>> I'M DR. ESTHER STERNBERG, CHAIR OF THE BOARD OF REGENTS, WELCOME TO THE MEMBERS AND VISITORS. I WOULD LIKE TO START WITH A MOMENT OF SILENCE FOR DR. KEVIN WALKER WHO AS Y'ALL KNOW PASSED AWAY RECENTLY. SO IF YOU COULD HAVE A MOMENT OF SILENCE. HE WILL BE GREATLY MISSED. HE IS GREATLY MISSED, VERY WISE MEMBER OF THE BOARD WHO ALWAYS KEPT US IN LINE. GREAT CONTRIBUTIONS. SO WITH THAT, I WILL CALL TO ORDER. OUR USUAL ORDER OF BUSINESS IS TO LOOK AT THE MINUTES, APPROVE THE MINUTES, THEN LOOK AT FUTURE MEETINGS. SO YOU HAVE ALL HAD AN OPPORTUNITY TO LOOK AT THE MINUTES. AND DO I HAVE A APPROVAL? VOTE? >> MOTION TO APPROVE. >> SECOND? >> SECONDED. >> THANK YOU. IN THE FUTURE MEETINGS, IT'S ON YOUR SCHEDULE, DOES ANYBODY HAVE ANY CONCERNS? THE ONE NOT YET SET IS A YEAR FROM NOW, MAY 12, '19. >> I WANT TO CALL YOUR ATTENTION, THAT'S TWO YEARS FROM NOW. IN 2020. IT HAPPENS TO BE THE WEDNESDAY BEFORE THE MLA MEETING BEGINS ON FRIDAY. IF YOU WOULD LIKE US TO RECONSIDER THAT DATE WE CERTAINLY CAN. IT IS CONSISTENT WITH OUR USUAL CYCLE, MLA IS THE ONE THAT CHANGED THE GAME THIS YEAR. >> ANYONE HAVE ANY CONCERNS WITH THAT? THOSE ATTENDING MLA? NO? THEN DO I HAVE AN APPROVAL? >> SO MOVED. >> AND JUST TO ALERT EVERYONE TO THE MOST RECENT UPCOMING MEETING, THE LEITER LECTURE WILL TAKE PLACE IN THE AUDITORIUM TOMORROW FROM 1:30 TO 2:30. SARA BUSHMAN TALKING PRECISION MEDICINE INITIATIVE. THAT SHOULD BE VERY EXCITING, AS YOU KNOW ERIC WAS ON OUR BOARD BEFORE HE GOT RECRUITED TO LEAD THIS INITIATIVE. SO WE HOPE YOU CAN SEE ALL OF YOU THERE. >> IT LAUNCHED SUNDAY. >> YES. GREAT. WITH THAT, I WILL TURN IT OVER TO DR. BRENNAN FOR YOUR REPORT. >> THANK YOU. >> GOOD MORNING, THANK YOU VERY MUCH FOR JOINING US HERE IN BETHESDA AT THIS MAY MEETING OF NATIONAL LIBRARY OF MEDICINE BOARD OF REGENTS. I WELCOME THOSE CONNECTING VIA WEBEX ALSO. THOSE SITTING IN THE ROOM MAY HAVE NOTICED SEVERAL THINGS ARE DIFFERENT SINCE FEBRUARY. WE HAVE CHANGED THE WALL COVERING AND WE HAVE ADDED A NEW PROJECTION SYSTEM. WE LOOKED FORWARD TO YOUR COMMENTS ABOUT HOW THIS PROJECTION SYSTEM WORKS FOR YOU. IN PARTICULAR, I'M INTERESTED IN WHETHER WE'RE BETTER AT MOVING OUR FRONT PROJECTOR TO MAKE TWO ON THE SIDE OR IF WE SHOULD ADD A SECOND ON THE SIDE THE RIGHT HAND SIDE AND LEAVE THE FRONT ONE IN PLACE ESSENTIALLY HAVING FIVE PROJECTORS. SORRY DISPLAYS. THE DISPLAYS WILL BE AFFIXED TO THE WALL AT SOME POINT, THIS WAS A PROCESS BY -- OF TRIAL AND ERROR OF MAKING SURE WE HAD THE RIGHT SYSTEMS SET UP AND I PERSONALLY AM VERY GRATEFUL TO THE GROUP THAT WORKED TO GET THIS IN PLACE. IN RECORD TIME FOR A FEDERAL ACQUISITION I HAVE TO SAY. THOSE THAT MISSED THE PROJECTOR DROPPING DOWN AND THE GEAR SHIFTING IN THE FAN, WE'LL BE GLAD TO TURN IT ON OVER THE LUNCH BREAK. IF YOU HAVE TO HAVE IT HERE AND SEE HOW THINGS ARE. SEE HOW TAKING BACK TO THOSE THRILLING MOMENTS OF YETER YEAR. WE HAVE BEEN BUSY SINCE FEBRUARY AND I'M PROUD THE TELL YOU SOME IMPORTANT ACTIVITIES THAT HAPPENED THEN WE'LL TALK IN DEPTH ABOUT HOW WE'RE PREPARING FOR THE FUTURE. WE HAVE INITIATED THE IMPLEMENTATION OF THE STRATEGIC PLAN THAT ALL OF YOU APPROVED DURING OUR FEBRUARY BOARD MEETING. I HAVE GIVEN MANY PRESENTATIONS AROUND NIH AND NATIONALLY AROUND THAT WE HAVE HEARD POSITIVE THINGS, VERY EXCITING RESPONSE FROM THE COMMUNITY, THE MEDICAL INFORMATICS COMMUNITY IS PARTICULARLY EXCITED ABOUT, THEY HAVE THE NEW INVESTMENT IN DATA SCIENCE, THE LIBRARY SCIENCE COMMUNITY HAS BEEN VERY EXCITED ABOUT THE MIX OF TRAINING AS WELL AS ENHANCED IMPROVED RESOURCES. WE HAVE HAD A COUPLE OF CONCERNS, MOST PERHAPS THE LARGEST ONE THAT'S LEVELED TO ME IS A FEAR THAT WE HAVE LOST A SENSE OF THE TRADITION OF LIBRARIES. IN THIS NEW STRATEGIC PLAN, I SAY IT IS ABSOLUTELY COMPLETELY ALIGNED WITH THE TRADITION OF LIBRARIES. WE CANNOT CREATE A DATA DRIVEN FUTURE WITHOUT THE FOUNDATION OF UNDERSTANDING WHAT DOES IT MEAN TO ACQUIRE AND CURATE APPROPRIATELY TO ASSURE PROTECTION OF PATRONS SEARCHING FOR MATERIAL AND PROVIDE PER DUTY STORAGE CONTENT IMPORTANT AS THE BASIS OF SCIENCE AND HEALTH SO WE ARE FUNDAMENTALLY AND WILL CONTINUE TO BE A LIBRARY. WE ARE DOING THINGS TO BE A MORE RESPECT WITH RESPONSIVE AND 21st CENTURY LIBRARY. WE HAVE ENHANCED ACCESS TO -- WE HAVE BEGUN A PROCESS TO ENHANCE TOXICOLOGY RESOURCES IN PARTNERSHIP BETWEEN SIS AND NCBI. THIS IS BRINGING TOGETHER A VERY ROBUST HEAVILY HUMAN CURATED REPOSITORY OF GOVERNMENT REPORTS OF COUNTY LEVEL REPORTS OF INFORMATION TOXICOLOGY AND QUALITY DISTRIBUTION SYSTEM THE NCBI DEVELOPED SO WE SEE THIS AS A WAY OF DEMONSTRATING SUPPORT OF TOXICOLOGY INFORMATION IN THE FUTURE AND I DIDN'T SEE FLORANCE IN HERE YET. IN CALIFORNIA SO JANICE KELLY IS HERE FOR THOSE THAT MAY HAVE QUESTIONS, NOT SURE HOW BRIEF BUT YOU ARE BUT I FIGURE YOU CAN MANAGE MOST OF THEM. WE'LL HEAR MORE PROJECT CALLED MED LINE 2022 WHICH IS A PURCHASE TO MAKE SURE OUR HIGH QUALITY, HIGH ESSENTIAL JOURNALS ARE ACCESSED AND INDEXED AND MADE ACCESSIBLE TO THE PUBLIC IN A WAY THAT IS EFFICIENT AND QUICK AND I'LL RETURN TO THAT BUT ESSENTIALLY BOTTOM LINE WITH MED LINE 2022 IS TO MAKE SURE WE ARE AT USING AUTOMATED INDEXING TOOLS FIRST AND APPLY OUR SCARCE BUT IMPORTANT HUMAN CURATED RESOURCES TO THOSE WHERE THEY'RE ESSENTIALLY NEEDED SO WE CAN ENSURE WE ARE ABLE TO MAKE LITERATURE ACCESSIBLE. THE NLM RESPONDED TO THE NIH HEEL INITIATIVE, HEEL IS HELPING TO END ADDICTION LONG TERM WHICH IS THE NIH PROGRAM AROUND ADDICTION PAIN MANAGEMENT AND OPIOID CARE. WE RECOGNIZE THAT THE SIGNIFICANCE OF SUBSTANCE ABUSE AND SUBSTANCE RISK PROBLEMS IN OUR COUNTRY AND AROUND THE WORLD ARE ONLY PARTIALLY RELATED TO OPIOIDS. THESE PARTNERSHIPS HAVE TO DO WITH PAIN MANAGEMENT, WITH CAREFUL TREATMENT OF INDIVIDUALS WHO HAVE ADDICTION, ADDICTIVE EXPERIENCES, ALSO ATTEND TO THE YOUNGEST CHILDREN WHO ARE BORN ADDICTED TO MAKE SURE THEY ARE GETTING A GOOD START IN LIFE. THE HEEL INITIATIVE IS DESIGNED TO BE A COMMUNITY-LEVEL, COMMUNITY-DRIVEN APPROACH THAT ENGAGES SCHOOLS, PUBLIC HEALTH AUTHORITIES, ENGAGES THE CRIMINAL JUSTICE SYSTEM. YOU MAY WONDER HOW A LIBRARY FITS WITH THIS. THROUGH VALERIE FLORANCE AND EXTRAMURAL PROGRAMS WORK WE IDENTIFIED EXISTING RESEARCH GRANTS THAT COULD BE ENHANCED BY BETTER ATTENTION TO OPIOIDS OR TERMINOLOGIES OR THE DISCOVERY OF OPIOID PATTERNS AND CLINICAL RECORDS. WE HAVE ALSO THROUGH OUR LISTER HILL CENTER BEEN EXPANDING USE OF UNDERSTANDING ADDICTIVE AND NON-ADDICTIVE PAIN MANAGEMENT TOOLS, MAKING SURE NOMENCLATURES ARE AVAILABLE AND ESSENTIAL FOR& THEM. THE SIS ESTABLISHED A GRAPHIC NOVEL COMMUNE DATE SOME OF THE RISKS OF OPIOID ADDICTION AND ALSO RESPONSES TO THEM SO WE'RE TAKING A MULTI-PRONG APPROACH AS YOU WOULD EXPECT A LIBRARY TO DO. THE MORE MUNDANE PARTS OF LIFE WE'RE ASSURING ENERGY EFFICIENT DATA CENTER THROUGH PROCESS OF AUTOMATIC MONITORING. I GOT THAT RIGHT. THIS IS ESSENTIAL TO MAKE SURE OUR ENERGY USE OF DATA CENTERS WHICH WILL CONTINUE FOR A SIGNIFICANT PERIOD OF TIME, IS DONE IN THE MOST EFFICIENT WAY POSSIBLE. WE HAVE EXPANDED USE OF DEEP LEARNING AND NEURAL NETWORKS PARTICULARLY IN LISTER HILL AREA IMPROVING ALGORITHM DEVELOPMENT AND INTERPRETATION. I HAVE TO BLAME JIM FOR THAT LAST LINE THE VDS CIT HAS ERA AND DB GAP DATA IN IT. AND I REALLY WORKED TO FIGURE WHAT THIS MEANS. JIM WILL EXPLAIN IN MORE DEPTH. ESSENTIALLY -- IT'S INTUITIVELY OBVIOUS. I THOUGHT YOU WERE GOING TO SAY LEFT AS HOME WORK ASSIGNMENT. BUT ESSENTIALLY, THERE'S -- THERE ARE IMPORTANT THINGS IN HERE SO THE ERA IS OUR IDENTITY MANAGEMENT SYSTEM. AND IN ORDER TO BE ADDUCE OF DATA, -- GOOD USE OF DATA, WE HAVE TO HAVE A MORE EFFICIENT AND IDENTITY MANAGEMENT SYSTEM THAT DOESN'T REQUIRE INDIVIDUAL TO REAUTHENTICATE EF TIME THEY PASS INTO A NEW DATA SET. SO NCBI TEAM HAS BEEN WORKING CLOSELY WITH THE ENTIRE NIH TO MAKE SURE A SOLUTION THAT HAS TERMINATION WITHIN NCBI IS AVAILABLE ACROSS THE NIH AND TO NIH VERY STAKEHOLDERS INCLUDING THOSE AVAILABLE TO NIH DATA SET NOT KNOWN TO US. IMPORTANTLY, THE NIH IN GENERAL AND NATIONAL LIBRARY OF MEDICINE IS LOOKING HOW WE ARE USING -- WE CAN AND MOST IMPORTANTLY LEVERAGE COMMERCIAL CLOUDS FOR MORE EFFICIENT STORAGE MORE COST EFFECTIVE STORAGE AND WE'LL HEAR MORE ABOUT THIS. BUT THIS -- WHAT THIS MEANS IN PART IS PRETTY SOON WE'LL BE ABLE TO HAVE SOME OF OUR VERY IMPORTANT AT LEAST PUBLIC ACCESSIBLE DATA SETS STORED IN COMMERCIAL CLOUDS AND MORE SACK ACCESSIBLE TO THE PUBLIC AS WHOLE. THIS IS A VERY EXCITING ASPECT OF THIS. WHY THIS IS IMPORTANT ME TELLING YOU NOW, WE HAVE -- WE HAVE HAD A C CHANGE IN ROLE OF NATIONAL LIBRARY OF MEDICINE DRIVING THE NIH INVESTMENT IN DATA SCIENCE. I'M EXTREMELY PROUD AND GRATEFUL FOR ALL THE PEOPLE ACROSS THE NATIONAL LIBRARY OF MEDICINE WHO HAVE TAKEN UP MORE TRANSMINI RESPONSIBILITIES IN THIS AREA. AND VERY PLEASED AND EXCITED ABOUT IT. AS IIALLY DO AT THIS POINT I SHOW YOU THE LATEST VIDEO DEVELOPED TO GIVE OUR INSPIRATIONAL VISION OF OUR FUTURE. SO HERE IS TODAY'S VIDEO. SOUND GUY? NO SOUND. THIS ONE IS BAD. OKAY. * * >> THE MOST IMPORTANT, MOST ESSENTIAL, MOST CRITICAL ASPECT OF NATIONAL LIBRARY OF MEDICINE IS THE TRUST ABILITY OF OUR RESOURCES. AND WE ARE FIRMLY COMMITTED TO TAKING EVERY ACTION TO THE FUTURE TO ENSURE THERE ARE MATERIALS CONSIDERED TRUSTED BY THE PUBLIC AS WHOLE. OUR CRITICAL ASPECT OF THAT IS MAKING SURE THAT THE LITERATURE AND OUR RESOURCES ARE MANAGED IN A WAY EFFICIENT, CONNECTED AND ABLE TO BE HANDLED AT SCALE. SO HERE YOU SEE THE OVERVIEW OF MED LINE 2020. 2022, JOYCE BACK AND JIM MOSTELLO ARE LEADING THIS, THERE'S 40 STAFF INVOLVED IN THIS ENDEAVOR. DEBORAH IS OUR KEY STAFF PERSON LADY SO YOU SHOULD SEE WE ARE IMPLEMENTING THE STRATEGIC PLAN AT ALL LEVELS OF NATIONAL LIBRARY OF MEDICINE. THE FIRST COLUMN DESCRIBES CURATION AT SCALE. WE HAVE A MILLION CITATIONS A YEAR COMING INTO THE NLM, WE HAVE KEEP PACE WITH PUBLISHERS, WE WANT TO HAVE OUR CITATIONS INDEXED WITHIN 24 HOURS SO ONCE THE CITATION HITS AS AVAILABLE AND SO USERS NEED. AUTOMATED INDEXING AND EXPERT HUMAN CURATION IS PARTNERSHIP TO PUT THE VALUE ADD WHY DATA, WHY LITERATURE SHOULD COME TO NLM AND NOT BE ACCESSIBLE THROUGH GOOGLE. WE ARE WORKING TO EXPAND METADATA TO OPTIMIZE THE METADATA SUPPORT TO ACCESS TO OUR TRIAL REGISTRIES CLINICAL TRIALS AND OTHER REGISTRIES TO PROVIDE COMPREHENSIVE GENETIC METADATA TO SUPPORT THE SCIENTIFIC COMMUNITY AND IMPROVE THE CHEMICAL METADATA SPANNING PHARMACEUTICAL AND TOXICOLOGY RESEARCH AREAS. WE WILL BE INCREASING FUNDING OF METADATA TO SUPPORT RESEARCH PORTFOLIO ANALYSIS. THE CONCEPTS ARE THE TAG, THE DATA ABOUT THE DATA OR DATA ABOUT THE OBJECT, AND THERE'S CERTAINLY A GREAT DEAL OF ACCEPTANCE IN THIS AREA BUT WILD WEST IN TERMS OF HOW TO DO IT SO WE BRING THE OPPORTUNITY TO INVEST IN RESEARCH IN THIS AREA. WE ARE FOCUSING ON EFFICIENCY WHICH MEANS PARTNERSHIPS WITH PUBLISHERS, WHICH MEANS MAKING SURE CO-VAN LAYERS ARE ROBUST -- CO-VAN CARES -- VOCABULARIES ARE ROBUST AND FOCUS ON LINKING OF DATA SETS IN SUPPORT OF THE NATIONAL NATIONAL LIBRARY OF MEDICINE AND NIH DATA SCIENCE GOALSLESS. WHILE LOGICAL TO SAY WHAT WE HAVE DONE FOR LITERATURE WE CAN DO FOR DATA IT'S NOT SUPPLY FLIPPING A SWITCH SO THERE'S WORK GOING INTO PREPARING THIS. IN ADDITION, THROUGH OUR LIBRARY OPERATIONS THROUGH THE NATIONAL NETWORK OF LIBRARIES AND MEDICINES WE PLAY A SIGNIFICANT ROLE IN THE LAUNCH OF THE ALL OF US PROGRAM. THE ALL OF US PROGRAM IS THE NIH INITIATIVE AND PRECISION MEDICINE TO ENGAGE IN MILLION PEOPLE IN TO A PARTNERSHIP IN UNDERSTANDING HEALTH AND HEALTH DISCOVERY THROUGH DATA DRIVEN RESEARCH. OUR GROUP WAS PARTICULARLY ACTIVE IN THE LAUNCH THAT OCCURRED IN KANSAS CITY, WE DIDN'T GO TO DETROIT TO KICK THE FOOTBALL WITH ERIC BUT WE HAD MEMBER OPT GROUND, MEMBERS OF NATIONAL LIBRARIES OF MEDICINE ARE INVOLVED ALL OVER THE COUNTRY PROVIDING INFORMATION SUPPORT AND RESOURCES. WE HAVE A FINANCIAL PARTNERSHIP WITH THE ALL OF US PROGRAM THAT'S HELPING TO ACCELERATE OURANT TO MAKE BETTER RESOURCES WITHIN OUR NATIONAL NETWORKS OF LIBRARIES OF MEDICINE. OUR EXTRAMURAL PROGRAMS YOU SEE THE BIG SIGN, THIS IS OUR FIRST HINT TO TELL YOU WE HAVE GREAT NEWS ABOUT OUR BUDGET. WE WERE ABLE TO WITH OUR FISCAL '18 FUNDS BE ABLE TO INCREASE BY $5 MILLION TO OUR EXTRAMURAL RESEARCH PROGRAM BASE. I'M PROUD OF THAT, WE'LL HAVE MORE RESEARCH PROGRAM GRANTS, RPG INVESTING IN DATA SCIENCE AND RESEARCH CENTERS AND DOING MORE OUTREACH TO HIGH SCHOOL STUDENTS AND HISTORICALLY BLACK COLLEGES AND UNIVERSITIES AS A WAY TO IMPROVE THE PIPELINE. WE HAVE A NEW FUNDING OPPORTUNITY THAT YOU REVIEWED IN THE FEBRUARY MEETING OUT ON THE STREET IN ABOUT SIX WEEKS OR SO FOR DIGITAL CURATION AT SCALE TO GIVE NEW METHODS FOR CURATION. OUR -- WE HAVE BEEN INVESTING IN A CORE CURRICULUM FOR BIOMEDICAL DATA SCIENCES WITHIN OUR T-15 THE GROUPS HAVE BEEN WORKING TOGETHER WITH RECOMMENDATIONS AND CREATING SHAREABLE RESOURCES. AND FINALLY, WE'RE REALLY EXCITED TO TELL YOU AS OF JUNE OF THIS YEAR WE HAVE A 15% INCREASE IN THE NUMBER OF APPLICATIONS THAT COMPARED THE JUST A YEAR AGO. WE'LL HAVE 21 NEW APPLICATIONS FOR OUR DATA SCIENCE RESEARCH INVESTMENT IN CITIZENS, THAT IS PERSONAL HEALTH LIBRARIES FOR CONSUMERS AND PARTICIPANTS AS WELL AS 110 NEW RESEARCH PROJECTS. BECAUSE OF THE NEW INFUSION OF FUNDS WE'LL BE ABLE TO FUND MORE OF THESE. THIS IS PART OF THE PIPING. OUR MODERNIZING NLM RESOURCES AND CONDUCT IT ASSESSMENT. THIS IS BEING LED BY JIM AND FLORANCE AND IT'S A COMPLEX PROCESS OF LOOKING AT THE INTERNAL WORKINGS OF OUR SYSTEMS, DO WE HAVE THE RIGHT LEVEL OF IT SERVICES, RIGHT LEVEL OF CONSOLIDATION, ARE WE IN COMPLIANCE WITH FEDERAL STANDARD AS WELL AS QUALITY OF FRONT END DELIVERABLES THAT EF WITH. WE'LL ENGAGE TO ASSIST US IN DOING EVALUATION AND IN PLANNING TO HAVE NEW TOOLS TO BE ABLE TO BENCHMARK OUR PERFORMANCE OVER TIME. THROUGH PART OF THIS PROCESS STARTED TO LOOK IN DEPTH WHO IS USING SERVICES SO I'LL PROVIDE A TEASER DATA TODAY. THESE ARE SPECIFIC ASSESSMENTS THAT WERE DONE IN A ONE TIME AREA, AND SHOULD NOT BE GENERALIZED ACROSS THE ENTIRE USER PROFILE BUT LATE FALL OF THIS YEAR, A PARTNERSHIP WITH FIRMED CALLED 18F STUDYING HUMAN USE AND HUMAN COMPUTER INTERACTION DID EVALUATION OF BRIEF PERIOD OF CLINICALTRIALS.GOV AND MORE PATIENTS CAREGIVERS AND CLINIC WERE USING IT DURING THIS PARTICULAR PERIOD, THAN WERE RESEARCHERS SO WE ARE SERVING THE PUBLIC WITH OUR DATA SERVICES DESIGNED TO PROVIDE RESEARCHER SUPPORT. NOTICE ALSO OFTEN THE INTENDED USER OF A CLINICALTRIALS.GOV FROM CLINICIAN PATIENT SIDE IS NOT IDENTIFIED PATIENT BUT FAMILY MEMBER OR FRIEND OR ACTUALEDLY IN ADDITION. WE LOOK AT WHO IS USING OUR PUBMED CENTRAL AND BOOKS, AND YOU WILL SEE FROM THIS HISTOGRAM, HERE THAT THE LARGEST USER OF OUR PUBMED CENTRAL IN BOOKS WHICH IS OUR ELECTRONIC BOOKSHELF ARE STUDENTS, THAT'S THIS GREEN LINE HERE, SET ABOVE. BUT WE DO HAVE EDUCATORS AND SCIENTISTS AND HEALTH PROFESSIONALS USING BOOKS. EACH LINE 100% SCALE. WE LOOK ALSO AT WHO USES OUR SEQUENCE DATABASES AND HERE WE SEE MUCH MORE OF AN EMPHASIS ON OUR LIFE SCIENCE USERS BUT STILL STUDENTS ARE INVOLVED. SO AS IN THE PAST I HAVE BEEN ABLE TO SAY OVER THE LAST 50 YEARS THERE'S NOT A DISCOVERY IN THE WORLD NOT TOUCHED BY THE NLM RESOURCES, I'M BEGINNING TO BE ABLE TO SAY THERE'S NOT A STUDENT IN THE WORLD THAT IS UNTOUCHED BY THE NLM RESOURCES. I'M EXTREMELY PROUD OF THAT. WE ARE IMPROVING OUR SPACE. YOU GOT TO WALK THROUGH OUR IMPROVEMENT PUBLIC SPACE HERE ON THE MEZZANINE, WE'RE HAPPY ABOUT, THE SPACE IS MORE ACCESSIBLE AND FUNCTIONAL AND NOTICE IF YOU LOOK OUTSIDE JUST BEYOND BELOW THE SCREEN, WE HAVE NEW BOTTLE FILLERS. SO WE ARE BUYING INTO THE WATER IS GOOD AND PLASTIC IS BAD AND WE HAVE REFILLABLE WATER BOTTLES. THIS IS ONE OF THE BIGGEST HITS, WE COULD HAVE JUST DONE THIS AND GONE A LONG WAY. WE HAVE TO TAKE CARE OF B 1 AND B 2, I KNOW THAT. BUDGET NEWS. THIS IS BEEN IF ANYWHERE CLOSE TO A NEWSPAPER YOU KNOW IT'S BEEN A GOOD YEAR FOR NIH. IN FISCAL 17 WE FINISHED THE YEAR WITH $406 MILLION BUT IN FISCAL 18, ABOUT THREE WEEKS AGO WE NOW HAVE A BASE BUDGET OF 428, $533,000. WE ARE VERY, VERY EXCITED ABOUT THIS $22 MILLION INCREASE. THE CHALLENGE WITH THE $22 MILLION INCREASE IN THIS ONE FISCAL YEAR, ALL THE FEDS IN THE ROOM KNOW THIS, WE HAVE TO SPEND $22 MILLION IN SIX MONTHS SO I CHALLENGED OUR TEAMS AND LEADERSHIP TO COME UP WITH CREATIVE WAYS TO DO THIS AND WE'RE DOING FANTASTIC THINGS. WE'RE LOOKING MORE AT OUR INFRASTRUCTURE AND EVALUATION BUT WE'RE ALSO INVESTING IN DEEP LEARNING Z INCREASING TRAINING AROUND THE COUNTRY, WE'LL PROVIDE SUPPLEMENTS FOR THE OPIOID RISKS SO WE'RE MAKING VERY GOOD USE OF THIS MONEY. I HAVE TO THANK MITT SHY ALLEN, INTERIM BUDGET DIRECTOR WHO HAS BEEN -- SHE'S OVER HERE IN THE BLACK SUIT, SHE'S BEEN TREMENDOUS IN REDOING AND REDOING AND REDOING BUDGET LISTS FOR ME. UNFORTUNATELY THE PRESIDENT BUDGET IN 2019 TAKES US BACK TO 395 MILLION. WE ARE RECOGNIZING THAT THIS IS A BUDGET RECOMMENDATION FROM THE PRESIDENT, YOU RECOGNIZE THAT THE PRESIDENT RECOMMENDS AND CONGRESS APPROVES THE BUDGET. WE HAD TO PROVIDE A CONGRESSIONAL JUSTIFICATION FOR HOW WE LOOK AT THIS LEVEL, WE RECOGNIZE THIS AS PART OF A PLANNING PROCESS. HAPPY TO TAKE QUESTIONS IN FEW MINUTES. WE MADE PERSONNEL CHANGES. ONE THING WE HAVE BEEN ABLE TO DO IS PROMOTE LONG TERM EXQUISITE SCIENTISTS T CURSCHMANN IS NOW AN INVESTIGATOR, AN IMPORTANT STEP IN THE PROGRESS OF SIGN TS. DINA, WOULD YOU WAVE, OUR NEW INTERIM DIRECTOR FOR POLICY ASSISTANT DIRECTOR FOR POLICY S. SHE COMES TO US FROM THE BUILDING ONE FROM OFFICE OF SCIENCE POLICY AND HAS BEEN A LONG COLLABORATOR AROUND SOME OF OUR KEY ISSUES PARTICULARLY DATA SHARING. THE OFFICE OF DIRECTOR HAS TWO NEW STAFF MEMBERS IN IT, TROY FISTER JOINED AS INTERIM OPERATIONS MANAGER, WE'RE SHARING HIM, WE HAVEN'T TAKEN HIM COMPLETELY AND (INDISCERNIBLE) MY NEW OPERATION SUPPORT PERSON. THE AGO BEAR NEWS IS THIS, WE HAVE HAD APPROVAL FOR 48 NEW POSITIONS. 48 NEW POSITIONS MEANS WE'LL BE ABLE TO EXPAND IN DATA SCIENCE SO THAT LARGE NUMBER FOR THE OFFICE OF DIRECTOR YOU MUST UNDERSTAND IS OUR INVESTMENT IN DATA SCIENCE WITH THE DIRECTOR& DATA SCIENCE AND NEW OPEN SCIENCE AND DATA SCIENCE LIBRARY AND OPEN SCIENCE OFFICER. WE ALSO ARE MANAGING PROVIDING A STRONGER MANAGEMENT STAFF, TODD HAD TO DEAL WITH A MUCH SHORTENED STAFF IN HIS AREA. THERE ARE DEPUTY EXECUTIVE OFFICER, AND BUDGET OFFICER AND ETHICS SPECIALISTS RETIRED THE SAME YEAR. SO WE HAVE ENDED UP WITH NEEDING TO MANAGE STRENGTHEN OUR STAFF HERE. PLEASE ALSO NOTE WE HAVE ENHANCED SUPPORT FOR LIBRARY RESOURCES AND WE HAVE ENHANCED SUPPORT FOR STANDARDS AND DATA SCIENCE WITH FOUR NEW INVESTIGATORS IN EACH OF THOSE INVESTIGATORS COMES WITH A PORTFOLIO OF TWO TO THREE SUPPORT PEOPLE, TWO TO THREE SUPPORT SCIENTISTS SO WE'RE EXCITED ABOUT THIS ACCELERATION IN WORKING HARD TO BE ABLE TO RECRUIT AND MAYBE GET APPOINTMENTS IN THIS FISCAL YEAR. I WILL TURN OVER NOW TO JERRY AND DINA TO TALK MORE ABOUT LEGISLATION THEN TIME FOR QUESTIONS AND WE'LL FOLLOW-UP WITH A BRIEF OVERVIEW OF THE MEETING. JERRY AND DINA, DO YOU WANT TO COME UP. (OFF MIC) >> YOU CAN SEE ME ALL AROUND THE ROOM NOW. SO I THINK PATTY GAVE THE BIGGEST NEWS LEGISLATIVELY THAT HAPPENED RELATED TO THE APPROPRIATIONS FOR THIS YEAR. WE'RE THANKFUL TO GIVE THE BIG BOOST IN FUNDING. THOSE WHO FOLLOW CONGRESSIONAL ACTIONS IN TAKING YOUR COURSE KNOW IT'S NOT ALWAYS WHAT'S IN THE LAW THAT MATTERS BUT IT'S WHAT'S IN THE ACCOMPANYING REPORTS THAT ALSO MATTERS. AND IN THE APPROPRIATIONS BILL FOR 2018 THERE ARE TWO ITEMS IN THE MATERIALS THAT WE GAVE YOU FOR TODAY'S MEETING THAT ARE IN THE REPORT THAT HAVE A IMPLICATIONS FOR NLM AND NIH. SO THE FIRST BEING AROUND CLINICAL TRIALS INFORMATION. THE GOOD NEWS IS THEY COMMENDED US FOR THE WORK THAT WE HAVE BEEN DOING WITH NLM AND ACROSS NIH TO INCREASE ACCESS TO CLINICAL TRIALS INFORMATION THROUGH CLINICALTRIALS.GOV AND REGISTRATION, RESULTS REPORTING REQUIREMENTS. AT THE SAME TIME THOUGH, COVEYED SOME CONCERNS THAT HAD BEEN BROUGHT TO THEIR ATTENTION RELATED TO THE DEFINITION OF CLINICAL TRIAL AND IN PARTICULAR RELATED TO BEHAVIORAL AND SOCIAL SCIENCES RESEARCH. I THINK THIS IS A SITUATION WHERE TRYING TO BE MORE HELPFUL TO THE COMMUNITY AND EXPLAIN BETTER WHAT A CLINICAL TRIAL IS AND PROVIDING EXAMPLES OF WHAT MIGHT BE CONSIDERED A CLINICAL TRIAL AND NOT, CLARIFICATION CAUSED MORE CONFUSION AMONG THE COMMUNITIES, THOSE COMMUNITIES HAVE BEEN QUITE ACTIVE IN ENSURING THAT THE NIH POLICY THE NOT -- DOES NOT EXPAND INTO SOME AREAS OF RESEARCH THEY FIND INAPPROPRIATE. SO IN ESSENCE, THE LANGUAGE REQUIRES THE NIH TO CONSULT WITH AFFECTED STAKEHOLDERS IN THESE AREAS TO BETTER UNDERSTAND HOW THE DEFINITION DOES AND DOES NOT AFFECT CERTAIN AREAS OF BEHAVIORAL AND SOCIAL SCIENCES BUT MORE GENERALLY THE TERMINOLOGY BEING USED IS AROUND FUNDAMENTAL BASIC STUDIES. I WOULD ONLY CAUTION THAT MAYBE THE OTHER PHRASING THAT NEEDS TO BE INCLUDED IN THERE IS THESE ARE MAYBE FUNDAMENTAL OR BASIC HUMAN SUBJECTS RESEARCH STUDIES, WHERE IN FACT MANY COMMUNITIES WHO ARE RAISING CONCERNS HAVE ALREADY ENDORSED THE PRINCIPLES OF TRANSPARENCY INTO THIS RESEARCH. SO NLM IS ENGAGED WITH NIH, THE OFFICE OF SCIENCE POLICY, LEGISLATIVE OFFICE AND OFFICE OF DIRECTOR TO TRY TO DETERMINE WHAT NEXT STEPS WE WILL TAKE TO ENHANCE THIS CONSULTATION WITH THE COMMUNITY, PROVIDE SOME BETTER CLARIFICATION, AND ADDRESS SOME OF THE CONCERNS THAT HAVE BEEN RAISED. I THINK WE HAVE A DEADLINE FOR REPORTING BACK TO CONGRESS ON THAT IN JUNE. SOMETIME AFTER JUNE I CAN TELL YOU WHAT WE'RE GOING TO DO BUT NOW I CAN SAY WE'RE HAVING MORE CONSULTATIONS INTERNALLY AND WITH AFFECTED STAKEHOLDER COMMUNITIES TO BETTER UNDERSTAND THOSE CONCERNS. (OFF MIC) >> THAT COULD BE ONE INTERPRETATION. ESPECIALLY WHEN THEY SAY WE AGREE WITH THE MOTION OF TRANSPARENCY AND TO SOME EXTENT REGISTRATION AND REPORTING OUR RESULTS BUT WE'RE NOT SURE THE WAY THIS IS BEING DONE IS THE RIGHT WAY. SO THEY DON'T WANT TO BE MAYBE IN CLINICALTRIALS.GOV, ALSO BEING CONSIDERED A CLINICAL TRIAL MEANS THERE ARE ADDITIONAL REQUIREMENTS, THERE ARE NEW EXPECTATIONS FROM NIH ABOUT SUBMITTING CLINICAL TRIALS ONLY IN RESPONSE TO FUNDING OPPORTUNITY ANNOUNCEMENT FOR CLINICAL TRIALS. THEIR REQUIREMENTS ABOUT DOING GOOD CLINICAL PRACTICE TRAINING WHICH AGAIN YOU COULD SAY MAYBE ANYBODY WHO TOUCHES A HUMAN SUBJECT IN THE COURSE OF RESEARCH OUGHT TO DO THAT. AS I SAID, WE'RE STILL WORKING OUT EXACTLY WHAT PROCESS OF ENGAGEMENT WILL BE. THIS IS ONE WHICH THERE'S QUITE A BIT OF VOCAL OPPOSITION. THE OTHER AREA THAT WAS MENTIONED OR TOPIC MENTIONED IN THE ACCOMPANYING REPORT RELATED TO DATA SCIENCE STRATEGY OR IN FACT I THINK THE TERMINOLOGY USED IN THE REPORT WAS A BIG DATA INFRASTRUCTURE PLAN FOR NIH. SO THERE WAS A REQUIREMENT TO PRODUCE SUCH A PLAN AND DELIVER IT TO CONGRESS BY WHAT I BELIEVE WAS SATURDAY. MAY 5TH. NIH PUT TOGETHER THROUGH THE SCIENTIFIC DATA COUNCIL WHICH IS A GROUP -- NUMBER OF IC DIRECTORS INCLUDING DR. BRENNAN FROM ACROSS NIH THEY PUT TOGETHER A REPORT THAT WENT OUT FOR PUBLIC COMMENT ABOUT A MONTH AND A HALF AGO, CALLED THE DATA SCIENCE STRATEGY, IT WAS A DRAFT DATA SCIENCE STRATEGY FOR NIH, THEY RECEIVED A NUMBER OF COMMENTS FROM THE COMMUNITY THAT I BELIEVE WERE REFLECTED IN THE FINAL REPORT THAT WAS TRANSMITTED TO CONGRESS OVER THE WEEKEND. I HAVE NOT YET SEEN THE FINAL REPORT, I DON'T KNOW IF DR. BRENNAN HAS SEEN THE FINAL REPORT YET. WE WILL SEE IT SOON, I EXPECT IT WILL BE PUBLIC SOON AS WAS THE DRAFT REPORT SO WE CAN MAKE SURE YOU HAVE AN OPPORTUNITY TO SEE THAT. IF YOU DIDN'T LOOK AT THE DRAFT, I WOULD SAY IT WAS NOTABLE IN THAT IT WAS A COMPREHENSIVE VIEW TO WHAT IT TAKES TO BRING MORE A DATA INFORMATICS ENTERPRISE ACROSS NIH. RESEARCH INFRASTRUCTURE WORK FORCE TRAINING ISSUES AND POLICY WAS KEPT AT FAIRLY HIGH LEVEL. I THINK ALSO CONSISTENT WITH THE NLM STRATEGIC PLAN IN THE AREAS THAT WE IDAHO PHID AND NIH IDENTIFIED. -- IDENTIFIED AND NIH IDENTIFIED. PATTY IS GIVING ME A LOOK. >> IT'S IMPORTANT TO NOTE JIM'S GROUP NCBI WAS SIGNATURE CAN'TLY INVOLVED IN SHAPING THIS AS WELL AS BEING IDENTIFIED AND CALLED OUT HAVING CRITICAL RESPONSIBILITY. SO WE ARE QUITE PLEASED RATHER THAN HAVING NIH BUILD SOMETHING IN PARALLEL WITH THIS, OR TRY TO IN SOME WAY BE IN CHARGE, WE HAVE ESTABLISHED A VERY GOOD PARTNERSHIP WITH THEM WE THINK GOING FORWARD THIS IS THE BEST FOR OUR CONSTITUENTS AS WELL AS THE NIH. >> WE'LL MAKE SURE THAT GETS OUT TO YOU AS SOON AS WE -- >> THEY EXPECT IT TO BE RELEASED BY THE CONGRESS BY FRIDAY OF THIS WEEK BUT WE DON'T HAVE A PERMANENT DATE. SO WE'LL SEND THAT OUT WHEN IT COMES IN. >> I THINK -- THERE'S SEVERAL OTHER BILLS MENTIONED IN THE WRITE UP YOU HAVE IN FRONT OF YOU. THE ONLY ONE I WILL CALL TO YOUR ATTENTION NOW IS IF FEDERAL DEPOSITORY LIBRARY PROGRAM MODERNIZATION ACT. THE FDLP IS WAY OF ENSURING GOVERNMENT DOCUMENTS AND REPORTS OUR PRESERVED ARCHIVED AND DISSEMINATED ACROSS THE COUNTRY. MODERNIZING THAT PROGRAM, I THINK IS SOMETHING THAT NOBODY COULD RAISE ANY OPPOSITION TO. WHAT THEY'RE TRYING TO DO IS PUT TOGETHER WHAT WOULD BE A NATIONAL COLLECTION OF INFORMATION DISSEMINATION PRODUCTS. THE GOVERNMENT PUBLISHING OFFICE, THE GPO WOULD PLAY A ROLE IN ORGANIZING THIS COLLECTION AND HAVING INDEXING AND CATALOGING AND METADATA ABOUT THE COLLECTION. AND COLLABORATING WITH OTHER FEDERAL AGENCIES IN DOING THIS. WE AT NLM ARE PARTICIPANT IN THE FDLP, WE ARE BOTH SELECTIVE LIBRARY FOR DEPOSIT OF THINGS THAT FIT WITHIN OUR COLLECTION, SOME OF OUR SERVICES, THINGS LIKE PUBMED, ARE INCLUDED WITHIN THE FDLP, WE PRESERVE AND MAKE THEM AVAILABLE. WE ARE STILL TRYING TO TEASE OUT THE LANGUAGE OF THIS BILL TO GET A BETTER UNDERSTANDING HOW IT MIGHT AFFECT NLM PROGRAMS AND SERVICES IN TERMS OF