1
00:00:06,546 --> 00:00:10,316
>> ALL RIGHT, I THINK IT
IS 

2
00:00:10,316 --> 00:00:11,885
10:00 RIGHT NOW SO I WANT TO 

3
00:00:11,885 --> 00:00:14,053
START ON TIME. GOOD MORNING, 

4
00:00:14,053 --> 00:00:16,956
WELCOME TO THE NATIONAL HEART 

5
00:00:16,956 --> 00:00:20,527
AND LUNG PULMONARY WORKPLACE 

6
00:00:20,527 --> 00:00:25,165
ENTITLED DISPARITY ACROSS 

7
00:00:25,165 --> 00:00:28,468
SPECTRUM OF PULMONARY DISEASE. 

8
00:00:28,468 --> 00:00:33,273
I'M DR. XIAO FOR THE PULMONARY 

9
00:00:33,273 --> 00:00:35,074
DISEASE ORGANIZING COMMITTEE 

10
00:00:35,074 --> 00:00:36,876
MEMBER FOR THIS WORKSHOP. ON 

11
00:00:36,876 --> 00:00:40,079
BE HALF OF THE WORKSHOP 

12
00:00:40,079 --> 00:00:41,414
ORGANIZATION COMMITTEE AND NHLBI

13
00:00:41,414 --> 00:00:44,317
COMMISSION I WOULD LIKE TO 

14
00:00:44,317 --> 00:00:45,852
WELCOME EVERYONE TO THIS 

15
00:00:45,852 --> 00:00:49,389
IMPORTANT NHLBI WORKSHOP 

16
00:00:49,389 --> 00:00:51,591
RESEARCHING AREAS SUCH AS 

17
00:00:51,591 --> 00:00:53,459
DISPARITIES IN PVD. I WOULD LIKE

18
00:00:53,459 --> 00:00:56,196
TO THANK EVERYONE FOR TAKING 

19
00:00:56,196 --> 00:00:58,164
YOUR PRECIOUS TIME TO 

20
00:00:58,164 --> 00:00:59,365
PARTICIPATE, ESPECIALLY FOR 

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00:00:59,365 --> 00:01:01,401
SPEAKERS AND CO-CHAIRS AND 

22
00:01:01,401 --> 00:01:02,435
EVERYONE WHO HAS SPENT MANY 

23
00:01:02,435 --> 00:01:03,670
HOURS OF THEIR PERSONAL TIME 

24
00:01:03,670 --> 00:01:06,906
WORKING ON THE PRESENTATIONS. WE

25
00:01:06,906 --> 00:01:08,474
APPRECIATE YOUR EFFORT AND 

26
00:01:08,474 --> 00:01:09,676
CONTRIBUTION TO THIS 

27
00:01:09,676 --> 00:01:12,545
WORKSHOP .ENTER ALSO I WANT A 

28
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SPECIAL THANKS TO OUR WORKSHOP 

29
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SUPPORT TEAM, ESPECIALLY JACKIE 

30
00:01:17,584 --> 00:01:24,624
AND HER SUPPORT TEAM, SHAUN, I 

31
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APPRECIATE YOUR WORK FOR SETTING

32
00:01:25,892 --> 00:01:29,629
UP THE WORKSHOP. THANK YOU, 

33
00:01:29,629 --> 00:01:32,999
JACKIE AND THE SUPPORT TEAM FOR 

34
00:01:32,999 --> 00:01:35,869
WONDERFUL JOB WELL DONE. ANOTHER

35
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IMPORTANT PEOPLE IS THE WORKSHOP

36
00:01:37,637 --> 00:01:40,740
CO -CHAIRS. I THINK MOST OF YOU 

37
00:01:40,740 --> 00:01:42,108
ALREADY KNOW THEM. TWO 

38
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CO -CHAIRS ARE DR. RISCHARD FROM

39
00:01:45,378 --> 00:01:49,616
UNIVERSITY OF ARIZONA AND ALSO 

40
00:01:49,616 --> 00:01:54,854
DR. LEOPOLD FROM BRIGHAM AND 

41
00:01:54,854 --> 00:01:57,156
HARVARD. THEY ARE THE MAIN 

42
00:01:57,156 --> 00:01:59,359
DRIVING WORKFORCE FOR THIS 

43
00:01:59,359 --> 00:02:03,229
WORKSHOP. REAL APPRECIATE YOU 

44
00:02:03,229 --> 00:02:05,231
GUYS. SO EVERYBODY HAS A CHANCE 

45
00:02:05,231 --> 00:02:07,734
TO DO A SELF-INTRODUCTION. IN 

46
00:02:07,734 --> 00:02:10,370
ORDER TO MAKE SURE WE STAY ON 

47
00:02:10,370 --> 00:02:13,373
TIME I'M ASKING EVERYONE JUST 

48
00:02:13,373 --> 00:02:15,308
TRY TO LIMIT YOUR INTRODUCTION 

49
00:02:15,308 --> 00:02:18,344
TO 15 SECONDS, AROUND THAT TIME.

50
00:02:18,344 --> 00:02:20,513
LIKE A STUDY SESSION, 

51
00:02:20,513 --> 00:02:27,987
INTRODUCTION. NAME, TITLE, 

52
00:02:27,987 --> 00:02:29,455
INSTITUTION AND YOUR RESEARCH 

53
00:02:29,455 --> 00:02:31,124
INTEREST OR CLINICAL 

54
00:02:31,124 --> 00:02:33,159
SPECIALTIES, IF APPLICABLE. ONCE

55
00:02:33,159 --> 00:02:35,228
YOUR NAME IS CALLED TURN DOWN 

56
00:02:35,228 --> 00:02:37,063
YOUR CAMERA AND MICROPHONE SO 

57
00:02:37,063 --> 00:02:39,332
YOU CAN START INTRODUCE 

58
00:02:39,332 --> 00:02:41,267
YOURSELF, OKAY. SO LET'S MOVE ON

59
00:02:41,267 --> 00:02:45,605
TO THE ROSTER. STARTING WITH THE

60
00:02:45,605 --> 00:02:50,043
TWO CO -CHAIRS, FRANZ. 

61
00:02:50,043 --> 00:02:51,644
>> HI, EVERYONE. GOOD
MORNING, 

62
00:02:51,644 --> 00:02:54,013
THANKS FOR ATTENDING. I'M AT THE

63
00:02:54,013 --> 00:02:57,083
UNIVERSITY OF ARIZONA, WHERE 

64
00:02:57,083 --> 00:02:58,418
I'VE BEEN HERE FOR ABOUT 25 

65
00:02:58,418 --> 00:03:01,621
YEARS. I'M THE DIRECTOR OF PH 

66
00:03:01,621 --> 00:03:05,058
AND ASSOCIATE DEAN OF CLINICAL 

67
00:03:05,058 --> 00:03:07,493
TRANSLATIONAL RESEARCH HERE. MY 

68
00:03:07,493 --> 00:03:13,266
RESEARCH INTERESTS LIE OUTSIDE 

69
00:03:13,266 --> 00:03:15,735
OF HEALTH DISPARITIES WITH 

70
00:03:15,735 --> 00:03:17,236
EFFECTIVE HISPANIC HEALTH 

71
00:03:17,236 --> 00:03:19,639
DISPARITIES, GIVEN OUR LOCATION 

72
00:03:19,639 --> 00:03:22,475
AND RV FUNCTION, COUPLING AND 

73
00:03:22,475 --> 00:03:24,610
EXERCISE PHYSIOLOGY. THANKS 

74
00:03:24,610 --> 00:03:25,311
AGAIN. 

75
00:03:25,311 --> 00:03:28,648
>> THANKS, FRANZ. JANE. 

76
00:03:28,648 --> 00:03:36,222
>> HI. I'M JANE LEOPOLD AT

77
00:03:36,222 --> 00:03:38,925
BRIGHAM, HARVARD. 20 YEARS OR SO

78
00:03:38,925 --> 00:03:41,661
HERE, A CARDIOLOGIST WITH 

79
00:03:41,661 --> 00:03:43,062
INTEREST IN PRECISION 

80
00:03:43,062 --> 00:03:46,199
PHENOTYPING WHICH HAS NOW 

81
00:03:46,199 --> 00:03:52,605
EXTENDED TO INCLUDE DISPARITIES 

82
00:03:52,605 --> 00:03:53,172
AND SOCIAL DETERMINANTS OF 

83
00:03:53,172 --> 00:03:55,108
HEALTH AS THEY AFFECT CLINICAL 

84
00:03:55,108 --> 00:03:56,709
PHENOTYPING. SO I WANT TO THANK 

85
00:03:56,709 --> 00:03:58,578
EVERYONE FOR ALL OF YOUR EFFORTS

86
00:03:58,578 --> 00:04:00,313
YOU PUT INTO THIS AND WELCOME 

87
00:04:00,313 --> 00:04:01,514
YOU TO THIS GREAT WORKSHOP. 

88
00:04:01,514 --> 00:04:04,884
>> THANK YOU, JANE. NOW
LET'S 

89
00:04:04,884 --> 00:04:08,755
INTRODUCE THE WORKSHOP SPEAKERS.

90
00:04:08,755 --> 00:04:12,992
THOSE ARE THE NHLBI SPEAKERS. WE

91
00:04:12,992 --> 00:04:14,360
WILL START WITH DR. GOEL. 

92
00:04:14,360 --> 00:04:17,797
>> HI, EVERYONE. MY NAME
IS 

93
00:04:17,797 --> 00:04:18,931
KHUSHBOO GOEL, ASSISTANT 

94
00:04:18,931 --> 00:04:21,034
PROFESSOR OF MEDICINE AT 

95
00:04:21,034 --> 00:04:22,402
CEDARS-SINAI AND INTERESTS 

96
00:04:22,402 --> 00:04:25,638
INCLUDE IDENTIFYING MECHANISMS 

97
00:04:25,638 --> 00:04:34,547
OF PULMONARY MODELLING IN THIS 

98
00:04:34,547 --> 00:04:37,550
ANDER DISPARITIES AND IMPROVING 

99
00:04:37,550 --> 00:04:38,718
ACCESS TO CARE. 

100
00:04:38,718 --> 00:04:40,353
>> SORRY IF I MESSED UP
THE 

101
00:04:40,353 --> 00:04:40,586
NAME. 

102
00:04:40,586 --> 00:04:41,421
>> NOT AT ALL. 

103
00:04:41,421 --> 00:04:42,855
>> CORRECT ME, I THINK I
RUN 

104
00:04:42,855 --> 00:04:48,461
INTO THE SAME THING. THE NEXT IS

105
00:04:48,461 --> 00:04:54,834
DR. ESTRADA. 

106
00:04:54,834 --> 00:04:59,305
>> GOOD MORNING, I'M
RODOLFO 

107
00:04:59,305 --> 00:05:02,675
FROM SAN STOANTONIO AND MY INTET

108
00:05:02,675 --> 00:05:05,144
LIES IN HISPANICS AS WELL. VERY 

109
00:05:05,144 --> 00:05:06,846
EXCITED TO BE PART OF THIS 

110
00:05:06,846 --> 00:05:08,448
WORKSHOP, THANK YOU. 

111
00:05:08,448 --> 00:05:14,654
>> NEXT, DR. SAHAY. 

112
00:05:14,654 --> 00:05:17,857
>> GOOD MORNING, SANDEEP
SAHAY. 

113
00:05:17,857 --> 00:05:18,925
I HOPE TO -- 

114
00:05:18,925 --> 00:05:20,760
>> TURN ON THE CAMERA. 

115
00:05:20,760 --> 00:05:22,662
>> I DID. CAN YOU SEE ME? 

116
00:05:22,662 --> 00:05:24,430
>> HERE NOW I CAN SEE. 

117
00:05:24,430 --> 00:05:26,265
>> OKAY. GOOD MORNING,
EVERYONE.

118
00:05:26,265 --> 00:05:28,434
THANK YOU FOR THE KIND 

119
00:05:28,434 --> 00:05:29,735
INVITATION. I'M SANDEEP SAHAY, 

120
00:05:29,735 --> 00:05:33,439
DR. OF PH PROGRAM AT HOUSTON AT 

121
00:05:33,439 --> 00:05:35,374
METHODIST, HOUSTON, TEXAS. MY 

122
00:05:35,374 --> 00:05:39,045
CLINICAL INTEREST, OF COURSE I'M

123
00:05:39,045 --> 00:05:41,581
CLINICIAN AND MAINLY IN CLINICAL

124
00:05:41,581 --> 00:05:43,616
TRIALS IN HYPERTENSION. I THINK 

125
00:05:43,616 --> 00:05:46,986
THAT IS WHERE I NOTICE 

126
00:05:46,986 --> 00:05:50,356
SIGNIFICANT DISPARITY OF THE 

127
00:05:50,356 --> 00:05:53,426
PATIENT POPULATION, CLINICAL 

128
00:05:53,426 --> 00:05:55,294
TRIALS. THAT DRIVES MY INTEREST 

129
00:05:55,294 --> 00:05:57,096
IN THIS TOPIC. I'M HAPPY TO BE 

130
00:05:57,096 --> 00:06:00,566
HERE AND PARTICIPATE IN THIS 

131
00:06:00,566 --> 00:06:03,402
WORKS

132
00:06:03,402 --> 00:06:03,703
WORKSHOP. 

133
00:06:03,703 --> 00:06:08,841
>> HELLO, MY NAME IS
HEATHER 

134
00:06:08,841 --> 00:06:13,613
STRAH, ASSOCIATE PROFESSOR OF 

135
00:06:13,613 --> 00:06:14,313
MEDICINE UNIVERSITY OF NEBRASKA 

136
00:06:14,313 --> 00:06:16,916
AND MEDICAL DIRECTOR LUNG 

137
00:06:16,916 --> 00:06:18,784
TRANSPLANT RESEARCH. MY INTEREST

138
00:06:18,784 --> 00:06:22,822
IS PULMONARY MECHANICS IN 

139
00:06:22,822 --> 00:06:23,589
TRANSGENDER INDIVIDUALS. 

140
00:06:23,589 --> 00:06:31,531
>> THANK YOU, NEXT ONE,
DR. 

141
00:06:31,531 --> 00:06:32,031
EGHB

142
00:06:32,031 --> 00:06:32,298
EGHBALI. 

143
00:06:32,298 --> 00:06:35,801
>> THANK YOU, MY NAME IS 

144
00:06:35,801 --> 00:06:43,009
MANSOUREH EGHBALI AT UNIVERSITY 

145
00:06:43,009 --> 00:06:45,378
OF CALIFORNIA AND MY INTEREST IS

146
00:06:45,378 --> 00:06:47,146
(?) AND SEX DIFFERENCE, IN 

147
00:06:47,146 --> 00:06:50,750
PARTICULAR ROLE OF ESTROGEN AND 

148
00:06:50,750 --> 00:06:52,985
SEX CHROMOSOME, THANK YOU. 

149
00:06:52,985 --> 00:06:59,825
>> THANK YOU, NEXT IS DR.
COREY 

150
00:06:59,825 --> 00:07:00,159
VENTETUOLO. 

151
00:07:00,159 --> 00:07:03,396
>> I'M COREY VENTETUOLO, 

152
00:07:03,396 --> 00:07:05,765
PROFESSOR AT BROWN UNIVERSITY. 

153
00:07:05,765 --> 00:07:08,100
MY INTERESTS ARE IN SEXUAL 

154
00:07:08,100 --> 00:07:14,440
INTERESTS IN DIMORPHISM AND 

155
00:07:14,440 --> 00:07:14,941
HYPERTENSION. 

156
00:07:14,941 --> 00:07:17,543
>> I APOLOGIZE FOR YOUR
NAME, A 

157
00:07:17,543 --> 00:07:20,613
TYPO ON THE SLIDE. I OVERLOOKED 

158
00:07:20,613 --> 00:07:27,753
THAT. THE NEXT IS DR. BERNARDO. 

159
00:07:27,753 --> 00:07:35,962
>> GOOD MORNING, BERNARDO
(LOW 

160
00:07:35,962 --> 00:07:39,298
AUDIO) 

161
00:07:39,298 --> 00:07:39,599
    

162
00:07:39,599 --> 00:07:43,269
>> ALL RIGHT, THANK YOU.
NEXT 

163
00:07:43,269 --> 00:07:53,746
ONE IS DR. VINIVIO PEREZ, A 

164
00:08:01,187 --> 00:08:03,522
TYPO, I APOLOGIZE FOR THAT. YOU 

165
00:08:03,522 --> 00:08:04,957
THERE? PROBABLY STILL TOO EARLY 

166
00:08:04,957 --> 00:08:07,827
FOR HIM. THIS IS WEST COAST. SO 

167
00:08:07,827 --> 00:08:12,632
LET'S MOVE ON TO THE NEXT 

168
00:08:12,632 --> 00:08:18,771
SPEAKER. DR. BRITTAIN? 

169
00:08:18,771 --> 00:08:20,539
>> GOOD MORNING, I'M A 

170
00:08:20,539 --> 00:08:23,175
CARDIOLOGIST. I STUDY THE 

171
00:08:23,175 --> 00:08:26,245
MECHANISMS OF THIS INCLUDING THE

172
00:08:26,245 --> 00:08:27,747
VETERAN'S AFFAIRS SYSTEM. 

173
00:08:27,747 --> 00:08:37,657
>> THANK YOU, EVAN. DR.
GOLD. 

174
00:08:37,657 --> 00:08:41,894
DR. RACHEL GOLD, ARE YOU THERE? 

175
00:08:41,894 --> 00:08:46,832
ALL RIGHT. IT IS ALSO WEST 

176
00:08:46,832 --> 00:08:49,735
COAST. LET'S MOVE ON TO THE NEXT

177
00:08:49,735 --> 00:08:51,737
ONE. DR. MARON. I BELIEVE YOU 

178
00:08:51,737 --> 00:08:54,740
ARE HERE ON THE EAST COAST. 

179
00:08:54,740 --> 00:08:59,979
>> HEY, EVERYONE, BRAD
MARON, 

180
00:08:59,979 --> 00:09:01,280
PROFESSOR OF MEDICINE MARYLAND 

181
00:09:01,280 --> 00:09:03,149
AND EXECUTIVE CO -DIRECTOR FOR 

182
00:09:03,149 --> 00:09:04,784
INSTITUTE FOR HEALTH COMPUTING 

183
00:09:04,784 --> 00:09:09,588
HERE. I HAVE A BASIC AND 

184
00:09:09,588 --> 00:09:15,428
TRANSLATIONAL INTEREST IN 

185
00:09:15,428 --> 00:09:17,029
PULMONARY VASCULAR DISEASE AND 

186
00:09:17,029 --> 00:09:18,831
HEALTH DISPARITIES IN POPULATION

187
00:09:18,831 --> 00:09:19,165
HEALTH. 

188
00:09:19,165 --> 00:09:23,302
>> THANK YOU, BRAD. NEXT
ONE, 

189
00:09:23,302 --> 00:09:33,412
DR. LIM. IS DR. LIM HERE? I KNOW

190
00:09:33,412 --> 00:09:35,147
HE FAMILY LEAVE NOW, BUT THAT IS

191
00:09:35,147 --> 00:09:42,421
OKAY. THE NEXT SPEAKER, DR. 

192
00:09:42,421 --> 00:09:47,526
MATHAI. HE HERE? ALL RIGHT. SO 

193
00:09:47,526 --> 00:09:49,762
NOT YET. DR. DESAI. 

194
00:09:49,762 --> 00:09:52,598
>> THANK YOU, WELCOME,
EVERYONE.

195
00:09:52,598 --> 00:09:55,134
PROFESSOR OF MEDICINE AT INDIANA

196
00:09:55,134 --> 00:09:58,771
UNIVERSITY AND CARDIOLOGIST. 

197
00:09:58,771 --> 00:10:01,707
RELATED TO THIS CONFERENCE I 

198
00:10:01,707 --> 00:10:04,810
(AUDIO INTERRUPTION) 

199
00:10:04,810 --> 00:10:08,914
>> THANK YOU, ANKIT. DR.
ORTEGA.

200
00:10:08,914 --> 00:10:13,652
>> I'M PROFESSOR OF
MEDICINE AT 

201
00:10:13,652 --> 00:10:16,455
THE MAYO CLINIC, PULL MONDAY OL 

202
00:10:16,455 --> 00:10:20,626
GIST AND EPIDEMIOLOGIST AND LEAD

203
00:10:20,626 --> 00:10:23,229
STUDIES FOR DIFFERENT NHLBI 

204
00:10:23,229 --> 00:10:24,530
NETWORKS BASED ON RARE AND 

205
00:10:24,530 --> 00:10:26,599
COMMON AIRWAY DISEASES WITH A 

206
00:10:26,599 --> 00:10:29,535
FOCUS ON ANCESTRAL DIVERSITY AND

207
00:10:29,535 --> 00:10:34,507
RARE VARIANTS AND POLYGENIC RISK

208
00:10:34,507 --> 00:10:37,243
SCORES AND ONE OF DIRECTORS OF 

209
00:10:37,243 --> 00:10:40,379
CENTERS FOR CENTER OF MEDICINE 

210
00:10:40,379 --> 00:10:42,248
AND RARE UNDIAGNOSED DISEASES 

211
00:10:42,248 --> 00:10:44,984
AND RISK IMPLEMENTATION. 

212
00:10:44,984 --> 00:10:50,890
>> THANK YOU. NEXT SPEAKER
IS 

213
00:10:50,890 --> 00:10:56,729
DR. GLENN. IS DR. GLENN HERE? IF

214
00:10:56,729 --> 00:11:01,400
NOT LET'S MOVE ON TO THE NEXT 

215
00:11:01,400 --> 00:11:03,436
SPEAKER. DR. HEMNES. 

216
00:11:03,436 --> 00:11:07,506
>> GOOD MORNING, ANNA
HEMNES, 

217
00:11:07,506 --> 00:11:08,307
PROFESSOR OF MEDICINE AT 

218
00:11:08,307 --> 00:11:09,575
VANDERBILT SCHOOL OF MEDICINE. 

219
00:11:09,575 --> 00:11:11,777
I'M INTERESTED BROADLY IN HOW 

220
00:11:11,777 --> 00:11:16,048
SEX HORMONES MODIFY PULMONARY 

221
00:11:16,048 --> 00:11:17,416
VASCULAR DISEASE AND RIGHT HEART

222
00:11:17,416 --> 00:11:18,184
RESPONSES. 

223
00:11:18,184 --> 00:11:21,020
>> THANK YOU, ANNA. THE
NEXT 

224
00:11:21,020 --> 00:11:23,389
SPEAKER IS DR. HORN. 

225
00:11:23,389 --> 00:11:27,226
>> GOOD MORNING,
EVERYBODY. 

226
00:11:27,226 --> 00:11:29,161
EVELYN HORN AT CORNELL AS 

227
00:11:29,161 --> 00:11:31,397
PROFESSOR OF MEDICINE AND 

228
00:11:31,397 --> 00:11:33,199
ADVANCE THE DEPARTMENT OF CARD 

229
00:11:33,199 --> 00:11:38,971
VALLECULAR DISEASE AND REALIZE 

230
00:11:38,971 --> 00:11:40,739
-- CARDIOVASCULAR DISEASE AND 

231
00:11:40,739 --> 00:11:43,876
RELEVANT TO THIS IN MIXED 

232
00:11:43,876 --> 00:11:51,083
DISEASE IN CARDIO-PULMONARY IN 

233
00:11:51,083 --> 00:11:53,118
IN MIXED SPACE AND IN GENDER. 

234
00:11:53,118 --> 00:11:54,353
>> I BELIEVE ALL THE
SPEAKERS 

235
00:11:54,353 --> 00:11:55,888
ARE HERE, SOME ARE MISSING. 

236
00:11:55,888 --> 00:11:57,690
PROBABLY TOO EARLY ON THE WEST 

237
00:11:57,690 --> 00:11:59,725
COAST. WE WILL INTRODUCE THEM 

238
00:11:59,725 --> 00:12:02,795
WHEN THEY ARE HERE. NEXT WE WILL

239
00:12:02,795 --> 00:12:05,164
GO TO THE NHLBI WORKSHOP 

240
00:12:05,164 --> 00:12:07,700
DISCUSSIONS. SO WE WILL START 

241
00:12:07,700 --> 00:12:10,836
AROUND THE LIST. SO DR. WAWUT. 

242
00:12:10,836 --> 00:12:17,843
>> I'M A PREFERENCE F
PROFESS / 

243
00:12:17,843 --> 00:12:18,677
/* PROFESSOR AT PENNY AND 

244
00:12:18,677 --> 00:12:23,649
INTEREST IN SEXUAL DIMORPHISM 

245
00:12:23,649 --> 00:12:25,217
AND DISPARITIES AND EXCITED TO 

246
00:12:25,217 --> 00:12:26,418
BE HERE. 

247
00:12:26,418 --> 00:12:28,554
>> THANK YOU, STEVE. 

248
00:12:28,554 --> 00:12:34,460
>> GOOD EVENING, KARIM
EL-KERSH.

249
00:12:34,460 --> 00:12:36,395
I'M WITH THE UNIVERSITY OF 

250
00:12:36,395 --> 00:12:40,799
ARIZONA, PHOENIX CAMPUS. 

251
00:12:40,799 --> 00:12:43,936
DIRECTOR OF PH PROGRAM. MY 

252
00:12:43,936 --> 00:12:45,204
INTEREST IS IN SOCIAL 

253
00:12:45,204 --> 00:12:47,139
DETERMINANTS OF HEALTH AND 

254
00:12:47,139 --> 00:12:49,241
PALLIATIVE CARE IN HYPERTENSION,

255
00:12:49,241 --> 00:12:52,278
ALSO WITH INTERESTS IN HEALTH 

256
00:12:52,278 --> 00:12:53,812
CARE UTILIZATION IN PULMONARY 

257
00:12:53,812 --> 00:12:55,314
HYPERTENSION. GLAD TO BE HERE. 

258
00:12:55,314 --> 00:13:02,821
>> THANK YOU. NEXT DR.
TSUANG. 

259
00:13:02,821 --> 00:13:05,057
>> GOOD MORNING, THANK
YOU. MY 

260
00:13:05,057 --> 00:13:06,825
NAME IS WAYNE. I'M ASSOCIATE 

261
00:13:06,825 --> 00:13:09,795
PROFESSOR AT THE CLEVELAND 

262
00:13:09,795 --> 00:13:12,998
CLINIC. I'M A TRANSPLANT PULL 

263
00:13:12,998 --> 00:13:14,199
MONDAY OL GIST AND INTERESTS IN 

264
00:13:14,199 --> 00:13:16,068
THE NEIGHBORHOOD EFFECTS ON 

265
00:13:16,068 --> 00:13:17,603
IN-STAGE CHRONIC LUNG DISEASES 

266
00:13:17,603 --> 00:13:28,013
AND EXCITED TO BE HERE. 

267
00:13:31,150 --> 00:13:36,689
>> DR. SAMAR FARHA AT
CLEVELAND 

268
00:13:36,689 --> 00:13:38,958
CLINIC AND INTERESTED IN 

269
00:13:38,958 --> 00:13:42,595
HYPERTENSION AND HAVE BEEN 

270
00:13:42,595 --> 00:13:45,331
WORKING WITH DR. WAYNE AND 

271
00:13:45,331 --> 00:13:46,532
SOCIAL DISPARITY IN OUR 

272
00:13:46,532 --> 00:13:47,299
HYPERTENSION POPULATION. LOOKING

273
00:13:47,299 --> 00:13:48,767
FORWARD TO LEARNING FROM ALL OF 

274
00:13:48,767 --> 00:13:50,536
YOU TODAY, THANK YOU. 

275
00:13:50,536 --> 00:14:00,279
>> THANK YOU. NEXT ONE IS
DR. 

276
00:14:00,279 --> 00:14:00,512
NICKEL. 

277
00:14:00,512 --> 00:14:03,382
>> GOOD MORNING, MY NAME
IS 

278
00:14:03,382 --> 00:14:06,885
(AUDIO DISRUPTION) -- BECAUSE WE

279
00:14:06,885 --> 00:14:09,254
HAVE A MAJORITY OF HISPANIC 

280
00:14:09,254 --> 00:14:10,089
UNDERSERVED PATIENTS SO I'M 

281
00:14:10,089 --> 00:14:13,192
GRATEFUL TO BE PART OF THIS 

282
00:14:13,192 --> 00:14:16,328
WORKSHOP TODAY, THANK YOU. 

283
00:14:16,328 --> 00:14:20,866
>> THANK YOU. LAST
DISCUSSANT IS

284
00:14:20,866 --> 00:14:22,267
DR. ELWING. 

285
00:14:22,267 --> 00:14:23,936
>> THANK YOU, I'M EXCITED.

286
00:14:23,936 --> 00:14:28,073
DIRECTOR OF MEDICINE THE 

287
00:14:28,073 --> 00:14:29,975
PULMONARY PROGRAM IN CINCINNATI.

288
00:14:29,975 --> 00:14:31,877
MY FOCUS IS ON SOCIAL 

289
00:14:31,877 --> 00:14:33,379
DETERMINANTS OF HEALTH WITH A 

290
00:14:33,379 --> 00:14:35,714
SPECIAL INTEREST IN HOW RURALITY

291
00:14:35,714 --> 00:14:38,083
AFFECTS OUTCOMES, SO THAT IS 

292
00:14:38,083 --> 00:14:41,620
WHAT AFFECTS MY PATIENTS, TO A 

293
00:14:41,620 --> 00:14:43,355
GREAT DEGREE. 

294
00:14:43,355 --> 00:14:45,424
>> ALL RIGHT, LET'S MOVE
ON TO 

295
00:14:45,424 --> 00:14:50,663
THE INTRODUCTION OF MY NHLBI 

296
00:14:50,663 --> 00:14:54,933
COLLEAGUE. FIRST IS LEADERSHIP 

297
00:14:54,933 --> 00:14:56,435
FROM NHLBI, DR. GUSTAVO 

298
00:14:56,435 --> 00:15:01,440
MATUTE-BELLO, WHO IS THE ACTING 

299
00:15:01,440 --> 00:15:06,779
DIRECTOR FOR DIVISION OF LUNG 

300
00:15:06,779 --> 00:15:13,252
DISEASE. GUS. 

301
00:15:13,252 --> 00:15:15,354
>> SURE, I'M HAPPY TO BE
HERE 

302
00:15:15,354 --> 00:15:18,891
AND THANKS FOR YOUR LEADERSHIP 

303
00:15:18,891 --> 00:15:21,360
AND FOR MAKING THIS POSSIBLE. 

304
00:15:21,360 --> 00:15:26,665
>> THANK YOU. THE BRANCH
CHIEF, 

305
00:15:26,665 --> 00:15:30,536
LUNG DISEASE BRANCH CHIEF, DR. 

306
00:15:30,536 --> 00:15:32,838
JOHN SHERIDAN. 

307
00:15:32,838 --> 00:15:35,074
>> HELLO, THANK YOU FOR
THE 

308
00:15:35,074 --> 00:15:36,208
INTRODUCTION. HI, EVERYONE. 

309
00:15:36,208 --> 00:15:37,409
LOOKING FORWARD TO THE 

310
00:15:37,409 --> 00:15:39,111
DISCUSSION. I JOINED NHLBI ON 

311
00:15:39,111 --> 00:15:42,281
THE LUNG DIVISION AS THE CHIEF 

312
00:15:42,281 --> 00:15:44,983
OF THE RESTRICTIVE AND VASCULAR 

313
00:15:44,983 --> 00:15:47,086
BRANCH A FEW MONTHS AGO, SO 

314
00:15:47,086 --> 00:15:48,287
LOOKING FORWARD TO DISCUSSION. 

315
00:15:48,287 --> 00:15:50,055
>> THANK YOU, JOHN. WE
ALSO HAVE

316
00:15:50,055 --> 00:15:51,390
OTHER COLLEAGUES HERE. I 

317
00:15:51,390 --> 00:15:54,126
PROBABLY DON'T HAVE THE TIME TO 

318
00:15:54,126 --> 00:15:56,528
INTRODUCE EVERYONE. WE WILL MOVE

319
00:15:56,528 --> 00:15:59,031
ON TO THE NEXT. BASICALLY AGAIN 

320
00:15:59,031 --> 00:16:00,299
THANK YOU EVERYONE FOR STAYING 

321
00:16:00,299 --> 00:16:02,501
ON TIME. I WOULD LIKE TO WELCOME

322
00:16:02,501 --> 00:16:06,071
OUR ACTING DIRECTOR OF THE 

323
00:16:06,071 --> 00:16:15,981
DIVISION OF LUNG DISEASE, DR. 

324
00:16:15,981 --> 00:16:17,683
GUSTAVO MATUTE-BELLO FOR THE 

325
00:16:17,683 --> 00:16:19,518
NHLBI LEADERSHIP PERSPECTIVE. 

326
00:16:19,518 --> 00:16:21,553
THANK YOU, GUS. 

327
00:16:21,553 --> 00:16:23,922
>> THANK YOU. GOOD
MORNING, 

328
00:16:23,922 --> 00:16:25,557
EVERYBODY. AS ACTING DIRECTOR OF

329
00:16:25,557 --> 00:16:27,960
DIVISION OF LUNG DISEASES AT 

330
00:16:27,960 --> 00:16:30,529
NHLBI, IT IS MY GREAT PLEASURE 

331
00:16:30,529 --> 00:16:33,365
TO WELCOME YOU ALL TO THIS NHLBI

332
00:16:33,365 --> 00:16:35,801
WORKSHOP ENTITLED HEALTH 

333
00:16:35,801 --> 00:16:39,605
DISPARITIES ACROSS SPECTRUM OF 

334
00:16:39,605 --> 00:16:42,508
PULMONARY VASCULAR DISEASE, PVD.

335
00:16:42,508 --> 00:16:45,144
THIS WORKSHOP WILL EXAMINE THE 

336
00:16:45,144 --> 00:16:48,113
RELATIONSHIP BETWEEN HEALTH 

337
00:16:48,113 --> 00:16:53,552
DISPARITIES AND PULMONARY 

338
00:16:53,552 --> 00:16:55,721
VASCULAR DISEASE, HOW THEY 

339
00:16:55,721 --> 00:16:59,324
AFFECT AND THE RELEVANCE OF 

340
00:16:59,324 --> 00:17:01,860
CARDIO PULMONARY VASCULAR 

341
00:17:01,860 --> 00:17:03,462
HEALTH. ONE OF THE KEYS IS 

342
00:17:03,462 --> 00:17:05,097
IDENTIFY FACTORS THAT ACCOUNT 

343
00:17:05,097 --> 00:17:07,065
FOR INDIVIDUAL DIFFERENCES AMONG

344
00:17:07,065 --> 00:17:09,101
PEOPLE OF DIFFERENT SEX, GENDER,

345
00:17:09,101 --> 00:17:13,238
RACE AND ETHNICITY IN TERMS OF 

346
00:17:13,238 --> 00:17:18,443
DISEASE PATHOBIOLOGY AND 

347
00:17:18,443 --> 00:17:22,181
TREATMENT. WE HAVE SIGNIFICANT 

348
00:17:22,181 --> 00:17:24,016
PROGRESS IN HEALTH DISPARITIES 

349
00:17:24,016 --> 00:17:26,718
AMONG MARGINALIZED GROUPS WITH 

350
00:17:26,718 --> 00:17:32,024
DISEASES LIKE HEART FAILURE AND 

351
00:17:32,024 --> 00:17:34,326
ASTHMA BUT LITTLE KNOWN HOW 

352
00:17:34,326 --> 00:17:36,161
AFFECT PATIENTS WITH PVD AND 

353
00:17:36,161 --> 00:17:38,864
GAPS INCLUDE UNDERSTANDING HOW 

354
00:17:38,864 --> 00:17:40,299
GENETICS AND PRECISION MEDICINE 

355
00:17:40,299 --> 00:17:44,937
SHOULD BE APPLIED TO RACIAL AND 

356
00:17:44,937 --> 00:17:46,605
ETHNIC GROUPS IN GROUPS AND O 

357
00:17:46,605 --> 00:17:52,144
HOW TO OPERATIONAL IZE BASED ON 

358
00:17:52,144 --> 00:17:52,911
SOCIAL DETERMINANTS OF HEALTH, A

359
00:17:52,911 --> 00:17:56,415
FIELD OF SCIENCE. IT IS KNOWN 

360
00:17:56,415 --> 00:17:56,982
THAT SOCIAL DETERMINANTS OF 

361
00:17:56,982 --> 00:17:59,685
HEALTH ARE IMPORTANT 

362
00:17:59,685 --> 00:18:05,390
CONTRIBUTIONS (AUDIO DISRUPTION)

363
00:18:05,390 --> 00:18:06,225
AND RELATIONSHIPS ARE NOT 

364
00:18:06,225 --> 00:18:08,026
KNOWN .ENTERIF WE WANT TO 

365
00:18:08,026 --> 00:18:11,230
DEVELOP AND DEFINE APPROACHES TO

366
00:18:11,230 --> 00:18:21,740
PULMONARY HYPERTENSION SUCH 

367
00:18:24,977 --> 00:18:25,477
TAILOR THERAPIES WE NEED TO 

368
00:18:25,477 --> 00:18:28,780
UNDERSTAND INTERACTIONS BETWEEN 

369
00:18:28,780 --> 00:18:29,348
DISPARITIES AND PULMONARY 

370
00:18:29,348 --> 00:18:31,917
VASCULAR DISEASE, UNDERSTANDING 

371
00:18:31,917 --> 00:18:32,484
HOW SOCIAL DETERMINANTS OF 

372
00:18:32,484 --> 00:18:33,919
HEALTH AFFECT ANALYSIS OF THE 

373
00:18:33,919 --> 00:18:36,255
DATA AS WELL AS DEVELOPING NEW 

374
00:18:36,255 --> 00:18:39,458
APPROACHES TO ANALYZE GENETIC 

375
00:18:39,458 --> 00:18:43,128
DATABASE AND ANCESTRAL ORIGINS. 

376
00:18:43,128 --> 00:18:45,364
TO HELP US MOVE FORWARD THE 

377
00:18:45,364 --> 00:18:47,399
NHLBI WORKSHOP WITH GOALS OF 

378
00:18:47,399 --> 00:18:49,134
DISCUSSING THE STATE OF 

379
00:18:49,134 --> 00:18:52,137
KNOWLEDGE OF HEALTH DISPARITIES 

380
00:18:52,137 --> 00:18:54,907
AND IMPACT ON PVD, IDENTIFY 

381
00:18:54,907 --> 00:18:56,275
AREAS WHERE FURTHER RESEARCH IS 

382
00:18:56,275 --> 00:18:58,110
NEEDED AND EXPLORE NEW 

383
00:18:58,110 --> 00:19:01,246
INTERVENTIONS TO ADDRESS HOW 

384
00:19:01,246 --> 00:19:02,114
HEALTH DISPARITIES AFFECT PVD. 

385
00:19:02,114 --> 00:19:03,949
AT THIS TIME I WOULD LIKE TO ASK

386
00:19:03,949 --> 00:19:09,521
OUR DOCTOR TO INTRODUCE DR. 

387
00:19:09,521 --> 00:19:11,690
LEOPOLD, THE CO -CHAIR TO 

388
00:19:11,690 --> 00:19:13,025
DISCUSS WORKSHOP GOALS AND 

389
00:19:13,025 --> 00:19:15,527
FUTURE OBJECTIVES, THANK YOU. 

390
00:19:15,527 --> 00:19:16,995
>> THANK YOU, GUS. I WENT 

391
00:19:16,995 --> 00:19:19,097
THROUGH THE SELF-INTRODUCTION 

392
00:19:19,097 --> 00:19:20,866
EARLIER SO WE WILL TRY TO STAY 

393
00:19:20,866 --> 00:19:25,037
ON TIME. NEXT WET WILL HAVE OUR 

394
00:19:25,037 --> 00:19:29,508
CO -CHAIRS, DR. RISCHARD, TO 

395
00:19:29,508 --> 00:19:38,550
GIVE US HIS PERSPECTIVE ON GOALS

396
00:19:38,550 --> 00:19:41,320
AND FUTURE PERSPECTIVE. 

397
00:19:41,320 --> 00:19:48,827
>> THANK YOU DR. XIAO AND
DR. 

398
00:19:48,827 --> 00:19:50,429
BELLO FOR THAT WELCOME. I WANT 

399
00:19:50,429 --> 00:19:53,832
TO THE GIVE A SPECIAL 

400
00:19:53,832 --> 00:19:55,400
INTRODUCTION AND REMIND EVERYONE

401
00:19:55,400 --> 00:19:58,236
THAT IT IS COMING UP NOW ALMOST 

402
00:19:58,236 --> 00:19:59,504
NINE-YEAR ANNIVERSARY OF WHEN I 

403
00:19:59,504 --> 00:20:04,643
SAT DOWN WITH THE OTHER PVDOMIX 

404
00:20:04,643 --> 00:20:05,844
INVESTIGATORS. FOR THOSE WHO 

405
00:20:05,844 --> 00:20:09,448
DON'T KNOW IT IS AN 

406
00:20:09,448 --> 00:20:10,882
NHLBI-SPONSORED PROJECT. NINE 

407
00:20:10,882 --> 00:20:12,985
YEARS AGO WE SAT DOWN AND WENT 

408
00:20:12,985 --> 00:20:16,288
THROUGH THE PROTOCOL TOGETHER. 

409
00:20:16,288 --> 00:20:19,157
ALMOST A YEAR PROTOCOL. PVDOMIX 

410
00:20:19,157 --> 00:20:22,761
WILL BE HIGHLIGHTED LATER IN THE

411
00:20:22,761 --> 00:20:26,164
SESSION. DR. LEOPOLD AND I MET 

412
00:20:26,164 --> 00:20:27,866
BACK THEN. I'M PROUD TO SAY AS 

413
00:20:27,866 --> 00:20:30,335
MUCH AS SHE IS A GREAT COLLEAGUE

414
00:20:30,335 --> 00:20:33,038
AND EXPERT IN CARDIOVASCULAR AND

415
00:20:33,038 --> 00:20:36,775
PH DISEASE, SHE IS A GREAT 

416
00:20:36,775 --> 00:20:42,614
FRIEND AS WELL. OUTSIDE THE 

417
00:20:42,614 --> 00:20:44,549
OBVIOUS I'M A WHITE MALE 

418
00:20:44,549 --> 00:20:46,385
CHAIRING A SESSION ON DIVERSITY.

419
00:20:46,385 --> 00:20:48,954
MY IMPOSTER SYNDROME IS GOING IN

420
00:20:48,954 --> 00:20:50,055
HIGH GEAR BECAUSE WE HAVE SO 

421
00:20:50,055 --> 00:20:55,460
MANY TALENTED -- 19 OTHER 

422
00:20:55,460 --> 00:20:56,228
SPEAKERS AND 6 EXPERT 

423
00:20:56,228 --> 00:20:58,363
DISCUSSANTS. SOMETIMES IT MAKES 

424
00:20:58,363 --> 00:21:01,333
ME NERVOUS WITH THE AMOUNT OF 

425
00:21:01,333 --> 00:21:03,235
BRAIN POWER WE HAVE THAT 

426
00:21:03,235 --> 00:21:04,770
CONFERENCE, BUT I'M VERY 

427
00:21:04,770 --> 00:21:06,805
EXCITED. THE DEPTH AND BREADTH 

428
00:21:06,805 --> 00:21:09,875
OF THE GROUP IS ASTOUNDING. WE 

429
00:21:09,875 --> 00:21:13,145
ARE ALL READY FOR A TREAT. ANY 

430
00:21:13,145 --> 00:21:15,080
ONLY ARE THEY DIVERSE IN SUBJECT

431
00:21:15,080 --> 00:21:18,250
AREA AND EXPERTISE, DR. XIAO, 

432
00:21:18,250 --> 00:21:21,787
DR. LEOPOLD AND I MADE A 

433
00:21:21,787 --> 00:21:24,723
CONCERTED EFFORT TO BRING IN 

434
00:21:24,723 --> 00:21:29,194
PEOPLE OF DIVERSE GENDER, 

435
00:21:29,194 --> 00:21:31,029
RACIAL, ETHNIC AND CAREER LEVELS

436
00:21:31,029 --> 00:21:41,573
AS WELL. WHAT WE WILL NOTICE IS 

437
00:21:42,107 --> 00:21:45,577
THERE ARE CROSS-CUTTING THEMES, 

438
00:21:45,577 --> 00:21:46,078
GENETICS, ENVIRONMENT, 

439
00:21:46,078 --> 00:21:47,879
VULNERABILITY AMONG OTHERS WITH 

440
00:21:47,879 --> 00:21:50,248
A LARGE FOUNDATION OF RESEARCH 

441
00:21:50,248 --> 00:21:51,450
OUTSIDE OF PH. THEREFORE YOU 

442
00:21:51,450 --> 00:21:54,453
WILL SEE A BODY OF EVIDENCE 

443
00:21:54,453 --> 00:21:57,789
PRESENTED IN THESE TOPICS THAT I

444
00:21:57,789 --> 00:22:01,126
HAVE -- HAVE A -- HAVE GAINED 

445
00:22:01,126 --> 00:22:03,728
SOME REPETITION THROUGHOUT THE 

446
00:22:03,728 --> 00:22:04,529
CONFERENCE. BUT WILL OFFER 

447
00:22:04,529 --> 00:22:08,567
DIFFERENT PERSPECTIVES ON THAT. 

448
00:22:08,567 --> 00:22:11,336
OBVIOUSLY BECAUSE PH IS A RARE 

449
00:22:11,336 --> 00:22:15,774
DISEASE THERE IS NOT A LARGE 

450
00:22:15,774 --> 00:22:18,910
BREADTH OF EVIDENCE ON ASSOCIATE

451
00:22:18,910 --> 00:22:19,978
DISPARITIES ON EVIDENCE SO, 

452
00:22:19,978 --> 00:22:22,347
AGAIN, WE HAVE A DIVERSE FACULTY

453
00:22:22,347 --> 00:22:24,049
WHO WILL DISCUSS AREAS OUTSIDE 

454
00:22:24,049 --> 00:22:26,518
OF PH. BUT I THINK WE WILL ALL 

455
00:22:26,518 --> 00:22:28,120
DO A GOOD JOB OF BRINGING IT 

456
00:22:28,120 --> 00:22:31,623
BACK TO PH ON ALL THE DIFFERENT 

457
00:22:31,623 --> 00:22:33,091
SUBJECTS AND SESSIONS. 

458
00:22:33,091 --> 00:22:35,160
    I THINK WE MUST RECOGNIZE 

459
00:22:35,160 --> 00:22:39,898
THAT THE IMPACTS THAT WE HAVE, 

460
00:22:39,898 --> 00:22:44,769
INTENDED OR UNINTENDED ON PUBLIC

461
00:22:44,769 --> 00:22:48,173
POLICY AND GUIDELINE FOUNDATION 

462
00:22:48,173 --> 00:22:58,817
ARE IMPORTANT. ANNE RAND SAID 

463
00:22:58,817 --> 00:23:00,352
THE GREATEST THING SCIENCE 

464
00:23:00,352 --> 00:23:04,289
TEACHES IS LAW OF UNINTENDED 

465
00:23:04,289 --> 00:23:05,090
CONSEQUENCES. ONE THING THAT IS 

466
00:23:05,090 --> 00:23:06,758
IMPORTANT, I THINK, TO 

467
00:23:06,758 --> 00:23:09,661
ILLUSTRATE SOME OF THESE 

468
00:23:09,661 --> 00:23:11,696
UNINTENDED CONSEQUENCES ARE 

469
00:23:11,696 --> 00:23:15,100
SOMETHING THAT'S COME UP FAIRLY 

470
00:23:15,100 --> 00:23:18,203
REC

471
00:23:18,203 --> 00:23:19,704
RECENTLY. TWO UNDERLYING 

472
00:23:19,704 --> 00:23:21,606
HYPOTHESES EXIST WHEN WE LOOK AT

473
00:23:21,606 --> 00:23:24,743
ROLE OF RACE IN HEALTH 

474
00:23:24,743 --> 00:23:26,444
DISPARITIES. ONE ON THE TOP ON 

475
00:23:26,444 --> 00:23:29,748
THE LEFT YOU CAN SEE 

476
00:23:29,748 --> 00:23:33,919
TRADITIONALLY RACE HAS BEEN A --

477
00:23:33,919 --> 00:23:44,362
CON FLATED WITH JEANETTE 

478
00:23:49,968 --> 00:23:51,136
HETEROGENAITY WITHIN RACE. THIS 

479
00:23:51,136 --> 00:23:55,373
HAS LARGELY BEEN DEBUNKED. THE 

480
00:23:55,373 --> 00:24:01,379
SECOND HYPOTHESIS IS STRUCTURAL 

481
00:24:01,379 --> 00:24:03,181
RACISM HAVING ROOTS IN POLICY AS

482
00:24:03,181 --> 00:24:05,150
WELL AS DECISIONS IN THE -- DOWN

483
00:24:05,150 --> 00:24:07,319
TO THE DECISIONS IN THE 

484
00:24:07,319 --> 00:24:17,762
COMMUNITY LEAD TO SOCIAL 

485
00:24:21,099 --> 00:24:22,400
DIVERSITIES AND OTHER THINGS 

486
00:24:22,400 --> 00:24:24,936
THAT LEAD TO HEALTH DISPARITIES.

487
00:24:24,936 --> 00:24:30,842
    ONE IMPORTANT EXAMPLE OF HOW

488
00:24:30,842 --> 00:24:33,979
THE LINEAGE OF RESEARCH BASED IN

489
00:24:33,979 --> 00:24:37,549
A LARGELY DEBUNKED HYPOTHESIS 

490
00:24:37,549 --> 00:24:39,851
MAY BE APPLIED TO CURRENT 

491
00:24:39,851 --> 00:24:43,221
RESEARCH IS IN A RECENT 

492
00:24:43,221 --> 00:24:47,259
PUBLICATION IN CHEST. EXERCISE 

493
00:24:47,259 --> 00:24:49,694
DYNAMICS PREDICT HYPERTENSION IN

494
00:24:49,694 --> 00:24:52,564
MUTATION CARRIERS. FOR THOSE WHO

495
00:24:52,564 --> 00:24:54,799
DON'T KNOW BM2R MUTATION IS ONE 

496
00:24:54,799 --> 00:24:59,904
OF THE MAIN MUTATIONS FOUND 

497
00:24:59,904 --> 00:25:01,706
RELATED TO PULMONARY 

498
00:25:01,706 --> 00:25:04,876
HYPERTENSION. THIS STUDY LOOKED 

499
00:25:04,876 --> 00:25:07,279
AT EXERCISE CATHETERIZATION TO 

500
00:25:07,279 --> 00:25:08,647
DETECT EARLY CHANGES AND 

501
00:25:08,647 --> 00:25:10,582
THEREFORE POTENTIALLY A MARK 

502
00:25:10,582 --> 00:25:13,318
TORE EXAMINE AND SCREEN FOR 

503
00:25:13,318 --> 00:25:17,622
FUTURE DEVELOPMENT OF PULMONARY 

504
00:25:17,622 --> 00:25:19,624
HYPERTENSION. IF YOU ARE NOT 

505
00:25:19,624 --> 00:25:22,861
FAMILIAR THIS IS OBTAINED 

506
00:25:22,861 --> 00:25:23,728
THROUGH EXERCISE 

507
00:25:23,728 --> 00:25:24,763
CATHETERIZATION. IF YOU MAY LOOK

508
00:25:24,763 --> 00:25:28,633
AT THE LIST OF AUTHORS ON THIS 

509
00:25:28,633 --> 00:25:33,405
PAPER YOU REALIZE THIS GROUP IS 

510
00:25:33,405 --> 00:25:35,473
VERY INFLUENTIAL IN TERMS OF 

511
00:25:35,473 --> 00:25:37,909
WORLD SYMPOSIUM, GUIDELINE 

512
00:25:37,909 --> 00:25:39,811
FORMATION, AMONG OTHERS. ONE 

513
00:25:39,811 --> 00:25:41,746
THING THEY PERHAPS HAVE NOT 

514
00:25:41,746 --> 00:25:43,014
CONSIDERED IS BELOW THIS. THERE 

515
00:25:43,014 --> 00:25:48,219
WAS A STUDY IN 1985 LOOKING AT 

516
00:25:48,219 --> 00:25:56,494
THE DIFFERENCES BETWEEN WHITE 

517
00:25:56,494 --> 00:25:56,895
K

518
00:25:56,895 --> 00:25:58,463
CAUCASIANS AND SUB SAHARAN 

519
00:25:58,463 --> 00:26:00,265
AFRICANS FROM BELGIAN GROUP AND 

520
00:26:00,265 --> 00:26:04,402
STUDIES THE PREMISE ONE CAN 

521
00:26:04,402 --> 00:26:05,470
HYPOTHESIZE BLACK 

522
00:26:05,470 --> 00:26:06,938
AFRICAN-AMERICANS -- NOT ONLY 

523
00:26:06,938 --> 00:26:08,473
LOOKING AT BLACK SUB SAHARAN 

524
00:26:08,473 --> 00:26:10,141
AFRICANS WHO HAVE LIVED IN 

525
00:26:10,141 --> 00:26:14,813
BELGIUM A SHORT PERIOD BUT CON 

526
00:26:14,813 --> 00:26:18,216
FLATING THAT WITH 

527
00:26:18,216 --> 00:26:18,850
AFRICAN-AMERICANS. THIS MADE 

528
00:26:18,850 --> 00:26:21,653
LESS CIRCULATION. WHEN WE LOOK 

529
00:26:21,653 --> 00:26:24,689
AT THE DIFFERENT FACTORS THAT 

530
00:26:24,689 --> 00:26:27,325
INFLUENCE DISTENSIBILITY, ONE OF

531
00:26:27,325 --> 00:26:27,992
THOSE POTENTIALLY BEING WHETHER 

532
00:26:27,992 --> 00:26:30,095
OR NOT YOU ARE BORN AND RAISED 

533
00:26:30,095 --> 00:26:32,797
IN SUB SAHARAN AFRICA, WAS 

534
00:26:32,797 --> 00:26:34,165
PROBABLY AND LIKELY NOT 

535
00:26:34,165 --> 00:26:36,701
CONSIDERED BY THE GROUP THAT 

536
00:26:36,701 --> 00:26:42,006
LOOKED AT THE DISTENSIBILITY 

537
00:26:42,006 --> 00:26:44,376
HERE AMONG THE DETECT RESEARCH 

538
00:26:44,376 --> 00:26:47,512
GROUP, WHICH IS THE RECENTLY 

539
00:26:47,512 --> 00:26:51,249
PUBLISHED ARTICLE IN CHEST. THEY

540
00:26:51,249 --> 00:26:53,885
ESSENTIALLY CUT OFF THE HEALTHY 

541
00:26:53,885 --> 00:26:56,388
SUB SAHARAN AFRICAN MEN IN 

542
00:26:56,388 --> 00:26:59,657
PREVIOUS STUDY ARE BELOW 1.5 

543
00:26:59,657 --> 00:27:00,725
BEST CUT-OFF FOR DEVELOPMENT OF 

544
00:27:00,725 --> 00:27:02,927
LATER PH. THIS MIGHT BE RINGING 

545
00:27:02,927 --> 00:27:05,663
SOME BELLS WITH REGARD TO HOW WE

546
00:27:05,663 --> 00:27:08,199
HAVE RECENTLY BEEN DEBATING THE 

547
00:27:08,199 --> 00:27:12,871
ROLE OF RACE CUT-OFFS IN 

548
00:27:12,871 --> 00:27:16,307
SPIROMETRY. AND THIS SAME DEBATE

549
00:27:16,307 --> 00:27:17,609
APPLIES NOW IN PULMONARY 

550
00:27:17,609 --> 00:27:21,012
HYPERTENSION, IF WE DON'T 

551
00:27:21,012 --> 00:27:23,348
EXAMINE WHAT POPULATIONS METRIC 

552
00:27:23,348 --> 00:27:25,049
HAS BEEN TESTED IN, PARTICULARLY

553
00:27:25,049 --> 00:27:29,220
IN RACES, WHEN WE BRING THIS UP 

554
00:27:29,220 --> 00:27:31,356
AND SUBSEQUENTLY POTENTIALLY 

555
00:27:31,356 --> 00:27:33,925
GUIDELINE FORMATION, WE MAY 

556
00:27:33,925 --> 00:27:35,827
PERPETUATE EVEN UNKNOWINGLY 

557
00:27:35,827 --> 00:27:44,002
STRUCTURAL RACISM. CAN WE MOVE 

558
00:27:44,002 --> 00:27:45,570
TO THE NEXT SLIDE? 

559
00:27:45,570 --> 00:27:47,005
    THERE WILL BE SEVERAL KEY 

560
00:27:47,005 --> 00:27:53,511
QUESTIONS WE WILL BE 

561
00:27:53,511 --> 00:27:55,814
APPROACHING. WITH A PASSION IN 

562
00:27:55,814 --> 00:27:58,450
THIS FIELD. WE WILL BE STARTING 

563
00:27:58,450 --> 00:28:05,190
OFF WITH DR. GOEL, DR. ESTRADA 

564
00:28:05,190 --> 00:28:13,531
AND DR. HAY. DOCTORS BERNARDO, 

565
00:28:13,531 --> 00:28:14,699
JESUS, PEREZ, BRITAIN WILL 

566
00:28:14,699 --> 00:28:15,333
DISCUSS SOCIAL DETERMINANTS OF 

567
00:28:15,333 --> 00:28:17,135
HEALTH, HEALTH IN PH PATIENTS 

568
00:28:17,135 --> 00:28:21,506
AND DR. GOEL WILL BE FINISHING 

569
00:28:21,506 --> 00:28:22,841
OFF WITH SOCIAL DETERMINANTS OF 

570
00:28:22,841 --> 00:28:25,910
HEALTH IMPLEMENTATION RESEARCH. 

571
00:28:25,910 --> 00:28:27,178
DR. SHAH WILL DISCUSS SEX AND 

572
00:28:27,178 --> 00:28:29,481
GENDER DISPARITIES, DR. EGHBALI 

573
00:28:29,481 --> 00:28:32,617
SOME BASIC SCIENCE ON SEX 

574
00:28:32,617 --> 00:28:34,285
HORMONES AND DR. VENTETUOLO WILL

575
00:28:34,285 --> 00:28:36,788
FINISH OFF WITH INTERVENTIONS 

576
00:28:36,788 --> 00:28:41,192
AIMED AT THESE DISPARITIES. DR. 

577
00:28:41,192 --> 00:28:44,462
DEASI WILL GIVE A LOOK WITH HOW 

578
00:28:44,462 --> 00:28:45,797
GENETICS INTERACT WITH 

579
00:28:45,797 --> 00:28:46,865
ENVIRONMENTAL FACTORS AND I LOOK

580
00:28:46,865 --> 00:28:48,867
FORWARD TO DR. ORTEGA PROVIDING 

581
00:28:48,867 --> 00:28:51,069
OVERVIEW OF GENETICS AND 

582
00:28:51,069 --> 00:28:52,770
ANCESTRY, PARTICULARLY RELEVANT 

583
00:28:52,770 --> 00:28:55,507
TO THE PREVIOUS SCENARIO I JUST 

584
00:28:55,507 --> 00:28:57,208
DISCUSSED. DR. GLENN WILL GIVE 

585
00:28:57,208 --> 00:28:59,210
US AN IDEA ON HOW CUMULATIVE 

586
00:28:59,210 --> 00:29:01,946
STRESS, TRAUMA IS MEASURED BY 

587
00:29:01,946 --> 00:29:04,949
ALOE STATIC LOAD AFFECTS OUR 

588
00:29:04,949 --> 00:29:10,188
HEALTH AND DR. LIM AND MATHAI ON

589
00:29:10,188 --> 00:29:12,257
ENVIRONMENTAL EXPOSURES 

590
00:29:12,257 --> 00:29:13,892
DISPROPORTIONATELY FELT BY 

591
00:29:13,892 --> 00:29:14,792
MARGINALIZED COMMUNITIES AND 

592
00:29:14,792 --> 00:29:22,667
WAYS TO MITIGATE BY DR. MATHAI 

593
00:29:22,667 --> 00:29:23,301
AND LOOK BACK AT MY COLLEAGUES 

594
00:29:23,301 --> 00:29:28,039
IN THE STUDY, MYSELF, HORN AND 

595
00:29:28,039 --> 00:29:30,775
HEMNIS DISCUSS THE RACIAL AND 

596
00:29:30,775 --> 00:29:35,513
AGE-RELATED ISSUES FROM THE 

597
00:29:35,513 --> 00:29:38,316
PVDOMIX STUDY. YOU WILL NOTICE 

598
00:29:38,316 --> 00:29:40,919
YOU WILL HAVE FIVE MINUTES FOR 

599
00:29:40,919 --> 00:29:42,220
DISCUSSION. THIS IS MOSTLY FOR 

600
00:29:42,220 --> 00:29:45,990
TRANSITION. WE WILL HAVE A 

601
00:29:45,990 --> 00:29:46,958
20-MINUTE INTERVAL TO ALSO 

602
00:29:46,958 --> 00:29:48,927
DISCUSS IN A TWO-HOUR DISCUSSION

603
00:29:48,927 --> 00:29:55,133
SESSION AT THE END OF THE SECOND

604
00:29:55,133 --> 00:30:02,640
D

605
00:30:02,640 --> 00:30:06,978
DAY. WE ARE TALKING ABOUT RACE, 

606
00:30:06,978 --> 00:30:07,979
ETHNICITY AND GENDER AND THESE 

607
00:30:07,979 --> 00:30:10,582
CAN BE CHARGED. I WOULD URGE YOU

608
00:30:10,582 --> 00:30:14,285
TO CRITICIZE POLICIES RATHER 

609
00:30:14,285 --> 00:30:17,889
THAN INDIVIDUALS. LASTLY WE WILL

610
00:30:17,889 --> 00:30:19,457
BE DEVELOPING A WORKSHOP 

611
00:30:19,457 --> 00:30:23,127
MANUSCRIPT. IF YOU HAVE IDEAS, 

612
00:30:23,127 --> 00:30:24,796
EMAIL ME, SEND COMMENTS IN CHAT 

613
00:30:24,796 --> 00:30:27,332
OR TEXT OR PING ME WITH THOSE 

614
00:30:27,332 --> 00:30:30,602
IDEAS. WITH THAT LET'S GET 

615
00:30:30,602 --> 00:30:35,473
STARTED. I WILL INTRODUCE DR. 

616
00:30:35,473 --> 00:30:39,310
GOEL, GIVING US A TALK ON THE 

617
00:30:39,310 --> 00:30:42,914
RELATIONSHIP BETWEEN HEALTH DIRT

618
00:30:42,914 --> 00:30:47,385
DISPARITIES, RACE, ETHNICITY AND

619
00:30:47,385 --> 00:30:51,823
ANDING ACCENTUATED BY RARE 

620
00:30:51,823 --> 00:30:52,457
DISEASES LIKE PH. 

621
00:30:52,457 --> 00:30:54,959
>> I SEE SOME OF THE
SPEAKERS 

622
00:30:54,959 --> 00:30:57,028
ARE HERE, MISSING FROM THE 

623
00:30:57,028 --> 00:30:58,329
INTRODUCTION SECTION. MAYBE WE 

624
00:30:58,329 --> 00:31:01,699
WILL ASK THEM TO DO A QUICK 

625
00:31:01,699 --> 00:31:04,902
SELF-INTRODUCTION FIRST BEFORE 

626
00:31:04,902 --> 00:31:13,978
THE SESSION START. I SEE DR. 

627
00:31:13,978 --> 00:31:16,147
GLENN AND DE-JESUS. MAY BE MORE.

628
00:31:16,147 --> 00:31:18,650
DR. GLENN, IF YOU ARE HERE YOU 

629
00:31:18,650 --> 00:31:20,818
TURN ON YOUR CAMERA AND 

630
00:31:20,818 --> 00:31:24,922
MICROPHONE AND GIVE A 15-SECOND 

631
00:31:24,922 --> 00:31:27,458
SELF-INTRODUCTION. BASICALLY -- 

632
00:31:27,458 --> 00:31:27,692
YEP. 

633
00:31:27,692 --> 00:31:31,029
>> GOOD MORNING. I'M JASON
GLENN

634
00:31:31,029 --> 00:31:31,929
ASSOCIATE PROFESSOR IN 

635
00:31:31,929 --> 00:31:33,498
DEPARTMENT OF HISTORY AND 

636
00:31:33,498 --> 00:31:34,399
PHILOSOPHITY AT DEPARTMENT OF 

637
00:31:34,399 --> 00:31:36,300
MEDICINE AT UNIVERSITY OF KANSAS

638
00:31:36,300 --> 00:31:37,702
MEDICAL CENTER AND ALSO 

639
00:31:37,702 --> 00:31:39,637
ASSOCIATE DIRECTOR OF CENTER FOR

640
00:31:39,637 --> 00:31:41,005
AFRICAN-AMERICAN HEALTH. IT IS 

641
00:31:41,005 --> 00:31:42,874
WONDERFUL TO BE WITH YOU ALL 

642
00:31:42,874 --> 00:31:43,641
THIS MORNING. 

643
00:31:43,641 --> 00:31:52,684
>> THANK YOU, DR. GLENN. 

644
00:31:52,684 --> 00:31:53,618
VENICIO, ARE YOU HERE? 

645
00:31:53,618 --> 00:31:54,619
>> CAN YOU HEAR ME? 

646
00:31:54,619 --> 00:31:57,755
>> YES, I CAN HEAR YOU. 

647
00:31:57,755 --> 00:32:08,299
>> WONDERFUL. I'M  AT THE
STAFF 

648
00:32:09,834 --> 00:32:12,770
UNIVERSITY AND SPECIALIZE IN 

649
00:32:12,770 --> 00:32:15,907
PULMONARY HYPERTENSION AND HAVE 

650
00:32:15,907 --> 00:32:19,610
INTEREST IN DRUG INDUCED 

651
00:32:19,610 --> 00:32:20,545
HYPERTENSION AND SOCIAL 

652
00:32:20,545 --> 00:32:21,079
DETERMINANTS OF HEALTH. 

653
00:32:21,079 --> 00:32:26,918
>> THANKS, VENICIO. NOT
SURE 

654
00:32:26,918 --> 00:32:34,125
WHETHER DR. GODE AND MATHAI ARE 

655
00:32:34,125 --> 00:32:35,993
HERE. IF YOU ARE PUT ON YOUR 

656
00:32:35,993 --> 00:32:37,628
MICROPHONE AND PROCEED. PROBABLY

657
00:32:37,628 --> 00:32:40,565
NOT HERE. LET'S MOVE ON TO DR. 

658
00:32:40,565 --> 00:32:44,068
GOEL TO START HER PRESENTATION, 

659
00:32:44,068 --> 00:32:47,705
THANK YOU. 

660
00:32:47,705 --> 00:32:50,508
>> PERFECT. HI, EVERYONE.
I 

661
00:32:50,508 --> 00:32:51,075
REALLY APPRECIATE THE 

662
00:32:51,075 --> 00:32:53,077
OPPORTUNITY TO SPEAK WITH YOU 

663
00:32:53,077 --> 00:32:55,580
ALL TODAY.LY BE DISCUSSING HOW 

664
00:32:55,580 --> 00:32:56,881
DISPARITIES ASSOCIATED WITH RACE

665
00:32:56,881 --> 00:33:01,452
AND ETHNICITY ARE ACCENTUATED 

666
00:33:01,452 --> 00:33:04,055
AMONG PATIENTS WITH PULMONARY 

667
00:33:04,055 --> 00:33:11,329
VASCULAR DISEASE AND 

668
00:33:11,329 --> 00:33:13,231
SPECIFICALLY ON PULMONARY 

669
00:33:13,231 --> 00:33:14,132
HYPERTENSION.LY START WITH A 

670
00:33:14,132 --> 00:33:16,601
RARE DISEASE SUCH AS PH AND INTO

671
00:33:16,601 --> 00:33:18,703
THE ROLE RACE AND ETHNICITY PLAY

672
00:33:18,703 --> 00:33:20,705
IN PERPETUATING THESE HEALTH 

673
00:33:20,705 --> 00:33:23,508
CARE DISPARITIES. I WILL TALK 

674
00:33:23,508 --> 00:33:27,245
ABOUT AN IMPORTANT MANIFESTATION

675
00:33:27,245 --> 00:33:30,014
CONSEQUENCE DISPARITIES, 

676
00:33:30,014 --> 00:33:31,349
UNDERREPRESENTATION IN PH 

677
00:33:31,349 --> 00:33:32,750
REGISTRIES AND CLINICAL TRIAL. 

678
00:33:32,750 --> 00:33:34,819
THEN GET INTO FUTURE DIRECTIONS 

679
00:33:34,819 --> 00:33:37,722
AND QUESTIONS. ONE OF MY BIG 

680
00:33:37,722 --> 00:33:39,991
GOALS FOR THIS TALK IS TO SET 

681
00:33:39,991 --> 00:33:43,427
THE STAGE FOR ALL THE SUBSEQUENT

682
00:33:43,427 --> 00:33:44,929
TALKS, WHICH WILL DELVE DEEPER 

683
00:33:44,929 --> 00:33:47,131
INTO TALKS I BRING UP TODAY. 

684
00:33:47,131 --> 00:33:47,365
NEXT. 

685
00:33:47,365 --> 00:33:51,102
    I DID WANT TO START OFF WITH

686
00:33:51,102 --> 00:33:53,437
THE STORY OF ONE OF MY PATIENTS.

687
00:33:53,437 --> 00:33:58,843
SO HE IS A 58 -YEAR-OLD MAN WITH

688
00:33:58,843 --> 00:34:04,682
HISTORY OF METH AND ADMITTED 

689
00:34:04,682 --> 00:34:06,984
WITH SEPTIC SHOCK. HE HAD AN 

690
00:34:06,984 --> 00:34:08,219
ECHO CARD GRAM, WHICH WAS 

691
00:34:08,219 --> 00:34:10,988
CONCERNING FOR PH. HE ENDED UP 

692
00:34:10,988 --> 00:34:12,690
NEEDING A CATHETER, SHOWING 

693
00:34:12,690 --> 00:34:15,259
ELEVATED ARTERY PRESSURE. HE WAS

694
00:34:15,259 --> 00:34:20,097
DIRE EASED, NEEDED ANDOBUTAMINE 

695
00:34:20,097 --> 00:34:25,536
AND IVOPROSTENAL. HE WAS ABLE TO

696
00:34:25,536 --> 00:34:26,971
SAFELY UNDERGO SURGERY AND 

697
00:34:26,971 --> 00:34:32,410
TRANSFERRED TO CEDARS FOR 

698
00:34:32,410 --> 00:34:34,312
FURTHER MANAGEMENT OF PH. WHEN 

699
00:34:34,312 --> 00:34:39,984
HE CAME TO WE CONTINUED TO 

700
00:34:39,984 --> 00:34:41,219
DIURESE AND WEAN HIM OFF AND 

701
00:34:41,219 --> 00:34:43,521
WORK UP FOR CAUSES OF PH, AFTER 

702
00:34:43,521 --> 00:34:46,457
WHICH WE PERFORMED A FORMAL 

703
00:34:46,457 --> 00:34:47,225
RIGHT HEART CATEGORY IZATION 

704
00:34:47,225 --> 00:34:49,694
WHICH DID CONFIRM PRECAPILLARY 

705
00:34:49,694 --> 00:34:52,597
PH AND WE WERE ABLE TO START HIM

706
00:34:52,597 --> 00:34:58,903
AS AN INPATIENT ON SILDYNAFIL. 

707
00:34:58,903 --> 00:35:00,338
GREAT NEWS IS EVERYTHING 

708
00:35:00,338 --> 00:35:03,140
IMPROVED DURING HIS HOSPITAL 

709
00:35:03,140 --> 00:35:05,409
STAY. NEXT. SO THIS REALLY FELT 

710
00:35:05,409 --> 00:35:08,379
LIKE A SUCCESS STORY. THIS, 

711
00:35:08,379 --> 00:35:10,915
AGAIN, IS A GREAT EXAMPLE OF 

712
00:35:10,915 --> 00:35:12,183
PEOPLE RECOGNIZING PH AND 

713
00:35:12,183 --> 00:35:14,418
APPROPRIATELY TRANSFERRING TO AN

714
00:35:14,418 --> 00:35:16,854
EXPERT PH CENTER, WHICH ALLOWED 

715
00:35:16,854 --> 00:35:21,192
US TO COMPLETE A THOROUGH 

716
00:35:21,192 --> 00:35:24,395
WORKUP. ULTIMATELY INITIATE 

717
00:35:24,395 --> 00:35:28,466
TREATMENT DIRECTED AT PAH. NEXT.

718
00:35:28,466 --> 00:35:31,202
THEN, YOU KNOW, AFTER WE 

719
00:35:31,202 --> 00:35:32,536
FINISHED GIVING HIGH-FIVES AND 

720
00:35:32,536 --> 00:35:33,804
PATTING OURSELVES ON THE BACK WE

721
00:35:33,804 --> 00:35:35,773
HAD TO THINK WHERE DO WE GO FROM

722
00:35:35,773 --> 00:35:37,541
HERE, WHAT ARE THE NEXT STEPS. 

723
00:35:37,541 --> 00:35:39,043
REALLY THE NEXT STEP WAS TO 

724
00:35:39,043 --> 00:35:41,879
START COORDINATING OUTPATIENT PH

725
00:35:41,879 --> 00:35:43,347
FOLLOW-UP SO TO FOLLOW HIM 

726
00:35:43,347 --> 00:35:45,950
CLOSELY AND CONTINUE TO ADD ON 

727
00:35:45,950 --> 00:35:55,393
DIFFERENT MEDICATIONS. NEXT. 

728
00:35:55,393 --> 00:35:58,429
BISHOP, CALIFORNIA IS CLOSER TO 

729
00:35:58,429 --> 00:36:00,364
THE STATE OF NEVADA THAN IT IS 

730
00:36:00,364 --> 00:36:01,933
TO ANY OTHER MAJOR CITY IN 

731
00:36:01,933 --> 00:36:06,938
CALIFORNIA. FOR HIM TO COME TO 

732
00:36:06,938 --> 00:36:07,271
S 

733
00:36:07,271 --> 00:36:09,073
CEDARS WOULD BE FOUR HOURS, NOT 

734
00:36:09,073 --> 00:36:11,876
INCLUDING L. A. TRAFFIC. NEXT. 

735
00:36:11,876 --> 00:36:13,244
SO WHEN WE SEARCHED ON THE 

736
00:36:13,244 --> 00:36:15,947
WEBSITE TO LOOK FOR OTHER PH 

737
00:36:15,947 --> 00:36:17,682
SPECIALISTS IT RESULTED IN FOUR 

738
00:36:17,682 --> 00:36:19,984
PH SPECIALISTS. INTERESTINGLY 

739
00:36:19,984 --> 00:36:24,388
ENOUGH, IT WOULD HAVE BEEN AN 

740
00:36:24,388 --> 00:36:26,390
EVEN LONGER DRIVE IF HE HAD TO 

741
00:36:26,390 --> 00:36:27,925
GO TO FRESNO OR SACRAMENTO, 

742
00:36:27,925 --> 00:36:32,396
WHERE THEY WERE LOCATED. NEXT. 

743
00:36:32,396 --> 00:36:33,464
FORTUNATELY HE WAS SOMEHOW ABLE 

744
00:36:33,464 --> 00:36:37,501
TO MAKE THE LONG DRIVE TO L. A. 

745
00:36:37,501 --> 00:36:41,138
TO BE SEEN, WHICH WE WERE ABLE 

746
00:36:41,138 --> 00:36:46,444
TO INITIATE MASETINTIN. 

747
00:36:46,444 --> 00:36:48,579
INSURANCE CHANGED AND REQUIRED 

748
00:36:48,579 --> 00:36:49,747
AUTHORIZATION, WHICH CLASSICALLY

749
00:36:49,747 --> 00:36:52,750
WAS DENIED, RAN OUT IN THE 

750
00:36:52,750 --> 00:36:54,518
INTERIM AS WELL, WHICH WAS 

751
00:36:54,518 --> 00:36:55,886
CONCERNING. AFTER A FEW MONTHS 

752
00:36:55,886 --> 00:36:58,389
HE WAS EVENTUALLY ABLE TO BE 

753
00:36:58,389 --> 00:37:00,624
APPROVED AT USC. SO THERE IS A 

754
00:37:00,624 --> 00:37:05,429
BIT OF A HAPPY ENDING TO THIS. 

755
00:37:05,429 --> 00:37:10,768
NEXT. SO I'M SURE THIS STORY 

756
00:37:10,768 --> 00:37:11,736
SOUNDS FAMILIAR BECAUSE I THINK 

757
00:37:11,736 --> 00:37:14,205
IT HIGHLIGHTS A LOT OF COMMON 

758
00:37:14,205 --> 00:37:16,107
THEMES WE FACE AND SEE. FOR 

759
00:37:16,107 --> 00:37:17,308
EXAMPLE, THE FACT THERE IS 

760
00:37:17,308 --> 00:37:19,643
VARYING DEGREE OF RESOURCES AND 

761
00:37:19,643 --> 00:37:21,679
EXPERTISE TO PROVIDE SPECIALIZED

762
00:37:21,679 --> 00:37:24,415
PH CARE. THERE IS A LIMIT TO HOW

763
00:37:24,415 --> 00:37:27,651
MUCH WE CAN OPTIMIZE ON THE 

764
00:37:27,651 --> 00:37:29,286
INPATIENT SIDE. AT SOME POINT WE

765
00:37:29,286 --> 00:37:31,255
HAVE TO LET THEM OUT INTO THE 

766
00:37:31,255 --> 00:37:32,857
REAL WORLD. ISSUES OF SAFE 

767
00:37:32,857 --> 00:37:35,659
DISCHARGE AND FOLLOW-UP PLANS, 

768
00:37:35,659 --> 00:37:40,197
PRESCRIBING AND MONITORING VASO 

769
00:37:40,197 --> 00:37:42,633
DILATOR THERAPY, INSURANCE 

770
00:37:42,633 --> 00:37:44,568
BARRIERS AND SUBSTANCE USE 

771
00:37:44,568 --> 00:37:48,205
DISORDER AS A CAUSE OF PH. NEXT.

772
00:37:48,205 --> 00:37:49,940
THIS IS WHERE WE GET INTO SOME 

773
00:37:49,940 --> 00:37:52,009
SAD FACTS ABOUT CARING FOR 

774
00:37:52,009 --> 00:37:53,611
PATIENTS WITH A RARE DISEASE 

775
00:37:53,611 --> 00:37:57,415
SUCH AS PH. FIRST AND FOREMOST 

776
00:37:57,415 --> 00:37:59,316
IS THE FACT WE STILL -- TAKES 

777
00:37:59,316 --> 00:38:01,152
PATIENTS A LONG TIME TO GET 

778
00:38:01,152 --> 00:38:03,220
DIAGNOSED WITH PH. THE TIME TO 

779
00:38:03,220 --> 00:38:05,389
DIAGNOSE IS STILL OVER ONE YEAR.

780
00:38:05,389 --> 00:38:07,758
A STUDY HAS SHOWN APPROXIMATELY 

781
00:38:07,758 --> 00:38:09,226
21 PEREZ OF PATIENTS HAD TO LIVE

782
00:38:09,226 --> 00:38:11,095
WITH SYMPTOMS MORE THAN TWO 

783
00:38:11,095 --> 00:38:14,532
YEARS BEFORE GETTING A 

784
00:38:14,532 --> 00:38:14,832
DIAGNOSIS. 

785
00:38:14,832 --> 00:38:16,400
    YOU KNOW, CERTAINLY THIS CAN

786
00:38:16,400 --> 00:38:18,969
STEM FROM THE FACT PH HAS PRETTY

787
00:38:18,969 --> 00:38:20,504
NON-SPECIFIC SYMPTOMS. ALSO 

788
00:38:20,504 --> 00:38:22,206
THERE IS STILL A LACK OF 

789
00:38:22,206 --> 00:38:24,975
AWARENESS ABOUT PH. SO PROVIDERS

790
00:38:24,975 --> 00:38:26,744
MAY, YOU KNOW, MISS THE 

791
00:38:26,744 --> 00:38:28,345
DIAGNOSIS OF PH BECAUSE THEY ARE

792
00:38:28,345 --> 00:38:33,551
THINKING OF MUCH MORE COMMON 

793
00:38:33,551 --> 00:38:36,287
DISEASES SUCH AS OBESITY, HEART 

794
00:38:36,287 --> 00:38:38,255
FAILURE. THE FLIP SIDE IS SOME 

795
00:38:38,255 --> 00:38:44,095
PATIENTIES CAN GET MISDIAGNOSED 

796
00:38:44,095 --> 00:38:48,332
WITH PH BASED ON ECHO CARD 

797
00:38:48,332 --> 00:38:51,302
GRAMS, ENLARGED PULMONARY ARTERY

798
00:38:51,302 --> 00:38:52,736
ON THE SCAN. THAT TOO WITHOUT 

799
00:38:52,736 --> 00:38:54,939
THE FORMAL GOLD STANDARD 

800
00:38:54,939 --> 00:38:57,374
DIAGNOSTIC TEST, WHICH IS A 

801
00:38:57,374 --> 00:38:59,577
RIGHT HEART CATEGORITIZATION, 

802
00:38:59,577 --> 00:39:01,245
RESULTING GETTING STARTED ON 

803
00:39:01,245 --> 00:39:08,552
SURVEY SEW D SURVEY SOE /* /* V 

804
00:39:08,552 --> 00:39:10,621
DILATOR THERAPY, WHICH HAS ME 

805
00:39:10,621 --> 00:39:12,623
WORKING BACKWARDS. THERE IS A 

806
00:39:12,623 --> 00:39:19,096
STUDY THAT SHOWED 6 PER% HAD 

807
00:39:19,096 --> 00:39:21,465
UNDERGONE ALL THE SCREENS, SUCH 

808
00:39:21,465 --> 00:39:26,370
AS AUTO IMMUNE, H.I.V., 

809
00:39:26,370 --> 00:39:29,673
HYPERTENSION, VQ SCANS, ALL THE 

810
00:39:29,673 --> 00:39:31,775
WORKUP TO APPROPRIATELY 

811
00:39:31,775 --> 00:39:35,212
PHENOTYPE BECAUSE THAT IS 

812
00:39:35,212 --> 00:39:35,880
ULTIMATELY HOW WE DETERMINE THE 

813
00:39:35,880 --> 00:39:42,920
TREATMENT APPROACH. NEXT. THE 

814
00:39:42,920 --> 00:39:44,321
NEXT BARRIER IS EVEN IF THEY 

815
00:39:44,321 --> 00:39:47,191
HAVE GOTTEN A DIAGNOSIS OR PH OR

816
00:39:47,191 --> 00:39:48,859
HAVE HIGH SUSPICION THEY MAY NOT

817
00:39:48,859 --> 00:39:59,403
HAVE ACCESS.  OR DON'T HAVE AN 

818
00:39:59,937 --> 00:40:03,340
ACCREDITED CENTER. HAVING SAID 

819
00:40:03,340 --> 00:40:04,575
THAT THERE ARE STILL PLENTY OF 

820
00:40:04,575 --> 00:40:06,110
EXPERT CENTERS THAT DON'T HAVE 

821
00:40:06,110 --> 00:40:08,245
THAT FORMAL ACCREDITATION. BUT 

822
00:40:08,245 --> 00:40:11,749
MAY STILL BE A LACK OF AWARENESS

823
00:40:11,749 --> 00:40:13,517
IN COMMUNITY KNOWING WHAT ARE 

824
00:40:13,517 --> 00:40:15,853
EXPERT PH CENTERS IN MY REGION, 

825
00:40:15,853 --> 00:40:20,691
THUS WHO DO I ACTUALLY REFER TO.

826
00:40:20,691 --> 00:40:24,895
NEXT. THEN FINALLY WE HAVE TO 

827
00:40:24,895 --> 00:40:26,163
THINK ABOUT EVEN PATIENTS WHO 

828
00:40:26,163 --> 00:40:28,599
HAVE MADE THEIR WAY AND GOTTEN 

829
00:40:28,599 --> 00:40:32,203
THEMSELVES TO AN EXPERT PH 

830
00:40:32,203 --> 00:40:33,604
CENTER THERE IS A TREMENDOUS 

831
00:40:33,604 --> 00:40:35,272
BURDEN. FIRST AND FOREMOST FROM 

832
00:40:35,272 --> 00:40:36,941
A FINANCIAL PERSPECTIVE. ONE 

833
00:40:36,941 --> 00:40:39,510
STUDY SHOWED THE COST PER 

834
00:40:39,510 --> 00:40:40,911
PATIENT PER MONTH IS FOUR TO 

835
00:40:40,911 --> 00:40:44,949
FIVE TIMES HIGHER FOR PATIENTS 

836
00:40:44,949 --> 00:40:45,449
WITH PULMONARY 

837
00:40:45,449 --> 00:40:47,384
ARTERIAL HYPERTENSION COMPARED 

838
00:40:47,384 --> 00:40:49,753
TO PATIENTS WITHOUT PAH, EVEN 

839
00:40:49,753 --> 00:40:52,456
AFTER MATCHING FOR AGE, SEX, 

840
00:40:52,456 --> 00:40:54,091
GEOGRAPHICAL AREA AND ANNUAL 

841
00:40:54,091 --> 00:40:57,428
INCOME. THIS FINANCIAL BURDEN 

842
00:40:57,428 --> 00:40:59,496
COMES IN THE MANIFESTATION OF 

843
00:40:59,496 --> 00:41:02,499
THE COST OF MEDICATIONS, EVEN IF

844
00:41:02,499 --> 00:41:04,902
THEY HAVE PRIVATE INSURANCE, TO 

845
00:41:04,902 --> 00:41:06,203
THE POINT WHERE MAYBE PATIENTS 

846
00:41:06,203 --> 00:41:08,539
HAVE TO START PICKING AND 

847
00:41:08,539 --> 00:41:10,841
CHOOSING WHICH MEDICATIONS AND 

848
00:41:10,841 --> 00:41:13,811
NOT BEING ADHERE RENT WITH THEIR

849
00:41:13,811 --> 00:41:15,012
REGIMEN. THE COST OF FREQUENT 

850
00:41:15,012 --> 00:41:16,880
AND LONG HOSPITALIZATIONS, ALL 

851
00:41:16,880 --> 00:41:21,285
THE TESTING THEY HAVE TO UNDERGO

852
00:41:21,285 --> 00:41:22,920
AND FREQUENT OFFICE VISITS THEY 

853
00:41:22,920 --> 00:41:24,121
HAVE TO GO TO. 

854
00:41:24,121 --> 00:41:27,057
    ALSO THE EMOTIONAL BURDEN OF

855
00:41:27,057 --> 00:41:28,626
LIVING WITH PH DUE TO THE 

856
00:41:28,626 --> 00:41:31,395
SYMPTOM BURDEN, DUE TO THE FACT 

857
00:41:31,395 --> 00:41:33,831
IT TAKES ON THEIR FUNCTIONAL 

858
00:41:33,831 --> 00:41:41,605
STATUS AND ALSO FOR T CARRYING 

859
00:41:41,605 --> 00:41:44,575
PEEM /* /* CAREGIVERS AND PEOPLE

860
00:41:44,575 --> 00:41:46,877
THAT SUPPORT THEM. I HOPE I HAVE

861
00:41:46,877 --> 00:41:49,346
PROVEN THE OBSTACLES PATIENTS 

862
00:41:49,346 --> 00:41:52,249
HAVE TO OVERCOME TO RECEIVE 

863
00:41:52,249 --> 00:41:53,984
HIGH-QUALITY PH CARE. NOW WHAT 

864
00:41:53,984 --> 00:41:57,254
HAPPENS WHEN WE ADD THE ISSUE OF

865
00:41:57,254 --> 00:42:00,257
HEALTH DISPARITIES TO THE 

866
00:42:00,257 --> 00:42:01,091
EQUATION. THIS WAS THE 

867
00:42:01,091 --> 00:42:03,560
DEFINITION ADOPTED BY THE ATS 

868
00:42:03,560 --> 00:42:06,964
HEALTH EQUITY SUBCOMMITTEE. THEY

869
00:42:06,964 --> 00:42:10,367
DEFINED RESPIRATORY HEALTH 

870
00:42:10,367 --> 00:42:11,435
DISPARITIES AS SIGNIFICANT 

871
00:42:11,435 --> 00:42:13,404
DIFFERENCES IN RESPIRATORY 

872
00:42:13,404 --> 00:42:18,909
HEALTH CLOSELY LINKED TO RACIAL 

873
00:42:18,909 --> 00:42:22,613
ANCESTRY, SOCIOECONOMIC AND/OR 

874
00:42:22,613 --> 00:42:24,815
ENVIRONMENTAL DIFFERENCES AND 

875
00:42:24,815 --> 00:42:26,083
EXPLAIN HEALTH DISPARITIES 

876
00:42:26,083 --> 00:42:29,053
AFFECT GROUPS WHO HAVE 

877
00:42:29,053 --> 00:42:30,454
EXPERIENCED GREATER OBSTACLES 

878
00:42:30,454 --> 00:42:33,457
BASED ON RACIAL AND ETHNIC 

879
00:42:33,457 --> 00:42:37,795
GROUPS, WHICH I WILL FOCUS ON, 

880
00:42:37,795 --> 00:42:40,564
RELIGION, SOCIOECONOMIC STATUS, 

881
00:42:40,564 --> 00:42:42,466
GENDER, SEXUAL ORIENTATION OR 

882
00:42:42,466 --> 00:42:44,535
IDENTITY, MENTAL HEALTH, 

883
00:42:44,535 --> 00:42:45,969
DISABILITIES AND OTHER 

884
00:42:45,969 --> 00:42:47,237
CHARACTERISTICS HISTORICALLY 

885
00:42:47,237 --> 00:42:50,974
LINKED TO DISCRIMINATION OR 

886
00:42:50,974 --> 00:42:51,608
EXCLUSION. 

887
00:42:51,608 --> 00:42:55,679
    NOW I DO WANT TO START WITH 

888
00:42:55,679 --> 00:42:57,481
OF COURSE ACKNOWLEDGING RACE IS 

889
00:42:57,481 --> 00:43:00,017
A SOCIAL CONSTRUCT AND IT IS 

890
00:43:00,017 --> 00:43:03,620
DIFFICULT TO CATEGORIZE AND 

891
00:43:03,620 --> 00:43:07,091
DEFINE PEOPLE INTO SPECIFIC 

892
00:43:07,091 --> 00:43:09,360
BOXES OF RACE OR ETHNICITY. THE 

893
00:43:09,360 --> 00:43:11,328
FACT THERE IS A SIGNIFICANT OF 

894
00:43:11,328 --> 00:43:13,530
INTER PLAY OF THER FACTORS SUCH 

895
00:43:13,530 --> 00:43:16,233
AS SOCIOECONOMIC STATUS, WHICH 

896
00:43:16,233 --> 00:43:17,801
SUBSEQUENT TALKS WE WILL GET 

897
00:43:17,801 --> 00:43:19,303
INTO. EVEN THEN THERE IS A GOOD 

898
00:43:19,303 --> 00:43:22,139
AMOUNT OF DATA TO SHOW THAT RACE

899
00:43:22,139 --> 00:43:25,209
AND ETHNICITY CAN CERTAINLY 

900
00:43:25,209 --> 00:43:26,443
EXACERBATE HEALTH DISPARITIES 

901
00:43:26,443 --> 00:43:28,645
AND PH, ON TOP OF THIS ALREADY 

902
00:43:28,645 --> 00:43:30,748
CHALLENGING PATHWAY WE HAVE 

903
00:43:30,748 --> 00:43:32,316
TALKED ABOUT THAT PH PATIENT S 

904
00:43:32,316 --> 00:43:42,860
HAVE TO NAVIGATE TO GET CARE. SO

905
00:43:44,294 --> 00:43:46,296
WHEN WE TALK ABOUT DIAGNOSIS A 

906
00:43:46,296 --> 00:43:48,432
PERSON'S RACE MAY COMPLICATE 

907
00:43:48,432 --> 00:43:49,900
THIS BECAUSE PEOPLE WITH OTHER 

908
00:43:49,900 --> 00:43:51,635
RACES OR MINORITIES MAY LIVE IN 

909
00:43:51,635 --> 00:43:53,504
MEDICAL DESERTS, WHERE THEY HAVE

910
00:43:53,504 --> 00:43:55,639
EVEN MORE LIMITED ACCESS TO 

911
00:43:55,639 --> 00:43:57,574
PRIMARY CARE PHYSICIANS AND EVEN

912
00:43:57,574 --> 00:44:01,011
MORE LIMITED ACCESS TO 

913
00:44:01,011 --> 00:44:02,413
PULMONOLOGIST AND CARDIOLOGISTS 

914
00:44:02,413 --> 00:44:04,782
WHO MAY BE THE FIRST PIECES OF 

915
00:44:04,782 --> 00:44:06,717
THE PUZZLE OF DIAGNOSING PH. 

916
00:44:06,717 --> 00:44:10,821
RACE, ETHNICITY AND INCOME ARE 

917
00:44:10,821 --> 00:44:13,223
ASSOCIATED WITH SEVERITY AND 

918
00:44:13,223 --> 00:44:15,459
THIS CAN MAKE A BIG IMPACT ON 

919
00:44:15,459 --> 00:44:17,594
MORTALITY. A STUDY SHOWED BLACK 

920
00:44:17,594 --> 00:44:19,096
AND HISPANIC WERE IN THE TWO 

921
00:44:19,096 --> 00:44:20,731
LOWEST INCOME CATEGORIES AT A 

922
00:44:20,731 --> 00:44:22,332
HIGHER FREQUENCY. PATIENTS IN 

923
00:44:22,332 --> 00:44:24,501
THESE LOWER INCOME CATEGORIES, 

924
00:44:24,501 --> 00:44:26,370
THERE WAS A MUCH HIGHER 

925
00:44:26,370 --> 00:44:28,572
PERCENTAGE OF PATIENTS WITH 

926
00:44:28,572 --> 00:44:36,980
FUNCTIONAL CLASS 3 AND 4 

927
00:44:36,980 --> 00:44:37,481
SYMPTOMS. NEXT. 

928
00:44:37,481 --> 00:44:40,150
    AGAIN WHEN WE TALK ABOUT 

929
00:44:40,150 --> 00:44:41,919
GETTING TO AN EXPERT PH CENTER 

930
00:44:41,919 --> 00:44:45,422
THIS CAN BE IMPACTED BY RACE OR 

931
00:44:45,422 --> 00:44:46,256
ETHNICITY. IT MIGHT CONTRIBUTE 

932
00:44:46,256 --> 00:44:48,492
TO FINANCIAL STATUS, INSURANCE 

933
00:44:48,492 --> 00:44:50,894
STATTY IS. WHEN WE TALK ABOUT 

934
00:44:50,894 --> 00:44:54,331
TRANSPORTATION NOT ONLY IS IT A 

935
00:44:54,331 --> 00:44:56,033
LONG COMMUTE BUT WHAT IF THEY 

936
00:44:56,033 --> 00:44:57,701
RELY ON PUBLIC TRANSPORTATION 

937
00:44:57,701 --> 00:45:00,237
AND WHAT IF THEY HAVE HOUSING 

938
00:45:00,237 --> 00:45:01,238
INSECURITY? I THINK EVERYONE ON 

939
00:45:01,238 --> 00:45:02,840
THE CALL KNOWS AND APPRECIATES 

940
00:45:02,840 --> 00:45:04,141
THERE ARE SIGNIFICANT 

941
00:45:04,141 --> 00:45:06,610
CONSEQUENCES TO NOT HAVING 

942
00:45:06,610 --> 00:45:09,580
ACCESS TO AN EXPERT PH CENTER. 

943
00:45:09,580 --> 00:45:11,915
THEY CAN ACUTE DECOMPENSATED 

944
00:45:11,915 --> 00:45:13,116
RIGHT HEART FAILURE, I THINK 

945
00:45:13,116 --> 00:45:14,852
FROM A CRITICAL CARE PERSPECTIVE

946
00:45:14,852 --> 00:45:17,588
IS ONE OF THE MOST FRIGHTENING 

947
00:45:17,588 --> 00:45:20,324
PROBLEMS TO DEAL WITH. FOR 

948
00:45:20,324 --> 00:45:23,494
PATIENTS WHO HAVE -- ARE ON 

949
00:45:23,494 --> 00:45:24,962
THERAPY, THEY MIGHT GET ADMITTED

950
00:45:24,962 --> 00:45:26,763
INTO A HOSPITAL THAT HAS LIMITED

951
00:45:26,763 --> 00:45:28,599
EXPERIENCE AND EXPOSURE TO 

952
00:45:28,599 --> 00:45:31,602
CARING FOR PATIENTS WITH PROSTA 

953
00:45:31,602 --> 00:45:34,438
PUMPS AND KNOWING HOW TO 

954
00:45:34,438 --> 00:45:38,342
TROUBLESHOOT OR MAY NOT HAVE THE

955
00:45:38,342 --> 00:45:48,852
PULMONARY VASO ON THE PATIENT 

956
00:45:49,286 --> 00:45:49,553
FO

957
00:45:49,553 --> 00:45:50,888
FORMULARY. IN DAYS WHERE ACCESS 

958
00:45:50,888 --> 00:45:57,394
TO REPRODUCTIVE HEALTH IS PRETTY

959
00:45:57,394 --> 00:46:04,568
LET HETEROGENOUS AT BEST. WHEN 

960
00:46:04,568 --> 00:46:07,771
SOMEONE IS ABLE TO GET TO A PH 

961
00:46:07,771 --> 00:46:09,172
CENTER I THINK WHAT IS 

962
00:46:09,172 --> 00:46:12,042
CONCERNING IS PATIENTS CAN STILL

963
00:46:12,042 --> 00:46:14,344
RECEIVE DIFFERENT TREATMENT 

964
00:46:14,344 --> 00:46:15,312
PATTERNS OR EXPERIENCE 

965
00:46:15,312 --> 00:46:17,748
DIFFERENCES IN TREATMENT 

966
00:46:17,748 --> 00:46:19,216
PATTERNS BASED ON THEIR RACE AND

967
00:46:19,216 --> 00:46:21,118
ETHNICITY. A LOT MAY COME FROM 

968
00:46:21,118 --> 00:46:23,120
PERCEIVED CONCERNS ABOUT HEALTH 

969
00:46:23,120 --> 00:46:25,155
LITERACY, MEDICATION ADHERENCE, 

970
00:46:25,155 --> 00:46:26,790
SOCIAL SUPPORT, LANGUAGE 

971
00:46:26,790 --> 00:46:28,091
BARRIERS. YOU KNOW, THESE 

972
00:46:28,091 --> 00:46:29,459
MEDICATIONS ARE SO SPECIALIZED 

973
00:46:29,459 --> 00:46:32,229
AND REQUIRE A LOT OF FOLLOW-UP 

974
00:46:32,229 --> 00:46:33,797
AND EDUCATION AND TEACHING. 

975
00:46:33,797 --> 00:46:36,466
THERE WAS AN INTERESTING STUDY 

976
00:46:36,466 --> 00:46:38,969
PUBLISHED BY DR. GROVES AND 

977
00:46:38,969 --> 00:46:42,339
COLLEAGUES WHO SHOWS THAT BLACK 

978
00:46:42,339 --> 00:46:43,507
PATIENTS WERE ACTUALLY 36 PEREZ 

979
00:46:43,507 --> 00:46:51,381
LESS LIKELY -- 36 % LESS LIKELY 

980
00:46:51,381 --> 00:46:54,151
TO RECEIVE THERAPY. THEY FOUND 

981
00:46:54,151 --> 00:46:56,587
THAT BLACK PATIENTS HAD LOWER 

982
00:46:56,587 --> 00:46:58,455
TREATMENT ADHERENCE. WHEN THEY 

983
00:46:58,455 --> 00:47:00,757
ARE PRESENTING THIS IN AN 

984
00:47:00,757 --> 00:47:02,726
ABSTRACT FORM AT A CONFERENCE, I

985
00:47:02,726 --> 00:47:04,895
REMEMBER THEY ALSO HAD SOME DATA

986
00:47:04,895 --> 00:47:06,530
WHICH SUGGESTED THAT HISPANIC 

987
00:47:06,530 --> 00:47:09,800
PATIENTS WERE LESS LIKELY TO 

988
00:47:09,800 --> 00:47:17,908
RECEIVE PROSTACYCLYN 

989
00:47:17,908 --> 00:47:19,977
MEDICATIONS. NEXT. WHAT I FIND 

990
00:47:19,977 --> 00:47:21,712
UNACCEPTABLE IS THERE CAN BE 

991
00:47:21,712 --> 00:47:23,680
DIFFERENCES IN OUTCOMES BASED ON

992
00:47:23,680 --> 00:47:26,683
RACE OR ETHNICITIES. I THINK ONE

993
00:47:26,683 --> 00:47:28,785
OF KEY EXAMPLES IS IT'S BEEN 

994
00:47:28,785 --> 00:47:30,287
SHOWN BLACK PATIENTS HAVE 

995
00:47:30,287 --> 00:47:32,522
INCREASED RISK OF DEATH, EVEN 

996
00:47:32,522 --> 00:47:36,727
AFTER ADJUSTING FOR AGE AND 

997
00:47:36,727 --> 00:47:38,395
FUNCTIONAL CLASS. SOME STUDIES 

998
00:47:38,395 --> 00:47:39,463
HAVE SHOWN DIFFERENCES IN 

999
00:47:39,463 --> 00:47:41,131
SURVIVAL RATES IN HISPANIC 

1000
00:47:41,131 --> 00:47:42,799
POPULATION WERE NOT ABLE TO 

1001
00:47:42,799 --> 00:47:49,039
ADJUST FOR DIFFERENCES IN 

1002
00:47:49,039 --> 00:47:50,340
SOCIOECONOMIC STATUS. 

1003
00:47:50,340 --> 00:47:55,479
    SO I THINK ONE OF THE KEY 

1004
00:47:55,479 --> 00:47:56,013
MANIFESTATIONS OF HEALTH 

1005
00:47:56,013 --> 00:48:02,085
INEQUITY PERPETUATED BY RACE AND

1006
00:48:02,085 --> 00:48:04,788
ETHNICITY IS LACK IN INDUSTRIES 

1007
00:48:04,788 --> 00:48:05,822
AND RANDOMIZED CONTROL TRIALS, 

1008
00:48:05,822 --> 00:48:07,324
WHICH IS REALLY THE FOUNDATIONS 

1009
00:48:07,324 --> 00:48:11,328
OF WHAT IS KNOWN ABOUT 

1010
00:48:11,328 --> 00:48:13,597
EPIDEMIOLOGY IN PH AND ALSO 

1011
00:48:13,597 --> 00:48:17,200
SERVE TO LAYOUT REALLY WHAT ARE 

1012
00:48:17,200 --> 00:48:18,902
TREATMENT ALGORITHMS ARE. 

1013
00:48:18,902 --> 00:48:22,639
    SO THIS IS A TABLE OF FOUR 

1014
00:48:22,639 --> 00:48:25,776
MAJOR REGISTRY USE FOR PH. THE 

1015
00:48:25,776 --> 00:48:27,477
TAKEAWAY IS THEY ARE PRIMARILY 

1016
00:48:27,477 --> 00:48:29,112
INCLUDING WHITE PATIENTS. WHEN 

1017
00:48:29,112 --> 00:48:32,149
WE LOOK AT THE U.S.  REVEAL 

1018
00:48:32,149 --> 00:48:35,318
REGISTRY, THERE IS A SIGNIFICANT

1019
00:48:35,318 --> 00:48:37,788
UNDERREPRESENTATION OF ASIAN AND

1020
00:48:37,788 --> 00:48:41,792
PACIFIC ISLANDERS COMPARED TO 

1021
00:48:41,792 --> 00:48:43,794
THE U.S.  CENSUS DATA. I HAVE TO

1022
00:48:43,794 --> 00:48:45,962
POINT OUT AT LEAST IT HAS A 

1023
00:48:45,962 --> 00:48:47,931
SLIGHTLY HIGHER REPRESENTATION 

1024
00:48:47,931 --> 00:48:52,803
OF BLACK AND HISPANIC PATIENTS. 

1025
00:48:52,803 --> 00:48:53,403
NEXT. 

1026
00:48:53,403 --> 00:48:55,272
    THIS UNDERREPRESENTATION OF 

1027
00:48:55,272 --> 00:48:58,241
CERTAIN RACES AND ETHNICITIES IS

1028
00:48:58,241 --> 00:48:59,476
MAGNIFIED ON AN INTERNATIONAL 

1029
00:48:59,476 --> 00:49:03,313
SCALE BECAUSE MOST DATA IS 

1030
00:49:03,313 --> 00:49:04,347
ACTUALLY COMING FROM THE UNITED 

1031
00:49:04,347 --> 00:49:07,684
STATES AND EUROPE. THE PDRA 

1032
00:49:07,684 --> 00:49:09,152
REGISTRIES IS AN EXCITING 

1033
00:49:09,152 --> 00:49:11,088
INITIATIVE BECAUSE IT IS TRYING 

1034
00:49:11,088 --> 00:49:14,591
TO CREATE A WORLDWIDE AND HIGHLY

1035
00:49:14,591 --> 00:49:15,892
PHENOTYPES REGISTRY. THEN SO FAR

1036
00:49:15,892 --> 00:49:18,829
THE MAJORITY OF CENTERS ARE 

1037
00:49:18,829 --> 00:49:25,235
STILL FROM AMERICA AND EUROPE. 

1038
00:49:25,235 --> 00:49:26,970
NEXT. 

1039
00:49:26,970 --> 00:49:29,005
    THERE IS A FURTHER 

1040
00:49:29,005 --> 00:49:30,540
DISCORDANCE BETWEEN REGISTRY 

1041
00:49:30,540 --> 00:49:33,510
ENROLLMENT AND CLINICAL TRIAL 

1042
00:49:33,510 --> 00:49:35,145
ENROLLMENT. THIS IS A LIST OR 

1043
00:49:35,145 --> 00:49:44,354
GRAPH OF PIVOTAL TRIALS IN PH. 

1044
00:49:44,354 --> 00:49:46,590
ONE OF THE LARGEST TRIALS TO 

1045
00:49:46,590 --> 00:49:48,692
DATE IS THE GRIFFIN TRIAL, WHICH

1046
00:49:48,692 --> 00:49:52,562
DID NOT PUBLICLY PUBLISH THE 

1047
00:49:52,562 --> 00:49:55,265
RACIAL BREAKDOWN -- ETHNIC 

1048
00:49:55,265 --> 00:49:56,700
BREAKDOWN OF THAT. THIS IS A 

1049
00:49:56,700 --> 00:49:58,301
CONSEQUENCE OF FACT THAT, IN 

1050
00:49:58,301 --> 00:50:00,904
PART, MOST OF THESE TRIALS ARE 

1051
00:50:00,904 --> 00:50:02,472
ENROLLING IN THE UNITED STATES, 

1052
00:50:02,472 --> 00:50:05,809
EUROPE AND AUSTRALIA. THERE IS A

1053
00:50:05,809 --> 00:50:09,546
SIGNIFICANT -- IN COMPARISON, 

1054
00:50:09,546 --> 00:50:11,181
UNDERREPRESENTATION OF CENTERS 

1055
00:50:11,181 --> 00:50:13,383
FROM SOUTH AMERICA, ASIA AND 

1056
00:50:13,383 --> 00:50:14,551
AFRICA. ALSO THIS LACK OF 

1057
00:50:14,551 --> 00:50:15,585
REPRESENTATION IN CLINICAL 

1058
00:50:15,585 --> 00:50:18,288
TRIALS IS, AGAIN, A CONSEQUENCE 

1059
00:50:18,288 --> 00:50:20,090
OF, YOU KNOW, MANY ROOT CAUSES 

1060
00:50:20,090 --> 00:50:21,224
COMING TOGETHER. YOU KNOW, SOME 

1061
00:50:21,224 --> 00:50:23,360
OF WHICH ARE ASSOCIATED WITH 

1062
00:50:23,360 --> 00:50:27,898
SOMEONE'S RACE AND ETHNICITY. 

1063
00:50:27,898 --> 00:50:32,803
NEXT. THIS IS COMING FROM AN 

1064
00:50:32,803 --> 00:50:35,238
ANALYSIS OF 18 PHASE-3 RAN 

1065
00:50:35,238 --> 00:50:37,274
MINORITIZED CONTROLLED TRIALS. 

1066
00:50:37,274 --> 00:50:38,775
THE TAKE AWAY IS THEY ARE 

1067
00:50:38,775 --> 00:50:41,077
SHOWING THE TRIALS EARLIER ON 

1068
00:50:41,077 --> 00:50:42,345
WERE PREDOMINANTLY ENROLLING IN 

1069
00:50:42,345 --> 00:50:45,182
WESTERN COUNTRIES AND INCLUDED 

1070
00:50:45,182 --> 00:50:46,650
NON-HISPANIC WHITE PATIENTS. 

