEE BACKGROUNDS, OTHERS BEING UNDOCUMENTED AND HAVING IMMIGRANT ISSUES THAT ARE IMPACTING THEIR HEALTH. HOW DOES ONE PICK APART THAT INFORMATION AS RESEARCH COMES OUT ON HISPANICS? WHAT CAN WE TAKE FROM THE INFORMATION THAT WE HAVE ON THE OVERALL HISPANIC ROUTE AND APPLY THAT TO THE SUBGROUPS? >> ELISEO PEREZ-STABLE THANK YOUTHANKA STABLE ELISEO PEREZ-STABLE:THANK YOU FERNANDO. IF YOU KEEP DIVIDING UP OUR HETEROGENOUS GROUPS IN THE SMALLER BOXES AS DIVIDE AND CONQUER APPROACH, AND WE CAN'T REALLY SAY MUCH ABOUT ANYBODY ANYWHERE. SO I'M A LUMPER, NOT A SPLITTER WHEN IT COMES TO THINKING ABOUT MINORITY HEALTH. THAT SAID, IT DOESN'T INVALIDATE AND IN FACT THERE IS TREMENDOUS VALUE IN LOOKING AT SOME POPULATIONS. I THINK THAT WAS THE WHOLE PURPOSE AND SPIRIT OF THE HISPANIC COMMUNITY HEALTH STUDY OF LATINOS AND IT IS A SEMINOLE STUDY IN THAT IT IS THE PRIMARY STUDY NOW THAT AL ALL OF US ARE NOW GOING SO WE WILL HAVE THAT IN THE NEAR FUTURE. BUT CLEARLY WE HAVE BEEN ABLE TO LOOK VERTICALLY MUCH MORE. SO I WILL REMIND US THAT IN 2020, WE'LL SEE WHAT THE CENSUS SHOWS, BUT ALMOST 70% OF U.S. LATINOS BORN IN THE UNITED STATES. SO THEY ARE AUTOMATICALLY AMERICAN CITIZENS. SO THIS WHOLE ISSUE OF THE PROFILE OF THE LATINO POPULATION HAS EVOLVED AND MEXICAN-AMERICANS MAKE UP OR CONTINUE TO MAKE UP ABOUT 65% OF ALL LATINOS IN THE U.S. AND BASED ON OTHER DATA THAT MEXICAN-AMERICANS APPEAR TO BE THE PRINCIPLE CONTRIBUTOR TO THE PARADOX OF BETTER HEALTH OUTCOMES DESPITE ADVERSE ECONOMIC STATUS, ALTHOUGH SOME ELEMENT OF THAT IS ALSO PRESENT IN OTHER GROUPS. AND IN THE AND COMPARE DIFFERENT POPULATIONS GROUPS, PUERTO RICANS DO WORSE. SO THE FACT THEY ARE AUTOMATICALLY AMERICAN CITIZENS DOESN'T SEEM TO HAVE HELPED. THEY DO WORSE COMPARED TO MEXICANS AND CUBANS AND CENTRAL AMERICANS WHERE I THINK THEY ARE COMPARABLE ENOUGH NUMBERS THAT YOU CAN SAY SOMETHING ABOUT THEM AS A GROUP. BUT THEIR RATES OF SOME CONDITIONS ARE STILL BETTER THAN WHITES. NUMBER 1. AND TWO, IN ANALYSIS DONE THROUGH THE INTRAMURAL PROGRAM, WE COMPARE MORTALITY RATES FOR LATIN AMERICA TO THOSE OF THE U.S. BY RACE ETHNICITY, AGAIN ONLY WHITE, PLAQUE AND LATINO AND HISPANICS INCLUDED AND LATINO MORTALITY IN THE U.S. WAS SIMILARLY LOW AS IT WAS IN PUERTO RICO AND IN THE MAJORITY OF COUNTRIES IN LATIN AMERICA THAT HAD ADEQUATE REGISTRY DATA BY ASSESSMENT OF THEIR DEATH EXPLAINED IN THEIR REGISTRIES. SO, I AGREE WE NEED TO LOOK AT HETEROGENEITY BUT I ENDORSE THE GROUPING TOGETHER AND THAT THERE ARE MORE COMMON THINGS THAN DIFFERENCES. TAKE THE HETEROGENEITY POSITION, WE CLEARLY SHOULDN'T BE LUMPING ALL WHITES TOGETHER. THERE IS HUGE SOCIOECONOMIC STATUS DIFFERENCES AND ALSO GEOGRAPHIC DIFFERENCES, HERITAGE BACKGROUND DIFFERENCES, THE CENSUS IN 2020 WILL PROVIDE SOME INSIGHT INTO THAT. THE SAME IS TRUE FOR AFRICAN-AMERICANS AND AFRICAN-AMERICANS FROM EASTERN TEXAS AND LOUISIANA ARE NOT THE SAME AS THE ONES FROM THE BRONX. SO BE THAT AS IT MAY, AS WELL AS THE CARIBBEAN IMMIGRANTS AND THE ENGLISH-SPEAKING CARIBBEAN IMMIGRANTS AND THE AFRICAN IMMIGRANTS WE HAVE SEEN INCREASING NUMBERS. SO, THIS IS A FACT OF ALL GROUPS AND I WOULDN'T SAY IT'S EXCLUSIVELY TOPIC FOR LATINOS. >> DR. HUNTER: ELISEO PEREZ-STABLE WOULD YOU LIKE TO INTRODUCE DR. TROMBERG? WE CAN'T HEAR YOU. >> ELISEO PEREZ-STABLE: BRUCE, YOU'RE ON? >> BRUCE TROMBERA TROM BRUCE TROMBERG: YES , I'M ON. THIS IS AN IMAGE I HAVE GOTTEN USED TO SEEING. >> ELISEO PEREZ-STABLE: I'M DELIGHTED TO HAVE DR. BRUCE TROMBERG TO PRESENT. I APOLOGIZE FOR THE DELAY. I KNOW YOU HAVE ANOTHER MEETING AFTER THIS. BRUCE HAS BEEN AT NIH FOR ABOUT A YEAR AND FIVE MONTHS IF I'M COUNTING CORRECTLY. I WAS ON THE RESEARCH COMMUNITY THAT FOUND HIM AND I CAN JUST COMMENT THAT -- NOT ONLY IS HE AN ACCOMPLISHED SCIENTIST, A PH.D. SCIENTIST WHO HAS DONE REMARKABLE WORK, HE WAS AT UC IRVINE FOR ALL OF HIS CAREER, IF I'M REMEMBERING CORRECTLY, ALTHOUGH HE DOES HAVE ROOTS IN THE DC AREA. SO HE WAS WILLING TO COME BACK AND LEAD LEAVE THAT SOUTHERN CALIFORNIA WEATHER FOR THIS AREA. AND BOY, HAS HE STEPPED INTO ACTIVITY. AND NIBIB, AS I MENTIONED DURING MY PRESENTATION, HAS BEEN CHANGED WITH RESPONSIBILITY OF DOING IN SIX MONTHS WHAT NORMALLY WOULD TAKE FIVE YEARS, AND BRUCE HAS TAKE THEN TASK ON WITH FULL STEAM AND EMBRACED ALL THE CHALLENGES AND ENGAGING ALL OF US INSTITUTES IN SUPPORTING HIM. SO BRUCE, WE LOOK FORWARD TO YOUR COMMENTS. >> BRUCE TROMBERG: THANK YOU. IT WAS REALLY GREAT TO BE HERE AND TO BE ABLE TO ADDRESS YOUR COUNCIL. CAN I GO AHEAD AND START SHARING MY SLIDES? OKAY. I'M GOING TO GET MY FIRST SLIDE UP THERE. SO I WAS INSPIRED BY ELISEO MOVING FROM CALIFORNIA. I FIGURED IT MAY NOT BE THAT BAD AND I DID GROW UP HERE SO I HAVE SOME DIM MEMORY, BUT IT'S BEEN EXHILARATING TO SAY THE LEAST, TO BE IN THIS SITUATION THAT WE ARE IN RIGHT NOW, CHALLENGING, AND I'LL FOCUS A PORTION OF MY TALK ON THAT. BUT WHAT I'D FIRST LIKE TO DO IS GIVE YOU ALL A FEELING OF THE OPPORTUNITIES FOR ENGINEERING IN MEDICINE AND HOW IT'S GROWING AND HOW WE HAVE BEEN VERY FORTUNATE TO ESTABLISH A WONDERFUL WORKING RELATIONSHIP WITH NIMHD AND HOW THE FOUNDATIONS OF THAT ARE CARRYING US INTO HOW WE ARE RESPONDING TO THE NEED FOR ENHANCED TESTING AND TECHNOLOGIES IN THE COVID PANDEMIC. SO I SHOWED THIS PICTURE TAKEN A FEW MONTHS AFTER I ARRIVED AT ONE OF OUR ALL HANDS MEETINGS. THERE IS NO SOCIAL DISTANCING GOING ON THERE. I REALLY WANTED TO KIND OF REVISE THE FEELING OF WHAT IT'S LIKE FOR ALL OF OUR GROUP TO GET-TOGETHER. THIS IS ABOUT HALF OF OUR INSTITUTE. THE INSTITUTE HAS ABOUT 200 PEOPLE. WE HAVE AN INTRAMURAL PROGRAM AND INTRAMURAL PROGRAM. WE HAVE EIGHT PRINCIPLE INVESTIGATORS IN THE INTRAMURAL PROGRAM AND WE HAVE BEEN ADDING FOLKS TO THAT. IT'S AN EXCITING PROGRAM WITH LOTS OF REALLY COOL TECHNOLOGIES AND GREAT PEOPLE. AND AS MENTIONED, MY BACKGROUND IN THE AREA, WE CALL IT OPTICS AND FA TONICS OR BIOFA TONICS. IT'S A NEW FIELD ALL THOSE THIS TECHNOLOGY HAS BEEN AROUND FOR QUITE SOMETIME. THEY HAVE EXPANDED AND TRANSFORMED OVER THE YEARS THE COST OF THESE TYPES OF THINGS HAVE GONE DOWN. AND I FORMERLY WAS DIRECTING AN INSTITUTE AT UC IRVINE, THE BECKMANN INSTITUTE WHERE IT WAS A COMBINED PROGRAM WITH THE CLINIC. WE HAD ABOUT 2000 PATIENT VISITS PER YEAR WE WENT FROM BENCH TO BEDSIDE. A TRANSFORMATIONAL PROCESS. WE DID A LOT OF COMMERCIALIZATION AS WELL. MANY OF THE TECHNOLOGIES WE DEVELOPED FROM THE CONCEPTUAL STAGE EVENTUALLY WENT TO INDUSTRY EITHER THROUGH OUR OWN STARTUPS OR THROUGH LICENSING TO OTHER COMPANIES. SO THAT IS REALLY THE BEST WAY TO DISSEMINATE IDEAS. YOU DON'T WANT TO JUST BE A BOUTIQUE OR YOU'RE ONE PLACE THAT CAN DO ONE THING. IT'S EXTREMELY IMPORTANT AND WE WERE VERY, VERYIVE IN THIS IN -- ACTIVE TO TRY TO HAVE THESE DISSEMINATED FOR AND I'D BROAD USE. THE ACTUAL OPERATION OF ENGINEERING IN MEDICINE AND THE FORMALIZATION OF IT AS A DISCIPLINE, IS FAIRLY NEW. BIOMEDICAL ALLEN ENGINEERING AS A DISCIPLINE HAS BEEN AROUND BUT -- BIOMEDICAL ENGINEERING. THE NIBIB WAS ESTABLISHED SO LOOKING BACK AT THE HISTORY. NIBIB WAS ESTABLISHED AND THIS WAS WRITTEN INTO LAW, THIS ACT WAS SIGNED INTO PUBLIC LAW BY PRESIDENT CLINTON ON DECEMBER 29, TWO, THIS RIGHT AT THE END OF HIS TERM -- 2000. YOU CAN SEE A PICTURE OF THE FOUNDER DIRECTOR OF NIBIB, MY PREDECESSOR, WHO LEFT TO HEAD AN ENTIRELY NEW SCHOOL OF MEDICINE AT TEXAS A&M. THAT'S A JOINT-VENTURE THAT IS BASED ON ENGINEERING IN MEDICINE AND IT'S THE SECOND SUCH SCHOOL IN THE COUNTRY, THE FIRST ONE IS AT THE UNIVERSITY OF ILLINOIS. THE ACADEMIC CURRICULUM IS FOUNDATION ALLEY IN ENGINEERING, IN ADDITION, OF COURSE, TO MEDICAL TRAINING. SO IT'S AN IDEA THAT IS REALLY TRANSFORMING HOW WE WORK AND WE CAN TRACE A LOT OF THIS BACK TO THE ORIGINAL FOUNDING OF THE NIBIB. AND