>> WELCOME. I'D LIKE TO CALL TO ORDER THE 53rd MEETING OF THE NIH ADVISORY ON RESEARCH ON WOMEN'S HEALTH. I AM SAMI NOURSI AND THIS IS OPEN FOR LIVE BROADCAST ON THE NIH VIDEOCAST NETWORK AND RECORDED FOR FUTURE ARCHIVE AND ON DEMAND VIEWING FROM THE PUBLIC. IF YOU'RE A MEMBER OF THE PUBLIC, PER THE FEDERAL REGISTER NOTICE YOU MAY SUBMIT YOUR QUESTIONS IN WRITING TO ME AT SAMIA.NOURSI@NIH.GOV WE'RE ALL PARTICIPATING REMOTELY. THE ADVISORY COMMITTEE AND THE INVITED GUEST PRESENTERS ARE PARTICIPATING THREW WEBEX. -- THROUGH WEBEX. NOW FOR OUR MEMBERS. AS MEMBERS OF THIS FEDERAL ADVISORY COMMITTEE YOU ARE SPECIAL GOVERNMENT EMPLOYEES. WHAT WE CALL SGE. IT MEANS YOUR SUBJECT TO THE SAME ETHIC RULES THAT APPLY TO GOVERNMENT EMPLOYEES. THESE RULES ARE DESCRIBED IN THE PAMPHLET ENTITLED STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH. YOU RECEIVED A COPY OF THE DOCUMENT WHEN YOU WERE APPOINTED. AT EVERY MEETING WE LIKE TO REVIEW THE STEPS WE TAKE AND THE PROCESS WE FOLLOW TO IDENTIFY AND ADDRESS ANY CONFLICT BETWEEN THE PUBLIC RESPONSIBILITIES AND YOUR PRIVATE INTEREST AS YOU KNOW, BEFORE EVERY MEETING, YOU PROVIDE US WITH A GREAT DEAL OF INFORMATION ABOUT YOUR PROFESSIONAL, PERSONAL AND FINANCIAL INTEREST AND USE THIS AS THE FOUNDATION FOR ASSESSING WHETHER YOU HAVE ANY REAL POTENTIAL OR APPARENT CONFLICTS OF INTEREST THAT COULD COMPROMISE YOUR ABILITY TO BE OBJECTIVE IN GIVING ADVICE DURING COMMITTEE MEETINGS. IF THE NEED FOR THE INDIVIDUAL SERVICES OUTWEIGHS THE POTENTIAL CONFLICT OF INTEREST WE HAVE IDENTIFIED, WE WOULD ISSUE A WAIVER OR RECUSE YOU FROM A PARTICULAR PORTION OF THE MEETING. WE USUALLY WAVE CONFLICTS OF INTEREST FOR GENERAL MATTERS BECAUSE WE BELIEVE YOUR ABILITY TO BE OBJECTIVE WILL NOT BE AFFECTED BY YOUR FINANCIAL INTERESTS. WE ALSO RELY A GREAT DEAL ON YOU. YOU NEED TO BE ATTENTIVE DURING MEETINGS TO THE POSSIBILITY AN ISSUE COULD APPEAR TO AFFECT YOUR FINANCIAL INTEREST WITH RESPECT TO A SPECIFIC PARTY OR MATTER. IF THIS HAPPENS, YOU'LL BE ASKED TO RECUSE YOURSELF FROM THAT PORTION OF THE MEETING. BEFORE INTRODUCTION, I'LL BRIEFLY REVIEW BEST PRACTICES FOR OUR WEBEX PARTICIPANTS. PLEASE MUTE YOUR MIC IF YOU ARE NOT SPEAKING. WHEN SPEAKING, PLEASE STATE YOUR NAME BEFORE MAKING COMMENTS, MOTIONS OR RECOMMENDATIONS. TRY TO USE A HEADSET ON MIC WHEN SPEAKING THAT WILL USUALLY RESULT IN A CLEARER SOUND AND PROVIDE THE LEAST AMOUNT OF AUDIO FEEDBACK. TURN OFF YOUR VIDEO IF YOU ARE NOT SPEAKING TO PRESERVE INTERNET BANDWIDTH. IF YOU HAVE A QUESTION OR WOULD LIKE TO MAKE A COMMENT UTILIZE THE CHAT FEATURE. THE WEBEX CHAT WILL BE KEPT AS PART OF THE OFFICIAL MEETING RECORDS. WE WILL BE VOTING WITH THE WEBEX POLLING FUNCTION DURING A VOTE AND MULTIPLE CHOICE QUESTION WITH YES AND NO DISPLAY ON THE RIGHT SIDE OF YOUR SCREEN. PLEASE SELECT YOUR RESPONSE AROUND CLICK SUBMIT. ADDITIONAL GUIDANCE IS AVAILABLE ON THE WEBEX PARTICIPANT GUIDE YOU WERE SENT PRIOR TO THE MEETING. I WOULD LIKE NOW TO WELCOME OUR NEWEST ACWRH MEMBERS. [LISTING NAMES] WELCOME. WE LOOK FORWARD TO WORKING CLOSELY WITH YOU IN THE COMING YEARS. AS I GO THROUGH THE ROSTER, AS YOU HEAR YOUR NAME UNMUTE YOURSE YOURSELF AND INTRODUCE YOURSELF BY NAME AND THE INSTITUTION YOU REPRESENT. DR. BREWSTER. >> WENDY BREWSTER, UNIVERSITY OF NORTH CAROLINA, CHAPEL HILL. >> THANK YOU. >> I'M FROM THE UNIVERSITY OF FLORIDA. >> DR. GELLAR. >> DR. GELLAR, UNIVERSITY OF ILLINOIS AT CHICAGO. >> THANK YOU. DR. HOLMGREN. >> WASHINGTON UNIVERSITY, ST. LOUIS. >> THANK YOU. >> UNIVERSITY OF MICHIGAN IN ANN ARBOR. >> THANK YOU. >> DR. KLEIN. >> I'M SORRY, I'M HEAR STRUGGLING TO GET MY VIDEO ON. HI. I'M A PROFESSOR OF MOLECULAR MICROBIOLOGY AT THE JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH. >> THANK YOU. DR. LANGAR. >> I'M A PROFESSOR AT THE HARVARD SCHOOL OF PUBLIC HEALTH. >> THANK YOU. FOR THOSE WHO INTRODUCED YOURSELF, MUTE YOUR MIC I HEAR A LOT OF BACKGROUND IF YOU'RE NOT SPEAKING. DR. McCARTHY. OKAY. DR. McCULLOUGH. >> GOOD MORNING. I'M FROM THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER IN HOUSTON. DR. McGREGOR. >> DR. McGREGOR HASN'T JOINED YET. AMY POLLER PROFESSOR OF DERMATOLOGY AND PEDIATRICS. I APOLOGIZE FOR THE NOISE IN THE BACKGROUND. >> THANK YOU. >> I'M DIRECTOR OF WOMEN'S HEALTH RESEARCH. >> DR. REYES. >> THEY HAVE NOT JOINED YET. >> DR. ROBINSON. >> GOOD MORNING I'M FROM THE UNIVERSITY OF ALABAMA AT BIRMINGHAM. >> DR. SODOSKI. >> I'M THE EXECUTIVE DIRECTOR OF McGEE WOMEN RESEARCH INSTITUTE AT THE UNIVERSITY OF PITTSBURGH. >> THANK YOU. DR. SHAW. >> HI, NEIL SHAW OB STET RICKS AND GIYNECOLOGY AT HARVARD MEDICAL SCHOOL. >> THANK YOU. DR. TEMPLETON. >> PROFESSOR OF ORTHOPEDIC SURGERY AT THE UNIVERSITY OF KANSAS AND PAST PRESIDENT OF THE AMERICAN WOMEN'S MEDICAL ASSOCIATION. >> THANK YOU. DR. WOOD. >> I'M SUSAN WOOD PROFESSOR OF HEALTH POLICY AND MANAGEMENT AT THE GEORGE WASHINGTON SCHOOL OF PUBLIC HEALTH. >> DID ANYONE JOIN AFTER I READ ALL NAMES? >> WE HAVE ONE MORE HOUSEKEEPING ITEM BEFORE MOVING ON WITH THE MEETING. YOU WERE SENT THE MINUTES FROM THE LAST MEETING ON NOVEMBER 2 FOR YOUR REVIEW I YOU HAD A CHANCE TO REVIEW IT. IS THERE A MOTION ON THE TABLE TO ACCEPT THE NOVEMBER 2, 2020 MINUTES AS WRITTEN? >> I MOVE. >> WHO WAS THAT? >> JUDY REGGENSTEINER. >> THANK YOU. DO I HEAR A SECOND. >> SECOND. DR. KLEIN. >> THANK YOU. IT'S OPEN FOR YOU IF YOU ARE IN FAVOR, OPPOSED OR ABSTAIN. YOU'LL HAVE 30 SECONDS TO RESPOND. >> DO WE HAVE THE VOTES? >> 13 IN FAVOR. >> THE NOVEMBER 2, 2020 MEETING MINUTES HAVE BEEN ACCEPTED WITH 13 IN FAVOR. NOW I'D LIKE TO INTRODUCE THE CHAIR OF THIS COMMITTEE AND DIRECTOR OF ORWH DR. JANINE CLAYTON. >> GOOD MORNING, EVERYBODY. THANK YOU FOR BEING HERE TO OUR ADVISORY COMMITTEE MEMBERS. DELIGHTED TO SEE YOU AND ALL THOSE ATTENDING. I'M PLEASED TO INTRODUCE -- WE'LL GO RIGHT INTO THE FIRST SPEAKER, DR. MARIE BERNARD SPEAKING ON THE NIH UNITE INITIATIVE. IT'S MY PLEASURE TO INTRODUCE DR. BERNARD. SHE SERVES AS THE DEPUTY DIRECTOR OF THE NATIONAL INSTITUTE ON AGING AND SHE IS NIH'S AND NIAA'S GERIATRICIAN SERVING AS A PRINCIPLE ADVISER AND SERVING IN THE DEPARTMENT OF WORKFORCE DIVERSITY. SHE HAS CO-CHAIRED OBJECTIVES AND OLDER ADULTS AND DEMENTIA'S INCLUDING ALZHEIMER'S DISEASE. IT'S A MY HONOR TO CO-CHAIR AT THE INCLUSION GOVERNANCE COMMITTEE OVERSEES CLINICAL RESEARCH BY SEX AND GENDER AND ETHNICITY BY AGE INCLUSIVE OF PEDIATRIC AND ADULT SUBJECTS. SHE CHAIRS THE WOMEN OF COLOR COMMITTEE ON THE NIH COMMITTEE OF WOMEN ON BIOMARKER CAREERS AND WAS A FOUNDING MEMBERS OF THE EQUITY COMMITTEE. DR. BERNARD HAS BEEN RECOGNIZED FOR HER LEADERSHIP WITH THE 2020 NIH DIRECTOR'S AWARD FOR EQUITY, DIVERSITY AND INCLUSION. UNTIL OCTOBER, 2008 DR. BERNARD WAS THE ENDOWED PROFESSOR OF THE FOUNDING CHAIR OF THE OKLAHOMA COLLEGE OF MEDICINE AND ASSOCIATE CHIEF OF STAFF FOR GERIATRICS AND EXTENDED CARE AT THE OKLAHOMA CITY VETERANS AFFAIRS MEDICAL CENTER. SHE'S HAD NUMEROUS NATIONAL LEADERSHIP ROLES AND LECTURED AND PUBLISHED WIDELY IN HER AREAS OF RESEARCH INCLUDING NUTRITION AND FUNCTION IN OLDER POPULATIONS WITH A SPECIAL FOCUS ON UNDER REPRESENTED MINORITIES AS IT RELATES TO GERIATRICS AND ALSO IN GERIATRIC EDUCATION. AND DR. BERNARD RECEIVED HER UNDERGRADUATE DEGREE AND MD FROM THE UNIVERSITY OF PENNSYLVANIA AND TRAINED AT TEMPLE IN INTERNAL MEDICINE SERVING AS CHIEF RESIDENT AND RECEIVED NUMEROUS AWARDS AND ACCOLADES AND IT'S MY PLEASURE TO INTRODUCE DR. MARIE BERNARD. WELL C WELCOME. >> THANK YOU. IT'S MY PLEASURE TO HAVE AN OPPORTUNITY TO TALK TO YOU AND BEING THE INDEPENDENT SOUL I AM I'LL ADVANCE MY OWN SLIDES AND WANT TO MAKE SURE YOU'RE ABLE TO SEE THEM. THANK YOU. I'LL GET THE LASER POINTING GOING BECAUSE THERE'S SOME THINGS I'D LIKE TO POINT OUT. AS DR. CLAYTON SAID I GET TO WEAR SEVERAL HATS THESE DAYS AND SPEAKING TO YOU TODAY AS CO-CHAIR OF THIS NEW INITIATIVE UNITE LAUNCHED PUBLICLY FEBRUARY 26 AT A SPECIAL MEETING WITH THE ADVISORY COMMITTEE TO THE DIRECTOR. SO HOW DOES THIS COME ABOUT? THIS CAME ABOUT BECAUSE THE EVENTS OF 2020 BROUGHT INTO SHARP RELIEF THE ONGOING REALITY OF RACIAL INJUSTICE IN OUR COUNTRY AND IT DIDN'T END IN 2020. THE HORRIBLE MURDERS IN ATLANTA JUST LAST MONTH DEMONSTRATE THERE'S A RESPONSIBILITY FOR YOU WILL OF US TO ADDRESS THESE ISSUES. THERE WERE A SERIES OF INTENSE INSTITUTE CENTERED DIRECTOR MEETINGS FROM JUNE ONWARD TO IDENTIFY INITIAL ISSUES. THERE WERE MEETINGS WITH A COUPLE SELF-ASSEMBLED AFFINITY GROUPS ONE CALLED ACRE AND ANOTHER COMPOSED OF SENIOR AFRICAN AMERICAN AND BLACK SIGN TIFS, MEETINGS -- SCIENTISTS AND A STEERING COMMITTEE HERE AT NIH FOR CANDID DISCUSSIONS ABOUT MOVING FORWARD IN AN INFORMED FASHION. IT LED TO A SHARED COMMITMENT TO ADDRESS STRUCTURAL RACISM. A CLEAR SENSE WE CANNOT LET THIS PIVOTAL MOMENT PASS. WHAT WERE SOME OF THE ISSUES IDENTIFIED WE MUST ENSURE BIOMEDICAL RESEARCH AND THE ADMINISTRATIVE SYSTEM IS DEVOID OF HOSTILITY GROUNDED IN RACE, SEX AND OTHER FEDERALLY PROTECTED CHARACTERISTICS. IN THIS NEW INITIATIVE WE'RE COMMITTING TO DELINEATE ELEMENTS THAT PERPETUATE STRUCTURAL RACISM WITHIN NIH WHETHER IT'S OUR SCIENTIFIC STAFF OR PEOPLE WHO DO NOT IDENTIFY SCIENTIFIC STAFF AND IN THE EXTRAMURAL COMMUNITY ANYTHING THAT LEADS TO LACK OF PERSONNEL, INCLUSIVENESS, EQUITY AND DIVERSITY. WE BELIEVE ALL IDEAS MUST BEGIN IN EQUAL AND FAIR REVIEW WITHOUT REGARD TO THE DOMINANT PARADIGM OF WHO IS PRESENTING THE IDEAS. AS COVID-19 MADE PAINFULLY CLEAR WITH DISPARITIES AND INEQUITIES IN HOSPITALIZATIONS AND DEATH RATES FOR INDIAN AMERICANS AND OTHERS THERE'S A LOT CONTRIBUTING TO MORBIDITY AND MORTALITY AND NEED TO ADDRESS THE FUNDAMENTAL CLAUSES AND COME UP WITH EFFECTIVE INTERVENTIONS. ON FEBRUARY 26 WE ANNOUNCED FIVE INTERRELATED WORK STREAMS THAT ARE DESIGNED TO ADDRESS THIS AND THIS IS WHERE THE NAME COMES FROM. THERE'S A COMMITTEE OR WORKING GROUP LOOKING AT UNDERSTANDING STAKEHOLDER EXPERIENCES THROUGH LISTENING AND LEARNING. A GROUP LOOKING AT NEW RESEARCH IN HEALTH DISPARITIES AND MINORITY HEALTH AND HEALTH EQUITY, ANOTHER GROUP LOOKING INTERNALLY WITH THE UNDERSTANDING WE NEED TO BE AN EXEMPLAR FOR THE OUTSIDE SCIENTIFIC WORLD. A GROUP LOOKING AT OUR BEING TRANSPARENT AND ACCOUNTABLE AND COMMUNICATE WHAT WE'RE DOING AND ANOTHER GROUP LOOKING EXTERNALLY AT THE EXTERNAL ECO SYSTEM AND WHAT THESE TO BE CHANGED THERE. S THE U GROUP IS TO DELINEATE ALMOSTS THAT LEAD TO LACK OF DIVERSITY, EQUITY AND INCLUSION WITHIN NIH AND EXTERNALLY. THEY'VE BEEN VERY BUSY. THEY'VE BEEN GATHERING DATA. THEY SOLICITED INFORMATION INTERNALLY FROM EACH OF THE INSTITUTES AND CENTERS AND PUBLISHED A REQUEST FOR INFORMATION THAT WENT OUT MARCH 1, THEFUL -- THE MONDAY AFTER THE FROM -- FRIDAY WE ANNOUNCED THIS AND WE HEARD FROM SOCIETIES THEY NEEDED EXTRA TIME TO GIVE A MEANINGFUL RESPONSE. IF YOU HAVE NOT HAD AN OPPORTUNITY TO RESPOND THERE'S STILL TIME. THE "N" COMMITTEE AND GLAD DR. CLAYTON IS A LEADER AND NOT OFFICIALLY A CO-CHAIR BUT LEADING A BIG EFFORT IS CHARGED WITH ADDRESSING LONG STANDING HEALTH DISPARITIES AND ISSUES RELATED TO MINORITY HEALTH TO CONVIENENCE -- ADVANCE HEALTH EQUITY FOR ACCOUNTABILITY AND SUSTAINABILITY. OUT OF THE GATE, THE GROUP PROPOSED A COMMON FUND INITIATIVE ON INNOVATION AND TRANSFORMATION TO HELP DISPARITIES RESEARCH WITH THE GOAL THAT FUNDING OPPORTUNITY ANNOUNCEMENT BEING RELEASED MARCH. THAT'S REALLY FAST FOR NIH. THEY DID IT. THEY'RE LOOKING AT PORTFOLIOS OF NIH WIDE STAKEHOLDERS. THEY'RE LOOKING AT ACCURATE ANALYSIS OF OUR INVESTMENTS IN THIS AREA. AS YOU KNOW, WE HAVE THE RCDC SYSTEM FOR ACCOUNTING FOR THINGS SOME 234 CATEGORIES. IT'S A COMPUTER-BASED ALGORITHM THAT LOOK AT THE ABSTRACT AND SPECIFIC AIMS TO CATEGORIZE PROJECTS AND HAVE NOT BEEN SUCCESSFUL IN THAT COMPUTERIZED ACCOUNTING FOR HEALTH DISPARITIES SO IT'S A MANUAL ACCOUNTING THAT GETS REPORTED AND THERE'S INTEREST HOW IT CAN BE MADE EFFICIENT TO MAKE SURE THERE'S NO GAPS OR OVER COUNTING. AND A PROPOSAL FOR ANOTHER COMMON FUND INITIATIVE. BOTH WERE APPROVED AT THE FEBRUARY 26 ADVISORY COMMITTEE TO THE DIRECTOR MEETING AND DR. CLAYTON IS LEADING THIS EFFORT. AND LOOKING AT THE CULTURE AND STRUCTURE TO PROMOTE EQUITY AND INCLUSION FOR ALL STAFF REGARDLESS OF THE STAFF CATEGORIZATION. THIS GROUP, I GET TO CO-LEAD THIS AS WELL AS THE OVERALL INITIATIVE WITH DR. ALFRED JOHNSON AND NOW DR. ARCHER FROM OUR INTRAMURAL PROGRAM PART OF THE DATA OF THE WORKFORCE FULL TIME EMPLOYEE EQUIVALENTS. IN BLUE YOU SEE HISPANICS OR LATINOS AND GREEN NON HISPANIC WHITES AND YELLOW AFRICAN AMERICANS AND BLACKS, REDS, ASIANS AND GRAY, ALASKAN NATIVE AND PACIFIC ISLANDER AND MORE RACES. THAT'S OVERALL. THAT HONESTLY IS NOT ALL OF NIH BECAUSE WE HAVE LOTS OF CONTRACTORS AND TRAINEES BUT THESE ARE THE FULL-TIME EMPLOYEES. HOWEVER, WHEN YOU LOOK AT VARIOUS JOB CATEGORIZATION SERVINGS A NURSE OR LAB TECHNICIAN OR INFRASTRUCTURE ROLE SUCH AS PROGRAM ANALYST OR GRANTS ANALYST, THERE ARE DIFFERENCES IN THE DISTRIBUTION AND THIS COMMITTEE IS LOOKING CAREFULLY TO SEE WHAT SORTS OF BARRIERS THERE MIGHT BE TO PEOPLE MOVING IN WITHIN THE RANK AND WHY THERE WOULD BE DIFFERENCES. INTERESTED IN MANY ROLES AND THE TOP FIVE POSITIONS. SOME THINGS BEING DONE IS A CAMPAIGN TO REPORT RACIST ACTIONS, EXPAND REG -- SCANNING RECRUITMENT AND THOSE IN SENIOR ROLES AND A STEERING COMMITTEE I'LL ELABORATE ON LATER AND WE'RE WORKING AND APPOINTING AN INCLUSION OFFICER OR EQUIVALENT POSITION TO MAKE SURE WE TRACK ADVANCE AND COORDINATE SPECIFIC ACTIVITIES WITHIN EVERY INSTITUTE AND CENTER TO FOSTER DIVERSITY. THE E COMMIT IS TASKED WITH PERFORMING A BROAD SYSTEMATIC EVALUATION OF NIH EXTRAMURAL PROCESSES TO IDENTIFY AND CHANGE PRACTICES AND STRUCTURES THAT PERPETUATE LACK OF INCLUSIVITY AND AWARE OF THESE AND THE OFFICER WAS ROLLED IN DESIGNED IN RESPONSE TO THE GINTER RECORD IN 2011 THAT SHOWED A GAP IN THEIR ANALYSIS AND MULTIPLE UNDER REPRESENTED GROUPS HAD CHALLENGES BUT WHEN YOU CONTROLLED FOR ENGLISH AS A FIRST LANGUAGE, EDUCATION, INSTITUTION, ETCETERA, THE GAPS SEEM TO GO AWAY FOR ALL GROUPS EXCEPT FOR AND -- AFRICAN AMERICANS AND BLACKS AND FRANCIS COLLINS LOOKED TO HOW TO BEST APPROACH THIS AND A NUMBER OF THINGS TO PUT IN PLACE INCLUDING THE ESTABLISH MANY OF THE CHIEF OFFICER FOR THE WORKFORCE DIVERSITY AND DR. VALENTINE SERVED IN THE ROYAL AND I'VE HAD THE PRIVILEGE OF BEING THE ACTING PERSON SINCE THAT TIME. AS DR. VALENTINE ARRIVED SHE LOOKED AT THE DATA AND STILL THE NUMBERS WERE NOT VERY ENCOURAGING. A SMALL NUMBER OF APPLICANTS IN 2013 WERE AFRICAN AMERICAN OR BLACK, A SMALL NUMBER OF HISPANICS AND SMALL NUMBER IN ASIANS EXCEPT FOR NON-HISPANIC WHITES AND YOU DON'T SEE AMERICAN INDIANS OR ALASKAN NATIVES SHOWN HERE BECAUSE THE NUMBERS ARE SO VERY SMALL. IN 2020 I ASKED THESE DATA BE UPDATED AND WE SEE SUCCESS RATES HAVE GOTTEN BETTER AND THERE'S A SUCCESS RATE FOR AFRICAN AMERICANS AND BLACKS UP TO 23.6% SUCCESS RATE BUT STILL A GAP. I POINT OUT THE NUMBERS ARE VERY SMALL ONLY 166 AND AGAIN, AMERICAN INDIANS AND ALASKAN NATIVES YOU FINALLY SEE A BAR BUT A LOT OF WORK THAT CAN AND NEEDS TO BE DONE. THIS SAY COMMITTEE WORKING HARD TO GET THEIR ARMS AROUND A LARGE CHARGE THEY'VE AGAIN GIVEN AND LOOKING AT DATA AND LOOKING AT THE TRANSPARENT AND DEMOGRAPHICS RECORDED IN THE DATA BOOK. AS THEY SAY SUNSHINE IS THE GREATEST DISINFECTANT AND WE'LL LOOK AT CULTURE AND NIH PROCESSES AND THINGS THAT CAN BE DONE WITH MINORITY SERVING INSTITUTIONS TO HELP ADDRESS THE DISPARITIES BEING SEEN. THEN FINALLY THE "T" COMMITTEE IS COMMUNICATING AND MAKING US ACCOUNTABLE AND LOOKING AT SUSTAINABLE EFFORTS. THEY ARE THE GROUP THAT LED THE DEVELOPMENT OF OUR WEB PAGE. HOPEFULLY YOU'VE BEEN ABLE TO LOOK AT ENDING STRUCTURAL RACISM AT NIH.gov OR JUST UNITE WILL TAKE YOU DIRECTLY TO IT AND WORKING ACROSS NIH WHEN WE DO RETURN TO THE PHYSICAL WORKPLACE, THE WAY THINGS LOOK WHEN YOU GO INTO THE NIH DIRECTOR'S BUILDING, BUILDING 1 OR CLINICAL CENTER OR WHERE THEY HAVE ADMINISTRATIVE SPACE, THERE'LL BE MORE VARIANCE AND THE COMMITMENTS MADE FEBRUARY 26 WERE WE WERE GOING TO PUBLICLY COMMIT TO IDENTIFYING AND CORRECTING ANY NIH POLICIES OR PRACTICE THAT MAY HAVE PERPETUATED STRUCTURAL RACISM AND CONTINUE TO AGGRESSIVELY IMPLEMENT APPROACHES TO ADDRESS THE GINTER GAP AND ADDRESS PORTFOLIO DIVERSITY AND LAUNCH A MULTI PHASED TIERED COMMON FUND INITIATIVE TO ADDRESS DISPARITIES AND A COMMITMENT TO FUNDING ANNOUNCEMENTS UNDER DEVELOPMENT AT THE TIME TO ADDRESS STRUCTURAL RACISM AND WE WERE GOING DEVELOP SUSTAINABLE PROCESSES TO SYSTEMATICALLY GATHER AND MAKE PUBLIC THE DEMOGRAPHICS OF OUR INTERNAL AND EXTERNAL WORKFORCE. THINGS THAT WERE SPECIFIC TO US WERE IMPLEMENT POLICY CHANGES TO PROMOTE ANTI-RACISM AND REMOVE BARRIERS FOR PROFESSIONAL GROWTH AND HAVE AN EQUITY AND INCLUSION OFFICER AT EVERY CENTER TO ADVANCE AND COORDINATE OUR EFFORTS. WE WERE GOING TO EXPAND SOMETHING CALLED THE DISTINGUISHED SCHOLARS PROGRAM IN OUR TENURED TRACK PROGRAM TO INCLUDE SENIOR INVESTIGATORS. ON THAT DAY AND FRANCIS COLLINS SAID TO THOSE INDIVIDUALS IN THE BIOMEDICAL ENTERPRISING, WE'RE SUPPORTING DIVERSITY AND INCLUSION AND IDENTIFYING AND DISMANTLING ANY POLICIES AND PRACTICES AT OUR OWN AGENCY THAT MAY HARM OUR WORKFORCE AND OUR SCIENCE. THERE'S BEEN A NUMBER OF ACTS TO SEM STRAIGHT THE RFI HAS BEEN PUBLISHED AND THE DEADLINE EXTENDED TO APRIL 23. THE COMMON FUND INITIATIVE APPROVED OF CONCEPTS, MARCH 26 THERE WERE TWO FUNDING OPPORTUNITY ANNOUNCEMENTS RELEASED RELATED TO IT. ONE IN GENERAL TO LOOK AT TRANSFORMED RESEARCH TO ADDRESS HEALTH DISPARITIES AND ANOTHER FOCUSSING ON MINORITY SERVING INSTITUTIONS UP TO $24 MILLION COMMITTEE -- COMMITTED TO THIS AND THE FUNDING ANNOUNCEMENT ON STRUCTURAL RACISM GOT RELEASED MARCH 23 AND THERE WERE 22 INSTITUTES AND CENTERS AND OFFICES THAT COMMITTED TO IT AND APPROACHING $31 MILLION FOR THE VARIOUS INITIATIVES THAT END UP GETTING FUNDED. THE NATIONAL INSTITUTE OF MEDICAL SCIENCES PUT IN A NOSI LOOKING AT THE IMPACT OF STRUCTURAL RACISM ON BIO MEDICAL CAREER PROGRESSION AND ENTERPRISING AND THE BRAIN INITIATIVE A NIH WIDE COALITION OF INSTITUTES THAT LOOK AT CENTRAL NEURAL SYSTEM SORTS OF PROBLEMS ARE LISTED HERE PUT FORWARD A NEW FUNDING OPPORTUNITY ANNOUNCEMENT JUST IN THE LAST WEEK THAT HAS DIVERSITY AS A SCORE DRIVING CRITERION IN ITS REVIEW. EVERYONE IS INTERESTED HOW THIS PLAYS OUT AND MAY SET A PRECEDENT GOING FORWARD. AS I MENTIONED, INTERNALLY WE HAVE INITIATIVE -- INITIATED AN ANTI-RACI ANTI-RACI ANTI-RACISM INITIATIVE AND FROM THE FIRST MEETING WE MADE IT CLEAR WE WANTED TO HEAR FROM EVERYONE AND PEOPLE TO FEEL SAFE. IT'S NOT MEANT TO TAKE THE PLACE OF ALREADY ESTABLISHED GROUPS. WE HAVE. OUR OFFICE IS CALLED OFFICE OF EQUITY, DIVERSITY AND INCLUSION AND THIS COMMITTEE IS NOT MEANT TO TAKE THE PLACE OF THAT. THIS IS INTENDED TO HELP US LOOK OBJECTIVE IN WHAT WE'RE SEEING IN TERMS OF PATTERNS AND CONCERNS ABOUT RACISM AND WHAT SORTS OF POLICIES AND PROCEDURES NEED TO BE MODIFIED OR ALTERED IF INDICATED. I'LL CLOSE OUT WITH THE QUOTE FROM MARTIN LUTHER KING, INJUSTICE ANYWHERE IS A THREAT TO JUSTICE EVERYWHERE. IT'S OUR VIEW AS WE STEP BACK AND TRY TO MAKE THE ENVIRONMENT A MUCH MORE EQUITABLE ENVIRONMENT FOR ALL INTERNALLY AND EXTERNAL, EVERYONE IS GOING TO BENEFIT. I'LL CLOSE WITH THIS THAT SHOWS THE 75 PLUS PEOPLE PART OF THE UNITE INITIATIVE. THE INTENT WAS TO GET SOMEONE FROM EVERY INSTITUTE AND CENTERS AND PEOPLE FROM INSTITUTE DIRECTORS TO PROGRAM ANALYSTS, A WIDE VARIETY OF EVALUATES RAIL RAIL -- REAL ATTENTION TO THE CO-CHAIRS OF THE VARIOUS SUBCOMMITTEES. NOT THE USUAL SUSPECTS AND IT'S BEEN EDIFYING TO HEAR THE VIEW POINTS HOW TO GO FORWARD IN DEALING WITH THE ISSUES AT HAND. I'M HAPPY TO STOP AND ANSWER QUESTIONS PEOPLE MAY HAVE. >> THANK YOU FOR THE WHIRLWIND WHEN REFLECTS HOW IT'S FELT ON THE INITIATIVES FOCUSSING ON DISPARITIES. >> THANK YOU FOR THE WONDERFUL OVERVIEW. IT SEEMS THERE'S A BOTTLENECK IN GETTING MINORITIES INTO POSITIONS INTO ELIGIBILITY. WONDERING IF WE CAN GET KIDS INTERESTED AT A YOUNG AGE SO THEY CAN TAKE THE TRAJECTORY THAT WOULD ALLOW THEM TO BE ACCESSIBLE TO THESE SORTS OF POSITIONS. >> GREAT QUESTION. THERE'S BARRIERS AT EACH STEP OF THE WAY IN PEOPLE PROGRESSING THROUGH THE SCIENCES AND THOSE TEND TO BE HIGHER FOR INDIVIDUALS FROM UNDER REPRESENTED GROUPS OFTEN TIMES THAN OTHERS BECAUSE OF CHALLENGES WITH RESOURCES IN THE EDUCATIONAL SYSTEM AND OPPORTUNITY TO ACCESS MENTORS AND WE AT NIH HAVE BEEN WORKING LONG AND HARD TO HELP SMOOTH OUT THE BARRIERS. IT'S INTERESTING, WHEN YOU LOOK AT THE DATA AND HIGH SCHOOL SENIORS AS THEY GRADUATE AND PEOPLE AS THEY START ENTERING COLLEGE YOU'LL SEE INDIVIDUALS WHO EXPRESS INTEREST IN A SCIENTIFIC CAREER. MANY PEOPLE WHO ARE FROM TRADITIONALLY UNDER REPRESENTED GROUPS BEING PART OF THAT. THEN AS YOU START LOOKING AT PEOPLE AS THEY GRADUATE FROM COLLEGE, THE NUMBER GOES DOWN AS YOU LOOK AT THE NUMBERS WHO ENTER GRADUATE SCHOOL AND GRADUATE IT GOES PROGRESSIVELY DOWN. CLEARLY THERE ARE BARRIERS ALONG THE WAY. WE'RE INTERESTED IN DOING EVERYTHING WE CAN TO IDENTIFY AND REMOVE THE BARRIERS AND THEY VARY FROM INDIVIDUAL ISSUES AND PERSONAL RESOURCES AND PERHAPS CALLED STEREOTYPE THREAT NOT SEEING PEOPLE LIKE THEMSELVES AND NOT NECESSARILY BELIEVING THEY SHOULD BE THERE TO THINGS GOING ON AROUND THEM BY OTHERS. UNINTENDED THREATS AND MICROAGGRESSIONS AND LACK OF OUTREACH FROM MENTORING TO THINGSMICRO AGGRESSIONS AND LACK OF OUTREACH FROM MENTORING TO THINGS GOING ON INSTITUTIONALLY ABOUT WHO CAN GET WAY IN THE WAY OF SUPPORT AND WHAT'S GOING ON SYSTEMATICALLY THROUGHOUT THE NATION. WE'RE WORKING ON IT. IT WON'T BE A QUICK FIX OR ONE THING BUT WE'RE INTERESTED IN MAKE A DIFFERENCE. >> THANK YOU. >> JANINE. >> THIS IS STASY GELLAR. >> OKAY. AND THEN DR. RIOS. >> THE PROGRESS IS SLOW BUT TIS HAPPENING SO I THINK WE SHOULD TAKE SOME PRIDE IN THAT. I'M GOING SUGGEST HIGH SCHOOL'S EVEN LATE. WE HAVE TO START MUCH EARLIER IN GRADE SCHOOL AND PRESCHOOL MAKE THE POSSIBLE FOR PRESCHOOL TO HAPPEN AND THINK OF CHILDREN'S SAVINGS ACCOUNTS WHICH IS ONE OF PRESIDENTBIDEN'S INITIATIVE SO THE MONEY IS THERE FOR COLLEGE OR VOCATIONAL SCHOOL. I THINK IF WE DON'T START EARLY HIGH SCHOOL IS TO LATE. THE PATH IS UNFORTUNATELY ALREADY TAKEN. THIS IS AN OPPORTUNITY. NIH IS IN A GOOD POSITION. YOU HAVE A CHAMPION AT THE TOP. ALL OF OUR UNIVERSITIES DON'T HAVE THAT. SOME OF US STRUGGLE MORE THAN OTHERS. THANK YOU AND PLEASE MAKE THE MOST OF THIS. WE HAVE DR. COLLINS AROUND. >> POSITIVELY WE ARE DELIGHTED THAT AGAIN AS WE SAID THIS IS A MOMENT WE CANNOT LET PASS >> I'D LOVE TO FOLLOW UP WITH YOU AND MY COMMENT IS ABOUT THE FOCUS ON INSTITUTIONS. I KNOW HOW IMPORTANT SCHOOLS ARE FOR GETTING THE ATTENTION OF THE FACULTY AND STUDENTS AT THE NATIONAL HISPANIC INSTITUTION WORKING WITH MINORITY DOCTORS AND NURSES AND HEALTH CARE PROFESSIONALS THAT HAVE AMONG THEIR NETWORKS SCIENTISTS. IT'S ANOTHER OPPORTUNITY TO COMPLEMENT THE FOCUS ON INSTITUTIONS. WE'RE PARTNERING WITH NORMAN BUT EVERYBODY FOCUSES ON INSTITUTIONS AND I CAN SEE WHY WITH GRANTS, ETCETERA. I'D LIKE TO BE ABLE TO HAVE A FOLLOW WITH YOU AND PERHAPS THE AMERICAN ASSOCIATION OF AMERICAN INDIAN PHYSICIANS, AAIP, AND ALSO A PARTNER WITH THE ASIAN DOCTORS, THE NATIONAL COUNCIL OF ASIAN PACIFIC ISLANDERS. WE CALL OURSELVES THE ALLIANCE OF MULTI-CULTURAL PHYSICIANS BUT WE HAVEN'T WORKED WITH NIH PER SE EXCEPT FOR ONE MEETING WE DID WITH NIMHD AND FINDING PEOPLE THAT COULD BECOME MORE INVOLVED IN YOUR PROGRAMS. >> THAT WOULD BE WELCOME AND WITH THIS WE NEED TO HEAR FROM AND WORK WITH OTHER THAN THE USUAL SUSPECTS TO MAKE THE ADVANCES WE WOULD LIKE TO MAKE. THAT WOULD BE VERY WELCOME. I'M EASILY FOUND MARIE BERNARD, A GOVERNMENT EMPLOYEE. >> AND WOMEN ARE THE BACKBONE OF ALL OF OUR ORGANIZATIONS. I HAVE TO TELL YOU THAT. IT'S A PLEASURE TO BE HERE AND FIND WOMEN LEADERS WITHIN THE RESEARCH SPACE TOO WOULD GO A LONG WAY. >> WHEN YOU DO THE DEMOGRAPHIC ANALYSIS OF INTRAMURAL STAFF AND EXTRAMURAL GRANTEES YOU BREAK IT OUT SIMULTANEOUSLY BY SEX AND GENDER BECAUSE WE KNOW PARTICULARLY WOMEN OF COLOR OF DIFFERENT RACE AND ETHNICITIES WILL HAVE DIFFERENT REPRESENTATION AND EXPERIENCES AND ISSUES AND SO ANALYZING THAT DATA AND HAVING IT AVAILABLE TO THE PUBLIC TO LOOK AT WITH THAT INTERSECTIONAL APPROACH SOMETIMES THE NUMBERS GET SMALL. I REALIZE THAT BUT I THINK IT'S REALLY CRITICAL TO MAKE SURE THAT THAT IS NOT JUST RACE OVER HERE AND SEX OVER HERE BUT TOGETHER. >> THANK YOU. WE'RE GOING TO DO OUR VERY BEST ALONG THOSE LINES AS A LONG-TERM CHAIR OF THE WORKING GROUP I'VE BEEN VERY SENSITIZED TO THAT. >> THANK YOU, SO MUCH, DR. BERNARD FOR JOINING US THIS MORNING. YOU CAN SEE OUR ADVISORY COMMITTEE IS VERY INTERESTED IN THESE ISSUES SO I WILL DEFINITELY BE FOLLOWING UP WITH YOU AND GOOD TO WORK WITH YOU ON THE VARIETY OF EFFORTS AND WE'RE EXCITED TO HAVE YOU HERE TODAY. WE APPRECIATE THAT. >> MY PLEASURE. >> WE'LL MOVE INTO THE NEXT PRESENTATION THE DIRECTOR'S REPORT. IT'S FUN FOR ME TO BE ABLE TO SHARE WITH YOU ALL EVERY TIME WE MEET AN UPDATE ON THE ACTIVITIES WE'RE UNDERTAKING HERE AT THE OFFICE OF RESEARCH AND WOMEN'S HEALTH. WHAT'S NEW IN SEX AND GENDER? I DON'T KNOW IF YOU'VE NOTICED SEX IS A BIOLOGICAL VARIABLES AND ISSUES OF SEX AND GENDER HAVE BEEN GETTING QUITE A LOT OF ATTENTION IN THE POPULATION PRESS AS WELL AS IN THE SCIENTIFIC LITERATURE. SOME THINGS WE'VE SEEN JUST IN THE POPULAR PRESS AT CNN THERE WAS A PIECE ON ONE OF OUR SCORE INVESTIGATOR'S WORK THAT LOOKED AT WHAT WAS A NORMAL BLOOD PRESSURE FOR WOMEN AND MEN AND THEY'RE DATA FOUND A NORMAL PRESSURE FOR WOMEN IS 10 MILLIMETERS OF MERCURY LOWER WOMEN AND IF THAT'S THE CASE, WHAT ARE THE CONSEQUENCES OF THAT NORMAL FOR WOMEN FOR MONITORING WHAT IS NORMAL BLOOD PRESSURE AND HIGHLIGHTED THIS IN A CNN.com PIECE. I'M SURE YOU'RE AWARE THE VARIETY OF REPORTS OF SIDE EFFECTS OF A VARIETY OF COVID VACCINES. UP TO YESTERDAY AND THE HIGHER RATES OF REPORTING FOR ADVERSE EVENTS IN MEN AND WOMEN AND SURE WE'LL HAVE AN OPPORTUNITY TO TALK ABOUT THAT LATER. HOW MUCH BIOMEDICAL RESEARCH LOOKS AT THIS AND PROGRESS IN CONSIDERATION SEX AS A BIOLOGICAL VARIABLE. ON THE SCIENTIFIC SIDE AND I'LL TALK ABOUT SEVERAL AND WON'T MENTION THOSE LOOKING AT WHETHER THERE'S A SPECIFIC ARCHITECTURE IN RESPONSE TO ACTUALLY DIET. THE CONCEPT OF PRECISION NUTRITION AND SEX IN AMERICAN AND KETO GENIC DIETS. HERE A QUOTE I PULLED FROM THE INVESTIGATION. THIS INVESTIGATOR WORKS ON THE BLOOD BRAIN BARRIER. AND FOUND SEX DIFFERENCES IN THE BLOOD BRAIN BARRIER JUNCTIONS. AND STATES I WORKED WITH VASCULAR CELLS FOR 20 YEARS AND UP UNTIL FIVE YEARS AGO IF YOU ASKED THE SEX OF MY CELLS MATTERED AT ALL I WOULD HAVE SAID NO. AND THEN WORKED ON A STUDY AND WE SEPARATED IT BY SEX AND ALL MADE SENSE. IT WAS AN AWAKENING FOR ME WE SHOULD BE STUDYING THIS AND DR. CLYNE IN HER PUBLICATION IN NATURE AND NEUROSCIENCE. ONE OF THE PUBLICATIONS, PUBLISHED IN NATURE AND NEUROSCIENCE A CALL FOR GLOBAL SHIFT IN SCIENCE CULTURE. THEY CHARACTERIZED THE SITUATION WHERE HOW DISEASE PRESENTS IN MEN IS CONSIDERED AS A STANDARD ADDS PERVASIVE AND CALLED OUT THE USE OF MALE RODENTS AS THE DEFAULT MODEL AND IT GOES TO HIGHER MISDIAGNOSE AND CALLED OUT THE PUBLICATIONS THAT PRIORITIZES EXTENDED RESEARCH OF A PARTICULAR PHENOMENON BEING PUBLISHED IN MALES AND ALSO WANTED TO KNOW AND PUT FORWARD SEVERAL IDEAS HOW SABB DIRECTIVES ACROSS THE WORLD COULD BE ENHANCED TO HOLD RECIPIENTS MORE ACCOUNTABLE. THEY CALLED FOR A CULTURAL SHIFT IN WHAT IS IMPACTFUL HIGH PROFILE AND RIGOROUS SCIENCE AND STATED WHAT WE CONSIDER RIGOROUS MUST BE A BODY OF WORK THAT INCLUDES MALES AND FEMALES IN ALL EXPERIMENTS EXCEPT FOR THOSE THAT CAN BE DONE ONE'S SEX. AND RELATED TO ACCOUNTABILITY, THEY PROPOSED SEVERAL SPECIFIC STEPS THAT FUNDING AGENCIES COULD TAKE ON SUCH AS MONITORING SABB COMPLIANCE IN ANNUAL PROGRESS REPORTS OR HAVING SABB COMPLIANCE CONTINGENT IN GRANT ROUX -- RENEWALS AND IT WILL REQUIRE AN ACTIVE PROCESS AND THAT SCIENTISTS HAVE AN OPPORTUNITY TO HOLD EACH OTHER ACCOUNTABLE THROUGH THIS AND SHOULD HOLD OFFICE AND THE FOOD AND DRUG ADMINISTRATION UPDATED THE COURSE TO IMPROVE HUMAN HEALTH AND IT'S A COMPLETELY MODERN CONTEMPORARY ONLINE COURSE WITH SIX MODULES. 