WHAT ADDITIONAL INFORMATION MIGHT NEED TO BE RELATED TO THE GPO. BPO HAS THE AUTHORITY TO SET THE STRUCTURE AND SO FORTH FOR THE WAY THAT DATA IS TRANSMITTED TO THEM. OUR INTEREST IS TRYING TO ENSURE THAT THERE'S SOME ADDITIONAL VALUE ADD IN PROVIDING ACCESS TO INFORMATION THAT NLM AND MANY CASES OTHER FEDERAL LIBRARIES ALSO CURRENTLY MAKE PUBLICLY AVAILABLE AND PRESERVE. SO WEAR TRYING TO TEASE OUT WHAT THE DIRECT EFFECTS OF THIS LEGISLATION WOULD BE ON NLM. WE HAVE NOT YET HAD AN OPPORTUNITY TO PROVIDE OUR COMMENT ON IT SO WE'RE LOOKING FORWARD TO THAT OPPORTUNITY WHEN IT ARISES. THE BILL IS IN THE HOUSE AND IS NOT INTRODUCED WHERE ET IN THE SENATE. SO WE'LL KEEP YOU APPRISED OF THAT LEGISLATION AS IT MOVES FORWARD. ONE OTHER ITEM TO BRING UP IS RELATED TO EUROPEAN UNION PRIVACY REGULATIONS WHICH GO INTO EFFECT AT THE END OF THIS MONTH. I WILL LET DINA WHO HAS BEEN FOLLOWING THIS MORE CLOSELY FOR US TELL YOU MORE ABOUT THAT. I THINK IT'S AGAIN A SITUATION WE'RE TRYING TO UNDERSTAND AND APPRAISE IN TERMS OF EFFECT ON NLM AND NIH GENERALLY SO I'LL TURN IT OVER TO DINA AND ALSO WELCOME YOU TO NLM. THANK YOU. >> THANK YOU. SO AS JERRY MENTIONED, THE EUROPEAN UNION GENERAL DATA PROTECTION REGULATION GOES INTO EFFECT ON MAY 25th. THIS REGULATION WAS PRIMARILY ENACTED TO PROTECT EUROPEAN CITIZENS FROM PRIVACY AND DATA BREECHES SO INVOLVES A NUMBER OF PROVISIONS INCLUDING HARMONIZING DATA PRIVACY LAWS, PROTECTING AND EMPOWERING DATA PRIVACY, AS WELL AS SHAPING THE WAY THE EU ORGANIZATION APPROACH DATA PRIVACY. SO WE'RE TRYING TO LEARN WHAT THIS MEANS, HOW IT WILL AFFECT ANY RESEARCH ON ARE RESEARCH COLLABORATIONS BETWEEN U.S. AND EU IF AT ALL, IT'S NOT OUR REGULATION BUT WE KNOW IT MAY HAVE SOME IMPACT. IT APPLIES TO THE EUROPEAN UNION, THERE ARE CHANGES IN IT THAT WERE -- WE'RE STILL TRYING TO LEARN ABOUT INCLUDING THE SCOPE, THE CONSENT RULES, AS WELL AS THE DEFINITION OF PERSONAL DATA, WHAT THE PENALTIES ARE, WE DO REALIZE THAT THE EUROPEAN UNION COUNTRIES INVOLVED, THEY'RE NON-COMPLIANT, THEY WILL HAVE TO FACE FINANCIAL PENALTIES. AS WELL AS WHAT THE ROLE IS OF A DATA PROTECTION OFFICER. BECAUSE GDPR SCOPE IS BROAD AND WE ARE DEALING WITH NEW DEFINITIONS ESPECIALLY WITH REGARDS TO CONSENT, THERE'S ALSO A LACK OF GUIDANCE AS TO WHAT THIS MEANS FOR RESEARCH, WE ARE TRYING TO LEARN MORE HOW COLLABORATIONS OR CONSORTIA WILL BE AFFECTED BY THIS, IN PARTICULAR NLM RESOURCES WE KNOW THAT NLM IS INVOLVED WITH A NUMBER OF CONSORTIA WHICH DATA ARE EXCHANGED DAILY. WE HAVE SOME RECORD-KEEPING THAT MAY BE IMPACTED SO WE ARE WORKING WITH HHS AS WELL AS THE STATE DEPARTMENT AND THE NIH OFFICE OF SCIENCE POLICY AND FOGARTY INTERNATIONAL CENTERS ARE THE LEAD AND WE'LL UPDATE YOU AS WE LEARN MORE. >> ARE THERE ANY ARTICLES OR CLAUSES ABOUT RESEARCH USES? VERSUS COMMERCIAL USE? I GET THE SENSE SUBSTANTIAL DISCUSSIONS (INAUDIBLE) RESEARCH WHICH WOULD BE LESS CUMBERSOME FOR SCIENTISTS. >> THAT IS CORRECT. WE'RE TRYING TO LEARN MORE, THE DEFINITION IS SO BROAD THAT WE ARE TRYING TO LEARN WHAT THE IMPACT IS OF THIS WITH THE RESEARCH. IT IS MORE CLEAR FOR THE COMMERCIAL PURPOSES BUT FOR RESEARCH WE'RE TRYING TO LEARN MORE, HHS AND THE STATE DEPARTMENT ARE TRYING TO TAKE THE LEAD AND PROVIDE COMMENTS AND HOPEFULLY WILL COME OUT WITH GUIDANCE THAT WILL APPLY TO US. (OFF MIC) >> RIGHT. MAKING SURE (INAUDIBLE) CUMBERSOME AND EXPENSIVE AND COSTLY FOR RESEARCHERS THAT WE EITHER FIND OUT IT'S NOT CAUSE OF SPECIAL READING OF CLAUSES OR NEGOTIATE WITH EUROPEAN COMMUNITY, MAKE SURE IN ADVANCE (INAUDIBLE) WE ARE CLEAR. >> THAT'S CORRECT. WE'LL SEE WHAT HAPPENS AND WHATEVER WE DO WILL BE IN COORDINATION WITH HHS. >> ERIC ONE THING WE HOPE TO DO APROPOS OF THE COST AND FORECASTING ISSUES WITH DATA IS PARTNERING WITH THE NATIONAL ACADEMIES TO DO A STUDY ON MODELING. ECONOMETRIC MODELING OF DATA TO GET TOOLS IN PLACE TO DO DECISION MAKING ABOUT INVESTMENTS SO WE HOPE THAT -- BECAUSE WE CAN DO THAT WITH FISCAL 18 MONEY WE HOPE IT'S AVAILABLE QUICKLY. (OFF MIC) COMMERCIAL ENTITIES, HATE TO HAVE THIS BE HAVE A FREEZING EFFECT ON RESEARCH (INAUDIBLE) EUROPEAN COMMUNITY. >> OR DIFFERENT RULES FOR COMMERCIAL USE VERSUS FEDERALLY FUNDED RESEARCH. A FEW THINGS ABOUT THE BOARD MEETING THEN ON TO -- DAVID H TAKE A FEW QUESTIONS, JILL TAYLOR IS NOT HERE WITH US, SHE HAD TO BE IN MEETING IN TOWN AND JANE BLUMENTHAL WILL BE HERE TODAY AND WILL TRY TO CALL IN TOMORROW. THE SURGEON GENERAL WILL ADDRESS THIS, HE USUALLY ADDRESS THIS IS FIRST THING IN THE MORNING, HE'LL COME IN AT 11 TODAY. ELISEO PEREZ-STABLE FROM THE NATIONAL INSTITUTES OF MINORITY HEALTH AND HEALTH DISPARITIES WILL BE HERE AT ONE O'CLOCK AND YOU WILL ENJOY A CONVERSATION WITH HIM. THIS EVENING WE SET ASIDE FOR A DINNER WITH THE BOARD OF REGENTS THE FNLM BOARD AND NLM LEADERSHIP AND WE LOOK FORWARD TO THAT DISCUSSION. WE HAVE SOMETHING UNUSUAL TOMORROW, WE WILL HAVE TWO CLOSED SESSIONS, ONE TO DISCUSS THE BLUE RIBBON PANEL AND ONE TO DISCUSS THE REVIEW OF ONE OUR SCIENTIFIC DIRECTORS. THERE WILL BE -- THIS WILL INVOLVE ONLY BOARD MEMBERS AND KEY PARTICIPANTS, THERE WILL NOT BE ANY INVITED GUESTS TO THESE SESSIONS AND WE WILL NOT HAVE ANY OPEN COMMUNICATION, VIDEO OR AUDIO. TO BOARD MEMBERS IN YOUR PACKET YOU HAVE THE REPORT OF THE REVIEW OF THE SCIENTIFIC DIRECTOR, THIS IS A CONFIDENTIAL DOCUMENT WE'RE NOT ABLE TO SEND TO YOU ELECTRONICALLY, WE ASK THAT YOU REVIEW IT TONIGHT AND I WILL BE COLLECTING COPIES BACK TOMORROW. THANK YOU VERY MUCH FOR YOUR SUPPORT WITH THAT. NOW WHILE WE'RE GETTING READY FOR THE NEXT DISCUSSION, REMINDER THAT YOU ARE FEDERALLY APPOINTED BODY TO GUIDE AND ADVISE THE NATIONAL LIBRARY OF MEDICINE AND SECRETARY ON ASPECTS RELATED TO THE BOARD OF REGENT AND FALL AND NATIONAL LIBRARY ITSELF. IN THE FALL WE ASKED YOU TO REFLECT ON THE ROLE AND FUNCTION OF THE BOARD OF REGENTS AND WHICH HEARD MANY NEW INTERESTING IDEAS IN THE SPRING OF THIS YEAR, WE BACK TO YOU THE BOARD STRUCTURE AND PROCESS, KEEP THE BOARD STRUCTURED AS IS, MEET AS IT DOES SO WE WON'T CHANGES LEGISLATION. THIS IS A GOOD THING BUT WE VALUE OUR BLENDS OF APPOINTED AND EX-OFFICIO MEMBERS. WE SEE THIS AS AN IMPORTANT STRENGTH. ASSESSMENT INDICATED THERE WAS A DESIRE TO INCREASE BOARD MEMBER ENGAGEMENT, RETAIN THE NARRATIVE RECORD OF MEETINGS AS YOU SAW TODAY AND IMPROVE THE BOARD FUNCTION AS AMBASSADORS FOR GOALS. WE HAVE TWO SESSIONS SET ASIDE, ESTHER WILL LEAD, FIRST TALK ABOUT GENERAL DIRECTIONS AND THEN TALK ABOUT SPECIFIC STRUCTURE OPPORTUNITIES WE HAVE WITHIN THE BOARD OF REGENTS. SO WE'RE LOOKING FORWARD TO THIS AS A PLANNING AND PROBLEM SOLVING AND DECISION MAKING SESSION. NOW I WILL PAUSE WHILE TRANSFER HAVE THE SLIDES AVAILABLE FOR ESTHER AND TAKE YOUR QUESTIONS. FROM THERE ANY QUESTIONS FOR ME FROM MY REPORT, FROM LEGISLATION OR ANYTHING WE HAVE BEEN REPORTING ON SO FAR? I TAKE THAT AS AN ENDORSEMENT OF MY POLICIES AND MY STRATEGIES THE STAFF IS ALL GETTING RAISES. (OFF MIC) >> THANK YOU SO MUCH, THANKS PATTY, FOR THE INTRODUCTION TO THE NEXT PORTION OF THE PROGRAM. THOSE AT OUR MEETING A COUPLE OF WEEKS AGO WE HAD A WORKING LUNCH, MEMBERS OF THE BOARD, WHERE WE -- I PROBABLY HAVE TO STAND NEXT TO THE MICROPHONE. WE HAD A WORKING LUNCH OF THE -- WITH MEMBERS OF THE BOARD IN ORDER TO FIGURE HOW WE WOULD LIKE TO BE OF GREATER HELP TO THE NLM. WE DETERMINED WE WANTED TO DO MORE WORK. WE WANTED GREATER INFLUENCE ON DECISION MAKING AND HELP WITH TREMENDOUS BREADTH OF EXPERTISE WE HAVE ON THE BOARD, DATA ANALYTICS, LIBRARY SCIENCE, MEDICINE, THE ARMED FORCES, OUTREACH, UNDERSERVED, AND WE WOULD LIKE TO BE ABLE TO HELP THE NLM STAFF, PATTY BRENNAN, WITH THE DECISIONS AS THEY GRAPPLE WITH THEM THROUGH THE COURSE OF TIME, ESPECIALLY BECAUSE WE WERE INVOLVED IN HELPING WITH ESTABLISHING THE NEW STRATEGIC PLAN, WE WANTED MORE INPUT ON IMPLEMENTING THAT STRATEGIC PLAN. SO THE WAY TO DO THAT IS TO HAVE MORE WORKING GROUPS SUBCOMMITTEES. RIGHT NOW THERE IS THE ESTABLISHED SUBCOMMITTEE FOR THE EXTRAMURAL GRANTS PROGRAM. THERE ARE TWO WAYS TO DO THIS ACCORDING TO FEDERAL RULES. YOU CAN HAVE SUBCOMMITTEES OR YOU CAN HAVE WORKING GROUPS. THE GOAL WILL BE THAT EVERY MEMBER OF THE BOARD WILL NEED TO BE ON A WORKING GROUP OR A SUBCOMMITTEE AND THE DECISION WE HAVE TO MAKE TODAY AS WE WORK THROUGH THIS DISCUSSION, IS THE CATEGORIES OF WORKING GROUPS OR SUBCOMMITTEES AND WHETHER THEY SHOULD BE WORKING GROUPS OR SUBCOMMITTEES. SO IN ORDER TO TRY TO DECIDE ON THAT, WE NEED TO KNOW THE FEDERAL RULES FOR DIFFERENCE BETWEEN SUBCOMMITTEES AND WORKING GROUPS. SO YOU HAVE LISTED THERE THE CATEGORIES OF ACTIVITIES OF SUBCOMMITTEES AND WORKING GROUPS. ONE OF THE BIGGEST DIFFERENCES IS THAT SUBCOMMITTEES ARE COMPOSED OF MEMBERS OF THE BOARD ONLY. WORKING GROUPS HAVE OUTSIDE MEMBERS AS WELL AS MEMBERS OF THE BOARD. SUBCOMMITTEES ARE GENERALLY LONG-TERM, FOR EXAMPLE THE ONE WE'RE FAMILIAR WITH IS THE EXTRAMURAL GRANTS REVIEW SUBCOMMITTEE AND IT IS LONG TERM, IT'S BEEN ESTABLISHED FOR I SUPPOSE SINCE THE BOARD WAS ESTABLISHED. A LONG TIME. (OFF MIC) '60s, THAT'S MORE THAN 20 YEARS. SO IT MUST -- A SUBCOMMITTEE MUST DECLARE MEETINGS. THEY CAN HAVE NON-VOTING CONSULTANT AND THEY NEED TO REPORT TO THE BOARD OF REGENTS FOR ACTION. THE WORKING GROUPS CAN HAVE OUTSIDE MEMBERS, AS WELL AS BOARD OF REGENTS MEMBERS, THEY CAN BE SHORTER TERM, BUT THEY CAN BE RENEWED SO THEY CAN BE LONGER TERM BUT REVIEW AND RENEWED. THEY HAVE TO REPORT TO THE BOARD FOR ACTION. SO WORKING GROUP IS A LITTLE BIT MORE AGILE, MORE FLEXIBLE, CAN BE APPLIED TO ISSUES AS THEY ARISE. A SUBCOMMITTEE IS MORE GENERAL STANDING COMMITTEE. SO I SHOULD THANK MEMBERS OF THE BOARD WHO WORKED WITH PATTEDTY AND ME, PRIOR TO THIS MEETING WHERE WE HAD SEVERAL CONFERENCE CALLS, TO COME UP WITH SUGGESTIONS FOR YOU FOR CATEGORY& OF SUBCOMMITTEES OR WORKING GROUPS THAT WE WOULD LIKE TO ESTABLISH. THIS IS UP FOR DISCUSSION. WE CAN DISCUSS IT THIS MORNING, NOW OR SECOND SESSION. SO JUST TO WE HAVE A LITTLE BIT MORE SPECIFIC PURPOSE OUTLINED HERE ON A SHEET, YOU HAVE TWO SHEETS IN YOUR PACKAGE THAT LOOK LIKE THIS. YOU CAN READ THE NEW WORDING. WHILE LOOKING FOR THOSE I WANT TO THANK DAN MASYS AND STAN KOSECKI AND JAEN BLUMENTHAL AND ERIC HORVITZ FOR YOUR HELP IN CONFERENCE CALLS LEADING UP TO THIS MEETING AS WE CAME UP WITH THESE CATEGORIES. SO IF ANYBODY WANTS TO BLAME ANYBODY, THOSE ARE THE PEOPLE TO TALK TO. HAS EVERYBODY FOUND THESE, THEY LOOK LIKE THIS. SO THE EXTRAMURAL PROGRAM SUBCOMMITTEE WHICH IS THE ONE ALREADY ESTABLISHED OVERSEES GRANTS PROGRAMS, ASSESSES EARLY CONCURRENCE OF GRANTS, REVIEWS, CONCEPT REVIEW FOR NEW GRANT PROGRAMS. VALERIE FLORANCE IS THE NLM POINT OF CONTACT FOR THAT COMMITTEE. WE HAVE PROPOSED AGAIN IN OUR WORKING SESSION, THE LUNCH WORKING SESSION COUPLE OF MEETINGS AGO, ONE OF THE THINGS THE BOARD MEMBERS ALL UNANIMOUSLY REQUESTED IS WE HAVE MORE INPUT INTO IMPLEMENTATION OF THE STRATEGIC PLAN. WE SUGGEST WE ESTABLISH A WORKING GROUP OR A SUBCOMMITTEE, FOR STRATEGIC PLAN IMPLEMENTATION. THE GOAL FOR THAT SUBCOMMITTEE OR WORKING GROUP IS TO GUIDE AND BENCHMARK PROGRESS TOWARDS THE STRATEGIC PLAN. MIKE HUERTA, CAN YOU ACTUALLY STAND UP? SO WE ALL KNOW WHO THE POINT OF CONTACT IS. SO THAT WILL BE MIKE HUERTA. ANOTHER WOULD BE RESEARCH FRONTIERS TO PROVIDE THEMEIC GUIDANCE FOR THE NLM INTRAMULE AND EXTRAMURAL RESEARCH PROGRAMS, MILT CORN. HI. AS POINT OF CONTACT. RESEARCH FRONTIERS WOULD PROVIDE THEMEIC GUIDANCE FOR THE NLM -- I JUST SAID THAT. PUBLIC SERVICES WOULD MONITOR THE QUALITY, INTEGRITY AND APPROPRIATENESS OF PUBLIC SERVICES. EDWARD DESOUZA: POINT OF CONTACT. LITERATURE AND COLLECTIONS WOULD EXECUTE BOARD POLICY FOR THE COLLECTIONS, JOYCE BACCUS WOULD BE POINT OF CONTACT. THANK YOU. SO WE CAN DISCUSS THAT IN THE DISCUSSION PERIOD. SO WE'RE GOING TO HAVE MORE CONVERSATION ABOUT THIS IN THE SECOND DISCUSSION BUT I'LL BRING IT UP NOW. IN ORDER TO HAVE THESE ESTABLISHED WORKING GROUPS OR SUBCOMMITTEES WE NEED TO RESTRUCTURE THE TIME OF THE BOARD MEETINGS. WE HAVE A COUPLE OF PROPOSED SUGGESTIONS. THE STRUCTURE WE HAVE NOW AND TWO OTHERS I'LL SHOW YOU IN A MOMENT. THE NEED WILL BE THERE FOR THE WORKING GROUPS AND SUBCOMMITTEES TO MEET AT EVERY BOARD MEETING. AS NEEDED IN BETWEEN. SO BE CAREFUL WHAT YOU WISH FOR, BOARD MEMBERS. BECAUSE WE ALL ASK FOR THIS AND NOW WE'RE GOING TO HAVE MORE WORK. BUT IT WILL BE I THINK VERY REWARDING BECAUSE WE WILL HAVE SOME INPUT, IMPORTANT INPUT INTO DECISION MAKING BY NLM. THERE WOULD BE A NEED FOR TWO, TWO AND A HALF HOUR BLOCKS OF TIME FOR GROUP MEETINGS DURING THE BOARD MEETING SESSIONS. EVERY MEMBER WILL BECOME A MEMBER OF ONE WORKING GROUP OR SUBCOMMITTEE. ALL THE GROUPS OR SUBCOMMITTEES WILL REPORT BACK TO THE ENTIRE BOARD OF REGENTS AT EACH MEETING. AND THERE WILL BE A NEED TO CONSIDER THEREFORE HOW TO WORK THIS EXTRA TIME DISCUSSION IN TO THE BOARD STRUCTURE. SO HERE ARE THREE OPTIONS, I DON'T EXPECT YOU TO LOOK AT THIS AND VOTE THIS MINUTE. BUT THIS WE'RE GOING TO BE TALKING ABOUT THIS THIS AFTERNOON AND I ASK YOU TO CONSIDER THIS OVER LUNCH AND COFFEE BREAK THINK HOW YOU WOULD LIKE TO ORGANIZE YOUR DAYS WHEN YOU COME HERE. THE LAST OPTION, THE TWO DAY STANDARD IS ONE WE HAVE NOW WHERE WE COME IN, DAY ONE, START IN THE MORNING AND DAY TWO HAVE A HALF DAY MEETING. THE FIRST OPTION IS A ONE DAY MEETING AND I'M NOT GOING TO GIVE AWAY MY PREFERENCE HERE. BUT IT WOULD START EARLIER AND FINISH LATER AND BE PACKED. AND INCLUDE THESE ONE AND A HALF TWO AND A HALF HOUR MEETINGS OF THE SUBCOMMITTEES AND WORKING GROUPS. AND THE THIRD OPTION IS A TWO DAY MEETING BUT INSTEAD OF STARTING IN THE MORNING, HAVE A HALF DAY MEETING, STARTING IN THE AFTERNOON ON DAY ONE AND THEN A FULL DAY MEETING ON DAY TWO. SO PLEASE CONSIDER THOSE AND WE CAN DISCUSS WHICH OF THOSE OPTIONS YOU PREFER. AND PATTY, WHEN WOULD THIS BE IMPLEMENTED IN >> WE CAN BEGIN AS EARLY AS SEPTEMBER '18 MEETING, THE NEXT BOARD MEETING. >> OKAY. SO WITH THAT, I WOULD LIKE TO OPEN IT UP FOR DISCUSSION. AND WE WILL GO BACK TO REALLY THE PART THAT NEEDS TO BE DISCUSSED IS THE CATEGORIES OF SUBCOMMITTEES OR WORKING GROUPS AND NUMBER ONE, I WOULD LIKE TO HEAR BACK FROM EVERYONE WHETHER YOU THINK THESE ARE THE CATEGORIES THAT ARE NEEDED, WHETHER THERE'S ANYTHING DIFFERENT, NEW, AND WHETHER EACH OF THESE SHOULD BE A WORKING GROUP OR SUBCOMMITTEE. THAT WILL BE ENOUGH TO DISCUSS THIS MORNING, IT MIGHT CARRY OVER TO THE LATE SECOND PIECE AND MOSTLY IN THE SECOND PIECE WE'RE GOING TO DISCUSS THE STRUCTURE OF THE DAYS OF BOARD. YES. BOB. >> HISTORICALLY THERE WAS ANOTHER WORKING -- SUBCOMMITTEE CALLED THE OUTREACH SUBCOMMITTEE. I'M WONDERING, IT MIGHT BE SOON, MAYBE UNDER STRATEGIC PLANNING ROTATION BUT ONE OF THE GOALS THAT WE ESPOUSED, IN THE STRATEGIC PLAN AND WHERE THE BOARD MIGHT BE UNIQUELY EQUIPPED, IS TO BRING IN PERSPECTIVES OR ELSE HELP TO BE AMBASSADORS TO OTHER AGENCIES ENTITIES OUTSIDE GROUPS THAT COULD BE PARTNERS IN NLM INITIATIVES. SO WONDERING IF THAT IS WAS THOUGHT OF OR WHETHER IT'S -- >> IT WAS THOUGHT OF AND SUBSUMED -- I AGREE WITH YOU, I FEEL THIS IS A REALLY IMPORTANT PART OF THE NLM MANDATE, AS PATTY MENTIONED IN HER OVERVIEW, IT IS REALLY THE WINDOW ON TO NIH AND SCIENCE AND THE NEED FOR CREDIBILITY OF HEALTH AND SCIENTIFIC DATA IS SO IMPORTANT IN THIS ERA. WE NEED TO GET THIS OUT INTO ALL COMMUNITIES SO IT'S REALLY IMPORTANT. SO THAT'S A GOOD POINT. SHOULD THIS BE A SEPARATE SUBCOMMITTEE WORKING GROUP OR SHOULD IT BE PART OF THE STRATEGIC PLAN IMPLEMENTATION, PUBLIC SERVICES, I SEE THAT AS PART OF PUBLIC SERVICES. PATTY, WHAT DO YOU THINK? >> I WELCOME A LONG DISCUSSION ABOUT OUTREACH. WE DEFINE OUTREACH AS DELIBERATE ACTIVITIES DESIGNED TO INCREASE ACCESS TO AND USE OF OUR RESOURCES. IT MAY RANGE FROM TEACHING SCIENTISTS HOW TO UPLOAD RESOURCE DATA SET INTO DB GAP, IT MAYBE PROVIDING A BASE OF LITERACY TO A GRAMMAR SCHOOL STUDENT SO THEY CAN FIGURE HOW TO READ HEALTH INFORMATION ON THEIR OWN, VERY BROAD. THE TERM OUTREACH ITSELF OFTEN CONNOTES A HUMAN TO HUMAN CONTACT AND INCREASINGLY OUR OUTREACH EFFORTS AND WE RUN THROUGH THE AUDIT LAST YEAR ARE ELECTRONIC, WE DO IT THROUGH THE WEB AND WE NEED TO CONSIDER THE POST WEB ERA, WHAT KIND OF OUTREACH WILL OCCUR DURING THE THAT TIME THAT WE HAVE THE NEED TO REACH SPACE OR PUERTO RICO AND THERE'S NO INTERNET IN PLACE. I'M ASKING TO THINK BROADLY ABOUT PUBLIC SERVICES WITHIN WHICH WOULD BE A COMMITMENT TO OUTREACH. RECOGNIZING THAT THE STRATEGIC PLAN CERTAINLY SPEAKS TO OUTREACH, RECOGNIZING THAT COLLECTION MANAGEMENT IS CONNECTED HOW WE DO CONDUCT OUTREACH AND FRANKLY THE EXTRAMURAL PROGRAMS DOES RESEARCH HOW TO DO OUTREACH. SO I'M OPEN TO RELABELING BUT I WANT TO MAKE SURE WE DON'T -- WE KEEP BROAD DEFINITION AS POSSIBLE. >> I HAD SOMETHING ELSE IN MIND, I AGREE WITH YOU ABOUT OUTREACH AS -- MAYBE OUTREACH ISN'T THE RIGHT TERM BUT IT'S REALLY HOW DOES NLM ENGAGE WITH OTHER PARTNERS IN SOME OF THE THINGS LIKE STANDARDS ADOPTION OR PROMOTING OF EFFICACY MEASURES, WHATEVER IT MIGHT BE. >> VERY INTERESTING. BECAUSE I THINK A LOT WILL BE THOUGHT ABOUT HOW TO LEVERAGE NLM IS REALLY WITHIN NIH BUT ALSO IN THE BROADER COMMUNITY, AND WE ARE A LOT OF US COME FROM DIFFERENT ORGANIZATIONS AND ENTITIES THAT RAND BELONG TO OTHER SOCIETIES THAT CAN HELP BROADEN ADOPTION AND ADD DIMENSION TO WHAT WE DO. THAT'S WHAT I MEANT BY OTHERS. I DON'T KNOW THAT THAT'S -- >> SO WHAT I AM HEARING, AND I KNOW ERIC HAS YOUR HAND UP. WAND WE'LL CALL YOU IN A MOMENT BUT WHAT I HERE IS THAT IS A ACTIVITY OF THE NLM THAT IS CROSS CUTTING ACROSS ALL OF THESE CATEGORIES SO THEN THE QUESTION BECOMES DO WE PULL IT OUT? AND HAVE A SEPARATE SUBCOMMITTEE OR DO WE LEAVE IT IN AND MAKE IT AN IMPORTANT PIECE OF EVERYTHING. THAT SPEAKS TO WHETHER YOU DO SILOS VERSUS INTEGRATING IT ACROSS. SO I WANT TO HEAR FROM ERIC AND -- DID YOU HAVE YOUR HAND UP? >> SHAKING MY HEAD IN AGREEMENT. >> DISCUSSION CAUGHT UP WITH MY COMMENT, QUESTION. BOB CLARIFIED INTENTION -- I LIKE THE IDEA OF WHAT PATTY SAID SOMEHOW MAKING PUBLIC SERVICE, THE CATEGORY FOR ENGAGE, PUBLIC SERVICE ENGAGING (INAUDIBLE) STRATEGIC ALLIANCES, THE QUESTION I HAVE THERE IS THERE ENOUGH TO DO IN ONGOING BASIS, I SEE WORKLOADS BE FAIRLY INTENSIVE BALANCED ACROSS THESE FIVE AND STRATEGIC ALLIANCE IS THE KIND OF THING MAYBE MORE FOCUS SESSION TO SEE WHERE ARE WE IN WHO WE WORK WITH OPPOSED TO -- KIND OF LIKE SHOULD WE WORK WITH ISO STANDARDS, SO WE TEAM -- THESE ARE LESS ONGOING MORE SPORADIC AND OPPORTUNISTIC BUT I'M NOT SURE ABOUT THAT. SO I WOULD TEND TO FIND THE PROXIMAL QUESTION, GO WITH THE INTENSITY ACROSS ALL THE -- BUT YOU NEVER KNOW IF THAT WILL ADDRESS PROPERLY. >> I THINK THAT'S A GOOD POINT. AGAIN SPEAKING TO -- THEN I'LL CALL ON GARY THEN DAN. SPEAKING TO THE NEED FOR THAT KIND OF DECISION MAKING TO BE SPORADIC, THAT WOULD FIT WITHIN A WORKING GROUP AND I THINK THAT WOULD FIT AS A SUBCATEGORY OF WHICHEVER ONE IS MORE RELEVANT FOR. THERE ARE STRATEGIC ALLIANCES FOR FRONTIERS PUBLIC SERVICES OUTREACH, STRATEGIC PLANNING, SO IT SHOULD BE NOTED THAT WE WANT TO CONTINUE TO HAVE INPUT ON THAT BUT MAKING IT A SUB-- ONE OF THE THINGS WE HAVE TO THINK ABOUT WHEN DOING THIS IS WE COULD MAKE AN INFINITE NUMBER OF SUBGROUPS, WORKING GROUPS. WE CAN'T DIVIDE UP AND HAVE TOO MANY OF THESE. SO GARY, DAN. (OFF MIC) OUTREACH TO INCLUDE WHAT I DESCRIBE ADS TECHNOLOGY TRANSFER. THAT'S THE NATIONAL LIBRARY OF MEDICINE IS BUILDING INCREDIBLE TECHNOLOGY AND CUTTING EDGE TECHNOLOGY, IT'S REALLY IMPORTANT FOR PUBLIC TO UNDERSTAND AND EVEN BEGIN TO USE. SOMEHOW THE LIBRARY HAS GOT TO HELP TRANSFER THAT INFORMATION OUT TO THE PUBLIC SO IT'S NOT A PASSIVE RELATIONSHIP THAT YOU'RE HAVING WITH THE PUBLIC BUT YOU'RE ALSO INTRODUCING THEM INTO THE WORLD YOU'RE TRYING TO BUILD, THIS WHOLE 21st CENTURY INFORMATION SYSTEM. YOU'RE DOING IT. BUT A LOT OF PEOPLE THAT ARE NOT GETTING ACCESS TO THAT TECHNOLOGY OR AT LEAST UNDERSTAND IT ENOUGH TO ENGAGE WITH IT. SO I THINK THINKING PUBLIC OUTREACH I THINK OF IT IN THAT BROAD SENSE OF HOW DO WE TRANSFER NOT JUST THE DATA BUT THE INFORMATION SYSTEMS THAT BUILDING >> THE NIH ADOPTS A VERY NARROW DEFINITION OF TECH TRANSFER, IP SHARING AND SPECIFIC SPECIAL RELATIONSHIPS. WE DO QUITE A BIT IN BOTH INDUSTRY BASED SHARING, CO-CHAIRING, I WILL ASK JIM TO SPEAK ABOUT THIS IN A MINUTE AND ALSO PROVIDE TOOLS FOR THE PUBLIC TO MAKE USE OF DATA EITHER THROUGH HACK ONATHONS AND OR NEW RESEARCH BUILDING THE KINDS OF INQUERY OR DATA MANAGEMENT TOOLS THAT'S USEFUL. DO YOU WANT TO SPEAK ABOUT INITIATIVES AROUND OPEN SOURCE COMPUTING AND THINGS SUCH AS THAT. >> FROM THE BEGINNING THE CODE WRITTEN HERE AS OPPOSED TO (INAUDIBLE). WE HAD THE IDEA THIS IS AVAILABLE. WE HAVE APPLICATIONS, WE PACKAGE FOR REDISTRIBUTION. WE HAVE SERVICES PEOPLE USE THROUGH API HERE. AND THERE'S COMMERCIAL SYSTEMS THAT USE THOSE AS PART OF THEIR PACKAGE. MOST RECENTLY, WITH THE ADVENT OF MOVING ON TO COMMERCIAL CLOUD WE'RE REPACKAGING SOME INTERNAL PIPELINES. TO BE MORE AMENABLE TO THOSE THINGS, CONTAINSERS, USING PROCESS CONTROL LANGUAGESES TYPICALLY SUPPORTED ON THOSE PLATFORMS AS OPPOSED TO (INAUDIBLE). WE HAVE BEEN HOLDING HACKATHONS SO PEOPLE CAN START USING THOSE TOOLS. ONE OF THEM WE'RE PARTNERING WITH SEQUENCE MANUFACTURERS T HACK BIO AND ALUMINA WHO WANT TO USE OUR ANALYSIS PIPELINES AT THE END OF -- THEIR PRODUCTS CYCLE. AND THE OUTPUT OF THOSE THINGS ARE SET UP SO THEY CAN BE SUBMITTED TO THE PUBLIC DATABASE SO IT GOES THROUGH MACHINE, PIPELINE, YOU GET THE END RESULT AND YOU GET YOUR DATABASE DEPOSIT. SO IT'S -- THAT'S A HEAVY LIFT AS YOU MIGHT IMAGINE, TRAINING PEOPLE TO USE IT. ONE THING WE LEARN IS CRITICAL PACKAGING, OUR UI UX DESIGN, THE BETTER IT IS THE LESS TRAINING TO USE IT AND SAME WAY FOR PACKAGING THESE PIPELINES, THE CLOSER IT IS LOOKING -- WHAT TO EXPECT ON THAT PLATFORM. AND MORE LIKELY (INAUDIBLE) THAT'S MORE WORK. FROM IT'S MORE COMMERCIAL (INAUDIBLE). >> THANK YOU. DAN, JIM. >> BRINGS TO MIND IN THE PLANNING PANEL MEETINGS SPONTANEOUSLY IN EACH ONE OF THEM PROMINENTLY AROSE THE IDEA OF NLM UNIQUE ABILITY TO SERVE ADS CONVENER FOR TOPICS VERY BROAD AND NOBODY OWNEDDED THE WHOLE TOPIC BUT NLM BY VIRTUE OF INSTITUTIONAL PRESTIGE AND GRAVITAS AND NATURAL TECHNICAL COMPETENCE AMONG OTHER THINGS COULD SERVE ADS CONVENER TO GET THINGS STARTED THAT DON'T CURRENTLY EXIST. THAT'S A LITTLE DIFFERENT THAN STRATEGIC ALLIANCES, TO ME STRATEGIC ALLIANCES SOUND LIKE WE HAVE A CORPORATE GOAL AND WE NEED A SET OF PARTNERS TO DO IT. AND SO I GUESS INCLUDING WHETHER WE DO IT ACROSS ALL OF THOSE OR IT BECOMES ITS OWN, THIS IMPORTANT IDEA AND REPETITIVELY EMERGING IDEA OF CONVENING OTHERS TO CREATE SOMETHING THAT DOESN'T YET EXIST OUGHT TO BE INCLUDED IN THE CHARGE. >> SO JIM YOU HAVE A COMMENT. >> JUST TO BUILD OFF THESE COMMENTS. THE NATIONAL SCIENCE FOUNDATION JUST RELEASED ITS STRATEGIC PLAN WITH THE 19 BUDGET. ONE PRIORITY, AGENCY PRIORITY SO BUILD PARTNERSHIPS STRATEGIC ALLIANCE, HOWEVER YOU WANT TO CALL IT, I WILL I'M ON THE WORKING GROUP THAT'S TRYING TO INCREASE THEM BY 5% IN 2019 RELATIVE TO 17. SO WE HAVE A TARGET WHICH WE IMMEDIATELY REALIZE EVERYBODY ACROSS THE FOUNDATION ABOUT PARTNERSHIP IS HOW MANY TYPES OF PARTNERSHIPS THEREFORE. -- THERE ARE. AND DEPENDS WHAT YOU NEED TO ACCOMPLISH. YOU HAVE FORMAL PARTNERSHIPS THAT ARE BOUND BY MEMORANDUM OF UNDERSTANDING AND TONS OF PARTNERSHIPS LEVERAGING THE ARCTIC PROGRAMS WITH LOCAL CAT FORS DOWN THERE. IT'S AMAZING AND HAVE TO COUNT THEM, WE HAVE FORMAL PARTNERSHIPS. I JUST THOUGHT WE DID BEND THEM INTO FOUR CATEGORIES THAT I THOUGHT I WOULD JUST LIST TO HELP US GET OUR HEADS AROUND THE THING. SO ONE IS INTERAGENCY, WE DO A LOT INTERAGENCY NSF AND NIH, WE HAVE JOINT FUNDINGCALS SO IT'S A SIMPLE ONE WITH MOUs BUT THEN YOU HAVE PUBLIC PRIVATE PARTNERSHIPS THAT HAVE TWO FLAVORS. ONE WITH COMMERCIAL ENTITIES FOR PROFIT AND SOME NON-PROFIT ENTITIES. THOSE HAVE COMPLETELY DIFFERENT FLAVORS. AND I CAN IMAGINE THAT DIFFERENT TYPES OF PARTNERSHIPS WOULD ALIGN WITH DIFFERENT PROGRAMS THERE. THEN WE HAVE PROGRAMMATIC PARTNERSHIPS TO GIVE GRANTS TO ACADEMIC INSTITUTIONS TO PARTNER. SO WE PUT FUNDS TO PARTNER WITH THE PRIVATE SECTOR, THEY CAN BE NON-PROFIT. NA SEEMS TO CAPTURE THE FORMAL INTO FOUR CATEGORIES. >> THAT'S EXTREMELY HELPFUL. THANK YOU VERY MUCH. ACTUALLY I'M GOING TO CALL ON THE MILITARY ADVISERS BECAUSE THEY DO A LOOT OF PARTNER -- LOT OF PARTNERING IN PUBLIC PRIVATE AND INTERAGENCY. CAN YOU COMMENT? >> PROBABLY BIG ePARTNER IS VA SO YOU SEE MORE FORMAL. EVEN JUST WITHIN THE SERVICES, QUITE A BIT WE'RE SEEING SOME OF THAT CHANGE WITH THE ADVENT OF DEFENSE HEALTH AGENCY ROLE AND ALL THAT TOGETHER IN ONE AGENCY. >> DEFENSE HEALTH AGENCY WILL BE RUNNING MILITARY HOSPITALS FROM STARTING IN OCTOBER AND ROLLED IN A COUPLE OF YEARS, THE DHA IS GOING TO BE IN CHARGE OF THE CLINICAL ASPECTS OF IT AND TRAINING ASPECTS MILITARY WILL BE IN CHARGE OF IT. WE'LL WORK CLOSELY TOGETHER MEETING AT LEAST THREE TIME AS YEAR. WITH AIR FORCE AND NAVY COLLEAGUES, SO THERE'S MORE OF THOSE THINGS AND MORE PARTNERSHIPS WITH THE VA FOR THINGS WE DON'T HAVE. LIKE IN HAWAII FOR INSTANCE THERE IS NO VA HOSPITAL. SO -- HOSPITAL IS THE INPATIENT FACILITY FOR THE VA PATIENTS AND THAT'S HOW WE HAVE FASTER SURGERY SERVICE BECAUSE WE DIDN'T HAVE FASTER SURGERY SERVICE WITHOUT HAVING VA PATIENTS. THEN THERE'S WAIT A BIT OF EDUCATIONAL PARTNERSHIPS. WE TRAIN SURGEONS BUT WE DON'T HAVE TRANSPLANT SURGERY TO SCALE SO -- WE DO QUITE A BIT OF THAT. THEN OTHER THINGS MILITARY DOES QUITE A BIT, WE AREN'T DIRECTLY INVOLVED AS MUCH WITH RESEARCH PARTNERSHIPS LIKE AT FORT DETRICK. I COULD NOT SPEAK THAT WELL ABOUT THOSE. BUT THERE'S A LOT INDUSTRY PARTNERSHIPS OUT THERE. >> GREAT. THANK YOU VERY MUCH. >> IN RESEARCH EDUCATION