I HIGHLIGHT THE ACT AND THE LAW HERE TO SORT OF SHOW YOU THE FORWARD-LOOKING LANGUAGE WHERE SPECIFICALLY IN THIS LAW IT SAYS, IMAGING BIOENGINEERING, COMPUTER SCIENCE, INFORMATICS AND RELATED FIELDS ARE CRITICAL TO IMPROVING HEALTH CARE BUT THEY ARE FUNDAMENTALLY DIFFERENT FROM THE RESEARCH AND MOLECULAR BEETLEY ON WHICH THE NIH IS BASED -- MOLECULAR BIOLOGY. TO ENSURE THE DEVELOPMENT OF NEW TECHNIQUES AND TECHNOLOGIES, THESE DISCIPLINES REQUIRE IDENTITY AND RESEARCH HOME AT THE NIH. THAT IS DIFFERENT FROM THE EXISTING STRUCTURE. SO THESE ARE KIND OF OUR -- THAT'S OUR GENESIS BOOK. THAT'S OUR FIRST CHAPTER, OUR FIRST VERSE. BACK TO THIS HISTORIC CONTEXT BECAUSE I THINK IF ALL OFF IMAGINE WHERE YOU WERE WITH RESPECT TO TECHNOLOGY BACK AT THE END OF THE 90s, IT REALLY WAS QUITE DIFFERENT THAN TODAY. THESE WORDS WERE WRITTEN IN THE ENACTED AS A LAW. SO VERY, VERY FORWARD-LOOKING AND I THINK ANTICIPATING THE KIND OF INTERDEPENDENCE BETWEEN ALL OF OUR LIVES AT TECHNOLOGIC ADVANCES THAT WAS QUITE REMARKABLE AND INSPIRING. AT THIS POINT WHEN NIBIB WAS CREATED, THERE WERE ONLY ABOUT 20 OR 30 DEPARTMENTS OF BIOENGINEERING ALL AROUND THE COUNTRY AND TODAY THERE ARE A LITTLE OVER 130 AND IT IS ONE OF THE FASTEST-GROWING UNDERGRADUATE MAJOR WITH 1600 UNDERGRADUATES IN BIOMEDICAL ENGINEERING ALL ACROSS THE COUNTRY EACH YEAR. AND QUITE A LARGE NUMBER OF FACULTY BEING HIRED IN THESE AREAS. ONE OF THE THINGS WE LIKE TO DO AT THE NIH IS MEASURE WHERE OUR DOLLARS ARE GOING AND ONE OF THE WAYS TO DO THIS IS TO, WE HAVE CERTAIN CODING LANGUAGE. ONE IS BIOENGINEERING ITSELF. IT IS WHAT WE CALL AN RCDC CODE. AND WHAT WE HAVE SEEN IS A REMARKABLE INCREASE ALL ACROSS THE NIH IN BIOENGINEERING ACTIVITIES. SO IN THE TIME THAT WE HAVE BEEN KEEPING STATISTICS HERE, THERE HAS BEEN A 13% INCREASE -- SORRY. WE NOW HAVE 13% OF THE NIH BUDGET. THE TOTAL NIH BUDGET IS SPENT BIOENGINEERING. AND THIS HAS BEEN A 78-% INCREASE SINCE WE STARTED TRACKING THIS WILL STATISTIC IN 2008. MUCH HIGHER THAN THE RATE OF INCREASE IN THE OVERALL NIH BUDGET. SO THIS IS PRETTY REMARKABLE IT'S ALSO REMARKABLE WHEN YOU PUT THAT IN THE CONTEXT OF NIBIB WHICH IS TASKED WITH SUPPORTING ENGINEERING. OUR BUDGET IS ONLY 1% OF THE TOTAL NIH BUDGET. SO WE ARE SEEING BIOENGINEERING ADOPTED AND EMBRACED BY ALL THE INSTITUTES AND CENTERS ACROSS THE NIH. AND SO I HAVE DONE A SIMPLE MATHEMATICAL MODEL AND PROJECTED IN 30 YEARS, ABOUT 90% OF THE NIH BUDGET WILL BE SPENT ON BIOENGINEERING. THAT IS OUR CONSERVATIVE PREDICTION. WE'LL SEE IF THAT COMES TO PASS. SO WHERE ARE WE IN TERMS OF THE NIH STRUCTURE? AND I THINK THAT THIS KIND OF REFLECTS OUR VISION. OF COURSE THERE ARE 27 INSTITUTES AND CENTERS. QUITE A LOT OF MONEY IS SPENT ALL ACROSS THE NIH AND COMMERCIALIZATION, WHICH IS SOMETHING WE DO A LOT OF. AND WE REALLY ENVISION THE VALUE OF TECHNOLOGY THAT NIBIB DEVELOPS AS BEING IMPORTANT FOR ALL INSTITUTES AND CENTERS. IN A LOT OF WAYS, OUR INVESTIGATORS, OUR EXTRAMURAL INVESTIGATORS, ARE DEDICATED TO BRINGING THOSE TECHNOLOGIES INTO PROBLEM AREAS THAT VIA COLLABORATIONS WITH EVERY INSTITUTE AND CENTER. WE SUPPORT A CORE OF ABOUT 1000 GRANTS AND AS I MENTIONED BEFORE, OUR ANNUAL BUDGET IS OR USED TO BE, 400 MILLION DOLLARS WITH THE COVID CRISIS THAT CHANGED AND I'LL MENTION THAT IN JUST A LITTLE BIT. SO WHAT IS IT THAT WE DO? WHAT ARE THOSE TECHNOLOGIES THAT UNDERPIN ALL OF THOSE ACTIVITIES? AT THE CENTER OF A LOT OF THIS, OUR COMMUNITY DOES MODELING, COMPLICATION, MACHINE INTELLIGENCE, WE HAVE BEEN HEARING QUITE A LOT ABOUT THESE THINGS. OUR COMMUNITY HAS BEEN INVOLVED IN THIS FOR DECADES. AND THAT IS THE FOUNDATION OF HOW WE APPROACH ANY PROBLEM. WE USE THAT IN ORDER TO HELP US DO BETTER AT HOW WE ENGINEER BIOLOGY AND THE CONTEMPORARY THINKING IS BUILT AROUND THE IDEA THAT CELLS CAN BE THOUGHT OF IN A NOT DISSIMILAR WAY TO INTEGRATED CIRCUITS, AND IF WE CAN UNDERSTAND THOSE COMPONENTS OF THE CELLS, THE CIRCUIT COMPONENTS, WE CAN THINK OF AND USE MOLECULAR APPROACHES TO EVEN REPROGRAM THE CELLS, TO GROW SINGLE CELLS OR MULTIPLE CELLULAR ORGANISMS WITH A REPROGRAMMING CAPACITY. WE ALSO DEVELOP A VARIETY OF DIFFERENT SENSORS, WEARABLE, IMPLANTABLE SENSORS AT POINT OF CARE DEVICES WHICH YOU'LL HEAR A LITTLE BIT MORE ABOUT AS I MOVE INTO OUR COVID DISCUSSIONS. WHEN WE SUPPORT IMAGING TECHNOLOGIES, ALL THE WAY FROM THE BIGGEST MRIs AND THE BIGGEST PHYSICS GOING ON IN THE COUNTRY TO RELATIVELY SMALL AND PORTABLE ONES AS THIS ONE THAT IS ILLUSTRATED HERE BY A GROUP AT THE UNIVERSITY OF MINNESOTA IS DEVELOPING A HEAD-ONLY MR I AND THERE ARE SEVERAL OF THOSE UNDER DEVELOPMENT, LOWER COST, MUCH MORE PORTABLE, OBVIOUSLY MORE COMFORTABLE. YOU CAN ACTUALLY MOVE AROUND IN THOSE SLIGHTLY. THERE IS SOME MOTION THAT IS TOLERATED. AND THEN WE ARE ALSO VERY ENGAGED IN THE DEVELOPMENT OF NEW THERAPEUTIC DEVICES. SOME OF THE MORE SPECTACULAR ONES ARE USING THINGS LIKE FOCUSED ULTRASOUNDS. SO A SERIES OF ULTRASOUND TRANSDUCERS THAT ARE PLACED AROUND THE SKULL. THEY CAN BE FOCUSED DOWN INTO THE BRAIN TO DO SURGERY WITHOUT A SCALPEL. FOR EXAMPLE, ESSENTIAL TREMOR CAN BE TREATED USING THESE APPROACHES. YOU CAN GENTLY PERTURB THE BLOOD-BRAIN BARRIER AND DELIVER MOLECULES SPECIFICALLY TO TARGET DEEP INSIDE THE BRAIN AND THIS IS WITHOUT ANY CUTTING, ANY SCALPEL. IT'S COMPLETELY BLOODLESS. THERE ARE ALSO MINIMALLY-INVASIVE APPROACHES WHERE ONE CAN THREAD FIBER OPTICS OR ELECTRODES OR PLANT SPECIFIC INTEGRATED CIRCUITS INTO REGIONS OF THE BODY AND CONTROL THE CENTRAL OR PERIPHERAL NERVOUS SYSTEM. SO THOSE ARE A VARIETY OF DIFFERENT NON-PHARMACOLOGIC-BASED TECHNOLOGY INTERVENTIONS GOING ON. AND I HAVE -- THIS IS AN EXPERIMENT. I HAVEN'T DONE THIS YET BUT I HAVE A VIDEO WITH SOUND THAT I'D LIKE TO PLAY THAT GIVES YOU A SENSE OF SOME OF THE TECHNOLOGIES THAT ARE UNDER DEVELOPMENT. SO I'M GOING TO JUST PHYSICALLY PLAGUES MY MICROPHONE ON MY COMPUTER AND I'LL JUST PLAY THIS VIDEO. [ VIDEO ] [ MUSIC PLAYING ] I HOPE THAT GIVES EVERYONE A SENSE OF TECHNOLOGIES UNDER DEVELOPMENT. WE ARE SO PROUD OF OUR COMMUNITY FOR THE CREATIVITY AND THE DRIVE OF OUR STUDENTS AND FACULTY AND VENTURES TO BRING THESE TECHNOLOGIES INTO SETTINGS THAT TRADITIONALLY WOULD NOT NECESSARILY BE THE FIRST CHOICE OF A MARKET BUT THERE ARE MANY, MANY INTERESTING MARKETS AND SOME OF THESE CAPTURED ARE THE WORK -- WE HAVE A CHALLENGE, A GRANT PROGRAM, BY UNDERGRADUATE TEAMS AND THIS IS A WELL-ESTABLISHED PROGRAM NOW WHERE WE GET MANY DIFFERENT APPLICATIONS FROM UNIVERSITIES ALL ACROSS THE COUNTRY, HUNDREDS OF STUDENTS WHO ARE ENGAGED, AND WE HAVE QUITE A LARGE NUMBER OF PRIZES WE GIVE OUT TO UNDERGRADUATE TEAMS. AND I'M WORKING WITH ELISEO, WE INTRODUCED A NEW SPECIFIC NIMHD PRIZE FOR TECHNOLOGIES THAT HAVE IMPORTANT IMPACT IN LOW-RESOURCE SETTINGS. WE ALWAYS HAVE APPLICATIONS IN THIS AREA AND VIRTUALLY ALWAYS HAVE WINNERS BUT THIS IS A WONDERFUL OPPORTUNITY FOR US TO SPECIFICALLY BRING ATTENTION TO THE GREAT WORK THAT IS GOING ON ALL ACROSS THE COUNTRY IN BIOENGINEERING ON THO TOPIC. UNFORTUNATELY, WITH THE COVID CRISIS AND ALL THE LABS BEING CLOSED AND THE INTERRUPTION OF STUDENT TRAINING, WE ARE EXTENDING THIS AND WILL BE ANNOUNCING THE WINNERS ACCORDING TO THIS TIMETABLE BUT WE STILL WILL BE ANNOUNCING WINNERS AT SOME POINT IT'S STILL A WORK IN PROGRESS TO FIGURE OUT HOW WORKING WITH THE DEPARTMENTS ALL AROUND THE COUNTRY, HOW WE'LL BE ABLE TO CAPTURE THE ACTIVITY OF ALL OF OUR STUDENTS. THIS IS AN EXCITING AREA WE HAVE BEEN ABLE TO COLLABORATE WITH NIMHD IN. ANOTHER AREA THAT WE HAVE BEEN VERY ACTIVE, WE RECENTLY, I THINK MANY OF YOU MAY HAVE FOLLOWED THE NEWS ABOUT THE NIH COLLABORATION WITH THE GATES FOUNDATION TO DEVELOP CURES FOR SICKLE CELL AND HIV ON A GRAND SCALE. AS A COMPANION PIECE TO