900 USER IN THE MOST RECENT REPORTING PERIOD SO THE DATA ARE HERE. I'M EXCITED TO SHARE WITH YOU THE SABB PRIMER HAS BEEN LAUNCHED. IT'S HOUSED ON NIGMSs PAGE INCLUDING TOOLS AND RESOURCES FOR ENHANCING REPRODUCABILITY AND TRANSPARENCY AND THE OFFICE OF THE DIRECTOR SUPPORTED OUR EFFORTS. YOU CAN SEE THE NUMBER OF USER'S AND EVEN CREATED AN INTRODUCTORY COURSE WITH A FACILITATOR'S GUIDE TO GET TO EARLY LEARNERS OF SEX AND GENDER AND HAD OVER 2300 VISITORS AND 1500 ACADEMIC INSTITUTIONS AND 18 COUNTRIES TO DATE. SO WE'RE EXCITED ABOUT THIS RESOURCE AND THE WEB PAGE WE HAVE ON OUR WEBSITE ABOUT THIS SO PLEASE HELP US SHARE THE WORD. AND NEXT WHAT'S NEW IN COVID-19 IN WOMEN'S HEALTH. WE HAVE TO BE TALKING ABOUT THAT NEXT. I WANT TO HIGHLIGHT A RECENT PUBLICATION AND WE KNOW WIDELY REPORTED MEN ARE DYING AT HIGHER RATES THAN WOMEN IN COVID AND FEW STUDIES HAVE LOOKED AT THE INTERSECTION OF SEX AND GENDER AND RACE AND ETHNICITY OR WITH AGE AND SIMULTANEOUSLY CHARACTERIZED THOSE RELATIONSHIPS. IN THIS PUBLICATION WHICH LOOKED AT TWO STATES, GEORGIA AND MICHIGAN, THEY FOUND BLACK WOMEN HAD COVID-19 MORTALITY RATES ALMOST FOUR TIMES HIGHER THAN THAT OF WHITE MEN, THREE TIMES HIGHER THAN ASIAN WOMEN AND HIGHER THAN ASIAN AND WHITE WOMEN. THEY REPORTED DISPARITIES IN MORTALITY REPLICATE EXISTING RACIAL AND GENDER HEALTH INEQUITIES. IN GEORGIA, BLACK MEN HAVE THE HIGHEST RATES OF CARDIOVASCULAR DISEASE. WHAT THIS DOES, IT HIGHLIGHTS THE FACT THAT WHILE MEN HAVE HIGHER COVID-19 DEATH RATES THAN WOMEN, OVERALL, SEX DISPARITY DOES NOT HOLD ACROSS RACIAL GROUPS. THE MALE-FEMALE MORTALITY RATIO IS DIFFERENT BY RACE AND ETHNICITY AS REPORTED IN THE PUBLICATION. HEALTH RISKS ARE STRUCTURED IN BROAD WAYS AND I THINK WITHOUT SEEING THE DATA YOU JUST DON'T GET A SENSE OF THE MAGNITUDE OF DIFFERENCE OF MORTALITY RATES. THEY'RE NOT NUMBERS. THEY'RE RATES. YOU CAN SEE MICHIGAN AND GEORGIA WITH STARK DIFFERENCES BETWEEN BLACK MEN AND BLACK WOMEN AND IN PARTICULAR THE CONCERNS ON RATES OF MORTALITY. SEVERAL STUDIES PUT FORWARD INFORMATION NOW IN THE PANDEMIC NOW ABOUT THE LONG-TERM CONSEQUENCES OF COVID-19 AND SARS COV2 INFECTION. AND THIS STUDY THERE WERE 52% OF THE SUBJECTS WERE MEN. THIS IS ROUGHLY 50-50 AND THE STUDY FROM WUHAN HOSPITAL. THE MOST COMMON COMORBIDITIES WERE DIABETES AND CARDIOVASCULAR DISEASE AND MEN MADE UP OF THE TWO-THIRDS CRITICALLY ILL PATIENTS AND NEEDING THE VENT FOR SARS COV2 AND LOOKING AT SIX MONTHS AFTER INFECTION AND ONSET, 75% OF THOSE REPORTED AT LEAST ONE SYMPTOM WERE WOMEN. THIS MOST ACUTE SEQUELAE OF COVID IS AN AREA OF SPECIAL IMPORTANCE FOR WOMEN'S HEALTH AND THERE'S BEEN SEVERAL FUNDING OPPORTUNITY ANNOUNCEMENTS NOW AVAILABLE TO DO THIS RESEARCH. THE MOST COMMON SYMPTOMS WERE FATIGUE OR MUSCLE WEAKNESS, SLEEP DIFFICULTY, ANG ZIT OR DEPRESSION -- ANXIETY OR DEPRESSION WHICH ARE MORE COMMON IN WOMEN. WHAT ABOUT THE AFFECT OF THE WOMEN FROM TE PANDEMIC AND THIS HAS BEEN A PARTICULARLY CHALLENGING TIME FOR SCIENTISTS AND LABORATORY INVESTIGATORS WHO NEED TO BE IN THE LABORATORY OR NEED TO BE SEEING PATIENTS TO CONDUCT CLINICAL RESEARCH. FACULTY WITH SMALL CHILDREN DEFINED AS 0 TO 5 YEARS OF AGE REPORTED SIGNIFICANTLY LESS WORK HOURS COMPARED TO OTHER FACULTY. YOU SEE THE DATA. WHAT DOES THAT TRANSLATE TO? WHAT WE'RE SEEING ARE WOMEN'S FIRST AND CORRESPONDING AUTHORS AND PUBLICATIONS DECREASED SIGNIFICANTLY EVEN FOR PRE PRINTS. WE'RE SEEING FACULTY WITH SMALLER CHILDREN HAVE COMPLETED FEWER PEER-REVIEW ASSIGNMENTS AND STUDY SECTIONS AND ATTENDED FEWER PANEL MEETINGS, SUBMITTED FEWER PAPERS AS WE TALKED ABOUT AND THOSE WITH OLDER CHILDREN OR NO CHILDREN ARE LESS LIKELY TO REPORT THE SAME. THERE'S A GROUP OF SCIENTISTS WITH A PARTICULAR IMPACT HERE. NIH SUPPORTED SEVERAL EFFORTS IN THIS REGARD. WE SUPPORTED A NATIONAL ACADEMIES OF SCIENCE AND MEDICINE STUDY ON TO THE IMPACTS OF COVID-19 ON THE CAREERS OF WOMEN IN SCIENCE AND MEDICINE AND LOOKED AT THE PATTERN OF DISRUPTION ON WOMEN ON CAREERS OF WOMEN FROM MARCH 2020 AND FOUND THE PANDEMIC NEGATIVELY AFFECTED THE WELL BEING OF WOMEN IN ACADEMIC S.T.E.M. FIELDS IN PRODUCTIVITY, WORK/LIFE BOUNDARY CONTROL AND NETWORK AND COMMUNITY BUILDING AND MENTAL WELL BEING AND ORWH IS CONCERNED ABOUT THE RAMIFICATIONS OF THESE NEGATIVE YIMTH OF IMPACTS -- IMPACTS ON THE CAREERS OF WOMEN IN S.T.E.M. NIH ALSO LED AND THE CHIEF OFFICER FOR SCIENTIFIC WORKFORCE DIVERSITY DR. BERNARD AND OTHERS WHO PRODUCED TE SURVEY TO WHAT THEY REPORTED TO NIH AND INSTITUTIONS AND 61% OF LAB-BASED RESEARCHERS SAID THE PANDEMIC WILL NEGATIVELY AFFECT THEIR CAREER TRAJECTORY. THE GREATEST CONCERN WAS AMONG RESIDENTS AND AMONG CARETAKERS THE GREATEST WERE THOSE WITH CHILDREN 0 TO 5 YEARS OF AGE SO THAT PARTICULAR GROUP. 41% SAID MENTAL AND PHYSICAL HEALTH WAS NEGATIVELY AFFECTED AND AFFECTING THE PRODUCTIVITY REPORTED HIGHEST AMONG WOMEN. SELF-IDENTIFIED OTHER AND EARLY CAREER INVESTIGATORS. NEARLY 80% REPORTED LOWER PRODUCTIVITY AND 83% CITED MODERATE TO MAJOR IMPACT ON RESEARCH PRODUCTIVITY. WE HAVE A LOT OF TO DO HERE TO BUILD BACK BETTER AND TO MOVE FORWARD AND RESTORE PRODUCTIVITY FOR ALL THE SCIENTISTS. ONE OF THE STEPS NIH HAS TAKEN IN THE MIDDLE OF THE PANDEMIC IS ADDRESS THE DISRUPTIONS WITH FUNDED AND UNFUNDED EXTENSIONS. YOU SEE THE INFORMATION ABOUT A GUIDE NOTICE WE PUT OUT THAT ALLOWS EARLY CAREER SICIENTISTS WHO'S CAREER TRAJECTORIES TO REQUEST FUNDED OR NO-COST EXTENSION AND IN PARTICULAR FOR AWARDEES. AND SO I WOULD ENCOURAGE EVERYONE TO TAKE A LOOK AT THIS GUIDE NOTICE AND TO BE AWARE THAT SOME OF THESE FLEXIBILITIES YOU DO NEED TO ASK FOR MOST OF THEM IN FACT. IT'S IMPORTANT TO SUPPORT AND MENTOR OUR COLLEAGUES AND MAKE SURE THEY'RE AWARE FLEXIBILITIES DO EXIST BUT IN MANY CASES YOU NEED TO SPEAK UP AND ASK FOR THEM. ANOTHER INITIATIVES THAT HAVE BEEN UNDERWAY THAT ADDRESS THE MANY BARRIERS TO ADVANCEMENT FOR WOMEN IN SCIENCE AS YOU KNOW FOR THE WOMEN ON BIOMEDICAL CAREERS AND RECOGNIZING TRANSFORMATIVE INSTITUTIONAL APPROACHES TO ADVANCE GENDER EQUITY. A DEADLINE FOR THOSE APPLICATIONS IS THIS WEEK. IF YOU'RE PLANNING TO APPLY GET YOUR APPLICATIONS IN. THOSE AWARDS WILL BE MADE VERY SOON. PLEASE STAY TUNED FOR THAT AND WE'LL HAVE A PRESENTATION OF THOSE LATER IN THE YEAR. WE ANNOUNCED OUR NOTICE OF INTENT TO PUBLIC AND ADVANCING GENDER INCLUSIVE EXCELLENCE COORDINATING CENTER. THAT'S A COLLABORATION AND PROVIDE AN ORGANIZATIONAL FRAMEWORK FROM ACTIVITIES AIMED AT ADDRESSING THE BARRIERS AND UP TO $2500 PER BUDGET PERIOD CAN BE APPLIED FOR FOR PARENTS WHO HAVE CHILDCARE COSTS FROM A LICENSED CHILDCARE PROVIDER AND WANT TO SHARE CHANGES TO THE R13 AND U13 APPLICATIONS SO THE NIH SUPPORTED CONFERENCES ARE NOW REQUIRED TO HAVE A DIVERSITY PLAN INCLUDED IN THEIR APPLICATION AND THOSE DIVERSITY PLANS ARE EVALUATED IN PEER-REVIEW. IN ADDITION THE INVESTIGATORS AND KEY PERSONNEL ON THOSE APPLICATIONS ARE NOW REQUESTED TO HIGHLIGHT THEIR RECORD AND ANY EXPERTISE THEY MAY HAVE IN ADVANCING DIVERSITY AND THOSE WILL ALSO BE EVALUATED AS PART OF PEER REVIEW. THANK YOU FOR MANY OF YOU PARTICIPATING THE ORWH 30th ANNIVERSARY EVENT AND WE HAD A VIDEOCAST OF THE SYMPOSIUM AND FANTASTIC KEY NOTE SPEAKERS. [LISTING NAMES] AND IF YOU HAVE NOT HAD A CHANCE TO JOIN THE VIRTUAL ENVIRONMENT IS STILL AVAILABLE TO YOU. PLEASE TAKE A LOOK AT THE AMAZING PRESENTATIONS THERE. 30 YEARS IS REALLY NOT THAT LONG BUT WE'VE MADE A LOT OF PROGRESS AND PROUD OF THAT PROGRESS AND SHARING THAT WITH OUR INSTITUTE AND CENTER COLLEAGUES. THERE'S SEVERAL I.C. DIRECTORS THAT SPOKE AT OUR SYMPOSIUM ON THE DIRECTOR'S PANEL SO PLEASE TAKE A LOOK. I KNOW MANY OF YOU HAVE BEEN KEEPING A CLOSE EYE ON THE UPDATES FOR THE NEW ADMINISTRATION AND WE WERE PRIVILEGED TO HAVE THE PRESIDENT AND VICE PRESIDENT VISIT NIH. WE WERE ONE OF THE FIRST FEDERAL AGENCIES VISITED. THIS NEW LEADERSHIP THAT HAS BEEN PUT IN PLACE BY THE NEW ADMINISTRATION IN TERMS OF BRINGING INCREASED FOCUS ON SCIENCE AND DIVERSITY IS ENCOURAGING AND EXCITING AND I HIGHLIGHT FOR YOU IN ADDITION TO THE PRESIDENT'S CHIEF MEDICAL ADVISORY BEING DR. FAUCI, OUR OWN DOCTORS ARE JOINING OSTP. AS YOU KNOW SECRETARY BECERRA HAS NOW BEEN CONFIRMED AND HAVE A CDC DIRECTOR IN DR. WALENSKY AND WELCOME BACK DR. MURTHY AS SURGEON GENERAL AND PRESIDENT BIDEN CHARACTERIZED US AS THE BEST AMERICA HAS TO OFFER AND SKATED TO WORK ON THE -- EXCITED TO WORK ON THE CHALLENGES WE FACE WITH THE NEW ADMINISTRATION. THERE'S A NEW OFFICE THAT HAS JOINED THE DIVISION OF PROGRAM COORDINATION, PLANNING AND STRATEGIC INITIATIVES THE OFFICE OF NUTRITION RESEARCH. IT'S BEEN ESTABLISHED WITH THE OFFICE OF THE DIRECTOR WITH O ORWH AND THERE ARE 14 OFFICES IN THIS DIVISION ALL COVER CROSS-CUTTING AREAS. THE ACTING DIRECTOR IS CHRIS LYNCH AND THE URL IS HERE TO TAKE A LOOK AT THE WEBSITE. AROUND NUTRITION RESEARCH AND SEX AND GENDER ARE PART OF PRECISION NUTRITION RESEARCH AND PROUD TO COORDINATE IN TERMS OF THAT IMPLEMENTATION. HERE'S A PRECISION NUTRITION DIAGRAM. I REFER YOU TO THE WEBSITE FOR MORE DETAILS. WE NOW HAVE 10 WOMEN INSTITUTE DIRECTOR. WE WELCOMED THE DIRECTOR OF THE NATIONAL INSTITUTE ON ARTHRITIS AND MUSCULOEXCEL CAL AND -- SKELETAL AND SKIN DISEASES AND THE PARTNERSHIP IN AUTOIMMUNE DISEASE AND DR. RUTTER IS LEADING THE NCATS AS THE ACTING DIRECTOR. I WANT TO THANK THE TEAM TO MAKE SURE SEX AND GENDER RESPONSE TO THE COVID-19 PANDEMIC. WE'VE BEEN WORKING TO EXPAND SEX DISAGGREGATION OF RESEARCH AND HIGHLIGHTING AND ADDRESSING THE NEED TO HAVE STRATEGIES TO MITT GITE THE IMPACT MUCH COVID-19 ON WOMEN AND STAFF. HERE'S SOME ACTIVITIES WE PARTICIPATED IN THE NIH WIDE STRATEGIC DEVELOPMENT AND WE MADE SURE SEX AND GENDER WERE INCLUDED PROMINENTLY IN THAT DOCUMENT. WE CREATED IN COLLABORATION WITH OUR COORDINATING COMMITTEE CCWH GUIDING PRINCIPLES FOR SEX AND GENDER INFLUENCES IN COVID-19 AVAILABLE TO OUR I.C. COLLEAGUES AND OUR NEW COVID WEB PAGE WOMEN'S SCIENCE AND THE IMPACT OF COVID TO ENCOURAGE INVESTIGATORS TO INTEGRATE SEX AND GENDER INFLUENCES. WE CREATED A NEW COVID-19 MATERNAL HEALTH WEB PAGE AND ESTABLISHED A NEW SEMINAR SERIES CALLED DIVERSE VOICES, COVID-19 INTERSECTIONALITY AND THE HEALTH OF WOMEN. THE NEXT SESSION IS JUNE 24 ON INTERSECTIONALITY AND COVID-19 APPLICATION AND ANALYSIS. I INVITE YOU TO OUR WEB PAGE TO HEAR MORE ABOUT THAT INFORMATION. IMPORTANTLY, WE EXPANDED OURSELF AND GENDER ADMINISTRATIVE SUPPLEMENT OUR U3 ADMINISTRATIVE SUPPLEMENT AND SEX AND GENDER RO1 WITH NOSIS TO INCORPORATE COVID-19 INTO THOSE FUNDING OPPORTUNITY ANNOUNCEMENT WHICH IS REPRESENT NIH'S ONLY SEX AND GENDER SPECIFIC COVID FOAs. WE'VE BEEN PARTICIPATING AGAINST COVID-19 DESPAIRS. I SPOKE AT A RECENT NATIONAL ACADEMIES WORKSHOP ON OVERCOMING BARRIERS AND THE 21st CENTURY CARES ACT EXPANDED INCLUSION IN SEVERAL WAYS EXPANDING REQUIREMENTS RELATED TO INCLUDING INDIVIDUALS OF ALL AGES AND SETTING THE PATH PREGNANT AND LACTATING WOMEN AND THE NEW REQUIREMENT APPLICABLE PHASE 3 TRIALS REPORT RESULTS BY SEX, GENDER RACE AND ETHNICITY TO CLINICALTRIALS.gov. THAT'S COMING. SCIENTIFIC COLLABORATION IS NEXT. I'M HIGHLIGHTING ONE OF OUR AMAZING SCORE P.I.s. THEY'RE ALL INCREDIBLE AND AMAZING BUT IN LIGHT OF TODAY'S MEETING IS FOCUSSED ON MENTAL HEALTH I'M HIGHLIGHTING DR. GOLDSTEIN'S WORK AND LOOKING AT THE IMPACT OF PRENATAL STRESS ON AUTOIMMUNE AND DYSREGULATION AND WORLDWIDE MAJOR DEPRESSIVE DISORDER IS THE LEADING CAUSE OF DISABILITY AND WITH THE WELL KNOWN SEX DIFFERENCE OF WOMEN BEING AFFECTED THAN MAN LOOKING AT STRESS IMMUNE PATHWAYS ABNORMALITIES THAT BEGIN IN FETAL DEVELOPMENT AND HAVE CONSEQUENCES FOR BRAIN CIRCUITRY REGULATING MOOD AND LIFE LONG RISK FROM DYSREGULATION OF HORE HORMONE AND THERE'S A RECENT PUBLICATION WHERE SHE LOOKED AT THE INTERSECTION OF DISORDER AT THE BRAIN AND HEART AND DECLARED IT A GLOBAL CRISIS OF MULTI-MORBIDITY AND A NOVEL OPPORTUNITY. SEX AND GENDER DIFFERENCES IN THE CO-OCCURRENCE OF CARDIOVASCULAR DISEASE AND ALZHEIMER'S DISEASE WERE THE FOCUS OF THIS PARTICULAR PAPER. AND SHE HIGHLIGHTED THE IMPORTANCE OF A LIFE SPAN APPROACH IN TACKLING MULTI-MORBIDITY. 1WR50U6SH 1Y50USHGS AND THE CO-AUTHORS ON THE LANCET PUBLICATION THAT LOOK AT SEX AND GENDER AS MODIFYING OF HEALTH, DISEASE AND MEDICINE. CAN'T NECESSARILY READ ALL THESE BUT HIGHLIGHTED DIFFERENCES ACROSS MANY DIFFERENT DISEASE AREAS. IT'S A GREAT REVIEW AND HERE'S JUST ONE EXAMPLE. THIS IS A CULTURALLY TAILORED TRAUMA-INFORMED APP. IT'S CALLED LINK POSITIVELY A TECHNOLOGY DELIVERED PEER AND SOCIAL NETWORKING INTERVENTION TO APPROVE HIV CARE ACROSS THE CONTINUUM FOR BLACK WOMEN AFFECTED BY INTERPERSONAL VIOLENCE AND PEER NAVIGATION AND CHECK-INS BY PHONE AND TEXT AND SUPPORT SERVICES AND I WORKED WITH THE OAR DIRECTOR ON CHANGING THE FACE OF HIV FOR WOMEN AND GIRLS AND CO-CHAIR THE TASK FORCE WITH THE DEPUTY DIRECTOR. AN INITIATIVE WE HAVE LAUNCHED LAST YEAR CALLED IMPROVE WHICH STRANDS FOR IMPLEMENTING MATERNAL HEALTH AND PREGNANCY OUTCOMES DIVISION FOR EVERYONE. IN FY20 WE ADDRESSED IMPORTANT CAUSES OF MATERNAL MORBIDITY AND MORTALITY AIMED AT IMPROVING THE HEALTH OF WOMEN BEFORE, DURING AND AFTER DELIVERY AND REDUCING THE PREVENTIBLE CAUSES OF MATERNAL DEATH. WE KNOW IT'S ONE OF THE PARTICULARLY DISTURBING AND DISTRESSING STATISTICS AND WE FUNDED 36 PROJECTS LAST YEAR AT OVER $70 MILLION AND YOU CAN GET MORE INFORMATION. THE NEXT SLIDE HIGHLIGHTS SOME OF THE PARTICULAR AREAS WE FUNDED LAST YEAR WHERE WE CALLED OUT MENTAL HEALTH, CARDIOVASCULAR DISEASE AND IMMUNITY AND INFECTION AS IMPORTANT AREAS LOOKING AT REMOTE SUPERVISION FOR IMPLEMENTING COLLABORATIVE CARE FOR PERI NATAL HEALTH AND PREDICT PREGNANCY RELATED HYPERTENSION AND WE KNOW THE RISK FOR HYPERTENSION AFTER PREECOLLAP PREECOLLAPSE -- PRE-ECLAMPSIA. SO FOR FY21 WE HAVE TWO NOSIS ON THE STREET. A SMALL BUSINESS FOCUSSED ON IMPROVING MATERNAL HEALTH AND THERE'S OTHER INSTITUTES, CENTERS AND OFFICES LOOKING FOR APPLICATIONS ON THE DEVELOPMENT OF TECHNOLOGIES TO PREDICT INCREASED RISK TO IDENTIFY PHENOTYPE OR SUBTYPE PATIENTS AT INCREASED RISK. TO ASSIST MULTI LEVEL INTERVENTIONS TO ADDRESS RACIAL DISPARITIES TO ASSIST IN CLINICAL DECISION MAKING FOR SOCIAL BIASES, WEARABLES AND DIAGNOSTICS AND THAT'S ONE OF OUR INTERESTING FOAs AND THE IMPROVED NOSI FOR FY21 IS FOCUSSED ON FACTORS THAT ARE RELATED TO PSYCHOSOCIAL IMPACTS OF THE PANDEMIC AND SOCIAL DETERMINANTS OF HEALTH AND WE WANT TO UNDERSTAND THE FACTORS AND HOW THE FACTORS RELATED TO INFECTION WITH SARS COV2 AND THE PANDEMIC AND UNDERLYING STRUCTURAL RACISM AND DISCRIMINATION WE SEE IN THIS COUNTRY IN TERMS OF HEALTH CARE AND HOW THAT IMPACTS MATERNAL MORBIDITY AND MORTALITY. WE ALSO REISSUED A NOSI FOR A PARTNERSHIP ON THE IDEA STATES PROGRAM WHICH SUPPORTS STATES THAT RECEIVE THE LEAST AMOUNT OF NIH FUNDING HIGHLIGHTED IN GREEN HERE. THIS IS A WOMEN'S HEALTH RESEARCH PROGRAM FOR THE IDEA STATE. APPLICATIONS ARE SUPPLEMENTS TO EXISTING PROGRAMS AND MUST ADDRESS ONE GOAL OF THE NIH WOMEN STRATEGIC PLAN FOR WOMEN HEALTH RESEARCH AND EMPHASIS ON MATERNAL MORBIDITY AND MORTALITY AND IN TERMS OF LINKING THAT TO SUBSEQUENT RISKS WITH A LIFE FORCE PERSPECTIVE. THERE'S 15 PARTICIPATING ICOs. APPLICATIONS ARE DUE NEXT WEEK. WE'RE LOOKING FORWARD TO THAT AND LAST YEAR WE FUNDED ALMOST $5 MILLION IN THIS PARTICULAR PROGRAM. FY20 RESEARCH FUNDING FOR ORWH. HERE'S OUR BUDGET HISTORY OVER THE YEARS. YOU CAN SEE THE PATTERN IS THERE. THERE HAS BEEN SOME MODEST CHANGE RECENTLY BUT NOT REALLY A CHANGE THAT HAS KEPT UM WITH THE INFLATION -- KEPT UP WITH THE INFLATION RATE OR ELEVATION OF THE OVERALL NIH BUDGET. YOU CAN SEE ON THE RIGHT IN THE PIE CHART THE DISTRIBUTION OF FUNDS ACROSS RESEARCH PROGRAMS. YOU SEE ROUGHLY AN A THIRD GOING TO CO-FUNDS AND WE WORK WITH INSTITUTES AND CENTERS ON EVERYTHING WE DO BECAUSE THEY ADMINISTER THE GRANTS WE FUND. AND WE DEVELOPED THE CAREER CONTINUITY SUPPLEMENTS THAT SUPPORT INVESTIGATORS WHO EXPERIENCE A QUALIFYING LIFE EVENT INCLUDING CHILD BIRTH THAT PROVIDE FUNDS TO SUPPORT THEM IN THAT SPACE. THOSE ARE FOR FIRST TIME RPG HOLDERS AND K AWARDEES. OUR NEW SEX AND GENDER RO1 WAS THE FIRST FOR THAT. HERE'S THE DATA ON THE INSTITUTES AND CENTERS THAT RECEIVE ORWH CO-FUNDING INVESTMENTS IN ORDER OF THE INVESTMENTS AMOUNT. OF COURSE OUR BIRCH PROGRAM IS A LARGE PROPORTION OF THAT SO MAKES A LARGE PROPORTION HIGHLIGHTED IN GREEN. IF YOU GO TO THE NEXT SLIDE YOU'LL SEE WITHOUT THE BIRCH WHAT THE PATTERN IS AND NIA IS RECEIVING THE LARGEST AMOUNT OF ORWH FUNDING BUT THERE'S SEVERAL SCORE CENTERS ADD AMERICAN -- ADMINISTERED BY THE AND WE'RE EXCITE ABOUT THE PATTERN. AND YOU CAN SEE THE LIST OF OUR CO-FUNDING INSTITUTES AND CENTERS. WE WORK WITH VIRTUALLY EVERY INSTITUTE AND CENTER ACROSS NIH. WE BELIEVE WOMEN'S HEALTH RESEARCH IS ALL OF OUR RESPONSIBILITY AND DELIGHTED AND PRIVILEGED TO SUPPORT THE INSTITUTES AND CENTERS IN THEIR ACTIVITIES AND SEX AND GENDER RO1 AND SUPPLEMENTS AND THEN I.C.s REQUEST FOR CO-FUNDING TO ORWH FOR CONSIDERATION. I SEE DR. GORDON HAS JOINED. LET ME ROUND MY PRESENTATION. IT'S MY PRIVILEGE TO INVITE YOU TO THE ANNUAL SYMPOSIUM NAMED IN HONOR OF THE FIRST FULL-TIME DIRECTOR OF ORWH AND INTEGRATING SEX AND GENDER INTO BIOMEDICAL RESEARCH AS A PATH FOR BETTER SCIENCE AND INNOVATION. OUR OBJECTIVES ARE TO CREATE BRIDGES ACROSS MULTIPLE SECTORS WITHIN THE SCIENTIFIC ENTERPRISING TO BUILD A BROAD BASED BUSINESS ORGANIZATIONS AND DEVELOP STRATEGIES TO INGRATE THIS ACROSS THE BIOMEDICAL ENTERPRISING AND APPLYING THE INTEGRATION THROUGH PARTNERSHIPS. YOU CAN GET MORE INFORMATION HERE AND WE ARE PARTNERING THIS YEAR ON OUR SYMPOSIUM AND THE REGISTRATION JUST OPENED. LOOK AT THE WEBSITE. WE HAVE AN EXCITING LINE UP FOR YOU. WE'LL HEAR MORE LATER IN THE DAY BUT THE HOUSE AND SENATE BOTH ISSUED SIGNIFICANT ITEMS REQUESTING CONSENSUS CONFERENCE ON WOMEN'S HEALTH. THE CONFERENCE NEEDS TO INCLUDE SEVERAL INSTITUTES AND CENTERS. ORWH WAS ASKED TO LEAD THE CONFERENCE ON BEHALF OF NIH AND WE NEED TO IDENTIFY AND EVALUATE RESEARCH AND IDENTIFY PRIORITIES IN SEVERAL AREAS SPECIFICALLY THE RISING RATES OF MATERNAL MORBIDITY AND MORTALITY, RISING RATES OF DEBILITATING CONDITIONS AND STAGNANT RATES AMONG CERVICAL CANCER PATIENTS YOU'LL HEAR MORE ABOUT LATER TODAY. THIS IS MY LAST SLIDE AND HAVE WE HIGHLIGHT INSTITUTE AND CENTER EFFORTS AS WELL AS INSTITUTIONS AND SPOTLIGHT WOMEN'S SCIENTISTS. PLEASE SUBSCRIBE TO THAT THERE AND FOLLOW US ON SOCIAL MEDIA AND SUBSCRIBE TO RECEIVE OUR MONTHLY PULSE E-MAIL. THANK YOU FOR YOUR ATTENTION. I LOOK LOOK -- FORWARD TO DISCUSS THIS LATER AND TO STAY ON TIME I'LL ASK OUR HEALTH SCIENCE ADMINISTRATOR AND PROGRAM OFFICER WITH ORWH TO INTRODUCE OUR NEXT SPEAKER. >> IT IS MY PLEASURE TO INTRODUCE DR. JOSH GORDON THE INSTITUTE OF THE RESEARCH ON MENTAL DISORDER. HE OVERSEES AN EXTENSIVE PORTFOLIO OF BASIC AND CLINICAL RESEARCH THAT SEEKS TO TRANSFORM THE UNDERSTANDING AND TREATMENT OF MENTAL ILLNESSES PAVING THE WAY FOR PREVENTION, RECOVERY AND CURE. DR. GORDON PURSUED A COMBINED MD/Ph.D. DEGREE AT THE UNIVERSITY OF SAN FRANCISCO AND HIS COURSE WORK IN PSYCHIATRY AND NEUROSCIENCE CONVINCED HIM THE GREATEST NEED AND GREATEST PROMISE FOR ADVANCING BIOMEDICAL SCIENCE WAS IN THESE AREAS. DURING THIS Ph.D. THESIS WITH DR. MICHAEL STREICHER HE PIONEERED A PROGRAM AT U.C. SF, DR. GORDON WENT ON TO COLUMBIA UNIVERSITY FOR PSYCHIATRY RESIDENCY AND RESEARCH FELLOWSHIP BECAUSE OF THE BREADTH AND DEPTH OF THE RESEARCH OPPORTUNITIES THERE. THEY STUDIED THE ROLE OF THE HIPPOCAMPUS KNOWN TO BE IMPORTANT FOR MEMORY AND EMOTIONAL PROCESSES ASSOCIATED WITH ANXIETY AND DEPRESSION. HE JOINED THE COLUMBIA FACULTY IN 2004 AS AN ASSISTANT PROFESSOR IN THE DEPARTMENT OF PSYCHIATRY. HIS RESEARCH FOCUSES ON THE ANALYSES OF NEURAL ACTIVITY IN MICE CARRYING MUTATIONS OF HE WILL RELEVANCE TO PSYCHIATRIC DISEASES. HIS LAB STUDIES GENETIC MODELS OF THESE DISEASES FROM AN INTEGRATIVE NEUROSCIENCE PERSPECTIVE FOCUSSING ON THE UNDERSTANDING OF HOW A GIVEN DISEASE MUTATION LEADS TO BEHAVIORAL PHENOTYPE ACROSS MULTIPLE LEVELS OF ANALYSES. TO THAT END, HE EM EMPLOYEES A RANGE OF TECHNIQUES INCLUDING IN VIVO IMAGING AND ANESS THES SIZED AND LIGHT TO CONTROL NEURAL ACTIVITY AND HIS RESEARCH HAS DIRECT RELEVANCE TO UNDERSTANDING SCHIZOPHRENIA, ANXIETY DISORDER AND DEPRESSION. WELCOME. >> IN REGARDS TO THE EFFECTS OF THE COVID-19 PANDEMIC IN MENTAL HEALTH, MUCH OF THE DATA IS AGGREGATED DATA ACROSS ALL GENDERS. AND A SPECIFIC UNDERSTANDING ON WOMEN AND A LOT OF THE DATA ISN'T PARSED OUT IN THAT WAY. AT THE SAME TIME WE'RE LEARNING A LOT ABOUT THE PANDEMIC AND WHAT WE'RE LEARNING FIRST AND FOREMOST IS THINGS ARE WORKED OUT HOW WE MIGHT HAVE EXPECTED. HOPEFULLY YOU'LL GET THAT THREAD AS I MOVE THROUGH THE TALK. THE AGENDA AS FOLLOWS, I'LL GIVER -- GIVE AN OVERVIEW AND THEN TALK ABOUT WHAT WE KNOW FIRST FROM PRIOR DISASTERS IN TRAUMATIC EVENTS IT INFORM OUR APPROACH TO THE COVID-19 PANDEMIC. I'LL GIVE YOU SOME DATA ABOUT WHAT WE KNOW FROM COVID-19 AND ITS IMPACTS ON MENTAL HEALTH AND HOW WE'RE RESPONDING. WE'LL TALK ABOUT THE OVERVIEW. THIS GRAPH I'M SHOWING YOU IS ALREADY A FEW WEEKS OLD THERE'S BEEN MILLION OF CASES OVER 30 MILLION OF COVID-19 AND WELL OVER HALF A MILLION DEATHS OVER THE COURSE OF A YEAR. THAT IS A TREMENDOUS BURDEN AND WON'T PRETEND THE MENTAL HEALTH BURDEN IS EQUIVALENT TO THE BURDEN OF DEATHS DUE TO INFECTION AND MENTAL SUBSTANCE USE DISORDER ARE OF TREMENDOUS BURDEN IN THE UNITED STATES AND THROUGHOUT THE WORLD. COLLECTIVELY THEY REPRESENT THE THIRD LEADING CAUSE OF DISABILITY IN THE UNITED STATES. AND GLOBALLY AS WELL. THAT MEANS WE NEED TO UNDERSTAND