AREAS, MILITARY HAS MORE PARTNERSHIPS THAN THEY DO IN CLINICAL CARE BECAUSE REQUIREMENT TO PROVIDE CRITICAL CARE IS PRIMARY MISSION FOR THE MEDICAL DEPARTMENTS BUT CONGRESSIONALLY FUNDED PROGRAMS YOU WILL HAVE A FEDERAL LAB, OR INVESTIGATOR PARTNERING WITH A UNIVERSITY LAB OR INVESTIGATOR. ALL THOSE HAVE TO HAVE FORMAL MOUs. PUBLIC PRIVATE PARTNERSHIPS, USING FOUNDATIONS, AS WELL AS EDUCATIONAL INSTITUTIONS AS WELL AS COMMERCIAL VENTURES. WE JUST ARE SIGNING COOPERATIVE AGREEMENT TO TRY AND BUILD A TABLET TOOL THAT A CORPSEMAN CAN USE AS PRIMARY CARE PROVIDER TO DO FIRST CUT IN CLINICS AND œLOT OF THAT KIND OF THING BUT A THEY ARE MINIMAL. SO YOUR RESEARCH PARTNERSHIPS, YOUR PUBLIC SERVICE PARTNERSHIPS, EXTRAMURAL PARTNERSHIPS WILL PROBABLY BE WHERE WE ALREADY ARE. I THINK THE CHALLENGE IN THOSE KIND OF THINGS IS KEEPING THE GENERAL COUNCIL HAPPY. ANY PARTNERSHIP WITH FEDERAL GOVERNMENT HAS A SMALL BOOKLET OF RULES YOU HAVE TO FOLLOW. IT WOULD BREAK THIS TABLE. >> >> SO I'M HEARING SO MANY DIFFERENT CATEGORIES O PARTNERSHIPS. REALLY RATHER THAN SEPARATING OUT AND DIFFERENT NEEDS RATHER THAN SEPARATING OUT HAVING ANOTHER SILO OF PARTNERSHIPS, IT NEEDS TO BE SOMEHOW CALLED OUT WITHIN EACH OF THESE WORKING GROUPS THAT AN IMPORTANT MANDATE WILL BE TO CONSIDER STRATEGIC ALLIANCES OUTREACH PARTNERSHIPS. IS THAT WHAT I'M HEARING? I SEE THAT BOB GREENES HAS HIS HAND UP AND CARLOS, MAYBE WE CAN HEAR FROM YOU NEXT. >> ONE OF THE ISSUES IS REACH. WHO ARE WE REACHING? AND THE FORMAL PARTNERSHIPS AND SORT OF TOP DOWN, HOW ARE WE REACHING HEALTH SYSTEMS, HOW ARE WE REACHING COMMUNITIES AND PATIENTS. CURRENTLY -- REALLY MORE ABOUT AN INTERNAL TOP-DOWN HAVING (INAUDIBLE). WHERE IS THE REACH OF THOSE PARTNERSHIPS AND HOW -- WHO'S MINING THAT PROCESS I THINK IS AN IMPORTANT PIECE OF THE STRUCTURE. >> WOULD YOU PUT THAT AS A SEPARATE COMMITTEE OR WORKING GROUP OR WITHIN EACH -- (OFF MIC) >> HOW THE ACTIVITY REACHING. WHERE ARE WE REACHING WHO ARE WE REACHING BY THIS PROCESS. I THINK IS AN IMPORTANT PIECE AS WELL. >> GREAT, BOB DID YOU HAVE ANOTHER COMMENT? >> OBVIOUSLY THE BOARD RUNS THESE PARTNERSHIPS BUT MAYBE A PERIODIC BASIS WE SHOULD BE REVIEWING WHAT PARTNERSHIPS THERE ARE OR WHAT PARTNERSHIPS THERE SHOULD BE AS A STANDING PROCESS. I DON'T KNOW IF IT -- IT MAY FIT WITHIN ONE OF THESE BUT MAYBE IT'S A SEPARATE THING THAT JUST MAYBE IS ONCE A YEAR. BUT SHOULD MEET PERIODICALLY JUST TO SEE -- >> AGAIN, I SEE THAT THERE ARE SO MANY DIFFERENT CATEGORIES THAT. RESEARCH PARTNERSHIP, MEMORANDUM OF UNDERSTANDING FOR RESEARCH IS DIFFERENT THAN THE KIND OF OUTREACH THAT WE TALK ABOUT TO COMMUNITIES. SO I THINK THE SOLUTION THAT I'M HEARING IS THAT WE HAVE A MANDATE THAT WITHIN EACH OF THESE CATEGORIES THERE BE A CONSTANT REVIEW OF WHAT PARTNERSHIPSES EXIST, WHAT ARE THE PURPOSES, ARE THEY FILLING FULFILLING THE NEED, REVIEWING THEM, AND SO ON. I SEE A LOT OF YES NODDING. >> >> REMEMBER WHAT JIM SAID WHEN THEY TRIED TO MAKE THE LIST AT NSF. THEY ARE ABOUT JUST IN ONE -- THE WHOLE AGENCY IS ONE FIFTH OF THE NIH. JUST THE MAKE OUR LIST MIGHT TAKE THAT YEAR TO GET READY. BUT IT WOULD BE HELPFUL TO KNOW. >> I THINK -- I DON'T THINK LIT TAKE A YEAR, MAYBE I'M WRONG. >> TO GET TO ADMIT TO THINGS THEY HAVE BEEN DOING WITH AWARENESS. >> >> PARTNERSHIP IS GENERALIZABLE METHOD TO ACHIEVING A GOAL, THE GOALS ARE BOUND SO THAT'S ENDORSEMENT. MENTION HOW TO GET STUFF DONE. >> THAT'S A GOOD SUMMARY. PATTY. >> THANK YOU. I WOULD LIKE TO THE BOARD TO TAKE A FEW MINUTE ON ROLE AND RELATIONSHIPS WE HAVE WITH INDUSTRY. THIS IS SOMETHING NIH HAS INCREASED ITS INTEREST IN THE LAST COUPLE OF YEARS RECOGNIZING THAT INDUSTRY PARTNERSHIPS ARE IMPORTANT BUT ALSO THAT SHARING RESEARCH INVESTMENTS WITH INDUSTRY IS VERY IMPORTANT. THERE ARE THINGS INDUSTRY DOES THAT WE SHOULD NOT DO, THERE ARE THINGS WE SHOULD DO THAT INDUSTRY WILL NOT DO. AND THERE NEEDS TO BE SOME MIDDLE GROUND. I WOULD LIKE YOU THE GIVE YOUR THOUGHTS ON INDUSTRY AS TECH INDUSTRY OR PHARMA INDUSTRY BUT ALSO INDUSTRY OR IMAGE -- THE IMAGE PRODUCTION INDUSTRY BUT ALSO CARE DELIVERY INDUSTRY. WE HAVE DIFFERENT LEVELS EF ENGAGEMENT AND IT IS REALLY TO ME THE -- ONE OF THE CRITICAL AREAS THAT ONLY THE BOARD IS ABLE TO LOOK BROADLY ABOUT. BEFORE YOU START THINKING. SO ARE YOU PROPOSING THERE BE A SEPARATE CATEGORY NOW FOR INDUSTRY? >> NOT NECESSARILY. THE COMMENTS BEGAN THERE BUT ECHOED BY OTHERS MADE ME REALIZE THE CONCEPT OF THESE GROUPINGS WHETHER THEIR WORK GROUPS OR SUBCOMMITTEES WILL ONLY ADDRESS PART OF THE BOARD'S MISSION. THERE ARE SOME THINGS YOU MUST BE ABLE TO ADDRESS WITH ME AS A BOARD AS A WHOLE. SO IT MAY BE THERE ARE THINGS LIKE, THINGS THAT WILL BE CROSS CUTTING SO NOT SUGGESTING WE SET UP A SUBCOMMITTEE FOR INDUSTRY BUT IF THAT IS YOUR GUIDANCE I'M WILLING TO WORK IN YOUR DIRECTION ALSO. >> BEFORE I GO IS TO JANE, IF WE LOOK AT EACH SUBCATEGORY. NOT NOSILY. (OFF MIC) WHAT I WANT TO DO, SO IT DOES HAVE SOMETHING TO DO WITH SBIR, STRATEGIC PLAN IMPLEMENTATION, YES. PRIVATE PUBLIC PARTNERSHIPS, DEFINITELY INVOLVE THEIR RESEARCH FRONTIERS, DEFINITELY INVOLVE PUBLIC SERVICES. PUBLIC SERVICES. COLLECTIONS MANAGEMENT YES. YES. THE USE OF GEN BASE AND SO ON. IT'S ANOTHER EXAMPLE OF A CROSS CUTTING OR OVERARCHING ISSUE THAT NEEDS TO BE ADDRESSED. THIS IS PUBLISHING INDUSTRY, YES, OF COURSE. SO THIS IS THE SAME ISSUE THAT WE WERE GRAPPLING WITH IN TERMS OF OUTREACH. DO WE MAKE ANOTHER SILO OR IS IT SOMETHING WE PUT IN THE MANDATE? I WILL GO TO JANE THEN ERIC. >> I THINK WE DO OURSELF AS DISSERVICE IF WE TRY THE COME UP WITH THE WORKING GROUP SUBCOMMITTEE AT THIS TIME. I THINK WHAT WE HAVE HERE ARE SOME GOOD RECOMMENDATIONS WHY NOT START HERE AND IN PROCESS OF GROUPS WORKING WE WILL UNCOVER WHETHER THERE NEED TO BE ADDITIONAL GROUPS OR PERHAPS THESE GROUPS ARE NOT REALLY NEEDED. >> ACTUALLY, THAT'S A VERY GOOD POINT, THAT SPEAKS TO WHETHER TO CALL SUBCOMMITTEE OR WORKING GROUP, A, WHOING GROUP CANNING ESTABLISHED AND DISAND DISBANDED. IT'S MORE AGILE. A SUBCOMMITTEE WOULD HAVE TO BE ESTABLISHED AND BE A LONG TERM PROCESS PLUS YOU CAN'T HAVE EXTERNAL ADVISERS ON IT. THAT GETS TO THE NEXT POINT, THE REST SHOULD BE WORKING GROUPS UNTIL WE FIGURE WHETHER THEY SHOULD BE SUBCOMMITTEES. CARLOS, SOMEBODY ELSE, ERIC? THEN CARLOS. >> I HEAR JANE SAY MAYBE WE DON'T NEED ALL FIVE? >> WE MIGHT NOT. >> THAT'S OKAY TO HAVE THAT ON THE TABLE ALSO. >> I'M GOOD WITH ALL -- >> ACCEPT THE EXTRAMURAL PROGRAMS. THAT WILL BE -- THAT'S REQUIRED THAT REVIEW OF REVIEW WORK GRANTS IS REQUIRED SO I DON'T KNOW THAT WE CAN DO WITHOUT THAT. WE MIGHT NOT -- ALL THE OUR FOUR. >> I THINK ACTUALLY THE ONES THERE ARE VERY GOOD AND KIND OF COVER THE MAJOR PART. OF NLM'S WORK. SO IF WE WANTED TO DO ALL OF THEM, IF SOMEBODY SAID LET'S PICK ONE OR TWO, AND SEE HOW THEY GO. THEN COME BACK FOR THE REST. I WOULD BE FINE WITH THAT AS WELL. >> ERIC. (OFF MIC) PROCESS THAT'S IMPORTANT SO FOUR GROUPS TO ME SEEMS LIKE GREAT SPANNING GROUPS, ANOTHER ONE -- DEALING WITH COMPLEXITY OF BREAK OUTS AND THINK ABOUT THAT, I'M CURIOUS TO SEE FOR MONITORING WHAT THE OUTPUT IS, MIGHT TURN OUT (INAUDIBLE) LET'S GET RID OF THAT GROUP. (INAUDIBLE) OVERRIDING QUESTIONS THAT MIGHT BE SPANNING THE GROUPS, JUST HAVE (INAUDIBLE) TAKE CARE OF THE ATTENTION THAT U YOU'RE NOT DOING X ESPECIALLY IF IT'S CROSS GROUP. >> OKAY. >> I THINK THE INTENTION HERE IS IT'S ALSO ONE ASPECT OF THE BOARD OF REQUIRE INTENSIVE DISCUSSION, SHORT PERIOD OF TIME. AND PART OF FUNCTION GENERAL IN -- (INDISCERNIBLE) EVERYTHING THAT WE DO IN PARTICULAR CATEGORY, I THINK THAT WILL BE SERVICE, THERE ARE SITUATIONS ARE WHERE TWO, TWO AND A HALF HOUR DISCUSSION WITH THE SPECIFIC RECOMMENDATIONS SHORTEN THE DIALOGUE ENHANCES QUALITY OF DIALOGUE. THE OTHER ASPECT OF RESTRUCTURING MAYBE THAT EVERY MEETING YOU HAVE GENERAL TOPIC THAT YOU WANT TO BRING UP AND HAVE DISCUSSION SAME TOPIC AREAS SOMETHING THAT NEEDS TO BE ADDRESSED AND DECIDED BY -- (INAUDIBLE) AND THAT BECOMES PART OF THE -- AND THEN WE GET MATERIALS AT A TIME, (INAUDIBLE) TOPIC AND WE'RE ALSO READY TO HAVE THAT HAPPEN. >> SO THAT COMES BACK TO ONE OF THE PARTS OF THE CONVERSATION THAT WE HAD WHEN WE STARTED THIS WORKING GROUP DISCUSSION A COUPLE OF MEETINGS AGO OVER LUNCH. THAT IS WE AS THE BOARD DON'T KNOW NECESSARILY WHAT DECISIONS THE NLM STAFF ARE GRAPPLING WITH SO WE NEED FEEDBACK AND THAT WAS THE PLAN WAS THAT PATTY WOULD WORK WITH THE CHAIR AND COME UP WITH IDENTIFYING ISSUES THAT NEED TO BE ADDRESSED OR THAT THE STAFF NEEDS THE BOARD'S INPUT. AND THAT CAN BE GENERAL DISCUSSION OR COULD BE THESE SUBCOMMITTEES OR WORKING GROUPS. THANK YOU. YES. >> NEXT SESSION BUT IT SUGGESTS THOUGH THAT YOU COULD ACTUALLY HAVE A VERY AGILE OPPOSED TO A STRUCTURAL MANDATE THAT EVERY WORKING GROUP MEETS AND REPORTS BACK TO THE BOARD WITH EVERY MEETING. PRE-POPULATED BY VIRTUE OF INTEREST SAY ONE OF THE THEMEIC GROUPS LIKE RESEARCH FRONTIERS BUT ONLY CONVENE THEM WHEN YOU HAVE A RESEARCH FRONTIER ISSUE, YOU WANT THEM TO BEGIN TO FOCUS ON. THAT WAY YOU HAVE AN ECONOMICAL USE OF MOST SCARCE RESOURCE WHICH IS JUST THE TIME OF TEN BOARD MEMBERS. SO WE CAN GO AHEAD AND LAY OUT THE FULL FRAMEWORK BUT NOT IN -- SORT OF WHAT JANE SAID, WE DON'T PULL THE TRIGGER ON ALL OF THEM RIGHT NOW. >> THAT SOUNDS LIKE A VERY GOOD IDEA. ANYBODY HAVE ANY COMMENTS ON THAT? >> A SUGGESTION. SINCE THE BOARD MEMBERS HAVE TO POPULATE SUBCOMMITTEES, AND WE HAVE CONSULTANTS TO THE BOARD THAT ARE EXTREMELY VALUABLE IN AREAS OF THE STRATEGIC PLAN, DESPITE THE FACT THAT I THINK WE NEED TO WORRY ABOUT THE STRATEGIC PLAN FOR ITS WHOLE LIFE, I WOULD MAKE IT A WORKING GROUP SO YOU CAN HAVE CONSULTANTS TO THE BOARD INVOLVED ON IT. THE OTHER THREE AREAS, ARE PROBABLY LONG TERM COMMITMENT SUBCOMMITTEE AREAS WHERE YOU WILL BRING IN EXPERTISE. DEPENDING ON SUBJECT. BUT IF YOU LOOK AT MISSION, THOSE COVER THE MISSION. IF WE'RE GOING TO DO THIS KIND OF THING WHETHER THEY REPORT OR NOT, THERE'S A FINITE AMOUNT OF TIME FOR EVEN IN BLOCK CONCURRENCE OF INFORMATION MEETING. I THINK IT WOULD BE REAL VALUE MAKING THE STRATEGIC PLAN IMPLEMENTATION. A WORKING GROUP TO BROADEN PEOPLE WE HAVE ON IT. PARTICULARLY TRUE SOME BOARD MEMBERS ROTATE OFF THE NEXT YEAR OR TWO AND WE WANT TO KEEP THEM ENGAGED AS CONSULTANTS, WHEREAS THE OTHER AREAS I THINK WILL BE MORE JUST HELPING THE STAFF IN AREAS WHERE THE STAFF IS ALREADY MOVING FORWARD QUITE WELL. >> SO THOSE ARE VERY GOOD POINTS. , I AGREE NUMBER ONE, THE STRATEGIC PLAN IMPLEMENTATION WORKING GROUP BE A WORKING GROUP FOR THAT PURPOSE TO HAVE A CONSULTANTS INVOLVED OR EXTERNAL MEMBERS INVOLVED. IN TERMS OF THE POINT DAN BROUGHT UP EARLIER OF BEING PRE-POPULATING AND THEN ONLY REPORTING WHEN NEEDED, THE STRATEGIC PLAN IMPLEMENTATION WORKING GROUP IS GOING TO NEED TO BE WORKING EVERY SINGLE TIME. THAT'S AN IMPORTANT PIECE. MAYBE THE MEMBERS OF THAT CAN ROTATE ON AND OFF AS IT EVOLVES WHETHER YOU'RE LOOKING MOVE OUTREACH AT COLLECTIONS, MORE AT DATA SCIENCE AND SO ON. IN TERMS OF RESEARCH FRONTIERS, PUBLIC SERVICES AND COLLECTIONS MANAGEMENT, I THINK MORE THE MOMENT MAY RECOLLECTING WORKING GROUPS FOR THE REASON JANE BROUGHT UP IS A GOOD IDEA, BECAUSE THAT WAY WE CAN DECIDE IF THEY'RE WORKING OR NOT AND WE CAN UNESTABLISH THEM, IT'S HARDER TO ESTABLISH A SUBCOMMITTEE AND THEN HARDER TO DISBAND IT IN MY UNDERSTANDING. (OFF MIC) IT'S THE SAME THING. >> SUBCOMMITTEES HAVE MORE FACA ENTANGLEMENTS. SO YOU REALLY GOT TO BEHAVE BY THE SAME FEDERAL ADVISORY COMMITTEE RULES THE WORKING GROUPS GET A LITTLE -- >> SO MAYBE WHAT WE NEED TO DO IS START AS WORKING GROUPS, SEE HOW THEY WORK AND THEN ALSO SEE WHAT COMBINATION PERMUTATION COMBINATION OF MEMBERS ARE ON EACH OF THESE DIFFERENT ONES. JANE. SANDRA. >> I WANT TO UNDERSCORE, THIS DISCUSSION SEEMS TO BE MOVING TOWARD OR MOVED TOWARD THE WORKING GROUP STRUCTURE. LEADING TO THAT IN TERMS OF ULTIMATELY FIGURING OUT WHAT WE'RE GOING TO DO. THIS WORKING GROUP MODEL IS THE START. >> SO YOU HINTED AT EXCLUSIVITY, YOU HAVE TO CHOOSE ONE, ONLY ONE. SEEMS TO ME IF WE HAD SOME MECHANISM, WE CAN BE ON A COUPLE, NOT MORE BUT ALLOW YOU THEN TO BE SOME MAYBE CREATIVE SCHEDULING DEPENDING ON WHAT THE TISSUES ARE, WHO YOU NEEDED TO GET ON TASK. >> WE ARE TALKING ABOUT PORTFOLIO MANAGEMENT THAT FITS IMMEDIATELY IN THE DISCUSSION OF RESEARCH FRONTIERS. I THINK THERE HAS TO BE MECHANISM FOR CROSS FERTILIZATION. >> FROM THAT POINT OF VIEW, WE HAVE FIVE CATEGORIES HERE, WE'RE 16 PEOPLE ON THE BOARD, SO THAT'S THREE MEMBERS PER SUBCATEGORY. YOU ALSO DON'T WANT TO SPLIT 15 -- I'M ASSUMING THE EXTRAMURAL PROGRAMS CONTINUE WITH 6 A.M. -- >> 3 A.M. >> I ASSUME THAT'S CONTINUING (INAUDIBLE) WORKING GROUPS. >> IT'S STILL FIVE AND THEN -- >> I'M ASSUMING -- PEOPLE ALREADY COMMITTED TO THAT NO MATTER WHAT. JOIN ONE OF THESE NEW -- >> THE REASON FOR THE MENTAL ARITHMETIC, SOCIAL STRESS TEST IN FRONT OF A GROUP. SO TELL WHICH ARE BEHAVIORAL SCIENTISTS. TO SEE WHETHER THIS IS FEASIBLE, IF YOU HAVE 15 OR 16 OF US, THERE'S THREE -- THERE'S FIVE DIFFERENT CATEGORIES AND THERE'S THREE PER AND DO WE REALLY WANT TO HAVE FOUR, WHAT IS THE IDEAL NUMBER OF PEOPLE ON ONE OF THESE SUBCOMMITTEES. MAYBE IT CAN BE FLUID. PEOPLE SAY THIS COMING MEETING, I'M INTERESTED IN DISCUSSING THE DATA SCIENCE INITIATIVE I WANT TO BE PART OF THE STRATEGIC PLAN DATA SCIENCE IMPLEMENTATION NEXT TIME WE TALK ABOUT COLLECTIONS, I'M NOT EXPERT IN THAT. IS THAT WHAT YOU'RE PROPOSE SOMETHING IN AND OUT, THESE THINGS AS FLUID? THAT MAKES SENSE. >> I CAN SEE PEOPLE GETTING THEIR MIND COMMITTED TO ONE OF THESE WAYS OF THINKING USEFUL LONG TERM. MONTHS OF POSED TO LIKE A DAY. >> THAT CAME UP IN SMALL GROUP DISCUSSION, THEN BACK TO STAN AND MARY AND DAN SUPPORT PERSON. I APOLOGIZE FOR -- THE IDEA WE NEED TO BUILD SOME MOMENTUM UM OF PEOPLE -- ASK YOU TODAY TO THINK ABOUT COLLECTION, IT'S TAKEN 18 MONTHS TO UNDERSTAND, I IMAGINE WE HAVE KNOWING FEDERAL REQUIREMENTS, WE HAVE CERTAIN PRACTICES THAT PERCEIVING THE BOARD, THAT MAY TAKE A COUPLE OF SESSIONS TO GET FAMILIAR WITH. ON THE OTHER HAND THERE ARE DECISIONS WE HAVE TO MAKE NOW DO WE INVEST IN ACQUIRING COLLECTION TO MAKE SPACE FOR CERTAIN COLLECTIONS LIKE EXPANDING INVESTMENT IN IMAGES OR MANAGING THE LINES CLEARINGHOUSE FADESSED OUT AT AHRQ. WE MIGHT NEED ADVICE ON QUICKER. IF THERE'S BALANCE BETWEEN PEOPLE WHO DEVELOP A DEEPER UNDERSTANDING AND PEOPLE COMING IN BECAUSE WE'RE TALKING ABOUT -- WHICH I THINK WE CAN HAVE THAT FLEXIBILITY. >> I THINK THAT THAT MAKES SENSE. AND CERTAINLY HAVING YOUR INPUT, PATTY AND THE LIBRARY STAFF INPUT AS TO WHAT ARE THE PROBLEMS THAT YOU ARE GRAPPLING WITH THAT YOU NEED OUR HELP ON, WILL HELP IDENTIFY AHEAD OF TIME WHAT BETWEEN YOU AND THE BOARD SHARE WHOM TO BRING IN TO THESE DISCUSSIONS ON A SHORT TERM BASIS BUT TO HAVE A STANDING GROUP THAT HAS TWO PEOPLE THAT ARE ASSIGNED TO THE AREA. AND IT'S PRETTY EASY BECAUSE WE'RE SO OUR EXPERTISE IS SO BROAD HERE THAT WE CAN IDENTIFY PEOPLE RIGHT AWAY. I CAN SEE JANE AND SANDRA AND THE COLLECTIONS. RIGHT? NOT NECESSARILY? >> I WOULDN'T BE PART OF COLLECTIONS BECAUSE I WOULDN'T KNOW ANYTHING ABOUT THAT. >> ASK PEOPLE TO (INAUDIBLE) SEE WHAT DISTRIBUTION LOOKS LIKE. >> SO I WILL USE THAT. THAT'S A GREAT HOME WORK PIECE FOR BETWEEN NOW AND THE SECOND SESSION WHERE WE HAVE TO DISCUSS THIS. I THINK WE'RE AT THE COFFEE BREAK. SO EVERYBODY -- 15 MORE MINUTES. OH MY GOODNESS. THEN WHILE WE'RE TALKING, THINK ABOUT WHERE YOU WANT TO POPULATE YOURSELF. >> ONE OF THE PROBLEMS WITH THE SORT OF SAMPLE TIMING BIMEETING, WHATEVER YOUR INTEREST IS, IS THAT YOU MIGHT HAVE A -- THE WORKING GROUP THAT IS NOT POPULATED BY ANY BOARD MEMBER, BUZZ WE DON'T HAVE -- PLACES WE WANT TO GO -- IF YOU ARE COMMITTING TO A FUNCTION WE HAVE TO BE CAREFUL AND I AGREE, I THINK THAT'S SORT OF THE TENSION BETWEEN THE COMMITTEE AND THE WHOLE SUBCOMMITTEE OR WORKING GROUP, THERE ARE THINGS THAT MAYBE SUFFICIENTLY IMPORTANT THAT DECIDE, THAT MAY FIT INTO PUBLIC SERVICE BUT WE NEED TO HEAR FROM EVERYONE. IF THE ISSUES YOU WANT FEEDBACK. SO THAT'S THE ONLY CONCERN IS YOU MIGHT HAVE BURNING PUBLIC SERVICE ISSUE FOR EXAMPLE. THAT STAFF WANTS FEEDBACK ON. BUT IT'S NOT PUT IN THE GENERAL AGENDA. WE DON'T NECESSARILY FEEL THAT BURNING PLATFORM, WE WILL BE IN OTHER COMMITTEES AT THAT POINT IN TIME THAT'S PART OF THE TENSION WE NEED TO BRING TOGETHER. >> (INAUDIBLE) STAFF LIAISONS WORKING GROUP TO HAVE A DESIGNATED BOARD LIAISON SO AT LEAST THERE'S ALWAYS DISCUSSION ABOUT -- REASON TO MEET AT ALL. REASON TO MEET AT THE WORKING GROUP LEVEL OR IT OUGHT TO BE PLENARY. >> WE ARE TALKING ABOUT ADDING A LAYER OF MANAGEMENT AROUND THE BOARD MEGMENT SO I'LL LOOK FOR YOUR GUIDANCE ABOUT HOW WE CAN DO THIS IN EFFICIENT FASHION. OUT EARLIER BY BOB AND DAN, THE SUBCOMMITTEE STRUCTURE BRINGS WITH THE BUNCH OF FEDERAL REQUIREMENTS THAT WE HAVE TO BE SHOULD BEADJUST. I LIKE THE IDEA OF HAVING AT LEAST WHATEVER WE STRUCTURE WE END UP WITH THERE SHOULD BE A MORE CONTACT PERSON -- BOARD CONTACT PERSON FOR THAT PARTICULAR STRUCTURE. I WANT TO TAKE THIS MOMENT TO THANK THE STAFF # LEADERSHIP AND SELECTED OPPORTUNITIES TO SERVE. >> BECAUSE WE HAVE THE PROBLEM OF MEETINGS AND US BEING LESS RELIABLE FOR PEOPLE WHO STAGE OUT THIS YEAR PROBABLY TOO PRIMARY ALTERNATE FOR EACH OF THESE TO BE THE LOWERED LEADERSHIP FOR THAT WORKING GROUP. >> THE ISSUE ABOUT ONE EACH MEMBER OF THE BOARD SERVING ON ONE OF THESE BODIES, REALLY CAME FROM THINKING THAT WE WOULD BE MOSTLY USING TIME AT THE MEETING THESE GROUPS TO BE DOING THE BULK OF THEIR WORK AND THAT WOULD BE CONCURRENT SO YOU MIGHT NOT BE ABLE TO ATTEND TO TWO DIFFERENT -- RESEARCH FRONTIERS AND PUBLIC SERVICE MEET AT IF THE SAME TIME YOU HAVE TO PICK WHERE AND THAT ALSO BRINGS A SPACE ISSUE WAFF TO THINK ABOUT TOO. >> WELL, DO PEOPLE FEEL THAT MOST OF THE WORK SHOULD BE DONE AT THESE MEETINGS? YES. DAN. >> I THINK WE WON'T BE DOING OUR JOB IF WE CONFINE IT TO THE MEETINGS. IF A STAFF MEMBER RAISES A PROBLEM, THERE IS AN ISSUE COMING TO US. IT'S THE 20th OF MAY. YOU MAY NEED TO TAKE ACTION THIS FISCAL YEAR. THE BOARD IS NOT GOING TO BE AVAILABLE TO YOU. THE VIRTUE OF HAVING TWO OR THREE PEOPLE WHO ARE IDENTIFIED AS A SUBCOMMITTEE, OR WORKING GROUP THAT CAN SPEAK IN THE NAME OF THE BOARD EVEN THOUGH WE AREN'T MAKING A RECOMMENDATION MIGHT BE HUGELY VALUABLE IN IDENTIFYING THE PARAMETERS THAT THE STAFF IMMEDIATELY SEE FROM THE BOARD PERSPECTIVE OUTSIDE. I THINK HAVING A DESIGNATED CHAIR AND ALTERNATE OR CO-CHAIR FOR EACH WORKING GROUP THAT CAN BE REACHED BETWEEN THE BOARDS CAN CONVENE A TELEPHONE OR GOOGLE HANG OUTS OR WHATEVER YOU WANT TO USE, CONFERENCE TO THINK ABOUT IDEAS. YOU CAN POLL THE WHOLE BOARD. YOU GOT AN EMAIL ON THIS. WE'RE GOING TO HAVE A CONFERENCE ON THIS SUBJECT AT THIS POINT. >> ALSO CHRISTINE TO GIVE A HEART ATTACK. AS LONG AS WORKING GROUPS -- >> NOT EVEN WORKING GROUPS BUT THEY CAN ONLY TAKE ACTION BY REPORTING BACK TO THE BOARD. >> WE'RE NOT TAKING ACTION WE'RE IDENTIFYING ISSUES FOR THE STAFF MEMBER. WE'RE NOT GIVING BOARD ADVICE. I DON'T THINK THE BOARD IS GOING TO GIVE CONSISTENT ADVICE ON ANY OF THESE THINGS. THE VALUE OF THE BOARD IS THE DIMENSIONS WE BRING TO IT THAT AREN'T REPRESENTED TO STAFF. RAISING THOSE DIMENSIONS IS WHAT'S COMING OUT OF SUBCOMMITTEES RATHER THAN A FORMAL RECOMMENDATION OF THE BOARD TO YOU. YOU ARE IN FACT PAID TO RUN THE PLACE, NOT US. >> BEFORE WE GO TO ERIC, I THINK THAT'S A GREAT IDEA ACTUALLY, TO HAVE THE -- A POINT OF CONTACT BOTH ON THE SUBCOMMITTEE AND FOR THE LIBRARY. THAT WAY THERE CAN BE MORE INFORMAL CONVERSATION BETWEEN THE TWO AND SAY OKAY HERE IS A PROBLEM WE HAVE COMING UP. IS THIS SOMETHING YOU CAN HELP US WITH. ERIC. >> >> THE RATIONALE FOR THIS DISCUSSION AND THIS DIRECTION WAS BOARD OF REGENTS FELT LIKE (INAUDIBLE) OTHERS HAVE BEEN HERE LONGER, THAT WE WERE CONTROLLING TO DC, BETHESDA, AND HEARING WEIRD PRESENTATIONS MAKING A FEW COMMENTS DIDN'T SEEM LIKE THERE WAS BOARD LIKE ACTIVITY GOING ON PER DECISION MAKING AND GUIDANCE. AND WOULD BE FABULOUS TO GET MORE INVOLVED AND MAKE USEFUL ON ALL SIDES. THAT WAS THE INTENT. THAT SAID I'M CURIOUS CAN SOMEBODY READ THE STATEMENT AS TO THE BOARD MISSION PER WHAT IS WRITTEN DOWN IN THE ARTICLES OF THIS ORGANIZATION? THAT'S ACTUALLY TO UNDERSTAND AGAIN WHY WE'RE SITTING HERE IN THIS MODE OF CONTEXT. I THINK THAT -- >> WHAT IS THAT? >> ADVISORY. >> MEMBERS ADVISORY SECRETARY AS WELL AS TO THE DIRECTOR OF NIH AS WELL AS (INAUDIBLE) SO THERE IS ACTUALLY A BROADER -- >> THE WE DON'T LIKE THE WAY YOU'RE RUNNING IT WE CAN COMPLAIN UP THE CHAIN. >> SO WE COULD -- (OVERLAPPING SPEAKERS) >> WE'LL GET THAT FOR EVERYBODY AND READ IT ON THE NEXT SESSION. GOOD POINT. ANY OTHER COMMENTS? IS EVERYBODY ANXIOUS FOR COFFEE? (OFF MIC) EXCEPTIONALLY HELPFUL CONVERSATION FOR ME AND I APPRECIATE HOW ENGAGED PEOPLE ARE. I DO WANT TO PUT JUST A LITTLE BIT OF CAUTION, IF YOU THINK YOU'RE SIGNING UP TO BE AN ON CALLED A VISOR, ACTUALLY WE RECOGNIZE YOU ALSO HAVE DAY JOBS, SO WE WILL BE -- EXCEPT FOR DAN. WE WILL BE -- WE WANT TO WORK WITH YOU ABOUT THE BEST WAY TO WORK WITH YOU. SO THIS IS -- WE -- AT THIS POINT IN TIME HAVE NO EXPECTATION KEEPING Y'ALL ON SPEED DIAL. >> THANK YOU VERY MUCH. GARY, I THINK YOU HAVE ANOTHER -- >> EDITED BY THE SUBCOMMITTEE OR BOARD, WHO IS GIVING -- >> ABSOLUTELY. (OVERLAPPING SPEAKERS) >> BIG LABEL DRAFT CAME OUT CONVERSATIONS, GOT FILTERED THROUGH MY HEAD AND ON TO THE SCREEN. SO THIS CAN BE -- THESE CAN BE MODIFIED. >> DATE'S A WORKING -- IT'S A WORKING DOCUMENT AND WE VALUE EVERYBODY'S INPUT. SO IN THE NEXT COUPLE OF HOURS, AS YOU THINK ABOUT CHANGES THAT YOU WOULD LIKE TO MAKE, WE CAN BRING THESE UP ON OUR SECOND DISCUSSION SO THAT WE CAN COME TO A CONCLUSION AS TO HOW TO DIVIDE THESE ACTIVITIES. SO THANK YOU, VERY MUCH FOR THIS DISCUSSION. AND WE'LL HAVE OUR COFFEE BREAK. >> DR. ADAMS WILL BE HERE AT ELEVEN O'CLOCK FOR OUR BRIEFING. THANK YOU VERY MUCH. >> IT IS MY PLEASURE TO INTRODUCE OUR NEXT SPEAKER, THE SURGEON GENERAL OF THE UNITED STATES. VICE ADMIRAL JEROME ADAMS, WHO WILL GIVE US AN UPDATE OF WHAT'S HAPPENING WITH THE SURGEON GENERAL'S OFFICE. THANK YOU. >> WELL, GOOD MORNING, EVERYONE. GREAT TO BE HERE TODAY, I WISH THIS COULD BE AN OUTDOOR MEETING. WE WENT TO THE WRONG BUILDING 38 WHICH WAS ACTUALLY A PLEASANT SURPRISE BECAUSE THEN WE GOT TO WALK FROM ONE TO THE OTHER. AND WE DIDN'T WANT TO COME IN. BUT IT'S REALLY GOOD TO BE HERE WITH Y'ALL TODAY AND APPRECIATE THE OPPORTUNITY TO COME BACK. I MET MANY OF YOU LAST TIME. JUST WANTED TO QUICKLY FOR THOSE OF YOU WHO I DIDN'T GET THE OPPORTUNITY TO MEET LAST TIME, LET YOU KNOW WHAT WE'RE WORKING ON IN THE OFFICE OF THE SURGEON GENERAL. PAST SURGEON GENERAL'S HAVE PICKED A PARTICULAR DISEASE OR RISK FACTOR TO GO AFTER SMOKING OR INFANT MORTALITY OR SOME PARTICULAR AREA. AND I THINK THAT'S ONE WAY TO ATTACK THINGS. BUT I HAVE BEEN IN PUBLIC HEALTH FOR ABOUT 20 YEARS. WHAT I FOUND IS THE COMMUNITYINGS THAT ARE HIGH -- COMMUNITIES AT HIGHEST RISK FOR INFANT MORE IT WILLTY, ALSO THE HIGHEST SMOKING RATES, HIGHEST CARDIOVASCULAR DISEASE RATES AND SO ON AND SO FORTH. SO I'M REALLY TRULY IN A PUBLIC HEALTH MIND SET TRYING TO GET AS FAR UPSTREAM AS POSSIBLE TO BUILD HEALTH AND WELLNESS TO OUR COMMUNITIES. THAT STARTS WITH BREAKING OUT OF OUR SILOS AND BEING BETTER PARTNERS. SO THE OVERALL THEME IS BETTER HEALTH THROUGH BETTER PARTNERSHIPS, IT'S INFORMED BY MY WORK IN PUBLIC HEALTH AND IN MEDICINE. AND THE REALIZATION THAT I HAVE GOTTEN A LOT FURTHER WHEN I HAVE EXPANDED MY NETWORK AND LEARNED TO SPEAK IN DIFFERENT LANGUAGES AND TO FOLLOW DIFFERENT METRICS. THEN WHEN I HUNKER DOWN WITH MY BUDDIES AND WE ALL TALK ABOUT THE SAME THINGS OVER AND OVER. I'M LEAVING HERE AND GOING TO THE NIOSH MEETING JUST LITERALLY RIGHT ACROSS THE STREET STILL NIH CAMPUS TO TALK ABOUT WORKER HEALTH. I THINK THAT'S A PARTICULAR AREA WHERE WE CAN GET TRACTION. BETTER HEALTH THROUGH BETTER PARTNERSHIPS IS THE OVERALL THEME, THAT LENDS ITSELF VERY WELL TO THE WORK Y'ALL ARE DOING BECAUSE YOU'RE AT AN INTERSECTION BETWEEN MANY DIFFERENT GROUPS. YOU HAVE THE ABILITY TO BE CONVENERS, TO BE PLACES WHERE FOLKS CAN COME TOGETHER AND SO I LOOK FORWARD TO WORKING WITH YOU IN THAT REGARD. UNDERNEATH THE BROADER UMBRELLA OF BETTER HEALTH THROUGH BETTER PARTNERSHIPS, WE ARE FOCUSED ON THREE PRIORITY AREAS RIGHT NOW. ONE IS HEALTH AND ECONOMIC PROSPERITY. THE PREMISE BEING HEALTHIER COMMUNITIES ARE MORE PROSPEROUS COMMUNITIES. WHY IS THAT? WHEN YOU LOOK AT POLLING OF THE AMERICAN PEOPLE, WHEN YOU LOOK AT THE POLITICAL LANDSCAPE WHEN YOU LOOK AT THE CURRENT AD MINUTE STRAIGHT STRAIGHTS, -- ADMINISTRATION, THERE'S FOCUS ON JOCKS AND ECONOMY. FOR FAR TOO LONG WE HAVE SEEN THAT FOLKS SEE JOBS AND THE ECONOMY AND BUSINESS AS BEING ONE END OF THE SPECTRUM AND SOCIAL SUPPORTS AND HEALTH AS BEING ON THE OTHER END OF THE SPECTRUM. THEY SEE THEM AS BEING OPPOSING THEORIES. AND I DON'T AGREE WITH THAT AT ALL. I THINK THERE'S PLENTY OF DATA TO SUGGEST NOT ONLY CAN WE DO BOTH BUT BOTH HEALTHIER COMMUNITIES ARE MORE PROWS PROWS AND MORE PROS POWS COMMUNITIES ARE -- PROWS PROWS COMMUNITIES -- PROSPEROUS COMMUNITIES ARE HEALTHIER. ONE THING WE'RE WORKING ON IS SURGEON GENERAL'S REPORT UNLIKE ANY OTHER OUT THERE AND IT WILL BE AROUND THE IDEA OF HEALTH AND ECONOMIC PROSPERITY. LOOKING AT THE DATA THAT EXISTS THAT SHOWS THE COMMUNITIES THAT HAVE INVESTED IN HEALTH HAVE SEEN INCREASED PROSPERITY METRICS INCLUDING DECREASED ABSENTEEISM, LOWER WORKPLACE ACCIDENTS, BETTER ABLE TO RECRUIT PEOPLE TO THEIR TOWNS AND COMMUNITIES. SO ON AND SO FORTH. FOR FAR TOO LONG WE LOOK AT HEALTH INTERVENTIONS PURELY THROUGH THE LENS OF HEALTH METRICS AND HEALTH OUTCOMES. AND THAT DOESN'T RESONATE WITH THE BUSINESS COMMUNITY. SO YOU LOWER THE HEMOGLOBIN A 1C BY TWO POINTS. SO WHAT. WHAT DOES THAT HAVE TO DO WITH MY BOTTOM LINE? WE NEED TO TRANSLATE THAT FOR FOLKS AND HELP THEM UNDERSTAND WHY DIABETES PREVENTION PROGRAM IS GOING TO LOWER THEIR HEALTHCARE COSTS AND INCREASE PROFITABILITY AND PRODUCTIVITY. THAT'S ONE AREA I'M FOCUSED ON. ANOTHER AREA OF HEALTH AND NATIONAL SECURITY, THE TROUBLING STATISTIC 7 OUT OF 10 YOUTH ARE INELIGIBLE FOR MILITARY SERVICE BECAUSE THEY CAN'T PASS THE PHYSICAL, CAN'T MEET THE EDUCATIONAL REQUIREMENTS OR HAVE CRIMINAL RECORD. WE KNOW THAT LIBRARIES AGAIN ARE NOT ONLY PLACES WHERE FOLKS CONVENE BUT PLACES THAT IMPROVE YOUR HEALTH, IMPROVE YOUR EDUCATIONAL OUTCOME, GIVE YOU SOMETHING TO DO SO YOU'RE NOT OUT ENGAGING IN ACTIVITIES WHICH MAY LEAD TO A CRIMINAL RECORD, I THISTY THERE'S LOTS OF OPPORTUNITY FOR OVERLAP THERE. BUT AGAIN, IT'S A LITTLE SELFISH. WE GO TO D.C. AND BELLING FOR NICKELS AN DIMES BEG FOR NICKELS AND DIMES AND DEPARTMENT OF DEFENSE SHOWS UP AND THEY GET $100 BILL THERE'S LOTS OF OPPORTUNITY THERE IF WE CAN SHOW THAT WE'RE PART OF THEIR MISSION TO TAP INTO SOME OF THAT DEPARTMENT OF DEFENSE FUNDING AND NOT ONLY HELP OURSELVES BUT HELP THEM MEET THEIR BOTTOM LINE OF BEING ABLE TO RECRUIT TALENT AND BEING ABLE TO RETAIN TALENT. WE HAVE GOT SEVERAL MILITARY OFFICIALS IN THE ROOM WHO CAN ATTEST TO THIS, THEY'RE STRUGGLING RIGHT NOW. BOTH GETTING AGAIN, FOLKS TO JOIN THE MILITARY TO MEET REQUIREMENTS BUT ALSO KEEP THEM IN, NAVY JUST RECENTLY HAD TO ADJUST, THEY DON'T LIKE TO SAY LOWER, BUT HAD TO ADJUST STANDARDS SO FOLKS COULD CONTINUE TO SERVE BECAUSE THEY SO MANY FOLKS COULDN'T MEET THE EDUCATIONAL REQUIREMENTS. AND MY CHALLENGE TO THEM IS, WELL, 70% OF YOUR FOLKS ARE SPENDING 70% OF TIME NOT ON BASE, SO WE HAVE GOT TO SEE MILITARY HEALTH NOT JUST ABOUT WHAT HAPPENS WHILE YOU'RE ON BASE IN UNIFORM BUT WHAT'S HAPPENING IN YOUR COMMUNITIES, Y'ALL ARE IN THE COMMUNITIES. SO I THINK LOTS OF AREA FOR OVERLAP THERE. THE FINAL AREA OF FOCUS FOR US IS ONE THAT'S THRUST UPON ME AND IT IS VERY DISEASE AND RISK FACTOR SPECIFIC AND THAT'S THE OPIOID EPIDEMIC. YOU KNOW THERE'S PERSON DYING 12.5 MINUTES FROM OPIOID OVERDOSE, WE KNOW THAT IT'S AFFECTING 2.1 MILLION AMERICANS DIRECTLY THROUGH OPIOID USE DISORDER AND MANY MILLIONS MORE WHO ARE MISUSING SUBSTANCES WHO ARE AFFECTED. AGAIN MT. MILITARY, THEY'RE HAVING SIGNIFICANT PROBLEMS WITH SUBSTANCE MISUSE AND IN THE JOB ENVIRONMENT COMPANIES ARE TELLING US THEY CAN'T FIND ENOUGH IMEMPLOYERS WHO CAN PASS A DRUG TEST TO STAFF THEIR BUSINESSES AND THEIR FACTRIES. SO LOTS -- FACTORIES. SO LOTS OF OVERLAP THERE BUT FROM THE SURGEON GENERAL'S POINT OF VIEW THIS IS A PUBLIC HEALTH CRISIS, A PERSON DYING EVERY 12.5 MINUTES. AND PEOPLE HAVE BEEN MISUSING SUBSTANCES FOR A LONG TIME BUT WHAT MAKES IT EPIDEMIC IS PRECIPITOUS INCREASE IN PEOPLE DYING. RECENTLY. SO I'LL FINISH BY QUICKLY GOING OVER SOME OF THE THINGS WE'RE DOING IN REGARDS TO THE OPIOID EPIDEMIC AND IF WE HAVE TIME, I'M HAPPY TO TAKE SOME QUESTIONS, I KNOW Y'ALL HAVE A BUSY AGENDA AND I DIDN'T WANT YOU TO BE SELFISH AND TAKE ALL YOUR TIME. BUT AGAIN, 2.1 MILLION PEOPLE WITH OPIOID USE DISORDER, PERSON DYING EVERY 12.5 MINUTES. HERE IS WHAT'S INTERESTING. 