1071
00:50:46,650 --> 00:50:47,984
THOUGH THE PROPORTION HAS 

1072
00:50:47,984 --> 00:50:49,653
SLIGHTLY DECREASED OVER TIME 

1073
00:50:49,653 --> 00:50:53,890
WITH INCLUSION OF NON-WESTERN 

1074
00:50:53,890 --> 00:50:57,494
COUNTRIES. NEXT. THE QUESTION IS

1075
00:50:57,494 --> 00:51:00,330
HOW ARE WE DOING NOW? WE ARE IN 

1076
00:51:00,330 --> 00:51:01,898
A GREAT SPACE WHERE WE HAVE HAD 

1077
00:51:01,898 --> 00:51:03,099
THREE TRIALS COME OUT IN THE 

1078
00:51:03,099 --> 00:51:05,535
LAST FEW YEARS. BUT ANSWERS 

1079
00:51:05,535 --> 00:51:07,370
UNFORTUNATELY IN TERMS OF 

1080
00:51:07,370 --> 00:51:08,471
REPRESENTATION, ABOUT THE SAME 

1081
00:51:08,471 --> 00:51:11,141
IF NOT SLIGHTLY WORSE WITH THE 

1082
00:51:11,141 --> 00:51:12,242
TRIALS HAVING OVERWHELMING 

1083
00:51:12,242 --> 00:51:13,910
MAJORITY OF WHITE PATIENTS AND 

1084
00:51:13,910 --> 00:51:16,713
TRIAL LOOKING AT COME NATION PD5

1085
00:51:16,713 --> 00:51:19,015
AND ERA PILL WAS NOT THE MOST 

1086
00:51:19,015 --> 00:51:21,218
CLEAR IN TERMS OF PUTTING OUT 

1087
00:51:21,218 --> 00:51:25,088
THE RACIAL AND ETHNIC BREAK DOWN

1088
00:51:25,088 --> 00:51:33,063
OF THAT TRIAL. NEXT. 

1089
00:51:33,063 --> 00:51:34,531
    AGAIN, REALLY IMPORTANT, 

1090
00:51:34,531 --> 00:51:36,666
THERE ARE CONSEQUENCES OF BEING 

1091
00:51:36,666 --> 00:51:38,768
UNDERREPRESENTED IN CLINICAL 

1092
00:51:38,768 --> 00:51:42,472
TRIALS BECAUSE IT CHALLENGES THE

1093
00:51:42,472 --> 00:51:44,074
INTERNAL AND EXTERNAL VALIDITY 

1094
00:51:44,074 --> 00:51:45,508
OF TREATMENT GUIDELINES AND CAN 

1095
00:51:45,508 --> 00:51:47,644
CONTRIBUTE TO UNEQUAL ACCESS TO 

1096
00:51:47,644 --> 00:51:50,046
NOVEL THERAPIES AND ULTIMATELY 

1097
00:51:50,046 --> 00:51:52,415
MAY AFFECT OUTCOMES, IN PART, 

1098
00:51:52,415 --> 00:51:56,319
BASED ON RACE AND ETHNICITY. 

1099
00:51:56,319 --> 00:51:59,522
NEXT. SO REALLY THE TAKE AWAY IS

1100
00:51:59,522 --> 00:52:01,424
GETTING ACCESS TO SPECIALIZED 

1101
00:52:01,424 --> 00:52:03,326
AND EQUITABLE PH CARE IS NOT AS 

1102
00:52:03,326 --> 00:52:05,295
SIMPLE AS A REFERRAL. BECAUSE, 

1103
00:52:05,295 --> 00:52:07,330
AS I HAVE TALKED ABOUT, THERE 

1104
00:52:07,330 --> 00:52:08,798
ARE MULTIPLE FACTORS THAT PLAY A

1105
00:52:08,798 --> 00:52:11,902
ROLE IN JUST GETTING REFERRED TO

1106
00:52:11,902 --> 00:52:16,806
A PH CENTER. SOMEONE'S RACE AND 

1107
00:52:16,806 --> 00:52:20,543
ETHNICITY CAN IMPACT THOSE 

1108
00:52:20,543 --> 00:52:22,913
FACTORS. EVEN AFTER GETTING IN, 

1109
00:52:22,913 --> 00:52:24,948
PATIENTS CAN FACE IMPLICIT 

1110
00:52:24,948 --> 00:52:27,617
BIASES FROM HEALTH CARE 

1111
00:52:27,617 --> 00:52:30,353
PROVIDERS PERHAPS DUE TO RACE 

1112
00:52:30,353 --> 00:52:31,955
AND ETHNICITY DUE TO REGISTRIES,

1113
00:52:31,955 --> 00:52:33,623
ACCESS TO CLINICAL TRIALS, THIS 

1114
00:52:33,623 --> 00:52:36,192
CAN AFFECT TREATMENT PATTERNS, 

1115
00:52:36,192 --> 00:52:39,396
POTENTIALLY OUTCOMES AND PER PCH

1116
00:52:39,396 --> 00:52:46,603
WAITS  -- PERPETUATES A VICIOUS 

1117
00:52:46,603 --> 00:52:49,139
CYCLE. NEXT. THE REASON I THINK 

1118
00:52:49,139 --> 00:52:50,774
WE ARE ALL HERE IS WE ARE TRYING

1119
00:52:50,774 --> 00:52:52,475
TO MOVE FROM THIS IDEA OF 

1120
00:52:52,475 --> 00:52:54,110
EQUALITY, TRYING TO ACHIEVE 

1121
00:52:54,110 --> 00:52:55,645
EQUITY AND ULTIMATELY ACHIEVE 

1122
00:52:55,645 --> 00:53:06,189
JUSTICE OR REMOVE THE BARRIERS..

1123
00:53:07,357 --> 00:53:08,959
THIS WAS THE BLUEPRINT FOR 

1124
00:53:08,959 --> 00:53:10,860
ACTION IN 2017, TALKING ABOUT 

1125
00:53:10,860 --> 00:53:13,730
COMMON THEMES AND CAPTURING 

1126
00:53:13,730 --> 00:53:14,831
INFORMATION ABOUT RACE AND 

1127
00:53:14,831 --> 00:53:16,066
ETHNICITY AND SOCIOECONOMIC 

1128
00:53:16,066 --> 00:53:17,534
STANDARDS, EDUCATION, 

1129
00:53:17,534 --> 00:53:18,535
PARTNERSHIP, YOU KNOW, 

1130
00:53:18,535 --> 00:53:21,671
INCREASING AWARENESS ABOUT 

1131
00:53:21,671 --> 00:53:27,911
IMPLICIT AND UNCONSCIOUS BUY 

1132
00:53:27,911 --> 00:53:28,445
YES, 

1133
00:53:28,445 --> 00:53:31,181
BIASES AND FOCUSSING ON CULTURAL

1134
00:53:31,181 --> 00:53:32,716
LANGUAGE APPROPRIATE SERVICES. 

1135
00:53:32,716 --> 00:53:32,983
NEXT. 

1136
00:53:32,983 --> 00:53:35,618
    THERE ARE CERTAINLY MANY 

1137
00:53:35,618 --> 00:53:38,088
UNMET NEEDS IN HEALTH 

1138
00:53:38,088 --> 00:53:43,927
DISPARITIES IN PH, BUT I THINK 

1139
00:53:43,927 --> 00:53:47,664
WITH THE RESOURCES, LIKE I HAVE 

1140
00:53:47,664 --> 00:53:49,566
OUTLINED HERE. NEXT. I THINK 

1141
00:53:49,566 --> 00:53:51,634
SOME OF THE QUESTIONS THAT ARE 

1142
00:53:51,634 --> 00:53:53,169
RAISED FROM THIS IS, YOU KNOW, 

1143
00:53:53,169 --> 00:53:55,305
WHAT IS THE MOST EFFECTIVE AND 

1144
00:53:55,305 --> 00:53:57,540
ACCURATE WAY TO CATEGORIZE AND 

1145
00:53:57,540 --> 00:54:00,410
DOCUMENT RACE AND ETHNICITY. DO 

1146
00:54:00,410 --> 00:54:02,445
PATIENTS WITH PH OF CERTAIN RACE

1147
00:54:02,445 --> 00:54:07,217
OR ETHNICITY HAVE CERTAIN 

1148
00:54:07,217 --> 00:54:08,151
CHARACTERISTICS OF THE DISEASE 

1149
00:54:08,151 --> 00:54:09,619
COURSE OR ASSOCIATED WITH 

1150
00:54:09,619 --> 00:54:11,321
WHETHER A PATIENT CAN BE SEEN AT

1151
00:54:11,321 --> 00:54:14,157
EXPERT CENTERS VERSUS TREATED IN

1152
00:54:14,157 --> 00:54:15,525
THEIR COMMUNITY AND DOES THIS 

1153
00:54:15,525 --> 00:54:16,760
IMPACT OUTCOME? NEXT. 

1154
00:54:16,760 --> 00:54:18,795
    I THINK ALTHOUGH WE ALL 

1155
00:54:18,795 --> 00:54:25,769
AGREE WE SHOULD AIM FOR ACCURATE

1156
00:54:25,769 --> 00:54:27,804
RACIAL REPRESENTATION IN PH 

1157
00:54:27,804 --> 00:54:29,406
TRIALS. THE QUESTION IS WHAT IS 

1158
00:54:29,406 --> 00:54:30,974
THE BEST WAY TO CREATE A 

1159
00:54:30,974 --> 00:54:33,710
REGISTRY AND BARRIERS FROM 

1160
00:54:33,710 --> 00:54:37,614
PREVENTING PATIENTS FROM ASIA, 

1161
00:54:37,614 --> 00:54:38,281
EUROPE AND SOUTH AMERICA. THOUGH

1162
00:54:38,281 --> 00:54:40,383
I THINK WE ARE LEFT WITH MORE 

1163
00:54:40,383 --> 00:54:41,184
QUESTIONS THAN ANSWER, I THINK 

1164
00:54:41,184 --> 00:54:43,920
THAT IS ONE OF THE BIG POINTS OF

1165
00:54:43,920 --> 00:54:45,522
THIS WORKSHOP. I THINK QUESTIONS

1166
00:54:45,522 --> 00:54:48,691
THAT WE WILL BE ABLE TO CHIP 

1167
00:54:48,691 --> 00:54:51,327
AWAY AT OVER THE NEXT TWO DAYS. 

1168
00:54:51,327 --> 00:54:52,896
I WILL YIELD MY TIME AND HAPPEN 

1169
00:54:52,896 --> 00:54:54,898
TO OPEN IT UP FOR DISCUSSION, 

1170
00:54:54,898 --> 00:54:55,632
THANK YOU. 

1171
00:54:55,632 --> 00:54:55,865
    

1172
00:54:55,865 --> 00:54:59,469
>> THANK YOU VERY MUCH,
DR. 

1173
00:54:59,469 --> 00:55:04,240
GOEL. THAT WAS AN EXCELLENT 

1174
00:55:04,240 --> 00:55:05,642
TALK. I HAVE A QUICK QUESTION. 

1175
00:55:05,642 --> 00:55:07,310
WE HAVE ABOUT FIVE MINUTES FOR 

1176
00:55:07,310 --> 00:55:08,278
QUESTIONS. ONE QUESTION I HAVE 

1177
00:55:08,278 --> 00:55:11,247
FOR YOU IS, ARE YOU FAMILIAR 

1178
00:55:11,247 --> 00:55:14,451
WITH ANY RESEARCH INDICATING 

1179
00:55:14,451 --> 00:55:16,886
THAT HEALTH DISPARITIES SUCH AS 

1180
00:55:16,886 --> 00:55:18,855
QUALITY OF LIFE IN PH PATIENTS 

1181
00:55:18,855 --> 00:55:21,458
ARE WORSE THAN OTHER CHRONIC 

1182
00:55:21,458 --> 00:55:22,926
DISEASES LIKE HEART FAILURE AND 

1183
00:55:22,926 --> 00:55:24,527
VARIOUS OTHERS, SOMETHING OF 

1184
00:55:24,527 --> 00:55:25,462
THAT COMPARISON? 

1185
00:55:25,462 --> 00:55:27,030
>> THAT IS A GOOD
QUESTION. YOU 

1186
00:55:27,030 --> 00:55:28,431
KNOW, I DON'T KNOW WHETHER I 

1187
00:55:28,431 --> 00:55:29,666
CAME ACROSS SPECIFICALLY 

1188
00:55:29,666 --> 00:55:31,201
COMPARING IT TO OTHER DISEASES 

1189
00:55:31,201 --> 00:55:33,203
BUT THERE ARE PLENTY OF STUDIES 

1190
00:55:33,203 --> 00:55:34,537
WHICH SHOW THAT EVEN PATIENTS, 

1191
00:55:34,537 --> 00:55:37,507
YOU KNOW, WHO ARE ON, QUOTE, 

1192
00:55:37,507 --> 00:55:39,576
OPTIMAL THERAPY REGIMENS FOR PH 

1193
00:55:39,576 --> 00:55:41,911
STILL EXPERIENCE SIGNIFICANTLY 

1194
00:55:41,911 --> 00:55:44,514
REDUCED QUALITY OF LIFE. AND 

1195
00:55:44,514 --> 00:55:46,349
HEAVY SYMPTOM BURDEN. I WOULD 

1196
00:55:46,349 --> 00:55:48,384
NOT BE SURPRISED IF THE QUALITY 

1197
00:55:48,384 --> 00:55:50,186
OF LIFE IS WORSE FOR PATIENTS 

1198
00:55:50,186 --> 00:55:52,956
WITH PH THAN, YOU KNOW, OTHER 

1199
00:55:52,956 --> 00:56:01,231
MORE COMMON DISEASES OR CO.  

1200
00:56:01,231 --> 00:56:04,200
CO MOR /* /* -- CO MORBIDITIES. 

1201
00:56:04,200 --> 00:56:05,435
>> THANK YOU FOR THAT
EVERYTHING

1202
00:56:05,435 --> 00:56:07,237
TALK. I'M IMPRESSED SEEING HOW 

1203
00:56:07,237 --> 00:56:09,606
YOU HAVE OUTLINED THE INCLUSION 

1204
00:56:09,606 --> 00:56:11,474
OF UNDERREPRESENTED GROUPS IN 

1205
00:56:11,474 --> 00:56:13,109
CLINICAL TRIALS AND REALLY HOW 

1206
00:56:13,109 --> 00:56:14,611
THERE HASN'T BEEN A LOT OF 

1207
00:56:14,611 --> 00:56:18,982
CHANGE. SO I HAVE TO ASK THE 

1208
00:56:18,982 --> 00:56:21,117
QUESTION WHICH IS, WHAT DO WE 

1209
00:56:21,117 --> 00:56:23,086
NEED TO DO DIFFERENTLY? IS THIS 

1210
00:56:23,086 --> 00:56:24,687
A QUESTION OF THE INVESTIGATORS?

1211
00:56:24,687 --> 00:56:27,423
IS THIS A QUESTION OF TRUST 

1212
00:56:27,423 --> 00:56:29,058
AMONG MINORITY GROUPS OR ARE WE 

1213
00:56:29,058 --> 00:56:30,527
JUST NOT REACHING THE RIGHT 

1214
00:56:30,527 --> 00:56:30,793
PEOPLE? 

1215
00:56:30,793 --> 00:56:34,731
>> YEAH. HONESTLY, I THINK
IT IS

1216
00:56:34,731 --> 00:56:38,201
A BIT OF THE, D, ALL OF THE 

1217
00:56:38,201 --> 00:56:40,503
ABOVE SITUATIONS. IF I HAD TO 

1218
00:56:40,503 --> 00:56:43,239
THINK IT, ONE OF THE BIGGEST 

1219
00:56:43,239 --> 00:56:44,707
BOTTLENECK S IS GETTING TO AN 

1220
00:56:44,707 --> 00:56:46,776
EXPERT CENTER, BECAUSE THAT IS 

1221
00:56:46,776 --> 00:56:48,111
WHERE WE ARE ENROLLING THE 

1222
00:56:48,111 --> 00:56:49,712
PATIENTS IN THE CLINICAL TRIALS.

1223
00:56:49,712 --> 00:56:52,715
THERE ARE A WHOLE HOST OF 

1224
00:56:52,715 --> 00:56:54,951
PROBLEMS FOR SOMEONE TO JUST GET

1225
00:56:54,951 --> 00:56:58,888
TO A CENTER OR A SITE FOR 

1226
00:56:58,888 --> 00:57:00,657
ENROLLING PATIENTS IN CLINICAL 

1227
00:57:00,657 --> 00:57:02,492
TRIALS. THE FACT THERE IS A 

1228
00:57:02,492 --> 00:57:03,560
DIFFERENCE BETWEEN REGISTRIES 

1229
00:57:03,560 --> 00:57:05,028
AND CLINICAL TRIALS INDICATES 

1230
00:57:05,028 --> 00:57:06,596
THAT JUST GETTING TO A CENTER IS

1231
00:57:06,596 --> 00:57:08,598
NOT ENOUGH. THERE COULD BE A LOT

1232
00:57:08,598 --> 00:57:10,433
OF THINGS LIKE WHETHER IT IS 

1233
00:57:10,433 --> 00:57:12,202
DISTRUST IN MEDICAL SYSTEM. FOR 

1234
00:57:12,202 --> 00:57:14,003
EXAMPLE HISTORICALLY WITH BLACK 

1235
00:57:14,003 --> 00:57:15,805
PATIENTS, ENTRUSTING THE MEDICAL

1236
00:57:15,805 --> 00:57:19,742
SYSTEM. JUST THE BURDEN OF A 

1237
00:57:19,742 --> 00:57:21,477
CLINICAL TRIAL AND WHAT THAT 

1238
00:57:21,477 --> 00:57:24,280
INVOLVES. ALSO THERE COULD BE 

1239
00:57:24,280 --> 00:57:25,882
IMPLICIT BIASES FROM US 

1240
00:57:25,882 --> 00:57:27,250
ENROLLING IN THE TRIALS. I THINK

1241
00:57:27,250 --> 00:57:28,885
THE NEED TO HAVE AN OBJECTIVE 

1242
00:57:28,885 --> 00:57:30,220
WAY TO SCREEN PATIENTS AND 

1243
00:57:30,220 --> 00:57:31,554
ALWAYS PRESENT TRIALS AND NOT 

1244
00:57:31,554 --> 00:57:42,098
MAKE ASSUMPTIONS. MANY EUROPEAN 

1245
00:57:49,105 --> 00:57:50,773
TRIALS DO NOT RECOGNIZE RACE OR 

1246
00:57:50,773 --> 00:57:51,074
ETHNICITY. 

1247
00:57:51,074 --> 00:57:52,508
>> GOOD POINT. THIS JUST 

1248
00:57:52,508 --> 00:57:54,077
REQUIRED US TO GO THROUGH EVERY 

1249
00:57:54,077 --> 00:57:56,379
SINGLE TRIAL AND GO THROUGH ALL 

1250
00:57:56,379 --> 00:57:58,248
THE APPENDICES AND EXTRA DATA 

1251
00:57:58,248 --> 00:58:00,450
AND SEE WHETHER THEY REPORTED 

1252
00:58:00,450 --> 00:58:01,651
BREAK-DOWNS, SO THAT IS HOW THAT

1253
00:58:01,651 --> 00:58:03,419
FIGURE WAS GENERATED. I THINK IT

1254
00:58:03,419 --> 00:58:04,554
IS ALSO IMPORTANT BECAUSE IT IS 

1255
00:58:04,554 --> 00:58:07,156
THE IDEA OF WHAT IS PUBLICLY 

1256
00:58:07,156 --> 00:58:08,992
AVAILABLE, AS OPPOSED TO GOING 

1257
00:58:08,992 --> 00:58:11,427
THROUGH DIFFERENT LAYERS BEHIND 

1258
00:58:11,427 --> 00:58:13,029
THE SCENES. 

1259
00:58:13,029 --> 00:58:15,999
>> A FOLLOW-UP TO THAT IS,
WHY 

1260
00:58:15,999 --> 00:58:17,767
DO YOU THINK EUROPEAN CLINICAL 

1261
00:58:17,767 --> 00:58:19,102
TRIALS DON'T REPORT ETHNICITY? 

1262
00:58:19,102 --> 00:58:20,470
>> I ACTUALLY DON'T KNOW.
I 

1263
00:58:20,470 --> 00:58:22,272
THINK IT WOULD BE INTERESTING. I

1264
00:58:22,272 --> 00:58:26,009
DON'T KNOW IF THERE ARE RULES 

1265
00:58:26,009 --> 00:58:29,479
THAT ARE DIFFERENT 

1266
00:58:29,479 --> 00:58:30,113
COUNTRY-TO-COUNTRY, WHERE THEY 

1267
00:58:30,113 --> 00:58:31,381
ARE REQUIRED TO OR NOT. THE 

1268
00:58:31,381 --> 00:58:32,649
BIGGEST THING IS HOW DO WE 

1269
00:58:32,649 --> 00:58:34,951
ACTUALLY REPORT IT, RIGHT. THE 

1270
00:58:34,951 --> 00:58:36,052
UNITED STATES MIGHT HAVE A 

1271
00:58:36,052 --> 00:58:38,454
CERTAIN WAY OF CATEGORIZING WHAT

1272
00:58:38,454 --> 00:58:39,489
THEY THINK THE APPROPRIATE RACE 

1273
00:58:39,489 --> 00:58:43,426
OR ETHNICITIES ARE. OTHER TRIALS

1274
00:58:43,426 --> 00:58:44,994
INCLUDED KIND OF GEOGRAPHIC, 

1275
00:58:44,994 --> 00:58:46,896
LIKE EASTERN EUROPE, WESTERN 

1276
00:58:46,896 --> 00:58:49,832
EUROPE, SO THERE'S A LOT OF 

1277
00:58:49,832 --> 00:58:50,733
DIFFERENCES THERE. 

1278
00:58:50,733 --> 00:58:53,469
>> COULD I MAKE A QUICK
GUESS? 

1279
00:58:53,469 --> 00:58:54,003
>> YES. 

1280
00:58:54,003 --> 00:58:58,141
>> ONE THING -- I LOOKED
INTO 

1281
00:58:58,141 --> 00:58:59,509
THE SAME THING. ESPECIALLY THE 

1282
00:58:59,509 --> 00:59:01,711
MORE RECENT TRIALS. WHAT YOU 

1283
00:59:01,711 --> 00:59:03,880
DON'T REALIZE IS MANY EUROPEAN 

1284
00:59:03,880 --> 00:59:05,748
TRIALS SEE PATIENTS FROM TWO TO 

1285
00:59:05,748 --> 00:59:08,184
THREE VERY BIG CENTERS. I WOULD 

1286
00:59:08,184 --> 00:59:09,285
ASSUME THEY CONSIDER THEMSELVES 

1287
00:59:09,285 --> 00:59:13,122
PRETTY UNIFORM IN TERMS OF 

1288
00:59:13,122 --> 00:59:14,557
ETHNICITIES, BASICALLY WHITE 

1289
00:59:14,557 --> 00:59:16,326
PATIENTS. I THINK ONE, THERE IS 

1290
00:59:16,326 --> 00:59:19,462
LACK OF INCENTIVE TO REALLY 

1291
00:59:19,462 --> 00:59:21,097
BREAK IT DOWN. WHEREAS IN REVEAL

1292
00:59:21,097 --> 00:59:23,066
YOU HAVE MULTIPLE CENTERS FROM 

1293
00:59:23,066 --> 00:59:24,100
DIFFERENT PART OF THE UNITED 

1294
00:59:24,100 --> 00:59:25,802
STATES. SO THAT MAKES IT A 

1295
00:59:25,802 --> 00:59:27,670
LITTLE MORE APPEALING TO SAY 

1296
00:59:27,670 --> 00:59:29,939
LET'S BREAK IT DOWN BY RACE. 

1297
00:59:29,939 --> 00:59:32,375
MANY OF THE BIG PIVOTAL EUROPEAN

1298
00:59:32,375 --> 00:59:34,911
TRIALS COME FROM TWO TO THREE 

1299
00:59:34,911 --> 00:59:37,580
MAJOR CENTERS. 

1300
00:59:37,580 --> 00:59:41,150
>> REAL QUICK, DR. KAMET. 

1301
00:59:41,150 --> 00:59:42,485
>> JUST A QUICK COMMENT.
THAT 

1302
00:59:42,485 --> 00:59:44,821
WAS AN AMAZING TALK. YOU REALLY 

1303
00:59:44,821 --> 00:59:47,023
COVERED SO MUCH. TO THE POINT 

1304
00:59:47,023 --> 00:59:48,858
HOW DO WE COLLECT RACE AND 

1305
00:59:48,858 --> 00:59:50,626
ETHNICITY DATA. WE SHOULD BE 

1306
00:59:50,626 --> 00:59:55,131
USING COMMON DATA ELEMENTS, 

1307
00:59:55,131 --> 00:59:59,569
SHARED COLLECTION METHODOLOGIES 

1308
00:59:59,569 --> 01:00:01,471
SO WE CAN HARMONIZE STUDIES AND 

1309
01:00:01,471 --> 01:00:03,005
KNOW MAKEUP OF STUDIES. 

1310
01:00:03,005 --> 01:00:12,749
SOMETIMES WE DON'T EVEN DO THAT.

1311
01:00:12,749 --> 01:00:16,686
>> FOR THOSE OF YOU DONE
STUDY 

1312
01:00:16,686 --> 01:00:18,721
DESIGN, OF COURSE, THAT SHOULD 

1313
01:00:18,721 --> 01:00:20,623
BE IN OUR MINDS, I THINK, WHEN 

1314
01:00:20,623 --> 01:00:24,193
WE ARE DESIGNING STUDIES; IS HOW

1315
01:00:24,193 --> 01:00:25,828
TO STANDARDIZE THAT ACROSS 

1316
01:00:25,828 --> 01:00:26,863
CENTERS, WHICH IS SOMETHING I 

1317
01:00:26,863 --> 01:00:28,364
THINK WE WILL NEED TO DISCUSS AS

1318
01:00:28,364 --> 01:00:30,166
WE MOVE ON. BUT THAT'S BEEN 

1319
01:00:30,166 --> 01:00:33,269
PARTICULARLY AN ISSUE DOWN HERE 

1320
01:00:33,269 --> 01:00:34,837
IN ARIZONA AND OTHER CENTERS 

1321
01:00:34,837 --> 01:00:37,840
INVOLVED IN OUR STUDIES, IS HOW 

1322
01:00:37,840 --> 01:00:41,511
DO WE DEFINE HISPANIC ETHNICITY.

1323
01:00:41,511 --> 01:00:42,912
THAT GETS DOWN TO THE HEART OF 

1324
01:00:42,912 --> 01:00:47,183
THE DIVERSITY, RIGHT. SO LET'S 

1325
01:00:47,183 --> 01:00:52,255
MOVE ON. OUR NEXT SPEAKER IS DR.

1326
01:00:52,255 --> 01:00:57,059
ESTRADA. HE WILL BE SPEAKING ON 

1327
01:00:57,059 --> 01:01:02,465
CONVERGENCE OF DISPARITIES AND 

1328
01:01:02,465 --> 01:01:06,369
PULMONARY VASCULAR PHENOTYPES 

1329
01:01:06,369 --> 01:01:09,972
AMONG BLACK, AFRICA, NATIVE 

1330
01:01:09,972 --> 01:01:16,345
AMERICAN, HISPANIC AND M

1331
01:01:16,345 --> 01:01:18,114
AND MORE PHENOTYPES, WOW. 

1332
01:01:18,114 --> 01:01:21,217
>> THANK YOU. I WANT TO
THANK 

1333
01:01:21,217 --> 01:01:22,652
THE CHAIR AND EXCITED TO 

1334
01:01:22,652 --> 01:01:23,853
CONTRIBUTE AND ACKNOWLEDGE THERE

1335
01:01:23,853 --> 01:01:25,755
ARE EXPERTS IN THE FIELD, IN 

1336
01:01:25,755 --> 01:01:26,856
TODAY'S MEETING WITH US HERE 

1337
01:01:26,856 --> 01:01:28,191
TODAY. MY OBJECTIVES ARE GOING 

1338
01:01:28,191 --> 01:01:31,294
TO BE DISCUSSING THE RACIAL AND 

1339
01:01:31,294 --> 01:01:33,796
ETHNIC DISPARITIES, HOW THEY 

1340
01:01:33,796 --> 01:01:36,899
INFLUENCE TREATMENT AND 

1341
01:01:36,899 --> 01:01:41,237
OUTCOMES, MAINLY FOCUSSING ON 

1342
01:01:41,237 --> 01:01:42,171
PULMONARY HYPERTENSION AND 

1343
01:01:42,171 --> 01:01:47,743
(AUDIO DISRUPTION) AS DR. GOEL 

1344
01:01:47,743 --> 01:01:49,846
POINTED OUT THIS LAYS FOUNDATION

1345
01:01:49,846 --> 01:01:53,015
FOR FUTURE DISCUSSIONS FOR THIS 

1346
01:01:53,015 --> 01:01:55,551
WORKSHOP .  OUR GOAL IS PROVIDE 

1347
01:01:55,551 --> 01:01:56,919
EQUAL HEALTH CARE DELIVERY. 

1348
01:01:56,919 --> 01:01:58,554
DISPARITY MEANS WE HAVE NOT 

1349
01:01:58,554 --> 01:02:01,491
REACHED THIS GOAL. I THINK TO 

1350
01:02:01,491 --> 01:02:02,492
UNDERSTAND DISPARITIES WE HAVE 

1351
01:02:02,492 --> 01:02:04,026
TO FIRST LEARN WHAT GROUPS WE 

1352
01:02:04,026 --> 01:02:05,862
ARE TALKING ABOUT. SO WHERE DOES

1353
01:02:05,862 --> 01:02:11,901
THIS -- SO SORRY. THE NEXT 

1354
01:02:11,901 --> 01:02:12,568
SLIDE. 

1355
01:02:12,568 --> 01:02:13,970
    WHERE DOES THIS CURRENT RACE

1356
01:02:13,970 --> 01:02:15,404
AND ETHNIC CLASSIFICATION COME 

1357
01:02:15,404 --> 01:02:19,041
FROM? OFFICE OF MANAGEMENT AND 

1358
01:02:19,041 --> 01:02:22,278
BUDGET IN' 97 ESTABLISHED WHITE,

1359
01:02:22,278 --> 01:02:25,915
ASIAN, BLACK, AMERICAN INDIAN, 

1360
01:02:25,915 --> 01:02:29,519
ALASKAN, NATIVE HAWAIIAN OR 

1361
01:02:29,519 --> 01:02:31,053
ISLANDER AND HISPANIC OR 

1362
01:02:31,053 --> 01:02:33,789
NON-HISPANIC. USED FOR 

1363
01:02:33,789 --> 01:02:39,061
STATISTICAL AND KEN SUS PUR SEN 

1364
01:02:39,061 --> 01:02:40,630
CENSUS TRIALS BUT WERE REQUIRED 

1365
01:02:40,630 --> 01:02:41,831
FOR TRIALS. 

1366
01:02:41,831 --> 01:02:44,200
    THE DEFINITION OF DIFFERENT 

1367
01:02:44,200 --> 01:02:45,935
TERMS ARE ETHNICITY, CULTURAL 

1368
01:02:45,935 --> 01:02:48,137
IDENTITY. SO LANGUAGE, RELIGION.

1369
01:02:48,137 --> 01:02:50,506
RACE IS ANCESTRAL ORIGIN, 

1370
01:02:50,506 --> 01:02:52,742
PHYSICAL CHARACTERISTICS. 

1371
01:02:52,742 --> 01:02:54,377
ANCESTRY REFERS TO REGION OF 

1372
01:02:54,377 --> 01:02:56,612
ORIGIN, OR LINEAGE OF DECENT, 

1373
01:02:56,612 --> 01:02:59,115
AND GENETIC MIXTURE IS EXCHANGE 

1374
01:02:59,115 --> 01:03:01,751
FROM PEOPLE FROM DIFFERENT 

1375
01:03:01,751 --> 01:03:02,051
ANCESTRIES. 

1376
01:03:02,051 --> 01:03:04,687
    I THINK ONE OF THE KEY 

1377
01:03:04,687 --> 01:03:06,188
CONCEPTS TO MOVE FROM IS, WE 

1378
01:03:06,188 --> 01:03:07,623
WOULD LIKE IT TO  BE LIKE THE 

1379
01:03:07,623 --> 01:03:10,092
IMAGE ON THE LEFT, THE CRAYONS. 

1380
01:03:10,092 --> 01:03:11,794
WHEN REALITY IT LOOKS MORE LIKE 

1381
01:03:11,794 --> 01:03:14,330
THE IMAGE ON THE RIGHT. HOW DO 

1382
01:03:14,330 --> 01:03:16,999
WE TEASE THIS APART? AS DR. GOEL

1383
01:03:16,999 --> 01:03:19,435
POINTED OUT, THESE ARE SOCIAL 

1384
01:03:19,435 --> 01:03:21,804
CONSTRUCTS THAT DON'T HAVE 

1385
01:03:21,804 --> 01:03:25,608
BIOLOGICAL MEAN BUT ARE DYNAMIC 

1386
01:03:25,608 --> 01:03:28,144
AND SHAPED BY POLITICAL AND GEO 

1387
01:03:28,144 --> 01:03:29,579
FORCES. 

1388
01:03:29,579 --> 01:03:31,347
    IN THIS PAPER IN 21 IT GIVES

1389
01:03:31,347 --> 01:03:32,715
GUIDANCE HOW TO REPORT. THEY 

1390
01:03:32,715 --> 01:03:33,983
SAID REPORTING RACE AND 

1391
01:03:33,983 --> 01:03:35,718
ETHNICITY SHOULD NOT BE 

1392
01:03:35,718 --> 01:03:37,219
CONSIDERED IN ISOLATION; USUALLY

1393
01:03:37,219 --> 01:03:38,888
SHOULD BE ACCOMPANIED OR 

1394
01:03:38,888 --> 01:03:42,792
REPORTING OF OTHER SOCIAL 

1395
01:03:42,792 --> 01:03:45,061
DEMOGRAPHIC OR DETERMINANTS. 

1396
01:03:45,061 --> 01:03:46,729
THESE TYPICALLY RELY ON 

1397
01:03:46,729 --> 01:03:47,463
INDIVIDUAL'S PARTICIPATION 

1398
01:03:47,463 --> 01:03:49,098
SELF-REPORT OR ASSIGNMENT BY 

1399
01:03:49,098 --> 01:03:50,533
INVESTIGATORS, BUT THEY ARE BOTH

1400
01:03:50,533 --> 01:03:52,535
FROM TRULY HIGHLY PRONE TO 

1401
01:03:52,535 --> 01:03:54,170
ERROR, ESPECIALLY WHEN COMPARED 

1402
01:03:54,170 --> 01:03:57,273
TO D.N.A.-BASED DETERMINATIONS. 

1403
01:03:57,273 --> 01:04:00,076
THIS PAPER, THE AUTHOR ASSESSED 

1404
01:04:00,076 --> 01:04:02,011
SELF-IDENTIFY HISPANICS IN YOUR 

1405
01:04:02,011 --> 01:04:04,447
CITY, SHOWN TO BE 29 PEREZ 

1406
01:04:04,447 --> 01:04:07,683
EUROPEAN, 26 PEREZ AFRICAN, 45 

1407
01:04:07,683 --> 01:04:08,985
PEREZ NATIVE AMERICAN WHEN 

1408
01:04:08,985 --> 01:04:12,755
ASSESSED BY ANCESTRY AND 

1409
01:04:12,755 --> 01:04:14,357
MARKERS. HOWEVER THE REPORT 

1410
01:04:14,357 --> 01:04:16,258
RAISED IN ETHNICITY MEDICAL 

1411
01:04:16,258 --> 01:04:18,427
RESEARCH DISREGARDS REALITY OF 

1412
01:04:18,427 --> 01:04:21,097
SOCIAL CERTIFICATION, 

1413
01:04:21,097 --> 01:04:21,931
INJUSTICES, INEQUITIES FOR 

1414
01:04:21,931 --> 01:04:24,300
POPULATION HEALTH. TRULY 

1415
01:04:24,300 --> 01:04:27,870
REMOVING RACE AND ETHNICITY MAY 

1416
01:04:27,870 --> 01:04:28,904
CONCEAL THESE DISPARITIES. THAT 

1417
01:04:28,904 --> 01:04:30,673
IS WHY WE ARE HERE TO DISCUSS 

1418
01:04:30,673 --> 01:04:31,140
ABOUT IT. 

1419
01:04:31,140 --> 01:04:33,376
    HOW HAS OUR POPULATION 

1420
01:04:33,376 --> 01:04:35,578
CHANGED IN THE UNITED STATES? 

1421
01:04:35,578 --> 01:04:37,780
COMPARED TO 2010 THE CENSUS IN 

1422
01:04:37,780 --> 01:04:39,415
2020 HAS DECREASE IN WHITE 

1423
01:04:39,415 --> 01:04:41,350
POPULATION, INCREASE IN P 

1424
01:04:41,350 --> 01:04:43,052
HISPANIC POPULATION AND MAPS ON 

1425
01:04:43,052 --> 01:04:46,656
THE LEFT REFLECT MAJORITY BY 

1426
01:04:46,656 --> 01:04:49,025
COUNTY. SO THE LARGEST GROUP BY 

1427
01:04:49,025 --> 01:04:51,560
COUNTY IN THE UPPER IMAGE IS 

1428
01:04:51,560 --> 01:04:56,032
MOSTLY WHITE ALONE, NON-HISPANIC

1429
01:04:56,032 --> 01:04:57,900
ACCEPT IN BORDER TOWNS, WHERE IS

1430
01:04:57,900 --> 01:04:59,869
THE MOST MAJORITY, THE HISPANIC.

1431
01:04:59,869 --> 01:05:03,305
THE SECOND LARGEST IS HISPANIC 

1432
01:05:03,305 --> 01:05:06,509
OR LATINO OF ANY RACE. NEXT. 

1433
01:05:06,509 --> 01:05:07,910
    WHEN COMES TO DISPARITIES 

1434
01:05:07,910 --> 01:05:10,112
THERE IS A BIG SOCIAL COST. THE 

1435
01:05:10,112 --> 01:05:13,516
COST TO U.S.  IS ESTIMATED TO BE

1436
01:05:13,516 --> 01:05:15,918
ABOUT $450 BILLION. LOOKS LIKE 

1437
01:05:15,918 --> 01:05:21,157
IT IS LARGELY DRIVEN BY 

1438
01:05:21,157 --> 01:05:22,491
DISPARITIES IN AFRICAN-AMERICAN 

1439
01:05:22,491 --> 01:05:23,826
POPULATION, SPECIFICALLY FOR 

1440
01:05:23,826 --> 01:05:27,897
EXCESS PREMATURE DEATHS. NEXT. 

1441
01:05:27,897 --> 01:05:30,800
    HOW DOES IT LOOK LIKE IN 

1442
01:05:30,800 --> 01:05:34,003
PULMONARY HEART DOES CEASE? THIS

1443
01:05:34,003 --> 01:05:40,910
REVIEW 2024, BETWEEN 2009 AND 

1444
01:05:40,910 --> 01:05:42,511
2020 THE AGE INCREASED THROUGH 

1445
01:05:42,511 --> 01:05:47,349
ABOUT 2026. THEY HAD STEADY 

1446
01:05:47,349 --> 01:05:48,918
INCREASE UNTIL 2020. ON THE 

1447
01:05:48,918 --> 01:05:59,028
RIGHT IMAGE THERE SIGNIFICANT 

1448
01:05:59,028 --> 01:05:59,495
RAC 

1449
01:05:59,495 --> 01:06:00,830
DISPARITIES ESPECIALLY IN THE 

1450
01:06:00,830 --> 01:06:03,966
BLACK POPULATION. HOW DOES 

1451
01:06:03,966 --> 01:06:10,072
OUTCOME FARE IN ETHNICITY. THE 

1452
01:06:10,072 --> 01:06:12,141
DATABASE USING CODES TO IDENTIFY

1453
01:06:12,141 --> 01:06:13,676
INDIVIDUALS WITH PH IDENTIFIED 

1454
01:06:13,676 --> 01:06:15,878
ABOUT 430,000 DEATHS. DESPITE 

1455
01:06:15,878 --> 01:06:18,280
ADVANCES IN THERAPY FOR PAH THE 

1456
01:06:18,280 --> 01:06:21,150
OVERALL MORTALITY INCREASED FROM

1457
01:06:21,150 --> 01:06:27,690
8 PER 100,000 TO UP TO 24 BY 

1458
01:06:27,690 --> 01:06:29,759
100,000. INTERESTINGLY, THOUGH, 

1459
01:06:29,759 --> 01:06:35,030
USING THIS SAME DATABASE FROM 

1460
01:06:35,030 --> 01:06:35,631
2003-2020 AND USING THE 

1461
01:06:35,631 --> 01:06:37,666
MORTALITY RATES, IT APPEARS 

1462
01:06:37,666 --> 01:06:42,004
DEATHS WERE LARGELY RELATED TO 

1463
01:06:42,004 --> 01:06:43,205
LEFT-HEARTED LUNG DISEASE, OR 

1464
01:06:43,205 --> 01:06:45,641
GROUP 2 TO 5. THOSE HAVE BEEN 

1465
01:06:45,641 --> 01:06:46,909
RISING OVER THE LAST TWO 

1466
01:06:46,909 --> 01:06:48,177
DECADES, ACCOUNTING FOR THE 

1467
01:06:48,177 --> 01:06:50,179
MAJORITY OF THIS MORTALITY 

1468
01:06:50,179 --> 01:06:52,047
BURDEN. THOUGH THERE HAS BEEN A 

1469
01:06:52,047 --> 01:06:53,983
DECLINE IN GROUP ONE MORTALITY 

1470
01:06:53,983 --> 01:06:56,252
RATES. AS YOU CAN TELL FROM ALL 

1471
01:06:56,252 --> 01:06:57,353
COHORTS THE BLACK POPULATION HAS

1472
01:06:57,353 --> 01:07:01,157
HAD THE WORST OUTCOMES. NEXT 

1473
01:07:01,157 --> 01:07:01,390
SLIDE. 

1474
01:07:01,390 --> 01:07:08,564
    WHEN IT COMES TO THE REVEAL 

1475
01:07:08,564 --> 01:07:10,866
REGISTRY, YOU WILL FIND THE 

1476
01:07:10,866 --> 01:07:13,803
FIVE-YEAR SURVIVAL ON THE LEFT, 

1477
01:07:13,803 --> 01:07:16,972
HIGHEST AMONG HISPANIC AMONG 

1478
01:07:16,972 --> 01:07:17,807
PREVIOUSLY DIAGNOSED PATIENTS. 

1479
01:07:17,807 --> 01:07:19,475
IN THIS STUDY THEY ANALYZED 

1480
01:07:19,475 --> 01:07:21,610
OUTCOMES BASED ON ETHNICITY AND 

1481
01:07:21,610 --> 01:07:24,079
FOUND THOSE IMPROVED SURVIVAL 

1482
01:07:24,079 --> 01:07:30,219
HISPANIC IN THE UNI-VARIANT 

1483
01:07:30,219 --> 01:07:34,657
ANALYSIS TBUT WHEN THEY ADJUSTE,

1484
01:07:34,657 --> 01:07:36,992
THERE WAS NO DIFFERENCE -- IS 

1485
01:07:36,992 --> 01:07:38,561
STUDY COULD NOT ACCOUNT IN 

1486
01:07:38,561 --> 01:07:40,629
SOCIOECONOMIC FACTORS, SINCE 

1487
01:07:40,629 --> 01:07:41,931
THIS INFORMATION WAS NOT 

1488
01:07:41,931 --> 01:07:46,035
AVAILABLE ON THE REVEAL 

1489
01:07:46,035 --> 01:07:48,037
REGISTRY. NEXT. 

1490
01:07:48,037 --> 01:07:50,506
    AS DR. GOEL POINTED OUT, 

1491
01:07:50,506 --> 01:07:51,373
REPRESENTATION, REGISTRIES AND 

1492
01:07:51,373 --> 01:07:53,242
FILES IS ONE OF THE KEY ASPECTS 

1493
01:07:53,242 --> 01:07:56,445
TO BE ADDRESSED. ON LEFT SIDE, 

1494
01:07:56,445 --> 01:07:57,713
DISCREPANCY BETWEEN WHAT IS 

1495
01:07:57,713 --> 01:07:59,081
EXPECTED IN CENSUS POPULATION 

1496
01:07:59,081 --> 01:08:02,084
AND THE REALITY WITHIN THE 

1497
01:08:02,084 --> 01:08:04,086
REGISTRY, IT IS STARK. ON THE 

1498
01:08:04,086 --> 01:08:07,556
RIGHT SIDE IT IS A CONDENSED 

1499
01:08:07,556 --> 01:08:10,292
CHART ABOUT THE TRIALS. MOST HAD

1500
01:08:10,292 --> 01:08:17,433
GREATER THAN 75 PEREZ OF WH % /%

1501
01:08:17,433 --> 01:08:20,102
OF WHITE POPULATION THEN IN U.S.

1502
01:08:20,102 --> 01:08:25,975
 54 TO 58 PEREZ. AND NEXT SLIDE,

1503
01:08:25,975 --> 01:08:29,311
PLEASE. SO WHEN COMES TO THE 

1504
01:08:29,311 --> 01:08:32,281
ETIOLOGY ON ETHNICITY, ANALYZING

1505
01:08:32,281 --> 01:08:36,485
THE PH BIOBANK, ONGOING FUNDED 

1506
01:08:36,485 --> 01:08:39,488
SAMPLE OF PATIENTS ENROLLED IN 

1507
01:08:39,488 --> 01:08:41,657
34 U.S.  CENTERS, THIS BIOBANK 

1508
01:08:41,657 --> 01:08:43,893
HAS CLINICAL DATA AND SAMPLES 

1509
01:08:43,893 --> 01:08:47,997
AND GENETIC DATA OF ABOUT 1,800,

1510
01:08:47,997 --> 01:08:58,641
80 PEREZ ROUGHLY WERE -- 80 % H 

1511
01:08:58,641 --> 01:09:00,209
THIS SEEMS LIKE THE HISPANIC 

1512
01:09:00,209 --> 01:09:03,612
COHORTS WERE YOUNGER. IN REVEAL 

1513
01:09:03,612 --> 01:09:07,549
REGISTRY APPEARS HISPANIC AND 

1514
01:09:07,549 --> 01:09:09,351
ASIAN WERE YOUNGER. MAJORITY 

1515
01:09:09,351 --> 01:09:12,554
WITH CONNECTIVE TISSUE DISEASE 

1516
01:09:12,554 --> 01:09:13,656
WERE MOST AFRICAN-AMERICAN OR 

1517
01:09:13,656 --> 01:09:15,891
BLACK. NON-HISPANIC OR WHITE 

1518
01:09:15,891 --> 01:09:17,426
HOUSE HAS FAMILIAR PH RELATED TO

1519
01:09:17,426 --> 01:09:20,329
DRUG OR TOXINS. HISPANICS WERE 

1520
01:09:20,329 --> 01:09:22,731
YOUNGER, HAD HIGHER INCIDENCE OF

1521
01:09:22,731 --> 01:09:24,266
CONGENITAL HEART DISEASE 

1522
01:09:24,266 --> 01:09:25,467
ASSOCIATED. THEY WERE LESS 

1523
01:09:25,467 --> 01:09:27,636
LIKELY TO BE DESCRIBED PH 

1524
01:09:27,636 --> 01:09:31,307
MEDICATION AS WELL. IN THE REAL 

1525
01:09:31,307 --> 01:09:35,311
REGISTRY MOST ASSOCIATED WITH 

1526
01:09:35,311 --> 01:09:36,745
PULMONARY HYPERTENSION. 

1527
01:09:36,745 --> 01:09:42,151
>> IN THE MESA CORE STUDY,
STUDY

1528
01:09:42,151 --> 01:09:47,523
OF AT HER ROW SCLEROSIS, ABOUT 

1529
01:09:47,523 --> 01:09:48,657
6800, AFRICAN-AMERICAN, 

1530
01:09:48,657 --> 01:09:50,326
HISPANIC, WHITE AND CHINESE 

1531
01:09:50,326 --> 01:09:55,064
AMERICAN, THEY ANALYZED THE 

1532
01:09:55,064 --> 01:09:57,366
INCIDENCE OF CONGESTIVE HEART 

1533
01:09:57,366 --> 01:09:59,635
FAILURE AND FOUND HIGHER 

1534
01:09:59,635 --> 01:10:00,803
INCIDENCE OF BLACK AND 

1535
01:10:00,803 --> 01:10:03,739
AFRICAN-AMERICANS, MOSTLY 

1536
01:10:03,739 --> 01:10:05,507
RELATED TO HYPERTENSION, 

1537
01:10:05,507 --> 01:10:07,142
DIABETES AND SOCIOECONOMIC 

1538
01:10:07,142 --> 01:10:10,646
STATUS. IN 2017 THIS PAPER 

1539
01:10:10,646 --> 01:10:12,514
ANALYZED RATE OF HEART FAILURE 

1540
01:10:12,514 --> 01:10:13,749
HOSPITALIZATIONS. IT WAS ABOUT 

1541
01:10:13,749 --> 01:10:18,887
230 PEREZ HIGHER IN BLACK MEN, 

1542
01:10:18,887 --> 01:10:20,456
240 PEREZ HIGHER IN BLACK WOMEN 

1543
01:10:20,456 --> 01:10:22,891
COMPARED TO WHITES IN 2013. 

1544
01:10:22,891 --> 01:10:24,994
THESE PERSISTED ACROSS THE 

1545
01:10:24,994 --> 01:10:26,695
DECADE. IN CONTRAST DIFFERENCE 

1546
01:10:26,695 --> 01:10:27,730
OF HEART FAILURE 

1547
01:10:27,730 --> 01:10:29,865
HOSPITALIZATIONS NARROWED WITHIN

1548
01:10:29,865 --> 01:10:31,934
THE HISPANICS DURING THE SAME 

1549
01:10:31,934 --> 01:10:35,304
TIME PERIOD. ASIAN AND PACIFIC 

1550
01:10:35,304 --> 01:10:37,406
ISLANDERS HAVE MAINTAINED THE 

1551
01:10:37,406 --> 01:10:39,675
LOWEST RATES COMPARED TO OTHER 

1552
01:10:39,675 --> 01:10:41,577
RACIAL ETHNIC GROUPS. THERE IS 

1553
01:10:41,577 --> 01:10:43,412
AN INTERESTING STUDY IN 

1554
01:10:43,412 --> 01:10:44,580
CALIFORNIA THAT SHOW YOUNG BLACK

1555
01:10:44,580 --> 01:10:46,382
ADULTS WERE NOT ONLY SIX TIMES 

1556
01:10:46,382 --> 01:10:48,951
MORE LIKELY TO BE HOSPITALIZED 

1557
01:10:48,951 --> 01:10:50,652
FOR HEART FAILURE COMPARED TO 

1558
01:10:50,652 --> 01:10:52,388
WHITE INDIVIDUALS BUT WERE ALSO 

1559
01:10:52,388 --> 01:10:54,623
YOUNGER AT THE TIME OF 

1560
01:10:54,623 --> 01:10:55,024
HOSPITALIZATION. 

1561
01:10:55,024 --> 01:10:58,193
    SO SOME KEY POINTS -- NEXT 

1562
01:10:58,193 --> 01:11:01,630
SLIDE, THANK YOU. SOME KEY 

1563
01:11:01,630 --> 01:11:04,333
POINTS FOR BLACK POPULATION, 

1564
01:11:04,333 --> 01:11:09,438
EVIDENCE IN 1986 SHOWED HIGHER 

1565
01:11:09,438 --> 01:11:13,709
LEVELS IN THE BLACK COHORT. 

1566
01:11:13,709 --> 01:11:18,247
NOTICE IN 2004 TESTED IMBALANCE 

1567
01:11:18,247 --> 01:11:20,849
AND QUESTIONED WHETHER IT WAS 

1568
01:11:20,849 --> 01:11:24,219
RELATED. GABULAR USED SIX RANDOM

1569
01:11:24,219 --> 01:11:26,088
TRIALS OF ERA SUBMITTED TO FDA 

1570
01:11:26,088 --> 01:11:28,424
AND FOUND THERE WAS A BLUNTED 

1571
01:11:28,424 --> 01:11:34,897
RESPONSE TO TREATMENT TO ERA IN 

1572
01:11:34,897 --> 01:11:37,366
THE STUDY, THE LONGITUDINAL 

1573
01:11:37,366 --> 01:11:39,234
PERSPECTIVE OBSERVATIONAL COHORT

1574
01:11:39,234 --> 01:11:44,206
OF AFRICAN-AMERICANS, ABOUT 3200

1575
01:11:44,206 --> 01:11:47,109
SELF-IDENTIFY AND POTENTIAL BY 

1576
01:11:47,109 --> 01:11:48,777
ECHO AND FOUND HIGHER LEVEL ONE 

1577
01:11:48,777 --> 01:11:51,947
WERE ASSOCIATED WITH HIGHER 

1578
01:11:51,947 --> 01:11:52,881
HYPERTENSION AND HEART FAILURE 

1579
01:11:52,881 --> 01:11:56,652
AND HIGHER MORTALITY. STUDY IN 

1580
01:11:56,652 --> 01:12:00,389
2024 USING NATIONAL IN-PATIENT 

1581
01:12:00,389 --> 01:12:05,027
SAMPLE FROM 2015 E 2019 AND 

1582
01:12:05,027 --> 01:12:07,162
CODES OF HIV AND PULMONARY 

1583
01:12:07,162 --> 01:12:09,865
HYPERTENSION, NOTICE OVER 

1584
01:12:09,865 --> 01:12:12,668
900,000 OF HIV, 3 PEREZ HAS THE 

1585
01:12:12,668 --> 01:12:13,669
HYPERTENSION. WHEN COMPARED TO 

1586
01:12:13,669 --> 01:12:16,505
HIV ALONE, THE PH PATIENTS WERE 

1587
01:12:16,505 --> 01:12:18,941
OLDER, MORE LIKELY TO BE BLACK, 

1588
01:12:18,941 --> 01:12:23,312
MALE AND HAD A HIGHER INCIDENCE 

1589
01:12:23,312 --> 01:12:29,885
OF CO. MORBIDITIES. IN 2019 

1590
01:12:29,885 --> 01:12:32,454
THERE WAS A HIGHER PERCENTAGE OF

1591
01:12:32,454 --> 01:12:35,524
BLACK CHILDREN LARGELY DRIVEN BY

1592
01:12:35,524 --> 01:12:37,493
LUNG DISEASE WITH PULMONARY 

1593
01:12:37,493 --> 01:12:39,128
HYPERTENSION. NEXT PLEASE. 

1594
01:12:39,128 --> 01:12:42,331
    SO CONNECTIVE TISSUE DISEASE

1595
01:12:42,331 --> 01:12:45,534
PULMONARY HYPERTENSION IN BLACKS

1596
01:12:45,534 --> 01:12:48,971
LARGELY RELATED TO INCIDENCE OF 

1597
01:12:48,971 --> 01:12:50,639
THIS AND LUPUS IN BLACK PP 

1598
01:12:50,639 --> 01:12:53,509
ALLEGATION ARE HIGHER AND SHOWS 

1599
01:12:53,509 --> 01:12:55,144
THIS IN AFRICAN-AMERICANS WERE 

1600
01:12:55,144 --> 01:12:57,679
ASSOCIATED WITH MORE SEVERE PH, 

1601
01:12:57,679 --> 01:13:00,048
THOUGH MORTALITY ASSOCIATED WITH

1602
01:13:00,048 --> 01:13:01,750
SOCIOECONOMIC STATUS, NOT RACE. 

1603
01:13:01,750 --> 01:13:04,786
THIS STUDY WAS A RETROSPECTIVE 

1604
01:13:04,786 --> 01:13:06,288
STUDY COMPARING 

1605
01:13:06,288 --> 01:13:08,590
AFRICAN-AMERICANS TO 

1606
01:13:08,590 --> 01:13:09,224
NON-AFRICAN-AMERICAN PATIENTS 

1607
01:13:09,224 --> 01:13:10,759
WITH THIS. THE COHORT ANALYSIS 

1608
01:13:10,759 --> 01:13:13,428
FROM THE HOPKINS PROGRAM FROM 

1609
01:13:13,428 --> 01:13:15,097
ABOUT 160 PATIENTS SHOWED BLACK 

1610
01:13:15,097 --> 01:13:17,332
PATIENTS WITHER FOUND TO HAVE 

1611
01:13:17,332 --> 01:13:19,902
WORST FUNCTIONAL CLASS UPON 

1612
01:13:19,902 --> 01:13:22,171
PRESENTATION, LOWER EXERCISE, 

1613
01:13:22,171 --> 01:13:23,872
HIGHER NATURAL PEPTIDES, MORE 

1614
01:13:23,872 --> 01:13:28,377
SEVERE HUMAN DYNAMIC METHODS AND

1615
01:13:28,377 --> 01:13:30,812
TRANSITORY TOWARDS SURVIVAL. 

1616
01:13:30,812 --> 01:13:31,246
NEXT SLIDE. 

1617
01:13:31,246 --> 01:13:33,482
    DO BLACKS HAVE WORSE 

1618
01:13:33,482 --> 01:13:36,518
OUTCOMES IN PH? THIS IS VERY 

1619
01:13:36,518 --> 01:13:37,920
INTERESTING STUDY FROM THE 

1620
01:13:37,920 --> 01:13:40,889
VANDERBILT GROUP ASSESSING THE 

1621
01:13:40,889 --> 01:13:42,891
CATH IN IN-PATIENT AND 

1622
01:13:42,891 --> 01:13:46,028
OUTPATIENT SETTINGS FROM 

1623
01:13:46,028 --> 01:13:48,997
2008-2014. ABOUT 4,500 PATIENTER

1624
01:13:48,997 --> 01:13:56,004
WERE INCLUDED, OF THE ONES 13 % 

1625
01:13:56,004 --> 01:14:03,812
ANAPHYLACTIC. THEY W AFZ /* --  

1626
01:14:03,812 --> 01:14:05,981
AFRICAN-AMERICAN AND HAD HIGHER 

1627
01:14:05,981 --> 01:14:08,450
PREVALENCE OF ALL ETIOLOGIES OF 

1628
01:14:08,450 --> 01:14:11,386
HYPERTENSION, 41 HIGHER RISK OF 

1629
01:14:11,386 --> 01:14:15,857
PH AND 24 PERCENT ADJUST RISK TO

1630
01:14:15,857 --> 01:14:17,793
MORTALITY. THIS OTHER STUDY IN 

1631
01:14:17,793 --> 01:14:19,928
2017 WAS MENTIONED ALREADY. 

1632
01:14:19,928 --> 01:14:21,263
INCLUDED 250PH PATIENTS 

1633
01:14:21,263 --> 01:14:23,999
ANALYZING TWO COHORTS. THEY ONLY

1634
01:14:23,999 --> 01:14:26,201
USED BLACK AND WHITE RACE, 

1635
01:14:26,201 --> 01:14:27,703
OTHERS WERE EXCLUDED. IF THEY 

1636
01:14:27,703 --> 01:14:31,039
HAD -- WERE OUT OF THIS TWO 

1637
01:14:31,039 --> 01:14:32,441
COHORTS. AFTER ADJUSTMENT FOR 

1638
01:14:32,441 --> 01:14:34,876
AGE AND FUNCTION OF CLASS, 

1639
01:14:34,876 --> 01:14:36,511
BLACKS HAD HIGHER, GREATER 

1640
01:14:36,511 --> 01:14:38,013
MORTALITY RISK BUT DISAPPEARED 

1641
01:14:38,013 --> 01:14:39,848
WHEN ADJUSTED FOR INSURANCE 

1642
01:14:39,848 --> 01:14:41,049
STATUS. THIS PAPER IS GOING TO 

1643
01:14:41,049 --> 01:14:50,826
BE QUOTED LATER ON AS WELL. PH 

1644
01:14:50,826 --> 01:14:51,960
IS MORE PREVALENCE IN BLACKS 

1645
01:14:51,960 --> 01:15:00,202
WITH SARCODOSIS IN REGISTRY AND 

1646
01:15:00,202 --> 01:15:03,171
12% HIGHER THAN IN CAUCASIANS 

1647
01:15:03,171 --> 01:15:05,173
AND IN THIS OBSERVATIONAL 

1648
01:15:05,173 --> 01:15:06,341
REGISTRY IN THE U.S. 

1649
01:15:06,341 --> 01:15:10,279
 INITIATE ED IN 2011, ABOUT 200 

1650
01:15:10,279 --> 01:15:11,480
PATIENTS WERE DIAGNOSED WITH 

1651
01:15:11,480 --> 01:15:16,718
THIS, 55% WERE OF BLACK RACE IN 

1652
01:15:16,718 --> 01:15:20,922
THE SARCODOSIS COHORT. WHEN 

1653
01:15:20,922 --> 01:15:25,027
COMES TO HUMAN DYNAMICS BLACK 

1654
01:15:25,027 --> 01:15:28,130
HAVE HIGHER MPAP PRESSURES AND 

1655
01:15:28,130 --> 01:15:32,434
THIS STUDY, THE CORONARY RISK 

1656
01:15:32,434 --> 01:15:36,872
DEVELOPMENT IN YOUNG ADULT. 

1657
01:15:36,872 --> 01:15:39,341
BETWEEN 1985, OVER 5,000 

1658
01:15:39,341 --> 01:15:41,677
PATIENTS WERE ENROLLED, USUALLY 

1659
01:15:41,677 --> 01:15:43,912
BLACK OR WHITE. 18 TO 30 YEARS 

1660
01:15:43,912 --> 01:15:46,014
OLD THEY WERE ENROLLED IN FOUR 

1661
01:15:46,014 --> 01:15:49,151
SITES. IN 2017 THIS STUDY FOUND 

1662
01:15:49,151 --> 01:15:50,886
THE ASSOCIATION BETWEEN BLACK 

1663
01:15:50,886 --> 01:15:52,254
AND HIGHER PULMONARY PRESSURES 

1664
01:15:52,254 --> 01:15:54,856
IN ECHO, IT WAS REGARDLESS OF 

1665
01:15:54,856 --> 01:15:56,425
AGE. ON THE RIGHT SIDE WE SEE 

1666
01:15:56,425 --> 01:15:59,328
THE JACKSON HEART STUDY, THE 

1667
01:15:59,328 --> 01:16:01,930
LONGITUDINAL POPULATION BASED 

1668
01:16:01,930 --> 01:16:03,632
COHORT, AND THIS FOR PATIENTS 

1669
01:16:03,632 --> 01:16:06,368
RESIDING IN JACKSON, 

1670
01:16:06,368 --> 01:16:07,502
MISSISSIPPI, FOUND HIGH 

1671
01:16:07,502 --> 01:16:08,303
ARTERIAL PRESSURE WAS 

1672
01:16:08,303 --> 01:16:13,075
SIGNIFICANT RISK FACTOR FOR 

1673
01:16:13,075 --> 01:16:14,276
HOSPITALIZATION. NEXT SLIDE, 

1674
01:16:14,276 --> 01:16:14,576
PLEASE. 

1675
01:16:14,576 --> 01:16:17,012
>> THIS IS WHEN WE TALK
ABOUT 

1676
01:16:17,012 --> 01:16:20,849
AMERICAN INDIAN AND ALASKAN 

1677
01:16:20,849 --> 01:16:22,951
NATIVE WITH CARDIOVASCULAR 

1678
01:16:22,951 --> 01:16:24,720
DISEASE, THERE WAS A SCARCITY. 

1679
01:16:24,720 --> 01:16:29,624
THIS IS ONE OF THE PAPERS FROM 

1680
01:16:29,624 --> 01:16:37,666
GEMA. 50% HAS CARDIOVASCULAR 

1681
01:16:37,666 --> 01:16:41,970
DISEASE AND USING THIS COHORT 

1682
01:16:41,970 --> 01:16:43,205
NOTICE THERE IS DECREASE IN CD, 

1683
01:16:43,205 --> 01:16:44,539
INCREASE IN MI AND HEART 

1684
01:16:44,539 --> 01:16:49,378
FAILURE. RATE OF CVA AND AFIB 

1685
01:16:49,378 --> 01:16:51,546
STAYED THE SAME. INTERESTING, 

1686
01:16:51,546 --> 01:16:54,216
20% MORTALITY RATE WITHIN THIS 

1687
01:16:54,216 --> 01:17:00,055
COHORT. NEXT SLIDE. IN THE 

1688
01:17:00,055 --> 01:17:04,426
KOREAN STUDY PATIENTS, ABOUT 1.9

1689
01:17:04,426 --> 01:17:05,494
PER YEAR PER MILLION. THE 

1690
01:17:05,494 --> 01:17:08,029
SURVIVAL WAS ABOUT 90%. FOR 

1691
01:17:08,029 --> 01:17:10,232
COMPARISON I PUT REVEAL OF 

1692
01:17:10,232 --> 01:17:13,268
REGISTRY 1 SURVIVAL ABOUT 90% AS

1693
01:17:13,268 --> 01:17:18,774
WELL. THIS KOREAN CORE RECEIVED 

1694
01:17:18,774 --> 01:17:20,208
LESS INTENSIVE THERAPY THOUGHT 

1695
01:17:20,208 --> 01:17:23,712
DUE TO INSURANCE. IN JAPAN, MORE

1696
01:17:23,712 --> 01:17:28,183
PREVALENT, ABOUT TWO-THIRDS. BUT

1697
01:17:28,183 --> 01:17:29,418
THREE-YEAR, PRE-SURVIVAL RATE 

1698
01:17:29,418 --> 01:17:31,319
WAS ABOUT SAME IN REVEAL 

1699
01:17:31,319 --> 01:17:35,190
REGISTRY, AROUND 70s. IN INDIAN 

1700
01:17:35,190 --> 01:17:36,191
CONGENITAL HEART DISEASE WAS 

1701
01:17:36,191 --> 01:17:39,361
MOST PREVALENT AND MORTALITY 8% 

1702
01:17:39,361 --> 01:17:42,731
IN PERIOD BETWEEN 2015 AND 2023.

1703
01:17:42,731 --> 01:17:45,066
IN PHILIPPINES, THIS WAS MOSTLY 

1704
01:17:45,066 --> 01:17:50,739
ASSOCIATED WITH LUPUS. HIGHEST 

1705
01:17:50,739 --> 01:17:53,642
MORTALITY WITH SCLERODERMA. 

1706
01:17:53,642 --> 01:17:55,777
    WHEN COMES TO ASIAN OUTCOMES

1707
01:17:55,777 --> 01:17:57,412
THESE REGISTRIES ARE 

1708
01:17:57,412 --> 01:17:58,780
INTERESTING. ONE ON LEFT IS 

1709
01:17:58,780 --> 01:18:02,784
SINGAPORE WITH MULTI -ETHNIC 

1710
01:18:02,784 --> 01:18:10,826
ASIAN COHORT FROM 2003-2016. 

1711
01:18:10,826 --> 01:18:13,328
THESE ARE BETTER WHEN COMPARED 

1712
01:18:13,328 --> 01:18:17,032
TO FRENCH AND KOREAN. MOST 

1713
01:18:17,032 --> 01:18:18,967
COMMON CON GENERATIVE HEART 

1714
01:18:18,967 --> 01:18:23,338
DISEASE, IDIOPATHIC AND 

1715
01:18:23,338 --> 01:18:25,106
CONNECTIVE TISSUE DISEASE, 

1716
01:18:25,106 --> 01:18:27,909
MAJORITY CLASS 2, 50% FUNCTIONAL

1717
01:18:27,909 --> 01:18:33,081
AND MOST WERE ON MONOTHERAPY. 

1718
01:18:33,081 --> 01:18:41,556
54%. THE ETHNICITY WERE A MIX OF

1719
01:18:41,556 --> 01:18:44,559
CHINESE, MALAI AND OTHERS. I 

1720
01:18:44,559 --> 01:18:45,760
THOUGHT IT INTERESTING TO SEE 

1721
01:18:45,760 --> 01:18:47,729
WHAT OTHER PARTS OF THE WORLD 

1722
01:18:47,729 --> 01:18:48,997
ARE DOING WELL, SAME CHALLENGES 

1723
01:18:48,997 --> 01:18:51,800
THEY ARE FACING. IN THIS CHINESE

1724
01:18:51,800 --> 01:19:00,041
REGISTRY FROM 199  9 TO 2004 

1725
01:19:00,041 --> 01:19:04,279
TLUZ WITH A DELAY AND WORSE THAN

1726
01:19:04,279 --> 01:19:07,516
REGISTRIES. AT THE TIME THEY 

1727
01:19:07,516 --> 01:19:11,453
DIDN'T HAVE (?) IN THAT REGION. 

1728
01:19:11,453 --> 01:19:12,153
NEXT SLIDE. 

1729
01:19:12,153 --> 01:19:14,823
    WHAT DO WE DO ABOUT HISPANIC

1730
01:19:14,823 --> 01:19:16,558
SURVIVAL AND HISPANIC COHORT? 

1731
01:19:16,558 --> 01:19:19,895
THE EVENT DISAPPEARED SOCIAL 

1732
01:19:19,895 --> 01:19:21,496
WROTE ECONOMIC STATUS ADJUSTMENT

1733
01:19:21,496 --> 01:19:24,633
IN THIS PAPER BY BERNARDO, 

1734
01:19:24,633 --> 01:19:26,735
QUOTED LATER ON, HAD A HIGHER 

1735
01:19:26,735 --> 01:19:29,838
REPRESENTATION OF MINORITIES 

1736
01:19:29,838 --> 01:19:35,176
FROM THE FAR REGISTRY COMPARED 

1737
01:19:35,176 --> 01:19:37,245
TO THE OTHER SHEET. HISPANIC 

1738
01:19:37,245 --> 01:19:39,447
PATIENTS WERE MOST COMMON 

1739
01:19:39,447 --> 01:19:41,216
ASSOCIATED TO DRUG OR CONGENITAL

1740
01:19:41,216 --> 01:19:43,251
HEART DISEASE. THERE WAS A HIGH 

1741
01:19:43,251 --> 01:19:45,253
IMPAIRED ACCESS TO HEALTH, LOWER

1742
01:19:45,253 --> 01:19:48,623
ANNUAL INCOME, LOWER EDUCATIONAL

1743
01:19:48,623 --> 01:19:50,425
LEVEL, HIGHER UNEMPLOYMENT, 

1744
01:19:50,425 --> 01:19:51,526
HIGHER FREQUENCY OF EMERGENCY 

1745
01:19:51,526 --> 01:19:52,827
VISITS AND HIGHER 

1746
01:19:52,827 --> 01:19:54,930
HOSPITALIZATIONS DESPITE SIMILAR

1747
01:19:54,930 --> 01:19:57,999
FUNCTIONAL CLASS, RISK, EXERCISE

1748
01:19:57,999 --> 01:20:00,435
CAPACITY AND SPECIFIC THERAPY. 

1749
01:20:00,435 --> 01:20:02,170
THIS SURVIVAL ANALYSIS WAS NO 

1750
01:20:02,170 --> 01:20:03,805
LONGER PRESENT AFTER ADJUSTMENT 

1751
01:20:03,805 --> 01:20:07,342
FOR AGE, SEX, PH SUB TYPE AND 

1752
01:20:07,342 --> 01:20:08,176
SOCIAL DETERMINANTS OF HEALTH. 

1753
01:20:08,176 --> 01:20:09,844
SOME LIMITATIONS IS IT IS A 

1754
01:20:09,844 --> 01:20:12,180
SMALLER DATA SET THAN THE 

1755
01:20:12,180 --> 01:20:14,316
REVEAL. THIS FROM PATIENTS 

1756
01:20:14,316 --> 01:20:15,717
REFERRED TO PH, WHICH I THINK IS

1757
01:20:15,717 --> 01:20:19,554
GOING TO BE A PROBLEM WE WILL BE

1758
01:20:19,554 --> 01:20:21,189
TALKING ABOUT OVER AND OVER 

1759
01:20:21,189 --> 01:20:24,926
AGAIN. NEXT SLIDE. HOW DO 

1760
01:20:24,926 --> 01:20:26,428
HISPANICS DO IN GENERAL? THEY 

1761
01:20:26,428 --> 01:20:28,463
HAVE A BETTER PROFILE. ON THE 

1762
01:20:28,463 --> 01:20:33,134
LEFT YOU WILL FIND TWO PAPERS 

1763
01:20:33,134 --> 01:20:35,670
THAT SHOW THAT A RETROSPECTIVE 

1764
01:20:35,670 --> 01:20:36,638
ANALYSIS WITH CATEGORY IZATION 

1765
01:20:36,638 --> 01:20:39,541
OF COHORT OVER TEN YEARS, ABOUT 

1766
01:20:39,541 --> 01:20:41,676
200 PATIENTS AND 61% WERE 

1767
01:20:41,676 --> 01:20:42,944
HISPANIC. HISPANIC PATIENTS HAD 

1768
01:20:42,944 --> 01:20:47,382
LOWER PRESSURES, LOWER PDR AND 

1769
01:20:47,382 --> 01:20:48,516
HIGHER CARE COMPLIANCE AND TREND

1770
01:20:48,516 --> 01:20:55,357
OF BETTER SURVIVAL ALSO BASED ON

1771
01:20:55,357 --> 01:20:58,793
THE LEVELS. THE RIGHT SIDE, A 

1772
01:20:58,793 --> 01:21:00,695
PAPER BY DR. WOODS' GROUP AND 

1773
01:21:00,695 --> 01:21:03,965
NOTICED DIFFERENCES BASED ON 

1774
01:21:03,965 --> 01:21:05,767
CARDIAC MRI FROM THE STUDY. THEY

1775
01:21:05,767 --> 01:21:08,003
HAD COMPARED TO WHITES, HISPANIC

1776
01:21:08,003 --> 01:21:12,841
HAD GREATER AND LARGER DIASTOLIC

1777
01:21:12,841 --> 01:21:14,542
VOLUME AND MASS, BLACKS HAD 

1778
01:21:14,542 --> 01:21:17,379
LOWER RV MASS WHEN ADJUSTING TO 

1779
01:21:17,379 --> 01:21:20,515
CO. VARIANTS INCLUDING LP MASS 

1780
01:21:20,515 --> 01:21:21,983
AND HISPANIC HAD HIGHER COMPARED

1781
01:21:21,983 --> 01:21:24,219
TO WHITES. QUESTION REMAINS 

1782
01:21:24,219 --> 01:21:25,954
WHERE THESE ARE DIFFERENCES 

1783
01:21:25,954 --> 01:21:31,693
REFLECT ADAPTIVE OR MALADAPTIVE 

1784
01:21:31,693 --> 01:21:33,428
MODELLING BUT DATA SUGGEST THIS 

1785
01:21:33,428 --> 01:21:35,263
ARE KNOWN TO HAVE PROGNOSTIC 

1786
01:21:35,263 --> 01:21:39,367
SIGNIFICANCE INCLUDING RV MASS. 

1787
01:21:39,367 --> 01:21:41,136
NEXT SLIDE. SO HISPANICS HAVE 

1788
01:21:41,136 --> 01:21:45,740
IMPROVED SURVIVAL DESPITE WORSE 

1789
01:21:45,740 --> 01:21:47,008
HEMODYNAMICS, BUT THE DOCTOR, 

1790
01:21:47,008 --> 01:21:48,810
WHO IS WITH US. COLLECTED DATA 

1791
01:21:48,810 --> 01:21:51,146
FROM FOUR COHORTS AND COMPARE 

1792
01:21:51,146 --> 01:21:53,281
HISPANIC, WHITE, BLACKS. THEY 

1793
01:21:53,281 --> 01:21:55,383
DID IT BETWEEN IDIOPATHIC AND 

1794
01:21:55,383 --> 01:21:57,686
HEREDITARY PH. ETHNICITY WAS 

1795
01:21:57,686 --> 01:21:59,421
SELF-REPORTED BY INDIVIDUALS. 

1796
01:21:59,421 --> 01:22:02,257
THOSE GENOMIC DATA GATHERED TO 

1797
01:22:02,257 --> 01:22:04,659
DETERMINE THEIR ANCESTRY. 

1798
01:22:04,659 --> 01:22:06,294
HISPANICS HAD SURVIVAL BENEFIT 

1799
01:22:06,294 --> 01:22:11,166
AFTER ADJUSTING FOR AGE, SEX AND

1800
01:22:11,166 --> 01:22:16,738
PDR. ALSO (?) USE LOWEST AMONG 

1801
01:22:16,738 --> 01:22:20,341
THE GROUP WITH HIGHEST AND 

1802
01:22:20,341 --> 01:22:23,311
LOWEST PRESSURES, THE SLIDE I 

1803
01:22:23,311 --> 01:22:23,978
MENTIONED. AFRICAN-AMERICAN HAD 

1804
01:22:23,978 --> 01:22:26,915
LOWEST AVERAGES AND LOWEST 

1805
01:22:26,915 --> 01:22:29,551
AVERAGE WALK DISTANCE. IN IMAGE 

1806
01:22:29,551 --> 01:22:31,453
ON THE RIGHT THE GRAPH REFLECTS 

1807
01:22:31,453 --> 01:22:35,490
COMBINED ESTIMATE OF PERCENTAGE 

1808
01:22:35,490 --> 01:22:39,561
OF AFRICAN, EUROPEAN AND DAY AND

1809
01:22:39,561 --> 01:22:41,763
INDICATED SELF-REPORTED RACE AND

1810
01:22:41,763 --> 01:22:43,698
ETHNICITY. WHEN TWO CORES WERE 

1811
01:22:43,698 --> 01:22:45,333
OVER LAID FOR MAGNITUDE IT WAS 

1812
01:22:45,333 --> 01:22:47,135
NOTICED TO BE HIGHER FOR 

1813
01:22:47,135 --> 01:22:50,438
NATIVE-AMERICAN AND LOWER FOR 

1814
01:22:50,438 --> 01:22:55,910
AFRICAN ANCESTRY. NEXT SLIDE. 

1815
01:22:55,910 --> 01:22:58,713
WHAT HAPPENS TO HISPANIC IN 

1816
01:22:58,713 --> 01:22:59,814
LATIN AMERICA BUT NOT UNITED 

1817
01:22:59,814 --> 01:23:02,250
STATES. REGISTRY SHOWS THEY ARE 

1818
01:23:02,250 --> 01:23:05,386
DIAGNOSED AT YOUNGER AGE, AROUND

1819
01:23:05,386 --> 01:23:07,489
34. MORE FEMALE THAN MALE. MORE 

1820
01:23:07,489 --> 01:23:09,591
ADVANCED STAGES OF PH, PROBABLY 

1821
01:23:09,591 --> 01:23:12,393
DUE TO LIMITED ACCESS TO HEALTH 

1822
01:23:12,393 --> 01:23:14,129
FACILITY AND DIAGNOSTIC. 

1823
01:23:14,129 --> 01:23:15,797
COMPARED TO REVEAL IN FRENCH 

1824
01:23:15,797 --> 01:23:19,167
REGISTRIES, THEY ARE SIMILAR. IN

1825
01:23:19,167 --> 01:23:25,106
BRAZIL N ADDITION OF (?) AND 

1826
01:23:25,106 --> 01:23:27,509
REGIONAL OUTCOMES ARE SIMILAR TO

1827
01:23:27,509 --> 01:23:31,179
OTHER WELL-KNOWN REGISTRIES. I 

1828
01:23:31,179 --> 01:23:38,920
WANT TO POINT OUT (AUDIO 

1829
01:23:38,920 --> 01:23:39,754
DISRUPTION) AND IN THE LAST 

1830
01:23:39,754 --> 01:23:41,823
MINUTE I WANT TO SHOW YOU WHY I 

1831
01:23:41,823 --> 01:23:44,058
BECAME INTERESTED. I DID NOT 

1832
01:23:44,058 --> 01:23:46,594
RESEARCH THIS BUT BORN IN 

1833
01:23:46,594 --> 01:23:48,863
GUATEMALA IT APPEARED MEDICAL 

1834
01:23:48,863 --> 01:23:53,701
RESEARCH WAS MISSING GRANULARITY

1835
01:23:53,701 --> 01:23:59,874
OF HOW HETEROGENEOUS THIS IS. I 

1836
01:23:59,874 --> 01:24:01,142
WANTED TO INQUIRE FURTHER. NEXT 

1837
01:24:01,142 --> 01:24:03,244
SLIDE. THE HISPANIC PARADOX THAT

1838
01:24:03,244 --> 01:24:05,079
TALKS ABOUT LONGER HISPANIC 

1839
01:24:05,079 --> 01:24:12,086
SURVIVAL DESPITE WORSENING 

1840
01:24:12,086 --> 01:24:15,423
CARDIOVASCULAR RISK FACTORS. I 

1841
01:24:15,423 --> 01:24:17,292
FOUND THIS STUDY AT OUR CENTER? 

1842
01:24:17,292 --> 01:24:19,694
SAN ANTONIO THAT TESTED THIS, 

1843
01:24:19,694 --> 01:24:21,196
LONGITUDINAL STUDY. THEY ASKED 

1844
01:24:21,196 --> 01:24:22,964
THE QUESTION, ARE ETHNIC 

1845
01:24:22,964 --> 01:24:25,733
DIFFERENCES IN MORTALITY 

1846
01:24:25,733 --> 01:24:27,001
CONSISTENT WITHIN HISPANIC 

1847
01:24:27,001 --> 01:24:29,904
PARADOX. MEXICAN-AMERICAN VERSUS

1848
01:24:29,904 --> 01:24:32,373
EUROPEAN-AMERICAN COHORTS. NEXT 

1849
01:24:32,373 --> 01:24:33,675
SLIDE. VERY IMPORTANTLY, 

1850
01:24:33,675 --> 01:24:35,009
CLASSIFICATION BY ETHNIC GROUP 

1851
01:24:35,009 --> 01:24:37,512
WAS INVALIDATED STANDARDIZED 

1852
01:24:37,512 --> 01:24:46,020
FORM THEY USED PARENTAL 

1853
01:24:46,020 --> 01:24:47,589
SURNAMES, BACKGROUNDS OF 

1854
01:24:47,589 --> 01:24:49,958
GRANDPARENTS AND CONCLUDED TO 

1855
01:24:49,958 --> 01:24:51,326
THE HISPANIC PARADOX HISPANIC 

1856
01:24:51,326 --> 01:24:53,394
WERE AT GREATER RISK OF 

1857
01:24:53,394 --> 01:24:56,164
MORTALITY. SOCIOECONOMIC STATUS 

1858
01:24:56,164 --> 01:24:57,599
DIFFERENCES LARGELY EXPLAINED 

1859
01:24:57,599 --> 01:24:59,334
THIS DISPARITY. WHEN ADJUSTED 

1860
01:24:59,334 --> 01:25:03,571
FOR THE ANALYSIS, CO MORBIDITY 

1861
01:25:03,571 --> 01:25:06,007
AND SYSTEMS WERE MORE PREDICTIVE

1862
01:25:06,007 --> 01:25:08,476
IN MORTALITIES. NEXT SLIDE. 

1863
01:25:08,476 --> 01:25:09,677
    WITHIN HISPANIC PARADOX, I 

1864
01:25:09,677 --> 01:25:11,746
THINK WE HAVE A PARADOX. MANY 

1865
01:25:11,746 --> 01:25:13,348
STUDIES THAT SUPPORTED HISPANIC 

1866
01:25:13,348 --> 01:25:15,416
PARADOX ARE BASED ON DATA FROM 

1867
01:25:15,416 --> 01:25:18,553
NATIONAL AND STATE VITAL 

1868
01:25:18,553 --> 01:25:20,188
STATISTICS AND NATIONAL HEALTH 

1869
01:25:20,188 --> 01:25:21,956
SERVICE, SO WHY DO WE HAVE THIS 

1870
01:25:21,956 --> 01:25:24,392
PARADOX? I THINK IT WOULD BE A 

1871
01:25:24,392 --> 01:25:25,627
MISCLASSIFICATION IN DEATH 

1872
01:25:25,627 --> 01:25:27,896
RECORDS, HEALTH IN MIGRANT 

1873
01:25:27,896 --> 01:25:29,264
EFFECT, JUST THE PEOPLE HEALTHY 

1874
01:25:29,264 --> 01:25:31,232
ENOUGH TO TRAVEL COME TO THE 

1875
01:25:31,232 --> 01:25:33,868
STATES, COULD BE THE SALMON BIAS

1876
01:25:33,868 --> 01:25:34,836
THAT TALKS ABOUT WHEN PATIENT 

1877
01:25:34,836 --> 01:25:36,137
GETS SICK ENOUGH THEY WOULD 

1878
01:25:36,137 --> 01:25:38,006
RATHER NOT DIE IN STATES SO GO 

1879
01:25:38,006 --> 01:25:39,807
BACK TO THEIR ORIGIN COUNTRY, SO

1880
01:25:39,807 --> 01:25:43,611
WE ARE MISS ING THAT DEATH 

1881
01:25:43,611 --> 01:25:46,748
RECORD OR SOCIAL-CULTURAL FACTS 

1882
01:25:46,748 --> 01:25:49,951
RELATIVE TO HISPANIC. NEXT 

1883
01:25:49,951 --> 01:25:50,184
SLIDES. 

1884
01:25:50,184 --> 01:25:52,253
    KEY QUESTIONS WILL BE HOW DO

1885
01:25:52,253 --> 01:25:54,088
WE CLASSIFY THESE GROUPS? HOW DO

1886
01:25:54,088 --> 01:25:57,358
WE NEED TO ADJUST AND ADAPT 

1887
01:25:57,358 --> 01:26:00,295
REGISTRY, TRUE DISTINCTIONS 

1888
01:26:00,295 --> 01:26:03,097
BETWEEN BIOLOGICAL AND SOCIAL 

1889
01:26:03,097 --> 01:26:07,335
DETERMINANTS AND CONCENTRATE 

1890
01:26:07,335 --> 01:26:13,741
OMIC PATTERNS WITHIN THIS? NEXT 

1891
01:26:13,741 --> 01:26:17,912
SLIDE. P 

1892
01:26:17,912 --> 01:26:19,247
    THIS IS HOW WE UNPACK THIS. 

1893
01:26:19,247 --> 01:26:23,217
TALK ABOUT THE COUNTRIES OF 

1894
01:26:23,217 --> 01:26:23,651
BIR

1895
01:26:23,651 --> 01:26:25,553
BIRTH, CITIZEN STATUS, LANGUAGE 

1896
01:26:25,553 --> 01:26:27,355
SPOKEN, SURVEY AND THIS IS FROM 

1897
01:26:27,355 --> 01:26:29,123
RESEARCH AND EVALUATION FROM 

1898
01:26:29,123 --> 01:26:30,325
WASHINGTON, TRYING TO UNPACK HOW

1899
01:26:30,325 --> 01:26:34,929
WE UNDERSTAND THESE COHORTS 

1900
01:26:34,929 --> 01:26:36,297
BETTER. SO DR. HYDE WILL TALK 

1901
01:26:36,297 --> 01:26:38,266
ABOUT THE NEXT INTERVENTIONS TO 

1902
01:26:38,266 --> 01:26:40,201
ADDRESS DISPARITIES. WANT TO 

1903
01:26:40,201 --> 01:26:41,402
LEAVE YOU WITH THIS LAST 

1904
01:26:41,402 --> 01:26:43,338
THOUGHT. SO OUR GOAL SHOULD BE 

1905
01:26:43,338 --> 01:26:45,873
TO PROVIDE A PRECISE FRAMEWORK 

1906
01:26:45,873 --> 01:26:49,844
FOR CLASSIFYING RACE AND 

1907
01:26:49,844 --> 01:26:50,611
ETHNICITY IN PULMONARY VASCULAR 

1908
01:26:50,611 --> 01:26:56,184
RESEARCH THAT CAPTURES GENETIC 

1909
01:26:56,184 --> 01:26:57,251
INFORMATION AND SOCIAL 

1910
01:26:57,251 --> 01:26:58,453
DETERMINANTS TO ADDRESS THIS. I 

1911
01:26:58,453 --> 01:26:59,821
WENT OVER THE TIME BUT 

1912
01:26:59,821 --> 01:27:01,656
APPRECIATE THE TIME TO SPEND 

1913
01:27:01,656 --> 01:27:02,924
WITH Y'ALL AND OPEN FOR 

1914
01:27:02,924 --> 01:27:04,359
QUESTIONS AND DISCUSSIONS. 

1915
01:27:04,359 --> 01:27:05,326
THANKS SO MUCH. 

1916
01:27:05,326 --> 01:27:07,862
>> THANK YOU, DR. ESTRADA.
THAT 

1917
01:27:07,862 --> 01:27:11,132
WAS AN INCREDIBLE SUMMARY OF THE

1918
01:27:11,132 --> 01:27:13,501
DISPARITIES IN THE DIFFERENT 

1919
01:27:13,501 --> 01:27:14,936
GROUPS. IT REALLY HIGHLIGHTS, I 

1920
01:27:14,936 --> 01:27:18,339
THINK, SOME OF THE ISSUES THAT 

1921
01:27:18,339 --> 01:27:21,542
WERE BROUGHT UP BY DR. KAY AND 

1922
01:27:21,542 --> 01:27:22,977
MYSELF WITH REGARD TO 

1923
01:27:22,977 --> 01:27:24,245
CLASSIFICATION. WE DON'T HAVE A 

1924
01:27:24,245 --> 01:27:26,147
LOT OF TIME FOR QUESTIONS RIGHT 

1925
01:27:26,147 --> 01:27:28,316
NOW, JUST A COUPLE MINUTES. WHAT

1926
01:27:28,316 --> 01:27:29,784
I'M GOING TO DO IS MOVE ON TO 

1927
01:27:29,784 --> 01:27:32,053
THE NEXT TALK. THEN WE WILL HAVE

1928
01:27:32,053 --> 01:27:33,421
20 MINUTES TO DISCUSS SOME OF 

1929
01:27:33,421 --> 01:27:35,323
THE QUESTIONS. I'M SURE THERE 

1930
01:27:35,323 --> 01:27:38,159
ARE LOTS OF QUESTIONS THAT ARE 

1931
01:27:38,159 --> 01:27:41,896
STARTING TO POP UP. SO WITH THAT

1932
01:27:41,896 --> 01:27:46,100
LET'S MOVE ON TO INTERVENTIONS 

1933
01:27:46,100 --> 01:27:50,171
WITH RACE, ETHNICITY AND 

1934
01:27:50,171 --> 01:27:52,707
IMPLEMENTATION BY DR. SAHAY. 

1935
01:27:52,707 --> 01:27:55,009
>> THANKS, EVERYONE.
THANKS 

1936
01:27:55,009 --> 01:27:56,744
ORGANIZERS FOR INVITING ME HERE 

1937
01:27:56,744 --> 01:28:01,816
TO DISCUSS THIS INTERESTING 

1938
01:28:01,816 --> 01:28:07,055
TOPIC. SOME OF THE THINGS ARE 

1939
01:28:07,055 --> 01:28:09,424
DISCUSSED BY THE PREVIOUS TWO 

1940
01:28:09,424 --> 01:28:11,225
SPEAKERS. I WILL TRY TO GO 

1941
01:28:11,225 --> 01:28:14,295
QUICKLY FROM THEM BUT HIGHLIGHT 

1942
01:28:14,295 --> 01:28:19,667
AREAS WE CAN WORK ON TOGETHER TO

1943
01:28:19,667 --> 01:28:20,935
IMPROVE REPRESENTATION OF 

1944
01:28:20,935 --> 01:28:23,738
RESEARCH AND IMPROVE CARE OF THE

1945
01:28:23,738 --> 01:28:24,405
PATIENTS. NEXT SLIDE. 

1946
01:28:24,405 --> 01:28:29,077
    THESE ARE MY DISCLOSURES. 

1947
01:28:29,077 --> 01:28:31,979
NEXT SLIDE. LET'S FIRST CLARIFY 

1948
01:28:31,979 --> 01:28:35,049
SOME OF THE TERMINOLOGY WE ARE 

1949
01:28:35,049 --> 01:28:36,417
DISCUSSING SINCE MORNING IN 

1950
01:28:36,417 --> 01:28:38,286
DIFFERENT TALKS. NEXT SLIDE. 

1951
01:28:38,286 --> 01:28:40,822
    SO WHAT ARE WE REALLY 

1952
01:28:40,822 --> 01:28:44,358
UNDERSTAND BY RACE, ETHNICITY 

1953
01:28:44,358 --> 01:28:45,493
AND DISPARITIES AND SOCIAL 

1954
01:28:45,493 --> 01:28:46,227
DETERMINANTS OF HEALTH? I WILL 

1955
01:28:46,227 --> 01:28:50,565
GO ONE-BY-ONE ON EACH OF THESE. 

1956
01:28:50,565 --> 01:28:51,232
NEXT SLIDE. 

1957
01:28:51,232 --> 01:28:54,001
    SO THE FIRST DESCRIPTION OF 

1958
01:28:54,001 --> 01:28:56,938
RACE ACTUALLY STARTED IN AROUND 

1959
01:28:56,938 --> 01:29:02,677
THE 15TH CENTURY, BUT FORMALLY 

1960
01:29:02,677 --> 01:29:12,687
DOCUMENTED BY THE SWEDISH 

1961
01:29:12,687 --> 01:29:13,521
TOKSTOK

1962
01:29:13,521 --> 01:29:15,323
TAXONOMIST. EUROPEANS ARE FAIR, 

1963
01:29:15,323 --> 01:29:19,060
GENTLE, ACUTE. AMERICANS 

1964
01:29:19,060 --> 01:29:20,995
COPPER-COLORED, OBSTINATE. 

1965
01:29:20,995 --> 01:29:26,868
ASIAN, SOOTY, SEVERE, HAUGHTY...

1966
01:29:26,868 --> 01:29:29,437
IT IS WHAT DIFFERENCE RACES 

1967
01:29:29,437 --> 01:29:32,974
MEANS HERE AND LET'S GO TO THE 

1968
01:29:32,974 --> 01:29:38,880
NEXT SLIDE. THIS IS PART OF THE 

1969
01:29:38,880 --> 01:29:45,853
DISCUSSED BY JOHANN BLUMENBACH, 

1970
01:29:45,853 --> 01:29:48,489
AROUND 17TH AND 18TH CENTURY, 

1971
01:29:48,489 --> 01:29:56,330
DEFINED IT MORTGAGEE GRAPHI-- 

1972
01:29:56,330 --> 01:29:57,331
GEOGRAPHICALLY AND HE WAS THE 

1973
01:29:57,331 --> 01:30:00,201
FIRST TO USE THE TERM CAUCASIAN,

1974
01:30:00,201 --> 01:30:01,536
DESCRIBED THEM AS BEAUTIFUL 

1975
01:30:01,536 --> 01:30:04,272
PEOPLE. REST DEPENDING WHERE THE

1976
01:30:04,272 --> 01:30:10,144
REGION THEY BELONGED TO. NEXT 

1977
01:30:10,144 --> 01:30:12,046
SLIDE. TECHNICALLY, THERE IS NOT

1978
01:30:12,046 --> 01:30:14,448
REALLY A LOT OF EVIDENCE AND 

1979
01:30:14,448 --> 01:30:16,784
DATA THAT THE RACE IS 

1980
01:30:16,784 --> 01:30:20,655
GENETICALLY DIVERSE. RACES IN 

1981
01:30:20,655 --> 01:30:29,797
21ST CENTURY ARE A 

1982
01:30:29,797 --> 01:30:31,566
SOCIO-POLITICAL CONSTRUCT AND 

1983
01:30:31,566 --> 01:30:34,268
DOES NOT HAVE A SCIENTIFIC OR 

1984
01:30:34,268 --> 01:30:39,006
BIOLOGICAL BASIS. WHAT IS AN 

1985
01:30:39,006 --> 01:30:42,843
ETHNICITY, IT IS A CONCEPT TO 

1986
01:30:42,843 --> 01:30:47,048
IDENTIFY INDIVIDUAL PEOPLE OR 

1987
01:30:47,048 --> 01:30:48,182
POPULATION, REFERENCE TO 

1988
01:30:48,182 --> 01:30:50,685
LANGUAGE, ATTRIBUTES OR 

1989
01:30:50,685 --> 01:30:52,653
RELIGION. RACE AND ETHNICITY MAY

1990
01:30:52,653 --> 01:30:58,926
OVERLAP BUT ON THE PHENOTYPE 

1991
01:30:58,926 --> 01:31:00,728
RELATED TO ETHNICITY. LIKE RACE 

1992
01:31:00,728 --> 01:31:04,632
IT IS A SOCIAL CONSTRUCT WITH NO

1993
01:31:04,632 --> 01:31:06,734
BIOLOGICAL BASIS. NEXT SLIDE. 

1994
01:31:06,734 --> 01:31:07,802
    WHEN WE TALK ABOUT 

1995
01:31:07,802 --> 01:31:08,736
DISPARITIES WHAT DO WE 

1996
01:31:08,736 --> 01:31:11,973
UNDERSTAND? THIS IS FROM THE NIH

1997
01:31:11,973 --> 01:31:14,709
BACK IN 2014. HEALTH DISPARITIES

1998
01:31:14,709 --> 01:31:17,178
ARE DIFFERENCES THAT EXIST AMONG

1999
01:31:17,178 --> 01:31:18,379
SPECIFIC POPULATION IN 

2000
01:31:18,379 --> 01:31:19,847
ATTAINMENT OF FULL HEALTH 

2001
01:31:19,847 --> 01:31:22,583
POTENTIAL THAT CAN BE MEASURED 

2002
01:31:22,583 --> 01:31:23,584
BY DIFFERENCES IN INCIDENCE, 

2003
01:31:23,584 --> 01:31:25,519
PREF LANCE, MORTALITY, BURDEN OF

2004
01:31:25,519 --> 01:31:28,089
DISEASE AND OTHER ADVERSE HEALTH

2005
01:31:28,089 --> 01:31:29,957
CONDITIONS. WHILE THE TERM OFTEN

2006
01:31:29,957 --> 01:31:32,960
USED OR INTERPRETED TO REFLECT 

2007
01:31:32,960 --> 01:31:33,995
DIFFERENCES BETWEEN RACIAL OR 

2008
01:31:33,995 --> 01:31:36,130
ETHNIC GROUPS, DISPARITIES CAN 

2009
01:31:36,130 --> 01:31:38,199
EXIST ACROSS MANY OTHER 

2010
01:31:38,199 --> 01:31:39,600
DIMENSIONS SUCH AS GENDER, 

2011
01:31:39,600 --> 01:31:42,903
SEXUAL ORIENTATION, AGE, 

2012
01:31:42,903 --> 01:31:45,206
DISABILITY STATUS, SOCIOECONOMIC

2013
01:31:45,206 --> 01:31:47,041
AND GEOGRAPHIC LOCATION. WE WILL

2014
01:31:47,041 --> 01:31:50,044
TOUCH ON SOME DURING THESE 

2015
01:31:50,044 --> 01:31:52,546
TWO-DAYS WORKSHOP. NEXT SLIDE. 

2016
01:31:52,546 --> 01:31:54,115
    WHAT IS SOCIAL DETERMINANTS 

2017
01:31:54,115 --> 01:31:57,218
OF HEALTH? ACCORDING TO THE WHO 

2018
01:31:57,218 --> 01:31:59,053
ARE DEFINED AS CIRCUMSTANCES IN 

2019
01:31:59,053 --> 01:32:01,722
WHICH HUMANS ARE BORN, DEVELOP, 

2020
01:32:01,722 --> 01:32:05,159
LIVE, EARN AND AGE. IN THE 

2021
01:32:05,159 --> 01:32:06,294
INTERNATIONAL REGIONAL, STATE OR

2022
01:32:06,294 --> 01:32:07,762
LOCAL LEVEL, THE DISTRIBUTION OF

2023
01:32:07,762 --> 01:32:11,932
MONEY, POWER AND RESOURCES SHAPE

2024
01:32:11,932 --> 01:32:14,001
THESE CIRCUMSTANCES. NEXT SLIDE.

2025
01:32:14,001 --> 01:32:19,573
WHAT DO WE KNOW ABOUT HEALTH 

2026
01:32:19,573 --> 01:32:21,942
DISPARITIES RELATED TO RACE, 

2027
01:32:21,942 --> 01:32:25,913
ETHNICITY IN PAH? ACTUALLY, NOT 

2028
01:32:25,913 --> 01:32:30,618
ENOUGH. NEXT. I THINK DR. GOEL 

2029
01:32:30,618 --> 01:32:32,486
AND DR. ESTRADA COVERED A LITTLE

2030
01:32:32,486 --> 01:32:33,587
BIT. I'M NOT GOING SPEND TOO 

2031
01:32:33,587 --> 01:32:34,288
MUCH TIME .

2032
01:32:34,288 --> 01:32:37,625
THE MESSAGE IS CLEAR THAT 

2033
01:32:37,625 --> 01:32:39,260
DIFFERENT HISTORIES AND 

2034
01:32:39,260 --> 01:32:41,028
DIFFERENT TRIALS OVER THE YEARS 

2035
01:32:41,028 --> 01:32:46,634
ARE OVER-REPRESENTED BY THE WIDE

2036
01:32:46,634 --> 01:32:46,934
POPULATION .

2037
01:32:46,934 --> 01:32:51,105
THE REAL PH, THE SCIENTIFIC 

2038
01:32:51,105 --> 01:32:53,174
REGISTRY, FAR REGISTRY AND 

2039
01:32:53,174 --> 01:32:54,942
DIFFERENT TRIALS ARE 

2040
01:32:54,942 --> 01:32:57,511
PREDOMINANTLY OVER-REPRESENTED 

2041
01:32:57,511 --> 01:33:00,648
BY THE WHITE POPULATION, 

2042
01:33:00,648 --> 01:33:02,983
INDICATED BY THE BLUE BARS IN 

2043
01:33:02,983 --> 01:33:05,619
THESE FIGURES. NEXT SLIDE. 

2044
01:33:05,619 --> 01:33:08,689
    AGAIN, THE MESSAGE CONTINUES

2045
01:33:08,689 --> 01:33:12,526
SINCE THE FIRST INITIAL ORAL 

2046
01:33:12,526 --> 01:33:15,930
THERAPY (?) PREDOMINANTLY WHITE 

2047
01:33:15,930 --> 01:33:19,633
AND THESE ARE PREDOMINANTLY 

2048
01:33:19,633 --> 01:33:24,972
WHITE. NEXT SLIDE. 

2049
01:33:24,972 --> 01:33:28,042
    NOTHING HAS REALLY CHANGED 

2050
01:33:28,042 --> 01:33:29,844
OVER THE LAST TWO DECADES. THAT 

2051
01:33:29,844 --> 01:33:31,812
IS SOMETHING WHAT WE SHOULD BE 

2052
01:33:31,812 --> 01:33:33,347
DISCUSSING TODAY, WHY THESE 

2053
01:33:33,347 --> 01:33:36,884
CLINICAL TRIALS HAVE REMAINED 

2054
01:33:36,884 --> 01:33:43,791
THE SAME, WERE ENROLLING EVEN IN

2055
01:33:43,791 --> 01:33:44,392
2024, STARTING BACK IN 2000. 

2056
01:33:44,392 --> 01:33:44,725
NEXT SLIDE. 

2057
01:33:44,725 --> 01:33:46,494
    THIS STORY IS NOT RELATED TO

2058
01:33:46,494 --> 01:33:48,896
PH BUT IF YOU LOOK, THIS IS THE 

2059
01:33:48,896 --> 01:33:52,032
DATA FROM THE FDA IN 2020. THIS 

2060
01:33:52,032 --> 01:33:54,402
IS DATA FROM ALL THE TRIAL DATA 

2061
01:33:54,402 --> 01:33:57,071
WHICH WAS PRESENTED TO FDA IN 

2062
01:33:57,071 --> 01:34:01,575
2020. YOU WILL SEE THAT 75% OF 

2063
01:34:01,575 --> 01:34:03,444
PATIENTS WERE WHITE. SO THIS 

2064
01:34:03,444 --> 01:34:05,913
ISSUE IS NOT RELATED TO THE PH 

2065
01:34:05,913 --> 01:34:08,549
CLINICAL TRIALS BUT IN GENERAL 

2066
01:34:08,549 --> 01:34:10,651
RELATED TO THE WAY WE CONDUCT 

2067
01:34:10,651 --> 01:34:14,021
OUR RESEARCH, AT LEAST IN THE 

2068
01:34:14,021 --> 01:34:18,959
UNITED STATES. NEXT SLIDE. IF 

2069
01:34:18,959 --> 01:34:21,762
YOU FOCUS ON THE PULMONARY 

2070
01:34:21,762 --> 01:34:24,198
HYPERTENSION, THE OLDER DATA, 

2071
01:34:24,198 --> 01:34:28,903
FROM' 79 TO' 96 WHEN TERM FOR 

2072
01:34:28,903 --> 01:34:32,006
HYPERTENSION WAS USED. AGAIN THE

2073
01:34:32,006 --> 01:34:32,640
AFRICAN-AMERICAN BLACK PEOPLE 

2074
01:34:32,640 --> 01:34:36,177
HAD HIGHER MORTALITY IN 1980 TO 

2075
01:34:36,177 --> 01:34:39,280
2002 DATA, SHOWING THAT PRIMARY 

2076
01:34:39,280 --> 01:34:41,348
AND SECONDARY PULMONARY 

2077
01:34:41,348 --> 01:34:42,817
HYPERTENSION, HIGHER MORTALITY 

2078
01:34:42,817 --> 01:34:44,118
IN AFRICAN-AMERICAN POPULATION. 

2079
01:34:44,118 --> 01:34:46,253
I'M NOT GOING INTO DETAIL 

2080
01:34:46,253 --> 01:34:47,588
BECAUSE DR. ESTRADA WENT INTO 

2081
01:34:47,588 --> 01:34:48,823
QUITE BIT OF DETAIL DISCUSSING 

2082
01:34:48,823 --> 01:34:52,993
THESE TOPICS. GO AHEAD, NEXT 

2083
01:34:52,993 --> 01:34:53,294
SLIDE. 

2084
01:34:53,294 --> 01:34:55,796
    AGAIN, IF WE LOOK AT MORE 

2085
01:34:55,796 --> 01:34:57,731
CONTEMPORARY DATA, AGAIN IT IS 

2086
01:34:57,731 --> 01:34:59,467
SHOWING THAT NON-HISPANIC BLACK 

2087
01:34:59,467 --> 01:35:00,701
PATIENT, THIS IS THE U.S. 

2088
01:35:00,701 --> 01:35:02,403
 EPIDEMIOLOGICAL DATA AGAIN 

2089
01:35:02,403 --> 01:35:05,005
SHOWING THE HIGHER MORTALITY IN 

2090
01:35:05,005 --> 01:35:06,774
NON-HISPANIC BLACK PATIENT 

2091
01:35:06,774 --> 01:35:08,742
POPULATION. THIS IS AGNOSTIC TO 

2092
01:35:08,742 --> 01:35:10,411
PH; THIS IS TALKING GENERAL 

2093
01:35:10,411 --> 01:35:14,148
DISEASE AND MORTALITY DATA IN 

2094
01:35:14,148 --> 01:35:15,115
THE UNITED STATES. NEXT SLIDE. 

2095
01:35:15,115 --> 01:35:17,985
    SO WE TRY TO ASSESS THIS IN 

2096
01:35:17,985 --> 01:35:19,553
THE REVEAL REGISTRY AND 

2097
01:35:19,553 --> 01:35:21,055
PUBLISHED THIS PAPER A FEW YEARS

2098
01:35:21,055 --> 01:35:22,890
AGO, WHERE WE WANTED TO ASSESS 

2099
01:35:22,890 --> 01:35:26,327
THE IMPACT OF RACE ON THE 

2100
01:35:26,327 --> 01:35:30,831
SURVIVAL IN PH. WE DID NOT FIND 

2101
01:35:30,831 --> 01:35:33,133
ANY SIGNIFICANT DIFFERENCE IN 

2102
01:35:33,133 --> 01:35:35,970
THE SURVIVAL WHEN ADJUSTED FOR 

2103
01:35:35,970 --> 01:35:41,542
AGE, SUBTYPE AND TIME FOR 

2104
01:35:41,542 --> 01:35:44,979
DIAGNOSIS. I THINK ROBERTO'S 

2105
01:35:44,979 --> 01:35:46,680
PAPER DID NOT FIND SIGNIFICANT 

2106
01:35:46,680 --> 01:35:49,183
DIFFERENCE IN HISPANIC MORTALITY

2107
01:35:49,183 --> 01:35:50,484
VERSUS OTHERS AFTER THE 

2108
01:35:50,484 --> 01:35:53,053
ADJUSTING FOR VARIABLES. NEXT 

2109
01:35:53,053 --> 01:35:53,654
SLIDE. 