THE IMPACT OF THE EVENTS OF THE COVID-19 PANDEMIC BECAUSE WE KNOW THE STRESSFUL EVENT CAN CREATE INCREASES IN THE RATES OF ILLNESSES AS WELL AS DISTRESS IN THE LARGER POPULATION. SO WHAT HAVE WE LEARNED FROM NIMH ON THE EFFECT OF TRAUMATIC EFFECT. WE CAN EXPECT MOST PEOPLE WHO ARE EXPOSED DIRECTLY TO TRAUMA EXPERIENCED SIGNIFICANT SYMPTOMS IN THE EARLY DAYS OF THE TRAUMAS AND EXPECT SYMPTOMS TO BE ASTRONOMICAL FOR THOSE DIRECTLY EXPOSED TO TRAUMA AND THOSE INDIRECTLY EXPOSED CAN EXPERIENCE SIGNIFICANT SYMPTOMS. FOR MOST OF THOSE INDIVIDUALS WHO DO EXPERIENCE SYMPTOMS OF DISTRESS, THOSE SYMPTOMS TEND TO IMPROVE OVER TIME BUT A SIGNIFICANT MINORITY WILL HAVE CHRONIC EXPERIENCES WITH MENTAL HEALTH AS A RESULT OF THOSE TRAUMAS. THE GRAPH ON THE RIGHT SIDE OF THIS PRESENTATION OF THE SLIDE SHOWS THREE CATEGORIES OF TIME COURSES WE TEND TO SEE. THE DOTTED LINE REPRESENTS THE EXPERIENCE OF MOST PEOPLE. YOU'LL EXPERIENCE SYMPTOMS RELEVANT TO PTSD THAT MAY INCLUDE INCREASED AROUSAL, HEIGHTENED STARTLE, NIGHTMARES OR OTHER RE-EXPERIENCING EVENTS AND GENERAL ANXIETY. WHAT YOU CAN SEE IS FOR MOST ON THE DOTTED LINE THOSE EXPERIENCES WILL REMIT RELATIVELY QUICKLY IN THIS CASE THE CHART WOULD INDICATE OVER THE NEXT SEVERAL MONTHS. THEN TWO OTHER CLASSES OF INDIVIDUALS, ONE WITH SLOWER REMITTING OR SYMPTOMS WHERE AGAIN THE SYMPTOMS WILL DECAY BUT PERHAPS OVER A LONGER TIME PERIOD IN THIS CASE MAYBE A YEAR. THEN AGAIN A SUBSET DEPENDING UPON THE EXPOSURE TO TRAUMA AND OTHER FACTORS WE'LL DISCUSS IN A MINUTE. SYMPTOMS WILL LONG OUT LAST THE TRAUMATIC EXPERIENCE. A POINT I'LL TALK TO IS SOCIAL INEQUALITIES AND HEALTH DISPARITIES ALSO INCREASE THE LIKELIHOOD OF SYMPTOMS IN THE AFTER MATH OF THOSE TRAUMAS AS WELL AS EXACERBATE DISPARITIES AND ACCESS TO CARE THAT CREATE INCREASED VULNERABILITIES. WHAT ARE THE RISKS OF OUTCOMES AND MAKES AN INDIVIDUAL MORE LIKELY TO HAVE CHRONIC OR SEVERE SYMPTOMS IN THE WAKE OF A TRAUMATIC EXPERIENCE. FIRST AND FORMOST ARE THOSE EXPOSED DIRECTLY TO DEATH OR INJURY IN THE CASE OF A PANDEMIC LIKE THIS, PEOPLE WHO HAVE SEEN THEIR LOVED ONES BE -- EXPERIENCE DIRECT EFFECTS OR TRAUMA AND SEVERITY OF EXPOSURE SINCE THE TRAUMA TIME IS RELATIVELY SIMILAR ACROSS THE POPULATION. INDIVIDUALS WITH A HISTORY OF TRAUMA OR SERIOUS MENTAL ILLNESS ARE AT GREATER RISK OF POORER OUTCOMES. PEOPLE WITH ONGOING STRESSORS OCCUPATIONAL AND FINANCIAL STRAIN ARE AT INCREASED RISK. THIS IS IMPORTANT BECAUSE THERE'S MANY SOURCES OF STRESS IN LIVES WHICH CAN RAISE THE RISK OF POORER OUTCOMES AND THEY'RE NOT EQUALLY EXPECTED IN SOCIETY. SUBSTANCE USE CAN INFECTIOUS RISK. FEMALES ARE AT INCREASED RISK COMPARED TO MALES AND PERHAPS BECAUSE THE OTHER INDIVIDUAL DIFFERENCES, MINORITY POPULATIONS ARE AT INCREASED RISK OF POORER OUTCOMES AND FINALLY ANOTHER SALIENT FEE -- RELEVANT AT RISK INCLUDING ENVIRONMENTAL FACTORS NOTABLY INDIVIDUALS WITH FEWER SOCIAL SUPPORTS FOR INCREASED RISK. THERE'S NO SINGLE VARIABLE. IT'S THE COMBINATION OFFER OR ADDITIVE OR SYNERGISTIC OF RISK FACTORS FOR AN INDIVIDUAL TO EXPERIENCE TRAUMA TO AN ADVERSE EVENT. HOW CAN WE MITIGATE THESE AFFECTS? WE KNOW A FAIR BIT FROM OUR PREVIOUS RESEARCH. FIRST AND FOREMOST FROM THE RISK FACTORS WE CAN MITIGATE OR MINIMIZE THE LIKELIHOOD OF SEVERE OR CHRONIC REACTIONS BY MEETING THE IMMEDIATE NEEDS OF THOSE EXPOSED TO TRAUMA THAT MEANS INCREASING FOOD SECURITY AND DECREASING HOUSING INSECURITY. MEETING ECONOMIC AND SOCIAL NEEDS. WE CAN ALSO SUPPORT LONG-TERM RECOVERY BY PRACTICING HEALTHY COPING STRATEGIES, EATING WELL, SLEEPING, REACHING OUT TO THROWS AROUND YOU. THESE HEALTHY COPING STRATEGIES HAVE BEEN SHOWN TO REDUCE THE LIKELIHOOD OF SEVERE OR PERSISTENT REACTION TO TRAUMA AND HAVE BEEN A MAINSTAY OF PUBLIC HEALTH MESSAGING THROUGHOUT THE PANDEMIC BOTH BY NIH AND GOVERNMENT AND NON-GOVERNMENT ORGANIZATIONS. THIRD IT'S IMPORTANT TO TREAT NEW OR WORSENING ILLNESS AND MENTAL ILLNESS. FOURTH, FINDING WAYS TO HELP OTHERS CAN PROMOTE EFFICACY AND SOCIAL CONNECTEDNESS AND SHOWN TO SUPPORT RECOVERY LONG TERM. I MENTIONED THAT ONE IN PARTICULAR BECAUSE ONE OF THE FEATURES OF THE PANDEMIC IS THAT THE PANDEMIC HAS AFFECTED FIRST RESPONDERS AND HEALTH CARE INDIVIDUALS DELIVERING HEALTH CARE ON THE FRONT LINES AND OTHER VOLUNTEERS BECAUSE THEY'RE OUT AND ABOUT AND HAVE BEEN MORE EXPOSED AND YET THE LONG-TERM CONSEQUENCES OF THOSE EXPOSURES ARE REDUCED BY THE FACT THESE INDIVIDUALS ARE HELPING OTHERS. AN IMPORTANT FEATURE I'LL COME BACK TO IS DISASTERS CAN EXACERBATE EXISTING DISPARITIES IN MENTAL HEALTH OUTREACH AND ACCESS. ONE EXAMPLE IS SHOWN IN THE AFTER MATH OF HURRICANE KATRINA WHICH SHOWED THAT INDIVIDUALS WITH PREEXISTING DISORDERS IN CERTAIN AREAS SUCH AS NEW ORLEANS TENDED TO RECEIVE TREATMENT AFTER THE HURRICANE MORE LIKELY THAN OTHER AREAS SUCH AS ALABAMA, LOUISIANA AND MISSISSIPPI. AS A RESULT OF THAT, MANY IN THOSE SURROUNDING AREAS DID NOT RECEIVE POST-HURRICANE TREATMENT THEY NEEDED. THAT'S INDIVIDUALS BEFORE BUT INDIVIDUALS WITH NEW ONSET DISORDER AFTER HAD THE EQUIVALENT AND HIGH RATES OF NOT RECEIVING POST-HURRICANE TREATMENT. THAT WAS TRUE EVEN IN NEW ORLEANS WHERE THE INDIVIDUALS HAD A HIGHER RATE OF ONSET DISORDER WHICH IS LIKELY CONTRIBUTED BY THE FACT THAT THOSE INDIVIDUALS WERE MORE DIRECTLY EXPOSED TO THE WORSE PARTS OF THE DISAST. -- DISASTER AND THE REASONS ARE COMPLEX. AND CONTRIBUTE TO THOSE DISPARITIES. BUT I WANT TO POINT OUT THAT THOUGH OFTEN IT'S BLAMED ON THINGS LIKE LOW PERCEIVED [INDISCERNIBLE] THERE'S OTHER FACTORS THAT MAKE IT MORE CHALLENGING TO DELIVER CARE TO INDIVIDUALS IN THE CONTEXT OF THESE DISASTERS. SO THAT'S WHAT WE KNOW FROM PRIOR DISASTERS AND TRAUMATIC EVENTS AND IF I HAD TO SUMMIT -- SUM IT UM MOST WILL GET BETTER OVER TIME AND SOME MORE RAPIDLY THAN OTHERS AND RISK FACTORS FOR WORSE OUTCOMES ARE MULTI FACTORIAL INCLUDING ECONOMIC AND OTHER STRESSES AND MITIGATION FACTORS SUCH AS AVAILABILITY OF TREATMENT CAN BE UNEQUALLY DISTRIBUTED TO THE POPULATION. NOW, WHAT DO WE KNOW SO FAR ABOUT COVID-19 AND MENTAL HEALTH. FIRST I'LL TALK ABOUT THE GENERAL POPULATION AND THEN TALK ABOUT SPECIFIC POPULATIONS. ONE OF THE EARLIER REPORTS AND MORE RELIABLE REPORTS OF THE TAL HEALTH IMPACTS OF THE PANDEMIC WAS PUT OUT BY THE CDC IN AUGUST OF 2020. THIS WAS A SURVEY THAT ATTEMPTED TO BE REPRESENTATIVE OF U.S. ADULTS AND THAT AS OF LATE JUNE OF LAST YEAR AS MANY AS 40% OF U.S. ADULTS REPORTED ISSUES AND SYMPTOMS OF THE PANDEMIC THAT AFFECTED THEIR MENTAL HEALTH INCLUDING ANXIETY, DEPRESSION AND SUBSTANCE USE AND TRAUMA AND STRESS RELATED SYMPTOMS SUCH AS THOSE I MENTIONED HEIGHTENED AROUSAL AND NIGHTMARES AND ANXIETY AND WORRIES THROUGHOUT AND ARELEVANT TO THE PANDEMIC. AS MANY AS 11% OF U.S. ADULTS REPORTED SERIOUSLY CONSIDERING SUICIDE IN THE PAST TWO WEEKS AND DISTURBINGLY FOR YOUNG ADULTS LATE TEENS AND EARLY 20s, THAT FIGURE WAS MORE CLOSER TO 20%. THAT'S A REMARKABLY HIGH NUMBER. ALL THE NUMBERS ARE REMARKABLY HIGH AND TWICE AS HIGH AS WE MAY HAVE EXPECTED IN THE GIVEN PERIOD BEFORE THE PANDEMIC. HERE WE HAVE A TRAUMATIC EVENT GLOBALLY IMPACTING ADULTS AND MOST ARE NOT IMMEDIATELY AFFECTED BY EXPOSURE TO ILLNESS BECAUSE 30 MILLION CASES AND FEWER IN JUNE MEANS THERE'S NOT A LOT OF EXPOSURE AND WE'VE BEEN EXPOSED TO THE THREAT AND MANY MEASURES IN PLACE TO REDUCE THE AFFECT AND LOTS OF PEOPLE AFFECTED IN TERMS OF MENTAL HEALTH. THE DATA WOULD SUGGEST THE REPORTING OF MENTAL HEALTH DATA HAS INCREASED AS THE DATA HAS CONTINUED. IN THE DARK BLUE LINE IS INDIVIDUALS REPORTING SYMPTOMS OF EITHER ANXIETY OR DEPRESSION IN THE LARGER DOTTED BLUE LINE, ANXIETY AND THINNER OR SMALLER BLUE LINE SYMPTOMS OF DEPRESSION. YOU CAN SEE SOMETHING LIKE 40% OF U.S. ADULTS, SLIGHTLY HIGHER LATER IN THE PANDEMIC THAN EARLIER ARE REPORTING ANXIETY AND DEPRESSION. THIS DOESN'T INCLUDE ANOTHER PERHAPS 10% OR 15% OF ADULTS AT INCREASED USE OF SUBSTANCES TO A MALADAPTIVE EXTENT. THESE IMPACTS CONTINUE AS THE PANDEMIC HAS CONTINUED. A SIZABLE PORTION OF THE 40% OF AMERICANS HAVE BEEN GETTING HELP FOR THEIR MENTAL HEALTH SYMPTOMS. CLOSE TO 25% TOOK PRESCRIPTION MEDICINE OR THERAPY AND 10% NEEDED COUNSELLING. THERE'S BEEN JOB AND FINANCIAL INSECURITY AND STUDIES HAVE BEEN DONE IN CHANGES IN SYMPTOMOLOGY AND JOB INSECURITY DURING THE PANDEMIC CAN INCREASE FINANCIAL CONCERNS WHICH IN TURN INCREASE ANXIETY SYMPTOMS. THE WHOLE MODEL EXPLAINS 75% OF THE VARIANTS IN THE POPULATION. AGAIN, WHAT WE KNOW FROM PREVIOUS PANDEMICS THINGS LIKE FINANCIAL INSTABILITY AND JOB INSECURITY CAND INCREASE THE RATE OF -- CAN INCREASE THE RATE OF SYMPTOMS AND SAME IS TRUE FOR THE COVID-19 PANDEMIC. WHAT ABOUT OUTCOMES. WHAT KINDS OF OUTCOMES ARE WE SEEING. ONE EARLY REPORTING WAS THE NOTION THERE WERE INCREASED DEATHS DUE TO OPIOID OVERDOSES. THIS IS DATA REPORTED OUT EARLIER THIS YEAR. THE BLUE LINE REPRESENTS THE WEEKLY OPIOID OVERDOSES IN COOK COUNTY, ILLINOIS. WHAT YOU CAN SEE IS AFTER A PERIOD OF RELATIVE STABILITY YOU SAW AN INCREASE IN 2020 BUT A BIGGER INCREASE WHEN THE STAY AT HOME ORDER WENT INTO EFFECT IN MARCH THROUGH MAY OF 2020 IN COOK COUNTY, ILLINOIS. SOME OF THAT MIGHT HAVE BEEN THE DIRECT EFFECT OF THE STAY AT HOME ORDER PREVENTING PEOPLE FROM OR MAKING IT MORE CHALLENGING FOR PEOPLE TO GET CARE FOR OPIOID USE DISORDER AND THE EVIDENCE IS ONCE THE STAY AT HOME ORDER WITH US LIFTED IN MAY, 2020 THE NUMBERS RETURNED BACK TO THEIR 2020 BASELINE BUT NOT BACK TO THE 2019 BASELINE. THERE'S SOME EVIDENCE THE PANDEMIC AFFECTED OUTCOMES IN OVERDOSE DEATHS AND WE'RE LOOKING FORWARD TO RECEIVING MORE NATIONWIDE DATA AS TIME CONTINUES. A BIG CONCERN IS SUICIDE MAY INCREASE AND SO FAR IT SEEMS LIKE THE DEATHS HAVE NOT INCREASED. THESE ARE CHARTS OF SUICIDE DEATH RATES IN THE UNITED STATES FROM 2018 TO 2020 AND WHETHER YOU LOOK AT DEATHS IN THE THREE-MONTH PERIOD OR AVERAGE OR THE QUARTER DEATHS DUE TO SUICIDE WERE RELATIVELY STABLE IN THE UNITED STATES OR SLIGHTLY DECREASING AS ONE PROGRESS FROM 2019 THROUGH QUARTER 1 AND IN QUARTER 2 WHEN THE PANDEMIC WAS IN ITS FULL FORCE. THIS DATA CONTINUED THROUGH THE REST OF 2020. IT LOOKS LIKE IF ANYTHING THERE'S BEEN A SLIDE DECREASE IN SUICIDE RATES IN 2020 CONSISTENT WITH ACTUALLY A DECREASE THAT OCCURRED FROM 2018 TO 2019. IT SEEMS LIKE THE PANDEMIC HAS YET TO LEAD INCREASES IN SUICIDE DEATHS AS AN OUTCOME. THAT'S REGARD TO THE GENERAL POPULATION AND A MIX OF CONCERNING NEWS AND GOOD NEWS. THE CONCERNING NEWS INCREASE THE RATES OF SYMPTOMS OF MENTAL ILLNESSES AND OF COURSE EVIDENCE DUE TO OPIOID OVERDOSES. THE REASONABLY COMPENSATING NEWS IS THERE'S BEEN A DECREASE IN SUICIDE DEATHS OF MENTAL ILLNESS AND WE HOPE THAT'S DUE TO THE FACT THAT MANY OF THESE INDIVIDUALS WITH SYMPTOMS WHO ARE EXPERIENCING SERIOUS SYMPTOMS ARE GETTING THE HELP THEY NEED. WE'LL TALK MORE ABOUT THAT IN A LITTLE BIT. LET'S TALK ABOUT VULNERABLE POPULATIONS BECAUSE THERE THE STORY'S A LITTLE BIT DIFFERENT. PRE PANDEMIC THERE WERE STRIKING DISPARITIES IN MENTAL ILLNESS. 41% OF AFRICAN AMERICAN YOUNG ADULTS WITH SERIOUS MENTAL ILLNESS AND SCHIZOPHRENIA AND BIPOLAR DISORDER RECEIVED TREATMENT IN 2019 AND 49% OF AFRICAN AMERICAN ADULTS [RECORD SCRATCH] ED TREATMENT IN -- DIFFICULTS RECEIVED TREATMENT AND HALF DID NOT GET TREATMENT FOR THEIR SERIOUS MENTAL ILLNESSES. AND THERE'S BEEN PUBLICATIONS AND THE BIGGEST FOR ISSUES HAVE BEEN PERI NATAL NEEDS AND DOMESTIC ABUSE. WE HAVE EXISTING STUDIES TO UNDERSTAND THE IMPACTS PARTICULARLY IN THE PERI NATAL PERIOD. WE HAVE FUNDED RESEARCH CARRIED OUT MOSTLY AT A -- COLUMBIA UNIVERSITY ON MATERNAL AND BABY OUTCOMES IN LOOKING AT BEHAVIORS AND BRAIN FUNCTIONS IN BOTH MOM AND BABY TO TRY TO UNDERSTAND IMPACT OF THE PANDEMIC. THOSE STUDIES ARE ONGOING. PARTICULARLY INDIVIDUALS WITH MENTAL ILLNESS ARE AT INCREASED FROM THE PANDEMIC NOT JUST IN TERMS OF EXACERBATIONS DURING ILLNESS AS WE MAY EXPECT FROM PREVIOUS STUDIES BUT EXPOSURE TO THE PANDEMIC ITSELF. ON THIS SLIDE THERE'S A STUDY BY OUR COLLEAGUE, NORA VOLKOW WITH HER LABORATORY MEMBERS DURING THE PANDEMIC LOOKED AT AVAILABLE DATA TO THE IMPACT OF YOUR MENTAL ILLNESS AND COVID-19 AND THERE WAS DEPRESSION AND SCHIZOPHRENIA. INDIVIDUALS WITH SCHIZOPHRENIA OR DEPRESSION HAVE A TENFOLD INCREASED RISK OF CONTRACTING COVID-19 INFECTION. THAT'S SUBSTANTIAL. MULTIPLE REASONS WHY THAT MAY BE INCLUDING OF COURSE MANY PEOPLE WITH SERIOUS MENTAL ILLNESS ARE HOMELESS, MANY INDIVIDUALS NEEDED TO CONTINUE GOING IN PERSON TO GET CARE AND MANY INDIVIDUALS HAVE CHALLENGES IN SELF-CARE AS WELL. ALSO CONCERNING IS THE DESPAIRS WERE NOT DISTRIBUTED THROUGHOUT THE POPULATION SUCH AS INDIVIDUALS, AFRICAN AMERICAN INDIVIDUALS WERE AT HIGHER RISK OF CONTRACTING COVID-19 COMPARED TO INDIVIDUALS WHO WERE WHITE EVEN GIVEN THE DISEASE. IF YOU HAVE SCHIZOPHRENIA AND AFRICAN AMERICAN HAVE YOU A TWO AND A HALF FOLD RISK COMPARED TO INDIVIDUALS WHO ARE WHITE. THERE'S ALSO DISPARITIES IF YOU HAVE ILLNESSES AND ARE FEMALE COMPARED TO MALE. YOU'RE AT INCREASED RISK OF CONTRACTING COVID-19 INFECTION. IF YOU'RE UNFORTUNATE ENOUGH TO HAVE SCHIZOPHRENIA AND CONTRACT THE COVID-19 VIRUS YOU'RE AT INCREASED RISK OF DEATH FROM THAT VIRUS AND THAT'S SHOWN HERE EVEN ADJUSTING FOR HYPERTENSION AND MYOCARDIAL FAILURE AND ALL INCREASED IN SCHIZOPHRENIA YOU HAVE A THREEFOLD INCREASE IN RISK OF DYING DUE TO COVID IF YOU HAVE SCHIZOPHRENIA. THE RISK FOR OTHER AND OTHERS DON'T SURVIVE THE CORRECTION STATISTICALLY SO IT'S UNCLEAR WHETHER THEY INCREASE RISK BUT THERE'S SUGGESTION THERE'S A POSSIBILITY. AN INTERESTING QUESTION IS HOW TO MITIGATE THE EFFECTS OF THE PANDEMIC ON VULNERABLE POPULATIONS AND ONE WE'RE CONCERNED ABOUT BUT THE DATA ISN'T REALLY OUT YET IS CHILDREN. AND CHILDREN PARTICULARLY AT HOME DURING THE PANDEMIC. THERE'S SOME EVIDENCE THAT SUGGESTED MANY CHILDREN WHO ARE HOME WITHOUT SCHOOLING ARE EXPERIENCING TANTRUMS, ARGUMENTS, DISOBEDIENT BEHAVIOR AND WHAT CAN BE DONE TO REDUCE THESE BEHAVIORS? THE SAME SURVEY DATA REVEALED THAT THERE ARE THINGS THAT MIGHT REDUCE THE LIKELIHOOD OF EXACERBATIONS OF THESE BEHAVIORS. ONE IS ESTABLISHING OR MAINTAINING FAMILY ROUTINES EVEN THOUGH OF COURSE THE REGULAR WORK AND SCHOOL SCHEDULE ROUTINES MAY HAVE BEEN DISRUPTED AND IT'S BEEN SHOWN THOSE FAMILIES ABLE TO ESTABLISH AND MAINTAIN THOSE ROUTINES REDUCE THE IMPACT OF THE PANDEMIC ON EXACERBATIONS OF DEPRESSIVE OR EXTERNALIZING SYMPTOMS. YOU CAN ALSO SHOW SOME OF THOSE MEASURES REDUCE DEPRESSIVE SYMPTOMS IN MOTHERS AS WELL AS STRESS SYMPTOMS IN OTHERS AS WELL. ANOTHER VULNERABLE POPULATION WAS AFRICAN AMERICANS. THOUGH AS SHOWN IN ORANGE IN THE DATA FROM MARYLAND, DURING THE PANDEMIC ITSELF SUICIDE RATES AMONGST WHITES IN MARYLAND DECREASED AND SHOWING THE DATA NATIONALLY THAT SUGGESTED THERE WAS A SLIGHT DECREASE OR AT LEAST A STEADINESS IN SUICIDE RATES IN THE GENERAL POPULATION IN THE UNITED STATES. THERE ARE VULNERABLE POPULATIONS WHERE WE'RE SEEING INCREASED RATES AND ONE WAS IN THE EARLY DAYS OF THE PANDEMIC INCREASE IN THE RATES OF SUICIDES AMONGST BLACKS IN THE STATE OF MARYLAND. THE DATA ON THE BLACK LINE WHERE YOU SEE AN INCREASE IN SLOPE IS INCREASED DEATHS IN 2020 COMPARED TO 2019 FOR THE BLACK POPULATION IN MARYLAND. THE DATA HAS BEEN CORROBORATED BY SIMILAR DATA IN MASSACHUSETTS AND CONNECTICUT. WARE CONCERNED THOUGH THERE'S NOT AN INCREASED RISK IN THE POPULATION FOR SUICIDE RISKS THERE MAY BE IN THE POPULATIONS HIT HARDEST BY THE PANDEMIC. YOU SEE IN EARLY 2020 BEFORE THE FIRST CASES WERE REPORTED IN THE STATE OF MARYLAND A MODEST OR POTENTIAL DECLINE IN SUICIDE RATES FOR BLACK MARYLANDERS AND THAT SUICIDE RATE STARTED INCREASING WITHIN A FEW WEEKS AFTER THE FIRST CASE REPORTS REPORTED AND MARYLAND SHUT DOWN AND WE KNOW THE SHUT DOWN HAD DISPARATE AFFECTS ON THE BLACK COMMUNITIES. WHEN WE REOPENING IN MAY SUGGESTED ONE OF THE SIGNIFICANT REASONS FOR THE POTENTIAL INFECTIOUS IN RATES OF SUICIDE AMONGST BLACK MARYLANDERS WERE THE ECONOMIC AND OTHER AFFECT AS OF THE PANDEMIC RATHER THAN THE THREAT OF INFECTION ITSELF. IN ENGLAND MENTAL AFFECTS OF THE PANDEMIC WERE GREATER IN BLACK, ASIAN, ETHNIC COMMUNITIES THAN WHITE COMMUNITIES. THIS WAS COMPARED TO THE HEIGHT OF THE PANDEMIC. WE SEA DISPARITIES IN REPORTS OF STRESS AND WORRY DURING THE COVID PANDEMIC IN THE UNITED STATES AS WELL WHERE YOU SEE HISPANIC AND BLACK COMMUNITIES HAVE HIGHER RATES OF HOUSING INSTABILITY AND INSUFFICIENT FOOD AND LOSS OF JOB OR INCOMES. ANOTHER VULNERABLE POPULATION, FRONT LINE HEALTH CARE WORKERS. WE'RE SEEING SUBSTANTIAL RATES OF SYMPTOMS ATTRIBUTABLE TO STRESS. SYMPTOMS OF DEPRESSION. SYMPTOMS OF ANXIETY AND IMPORTANTLY THEY'RE SEEN GREATEST IN THE FRONT LINE OF THE FRONT LINE, THE NURSES AND RESIDENTS AND FELLOWS WORKING THE HOSPITALS THOUGH SUBSTANTIAL NUMBERS OF INDIVIDUALS AND ATTENDING PHYSICIANS ALSO EXPERIENCING THE SYMPTOMS. THIS IS THE DATA ON SUICIDE PREPANDEMIC DATA TO GIVE CONTEXT. AGAIN, WHITE SUICIDE RATES AS WELL AS THE OVERALL SUICIDE RATE IN BLACK SHOWED SLIGHT DECLINES FROM 2018 TO 2019. ALREADY WE WERE SEEING SIGNS THE DECLINES WERE NOT BEING SEEN IN BLACK COMMUNITIES AND ASIAN COMMUNITIES WHICH HAVE HAD HISTORICALLY LOWER SUICIDE RATES. THIS IS DATA FROM MARYLAND SHOWING IN MARCH TO MAY, THE EARLY PART OF THE PANDEMIC THE RATES OF SUICIDE AMONGST BLACKS INCREASED WHILE THE RATES OF SUICIDES AMONGST WHITES DECREASED. THIS IS THE DATA SHOWING NON-WHITE SUICIDES INCREASED TO BE ABOVE THE FIVE-YEAR AVERAGE DURING THE EARLY PART OF 2020 WHEREAS WHITES TOTAL OVERALL RATES SUICIDE RATES DECREASED. I'LL CLOSE BY TALKING ABOUT HOW WE RESPOND TO THE COVID-19 PANDEMIC HERE AND ELSEWHERE. ONE OF THE IMPORTANT RESPONSES WAS TELEHEALTH. PRIOR TO THE PANDEMIC IT WAS EXPANDING AND MENTAL HEALTH WAS ONE AREA WHERE IT'S BEEN SHOWN TO BE EFFICACIOUS AND AS EFFICACIOUS AS IN PERSON HEALTH CARE DELIVERY. DURING THE PANDEMIC FEDERAL AND STATE LEGISLATION AND REGULATIONS QUICKLY CHANGED IN ORDER TO ENHANCE ACCESS TO TELEHEALTH IN THE CONTEXT OF THE SHUT DOWNS. THAT TOOK PLACE IN MENTAL AND PHYSICAL HEALTH. ONE OF THE OTHER CHANGES BESIDES S IN TELEHEALTH WAS DECREASES IN EMERGENCY ROOM VISITS. PHYSICAL HEALTH REASONS YOU SEE HERE IN THE BLUE IS ALL MENTAL HEALTH RELATED VISITS TO MORTGAGE ROOMS. -- EMERGENCY ROOMS AND THE PROCLAMATION OF SLOWING THE SPREAD WAS MADE AND BEFORE THAT AS MANY STATES STARTED TO SHUT DOWN EARLIER WITH DRAMATIC DECREASES IN THE RATES OF VISITS FOR TOTAL EMERGENCY ROOM VISITS AS WELL AS INDIVIDUAL MENTAL HEALTH COMPLAINTS SUCH AS OPIOID OVERDOSES AND SUBSTANCE ABUSE AND INTIMATE PARTNER VIOLENCE AND SUICIDE TEAMS. -- ATTEMPTS. INSTEAD OF IN PERSON CARE WE SWITCHED TO TELEHEALTH. ONE OF THE THINGS WE LEARNED FROM THE SWITCH TO TELEHEALTH IS IT CAN BE USED IN LOW-INCOME SETTINGS. THESE DATA ARE FROM FEDERALLY QUALIFIED HEALTH CARE CENTERS FOR PRIMARY CARE ON THE LEFT AND BEHAVIORAL HEALTH ON THE RIGHT. YOU SEE THE TOTAL VISITS FOR PRIMARY CARE AND BEHAVIORAL HEALTH STAYED THE SAME OR BEHAVIORAL HEALTH WENT UP A LITTLE BIT THAT'S ENCOURAGING GIVEN THE INCREASE IN SYMPTOMS. THE IN PERSON SYMPTOMS DECREASED FOR BEHAVIORAL HEALTH AND REPLACED PRIMARILY BY TELEPHONE OR AUDIO ONLY VISITS OPPOSED TO VIDEO VISITS IN THE GRAY BAR. OTHER DATA FROM INSURED POPULATIONS SUGGEST THE VIDEO VISITS WERE PREDOMINANT COMPARED TO AUDIO VISITS. WE DON'T HAVE COMPARATIVE KNOWING AUDIO IS AS GOOD AS VIDEO BUT IN LOW-INCOME SETTINGS WE'LL SEE DIFFERENT KINDS OF HEALTH CARE DELIVERY. WE'LL WRAP UP AND SAYING IDENTIFYING RISK AND PROMOTING RESILIENCE IS THE IMPORTANT MESSAGE IN MITIGATING THESE EFFECTS. I THINK WE CAN END BY SAYING THERE'S A LOT OF NIMH RESEARCH WE'VE PROMOTED TO INCREASE INFORMATION AND MEET THE NEEDS OF ENDING THE PANDEMIC AND I'LL OPEN IT UP TO QUESTIONS THERE. THANK YOU. >> THERE'S SO MUCH GOING ON AND LAID OUT A COMPREHENSIVE PICTURE LOCALLY AND NATIONALLY. I DO BELIEVE THERE'S A FIRST QUESTION FROM DR. BREWSTER. DO YOU HAVE A QUESTION OR COMMENT. >> JOSH, HOW WOULD YOU COMMENT ON SOME OF THE DISTURBING DATA THAT WE'RE SEEING ABOUT OF COURSE WE KNOW THE RATE OF MORTALITY IS HIGHER IN WOMEN FOR COVID-19 BUT I PRESENTED SOME DATA IN MY DIRECTOR'S REPORT THIS MORNING LOOKING AT GEORGIA AND MICHIGAN AND IT SHOWED THE MORALITY RATES FOR BLACK WOMEN EXCEEDED THE RATES FOR WHITEMAN. -- HATE WHITE MEN. THIS IS RATES NOT ABSOLUTE NUMBERS. CAN YOU COMMENT ON WHAT YOU SEE IN DIFFERENCES IN STATE LEVELS LIKE THAT. >> MY GUESS IS THE DIFFERENCE AT STATE LEVEL WILL BE DIFFERENCES AND WE DON'T HAVE NATIONAL DATA TO REPORT OUT. BASED ON THE FACT NATIONAL SURVEY INDICATE INCREASED RATES OF STRESSORS AND SYMPTOMS AMONGST MINORITY POPULATIONS MY GUESS IS THAT WILL BE MANIFEST IN NATIONAL CHANGES IN SUICIDE RATES. THE REASONS IF WE THINK ABOUT THE MENTAL HEALTH IMPACT ARE OBVIOUS NOT ONLY DID WE HAVE DESPAIRS IN SOCIAL SUPPORTS AND FINANCIAL SUPPORTS AND FOOD SECURITY AND IN HOUSING SECURITY, THOSE DISPARITIES BY RACE AND BY COMMUNITIES PREEXIST THE PANDEMIC BUT AS STUDY AFTER STUDY HAS SHOWN THE DISPARITIES INCREASED SO WAY MORE AFRICAN AMERICANS LOFT JOBS THAN WHITES AND THERE'S SOME DATA THAT SUGGESTS FOOD PROVISION ACTUALLY CAN MITIGATE THOSE EFFECTS AND COULD CREATE LOCAL AND STATEWIDE INEQUALITIES. ONE STUDY IS YOU CAN REDUCE THE LEVEL OF DEPRESSION SYMPTOMOLOGY AND THOSE RECEIVED FOOD FROM FOOD BANKS AND OTHER PROGRAMS DURING THE PANDEMIC HAVE LOWER RATES -- NOT DRAMATICALLY LOWER BUT LOWER RATES OF DEPRESSION SYMPTOMS. AND SUGGESTS THE ECONOMIC PACKAGES DELIVERED COULD BE REDUCING MENTAL HEALTH IMPACTS. THEY COULD ALSO ADD TO DISPARITIES. >> DR. TEMPLETON HAS A COMMENT. >> THANK YOU SO MUCH. THAT WAS A GREAT PRESENTATION. I'M THRILLED YOU'RE INCLUDING HEALTH CARE WORKERS IN THE VULNERABLE POPULATIONS. AND SINCE THE VAST MAJORITY OF THOSE ARE WOMEN IS THAT IS THAT A SEX AND GENDER ISSUE OR DOES IT REFLECT THEIR JOBS. THAT'S AN ISSUE WE'VE SEEN IN THE DATA FROM WUHAN FROM EARLY DAYS OF THE PANDEMIC NOTING INCREASED ISSUES OF MENTAL HEALTH BUT NOT SEGREGATING IT OUT DUE TO SEX AND GENDER AND IF YOU LOOK AT THE RISK FACTOR US MENTIONED WOMEN AND PREEXISTING MENTAL HEALTH CONDITIONS AND PRIOR TO THE PANDEMIC NEUROSCIENCES AND PHYSICIANS WERE BY AND LARGE BURNED OUT AND IT'S ADDING ONE MORE ISSUE TO THAT. WE ALSO TALKED ABOUT THE ISSUES AFTER PRIOR DISAST ERS OF NOT SEEKING MENTAL HEALTH CARE AND WONDER IF ANYBODY'S LOOKING AT THAT IN TERMS OF HEALTH CARE PROFESSIONALS AND PHYSICIANS WE KNOW THE HEALTH CARE CLIMATE IS MAKING PEOPLE DISINCLINED TO SEE HEALTH CARE AND I WORRY ABOUT THE IMPACT OF FRONT LINE WORKERS AND HEROES AND THE IMPLICATIONS OF NOT SEEKING HELP AND IF PEOPLE ARE LOOKING AT THE RATES OF HEALTH CARE AMONG HEALTH CARE PROFESSIONALS AND IF THAT'S BEGINNING TO KEEP PACE WITH WHAT THE NEED IS. >> I WAS LOOKING AT THE SCHECTER PAPER TO SAY IF THEY BROKE IT OUT AND THEY DID NOT. THE OVERWHELMING MAJORITY OF RESPO RESPONDENTS WERE WOMEN, 70% BUT DIDN'T BREAK IT DOWN BY ROLE. I DON'T HAVE A GOOD ANSWER FOR THAT BUT YOU'RE RIGHT, THAT COULD BE A CONTRIBUTING FACTOR. WE KNOW WOMEN EXPERIENCE DEPRESSIVE AND ANXIETY ISSUES PORE THAN MEN. NOT ON THE PTSD ANGLE THAT'S A LITTLE BIT LESS GENDER BIASSED BUT STILL GENDER BIASSED AND IT WILL BE INTERESTING TO DELVE INTO THE ISSUES. >> DR. LANGER DID YOU HAVE A QUESTION. >> THANK YOU FOR A GREAT PRESENTATION. MOST THE HEALTH CARE PROFESSIONALS WOMEN AND MANY ARE BLACK, THEY'RE ALSO IN THE REDUCTIVE AGE BRACKET MANY ARE ALSO PREGNANT. I WONDERED HOW YOU'RE LOOKING AT COMBINED SOURCES OF STRESS AND POTENTIALLY MENTAL ILLNESS AND ONE COMMENT ABOUT TELEHEALTH. I WONDERED IF YOU'RE DISAGGREGATING THE DATA ON GENDER BASED BIAS ARE NOT ABLE TO SEEK HEALTH FROM HOME AS THEY MOVED AROUND BEFORE THE PANDEMIC HIT. THANK YOU. >> THEY HAVEN'T DONE ALL THE ANALYSES. LET ME SEE IF IT HAS' -- HAS A BREAKOUT ON TELEHEALTH USE BY GENDER AND DOES NOT. THE TELEHEALTH BY RACE IS INTERESTING AND IN CALIFORNIA IT'S HEAVILY HISPANIC AND SUBSTANTIAL NUMBERS OF BLACKS. AND THERE'S LOW SOCIO ECONOMIC CONDITIONS YOU'RE SEEING WITH ADOPTION OF TELEHEALTH AND EVEN IN INSURED POPULATIONS THERE'S DATA FROM THE KAISER CENTERS THERE'S GOOD ACCESS TO TELEHEALTH REGARDLESS OF RACE AMONG THESE INDIVIDUALS INSURED EITHER BY THE PRIVATE OR KAISER COMPONENTS THAT ARE MEDICARE AND MEDICAID DON'T KNOW ABOUT GENDER ACTUALLY. I HAVEN'T SEEN THAT DATA BROKEN OUT. YOU RAISE A GOOD QUESTION ABOUT TELEHEALTH BEING EFFICACIOUS AND YOU POINTED OUT INDIVIDUALS WITH TRAUMA WILL BE AFFECTED DIFFERENTIALLY BY THE ACCESS TO HEALTH. IT'S A GOOD POINT. >> GO DR. ROBERSON DO YOU HAVE A QUICK QUESTION? >> YES. THANK YOU FOR THE PRESENTATION. VERY INFORMATIVE. LOTS OF DATA. I'M IN ALABAMA AND ONE OF THE STATES AND SURE THERE'S OTHERS WHERE WITH THE VACCINE WE'RE GETTING PRESSURE FROM THE PUBLIC TO RETURN TO BACK TO RETURN TO OLD NORMAL AND SEEING UNIVERSITIES AND BUSINESSES WORKING AT HOME TO TRANSITION BACK AND PEOPLE HAVE A LOT OF ANXIETY ON THAT. DO YOU HAVE DATA