77% OF OPIOID OVERDOSES OCCUR, DEATH AND OVERDOSE OCCUR OUTSIDE OF THE MEDICAL SETTING. SO YOU HEAR OVERDOSE, YOU THINK CALL 1911, THIS IS A MEDICAL ISSUE U BUT THE REALITY IS BY THE TIME PARAMEDICS GET THERE, FOLKS ARE DEAD IN FAR TOO MANY CASES. THE OTHER THING THAT'S TROUBLING TO ME AS I GO AROUND THE COUNTRY, I CAN'T TELL YOU HOW MANY MOTHERS AND FATHERS I TALKED TO WHO LOST THEIR CHILDREN TO OVERDOSE AND SOMEONE HAS BEEN RIGHT ON THE OTHER SIDE OF THAT BATHROOM WALL, OF THAT GARAGE DOOR. OF THAT BEDROOM, OF THAT BEDROOM DOOR WHO COULD HAVE INTERVENED HAD THEY KNOWN ABOUT NALOXONE, HAD THEY HAD IT ON THEM. SO IT REALLY HAD ME THINKING ABOUT HOW COULD WE UNIQUELY LEAN INTO THIS, ENGAGING THE MEDICAL SETTING THE TRADITIONAL PARTNERS BUT THAT'S NOT GOING TO SOLVE THE PROBLEM BECAUSE AGAIN, OVER HALF THE OVERDOSES OCCUR IN NON-MEDICAL SETTING. 56% OCCURING IN A HOME SETTING. ON TUESDAY APRIL 15th I PUT OUT THE FIRST SURGEON GENERAL ADVISORY IN 13 YEARS. SURGEON GENERAL ADVISORY IS FOR THE RARE MOMENTS IN TIME WE HAVE SIGNIFICANT EVENT IN PUBLIC HEALTH AND WHERE THERE'S A NEED FOR UNIVERSAL CALL TO ACTION. THE LAST ONE WAS OVER 13 YEARS AGO AND IT WAS RELATED TO DRINKING DURING PREGNANCY. OUR ADVISORIES URGING MORE AMERICANS TO USE AND KEEP WITHIN REACH THE OPIOID REVERSING DRUG NALOXONE, INCLUDING FAMILY FRIENDS AND PATIENTS AT RISK FOR YEAR DOSE, IT HIGHLIGHTS -- OVERDOSE. IT HIGHLIGHTS AVAILABLE BEING A STANDING ORDER MEANING ANYONE CAN GO INTO A PHARMACY AND GET NALOXONE, ANY ONE OF YOU CAN CARRY NALOXONE, I CAN YOU THIS QUESTION. IF SOMEONE HERE WERE TO HAVE A HEART ATTACK RIGHT NOW, WOULD YOU EXPECT THAT SOMEONE IN THIS ROOM KNOW HOW TO ADMINISTER CPR? EVEN IF THERE WASN'T A SURGEON GENERAL STANDING UP HERE. I WOULD SAY YES, WE WOULD BUT IF SOMEONE WERE TO HAVE AN OVERDOSE OR BURST THROUGH THAT DOOR NOW AND SAY SOMEONE IS IN THE BATHROOM AND THEY'RE PASSED OUT AND THERE'S A NEEDLE IN THEIR ARM, WHICH IS HAPPENING IN MORE AND MORE PLACES, IN PARTICULAR LIBRARIES I MIGHT ADD, WOULD SOMEONE IN HEAR SAY I KNOW HOW TO USE NALOXONE, I KNOW WHAT TO DO. YOU KNOW WHAT, I HAVE IT ON ME. WITH NEED TO MAKE NALOXONE THAT AVAILABLE AND WE NEED TO HAVE FOLKS THAT COMFORTABLE IF WE'LL TURN AROUND THIS EPIDEMIC. SO AFTER OUR ADVISORY WE'RE REALLY PLEASED WITH HOW WELL THIS HAS BEEN RECEIVED. I DIDN'T KNOW HOW WELL IT WAS RECEIVED TO BE FRANK. BECAUSE JUST A FEW WEEKS BEFORE THAT, THERE WAS AN ARTICLE THAT CAME OUT TALKING ABOUT THE MORAL HAZARD OF GIVING NALOXONE TO FOLKS AND MAKING IT MORE AVAILABLE. THE IDEA YOU'RE SAVING THEIR LIFE ONLY SO THEY CAN GO OUT AND USE DRUGS AGAIN. MORAL HAZARD BY DEFINITION, I HAD TO LOOK THIS UP BECAUSE I READ THIS ARTICLE AND I'M LIKE WHAT THE HECK. I KNEW WHAT I THOUGHT THEY WERE TALKING ABOUT BUT I JUST COULDN'T BELIEVE SOMEONE WOULD WRITE THIS. A MORAL HAZARD IS WHEN YOU CONTINUE TO TAKE RISK BECAUSE YOU ARE REMOVED FROM THE CONSEQUENCES OF THE ACTIONS THAT YOU ARE TAKING. SO THEY'RE SUGGESTING THAT WE'RE REMOVING THEM FROM THE CONSEQUENCES OF USING THOSE DRUGS AND THEY CONTINUE TO GO ON AND USE. THE ALTERNATIVE IS TO ALLOW THEM TO EXPERIENCE CONSEQUENCES OF THEIR ACTS WHICH ARE DEATH. AS -- ACTIONS WHICH IS DEATH. I CAN'T WRAP MY HEAD AROUND THAT BUT THAT SAID, I THINK IT'S ALSO EASY TO STAND THERE WHEN IT'S NOT YOUR CHILD OR LOVED ONE DYING FROM OVERDOSE, WHEN YOU'RE E REMOVED FROM THAT CONSEQUENCE THE SAY WE SHOULDN'T MAKE THIS MEDICATION MORE AVAILABLE. THAT SAID, PRETTY WELL RECEIVED. OVER 2000 STORIES, MADE MORE THAN THREE QUARTERS OF A BILLION IMPRESSIONS, DIRECTLY RELATED TO THE ADVISORY. WE STILL AT THIS POINT SEVERAL WEEKS OUT ARE SAVING NEW STORY AT LEAST ONE TO TWO NEW STORIES EVERY DAY RELATED TO THE NALOXONE ADVISORY WHICH IS EXACTLY WHAT WE WERE HOPING FOR. WE ALSO HAVE SEEN FOLKS ADJUST POLICIES DIRECTLY REFERENCING ADVISORY. NEBRASKA, DEPARTMENT OF HEALTH SIGNS A STANDING ORDER FOR NALOXONE, THE LAST STATE TO NOT HAVE A STANDING ORDER. WHEN I RELEASED, I SAID 49 OUT OF 50 HAVE A STANDING ORDER. AEDINE CALL OUT NEBRASKA. THEY THANKED ME FOR NOT CALLING& THEM OUT. BUT THAT SAID, THEY PROMPTLY STOUTED A STANDING ORDER. WEST VIRGINIA, THEY REQUIRED ALL FIRST RESPONDERS TO CARRY IT. THAT'S SHOCKING. A LOT OF OUR COUNTY COUNTRY FIRST RESPONDERS DO NOT CARRY IT. YOU EXPECT AN AMBULANCE TO PULL UP AND NOT BE ABLE ADMINISTER CPR OR HAVE EF NEFF REIN IF CHILD IS SUFFERING FROM ALLERGIC REACTION. ONLY ONE FIFTH OF LAW ENFORCEMENT ARE CARRYING NALOXONE. THIS IS A BIG DEAL. CALEO LAUNCHED A VIRTUAL STANDING ODORRER, ONE OF THE PRODUCERS OF NALOXONE. THEY MAKE THE INJECTABLE VERSION. AND ADAPT PHARMA IS ALSO REACHING OUT TO CVS, WALGREENS TO MAKE MORE NALOXONE AVAILABLE. INDUSTRY DATA WE SAW INDICATED THAT THERE WAS OVER 25% INCREASE IN THE NUMBER OF RETAIL DISPENSED PRESCRIPTIONS FROMNA LOCKSON AFTER RELEASE -- NALOXONE AFTER RELEASE OF ADVISORY. REAL IMPACT THERE. I ALSO SAY THAT I RECOGNIZE THIS IS JUST ONE STEP. WE DON'T WANT TO JUST SAVE LIVES APPROXIMATE SEND THEM BACK OUT INTO THE ARMS OF THE DRUG DEALER AND CONTINUE THAT SAME PATTERN. WE WANT TO DISRUPT THAT PATTERN. WE WANT TO USE NALOXONE AS A TOUCH POINT TO SAVE A LIFE, TO HAVE A FARM HAND OFF TO A PEER RECOVERY COACH OR SOCIAL WORKER TO GET THEM INTO TREATMENT AND EFFECTIVE LONG TERM RECOVERY, ALSO USE AS AN OPPORTUNITY TO TALK ABOUT HOW WE GOT HERE IN THE FIRST PLACE. PREVENTION. COMMUNITY BUILDING AND WELLNESS WHICH AGAIN I THINK IS AN AREA Y'ALL CAN REALLY LEAN INTO. I COULDN'T DO AN ADVISORY THAT WOULD BE ALL THINGS TO ALL PEOPLE. ONE OF THE COMPLAINTS WE GOT PUTTING THIS TOGETHER, WHY AREN'T YOU TALKING PREVENTION OR TREATMENT? WHY AREN'T YOU TALKING RECOVERY? MY ANSWER WAS I WANT TO TALK ABOUT ALL THESE THINGS BUT FIRST WE HAVE TO SAVE THE LIFE AND THEN USE THE ADVISORY AS AN OPPORTUNITY TO TALK ABOUT ALL THE OTHER PARTS OF-PUZZLE YOU'RE PASSIONATE ABOUT. SO HOW CAN THE NATIONAL LIBRARY OF MEDICINE HELP? YOU CAN SPREAD THE WORD. YOU CAN HELP SPREAD THE WORD ABOUT ADVISORY, ABOUT THE IMPACT OF OPIOID EPIDEMIC WHICH IS WHY I TOOK TIME TO GIVE YOU SOME CONTEXT. YOU CAN EDUCATE THE PUBLIC AND THAT STARTS WITH EDUCATING YOURSELVES. ALL OF Y'ALL AREN'T FAMILIAR WITH NALOXONE. DON'T KNOW HOW TO ACCESS IT. NEXT TIME YOU GO INTO PHARMACY AK THE PHARMACIST, I WOULD LIKE TO GET NALOXONE. CAN I? EVEN THAT HELPS BECAUSE WE KNOW THAT UNFORTUNATELY THE PHARMACY CHAINS TELL US THAT IT'S AVAILABLE IN ALL THEIR STORES BUT WHEN THE PEOPLE ACTUALLY GO INTO THE PHARMACIES, THEY'RE STILL FACED WITH STIGMA, STILL FACED WITH A LACK OF INFORMATION ABOUT THE RULES AND JUST ASKING THAT QUESTION THE NEXT TIME YOU GO TO THE PHARMACY WILL HELP YOU BECOME MORE EDUCATED ABOUT THE PROCESS, AND HELP PRESS THE PHARMACIES FOLKS WORKING THERE TO BECOME MORE EDUCATE AND LOWER STIGMA. WE CAN DO EVERYTHING RIGHT BUT IF YOU WALK IN AND YOU ASK FOR NALOXONE, IF SOMEONE ROLES THEIR EYES AT YOU AND JUDGES YOU, THAT'S GOING TO DISCOURAGE FOLKS FROM GOING IN, WE HEAR THAT HAPPENING BUT IF Y'ALL WALK IN IN YOUR NICE SUITS AND YOUR NICE INSURANCE CARDS AND SAY I WANT NALOXONE, THAT HELPS LOWER STIGMA. SO GET EDUCATED AND HELP EDUCATE THE PUBLIC AND THEN FINALLY ENCOURAGE CLINICIANS. WE ALSO THINK EVERY CLINICIAN KNOWS EVERYTHING AND DR. BRENNAN AND I CAN TELL YOU THAT'S NOT THE CASE. AND I REALLY NEED Y'ALL TO HELP US OUT HERE BECAUSE ONE OF THE MOST DANGEROUS THINGS IS WHEN CLINICIANS CARRY AND PERPETUATE STIGMA. WHEN SOMEONE GOES I KNOW A NURSE, OR I KNOW A DOCTOR AND THEY SAY NALOXONE IS REALLY JUST -- NOT HELPING. REALLY JUST ALLOWING THEM TO CONTINUE WITH BAD HABITS. THEY SAY MEDICATION ASSISTED TREATMENT DOESN'T WORK. THEY SAY THAT WE SHOULD JUST USE OUR TIME AND OUR ENERGY SOMEPLACE MORE EFFECTIVE. THE MORE YOU ALL CAN HELP EDUCATE CLINICIANS, THE BETTER. BECAUSE WHEN IT COMES TO HEALTH IN PARTICULAR, I'M A PERSON WHO LIKES POLLS, IF YOU LOOK AT WHO IS THE MOST TRUSTED INDIVIDUAL OUT THERE, TO HELP DEVELOP HEALTH POLICY, NUMBER ONE IS NURSES, NUMBER TWO IS DOCTOR, NUMBER THREE IS PHARMACISTS. WHO IS AT THE BOTTOM? POLITICIANS. AND JUST ABOVE THEM IS LAWYERS, NOT SAYING ANYTHING BAD ABOUT THOSE TWO GROUPS, THOSE ARE THE FACTS WE NEED TO MAKE SURE OUR CLINICIANS THE PEOPLE WHO ARE TRUSTED IN COMMUNITIES ARE EDUCATED. UPCOMING OPIOID DELIVERABLES. WE'LL HAVE A STATUS REPORT FACING ADISTINCTION IN AMERICA SO -- ADDICTION IN AMERICA. SO YOU KNOW SURGEON GENERAL MURTHY PUT OUT FACING ADDICTION IN AMERICA REPORT AND WE WILL LOOK BACK AND SEE WHERE WE ARE POST THAT REPORT COMING OUT. WE WILL DO A SURGEON GENERAL SPOTLIGHT ON OPIOIDS, HIS REPORT WAS ABOUT ADDICTION AND IT COVERED TOBACCO, ALCOHOL, IT COVERED OPIOIDS AND HE STILL GOT YELLED AT BECAUSE HE DIDN'T PUT EVERYTHING IN THERE PEOPLE WANTED. THAT SAID IT'S A REPORT THAT IS THIS THICK, IT'S A GREAT DOCUMENT TO REFER TO BUT WHICH PROBABLY NO ONE IN THIS WORLD HAS READ COVER TO COVER. SO WE WANT TO DO A PULL OUT ON OPIOIDS THAT'S REALLY ABOUT 12 TO 13 PAGES THAT ANYONE CAN READ. ANY POLICY MAKER, IN HI CLINICIAN, AND WE'RE EXCITED FOR THAT TO COME OUT SOUP PARTNERD WITH A POST CARD THAT'S REALLY JUST BULLET POINTS. SO IS IT'S THE CRIB NOTES OF CRIB NOTES SO HOPEFULLY THEY CAN GET INTERESTED AND REFER THEM PACK, IT WILL BE A -- LETTER ON HIV THAT HE PUT OUT. SEVERAL YEARS AGO. THAT'S THE SURGEON GENERAL PRESCRIPTION FOR AMERICA THAT I'M TALKING ABOUT. THEN THE PERSPECTIVE ON IMPROVING ACCESS TO EFFECTIVE OPIOID USE DISORDER TREATMENT, HALF THE PUBLIC OUT THERE IN POLLING DOES NOT BELIEVE THERE'S EFFECTIVE LONG TERM TREATMENT FOR OPIOID USE DISORDER. WE NEED TO HELP FOLKS UNDERSTAND THAT THERE IS EFFECTIVE TREATMENT AND HELP UNDERSTAND WHAT EFFECTIVE TREATMENT IS SO WE LOWER STIGMA, SO FOLKS ARE MORE INCLINED TO ENGAGE IN AND TO FIND PROGRAMS THAT HELP US WITH TREATMENT. SO I PROBABLY WENT OVER. I WASN'T PAYING ATTENTION TO THE TIME. BUT THAT SAID, I'LL LEAVE IT TO OUR CHAIR TO DECIDE WHETHER OR NOT THERE'S TIME FOR A FEW QUESTIONS AND I'M HAPPY TO TAKE A COUPLE. >> >> THANK YOU FOR THE ADVISORY, THAT'S GREAT, AS A FOUNDING PHYSICIAN I RESPECT WHAT YOU'RE DOING. WHEN WE IMPLEMENT CPR, IN AND BRING PEOPLE BACK, WE HAVE EFFECTIVE TREATMENTS THAT ARE AVAILABLE. SO PEOPLE CAN BE ON STATINS, THEY CAN DO BEHAVIORAL CHANGES, AS PRIMARY CARE PHYSICIAN PART OF THE CHALLENGE IS OPIOID AND EVEN DRUG RESISTANT OPIOID TREATMENTS ARE NOT NECESSARILY WELL SUPPORTED BY CMS IN A BRANCH YOU WORK CLOSELY WITH, TO WHAT EXTENT ARE YOU ADVOCACY WORKING WITH THEM TO GET THE APPROPRIATE COMPONENTS, WHAT I HEARD YESTERDAY IS THAT WE'RE GOING TO BE CUTTING ANYTHING THAT IS -- WHEN IT COMES TO PRIMARY CARE IMPLEMENTATION, THAT'S DIFFICULT TO PUT THOSE TWO PIECES TOGETHER. >> LET ME TELL YOU THIS, AS BOTH CLINICIAN, I'M AN ANESTHESIOLOGIST. I TRAINED IN ACUTE AND CHRONIC PAIN MANAGEMENT SO CLINICALLY I'M FAMILIAR WITH THIS AND ALSO FROM A PUBLIC HEALTH POINT OF VIEW, I'M FAMILIAR WITH THIS. MOST OF YOU KNOW THIS BUT I WAS A FORMER STATE HEALTH COMMISSIONER IN INDIANA WHEN WE HAD THE LARGEST HIV OUTBREAK RELATED TO INJECTION DRUG USE AND HISTORY OF THE UNITED STATES. SO I DEALT WITH THIS CLINICALLY AND FROM A PUBLIC HEALTH POINT OF VIEW IN MY LITTLE BROTHER PHILLIP SITS IN PRISON, MARYLAND STATE PRISON A FEW MILES FROM HERE RIGHT NOW BECAUSE HE STOLE $200 TO SUPPORT HIS HABIT AND THE JUDGE GAVE HIM A TEN YEAR PRISON SENTENCE. IN MULTIPLE CAPACITIES I'M VERY FAMILIAR WITH THE EVIDENCE AND THE NEED FOR TREATMENT AND BARRIERS THAT EXIST TO TREATMENT. SO I WOULD SAY TO YOU A COUPLE OF THINGS. NUMBER ONE, I WOULD SAY TO YOU AS YOUR SURGEON GENERAL I AM 100% COMMITTED TO MAKING SURE WE ARE FUNDING EVIDENCE BASED INTERVENTIONS AND THAT WE'RE SHARING BEST PRACTICES, I'M GOING TO WEST VIRGINIA, THE EPICENTER OF THE OPIOID EPIDEMIC TOMORROW. MIAMI ON FRIDAY. WE HAVE BEEN TO MICHIGAN, WE HAVE BEEN TO OHIO AND KENTUCKY. WE HAVE BEEN TO RHODE ISLAND AND NEW HAMPSHIRE. SHARING BEST PRACTICES AND HELPING LOWER STIGMA. NUMBER TWO, THE CURRENT ADMINISTRATION AND THIS IS NOT A VALUE JUDGMENT RIGHT OR WRONG, THIS IS JUST IS WHAT IT IS. REALLY BELIEVES IN STATE'S RIGHTS AND LOCAL DECISION MAKING. WITHIN THAT CONTEXT WHAT I'M TRYING TO DO IS HELP GOVERNORS, MAYOR, STATE LEGISLATURES UNDERSTAND UNDERSTAND WHAT EVIDENCE BASED LOOKS LIKE AND ONE OF THE THINGS FOLKS ARE COMMITTED TO DO WITHIN CMS IS TO ALLOW MEDICAID WAIVERS AND TO ALLOW STATE-LED INNOVATION AND THAT'S WHERE I'M LEANING IN BECAUSE AT THE END OF THE DAY THAT'S WHERE THE RUBBER MEETS THE ROAD. IT'S WHERE CARE IS DELIVERED AND SO THAT'S HOW I'M LEANING INTO IT. I'M ALWAYS GOING TO SAY CMS SHOULD BE PAYING FOR EVIDENCE BASED INTERVENTIONS. THE OTHER THING IS, WE HAVE TO RETHINK THE WAY WE DELIVER CARE. THEY'RE SIMPLY WILL NOT BE ENOUGH INPATIENT TRADITIONAL TREATMENT PROGRAMS FOR EVERYONE WHO NEEDS IT. SO WE NEED TO WORK WITH PRIMARY CARE PHYSICIANS AND HELP THEM UNDERSTAND THEIR JOB HAS NEEDS TO EXPAND IN IFP, I TALKED WITH THEM, THAT'S SOMETHING YOU ALWAYS DO, THERE WAS A TIME WHERE WE DIDN'T DO COLONOSCOPY, NOW FOLKS ARE DOING THAT, THEY ADAPT PRACTICE TO MEET THE NEED. WE ALSO LOOK AT OUTPATIENT TREATMENT AND MAKE SURE WE'RE FUNDING THAT AND FOLKS REALIZE THAT THAT NOT ONLY CAN BE EFFECTIVE, IN MANY CASES MORE EFFECTIVE THAN INPATIENT TREATMENT. I HEAR YOU. I'M FIGHTING FOR YOU WITHIN THE CURRENT LANES THE ELECTORATE HAVE SET UP FOR US AND I REALLY DO THINK THERE'S OPPORTUNITY AND TO BRING IT BACK TO THE NATIONAL LIBRARY OF MEDICINE, THAT'S WHY YOUR ROLES AND COMMUNITIES AS EDUCATORS IS SO IMPORTANT BECAUSE WE NEED THOSE COUNTY COMMISSIONERS, THOSE MAYORS, THOSE STATE LEGISLATORS TO UNDERSTAND WHAT EVIDENCE BASED TREATMENT LOOKS LIKE AND TO UNDERSTAND THE BARRIERS THAT CLINICIANS FACE. SO THAT ON A STATE LEVEL THEY CAN GO AFTER THE FEDERAL MONEY AND SPEND IT IN A WAY THAT WE KNOW WILL IMPROVE OUTCOMES. >> THANK YOU FOR THE PRESENTATION. I WANT TO GO BACK TO THE FIRST FACTOR YOU MENTIONED, I AM TOLD THE FOCUS ON THE RELATIONSHIP BETWEEN PROSPERITY AND HEALTH AND WHEN WE LOOK AT THAT, (INAUDIBLE) WHERE MY QUESTIONS COME FROM. >> AND I DON'T WANT TO CUT YOU OFF THERE BUT I WANT TO LET YOU KNOW WHEN I SAID THIS REPORT IS GOING TO BE DIFFERENT I DON'T WANT IT TO BE A REPORT THAT SPEAKS TO HEALTH PEOPLE. BECAUSE THE HEALTH PEOPLE ALREADY GET IT. I WANT IT TO BE A REPORT THAT SPEAKS TO THE BUSINESS COMMUNITY AND TO THE ECONOMIC PEOPLE SO WE PARTNERED WITH THE NATIONAL BUSINESS GROUP ON HEALTH, WITH THE NATIONAL CHAMBER OF COMMERCE, WE MET WITH CDC ECONOMISTS AND WE WOULD LOVE TO MEET WITH YOU TOO, AGAIN FROM NATIONAL LIBRARY OF MEDICINE POINT OF VIEW WE'RE TRYING TO GATHER ALL THE DATA THAT EXISTS, AND TRANSLATE IN A WAY THAT RESONATES NOT WITH THE M.D. AND NOT WITH THE HEAD OF THE PHILANTHROPIC ORGANIZATION AS MUCH AS I DO LIKE MEETING WITH THEM BUT RESONATES WITH THE CFO AND THE CEO. >> MY QUESTION RELATES TO THIS. IF YOU LOOK AT THE LAST (INAUDIBLE) WE GROW AS EFFECTIVE, DIFFERENTLY. DIFFERENT SOCIAL ECONOMIC GROUPS WHERE INCOME GROWTH BEING CONCENTRATED (INAUDIBLE) INCOME BEING STAGNANT OR EVEN NEAR TERM (INAUDIBLE) DECREASEING -- SO TO WHAT EXTENT DO YOU SEE A POSSIBILITY OF RESEARCH AND EDUCATING OTHERS ON THE ADMITTED LY VERY (INAUDIBLE) FROM ECONOMIC POLITICAL STANDPOINT RELATIONSHIP BETWEEN MINIMUM WAGE AND HEALTH METRICS? >> AS I MENTIONED EARLIER THERE'S TWO WAYS TO LOOK AT THIS ARGUMENT. AND I'M NOT SAYING EITHER OR, I'M SAYING BOTH. THERE'S PROSPERITY, LEADS TO HEALTH AND THERE'S HEALTH LEADS TO PROSPERITY. NOW IT'S IMPORTANT THAT WE UNDERSTAND THE DISTINCTION BETWEEN THOSE TWO BECAUSE THE LEVERS, THE POLICY LEVERS IN PARTICULAR THAT YOU UTILIZE ARE VERY DIFFERENT DEPENDING ON WHICH POINT OF VIEW YOU'RE LOOKING AT IT FROM. IF YOU SAY PROSPERITY EQUALS HEALTH YOU SAY OKAY, I NEED TO INCREASE THE PROSPERITY OF FOLKS BY RAISING THE MINIMUM WAGE, BY REDISTRIBUTING INCOME IN SOME WAYS, TO HELP PROMOTE HEALTH. IF YOU LOOK AT IT THE OTHER WAY YOU SAY HEALTH EQUALS PROSPERITY YOU SAY I NEED TO DO THINGS WHICH WILL IMPROVE HEALTH. IT'S NOT JUST ON THE FRONT END, THE POLICY, IT'S WHAT'S THE OUTCOME THAT FOLKS CARE ABOUT. THE PREMISE THAT -- COMING AT IT FROM THE PREMISE OF PROSPERITY INCREASED PROSPERITY EQUALS HEALTH, ASSUMING THE PERSON YOU ARE TALKING TO GIVES A DARN ABOUT THE HEALTH OF THE PERSON ON THE OTHER SIDE OF THE TRACKS. I'M SORRY IF THAT SOUNDS CRUEL BUDDHA ICE AS BLUNT AS I CAN BE FROM MY EXPERIENCE IN 20 PLUS YEARS IN PUBLIC HEALTH THAT UNFORTUNATELY A LOT OF FOLKS THAT I TALK TO DON'T CARE THAT THERE'S A PERSON IN SCOTT COUNTY, INDIANA DYING FROM HIV BECAUSE THEY HAVE BEEN INJECTING DRUGS, THEY DON'T CARE THAT THERE IS A MINORITY WHO IS SUFFERING FROM A STROKE BECAUSE THEY HAVE BEEN SMOKING AND EATING FOOD ALL THEIR LIVES BECAUSE THEY LIVE IN AN ENVIRONMENT WHERE THE WRONG CHOICE IS THE EASY CHOICE AND HEALTHY CHOICE ISN'T THE BETTER CHOICE. WHAT THEY DO CARE ABOUT IS PROSPERITY AS AN OUTCOME, THAT'S -- I'M DIGGING INTO IT BECAUSE I WANT YOU U TO UNDERSTAND WHY I'M PURPOSEFULLY FOCUSING ON CREATING HEALTHIER COMMUNITIES TO GET TO A OUTCOME OF MORE PROSPERITY. A QUICK EXAMPLE. CHATTANOOGA, TENNESSEE. THEY USE ALL THESE INCENTIVES TO GET A VOLKSWAGEN PLANT TO COME TO THEIR TOWN AND OPEN UP THERE BECAUSE THEY WANTED MORE JOBS IN THEIR TOWN. VOLKSWAGEN MOVED TO CHATTANOOGA, TENNESSEE AND FOUND THEY COULDN'T FIND ENOUGH PEOPLE WHO COULD PASS A PHYSICAL TO WORK IN THEIR FACTORY. CHATTANOOGA IS ALSO THE HOME OF LITTLE DEBBIE SNACK CAKES AN MOON PIES AND ALL SORTS OF UNFORTUNATE THINGS READILY AVAILABLE. SO CHATTANOOGA, WHAT THE VOLKSWAGEN PLANT DID, THEY MAID IT MANDATORY FOR FOLKS TO WORK OUT FOR AN HOUR ON CLOCK. FROM THE PUBLIC HEALTH POINT OF VIEW WE GO YEAH, GO VOLKSWAGEN, FROM A BUSINESS ECONOMIC POINT OF VIEW, VOLKSWAGEN IS LOOKING AT THAT SAYING WE'RE LOSING OUR AN HOUR PER PERSON PER DAY BECAUSE OF PRODUCTIVITY BECAUSE THIS TOWN IS UNHEALTHY. IT'S NOT THE MICHELIN, MAYBE MICHELIN BUT IN SOUTH CAROLINA, WHERE THERE WAS A BIG TIRE PLANT DOWN THERE, MICHELIN, THEY GOT THE HIGHEST DIABETES RATES IN THE COUNTRY. LOOKING AT MOVING THEIR FACTORY AWAY FROM THERE. WHEN YOU LOOK AT INDIANA, THEY -- OVER HALF THE PEOPLE ENTERING FOR JOBS WERE FAILING DRUG TESTS AND COSTING THEM TONS AND TONS OF MONEY. SO TO ANSWER YOUR QUESTION, I AGREE WITH YOU BUT I'M FRAMING IT IN A WAY THAT BASED ON POLLS WILL RESONATE WITH VOTERS AND WILL ULTIMATELY GET US TO THE SAME OUTCOME BECAUSE FROM AN EQUITY POINT OF VIEW, I'M BED HEALTH EQUITY INTO EVERYTHING I TALK ABOUT, HERE IS THE OTHER SIDE OF THAT STORY. CHATTANOOGA ALSO HAS A HIGHER THAN THE NATIONAL AVERAGE OF MINORITIES IN THAT COMMUNITY. SO WE CAN GO TO THAT COMMUNITY AND SAY LOOK, YOU NEED TO IMPROVE THE HEALTH OF THIS COMMUNITY, AND IMPROVE JOB OPPORTUNITIES BECAUSE IT'S GOING TO MAKE YOU A MORE ATTRACTIVE PLACE FOR EMPLOYERS, THEY'RE GOING TO ACHIEVE MORE PROSPERITY BUT WE'LL ALSO ADDRESS HEALTH INEQUITY IN THE SAME WAY. SO I DO COMPLETELY AGREE WITH YOU, I'M ATTACKING BOTH BUT I'M INTENTIONALLY PUTTING ONE IN FRONT OF THE OTHER IF THAT MAKES SENSE. >> THANK YOU VERY MUCH. [APPLAUSE] >> I REALLY DO WANT TO WORK WITH EACH AND EVERY ONE OF YOU, I TRAVEL WEEKLY WHEN I'M OUT IN COMMUNITIES, LET ME KNOW, I WILL TRY THE REACH OUT TO YOU TO THE EXTENT I KNOW YOU'RE IN THE COMMUNITIES, BUT I FEEL YOU CAN BE EXTREMELY VALUABLE PARTNER HELPING US LIFT UP NOT JUST MY INITIATIVES BUT OVERALL THE ENTIRE NATION HEALTH. THANKS FOR THE OPPORTUNITY TO ADDRESS YOU AND I APPRECIATE YOUR TIME, I'M SORRY, WE HAVE TO RUN RIGHT AWAY FOR THE NEXT? >> I WANT TO SAY THIS FITS PERFECTLY WITH OUR CONVERSATION JUST BEFORE YOU CAME ABOUT OUR ROLE AMBASSADORS TO THE GENERAL COMMUNITIES FOR HEALTH AND CONVENERS, SO THANK YOU VERY MUCH, WE'RE HAPPY TO WORK WITH YOU. >> THANK YOU ALL. >> THIS IS A VERY WONDERFUL MOMENT TO FOLLOW. I'M ALWAYS IMPRESSED WITH THE SURGEON GENERAL'S VISION AND HIS HOPEFULNESS OF OUR FUTURE. AND TODAY WE GET TO HONOR AND CELEBRATE THOSE WHO HAVE BEEN SUPPORTIVE TO THE NATIONAL LIBRARY OF MEDICINE MISSION IN VERY SPECIAL WAYS. I'LL MAKE SEVERAL AWARD OVER THE NEXT 15 MINUTES, AFTERWARDS WE'RE GOING TOABLE GOING DOWNSTAIRS FOR A GROUP PICTURE FOR THE BOARD OF REGENTS AND ALSO ONE OF OUR AWARD TEAMS WHICH IS QUITE A LARGE TEAM, WILL BE COMING WITH US. BUT LET ME BEGIN BY FIRST ASKING CHRISTY MOVE FETE TO COME -- MOFFET TO STAND WITH ME. SHE'S A LEADING STAFF IN THE AREA OF ARCHIVING. SHE IS RECIPIENT OF THE FRANK B. ROGERS AWARD. THIS AWARD IS ESTABLISHED TO RECOGNIZE EMPLOYEE WHOSE HAD A SIGNIFICANT CONTRIBUTION TO THE NATIONAL LIBRARY OF MEDICINE FUNDAMENTAL OPERATIONAL PROGRAMS AND SERVICES. NOW, CHRISTY'S LEADERSHIP HAS BEEN IN THE AREA OF WEB COLLECTING AND ARCHIVING, SHE HELPED IMPLEMENT NEW OPERATIONAL PROGRAM AND IN CHALLENGING AREA HOW WE KEEP HISTORY OF WEB ALWAYS CHANGING, SHE LED A GROUP TASKED WITH DEVELOPING THIS PROGRAM AND ALSO LEARNING TO EXPLORE ENTIRE NEW TERRAIN. CHRISTY HAS CONTINUOUSLY EXPANDED EXPERTISE BY EARNING ARCHIVIST SPECIALIST CERTIFICATE FROM SOCIETY OF AMERICAN ARCHIVIST. SHE SHARED EXPERTISE IN AREA SEVERAL FEDERAL WORKING GROUPS. THESE INTERACTIONS HAVE ALLOWED HER BOTH TO SHARE OUR KNOWLEDGE AND BRING BEST PRACTICES FROM THE NATIONAL LIBRARY OF MEDICINE. SO IN RECOGNITION OF SIGNIFICANT CONTRIBUTIONS AND LEADERSHIP IN WEB COLLECTING AND ARCHIVING, RESULTING IN IMPORTANT PROGRAM WITH THE NATIONAL LIBRARY OF MEDICINE, I'M PROUD TO PRESENT THE FRANK B. ROGERS AWARD TO CHRISTY MOFFETT. CONGRATULATIONS. [APPLAUSE] [APPLAUSE] >> NOW I'M GOING TO ASK LINDA LORD TO JOIN ME UP HERE. LINDA LORD IS A GIFT. A SPECIAL PERSON HERE AT MARBLE LIBRARY OF MEDICINE. I'M GOING TO ASK HER TO JOIN ME BECAUSE SHE IS THIS YEAR'S RECIPIENT OF THE NLM DIRECTOR'S AWARD. THIS AWARD IS ESTABLISHED NOW SINCE 1969. AND IT RECOGNIZES AND ACKNOWLEDGE IT IS WORK OF NLM EMPLOYEES WHO MADE SIGNIFICANT CONTRIBUTIONS TO THE ACHIEVEMENT OF THE LIBRARY. WE HAD SEVERAL NOMINEES FOR THIS AWARD. THERE'S NO ONE BETTER IN THE WORLD. LINDA LORD HAS BEEN OUR CHIEF ETHICS OFFICER AND OUR PRIME CHEERLEADER FOR THE MANAGING ENORMOUS AWARDS PROGRAM. AWARDS ARE CRITICALLY IMPORTANT IN A FEDERAL SECTOR. WHERE SALARY AND ADJUSTMENTS FOR PERFORMANCE DON'T ALWAYS COME AS QUICKLY AS POSSIBLE, A ROBUST AWARD PROGRAM ALLOWS US TO ACKNOWLEDGE PEOPLE IN MANY WAYS WHO CONTRIBUTE TO SOCIETY. LINDA FERRETS THEM OUT, GETS AWARDS AND MANAGING THE PROGRAM. THIS YEAR IN RECOGNITION FOR SKILLED SUSTAINED EXCELLENCE PERFORMANCE IN THE DAILY ADMINISTRATION OF