THAT, WE WERE ABLE TO TEAM UP WITH OTHER INSTITUTES AND WE OURSELVES WERE ABLE TO BRING SUBSTANTIAL RESOURCES INTO ANOTHER CHALLENGE PRIZE, A MILLION DOLLAR CHALLENGE, THAT SEEKS TO DEVELOP A NON-INVASIVE PLATFORM DEVICE, SO NOT TAKING BLOOD OUT OF THE BODY BUT AN ENTIRELY NON-INVASIVE DEVICE TO TRACK DISEASE STATE AND RESPONSE TO THERAPY IN MALARIA, SICKLE CELL DISEASE AND ANEMIA. AND AGAIN, THIS IS AN ONGOING CHALLENGE. WE ARE NOT QUITE SURE TO WHAT TO DO WITH THE DEADLINES FOR THIS BECAUSE SO MUCH HAS BEEN INTERRUPTED. THIS IS TERRIFIC RESEARCH AND SUPPORT AND OPPORTUNITIES FOR EXPANDING TECHNOLOGIES INTO LOW-RESOURCE SETTINGS INTO AREAS WHERE THERE IS A SIGNIFICANT GLOBAL HEALTH DISEASE BURDEN. AND THEN, OF COURSE, THIS HAPPENED. AND WE HAVE BEEN FOCUSED QUITE A LOT IN OUR COMMUNITY ON THE ISSUE OF TESTING. AS YOU CAN SEE FROM THE DESCRIPTION OF THE TYPES OF TECHNOLOGIES IN OUR PORTFOLIO, TESTING CLEARLY FALLS INTO THE KIND OF THINGS THAT WE DO, THE BIOLOGY COMPONENT, ENGINEERED BIOLOGY, THE MATHEMATICS, THE SENSING PLATFORMS. THOSE ARE ALL COMPONENTS OF WHAT WE DO AND WHAT WE SUPPORT AT THE NIBIB. AND THERE IS THIS PERVASIVE QUESTION ABOUT WHY HAS THE U.S. REALLY FAILED TO DEVELOP A SUBSTANTIAL ADVANCED TESTING CAPACITY THAT WOULD BE MEETING AND RESPONDING TO THE NEEDS OF THE COUNTRY? AND AS A QUICK SNAPSHOT OF THIS, YOU CAN SEE THAT OUR TESTING STARTED OFF REALLY QUITE SLOWLY. IF YOU GO BACK INTO MARCH, YOU SEE IT WAS A RELATIVELY SLOW RAMP UP, AND THEN IT BEGAN TO PLATEAU IN APRIL AT AROUND 150,000 TESTS PER DAY. AND WE HAVE SEEN ANOTHER INCREASE AND WE ARE UP 300,000 TESTS PER DAY. OUR TOTAL NUMBER OF TESTS THAT WE HAVE DONE IN THE COUNTRY IS A LITTLE OVER 9 MILLION TESTS. AND FOR THE MOST PART, THE CDC AND OTHER GUIDELINES FOR TESTING SUGGESTS THAT INDIVIDUALS WITH SYMPTOMS SHOULD BE THE HIGHEST PRIORITY FOR TESTING. INDIVIDUALS OR OTHERS WHO MAY BE AT RISKING AND ALSO WITH SYMPTOMS ARE A HIGH PRIORITY. BUT THERE IS A SIGNIFICANT COMPONENT OF THE POPULATION THAT'S NOT GOT READY ACCESS TO TESTS. AND THERE ARE SOME LIMITATIONS TO THAT. THOSE LIMITATIONS ARE BASED, IN PART, ON THE TYPES OF TECHNOLOGIES THAT ARE USED FOR TESTING RIGHT NOW. THEIR COST, THEIR ACCESSIBILITY, AND IF YOU LOOK AT MANY OF THE DIFFERENT PUBLICATIONS THAT DESCRIBE WHAT WE NEED TO DO WITH TESTING, THEY ARE CALLING FOR ANYWHERE FROM TENS OF MILLIONS TO AS HIGH AS PERHAPS 30 MILLION TESTS PER DAY. AND SORT OF AT A MINIMUM, FROM HALF A MILLION TO A MILLION, MAYBE A COUPLE MILLION TESTS PER DAY. CLEARLY, MUCH LARGER THAN WHERE WE CURRENTLY ARE WITH OUR FEW50,000 OR 3,000 TESTS PER DAY. -- 250,00TWO IF WE ARE GOING TO REOPEN THE COUNTRY AND HAVE PEOPLE FEEL SAFER TO ENGAGE IN THEIR ACTIVITIES, NOT ONLY DO WE NEED TO INVEST IN THE CURRENT PLATFORM OF TECHNOLOGIES THAT ARE OUT THERE, AND THERE ARE MANY LIMITATIONS THO THOSE TECHNOLOGIES, BUT WE NEED TO HAVE GREATER DIVERSITY IN THE TYPE OF TESTING. WE NEED TO HAVE HOME-BASED TESTING EXPANDED. THERE REALLY IS VERY LITTLE HOME-BASED TESTING. THERE ARE A VARIETY OF DIFFERENT TEST PLATFORMS THAT ARE CONDUCIVE TO THAT. MANY OF THEM ARE IN CUTTING-EDGE RESEARCH LABORATORIES. AND THE QUESTION IS IT, HOW CAN WE BRING THOSE OUT AND GET THEM COMMERCIALIZED QUICKLY AND DISSEMINATED WIDELY SO THAT EVERYONE CAN TAKE ADVANTAGE OF THOSE THINGS? WE NEED MORE POINT OF CARE TESTING AND WE CAN EVEN IMPROVE HOSPITAL AND TESTING LABORATORY PLATFORMS BY DRAMATICALLY INCREASING THE THROUGH PUTE OF THESE DEVICES USING INNOVATIONS THAT THE NIBB SUPPORTED. THIS LED TO RAPID ACCELERATION OF DIAGNOSTICS AND YES, RAD IS A NOD TO SOUTHERN CALIFORNIA. IT'S ALSO A NOD TO THE LABORATORY AT MIT, THE RAD LAB, THAT DEVELOPED RADAR, ONE OF THE KEY INNOVATIONS THAT WON WORLD WAR II. AND WE HOPE THIS IS AN ACTIVITY THEY WILL LEAD TO KEY INNOVATIONS THAT WILL HELP US WIN THE WAR WITH THE COVID PANDEMIC. WE LAUNCHED THIS PROGRAM ON APRIL 29 AND THIS WAS ONLY FIVE DAYS AFTER THE CONGRESSIONAL APPROPRIATION FOR TESTING ADVANCES THAT THE NIH RECEIVED. AND NIBIB RECEIVED 500 MILLION DOLLARS IN THAT APPROPRIATION AND OVERALL, THE NIH RECEIVED 1.8 BILLION DOLLARS FOR TESTING, BOTH VIRAL TESTING AS WELL AS SEROLOGIC TESTING, BUT THE PORTION OF THE PROGRAM THAT I LEAD IS DEDICATED EXCLUSIVELY TO DIRECT VIRUS TESTING AND NOT SEROLOGIC TESTS. THE REASON WHY WE ARE ABLE TO GO SO QUICKLY FIVE DAYS FROM APPROPRIATION TO FULLY-STOOD UP PROGRAM, IS THAT WE WERE ABLE TO LEVERAGE ONE OF OUR TECHNOLOGY NETWORKS, IT'S CALLED THE POINTED OF CARE TECHNOLOGY NETWORK. IT'S A U54 PROGRAM THAT IS A PARTNERSHIP BETWEEN US AND SEVERAL OTHER NIH INSTITUTES AND IT IS LOCATED IN FIVE SITES ALL AROUND THE COUNTRY. ONE IS AT EMORY AND GEORGIA TECH, ANOTHER IS AT NORTHWESTERN, THIRD JOHNS HOPKINS AND FOURTH IS AT UMASS LOWELL. AND ALSO UMASS MEDICAL CENTER. AND THEN THE FIFTH SITE IS SIMIT, THE SIMIT CENTER AT MASS GENERAL HOSPITAL IN HARVARD MEDICAL SCHOOL. THE SIMIT SITE SERVES AS OUR COORDINATING CENTER AND THE OTHER FOUR SITES ARE RESEARCH SITES. BUT WHAT THIS NETWORK ALLOWS US TO DO IS ACCELERATE THE DEVELOPMENT OF POINT OF CARE AND HOME-BASED TECHNOLOGIES USING BOTH EXPERTS IN ALL OF THESE SITES AND RESOURCES FOR VALIDATION, COMMERCIALIZATION, AND CLINICAL TRIALS. AND WE CAN ALSO, WITHIN THIS NETWORK, ACCEPT APPLICATIONS FROM INVESTIGATORS ALL AROUND THE COUNTRY IN ORDER TO PUT IDEAS THROUGH WHAT WE CALL A KIND OF INNOVATION FUNNEL. SOME OF YOU HAVE MAYBE HEARD OF OR SEEN ARTICLES WRITTEN ABOUT THE NIH SHARK TANK RAD X. W USE A SHANK TANK-LIKE SELECTION PROCESS. IT'S NOT THE SAME AS THE T.V. SHOW BUT EVERYONE HAS RALLIED AROUND THAT SORT OF POPULAR IMAGERY OF SHANK TANK AND I THINK WE ARE MORE OR LESS STUCK WITH THAT. THE WAY THIS WORKS IS THAT ON APRIL 29, NOT THE 28 AS IN THIS SLIDE, WE BEGAN ACCEPTING ALLOCATIONS AT OUR COORDINATING SITE AND THEY STARTED TO FILL THEM OUT. WITHIN THE FIRST 24 HOURS, WE HAD 400 APPLICATIONS THAT WERE STARTED. AND THEN THEY GO THROUGH A MULTI-PHASE SELECTION PROCESS. SO AFTER THESE APPLICATIONS ARE REVIEWED BY A SERIES OF EXPERTS, TEAM OF EXPERTS, THEY MAY BE RECOMMENDED TO GO INTO WHAT WE CALL A DEEP DIVE ANALYSIS, WHICH IS A LITTLE BIT LIKE THAT SHARK TANK. IF THEY MAKE IT THROUGH THAT, THE TEAM WILL HAVE A WORK PACKAGE THAT IS CUSTOMIZED SPECIFICALLY FOR THE CONCEPT OR PROJECT, AND THERE ARE MILESTONES IN THAT WORK PACKAGE WHICH THEY HAVE TO MEET. IF THEY CAN MEET THOSE, THEY'LL MOVE ON TO A SECOND PHASE, A NEW WORK PACKAGE THAT WILL FOCUS ON CLINICAL TESTING, REGULATORY APPROVAL, SCALING UP. WE ALSO HAVE VALIDATION AND RISK REVIEW IN ALL OF THIS PROCESS. AND ULTIMATELY, WE ARE HOPING, AFTER PERHAPS 5-6 MONTHS OF BEING IN THIS PROCESS, WE'LL START TO SEE ENTIRELY NEW PLATFORM TECHNOLOGIES COMING OUT WHICH WILL HELP US SUBSTANTIALLY INCREASE BOTH THE TYPES OF TESTS AS WELL AS THE ACTUAL ABSOLUTE NUMBERS OF TESTS THAT THE COUNTRY HAS AVAILABLE. SO WHAT IS THE RESPONSE BEEN SO FAR? AS YESTERDAY, SHEAR A SNAPSHOT. WE HAVE MORE THAN 1200 NEW PROPOSALS THAT WERE INITIATED. 