OR PROJECTIONS ON WHAT TO EXPECT AS PEOPLE COME BACK? ARE WE GOING TO BE SEEING MORE MENTAL HEALTH ISSUES? WILL IT BEING DIFFERENT FOR PEOPLE IN UNDER SERVED POPULATIONS? WHAT DOES THAT LOOK LIKE? >> THOSE ARE GREAT QUESTIONS AND I MENTIONED WHAT WE KNOW FROM PREVIOUS DISASTERS AND PANDEMICS. WE HAVE A LITTLE BIT OF DATA THAT SUGGESTS THE LONGER INDIVIDUALS ARE QUARANTINED IN THE CONTEXT OF AN EPIDEMIC, THE GREATER THE MENTAL HEALTH IMPACT. WE DON'T HAVE GOOD DATA ON RETURN TO WORK ISSUES. I THINK THAT'S ONE THING WE HOPE TO GET. WE HAVE A NUMBER OF STUDIES OUT THAT WILL BE FOLLOWING MINORITIES. I HAVE A LOT OF CONCERNS ABOUT THE PUSH TO RETURN TO WORK AND THINK THERE'LL BE A LOT OF VARIABILITY. WE AT NIH ARE BLESSED WITH AN UNDERSTANDING LEADERSHIP THAT SAID FROM THE BEGINNING WE'RE GOING TO TAKE IT SLOW AND SO FAR IT'S BEEN OPTIONAL AND IT'S A SAFE WORKPLACE AND OTHERS ARE NOT EXPERIENCING THAT. IT'S GOING TO BE SOMETHING TO WATCH. THE DATA WE ACCUMULATED IN THE CONTEXT OF COVID WILL BE INFORMATIVE ON THAT FRONT. >> THANK YOU. NOW TO THE SENIOR PROGRAM OFFICER AT ORWH TO INTRODUCE OUR NEXT SPEAKER. >> THANK YOU. I'M HAPPY TO INTRODUCE OUR NEXT SPEAKER DR. PUTRINO. HE'S A PHYSICAL THERAPIST WITH A Ph.D. IN NEUROSCIENCE. HE WORKED AT A CLINICIAN IN AUSTRALIA BEFORE MOVING TO THE U.S. TO STUDY COMPUTATIONAL NEUROSCIENCE AT HARVARD MEDICAL SCHOOL, M.I.T. AND NYU AND SUBBED AS CORNELL MEDICINE. HE'S CURRENTLY THE DIRECTOR OF REHABILITATION, INNOVATION FOR THE MOUNT SINAI HEALTH SYSTEM AND FOR HUMAN PERFORMANCE AT ICAHN SCHOOL OF MEDICINE AND WORKS ON INNOVATIVE TECHNOLOGY SOLUTIONS FOR INDIVIDUALS IN NEED OF BETTER HEALTH CARE. HE WORKS WITH HIGH PERFORMANCE DIVISION AND BROOKLYN NETS NATIONAL BEEN ASSOCIATION TEAM TO USE EVIDENCE-BASED TECHNOLOGIES TO IMPROVE ATHLETIC PERFORMANCE AND THE CHIEF SCIENTIST OF NOT IMPOSSIBLE LABS. A GROUP THAT CROWD SOURCES ACCESSIBLE TECHNOLOGY SOLUTIONS FOR HIGH IMPACT HUMAN PROBLEMS. HIS RESEARCH HAS BEEN FOCUSSED AND RESEARCHED ON ABC AND ON THE WALL STREET JOURNAL AND BBC, TIME MAGAZINE AND THE NEW YORK TIMES TO NAME A FEW. HE'S THE AUTHOR OF HOW TO MAKE MONEY AND SAVE LIVE IN THE HEALTH CARE TECH WORLD WHICH IS AVAILABLE FROM AMAZON AND IN 2019 HE WAS NAMED GLOBAL AUSTRALIAN OF THE YEAR FOR CONTRIBUTION TO HEALTH CARE. WELCOMING TO DR. PUTRINO. >> THANK YOU FOR HAVING ME. TODAY I WANTED TO HAVE A CHAT WITH THE GROUP ABOUT SOMETHING THAT WE'VE BEEN REFERRING TO AS POST ACUTE COVID SYNDROME AND ESPECIALLY FOR THIS PARTICULAR GROUP. I THINK WE SHOULD DISCUSS THE IMPLICATIONS THERE IS FOR WOMEN'S HEALTH. YOU MAY HAVE HEARD OF POST-ACUTE COVID SYNDROME REFERRED TO AS LUNG COVID OR LONG HAUL COVID. WHAT MAY BE USEFUL WOULD BE TO START OFF WITH A SLIDE EXPRESSING HOW WE'RE CURRENTLY THINKING ABOUT THE NOMENCLATURE. AROUND WE STARTED TO TALK ABOUT POST-ACUTE SEQUELAE OF COVID. I WORK AT A CENTER DEDICATED TO MANAGING PERSISTENT SYMPTOMS AFTER COVID AND MANAGED MORE THAN 2,000 PATIENTS SINCE MAY OF LAST YEAR. WE TEND TO THINK ABOUT THESE CASES IN TWO DIFFERENT FORMS. THE FIRST ARE PEOPLE WHO COME WITH PERSISTENT SYMPTOMS WITH CLEAR AND EXPLICABLE MEDICAL COURSE AND SOME SAY WE HAVE SHORTNESS OF BREATHE AND SCAN THEIR LUNGS AND SEE SIGNIFICANT LUNG DAMAGE AND SEND THEM TO PULMONARY REHABILITATION AND SOMEONE SAYS I'M FEELING A BIT OFF. MY CHEST HURTS AND I'M FATIGUED ALL THE TIME WE DO A CARDIAC WORK UP AND MEDICATION TO MANAGE THE PERICARDITIS AND KIDNEY DAMAGE, ALL THESE VERY VARIED AND DIAGNOSABLE CONDITIONS AS A RESULT OF PERSISTENT SYMPTOMS OF COVID. HOWEVER, WE ALSO HAVE A GROUP OF PATIENTS AT LAST COUNT THROUGH THE CENTER FOR POST-COVID CARE OPENED T OPENED 900 PATIENTS AND HAVE MEDICALLY UNEXPLAINED MEDICAL SYMPTOMS MEANING THEY'LL PRESENT WITH A NUMBER OF SYMPTOMS THAT ARE SEVERE AND DEBILITATING BUT AFTER TESTS CANNOT EXPLAIN THE SYMPTOMS IN THE LUNG COVID CASES. THIS IS WITH WHAT WE'RE TO TALK ABOUT TODAY. WE'LL DISCUSS A LITTLE BIT ABOUT HOW IT CAME ABOUT. I WANTED TO GIVE A BRIEF INTRODUCTION TO WHY I'M TALKING ABOUT POST-ACUTE COVID SYNDROME. IN MARCH OF 2020 WE WERE GETTING HIT HARD HERE IN NEW YORK. WHAT I'M SHOWING HERE IS THIS IS TYPICALLY THE ATRIUM OF MAIN ATRIUM IN THE MOUNT SINAI HOSPITAL WHICH THIS IS USUALLY AN OPEN BEAUTIFUL AREA WITH GLASS CEILINGS SO SUNLIGHT CAN STREAM IN AND IT'S A NICE SPACE. YOU'RE SEEING THE ENTIRE SPACE BEING TURNED INTO TEMPORARY ICU BEDS. IF WE GO TO THE NEXT SLIDE THIS IS WHAT THE BEDS LOOK LIKE IN USE. IT'S DAUNTING TO THINK ABOUT NEW YORK BEING IN THAT STATE ONCE AGAIN BUT THAT'S WHERE WE WERE A YEAR AGO. WE MOVED TO THE NEXT SLIDE. YOU'LL ALSO SEE WE WERE IN OVER FLOW. THIS IS CENTRAL PARK IN FRONT OF THE MAIN MOUNT SINAI HOSPITAL AND HAD TO PUT UP TENTS TO MANAGE ALL THE PATIENT OVERFLOW. PATIENTS WOULD SHOW UP IN MARCH OR APRIL AND SHOW UP WITH SYMPTOMS CONSISTENT WITH COVID AND IN DISTRESS BECAUSE IT WAS UNKNOWN AND OUR FIRST RESPONDERS WHETHER THEY BE URGENT CARE OR VIRTUAL URGENT CARE PHYSICIANS OR EMERGENCY DEPARTMENT PHYSICIANS CAME TO MY DEPARTMENT WITH THIS REAL CONCERN OF PATIENTS COMING TO US WITH SYMPTOMS AND WE KNOW THEY'RE TOO KICK. -- SICK. THEY ARE NOT MEETING CRITERIA FOR US TO ACTUALLY ADMIT THEM AND GIVE THEM A HOSPITAL BED WE DIDN'T KNOW ABOUT WHAT TO DO AND STRUGGLING BECAUSE WE DIDN'T KNOW THE DISEASE COURSE AND IT WAS PLACING A STRAIN ON EMERGENCY SERVICES AND WE STOOD UP IN APP FOR ACUTE COVID SYMPTOMS. IT WAS SIMPLE AND WE WOULD ONBOARD SYMPTOMS AND WE WOULD CHECK IN ON THEM AND MAKE SURE THE SYMPTOMS WERE NOT GETTING OUT OF CONTROL AND WERE USING EVIDENCE-BASED SCIENCE OF INDIVIDUALS GOING INTO AT RISK OF GOING INTO RESPIRATORY FAILURE AND FOR MANAGING ACUTE COVID THIS PARTICULAR PROTOCOL WORKED WELL AND WE PUBLISHED ON THIS IT WAS EFFECTIVE AND NO WORRIES. IF WE MOVE FORWARD TO THE NEXT SLIDE WHEN WE ROLLED THE PROGRAM OUT ALMOST IMMEDIATELY AND THE FIRST PATIENT WAS ONBOARDED MARCH 16 OF 2020. BY THE TIME WE HIT MAY 2020 WE STARTED TO NOTICE TO SO% -- OF THE 10% LESS SEVERE COVID CASES ONBOARDED ON OUR APP WEREN'T GETTING BETTER AND REPORTING PERSISTENT SYMPTOMS FROM WHAT WE KNEW WAS COMMON SYMPTOMOLOGY OF ACUTE COVID-19 AND WE WERE STARTING TO GET THE SENSE THERE WAS SOMETHING AT PLAY LIKE A POST-VIRAL SYMPTOM. BY NO MEANS ARE WE TALKING ABOUT EPIDEMIOLOGY. THE DEMOGRAPHICS IN THE FIRST 200 CASES THROUGH OUR DOOR. THERE'S A SKEW TOWARDS MORE FEMALES THAN MALES AFFECTED. THE MEDIAN AGE IS 43 YEARS OF AGE AND WE'RE TALKING ABOUT A CONDITION DISPROPORTIONATELY AFFECTING A YOUNGER POPULATION THAN WITH MORTALITY AGE OLDER POPULATION. FIT AND HEALTHY FOR THE MOST PART AND WHAT YOU'LL NOTICE IN TERM OF THEIR COVID STATUS IS THAT IT'S ROUGHLY 50/50 FOR THOSE AND THOSE WHO HAD POSITIVE PCR OR ANTIBODY TESTS IN THEIR MEDICAL HISTORY. WE'LL DISCUSS THAT FINDING A LITTLE BIT LATER. AS YOU CAN SEE HERE IN TERMS OF RACE AND ETHNICITY ALMOST 90% BLACKS. AGAIN I WOULD STRESS THIS IS NOT EPIDEMIOLOGY. THIS IS JUST WE'RE A HOSPITAL IN THE UPPER EAST SIDE. THERE'S KNOWN HISTORICALLY EXCLUDED GROUPS PROBABLY NOT SHOWING UP FOR CARE BECAUSE THEY ARE FEELING EXTREME FATIGUE AND HEART PAL PATATIONS AND AND IT'S JUST THE DEMOGRAPHICS OF THE GROUP WE WERE WORKING WITH IN THIS CASE. AND NOTABLE COMORBIDITIES WE DON'T KNOW WHAT TO DO WITH JUST YET. I'LL SHARE THAT. AND PREVIOUS EXISTING ASTHMA OR THIS SORT OF IS SHOWING UP IN HIGH PROPORTION AND AGAIN MAY POINT TOWARDS AN IMMUNE INVOLVEMENT IN THE CONDITION. WE'RE DIGGING INTO THE PATHOPHYSIOLOGY WITH WONDERFUL STUDIES OUT OF YALE UNIVERSITY. AND KEEP AN EYE OUT FOR PUBLISHERS AS WE TRY TO UNDERSTAND WHAT'S HAPPENING ON THAT LEVEL. THIS IS SHOWING SOME OF THE MOST COMMON SYMPTOMS WE'RE SEEING IN THIS COHORT. YOU CAN SEE FATIGUE AND COGNITIVE ISSUES REALLY SHOW UP AS SOME OF THE MOST PROMINENT SYMPTOMS. FEELING GENERALLY WEEK AND EXPERIENCING HEART PAL PATITIONS, SHORTNESS OF BREATH, CHEST PAIN ARE COMMON IN THE COHORT. I WANT TO INFORM EVERYONE ABOUT THE OTHER MORE INTERESTING OBJECTIVE SIGNS AND SYMPTOMS WE'RE SEEING IN THE COHORT AS WE START TO TRY TO MOVE TOWARDS SOME DIAGNOSTIC CRITERIA FOR PEOPLE WITH POST-ACUTE COVID SYMPTOMS AND HYPOCAPNIA IS SHOWING UP AS A SYMPTOM OF POSTACUTE COVID SYNDROME. SO FAR EVERY PATIENT TESTED HAVE A LEVEL BELOW NORMATIVE VALUES. WE'RE SEEING LOW LEVELS OF CO2. WE'RE SEEING REDUCED HEART DIMENSIONS. THIS IS A COMMON FINDING IN MANY STUDIES AS WELL. WE'VE BEEN STUDYING THE POX LITERATURE BECAUSE MANY REPORTED. IT'S IMPORTANT TO NOTE THESE ARE GROUP AFFECTS IF YOU JUST LOOK AT A PERSON'S ECHO IT WILL BE WITHIN NORMAL LIMITS. THE LV DIMENSIONS WILL BE SMALL FOR THEIR AGE AND GENDER AND WEIGHT. WHEN YOU LOOK AT THE GROUP EFFECTS IT'S A TREND WE'RE SEEING REDUCED LV DIMENSIONS ACROSS THE POPULATION. IF WE MOVE TO THE NEXT SLIDE I HAVE A FEW COMMENTS ON INTERVENTIONS WE'VE BEEN WORKING ON, HOW THEY'RE WORKING AND I JUST WANTED TO QUICKLY TAKE A MOMENT TO ACKNOWLEDGE THE WORK OF SPECIAL AND REMARKABLE PEOPLE. WE HAVE PODIATRISTS THAT BASICALLY PUT THEIR REGULAR PRACTICE ASIDE TO RUN TOO THE FIRE AND CARE FOR THESE PATIENTS. THESE HUNDREDS OF PATIENTS COMING TO OUR DOOR WITH NO TREATMENT OPTIONS AND NO UNDERSTANDING OF WHAT'SENING TO THEIR BODY -- WHAT'S HAPPENING TO THEIR BODY. AND CLINICAL COORDINATORS HAVE GONE ABOVE AND BEYOND TO PROVIDE SONS -- CONCIERGE CARE FOR THE PATIENTS BECAUSE THEY CAN'T MAKE APPOINTMENTS AND MANAGE SCHEDULES. THESE PEOPLE HAVE TAKEN INCREDIBLE AMOUNTS OF TIME FROM THEIR DAY TO MANAGE CARE. THESE ARE IMPORTANT BECAUSE THEY SPEAK TO THE SPECIAL FOR DISPARITY OF CARE IF YOU DON'T HAVE AN INCREDIBLE TEAM WORKING FOR THEM AND ON THE BOTTOM LEFT CORNER OF SCREEN DEVELOPED A NOVEL PROGRAM FOR THE PATIENTS. WE START WITH A NUMBER OF BEHAVIORAL CHANGES TO HABITS AND DAILY EXPERIENCES BY IDENTIFY THINGS THAT TRIGGER SYMPTOM ATTACKS AND EXPLAIN WHY THE SYMPTOMS ATTACKS ARE HAPPENING FROM A PHYSIOLOGICAL POINT OF VIEW AND WAYS TO AVOID THE SYMPTOM ATTACKS. THINGS SUCH AS HOT SHOWERS CAUSING A SYMPTOM ATTACK BECAUSE THE HOT AND HUMID ENVIRONMENT WILL RAISE YOUR HEART RATE TO TRIGGER AN AUTONOMIC EPISODE AND A LARGE MEAL WILL TRIGGER AN ATTACK BECAUSE THE STRETCH ON THE STOMACH CAUSE OFS AN EPISODE. -- CAUSES IN EPISODE. IT'S BEEN IMPORTANT FOR OUT PATIENTS. SECONDARILY WE WORK WITH A BREATH WORKING GROUP THAT DEVELOPED INCREASING CO2 RETENTION AND HELPED REDUCE SYMPTOMS FOR PHYSICAL READINESS. THE PHYSICAL REHABILITATION AN AUTONOMIC RECONDITIONING PROTOCOL BASED ON EXISTING PROTOCOLS OUT THERE SUCH AS THE LEVINE PROTOCOL. WE'VE HAD TO DIAL DOWN THE INTENSITY OF THE PROTOCOL TO AVOID POST-EXERCISE MALAISE AND OTHER ISSUES THAT WOULD HAVE BEEN ASSOCIATED WITH REHABILITATION IF WE USED EXISTING PROTOCOLS. WE START VERY LOW AND WE'VE BEEN LOW INTENSITY AND WORKING ON IN SERVICING HUNDREDS OF PHYSICAL THERAPISTS AROUND THE COUNTRY ON EXACTLY HOW TO RUN THIS PROTOCOL. IT'S A GOOD EFFECT. IF WE MOVE TO THE NEXT SLIDE I WANT TO SHOW THE REPRESENTATIONS. WE HAVE A PHYSICIAN DO THE INITIAL EVALUATION. IT'S IMPERATIVE WE GET CARDIAC CLEARANCE BECAUSE OF THE PATIENTS MO HAVE COME WITH POST-ACUTE COVID SYMPTOMS ENDED UP HAVING A PERI CARDITIS OR SOME CARDIAC CONDITION CAUSING THEIR CONDITION AND WANT TO CLEAR THAT OUT GIVEN EXERCISE THERAPY AND WANT TO LOOK AT REHABILITATION AND REFER ON PSYCHOLOGY, NUTRITION, ANY OTHER SPECIAL NEEDS THESE PATIENTS MAY HAVE. WE BRING IN SPECIALTY CARE FOR THEM. AND THEN REFER THEM ON TO PHYSICAL THERAPY ONCE THEY'RE CLEARED WE HAD RESULTS FROM 90 PEOPLE THAT WENT THROUGH THE RECONDITIONING PROTOCOL VERSUS A GROUP OF INDIVIDUALS THAT DID NOT. USING PATIENT REPORTED OUTCOMES WE'RE STARTING TO SEE PEOPLE WHO ARE INVOLVED IN THE PHYSICAL THERAPY REHABILITATION ARE IMPROVING AND THE MRC IS A BREATHLESSNESS ON EXERTION SCALE AND THE EQ5 IS HEALTH RELATED PATIENT REPORTED OUTCOME. IF WE MOVE TO THE NEXT SLIDE, AND AGAIN CLICK THROUGH AGAIN, YOU CAN SEE OVERALL DISABILITY IS REDUCED IN THE P.T. GROUP. PAIN IS REDUCED IN THE P.T. GROUP AND GENERAL REPORTING OF HEALTH IS IMPROVED IN THE P.T. GROUP VERSUS NO CHANGES IN THE NO P.T. GROUP. IN ADDITION THE BIGGEST THING WE'RE FINDING IS THE FATIGUE. THE P.T. GROUP IS EXPERIENCING SIGNIFICANT REDUCTION IN FATIGUE AROUND 40% WHERE IN THE NO P.T. GROUP IT WASN'T OVER TIME. THAT'S THE GOOD NEWS. THE BAD NEWS IS TO GET THE CHANGE WE'RE TALKING ABOUT A MINIMUM OF TWICE WEEKLY PHYSICAL THERAPY. THIS IS A VERY DEBILITATING CONDITION TAKING A LONG TIME TO RECOVER. IN OUR COHORT WE HAVE FOUR OR FIVE PEOPLE REPORTING THEY HAVE EXPERIENCED FULL RECOVERY. WE'RE TALKING ABOUT NINE TO 12 MONTHS OF REHABILITATION TO GET THEM TO THAT POINT. THIS IS NOT A VICTORY LAP AND THE PROTOCOL APPEARS TO BE HAPPENING VERSUS DOING NOTHING WHICH IS A LOW BAR TO BE BRANK -- FRANK BUT TAKING A LONG TIME AND WE NEED TO BE COGNIZANT OF THAT. A FEW CONSIDERATIONS. WE NEED TO THINK ABOUT DISPARITIES FOR WOMEN AND HISTORICALLY EXCLUDED GROUPS THAT ARE NOT WOMEN AND MINORITIES AND WE TELL PATIENTS REHAB IT THEIR JOB AND A LOT OF OUR PATIENTS CAN AFFORD TO DO THAT FRANKLY. IT'S NOT SUSTAINABLE FOR A LOT OF PEOPLE WHO ARE EMERGING OR FOR PEOPLE WHO ARE INVOLVED IN OTHER GROUP WE'RE COLLABORATING WITH SUCH AS OUR COLLABORATIVE HOSPITALS IN SAU PAULO AND BRAZIL CATERING TO UNDER SERVED COMMUNITIES. INSURANCE IS UNCOVER THE CARE OF PEOPLE IN NEEDS. MY TEAM IS PROVIDING A LOT OF PRO BONO CARE AND WE RAPIDLY NEED TO GET CDC AND SOCIAL SECURITY ADMINISTRATION TO STEP UP AND MAKE RECOMMENDATIONS AROUND WHAT INSURERS NEED TO DO TO COVER THIS. AND IF YOU NEED TO DO A TON OF REHAB EVERY DAY AND ARE A YOUNG MOM THIS IS GOING TO BE A REAL STRUGGLE AND THINGS WE NEED TO BE COGNIZANT OF AS WE TRY TO BUILD POLICY AROUND SUPPORTIVE CARE FOR THESE CONDITIONS. IF THERE'S ONE TAKEAWAY, THE FIGURE ON THE RIGHT SHOWS PUBLICATION FROM LAST YEAR SHOWING THE FALSE NEGATIVE RATE ON A PCR TESTING BASED ON DAYS POST EXPOSURE THAT YOU TEST AND AS YOU CAN SEE THE BEST THAT IT GETS TO IS 20%. I KNOW MORE RECENTLY WE'VE GOTTEN PRC TESTING TO A FALSE NEGATIVE OF 10% IF YOU TEST DURING AN OPTIMAL TIME. THAT'S STILL NOT GREAT AND OPEN DOOR FOR PCR NEGATIVE TESTS TO RETURN. SIMILAR SIMILARLY WE KNOW ANTIBODIES TITERS WERE WEIGHED OVER TIME IN INDIVIDUALS WITH LESS SEVERE CASES AND KNOW ANTIBODY LEVELS WANE AND THE CDC IS NOW TELLING PEOPLE AFTER THE VACCINE DON'T GET TESTED FOR ANTIBODIES TITERS WILL WANE QUICKLY. THERE APPEARS TO BE A DOUBLE STANDARD AROUND USING ANTIBODY TITERS AS A DIAGNOSTIC CRITERIA TO LET PEOPLE IN TO POST-COVID CARE PROGRAMS VERSUS USING TITERS AS A DECLARATION YOU NOW HAVE ANTIBODIES AND THE VACCINE WORKED. WE SHOULD BE MINDFUL AND MAKE SURE WE DO NOT GATE ACCESS TO CARE BASED ON WHO HAS A PCR TEST IN THEIR MEDICAL HISTORY OR POSITIVE ANTIBODY TEST IN THEIR HISTORY LEADING TO PEOPLE PARTICULARLY UNDER SERVED GROUPS BEING AFFECTED. FINAL KEY TAKEAWAYS. WE NEED TO MANAGE CARE IN A SYMPTOM WAY AND THERE'S NO PIPELINE NOW OR FORMULA MEDICINE AND NEED TO BE SYMPTOM CENTRIC. WE KNOW WE SHOULD BE LEARNING FROM OTHER CLOSE VIRAL SYNDROMES THAT EXIST THERE'S A RICH LITERATURE GOING BACK ALMOST A HUNDRED YEARS ON POST-VIRAL FATIGUE AND PATIENTS ARE THE EXPERTS ON THE SYMPTOMS. DON'T DISCOUNT LIVED EXPERIENCES. BELIEVE WHAT'S GOING ON. THIS IS PERTINENT FOR WOMEN'S HEALTH AND FOR MANAGING HISTORICALLY EXCLUDED GROUPS. THIS IS AN OPPORTUNITY. WE HAVE THE CONDITION AFFECTING 30% WOMEN AND WE CAN TURN THIS INTO A POSITIVE EXPERIENCE WITH WHERE THE SILVER LINING IS MANY OTHER CONDITIONS THAT HAVE SUBJECTIVE MEDICALLY UNEXPLAINED PHYSICAL SYMPTOMS GET TAKEN MORE SERIOUSLY OR WE CAN TOTALLY BOTCH THIS AND MAKE THINGS OVERALL WORSE. ON THAT NOTE I'D LIKE TO ACKNOWLEDGE THE WONDERFUL PEOPLE THAT HAVE REALLY ADVOCATED FOR OUT PATIENTS AND GONE ABOVE AND BEYOND AFTER WORK ON FRONT LINES FOR 12 MONTHS TO SWITCH STRAIGHT INTO WORKING ON THIS NEW PROBLEM. I'M REALLY APPRECIATIVE AND THANK YOU FOR YOUR ATTENTION. I'LL TAKE SOME QUESTIONS. >> THANK YOU, DR. PUTRINO. QUESTIONS FROM THE GROUP? ANY QUESTIONS FROM THE ADVISORY COMMITTEE MEMBERS? >> THIS IS A GREAT AREA YOU ARE PURSUING. I WONDER WHAT YOU THINK OF YOUR DEPLOYMENT OF PROTOCOLS TO PREGNANCY BECAUSE PREGNANT WOMEN HAVE MANY SYMPTOMS THAT OVERLAP WITH THE SYMPTOMS OF THIS SYNDROME, FATIGUE, AND HYPOCAPNIA ARE NORMAL FOR PREGNANT WOMEN AND HOW DO YOU DEPLOY YOUR CARE TO THEM? >> GREAT QUESTION. WITH REGARD TO THE BREATH WORK FOR HYPOCAPNIA IT WOULD BE A WONDERFUL TRANSFERENCE OF SOME OF THE WORK WE'RE DOING WITH SOME PATIENTS. BREATH WORK COACHES WE'RE WORKING WITH USE VERY EVIDENCE-BASED PROTOCOLS AND ACCREDITED INDIVIDUALS FROM NATIONAL SOCIETIES. THEY'RE VERY MUCH ADVOCATING THAT EVERYONE CAN BENEFIT FROM BREATH WORK AND HYPOCAPNIA IN PREGNANCY CAN BENEFIT BECAUSE IT ADDRESSES THE SAME ISSUES BY IMPROVING CO2 RETENTION AND UNLESS THE PREGNANT WOMEN ARE SHOWING SIGNS AND SYMPTOMS CONSISTENT WITH OTHER SITUATIONS I WOULD RECOMMEND EXERCISE AS TOLERATED WHICH WE USUALLY RECOMMEND TO REG -- PREGNANT WOMEN WHICH IS FINE BUT WE CAN SENSE THE FATIGUE BEING EXPERIENCED IN SOME OF THESE PREGNANT INDIVIDUALS IS RELATED TO A SYNDROME THERE COULD BE AN INDICATION FOR THIS BUT FATIGUE IN PREGNANCY IS HARD TO UNTANGLE FROM A HORMONAL CAUSE AND BEING PREGNANT IS EXHAUST ING IN GENERAL AND THERE COULD BE A ROLE WE WANT TO EVALUATE DEEPER. >> A QUESTION FROM DR. HOLGREN AND THEN DR. KLEIN AND WE'RE A LITTLE OVER BUT THOSE TWO QUESTIONS. >> I HAVE TWO QUESTIONS. ONE, BOTH YOU AND THE LAST SPEAKER NOTED NUTRITION AND FOOD HAD POSITIVE EFFICACIOUS EFFECT. IS ANYONE LOOKING AT THE GUT-BRAIN ACCESS FOR THE SYMPTOMOLOGIES. IT'S KNOWN BACTERIA MAKE AMYLOIDS IN THE MICROBIOTA AND CAN MIGRATE UP THE NAVAL NERVE STEM TO EXACERBATE PARKINSON'S AND WONDERING IF ANYONE IS LOOKING AT THE GUT BRAIN AXIS AND ONE THE PERSISTENT SYMPTOMS YOU MENTIONED URINE ISSUES AND WONDERED WHAT THOSE ARE. >> TO START WITH THE MICROBIOME QUESTION FIRST. IN TERMS OF WHAT WE'RE SEEING THERE, WE HAD A COUPLE NUTRITIONISTS DO MICROBIOME PANELS ON OUR INITIAL COHORT AND THERE'S G.I. SYMPTOMS AND WEIGHT LOSS GOING ON IN THE COHORT. WE DID NOT SEE ANYTHING REMARKABLE AND I'M NOT A MICROBIOME SPECIALIST SO I HAVE TO PLAY IGNORANCE IN EXACTLY WHAT WAS SEEN OTHER THAN EVERYTHING WAS IN NORMAL LIMITS. THERE WAS NO CONCERN OF A DYSBUY -- DYSBIOS AND SOME FALL INTO THE EATING PATTERN OF THEY ASSOCIATE EATING WITH A BAD EXPERIENCE SO THEY STARVE THEMSELVES AND THEY'LL ONLY EAT ONCE PER DAY BECAUSE THEY KNOW THEY'LL FEEL TERRIBLE AFTER EATING WHICH ACTUALLY ENTERS INTO A CYCLE BECAUSE THEY EAT A LOT WHEN IT'S THEIR ONE AND ONLY MEAL OF THE DAY AND IT'S THE GASTRIC STRETCHING THAT SEEMS TO LEAD THEIR SYMPTOMS. OUR NEW TRIGSISTS HAVE BEEN -- NUTRITIONISTS HAVE BEEN WORKING WITH THEM IN PLANNING OUT SMALLER MEALS AND WE'RE SEEING NOVEL FOOD SENSITIVITIES BUT NOT IN A CONSISTENT PATTERN. IT'S VERY INDIVIDUAL. PUTTING SOMEONE ON AN ANTI-HISTAMINE DIET HAS NOT BEEN ACROSS THE BOARD EFFECTIVE FOR US. BUT LEARNING HOW TO IDENTIFY FOODS THAT ARE CAUSING SYMPTOMS VIA INTUITIVE EATING TECHNIQUES HAVE ASSISTS OUTPATIENTS IN REGAINING THE WEIGHT LOST WITH COVID. IN TERM OF THE URINARY SYMPTOMS WE'VE BEEN SEEING RECURRENT UTIs AND ISSUES WITH INCREASED FREQUENCY AND URGENCY. AND A LITTLE BIT OF BLADDER PAIN AND THIS IS ROUGHLY 5% OF OUR POPULATION REPORTING THIS AND HAVE BEEN WORKING WITH A BUNCH OF UROLOGISTS TO MANAGE THAT. SO FAR THEY'VE ASSIST WITH TYPICAL TECHNIQUE FOR MANAGING SYMPTOMS BUT IT'S THE LOWER URINARY TRACT SYMPTOMS WE'RE SEEING. >> DR. KLEIN, WE'LL GIVE YOU THE LAST WORD. >> THANK YOU. THAT WAS A WONDERFUL TALK. >> TO SIMPLIFY MY QUESTION TO GET OUT OF HERE, AUTOANTIBODIES IS THERE ANYTHING WITH THE POST-ACUTE SYNDROME IN >> I THINK IT'S A PROMISING AREA TO LOOK INTO. THERE'S BEEN WORK AT THE FOREFRONT OF THIS. WE HAVE AN IRB PROTOCOL PENDING ACCEPTANCE TO SEND BLOOD UP TO DO EXTENSIVE AUTOANTIBODY MAPPING ON THIS COHORT. I THINK THERE'S GOING TO BE A LINK SOMEWHERE MY GUT FEEL IS WE'LL SEE A LINK IN EVERYBODY OR IN A CORE HORT AND REGRET CALLING IT THAT BUT POST-ACUTE COVID SYNDROMES PLURAL. >> I WONDER IF THE FOOD SENSITIVITIES YOU WERE SPEAKING ABOUT IN THE CONTEXT OF SCOTT'S QUESTION THAT'S ALSO COULD BE ANTIBODY MEDIATED. THANK YOU SO MUCH. >> THANK YOU, DR. PUTRINO WE CALL IT POST-ACUTE SEQUELAE OF COVID, PLURAL, REALIZING IT'S A BROAD SPECTRUM AND AN APPRECIATE YOUR PRESENTATION. I NOTED YOUR DISAGGREGATION OF DATA. I THINK WE SHOULD GO AHEAD TO OUR ACRWH PHOTOGRAPH. TURN YOUR CAMERA ON TO TAKE A PICTURE. >> WHAT TIME DO YOU WANT TO COME BACK. WE'RE 17 MINUTES BEHIND SCHEDULE. >> WE NEED TO COME BACK ON TIME BECAUSE THAT'S WHAT WE POSTED AND PEOPLE WILL JOIN AT 1:00. MY APOLOGIES WE ATE INTO YOUR LUNCH TIME BUT RETURN AT 1:00 P.M. TO GET STARTED WITH THE AFTERNOON PRESENTATION. I KNOW SINCE WE'RE VIRTUAL PEOPLE ARE TAKING THEIR BIO BREAKS BUT WE'RE ADJOURNED FOR NOW. >> GOOD AFTERNOON. I'M PLEASED TO INTRODUCE DAWN CORBETT IN THE OFFICE OF EXTRAMURAL RESEARCH, OER. SHE PROVIDES OVERSIGHT OF TRANS NIH EFFORTS TO ENSURE ENCOLLUSION -- INCLUSION OF WOMEN AND MINORITIES ACROSS THE LIFE SPAN IN CLINICAL RESEARCH. PRIOR TO JOINING OER, SHE LED EFFORTS TO INCREASE THE EFFICIENCY AND TRANSPARENCY OF CLINICAL RESEARCH THROUGH ENHANCED RECRUITMENT MONITORING AND THE INCREASED COMPLIANCE EFFORTS OF HEALTH SCIENCE POLICY ANALYST IN THE NATIONAL INSTITUTE OF MENTAL HEALTH IMH OFFICE OF CLINICAL TRIALS OPERATIONS AND BIOSTATISTICAL BRANCH. SHE BEGAN HER CAREER IN THE OFFICE OF RESEARCH DISPARITIES IN GLOBAL MENTAL HEALTH. FORMERLY THE OFFICE FOR SPECIAL POPULATIONS WHERE SHE COORDINATED PROGRAMS RELATED TO DIVERSITY AND DESIGN AND CONDUCTED ANALYSIS IN THE AREAS OF GLOBAL MENTAL HEALTH AND MENTAL HEALTH DISPARITIES. SHE HAS A MASTER'S DEGREE IN PUBLIC HEALTH FROM JOHNS HOPKINS AND HAS A DEGREE FROM UNIVERSITY OF ILLINOIS. WELCOME, MS. CORBETT. >> THANK YOU FOR THAT WONDERFUL INTRODUCTION. I APPRECIATE THE OPPORTUNITY TO BE HERE. I'M HAPPY TO TALK ABOUT WHAT WE'VE BON -- BEEN DOING. THE GOALS ARE TO GET TO YOU UNDERSTAND MA WE'VE BEEN DOING IN INDIVIDUALS ACROSS LIFE SPAN IN NIH FUNDED CLINICAL RESEARCH. TO REVIEW THE STATUS OF OUR GOVERNMENT ACCOUNTABILITY OFFICE, OUR RECOMMENDATIONS RELATED INCLUSION OF WOMEN AND MINORITIES AND TO REVIEW DATA FROM FISCAL YEARS 2019 AND 2020 ON INCLUSION OF WOMEN AND MINORITIES AND NIH CLINICAL RESEARCH AND TO HELP YOU LEARN A BIT ABOUT RESOURCES RELATED TO THE INCLUSION OF WOMEN AND RACIAL AND ETHNIC MINORITY GROUPS AND INDIVIDUALS ACROSS THE LIFE SPAN. I WANT TO START TO ORIENT YOU TO GIVE YOU A SENSE OF THE TIME LINE. NIH HAS HAD INCLUSION POLICIES ON THE BOOKS FOR ABOUT 35 YEARS. BACK IN 1986 NIH ENCOURAGED STUDIES ON WOMEN BECAUSE OF WOMEN OF CHILDBEARING AGE BEING EXCLUDED AND THE REVITALIZATION ACT WAS PASSED AND IT WAS INCLUDED WOMEN AND MINORITIES BE INCLUDED IN NIH CLINICAL RESEARCH AND FORMED WHAT IS THE BASIS TODAY OF OUR NIH POLICY ON THE INCLUSION OF WOMEN AND MINORITIES. IN 1998 THIS WAS THE FIRST TIME NIH ISSUED A POLICY BASED ON AGE AND THEN IN 2016 WE HAD QUITE A FEW CHANGES. IN RESPONSE TO THE 21st CENTURY CURES ACT THAT CAME INTO EFFECT IN DECEMBER OF THAT YEAR AND CONCLUDED A NUMBER OF REQUIREMENTS FOR INCLUSION INCLUDING REPORTING REQUIREMENTS AND OTHER REQUIREMENTS FOR APPLICABLE PHASE 3 TRIALS. IN 2017 WE STARTED REQUIRING THE PHASE 3 CLINIC TRIALS REPORT TO CLINICALTRIALS.gov AND MOST RECENTLY IN 2019, OUR INCLUSION ACROSS THE LIFE SPAN POLICY BECAME EFFECTIVE FOR APPLICATIONS SUBMITTED JANUARY 25, 2019 OR LATER AND THIS INCLUDES THE INCLUSION ACROSS THE LIFE SPAN POLICY INCLUDES REQUIREMENTS OF INDIVIDUALS OF ALL AGES BEING INCLUDED IN RESEARCH. WE ALSO RELEASED A NEW REPORT CALLED OUR NIH RCDC REPORT AND WE HAD POLICIES ON THE BOOKS AND HAVE BEEN PRETTY BUSY. WE MOVED TO THE NEXT SLIDE AND WE'LL TALK MORE IN DETAIL ABOUT THE POLICIES. STARTI STARTING WITH THE POLICY ON INCLUSION OF WOMEN AND MINORITIES ON NIH CLINICAL RESEARCH, NIH POLICY REQUIRES KIM AND MINORITY -- AND WHEN WE SPEND A FAIR AMOUNT OF TIME TALKING ABOUT WHAT IS A COMPELLING RATIONALE, FOR EXAMPLE, A STUDY ON PROSTATE CANCER MAY NOT NEED TO INCLUDE INDIVIDUALS WHOSE SEX AT BIRTH IS FEMALE BUT THE REASONS CAN'T BE BASED ON CONVENIENCE ALONE. THE LAW SPECIFIES COST IS NOT A REASON AND PHASE 3 CLINICAL TRIALS MUST BE DESIGNED TO ALLOW FOR ANALYSIS FOR SEX, GENDER RACE AND ETHNICITY AND A SUBSET OF THE TRIALS WHICH ARE APPLICABLE NIH PHASE 3 TRIALS NEED TO REPORT THE RESULTS IN CLINICALTRIALS.gov. TO UNPACK THAT A BIT, AND IT'S REQUIRED TO DESIGN STUDIES TO REPORT THE ANALYSES. WHAT WE'RE ASKING IN GENERAL IS A STRATIFICATION OF THE PRIMARY OUTCOMES. IF YOU'RE LOOKING AT RISK RATIO YOU PROVIDE THAT FOR SEX, GENDER, RACE AND ETHNICITY. A SUBSET OF PHASE 3 TRIALS FDA RELATED DRUG AND DEVICE STUDIES HAVE THE ADDITIONAL REQUIREMENT WHEN SUBMITTING RESULT TO