OUR ETHICS PROGRAM, WHICH ENSURES THAT WE ARE COMPLIANT WITH THE FEDERAL AND PUBLIC REQUIREMENTS FOR REPORTING AND ADS WELL AS GENERAL GREAT COLLEAGUE. I'M PROUD TO PRESENT THIS AWARD. [APPLAUSE] >> LINDA HAS KEPT ME FROM FALLING INTO MANY FEDERAL PUDDLES. I APPRECIATE THAT VERY MUCH. ETHICS IS IMPORTANT, WE HAD FINANCIAL REPORTING, WE HAVE A RELATIONSHIP REPORTING, ALL THIS STUFF WE DISCUSSED THIS MORNING AND ETHICS OFFICERS KEY TO OPERATION. NOW I WOULD LIKE TO ASK TO JOIN ME THE ENTIRE TEAM IS WAITING OUTSIDE THE DOOR. THIS IS A VERY SPECIAL AWARD, RECOGNITION THAT WE ARE REALLY VERY PROUD TO BE ABLE TO GIVE. I'LL HAVE Y'ALL COME UP OTHER AND JAM UP FOR A FEW MINUTES. YOU WILL SEW WHAT IT TAKES TO CHANGE AN ENVIRONMENT AND TO MOVE A SYSTEM. AT THIS POINT IN TIME, WE HAVE A DEVELOPMENT TEAM HERE THAT HAS LED TO MANAGING IDENTITY ACROSS THE ENTIRE NIH. MANAGING IDENTITY DOESN'T MEAN NEW PERSONALITIES BUT WHAT IT DOES MEAN IS THESE PEOPLE ARE CHARGED WITH I CAN MA MAKING SURE THEY KNOW WHO WE ARE. A SIGNIFICANT CHALLENGE TO BE ENSURED THE SYSTEMS THAT HAVE BUILT UP UNIQUELY, DIFFERENT ID LOG IN ONE BUILDING VERSUS ANOTHER BUILDING, NEED TO BE BROUGHT INTO HARMONY AND IN ADDITION THEY NEED TO BE ABLE TO BE USED ADDRESS DOMAINS THEY NEVER ANTICIPATED TO BE USED FOR. THIS GROUP WAS FORMED JUST AS THE WINTER THIS YEAR, THE NIH IDENTITY AND ACCESS MANAGEMENT COUNCIL, THEY REVIEWED REPOSITORY, FOUND REPOSITORIES, REVIEWED THEM DETERMINED THERE WAS A OPPORTUNITY TO STANDARDIZE AUTHENTICATION METHODS, ROLES ENTITLEMENTS, CLEAN UP BAD DATA AND SOLVE IDENTITY ATHE RESOURCES. ANOTHER SIGNIFICANT IDENTITY TO REPOSITORIES CONTINUE TO BE EMPLOYED AND MADE AVAILABLE AND ROBUST ENOUGH TO MEET THE DATA CHALLENGES OF THE FUTURE. WITH THIS GROUP WE HAVE BEEN ABLE TO IN A SHORT PERIOD OF TIME PUT IN PLACE A TECHNICAL SOLUTION TO A VERY COMMONLY EXPERIENCE PROBLEM. SO I'M VERY PLEASED TO ACKNOWLEDGE WITH DIRECTOR'S AWARD THE FOLLOWING STAFF MEMBERS. GIVE ME PATIENCE WHILE I GO THROUGH THESE. WE HAVE (CALLING OUT NAMES) NOT HERE. ALL RIGHT. THERE WE ARE. STEVE SHERRI, I KNOW YOU'RE HERE. CONGRATULATIONS. I WILL ASK YOU GUYS TO WAIT. WE'LL TAKE A PHOTO DOWN TEAR STAIRS WITH THIS TOGETHER. GREGORY IS NOT HERE WITH US. EUGENEA, CONGRATULATIONS. THANK YOU SO MUCH. I KNOW YOU'RE WORKING HARD. CARL LUSDORF. GOODNESS, I'M SORRY, WE'RE OUT OF ORDER. HANG ON A SECOND. HERE WE GO. ABOUT THAT JOB YOU SAID EARLIER ABOUT ME BEING IN CHARGE. CARL. OKAY. THANK YOU, CARL. TOM MURPHY. >> THANKS VERY MUCH. JEFF ERICSON. JEFF NOT HERE. OKAY. (INDISCERNIBLE) (CALLING OUT AWARD RECIPIENT NAMES) CONGRATULATIONS. I GOT IT. I'M WORKING OFF TWO DIFFERENT LISTS, MY FAULT. (CALLING OUT AWARD RECIPIENTS' NAMES) NOT HERE, OKAY. (CALLING OUT AWARD RECIPIENTS' NAMES) DMITRI -- HOW DID I DO? >> GREAT. >> THANK YOU SO MUCH. I'M JOINING WITH MY COLLEAGUE, THANK YOU, STACY, STACY BOYD FROM CIT, THIS AWARD JOINTLY PRESENTED ACROSS THE NIH RECOGNIZING THE COLLABORATION WITH THIS GROUP. SO WE'LL MEET YOU GUYS DOWNSTAIRS FOR A PHOTO OPPORTUNITY IN A FEW MINUTES. [APPLAUSE] THANKS SO MUCH FOR COMING IN. MENT SO NOW WE HAVE TO PAUSE AND ACKNOWLEDGE OUR LEADERSHIP OF THE BOARD OF REGENTS AND THE NATIONAL LIBRARY OF MEDICINE WHO SERVED US IN THIS PROCESS. I'M GOING TO ASK ESTHER TO JOIN ME UP HERE FOR A MOMENT, PLEASE. SERVING AS MEMBER OF THE BOARD OF REGENTS IS A CONSIDERABLE RESPONSIBILITY, WE APPRECIATE THE WORK THAT HAS BEEN DONE ESPECIALLY WHEN INDIVIDUALS TRAVEL TO BE HERE WITH US. ESTHER, THANK YOU FOR YOUR SERVICE ON THE BOAR AND BUT ALSO AS CHAIR AND I'M HAPPY TO PRESENT YOU WITH A CERTIFICATE. THANK YOU. [APPLAUSE] THANK YOU SO MUCH. SANDRA, CAN I ASK YOU TO JOIN US, PLEASE. SANDRA MARTIN IS MEMBER OF THE BOARD OF THE REGENTS OF THE NATIONAL LIBRARY OF MEDICINE, SHE'S ADVISOR, HELPED US WITH SEARCHES, HELPED WITH OUR STRATEGIC PLANNING ACTIVITY, AND WE'RE GOING TO MISS YOU. SHE'S GOING ON THOUGH TO BIGGER SERVICE WITH THE BOARD OF THE MEDICAL LIBRARY ASSOCIATION. SO PLEASE ACCEPT THIS PLAQUE TO READ IN YOUR SPARE TIME. [APPLAUSE] >> THANK YOU SO MUCH. THANK YOU, EVERY, FOR SUPPORTING ACKNOWLEDGING THESE TREMENDOUS COLLEAGUES WE HAVE WORKING WITH US. WE'RE NOW GOING TO BE BREAKING FOR LUNCH T BOARD OF REGENTS WILL GO TO READING ROOM DOWNSTAIRS IN HISTORY OF MEDICINE DIVISION FOR MOTOR GRAPH AND THEN O PHOTOGRAPH AND THEN WALK OVER TO LISTER HILL CENTER FOR LUNCH. IN THE VISITOR CENTER. THEN WE WOULD LIKE TO BE BACK HERE AT 1 P.M. WHEN WE'LL HAVE OUR FEATURE PRESENTATION FROM AN INSTITUTE CENTER DIRECTOR. THANK YOU VERY MUCH. >> IT IS MY PLEASURE TO INTRODUCE OUR NEXT SPEAKER, DR. ELISEO PEREZ-STABLE, WHO IS DIRECTOR OF THE NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES AT NIH. PRAYER TO BECOMING NIMHD DIRECTOR DR. PEREZ-STABLE BUILT A CAREER AT THE UNIVERSITY OF CALIFORNIA SAN FRANCISCO WHERE HE WAS PROFESSOR OF MEDICINE, CHIEF OF DIVISION OF GENERAL MEDICINE AND DIRECTOR OF CENTER ON AGING IN DIVERSE COMMUNITIES. DR. PEREZ-STABLE HAS BEEN A LEADER IN THE FIELD OF RESEARCH ON AGING AMONG MINORITIES. AND SERVED AS MEMBER OF THE NIH'S NATIONAL INSTITUTE ON AGING ADVISORY COUNCIL FROM 2011 TO 2014. AND AS CHAIR OF THE COUNCIL MINORITY TASK FORCE ON AGING FROM 2012 TO 2014, DR. PEREZ-STABLE'S EXPERTISE SPANS A BROAD RANGE OF HEALTH DISPARITIES DISCIPLINES. HIS RESEARCH INTERESTS HAVE CENTERED ON IMPROVING THE HEALTH OF RACIAL AND ETHNIC MINORITIES AND UNDERSERVED POPULATIONS. ADVANCING PATIENT CENTERED CARE, IMPROVING CROSS CULTURAL COMMUNICATION SKILLS AMONG HEALTH PROFESSIONALS AND PROMOTING DIVERSITY IN THE BIOMEDICAL RESEARCH WORKPLACE. WELL. CO, DR. PEREZ-STABLE TO TALK MINORITY HEALTH AND HEALTH DISPARITIES. THANK YOU. [APPLAUSE] >> THANK YOU VERY MUCH FOR THAT INTRODUCTION AND WELCOME, IT'S A PLEASURE TO BE BACK HERE, I THINK BEFORE PATTY STARTED, COUPLE OF OVER TWO YEARS AGO I CAME AND PRESENTED THIS BOARD. HOPEFULLY WILL HAVE SOME GOOD CONVERSATION. I WANTED TO GIVE YOU A GLOBAL SCREW OF MINORITY HEALTH, HEALTH DISPARITIES WITHIN NIMHD AND SHARE A COUPLE OF EXAMPLES WHERE OUR INTERESTS OVERLAP. AND THEN WE'LL OPEN UP FOR CONVERSATION. NIMHD HAS AN INTERESTING HISTORY, THE NEWEST INSTITUTE ON THE CAMPUS. WE WERE ESTABLISHED IN 1990 AS AN OFFICE UNDER THEN PRESIDENT BUSH SECRETARY SOLOMON STARTED OFFICE OF MINORITY HEALTH AFFAIRS OR SOMETHING LIKE THAT. IN '93 IT WAS CHANGED TO OFFICE OF MINORITY HEALTH RESEARCH BUT IN 2000 WE WERE TRANSITIONED TO A CENTER THROUGH CONGRESSIONAL LEGISLATION CHAMPIONED BY REPRESENTATIVE STOKES AND CONGRESSIONAL BLACK CAUCUS. AS PART OF THE AFFORDABLE CARE ACT IN 2010, WE WERE ELEVATED TO AN INSTITUTE AND THAT SAME REGISTRATION EACH OF THE HHS AGENCIES WERE REQUIRED TO HAVE OFFICE OF MINORITY HEALTH OR HEALTH EQUITY IF THEY DIDN'T ALREADY HAVE THEM, THESE WERE NIMHD WAS GIVEN THE RESPONSIBILITY OF BEING NIH REPRESENTATIVE SO I RELATE TO INDIVIDUALS COORDINATED BY OFFICE OF MINORITY HEALTH, AT AHRQ, CDC SAMSA, HRSA IN THE OFFICE OF MINORITY HEALTH AND CMS, OUR EMPHASIS IS ON SCIENCE AS YOU KNOW, WE'RE AT NIH SO WHENEVER I TALK TO STAKEHOLDERS COMMUNITY GROUPS I EMPHASIZE THOSE TOP TWO, WE HAVE TWO PILLARS TO OUR RESEARCH, MINORITY HEALTH AND HEALTH DISPARITIES, I WILL EXPLAIN THAT. BECAUSE WE'RE AT NIH WE ALSO DO MODERATE AMOUNT OF TRAINING MUCH LESS THAN OTHER INSTITUTES BUT WE DO HAVE A STRONG INTEREST IN DEVELOPING CAPACITY IN THAT AREA. PARTICULARLY AS IT REFERS TO DIVERSITY OF THE WORK FORCE. COMMUNICATING ALL THE TIME AND FOSTERING COLLABORATION ESPECIALLY WITHIN NIH AND WITHIN GOVERNMENT, COLLABORATIONS EXTERNALLY ARE OFTEN NET WITH MORE CHALLENGES. OUR DEFINITION OF MINORITY HEALTH IS ANYTHING AND EVERYTHING THAT RELATES TO THE RACE ETHNIC MINORITY GROUPS IDENTIFIED BY THE U.S. CENSUS IN THE OFFICE OF -- IN THE OMB DEFINITION, WHETHER OUTCOMES ARE GOOD OR NOT GOOD. THIS IS NOT ONLY DISPARITIES, THERE ARE SOME OUTCOMES THAT ARE BETTER FOR MINORITIES. PARTICULARLY FOR LATINOS AND ASIANS. BUT IN GENERAL WE ARE INTERESTED IN ANYTHING WITHIN EACH RACE ETHNIC MINORITY GROUP IN THE US. WE ALSO ENDORSE THE IDEA THAT EVERY RACE ETHNIC GROUP IN THE U.S. IS TO SOME EXTENT SUFFERED FROM DISCRIMINATION. THIS IS VERY CONSIDERABLE FROM LEGACY OF SLAVERY AND WARS AGAINST THE NATIVE PEOPLE OF NORTH AMERICA TO THE CURRENT AMBIENCE OF DISCRIMINATION AND IMMIGRANTS. THERE ARE MANY HISTORICAL EXAMPLES OF THIS OVER OUR HISTORY. AND THAT THIS PRESENTS A CERTAIN AMOUNT OF SOCIAL DISADVANTAGE FOR MINORITIES. YOU MAY BE FAMILIAR WITH THIS LIST, THIS IS THE RACEETH IN IN THIS CASE CLASSIFICATION, IT WAS GOING TO CHANGE FOR 2020 BUT DECIDED NOT TO EARLIER THIS YEAR. AFRICAN AMERICAN OR BLACK, THIS IS THE WAY IT'S LISTED INNED THE CENSUS, WE ENDORSE THIS NOMENCLATURE, ASIAN WHICH IS PROBLEMATIC, SO HETEROGENEOUS, PARTICULARLY SOUTH ASIANS ARE DIFFERENT THAN EAST ASIANS IN EVERY WAY YOU CAN THINK OF. SO PULLING THEM TOGETHER DOESN'T MAKE SENSE BUT THAT'S THE WAY IT IS. AMERICAN INDIAN ALASKA NATIVE, NATIVE HAWAII AND OTHER PACIFIC ISLANDERS IMPORTANT VERY SMALL GROUP ACTUALLY SMALLER IN NUMBER THAN AMERICAN INDIANS, OFTEN LUMP TOGETHER WITH ASIANS WHICH IS WRONG, THOUGH WE DO IT ALL THE TIME AND STILL FEDERAL AGENCIES LUMP THEM TOGETHER, DEATH CERTIFICATES ARE LUMPED TOGETHER, THIS IS AN ERROR THAT NEEDS TO BE CHANGED. IT'S IMPORTANT NOT ONLY BECAUSE THERE ARE DIFFERENT RACE BUT ALSO BECAUSE PACIFIC ISLANDERS HAVE BEEN STUDIED AND HEALTH PROFILE LOOKED MORE LIKE AFRICAN AMERICANS THAN THEY DO LIKE EAST ASIANS. LATINO HISPANIC IS THE ONLY ETHNIC GROUP RECOGNIZED IN THE CENSUS NOW AND IT DOES INCLUDE 20 COUNTRIES. IT IS A HETEROGENEOUS GROUP BUT IT IS A MIX GROUP OF OVER 500 YEARS IN THE AMERICAS. THEN WHITES, WHICH INCLUDE MIDDLE EASTERN PEOPLE AS WELL AS NORTH AFRICANS SO ARAB AMERICANS ARE INCLUDED, THERE WAS A PROPOSAL TO SEPARATE THEM OUT AS SEPARATE ETHNIC GROUP AND THAT GOT NIXED. HEALTH DISPARITY POPULATIONS ARE DEFINED BY US, BY NIMHD, THE IN COLLABORATION WITH DIRECTOR OF AHRQ. OF COURSE ENDORSED BY DIRECTOR OF NIH. SO RACIALs IN THIS CASE MINORITIES LESS PRIVILEGED SOCIAL ECONOMIC STATUS, POOR PEOPLE OF ANY RACE, AND UNDERSERVED RURAL RESIDENTS ARE INCLUDED IN LEGISLATION FROM 2010. AS DISPARITY POPULATIONS, OR 2000. SORRY. IN OCTOBER OF '16 WE ADDED SEXUAL GENDER MINORITIES AFTER A LONG PROCESS THAT LED MOSTLY BY LARRY TABAK FROM OFFICE OF DIRECTOR AND OTHERS WORKING WITH THE DEPARTMENT OF HEALTH AND HUMAN SERVICES. I GOT CREDIT AS DIRECTOR OF NIMHD, I ANNOUNCED IT THOUGH OUR EFFORTS WERE CRITICAL IN THE FINAL PHASE, IT WAS REALLY A LOT OF WORK DONE BY OTHERS. THIS IS FOR FOSTERING RESEARCH BECAUSE THE LACK OF RESEARCH DATA REALLY MAKES IT HARD TO JUSTIFY THIS ON THE BASIS OF NATIONAL MORBIDITY MORTALITY OUTCOMES. SO WE ARE LOOKING FORWARD TO SEEING MORE OF THAT HAPPEN. IN OUR DEFINITION OF DISPARITY, A POPULATION HAS A WORSE HEALTH IN THESE GROUPS, COMPARED TO REFERENCE GROUP USUALLY RICHER PEOPLE, WHITES, OR URBAN VERSUS RURAL OR NON-SEXUAL GENDER MINORITIES. AND I THINK THAT'S THE CRITICAL FINE POINT HERE, THE FACT THAT WHITE MEN GENERALLY HAVE MORE HEART ATTACKS THAN OTHER GROUPS IS NOT A DISPARITY, IT'S A DIFFERENCE. OR THAT WHITE WOMEN HAVE MORE BREAST CANCER THAN OTHER RACEETH IN IN THIS CASE GROUP. THERE MAYBE BIOLOGICAL FACTORS INVOLVED BUT CLEARLY THIS IS AN IMPORTANT FOR US TO PAUSE ON. ONE OF THE EXCITING THINGS ABOUT MINORITY HEALTH, HEALTH DISPARITY SCIENCE IS HOW MUCH HAS COME TO LIGHT IN THE LAST 20 YEARS. WHEN THE CENTER WAS STARTED IN YEAR YOU WE HAD LITTLE SENSE WHAT WAS CAUSING THESE THINGS, EVEN ASSUMED A LOT HAD TO DO WITH BEHAVIOR AND ACCESS. AND IF WE CAN SOLVE THOSE TWO THINGS OR IMPROVE THE BEHAVIOR OR DEAL WITH ACCESS, IMPROVE QUALITY, WE WOULD DISSOLVE OR MAKE DIFFERENCES IN ALL THESE DISPARITIES. SOME OF THAT IS CORRECT. THOUGH WE NOW UNDERSTAND THAT EFFECTS OF EARLY ADVERSE CHILDHOOD ADVERSE EVENTS COULD HAVE LONG TERM CONSEQUENCES IN ADULT HEALTH, YOU CAN'T CHANGE AT AGE 40 THAT WHAT HAPPENED TO YOU LED TO YOUR PROBLEM AT AGE 3. YOU CAN TRY TO ADDRESS THIS ON LONG TERM BASIS. SIMILARLY WE HAVE HAD E EXPLOSION OF BIOLOGICAL INFORMATION IN THE LAST 20 YEARS NOT ONLY HUMAN GENOME PROJECT AND EPIGENETICS BUT ALSO IDENTIFY METABOLIC DIFFERENCES, DIFFERENT SUSCEPTIBILITY, FASTER PROGRESSION, THE BRAIN INITIATIVE IS UNVEILING A NEW AREA THAT IS JUST RIGHT AT THE RODENT LEVEL RIGHT NOW BUT WILL NEED TO BE ADDRESSED BY DIFFERENT DEMOGRAPHIC FACTORS. EXTRA CELLULAR RNA, MICROBIOME, ET CETERA. I SEE THESE AS TOOLS TO UNDERSTAND WHAT WE OBVIOUS SERVE CLINICALLY OR EPIDEMIOLOGICALLY, THERE ARE BIG DIFFERENCES THAT ARE NOT READILY EXPLAIN, THAT'S WHEN WE THINK WHAT MECHANISMS MIGHT BE UNDERLYING THERE ON THE ONE HAND BIOLOGICALLY AND OTHER FACTOR, THE OTHER AREA THAT HAS EXPANDED TREMENDOUSLY IN 20 YEARS IS IMPORTANCE OF PHYSICAL ENVIRONMENT. WHERE ONE LIVES WORKS OR PLAY WHETHER ONE LIVES IN SEGREGATED NEIGHBORHOODS OR NOT, WHETHER STREETS ARE SAFE, WHETHER YOU HAVE ACCESS TO HEALTHY FOODS, WHETHER THERE'S GREEN SPACE, AND WHETHER THERE'S COMMUNITY, PEOPLE TALKING TO EACH OTHER AND HAVE SOME INTERACTIONS. SO THIS WHOLE CONCEPT OF IMPORTANCE OF PLACE OR THEIR ZIP CODE IS MORE IMPORTANT THAN GENETIC CODE FOR YOUR HEALTH, WHICH IS TRUE, REALLY HAS COME INTO LIGHT THE LAST 20 YEARS, THAT IS EXPANSION OF RESEARCH IN THIS AREA WHICH WE ARE VERY MUCH ENDORSE. THEN FINALLY, I'M A GENERAL INTERNIST, UNTIL THREE YEARS AGO I USED TO BE A REAL DOCTOR. AND SEE PATIENTS. AND FOLLOW THEM OVER TIME. I HAVE A STRONG FUNDAMENTAL BELIEF IN THE IMPORTANCE OF PRIMARY CARE, IN OUR HEALTHCARE SYSTEM, I HAVE SEEN WHAT A DIFFERENCE THE WEST AND THE EAST MAKES IN THAT REGARD. BUT THAT'S FOR ANOTHER CONVERSATION. AND I THINK WHAT HAPPENS EVERY DAY IN PRACTICE, WHETHER IT BE PRIMARY CARE SPECIALTY CARE, URGENT CARE OR THE HOSPITAL IS IMPORTANT. SO THIS IS A DISEASE AGNOSTIC FOCUS. WE'RE LOOK -- WE ARE INTERESTED IN WHAT HAPPENS TO PATIENTS IN THE CLINICAL SETTING. NOW, ON OUR WEBSITE WE HAVE THIS FRAMEWORK, WHICH TRIES TO CAPTURE GRAPHICALLY WHAT I HAVE JUST EXPLAINED TO YOU OR GIVEN YOU HIGHLIGHTS OF, THIS IS NOT MEANT TO BE COMPREHENSIVE OR CAUSAL BUT JUST TO REFLECT COMPLEXITY AND CHALLENGES OF THE KIND OF SCIENCE WE'RE INVOLVED WITH, I THINK IT HAS SERVED OUR INVESTIGATOR COMMUNITY WELL. WE HAVE REORGANIZED NIMHD, WE'RE IN THE PROCESS OF DOING THAT. THIS YEAR, OFFICIALLY. INTO THREE FUNCTIONAL DIVISIONS RIGHT NOW. THE FIRST IS BIOLOGY AND BEHAVIOR. MOSTLY FOCUSED ON MECHANISMS AND ETIOLOGY. THE COMMUNITY HEALTH AND POPULATION SCIENCE REFLECTING OUR TRADITIONAL EFFORTS IN COMMUNITY BASED PARTICIPATORY RESEARCH BUT NOT EXCLUSIVELY THAT, I PREFER COMMUNITY ENGAGED RESEARCH AND EXPAND THIS TO PUBLIC HEALTH SCIENCE OR POPULATION HEALTH, THIS IS WHERE LEVERAGING BIG DATA MAY COME IN. THEN THE CLINICAL HEALTH SERVICES RESEARCH TO REALLY EMPHASIZE THE TOPIC I JUST ALLUDED TO EARLIER. HESE ARE GLOBAL FUTURE RESEARCH DIRECTIONS FOR SCIENCE OF MINORITY HEALTH, HEALTH DISPARITIES AREAS. FIRST MUCH OF WHAT WE NEED TO DO HAS TO HAVE MULTI-LEVEL INTERVENTION. ONE CANNOT EXPECT GIVING A PILL FOR LOWERING BLOOD PRESSURE IS ENOUGH. YOU NEED BEHAVIOR CHANGE FROM THE PATIENT. YOU NEEDILY IN ADDITION TO HAVE A -- NEED THE CLINICIAN TO HAVE PROTOCOL, SYSTEM TO BE ACCESSIBLE AND FRIENDLY TO THE PATIENT TO GET THE OUTCOME THAT YOU WANT WHICH IS BLOOD PRESSURE CONTROL. AND THEN MULTIPLE OTHER THINGS. I AM A BIG FAN OF IDENTIFYING MECHANISMS. MANY THINGS WORSE THAN HAVING INTERVENTION THAT HAS NO AFFECT BUT IT SURE DOES FEEL GOOD, IF AN INSTITUTE FUNDS A BIG STUDY WITH A NEGATIVE RESULT, OR THE INVESTIGATORS, YOU GET NEW ENGLAND JURY ROOM PUBLICATION LIKE MOST RECENT ABOUT ALZHEIMERS EARLY ALZHEIMERS TREATMENT AND THAT MAY NOT BE THE BEST EXAMPLE BUT THERE WERE NUMBER OF STROKE TRIALS NEGATIVE AND I'M SURE NINDS WAS NOT HAPPY ABOUT THAT FOR MANY YEARS. I'M ALSO FEEL THERE IS A POWER TO PATIENT CLINICIAN RELATIONSHIPS AND COMMUNICATION. AND THAT CAN HAVE TREMENDOUS IMPACT ON PATIENT BEHAVIOR. MOST PATIENTS DON'T ACTUALLY DO WHAT WE RECOMMEND THEY DO, BECAUSE THEY UNDERSTAND THE RISKS AND BENEFITS AND THE DATA. THEY DO IT BECAUSE THEY LIKE YOU AS A DOCTOR, AS A CLINICIAN. THEY THINK THAT YOU'RE TRUSTWORTHY AND THEY HAVE THIS RELATIONSHIP WITH YOU OVER TIME THAT ALLOWS THEM TO SAY YES I'LL GET MY MAMMOGRAM EVERY OTHER YEAR, THEY'RE NOT THINKING ABOUT RISK. THAT'S MOST PEOPLE. I THINK THAT COMMUNICATION LABORATORY IS A CRITICAL ONE WHERE WE HAVE APPLIED LIMITED SCIENCE AND REALLY CAN HELP US UNDERSTAND MORE ABOUT IMPROVING MINORITY HEALTH AND DECREASING HEALTH DISPARITIES. IMPLEMENTING STRUCTURAL CHANGES, THERE WAS A STUDY WE FUNDED IN SOUTHERN CALIFORNIA WHERE THEY WERE FOCUSED ON DECREASING SUGAR SWEETENED BEVERAGE CONSUMPTION BY MIDDLE SCHOOL STUDENTS AND THEY DID RANDOMIZED CLUSTER TRIAL OF SCHOOLS. AND ENDED UP AT ALL EDUCATIONAL INTERVENTIONS AND MATERIALS PROVIDED HAD NO EFFECT BUT WHAT CHANGED BEHAVIOR OF THE KIDS WAS GIVING EASY ACCESS TO CHILLED WATER AND BEING IN SOUTHERN CALIFORNIA THAT WAS IMPORTANT, THAT IT BE CHILLED. SO SOMETHING THAT WE NOT EVEN THINK ABOUT WAS SIMPLE, STRUCTURAL CHANGE, YOU GIVE ALTERNATIVE THAT'S EASY AND FREE AND THE KIDS WERE MORE THAN HAPPY TO ENDORSE THAT. SO WE HAVE NUMBER OF FUNDING OPPORTUNITY ANNOUNCEMENTS. I LISTED ALL OF THEM HERE, WE SEENED UP OTHERS WITH OTHER INSTITUTES, IMMIGRANT POPULATIONS DISPARITIES IN SOCIAL CARE, SOCIAL GENOMICS WHERE YOU FUNDED NINE RO1s UNDER THAT FUNDING OPPORTUNITY ANNOUNCEMENT. WE HAVE A CARIBBEAN ANNOUNCEMENT TO CREATE COHORT OF CARIBBEAN BASED COHORTS COMPARED TO U.S. POPULATIONS, WE'LL FUND ONE COMING OUT OF THE BLACK CARIBBEAN SLEEP DISPARITIES LIVER CANCER OPIOID USE, JUST GOT PUBLISHED IT WAS TIMELY, AND WE HAVE BEEN WORKING ON THIS, I HAVE BEEN WORKING ON STAFF TO WORK ON THIS FOR OVER A YEAR. INTERESTING THING IS OVERDOSES ARE LESS, LOWER AMONG AFRICAN AMERICANS AND LATINOS COMPARED TO WHITES. BY A BIG GAP. HUGE GAP, WHICH IS UP EXPLAINED, AMERICAN INDIANS ARE WORSE THAN WHITES SO THERE'S NOT A CROSS THE BOARD CONSISTENT MINORITIES AND ASIANS ARE LOW. SO THIS IS AN AREA THAT WE'RE INTERESTED IN BOTH FROM THE ETIOLOGIC AS WELL AS HEALTH SERVICES PART. I THINK ONE OF OUR STAFF WORKED HARD ON SIMULATION MODELING AND SYSTEM SCIENCE WENT OUT, EIGHT OR NINE ICs ARE SIGNED UP TO THAT AND THE OTHER TWO INCLUDING THE HEALTH INFORMATION TECHNOLOGIES ARE IN THE PIPELINE. WORKING THEIR WAY, CLEARED BY COUNCIL SO THERE IS A SHORT SUMMARY ON OUR WEBSITE. LET ME SAY A FEW MORE THINGS HERE IN A COUPLE OF MINUTES. INCLUSION OF DIVERSE PARTICIPANTS IS IMPORTANT. MINORITIES ARE HISTORICALLY UNDER-REPRESENTED IN RESEARCH, DOING BETTER, IT'S IMPORTANT, IT'S IMPORTANT TO KEEP IN MIND THAT HAVING A BUNCH OF MINORITIES IN YOUR CLINICAL STUDY IS NOT THE SAME THING AS DOING MINORITY HEALTH RESEARCH. BECAUSE SOMETIMES PEOPLE WILL SAY, I HAVE 30% MINORITY SO IS IT'S MINORITY HEALTH RESEARCH. RIGHT? IF YOU'RE LOOKING AT A QUESTION THAT RELATES TO THAT GROUP, THEN IT BECOMES RESEARCH SIDE. IT IS NOT JUST SOCIAL JUSTICE AND COMMON SENSE, ALMOST 40% OF THE U.S. POPULATION IN GENERAL IS ONE OF THE MINORITY GROUPS, THIS WILL BE TRUE IN THE 2020 CENSUS BUT RIGHT NOW 50% OF CHILDREN ARE MINORITIES. RIGHT NOW. YOU KNOW WHAT THAT MEANS FOR THE FUTURE. IF 50% OF KIDS IN 2015 ARE ONE OF THE RACE ETHNIC MINORITY GROUPS, IT'S ALSO GOOD SCIENCE, THERE'S REALLY DISCOVERY TO BE MADE WITH DIVERSE PARTICIPANTS THAT OTHERWISE WOULDN'T BE MADE. AND THERE ARE A NUMBER OF EXAMPLES OF THAT. NIH LAST TIME I SAW DATA ON THIS, FROM OFFICE OF EXTRAMURAL RESEARCH, IT WAS 28% OF ALL NIH FUNDED CLINICAL STUDY, STUDIES WITH HUMAN BEINGS. NOT JUST CLINICAL TRIAL TYPE STUDIES, 2% MINORITIES, THE YELLOW BUS STUDY WHICH ISN'T SHOWING UP ON THE SLIDE IS AIMING TO RECRUIT 50% MINORITIES IN THE MILLION PERSON COHORT. THINK INITIAL START HAS BEEN GOOD. WE ARE WANTING TO BUILD A TRAINING PORTFOLIO. WE JUST SIGNED UP TO THE PARENT K PROGRAM, WE HAVEN'T YET FUNDED ANY, WE HAVE BEEN FUNDING K-99s, A FEW OVER YEAR, INDIVIDUAL FELLOWSHIP GRANTS AND WE ARE ONE OF THE LEADING INSTITUTES THAT FUNDS LOAN REPAYMENT PROGRAMS, MANDATED BY CONGRESS ADS WELL. -- AS WELL. WHEN CONGRESS CHARGED NIH TO DO THIS, THEY CREATED FOUR CATEGORIES, INITIALLY TWO WERE RELATED TO US WHICH WERE MINORITY HEALTH HEALTH DISPARITIES RESEARCH AND UNDERPRIVILEGED INVESTIGATORS BY SES, SOCIOECONOMIC STATUS, NOT RACE ETHNICITY. THE OTHER TWO WERE RELEVANT TO CHILD HEALTH. THEY ADDED THE CLINICAL COMPONENT. NOW THEY LIFTED ALL THOSE RESTRICTIONS SO NIH IS TRYING TO FIGURE OUT WHAT TO DO. NIMHD FUNDS 10% OF LOAN REPAYMENT PROGRAMS AWARDS AT NIH, WE HAVE LESS THAN 1% BUDGET, JUST TO PUT THAT IN PERSPECTIVE. WE STARTED A HEALTH DISPARITIES RESEARCH INSTITUTE, GREW OUT OF FORMER COURSE THAT WAS TAUGHT FOR FIVE YEARS, VERY SUCCESSFULLY. AND WHEN I GOT HERE I SAID I DON'T WANT TO DO THIS NOW MORE, I WANT SOMETHING SPECIFIC FOR TRAINEES. SO THIS IS AIMED TO TARGET SENIOR POST DOCS AND JUNIOR FACULTY. WE GOT 200 APPLICATIONS LAST YEAR, WE FUND THEM -- WE GIVE THEM UP TO A THOUSAND DOLLARS FOR TRAVEL AND WE GIVE THEM A WEEK AT NIH IN THE MIDDLE OF THE SUMMER SO IT'S A LOVELY TIME TO BE ENDORSED. AND ENJOY THEIR EVENING SO WE DO SELECTED SCIENTIFIC LECTURES AND GIVE THEM TIME WITH INTERACTING WITH STAFF, SOME NETWORKING, AAMC HELPED WITH SOME OF THE WORKSHOPS AND WE ALSO HAVE DONE A MOCK REVIEW, WHICH IS SORT OF THE MOST REMEMBERED IF NOT FAVORITE ACTIVITY OF THE WEEK. LAST NOVEMBER MY RECRUIT SCIENTIFIC DIRECTOR STARTED, WE WERE CAUGHT IN BETWEEN THE CHANGE OF ADMINISTRATION. SO TOOK A WHILE TO GET HER ON BOARD. IT IS Ph.D. EPIDEMIOLOGIST SOCIAL BEHAVIORAL EPIDEMIOLOGIST WHO I USED TO WORK WITH AT UCSF AND LOOKING FOR HER TO BUILD OUR INTRAMURAL PROGRAM, IT'S SMALL RIGHT NOW BUT PROCESS OF RECRUIT ING INVESTIGATORS AS WELL AS CONTINUE TO PUT NETWORK WITH MULTIPLE DIFFERENT INSTITUTES. AND THEN ON THE BIG DATA SCIENCE, WRAP THIS UP. I THINK THIS IS A TOPIC WHERE WE CAN OVERLAP, TWO TOPICS I'LL MENTION WE HAVE THIS, I THINK THE MOST BASIC THING THAT NEEDS TO BE DONE IS TO GET THE SOCIAL DETERMINANTS RIGHT INTO THE SYSTEM. BECAUSE EVEN THOUGH RESEARCHERS KNOW WHAT TO DO, HEALTH SYSTEMS DON'T DO WHAT THEY'RE SUPPOSED TO DO. BASIC COLLECTION OF DATA, WHETHER RACE ETHNICITY, EDUCATION. THEY GET YOUR INSURANCE RIGHT AND AGE AND GENDER USUALLY CORRECT BUT THAT IS ABOUT IT. THEY DON'T GET THESE OTHER FACTORS IN THE IOM HAS A REPORT THAT YOU CAN LOOK AT AS A REFERENCE POINT. HEALTHY PEOPLE 2020 HAS A LIST OF SOCIAL DETERMINANTS. BUT THIS IS I THINK THE MOST IMPORTANT THING AND SIMILARLY FOR THE IMPROVING CARE AND ESPECIALLY GIVEN WHERE WE ARE NOW WITH ELECTRONIC HEALTH RECORDS OVER 90% OF PRACTICES ARE ON THEM, THIS IS A CRITICAL CHANGE. A NUMBER OF ISSUES THAT COULD BE DISCUSSED WITH THAT. FINALLY, WE DO HAVE A PROJECT THAT'S ACTUALLY ABOUT TO -- ALREADY STARTED I THINK. THIS IS A RELATED TO COMMON DATA ELEMENTS. IT OCCURRED TO ME IN LISTENING TO VARIOUS TOPICS AND KNOWING WHAT THE NATIONAL LIBRARY OF MEDICINE HAS THAT WE DON'T HAVE COMMON DATA SET THAT SAYS WE'RE ENDORSING THESE AS MINORITY HEALTH HEALTH DATA, WE CAN INCLUDE THEM IN OUR FOA. GENOME INSTITUTE HAS A LEAD ON THIS SO WE'RE FUNDING THROUGH THIS AS ADMINISTRATIVE SUPPLEMENT TO DEVELOP WHETHER THERE BE TOOL KIT OR ENDORSEMENT OF SOCIAL DETERMINE NICHE, WHEN I LOOKED AT WHAT'S THERE, THERE ARE PIECES AND ELEMENTS SCATTERED AROUND DIFFERENT DOCUMENTS MOSTLY AROUND NCI AND BEHAVIOR BUT NOT SOMETHING THAT'S SPECIFIC TO MINORITY HEALTH, HEALTH DISPARITIES. WE HAVE A LANGUAGE PORTAL, THAT IS MORE OUTREACH FOR THE COMMUNITY. I SHOULD ALSO ESPECIALLY WITH LYNN HERE MENTION WE HAD A SUCCESSFUL SCIENCE DAY. WE MISSED YOU THERE, PATTY, BUT IT WAS VERY GOOD. JERRY DID A GREAT JOB. WE HAD 500 HIGH SCHOOL STUDENTS. HOW MANY? MIDDLE AND HIGH SCHOOL STUDENTS. COUPLE OF NIH SCIENTISTS ACTUALLY EMAILED ME AND SAID I WAS THERE AS A MOM. SO GOOD TO SEE YOU. ANYWAY, THANK YOU FOR YOUR ATTENTION HOPEFULLY YOU HAVE A COUPLE OF MINUTES FOR QUESTIONS. [APPLAUSE] >> WE HAVE TIME FOR A COUPLE OF QUESTIONS. >> I THINK THE OBVIOUS ONE WOULD BE WHERE YOU SEE THE MAJOR INTERSECTIONS WHERE THE LIBRARY COULD BE CATALYTIC IN ACCELERATING PROGRESS IN YOUR GROUPS MISSION. I KNOW EXACTLY WHAT NLM DOES. I THINK THE DATA SCIENCE WORK FORCE ISSUE IS A BIG ONE THERE IS LITTLE DIVERSITY IN THAT WORK FORCE BOTH FROM THE INDUSTRY SIDE AND ACADEMIC SIDE AND WE NEED TO BE AT THAT TABLE. AND IN FACT IN BD 2K, I DON'T KNOW WHERE THE STATUS OF THAT IS NOW BUT MAIN ROLE IS IT'S OVER. OUR MAIN ROLE WAS PROMOTE THE WHOLE TRAINING AND DIVERSITY OF THE WORK FORCE. >> I'LL ASK ABOUT PROPOSED INVESTMENT THIS YEAR. >> SO (OFF MIC) TO MAKE CONNECTIONS, THIS IS ALL ABOUT DATA SCIENCE. WITH HPU HPCU AND DIVERSITY SERVING INSTITUTIONS. FACULTY WORK TOGETHER WITH TRAINING FACULTY TO START TO BUILD COLLABORATION AND CURRICULUM SHARING. WE'RE ALSO LOOKING FOR -- LOOKING TO SET UP SOME SUMMER PROGRAMS FOR HIGH SCHOOL AND -- I GUESS I WOULD SAY WITH AN EMPHASIS ON THIS COMMUNITY. BECAUSE WE KNOW IT'S -- WE TRY AND WE KNOW OUR PROGRAMS TRY TO RECRUIT A MORE DIVERSE POPULATION TO TRAINING IN THAT FIELD. NOTHING THE PERFECT. THESE ARE TWO INITIATIVES. BY THE WAY, WE ARE -- WE'RE WITH YOU ON YOUR SYSTEM SCIENCE, >> I KNOW. BUT EXTEND THAT, THE RESOURCE CENTERS FOR MINORITY INSTITUTIONS, THE RCMI PROGRAM IS A GOOD TEMPLATE TO APPLY THIS TO, NOT JUST HBCCUs, PROCESS OF TRANSITIONING RENEWING THOSE GRANTS BUT CURRENT INSTITUTION ONE TERRIFIC FOR RECEPTOR SITES FOR PARTNERSHIP. THE OTHER DATA SCIENCE TRAINING PART THAT I DON'T SEE AS MUCH OF IS WHEN I LISTEN TO PATTY PRESENT A DIRECTOR'S MEETING IS A LOOT OF DATA SCIENCE IS ABOUT GENOMICS AND PHENOTYPES