133 WERE COMP PLETED AND 28 ARE NOW IN THIS SHARK TANK DEEP DIVE PROCESS. THAT IS AS OF YESTERDAY. THEY JUST ENTERED INTO THAT PROCESS. AND THE REPRESENTATION HERE IS FROM A VARIETY OF DIFFERENT ORGANIZATIONS HEAVILY DOMINATED BY SMALL BUSINESS, BUT WE ALSO SEE MANY ACADEMIC GROUPS, START-UP COMPANIES LESS THAN A YEAR OLD, MID SIZE COMPANIES AND LARGE BUSINESSES ARE ALSO COMPETING IN THIS. THE IDEAS SPAN PRIMARILY MOSTLY NEW CONCEPTS OR NEW IDEAS AND SOME OF THESE, A SMALL PERCENTAGE, ARE SCALE-UP TECHNOLOGIES WHERE THE PROPOSALS WILL COVER AN EXISTING PLATFORM THAT MAY HAVE EMERGENCY USE AUTHORIZATION BUT WILL INTRODUCE ENGINEERING INNOVATIONS TO TRY TO DRAMATICALLY IN CREWS THE THROUGH PUT. ANOTHER FEATURE OF THIS WE ARE TRYING TO GET OUR ENTIRE COMMUNITY EXCITED AND INVOLVED. WE ESSENTIALLY WANT TO HAVE YOU SUBMIT AN IDEA AND GET INTO THIS PROCESS, THE INNOVATION FUNNEL OR WE WANT YOU TO VOLUNTEER TO HELP. AND WE HAVE HAD 350 EXPERTS WHO VOLUNTEERED TO REVIEW PROPOSALS, TO SERVE AS MENTORS AND GUIDES AND PROJECT MANAGERS THROUGHOUT THIS ENTIRE PROCESS. WHAT ARE SOME OF THESE TECHNOLOGIES LOOK LIKE? THEY REALLY REPRESENT A VARIETY OF DIFFERENT MECHANISMS OF ACTION AND FORM FACTORS. SOME OF THE EXCITING ONES YOU MAY HAVE HEARD OF CRISPR-BASED APPROACHES. THESE ARE PARTICULARLY POTENTIALLY QUITE INVOLVE PROMISING APPROACHES FOR BEING ABLE TO THE ANALYSIS OF NUCLEIC ACIDS IN THE VIRUS, AND THERE ARE MANY ADVANTAGES TO THIS AS OPPOSED TO CONVENTIONAL PCR APPROACHES THAT MAY REQUIRE, PROX, RTPCR, WHICH REQUIRES AN AMPLIFICATION STEP TO THE NUCLEIC ACID. THE CHRIS PER-BASED APPROACHES TYPICALLY DO NOT REQUIRE THE TEMPERATURE CYCLING THE PCR DO AND THEY MAY HAVE ISOTHERMAL AMPLIFICATION SORTED WITH THEM. WE ARE ALSO SEEING LOTS OF VIRAL ANTIGEN PROPOSALS WHICH ULTIMATELY CAN BE READ OUT IN THE CONTEXT OF THESE TYPES OF STRIPS LIKE PREGNANCY TESTS, SIMILAR IN FORM FACTOR AND ACTUALLY IN STRUCTURE TO WHAT WE CALL LATERAL FLOW. AND THE FIRST FDA EMERGENCY USE AUTHORIZATION WAS GRANTED JUST TWO DAYS AGO FOR AN ANTIGEN-BASED LATERAL FLOW ASSAY THAT IS USEABLE IN 15 MINUTES WE ARE SEEING LOTS OF UNCONVENTIONAL OR NON TRADITIONAL WAYS TO DO SAMPLE EXCISIONING. AS EVERYONE KNOWS, IT'S QUITE UNCOMFORTABLE TO THINK OF THESE NASOFRENCHIAL SWABS AND IDEALLY WE WOULD LIKE TO SEE ALTERNATIVE APPROACHES AND ABOUT 40% OF OUR APPLICATIONS INVOLVE USING SALIVA OR ORAL SWAB. SO WE ARE HOPEFUL THOSE TYPES OF OPERATIONAL CONVENIENCES AND SPEED AND FORM FACTORS CAN BE INTRODUCED WITH THESE NEW TESTS. AND IF WE LOOK AT THE OVERALL RAD X PROGRAM, PART OF IT IS THIS NEW DIAGNOSTIC TECHNOLOGY DEVELOPMENT OR TEK AND DEMONSTRATION-TYPES OF PROJECTS. ELISEO MENTIONED SOME OF THIS, THAT WILL BE SUPPORTED BY THE OFFICE OF THE DIRECTOR. THE NIH OFFICE OF THE DIRECTOR RECEIVED AN ADDITIONAL BILLION DOLLARS IN FUNDING, WHICH IS NOW BEING DISTRIBUTED INTO DIFFERENT AREAS. AND ABOUT HALF OF THAT WILL GO INTO THESE DEMONSTRATION PROJECTS. SO TO KIND OF CONNECT ALL OF THAT, WHAT WE ARE ALSO WORKING ON AND AGAIN, IN COLLABORATION WITH ELISEO AND NIMHD, ALSO THE FOGARTY CENTER AND THE OFFICE OF DATA SCIENCES AND OBSSR, ARE MOBILE APPS, DEVICES OR APPROACHES, SOFTWARE, DIGITAL HEALTH PLATFORMS THAT WILL HELP US KEEP TRACK OF THIS INFORMATION THAT COMES IN FROM ALL OF THESE TESTING INPUTS AND HELP FACILITATE THESE KINDS OF RESEARCH STUDIES SO THAT THE INFORMATION CAN BE MIND AND USED IN DE-IDENTIFIED WAYS TO GET A BETTER UNDERSTANDING OF HOW POPULATIONS ARE BEING AFFECTED BY THE VIRUS AND OTHER RESEARCH QUESTIONS OR INDIVIDUALS AS WE FOLLOW THEM LONGITUDINALLY, CAN ALSO BE ADDRESSED. AND THE GENERAL ARCHITECTURE OF THIS IS THE APP AND THE APPS SO WE ENVISION HAVING MULTIPLE APPS THAT ARE BEING DEVELOPED BY A VARIETY OF DIFFERENT APP DEVELOPERS WHO WOULD BE ABLE TO COLLECT INFORMATION SUCH AS ACUTE SYMPTOMS, CLINICAL HISTORY, TESTING RESULTS AND EVEN OUT-OF-THE-BOX SENSORS. THERE ARE A VARIETY OF DIFFERENT HEART RATE SENSORS, FIT BITS, APPLE WATCHES, AND IT LOOKS LIKE ABOUT A QUARTER OF THE POPULATION HAS ACCESS TO THOSE SENSORS. SO QUITE A LARGE NUMBER OF PEOPLE. THE APP CAN TAKE IN THAT TYPE OF INFORMATION. IT CAN ALSO CONNECT TO ELECTRONIC HEALTH RECORDS AND IT CAN ACCESS THINGS LIKE GEOGRAPHIC DATA, TEST SITES TO HELP PROVIDE PEOPLE WITH INSIGHT AND INFORMATION ON WHERE THEY COULD POTENTIALLY GO AND GET TESTS AND ENSURE THAT YOU ARE THE PERSON WHO IS GETTING THE TEST AS OPPOSED TO NOT HAVING SECURE TESTS WHERE THERE IS AMBIGUITY ABOUT WHETHER IT IS YOU OR PERHAPS YOU'RE USING BODY FLUID FROM ANOTHER PERSON OR NOT A REAL SAMPLE. SO WE ENVISION HAVING THIS APP OR A SERIES OF APPS THAT WOULD BE ABLE TO HELP FACILITATE THE ENTIRE RESEARCH ECOSYSTEM, DIGITAL HEALTH PLATFORM AND IT WOULD BE ABLE TO PROVIDE DE-IDENTIFIED DATA TO OUR RESEARCH COMMUNITY TO HELP FACILITATE THOSE RAD X UPSTUDIES AS WELL AS OTHER RESEARCH STUDIES. SO I THINK I'LL TRY TO WRAP IT UP NOW AND JUST SORT OF SUMMARIZE. I HOPE I HAVE CONVINCED ALL OF YOU THAT ENGINEERING IS IMPORTANT IN THIS ENTERPRISE. WE AS AN INSTITUTE HAVE A LOT WE CAN CONTRIBUTE. BOTH IN TERMS OF UNDERSTANDING, PREVENTING AND DETECTING DISEASE AND ALSO IN HELPING US DEVELOP NEW TECHNOLOGIES TO PERSONALIZE DISEASE DIAGNOSIS AND TREATMENT. WE THINK THIS IS GOING TO BE IMPORTANT IN EXTENDING HEALTH SPAN AND BECAUSE MANY OF THE TECHNOLOGIES CAN BE DEPLOYED AT SCALE WITH MATERIALS AND COMPUTATIONAL APPROACHES THAT ARE INTRINSICALLY IN EXPENSIVE, WE SEE THIS AS AN OPPORTUNITY TO REDUCE COST AND BARRIERS TO ACCESS AND CHANGE THE TRADITIONAL PARADIGM OF HOW MEDICINE IS BEING DONE AND OF COURSE, THIS FURTHER DRIVES INNOVATION AND EVEN COMMERCIALIZATION, WHICH IS ULTIMATELY IMPORTANT IF WE ARE GOING TO DISSEMINATE THESE TECHNOLOGIES TO A LARGE POPULATION. SO WITH THAT, I'LL END AND TAKE QUESTIONS IF WE HAVE TIME. >> DR. HUNTER: PLEASE INDICATE YOUR QUESTIONS IN THE CHAT BOX. I SEE FIRST UP DR. SUTHERLAND. DR. SUTHERLAND, DID YOU HAVE A QUESTION? >> DR. SUTHERLAND: THIS IS BILL SUTHERLAND FROM HOWARD UNIVERSITY. I WANT TO THANK YOU FOR AN EXCELLENT PRESENTATION. IT'S VERY INFORMATIVE. VERY EXCITING. MY GENERAL -- AND IT'S NOT DIRECTLY RELATED TO COVID. BUT I GUESS IN YOUR PRESENTATION YOU SAID THAT THERE HAS BEEN LIKE A 13% INCREASE IN THE BIOENGINEERING BUDGET ACROSS NIH AND ABOUT A 1% INCREASE IN NIBIB. IF I UNDERSTAND THAT CORRECTLY. TO WHAT EXTENT DOES NBIB INFLUENCE OR DIRECTOR GUIDE OR PROVIDE INPUT FOR THE ENGINEERING ACTIVITIES ACROSS THE OTHER INSTITUTES AT NIH? >> BRUCE TROMBERG: I THINK I MESSED UP THE POINT ON THE SLDE. I PROBABLY DIDN'T ARTICULATE IT AS CLEARLY AS I COULD. SO WHAT WE HAVE SEEN IS THAT ALL AROUND THE NIH WE ARE SUPPORTING RESEARCH THAT HAS BIOENGINEERING IN IT AND THEY MAY NOT EVEN KNOW IT, BUT TO TRACK ALL THESE DIFFERENT PROJECTS, ALL ACROSS THE NIH 13% OF THE TOTAL NIH BUDGET -- SO 13% IS SUPPORTING BIOENGINEERING RESEARCH ACTIVITIES. AND THE NIBIB, BY CONTRAST, 100% OF OURS GOES TO BIOENGINEERING, BUT OUR BUDGET IS JUST A SMALL SLIVER OF THE NIH BUDGET. ONLY ABOUT 1% OF THE TOTAL NIH BUDGET. SO TO ME, WHAT THAT MEANS IS THAT BY OWEN ENGINEERING IS GROWING ALL AROUND THE COUNTRY. WE COULDN'T POSSIBLY AS AN INSTITUTE, SUPPORT ALL THE BIOENGINEERING. I THINK THE BIG SUCCESS STORY THAT OTHERS -- OUR COLLEAGUES AT NCI AND NHLBI AND NINDS AND ALL THE OTHER INSTITUTES ARE ALL HAVING BIOENGINEERING PROJECTS. WE SEE THAT AS A GOOD SIGN. IN OTHER WORDS, YOU DON'T HAVE TO BE A BIOENGINEER TO HELP SUPPORT IT. SO WE THINK THAT THAT MEANS GETTING REALLY MORE BROADLY TO EMBRACE ALL ACROSS OUR COMMUNITY COMMUNITY. >> I HAD ONE COVID-FOLLOW-UP QUESTION. WHEN YOU LOOK AT ALL THE EXCITING WORK THAT YOU'RE SUPPORTING AND ENCOURAGING FOR THE TESTING, HOW MUCH CONSIDERATION IS GIVEN TO POINT OF CARE COSTS SINCE THAT MIGHT IMPACT AVAILABILITY TO MINORITY COMMUNITIES? >> DR. TROMBERG: SO THE GROUPINGS THAT ARE DEVELOPING THESE TECHNOLOGIES, USUALLY THE DRIVER AND THE BIGGEST PUZZLE THAT THEY TEND TO HAVE TO SOLVE IS THEY ARE TRYING TO COMMERCIALIZE S RELATED TO COSTS AND THE COST MODEL. AND WHAT IS VERY INTERESTING, WE HAVE A VERY UNIQUE OPPORTUNITY HERE BECAUSE THE MARKET ITSELF IS NOW VERY WELL DEFINED. IF WE ARE DOING TENS OF MILLIONS OF TESTS PER DAY, THAT IS AN UNPRECEDENTED SCALE OF A MARKET. AND I GUESS THE OPPORTUNITY FOR THAT IS, AS VE HAVE SEEN WITH PHONES, FOR EXAMPLE, TECHNOLOGY IN OUR PHONES, IT IS SO -- IF YOU ONLY HAD 100 OR 1000 OF THOSE PHONES, IT WOULD BE IMPOSSIBLE TO BUY