2110
01:35:53,654 --> 01:35:55,222
    HOWEVER, THERE WERE CERTAIN 

2111
01:35:55,222 --> 01:35:58,726
OBSERVATIONS IN THIS ANALYSIS 

2112
01:35:58,726 --> 01:36:01,795
THAT THE ERAs WERE LOWER USED IN

2113
01:36:01,795 --> 01:36:03,264
HISPANIC PATIENTS. NOT EXACTLY 

2114
01:36:03,264 --> 01:36:05,533
CLEAR WHY. ONE OF THE 

2115
01:36:05,533 --> 01:36:07,735
ASSUMPTIONS WAS BECAUSE THEY HAD

2116
01:36:07,735 --> 01:36:10,905
MORE HYPERTENSION, PERHAPS ERA 

2117
01:36:10,905 --> 01:36:13,274
WAS LESS USED, AFRICAN-AMERICAN 

2118
01:36:13,274 --> 01:36:17,444
PEOPLE HAD LESS USE OF 

2119
01:36:17,444 --> 01:36:22,983
PHOSPHOROUS DIESTERASE INHIBITOR

2120
01:36:22,983 --> 01:36:26,053
AND LESS USED IN THIS ANALYSIS. 

2121
01:36:26,053 --> 01:36:26,487
NEXT SLIDE. 

2122
01:36:26,487 --> 01:36:28,455
    THIS IS ANOTHER 

2123
01:36:28,455 --> 01:36:31,458
SINGLE-CENTER STUDY, MAINLY 

2124
01:36:31,458 --> 01:36:37,731
FOCUSED ON IDIOPATHIC AND 

2125
01:36:37,731 --> 01:36:47,474
ANOREXIG  E /* EN PATIENTS. MORE

2126
01:36:47,474 --> 01:36:48,576
CONFLICTS WITH THIS RESEARCH, 

2127
01:36:48,576 --> 01:36:51,378
THE MORE YOU WILL FIND. THAT 

2128
01:36:51,378 --> 01:36:55,182
SHOULD BE THOUGHT-PROVOKING SO 

2129
01:36:55,182 --> 01:36:56,183
CLEARLY HERE THE 

2130
01:36:56,183 --> 01:36:57,551
AFRICAN-AMERICAN AND 

2131
01:36:57,551 --> 01:37:00,988
ASIAN-AMERICAN SHOWED HIGHER 

2132
01:37:00,988 --> 01:37:02,890
MORTALITY. NEXT SLIDE. 

2133
01:37:02,890 --> 01:37:07,194
    THIS IS FROM THE PHAR 

2134
01:37:07,194 --> 01:37:10,898
REGISTRY, I THINK FROM ROBERTO'S

2135
01:37:10,898 --> 01:37:14,501
PAPER. FOCUSSING ON THE HISPANIC

2136
01:37:14,501 --> 01:37:15,703
POPULATION COMPARED TO THE 

2137
01:37:15,703 --> 01:37:19,139
ACCESS TO HEALTH CARE, LOWER 

2138
01:37:19,139 --> 01:37:27,548
EDUCATION LEVEL, INCOME. THIS IS

2139
01:37:27,548 --> 01:37:30,951
DESPITE HAVING SIMILAR DISEASE 

2140
01:37:30,951 --> 01:37:34,221
SIMILARITY. NEXT SLIDE. BUT AS I

2141
01:37:34,221 --> 01:37:38,792
MENTIONED EARLIER THE ADJUSTED 

2142
01:37:38,792 --> 01:37:41,428
MORTALITY ANALYSIS DID NOT FIND 

2143
01:37:41,428 --> 01:37:43,230
DIFFERENCE IN THE HISPANIC 

2144
01:37:43,230 --> 01:37:44,131
POPULATION. NEXT SLIDE. 

2145
01:37:44,131 --> 01:37:47,368
    THIS WAS A NICELY DONE STUDY

2146
01:37:47,368 --> 01:37:48,469
FROM CHINA WHERE THEY ACTUALLY 

2147
01:37:48,469 --> 01:37:50,871
WANTED TO ASSESS THE IMPACT OF 

2148
01:37:50,871 --> 01:37:53,641
THE SOCIOECONOMIC STATUS. AS YOU

2149
01:37:53,641 --> 01:37:55,342
CAN SEE IN THESE FIGURES, A 

2150
01:37:55,342 --> 01:38:01,081
WHERE THEY ADJUSTED IT FOR THE 

2151
01:38:01,081 --> 01:38:03,851
AGE, SEX, B IS AGE, SEX, 

2152
01:38:03,851 --> 01:38:06,153
FUNCTION, CLASS AND PVR THEN 

2153
01:38:06,153 --> 01:38:11,158
AGE, SEX, FUNCTION CLASS, PVR 

2154
01:38:11,158 --> 01:38:17,131
AND THE PDE5A AND AFFECTED THE 

2155
01:38:17,131 --> 01:38:20,567
SURVIVAL IN THE CENTER IN CHINA.

2156
01:38:20,567 --> 01:38:22,436
PUBLISHED IN A JOURNAL. I THINK 

2157
01:38:22,436 --> 01:38:25,139
THIS IS ONE OF THE ONLY STUDY I 

2158
01:38:25,139 --> 01:38:29,109
I COULD FIND WHERE SOCIOECONOMIC

2159
01:38:29,109 --> 01:38:35,849
STATUS IMPLICATING SURVIVAL OF 

2160
01:38:35,849 --> 01:38:36,617
PAH. NEXT SLIDE. 

2161
01:38:36,617 --> 01:38:38,852
    NOW WHAT IS THE REASON THAT 

2162
01:38:38,852 --> 01:38:41,321
WHY WE ARE SEEING THESE ISSUES 

2163
01:38:41,321 --> 01:38:44,491
THAT WE ARE NOT ABLE TO SEE MUCH

2164
01:38:44,491 --> 01:38:48,228
OF THE PRESENTATION OF THER 

2165
01:38:48,228 --> 01:38:50,197
RACES IN THE CLINICAL TRIALS? 

2166
01:38:50,197 --> 01:38:53,033
I'M GOING TO -- IN THE NEXT FEW 

2167
01:38:53,033 --> 01:38:54,568
SLIDES I'M GOING TO TALK SOME OF

2168
01:38:54,568 --> 01:38:57,037
THESE AREAS AND SOME OF THESE 

2169
01:38:57,037 --> 01:38:58,639
POINTS WILL BE PROVOCATIVE TO 

2170
01:38:58,639 --> 01:39:01,075
THINK AND THE REALITY OF OUR 

2171
01:39:01,075 --> 01:39:03,811
LIVES. THERE MAY BE A PERCEIVED 

2172
01:39:03,811 --> 01:39:05,979
PERSONAL RISK OR FEAR, TRUST IN 

2173
01:39:05,979 --> 01:39:08,782
MEDICAL COMMUNITY, ETHNIC OR 

2174
01:39:08,782 --> 01:39:10,384
CULTURAL BACKGROUND OR DIVERSITY

2175
01:39:10,384 --> 01:39:12,019
IN HEALTH CARE. I'M SURE 

2176
01:39:12,019 --> 01:39:15,222
EVERYONE WHO IS PRESENT HERE IS 

2177
01:39:15,222 --> 01:39:19,326
FAMILIAR ABOUT THE TUSKEGEE 

2178
01:39:19,326 --> 01:39:21,762
STUDY, WHERE THE 100 

2179
01:39:21,762 --> 01:39:23,330
AFRICAN-AMERICAN PEOPLE, MALES 

2180
01:39:23,330 --> 01:39:26,333
ACTUALLY, DIED DURING THE PERIOD

2181
01:39:26,333 --> 01:39:29,603
OF THIS STUDY. AS YOU MAY KNOW 

2182
01:39:29,603 --> 01:39:32,072
PENICILLIN WAS APPROVED IN 1947 

2183
01:39:32,072 --> 01:39:38,011
BUT THEY WERE INJECTED WITH THE 

2184
01:39:38,011 --> 01:39:41,048
SYPHILIS AND -- THE ORGANISM, 

2185
01:39:41,048 --> 01:39:43,517
NOT TREATED AND OBSERVED FOR THE

2186
01:39:43,517 --> 01:39:45,486
NATURAL PROGRESSION OF THE 

2187
01:39:45,486 --> 01:39:48,589
DISEASE. THE STUDY ACTUALLY 

2188
01:39:48,589 --> 01:39:53,026
CONTINUED UNTIL 1972. CLEARLY 

2189
01:39:53,026 --> 01:39:57,364
STUDIES LIKE THIS LEADS TO THE 

2190
01:39:57,364 --> 01:39:59,967
MISTRUST IN HEALTH CARE IN 

2191
01:39:59,967 --> 01:40:03,003
GENERAL AND CLINICAL RESEARCH. 

2192
01:40:03,003 --> 01:40:03,570
NEXT SLIDE. 

2193
01:40:03,570 --> 01:40:07,007
    I WOULD ALSO WANT TO 

2194
01:40:07,007 --> 01:40:15,783
HIGHLIGHT THIS STUDY, FROM JOHNS

2195
01:40:15,783 --> 01:40:24,558
HOPKINS. HENRY HENRIETTA LACKS, 

2196
01:40:24,558 --> 01:40:26,660
WHERE THE BIO COMPANIES 

2197
01:40:26,660 --> 01:40:28,028
BENEFITTED, NEVER GAVE CONSENT, 

2198
01:40:28,028 --> 01:40:33,467
DIED AT 31, FAMILY NEVER 

2199
01:40:33,467 --> 01:40:36,870
COMPENSATED. IN 2020 FINALLY 

2200
01:40:36,870 --> 01:40:38,305
JOHNS HOPKINS HAD SORT OF LIKE A

2201
01:40:38,305 --> 01:40:42,776
DEAL OR CONTRACT WITH HER FAMILY

2202
01:40:42,776 --> 01:40:45,245
MEMBERS, CAME UP -- AND NIH WAS 

2203
01:40:45,245 --> 01:40:48,982
INVOLVED TO APPROVE THE RESULTS 

2204
01:40:48,982 --> 01:40:50,350
OF WHATEVER RESEARCH THEY HAD 

2205
01:40:50,350 --> 01:40:51,819
CONDUCTED OVER THE YEARS. SO 

2206
01:40:51,819 --> 01:40:56,623
THESE ARE THE STORIES WHICH ARE 

2207
01:40:56,623 --> 01:40:58,625
REAL LIFE AND NOT REALLY OLD. 

2208
01:40:58,625 --> 01:41:01,295
THIS CENTURY, THE LAST FEW 

2209
01:41:01,295 --> 01:41:02,896
YEARS. MANY OF US WERE PROBABLY 

2210
01:41:02,896 --> 01:41:05,432
BORN WHEN THESE STUDIES WERE 

2211
01:41:05,432 --> 01:41:06,934
ONGOING, SO THEY DEFINITELY LEAD

2212
01:41:06,934 --> 01:41:10,370
TO LACK OF TRUST IN THE HEALTH 

2213
01:41:10,370 --> 01:41:19,146
CARE SYSTEM. NEXT SLIDE. 

2214
01:41:19,146 --> 01:41:21,315
    THIS IS SOMETHING I WANT TO 

2215
01:41:21,315 --> 01:41:24,051
SHOW CONTEMPORARY, CURRENTLY 

2216
01:41:24,051 --> 01:41:29,022
WHAT WE ARE DOING IN THIS 

2217
01:41:29,022 --> 01:41:33,060
EXAMINATION SURVEY. I WANT TO 

2218
01:41:33,060 --> 01:41:34,661
SHOW YOU THE GRAY BOX. I DON'T 

2219
01:41:34,661 --> 01:41:36,597
KNOW IF YOU CAN SEE MY CURSOR, 

2220
01:41:36,597 --> 01:41:41,969
BUT THE NON-HISPANIC BLACK HAVE 

2221
01:41:41,969 --> 01:41:42,970
SIGNIFICANTLY HIGHER OBESITY, 

2222
01:41:42,970 --> 01:41:50,010
MALES AND FEMALES, 49 FOR MALES,

2223
01:41:50,010 --> 01:41:50,344
56

2224
01:41:50,344 --> 01:41:52,412
56.9 IN BLACK WOMEN. WHEN WE ARE

2225
01:41:52,412 --> 01:41:53,981
DESIGNING OUR CLINICAL TRIAL 

2226
01:41:53,981 --> 01:41:56,416
PROTOCOLS, HOW ARE WE USING OUR 

2227
01:41:56,416 --> 01:41:58,352
INCLUSION CRITERIA WITH 

2228
01:41:58,352 --> 01:42:01,755
SYSTEMATICALLY EXCLUDE THESE 

2229
01:42:01,755 --> 01:42:02,222
PATIENTS. NEXT SLIDE 

2230
01:42:02,222 --> 01:42:04,391
    THIS IS ONE OF THE EXAMPLES 

2231
01:42:04,391 --> 01:42:07,527
I WANT TO PUT IT THERE. THE 

2232
01:42:07,527 --> 01:42:10,998
SERAPHIN STUDY USED A BMI CUT OF

2233
01:42:10,998 --> 01:42:14,468
30. THIS IS THE U.S.  DATA WHERE

2234
01:42:14,468 --> 01:42:18,205
THE OBESITY IS DEFINED BMI30. IF

2235
01:42:18,205 --> 01:42:20,574
YOU PUT 30 AUTOMATICALLY YOU ARE

2236
01:42:20,574 --> 01:42:21,375
EXCLUDING THE BLACK PATIENT 

2237
01:42:21,375 --> 01:42:22,743
POPULATION. THAT IS ONE OF THE 

2238
01:42:22,743 --> 01:42:24,778
REASON YOU ARE NOT ABLE TO SEE 

2239
01:42:24,778 --> 01:42:26,880
THESE PATIENTS IN YOUR CLINICAL 

2240
01:42:26,880 --> 01:42:33,887
TRIALS. I'M NOT SAY ING THIS IS 

2241
01:42:33,887 --> 01:42:39,192
THE ONLY REASON BUT 

2242
01:42:39,192 --> 01:42:49,736
COMORBIDITIES IS A BIG FACTOR. I

2243
01:42:52,806 --> 01:42:54,107
WANT TO HIGHLIGHT THE 

2244
01:42:54,107 --> 01:42:57,611
COMORBIDITY, THE PREF LANCE OF 

2245
01:42:57,611 --> 01:43:03,116
-- THIS IS FROM CDC. THE 

2246
01:43:03,116 --> 01:43:07,454
PREVALANCE IS HIGHER IN BLACK 

2247
01:43:07,454 --> 01:43:17,998
SIGNIFICANTLY THAN WHITE. SO IF 

2248
01:43:18,498 --> 01:43:20,200
YOU HAVE LESS THAN 70, THIS IS 

2249
01:43:20,200 --> 01:43:24,705
FROM OUR DATA THAT 33% WERE 

2250
01:43:24,705 --> 01:43:26,306
INELIGIBLE BECAUSE OF THE (?) 

2251
01:43:26,306 --> 01:43:27,874
LESS THAN 70. POINT I'M TRYING 

2252
01:43:27,874 --> 01:43:30,344
TO HIGHLIGHT, IF WE ARE GOING TO

2253
01:43:30,344 --> 01:43:32,412
HAVE SUCH INCLUSION OF 

2254
01:43:32,412 --> 01:43:34,514
EXCLUSIONARY CRITERIA WE ARE 

2255
01:43:34,514 --> 01:43:35,582
AUTOMATICALLY GOING DISQUALIFY 

2256
01:43:35,582 --> 01:43:38,352
BLACK POPULATION. SIMILARLY IN 

2257
01:43:38,352 --> 01:43:42,756
THE GRIFFIN, SERAPHIN AND 

2258
01:43:42,756 --> 01:43:44,825
CUT-OFF 85% WILL AUTOMATICALLY 

2259
01:43:44,825 --> 01:43:45,993
EXCLUDE BLACK POPULATION. THIS 

2260
01:43:45,993 --> 01:43:48,795
IS FROM MY CENTER DATA, AROUND 

2261
01:43:48,795 --> 01:43:51,665
350 PATIENTS, WHEN APPLIED 

2262
01:43:51,665 --> 01:43:53,533
INCLUSION-EXCLUSION CRITERIA ON 

2263
01:43:53,533 --> 01:43:57,004
THE REAL WORLD PH POPULATION WE 

2264
01:43:57,004 --> 01:44:05,212
EXTRUDED THESE. I HAVE NOT GONE 

2265
01:44:05,212 --> 01:44:07,047
IN BUT QUITE CONFIDENT WE WILL 

2266
01:44:07,047 --> 01:44:10,884
FIND SIMILAR RESULTS. THIS IS AN

2267
01:44:10,884 --> 01:44:11,918
ONGOING ANALYSIS. NEXT SLIDE. 

2268
01:44:11,918 --> 01:44:14,488
    SO WHAT ARE THE OTHER 

2269
01:44:14,488 --> 01:44:16,223
FACTORS OF LACK OF HEALTH, 

2270
01:44:16,223 --> 01:44:17,524
EDUCATION AND KNOWLEDGE OF 

2271
01:44:17,524 --> 01:44:18,992
CLINICAL TRIALS, TIME 

2272
01:44:18,992 --> 01:44:20,794
COMMITMENT, COST OF 

2273
01:44:20,794 --> 01:44:22,863
PARTICIPATION, EDUCATION LEVEL, 

2274
01:44:22,863 --> 01:44:23,930
SOCIOECONOMIC STATUS AND 

2275
01:44:23,930 --> 01:44:25,599
INSTITUTIONAL BARRIERS? I WILL 

2276
01:44:25,599 --> 01:44:26,700
DISCUSS THOSE IN A MINUTE ABOUT 

2277
01:44:26,700 --> 01:44:28,935
THE INSTITUTIONAL BARRIER 

2278
01:44:28,935 --> 01:44:30,871
BECAUSE THAT IS SOMETHING WHICH 

2279
01:44:30,871 --> 01:44:33,473
I EXPERIENCED AT MY INSTITUTE 

2280
01:44:33,473 --> 01:44:36,843
AND HAVE TRIED TO HELP TO SOME 

2281
01:44:36,843 --> 01:44:47,387
EXTENT BUT NOT COMPLETELY. NEXT 

2282
01:44:49,256 --> 01:44:56,496
SLIDE. PRSO WHAT GUIDING THIS? 

2283
01:44:56,496 --> 01:45:00,834
CERTAIN BIOLOGICAL DIFFERENCES 

2284
01:45:00,834 --> 01:45:02,235
WHICH MAY CONTRIBUTE, 

2285
01:45:02,235 --> 01:45:04,805
INFLUENCING TO THE TREATMENT. I 

2286
01:45:04,805 --> 01:45:06,940
THINK DR. ESTRADA AND GOEL 

2287
01:45:06,940 --> 01:45:08,542
HIGHLIGHTED THE (?) OVER 

2288
01:45:08,542 --> 01:45:09,776
EXPRESSED IN AFRICAN-AMERICAN 

2289
01:45:09,776 --> 01:45:12,446
POPULATION BUT BLUNTED RESPONSE 

2290
01:45:12,446 --> 01:45:14,581
WITH THE ER, I THINK THOSE COULD

2291
01:45:14,581 --> 01:45:16,683
BE VARIATIONS WHICH WE THINK 

2292
01:45:16,683 --> 01:45:19,052
RACE AND ETHNICITY ARE COMPLEX 

2293
01:45:19,052 --> 01:45:27,994
AND SOCIAL CONSTRUCT AND OVERLAP

2294
01:45:27,994 --> 01:45:29,129
VERIAL WITH DONE WHICH CLEARLY 

2295
01:45:29,129 --> 01:45:36,303
SHOWS IMPACT OF SOCIAL OWE 

2296
01:45:36,303 --> 01:45:38,271
IMPACT. SOME ARE SHOWN TO LIVE 

2297
01:45:38,271 --> 01:45:41,842
IN DEPRIVED COMMUNITIES AND DR. 

2298
01:45:41,842 --> 01:45:43,643
(?) STUDY SHOWED THE PATIENT WHO

2299
01:45:43,643 --> 01:45:45,612
LIVED FAR FROM THE EXPERT CARE 

2300
01:45:45,612 --> 01:45:49,182
CENTER SO IMPACTS THEIR ACCESS 

2301
01:45:49,182 --> 01:45:51,284
AND HEALTH CARE AND DIFFERENCES 

2302
01:45:51,284 --> 01:45:53,820
IN OUTCOME MAY NOT ONLY REFLECT 

2303
01:45:53,820 --> 01:45:55,255
BIOLOGICAL SYSTEMS BUT SHAPED BY

2304
01:45:55,255 --> 01:46:03,430
SYSTEM INEQUITIES IN THE THEIR 

2305
01:46:03,430 --> 01:46:04,631
ACCESS TO HEALTH CARE. I THINK 

2306
01:46:04,631 --> 01:46:06,666
WE HAVE COVERED ALL THIS 

2307
01:46:06,666 --> 01:46:07,300
MORNING. NEXT SLIDE. 

2308
01:46:07,300 --> 01:46:10,303
    THIS IS ONE SLIDE. I THINK 

2309
01:46:10,303 --> 01:46:13,473
DR. ESTRADA PRESENTED EARLIER. 

2310
01:46:13,473 --> 01:46:15,675
JUST WANT TO HIGHLIGHT, IF YOU 

2311
01:46:15,675 --> 01:46:18,044
FOCUS ON RED AND ORANGE LINES 

2312
01:46:18,044 --> 01:46:20,413
HERE, THEY PRESENT THE BLACK AND

2313
01:46:20,413 --> 01:46:23,250
HISPANIC PATIENT POPULATION AND 

2314
01:46:23,250 --> 01:46:25,719
JUST SHOWING THE U.S.  CENSUS 

2315
01:46:25,719 --> 01:46:27,287
DATA, WHICH CLEARLY SHOWS THAT 

2316
01:46:27,287 --> 01:46:29,689
THE PER-CAPITA INCOME OF THE 

2317
01:46:29,689 --> 01:46:30,957
BLACK AND HISPANIC PATIENT 

2318
01:46:30,957 --> 01:46:33,560
POPULATION IS MUCH LESS THAN THE

2319
01:46:33,560 --> 01:46:36,296
OTHER RACES IN THE UNITED 

2320
01:46:36,296 --> 01:46:36,796
STATES. NEXT SLIDE. 

2321
01:46:36,796 --> 01:46:38,565
    SO WHAT ARE THE 

2322
01:46:38,565 --> 01:46:40,200
INTERVENTIONS? WHAT CAN WE DO? 

2323
01:46:40,200 --> 01:46:42,702
THERE COULD BE SOME 

2324
01:46:42,702 --> 01:46:44,070
DISEASE-AGNOSTIC INTERVENTION 

2325
01:46:44,070 --> 01:46:45,839
WHICH COULD BE WIDESPREAD INTO 

2326
01:46:45,839 --> 01:46:47,874
HEALTH CARE AND DISEASE-SPECIFIC

2327
01:46:47,874 --> 01:46:50,076
WHICH ARE RELATED TO PULMONARY 

2328
01:46:50,076 --> 01:46:51,545
DISEASES. I WILL PROVIDE A 

2329
01:46:51,545 --> 01:46:55,949
LITTLE OVERVIEW OF THAT. NEXT 

2330
01:46:55,949 --> 01:46:56,449
SLIDE. 

2331
01:46:56,449 --> 01:47:04,457
    CULTURALLY TAYLORED  -- 

2332
01:47:04,457 --> 01:47:06,126
TAILORED INTERVENTION AND 

2333
01:47:06,126 --> 01:47:07,827
MATERIAL AND WORKSHOP ON 

2334
01:47:07,827 --> 01:47:09,796
CLINICAL RESEARCH, I THINK THAT 

2335
01:47:09,796 --> 01:47:11,131
IS AT THE GROUND LEVEL, WE 

2336
01:47:11,131 --> 01:47:13,066
SHOULD BE INVOLVING THESE 

2337
01:47:13,066 --> 01:47:15,001
ORGANIZATIONS IF WE ARE TALKING 

2338
01:47:15,001 --> 01:47:17,771
ABOUT CLINICAL TRIALS OR THEIR 

2339
01:47:17,771 --> 01:47:21,074
HEALTH CARE NEEDS OR RESOURCES 

2340
01:47:21,074 --> 01:47:23,643
FOR THESE PATIENT -- THESE 

2341
01:47:23,643 --> 01:47:25,011
ECONOMICALLY OR SOCIALLY 

2342
01:47:25,011 --> 01:47:26,479
DEPRIVED PATIENT POPULATION. 

2343
01:47:26,479 --> 01:47:28,281
THEN ENGAGE PROVIDERS FROM 

2344
01:47:28,281 --> 01:47:30,817
SIMILAR BACK GROUNDS. I THINK 

2345
01:47:30,817 --> 01:47:33,153
THAT HAS A BIG IMPACT. I LIVE IN

2346
01:47:33,153 --> 01:47:36,556
HOUSTON. WHEN I HAVE PHYSICIAN 

2347
01:47:36,556 --> 01:47:38,058
WHO CAN SPEAK SPANISH WITH THE 

2348
01:47:38,058 --> 01:47:40,227
PATIENT, UNFORTUNATELY I'M NOT 

2349
01:47:40,227 --> 01:47:42,862
ABLE TO, BUT THEY ARE -- THEY 

2350
01:47:42,862 --> 01:47:43,863
DEFINITELY FEEL CONNECTED WITH 

2351
01:47:43,863 --> 01:47:46,700
THOSE PHYSICIANS OR MY 

2352
01:47:46,700 --> 01:47:48,401
COLLEAGUES WHO CAN SPEAK SPAN, 

2353
01:47:48,401 --> 01:47:50,103
AS THEY ARE MORE TRUSTED BY THE 

2354
01:47:50,103 --> 01:47:52,405
MINORITY POPULATION AND BETTER 

2355
01:47:52,405 --> 01:47:53,340
POSITIONED TO DISCUSS 

2356
01:47:53,340 --> 01:47:56,910
PARTICIPATION BENEFITS AND 

2357
01:47:56,910 --> 01:47:59,246
RISKS. NEXT SLIDE. 

2358
01:47:59,246 --> 01:48:01,214
    INCLUSIVE INSTITUTIONAL 

2359
01:48:01,214 --> 01:48:02,716
POLICIES REQUIRING INFORMED 

2360
01:48:02,716 --> 01:48:04,150
CONSENT FORMS IN DIFFERENT 

2361
01:48:04,150 --> 01:48:06,720
LANGUAGES, PATIENT FACING 

2362
01:48:06,720 --> 01:48:08,088
MATERIAL, MULTIPLE LANGUAGE 

2363
01:48:08,088 --> 01:48:10,123
RELEVANT TO LOCATION'S 

2364
01:48:10,123 --> 01:48:11,358
DEMOGRAPHIC. THIS IS ONE 

2365
01:48:11,358 --> 01:48:12,926
CHALLENGE AT MY PLACE, WHICH WAS

2366
01:48:12,926 --> 01:48:14,961
THERE FEW YEARS AGO. I'M NOT 

2367
01:48:14,961 --> 01:48:18,498
GOING TO SAY IT IS COMPLETELY 

2368
01:48:18,498 --> 01:48:20,100
ELIMINATED, BUT MY PRIMARY GOAL 

2369
01:48:20,100 --> 01:48:25,071
HERE IS AS A CLINICAL TRIAL 

2370
01:48:25,071 --> 01:48:31,411
IS'-IT IS A BIG CENTER IN 

2371
01:48:31,411 --> 01:48:33,947
PULMONARY HYPERTENSION, I 

2372
01:48:33,947 --> 01:48:44,491
REALIZED SPONSOR DO NOT PRO ARE 

2373
01:48:45,058 --> 01:48:45,425
VIE

2374
01:48:45,425 --> 01:48:46,159
PROVIDE THE FORM IN SPANISH AND 

2375
01:48:46,159 --> 01:48:48,128
INSTITUTE DOES NOT SUPPORT 

2376
01:48:48,128 --> 01:48:50,930
BILINGUAL FORMS OR ANYTHING LIKE

2377
01:48:50,930 --> 01:48:52,499
THAT. IN A HISPANIC PREDOMINANT 

2378
01:48:52,499 --> 01:48:55,302
AREA YOU ARE AUTOMATICALLY 

2379
01:48:55,302 --> 01:48:56,536
EXCLUDING THAT BIG PATIENT 

2380
01:48:56,536 --> 01:48:59,272
POPULATION TO PARTICIPATE IN 

2381
01:48:59,272 --> 01:49:00,340
CLINICAL TRIALS. CLEARLY, IF YOU

2382
01:49:00,340 --> 01:49:03,877
LOOK AT MY SIDE DATA, CLEARLY 

2383
01:49:03,877 --> 01:49:05,712
REPRESENTED BY JUST THE WIDE 

2384
01:49:05,712 --> 01:49:06,446
PATIENT POPULATION. 

2385
01:49:06,446 --> 01:49:08,882
    SO FEW YEARS AGO, AT LEAST 

2386
01:49:08,882 --> 01:49:11,785
THREE, FOUR YEARS AGO, I STARTED

2387
01:49:11,785 --> 01:49:13,386
IMPOSE ING THAT ANY NEW RESEARCH

2388
01:49:13,386 --> 01:49:17,924
STAFF WE ARE GOING TO HIRE MUST 

2389
01:49:17,924 --> 01:49:22,462
BE BILINGUAL. CERTIFIED IN DOING

2390
01:49:22,462 --> 01:49:24,931
THE CONSENTING PROCESS. THERE IS

2391
01:49:24,931 --> 01:49:26,900
A WHOLE INSTITUTIONAL PROCESS. 

2392
01:49:26,900 --> 01:49:29,002
AGAIN, I FEEL LIKE THERE IS A 

2393
01:49:29,002 --> 01:49:30,937
LOT OF RED TAPE FROM THE 

2394
01:49:30,937 --> 01:49:32,138
INSTITUTE ALSO FROM THAT, PEOPLE

2395
01:49:32,138 --> 01:49:37,243
WHO ARE SPECIFICALLY NATIVE 

2396
01:49:37,243 --> 01:49:38,912
SPANISH SPEAKING THEY HAD TO 

2397
01:49:38,912 --> 01:49:43,683
UNDERGO TRAININGS TO PROVE THEY 

2398
01:49:43,683 --> 01:49:45,085
COULD SPEAK SPANISH. REGARDLESS 

2399
01:49:45,085 --> 01:49:48,088
I WILL SAY WE ARE FAR FROM A BIG

2400
01:49:48,088 --> 01:49:51,424
SUCCESS BUT I IN ALL HONESTY ONE

2401
01:49:51,424 --> 01:49:52,492
TOTALLY SPANISH SPEAKING PATIENT

2402
01:49:52,492 --> 01:49:54,294
IN A CLINICAL TRIAL. IT IS STILL

2403
01:49:54,294 --> 01:49:56,563
NOT A SUCCESS BUT A CHANGE FROM 

2404
01:49:56,563 --> 01:49:59,299
ZERO TO ONE. AS I MENTIONED 

2405
01:49:59,299 --> 01:50:01,735
ABOUT EMPLOYING BILINGUAL STAFF 

2406
01:50:01,735 --> 01:50:05,038
INVOLVING RESEARCH, 

2407
01:50:05,038 --> 01:50:09,175
INCORPORATING TELEHEALTH, IT IS 

2408
01:50:09,175 --> 01:50:10,543
A BIG STATE AND PEOPLE DRIVE 

2409
01:50:10,543 --> 01:50:18,017
EASILY, SO INCORPORATING 

2410
01:50:18,017 --> 01:50:20,086
TELEHEALTH CAN HELP AND REDUCE 

2411
01:50:20,086 --> 01:50:24,958
TRIAL -- REDUCE BURDEN ON THE 

2412
01:50:24,958 --> 01:50:26,493
TRIAL AND CARE PROVIDER. THESE 

2413
01:50:26,493 --> 01:50:28,294
SHOULD BE INCORPORATED IN TRIALS

2414
01:50:28,294 --> 01:50:30,597
KEEPING THESE THINGS IN MIND. WE

2415
01:50:30,597 --> 01:50:33,867
TALK ABOUT STIPEND 

2416
01:50:33,867 --> 01:50:38,538
REIMBURSEMENT. THIS RECENTLY WAS

2417
01:50:38,538 --> 01:50:41,007
DOCTOR BRAND ABOUT COMPENSATION 

2418
01:50:41,007 --> 01:50:42,876
FOR LOST WAGES. MANY OF TRIALS 

2419
01:50:42,876 --> 01:50:48,114
AND INSTITUTES DO NOT MANDATE 

2420
01:50:48,114 --> 01:50:49,516
COMPENSATED FOR THEIR LOST WAGES

2421
01:50:49,516 --> 01:50:54,621
IF COMING FOR TRIAL OR RESEARCH 

2422
01:50:54,621 --> 01:50:56,756
VISIT. THAT IS SOMETHING SHOULD 

2423
01:50:56,756 --> 01:50:58,758
BE VERY IMPORTANT THING, COMING 

2424
01:50:58,758 --> 01:51:01,628
TO A CLINICAL TRIAL VISIT HAD ME

2425
01:51:01,628 --> 01:51:03,229
LEASE ONE DAY SALARY, I DO NOT 

2426
01:51:03,229 --> 01:51:05,498
WANT TO PARTICIPATE IN THE 

2427
01:51:05,498 --> 01:51:07,567
CLINICAL TRIAL. OF COURSE THE 

2428
01:51:07,567 --> 01:51:11,271
ADDITIONAL STIPEND FOR CARE 

2429
01:51:11,271 --> 01:51:18,978
PROVIDERS. NEXT SLIDE. WE TALK 

2430
01:51:18,978 --> 01:51:21,981
ABOUT AFFORDABLE CARE ACT. THE 

2431
01:51:21,981 --> 01:51:23,283
GOVERNMENT SHOULD HAVE 

2432
01:51:23,283 --> 01:51:27,053
LEGISLATION, REMOTE CULTURALLY 

2433
01:51:27,053 --> 01:51:29,756
TAILORED OUTREACH TO HELP 

2434
01:51:29,756 --> 01:51:34,194
ECONOMIC AND SOCIALLY DEPRIVED 

2435
01:51:34,194 --> 01:51:35,161
PATIENT POPULATION. NEXT SLIDE. 

2436
01:51:35,161 --> 01:51:37,130
WE TALKED ABOUT THE CULTURALLY 

2437
01:51:37,130 --> 01:51:42,368
COMPETENT CARE OF TRAINED 

2438
01:51:42,368 --> 01:51:44,370
PHYSICIANS WHO ARE COGNIZANT 

2439
01:51:44,370 --> 01:51:46,072
ABOUT THESE DIFFERENCES AND CAN 

2440
01:51:46,072 --> 01:51:47,073
ADDRESS THOSE DIFFERENCES WITH 

2441
01:51:47,073 --> 01:51:50,176
PATIENT, INCREASED 

2442
01:51:50,176 --> 01:51:50,777
REPRESENTATION IN THE HEALTH 

2443
01:51:50,777 --> 01:51:54,247
CARE FROM THE MINORITY PEOPLE 

2444
01:51:54,247 --> 01:51:56,115
WILL DEFINITELY HELP DEVELOP 

2445
01:51:56,115 --> 01:51:56,816
MORE CONVERSATION IN HEALTH CARE

2446
01:51:56,816 --> 01:51:59,919
IN GENERAL AND PARTICIPATION IN 

2447
01:51:59,919 --> 01:52:01,287
CLINICAL RESEARCH. NEXT SLIDE. 

2448
01:52:01,287 --> 01:52:04,057
    HEALTH LITERACY AND LANGUAGE

2449
01:52:04,057 --> 01:52:06,860
SERVICES, TRANSLATORS SHOULD BE 

2450
01:52:06,860 --> 01:52:08,294
EASILY AVAILABLE, ESPECIALLY FOR

2451
01:52:08,294 --> 01:52:10,196
CONSENTING PROCESS IN CLINICAL 

2452
01:52:10,196 --> 01:52:14,234
TRIALS, WHICH IS VERY CONVO

2453
01:52:14,234 --> 01:52:15,301
CONVOLUTED, PERHAPS HAVING 

2454
01:52:15,301 --> 01:52:17,003
DEDICATED SERVICE DEPENDING ON 

2455
01:52:17,003 --> 01:52:19,305
WHAT PREDOMINANT LANGUAGE 

2456
01:52:19,305 --> 01:52:21,174
SERVICE, THAT MIGHT HELP. AND 

2457
01:52:21,174 --> 01:52:23,343
ENCOURAGE PARTICIPATION IN 

2458
01:52:23,343 --> 01:52:26,279
CLINICAL TRIALS. NEXT SLIDE. 

2459
01:52:26,279 --> 01:52:27,914
THIS IS ONE IMPORTANT SLIDE, 

2460
01:52:27,914 --> 01:52:29,315
WHICH I WANTED TO HIGHLIGHT. I 

2461
01:52:29,315 --> 01:52:33,419
THINK THIS IS NOT GOING TO BE 

2462
01:52:33,419 --> 01:52:37,190
JUST AN INDIVIDUAL 

2463
01:52:37,190 --> 01:52:38,024
INVESTIGATOR-DEPENDENT THING BUT

2464
01:52:38,024 --> 01:52:39,425
SHOULD BE MULTIPLE STAKEHOLDER 

2465
01:52:39,425 --> 01:52:41,928
FROM PUBLIC, PRIVATE AND 

2466
01:52:41,928 --> 01:52:47,367
NONPROFIT ORGANIZATIONS LIKE PHA

2467
01:52:47,367 --> 01:52:49,936
SHOULD COME TOGETHER TO ADDRESS 

2468
01:52:49,936 --> 01:52:52,171
DISPARITIES IN CLINICAL TRIAL 

2469
01:52:52,171 --> 01:52:53,139
PARTICIPATION, PERHAPS PROVIDE 

2470
01:52:53,139 --> 01:52:55,074
GUIDANCE FOR NEW SPONSORS COMING

2471
01:52:55,074 --> 01:52:57,911
UP WITH NEWER DRUG TRIALS, 

2472
01:52:57,911 --> 01:52:58,778
IDENTIFY ROOT CAUSE OF 

2473
01:52:58,778 --> 01:53:00,313
DISPARITIES IN MAKING CRITICAL 

2474
01:53:00,313 --> 01:53:03,082
POLICY CHANGES. I THINK WE 

2475
01:53:03,082 --> 01:53:04,450
SHOULD WORK ON MAKING CLINICAL 

2476
01:53:04,450 --> 01:53:06,619
TRIALS MORE RESPONSIVE TO 

2477
01:53:06,619 --> 01:53:10,089
ACKNOWLEDGE THE CHANGING 

2478
01:53:10,089 --> 01:53:11,858
EPIDEMIOLOGY. 20 YEARS AGO 

2479
01:53:11,858 --> 01:53:13,493
PATIENTS WERE MUCH YOUNGER, 

2480
01:53:13,493 --> 01:53:20,700
MAYBE DID NOT HAVE THAT MUCH 

2481
01:53:20,700 --> 01:53:22,368
COMORBIDITIES, MAYBE LIVING 

2482
01:53:22,368 --> 01:53:23,836
LONGER. SO TRIAL SHOULD BE 

2483
01:53:23,836 --> 01:53:26,339
CHANGED OR ADAPTED ACCORDING TO 

2484
01:53:26,339 --> 01:53:28,074
CHANGING EPIDEMIOLOGY OF DISEASE

2485
01:53:28,074 --> 01:53:30,043
TO ENCOURAGE MORE INVOLVEMENT OF

2486
01:53:30,043 --> 01:53:31,377
SUCH PATIENTS. 

2487
01:53:31,377 --> 01:53:33,646
    I'M NOT ENTIRELY SURE HOW 

2488
01:53:33,646 --> 01:53:37,817
MUCH FDA OR NIH MANDATES OR 

2489
01:53:37,817 --> 01:53:38,484
PROVIDES INSTRUCTIONS TO THESE 

2490
01:53:38,484 --> 01:53:41,154
FOLKS WHO ARE CONDUCTING THE 

2491
01:53:41,154 --> 01:53:43,056
CLINICAL TRIALS OR NEW DRUG 

2492
01:53:43,056 --> 01:53:45,892
TRIALS OR ANY KIND OF REGISTRY, 

2493
01:53:45,892 --> 01:53:49,362
THAT THEY SHOULD HAVE 

2494
01:53:49,362 --> 01:53:50,597
PARTICIPATION OF HISPANIC 

2495
01:53:50,597 --> 01:53:52,465
POPULATION OR BLACK POPULATION. 

2496
01:53:52,465 --> 01:53:54,767
I'M NOT ENTIRELY SURE. PERHAPS 

2497
01:53:54,767 --> 01:53:57,704
THE EXPERTS HERE FROM NIH CAN 

2498
01:53:57,704 --> 01:53:59,472
PROVIDE INSIGHT. BUT THIS SHOULD

2499
01:53:59,472 --> 01:54:04,777
BE MANDATED TO EVEN A PRIVATELY 

2500
01:54:04,777 --> 01:54:07,313
SPONSORED TRIAL OR NIH STUDY. 

2501
01:54:07,313 --> 01:54:08,548
SUBSTANTIAL INCENTIVES FOR 

2502
01:54:08,548 --> 01:54:11,985
APPROPRIATE INCLUSION PLANS. 

2503
01:54:11,985 --> 01:54:13,319
NEXT SLIDE. 

2504
01:54:13,319 --> 01:54:17,156
    AGAIN, REQUIRE FURTHER GOING

2505
01:54:17,156 --> 01:54:18,825
INTO THIS REQUIRE DEMONSTRATION 

2506
01:54:18,825 --> 01:54:20,960
AND PROTOCOL METHODS, PROTOCOLS 

2507
01:54:20,960 --> 01:54:23,229
OF METHODS AND MEASURES TO 

2508
01:54:23,229 --> 01:54:25,765
ENSURE MEANINGFUL COMMUNITY 

2509
01:54:25,765 --> 01:54:26,966
PARTICIPATION THROUGHOUT THE 

2510
01:54:26,966 --> 01:54:29,369
PROCESS, REQUIRE DETAILED PLAN 

2511
01:54:29,369 --> 01:54:30,803
TO BUILD COMMUNITY CAPACITY FOR 

2512
01:54:30,803 --> 01:54:32,805
UNDERSTANDING AND SUPPORTING THE

2513
01:54:32,805 --> 01:54:34,707
CLINICAL RESEARCH. REQUIRE THAT 

2514
01:54:34,707 --> 01:54:37,977
ALL LOCAL CLINICAL TRIAL TEAMS 

2515
01:54:37,977 --> 01:54:42,849
CONVENE COMMITTEE -- RETENTION 

2516
01:54:42,849 --> 01:54:44,250
COMMITTEE TO REVISE PART OF THE 

2517
01:54:44,250 --> 01:54:46,419
PLAN. I THINK THIS IS VERY MUCH 

2518
01:54:46,419 --> 01:54:48,087
LACKING. AT LEAST I CAN SPEAK 

2519
01:54:48,087 --> 01:54:54,293
FOR MY PLACE. PROJECTS LIKE 

2520
01:54:54,293 --> 01:54:55,662
EDICT, I REALLY LIKE AND READ A 

2521
01:54:55,662 --> 01:54:57,130
LOT. I THINK IT IS TIME TO COME 

2522
01:54:57,130 --> 01:55:00,466
UP WITH SOMETHING LIKE THIS, 

2523
01:55:00,466 --> 01:55:01,300
ELIMINATING DISPARITIES IN 

2524
01:55:01,300 --> 01:55:02,301
CLINICAL TRIALS. THIS IS 

2525
01:55:02,301 --> 01:55:03,603
ACTUALLY IN CANCER TRIALS, WHERE

2526
01:55:03,603 --> 01:55:05,571
I LEARNED MORE ABOUT IT, ARE 

2527
01:55:05,571 --> 01:55:08,741
NEEDED IN PH AS WELL. WHERE THEY

2528
01:55:08,741 --> 01:55:19,218
HAVE IDENTIFIED THE ROOT CAUSES.

2529
01:55:19,218 --> 01:55:21,587
AWARE ONE OF MY ONCOLOGY FRIEND 

2530
01:55:21,587 --> 01:55:26,125
TELL US THE NCI RECOGNITION, 

2531
01:55:26,125 --> 01:55:29,962
WHICH CANCER CENTERS GET -- TO 

2532
01:55:29,962 --> 01:55:31,664
GET, TO OBTAIN THAT RECOGNITION 

2533
01:55:31,664 --> 01:55:35,835
THE CENS CENTERS NEED TO SHOW H 

2534
01:55:35,835 --> 01:55:37,570
MANY THEY HAVE ENROLLED FROM 

2535
01:55:37,570 --> 01:55:40,807
MINORITIES OR SOCIALLY OR 

2536
01:55:40,807 --> 01:55:42,041
ECONOMICALLY DEPRIVED 

2537
01:55:42,041 --> 01:55:45,211
ETHNICITIES IN THEIR CLINICAL 

2538
01:55:45,211 --> 01:55:48,214
TRIALS. I DO NOT KNOW IF WE 

2539
01:55:48,214 --> 01:55:49,449
COULD COME UP WITH SOMETHING 

2540
01:55:49,449 --> 01:55:54,954
LIKE THAT, EVEN PHCC 

2541
01:55:54,954 --> 01:55:57,623
ACCREDITATION OR ORIENTATION 

2542
01:55:57,623 --> 01:55:58,691
PROCESS. NEXT SLIDE. 

2543
01:55:58,691 --> 01:56:00,159
    TO CONCLUDE RACIAL AND 

2544
01:56:00,159 --> 01:56:02,328
ETHNIC MINORITIES ARE 

2545
01:56:02,328 --> 01:56:04,297
UNDERREPRESENTED IN CLINICAL 

2546
01:56:04,297 --> 01:56:08,735
TRIALS, LIMITING INSIGHT INTO 

2547
01:56:08,735 --> 01:56:11,804
HEALTH DISPARITIES AND DRIVEN BY

2548
01:56:11,804 --> 01:56:13,172
ECONOMIC, LEVEL OF EDUCATION AND

2549
01:56:13,172 --> 01:56:15,274
LIMITED ACCESS TO HEALTH CARE. 

2550
01:56:15,274 --> 01:56:18,444
BOTH DISEASE-AGNOSTIC AND 

2551
01:56:18,444 --> 01:56:19,645
DISEASE-SPECIFIC INTERVENTIONS 

2552
01:56:19,645 --> 01:56:21,547
ARE NEEDED FOR DISPARITIES. 

2553
01:56:21,547 --> 01:56:22,949
THANK YOU FOR YOUR ATTENTION, 

2554
01:56:22,949 --> 01:56:24,851
SORRY TO TAKE COUPLE MINUTES 

2555
01:56:24,851 --> 01:56:28,087
EXTRA. I'M OPEN FOR ANY 

2556
01:56:28,087 --> 01:56:30,823
QUESTIONS, THANK YOU. 

2557
01:56:30,823 --> 01:56:32,892
>> THEY VERY MUCH, DR.
SAHAY. 

2558
01:56:32,892 --> 01:56:36,562
THAT WAS EXCELLENT. LOOKS LIKE 

2559
01:56:36,562 --> 01:56:38,064
THERE IS A BIT OF AN ISSUE WITH 

2560
01:56:38,064 --> 01:56:40,600
THE AGENDA. WE ARE SUPPOSED TO 

2561
01:56:40,600 --> 01:56:43,302
BREAK FOR LUNCH FOR FIVE MINUTES

2562
01:56:43,302 --> 01:56:44,804
ON THE EAST COAST, MAYBE 

2563
01:56:44,804 --> 01:56:50,343
BREAKFAST ON THE WEST. I WILL 

2564
01:56:50,343 --> 01:56:52,812
MAKE THE EXECUTIVE DECISION TO 

2565
01:56:52,812 --> 01:56:55,114
EXTEND 15 MINUTES INTO LUNCH. IF

2566
01:56:55,114 --> 01:56:57,784
EVERYONE IS OKAY. IF NOT, SIGN 

2567
01:56:57,784 --> 01:57:02,889
OFF AND WE WILL SEE YOU AT 1:00.

2568
01:57:02,889 --> 01:57:04,090
LET'S TAKE 20 MINUTES TO FIELD 

2569
01:57:04,090 --> 01:57:07,059
QUESTIONS. I WILL START THINGS 

2570
01:57:07,059 --> 01:57:09,428
OFF BY DR. SAHAY. ASKING YOU A 

2571
01:57:09,428 --> 01:57:12,498
QUESTION. DR. ESTRADA ALSO YOU 

2572
01:57:12,498 --> 01:57:15,601
CAN JUMP IN. YOU BOTH AS WELL AS

2573
01:57:15,601 --> 01:57:19,205
DR. GOEL, ALLUDED TO THE FACT 

2574
01:57:19,205 --> 01:57:22,308
THAT SOCIOECONOMIC STATUS, 

2575
01:57:22,308 --> 01:57:23,709
PERHAPS SOCIAL DETERMINANTS, 

2576
01:57:23,709 --> 01:57:26,179
WHICH WE WILL GET INTO NEXT 

2577
01:57:26,179 --> 01:57:27,880
SESSION, ARE VERY IMPORTANT. 

2578
01:57:27,880 --> 01:57:30,316
WHEN WE DESIGNED CLINICAL 

2579
01:57:30,316 --> 01:57:33,719
TRIALS, COHORT STUDIES AND CASE 

2580
01:57:33,719 --> 01:57:38,891
CONTROL STUDIES, WE DON'T 

2581
01:57:38,891 --> 01:57:41,961
TYPICALLY ASSESS SOCIAL 

2582
01:57:41,961 --> 01:57:45,798
DETERMINANTS OR SOCIOECONOMIC 

2583
01:57:45,798 --> 01:57:49,168
STATUS. YOU HAVE MENTIONED IN 

2584
01:57:49,168 --> 01:57:51,904
TERMS OF HETEROGENEITY AND HOW 

2585
01:57:51,904 --> 01:57:53,573
TO ASSESS RACE. IS IT IMPORTANT 

2586
01:57:53,573 --> 01:57:56,742
FOR US TO TRACK THOSE IN ALL 

2587
01:57:56,742 --> 01:57:58,277
THOSE SITUATIONS AND IF THERE 

2588
01:57:58,277 --> 01:58:01,047
ARE -- YOU KNOW, NORMALLY IN 

2589
01:58:01,047 --> 01:58:02,682
RANDOMIZED CONTROL TRIAL WHEN WE

2590
01:58:02,682 --> 01:58:05,251
DESIGN THE TRIAL WE ASSUME BOTH 

2591
01:58:05,251 --> 01:58:06,919
TREATMENT ARM AND CONTROL ARM 

2592
01:58:06,919 --> 01:58:11,123
ARE THROUGH RANDOM IZATION 

2593
01:58:11,123 --> 01:58:12,792
PROCESS THERE IS MATCHING OF IN 

2594
01:58:12,792 --> 01:58:23,202
BOTH ARMS. IF THIS IS A 

2595
01:58:24,937 --> 01:58:27,306
MISMATCH, HOW DO WE ASSESS IT 

2596
01:58:27,306 --> 01:58:29,041
AND NUMBER TWO, HOW DO WE 

2597
01:58:29,041 --> 01:58:32,645
APPROACH THAT? LET'S START OFF 

2598
01:58:32,645 --> 01:58:34,180
WITH DR. SAHAY. 

2599
01:58:34,180 --> 01:58:37,717
>> SO YOU ARE EXACTLY
ASKING HOW

2600
01:58:37,717 --> 01:58:40,019
DO WE ASSESS WITH LIKE THE 

2601
01:58:40,019 --> 01:58:41,320
SOCIOECONOMIC STATUS OF THE 

2602
01:58:41,320 --> 01:58:45,524
PATIENT WHEN WE ARE -- 

2603
01:58:45,524 --> 01:58:48,794
>> SHOULD WE BE ASSESSING 

2604
01:58:48,794 --> 01:58:52,965
SOCIOECONOMIC STATUS AND SOCIAL 

2605
01:58:52,965 --> 01:58:55,902
DETERMINE NANTS AND HOW TO ADDR 

2606
01:58:55,902 --> 01:58:56,068
IT? 

2607
01:58:56,068 --> 01:58:58,304
>> I THINK THE SHORT
ANSWER IS 

2608
01:58:58,304 --> 01:58:59,138
YES BECAUSE THIS MORNING IN 

2609
01:58:59,138 --> 01:59:01,407
THREE DIFFERENT TALKS WE HAVE 

2610
01:59:01,407 --> 01:59:03,643
CLEARLY DEMONSTRATED THAT THIS 

2611
01:59:03,643 --> 01:59:14,186
AFFECTS THEIR OUTCOMES. NO DOUBT

2612
01:59:19,725 --> 01:59:23,596
OF SOCIOECONOMICS STATUS SO TO 

2613
01:59:23,596 --> 01:59:25,698
COLLECT FAR BETTER THAN PRIOR 

2614
01:59:25,698 --> 01:59:28,901
DATA, TO COLLECT THE INFORMATION

2615
01:59:28,901 --> 01:59:30,903
ABOUT THEIR -- ADMIT PERSONAL 

2616
01:59:30,903 --> 01:59:31,971
INFORMATION ABOUT THEIR INCOME, 

2617
01:59:31,971 --> 01:59:33,839
WHERE THEY LIVE, IF THEY HAVE 

2618
01:59:33,839 --> 01:59:36,008
BARRIERS TO COME TO THE DOCTOR'S

2619
01:59:36,008 --> 01:59:38,277
OFFICE OR GETTING THE 

2620
01:59:38,277 --> 01:59:41,280
MEDICATIONS. I DO NOT REMEMBER 

2621
01:59:41,280 --> 01:59:43,916
ME ASKING EVERY PATIENT WHEN I 

2622
01:59:43,916 --> 01:59:45,484
SEE THEM OR THOSE PARTICIPATING 

2623
01:59:45,484 --> 01:59:47,820
IN THE CLINICAL TRIAL HAVE THEY 

2624
01:59:47,820 --> 01:59:50,122
-- DO THEY ROUTINELY HAVE TO 

2625
01:59:50,122 --> 01:59:52,325
UNDERGO BARRIERS TO OBTAIN 

2626
01:59:52,325 --> 01:59:54,327
MEDICATIONS OR PICK UP THEIR 

2627
01:59:54,327 --> 01:59:55,895
MEDICATIONS? I THINK THESE ARE 

2628
01:59:55,895 --> 01:59:56,729
IMPORTANT INFORMATION THAT WE 

2629
01:59:56,729 --> 01:59:58,531
SHOULD BE COLLECTING. BECAUSE IF

2630
01:59:58,531 --> 02:00:00,433
WE ARE NOT ASKING THESE 

2631
02:00:00,433 --> 02:00:02,234
QUESTIONS, FOR US THEY DO NOT 

2632
02:00:02,234 --> 02:00:04,603
EXIST. I THINK THAT IS A BIG 

2633
02:00:04,603 --> 02:00:06,639
CHALLENGE THERE. ONE OF THE WAYS

2634
02:00:06,639 --> 02:00:08,140
WHICH CURRENTLY WE ARE WORKING 

2635
02:00:08,140 --> 02:00:10,876
WITH PDRI IS TO COME UP. I THINK

2636
02:00:10,876 --> 02:00:12,478
WHILE I WAS LISTENING TO THE 

2637
02:00:12,478 --> 02:00:16,215
TALK THIS MORNING, WE ARE COMING

2638
02:00:16,215 --> 02:00:24,023
UP WITH A GLOBAL SORT OF -- YOU 

2639
02:00:24,023 --> 02:00:26,659
KNOW, WHERE THE CONSENSUS ON THE

2640
02:00:26,659 --> 02:00:28,794
VARIABLES TO BE COLLECTED IN ANY

2641
02:00:28,794 --> 02:00:32,031
OF THE REGISTRY STUDY FOR PH. 

2642
02:00:32,031 --> 02:00:34,834
CURRENTLY DIFFERENT LOGISTICS 

2643
02:00:34,834 --> 02:00:36,168
COLLECT VARIABLES DIFFERENTLY 

2644
02:00:36,168 --> 02:00:38,938
ALSO. AFTER THESE FIRST FEW 

2645
02:00:38,938 --> 02:00:40,973
TAKES I SUDDENLY REALIZED IN 

2646
02:00:40,973 --> 02:00:44,977
PROPOSALAL WE HAVE NOT TALKED 

2647
02:00:44,977 --> 02:00:45,444
ABOUT DISPARITIESES, 

2648
02:00:45,444 --> 02:00:48,681
SOCIOECONOMIC STATUS OR THE RACE

2649
02:00:48,681 --> 02:00:50,116
DATA. IT ACTUALLY HIS QUESTION, 

2650
02:00:50,116 --> 02:00:51,984
WHEN HE MENTIONED ABOUT THAT 

2651
02:00:51,984 --> 02:00:53,619
EUROPEANS DO NOT TALK ABOUT IT. 

2652
02:00:53,619 --> 02:00:57,523
IT SUDDENLY DAWNEDED ON ME, YES.

2653
02:00:57,523 --> 02:00:58,724
BECAUSE IT IS A GLOBAL THING WE 

2654
02:00:58,724 --> 02:01:01,427
ARE DOING. THIS WAS NOT BROUGHT 

2655
02:01:01,427 --> 02:01:04,663
UP INTO THE CONVERSATION SO THIS

2656
02:01:04,663 --> 02:01:08,834
IS SOMETHING I'M GOING TO SEND 

2657
02:01:08,834 --> 02:01:13,806
AN EMAIL THAT WE SHOULD BE 

2658
02:01:13,806 --> 02:01:14,707
INCLUDING OR ASKING. IT STARTS 

2659
02:01:14,707 --> 02:01:18,611
WITH US, THAT WE NEED TO START 

2660
02:01:18,611 --> 02:01:20,713
COLLECTING THAT INFORMATION MORE

2661
02:01:20,713 --> 02:01:22,715
SYSTEMATICALLY, WHICH WE ARE NOT

2662
02:01:22,715 --> 02:01:23,282
DOING CURRENTLY. 

2663
02:01:23,282 --> 02:01:25,618
>> DR. ESTRADA DO YOU HAVE
A 

2664
02:01:25,618 --> 02:01:28,187
STANDARDIZED WAY YOU LOOK AT 

2665
02:01:28,187 --> 02:01:30,489
THESE VARIABLES WITH YOUR 

2666
02:01:30,489 --> 02:01:32,024
PATIENTS IN SAN ANTONIO? 

2667
02:01:32,024 --> 02:01:37,496
>> YEAH, I WANT TO TAKE A
LITTLE

2668
02:01:37,496 --> 02:01:39,865
WHAT DR. HYDE SAID, I TOOK AWAY 

2669
02:01:39,865 --> 02:01:41,734
A SLIDE WE ARE CREATING A MODEL 

2670
02:01:41,734 --> 02:01:43,836
FOR THE U.S.  BUT TRYING TO 

2671
02:01:43,836 --> 02:01:50,042
CREATE SOMETHING THAT IS 

2672
02:01:50,042 --> 02:01:51,110
REPLICABLE. THESE ARE 

2673
02:01:51,110 --> 02:01:52,278
CHARACTERISTIC OF WHAT WE HAVE 

2674
02:01:52,278 --> 02:01:55,714
NOW. THESE HAPPENED, AS I 

2675
02:01:55,714 --> 02:01:56,882
MENTIONED IN THE SINGAPORE 

2676
02:01:56,882 --> 02:01:58,317
PEOPLE THROUGHOUT THE WORLD. IF 

2677
02:01:58,317 --> 02:02:00,686
WE CAN CAPTURE DATA AND HAVE IT 

2678
02:02:00,686 --> 02:02:01,454
REPLICATED, THE SPECIFIC 

2679
02:02:01,454 --> 02:02:02,888
QUESTION, WHEN I STARTED LOOKING

2680
02:02:02,888 --> 02:02:05,191
INTO THE SUBJECT, THAT LAST 

2681
02:02:05,191 --> 02:02:06,559
SLIDE I MENTIONED WHERE THE 

2682
02:02:06,559 --> 02:02:09,428
CENSUS IS REALLY TRYING TO 

2683
02:02:09,428 --> 02:02:15,801
GATHER THE GRAN YULARITY, 

2684
02:02:15,801 --> 02:02:17,303
SPECIFICALLY THE HISPANIC 

2685
02:02:17,303 --> 02:02:19,305
POPULATION, THESE ARE SENSITIVE 

2686
02:02:19,305 --> 02:02:29,081
QUESTIONS. THESE ARE SPECIFIC 

2687
02:02:29,081 --> 02:02:31,550
BUT COULD DETER, TO ANSWER 

2688
02:02:31,550 --> 02:02:33,652
FAITH FULLY. WHAT WE P SPEAK THE

2689
02:02:33,652 --> 02:02:35,187
MOST ABOUT ONE SPECIFIC CHANGE 

2690
02:02:35,187 --> 02:02:37,089
IS MIGRATION PATTERNS ARE 

2691
02:02:37,089 --> 02:02:38,591
SOMEWHAT DIFFERENT THAN OTHER 

2692
02:02:38,591 --> 02:02:40,793
COHORTS BECAUSE OF PROXIMITY. 

2693
02:02:40,793 --> 02:02:42,361
WHEN COMES TO SOCIOECONOMIC 

2694
02:02:42,361 --> 02:02:45,464
STATUS, EMPLOYMENT OR INCOME, 

2695
02:02:45,464 --> 02:02:46,932
EVEN THOUGH THEY ARE 

2696
02:02:46,932 --> 02:02:49,034
MEASUREMENT, MAY NOT BE RELIABLY

2697
02:02:49,034 --> 02:02:51,170
STENTLY MEASURED WITHIN

2698
02:02:51,170 --> 02:02:53,939
THE POPULATION WHO MAY NOT HAVE 

2699
02:02:53,939 --> 02:02:56,375
A STABLE JOB OR STABLE INCOME. 

2700
02:02:56,375 --> 02:02:58,644
THEY GET MISSED. THESE ARE THE 

2701
02:02:58,644 --> 02:03:00,179
PATIENTS WE ARE SEEING AND 

2702
02:03:00,179 --> 02:03:02,181
PROBABLY ACCESS THE CARE. I 

2703
02:03:02,181 --> 02:03:04,116
THINK THE FRAMEWORK WHERE WE CAN

2704
02:03:04,116 --> 02:03:06,185
CAPTURE POPULATION, NOT 

2705
02:03:06,185 --> 02:03:07,920
ROUTINELY CAPTURED IN BIGGER 

2706
02:03:07,920 --> 02:03:09,121
CENTERS, WOULD BE THE IDEAL 

2707
02:03:09,121 --> 02:03:18,831
SCENARIO. I THINK A SURVEY 

2708
02:03:18,831 --> 02:03:20,833
GRANDPARENT HERITAGE, KIND OF 

2709
02:03:20,833 --> 02:03:22,601
ABOUT MIGRATION PATTERNS, WOULD 

2710
02:03:22,601 --> 02:03:28,574
BE KEY COMPONENT TO THAT 

2711
02:03:28,574 --> 02:03:30,676
QUESTION. 

2712
02:03:30,676 --> 02:03:31,677
>> THANK YOU. 

2713
02:03:31,677 --> 02:03:36,081
>> I HAVE TWO QUESTIONS
FOR YOU.

2714
02:03:36,081 --> 02:03:38,417
BOTH WHICH YOU SORT OF ALLUDED 

2715
02:03:38,417 --> 02:03:41,220
TO EARLIER. YOU KNOW, WHAT DO WE

2716
02:03:41,220 --> 02:03:44,223
KNOW ABOUT THE PROVIDERS, THE 

2717
02:03:44,223 --> 02:03:46,592
CLINICAL TRIALISTS AND 

2718
02:03:46,592 --> 02:03:47,826
INSTITUTIONS ENROLLING PATIENTS 

2719
02:03:47,826 --> 02:03:50,529
AND PARTICIPANTS IN STUDIES AND 

2720
02:03:50,529 --> 02:03:52,164
REGISTRIES? BECAUSE IF YOU ARE 

2721
02:03:52,164 --> 02:03:56,068
COMING FROM AN INSTITUTION WHERE

2722
02:03:56,068 --> 02:04:00,539
YOU ONLY SEE 95% WHITE PEOPLE 

2723
02:04:00,539 --> 02:04:03,309
AND, YOU KNOW, YOUR EXPOSURE TO 

2724
02:04:03,309 --> 02:04:05,177
MINORITIES IS VERY SMALL, VERSUS

2725
02:04:05,177 --> 02:04:08,414
ANOTHER CENTER WHERE YOU MAY SEE

2726
02:04:08,414 --> 02:04:11,116
ALMOST EXCLUSIVELY 

2727
02:04:11,116 --> 02:04:12,351
UNDERREPRESENTED GROUPS. YOU 

2728
02:04:12,351 --> 02:04:14,553
KNOW, THE ABILITY TO ENROLL IS 

2729
02:04:14,553 --> 02:04:15,888
GOING TO BE VERY DIFFERENT. SO 

2730
02:04:15,888 --> 02:04:20,059
DO WE KNOW ANYTHING ABOUT THESE 

2731
02:04:20,059 --> 02:04:23,295
MAJOR CLINICAL TRIALS AND PEOPLE

2732
02:04:23,295 --> 02:04:25,998
WHO ARE ENROLLING? 

2733
02:04:25,998 --> 02:04:27,600
>> YES. I WOULD LIKE TO
TAKE 

2734
02:04:27,600 --> 02:04:30,069
THAT QUESTION. I LIVE IN 

2735
02:04:30,069 --> 02:04:33,272
HOUSTON, WHICH IS A VERY DIVERSE

2736
02:04:33,272 --> 02:04:34,840
CITY. CULTURALLY, ETHNICITY, 

2737
02:04:34,840 --> 02:04:37,509
RACE, WHATEVER YOU WANT TO SAY. 

2738
02:04:37,509 --> 02:04:40,079
IT IS A VERY DIVERSE CITY, THE 

2739
02:04:40,079 --> 02:04:41,747
FOURTH LARGEST CITY IN THE 

2740
02:04:41,747 --> 02:04:43,649
COUNTRY. I CAN TELL YOU 

2741
02:04:43,649 --> 02:04:45,784
HISTORICALLY, AND THERE WERE 

2742
02:04:45,784 --> 02:04:47,486
BARRIERS THAT -- THERE ARE STILL

2743
02:04:47,486 --> 02:04:49,822
MULTIPLE BARRIERS TO ENROLL 

2744
02:04:49,822 --> 02:04:52,891
PATIENTS. IT IS ALL ALONG THE 

2745
02:04:52,891 --> 02:04:56,495
BARRIERS THAT ARE INSTITUTIONAL,

2746
02:04:56,495 --> 02:05:01,000
SITE AND ALSO THE CLINICAL 

2747
02:05:01,000 --> 02:05:02,901
TRIALS. SOME OF THE POINTS I 

2748
02:05:02,901 --> 02:05:04,136
HIGHLIGHTED AND FINE TO 

2749
02:05:04,136 --> 02:05:06,005
HIGHLIGHT IN THE PROTOCOLS, LIKE

2750
02:05:06,005 --> 02:05:08,974
FOR EXAMPLE, BMI CUT-OFF OF 30, 

2751
02:05:08,974 --> 02:05:13,045
TO ME IT APPEARS VERY 

2752
02:05:13,045 --> 02:05:13,846
CONSERVATIVE. ESPECIALLY, I LIVE

2753
02:05:13,846 --> 02:05:15,881
IN TEXAS. IF YOU HAVE A CUT-OFF 

2754
02:05:15,881 --> 02:05:19,785
OF 30 AND I SHOWED YOU THE DATA 

2755
02:05:19,785 --> 02:05:22,721
FROM THE U.S.  CENSUS DATA OR 

2756
02:05:22,721 --> 02:05:25,424
CDC DATA THAT PREDOMINANTLY THE 

2757
02:05:25,424 --> 02:05:27,026
AFRICAN-AMERICAN POPULATION HAD,

2758
02:05:27,026 --> 02:05:30,929
THAT WHOLE 60% OF BLACK WOMEN 

2759
02:05:30,929 --> 02:05:35,868
AND ALMOST 50% OF BLACK MEN HAD 

2760
02:05:35,868 --> 02:05:38,237
BMI ABOVE 30. THIS IS 

2761
02:05:38,237 --> 02:05:39,371
NATIONALLY. YOU ARE 

2762
02:05:39,371 --> 02:05:41,473
AUTOMATICALLY DISQUALIFYING 

2763
02:05:41,473 --> 02:05:42,474
SIGNIFICANT AMOUNT OF BLACK 

2764
02:05:42,474 --> 02:05:43,275
PATIENT POPULATION. 

2765
02:05:43,275 --> 02:05:47,746
    SIMILARLY I USE THE PFD 

2766
02:05:47,746 --> 02:05:50,282
EXAMPLE, THE OTHER 

2767
02:05:50,282 --> 02:05:51,817
COMORBIDITIES. IF YOU PICK UP 

2768
02:05:51,817 --> 02:05:58,257
LAST FIVE CLINIC CAL TRIALS ACCT

2769
02:05:58,257 --> 02:06:00,459
DRUG TESTED DIFFERENT, TO ME 

2770
02:06:00,459 --> 02:06:02,461
LOOK LIKE COPY EXACTLY THE SAME.

2771
02:06:02,461 --> 02:06:13,005
SAME EXCLUSIONARY CRITERIA, SAME

2772
02:06:14,473 --> 02:06:15,307
INELECTROC

2773
02:06:15,307 --> 02:06:15,974
INCLUSION AND DIFFERENT IN 3 BUT

2774
02:06:15,974 --> 02:06:17,543
IF YOU ARE LOOKING AT THE 

2775
02:06:17,543 --> 02:06:18,610
PREDOMINANT DATA THEY ARE PRETTY

2776
02:06:18,610 --> 02:06:27,720
MUCH DONE THE SAME WAY. PD, FB 

2777
02:06:27,720 --> 02:06:29,922
EXCLUDES AFRICAN-AMERICANS AND 

2778
02:06:29,922 --> 02:06:31,623
OBESITY IS PREVALENT IN HISPANIC

2779
02:06:31,623 --> 02:06:32,958
POPULATION. WE EXCLUDE THEM. WE 

2780
02:06:32,958 --> 02:06:36,328
KNOW INCREASE RISK FOR 

2781
02:06:36,328 --> 02:06:38,297
OBSTRUCTIVE AIRWAY DISEASES. SO 

2782
02:06:38,297 --> 02:06:39,898
CLEARLY YOU ARE -- WE ARE NOT 

2783
02:06:39,898 --> 02:06:42,000
TALKING ABOUT THE LANGUAGE ISSUE

2784
02:06:42,000 --> 02:06:44,002
BUT EVEN WITH THE CO. MORBID 

2785
02:06:44,002 --> 02:06:45,237
CONDITIONS WHICH MAY OR MAY NOT 

2786
02:06:45,237 --> 02:06:48,507
HAVE THAT IMPLICATION OF 

2787
02:06:48,507 --> 02:06:52,111
PERMANENT VASCULAR DISEASE BUT 

2788
02:06:52,111 --> 02:06:55,547
THESE PATIENTS ARE BEING 

2789
02:06:55,547 --> 02:06:58,283
EXCLUDED. SO THE QUESTION IS, 

2790
02:06:58,283 --> 02:06:59,952
WHAT SHOULD WE DO? I FEEL WE 

2791
02:06:59,952 --> 02:07:01,954
NEED TO BE MORE ADAPTIVE TO 

2792
02:07:01,954 --> 02:07:02,955
CHANGING EPIDEMIOLOGY OF 

2793
02:07:02,955 --> 02:07:06,225
DISEASE. WE ARE NOT DOING THE 

2794
02:07:06,225 --> 02:07:08,494
TRI

2795
02:07:08,494 --> 02:07:13,966
TRIALS WHEN EVERYONE THE CLASSIC

2796
02:07:13,966 --> 02:07:16,568
DEFINITION WAS EVERYONE WAS 

2797
02:07:16,568 --> 02:07:19,938
YOUNG-WE KNOW ALL AGE GROUPS WE 

2798
02:07:19,938 --> 02:07:21,707
ARE SEEING SO PERHAPS NEED TO 

2799
02:07:21,707 --> 02:07:23,475
CHANGE THOSE PROTOCOLS. SOME OF 

2800
02:07:23,475 --> 02:07:27,246
THE POINTS I HIGHLIGHTED ABOUT 

2801
02:07:27,246 --> 02:07:29,314
INSTITUTION ALSO INVOLVING MORE 

2802
02:07:29,314 --> 02:07:33,252
BILINGUAL STAFF, WE DIDN'T HAVE 

2803
02:07:33,252 --> 02:07:34,820
EARLIER, HIRED BILINGUAL STAFF 

2804
02:07:34,820 --> 02:07:40,993
TO ENCOURAGE ENROLLMENT. THERE 

2805
02:07:40,993 --> 02:07:42,428
ARE INSTITUTIONAL BARRIERS AS 

2806
02:07:42,428 --> 02:07:42,761
WELL. 

2807
02:07:42,761 --> 02:07:46,932
>> AGREED. MY QUESTION IS
DO WE 

2808
02:07:46,932 --> 02:07:49,201
KNOW ANYTHING ABOUT THE RACE AND

2809
02:07:49,201 --> 02:07:51,336
ETHNICITY OF CLINICAL TRIALISTS,

2810
02:07:51,336 --> 02:07:53,739
MAYBE THOSE DESIGNING THE STUDY 

2811
02:07:53,739 --> 02:07:57,009
PROTOCOLS AND MAKEUP OF THE SAY 

2812
02:07:57,009 --> 02:08:01,280
INSTITUTIONS THAT ARE ENROLLING?

2813
02:08:01,280 --> 02:08:03,949
WE TALK A LOT ABOUT 

2814
02:08:03,949 --> 02:08:05,250
UNDERREPRESENTATION IN CLINICAL 

2815
02:08:05,250 --> 02:08:08,420
TRIALS, ET CETERA, BUT, YOU 

2816
02:08:08,420 --> 02:08:11,657
KNOW, THERE IS MORE THAN ONE 

2817
02:08:11,657 --> 02:08:16,862
SIDE TO THIS THAT NEEDS TO BE 

2818
02:08:16,862 --> 02:08:17,830
ADDRESSED SO I'M ASKING ON THE 

2819
02:08:17,830 --> 02:08:18,897
FLIP SIDE OF THINGS. 

2820
02:08:18,897 --> 02:08:21,500
>> I CANNOT SPEAK FOR THE
WHOLE 

2821
02:08:21,500 --> 02:08:25,237
COUNTRY BUT I CAN SPEAK ABOUT MY

2822
02:08:25,237 --> 02:08:30,309
PROGRAM, WHICH IS IN TERMS OF 

2823
02:08:30,309 --> 02:08:32,978
HEALTH CARE PROVIDERS IS FAIRLY 

2824
02:08:32,978 --> 02:08:34,513
DIVERSE. LIKE RIGHTLY POINTED 

2825
02:08:34,513 --> 02:08:38,116
OUT THAT FOLKS INVOLVED IN TRIAL

2826
02:08:38,116 --> 02:08:41,153
DESIGN AND ALSO THE INDIVIDUAL 

2827
02:08:41,153 --> 02:08:43,188
HEALTH CARE PROVIDER SHOULD BE 

2828
02:08:43,188 --> 02:08:45,290
EQUALLY DIVERSE TOO TO 

2829
02:08:45,290 --> 02:08:46,558
ACKNOWLEDGE THAT DIVERSITY IN 

2830
02:08:46,558 --> 02:08:48,927
THE PATIENT POPULATION. THAT IS 

2831
02:08:48,927 --> 02:08:50,329
A FAIR POINT. 

2832
02:08:50,329 --> 02:08:52,364
>> MAY I ADD SOMETHING TO
IT? I 

2833
02:08:52,364 --> 02:08:54,867
THINK IT IS A GREAT POINT. THE 

2834
02:08:54,867 --> 02:08:56,702
CULTURAL COMPETENCY TO ADDRESS 

2835
02:08:56,702 --> 02:08:58,303
QUESTIONS WITHIN TRIALS, IF YOU 

2836
02:08:58,303 --> 02:08:59,304
DON'T KNOW WHAT YOU DON'T KNOW, 

2837
02:08:59,304 --> 02:09:01,340
IT IS HARD TO HAVE THAT 

2838
02:09:01,340 --> 02:09:02,875
CONVERSATION. I THINK ONE POINT 

2839
02:09:02,875 --> 02:09:04,543
OF THAT AND SOMETHING WE CAN 

2840
02:09:04,543 --> 02:09:05,844
THINK ABOUT INTERVENTION IS IF 

2841
02:09:05,844 --> 02:09:07,479
YOU THINK ABOUT PLACES THAT HAVE

2842
02:09:07,479 --> 02:09:09,181
TRIALS, ARE USUALLY THE SIGN TO 

2843
02:09:09,181 --> 02:09:11,283
DO TRIALS. WHETHER A BIGGER 

2844
02:09:11,283 --> 02:09:12,317
INSTITUTION, BIGGER ECONOMIC 

2845
02:09:12,317 --> 02:09:14,620
CENTER, THERE ARE PROVIDERS WHO 

2846
02:09:14,620 --> 02:09:17,189
DO WANT TO DO TRIALS BUT DON'T 

2847
02:09:17,189 --> 02:09:19,191
KNOW HOW TO START. I HAD 

2848
02:09:19,191 --> 02:09:25,497
PERSONAL EXPERIENCE WHEN I JO

2849
02:09:25,497 --> 02:09:26,131
JOINED WE DIDN'T KNOW AND I HAD 

2850
02:09:26,131 --> 02:09:26,832
GREAT MENTORS THAT COULD HELP. 

2851
02:09:26,832 --> 02:09:30,669
MAYBE AS COMMUNITY WE COULD DO A

2852
02:09:30,669 --> 02:09:31,737
MENTORSHIP PROGRAM, IF SOMEONE 

2853
02:09:31,737 --> 02:09:33,405
WANTS TO DO A TRIAL, NEW MEXICO 

2854
02:09:33,405 --> 02:09:35,140
OR SOMEWHERE ELSE, WHERE WE MAY 

2855
02:09:35,140 --> 02:09:37,643
HAVE CERTAIN MORE DIVERSE 

2856
02:09:37,643 --> 02:09:39,244
POPULATION THAT WE ARE NOT 

2857
02:09:39,244 --> 02:09:40,312
GETTING TO AND THERE IS AN 

2858
02:09:40,312 --> 02:09:41,747
INTERESTING PROVIDER, WE CAN 

2859
02:09:41,747 --> 02:09:43,181
SUPPORT THEM IN A WAY THEY DON'T

2860
02:09:43,181 --> 02:09:45,050
FEEL THEY ARE BY THEMSELVES 

2861
02:09:45,050 --> 02:09:47,653
TRYING TO BUILD UP A RESEARCH, 

2862
02:09:47,653 --> 02:09:49,388
GROUP OR TRIAL GROUP. 

2863
02:09:49,388 --> 02:09:52,891
>> I HAVE A FOLLOW-UP
COMMENT ON

2864
02:09:52,891 --> 02:09:55,394
THIS. IN ONE OF THE SLIDES I DID

2865
02:09:55,394 --> 02:10:01,366
MAKE A POINT THAT DO WE KNOW 

2866
02:10:01,366 --> 02:10:07,272
REGARDLESS OF THE PVD ANY OTHER 

2867
02:10:07,272 --> 02:10:11,777
DISEASES THAT NIH OR FDA 

2868
02:10:11,777 --> 02:10:13,378
MANDATES PRIVATE SPONSORS OR 

2869
02:10:13,378 --> 02:10:16,615
STUDIES THAT YOU NEED TO HAVE 

2870
02:10:16,615 --> 02:10:19,251
CERTAIN PERCENTAGE OF PATIENT 

2871
02:10:19,251 --> 02:10:21,453
POPULATION REPRESENTING HISPANIC

2872
02:10:21,453 --> 02:10:24,957
OR BLACK, INCONSISTENT WITH 

2873
02:10:24,957 --> 02:10:26,592
POPULATION OR DEMOGRAPHICS. I'M 

2874
02:10:26,592 --> 02:10:31,730
NOT AWARE OF THAT. I FEEL UNLESS

2875
02:10:31,730 --> 02:10:36,168
NIH OR FDA MANDATES THAT TYPE OF

2876
02:10:36,168 --> 02:10:37,636
THING, I THINK THAT IS ONE OF 

2877
02:10:37,636 --> 02:10:39,538
THE ROOT CAUSE ISSUES WHICH CAN 

2878
02:10:39,538 --> 02:10:41,306
ADD TRESZ THERE. I DON'T KNOW 

2879
02:10:41,306 --> 02:10:42,007
ABOUT THAT PART. 

2880
02:10:42,007 --> 02:10:46,044
>> I CAN HELP TO ADDRESS
THAT. I

2881
02:10:46,044 --> 02:10:49,414
WAS INTENDING TO ANSWER A 

2882
02:10:49,414 --> 02:10:51,483
QUESTION. I CAN'T HELP ON THE 

2883
02:10:51,483 --> 02:10:53,385
FDA BUT NIH, THIS IS WHILE 

2884
02:10:53,385 --> 02:10:56,822
MAINTAINED REQUIRED ISSUE FOR 

2885
02:10:56,822 --> 02:11:01,293
THE OLDER (?) TRIAL ENROLL 

2886
02:11:01,293 --> 02:11:03,295
PATIENTS. IF YOU GET FUNDED 

2887
02:11:03,295 --> 02:11:05,764
BEFORE FOR THIS TYPE STUDY THERE

2888
02:11:05,764 --> 02:11:08,333
WILL BE INCLUSION ENROLLMENT 

2889
02:11:08,333 --> 02:11:09,968
RECORD TABLE WHEN YOU SUBMIT 

2890
02:11:09,968 --> 02:11:13,872
YOUR APPLICATION. THAT IS A 

2891
02:11:13,872 --> 02:11:15,240
TABLE SPECIFICALLY MENTIONED, 

2892
02:11:15,240 --> 02:11:16,908
YOU HAVE TO DESCRIBE HOW MANY 

2893
02:11:16,908 --> 02:11:19,745
YOU PLAN TO ENROLL AND ONCE 

2894
02:11:19,745 --> 02:11:23,315
RACIAL AND ETHNICITY DIVERSITY 

2895
02:11:23,315 --> 02:11:27,753
FOR THIS. SO ASK THE SPECIFIC 

2896
02:11:27,753 --> 02:11:30,355
FOR MEMBERS IN EACH CATEGORY. 

2897
02:11:30,355 --> 02:11:33,158
THIS WILL BE AN ANNUAL REPORT. 

2898
02:11:33,158 --> 02:11:35,560
WE AS PO, PROGRAM OFFICER, WE 

2899
02:11:35,560 --> 02:11:38,130
WILL REVIEW ENROLLMENT IN 

2900
02:11:38,130 --> 02:11:40,399
PROGRAM. NOT ONLY TOTAL NUMBER 

2901
02:11:40,399 --> 02:11:42,501
BUT DIVERSITY. THIS IS A 

2902
02:11:42,501 --> 02:11:44,002
REQUIREMENT FOR US IN THAT JOB. 

2903
02:11:44,002 --> 02:11:45,971
OF COURSE WE HAVEN'T HAD A FIXED

2904
02:11:45,971 --> 02:11:47,873
NUMBER FOR EACH RULE HOW MANY 

2905
02:11:47,873 --> 02:11:49,941
PATIENT WE HAVE. THIS IS 

2906
02:11:49,941 --> 02:11:54,613
PROBABLY NOT REALISTIC FOR 

2907
02:11:54,613 --> 02:11:56,415
CERTAIN INVESTIGATORS IN CERTAIN

2908
02:11:56,415 --> 02:11:57,816
AREA, BUT THIS IS DEFINITELY YOU

2909
02:11:57,816 --> 02:11:59,518
HAVE TO PUT IT IN THERE. SO THAT

2910
02:11:59,518 --> 02:12:04,056
IS WHY THIS IS REQUIRED ITEMS 

2911
02:12:04,056 --> 02:12:07,092
FOR CLINICAL STUDY. IF YOU -- 

2912
02:12:07,092 --> 02:12:08,360
JUST SAY YOU APPLICATION ONLY 

2913
02:12:08,360 --> 02:12:10,095
INCLUDES SAY WE ARE ENROLLED 

2914
02:12:10,095 --> 02:12:13,031
TOTALLY CAUCASIAN POPULATION, 

2915
02:12:13,031 --> 02:12:14,466
YOUR GRANT WILL NOT BE FUNDED SO

2916
02:12:14,466 --> 02:12:17,969
THIS IS THE PRESSURE ABOUT THAT.

2917
02:12:17,969 --> 02:12:20,272
SO YEAH, THAT IS -- TRY -- I 

2918
02:12:20,272 --> 02:12:22,007
THINK FDA HAVE SIMILAR PROBABLY 

2919
02:12:22,007 --> 02:12:24,142
POLICY, BUT I COULD NOT ANSWER 

2920
02:12:24,142 --> 02:12:27,446
ON BE HALF OF THEM. 

2921
02:12:27,446 --> 02:12:32,818
>> THANK YOU. DR. ORTEGA. 

2922
02:12:32,818 --> 02:12:34,953
>> YOU KNOW, MY COMMENT IS
MORE 

2923
02:12:34,953 --> 02:12:42,194
AS WE LOOKOUT  -- LOOK OUTWARD 

2924
02:12:42,194 --> 02:12:43,929
TO INCREASE CLINICAL TRIALS IT 

2925
02:12:43,929 --> 02:12:45,831
IS IMPORTANT TO LOOK INWARDS FOR

2926
02:12:45,831 --> 02:12:47,232
TRIALS. WE ARE TRYING TO RECRUIT

2927
02:12:47,232 --> 02:12:49,101
AS MANY PATIENTS AS FAST AS 

2928
02:12:49,101 --> 02:12:50,502
POSSIBLE. THAT USUALLY DEFAULTS 

2929
02:12:50,502 --> 02:12:51,837
TO THE MOST CONVENIENT SAMPLE. 

2930
02:12:51,837 --> 02:12:53,538
YOU KNOW WHAT I MEAN? OUR 

2931
02:12:53,538 --> 02:12:55,373
PATIENTS THAT ARE THE MOST 

2932
02:12:55,373 --> 02:12:56,475
CONSISTENTLY, OH THIS IS THE 

2933
02:12:56,475 --> 02:12:58,176
BEST PATIENT WE HAVE. INSTEAD OF

2934
02:12:58,176 --> 02:12:59,578
TAKING ALL YOUR PATIENTS, 

2935
02:12:59,578 --> 02:13:01,079
THROWING ALL IN A HAT AND 

2936
02:13:01,079 --> 02:13:06,818
RANDOMLY PICKING YOUR NEXT 

2937
02:13:06,818 --> 02:13:08,854
PATIENT TO DO THE BEST JOB, THE 

2938
02:13:08,854 --> 02:13:10,655
MOST AVAILABLE, THE MOST 

2939
02:13:10,655 --> 02:13:12,591
CONVENIENT. I THINK WE HAVE TO 

2940
02:13:12,591 --> 02:13:14,025
LOOK IN MORE AND BE MORE WILLING

2941
02:13:14,025 --> 02:13:15,427
TO TAKE ON PATIENTS THAT ARE 

2942
02:13:15,427 --> 02:13:17,028
GOING TO BE HARDER TO BRING IN. 

2943
02:13:17,028 --> 02:13:18,630
THAT ALSO IS HARD ON 

2944
02:13:18,630 --> 02:13:19,431
INFRASTRUCTURE, RIGHT. LIKE WE 

2945
02:13:19,431 --> 02:13:22,167
REALLY HAVE TO HAVE PEOPLE WORK 

2946
02:13:22,167 --> 02:13:23,168
ON WEEKENDS. BECAUSE THOSE 

2947
02:13:23,168 --> 02:13:25,771
POPULATIONS THAT ARE HIT THE 

2948
02:13:25,771 --> 02:13:27,038
HARDEST DON'T NECESSARILY -- 

2949
02:13:27,038 --> 02:13:28,573
MAYBE THEY ARE WORKING TWO JOBS.

2950
02:13:28,573 --> 02:13:31,777
THERE'S REASONS. IT IS -- 

2951
02:13:31,777 --> 02:13:34,780
UNFORTUNATELY, IT IS A VICIOUS 

2952
02:13:34,780 --> 02:13:35,781
CYCLE THAT FEEDS ONTO ITSELF FOR

2953
02:13:35,781 --> 02:13:38,116
THIS. I THINK WE HAVE TO LOOK 

2954
02:13:38,116 --> 02:13:40,318
INWARD, LOOK AT OUR STRATEGIES 

2955
02:13:40,318 --> 02:13:43,188
AS WELL. AND I HEARD THE BELL. 

2956
02:13:43,188 --> 02:13:45,257
>> YEAH, ACTUALLY I AGREE
WITH 

2957
02:13:45,257 --> 02:13:47,926
DR. ORTEGA'S COMMENT. WE HAVE --

2958
02:13:47,926 --> 02:13:51,429
I JUST WANT TO SHARE WITH YOU, 

2959
02:13:51,429 --> 02:13:53,398
SOME OF THE (?) MANAGING THE 

2960
02:13:53,398 --> 02:13:57,269
TRIAL, THERE WAS A STUDY 

2961
02:13:57,269 --> 02:14:00,305
REALIZED CAUCASIAN IS LIMITED TO

2962
02:14:00,305 --> 02:14:01,506
SHOULD HAVE AND LACK IN BLACK 

2963
02:14:01,506 --> 02:14:02,874
POPULATION SO TELL THE 

2964
02:14:02,874 --> 02:14:04,342
INVESTIGATORS OF THE STUDY TO 

2965
02:14:04,342 --> 02:14:09,247
START RECRUITING MORE CAUCASIAN 

2966
02:14:09,247 --> 02:14:10,782
PATIENT, THEY HAVE ONLY FOCUSED 

2967
02:14:10,782 --> 02:14:13,819
ON MINORITIES BECAUSE THEY ARE 

2968
02:14:13,819 --> 02:14:16,922
-- OVER THE QUOTA FOR CAUCASIAN 

2969
02:14:16,922 --> 02:14:18,056
POPULATION. THIS IS REALLY 

2970
02:14:18,056 --> 02:14:20,192
HAPPENING FOR THE NIH-FUNDED 

2971
02:14:20,192 --> 02:14:22,828
STUDY. AS YOU SAID SOME OF -- IT

2972
02:14:22,828 --> 02:14:27,065
IS MORE CONVENIENT -- DEPENDS ON

2973
02:14:27,065 --> 02:14:28,567
WHERE THEY ARE LOCATION -- 

2974
02:14:28,567 --> 02:14:31,002
PROBABLY EASIER FOR INVESTIGATOR

2975
02:14:31,002 --> 02:14:33,238
IN CERTAIN POPULATION BUT SINCE 

2976
02:14:33,238 --> 02:14:34,973
FUNDED BY NIH THIS IS REQUIRED 

2977
02:14:34,973 --> 02:14:36,107
SO HAVE CERTAIN TIME THEY HAVE 

2978
02:14:36,107 --> 02:14:38,677
TO MAKE SURE THEY ARE CATCHING 

2979
02:14:38,677 --> 02:14:40,478
UP WITH THE MINORITY POPULATION 

2980
02:14:40,478 --> 02:14:42,747
TOO, SO THAT IS PART OF THE 

2981
02:14:42,747 --> 02:14:43,148
REQUIREMENT. 

2982
02:14:43,148 --> 02:14:47,719
>> IN LITERATURE THERE ARE

2983
02:14:47,719 --> 02:14:49,721
EXAMPLE OF MINORITY GIVEN LESS 

2984
02:14:49,721 --> 02:14:52,624
OR COMBINATION DRUGS. THERE ARE 

2985
02:14:52,624 --> 02:14:53,625
INHERENT BIASES THAT EXIST AND 

2986
02:14:53,625 --> 02:14:56,127
APPLY TO THERAPIES IN MORE 

2987
02:14:56,127 --> 02:14:58,830
ADVANCED CLINICAL TRIALS. WHY IT

2988
02:14:58,830 --> 02:15:01,633
EXISTS, WHO KNOWS BUT WE NEED TO

2989
02:15:01,633 --> 02:15:02,968
RECOGNIZE AND GO FOR THAT 

2990
02:15:02,968 --> 02:15:03,235
EXAMPLE. 

2991
02:15:03,235 --> 02:15:06,238
>> YOU CAN ADD TOO, THAT
MAY BE 

2992
02:15:06,238 --> 02:15:08,840
PROVIDER BIAS. YOU KNOW, BECAUSE

2993
02:15:08,840 --> 02:15:11,109
OF DIVERSE -- YEP, SO THOSE 

2994
02:15:11,109 --> 02:15:14,312
THINGS NEED TO BE INCORPORATED 

2995
02:15:14,312 --> 02:15:15,513
AS WELL. 

2996
02:15:15,513 --> 02:15:18,049
>> I ALWAYS SAY PHYSICIAN
BIAS, 

2997
02:15:18,049 --> 02:15:19,384
WHEN YOU DECIDE WHAT TREATMENT 

2998
02:15:19,384 --> 02:15:23,655
IS GOOD FOR YOU INSTEAD OF 

2999
02:15:23,655 --> 02:15:25,757
PATIENT TELLING YOU WHAT THEY 

3000
02:15:25,757 --> 02:15:26,858
DESIRE OR WHAT GUIDELINE 

3001
02:15:26,858 --> 02:15:27,559
RECOMMENDS THAT PATIENT SHOULD 

3002
02:15:27,559 --> 02:15:29,594
BE ON. I THINK YOU BROUGHT UP A 

3003
02:15:29,594 --> 02:15:31,997
VERY REALISTIC -- DR. ORTEGA, 

3004
02:15:31,997 --> 02:15:35,867
YOUR POINT IS VERY WELL TAKEN. 

3005
02:15:35,867 --> 02:15:39,271
THIS IS A VERY REAL -- RUNNING A

3006
02:15:39,271 --> 02:15:41,172
CLINICAL TRIAL ISSUE THAT YOU 

3007
02:15:41,172 --> 02:15:43,141
BROUGHT UP. THIS IS LIKE AN 

3008
02:15:43,141 --> 02:15:44,109
EVERYDAY CONVERSATION WITH MY 

3009
02:15:44,109 --> 02:15:45,710
TEAM. OH, WHICH PATIENT SHOULD 

3010
02:15:45,710 --> 02:15:47,545
WE ENROLL, WHETHER THIS PATIENT 

3011
02:15:47,545 --> 02:15:50,382
IS GOING TO BE RELIABLE TO 

3012
02:15:50,382 --> 02:15:52,350
PARTICIPATE IN THE CLINICAL 

3013
02:15:52,350 --> 02:15:54,519
TRIAL. SOME WERE RANDOMLY, SOME 

3014
02:15:54,519 --> 02:15:56,288
WERE IN THE CHART DOCUMENTED FOR

3015
02:15:56,288 --> 02:15:57,689
WHATEVER REASON, THE PATIENT 

3016
02:15:57,689 --> 02:16:01,960
MISSED TWO DOSES OR 

3017
02:16:01,960 --> 02:16:03,261
NON-COMPLIANT, LIKE DOCUMENTED 

3018
02:16:03,261 --> 02:16:05,363
IN OUR RECORDS AND THIS PATIENT 

3019
02:16:05,363 --> 02:16:07,666
FOREVER IS LABELED AS 

3020
02:16:07,666 --> 02:16:09,134
NON-COMPLIANT. WHEN I GO AND I 

3021
02:16:09,134 --> 02:16:10,635
HAVE A DIFFERENT OPINION AND MY 

3022
02:16:10,635 --> 02:16:12,570
RESEARCH NURSE REVIEWS THE CART 

3023
02:16:12,570 --> 02:16:13,571
AND SHE WILL HAVE A DIFFERENT 

3024
02:16:13,571 --> 02:16:15,140
OPINION AND I HAVE TO HAVE THIS 

3025
02:16:15,140 --> 02:16:16,341
CONVERSATION AGAIN THAT NO, THIS

3026
02:16:16,341 --> 02:16:18,877
COULD BE. BUT I THINK THIS IS A 

3027
02:16:18,877 --> 02:16:21,713
VERY MUCH REAL LIFE ISSUE, WHAT 

3028
02:16:21,713 --> 02:16:25,083
YOU BROUGHT UP. THAT IS WHERE 

3029
02:16:25,083 --> 02:16:28,219
THE BIASES START, PRETTY MUCH. 

3030
02:16:28,219 --> 02:16:30,155
>> I THINK WE ARE NEARING
OUR 

3031
02:16:30,155 --> 02:16:32,457
POINT WHERE WE MAY HAVE TO 

3032
02:16:32,457 --> 02:16:34,759
ADJOURN, BUT I THINK DR. ORTEGA 

3033
02:16:34,759 --> 02:16:38,129
BROUGHT UP A VERY IMPORTANT 

3034
02:16:38,129 --> 02:16:39,931
POINT, JUST TO REITERATE. AND 

3035
02:16:39,931 --> 02:16:41,533
PART OF MY INITIAL POINT OF 

3036
02:16:41,533 --> 02:16:43,134
MAKING THAT WE DON'T KNOW 

3037
02:16:43,134 --> 02:16:49,040
SOMETIMES OUR OWN BIASES. THE 

3038
02:16:49,040 --> 02:16:50,675
BIASES WE INCORPORATE WHEN WE 

3039
02:16:50,675 --> 02:16:52,677
ARE DESIGNING TRIALS OR 

3040
02:16:52,677 --> 02:16:53,979
GUIDELINES THAT MAY BE RELIANT 

3041
02:16:53,979 --> 02:16:56,614
ON PREVIOUS RESEARCH THAT WAS 

3042
02:16:56,614 --> 02:16:56,881
BIASSED. 

3043
02:16:56,881 --> 02:16:58,483
    IS THERE ANYTHING -- BEFORE 

3044
02:16:58,483 --> 02:17:01,953
WE ADJOURN IS THERE ANYTHING WE 

3045
02:17:01,953 --> 02:17:07,525
CAN DO IN THE DESIGN PHASE OF A 

3046
02:17:07,525 --> 02:17:09,928
TRIAL, WHETHER IT IS US OR 

3047
02:17:09,928 --> 02:17:11,563
INDUSTRY OR WHATEVER ELSE, 

3048
02:17:11,563 --> 02:17:14,532
SHOULD WE BRING IN MORE OPINIONS

3049
02:17:14,532 --> 02:17:17,435
TO EXAMINE OUR OWN BIASES AND 

3050
02:17:17,435 --> 02:17:21,039
HOW THOSE MIGHT LAYOUT WHEN IT 

3051
02:17:21,039 --> 02:17:23,475
COMES TO THE TRIAL RESULTS OR 

3052
02:17:23,475 --> 02:17:25,910
WHAT ARE YOUR RECOMMENDATIONS? 

3053
02:17:25,910 --> 02:17:27,879
>> I DON'T THINK WE -- I
JUST 

3054
02:17:27,879 --> 02:17:30,749
HAVE ONE COMMENT TO MAKE ON THAT

3055
02:17:30,749 --> 02:17:32,951
PART. I SEE SO MANY CLINICAL 

3056
02:17:32,951 --> 02:17:36,287
TRIALS PROTOCOLS ON REGULAR 

3057
02:17:36,287 --> 02:17:37,789
BASIS, FROM DIFFERENT INDUSTRY 

3058
02:17:37,789 --> 02:17:41,359
SPONSORS OR ANYONE. I AM YET TO 

3059
02:17:41,359 --> 02:17:46,464
SEE A PROTOCOL WHERE ANY OF THE 

3060
02:17:46,464 --> 02:17:50,735
SPONSORS HAVE SPECIFIED THAT NOT

3061
02:17:50,735 --> 02:17:54,939
AS A TOOL BUT AS ENCOURAGEMENT. 

3062
02:17:54,939 --> 02:17:56,908
THAT WE ENCOURAGE PARTICIPATION 

3063
02:17:56,908 --> 02:17:59,210
FROM A DIVERSE PATIENT 

3064
02:17:59,210 --> 02:18:02,347
POPULATION, AS REQUIRED BY THE 

3065
02:18:02,347 --> 02:18:04,349
FDA, OR EXPECTED BY THE FDA NOT 

3066
02:18:04,349 --> 02:18:08,119
EVEN REQUIRED. I DON'T THINK -- 

3067
02:18:08,119 --> 02:18:09,287
WE DON'T EVEN TALK ABOUT THAT.  

3068
02:18:09,287 --> 02:18:11,523
WHEN YOU DO NOT TALK ABOUT THAT,

3069
02:18:11,523 --> 02:18:13,291
THIS IS DEFINITELY OVERLOOKED. I

3070
02:18:13,291 --> 02:18:14,392
THINK WE NEED TO START 

3071
02:18:14,392 --> 02:18:18,063
CONVERSATIONS SOMEWHERE THAT WE 

3072
02:18:18,063 --> 02:18:19,264
START DOCUMENTING THESE IN THESE

3073
02:18:19,264 --> 02:18:21,032
-- I DON'T THINK THERE IS GOING 

3074
02:18:21,032 --> 02:18:22,901
O BE ANY HARM OR DOWNSIDE OF 

3075
02:18:22,901 --> 02:18:24,569
THAT. BUT IF YOU START 

3076
02:18:24,569 --> 02:18:27,238
DOCUMENTING THAT HEY, WE 

3077
02:18:27,238 --> 02:18:31,409
ENCOURAGE THE PATIENT -- IF YOU 

3078
02:18:31,409 --> 02:18:34,512
ARE LOOKING A SITE IN TEXAS OR 

3079
02:18:34,512 --> 02:18:36,414
ARIZONA, HEAVILY HISPANIC 

3080
02:18:36,414 --> 02:18:38,316
POPULATION, PREDOMINANT AREAS, 

3081
02:18:38,316 --> 02:18:41,653
WE ENCOURAGE THAT YOU ENROLL 

3082
02:18:41,653 --> 02:18:42,654
MORE HISPANIC PATIENT 

3083
02:18:42,654 --> 02:18:44,089
POPULATION. SUDDENLY, PEOPLE 

3084
02:18:44,089 --> 02:18:46,458
WILL START TO THINK ABOUT IT. 

3085
02:18:46,458 --> 02:18:47,725
BECAUSE CURRENTLY NO ONE EVEN 

3086
02:18:47,725 --> 02:18:50,495
THINKS ABOUT IT. THAT IS JUST MY

3087
02:18:50,495 --> 02:18:52,197
COMMENT. I DON'T KNOW WE CAN 

3088
02:18:52,197 --> 02:18:54,365
MANDATE TO THE PRIVATE SPONSORS,

3089
02:18:54,365 --> 02:18:57,936
BUT AT LEAST MAKING THIS 

3090
02:18:57,936 --> 02:18:59,037
REQUIREMENT AT LEAST DO 

3091
02:18:59,037 --> 02:19:00,472
DOCUMENT, SO THAT THE 

3092
02:19:00,472 --> 02:19:01,840
INVESTIGATOR OR THE RESEARCH 

3093
02:19:01,840 --> 02:19:04,676
TEAM, WHOEVER IS REVIEWING THOSE

3094
02:19:04,676 --> 02:19:05,643
PROTOCOLS, CAN START THINKING 

3095
02:19:05,643 --> 02:19:08,313
ABOUT IT. I CAN MAKE IT PART. 

3096
02:19:08,313 --> 02:19:11,549
THE IRB, WHO KNOWS HOW THEY WILL

3097
02:19:11,549 --> 02:19:13,651
DIFFERENTIATE THE INDIVIDUAL 

3098
02:19:13,651 --> 02:19:14,119
IRBs. 

3099
02:19:14,119 --> 02:19:15,987
>> THANK YOU. YOU KNOW,
INDUSTRY

3100
02:19:15,987 --> 02:19:16,988
HAS THEIR GOALS. 

3101
02:19:16,988 --> 02:19:17,522
>> YEAH. 

3102
02:19:17,522 --> 02:19:20,125
>> THEY HAVE THEIR GOALS.
THEY 

3103
02:19:20,125 --> 02:19:21,693
ARE IN THE PRESSURE COOKER LIKE 

3104
02:19:21,693 --> 02:19:23,761
WE ARE. IF YOU ARE IN A PRESSURE

3105
02:19:23,761 --> 02:19:25,597
COOKER AND GOT TO RECRUIT YOU 

3106
02:19:25,597 --> 02:19:26,998
WILL BE LESS LIKELY TO RECRUIT 

3107
02:19:26,998 --> 02:19:29,434
PEOPLE YOU THINK ARE LESS LIKELY

3108
02:19:29,434 --> 02:19:30,969
TO BE HARD OR LIKELY TO FOLLOW. 

3109
02:19:30,969 --> 02:19:32,737
THAT IS THE WAY IT IS. THERE HAS

3110
02:19:32,737 --> 02:19:35,607
TO BE AWARENESS AND HAS TO BE 

3111
02:19:35,607 --> 02:19:37,475
ACCOUNTABILITY TO THOSE BODIES, 

3112
02:19:37,475 --> 02:19:41,045
THOSE INDUSTRIAL BODIES. NHLBI 

3113
02:19:41,045 --> 02:19:42,714
DOES PROVIDE ACCOUNTABILITY. I 

3114
02:19:42,714 --> 02:19:43,948
HAVE HAD TO FILL THOSE TABLES 

3115
02:19:43,948 --> 02:19:45,617
OUT A LONG TIME. I DON'T KNOW 

3116
02:19:45,617 --> 02:19:48,119
HOW MANY GET REJECTED BASED -- I

3117
02:19:48,119 --> 02:19:49,821
DON'T KNOW THE FORMULA FOR 

3118
02:19:49,821 --> 02:19:51,055
REJECTION. IF THERE IS ANY 

3119
02:19:51,055 --> 02:19:53,725
USEFUL USE FOR THESE 

3120
02:19:53,725 --> 02:19:56,027
NON-BIOLOGIC RACE/ETHNICITY 

3121
02:19:56,027 --> 02:19:57,629
THINGS IT IS TO MAKE SURE WE ARE

3122
02:19:57,629 --> 02:19:58,897
ACTUALLY FILLING THOSE TABLES 

3123
02:19:58,897 --> 02:20:00,899
OUT AND RECRUITING DIVERSELY. IF

3124
02:20:00,899 --> 02:20:02,133
THERE IS ANY GOOD USE, THAT 

3125
02:20:02,133 --> 02:20:05,670
WOULD BE ONE FOR SURE, BECAUSE 

3126
02:20:05,670 --> 02:20:07,605
IT IS NOT GREAT PRINCIPLE WE'VE 

3127
02:20:07,605 --> 02:20:09,607
GOT BUT IT IS A MATTER OF -- 

3128
02:20:09,607 --> 02:20:11,242
DON'T KNOW HOW WE DO THIS, BUT 

3129
02:20:11,242 --> 02:20:13,645
THAT AWARENESS, I CAN'T GET AWAY

3130
02:20:13,645 --> 02:20:15,613
FROM THE FACT THIS BEHAVIOR IS 

3131
02:20:15,613 --> 02:20:16,748
JUST SOMETHING THAT WE'VE ALL 

3132
02:20:16,748 --> 02:20:19,551
PROBABLY DONE IT. WE WANT TO 

3133
02:20:19,551 --> 02:20:21,085
RECRUIT. WE HAVE OUR PATIENTS 

3134
02:20:21,085 --> 02:20:22,487
THAT ARE OUR FAVORITE PATIENTS. 

3135
02:20:22,487 --> 02:20:24,355
THAT IS NOT FAIR. WHAT IS FAIR 

3136
02:20:24,355 --> 02:20:27,258
IS TAKING ALL THE PATIENTS, 

3137
02:20:27,258 --> 02:20:28,860
PUTTING THEIR NAMES IN A HAT AND

3138
02:20:28,860 --> 02:20:30,195
RANDOMLY PICKING A NUMBER. OH, 

3139
02:20:30,195 --> 02:20:33,164
THIS ONE IS... WHO CARES, THIS 

3140
02:20:33,164 --> 02:20:34,766
IS JUST, THIS IS FAIR TO INCLUDE

3141
02:20:34,766 --> 02:20:36,901
THESE PATIENTS. THOUGH IT WILL 

3142
02:20:36,901 --> 02:20:38,836
BE HARDER TO MAKE SURE THIS 

3143
02:20:38,836 --> 02:20:41,739
PATIENT IS COMPLIANT. THAT IS AN

3144
02:20:41,739 --> 02:20:42,707
INHERENT BIAS. WOULD THEY REALLY

3145
02:20:42,707 --> 02:20:44,776
BE THAT HARD TO BE IN A TRIAL? 