AND BIOLOGICAL DATA AND LESS SKILL DEVELOPMENT HOW TO MINE PUBLIC HEALTH SCIENCE DATA HOW TO MINE ELECTRONIC HEALTH RECORDS, HOW DO WE GET AT THIS LARGE SET OF DATA. I'M NOT -- I DON'T THINK THAT WE -- AS A CLINICIAN SCIENTIST THINK BENEED TO DO CLINICAL TRIALS FOR MANY OR IF NOT MOST QUESTIONS NOW IF WE LEVERAGE EXISTING DATA AND HAVE SYSTEMATIC GOOD COLLECTION OF PREDICTORS OF DEMOGRAPHICS AND OTHER CLINICAL PHENOTYPE PREDICTORS THAT LEVERAGING BIG DATA WITH OBSERVATIONAL, WITH THE CURRENT STATISTICAL ANALYTICAL TOOLS ONE CAN ANSWER MOST OF THE CLINICAL QUESTIONS. NOT WHETHER DRUG IS EFFICACIOUS OR NOT BUT WHAT'S ALREADY OUT THERE IN TERMS OF APPROACHES. AND I THINK WE ARE AT THE POINT TO SEE THAT ACTUALLY HAPPENING. BUT WHICH NEED PEOPLE TO BE ABLE TO HAVE THE SKILL SET TO DO IT. I THINK THOSE ARE COUPLE OF GOOD THINGS TO WORK ON. IN THE BACK. YES. >> SOUTHERN DETERMINANTS, I UNDERSTOOD THAT IN THE LAST ROUND OF PROPOSAL JUST LIKE 28 NEW VARIABLES FOR SOCIAL DETERMINANTS, ARE THEY OUT YET OR JUST NOT WORKING OR WHAT'S HAPPENED? >> WE HAVE A SLIDE WITH LIST OF SOCIAL DETERMINANTS. IF YOU LOOK AT THE NATIONAL ACADEMY OF MEDICINE REPORT, THEY ASK -- IT WAS HEAVILY INFLUENCED BY PSYCHOLOGISTS. THERE'S MORE QUESTIONS ON DEPRESSION AND OTHER ANXIETY, OTHER THINGS ABOUT THAN PERHAPS EVERYONE WOULD AGREE ON BUT IT'S A GOOD DOCUMENT TO START WITH. BUT I'M REFERRING TO THINGS LIKE NOT JUST THE DEMOGRAPHIC SOCIAL DETERMINANTS OF AGE, GENDER, RACE ETHNICITY, SOCIOECONOMIC STATUS IS EXTREMELY POWERFUL. ONE LOOKS AT ONE THING I WOULD DO THAT BECAUSE IT PREDICTS MORTALITY IN A ROBUST WAY THAT WE AS CLINICIANS DON'T TAKE INTO ACCOUNT MOST OF THE TIME. IF YOU'RE POOR IN THE U.S. YOU'RE THREE TIMES MORE LIKELY TO DIE FROM ANYTHING THAN IF YOU MAKE -- IF YOUR HOUSE MAKES $115,000 A YEAR, WHICH IS NOT WEALTHY AS WE KNOW. AND WE IGNORE THAT AS -- WE THINK OF BLOOD PRESSURE, CHOLESTEROL, HEMOGLOBIN A 1C BUT THIS IS MORE POWERFUL THAN OF THOSE PACK FORS. FOOD INSECURITY IS IMPORTANT, HOUSING SECURITY IS IMPORTANT. I MENTION SEXUAL GENDER MINORITY, SO SEXUAL -- GENDER IDENTITY AND SEXUAL ORIENTATION IS IMPORTANT. CULTURE IS IMPORTANT. NATIONAL ORIGIN. WE HAVE MINIMIZED THE DIFFERENCES THAT EXIST GEOGRAPHICALLY IN THE UNITED STATES, WE'RE MORE AWARE OF THOSE NOW, ESPECIALLY RURAL URBAN DICHOTOMY BUT -- AND MAYBE THE COASTS DICHOTOMY. BUT IF YOU'RE AFRICAN AMERICAN FROM LOUISIANA OR MISSISSIPPI IS NOT THE SAME AS BEING FROM OAKLAND OR NEW YORK. I THINK THERE'S A GEOGRAPHIC -- WE PUT PEOPLE ALL TOGETHER. SO I THINK THERE IS AN IMPORTANT VARIETY OF FACTORS THAT CAN BE CONSIDERED IN THINKING ABOUT THE PATHWAYS TO OUTCOMES THAT WE CARE ABOUT. YES. >> NLM IS PLEASED TO BE PART OF ADVISORY COMMITTEE RECENTLY PUT TOGETHER TO SUPPORT THE WORK YOU'RE GOING TO BE DOING WITH NHGRI TO AUGMENT WHAT THEY HAVE ALREADY GOT IN THAT DOMAIN FOR SOCIAL DETERMINANTS TO MAKE SURE THESE IMPORTANT VARIABLES ARE AVAILABLE TO THE COMMUNITY OF RESEARCHERS THAT YOU FUND AND ALSO GENERAL RESEARCH COMMUNITY AT LARGE. >> I COME HERE AND LEARN STUFF. NO, OUR GOAL IS NOT TO REINVENT THE WHEEL, PHOENIX HAS THIS PROCESS THAT YOU GO THROUGH GETTING EXPERTS INTO PANELS SO WE WANT TO GO THROUGH THAT, I THINK A LOT OF THE ELEMENTS MAY BE SCATTERED IN THERE SOMEWHERE. BUT WE WANT THE GROUP THEM TOGETHER, COME UP, SAY WE DID THIS PROCESSING WE'RE ENDORSING THESE AND REFER OUR INVESTIGATOR S TO THAT WEBSITE TO USE. I HAVE SEEP THAT WORK IN OTHER INSTITUTES. N IA HAS BEEN EFFECTIVE AT GETTING TOOL KIT FOR COGNITIVE IMPAIRMENT, ENDORSED AND USED WE FUNDED NOW YOU USE THIS. WE CAN'T FORCE PEOPLE TO BUT YOU KNOW. PERSUASIVE POWER WITH FUNDING. >> THANK YOU VERY MUCH. >> THANK YOU FOR YOUR QUESTIONS. [APPLAUSE] >> BEFORE WE MOVE TO THE NEXT SEGMENT WHICH IS CONTINUE OUR CONVERSATION FROM THIS MORNING, ON RESTRUCTURING THE BOARD, I SHOULD MENTION THAT DR. CAR LOWS HIEM IS OUR NEW BOARD MEMBER, I SHOULD HAVE MENTIONED THAT AT THE BEGINNING. HE WAS HERE LAST TIME AS CONSULTANT NOW PROMOTED TO OFFICIAL MEMBER OF THE BOARD. [APPLAUSE] >> I HOPE I PRONOUNCED YOUR NAME RIGHT. >> >> PERFECT. >> JOSEPH FRANCIS REPRESENTING -- WAS NOT HERE TODAY SO HE WILL BE BRIEFED ON EVERYTHING WE ARE DOING. I HAVE HAD A SUGGESTION FROM OUR TWO MAIN DISCUSSANTS FOR THIS SEGMENT, JANE BLUMENTHAL AND ERIC HORVITZ, THAT WE BREAK INTO SUBGROUPS NOW ACCORDING TO OUR CHOICE. IN ONE OF THESE FIVE CATEGORIES OR MAYBE WE SHOULDN'T CHOOSE THE EP BECAUSE THAT'S ALREADY SET, WHAT DO YOU THINK, VALERIE? (OFF MIC) >> WORK ON THE OTHER FOUR. (OFF MIC) >> OKAY. LET'S PICK THE FOUR AND PICK CORNERS OF THE ROOM SO STRATEGIC PLAN IMPLEMENTATION OVER THERE. RESEARCH FRONTIERS HERE, PUBLIC SERVICES DOWN THERE AND COLLECTION MANAGEMENT AT THAT END. AND THE THOUGHT, I'M GOING TO BLAME ERIC AND JANE FOR THIS. THE THOUGHT IS YOU CAN VOTE WITH YOUR FEET WHICH CATEGORIES YOU FEEL YOU WOULD LIKE TO BE IN. IN EARLIER CONVERSATION WITH JANE WE TALKED ABOUT SO IF THERE IS THREE PEOPLE IN EACH OF THESE SUBGROUPS, DO WE WANT THEM ALL TO BE DOMAIN EXPERTS? NO, WE PROBABLY DON'T. WE WANT ONE OR TWO DOMAIN EXPERTS AND SOMEBODY WHO IS NOT AN EXPERT WHO GIVE FEEDBACK AND DIFFERENT POINT OF VIEW. THIS IS ACTUALLY A GOOD EXERCISE HERE. LITERALLY WE'LL GET MOVING AFTER LUNCH AND WE MAY FIND EVERYBODY IS STANDING THERE IN THE STRATEGIC PLANNING GROUP WHICH CASE WE'LL HAVE REORGANIZE EVERYTHING. YES ERIC. (OFF MIC) WE WERE TALKING MOSTLY THEORETICALLY, WHY NOT GET A SENSE FOR THE TOP LEVEL ISSUED THAT COME UP INTERESTS POTENTIAL GUIDANCE AND DIRECTIONS AND HOW MUCH TIME DO WE HAVE TO DO THIS? >> WE HAVE UNTIL 2:15. WE HAVE ABOUT 40 MINUTES AT THIS POINT. >> I THINK WE CAN STAY 10, 15 MINUTES DISCUSSION ABOUT WHAT WE FOUND. >> I THINK WE SHOULD DO THIS ONLY FOR TEN MINUTES. IT WILL TAKE -- DON'T YOU THINK? >> 10 OR 15. >> YOU'LL GIVE YOU 15 AND THEN WE RECONVENE AT THE TABLE AND HAVE A DISCUSSION AND WHAT WE WOULD LIKE TO DO TODAY AND WE STILL HAVE TO DO THIS AT THE END OF THIS MEETING. IS GET A GENERAL SENSE WHETHER THESE ARE CATEGORIES. WE DON'T HAVE TO BE FIXED TO WHO IS IN WHICH CATEGORY. THAT YOU CAN GO HOME AND THINK ABOUT. WHETHER THEY SHOULD BE WORKING GROUPS, I HAVE THE SENSE THAT WE AGREED EVERYTHING WE ARE DOING WITH EP FOR THE MOMENT SHOULD BE A WORKING GROUP. AND THEN WE DO WANT TO TALK ABOUT THE NEXT AT THE VERY END, WHOOPS. WE WANT TO DECIDE WHETHER THE NEXT MEETING FITS INTO THESE THREE OPTIONS. THAT'S FAIRLY EASY. YES. THESE ARE NOT PHYSICAL COLLECTIONS, THIS IS CONSIDERED CONSIDERED ANYTHING, WHETHER GEN BANK HEALTH SERVICES RESEARCH, CLINICAL TRIALS RECORDS, THOSE CONSIDERING COLLECTIONS AND I AM NOT TALKING PUBLIC SERVICES BUT PUBLIC FACING SERVICES. SERVICES FOR PEOPLE WHO DEFINE THEMSELVES IN GENERAL PUBLIC SO I WAS MAKING A CLARIFICATION, NOT PHYSICAL LIBRARY MATERIALS, EVERYTHING THAT IT TAKES. THOUGHT ABOUT THIS BEFORE WE WOULD HAVE HAVED EACH POINT OF CONTACT TO BE HERE TO BE AVAILABLE FOR THESE LITTLE SUBDISCUSSION GROUPS BECAUSE WE WANT YOUR SENSE OF WHAT ARE THE ISSUES YOU'RE GRAPPLING WITH NOW -- IS NOT HERE. MILT IS THERE. GOOD. MIKE, GOOD. SO EACH OF THE POINT OF CONTACTS WILL BE HELPFUL TO HAVE YOU IN THESE LITTLE GROUPS AND THEN SEE WHERE WE GO FROM THERE. >> CAN YOU RELAY CAN CORRIDORS? >> STRATEGIC PLAN IMPLEMENTATION OVER THERE. RESEARCH FRONTIERS HERE, PUBLIC SERVICES DOWN THERE AND COLLECTIONS MANAGEMENT OVER IN THE CORNER IN THAT CORNER. FIVE -- FIVE TO TWO -- NO. FIVE TO TWO AT THE VERY LATEST. WE'LL STOP OUR CONVERSATIONS. THANK YOU. PUBLIC SERVICES DOWN THERE. LITERATURE COLLECTIONS OVER THERE. >> I WOULD LIKE EVEN TO SIT DOWN. WELL I WOULD LIKE TO MAKE AN OBSERVATION. WE'RE ON TIME. THAT'S AN OBSERVATION. NO, THE INTERESTING OBSERVATION TO ME WAS WHEN WE HAD OUR FIRST WORKING GROUP OF THE BOARD ON THIS ISSUE THE VAST MAJORITY OF PEOPLE FELT THEY NEEDED TO DO THIS TO TRACK IMPLEMENTATION OF THE STRATEGIC PLAN. THERE WAS HARDLY ANYBODY OVER THE STRATEGIC PLAN AREA. SO IT'S -- THIS WAS A VERY GOOD IDEA. THANK YOU, ERIC AND JANE FOR SUGGESTING. CAN WE HAVE THAT SLIDE UP OF THE BOARD OF REGENTS -- YEAH. >> IT'S COMING. >> >> WE NEED YOU TO SWITCH BACK TO MY COMPUTER. >> WE WANTED TO SEE THE MANDATE OF BOARD OF REGENTS. ANDREW, CAN YOU SWITCH THE DISPLAY? WHILE DOING THAT, I THOUGHT THERE WAS THE PEACE SIGN. >> WE HAVE A REQUEST THAT WE HAVE -- TO SEE THE REQUIREMENTS OR THE MANDATE FOR THE BOARD OF REGENTS SO WE ARE SURE WE'RE OPERATING WITHIN OUR MANDATE, THAT IS THE MANDATE OF THE BOARD OF REGENTS AND WHAT WE CAN AND CANNOT DO. WHEN WE SET UP THIS -- THESE DIFFERENT SUBGROUPS WE DID BEAR THIS IN MIND SO THAT'S WHY WE LISTED SOME OF THESE WORKS GROUPS AND SOME OF SUBCOMMITTEES. RATHER THAN TAKING TIME TO DISCUSS THAT, LET'S HEAR FROM EACH OF THE SUBGROUPS. SO STARTING WITH -- DAN MASYS VOLUNTEERED TO TALK STRATEGIC PLAN SUBGROUP. >> TURNS OUT TRANSLATION STRATEGIC PLAN INTO IMPLEMENTATION PLAN IS WELL UNDERWAY UNDER AUSPICES OF MIKE'S OFFICE. WITH I THINK A GRATIFYINGLY STRUCTURED APPROACH. HISTORICALLY THESE LONG RANGE PLANS HAVE ALWAYS BEEN A TEN POUNDS OF FLOWER AND FIVE POUND SACK, DOZENS UPON DOZENS OF THINGS THAT WOULD BE GOOD FOR THE LIBRARY TO DO. BUT IF YOU CHECKED A YEAR LATER YOU WOULD FIND THERE ARE FIVE OR EIGHT OR THINGS THAT NLM DIRECTOR HAD CHOSEN TO PLUCK OUT FROM THE TEXT AND MOVE AHEAD WITH. I THINK WE'RE HEARING THAT -- MIKE'S APPROACH HAS BEEN TO CATALOG ALL OF THEM. SO IT WILL BE APPARENT THOSE WHICH THERE ARE ACTIVITIES UNDERWAY AND STATUS OF EACH OF THOSE ACTIVITIES AND ALSO SEE THOSE LEFT FALLOW, NOT YET ACTED UPON FOR ONE REASON OR ANOTHER. IN OUR DISCUSSIONS, ONE OF THE DIFFERENCES FROM PREVIOUS PLANNING TRANSLATING TO IMPLEMENTATION, ONCE INLAR NATURE IF YOU WILL OF THE NLM PLANNING PROCESS, IT CONVENED ITS OWN COMMUNITY OF EXPERTS IN RELEVANT DISCIPLINE, PRETTY MUCH INWARD AND FOCUSED IN OPPORTUNITIES FOR THE LIBRARY, NEW STUFF COULD DO, THINGS THAT NEEDED TO BE REPAIRED. NONE HAVE THIS LINEAGE OF WORKING GROUPS TO THE NIH DIRECTOR. SO THE ACD WORKING GROUP ON DATA INFORMATICS IN 2012 FOLLOWED BY THE NIH STRATEGIC PLAN, FOLLOWED BY NLM REVIEW, THAT HAVE CREATED EXTERNAL SETS OF REQUIREMENTS FOR THE INSTITUTION AND THE IMPLEMENTATION IS SERVING BOTH ITS SHOWING RESPONSIVENESS TO THOSE EXTERNALLY ARRIVING REQUIREMENTS IF YOU WILL ADS WELL AS -- AS WELL AS OPPORTUNITIES TO DO NEW THINGS, ONLY THE LIBRARY CAN DO OR EVEN THINK OF DOING. SO I THINK THAT'S A LONG WINDED WAY OF SAYING IT WILL BE FUN IN THIS WORKING GROUP BECAUSE THERE'S JUST A LOT OF STUFF UNDERWAY. HOPEFULLY WE CAN HELP. >> IF I CAN ASK JANE, YOU MADE A COMMENT THAT'S IMPORTANT. >> YES, ONE OF THE THINGS I FEEL STRONGLY IS THAT THERE DOES NEED TO BE SOMEBODY FROM THE LIBRARY COMMUNITY ON THIS GROUP BOTH TO BE AWARE OF AND MAKE THE SUBCOMMITTEE OR WORKING GROUP AWARE OF, WHAT THE ISSUES ARE. AND ALSO TO REPRESENT THE STRATEGIC PLAN AND ITS IMPLEMENTATION BACK TO THE LIBRARY COMMUNITY. >> LAST POINT MIKE MADE IS THAT WE WOULD BE ABLE TO TRACK THE PROGRESS OF THE STRATEGIC PLAN ON THE SOFTWARE THAT YOU HAVE IMPLEMENTED. AND THAT YOU CAN REACH OUT TO US AT ANY POINT EVEN WEEKLY, ABOUT UPCOMING ISSUES. SO I THINK THAT IS A GOOD SUBCOMMITTEE TO HAVE AND WE'RE NOT SET IN STONE AS TO WHO IS ON IT. >> WORKING GROUP. >> SORRY. WORKING GROUP. >> THAT'S WHAT I WAS -- YOU MADE ME THINK THIS IS -- A WORKING GROUP. WORKING GROUP. >> IS THIS FOCUSED ON THE STRATEGIC PLAN OR TACTICS IMPLEMENTATION OF STRATEGIC PLAN, NOT CHANGING IT >> SO IT'S TACTICS YOU'RE USING IN THE CURRENT YEAR. >> TRACKING THE IMPLEMENTATION OF IT. >> I WOULD SAY NECESSARILY BY CONSTRAINTS OF AVAILABLE RESOURCES, IMPLEMENTATION OF SUBSET OF THE IDEAS IN THAT DOCUMENT. IT WILL ALWAYS HAVE MORE CAN BE DONE THAT CAN ACTUALLY BE DONE AT ANY GIVEN TIME. >> I DON'T WANT TO SPEND TOO MUCH TIME ON EACH ONE OF THESE SO I'M GOING TO ASK PEOPLE TO BE SUCCINCT BECAUSE WE HAVE TO HAVE A CONVERSATION AS A WHOLE. RESEARCH FRONTIERS, WHO IS THE POINT OF CONTACT -- WHO IS THE -- RESEARCH FRONTIERS? >> MYSELF. I THINK WE TALKED ABOUT THE FIST WE'RE INTERESTED IN -- FIRST WE'RE INTERESTED IN STATUS QUO FOR HOW CALLS GET WRITTEN FOR EXAMPLE, FOR RESEARCH AND WE LEARNED FROM SMALL GROUP GET TOGETHER AND THINGS TO TRENDS IN INTERESTINGSING DIRECTIONS AND THERE DEFINITELY WILL BE OPEN INTEREST TO HAVING LARGER INPUTS FROM WORKING GROUP LIKE THIS INTO THAT PROCESS. TURNS OUT INTERNAL FLOW OF IDEAS ACROSS NIH INTO NLM AND OUT AGAIN FOR HOW -- WHO GETS WHO FUNDS WHAT. PATTY WAS EXPERT IN TALKING TO AND THE IDEA BASICALLY IS -- AND THIS IDEA OF US HELPING TO THIS COMMITTEE, HELPING FINDING THE LANGUAGE USED TO REFER TO CONCEPTS BEING STUDIED IN RESEARCH SETTING TO HELP INTERNAL COMMUNICATIONS, EVEN FOR THE -- TO BE VEHICLE TO WHICH THE BOARD MAKE REQUESTS OF OTHER INSTITUTES IN TERMS OF HOW RESEARCH IS FUNDED AND HOW WE COLLABORATE ON PROJECTS WILL BE VALUABLE. THE GROUP COULD LOOK THROUGH PORTFOLIO CONCEPTS, THIS MORNING, WE MENTIONED WE HAD A TALK FROM SOMEONE FROM THE NIH OFFICE OF PORTFOLIO MANAGEMENT, WHAT IS THE FORMAL TITLE OF THAT GROUP? MCMIC -- (OFF MIC) IT WAS A GROUP -- VISUALIZATIONS, EVEN IF NLM PREVIOUS YEAR EXTRAMURAL FUNDING COMES A COLORFUL CHART IN TERMS OF AREAS REPRESENTING HOW MUCH -- >> FISH SCALES. >> FISH SCALES WITH ABSTRACTION. THIS COULD BE A POINT OF CONTACT HOW TO USE THEM, TO UNDERSTAND WHAT VIEWS MIGHT BE STANDING VIEWS WE APPRECIATE OVER TIME. TO HELP US GUIDE CALLS, SO ON. WHAT ELSE DID I LEAVE OUT MILITARY? >> THAT WAS FINE, I THINK IT DID HIGHLIGHT THE FACT THAT OUR PROCESS HAS TO LARGE EXTENT BEEN VERY USEFUL, WE HAVE DONE SO MANY GOOD THINGS BUT IT'S BEEN AD HOC. AND I THINK THAT A COMMITTEE THAT ACTUALLY WAS CHARGED WITH LOOKING TO SEE ALL OVER SCIENCE AS ADVICE TO NLM, WHERE SHOULD WE BE GOING. COULD REALLY ENLARGE OUR HORIZONS BEAUTIFULLY. I THINK THAT'S WHAT -- >> THAT'S GREAT. THANK YOU. PUBLIC SERVICES. >> WE SHOULD HAVE A POINTER TO TALK. >> RECOMMENDATION ABOUT SUBCOMMITTEE OR WORK GROUP FOR RESEARCH FRONTIERS. SUBCOMMITTEE WORK GROUP. SUBCOMMITTEES ONLY BOARD MEMBERS WORKING GROUP CAN HAVE NOR THAN THAT. (OFF MIC) >> SO MUCH EASIER TO MANAGE THE PROCESS. >> EXTERNAL -- THE ONLY LIMITATION WITH THE WORKING GROUP IS THE WORKING GROUP MUST ALWAYS REPORT DIRECTLY TO THE BOARD OF REGENTS AND ONLY ACT THROUGH THEM AND THE SECOND PART IS THAT WE DO HAVE TO MONITOR SO WE CAN'T SET UP A WORKING GROUP THAT LASTS FIVE YEARS, WE HAVE TO MONITOR AND MAKE SURE THEY'RE CONSTANTLY FOCUSED ON WORK AS OPPOSED TO MAINTENANCE OF THE (OVERLAPPING SPEAKERS) >> BETTER UNDERSTAND THE FIRST YOU MENTIONED, PRACTICALLY -- SAY WE HAVE RESEARCH FRONTIERS GROUP, WHAT DOES IT MANE HAVE TO GO THROUGH THE BOARD? >> IT'S THE OTHER ONE. SUBCOMMITTEES HAVE STATUS -- >> REPORT OUT TO THE BOARD. WHY WOULDN'T THAT BE -- I THINK IT WOULD BE, JUST WILL TAKE TIME ON THE AGENDA AND -- (OVERLAPPING SPEAKERS) >> OF THE BOARD CORRECT. >> AT THE BEGINNING, I THOUGHT FROM EARLIER DISCUSSION WE THOUGHT LET'S MAKE WORKING GROUPS AT THE BEGINNING BECAUSE WE WANT TO SEE EXMORETORY, IT'S A PILOT STUDY -- EXPLORATORY. >> >> YOU CAN GIVE ADVICE OR RECOMMENDATIONS AS A SUBCOMMITTEE BUT AS WORKING GROUP WE ONLY GET FINDINGS AND ADVICE OF ATTENDEES SO YOU LOSE THE POWER OF A GROUP ADVICE, IT'S A NUANCE, IT'S A FEDERAL NUANCE, WE CAN IGNORE WORKING GROUP (OVERLAPPING SPEAKERS) SAY THIS SLOWLY. >> IF WORKING GROUPS GET AD VICE OF ATTENDEES, -- ADVICE OF THE ATTENDEES SUBCOMMITTEES -- >> BY NAME >> INDIVIDUALS COMING TOGETHER, SUBCOMMITTEES ARE FORMAL BODIES THAT ARE SAYING -- FORMAL BODIES. THE BODY SPEAKS. >> AGAIN, FOR A START COMING FROM RESEARCH BACKGROUND, AS A PILOT STUDY WE'RE BETTER OFF DOING THIS AS WORKING GROUPS. LET'S REASSESS NEXT MEETING AFTER WE HAVE DONE THIS AS TO WHETHER THESE ARE USEFUL OR NOT. AND THEN -- >> GIVE IT A YEAR. (OVERLAPPING SPEAKERS) >> FINDINGS TO THE BOARD, THE BOARD CAN THEN MAKE A RECOMMENDATION. >> MINUTES WHEN WORKING GROUP SPEAKS IN THE MINUTES AS RECORDED, YOU HAVE TAKE EACH SENTENCE IN FACT AND -- (OVERLAPPING SPEAKERS) >> THEY DON'T HAVE TO HAVE -- >> YOU DON'T HAVE TO HAVE MINUTE? >> YOU DOPE HAVE TO HAVE MINUTES. IN OUR PHONE CALLS, I HAD THE EXPERIENCE OVER FIVE YEARS CHAIRING THE WORKING GROUP, THE CA BIG OVERSIGHT. NCI BUT TURNS OUT WE WERE WORKING GROUP OF NATIONAL CANCER ADVISORY BOARD, THEIR HIGHEST COUNCIL. IT MEANS WORKING GROUP HAVE THE BEST OF BOTH WORLDS BECAUSE IT NEEDED SOMETHING THAT NEEDED A MANDATE VOTED DECISION. THEY JUST LET THE BOARD DO IT. BUT THE SAME THING DEFINING WORKING GROUP ARE ACTUALLY IMMEDIATELY IMPACTED NCI BUDGETS AND PROGRAM MANAGEMENT OFFICE. SO I THINK IT'S THE SWEET SPOT HERE IN TERMS OF NOT HAVING LOTS OF ADMINISTRATIVE OVER HEAD THAT FACA COMMITTEES DO. SEEMS THAT LONGEVITY PROVISION IS NOT STRUCTURALLY PUT IN TO KIND OF TIME LIMIT. THEY CAN PERSIST AND RENEW. >> SOMEONE SAYS OH YOU HAVE A SUBCOMMITTEE FOR THAT. TWO OF THOSE WILL SAY OKAY WE'RE A SUBCOMMITTEE. TWO OF THOSE LIKE -- OKAY -- >> OTHER REASON IS IT'S EASY WORKING GROUP TO SUBCOMMITTEE THAN SUBCOMMITTEE TO WORKING GROUP. SO WE HAVE SIX MINUTES TO GO. SO LET'S HEAR, YOU HAVE HAD TIME TO THINK NOW. >> PUBLIC SERVICE. >> CERTAINLY. IT WAS VERY INTERESTING, GARY AND MYSELF WERE ANCHORING ON WHAT SURGEON GENERAL HAVE THIS MORNING, SPECIFICALLY THE # 0% OF -- 70% POPULATION ELIGIBLE FOR SERVICES, IN UNIFORM ARE NOT QUALIFIED. ALL THREE OF US TOOK DIFFERENT SPIN ON IT BUT ESSENCE IS THERE'S DEFINITELY THIS SPACE FOR US TO IMPROVE WHAT NLM DOES AND PROVIDE SOME MEANINGFUL IMPACTS AND OUTCOMES AS THE RESULT OF OUR ACTIVITIES. ACTIVITIES OF NATIONAL LIBRARY OF MEDICINE SO THE QUESTION THAT REMAIN IS HOW DO WE STRIKE THE BALANCE BETWEEN OUTCOMES ECONOMICS AND SOCIETAL FORCES THAT WILL HAVE TO DEAL WITH. >> ALSO WHAT I'M HEARING IS HOW DO YOU STRENGTHEN BONDS BETWEEN GOALS OF THE SURGEON GENERAL'S OFFICE AND NLM, IN ADDITION TO HEARING REPORTS EVERY MEETING. SO MAYBE THAT COULD BE PART OF THAT SUBWORKING GROUP MANDATE. >> CERTAINLY. >> OKAY. I DO THINK SHOULD BE A WORKING GROUP OR SUBCOMMITTEE. >> BY ALL MEANS WORKING GROUP. >> COLLECTIONS MANAGEMENT WITH THE CAVEAT THAT COLLECTIONS IS MORE THAN HARD COPY BOOKS. >> ACTUALLY, JOYCE'S GROUP RECOMMENDED WE TOTALLY CHANGE THE NAME TO BE LITERATURE AND COLLECTIONS SO IT MOVES FROM -- IT'S NOT THESE COMMITTEES RESPONSE NOT JUST MANAGE CONNECTION BUT ESTABLISH POLICY AROUND IT. >> OKAY. WHO DO WE HAVE FROM THAT GROUP? >> JOYCE TOLD US WITH BUDGET INCREASE OF ONLY 10 TO THE 2ND POWER WE WOULD SOLVE ALL THE PROBLEMS. BARRING THAT, THE BOARD WILL OVER TIME NEED TO MODIFY ITS COLLECTION POLICY TO REFLECT THE HUGE DIVERSITY OF HEALTH INFORMATION THAT IS NOW BEING CREATED. AND WE CAN COLLECT SOME, WE CAN CONSERVE SOME BUT PROBABLY CAN'T AFFORD TO KEEP EVERYTHING. IT'S NO LONGER THE AGE BEFORE PENNY PRESS WHEN PUBLISHING WAS EXPENSIVE. THIS HAS TO BE A WORKING GROUP BECAUSE THE BOARD'S CHARGE IS TO RECOMMEND POLICY, COLLECTION POLICY DRIVE AS LIBRARY. SO WE HAVE TO COME BACK TO THE BOARD PERMANENTLY BUT SHE ALSO SAID THAT COLLECTION POLICY RIGHT NOW IS WORKING. IT'S THE IMPLEMENTING OF IT AND DETAILED SECOND TIER LEVEL WHERE POLICY AND SUGGESTION ARE HELPFUL FROM DIVERSE COMMUNITY. SO I THINK WE HAVE GOT A CLEAR MANDATE UNLESS THE DIRECTOR BELIEVES WE CAN INCREASE THE BUDGET FOR OPERATONS BY 10 TO THE 2ND POWER. >> I'M QUITE OPTIMISTIC THAT SOMEONE -- ELISEO WAS ASKING ABOUT BD 2K AND WHAT'S HAPPENED WITH THAT, BD 2K IS AN EIGHT YEAR MANDATE TO INVEST IN DATA SCIENCE, IT ORIGINATEED FROM THIS COMMITMENT, THERE ARE OTHER DAA SCIENCE COMMITMENTS AND IT IS MY HOPE THAT A BIG CHUNK OF THE CONTINUED COMMITMENT FOR DATA SCIENCE WILL GO TO OUR COLLECTIONS AND THE MANAGEMENT OUR COLLECTIONS INCLUDING ACQUIRING AND PRESERVING BOTH DATA SETS IN THE LITERATURE DRAWN FROM THOSE DATA SETS, TOOLS USED TO CAPTURE THEM SO WE ENVISION ACCELERATING DEVELOPMENT OF A PHRASE MIKE HAS BEEN USING. OBJECTS RESEARCH DIGITAL RESEARCH OBJECTS ECOSYSTEM. I'M HOPEFU WE WILL GET CLOSE TO THAT TEN TO THE TWO. >> BOB THEN DAN. >> I HAD A QUESTION ABOUT WHAT'S INCLUDED IN COLLECTIONS BECAUSE I'M -- AS YOU MENTION DATA AND OTHER RESOURCES THAT MIGHT NOT BE ACTUALLY MANAGED BY NLM IS A LOCATING SERVICE OR DIRECTORIES. >> ABSOLUTELY. >> THIS MIGHT BE A CANDIDATE IF THERE WERE ANY AS NEW ENTITIES TO BE A SUBCOMMITTEE. THE REASON I SAY THAT, THIS IS THE ONE MOST LIKELY TO CREATE SOMETHING THAT IS CHALLENGED BY SOME UNHAPPY PUBLISHER OR -- WHO SAYS YOU -- YOUR PEOPLE MADE A DECISION THAT EXCLUDES DISADVANTAGE IN THE MARKETPLACE. THIS IS ONE BECAUSE IT HAS EXTERNAL FACING WRITTEN DOWN POLICY THAT HAS TO BE ENFORCED, MIGHT WANT TO BE A SUBCOMMITTEE OF THE BOARD AS A WHOLE. BUT SINCE WORKING GROUPS CAN ALSO BRING THE MOTION TO THE BOARD AS A WHOLE, MAY NOT BE THAT BIG A DEAL. BUT IT ALSO HAS THE CHARACTER LIKE EP OF SOMETHING THAT NEVER, EVER GOES AWAY, BECAUSE AS LONG AS YOU'RE A LIBRARY YOU HAVE A COLLECTIONS BOX. >> GREAT. WE HAVE 30 SECONDS MORE. BEFORE OUR INVITED GUEST SPEAKER. SO I THINK WEAPON COME TO CONCLUSION AT LEAST THAT -- WE AGREE AS A STARTING POINT TO START WITH THESE SUBGROUPS. >> BUT NOT -- DAN'S RECOMMENDATIONS (OVERLAPPING SPEAKERS) >> >> EVERYTHING SHOULD BE A WORKING GROUP EXCEPT FOR EP AND WE HAVE SORTED OURSELVES OUT INTO MEMBERS OF THESE WORKING GROUPS AND THAT CAN ALWAYS CHANGE IF YOU GO HOME AND THINK OH DEAR WRONG ONE. BUT WE'LL TRY THIS AS A PILOT. WE SHOULD GO TO THE NEXT SLIDE BECAUSE WE NEED TO VOTE QUICKLY ON THE LAST SLIDE. THE THREE OPTIONS. SO THERE'S THE ONE DAY MEETING, TWO DAY MEETING WITH AN AFTERNOON START SO THE WORKING GROUPS CAN MEET TOGETHER FIRST AND THEN HAVE THE FULL DAY, THE SECOND DAY AND THEN THE THIRD OPTION WHICH IS THE SAME AS WHAT WE HAVE NOW. FULL DAY. ON THE FIRST DAY AND HALF DAY ON THE SECOND DAY. SO WHO WOULD LIKE A ONE DAY MEETING VERY INTENSE -- OKAY. >> I WANT YOU TO NOTICE THE COMMITTEE WORK SHOWS UP AT 2 IN THE ASP, NOT 7:45. >> I WOULD SUGGEST EP -- (OFF MIC) >> WE CAN KEEP THAT 7:45 COMMITMENT. >> THANK YOU SO MUCH. >> PROBABLY NEEDS TO BE DRIVEN -- >> NOT PARALLEL I GUESS BECAUSE I THINK IT'S -- >> ONE DAY MEETING STILL HAVE EP YOU'RE GOING TO HAVE PEOPLE BEING MEMBERS OF EP GROUP, I DON'T SEE HOW ONE DAY MEETING WOULD WORK. ANYBODY FEEL PASSION ABOUT A ONE DAY MEETING? >> WE HAVE ICs THAT HAVE ONE DAY MEETINGS. BUT IT SEEMS VERY -- WE DO GET THAT 10:30 VOTE WE HAVE TO HAVE THE MEETING RIGHT BEFORE INCLUDE PEOPLE BEING MULTIPLE WORKING GROUPS OR COMMITTEES. >> THE EP. >> THAT IS 6:45 MEETING, NOT A 7:45 MEETING. >> >> THERE'S REALLY ONLY TWO OPTIONS ONE DAY OR TWO DAY. THE MIDDLE ONE IS A NON-STARTER. THERE'S NOTHING THAT GETS HERE 2:30. >> WE HAVE TWO ICs THAT SUPPORT THAT STRUCTURE. WORKING IN THE AFTERNOON AND -- >> EAST OF THE MISSISSIPPI. >> OR THEIR WEST COAST PEOPLE SACRIFICE AND SPEND A WHOLE DAY WITH THIS. >> I ACTUALLY THINK THAT IS DESIRABLE. >> WHAT IT DOES DO IS PUSH YOUR WEST COAST PEOPLE INTO A DIFFERENT MODE PARTICIPATING BY VIDEO CONFERENCE, NO OTHER WAY. >> DON'T WANT THAT. >> SHALED WE VOTE? WHO IS FOR A ONE DAY MEETING? >> TEN POUND OF FIVE POUND SACK PROBLEM PLUS ALSO SUBSTANTIAL VERY FEMORAL NOTION OF SLEEPING ON IT AND TALKING THE NEXT DAY. >> THANK YOU. OKAY. TWO DAY MEETING, ANYBODY FOR THAT? >> GOING ONCE. GOING TWICE. OKAY. NOBODY -- ANYBODY STICK WITH WHAT WE HAVE GOT? CAN I DRAW YOUR ATTENTION TO ONE ASPECT OF THE TWO DAY OPTION, WE HAVE ALSO STARTED TO REARRANGE WHAT WE DO IN THE EVENING. AND IT'S PARTICULARLY IMPORTANT THAT WE RECOGNIZE WE HAVE FRIENDS OF THE NATIONAL LIBRARY OF MEDICINE AND THEY ARE A DIFFERENT KIND OF PUBLIC GROUP FOR US TO WORK WITH. WE HAVE THEIR -- GLENN CAMPBELL IS HERE, PRESIDENT, MANY OF YOU HAVE MET HIM BEFORE. WE WANT TO BE SURE THAT WE USED OUR EVENING TIME NOT JAMMING WORK INTO PEOPLE BUT MAKING SURE WE HAD TIME FOR CONVERSATION. SO THIS -- THE WAY THIS IS SET UP IS OUR ANNUAL GALA, A FRIENDS EVENT, WE HAVE BEEN IN THE SEPTEMBER MEETING, IN THE FEBRUARY MEETING THERE WOULD BE A WARD ON SENIOR STAFF ONLY MEETING LIKE WE HAD LAST TIME, A SMALL INTIMATE DINNER, AND HAVE THIS EVENING WHICH IS OUR BOARD, OUR FRIENDS OF THE NATIONAL LIBRARY OF MEDICINE BOARD AND SENIOR STAFF, A SLIGHTLY BIGGER DINNER PLAN, PROBABLY 25 PEOPLE. DOES THAT STRUCTURE MAKE SENSE TO YOU? OR IS THERE A STRONG DESIRE TO GO BACK TO THE DINNER 85 PEOPLE AND SPEAKER IN THE EVENING. >> I LIKE THE SMALLER GROUP. >> OKAY. GOOD. >> THE MEETING WE HAD IS REALLY VERY GOOD. >> OKAY. I THINK WE HAVE A QUORUM TO STICK WITH TWO DAY STANDARD. DO I HAVE A MOTION? >> SO MOVED. >> SECOND. >> SECOND. THIRD. PASSED. >> THANK YOU, EVERYONE. IN OUR REPORT THIS YEAR THIS IS A VERY IMPORTANT ACTIVITY FOR BOARD TO GO THROUGH A SELF-ASSESSMENT PLANNING SO THIS IS I'M REALLY PLEASED, THANK YOU VERY MUCH FOR THE THOUGHT AND TIME PUT INTO THIS. SO WE CAN SWITCH NOW FOR OUR SPEAKERS. >> EXECUTIVE DIRECTOR OF SENTER FOR CARDIOVASCULAR HEALTH AT COLUMBIAN NEUROMEDICAL CENTER. DR. DAVIDSON'S PROGRAM OF RESEARCH FOCUSES ON BEHAVIORAL PSYCHOSOCIAL MECHANISMS AND INTERVENTIONS FOR PATIENTS WITH CARDIOVASCULAR DISEASE. SHE CONDUCTED RANDOMIZED CONTROL TRIALS OF ANGER MANAGEMENT AND DEPRESSION TREATMENT FOR HYPERTENSIVE AND POST MYOCARDIAL INFARCTION PATIENTS. SHE LESS ALSO TESTING A TELEPHONE BASED PROBLEM SOLVING TREATMENT TO IMPROVE COMPLIANCE WITH MEDICAL RECOMMENDATIONS IN CARDIOVASCULAR DISEASE PATIENTS. IN 2017 SHE RECEIVED A TRANSFORMATIVE RESEARCH AWARD FOR HER PROPOSED RESEARCH ENTITLED RE-ENGINEERING PRECISION THERAPEUTICS THROUGH N OF ONE TRIALS. SHE'S GOING TO TALK TO US ABOUT THIS VERY IMPORTANT AND CUTTING EDGE WORK. THANK YOU AND WELCOME, DR. DAVIDSON. [APPLAUSE] >> I'M ABSOLUTELY DELIGHTED TO BE HERE, I HAVE ENJOYED THE MORNING