ONE. BUT TO THE SCALING THE COST REALLY GOES DOWN. WHAT WE ARE HOPING IS THAT THERE WILL BE A REAL TRANSFORMATION AS PEOPLE THINK ABOUT TESTING AND MAKING IT MORE PERSONAL AND MAKING IT SO THAT IT'S NOT ONLY CONTROLLED BY BIG TESTING CORPORATIONS AND BIG LABORATORIES BUT MORE WIDELY ACCESSIBLE LIKE PREGNANCY TEST KITS AND THOSE TYPES OF THINGS. SO HOW THE PRICING WILL TURN OUT IS HARD TO SAY BUT I SEE THIS AS A HUGE, HUGE DRIVER ECONOMICALLY AS WELL AS SOCIALLY AND THE OPPORTUNITY TO CREATE APPS, THESE HEALTH PLATFORMS TO, PUT THE POWER OF THAT INFORMATION INTO PEOPLE'S HANDS THEMSELVES SO THAT THEY CAN HELP MAKE THEIR OWN DECISIONS IS ALSO GOING TO BE ANOTHER TRANSFORMATIONAL ASPECT. >> THANK YOU. >> DR. HUNTER: WE HAVE A QUESTION FROM DR. CALMAN AND THEN DOCTOR ZERILLA. >> THAT PRESENTATION REALLY EXCITED ME TO THINK ABOUT WHAT THE FUTURE LOOKS LIKE. MY QUESTION IS, SINCE THESE ACTIVITIES ARE ALL PUBLICLY-FUNDED WITH NIH DOLLARS, IS THERE A MECHANISM THAT WHEN THEY GET COMMERCIALIZED THAT SOME OF THOSE DOLLARS COME BACK TO SUPPORT CONTINUED DEVELOPMENT OF RESEARCH WITHIN THE SAME FAMILY? BECAUSE THESE THINGS AREN'T COMMERCIALIZED AND THEY DO GENERATE MILLIONS IF NOT BILLIONS OF DOLLARS, SOMETIMES. IS THERE A MECHANISM FOR THAT TO HAPPEN? >> DR. TROMBERG: I THINK A LOT OF THE ECONOMIC ANALYSIS SHOWS THAT WHEN THESE THINGS DO HAPPEN HAPPEN, THE GROWTH AND THE CREATION OF THE VALUE IN THE REGION IS THE HIRING OF THE PEOPLE THAT HAPPENS WITHIN THE COMPANIES AND THE GENERAL ASSOCIATED ECONOMIC GROWTH THAT GOES INTO THAT GETS REINVESTED BACK INTO THOSE REEGENCE AND INTO THE COUNTRY. SO WE ARE SORT OF USING THE SAME STANDARD MODEL THAT HAS BEEN DEVELOPED AND DEFINED AND ARTICULATED. MANY OF THE COMMERCIALIZATION ACTIVITIES ALL ACROSS THE NIH WERE ACTUALLY PRETTY MUCH EMULATING EVERYTHING. WE ARE NOT INVESTING A NEW PLATFORM, REALLY FOR COMMERCIALIZATION ACTIVITIES BUT WE ARE DEFINITELY TRYING TO ACCOMMODATE IT. SO WHAT WE ARE DOING RIGHT NOW, IT TYPICALLY TAKES US ABOUT 5-10 YEAR-CYCLE, DEPENDING UPON WHETHER OR NOT YOUR COMPANY IS IDENTIFIED TO MARKET AND THE TECHNOLOGY. I'D SAY THAT'S THE BIG REVOLUTIONARY SUPER HIGH RISK WE ARE DOING. AND YOU CAN ALMOST THINK OF THIS AS SHOTS ON GOAL IN A SENSE. WE ARE GOING TO BE TAKING A LOT OF SHOTS ON GOAL. THERE ARE GOING TO BE A LOT OF RISK HERE SO WE ARE TRYING TO STICK WITHIN MORE OR LESS HOW WE GENERALLY DO IT TO MAKE SURE THAT WE DON'T VIOLATE THE NORMAL MODE OF OPERATION OF THE NIH BUT AT THE SAME TIME, TAKE TIMED RISKS AND TECHNOLOGY RISKS. HOPEFULLY FOR THE BIG BREAKTHROUGHS. >> IF I COULD JUST ASK A QUICK FOLLOW-UP. DO YOU THINK THAT THE GOAL TOWARDS COMMERCIALIZATION -- DOES IT HELP THE COLLABORATION BETWEEN RESEARCH GROUPS OR DOES IT IMPEDE? AND WOULD THERE BE SORT OF A GREATER PUBLIC GOOD IF PEOPLE WERE COOPERATING ON TRYING TO FIND THE BEST SOLUTIONS RATHER THAN COMING UP WITH 1400 DIFFERENT SOLUTIONS? >> BRUCE TROMBERG: IN A SENSE, OUR INNOVATION FUNNEL IS REALLY DISTILLING AND FOCUSING THAT DOWN TO THE BEST SOLUTIONS. THE NUMBERS THAT WE ARE MODELING ARE QUITE DAUNTING. WE HAVE, AS I MENTIONED, AROUND 1200 OR SO APPLICATIONS THAT HAVE BEEN STARTED. WE ARE EXPECTING TO HAVE MAYBE FIVE WINNERS COME OUT OF THE FUNNEL. SO WE WILL NOT BE LAUNCHING THOUSANDS OF SHIPS. WE WILL BE SINKING THOUSANDS OF SHIPS. BUT THAT IS THE NATURE OF THE PROCESS AND I THINK THAT THAT IS WHY ALEXANDER HAS BEEN CALLING THIS A SHARK TANK THAT CAPTURED PEOPLE'S IMAGINATIONS. IT'S NOT REALLY THE PROCESS, BUT IT IS QUITE COMPETITIVE. >> THANK YOU VERY MUCH. >> HI, THANK YOU DR. TROMBERG FOR THIS EXCITING PRESENTATION. I HAVE QUESTIONS AND MAYBE SUGGESTIONS, LIKE FOR EXAMPLE, THERE IS A LOT OF NEED FOR INTERVIEWING COMBINATIONS -- [ INAUDIBLE ] IN TERMS OF PATIENT NEEDS AND -- [ INAUDIBLE ] ALSO, IN TERMS OF AGING POPULATIONS AND IMPORTANTLY ENGINEERING DEVICES -- [ INAUDIBLE ] AND JUST ONE LAST COMMENT, THE VIDEO WAS FANTASTIC. WE NEED TO MAKE SURE THAT INSERT WAS PLACING THE CAROTTED ARTERY ON THE VEIN NOT IN THE AORTA. THAT NEEDS TO BE CORRECTED IF THE WANT THE ANATOMY WELL -- THAT IS JUST A CORRECTION THERE. BUT THAT WAS FANTASTIC AND THANK YOU VERY MUCH. THIS IS EXCITING AND LEADS US FORWARD. >> BRUCE TROMBERG: THANK YOU VERY MUCH. IF YOU DON'T MIND, IF YOU WANT TO SEND ME AN E-MAIL TO FOLLOW-UP THAT, I'D BE HAPPY TO MAKE SURE THAT WE ARE THINKING ABOUT ALL THOSE THINGS. SO THANK YOU VERY MUCH. >> WILL DO. >> DR. HUNTER: OKAY, I DON'T SEE ANYMORE QUESTIONS. ELISEO, WOULD YOU LIKE TO HAVE THE LAST SAY? >> ELISEO PEREZ-STABLE: THANK YOU, BRUCE FOR THE INTERESTING AND EXCITING PRESENTATION. WE LOOK FORWARD TO WORKING WITH YOU MORE CLOSELY ON THESE TOPICS IN THE NEXT FEW MONTHS TO SEE HOW WE CAN MAKE A DIFFERENCE FOR OUR COMMUNITIES THAT IMPACT THIS TRAGEDY OF THIS PANDEMIC. AND YOU EVEN OPENED THE DOOR TO THE POSSIBILITY THAT MIGHT EVENTUALLY MAKE HEALTH CARE LESS EXPENSIVE, WHICH WOULD BE GREAT. [ LAUGHS ] SO ONE OF THE FEW THINGS WE HAVEN'T CRACKED YET BUT IT MAY TAKE STRUCTURAL CHANGES TO RESULT IN THAT. THIS WAS A WONDERFUL PRESENTATION AND I APPRECIATE IT. >> BRUCE TROMBERG: THANK YOU,, LEASEIO. >> DR. HUNTER: THANK YOU VERY MUCH, AND THNK YOU DR. TROMBERG. NOW WE ARE GOING TO -- BYE-BYE NOW WE ARE GOING TO MOVE ON TO THE CONCEPTS. WE HAVE TWO CONCEPTS TO REVIEW. FIRST ONE IS RESOURCE CENTERS FOR THE TRIBAL EPIDEMIOLOGY CENTERS. THE COUNCIL REVIEWERS ARE DR. KULA AND DR. RAMIREZ, THE PROGRAM OFFICER IS DR. NATHAN STINSON. DR. STINSON, TAKE IT AWAY. >> NATHAN STINSON: THANK YOU VERY MUCH AND GOOD AFTERNOON TO EVERYONE. CAN I HAVE THE NEXT SLIDE, PLEASE. THE NOB JECTIVE OF THERE IS SUPPORTED RESEARCH CENTER TO ENHANCE THE CAPACITY OF TRIBAL EPIDEMIOLOGY CENTERS ALSO KNOWN AS -- THAT CAN BE USED IN HEALTH RESEARCH AND/OR DIRECTLY ENGAGE IN HEALTH RESEARCH FOCUS AMERICAN INDIAN AND ALASKA NATIVE POPULATIONS. AND TO DEVELOP RESEARCH CAPACITY AMONG EARLY-STAGE INVESTIGATORS BASED OR AFFILIATED WITH -- NEXT SLIDE. THERE ARE ABOUT 5.6 MILLION INDIVIDUALS WHO IDENTIFY AS AMERICAN INDIANA, ALASKA NATIVE AND THERE ARE 574 RECOGNIZED TRIBES IN MANY -- AND MANY STATE-RECOGNIZED TRIBES. THE TRIBAL EPIDEMIOLOGY CENTERS ARE LOCATED THROUGHOUT THE COUNTRY AND THEY HAVE THREE COMPONENTS TO THEIR CONDITION. IDENTIFYING HEALTH PROBLEMS AND DISEASE RISKS, STRENGTHENING PUBLIC HEALTH CAPACITY AND DEVELOPING SOLUTIONS FOR DISEASE, PREVENTION AND CONTROL. EACH EVERYONE IS MULTIPLE TRIBAL COMMUNITIES WITH THE INDIAN POPULATIONS WITH A SPECIFIC GEOGRAPHICAL REGION AND TECs GENERALLY GO UNDER THE UMBRELLA UNDER A STATE OR REGIONAL INDIAN HEALTH BOARD OR TRIBAL HEALTH CONSORTIUM IT'S UNDER THE PER VIEW OF THE INDIAN HEALTH SERVICE, THE INDIAN HEALTH SERVICE IS ESSENTIALLY A SERVICE ORGANIZATION PROVIDING HEALTH CARE AND PUBLIC HEALTH THROUGH MESH INDIANS AND ALASKA NATIVES. SO RESEARCH IS ONLY A VERY, VERY SMALL PART OF THEIR MISSION. OUR INSTITUTE HAS PROVIDED SUPPORT TO TECs FOR OVER 10 YEARS. THE TECs ARE IDEALLY POSITIONED AND CONTRIBUTE SIGNIFICANTLY TO THE EVIDENCE-BASE AND SCIENTIFIC RESEARCH ON AMERICAN INDIANS AND ALASKA NATIVE HEALTH. NEXT SLIDE, PLEASE. THIS IS A GRAPHICAL REPRESENTATION OF WHERE THE TRIBAL EPIDEMIOLOGY CENTERS ARE LOCATED. THERE ARE 12 OF THEM. AND THEY BIND WITH THE INDIAN HEALTH SERVICE UNITS. NEXT SLIDE, PLEASE. INITIALLY WE WILL SUPPORT A SINGLE RESEARCH CENTER TO PROVIDE TECHNICAL ASSISTANCE, RESEARCH CAPACITY ON EARLY-STAGE INVESTIGATORS FILL EIGHTED WITH TECs AND TO PROVIDE -- AFFILIATED -- AND TO PROVIDE SUPPORT TO THE 12TECs FOR ONGOING OPERATIONS. THE RESOURCE CENTERS PROVIDE SUPPORT TO EACH, TO ENHANCE CAPACITY, TO ENGAGE IN DATA COLLECTION, COMPILATION ANALYSIS AND REPORTING, PROVIDE TECHNICAL ASSISTANCE TO THE TECs WITH DATA