3146
02:20:44,776 --> 02:20:47,111
THAT IS ACTUALLY A BIAS. I JUST 

3147
02:20:47,111 --> 02:20:50,248
SAID IT, A BIAS. I DID THAT 

3148
02:20:50,248 --> 02:20:51,382
INTENTIONALLY, LIKE I'M AWARE OF

3149
02:20:51,382 --> 02:20:55,453
THE BIAS. THERE ARE 

3150
02:20:55,453 --> 02:20:57,855
SELF-ADMINISTERED TESTS ON BIAS 

3151
02:20:57,855 --> 02:21:00,058
I WOULD ENCOURAGE. IT IS A 

3152
02:21:00,058 --> 02:21:02,327
MATTER OF AWARENESS IN INDUSTRY 

3153
02:21:02,327 --> 02:21:06,130
AT ALL LEVELS BUT WHAT IS THE 

3154
02:21:06,130 --> 02:21:09,167
MAGIC FORMULA? WE ALSO HAVE TO 

3155
02:21:09,167 --> 02:21:12,804
LOOK INWARD. WE ARE PEOPLE WHO 

3156
02:21:12,804 --> 02:21:15,206
TALK TO INDUSTRY, CONNECTED TO 

3157
02:21:15,206 --> 02:21:17,175
THOSE CLINICAL TRIALS. IT IS 

3158
02:21:17,175 --> 02:21:19,043
REALLY -- WISH I HAD A BETTER 

3159
02:21:19,043 --> 02:21:22,013
ANSWER THAN THAT BUT PROBABLY 

3160
02:21:22,013 --> 02:21:22,580
WHAT I GOT. 

3161
02:21:22,580 --> 02:21:23,915
>> ALL RIGHT. THANK YOU
VERY 

3162
02:21:23,915 --> 02:21:26,584
MUCH, DR. ORTEGA. I WANT TO 

3163
02:21:26,584 --> 02:21:27,452
ENCOURAGE EVERYONE TO LOOK AT 

3164
02:21:27,452 --> 02:21:31,956
THE GREAT COMMENTS WE HAVE FROM 

3165
02:21:31,956 --> 02:21:33,324
DOCTORS GLEN AND VENTETUOLO IN 

3166
02:21:33,324 --> 02:21:35,526
THE CHAT. ALSO THERE IS A 

3167
02:21:35,526 --> 02:21:39,163
QUESTION REALLY QUICK ON 

3168
02:21:39,163 --> 02:21:46,371
DISTENSIBILITY AND DEMOGRAPHY. 

3169
02:21:46,371 --> 02:21:50,308
DID TENSABILITY IS DETERMINED BY

3170
02:21:50,308 --> 02:21:54,345
RIGHT HEART CATEGORITIZATION AND

3171
02:21:54,345 --> 02:21:56,948
RELATIONSHIP TO DISTENSIBILITY, 

3172
02:21:56,948 --> 02:21:58,549
SEX, AGE, ALTITUDE. NONE OF 

3173
02:21:58,549 --> 02:22:02,120
THOSE FACTORS WERE REFERENCED BY

3174
02:22:02,120 --> 02:22:04,289
THE CHEST PUBLICATION. IN ANY 

3175
02:22:04,289 --> 02:22:10,261
CASE, THE POINT HERE IS THAT 

3176
02:22:10,261 --> 02:22:11,462
AFRICAN-SUB SAHARANS MAY 

3177
02:22:11,462 --> 02:22:12,864
INFLUENCE DISTENSIBILITY BY 

3178
02:22:12,864 --> 02:22:14,432
ENVIRONMENT IN WHICH THEY GREW 

3179
02:22:14,432 --> 02:22:16,301
UP. THAT WAS OVERLOOKED BY THE 

3180
02:22:16,301 --> 02:22:19,871
INITIAL STUDY IN 1985. IF IT IS 

3181
02:22:19,871 --> 02:22:21,906
OVERLOOKED CONTINUOUSLY THROUGH 

3182
02:22:21,906 --> 02:22:24,842
GUIDELINE PRESENTATION, THEN WE 

3183
02:22:24,842 --> 02:22:26,711
MAY MISS THE BALL THERE. SO IN 

3184
02:22:26,711 --> 02:22:29,347
ANY CASE, LET'S ADJOURN. SORRY 

3185
02:22:29,347 --> 02:22:32,116
FOR THE DELAY FOR YOUR LUNCH ON 

3186
02:22:32,116 --> 02:22:35,453
THE EAST COAST. WE WILL 

3187
02:22:35,453 --> 02:22:41,259
RECONVENE IN APPROXIMATELY 40 

3188
02:22:41,259 --> 02:22:43,261
MINUTES-ISH WITH THE SEX AND 

3189
02:22:43,261 --> 02:22:44,156
GENDER DIFFERENCES SESSION,
THANK YOU. (LUNCH BREAK) 

3190
02:22:47,192 --> 02:22:48,994
>> AFTER GOOD LUNCH ON
EAST 

3191
02:22:48,994 --> 02:22:51,163
COAST, BREAKFAST ON THE WEST AND

3192
02:22:51,163 --> 02:22:53,332
SOMEWHERE IN BETWEEN... IF WE 

3193
02:22:53,332 --> 02:22:55,634
ARE READY, CAN WE -- ARE WE 

3194
02:22:55,634 --> 02:22:58,070
READY, SHAUN, TO START? 

3195
02:22:58,070 --> 02:22:59,939
>> YES, SIR, WE ARE. 

3196
02:22:59,939 --> 02:23:05,411
>> OKAY, GREAT. WITH THAT
I WILL

3197
02:23:05,411 --> 02:23:07,346
INTRODUCE THE NEXT SESSION, SEX 

3198
02:23:07,346 --> 02:23:14,153
AND GENDER DIFFERENCES WITH 

3199
02:23:14,153 --> 02:23:21,460
THOSE WITH PULMONARY VASCULAR 

3200
02:23:21,460 --> 02:23:29,168
DISEASE.

3201
02:23:29,168 --> 02:23:39,712
DISEASE. TAKE IT AWAY, DR. 

3202
02:23:49,355 --> 02:23:51,256
STHAH. 

3203
02:23:51,256 --> 02:23:53,826
>> WE DON'T SEE THEM YET. 

3204
02:23:53,826 --> 02:23:56,462
>> I THOUGHT IT WAS ME. 

3205
02:23:56,462 --> 02:23:58,764
>> THAT ODD, BECAUSE I DO
SEE 

3206
02:23:58,764 --> 02:23:58,998
THEM. 

3207
02:23:58,998 --> 02:24:01,300
>> DR. HORN SEES THEM. 

3208
02:24:01,300 --> 02:24:04,703
>> DON'T SEE THEM. MOST 

3209
02:24:04,703 --> 02:24:15,214
IMPORTANT THING IS DR. STRAH. 

3210
02:24:20,119 --> 02:24:23,389
>> AT THE TOP OF THE
SCREEN. 

3211
02:24:23,389 --> 02:24:31,997
>> WONDERFUL, THANK YOU. 

3212
02:24:31,997 --> 02:24:35,667
>> I WANT TO THANK YOU. IT
IS AN

3213
02:24:35,667 --> 02:24:42,174
HONOR. I'M HEATHER STRAH FROM 

3214
02:24:42,174 --> 02:24:44,543
THE UNIVERSITY OF NEBRASKA AND 

3215
02:24:44,543 --> 02:24:47,913
TALKING ABOUT INTERSECTION OF 

3216
02:24:47,913 --> 02:24:53,852
SEX, GENDER AND PULMONARY 

3217
02:24:53,852 --> 02:24:58,257
DISEASE. NEXT SLIDE, PLEASE. 

3218
02:24:58,257 --> 02:25:06,532
    OKAY. FIRST I WOULD LIKE TO 

3219
02:25:06,532 --> 02:25:09,068
CLARIFY THIS A BROAD TERM THAT 

3220
02:25:09,068 --> 02:25:11,303
REFER TO A BROAD GROUP OF 

3221
02:25:11,303 --> 02:25:12,371
INDIVIDUALS THAT DO NOT IDENTIFY

3222
02:25:12,371 --> 02:25:18,143
TO SEX ASSIGNED AT BIRTH, 

3223
02:25:18,143 --> 02:25:19,912
TRANSGENDER HAVE VARYING DEGREES

3224
02:25:19,912 --> 02:25:21,713
OF EXPRESSION AND ALL ARE 

3225
02:25:21,713 --> 02:25:23,682
INDEPENDENT OF MEDICAL CARE AND 

3226
02:25:23,682 --> 02:25:30,322
PHYSICAL APPEARANCE. I MIGHT USE

3227
02:25:30,322 --> 02:25:33,926
TRANSGENDER, GENDER-DIVERSE, TGT

3228
02:25:33,926 --> 02:25:34,793
SYNONYMOUSLY DURING THIS TIME 

3229
02:25:34,793 --> 02:25:36,695
AND WILL BE BEST TO BE CLEAR IF 

3230
02:25:36,695 --> 02:25:40,299
I'M REFERRING TO A 

3231
02:25:40,299 --> 02:25:50,809
GENDER-SPECIFIC GROUP. SHAUN, 

3232
02:25:53,912 --> 02:25:55,314
WILL YOU PROVIDE GUIDANCE FOR 

3233
02:25:55,314 --> 02:25:56,648
PEOPLE IN THE CHAT TO SEE 

3234
02:25:56,648 --> 02:25:57,249
SLIDES. 

3235
02:25:57,249 --> 02:25:59,351
>> IF YOU ARE NOT SEEING
SLIDES 

3236
02:25:59,351 --> 02:26:02,721
AT THE TOP OF YOUR ZOOM, WHERE 

3237
02:26:02,721 --> 02:26:10,162
YOU SEE YOUR NAME, SHAUN PATTON,

3238
02:26:10,162 --> 02:26:12,431
IF YOU CLICK ON THAT IT SHOULD 

3239
02:26:12,431 --> 02:26:19,438
LET YOU SEE MY SCREEN. 

3240
02:26:19,438 --> 02:26:27,679
>> OKAY. DURING THIS TALK
I WILL

3241
02:26:27,679 --> 02:26:28,213
SMEVE

3242
02:26:28,213 --> 02:26:28,881
MENTION THE TRANSGENDER SURVEY 

3243
02:26:28,881 --> 02:26:31,150
BY THE CENTER FOR EQUALITY. THE 

3244
02:26:31,150 --> 02:26:32,518
TRANSGENDER SURVEY WAS PERFORMED

3245
02:26:32,518 --> 02:26:39,625
IN 2015, UPDATED IN 2022. IT 

3246
02:26:39,625 --> 02:26:40,225
INCLUDED ALMOST 85,000 ADULT 

3247
02:26:40,225 --> 02:26:42,327
TRANSGENDER INDIVIDUALS. DATA IS

3248
02:26:42,327 --> 02:26:43,862
STILL BEING ANALYZED AND 

3249
02:26:43,862 --> 02:26:45,697
PROVIDES INVALUABLE INSIGHTS 

3250
02:26:45,697 --> 02:26:48,700
INTO THE EXPERIENCES AND NEEDS 

3251
02:26:48,700 --> 02:26:50,335
OF THE TRANSGENDER COMMUNITY. I 

3252
02:26:50,335 --> 02:26:51,436
WANTED TO PROVIDE THIS CONTEXT 

3253
02:26:51,436 --> 02:26:55,707
NOW FOR WHEN IT IS REFERENCED 

3254
02:26:55,707 --> 02:26:57,476
LATER. NEXT SLIDE, PLEASE. OKAY.

3255
02:26:57,476 --> 02:27:00,412
WHILE OTHERS WILL SPEAK MORE 

3256
02:27:00,412 --> 02:27:03,482
SUBSTANTIALLY ABOUT SEX 

3257
02:27:03,482 --> 02:27:06,051
DIFFERENCES AND PULMONARY 

3258
02:27:06,051 --> 02:27:07,386
HYPERTENSION I WANT TO TOUCH ON 

3259
02:27:07,386 --> 02:27:09,922
THIS TALK AS IT WILL INFORM THE 

3260
02:27:09,922 --> 02:27:10,455
DISCUSSION. 

3261
02:27:10,455 --> 02:27:13,025
    THERE'S BEEN LONGSTANDING 

3262
02:27:13,025 --> 02:27:14,359
KNOWLEDGE FEMALE SEX IS A RISK 

3263
02:27:14,359 --> 02:27:23,001
FAR TOR. REGISN FACTOR. REGISTR 

3264
02:27:23,001 --> 02:27:24,836
ILLUSTRATED THE PREDOMINANCE. 

3265
02:27:24,836 --> 02:27:26,972
DESPITE THIS MALES HAVE WORSE 

3266
02:27:26,972 --> 02:27:28,607
LONG-TIME SURVIVAL. THE 

3267
02:27:28,607 --> 02:27:30,742
ASSOCIATION REGISTRY IS NO 

3268
02:27:30,742 --> 02:27:33,712
DIFFERENT, AND IT TOO 

3269
02:27:33,712 --> 02:27:38,784
DEMONST

3270
02:27:38,784 --> 02:27:41,220
DEMONSTRATES THAT PH SEEMS MORE 

3271
02:27:41,220 --> 02:27:44,289
EQUAL. IN THE JLT PUBLICATION 

3272
02:27:44,289 --> 02:27:46,925
THE PULMONARY HYPERTENSION 

3273
02:27:46,925 --> 02:27:48,293
REGISTRY INVESTIGATORS 

3274
02:27:48,293 --> 02:27:56,902
DEMONSTRATED AND PROVED SURVIVAL

3275
02:27:56,902 --> 02:27:59,304
IN FEMALE PATIENTS. 25 

3276
02:27:59,304 --> 02:28:00,606
TRANSGENDER WERE EXCLUDED FROM 

3277
02:28:00,606 --> 02:28:04,543
THE ANALYSIS. WHILE I'M GREATLY 

3278
02:28:04,543 --> 02:28:06,245
OVERSIMPLIFYING THIS ELEGANT 

3279
02:28:06,245 --> 02:28:08,080
WORK, THE AUTHORS, ONE OF WHOM 

3280
02:28:08,080 --> 02:28:09,681
WE WILL HAVE THE PLEASURE OF 

3281
02:28:09,681 --> 02:28:14,152
HEAR ING FROM, NOTE MALE WITH 

3282
02:28:14,152 --> 02:28:16,955
PAH MORE OFTEN HAD DRUG AND 

3283
02:28:16,955 --> 02:28:18,957
TOXIN DISEASE FOR PULMONARY 

3284
02:28:18,957 --> 02:28:21,994
HYPERTENSION AND HIV-RELATED 

3285
02:28:21,994 --> 02:28:24,363
DISEASE AND SUGGEST PERHAPS A 

3286
02:28:24,363 --> 02:28:27,165
MORE SIGNIFICANT ASSAULT WAS 

3287
02:28:27,165 --> 02:28:29,968
REQUIRED TO REQUIRE PH IN MALE 

3288
02:28:29,968 --> 02:28:32,004
PATIENTS THAN IN FEMALE 

3289
02:28:32,004 --> 02:28:34,406
COUNTERPARTS WHICH CONTRIBUTES 

3290
02:28:34,406 --> 02:28:37,442
TO THE POORER OUTCOME. IN TWO 

3291
02:28:37,442 --> 02:28:39,478
PUBLICATIONS LOOKING AT HORMONES

3292
02:28:39,478 --> 02:28:44,216
IN MALES WITH PAH, HIGHER 

3293
02:28:44,216 --> 02:28:50,289
ESTRADIOL AND LO LOWER 

3294
02:28:50,289 --> 02:28:53,058
TESTOSTERONE WERE ASSOCIATED. 

3295
02:28:53,058 --> 02:28:58,096
THE PDOLPIC SUGGESTED LONGER 

3296
02:28:58,096 --> 02:29:00,666
EXPOSURE WAS ASSOCIATED WITH 

3297
02:29:00,666 --> 02:29:03,468
BETTER PRESSURE AND RF FUNCTION 

3298
02:29:03,468 --> 02:29:09,174
IN FEMALES. WHAT WE KNOW IN CIS 

3299
02:29:09,174 --> 02:29:12,444
GENDER THAT IT IS FAR FROM 

3300
02:29:12,444 --> 02:29:13,945
RESOLVED. I WOULD LIKE TO 

3301
02:29:13,945 --> 02:29:15,480
DISTINGUISH BETWEEN SEX AND 

3302
02:29:15,480 --> 02:29:19,184
GENDER AND DEFINE TERMS. SEX 

3303
02:29:19,184 --> 02:29:21,987
WITH A BIOLOGICAL CONSTRUCT 

3304
02:29:21,987 --> 02:29:26,925
DEFINED BY GENETIC, AN MATOMY A 

3305
02:29:26,925 --> 02:29:31,029
HORMONES AND ASSIGNED. GENDER IS

3306
02:29:31,029 --> 02:29:33,031
A SOCIAL CONSTRUCT IN WHICH 

3307
02:29:33,031 --> 02:29:34,866
RULES AND NORMS, EXPECTATIONS 

3308
02:29:34,866 --> 02:29:37,636
AND POWER STRUCTURES ARE BASED. 

3309
02:29:37,636 --> 02:29:41,707
HOW PEOPLE EXPRESS GENDER VARIES

3310
02:29:41,707 --> 02:29:44,109
GEOGRAPHICALLY, EVOLVES 

3311
02:29:44,109 --> 02:29:45,077
GENERATIONALLY, DIFFERS WITHIN 

3312
02:29:45,077 --> 02:29:47,612
SUBSETS OF SAME SOCIETY AND 

3313
02:29:47,612 --> 02:29:49,181
DIFFERENT SOCIETIES. THERE ARE 

3314
02:29:49,181 --> 02:29:51,083
OVER 1.4 MILLION PEOPLE IN U.S. 

3315
02:29:51,083 --> 02:29:58,357
 THAT IDENTIFY AS TRANSGENDER OR

3316
02:29:58,357 --> 02:29:59,358
GENDER-DIVERSE. 2% IN HIGH 

3317
02:29:59,358 --> 02:30:01,026
SCHOOLS ARE QUESTIONING THEIR 

3318
02:30:01,026 --> 02:30:05,063
GENDER. 0.5 ADULTS ARE 

3319
02:30:05,063 --> 02:30:10,602
TRANSGENDER. CIS GENDER IS ONE 

3320
02:30:10,602 --> 02:30:13,772
WHO IDENTIFIES WITH THE GENDER 

3321
02:30:13,772 --> 02:30:17,676
AT BIRTH. CIS NORMA TIFFTY 

3322
02:30:17,676 --> 02:30:22,080
ASSUMES CIS GENDER IS NORMAL OR 

3323
02:30:22,080 --> 02:30:23,482
REFERENCE STATE AND TRANSGENDER 

3324
02:30:23,482 --> 02:30:31,423
IS THE ALTERNATIVE STATE. 

3325
02:30:31,423 --> 02:30:35,527
PERVASIVENESS IS FOUND IN HEALTH

3326
02:30:35,527 --> 02:30:38,463
CARE, AND RESEARCH, INCLUDING 

3327
02:30:38,463 --> 02:30:39,931
SOME OF THE RESEARCH PRESENTED 

3328
02:30:39,931 --> 02:30:49,708
HERE. GENDER AFFIRMATION IS 

3329
02:30:49,708 --> 02:30:51,543
ACCEPTING INTERNALLY AND 

3330
02:30:51,543 --> 02:30:53,011
EXPRESSING OUTWARDLY GENDER. 

3331
02:30:53,011 --> 02:30:56,314
THIS IS A PROCESS THAT MAY BE 

3332
02:30:56,314 --> 02:30:57,416
PSYCHOLOGICAL AND ACCEPTING 

3333
02:30:57,416 --> 02:31:00,352
ONE'S IDENTITY, REJECTING 

3334
02:31:00,352 --> 02:31:01,620
INTERNALIZED STIGMA AND 

3335
02:31:01,620 --> 02:31:03,288
INTERNATIONALIZING PRIDE. MAY BE

3336
02:31:03,288 --> 02:31:05,123
SOCIAL BY CHANGING ONE'S NAMES 

3337
02:31:05,123 --> 02:31:07,125
AND PRONOUNS, SEEKING SOCIAL 

3338
02:31:07,125 --> 02:31:10,495
SUPPORT, CHANGING ONE'S GENDER 

3339
02:31:10,495 --> 02:31:12,297
EXPRESSION. LEGAL, BY LEGALLY 

3340
02:31:12,297 --> 02:31:13,698
CHANGING ONE'S GENDER AND 

3341
02:31:13,698 --> 02:31:15,567
MARKER. MAY BE MEDICAL, BY 

3342
02:31:15,567 --> 02:31:18,670
SEEKING GENDER-AFFIRMING MEDICAL

3343
02:31:18,670 --> 02:31:20,572
CARE, PROTOCOLS FOR CROSS-SEX 

3344
02:31:20,572 --> 02:31:22,474
HORMONE THERAPY ARE BASED ON 

3345
02:31:22,474 --> 02:31:24,643
DECADES OF EXPERIENCE OF WHAT 

3346
02:31:24,643 --> 02:31:27,779
HAS BEEN EFFECTIVE BUT THOSE 

3347
02:31:27,779 --> 02:31:30,582
FINDING, RCTs, HAVE NEVER BEEN 

3348
02:31:30,582 --> 02:31:41,126
PERFORMED. IT IS ASSUMED (AUDIO 

3349
02:31:41,526 --> 02:31:43,261
INTERRUPTION) TOWARD MALE OR 

3350
02:31:43,261 --> 02:31:45,597
MALE-FEMALE BUT UNKNOWN IF THESE

3351
02:31:45,597 --> 02:31:46,932
TARGET LEVELS ARE APPROPRIATE. 

3352
02:31:46,932 --> 02:31:48,700
UP TO ONE QUARTER OF TRANSWOMEN 

3353
02:31:48,700 --> 02:31:51,603
DO NOT ACHIEVE THE DESIRED 

3354
02:31:51,603 --> 02:31:53,638
DEGREE OF ANDROGEN SUPPRESSION 

3355
02:31:53,638 --> 02:31:58,043
EVEN WITH ESTROGEN LEVELS 

3356
02:31:58,043 --> 02:32:00,579
COMPARABLE TO MALE-FEMALES. 

3357
02:32:00,579 --> 02:32:01,847
CROSS-SEX HORMONE THERAPY IS 

3358
02:32:01,847 --> 02:32:03,882
TAKEN FOR SUBSTANTIALLY LONGER 

3359
02:32:03,882 --> 02:32:05,050
THAN HORMONE THERAPY S HAVE EVER

3360
02:32:05,050 --> 02:32:08,086
BEEN STUDIED IN ANY PATIENT 

3361
02:32:08,086 --> 02:32:09,754
POPULATION. LITERATURE DOES SHOW

3362
02:32:09,754 --> 02:32:13,325
THAT GENDER AFFIRMATION, IN 

3363
02:32:13,325 --> 02:32:14,459
PARTICULAR MEDICAL AFFIRMATION, 

3364
02:32:14,459 --> 02:32:16,995
IS ASSOCIATED WITH IMPROVED 

3365
02:32:16,995 --> 02:32:18,296
OUTCOMES BOTH PSYCHOLOGICALLY 

3366
02:32:18,296 --> 02:32:27,072
AND MEDICALLY. NEXT SLIDE, 

3367
02:32:27,072 --> 02:32:27,639
PLEASE. 

3368
02:32:27,639 --> 02:32:29,841
    OKAY. THESE SLIDES ARE 

3369
02:32:29,841 --> 02:32:32,344
DIFFERENT FROM THE ONES I SENT 

3370
02:32:32,344 --> 02:32:36,381
YOU SO WE ARE GOING TO WORK 

3371
02:32:36,381 --> 02:32:42,621
THROUGH THIS. OKAY. THE 

3372
02:32:42,621 --> 02:32:45,557
INTERSECTION ALLTY OF GENDER 

3373
02:32:45,557 --> 02:32:51,129
STATUS ALONG WITH OTHER 

3374
02:32:51,129 --> 02:32:54,099
CONDITIONS SUCH AS SOCIOECONOMIC

3375
02:32:54,099 --> 02:32:55,634
STATUS AND RACE PUTS PEOPLE AT 

3376
02:32:55,634 --> 02:32:57,302
RISK. SURVEYS EXAMINING THE 

3377
02:32:57,302 --> 02:32:58,136
SOCIAL DETERMINANTS OF HEALTH 

3378
02:32:58,136 --> 02:33:01,006
OUTLINED IN HEALTHY PEOPLE 2030 

3379
02:33:01,006 --> 02:33:01,773
HAVE SHOWN THE TRANSGENDER 

3380
02:33:01,773 --> 02:33:06,678
COMMUNITY IS AMONG THE HIGHEST 

3381
02:33:06,678 --> 02:33:08,713
RISK FOR HEALTH DISPARITIES. 

3382
02:33:08,713 --> 02:33:09,981
LIVING WITHIN THE INTERSECTION 

3383
02:33:09,981 --> 02:33:12,584
OF RACE, GENDER MINORITY AND 

3384
02:33:12,584 --> 02:33:15,687
FEMALE DISEMPOWERMENT BLACK AND 

3385
02:33:15,687 --> 02:33:16,922
LATINA TRANSWOMEN EXPERIENCE 

3386
02:33:16,922 --> 02:33:19,291
HIGHER RATES OF VIOLENCE, 

3387
02:33:19,291 --> 02:33:21,026
SUICIDE AND H.I.V. A.I.D.S. THAN

3388
02:33:21,026 --> 02:33:23,328
ANY OTHER SEGMENT OF THE 

3389
02:33:23,328 --> 02:33:24,329
POPULATION. BECAUSE GENDER 

3390
02:33:24,329 --> 02:33:26,231
IDENTITY IS NOT REPORTED ON U.S.

3391
02:33:26,231 --> 02:33:29,568
 DEATH CERTIFICATES THE EXACT 

3392
02:33:29,568 --> 02:33:33,572
STATISTICS ARE NOT KNOWN. 

3393
02:33:33,572 --> 02:33:36,541
GENDER-DIVERSE INDIVIDUALS 

3394
02:33:36,541 --> 02:33:40,011
EXPERIENCE STARTGINGLY HIGH RATS

3395
02:33:40,011 --> 02:33:42,581
OF POVERTY, ISOLATION, HOUSING 

3396
02:33:42,581 --> 02:33:45,083
INSECURITY AND VICTIMIZATION, 

3397
02:33:45,083 --> 02:33:47,519
WHEN COMPARED WITH THE GENERAL 

3398
02:33:47,519 --> 02:33:51,156
POPULATION. SPEAKING 

3399
02:33:51,156 --> 02:33:55,727
SPECIFICALLY TO HEALTH, MANY 

3400
02:33:55,727 --> 02:33:59,130
TRANSGENDER INDIVIDUALS REPORT 

3401
02:33:59,130 --> 02:33:59,664
DELAY

3402
02:33:59,664 --> 02:34:01,032
DELAYING SEEKING MEDICAL CARE 

3403
02:34:01,032 --> 02:34:06,171
DUE TO REFUSAL OF CARE OR 

3404
02:34:06,171 --> 02:34:09,608
MISTREATMENT. MANY TRANSMEN 

3405
02:34:09,608 --> 02:34:15,046
REQUIRE ROUTINE GENE LOGIC CARE.

3406
02:34:15,046 --> 02:34:18,516
IT IS HARD TO FIND BECAUSE THEY 

3407
02:34:18,516 --> 02:34:21,386
MAYBE ARE REFUSED CARE OR A 

3408
02:34:21,386 --> 02:34:24,456
PROVIDER MAY HAVE MORAL 

3409
02:34:24,456 --> 02:34:26,958
OBJECTIONS AND DECIDE THEY WON'T

3410
02:34:26,958 --> 02:34:31,696
PROVIDE A ROUTINE PHYSICAL EXAM.

3411
02:34:31,696 --> 02:34:33,932
FURTHER RECEIVING CARE AT A 

3412
02:34:33,932 --> 02:34:39,804
WOMEN'S HEALTH CLINIC IS 

3413
02:34:39,804 --> 02:34:41,072
GENDER-NON-AFFIRMING. SO MANY 

3414
02:34:41,072 --> 02:34:43,575
TRANSMEN JUST AVOID TREATMENT IN

3415
02:34:43,575 --> 02:34:45,477
GENERAL. SIMILARLY, CHANGING 

3416
02:34:45,477 --> 02:34:49,481
ONE'S GENDER MARKER ON LEGAL 

3417
02:34:49,481 --> 02:34:51,383
DOCUMENTS IS GENDER-AFFIRMING 

3418
02:34:51,383 --> 02:34:54,252
AND ASSOCIATED WITH APPROVED -- 

3419
02:34:54,252 --> 02:34:57,489
IMPROVED OUTCOMES. ON THE OTHER 

3420
02:34:57,489 --> 02:35:00,525
HAND, INSURANCE COMPANIES MAY 

3421
02:35:00,525 --> 02:35:08,299
DENY MEDICALLY APPROPRIATE 

3422
02:35:08,299 --> 02:35:10,368
PROCEDURES IF INCONGRUENT WITH 

3423
02:35:10,368 --> 02:35:11,603
THE MARKER THEREFORE TRANSGENDER

3424
02:35:11,603 --> 02:35:20,945
MEMBERS MAY BE DEPRIVED AN 

3425
02:35:20,945 --> 02:35:25,116
ANATOMICALLY APPROPRIATE 

3426
02:35:25,116 --> 02:35:25,750
SCREEN

3427
02:35:25,750 --> 02:35:26,851
SCREENINGS. NEXT SLIDE, PLEASE. 

3428
02:35:26,851 --> 02:35:30,488
    SO GENDER-AFFIRMING MEDICAL 

3429
02:35:30,488 --> 02:35:38,897
CARE STARTS WITH MEDICAL CARE, 

3430
02:35:38,897 --> 02:35:42,600
PROVIDING -- OR NOT PROVIDING 

3431
02:35:42,600 --> 02:35:43,635
GENDER-AFFIRMED MEDICAL CARE 

3432
02:35:43,635 --> 02:35:45,970
THROUGH LACK OF AWARENESS. FOR 

3433
02:35:45,970 --> 02:35:48,606
INSTANCE, BY USING THE TERM SEX 

3434
02:35:48,606 --> 02:35:50,508
AND GENDER INTERCHANGEABLY. 

3435
02:35:50,508 --> 02:35:54,746
    IN THE 2022 UPDATE OF THE 

3436
02:35:54,746 --> 02:35:57,649
U.S.  TRANSGENDER SURVEY, ALMOST

3437
02:35:57,649 --> 02:36:00,018
HALF OF TRANSGENDER INDIVIDUALS 

3438
02:36:00,018 --> 02:36:02,454
WERE REPORTED NEGATIVE HEALTH 

3439
02:36:02,454 --> 02:36:03,888
CARE EXPERIENCE. ONE-THIRD 

3440
02:36:03,888 --> 02:36:06,658
REPORTED A NEGATIVE HEALTH CARE 

3441
02:36:06,658 --> 02:36:11,362
EXPERIENCE IN THE LAST YEAR. 

3442
02:36:11,362 --> 02:36:13,565
NEGATIVE HEALTH CARE EXPERIENCES

3443
02:36:13,565 --> 02:36:18,436
RANGE FROM BEING MIS-GENDERED OR

3444
02:36:18,436 --> 02:36:21,806
DEAD NAMED TO EXPLAIN AND BE 

3445
02:36:21,806 --> 02:36:22,974
DENIED APPROPRIATE CARE BECAUSE 

3446
02:36:22,974 --> 02:36:24,943
OF YOUR TRANSGENDER STATUS. 

3447
02:36:24,943 --> 02:36:26,311
MISPERCEPTIONS ABOUT WHAT IT 

3448
02:36:26,311 --> 02:36:28,046
MEANS TO BE TRANSGENDER ARE 

3449
02:36:28,046 --> 02:36:30,381
PERVASIVE, WITH WIDESPREAD 

3450
02:36:30,381 --> 02:36:32,450
ASSUMPTIONS THAT TRANSGENDER 

3451
02:36:32,450 --> 02:36:34,085
PEOPLE ALL WANT OR RECEIVE 

3452
02:36:34,085 --> 02:36:36,087
CROSS-SEX HORMONE THERAPY. IN 

3453
02:36:36,087 --> 02:36:38,890
REALITY APPROXIMATELY 78% OF 

3454
02:36:38,890 --> 02:36:41,626
TRANSGENDER AND GENDER-DIVERSE 

3455
02:36:41,626 --> 02:36:42,694
INDIVIDUALS WANT HORMONE 

3456
02:36:42,694 --> 02:36:46,131
THERAPY. ONLY 44% ARE CURRENTLY 

3457
02:36:46,131 --> 02:36:47,565
TAKING CROSS-SEX HORMONE 

3458
02:36:47,565 --> 02:36:50,835
THERAPY. INSURANCE IS A 

3459
02:36:50,835 --> 02:36:53,872
SIGNIFICANT BARRIER TO OBTAINING

3460
02:36:53,872 --> 02:36:56,875
HORMONE THERAPY. 25% OF PATIENTS

3461
02:36:56,875 --> 02:36:58,777
HAVE HAD CROSS-SEX HORMONE 

3462
02:36:58,777 --> 02:37:02,247
THERAPY REFUSED BY THEIR 

3463
02:37:02,247 --> 02:37:05,250
INSURANCE CARRIER. 14% OF 

3464
02:37:05,250 --> 02:37:09,053
PATIENTS IN THE USTS SURVEY IN 

3465
02:37:09,053 --> 02:37:10,688
2015 WERE UNINSURED, COMPARE ED 

3466
02:37:10,688 --> 02:37:12,857
WITH 11% OF THE U.S.  POPULATION

3467
02:37:12,857 --> 02:37:16,361
THAT YEAR. ONLY 25% OF 

3468
02:37:16,361 --> 02:37:18,963
TRANSGENDER INDIVIDUALS HAVE HAD

3469
02:37:18,963 --> 02:37:20,565
GENDER-AFFIRMING SURGERIES. MANY

3470
02:37:20,565 --> 02:37:23,935
DON'T DESIRE GENDER-AFFIRMING 

3471
02:37:23,935 --> 02:37:25,870
SURGERIES. SO AS HEALTH CARE 

3472
02:37:25,870 --> 02:37:27,605
PROVIDERS PROVIDING PH CARE, WE 

3473
02:37:27,605 --> 02:37:29,307
NEED TO RECOGNIZE THAT BECAUSE 

3474
02:37:29,307 --> 02:37:31,810
PREVALENCE AND OUTCOMES ARE 

3475
02:37:31,810 --> 02:37:33,278
INFLUENCED BY SEX ASSIGNED AT 

3476
02:37:33,278 --> 02:37:35,180
BIRTH AND HORMONES WE SHOULD 

3477
02:37:35,180 --> 02:37:38,550
OBTAIN A SURGICAL HISTORY 

3478
02:37:38,550 --> 02:37:42,053
CLARIFYING WHETHER OR NOT GONADS

3479
02:37:42,053 --> 02:37:44,856
WERE REMOVED IN THE SURGERIES, 

3480
02:37:44,856 --> 02:37:47,826
ALONG WITH MEDICATION HISTORY IN

3481
02:37:47,826 --> 02:37:57,902
ALL TRANSAND NONBINARY, AND 

3482
02:37:57,902 --> 02:37:58,837
IMPORTANT FOR WOMEN WHO MAY NOT 

3483
02:37:58,837 --> 02:38:04,943
HAVE RECEIVED THE NON-ANDROGEN 

3484
02:38:04,943 --> 02:38:06,344
THERAPY. NEXT SLIDE, NEXT, 

3485
02:38:06,344 --> 02:38:11,182
PLEASE -- SORRY, CAN YOU GO 

3486
02:38:11,182 --> 02:38:13,518
BACK? THANK YOU. OKAY. 

3487
02:38:13,518 --> 02:38:16,254
    SO WE RECOGNIZE THAT 

3488
02:38:16,254 --> 02:38:18,156
TRANSGENDER INDIVIDUALS DO 

3489
02:38:18,156 --> 02:38:19,023
EXPERIENCE GREATER PSYCHOLOGICAL

3490
02:38:19,023 --> 02:38:20,592
STRESS THAT AIR FORCE BASES 

3491
02:38:20,592 --> 02:38:23,828
PHYSICAL HEALTH, IN ADDITION TO 

3492
02:38:23,828 --> 02:38:28,266
RISK CONDITIONS THAT OCCUR WITH 

3493
02:38:28,266 --> 02:38:31,169
GREATER FREQUENCY THAN GENDER 

3494
02:38:31,169 --> 02:38:32,103
MINORITY INDIVIDUALS. FOR 

3495
02:38:32,103 --> 02:38:34,572
INSTANCE SMOKING OCCURS AT 

3496
02:38:34,572 --> 02:38:36,007
ROUGHLY TWICE THE RATE OF 

3497
02:38:36,007 --> 02:38:37,675
GENERAL POPULATION PRIMARILY AS 

3498
02:38:37,675 --> 02:38:41,713
A RESULT OF TARGETED MARKETING 

3499
02:38:41,713 --> 02:38:45,516
BY THE TOBACCO INDUSTRY. IN THE 

3500
02:38:45,516 --> 02:38:48,653
FOUR PATH SURVEY PUBLISHED IN 

3501
02:38:48,653 --> 02:38:50,989
22, 40% WERE CURRENT TOBACCO 

3502
02:38:50,989 --> 02:38:54,125
USERS COMPARED TO 19% OF 

3503
02:38:54,125 --> 02:38:55,927
CISGENDER INDIVIDUALS. OBESITY 

3504
02:38:55,927 --> 02:38:58,963
HAS A HIGHER PREVALENCE IN 

3505
02:38:58,963 --> 02:39:00,198
TRANSGENDER ADULTS. BOTH 

3506
02:39:00,198 --> 02:39:02,300
TRANSGENDER MEN AND WOMEN 

3507
02:39:02,300 --> 02:39:03,201
EXPERIENCE WEIGHT GAIN AS A 

3508
02:39:03,201 --> 02:39:03,801
RESULT OF THE TRANSGENDER 

3509
02:39:03,801 --> 02:39:06,437
HORMONE THERAPY. IN A 

3510
02:39:06,437 --> 02:39:07,672
LONGITUDINAL STUDY OF TDG 

3511
02:39:07,672 --> 02:39:10,541
PATIENTS ON GENDER-AFFIRMING 

3512
02:39:10,541 --> 02:39:13,778
THERAPY, UP TO 30% OF PATIENTS 

3513
02:39:13,778 --> 02:39:16,047
EXPERIENCED GREATER OF FIVE KILO

3514
02:39:16,047 --> 02:39:17,949
WEIGHT GAIN IN 21 MONTHS 

3515
02:39:17,949 --> 02:39:19,350
FOLLOWING INITIATION OF HORMONE 

3516
02:39:19,350 --> 02:39:22,086
THERAPY. STUDIES ARE NEEDED TO 

3517
02:39:22,086 --> 02:39:24,255
BETTER UNDERSTAND BODY 

3518
02:39:24,255 --> 02:39:27,358
COMPOSITION CHANGES WITH 

3519
02:39:27,358 --> 02:39:27,992
GENDER-AFFIRMING THERAPY. IN 

3520
02:39:27,992 --> 02:39:30,628
CROSS SECTIONAL SURVEYS COLLEGE 

3521
02:39:30,628 --> 02:39:32,530
STUDENTS AND ADOLESCENTS ARE 

3522
02:39:32,530 --> 02:39:34,465
MORE LIKELY TO REPORT POOR SLEEP

3523
02:39:34,465 --> 02:39:37,535
QUALITY. ADDITIONALLY SIMILAR 

3524
02:39:37,535 --> 02:39:39,037
REPORTS REPORT FREQUENT EXERCISE

3525
02:39:39,037 --> 02:39:41,306
AND AVOIDANCE OF 

3526
02:39:41,306 --> 02:39:43,041
GENDER-SEGREGATED ACTIVITIES. 

3527
02:39:43,041 --> 02:39:45,176
FINALLY A SUBSTANTIAL RISK 

3528
02:39:45,176 --> 02:39:49,781
FACTOR FOR PAH, WORTH NOTING AS 

3529
02:39:49,781 --> 02:39:53,351
HI DISEASE, WITHIN THE GENERAL 

3530
02:39:53,351 --> 02:39:54,919
POPULATION THE ADULT PREVALENCE 

3531
02:39:54,919 --> 02:39:58,823
OF H.I.V. IS 0.4%, ACCORDINGS TO

3532
02:39:58,823 --> 02:40:00,858
THE CDC. EARLIER THE CDC 

3533
02:40:00,858 --> 02:40:02,894
REPORTED 2% OF INCIDENT H.I.V. 

3534
02:40:02,894 --> 02:40:05,463
CASES IN 2023 WERE IN 

3535
02:40:05,463 --> 02:40:08,466
TRANSGENDER INDIVIDUALS. 

3536
02:40:08,466 --> 02:40:09,100
DISPROPORTIONATELY AFFECTING THE

3537
02:40:09,100 --> 02:40:12,770
TRANSGENDER POPULATION. IN THE 

3538
02:40:12,770 --> 02:40:15,840
CDC'S NHBS TRANSSAMPLE OF 1600 

3539
02:40:15,840 --> 02:40:18,276
TRANSWOMEN LIVING IN SEVEN URBAN

3540
02:40:18,276 --> 02:40:20,478
CITIES WITH HIGH H.I.V. RATES, 

3541
02:40:20,478 --> 02:40:23,448
44% OF WOMEN SURVEYED AND 

3542
02:40:23,448 --> 02:40:26,284
SUBSEQUENTLY TESTED FOR H.I.V. 

3543
02:40:26,284 --> 02:40:33,591
WERE POSITIVE. NEXT SLIDE, 

3544
02:40:33,591 --> 02:40:37,428
PLEASE. PULMONARY CARE IN 

3545
02:40:37,428 --> 02:40:40,064
TRANSGENDER PATIENTS IS AN OPEN 

3546
02:40:40,064 --> 02:40:43,634
FIELD AND OPPORTUNITY FOR US. IN

3547
02:40:43,634 --> 02:40:45,837
THE DRAFTEST WAY THIS IS A 

3548
02:40:45,837 --> 02:40:47,438
RETROSPECTIVE COHORT FROM THE 

3549
02:40:47,438 --> 02:40:48,973
AMSTERDAM GENDER IDENTITY CLINIC

3550
02:40:48,973 --> 02:40:54,312
THAT INCLUDED OVER 2,900 

3551
02:40:54,312 --> 02:40:54,979
TRANSGENDER WOMEN AND OVER 1,600

3552
02:40:54,979 --> 02:40:56,481
TRANSGENDER MEN. THE STUDY RAN 

3553
02:40:56,481 --> 02:41:00,318
FROM 1972 TO 2018. THE MORTALITY

3554
02:41:00,318 --> 02:41:03,021
RATE FOR TRANSMEN WAS HIGHER 

3555
02:41:03,021 --> 02:41:03,988
THAN EXPECTED FOR CISGENDER 

3556
02:41:03,988 --> 02:41:05,990
WOMEN BUT NOT FOR CISGENDER MEN.

3557
02:41:05,990 --> 02:41:09,660
ON THE OTHER HAND, THE MORTALITY

3558
02:41:09,660 --> 02:41:11,129
RATE FOR TRANSWOMEN WAS 

3559
02:41:11,129 --> 02:41:12,230
SIGNIFICANTLY HIGHER THAN 

3560
02:41:12,230 --> 02:41:15,933
EXPECTED FOR THE POPULATION AS A

3561
02:41:15,933 --> 02:41:16,167
WHOLE. 

3562
02:41:16,167 --> 02:41:17,235
    TRANSGENDER WOMEN 

3563
02:41:17,235 --> 02:41:20,438
EXPERIENCED HIGHER RATES OF 

3564
02:41:20,438 --> 02:41:24,475
CAUSE-SPECIFIC MORTALITY FROM 

3565
02:41:24,475 --> 02:41:27,645
CARDIOVASCULAR DISEASE, LUNG 

3566
02:41:27,645 --> 02:41:38,156
CANCER, H.I.V. THERE ARE MORE 

3567
02:41:42,593 --> 02:41:43,294
HIGHER RISK IN INDIVIDUAL AND 

3568
02:41:43,294 --> 02:41:45,563
THE RISK FOR MORTALITY IS 

3569
02:41:45,563 --> 02:41:48,566
VISIBLE IN TRANSGENDER WOMEN 

3570
02:41:48,566 --> 02:41:51,235
WHEN WE COMPARE TO CISGENDER 

3571
02:41:51,235 --> 02:41:52,904
WOMEN WITH A CARDIOVASCULAR 

3572
02:41:52,904 --> 02:41:58,342
MORTALITY RATE THAT IS 2.6 TIMES

3573
02:41:58,342 --> 02:42:02,547
HIGHER. IN PATIENTS ON CROSS-SEX

3574
02:42:02,547 --> 02:42:03,648
THER

3575
02:42:03,648 --> 02:42:07,618
THERAPY LIPID STUDIES ARE THE 

3576
02:42:07,618 --> 02:42:10,254
BEST METABOLIC VARIABLE. 

3577
02:42:10,254 --> 02:42:12,223
HOWEVER, CHANGES IN LIPID 

3578
02:42:12,223 --> 02:42:15,193
PROFILES VARY BASED ON WHETHER 

3579
02:42:15,193 --> 02:42:23,501
THE PERSON IS ON M ASCULINIZING 

3580
02:42:23,501 --> 02:42:29,841
OR FEMININE IZING. ALCOHOL, 

3581
02:42:29,841 --> 02:42:33,644
DIET, SLEEP AND STRESS ARE 

3582
02:42:33,644 --> 02:42:39,650
POORLY STUDIED. NEXT SLIDE, 

3583
02:42:39,650 --> 02:42:43,588
PLEASE. 

3584
02:42:43,588 --> 02:42:43,754
    

3585
02:42:43,754 --> 02:42:46,491
    AS WE LOOK TO THE FUTURE OF 

3586
02:42:46,491 --> 02:42:47,959
ADDRESSING DISPARITIES OF CARE 

3587
02:42:47,959 --> 02:42:49,293
IN TRANSGENDER PATIENTS IT IS 

3588
02:42:49,293 --> 02:42:52,196
IMPORTANT TO UNDERSTAND WHAT 

3589
02:42:52,196 --> 02:42:53,598
LIMITATIONS OF CURRENT RESEARCH 

3590
02:42:53,598 --> 02:42:56,467
ARE. SO FIRST MEASUREMENT OF 

3591
02:42:56,467 --> 02:42:58,469
TRANSGENDER STATUS NEEDS TO BE 

3592
02:42:58,469 --> 02:43:00,872
STANDARDIZED ACROSS HEALTH CARE 

3593
02:43:00,872 --> 02:43:02,740
SYSTEMS AND RESEARCH PROTOCOLS 

3594
02:43:02,740 --> 02:43:05,743
UTILIZING A TWO-STEP 

3595
02:43:05,743 --> 02:43:07,378
IDENTIFICATION PROCESS TO 

3596
02:43:07,378 --> 02:43:08,813
SEPARATELY IDENTIFY SEX ASSIGNED

3597
02:43:08,813 --> 02:43:12,550
AT BIRTH AND GENDER IDENTITY, 

3598
02:43:12,550 --> 02:43:14,852
IMPROVED ACCURACY AND ALLOWS FOR

3599
02:43:14,852 --> 02:43:18,523
AFFIRMING CARE AND IMPROVED 

3600
02:43:18,523 --> 02:43:23,294
RESEARCH QUALITY. SECOND RCTs TO

3601
02:43:23,294 --> 02:43:25,796
EXAMINE DOSAGE IN CROSS-SEX 

3602
02:43:25,796 --> 02:43:27,665
HORMONE THERAPY WILL BENEFIT 

3603
02:43:27,665 --> 02:43:31,035
TRANSGENDER PATIENTS TO ALLOW 

3604
02:43:31,035 --> 02:43:34,939
FOR DOSING TO OPTIMAL EFFECT 

3605
02:43:34,939 --> 02:43:37,308
WHILE MINIMALIZING EFFECT. THE 

3606
02:43:37,308 --> 02:43:39,877
SCIENTIFIC COMMUNITY NEEDS TO 

3607
02:43:39,877 --> 02:43:43,981
HAVE A CONVERSATION ABOUT CIS 

3608
02:43:43,981 --> 02:43:45,516
NORMALATIVITY AND SEEK TO DEFINE

3609
02:43:45,516 --> 02:43:47,919
WHAT A APPROPRIATE CONTROL 

3610
02:43:47,919 --> 02:43:49,987
POPULATION IS IN A TRANSGENDER 

3611
02:43:49,987 --> 02:43:53,057
RESEARCH STUDY. NEXT SLIDE, 

3612
02:43:53,057 --> 02:43:53,724
PLEASE. 

3613
02:43:53,724 --> 02:43:57,828
    WITHIN TRANSGENDER HEALTH 

3614
02:43:57,828 --> 02:43:59,697
RESEARCH NONCOMMUNICABLE CHRONIC

3615
02:43:59,697 --> 02:44:02,867
DISEASE HAS ONLY BE GUN TO BE 

3616
02:44:02,867 --> 02:44:06,404
INVESTIGATED. IN THIS 2024 META 

3617
02:44:06,404 --> 02:44:08,072
ANALYSIS OF ARTICLES OF 

3618
02:44:08,072 --> 02:44:11,008
TRANSGENDER HEALTH, ONLY 4% 

3619
02:44:11,008 --> 02:44:13,010
EVALUATED RESPIRATORY HEALTH AND

3620
02:44:13,010 --> 02:44:16,814
ONLY 9% EVALUATED CARDIOVASCULAR

3621
02:44:16,814 --> 02:44:22,386
HEALTH. IN A QUICK SEARCH OF 

3622
02:44:22,386 --> 02:44:24,589
CLINICALTRIALS.GOV I FOUND FIVE 

3623
02:44:24,589 --> 02:44:25,156
RELATED TO CARDIOVASCULAR 

3624
02:44:25,156 --> 02:44:26,390
DISEASE AND TRANSGENDER HEALTH 

3625
02:44:26,390 --> 02:44:29,293
AND ONE REGISTERED TRIAL RELATED

3626
02:44:29,293 --> 02:44:38,202
TO PULMONARY FUNCTION AND 

3627
02:44:38,202 --> 02:44:40,972
GENDER-AFFIRMING CARE. (BELL) 

3628
02:44:40,972 --> 02:44:42,039
BECAUSE THERE SO LITTLE 

3629
02:44:42,039 --> 02:44:44,475
KNOWLEDGE ABOUT THOUSAND BEST 

3630
02:44:44,475 --> 02:44:47,044
CARE FOR TRANSGENDER PATIENTS 

3631
02:44:47,044 --> 02:44:47,845
WITH PULMONARY HYPERTENSION I 

3632
02:44:47,845 --> 02:44:50,381
WANTED TO THINK OF THIS IN A 

3633
02:44:50,381 --> 02:44:52,049
STEPWISE APPROACH SO MY 

3634
02:44:52,049 --> 02:44:53,251
RECOMMENDATIONS, I THINK THE 

3635
02:44:53,251 --> 02:44:55,086
FIRST THING IS START WITH THE 

3636
02:44:55,086 --> 02:45:00,258
BASICS. WE NEED A BETTER 

3637
02:45:00,258 --> 02:45:07,164
UNDERSTANDING OF AN ANDOGENOUS 

3638
02:45:07,164 --> 02:45:09,300
HORMONE S SO WE UNDERSTAND HOW 

3639
02:45:09,300 --> 02:45:11,669
THEY MAY AFFECT DEVELOPMENT OF 

3640
02:45:11,669 --> 02:45:12,903
CARDIOVASCULAR DISEASE. I THINK 

3641
02:45:12,903 --> 02:45:15,640
GENDER CARE CLINICS AND LARGE 

3642
02:45:15,640 --> 02:45:17,208
HEALTH CARE ORGANIZATIONS AS 

3643
02:45:17,208 --> 02:45:19,610
WELL AS PH REGISTRIES NEED TO 

3644
02:45:19,610 --> 02:45:27,918
WORK TO CREATE PRO SPE PROSPECT 

3645
02:45:27,918 --> 02:45:29,987
COHORTS OF GCD PATIENTS AND THE 

3646
02:45:29,987 --> 02:45:31,322
STATE OF HEALTH OF THE PATIENTS.

3647
02:45:31,322 --> 02:45:33,291
WITH E NEED TO DEFINE AND 

3648
02:45:33,291 --> 02:45:35,826
UNDERSTAND THE BARRIERS TO CARE 

3649
02:45:35,826 --> 02:45:38,896
THAT TGD PATIENTS ARE 

3650
02:45:38,896 --> 02:45:40,131
EXPERIENCING. I HAVE LISTED HERE

3651
02:45:40,131 --> 02:45:44,368
A FEW OF MY PERCEPTIONS OF 

3652
02:45:44,368 --> 02:45:45,369
BARRIERS TO CARE BUT THESE ARE 

3653
02:45:45,369 --> 02:45:47,138
ONLY ASSUMPTIONS AND WORKING 

3654
02:45:47,138 --> 02:45:50,908
UNDER ASSUMPTIONS DOESN'T HELP 

3655
02:45:50,908 --> 02:45:55,746
OUR PATIENTS. WE NEED TO 

3656
02:45:55,746 --> 02:45:58,282
EVALUATE RISK-ASSOCIATED 

3657
02:45:58,282 --> 02:46:00,284
CONDITIONS AND HOW THOSE THINGS 

3658
02:46:00,284 --> 02:46:03,421
MAY AFFECT THE HEALTH OF OUR 

3659
02:46:03,421 --> 02:46:06,090
PATIENTS. AND FINALLY WE NEED TO

3660
02:46:06,090 --> 02:46:09,627
LOOK AT MINORITY STRESS AND HOW 

3661
02:46:09,627 --> 02:46:11,162
DOES MINORITY STRESS INFLUENCE 

3662
02:46:11,162 --> 02:46:17,368
THE RISK OF DEVELOPMENT OF 

3663
02:46:17,368 --> 02:46:21,772
PULMONARY HYPERTENSION IN BINARY

3664
02:46:21,772 --> 02:46:25,776
AND NON-BINARY INDIVIDUALS. NEXT

3665
02:46:25,776 --> 02:46:33,718
SLIDE, PLEASE. 

3666
02:46:33,718 --> 02:46:35,453
    WITHIN THE SEX PARADOX AND 

3667
02:46:35,453 --> 02:46:39,724
GENDER, WE NEED TO EVALUATE HOW 

3668
02:46:39,724 --> 02:46:42,893
DOES THE CROSS-SEX HORMONE 

3669
02:46:42,893 --> 02:46:46,097
THERAPY OUR PATIENTS ARE ON 

3670
02:46:46,097 --> 02:46:51,102
ALTER THE RISK OF DEVELOPING 

3671
02:46:51,102 --> 02:46:54,505
PAH. FOR INSTANCE, SPURNOLACTONE

3672
02:46:54,505 --> 02:46:58,876
IS USED AS ANTI ANDROGEN IN 

3673
02:46:58,876 --> 02:47:01,679
TRANSWOMEN. DOES IT MITIGATE 

3674
02:47:01,679 --> 02:47:04,081
EFFECTS OF TESTOSTERONE ON THE 

3675
02:47:04,081 --> 02:47:04,882
RIGHT VENTRICLE IF USED BEFORE 

3676
02:47:04,882 --> 02:47:07,752
THE DEVELOPMENT OF CLINICALLY 

3677
02:47:07,752 --> 02:47:08,953
APPARENT DISEASE? IN PATIENTS 

3678
02:47:08,953 --> 02:47:15,126
WITH RISK FACTORS FOR PULMONARY 

3679
02:47:15,126 --> 02:47:16,861
HYPERTENSION, FOR INSTANCE A 

3680
02:47:16,861 --> 02:47:19,196
TRANSWOMAN WITH H.I.V. SHOULD 

3681
02:47:19,196 --> 02:47:23,501
PERIODIC SCREENING FOR PULMONARY

3682
02:47:23,501 --> 02:47:31,542
HYPERTENSION OCCUR. 

3683
02:47:31,542 --> 02:47:32,610
    FINALLY I WOULD REALLY LIKE 

3684
02:47:32,610 --> 02:47:35,513
TO ADVOCATE FOR AN EFFORT TOWARD

3685
02:47:35,513 --> 02:47:45,289
IDENTIFYING A GENDER-NEUTRAL AND

3686
02:47:45,289 --> 02:47:47,224
BODY-COMPOSITION NEUTRAL 

3687
02:47:47,224 --> 02:47:50,294
BIO MARKER. THESE ARE AFFECTED 

3688
02:47:50,294 --> 02:47:54,432
BY ESTROGEN ANDROGENS AND WE 

3689
02:47:54,432 --> 02:47:57,601
SHOULD IDENTIFY THE BRASS RING 

3690
02:47:57,601 --> 02:48:05,576
OF BIOMARKERS NOT INFLUENCED BY 

3691
02:48:05,576 --> 02:48:12,249
SEX BODY SIZE. NEXT SLIDE. 

3692
02:48:12,249 --> 02:48:15,853
    FOR PROGRESS IN OUR GENDER 

3693
02:48:15,853 --> 02:48:18,522
AFFIRMING CARE, WE NEED TO 

3694
02:48:18,522 --> 02:48:20,458
PROVIDE EDUCATION FOR HEALTH 

3695
02:48:20,458 --> 02:48:24,061
CARE PROVIDERS TO ENSURE THAT 

3696
02:48:24,061 --> 02:48:28,833
KNOWLEDGE GAPS ARE FILLED IN. WE

3697
02:48:28,833 --> 02:48:31,001
NEED TO FOLLOW THE PHILOSOPHY, 

3698
02:48:31,001 --> 02:48:34,605
NOTHING ABOUT US WITHOUT US, AND

3699
02:48:34,605 --> 02:48:35,806
CREATE MINORITY INCLUSIVE 

3700
02:48:35,806 --> 02:48:37,475
RESEARCH TEAMS. WHEN THOSE 

3701
02:48:37,475 --> 02:48:39,577
TEAM S HAVE BEEN CREATED WHICH 

3702
02:48:39,577 --> 02:48:44,348
WILL BY EXTENSION GENERATE 

3703
02:48:44,348 --> 02:48:45,416
GENDER-EXCLUSIVE RESEARCH 

3704
02:48:45,416 --> 02:48:54,024
QUESTIONS AND GOALS. NEXT SLIDE.

3705
02:48:54,024 --> 02:48:56,460
THANK YOU. 

3706
02:48:56,460 --> 02:49:00,564
>> THANK YOU VERY MUCH,
DR. 

3707
02:49:00,564 --> 02:49:01,832
STRAH. THAT WAS EXCELLENT 

3708
02:49:01,832 --> 02:49:03,100
PARTICULARLY SINCE YOU HAD TO 

3709
02:49:03,100 --> 02:49:04,602
WING IT ON THE FLY THERE. THAT 

3710
02:49:04,602 --> 02:49:06,337
IS ALWAYS A BIG STRESSER, BUT 

3711
02:49:06,337 --> 02:49:08,639
YOU DID AN EXCELLENT JOB. YOU 

3712
02:49:08,639 --> 02:49:10,207
BROUGHT UP SOME INTERESTING 

3713
02:49:10,207 --> 02:49:13,677
CONCEPTS THAT I HADN'T THOUGHT 

3714
02:49:13,677 --> 02:49:21,218
ABOUT WITH BNP, SPURNALACTONE, 

3715
02:49:21,218 --> 02:49:23,654
THAT IS PERTINENT TO OUR 

3716
02:49:23,654 --> 02:49:26,891
PRACTICE. ONE QUICK QUESTION I 

3717
02:49:26,891 --> 02:49:34,632
HAD FOR YOU IS AS GROUPS ARE NOT

3718
02:49:34,632 --> 02:49:37,468
REPRESENTED IN OUR CLINICAL 

3719
02:49:37,468 --> 02:49:39,136
TRIALS AT ALL EITHER, THAT IS 

3720
02:49:39,136 --> 02:49:43,407
JUST A GUESS. I'M ASSUMING THAT 

3721
02:49:43,407 --> 02:49:46,911
IS CORRECT. OF COURSE SEX IS A 

3722
02:49:46,911 --> 02:49:51,282
MAJOR THING THAT WE LOOK AT. 

3723
02:49:51,282 --> 02:49:52,783
GENDER NOT NECESSARILY. AND THEY

3724
02:49:52,783 --> 02:49:56,487
ARE CONFLATED. HOW WOULD YOU 

3725
02:49:56,487 --> 02:50:05,829
APPROACH THAT ISSUE WITH 

3726
02:50:05,829 --> 02:50:07,598
INCLUDING THIS GROUP FOR TRIALS.

3727
02:50:07,598 --> 02:50:09,667
WHAT IS THE MECHANISM FOR THAT? 

3728
02:50:09,667 --> 02:50:13,704
>> I THINK THIS IS REALLY 

3729
02:50:13,704 --> 02:50:15,172
IMPORTANT. SO THE PULMONARY 

3730
02:50:15,172 --> 02:50:17,041
HYPERTENSION ASSOCIATION 

3731
02:50:17,041 --> 02:50:20,544
REGISTRY IS THE FIRST REGISTRY 

3732
02:50:20,544 --> 02:50:22,479
TO INCLUDE GENDER SEPARATELY 

3733
02:50:22,479 --> 02:50:24,915
FROM SEX ASSIGNED AT BIRTH. ALL 

3734
02:50:24,915 --> 02:50:29,153
OF OUR PRIOR REGISTRIES ONLY 

3735
02:50:29,153 --> 02:50:32,823
INCLUDE SEX OR GENDER. THEY USE 

3736
02:50:32,823 --> 02:50:34,858
THE TERM INTERCHANGEABLY. 

3737
02:50:34,858 --> 02:50:36,560
>> RIGHT. 

3738
02:50:36,560 --> 02:50:40,264
>> SO I THINK THE
PULMONARY 

3739
02:50:40,264 --> 02:50:42,633
HYPERTENSION REGISTRY HAS MADE A

3740
02:50:42,633 --> 02:50:45,636
REAL STEP FORWARD IN IDENTIFYING

3741
02:50:45,636 --> 02:50:49,506
SEX AND GENDER SEPARATELY. I 

3742
02:50:49,506 --> 02:50:51,842
THINK, AS I MENTIONED, THIS 

3743
02:50:51,842 --> 02:50:55,713
TWO-STEP IDENTIFICATION PROCESS 

3744
02:50:55,713 --> 02:50:57,047
IS REALLY IMPORTANT IN 

3745
02:50:57,047 --> 02:51:00,618
IDENTIFYING SEX ASSIGNED AT 

3746
02:51:00,618 --> 02:51:04,588
BIRTH AND THEN SEPARATELY ADDING

3747
02:51:04,588 --> 02:51:09,760
TO EVERY REGISTRY GENDER AND NOT

3748
02:51:09,760 --> 02:51:12,429
UTILIZING TRANSGENDER AS A 

3749
02:51:12,429 --> 02:51:15,633
GENDER. WE NEED MORE SPECIFIC 

3750
02:51:15,633 --> 02:51:21,939
THAN THAT TRANSGENDER COMMA 

3751
02:51:21,939 --> 02:51:24,308
FEMALE-TO-MALE, TRANSGENDER, 

3752
02:51:24,308 --> 02:51:27,911
MALE-TO-FEMALE, TO VERY CLEARLY 

3753
02:51:27,911 --> 02:51:30,948
IDENTIFY AND, FOR LACK OF A 

3754
02:51:30,948 --> 02:51:34,985
BETTER WORD, CATEGORIZE OUR 

3755
02:51:34,985 --> 02:51:41,825
PATIENTS. THEN WHEN WE HAVE 

3756
02:51:41,825 --> 02:51:42,960
PATIENT WHO'S FALL IN THE 

3757
02:51:42,960 --> 02:51:45,262
TRANSGENDER CATEGORIES, ASKING 

3758
02:51:45,262 --> 02:51:47,898
ABOUT GENDER AFFIRMING HORMONE 

3759
02:51:47,898 --> 02:51:51,735
THERAPY. THE AFFECT OF CROSS-SEX

3760
02:51:51,735 --> 02:51:54,972
HORMONE THERAPY INFLUENCES OUR 

3761
02:51:54,972 --> 02:51:57,041
CONCEPTS AND PERCEPTIONS OF 

3762
02:51:57,041 --> 02:51:58,876
DISEASE DEVELOPMENT. I THINK 

3763
02:51:58,876 --> 02:52:02,513
THAT THE ONLY WAY TO LEARN MORE 

3764
02:52:02,513 --> 02:52:05,549
ABOUT THIS IS TO ASK. 

3765
02:52:05,549 --> 02:52:07,317
>> SO IF I'M HEARING YOU 

3766
02:52:07,317 --> 02:52:10,554
CORRECTLY, THE TWO-STEP PROCESS 

3767
02:52:10,554 --> 02:52:12,256
IS CLEAR BUT WHEN REPORTING 

3768
02:52:12,256 --> 02:52:15,926
RESULTS FROM STUDIES, WE SHOULD 

3769
02:52:15,926 --> 02:52:18,429
REPORT BY NOT ONLY SEX BUT 

3770
02:52:18,429 --> 02:52:20,097
GENDER AND GENDER AS TO WHETHER 

3771
02:52:20,097 --> 02:52:22,132
OR NOT THEY ARE ON HORMONE 

3772
02:52:22,132 --> 02:52:24,368
THERAPY AS WELL. IS THAT WHAT 

3773
02:52:24,368 --> 02:52:25,536
I'M GETTING -- ALL RIGHT. 

3774
02:52:25,536 --> 02:52:27,104
>> YES. 

3775
02:52:27,104 --> 02:52:35,813
>> ONE MORE THING. JUST TO

3776
02:52:35,813 --> 02:52:36,714
ORGANIZATIONAL STRUCTURE AND 

3777
02:52:36,714 --> 02:52:37,981
MAKING SURE WE HAVE EVERYONE'S 

3778
02:52:37,981 --> 02:52:40,184
SLIDES. IF ANY OF THE SPEAKERS 

3779
02:52:40,184 --> 02:52:42,119
SENT A SLIDE DECK WITH MULTIPLE 

3780
02:52:42,119 --> 02:52:43,153
VERSIONS OR VERSIONS THIS 

3781
02:52:43,153 --> 02:52:48,425
MORNING, I WOULD ENCOURAGE YOU 

3782
02:52:48,425 --> 02:52:52,796
TO EMAIL JACKIE AND MAKE SURE WE

3783
02:52:52,796 --> 02:52:59,036
HAVE THE CURRENTLY VERSION. 

3784
02:52:59,036 --> 02:52:59,570
DIREC

3785
02:52:59,570 --> 02:53:01,205
DIRECTOR LEOPOLD, A QUESTION? 

3786
02:53:01,205 --> 02:53:01,839
>> THANK YOU FOR THAT
TERRIFIC 

3787
02:53:01,839 --> 02:53:02,940
TALK. THIS IS SOMETHING THAT IS 

3788
02:53:02,940 --> 02:53:04,475
SO INCREDIBLY NECESSARY FOR US 

3789
02:53:04,475 --> 02:53:07,644
TO HEAR BECAUSE THIS IS 

3790
02:53:07,644 --> 02:53:08,912
SOMETHING THAT WE DON'T THINK 

3791
02:53:08,912 --> 02:53:12,916
ABOUT 90% OF THE TIME, IF NOT 

3792
02:53:12,916 --> 02:53:15,018
MORE. I WANTED TO ASK LIKE IS 

3793
02:53:15,018 --> 02:53:18,255
THERE SOMETHING WE SHOULD BE 

3794
02:53:18,255 --> 02:53:25,963
DOING IN TERMS OF ADVOCACY? YOUR

3795
02:53:25,963 --> 02:53:28,065
COMMENT ABOUT NOTHING ABOUT US 

3796
02:53:28,065 --> 02:53:32,903
WITHOUT OUT, HOW DO WE BRING 

3797
02:53:32,903 --> 02:53:34,471
THIS TO THE FOREFRONT OF 

3798
02:53:34,471 --> 02:53:41,779
CLINICAL TRIALS AND PH? 

3799
02:53:41,779 --> 02:53:44,815
>> I THINK THAT IS AN
EXCELLENT 

3800
02:53:44,815 --> 02:53:48,819
QUESTION. I THINK THE -- I THINK

3801
02:53:48,819 --> 02:53:56,426
THE POLICE TO GO FIND OUT HOW WE

3802
02:53:56,426 --> 02:53:58,962
SHOULD BETTER APPROACH RESEARCH 

3803
02:53:58,962 --> 02:54:01,331
AND HOW TO BE MORE INCLUSIVE IS 

3804
02:54:01,331 --> 02:54:05,369
TO REACH OUT TO OUR ADVOCACY 

3805
02:54:05,369 --> 02:54:07,371
GRO

3806
02:54:07,371 --> 02:54:11,208
GROUPS. AS AN EXAMPLE WHEN I WAS

3807
02:54:11,208 --> 02:54:16,146
DESIGNING MY OWN STUDY I WANTED 

3808
02:54:16,146 --> 02:54:18,315
TO MAKE SURE I WAS BEING AS 

3809
02:54:18,315 --> 02:54:21,418
INCLUSIVE AS POSSIBLE. SO I 

3810
02:54:21,418 --> 02:54:24,488
REACHED OUT TO OUR GENDER CLINIC

3811
02:54:24,488 --> 02:54:28,525
AND OUR GENDER CLINIC CONNECTED 

3812
02:54:28,525 --> 02:54:32,162
ME WITH A GENDER MINORITY 

3813
02:54:32,162 --> 02:54:42,339
INDIVIDUAL WHO HAS A DEGREE IN 

3814
02:54:42,339 --> 02:54:44,208
ADVOCACY. WE WENT THROUGH. HE 

3815
02:54:44,208 --> 02:54:45,709
JOINED OUR RESEARCH TEAM. WE 

3816
02:54:45,709 --> 02:54:51,148
TOOK ON THAT PHILOSOPHY, NOTHING

3817
02:54:51,148 --> 02:54:52,916
ABOUT US WITHOUT US. HE HAS 

3818
02:54:52,916 --> 02:54:56,253
HELPED US IN RECRUITING, HE 

3819
02:54:56,253 --> 02:54:58,155
HELPED US IN ENSURING THE 

3820
02:54:58,155 --> 02:55:01,725
LANGUAGE APPROPRIATE. SO I THINK

3821
02:55:01,725 --> 02:55:07,931
THAT FINDING ADVOCATES WHO CARE 

3822
02:55:07,931 --> 02:55:12,302
ABOUT ADDING PATIENTS TO YOUR 

3823
02:55:12,302 --> 02:55:16,506
STUDY (BELL) ARE REALLY -- IS 

3824
02:55:16,506 --> 02:55:17,374
PROBABLY STEP ONE. 

3825
02:55:17,374 --> 02:55:21,645
>> YEP, I THINK THAT IS 

3826
02:55:21,645 --> 02:55:24,748
IMPORTANT. LOOKS LIKE THERE IS A

3827
02:55:24,748 --> 02:55:32,122
COMMENT FROM DR. QUIT. IN PRR 

3828
02:55:32,122 --> 02:55:34,391
YOU USED STANDARDIZED QUESTIONS 

3829
02:55:34,391 --> 02:55:36,159
THAT WERE STANDARD 11 YEARS AGO 

3830
02:55:36,159 --> 02:55:38,061
BUT HAVE EVOLVED. YOU HAVE A 

3831
02:55:38,061 --> 02:55:40,397
PLAN FOR INEVITABLE CHANGES OF 

3832
02:55:40,397 --> 02:55:45,669
HOW TO COLLECT THE DATA. THAT IS

3833
02:55:45,669 --> 02:55:48,105
GREAT. 

3834
02:55:48,105 --> 02:55:54,378
>> BACK TO THAT, DR. KAIL,
ARE 

3835
02:55:54,378 --> 02:55:59,383
THOSE VARIABLE TO NON-FAR GROUPS

3836
02:55:59,383 --> 02:56:00,284
TO EMULATE THOSE? 

3837
02:56:00,284 --> 02:56:02,653
>> ABSOLUTELY, IT IS A
GREAT 

3838
02:56:02,653 --> 02:56:05,289
QUESTION. I THINK -- ACTUALLY I 

3839
02:56:05,289 --> 02:56:08,525
DON'T KNOW IF PVDOMICS USE THAT 

3840
02:56:08,525 --> 02:56:10,294
QUESTION, I KNOW THEY USE THE 

3841
02:56:10,294 --> 02:56:12,429
RACE, ETHNICITY QUESTIONS, I 

3842
02:56:12,429 --> 02:56:12,930
BELIEVE -- 

3843
02:56:12,930 --> 02:56:14,531
>> NO, NO. 

3844
02:56:14,531 --> 02:56:15,666
>> WE DIDN'T -- 

3845
02:56:15,666 --> 02:56:17,668
>> YEAH, BUT THOSE
QUESTIONS ARE

3846
02:56:17,668 --> 02:56:19,803
PROBABLY NOW OUTDATED SO ANY OF 

3847
02:56:19,803 --> 02:56:21,305
THESE STUDIES YOU NEED TO PLAN 

3848
02:56:21,305 --> 02:56:25,776
FOR FUTURE, HOW TO HARMONIZE 

3849
02:56:25,776 --> 02:56:28,979
DATA FOR LONG PERIODS OF TIME. 

3850
02:56:28,979 --> 02:56:30,480
>> ALONG THOSE LINE, I
DON'T 

3851
02:56:30,480 --> 02:56:32,482
KNOW IF LEI IS AVAILABLE BUT 

3852
02:56:32,482 --> 02:56:35,118
SHOULD NIH BE ADDING THIS TO THE

3853
02:56:35,118 --> 02:56:36,286
TABLES THAT WE ARE ALL FILLING 

3854
02:56:36,286 --> 02:56:37,888
OUT, IF WE ARE FILLING OUT ABOUT

3855
02:56:37,888 --> 02:56:41,692
RACE AND ETHNICITY, MIGHT NOT 

3856
02:56:41,692 --> 02:56:45,529
INCLUDE TRANSGENDER, GENDER, SEX

3857
02:56:45,529 --> 02:56:46,463
AND TRANSGENDER INDIVIDUALS. 

3858
02:56:46,463 --> 02:56:48,899
>> I THINK THAT IS A GOOD 

3859
02:56:48,899 --> 02:56:49,967
QUESTION. AFTER THIS WORKSHOP 

3860
02:56:49,967 --> 02:56:53,737
THIS IS THE TOPIC THAT WE WILL 

3861
02:56:53,737 --> 02:56:56,006
NEED TO DISCUSS. CURRENTLY WE 

3862
02:56:56,006 --> 02:56:58,508
DON'T HAVE THAT ON OUR TABLE FOR

3863
02:56:58,508 --> 02:56:59,843
INCLUSION BUT THIS IS GOOD 

3864
02:56:59,843 --> 02:57:03,647
DISCUSSION, EYE-OPENING FOR ME 

3865
02:57:03,647 --> 02:57:07,417
TOO. I DIDN'T REALIZE THE 

3866
02:57:07,417 --> 02:57:09,152
DIFFERENCE BETWEEN SEX AND 

3867
02:57:09,152 --> 02:57:10,554
GENDER, NOW VERY CLEAR AND 

3868
02:57:10,554 --> 02:57:11,722
TRANSGENDER ISSUE. THIS IS 

3869
02:57:11,722 --> 02:57:15,759
SOMETHING WE WILL HAVE MORE 

3870
02:57:15,759 --> 02:57:19,429
DISCUSSION AND WITH OUTSIDE 

3871
02:57:19,429 --> 02:57:20,030
INVESTIGATOR SO THANK YOU. 

3872
02:57:20,030 --> 02:57:23,834
>> ALL RIGHT. WITH THAT WE
NEED 

3873
02:57:23,834 --> 02:57:34,378
TO MOVE ON. THANKS TO THE TALK, 

3874
02:57:35,712 --> 02:57:45,856
DR. STRAUL. 

3875
02:57:48,291 --> 02:57:50,027
>> THANKS FOR INCLUDING
ME. 

3876
02:57:50,027 --> 02:57:53,130
>> THE NEXT IS DR.
EGHBALI, 

3877
02:57:53,130 --> 02:57:54,398
TALKING ABOUT DIFFERENCE ON 

3878
02:57:54,398 --> 02:57:55,766
WORLD SYMPOSIUM GROUPS, 

3879
02:57:55,766 --> 02:57:57,200
IMPLICATIONS FOR DIAGNOSIS, 

3880
02:57:57,200 --> 02:58:00,637
TREATMENT AND CLINICAL OUTCOMES.

3881
02:58:00,637 --> 02:58:01,471
DR. EGHBALI. 

3882
02:58:01,471 --> 02:58:04,074
>> THANK YOU SO MUCH FOR 

3883
02:58:04,074 --> 02:58:08,545
INVITING ME. VERY HAPPY TO BE 

3884
02:58:08,545 --> 02:58:10,847
HERE. MY TALK IS GOING TO BE A 

3885
02:58:10,847 --> 02:58:12,816
BIT DIFFERENT. I'M A PHD 

3886
02:58:12,816 --> 02:58:14,951
SCIENTIST WORKING MAINLY 

3887
02:58:14,951 --> 02:58:16,153
PRE-CLINICAL AND TRANSLATIONAL 

3888
02:58:16,153 --> 02:58:20,690
RESEARCH ANIMAL MODELS. NEXT, 

3889
02:58:20,690 --> 02:58:21,758
PLEASE. 

3890
02:58:21,758 --> 02:58:32,269
    MY TALK I WILL TALK ABOUT 

3891
02:58:32,569 --> 02:58:35,205
TRANSLATIONAL KNOWLEDGE IN 

3892
02:58:35,205 --> 02:58:37,541
RESEARCH GROUPS, WE HAD SIX 

3893
02:58:37,541 --> 02:58:38,842
HORMONES AND SIX CHROMOSOMES, 

3894
02:58:38,842 --> 02:58:43,613
THEN LEAVE YOU FEW CLINICAL 

3895
02:58:43,613 --> 02:58:45,215
TRIALS TARGETING ESTROGEN 

3896
02:58:45,215 --> 02:58:46,550
SIGNALS AND HAVE RECOMMENDATIONS

3897
02:58:46,550 --> 02:58:53,790
AS TO HOW TO COMPREHENSIVELY 

3898
02:58:53,790 --> 02:58:56,626
STUDY SEX DIFFERENCES FOR FUTURE

3899
02:58:56,626 --> 02:58:58,395
RESEARCH. 

3900
02:58:58,395 --> 02:59:01,531
    WE TALK ABOUT SEX IN THIS IS

3901
02:59:01,531 --> 02:59:03,066
UNKNOWN. THERE IS HIGHER KNOWN 

3902
02:59:03,066 --> 02:59:05,168
INSTANCE OF PH IN WOMEN, 

3903
02:59:05,168 --> 02:59:07,104
PARTICULARLY GROUP ONE. HERE YOU

3904
02:59:07,104 --> 02:59:11,007
SEE A RECENT TABLE FROM 

3905
02:59:11,007 --> 02:59:15,745
PUBLICATION OF DR. EARNEST AND 

3906
02:59:15,745 --> 02:59:18,448
COLLEAGUE (?) AS YOU SEE THEY 

3907
02:59:18,448 --> 02:59:22,152
LOOK AT 750 PATIENTS FROM GROUP 

3908
02:59:22,152 --> 02:59:26,189
ONE TO GROUP FIVE. 73% OF 

3909
02:59:26,189 --> 02:59:28,692
PATIENTS ARE FEMALE. THE SAME 

3910
02:59:28,692 --> 02:59:30,494
ARE ALSO HIGHER FEMALE OVERALL 

3911
02:59:30,494 --> 02:59:36,233
IN GROUP TWO, THREE, FOUR EXCEPT

3912
02:59:36,233 --> 02:59:38,268
GROUP FIVE. THEN HIGHER 

3913
02:59:38,268 --> 02:59:39,736
INCIDENCE IN WOMEN. WOMEN ARE 

3914
02:59:39,736 --> 02:59:43,573
DIAGNOSED WITH PH IS KNOWN THEY 

3915
02:59:43,573 --> 02:59:46,510
RESPOND BETTER TO THERAPY. HAVE 

3916
02:59:46,510 --> 02:59:48,245
BETTER FUNCTION, WHICH 

3917
02:59:48,245 --> 02:59:50,213
TRANSLATES TO HIGHER SURVIVAL IN

3918
02:59:50,213 --> 02:59:52,082
WOMAN. SO THEN WE LOOK AT 

3919
02:59:52,082 --> 02:59:55,118
EXPERIMENTAL MODELS OF PH. YOU 

3920
02:59:55,118 --> 02:59:59,022
SEE, MOST OF THE TIME THERE IS 

3921
02:59:59,022 --> 03:00:00,657
CONFIDENT THAT THE FEMALES ARE 

3922
03:00:00,657 --> 03:00:02,492
DOING BETTER OR MORE PROTECTED 

3923
03:00:02,492 --> 03:00:05,195
OR ESTROGEN IS PROTECTIVE. 

3924
03:00:05,195 --> 03:00:06,897
SOMETHING KNOWN AS SEX PARADOX 

3925
03:00:06,897 --> 03:00:11,668
OR ESTROGEN PARADOX NPH. NEXT 

3926
03:00:11,668 --> 03:00:12,269
SLIDE. 

3927
03:00:12,269 --> 03:00:14,104
    I'M GOING TO TALK ABOUT 

3928
03:00:14,104 --> 03:00:18,608
GROUP ONE. PAH. HAD DIFFERENT 

3929
03:00:18,608 --> 03:00:23,747
SUB TYPES, CONNECTIVE TISSUE, 

3930
03:00:23,747 --> 03:00:25,081
ASSOCIATED PULMONARY 

3931
03:00:25,081 --> 03:00:26,583
HYPERTENSION AND H.I.V. RELATED.

3932
03:00:26,583 --> 03:00:33,823
AGAIN THERE IS A NEW TABLE FROM 

3933
03:00:33,823 --> 03:00:37,527
DR. VENTETUOLO AND MARCO, ALMOST

3934
03:00:37,527 --> 03:00:42,265
2,000 PATIENTS BUT 1,500 FEMALE,

3935
03:00:42,265 --> 03:00:44,000
500 ARE MALE. WHEN YOU LOOK AT 

3936
03:00:44,000 --> 03:00:47,437
DIFFERENT SUBTITLES OF PAH, YOU 

3937
03:00:47,437 --> 03:00:50,707
SEE MAJORITY OF THEM ARE STILL 

3938
03:00:50,707 --> 03:00:56,713
WOMAN EXCEPT IN H.I.V. RELATED 

3939
03:00:56,713 --> 03:01:01,251
(?). IT IS WELL ACCEPTED 

3940
03:01:01,251 --> 03:01:02,285
INCIDENCE IS MORE COMMON IN 

3941
03:01:02,285 --> 03:01:06,356
WOMAN. WE LOOK AT ANIMAL MODELS,

3942
03:01:06,356 --> 03:01:07,557
NEXT SLIDE, PLEASE. 

3943
03:01:07,557 --> 03:01:09,893
    THESE ARE CLASSICAL ANIMAL 

3944
03:01:09,893 --> 03:01:11,962
MODELS USED BY INVESTIGATORS. 

3945
03:01:11,962 --> 03:01:15,398
THE MODEL THAT WE PUT THE 

3946
03:01:15,398 --> 03:01:16,366
ANIMALS IN HYPOXIA FOR TWO 

3947
03:01:16,366 --> 03:01:19,603
WEEKS. ONE OF THE FIRST EARLY 

3948
03:01:19,603 --> 03:01:21,905
ONES WAS FROM DR. (?) ALMOST 40 

3949
03:01:21,905 --> 03:01:25,575
YEARS AGO SHOWING FEMALE SEX IS 

3950
03:01:25,575 --> 03:01:27,310
PROTECTIVE IN HYPOXIA RAT MODEL 

3951
03:01:27,310 --> 03:01:29,613
AND OVER ACTIVITY MAKES IT 

3952
03:01:29,613 --> 03:01:32,482
WORSE. LATER THE DOCTOR SHOWED 

3953
03:01:32,482 --> 03:01:35,952
ESTROGEN APPEARS IN THE HYPOXIA 

3954
03:01:35,952 --> 03:01:39,489
IN MAY RATS. OTHER MODEL 

3955
03:01:39,489 --> 03:01:42,459
EXTENSIVELY IS MTC MODEL THAT WE

3956
03:01:42,459 --> 03:01:45,695
JUST GAVE THIS TOXIN AND ONE IS 

3957
03:01:45,695 --> 03:01:48,031
SUFFICIENT TO INDUCE PULMONARY 

3958
03:01:48,031 --> 03:01:49,599
HYPERTENSION. SEVERAL GROUPS 

3959
03:01:49,599 --> 03:01:51,001
INCLUDING MY LAB HAVE SHOWN 

3960
03:01:51,001 --> 03:01:55,105
FEMALE SEX IS PROTECTIVE IN THE 

3961
03:01:55,105 --> 03:02:00,543
MCT RAT MODEL AND OVER ACTIVITY 

3962
03:02:00,543 --> 03:02:01,244
MAKE DISEASE WORSE. 

3963
03:02:01,244 --> 03:02:02,812
    ALSO THERE WAS A WORK ALMOST

3964
03:02:02,812 --> 03:02:05,682
40 YEARS AGO SHOWING WITH 

3965
03:02:05,682 --> 03:02:09,219
ESTROGEN METABOLIZED IS ABLE TO 

3966
03:02:09,219 --> 03:02:15,558
SLOW DOWN THE DISEASE IN MCT 

3967
03:02:15,558 --> 03:02:18,695
MODEL. NEXT SLIDE. SINCE PH IS 

3968
03:02:18,695 --> 03:02:21,998
NOT ALWAYS DIAGNOSED EARLY WE 

3969
03:02:21,998 --> 03:02:25,502
DECIDED TO SEE IF ESTROGEN COULD

3970
03:02:25,502 --> 03:02:27,971
RESCUE PRE-EXISTING PAH. IN THE 

3971
03:02:27,971 --> 03:02:30,240
MCT MODEL AND RESTART ESTROGEN 

3972
03:02:30,240 --> 03:02:32,676
TREATMENT THREE WEEKS AFTER MCT,

3973
03:02:32,676 --> 03:02:34,477
NO TYPE OF DISEASES ALREADY 

3974
03:02:34,477 --> 03:02:35,979
ESTABLISH ED IN THE ANIMAL. WE 

3975
03:02:35,979 --> 03:02:39,015
SHOW ONLY TEN DAYS OF ESTROGEN 

3976
03:02:39,015 --> 03:02:41,584
TREATMENT IS ABLE TO RESCUE 

3977
03:02:41,584 --> 03:02:43,720
PRE-EXISTING DISEASES YOU SEE 

3978
03:02:43,720 --> 03:02:47,057
FROM DISTOL IK PRESSURE AND (?).

3979
03:02:47,057 --> 03:02:49,092
WHAT WAS INTERESTING IS THAT WE 

3980
03:02:49,092 --> 03:02:51,161
HAD ANOTHER GROUP THAT WE ONLY 

3981
03:02:51,161 --> 03:02:54,764
TREATED THEM FOR TEN DAYS BUT 

3982
03:02:54,764 --> 03:02:57,133
DIDN'T SACRIFICE THEM. KEPT THEM

3983
03:02:57,133 --> 03:02:59,002
FOR ANOTHER 12 DAYS TO SEE IF 

3984
03:02:59,002 --> 03:03:00,670
PROTECTIVE ACTION OF ESTROGEN IS

3985
03:03:00,670 --> 03:03:03,139
GOING TO BE SUSTAINED. AS YOU 

3986
03:03:03,139 --> 03:03:05,542
CAN SEE THE ESTROGEN CONTROL 

3987
03:03:05,542 --> 03:03:10,146
GROUP WE SEE SIGNIFICANT 

3988
03:03:10,146 --> 03:03:12,482
IMPROVEMENT IN PRESSURE AND THIS

3989
03:03:12,482 --> 03:03:16,453
IMPROVEMENT WAS THERE IN THE 

3990
03:03:16,453 --> 03:03:22,826
ABSENCE (AUDIO DISRUPTION) AND 

3991
03:03:22,826 --> 03:03:25,428
WE WANTED TO KNOW IF RECEPTOR. 

3992
03:03:25,428 --> 03:03:28,098
THAT IS WHY THERE ARE TWO MAIN 

3993
03:03:28,098 --> 03:03:34,337
RECEPTIONIST S RECEPTIONIST /* *

3994
03:03:34,337 --> 03:03:42,679
-- RECEPTORS AND COMPARE. THE 

3995
03:03:42,679 --> 03:03:45,014
AGONISTS AND AS WE USE B AGONIST

3996
03:03:45,014 --> 03:03:47,317
IN GREEN BARS WE SEE THAT IS 

3997
03:03:47,317 --> 03:03:49,652
ALMOST AS EFFECTIVE AS ESTROGEN.

3998
03:03:49,652 --> 03:03:54,124
WHEREAS ESTROGEN RECEPTOR FOR 

3999
03:03:54,124 --> 03:03:55,091
AGONIST REALLY HAVE MUCH 

4000
03:03:55,091 --> 03:03:56,393
PROTECTION TO OFFER. OUR 

4001
03:03:56,393 --> 03:03:58,261
CONCLUSION WAS THAT THE 

4002
03:03:58,261 --> 03:04:00,997
PROTECTIVE ACTION OF ESTROGEN IN

4003
03:04:00,997 --> 03:04:06,736
MTC MODEL WE USE IS TO ESTROGEN 

4004
03:04:06,736 --> 03:04:10,240
RECEPTOR B. NEXT SLIDE. WE 

4005
03:04:10,240 --> 03:04:20,250
PUBLISHED THIS IN JOURNAL IN 

4006
03:04:20,250 --> 03:04:22,452
2011 AND THERE WAS EDITORIAL AND

4007
03:04:22,452 --> 03:04:24,053
HAPPY TO SEE THE IMAGE ON THE 

4008
03:04:24,053 --> 03:04:27,557
COVER OF THE MAGAZINE. NEXT, 

4009
03:04:27,557 --> 03:04:31,795
PLEASE. BUT NOT ONLY ESTROGEN, 

4010
03:04:31,795 --> 03:04:34,497
ESTROGEN METABOLITES LIKE 

4011
03:04:34,497 --> 03:04:44,908
2METOXY OR 2HYDROXY IS 

4012
03:04:46,543 --> 03:04:48,778
PROTECTIVE. THIS IS CONVERTED TO

4013
03:04:48,778 --> 03:04:54,451
TESTOSTERONE AND WITH HELP OF 

4014
03:04:54,451 --> 03:04:57,587
AROMATASE IS MAKING ESTROGEN 

4015
03:04:57,587 --> 03:04:59,789
CONVERTED TO METABOLITES. THESE 

4016
03:04:59,789 --> 03:05:01,724
ARE KNOWN AS GOOD METABOLITES. 

4017
03:05:01,724 --> 03:05:03,793
THERE ARE MANY PEOPLE SHOWING 

4018
03:05:03,793 --> 03:05:07,330
THESE TWO ARE PROTECTED IN PH, 

4019
03:05:07,330 --> 03:05:16,439
WHEREAS ON THE RED 16HYPOXY IS 

4020
03:05:16,439 --> 03:05:22,278
SHOWN (?). NEXT ONE, PLEASE. THE

4021
03:05:22,278 --> 03:05:26,149
OTHER MODEL WE HAVE EXTENSIVELY 

4022
03:05:26,149 --> 03:05:28,451
USED IS HYPOXIA, THAT MODEL. IN 

4023
03:05:28,451 --> 03:05:39,095
MANY WAYS IT  IT MY MIK /* /* --

4024
03:05:42,265 --> 03:05:45,969
IT MIMICS AND WHEN THEY COMPARE 

4025
03:05:45,969 --> 03:05:48,171
FEMALE TO MALE THEY HAVE BETTER 

4026
03:05:48,171 --> 03:05:49,439
PERFORMANCE AND LOWER 

4027
03:05:49,439 --> 03:05:52,408
INFLAMMATORY IN ARTERIES, LOWER 

4028
03:05:52,408 --> 03:05:55,378
RV FIBROSIS AND BETTER SURVIVAL.

4029
03:05:55,378 --> 03:05:57,847
IN THE FOLLOW-UP WORK BY DR. TIM

4030
03:05:57,847 --> 03:06:00,283
LAMB AND (?) THEY ACTUALLY SHOW 

4031
03:06:00,283 --> 03:06:03,486
THE MECHANISM THAT ESTROGEN IS 

4032
03:06:03,486 --> 03:06:07,323
PROTECTIVE, ESTROGEN RECEPTOR 

4033
03:06:07,323 --> 03:06:16,733
(?) TO SIGNALLING TO (?) POTENT 

4034
03:06:16,733 --> 03:06:18,034
EFFECTECTOR. ANOTHER GROUP USING

4035
03:06:18,034 --> 03:06:20,937
THE SAME HYPOXIA RAT MODEL 

4036
03:06:20,937 --> 03:06:22,071
SHOWING COMPLETELY OPPOSITE 

4037
03:06:22,071 --> 03:06:24,474
RESULT THAT ACTUALLY INSTEAD OF 

4038
03:06:24,474 --> 03:06:27,076
ACTIVATING ESTROGEN RECEPTOR 

4039
03:06:27,076 --> 03:06:30,213
THEY SHOW INHIBITION OF RECEPTOR

4040
03:06:30,213 --> 03:06:33,583
HAD THERAPEUTIC EFFECT IN FEMALE

4041
03:06:33,583 --> 03:06:39,756
RATS AND USE OF THE ENZYME THAT 

4042
03:06:39,756 --> 03:06:44,060
CONVERT TO ESTROGEN, SHOWN TO 

4043
03:06:44,060 --> 03:06:47,931
THE PH DEVELOPMENT. NEXT SLIDE. 

4044
03:06:47,931 --> 03:06:49,766
    THERE ARE ALSO GENETICALLY 

4045
03:06:49,766 --> 03:06:51,467
MODIFIED MICE THAT THEY SHOWED 

4046
03:06:51,467 --> 03:06:53,303
THEY DON'T SUPPORT THE FEMALE 

4047
03:06:53,303 --> 03:06:55,071
PROTECTION IN PH. MOST OF THIS 

4048
03:06:55,071 --> 03:06:58,875
WORK HAS BEEN DONE BY DR. 

4049
03:06:58,875 --> 03:07:02,312
MC LAIN. SHE USED PH MODEL USED 

4050
03:07:02,312 --> 03:07:07,317
BY OVEREXPRESSION OF THIS IN 

4051
03:07:07,317 --> 03:07:09,886
MICE. THEY SHOW ACTUALLY IN THIS

4052
03:07:09,886 --> 03:07:13,623
MODEL ONLY FEMALE MICE DEVELOP 

4053
03:07:13,623 --> 03:07:23,866
PH. (?) ACTUALLY MAKES -- IN 

4054
03:07:23,866 --> 03:07:27,804
FEMALES. THERE IS ANOTHER MODEL 

4055
03:07:27,804 --> 03:07:32,475
INDUCED BY BINDING PROTEINS AND 

4056
03:07:32,475 --> 03:07:36,145
SHOW DEVELOPMENT OF LESION ONLY 

4057
03:07:36,145 --> 03:07:42,018
BEING SEEN IN FEMALE MICE. NEXT 

4058
03:07:42,018 --> 03:07:43,753
SLIDE. 

4059
03:07:43,753 --> 03:07:48,091
    WE ALSO LOOK AT MODEL FEW 

4060
03:07:48,091 --> 03:07:50,927
YEARS AGO BY FEEDING THE WILD 

4061
03:07:50,927 --> 03:07:53,496
TYPE MICE WITH DIET RICH IN 

4062
03:07:53,496 --> 03:07:56,633
OXIDIZED LIPI D. PUT THE DIET ON

4063
03:07:56,633 --> 03:07:59,035
THIS DIET THREE WEEKS AND 

4064
03:07:59,035 --> 03:08:00,403
DEVELOP HYPERTENSION. 

4065
03:08:00,403 --> 03:08:03,373
INTERESTINGLY IN THIS MODEL, AS 

4066
03:08:03,373 --> 03:08:05,208
YOU CAN SEE IN PANEL C, WE 

4067
03:08:05,208 --> 03:08:07,910
COMPARE MALE AND FEMALE. IN THIS

4068
03:08:07,910 --> 03:08:11,814
MODEL WE SEE ACTUALLY FEMALE 

4069
03:08:11,814 --> 03:08:14,450
DEVELOP MORE SERIOUS 

4070
03:08:14,450 --> 03:08:16,119
HYPERTENSION THAN ME AND PUBLISH

4071
03:08:16,119 --> 03:08:19,689
FOR PEOPLE INTERESTED TO LOOK AT

4072
03:08:19,689 --> 03:08:23,660
THIS MODEL. NEXT SLIDE. THEN 

4073
03:08:23,660 --> 03:08:27,363
WHEN COMES TO PH GROUP 2, WHICH 

4074
03:08:27,363 --> 03:08:29,866
IS THE PH SECOND TO HEART 

4075
03:08:29,866 --> 03:08:31,534
DISEASE, THIS IS ACTUALLY THE 

4076
03:08:31,534 --> 03:08:35,238
MOST COMMON TYPE OF PH, EITHER 

4077
03:08:35,238 --> 03:08:37,840
SECONDARY TO HEART FAILURE WITH 

4078
03:08:37,840 --> 03:08:40,309
(?) OR HEART FAILURE WITH 

4079
03:08:40,309 --> 03:08:43,246
REDUCED EJECTION FRACTURE. WHEN 

4080
03:08:43,246 --> 03:08:45,782
COMES TO PH SECONDARY TO HEART 

4081
03:08:45,782 --> 03:08:47,016
FAILURE REDUCED EJECTION 

4082
03:08:47,016 --> 03:08:50,253
FRACTION THERE ARE SEVERAL 

4083
03:08:50,253 --> 03:08:52,689
CLINICAL TRIALS THAT THEY SHOW 

4084
03:08:52,689 --> 03:08:55,324
MORE MALE TO FEMALE RATIO, 

4085
03:08:55,324 --> 03:08:58,795
INDICATING A HIGHER OF GROUP 2. 

4086
03:08:58,795 --> 03:09:02,065
THEN YOU LOOK AT THE PH 

4087
03:09:02,065 --> 03:09:02,999
SUBPOENAING DARE TO HEART 

4088
03:09:02,999 --> 03:09:05,101
FAILURE WITH PRESERVE EJECTION 

4089
03:09:05,101 --> 03:09:08,504
FRACTION, THE RESULT IS QUITE 

4090
03:09:08,504 --> 03:09:13,342
MIXED. THERE ARE SOME CLINICAL 

4091
03:09:13,342 --> 03:09:17,613
TRIALS THEY SHOW HIGHER RATIOS. 

4092
03:09:17,613 --> 03:09:20,049
WHEN COMES TO PH GROUP 2 THERE 

4093
03:09:20,049 --> 03:09:21,551
IS NOT REALLY MANY ANIMAL 

4094
03:09:21,551 --> 03:09:23,820
MODELS. THERE ARE A LOT OF 

4095
03:09:23,820 --> 03:09:28,191
ANIMAL MODELS TO INDUCE, REDUCE 

4096
03:09:28,191 --> 03:09:31,594
EJECTION FRACTION. THAT IS 

4097
03:09:31,594 --> 03:09:33,362
USUALLY DONE BY CONSTRICTION BUT

4098
03:09:33,362 --> 03:09:36,532
NO ONE REALLY LOOKS AT PULMONARY

4099
03:09:36,532 --> 03:09:38,668
VASCULAR REMODELLING IN THESE 

4100
03:09:38,668 --> 03:09:40,770
MICE. INSTEAD THERE IS A LOT OF 

4101
03:09:40,770 --> 03:09:44,107
WORK THAT NEEDS TO BE DONE IN 

4102
03:09:44,107 --> 03:09:49,746
THIS GROUP. NEXT SLIDE. THEN PH 

4103
03:09:49,746 --> 03:09:53,316
GROUP THREE IS SECONDARY TO 

4104
03:09:53,316 --> 03:09:56,219
CHRONIC LUNG DISEASE. THIS 

4105
03:09:56,219 --> 03:09:57,620
REALLY DEPENDS. THERE ARE 

4106
03:09:57,620 --> 03:10:00,857
REPORTS WHEN THEY LOOK AT THE 

4107
03:10:00,857 --> 03:10:03,793
ENTIRE GROUP THREE THEY SHOW 

4108
03:10:03,793 --> 03:10:05,328
THAT FEMALES WERE MOST 

4109
03:10:05,328 --> 03:10:06,362
SUSCEPTIBLE MAINLY BECAUSE OF 

4110
03:10:06,362 --> 03:10:08,564
MUCH HIGHER ABUNDANCE OF PULL 

4111
03:10:08,564 --> 03:10:10,833
MOP NEAR HYPERTENSION ASSOCIATED

4112
03:10:10,833 --> 03:10:12,902
WITH AUTO IMMUNE PULMONARY 

4113
03:10:12,902 --> 03:10:16,339
FIBROSIS IN WOMAN. BUT IF YOU 

4114
03:10:16,339 --> 03:10:25,248
LOOK AT OTHER  OTHER ETIOLOGIES,

4115
03:10:25,248 --> 03:10:27,216
THERE MAY BE MORE SUSCEPTIBLE IN

4116
03:10:27,216 --> 03:10:30,019
GROUP THREE, COPD IS HIGH NER 

4117
03:10:30,019 --> 03:10:33,790
MEN DUE TO SMOKING. ALSO IN 

4118
03:10:33,790 --> 03:10:35,424
IDIOPATHIC FIBROSIS MEN ARE MORE

4119
03:10:35,424 --> 03:10:38,795
PRONE TO BE AFFECTED THEN WOMEN.

4120
03:10:38,795 --> 03:10:42,031
AGAIN IN IDIOPATHIC PULMONARY 

4121
03:10:42,031 --> 03:10:44,300
FIBROSIS REPORTED MALE SEX IS 

4122
03:10:44,300 --> 03:10:46,569
RISK FACTOR FOR (?) DYSFUNCTION 

4123
03:10:46,569 --> 03:10:54,076
EVEN A CRU ADJUSTING THE PRESSU 

4124
03:10:54,076 --> 03:10:54,777
NEXT SLIDE. 

4125
03:10:54,777 --> 03:10:56,112
    THERE ARE NOT REPORTS TO 

4126
03:10:56,112 --> 03:10:58,681
LOOK AT RULE OF ESTROGEN AND 

4127
03:10:58,681 --> 03:11:00,116
RECEPTORS IN PH GROUP 3. THIS IS

4128
03:11:00,116 --> 03:11:02,318
ONE OF THE FEW STUDIES FOUND 

4129
03:11:02,318 --> 03:11:10,159
THAT THEY LOOKING AT THIS IN 

4130
03:11:10,159 --> 03:11:12,028
LUNG OF HEALTHY SUBJECTS, IN 

4131
03:11:12,028 --> 03:11:21,370
PATIENTS WITH PH SECONDARY TO 

4132
03:11:21,370 --> 03:11:24,507
IPF. ESTROGEN RECEPTOR 

4133
03:11:24,507 --> 03:11:25,842
EXPRESSION WAS SIGNIFICANTLY 

4134
03:11:25,842 --> 03:11:28,845
HIGHER IN PAH SUBJECTS COMPARED 

4135
03:11:28,845 --> 03:11:32,548
TO GROUP 3 HYPERTENSION. NEXTED 

4136
03:11:32,548 --> 03:11:34,817
SLIDE. ALSO WHEN COMES TO ANIMAL

4137
03:11:34,817 --> 03:11:36,352
MODELS, THERE ARE NOT MANY 

4138
03:11:36,352 --> 03:11:38,054
ANIMAL MODELS COMPARING MALE AND

4139
03:11:38,054 --> 03:11:41,891
FEMALE. THERE IS A STUDY THAT 

4140
03:11:41,891 --> 03:11:45,061
THEY INDUCE GROUP THREE 

4141
03:11:45,061 --> 03:11:47,296
HYPERTENSION IN RATS BY (?) THAT

4142
03:11:47,296 --> 03:11:49,232
WORK WAS DONE BY (?) MANY YEARS 

4143
03:11:49,232 --> 03:11:51,634
AGO. IN THIS ONE, AS RIGHT NOW 

4144
03:11:51,634 --> 03:11:57,106
SEE, YOU CAN SEE SURVIVAL WHEN 

4145
03:11:57,106 --> 03:11:59,575
THEY (?) THE RATS AND SEE THE 

4146
03:11:59,575 --> 03:12:02,778
MORTALITY HAS INCREASED, EVIDENT

4147
03:12:02,778 --> 03:12:06,415
BY HIGHER SYSTOLIC PRESSURE AND 

4148
03:12:06,415 --> 03:12:09,986
LONG, BUT WHEN TREAT WITH 

4149
03:12:09,986 --> 03:12:18,060
ESTROGEN METABOLITE TO 

4150
03:12:18,060 --> 03:12:19,528
METOXYESTRADIOL, SURVIVAL IS 

4151
03:12:19,528 --> 03:12:24,233
INCREASED IN PRESSURE AND (?) 

4152
03:12:24,233 --> 03:12:26,269
NEXT SLIDE. WE ALSO DECIDED TO 

4153
03:12:26,269 --> 03:12:30,439
LOOK AT THE RULE OF SEX 

4154
03:12:30,439 --> 03:12:31,073
CHROMO

4155
03:12:31,073 --> 03:12:32,475
CHROMOSOME. WE KNOW INDENSE IS 

4156
03:12:32,475 --> 03:12:35,077
HIGHER IN FEMALE IN PAH. MAYBE 

4157
03:12:35,077 --> 03:12:37,680
MAY THEY HAVE A PROTECTIVE 

4158
03:12:37,680 --> 03:12:40,750
FACTOR. THEN LOOK AT ROLE IN 

4159
03:12:40,750 --> 03:12:42,818
COLLABORATION WITH DR. ARNOLD AT

4160
03:12:42,818 --> 03:12:47,223
UCLA. DR. ARNOLD AND HIS 

4161
03:12:47,223 --> 03:12:50,793
COLLEAGUE, THEY PIONEERED 

4162
03:12:50,793 --> 03:12:53,262
SEVERAL MOUSE MODELS KNOWN AS 

4163
03:12:53,262 --> 03:12:54,797
(?). THESE MICE HAVE BEEN USED 

4164
03:12:54,797 --> 03:12:56,666
BY MANY INVESTIGATORS LOOKING AT

4165
03:12:56,666 --> 03:13:01,904
DIFFERENT TYPES OF DISEASE AND 

4166
03:13:01,904 --> 03:13:03,873
HIGHLIGHTED BY THE NIH 

4167
03:13:03,873 --> 03:13:09,745
DIRECTOR'S OFFICE. NEXT SLIDE. 

4168
03:13:09,745 --> 03:13:14,684
IN THE (?) ON THE LEFT IT IS 

4169
03:13:14,684 --> 03:13:16,185
INTERESTING YOU CAN HAVE A 

4170
03:13:16,185 --> 03:13:20,556
FEMALE MICE WITH X, X OR XY 

4171
03:13:20,556 --> 03:13:22,124
CHROMOSOME. THE REASON IS 

4172
03:13:22,124 --> 03:13:24,794
BECAUSE THE SRY GENE THAT 

4173
03:13:24,794 --> 03:13:26,362
DETERMINES THE PRESENCE OF 

4174
03:13:26,362 --> 03:13:31,467
TESTES ARE REMOVED FROM THE Y 

4175
03:13:31,467 --> 03:13:33,903
CHROMOSOME AND THOUGH MICE HAS 

4176
03:13:33,903 --> 03:13:37,306
XY CHROMOSOME, SEEING NOT THERE 

4177
03:13:37,306 --> 03:13:38,574
THEY DEVELOP OVARIES AND 

4178
03:13:38,574 --> 03:13:41,310
CONSIDERED FEMALE. COULD ALSO 

4179
03:13:41,310 --> 03:13:44,347
HAVE MICE WITH XX CHROMOSOME. IN

4180
03:13:44,347 --> 03:13:48,384
THIS CASE WHEN THEY PUT THIS ON 

4181
03:13:48,384 --> 03:13:53,923
THE AUTOSOME THEN HAS X AND ONE 

4182
03:13:53,923 --> 03:13:55,458
HAS THE GENE AND WHY THEY 

4183
03:13:55,458 --> 03:13:58,427
DEVELOP TEST IT. THIS ALLOWS YOU

4184
03:13:58,427 --> 03:13:59,495
LOOK AT ROLE INDEPENDENT 

4185
03:13:59,495 --> 03:14:04,400
DEPARTMENT OF THE GONAD AND SEX.

4186
03:14:04,400 --> 03:14:06,335
    THE OTHER MOUSE MODEL, IN 

4187
03:14:06,335 --> 03:14:10,673
THIS MICE YOU CAN TEST THE ROLE 

4188
03:14:10,673 --> 03:14:13,976
OF SEX CHROMOSOME DOSAGE, 1X 

4189
03:14:13,976 --> 03:14:16,045
VERSUS 2X. CAN HAVE A FEMALE 

4190
03:14:16,045 --> 03:14:19,615
MICE WITH 1X OR 2X AND MALE WITH

4191
03:14:19,615 --> 03:14:21,984
1X OR 2X AND THEN LOOK TO SEE IF

4192
03:14:21,984 --> 03:14:25,521
THE DIFFERENCES THAT WE SEE IS 

4193
03:14:25,521 --> 03:14:28,457
BECAUSE OF THE (?) OR BECAUSE OF

4194
03:14:28,457 --> 03:14:33,529
THE ABSENCE OR PRESENCE OF Y 

4195
03:14:33,529 --> 03:14:40,836
CHROMOSOME. NEXT SLIDE. 