HEARING ALL THE IMPORTANT INTERESTING THINGS YOU'RE DOING AS WELL AS THE REORGANIZATION YOU'RE GOING THROUGH, IT'S ALWAYS EXCITING TO SEE HOW PEOPLE FIGURE OUT HOW TO HELP ORGANIZATIONS DO THE THINGS WE NEED TO DO. I'M PARTICULARLY PLEASED TO BE HERE AND PROUD AND HONORED THAT NATIONAL LIBRARY OF MEDICINE IS SUPPORTING THIS GRANT. AS I THINK IT'S DIGITAL INTERFACE AND WAY OF COLLECTING DATA SYSTEMATICALLY THAT REVOLUTIONIZES THE WAY WE PRACTICE MEDICINE. I WOULD LIKE TO ACKNOWLEDGE THE FUNDER. THIS GRANT -- THIS GRANT REALLY DID TAKE A VILLAGE. THE GROUP YOU SEE HERE ARE INTERNISTS, CRITICAL CARE PULMONOLOGISTS CARDIOLOGISTS, BIOMEDICAL INFORMATICIANS, STATISTICIANS, EXERCISE PHYSIOLOGISTS, PSYCHOLOGISTS AND WITH MBAs WHO ALL WORK ON THIS TOGETHER. IT'S EXCITING TO SEE THROUGH TO FRUITION THAT YOU WILL SEE TODAY. SO I'M GOING TO IN THIS SHORT TALK JUST WALK THROUGH BASICS OF WHAT N OF 1 TRIAL IS AND WHAT THE VISION COULD BE. FOR CONVENTIONAL CLINICAL PRACTICE, WHAT WE DO HAVE CLINICIANS READ WHAT THE SYSTEMATIC REVIEWS OR THE BEST EVIDENCE SUGGESTS TO THEM, FACE A PATIENT WITH TREATMENT WILL NOT WORK, WILL WORK PARTIALLY, BENIGN, MIGHT BE HARMFUL AND FROM THERE SCHEDULE FOLLOW-UPS WITH THAT PATIENT IN ORDER TO DETERMINE THE BEST CARE FOR THAT PATIENT. EVEN WHEN WE HAVE A POSITIVE LARGE RANDOMIZE CONTROL TRIAL WHICH I SPENT MUCH OF MY LIFE RUNNING, I'M A BELIEVER IN LARGE RANDOMIZE CONTROL TRIALS AND SIT AS MEMBER OF THE USPSTF WHERE WE REVIEW BEST EVIDENCE FOR DETERMINING PREVENTIVE AND BEHAVIORAL COUNSELING TOPIC. WE ALL KNOW CLINICALLY, THERE ARE SOME PATIENTS WHO RECEIVE A LARGE BENEFIT FROM TREATMENTS OR SERVICES, WE HAVE SOME GROUP OF PATIENTS WITH A NEUTRAL OR NON-RESPONSE AND WE STILL EVEN IN A POSITIVE TREATMENT TRIAL HAVE SOME PATIENTS WHO EVEN IN THE TRIAL WERE HARMED. OF COURSE THE MAGIC BULLET IS CAN YOU FIGURE OUT WHICH PATIENT IS WHICH. AND PARTICULARLY, CAN YOU FIGURE IT OUT FAST SO THAT YOU'RE NOT CAUSING HARM TO PATIENTS EVEN WHILE APPLYING BEST EVIDENCE CARE. TO THAT PARTICULAR PATIENT. PERSONALIZED TRIALS CUSTOMIZED MEDICAL DECISIONS AN TREATMENTS ACCORDING TO UNIQUE PROPERTIES AND RESPONSES OF THE INDIVIDUAL. ESSENTIALLY IT'S ACROSS A MULTIPLE TIME CROSS OVER TRIAL. IF THERE IS RANDOMIZATION AND PERSONALIZED TRIALS HAVE DESIGNS THAT ARE BOTH RANDOMIZED AND NON-RANDOMIZED BUT THE UNIT THAT IS EITHER RANDOMIZED OR OBSERVED AS THE DENOMINATOR WHICH YOU TRACK CHANGES IS TIME, NOT N. SO IT'S TIME UNITS, NOT N UNITS. SO FOR THOSE WHO THINK DATA ANALYTICALLY IT'S TRANSPOSITION OF THE MATRIX SO THAT YOU HAVE TIME ONE TIME TWO TIME 3 RATHER THAN SUBJECT ONE SUBJECT TWO SUBJECT THREE THEN VARIABLE ONE, VARIABLE 2, VARIABLE 3. SO THE EWE VETS YOU'RE TRYING TO GENERALIZE TO IS THAT SINGLE PERSON. IT IS RADICAL, REJECTING WE CAN GENERALIZE ACROSS PATIENTS AND SUGGESTING THAT WE ONLY NEED TO KNOW WHAT'S BEST FOR THAT PARENT -- PATIENT. THERE WAS JOHNS HOPKINS ANATOMIST IN THE 1850s, I HAVE THE QUOTE BUT NEVER FOUND THE BOOK THOUGH I HAVE BEEN TO THAT LIBRARY MULTIPLE TIMES ASKING THE LIBRARIAN TO HELP ME FIND IT. IF YOU WANT TO UNDERSTAND THE ANATOMY OF A CAT, BEST TO STUDY THE ANATOMY OF THE SPECIES OF CAT. BETTER YET, STUDY THE ANATOMY OF THAT CAT. THAT IS THE ESSENCE OF PERSONALIZED TRIALS. THE INFORMATION DATA FROM YOU BEST PREDICTOR OF YOUR RESPONSE RATHER THAN OF YOUR SUBGROUP OR OF ALL HUMANS OR OF PEOPLE WHO ARE OVER HERE IN THIS CLINICAL TRIAL WHICH WE HOPE GENERALIZES TO YOU. SO DESIGNS LOOK LIKE THIS, ESSENTIALLY YOU HAVE TRIAL PERIODS THAT ARE BALANCE OR RANDOMIZED. DEPENDING WHICH DESIGN YOU'RE FOLLOWING. YOU GET REPEATED MEASUREMENT ACROSS TIME, YOU THEN APPLY STATISTICAL ANALYSIS WHICH MEANS WE NEED ENTIRELY NEW STATISTICS FOR POWER WITHIN SUBJECT FOR CORRECTING FOR AUTO CORRELATION FOR THINKING THROUGH THE COMPLEXITIES OF SOME OF THE TIME SERIES ANALYSES THAT ARE NEEDED TO ADEQUATELY DO THIS. AS I IN ONE STATISTICIAN SAY TO EACH OTHER WHICH I HOPE SOME OF YOU READ BRITISH HUMORIST TERRY PRATCHETT, IT'S TURTLES ALL WAY DOWN. MOST ASSUMPTIONS WE MAKE IN CALCULATING POWER OR DOING ANY KIND OF ESTIMATION OF HOW MANY OBSERVATIONS WE NEED MAKE ASSUMPTIONS. THOSE ASSUMPTIONS ARE MADE ON BETWEEN SUBJECT NUMBERS. SO IF I THINK THAT I KNOW THE SHELF LIFE OF A DRUG OR THE HALF LIFE OF THE TOXICITY OR ANYTHING I KNOW IT FROM FIVE OR SIX PEOPLE IN A PHASE 1 TRIAL WHO ARE NOT THE PERSON IN FRONT OF ME. HOW FAST THEY RESPOND TO SOMETHING, HOW FAST SHED, HOW LONG THE LEG IS, ALL THOSE THINGS ACTUALLY WHEN YOU START THINKING THIS WAY ARE -- HAVE TO BE EMPIRICALLY TESTED RATHER THAN ASSUMED TO BE WHAT THE AVERAGE IS. WE CONSTANTLY MAKE THE BEST ASSUMPTION THE AVERAGE IS BEST PREDICTOR WHAT WORKS FOR THAT PERSON UNTIL WE KNOW BETTERED BUT WE HAVE TO THINK OF WAYS TO GO THROUGH POWER GOALS AS WE GO THROUGH TRIALS. DJ IS A 62-YEAR-OLD MALE WITH NEW ONSET HYPERTENSION, CONCERNED ABOUT SIDE EFFECTS ABOUT TREATMENT AND WANTS THE LEAST AMOUNT OF MEDICATION TO CONTROL HIS BLOOD PRESSURE AND HE WONDERS WHICH DRUG IS BEST FOR HIM. SO WE PUT HIM THROUGH A RANDOMIZED TRIAL, THIS HAPPEN TO BE SEQUENCE WHICH HE GOT THREE ACTIVE BP MEDS AND HERE ARE HIS PERSONAL RESULTS. YOU SEE THE HCTZ ON THE FIRST IN THE END HAD THE LOWEST LEVEL AND YOU CAN SEE THAT GRAPHICALLY HERE. THE BLUE BAR HE HAD THE BEST BLOOD PRESSURE RESPONSE AND IT JUST HAPPENED FOR HIM HE WAS REPORTING HEADACHES AS A RESULT OF BEING ON SOME OF HIS MEDICATIONS, HE IN FANTASTIC WAS HAVING HEADACHES. FOR WHATEVER REASON. N OF ONE EXPERIMENTAL TRIALS STARTED IN PSYCHOLOGY IN THE 1880s THAT WAS ONE OF THE FIRST EXPERIMENTAL METHODS THAT WERE TAUGHT TO PSYCHOLOGISTS. THEY MOVED OVER INTO MEDICINE, AND WERE POPULARIZED BY GORDON IN 1986 ONE THING I FIND AMAZING, IN THE EVIDENCE BASED PYRAMID THAT IS PUBLISHED IN THAT 1986 ARTICLE, N OF ONE RANDOMIZED TRIAL WAS TOP OF PINNACLE. NOW, YOU ALL DON'T SEE PYRAMIDS THAT HAVE A FLATTENED TOP THAT SAY SYSTEMATIC REVIEW OF RANDOMIZED TRIAL THAT ARE MISSING, THE CAP. SO IT'S FAIRLY INTERESTING THAT THAT'S WHAT WE HAVE DONE AS EVIDENCE BASED MOVEMENT. WHY? WELL, THEY WERE HARD TO DO. WHEN THEY MOVED OVER TO MEDICINE IN 1986, WE HAD GORDON TRYING THEM AT MCMASTER AND HE TAUGHT MEDICAL STUDENTS HOW TO DO THEM, PHARMACIES DOING HAND CARVING OF THE PLACEBOS, HE HAD INTERNS HAND CALCULATING STATISTICS AS THE PIECES OF PAPERS WERE COMING IN. AND IT DIDN'T WORK. WE HAD OTHER PEOPLE WHO GOT GRANTS IN THE EARLY '90s NOTABLY ERIC LARSON WHO RAN AN N OF 1 SERVICE, HE GOT 72 PATIENTS THROUGH IN FIVE YEARS AND CONCLUDED THE END OF IT THAT IT TOOK $500 PER SINGLE SUBJECT, IT TOOK 17 PHYSICIAN HOURS TO DO. AND HE WASN'T SURE THERE WAS A MARKET FOR THIS. SO WE DID MARKET RESEARCH. WE ASKED PCORI FOR A GRANT IN METHODOLOGY SERIES TO UNDERSTAND THE USE CASES THAT WOULD BE APPEALING TO PATIENTS AND CLINICIANS. TO UNDERSTAND WHAT WE COULD BE DOING TO HELP DESIGN THEM SO THEY WERE ACTUALLY DOABLE AND THINK THROUGH SOFT CONCERNS AND BARRIERS THAT OBVIOUSLY WE MUST DESIGN AROUND. WE ENDED UP WITH 54 PATIENTS IN MULTIPLE FOCUS GROUPS AS WELL AS 24 PRIMARY CARE PROVIDERS AND WE RAN TWO NATIONAL POLLS TO START UNDERSTANDING SOME OF THE INFORMATION WE GATHERED QUALITATIVELY. THIS KEY QUESTIONS WE ASKED WERE CONDITIONS DISEASES SYMPTOMS OR TREATMENTS, THAT WERE APPEALING TO PATIENTS AND CLINICIANS FOR PERSONALIZED TRIALS. WHAT WERE THE PERCEIVED BENEFITS AND BARRIERS AND THEN WHAT DESIGN DECISIONS LIKE HOW OFTEN WOULD SOMEONE BE WILLING TO MEASURE SOMETHING. OR HOW LONG THEY'RE WILLING TO BE IN IT OR ABLE OR WILLING TO HAVE PLACEBO. IF THERE WAS A PLACEBO WERE THEY WILLING TO BE BLINDED? WERE THEY WILLING TO HAVE THE PROVIDER BE BLINDED? WE ASK THOSE QUESTIONS TO UNDERSTAND WHAT DESIGN FEATURES WE'RE MAKING PERSONALIZED TRIALS DIFFICULT AND WHICH DESIGN FEATURES WERE ATTRACTIVE. SO HERE YOU SEE THE IDEAL CONDITIONS FOR PERSONALIZED TRIALS, WHAT CLINICS THOUGHT, WHAT CLINICIANS AND PATIENTS THOUGHT AND WHAT PATIENTS ALONE THOUGHT. YOU CAN SEE THERE'S QUITE A BREADTH OF CONDITIONS. FROM THE FOCUS DATA YOU CAN SEE HERE IS A WHAT ONE PATIENT SAID, I KIND OF LIKE THAT APPROACH, BECAUSE I THINK IT WOULD EMPOWER ME TO SENSE HOW THE TREATMENT IS AFFECTING MY BODY. IT WOULD BE BENEFICIAL BEING RESPONSIBLE FOR MY OWN HEALTH. YOU CAN SEE THERE WERE THEMES OF HOW IT MIGHT IMPROVE MEDICAL CARE, HOW IT MIGHT IMPROVE THE CLINICIAN PATIENT RELATIONSHIP, IMPROVE ENGAGEMENT AND ALLOW PATIENTS THE OPPORTUNITY TO ENGAGE IN RESEARCH MEANINGFUL TO THEM. THERE ARE ALSO A NUMBER OF CONCERNS I SHOW THEM HERE AS CLINICIANS ONLY, THOSE BOTH CLINICIANS AND PATIENTS HAD AND WHAT PATIENTS THOUGHT ALONE. CLINICIANS WERE WORRIED ABOUT REGULATORY DEMANDS, INTERESTINGLY LOSS OF CREDIBILITY, IF YOU DON'T KNOW WHICH FIRST LINE ANTI-HYPERTENSIVE TREATMENT IS BEST FOR YOUR PATIENT, SAME TO PATIENT, I DON'T KNOW WHICH ONE IS BEST FOR YOU. HAS SOME ISSUES THAT HAVE TO BE THOUGHT THROUGH. EXPECTATION OF IMMEDIATE FEEDBACK, IF I'M GOING TO PRESCRIBE THREE FIRST LINE ANTI-HYPERTENSIVE PATIENTS TO YOU YOU WILL WANT TO KNOW BY THE WEEKEND WHICH IS BEST. AND THINKING THROUGH THE REGULATORY AND INFRASTRUCTURE NEEDED TO MAKE IT A REAL TIME POINT OF CARE EASY TO USE SYSTEM THAT ISN'T THE WAY STORIES ARE WRITTEN FROM THE 1980s AND 19990s WHICH WERE GRUESOME ABOUT BURDEN ON CLINICIANS TO DO THIS. PATIENTS WERE WORRIED ABOUT THE CHANGE ROUTINES, THAT A STUDY PROTOCOL CAN SEEM OVERWHELMING. AND THEY MIGHT END UP FINDING THAT THE BEST TREATMENT FOR THEM IS NOT THE ONE THEY CAN AFFORD. SO IN THIS TRANSFORMATIVE RO1 OUR APPROACH WAS TO DO THREE PILOTS, WE'RE HAVING A COMPETITION AMONG TESTIMONY APT DEVELOPMENT COMPANIES AND BACK END TEXTING COMPANIES. WE'RE USING THREE USE CASES THAT MET OUR CRITERIA THROUGH THE MARKET RESEARCH OF ONES THAT PATIENTS AND CLINICIANS THOUGHT IT WOULD BE MOST USEFUL FOR. FOR PROBLEMS, THAT WEREN'T EASILY SOLVABLE, ONCE WE HAVE& GONE THROUGH THIS COMPETITION FIGURE OUT WHICH IS THE BEST PARTNER TO WORK WITH WILL BE GOING THROUGH A TRIAL OF 200 PEOPLE WHERE PEOPLE GET RANDOMIZED TO THE N OF ONE TRIAL OR TO USUAL BEST CARE TO DETERMINE IF N OF ONE GETS YOU A BETTER TREATMENT OUTCOME. FOR OUR USE CASES WE CHOOSE LIGHT THERAPY WHICH IS FOR FATIGUE SYMPTOMS AND WE CHOSE INSOMNIA AND BLOOD PRESSURE. SO THIS WE CHOSE BECAUSE WE CAN, IT'S DIRECT TO CONSUMER AND RED LIGHTS FROM BRIGHT LIGHT AND FIRST TWO USE CASES ARE THROUGH AN INTERESTINGLY FOR BOTH OF THEM, THEY'RE REPORTING LESS FATIGUE WHEN THEY USE THE RED LIGHT. MORE SIGNIFICANTLY BETTER ON THE RED LIGHT. >> WE HAVE EQUIPOISE. THE INTERESTING THICK ABOUT INCOMES OF ONE CASES IS WHEN WE ASKED IN DISCLOSURE THE RED LIGHT WAS A WAY TO MED TAD, IT WAS SOFT ON THEIR EYES. IT WASN'T STARTLING THEY DIFFERENT START OFF IN THE BAD WAY OF THE DAY, IT BROUGHT THEM TONE THE DAY. THE RIGHT WAY. THEY'D PREFERRED RED LIGHT, IT WAS NOT HIS TAKEN PROTOCOL, HETEROGENEITY OF TREATMENT AFFECT FOR PEOPLE THAT HARSH BRIGHT LIGHT DOES NOT CONTRIBUTE TO THEM FEELING LESS FATIGUE OR REPORTING IT THROUGH ECOLOGICAL MOMENTARY ASSESSMENT DONE RANDOMLY ACROSS THE 12 WEEKS THEY WERE IN THE STUDY. THE SECOND ONE WE WANTEDDED TO HAVE ONE PLACEBO USE CASE SO WE CHOSE MELATONIN VERSUS PLACEBO FOR SLEEP DURATION SO PATIENTS WILL BE WEARING FIT BITS, AND THEN WE WILL TRACK THE EXACT AMOUNT OF SLEEP THEY GET WHEN ON MELATONIN. THE MELATONIN ALSO HAS THREE DIFFERENT DOSES SO WE CAN SEE IF PEOPLE RESPOND TO DIFFERENT DOSES SO IT'S FOUR ARM FOR THIS PARTICULAR ONE. I GAIN DESIGN FEATURES WE WANTED TO USE IN ONE OF OUR USE CASES. WE WANTED AN ACTIVE COMPARATOR AND SOMETHING PARTICULAR INTERNISTS WERE INTERESTED IN IS CAN I GET TO THE RIGHT SINGLE BP MEDICATION FOR A PATIENT RA THIS THAN ADDING A SECOND OR A THIRD FINDING OUT THEY'RE NOW CONTROL AND NOT KNOWING CAN I TAKE THEM OFF THE SECOND AND FIRST IN ORDER TO ACHIEVE THAT CONTROL BECAUSE THEY'RE ON THREE DRUGS. THIS IS OUR LONG TERM VISION AND I'M ALMOST DONE WITH MY TALK. HOPING WE HAVE SOME TIME FOR QUESTIONS. WE WANT THIS TO BE REAL TIME POINT OF CARE. THAT A CLINICIAN WITH A PATIENT CHOOSES A SYMPTOM OR A PROBLEM THAT PATIENT IS HAVING LIKE FATIGUE, LIKE BLOOD PRESSURE, LIKE HEADACHES LIKE AFIB AND ORDERS THE RANDOMIZATION THE ORDER OF TREATMENTS IS MAILED TO THE PATIENT'S HOME, MEASURES WHATEVER NEEDS TO BE MEASURED WHETHER BLOOD PRESSURE OR FIT BIT, OR A PILL BOX THAT MONITORS TAKING OF THEIR PILLS, THEN THE PATIENT GOES THROUGH THE TESTING OF IT. THERE'S A STATISTICAL ANALYSIS, THERE'S A VISUALIZATION AND FEEDBACK TO FOR THE FOLLOW-UP VISIT, THE CLINICIAN NEEDS TO SEE THE PATIENT TWICE, ONCE TO DECIDE THIS SHOULD BE DONE, ONCE TO THE SIDE WHICH IS THE BEST PREFERRED TREATMENT BY THE PATIENT. WE ARE ALSO HOPING TO BUILD A DEEP DATA PHENOTYPING ARCHIVE BECAUSE YOU WILL HAVE PATIENTS WHO WILL RANDOMLY EXPOSE TO MULTIPLE TREATMENTS, MULTIPLE DRUGS, MULTIPLE WHATEVER IT IS BEING BUILT FOR THAT USE CASE AND YOU CAN FIND THE PATIENTS WHO HAVE UNIQUE RESPONSES OR SIGNATURE RESPONSES TO CERTAIN PROFILES WHEN COMPARED AGAINST ACTIVE PLACEBO WITHIN SUBJECT RATHER THAN BETWEEN SUBJECTS. WE HAVE BEEN DELIGHTED TO ALREADY START DISSEMINATING SOME THOUGHTS AND DESIGN EFFORTS IN THIS FIRST YEAR OF THE GRANT. WE HAVE LAUNCHED A PATIENT FACING WEBSITE WE HAVE BUILT IT SO IF YOU'RE A PATIENT, YOU FIND OUT WHAT THESE ARE, IF YOU'RE CLINICIAN YOU FIGURE HOW TO ORDER FOR YOUR PATIENTS AND RESEARCHER HOW TO CONTRIBUTE TO THE BUILDING UP OF THE DATA BANKS. WE NEED TO DISRUPT THE WAY WE MANAGE CHRONIC DISEASE AND WHAT WE'RE TRYING TO DO IS BRING SCIENCE TO THE CLINICAL ENCOUNTER TO PERSONALIZED TRIALS. THANK YOU. [APPLAUSE] >> SO WE HAVE TIME FOR QUESTIONS. >> REALLY INTERESTED IN THE PATIENT FACING WEBSITE. WE GET QUITE A FEW PATIENTS COME IN, AND ALSO WE GET THEM ON THE PHONE, WE'RE ASKING THESE SAME KIND OF QUESTIONS. SO TELL ME AGAIN HOW THAT PATIENT -- >> THE PATIENT RIGHT NOW EXPLAINS (INAUDIBLE) LANGUAGE (INAUDIBLE) WHAT THESE ARE AND HOW YOU WOULD -- WHAT WE'RE HOPING TO DO IS GO VIRTUAL, WE'RE OBVIOUSLY NOT THERE BUT TELL PATIENTS YOU'RE INTERESTED IN -- YOU CAN ORDER A FIT BIT, WHAT YOU WANT TO DO IS YOU WANT TO WORK WITH SOMEONE WHO GIVES YOU THIS PILL AND THIS PILL, PILL BOX A AND PILL BOX B AND YOU DON'T KNOW WHICH IS A AND WHICH IS B AND THEN ONE WEEK YOU TAKE A, ONE WEEK YOU -- SO WE'RE STARTING TO BUILD TRYING TO TELL THEM HOW TO DO IT FOR THE THINGS THAT ARE APPROPRIATE FOR DIRECT TO CONSUMER. WHICH IS WHY WE HAD ONE USE CASE THAT WAS DIRECT. PATIENTS GO OUT AND BUY THEMSELVES BOXES BECAUSE THEY THINK IT MIGHT HELP. THIS IS FOR THE PATIENT. FOR THE CONSUMER WHO THINKS NOW THAT I BOUGHT THIS, NOW THAT I BOUGHT MYSELF MELATONIN, I'M INTERESTED IN FINDING OUT IS THIS DOING SOMETHING. >> WE HAVE ERIC THEN (INAUDIBLE). >> THIS IS VERY EXCITING. AND PART OF THE -- YOU HAVE A PATIENT FACING BOARD AND I GUESS ADS CLINICIAN I WOULD LOVE TO HAVE CLINICIAN FACING WHERE YOU CAN SIT TOGETHER AND SAY THIS IS WHAT WE'RE GOING TO DO IT, THESE STEPS WE NEED TO TAKE. >> SO THAT'S WHAT WE ARE BUILDING. SCAFFOLDING FOR THE CLINICIAN FACING, WHAT WE'RE REALLY INTERESTED IN IS BUILDING SOMETHING THAT'S ADD ON TO EHR. (INAUDIBLE) SIX ELECTRONIC HEALTH RECORDS (INAUDIBLE). >> OR IF WE CAN PLUG INTO EVERYTHING. >> SO -- (INAUDIBLE) >> IT WILL TAKE US LONGER. >> SO ONE OF THE -- SO ONE OF THE ISSUES THAT I WONDER IS IN THE CONTEXT OF PERSONALIZING, YOU'RE COLLECTING INFORMATION ON (INAUDIBLE) IS THERE A WAY TO AGGREGATE N OF ONE STUDIES? >> THERE IS. THAT IS WHAT THE PHENOTYPE DATA BANK IS FOR, IS WE ACTUALLY IN ADDITION WE HAVE SOMETHING LIKE A DATA REPOSITORY. WHERE IF YOU CHOSE THIS DESIGN, ALMOST YOU CAN SEE IT AS -- YOU COULD SEE IT ON A WEBSITE, IF YOU CHOSE THIS DESIGN FROM THE CLINICIAN ORDERED SET THE DATA CAN BE ANONYMIZED AND DROPPED HERE. SO YOU MIGHT HAVE CHOSEN AS A PHYSICIAN ALL THREE FIRST LINE BPs, THEN PUT IN THIS ONE FOR THIS PATIENT YOU MIGHT HAVE SAID NO I'M WILLING TO TRY YOU ON TWO OF THEM. THEN DROP DATA INTO ONLY TWO ARM TRIALS. >> ANOTHER QUESTION, IF YOU'RE ABLE TO AGGREGATE IT, (INDISCERNIBLE) IN TERMS OF CULTURE, IN TERMS OF PLACE, IN TERMS OF CONTEXT, IN TERMS OF SOCIOECONOMIC STATUS AND IT MAYBE SO BIOLOGICALLY IT'S HARD TO MAKE THAT ARDUOUS, BUT I CAN SEE COMBINING AC -- WITH MY WALKING, MAYBE MORE EFFECTIVE BUT YOU MIGHT NOT BE CAPTURING THAT, BUT I DON'T HAVE THE OPPORTUNITY TO WALK IN MY NEIGHBORHOOD, THAT SAYS SOMETHING THEY WILL CAPTURE SO WONDER IF YOUR GROUP IS THINKING ABOUT -- >> WHAT I WOULD LOVE TO SEE, WHAT I WOULD BE PROPOSING TO THE TEAMS WHEN YOU GET TO THE LARGE TRIAL BUILDING OUT OUR USE CASES SCAFFOLDING ACROSS ALL THE SYMPTOMS. THERE'S A SAME KIT THAT GOES OUT TO EVERY PATIENT. >> SO THOUGH YOUR INTEREST IN BLOOD PRESSURE WE'RE GOING TO SUGGEST YOU COLLECTION YOUR SLEEP. BECAUSE IF WE HAD AN ADVERSE EFFECT ON YOUR SLEEP WE WOULDN'T KNOW THAT IF (INAUDIBLE) BLOOD PRESSURE. WHAT WE FEEL A REASONABLE NUMBER OF THINGS THAT GO OUT TO SOMEONE, SO WE CAN MEASURE THE ALMOST LIKE CORE COVERING AND MAKE SURE THERE AREN'T PERTURBATIONS IN OTHER SYSTEMS. >> I WOULD SUGGEST YOU DON'T LIMIT TO BIOMETRICS AND YOU ALSO HAVE SOME MEASUREMENTS -- >> THAT'S THE LAYERING OF DATA, VERY EXCITED TO BE THINKING ABOUT AS MEMBER OF THE USPS I'M INTERESTED IN HAVING A REASONABLE NUMBER OF SOCIAL DETERMINANTS OF HEALTH THAT CLINIC CAN DO SOMETHING ABOUT, ALL IN THE SAME WAY ONCE WE ALL AS A UNIVERSE COME TO AGREEMENT. ASK PATIENTS WILL BE WILLING TO FILL OUT THIS INFORMATION. >> AS A SCAFFOLD. >> I DON'T KNOW IF I CAN TAKE QUESTIONS. >> THERE'S PROBLEMS WITH -- HOW DO YOU DO POWER CALCULATIONS, AND HOW MANY REPEATS DO YOU NEED TO GET IT -- >> WE DO POWER ANALYSES FOR EVERY SINGLE ONE OF OUR TRIALS. STATISTICIANS AT COLUMBIA WORKING AS A HACKATHON, CAN THEY COME UP WITH ALGORITHMS FIGURE IT OUT, THE FASTEST THEY FOUND, BASELINE OBSERVATIONS WITH THE PATIENT WITH THE OUTCOME WE'RE INTERESTED IN, FOR THE PATIENT WHICH THEY CALCULATE HOW MANY ON VARIATIONS THEY NEED FOR THAT PARTICULAR THING THAT PARTICULAR LOCATION. (OFF MIC) >> I DON'T KNOW YET. THAT ONE IS LAUNCHING -- IRB STAGE, CHECK BACK WITH YOU. >> RATHER THAN RAISE YOUR HAND JUST DO THIS. >> ERIC WAS NEXT. GARY. >> CURIOUS WHAT ABOUT LONGER TERM EFFECTS THAT REQUIRE A LONG -- LIMITATIONS IN -- >> THERE IS PRAGMATIC LIMITATION BUT NOT A -- THERE'S A PRAGMATIC ONE WHICH IS ONE OF THE BARRIERS. SO I HAVE HAD THREE INTERVENTIONS WHICH JUST HAPPEN TO SIT IN MY TRUCK. MARKET RESEARCH SAYS, DO IT FOR AFIT AND THE STATISTICIAN DID THE CALCULATION AND SAID THREE YEARS. >> AND THIS WAS OBSERVATIONAL, NOT RAP DOCUMENT'SED NOT TREATMENT, THIS WAS BECAUSE ALL PHYSICIANS AND PATIENTS FEEL THERE'S SOMETHING THAT TRIGGERED THEIR AFIB AND YOU HAVE TO HOVER THAT LONG TO HAVE SUFFICIENT POWER TO BE ABLE TO DIFFERENTIATE WHAT THAT TRIGGER WAS AT REASONABLE -- WITH SOME GUESSTIMATE WHAT IS THE EXPOSURE RATE IS AND THE PROBABILITY OF AFIB AS ACTUAL RESULT OF BEING EXPOSURE. TO BE CONSERVATIVE, THREE YEARS. (OFF MIC) I'M SAFE NOW BECAUSE I'M DOING SET PROTOCOLS, THREE ACTIVE BP NETS FOR THIS PATIENT TO BE IN YOU HAVE TO AGREE THIS PATIENT IS SAFE TO GO FORWARD WITH THREE ACTIVE BP METS, THAT'S NOT THE SPIRIT OF N OF ONE TRIALS, IF A PATIENT SAYS I DON'T WANT TO TRY THAT BETA BLOCKER, I HAVE BEEN ON BETA BLOCKERS BEFORE AND I KNOW THEY GIVE SIDE EFFECTS NOT WILLING TO DO IT, WILLING TO DO TWO WE HAD IRB DIFFERENT IRB NUMBER, PUT THAT ONE THROUGH, HOW MANY SUBJECTS GOING TO DO IT, THAT'S A SIX MONTHS DELAY. WE NEED A POINT OF CARE IRB. IS IT SAFED TO DO THIS. WHICH I HAVEN'T ENGAGE WITH IRB. >> I LIKE IT. >> A WEALTH OF OPPORTUNITY HERE. PARTICULARLY FOR MINORITY POPULATIONS THAT HAVE NOT BEEN IN CLINICAL TRIALS THE WHOLE CON TORE HAVE SI HUGE YOU SHOULD DO THIS ALMOST IMMEDIATELY BECAUSE PHYSICIANS -- COMPOUNDED BY TWO TO DO. SO THIS COULD AT LEAST START THE BALL DOWN QUICKLY, NOT SURE WHAT THE END POINTS COULD BE. >> THAT'S A PROBLEM. FOR SOME THINGS, I GAVE YOU MY ONE ON ONE TALK. I HAVE TO KNOW I HAVE MORE TALENT, AS AN END POINT BECAUSE IT HAS TO BE MEASURED REPEATEDLY, AND HAVE QUICK RESPONSE AND OFF RESPONSE. WE DO HAVE BAYESIAN STATISTICIAN WHOSE ARE ABLE TO CALCULATE WHAT THE PROBABLE RATE OF OFF TIMING IS. SO THAT WE DON'T HAVE TO HAVE A WEEK WASH OUT AND THEN WEAK EXPOSURE AND WEEK OFF ANYTHING. SO YOU CAN DO THAT ANALYTICALLY BUT EVEN BINARY EVENTS THAT ARE ON OFF WE CAN DO RATHER THAN -- >> ADVERSE REACTIONS. >> THAT WE CAN DO. >> >> YOU CAN DO THAT. >> IT'S HEADACHES SO WE HAVE TO HAVE SOMETHING THAT HAS PERIODIC >> DAN. >> HOW DO YOU WANT -- (OVERLAPPING SPEAKERS) >> PRACTICE HEALTHCARE AS IF WE NEVER WROTE ANYTHING DOWN. S IN THE OPPOSITE BECAUSE YOU'RE INVOLVING THE PATIENT IN A STRUCTURED DATA COLLECTION AND IN APRIORI SEEMS INEVITABLE WHAT YOU'RE GOING TO DO IS INCREASE THEIR CONFIDENCE ALL RIGHT THINGS SO ARE YOU MEASURING THEIR SATISFACTION AND OWN CONFIDENCE LEVEL OF DECISIONS MADE RELATIVE TO THE OLD DOCTOR TOLD ME TO TAKE THIS. >> WE HAVEN'T YET BUT IRB PROTOCOLS RECORDING WHAT THE JOYCE IS AND VERBATIM SPEAK ALLOWED WHY THEY MAKE THAT CHOICE. IS IT BECAUSE IT WAS CHEAPER, IF THEY HAD APRIORI BELIEF THAT -- IS GOING TO WORK FOR THEM, ARE THEY GOING TO SAY I THOUGHT THAT WOULD RECOLLECTS FOR ME BEST, I DON'T KNOW WHY I'M RESPONDING TO DIURETIC THE OTHER ONE THAT I WILL TAKE THE THIGH SIDE ANYWAY, WE'RE TRYING TO CAPTURE WHAT THEIR THOUGHTS ARE. WHEN THEY MAKE THE CHOICE AND HERE WE HAVE SOME SAY, WHAT THEY'RE PREFERRED TREATMENT IS BASED ON THE DATA AND GET THE PATIENTS CHOICES TO WHAT THEY DID AND SEE HOW OFTEN THERE'S DISCREPANCY AS A WAY >> MILITARY IS VERY INTERESTED IN SLEEP, IT WOULD BE INTERESTING IN POPULATION. ONE THING I THINK WOULD BE DIFFICULT TO DO, PROBABLY IN OTHER POPULATIONS IS THAT THE (INAUDIBLE) DON'T WANT STUFF IN THEIR FEDERAL RECORD, PERIOD. AND THEY -- DOING THAT, SO IF YOU CAN -- MEDICAL RECORD I ASSUME THEY'RE ASLEEP, THE DATA ALSO TALK ABOUT THAT OR IS THAT A PROBLEM OR IS THERE A WAY TO SORT OF WHAT INFORMATION COULD THEY HIDE FOR THEIR PHYSICIAN? >> WE WERE DOING NATIONAL SAMPLES OF PATIENTS FROM PRIMARY CARE PRACTICES WITH TWO OR MORE CHRONIC DISEASES. THAT'S WHERE OUR MARKET RESEARCH IS. PRIVACY OF DATA DID NOT COME UP AS A BARRIER FOR THEM BECAUSE FOR THEM THEY'RE IN A SITUATION WHERE THEY'RE SAYING I WANT MY SLEEP -- MY CLINICIAN TO DO SOMETHING ABOUT MY SLEEP, RECORDING SLEEP IN THEIR ELECTRONIC HEALTH RECORD AT LEAST QUESTIONS DID NOT COME UP AS CONCERN. I THINK WE HAVE TO THINK THROUGH CAREFULLY AND FOCUS GROUPS WITH PEOPLE FROM THE MILITARY, WHO THIS MIGHT BE OPTION TO DESIGN AROUND ISSUES. >> I THINK SOME PEOPLE ONLY SHARE SO MUCH INFORMATION WITH THEIR DOCTORS. WE HAVE A NICE POPULATION THAT LIKES TO SHARE EVERYTHING. >> THIS IS GOING TO BE PRIMARILY FOR TREATMENT SEEKING PATIENTS, I'M JUST SAYING THAT, THAT'S THE DENOMINATOR, HAVING DEPRESSION AND I WANT TO KNOW WHETHER THE SAINT JOHN'S WORTH WORKS FOR ME OR WHETHER I NEED ANTIDEPRESSANT OR WHETHER IMPROVING TO IMPROVE (INAUDIBLE) SO IT'S SOMEBODY WHO IS SAYING IMA SYMPTOM AND I WANT TO TREAT IT. >> MY QUESTION FOLLOWS UPPER RICK'S QUESTION, HOW DO YOU ACCOUNT FOR OLDER (INAUDIBLE) >> SO THE HALF LIFE PROBLEM, WE HAVE SOLD ANICALLY IN THE ANTI-HYPERTENSIVE SPACE, WE HAVE TO DO IT FOR EACH AND EVERYONE BECAUSE ANY DRUG YOU BRING INTO THIS YOU HAVE TO START THINKING OF THE PHARMACOKINETICS OF IT. THE POWER ANALYSES SUGGEST CLASS WE'RE USING FOR THIS PARTICULAR PROBLEM THAT DOUBLE EXPOSURE, AT LEAST TWICE OF AT LEAST SEVEN DAYS IS SUFFICIENT FOR US TO FIGURE IT OUT. IT'S GOING TO BE DIFFERENT FOR EVERY DROP. DEPENDING ON THE TIMING OF RESPONSE. HOW BIG THE RESPONSE IS, AND AMOUNT OF VARIABILITY WE HAVE TO PLAY WITH. >> DO YOU GET SITUATION WHERE IS YOU MIGHT DEVELOP TOLERANCE TO A DRUG OR NEED TO HAVE INCREASED DOSE TO HAVE EFFECTIVENESS THAT MIGHT NOT ALLOW THIS KIND OF -- >> WE HAVE TRYING TO TAKE CIVIL USE CASES SO YES I'M SURE WE'RE GOING TO RUN INTO THOSE PROBLEMS. DOUBLE -- TRIPLE. >> HOW DO YOU ACCOUNT FOR PLACEBO EFFECTS? >> BECAUSE I'M AN EXPERIMENTALIST, WE HAVE GOT A PLACEBO IN TWO O OUR TRIALS, ONLY ONE ACTIVE COMPARATOR. >> BEYOND HAVING AN APPEAL THAT DOESN'T WORK, JUST A PERCEPTION, THE PLACEBO EFFECT IN CONTEXT OF THE LITERATURE GOES BEYOND -- >> IN THE COME -- IN A COMPOUND PLACEBO EFFECT THAT IS PASSED USE OF NON-PHARMACEUTICALLY ACTIVE PILL OR LIGHT THAT'S BRIGHT THAT'S WHITE THAT DOESN'T DELIVER THE ACTIVE DOSE, THAT'S IN THE N OF ONE UNIVERSE OF THINKING, IF YOU GET FATIGUE RESPONSE, YOU GET A SLEEP DURATION CHANGE, BLOOD PRESSURE RESPONSE, WE'LL TAKE -- WE'RE NOT INTERESTING IN EFFICACY AT THE SENSE OF STRIPPING AWAY ALL OTHER EXPLANATIONS FOR POSITIVE RESPONSES OF PATIENT. WE'RE INTERESTED IN SMALLEST AMUNT OF EXPOSURE TO DRUG OR TREATMENT FOR THE SHORTEST AM OF TIME. THAT SOMEONE HAS TO DO FOR THE REST OF THEIR LIFE. >> WOULDN'T THAT BE THE PREFERRED AGENT? >> POWER OF PLACEBO. (OVERLAPPING SPEAKERS) >> THERE ARE POLICIES IN PLACE LIKE STATINS FOR LIFE GIVEN SYSTOLIC BLOOD PRESSURE THAT YOU SEE, YOUR (INDISCERNIBLE) RISK HEART ATTACK. >> ONCE YOU'RE MALE AND 65. >> THAT'S BIG GIANT -- OVER THE MEANS. YET LIKE A $1,200 CT WITH ONE YEAR REMEDIATIONS WILL RULE OUT& PUT YOU IN A CATEGORY, EVEN GETTING YOUR STATS YOU NEVER HAVE A HEART ATTACK, YOU DON'T NEED THESE DRUGS. YOU CAN DO TRIALS OF ONE TO REMOVE PEOPLE FROM THESE EXPENSIVE CHRONIC. >> I DO NOT AGREE WITH YOUR USE CASE BECAUSE THE PREVENTION OF HEART ATTACK IS NOT A USE CASE BUT SAID A DIFFERENT WAY -- (OVERLAPPING SPEAKERS) >> IT WAS COMPLIMENTARY. >> YES. I'LL SAY BACK TO YOU WHERE I THINK (OVERLAPPING SPEAKERS) >> I THINK WE HAVE GERIATRIC PATIENTS WHO ARE ON 14, 16 DRUGS IN PLACES WITH VERY LITTLE MEDICAL OVERSIGHT AND YOU CAN