COLLECTION, DURATION AND ANALYSIS. THROUGH SEVERAL DIFFERENT MEETINGS INCLUDING REGULARLY-SCHEDULED CONSULTATIONS TO INDIVIDUAL TECs AS WELL AS WEBINARS OR WORKSHOPS THAT ARE AVAILABLE TO ALL THE TECs. DEVELOPMENT AND SUSTAINED MENTORING PROGRAMS FOR EARLY-STAGE INVESTIGATORS BASED IN OR CLOSELY AFFILIATED WITH THE TRIAL EPIDEMIOLOGY CENTER. NEXT SLIDE. DISSEMINATING INFORMATION ABOUT NIH AND OTHER FEDERAL RESEARCH FUNDING, TRAINING AND MENTORSHIP OPPORTUNITIES AND PROVIDE TECHNICAL ASSISTANCE TO TECs ON HOW TO PREPARE APPLICATIONS FOR RESEARCH GRANT FUNDING. MAINTAIN A LISTING OF SHAREABLE DATA RESOURCES GENERATED BY THE TECs AND AS WELL AS DATA SHARING AND POLICIES AND REQUIREMENTS OF THE TECs TO FOSTER COLLABORATION ACROSS TECs AND BETWEEN THEM AND EXTERNAL RESEARCHERS. MAINTAIN COMPENDIUM OF PUBLICLY-AVAILABLE RESOURCES INCLUDING PUBLICATIONS, REPORTS AND PUBLIC HEALTH CAMPAIGN MATERIALS. AND FINALLY TO SERVE AS A LIAISON BETWEEN THE TECS AND EXTERNAL RESEARCHERS INTERESTED IN COLLABORATIVE RESEARCH. THIS INITIATIVE WOULD BE COMPLEMENTARY TO ANOTHER INITIATIVE THAT WE HAVE PROVIDING RESEARCH FUNDING TO EXTRAMURAL INVESTIGATORS TO WORK WITH THE DATA THAT TECs HAVE ALREADY COLLECTED. NEXT SLIDE TALKED ABOUT THE ELIGIBILITY THAT WILL BE OPEN TO THE WIDE RANGE OF INSTITUTIONS. CLEARLY WE ARE INTERESTED IN RECEIVING APPLICATIONS FROM ORGANIZATIONS THAT HAVE A HISTORY OF WORKING WITH THE TECs OR FROM ANY ONE OF THEM AS WELL. THE MECHANISM OF SUPPORT THAT WE WILL USE WILL BE ACQUIRED BECAUSE WE EXPECT THAT THERE WILL BE A SUBSTANTIAL FEDERAL INVOLVEMENT IN THE RESOURCE CENTER AS IT PROVIDES ACTIVITIES TO THE INDIVIDUAL TRIBAL EPIDEMIOLOGY CENTERS. NIMHD HAS DISCUSSED THIS INITIATIVE WITH THE DIRECTOR OF THE INDIAN HEALTH SERVICE AND HE ENDORSED THIS INITIATIVE SHOULD IT GET APPROVED BY OUR COUNCIL. AND WE HAVE ALSO TALKED WITH THE NIH TRIBAL HEALTH RESEARCH OFFICE AS WELL. THAT IS ALL. >> DR. HUNTER: THANK YOU VERY MUCH. UNFORTUNATELY, WE ONLY HAD SIX SLIDES IN THAT LAST SET. SO, WE WERE MISSING ONE. DR. KULA, WILL YOU PLEASE -- >> CAN YOU HEAR ME? >> DR. HUNTER: YES, WE CAN HEAR YOU. >> THANK YOU VERY MUCH. FIRST I WANT TO THANK DR. TIN SEN ANDAL VERES FOR THEIR EXCELLENT AUTHORSHIP FOR THIS INITIATIVE TO DEVELOP A RESOURCE CENTER FOR THE TECs. I THINK IT'S AN EXCELLENT CONCEPT OR INITIATIVE THAT IS WELL-NEEDED TO EXPAND THE CAPACITY OF ITS TECs IN THIS AREA OF RESEARCH BUT I'M PARTICULARLY EXCITED ABOUT THE OPPORTUNITY IT HOLDS TO DEVELOP EARLY-STAGE INVESTIGATORS, ESPECIALLY THOSE FROM AMERICAN INDIAN ALASKA NATIVE BACKGROUNDS& AND ALSO TO INCREASE A NUMBER OF HEALTH DISPARITIES RESEARCH OF THESE POPULATIONS FOR OTHER INVESTIGATORS AS WELL AND LEVERAGING THE RESOURCES AND THE ABILITIES OF THESE TECs IN DOING THAT. I'D LIKE TO JUST GIVE THE RESEARCH CAPACITY ACROSS THE TECs VARY CONSIDERABLE, PERHAPS SOME VERY LIMITED RESEARCH CAPACITY CURRENTLY TO MAYBE A HANDFUL THAT MIGHT HAVE STRONGER CAPACITY FOR RESEARCH. I THINK THIS PARTICULAR INITIATIVE IS EXCELLENT NEXT STEPS FOR NIMHD GIVEN INVESTMENT THAT NIMHD ALREADY MADE IN THE TECs TO REALLY MOVE TOWARDS INCREASING HEALTH DISPARITIES RESEARCH IN THESE POPULATIONS. SEVERAL OTHER COMMENTS REGARDING THIS HAS TO DO WITH ENSURING THAT GIVEN THE NATURE OF THE RESEARCH HEALTH DISPARITIES RESEARCH, AND THE BREATH OF RESEARCH IN THE TECs COULD BE DOING THAT PART OF THE GRANTEE WHAT THAT WOULD HAVE THE HEALTH COMMUNICATION, CAMPAIGNING EXPERTISE, AS WELL AS CULTURAL TAILORING EXPERTISE, BEHAVIORAL SCIENCE AND PERHAPS EVEN IMPLEMENTATION DISSEMINATION SCIENCE EXPERTISE TO EFFECTIVELY ASSIST AS A RESOURCE CENTER AND PROVIDE THE NEEDED EXPERTISE FOR THE TECs. WITH THAT SAID, GOING BACK TO THE EQUITABLE ISSUES OF DIFFERENCES ACROSS THE TECs AND RESEARCH CAPACITY, ENSURING THAT THERE IS IT AN EQUITABLE SUPPORT GIVEN TO EACH AND MEETING THEIR NEEDS OF WHERE THEY ARE AT IN READINESS TO ENGAGE IN RESEARCH. AND ANOTHER IDEA TO THINK ABOUT AS MENTIONED THAT HAS ALREADY BEEN A LOT OF OTHER SUPPORTS TO THE TEC CURRENTLY OR TO RESEARCH USING PARTNERING WITH THE TECs, THE IDEA OF MARKETING THIS NETWORK TO THE LARGER AND BROADER ACADEMIC COMMUNITY TO ENSURE ONE THAT PEOPLE ARE AWARE AND JUNIOR INVESTIGATORS ARE AWARE OF THIS OPPORTUNITY, SO THAT MIGHT BE ONE THING TO CONSIDER OR NEED TO BE ADDRESSED WITH THIS PARTICULAR CONCEPT. BUT THAT IS ALL I HAVE. THANK YOU. >> DR. HUNTER: THANK YOU VERY MUCH. DR. RAMIREZ? >> HELLO. THANK YOU FOR THE OPPORTUNITY TO COMMENT ON THIS CONCEPT. IT'S A VERY INTERESTING AND MUCH-NEEDED CONCEPT. THIS IS TO ESTABLISH A RESOURCE CENTER TO ENHANCE THE RESEARCH CAPABILITIES OF THE 12 CURRENTLY-FUNDED TRIBAL AND EPICENTERS. THESE EPICENTERS WERE ESTABLISHED BACK IN 1996 AND NIMHD HAD A MAJOR PART IN SUPPORTING THEM OVER THE YEARS. ONE OF THE IMPORTANT FUNCTIONS OF THIS GROUP IS TO INCREASE RESEARCH CAPACITY WITHIN THE AMERICAN INDIAN AND ALASKA NATIVE POPULATIONS. THE RESEARCH CENTERS WILL PROVIDE A RANGE OF SUPPORT TO THESE 12 CENTERS FROM TECHNICAL ASSISTANCE TO CAREER MENTORING TO AGAIN, INCREASING RESEARCH CAPACITY. SO IT WAS VERY WELL WRITTEN. THANK YOU DR. STINSON ANDAL VERES FOR THIS CONCEPT. SOME POINTS THAT I THINK YOU SHOULD BE SENSITIVE TO IS THAT DUE TO THE VARIETY OF EXPERTISE AT EACH OF THESE 12 CENTERS, SOME RANGING FROM MASTERS-LEVEL INDIVIDUALS TO PH.D., IT WOULD BE IMPORTANT FOR THE APPLICANTS TO BE SENSITIVE TO THE PARITY ACROSS THE 12 CENTERS AND THAT DEPENDING ON WHAT EXPERIENCE TO THE APPLICANTS HAVE TO DEAL WITH THIS VARIETY OF CAPACITY. SO THAT THEY SHOULD JUST BE SENSITIVE TO THAT AND MAYBE HAVE CAREER DEVELOPMENT FOR EACH OF THESE DIFFERENT STAGES. EARLY-STAGE INVESTIGATORS WILL VARY ACROSS SITES AND THE CONCEPT SHOULD BE OF THE TYPE OF EXPERIENCE THAT THEY ARE GOING TO NEED OR SUPPORT WILL VARY ACROSS EACH OF THE SITES. SO THEY JUST NEED TO BE SENSITIVE TO THIS ISSUE SO THAT THESE YOUNG INVESTIGATORS CAN BE MORE SUCCESSFUL IN THEIR SUBMISSION OF FUTURE GRANTS. THE RESEARCH CENTERS SHOULD ALSO HAVE ACCESS TO A VARIETY OF EXPERTISE AS WAS STATED AND SHOULD NOT JUST BE LIMITED TO SPECIFIC RESEARCH STUDIES BUT ALSO BE MORE IN TUNE WITH DIFFERENT TYPES OF INTERVENTION STUDIES RANGING FROM EITHER HEALTH COMMUNICATIONS, BEHAVIORAL SCIENCE AND MOST OF ALL, BEING VERY SENSITIVE TO CULTURAL TAILORING. AND ANOTHER ITEM TO CONSIDER IS THAT THE RESOURCE CENTER SHOULD IDENTIFY WAYS TO HOW TO CONNECT WITH RESEARCHERS IN ACADEMIC INSTITUTIONS WHO MIGHT BE INTERESTED IN WORKING MORE CLOSELY WITH OUR TRIBAL CENTERS. BUT OVERALL, I FOUND THIS TO BE A VERY IMPORTANT CONCEPT AND A VERY SUPPORTED. THANK YOU. >> DR. HUNTER: THANK YOU VERY MUCH. AT THIS TIME I'D LIKE TO OPEN THE FLOOR TO THE OTHER COUNCIL MEMBERS IF THEY HAVE ANY COMMENTS THEY'D LIKE TO MAKE ABOUT THIS CONCEPT. SEEING NONE, MAY I PLEASE HAVE A MOTION TO MOVE THIS CONCEPT FORWARD TO FUNDING OPPORTUNITY ANNOUNCEMENT DEVELOPMENT. >> SO MOVED. >> SECOND. >> DR. HUNTER: OKAY, I THINK I HEARD A SECOND FROM DR. RAMIREZ AND FROM DR. ZORILLA. CORRECT? >> YES. >> DR. HUNTER: ALL IN FAVOR OF MOVING THIS CONCEPT FORWARD TO FOA DEVELOPMENT, PLEASE PUT A YES IN THE CHAT BOX. I SEE QUITE A FEW COMING UP NOW. IF ARE THERE ARE ANY OPPOSED, PLEASE PUT A "NO" IN THE CHAT BOX. SEEING -- NOT SEEING ANY "NO" VOTES, THE MOTION CARRIES AND THE CONCEPT IS APPROVED TO MOVE FORWARD TO FOA DEVELOPMENT. THANK YOU ALL VERY MUCH FOR THAT. SO THE NEXT CONCEPT THAT WE WILL LOOK AT AT THIS TIME IS THE HEALTH SERVICES RESEARCH ON MINORITY HEALTH AND HEALTH DISPARITIES RE-ISSUANCE. THE PROGRAM OFFICER IS DR. A DAG DAG. THE COUNCIL REVIEWERS ARE DR.S CHIN AND KORBY SMITH. DR. DAGHER, PLEASE. >> THANK YOU DR. HUNTER AND GOOD AFTERNOON EVERYONE. I'M IN THE DIVISION OF CLINICAL AND HEALTH SERVICES