4196
03:14:40,836 --> 03:14:41,437
PARAGR

4197
03:14:41,437 --> 03:14:43,239
    ALMOST TEN YEARS AGO WE 

4198
03:14:43,239 --> 03:14:45,441
LOOKED AT THESE MICE TO SEE THE 

4199
03:14:45,441 --> 03:14:49,645
ROLE IN HYPERTENSION. WE UTILIZE

4200
03:14:49,645 --> 03:14:52,782
ALL THESE DOCTORS FOR (?) SEX 

4201
03:14:52,782 --> 03:14:54,784
HORMONES. WE WAITED FOR A MONTH.

4202
03:14:54,784 --> 03:14:58,154
AFTER THAT WE PUT THESE MICE 

4203
03:14:58,154 --> 03:15:01,624
EITHER IN AMOXIA OR HYPOXIA A 

4204
03:15:01,624 --> 03:15:05,161
FEW WEEKS. AS YOU CAN SEE IN FGC

4205
03:15:05,161 --> 03:15:07,129
MICE THEY ALL LOOK THE SAME BUT 

4206
03:15:07,129 --> 03:15:09,432
WHEN PUT IN HYPOXIA, THE MICE 

4207
03:15:09,432 --> 03:15:11,667
THEY HAVE XX CHROMOSOME, 

4208
03:15:11,667 --> 03:15:19,141
REGARDLESS IF THEY HAD TESTES OR

4209
03:15:19,141 --> 03:15:19,442
O

4210
03:15:19,442 --> 03:15:25,081
OVARIES THEY HAVE HIGH DISTOLIC 

4211
03:15:25,081 --> 03:15:26,749
PRESSURE. IT DOESN'T MATTER HERE

4212
03:15:26,749 --> 03:15:34,323
IF THEY HAVE 1X OR 2X. THE MOUSE

4213
03:15:34,323 --> 03:15:37,126
WITH Y CHROMOSOME, THEY ARE 

4214
03:15:37,126 --> 03:15:37,793
PROTECTED. NEXT SLIDE. 

4215
03:15:37,793 --> 03:15:41,097
    WE HAVE PUBLISHED THIS WORK 

4216
03:15:41,097 --> 03:15:44,100
IN BLUE JOURNAL IN 2018 SHOWING 

4217
03:15:44,100 --> 03:15:51,774
THE Y CHROMOSOME PLAYS ROLE IN 

4218
03:15:51,774 --> 03:15:54,043
EXPERIMENT MEN HI POX IK 

4219
03:15:54,043 --> 03:15:55,111
PULMONARY HYPERTENSION AND WE 

4220
03:15:55,111 --> 03:15:58,781
USED ANALYSIS OF CHROMOSOME Y 

4221
03:15:58,781 --> 03:16:01,450
GENE TO SEE WHAT GENES ON Y 

4222
03:16:01,450 --> 03:16:03,252
CHROMOSOME ARE EXPRESSED BOTH IN

4223
03:16:03,252 --> 03:16:06,856
THE HEART AND IN THE LUNG. WE 

4224
03:16:06,856 --> 03:16:10,092
FIND THERE ARE ONLY FOUR GENES 

4225
03:16:10,092 --> 03:16:12,261
ON Y CHROMOSOME EXPRESSED IN 

4226
03:16:12,261 --> 03:16:14,096
LUNGS OF THESE MICE. 

4227
03:16:14,096 --> 03:16:15,131
INTERESTINGLY, THREE OF THEM ARE

4228
03:16:15,131 --> 03:16:18,100
ALSO EXPRESSED IN HUMAN LUNGS. 

4229
03:16:18,100 --> 03:16:20,870
BUT WHAT IS MORE IMPORTANT IS 

4230
03:16:20,870 --> 03:16:22,304
THAT WE SEE THESE THREE GENES 

4231
03:16:22,304 --> 03:16:26,142
THAT ARE EXPRESSED IN HUMAN 

4232
03:16:26,142 --> 03:16:28,110
LUNGS, WHEN THESE PEOPLE HAVE 

4233
03:16:28,110 --> 03:16:33,782
PULMONARY HYPERTENSION THE 

4234
03:16:33,782 --> 03:16:37,987
EXPRESS ARE DOMINATED IN 

4235
03:16:37,987 --> 03:16:39,121
PULMONARY HYPERTENSION. NEXT, 

4236
03:16:39,121 --> 03:16:39,455
PLEASE. 

4237
03:16:39,455 --> 03:16:43,092
    NEXT WHAT WE DID, WE WANTED 

4238
03:16:43,092 --> 03:16:45,394
TO KNOW WHAT GENE ON Y 

4239
03:16:45,394 --> 03:16:46,462
CHROMOSOME IS RESPONSIBLE FOR 

4240
03:16:46,462 --> 03:16:47,963
THIS PROTECTION. SINCE THERE 

4241
03:16:47,963 --> 03:16:50,566
WERE ONLY FOUR IT WAS VERY EASY.

4242
03:16:50,566 --> 03:16:52,801
WHAT WE DID, WE SILENCED ONE 

4243
03:16:52,801 --> 03:16:55,371
GENE AT THE TIME. FIRST WE GOING

4244
03:16:55,371 --> 03:16:57,573
TO (?) ALL THE MICE. WE WAITED 

4245
03:16:57,573 --> 03:17:00,476
30 DAYS. AFTER THAT WE PUT THEM 

4246
03:17:00,476 --> 03:17:08,884
IN TAMOXIA OR HYPOXIA AND 

4247
03:17:08,884 --> 03:17:12,755
SILENCED ONE AT A TIME BY SNRNA.

4248
03:17:12,755 --> 03:17:15,391
THE THREE ON THE TOP, WHEN WE 

4249
03:17:15,391 --> 03:17:16,992
SILENCED THEM WE DIDN'T SEE 

4250
03:17:16,992 --> 03:17:19,828
CHANGE IN RV SYSTOLIC PRESSURE 

4251
03:17:19,828 --> 03:17:22,698
BUT AS SOON AS WE SILENCED UTY, 

4252
03:17:22,698 --> 03:17:24,466
WE SEE THE Y CHROMOSOME 

4253
03:17:24,466 --> 03:17:26,602
PROTECTION WAS GONE. AS YOU CAN 

4254
03:17:26,602 --> 03:17:31,307
SEE, THERE WAS A HIGHER SYSTOLIC

4255
03:17:31,307 --> 03:17:34,210
PRESSURE AND WE REPEATED THIS 

4256
03:17:34,210 --> 03:17:35,844
EXPERIMENT SEVERAL TIME. NEXT 

4257
03:17:35,844 --> 03:17:36,812
SLIDE, PLEASE. 

4258
03:17:36,812 --> 03:17:39,748
    WHAT IS REALLY INTERESTING 

4259
03:17:39,748 --> 03:17:42,318
IS WE IDENTIFY ON Y CHROMOSOME 

4260
03:17:42,318 --> 03:17:44,653
BUT WHEN LOOK AT DIFFERENT 

4261
03:17:44,653 --> 03:17:47,990
ANIMAL MODELS OF PULMONARY 

4262
03:17:47,990 --> 03:17:49,525
HYPERTENSION, WE LOOK AT THE 

4263
03:17:49,525 --> 03:17:52,695
HYPOXIA MODEL IN MICE WE SEE UTY

4264
03:17:52,695 --> 03:17:55,998
IS DOWN REGULATED IN HYPOXIA IN 

4265
03:17:55,998 --> 03:17:58,467
MICE. SEE UTY EXPRESSION IN 

4266
03:17:58,467 --> 03:18:02,271
LUNGS OF BOTH MCT AND (?) 

4267
03:18:02,271 --> 03:18:05,407
HYPOXIA DOWN-REGULATED. WE SEE 

4268
03:18:05,407 --> 03:18:08,410
UTY IS DOWNGRADED IN LUNGS OF 

4269
03:18:08,410 --> 03:18:12,014
PATIENTS WITH PULMONARY 

4270
03:18:12,014 --> 03:18:13,682
HYPERTENSION. NEXT SLIDE. 

4271
03:18:13,682 --> 03:18:17,753
    THE NEXT QUESTION WAS, WE 

4272
03:18:17,753 --> 03:18:19,121
WANTED TO SEE WHAT ARE DOWN 

4273
03:18:19,121 --> 03:18:28,230
STREAM EFFECT TOORS. THAT IS WHE

4274
03:18:28,230 --> 03:18:32,801
EXTEND LUNGS OF THE MICE, UT AND

4275
03:18:32,801 --> 03:18:35,671
WILD TYPE FOR R.N.A. SEQUENCING 

4276
03:18:35,671 --> 03:18:36,905
AND IDENTIFY INFLATION AS 

4277
03:18:36,905 --> 03:18:42,478
PATHWAY WAS ENRICHED. WE ALSO 

4278
03:18:42,478 --> 03:18:43,846
ANTICIPATED WITH ALL ONLINE WITH

4279
03:18:43,846 --> 03:18:47,249
MALE AND FEMALE PH LUNGS AND 

4280
03:18:47,249 --> 03:18:52,121
IDENTIFY TWO GENES, CXCL9 AND 

4281
03:18:52,121 --> 03:18:56,558
10. THESE ARE TWO PRO 

4282
03:18:56,558 --> 03:18:58,761
INFLAMMATORY CYTOKINES REGULATED

4283
03:18:58,761 --> 03:19:01,730
AS OF UT KNOCK-DOWN AND ALSO IN 

4284
03:19:01,730 --> 03:19:05,601
FEMALE PATIENTS THAT THEY DON'T 

4285
03:19:05,601 --> 03:19:09,238
HAVE UT PART. NEXT SLIDE. 

4286
03:19:09,238 --> 03:19:11,874
    NEXT WE WANTED TO SEE IF THE

4287
03:19:11,874 --> 03:19:22,351
INHIBITOR ACTIVITY OF CX9, 

4288
03:19:22,618 --> 03:19:24,687
BETWEEN THE TWO, CAN WE USE THIS

4289
03:19:24,687 --> 03:19:27,256
AS PRO TEN SHALL THERAPY IN 

4290
03:19:27,256 --> 03:19:29,458
FEMALES. IN THIS WE USED FEMALE 

4291
03:19:29,458 --> 03:19:34,830
RATS, USED GONAD INTACTS AND 

4292
03:19:34,830 --> 03:19:39,401
BOTH MODEL OF THIS AND HYPOXIA 

4293
03:19:39,401 --> 03:19:42,171
AND STARTED TWO WEEKS AFTER USE 

4294
03:19:42,171 --> 03:19:46,108
OF MCT AND THREE WEEKS AFTER 

4295
03:19:46,108 --> 03:19:49,278
SUCHING WHEN WE KNOW DISEASE IS 

4296
03:19:49,278 --> 03:19:51,380
STARTING TO ESTABLISH. NEXT 

4297
03:19:51,380 --> 03:19:51,613
SLIDE. 

4298
03:19:51,613 --> 03:19:53,882
    WE ACTUALLY WERE QUITE 

4299
03:19:53,882 --> 03:19:57,419
IMPRESSED TO SEE THIS SMALL 

4300
03:19:57,419 --> 03:20:01,023
MOLECULE. LOOKING ACTIVITY OF 9 

4301
03:20:01,023 --> 03:20:04,360
AND 10 WERE ABLE TO 

4302
03:20:04,360 --> 03:20:06,895
SIGNIFICANTLY REDUCE THE MCT IN 

4303
03:20:06,895 --> 03:20:08,897
BOTH, MCT AND HYPOXIA. YOU SEE 

4304
03:20:08,897 --> 03:20:14,670
THE SYSTOLIC PRESSURE IS (?). 

4305
03:20:14,670 --> 03:20:18,440
ALSO SEE PULMONARY INCREASE AND 

4306
03:20:18,440 --> 03:20:25,381
SEE THE RV HYPITROPHY WAS 

4307
03:20:25,381 --> 03:20:27,216
REVERSED. I REPEATED WORK AND 

4308
03:20:27,216 --> 03:20:29,184
DON'T WANT TO GO INTO DETAILS 

4309
03:20:29,184 --> 03:20:30,886
BUT THIS WAS PUBLISHED IN BLUE 

4310
03:20:30,886 --> 03:20:33,055
JOURNAL TWO YEARS AGO. THERE WAS

4311
03:20:33,055 --> 03:20:40,229
A NICE EDITORIAL BY DR. STEFAN 

4312
03:20:40,229 --> 03:20:42,798
CHANT AT U D TO EXPRESS 

4313
03:20:42,798 --> 03:20:45,834
DIFFERENCES IN PULMONARY 

4314
03:20:45,834 --> 03:20:46,535
HYPERTENSION. NEXT SLIDE. 

4315
03:20:46,535 --> 03:20:49,872
    NOW I'M GOING TO JUST REVIEW

4316
03:20:49,872 --> 03:20:53,509
A COUPLE OF CLINICAL TRIALS THAT

4317
03:20:53,509 --> 03:20:55,844
THEY ARE LOOKING AT, IF 

4318
03:20:55,844 --> 03:20:58,647
TARGETING THE ESTROGEN ACTIVITY,

4319
03:20:58,647 --> 03:21:02,618
ESTROGEN RECEPTOR OR THEY LOOK 

4320
03:21:02,618 --> 03:21:09,091
AT THE ESTROGEN BIOCENTIS 

4321
03:21:09,091 --> 03:21:14,797
BLOCKING AND CAN USE AS TRIALS. 

4322
03:21:14,797 --> 03:21:17,533
(BELL) NEXT. 

4323
03:21:17,533 --> 03:21:20,769
    MOST CLINICAL TRIALS DONE BY

4324
03:21:20,769 --> 03:21:23,739
DR. (?) SHOWN LOOKING AT THE (?)

4325
03:21:23,739 --> 03:21:25,607
ESTROGEN ANTAGONIST. IN THIS WAS

4326
03:21:25,607 --> 03:21:28,577
A CLINICAL TRIAL. IN THIS ONE 

4327
03:21:28,577 --> 03:21:30,646
THEY ONLY SHOW THE LEVEL OF 

4328
03:21:30,646 --> 03:21:33,382
SECRETING ESTROGEN REDUCED BUT 

4329
03:21:33,382 --> 03:21:35,484
NO REAL SIGNIFICANT IMPROVEMENT 

4330
03:21:35,484 --> 03:21:38,353
IN THIS CHANGE. THERE WAS 

4331
03:21:38,353 --> 03:21:41,890
ANOTHER CLINICAL TRIAL, AND THIS

4332
03:21:41,890 --> 03:21:43,959
WAS BY DR. (?). IN SHORT JUST 

4333
03:21:43,959 --> 03:21:47,830
THREE MONTHS, PUT THEM IN (?) 

4334
03:21:47,830 --> 03:21:51,733
FOR JUST ONE PERIOD A DAY. HERE 

4335
03:21:51,733 --> 03:21:54,470
THEY SHOW IT WAS SIGNIFICANTLY 

4336
03:21:54,470 --> 03:21:58,674
REDUCED BUT THERE WAS NO REALLY 

4337
03:21:58,674 --> 03:22:05,113
DIFFERENCE IN (?) BUT WHAT WAS 

4338
03:22:05,113 --> 03:22:08,450
INTERESTING WAS (?). 

4339
03:22:08,450 --> 03:22:11,019
    THERE ARE OTHER CUT WITH 

4340
03:22:11,019 --> 03:22:15,691
ERIC AUSTIN AND OTHER WITH DR. 

4341
03:22:15,691 --> 03:22:21,063
(?) LOOKING AT (?) AND 

4342
03:22:21,063 --> 03:22:22,064
TAMOXOFIN. SOME OF THESE ARE 

4343
03:22:22,064 --> 03:22:23,398
FINISHED. WITH E CAN LOOK AT 

4344
03:22:23,398 --> 03:22:25,033
DATA ON THE CLINICAL TRIAL BUT 

4345
03:22:25,033 --> 03:22:27,636
STILL NOT PUBLISHED BUT LOOKING 

4346
03:22:27,636 --> 03:22:29,805
-- DR. CABLE IS LOOKING AT 

4347
03:22:29,805 --> 03:22:33,375
BIGGER STUDY, PATIENTS AMEND 

4348
03:22:33,375 --> 03:22:34,977
WOMEN AND PUT THEM ON FOR SIX 

4349
03:22:34,977 --> 03:22:40,749
MONTHS, UP TO ONE YEAR, LOOKING 

4350
03:22:40,749 --> 03:22:48,857
AT SOME PRIMARY AND SECONDARY 

4351
03:22:48,857 --> 03:22:53,095
AND THE CLINICAL TRIAL THEY SHOW

4352
03:22:53,095 --> 03:22:57,699
THIS AND IMPROVE THE TEST AND 

4353
03:22:57,699 --> 03:23:01,570
NOT MUCH ON TAXI OR TEST AND 

4354
03:23:01,570 --> 03:23:04,540
KNOW THE CLINICAL TRIALS ARE 

4355
03:23:04,540 --> 03:23:08,677
STILL NOT PUBLISHED. THEN JUST 

4356
03:23:08,677 --> 03:23:14,082
TO HAVE SOME RECOMMENDATION, THE

4357
03:23:14,082 --> 03:23:17,986
DIFFERENCES FOR FUTURE CONCERN. 

4358
03:23:17,986 --> 03:23:19,221
NEXT. IT IS VERY IMPORTANT TO 

4359
03:23:19,221 --> 03:23:22,824
HAVE A PROPER STUDY DESIGN TO 

4360
03:23:22,824 --> 03:23:25,827
INTEGRATE AND INVESTIGATE THE 

4361
03:23:25,827 --> 03:23:28,564
ROLE OF SEX CHROMOSOME AND 

4362
03:23:28,564 --> 03:23:31,033
GONADAL HORMONES IN PRECLINICAL 

4363
03:23:31,033 --> 03:23:33,035
MODELS. I'M PART OF A GROUP 

4364
03:23:33,035 --> 03:23:35,871
INVITED BY ATS TO WRITE A 

4365
03:23:35,871 --> 03:23:36,705
RESEARCH STATEMENT THAT WE ARE 

4366
03:23:36,705 --> 03:23:38,307
CURRENTLY WORKING ON THAT. DR. 

4367
03:23:38,307 --> 03:23:40,976
ARNOLD IS PART OF THE GROUP. WE 

4368
03:23:40,976 --> 03:23:43,011
WANTED TO JUST WRITE SOME 

4369
03:23:43,011 --> 03:23:44,546
RESEARCH STATEMENT AS A 

4370
03:23:44,546 --> 03:23:46,114
GUIDELINE AS HOW TO ADDRESS SEX 

4371
03:23:46,114 --> 03:23:48,850
AS A BIOLOGICAL VARIABLE IN 

4372
03:23:48,850 --> 03:23:51,954
PRECLINICAL MODELS OF LUNG 

4373
03:23:51,954 --> 03:23:53,589
DISEASE. AS YOU CAN SEE 

4374
03:23:53,589 --> 03:23:55,657
SUMMARIZED IN THIS FLOWCHART, IF

4375
03:23:55,657 --> 03:23:58,193
THERE IS A SEX DIFFERENCE WE 

4376
03:23:58,193 --> 03:23:59,761
WANT TO LOOK AT ROLE OF SEX 

4377
03:23:59,761 --> 03:24:00,929
HORMONES AND SEX CHROMOSOME. ON 

4378
03:24:00,929 --> 03:24:02,965
THE NEXT YOU SEE THE FIRST 

4379
03:24:02,965 --> 03:24:08,604
OBVIOUSLY THING, THE EASY THING 

4380
03:24:08,604 --> 03:24:19,314
TO DO TH IS GONADECTOMY AND ARE 

4381
03:24:19,715 --> 03:24:20,882
PLACE HORMONE AND SEE WHICH SUB 

4382
03:24:20,882 --> 03:24:24,620
TYPES IS THE TARGET. THEN 

4383
03:24:24,620 --> 03:24:27,823
IDENTIFY THE DOWN STREAM EFFECTS

4384
03:24:27,823 --> 03:24:30,425
OF THIS. THEN WHEN WANT TO LOOK 

4385
03:24:30,425 --> 03:24:32,361
AT SEX HORMONE THE MOUSE AND 

4386
03:24:32,361 --> 03:24:34,262
MODEL VERY POWERFUL, YOU CAN 

4387
03:24:34,262 --> 03:24:36,231
IDENTIFY IF IT IS X CHROMOSOME 

4388
03:24:36,231 --> 03:24:39,301
OR Y. IF IT IS X OR Y, WHICH 

4389
03:24:39,301 --> 03:24:41,470
GENE UNDER X OR Y. THEN YOU ALSO

4390
03:24:41,470 --> 03:24:44,640
WANT TO IDENTIFY THE DOWN STREAM

4391
03:24:44,640 --> 03:24:46,975
EFFECT OF THE SEX CHROMOSOME 

4392
03:24:46,975 --> 03:24:48,543
GENE IN A SPECIFIC TEST SIMILAR 

4393
03:24:48,543 --> 03:24:52,381
TO WHAT WE DID WHEN WE LOOK AT 

4394
03:24:52,381 --> 03:24:54,950
THE RULE OF THE UTY BUT AT THE 

4395
03:24:54,950 --> 03:24:57,719
END WE NEED TO BRING EVERYTHING 

4396
03:24:57,719 --> 03:24:59,221
BACK TOGETHER, BOTH SEX HORMONE 

4397
03:24:59,221 --> 03:25:02,090
AND CHROMOSOME AND LOOK AT THE 

4398
03:25:02,090 --> 03:25:12,501
INTERACTION OF BOTH. NEXT SLIDE.

4399
03:25:12,501 --> 03:25:14,703
THIS IS A LARGE MULTI -CENTER 

4400
03:25:14,703 --> 03:25:16,672
STUDY TOWARD CENTERS. FOR THE 

4401
03:25:16,672 --> 03:25:19,408
FIRST TIME THEY ARE LEVERAGING 

4402
03:25:19,408 --> 03:25:23,812
THE LARGEST PH BIOBANK, WE HAD 

4403
03:25:23,812 --> 03:25:27,015
96 LUNGS VERSUS 52 CONTROLLED 

4404
03:25:27,015 --> 03:25:31,987
LUNGS. WHAT WE DID WAS HAVE RNA,

4405
03:25:31,987 --> 03:25:33,655
GENE NETWORK AND FIND WHICH 

4406
03:25:33,655 --> 03:25:37,726
MODULE AND IDENTIFY A GENE AND 

4407
03:25:37,726 --> 03:25:42,864
FIND HAS PROTECTIVE WALL. NEXT 

4408
03:25:42,864 --> 03:25:48,704
SLIDE. WHAT IS REALLY 

4409
03:25:48,704 --> 03:25:50,038
INTERESTING, WE HAVE ALL THE 

4410
03:25:50,038 --> 03:25:52,074
CLINICAL DATA FOR ALL THESE 

4411
03:25:52,074 --> 03:25:53,175
SAMPLES. ALSO WE HAVE ALL THE 

4412
03:25:53,175 --> 03:25:57,446
RAW DATA THAT YOU CAN USE WITH 

4413
03:25:57,446 --> 03:26:00,382
THIS ACCESSION NUMBER. IN CASE 

4414
03:26:00,382 --> 03:26:05,654
YOU ARE INTERESTED TO LOOK IN 

4415
03:26:05,654 --> 03:26:11,193
ANY INTEREST, CONTACT ME OR DR. 

4416
03:26:11,193 --> 03:26:13,295
JASON FOR THIS ANALYSIS. NEXT 

4417
03:26:13,295 --> 03:26:13,528
SLIDE. 

4418
03:26:13,528 --> 03:26:16,198
    I JUST WANT TO THANK 

4419
03:26:16,198 --> 03:26:17,766
EVERYONE IN MY LAB, 

4420
03:26:17,766 --> 03:26:23,505
COLLABORATORS AT UCLA, JASON 

4421
03:26:23,505 --> 03:26:28,276
LONG, DR. REDDY AND EVERYONE 

4422
03:26:28,276 --> 03:26:33,281
FROM THE LAB. THANK YOU SO MUCH,

4423
03:26:33,281 --> 03:26:33,648
EVERYONE. 

4424
03:26:33,648 --> 03:26:37,219
>> THANK YOU VERY MUCH FOR
THAT 

4425
03:26:37,219 --> 03:26:42,257
WONDERFUL TALK. WE ARE SHORT ON 

4426
03:26:42,257 --> 03:26:43,625
TIME SO I'M GOING TO MOVE ON TO 

4427
03:26:43,625 --> 03:26:45,260
OUR NEXT SPEAKER. AFTER THAT I 

4428
03:26:45,260 --> 03:26:48,764
DO HAVE QUESTIONS FOR YOU, DR. 

4429
03:26:48,764 --> 03:26:50,465
EGHBALI. SO EXCELLENT TALK, I 

4430
03:26:50,465 --> 03:26:54,302
APPRECIATE YOUR INSIGHTS. 

4431
03:26:54,302 --> 03:26:57,272
    ALL RIGHT. MOVING ON, LET'S 

4432
03:26:57,272 --> 03:27:00,542
GO TO OUR NEXT TALK, WHICH IS 

4433
03:27:00,542 --> 03:27:03,745
DR. VENTETUOLO, WHICH IS 

4434
03:27:03,745 --> 03:27:04,446
ASSOCIATE PROFESSOR AT BROWN. 

4435
03:27:04,446 --> 03:27:06,248
SHE IS SPEAKING ON INTERVENTIONS

4436
03:27:06,248 --> 03:27:10,786
AND IMPLEMENTATION TO REMEDIATE 

4437
03:27:10,786 --> 03:27:12,687
SEX-BASED DIFFERENCES IN 

4438
03:27:12,687 --> 03:27:16,258
PULMONARY VASCULAR DISEASE. 

4439
03:27:16,258 --> 03:27:17,859
>> THANK YOU SO MUCH.
THANK YOU 

4440
03:27:17,859 --> 03:27:19,628
FOR THE ORGANIZERS FOR PUTTING 

4441
03:27:19,628 --> 03:27:21,863
ON THIS GREAT SYMPOSIUM. I HAVE 

4442
03:27:21,863 --> 03:27:23,265
LEARNED A LOT AND LOOK FORWARD 

4443
03:27:23,265 --> 03:27:26,434
TO CONTINUING TO  LEARN. NEXT 

4444
03:27:26,434 --> 03:27:32,274
SLIDE, PLEASE. SO I WILL START 

4445
03:27:32,274 --> 03:27:34,209
WITH MY DISCLOSURE, PROBABLY THE

4446
03:27:34,209 --> 03:27:35,877
MOST RELEVANT, I'M FUNDED TO DO 

4447
03:27:35,877 --> 03:27:37,846
WORK IN THIS AREA, THOUGH I'M 

4448
03:27:37,846 --> 03:27:39,447
NOT GOING TO COVER A LOT OF WHAT

4449
03:27:39,447 --> 03:27:43,351
WE ARE FOCUSSING ON TODAY. I 

4450
03:27:43,351 --> 03:27:45,187
ALSO WANT TO SAY THAT, YOU KNOW,

4451
03:27:45,187 --> 03:27:47,722
IN THINKING ABOUT DR. STRAH'S 

4452
03:27:47,722 --> 03:27:49,591
PRESENTATION EARLIER, IT IS 

4453
03:27:49,591 --> 03:27:50,826
IMPORTANT TO KIND OF RECOGNIZE 

4454
03:27:50,826 --> 03:27:54,763
TO DATE MUCH OF WHAT HAS BEEN 

4455
03:27:54,763 --> 03:27:57,833
PUBLISHED REFERS TO SEX AND 

4456
03:27:57,833 --> 03:27:59,568
GENDER INTERCHANGEABLY. I 

4457
03:27:59,568 --> 03:28:05,240
ACKNOWLEDGE THAT IS AN OVER 

4458
03:28:05,240 --> 03:28:06,708
SIGHT OF MOST PUBLISHED 

4459
03:28:06,708 --> 03:28:08,410
LITERATURE TO DATE AND WE ARE 

4460
03:28:08,410 --> 03:28:10,545
REGARDING THIS MOSTLY AS A 

4461
03:28:10,545 --> 03:28:12,314
BINARY PHENOMENON IN TERMS OF 

4462
03:28:12,314 --> 03:28:13,782
GENDER, AS WELL AS BIOLOGICAL 

4463
03:28:13,782 --> 03:28:17,552
SEX. THAT, OF COURSE, IS NOT THE

4464
03:28:17,552 --> 03:28:22,190
CASE. NEXT SLIDE, PLEASE. SO THE

4465
03:28:22,190 --> 03:28:23,525
OBJECTIVES ARE TO THINK ABOUT 

4466
03:28:23,525 --> 03:28:27,395
HOW TO INTERVENE AND IMPLEMENT 

4467
03:28:27,395 --> 03:28:30,665
SOME STRATEGIES TO REMEDIATE 

4468
03:28:30,665 --> 03:28:32,834
SEX-BASED DIFFERENCES IN 

4469
03:28:32,834 --> 03:28:34,369
PULMONARY VASCULAR DISEASES. I 

4470
03:28:34,369 --> 03:28:39,007
WILL NOT HAVE A TON BUT I WOULD 

4471
03:28:39,007 --> 03:28:40,642
FOCUS ON NUANCES WE KNOW 

4472
03:28:40,642 --> 03:28:41,776
OBSERVED TO DATE AND THINK HOW 

4473
03:28:41,776 --> 03:28:45,180
WE CAN PERSPECTIVELY DESIGN, 

4474
03:28:45,180 --> 03:28:46,381
PARTICULARLY PATIENTS THAT HAVE 

4475
03:28:46,381 --> 03:28:47,649
SEARCHED TO ADDRESS GAPS. WE 

4476
03:28:47,649 --> 03:28:49,651
WILL TALK A LITTLE ABOUT 

4477
03:28:49,651 --> 03:28:50,785
TRANSLATIONAL BARRIERS FROM 

4478
03:28:50,785 --> 03:28:52,821
EXPERIMENTAL MODELS TO HUMAN 

4479
03:28:52,821 --> 03:28:53,688
OBSERVATIONS. I'M GOING TO SPEND

4480
03:28:53,688 --> 03:28:55,657
A FEW MINUTES ON SEX 

4481
03:28:55,657 --> 03:28:58,126
CHROMOSOMES, AS WE JUST HEARD 

4482
03:28:58,126 --> 03:28:59,427
ABOUT FROM DR. EGHBALI, THEN 

4483
03:28:59,427 --> 03:29:04,833
SPEND THE BULK OF THE TIME 

4484
03:29:04,833 --> 03:29:08,303
TALKING ABOUT IMPACT OR THINKING

4485
03:29:08,303 --> 03:29:12,707
ABOUT THE IMPORTANCE OF RESEARCH

4486
03:29:12,707 --> 03:29:17,746
AT THE END HERE. NEXT SLIDE, 

4487
03:29:17,746 --> 03:29:22,584
PLEASE. TO FOCUS ON 

4488
03:29:22,584 --> 03:29:23,518
TRANSLATIONAL BARRIER, NEXT 

4489
03:29:23,518 --> 03:29:24,152
SLIDE, PLEASE. 

4490
03:29:24,152 --> 03:29:25,453
    WHEN I FIRST STARTED 

4491
03:29:25,453 --> 03:29:28,223
THINKING OF HOW TO RESOLVE 

4492
03:29:28,223 --> 03:29:30,392
WHAT'S BEEN LABELED ESTROGEN 

4493
03:29:30,392 --> 03:29:33,828
PARADOX OR PUZZLE OF 

4494
03:29:33,828 --> 03:29:34,996
ARTERIAL HYPERTENSION, WE KNOW 

4495
03:29:34,996 --> 03:29:40,335
THIS IN GROUPS 1, 2, 3, 

4496
03:29:40,335 --> 03:29:40,936
PULMONARY HYPERTENSION, MANY 

4497
03:29:40,936 --> 03:29:42,637
MORE FEMALES OR WOMEN WHO 

4498
03:29:42,637 --> 03:29:44,639
DEVELOP DISEASE AND YET WOMEN 

4499
03:29:44,639 --> 03:29:47,108
APPEAR TO HAVE PROTECTIVE RIGHT 

4500
03:29:47,108 --> 03:29:48,276
VENTRICLES AND SURVIVE LONGER 

4501
03:29:48,276 --> 03:29:49,511
THAN MEN WITH THE DISEASE. AT 

4502
03:29:49,511 --> 03:29:51,112
THE TIME THERE ARE A NUMBER OF 

4503
03:29:51,112 --> 03:29:55,216
ELEGANT STUDIES IN LITERATURE, 

4504
03:29:55,216 --> 03:29:59,387
ONE OF WHICH IS BY DR. FAHA, 

4505
03:29:59,387 --> 03:30:01,489
DEMONSTRATING WHEN WE OVARIAN 

4506
03:30:01,489 --> 03:30:03,158
ACTIVATE FEMALES AND GIVE BACK 

4507
03:30:03,158 --> 03:30:06,628
FIZZ LOGIC DOSES OF ESTROGEN 

4508
03:30:06,628 --> 03:30:07,829
THEY DEVELOP LEVELS IN THE 

4509
03:30:07,829 --> 03:30:11,032
LUNGS, POTENTIALLY EXPLAINING 

4510
03:30:11,032 --> 03:30:13,802
WHY WOMEN WITH PH ARE MORE 

4511
03:30:13,802 --> 03:30:15,303
SUSCEPTIBLE. USING SOME OF THE 

4512
03:30:15,303 --> 03:30:17,605
SAME STRATEGIES A NUMBER OF LABS

4513
03:30:17,605 --> 03:30:20,141
HAVE SHOWN THAT THE RIGHT AND 

4514
03:30:20,141 --> 03:30:22,043
LEFT VENTRICALS ARE PROTECT ED 

4515
03:30:22,043 --> 03:30:24,813
WITH MORE CAPILLARY DENSITY AND 

4516
03:30:24,813 --> 03:30:28,183
PRESERVED EXERCISE CAPACITY. SO 

4517
03:30:28,183 --> 03:30:30,919
THIS TRANSLATES BROADLY TO 

4518
03:30:30,919 --> 03:30:31,786
ESTROGEN BEING BAD FOR LUNG, 

4519
03:30:31,786 --> 03:30:34,356
GOOD FOR THE HEART. WITH I HAVE 

4520
03:30:34,356 --> 03:30:37,993
OTHERWISE EXPLAINED THE 

4521
03:30:37,993 --> 03:30:39,527
DESPERATE EPIDEMIOLOGIC 

4522
03:30:39,527 --> 03:30:40,895
OBSERVATIONS AND CAN MOVE ON. 

4523
03:30:40,895 --> 03:30:44,165
YET WE ARE STILL HERE TALKING 

4524
03:30:44,165 --> 03:30:45,800
ABOUT THIS TODAY. NEXT SLIDE. 

4525
03:30:45,800 --> 03:30:47,669
    WHAT ARE SOME PROBLEMS WITH 

4526
03:30:47,669 --> 03:30:51,239
TRANSLATING EXPERIMENTAL MODELS 

4527
03:30:51,239 --> 03:30:53,541
TO HUMAN DISEASE? FIRST IF THE 

4528
03:30:53,541 --> 03:30:59,881
YOU LOOK ACROSS SEXUAL DID 

4529
03:30:59,881 --> 03:31:00,615
MORPHISM, AND DR. EGHBALI 

4530
03:31:00,615 --> 03:31:03,284
REFERRED TO SOME OF THIS, THE 

4531
03:31:03,284 --> 03:31:04,586
RESULTS DEPEND ON EXPERIMENTAL 

4532
03:31:04,586 --> 03:31:08,490
CONDITIONS AND LAB OF DOING THE 

4533
03:31:08,490 --> 03:31:11,926
WORK. YOU CAN SHOW VARIABLE 

4534
03:31:11,926 --> 03:31:13,495
EFFECTS OF ANIMALS AND AGE OF 

4535
03:31:13,495 --> 03:31:16,031
ANIMALS YOU ARE STUDYING. THERE 

4536
03:31:16,031 --> 03:31:16,931
IS WORK OUTSIDE PULMONARY 

4537
03:31:16,931 --> 03:31:18,199
DISEASE WHICH SHOWS YOU CAN 

4538
03:31:18,199 --> 03:31:19,801
ALTER RESULTS OF EXPERIMENTS 

4539
03:31:19,801 --> 03:31:23,838
WHEN THE SEX OF THE ANIMAL 

4540
03:31:23,838 --> 03:31:28,877
HANDLER CHANGES. NEXT. THINKING 

4541
03:31:28,877 --> 03:31:30,278
ABOUT CROSSING THE DIVIDE TO 

4542
03:31:30,278 --> 03:31:34,182
HUMAN, WE HAVE TO CONSIDER THESE

4543
03:31:34,182 --> 03:31:37,485
RESULTS WE SEE IN PRECLINICAL 

4544
03:31:37,485 --> 03:31:39,687
MODELS. SEX HORMONE AND RECEPTOR

4545
03:31:39,687 --> 03:31:41,256
RELATIONSHIPS ARE INCREDIBLY 

4546
03:31:41,256 --> 03:31:42,624
COMPLICATED. THERE ARE TISSUE 

4547
03:31:42,624 --> 03:31:43,892
AND COMPARTMENT SPECIFIC EFFECTS

4548
03:31:43,892 --> 03:31:45,393
WE HAVE TO CONSIDER. UNTIL 

4549
03:31:45,393 --> 03:31:46,961
RECENTLY WE HAVE HAD A LACK OF 

4550
03:31:46,961 --> 03:31:49,697
TISSUE OR CELLS UNLESS WE ARE 

4551
03:31:49,697 --> 03:31:50,532
STUDYING INDIVIDUALS WITH 

4552
03:31:50,532 --> 03:31:52,300
N-STAGE DISEASE AT THE TIME OF 

4553
03:31:52,300 --> 03:31:53,668
DEATH OR LUNG TRANSPLANT. WE 

4554
03:31:53,668 --> 03:31:55,570
HAVE TO CONSIDER THE IMPACT OF 

4555
03:31:55,570 --> 03:31:59,674
LIFE CYCLE CHANGES. THEN AS HAS 

4556
03:31:59,674 --> 03:32:02,877
ALREADY BEEN MENTIONED THIS 

4557
03:32:02,877 --> 03:32:07,282
CONCEPT OF INTERSECTION ALT HAS 

4558
03:32:07,282 --> 03:32:13,855
NOT BEEN PUBLISHED IN THE 

4559
03:32:13,855 --> 03:32:15,223
INTERSECTION OF CARDIOVASCULAR 

4560
03:32:15,223 --> 03:32:15,490
DISEASE. 

4561
03:32:15,490 --> 03:32:17,258
    ONE REASON THIS MAY BE 

4562
03:32:17,258 --> 03:32:18,326
IMPORTANT IN INTERPRETING 

4563
03:32:18,326 --> 03:32:22,964
RESULTS COMES FROM WORK BY DR. 

4564
03:32:22,964 --> 03:32:24,699
COX-FLARITY, PREVIOUSLY IN THE 

4565
03:32:24,699 --> 03:32:27,836
GROUP, NOW AT INOVA. ANOTHER BY 

4566
03:32:27,836 --> 03:32:30,805
DR. PRUDESCUE'S GROUP WHICH HAS 

4567
03:32:30,805 --> 03:32:32,474
SHOWN IN COMMERCIAL CELL LINES 

4568
03:32:32,474 --> 03:32:36,678
AND IN CASE OF DR. PRUDESCUE'S 

4569
03:32:36,678 --> 03:32:45,353
LAB, THE PULMONARY AND EN 

4570
03:32:45,353 --> 03:32:46,988
ENDOTHELIAL CELLS, WHEN WE LOOK 

4571
03:32:46,988 --> 03:32:49,090
AT DONORS WITH BIOLOGICAL 

4572
03:32:49,090 --> 03:32:50,058
DIFFERENCES THERE ARE 

4573
03:32:50,058 --> 03:32:51,893
DIFFERENCES IN SEX. THINKING OF 

4574
03:32:51,893 --> 03:32:53,228
COMBINING THESE INTO ONE 

4575
03:32:53,228 --> 03:32:55,096
EXPERIMENTAL STRATEGY, THIS MAY 

4576
03:32:55,096 --> 03:33:00,235
BECOME PROBLEMATIC. NEXT SLIDE. 

4577
03:33:00,235 --> 03:33:06,040
THIS WE RUZ CEN WAS /* -- WAS 

4578
03:33:06,040 --> 03:33:09,611
RECENTLY ADDRESSED IN A DOCUMENT

4579
03:33:09,611 --> 03:33:11,779
THAT CAME OUT AND ADVOCATED FOR 

4580
03:33:11,779 --> 03:33:13,081
STANDARDIZED REPORTING OF AT 

4581
03:33:13,081 --> 03:33:14,482
LEAST AGE AND BIOLOGICAL SEX OF 

4582
03:33:14,482 --> 03:33:20,388
THE SAMPLES BEING USED AND P FOR

4583
03:33:20,388 --> 03:33:30,932
STUDY OF SEXUAL DIMORPHISM AND 

4584
03:33:32,033 --> 03:33:33,535
METHODS. I WANT TO SPEND TIME 

4585
03:33:33,535 --> 03:33:35,803
TALKING ABOUT SEX CHROMOSOMES 

4586
03:33:35,803 --> 03:33:37,105
BECAUSE I THINK THIS IS AN 

4587
03:33:37,105 --> 03:33:40,308
EMERGING AREA TO THINK HOW TO 

4588
03:33:40,308 --> 03:33:43,311
TRANSLATE TO HUMANS. THIS WORK 

4589
03:33:43,311 --> 03:33:44,679
HAS ALREADY BEEN HIGHLIGHTED. 

4590
03:33:44,679 --> 03:33:46,247
THIS IS A BEAUTIFUL WORK BY DR. 

4591
03:33:46,247 --> 03:33:50,652
EGHBALI AND UMAR THAT LEVERAGED 

4592
03:33:50,652 --> 03:33:52,487
THIS MODEL TO REALLY TURN THE 

4593
03:33:52,487 --> 03:33:55,190
FIELD'S ATTENTION TO WHAT ROLE 

4594
03:33:55,190 --> 03:33:59,260
SEX CHROMOSOMES MAY BE HAVING IN

4595
03:33:59,260 --> 03:34:02,230
PREDILECTION AND OUTCOMES OF 

4596
03:34:02,230 --> 03:34:05,567
PULMONARY DISEASE. NEXT SLIDE. 

4597
03:34:05,567 --> 03:34:08,136
    I ALSO WANTED TO DRAW 

4598
03:34:08,136 --> 03:34:10,305
ATTENTION TO CONCEPT OF X 

4599
03:34:10,305 --> 03:34:12,140
CHROMOSOME AND ACTIVATION, AN 

4600
03:34:12,140 --> 03:34:17,045
EMERGING AREA STUDIED I THINK 

4601
03:34:17,045 --> 03:34:19,180
MOST ROBUSTLY IN AUTO IMMUNITY 

4602
03:34:19,180 --> 03:34:24,252
BUT IMPLICATIONS FOR PULMONARY 

4603
03:34:24,252 --> 03:34:25,687
HYPERTENSION. FOR THOSE THAT MAY

4604
03:34:25,687 --> 03:34:27,589
NOT HAVE HEARD EXIST IS 

4605
03:34:27,589 --> 03:34:29,757
LONG-CODING R.N.A. WHOSE JOB IS 

4606
03:34:29,757 --> 03:34:32,727
TO ACTIVATE ONE X CHROMOSOME TO 

4607
03:34:32,727 --> 03:34:37,265
MITIGATE CHAIN DOSAGE EFFECTS IN

4608
03:34:37,265 --> 03:34:40,468
FEMALES, EXIST IN MALES LEADING 

4609
03:34:40,468 --> 03:34:45,873
TO AUTO IMMUNE PHENOMENA AND 

4610
03:34:45,873 --> 03:34:51,446
REPROMOTES CELLS TO A DIFFERENT 

4611
03:34:51,446 --> 03:34:53,781
PARADIGM AND CHARACTERIZE BIAS 

4612
03:34:53,781 --> 03:34:56,217
IMMUNITIES, OBSERVED IN LUPUS 

4613
03:34:56,217 --> 03:34:58,486
AND OTHER CONNECTIVE TISSUE 

4614
03:34:58,486 --> 03:35:04,826
DISEASES AS WELL. NEXT SLIDE. 

4615
03:35:04,826 --> 03:35:07,195
THERE TO DATE HAS BEEN VERY 

4616
03:35:07,195 --> 03:35:08,229
LITTLE REPORTS IN 

4617
03:35:08,229 --> 03:35:09,731
ARTERIAL HYPERTENSION. WE ARE 

4618
03:35:09,731 --> 03:35:11,666
WORKING TO STUDY THIS MORE 

4619
03:35:11,666 --> 03:35:14,435
ROBUSTLY NOW. I HEAR ONE PIECE 

4620
03:35:14,435 --> 03:35:17,972
OF WORK BUT DR. PREDESCUE'S LAB 

4621
03:35:17,972 --> 03:35:25,613
IN EFFORT TO ESTABLISH A MODEL, 

4622
03:35:25,613 --> 03:35:26,914
TRANSGENIC FOR (?) BUT REPORTED 

4623
03:35:26,914 --> 03:35:28,416
ON PRESENCE OF EXIST IN HUMAN 

4624
03:35:28,416 --> 03:35:30,618
PAH LUNGS AT THE TIME OF 

4625
03:35:30,618 --> 03:35:32,887
EX PLANTS AS COMPARED TO DONORS.

4626
03:35:32,887 --> 03:35:34,522
THERE APPEARS TO BE ENOUGH 

4627
03:35:34,522 --> 03:35:44,198
REGULATION OF EXIST IN HUMAN 

4628
03:35:44,198 --> 03:35:44,932
PAH. NEXT SLIDE. 

4629
03:35:44,932 --> 03:35:46,534
    WHEN WE THINK OF STUDYING 

4630
03:35:46,534 --> 03:35:48,603
SEX CHROMOSOMES MORE ROBUSTLY, 

4631
03:35:48,603 --> 03:35:50,071
PARTICULARLY IN HUMAN DISEASE, 

4632
03:35:50,071 --> 03:35:51,873
WE CAN'T JUST STOP AT THE 

4633
03:35:51,873 --> 03:35:53,007
CONCEPTS WE HAVE ALREADY HEARD 

4634
03:35:53,007 --> 03:35:55,877
ABOUT TODAY. NOT ONLY DO WE HAVE

4635
03:35:55,877 --> 03:35:58,479
TO CONSIDER THE SEX CHROMOSOME 

4636
03:35:58,479 --> 03:35:59,614
COMPLEMENTS AS WELL AS 

4637
03:35:59,614 --> 03:36:00,815
CHROMOSOME GENE EXPRESSION BUT 

4638
03:36:00,815 --> 03:36:02,383
HAVE TO THEN GO ON AND THINK 

4639
03:36:02,383 --> 03:36:06,154
ABOUT EPIGENETIC REGULATION, 

4640
03:36:06,154 --> 03:36:11,726
THERE ARE KNOWN GONAD ON D.N.A. 

4641
03:36:11,726 --> 03:36:14,762
METHYL-CATION AND CONCEPT OF X 

4642
03:36:14,762 --> 03:36:18,700
CHROMOSOME ESCAPE, EVIDENCE IN 

4643
03:36:18,700 --> 03:36:19,534
CARDIOVASCULAR DISEASE ABOUT SEX

4644
03:36:19,534 --> 03:36:21,302
DIFFERENCES AND IMPRINTING DUE 

4645
03:36:21,302 --> 03:36:23,071
TO PARENT OF ORIGIN. FINALLY 

4646
03:36:23,071 --> 03:36:26,974
WITH ADVENT OF SINGLE-CELL SEAT 

4647
03:36:26,974 --> 03:36:27,308
TE

4648
03:36:27,308 --> 03:36:29,977
TECHNOLOGIES GROUP S HAVE SHOWN,

4649
03:36:29,977 --> 03:36:32,080
PARTICULARLY IN THE HEART, THERE

4650
03:36:32,080 --> 03:36:34,982
ARE DIFFERENCES IN CELL 

4651
03:36:34,982 --> 03:36:38,353
POPULATIONS. YOU CAN SEE HERE 

4652
03:36:38,353 --> 03:36:43,124
TYPICALLY AN ENDOTHELIAL FIBER 

4653
03:36:43,124 --> 03:36:45,827
BLAST WITH HIGH RELEVANCE TO 

4654
03:36:45,827 --> 03:36:49,030
PULMONARY DISEASE. NEXT. I WOULD

4655
03:36:49,030 --> 03:36:52,567
ADVOCATE SEX CHROMOSOMES AND 

4656
03:36:52,567 --> 03:36:54,402
HUMAN CARDIOVASCULAR DISEASE IS 

4657
03:36:54,402 --> 03:36:59,407
UNDERSTUDIED AND WILL TAKE 

4658
03:36:59,407 --> 03:36:59,841
NAT

4659
03:36:59,841 --> 03:37:02,343
INNOVATIVE APPROACHES IN HUMANS.

4660
03:37:02,343 --> 03:37:05,480
    ACTUALLY ONE PAPER THAT 

4661
03:37:05,480 --> 03:37:15,223
CAUGHT MY ATTENTION (AUDIO 

4662
03:37:15,223 --> 03:37:17,792
DISRUPTION) DISEASES ARE AMONG 

4663
03:37:17,792 --> 03:37:20,194
SOME WE WILL BE SPEAKING OF. 

4664
03:37:20,194 --> 03:37:21,896
THIS IS A REPORT USING TWO LARGE

4665
03:37:21,896 --> 03:37:24,065
COHORT STUDIES THAT HAS 

4666
03:37:24,065 --> 03:37:25,833
DEMONSTRATED THE PRESENCE OF A 

4667
03:37:25,833 --> 03:37:29,103
SUPER NUMARY SEX CHROMOSOME 

4668
03:37:29,103 --> 03:37:31,939
INCREASES RISK OF VTE EVENTS 

4669
03:37:31,939 --> 03:37:35,510
BOTH IN MY CODE DATA SET AS WELL

4670
03:37:35,510 --> 03:37:37,345
AS U.K.  BIOBANK. MAY BE 

4671
03:37:37,345 --> 03:37:38,546
DIFFICULT TO TRANSLATE TO THE 

4672
03:37:38,546 --> 03:37:42,250
RARE E DISEASES BUT EVIDENCE 

4673
03:37:42,250 --> 03:37:45,853
THAT SOME FORMS OF PULMONARY 

4674
03:37:45,853 --> 03:37:48,022
VASCULAR DISEASE RISK MAY BE 

4675
03:37:48,022 --> 03:37:52,460
CHARACTERIZED BY SEX CHROMOSOME 

4676
03:37:52,460 --> 03:37:53,594
ANIPLOYDY. NEXT. 

4677
03:37:53,594 --> 03:37:55,363
    I WANTED TO SWITCH GEARS AND

4678
03:37:55,363 --> 03:37:57,365
TALK ABOUT LIFE CYCLE CHANGES 

4679
03:37:57,365 --> 03:38:02,270
AND PATIENT CENTER RESEARCH AND 

4680
03:38:02,270 --> 03:38:04,105
PULMONARY VASCULAR DISEASE. 

4681
03:38:04,105 --> 03:38:06,474
THINKING ABOUT OUR YOUNGEST 

4682
03:38:06,474 --> 03:38:08,676
PATIENTS, IS FEMALE SEX A RISK 

4683
03:38:08,676 --> 03:38:11,045
FACTOR FOR PAH IN CHILDREN? I 

4684
03:38:11,045 --> 03:38:13,047
WOULD SAY UNTIL RECENTLY THIS 

4685
03:38:13,047 --> 03:38:19,587
WASN'T CLEAR. BUT WITH EM M

4686
03:38:19,587 --> 03:38:20,855
EMERGING OF PEDIATRIC REGISTRIES

4687
03:38:20,855 --> 03:38:22,723
THE ANSWER IS PROBABLY NO. IF 

4688
03:38:22,723 --> 03:38:24,358
YOU LOOK ACROSS FOUR REGISTRIES 

4689
03:38:24,358 --> 03:38:26,461
ON THIS SLIDE, ON BALANCE, ABOUT

4690
03:38:26,461 --> 03:38:30,264
50% OF CHILDREN AFFECTED BY PAH 

4691
03:38:30,264 --> 03:38:36,537
ARE FEMALE. ABOUT 50% ARE MALE. 

4692
03:38:36,537 --> 03:38:41,242
NE

4693
03:38:41,242 --> 03:38:42,743
NEXT. YET IN LITERATURE THERE 

4694
03:38:42,743 --> 03:38:47,348
ARE CASE REPORTS OF PUBERTY 

4695
03:38:47,348 --> 03:38:49,050
ASSOCIATED WITH REGRESSION OF 

4696
03:38:49,050 --> 03:38:50,551
PULMONARY VASCULAR DISEASE IN 

4697
03:38:50,551 --> 03:38:52,253
MALE WHO WHEN DEVELOPED PUBERTY 

4698
03:38:52,253 --> 03:38:54,755
HAD HIS PH RESOLVED. IN TALKING 

4699
03:38:54,755 --> 03:38:58,593
TO SOME OF OUR PEDIATRIC 

4700
03:38:58,593 --> 03:39:00,495
COLLEAGUES MY UNDERSTANDING IS 

4701
03:39:00,495 --> 03:39:02,230
THEIR GENERAL FEELING IS THIS 

4702
03:39:02,230 --> 03:39:03,898
TRANSITION IS A RISK TIME FOR 

4703
03:39:03,898 --> 03:39:05,199
PATIENTS, ALTHOUGH THIS IS NOT, 

4704
03:39:05,199 --> 03:39:07,735
TO MY KNOWLEDGE, BEEN ROBUSTLY 

4705
03:39:07,735 --> 03:39:11,806
STUDIED TO DATE. NEXT. WE WANTED

4706
03:39:11,806 --> 03:39:15,743
TO FOCUS ON THE MENSTRUAL CYCLE 

4707
03:39:15,743 --> 03:39:19,080
IN PULMONARY HYPERTENSION SINCE 

4708
03:39:19,080 --> 03:39:20,448
WE KNOW THIS DISEASE AFFECTS 

4709
03:39:20,448 --> 03:39:22,817
YOUNG WOMEN OF CHILD-BEARING 

4710
03:39:22,817 --> 03:39:24,819
POTENTIAL. SO WE DESIGNED THIS 

4711
03:39:24,819 --> 03:39:28,489
STUDY TO LOOK AT FLUCTUATION 

4712
03:39:28,489 --> 03:39:30,958
OVER THE COURSE OF ONE-MONTH 

4713
03:39:30,958 --> 03:39:32,793
PERIOD OF TIME. WE ENROLLED 

4714
03:39:32,793 --> 03:39:35,897
SUBJECTS FIRST DAY OF MENSES AND

4715
03:39:35,897 --> 03:39:38,399
CAME FOR FOUR VISITS FIXED BY 

4716
03:39:38,399 --> 03:39:47,208
ONE WEEK AND FOLLOWED MARKERS OF

4717
03:39:47,208 --> 03:39:49,176
THE BURDEN OVER FACES. AS 

4718
03:39:49,176 --> 03:39:50,111
COMPARED TO CONTROLS 

4719
03:39:50,111 --> 03:39:53,915
HIGHLIGHT ED IN BLUE, PAH 

4720
03:39:53,915 --> 03:39:57,218
FEMALES HAD HIGHER LEVELS OF 

4721
03:39:57,218 --> 03:40:01,289
CIRCULATING ESTRADIOL AND MORE 

4722
03:40:01,289 --> 03:40:02,056
FLUCTUATIONS IN CONTROL 

4723
03:40:02,056 --> 03:40:04,458
INDIVIDUALS AS COMPARED TO PAH 

4724
03:40:04,458 --> 03:40:06,494
PATIENT, SUGGESTING THAT PERHAPS

4725
03:40:06,494 --> 03:40:11,666
THERE WAS AN EXOGENOUS SOURCE OF

4726
03:40:11,666 --> 03:40:14,035
ESTRADIOL FROM PULMONARY CAUSING

4727
03:40:14,035 --> 03:40:17,305
HIGHER LEVELS IN PAH WOMEN OR 

4728
03:40:17,305 --> 03:40:18,973
FEMALES. PERHAPS MORE ENTERING 

4729
03:40:18,973 --> 03:40:20,641
IS DIRECT ASSOCIATIONS WITH 

4730
03:40:20,641 --> 03:40:24,045
MARKERS LIKE SIX-MINUTE WALK 

4731
03:40:24,045 --> 03:40:26,847
DISTANCE, ANTI PROBE PMT AND 

4732
03:40:26,847 --> 03:40:29,150
TAXI WAS PHASE-DEPENDENT SO 

4733
03:40:29,150 --> 03:40:31,152
DEPENDING WHERE YOU WERE IN THE 

4734
03:40:31,152 --> 03:40:32,353
MENTSRUAL CYCLE, MAY HAVE BEEN 

4735
03:40:32,353 --> 03:40:33,721
FAVORABLE OR POSITIVE 

4736
03:40:33,721 --> 03:40:36,924
ASSOCIATION BETWEEN YOUR PH 

4737
03:40:36,924 --> 03:40:38,559
MARKERS OR UNFAVORABLE 

4738
03:40:38,559 --> 03:40:44,465
ASSOCIATION WITH YOUR PAH 

4739
03:40:44,465 --> 03:40:46,100
MARKERS. NEXT SLIDE. 

4740
03:40:46,100 --> 03:40:48,736
    JESSICA BADLUM AT UNIVERSITY

4741
03:40:48,736 --> 03:40:51,739
OF VERMONT TRIED TO CHARACTERIZE

4742
03:40:51,739 --> 03:40:56,744
THIS IN USPHSAR REGISTRY. THEY 

4743
03:40:56,744 --> 03:40:59,013
ARE TO BE CREDITED WITH 

4744
03:40:59,013 --> 03:41:02,249
COLLECTING DATA ABOUT 

4745
03:41:02,249 --> 03:41:12,026
POTENTIALLY AN  AN NUS /* /* 

4746
03:41:12,026 --> 03:41:14,161
ANDOGENOUS INFORMATION, 

4747
03:41:14,161 --> 03:41:15,496
BREASTFEEDING, MENOPAUSE, ET 

4748
03:41:15,496 --> 03:41:16,764
CETERA. UNFORTUNATELY BECAUSE OF

4749
03:41:16,764 --> 03:41:18,699
THE WAY THE STUDY WAS DESIGNED 

4750
03:41:18,699 --> 03:41:21,268
THERE WAS NO CONTROL POPULATION.

4751
03:41:21,268 --> 03:41:22,903
OF COURSE SOME ARE SUBJECT TO 

4752
03:41:22,903 --> 03:41:25,339
RECALL BIAS, AS ARE A LOT OF 

4753
03:41:25,339 --> 03:41:29,644
REGISTRY SURVEYS WE USE. THEY 

4754
03:41:29,644 --> 03:41:31,846
FAIL TO SHOW CLEAR RELATIONSHIPS

4755
03:41:31,846 --> 03:41:36,550
BETWEEN SUB TYPES OF PH AND ANY 

4756
03:41:36,550 --> 03:41:40,588
OF THESE ANDOGENOUS FLUCTUATIONS

4757
03:41:40,588 --> 03:41:42,890
OVER THE COURSE OF A 

4758
03:41:42,890 --> 03:41:43,824
INDIVIDUAL'S LIFE. 

4759
03:41:43,824 --> 03:41:47,094
    SO WE ASKED WHETHER AGE 

4760
03:41:47,094 --> 03:41:48,829
COULD BE AN IMPORTANT EFFECT 

4761
03:41:48,829 --> 03:41:52,366
MODIFIER OF BASELINE HUMAN 

4762
03:41:52,366 --> 03:41:54,468
DYNAMICS. IN THIS STUDY STEVE 

4763
03:41:54,468 --> 03:41:55,970
KAYWOOD AND I USED INDIVIDUAL 

4764
03:41:55,970 --> 03:41:57,538
PARTICIPANT DATA FROM A NUMBER 

4765
03:41:57,538 --> 03:42:00,141
OF CLINICAL TRIALS SUBMITTED TO 

4766
03:42:00,141 --> 03:42:02,743
THE FDA FOR DRUG APPROVAL IN 

4767
03:42:02,743 --> 03:42:06,347
PAH. WHAT YOU WILL SEE IS AT 

4768
03:42:06,347 --> 03:42:07,782
BASELINE MALES AS COMPARED TO 

4769
03:42:07,782 --> 03:42:10,418
FEMALES TENDED TO HAVE HIGHER 

4770
03:42:10,418 --> 03:42:18,059
PRESSURE, LOWER CARDIAC OUTPUT 

4771
03:42:18,059 --> 03:42:20,061
AND HIGHER PULMONARY VASCULAR 

4772
03:42:20,061 --> 03:42:23,197
ASSISTANCE ADJUSTED FOR RACE, 

4773
03:42:23,197 --> 03:42:26,567
WEIGHT, HEIGHT IN STUDY THEY 

4774
03:42:26,567 --> 03:42:32,973
PARTICIPATED. WHEN CAME TO MEAN 

4775
03:42:32,973 --> 03:42:34,742
PRESSURE YOU CAN SEE YOUNGER 

4776
03:42:34,742 --> 03:42:36,510
MALES HAD HIGHER MEAN COMPARED 

4777
03:42:36,510 --> 03:42:38,045
TO FEMALES BUT THIS DIFFERENCE 

4778
03:42:38,045 --> 03:42:40,481
AT TEN WAITED BY THE TIME MOST 

4779
03:42:40,481 --> 03:42:43,884
U.S.  FEMALES UNDERGO THE 

4780
03:42:43,884 --> 03:42:44,418
MENOPAUSAL TRANSITION. 

4781
03:42:44,418 --> 03:42:46,821
    WHILE WE DON'T HAVE DATA ON 

4782
03:42:46,821 --> 03:42:48,622
MENOPAUSE DATE IN THIS DATASET 

4783
03:42:48,622 --> 03:42:51,092
WE SORT OF A ARGUED AGE IS AN 

4784
03:42:51,092 --> 03:42:52,426
IMPORTANT CONSIDERATION WHEN 

4785
03:42:52,426 --> 03:42:58,532
THINKING ABOUT SEXUAL DIMORPHISM

4786
03:42:58,532 --> 03:42:59,366
IN INDIVIDUALS WITH PULMONARY 

4787
03:42:59,366 --> 03:43:01,502
VASCULAR DISEASE. NEXT SLIDE. WE

4788
03:43:01,502 --> 03:43:03,738
DID A FOLLOW-UP STUDY NOW 

4789
03:43:03,738 --> 03:43:06,307
INCLUDING 18 RANDOMIZED TRIALS 

4790
03:43:06,307 --> 03:43:08,109
AND ALMOST 7,000 PARTICIPANTS IN

4791
03:43:08,109 --> 03:43:09,677
THESE RANDOMIZED CLINICAL 

4792
03:43:09,677 --> 03:43:11,946
TRIALS. WE WANTED TO LOOK 

4793
03:43:11,946 --> 03:43:13,848
SPECIFICALLY AT THINGS LIKE AGE 

4794
03:43:13,848 --> 03:43:17,752
AND BODY MASS INDEX AND WHETHER 

4795
03:43:17,752 --> 03:43:19,954
THESE COULD IMPACT SOME OF THE 

4796
03:43:19,954 --> 03:43:21,422
MAJOR SURROGATE OUTCOMES WE USE 

4797
03:43:21,422 --> 03:43:23,224
IN CLINICAL TRIALS. HERE I'M 

4798
03:43:23,224 --> 03:43:25,092
JUST SHOWING YOU RESULTS FOR 

4799
03:43:25,092 --> 03:43:26,393
SIX-MINUTE WALK DISTANCE. AS YOU

4800
03:43:26,393 --> 03:43:29,697
CAN SEE ON THE LEFT PANEL THERE 

4801
03:43:29,697 --> 03:43:33,534
WAS NO EFFECT BETWEEN AGE AND 

4802
03:43:33,534 --> 03:43:36,003
SIX-MINUTE WALK DISTANCE WHEN WE

4803
03:43:36,003 --> 03:43:38,172
LOOKED AT INTERACTIONS BY SEX. 

4804
03:43:38,172 --> 03:43:40,241
IN TERMS OF BMI FEMALES ARE 

4805
03:43:40,241 --> 03:43:41,642
REPRESENTED IN RED AS COMPARED 

4806
03:43:41,642 --> 03:43:43,010
TO MALES IN BLUE. YOU CAN SEE 

4807
03:43:43,010 --> 03:43:46,914
THAT FEMALES IN PARTICULAR AS 

4808
03:43:46,914 --> 03:43:48,883
BMI INCREASED HAD MUCH LOWER 

4809
03:43:48,883 --> 03:43:50,351
SIX-MINUTE WALK DISTANCE. WE 

4810
03:43:50,351 --> 03:43:53,487
FOUND FEMALES HAD LOWER 

4811
03:43:53,487 --> 03:43:54,855
PRESSURE, MEAN PRESSURE AND 

4812
03:43:54,855 --> 03:43:56,724
HIGHER CARDIAC INDEX AND THESE 

4813
03:43:56,724 --> 03:43:59,226
OTHER FACTORS LIKE AGE AND BMI 

4814
03:43:59,226 --> 03:44:03,297
REALLY HAD A GREATER IMPACT ON 

4815
03:44:03,297 --> 03:44:06,066
THE MALE HEMAMATIC 

4816
03:44:06,066 --> 03:44:07,301
RELATIONSHIPS, ALTOGETHER 

4817
03:44:07,301 --> 03:44:08,402
SUGGESTING IF WE DON'T CONSIDER 

4818
03:44:08,402 --> 03:44:10,004
SOME OF THESE KEY FACTORS WHEN 

4819
03:44:10,004 --> 03:44:14,241
WE ANALYZE OUR CLINICAL TRIAL 

4820
03:44:14,241 --> 03:44:17,444
RESULTS -- AND BY KEY FACTORS 

4821
03:44:17,444 --> 03:44:19,146
AND ANALYSIS I MEAN EFFECT 

4822
03:44:19,146 --> 03:44:20,147
MODIFICATION, WE COULD ACTUALLY 

4823
03:44:20,147 --> 03:44:23,417
BE REACHING INCORRECT 

4824
03:44:23,417 --> 03:44:26,086
CONCLUSIONS WITHOUT APPROPRIATE 

4825
03:44:26,086 --> 03:44:27,621
-- THINKING ABOUT CAUSAL 

4826
03:44:27,621 --> 03:44:31,859
INFERENCE AND HOW TO MODEL 

4827
03:44:31,859 --> 03:44:35,930
EFFECT MODIFICATION. NEXT SLIDE.

4828
03:44:35,930 --> 03:44:38,232
    SO THE IMPACT OF THINGS LIKE

4829
03:44:38,232 --> 03:44:41,268
AGE IN THE MENOPAUSAL TRANSITION

4830
03:44:41,268 --> 03:44:47,508
AS WELL AS ANTHROMETRICS GOT ME 

4831
03:44:47,508 --> 03:44:49,710
THINKING ABOUT ADIPOSE STORES. 

4832
03:44:49,710 --> 03:44:51,979
THIS IS A NICE REVIEW. FOR THOSE

4833
03:44:51,979 --> 03:44:53,581
OF YOU THAT DON'T SPEND TIME 

4834
03:44:53,581 --> 03:44:56,450
THINKING ABOUT SEX HORMONES, 

4835
03:44:56,450 --> 03:45:00,454
ADIPOSE TISSUE WITH AGE AND 

4836
03:45:00,454 --> 03:45:04,792
MENOPAUSE IS ACTIVE SITE HORMONE

4837
03:45:04,792 --> 03:45:08,762
METABOLISM, AROMATISATION. 

4838
03:45:08,762 --> 03:45:11,065
THERE'S BEEN WORK SUGGESTS 

4839
03:45:11,065 --> 03:45:12,666
ADIPOSE STORES IMPACT WITH 

4840
03:45:12,666 --> 03:45:15,903
IMPACT OF SEX HORMONES ON 

4841
03:45:15,903 --> 03:45:18,939
PULMONARY REMODELLING AND THOSE 

4842
03:45:18,939 --> 03:45:22,309
EFFECTS ARE SEX-SPECIFIC. NEXT. 

4843
03:45:22,309 --> 03:45:25,613
    THERE'S BEEN SEVERAL NICE 

4844
03:45:25,613 --> 03:45:28,148
PUBLICATIONS TO DATE LOOKING AT 

4845
03:45:28,148 --> 03:45:33,554
IN PARTICULAR THORACIC ADIPOSE 

4846
03:45:33,554 --> 03:45:36,023
BY CT AND M RI AND RISK ON THE 

4847
03:45:36,023 --> 03:45:40,027
LEFT IS NICE REPORT BY DR. AMANI

4848
03:45:40,027 --> 03:45:43,063
AND COLLEAGUES AT PENN 

4849
03:45:43,063 --> 03:45:43,664
DEMONSTRATING RELATIONSHIP 

4850
03:45:43,664 --> 03:45:46,200
BETWEEN VISCERAL ADIPOSE 

4851
03:45:46,200 --> 03:45:48,202
CHARACTERIZED BY CT AND RISK OF 

4852
03:45:48,202 --> 03:45:50,037
PH IN INDIVIDUALS UNDERGOING 

4853
03:45:50,037 --> 03:45:51,906
LUNG TRANSPLANT EVALUATION WITH 

4854
03:45:51,906 --> 03:45:55,175
PH OF ALL FORMS. ON THE RIGHT IS

4855
03:45:55,175 --> 03:45:56,944
RECENT PUBLICATION FROM 

4856
03:45:56,944 --> 03:45:58,512
INVESTIGATORS IN CHINA WHO 

4857
03:45:58,512 --> 03:46:03,117
LOOKED AT EPICARDIAL TISSUE 

4858
03:46:03,117 --> 03:46:05,986
CHARACTERIZED BY MRI AROUND R 

4859
03:46:05,986 --> 03:46:10,090
AND SHOWED A U-SHAPE IN CLINICAL

4860
03:46:10,090 --> 03:46:12,159
WORSENING AND EPE VOLUME. AT 

4861
03:46:12,159 --> 03:46:14,161
EXTREMES INDIVIDUALS WITH PH 

4862
03:46:14,161 --> 03:46:14,995
TENDED TO DO WORSE. 

4863
03:46:14,995 --> 03:46:19,767
    SO WE ARE INTERESTED IN 

4864
03:46:19,767 --> 03:46:24,171
DOING DEEP ANTHROPOMETRIC WITH 

4865
03:46:24,171 --> 03:46:27,675
PHENOTYPE AND ADIPOMETRIC TISSUE

4866
03:46:27,675 --> 03:46:30,044
AND BONE HEALTH, GOING FORWARD. 

4867
03:46:30,044 --> 03:46:30,377
NEXT SLIDE. 

4868
03:46:30,377 --> 03:46:32,713
    WE HAVE TALKED A LITTLE 

4869
03:46:32,713 --> 03:46:36,417
ABOUT NATURAL LIFE EVENTS, AN 

4870
03:46:36,417 --> 03:46:38,252
DODGE NOWS EXPOSURE BUT WHAT 

4871
03:46:38,252 --> 03:46:42,289
ABOUT OTHER EXPOSURES AND RISK 

4872
03:46:42,289 --> 03:46:45,659
OF CARDIOVASCULAR DISEASE. DR. 

4873
03:46:45,659 --> 03:46:47,561
BADLUM, AUSTIN AND COLLEAGUES 

4874
03:46:47,561 --> 03:46:50,664
LOOK T AT THE VANDERBILT COHORT 

4875
03:46:50,664 --> 03:46:55,669
AND LOOKED AT DURATION OF 

4876
03:46:55,669 --> 03:47:00,574
CONTRACEPTION AND AN ANDOGENOUS 

4877
03:47:00,574 --> 03:47:02,076
HORMONE THERAPY USE AND FOUND NO

4878
03:47:02,076 --> 03:47:06,547
DIFFERENCE IN TERMS OF SOME OF 

4879
03:47:06,547 --> 03:47:09,316
THE EXOGENOUS HORMONE EXPOSURE 

4880
03:47:09,316 --> 03:47:12,953
OVER SOME OF THE SUBGROUPS. 

4881
03:47:12,953 --> 03:47:15,089
    SOME YEARS AGO STEVE KAYWOOD

4882
03:47:15,089 --> 03:47:18,025
AND I PUBLISHED IN THE MESA RV 

4883
03:47:18,025 --> 03:47:21,895
COHORT THAT THE USE OF HORMONE 

4884
03:47:21,895 --> 03:47:23,731
THERAPY MODERATED THE EFFECT OF 

4885
03:47:23,731 --> 03:47:28,836
CIRCULATING ESTRADIOL ON RV 

4886
03:47:28,836 --> 03:47:30,270
PHENOTYPE. IN BLUE THE 

4887
03:47:30,270 --> 03:47:30,971
RELATIONSHIPS BETWEEN 

4888
03:47:30,971 --> 03:47:34,775
CIRCULATING ESTRADIOL AND RIGHT 

4889
03:47:34,775 --> 03:47:37,077
EJECTION FRACTION THERE WAS NO 

4890
03:47:37,077 --> 03:47:38,245
ASSOCIATIONS IN NON-HORMONE 

4891
03:47:38,245 --> 03:47:40,114
THERAPY USERS, WHEREAS THOSE 

4892
03:47:40,114 --> 03:47:41,415
INDIVIDUALS WHO HAD BEEN USING 

4893
03:47:41,415 --> 03:47:43,517
HORMONE THERAPY AT TIME OF THE 

4894
03:47:43,517 --> 03:47:45,486
MESA BASELINE WAS CONDUCTED HAD 

4895
03:47:45,486 --> 03:47:48,322
A FAVORABLE ASSOCIATION BETWEEN 

4896
03:47:48,322 --> 03:47:50,724
CIRCULATING LEVELS OF ESTRADIOL 

4897
03:47:50,724 --> 03:47:52,626
AND RAVF. IN FACT, THERE'S BEEN 

4898
03:47:52,626 --> 03:47:54,495
TWO REPORTS OF HORMONE 

4899
03:47:54,495 --> 03:47:57,364
REPLACEMENT THERAPY IN 

4900
03:47:57,364 --> 03:47:58,966
INDIVIDUALS WITH SYSTEMIC 

4901
03:47:58,966 --> 03:48:03,370
SCLEROSIS AS IT BEING PROTECTIVE

4902
03:48:03,370 --> 03:48:05,305
AGAINST DEVELOPMENT OF PULMONARY

4903
03:48:05,305 --> 03:48:06,407
HYPERTENSION. ALTHOUGH I WOULD 

4904
03:48:06,407 --> 03:48:08,308
SAY THIS IS ANECDOTAL AND NOT 

4905
03:48:08,308 --> 03:48:12,479
CONTROLLED DATA. NEXT. 

4906
03:48:12,479 --> 03:48:14,715
    SO LASTLY IN THE LAST SORT 

4907
03:48:14,715 --> 03:48:16,450
OF FEW MINUTES I WANTED TO TURN 

4908
03:48:16,450 --> 03:48:19,887
BACK TO THIS CONCEPT OF INTER 

4909
03:48:19,887 --> 03:48:22,756
SECTIONAL RESEARCH OBJECTIVES. 

4910
03:48:22,756 --> 03:48:28,262
YOU HAVE SEEN THIS SCHEMATIC 

4911
03:48:28,262 --> 03:48:29,763
ACKNOWLEDGING SEX AND GENDER ARE

4912
03:48:29,763 --> 03:48:33,400
NOT INTERCHANGEABLE. I THINK TWO

4913
03:48:33,400 --> 03:48:36,070
STUDIES I PARTICIPATED IN THAT 

4914
03:48:36,070 --> 03:48:37,805
WERE REALLY ILLUSTRATIVE OF THIS

4915
03:48:37,805 --> 03:48:39,973
FACT WERE SOME OF THE WORK I DID

4916
03:48:39,973 --> 03:48:42,076
WITH INTEGRATIVE BEHAVIORAL 

4917
03:48:42,076 --> 03:48:43,410
HEALTH COLLEAGUES TO LOOK AT 

4918
03:48:43,410 --> 03:48:45,913
RATES OF SEXUAL DYSFUNCTION IN 

4919
03:48:45,913 --> 03:48:48,749
INDIVIDUAL WHO'S IDENTIFY AS 

4920
03:48:48,749 --> 03:48:50,951
WOMEN WHO PULMONARY 

4921
03:48:50,951 --> 03:48:51,618
ARTERIAL HYPERTENSION AND NOTE 

4922
03:48:51,618 --> 03:48:53,787
THEY HAVE HIGH RATES OF SEXUAL 

4923
03:48:53,787 --> 03:48:54,788
DYSFUNCTION EVEN AFTER 

4924
03:48:54,788 --> 03:48:57,091
ACCOUNTING FOR THINGS LIKE 

4925
03:48:57,091 --> 03:48:58,926
ANXIETY AND DEPRESSION. WE 

4926
03:48:58,926 --> 03:49:01,895
CONDUCTED INDEPTH INTERVIEWS IN 

4927
03:49:01,895 --> 03:49:05,132
THESE INDIVIDUALS AND REALLY 

4928
03:49:05,132 --> 03:49:08,068
WERE ABLE TO TIE THAT SEXUAL 

4929
03:49:08,068 --> 03:49:09,603
DYSFUNCTION IS RELATE ED WITH 

4930
03:49:09,603 --> 03:49:12,106
POOR QUALITY OF LIFE AND OUR PAH

4931
03:49:12,106 --> 03:49:14,475
THERAPIES MAY SPECIFICALLY 

4932
03:49:14,475 --> 03:49:16,276
AFFECT THESE DOMAINS DIFFERENTLY

4933
03:49:16,276 --> 03:49:18,112
IN INDIVIDUAL WHO'S IDENTIFY AS 

4934
03:49:18,112 --> 03:49:21,548
WOMEN VERSUS MEN. SO DURING 

4935
03:49:21,548 --> 03:49:23,250
THESE INTERVIEWS THAT CAME OUT 

4936
03:49:23,250 --> 03:49:24,852
THAT MANY WHO IDENTIFIED AS 

4937
03:49:24,852 --> 03:49:26,854
WOMEN WERE DOING THINGS LIKE 

4938
03:49:26,854 --> 03:49:30,791
TAKING OFF THEIR PROST PUMPS TO 

4939
03:49:30,791 --> 03:49:32,493
ENGAGE IN SEXUAL INTERCOURSE 

4940
03:49:32,493 --> 03:49:35,295
WHEREAS SOME OF THE BIOLOGICALLY

4941
03:49:35,295 --> 03:49:39,900
MALE (BELL) REPORTED USE OF 

4942
03:49:39,900 --> 03:49:42,035
SODANOFIL HELPED IN THIS REGARD.

4943
03:49:42,035 --> 03:49:43,537
    ON THE RIGHT, I DON'T MEAN 

4944
03:49:43,537 --> 03:49:45,139
TO TALK ABOUT POLITICS BUT I'M 

4945
03:49:45,139 --> 03:49:46,740
GOING TO MENTION THAT I THINK WE

4946
03:49:46,740 --> 03:49:50,777
ARE AT A CRITICAL POINT IN 

4947
03:49:50,777 --> 03:49:53,247
REALLY HISTORY IN TERMS OF 

4948
03:49:53,247 --> 03:49:55,249
LIMITING ACCESS TO REPRODUCTIVE 

4949
03:49:55,249 --> 03:49:57,117
CARE ESPECIALLY FOR PAH 

4950
03:49:57,117 --> 03:49:58,852
PATIENTS. AND REGIONS OF COUNTRY

4951
03:49:58,852 --> 03:50:01,221
WHERE THIS MAY MOST IMPACT OUR 

4952
03:50:01,221 --> 03:50:03,323
PATIENTS ARE THOSE ALSO AT THE 

4953
03:50:03,323 --> 03:50:06,460
GREATEST RISK FOR HEALTH CARE 

4954
03:50:06,460 --> 03:50:07,394
DISPARITIES WITHOUT 

4955
03:50:07,394 --> 03:50:08,795
COMPREHENSIVE PAH CARE AND AT 

4956
03:50:08,795 --> 03:50:11,632
THE HIGHEST RISK OF HAVING 

4957
03:50:11,632 --> 03:50:13,734
COMPLICATIONS RELATED TO 

4958
03:50:13,734 --> 03:50:15,102
PREGNANCY. SO I THINK STUDYING 

4959
03:50:15,102 --> 03:50:17,604
THESE THINGS AND HOW THEY FACTOR

4960
03:50:17,604 --> 03:50:18,772
INTO OUR PATIENT'S EVERYDAY 

4961
03:50:18,772 --> 03:50:22,643
LIVE S IS GOING TO BE CRITICAL 

4962
03:50:22,643 --> 03:50:28,515
GOING FORWARD. NEXT. AS I 

4963
03:50:28,515 --> 03:50:30,450
MENTIONED I DON'T HAVE A LOT OF 

4964
03:50:30,450 --> 03:50:31,652
SOLUTIONS OTHER THAN I THINK 

4965
03:50:31,652 --> 03:50:32,753
THESE ARE ALL IMPORTANT FACTORS 

4966
03:50:32,753 --> 03:50:36,356
WE NEED TO THINK ABOUT WHEN 

4967
03:50:36,356 --> 03:50:37,724
TALKING ABOUT THIS LINE OF 

4968
03:50:37,724 --> 03:50:39,026
INQUIRY. WE NEED TO CONSIDER 

4969
03:50:39,026 --> 03:50:41,361
ROLE OF SEX CHROMOSOMES AND 

4970
03:50:41,361 --> 03:50:43,864
OTHER THINGS THAT EXIST IN 

4971
03:50:43,864 --> 03:50:45,065
ACTIVATION. WE NEED TO CONSIDER 

4972
03:50:45,065 --> 03:50:51,705
SEX, GENDER, AGE, ADIPOSE, 

4973
03:50:51,705 --> 03:50:55,409
ANTHRO METRICS, ENDOGENOUS AND 

4974
03:50:55,409 --> 03:51:02,416
EX DODGE NOWS HORMONES, INTER 

4975
03:51:02,416 --> 03:51:05,385
SECTIONALITY, THEN FINALLY 

4976
03:51:05,385 --> 03:51:09,156
TRANSPARENT REPORTING OF 

4977
03:51:09,156 --> 03:51:10,691
EVERYTHING SO WE CAN LEARN 

4978
03:51:10,691 --> 03:51:14,428
TOGETHER GOING FORWARD. NEXT. 

4979
03:51:14,428 --> 03:51:16,330
WITH THAT I'LL WRAP UP BY SAYING

4980
03:51:16,330 --> 03:51:18,832
I WANT TO THANK THE RESEARCH 

4981
03:51:18,832 --> 03:51:20,500
PARTICIPANTS THAT ENGAGE IN OUR 

4982
03:51:20,500 --> 03:51:23,270
HUMAN SUBJECTS RESEARCH. WITHOUT

4983
03:51:23,270 --> 03:51:29,843
THEM, THEIR CAREGIVERS, WE 

4984
03:51:29,843 --> 03:51:32,079
WOULDN'T HAVE THE RESOURCE, AS 

4985
03:51:32,079 --> 03:51:35,816
WELL AS MY COLLABORATORS AND 

4986
03:51:35,816 --> 03:51:39,152
FUNDING SOURCES. 

4987
03:51:39,152 --> 03:51:41,054
>> THANK YOU VERY MUCH,
DR. 

4988
03:51:41,054 --> 03:51:41,955
VENTETUOLO. EXCELLENT TALK 

4989
03:51:41,955 --> 03:51:44,091
THERE. I HAVE QUITE A FEW 

4990
03:51:44,091 --> 03:51:45,726
QUESTIONS. I'M SURE THE AUDIENCE

4991
03:51:45,726 --> 03:51:49,730
DOES AS WELL. WE HAVE ABOUT HALF

4992
03:51:49,730 --> 03:51:53,667
AN HOUR FOR DISCUSSION. 

4993
03:51:53,667 --> 03:51:56,803
    BEFORE WE MOVE ON I THINK 

4994
03:51:56,803 --> 03:52:00,307
DR. MATHIA HAS JOINED US. I 

4995
03:52:00,307 --> 03:52:01,708
WOULD LIVE TO GIVE HIM THE 

4996
03:52:01,708 --> 03:52:08,482
OPPORTUNITY TO DO AN 

4997
03:52:08,482 --> 03:52:09,316
INTRODUCTION. 

4998
03:52:09,316 --> 03:52:14,288
>> HI, STEVE MATHIA. I'M
AT 

4999
03:52:14,288 --> 03:52:15,822
JOHNS HOPKINS AND THIS IS 

5000
03:52:15,822 --> 03:52:17,791
UNDERLYING CONNECTIVE TISSUE 

5001
03:52:17,791 --> 03:52:18,692
DISEASES IN PARTICULAR AND LOOK 

5002
03:52:18,692 --> 03:52:21,728
FORWARD TO DISCUSSIONS TO TALK 

5003
03:52:21,728 --> 03:52:26,933
ABOUT DISPARITIES AND 

5004
03:52:26,933 --> 03:52:27,567
CARDIOVASCULAR DISEASE, THANK 

5005
03:52:27,567 --> 03:52:27,901
YOU. 

5006
03:52:27,901 --> 03:52:34,741
>> THANKS A LOT, STEVE. MY
FIRST

5007
03:52:34,741 --> 03:52:39,046
QUESTION IS FOR DR. EGHBALI. MY 

5008
03:52:39,046 --> 03:52:43,050
QUESTION IS, IS THERE A -- AN 

5009
03:52:43,050 --> 03:52:44,918
EFFORT OR DO YOU KNOW OF ANY 

5010
03:52:44,918 --> 03:52:48,989
DATA WITH REGARD TO PRE-CLINICAL

5011
03:52:48,989 --> 03:52:52,793
MODELS USING TRANSGENDER TYPE 

5012
03:52:52,793 --> 03:52:57,364
APPROACHES? FOR EXAMPLE, GIVING 

5013
03:52:57,364 --> 03:53:00,867
MALE -- BIOLOGICALLY MALE RATS 

5014
03:53:00,867 --> 03:53:03,737
FEMALE HORMONES AND VICE VERSA? 

5015
03:53:03,737 --> 03:53:14,281
>> THAT IS A VERY GOOD
QUESTION.

5016
03:53:14,848 --> 03:53:16,717
I DON'T KNOW ABOUT THAT BUT IN 

5017
03:53:16,717 --> 03:53:18,185
SOME OF OUR RATS WE WERE 

5018
03:53:18,185 --> 03:53:20,687
TREATING WITH ESTROGEN TO SEE IF

5019
03:53:20,687 --> 03:53:22,389
ESTROGEN CAN REALLY PROTECT THE 

5020
03:53:22,389 --> 03:53:25,959
ANIMAL. BUT THAT WAS FOR A VERY 

5021
03:53:25,959 --> 03:53:32,766
SHORT TIME. TREATING THE MALE 

5022
03:53:32,766 --> 03:53:35,569
RAT TEN DAYS WITH ESTROGEN, BOTH

5023
03:53:35,569 --> 03:53:37,337
MALE AND FEMALE, LOOKING TO SEE 

5024
03:53:37,337 --> 03:53:38,372
IF THIS TREATMENT CAN REALLY 

5025
03:53:38,372 --> 03:53:40,874
REVERSE THE DISEASE OR REDUCE 

5026
03:53:40,874 --> 03:53:43,009
THE SEVERITY OF THE DISEASE. 

5027
03:53:43,009 --> 03:53:44,411
YES, WE HAVE SEEN AND WE HAVE 

5028
03:53:44,411 --> 03:53:50,550
DONE IN MY LAB. OTHER PEOPLE -- 

5029
03:53:50,550 --> 03:53:52,686
I KNOW H TREATING HIS MALE RATS 

5030
03:53:52,686 --> 03:53:54,588
WITH ESTROGEN. BUT TO LOOK AT IT

5031
03:53:54,588 --> 03:53:58,458
THE WAY YOU ARE TALKING TODAY, 

5032
03:53:58,458 --> 03:54:01,294
NO, I (?) 

5033
03:54:01,294 --> 03:54:03,463
>> DO YOU THINK THERE
SHOULD BE 

5034
03:54:03,463 --> 03:54:05,799
MORE OF AN EFFORT DO THAT? 

5035
03:54:05,799 --> 03:54:08,001
>> BECAUSE WHAT WE ARE
DOING IS 

5036
03:54:08,001 --> 03:54:12,439
JUST FOR A VERY SHORT TIME. I 

5037
03:54:12,439 --> 03:54:17,177
THINK WHEN THESE PEOPLE ARE 

5038
03:54:17,177 --> 03:54:18,378
GOING THROUGH TRANSGENDER AND 

5039
03:54:18,378 --> 03:54:19,613
RECEIVE HORMONE, I THINK IT IS 

5040
03:54:19,613 --> 03:54:21,748
FOR A VERY LONG TIME THEY 

5041
03:54:21,748 --> 03:54:23,250
RECEIVE THESE. I THINK WHAT IS 

5042
03:54:23,250 --> 03:54:24,284
ALSO VERY IMPORTANT FOR OUR 

5043
03:54:24,284 --> 03:54:30,023
ANIMAL STUDIES WHEN WE TREAT 

5044
03:54:30,023 --> 03:54:34,394
THEM WITH EXOGENOUS ESTROGEN OR 

5045
03:54:34,394 --> 03:54:36,096
TESTOSTERONE WE HAVE TO BE 

5046
03:54:36,096 --> 03:54:39,199
CAREFUL. WANT TO USE THE DOSE TO

5047
03:54:39,199 --> 03:54:40,667
ACHIEVE PHYSIOLOGICAL CHANGE. 

5048
03:54:40,667 --> 03:54:43,937
SOMETHING LIKE ESTROGEN, IF YOU 

5049
03:54:43,937 --> 03:54:46,973
USE A LONG TIME IN HIGH DOSE IT 

5050
03:54:46,973 --> 03:54:54,514
CAN INDUCE TOMO OR BREAST CANCER

5051
03:54:54,514 --> 03:55:01,254
OR ENDOMETRIAL CANCER THAT.  IS 

5052
03:55:01,254 --> 03:55:03,690
WHY DOSE TO MAKE SURE LEVEL IS 

5053
03:55:03,690 --> 03:55:06,293
AT THE PHYSIOLOGICAL RANGE AND 

5054
03:55:06,293 --> 03:55:07,794
NOT VERY HIGH DOSE. 

5055
03:55:07,794 --> 03:55:09,763
>> I'M NOT SURE WE ARE
GOING TO 

5056
03:55:09,763 --> 03:55:12,766
BE UNTANGLE GENDER IN 

5057
03:55:12,766 --> 03:55:15,035
PRE-CLINICAL MODELS, 

5058
03:55:15,035 --> 03:55:17,437
RESPECT FULLY. I WOULD JUST ADD 

5059
03:55:17,437 --> 03:55:20,774
THAT I WAS INTERESTED IN TRYING 

5060
03:55:20,774 --> 03:55:23,243
TO LEARN MORE ABOUT THIS 

5061
03:55:23,243 --> 03:55:27,714
POTENTIAL EFFECTS ON THE CARDIO 

5062
03:55:27,714 --> 03:55:28,482
PULMONARY SYSTEM IN THE 

5063
03:55:28,482 --> 03:55:30,016
TRANSGENDER COMMUNITY. I 

5064
03:55:30,016 --> 03:55:31,418
PARTNERED WITH COLLEAGUES HERE 

5065
03:55:31,418 --> 03:55:32,786
WHO DO TRANSGENDER MEDICINE. I 

5066
03:55:32,786 --> 03:55:37,858
THINK ONE OF THE THINGS I WAS 

5067
03:55:37,858 --> 03:55:39,326
INTERESTED TO LEARN AND CURIOUS 

5068
03:55:39,326 --> 03:55:41,761
ON DR. STRAH'S COMMENTS ABOUT 

5069
03:55:41,761 --> 03:55:46,566
THIS, IS THAT WHEN INDIVIDUALS 

5070
03:55:46,566 --> 03:55:48,702
UNDERGO TRANSITION, THERE IS NOT

5071
03:55:48,702 --> 03:55:51,338
ROUTINE CLINICAL PHENOTYPING 

5072
03:55:51,338 --> 03:55:52,639
NECESSARILY THAT IS DONE WITH 

5073
03:55:52,639 --> 03:55:54,474
RESPECT TO HEART OR LUNG 

5074
03:55:54,474 --> 03:55:57,911
FUNCTION. I THINK THAT MAKES IT 

5075
03:55:57,911 --> 03:55:59,779
POTENTIALLY MORE DIFFICULT TO 

5076
03:55:59,779 --> 03:56:04,417
LEARN ABOUT LONGER TERM HEALTH 

5077
03:56:04,417 --> 03:56:11,892
EFFECTS IN THESE PEOPLE. 

5078
03:56:11,892 --> 03:56:13,493
>> YOU BRING UP A GREAT
POINT. I

5079
03:56:13,493 --> 03:56:15,462
THINK THAT IS ONE OF THE THINGS 

5080
03:56:15,462 --> 03:56:19,466
THAT IS A QUESTION. YOU KNOW, WE

5081
03:56:19,466 --> 03:56:24,471
ARE GUIDED THAT PATIENTS THAT 

5082
03:56:24,471 --> 03:56:28,842
HAVE HISTORY OF THROMBOEMBOLIC 

5083
03:56:28,842 --> 03:56:31,878
DISEASES THERE SHOULD BE 

5084
03:56:31,878 --> 03:56:34,915
SCREENING. HOWEVER, IN PATIENTS 

5085
03:56:34,915 --> 03:56:40,186
THAT HAVE RISK FACTORS SUCH AS 

5086
03:56:40,186 --> 03:56:42,122
OBESITY AND INITIATING 

5087
03:56:42,122 --> 03:56:44,524
TRANSITION, SHOULD THERE BE 

5088
03:56:44,524 --> 03:56:47,961
CLINICAL PHENOTYPING OR IN 

5089
03:56:47,961 --> 03:56:49,729
PATIENTS WHO HAVE H.I.V. SHOULD 

5090
03:56:49,729 --> 03:56:51,665
THERE BE CLINICAL PHENOTYPING 

5091
03:56:51,665 --> 03:56:54,200
PRIOR TO INITIATING. SHOULD BE 

5092
03:56:54,200 --> 03:56:55,802
CLINICAL PHENOTYPING 

5093
03:56:55,802 --> 03:56:59,506
PERIODICALLY AFTER INITIATING 

5094
03:56:59,506 --> 03:57:00,373
GENDER-AFFIRMING HORMONE 

5095
03:57:00,373 --> 03:57:03,443
THERAPY. I THINK THAT IS 

5096
03:57:03,443 --> 03:57:06,646
SOMETHING WE DON'T KNOW YET. I 

5097
03:57:06,646 --> 03:57:07,847
THINK THE OTHER QUESTION THAT 

5098
03:57:07,847 --> 03:57:14,387
WILL BE RAISED IS IF WE START 

5099
03:57:14,387 --> 03:57:17,691
CLINICAL PHENOTYPING EVENTUALLY,

5100
03:57:17,691 --> 03:57:21,328
THE COST-EFFECTIVENESS OF THAT 

5101
03:57:21,328 --> 03:57:26,566
WILL COME INTO QUESTION SO I 

5102
03:57:26,566 --> 03:57:27,901
THINK IT IS SOMETHING UNKNOWN. 

5103
03:57:27,901 --> 03:57:31,271
ALTHOUGH A VERY INTERESTING 

5104
03:57:31,271 --> 03:57:34,274
RESEARCH QUESTION. 

5105
03:57:34,274 --> 03:57:36,943
>> I MEAN I WOULD ALSO ADD
TOO 

5106
03:57:36,943 --> 03:57:40,914
THERE IS GREAT WORK AND NOW VERY

5107
03:57:40,914 --> 03:57:46,086
OLD WORK FROM THE CLINIC AT BMC 

5108
03:57:46,086 --> 03:57:49,623
SHOWING THAT BRACHIAL ARTERY 

5109
03:57:49,623 --> 03:57:52,859
VASCULAR ACTIVITY, MARKER OF 

5110
03:57:52,859 --> 03:57:56,363
VASCULAR HEALTH CHANGED 

5111
03:57:56,363 --> 03:57:58,999
SIGNIFICANTLY BOTH IN MEN 

5112
03:57:58,999 --> 03:58:02,535
TRANSITIONING TO WOMEN, WOMEN 

5113
03:58:02,535 --> 03:58:03,637
TRANSITIONING TO MEN WITH 

5114
03:58:03,637 --> 03:58:04,838
HORMONE THERAPY AND THEY WERE 

5115
03:58:04,838 --> 03:58:07,073
ABLE TO DOCUMENT PRIOR TO 

5116
03:58:07,073 --> 03:58:10,343
HORMONE ARE REPLACEMENT THERAPY 

5117
03:58:10,343 --> 03:58:11,978
OR HORMONE THERAPY AND AFTER, 

5118
03:58:11,978 --> 03:58:14,881
YOU KNOW, SEVERAL LONGITUDINAL 

5119
03:58:14,881 --> 03:58:16,082
SESSIONS. THERE WERE REALLY 

5120
03:58:16,082 --> 03:58:19,686
MARKED AND NOTABLE DIFFERENCES. 

5121
03:58:19,686 --> 03:58:22,022
SO YOU EXTRAPOLATE WHAT YOU MAY 

5122
03:58:22,022 --> 03:58:26,426
THINK IN THE PULMONARY 

5123
03:58:26,426 --> 03:58:30,063
VASCULARATUR V, IT WOULD BE 

5124
03:58:30,063 --> 03:58:34,401
SOMETHING INFORMATIVE. SO I JUST

5125
03:58:34,401 --> 03:58:37,370
WANT TO TALK A SECOND AND ASK 

5126
03:58:37,370 --> 03:58:39,372
DR. VENTETUOLO, I'M REALLY 

5127
03:58:39,372 --> 03:58:42,509
IMPRESSED BY THE STUDY YOU WERE 

5128
03:58:42,509 --> 03:58:46,279
TALKING ABOUT WITH ENDOTHELIAL 

5129
03:58:46,279 --> 03:58:49,516
CELLS, DIFFERENCES BETWEEN MALE 

5130
03:58:49,516 --> 03:58:53,953
AND FEMALE PULMONARY CELLS, MADE

5131
03:58:53,953 --> 03:59:00,527
WE START THINKING DO WE KNOW 

5132
03:59:00,527 --> 03:59:01,928
ANYTHING -- EVERYTHING WE HAVE 

5133
03:59:01,928 --> 03:59:07,067
BEEN DOING IN VITRO IS NOW 

5134
03:59:07,067 --> 03:59:07,300
WRONG? 

5135
03:59:07,300 --> 03:59:10,236
>> I THINK, IN SHORT,
JANE, IT 

5136
03:59:10,236 --> 03:59:13,406
DEPENDS ON THE QUESTION THAT YOU

5137
03:59:13,406 --> 03:59:22,549
ARE ASKING. WE STARTED 

5138
03:59:22,549 --> 03:59:25,952
DEVELOPING THIS TO EX TRANSIT  

5139
03:59:25,952 --> 03:59:27,821
TRACT THESE FROM TIPS OF THE 

5140
03:59:27,821 --> 03:59:30,690
CATHETER AND SOMEONE INTERESTED 

5141
03:59:30,690 --> 03:59:32,392
I ASKED KATHERINE TO -- ARE 

5142
03:59:32,392 --> 03:59:35,995
THERE DIFFERENCES IN COMMERCIAL 

5143
03:59:35,995 --> 03:59:38,498
CELLS. I WAS ACTUALLY -- AS A 

5144
03:59:38,498 --> 03:59:40,166
TRAINED TRIALIST AND 

5145
03:59:40,166 --> 03:59:43,336
EPIDEMIOLOGIST I WAS SHOCKED TO 

5146
03:59:43,336 --> 03:59:45,839
LEARN THAT NO ONE HAD PUBLISHED 

5147
03:59:45,839 --> 03:59:51,978
THIS IN CELLS FROM THE PULMONARY

5148
03:59:51,978 --> 03:59:52,979
CIRCULATION. THERE IS BEEN A LOT

5149
03:59:52,979 --> 03:59:54,881
FROM OTHER SYSTEMS AND OTHER 

5150
03:59:54,881 --> 03:59:56,216
ORGANS. I WAS SHOCKED TO LEARN 

5151
03:59:56,216 --> 03:59:58,752
HOW DIFFICULT IT IS TO GET DONOR

5152
03:59:58,752 --> 04:00:02,055
INFORMATION FROM COMMERCIAL CELL

5153
04:00:02,055 --> 04:00:04,991
LINES. SO I THINK WE TALKED 

5154
04:00:04,991 --> 04:00:06,493
ABOUT THIS, THE GROUP THAT PUT 

5155
04:00:06,493 --> 04:00:08,428
OUT THIS ATS DOCUMENT. I THINK 

5156
04:00:08,428 --> 04:00:10,463
IT DEPENDS WHAT YOU ARE 

5157
04:00:10,463 --> 04:00:11,698
STUDYING. IF WHAT YOU ARE 

5158
04:00:11,698 --> 04:00:13,533
STUDYING TO KNOWN TO POTENTIALLY

5159
04:00:13,533 --> 04:00:16,903
BE SEXUALLY DIMORPHIC I THINK 

5160
04:00:16,903 --> 04:00:18,138
EVENTUALLY WE ARE GOING TO HAVE 

5161
04:00:18,138 --> 04:00:21,241
TO SORT OF, YOU KNOW, THINK 

5162
04:00:21,241 --> 04:00:26,346
ABOUT THOSE PHENOTIWIC 

5163
04:00:26,346 --> 04:00:29,349
DIFFERENCES. WE DIDN'T TEST FOR 

5164
04:00:29,349 --> 04:00:32,318
CELLULAR CARIOTYPE BUT THAT CAN 

5165
04:00:32,318 --> 04:00:34,954
CHANGE IN A DYNAMIC PHENOMENON. 

5166
04:00:34,954 --> 04:00:37,457
THE DEEPER YOU GO, SORT OF THE 

5167
04:00:37,457 --> 04:00:38,992
DEEPER YOU GO. 

5168
04:00:38,992 --> 04:00:40,894
>> YEAH. 

5169
04:00:40,894 --> 04:00:42,896
>> THEN I GUESS COMPLETELY

5170
04:00:42,896 --> 04:00:43,663
UNRELATED, SO GIVEN EVERYTHING 

5171
04:00:43,663 --> 04:00:45,098
WE HAVE BEEN TALKING ABOUT 

5172
04:00:45,098 --> 04:00:48,468
HEESHGS SAY WE ARE DESIGNING A 

5173
04:00:48,468 --> 04:00:53,506
NEW TRIAL AND WE WANT TO COLLECT

5174
04:00:53,506 --> 04:00:57,310
INFORMATION. WOMEN, GENDER, SEX,

5175
04:00:57,310 --> 04:00:59,145
HORMONE LEVELS, HORMONE 

5176
04:00:59,145 --> 04:01:00,513
REPLACEMENT USE, ALL THAT. WHAT 

5177
04:01:00,513 --> 04:01:04,117
DO WE NEED TO INCLUDE IN 

5178
04:01:04,117 --> 04:01:05,018
QUESTIONNAIRES, WHAT KIND OF 

5179
04:01:05,018 --> 04:01:10,723
INFORMATION DO WE NEED TO 

5180
04:01:10,723 --> 04:01:11,558
COLLECT? 

5181
04:01:11,558 --> 04:01:13,426
>> YEAH, I THINK THAT IS A
GREAT

5182
04:01:13,426 --> 04:01:14,761
QUESTION. I THINK WE NEED TO 

5183
04:01:14,761 --> 04:01:16,329
START WITH SOME OF THE THINGS 

5184
04:01:16,329 --> 04:01:17,897
HIGHLIGHTED PREVIOUSLY SO 

5185
04:01:17,897 --> 04:01:22,468
CERTAINLY BIOLOGICAL SEX AT 

5186
04:01:22,468 --> 04:01:24,270
BIRTH. GENDER. WE, YOU KNOW, IN 

5187
04:01:24,270 --> 04:01:29,042
OUR TRIAL OF DHEA, WE COLLECTED 

5188
04:01:29,042 --> 04:01:32,445
A LOT MORE KIND OF DETAILED 

5189
04:01:32,445 --> 04:01:34,247
HISTORICAL INFORMATION ABOUT 

5190
04:01:34,247 --> 04:01:42,255
LIFETIME POTENTIAL ANDOGENOUS 

5191
04:01:42,255 --> 04:01:44,023
AND ENDOGENOUS TO HORMONES. WHEN

5192
04:01:44,023 --> 04:01:45,758
YOU HAVE A TRIAL WHERE YOU ARE 

5193
04:01:45,758 --> 04:01:47,627
MODULATING THINGS THAT ARE 

5194
04:01:47,627 --> 04:01:48,528
HORMONES OR COULD DIRECTLY 

5195
04:01:48,528 --> 04:01:51,264
IMPACT HORMONES THIS IS DATA 

5196
04:01:51,264 --> 04:01:55,602
THAT IS IMPORTANT TO HAVE. EVEN 

5197
04:01:55,602 --> 04:01:57,470
IN FACE OF NEGATIVE TRIAL IT IS 

5198
04:01:57,470 --> 04:01:59,772
CRITICAL WE TRY TO LEARN 

5199
04:01:59,772 --> 04:02:03,943
EVERYTHING WE CAN FROM THE DATA 

5200
04:02:03,943 --> 04:02:12,852
WE COLLECT. 

5201
04:02:12,852 --> 04:02:14,821
>> GREAT. 

5202
04:02:14,821 --> 04:02:19,492
>> SO SORRY, CAN I ASK
TECHNICAL

5203
04:02:19,492 --> 04:02:21,761
QUESTION TO DR. EGHBALI. MAY NOT

5204
04:02:21,761 --> 04:02:24,464
DIRECTLY RELATED TO THIS 

5205
04:02:24,464 --> 04:02:26,165
WORKSHOP THEME BUT I'M VERY 

5206
04:02:26,165 --> 04:02:28,001
INTERESTED IN -- YOU MENTIONED 

5207
04:02:28,001 --> 04:02:33,539
YOUR ANIMAL MODEL THAT (?) 

5208
04:02:33,539 --> 04:02:36,843
LIPIDS CAN CAUSE PULMONARY 

5209
04:02:36,843 --> 04:02:37,944
HYPERTENSION. THIS IS SOMETHING 

5210
04:02:37,944 --> 04:02:42,181
NEW. DID YOU SEE ANIMAL HAVE 

5211
04:02:42,181 --> 04:02:43,750
SYSTEMIC HYPERTENSION OR UNIQUE 

5212
04:02:43,750 --> 04:02:46,252
ONLY FOR THE CAUSE OF PULMONARY 

5213
04:02:46,252 --> 04:02:46,586
HYPERTENSION? 

5214
04:02:46,586 --> 04:02:48,321
>> YEAH, THAT IS A VERY
GOOD 

5215
04:02:48,321 --> 04:02:50,390
QUESTION. IN THIS ANIMAL MODEL 

5216
04:02:50,390 --> 04:02:53,626
WE USED WILD TYPE MICE. WE PUT 

5217
04:02:53,626 --> 04:02:56,629
THEM IN THIS DIET WHICH IS VERY 

5218
04:02:56,629 --> 04:03:07,106
HIGH RICH IN THIS. THIS IS 

5219
04:03:09,575 --> 04:03:10,543
INTERESTING IN THIS DIET FOR 

5220
04:03:10,543 --> 04:03:13,279
THREE WEEKS WE ONLY SEE INCREASE

5221
04:03:13,279 --> 04:03:16,349
IN THE SYSTOLIC PRESSURE AND NOT

5222
04:03:16,349 --> 04:03:19,786
IN LV. THERE ARE OTHER MODELS 

5223
04:03:19,786 --> 04:03:26,125
MORE PRONE TO DEVELOP ART 

5224
04:03:26,125 --> 04:03:27,327
SCLEROSIS, LIKE DIFFERENT TYPE 

5225
04:03:27,327 --> 04:03:31,698
MICE. WHEN WE PUT ON HIGH FAT 

5226
04:03:31,698 --> 04:03:34,500
DIET THREE MONTHS ALSO DEVELOP 

5227
04:03:34,500 --> 04:03:36,536
HYPERTENSION. DR. RABINICH 

5228
04:03:36,536 --> 04:03:39,939
PUBLISHED MANY YEARS AND MY LAB 

5229
04:03:39,939 --> 04:03:42,709
PUBLISHED ANOTHER WITH RECEPTOR 

5230
04:03:42,709 --> 04:03:45,178
KNOCKOUT MICE. BUT WE PUT THEM 

5231
04:03:45,178 --> 04:03:46,879
ON HIGH FAT DIET FOR THREE 

5232
04:03:46,879 --> 04:03:50,083
MONTHS. EVERY WEEK WE DID AN 

5233
04:03:50,083 --> 04:03:55,989
ECHO. WHAT WE FOUND WAS THAT WE 

5234
04:03:55,989 --> 04:03:58,324
ACTUALLY SAW UP CREASE IN 

5235
04:03:58,324 --> 04:04:00,393
SYSTOLIC PRESSURE BEFORE WE SAW 

5236
04:04:00,393 --> 04:04:02,695
CHANGE IN LV. THAT IS WHY WE ARE

5237
04:04:02,695 --> 04:04:04,864
THINKING MAYBE THIS IS A GOOD 

5238
04:04:04,864 --> 04:04:08,735
MODEL FOR GROUP 2. BUT GROUP 2 

5239
04:04:08,735 --> 04:04:12,105
USUALLY WANTED TO HAVE (?) FIRST

5240
04:04:12,105 --> 04:04:13,873
AND DEVELOP HYPERTENSION AFTER 

5241
04:04:13,873 --> 04:04:17,543
THAT. WHICH IS IN THIS MODEL WE 

5242
04:04:17,543 --> 04:04:19,212
ACTUALLY SAW PULMONARY 

5243
04:04:19,212 --> 04:04:22,281
HYPERTENSION PRECEDE THE LV 

5244
04:04:22,281 --> 04:04:22,548
FAILURE. 