CLINICALTRIALS.gov WHICH IS A REQUIREMENT THEY NEED TO INCLUDE THE RESULTS OF THOSE ANALYSES. AND THE DEADLINE FOR THAT IS THE SAME AS THE OTHER RESULTS THEY HAVE TO SUBMIT TO CLINICALTRIALS.gov WHICH IS IN ONE YEAR OF THEIR PRIMARY COMPLETION DATE. FINALLY TO RECRUIT WOMEN AND SUBPOPULATIONS AND MINORITIES. I ALSO MENTIONED THAT OUR POLICY ON INCLUSION ACROSS THE LIFE SPAN WAS SUBMITTED FOR 2019 AND LATER AND WE HAD THE INCLUSION OF CHILDREN POLICY ON THE BOOKS FOR SOME TIME SINCE 1998 AND THERE WAS A LOT OF WORK THAT WENT IN THE DEVELOPMENT. WE HELD A WORKSHOP AND ISSUED AN RFI AND IT GOT A LOT OF INPUT FROM STAKEHOLDERS FROM VARIOUS COMMUNITIES, RESEARCHERS AND CLINICIANS AND PATIENT ADVOCACY GROUPS, ETCETERA. ALL CONTRIBUTED. A LOT OF INFORMATION AND NIH WAS ABLE TO CONSIDER THAT INFORMATION AND DEVELOP THE INCLUSION ACROSS THE LIFE SPAN POLICY, WHICH WE DID ANNOUNCE BACK IN 2017 BUT TOOK EFFECT IN TO 19. -- 2019. THIS REQUIRES INDIVIDUALS OF ALL AGES BE INCLUDED IN NIH HUMAN SUBJECT RESEARCH UNLESS THERE'S SCIENTIFIC OR ETHICAL REASONS NOT TO DO SO. THE BOTTOM LINE OF THE POLICY IS IF YOU'RE GOING TO EXCLUDE SOMEONE BASED ON AGE, ANY AGE, THEY'RE OUGHT TO BE A GOOD REASON FOR DOING SO AND THAT'S WHAT NIH IS LOOKING FOR ANYTIME SOMEONE IS EXCLUDEDLESS -- REGARDLESS WHETHER THAT PERSON IS A MIDDLE CHILD WE WANT TO MAKE SURE THEY'RE A GOOD REASON. ONE OF THE THINGS I MENTIONED WE'RE TRYING TO GET AWAY FROM THIS POLICY IS WHAT I CALL SOMETIMES THE COPY AND PASTE INCLUSION AND EXCLUSION CRITERIA. WE WANT TO MAKE SURE THE AGE LIMIT IN YOUR INCLUSION/EXCLUSION CRITERIA IF THERE ARE THOUGHTFUL AND JUSTIFIED. SO THIS HAS BEEN VERY EXCITING TO ROLL OUT. WE ALSO HAVE AN ADDITIONAL REQUIREMENT OF THIS POLICY THAT REQUIRES THE SUBMISSION OF INDIVIDUAL LEVEL DATA ON PARTICIPANT AGE ON ENROLLMENT IN PROGRESS REPORTS. IF ANY OF YOU ARE NIH FUNDED INVESTIGATORS YOU MAY RECALL EVERY YEAR YOU SUBMIT A TABLE WITH INFORMATION ON SEX AND GENDER. THE REQUIREMENT IS A LITTLE DIFFERENT. INSTEAD OF THE TABLES THEY SEND A SPREAD SHEET AND FILE THAT PROVIDES DATA FOR EACH PARTICIPANT AND PROVIDE SEX OR GENDER, RACE, ETHNICITY AND AGE AT ENROLLMENT OF EACH PARTICIPANT. THIS ALLOWS MORE FLEXIBILITY IN TERMS OF REPORTING. AND IS EASIER FOR INVESTIGATORS SO THEY DON'T HAVE TO AGGREGATE ALL THE INFORMATION. I WANTED TO TALK ABOUT IMPLEMENT OF OUR POLICIES. YOU MAY RECALL FOR THOSE WHO HAVE BEEN WITH ACRWH FOR A WHILE, BACK IN 2019 THE GOVERNMENT ACCOUNTABILITY OFFICE CAME OUT TO LOOK AT THE INCLUSION PROCEDURES AT NIH. THEY CONCLUDED NIH NEEDED ADDITIONAL OVERSIGHT TO HELP ENSURE CONTINUED PROGRESS INCLUDING WOMEN AND HEALTH RESEARCH. THEY ISSUED SEVERAL RECOMMENDATIONS. THERE'S A TOTAL OF FIVE THE GAO GAVE TO NIH. THE FIRST ONE IS TO MAKE IC LEVEL ENROLLMENT DATA AVAILABLE THROUGH PUBLIC MEANS. NIH HAS LONG PUBLISHED THE SEX OR GENDER RACE AND ETHNICITY OF THE PARTICIPANTS AT HNIH FUNDED RESEARCH AND THEY ARE SHARED THIS INFORMATION WITH THEM HOWEVER, IN THE PAST THE INFORMATION WAS NOT PUBLICLY AVAILABLE. SO WE'VE DONE SO AND THERE'S A LINK TO THE WEBSITE AT THE END OF THE PRESENTATION WHERE YOU CAN SEE THAT NOW AND THE RECOMMENDATION WAS CLOSED. AND THEY ASKED FOR MORE AGGREGATED DATA AND THE RECOMMENDATION WAS CLOSED AND NIH WAS ABLE TO DO THAT AND NOW DO HAVE DATA ON THE DEMOGRAPHICS OF OUR PARTICIPANTS AVAILABLE BY DISEASE OR CONDITION. THEN THE THIRD RECOMMENDATION WAS TO ENSURE PROGRAM OFFICERS HAVE A MEANS OF RECORDING AND CONDUCTI CONDUCTI CONDUCTING ANALYSES OF POTENTIAL DIFFERENCES AND THEY CONDITION INDICATE WHETHER THE ANALYSES ARE REQUIRED AND ADJUSTED SYSTEMS TO PUT IN INDICATORS TO CAPTURE THIS INFORMATION. THE FOURTH RECOMMENDATION WAS TO ON A REGULAR BASIS SYSTEMICALLY COLLECT AND ANALYZE THE INFORMATION ON WHETHER OR NOT ANALYSES OF POTENTIAL SEX DIFFERENCES WERE REQUIRED. AND THE FIFTH IS TO REPORT ON THE INCLUSION OF WOMEN ON RESEARCH. THIS ONE IS OPEN BUT I'LL SHOW YOU DATA PRESENTED IN THE REPORT THAT'S REQUESTED AND WE HOPE THIS WILL BE CLOSED OUT LATER THIS YEAR AS WE PRESENT THOSE DATA. SOME DATA IS RIGHT HERE. I'LL GET IN OUR FISCAL YEAR 2019 AND FISCAL YEAR 2020 NIH INCLUSION DATA. THE FIRST TABLE GIVES THE UNIVERSE OF WHAT I'LL BE TALKING ABOUT TODAY. TO CLARIFY A FEW TERMS WITH YOU. YOU'LL SEE IN THE FIRST COLUMN ON THE FIRST TABLE TOTAL INCLUSION RECORDS. WHAT WE'RE TALKING ABOUT ARE SIMPLY RECORDS THAT WERE SUBMITTED TO NIH. TYPICALLY YOU HAVE ONE RECORD FOR EACH STUDY. IT DOESN'T HAVE TO BE THE CASE. IT ROUGHLY CORRELATES WITH A NUMBER OF STUDIES AND THEN THE INCLUSION RECORDS WITH ENROLLMENT AND RECORDS WHERE WE STARTED ENROLLMENT AND MOST THE DATA I'M GOING TO SHOW YOU TODAY -- THIS IS THE DENOMINATOR WE'RE LOOKING AT. YOU CAN SEE THERE WAS A BIT OF AN INCREASED IN RECORDS FROM 2019 TO 2020. HOWEVER, THERE WAS A SMALLER INCREASE IN THE NUMBER OF RECORDS WITH ENROLLMENT. CERTAINLY WE HAVE SEEN THE IMPACT OF THE PANDEMIC ON ENROLLMENT IN GENERAL. WE HAVE MORE STUDIES THAT HAVE HAD TO DELAY STARTING. THIS ISN'T AS MUCH OF A SURPRISE BUT SOMETHING WE SAW IN OUR DATA THIS YEAR. THEN IN THE NEXT COLUMN THE VAST MAJORITY OF THESE STUDIES ARE CONDUCTING RESEARCH IN THE U.S. SO THIS PERCENTAGE OF NIH RESEARCH REFLECTS RECRUITMENT WITHIN THE U.S. AND THE REST ARE NON-U.S. STUDIES THERE'S A PROPORTION OF FEMALE ONLY AND A SMALLER PROPORTION THAT INCLUDE ONLY MALES ABOUT 5%. THIS PROVIDES DATA FOR INTRAMURAL AND EXTRAMURAL AND WE'RE TALKING ABOUT A SMALLER UNIVERSE OF OUR STUDIES. ONLY OUR NIHD PHASE 3 TRIALS AND INCLUSION RECORDS BUT NOT AS LARGE WHEN WE LOOK AT THOSE THAT STARTED ENROLLMENT. THREES A LARGER PROPORTION OF THE PHASE 3 TRIALS CONDUCTED OUTSIDE THE U.S. YOU'LL SEE HERE IN A LITTLE OVER 22% OR SO WERE CONDUCTED OUTSIDE THE U.S. OPPOSED TO WITHIN THE U.S. WE ALSO HAVE A HIGHER PROPORTION OF FEMALE ONLY STUDY, ABOUT 17% OF THE PHASE 3 CLINICAL TRIALS ARE FEMALE ONLY AND YOU'LL SEE THAT REFLECTED IN THE DATA. THEN ALSO AND A LITTLE BIT HIGHER PROPORTION, ABOUT 6% MALE ONLY. MOVING ON TO THE NEXT SLIDE. I'LL TALK A LITTLE BIT MORE ABOUT THE REQUIREMENTS FOR ANALYSES BY SEX OR GENDER, RACE AND ETHNICITY FOR THE PHASE 3 CLINICAL TRIALS. YOU MAY RECALL ON THE PREVIOUS SLIDE I TALKED ABOUT THE RECOMMENDATION WE COLLECT DATA ON ANALYSES BY SEX AND WE ANALYZE THE DATA AND REPORT THEM OUT. WE'VE ADDED THIS TABLE ON REQUIREMENTS FOR VALID ANALYSIS OR PHASE 3 EXTRAMURAL GRANTS REPORTED BETWEEN FISCAL YEAR 2019 AND 2020. YOU CAN SEE WHEN WE LOOK AT THE TOTAL NUMBER OF RECORDS, THIS INCLUDES BOTH THOSE THAT HAVE AND HAVE NOT STARTED ENROLLMENT BECAUSE WE LOOK AT REQUIREMENTS WHEN APPLICATIONS COME IN BEFORE ENROLLMENT BEGINS. YOU CAN SEE IN THE THIRD COLUMN LOOKING AT THE PROPORTION OF RECORDS THAT REQUIRE RACE AND ETHNICITY ANALYSIS THE VAST MAJORITY OF OUR STUDIES REQUIRE ANALYSES BY THIS ABOUT 94%. THE MAJORITY DO REQUIRE ANALYSES BY SEX OR GENDER AND DECREASED A LITTLE BIT TO 88%. THE STUDIES THAT NOT REQUIRE THESE ARE GENERALLY SINGLE RACE, SINGLE ETHNICITY OR SINGLE SEX STUDIES. VIRTUALLY ALL OF OUR STUDIES WOULD REQUIRE THESE ANALYSES. ON THIS SLIDE I WANT TO SHOW YOU THE BROAD PICTURE OF THE ENROLLMENT BY SEX OR GENDER IN ALL OF NIH DEFINED CLINICAL RESEARCH. THIS IS AGGREGATED DATA AND INTERIM DATA FOR SOME STUDIES AND SOMETHING TO KEEP IN MIND WHILE LOOKING AT THE NUMBERS. WHAT WE SEE WE TEND TO SEE SLIGHTLY HIGHER PROPORTION OF FEMALES IN OUR STUDY OPPOSED TO MALES THAT HELD TRUE IN FISCAL YEAR 2019 WITH 52% OF OUR PARTICIPANTS IDENTIFIED AS FEMALE IN FISCAL YEAR 2020 IT INCREASED TO ABOUT 55%. SMALLER PROPORTION, ABOUT 45% DECREASED IN 2020 IDENTIFIED AS MALE AND A SMALL NUMBER OF UNKNOWNS, 3% AT 4.5% IN FISCAL YEAR 2020. YOU'LL SEE A LARGER PROPORTION OF FEMALES IN THE STUDIES AND THIS IS SOMETHING HELD TRUE OVER THE YEARS. YOU'LL RECALL WE HAVE A HIGHER PROPORTION OF FEMALE ONLY STUDIES AND HAVE LARGE FEMALE ONLY PHASE 3 CLINICAL TRIALS REFLECTED IN THE NUMBER. AND WE'RE LOOKING AT RACE AND THIS SHOWS DATA FROM FISCAL YEAR 2019 AND 2020. YOU'LL SEE FROM FISCAL YEAR, 2019 TO 2020 WE HAD AN INCREASE IN CERTAIN GROUPS. A SMALL INCREASE IN BLACK OR AFRICAN AMERICAN PARTICIPANTS YOU CAN SEE IN THE GRAY AND THEN WE ALSO HAD A SMALL INCREASE IN PARTICIPANTS AT 2.6%. THERE WAS AN INCREASE IN THOSE UNKNOWN OR UNREPORTED. WE EXPECT THIS TREND TO CONTINUE. WE SEE MORE STUDIES USING EHRs. WE'RE SEEING MORE DATA ON RACE UNKNOWN OR NOT REPORTED. WE DID SEE A DECREASE IN AMERICAN POPULATION AND AMERICAN INDIAN OR ALASKAN NATIVE WAS PRIMARILY FROM AN EXISTING DATA SET IT DOESN'T REFLECT AN ACTUAL DECREASE. MORE OF A CODING ISSUE THERE. AND WE SAW A DIFFERENCE IN PARTICIPANTS AND HAD A LARGE STUDY IN ASIA THAT ENDED DURING THAT TIME. NO CHANGE IN PACIFIC ISLANDER AND A DECREASE IN WHITES AS WELL. IF WE LOOK AT U.S. OPEN IT MAY LOOK DIFFERENT AND WE LIKE TO BREAK DOWN DATA ON RACE AND ETHNICITY LOOKING AT U.S. VERSUS NON-U.S. IF WE LOOK WE SEE CERTAIN GROUPS HELD STEADY. AMERICAN INDIAN, ALASKAN NATIVE OR PACIFIC ISLANDER AND SAW INCREASES IN ASIAN PARTICIPANTS BUT THE NUMBERS ARE SMALLER WITHIN THE U.S. AND OUTSIDE THE U. U.S. WE ALSO SAW A SMALL DECREASE IN BLACK OR AFRICAN AMERICAN PARTICIPANTS FROM 16% TO 15%. THEY'RE IN THE GRAY AND WE SAW A BIT OF A DECREASE IN WHITE PARTICIPANTS FROM 66% TO 61%. AND WE SAW AN INCREASE AND SAW IT IN UNKNOWN OR NOT REPORTED IN THE U.S. AS WELL. LOOKING AT THE ENROLLMENT THEY JUMP AROUND A BIT WHEN WE LOOK AT THE UNIVERSE OF STUDIES AND BECAUSE THESE HAVE SMALLER AND THE STUDIES ARE LARGE THEY VARY FROM YEAR TO YEAR. THIS SHOWS FISCAL YEARS 2019 AND TO 20. YOU CAN SEE -- 2020. YOU CAN SEE A SMALL DECREASE IN AMERICAN NATIVE AND ALASKAN NATIVE PARTICIPANTS AND FAIRLY LARGE INCREASE IN ASIAN PARTICIPANTS IN THE NIH DEFINED PHASE 3 TRIALS AND THEN 30% IN AFRICAN AMERICAN AND SMALL INCREASE IN NATIVE HAWAIIAN AND PACIFIC ISLANDER AND INCREASE FROM 54% TO 38% AND TEND TO HAVE A SMALLER NUMBER OF UNKNOWN OR NOT REPORTED PARTICIPANTS GIVEN THE NATURE OF THE STUDIES THEY'RE GENERALLY INVOLVING CONTACT WITH PEOPLE SO WE TEND TO GET MORE PEOPLE THAT IDENTIFY. THAT WAS NOT A SURPRISE. YOU SEE THE STUDY HAD ABOUT 1%. AND ASIAN PARTICIPANTS INCREASE FROM AND A SMALLER NUMBER THAN WE SAW ON THE NUMBERS WHEN WE LOOK AT BOTH U.S. AND NON-U.S. THEN WE SEE BLACK AND AFRICAN AMERICAN PARTICIPANTS AN INCREASE FROM 18% TO 19%. AND SMALL INCREASE ON THE PACIFIC ISLANDER AND DECREASE IN WHITE PARTICIPANTS. 73% TO 63%. A LARGE INCREASE IN THE NUMBER IDENTIFYING AS MORE THAN ONE RACE FROM 1.4% TO 5.6% AND THE NUMBER OF UNREPORTED INCREASED BUT NOT AS MUCH AS IN THE REST OF OUR DATA. THIS SHOWS ALL CLINICAL RESEARCH ENROLLMENT BY ETHNICITY. WE CAN SEE THERE'S BEEN A SMALL INCREASE WHEN WE'RE LOOKING AT U.S. AND NON-U.S. AND THOSE IDENTIFIED AS HISPANIC OR LATINO. WE SEE AN INCREASE FROM 10.5% TO 12% AND THE REMAINING PARTICIPANTS IDENTIFIED AS NON-HISPANIC, 79% IN FISCAL 2019 AND 77% IN 2020. IF WE LOOK AT U.S. ONLY WE'VE SEEN AN INCREASE IN ENROLL MANY OF PARTICIPANTS IDENTIFIED AS HISPANIC OR LATINO FROM 9% IN PHYSICAL YEAR IN FISCAL 2019 AND SEE THE NUMBER CONTINUE TO CLIMB OVER TE YEARS. -- OVER THE YEARS. WE'LL SEE IF THIS HOLDS STEADY IN THE FUTURE. WE HAVE A LARGE PERCENTAGE OF UNKNOWN OR NOT REPORTED LARGELY DUE TO EHR STUDIES. THAT INCREASED. LOOKING AT PHASE 3 CLINICAL TRIALS WE SAW A LARGER INCREASE IN THOSE WHO IDENTIFIED AS HISPANIC OR LATINO FROM FISCAL 2019 TO FISCAL 2020. AND SO HERE WE SEE A MUCH LARGER PERCENTAGE OF PARTICIPANTS IDENTIFYING AS HISPANIC OR LATINO FROM 9% TO 17% IN FISCAL YEAR 2020. WE SEE IN THE PHASE 3 DATA A SMALLER PROPORTION OF UNKNOWN OR NOT REPORTED THOUGH THERE'S A SMALL INCREASE FROM FISCAL 2019 TO 2020. I KNOW I'VE GIVEN YOU A LOT OF INFORMATION TO THINK ABOUT. I ENCOURAGE YOU TO TAKE A LACK AT OUR NIH INCLUSION STATISTICS REPORT RELEASED IN 2018 UPDATE THIS ON A TRIENNIAL BASIS AND YOU CAN CLICK ON TO THE RESEARCH DISEASE OR CONDITION CATEGORIES AND YOU CAN GET A LOT OF INFORMATION. ON THE DEFAULT SCREEN SEE THE PARTICIPANTS AND HAVE A DROP DOWN FOR SEX, GENDER, RACE AND ETHNICITY AND SEE THAT FOR EACH. IF YOU CLICK YOU CAN SEE INFORMATION BY I.C. AND MORE DETAILED INFORMATION ALONG WITH THE NUMBER OF PARTICIPANTS IN EACH CATEGORY. IT'S QUITE INTERESTING. I THINK THERE'S 190 CATEGORIES SO IT'S A LOT TO TAKE IN BUT IF YOU'RE INTEREST IN DISEASE SPECIFIC AREAS IT'S QUITE INFORMATIVE. WE DO QUITE A BIT OF TRAINING INTERNALLY AND EXTERNALLY. THESE ARE A COUPLE TRAININGS IN THE LAST COUPLE OF YEARS. THE FIRST TRAINING IS A MORE NUTS AND BOLT SYSTEMS TRAINING ON ENTERING INCLUSION DATA USING THE PARTICIPANT DATA TEMPLATE WITH THE INCLUSION ACROSS THE LIFE SPAN THE INVESTIGATORS ARE NOW REQUIRED TO SUBMIT THEIR DATA IN A DIFFERENT WAY AND INCLUDE A FILE OR SPREAD SHEET. THIS TRAINING IS INTENDED TO HELP THEM UNDERSTAND HOW TO DO THAT TO IMPLEMENT THE REQUIREMENTS. THEN THE SECOND TRAINING HERE IS ONE I DID RECENTLY AT THE NIH ENVIRONMENT SEMINAR IS STILL AVAILABLE ONLINE. YOU CAN FEEL FREE TO CLICK ON THE LINK. THIS WAS TRAINING FOR INVESTIGATORS ON INCLUDING DIVERSE POPULATIONS IN NIH CLINICAL RESEARCH WHERE I DISCUSSED HOW THINGS TO THINK ABOUT WHEN DEVELOPING AN INCLUSION PLAN AND NIH'S EXPECTATIONS AT THE TIME OF APPLICATION AND FOR MONITORING. THEN FINALLY I WANT TO MAKE YOU AWARE OF A NUMBER OF RESOURCES WE HAVE IN THE OFFICE SPECTRUM RESEARCH IF YOU WANT MORE INFORMATION IN WHAT WE DISCUSSED FEEL FREE TO LOOK AT OUR EXTERNAL WEBSITES FOR INCLUSION OF WOMEN AND MINORITIES AND INCLUSION ACROSS THE LIFE SPAN. THAT INCLUSION AND REPORT PAGE WILL TAKE YOU TO OUR REPORTS INCLUDING THE INCLUSION BY RCDC CATEGORY OF REPORT AND HAVE TRAINING ON THE SYSTEMS WE USE TO COLLECT THE DATA AND INVALIDATE OUR MANY REQUIREMENTS. SO WITH THAT, IF WE HAVE TIME I'M HAPPY TO TAKE ANY QUESTIONS YOU MAY HAVE. THANKS SO MUCH, DAWN. YOU PRESENTED A LOT OF INFORMATION. I'M SURE THE MEMBERS ARE APPRECIATIVE SEEING THAT COMPLEX AND GRANULAR STORY. DR. ROBINSON HAS A QUESTION. >> THANK YOU FOR THE PRESENTATION. YOU TALKED ABOUT THE TRAINING AND IN THE SECOND PART OF THE TRAINING WHERE I THINK YOU DID THAT ONE IN LATE OCTOBER, DO YOU INCLUDE STRATEGIES HOW RESEARCHERS CAN ATTRACT MORE DIVERSE POPULATIONS TO THEIR STUDIES. >> IT'S FOCUSSED ON DEVELOPMENT OF THE INCLUSION PLANS. WE HAVE USED -- I DO USE FEEDBACK WE'VE RECEIVED AT SOME OF OUR WORK SHOPS RECENTLY OUR INCLUSION ACROSS THE LIFE SPAN WORKSHOP IN TERMS OF THINGS YOU KNEAD TO THINK ABOUT. ONE THING IS CLEAR IS EARLY ENGAGEMENT OF DIVERSE PARTICIPANTS EVEN BEFORE YOU START THE STUDY. ARE YOU LOOKING AT THE RIGHT OUTCOMES. IT'S SOMETHING YOU NEED TO LOOK AT BEFORE A STUDY EVEN BEGINS. WE TRY TO EMPHASIZE DOING ALL THIS UP FRONT AT THE TIME OF APPLICATION YOU NEED TO BE THINKING ABOUT WHO'S GOING TO BE INVOLVED AND ARE THE OUTCOMES RELEVANT TO THE APPROPRIATE GROUPS. THINKING ABOUT THINGS LIKE MINIMIZING BURDENS TO PARTICIPANTS WHICH ISN'T A BIG ISSUE FOR INCLUSION BUT A BIG ISSUE FOR ENROLLMENT IN GENERAL. NOT EVERYONE CAN COME TO MULTIPLE VISITS AND PARTICIPATE IN A STUDY THAT LASTS SEVERAL HOURS OR CAN COME AT 10:00 ON A WEEKDAY. THESE ARE ALL THINGS WE WANT VATHE INVESTIGATORS TO THINK ABOUT UP FRONT AS THEY THINK ABOUT BUDGET AND STRATEGY AND WHO WILL DO THE TRIALS AND WE'VE BEEN TRYING TO EMPHASIZE THAT. SO WHEN SHAY -- THEY HAVE A SUBMISSION HAVE A REALISTIC EXPECTATION RATHER THAN CORRECT DOWN THE ROAD WHICH WE CAN DO BUT DON'T ALWAYS GET THE RESULT WE WANT. >> I'D LIKE TO ADD ON THE WEBSITE WE HAVE COMPLIED A RICH LIST OF RESOURCES FOR INVESTIGATORS THEY'RE ABLE TO USE HONE THEY'RE THINKING OF CONDUCTING A STUDY AND TO EDUCATE OTHERS WITH REGARD TO THAT INCLUDING A SLIDE PRESENTATION THAT WE ACTUALLY HAVE READY TO GO THAT INVESTIGATORS CAN USE WOMEN THEIR STUDENTS. DAWN WAS VERY INVOLVED IN THE PROCESS. IT'S CALLED THE NIH INCLUSION TOOL KIT. HOW TO ENGAGE AND RETAIN I BELIEVE SOMETHING LIKE THAT. IT'S A LONG NAME. WE'LL BE HAPPY TO SEND YOU THE LINK BUT IT'S UP TO DATE. LAST SUMMER WE WORKED TO MAKE SURE IT'S UP TO DATE AND INCLUDES THE NEW POLICY. I'M HAPPY TO SHARE THAT WITH THE ENTIRE COMMITTEE IN THE CHAT BOX. >> THANK YOU. >> DR. ROBINSON, I ONLY GOT TO BRIEFLY MENTION THE COMMUNITY ENGAGED ALLIANCE AGAINST COVID-19 THE NIH WIDE EFFORT AND OWRH IS SUPPORTING THAT EFFORT AND THROUGH THAT NIH HAS SUPPORTED FINANCIALLY THE DEVELOPMENT OF SEVERAL LOCATIONS AROUND MULTIPLE STATES WITH SIGNIFICANT POPULATIONS OF INDIVIDUALS AFFECTED BY COVID AND ENGAGEMENT AT A LOCAL LEVEL WITH CHURCHES, CIVIC GROUPS AND OTHER ORGANIZATIONS SOW THAT'S ANOTHER RESOURCE AND MATERIALS AND THE WEBSITE AS WELL THAT ARE AVAILABLE. AS WE'VE SEEN WITH THE SABB POLICY WE BELIEVE WE'RE SEEING NEW DISCOVERIES ON SEX DIFFERENCES AN HEALTH AND MECHANISMS. IS THERE A POSSIBILITY WITH THE INCLUSION MEASURES BEING MONITORED WE CAN TRACK NEW INFORMATION RESULTING FROM BROADER INCLUSION IN CLINICAL STUDIES AND TRIALS THAT MAY ULTIMATELY BENEFIT THE HEALTH OF POPULATIONS THAT WERE HISTORICALLY UNDER REPRESENTED? >> I THINK THAT'S AN INTERESTING IDEA. THAT'S PART OF WHAT THE CLINICAL TRIAL'S REQUIREMENT WAS MAKING IT PUBLICLY AVAILABLE SO PEOPLE CAN LOOK AT THEM. IN SOME CASES THE INFORMATION CAN BE USED TO INFORM FUTURE STUDIES AS WELL. WE ENCOURAGE TRANSPARENCY AND WE ENGAGE THEM IN CONVERSATIONS. WE HAD A NUMBER OF JOURNAL EDITORS AND OTHERS COME AND PARTICIPATE UP OUR WORK SHOPS LIKE THE FIRST AND SECOND INCLUSION ACROSS THE WORKSHOP BUT WE CAN CONTROL CLINICALTRIALS.gov. WE'VE ENCOURAGED THAT AND IT'S REQUIRED FOR PHASE 3 CLINICAL TRIALS AND LOOKS LIKE PEOPLE ARE REPORTING MORE THAN THEY USED TO. NNLM RECENTLY PUBLISH AN ARTICLE INDICATING ABOUT 90% OF PEOPLE SUBMITTING TO CLINICALTRIALS.gov ARE NOW INCLUDING DATA ON SEX OR GENDER, RACE AND ETHNICITY IN THEIR RESULTS WHICH IS DIFFERENT THAN WHAT WE SAW IN EARLIER ANALYSES. WE'RE GETTING THERE BUT IT DOES TAKE TIME FOR THE REQUIREMENTS TO BE FULLY IMPLEMENTED. WITH ENCOURAGE THAT AT NIH AND WE'RE DOING IT BECAUSE WE WANT THE INFORMATION WE GET TO BE GENERALIZABLE TO THE POPULATION OF INTEREST. >> THANK YOU. BECAUSE WE'RE LOOKING TO COMMUNICATE TO AS MANY AUDIENCES AS POSSIBLE AND WHEN WE COMMUNICATE TO THE GENERAL PUBLIC ABOUT THE VALUE OF INCLUSION IT'S IMPORTANT WE HAVE MESSAGES THAT CONVEY THE VALUE ADDED FOR COMMUNITIES AND STORIES TO TELL IN TERM OF THE SICKLE CELL RESEARCH NIH HAS INVESTED IN, FOR EXAMPLE AND WE DO IT FOR RARE DISEASES WE'RE GOOD AT PUBLICIZING THE GENES WE DISCOVERED AND MUTATIONS BUT YOU'VE GIVEN ME SOMETHING TO THINK ABOUT IN TERMS OF AND THE VALUE IN INCLUDING AS MANY PEOPLE AS POSSIBLE IN THE STUDY. THE MAJOR REASON IS IF EVERYBODY'S AFGHANED -- AFFECTED BY THE DISEASE THE TREATMENT CAN BE INFORMED BY EVIDENCE. LIKE WE DON'T WANT FINDINGS APPLIED FROM MEN TO WOMEN. AND MAYBE THE AGE THING MIGHT BE ONE WAY FOR US TO DO THAT. THANK YOU FOR THAT ROGER. BEHAVE FOUR MINUTES LEFT IN THIS SESSION. ARE THERE OTHER QUESTIONS BY ADVISORY COMMITTEE MEMBERS OR COMMENTS? >> I THINK POLICIES HIP -- NIH HAVE WORKED ON ARE GREAT BUT IN THE STUDY LAST YEAR LOOKING AT THIS THE TRANSLATION TO JOURNALS WASN'T GREAT SO GETTING THE JOURNAL EDITORS INVOLVED EARLY ON IS CRITICAL AND TRAINING OF RESEARCHERS. I CAN'T STRESS THAT ENOUGH IT WAS PRETTY BAD FOR SEX AND GENDER AND WORSE FOR RACE AND ETHNICITY. THE OTHER THING I WANTED TO BRING ALONG IS POLICY CHANGE THAT COMES OUT OF RESEARCH. I THINK THAT'S A REAL OPPORTUNITY FOR NIH TO THINK ABOUT AND I CAN GIVE YOU ONE CONCRETE EXAMPLE OF SOME OF THE WORK I WAS FUNDED NOT THROUGH NIH BUT THROUGH HRSA AND CDC RESULTED IN ILLINOIS BECOMING ONE OF THE FIRST STATES FOR THE MEDICAID WAIVER UP THROUGH ONE YEAR POSTPARTUM. THAT'S HUGE. I THINK YOU GUYS NEED TO START TAKING CREDIT FOR MORE OF THE POLICY CHANGES BECAUSE THERE'S CERTAINLY SPEAKING AS AN ACADEMIC AS IMPORTANT AS A PUBLICATION AND JOURNAL AND MANY WOULD SAY FAR MORE IMPORTANT. I ENCOURAGE THAT. >> I WAS HAPPY TO HEAR ABOUT THAT IN ILLINOIS RECEIVE COVERAGE UP TO A YEAR POSTPARTUM AND A LOT OF THE DEATHS HAPPEN IN THE AREA AND REGARDING YOUR PUBLICATION YOUR'S IS ONE OF MY FAVORITE TO CITE. I USUALLY GET DESPONDENT BECAUSE I SAY THE PROPORTION OF PHASE 3 CLINICAL TRIALS DON'T RELATE TO SEX AND GENDER AT ALL AND THE OUTCOME MEASURES HAVE GONE DOWN AND WE ENGAGE JOURNAL EDITORS AND PUBLISHERS BUT THEY HAVE THEIR OWN WAYS OF DOING THINGS. IT MIGHT BE HELPFUL IF THERE'S SPECIFIC SUGGESTIONS THE GROUP MAY HAVE IN TERMS OF GATE KEEPING ROLES FOR EDITORS AND PUBLISHERS. ANYTHING TO ADD THERE, STACY? >> DAWN, ANY LAST WORDS? >> THANK YOU ALL. >> I WELCOME OUR NEXT DOCTOR. DR. WEISZ IS FROM HARVARD UNIVERSITY AND ADDRESSES MENTAL HEALTH PROBLEMS AMONG YOUTH AND LOOKING AT THE MENTAL HEALTH AND HIS RECENT WORK INVOLVES THE DEVELOPMENT AND TESTING OF TRANSDIAGNOSTIC APPROACHES WITH PSYCHO THERAPY AND TREATMENT FOR MODULAR DESIGN AND GUIDED BY PSYCHOLOGICAL CHANGE AND INTEGRATES STRATEGIES TO FIT INDIVIDUAL YOUTH AND FAMILY CHARACTERISTICS. HIS META-ANALYSES PROVIDED PSYCHO THERAPY BENEFIT AND RECEIVED HIS B.A. FROM MISSISSIPPI COLLEGE AND Ph.D. IN CLINICAL AND DEVELOPMENT PSYCHOLOGY FROM YALE. HE IS HELD FACULTY POSITIONS AT CORNELL, UNIVERSITY OF NORTH CAROLINA CHAPEL HILL AND UNIVERSITY OF CALIFORNIA LOS ANGELES WHERE HE LEVERAGED PARTNERSHIPS WITH SOUTHERN CALIFORNIA COMMUNITY MENTAL HEALTH CLINICS TO STUDY IN REAL WORLD CONTEXT AND MOVED TO MEMPHIS -- MASSACHUSETTS IN 2004 WHERE HE WAS PRESIDENT AND CEO OF THE JUDGE BAKER CHILDREN'S CENTER. HIS POSITION BLENDED WITH ACADEMIC APPOINTMENTS AND NOW WORKS FULL TIME AS A PROFESSOR IN THE HARVARD PSYCHOLOGY DEPARTMENT EXPANDING HIS BODY OF RESEARCH ON STRATEGIES FOR IMPROVING YOUTH MENTAL HEALTH CARE. JOIN ME IN WELCOMING JOHN WEISZ. >> THE PANEL WILL CONSISTENT OF FOUR S -- PRESENTATIONS OF THE IMPACT OF COVID AND IF YOU HAVE A QUESTION TYPE THEM IN THE RIGHT BOTTOM CORNER AND WE'LL KEEP TRACK. FIRST IS DR. RAGAVAN FROM PITTSBURGH UNIVERSITY CENTER. HER VRCH -- FOCUS IS ON INTIMATE VIOLENCE WITH A PARTICULAR INTEREST IN SUPPORTING MARGINALIZED COMMUNITIES AND IS PASSIONATE ABOUT INCLUSION OF ENGLISH LANGUAGE LEARNERS AND FUNDED TO CREATE A VIOLENCE INTERVENTION FOR LATINEX, ADOLESCENTS AND PARENTS AND PART OF THE CENTERS FOR DISEASE CONTROL FUNDED PROJECT EXAMINING HOW THE COVID-19 PANDEMIC AFFECTED INTIMATE PARTNER VIOLENCE AND PUBLISHED OVER 20 PAPERS ON INTIMATE PARTNER VIOLENCE AND SPOKEN ABOUT THE IMPACT OF COVID-19 PANDEMIC ON FAMILIES WHO HAVE EXPERIENCED VIOLENCE. SHE'S ALSO A GENERAL PEDIATRICIAN AND TEACHES ON SUPPORTING INTIMATE PARTNER VIOLENCE SURVIVORS IN PEDIATRIC HEALTH CARE SETTING. SHE COMPLETED MEDICAL SCHOOL AT NORTHWESTERN AND RESIDENCY AT STANFORD AND PEDIATRIC FELLOWSHIP AT BOSTON MEDICAL CENTER. WELCOME. >> THANK YOU FOR THE IN THE VIT INVITATION. AT THE BEGINNING OF THE PANDEMIC WHEN SHELTER WAS STARTING THERE WAS A SLEW OF PRESS ARTICLES ABOUT THE CONCERN REGARDING INTIMATE PARTNER VIOLENCE SURVIVORS THE CONCERN THAT FREQUENCY AND SEVERITY WAS GOING TO INCREASE DUE TO THE COVID-19 PANDEMIC PARTICULAR BECAUSE OF SHELTER IN PLACE. MORE STUDIES HAVE BEEN EMERGING TO DETERMINE IF THAT HAPPENED AND STUDIES ARE SHOWING YES, THE FREQUENCY AND SEVERITY DID INCREASE DURING THE COVID-19 PANDEMIC AND THERE'S BEEN STUDIES GLOBALLY LOOKED AT THIS AND THE TIME PERIOD WAS COMPARED FROM SHELTER IN PLACE TO MONTHS PRIOR AND FOUND THE INCREASE IN REPORTS DURING SHELTER IN PLACE. THIS STUDY WAS LOOKING AT CRIME REPORTS IN GENERAL AND IT WENT UP DURING THIS TIME. A MORE RECENT STUDY FROM CHINA SHOWS IT TRIPLED IN FEBRUARY 2020 COMPARED TO FEBRUARY 2019. SIMILAR STUDIES WERE FOUND AROUND THE WORLD THERE WAS ANOTHER IN FRANCE THAT SHOWED INCREASE OF 30% DURING THE PANDEMIC AND STUDIES HAVE LOOKED AT PREVALENCE AND SHOWED HIGH PREVALENCE DURING THE PANDEMIC. IN GENERAL IT LOOKS LIKE IT INCREASED IN SEVERITY AND FREQUENCY DURING THE PANDEMIC. IT'S USUALLY ROOTED IN POWER AND CONTROL AND WE WERE CONCERNED IT WOULD BE A WAY TO CONTROL SURVIVORS AND CHILDREN AND WE ENGAGED IN A MULTI DISCIPLINARY COLLABORATIVE TEAM TO STUDY THE QUESTIONS. THIS IS A COLLABORATION WITH THE UNIVERSITY OF PITTSBURGH AND AMERICAN ACADEMY OF PETE TRICKS AND FUNDED -- PEET PEDIATRIC AND PEDIATRICS AND HERE'S THE FULL TEAM. THE STUDY OBJECTS ARE TO UNDERSTAND THE IMPACT ON SURVIVORS AND CHILDREN EXPERIENCI EXPERIENCING ABUSE AND NEGLECT AND HOW CHILD PROTECTIVE SERVICES ADAPTED AND PRACTICES AROUND THE COUNTRY. I'LL TALK ABOUT ONE SMALL PIECE. WE'VE BEEN INTERVIEWING ADVOCATES, ADMINISTRATORS AND COALITION LEADERS AS WELL AS FOLKS IN CHILD PROTECTIVE SERVICES AND SHOW A SMALL AMOUNT OF DATA FROM THE INTERVIEWS. FOR THIS PARTICULAR PIECE OF THE STUDY, PARTICIPANTS WERE THOSE IDENTIFIED ADVOCATES WHO DO DIRECT WORK WITH THE SURVIVORS AND THEIR CHILDREN. WE FOCUSSED ON U.S. BASED AGENCIES. ALL THE INTERVIEWS WERE DONE IN