RESEARCH. BEFORE I START, I WOULD LIKE TO ACKNOWLEDGE DR. LARRY DESANTA AND DR. ELISEO PEREZ-STABLE FOR PROVIDING VALUABLE FEEDBACK AS I WAS DEVELOPING THIS CONCEPT AND ALSO I WOULD LIKE TO THANK MY COLLEAGUES AT NIMHD AND OTHER SENIOR LEADERSHIP WHO WHIFFEDDED FEEDBACK WHEN I PRESENTED THIS BEFORE. -- WHO PROVIDED FEED BACK -- THE PURPOSE IS TO RENEW THE EXISTING FUNDING ANNOUNCEMENT ON HEALTH SERVICES RESEARCH ON MINORITY HEALTH AND HEALTH DISPARITIES. AND ITS PURPOSE IS TO SUPPORT INNOVATIVE HEALTH SERVICES RESEARCH TO IMPROVE HEALTH CARE ACCESS DELIVERY, UTILIZATION AND QUALITY AND HEALTH OUTCOMES OF HEALTH DISPARITY POPULATIONS. NEXT SLIDE, PLEASE. SO, SOME OF THE REASONS FOR RENEWING THIS ANNOUNCEMENT IS FIRST, THE FUNDED GRANTS FOR THE PREVIOUS ANNOUNCEMENT CONSTITUTED A BROAD LINE OF RESEARCH INQUIRY. AND NOT ALL THE SPECIFIC RESEARCH INTEREST AREA IN THE FUNDING ANNOUNCEMENT WERE COVERED. FOR EXAMPLE, NO GRANTS ANALYZING INITIATIVES SUPPLY HEALTH CARE PRACTITIONERS IN MEDICALLY-UNDERSERVED AREAS WERE FUNDED. THE SECOND REASON IS THERE ARE NO OTHER SIMILAR FUNDING OPPORTUNITIES AT NIH. OTHER AGENCIES SUCH AS THE AGENCY FOR HEALTH CARE RESEARCH AND QUALITY, THEY FUND HEALTH SERVICES RESEARCH BUT THEIR FUNDING DOES NOT ADDRESS HEALTH DISPARITIES. IN TERMS OF THE LITERATURE, DIFFERENCES IN UTILIZATION PATTERNS AND QUALITY OF CARE FOR HEALTH DISPARITY POPULATIONS VERSUS THE GENERAL POPULATION, HAVE BEEN WELL DOCUMENTED. HOWEVER, THE RESEARCH IS THAT MORE WORK IS NEEDED TO UNDERSTAND HOW BEST TO ELIMINATE INEQUITIES. THIS COULD OCCUR THROUGH EVALUATING INTERVENTIONS, EXISTING POLICIES, MAKING USE OF NATURAL EXPERIMENTS AND ALSO EXAMINING CAUSES OF DISPARITIES THAT ARE AMENABLE TO CHANGE. IN ADDITION, WITH THE EMERGING COVID-19 EPIDEMIC, THE UTILIZATION PATTERNS AND QUALITY OF CARE WILL NEED TO BE REVISITED AS NEW PATTERNS MAY EMERGE. FINALLY, THE NEW REPORT BY THE NATIONAL ACADEMY OF MEDICINE IN 2018 HIGHLIGHTED SIMILAR PRIORITIES AS THE ONES THAT ARE OUTLINED IN THIS FUNDING ANNOUNCEMENT, FOR EXAMPLE, THEY TALK ABOUT DEVELOPING MORE EFFECTIVE APPROACHES FOR INTEGRATING DATA ON SOCIAL DETERMINANTS OF HEALTH WITH OTHER HEALTH CARE DATA. THEY TALK ABOUT DETERMINING WHICH QUALITY MEASURES AND OUTCOMES ARE -- [ READING ] THEY TALKED ABOUT UNDERSTANDING THE IMPACT OF ALTERNATIVE MODELS, INNOVATIVE CARE DELIVERY MODELS AND ARTIFICIAL INTELLIGENCE IN HEALTH CARE. AND BUILD UPON EXISTING PROGRESS AND PATIENT SAFETY AND MEDICAL ERRORS AND FINALLY TO EXPLORE HOW TO BEST TRANSLATE HEALTH SERVICES RESEARCH AND SCALE AND IMPACT WITHIN POLICY SETTINGS AND HEALTH SYSTEMS. NEXT SLIDE, PLEASE. SO IF YOU LOOK THAT THE SLIDE, YOU CAN SEE THAT WE HAVE TWO FUNDING MECHANISMS FOR THIS. AN RO1 AND R21, AND THEY WERE RENEWED ONCE, RE-ISSUED. ANDBASICALLY THOSE FUNDING ANNOUNCEMENTS WERE DEVELOPED BECAUSE INITIALLY AT THE TIME OF THIS CONCEPT WAS DEVELOPED -- [ INAUDIBLE ] THE FOCUS ON THE SYSTEM LEVEL RESEARCH AND POLICY RESEARCH, ONLY CONSTITUTED 20% OF NIMHD'S RO1 SOCIAL BEHAVIOR PORTFOLIO. SO THIS WAS AN ATTEMPT TO INCREASE THAT PERCENTAGE. SO, IF WE LOOK AT THE FUNDING ANNOUNCEMENT IN GENERAL, THE RO1 FUNDING ANNOUNCEMENT GOT A 27.3% FUNDING RATE. AND THE RE-ISSUE SIMILARLY GOT A HIGH RATE OF FUNDING. HOWEVER, FOR THE R21, ONLY 6.4% FUNDING RATE WAS HAPPENING AT THE FIRST ROUND AND THEN THE REISSUE THERE WAS 0% FUNDING RATE. SO BASICALLY, WE ARE ASKING TO RENEW THE RO1 ANNOUNCEMENT. NEXT SLIDE, PLEASE. SO, SOME OF THE RESEARCH AREAS THAT WE ARE INTERESTED IN FOR RENEWING THIS FUNDING ANNOUNCEMENT IS TO EXPLAIN POPULATION-SPECIFIC PRESENTATION AND MANIFESTATION OF DISEASES AND THEIR COMPLICATIONS WITHIN THE CONTEXT OF HEALTH CARE SETTINGS, EXAMINE SERVICES WITHIN HEALTH CARE SYSTEMS AND NON-CLINICAL SETTINGS LINKED TO HEALTH CARE SYSTEMS SUCH AS SCHOOL-BASED HEALTH CENTERS, THE WORKPLACE AND CRIMINAL JUSTICE SETTINGS. EXAMINE ETIOLOGY AND REDUCTION OF HEALTH CARE DISPARITIES, ALSO EXAMINE THE STRUCTURE AND ORGANIZATION OF HEALTH CARE SYSTEMS AND HOW HEALTH CARE IS COORDINATED AND EXAMINE THE IMPACT OF HEALTH CARE AND NON-HEALTH CARE POLICIES THAT INCREASE OR REDUCE HEALTH CARE AND HEALTH DISPARITIES SUCH AS THOSE RELATED TO HEALTH INSURANCE COVERAGE, SICK LEAVE, MEDICAL LEAVE POLICIES ET CETERA. AND EXAMINE THE IMPACT OF SYSTEM-WIDE INTERVENTIONS OR MULTI-LEVEL INTERVENTIONS. NEXT SLIDE, PLEASE. SO, WE ENVISIONED THE SCOPE OF THE PROJECTS TO INCLUDE HEALTH SERVICES PERTAINING TO HEALTH PROMOTION, SCREENING FOR DISEASE OR RISK FACTORS, PREVENTION AT ANY LEVEL OF PRIMARY AND DIAGNOSIS AND TREATMENT OF PARTICULAR HEALTH CONDITIONS WHICH COULD INCLUDE CHRONIC DISEASES, MENTAL DISORDERS, SUBSTANCE ABUSE DISORDERS AND INFECTIOUS DISEASES SUCH AS THE COVID-19 OUTBREAK. WE ALSO WOULD LIKE TO SEE SPECIFIC SEGMENTS OF THE POPULATION AFFECTED BY HEALTH DISPARITIES BEING STUDIED SUCH AS PREGNANT WOMEN, CHILDREN, PERSONS WITH DISABILITIES AND OLDER ADULTS. WE ALSO WANT MORE GENERAL IN THE CASE OF NOT JUST CONDITION-SPECIFIC ONES. SO FOR EXAMPLE, ACCESS TO PRIMARY CARE SERVICES. AND THAT'S ABOUT IT. THANK YOU. >> DR. HUNTER: THANK YOU VERY MUCH. THAT WAS VERY GOOD. DR. CHIN, MAY WE HAVE YOUR COMMENTS, PLEASE. >> DR. CHIN: THANK YOU VERY MUCH TO YOU AND YOUR TEAM FOR A GREAT PRESENTATION AND AN OUTSTANDING FOA HEALTH SYSTEM RESEARCH IS ONE OF THE THREE MAJOR AREAS OF THE INSTITUTE AND THIS COMPREHENSIVE FOA DOES A GREAT JOB OF SETTING UP THAT PARTICULAR PROGRAM FOR A GREAT CHANCE FOR SUCCESS. SO IT'S SUPPOSED TO -- AS OPPOSED TO SPENDING MOST OF MY TIME ABOUT THE GREAT STRENGTHS OF THE FOA, I'M GOING TO FOCUS ON SIX SUGGESTIONS FOR HELPING TO IMPROVE IT FURTHER. AND THIS IS TAKEN IN THE SPIRIT OF WAYNE GRETZKY HOCKEY STORY WHERE THE GREAT HOCKEY PLAYER DOESN'T WANT TO BE WHERE THE PUCK IS BUT WHERE THE PUCK IS GOING TO GO. AND ALL YOU HEAR IS WITH COVID-19, THERE IS NO SUCH THING AS RETURNING TO THE PRIOR COVID WORLD IN TERMS OF HEALTH CARE AND AS WELL AS THE ECONOMY AND ESSENTIAL SYSTEMS AND SO WE THINK ABOUT WHAT ARE THE EVOLVING QUESTIONS AND SOLUTIONS AS YOU MOVE INTO THIS NEW ERA. MY FIRST SUGGESTION IS REGARDING SOCIAL DETERMINANTS OF HEALTH, I WOULD HAVE PERHAPS A BROADER DEFINITION OF SOCIAL DETERMINANTS OF HEALTH THAN IS IN THE CURRENT DOCUMENT. IN THE CURRENT DOCUMENT WHICH IS LARGELY TAKEN FROM THE NATIONAL ACADEMY OF MEDICINE REPORT, ABOUT THE ASSESSMENT INITIATIVES THAT INTEGRATE SOCIAL DETERMINANTS OF HEALTH PUBLIC HEALTH CARE DATA AND THEIR IMPACT ON HEALTH CARE ACCESS AND HEALTH OUTCOMES OF POPULATIONS AFFECTED BY HEALTH DISPARITIES. IT'S ALMOST IMPLIED THAT IT'S MOSTLY ANALYZING SOCIAL DETERMINANTS OF HEALTH AS PART OF SECONDARY SETS. THAT CLEARLY IS IMPORTANT BUT SOCIAL DEPLETES OF HEALTH SPANS THE FULL RANGE OF STUDIES THAT NIH DOES FROM PRIMARY DATA COLLECTION STUDIES TO POLICY STUDIES TO COMMUNITY-BASED RESEARCH AND THE FULL SPECTRUM. SIMILARLY, THERE IS A SENSE THAT DIFFERENT PEOPLE CAN DEFINE STORM DETERMINANTS OF HEALTH IN VARIOUS WAYS AND I MAKE CLEAR THAT AT A MINIMUM, WE TEND TO THINK ABOUT IT ON TWO DIFFERENT LEVELS. THE HEALTH CARE SYSTEM OFTEN THINKS ABOUT ADDRESSING INDIVIDUAL PERSONS SOCIAL NEEDS AT THE SAME TIME IT'S CRITICAL TO ADDRESS THE UNDERLYING STRUCTURAL SYSTEM DRIVERS OF THAT SOCIAL DETERMINANT. SO FOR EXAMPLE, HELPING ONE FOOD-INSECURE PERSON WITH THEIR INSECURITIY IS IMPORTANT BUT EQUALLY IS ADDRESSING THE WIDER PROP OF FOOD INSECURITY, ESSENTIAL DETERMINANTS OF HEALTH CAN INCORPORATE BOTH. SIMILARLY, WE WANT TO MAKE CLEAR FOR THE FO. THAT WE ARE NOT TALKING ABOUT HEALTH CARE SILO. THE CUTTING-EDGE OF SOCIAL DETERMINANTS OF HEALTH IS THE INTERSECTORAL PARTNERSHIPS, SO FOR EXAMPLE HOW CAN HEALTH CARE PARTNER WITH COMMUNITY-BASED ORGANIZATIONS TO MORE BROADLY