5245
04:04:22,548 --> 04:04:24,450
>> YEAH, THAT IS VERY 

5246
04:04:24,450 --> 04:04:27,020
INTERESTING. YEARS AGO I DO 

5247
04:04:27,020 --> 04:04:28,921
STUDY ON THE LEFT HEART FAILURE 

5248
04:04:28,921 --> 04:04:33,693
OR HYPE TROPHY. WE KNOW LIPID 

5249
04:04:33,693 --> 04:04:36,262
CAN CAUSE HIGH TROPHY AND 

5250
04:04:36,262 --> 04:04:37,630
FAILURE. WE THOUGHT BECAUSE OF 

5251
04:04:37,630 --> 04:04:39,298
SYSTEMIC HYPERTENSION. THAT IS 

5252
04:04:39,298 --> 04:04:40,900
WHY I'M ASKING QUESTION. YOUR 

5253
04:04:40,900 --> 04:04:43,503
FIND ING IS REALLY INTERESTING. 

5254
04:04:43,503 --> 04:04:45,972
IF IT IS UNIQUE TO PULMONARY 

5255
04:04:45,972 --> 04:04:49,375
ARTERY SYSTEM THAT IS SOMETHINGS

5256
04:04:49,375 --> 04:04:53,646
FOR US TO LOOK INTO IT, THANK 

5257
04:04:53,646 --> 04:04:55,248
YOU, THANK YOU. 

5258
04:04:55,248 --> 04:05:06,225
>> DR. MARI MR /* MV --
DR. MAR 

5259
04:05:10,096 --> 04:05:13,833
>> YOU ARE ON MUTE. STILL
CAN'T 

5260
04:05:13,833 --> 04:05:24,343
HEAR YOU, BRAD. BRAD, MAY YOU 

5261
04:05:34,654 --> 04:05:36,055
DOUBLE-MUTED. YOU HAVE A DEVICE?

5262
04:05:36,055 --> 04:05:37,924
>> ON YOUR AUDIO, BRAD,
CHECK TO

5263
04:05:37,924 --> 04:05:41,861
SEE IF YOU ARE USING THE CORRECT

5264
04:05:41,861 --> 04:05:44,263
DEVICE. SO WHERE IT SAYS AUDIO 

5265
04:05:44,263 --> 04:05:46,432
CLICK ON THE LITTLE ARROW. SEE 

5266
04:05:46,432 --> 04:05:56,943
IF YOU ARE USING THE CORRECT 

5267
04:06:00,279 --> 04:06:01,414
DEVICE. 

5268
04:06:01,414 --> 04:06:04,917
>> I WILL ASK A QUESTION
WHY DR.

5269
04:06:04,917 --> 04:06:06,986
MARON IS WORKING ON HIS AUDIO. 

5270
04:06:06,986 --> 04:06:08,020
DR. VENTETUOLO, I HAVE A 

5271
04:06:08,020 --> 04:06:12,458
QUESTION. YOU MENTIONED SEVERAL 

5272
04:06:12,458 --> 04:06:14,060
STUDIES. I DON'T KNOW WHAT TYPE 

5273
04:06:14,060 --> 04:06:18,231
PH THEY WERE. ONE IN SQUARE 

5274
04:06:18,231 --> 04:06:20,933
DERMA LOOKING AT HRT. WHICH IS 

5275
04:06:20,933 --> 04:06:23,102
INTERESTING. DR. HEMNIS WILL BE 

5276
04:06:23,102 --> 04:06:24,670
PRESENTING DAY WE HAVE BEEN 

5277
04:06:24,670 --> 04:06:28,241
WORKING ON TOGETHER WITH PVOMICS

5278
04:06:28,241 --> 04:06:31,577
LOOKING AT PROTECTIVE EFFORT OF 

5279
04:06:31,577 --> 04:06:36,215
HRT. IS THAT -- HAVE YOU LOOKED 

5280
04:06:36,215 --> 04:06:40,453
FURTHER INTO THAT AND WHAT DO 

5281
04:06:40,453 --> 04:06:42,922
YOU THINK IS GOING ON? IS THIS A

5282
04:06:42,922 --> 04:06:43,556
ESTROGEN EFFECT? 

5283
04:06:43,556 --> 04:06:45,658
>> I THINK ONE OF THE
CHALLENGES

5284
04:06:45,658 --> 04:06:47,693
WITH ALL HORMONE THERAPY 

5285
04:06:47,693 --> 04:06:48,794
STUDIES, PARTICULARLY HORMONE 

5286
04:06:48,794 --> 04:06:52,398
THERAPY STUDIES THAT WERE 

5287
04:06:52,398 --> 04:06:53,666
CONDUCTED SORT OF EARLIER WHEN 

5288
04:06:53,666 --> 04:06:58,704
WE WERE GIVING A LOT OF 

5289
04:06:58,704 --> 04:07:00,673
INDIVIDUALS WHO WERE POST 

5290
04:07:00,673 --> 04:07:06,979
MENOPAUSAL, PARTICULARLY OR LATE

5291
04:07:06,979 --> 04:07:08,848
PERIMEN PAUSE THERAPY, THEY 

5292
04:07:08,848 --> 04:07:12,218
TENDED TO BE HEALTHY, AS OPPOSED

5293
04:07:12,218 --> 04:07:13,486
TO THOSE THAT AREN'T OFFER ED 

5294
04:07:13,486 --> 04:07:17,089
THAT THERAPY. THOSE AT RISK FOR 

5295
04:07:17,089 --> 04:07:19,759
CANCER OR CLOTTING, ET CETERA. 

5296
04:07:19,759 --> 04:07:25,097
THP THIS DATA AND TWO REPORTS OF

5297
04:07:25,097 --> 04:07:26,732
SCLERADATA, IT COULD BE CON 

5298
04:07:26,732 --> 04:07:28,634
FOUNDING. COULD BE IT HAS 

5299
04:07:28,634 --> 04:07:31,470
PROTECTIVE EFFECT BECAUSE IT IS 

5300
04:07:31,470 --> 04:07:34,941
A VASO DILATOR AND HAS CHANGES 

5301
04:07:34,941 --> 04:07:38,144
MORE GENOMIC EFFECTS. I THINK WE

5302
04:07:38,144 --> 04:07:40,413
DON'T YET KNOW BUT OBSERVATIONS 

5303
04:07:40,413 --> 04:07:42,548
ARE INTERESTING. ONE OF THE 

5304
04:07:42,548 --> 04:07:45,718
THINGS I HOPE COMES FROM WORK 

5305
04:07:45,718 --> 04:07:49,755
LIKE PVDOMICS IS WE UNDERSTAND 

5306
04:07:49,755 --> 04:07:50,656
TEMPORAL RELATIONSHIPS AS WELL 

5307
04:07:50,656 --> 04:07:54,961
AS STUDYING EFFECTS ACROSS ALL 

5308
04:07:54,961 --> 04:07:56,162
TYPES OF PULMONARY VASCULAR 

5309
04:07:56,162 --> 04:07:58,931
DISEASE TO SEE IF WE CAN 

5310
04:07:58,931 --> 04:08:03,202
VALIDATE SMALLER SCALE 

5311
04:08:03,202 --> 04:08:03,536
OBSERVATIONS. 

5312
04:08:03,536 --> 04:08:05,137
>> GREAT, THANK YOU. DR.
MARION,

5313
04:08:05,137 --> 04:08:08,474
ARE YOU WITH US? 

5314
04:08:08,474 --> 04:08:10,876
>> CAN YOU HEAR ME? 

5315
04:08:10,876 --> 04:08:12,578
>> THERE WE GO, GOTCHA. 

5316
04:08:12,578 --> 04:08:13,779
>> SORRY ABOUT THAT.  I
HAVE A 

5317
04:08:13,779 --> 04:08:17,116
NEW SYSTEM THAT I CLICKED OVER. 

5318
04:08:17,116 --> 04:08:19,252
DR. STRAH, I WANTED TO ASK YOU A

5319
04:08:19,252 --> 04:08:20,519
QUESTION. I THOUGHT YOU GAVE A 

5320
04:08:20,519 --> 04:08:22,989
GREAT PRESENTATION. I WAS ONCE 

5321
04:08:22,989 --> 04:08:27,293
READING CARDIO PULMONARY 

5322
04:08:27,293 --> 04:08:28,127
EXERCISE REFER TO 43 -YEAR-OLD 

5323
04:08:28,127 --> 04:08:30,896
TRANSGENDER WOMAN TRANSITIONING 

5324
04:08:30,896 --> 04:08:33,833
MALE TO FEMALE. THE QUESTION OF 

5325
04:08:33,833 --> 04:08:41,374
HOW TO CALCULATE, HOW TO REPORT 

5326
04:08:41,374 --> 04:08:42,708
WAS RAISED BECAUSE THIS 

5327
04:08:42,708 --> 04:08:43,409
PARTICULAR PATIENT WAS IN 

5328
04:08:43,409 --> 04:08:47,113
BETWEEN THE TRANSITION. SO THE 

5329
04:08:47,113 --> 04:08:55,621
DISCUSSION WITH THE TRANSITION 

5330
04:08:55,621 --> 04:08:57,823
AND SEX-AFFIRMING THERAPY THIS 

5331
04:08:57,823 --> 04:08:59,392
PATIENT WAS ON SO BASED ON THAT 

5332
04:08:59,392 --> 04:09:01,060
WE MADE A DECISION ABOUT WHAT 

5333
04:09:01,060 --> 04:09:03,195
THE MOST APPROPRIATE DECISION 

5334
04:09:03,195 --> 04:09:04,730
WAS TO STANDARDIZE RESULTS TO A 

5335
04:09:04,730 --> 04:09:12,838
MALE OR TO A FEMALE HOP 

5336
04:09:12,838 --> 04:09:14,340
ALLEGAT POP /* 

5337
04:09:14,340 --> 04:09:17,777
-- POPULATION. SO THAT WAS 

5338
04:09:17,777 --> 04:09:19,078
HELPFUL AND REAL WORLD 

5339
04:09:19,078 --> 04:09:22,548
APPLICATION TO CONCEPTS YOU WERE

5340
04:09:22,548 --> 04:09:23,816
DISCUSSING. IN THAT SCENARIO 

5341
04:09:23,816 --> 04:09:27,553
THERE WAS A NEED TO CALIBRATE 

5342
04:09:27,553 --> 04:09:30,523
NORMATIVE VALUES FOR TRANSGENDER

5343
04:09:30,523 --> 04:09:31,957
PEOPLE. YOU HAD MENTIONED 

5344
04:09:31,957 --> 04:09:34,960
INTERNAL PROBIANP TO ANOTHER 

5345
04:09:34,960 --> 04:09:36,796
DIRECTION OF THE CONVERSATION, 

5346
04:09:36,796 --> 04:09:38,297
WHICH I THINK IS GREAT. I GUESS 

5347
04:09:38,297 --> 04:09:40,599
THE QUESTION HOW DO YOU KNOW 

5348
04:09:40,599 --> 04:09:51,077
WHICH OF THE BIO MARKERS OR 

5349
04:09:51,077 --> 04:09:51,744
PARAMETERS IN CARDIOVASCULAR IS 

5350
04:09:51,744 --> 04:09:55,848
RIGHT. YOU CAN MAKE THE CASE FOR

5351
04:09:55,848 --> 04:09:57,383
PROBIA, IT IS SO SENSITIVE THAT 

5352
04:09:57,383 --> 04:09:59,485
IT IS ELEVATED AND RECRAFTING 

5353
04:09:59,485 --> 04:10:01,754
NORMATIVE VALUES MAY NOT BE AS 

5354
04:10:01,754 --> 04:10:03,222
CLINICALLY IMPACTFUL AS PEAK 

5355
04:10:03,222 --> 04:10:05,224
VOLUME OF OXYGEN CONSUMPTION, 

5356
04:10:05,224 --> 04:10:08,994
WHICH IN MY LAB AND COULD EASILY

5357
04:10:08,994 --> 04:10:11,397
LAND IN MY LAB IF I'M READING 

5358
04:10:11,397 --> 04:10:13,299
(?) FOR EXAMPLE. I THINK YOU ARE

5359
04:10:13,299 --> 04:10:17,470
EXACTLY RIGHT. I THINK THAT, YOU

5360
04:10:17,470 --> 04:10:21,340
KNOW, REESTABLISHING NORMATIVE 

5361
04:10:21,340 --> 04:10:30,216
VALUES FOR THESE WOULD NOT BE 

5362
04:10:30,216 --> 04:10:32,618
HELPFUL. IN STUDIES OF 

5363
04:10:32,618 --> 04:10:35,988
TRANSGENDER INDIVIDUALS WHO HAD 

5364
04:10:35,988 --> 04:10:42,928
CARDIAC EVENTS USING SEX 

5365
04:10:42,928 --> 04:10:44,764
ASSIGNED AT BIRTH VERSUS 

5366
04:10:44,764 --> 04:10:46,098
AFFIRMED GENDER REALLY DIDN'T 

5367
04:10:46,098 --> 04:10:49,702
CHANGE OUTCOMES AND DIDN'T MOVE 

5368
04:10:49,702 --> 04:10:57,476
PEOPLE FROM A DIAGNOSIS GROUP. I

5369
04:10:57,476 --> 04:11:01,347
THINK WHAT REALLY -- I GUESS MY 

5370
04:11:01,347 --> 04:11:02,748
ASPIRATIONAL RECOMMENDATION 

5371
04:11:02,748 --> 04:11:13,292
WOULD BE TO TRY TO REFOCUS ON A 

5372
04:11:15,094 --> 04:11:16,162
DIFFERENT BIOMARKER THAT ISN'T 

5373
04:11:16,162 --> 04:11:21,500
DEPENDENT ON GENDER OR BODY 

5374
04:11:21,500 --> 04:11:24,970
HABITUS, FAT DISTRIBUTION, RENAL

5375
04:11:24,970 --> 04:11:26,705
FUNCTION, SOMETHING THAT IS 

5376
04:11:26,705 --> 04:11:29,108
UNIVERSAL AND ACCESSIBLE TO OUR 

5377
04:11:29,108 --> 04:11:34,814
ENTIRE POPULATION INDEPENDENT OF

5378
04:11:34,814 --> 04:11:40,886
GENDER, BE PEND INDEPENDENT /*  

5379
04:11:40,886 --> 04:11:42,688
INDEPENDENT OF BMI. 

5380
04:11:42,688 --> 04:11:44,824
>> I APPRECIATE THAT THAT,
IS 

5381
04:11:44,824 --> 04:11:45,191
HELPFUL. 

5382
04:11:45,191 --> 04:11:49,195
>> I HAD A QUESTION FOR
DR. 

5383
04:11:49,195 --> 04:11:53,199
EGHBALI. SO MINORITY STRESS IS 

5384
04:11:53,199 --> 04:11:59,205
SOMETHING THAT WE IN TRANSGENDER

5385
04:11:59,205 --> 04:12:02,107
HEALTH DISCUSS QUITE BIT. ONE OF

5386
04:12:02,107 --> 04:12:03,809
THE THINGS IS THAT IT IS 

5387
04:12:03,809 --> 04:12:06,378
BELIEVED TO EXIST. IT IS HARD TO

5388
04:12:06,378 --> 04:12:12,451
STUDY. SO I'M WONDERING IS THERE

5389
04:12:12,451 --> 04:12:16,889
A WAY TO TAKE THIS BACK TO A 

5390
04:12:16,889 --> 04:12:19,992
PRECLINICAL MODEL IN A WAY THAT 

5391
04:12:19,992 --> 04:12:30,135
WOULD BE I GUESS FEASIBLE AND 

5392
04:12:30,135 --> 04:12:35,307
SAFE FOR AN  AN ANIMAL TO ASSESS

5393
04:12:35,307 --> 04:12:36,509
THE STRESS. 

5394
04:12:36,509 --> 04:12:38,377
>> WHAT DO YOU MEAN BY
MINORITY 

5395
04:12:38,377 --> 04:12:42,047
STRESS? TO SEE HOW WE CAN MODEL 

5396
04:12:42,047 --> 04:12:46,485
IT IN THE ANIMAL? 

5397
04:12:46,485 --> 04:12:56,061
>> SO THE EXPERIENCE OF 

5398
04:12:56,061 --> 04:12:57,096
DIFFERENT ENVIRONMENTAL 

5399
04:12:57,096 --> 04:13:06,138
STRESSERS THAN THE, YOU KNOW, 

5400
04:13:06,138 --> 04:13:08,874
HETERONORMATIVE, CISNORMATIVE 

5401
04:13:08,874 --> 04:13:11,610
MAJORITY POPULATION. SO IS THERE

5402
04:13:11,610 --> 04:13:14,513
A WAY TO I GUESS CREATE AN 

5403
04:13:14,513 --> 04:13:18,117
ENVIRONMENTAL STRESSOR IN A 

5404
04:13:18,117 --> 04:13:20,686
PRE-CLINICAL MODEL? 

5405
04:13:20,686 --> 04:13:23,656
>> IN ONE WHEN USING MICE
OR 

5406
04:13:23,656 --> 04:13:27,192
RATS, THEY NEVER LET US TO HAVE 

5407
04:13:27,192 --> 04:13:28,227
A SINGLE CAKE BECAUSE THEY THINK

5408
04:13:28,227 --> 04:13:30,496
WILL CREATE A LOT OF STRESS FOR 

5409
04:13:30,496 --> 04:13:31,797
THEM. THAT IS WHY WE ALWAYS HAVE

5410
04:13:31,797 --> 04:13:33,866
TO USE A GROUP OF THEM TOGETHER.

5411
04:13:33,866 --> 04:13:36,468
YOU KNOW, USUALLY YOU HAVE FOUR 

5412
04:13:36,468 --> 04:13:39,238
OR FIVE PER CAGE. RATS ALWAYS, 

5413
04:13:39,238 --> 04:13:40,573
DEPENDING ON THE SIZE, EITHER 

5414
04:13:40,573 --> 04:13:42,741
TWO OR THREE IN THE SAME CAGE. 

5415
04:13:42,741 --> 04:13:47,179
THEY NEVER LET US TO USE ANIMAL 

5416
04:13:47,179 --> 04:13:47,980
INDIVIDUAL CAGE BECAUSE THEY 

5417
04:13:47,980 --> 04:13:50,683
THINK IS GOING TO REALLY AFFECT 

5418
04:13:50,683 --> 04:13:53,352
THEIR STRESS LEVEL. THAT IS ONE 

5419
04:13:53,352 --> 04:13:56,055
THING. BUT ALSO WE SEE MORE AND 

5420
04:13:56,055 --> 04:14:02,261
MORE ABOUT CIRCADIAN EFFORT. ONE

5421
04:14:02,261 --> 04:14:04,463
IS SOCIALIZING. THAT IS WHY WHEN

5422
04:14:04,463 --> 04:14:06,532
WE DO EXPERIMENT. ANOTHER REASON

5423
04:14:06,532 --> 04:14:08,000
WE NEED TO ALWAYS HAVE GROUP OF 

5424
04:14:08,000 --> 04:14:09,902
ANIMALS TOGETHER. BECAUSE IT'S 

5425
04:14:09,902 --> 04:14:11,737
BEEN ALSO SHOWN IF YOU DON'T PUT

5426
04:14:11,737 --> 04:14:13,939
A GROUP OF ANIMALS TOGETHER IT 

5427
04:14:13,939 --> 04:14:16,375
IS GOING TO AFFECT THEIR 

5428
04:14:16,375 --> 04:14:17,610
CIRCADIAN RHYTHM. THERE ARE 

5429
04:14:17,610 --> 04:14:18,844
CERTAIN GENES THAT ARE SHOWN 

5430
04:14:18,844 --> 04:14:29,388
THAT ARE REGULATED BY THE CLOCK 

5431
04:14:31,690 --> 04:14:34,293
THAT ARE REGULATED BY ESTROGEN. 

5432
04:14:34,293 --> 04:14:36,261
    THE TALK TODAY IS REALLY 

5433
04:14:36,261 --> 04:14:38,530
INTERESTING AND WE AS BASIC 

5434
04:14:38,530 --> 04:14:42,835
SCIENTISTS NEED TO AGREE IN LAB 

5435
04:14:42,835 --> 04:14:45,437
TO SEE HOW WE CAN ADDRESS THAT 

5436
04:14:45,437 --> 04:14:46,438
EXPERIMENTALLY. NOW I REALLY 

5437
04:14:46,438 --> 04:14:48,040
DON'T KNOW BEST WAY. 

5438
04:14:48,040 --> 04:14:50,576
>> I LIKE THAT DR. GLEN
WILL BE 

5439
04:14:50,576 --> 04:14:55,848
TALKING ABOUT ALOSTAIC LOAD AND 

5440
04:14:55,848 --> 04:14:58,951
THE SUBJECT YOU BROUGHT UP. SO 

5441
04:14:58,951 --> 04:15:00,152
THAT IS SOMETHING -- ANOTHER 

5442
04:15:00,152 --> 04:15:02,855
THING THAT IS INTERESTING AND 

5443
04:15:02,855 --> 04:15:05,991
COMES TO MIND AND DR. VENTETUOLO

5444
04:15:05,991 --> 04:15:10,295
DISCUSSED THE INFLUENCE OF THE 

5445
04:15:10,295 --> 04:15:13,332
HUMAN ANIMAL CAREGIVER, SEX OF 

5446
04:15:13,332 --> 04:15:23,876
HUMAN ANIMAL CAREGIVER. I WONDER

5447
04:15:27,479 --> 04:15:30,749
IF THAT IS MORE OR LESS STRESS? 

5448
04:15:30,749 --> 04:15:31,984
IT IS THE INTERESTING THAT THAT 

5449
04:15:31,984 --> 04:15:33,886
IS A FACTOR. IF YOU HAVE 

5450
04:15:33,886 --> 04:15:35,554
COMMENTS OR MAYBE AN 

5451
04:15:35,554 --> 04:15:35,888
OBSERVATION. 

5452
04:15:35,888 --> 04:15:40,859
>> YEAH, I DON'T KNOW THE 

5453
04:15:40,859 --> 04:15:43,762
MECHANISM IS KNOWN BUT CERTAINLY

5454
04:15:43,762 --> 04:15:44,463
COULD BE. 

5455
04:15:44,463 --> 04:15:45,464
>> I WILL COMMENT WITH
THAT 

5456
04:15:45,464 --> 04:15:48,367
BECAUSE I USED TO WORK WITH 

5457
04:15:48,367 --> 04:15:49,068
ANIMAL BEFORE. AS DR. EGHBALI 

5458
04:15:49,068 --> 04:15:53,205
WAS SAYING, NORMALLY PUT IN SAME

5459
04:15:53,205 --> 04:15:56,608
CAGE BUT ESPECIALLY FOR MICE YOU

5460
04:15:56,608 --> 04:15:58,177
CANNOT PUT DIFFERENT. MALE MICE 

5461
04:15:58,177 --> 04:15:59,812
IN SAME CAGE. THEY WILL KILL 

5462
04:15:59,812 --> 04:16:02,047
EACH OTHER UNLESS THEY ARE FROM 

5463
04:16:02,047 --> 04:16:03,982
SAME LEADER, THEY GROW UP 

5464
04:16:03,982 --> 04:16:05,317
TOGETHER, WHERE THEY WERE BORN. 

5465
04:16:05,317 --> 04:16:07,586
SO THEY ARE OKAY. OTHERWISE IF 

5466
04:16:07,586 --> 04:16:09,321
YOU PUT MALE MICE IN THE SAME 

5467
04:16:09,321 --> 04:16:10,789
CAGE FROM DIFFERENT LITTERS, 

5468
04:16:10,789 --> 04:16:12,825
THEY WILL EVENTUALLY KILL EACH 

5469
04:16:12,825 --> 04:16:14,526
OTHER, ONLY ONE LEFT THAT.  IS 

5470
04:16:14,526 --> 04:16:16,428
TOTALLY DIFFERENT BEHAVIOR FROM 

5471
04:16:16,428 --> 04:16:18,464
THE MODERN HUMAN BEING BEHAVIOR.

5472
04:16:18,464 --> 04:16:21,333
SO THAT IS MAKING IT DIFFICULT 

5473
04:16:21,333 --> 04:16:23,402
FOR TO USE ANIMAL MODEL, AT 

5474
04:16:23,402 --> 04:16:25,404
LEAST MALE MICE TO STUDY. FEMALE

5475
04:16:25,404 --> 04:16:26,638
YOU CAN PUT IN SAME CAGE THAT, 

5476
04:16:26,638 --> 04:16:28,640
IS BETTER. BUT FOR MALE MICE 

5477
04:16:28,640 --> 04:16:32,444
THAT IS PROBABLY COULD NOT BE 

5478
04:16:32,444 --> 04:16:34,413
DONE. THAT IS MY CONCERN FROM 

5479
04:16:34,413 --> 04:16:36,281
WHEN RUNNING MY LAB YEARS AGO. 

5480
04:16:36,281 --> 04:16:39,418
>> THANKS, LEI. MAYBE
SHOULD BE 

5481
04:16:39,418 --> 04:16:43,288
MEASURING MARKERS OF ALOSTAIC 

5482
04:16:43,288 --> 04:16:46,859
LOAD IN ANIMALS, JUST AS A 

5483
04:16:46,859 --> 04:16:50,229
THOUGHT. AND DOCTOR -- 

5484
04:16:50,229 --> 04:16:52,264
>> SURE. 

5485
04:16:52,264 --> 04:16:58,003
>> -- DR. DE-JESUS PEREZ,
A 

5486
04:16:58,003 --> 04:16:58,604
QUESTION? 

5487
04:16:58,604 --> 04:17:00,405
>> THANKS FOR THE
PRESENTATION. 

5488
04:17:00,405 --> 04:17:02,407
I'M ACTUALLY EAGER TO HEAR MORE,

5489
04:17:02,407 --> 04:17:03,909
IF POSSIBLE, ABOUT THE RESULTS 

5490
04:17:03,909 --> 04:17:06,645
OF THE PHANTOM STUDY, WHICH WAS 

5491
04:17:06,645 --> 04:17:07,713
BROUGHT BY DR. EGHBALI. THIS WAS

5492
04:17:07,713 --> 04:17:13,185
A STUDY USING AN ASTROS TO 

5493
04:17:13,185 --> 04:17:19,758
INHIBIT AROMATASE TO SHOW 

5494
04:17:19,758 --> 04:17:20,926
SUPPRESSING ESTROGEN PRODUCTION 

5495
04:17:20,926 --> 04:17:23,128
THAT COULD LEAD TO THERAPEUTIC 

5496
04:17:23,128 --> 04:17:25,330
BENEFIT. I THINK IT IS RELEVANT 

5497
04:17:25,330 --> 04:17:26,999
CONSIDERING THE PRESENTATION BY 

5498
04:17:26,999 --> 04:17:29,101
DR. VENTETUOLO AND OTHERS 

5499
04:17:29,101 --> 04:17:32,070
REGARDING HOW WE MEASURE THE 

5500
04:17:32,070 --> 04:17:35,674
EFFECT OF ESTROGEN, ESTROGEN 

5501
04:17:35,674 --> 04:17:38,610
METABOLITES. I THINK WE HAVE 

5502
04:17:38,610 --> 04:17:42,481
COMPELLING EVIDENCE OF GOOD AND 

5503
04:17:42,481 --> 04:17:45,384
BAD ORGAN DEPENDENCE OR 

5504
04:17:45,384 --> 04:17:46,451
CELL-SPECIFIC SO AT THE END OF 

5505
04:17:46,451 --> 04:17:48,086
THE DAY WILL BE INTERESTING TO 

5506
04:17:48,086 --> 04:17:50,122
HEAR ULTIMATELY SINCE THE TRIAL 

5507
04:17:50,122 --> 04:17:54,193
WAS COMPLETED A YEAR OR SOING A 

5508
04:17:54,193 --> 04:17:56,061
IF THERE'S ANY RESULTS THAT 

5509
04:17:56,061 --> 04:17:57,529
POINT OUT TO ULTIMATELY WHAT 

5510
04:17:57,529 --> 04:18:03,602
HAPPENS WHEN YOU TARGET ESTROGEN

5511
04:18:03,602 --> 04:18:07,906
PRODUCTION. 

5512
04:18:07,906 --> 04:18:11,777
>> DOCTOR KAWUT. DON'T
WANT O 

5513
04:18:11,777 --> 04:18:13,846
PUT HIM ON THE SPOT. I CAN FEEL 

5514
04:18:13,846 --> 04:18:14,246
THE QUESTION. 

5515
04:18:14,246 --> 04:18:18,317
>> YOUR NAME IS ALL OVER
THOSE 

5516
04:18:18,317 --> 04:18:18,584
STUDIES. 

5517
04:18:18,584 --> 04:18:24,189
>> SORRY. GO AHEAD, COREY.

5518
04:18:24,189 --> 04:18:26,024
>> DESPITE A POSITIVE
EARLY 

5519
04:18:26,024 --> 04:18:27,926
PHASE 2 TRIAL OF 18 PARTICIPANTS

5520
04:18:27,926 --> 04:18:29,761
IN WHICH WE IMPROVED SIX-MINUTE 

5521
04:18:29,761 --> 04:18:31,563
WALK DISTANCE IN INDIVIDUALS 

5522
04:18:31,563 --> 04:18:35,934
GETTING AN ASTROSOL OVER SHORTER

5523
04:18:35,934 --> 04:18:37,336
PERIOD OF TIME THE FOLLOW-UP 

5524
04:18:37,336 --> 04:18:39,471
PHANTOM STUDY, EIGHT-CENTER 

5525
04:18:39,471 --> 04:18:42,140
CLINICAL TRIAL OF 84 

5526
04:18:42,140 --> 04:18:42,774
PARTICIPANTS CONDUCTED DURING 

5527
04:18:42,774 --> 04:18:44,243
COVID WAS ACTUALLY NEGATIVE. 

5528
04:18:44,243 --> 04:18:46,945
THAT WAS PUBLISHED, WHEN STEVE, 

5529
04:18:46,945 --> 04:18:50,215
LAST MONTH IN THE BLUE JOURNAL? 

5530
04:18:50,215 --> 04:18:51,984
WHAT WE KNOW -- WELL, WHAT WE 

5531
04:18:51,984 --> 04:18:53,051
SPECULATE IS THERE ARE 

5532
04:18:53,051 --> 04:18:54,119
DIFFERENCES BETWEEN THE FIRST 

5533
04:18:54,119 --> 04:18:56,188
AND SECOND TRIAL. ONE OF THOSE 

5534
04:18:56,188 --> 04:18:58,423
DIFFERENCES, FOR EXAMPLE, IS WE 

5535
04:18:58,423 --> 04:19:00,225
GAVE INDIVIDUALS -- GAVE ALL 

5536
04:19:00,225 --> 04:19:03,795
INDIVIDUALS VITAMIN D 

5537
04:19:03,795 --> 04:19:04,696
SUPPLEMENT

5538
04:19:04,696 --> 04:19:05,330
SUPPLEMENTATION, WHETHER THAT 

5539
04:19:05,330 --> 04:19:06,498
BIAS POTENTIALLY CHANGED SOME OF

5540
04:19:06,498 --> 04:19:07,966
THESE PATHWAYS THAT INTERACT 

5541
04:19:07,966 --> 04:19:10,736
WITH EACH OTHER, WE DON'T KNOW. 

5542
04:19:10,736 --> 04:19:13,038
WE KNOW, HOWEVER, ONE OF THE BIG

5543
04:19:13,038 --> 04:19:15,874
QUESTIONS ABOUT REDUCING 

5544
04:19:15,874 --> 04:19:17,276
ESTRADIOL IS WHETHER IT WOULD BE

5545
04:19:17,276 --> 04:19:20,012
SAFE FOR THE RIGHT VENTRICLE. AS

5546
04:19:20,012 --> 04:19:21,513
WE HAVE HEARD THERE IS CERTAINLY

5547
04:19:21,513 --> 04:19:23,815
DATA THAT SUGGESTS AS WELL AS 

5548
04:19:23,815 --> 04:19:29,955
MESA STUDY IF YOU REDUCE E2 YOU 

5549
04:19:29,955 --> 04:19:31,723
COULD HARM RV SO OUT TO A YEAR 

5550
04:19:31,723 --> 04:19:34,293
WE HAVE ECHO-BASED PARAMETERS TO

5551
04:19:34,293 --> 04:19:37,663
SUGGEST WHILE WE DIDN'T DO MUCH 

5552
04:19:37,663 --> 04:19:40,265
OF ANYTHING, WE DIDN'T HURT THE 

5553
04:19:40,265 --> 04:19:41,867
RIGHT VENTRICLE. STEVEN, I DON'T

5554
04:19:41,867 --> 04:19:52,411
KNOW IF YOU HAVE OTHER COMMENTS.

5555
04:19:55,647 --> 04:19:58,784
>> I THINK YOU ANSWERED IT

5556
04:19:58,784 --> 04:19:59,584
NICELY. 

5557
04:19:59,584 --> 04:20:02,354
>> ALL RIGHT. WITH THAT
I'M 

5558
04:20:02,354 --> 04:20:05,090
GOING TO -- BECAUSE DR. RACHEL 

5559
04:20:05,090 --> 04:20:06,758
GOLD JUST JOINED US, I'M GOING 

5560
04:20:06,758 --> 04:20:09,494
TO ALLOW HER TO INTRODUCE 

5561
04:20:09,494 --> 04:20:11,296
HERSELF AS ONE OF OUR SPEAKERS. 

5562
04:20:11,296 --> 04:20:13,598
HER TALK WILL BE AT THE END OF 

5563
04:20:13,598 --> 04:20:15,200
THE NEXT SESSION. BUT SINCE 

5564
04:20:15,200 --> 04:20:22,374
SHE'S JUST JOINED. RACHEL. 

5565
04:20:22,374 --> 04:20:24,443
>> THANKS SO MUCH. I HAD A

5566
04:20:24,443 --> 04:20:25,510
MANDATORY MEETING AT MY 

5567
04:20:25,510 --> 04:20:26,912
ORGANIZATION ALL MORNING IN 

5568
04:20:26,912 --> 04:20:28,447
PORTLAND, OREGON. I'M A SENIOR 

5569
04:20:28,447 --> 04:20:30,749
VIOLENTY TOR AT THE KAISER 

5570
04:20:30,749 --> 04:20:34,052
PERMANENTE CENTER AND DIRECTOR 

5571
04:20:34,052 --> 04:20:37,689
OF THE PROGRAMS AT -- SENIOR 

5572
04:20:37,689 --> 04:20:39,458
INVESTIGATOR AT THE KAISER 

5573
04:20:39,458 --> 04:20:41,526
PERMANENTE CENTER (CORRECTION) 

5574
04:20:41,526 --> 04:20:43,462
AND WE HAVE A PRETTY RIGOROUS 

5575
04:20:43,462 --> 04:20:45,998
RESEARCH ENDEAVOR GOING USING 

5576
04:20:45,998 --> 04:20:54,172
THE DATA SET THAT IS (AUDIO 

5577
04:20:54,172 --> 04:20:56,475
INTERRUPTION) SOCIOECONOMIC 

5578
04:20:56,475 --> 04:20:57,576
DISPARITIES IN SAFETY NET 

5579
04:20:57,576 --> 04:20:58,944
SETTING AND HOW TO IMPLEMENT 

5580
04:20:58,944 --> 04:21:00,045
INTERVENTIONS TO THAT EFFECT. A 

5581
04:21:00,045 --> 04:21:02,047
LOT OF EMPHASIS ON SOCIAL 

5582
04:21:02,047 --> 04:21:03,215
DETERMINANTS OF HEALTH. THANKS 

5583
04:21:03,215 --> 04:21:05,617
VERY MUCH FOR HAVING ME. 

5584
04:21:05,617 --> 04:21:07,419
>> THANK YOU, DR. GOLD. I 

5585
04:21:07,419 --> 04:21:10,856
ANTICIPATE THERE WILL BE A LOT 

5586
04:21:10,856 --> 04:21:14,092
OF QUES

5587
04:21:14,092 --> 04:21:16,161
OF QUESTIONS. WE HAD MANY COME 

5588
04:21:16,161 --> 04:21:19,164
IN THROUGH THE DISCUSSANTS HOW 

5589
04:21:19,164 --> 04:21:21,967
TO STANDARDIZE. SO THAT (BELL) 

5590
04:21:21,967 --> 04:21:24,169
>> GOT A GOOD SENSE OF
THAT. 

5591
04:21:24,169 --> 04:21:28,740
>> ANY OTHER QUESTIONS FOR
OUR 

5592
04:21:28,740 --> 04:21:32,411
PANEL HERE EITHER FROM 

5593
04:21:32,411 --> 04:21:38,950
DISCUSSANTS OR OTHER SPEAKERS? 

5594
04:21:38,950 --> 04:21:42,187
OKAY. WITH THAT WE HAVE A BREAK 

5595
04:21:42,187 --> 04:21:45,023
FOR 15 MINUTES. WE WILL ADJOURN 

5596
04:21:45,023 --> 04:21:52,697
AND COME BACK AT 3:15 EASTERN
TIME. 

5597
04:21:52,697 --> 04:22:44,879


5598
04:22:44,879 --> 04:22:53,488
    HE WILL BE GIVING AN 

5599
04:22:53,488 --> 04:22:58,092
OVERVIEW. WITH THAT DR. 

5600
04:22:58,092 --> 04:22:58,359
BERNARDO. 

5601
04:22:58,359 --> 04:23:05,800
>> THANK YOU FRANZ AND
JAMES ON 

5602
04:23:05,800 --> 04:23:09,971
ONE OF MY FAVORITE TOPIC, 

5603
04:23:09,971 --> 04:23:11,239
RELATIONSHIP BETWEEN SOCIAL 

5604
04:23:11,239 --> 04:23:12,173
DETERMINANTS OF HEALTH AND 

5605
04:23:12,173 --> 04:23:13,608
CARDIOVASCULAR DISEASE. THESE 

5606
04:23:13,608 --> 04:23:20,147
ARE MY DISCLOSURES. THE NEXT 

5607
04:23:20,147 --> 04:23:22,383
SLIDE. I WILL BE GOING THROUGH 

5608
04:23:22,383 --> 04:23:23,384
TERMINOLOGY THAT RELATES TO 

5609
04:23:23,384 --> 04:23:24,051
SOCIAL DETERMINANTS OF HEALTH. 

5610
04:23:24,051 --> 04:23:25,453
WE WILL BE TALKING ABOUT SOME OF

5611
04:23:25,453 --> 04:23:31,459
THE DATA THAT PERTAINS TO SOCIAL

5612
04:23:31,459 --> 04:23:32,093
DETERMINANTS OF HEALTH, SOCIAL 

5613
04:23:32,093 --> 04:23:39,500
DEPRIVATION IN PATIENTS WITH 

5614
04:23:39,500 --> 04:23:43,704
CARDIOVASCULAR DISEASE AND 

5615
04:23:43,704 --> 04:23:45,072
HYPERTENSION. NEXT SLIDE, 

5616
04:23:45,072 --> 04:23:45,339
PLEASE. 

5617
04:23:45,339 --> 04:23:48,910
    AS SPOKE EARLIER MOST OF 

5618
04:23:48,910 --> 04:23:52,980
DATA WE USE FOR DECISION-MAKING 

5619
04:23:52,980 --> 04:23:56,217
IN PAH COMES FROM LARGE TRIALS. 

5620
04:23:56,217 --> 04:23:58,553
HOWEVER, THE REPRESENTATION OF 

5621
04:23:58,553 --> 04:24:03,190
MINORS IN CLINICAL TRIALS IS 

5622
04:24:03,190 --> 04:24:06,127
SIGNIFICANTLY MINIMAL. NEXT 

5623
04:24:06,127 --> 04:24:06,360
SLIDE. 

5624
04:24:06,360 --> 04:24:10,064
    IN THIS NICE FIGURE WE CAN 

5625
04:24:10,064 --> 04:24:13,301
SEE REPRESENTATION OF MINORITIES

5626
04:24:13,301 --> 04:24:15,169
IN DIFFERENT TRIALS BUT AS YOU 

5627
04:24:15,169 --> 04:24:18,039
CAN SEE MOST CALLED REGISTRIES 

5628
04:24:18,039 --> 04:24:28,583
ARE PREDOMINANTLY WHITE AND MY 

5629
04:24:29,884 --> 04:24:32,687
SOME MINORITIES. (?) GROUP OF 

5630
04:24:32,687 --> 04:24:33,955
INVESTIGATORS FROM AMERICAN 

5631
04:24:33,955 --> 04:24:35,756
THORACIC SOCIETY HAD THIS 

5632
04:24:35,756 --> 04:24:37,258
STATEMENT WHERE THEY WERE 

5633
04:24:37,258 --> 04:24:38,292
PROVIDING SOME KEY 

5634
04:24:38,292 --> 04:24:40,995
RECOMMENDATIONS WHEN COMES TO 

5635
04:24:40,995 --> 04:24:45,533
RESEARCH RELATED TO HEALTH CARE 

5636
04:24:45,533 --> 04:24:46,734
DISPARITIES AND WERE EMPHASIZING

5637
04:24:46,734 --> 04:24:48,035
SHOULD BE ABLE TO CAPTURE 

5638
04:24:48,035 --> 04:24:50,771
INFORMATION RELATED TO RACE, 

5639
04:24:50,771 --> 04:24:53,240
ETHNICITY AND SOCIOECONOMIC 

5640
04:24:53,240 --> 04:24:55,176
STATUS OF PATIENTS AND SHOULD BE

5641
04:24:55,176 --> 04:24:57,878
INCLUDED SO WE CAN IDENTIFY 

5642
04:24:57,878 --> 04:25:00,314
WHICH PATIENTS MAY BE AT GREATER

5643
04:25:00,314 --> 04:25:03,351
RISK FOR NONCOMPLIANCE. NEXT 

5644
04:25:03,351 --> 04:25:03,651
SLIDE. 

5645
04:25:03,651 --> 04:25:05,219
    LET ME GO THROUGH SOME OF 

5646
04:25:05,219 --> 04:25:09,023
THE DEFINITIONS. NEXT SLIDE. 

5647
04:25:09,023 --> 04:25:11,592
HEALTHY PEOPLE 2030 IS A FEDERAL

5648
04:25:11,592 --> 04:25:14,795
INITIATIVE. IT IS VERY 

5649
04:25:14,795 --> 04:25:17,131
INTERESTING. THE RATIONALE FOR 

5650
04:25:17,131 --> 04:25:19,066
HEALTHY PEOPLE IS TO HAVE AN 

5651
04:25:19,066 --> 04:25:21,402
IDEA OF GOALS OVER A DECADE THAT

5652
04:25:21,402 --> 04:25:23,437
HAVE TO BE PURSUED TO MAXIMIZE 

5653
04:25:23,437 --> 04:25:25,006
THE WELL-BEING AND QUALITY OF 

5654
04:25:25,006 --> 04:25:27,942
LIFE OF INDIVIDUALS. HEALTHY 

5655
04:25:27,942 --> 04:25:29,577
PEOPLE HAVE DIFFERENT DOMAINS. 

5656
04:25:29,577 --> 04:25:34,181
FOCUS ON HEALTH CARE EQUALITY, 

5657
04:25:34,181 --> 04:25:37,284
HEALTH CARE DISPARITIESES AND 

5658
04:25:37,284 --> 04:25:37,952
SOCIAL DETERMINANTS OF HEALTH. 

5659
04:25:37,952 --> 04:25:38,285
NEXT SLIDE. 

5660
04:25:38,285 --> 04:25:39,854
    WHEN COMES TO SOCIAL 

5661
04:25:39,854 --> 04:25:41,555
DETERMINANTS OF HEALTH THEY HAVE

5662
04:25:41,555 --> 04:25:45,359
FIVE DOMAINS THAT PERTAIN TO 

5663
04:25:45,359 --> 04:25:47,561
ECONOMIC INSTABILITY. UNDER THE 

5664
04:25:47,561 --> 04:25:48,896
ASSUMPTION THAT INDIVIDUALS WHO 

5665
04:25:48,896 --> 04:25:51,465
HAVE A DIFFERENT INCOME TO 

5666
04:25:51,465 --> 04:25:53,768
SATISFY THAT ARE BASIC NEEDS TO 

5667
04:25:53,768 --> 04:25:56,170
STAY HEALTHY. BY STAYING HEALTHY

5668
04:25:56,170 --> 04:25:58,139
THATTING WITH BEING IS 

5669
04:25:58,139 --> 04:26:00,341
PRESERVED. THE SECOND COMPONENT 

5670
04:26:00,341 --> 04:26:02,076
OF SOCIAL DETERMINANTS OF HEALTH

5671
04:26:02,076 --> 04:26:03,444
COMES TO EDUCATION ACCESS. IT 

5672
04:26:03,444 --> 04:26:06,313
GOES WITH A SIMILAR CONCEPT. 

5673
04:26:06,313 --> 04:26:07,581
INDIVIDUALS WHO HAVE HIGH LEVELS

5674
04:26:07,581 --> 04:26:08,983
OF EDUCATION ARE MORE LIKELY TO 

5675
04:26:08,983 --> 04:26:11,852
STAY HEALTHY. THERE IS A STRONG 

5676
04:26:11,852 --> 04:26:14,121
DATA SUPPORTING THAT ASSUMPTION.

5677
04:26:14,121 --> 04:26:16,657
A THIRD COMPONENT IS EQUAL 

5678
04:26:16,657 --> 04:26:18,859
ACCESS TO HEALTH CARE UNDER THE 

5679
04:26:18,859 --> 04:26:20,728
ASSUMPTION, ONCE AGAIN, THAT 

5680
04:26:20,728 --> 04:26:23,431
WHOEVER NEEDS ACCESS TO HEALTH 

5681
04:26:23,431 --> 04:26:26,967
CARE CAN DO SO WITHOUT AFFECTING

5682
04:26:26,967 --> 04:26:31,405
THEIR FAMILIAR ECONOMY OR SO. 

5683
04:26:31,405 --> 04:26:35,242
THE TWO NEXT THINGS THAT ARE 

5684
04:26:35,242 --> 04:26:37,678
IMPORTANT IS SAFETY OF 

5685
04:26:37,678 --> 04:26:39,213
ENVIRONMENT INDIVIDUALS GROW 

5686
04:26:39,213 --> 04:26:42,983
WITH. THOSE ARE COMPONENTS OF 

5687
04:26:42,983 --> 04:26:43,617
SOCIAL DETERMINANTS OF HEALTH. 

5688
04:26:43,617 --> 04:26:47,621
NEXT SLIDE, PLEASE. WHEN WE TALK

5689
04:26:47,621 --> 04:26:54,829
ABOUT PAH (?) WE TALK ABOUT 

5690
04:26:54,829 --> 04:26:58,999
INTER PLAY BETWEEN BIOLOGY AND 

5691
04:26:58,999 --> 04:27:03,270
SOCIOECONOMIC FACTORS OF RACIAL 

5692
04:27:03,270 --> 04:27:05,740
AND ECONOMIC FACTORS SO LET ME 

5693
04:27:05,740 --> 04:27:07,241
TELL YOU ABOUT SOME OF THE DATA 

5694
04:27:07,241 --> 04:27:12,246
WHEN COMES TO INTERPLAY BETWEEN 

5695
04:27:12,246 --> 04:27:15,416
DISEASE AND SOME OF THE 

5696
04:27:15,416 --> 04:27:17,752
SOCIOECONOMIC FACTORS. WHEN I 

5697
04:27:17,752 --> 04:27:19,487
GIVE THIS TALK I REFER TO THIS 

5698
04:27:19,487 --> 04:27:21,856
MAP. IT IS RELATIVELY OUTDATED. 

5699
04:27:21,856 --> 04:27:23,657
WE DON'T HAVE UPDATED YET BUT 

5700
04:27:23,657 --> 04:27:26,594
REFERS TO SEGREGATION. IT OCCURS

5701
04:27:26,594 --> 04:27:28,429
IN THE UNITED STATES. BY THAT I 

5702
04:27:28,429 --> 04:27:30,498
MEAN PARTS OF U.S.  WHERE 

5703
04:27:30,498 --> 04:27:31,565
MINORITIES LIVE IN A DIFFERENT 

5704
04:27:31,565 --> 04:27:37,304
PART OF TOWN, THE AREAS YOU SEE 

5705
04:27:37,304 --> 04:27:43,244
IN PURPLE OR LILAC HAVE HIGH 

5706
04:27:43,244 --> 04:27:46,714
INCIDENCE OF SEGREGATION AND 

5707
04:27:46,714 --> 04:27:48,048
BLUE ARE WHERE COMMUNITIES 

5708
04:27:48,048 --> 04:27:50,518
INTEGRATE VERY WELL. NEXT SLIDE.

5709
04:27:50,518 --> 04:27:52,186
SO WHEN COMES TO BALTIMORE, 

5710
04:27:52,186 --> 04:27:55,022
WHERE SOME ARE LOCATED, DOWNTOWN

5711
04:27:55,022 --> 04:27:56,857
BALTIMORE IS HIGHLY SEGREGATED 

5712
04:27:56,857 --> 04:27:59,260
AREA AND ACCOUNTS FOR MOST AREAS

5713
04:27:59,260 --> 04:28:00,995
IN THE UNITED STATES. THAT IS 

5714
04:28:00,995 --> 04:28:04,165
IMPORTANT TO KEEP IN MIND. AS WE

5715
04:28:04,165 --> 04:28:06,100
TRY UNDERSTAND DIFFERENCES THAT 

5716
04:28:06,100 --> 04:28:08,536
COME WITH A CONCEPT OF RACE OR 

5717
04:28:08,536 --> 04:28:11,772
ETHNICITY, THOSE HAVE TO BE 

5718
04:28:11,772 --> 04:28:18,546
ACCOUNTED FOR THIS LEVEL BECAUSE

5719
04:28:18,546 --> 04:28:21,148
WHEN THEY SEGREGATE, WHICH MOST 

5720
04:28:21,148 --> 04:28:22,449
ARE. EXPOSURES ARE DIFFERENT. TO

5721
04:28:22,449 --> 04:28:26,187
POLLUTION, TO CRIME, TO ACCESS 

5722
04:28:26,187 --> 04:28:29,957
TO HEALTHY OR -- WITH AMERICANS 

5723
04:28:29,957 --> 04:28:31,926
WITH HEALTHY FOOD, THOSE 

5724
04:28:31,926 --> 04:28:40,401
DIFFERENCES AFFECT QUALITY UNDER

5725
04:28:40,401 --> 04:28:44,305
WHICH TOGETHER. NEXT SLIDE. WHEN

5726
04:28:44,305 --> 04:28:46,140
WE TRY TO UNDERSTAND 

5727
04:28:46,140 --> 04:28:47,308
DIFFERENCES, THEY RELATE NOT 

5728
04:28:47,308 --> 04:28:49,009
JUST TO COLOR OF INDIVIDUAL BUT 

5729
04:28:49,009 --> 04:28:51,312
RELATE TO DIFFERENCES ABOUT SEX 

5730
04:28:51,312 --> 04:28:53,814
AND GENDER AS PRIOR SPEAKERS 

5731
04:28:53,814 --> 04:28:55,449
EMPHASIZE ABOUT IT. THEY COME TO

5732
04:28:55,449 --> 04:28:58,319
DIFFERENCES ABOUT GENETICS AND 

5733
04:28:58,319 --> 04:29:01,055
BIOLOGY OF SOCIOECONOMIC STATUS,

5734
04:29:01,055 --> 04:29:02,556
ENVIRONMENTAL EXPOSURES, 

5735
04:29:02,556 --> 04:29:04,491
DIFFERENCES IN ACCESS TO HEALTH 

5736
04:29:04,491 --> 04:29:06,694
CARE, TO EXPOSURE OF THE LEVEL 

5737
04:29:06,694 --> 04:29:10,397
AND DIFFERENCES IN LIFESTYLE. 

5738
04:29:10,397 --> 04:29:11,799
NEXT SLIDE. 

5739
04:29:11,799 --> 04:29:15,769
    ONCE AGAIN, WE HAVE FIVE 

5740
04:29:15,769 --> 04:29:16,370
DOMAINS WHEN COMES TO SOCIAL 

5741
04:29:16,370 --> 04:29:18,205
DETERMINANTS OF HEALTH. WE HAVE 

5742
04:29:18,205 --> 04:29:20,341
EDUCATION, ACCESS TO HEALTH 

5743
04:29:20,341 --> 04:29:22,276
CARE, SAFETY OF YOUR 

5744
04:29:22,276 --> 04:29:24,178
NEIGHBORHOOD, THE SUPPORT 

5745
04:29:24,178 --> 04:29:25,746
SUPPORT AND ECONOMIC STABILITY. 

5746
04:29:25,746 --> 04:29:27,681
THE NEXT SLIDE. 

5747
04:29:27,681 --> 04:29:34,054
    NOT SO LONG AGO WITH (?) 

5748
04:29:34,054 --> 04:29:35,823
NGOS FROM CINCINNATI WE TRY HAVE

5749
04:29:35,823 --> 04:29:39,560
DIFFERENT APPROACH, SOMETHING WE

5750
04:29:39,560 --> 04:29:41,295
REFER TO AS NOVEL SOCIAL 

5751
04:29:41,295 --> 04:29:41,929
DETERMINANTS OF HEALTH, WHICH 

5752
04:29:41,929 --> 04:29:44,965
HAVE CERTAIN VARIATIONS OF 

5753
04:29:44,965 --> 04:29:46,133
CERTAIN SOCIAL DETERMINANTS OF 

5754
04:29:46,133 --> 04:29:48,068
HEALTH THAT PERHAPS APPLY WITH 

5755
04:29:48,068 --> 04:29:50,204
MORE PRECISION TO MINORITIES 

5756
04:29:50,204 --> 04:29:53,140
WITH PROBLEMATIC HYPERTENSION. 

5757
04:29:53,140 --> 04:29:56,377
AND SOME OF PRIOR SPEAKERS HAVE 

5758
04:29:56,377 --> 04:29:57,778
REFERRED TO THIS BUT RELATED TO 

5759
04:29:57,778 --> 04:30:01,015
DIFFERENCES IN ENVIRONMENTAL 

5760
04:30:01,015 --> 04:30:03,684
EXPOSURE FOR INDIVIDUALS WHO ARE

5761
04:30:03,684 --> 04:30:05,753
(?) AND FACTORS THAT AFFECT 

5762
04:30:05,753 --> 04:30:08,255
ACCESS TO HEALTH CARE RELATED TO

5763
04:30:08,255 --> 04:30:11,425
IMMIGRATION STATUS OR LANGUAGE 

5764
04:30:11,425 --> 04:30:12,626
BARRIERS, DIFFERENCES IN HEALTH 

5765
04:30:12,626 --> 04:30:14,862
CARE, DIFFERENCES IN MENTAL 

5766
04:30:14,862 --> 04:30:15,996
HEALTH AND TRANSPORTATION AND 

5767
04:30:15,996 --> 04:30:19,400
ALL THESE FACTORS COMBINED. ALL 

5768
04:30:19,400 --> 04:30:21,302
COMPLEMENT EACH OTHER AND 

5769
04:30:21,302 --> 04:30:23,671
CONSTITUTE OPTIMAL MEDICAL CARE 

5770
04:30:23,671 --> 04:30:26,073
BARRIERS TO ENGAGEMENT CLINICAL 

5771
04:30:26,073 --> 04:30:27,775
TRIALS PARTICIPATION, 

5772
04:30:27,775 --> 04:30:29,076
DIFFERENCES ADHERENCE TO 

5773
04:30:29,076 --> 04:30:30,644
TREATMENT AND DIFFERENCES IN 

5774
04:30:30,644 --> 04:30:32,913
CONTINUITY OF CARE. THE NEXT 

5775
04:30:32,913 --> 04:30:33,414
SLIDE. 

5776
04:30:33,414 --> 04:30:34,982
    LET ME TELL YOU ABOUT WHAT 

5777
04:30:34,982 --> 04:30:37,451
WE KNOW ABOUT SOCIOECONOMICS AND

5778
04:30:37,451 --> 04:30:41,622
HYPERTENSION. BACK IN 2013, 12 

5779
04:30:41,622 --> 04:30:42,489
YEARS AGO, STUDY ON 200 PATIENTS

5780
04:30:42,489 --> 04:30:44,591
FROM CHINA SHOWED THAT 

5781
04:30:44,591 --> 04:30:49,663
INDIVIDUALS AT THE LOWER TILE OF

5782
04:30:49,663 --> 04:30:50,564
SOCIOECONOMIC STATUS HAS LOWER 

5783
04:30:50,564 --> 04:30:53,133
AS COMPARED TO TWO OTHER 

5784
04:30:53,133 --> 04:30:54,835
DETAILS. DIFFERENCES PERSISTED 

5785
04:30:54,835 --> 04:30:59,106
EVEN IF YOU ARE JUST FOR OTHER 

5786
04:30:59,106 --> 04:31:08,415
VARIABLES SUCH AS (AUDIO 

5787
04:31:08,415 --> 04:31:10,117
INTERRUPTION) BACK IN 2016 A 

5788
04:31:10,117 --> 04:31:12,319
STUDY FROM USING DATA FROM LARGE

5789
04:31:12,319 --> 04:31:13,687
HOSPITAL SYSTEM IN NEW YORK 

5790
04:31:13,687 --> 04:31:15,556
FOUND INDIVIDUALS WITH THE 

5791
04:31:15,556 --> 04:31:17,224
LOWEST ANNUAL INCOME WERE MORE 

5792
04:31:17,224 --> 04:31:18,692
LIKELY TO PRESENT WITH MORE 

5793
04:31:18,692 --> 04:31:20,494
SEVERE SYMPTOMS SO INDIVIDUALS 

5794
04:31:20,494 --> 04:31:22,763
WITH LOWEST INCOMES, THEY WERE 

5795
04:31:22,763 --> 04:31:25,666
MORE LIKELY TO PRESENT WITH 

5796
04:31:25,666 --> 04:31:27,901
FUNCTIONAL CLASS 3 OR 4 

5797
04:31:27,901 --> 04:31:32,806
SYMPTOMS. THE NEXT SLIDE. 

5798
04:31:32,806 --> 04:31:35,876
    HOWEVER, IN TWO STUDIES IN 

5799
04:31:35,876 --> 04:31:39,680
EUROPE, PARTICULARLY SCOTLAND, 

5800
04:31:39,680 --> 04:31:43,550
THESE PRIOR FAMILIES WERE (?) 

5801
04:31:43,550 --> 04:31:46,353
DIFFERENCES IN SURVIVAL BASED ON

5802
04:31:46,353 --> 04:31:47,888
SOCIOECONOMIC STATUS WERE NOT 

5803
04:31:47,888 --> 04:31:51,258
SEEN AND ALSO NO DIFFERENCES 

5804
04:31:51,258 --> 04:31:55,462
WHEN COMES TO SEVERITY OF 

5805
04:31:55,462 --> 04:31:57,865
SYMPTOMS THAT WERE FOUND. SO WE 

5806
04:31:57,865 --> 04:32:02,403
HAVE SOME CONFLICT DATA. WE USE 

5807
04:32:02,403 --> 04:32:04,505
DATA FROM THE HYPERTENSION 

5808
04:32:04,505 --> 04:32:06,507
INDUSTRY TO NOTE THE 

5809
04:32:06,507 --> 04:32:10,010
SIGNIFICANCE OF POVERTY AND 

5810
04:32:10,010 --> 04:32:17,885
SOCIAL DEPRIVATION. WE USED DATA

5811
04:32:17,885 --> 04:32:20,320
FROM THE FOG. IT IS A GREAT 

5812
04:32:20,320 --> 04:32:21,355
REGISTRY, AS MENTIONED BEFORE, 

5813
04:32:21,355 --> 04:32:24,525
BECAUSE THE SYSTEM COLLECTS DATA

5814
04:32:24,525 --> 04:32:25,526
ON SOCIAL DETERMINANTS OF HEALTH

5815
04:32:25,526 --> 04:32:28,796
AND SOCIAL DEMOGRAPHICS. NEXT 

5816
04:32:28,796 --> 04:32:29,029
SLIDE. 

5817
04:32:29,029 --> 04:32:31,632
    FOR THIS ANALYSIS WE ARE 

5818
04:32:31,632 --> 04:32:32,800
USING THE ABSOLUTE DIFFERENCE. 

5819
04:32:32,800 --> 04:32:34,535
FOR THOSE OF YOU NOT VERY 

5820
04:32:34,535 --> 04:32:37,037
FAMILIAR WITH THE STANDARD OF 

5821
04:32:37,037 --> 04:32:40,607
DIFFERENCES, ANY VALUE GREATER 

5822
04:32:40,607 --> 04:32:41,909
THAN.25, THERE IS A DIFFERENCE 

5823
04:32:41,909 --> 04:32:45,279
BETWEEN THOSE TWO GROUPS SO THE 

5824
04:32:45,279 --> 04:32:47,181
VALUE OF THE ASD MORE THAN 

5825
04:32:47,181 --> 04:32:48,782
LIKELY THERE IS A DIFFERENCE IN 

5826
04:32:48,782 --> 04:32:51,251
THE TWO GROUPS. WHAT WE FIND IS 

5827
04:32:51,251 --> 04:32:53,954
INDIVIDUALS IN POVERTY ARE LESS 

5828
04:32:53,954 --> 04:32:55,789
LIKELY TO HAVE PRIVATE 

5829
04:32:55,789 --> 04:32:58,826
INSURANCE, MORE LIKELY TO HAVE 

5830
04:32:58,826 --> 04:33:00,527
MEDICAID. ARE INDIVIDUALS LIVING

5831
04:33:00,527 --> 04:33:01,995
UNDER FEDERAL POVERTY LEVELS ARE

5832
04:33:01,995 --> 04:33:07,134
MORE LIKELY TO BE UNEMPLOYED. WE

5833
04:33:07,134 --> 04:33:10,370
SEE ALSO INDIVIDUALS HAVE HIGHER

5834
04:33:10,370 --> 04:33:15,075
FREQUENCY OF REPORTED 

5835
04:33:15,075 --> 04:33:16,910
METHAMPHETAMINE USE. WE SEE THAT

5836
04:33:16,910 --> 04:33:20,080
INDIVIDUALS LIVING UNDER FEDERAL

5837
04:33:20,080 --> 04:33:23,817
POVERTY LEVELS HAVE SUGGESTS 

5838
04:33:23,817 --> 04:33:26,487
MORE SOCIAL DEPRIVATION WHETHER 

5839
04:33:26,487 --> 04:33:28,655
THE SBA OR SOCIAL INDEX WHERE 

5840
04:33:28,655 --> 04:33:30,023
HIGHER VALUES WERE FOUND 

5841
04:33:30,023 --> 04:33:32,059
INDIVIDUALS LIVING UNDER POVERTY

5842
04:33:32,059 --> 04:33:36,263
LEVELS. THE NEXT SLIDE. 

5843
04:33:36,263 --> 04:33:38,465
    SOMETHING THAT WE WANTED TO 

5844
04:33:38,465 --> 04:33:40,200
SPECIFICALLY STUDY IN THIS 

5845
04:33:40,200 --> 04:33:43,237
ANALYSIS WAS TO SEE THAT OTHER 

5846
04:33:43,237 --> 04:33:44,238
OF HEALTH CARE INDIVIDUALS IN 

5847
04:33:44,238 --> 04:33:46,874
POVERTY OR NOT IN POVERTY. WHAT 

5848
04:33:46,874 --> 04:33:50,777
WE FOUND, SIMILAR TO A STUDY I 

5849
04:33:50,777 --> 04:33:52,880
WILL TELL YOU LATER TODAY, IS 

5850
04:33:52,880 --> 04:33:56,250
INDIVIDUALS IN POVERTY ARE MORE 

5851
04:33:56,250 --> 04:33:59,987
LIKELY TO GO TO THE EMERGENCY 

5852
04:33:59,987 --> 04:34:01,655
ROOM OR GET HOSPITALIZED THAN 

5853
04:34:01,655 --> 04:34:08,061
INDIVIDUALS NOT IN POVERTY. THE 

5854
04:34:08,061 --> 04:34:09,897
NEXT SLIDE. WE DON'T SEE 

5855
04:34:09,897 --> 04:34:11,064
DIFFERENCES IN SURVIVAL. THE 

5856
04:34:11,064 --> 04:34:13,400
CURVE IS BETTER SORT OF POVERTY,

5857
04:34:13,400 --> 04:34:16,537
THIS DIFFERENCE IN CURVES BY THE

5858
04:34:16,537 --> 04:34:18,972
LONG-RUN DID NOT REACH A 

5859
04:34:18,972 --> 04:34:20,073
STATISTICAL SIGNIFICANCE. THE 

5860
04:34:20,073 --> 04:34:21,241
NEXT SLIDE. 

5861
04:34:21,241 --> 04:34:23,343
    WHEN WE USE DIFFERENT METRIC

5862
04:34:23,343 --> 04:34:25,812
OF SOCIAL PREVENTIONS SUCH AS 

5863
04:34:25,812 --> 04:34:28,682
THE SOCIAL MOBILITY INDEX OR 

5864
04:34:28,682 --> 04:34:31,084
FAMILY INCOME RATIO WE DO NOT 

5865
04:34:31,084 --> 04:34:33,053
SEE THESE DIFFERENCES. SO 

5866
04:34:33,053 --> 04:34:36,757
OVERALL WE SEE INDIVIDUALS 

5867
04:34:36,757 --> 04:34:38,292
LIVING UNDER POVERTY LEVEL, EVEN

5868
04:34:38,292 --> 04:34:40,928
IF THEY HAVE A PATTERN OF 

5869
04:34:40,928 --> 04:34:42,529
ILLNESS THEY HAVE HIGHER 

5870
04:34:42,529 --> 04:34:43,230
FREQUENCIES OF GOING TO AN 

5871
04:34:43,230 --> 04:34:46,934
EMERGENCY ROOM OR GETTING 

5872
04:34:46,934 --> 04:34:52,239
HOSPITALIZED. THE NEXT SLIDE. 

5873
04:34:52,239 --> 04:34:54,141
LET ME TELL YOU WHAT WE KNOW 

5874
04:34:54,141 --> 04:34:56,143
BETWEEN RACE, ETHNICITY AND 

5875
04:34:56,143 --> 04:35:00,881
SOCIOECONOMIC FACTORS. THE NEXT 

5876
04:35:00,881 --> 04:35:02,716
SLIDE. 

5877
04:35:02,716 --> 04:35:05,953
    (?) REFERRED TO THIS STUDY, 

5878
04:35:05,953 --> 04:35:07,955
A PAPER LED BY THE INDIANA 

5879
04:35:07,955 --> 04:35:09,756
UNIVERSITY. IT IS A VERY ELEGANT

5880
04:35:09,756 --> 04:35:14,795
STUDY WHERE THEY USED DATA FROM 

5881
04:35:14,795 --> 04:35:19,266
PAH BUT ALSO FROM (?) AND USE 

5882
04:35:19,266 --> 04:35:24,905
DATA FROM UNIVERSITY (?) NEXT 

5883
04:35:24,905 --> 04:35:25,772
SLIDE. 

5884
04:35:25,772 --> 04:35:30,077
    WHAT THEY FOUND IS HISPANIC 

5885
04:35:30,077 --> 04:35:33,380
PATIENTS WITH PAH HAVE BETTER 

5886
04:35:33,380 --> 04:35:35,716
SURVIVAL THAN NON-HISPANIC OR 

5887
04:35:35,716 --> 04:35:37,951
NON-HISPANIC BLACK PATIENTS. 

5888
04:35:37,951 --> 04:35:38,318
NEXT SLIDE. 

5889
04:35:38,318 --> 04:35:45,792
    SIMILAR PATTERN WAS SEEN BY 

5890
04:35:45,792 --> 04:35:47,494
SANDEEP SAHAY FROM HOUSTON 

5891
04:35:47,494 --> 04:35:51,331
METHODIST. NEXT SLIDE. IN THIS 

5892
04:35:51,331 --> 04:35:53,033
SPECIFIC ANALYSIS IT WAS 

5893
04:35:53,033 --> 04:35:55,269
HISPANIC INDIVIDUALS WILL HAVE 

5894
04:35:55,269 --> 04:35:57,104
BETTER SURVIVAL OR DO IN THIS 

5895
04:35:57,104 --> 04:36:00,274
MUCH LARGER STUDY USING DATA, 

5896
04:36:00,274 --> 04:36:02,442
ONCE THEY ADJUSTED FOR AGE OF 

5897
04:36:02,442 --> 04:36:04,845
INDIVIDUALS OR SUB TYPE OF PAH, 

5898
04:36:04,845 --> 04:36:06,380
DIFFERENCES IN SURVIVOR WERE NO 

5899
04:36:06,380 --> 04:36:14,087
LONGER SEEN. NEXT SLIDE. ALSO 

5900
04:36:14,087 --> 04:36:16,290
MENTION THIS STUDY FROM PATIENTS

5901
04:36:16,290 --> 04:36:18,925
THAT BELONG TO TWO HOSPITAL 

5902
04:36:18,925 --> 04:36:20,193
SYSTEMS WHICH ARE DUKE AND 

5903
04:36:20,193 --> 04:36:23,964
CLEVELAND CLINIC, NEXT SLIDE. 

5904
04:36:23,964 --> 04:36:26,433
    IN THIS SPECIFIC STUDY THEY 

5905
04:36:26,433 --> 04:36:30,437
SHOW THAT BLACK PATIENTS HAD 

5906
04:36:30,437 --> 04:36:33,507
BETTER SURVIVAL THAN WHITE 

5907
04:36:33,507 --> 04:36:36,076
INDIVIDUALS IN THE (?) ANALYSIS,

5908
04:36:36,076 --> 04:36:38,045
TAKING INTO ACCOUNT THE 

5909
04:36:38,045 --> 04:36:40,647
INSURANCE OF INDIVIDUALS. THIS 

5910
04:36:40,647 --> 04:36:43,817
DIFFERENCES DISAPPEARED, WHICH 

5911
04:36:43,817 --> 04:36:45,919
LED TO HYPOTHESIZE THAT PERHAPS 

5912
04:36:45,919 --> 04:36:47,654
ANY DIFFERENCE RELATED TO RACE 

5913
04:36:47,654 --> 04:36:58,165
AND ETHNICITY HAS TO BE ACCO

5914
04:36:58,165 --> 04:37:00,967
ACCOUNTED. WITH THE STANFORD 

5915
04:37:00,967 --> 04:37:03,470
GROUP AND STEVEN KAYWOOD WE USED

5916
04:37:03,470 --> 04:37:05,172
DATA FROM THE FAR A FEW YEARS 

5917
04:37:05,172 --> 04:37:08,342
AGO AND WANTED TO ASSESS 

5918
04:37:08,342 --> 04:37:10,444
DIFFERENCE IN SURVIVAL IN 

5919
04:37:10,444 --> 04:37:13,980
HISPANIC PATIENTS WITH PAH BUT 

5920
04:37:13,980 --> 04:37:15,282
WANTED TO CONDUCT THE SOCIAL 

5921
04:37:15,282 --> 04:37:16,883
DEMOGRAPHIC AND PROFILE OF THE 

5922
04:37:16,883 --> 04:37:20,354
PATIENTS AND TO KNOW WHAT WAS 

5923
04:37:20,354 --> 04:37:21,321
THE SIGNIFICANCE OF SOCIAL 

5924
04:37:21,321 --> 04:37:21,922
DETERMINANTS OF HEALTH WHEN 

5925
04:37:21,922 --> 04:37:24,458
COMES TO SURVIVAL. THE NEXT 

5926
04:37:24,458 --> 04:37:24,691
SLIDE. 

5927
04:37:24,691 --> 04:37:26,293
    WE FOUND, AND NOT SURPRISING

5928
04:37:26,293 --> 04:37:28,228
TO ANY OF YOU, THAT HISPANIC 

5929
04:37:28,228 --> 04:37:30,797
INDIVIDUALS HAD LOWER INCOME 

5930
04:37:30,797 --> 04:37:32,632
THAN NON-HISPANIC. AS YOU CAN 

5931
04:37:32,632 --> 04:37:34,868
SEE, UP TO A THIRD OF PATIENTS 

5932
04:37:34,868 --> 04:37:39,539
HAD ANNUAL INCOME OF LESS THAN 

5933
04:37:39,539 --> 04:37:41,007
$20,000. NEXT SLIDE. 

5934
04:37:41,007 --> 04:37:42,776
    WHEN COMES TO SURVIVAL YOU 

5935
04:37:42,776 --> 04:37:44,745
HAVE ADJUSTED ANALYSIS SO YOU 

5936
04:37:44,745 --> 04:37:46,046
SEE THE HISPANIC INDIVIDUALS. 

5937
04:37:46,046 --> 04:37:48,115
HOWEVER ON RIGHT YOU CAN SEE THE

5938
04:37:48,115 --> 04:37:50,951
ADJUSTED CURVE WHERE WE DO A 

5939
04:37:50,951 --> 04:37:55,522
MULTI VARIABLE ANALYSIS FOR AGE,

5940
04:37:55,522 --> 04:37:57,691
SEX, (?) EDUCATION LEVEL, INCOME

5941
04:37:57,691 --> 04:38:01,395
AND HEALTH INSURANCE. AFTER WE 

5942
04:38:01,395 --> 04:38:03,196
ADJUST FOR THIS VARIABLES WE DO 

5943
04:38:03,196 --> 04:38:05,732
NOT SEE ANY DIFFERENCES IN 

5944
04:38:05,732 --> 04:38:07,634
SURVIVAL. THIS LED US TO 

5945
04:38:07,634 --> 04:38:10,871
HYPOTHESIZE THAT ALTHOUGH IT IS 

5946
04:38:10,871 --> 04:38:13,206
POSSIBLE THAT FOR DIFFERENT 

5947
04:38:13,206 --> 04:38:15,208
BIOLOGICAL REASONS THAT HISPANIC

5948
04:38:15,208 --> 04:38:17,310
PATIENTS COULD HAVE BETTER 

5949
04:38:17,310 --> 04:38:19,413
SURVIVAL. THE SIGNIFICANCE OF 

5950
04:38:19,413 --> 04:38:21,314
THIS BETTER SURVIVAL IS 

5951
04:38:21,314 --> 04:38:26,186
MITIGATED IN THE PRESENCE OF 

5952
04:38:26,186 --> 04:38:28,455
SOCIAL DISADVANTAGE. NEXT SLIDE.

5953
04:38:28,455 --> 04:38:29,756
    NOW LET ME TELL YOU ABOUT 

5954
04:38:29,756 --> 04:38:31,758
SOME OF THE GAPS IN KNOWLEDGE WE

5955
04:38:31,758 --> 04:38:37,464
HAVE. THE NEXT SLIDE. 

5956
04:38:37,464 --> 04:38:42,068
    I BELIEVE SEEING THE 2017-18

5957
04:38:42,068 --> 04:38:43,403
STATEMENT THERE HAS BEEN 

5958
04:38:43,403 --> 04:38:46,273
IMPROVEMENT AND INCREMENT ON 

5959
04:38:46,273 --> 04:38:47,641
PUBLICATIONS LED TO HEALTH 

5960
04:38:47,641 --> 04:38:49,776
QUALITY IN PAH BUT MOST STUDIES 

5961
04:38:49,776 --> 04:38:51,578
HAVE BEEN FOCUSSING ON THE 

5962
04:38:51,578 --> 04:38:52,913
HISPANIC POPULATION, WHICH IS 

5963
04:38:52,913 --> 04:38:55,649
IMPORTANT TO DO SO. HISPANIC 

5964
04:38:55,649 --> 04:38:57,317
PATIENTS PERCENT LARGEST 

5965
04:38:57,317 --> 04:38:58,652
MINORITY GROUP IN THE U.S.  BUT 

5966
04:38:58,652 --> 04:39:00,053
THERE IS SO MUCH MORE WE DON'T 

5967
04:39:00,053 --> 04:39:04,224
KNOW ABOUT OTHER MINORITY GROUPS

5968
04:39:04,224 --> 04:39:06,159
SUCH AS BLACK PATIENTS, BLACK 

5969
04:39:06,159 --> 04:39:08,094
AMERICANS, ASIAN AMERICANS AND 

5970
04:39:08,094 --> 04:39:10,030
NATIVE AMERICAN PATIENTS WITH 

5971
04:39:10,030 --> 04:39:11,998
PH. THERE IS MORE THAN WE NEED 

5972
04:39:11,998 --> 04:39:13,934
TO KNOW ABOUT THE SIGNIFICANCE 

5973
04:39:13,934 --> 04:39:17,471
OF OMICS IN MINORITIES. I 

5974
04:39:17,471 --> 04:39:20,440
BELIEVE DATA FROM PVDOMICS WILL 

5975
04:39:20,440 --> 04:39:23,143
BE USEFUL TO UNDERSTAND THAT. WE

5976
04:39:23,143 --> 04:39:24,711
NEED TO UNDERSTAND WHAT IS 

5977
04:39:24,711 --> 04:39:26,646
SIGNIFICANCE OF DIFFERENCES IN 

5978
04:39:26,646 --> 04:39:27,981
GEOGRAPHIC OR ENVIRONMENTAL 

5979
04:39:27,981 --> 04:39:29,749
EXPOSURES. WE NEED TO KNOW MORE 

5980
04:39:29,749 --> 04:39:31,651
ABOUT PH OUTSIDE U.S.  AND 

5981
04:39:31,651 --> 04:39:34,120
OUTSIDE OF EUROPE. I THINK WE 

5982
04:39:34,120 --> 04:39:40,093
ALSO NEED TO KNOW MORE ABOUT 

5983
04:39:40,093 --> 04:39:41,428
DIFFERENCES IN DEMOGRAPHICS OF 

5984
04:39:41,428 --> 04:39:50,504
ALL FORMS, NOT JUST PH OR CTIF. 

5985
04:39:50,504 --> 04:39:51,605
I WILL FINALIZE THAT SOCIAL 

5986
04:39:51,605 --> 04:39:54,608
DETERMINANTS OF HEALTH IS JUST A

5987
04:39:54,608 --> 04:39:57,310
COMPONENT OF DIFFERENCES, ACCESS

5988
04:39:57,310 --> 04:39:59,746
TO CARE OR DIFFERENCES OF HEALTH

5989
04:39:59,746 --> 04:40:03,850
CARE EQUALITY. BUT PERHAPS WHAT 

5990
04:40:03,850 --> 04:40:07,354
MATTERS THE MOST IS HOW 

5991
04:40:07,354 --> 04:40:08,955
INDIVIDUALS RECEIVE THESE AT THE

5992
04:40:08,955 --> 04:40:11,591
INDIVIDUAL LEVEL, MEANING IN THE

5993
04:40:11,591 --> 04:40:14,394
PRESENCE OF SOCIAL DISADVANTAGE,

5994
04:40:14,394 --> 04:40:17,163
WHAT IS THE COMMUNITY EFFECT ON 

5995
04:40:17,163 --> 04:40:20,300
GLOBAL STRESS. WHAT IS THE 

5996
04:40:20,300 --> 04:40:21,868
SIGNIFICANCE OF THESE CHRONIC 

5997
04:40:21,868 --> 04:40:23,637
AND MITIGATED STRESS AT THE 

5998
04:40:23,637 --> 04:40:24,871
INDIVIDUAL LEVEL. THERE ARE 

5999
04:40:24,871 --> 04:40:26,439
DIFFERENT WAYS THAT CAN BE DONE.

6000
04:40:26,439 --> 04:40:28,141
I BELIEVE ONE OF THESE WAYS TO 

6001
04:40:28,141 --> 04:40:33,213
DO SO COULD BE THE ALOSTATIC 

6002
04:40:33,213 --> 04:40:35,081
LOAD, REFERRING TO A MEASUREMENT

6003
04:40:35,081 --> 04:40:37,751
OF GLOBAL STRESS THAT IS 

6004
04:40:37,751 --> 04:40:44,457
REFLECTED BY HYPERACTIVITY. YOUR

6005
04:40:44,457 --> 04:40:45,525
SYMPATHETIC SYSTEM. OUR GROUP 

6006
04:40:45,525 --> 04:40:47,360
GOT FUNDED TO STUDY DIFFERENCE 

6007
04:40:47,360 --> 04:40:54,467
OF ALOSTATIC LOADS IN HISPANIC 

6008
04:40:54,467 --> 04:40:56,369
PATIENTS WITH PAH AND I'M VERY 

6009
04:40:56,369 --> 04:40:59,306
MUCH LOOKING FORWARD TO HEAR THE

6010
04:40:59,306 --> 04:41:00,774
NEXT THREE PRESENTATIONS AND THE

6011
04:41:00,774 --> 04:41:05,178
PRESENTATION BY DR. JASON GLENN 

6012
04:41:05,178 --> 04:41:05,845
TOMORROW. NEXT SLIDE. 

6013
04:41:05,845 --> 04:41:07,881
    AS A SUMMARY MINORITIES HAD 

6014
04:41:07,881 --> 04:41:09,883
ANNUAL PERCENTAGE IN PAH 

6015
04:41:09,883 --> 04:41:11,918
REGISTRIES IN CLINICAL TRIALS 

6016
04:41:11,918 --> 04:41:14,020
AND RACE, ETHNICITY AND 

6017
04:41:14,020 --> 04:41:15,755
SOCIOECONOMIC FACTORS NEED TO BE

6018
04:41:15,755 --> 04:41:16,756
CONSIDERED WHEN ASSESSING 

6019
04:41:16,756 --> 04:41:18,425
INDIVIDUAL OF RISK AND HAS TO BE

6020
04:41:18,425 --> 04:41:20,694
MUCH MORE AWARENESS ABOUT WHAT 

6021
04:41:20,694 --> 04:41:23,930
CAN WE DO AS A GLOBAL LEVEL. 

6022
04:41:23,930 --> 04:41:25,765
NEXT SLIDE. THANK YOU TO MY 

6023
04:41:25,765 --> 04:41:27,100
COLLABORATORS. I THINK WE CAN DO

6024
04:41:27,100 --> 04:41:32,872
A FEW QUESTIONS. NEXT SLIDE. 

6025
04:41:32,872 --> 04:41:33,340
THANK YOU. 

6026
04:41:33,340 --> 04:41:35,942
>> THANK YOU VERY MUCH,
DR. 

6027
04:41:35,942 --> 04:41:39,412
BERNARDO. THAT WAS EXCELLENT 

6028
04:41:39,412 --> 04:41:41,948
OVERVIEW OF THE SOCIAL 

6029
04:41:41,948 --> 04:41:45,218
DETERMINANTS, HOW THEY INTERACT 

6030
04:41:45,218 --> 04:41:47,887
WITH HEALTH CARE DISPARITIES AND

6031
04:41:47,887 --> 04:41:49,322
PH. YOU BROUGHT UP ESSENTIALLY 

6032
04:41:49,322 --> 04:41:51,224
SEVERAL STUDIES, INCLUDING YOUR 

6033
04:41:51,224 --> 04:41:54,761
OWN WITH THE FAR, THAT LOOK AT 

6034
04:41:54,761 --> 04:41:55,795
WHEN CONTROLLING -- OF COURSE 

6035
04:41:55,795 --> 04:41:56,930
THIS IS PARTICULAR I THINK TO 

6036
04:41:56,930 --> 04:41:59,032
THE HISPANIC POPULATION. YOU 

6037
04:41:59,032 --> 04:42:01,801
ALLUDED TO SOMETHING WITH THE 

6038
04:42:01,801 --> 04:42:08,308
BLACK POPULATION AS WELL. IN 

6039
04:42:08,308 --> 04:42:09,809
MODELS, WHEN LOOKING AT 

6040
04:42:09,809 --> 04:42:15,415
MULTI -VARIANT MODELS AND 

6041
04:42:15,415 --> 04:42:16,850
CONTROLLING FOR SOCIOECONOMIC 

6042
04:42:16,850 --> 04:42:22,389
DETERMINANTS YOU SEE SOME OF THE

6043
04:42:22,389 --> 04:42:25,825
RACIAL DISPARITIES ARE NOW 

6044
04:42:25,825 --> 04:42:26,893
NON-SIGNIFICANT. IS THAT TRUE TO

6045
04:42:26,893 --> 04:42:28,028
YOUR RESULTS? 

6046
04:42:28,028 --> 04:42:29,996
>> YES. ONE OF THE THINGS
WE 

6047
04:42:29,996 --> 04:42:32,032
NEED TO KEEP IN MIND, BASED ON 

6048
04:42:32,032 --> 04:42:34,200
STUDIES WE HAVE DONE, IS WE ARE 

6049
04:42:34,200 --> 04:42:40,807
USING DATA FROM THE FAR THAT 

6050
04:42:40,807 --> 04:42:43,943
ALTHOUGH I CONSIDER IT THE BEST 

6051
04:42:43,943 --> 04:42:50,617
REGISTRY TO UNDERSTAND BEST  

6052
04:42:50,617 --> 04:42:51,551
REGISTRY TO UNITED STATES SOCIAL

6053
04:42:51,551 --> 04:42:55,088
DETERMINANTS OF HEALTH ARE 

6054
04:42:55,088 --> 04:42:56,122
PATIENTS THAT RECEIVE FROM 

6055
04:42:56,122 --> 04:42:57,524
CENTERS OF EXCELLENCE SO DATA 

6056
04:42:57,524 --> 04:42:59,059
THAT MAY NOT NECESSARILY REFLECT

6057
04:42:59,059 --> 04:43:01,094
IN THE COMMUNITY OR HAVE MORE 

6058
04:43:01,094 --> 04:43:02,262
DIFFICULTIES IN ACCESSING THESE 

6059
04:43:02,262 --> 04:43:07,801
TYPE OF CENTERS. SO IT IS 

6060
04:43:07,801 --> 04:43:11,271
POSSIBLE THAT WHAT WE DON'T FIND

6061
04:43:11,271 --> 04:43:12,138
DIFFERENCE IN SURVIVAL WHEN 

6062
04:43:12,138 --> 04:43:14,441
COMES TO RACE, ETHNICITY AND 

6063
04:43:14,441 --> 04:43:20,180
FEDERAL POVERTY LEVELS, PERHAPS 

6064
04:43:20,180 --> 04:43:23,683
THAT IS DUE PATIENTS ARE FINALLY

6065
04:43:23,683 --> 04:43:26,119
GETTING STANDARD OF CARE FOR PAH

6066
04:43:26,119 --> 04:43:27,654
PATIENTS. COULD BE DIFFERENT 

6067
04:43:27,654 --> 04:43:29,022
REALITY FOR PATIENTS THAT EITHER

6068
04:43:29,022 --> 04:43:32,125
ARE NOT GETTING DIAGNOSED YET OR

6069
04:43:32,125 --> 04:43:35,762
INSURANCES OR PROVIDERS DON'T 

6070
04:43:35,762 --> 04:43:38,098
KNOW HOW TO MAKE PROPER WAY TO 

6071
04:43:38,098 --> 04:43:41,534
SEND PATIENTS TO CENTERS OF MORE

6072
04:43:41,534 --> 04:43:42,602
EXPERIENCE IN PAH. 

6073
04:43:42,602 --> 04:43:46,840
>> THAT IS A FAIR POINT.
ONE OF 

6074
04:43:46,840 --> 04:43:51,444
MY QUESTIONS TO YOU IS ASSUMING 

6075
04:43:51,444 --> 04:43:58,084
THAT POTENTIALLY SOCIOECONOMIC 

6076
04:43:58,084 --> 04:44:01,788
STATUS OR SOCIAL DETERMINANTS 

6077
04:44:01,788 --> 04:44:04,190
ARE MEDIATORS OF RACIAL 

6078
04:44:04,190 --> 04:44:07,427
DIFFERENCES OR ETHNIC 

6079
04:44:07,427 --> 04:44:10,130
DIFFERENCES, STRUCTURAL RACISM 

6080
04:44:10,130 --> 04:44:13,066
BEING AN PREACH TO STUDIES, OF 

6081
04:44:13,066 --> 04:44:15,902
COURSE WHICH IS AN IMPORTANT 

6082
04:44:15,902 --> 04:44:17,337
QUESTION AND THEREFORE IN THAT 

6083
04:44:17,337 --> 04:44:20,106
CONTEXT PERHAPS IT IS USEFUL TO 

6084
04:44:20,106 --> 04:44:23,910
INVESTIGATE RACE. BUT PERHAPS IS

6085
04:44:23,910 --> 04:44:27,547
IT EQUALLY OR PERHAPS MORE 

6086
04:44:27,547 --> 04:44:33,486
IMPORTANT THAT WE IDENTIFY THE 

6087
04:44:33,486 --> 04:44:36,055
SOCIAL DETERMINANTS AS MEDIATORS

6088
04:44:36,055 --> 04:44:40,093
OF THE OUTCOMES THAN NECESSARILY

6089
04:44:40,093 --> 04:44:44,197
DIVERTING OUR ATTENTION TO 

6090
04:44:44,197 --> 04:44:47,567
CATEGORIZING SUBGROUPS WITHIN 

6091
04:44:47,567 --> 04:44:55,008
RACE. DOES THAT MAKE SENSE? 

6092
04:44:55,008 --> 04:44:58,311
>> ON THE TOPIC, I WAS
READING A

6093
04:44:58,311 --> 04:44:59,179
MEDICAL YESTERDAY ABOUT 

6094
04:44:59,179 --> 04:45:02,482
MEDIATION ANALYSIS ABOUT THE 

6095
04:45:02,482 --> 04:45:05,885
MECHANISMS THAT DRIVE HEALTH 

6096
04:45:05,885 --> 04:45:09,455
CARE INEQUALITY. WHILE SOCIAL 

6097
04:45:09,455 --> 04:45:10,056
DETERMINANTS OF HEALTH MAY 

6098
04:45:10,056 --> 04:45:12,625
EXPLAIN PARTIALLY SOME OF THE 

6099
04:45:12,625 --> 04:45:14,327
DIFFERENCES, MEANING BARRIERS OF

6100
04:45:14,327 --> 04:45:16,930
INDIVIDUALS SAY IS TO GET PROPER

6101
04:45:16,930 --> 04:45:18,565
ACCESS TO HEALTH CARE, THERE ARE

6102
04:45:18,565 --> 04:45:22,101
OTHER COMPONENTS THAT CERTAINLY 

6103
04:45:22,101 --> 04:45:23,803
MATTER PERHAPS THE SAME OR SOME 

6104
04:45:23,803 --> 04:45:27,106
PERHAPS MORE SUCH AS ONE OF THE 

6105
04:45:27,106 --> 04:45:31,744
SPEAKERS ALLUDED TO TODAY THAT 

6106
04:45:31,744 --> 04:45:34,614
MICRO-TRAUMA, STRESS, SYSTEMIC 

6107
04:45:34,614 --> 04:45:37,784
RACISM, DISCRIMINATION, THESE 

6108
04:45:37,784 --> 04:45:40,553
OTHER FACTORS THAT PERHAPS 

6109
04:45:40,553 --> 04:45:42,622
RELATED MORE TO HOW INTERVIEWER 

6110
04:45:42,622 --> 04:45:44,224
PERCEIVES THESE BARE YERS AND 

6111
04:45:44,224 --> 04:45:47,460
HOW ALL THESE FACTORS AFFECT 

6112
04:45:47,460 --> 04:45:48,661
WELL-BEING OF AN INDIVIDUAL MAY 

6113
04:45:48,661 --> 04:45:53,833
HAVE A HIGHER IMPACT INTO THEIR 

6114
04:45:53,833 --> 04:45:56,970
DECISION AND HOW THEY ADAPT TO 

6115
04:45:56,970 --> 04:46:00,473
THIS. PART OF THE REASON FOR THE

6116
04:46:00,473 --> 04:46:02,508
ALOSTATIC LOAD CONCEPT, 

6117
04:46:02,508 --> 04:46:03,910
MEASURING MECHANISM DRIVING 

6118
04:46:03,910 --> 04:46:06,613
HEALTH CARE AND EQUALITY IS 

6119
04:46:06,613 --> 04:46:10,583
MEASURING MORE ABOUT THE GLOBAL 

6120
04:46:10,583 --> 04:46:11,618
UNMITIGATED DISTRESS INDIVIDUALS

6121
04:46:11,618 --> 04:46:15,688
ARE FACING ON A DAILY BASIS. 

6122
04:46:15,688 --> 04:46:17,624
THIS SIGNIFICANT STRESS THEY 

6123
04:46:17,624 --> 04:46:19,092
FACE MAY PLAY A ROLE INTO HOW 

6124
04:46:19,092 --> 04:46:23,863
THEY HAVE A MALADAPTIVE RESPONSE

6125
04:46:23,863 --> 04:46:26,599
TO A CERTAIN PHASE. 

6126
04:46:26,599 --> 04:46:31,037
>> THANK YOU. 

6127
04:46:31,037 --> 04:46:32,939
>> I WAS INTERESTED IN
DATA YOU 

6128
04:46:32,939 --> 04:46:35,575
WERE SHOWING, NO DIFFERENCES IN 

6129
04:46:35,575 --> 04:46:36,476
TRANSPLANT-FREE SURVIVAL BETWEEN

6130
04:46:36,476 --> 04:46:37,377
DIFFERENT GROUPS WHEN LOOKING AT

6131
04:46:37,377 --> 04:46:40,346
SOME OF THE -- AFTER LOOKING AT 

6132
04:46:40,346 --> 04:46:41,514
SOCIOECONOMIC FACTORS AND 

6133
04:46:41,514 --> 04:46:43,616
LOOKING AT POVERTY, ET CETERA. 

6134
04:46:43,616 --> 04:46:45,652
BUT IT RAISES THE QUESTION, IS 

6135
04:46:45,652 --> 04:46:47,654
THAT THE WRONG METRIC TO LOOK AT

6136
04:46:47,654 --> 04:46:51,090
AND SHOULD WE BE LOOKING AT SOME

6137
04:46:51,090 --> 04:46:54,827
MORE LIKE -- MORBIDITY BURDEN? 

6138
04:46:54,827 --> 04:46:57,297
SO THAT, YOU KNOW, IF -- 

6139
04:46:57,297 --> 04:46:59,065
REGARDLESS OF THE FACT THERE IS 

6140
04:46:59,065 --> 04:47:02,001
NO DIFFERENCE IN TRANSPLANT-FREE

6141
04:47:02,001 --> 04:47:03,136
SURVIVAL, ARE THESE PATIENTS 

6142
04:47:03,136 --> 04:47:05,939
LIVING THE SAME LIVES TO GET TO 

6143
04:47:05,939 --> 04:47:07,607
THAT END POINT BEFORE -- FOR 

6144
04:47:07,607 --> 04:47:13,112
THOSE THAT DON'T GET TO THAT END

6145
04:47:13,112 --> 04:47:16,416
POINT, I SHOULD SAY. 

6146
04:47:16,416 --> 04:47:18,918
>> I WILL ANSWER THE
QUESTION, 

6147
04:47:18,918 --> 04:47:20,386
JANE. MAYBE A SIMILAR AMOUNT BUT

6148
04:47:20,386 --> 04:47:22,188
THE WAY THEY LIVE IS PROBABLY 

6149
04:47:22,188 --> 04:47:23,790
MORE IMPAIRED. THE FACT THEY ARE

6150
04:47:23,790 --> 04:47:26,893
GOING TO THE EMERGENCY ROOM OR 

6151
04:47:26,893 --> 04:47:28,928
GETTING HOSPITALIZED MORE 

6152
04:47:28,928 --> 04:47:30,396
FREQUENT MAY SUGGEST THEIR 

6153
04:47:30,396 --> 04:47:31,831
DEFICIENCIES ARE NOT PROPERLY 

6154
04:47:31,831 --> 04:47:34,000
CONTROLLED. YES, THEY LIVE THE 

6155
04:47:34,000 --> 04:47:35,902
SAME BUT THEIR QUALITY OF LIFE 

6156
04:47:35,902 --> 04:47:38,471
MAYBE BE FURTHER IMPAIRED WITH 

6157
04:47:38,471 --> 04:47:39,672
AT LEAST BASELINE. THEY HAVE 

6158
04:47:39,672 --> 04:47:44,110
MORE IMPAIRED QUALITY OF LIFE 

6159
04:47:44,110 --> 04:47:45,311
METRICS. BUT ALSO IT RAISES THE 

6160
04:47:45,311 --> 04:47:47,013
QUESTION, WHY ARE THESE PATIENTS

6161
04:47:47,013 --> 04:47:47,947
GETTING HOSPITALIZED MORE 

6162
04:47:47,947 --> 04:47:52,018
FREQUENT OR GOING O THE ER MORE 

6163
04:47:52,018 --> 04:47:54,887
FREQUENT? IS THIS BECAUSE IS NOT

6164
04:47:54,887 --> 04:47:56,022
OPTIMALLY CONTROLLED OR BECAUSE 

6165
04:47:56,022 --> 04:47:58,324
THEY ARE HAVING MORE BARRIERS OR

6166
04:47:58,324 --> 04:48:01,627
DIFFICULTIES FROM GETTING ACCESS

6167
04:48:01,627 --> 04:48:05,365
TO COME FROM PROVIDERS. BECAUSE 

6168
04:48:05,365 --> 04:48:06,466
IDEALLY WHEN PATIENTS NEEDS 

6169
04:48:06,466 --> 04:48:08,134
HAVING MORE SYMPTOMS OR SO, WE 

6170
04:48:08,134 --> 04:48:09,535
EXPECT THEM TO CALL OUR CENTER 

6171
04:48:09,535 --> 04:48:13,673
SO WE CAN PROVIDE SOME ADVICE OR

6172
04:48:13,673 --> 04:48:16,242
DO SOME TESTING OR ADJUST 

6173
04:48:16,242 --> 04:48:18,378
MEDICATIONS TO PREVENT THEM FROM

6174
04:48:18,378 --> 04:48:20,747
HAVING TO GET TREATED. PERHAPS 

6175
04:48:20,747 --> 04:48:22,048
MINORITIES ARE FACING BARRIERS 

6176
04:48:22,048 --> 04:48:24,217
ABOUT THIS. INCLUDING PATIENTS 

6177
04:48:24,217 --> 04:48:26,552
LIVING AT THE POVERTY LEVELS. WE

6178
04:48:26,552 --> 04:48:28,921
DON'T KNOW. I DON'T AGREE THAT 

6179
04:48:28,921 --> 04:48:31,491
SURVIVAL MAY NOT BE THE BEST 

6180
04:48:31,491 --> 04:48:36,629
METRIC TO ASSESS (BELL) A 

6181
04:48:36,629 --> 04:48:38,131
SIGNIFICANCE OF HEALTH CARE 

6182
04:48:38,131 --> 04:48:39,198
DISPARITIES. 

6183
04:48:39,198 --> 04:48:41,501
>> HAS SOMEONE GONE BACK
AND 

6184
04:48:41,501 --> 04:48:47,040
SOMETHING SIMPLE LIKE 

6185
04:48:47,040 --> 04:48:47,673
CALCULATING THE CHARLESTON 

6186
04:48:47,673 --> 04:48:50,843
MORBIDITY INDEX TO SEE IF THERE 

6187
04:48:50,843 --> 04:48:57,617
ARE DIFFERENCES DESPITE THE 

6188
04:48:57,617 --> 04:49:03,189
(AUDIO INTERRUPTION) MAKES 

6189
04:49:03,189 --> 04:49:03,423
SENSE. 

6190
04:49:03,423 --> 04:49:09,228
>> DR. SANDEEP, QUESTION? 

6191
04:49:09,228 --> 04:49:11,230
>> I WAS WONDERING ABOUT 

6192
04:49:11,230 --> 04:49:13,399
SURVIVAL. THESE ARE MULTIPLE 

6193
04:49:13,399 --> 04:49:17,970
STUDIES. ANALYSIS, YOUR FOREIGN 

6194
04:49:17,970 --> 04:49:19,405
ANALYSIS AND I GUESS THERE WAS 

6195
04:49:19,405 --> 04:49:20,540
ANOTHER PAPER. NONE ARE REALLY 

6196
04:49:20,540 --> 04:49:22,809
SHOWING THAT RACE-BASED 

6197
04:49:22,809 --> 04:49:25,445
DIFFERENCES IN THE SURVIVAL. BUT

6198
04:49:25,445 --> 04:49:28,781
I AGREE WITH YOU THAT ISSUES NOT

6199
04:49:28,781 --> 04:49:31,984
JUST THE SURVIVAL BUT THERE ARE 

6200
04:49:31,984 --> 04:49:34,821
MULTIPLE ISSUES LIKE EARLIER 

6201
04:49:34,821 --> 04:49:38,157
THIS MORNING THIS WAS ABOUT 

6202
04:49:38,157 --> 04:49:41,627
INVOLVEMENT IN ENROLLMENT IN 

6203
04:49:41,627 --> 04:49:43,362
TRIALS, ISSUES AND CLINICAL 

6204
04:49:43,362 --> 04:49:44,897
TRIALS. SO THAT IS ONE ISSUE. 

6205
04:49:44,897 --> 04:49:47,233
DON'T KNOW IF THERE IS DATA 

6206
04:49:47,233 --> 04:49:48,935
ABOUT -- PARTICULARLY FOR 

6207
04:49:48,935 --> 04:49:49,535
HOSPITALIZATION OR ANYTHING 

6208
04:49:49,535 --> 04:49:54,040
BECAUSE IF YOU ARE LOOKING 

6209
04:49:54,040 --> 04:49:55,975
PARTICULARLY AT HOSPITALIZATION,

6210
04:49:55,975 --> 04:49:59,445
THEN THEY KNOW THAT SHOULD -- 

6211
04:49:59,445 --> 04:50:01,781
SURVIVAL AS WELL. WE SHOULD SEE 

6212
04:50:01,781 --> 04:50:03,516
SOME DIFFERENCE IN SURVIVAL. I 

6213
04:50:03,516 --> 04:50:07,286
DON'T KNOW WHAT IS THE RIGHT 

6214
04:50:07,286 --> 04:50:09,489
ANSWER. I GUESS WE NEED TO LOOK 

6215
04:50:09,489 --> 04:50:11,290
BACK INTO THESE DATABASES AGAIN,

6216
04:50:11,290 --> 04:50:13,593
WHY WE ARE NOT SEEING THAT 

6217
04:50:13,593 --> 04:50:14,861
SURVIVAL DIFFERENCES. DESPITE OF

6218
04:50:14,861 --> 04:50:18,898
IF WE ARE SAYING THAT 

6219
04:50:18,898 --> 04:50:20,099
AFRICAN-AMERICAN, HISPANIC OR 

6220
04:50:20,099 --> 04:50:21,567
MINORITIES ARE HAVING MORE 

6221
04:50:21,567 --> 04:50:25,738
HOSPITALIZATION, ER VISITS OR IF

6222
04:50:25,738 --> 04:50:30,309
THESE ARE PH LETTER WHY NO 

6223
04:50:30,309 --> 04:50:33,679
IMPACT ON SURVIVAL COMPARED TO 

6224
04:50:33,679 --> 04:50:34,413
EFFECTS CONSIDERED AS 

6225
04:50:34,413 --> 04:50:34,747
CONTROLLED. 

6226
04:50:34,747 --> 04:50:37,049
>> THAT IS A GREAT
QUESTION, 

6227
04:50:37,049 --> 04:50:38,484
SANDEEP. I DON'T HAVE AN ANSWER.

6228
04:50:38,484 --> 04:50:40,119
>> I DON'T HAVE AN ANSWER 

6229
04:50:40,119 --> 04:50:42,922
EITHER. BUT I DO BELIEVE THAT 

6230
04:50:42,922 --> 04:50:46,192
THERE IS SOMETHING PROBABLY WE 

6231
04:50:46,192 --> 04:50:51,931
ARE NOT LOOKING CLEARLY. I SEE 

6232
04:50:51,931 --> 04:50:53,533
(?) IS ONLINE BECAUSE HE HAS 

6233
04:50:53,533 --> 04:50:55,334
ANALYSIS FOR THAT. I KNOW ABOUT 

6234
04:50:55,334 --> 04:50:56,769
IT. GO AHEAD. YOU TALK ABOUT 

6235
04:50:56,769 --> 04:50:57,670
YOUR PAPER. 

6236
04:50:57,670 --> 04:50:59,705
>> NO, NO, THAT IS OKAY. I
LOVE 

6237
04:50:59,705 --> 04:51:01,607
THE DISCUSSION. I THINK IT IS 

6238
04:51:01,607 --> 04:51:02,775
REALLY IMPORTANT. I DON'T MEAN 

6239
04:51:02,775 --> 04:51:08,247
TO CUT YOU GUYS OFF EITHER. I 

6240
04:51:08,247 --> 04:51:11,317
THINK THAT SOMEONE WHO DOESN'T 

6241
04:51:11,317 --> 04:51:13,686
DO MUCH CLINICAL RESEARCH, I 

6242
04:51:13,686 --> 04:51:16,189
WILL HAVE TO DO SOME BASIC 

6243
04:51:16,189 --> 04:51:18,591
TRAINING TO UNDERSTAND PRIMARY, 

6244
04:51:18,591 --> 04:51:20,092
SECONDARY ENDPOINTS AND WHAT ARE

6245
04:51:20,092 --> 04:51:21,994
THE ENDPOINTS WE NEED TO LOOK AT

6246
04:51:21,994 --> 04:51:23,796
WHEN LOOKING AT POPULATION-LEVEL

6247
04:51:23,796 --> 04:51:25,164
STUDIES. ONE OF THE THINGS I 

6248
04:51:25,164 --> 04:51:27,433
LEARNED IS MORTALITY IS ALMOST A

6249
04:51:27,433 --> 04:51:31,404
DREAM WHEN WE TALK ABOUT -- AS 

6250
04:51:31,404 --> 04:51:35,474
AN ENDPOINT FOR CARDIOVASCULAR 

6251
04:51:35,474 --> 04:51:36,576
DISEASE, ESPECIALLY IF YOU LOOK 

6252
04:51:36,576 --> 04:51:39,779
AT THE CLINICAL TRIALS. WE NEVER

6253
04:51:39,779 --> 04:51:41,214
SAY MOST DRUGS LOOK ANYTHING 

6254
04:51:41,214 --> 04:51:42,048
LIKE MORTALITY BECAUSE WE DON'T 

6255
04:51:42,048 --> 04:51:43,583
HAVE THE POWER. THEN WHEN WE 

6256
04:51:43,583 --> 04:51:47,253
TALK ABOUT MORTALITY IN A RARE 

6257
04:51:47,253 --> 04:51:49,422
DISEASE IN A SUB POPULATION THAT

6258
04:51:49,422 --> 04:51:52,858
HAS BARELY BEEN REGISTERED, I 

6259
04:51:52,858 --> 04:51:55,361
THINK WE HAVE TO BE VERY CAREFUL

6260
04:51:55,361 --> 04:51:57,196
ABOUT OUR CONCLUSIONS. ONE OF 

6261
04:51:57,196 --> 04:52:00,399
THE THINGS I HAVE BEEN DINGED 

6262
04:52:00,399 --> 04:52:02,668
FOR IN MY PAST HAS BEEN 

6263
04:52:02,668 --> 04:52:04,937
OVERCORRECTING AND 

6264
04:52:04,937 --> 04:52:06,672
OVERADJUSTING. IF YOU LOOK AT 

6265
04:52:06,672 --> 04:52:09,075
YOUR SAMPLE POPULATION ACROSS 

6266
04:52:09,075 --> 04:52:12,345
ALL THESE PAPERS, WE ARE TALKING

6267
04:52:12,345 --> 04:52:16,482
A SAMPLE SIZE OF 50 TO 150 

6268
04:52:16,482 --> 04:52:18,918
HISPANIC PATIENTS, WHICH HOW 

6269
04:52:18,918 --> 04:52:22,388
MANY ACTUALLY DIED. THEN WHEN 

6270
04:52:22,388 --> 04:52:24,824
YOU TRY TO START ADDRESSING 

6271
04:52:24,824 --> 04:52:26,392
VARIOUS VARIABLES THAT CORRECT 

6272
04:52:26,392 --> 04:52:29,328
FOR MORTALITY, I THINK ANY 

6273
04:52:29,328 --> 04:52:31,063
NEGATIVE OR POSITIVE DATA, YOU 

6274
04:52:31,063 --> 04:52:33,165
HAVE TO BE A LITTLE CAREFUL 

6275
04:52:33,165 --> 04:52:34,967
ABOUT WHAT THAT REALLY MEANS. 