ENGLISH. THE RECRUITMENT WAS USED E-MAIL TO NATIONAL REGISTERED LIST SERVES FOR ADVOCATES AND WE TRIED PARTICULARLY TO IDENTIFY ADVOCATES WHO WORK WITH MARGINALIZED COMMUNITIES AND AS WELL AS OTHERS TO ELEVATE THEIR VOICES BECAUSE SOMETIMES THEY CAN BE MISSED FROM THE CONVERSATION. WE CREATED AN INTERVIEW GUIDE IN LINE WITH OUR RESEARCH GOALS AND THE DATA COLLECTION HAPPENED THROUGH ZOOM AND USED A CONDUCTIVE ANALYSIS APPROACH. HERE'S SOME OVERVIEW OF THOSE WHO PARTICIPATED. WE INTERVIEWED THE ADVOCATES AND UNDER POPULATIONS SERVED THESE ARE THE DIFFERENT COMMUNITIES THE ADVOCATES SERVED. NOT ALL SERVED THIS COMMUNITY BUT WANTED TO HIGHLIGHT THE ADVOCATES THAT DO WORK WITH MARGINALIZED COMMUNITIES. THE RACE AND ETHNICITY. THE WAY THEY IDENTIFY THEIR OWN RACE AND ETHNICITY AND I APOLOGIZE THERE'S A TYPO, THE 98 SHOULD BE 8% AND GENDER I.D. OF THE ADVOCATES. I WANT TO SHARE SOME FINDINGS. FIRST, ADVOCATES TALKED A LOT ABOUT THE WAY COVID-19 IMPACTED SURVIVORS. SO ONE OF THE THINGS THEY DISCUSSED IS THE CHALLENGES MEETING BASIC NEEDS. THAT PREDATED COVID AND WAS COMPOUNDED BY COVID. AND DISCUSSED ISOLATION AND EMOTIONAL IMPACT OF COVID-19 ON SURVIVORS. ONE ADVOCATE SAID THERE'S BEEN A LOT OF EMOTIONAL IMPACT ON THE SURVIVORS ALREADY EXPERIENCING ISOLATION DUE TO ABUSE AND THAT INCREASED BECAUSE OF SHELTER IN PLACE ORDERS. AND THE INTERSECTIONAL INEQUITIES AND HOW IT AFFECTED SURVIVORS FOR MARGINALIZED COMMUNITIES AND SO SEVERAL EXAMPLES WERE GIVEN WITH RACISM AND CHALLENGES FOR FOLKS LIVING WITHOUT DOCUMENTATION AND LANGUAGE AND JUSTICE BARRIERS AND HOW ALL THIS PREDATED COVID BUT WAS IMPACTED AND THEY SAID IT WAS HARD TO MANAGE AND FIND RESOURCES FOR UNDOCUMENTED SURVIVORS IN THE BEGINNING AND WHEN YOU LOSE YOUR JOB YOU GO TO UNEMPLOYMENT AND GET UNEMPLOYMENT AND FOOD STAMPS AND ALL THAT WHEN YOU'RE DOCUMENTS WHEN YOU'RE NOT THERE'S NOTHING AT ALL. THIS ADVOCATE WORKED WITH COMMUNITIES OF COLOR AND IN TALKING ABOUT BLACK TRANS WOMEN IN COMBINATION WITH COVID AND WHAT'S GOING ON IN THE U.S. WE DON'T WANT SOMEONE TO CALL OUR HOT LINE AND THE FIRST RESPONSE BE TO CALL THE POLICE. AND THEY TALKED ABOUT MANIPULATION OF SURVIVORS. EXAMPLES ECONOMIC ABUSE OR WHERE THEY WERE NOT ABLE TO WORK OR AROUND HEALTH RELATED COERCION AND NOT ALLOWING SURVIVORS TO WEAR MASKS OR TO HAVE PROTECTIVE EQUIPMENT AND WHEN COVID HIT HARD THE ABUSER WAS SAYING THEY WEREN'T COMFORTABLE EXCHANGING THE WEEKENDS AND WASN'T ABLE TO SEE HER CHILDREN EXCEPT BY FACETIME. SEVERITY DISCUSSIONS AROUND SAFETY PLANNING RELATED TO CHANGE AND HARM REDUNGS -- HARM REDUCTION STRATEGIES AND MANY SPACES OUTSIDE THE HOME WERE NO LONGER AVAILABLE. SOME OF THE SAFETY MEASURES COULD BE TRAM -- TRAUMATIZING AND WEARING A MASK CAN BE TRAUMATIC. AND TO BE TRAUMA INFORMED WITH HEALTH MEASURES AND A THEME THAT EMERGED WITH VIRTUAL SERVICES MANY AGENCIES AND THE CONCERN ABOUT PRIVACY AND UNCLEAR WHETHER THE SURVIVOR WAS IN A SAFE ENVIRONMENT AND CAREFUL WHEN CONVERSATIONS WERE TAKING PLACE. THE ADVOCATE WAS AWARE AND WAS CAREFUL WITH THAT. AND SOME DISCUSSION POINTS. A LOT OF DISCUSSION ABOUT SURVIVOR LONELINESS AND TRAUMA MAKING SURE SUPPORTS ARE AVAILABLE AND COVID-19 HAS BEEN USED TO CONTROL AND MANIPULATE SURVIVORS AND A LOT OF CHALLENGES AND OPPORTUNITIES RELATED AND MANY ADVOCATES WERE DISCUSSING IF SERVICES CAN BE PROVIDED IN A SAFE WAY CAN HELP SURVIVORS AND HOW STRUCTURAL INEQUITIES WERE COMPOUNDING AND A CALL TO ACTION TO CONTINUE POLICIES THAT EXAMINE THE FRAMEWORK. WE'RE CURRENTLY DEVELOPING RECOMMENDATIONS ON THE WORK AND CROSS-SECTOR COLLABORATION. INTERESTING STUFF EMERGED AND HEALTH CARE PROVIDERS NEVER CAME UP AND WEREN'T MENTIONED AND SHOWS HOW WE NEED TO PARTNER WITH OTHER AGENCIES IN HELPING SURVIVORS AND THE NEED TO INCLUDE DISASTER PREPAREDNESS AND EMERGENCY RESPONSE PLANS, DEVELOPING TECHNOLOGY THAT ALLOWS FOR SAFE, CONFIDENTIAL AND PRIVATE. A LOT OF DISCUSSION ABOUT THE NEED FOR FUNDING AND SUPPORT FOR AGENCIES PARTICULARLY CULTURALLY SPECIFIC ONES AND SERVING MARGINALIZED COMMUNITIES AND PRIORITIZING THEM AS FRONT LINE WORKERS MAKING SURE THEY GET VACCINATED AND ALL THAT AS WELL. THAT'S IT. THANK YOU SO MUCH AND WELCOME ANY QUESTIONS. >> POST YOUR QUESTIONS AND COMMENT IN THE CHAT AND WE'LL GET TO IT AT THE END OF THE PRESENTATION. NEXT IS MAGGI PRICE AT BOSTON COLLEGE AND DIRECTOR OF THE AFFIRM LAB. SHE ALSO SERVES IN THE DEPARTMENT OF PSYCHOLOGY AT HARVARD UNIVERSITY AND WAS AT THE LABORATORY FOR YOUTH AND MENTAL HEALTH. SHE EARNED HER Ph.D. FROM BOSTON COLLEGE IN 2018 IN COUNSELLING AND M.A. FROM UNIVERSITY OF HAWAI'I IN 2012 AND B.S. IN PSYCHOLOGY AND SOCIOLOGY FROM THE UNIVERSITY OF OREGON IN 2010 AND COMPLETED HER TRAINING AT YALE UNIVERSITY AFTER FINISHING AS A HARVARD MEDICAL FELLOW AT CAMBRIDGE HEALTH ALLIANCE AND MASSACHUSETTS GENERAL HOSPITAL. SHE TRAINED IN CULTURALLY RESPONSIVE EVIDENCE-BASED PRACTICES FOR CHILDREN, ADOLESCENTS WITH A FOCUS ON PSYCH YO PATHOLOGY AND HER FOCUS IS ON INTERSECTION BETWEEN STIGMA, TRAUMA AND YOUTH MENTAL HEALTH WITH AN EMPHASIS ON ADDRESSING THE EXPERIENCES OF TRANSGENDER AND NON-BINARY YOUNG PEOPLE. WELCOME. >> THANK YOU FOR THE LOVELY INTRODUCTION. WE'RE ALL SET. THANK YOU SO MUCH. SO TODAY I'LL FOCUS IN ON ONE STUDY MY CO-AUTHOR DR. RICE AND OTHERS AND I CONDUCTED A SPATIAL META-ANALYSIS WE FOUND PSYCHO THERAPY IS LESS EFFECTIVE FOR GIRLS LIVING IN PLACES WITH HIGH LEVELS OF STRUCTURAL RACISM. I WANT TO START WITH WHAT STRUCTURAL RACISM IS AND HOW IT'S BROADLY DEFINED AND HOW WE'RE OPERATIONALIZING IT IN THE STUDY. IT INCLUDES MULTIPLE MEASURES. STRUCTURAL SEXISM CAN BE MEASURED VIA FORMS AND POLICIES AND LAWS WHICH SUSTAIN GENDER INEQUITY SPECIFICALLY IN POWER AND RESOURCES. A CONCRETE EXAMPLE AND COMMON MEASURE IS WAGE GAPS. IN OUR STUDY WE LOOKED AND NORMS AND WOMEN'S AND MEN'S VIEWS ON SUITABILITY ON POLITICS. WE KNOW THERE'S A HANDFUL OF POLICIES AND IT'S OFTEN MEASURED AT THE STATE LEVEL. WE MEASURED IT AT THE COUNTY AND STATE LEVEL AND WILL FOCUS PRIMARILY ON OUR FINDINGS ON THE STATE LEVEL INDICATORS BECAUSE THEY DIDN'T MEANINGFULLY DIFFER. WE KNOW WOMEN IN LIVING IN STATES WITH HIGHER LEVELS OF STRUCTURAL SEXISM EXPERIENCE MORE VIOLENCE AND HEALTH PROBLEMS AND WE WEREN'T PARTICULARLY INTERESTED IN THIS IN PARTICULAR AND MENTAL HEALTH INEQUITY AND DR. WOOIRS -- DR. WEIS AND I WERE INTERESTED IF STRUCTURAL SEXISM AFFECT HEALTH BY UNDERMINING TREATMENT AND IS IT POSSIBLE GIRLS AND WOMEN WHO GO TO TREATMENT MIGHT NOT PERHAPS EXPERIENCE THE TYPES OF GAINS WE WANT TO SEE BECAUSE THE GAINS THEY'RE MAKING ARE CONSTANTLY BEING ARE MINED BY LIVING IN SEXIST AND TOXIC ENVIRONMENTS. WE HAVE AN EXAMPLE OF A STUDY THAT EXAMINED STRUCTURAL STIGMA AND IT WAS CONDUCTED BY OUR COLLEAGUES AND CO-AUTHORS AND THEY FOUND ANTI-BLACK RACISM UNDERMINED HIV TREATMENT AND CONDUCTED A SPATIAL META-ANALYSIS AND UNDER RANDOMIZED CONTROL STUDIES WITH THE MAJORITY BLACK SAMPLES, INTERVENTIONS WERE LESS EFFECTIVE WITH HIGH LEVELS OF RACISM. WE SOUGHT TO REPLICATE IT WITH PSYCHO THERAPY INTERVENTION INSTEAD OF HIV PREVENTION INTERVENTION AND THE RESEARCH QUESTION WAS IS STRUCTURAL SEXISM IS ASSOCIATED WITH PSYCHO THERAPY EF CASE FOR GIRLS. -- EFFICACY FOR GIRLS. WE LOOKED AT ATTITUDES OR SEGREGATION HOW THEY RELATE TO INTERVENTION ADVOCACY. WE DID A STUDY AND DID THAT VEE -- VIA FACTOR ANALYSIS AND NEXT WE CONDUCTED A META-ANALYSIS WHERE STRUCTURAL SEXISM WAS TREATED AS A MODERATOR. MORE DETAIL ON THESE. MEASURING STRUCTURAL SEXISM WE FOCUSSED IN ON STATE LEVEL ATTITUDES OR NORMS ABOUT WOMEN. WE WERE INTERESTED IN IMPLICIT AND EXPLICIT ATTITUDES FROM THE ASSOCIATION TEST AND IT CAME FROM THE IMPLICIT TEST AND SOCIAL SURVEY AND IT'S BETTER FOR EVERYONE INVOLVED IF THE MAN TAKES CARE OF THE FINANCES AND THE WOMAN TAKES CARE OF THE HOME AND WE RATE THE SEXISM FACTOR AND THIS IS WHAT SEXISM LOOKED LIKE ACROSS THE COUNTRY. I'LL GIVE YOU A MOMENT TO IDENTIFY YOUR HOME STATE AND SEE IF IT MATCHES YOUR SENSE OF SEXISM. IN THE SOUTHEAST WE SEE DARKER MEANS MORE SEXISM AND HIGH LEVELS OF SEXISM IN THE EAST AND LESS ON THE COASTS. DR. WEISZ HAD A DATABASE AND WE FOUND THOSE QUICK MAJORITY GIRLS SAMPLES IN THE UNITED STATES CONTROLLED FOR MEDIAN HOUSEHOLD INCOME AND THIS WAS SIGNIFICANTLY CORRELATED WITH THE OUTCOME. IT RELATIVE HUMIDITIES REPRESENT REPRESENTS 6,000 YOUTH AND LESS THAN A THIRD OF THOSE HAD 50% OR MORE GIRLS WHICH REFLECTS THE UNDER REPRESENTATION OF WOMEN IN DATA RESEARCH AND 32 STATES WERE REPRESENTED AND THE MAIN FINDING TREATMENT EFFICACY WAS LOWER IN STATES WITH HIGHER SEXISM AND WE HAVE STRUCTURAL SEXISM, AS IT GETS HIGHER WE EFFECT SIZE GETS LOWER. WE READ A NUMBER OF ANALYSES AND I'LL READ ONE TODAY AND TELL YOU HOW TO ACCESS OUR PAPER IF YOU'RE INTERESTED IN LEARNING MORE ABOUT THE OTHER ANALYSES AT THE END OF THE PRESENTATION. WE HAD A DIFFERENT SUBSET OF DATA AND INSTEAD OF MAJORITY GIRLS BUT BOYS AND FOUND WAS A NON-SIGNIFICANT EFFECT AND GRAPHICCALLY THIS IS WHAT THAT LOOKED LIKE HERE. AND YOU CAN COMPARE THEM SIDE BY SIDE. SO WHAT'S THE TAKEAWAY. IT APPEARS STRUCTURAL RACISM MAKES IT HARDER FOR GIRLS TO BENEFIT FROM THERAPY AND DON'T KNOW WHY AND IT'S AN IMPORTANT AVENUE FOR FUTURE RESEARCH. STUDIES MAY WANT TO WHICH STRUCTURAL RACISM ENHANCES THE LIKELIHOOD OF HOPELESSNESS OR HYPERVIGILANCE AND IF THE CONTEXT, THE STRUCTURAL SEXISM IN ONE'S ENVIRONMENT IS UNDERMINING TREATMENT, EFFICACY OR GAINS MADE IN TREATMENT OVER TIME, IT'S POSSIBLE THE ENVIRONMENT NEEDS TO BE INTERVENED ON FOR THE PERSON LEVEL TO BE EFFECTIVE. AND WE LOOKED AT ANTI-BLACK RACISM AND FOUND STRONGER EFFECT. WE KNOW THERE'S HEIGHTENED MATERIAL SEXISM OR INEQUITY DUE TO THEPANDEMIC HIGHER UNEMPLOYMENT AMONG WOMEN AND THEY EXACERBATE THE FINDINGS IN THE TREATMENT EFFICACY FOR GIRLS. THANK YOU FOR HAVING ME. PLEASE FEEL FREE TO CONTACT ME WITH ANY FOLLOW-UP QUESTIONS WE DON'T GET THROUGH DURING THE Q&A AND IF YOU'D LIKE THE PAPER I MENTIONED THEY'RE AVAILABLE ON MY WEBSITE. THANK YOU. >> NEXT IS KATHERINE VENTURO-CONERLY. SHE GRADUATED FROM HARVARD COLLEGE WITH AN MAJOR IN PSYCHOLOGY AND MINOR IN HEALTH POLICY AND FOCUSES ON INTERVENTIONS FOR LOW RESOURCE YOUTH INTERNATIONALLY WITH THE AIM OF PROVIDING YOUTH WITH ACCESS TO EFFECTIVE MENTAL HEALTH CARE AND HAS A RELATED INTEREST IN RESEARCH TO TRADITIONAL LONG FORMS PSYCHO THERAPY INCLUDING DIGITAL MENTAL HEALTH INTERVENTIONS AND BRIEF INTERVENTIONS. SHE CO-FOUNDED AND SERVES AS THE SCIENTIFIC DIRECTOR OF THE SHANIRI INSTITUTE DEDICATED SCALEABLE WELLNESS INTERVENTIONS FOR LOW RESOURCE YOUTH IN KENYA AND BEYOND. WELCOME. WE DECIDED TO >> WE DECIDED TO INVESTIGATE THE PSYCHO THERAPIES. WE ALL KNOW THE CURRENT COVID-19 PANDEMIC FORCED A DRASTIC SHIFT FROM IN PERSON CARE TO MOSTLY VIRTUALLY MENTAL HEALTH CARE AND SEEMS THERAPIES THAT DO NOT INVOLVE IN PERSON CONTACT MAY BE DIFFERENT IN THEIR EFFECTIVE, AND IN PERSON PSYCHO THERAPIES. MOST YOUNG PEOPLE THAT LEAD OR BENEFIT FROM MENTAL HEALTH CARE AREN'T ABLE TO ACCESS IT. IN HIGH INCOME COUNTRIES IT'S ESTIMATED A THIRD OF YOUTH RECEIVE CARE AND IN LOW AND INCOME COUNTRIES A TENTH OF YOUTH IN NEED RECEIVE CARE. THE OTHER AIM WAS TO OTHER VIA META-ANALYSIS WAS TO ASK HOW EFFECTIVE ARE REMOTE YOUTH THERAPIES OVERALL AND WHAT MODERATES THEIR EFFECTIVENESS. INCLUDED STUDIES HAD TO BE FOCUSSED ON CHILD OR ADOLESCENT SAMPLES AND THE SECOND IS THEY HAD TO HAVE BEEN SELECTED OR TREATED FOR ONE OR MORE OF FOUR BROAD PROBLEM DOMAINS THAT ACCOUNT FOR MOST REFERRALS IN YOUTH. THEY'RE ANXIETY PROBLEMS INCLUDING TRAUMA AND OCD, DEPRESSION, ADHD AND CONDUCT PROBLEMS. WE ALSO REQUIRED TO BE INCLUDED STUDIES NEEDED TO BE RANDOMIZED CLINICAL TRIALS SO WE REQUIRED THEY INVOLVE TREATMENT VERSUS CONTROL CONDITIONS AND THERE'S STUDIES THAT COMPARE REMOTE THERAPIES TO IN PERSON THERAPIES IN TREATMENT VERSUS CONTROL CONDITION AFFECT STUDIES WOULD HAVE MUDDIED OUR EFFECT ESTIMATES. AND WE REQUIRED AT LEAST ONE INTERVENTION OR TREATMENT CONDITION BE NOT DE FIND AS NO IN PERSON THERAPEUTIC CONTACT. LOGISTIC CAL CONTACT WAS ALLOWED. WE ASSESSED ABOUT 5,000 FULL TEXT ARTICLES FOR ELIGIBILITY FOR THE STUDY AND FOUND 37 MET INCLUSION CRITERIA AND HAD SUFFICIENT INFORMATION TO EXTRACT SIZES OF POST-TREATMENT AND/OR FOLLOW-UP. IN TOTAL FROM THE 37 WE IDENTIFIED 43 COMPARISONS FOR SUDDENIES. THE MEAN AGE WAS 9 AND IT LASTED NINE WEEK AND THE MAJORITY WERE CAUCASIAN AND OTHER STUDIES DID NOT REPORT RACE AND ETHNICITY AND 51% HAD MAJORITY FEMALE PARTICIPANTS AS TO THE MEDIA DELIVERY ABOUT 50% OF INCLUDED STUDIES USED THE PHONE IN SOME WAY, 63% USED A COMPUTER PROGRAM, 23% INVOLVED E-MAIL CONTACT AND THERE WERE PRE-RECORDED VIDEOS OF ACTORS DEMONSTRATING THERAPEUTIC SKILLS AND THERE WERE WRITTEN TEXTS SUCH AS BOOKS AND 19% INVOLVED LONG-FORM FEEDBACK OFTEN IN THE FORM OF PROVIDER FEEDBACK ON PARTICIPANT HOMEWORK ASSIGNMENTS. ABOUT 40% TARGETED ANXIETY AND ONLY 9% TARGETED DEPRESSION AND 5% TARGETED MULTIPLE EXTERNALIZING PROBLEMS. OF NOTE THERE WERE NO OTHER COMBINATIONS OF MULTIPLE PROBLEMS TARGETED BY THE STUDY IN THIS META-ANALYSIS. ABOUT 56% HAD SYNCHRONOUS OR REAL TIME PROVIDER CONTACT SUCH AS A PHONE CALL. HOW WELL DO REMOTE THERAPIES WORK. WE ANALYZED THE QUESTION VIA A META-ANALYSIS OF POST TREATMENT AFFECT SIZES AND FOLLOW-UP EFFECT SIZES AND WERE ABLE TO COMPARE THE NUMBERS WE GOT TO ESTIMATES OF EFFECT SIZE AT POST TREATMENT AND FOLLOW-UP FOR ALL YOUTH PSYCHO THERAPIES AND THIS WAS ALSO DONE BY DR. WEISZ AND OTHER FOLKS IN OUR LAB. WE FOUND OVERALL, REMOTE THERAPIES HAVE A POOLED AFFECT SIZE OF 4.7 ABOUT THE SAME AS AN ESTIMATE OF ALL YOUTH PSYCHO THERAPIES AND AT FOLLOW-UP REMOTE THERAPIES APPEAR TO HAVE A SLIGHTLY GREATER AFFECT SIZE AT .44 BUT THAT'S A SMALL END. IT MAY CHANGE WITH MORE DATA. WE IDENTIFIED MODERATORS AND IF YOUR INTERESTED PLEASE REFER TO THE ARTICLE I'LL PROVIDER A LINK TO AT THE END OF THIS PRESENTATION. WE FOUND THERAPEUTIC PROVIDER CONTACT WAS A SIGNIFICANT PREDICTOR OR ASSOCIATED WITH EFFECTIVENESS AND GREATER EFFECT SIZES. CONVERSELY, WE FOUND THE PRESENCE OF LOGISTICAL PROVIDER CONTRACT PREDICTED LOWER EFFECT SIZES FOR REMOTE PSYCHO THERAPIES. THIS MAY BE A CONFOUNDED ART FACTUAL FINDING AS IT SEEMS UNLIKELY THE MERE PRESENCE OF A REMINDER PHONE CALL OR TEXT SUPPORT ITSELF IS WHAT CAUSES LOWER EFFECT SIZES FOR REMOTE PSYCHO THERAPIES. INSTEAD IT MAY BE FOR EXAMPLE STUDIES THAT INCLUDE PROVIDER CONTRACT ARE LESS LIKELY TO REPORT ON LOGISTICAL PROVIDER CONTACT AND SYNCHRONOUS AND PHONE CONTACT WERE BOTH ASSOCIATED WITH GREATER AFFECT SIZE FOR REMOTE PSYCHO THERAPIES. ATTENTION AND WORKING MEMORY TRAINING AND IN PRESENCE OF THE TIMES OF INTERVENTIONS IN REMOTE PSYCHO THERAPIES WERE ASSOCIATED WITH LOWER EFFECT SIZES SUGGESTING WHEN DELIVERED REMOTELY MEMORY MAY NOT BE PARTICULARLY EFFECTIVE FOR YOUTH MENTAL HEALTH PROBLEMS. FIN FINALLY THE DISCUSSION ON IMPLEMENT DIFFICULTIES WITH PROVIDERS WERE BOTH ASSOCIATED WITH GREATER AFFECT SIZES. WOE FOUND OTHER SIGNIFICANT MODERATORS OF PSYCHO THERAPIES AND THOSE THAT TARGETED ANXIETY AND CONDUCT PROBLEMS HAD ON AVERAGE SIGNIFICANTLY GREATER EFFECT SIZES THAN THOSE WHO TARGETED [INDISCERNIBLE] AND THOSE WHO HAD INTERVENTIONS THAT BEHAVIOR OR COGNITIVE BEHAVIOR THERAPY COMPARED TO OTHERS HAD GREATER EFFECT SIZES. THE PERCENT OF TIME SPENT WITH A PROVIDER WAS A SIGNIFICANT PREDICTOR OF REMOTE PSYCHO THERAPY EFFECTIVENESS FOR YOUTH. THERE ARE SEVERAL LIMITATIONS TO THIS STUDY. FIRST IT'S DIFFICULT TO DISENTANGLE CONFOUNDERS WITH 23 TREATMENT CONTROL COMPARISONS. FOR EXAMPLE, I MENTIONED THAT THE FINDING THAT LOGISTICAL CONTACT IS ASSOCIATED WITH LOWER EFFECT SIZES MAY BE CONFOUNDED BUT IT'S VERY DIFFICULT TO ASSESS WITHOUT A LARGE ENOUGH SAMPLE SIZE TO DETECT INTERACTIONS AND MAYBE AN IMPORTANT FUTURE DIRECTION TO GATHER MORE STUDIES TO BETTER UNDERSTAND THE INTERACTIONS AMONG THE MODERATORS. WE HAD LIMITED DATA WITH CERTAIN MEDIA AND WE DID NOT HAVE ENOUGH TO ESTIMATE INTERVENTIONS WITH THESE MEDIA. COMMUNICATION VIA TECHNOLOGY IS DEVELOPING RAPIDLY AND THE WAY IT WORKS AND THE LANDSCAPE OF STUDIES WILL LOOK DIFFERENT IN EVEN A FEW YEAR. WE HOPE THIS WILL HELP INFORM DESIGN AND PRACTICE. THE FINDINGS MAY INSPIRE US TO LOOK INTO ALTERNATIVE REMOTE TECHNIQUES FOR ADDRESSING ADHD OTHER THAN ATTENTION AND WORKING MEMORY TRAINING AND MAY TEST MEDICATION OR PHYSICAL ACTIVITY AND MAY WISH TO CONDUCT MORE STUDIES OF REMOTE THERAPIES TARGETING PROBLEMS AS THEY ARE WERE FEW IN THE DATABASE. I BELIEVE IT WOULD BE INTERESTING AND VALUABLE TO INVESTIGATE WHY SOME INTERVENTIONS THAT DON'T INVOLVE THERAPEUTIC PROVIDER SUPPORT ARE STILL EFFECTIVE. I'VE CITED A MIND SET AND INTERVENTION WITH NO PROVIDER SUPPORT BUT STILL SHOWS EFFECT. IT MAY SAVE PROVIDERS AND FAMILIES WORK TO DO UNGUIDED INTERVENTIONS BUT WE NEED TO UNDERSTAND WHAT MAKES THOSE EFFECTIVE. FINALLY, THANK YOU TO ALL WHO COLLABORATED AND THIS PAPER IS AVAILABLE SHORTLY. IT'S NOT PUBLISHED QUITE YET BUT BELIEVE IT WILL BE SOON. IF YOU'RE INTERESTED IN READING MORE ABOUT THE FINDINGS, YOU CAN FIND IT THERE. THANK YOU. >> THANK YOU. MS. FITZ PATRICK IS A STUDENT AT HARVARD UNIVERSITY AND HAILS FROM OHIO ORIGINALLY WHERE SHE RECEIVED HER B.A. IN PSYCHOLOGY IN PUBLIC HEALTH FROM OHIO STATE UNIVERSITY AND PRIOR TO JOINING HARVARD, SHE MANAGED A UNIVERSITY OF CALIFORNIA OF LOS ANGELES RESEARCH PROGRAM AND CLINIC FOR BRIEF INTERVENTIONS FOR ADOLESCENT AT RISK FOR SUICIDAL BEHAVIOR. HER RESEARCH AIMS TO EXPLORE METHODS FOR EXPANDING ACCESS TO AND IMPROVING THE EFFECTIVENESS OF MENTAL HEALTH SERVICES FOR CHILDREN AND ALSO ADOLESCENTS AND FAMILIES. TO THIS END SHE PRIMARILY FOCUSES ON UNDERSTANDING THE POTENTIAL BENEFITS OF BRIEF TRANSDIAGNOSTIC AND TECHNOLOGY-BASED INTERVENTIONS THROUGH ORIGINAL RESEARCH AND THROUGH META-ANALYSIS. SHE IS ALSO INTERESTED IN IDIOGRAPHIC TOPIC AND TREATMENT RESPONSE AND EXPLORING WAYS TO DIRECTLY INVOLVE FAMILIES IN CLINICAL DECISION MAKING TO BOOST OUTCOMES. WELCOME MS. FITZPATRICK. >> THANK YOU, SO MUCH, JOHN. I'M DELIGHTED TO BE HERE WITH VIRTUAL SPACE AND TO SHARE THIS WORK AT THE BEGINNING OF THE PANDEMIC. IT'S NO SURPRISE COVID-19 HAS HAD NEGATIVE AFFECTS ON CHILDREN AND ADOLESCENTS AND PARENTS AND CAREGIVERS. I'LL USE THE TERM CAREGIVERS TO CAPTURE THE DIFFERENT KINDS OF FOLKS WHO CAN RAISE CHILDREN AND ADOLESCENTS. EVIDENCE IS SHOWING MANY ARE EXPERIENCING INTERNALIZING AND EXTERNALIZING DURING THIS TIME AND SOCIAL ISOLATION IS ASSOCIATED WITH MENTAL HEALTH CHALLENGES ESPECIALLY FOR YOUNG PEOPLE. THIS IS THE CASE FOR THE FACT SCHOOLS ARE CLOSED AND KIDS ARE LESS LIKELY TO SOCIALIZE AND ADULT PEN MENTORS OUTSIDE OF THE FOLKS WHO RAISE THEM AND DOING ORGANIZED ACTIVITIES. AND THE MAJORITY OF KIDS WHO DO RECEIVE MENTAL HEALTH SERVICES RECEIVE SOME FORM THROUGH THE SCHOOL. THE NECESSARY SCHOOL CLOSURES MAY HAVE INADVERTENTLY DECREASED ACCESS TO SERVICES IN THE TIME OF MAKING THE QUICK MOVES TO VIRTUAL CARE. CAREGIVERS ARE EXPECTED TO HAVE INCREAS INCREASED CHILDCARE RESPONSIBILITIES AND HEIGHTENED FINANCIAL STRAIN AND LOSS OF EMPLOYMENT AND HEALTH CARE COVERAGE. THE STAY AT HOME ORDERS WHICH WERE SALIENT WHEN WE FIRST BEGAN THE STUDY INTRODUCED INCREASED OPPORTUNITIES FOR FAMILIAL CONFLICT WHEN PEOPLE ARE ASKED TO SPEND A LOT OF TIME TOGETHER IN CONFINED SPACES. WE'RE LIKELY TO SEE INTERPERSONAL DIFFICULTIES. THESE ARE THE MANY ASPECTS OF THE PANDEMIC. IN RESPONSE TO THE PANDEMIC AND DISRUPTION TO LIFE, MENTAL HEALTH PROFESSIONALS HAVE DONE A GOOD JOB MOVING TO VIRTUAL CARE OPTIONS. MANY RESEARCHERS, OURSELVES INCLUDED, HAVE BEEN WORKING TO QUICKLY DEVELOP AND DISSEMINATE DIGITAL SUPPORTS THAT DON'T NECESSARILY REQUIRE FACE TO FACE CONTACT. THESE MAY BE HELPFUL AND HAVING BENEFITS AND THE RAPID EMERGENCE AND SPREAD OF COVID DEVELOPED QUICKLY WITH A LITTLE DATA ON PSYCHOLOGICAL AFFECTS ASSOCIATED WITH THE PANDEMIC. WHEN WE STARTED THE STUDY AT THE BEGINNING OF QUESTIONED THE INTERVENTIONS AND FOCUSSING ON WHICH PROBLEMS WOULD BE MOST HELPFUL BY ASKING CONSUMERS THROUGH INTERVENTIONS WHAT THEY THINK AND YOU CAN SEE THE AGE RANGE FOR THE CHILDREN IN ADOLESCENTS CAREGIVERS WERE RAISING IS QUITE BROAD AND THIS IS INTENTIONAL GIVEN WE DIDN'T KNOW MUCH ABOUT COVID AT THE TIME AND HOPED TO DO SAMPLE ANALYSES WITHIN THE AGE RANGES. CAREGIVERS WERE ETHNICALLY DIVERSE AS WELL AS PRESENTING WITH A RANGE OF HOUSEHOLD INCOMES WITH THE AVERAGE AGE AROUND MID 30s. A LARGE MAJORITY IDENTIFIED AS FEMALE WHICH ALIGNS WITH BROADER DEVELOPMENT AND CHILD AND ADOLESCENT PSYCHOLOGICAL RESEARCH AND IT'S PERSON CONTEXT TO KEEP IN MIND AS WE LOOK AT THE RESULTS KNOWING A LOT OF ADDITIONAL CHILDCARE RESPONSIBILITIES HAVE BEEN FALLING ON CAREGIVERS WHO IDENTIFY AS MOTHERS AND HETEROSEXUAL RELATIONSHIPS. KEEP THAT CONTEXT IN MIND. CAREGIVERS WERE ASKED TO COUPLE A QUESTION QUESTIONS WITH A CHILD IN MIND AND USED IN APPROACH AND GENERATED TEXT DATA AND WE USED ESTABLISHED GUIDELINES TO PURSUE THIS APPROACH WHICH ESSENTIALLY INVOLVES IDENTIFYING THEMES AND PATTERNS ACROSS PARTICIPANT RESPONSES. SOME OF THE MODELS SUGGEST YOU ONLY NEED LIKE 12 RESPONSES IN ORDER TO CREATE A SUFFICIENT SAMPLE SIZE BUT GIVEN THE HETEROGENEITY WE RECRUITED FAR MORE PARTICIPANTS. AND WE USED THE APPROACH CALLED THEMATIC SATURATION TO DETERMINE A SUFFICIENT SAMPLE SIZE WHICH JUST CAPTURES THE POINT AT WHICH NEW THEMES STOP EMERGING IN PARTICIPANT RESPONSES. WHAT DID WE MEASURE? WE LOOKED AT THE THOUGHTS AND FEELINGS AND BEHAVIORS OF THEIR CHILD WITH GREATEST EMOTIONAL DIFFICULTIES AT THE TIME AND ASKED CAREGIVERS REPORT ON THEIR ANXIETY AND ANSWER ABOUT THEIR ZIP CODE AND SATISFACTION WITH LIVING SITUATION AND HOW MANY FOLKS ARE IN THE HOME AND ASKED ABOUT THE EFFECTS OF COVID-19 ON FINANCES OF THE HOUSEHOLD. WE USED A QUALITATIVE APPROACH AND ASKED CAREGIVERS TO IDENTIFY THE OPEN ENDED TOP PROBLEMS AND NEEDS OF THEMSELVES AND THOSE WITH THE GREATEST EMOTIONAL AND BEHAVIORAL DIFFICULTIES AT THE TIME AND WE WENT THROUGH THE RESPONSES AND IDENTIFIED THEMES, BUILD A CODE BOOK AND CAME TO SOME CONCLUSIONS SURROUNDING THE MOST PROMINENT PATTERNS WE'LL TALK ABOUT IN A BIT. WHAT DID WE FIND FOR QUANTITATIVE RESULTS? SELF-REPORTED ANXIETY AND DEPRESSION AMONG CAREGIVERS WERE CLINICALLY SIGNIFICANT SYMPTOMS AND SAME FOR YOUTH INTERNALIZING AND EXTERNALIZING PROBLEMS AND HITTING WHAT WE SEE IN CLINICAL SAMPLES HIGHLIGHTING THE SYMPTOMS IN THE GENERAL POPULATION SAMPLE LOWER SATISFACTION WITH THE LIVING SITUATION AND COVID RELATED POLICIES WERE ASSOCIATED WITH HIGHER CAREGIVER ANXIETY AND DEPRESSION. I'M HAPPY TO TALK MORE ABOUT THAT AND THE NUMBER OF CHILDREN LIVING IN THE HOME WAS ASSOCIATED WITH YOUTH INTERNALIZING AND EXTERNALIZING PROBLEMS. IN TERMS OF QUALITATIVE RESULTS. CAREGIVER IDENTIFIED TO THE TOP PROBLEMS FOR THEIR CAREGIVERS AND ADD LEOLESCENTS AND IN THE DOMAIN OF SOCIAL ISOLATION WHICH IS NOT SO SURPRISING. CAREGIVER IDENTIFIED NEEDS OF CHILDREN AND ADOLESCENTS COMMONLY WITHIN SOCIAL INTERACTION WHICH WE CAN'T DO SO MUCH ABOUT AS MENTAL HEALTH PROVIDERS AND THE NEED FOR MENTAL HEALTH SERVICES WHICH WE CAN DO. WE SEE THAT AGAIN FOR CAREGIVER NEEDS AND MENTAL HEALTH SERVICES WAS THE MOST COMMONLY REPORTED NEED. WHAT DOES ALL THIS MEAN? THIS MIXED METHOD STUDY WAS DESIGNED TO ENHANCE OUR UNDERSTANDING OF THE POTENTIAL PSYCHOLOGICAL AFFECTS OF COVID AS WELL AS WHICH MENTAL HEALTH INTERVENTIONS FOCUS ON WHICH PROBLEMS MAY BE MOST NEEDED DURING THE PANDEMIC FOR FAMILIES AND ALSO IN RELATED CRISES IN THE FUTURE AND FOUND MENTAL HEALTH SYMPTOMS FELL WITHIN THE CLINICAL RANGE IN WHAT APPEARS TO BE HEIGHTENED MENTAL HEALTH ISSUES IN THIS POPULATION WHICH WE SAW IN OTHER DATA DURING THIS TIME. QUALITATIVE ANALYSES REVEALED SOME FACTORS WERE ASSOCIATED WITH YOUTH MENTAL AND CAREGIVER MENTAL HEALTH SYMPTOMS WITH A NUMBER OF CHILDREN IN THE HOME BEING ASSOCIATED WITH GREATER YOUTH MENTAL HEALTH SYMPTOMS AND CAREGIVER AND YOUTH SYMPTOMS MORE PRONOUNCED IN REGIONS WITH MORE RELAXED COVID RESTRICTIONS AND CAREGIVERS FELT A RANGE OF MENTAL HEALTH PROBLEMS THAT MAY BE IMPORTANT FOR PANDEMIC SPECIFIC INTERVENTION TARGETS. THOSE SALIENT THINGS INCLUDE THINGS LIKE SOCIAL ISOLATION AND LONELINESS, BOREDOM, LACK OF MOTIVATION AND LACK OF ROUTINE. INTERVENTION ARE DESIGNED TO TARGET THESE SPECIFIC DOMAINS MIGHT BE PARTICULARLY HELPFUL IN CRISES LIKE THIS. THAT'S ALL I HAVE FOR TODAY. THANK YOU SO MUCH FOR IS LISTENING AND HAPPY TO ANSWER QUESTIONS OR COMMENTS RIGHT NOW. >> THANK YOU. THE FIRST QUESTION IS FOR DR. RAGAVAN. >> I WAS INTERESTED IN LEARNING MORE IN DR. RAGAVAN'S WORK IN PARTICULAR WHETHER YOU AND YOUR TEAM ARE DOING ANYTHING TO COLLECT DATA FROM THE VICTIM OF INTIMATE PARTNER VIOLENCE DIRECTLY. I UNDERSTAND THE DIFFICULTIES INVOLVED IN DOING SO BUT I WONDER -- TO WHAT EXTENT IS THE INFORMATION YOU GET FROM PROXY SOURCES OF INFORMATION HAS THE SAME VALIDITY AS THE INFORMATION YOU WOULD GET DIRECTLY FROM THE PEOPLE AFFECTED