EFFECT AND IMPACT SOCIAL DETERMINANTS OF HEALTH? THE SECOND SUGGESTION IS SPECIFICALLY INCORPORATE NEIGHBORHOOD IN GEOGRAPHY AS ONE OF THE BULLETS IN PRIORITIES. IT'S INCLUDED IMPLICITLY IN THE MULTI-LEVEL NIMHD PROFESSIONAL MODELED FOR DISPARITIES RESEARCH BUT ESPECIALLY IMPORTANT ISSUE THINKING ABOUT GOING BEYOND THE INDIVIDUAL FACTORS OF A PERSON TO BY SURROUNDING NEIGHBORHOOD AND PLACE, THE CRITICAL CUTTING AGENCY AREAS OF RESEARCH. THIRD, THERE WAS NOTHING MENTION OF INTERSECTIONALITY IN THE DOCUMENT AND SO OFTENTIMES WE SIMPLIFY AND TALK ABOUT INDIVIDUAL PERSONAL CHARACTERISTICS OR RISK FACTORS BUT IN REALITY, WE ALL HAVE MULTIPLE IDENTITIES AND THESE RELATIONSHIPS ARE CRITICAL. SO MULTIDIMENSION ALLOTTEES AS WELL AS THE DEFINITION OF INTERSECTIONALITY WHICH TALKS ABOUT INTERSECTING SYSTEM AND OPPRESSION THAT LEADS TO DISPARITIES AND BOTH ARE IMPORTANT WITH DISPARITIES. RELATED IS THAT WE NEED TO ALSO THINK ABOUT HETEROGENEITY WITHIN DIFFERENT POPULATION SUBGROUPS. SO FOR EXAMPLE, WITHIN THE LATTEN POPULATIONS THE DIVERSITY ACROSS PUERTO RICAN, CUBAN, AND MEXICAN-AMERICAN POPULATIONS. FOURTH, I WOULD FURTHER HAVE DESCRIPTION ABOUT THE COST AND FINANCIAL ASPECTS WHICH ARE A CRITICAL DRIVER OF HEALTH DISPARITIES AND CRITICAL COMPONENT OF SOLUTIONS. CURRENTLY IN THE FOA THERE IS ONE BULLET THAT TALKS ABOUT COST TO FINISH AND DELIVER HEALTH CARE TO IMPROVE MINORITY HEALTH OR REDUCE HEALTH DISPARITIES. IT DOESN'T REALLY TALK ABOUT THE RANGE OF THE COST ANALYSIS WHICH ARE ELIGIBLE AND I WOULD ARGUE THAT A WHOLE VARIETY OF COST ANALYSIS ARE IMPORTANT FOR DIFFERENT STAKEHOLDERS RANGING FROM THE COST IN A BUSINESS CASE FROM A USER INTERVENTION, SOCIETAL COST ANALYSIS, POLICY INTERVENTIONS, AND SEVERAL DIFFERENT TYPES OF COST ANALYSIS. FIGHT, THE BULLET ABOUT POLICIES -- FIFTH -- IT GOT A LITTLE BIT BIG. ON ONE HAND ONE CAN INTERPRET THIS AS SAYING WE SHOULD LOOK AT VERY SPECIFIC POLICIES SUCH AS INSURANCE COVERAGE OR SICK LEAVE, AND THAT IS PART OF IT, AT THE SAME TIME THOUGH, THERE IS ALSO A ROLE IN THINKING ABOUT BROADER POLICIES AND IT'S NOT JUST A PARTIAL OBSERVER AS A BYPRODUCT OF CONSEQUENCES AND POLICIES. THE CUTTING-EDGE IS REALLY POLICIES ARE SPECIFICALLY DESIGNED TO REDUCE DISPARITIES. THAT'S WHERE A LOT OF THE ACTION IS AT AND ESPECIALLY AS THE COVID PANDEMIC PROGRESSES. THIS IS BELIEVE PROY GOING TO BE THE MOST IMPORTANT SET OF POLICIES. 6th IS RIGHT NOW WE DOCUMENT THERE IS NOT SPECIFIC MISSION OR IMPLEMENTATION SCIENCE DISSEMINATION SCIENCE, REALLY LIKE A FACILITATORS AND BARRIERS TO HAVING AN INTERVENTION BE SUCCESSFULLY IMPLEMENTED AND SPREAD OR TRANSLATION SCIENCE OF IMPLEMENTING INTERVECTIONS IN THE REAL WORLD. SO I THINK OVERALL, A TERRIFIC START AND REALLY I FOUNDATION FOR HEALTH SERVICE RESEARCH ELEMENT OF THE INSTITUTE AND I THINK IT'S A HANDFUL OF ADDITIONS THAT CAN MAKE THIS MORE POWERFUL AND RELEVANT AS WE MOVE AHEAD IN OUR PANDEMIC WORLD. >> DR. HUNTER: THANK YOU VERY MUCH DR. CHIN. DR. KORBY SMITH. >> DR. SMITH: THANK YOU VERY MUCH, JOYCE AND MARSHAL THANK YOU FOR THAT COMPREHENSIVE SET OF SUGGESTIONS. I ONLY HAVE A FEW ADDITIONS TO MAKE. FIRST OF ALL, I WANT TO REITERATE THE IMPORTANCE OF THIS CONCEPT PAPER. IT'S A CRITICAL -- IT'S ALREADY A CRITICAL SORT OF LEG OF NIMHD BUT I THINK THAT THERE IS AN OPPORTUNITY HERE TO CONTINUE TO MOVE THIS NEEDLESS FORWARD FROM UNDERSTANDING HEALTH IN EQUALITIES TO ACTUALLY MELIORATING AND ADVANCE TOWARDS HEALTH EQUITY. I WILL SAY THAT MY SUGGESTION WOULD BE TO CONTINUE TO REDUCE THE AMOUNT OF EMPHASIS THAT IS PLACED ON CAUSAL ON THE SORT OF CAUSAL, UNDERSTANDING THE CAUSAL RELATIONSHIPS BETWEEN FACTORS AND REALLY EMPHASIZING THE OPPORTUNITIES TO NOT ONLY STUDY INTERVENTIONS THAT MIGHT MITIGATE HEALTH INEQUALITIES BUT ALSO STUDY WAYS TO TRANSLATE THOSE INTERVENTIONS TO MORE PEOPLE IN MORE PLACES, MORE QUICKLY. SO DISSEMINATION AND IMPLEMENTATION OR IMPLEMENTATION SCIENCE RESEARCH COULD BE UNDERSCORED HERE. I WOULD ALSO SUGGEST THAT THERE ARE A LOT OF SEVERAL INNOVATIVE METHODS THAT COULD BE CALLED OUT AROUND SYSTEM SCIENCE AND SOME OF THE WAYS TO THINK ABOUT MULTI-LEVEL INTERVENTIONS. SOME OF THE WAYS TO THINK ABOUT TESTING MULTI-LEVEL INTERVENTIONS, PARTICULARLY THROUGH SYSTEM SCIENCE. AND THEN THE LAST POINTED THAT I WOULD ADD AND UNDERSCORE WHAT MARSHAL HAS ALREADY SAID, IS TO REALLY EMPHASIZE AND UNDERSCORE THE POTENTIAL ROLE THAT HEALTH CARE SYSTEMS CAN MAKE AS ANCHOR INSTITUTIONS IN ADDRESSING HEALTH INEQUALITIES. SO STUDYING THE WAYS THAT PARTNERSHIPS, NOVEL PARTNERSHIPS AND HEALTH CARE SYSTEMS AND COMMUNITY ORGANIZATIONS OR COMMUNITY SERVICE ORGANIZATIONS CAN DRIVE NOT ONLY PROXIMAL PATIENT-LEVEL OUTCOMES AND SYSTEM-LEVEL OUTCOMES BUT CAN BE AN ANCHOR FOR ADDRESSING THE ROOT CAUSES OF HEALTH INEQUALITIES WE SEE IN OUR COUNTRY. THANK YOU. >> DR. HUNTER: FAUCI. I WOULD NOW OPEN THE FLOOR TO THE OTHER COUNCIL MEMBERS IF YOU HAVE COMMENTS. EXCUSE ME. MAY I PLEASE HAVE A MOTION TO MOVE THE CONCEPT FORWARD TO FOA DEVELOPMENT. MAY I HAVE A SECOND? ALL IN FAVOR OF MOVING THE CONCEPT FORWARD TO FOA DEVELOPMENT VOTE YES IN THE CHAT BOX. IF THERE ARE ANY COUNCIL MEMBERS OPPOSED TO MOVING THAT FORWARD, PLEASE VOTE NO IN THE CHAT BOX. SEEING NONE, THE MOTION CARRIES FORWARD FOR THE CONCEPT TO BE DEVELOPED INTO AN FOA. THANK YOU ALL VERY MUCH. I APPRECIATE YOUR PARTICIPATION IN THIS PROCESS. I'LL NOW TURN IT BACK OVER TO AT A STABLELISEO PEREZ-STABLE. >> ELISEO PEREZ-STABLE: THANK YOU JOYCE AND FOR YOUR PARTICIPATION AND ENGAGEMENT THROUGH A LONG DAY OF WEB-BASED MEETINGS. I DON'T BELIEVE THAT WE HAVE ANYBODY REQUEST FOR PUBLIC COMMENT. IF THAT'S NOT THE CASE, JOYCE, LET ME KNOW. BUT I'M ASSUMING NOT. I DIDN'T SEE ANYBODY ELSE INVITED TO THE VIRTUAL TABLE. >> DR. HUNTER: THAT'S CORRECT. >> ELISEO PEREZ-STABLE: ANY SPECIAL PARTING WORDS OTHER THAN BEING VERY APPRECIATIVE OF YOUR CONTRIBUTIONS, I THINK I HAVE A COUPLE OF E-MAILS FROM INDIVIDUALS ON COUNCIL ABOUT QUESTIONS. YOU'RE FREE TO CONTACT US DIRECTLY OR THROUGH PROGRAM OR WHOMEVER REGARDING ANY OF THE ISSUES THAT WE HAVE DISCUSSED. I DO EXPECT INFORMATION TO CONTINUE TO BE GENERATEDDED ON A RAPID PACE AS WE CONTINUE TO TRY AND DEAL WITH THIS PANDEMIC FROM A SCIENCE PERSPECTIVE AT NIH AND ALSO GIVEN OUR CONCERNS. ARE THERE ANY OTHER COMMENTS OR QUESTIONS OR ANY COUNCIL MEMBERS WOULD LIKE TO MAKE BEFORE WE CLOSE THE MEETING? HE SAYS EQUITYINAL ENS THE CURVE. THAT'S A GOOD SAYING. THE CONCEPT OF THE FLATTENING THE CURVE, WHICH IS -- I GUESS EVERYBODY HAS GOTTEN -- [ READING ] REALLY EXTENDS FROM THE AVOIDING WHAT HAPPENED IN NEW YORK CITY, THIS MASSIVE SURGE OF CASES OR NORTHERN ITALY, AND PUSH THE HEALTH SYSTEM TO THE BREAKING POINT. AND IT DOES BRING INCREDIBLE DILEMMAS TO THE HEALTH CARE SYSTEM AND SOCIETY. BUT IT'S NOT A SOLUTION. LOCKDOWN HAS ENORMOUS ADVERSE EFFECT ON THE POPULATION, PARTICULARLY THE 50-60% OF THE PEOPLE WHO CANNOT TELEWORK FOR A LIVING. AND FORGET ABOUT PHYSICAL DISTANCING AND CROWDED SITUATIONS. THEIR JOB DEPENDS ON PEOPLE GOING TO A RESTAURANT OR HAVING SERVICE PROVIDED AND THE FRONT LINE WORKERS IN THE SERVICE STORES OBVIOUSLY ARE CONTINUING TO WORK BUT THERE ARE A LOT OF INDUSTRIES THAT ARE GOING TO BE IMPACTED BY THIS, NOT JUST DURING THIS LOCKDOWN BUT FOR A LONG TIME IF NOT PERMANENTLY. SO WE'LL SEE WHAT HAPPENS. IN THE MEANTIME, DON'T HESITATE TO COMMUNICATE. WE DEPEND ON YOU FOR ADVICE. NO ONE ELSE HAS A PROBLEM SENDING ME E-MAILS SO I ALWAYS LOOK FORWARD TO YOURS. SO, STAY SAFE. KEEP OUR SPIRITS UP. CONTINUE TO DO YOUR WORK, WHICH WILL BE REALLY -- WE ARE AN IMPORTANT PART OF THE SOLUTION IN MOVING OUR SOCIETY FORWARD THROUGH THIS PANDEMIC. THANKS AGAIN, VERY MUCH. >> : WE WILL END THE MEETING WITH A VIRTUAL GAVEL. THANK YOU, EVERYBODY.