6276
04:52:34,967 --> 04:52:39,071
YOU KNOW, I DON'T WANT TO -- I 

6277
04:52:39,071 --> 04:52:42,008
THINK IT IS ONE OF MY GAPS. I 

6278
04:52:42,008 --> 04:52:43,843
THINK WE NEED TO DO A LOT MORE 

6279
04:52:43,843 --> 04:52:45,111
STUDIES WHERE OUR SAMPLE SIZE 

6280
04:52:45,111 --> 04:52:47,113
WILL HOPEFULLY EVOLVE AND GROW, 

6281
04:52:47,113 --> 04:52:54,420
SO WE CAN LOOK AT SOME OF THESE.

6282
04:52:54,420 --> 04:52:58,324
THE UNADJUSTED REMAINS 

6283
04:52:58,324 --> 04:52:59,792
DIFFERENT. DESPITE ALL THE 

6284
04:52:59,792 --> 04:53:02,161
NOISE, DESPITE THE VARIOUS 

6285
04:53:02,161 --> 04:53:04,330
COHORTS. SO, YOU KNOW, WE WILL 

6286
04:53:04,330 --> 04:53:05,831
GO INTO MORE OF THIS DISCUSSION 

6287
04:53:05,831 --> 04:53:07,033
TOMORROW. I WOULD SAY I DON'T 

6288
04:53:07,033 --> 04:53:09,101
KNOW IF WE KNOW THE ANSWER BUT I

6289
04:53:09,101 --> 04:53:12,171
THINK THERE IS A LOT MORE HERE 

6290
04:53:12,171 --> 04:53:14,640
THE DISCUSS. I'M REALLY GLAD WE 

6291
04:53:14,640 --> 04:53:15,574
ARE HAVING THAT DISCUSSION. 

6292
04:53:15,574 --> 04:53:19,845
>> I AGREE WITH YOU.
BECAUSE IN 

6293
04:53:19,845 --> 04:53:22,281
REVEAL ANALYSIS WHEN WE DID THE 

6294
04:53:22,281 --> 04:53:25,017
SURVIVE, WHEN YOU LOOK AT THE 

6295
04:53:25,017 --> 04:53:27,820
ORIGINAL PAPER FROM REVEAL, LED 

6296
04:53:27,820 --> 04:53:33,125
BY FARBAR, THAT WAS SURVIVAL FOR

6297
04:53:33,125 --> 04:53:35,594
CAUCASIAN POPULATION. BUT OUR 

6298
04:53:35,594 --> 04:53:37,830
ANALYSIS DID NOT. THE DIFFERENCE

6299
04:53:37,830 --> 04:53:43,135
WAS BECAUSE ADJUSTED FOR AGE AND

6300
04:53:43,135 --> 04:53:45,037
TYPE. JUST ONE MORE THING. WE 

6301
04:53:45,037 --> 04:53:48,307
DID NOT FIND. BUT YOU ARE -- IF 

6302
04:53:48,307 --> 04:53:51,911
YOU LOOK AT THE SAMPLE SIZE FOR 

6303
04:53:51,911 --> 04:53:53,913
AGING POPULATION, IN THAT IT IS 

6304
04:53:53,913 --> 04:53:57,016
LIKE 104 OR 150 PEOPLE. 

6305
04:53:57,016 --> 04:54:03,255
CAUCASIAN WAS LIKE AROUND 2,500 

6306
04:54:03,255 --> 04:54:03,856
AND AFRICAN-AMERICAN SAW LIKE 

6307
04:54:03,856 --> 04:54:05,257
800. LITERALLY LESS THAN HALF. 

6308
04:54:05,257 --> 04:54:07,326
REST ARE EVEN LESS THAN THAT. 

6309
04:54:07,326 --> 04:54:10,796
PROBABLY NUMBER OF EVENTS ARE 

6310
04:54:10,796 --> 04:54:11,831
MUCH LESS. 

6311
04:54:11,831 --> 04:54:14,333
>> (?) YOU AND I HAVE
SPOKE 

6312
04:54:14,333 --> 04:54:17,269
BEFORE. EVEN IF WE DO A META 

6313
04:54:17,269 --> 04:54:19,939
ANALYSIS, COMBINE THREE 

6314
04:54:19,939 --> 04:54:24,910
REGISTRIES OR SO, THE FORMATION 

6315
04:54:24,910 --> 04:54:30,616
BETWEEN REGISTRIES MAKES THESE 

6316
04:54:30,616 --> 04:54:33,486
COMBINATION OF DIFFERENT 

6317
04:54:33,486 --> 04:54:37,256
DATASETS DIFFICULT. BUT IN THE 

6318
04:54:37,256 --> 04:54:38,424
ANALYSIS HISPANIC PATIENTS SEEM 

6319
04:54:38,424 --> 04:54:40,192
TO HAVE BETTER SURVIVAL, 

6320
04:54:40,192 --> 04:54:41,026
WHATEVER THE MECHANISM OR 

6321
04:54:41,026 --> 04:54:42,628
WHATEVER WE ASSUME THAT IS. 

6322
04:54:42,628 --> 04:54:45,965
>> I THINK ANKIT YOU BRING
UP AN

6323
04:54:45,965 --> 04:54:47,233
INCREDIBLY IMPORTANT POINT. THIS

6324
04:54:47,233 --> 04:54:48,768
IS A GREAT DISCUSSION. I WANT TO

6325
04:54:48,768 --> 04:54:50,569
TABLE IT BECAUSE WE HAVE TO MOVE

6326
04:54:50,569 --> 04:54:53,339
ON. WE HAVE HAD SEVERAL 

6327
04:54:53,339 --> 04:54:54,407
QUESTIONS ABOUT THE HISPANIC 

6328
04:54:54,407 --> 04:54:57,777
PARADOX. ALSO I'M GOING TO COME 

6329
04:54:57,777 --> 04:55:03,282
BACK TO THAT FROM THE 

6330
04:55:03,282 --> 04:55:04,917
DISCUSSANTS. JUST TO SORT OF 

6331
04:55:04,917 --> 04:55:08,087
REITERATE WHAT YOU ARE SAYING 

6332
04:55:08,087 --> 04:55:10,356
AND IS -- I THINK IS INCREDIBLY 

6333
04:55:10,356 --> 04:55:12,358
IMPORTANT WITH REGARD TO 

6334
04:55:12,358 --> 04:55:15,060
ADJUSTMENT MODELS AND HOW THAT'S

6335
04:55:15,060 --> 04:55:17,363
-- I THINK WE SHOULD COME BACK 

6336
04:55:17,363 --> 04:55:20,833
TO THAT POINT TOO ALSO. WE NEED 

6337
04:55:20,833 --> 04:55:24,904
TO MOVE ON. SO LET'S MOVE ON TO 

6338
04:55:24,904 --> 04:55:30,176
OUR NEXT TALK. IT IS ON SOCIAL 

6339
04:55:30,176 --> 04:55:33,579
DISPARITIES, MENTAL HEALTH AND 

6340
04:55:33,579 --> 04:55:41,120
RECREATIONAL DRUG USE BY DPEREZ 

6341
04:55:41,120 --> 04:55:42,254
WHO DOES KNOW SOMETHING ABOUT 

6342
04:55:42,254 --> 04:55:44,290
THIS. HE IS AT STANFORD, 

6343
04:55:44,290 --> 04:55:47,493
ASSOCIATE DEAN OF ADMISSIONS AND

6344
04:55:47,493 --> 04:55:58,204
PROFESSOR OF MEDICINE. VENICIO. 

6345
04:55:58,204 --> 04:56:00,840
>> THANK YOU. WE WILL TALK
ABOUT

6346
04:56:00,840 --> 04:56:04,310
A LITTLE DIFFERENT OF THE TOPIC,

6347
04:56:04,310 --> 04:56:07,446
WHICH IS DRUGS. I REDEFINE TITLE

6348
04:56:07,446 --> 04:56:10,049
TO FOCUS ON SOCIAL DISPARITIES, 

6349
04:56:10,049 --> 04:56:11,417
METHAMPHETAMINE USE. THAT IS 

6350
04:56:11,417 --> 04:56:13,252
WHERE MY EXPERTISE LIES AND MOST

6351
04:56:13,252 --> 04:56:15,087
OF THE DATA I'M GOING SHARE WITH

6352
04:56:15,087 --> 04:56:16,989
YOU TODAY LIES. LET'S MOVE ON TO

6353
04:56:16,989 --> 04:56:20,860
THE NEXT SLIDE, PLEASE. I WILL 

6354
04:56:20,860 --> 04:56:23,796
BEGIN AND END WITH THIS SLIDE. 

6355
04:56:23,796 --> 04:56:27,066
THE EXPOSUM, A CONCEPT I WOULD 

6356
04:56:27,066 --> 04:56:30,035
LIKE FOR US TO THINK ABOUT AND 

6357
04:56:30,035 --> 04:56:32,671
HOPEFULLY INCORPORATE IN ALL THE

6358
04:56:32,671 --> 04:56:36,075
CONVERSATIONS MOVING FORWARD. 

6359
04:56:36,075 --> 04:56:38,010
ESPECIALLY AFTER THIS WORKSHOP 

6360
04:56:38,010 --> 04:56:39,545
BECAUSE IT INTEGRATES A LOT OF 

6361
04:56:39,545 --> 04:56:41,514
WHAT WE HAVE BEEN DISCUSSING BUT

6362
04:56:41,514 --> 04:56:44,917
ALSO ADDS OTHER ELEMENTS THAT 

6363
04:56:44,917 --> 04:56:47,853
ARE POTENTIAL MODIFIERS THAT 

6364
04:56:47,853 --> 04:56:48,921
INFLUENCE HEALTH OF THE 

6365
04:56:48,921 --> 04:56:50,089
POPULATION. WE HAVE BEEN TALKING

6366
04:56:50,089 --> 04:56:52,858
ABOUT SEX, WE HAVE BEEN TALKING 

6367
04:56:52,858 --> 04:57:01,066
ABOUT SOCIAL DETERMINE NA 

6368
04:57:01,066 --> 04:57:02,535
DETERMINANTS OF HEALTH. WE HAVE 

6369
04:57:02,535 --> 04:57:04,703
SPOKEN FROM POLLUTION TO 

6370
04:57:04,703 --> 04:57:06,772
POTENTIAL GEOGRAPHIC STRESSORS 

6371
04:57:06,772 --> 04:57:10,809
RELATED TO THE WORK THAT THEY DO

6372
04:57:10,809 --> 04:57:12,278
RELATED TO THEIR -- EVEN BEFORE 

6373
04:57:12,278 --> 04:57:18,817
THEY WERE BORN, RIGHT. SO 

6374
04:57:18,817 --> 04:57:20,152
ULTIMATELY WE HAVE TO THINK OF 

6375
04:57:20,152 --> 04:57:23,556
AN INDIVIDUAL IN THE SAME WAY WE

6376
04:57:23,556 --> 04:57:26,759
THINK ABOUT THE OMICS IN 

6377
04:57:26,759 --> 04:57:27,693
PARTICULAR. FOR THIS COMPLEXITY 

6378
04:57:27,693 --> 04:57:29,328
OF THE PATIENT, WE HAVE TO LOOK 

6379
04:57:29,328 --> 04:57:30,763
ALSO AT THE COMPLEXITY OUTSIDE 

6380
04:57:30,763 --> 04:57:32,531
OF THE PATIENT AS PART OF OUR 

6381
04:57:32,531 --> 04:57:34,500
APPROACH. I'M GOING TO FOCUS ON 

6382
04:57:34,500 --> 04:57:36,735
DRUGS BECAUSE THAT IS WHAT I 

6383
04:57:36,735 --> 04:57:38,571
HAVE BEEN ASKED TO DISCUSS. 

6384
04:57:38,571 --> 04:57:40,372
SINCE WE HAVEN'T TALKED ABOUT 

6385
04:57:40,372 --> 04:57:43,842
THIS IN PARTICULAR I THINK IT IS

6386
04:57:43,842 --> 04:57:54,353
IMPORTANT SO WE CAN ACTUALLY 

6387
04:57:55,521 --> 04:57:55,988
BROAD

6388
04:57:55,988 --> 04:57:57,189
BROAD -- BROADEN THE CONTEXT OF 

6389
04:57:57,189 --> 04:58:00,392
WHAT WE HAVE BEEN TALKING ABOUT.

6390
04:58:00,392 --> 04:58:03,429
DRUGS ARE A PROBLEM AND FROM THE

6391
04:58:03,429 --> 04:58:05,331
SEVEN WORLD SYMPOSIUM AND 

6392
04:58:05,331 --> 04:58:06,799
THERE'S QUITE A FEW DRUGS WE 

6393
04:58:06,799 --> 04:58:11,604
HAVE COME TO RECOGNIZE, LIKE 

6394
04:58:11,604 --> 04:58:18,711
AMENOREX, DEXT, FENFLOURAMINE 

6395
04:58:18,711 --> 04:58:20,713
AND METHAMPHETAMINES. THESE 

6396
04:58:20,713 --> 04:58:24,116
BELONG TO THE AMPHETAMINE 

6397
04:58:24,116 --> 04:58:26,619
FAMILY. THIS IS WHAT I WANT TO 

6398
04:58:26,619 --> 04:58:28,587
DEVOTE MY DISCUSSION. THIS 

6399
04:58:28,587 --> 04:58:31,624
FAMILY OF DRUGS IS INTIMATELY 

6400
04:58:31,624 --> 04:58:35,260
LINKED WITH PULMONARY 

6401
04:58:35,260 --> 04:58:37,763
HYPERTENSION. UNLIKE THE OTHER 

6402
04:58:37,763 --> 04:58:40,099
AGENTS IT IS PART OF THE 

6403
04:58:40,099 --> 04:58:46,238
EVOLVING LANDSCAPE OF DRUG USE 

6404
04:58:46,238 --> 04:58:48,741
IN THAT AMPHETAMINES HAVE 

6405
04:58:48,741 --> 04:58:51,010
DEFINED THE 20TH CENTURY. 

6406
04:58:51,010 --> 04:58:55,814
WHETHER IT IS WORLD WAR 1, WORLD

6407
04:58:55,814 --> 04:58:59,284
WAR II, PRESIDENTIAL

6408
04:58:59,284 --> 04:59:03,389
DECISIONS ABOUT THE CUBAN 

6409
04:59:03,389 --> 04:59:05,024
MISSILE CRISIS, ART WORK, 

6410
04:59:05,024 --> 04:59:06,091
AMPHETAMINES HAVE BEEN A BIG 

6411
04:59:06,091 --> 04:59:07,793
PART. EVEN WHEN THEY ARE 

6412
04:59:07,793 --> 04:59:11,096
OUTLAWED THEIR IMPACT REMAINS 

6413
04:59:11,096 --> 04:59:13,832
UNSCATHED. IN FACT, WHAT WE ARE 

6414
04:59:13,832 --> 04:59:21,774
SEEING NOW IS THE AFTERMATH OF 

6415
04:59:21,774 --> 04:59:23,042
RECREATIONAL AND PRACTICAL 

6416
04:59:23,042 --> 04:59:24,009
METHAMPHETAMINE USE THAT STARTED

6417
04:59:24,009 --> 04:59:25,811
EARLY IN THE 20TH CENTURY AND 

6418
04:59:25,811 --> 04:59:29,815
SEE THAT SHOCK WAVE STILL TO 

6419
04:59:29,815 --> 04:59:31,483
THIS DAY. NEXT SLIDE, PLEASE. 

6420
04:59:31,483 --> 04:59:32,918
    ALL RIGHT, SO WE ARE TALKING

6421
04:59:32,918 --> 04:59:34,353
ABOUT A GLOBAL PROBLEM. I WANT 

6422
04:59:34,353 --> 04:59:36,922
TO START THERE BECAUSE IT IS 

6423
04:59:36,922 --> 04:59:40,626
VERY EASY TO THINK THAT 

6424
04:59:40,626 --> 04:59:44,496
AMPHETAMINE PROBLEM SAN AMERICAN

6425
04:59:44,496 --> 04:59:49,201
PROBLEM. IT IS NOT. TAKE A LOOK,

6426
04:59:49,201 --> 04:59:51,737
THIS IS 2021. THIS IS LEGAL AS 

6427
04:59:51,737 --> 04:59:54,506
WELL AS ILLEGAL ABUSE. YOU ARE 

6428
04:59:54,506 --> 04:59:56,208
NOT GOING TO SAY AS YOU SEE 

6429
04:59:56,208 --> 04:59:59,845
CERTAINLY LEADS IN TERMS OF THE 

6430
04:59:59,845 --> 05:00:01,280
GLOBAL PREVALENCE, BUT ACROSS 

6431
05:00:01,280 --> 05:00:03,549
THE UNITED STATES -- THE WORLD 

6432
05:00:03,549 --> 05:00:07,386
YOU CAN SEE THAT THERE ARE 

6433
05:00:07,386 --> 05:00:09,321
CERTAIN FOLKS WHERE THE 

6434
05:00:09,321 --> 05:00:18,363
PREVALENCE HAS EXPOUNDED. YOU 

6435
05:00:18,363 --> 05:00:20,399
SEE THE CIRCLES EXPAND AS THE 

6436
05:00:20,399 --> 05:00:22,501
RIPPLE EFFECT CONTINUES TO 

6437
05:00:22,501 --> 05:00:24,269
EVOLVE. SO USE CONTINUES TO 

6438
05:00:24,269 --> 05:00:27,940
INCREASE. IT DOESN'T REGRESS. 

6439
05:00:27,940 --> 05:00:32,778
NEXT SLIDE, PLEASE. MY FOCUS ON 

6440
05:00:32,778 --> 05:00:33,712
METHAMPHETAMINE, I HAVE BEEN 

6441
05:00:33,712 --> 05:00:34,947
DEEPLY INVOLVED THERE THE CARE 

6442
05:00:34,947 --> 05:00:38,450
OF THESE PATIENTS SINCE I 

6443
05:00:38,450 --> 05:00:42,020
STARTED MY CAREER IN PULMONARY 

6444
05:00:42,020 --> 05:00:44,323
CAREER AT STANFORD IN 2005. THIS

6445
05:00:44,323 --> 05:00:47,292
IS A TERRIBLE DISEASE. 

6446
05:00:47,292 --> 05:00:48,994
METHAMPHETAMINE ADDICTION IS A 

6447
05:00:48,994 --> 05:00:50,496
DISEASE. IT IS SOMETHING THAT IS

6448
05:00:50,496 --> 05:00:53,398
VERY DIFFICULT FOR THE PATIENT 

6449
05:00:53,398 --> 05:00:55,434
TO KICK. IT REWRITES THE 

6450
05:00:55,434 --> 05:00:57,402
COMPLETE LIFESTYLE OF THE 

6451
05:00:57,402 --> 05:00:59,571
PATIENT AND ULTIMATELY, EVEN 

6452
05:00:59,571 --> 05:01:04,209
THOUGH THE PATIENT IS LITERALLY 

6453
05:01:04,209 --> 05:01:05,477
EXPERIENCES A COMPLETE 

6454
05:01:05,477 --> 05:01:09,715
DEGRADATION OF MIND, BODY, 

6455
05:01:09,715 --> 05:01:13,152
SPIRIT, THE PATIENT HAS A ROUGH 

6456
05:01:13,152 --> 05:01:16,255
TIME KICKING THIS OUT. THIS IS 

6457
05:01:16,255 --> 05:01:17,556
IMPORTANT, BECAUSE WHEN IT COMES

6458
05:01:17,556 --> 05:01:20,592
TO DEALING WITH THESE PATIENTS, 

6459
05:01:20,592 --> 05:01:24,296
THEY ARE REALLY VULNERABLE TO 

6460
05:01:24,296 --> 05:01:26,198
EVERY SINGLE SOCIAL DETERMINANT 

6461
05:01:26,198 --> 05:01:29,334
YOU CAN THINK ABOUT. AND 

6462
05:01:29,334 --> 05:01:30,369
ULTIMATELY, THEY ARE REALLY -- 

6463
05:01:30,369 --> 05:01:34,807
YOU KNOW, THEY ARE REALLY AT THE

6464
05:01:34,807 --> 05:01:36,675
MERCY OF THIS DRUG WHEN IT COMES

6465
05:01:36,675 --> 05:01:40,646
TO DEFINING THE AMOUNT OF 

6466
05:01:40,646 --> 05:01:45,617
BENEFIT THAT WE CAN OFFER WITH 

6467
05:01:45,617 --> 05:01:47,352
OUR INTERVENTIONS. NEXT SLIDE, 

6468
05:01:47,352 --> 05:01:47,586
PLEASE. 

6469
05:01:47,586 --> 05:01:49,655
    I WANT YOU TO LOOK CAREFULLY

6470
05:01:49,655 --> 05:01:51,824
AT THIS DATA. PROBABLY THE MOST 

6471
05:01:51,824 --> 05:01:52,891
IMPORTANT SLIDE I'M GOING TO 

6472
05:01:52,891 --> 05:01:54,293
SHOW YOU TODAY. LET'S START WITH

6473
05:01:54,293 --> 05:01:56,829
THE RIGHT SIDE. THIS IS THE 

6474
05:01:56,829 --> 05:01:59,865
TREND OF METHAMPHETAMINE 

6475
05:01:59,865 --> 05:02:03,535
ADMISSIONS IN THE UNITED STATES.

6476
05:02:03,535 --> 05:02:04,236
2010, 2017. LITTLE BIT OUTDATED 

6477
05:02:04,236 --> 05:02:05,637
BUT I THINK THE INFORMATION IS 

6478
05:02:05,637 --> 05:02:07,739
QUITE CLEAR. FIRST UP, IF YOU 

6479
05:02:07,739 --> 05:02:09,374
LOOK ON THE RIGHT SIDE, YOU CAN 

6480
05:02:09,374 --> 05:02:11,043
SEE THE TRENDS. INDEED, THE 

6481
05:02:11,043 --> 05:02:15,581
WEST, WHERE I WORK, IS WHERE THE

6482
05:02:15,581 --> 05:02:17,716
PREVALENCE HAS BEEN INCREASING. 

6483
05:02:17,716 --> 05:02:19,017
BUT I WANT YOU ALSO SEE THAT 

6484
05:02:19,017 --> 05:02:22,855
OVER THE LAST COUPLE OF YEARS, 

6485
05:02:22,855 --> 05:02:25,357
DURING THIS TIME, ADMISSIONS FOR

6486
05:02:25,357 --> 05:02:27,459
METH USE IN MIDWEST AND THE 

6487
05:02:27,459 --> 05:02:29,661
SOUTH HAVE INCREASED. MOVING TO 

6488
05:02:29,661 --> 05:02:33,565
THE LEFT, WHEN WE LOOK AT THE 

6489
05:02:33,565 --> 05:02:37,302
DIFFERENCE OF RACES, YOU WILL 

6490
05:02:37,302 --> 05:02:41,373
SEE THAT, YES, THE WHITES HAVE 

6491
05:02:41,373 --> 05:02:49,114
CERTAINLY BEEN (AUDIO 

6492
05:02:49,114 --> 05:02:50,749
INTERRUPTION) HAVE INCREASED. 

6493
05:02:50,749 --> 05:02:52,918
FOR BLACKS A SMALL INCREASE. 

6494
05:02:52,918 --> 05:02:53,785
INTERESTINGLY ENOUGH AMERICAN 

6495
05:02:53,785 --> 05:02:55,287
INDIAN S HAVE EXPERIENCED 

6496
05:02:55,287 --> 05:02:56,455
REMARKABLE INCREASE IN THE RATE 

6497
05:02:56,455 --> 05:02:59,291
OF ADMISSIONS, AS WELL AS 

6498
05:02:59,291 --> 05:03:00,826
HISPANICS. WHEN COMES TO AGE 

6499
05:03:00,826 --> 05:03:03,428
THEY CAN LOOK AT THAT. ALL AGE 

6500
05:03:03,428 --> 05:03:06,231
GROUPS, BUT PARTICULARLY AGES 

6501
05:03:06,231 --> 05:03:11,436
BETWEEN 25 AND 34, 35, 44, THESE

6502
05:03:11,436 --> 05:03:12,938
ARE YOUNG PATIENTS. THESE ARE 

6503
05:03:12,938 --> 05:03:18,043
NOT YOUR TRADITIONAL IPH, AGE OF

6504
05:03:18,043 --> 05:03:20,679
55. YOUNG PATIENTS. I WANT TO 

6505
05:03:20,679 --> 05:03:23,615
POINT OUT, WHICH IS CONCERNING, 

6506
05:03:23,615 --> 05:03:26,018
AGES 12 TO 17 AND 55 AND OLDER 

6507
05:03:26,018 --> 05:03:27,519
ALSO ARE SHOWING INCREASES IN 

6508
05:03:27,519 --> 05:03:29,187
THE RATE OF HOSPITALIZATION. SO 

6509
05:03:29,187 --> 05:03:31,023
THIS IS A REAL CONCERN. BECAUSE 

6510
05:03:31,023 --> 05:03:32,958
WE ARE SEEING YOUNG PATIENT 

6511
05:03:32,958 --> 05:03:36,929
WHO'S ARE ALREADY GETTING PRIMED

6512
05:03:36,929 --> 05:03:40,332
POTENTIALLY TO BECOME ADDICTS 

6513
05:03:40,332 --> 05:03:43,869
AND POTENTIAL PH PATIENTS. LAST 

6514
05:03:43,869 --> 05:03:46,738
BUT NOT LEAST BOTH SEXES, THE 

6515
05:03:46,738 --> 05:03:48,573
RATE OF HOSPITALIZATION HAS 

6516
05:03:48,573 --> 05:03:49,708
INCREASED. LOOK CAREFULLY WHEN 

6517
05:03:49,708 --> 05:03:50,943
YOU HAVE THE TIME. BECAUSE THIS 

6518
05:03:50,943 --> 05:03:52,511
SHOWS YOU THE RAW REALITY OF 

6519
05:03:52,511 --> 05:03:55,614
WHAT WE ARE DEALING WITH WITH 

6520
05:03:55,614 --> 05:03:56,481
METHAMPHETAMINE USE CURRENTLY. 

6521
05:03:56,481 --> 05:03:59,518
NEXT SLIDE, PLEASE. 

6522
05:03:59,518 --> 05:04:04,189
    DRUG OVERDOSES, THIS IS ALSO

6523
05:04:04,189 --> 05:04:05,290
REVEALING. YOU CAN SEE YOU CAN 

6524
05:04:05,290 --> 05:04:06,558
CUT THE UNITED STATES IN HALF. 

6525
05:04:06,558 --> 05:04:09,461
THIS GOES IN HAND WITH THE DATA 

6526
05:04:09,461 --> 05:04:12,264
REGARDING PREVALENCE OF PH IN 

6527
05:04:12,264 --> 05:04:13,865
THE UNITED STATES BASED ON 

6528
05:04:13,865 --> 05:04:17,903
FARVA. YOU CAN SEE HOW IT IS 

6529
05:04:17,903 --> 05:04:19,638
DIVIDED BETWEEN FENTANYL AND 

6530
05:04:19,638 --> 05:04:21,440
METHAMPHETAMINE OVERDOSES. 

6531
05:04:21,440 --> 05:04:23,141
UNITED STATES, THIS IS PERFECTLY

6532
05:04:23,141 --> 05:04:24,710
CLEAR. WHAT I CAN ALSO TELL YOU 

6533
05:04:24,710 --> 05:04:26,478
IS, AGAIN, THE EVOLUTION SHOWS 

6534
05:04:26,478 --> 05:04:30,015
YOU THAT METHAMPHETAMINE IS 

6535
05:04:30,015 --> 05:04:31,984
MAKING A SLOW BUT STEADY MOVE 

6536
05:04:31,984 --> 05:04:34,186
TOWARDS THE EAST. BUT KEEP THIS 

6537
05:04:34,186 --> 05:04:37,389
IN MIND. METHAMPHETAMINE IS 

6538
05:04:37,389 --> 05:04:41,760
ACTIVELY INVOLVED IN MANY 

6539
05:04:41,760 --> 05:04:42,794
DEATHS. I MEAN THE DEVASTATION. 

6540
05:04:42,794 --> 05:04:47,299
WHY IS THAT? IT IS NOT JUST PAH.

6541
05:04:47,299 --> 05:04:49,368
NEXT SLIDE, PLEASE. 

6542
05:04:49,368 --> 05:04:53,872
    THE PROBLEM HERE IS THAT 

6543
05:04:53,872 --> 05:04:57,242
METHAMPHETAMINE IS PART OF A 

6544
05:04:57,242 --> 05:04:59,845
ADDICTION CYCLE. THIS ADDICTION 

6545
05:04:59,845 --> 05:05:04,249
CYCLE IS DOMINATED BY SOCIAL 

6546
05:05:04,249 --> 05:05:06,685
DETERMINANTS THAT FAVOR THE 

6547
05:05:06,685 --> 05:05:10,889
PATIENT ENGAGING AND IN THIS 

6548
05:05:10,889 --> 05:05:12,724
DISEASE, SUCH AS DOMESTIC 

6549
05:05:12,724 --> 05:05:14,860
VIOLENCE, FACTORS WE HAVE 

6550
05:05:14,860 --> 05:05:15,927
DISCUSSED, LACK OF FAMILY 

6551
05:05:15,927 --> 05:05:16,962
SUPPORT, WHERE THE PATIENT IS 

6552
05:05:16,962 --> 05:05:18,563
LIVING, IMMIGRATION STATUS, 

6553
05:05:18,563 --> 05:05:21,433
SOCIAL INJUSTICE, HOUSING, 

6554
05:05:21,433 --> 05:05:23,435
SCHOOL, ACADEMIC FAILURE. IN 

6555
05:05:23,435 --> 05:05:25,804
THIS DAY AND AGE WHEN 

6556
05:05:25,804 --> 05:05:27,539
IMMIGRATION AND SOCIAL INJUSTICE

6557
05:05:27,539 --> 05:05:29,574
ARE SUCH A IMPORTANT PART OF OUR

6558
05:05:29,574 --> 05:05:31,009
POLITICAL JARGON YOU CAN IMAGINE

6559
05:05:31,009 --> 05:05:33,945
HOW VULNERABLE SOME INDIVIDUALS 

6560
05:05:33,945 --> 05:05:42,087
ARE CURRENTLY TO ENTERING THIS

6561
05:05:42,087 --> 05:05:43,388
ONE THING THAT WE HAVEN'T

6562
05:05:43,388 --> 05:05:45,323
DISCUSSED AND HAS HAD A

6563
05:05:45,323 --> 05:05:47,893
REMARKABLE IMPACT IN OUR CULTURE

6564
05:05:47,893 --> 05:05:49,161
AND OUR PATIENT POPULATION IS

6565
05:05:49,161 --> 05:05:49,928
THE PANDEMIC.

6566
05:05:49,928 --> 05:05:51,797
THE PANDEMIC WAS A TIME OF GREAT

6567
05:05:51,797 --> 05:05:53,665
STRESS TO PEOPLE, AND IT

6568
05:05:53,665 --> 05:05:55,300
CERTAINLY PUSHED A LOT OF PEOPLE

6569
05:05:55,300 --> 05:05:59,337
INTO ADDICTION, PARTICULARLY

6570
05:05:59,337 --> 05:06:02,641
METH ADDICTION, WE SAW AN UPTICK

6571
05:06:02,641 --> 05:06:03,508
IN THE NUMBER OF PATIENTS THAT

6572
05:06:03,508 --> 05:06:04,810
STARTED USING METH AND PATIENTS

6573
05:06:04,810 --> 05:06:07,679
WHO WERE FORMER METH USERS WENT

6574
05:06:07,679 --> 05:06:09,414
BACK TO IT TO DEAL WITH THE

6575
05:06:09,414 --> 05:06:09,748
STRESS.

6576
05:06:09,748 --> 05:06:12,250
SO THIS KIND OF EVENTS ALSO HAS

6577
05:06:12,250 --> 05:06:18,390
TO BE TAKEN INTO CONSIDERATION

6578
05:06:18,390 --> 05:06:19,791
BECAUSE HISTORICALLY THEY COULD

6579
05:06:19,791 --> 05:06:21,893
ACTUALLY CREATE SIGNIFICANT

6580
05:06:21,893 --> 05:06:25,630
INCREASES THAT ARE NOT

6581
05:06:25,630 --> 05:06:29,434
NECESSARILY SEEN AT OTHER TIMES.

6582
05:06:29,434 --> 05:06:30,535
NEXT SLIDE, PLEASE.

6583
05:06:30,535 --> 05:06:38,343
SO WHY DO WE SEE SUCH A HIGH

6584
05:06:38,343 --> 05:06:39,611
MORTALITY WITH METHAMPHETAMINE?

6585
05:06:39,611 --> 05:06:41,313
THE PROBLEM WITH METHAMPHETAMINE

6586
05:06:41,313 --> 05:06:43,548
IS THIS IS A DRUG THAT AFFECTS

6587
05:06:43,548 --> 05:06:45,750
MULTIPLE ORGANS.

6588
05:06:45,750 --> 05:06:48,820
CLASSICALLY WHEN IT COMES THE

6589
05:06:48,820 --> 05:06:53,725
BRAIN, WE SEE STROKES AND

6590
05:06:53,725 --> 05:06:55,894
CATECHOLAMIE TOXICITY, WITH THE

6591
05:06:55,894 --> 05:06:59,064
HEART WE SEE CARDIAC

6592
05:06:59,064 --> 05:07:01,366
ARRHYTHMIAS, DILATED

6593
05:07:01,366 --> 05:07:02,467
CARDIOMYOPATHY, HEART ATTACKS,

6594
05:07:02,467 --> 05:07:04,002
THOSE BY THEMSELVES ARE ALREADY

6595
05:07:04,002 --> 05:07:05,237
ENOUGH TO KILL THESE PATIENTS

6596
05:07:05,237 --> 05:07:06,738
AND INCREASE MORBIDITY, RIGHT?

6597
05:07:06,738 --> 05:07:10,242
BUT WHEN IT COMES TO PULMONARY

6598
05:07:10,242 --> 05:07:12,444
HYPERTENSION, THAT'S A MORE

6599
05:07:12,444 --> 05:07:15,380
NOVEL, IF YOU WILL, SINCE ITS

6600
05:07:15,380 --> 05:07:18,016
FIRST DESCRIPTION IN 1993 UNTIL

6601
05:07:18,016 --> 05:07:21,286
NOW THAT WE ARE ALREADY STARTING

6602
05:07:21,286 --> 05:07:23,155
TO UNRAVEL, BUT IT HAS A

6603
05:07:23,155 --> 05:07:25,223
SIGNIFICANT IMPACT ALSO IN THE

6604
05:07:25,223 --> 05:07:28,293
LIFESTYLE AND THE SURVIVAL OF

6605
05:07:28,293 --> 05:07:29,094
THE PATIENT.

6606
05:07:29,094 --> 05:07:30,896
IT IS INDISTINGUISHABLE

6607
05:07:30,896 --> 05:07:34,099
PATHOLOGICALLY TO THAT OF OTHER

6608
05:07:34,099 --> 05:07:35,066
PATIENTS WHICH IS WHY IT'S

6609
05:07:35,066 --> 05:07:36,601
CONSIDERED A GROUP ONE DISEASE.

6610
05:07:36,601 --> 05:07:38,770
NEXT SLIDE, PLEASE.

6611
05:07:38,770 --> 05:07:42,541
SO IN THIS STUDY IN 2017 WHERE

6612
05:07:42,541 --> 05:07:46,912
WE COLLECTED OUR DATA FROM YEARS

6613
05:07:46,912 --> 05:07:48,747
OF LOOKING AT THESE PATIENTS, WE

6614
05:07:48,747 --> 05:07:52,717
WERE ABLE TO COMPARE IPAH, 97

6615
05:07:52,717 --> 05:07:56,188
PATIENTS, AND 90 PATIENTS, WITH

6616
05:07:56,188 --> 05:07:59,157
METH PH, THIS WAS A STUDY DONE

6617
05:07:59,157 --> 05:08:04,629
WITH ROHAM ZAMANIAN AND STEVE

6618
05:08:04,629 --> 05:08:06,398
KAWUT BASED ON OUR STANFORD

6619
05:08:06,398 --> 05:08:08,333
DATASET AND WHAT WE FOUND WAS

6620
05:08:08,333 --> 05:08:10,068
THAT MOST OF THE PATIENTS WITH

6621
05:08:10,068 --> 05:08:12,370
METH APAH WERE MOSTLY MALE.

6622
05:08:12,370 --> 05:08:13,572
INTERESTINGLY ENOUGH, THEY AT

6623
05:08:13,572 --> 05:08:16,741
LEAST IN OUR GROUP, THE

6624
05:08:16,741 --> 05:08:19,277
SOCIOECONOMIC STATUS WAS

6625
05:08:19,277 --> 05:08:24,316
SIMILAR, THEY HAVE SIMILAR

6626
05:08:24,316 --> 05:08:26,284
HEMODYNAMIC BUT INTERESTINGLY

6627
05:08:26,284 --> 05:08:28,787
ENOUGH THEIR FUNCTION WAS WORSE

6628
05:08:28,787 --> 05:08:32,090
IN ECHO AND STILL FOUND THAT

6629
05:08:32,090 --> 05:08:35,694
METH APAH STAISHTS COMPARED WITH

6630
05:08:35,694 --> 05:08:37,095
IPAH PATIENTS HAD SIGNIFICANT

6631
05:08:37,095 --> 05:08:37,963
INCREASED MORTALITY.

6632
05:08:37,963 --> 05:08:39,731
NEXT SLIDE, PLEASE.

6633
05:08:39,731 --> 05:08:43,001
THIS, AGAIN, IF YOU LOOK AT THE

6634
05:08:43,001 --> 05:08:45,737
FAR REGISTRY, WE NEXT WENT TO

6635
05:08:45,737 --> 05:08:49,241
LOOK AT THE PHAR REGISTRY TO GET

6636
05:08:49,241 --> 05:08:51,076
MORE CLARITY REGARDING THE

6637
05:08:51,076 --> 05:08:51,843
CHARACTERISTICS OF THESE

6638
05:08:51,843 --> 05:08:52,210
PATIENTS.

6639
05:08:52,210 --> 05:08:54,846
WHY THE PHAR REGISTRY?

6640
05:08:54,846 --> 05:08:56,147
BECAUSE IT HAS A GOOD

6641
05:08:56,147 --> 05:08:58,216
REPRESENTATION OF METH APAH

6642
05:08:58,216 --> 05:08:59,217
PATIENTS FROM THE DIFFERENT

6643
05:08:59,217 --> 05:09:00,318
STHEARNTS PROVIDE DATA.

6644
05:09:00,318 --> 05:09:02,120
AGAIN, IF YOU COMPARE THIS MAP

6645
05:09:02,120 --> 05:09:04,789
WITH THE MAP OF METH FELT

6646
05:09:04,789 --> 05:09:06,658
MINIMUM OVERDOSES --

6647
05:09:06,658 --> 05:09:07,525
METHAMPHETAMINE OVERDOSES YOU

6648
05:09:07,525 --> 05:09:09,594
WILL SEE AGAIN THAT DIVISION IN

6649
05:09:09,594 --> 05:09:12,330
THE MIDDLE WHERE MOST OF YOUR

6650
05:09:12,330 --> 05:09:13,331
METH PATIENTS ARE ON THE WEST

6651
05:09:13,331 --> 05:09:15,300
AND AS YOU MOVE TO THE EAST

6652
05:09:15,300 --> 05:09:17,135
COAST, YOU START SEEING THAT THE

6653
05:09:17,135 --> 05:09:20,305
PREVALENCE OF IPH PATIENTS IS

6654
05:09:20,305 --> 05:09:21,306
ACTUALLY HIGHER.

6655
05:09:21,306 --> 05:09:23,174
SO NEXT SLIDE, PLEASE.

6656
05:09:23,174 --> 05:09:26,244
SO WHEN NOW IN THIS STUDY, LED

6657
05:09:26,244 --> 05:09:29,648
BY NICHOLAS KOLAITIS, WHAT WE

6658
05:09:29,648 --> 05:09:32,050
FOUND IS SOME THINGS THAT ARE

6659
05:09:32,050 --> 05:09:35,420
CLEARLY PUT TO A UNIQUE PATIENT

6660
05:09:35,420 --> 05:09:38,089
PROFILE FOR METH PAH PATIENTS.

6661
05:09:38,089 --> 05:09:40,258
FIRST OFF, THEY'RE YOUNGER, 47

6662
05:09:40,258 --> 05:09:41,660
YEARS VERSUS 55.

6663
05:09:41,660 --> 05:09:44,629
THESE PATIENTS ARE UNINSURED,

6664
05:09:44,629 --> 05:09:47,265
NEVER MARRIED, THEY DID NOT

6665
05:09:47,265 --> 05:09:50,735
FINISH COLLEGE, AND MOST OF THEM

6666
05:09:50,735 --> 05:09:53,371
FLENT A WORSE -- PRESENT THIS A

6667
05:09:53,371 --> 05:09:54,239
WORSE FUNCTIONAL CLASS COMPARED

6668
05:09:54,239 --> 05:09:55,540
TO IPAH.

6669
05:09:55,540 --> 05:09:57,409
NEXT SLIDE, PLEASE.

6670
05:09:57,409 --> 05:09:59,911
MOREOVER, THE HEMODYNAMICS

6671
05:09:59,911 --> 05:10:05,417
APPEAR TO BE WORSE BASED ON RA

6672
05:10:05,417 --> 05:10:07,786
PRESSURE, CARDIAC OUTPUT LOWER

6673
05:10:07,786 --> 05:10:10,322
AS WELL AS STROKE VOLUME SO

6674
05:10:10,322 --> 05:10:11,856
WORSE HEMODYNAMICS WHICH MAY

6675
05:10:11,856 --> 05:10:14,259
EXPLAIN WHY THESE PATIENTS ARE

6676
05:10:14,259 --> 05:10:15,694
DOING -- HAVE A WORSE MORTALITY.

6677
05:10:15,694 --> 05:10:17,762
SO THE NEXT QUESTION IS, WELL,

6678
05:10:17,762 --> 05:10:19,297
ARE THEY GETTING TREATED?

6679
05:10:19,297 --> 05:10:22,367
NEXT SLIDE, PLEASE.

6680
05:10:22,367 --> 05:10:24,669
SO THEY ARE GETTING TREATED

6681
05:10:24,669 --> 05:10:26,938
EXCEPT THAT IN OUR COHORT, THIS

6682
05:10:26,938 --> 05:10:29,708
IS FROM OUR STANFORD STUDY, WHAT

6683
05:10:29,708 --> 05:10:33,745
WE FOUND IS THAT MOST METH

6684
05:10:33,745 --> 05:10:38,650
PATIENTS ARE GETTING

6685
05:10:38,650 --> 05:10:43,054
INHALED/ORAL THERAPIES, GET

6686
05:10:43,054 --> 05:10:44,856
IV/SQ BUT IN LESS NUMBERS

6687
05:10:44,856 --> 05:10:47,826
COMPARED TO THE IPAH WHERE YOU

6688
05:10:47,826 --> 05:10:49,094
CAN SEE THAT A GREATER NUMBER

6689
05:10:49,094 --> 05:10:51,796
ARE ON IV SUB Q COMPARED TOIN

6690
05:10:51,796 --> 05:10:52,897
HAILED ORAL, AND THERE'S A

6691
05:10:52,897 --> 05:10:55,200
REASON FOR THAT, AND IT IS DUE

6692
05:10:55,200 --> 05:10:59,704
TO THE FACT THAT THESE PATIENTS

6693
05:10:59,704 --> 05:11:01,973
WHO MAY BE STILL ACTIVELY USING

6694
05:11:01,973 --> 05:11:06,678
OR MAY NOT HAVE SOCIAL SUPPORT

6695
05:11:06,678 --> 05:11:08,847
AND OTHER REQUIREMENTS TO

6696
05:11:08,847 --> 05:11:11,282
MAINTAIN, TO BE ABLE TO USE THIS

6697
05:11:11,282 --> 05:11:13,017
DRUG SAFELY, UNFORTUNATELY, IT'S

6698
05:11:13,017 --> 05:11:15,320
DIFFICULT FOR US TO BE ABLE TO

6699
05:11:15,320 --> 05:11:18,056
OFFER THESE THERAPIES UNTIL THEY

6700
05:11:18,056 --> 05:11:21,459
ARE ABLE TO REGAIN A BETTER

6701
05:11:21,459 --> 05:11:22,861
FUNCTIONAL AND SOCIAL STATUS,

6702
05:11:22,861 --> 05:11:27,899
WHICH OF COURSE IS NOT EASY TO

6703
05:11:27,899 --> 05:11:29,434
ASK OR REGAIN.

6704
05:11:29,434 --> 05:11:31,202
NEXT SLIDE, PLEASE.

6705
05:11:31,202 --> 05:11:33,705
THIS IS FROM A STUDY THAT IS

6706
05:11:33,705 --> 05:11:35,240
CURRENTLY UNDER REVIEW, AND WHAT

6707
05:11:35,240 --> 05:11:36,975
YOU CAN SEE HERE IS THAT ACROSS

6708
05:11:36,975 --> 05:11:39,611
THE UNITED STATES, USING

6709
05:11:39,611 --> 05:11:40,812
INSURANCE DATABASE LOOKING FOR

6710
05:11:40,812 --> 05:11:43,415
THE DIAGNOSIS OF METH AND

6711
05:11:43,415 --> 05:11:44,749
PULMONARY HYPERTENSION, THE RATE

6712
05:11:44,749 --> 05:11:46,718
AT WHICH THESE PATIENTS ARE

6713
05:11:46,718 --> 05:11:48,353
BEING TREATED, AND THIS IS A

6714
05:11:48,353 --> 05:11:54,826
STUDY WHERE WE WENT FROM 2017 TO

6715
05:11:54,826 --> 05:11:56,327
2022 INSURANCE CLAIM DATABASE,

6716
05:11:56,327 --> 05:11:57,996
AGAIN THE LIGHTER BLUE MEANS

6717
05:11:57,996 --> 05:12:00,064
THESE PATIENTS ARE GEG, IT'S A

6718
05:12:00,064 --> 05:12:03,902
PERCENT OF PATIENTS THAT ARE

6719
05:12:03,902 --> 05:12:05,303
GETTING MEDICATION.

6720
05:12:05,303 --> 05:12:07,205
LIGHTER BLUE, MORE PATIENTS.

6721
05:12:07,205 --> 05:12:09,674
DARKER BLUE, LESS PATIENTS.

6722
05:12:09,674 --> 05:12:16,147
AND YOU CAN SEE THAT AS WE NEUF

6723
05:12:16,147 --> 05:12:18,216
THE EAST COAST THERE'S MORE OF

6724
05:12:18,216 --> 05:12:19,851
THE DARK BLUE LESS PATIENTS

6725
05:12:19,851 --> 05:12:21,719
BEING PRESCRIBED OR RECEIVING

6726
05:12:21,719 --> 05:12:23,455
MEDICATIONS, WE CANNOT SAY THAT

6727
05:12:23,455 --> 05:12:24,989
THEY'RE NOT BEING PRESCRIBED, OR

6728
05:12:24,989 --> 05:12:26,524
THEY'RE JUST NOT GETTING THE

6729
05:12:26,524 --> 05:12:29,294
MEDICATION, YOU CAN SEE FOR

6730
05:12:29,294 --> 05:12:32,197
EXAMPLE IN FLORIDA, NEW JERSEY,

6731
05:12:32,197 --> 05:12:34,299
THESE AREAS ARE NOT THE PATIENTS

6732
05:12:34,299 --> 05:12:35,733
THAT ARE THERE, EVEN THOUGH

6733
05:12:35,733 --> 05:12:37,869
THERE MAY BE LESS PREVALENT THAN

6734
05:12:37,869 --> 05:12:39,204
ON THE WEST COAST, THERE ARE

6735
05:12:39,204 --> 05:12:40,638
STILL PATIENTS THERE THAT ARE

6736
05:12:40,638 --> 05:12:42,073
GETTING DIAGNOSED BUT THEY'RE

6737
05:12:42,073 --> 05:12:42,807
NOT BEING TREATED.

6738
05:12:42,807 --> 05:12:45,210
AND WE CAN TALK ABOUT WHAT

6739
05:12:45,210 --> 05:12:46,978
FACTORS DETERMINE THAT.

6740
05:12:46,978 --> 05:12:51,249
BUT ULTIMATELY, THIS POINTS TO A

6741
05:12:51,249 --> 05:12:54,519
BIG DISCREPANCY THAT MAY

6742
05:12:54,519 --> 05:12:56,821
EVIDENCE THE DISPARITY AFFECTING

6743
05:12:56,821 --> 05:12:58,690
THIS PARTICULAR PATIENT GROUP.

6744
05:12:58,690 --> 05:12:59,991
NEXT SLIDE, PLEASE.

6745
05:12:59,991 --> 05:13:02,393
SO WHAT ARE THE SOURCES OF

6746
05:13:02,393 --> 05:13:05,363
HEALTH DISPARITIES FOR METH

6747
05:13:05,363 --> 05:13:06,798
PULMONARY ARTERIAL HYPERTENSION?

6748
05:13:06,798 --> 05:13:08,633
THERE ARE SOME THINGS THAT ARE

6749
05:13:08,633 --> 05:13:10,068
UNIQUE, AND I AM GOING TO FOCUS

6750
05:13:10,068 --> 05:13:10,635
ON THOSE.

6751
05:13:10,635 --> 05:13:14,138
I WANT TO REITERATE THAT THIS IN

6752
05:13:14,138 --> 05:13:17,408
NO MEANS TAKES OUT THE SEX OR

6753
05:13:17,408 --> 05:13:18,943
THE OTHER SOCIAL DETERMINANTS OF

6754
05:13:18,943 --> 05:13:20,245
HEALTH THAT WE'VE DISCUSSED.

6755
05:13:20,245 --> 05:13:21,679
I'M JUST GOING TO FOCUS ON THE

6756
05:13:21,679 --> 05:13:24,182
THINGS THAT ARE PARTICULARLY

6757
05:13:24,182 --> 05:13:26,084
IMPORTANT FOR THIS PATIENT

6758
05:13:26,084 --> 05:13:26,484
POPULATION.

6759
05:13:26,484 --> 05:13:27,785
THERE'S THE LACK OF PHYSICIAN

6760
05:13:27,785 --> 05:13:29,420
AND PATIENT AWARENESS.

6761
05:13:29,420 --> 05:13:31,389
NOT EVERYBODY KNOWS THAT METH

6762
05:13:31,389 --> 05:13:33,258
CAUSES PAH OR WANT TO BELIEVE

6763
05:13:33,258 --> 05:13:38,396
IT, SO THAT'S ALREADY A PROBLEM

6764
05:13:38,396 --> 05:13:40,164
THAT LEADS TO PROBLEMS IN TERMS

6765
05:13:40,164 --> 05:13:43,735
OF HOW TO ADDRESS SCREENING THIS

6766
05:13:43,735 --> 05:13:43,968
PATIENT.

6767
05:13:43,968 --> 05:13:45,603
THERE'S OF COURSE THE IMPLICIT

6768
05:13:45,603 --> 05:13:47,705
BIAS FROM BEAU THE PATIENT AND

6769
05:13:47,705 --> 05:13:48,907
THE PHYSICIAN -- FROM BOTH THE

6770
05:13:48,907 --> 05:13:50,108
PATIENT AND THE PHYSICIAN, THE

6771
05:13:50,108 --> 05:13:51,309
PATIENT MISTRUST, THESE ARE

6772
05:13:51,309 --> 05:13:54,579
PATIENTS THAT USUALLY ARE SEEN

6773
05:13:54,579 --> 05:13:57,849
AS BEING SOCIAL PARIAHS AND NOT

6774
05:13:57,849 --> 05:13:59,617
RESPECT THE PATIENT BY ITSELF IS

6775
05:13:59,617 --> 05:14:02,253
ALREADY GOING TO COME WITH

6776
05:14:02,253 --> 05:14:02,520
MISTRUST.

6777
05:14:02,520 --> 05:14:04,322
THERE IS ALSO THE ACCESS TO CARE

6778
05:14:04,322 --> 05:14:06,090
BASED ON WHETHER THE PATIENT IS

6779
05:14:06,090 --> 05:14:10,228
ON A RURAL OR URBAN AREA.

6780
05:14:10,228 --> 05:14:12,096
THERE'S STIGMA AND

6781
05:14:12,096 --> 05:14:12,463
CRIMINALIZATION.

6782
05:14:12,463 --> 05:14:13,498
THESE PATIENTS HAVE ALREADY BEEN

6783
05:14:13,498 --> 05:14:17,035
IN JAIL OR HAVE ALREADY BEEN

6784
05:14:17,035 --> 05:14:18,736
FINED, SO THESE PATIENTS ARE

6785
05:14:18,736 --> 05:14:21,472
ALREADY HIGHLY HESITANT TO ENTER

6786
05:14:21,472 --> 05:14:23,875
THE SYSTEM TO RECEIVE CARE.

6787
05:14:23,875 --> 05:14:26,311
THERE'S A LACK OF TOXICOLOGY

6788
05:14:26,311 --> 05:14:28,379
SCREENING, LACK OF ADDICTION

6789
05:14:28,379 --> 05:14:30,281
SERVICES IN AREAS WHERE THESE

6790
05:14:30,281 --> 05:14:31,249
PATIENTS LIVE.

6791
05:14:31,249 --> 05:14:34,285
SO THESE PATIENTS PROBABLY FEEL

6792
05:14:34,285 --> 05:14:38,122
LIKE, YOU KNOW, THEY CAN THROW

6793
05:14:38,122 --> 05:14:39,991
IN THE TOWM BECAUSE THEY'RE NOT

6794
05:14:39,991 --> 05:14:41,426
GOING -- IN THE TOWEL BECAUSE

6795
05:14:41,426 --> 05:14:42,060
THAIRNLTD GOING TO BE RECEIVING

6796
05:14:42,060 --> 05:14:43,828
ANY CARE, SO WHY EVEN TRY.

6797
05:14:43,828 --> 05:14:45,196
AND THEN THERE'S THE LACK OF

6798
05:14:45,196 --> 05:14:47,332
PUBLIC HEALTH INITIATIVES TO

6799
05:14:47,332 --> 05:14:50,501
TARGET THESE POPULATIONS, SO

6800
05:14:50,501 --> 05:14:53,538
THAT OBVIOUSLY COMES FROM OUR

6801
05:14:53,538 --> 05:14:54,872
SIDE, OUR GOVERNMENTS AND OUR

6802
05:14:54,872 --> 05:14:57,075
COMMUNITIES TO PROVIDE THIS, AND

6803
05:14:57,075 --> 05:14:58,443
THEY'RE NOT WIDELY AVAILABLE.

6804
05:14:58,443 --> 05:15:00,345
NEXT SLIDE, PLEASE.

6805
05:15:00,345 --> 05:15:03,615
SO HOW CAN WE BRIDGE THIS GAP

6806
05:15:03,615 --> 05:15:06,150
FOR OUR METH PAH PATIENTS?

6807
05:15:06,150 --> 05:15:10,321
NEXT SLIDE, PLEASE.

6808
05:15:10,321 --> 05:15:11,623
THESE ARE THE THINGS AWE'RE

6809
05:15:11,623 --> 05:15:13,558
DOING IN OUR GROUP AS WELL AS

6810
05:15:13,558 --> 05:15:15,860
OTHER GROUPS THAT ARE TAKING

6811
05:15:15,860 --> 05:15:18,429
CARE OF THESE PATIENTS.

6812
05:15:18,429 --> 05:15:20,999
WE ARE VERY CLEAR AND

6813
05:15:20,999 --> 05:15:22,567
NONJUDGMENTAL WHEN WE ASK

6814
05:15:22,567 --> 05:15:24,502
PATIENTS ABOUT THEIR CURRENT OR

6815
05:15:24,502 --> 05:15:26,070
PAST METH USE, AND WE'RE VERY

6816
05:15:26,070 --> 05:15:28,006
CAREFUL WITH HOW WE ASK THEM

6817
05:15:28,006 --> 05:15:30,208
THAT, BECAUSE WE DON'T TO WANT

6818
05:15:30,208 --> 05:15:35,313
MAKE THE PATIENT FEEL SELF-AWARE

6819
05:15:35,313 --> 05:15:37,649
OR EMBARRASSED.

6820
05:15:37,649 --> 05:15:40,718
THIS IS SOMETHING THAT IS

6821
05:15:40,718 --> 05:15:42,253
ROUTINE AND WE ENCOURAGE THE

6822
05:15:42,253 --> 05:15:43,788
PATIENT TO ESTABLISH THAT TRUST.

6823
05:15:43,788 --> 05:15:45,423
THIS IS REALLY IMPORTANT.

6824
05:15:45,423 --> 05:15:48,159
WE SCREEN FOR BOTH HIV AND LIVER

6825
05:15:48,159 --> 05:15:49,927
DISEASE BECAUSE THESE ARE

6826
05:15:49,927 --> 05:15:50,995
COMORBIDITIES THAT ARE

6827
05:15:50,995 --> 05:15:53,197
PARTICULARLY IMPORTANT WITH THIS

6828
05:15:53,197 --> 05:15:55,800
PATIENT POPULATION.

6829
05:15:55,800 --> 05:15:58,236
WE ACTUALLY RUN URINE AND BLOOD

6830
05:15:58,236 --> 05:15:59,971
TOXICOLOGY FOR EVERY PATIENT, SO

6831
05:15:59,971 --> 05:16:02,607
WE DON'T DISCRIMINATE IN TERMS

6832
05:16:02,607 --> 05:16:03,708
OF ORDERING THIS.

6833
05:16:03,708 --> 05:16:06,244
WE SCREEN FOR MENTAL DISORDERS

6834
05:16:06,244 --> 05:16:07,378
OTHER THAN ADDICTION.

6835
05:16:07,378 --> 05:16:09,847
YOU CAN IMAGINE THESE PATIENTS

6836
05:16:09,847 --> 05:16:13,017
COME WITH OTHER BASED ON THE

6837
05:16:13,017 --> 05:16:15,186
LEVEL OF ABUSE THEY MAY HAVE

6838
05:16:15,186 --> 05:16:16,521
EXPERIENCED, OTHER SOCIAL

6839
05:16:16,521 --> 05:16:18,690
STRESSORS, THEY COME WITH

6840
05:16:18,690 --> 05:16:20,258
DEPRESSION, BIPOLAR DISORDER,

6841
05:16:20,258 --> 05:16:22,193
IT'S VERY IMPORTANT BECAUSE THIS

6842
05:16:22,193 --> 05:16:24,996
IS GOING TO BE A HUGE ASPECT OF

6843
05:16:24,996 --> 05:16:26,264
THE CARE AND THE SUCCESS THAT

6844
05:16:26,264 --> 05:16:28,633
YOU'RE GOING TO HAVE IN TREATING

6845
05:16:28,633 --> 05:16:29,767
THESE PATIENTS.

6846
05:16:29,767 --> 05:16:31,169
WE ESTABLISH A MEDICAL CONTRACT,

6847
05:16:31,169 --> 05:16:33,237
AND THIS IS SOMETHING THAT I CAN

6848
05:16:33,237 --> 05:16:35,106
SPEAK OFFLINE, BUT IT IS A

6849
05:16:35,106 --> 05:16:36,641
DOCUMENT THAT WE DISCUSS WITH

6850
05:16:36,641 --> 05:16:38,810
THE PATIENT AND WE SIGN WHERE WE

6851
05:16:38,810 --> 05:16:40,044
DISCUSS WHAT WE'RE PREPARED TO

6852
05:16:40,044 --> 05:16:42,914
OFFER AND WHAT WE ARE EXPECTING

6853
05:16:42,914 --> 05:16:45,817
FOR THE PATIENT.

6854
05:16:45,817 --> 05:16:47,785
WE DO RANDOM URINE TOXICOLOGIES

6855
05:16:47,785 --> 05:16:48,753
AND WE TELL THE PATIENT THAT

6856
05:16:48,753 --> 05:16:50,088
THIS IS GOING TO BE PART OF THE

6857
05:16:50,088 --> 05:16:51,823
CARE, SO THAT'S IN THE MEDICAL

6858
05:16:51,823 --> 05:16:52,156
CONTRACT.

6859
05:16:52,156 --> 05:16:54,125
WE'RE MINDFUL ABOUT USING IV

6860
05:16:54,125 --> 05:16:54,392
THERAPIES.

6861
05:16:54,392 --> 05:16:55,993
WHAT DOES THAT MEAN?

6862
05:16:55,993 --> 05:16:57,195
DOES THAT MEAN THAT WE DO NOT

6863
05:16:57,195 --> 05:16:58,196
OFFER IT?

6864
05:16:58,196 --> 05:16:58,863
ABSOLUTELY NOT.

6865
05:16:58,863 --> 05:17:00,364
BUT WE'RE VERY CAREFUL AND WE'RE

6866
05:17:00,364 --> 05:17:01,766
VERY CLEAR WITH THE PATIENT THAT

6867
05:17:01,766 --> 05:17:03,534
AS LONG AS THEY'RE ACTIVELY

6868
05:17:03,534 --> 05:17:05,303
USING, WE CANNOT IN GOOD

6869
05:17:05,303 --> 05:17:06,938
CONSCIENCE OFFER THE THERAPY.

6870
05:17:06,938 --> 05:17:08,773
WE DEFINITELY WANT TO HELP THE

6871
05:17:08,773 --> 05:17:10,641
PATIENT, WHICH IS WHY WE INVOLVE

6872
05:17:10,641 --> 05:17:12,744
AN ADDICTION SPECIALIST AND

6873
05:17:12,744 --> 05:17:15,012
SOCIAL WORKER, WE TRY TO

6874
05:17:15,012 --> 05:17:17,081
IDENTIFY THE BARRIERS TO

6875
05:17:17,081 --> 05:17:18,349
SUCCESS, LIKE IS THE PATIENT

6876
05:17:18,349 --> 05:17:21,486
LIVING IN AN AREA, ARE THEY

6877
05:17:21,486 --> 05:17:22,787
HOMELESS, CAN WE DO SOMETHING

6878
05:17:22,787 --> 05:17:24,222
ABOUT THAT?

6879
05:17:24,222 --> 05:17:28,059
CAN WE IMPROVE TRANSPORTATION

6880
05:17:28,059 --> 05:17:28,926
ACCESS TO CENTER?

6881
05:17:28,926 --> 05:17:31,095
SO WE TRY TO HELP THE PATIENT

6882
05:17:31,095 --> 05:17:33,498
COME UP WITH A POINT WHERE THEY

6883
05:17:33,498 --> 05:17:35,366
ARE BETTER CONNECTED, THEY HAVE

6884
05:17:35,366 --> 05:17:38,302
MORE SUPPORT, AND ULTIMATELY WE

6885
05:17:38,302 --> 05:17:42,039
CAN ACTUALLY INTRODUCE THIS

6886
05:17:42,039 --> 05:17:43,274
THERAPEUTIC, BUT IN THE

6887
05:17:43,274 --> 05:17:43,941
MEANTIME, EVERYTHING ELSE THAT

6888
05:17:43,941 --> 05:17:45,143
WE CAN OFFER, WE OFFER.

6889
05:17:45,143 --> 05:17:46,444
SO THAT'S REALLY IMPORTANT.

6890
05:17:46,444 --> 05:17:47,845
YOU DO NOT WITHHOLD THERAPY FOR

6891
05:17:47,845 --> 05:17:48,679
THESE PATIENTS.

6892
05:17:48,679 --> 05:17:53,885
NEXT SLIDE, PLEASE.

6893
05:17:53,885 --> 05:17:55,953
THE LAST THING I'M GOING TO SAY

6894
05:17:55,953 --> 05:17:59,090
IS THAT, YOU KNOW, WE CANNOT --

6895
05:17:59,090 --> 05:18:01,759
I WANT US TO ALSO START THINKING

6896
05:18:01,759 --> 05:18:04,595
THAT, YOU KNOW, METH DOES NOT

6897
05:18:04,595 --> 05:18:06,898
COME ALONG -- DOES NOT COME

6898
05:18:06,898 --> 05:18:07,398
ALONE.

6899
05:18:07,398 --> 05:18:09,300
PATIENTS WHO USE METH USUALLY

6900
05:18:09,300 --> 05:18:10,301
INVOLVE HIGH RISK SEXUAL

6901
05:18:10,301 --> 05:18:11,269
ACTIVITIES, THEY USE OTHER

6902
05:18:11,269 --> 05:18:13,371
DRUGS, SO THE FACT THAT HIV AND

6903
05:18:13,371 --> 05:18:14,872
METH CAN COME TOGETHER IS NO

6904
05:18:14,872 --> 05:18:15,139
SURPRISE.

6905
05:18:15,139 --> 05:18:16,974
THIS IS A HUGE PROBLEM HERE IN

6906
05:18:16,974 --> 05:18:20,144
THE BAY AREA WHERE MEN WHO HAVE

6907
05:18:20,144 --> 05:18:23,881
SESSION WITH MEN -- MEN WHO HAVE

6908
05:18:23,881 --> 05:18:27,418
SEX WITH MEN USE METHAMPHETAMINE

6909
05:18:27,418 --> 05:18:29,654
AS PART OF RECREATION, WHEN YOU

6910
05:18:29,654 --> 05:18:31,422
THINK OF THESE TWO GUYS COMING

6911
05:18:31,422 --> 05:18:32,824
TOGETHER, IT'S A DOUBLE HIT MADE

6912
05:18:32,824 --> 05:18:33,491
IN HELL.

6913
05:18:33,491 --> 05:18:34,592
NEXT SLIDE, PLEASE.

6914
05:18:34,592 --> 05:18:36,227
AND I'M GOING TO END UP BY

6915
05:18:36,227 --> 05:18:38,963
SHOWING YOU THIS, AND THIS IS

6916
05:18:38,963 --> 05:18:40,298
JUST FOOD FOR THOUGHT.

6917
05:18:40,298 --> 05:18:46,070
WHEN YOU LOOK AT THE PATIENTS

6918
05:18:46,070 --> 05:18:47,939
USE -- IDIOPATHIC USE OF

6919
05:18:47,939 --> 05:18:48,706
METHAMPHETAMINE IN THE GROUP,

6920
05:18:48,706 --> 05:18:51,843
YOU SEE OUT OF THIS GROUP 523,

6921
05:18:51,843 --> 05:18:55,279
33 INVESTIGATOR USED METH.

6922
05:18:55,279 --> 05:18:57,248
HIV PAH MUCH SMALLER BUT STILL A

6923
05:18:57,248 --> 05:18:57,882
HIGHER PROPORTION.

6924
05:18:57,882 --> 05:19:01,285
SO IS THERE A LINK BETWEEN THESE

6925
05:19:01,285 --> 05:19:03,888
TWO WELL-KNOWN CAUSES OF PAH?

6926
05:19:03,888 --> 05:19:06,424
THIS IS A SUBJECT FOR FUTURE

6927
05:19:06,424 --> 05:19:06,757
INVESTIGATION.

6928
05:19:06,757 --> 05:19:09,360
NEXT SLIDE, PLEASE.

6929
05:19:09,360 --> 05:19:12,430
SO AS I SAID, I THINK HOPEFULLY

6930
05:19:12,430 --> 05:19:14,298
AFTER FOCUSING ON DRUGS, I WANT

6931
05:19:14,298 --> 05:19:17,368
TO TAKE US BACK, I WANT TO ZOOM

6932
05:19:17,368 --> 05:19:20,438
OUT AND AGAIN PUT US BACK IN

6933
05:19:20,438 --> 05:19:20,972
PERSPECTIVE.

6934
05:19:20,972 --> 05:19:24,575
DRUG EXPOSURE IS AN IMPORTANT

6935
05:19:24,575 --> 05:19:30,147
PART OF WHAT DEFINES OUR

6936
05:19:30,147 --> 05:19:32,917
PATIENTS' ACCESS TO CARE, THEIR

6937
05:19:32,917 --> 05:19:35,419
OWN RESPONSE TO CARE, THEIR

6938
05:19:35,419 --> 05:19:37,188
TRUST, THEIR SUPPORT.

6939
05:19:37,188 --> 05:19:38,923
SO WE HAVE TO BE VERY CAREFUL

6940
05:19:38,923 --> 05:19:42,560
WHEN IT COMES TO THIS PATIENT

6941
05:19:42,560 --> 05:19:43,561
POPULATION BECAUSE IN ADDITION

6942
05:19:43,561 --> 05:19:45,296
TO EVERYTHING ELSE THAT WE HAVE

6943
05:19:45,296 --> 05:19:47,598
DEFINED SO FAR REGARDING

6944
05:19:47,598 --> 05:19:49,333
BARRIERS TO CARE AND

6945
05:19:49,333 --> 05:19:52,169
DETERMINANTS OF HEALTH, THIS BY

6946
05:19:52,169 --> 05:19:54,372
ITSELF CAN ALSO OPEN THE DOOR TO

6947
05:19:54,372 --> 05:19:57,408
OTHER COMPLEXITIES THAT WE AS

6948
05:19:57,408 --> 05:19:59,510
PHYSICIANS NEED TO BE AWARE, NOT

6949
05:19:59,510 --> 05:20:00,511
NECESSARILY BECAUSE WE CAN

6950
05:20:00,511 --> 05:20:02,580
TREAT, BUT ULTIMATELY AS WE TRY

6951
05:20:02,580 --> 05:20:05,316
TO THINK ABOUT HOW TO ADDRESS

6952
05:20:05,316 --> 05:20:07,518
THESE AND THINK ABOUT HOW TO

6953
05:20:07,518 --> 05:20:08,719
PROPERLY TREAT THESE PATIENTS,

6954
05:20:08,719 --> 05:20:10,588
HOW TO CONNECT THEM WITH THE

6955
05:20:10,588 --> 05:20:13,190
SYSTEM, WE ALSO HAVE TO THINK

6956
05:20:13,190 --> 05:20:15,860
ABOUT HOW ALL OF THESE FACTORS

6957
05:20:15,860 --> 05:20:21,098
INTERACT TOGETHER TO ULTIMATELY

6958
05:20:21,098 --> 05:20:22,300
DEFINE WHAT THIS INDIVIDUAL CAN

6959
05:20:22,300 --> 05:20:23,701
EXPECT FROM OUR SYSTEM AND WHAT

6960
05:20:23,701 --> 05:20:25,903
WE CAN EXPECT IN TERMS OF

6961
05:20:25,903 --> 05:20:27,204
OUTCOMES FOR THESE PATIENTS.

6962
05:20:27,204 --> 05:20:32,677
NEXT SLIDE, PLEASE.

6963
05:20:32,677 --> 05:20:35,313
VERY BRIEFLY, I HOPE I'VE

6964
05:20:35,313 --> 05:20:36,614
CONVINCED YOU THAT THIS IS AN

6965
05:20:36,614 --> 05:20:39,784
IMPORTANT FORM OF PULMONARY

6966
05:20:39,784 --> 05:20:41,986
HYPERTENSION, THINK ABOUT HIV

6967
05:20:41,986 --> 05:20:43,688
AND METHAMPHETAMINE, THEY NEED

6968
05:20:43,688 --> 05:20:45,589
TO BE SCREENED AT THE SAME TIME,

6969
05:20:45,589 --> 05:20:48,125
AND ALSO THIS IS A

6970
05:20:48,125 --> 05:20:50,594
MULTIDISCIPLINARY FORM OF PAH,

6971
05:20:50,594 --> 05:20:52,263
ALWAYS BE VERY CLEAR ABOUT

6972
05:20:52,263 --> 05:20:53,998
INVOLVING ADDICTION SPECIALISTS,

6973
05:20:53,998 --> 05:20:56,867
SOCIAL WORKERS, PSYCHIATRISTS,

6974
05:20:56,867 --> 05:20:58,069
BECAUSE ULTIMATELY THAT'S HOW

6975
05:20:58,069 --> 05:20:59,270
YOU'RE GOING TO SUCCESSFULLY

6976
05:20:59,270 --> 05:21:01,172
TREAT THESE PATIENTS.

6977
05:21:01,172 --> 05:21:04,408
SO WITH THAT, I BELIEVE MY NEXT

6978
05:21:04,408 --> 05:21:05,309
SLIDE IS COMING.

6979
05:21:05,309 --> 05:21:06,811
I WANT TO THANK YOU ALL.

6980
05:21:06,811 --> 05:21:08,546
I'M HAPPY TO TAKE QUESTIONS IF

6981
05:21:08,546 --> 05:21:15,252
THERE'S TIME.

6982
05:21:15,252 --> 05:21:17,521
>> THANK YOU, THAT WAS A

6983
05:21:17,521 --> 05:21:19,056
WONDERFUL OVERVIEW OF ESPECIALLY

6984
05:21:19,056 --> 05:21:21,892
A VERY PERTINENT TOPIC FOR US IN

6985
05:21:21,892 --> 05:21:22,626
THE SOUTHWEST.

6986
05:21:22,626 --> 05:21:26,497
YOU CAN ACTUALLY TRACK OUR

6987
05:21:26,497 --> 05:21:29,433
EPIDEMIC DOWN HERE, OUR IPH

6988
05:21:29,433 --> 05:21:31,302
POPULATION IS THIS, OUR METH

6989
05:21:31,302 --> 05:21:34,905
POPULATION IS THIS.

6990
05:21:34,905 --> 05:21:36,240
SO I'M SURE THERE ARE OTHER

6991
05:21:36,240 --> 05:21:37,942
CENTERS AS WELL.

6992
05:21:37,942 --> 05:21:39,944
I HAVE A QUICK QUESTION FOR YOU,

6993
05:21:39,944 --> 05:21:45,082
MAYBE NOT SO QUICK, BUT HOW MUCH

6994
05:21:45,082 --> 05:21:46,417
DO YOU THINK THAT THESE

6995
05:21:46,417 --> 05:21:48,152
DISPARITIES IN TREATMENT OF

6996
05:21:48,152 --> 05:21:49,553
METHAMPHETAMINE PATIENTS, YOU

6997
05:21:49,553 --> 05:21:51,389
SHOWED SORT OF THE NATIONAL MAP

6998
05:21:51,389 --> 05:21:53,624
AS WELL AS YOUR CENTERED, YOU

6999
05:21:53,624 --> 05:21:56,894
POINTED OUT THERE IS SOME

7000
05:21:56,894 --> 05:21:59,964
TREATMENT DISPARITY IN TERMS OF

7001
05:21:59,964 --> 05:22:04,535
PARENTERAL PROSTACYCLINS, HOW

7002
05:22:04,535 --> 05:22:05,536
MUCH OF THAT DO YOU THINK IS DUE

7003
05:22:05,536 --> 05:22:07,938
TO OUR OWN BIASES GOING INTO AND

7004
05:22:07,938 --> 05:22:12,643
ASKING OUR PATIENTS TO MODIFY

7005
05:22:12,643 --> 05:22:15,079
THEMSELVES OR THE WAY THAT WE

7006
05:22:15,079 --> 05:22:17,915
APPROACH PAH TREATMENT IN THEM,

7007
05:22:17,915 --> 05:22:20,217
AS OPPOSED TO US ADJUSTING OUR

7008
05:22:20,217 --> 05:22:23,387
OWN BIASES IN ACCORDANCE WITH

7009
05:22:23,387 --> 05:22:24,922
PERHAPS WHAT WILL WORK FOR THEM?

7010
05:22:24,922 --> 05:22:29,326
I'LL GIVE YOU AN EXAMPLE.

7011
05:22:29,326 --> 05:22:31,829
OUR PROGRAM HERE HAS A

7012
05:22:31,829 --> 05:22:33,230
MULTIDISCIPLINARY APPROACH TO

7013
05:22:33,230 --> 05:22:35,533
PATIENTS ALSO, BUT EVERY

7014
05:22:35,533 --> 05:22:37,168
PRACTITIONER SORT OF HAS

7015
05:22:37,168 --> 05:22:38,269
THEIR -- IN GRURNG HAS THEIR

7016
05:22:38,269 --> 05:22:40,671
SORT OF LEVEL OF OKAY THERE'S

7017
05:22:40,671 --> 05:22:43,741
THIS MUCH AMOUNT OF

7018
05:22:43,741 --> 05:22:44,708
SOCIOECONOMIC DISCORD IN A

7019
05:22:44,708 --> 05:22:46,544
PATIENT THAT WE BELIEVE THEY ARE

7020
05:22:46,544 --> 05:22:48,112
HIGH RISK FOR, SAY, PREANT

7021
05:22:48,112 --> 05:22:50,247
RESIDUAL THERAPY -- PA RENTED

7022
05:22:50,247 --> 05:22:51,715
RESIDUAL THERAPY, RIGHT?

7023
05:22:51,715 --> 05:22:53,484
WE'RE NOT GOING TO GO THAT FAR.

7024
05:22:53,484 --> 05:22:55,319
BUT DO WE HAVE THE DATA ACTUALLY

7025
05:22:55,319 --> 05:22:57,621
TO SHOW THAT THOSE PATIENTS ARE

7026
05:22:57,621 --> 05:22:59,623
ACTUALLY NOT GOING TO BE

7027
05:22:59,623 --> 05:23:02,460
ADHERENT TO PARENTERAL THERAPY,

7028
05:23:02,460 --> 05:23:06,497
SAY SUBCUTANEOUS THERAPY, IF A

7029
05:23:06,497 --> 05:23:08,599
GROUP OR A CENTER IS USED TO

7030
05:23:08,599 --> 05:23:11,669
GIVING IV THERAPY, THAT'S THEIR

7031
05:23:11,669 --> 05:23:13,170
PRACTICE PATTERN, RIGHT?

7032
05:23:13,170 --> 05:23:14,939
THEY MAY REFUSE THERAPY FOR A

7033
05:23:14,939 --> 05:23:17,007
PATIENT WHO USES

7034
05:23:17,007 --> 05:23:18,409
METHAMPHETAMINE, AS OPPOSED TO

7035
05:23:18,409 --> 05:23:20,511
MOVING TO SUBCUTANEOUS THERAPY

7036
05:23:20,511 --> 05:23:22,079
OR INHALED THERAPY, SOMETHING OF

7037
05:23:22,079 --> 05:23:23,547
THAT SORT.

7038
05:23:23,547 --> 05:23:26,250
SO JUST PUTTING THAT OUT THERE.

7039
05:23:26,250 --> 05:23:29,787
>> YEAH, THAT'S A VERY
COMPLEX

7040
05:23:29,787 --> 05:23:31,288
YET RELEVANT QUESTION.

7041
05:23:31,288 --> 05:23:36,460
I WILL TELL YOU THAT ALL OF US

7042
05:23:36,460 --> 05:23:40,431
WHO WORK AT CENTERS WHERE THERE

7043
05:23:40,431 --> 05:23:43,934
IS HIGH EXPERTISE AND SUPPORT

7044
05:23:43,934 --> 05:23:46,770
FOR TREATING PULMONARY ARTERIAL

7045
05:23:46,770 --> 05:23:48,372
HYPERTENSION PATIENTS, WE WILL

7046
05:23:48,372 --> 05:23:51,142
ALL BE ABLE TO TAKE A LOOK AT

7047
05:23:51,142 --> 05:23:52,543
THESE PATIENTS, WE HAVE NURSES,

7048
05:23:52,543 --> 05:23:53,944
WE HAVE AN INFRASTRUCTURE THAT

7049
05:23:53,944 --> 05:24:01,752
WE CAN USE TO LEVERAGE TRYING TO

7050
05:24:01,752 --> 05:24:04,288
OFFER THESE PATIENTS THE MOST

7051
05:24:04,288 --> 05:24:10,327
IMPORTANT AND VITAL OPTIONS.

7052
05:24:10,327 --> 05:24:11,862
IN MY OWN EXPERIENCE AND I DON'T

7053
05:24:11,862 --> 05:24:13,364
KNOW DATD TO SAY THAT THESE

7054
05:24:13,364 --> 05:24:15,533
PATIENTS ARE NOT AS COMPLEX,

7055
05:24:15,533 --> 05:24:20,237
ALTHOUGH I CAN TELL YOU FROM OUR

7056
05:24:20,237 --> 05:24:22,873
STUDY, WHICH IS CURRENTLY UNDER

7057
05:24:22,873 --> 05:24:27,144
REVIEW, I CAN TELL YOU THAT WE

7058
05:24:27,144 --> 05:24:31,282
DID LOOK AT THE RATE OF

7059
05:24:31,282 --> 05:24:34,685
ADHERENCE OF PATIENTS, METH PAH

7060
05:24:34,685 --> 05:24:36,954
VERSUS NONMETH PAH IN THIS

7061
05:24:36,954 --> 05:24:38,956
PARTICULAR INSURANCE CLAIMS

7062
05:24:38,956 --> 05:24:39,290
ANALYSIS.

7063
05:24:39,290 --> 05:24:42,126
WE LOOKED AT MONOTHERAPY, DUAL

7064
05:24:42,126 --> 05:24:43,627
THERAPY AND TRIPLE THERAPY

7065
05:24:43,627 --> 05:24:45,062
ACROSS FROM THIS, AND WHAT WE

7066
05:24:45,062 --> 05:24:47,498
CAN TELL YOU, THOUGH, IS THAT AT

7067
05:24:47,498 --> 05:24:50,868
LEAST IN METH PAH, THERE IS

7068
05:24:50,868 --> 05:24:52,603
LOWER TREATMENT ADHERENCE BUT

7069
05:24:52,603 --> 05:24:54,138
NOT BY MUCH.

7070
05:24:54,138 --> 05:24:56,874
WE'RE TALKING ABOUT COMPARISON

7071
05:24:56,874 --> 05:24:59,610
BETWEEN WITH THE NON-METH PAH

7072
05:24:59,610 --> 05:25:04,415
THE DIFFERENCES ARE ABOUT 2.6, .

7073
05:25:04,415 --> 05:25:05,983
SO IT IS, IT IS SIGNIFICANT.

7074
05:25:05,983 --> 05:25:08,018
>> AS WE THOUGHT IT WOULD
BE,

7075
05:25:08,018 --> 05:25:08,285
BASICALLY.

7076
05:25:08,285 --> 05:25:09,887
>> WELL, IT'S NOT LIKE
WHAT YOU

7077
05:25:09,887 --> 05:25:13,691
WILL SAY, IT'S NOT REAL -- SO I

7078
05:25:13,691 --> 05:25:16,694
DON'T THINK THAT WE CAN USE THAT

7079
05:25:16,694 --> 05:25:24,335
TO JUSTIFY NOT OFFERING SYSTEMIC

7080
05:25:24,335 --> 05:25:25,202
PROSTEMOIDS TO A PATIENT.

7081
05:25:25,202 --> 05:25:26,837
WHAT I'M MORE SCARED ABOUT IS A

7082
05:25:26,837 --> 05:25:29,039
PATIENT WHO IS ACTIVELY USING

7083
05:25:29,039 --> 05:25:30,140
BECAUSE THESE PATIENTS USUALLY

7084
05:25:30,140 --> 05:25:34,511
DO NOT HAVE THE CAPACITY TO

7085
05:25:34,511 --> 05:25:38,115
MANAGE THE PROTOCOL REQUIRED TO

7086
05:25:38,115 --> 05:25:39,316
ADMINISTER THE DRUG.

7087
05:25:39,316 --> 05:25:41,752
IN SOME CASES, LIKE ONE OF THE

7088
05:25:41,752 --> 05:25:44,255
CASES I LIKE TO RELY ON, WE HAD

7089
05:25:44,255 --> 05:25:47,625
A PATIENT WITH AN INTRAVENOUS

7090
05:25:47,625 --> 05:25:50,261
LINE AND THEY USED TO INJECT

7091
05:25:50,261 --> 05:25:51,462
METHAMPHETAMINE THROUGH THAT

7092
05:25:51,462 --> 05:25:51,695
LINE.

7093
05:25:51,695 --> 05:25:53,764
AND SINCE, YOU KNOW, THAT'S ONLY

7094
05:25:53,764 --> 05:25:55,966
HAPPENED ONE TIME, WHICH IS WHY

7095
05:25:55,966 --> 05:25:57,701
FOR THESE PATIENTS, SO IF WE

7096
05:25:57,701 --> 05:25:59,470
HAVE A PATIENT, FOR EXAMPLE, A

7097
05:25:59,470 --> 05:26:02,039
METH USER WHO IS VERY, VERY,

7098
05:26:02,039 --> 05:26:05,242
VERY SICK, WE WILL PUT THEM ON

7099
05:26:05,242 --> 05:26:06,777
SUBCUTANEOUS THERAPY, AND WE

7100
05:26:06,777 --> 05:26:07,544
WILL SUPPORT THEM.

7101
05:26:07,544 --> 05:26:10,281
SO AGAIN, WE WILL NOT WITHHOLD.

7102
05:26:10,281 --> 05:26:13,350
BUT WE WILL BE VERY CAREFUL AND

7103
05:26:13,350 --> 05:26:13,617
SELECTIVE.

7104
05:26:13,617 --> 05:26:14,852
IF THERE'S NO OTHER CHOICE, THIS

7105
05:26:14,852 --> 05:26:17,821
IS A PATIENT WHOSE FUNCTIONAL

7106
05:26:17,821 --> 05:26:18,789
CLASS FOUR, THEY'RE GOING TO

7107
05:26:18,789 --> 05:26:20,557
DIE, WE WILL DEFINITELY START

7108
05:26:20,557 --> 05:26:20,958
THEM.

7109
05:26:20,958 --> 05:26:22,593
BUT ONCE WE STABILIZE THEM, IF

7110
05:26:22,593 --> 05:26:24,261
WE FEEL THAT THIS PATIENT IS NOT

7111
05:26:24,261 --> 05:26:25,929
A CANDIDATE TO BE AT HOME ON

7112
05:26:25,929 --> 05:26:27,331
THESE THERAPIES, THEN WE WILL

7113
05:26:27,331 --> 05:26:30,401
HAVE TO TRANSITION THEM

7114
05:26:30,401 --> 05:26:32,469
IN-HOUSE, WITH THE GOAL THAT

7115
05:26:32,469 --> 05:26:35,105
ULTIMATELY ONCE THE PATIENT IS

7116
05:26:35,105 --> 05:26:37,608
ABLE TO, YOU KNOW, BE ABLE TO BE

7117
05:26:37,608 --> 05:26:39,576
RESPONSIBLE AND SHOW THAT THEY

7118
05:26:39,576 --> 05:26:43,747
HAVE ADEQUATE SUPPORT AND A MORE

7119
05:26:43,747 --> 05:26:46,583
SOLID SOCIAL STRUCTURE AROUND

7120
05:26:46,583 --> 05:26:48,652
THEM, THEN WE CAN GO AHEAD.

7121
05:26:48,652 --> 05:26:50,754
BUT TO ADDRESS YOUR QUESTION, AT

7122
05:26:50,754 --> 05:26:53,057
THIS POINT IN TIME, IN MY OWN

7123
05:26:53,057 --> 05:26:53,924
EXPERIENCE, I THINK THESE

7124
05:26:53,924 --> 05:26:56,226
PATIENTS ARE INCREDIBLY

7125
05:26:56,226 --> 05:26:56,493
ADHERENT.

7126
05:26:56,493 --> 05:26:58,295
WE HAVEN'T HAD A PATIENT WHO HAS

7127
05:26:58,295 --> 05:27:00,397
BEEN LIKE -- IN FACT, ONCE THEY

7128
05:27:00,397 --> 05:27:03,567
ARE ON IV OR SUB Q MORE ADHERE

7129
05:27:03,567 --> 05:27:05,102
ENLT THAN WHEN THEY ARE ON ORALS

7130
05:27:05,102 --> 05:27:06,937
OR INHALES, TO BE PERFECTLY

7131
05:27:06,937 --> 05:27:07,504
HONEST WITH YOU.

7132
05:27:07,504 --> 05:27:09,039
BUT THAT'S MY OWN EXPERIENCE

7133
05:27:09,039 --> 05:27:10,841
WITH THESE PATIENTS.

7134
05:27:10,841 --> 05:27:11,442
>> GREAT.

7135
05:27:11,442 --> 05:27:11,809
THANK YOU.

7136
05:27:11,809 --> 05:27:12,976
WE NEED TO MOVE ON.

7137
05:27:12,976 --> 05:27:14,912
I APPRECIATE THAT VERY MUCH.

7138
05:27:14,912 --> 05:27:16,947
IT WAS AN EXCELLENT TALK AND

7139
05:27:16,947 --> 05:27:21,385
OVERVIEW ON PAH AND

7140
05:27:21,385 --> 05:27:22,386
METHAMPHETAMINE USE.

7141
05:27:22,386 --> 05:27:25,622
LET'S MOVE ON TO OUR NEXT TALK,

7142
05:27:25,622 --> 05:27:27,191
THAT IS PULMONARY VASCULAR

7143
05:27:27,191 --> 05:27:29,360
DISEASE AND SOCIAL DISPARITIES

7144
05:27:29,360 --> 05:27:32,096
AMONG THE UNHOUSED AND VETERAN

7145
05:27:32,096 --> 05:27:33,330
GROUPS.

7146
05:27:33,330 --> 05:27:35,666
DR. EVAN BRITAIN IS ASSOCIATE

7147
05:27:35,666 --> 05:27:38,769
PROFESSOR OF MEDICINE, HE'S A

7148
05:27:38,769 --> 05:27:39,870
CARDIOLOGIST AT VANDERBILT.

7149
05:27:39,870 --> 05:27:43,273
EVAN, GO AHEAD.

7150
05:27:43,273 --> 05:27:44,375
>> THANK YOU.

7151
05:27:44,375 --> 05:27:45,843
GOOD AFTERNOON, EVERYONE.

7152
05:27:45,843 --> 05:27:48,479
I APPRECIATE THE INVITATION FROM

7153
05:27:48,479 --> 05:27:52,216
THE CHAIRS AND THE NHLBI.

7154
05:27:52,216 --> 05:27:53,217
IT'S REALLY A PRIVILEGE TO BE

7155
05:27:53,217 --> 05:27:53,417
HERE.

7156
05:27:53,417 --> 05:27:54,551
I WAS ASKED TO SHARE SOME

7157
05:27:54,551 --> 05:27:56,053
THOUGHTS ON THE INTERSECTION OF

7158
05:27:56,053 --> 05:27:57,688
PULMONARY VASCULAR DISEASE,

7159
05:27:57,688 --> 05:27:59,656
SOCIAL DISPARITIES AMONG THE

7160
05:27:59,656 --> 05:28:01,859
HOMELESS AND VETERANS GROUP, AND

7161
05:28:01,859 --> 05:28:02,960
I INTERPRETED THAT AND TREAT

7162
05:28:02,960 --> 05:28:04,361
THOSE AS SEPARATE GROUPS,

7163
05:28:04,361 --> 05:28:05,462
ALTHOUGH CERTAINLY THERE'S SOME

7164
05:28:05,462 --> 05:28:06,563
OVERLAP AND I'LL TOUCH ON THAT

7165
05:28:06,563 --> 05:28:07,831
AS WELL.

7166
05:28:07,831 --> 05:28:10,601
ONE OF THE EARLY DISCLAIMERS IS

7167
05:28:10,601 --> 05:28:12,503
THAT THIS IS REALLY A DATA-FREE

7168
05:28:12,503 --> 05:28:15,739
ZONE WITH RESPECT TO HOMELESS

7169
05:28:15,739 --> 05:28:16,039
INDIVIDUALS.

7170
05:28:16,039 --> 05:28:18,809
SO IF YOU'LL INDULGE ME, I'LL

7171
05:28:18,809 --> 05:28:20,978
TRY TO CONNECT SOME DOTS BETWEEN

7172
05:28:20,978 --> 05:28:22,746
SOCIAL DISPARITIES, CHALLENGES

7173
05:28:22,746 --> 05:28:23,947
FAILED BY HOMELESS INDIVIDUALS

7174
05:28:23,947 --> 05:28:26,049
AND HOW THAT MIGHT CREATE THE

7175
05:28:26,049 --> 05:28:29,086
CONDITIONS FOR DEVELOPMENT OF

7176
05:28:29,086 --> 05:28:30,854
PULMONARY VASCULAR DISEASE.

7177
05:28:30,854 --> 05:28:31,288
NEXT SLIDE.

7178
05:28:31,288 --> 05:28:33,123
SO THIS IS A SNAPSHOT OF

7179
05:28:33,123 --> 05:28:34,792
HOMELESSNESS IN AMERICA, DRAWING

7180
05:28:34,792 --> 05:28:36,093
YOUR ATTENTION ON THE FIGURE ON

7181
05:28:36,093 --> 05:28:39,029
THE LEFT FIRST, THIS IS NUMBERS

7182
05:28:39,029 --> 05:28:41,865
OVER TIME OF CHRONIC

7183
05:28:41,865 --> 05:28:44,968
HOMELESSNESS DEFINED HERE AS

7184
05:28:44,968 --> 05:28:48,338
EXTENDED PERIOD OF BEING WITHOUT

7185
05:28:48,338 --> 05:28:49,106
THE SHELTER.

7186
05:28:49,106 --> 05:28:50,641
AND IF YOU CONSIDER ON ANY GIVEN

7187
05:28:50,641 --> 05:28:52,176
NIGHT, THE NUMBERS ARE ABOUT

7188
05:28:52,176 --> 05:28:54,745
THREE TO FOUR FOLDER HIGHER, BUT

7189
05:28:54,745 --> 05:28:57,314
THIS IS DATA FOR CHRONIC

7190
05:28:57,314 --> 05:28:57,648
HOMELESSNESS.

7191
05:28:57,648 --> 05:28:59,283
YOU CAN SEE THERE'S AN UPTICK

7192
05:28:59,283 --> 05:29:00,484
OVER THE LAST SEVERAL YEARS.

7193
05:29:00,484 --> 05:29:01,919
I DON'T THINK THERE'S ANY SINGLE

7194
05:29:01,919 --> 05:29:04,521
CAUSE OF THAT, BUT SOME

7195
05:29:04,521 --> 05:29:05,489
CONTRIBUTORS THAT HAVE BEEN

7196
05:29:05,489 --> 05:29:07,591
CITED AND SEEM TO BE SORT OF

7197
05:29:07,591 --> 05:29:09,560
CONSENSUS CONTRIBUTORS ARE

7198
05:29:09,560 --> 05:29:11,495
GENERAL ECONOMIC INSTABILITY

7199
05:29:11,495 --> 05:29:13,297
OVER THE LAST SEVERAL YEARS,

7200
05:29:13,297 --> 05:29:15,799
COUPLED WITH INFLATION, COVID

7201
05:29:15,799 --> 05:29:16,867
PANDEMIC, WHICH AFFECTED

7202
05:29:16,867 --> 05:29:18,869
INDIVIDUALS WHO WERE SORT OF ON

7203
05:29:18,869 --> 05:29:20,737
THE MARGINS IN TERMS OF ECONOMIC

7204
05:29:20,737 --> 05:29:22,706
STABILITY MORE SO THAN OTHERS,

7205
05:29:22,706 --> 05:29:24,875
WITHDRAWAL OF COVID ASSISTANCE

7206
05:29:24,875 --> 05:29:26,944
DURING THE PANDEMIC, AND SOME

7207
05:29:26,944 --> 05:29:29,546
OTHER CAUSES.

7208
05:29:29,546 --> 05:29:31,648
ONE OF THE DISPARITIES AMONG THE

7209
05:29:31,648 --> 05:29:32,649
HOMELESS THAT IS REALLY

7210
05:29:32,649 --> 05:29:34,952
IMPORTANT TO CONSIDER IS

7211
05:29:34,952 --> 05:29:36,053
DISPLAYED ON THE RIGHT.

7212
05:29:36,053 --> 05:29:39,523
HERE YOU SEE IN GREEN THE

7213
05:29:39,523 --> 05:29:42,626
DISTRIBUTION OF DIFFERENT RACIAL

7214
05:29:42,626 --> 05:29:44,361
GROUPS IN THE U.S., AND IN BLUE

7215
05:29:44,361 --> 05:29:46,997
IS THE DISTRIBUTION AMONG THE

7216
05:29:46,997 --> 05:29:47,764
HOMELESS POPULATION.

7217
05:29:47,764 --> 05:29:49,566
SO ANYWHERE THAT THE BLUE BAR IS

7218
05:29:49,566 --> 05:29:52,069
LONGER THAN THE GREEN BAR

7219
05:29:52,069 --> 05:29:53,270
ACCIDENT THERE'S A RACIAL

7220
05:29:53,270 --> 05:29:54,571
DISPARITY IN TERMS OF

7221
05:29:54,571 --> 05:29:55,873
REPRESENTATION AMONG THE

7222
05:29:55,873 --> 05:29:56,139
HOMELESS.

7223
05:29:56,139 --> 05:29:59,076
YOU SEE THAT AS PARTICULARLY

7224
05:29:59,076 --> 05:30:00,244
MARKED AMONG BLACK INDIVIDUALS,

7225
05:30:00,244 --> 05:30:01,245
HISPANICS AND OTHERS.

7226
05:30:01,245 --> 05:30:03,447
NEXT SLIDE.

7227
05:30:03,447 --> 05:30:07,050
THERE ARE SOME DATA AMONG

7228
05:30:07,050 --> 05:30:07,317
VETERANS.

7229
05:30:07,317 --> 05:30:08,919
THIS IS VETERANS EXPERIENCING

7230
05:30:08,919 --> 05:30:10,153
HOMELESSNESS IN THE U.S., AND

7231
05:30:10,153 --> 05:30:12,055
YOU CAN SEE THAT THIS IS A

7232
05:30:12,055 --> 05:30:14,057
LITTLE BIT MORE OF A POSITIVE

7233
05:30:14,057 --> 05:30:14,291
PICTURE.

7234
05:30:14,291 --> 05:30:15,559
THERE'S A DECLINE OVER THE LAST

7235
05:30:15,559 --> 05:30:16,793
TEN TO TWELVE YEARS.

7236
05:30:16,793 --> 05:30:18,962
THIS IS LARGELY ATTRIBUTED ON A

7237
05:30:18,962 --> 05:30:21,265
LARGE INVESTMENT FROM THE OBAMA

7238
05:30:21,265 --> 05:30:22,666
ADMINISTRATION AND HOUSING AND

7239
05:30:22,666 --> 05:30:23,800
URBAN DEVELOPMENT AND IS REALLY

7240
05:30:23,800 --> 05:30:27,604
CITED AS A SUCCESS STORY FOR

7241
05:30:27,604 --> 05:30:29,339
ALLEVIATING HOMELESS VETERANS.

7242
05:30:29,339 --> 05:30:33,176
NEXT SLIDE, PLEASE.

7243
05:30:33,176 --> 05:30:35,012
SO THERE'S A LOT ON THIS SLIDE,

7244
05:30:35,012 --> 05:30:36,213
AND THE DETAILS ARE LESS

7245
05:30:36,213 --> 05:30:37,548
IMPORTANT THAN THE OVERALL

7246
05:30:37,548 --> 05:30:38,815
MESSAGE, AND THIS IS PROBABLY

7247
05:30:38,815 --> 05:30:40,050
ONE OF THE MORE IMPORTANT POINTS

7248
05:30:40,050 --> 05:30:41,184
THAT I WANT TO MAKE.

7249
05:30:41,184 --> 05:30:42,252
REALLY IT'S JUST TO HIGHLIGHT

7250
05:30:42,252 --> 05:30:45,956
THE INTERACTIONS AMONG SOCIAL

7251
05:30:45,956 --> 05:30:49,059
DISPARITIES, HOMELESSNESS AND

7252
05:30:49,059 --> 05:30:50,594
CHRONIC HEALTH CONDITIONS.

7253
05:30:50,594 --> 05:30:53,530
THE KEY POINT IS THAT THE

7254
05:30:53,530 --> 05:30:54,965
CONDITIONS AMONG SOCIAL

7255
05:30:54,965 --> 05:30:58,135
DISPARITIES SUCH AS POVERTY,

7256
05:30:58,135 --> 05:30:59,636
TRAUMA, DISCRIMINATION, CREATE

7257
05:30:59,636 --> 05:31:01,071
THE CONDITIONS THAT INCREASE

7258
05:31:01,071 --> 05:31:03,373
RISK FOR HOMELESSNESS, AND THEY

7259
05:31:03,373 --> 05:31:05,776
ALSO INCREASE RISK FOR VARIOUS

7260
05:31:05,776 --> 05:31:08,545
CHRONIC DISEASES.

7261
05:31:08,545 --> 05:31:10,647
THE EXPERIENCE OF BEING HOMELESS

7262
05:31:10,647 --> 05:31:11,915
AND THE CHALLENGES WITH

7263
05:31:11,915 --> 05:31:13,350
RECEIVING MEDICAL CARE AND

7264
05:31:13,350 --> 05:31:14,184
TREATING CHRONIC CONDITIONS

7265
05:31:14,184 --> 05:31:15,953
REALLY MAKE IT MORE DIFFICULT TO

7266
05:31:15,953 --> 05:31:17,821
EMERGE FROM THE HOMELESS

7267
05:31:17,821 --> 05:31:19,356
CONDITION AND THE RESULT IS AN

7268
05:31:19,356 --> 05:31:21,091
INCREASE IN CHRONIC DISEASES

7269
05:31:21,091 --> 05:31:24,161
ACROSS THE HUMAN PHENOME AS WELL

7270
05:31:24,161 --> 05:31:25,796
AS MARKED INCREASE IN THE RATES

7271
05:31:25,796 --> 05:31:27,130
OF MENTAL HEALTH CONDITIONS AND

7272
05:31:27,130 --> 05:31:29,433
SUBSTANCE USE DISORDERS.

7273
05:31:29,433 --> 05:31:32,402
NEXT SLIDE, PLEASE.

7274
05:31:32,402 --> 05:31:34,805
THIS IS A LOOK AT UNMET

7275
05:31:34,805 --> 05:31:36,873
HEALTHCARE NEEDS AMONG HOMELESS

7276
05:31:36,873 --> 05:31:37,107
ADULTS.

7277
05:31:37,107 --> 05:31:40,043
THESE DATA ARE A LITTLE OLDER,

7278
05:31:40,043 --> 05:31:42,879
ABOUT 1,000 SURVEYED HOMELESS

7279
05:31:42,879 --> 05:31:43,180
INDIVIDUALS.

7280
05:31:43,180 --> 05:31:45,182
WHAT WE SEE IS ABOUT A THIRD OF

7281
05:31:45,182 --> 05:31:47,150
THOSE INDIVIDUALS HAD UNMET

7282
05:31:47,150 --> 05:31:49,553
MEDICAL OR SURGICAL CARE NEEDS,

7283
05:31:49,553 --> 05:31:50,887
ABOUT A THIRD NEEDED

7284
05:31:50,887 --> 05:31:53,156
PRESCRIPTIONS THAT WEREN'T

7285
05:31:53,156 --> 05:31:54,591
OBTAINED, AND PERHAPS SORT OF

7286
05:31:54,591 --> 05:31:56,893
OBVIOUS NOW THAT WE'RE SEEING IT

7287
05:31:56,893 --> 05:31:59,062
BUT IT CERTAINLY WASN'T ON THE

7288
05:31:59,062 --> 05:32:00,063
FOREFRONT OF WHAT I WAS

7289
05:32:00,063 --> 05:32:02,132
THINKING, THE BIGGEST NEEDS WERE

7290
05:32:02,132 --> 05:32:03,333
EYEGLASSES AND DENTAL CARE,

7291
05:32:03,333 --> 05:32:04,768
WHICH MAKES A LOT OF SENSE.

7292
05:32:04,768 --> 05:32:06,069
THOSE ARE MAJOR DRIVERS OF

7293
05:32:06,069 --> 05:32:08,805
QUALITY OF LIFE AND REALLY

7294
05:32:08,805 --> 05:32:11,108
IMPORTANT UNMET HEALTHCARE NEEDS

7295
05:32:11,108 --> 05:32:12,843
AMONG THE HOMELESS.

7296
05:32:12,843 --> 05:32:15,946
NEXT SLIDE.

7297
05:32:15,946 --> 05:32:18,548
SO LOOKING HERE AT ALL CAUSE

7298
05:32:18,548 --> 05:32:20,183
MORTALITY AMONG THE HOMELESS,

7299
05:32:20,183 --> 05:32:21,818
THESE ARE CENSUS DATA.

7300
05:32:21,818 --> 05:32:24,021
THE Y AXIS IS THE PROBABILITY OF

7301
05:32:24,021 --> 05:32:24,421
DEATH.

7302
05:32:24,421 --> 05:32:25,656
THOSE NUMBERS ARE QUITE LOW

7303
05:32:25,656 --> 05:32:27,290
BECAUSE IT'S JUST A SIX-MONTH

7304
05:32:27,290 --> 05:32:29,359
PERIOD, BUT YOU CAN EXTRAPOLATE

7305
05:32:29,359 --> 05:32:31,995
AND THE SEPARATION WOULD BE THE

7306
05:32:31,995 --> 05:32:32,195
SAME.

7307
05:32:32,195 --> 05:32:34,831
I THINK THE KEY TAKE AWAY HERE

7308
05:32:34,831 --> 05:32:39,202
IS THE WIDE GAP BETWEEN THE

7309
05:32:39,202 --> 05:32:40,203
HOMELESS POPULATION WHICH IS THE

7310
05:32:40,203 --> 05:32:42,472
TOP LINE AND THOSE WHO ARE POOR

7311
05:32:42,472 --> 05:32:45,342
BUT HAVE A HOME, AND THAT'S THE

7312
05:32:45,342 --> 05:32:47,411
SECOND LINE THERE, WHICH THEY DO

7313
05:32:47,411 --> 05:32:49,279
WORSE THAN INDIVIDUALS WHO ARE

7314
05:32:49,279 --> 05:32:53,116
NOT POOR, BUT THE BIG GAP REALLY

7315
05:32:53,116 --> 05:32:54,851
IS BETWEEN -- IS REALLY IMPOSED

7316
05:32:54,851 --> 05:32:57,921
BY VIRTUE OF BEING HOMELESS.

7317
05:32:57,921 --> 05:33:01,858
NEXT SLIDE, PLEASE.

7318
05:33:01,858 --> 05:33:02,426
OR ADVANCE.

7319
05:33:02,426 --> 05:33:03,260
THANK YOU.

7320
05:33:03,260 --> 05:33:06,129
THESE ARE DATA, ALL CAUSE

7321
05:33:06,129 --> 05:33:07,097
MORTALITY AMONG THE VETERAN

7322
05:33:07,097 --> 05:33:08,532
POPULATION USING NATIONAL DEATH

7323
05:33:08,532 --> 05:33:09,166
INDEX DATA.

7324
05:33:09,166 --> 05:33:11,068
THIS IS A MUCH LONGER TERM

7325
05:33:11,068 --> 05:33:12,369
STUDY, THE FOLLOW-UP IS LONGER

7326
05:33:12,369 --> 05:33:13,603
THAN TEN YEARS, AS YOU CAN SEE

7327
05:33:13,603 --> 05:33:16,073
ON THE X AXIS.

7328
05:33:16,073 --> 05:33:18,608
AND HERE THEY'VE STRATIFIED

7329
05:33:18,608 --> 05:33:20,911
BASED ON NOT JUST HOMELESS

7330
05:33:20,911 --> 05:33:23,213
STATUS BUT ALSO AGE.

7331
05:33:23,213 --> 05:33:24,948
NOT SURPRISINGLY, OLDER

7332
05:33:24,948 --> 05:33:26,683
INDIVIDUALS HAVE HIGHER

7333
05:33:26,683 --> 05:33:30,087
MORTALITY THAN YOUNGER

7334
05:33:30,087 --> 05:33:31,188
INDIVIDUALS, BUT YOU CAN SEE

7335
05:33:31,188 --> 05:33:33,256
THAT THE SOLID LINES ARE BOTH

7336
05:33:33,256 --> 05:33:34,691
VETERAN AND HOMELESS

7337
05:33:34,691 --> 05:33:36,326
POPULATIONS, THOSE ARE BOTH

7338
05:33:36,326 --> 05:33:38,295
SHIFT DOWN QUITE A BIT.