BY INTIMATE PARTNER VIOLENCE. THANK YOU. >> THANK YOU FOR THAT QUESTION. I TOTALLY AGREE. WE DECIDED NOT TO INTERVIEW IPV SURVIVORS AND I'M CURRENTLY NOT AND WE WERE CONCERNED ABOUT DOING INTERVIEWS AND IT'S ONLY THE SURVIVORS THAT REACH OUT TO SERVICES AND NOT ALL IPV SURVIVORS. RECRUITING THE PERSPECTIVES TO THOSE CONNECTED IS HARD BECAUSE A LOT OF THE RESEARCH HAPPENS IN COLLABORATION WITH VICTIM SERVICE AGENCIES SO I AGREE. WHILE IT PROVIDES A GOOD PERSPECTIVE ABOUT THE CHALLENGES THEY'RE EXPERIENCING, IT'S INCLUDING -- EXCLUDING THE STORIES OF THOSE THAT DON'T REACH OUT. WE WANTED TO BE CAREFUL IN REACHING SMALLER AGENCIES BECAUSE OTHERWISE IF WE TALK TO THE BIG NAME AGENCIES A LOT OF THOSE WILL BE LEFT OUT SO THANK YOU FOR THE QUESTION. I APPRECIATE IT. >> THANK YOU SO MUCH. ARE THERE COMMENTS OR QUESTIONS PEOPLE WOULD LIKE TO STATE ALOUD? >> DR. WEISZ, IS THERE ANYTHING YOU WANT TO SHARE WITH US? >> I HADN'T PREPARED ANYTHING. THE ONE THING I WOULD LIKE TO SAY IS REALLY EXCELLENT PRESENTATIONS. I LEARNED A LOT. ALSO TO THE DISCUSSION POINTS AND KEEPING TO THE TIME LIMITATIONS. >> THANK YOU ALL, DR. WEISZ FOR MODERATING THE PANEL. DR. RAGAVAN AND DR. PRICE, MS. VENTURO-CONERLY AND MS. FITZPATRICK FOR PRESENTING SUCH TIMELY ISSUES. EACH ONE OF YOU BROUGHT UNIQUE PERSPECTIVES TO WHAT WE ARE DEALING WITH WE APPRECIATE THE PRESENTATION AND FRESH RESULTS. THANK YOU SO MUCH. I WOULD LIKE TO TELL THAT THE MEMBERS SHOULD YOU HAVE ANY OTHER THOUGHTS OR RESEARCH TO GET IN TOUCH WITH THE PRESENTERS WE'LL BE HAPPY SHARE THEM WITH THEM AND REACH OUT TO ALL OF YOU AND THANK YOU AGAIN FOR JOINING US. YOU'RE WELCOME TO STAY BUT I DON'T HAVE TO YOU HAVE OTHER PRESSING ISSUES TO DEAL WITH. I'D LIKE NOW TO INTRODUCE DR. RAJEEV AGARWAL AND LEADS TWO PROGRAMS THE CENTER FOR RESEARCH EXCELLENCE AND SCHOOL ON SEX DIFFERENCES TO PROMOTE INNOVATIVE TRANSLATIONAL RESEARCH FOCUSSING ON SEX DIFFERENCES AND MAJOR MEDICAL CONDITIONS AFFECTING WOMEN. AND THE SECOND PROGRAM ADMINISTRATIVE SUPPLEMENT PROGRAM TO SUPPORT RESEARCH HIGHLIGHTING THE IMPACT OF SEX AS A BIOLOGICAL VARIABLE AND SOCIAL CONSTRUCT AND IS A SENIOR SCIENTIFIC LEAD AND COORDINATOR FOR ALL COVID-19 RELATED ACTIVITIES AND CO-CHAIR OF THE COVID-19 WORKING GROUP THAT COORDINATES MANY RESEARCH ON WOMEN'S HEALTH. DR. AGARWAL HOLDS MSC Ph.D. DEGREES FROM INDIA AND IN THE UNITED STATES HE WORKED AT NEW YORK HEALTH SCIENCE CENTER, SYRACUSE AND IN THE INTRAMURAL PROGRAM OF THE NATIONAL EYE INSTITUTE. WELCOME, RAJEEV. >> THANK YOU. IT IS MY PRIVILEGE. CAN YOU HEAR ME PROPERLY? >> YES. >> IT'S MY PRIVILEGE TO PRESENT THE PROGRAM AND EVALUATION AND CONCEPT CLEARANCE. TODAY I'M GOING TO SHOW A BRIEF OVERVIEW OF THE SUPPLEMENT WHICH WE CALL SAGE PROGRAM AND THE EVALUATION DATA AND IMPACT OF THE PROGRAM. WHEN WE START THE PROGRAM WE HAD CAUTIONS IN MIND. DID THE PROGRAM COMPLETE THE INTENDED OBJECTIVES TO SUPPORT RESEARCH HIGHLIGHTING THE IMPACT OF SELF GENDER INFLUENCES IN HUMAN HEALTH AND ILLNESS INCLUDING BASIC PRE CLINICAL AND CLINICAL TRANSLATION SERVICES. THIS WAS DONE BY THREE DIFFERENT APPROACHES BY THE OPPOSITE SEX AND GENDER AND INCREASED CENTER SIZE TO INCREASE THE POWER AND ANALYZE EXISTING DATA AND STIMULATE THE INVESTIGATORS TO ADDRESS GOAL ONE, GOAL TWO AND GOAL THREE. ANY ONE OF THE OBJECTIVES FROM THE GOALS OF PREVIOUS NIH STRATEGY PLAN AND THIS WAS THE PREVIOUS ONE. THE APPROACHES TO THE PROGRAM VIEWS AND DEMOGRAPHIC INFORMATION OF THE APPLICANTS AS WELL AS BIBLIOMETRIC DATA AND WE ALSO HAD A SURVEY TO ALL THE SUPPLEMENT AND ANALYZED SUBSEQUENT GRANT APPLICATIONS SUBMITTED AND A BRIEF OVERVIEW OF THE WORKSHOP WHICH WAS SUPPORTED BY ORWH FOR THOSE SUPPORTED BY THE WORK. IN 2012 DR. CLAYTON BECAME THE DIRECTOR AND WANTED TO IDENTIFY A WAY TO ADVANCE SEX AND GENDER AND CONGRESS WAS ALSO INTERESTED IN THE EXTENT TO WHICH NIH WAS STUDYING MALES AND FEMALES. WITH THAT INFORMATION IN MIND IN TO 13 IN 2013 ORWH IMPLEMENTED THE PROGRAM AND IT WAS SUPPOSED TO ANSWER AT LEAST ONE OF THE APPROACHES AND ADD THE OPPOSITE SEX OR INCREASE SAMPLE SIZE AND ANALYZE DATA AND WERE TO ADDRESS AT LEAST ONE OBJECTIVES FROM GOALS ONE AND THREE OF THE PREVIOUS GRANTS FOR THE HUMAN CELL AND WE USED DEFINITIONS FOR SEX AND GENDER. IN 2021, INSTITUTE OF MEDICINE DEFINED SEX AS A CLASSIFICATION OF LIVING THINGS AS MALE OR FEMALE AND GENDER REFERS TO A PERSON'S DEVELOP REPRESENTATION OF MALE OR FEMALE OR HOW THAT PERSON IS RESPONDED TO BY SOCIAL INSTITUTION BASED ON THE INDIVIDUAL'S GENDER PRESENTATION. ORWH COLLABORATED WITH ALL THE INSTITUTE, CENTERS AND OFFICES ACROSS NIH AND FUNDED APPLICATIONS. I WOULD LIKE TO POINT OUT THE NEUROLOGICAL INSTITUTE AND THE NATIONAL INSTITUTE ON DRUG ABUSE AND NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES WERE MOST BENEFITTED BY THE PROGRAM. THIS SLIDE SHOWS THE DEMOGRAPHIC INFORMATION WE CALL PII, PERSONALLY IDENTIFIED INFORMATION OF APPLICANTS AS WELL AS ORDs. THE BLUE BAR REPRESENTS THE APPLICATION AND INVESTIGATORS AND WHILE WE RECEIVED APPLICATIONS FROM 38% FEMALES AND 11% WERE FUNDED. THESE NUMBERS MATCH WITH THE OVERALL DATA AND THE MAJORITY WERE FROM Ph.D.'S AND FROM OTHERS. THE SLIDE SHOWS THE RACE AND ETHNICITY OF THE APPLICANTS. WE RECEIVED THE MAJORITY OF THE APPLICATIONS FROM THE WHITE AMERICANS AND FOLLOWED BY ASIANS AND AFRICAN AMERICAN POPULATION AND THE MAJORITY RECEIVED FROM NON-HISPANIC AGAIN. THESE NUMBERS MATCH THE OVERALL NIH NUMBERS. THE MAJORITY OF THE APPLICANTS FOR NON-DISABILITY CATEGORY. THIS SHOWS THE NUMBER RECEIVED BY NIH SINCE THE INCEPTION OF THE PROGRAM. YOU CAN SEE THE TREND IS DECLINING. AND WE SAW INCREASED APPLICATION AND THINK THIS IS BECAUSE OF ISSUANCE OF POLICY BY NIH. MORE PEOPLE WANT TO TAKE ADVANTAGE OF THE PROGRAM AND WE RECEIVED INCREASED NUMBER OF APPLICATIONS. OVERALL ORWH INVESTMENT SINCE THE INCEPTION IS APPROXIMATELY $40 MILLION AND WE HAVE ABOUT 383 INVESTIGATORS WITH A SUCCESS RATE OF MORE THAN 38%. NOW THAT WE'VE SEEN A SNAPSHOT OF THE PROGRAM HOW THEY UTILIZE THE AWARD. THE POLICY HAS AN IMPACT ON WHAT WAS SUBMITTED AND AWARDED AND THIS IS AGGREGATED DATA FOR SIX YEARS BECAUSE WE STARTED THE ANALYSIS IN 2019 SO WE'RE USING THE SIX-YEAR DATA AND RECENTLY I ALSO DID THE EVALUATION AND THE PATTERN IS VERY MUCH IDENTICAL IN 2020. THE MAJORITY OF THE APPLICATIONS AWARDED WERE IN PRE CLINICAL 58% AND 36% CLINICAL. THE MAJORITY, 45% APPLICATIONS WERE ANALYZING EXISTING DATA AND 20% INCREASE THE SUBJECTS. THIS SLIDE SHOWS THE SAME AS THE PREVIOUS SLIDE BUT ON A FISCAL YEAR BASIS. FOR THE LAST SIX YEARS. WE HAVE TO REMEMBER THE POLICY WAS ISSUED IN JUNE OF 2015 AND SOME OF THAT HAS CHANGED WE AU INCREASING TREND OF PRE-CLINICAL RESEARCH AND DECLINING TRENDS FOR CLINICAL AS WELL AS CLINICAL AND PRE CLINICAL. AFTER ISSUANCE OF THE POLICY WE SAW DECREASED IN THE NUMBER OF PROPOSALS AND CLINICAL RESEARCH IN 2017. DECREASE IN NUMBER OF APPLICATIONS PROPOSING BOTH PRE CLINICAL AND CLINICAL RESEARCH IN 2018 AND INCREASE IN APPLICATIONS PROPOSING PRE-CLINICAL RESEARCH IN 2017 WHICH IS ALSO SIMILAR IN TO -- 2018. INCREASING TREND OF PRE-CLINICAL RESEARCH. AND DISAGGREGATED DATA AND WE SAW THE TREND OF ANALYZING EXISTING DATA WHEREAS AFTER ISSUANCE OF THE POLICY WE STARTED DECREASING APPLICATIONS ADDING INCREASED SUBJECTS ACCORDING TO THE DATA. AND NEARLY IDENTICAL IN 2018. THE POLICY DID HAVE AN AFFECT OU THE INVESTIGATOR UTILIZED THE PROGRAM. THE STUDY CONDUCTED WITH THE RECIPIENT OF THE AWARD AND MOST OF OUR ACTIVELIES AN IMPACT OF THE -- ACTIVITIES AND THE IMPACT OF THE SAGE AWARD. WE CONTACTED ALL THE INVESTIGATORS SO 314 EVALUATED AND WE RECEIVED A RESPONSE RATE FROM APPROXIMATELY 50%. EQUAL RESPONSE RATE WAS SEEN FOR EACH PARTICULAR YEAR. THE MAJORITY OF RESPONSE WAS FROM Ph.D. IN LINE WITH WHAT WE SAW IN THE DEMOGRAPHIC INFORMATION AND THE DATA SHOWS THE INVESTIGATORS AND SIGN -- SCIENTISTS. THIS SHOWS THE MAJORITY OF THE APPLICATION FOR AWARDS WERE INVESTIGATORS AND THE MAJORITY NOT HAVING EARLY STAGE INVESTIGATOR OR NEW INVESTIGATOR CRITERIA. I'LL FOCUS MOSTLY ON THE RESPONDENTS THAT RECEIVED THE SUPPLEMENT AND WE DECIDED TO FOCUS ON 2013 COHORT BECAUSE THEY HAD TO PROVIDE FOR A MAXIMUM NUMBER OF YEARS SO WE HAVE MUCH MORE INFORMATION AND MORE YEARS TO FOLLOW THEM TO LOOK FOR ALL THE INFORMATION. HERE IS THE COHORT FOR SEX AND GENDER. WE HAD PUBLICATIONS AND WERE PUBLISHED BY THE 2013 COHORT AND LOOKED WHETHER THEY HAD THIS IN THEIR PUBLICATION AND THE GREEN BAR RELATED TO SEX AND GENDER AND THE BLUE REPRESENTS A PUBLICATION THAT DOES NOT CONTAIN SABV AND SAW THE INCREASE. WE WANTED TO ANALYZE THE SAME COVID-19 COHORT FOR THE SUBSEQUENT SUBMISSIONS. IN THIS PARTICULAR GRAPH WE ARE SHOWING APPLICATIONS SUBMITTED FOR FUNDING AND ANY OF THE SABV AND RED BARS SHOWS APPLICATIONS WHICH DID NOT HAVE SABV AND THE BLUE BARS SHOWS WHICH CONTAINED SABV AND SAW THE INCREASING TREND OF THE APPLICATIONS AND DECLINING TREND FOR SO-CALLED NON-RESPONSIVE APPLICATIONS. THEN WE WANTED TO FURTHER AWARDS. THE APPLICATIONS WHICH WERE AWARDED BY NIEHS AND WHAT IS THE TREND. WE NOTICED THE APPLICATIONS WHICH WERE AWARDED BY NIH AND DID NOT CONTAIN SABV WHEREAS THE AWARDS BY NIH AND IN THE APPLICATIONS SABV. THE PROGRAM IS HAVING THE INTENDED OBJECTIVES AND P.I. OR INVESTIGATORS ARE THOSE AWARDED AND THE TRENDS WERE INCREASING. IN FURTHER ANALYSIS WE ASKED DID YOU PRESENT ANY DATA FROM THE SUPPLEMENT AWARD AT MEETINGS AND 82% SAID YES. THE FURTHER QUESTION WAS IF YOU INDICATED YES TO THE PREVIOUS QUESTION, DID YOU PRESENT THE DATA SPECIFICALLY THE MEETING FOCUSSED ON SEX AND GENDER AND 90% SAID NO. THAT'S GOOD NEWS THEY HAVE SHOWING THE DATA TO BIGGER AUDIENCE. HERE ON THE LEFT PIE CHART THE SUPPLEMENTAL AWARD TO STUDENT FELLOWS AND OTHER TRAINEES IN THEIR LABBETTER EQUIPPED TO CONSIDER SEX AND GENDER AND 90% SAID YES. ANOTHER QUESTION, DO YOU FEEL THE RESEARCH IN THEIR FIELD OR DISCIPLINE APPROPRIATELY ADDRESSES SEX AND GENDER. AND THAT IS TO OUR SURPRISE MORE THAN OR APPROXIMATELY 60% SAID NO SO MEANING THERE'S STILL GAPS. THE NEXT QUESTION WAS SUPPLEMENT AWARD HAD AN IMPACT ON THEIR CAREER PATH. LOOKING AT THE DATA WE SAW INCREASE AWARENESS OF INCLUDING SEX AND GENDER. NEXT PLEASE FOLLOWED BY CHANGE RESEARCH PARADIGM INCLUDING MODIFYING PROTOCOLS AND METHODOLOGIES TO INCORPORATE SEX AND GENDER AND WE ALSO SAW WHICH WAS FOLLOWED BY INCREASED RESEARCH FUNDING RELATED TO SEX AND GENDER. NEXT PLEASE. IN 2016 I JOINED THE OFFICE AND THE FIRST WERE MADE WHEN I DID THE ANALYSIS OF ALL THE APPLICATIONS AWARDED AND WHAT WAS THE STRATEGY PLAN IN EVALUATION OR IN SHORT THE OBJECTIVES AND THE DISTRIBUTION OF ALL THE OBJECTIVES. WE NOTICE GAPS LIKE 2.3 AND 3.7 AND 3.8 WERE NOT COVERED BY INVESTIGATORS. I'M NOT TALKING ABOUT 1.9. IT WAS NOT COVERED AND PART OF THE SUPPLEMENT PROGRAM. IN THE FOLLOWING YEARS OF THE FOA WE ASKED TO FILL THE GAPS AND PEOPLE ADDRESSED THE OBJECTIVES WERE GIVEN HIGHER CONSIDERATION. IT WAS INTERESTING TO NOTE THE HEALTH DISPARITY WAS LACK OF CARE. NEXT PLEASE. A POSITIVE BUT UNANTICIPATED IMPACT IS LEADING US TO START THE NEW PROGRAM UNDER INVESTIGATED AND REPORTED AND BASED ON THE ANALYSIS WE SAW THERE WAS GAP AND THE LEADERSHIP ADDRESSED THIS BY A NEW FUNDING OPPORTUNITY ANNOUNCEMENT. SO FAR THEY HAVE INVESTED MORE THAN $10 MILLION IN THE PROGRAM. IN 2017 WITH THE OFFICE OF STRATEGY AND COORDINATION ORGANIZED FIRST THE SABV WORKSHOP FROM AWARDED INVESTIGATORS. THE OVER ARCHING THEME WAS TO LEARN FROM THE RECIPIENTS THE CHALLENGES ENCOUNTERED AND LESSON LEARNED AND THE KEY NOTE ADDRESS WAS GIVEN BY THE MAYO CLINIC FOLLOWED BY SIX SESSIONS. THE WORKSHOP MATERIALS ON BIOS AND VIDEOCAST ARE AVAILABLE ONLINE. THE IMPORTANT THING I'D LIKE TO MENTION WE HAVE SEEN ONLINE VIEWING INCREASING SINCE THE WORKSHOP FINISHED AND THE GRAPH FOR DAY ONE AND TWO WERE INCREASING. WE HAVE WORKSHOP DATA AND INFORMED THE PROGRAM AND PROGRAM PARTICIPANTS HAVE BENEFITTED. FROM THE SEX AND GENDER ADMINISTRATIVE SUPPLEMENT PROGRAM. FURTHERMORE, THE AWARDEES HAVE CONTINUED TO CONDUCT AND PUBLISH RESEARCH. I HAVE SHOWN THE DATA RESEARCHERS TO INCREASE SAMPLE SIZE AND INCREASE EXISTING DATA AND ADDRESS SEX DIFFERENCES IN SEX AND GENDER APPROACHES AND METHOLOGI METHOLOGIES -- METHODOLOGIES AND THE AWARDEES SOUGHT ADDITIONAL FUNDING RELATED TO SEX AND GENDER AND 60% APPROXIMATELY SUBMITTED SUBSEQUENT APPLICATIONS USING THE DATA FROM THE SAGE SUPPLEMENT AWARD AS WE HAVE SEEN IN THE SURVEY DATA. THEY'RE ADDRESSING OTHER GAPS IN THE CONCENTRATION OF SEX AND GENDER IN BIOMEDICAL RESEARCH. AND WE HAVE SEEN WOMEN ARE SIGNIFICANTLY AFFECTED BY COVID PANDEMIC AND WOMEN ARE ALSO EXPERIENCING LONG COVID SYMPTOMS CALLED POST ACUTE SEQUELAE AND WE HEARD WOMEN ARE DEVELOPING SEVERAL SINUS THROMBOSIS WITH THE J&J VACCINE AND TO ADDRESS THE SEX AND GENDER GAPS DUE TO COVID-19 PANDEMIC IN 2020 ORWH PUBLISHED SEX AND GENDER DIFFERENCES IN COVID-19 IN COLLABORATION WITH THE WORKING GROUP MEMBERS. IT CONTAINS FIVE MAJOR THEMES AND POLICY REQUIREMENTS IN COVID-19 AND NIH INCLUSION AND COVID-19 AND THE HEALTH OF WOMEN AND CONSEQUENCES OF COVID-19 ON THE BIOMEDICAL WAKE FOREST. -- WORKFORCE. I WOULD LIKE TO PROPOSE A NEW CONCEPT COVID-19 AND THE HEALTH OF WOMEN AND SEEK APPROVAL. THE NEW FOA FUNDING OPPORTUNITY ANNOUNCEMENT TO SUPPORT THE COVID-19 DISEASE FOCUSES ON ALLIANCES WITH NIH TO DEVELOP AND IMPLEMENT EFFECTIVE THERAPEUTICS AND VACCINES AND RESEARCH ON TECHNOLOGIES TO VALIDATE AND IMPROVE WHAT WILL OVERCOME BARRIERS AND INCREASE UP TAKE OF VACCINES AND THERAPEUTICS AT THE POINT OF CARE. AND INVESTIGATIONS OF SEX AND DIFFERENCES IN ACCESS OF CARE AND INVESTIGATION OF SEX AND GENDER INFLUENCES ON THE OUTCOME PATIENTS INTERACTION WITH HEALTH CARE PROVIDERS AND IMPACT ON COMORBID CONDITIONS. THANK YOU SO MUCH. >> THANK YOU. WE HAVE A FEW MINUTES FOR QUESTIONS. >> THANK YOU FOR YOUR QUESTION. WE DID NOTICE A DECLINING TREND OF THE APPLICATIONS AS WELL AS WE KNOW NIH HAS POLICY SO INVESTIGATORS HAVE TO ANSWER THE POLICY IN THEIR APPLICATIONS. WE THOUGHT THIS IS AN OPPORTUNITY FOR US TO REALIGN RESOURCES INSTEAD OF FROM SEX AND GENDER SUPPLEMENTAL PROGRAM AND TO FOCUS INTO THE PANDEMIC. WE WILL USE RESOURCES TO ANSWER THE GAPS FOR THE PANDEMIC. >> WE WANT TO PRIORITIZE WHAT IS MOST NEEDED RIGHT NOW. >> THERE'S A QUESTION FROM DR. HOLGREN AND THEN DR. TEMPLETON. >> THANK YOU FOR THE OUTSTANDING WORK YOU ARE DOING. I WONDER IF THE FOA IS ONLY FOR ACADEMIC LABS OR ALSO FOR SMALLER BIO TECH COMPANIES THAT ARE NIH SUPPORTED? >> WE DID INCLUDE GRANTS SO I BELIEVE IF THERE ARE ENTHUSIASM WE WANT TO HEAR FROM YOU WHAT IS THE RECOMMENDATION WE'D BE HAPPY TO INCLUDE. AND AS A RESULT OF AND AFTER THE PANDEMIC LOOK AT THE IMPACT OF SEX AND GENDER NOT ONLY ON PATIENT OUTCOME BUT THE OUTCOME OF THE HEALTH CARE PROFESSIONAL PROVIDING CARE. >> GOOD POINT. THESE ARE SOME OF THE EXAMPLES. AND WE ARE NOT GOING THROUGH THE FOUR EXAMPLES. WE NEED TO LOOK AT WHAT YOU ARE SUGGESTING. THANK YOU. >> THIS IS AN IMPORTANT FOA BUT SAY THINGS GO WELL WITH COVID AND NOT THAT WE'RE RUNNING OUT OF PROBLEMS WITH COVID SOON BUT IS IT TOO NARROW THINKING OF THE OTHER ISSUES OF WOMEN AND IN THE WANTING TO BE TOO CONFINED IN HOW WE EXPLORE THEM. >> YOU HAVE A VALID AND GOOD POINT. WE ARE NOT MARRIED TO ANY PARTICULAR IDEA AND WE'RE OPEN AND PRESENTING TO YOU TO GET THE FEEDBACK ONCE WE GET APPROVAL FROM EVERYONE. >> DO I WANT TO ELABORATE ON THE AREAS YOU NEED TO CONTINUE TO ADDRESS. >> ALL OF THEM. YOU KNOW HOW I FEEL, JANINE, IT'S SUCH A BIG AREA AND REMAINS A PIONEER AREA THOUGH ORWH MADE INCREDIBLE ADVANCES BUT SAY INFECTION SHOW DISEASE IN THE HEALTH OF WOMEN. AND HOPEFULLY SARS COV2 WILL START RECEDING AND OTHER INFECTIOUS DISEASE HAS BEEN UNDER STUDIED AND MAKING IT BROADER SO GENERALIZABILITY WILL RESULT. THAT'S ALL. >> APPRECIATE IT. >> I WANTED TO LOOK AT THE SEX AND GENDER AND HEALTH OF WOMEN AND SHE MAY NOT BE ABLE TO UNMUTE RIGHT NOW. >> T.B. KILLS MORE WOMEN THAN ANYTHING ELSE ON EARTH AND INFECTIOUS DISEASE IS THE BIGGEST KILLER OF WOMEN I LIKE THE FOCUSSED APPROACH AND NIH GETTING AHEAD OF THE CURVE ON THIS. >> WHEN WE LOOK AT HYPERTENSION AND DIABETES AND PREGNANCY AND TO BUILD ON WHAT JUDY SAID WE SHOULD TRY TO THINK BOLDER ON WHAT ARE THE METABOLIC OR MANIFESTATIONS THAT MAY IMPACT TO YEARS FROM NOW. >> AND THERE NEEDS TO BE CONTINUED EFFORT AND FOCUSSED ATTENTION. I THINK IT'S COMPELLING THE PUBLIC HEALTH NEEDS ARE VERY COMPELLING. BEING ABLE TO ARTICULATE THOSE HERE IS VERY HELPFUL TO US. THANK YOU DR. BREWSTER AND I MENTIONED IN MY REMARKS BY REAL CONCERN THE DIAGNOSIS OF HYPERTENSION IS OCCURRING AND CENTRAL HYPERTENSION IS OCCURRING SO MUCH SOONER AFTER DELIVERY WE USED TO THINK IT WAS 10 OR IS15 OR 20 YEARS LATER BUT WE VIEW HEALTH THROUGH THE LIFE COURSE PERSPECTIVE AND WE'RE ALWAYS TRYING TO WORK MORE COLLABORATIVELY AND ENGAGE OUR INSTITUTE AND CENTERS AND PARTNERS AND COLLEAGUES ON THAT VIEW POINT. OTHER THOUGHTS. >> ONE OF THE THOUGHTS I HAD IS AND THINK IT COULD FIT IN IS WHAT IS THE IMPACT OF COVID ON THE HEALTH OF WOMEN MOVING FORWARD. I THINK THAT'S WHAT SOME OF THE PEOPLE WERE TALKING ABOUT. I'M THINKING MOSTLY ABOUT MATERNAL HEALTH BUT WE'RE PAYING A LOT OF ATTENTION NOW TO THE FOURTH TRIMESTER AND I'M READING OTHER PAPERS ABOUT THIS THAT WOMEN ARE SUFFERING FROM A LOT OF TRAUMA, POSTTRAUMATIC STRESS OF THEIR EXPERIENCE OF BEING PREGNANT DURING THE TIME OF COVID AND FEELINGS OF ISOLATION CONTINUES IN THE POSTPARTUM PERIOD BECAUSE WE'RE SO USED TO GATHERING AROUND NEW MOTHERS AND THEIR BABIES AND THAT'S NOT HAPPENING NOW. I'M THINKING MORE OF THE ONGOING EFFECTS ON THE PANDEMIC ON HE -- THE HEALTH OF WOMEN AND THE EFFECTS ON MATERNAL HEALTH. >> I WANT TO MAKE SURE YOU ARE AWARE THE IMPROVED NOSI FOR 2021 INCORPORATES RESEARCH ON THE CONSEQUENCES SOCIAL ISOLATION RELATED TO COVID-19 ON MATERNAL MENTAL HEALTH. THAT WOULD BE COVERED IN THE IMPROVED NOSI FOR FY2021. THAT'S WHERE WE ARE TRYING TO ADDRESS THE COLLISION OF CRISES IS WHAT I CALL IT WITH COVID AND STRUCTURAL RACISM AND HEALTH INEQUITIES. JUST PREGNANT WOMEN RIGHT NOW ARE DEALING AND THE CONTEXT IS UNHEARD OF. WE WANTED TO BE ABLE TO SUPPORT RESEARCH THAT WOULD WORK THERE. I DO TAKE THE OTHER SIDE OF YOUR POINT AND WHAT OTHERS WERE SAYING WHICH IS THE LONGER TERM CONSEQUENCE OF COVID ON THE HEALTH OF WOMEN ARE WHAT WE'RE HEARING PEOPLE ARE INTERESTED IN THAT AS WELL. IN PART THIS IS THE LOWEST PERCENTAGE OF WOMEN IN THE WORKFORCE AND I FORGET THE NUMBER BUT I THINK IT'S 20 OR 30 YEARS WHICH IS QUITE LARMING -- LARMING AND -- QUITE ALARMING AND HAVE AN IMPACT ON HEALTH INSURANCE AND OTHER FACTORS. >> WE'RE ALL VERY CONCERNED ABOUT THE EXIT OF WOMEN THROUGH THE WORKFORCE THROUGH NO FAULT OF THEIR OWN AND GIVEN WOMEN REPRESENTED A LARGE NUMBER OF ESSENTIAL WORKERS AND THEIR EXPOSURE WAS ELEVATED BECAUSE OF THAT AND EVERY JOB CAN'T BE DONE FROM HOME AND THAT'S IMPACTED CERTAIN POPULATIONS OF WOMEN AND MAKE SURE WE'RE HEARING FROM YOU ALL THAT'S ALSO OF INTEREST TO YOU. THIS VERY HELPFUL. ANY LAST QUESTIONS BEFORE I TURN IT BACK TO DR. NOURSI. GO AHEAD. >> THANK YOU, RAJEEV AND ALL FOR THE QUESTIONS. AT THIS TIME WE'LL VOTE TO APPROVE THE CONCEPT CLEARANCE FOR ORWH SEX AND GENDER ADMINISTRATIVE SUPPLEMENT PROGRAM. IS THERE A MOTION ON THE TABLE TO APPROVE THE CONCEPT CLEARANCE FOR THE ORWH SEX AND GENDER. >> MOTION APPROVED. >> WHO WAS THAT? >> WENDY BREWSTER. >> DR. BREWSTER HAS SUBMITTED THE MOTION. DO I HEAR A SECOND? >> SECOND. >> THANK YOU, DR. HOLGREN. THE POLL IS OPEN FOR YOU TO BE IN -- FOR YOU TO RESPOND. >> WE HAVE SP IN FAVOR. -- 13 IN FAVOR. NONE OPPOSED. >> THANK YOU, SARAH. THIS CONCEPT CLEARANCE HAS BEEN ACCEPTED WITH 13 IN FAVOR. THANK YOU. I WOULD LIKE NOVE AND DISCUSS THE CREATION OF THE ORWH ACRWH CENSUS CONFERENCE YOU RECEIVED A COPY FROM THE WORKING GROUP FOR THE WOMEN'S HEALTH CENSUS CONFERENCE INITIATIVE STATEMENT. THANK YOU ALL FOR REVIEWING IT AND WOULD LIKE TO PROVIDE MORE CONTEXT OF THE WORKING GROUP. WE ARE ASKING YOU AS OUR ADVISORY COMMITTEE TO PROVIDE YOUR INVOLVEMENT, LEADERSHIP AND EXPERTISE FOR THIS EFFORT. IN FACT, AS AN ADVISORY COMMITTEE, YOU ARE THE ONLY ONES ALLOWED TO PROVIDE THIS PROFESSION. AS A MIAMI BER -- MEMBER YOU HAVE THE RESPONSIBILITY FOR THE ACTIVITY TO BE UNDERTAKEN BY THE NATIONAL RESEARCH INSTITUTES WITH RESPECT TO RESEARCH ON WOMEN'S HEALTH, RESEARCH ON OBSTETRICAL AND GYNECOLOGICAL TREATMENTS AND RESEARCH OF WOMEN'S HEALTH CONDITIONS WHICH REQUIRE A MULTI DISCIPLINE APPROACH AND ALSO YOUR RESPONSIBILITY TO PROVIDE THE FOUNDATIONS OF PRIORITIES TO CARRY THOSE RESEARCH TOPICS. DR. CLAYTON MENTIONED SOME AND I'D LIKE TO ELABORATE. CONGRESS BELIEVES MORE RESEARCH IS REQUIRED TO ADDRESS THE RISING MORE BUILT AND -- MORBIDITY AND MORTALITY AND CERVICAL CANCER RATES. THEY ENCOURAGE NIH TO CONVENE A CENSUS CONFERENCE WITH RELEVANT ICOs AND ENCOURAGED US TO REACH OUT TO PUBLIC STAKEHOLDERS TO EVALUATE RESEARCH UNDERWAY. THEY DIRECT AN UPDATE FOR THE CONGRESSIONAL JUSTIFICATION OF APPROPRIATIONS THAT IDENTIFIES PRIORITY AREAS FOR ADDITIONAL STUDIES TO ADVANCE WOMEN'S HEALTH RESEARCH INCLUDING REPRODUCTIVE SCIENCES. SO WHAT'S AHEAD OF US. WE'LL CONVENE THE WOMEN'S HEALTH CENSUS CONFERENCE INCLUDING RESEARCHERS, REPRESENTATIVES AND PUBLIC STAKE HOLDERS. IT WILL BE IN THE FALL SO THE FALL MEETING WILL SERVE AS A CENSUS FORUM TO FOCUS ON ASSESSING CURRENT STATE OF NIH SUPPORTED WOMEN'S HEALTH RESEARCH. WE'D LIKE TO HAVE OVERALL ASSESSMENT ON THE RESEARCH AND HEALTH OF WOMEN AND FOCUSSED ASSESSMENT OF REQUESTED RESEARCH AND THE GAPS AND WHERE WE GO FROM THERE. WE'LL WORK WITH YOU ON PREPARING A REPORT ON IDENTIFYING PRIORITY AREAS AND DUE AT THE END OF THE CALENDAR YEAR. WHAT ARE THE MOVING PARTS? SEVERAL. OUR OFFICE IS THE LEAD FOR THIS CONSENSUS CONFERENCE AND WILL WORK WITH OTHER ICOs AND A COORDINATING RESEARCH ON ALL OF YOU AND THE PUBLIC. EACH ONE WILL PAY A VITAL ROLE IN THIS. SO WHAT'S THE ASK FROM YOU? THAT'S PROBABLY WHAT YOU WANT TO HEAR? I'D LAKE TO TAKE THE OPPORTUNITY -- LIKE TO TAKE THE OPPORTUNITY TO THANK YOU ALL FOR YOUR CONTRIBUTIONS TO INFORMATION TO HELP US IN PREPARING FOR THIS SUCH AS THE BIENNIAL REPORT AND GAVE YOUR INPUT ON THE SECTIONS SO THANK YOU VERY MUCH. WHAT'S THE ASK? WE WOULD LIKE INPUT. WE SEEK INPUT FROM PUBLIC AND RELEVANT STAKEHOLDERS. ONE POSSIBILITY IS THROUGH AN RFI, REQUEST FOR INFORMATION ON ANOTHER FORMAT. WE WOULD LIKE TO REVIEW WOMEN'S HEALTH PORTFOLIO ASSESSMENT TO EVALUATE GAPS IN PORTFOLIO REGARDING PUBLIC HEALTH NEEDS TO IDENTIFY AREAS FOR US TO MOVE FORWARD. SCIENTIFICALLY TOPICS WITH THE ORPHAN ISSUE AND POTENTIAL PRIORITIES AND PERHAPS PRIORITIZE THEM AND SEE WHICH ARE THE MOST IMPORTANT ONES WHICH ARE THE ONES WE NEED TO FOCUS ON RIGHT NOW. AND WHAT OTHERS WILL BE ABLE TO FOCUS ON DOWN THE ROAD BECAUSE WE CAN'T DO IT AT ONCE. AND THE CONSENSUS CONFERENCE INCLUDING DEVELOPING AGENDA INFORMED HEALTH PORTFOLIO ASSESSMENT WHICH I MENTIONED AND PUBLIC HEALTH NEEDS AND SCIENTIFIC AREAS FOR ADVANCEMENT. WE WOULD LIKE YOUR HELP IN MODERATING SOME OF THE SESSIONS WITH OTHER COLLEAGUES FROM NIH AND RECEIVE INPUT ON POTENTIAL PRIORITIES. LASTLY TO HELP QUICK -- HELP WITH THE FINAL REPORT TO AND RECOMMEND WAYS TO ENCOURAGE GREATER WOMEN'S HEALTH RESEARCH TO ADDRESS PRIORITIES ACROSS NIH INCLUDING BUT NOT LIMITED TO THE FUNCTIONS OF ORWH. WE'D LIKE TO HAVE THREE MONTHLY MEETINGS. ONE IN MAY AND SECOND IN JUNE AND THIRD IN JULY. DATES TO BE DETERMINED. WE'LL MAKE SURE THOSE DATES WORK FOR THOSE WHO WILL JOIN THIS WORKING GROUP AND SEPTEMBER 1, WE ALREADY TAKE TIME FOR SEPTEMBER 1. WE'LL SHARE THAT WITH YOU AND THAT WILL BE PERHAPS IN THE AFTERNOON MOST LIKELY TO APREF THE EFFORTS OF THE WORKING GROUP PRIOR TO THE CONSENSUS CONFERENCE AND CONFERENCE WILL BE IN THE FALL MEETING OCTOBER 20 TO OCTOBER 21. THAT'S IN A NUTSHELL THE CENSUS CONFERENCE PLANS AND WE'RE HAPPY IT TAKE QUESTIONS. DR. CLAYTON, MYSELF AND SEVERAL MEMBERS OF THE LEADERSHIP TEAM ARE WORKING RIGHT NOW ON PLANNING FOR IT SO WE'RE HAPPY TO ANSWER QUESTIONS YOU MAY HAVE. >> ARE YOU LOOKING FOR A SUBSET OF THIS ADVISORY COMMITTEE TO SERVE AS THE WORK GROUP? -- WORKING GROUP OR ARE ALL OF US CONSIDERED THE WORKING GROUP? >> NO, WE WOULD LIKE FOR A SUBSET OF THIS WORKING GROUP. THOSE ABLE TO DEDICATE THE TIME TO HELP US WITH THAT. THE WORKING GROUP MAY ALSO INVOLVE SEVERAL MEMBERS FROM THE VARIOUS ICs AND WOULD LIKE TO IDENTIFY OTHER STAKEHOLDERS. WE ALREADY GOT APPROVAL TO INVOLVE OTHER STAKEHOLDERS. >> THIS IS AN INTERESTING PROJECT AND WOULD BE HAPPY TO HELP AND FIRST THE KIND OF CONFERENCE YOU HAVE IN MIND. A HUGE ONE? INVITED SPEAKERS, A BROAD AUDIENCE? I WOULD LIKE TO KNOW THE FINAL OUTCOME OF THE WORK OVER THE NEXT FEW MONTHS. >> DR. CLAYTON WOULD YOU LIKE TO ANSWER THAT OR WANT ME TO HELP? >> DR. NOURSI OUTLINED THE GENERAL FRAMEWORK. THIS HAS TO BE A ONE-DAY CONFERENCE IN CONNECTION WITH