DO DISMANTLING N OF ONE TRIALS, TAKE THEM OFF THIS AND SEE IF THEY'RE STILL REPORTING LOW AMOUNTS OF PAIN, TAKE THEM OFF THAT AND SEE IF SLEEP. TAKE THEM OFF THAT AN SEE IF (INAUDIBLE) BLOOD PRESSURE. YOU MIGHT FIND THERE'S ONLY TWO OR THREE THAT ARE DOING (OVERLAPPING SPEAKERS) >> LATER WITH (INAUDIBLE) >> YOUR USE CASES RECURRING REMITTING SYSTEM TOM IS. IT'S NOT CHOLESTEROL LOWERS THAT IT'S PREVENT ACTIVE OF THE HEART ATTACK. >> PHENOTYPES WHERE YOU HAVE NO PLAQUES YOU CAN GET HIGH CHOLESTEROL. >> CALCIUM. >> SANDRA AND PATTY. >> IN THE BEST OF ALL POSSIBLE WHERE DO YOU SEE THE PATIENT ACTUALLY LOOKING FOR THAT INFORMATION ON THEIR OWN? Q. IN MY WILDEST DREAMS. I GO WEIRD PLACES. MEDICAL SCHOOLS THAT TRAIN PRIMARILY FAMILY MEDICINE AND PEDIATRICIANS TO BE TEACHING PATIENTS HOW TO GUINEA GUSH OUT WHAT ARE THE SYSTEM TOMS AND VIRTUALLY VIRTUAL VISITS, HELP THEM DETERMINE THE TREATMENT OPTION THAT MANAGES THAT SYMPTOM, THE BEST WE AFFORD THEM. IT TAKES EDUCATION OF PATIENTS, ENGAGEMENT OF PATIENTS FOR THIS CLINICAL ENCOUNTER FOR THEM TO UNDERSTAND, THIS IS THE BEST -- THIS IS THE OPTIMAL WAY TO TREAT ALL THE RELAPSING REMITTING, WEIGHT GAIN SEDENTARINESS, ALL THE CHRONIC SYSTEM TOMS THAN HAVE FIRST LINE TREATMENT THAT FIXES SOMETHING FOR 8% OF THE POPULATION. >> IN MY ENVIRONMENT WE HAVE CD 1 CLINICS. SO IN YOUR SCENARIO, THAT'S (INAUDIBLE) PATIENT WALK THROUGH THIS KIND OF THING. >> EXACTLY. AND SEND THEM HOME AND LET THEM FIGURE OUT WITH IN PARTNERSHIP WITH CLINICIAN VIRTUALLY, WHAT'S THE BEST THING FOR THEM. >> TELL THEM STOP TAKING THAT APPLE CIDER VINEGAR. >> MAYBE NOT. >> I HAD A SCIENCE QUESTION AND NLM QUESTION, MY SCIENCE QUESTION, HOW DO YOU CONVEY RISK TO PARTICIPANT IN THIS -- >> BECAUSE WE'RE UNDER IRB PROTOCOLS, FOR EACH THREE USE CASES WE HAVE KNOWN SIDE EFFECTS AND PATIENTS ENSURING THAT THEY UNDERSTAND WHAT THE BENEFITS TO THEM AND RISK TO THEM. >> EXPOSURIST TO MEDICATION. NOT DELAY THIS FOR THE FACT THAT YOU MIGHT BE WASH OUT PERIODS OR THING LIKE THAT. >> ANYTHING THAT'S A KNOWN -- LET ME BACK UP AND SAY, IN MY THREE USE CASES, BLOOD PRESSURE IS THE ONLY ONE WHICH IS USING ACTIVE DRUG THAT'S NOT COMPLIMENTARY SO FOR THOSE IN THE IRB CONSENT APPROVED CONSENT FORM, WE TELL THEM THE KNOWN SIDE EFFECTS AND THEREFORE ADVERSE EVENTS OF ANTI-HYPERTENSIVE, THAT ONE IS AN ACTIVE COMPARE TON SO THEY'RE NEVER (INAUDIBLE). >> OKAY. I WAS INTERESTED HOW YOU EXPLAIN THERE'S VERY LOOSE EVIDENCE PSYCHOLOGICAL RESPONSE TO LIGHT PARTICULARLY TO NEGATIVE PSYCHOLOGICAL EXPERIENCE. TO WHAT EXTENT DO VOCABULARIES CHARACTERIZE SYMPTOMS YOU'RE TRACING WITH THESE END POINTS YOU'RE TRACING? >> DO YOU MEAN MESH HEAD SOMETHINGS >> I MEAN IT MAYBE -- THIS IS CONVERSATION WE HAD A LOT. HOW DO YOU GET INVESTIGATORS TO START MAKING USE OF VOCABULARY (INAUDIBLE)? >> AS A GENERAL RESPONSE I HAVE INFORMATICIANS INSIDE MY SHOP TELL ME SYSTEMS THAT I NEED TO HAVE ACCESS TO. (OFF MIC) >> LITERALLY INSIDE MY SHOP; NOT AT THE LIBRARY. NO, NO, NO. >> I KNOW WHAT YOU'RE SAYING AND AGREE. MOVING ON. FOR N OF ONE THERE'S GOING TO -- FOR DATA REPOSITORIES, DATA DICTIONARIES, FOR DATABASE, CLINICAL TRIAL REGISTRATION REPORTING HOE (INAUDIBLE) LAY OUT SO UNIVERSE WE DO HAVE AN OPPORTUNITY. WE HAVE BEEN DOING SYSTEMATIC REVIEWS OF WHAT N OF ONE TRIALS ARE OUT THERE FOR SYMPTOMS AND WE CAN DEPRESSION, THERE'S FIVE. SO AT THE BEGINNING OF A FIELD. >> THANK YOU. [APPLAUSE] >> SO BEFORE WE HAVE OUR REPORT, VALERIE REPORTS ON EXTRAMURAL PROGRAMS, (INAUDIBLE). >> WE RECEIVED A WONDERFUL SUMMARY OF SOME OF THE WORK BEING DONE BY HISTORY OF MEDICINE DIVISION AND A LITTLE BIT OF MATERIALS USED FOR PROMOTING ALL PROGRAM LAST WEEKEND RATHER THAN PUTTING IN OUR SLIDE SHOW, I (INAUDIBLE). ANYONE WOULD LIKE ELECTRONIC COPY LET ME KNOW AND I'LL SEND IT TO YOU. WE HAD TREMENDOUS EXHIBITS FOR HISTORY OF MEDICINE THIS SPRING. (INAUDIBLE) SO I HOPE YOU'LL ENJOY THIS. >> WITH THAT WE MOVE TO DR. VALERIE FLORANCE REPORTING ON EXTRAMURAL PROGRAMS REPORT. >> YOU KNOW HOW I LOVE FOLLOWING A GREAT SPEAKER. WITH REALLY BORING SLIDES. DOING THAT AGAIN TODAY. (INAUDIBLE) THE GRAPHICS, BUT I'M HERE TO TALK ABOUT -- WE TALKED A LOT ABOUT WORK FORCE AROUND HERE. SO I WANTED TO DO A LITTLE HISTORY OF WHAT WE HAVE BEEN DOING AND WHAT ARE THE QUESTIONS I THINK WE NEED TO BE THINKING ABOUT NOW IN TERMS OF THESE PARTICULAR TRENDS. SO I'M LOOKING AT THOSE AWARDS AND CAREER AWARDS. WE TALK ABOUT TRAINING PROGRAMS A LOT SO I WILL TALK ABOUT THEM A LITTLE BIT AT THE END. AND I ALSO WANT -- SO THERE ARE SOME TRADITIONAL INDICATORS OF SUCCESSFUL OUTCOMES FOR FELLOWSHIPS AND CAREER AWARDS. I WANT TO LOOK AT THE CURRENT STATE OF WHAT WE OFFER NOW IN THOSE AWARD AREAS AND ALSO WHAT IT COSTS US AND THEN I WILL COMPARE TO UNIVERSITY PROGRAMS BECAUSE IN SOME WAYS, THERE ARE SOME SIMILARITIES. THEN I'M SEEKING YOUR INSIGHT AND THINKING ABOUT THOUGHTFUL WAY TO EVALUATE WORK FORCE DEVELOPMENT. INVESTMENTS PERIOD. THIS IS THEN, BACK IN THE GOOD OLD DAYS 1992, WE LAUNCHED THE FIRST FELLOWSHIPS, WE HAVE OUR OWN UNIQUE FELLOWSHIP MECHANISMS YOU HAVE NEVER SEEN F-37 AND F 38 BECAUSE THEY BELONG TO US. THEY CAME WITH OUR SPERM AUTHORITIES THROUGH THE LIBRARY ASSISTANCE ACT SO WE HAD TWO KINDS OF FELLOWSHIPS, THE F 37s BEING INDIVIDUAL, CLOSE TO WHAT A PRE-DOC, LIKE A DOCTORAL FELLOWSHIP MIGHT BE LIKE. WE PAID UP TO $50,000 A YEAR. AND GAVE THEM SOME TUITION SUPPORT TRAVEL FUNDS ONLY A COUPLE OF YEARS. IN 2003 WE MOVED ON TO USE NRSA, NATIONAL RESEARCH SERVICE AWARD, STIPEND AND TUITION LEVELS BECAUSE WE WANTED TO MAKE IT SIMPLER FOR PEOPLE. WHY MAKE THEM HAVE THREE KINDS OF FELLOWSHIP AWARD LEVELS, WE MADE 39 AWARDS IN THIS PROGRAM BEFORE SHUTTING DOWN IN 2005. THE F 38 WAS ISSUED AT THE SAME TIME AS SENIOR FELLOWSHIP WITH THE IDEA AND THIS IS SOMETHING WE TALKED ABOUT FOR DATA SCIENCE TRAINING TOO. THERE ARE EXPERIENCED SCIENTISTS AND CLINIC WHOSE WANTED TO CHANGE DIRECTION A LITTLE BIT IN THEIR CAREERS OR TO BROADEN THEIR BACKGROUNDS. SO THESE WERE FOR PEOPLE WHO HAVE AT LEAST TEN YEARS, AT LEAST TEN YEARS OUT DOCTOR OR PROFESSIONAL DEGREES. WE MADE 41 AWARD IN THOSE PROGRAMS. WE DON'T HAVE THEM ANY MORE. WE CLOSED IN 2005 AND I WILL SAY MORE ABOUT THAT. BUT NOW WHAT WE HAVE, WE DO HAVE FELLOWSHIP PROGRAMS F 30 AND F-31. WHICH ARE NIH WIDE NATIONAL RESEARCH SERVICE AWARDS, WE WERE TOLD WE NEEDED TO HAD TO PARTICIPATE IN THESE PROGRAMS, SO WE DO. SO WE HAVEN'T BEEN MAKING THEM THAT LONG, THESE ARE PRE-DOCTORAL TRAINING LIKE WE DO IN UNIVERSITY BASED TRAINING PROGRAMS. THEY CAN SUPPORT SOMEONE UP TO FIVE YEARS AT STANDARD NRSA LEVEL. SO MANY OF THESE -- MANY INSTITUTES AT NIH AWARD THIS TYPE OF FELLOWSHIP NOW BACK TO CAREER. OUR ORIGINAL CAREER AWARDS LAUNCHED IN 2004 BY MILTON CORN, THESE WERE -- WE KNEW OTHER INSTITUTES HAVE CAREER TRANSITION AWARDS TO HELP PEOPLE MOVE INTO THEIR FIRST AND BE SUCCESSFUL IN RESEARCH POSITION BY 2004 OUR BUDGET WAS LOOKING GOOD MUST HAVE HAD WE FELT WE COULD START SUPPORTING THESE, WE INVENTED A CAREER AWARD THAT WAS THREE YEARS UNMENTORRED, AND PEOPLE COULD APPLY FOR IT BEFORE THEY FOUND THEIR JOB. THAT WAS A TIME WHEN NIH WOULD ALLOW YOU TO MAKE A GRANT TO AN INDIVIDUAL, SO SOMEONE COULD APPLY AND WE WOULD LOVE IT AND SAY FINE WILL AWARD IT BUT AWARD HAS TO GO TO AN INSTITUTION. SO WE WAITED UNTIL THEY GOT THAT JOB THEN GIVE AWARD. WE MAD 27 AWARDS IN THIS PROGRAM BEFORE SUSPENDED AND THERE WERE A BUNCH OF WELL NOPE PEOPLE WHO WERE -- WHO USED THIS PROGRAM. WE WERE PROUD OF THEM. WE LOVE THIS PROGRAM AND THEY DID TOO. THEN NIH DECIDED THAT EVERYONE NEEDED TO GET K-99 ROO, A FIVE YEAR, FRESH OUT DOCTORAL TRAINING UP TO FOUR YEARS YOU CAN GET TWO YEARS OF K SUPPORT, SUPPOSED TO HELP YOU WRITE EXTRA ARTICLES THEN FIND A JOB. THE ROO SUPPORT WOULD BE AVAILABLE TO YOU AND YOU WOULDN'T HAVE TO COME BOOK TO ANOTHER REVIEW. THE GRANT REVIEW IS DONE AT ONE TIME FOR BOTH COMPONENTS. ONCE SOMEONE FINDS A JOB THEY SEND US THE DESCRIPTION AND WHAT THE OFFER WAS MADE, WHAT THE UNIVERSITY SAID THEY WOULD GIVE THEM THEN STAFF REVIEW AND MAKE SURE IT'S A DECENT OFFER. THEY ARE DOING RESEARCH OUR COMMITTEE REVIEWED. THAT'S AN NIH WIDE PROGRAM. WE HAD TO JOIN IT AND WE COULDN'T AFFORD TWO KS SO WE CLOSED THE K 22 IN ORDER TO HAVE THIS ONE. THEN WE NOTICED MOST -- OUR OLD PROGRAM WE HAD LOTS OF OUR TRAINEES ARE MDs, COMING OUTPOST DOCTORAL, THEY STOPPED APPLYING BECAUSE THEY WEREN'T INTERESTEDDED IN TWO YEARS OF MENTORED THREE YEARS. THEY WANT TOED GO DIRECTLY TO A JOB AND GET STARTED. SO WE LAUNCHED A KO 1 WHICH DOES THAT, THREE YEAR AWARD FIRST COUPLE OF YEARS FIRST THREE YEARS AND WHAT WOULD BE CONSIDERED FIRST PROFESSIONAL RESEARCH JOB. IT PAYS 75% OF YOUR TIME UP TO A CERTAIN SALARY AND GIVES RESEARCH FUND. THE EXPECTATION WITH ANY CAREER AWARD IS FROM NIH BECAUSE WE'RE NIH, THIS IS HOW WE THINK, WE EXPECT YOU'RE GOING TO APPLY FOR AN RO1 AT THE END. THAT'S PART OF WHAT YOU'RE SUPPOSED TO DO. BECAUSE WE THINK YOU'LL WANT MONEY FROM US FOR LIFE. I'M JOKING. IN THE END WHAT WE HAVE NOW, WE HAVE THE F 30, F 31 FELLOWSHIPS AND WE HAVE THE K-9 9 AND THE KO 1 SO WE HAVE TWO CAREER AWARDS. AND TWO FELLOWSHIPS. SO OVER THIS PERIOD 1990 TO 2017, ALL TOGETHER WE AWARDED 154 AWARDS IN THIS AREA. AND I'M GOING TO SAY JUST A LITTLE BIT MORE ABOUT THEM. SO WE KNOW THAT AT NIH WHAT PEOPLE LOOK AT WHEN THEY SAY ARE WE SUCCESSFUL OR NOT IN THIS, LOOK AT PUBLICATIONS AND THEY LOOK TO SEE IF YOU HAVE GOTTEN MORE NIH GRANTS; THOSE ARE TWO SO I LOVE THIS TABLE, I HOPE YOU CAN SEE IT BECAUSE I LEARNED SOMETHING FROM THIS. ASIDE FROM BEGINNING ABOUT THE OTHER GREAT THINGS TRAINEES CAN DO, YOU CAN SEE THAT -- FIRST OF ALL 42% OF THOSE PEOPLE WE FUNDED IN FELLOWSHIPS OR IN CAREER HAVE COME BACK AND GOTTEN NIH GRANTS. BUT THE INTERESTING PICTURE IS HOW MANY OTHER INSTITUTES AND CENTERS HAVE PROVIDED GRANTS. SO IN SOME SENSE WE'RE PROVIDING A WORK FORCE THAT SUPPORTS THE RESEARCH AND 14 OTHER INSTITUTES AND CENTERS. I DON'T THINK PEOPLE THINK ABOUT OUR INFORMATICS TRAINEES BUT WE KNOW THAT ABOUT THEM. THEY CAN APPLY SKILLS AND A BUNCH OF DIFFERENT AREAS AND HERE ARE SOME PROOF OF THAT. IN TERMS OF PEER REVIEWED PUBLICATION, THE K-22 WIN THE AWARD FOR THE MOST PUBLICATIONS FROM THAT GROUP, THAT WAS OUR ORIGINAL CAREER AWARD. BUT OF COURSE, THOSE WERE NUMBER OF YEARS AGO. SO YOU KNOW THIS MODEL. PEOPLE CONTINUE TO SITE GRANTS THEY HAVE HAD IF THEY FEEL THE RESEARCH IN THEM WAS RELEVANT WHAT THEY'RE WORKING ON NOW. SO AND THEY MENTION THEM AND -- IN THEIR ACKNOWLEDGMENTS AND WE GET THE CREDIT. WE LIKE IT. IN THE CASE OF THE K-99 ET CETERA, THEY BETTER PUBLISH BECAUSE THEY FIND A JOB. SO WE CAN SEE THAT IS WORKING. THE KO 1 THAT PROGRAM IS NEW ENOUGH IT'S ONLY A FEW YEARS OLD. YOU WOULDN'T EXPECT THE SAME NUMBER BUT I THINK WE CAN SEE PUBLISHING IS GOING ON, 642 PUBLICATIONS FROM THAT GROUP. I DIDN'T GO INTO A DEEP ANALYSIS. I WOULD SAY SO 82% OF THOSE INDIVIDUAL FELLOWSHIPS AND 56% OF THE SENIOR FELLOWSHIPS PUBLISHED AT LEAST ONE ARTICLE. CITED BY SOMEBODY. IT ISN'T THINKING TO SAY IT THAT WAY BUT SOME HAVE -- WHEN I SAID EYE SIGHT WE'RE TALKING RELATIVE CITATION RANK NIH IS A WAY OF LOOKING AT PEOPLE CITATIONS IN TERMS OF THEIR CO-CITATION NETWORKS. SO ONE IS AVERAGE. SO WHEN YOU SEE 4.9 OR 4.3 OR 35.5, THAT MEANS THOSE ARE HAVING GREATER INFLUENCE IN THE COMMUNITY. IN OUR MEETING THIS MORNING IN EP SUBCOMMITTEE MEETING, WE WERE TALKING HOW WE KNOW THIS, THE SINGLE WORDS SCIENTIFIC JOURNALS, CERTAIN JOURNALS, HAVE HIGH CITATION POWER. IF YOU PUBLISH IN NATURE YOU'LL HAVE A BUNCH MORE CITATIONS. SO YOU CAN SEE CAWAMOTO, THAT'S A PERFECT EXAMPLE, HIS RELATIVE CITATION RATIOS 35.5, IT IS THE BMJ BUT ALSO OBVIOUSLY IT WAS AN IMPORTANT PUBLICATION, HE HAD A LOT OF CITATIONS IN USE A LOT. IN THE CAREER AWARDEES, SO WE HAVE HAD A LOT, 566 PUBLICATIONS IN THOSE AND SO FOR THE K 22s, THOSE ARE THE OLDER ONES KO 1 ARE NEWER ONES AND THE K-99 SO YOU CAN SEE PUBLISH AND GETTING CITED RESPECTIVELY, NOT EVERYBODY SO I'M ONLY CHERRY PICKING TO SHOW YOU THESE ARE THE KINDS OF THINGS WE CAN KNOW ABOUT THEM. BUT IS THAT REALLY ENOUGH? TO KNOW ABOUT THEM? IF YOU'RE TRYING TO -- I'M LEADING -- SO HERE IS WHERE WE ARE NOW. WE HAVE PRE-DOCTORAL TRAINING AT 16 UNIVERSITY IN THE UNITED STATES, A HUNDRED PRE-DOCS THERE AND THEN WE HAVE SIX FELLOWSHIPS THAT WOULD BE COMPARABLE PRE-DOCTORAL FELLOWS TRAINING TO GET Ph.D.s IN BIOMEDICAL ININFORMATICS OR DATA SCIENCE. WE ALSO HAVE 57 POST-DOCTORAL SLOTS AT OUR 16 UNIVERSITIES. AND THEN IN THE CAREER TRANSITION AWARDS WE HAVE EIGHT CURRENT ACTIVE CAREER AWARDS, WE DON'T HAVE CURRENT K-99 BUT SEVEN ACTIVE ROO, WHAT THAT MEANS IS SEVEN PEOPLE GOT THAT AWARD, THEY MOVED ON, FOUND JOBS, NOW THEY'RE WORKING IN THAT SECOND PART OF THEIR GRANTS. THAT IS OUR UNIVERSE OF ACTIVE WORK FORCE INVESTMENT AT THIS TIME. HERE ARE SOME NUMBERS. I -- YOU DO HAVE A PRINTED THING SO YOU DON'T HAVE TO TRY AND READ THIS IF YOU DON'T WANT TO. BUT I WANTED TO THINK ABOUT THE INVESTMENTS, IT'S NOT FAIR TO COMPARE THINGS ANCIENT LIKE FELLOWSHIPS NECESSARILY BUT COSTS WERE DIFFERENT. WE WERE PAYING MORE SUBSTANTIAL PART OF PEOPLE'S SALARIES FOR EXAMPLE. AND OUR CURRENT FELLOWSHIP PROGRAMS THAT ISN'T THE CASE. THE CAREER AWARDS, WE SPENT FOR THOSE FELLOWSHIPS AND CAREERS OVER TIME WE SPENT ABOUT $28 MILLION FOR UNIVERSITY BASED PROGRAMS, FOR THE PERIOD, IT'S $330 MILLION. SO WE HAVE ALWAYS MADE A SUBSTANTIAL INVESTMENT IN WORK FORCE DEVELOPMENT IN OUR FIELD AND IT IS STILL ABOUT 30%, LIKE 25 TO 30% OVER THE LAST DECADE OR SO. THAT MEANS SO IF YOU SUBTRACT YOU'RE SAYING WHERE DOES THE REST OF YOUR MONEY GO? ACCORDING TO 2017, RESEARCH GRANTS AND SMALL BUSINESS GRANTS WERE 69%. THAT MEANS A MINCE SCHOOL AMOUNT WAS LEFT. FOR RESOURCE GRANTS. OUR G GRANTS. SO THIS HAS ALWAYS -- THIS FOR THE LAST TEN YEARS IT HAS BEEN OUR MODEL WE PROTECT -- TRY TO PROTECT AS MUCH AS POSSIBLE THE SUPPORT FOR RESEARCH GRANTS AND SUPPORT FOR TRAINING BUT IT IS A COMPLEX QUESTION TO ASK. WE WERE BUILDING THE FIELD IN BIOMEDICAL INFORMATICS. DO WE HAVE TO BUILD IT AT THIS RATE? I'M NOT SAYING WE SHOULDN'T, ONLY SAYING THAT IT IS THE WAY WE DO IT IS COSTLY T. MAYBE THAT'S FINE. SEW THAT MADE ME THINK ABOUT EVALUATION. FROM BECAUSE DISEASE NOT ONLY MONEY, IT IS ABOUT THE SUCCESS OF THE PEOPLE THAT YOU ARE TRAINING, WHETHER MOVING FIELD FORWARD. ONE OF THE MODELS THAT I HAVE SEEN AT NIH, THIS IS REALLY NOT EVALUATING THE PEOPLE, IT'S -- VALUE WAITING A PROGRAM. YOU SAY OKAY, THEY TOOK THE K-22 PROGRAMS OF 11 INSTITUTES AND THEY COMPARED THE AWARDEES TO PEOPLE WHO DIDN'T GET A K-2 AND 22 AWARD BUT HAD SCORE CLOSE TO THE SAME. THEY THOUGHT IT A FAIR COMPARISON GROUP. THEY JUST CAME OUT SAYING AWARDEES WERE -- HAD MORE SENIOR AUTHORED ARTICLES, AND RECEIVE MORE NIH GRANTS, MORE OF THEM HAD GOTTEN SECURE OR TENURED TRACK POSITION. AND ODDLY UNMENTORRED PROGRAMS MORE SUCCESSFUL AND LEST COSTLY BUT NIH DOESN'T ALLOW THEM ANY MORE. MENTORING IS IMPORTANT. BY OUR STANDARDS. SO I SEE THAT MODEL BUT THAT'S A PROGRAM EVALUATION MODEL AND I DON'T THINK THAT GETS TO THE QUESTION I'M ASKING IF WE SHOULD ASK, WHACK IS THE SUCCESSFUL CAREER PATH LOOK LIKE AND ARE PEOPLE WE'RE TRAINING ON IT. WE HAD TO CONTRACTOR A NUMBER OF YEARS AGO GO BACK AND LOOK AT AND PROPOSE TO US BASED ON WHAT WE COULD SEE OF THE JOBS TRAINEES HAD ACROSS TIME, THE ROLES THEY HAVE TAKEN, WE KNOW TRAINEES GO INTO INDUSTRY, THEY GO INTO ACADEMICS. THEY COME INTO GOVERNMENT, THEY START SMALL BUSINESSES. THEY DON'T ONLY DO ONE THING, THEY MOVE IN AND OUT OF THOSE AREAS. SO THESE THREE AREAS ARE WHAT OUR CONTRACTOR SUGGESTED, BASED ON LOOKING AT SUCCESSFUL CAREERS IN OUR FIELD AT THIS TIME, WE LOOK FOR SEQUENTIAL MILESTONES, SEE IF THEY'RE ADVANCING SCIENCE AND PRACTICE OF OUR FIELD AND ALSO WHETHER THEY WERE TRAINING AND MENTORING THE NEXT GENERATION. Z THOSE WERE PROPOSED. NUMBERS NUMBERS I SHOWED YOU I WAS LOOKING AT SOME ASPECT BUS NOT ALL. BECAUSE WE HAVE A BUNCH OF PEOPLE IN INDUSTRY BUT I DON'T KNOW WHO THEY ARE. WE HAVE PEOPLE WHO GOTTEN GRANTS, WHAT ABOUT CONTRACTS? WHAT ABOUT DARPA, IT'S BIGGER PICTURE WE NEED AND I THINK IMPACT OVER TIME IS EVEN MORE INTERESTING KIND OF QUESTION. SOME SUGGESTED YOU MIGHT WANT TO USE A GROUP, MAYBE A WORK GROUP THAT ACTUALLY LOOK AT SAMPLE. AND ESTIMATE HOW SUCCESSFUL THAT PARTICULAR GROUP HAS BEEN. SO IT'S POINTS TO PONDER I'M SORRY I DON'T HAVE ANSWERS, I'M LOOKING FOR THOUGHTS BECAUSE YOU MAY HAVE SEEN CREATIVE WAYS PEOPLE ADDRESS THIS, WE HAVE A DEEP COMMITMENT AND AS BIG LEVEL INVESTMENT IN WORK FORCE SO WE NEED TO FIND A WAY, I THINK, TO EVALUATE ASPECTS OF IT AND WE CAN EVALUATE BOTH THE PROGRAM IN TERMS OF QUALITY OF PEOPLE THEY GET AND HOW MANY OF THEM GRADUATE AND THINGS LIKE THAT. AND WE CAN ALSO LOOK AT CAREER TRAJECTORY AND THEN WE NEED THE THINK ABOUT POINTS WHEN IT MADE SENSE TO LOOK AT FIVE YEARS TEN YEARS, 15 YEARS. I HAVE NO ANSWERS. THAT IS WHERE I'M LEAVING AND I HOPE YOU HAVE SOME ANSWERS, SOME THOUGHTS ABOUT IT. BECAUSE IT IS A HARD QUESTION BUT WE -- I -- SO WHAT I WOULD PROPOSE TO DO IS WORK WITH EP SUBCOMMITTEE TO TRY AND DRAFT SOME MODEL HOW WE MIGHT DO THIS. WE WELCOME YOUR THOUGHTS. [APPLAUSE] >> DO WE HAVE TIME FOR QUESTIONS? COMMENTS? ANY ANSWERS TO PROVIDE TO VALERIE? >> THIS NOTION OF CAREER TRAJECTORY, I THINK ONE WAY CONFOUND IT IS TO TRY TO DEFINE CASE THAT WOULD REPRESENT FAILED CAREER TRAJECTORY. A LOT IS FOCUSED ON DO THEY GO INTO ACADEMIA, BUSINESS, AND I THINK THOSE DISTINCTIONS ARE PROBABLY LESS ACTIONABLE BECAUSE WHO KNOWS WHO WILL CHANGE THE WORLD FOR THE BETTER. HAPPEN ACTIVITYING ALL OF THEM TOGETHER. BUT WHAT YOU REALLY WANT TO KNOW IS KEEP NLM FROM WASTING ITS RESOURCES. COULD PROVE -- YOU COULD PROVABLY SHOW IT WAS A WASTE OF TRAINING, THEY GAVE SOMETHING WITH THEIR LIFE WHICH IS NOT AT ALL INFLUENCED FAVORABLY. I'M ONLY -- I HAVE ALL THESE -- I ONLY POSIT THAT BECAUSE I'M NOT SURE YOU CAN COME UP WITH THE FAILURES SCENARIO OF WASTED TRAINING. IF YOU CAN'T, THEN THE ANSWER TO THIS IS MOSTLY, WELL, HEAD TO YOUR BEST, MORE IS DEBTOR. TRAINING MORE PEEP -- MORE IS BETTER. TRAINING MORE PEOPLE WITH MORE TALENT IS A GOOD THING AND CONTRIBUTION TO SOCIETY. SO I DON'T KNOW IF YOU LOOKED AT IT THAT WAY OF CATEGORIZING WHAT WOULD BE A FAILED INFORMATICS Ph.D.? DOES IT GAIN -- >> DIDN'T GRADUATE. WE DON'T TRACK THE PEOPLE WHO DON'T GRADUATE. >> SO THAT'S A FAILURE TO ACHIEVE EDUCATIONAL GOAL. >> FAILURE OF TRAINING INVESTMENT IF WE FUND FOR THREE OR FOUR YEARS AND THEY DON'T GRADUATE. >> THAT IS ONE, THAT'S ACTION TELL ME TRICK IT ESSENTIALLY GIVES YOU A MODEL THAT SAYS DON'T START TRAINING THAT KIND OF PERSON BECAUSE WE KNOW THEY'RE NOT GOING TO FINISH. I WONDER ABOUT THOSE WHO CONSUME AWARDS AND GRANTS SUPPORT AND HAVE WONDERFUL YEARS OF EDUCATION AND LOTS OF PARTIES, AND THEN THEY JUST DO SOMETHING THAT'S SEEMS COMPLETELY -- >> OR WHILE WE HAD ONE, OUR TRAINING PROGRAM, WHO IS A MAGICIAN. >> I'M QUITE INTERESTED. IF YOU LOOK CAREFULLY AT THE MONEY YOU SPEND, THIS IS A BIG PORTION, WORK FORCE DEVELOPMENT IS A BIG PORTION OF SCARCE RESOURCE DOLLARS A. WE DON'T KNOW IF RIGHT PROPORTION, MAYBE IT SHOULD BE HIGHER. WE HAVE SPENT A LOT OF TIME LAST YEAR LOOKING AT VISITING INSTITUTIONS AND LOOKING. I AM PARTICULARLY CONCERNED RIGHT NOW ABOUT DEPARTURINGS TO INDUSTRY, NOT BECAUSE OF WASTED TRAINING BUT BECAUSE I DON'T UNDERSTAND -- AND VALERIE HAS ONE METRIC I REALLY LIKE, TRAINING THE NEXT GENERATION. IF WE'RE RECOGNIZING THAT OUR GRADUATES ARE NOT GOING INTO THE -- FOR LOTS OF DIFFERENT REASONS WE NEED TO FIND WAYS TO MAKE SURE THAT TRAINING OF THE NEXT GENERATION STILL HAPPENS IN THEIR WORK PLACE SO NOT CAREER PATH WE EXPECTED BUT IF THEY'RE GOING TO A LINKED N OR START UP OR ANALYTICS FIRM OR DELOITTE, WE CAN STILL FIND A WAY THEY PROVIDE A PATHWAY TO TRAINING FOR OUR TRAINEES, THEY MAY NOT BE ACCELERATING THE RESEARCH BUT MAYBE PROVIDING VALUABLE TRAINING. I WOULD BE HAPPY WITH THAT, RIGHT NOW WE ONLY KNOW THEY DROP OFF. >> IT'S IMPORTANT -- SORRY. IT' IMPORTANT TO NOT SAY GOING TO INDUSTRY IS FAILURE, IT'S NOT A FAILUREMENT -- FAILURE. (INAUDIBLE) COULDN'T POSSIBLY SAY THAT. (OFF MIC) THEY DON'T HAVE A Ph.D. BUT CHANGING HOW WE MOVE THINGS. >> ANOTHER QUESTION THAT'S RELEVANT, PROGRAMS ARE DESIGNED TO PROMOTE CAREER PATHS SO WE HAVE POST-DOCTORAL -- WE HAD INTERESTING, 42% GOT RO1s. THE QUESTION IS HOW MANY TO COMPARE THEM TO POST DOC SUPPORTED ON RO1 GRANTS BECAUSE A LOT OF THEM THERE, POST-DOCS WITH THE F-32 ONLY. YOU KNOW WHAT I MEAN? HOW DOES THIS IMPACT? BECAUSE IF THERE'S NO REAL DIFFERENCE WHY WE DO ALL THE WORK OF HAVING THIS SPECIAL -- >> NIH IS LOOKING AT THAT BROADLY AND THERE'S SOME EVIDENCE THAT TRAINEES SHOULD WRITE THEIR OWN TRAINING GRANT AT SOME POINT IN THEIR PROGRAM. WE GO AFTER THE T THE EARLIER (INAUDIBLE) UNDERSTOOD PENDENT FUNDING AND MORE ENDURING IN INDEPENDENT FUNDING. SO THAT SUGGESTS VERY ODDLY OUR CLUSTERED TRAINING MODEL ISN'T THE RIGHT ONE. >> ONE POINT TO ADD ABOUT THE WAY OTHER INSTITUTES GENERALLY NIH REPORTS INVESTMENT WORK FORCE (INAUDIBLE) BUT THAT IS ONLY IN NRSA PROGRAMS SO WE ALL KNOW WHAT THEY DO IS WHAT YOU JUST SAID, FINISH TRAINING ON SOMEONE'S GRANT. SO TAKE CREDIT FOR THAT? >> I GOT SO FRUSTRATED WITH THIS QUESTION I HAD AN INTERN USE SOCIAL MEDIA TO TRACK EVERYBODY DOWN COMPARE GROUPS. BECAUSE I WAS PERSONALLY WILLING TO SHUT DOWN ONE OF OUR POST-DOC PROGRAMS IF I COULDN'T SEE SOME INDICATION THAT IT WAS HAVING A DIFFERENCE. >> DID YOU FIND SOMETHING? >> IN THE POST-DOC PROGRAM SEEMED TO BE -- WE DID A FOR POST-DOC TRACKS AND SPECIAL AREAS OF BIOLOGICAL SCIENCES. WE COMPARED IT TO POST DOCS NOT RO1 BUT RESEARCH GRANTS, TWO FOLD INCREASE OF FOLKS THAT GOT THEIR OWN GRANTS THAT WENT INTO TEN YOUR TRACK POSITIONS. WE HAD MORE FINELY ANALYZE THAT, IT MIGHT HAVE JUST BEEN THEY GOT SELECTED, I DON'T KNOW IF IT WAS BECAUSE OF THE GRANT BUT -- >> THERE'S BEEN SOME TALK ACROSS NIH THE ISSUE OF SELECTION BIAS. SO ARE WE GETTING PEOPLE WHO WOULD BE GOOD ANYWAY? THEY'RE LOOKING AT SOME PEOPLE CALL THE ANALYSIS. BASICALLY LOOKING AT PEOPLE WHO MISSED FUNDING AND JUST ODE THAT IS SHOWING US ACROSS NIH THAT DISCRIMINATION ISN'T QUITE AS GOOD AS WE LIKE TO BELIEVE OR OUR CUT POINTS AREN'T NECESSARILY SEPARATING GROUPS PROPERLY. >> WHAT IT COMES DOWN TO IS WHAT VALERIE ALLUDED TO RAISED IN PREVIOUS MEETINGS, WE NEED A COMPREHENSIVE SET OF CRITERIA WHAT SUCCESS LOOKS LIKE. MAKING A PRODUCT CHANGING THE WORLD. CREATE FACEBOOK, WHATEVER. MILITARY CONTRACTS. >> SO I THINK WE DO HAVE TO -- I WILL ASK -- NOW THAT WE HAVE THESE WORKING GROUPS, I WILL BE ASKING RESEARCH WORK GROUPS TO TAKE ON TRAINING AT SOME POINT. WE DO NOT TRAIN IN SOME AREAS AND WE DO IN OTHERS AND THESE CHOICES, GREAT DEAL OF RESPONSIBILITY YES IT'S WELL AND GOOD SOMEONE GOES TO INDUSTRY AND CREATES THAT SPACE BUT WE ARE TAKING FEDERAL DOLLARS FOR HEALTH AND WE SHOULD BE ABLE TO SHOW SOME HEALTH IMPACT. WE DON'T TRAIN LIBRARIANS AS MUCH AS WE NEED, WE NEED TO EXPAND DATA SCIENTISTS AT THE DOCTORAL AND POST-DOCTORAL LEVEL AS WELL AS FRANKLY AT THE TECHNICAL LEVEL. HOW DO WE DO THAT? WE WILL BE HAVING MORE DEMANDS ON OUR FUNDS IN THE FUTURE AND WHILE I'M OPTIMISTIC WE ARE GET MORE WE CAN DOUBLE TRAINING IN FIVE YEARS I WOULD BE HAPPY BUT DOUBLING TRAINING IS ONLY 50 MILLION AND THAT'S NOT THAT MUCH. >> PRECISION OF FLAVORS, DOES HARKEN BACK TO OBSERVATION, ALWAYS TELL THE GRADUATE FACULTY GOOD STUDENTS WILL LEARN IN SPITE OF YOU. DOESN'T MATTER WHAT YOUR PEDAGOGUE IS OR YOUR PROGRAMMATIC SUPPOR IN A LOT OF WAYS, THEY'RE JUST GOING TO BECOME SUCCESS WITH OR WITHOUT YOU. >> SO HERE IS ONE OF THE THINGS WE NEED YOU TO THINK ABOUT FOR US. OR WITH US. I MENTIONED IN THE LAST -- IN FEBRUARY, IT'S KIND OF TOUGH TO DO DATA SCIENCE WHEN EVERYBODY AT NIH DOES DATA SCIENCE SO WE GET THIS KIND OF -- WE DON'T NEED A SPECIAL INVESTMENT BECAUSE NHGRI DOES DATA SCIENCE, I BELIEVE WHAT WE SHOULD BE ABLE TO SHOW WITH OUR GRADUATES IS A INDIVIDUAL WHO IS CAPABLE OF DESIGNING SUSTAINABLE REUSABLE STRATEGIES WHETHER IT'S TOOL DEVELOPMENT OR CURATION APPROACHES OR ANALYTICS THAT COULD BE APPLIED IN MULTIPLE AREAS AND ROBUSTNESS IN THIS COMES FROM THE BLENDING OF MEDICAL INFORMATICS IDEAS AND FORMALIZATION TOOLS, WITH THE ANALYTICS I WOULD LOVE TO SAY THAT, I TELL YOU I LOOK AT TRAINING PROGRAMS THAT ARE MORE LIKE WHAT DAN JUST SAID. BRIGHT STUDENTS DOING COOL STUFF, DOING IT IN SPITE OF WHAT WE PUT INTO THEIR CURRICULUM. SO I'LL LOOK FOR YOUR GUIDANCE ABOUT THAT, I DON'T WANT -- I DON'T THINK IT'S PROBLEM WITH TRAINING IN DATA SCIENCE IS ROBUST FOR WHAT WE NEED IN THE FUTURE. >> I GUESS I WOULD THROW ANOTHER QUESTION IN HERE, WE NEVER TOLD UNIVERSITIES WITH WHAT THE CURRICULUM OUGHT TO BE. OR TRACK THEM IN ANY PARTICULAR WAY. BUT MAKING THAT DECISION OF INVESTMENT, JUST LIKE WE'RE TALKING ABOUT FOR OUR GRANTS. THEIR PORTFOLIO AREAS. THAT WE WANT AND THERE ARE NOW EXAMPLES OF CURRICULUM. CORE CURRICULUM FROM -- CORE CURRICULUM WE WORK ON WITH OUR TRAINING GRANTS THAT MIGHT ALLOW US TO DO THAT IF WE WANT. >> WE CAME TO THIS TOE DIFFERENCE BETWEEN ADEQUATE GRADUATE STUDENT AND FUTURE SUPERSTAR, IS THEIR CAPACITY FOR ABSTRACTION. SO ONE WILL FOLLOW CURRICULUM AND LEARN TO USE SET OF TOOLS BUT THE STARS WILL SAY WAIT A MINUTE, I CAN REUSE THAT, THEY ALL DO ASSOCIATION CREATIVE ASSOCIATIONS THAT ARE BASED ON CAPACITY TO TAKE INSTANCE AND CREATE A GENERALIZABLE EXTRACTS FROM THAT. -- EXTRACTION FOR THAT AND WE RECOGNIZE IT WHEN IT OCCURS. >> SPEAKING AS PERSON (INAUDIBLE) >> OKAY. THANK YOU VERY MUCH. THANK YOU VERY MUCH, VALERIE, WE HAVE NOW REACHED THE POINT IN OUR DISCUSSION WHERE IT'S CLOSED PORTION SO ALL NON-OFFICIAL MEMBER HEARSAY OF THE BOARD ARE -- ASKED TO LEAVE.