THE ADVISORY COMMITTEE MEETING IN OCTOBER. IT'S TIME LIMITED BASED ON THAT AND FIT INTO THE ONE-DAY SLOT. THAT WILL LIMIT THE SIZE ON THAT BASIS. THE SCALE AND SCOPE WILL BE INFORMED BY THE WORKING GROUP AS WELL AS THE PORTFOLIO ASSESSMENTS THAT WILL BE PERFORMED AND AS DR. NOURSI OUTLINED AND OUR COLLEAGUES ACROSS THE INSTITUTES AND CENTERS WHO DO WOMEN'S HEALTH RESEARCH WILL CONTRIBUTE TO THAT EFFORT. THERE'S AN OPPORTUNITY FOR THE WORKING GROUP TO DESIGN WHAT THIS LOOKS LIKE. WE LOOK FORWARD TO YOUR IDEAS AND HOW TO MOVE THIS FORWARD AND WE MUST BE RESPONSIVE TO THE THREE AREAS CONGRESS ASKED US TO ADDRESS. >> MAYBE I GOT CONFUSED BECAUSE I SAW OCTOBER 20 AND OCTOBER 21. I THOUGHT AS IT A TWO-DAY CONFERENCE. >> THE FIRST DAY BEING THE CENSUS CONFERENCE AND THEN THE SECOND DAY WITH REGULAR BUSINESS IN THE FALL. >> THIS IS IN PERSON I ASSUME? IS THAT THE GOAL? >> IT ALL DEPENDS. WE'RE PLANNING FOR BOTH CONTINGENCIES. I WOULD LOVE TO BE IN PERSON BUT WE'LL DO IT IN THE MOST SAFE WAY POSSIBLE BASED ON THE CIRCUMSTANCES AT THAT TIME BUT ARE PLANNING FOR BOTH. >> THE SAME WORKING GROUP WILL ADDRESS ALL THREE QUESTIONS. >> YES. IT WILL BE A SUBSET OF THE ORWH AND NEED TO ADDRESS ALL THREE QUESTIONS BUT YOU MAY SAY TWO PEOPLE WILL WORK ONE PIECE ON ANOTHER AND ANOTHER TWO OR THREE ON ANOTHER. WE HAVE THE FLEXIBILITY BASED ON YOUR EXPERTISE TO BREAK UP AND COME BACK TOGETHER. >> WE'LL ASK FOR A MOTION TO FORM THE WORKING GROUP. WE NEED A MOTION FROM YOU TO FORM THE WORKING GROUP THE GREAT QUESTIONS AND ENTHUSIASM FROM SEVERAL. >> ARE YOU LOOKING FOR US TO SUBMIT TO YOU SOME IDEAS? >> I'M HEARING IF I DON'T PARTICIPATE IN THE WORKING GROUP DO YOU GET A VOICE AND IF YOU WANT TO MAKE SURE YOUR VOICE IS HEARD GET ON THE WORKING GROUP BUT THE WAY THE WORKING GROUPS WORK IS THEY ALWAYS HAVE TO REPORT OUT TO THE COUNCIL. YOU'LL HEAR ABOUT IT BUT YOU'LL HAVE A BETTER CHANCE TO INFLUENCE THE PROCESS IF YOU'RE ON THE WORKING GROUP. >> THANK YOU. >> A QUICK QUESTION ABOUT THE WORD CENSUS. >> SO WE CLARIFIED WHAT CONGRESS MEANT BY THAT. THEY DID NOT MEAN THE SPECIFIC CENSUS FORMAT NIH HAD IN THE PAST. IN FACT IT'S NO LONGER IN USE. WE'RE TOLD IT MEANT INPUT FROM BROAD DIFFERENT STAKEHOLDERS ACROSS DIFFERENT SCIENTIFIC AREAS BOTH THE PUBLIC INSIDE AND OUTSIDE NIH. CARE PROVIDERS AS WELL AS RESEARCHERS AND OF COURSE ADVOCACY GROUPS, STAKEHOLDERS THAT WOULD BRING FORTH THE VOICE OF WOMEN INCLUDED AS WELL. DOES THAT ANSWER YOUR QUESTION? >> WE WON'T BE VOTING ON THAT. >> IT'S IN THE CONTEXT OF THE GROUP. THE WORKING GROUP DOESN'T VOTE. >> THE -- I DON'T ENVISION IT AS A VOTING PER SE BUT YOU WANT QUA QUANTIFICATION FROM STAKEHOLDERS AND DR. NOURSI MENTIONED AN RFI AND OTHER SOFTWARE APPLICATIONS TO RECEIVE INPUT. >> THE SEPTEMBER 1 SPECIAL MEETING IS TO MAKE SURE THEY'LL HEAR FROM THE DELIBERATIONS OF THE WORKING GROUP IN AN ACTUAL MEETING SEPTEMBER 1. >> I'M NOT SEEING ANY OTHER QUESTIONS IN THE CHAT. SARAH, ANYTHING IN THE CHAT WE MISSED? >> NO, WE'RE GOOD TO VOTE. >> AT THIS TIME WE'D LIKE TO MOVE ON TO VOTE ON APPROVING THE CREATION OF AN ACRWH WORKING GROUP FOR THE CONFERENCE. IS THERE A MOTION ON THE TABLE TO APPROVE THAT CREATION OF AN ACRWH WORKING GROUP FOR THE UPCOMING WOMEN'S HEALTH CENSUS CONFERENCE. >> SCOTT WALKER APPROVE. >> THANK YOU. DO I HEAR A SECOND? >> SECOND. >> ENTER YOURS RESPONSES NOW. YOU'LL HAVE 30 SECONDS. >> WE HAVE 16 IN FAVOR UNANIMOUSLY. >> THANK YOU. THIS THE WORKING GROUP HAS BEEN AC SEPPED WITH 16 IN FAVOR. THANK YOU ALL. I WOULD LIKE TO TURN IT BACK TO THE CHAIR OF THIS COMMITTEE DR. CLAYTON. >> THANK YOU FOR THIS PART WHERE WE'VE HAD ALL OF OUR PRINGSS AND GOOD DISCUSSION -- PRESENTATIONS AND GOOD DISCUSSION AND TAKING CARE BUSINESS OF HIGH PRART FOR THE HOFS. -- PRIORITY FOR THE OFFICE AND THANK YOU FOR BEING HERE AND SHARING YOUR INPUT OR THE FUTURE DIRECTION. THAT'S WHAT WE'RE COUNTING ON AND WANT TO ADD MY THANKS FOR ALL THE WORK YOU'VE DONE IN REVIEWING THE INSTITUTE AND CENTER REPORTS. THE REPORTING IS A FORMAL REPORT FROM YOU AND SO WE WORK WITH YOU TO DO THAT. THANK YOU VERY MUCH FOR YOUR INPUT ON THAT. WE HAVE AN OPPORTUNITY TO MAKE SURE WE HAVE A CHANCE TO DISCUSS ANYTHING ON YOUR MIND RELATED TO ORWH ACTIVITIES AND THINGS THAT AREN'T HAPPENING YOU'D LIKE TO SEE. CLINICAL CONUNDRUMS, PUBLIC HEALTH NEEDS AND ORGANIZATIONAL OR STRATEGIC ISSUES AND LOOKS LIKE DR. McGREGOR WOULD LIKE TO GET US STARTED. >> GRET -- GREAT MEETING. IT'S AMAZING THE INFORMATION YOU CAN PACK IN. I WAS LOOKING FORWARD TO ASKING THIS GROUP FOR THEIR OPINION ON LANGUAGE. WHEN YOU'RE WRITING MANUSCRIPTS VERSUS USING SEX VERSUS GENDER OR MALE VERSUS MALE AND FEMALE VERSUS MEN AND WOMEN. WHAT'S HAPPENING IS THE SYSTEM IS EVOLVING, WHEN YOU LOOK AT OLDER RESEARCH AND THEY WERE USING THE TERMS GENDER FOR EVERYTHING IT'S OKAY TO RECOGNIZE THAT'S AN ANTIQUATED WAY OF LOOKING AT IT AND WHEN WE REFERENCE IT CAN WE CHANGE THE TERM AND THEN GOING BACK AND FORTH TRYING TO DECIDE WHETHER THEY LOOKED AT GENDER OR THE SEX PIECE. AND WE'RE LOOKING AT WOMEN WHO HAVE DIED FROM OPIATE RELATED OVERDOSE AND A CO-INGESTION WITH BENZOS. WOULD THAT BE A GENDER PRESCRIBING THING OR METABOLISM THINGS. IT'S WRITTEN MOSTLY IN FEMALES BECAUSE IT'S A WOMAN'S THING AND GOT FEEDBACK PERSON-CENTERED LANGUAGE WOULD BE PREFERRED, MALE OR FEMALE. LIKE MAN OR WOMAN, SORRY. SOMETIMES YOU WANT TO SPECIFY WHAT YOU'RE TALKING ABOUT AND AUTHORS OR CO-AUTHORS OR COLLEAGUES PUSHING YOU TO SAY WHAT DO YOU REALLY MEAN HERE AND THEN I ALSO HEAR YOU SAY ALISON TRYING TO UNDERSTAND WHAT WAS REFERRED TO IN THE PAST WHICH MEANS POLITELY USING THE TERM GENDER INACCURATELY IN PREVIOUS DOCUMENTS. >> YOU CAN'T JUST SAY MEN AND WOMEN ANN MORE. IT'S A BRAVE NEW WORLD. THANK YOU FOR BRINGING THAT UP. I SEE SEX AND GENDER BEING USED PROPERLY BUT THE OLD LITERATURE, FORGET ABOUT IT. >> I THINK WE HAVE TO SET THE PATH FORWARD BRAVELY. >> I WAS GOING TO ADD YOUR QUESTION IS TWO FOLD IT'S ABOUT LOOKING BACK AS WELL AS FORWARD AND WHEN I YOU WRITE A PAPER REVIEWING PREVIOUS ARTICLES YOU MAKE SURE YOUR DEFINITIONS ARE CLEAR AND STICK WITH THOSE AND MAY NEED TO CLARIFY PREVIOUS LITERATURE WAS NOT CORRECT BUT USED IN A LANGUAGE IN A DIFFERENT FASHION. SEX AND GENDER GETS CONFLATED WITH BIOLOGY. LOOKING FORWARD IF YOU TALK ABOUT BIOLOGY AND YOU USE SEX IF NOT YOU USE GENDER AND SOMETIMES SEX YOU'RE NOT SURE WHERE SO IT'S SEX/GENDER. I DON'T KNOW MALE AND FEMALE AND THEN YOU GET NO CIS AND YOU MAY NEED TO DEAL WITH THE RANGE OF GENDERS OR -- >> YOU GOT MUTED AT THE END. >> I DON'T KNOW WHAT HAPPENED THERE. I THINK SOMEONE'S JUST TRYING TO SHUT ME UP. >> NOT AT ALL. THANK YOU EVERYBODY FOR YOUR COMMENTS. GENDER IS SO MUCH MORE COMPLICATIONS AND DIFFERENT TO MEASURE AND WEREN'T VALIDATED MEASURES TO THE U.S. HAS ACCEPTED AND THERE'S A NEW PUBLICATION OUT AND WILL BE HAPPY TO SHARE THAT WITH THE COMMITTEE AFTERWARDS AND LOOK TO THE NEIGHBORS TO THE NORTH IN CANADA AND THEY USE THE TERM, MAN WOMAN AND GENDER DIVERSE PEOPLE. THAT IS A RANGE OF IDENTITIES AND SEEING MALE AND FEMALE INTERSECTS SO THAT'S ANOTHER ADDED DIMENSION. IT IS A WORK IN PROGRESS BUT WE'RE TRYING TO BE THOUGHTFUL AND EVIDENCE-BASED ON THE USAGE OF TERMS AND EVOLVE THEM. NOT JUST SAYING WITH THE ONES THERE. THIS SAY REAL OPPORTUNITY TO COLLABORATE WITH OUR SOCIAL SCIENCE COLLEAGUES WHO HAVE DONE THE VAST MAJORITY OF WORK IN THE GENDER SPACE AND COME AT THE CONVERSATION FROM A VERY DIFFERENT PERSPECTIVE. IT SEEMS LIKE AN OPPORTUNITY TO HAVE MORE OF THOSE CONFERENCE CONVERSATIONS. I DON'T KNOW IF MANY HERE HAVE ACTED WITH SOCIAL SCIENTISTS AND HAVE COMMENTS OR GUIDANCE ABOUT THAT. >> LET PEOPLE KNOW ABOUT A RESOURCE SOME PROBABLY HAVE SEEN. THE CDC HAS A HEALTH EQUITY STYLE GUIDE. IT HAS DEFINED HOW TO USE TERM AROUND SEX, GENDER, ETHNICITY, RACE, AND SOME HAVE PROBABLY SEEN IT. IT'S JUST A RESOURCE. IT WON'T FULLY ANSWER ALL THE QUESTIONS BUT TELLS YOU DON'T SAY THIS, SAY THIS. I FOUND THAT HELPFUL IN TERMS OF WHEN I WRITE AND SPEAK AND DO PRESENTATIONS. JANINE, WERE YOU AWARE OF THAT HAVE YOU SEEN THAT? >> NO, BUT WE JUST WORKED ON AN HIV SEX AND GENDER RELATED STYLE GUIDE SO HAPPY TO HEAR CDC HAS ONE AND WOULD BE HAPPY TO PUT THE INFORMATION TOGETHER FOR YOU BUT SOUNDS LIKE YOU MIGHT BE INTERESTED IN A PRESENTATION ON THIS TOPIC IN THE FUTURE AT A FUTURE MEETING. WE WOULD BENEFIT FROM SOME OF OUR COLLEAGUES WHO ARE EXPERT IN THESE AREAS AND HAVE THEM MAYBE DO A PRESENTATION FOR US AND DUKE IT OUT. >> OR EVEN PART OF THE CENSUS CONFERENCE. LIKE WE'LL CREATE CENSUS AROUND THIS FOR JOURNAL PUBLICATIONS AND THINGS. >> THE BOTTOM LINE IS THE WOMAN, THE PERSON IN FRONT OF YOU YOU'RE TRYING TO PROVIDE CARE FOR AND PROVIDE EVIDENCE-BASED CARE BASED ON THE LITERATURE. IF YOU DON'T HAVE LITERATURE CAREFULLY DONE, YOU AS A CLINICIAN DON'T HAVE THE INFORMATION YOU NEED TO MAKE AN EVIDENCE-BASED CARE DECISION EVERY HUMAN BEING DESERVES THAT FROM THEIR HEALTH CARE PROVIDER AND TODAY WE CANNOT DELIVER THOSE DECISIONS FOR SOME BASIC TREATMENT DECISIONS, WOULD YOU AGREE? >> YOU SAID IT EXACTLY. >> MAYBE THAT'S A WAY WE COME IN THE CONVERSATION IN THE CONTEXT OF THE CENSUS CONFERENCE AND ALSO YOU HIGHLIGHTED THE ISSUE RELATED TO PUBLICATIONS. WE'VE TALKED MANY TIMES ABOUT THE CHALLENGES IN INTERACTING WITH JOURNAL EDITORS AND PUBLISHERS. MAYBE IT GIVES A FRESH PERSPECTIVE TO THAT DISCUSSION AS WELL. THANK YOU VERY MUCH FOR BRINGING IT UP. IT SOUNDS LIKE IT'S OPENED UP EVEN MORE OPPORTUNITIES TO HAVE MORE NUANCEDS. NUANCED CONVERSATIONS. >> EVEN RELEVANT IN PREGNANCY BECAUSE OF TRANSGENDER AND WE HAVE TO BE CAREFUL TO SAY PREGNANT OR POSTPARTUM PERSONS WHICH ISN'T UNIVERSALLY ACCEPTED THOUGH WE TRY TO BE AS BROAD IN OUR ACCEPTANCE AS POSSIBLE. >> THANK YOU FOR BRINGING THAT UP. IT WAS BROUGHT IN WITH ME RECENTLY IN TERMS OF BIRTHING PERSONS AND WISE TO BE AS CULTURALLY SENSITIVE AND AS INCLUSIVE AS POSSIBLE I THINK A LOT OF PEOPLE ARE TRYING TO DO THAT. IF WE CAN HELP MOVE THAT ALONG BY PROVIDING THIS. >> I APPRECIATE THE CANDID DISCUSSION. TO SOME EXTENT WE ARE ALL STRUGGLING WITH LANGUAGE AND FINDING THE RIGHT LANGUAGE AND I WORK MOSTLY IN THE MATERNAL HEALTH FIELD AND SOMETIMES YOU SAY PREGNANT INDIVIDUALS INSTEAD OF THE WORD WOMEN AND WORKING WITH YOUNGER COLLEAGUES OR STUDENTS I DON'T KNOW IF I SHOULD PROVIDE THEM TO SAY WOMEN OR IF IT'S STILL OKAY TO SAY WOMEN. THERE'S A MATTER OF EVIDENCE AND POLITICAL CORRECTNESS. IT'S A GRAY AREA. IT WOULD BE WONDERFUL TO REACH CONCERNS WHETHER IT'S PART OF THE CONCERNS OR OTHERWISE AND WOULD APPRECIATE LOOKING INTO THE PAPER. >> AND YOU MENTIONED SOMETHING. AS SCIENTISTS WE'RE MOTIVATED BY EVIDENCE AND DATA AND I THINK WE'LL BE IN THE RIGHT PLACE AND THAT'S WHAT WE'RE ABOUT. WE WANT TO BE AS INCLUSIVE AS POSSIBLE AND NIH HAS TAKEN SIGNIFICANT STEPS FORWARD IN TRYING TO ADDRESS THE STRUCTURAL RACISM AND DISCRIMINATION AND THE LONG STANDING CONSEQUENCES OF THOSE FORCES AND THE IMPACT AT EVERY LEVEL. THANK YOU FOR THE GREAT DISCUSSION. SOUNDS LIKE WE'LL HAVE MORE AND I BELIEVE COMMENTS IN THE CHAT AND DR. HOLGREN HAS AN ISSUE. >> I WANTED TO ANNOUNCE SOMETHING THAT MAY BE OF INTEREST TO THE FOLKS HERAL THE ANNUAL MEETING OF THE NATIONAL ACADEMY OF SCIENCES THERE'LL BE A LOT OF COVID PRESENTATIONS AVAILABLE TO THE PUBLIC AND PRESIDENT BIDEN WILL SPEAK TO THE ACADEMY APRIL 25 IF ANYONE IS INTERESTED. AND WE WILL >> OTHER THOUGHTS OR COMMENTS OR FEEDBACK ON THE ITEMS YOU HEARD ABOUT IN TODAY'S PRESENTATION. >> I WANT TO CIRCLE BACK TO HOW TO ENGAGE GENERAL EDITORS. I DO A LOT OF TRAINING ON THE CHAMPION MODEL AND I THINK NIH IS A GREAT MODEL AND IF YOU CAN ENGAGE SOME EDITORS. THE LAN SET IS TRYING TO DO -- LANCET IS TRYING TO DO BETTER AND JAMA AND MANY JOURNALS ARE INCREASING THEIR AWARENESS OF THE IMPORTANCE OF PRESENTING DATA BY SEX AND GENDER AND RACE A A ENGAGING THEM AND SEEING COLIN FRANCIS AS A MODEL COULD HAVE A BIG IMPACT AND A WAY TO CHANGE THINGS. IT'S NOT JUST NIH'S RESPONSIBILITY. I THINK THE OTHER FEDERAL AGENCIES SHOULD ALSO ENGAGE IN THIS. THERE'S THE FDA AND HRSA AND CDC AND THE WHOLE GROUP. IT SOUNDS LIKE A BIG INITIATIVE BUT I THINK IF YOU GET A COUPLE KEY PLAYERS A GROUP OF KEY LEADING EDITORS TO LEAD THE WAY, THEY COULD BE THE ONES TO TAKE THIS OVER. >> JUST SOME THOUGHTS. >> AND AFTER WE WROTE THE PIECE IN JAMA THEY CHANGED THEIR INSTRUCTIONS TO AUTHORS AND OTHER JOURNALS HAVE FOLLOWED UP AND SAID WE'RE GOING TO CHANGE OUR INSTRUCTIONS WOULD YOU MIND TAKING A LOOK AND WE'VE SEEN PROGRESS AND THE GUIDELINES HAVE BEEN OUT FOR MANY YEARS AT THIS POINT. WE'RE SEEING SOME UPTAKE BUT THERE'S SO MANY JOURNALS OUT THERE. YOUR APPROACH SOUNDS VERY STRATEGIC. ONE OTHER ONE I'D LOVE YOUR FEEDBACK ON IS NEARLY ALL SCIENTIFIC ASSOCIATIONS AND ORGANIZATIONS ARE AFFILIATED WITH SOME JOURNALS. GOING THE ROUTE THROUGH THE SOCIETY TO THE JOURNAL EDITOR OR PUBLISHER IS ANOTHER APPROACH WE'VE USED. I DON'T KNOW IF FOLKS ON THE ADVISORY COMMITTEE ARE ELECTED OFFICIALS OR ON BOARD. >> AND GOING TO THE BIG PUBLISHERS AS THE NIH AS LEADERSHIP AT NIH WITH THE SABV POLICY AND OTHER POLICIES YOU HAVE, IT CAN COME FROM THE TOP DOWN AS WELL AS THE BOTTOM UP. >> THEY'VE MADE LARGE CHANGES AS YOU SAID. ARE THERE THOUGHTS ABOUT THIS? FEEDBACK ON THE FORMAT OF THE MEETINGS. THOUGHTS ON THAT WE HEARD TODAY? WE ALWAYS WELCOME YOUR FEEDBACK OR ITEMS YOU'D LIKE TO SEE AT FUTURE MEETINGS. >> I THINK WHEN WE MEET IN PERSON IT'S SO POWERFUL WHEN WE'RE TOGETHER AS A GROUP. >> I HOPE SO. >> WHEN DO YOU THINK YOU'LL KNOW? >> ALL THE MAY COUNCILS WILL BE VIRTUAL. I SUSPECT IN ANOTHER TWO MONTHS OR SO WE'LL MAKE DECISIONS FOR THE FALL COUNCILS. WE'RE HOPEFUL AND PLANNING FOR BOTH. OTHER COMMENTS OR QUESTIONS FROM ANY COMMITTEE MEMBERS ON ANY TOPICS? >> I ALWAYS SAY THIS AND THERE WERE GREAT PRESENTATIONS WHERE I DIDN'T FEEL WE HAD ADEQUATE TIME FOR QUESTIONS AND DISCUSSION. ONE POSSIBILITY IS FEWER PRESENTATIONS OR SHORTER PRESENTATIONS AND MORE TIME FOR DISCUSSION. >> I APPRECIATE THE FEEDBACK. WE'VE INCREASED THE DISCUSSION TIME INCREASINGLY OVER THE YEARS BUT I SEE WE NEED DISCUSSION TIME AFTER THE PRESENTATION. IT'S CHALLENGING TO SHORTEN THE PRESENTATIONS, AS YOU KNOW, BUT THE DISCUSSION TIME I HEAR YOU. AND THE WERE GREAT PRESENTATIONS. THAT MAKES IT SO PEOPLE WANT THE OPPORTUNITY TO HAVE QUESTIONS. SO YOU KNOW, IF YOU HAVE QUESTIONS OR COMMENTS ABOUT ANY OF THE PRESENTATIONS FROM TODAY, FEEL FREE TO SEND THEM TO US AND WE'LL GET THEM TO THE SPEAKERS FOR YOU. IF THERE'S A BURNING QUESTION OR PIECE OF FEEDBACK YOU WANTED TO PROVIDE, PLEASE SEND OUT TO US. DR. LANGER. >> I REMEMBERED AN EARLY QUESTION I WAS MEANING TO ASK. YOU HAVE THESE WONDERFUL EDUCATIONAL RESOURCES THAT YOU DEVELOPED OVER THE YEARS AND ARE EXCELLENT AND WONDER IF IT COULD BE A REQUIREMENT LIKE PEOPLE SUBMITTING A PROPOSAL FOR A GRANT OR MAYBE THROUGH SOME OTHER MECHANISM TO BE ABLE TO BE MORE PROACTIVE IN TERMS OF MAKING PEOPLE TAKE SOME OF THOSE COURSES AND IF THAT'S POSSIBLE. MAYBE IT GOES AGAINST THE RULES. I WANT TO MAKE SURE WHAT YOU'RE CLEARLY DESCRIBING IN THE MATERIALS. >> WE'RE ALWAYS TRYING TO BALANCE OUT ADMINISTRATIVE BURDEN AND THINGS WE ASK PEOPLE TO DO AS PART OF THEIR INTERACTIONS WITH US BUT WE SPENT A SIGNIFICANT AMOUNT TIME AND EFFORT TO DEVELOP THESE RESOURCES WITH OUR PARTNERS AND WITH MANY WHO PARTICIPATED IN SOME OF THEM. THAT WAS A RESPONSE TO FEEDBACK WE GOT FROM THE COMMUNITY THAT THESE WERE NEEDED. SO NOW THAT THEY'RE AVAILABLE, WE WILL BE WORKING THROUGH ONE OF THE BEST WAYS TO DISSEMINATE THEM AND TO IMPLEMENT THEM. IT CAN TRY TO PUT IN PLACE REQUIREMENTS OR ARE THERE WAYS TO DO CARROTS AND STICKS TOGETHER. HOW CAN WE INCENTIVIZE USE OF HOME TO AND WE WOULD WELCOME YOUR FEEDBACK AND THOUGHTS ON THAT. THE INTERPROFESSIONAL PAGE IS DEVELOPED AND WE THINK OF YOU AS SEX AND GENDER AMBASSADORS FOR ORWH AND SHARING THE INFORMATION WITH YOUR STAKEHOLDERS IS IMPORTANCE TO US AS WELL. I HEAR YOU. THANK YOU. OTHER THOUGHTS? AND THERE'S A COUPLE FOLKS WE HAVEN'T HEARD FROM AND WANT TO MAKE SURE YOU CAN COMMENT OR ASK A QUESTION IF YOU HAD NOT HAD A CHANCE TO DO SO AND LET ME MAKE SURE THE FOLKS WHO HAVE NOT HAD A CHANCE HAVE TIME TO RAISE POINTS YOU'D LIKE TO RAISE. >> I HAVE BEEN IN AND OUT AND HAD A BIG RESIDENCY DAY TODAY BUT ENJOYED HEARING THE TALKS WHEN THEY WENT INTO THE FEMALE ADOLESCENTS AND PEDIATRIC AGE. I'M COMING TO THE END OF MY TERM OR I'D VOLUNTEER TO BE PART OF YOUR PROJECTS BUT FOR THE FUTURE I THINK THERE'S SO MUCH OUT THERE WE CAN BRING INTO THE GROUP TO GET FOCUS ON TEEN AGE GIRLS AND EVEN BEFORE. WE TALKED ABOUT GETTING BACK IN AGE. I WANTED TO PUT IN MY TWO CENTS I ENJOYED HEARING MORE ABOUT THAT TODAY AND HOPE THAT'S SOMETHING THERE CAN BE FOCUS ON INCLUDING IN THE MEETING. >> THAT'S VERY HELPFUL. I APPRECIATE IT AND WE UNDERSTAND. IT'S GREAT YOU'RE HAVING RESIDENT DAY THERE. IT'S CHALLENGING TO KEEP THOSE KINDS OF ACTIVITIES GOING NOW. WE APPRECIATE THE FEEDBACK. THANKS SO MUCH. DR. TEMPLETON. >> ONE, I LOVE THE DISCUSSION ABOUT THE ISSUES WITH PUBLISHING. WE'VE DISCUSSED THAT PREVIOUSLY. MAYBE A DISCUSSION AT FUTURE MEETINGS ON TRANSLATION OF RESEARCH TO PATIENT CARE MEANING EDUCATION BECAUSE EDUCATION IS A HUGE GAP. WE NEED THE RESEARCH BUT NO MATTER HOW GOOD THE RESEARCH IS STUDENTS AT WHATEVER HEALTH CARE PROFESSION AREN'T BEING TAUGHT THIS THEY WON'T IMPLEMENT IT IN PRACTICE AND MAYBE DISCUSSION WHERE THE GAPS ARE IN SEX AND GENDER EDUCATION. AND MAYBE THIS IS A DIFFERENT PART OF THE NIH IS THERE DISCUSSION LOOKING AT THE LGBTQ COMMUNITIES AND HEALTH CARE DISPARITIES IN THAT COMMUNITY AND PERHAPS ENHANCE RESEARCH IN THAT. >> THERE'S THE SEXUAL GENDER MINORITY RESEARCH OFFICE AHEADED UP BY DR. PARKER AND THAT'S ONE OF OUR OFFICES IN THE DIVISION. WE HAVE SUPPORTED SOME OF THEIR ADMINISTRATIVE EFFORTS AND SOME OF THEIR PROGRAMS ARE MODELLED AFTER OURS. THEY LEAD THE NIH WIDE STRATEGIC PLAN FOR MINORITY RESEARCH AND IT'S A SMALL OFFICE BUT GROWING. THANK YOU FOR HIGHLIGHTING IF FOLKS ARE NOT EDUCATED, NEW HEALTH CARE PROFESSIONALS OF THE FUTURE ON THESE ISSUES, IT FEELS LIKE WE'RE PLAYING CATCH UP ALL THE TIME IN TRYING TO RETROFIT THINGS VERSUS BUILDING THEM THE WAY THEY'RE SUPPOSED TO BE FROM THE BEGINNING. SYSTEMS PERSPECTIVES AND INTEGRATING AND BUILDING THE PERSPECTIVES. IDEAS ON THAT AND BY THE WAY, THE VIVIAN PINN SYMPOSIUM WILL LOOK AT THESE ISSUES AND I'M LOOKING FORWARD TO HEAR FROM DIFFERENT SECTORS AND THE ECONOMIC IMPACT OF NOT DOING ENOUGH WOMEN'S HEALTH RESEARCH OR DISAGGREGATING THE DATA BY SEX AND WHAT DO WE GAIN WHEN WE HAVE MODEST INVESTMENTS AND WHAT DO WE GAIN BY THOSE. THANK YOU. OTHER QUESTIONS, COMMENTS, FEEDBACK. >> THANK YOU. WHAT AN EXTRAORDINARY DAY. THE BREADTH AND DEPTH OF THE DISCUSSIONS AND TOPICS TOUCH BY THIS GROUP HAVE ME BREATHLESS. I'M GRATEFUL TO BE PART OF THIS. I WANTED TO THINK THROUGH THE USE OF LANGUAGE. I TREAT BREAST CANCER AND DON'T THINK BREASTS AS GENDERED ORGAN AND MEN ALSO HAVE BREAST CANCER BUT I USED THE WORD BREAST FEEDING IN SPEAKING ABOUT WOMEN IN MEDICINE AND ISSUED RELATED TO GENDER EQUITY AND CORRECTED BY A MEMBER OF THE TRANSCOMMUNITY THAT THAT'S AN ALIENATING TERM AND SHOULD USE CHEST FEEDING AND CONTINUE TO EVOLVE TO BE MAXIMALLY INCLUSIVE AS WE ADDRESS THESE ISSUES. I'M GRATEFUL THIS GROUP IS ACTUALLY GOING TO BE GIVING THOUGHT TO WHAT LANGUAGE TO USE BECAUSE IT IS SO IMPORTANT AND WE ALL NEED TO LEARN. >> GLAD TO HAVE YOU ON BOARD AND THE CAREER FOCUS ISSUED YOU PUBLISH EXTENSIVELY ON ARE SO IMPORTANT. I AM VERY CONCERNED ABOUT THE FUTURE OF WOMEN SCIENTIST AND WOMEN PHYSICIAN AND CLINICIAN SCIENTISTS AND EARLY CAREER AND MID-CAREER SCIENTISTS ALL THE ABOVE. WOMEN HEALTH CARE PROVIDERS ARE FACING INCREDIBLE CHALLENGE AND I'M CHOOSING TO LOOK AT THIS MOMENT AS AN OPPORTUNITY TO IMPROVE THE SYSTEM AND WE KNOW THERE'S A RISK OF LOSING WHAT WAS HEARD FOUGHT IN TERMS OF GENDER EQUITY. WE'RE TAKING THE MOMENT AND WORKING WITH ALL OF YOU MOVING INTO THE NEXT YEAR AND ALL WOMEN REACH THEIR FULL POTENTIAL. THE POST-IT SAYS 18% OF HOSPITAL CEOs ARE WOMEN. 16% OF MEDICAL SCHOOL DEAN AND CHAIRS ARE WOMEN AND 16% OF EDITORS IN CHIEF ARE WOMEN AND IN TERMS OF UNDER REPRESENTED IN MEDICINE WOMEN FACULTY THE NUMBER HAS NOT CHANGED. IT WAS 12% IN 2009 AND 13% NOW AND MOST WOMEN OF COLOR IN FACULTY POSITIONS ARE AT THE INSTRUCTOR OR ASSISTANT LEVEL. THIS IS BEFORE COVID. I'M ENCOURAGED BY HAVING AMAZING FOLKS ON THIS ADVISORY COMMITTEE AND KNOW YOU'RE WILLING TO ROLL UP YOUR SLEEVES AND MEET THE CHALLENGES AND PICKING WHAT WE'LL PRIORITIZE TO WORK ON FIRST. IT'S NOT JUST WHAT WE'LL WORK ON BUT WHAT WE'LL WORK ON FIRST. WE NEED TO THINK STRATEGICALLY AND LOOKING FORWARD TO INPUT ON EVERY ONE OF YOU. YOU'LL MAKE US BETTER. THANK YOU VERY MUCH. THANKS FOR GETTING THE WORD IN AT THE END. I APPRECIATE IT. WE'RE WOUNDING OUT THE END AND DO WE HAVE OTHER COMMENTS FROM EARLIER TODAY YOU THINK WE CAN BRING BACK AROUND OR ANYTHING ELSE YOU THINK WE NEED TO ADDRESS AS WE'RE COMING TO OUR CLOSE? >> I DON'T SEE COMMENTS. I WOULD LIKE TO GIVE ANNOUNCEMENT BEFORE WE WRAP UP. >> OKAY. BEFORE WE DO THAT LAST MINUTE COMMENTS? >> DR. TEMPLETON MADE AN INTERESTING COMMENT THIS MORNING TALKING ABOUT THE DATA ON THE IMPACT OF THE DATA PANDEMIC ON THE HEALTH CARE OFFICIALS. >> DO YOU WANT TO ELABORATE ON YOUR POINT WHEN DR. GORDON WAS SPEAKING? >> SURE, THANK YOU. DOES THE DATA LOOK AT HEALTH CARE PROFESSIONALS OUTCOME BASED ON THEIR PROFESSION OR BASED ON THEIR GENDER WITHOUT LOOKING AT PROFESSIONALS? IF IT'S CHALLENGING AND WE'RE GOING TO DEVELOP INTERVENTIONS BECAUSE WITH THE DATA HE SHOWED AND THAT'S THE BEST DATA OUT THERE WILL SHOW MID LEVEL PROVIDERS AND NURSES HAVE THE HIGHEST RATE OF ANXIETY AND DEPRESSION DURING THE PANDEMIC. THERE'S ALSO A HIGHER PROPORTION OF WOMEN. SO DO THEY HAVE MORE ISSUES BECAUSE THEY'RE FRONT LINE HEALTH CARE WORKERS OR MORE BECAUSE THEY'RE WOMEN AND THEY HAVE A HIGHER RATE OF ANXIETY AND DEPRESSION ANYWAY. THAT'S A PROBLEM. WE'RE TRYING TO DEVELOP INTERVENTIONS AND PREVENTION INITIATIVES SO DO YOU BASE THOSE ON SOMEONE'S JOB NO MATTER THE GENDER OR BASE IT ON THEIR GENDER NO MATTER WHAT THEIR ROLE IS? FOR THOSE LOOKING AT THE DATA IF WE CAN DO DISAGGREGATION TO HAVE A MORE TARGETED INITIATIVE. >> AND TO LOOK AT THE EFFECTS SEPARATELY AND INTERACTIONS BETWEEN THOSE VARIABLES. THANK YOU FOR BRINGING THAT US. -- BRINGING THAT UP. I'M WONDERING IF OUR NURSING COLLEAGUES ARE THINKING ABOUT THESE ISSUES IN THAT WAY. COLLEAGUES HAVE A NEW DIRECTOR. THANKS FOR BRINGING THAT UP. >> DR. NOURSI, OVER TO YOU FOR ANNOUNCEMENTS BEFORE WE ADJOURN. >> I WOULD ASK YOU PLEASE LOOK FOR FOLLOW-UP E-MAILS FROM US. IN ADDITION TO THE MONTHLY E-MAIL I SENT AT THE BEGINNING, I WILL PROBABLY BE COMMUNICATING WITH YOU TO FOLLOW-UP ON THE DISCUSSION REGARDING THE WORKING GROUP. THAT WOULD BE THE MOST PRESSING ONE. WE ARE DONE WITH THE BIENNIAL REPORT. WE'RE FINALIZING THE REPORT BUT THE WORKING GROUP FOR THE CENSUS CONFERENCE IS THE NEXT STEP. I APPRECIATE YOU LOOKING FOR THOSE E-MAILS AND RESPONDING TO GET THE FIRST MEETING TOGETHERED FOR NEXT MONTH. AND I WOULD LIKE TO THANK THE WORKING GROUP WHO WORKED WITH US ON IMPLEMENTING AND EVALUATING THE STRATEGIC PLAN. THAT WAS THE PREVIOUS WORKING GROUP. I WOULD LIKE TO THANK YOU ALL. I SENT YOU AN E-MAIL WITH THE GUIDE RECENTLY AND THAT IS THE FINAL PRODUCT THAT NOW WE ARE SHARING WITH THE INSTITUTE AND OFFICES AND CENTERS ACROSS NIH TO TAKE THE TRANS-NIH STRATEGIC PLAN AND TRY TO IMPLEMENT IT IN THEIR I.C.s TO BE ALIGNED WITH SUBMISSION. THANK YOU AGAIN FOR YOUR CONTRIBUTION. THAT WAS A ONE-YEAR COMMITMENT ON YOUR PART SO THANK YOU VERY MUCH. IT'S THE FIRST TIME THIS IS PLANNED AND KEEP YOU POSTED WHERE THINGS ARE GOING WITH IT. THAT'S IT FOR ME. >> I HAVE ONE ANNOUNCEMENT TO MAKE BEFORE WE ADJOURN. WE WANT TO WELCOME DR. TEMKIN. SHE'S A GYNECOLOGIC ONCOLOGIST AND HAS AN INTEREST IN HEALTH EQUITY AS WELL. WE'RE DELIGHTED TO WELCOME TO ORWH AND KNOW YOU'LL HEAR FROM HER SOON. IN ADDITION TO THANKING ALL OF YOU I WANT TO THANK EVERYONE WHO WORKED ON PLANNING THE MEETING AND DR. NOURSI THE EXECUTIVE SECRETARY, SARAH HELMAN AND MICHAEL HAHN AND EVERYONE WHO GAVE PRESENTATIONS. THEY WERE AMAZING. WE HAVE THE DIVERSE VOICES IN COVID INTERSECTIONALITY AND HEALTH OF WOMEN SERIES JUNE 24 AND THE VIVIAN PINN SYMPOSIUM AND YOU'LL RECEIVE INFORMATION HOW TO REGISTER AND IN JUNE 4 THE DIVERSE VOICES AND OCTOBER 20 AND OCTOBER 21 AND THEN THE BIRCWH MEETING NOVEMBER 1 AND THANK YOU FOR THE CONTRACTORS WHO GOT US DEPLOYED VIRTUALLY AND TEAM ORWH. THEY'RE AN AMAZING GROUP OF PEOPLE. WE'VE ALL BEEN TELEWORKING A YEAR AND WE ONBOARDED PEOPLE AND HAD PEOPLE TRANSITION AND EVERY INDIVIDUAL ON TEAM ORWH IS UNITED IN THEIR COMMON COMMITMENT TO WOMEN'S HEALTH. I GET TO PRESENT THE WORK THEY DO, THANK YOU TEAM ORWH. I BELIEVE WE ARE NOW ADJOURNED. THANK YOU EVERYBODY.