7339
05:33:38,295 --> 05:33:42,466
SO THE MEDIAN SURVIVAL IN OLDER

7340
05:33:42,466 --> 05:33:45,736
HOMELESS VETERANS IS ABOUT TEN

7341
05:33:45,736 --> 05:33:45,936
YEARS.

7342
05:33:45,936 --> 05:33:48,572
NEXT SLIDE.

7343
05:33:48,572 --> 05:33:50,574
SO GETTING CLOSER, TRYING AT

7344
05:33:50,574 --> 05:33:51,975
LEAST AND GETTING CLOSER TO

7345
05:33:51,975 --> 05:33:53,410
CONNECTING THE DOTS WITH

7346
05:33:53,410 --> 05:33:54,311
PULMONARY VASCULAR DISEASE, THIS

7347
05:33:54,311 --> 05:33:56,813
IS NOW LOOKING AT HOMELESS

7348
05:33:56,813 --> 05:33:58,115
INDIVIDUALS AND RISK OF HEART

7349
05:33:58,115 --> 05:33:58,348
DISEASE.

7350
05:33:58,348 --> 05:34:01,384
THIS IS A META-ANALYSIS OF NINE

7351
05:34:01,384 --> 05:34:01,718
STUDIES.

7352
05:34:01,718 --> 05:34:06,957
THESE ARE POPULATIONS ACROSS THE

7353
05:34:06,957 --> 05:34:07,290
WORLD.

7354
05:34:07,290 --> 05:34:08,925
SO MORE THAN JUST THE UNITED

7355
05:34:08,925 --> 05:34:09,159
STATES.

7356
05:34:09,159 --> 05:34:10,560
WHAT YOU SEE IS THERE'S AN

7357
05:34:10,560 --> 05:34:11,795
INCREASED RISK OF CARDIOVASCULAR

7358
05:34:11,795 --> 05:34:13,730
DISEASE AMONG THE HOMELESS, THE

7359
05:34:13,730 --> 05:34:15,398
BOTTOM SQUARE THERE SHOWS THAT

7360
05:34:15,398 --> 05:34:17,033
THE OVERALL ODDS OF

7361
05:34:17,033 --> 05:34:18,034
CARDIOVASCULAR DISEASE ARE ABOUT

7362
05:34:18,034 --> 05:34:19,936
TWO TO THREEFOLD HIGHER AMONG

7363
05:34:19,936 --> 05:34:22,806
THE HOMELESS COMPARED TO THOSE

7364
05:34:22,806 --> 05:34:24,040
WHO AREN'T.

7365
05:34:24,040 --> 05:34:27,410
NEXT SLIDE.

7366
05:34:27,410 --> 05:34:30,147
SO I THINK ONE OF THE MORE SORT

7367
05:34:30,147 --> 05:34:33,416
OF SUCCINCT AND CLEVER WAYS OF

7368
05:34:33,416 --> 05:34:35,418
PUTTING THIS WAS FROM ONE OF THE

7369
05:34:35,418 --> 05:34:36,486
EDITORIALS I CAME ACROSS WHICH

7370
05:34:36,486 --> 05:34:38,255
SAYS THAT HOMELESSNESS IS A

7371
05:34:38,255 --> 05:34:40,090
CAUSE OF THE CAUSES OF

7372
05:34:40,090 --> 05:34:41,124
CARDIOVASCULAR DISEASE, AND I'LL

7373
05:34:41,124 --> 05:34:44,261
TRY TO CONVINCE YOU THAT THAT'S

7374
05:34:44,261 --> 05:34:45,796
ALSO -- HOMELESSNESS IS ALSO A

7375
05:34:45,796 --> 05:34:47,864
CAUSE OF THE CAUSES OF PULMONARY

7376
05:34:47,864 --> 05:34:49,466
VASCULAR DISEASE.

7377
05:34:49,466 --> 05:34:51,601
THIS IS AN ILLUSTRATION FROM A

7378
05:34:51,601 --> 05:34:54,004
RECENT REALLY WELL DONE REVIEW

7379
05:34:54,004 --> 05:34:56,506
ARTICLE FROM JACK AND IT

7380
05:34:56,506 --> 05:34:58,041
DISCUSSES -- FROM JACC AND

7381
05:34:58,041 --> 05:34:59,142
DISCUSSES THAT HOMELESS

7382
05:34:59,142 --> 05:35:00,510
INDIVIDUALS HAVE TRADITIONAL

7383
05:35:00,510 --> 05:35:02,445
RISK FACTORS FOR CARDIOVASCULAR

7384
05:35:02,445 --> 05:35:04,815
DISEASE, ABOUT 06 TO 80% ARE

7385
05:35:04,815 --> 05:35:06,683
SMOKERS OR FORMER SMOKERS, THAT

7386
05:35:06,683 --> 05:35:08,385
DRIVES A LOT OF THE ISCHEMIC

7387
05:35:08,385 --> 05:35:09,519
HEART DISEASE IN THIS

7388
05:35:09,519 --> 05:35:10,821
POPULATION.

7389
05:35:10,821 --> 05:35:12,489
INTERESTINGLY, AT LEAST BY THE

7390
05:35:12,489 --> 05:35:15,225
REPORTS THAT ARE PUBLISHED, THE

7391
05:35:15,225 --> 05:35:16,726
PREVALENCE OF HYPERTENSION AND

7392
05:35:16,726 --> 05:35:18,495
DIABETES IS FAIRLY SIMILAR

7393
05:35:18,495 --> 05:35:20,463
BETWEEN HOMELESS INDIVIDUALS AND

7394
05:35:20,463 --> 05:35:21,998
THOSE WHO AREN'T HOMELESS,

7395
05:35:21,998 --> 05:35:22,999
ALTHOUGH I SUSPECT THERE'S

7396
05:35:22,999 --> 05:35:24,734
PROBABLY QUITE A BIT OF

7397
05:35:24,734 --> 05:35:26,369
UNDERDIAGNOSIS OR MISDIAGNOSIS

7398
05:35:26,369 --> 05:35:26,736
THERE.

7399
05:35:26,736 --> 05:35:29,306
BUT IT'S ALSO IMPORTANT THAT

7400
05:35:29,306 --> 05:35:30,974
THESE COMORBIDITIES ARE LESS

7401
05:35:30,974 --> 05:35:32,609
WELL CONTROLLED IN THE HOMELESS

7402
05:35:32,609 --> 05:35:34,144
POPULATION, THAT'S PRETTY WELL

7403
05:35:34,144 --> 05:35:34,477
ESTABLISHED.

7404
05:35:34,477 --> 05:35:36,213
AND THEN ON THE TOP RIGHT, THERE

7405
05:35:36,213 --> 05:35:38,181
ARE ALSO QUITE A BIT OF

7406
05:35:38,181 --> 05:35:40,050
HEIGHTENED NONTRADITIONAL RISK

7407
05:35:40,050 --> 05:35:41,151
FACTORS, INCLUDING CHRONIC

7408
05:35:41,151 --> 05:35:42,886
STRESS, AND WE'LL HEAR SOME

7409
05:35:42,886 --> 05:35:46,056
EXPERT COMMENTARY ON ALLOSTERIC

7410
05:35:46,056 --> 05:35:47,824
LOAD, INCREASED RISK OF

7411
05:35:47,824 --> 05:35:49,793
DEPRESSION, HEAVY ALCOHOL AND

7412
05:35:49,793 --> 05:35:52,729
COCAINE USE, AND THEN A SPECIAL

7413
05:35:52,729 --> 05:35:54,497
RISK FACTOR THAT'S HEIGHTENED

7414
05:35:54,497 --> 05:35:56,132
AMONG THE VETERANS -- OR THE

7415
05:35:56,132 --> 05:35:57,667
HOMELESS RATHER IS HIV, AND

7416
05:35:57,667 --> 05:35:58,869
SOMEWHERE BETWEEN TWO TO TEN

7417
05:35:58,869 --> 05:36:00,503
PERCENT OF HOMELESS INDIVIDUALS

7418
05:36:00,503 --> 05:36:02,606
ARE HIV POSITIVE DEPENDING ON

7419
05:36:02,606 --> 05:36:04,674
THE POPULATION THAT YOU STUDY.

7420
05:36:04,674 --> 05:36:07,077
SO YOU TAKE THESE INCREASED

7421
05:36:07,077 --> 05:36:08,278
CARDIOVASCULAR RISK FACTORS AND

7422
05:36:08,278 --> 05:36:10,013
YOU LAYER ON THAT THE DIFFICULTY

7423
05:36:10,013 --> 05:36:12,115
WITH DIAGNOSING CARDIOVASCULAR

7424
05:36:12,115 --> 05:36:13,950
DISEASE IN THIS POPULATION AND

7425
05:36:13,950 --> 05:36:16,052
THAT STEMS FROM CHALLENGES

7426
05:36:16,052 --> 05:36:17,888
AROUND THE LOGISTICS OF TESTING,

7427
05:36:17,888 --> 05:36:20,624
WHICH I'LL COMMENT ON, THE LACK

7428
05:36:20,624 --> 05:36:24,160
OF USUAL CARE SOURCES, AND OTHER

7429
05:36:24,160 --> 05:36:24,461
CAUSES.

7430
05:36:24,461 --> 05:36:26,429
SO EVEN IF YOU CAN DIAGNOSE

7431
05:36:26,429 --> 05:36:28,498
CARDIOVASCULAR DISEASE IN THIS

7432
05:36:28,498 --> 05:36:30,467
POPULATION, THEN YOU'RE FACING

7433
05:36:30,467 --> 05:36:33,336
DIFFICULT MANAGEMENT

7434
05:36:33,336 --> 05:36:33,703
CONSIDERATIONS.

7435
05:36:33,703 --> 05:36:36,072
THERE ARE ALL KINDS OF

7436
05:36:36,072 --> 05:36:39,009
CHALLENGES WITH OBTAINING

7437
05:36:39,009 --> 05:36:40,977
MEDICATIONS, STAYING ADHERENCE,

7438
05:36:40,977 --> 05:36:42,178
THERE'S FRAGMENTATION OF CARE

7439
05:36:42,178 --> 05:36:45,582
BECAUSE THE ACCESS TO CARE IS

7440
05:36:45,582 --> 05:36:47,550
LIMITED AMONG MANY OF THESE

7441
05:36:47,550 --> 05:36:47,851
POPULATIONS.

7442
05:36:47,851 --> 05:36:50,053
AND ALL OF THESE CONVERGE TO

7443
05:36:50,053 --> 05:36:51,788
INCREASE RISK OF CARDIOVASCULAR

7444
05:36:51,788 --> 05:36:54,090
DISEASE, WHICH IS A MAJOR

7445
05:36:54,090 --> 05:36:55,959
CONTRIBUTOR TO DEATH AMONG THE

7446
05:36:55,959 --> 05:36:56,693
HOMELESS POPULATION.

7447
05:36:56,693 --> 05:36:58,495
IF YOU LOOK ACROSS REALLY ALL

7448
05:36:58,495 --> 05:37:01,431
AGE GROUPS AMONG THE HOMELESS,

7449
05:37:01,431 --> 05:37:03,300
HEART DISEASE AND CANCER ARE

7450
05:37:03,300 --> 05:37:04,601
VIRTUALLY IDENTICAL, BUT THEY'RE

7451
05:37:04,601 --> 05:37:07,003
THE SECOND LEADING CAUSE OF

7452
05:37:07,003 --> 05:37:08,738
DEATH ACROSS ALL AGE GROUPS FOR

7453
05:37:08,738 --> 05:37:11,675
THE HOMELESS POPULATION.

7454
05:37:11,675 --> 05:37:16,112
NEXT SLIDE, PLEASE.

7455
05:37:16,112 --> 05:37:18,715
SO I HAVEN'T FORGOTTEN ABOUT THE

7456
05:37:18,715 --> 05:37:19,582
PULMONOLOGISTS IN THE GROUP.

7457
05:37:19,582 --> 05:37:21,318
THERE ALSO IS AN INCREASED RISK,

7458
05:37:21,318 --> 05:37:22,986
NOT SURPRISINGLY, IN PREVALENCE

7459
05:37:22,986 --> 05:37:25,588
OF PULMONARY DISEASE IN THE

7460
05:37:25,588 --> 05:37:25,855
HOMELESS.

7461
05:37:25,855 --> 05:37:27,891
THIS IS A NICE STUDY IN THE

7462
05:37:27,891 --> 05:37:35,432
GREATER LONDON AREA, I THINK

7463
05:37:35,432 --> 05:37:38,735
COMMON -- LOOKING AT CHRONIC

7464
05:37:38,735 --> 05:37:41,037
COMMON CO-MORE DID TIZ.

7465
05:37:41,037 --> 05:37:43,106
ONE IS LEAST DEPRIVED, FIVE IS

7466
05:37:43,106 --> 05:37:43,907
MOST DEPRIVED.

7467
05:37:43,907 --> 05:37:45,175
IF YOU SQUINT THERE'S A STEP

7468
05:37:45,175 --> 05:37:46,776
WISE INCREASE AS THE DEPRIVATION

7469
05:37:46,776 --> 05:37:48,545
INDEX WORSENS BUT THEN THERE'S

7470
05:37:48,545 --> 05:37:50,447
THIS HUGE JUMP WHEN IT COMES TO

7471
05:37:50,447 --> 05:37:51,648
HOMELESS STATUS.

7472
05:37:51,648 --> 05:37:53,950
YOU SEE THAT WITH HEART DISEASE,

7473
05:37:53,950 --> 05:37:56,119
BUT PARTICULARLY PRONOUNCED WITH

7474
05:37:56,119 --> 05:37:59,189
CHRONIC RESPIRATORY DISEASES,

7475
05:37:59,189 --> 05:38:01,257
PARTICULARLY COPD AND ASTHMA.

7476
05:38:01,257 --> 05:38:02,258
SO WHAT YOU FOUND IS THAT

7477
05:38:02,258 --> 05:38:03,660
THERE'S AN INCREASE BOTH WITH

7478
05:38:03,660 --> 05:38:05,095
CARDIOVASCULAR AND PULMONARY

7479
05:38:05,095 --> 05:38:06,963
DISEASE THAT WE KNOW ARE THE

7480
05:38:06,963 --> 05:38:08,932
MAJOR UNDERLYING RISK FACTORS

7481
05:38:08,932 --> 05:38:10,467
FOR MOST OF THE PULMONARY

7482
05:38:10,467 --> 05:38:12,736
HYPERTENSION IN THE U.S. AND

7483
05:38:12,736 --> 05:38:13,003
WORLDWIDE.

7484
05:38:13,003 --> 05:38:16,906
NEXT SLIDE.

7485
05:38:16,906 --> 05:38:18,775
SO THIS WAS MY ATTEMPT TO

7486
05:38:18,775 --> 05:38:20,410
CONNECT SOME DOTS IN THE

7487
05:38:20,410 --> 05:38:21,811
HOMELESS POPULATION WHERE THERE

7488
05:38:21,811 --> 05:38:23,780
REALLY IS NOT ANY DIRECT DAFT ON

7489
05:38:23,780 --> 05:38:24,681
PULMONARY VASCULAR DISEASE.

7490
05:38:24,681 --> 05:38:27,617
IF I MISS IT, ARE PLEASE BRING

7491
05:38:27,617 --> 05:38:30,120
IT UP IN THE DISCUSSION.

7492
05:38:30,120 --> 05:38:31,788
THIS IS ALSO NOT AN ATTEMPT

7493
05:38:31,788 --> 05:38:33,757
ALTHOUGH AN ATTEMPTED ACYCLIC

7494
05:38:33,757 --> 05:38:35,592
GRAVMENT I APOLOGIZE TO ANY OF

7495
05:38:35,592 --> 05:38:37,060
THE EPIDEMIOLOGISTS, THERE ARE

7496
05:38:37,060 --> 05:38:38,661
PROBABLY SOME MISSING ARROWS

7497
05:38:38,661 --> 05:38:40,296
HERE AND LOOPS I DIDN'T CONNECT.

7498
05:38:40,296 --> 05:38:41,831
BUT THE POINT I WANT TO MAKE IS

7499
05:38:41,831 --> 05:38:44,801
THAT SOCIAL DISPARITIES IN

7500
05:38:44,801 --> 05:38:46,302
HOMELESSNESS ARE RISK FACTORS

7501
05:38:46,302 --> 05:38:47,737
FOR ONE ANOTHER AND THEY

7502
05:38:47,737 --> 05:38:48,938
EXACERBATE ONE ANOTHER.

7503
05:38:48,938 --> 05:38:50,807
THEY BOTH CONTRIBUTE TO THE

7504
05:38:50,807 --> 05:38:53,643
DEVELOPMENT OF RISK FACTORS FOR

7505
05:38:53,643 --> 05:38:55,612
CARDIOVASCULAR AND PULMONARY

7506
05:38:55,612 --> 05:38:57,680
DISEASE, WHICH IN TURN ARE OF

7507
05:38:57,680 --> 05:38:59,983
COURSE THE GREATEST RISK FACTORS

7508
05:38:59,983 --> 05:39:01,418
FOR PULMONARY VASCULAR DISEASE.

7509
05:39:01,418 --> 05:39:03,286
SO I'VE TRIED TO MAKE THOSE SORT

7510
05:39:03,286 --> 05:39:05,889
OF LOGICAL EXTENSIONS.

7511
05:39:05,889 --> 05:39:07,657
JUST A BRIEF COMMENT ON SOME OF

7512
05:39:07,657 --> 05:39:08,858
THE SPECIAL CHALLENGES WITH

7513
05:39:08,858 --> 05:39:10,593
RESPECT TO PULMONARY VASCULAR

7514
05:39:10,593 --> 05:39:11,694
DISEASE DIAGNOSIS AND MANAGEMENT

7515
05:39:11,694 --> 05:39:13,563
IN THE HOMELESS POPULATION.

7516
05:39:13,563 --> 05:39:15,965
THOSE OF US WHO EVALUATE THESE

7517
05:39:15,965 --> 05:39:18,701
PATIENTS IN THE CLINIC KNOW THAT

7518
05:39:18,701 --> 05:39:20,003
THE EVALUATION OF COURSE

7519
05:39:20,003 --> 05:39:22,305
DEPENDING ON SORT OF UNDERLYING

7520
05:39:22,305 --> 05:39:23,606
CONSIDERATIONS IS

7521
05:39:23,606 --> 05:39:25,041
TIME-CONSUMING, IT'S OFTEN

7522
05:39:25,041 --> 05:39:27,110
COSTLY, AND IN MANY CASES TO GET

7523
05:39:27,110 --> 05:39:28,778
THE DEFINITIVE DIAGNOSIS

7524
05:39:28,778 --> 05:39:30,613
REQUIRES AN INVASIVE ASSESSMENT.

7525
05:39:30,613 --> 05:39:32,248
SO THERE ARE LOTS OF CHALLENGES

7526
05:39:32,248 --> 05:39:34,284
AROUND COMPLETING A THOROUGH

7527
05:39:34,284 --> 05:39:35,552
DIAGNOSTIC WORK-UP IN THE

7528
05:39:35,552 --> 05:39:37,053
HOMELESS POPULATION.

7529
05:39:37,053 --> 05:39:38,721
THEN THERE'S ALSO SOME

7530
05:39:38,721 --> 05:39:39,489
LIMITATIONS AROUND TREATMENT AND

7531
05:39:39,489 --> 05:39:42,425
A LOT OF THESE PATIENTS REQUIRE

7532
05:39:42,425 --> 05:39:43,626
FREQUENT DIURETIC ADJUSTMENTS

7533
05:39:43,626 --> 05:39:45,328
WHICH IN A PERFECT WORLD ALSO

7534
05:39:45,328 --> 05:39:47,697
COME ALONG WITH ELECTROLYTE

7535
05:39:47,697 --> 05:39:49,332
MONITORING AND FREQUENT

7536
05:39:49,332 --> 05:39:50,967
FOLLOW-UP, WHICH ISN'T ALWAYS

7537
05:39:50,967 --> 05:39:52,702
PRACTICAL AND OF COURSE SOME OF

7538
05:39:52,702 --> 05:39:57,207
THE MORE ADVANCED TREATMENTS FOR

7539
05:39:57,207 --> 05:39:59,175
PULMONARY ARTERIAL HYPERTENSION

7540
05:39:59,175 --> 05:40:00,276
IN PARTICULAR INCLUDING

7541
05:40:00,276 --> 05:40:01,478
INFUSIONS REPRESENT A PARTICULAR

7542
05:40:01,478 --> 05:40:08,785
CHALLENGE IN THIS POPULATION.

7543
05:40:08,785 --> 05:40:09,853
SO I'M GOING TO TRANSITION NOW

7544
05:40:09,853 --> 05:40:11,721
TO PULMONARY VASCULAR DISEASE

7545
05:40:11,721 --> 05:40:12,822
AMONG U.S. VETERANS WHICH WE

7546
05:40:12,822 --> 05:40:14,424
KNOW A LITTLE BIT MORE ABOUT BUT

7547
05:40:14,424 --> 05:40:15,758
FIRST I WANT TO GIVE SOME

7548
05:40:15,758 --> 05:40:18,261
BACKGROUND ABOUT U.S. VETERANS.

7549
05:40:18,261 --> 05:40:19,262
THE FIRST POINT IS THAT THERE

7550
05:40:19,262 --> 05:40:20,463
ARE A LOT OF THEM.

7551
05:40:20,463 --> 05:40:22,332
THERE ARE 18 MILLION VETERANS,

7552
05:40:22,332 --> 05:40:25,268
THAT'S ABOUT 1 IN 14 U.S.

7553
05:40:25,268 --> 05:40:25,502
ADULTS.

7554
05:40:25,502 --> 05:40:28,271
ABOUT HALF OF THE ADULTS OVER 65

7555
05:40:28,271 --> 05:40:30,406
ARE U.S. VETERANS, WHICH IS A

7556
05:40:30,406 --> 05:40:32,242
PRETTY STRIKING NUMBER, IF YOU

7557
05:40:32,242 --> 05:40:36,312
JUST PAUSE TO THINK ABOUT THAT.

7558
05:40:36,312 --> 05:40:36,546
ADVANCE.

7559
05:40:36,546 --> 05:40:40,150
ABOUT A QUARTER OF VETERANS ARE

7560
05:40:40,150 --> 05:40:42,018
MINORITIES, AND AMONG ACTIVE

7561
05:40:42,018 --> 05:40:46,289
DUTY VETERANS, SERVICE MEMBERS,

7562
05:40:46,289 --> 05:40:47,390
43 PERCENT ARE MINORITY.

7563
05:40:47,390 --> 05:40:49,792
SO MOST OF THOSE WHO ARE OVER 65

7564
05:40:49,792 --> 05:40:51,628
ARE WHITE, AND AS THEY PASS

7565
05:40:51,628 --> 05:40:54,364
AWAY, THE PROPORTION OF VETERANS

7566
05:40:54,364 --> 05:40:56,332
WHO ARE MINORITIES WILL GROW

7567
05:40:56,332 --> 05:40:59,402
SUBSTANTIALLY OVER THE COMING

7568
05:40:59,402 --> 05:40:59,836
YEARS.

7569
05:40:59,836 --> 05:41:00,403
ADVANCE, PLEASE.

7570
05:41:00,403 --> 05:41:02,572
SO IF YOU'LL FORGIVE THE SOAPBOX

7571
05:41:02,572 --> 05:41:05,308
MOMENT, I JUST WANT TO EMPHASIZE

7572
05:41:05,308 --> 05:41:06,543
HOW MANY WOMEN VETERANS THERE

7573
05:41:06,543 --> 05:41:07,010
ARE.

7574
05:41:07,010 --> 05:41:09,345
SO 10% OF VETERANS ARE WOMEN,

7575
05:41:09,345 --> 05:41:12,849
THAT'S ABOUT 2 MILLION WOMEN,

7576
05:41:12,849 --> 05:41:15,585
AND WITHOUT FAIL, WHEN WE

7577
05:41:15,585 --> 05:41:17,921
PRESENT DATA ON THE VETERAN

7578
05:41:17,921 --> 05:41:19,889
POPULATION FOR STUDYING

7579
05:41:19,889 --> 05:41:21,090
PULMONARY VASCULAR DISEASE, THE

7580
05:41:21,090 --> 05:41:23,059
CRITICISM IS THEY'RE MOSTLY MEN,

7581
05:41:23,059 --> 05:41:25,929
AND THAT'S TRUE AS A PERCENTAGE,

7582
05:41:25,929 --> 05:41:30,166
BUT THE ABSOLUTE NUMBER OF WOMEN

7583
05:41:30,166 --> 05:41:32,268
VETERANS IS MORE THAN

7584
05:41:32,268 --> 05:41:33,770
FRAMINGHAM, CARDIA, ERIC, MESA

7585
05:41:33,770 --> 05:41:37,273
AND OTHER NHLBI COHORT COMBINED.

7586
05:41:37,273 --> 05:41:40,009
SO I SORT OF BRISTLE WITH THE

7587
05:41:40,009 --> 05:41:41,444
NOTION THAT THE VETERAN

7588
05:41:41,444 --> 05:41:42,745
POPULATION IS INVALUABLE FOR

7589
05:41:42,745 --> 05:41:43,846
LEARNING ABOUT PULMONARY

7590
05:41:43,846 --> 05:41:47,116
VASCULAR DISEASE IN WOMEN.

7591
05:41:47,116 --> 05:41:50,286
NEXT SLIDE.

7592
05:41:50,286 --> 05:41:53,556
SO JUST A LITTLE BACKGROUND

7593
05:41:53,556 --> 05:41:55,291
ABOUT SOCIODEMOGRAPHICS OF U.S.

7594
05:41:55,291 --> 05:41:56,859
VETERANS, AS I JUST SHOWED YOU,

7595
05:41:56,859 --> 05:41:58,928
THEY TEND TO BE OLDER THAN

7596
05:41:58,928 --> 05:42:00,029
NONVETERANS, THEY'RE MORE LIKELY

7597
05:42:00,029 --> 05:42:03,299
TO BE MARRIED, THE EDUCATIONAL

7598
05:42:03,299 --> 05:42:06,002
PROFILE IS PRETTY INTERESTING.

7599
05:42:06,002 --> 05:42:08,538
SIMILAR RATES OF LESS THAN HIGH

7600
05:42:08,538 --> 05:42:10,173
SCHOOL EDUCATION, BUT

7601
05:42:10,173 --> 05:42:11,507
INTERESTINGLY THERE'S AN

7602
05:42:11,507 --> 05:42:14,110
INCREASED PROPORTION OF WHANS

7603
05:42:14,110 --> 05:42:15,878
WHO ARE COLLEGE EDUCATED IN

7604
05:42:15,878 --> 05:42:19,249
LIGHT OF ACCESS TO THE GI BILL.

7605
05:42:19,249 --> 05:42:20,550
THE UNEMPLOYMENT DATA ARE A

7606
05:42:20,550 --> 05:42:21,451
LITTLE BIT HARD TO INTERPRET

7607
05:42:21,451 --> 05:42:22,986
BECAUSE MANY OF THESE VETERANS

7608
05:42:22,986 --> 05:42:25,054
ARE RETIRED, BUT AMONG THOSE WHO

7609
05:42:25,054 --> 05:42:27,123
ARE NOT RETIRED, UNEMPLOYMENT

7610
05:42:27,123 --> 05:42:28,791
RATES ARE FAIRLY SIMILAR BETWEEN

7611
05:42:28,791 --> 05:42:31,961
VETERANS AND NONVETERANS.

7612
05:42:31,961 --> 05:42:33,463
HOUSEHOLD INCOME IS A LITTLE BIT

7613
05:42:33,463 --> 05:42:34,897
HIGHER AMONG VETERANS, PROBABLY

7614
05:42:34,897 --> 05:42:38,067
AGAIN REFLECTING AGE AND LONGER

7615
05:42:38,067 --> 05:42:39,702
EARNING POTENTIAL.

7616
05:42:39,702 --> 05:42:41,471
AND THEN THERE ARE INCREASED

7617
05:42:41,471 --> 05:42:43,873
RATES OF HOMELESSNESS AND

7618
05:42:43,873 --> 05:42:46,409
SUBSTANTIALLY INCREASED RATES OF

7619
05:42:46,409 --> 05:42:48,378
MENTAL HEALTH CONDITIONS,

7620
05:42:48,378 --> 05:42:50,647
DEPRESSION AND PTSD IN

7621
05:42:50,647 --> 05:42:54,284
PARTICULAR AS WELL AS SUBSTANCE

7622
05:42:54,284 --> 05:42:54,484
USE.

7623
05:42:54,484 --> 05:42:56,319
WHILE I'M ON THIS SLIDE, I GOT

7624
05:42:56,319 --> 05:42:57,220
SOME DATA THIS MORNING THAT I

7625
05:42:57,220 --> 05:42:58,454
DIDN'T HAVE TIME TO INTEGRATE

7626
05:42:58,454 --> 05:42:59,889
BUT I WANTED TO SHARE, WHICH IS

7627
05:42:59,889 --> 05:43:02,725
AMONG THE SOCIODEMOGRAPHIC

7628
05:43:02,725 --> 05:43:05,194
FEATURES THAT ARE RISK FACTORS

7629
05:43:05,194 --> 05:43:07,730
OR PROTECTIVE FOR PULMONARY

7630
05:43:07,730 --> 05:43:09,232
HYPERTENSION, THE STRONGEST

7631
05:43:09,232 --> 05:43:12,335
PROTECTIVE FEATURE AMONG U.S.

7632
05:43:12,335 --> 05:43:14,037
VETERANS AGAINST PULMONARY

7633
05:43:14,037 --> 05:43:15,938
HYPERTENSION RISK WAS BEING

7634
05:43:15,938 --> 05:43:18,107
MARRIED, AND IN A POPULATION

7635
05:43:18,107 --> 05:43:19,542
THAT'S PREDOMINANTLY MALE, I'LL

7636
05:43:19,542 --> 05:43:20,843
LET YOU MAKE YOUR OWN

7637
05:43:20,843 --> 05:43:24,013
INTERPRETATION OF THAT FINDING.

7638
05:43:24,013 --> 05:43:27,083
NEXT SLIDE, PLEASE.

7639
05:43:27,083 --> 05:43:28,084
THIS GIVES A LITTLE BIT MORE

7640
05:43:28,084 --> 05:43:31,421
ABOUT THE COMORBIDITY PROFILE

7641
05:43:31,421 --> 05:43:32,555
AMONG U.S. VETERANS.

7642
05:43:32,555 --> 05:43:36,159
YOU SEE INCREASED RATES OF COPD,

7643
05:43:36,159 --> 05:43:39,228
INCREASED RATES OF DIABETES, AND

7644
05:43:39,228 --> 05:43:40,797
PARTICULARLY HIGHER RATES OF

7645
05:43:40,797 --> 05:43:42,632
MENTAL HEALTH CONDITIONS, IN

7646
05:43:42,632 --> 05:43:46,135
PARTICULAR AS I SAID PTSD ON THE

7647
05:43:46,135 --> 05:43:47,136
FAR RIGHT.

7648
05:43:47,136 --> 05:43:49,539
NEXT SLIDE, PLEASE.

7649
05:43:49,539 --> 05:43:51,407
SO NOW I'M GOING TO SHOW YOU A

7650
05:43:51,407 --> 05:43:52,608
LITTLE BIT OF SORT OF THE RAW

7651
05:43:52,608 --> 05:43:54,677
DATA THAT WE KNOW ABOUT

7652
05:43:54,677 --> 05:43:56,446
PULMONARY VASCULAR DISEASE AND

7653
05:43:56,446 --> 05:43:58,114
PULMONARY HYPERTENSION IN THE

7654
05:43:58,114 --> 05:43:59,615
VETERAN POPULATIONS.

7655
05:43:59,615 --> 05:44:01,484
BY AND LARGE, THESE ARE

7656
05:44:01,484 --> 05:44:03,219
COMPARISONS OF VETERANS WITH THE

7657
05:44:03,219 --> 05:44:03,986
VANDERBILT POPULATION BECAUSE

7658
05:44:03,986 --> 05:44:05,888
THAT'S WHAT WE HAVE ACCESS TO

7659
05:44:05,888 --> 05:44:08,458
AND IS A LARGE TERTIARY CARE

7660
05:44:08,458 --> 05:44:10,993
CENTER OF PATIENTS SEEKING CARE.

7661
05:44:10,993 --> 05:44:12,762
AND THIS IS GOING TO BE A

7662
05:44:12,762 --> 05:44:14,163
COMPARISON OF INDIVIDUALS WHO

7663
05:44:14,163 --> 05:44:16,466
WERE REFERRED FOR

7664
05:44:16,466 --> 05:44:16,833
ECHOCARDIOGRAMS.

7665
05:44:16,833 --> 05:44:18,334
THIS IS NOT THE POPULATION IN

7666
05:44:18,334 --> 05:44:19,302
GENERAL, THESE ARE PATIENTS

7667
05:44:19,302 --> 05:44:20,737
SEEKING CARE AND THEIR PROVIDER

7668
05:44:20,737 --> 05:44:24,440
HAD SOME REASON TO ORDER AN

7669
05:44:24,440 --> 05:44:25,274
ECHOCARDIOGRAM.

7670
05:44:25,274 --> 05:44:27,744
SO PRESUMABLY SOME SUSPICION OF

7671
05:44:27,744 --> 05:44:29,946
CARDIOPULMONARY DISEASE.

7672
05:44:29,946 --> 05:44:31,381
THE AGE OF INDIVIDUALS REFERRED

7673
05:44:31,381 --> 05:44:34,650
FOR ECHO IS FAIRLY SIMILAR.

7674
05:44:34,650 --> 05:44:36,052
AGAIN, THE PROPORTION OF

7675
05:44:36,052 --> 05:44:39,122
VETERANS WHO ARE MALES IS MUCH

7676
05:44:39,122 --> 05:44:39,455
HIGHER.

7677
05:44:39,455 --> 05:44:41,324
VANDERBILT IS A LITTLE BIT MORE

7678
05:44:41,324 --> 05:44:41,591
BALANCED.

7679
05:44:41,591 --> 05:44:43,559
THE BMI IS SIMILAR.

7680
05:44:43,559 --> 05:44:45,661
THERE IS A HIGHER PROPORTION OF

7681
05:44:45,661 --> 05:44:46,863
BLACK AND HISPANIC INDIVIDUALS

7682
05:44:46,863 --> 05:44:48,664
AMONG VETERANS WHO WERE REFERRED

7683
05:44:48,664 --> 05:44:49,632
FOR ECHO.

7684
05:44:49,632 --> 05:44:51,501
HEART FAILURE RATES ARE FAIRLY

7685
05:44:51,501 --> 05:44:54,337
SIMILAR, AS YOU CAN SEE, 18

7686
05:44:54,337 --> 05:44:55,872
VERSUS 21-H THE SUBSTANTIALLY

7687
05:44:55,872 --> 05:44:57,640
MORE, MORE THAN TWICE AS HIGH,

7688
05:44:57,640 --> 05:45:00,910
PREVALENCE OF COPD AMONG

7689
05:45:00,910 --> 05:45:01,344
VETERANS.

7690
05:45:01,344 --> 05:45:02,445
LOTS OF PEOPLE HAVE

7691
05:45:02,445 --> 05:45:02,779
HYPERTENSION.

7692
05:45:02,779 --> 05:45:04,313
THIS IS AN OLDER POPULATION, SO

7693
05:45:04,313 --> 05:45:07,383
THOSE RATES ARE FAIRLY SIMILAR.

7694
05:45:07,383 --> 05:45:08,885
BUT THERE IS INTERESTINGLY A

7695
05:45:08,885 --> 05:45:11,087
MUCH HIGHER PREVALENCE OF

7696
05:45:11,087 --> 05:45:12,722
DIABETES AMONG VETERANS COMPARED

7697
05:45:12,722 --> 05:45:14,924
IN THIS CASE TO THE VANDERBILT

7698
05:45:14,924 --> 05:45:15,892
POPULATION.

7699
05:45:15,892 --> 05:45:17,760
I SUSPECT THERE ARE SORT OF

7700
05:45:17,760 --> 05:45:19,295
SCREENING AND DIAGNOSIS METRICS

7701
05:45:19,295 --> 05:45:20,830
WITHIN THE VA THAT THEY'RE

7702
05:45:20,830 --> 05:45:22,899
PROBABLY MORE VIGOROUS THAN

7703
05:45:22,899 --> 05:45:24,967
VANDERBILT IN THAT WAY,

7704
05:45:24,967 --> 05:45:26,636
EXPLAINING PART OF THAT

7705
05:45:26,636 --> 05:45:27,003
INCREASE.

7706
05:45:27,003 --> 05:45:31,140
NEXT SLIDE.

7707
05:45:31,140 --> 05:45:33,276
SO THIS IS LOOKING AT A LARGE

7708
05:45:33,276 --> 05:45:35,044
POPULATION OF VETERANS AND

7709
05:45:35,044 --> 05:45:37,780
VANDERBILT PATIENTS WHO HAVE AN

7710
05:45:37,780 --> 05:45:39,215
ECHO REFERRAL AS WELL AS A

7711
05:45:39,215 --> 05:45:41,617
PULMONARY PRESSURE ESTIMATE.

7712
05:45:41,617 --> 05:45:44,387
SO ABOUT 389,000 VETERANS.

7713
05:45:44,387 --> 05:45:46,322
I'LL NOTE THAT ABOUT 25,000 OF

7714
05:45:46,322 --> 05:45:50,026
THOSE INDIVIDUALS ARE WOMEN, AND

7715
05:45:50,026 --> 05:45:52,462
ABOUT 117,000 INDIVIDUALS FROM

7716
05:45:52,462 --> 05:45:52,762
VANDERBILT.

7717
05:45:52,762 --> 05:45:54,964
IF YOU LOOK AT THE PREVALENCE OF

7718
05:45:54,964 --> 05:45:56,866
PULMONARY HYPERTENSION, WHICH IS

7719
05:45:56,866 --> 05:45:58,134
IN A GIVEN INDIVIDUAL DO THEY

7720
05:45:58,134 --> 05:46:02,271
EVER HAVE A PH -- A PASP GREATER

7721
05:46:02,271 --> 05:46:03,806
THAN 35, THE PREVALENCE IS ABOUT

7722
05:46:03,806 --> 05:46:06,642
ONE IN THREE FOR BOTH

7723
05:46:06,642 --> 05:46:07,210
POPULATIONS.

7724
05:46:07,210 --> 05:46:09,278
AND YOU COULD CERTAINLY QUIBBLE

7725
05:46:09,278 --> 05:46:10,913
WITH 35 AS A CUTOFF.

7726
05:46:10,913 --> 05:46:12,348
MORE SENSITIVE, LESS SPECIFIC.

7727
05:46:12,348 --> 05:46:13,983
BUT THE RELATIVE PRO POURINGS

7728
05:46:13,983 --> 05:46:15,184
ARE FAIRLY SIMILAR BETWEEN

7729
05:46:15,184 --> 05:46:17,253
VETERANS AND NONVETERANS.

7730
05:46:17,253 --> 05:46:20,456
AND THEN I'M GOING TO GET INTO

7731
05:46:20,456 --> 05:46:22,625
THE INCIDENT RATES ON THE NEXT

7732
05:46:22,625 --> 05:46:24,160
SLIDE, AND I JUST WANT TO

7733
05:46:24,160 --> 05:46:25,461
HIGHLIGHT THAT MOST OF WHAT WE

7734
05:46:25,461 --> 05:46:28,664
KNOW FROM COHORT STUDIES AND

7735
05:46:28,664 --> 05:46:30,500
PULMONARY HYPERTENSION RELATES

7736
05:46:30,500 --> 05:46:32,502
PREVALENCE OF PULMONARY

7737
05:46:32,502 --> 05:46:33,436
HYPERTENSION, WE KNOW RELATIVELY

7738
05:46:33,436 --> 05:46:36,272
LESS ABOUT PH INCIDENTS.

7739
05:46:36,272 --> 05:46:36,806
-- INCIDENCE.

7740
05:46:36,806 --> 05:46:38,908
SO IN THIS STUDY WE IDENTIFIED

7741
05:46:38,908 --> 05:46:41,344
PEOPLE WHO HAD HAD AN ECHO WITH

7742
05:46:41,344 --> 05:46:43,746
A PULMONARY PRESSURE LESS THAN

7743
05:46:43,746 --> 05:46:46,148
35, SO EVIDENCE OF LACK OF

7744
05:46:46,148 --> 05:46:47,550
PULMONARY HYPERTENSION AT

7745
05:46:47,550 --> 05:46:49,318
BASELINE AND THEN LOOKED AT

7746
05:46:49,318 --> 05:46:52,588
SUBSEQUENTLY WHO WENT ON TO

7747
05:46:52,588 --> 05:46:54,557
DEVELOP PH ON A FUTURE ECHO.

7748
05:46:54,557 --> 05:46:57,293
AND THIS IS A BUSY TABLE, BUT

7749
05:46:57,293 --> 05:46:58,594
I'LL JUST DRAW YOUR ATTENTION TO

7750
05:46:58,594 --> 05:47:01,130
THE TWO RED BOXES.

7751
05:47:01,130 --> 05:47:02,865
THE TOABLGHTS INCIDENCE RATES

7752
05:47:02,865 --> 05:47:06,602
ARE -- TOTAL INCIDENCE RATES ARE

7753
05:47:06,602 --> 05:47:08,337
SIMILAR, 22 PER 1,000 PATIENT

7754
05:47:08,337 --> 05:47:09,972
YEARS VERSUS 25 PER 1,000

7755
05:47:09,972 --> 05:47:11,073
PATIENT YEARS.

7756
05:47:11,073 --> 05:47:12,375
FOR VISUALIZATION PURPOSES WE

7757
05:47:12,375 --> 05:47:13,175
STRATIFIED THESE INDIVIDUALS

7758
05:47:13,175 --> 05:47:16,445
BASED ON HEART FAILURE AND COPD

7759
05:47:16,445 --> 05:47:17,647
STATUS BECAUSE THAT'S FAR AND

7760
05:47:17,647 --> 05:47:20,049
AWAY THE MOST COMMON CAUSES OF

7761
05:47:20,049 --> 05:47:23,219
PH IN BOTH OF THESE POPULATIONS.

7762
05:47:23,219 --> 05:47:24,220
INTERESTINGLY WHAT YOU SEE IS

7763
05:47:24,220 --> 05:47:26,923
THAT THE INCIDENCE RATES OF PH

7764
05:47:26,923 --> 05:47:28,457
IS FAIRLY SIMILAR BETWEEN THESE

7765
05:47:28,457 --> 05:47:29,458
TWO POPULATIONS IF YOU CONSIDER

7766
05:47:29,458 --> 05:47:33,162
THAT IT'S PER 1,000 PATIENT

7767
05:47:33,162 --> 05:47:33,362
YEARS.

7768
05:47:33,362 --> 05:47:37,333
COPD IS HIGHER THAN NOT HAVING

7769
05:47:37,333 --> 05:47:38,568
COPD, HEART FAILURE IS HIGHER

7770
05:47:38,568 --> 05:47:40,703
THAN THE HAVING COPD AND THEN

7771
05:47:40,703 --> 05:47:42,471
THE COMBINATION IS ESSENTIALLY

7772
05:47:42,471 --> 05:47:42,738
ADDITIVE.

7773
05:47:42,738 --> 05:47:46,075
BUT AGAIN, ON A POPULATION LEVEL

7774
05:47:46,075 --> 05:47:47,510
FAIRLY SIMILAR RATES BETWEEN

7775
05:47:47,510 --> 05:47:49,412
THESE TWO COHORTS.

7776
05:47:49,412 --> 05:47:51,213
NEXT SLIDE.

7777
05:47:51,213 --> 05:47:52,748
BUT WHAT'S INTERESTING WHAT

7778
05:47:52,748 --> 05:47:55,351
HAPPENS AFTER THE DIAGNOSIS OF

7779
05:47:55,351 --> 05:47:56,352
INCIDENT PH.

7780
05:47:56,352 --> 05:47:58,988
SO THIS IS AN ALL CAUSE

7781
05:47:58,988 --> 05:48:00,957
MORTALITY CURVE STRATIFIED BY

7782
05:48:00,957 --> 05:48:04,794
HEART FAILURE AND COPD STATUS.

7783
05:48:04,794 --> 05:48:06,228
NEITHER IS THE CURVE ON THE TOP,

7784
05:48:06,228 --> 05:48:07,463
BOTH IS THE CURVE ON THE BOTTOM

7785
05:48:07,463 --> 05:48:08,864
FOR BOTH OF THESE, AND THE

7786
05:48:08,864 --> 05:48:10,633
SEPARATION IS FAIRLY SIMILAR

7787
05:48:10,633 --> 05:48:13,235
BASED ON HEART FAILURE AND COPD

7788
05:48:13,235 --> 05:48:14,870
STATUS, BUT WHAT YOU SEE IS THAT

7789
05:48:14,870 --> 05:48:16,405
THE VA CURVE ALL OF THOSE CURVES

7790
05:48:16,405 --> 05:48:18,941
ARE SHIFT SHIFTED DOWN.

7791
05:48:18,941 --> 05:48:20,676
SO THE PROGNOSIS AMONG VETERANS

7792
05:48:20,676 --> 05:48:24,080
AFTER A DIAGNOSIS OF PH IS

7793
05:48:24,080 --> 05:48:27,016
SUBSTANTIALLY WORSE COMPARED TO

7794
05:48:27,016 --> 05:48:28,451
THE CONTROL POPULATION, THE

7795
05:48:28,451 --> 05:48:31,020
CIVILIAN POPULATION, RATHER, AT

7796
05:48:31,020 --> 05:48:31,320
VANDERBILT.

7797
05:48:31,320 --> 05:48:33,356
SO THAT HAS SOME IMPLICATIONS

7798
05:48:33,356 --> 05:48:35,024
AROUND POTENTIALLY PH

7799
05:48:35,024 --> 05:48:37,093
RECOGNITION OR MANAGEMENT,

7800
05:48:37,093 --> 05:48:40,730
COMPETING RISKS, AND OTHER

7801
05:48:40,730 --> 05:48:43,132
INFLUENCES ON LARGER OUTCOMES.

7802
05:48:43,132 --> 05:48:49,138
NEXT SLIDE.

7803
05:48:49,138 --> 05:48:51,440
SO THAT WAS DATA ON ECHO

7804
05:48:51,440 --> 05:48:52,942
CARDIOGRAPHIC PULMONARY

7805
05:48:52,942 --> 05:48:53,909
HYPERTENSION AMONG VETERANS.

7806
05:48:53,909 --> 05:48:57,113
HERE WE'RE LOOKING AT PH

7807
05:48:57,113 --> 05:48:59,315
PREVALENCE AND PHENOTYPES AMONG

7808
05:48:59,315 --> 05:49:01,250
PATIENTS REFERRED FOR RIGHT

7809
05:49:01,250 --> 05:49:03,219
HEART CATHETERIZATION.

7810
05:49:03,219 --> 05:49:05,421
AGAIN, NOT AN UNSELECTED

7811
05:49:05,421 --> 05:49:06,622
POPULATION, THESE WERE PATIENTS

7812
05:49:06,622 --> 05:49:08,157
REFERRED FOR RIGHT HEART CATH

7813
05:49:08,157 --> 05:49:12,094
AND IF YOU LOOK AT CONSECUTIVE

7814
05:49:12,094 --> 05:49:13,629
INDIVIDUALS AT VANDERBILT AND

7815
05:49:13,629 --> 05:49:17,133
VA, SLIGHTLY HIGHER MILD PH

7816
05:49:17,133 --> 05:49:18,567
AMONG VETERANS, SLIGHTLY HIGHER

7817
05:49:18,567 --> 05:49:21,370
MORE SEVERE PH AMONG THE

7818
05:49:21,370 --> 05:49:23,239
VANDERBILT POPULATION.

7819
05:49:23,239 --> 05:49:25,341
AND THEN LOOKING SPECIFICKING AT

7820
05:49:25,341 --> 05:49:27,410
PULMONARY VASCULAR DISEASE USING

7821
05:49:27,410 --> 05:49:29,578
PVR AND AGAIN YOU CAN ARGUE

7822
05:49:29,578 --> 05:49:31,781
ABOUT THE CUTOFFS, SLIGHTLY

7823
05:49:31,781 --> 05:49:33,949
HIGHER AMONG VANDERBILT PATIENTS

7824
05:49:33,949 --> 05:49:37,153
FOR INCREASED RISK OF SEVERE

7825
05:49:37,153 --> 05:49:39,088
PULMONARY VASCULAR DISEASE.

7826
05:49:39,088 --> 05:49:41,390
NEXT SLIDE.

7827
05:49:41,390 --> 05:49:43,793
SO I JUST WANT TO END WITH A

7828
05:49:43,793 --> 05:49:45,761
COUPLE OF SPECIFIC RISK FACTORS

7829
05:49:45,761 --> 05:49:47,763
IN PH AND I'LL WRAP UP SHORTLY.

7830
05:49:47,763 --> 05:49:50,366
SO HIV IS A SPECIFIC RISK FACTOR

7831
05:49:50,366 --> 05:49:52,468
FOR PULMONARY ARTERIAL

7832
05:49:52,468 --> 05:49:54,403
HYPERTENSION WE KNOW AND THERE'S

7833
05:49:54,403 --> 05:49:56,939
SOME DATA FROM THE VA POPULATION

7834
05:49:56,939 --> 05:49:58,474
SUGGESTING THAT'S ALSO AN

7835
05:49:58,474 --> 05:49:59,675
INDEPENDENT RISK FACTOR FOR

7836
05:49:59,675 --> 05:50:02,745
OTHER CAUSES OF PH AMONG

7837
05:50:02,745 --> 05:50:03,012
VETERANS.

7838
05:50:03,012 --> 05:50:05,014
ON THE LEFT YOU CAN SEE THIS IS

7839
05:50:05,014 --> 05:50:07,450
COMPARING VETERANS WITH HIV TO

7840
05:50:07,450 --> 05:50:09,719
VETERANS WITHOUT HIV, HIGHER

7841
05:50:09,719 --> 05:50:12,354
INCIDENCE OF PH AMONG THOSE WITH

7842
05:50:12,354 --> 05:50:14,657
HIV, AND WHEN YOU DO A TIME

7843
05:50:14,657 --> 05:50:15,925
DEFINITIVE ANALYSIS ADJUSTING

7844
05:50:15,925 --> 05:50:17,526
FOR LOTS OF CO-VARIATES THAT

7845
05:50:17,526 --> 05:50:20,029
RISK IS INCREASED BY ABOUT

7846
05:50:20,029 --> 05:50:20,329
18 PERCENT.

7847
05:50:20,329 --> 05:50:24,500
NEXT SLIDE, PLEASE.

7848
05:50:24,500 --> 05:50:25,701
I WANT TO BRING ATTENTION TO

7849
05:50:25,701 --> 05:50:27,670
ANOTHER SORT OF EMERGING AND

7850
05:50:27,670 --> 05:50:30,039
NOVEL RISK FACTOR FOR PVD WHICH

7851
05:50:30,039 --> 05:50:31,807
IS NOT PARTICULARLY A SOCIAL

7852
05:50:31,807 --> 05:50:35,077
DISPARITY EXCEPT THAT IT'S A

7853
05:50:35,077 --> 05:50:37,279
RISK FACTOR THAT'S UNIQUE TO

7854
05:50:37,279 --> 05:50:40,116
VETERANS, AND THAT IS BURN PIT

7855
05:50:40,116 --> 05:50:40,549
EXPOSURE.

7856
05:50:40,549 --> 05:50:41,884
THIS FIRST GAINS SOME

7857
05:50:41,884 --> 05:50:44,620
RECOGNITION IN THE EARLY 2000S

7858
05:50:44,620 --> 05:50:46,489
AMONG SOLDIERS WHO ARE RETURNING

7859
05:50:46,489 --> 05:50:48,758
WITH UNEXPLAINED DYSPNEA FOUND

7860
05:50:48,758 --> 05:50:52,261
TO HAVE CONSTRICTIVE BRON YOA

7861
05:50:52,261 --> 05:50:54,363
LIGHTS AMONG LUNG BIOLOGY,

7862
05:50:54,363 --> 05:50:58,367
FOLLOWED UP BY PATHOLOGISTS AT

7863
05:50:58,367 --> 05:51:00,536
VANDERBILT WHO DID ANALYSIS OF

7864
05:51:00,536 --> 05:51:03,439
52 OPEN LUNG BIOPSIES,

7865
05:51:03,439 --> 05:51:04,974
UNEXPLAINED DYSPNEA HAD AN

7866
05:51:04,974 --> 05:51:07,042
APPROPRIATE WORK-UP,

7867
05:51:07,042 --> 05:51:07,810
NONDIAGNOSTIC LUNG BIOPSY, WHAT

7868
05:51:07,810 --> 05:51:09,678
YOU SEE IS THERE'S WHAT'S

7869
05:51:09,678 --> 05:51:13,482
DESCRIBED AS HYPERTENSIVE

7870
05:51:13,482 --> 05:51:14,817
VASCULOPATHY AS WELL AS FIBROSIS

7871
05:51:14,817 --> 05:51:17,987
OF AIRWAYS, PA RINK MA AND

7872
05:51:17,987 --> 05:51:20,723
PLEURA, AND I THINK THE

7873
05:51:20,723 --> 05:51:22,258
INTERESTING ASPECTS OF THIS, YOU

7874
05:51:22,258 --> 05:51:25,761
LOOK AT CLUSTER ONE IS

7875
05:51:25,761 --> 05:51:26,829
NONDEPLOYED INDIVIDUALS,

7876
05:51:26,829 --> 05:51:27,930
CLUSTERED TOGETHER THAT'S SORT

7877
05:51:27,930 --> 05:51:29,698
OF REASSURING, THERE'S SOME

7878
05:51:29,698 --> 05:51:32,201
INDIVIDUALS WHO HAD THIS POST

7879
05:51:32,201 --> 05:51:34,170
DEPLOYMENT RESPIRATORY SYNDROME

7880
05:51:34,170 --> 05:51:38,007
CLUSTERED WITH PULMONARILY --

7881
05:51:38,007 --> 05:51:39,308
PATIENTS AND MOST OF THEM

7882
05:51:39,308 --> 05:51:41,076
CLUSTERED AS A UNIQUE ENTITY,

7883
05:51:41,076 --> 05:51:45,447
FIVE OF THOSE WENT ON TO HAVE

7884
05:51:45,447 --> 05:51:47,082
CATH ASSESSMENT, THREE OUT OF

7885
05:51:47,082 --> 05:51:49,251
FIVE OF WHOM WERE ULTIMATELY

7886
05:51:49,251 --> 05:51:50,452
DIAGNOSED WITH CLINICAL DPIEG

7887
05:51:50,452 --> 05:51:54,290
NOTICES OF PH.

7888
05:51:54,290 --> 05:51:55,324
SO -- DIAGNOSIS OF PH.

7889
05:51:55,324 --> 05:51:57,459
THIS IS A NOVEL ENTITY OF POST

7890
05:51:57,459 --> 05:51:58,661
DEPLOYMENT RESPIRATORY SYNDROME

7891
05:51:58,661 --> 05:51:59,995
WHICH AT LEAST IN THESE

7892
05:51:59,995 --> 05:52:02,064
INDIVIDUALS WASN'T A STRONG OR

7893
05:52:02,064 --> 05:52:04,033
OVERT CAUSE OF PULMONARY

7894
05:52:04,033 --> 05:52:05,334
HYPERTENSION PER SE BUT

7895
05:52:05,334 --> 05:52:09,271
CERTAINLY LED TO VASCULOPATHY ON

7896
05:52:09,271 --> 05:52:10,406
HISTO PATHOLOGY.

7897
05:52:10,406 --> 05:52:13,576
NEXT SLIDE.

7898
05:52:13,576 --> 05:52:15,377
SO SOME MORE OBSERVATIONAL DATA

7899
05:52:15,377 --> 05:52:17,046
IN THE VA POPULATION WHICH I'LL

7900
05:52:17,046 --> 05:52:19,348
SKIP OVER, BUT AGAIN, BURN PIT

7901
05:52:19,348 --> 05:52:21,984
EXPOSURE IS AN EMERGING RISK

7902
05:52:21,984 --> 05:52:23,619
FACTOR FOR CARDIOPULMONARY

7903
05:52:23,619 --> 05:52:23,853
DISEASE.

7904
05:52:23,853 --> 05:52:29,191
I'LL END ON THE NEXT SLIDE,

7905
05:52:29,191 --> 05:52:31,360
WHICH REALLY MIELTS UNDER

7906
05:52:31,360 --> 05:52:35,197
RECOGNITION AMONG VETERANS AND R

7907
05:52:35,197 --> 05:52:36,565
RECOGNITION AMONG U.S. VETERANS,

7908
05:52:36,565 --> 05:52:38,167
PROBABLY TRUE IN MOST OF OUR

7909
05:52:38,167 --> 05:52:40,135
MEDICAL SYSTEMS, FROM ABOUT A

7910
05:52:40,135 --> 05:52:44,039
DECADE AGO, FROM DR. MARON,

7911
05:52:44,039 --> 05:52:46,475
SHOWING 340 VETERANS WITH SEVERE

7912
05:52:46,475 --> 05:52:47,776
PULMONARILY HYPERTENSION BY

7913
05:52:47,776 --> 05:52:49,645
ECHO, PASP GREATER THAN 60,

7914
05:52:49,645 --> 05:52:51,046
RATES OF DIAGNOSTIC TESTING WERE

7915
05:52:51,046 --> 05:52:52,414
FAIRLY LOW AS YOU CAN SEE ON THE

7916
05:52:52,414 --> 05:52:54,884
RIGHT, ABOUT HALF GOT PFT'S,

7917
05:52:54,884 --> 05:52:56,218
ABOUT A THIRD GOT RIGHT HEART

7918
05:52:56,218 --> 05:52:58,220
CATHS AND THERE ARE REASONS WHY

7919
05:52:58,220 --> 05:52:59,188
SOME OF THESE INDIVIDUALS MAY

7920
05:52:59,188 --> 05:53:00,689
NOT GET A COMPLETE WORK-UP BUT I

7921
05:53:00,689 --> 05:53:02,124
THINK THE MOST STRIKING IS IF

7922
05:53:02,124 --> 05:53:05,160
YOU ADVANCE ON THIS SLIDE, THAT

7923
05:53:05,160 --> 05:53:06,829
ONLY 17 PERCENT OF THESE

7924
05:53:06,829 --> 05:53:08,264
INDIVIDUALS HAD PULMONARY

7925
05:53:08,264 --> 05:53:11,300
HYPERTENSION LISTED IN THE

7926
05:53:11,300 --> 05:53:12,735
PROBLEM LIST AND CONSIDERING

7927
05:53:12,735 --> 05:53:16,005
THAT A PASP OF GREATER THAN 60

7928
05:53:16,005 --> 05:53:16,805
CONSIDERING SYSTEMIC BLOOD

7929
05:53:16,805 --> 05:53:18,207
PRESSURE OF GREATER THAN 200

7930
05:53:18,207 --> 05:53:19,375
WHICH I SUSPECT WOULD SHOW UP ON

7931
05:53:19,375 --> 05:53:21,577
THE PROBLEM LIST OF ALL OF THESE

7932
05:53:21,577 --> 05:53:21,844
PATIENTS.

7933
05:53:21,844 --> 05:53:22,678
ADVANCE PLEASE.

7934
05:53:22,678 --> 05:53:23,545
THEN IF YOU LOOK AT THE

7935
05:53:23,545 --> 05:53:25,948
INDIVIDUALS WHO HAD PH BY ECHO

7936
05:53:25,948 --> 05:53:27,049
AND CROSS-REFERENCE THAT WITH

7937
05:53:27,049 --> 05:53:29,318
THE PRESENCE OF A CODE FOR PH

7938
05:53:29,318 --> 05:53:31,854
ONLY ABOUT 18 PERCENT OF

7939
05:53:31,854 --> 05:53:33,589
PATIENTS WITH PH BY ECHO

7940
05:53:33,589 --> 05:53:36,725
ACTUALLY HAD A CODE.

7941
05:53:36,725 --> 05:53:38,193
SO FURTHER EVIDENCE IT'S UNDER

7942
05:53:38,193 --> 05:53:40,496
RECOGNIZED IN THIS POPULATION

7943
05:53:40,496 --> 05:53:41,563
BUT FURTHER EVIDENCE THAT CODES

7944
05:53:41,563 --> 05:53:43,866
ARE NOT PARTICULARLY HELPFUL FOR

7945
05:53:43,866 --> 05:53:44,667
STUDYING CARDIOVASCULAR DISEASE

7946
05:53:44,667 --> 05:53:45,434
IN THESE PATIENTS.

7947
05:53:45,434 --> 05:53:50,239
SO NEXT SLIDE AND I'LL END

7948
05:53:50,239 --> 05:53:50,439
THERE.

7949
05:53:50,439 --> 05:53:51,974
I TRIED TO DEFENSE YOU THAT

7950
05:53:51,974 --> 05:53:53,175
HOMELESSNESS IS A CAUSE OF THE

7951
05:53:53,175 --> 05:53:54,810
CAUSE OF PULMONARY VASCULAR

7952
05:53:54,810 --> 05:53:55,978
DISEASE, ALTHOUGH I CONFESS I

7953
05:53:55,978 --> 05:53:57,446
DON'T HAVE ANY DIRECT DATA OF

7954
05:53:57,446 --> 05:53:58,914
THAT AND THEN THAT VETERANS

7955
05:53:58,914 --> 05:54:00,182
COMPRISE A LARGE AND VULNERABLE

7956
05:54:00,182 --> 05:54:01,717
POPULATION WITH RESPECT TO

7957
05:54:01,717 --> 05:54:10,526
PULMONARY HYPERTENSION RISK.

7958
05:54:10,526 --> 05:54:12,328
>> THANKS VERY MUCH, EVAN,
I

7959
05:54:12,328 --> 05:54:13,062
APPRECIATE THAT TALK.

7960
05:54:13,062 --> 05:54:15,397
IT WAS WONDERFUL AND INSIGHTFUL.

7961
05:54:15,397 --> 05:54:17,099
I LEARNED A FEW THINGS FOR SURE.

7962
05:54:17,099 --> 05:54:22,371
I THINK FOR THE SAKE OF TIME,

7963
05:54:22,371 --> 05:54:23,605
DR. LEOPOLD, DID YOU HAVE A

7964
05:54:23,605 --> 05:54:23,906
QUESTION?

7965
05:54:23,906 --> 05:54:26,008
>> WELL, IF WE'RE
STRETCHED FOR

7966
05:54:26,008 --> 05:54:29,278
TIME, WE'LL WAIT UNTIL THE

7967
05:54:29,278 --> 05:54:29,578
DISCUSSION.

7968
05:54:29,578 --> 05:54:31,146
>> LET'S MAYBE MOVE ON TO
OUR

7969
05:54:31,146 --> 05:54:32,548
LAST TALK OF THE DAY, AND THEN

7970
05:54:32,548 --> 05:54:34,516
WE'LL HAVE SOME TIME FOR

7971
05:54:34,516 --> 05:54:34,817
DISCUSSION.

7972
05:54:34,817 --> 05:54:37,052
I'M SURE THERE WILL BE QUITE A

7973
05:54:37,052 --> 05:54:39,555
FEW QUESTIONS ON THESE SUBJECTS.

7974
05:54:39,555 --> 05:54:45,260
OUR NEXT SPEAKER IS DR. RACHEL

7975
05:54:45,260 --> 05:54:45,461
GOLD.

7976
05:54:45,461 --> 05:54:47,896
SHE IS TALKING ON SOCIAL

7977
05:54:47,896 --> 05:54:49,431
DETERMINANTS OF HEALTH SCREENING

7978
05:54:49,431 --> 05:54:52,901
AND REFERRALS:  WHAT DO WE KNOW?

7979
05:54:52,901 --> 05:54:55,871
SHE IS, TO REITERATE, SHOWS A

7980
05:54:55,871 --> 05:54:58,507
SENIOR INVESTIGATOR AT KAISER

7981
05:54:58,507 --> 05:55:00,042
PERMANENTE, SHE'S ALSO LEAD

7982
05:55:00,042 --> 05:55:01,777
RESEARCH SCIENTIST AND PROGRAM

7983
05:55:01,777 --> 05:55:04,113
DIRECTOR AT THE NONPROFIT OCHIN.

7984
05:55:04,113 --> 05:55:05,381
GO AHEAD, RACHEL.

7985
05:55:05,381 --> 05:55:07,049
>> GREAT, THANKS SO MUCH
FOR

7986
05:55:07,049 --> 05:55:07,516
HAVING ME.

7987
05:55:07,516 --> 05:55:09,218
I HOPE EVERYONE IS STILL AWAKE.

7988
05:55:09,218 --> 05:55:10,753
I KNOW YOU'VE ALL HAD A LONG DAY

7989
05:55:10,753 --> 05:55:12,421
OF TALKS, BUT I THINK THIS IS A

7990
05:55:12,421 --> 05:55:13,922
NICE ONE TO END WITH BECAUSE

7991
05:55:13,922 --> 05:55:14,757
THERE'S BEEN SO MUCH INTERESTING

7992
05:55:14,757 --> 05:55:16,558
DISCUSSION ABOUT THE WAY THAT

7993
05:55:16,558 --> 05:55:18,193
SOCIAL DETERMINANTS OR I PREFER

7994
05:55:18,193 --> 05:55:21,263
THE TERM SOCIAL RISKS, AFFECT

7995
05:55:21,263 --> 05:55:23,966
HEALTH AND CHRONIC DISEASE

7996
05:55:23,966 --> 05:55:24,767
MANAGEMENT, BUT I'M GOING TO

7997
05:55:24,767 --> 05:55:26,402
TALK ABOUT WHAT DO WE KNOW ABOUT

7998
05:55:26,402 --> 05:55:28,804
WHAT WE CAN DO TO MITIGATE THOSE

7999
05:55:28,804 --> 05:55:30,873
IMABLGHTS.

8000
05:55:30,873 --> 05:55:31,507
IMPACTS.

8001
05:55:31,507 --> 05:55:31,840
NEXT, PLEASE.

8002
05:55:31,840 --> 05:55:33,375
I'M NOT GOING TO SPEND TOO MUCH

8003
05:55:33,375 --> 05:55:35,044
TIME ON THE NEXT COUPLE SLIDES.

8004
05:55:35,044 --> 05:55:36,445
WE'VE HAD A NUMBER OF SPEAKERS

8005
05:55:36,445 --> 05:55:37,546
TODAY ALREADY COVER THIS.

8006
05:55:37,546 --> 05:55:40,149
AGAIN I PREFER THE TERM SOCIAL

8007
05:55:40,149 --> 05:55:41,050
RISKS MYSELF.

8008
05:55:41,050 --> 05:55:42,684
I THINK IT'S IMPORTANT TO

8009
05:55:42,684 --> 05:55:43,452
DIFFERENTIATED BETWEEN THOUGH

8010
05:55:43,452 --> 05:55:45,421
INSTEAD OF VERY DIRECTLY DRIVEN

8011
05:55:45,421 --> 05:55:46,822
BY POVERTY AND THOSE THAT ARE

8012
05:55:46,822 --> 05:55:48,257
NOT, IT CAN ALSO MEAN

8013
05:55:48,257 --> 05:55:49,992
NEIGHBORHOOD FACTORS AS WELL AS

8014
05:55:49,992 --> 05:55:53,962
INDIVIDUAL LEVEL FACTORS.

8015
05:55:53,962 --> 05:55:55,697
SINCE SO MUCH TIME HAS BEEN

8016
05:55:55,697 --> 05:55:56,899
SPENT ON THIS ALREADY, I DON'T

8017
05:55:56,899 --> 05:55:58,434
THINK YOU GUYS NEED ME TO

8018
05:55:58,434 --> 05:55:59,134
REITERATE THIS.

8019
05:55:59,134 --> 05:56:00,202
SO I'LL GO ON.

8020
05:56:00,202 --> 05:56:01,070
NEXT, PLEASE.

8021
05:56:01,070 --> 05:56:02,571
YOU ALL MAY HAVE SEEN THIS

8022
05:56:02,571 --> 05:56:04,339
BEFORE, BUT JUST VERY BROADLY

8023
05:56:04,339 --> 05:56:05,307
SPEAKING, THERE'S A LOT OF

8024
05:56:05,307 --> 05:56:06,742
EVIDENCE THAT MOST HEALTH

8025
05:56:06,742 --> 05:56:08,944
OUTCOMES ARE IN FACT DRIVEN BY

8026
05:56:08,944 --> 05:56:10,579
SOCIAL CONTEXT, SOCIAL RISKS,

8027
05:56:10,579 --> 05:56:12,881
AND THAT CLINICAL CARE IN A LOT

8028
05:56:12,881 --> 05:56:14,616
OF CASES IS REALLY ONLY TAKES

8029
05:56:14,616 --> 05:56:16,585
CARE OF A VERY SMALL PERCENTAGE

8030
05:56:16,585 --> 05:56:18,687
OF HEALTH OUTCOMES.

8031
05:56:18,687 --> 05:56:20,289
AGAIN, AS HAS BEEN DISCUSSED,

8032
05:56:20,289 --> 05:56:22,491
THE SOCIAL RISKS AFFECT SOCIAL

8033
05:56:22,491 --> 05:56:24,126
CIRCUMSTANCES, BEHAVIORS, HEALTH

8034
05:56:24,126 --> 05:56:25,461
BEHAVIORS, SOME ENVIRONMENTAL

8035
05:56:25,461 --> 05:56:26,762
EXPOSURES AND OF COURSE ACCESS

8036
05:56:26,762 --> 05:56:27,629
TO HEALTHCARE.

8037
05:56:27,629 --> 05:56:29,298
WE'RE GOING TO TALK A LITTLE BIT

8038
05:56:29,298 --> 05:56:31,033
THOUGH ABOUT EVEN HOW WHEN YOU

8039
05:56:31,033 --> 05:56:32,134
HAVE ACCESS TO HEALTHCARE, IT

8040
05:56:32,134 --> 05:56:33,202
DOESN'T ALWAYS MAKE A

8041
05:56:33,202 --> 05:56:33,502
DIFFERENCE.

8042
05:56:33,502 --> 05:56:35,170
I'LL GO ON IN A MOMENT.

8043
05:56:35,170 --> 05:56:36,939
NEXT, PLEASE.

8044
05:56:36,939 --> 05:56:38,040
I'M GOING TO GET A LITTLE MORE

8045
05:56:38,040 --> 05:56:38,540
INTO THIS.

8046
05:56:38,540 --> 05:56:40,542
I KNOW IT'S BEEN TOUCHED ON SOME

8047
05:56:40,542 --> 05:56:41,743
ALREADY TODAY BUT I THINK IT'S

8048
05:56:41,743 --> 05:56:42,744
FINANCIAL CORRESPONDENT

8049
05:56:42,744 --> 05:56:43,846
REITERATE THESE BECAUSE IT'S

8050
05:56:43,846 --> 05:56:44,713
REALLY IMPORTANT TO UNDERSTAND

8051
05:56:44,713 --> 05:56:46,115
THESE PATHWAYS.

8052
05:56:46,115 --> 05:56:47,449
SO ONE WAY THAT SOCIAL RISKS

8053
05:56:47,449 --> 05:56:49,284
AFFECT HEALTH IS BY FOLKS HAVE

8054
05:56:49,284 --> 05:56:51,453
LESS ACCESS TO AFFORDABLE CARE.

8055
05:56:51,453 --> 05:56:53,122
I DO MOST OF MY RESEARCH IN

8056
05:56:53,122 --> 05:56:55,190
PRIMARY CARE COMMUNITY HEALTH

8057
05:56:55,190 --> 05:56:56,959
CENTERS, IN WHICH PATIENTS ARE

8058
05:56:56,959 --> 05:56:59,561
EITHER UNINSURED OR PUBLICLY

8059
05:56:59,561 --> 05:57:02,764
INSURED AND PUBLIC INSURANCE IS

8060
05:57:02,764 --> 05:57:06,468
LIKE ADEQUATE BUT NOT GREAT.

8061
05:57:06,468 --> 05:57:09,104
IT INCREASES EXPOSURES TO RISKS,

8062
05:57:09,104 --> 05:57:10,506
AGAIN, HAS BEEN DISCUSSED SOME,

8063
05:57:10,506 --> 05:57:13,041
STRESS, DISCRIMINATION, UNSAFE

8064
05:57:13,041 --> 05:57:15,277
EMPLOYMENT, LESS HEALTH LI

8065
05:57:15,277 --> 05:57:17,212
LITERACY, MORE POTENTIAL FOR

8066
05:57:17,212 --> 05:57:18,380
ADVERSE CHILDHOOD EVENTS, ALL OF

8067
05:57:18,380 --> 05:57:20,916
WHICH CAN AFFECT HEALTH IN

8068
05:57:20,916 --> 05:57:21,183
ADULTHOOD.

8069
05:57:21,183 --> 05:57:23,752
THE STUFF THAT I FIND REALLY

8070
05:57:23,752 --> 05:57:25,154
IMPORTANT I THINK AND IN THE

8071
05:57:25,154 --> 05:57:26,688
CONTEXT ESPECIALLY OF CHRONIC

8072
05:57:26,688 --> 05:57:30,225
DISEASE MANAGEMENT IS HOW SOCIAL

8073
05:57:30,225 --> 05:57:32,161
RISKS IMPACT INDIVIDUAL

8074
05:57:32,161 --> 05:57:33,929
PATIENTS' ABILITY TO ENGAGE IN

8075
05:57:33,929 --> 05:57:35,330
HEALTHY BEHAVIORS, TO ADHERE TO

8076
05:57:35,330 --> 05:57:37,199
CARE PLANS, TO ACT ON CARE

8077
05:57:37,199 --> 05:57:38,400
RECOMMENDATIONS, AND AS WAS

8078
05:57:38,400 --> 05:57:40,402
NOTED BEFORE, THESE ELEMENTS CAN

8079
05:57:40,402 --> 05:57:48,677
INTERACT AND BE CUMULATIVE, SO

8080
05:57:48,677 --> 05:57:50,212
LET'S MOVE ON BECAUSE I THINK

8081
05:57:50,212 --> 05:57:51,647
YOU GUYS WILL REALLY WANT TO

8082
05:57:51,647 --> 05:57:53,482
HEAR ME TALK ABOUT HOW WE CAN

8083
05:57:53,482 --> 05:57:54,483
MITIGATE THIS STUFF.

8084
05:57:54,483 --> 05:57:55,350
NEXT, PLEASE.

8085
05:57:55,350 --> 05:57:55,551
OKAY.

8086
05:57:55,551 --> 05:57:56,785
I AM GOING TO TALK A LITTLE BIT

8087
05:57:56,785 --> 05:57:59,421
OF DETAIL ABOUT HOW CHRONIC

8088
05:57:59,421 --> 05:58:01,723
DISEASE RISK MANAGEMENT IS

8089
05:58:01,723 --> 05:58:03,592
AFFECTED BY HAD SOCIAL RISKS,

8090
05:58:03,592 --> 05:58:06,395
AND I'M A PVD PERSON, BUT I'M

8091
05:58:06,395 --> 05:58:08,163
BETTING THAT THESE VERY SAME

8092
05:58:08,163 --> 05:58:11,433
PATHWAYS DO AFFECT PVD.

8093
05:58:11,433 --> 05:58:13,535
MOST NUMBERS MORE FOCUSED ON

8094
05:58:13,535 --> 05:58:14,503
DIEBILITIES THAN CARDIOVASCULAR

8095
05:58:14,503 --> 05:58:15,704
DISEASE SPECIFICALLY BUT HERE IS

8096
05:58:15,704 --> 05:58:18,907
HOW THIS STUFF WORKS.

8097
05:58:18,907 --> 05:58:20,442
MANY CHRONIC DISEASE RISK

8098
05:58:20,442 --> 05:58:22,477
FACTORS ARE MANAGEABLE.

8099
05:58:22,477 --> 05:58:23,278
WE CAN MANAGE THEM.

8100
05:58:23,278 --> 05:58:25,347
FOR EXAMPLE, HYPERTENSION, WITH

8101
05:58:25,347 --> 05:58:26,882
CLINICAL AND BEHAVIORAL

8102
05:58:26,882 --> 05:58:28,317
INTERVENTIONS, MEDICATIONS,

8103
05:58:28,317 --> 05:58:29,585
DIET, EXERCISE, MOST OF THE

8104
05:58:29,585 --> 05:58:31,420
TIME, NOT ALL THE TIME, BUT MOST

8105
05:58:31,420 --> 05:58:34,556
OF THE TIME, THE RISK CAN BE

8106
05:58:34,556 --> 05:58:35,757
MANAGED IF THE PATIENT CAN

8107
05:58:35,757 --> 05:58:38,260
ENGAGE IN THOSE BEHAVIORS.

8108
05:58:38,260 --> 05:58:40,262
BUT SOCIAL RISKS DIRECTLY AFFECT

8109
05:58:40,262 --> 05:58:41,230
PEOPLE'S ABILITY TO DO THAT.

8110
05:58:41,230 --> 05:58:42,931
SO IF SOMEONE DOESN'T HAVE

8111
05:58:42,931 --> 05:58:45,367
AFFORDABLE CARE, FIRST OF ALL

8112
05:58:45,367 --> 05:58:47,135
THEIR DISEASE RISK MAY NOT BE

8113
05:58:47,135 --> 05:58:48,103
IDENTIFIED, IT'S CERTAINLY NOT

8114
05:58:48,103 --> 05:58:49,471
BEING MONITORED REGULARLY, IF

8115
05:58:49,471 --> 05:58:51,173
THEY HAVE TRANSPORTATION

8116
05:58:51,173 --> 05:58:52,708
INSECURITY, IT BECOMES HARD

8117
05:58:52,708 --> 05:58:54,343
TO -- TEN VISITS, MAYBE IT'S --

8118
05:58:54,343 --> 05:58:55,410
HARD TO ATTEND VISITS, MAYBE

8119
05:58:55,410 --> 05:58:57,212
IT'S HARD TO FILL PRESCRIPTIONS.

8120
05:58:57,212 --> 05:58:59,047
EVEN IF YOU DO HAVE A STATE

8121
05:58:59,047 --> 05:59:00,349
MEDICAID OFFICE THAT WILL PAY

8122
05:59:00,349 --> 05:59:01,016
YOUR TRANSPORTATION THAT'S

8123
05:59:01,016 --> 05:59:02,117
USUALLY TO THE MEDICAL OFFICE

8124
05:59:02,117 --> 05:59:03,318
AND NOT NECESSARILY TO FILL A

8125
05:59:03,318 --> 05:59:04,519
PRESCRIPTION AND THAT CAN BE A

8126
05:59:04,519 --> 05:59:05,621
REAL PROBLEM FOR PEOPLE THAT

8127
05:59:05,621 --> 05:59:07,022
HAVE TRANSPORTATION BARRIERS.

8128
05:59:07,022 --> 05:59:08,123
ANOTHER PLACE TRANSPORTATION

8129
05:59:08,123 --> 05:59:09,458
BARRIERS REALLY PLAYS OUT AND

8130
05:59:09,458 --> 05:59:11,293
ENTER PLAYS WITH OTHER SOCIAL

8131
05:59:11,293 --> 05:59:12,861
RISKS FOR EXAMPLE IS, YOU KNOW,

8132
05:59:12,861 --> 05:59:14,263
IT'S ALL WELL AND GOOD TO REFER

8133
05:59:14,263 --> 05:59:16,031
A PATIENT WITH FOOD INSCRURT TO

8134
05:59:16,031 --> 05:59:17,799
A FOOD BANK BUT THEY NEED TO GO

8135
05:59:17,799 --> 05:59:19,201
BACK OVER AND OVER, YOU DON'T

8136
05:59:19,201 --> 05:59:20,936
JUST DID TO THE FOOD BANK ONCE,

8137
05:59:20,936 --> 05:59:22,137
AND THEN AGAIN, IF YOU DON'T

8138
05:59:22,137 --> 05:59:24,006
HAVE TRANSPORTATION, THEN THAT

8139
05:59:24,006 --> 05:59:25,907
BECOMES NOT REALLY A SOLUTION.

8140
05:59:25,907 --> 05:59:26,942
HOUSING FOOD AND FINANCIAL

8141
05:59:26,942 --> 05:59:29,044
INSECURITY CAN ALL MAKE IT HARD

8142
05:59:29,044 --> 05:59:31,113
TO EAT A HEALTHY DIET, HARD TO

8143
05:59:31,113 --> 05:59:32,981
GET EXERCISE, OTHER NEEDS ARE

8144
05:59:32,981 --> 05:59:34,616
PRIORITIZED WHICH MAKES A LOT OF

8145
05:59:34,616 --> 05:59:36,251
SENSE, AND AGAIN CAN IMPEDE

8146
05:59:36,251 --> 05:59:38,553
ABILITY TO PAY FOR MEDICATIONS

8147
05:59:38,553 --> 05:59:40,188
EVEN WHEN THERE'S A VERY LOCO

8148
05:59:40,188 --> 05:59:40,756
PAY.

8149
05:59:40,756 --> 05:59:42,924
SO OVER-- LOW CO-PAY.

8150
05:59:42,924 --> 05:59:44,226
OVERALL PATHWAY GOES LIKE THIS,

8151
05:59:44,226 --> 05:59:46,428
LOWER INCOME, LESS THIS SEASON K

8152
05:59:46,428 --> 05:59:49,364
DRIVES SOCIAL RISKS, SOCIAL

8153
05:59:49,364 --> 05:59:50,799
RISKS HAMPERS A PATIENT'S

8154
05:59:50,799 --> 05:59:52,434
ABILITY TO ENGAGE IN PREVENTIVE

8155
05:59:52,434 --> 05:59:53,635
BEHAVIORS AND OTHER

8156
05:59:53,635 --> 05:59:54,736
INTERVENTIONS, LEADS TO

8157
05:59:54,736 --> 05:59:55,604
UNMANAGED CHRONIC DISEASE AND

8158
05:59:55,604 --> 05:59:56,805
POOR OUTCOMES AND BETTING

8159
05:59:56,805 --> 05:59:57,806
ANYTHING THAT PATHWAY IS THE

8160
05:59:57,806 --> 06:00:00,776
SAME FOR PVD AS IT IS FOR

8161
06:00:00,776 --> 06:00:02,678
HYPERTENSION AND DIABETES.

8162
06:00:02,678 --> 06:00:05,280
NEXT, PLEASE.

8163
06:00:05,280 --> 06:00:05,714
OKAY.

8164
06:00:05,714 --> 06:00:08,016
AND I MENTIONED BEFORE THAT THIS

8165
06:00:08,016 --> 06:00:09,217
STUFF STILL HAPPENS, ACCESS TO

8166
06:00:09,217 --> 06:00:10,319
HEALTHCARE IS IMPORTANT, BUT

8167
06:00:10,319 --> 06:00:11,853
EVEN WHEN PATIENTS HAVE ACCESS

8168
06:00:11,853 --> 06:00:13,488
TO HEALTHCARE, TO DISEENT

8169
06:00:13,488 --> 06:00:15,791
QUALITY HEALTHCARE, IT -- DECENT

8170
06:00:15,791 --> 06:00:16,858
QUALITY HEALTHCARE, IT DOESN'T

8171
06:00:16,858 --> 06:00:18,627
SOLVE THE PROBLEM BY ITSELF.

8172
06:00:18,627 --> 06:00:21,196
THIS IS A STUDY FROM A COUPLE OF

8173
06:00:21,196 --> 06:00:24,299
YEARS AGO WHERE WE LOOKED AT

8174
06:00:24,299 --> 06:00:25,267
PATIENTS IN COMMUNITY HEALTH

8175
06:00:25,267 --> 06:00:26,802
CENTERS AND PRIMARY CARE

8176
06:00:26,802 --> 06:00:27,803
COMMUNITY HEALTH CENTERS AND

8177
06:00:27,803 --> 06:00:29,671
PUBLIC SAFETY NET OF PRIMARY

8178
06:00:29,671 --> 06:00:32,074
CARE WITH DIABETES AND WE LOOKED

8179
06:00:32,074 --> 06:00:33,942
AT WHETHER THEY HAD

8180
06:00:33,942 --> 06:00:36,545
TRANSPORTATION, HOUSING OR FOOD

8181
06:00:36,545 --> 06:00:40,115
INSECURITY IF THEY WERE MORE OR

8182
06:00:40,115 --> 06:00:41,883
LESS LIKELY TO BE UP TO DATED ON

8183
06:00:41,883 --> 06:00:42,718
THEIR DIABETES CARE AND THEN IF

8184
06:00:42,718 --> 06:00:44,419
THEY WERE, WERE THEY MORE OR

8185
06:00:44,419 --> 06:00:45,954
LESS LIKELY TO HAVE THEIR

8186
06:00:45,954 --> 06:00:47,155
DIABETES MANAGED AND WHAT WE

8187
06:00:47,155 --> 06:00:49,891
FOUND WAS THAT FOLKS WITH SOCIAL

8188
06:00:49,891 --> 06:00:52,294
RISKS HAD THE SAME QUALITY OF

8189
06:00:52,294 --> 06:00:52,728
CARE.

8190
06:00:52,728 --> 06:00:54,262
GOT THEIR SCREENINGS ON TIME AT

8191
06:00:54,262 --> 06:00:55,797
THE SAME LEVEL AS THOSE WHO DID

8192
06:00:55,797 --> 06:00:56,998
NOT REPORT THESE RISKS.

8193
06:00:56,998 --> 06:00:58,867
SO THEY'RE GETTING GOOD QUALITY

8194
06:00:58,867 --> 06:01:00,302
CARE, BUT EVEN AMONG THOSE UP TO

8195
06:01:00,302 --> 06:01:01,937
DATE ON THEIR PREVENTIVE CARE,

8196
06:01:01,937 --> 06:01:03,338
THOSE WITH FOOD INSECURITY HAD

8197
06:01:03,338 --> 06:01:05,774
LOWER RATES OF CONTROLLED A1C,

8198
06:01:05,774 --> 06:01:07,042
THOSE WITH TRANSPORTATION

8199
06:01:07,042 --> 06:01:08,477
INSECURITY HAD LOWER RATES OF

8200
06:01:08,477 --> 06:01:09,811
CONTROL, ALL THE BIOMARKERS WE

8201
06:01:09,811 --> 06:01:12,147
LOOKED AT, A1C, BLOOD PRESSURE,

8202
06:01:12,147 --> 06:01:14,483
LIPIDS, AND THOSE WITH HOUSING

8203
06:01:14,483 --> 06:01:15,584
INSECURITY NO DIFFERENCES.

8204
06:01:15,584 --> 06:01:17,352
WE THOUGHT THAT WAS REALLY

8205
06:01:17,352 --> 06:01:17,652
FASCINATING.

8206
06:01:17,652 --> 06:01:18,787
I WILL SAY THERE'S QUITE A

8207
06:01:18,787 --> 06:01:21,723
GROWING BODY OF RESEARCH SHOWING

8208
06:01:21,723 --> 06:01:22,758
THAT TRANSPORTATION BARRIERS ARE

8209
06:01:22,758 --> 06:01:25,660
ONE OF THE BIGGEST DRIVERS

8210
06:01:25,660 --> 06:01:26,728
COMPARED TO FOOD AND HOUSING,

8211
06:01:26,728 --> 06:01:28,697
ALL IMPORTANT, BUT

8212
06:01:28,697 --> 06:01:30,532
TRANSPORTATION IS MORE IMPORTANT

8213
06:01:30,532 --> 06:01:31,466
THAN -- MAYBE MORE IMPORTANT

8214
06:01:31,466 --> 06:01:32,467
THAN THE OTHERS.

8215
06:01:32,467 --> 06:01:34,770
DON'T TAKE ME ON THAT AS GOSPEL,

8216
06:01:34,770 --> 06:01:36,071
BUT THERE'S A PATTERN THAT'S

8217
06:01:36,071 --> 06:01:37,506
EMERGING IN THE LITERATURE AS I

8218
06:01:37,506 --> 06:01:38,173
PERCEIVE IT.

8219
06:01:38,173 --> 06:01:42,878
SO REALLY IMPORTANT TO NOTE HERE

8220
06:01:42,878 --> 06:01:45,247
THAT GUIDELINE IN IMPORTANT CARE

8221
06:01:45,247 --> 06:01:47,249
DOES NOT NECESSARILY GUIDE

8222
06:01:47,249 --> 06:01:49,017
OUTCOMES IF PATIENT HAS SOCIAL

8223
06:01:49,017 --> 06:01:49,317
RISKS.

8224
06:01:49,317 --> 06:01:50,552
WHAT CAN HEALTHCARE PROVIDERS DO

8225
06:01:50,552 --> 06:01:51,620
ABOUT THIS?

8226
06:01:51,620 --> 06:01:53,622
THERE'S A WONDERFUL 2019

8227
06:01:53,622 --> 06:01:54,790
NATIONAL ACADEMIES REPORT THAT

8228
06:01:54,790 --> 06:01:55,991
REALLY SUMMARIZED WHAT THEY CALL

8229
06:01:55,991 --> 06:01:57,859
THE FIVE A'S OF SOCIAL CARE

8230
06:01:57,859 --> 06:02:01,062
INTEGRATION OR FIVE A'S, FIVE

8231
06:02:01,062 --> 06:02:02,264
DIFFERENT THINGS THAT HEALTHCARE

8232
06:02:02,264 --> 06:02:04,232
PROVIDERS CAN DO TO TRY AND

8233
06:02:04,232 --> 06:02:06,301
MITIGATE HOW SOCIAL RISKS AFFECT

8234
06:02:06,301 --> 06:02:08,170
HEALTH OUTCOMES, AND SOME OF THE

8235
06:02:08,170 --> 06:02:10,005
THEM ARE FOCUS ODD COMMUNITY.

8236
06:02:10,005 --> 06:02:11,840
THE FIRST ONE IS AWARENESS,

8237
06:02:11,840 --> 06:02:12,741
FIRST AVE., YOU'VE GOT TO KNOW

8238
06:02:12,741 --> 06:02:14,943
WHAT'S GOING ON, THAT APPLIES TO

8239
06:02:14,943 --> 06:02:16,011
BOTH HEALTHCARE ACTIVITIES AND

8240
06:02:16,011 --> 06:02:17,345
COMMUNITY FACING ACTIVITIES, AND

8241
06:02:17,345 --> 06:02:19,314
I'LL TALK ABOUT THE ACTIVITIES

8242
06:02:19,314 --> 06:02:20,415
FOCUSED ON THE HEALTHCARE

8243
06:02:20,415 --> 06:02:21,917
SETTING BUT I JUST WANT TO NOTE

8244
06:02:21,917 --> 06:02:23,919
THAT THERE ARE COMMUNITY LEVEL

8245
06:02:23,919 --> 06:02:25,487
ALIGNMENT AND ADVOCACY ELEMENTS

8246
06:02:25,487 --> 06:02:26,655
AS WELL.

8247
06:02:26,655 --> 06:02:27,756
BUT FOR INDIVIDUAL PATIENTS,

8248
06:02:27,756 --> 06:02:29,391
WHAT CAN YOU DO IF YOU'RE A

8249
06:02:29,391 --> 06:02:31,893
PROVIDER, ONE WE TALK ABOUT IS

8250
06:02:31,893 --> 06:02:33,261
ADJUSTMENTS OR SOCIAL RISK

8251
06:02:33,261 --> 06:02:35,197
INFORMED CARE AND THAT INVOLVES

8252
06:02:35,197 --> 06:02:36,531
ADAPTING THE CARE PLAN TO

8253
06:02:36,531 --> 06:02:37,933
ACCOMMODATE A PATIENT'S SOCIAL

8254
06:02:37,933 --> 06:02:38,266
RISK.

8255
06:02:38,266 --> 06:02:40,101
THE OTHER IS ASSISTANCE, WHICH

8256
06:02:40,101 --> 06:02:41,770
IS TRYING TO MITIGATE SOCIAL

8257
06:02:41,770 --> 06:02:43,138
RISK ITSELF, EITHER GIVING

8258
06:02:43,138 --> 06:02:44,172
PATIENTS FOOD OR REFERRING THEM

8259
06:02:44,172 --> 06:02:46,341
ON A FOOD BANK ET CETERA, ET

8260
06:02:46,341 --> 06:02:48,777
CETERA, REFERRING THEM TO SOCIAL

8261
06:02:48,777 --> 06:02:49,211
SERVICES.

8262
06:02:49,211 --> 06:02:50,846
AND THE WORDS ADJUSTMENT AND

8263
06:02:50,846 --> 06:02:52,247
ASSISTANCE AND AWARENESS I'LL

8264
06:02:52,247 --> 06:02:53,482
USE A LOT THROUGHOUT THIS TALK,

8265
06:02:53,482 --> 06:02:54,950
SO AWARENESS AGAIN IS DO YOU

8266
06:02:54,950 --> 06:02:56,218
KNOW THIS IS GOING ON,

8267
06:02:56,218 --> 06:02:57,419
ADJUSTMENT IS ADAPTING THE CARE

8268
06:02:57,419 --> 06:02:58,720
PLAN TO MAKE IT SO THE PATIENT

8269
06:02:58,720 --> 06:03:00,388
IS MORE ABLE TO FOLLOW IT,

8270
06:03:00,388 --> 06:03:02,123
ASSISTANCE IS ACTUALLY TRYING TO

8271
06:03:02,123 --> 06:03:03,658
MITIGATE SOCIAL RISK ITSELF

8272
06:03:03,658 --> 06:03:04,493
THROUGH COMMUNITY REFERRAL OR

8273
06:03:04,493 --> 06:03:05,827
SOME OTHER METHOD.

8274
06:03:05,827 --> 06:03:07,496
NEXT, PLEASE.

8275
06:03:07,496 --> 06:03:07,696
OKAY.

8276
06:03:07,696 --> 06:03:09,764
SO WE TALKED ABOUT AWARENESS.

8277
06:03:09,764 --> 06:03:11,633
THE POINT I WANT TO MAKE HERE IS

8278
06:03:11,633 --> 06:03:12,934
BECAUSE IT'S SOMETHING I SEE

8279
06:03:12,934 --> 06:03:15,003
COME UP OVER AND OVER AGAIN AND

8280
06:03:15,003 --> 06:03:16,872
I SAW A LITTLE BIT OF IT TODAY,

8281
06:03:16,872 --> 06:03:18,740
FOLKS CAN I JUST USE COMMUNITY

8282
06:03:18,740 --> 06:03:20,609
LEVEL DATA, CAN I JUST USE

8283
06:03:20,609 --> 06:03:21,476
NEIGHBORHOOD CHARACTERISTICS TO

8284
06:03:21,476 --> 06:03:23,211
ASSUME I'M AWARE OF WHAT WI

8285
06:03:23,211 --> 06:03:24,145
GIVEN PATIENT NEEDS, AND THE

8286
06:03:24,145 --> 06:03:25,280
ANSWER IS NO.

8287
06:03:25,280 --> 06:03:26,615
THEY DO NOT ALIGN.

8288
06:03:26,615 --> 06:03:28,250
IT'S LIKE FLIPPING A COIN,

8289
06:03:28,250 --> 06:03:29,351
LOOKING AT A PATIENT'S COMMUNITY

8290
06:03:29,351 --> 06:03:30,785
LEVEL DATA TO UNDERSTAND WHAT

8291
06:03:30,785 --> 06:03:32,420
THEIR INDIVIDUAL NEEDS ARE.

8292
06:03:32,420 --> 06:03:34,055
A COUPLE DIFFERENT STUDIES HAVE

8293
06:03:34,055 --> 06:03:35,724
SHOWN THIS NOW.

8294
06:03:35,724 --> 06:03:36,892
NOW, THOSE COMMUNITY LEVEL DATA

8295
06:03:36,892 --> 06:03:38,360
ARE ABSOLUTELY USEFUL FOR

8296
06:03:38,360 --> 06:03:39,961
ALIGNMENT, FOR ADVOCACY, FOR

8297
06:03:39,961 --> 06:03:40,896
THINKING ABOUT WHAT'S GOING ON

8298
06:03:40,896 --> 06:03:42,163
AT THE COMMUNITY LEVEL BUT IN

8299
06:03:42,163 --> 06:03:44,032
TERMS OF POINT OF CARE, PATIENT

8300
06:03:44,032 --> 06:03:45,233
NEEDS, YOU HAVE TO ASK THEM WHAT

8301
06:03:45,233 --> 06:03:45,967
IS GOING ON.

8302
06:03:45,967 --> 06:03:47,202
AND I THINK IT'S REALLY

8303
06:03:47,202 --> 06:03:49,037
IMPORTANT THAT I WOULD LIKE TO

8304
06:03:49,037 --> 06:03:50,071
REALLY HAMMER THAT POINT ON

8305
06:03:50,071 --> 06:03:51,473
BECAUSE I SEE ALL THE TIME THIS

8306
06:03:51,473 --> 06:03:53,341
SORT OF INTEREST IN WE'LL JUST

8307
06:03:53,341 --> 06:03:54,643
USE COMMUNITY LEVEL DATA BUT YOU

8308
06:03:54,643 --> 06:03:55,310
REALLY CAN'T.

8309
06:03:55,310 --> 06:03:59,881
NEXT PLEASE.

8310
06:03:59,881 --> 06:04:02,751
SO THAT MEANS TO HAVE EFFECTIVE

8311
06:04:02,751 --> 06:04:03,618
AWARENESS PROCEDURES YOU REALLY

8312
06:04:03,618 --> 06:04:04,619
NEED TO SCREEN PATIENTS, YOU

8313
06:04:04,619 --> 06:04:07,455
HAVE TO ASK THEM WHAT'S GOING

8314
06:04:07,455 --> 06:04:08,990
ON, BUT THERE'S HUGE VARIATION

8315
06:04:08,990 --> 06:04:10,191
IN HOW MUCH THAT IS HAPPENING.

8316
06:04:10,191 --> 06:04:12,260
AGAIN IN A NATIONAL NETWORK WHEN

8317
06:04:12,260 --> 06:04:14,796
WE CONDUCTED IT OVER ABOUT IT'S

8318
06:04:14,796 --> 06:04:17,632
ABOUT 2,000 CLINICS NOW IN THE

8319
06:04:17,632 --> 06:04:19,034
NETWORK, WE HAVE ALMOST THREE

8320
06:04:19,034 --> 06:04:21,670
AND A HALF MILLION SOCIAL RISK

8321
06:04:21,670 --> 06:04:23,104
SCREENINGS EXPUCTD THIS IS AGAIN

8322
06:04:23,104 --> 06:04:24,172
IN SEVERAL -- CONDUCTED AND THIS

8323
06:04:24,172 --> 06:04:26,274
IS AGAIN IN SIX MILLION PATIENTS

8324
06:04:26,274 --> 06:04:27,642
BUT ONLY 20 PERCENT OF THE

8325
06:04:27,642 --> 06:04:29,010
PATIENTS HAVE EVER BEEN SCREENED

8326
06:04:29,010 --> 06:04:30,512
SO THERE ARE SOME CLINICS OR

8327
06:04:30,512 --> 06:04:31,413
CARE ORGANIZATIONS THAT ARE

8328
06:04:31,413 --> 06:04:32,814
DOING A GREAT JOB IN SCREENING

8329
06:04:32,814 --> 06:04:34,482
LOTS OF THEIR PATIENTS AND SOME

8330
06:04:34,482 --> 06:04:35,684
THAT HAVEN'T EVEN STARTED.

8331
06:04:35,684 --> 06:04:39,821
THERE'S TONS OF VARIATION HERE,

8332
06:04:39,821 --> 06:04:40,822
AND WHAT'S HAPPENING SOMETIMES

8333
06:04:40,822 --> 06:04:42,457
IS THAT FOLKS IT'S KIND OF

8334
06:04:42,457 --> 06:04:44,225
HAPPENING AT HOCK LIKE YOU'VE

8335
06:04:44,225 --> 06:04:46,394
GOT ONE CARE TEAM THAT'S REALLY

8336
06:04:46,394 --> 06:04:47,796
EXCITED ABOUT IT BUT THEN NO ONE

8337
06:04:47,796 --> 06:04:49,130
ELSE IS SCREENING FOR SOCIAL

8338
06:04:49,130 --> 06:04:50,665
RISKS AND REALLY THE BIG TAKE

8339
06:04:50,665 --> 06:04:51,833
HOME POINT I WANT TO MAKE IS

8340
06:04:51,833 --> 06:04:54,235
THERE'S A TON OF VARIATION, IT'S

8341
06:04:54,235 --> 06:04:56,004
ALMOST INCREASE IML THIS IS

8342
06:04:56,004 --> 06:04:57,339
HAPPENING AND -- INCREASINGLY

8343
06:04:57,339 --> 06:04:58,006
THIS IS HAPPENING AND THOSE

8344
06:04:58,006 --> 06:04:59,207
RATES ARE GOING UP BECAUSE

8345
06:04:59,207 --> 06:05:01,042
THERE'S MORE AND MORE

8346
06:05:01,042 --> 06:05:02,911
INITIATIVES SUPPORTING OR

8347
06:05:02,911 --> 06:05:04,212
INCENTIVIZING THE SCREENING BUT

8348
06:05:04,212 --> 06:05:05,880
IT'S STINLT HAPPENING ANYWHERE

8349
06:05:05,880 --> 06:05:08,383
NEAR AT THE -- IT'S STILL NOT

8350
06:05:08,383 --> 06:05:09,918
HAPPENING ANYWHERE NEAR AT THE

8351
06:05:09,918 --> 06:05:11,353
LEVEL WE WANT IT TO HAPPEN AND

8352
06:05:11,353 --> 06:05:13,188
IT'S REALLY INCONSISTENT.

8353
06:05:13,188 --> 06:05:14,923
THIS IS IN PRIMARY CARE I SHOULD

8354
06:05:14,923 --> 06:05:15,123
NOTE.

8355
06:05:15,123 --> 06:05:16,257
WHY IS THAT?

8356
06:05:16,257 --> 06:05:17,258
BECAUSE THERE ARE SUBSTANTIAL

8357
06:05:17,258 --> 06:05:18,426
BARRIERS TO IMPLEMENTING

8358
06:05:18,426 --> 06:05:20,962
SCREENING TO GET TO AWARENESS.

8359
06:05:20,962 --> 06:05:22,464
THOSE IDENTIFIED AT THAT

8360
06:05:22,464 --> 06:05:24,566
NATIONAL ACADEMIES REPORT AND

8361
06:05:24,566 --> 06:05:26,001
MANY OTHERS SINCE HAVE SHOWN THE

8362
06:05:26,001 --> 06:05:28,403
SAME THING AND I INTENTIONALLY

8363
06:05:28,403 --> 06:05:29,804
PUT A LOT OF STUFF ON THIS SLIDE

8364
06:05:29,804 --> 06:05:31,106
SO I REALLY WANT TO MAKE SURE

8365
06:05:31,106 --> 06:05:32,540
THAT THERE ARE LOTS OF BARRIERS

8366
06:05:32,540 --> 06:05:32,974
HERE.

8367
06:05:32,974 --> 06:05:34,943
CLINICS GOT COMPETING NEEDS,

8368
06:05:34,943 --> 06:05:36,077
COMPETING INITIATIVES, DON'T

8369
06:05:36,077 --> 06:05:37,312
HAVE ENOUGH RESOURCES TO DO IT,

8370
06:05:37,312 --> 06:05:38,346
THIS IS VERY IMPORTANT.

8371
06:05:38,346 --> 06:05:40,615
OH, I ALREADY KNOW MY PATIENTS

8372
06:05:40,615 --> 06:05:42,417
NEEDS, OH, MY STAFF DON'T FEEL

8373
06:05:42,417 --> 06:05:43,418
COMFORTABLE ASKING, WHY SCREEN

8374
06:05:43,418 --> 06:05:45,353
IF I CAN'T REFER, PEOPLE GET

8375
06:05:45,353 --> 06:05:46,655
VERY URVELG SOMETIMES ASKING

8376
06:05:46,655 --> 06:05:47,756
PEOPLE ABOUT THESE IMPORTANT

8377
06:05:47,756 --> 06:05:48,957
PARTS OF THEIR LIVES IF THEY

8378
06:05:48,957 --> 06:05:52,327
DON'T HAVE A SOLUTION TO

8379
06:05:52,327 --> 06:05:55,397
PROVIDE, WHICH I GET BUT THEN

8380
06:05:55,397 --> 06:06:00,001
YOU GET YOURSELF IN A PICKLE.

8381
06:06:00,001 --> 06:06:01,970
ROLES, SHOULD THE CLINICIAN BE

8382
06:06:01,970 --> 06:06:05,173
DOING T NO, DEFINITELY SUPPORT

8383
06:06:05,173 --> 06:06:07,542
STAFF, SMALL CLINICS, MAYBE THE

8384
06:06:07,542 --> 06:06:09,310
CLINICIAN COULD DO T THIS NEEDS

8385
06:06:09,310 --> 06:06:10,178
TO BE DEFINED.

8386
06:06:10,178 --> 06:06:11,379
THERE'S TENSION AROUND WE HEAR

8387
06:06:11,379 --> 06:06:12,914
THIS OVER AND OVER IN MY

8388
06:06:12,914 --> 06:06:14,349
RESEARCH THIS IS WHAT I STUDY

8389
06:06:14,349 --> 06:06:15,550
BETWEEN CLINICS LOOK THE STAFF

8390
06:06:15,550 --> 06:06:16,651
WHO ARE ASKING THE QUESTIONS

8391
06:06:16,651 --> 06:06:17,719
ABOUT THE SOCIAL RISKS ARE LIKE

8392
06:06:17,719 --> 06:06:19,087
I WANT TO TALK TO THE PATIENTS,

8393
06:06:19,087 --> 06:06:20,288
I WANT TO HAVE A CONVERSATION, I

8394
06:06:20,288 --> 06:06:21,456
DON'T WANT TO BE FILLING OUT A

8395
06:06:21,456 --> 06:06:23,525
CHECK BOX ABOUT LIKE OH HOUSING

8396
06:06:23,525 --> 06:06:24,726
INSECURITY, CHECK, THAT FEELS

8397
06:06:24,726 --> 06:06:28,797
TECIALT -- THAT FEELS TERRIBLE,

8398
06:06:28,797 --> 06:06:29,097
RIGHT?

8399
06:06:29,097 --> 06:06:31,199
STAFF TURNOVER, NEED TO HAVE THE

8400
06:06:31,199 --> 06:06:33,034
RIGHT TRAINING, HR IS NOT VERY

8401
06:06:33,034 --> 06:06:35,136
GOOD AT SCREEN DOCUMENTING

8402
06:06:35,136 --> 06:06:36,337
SCREENING RESULTS AND SO FORTH.

8403
06:06:36,337 --> 06:06:37,539
THESE ARE SOME OF THE REASONS

8404
06:06:37,539 --> 06:06:39,074
WHY WE HAVE BARRIERS TO

8405
06:06:39,074 --> 06:06:39,340
SCREENING.

8406
06:06:39,340 --> 06:06:40,175
NEXT PLEASE.

8407
06:06:40,175 --> 06:06:41,576
I'LL JUST QUICKLY THE RESULTS OF

8408
06:06:41,576 --> 06:06:44,045
A STUDY THAT MY TEAM DID ON HOW

8409
06:06:44,045 --> 06:06:46,181
CAN YOU SUPPORT AGAIN PRIMARY

8410
06:06:46,181 --> 06:06:47,916
CARE COMMUNITY CLINICS IN

8411
06:06:47,916 --> 06:06:49,017
IMPLEMENTING SOCIAL RISK

8412
06:06:49,017 --> 06:06:50,452
SCREENING, LONG STORY SHORT, WE

8413
06:06:50,452 --> 06:06:53,955
GAVE CLINICS SIX MONTHS OF

8414
06:06:53,955 --> 06:06:57,225
PERSONALIZED TECHNICAL SUPPORT,

8415
06:06:57,225 --> 06:06:59,627
EHR TOOLS CUSTOMIZED TO BE USED

8416
06:06:59,627 --> 06:07:01,362
FOR SOCIAL RISK SCREENING, COACH

8417
06:07:01,362 --> 06:07:02,697
WALK THEM THROUGH FIVE STEPS

8418
06:07:02,697 --> 06:07:04,232
SHOWN HERE ON THE RIGHT, WE MET

8419
06:07:04,232 --> 06:07:05,734
WITH THEM TWICE A MONTH FOR SIX

8420
06:07:05,734 --> 06:07:06,901
MONTHS, PEER TO PEER LEARNING,

8421
06:07:06,901 --> 06:07:08,269
EVERYTHING THAT THE LITERATURE

8422
06:07:08,269 --> 06:07:09,471
SUGGESTS WOULD BE HELPFUL WE

8423
06:07:09,471 --> 06:07:11,439
TRIED TO PROVIDE TO THE CLINICS

8424
06:07:11,439 --> 06:07:12,874
IN THIS STUDY TO SEE WHETHER

8425
06:07:12,874 --> 06:07:13,975
THAT LEVEL OF SUPPORT WOULD

8426
06:07:13,975 --> 06:07:15,376
IMPROVE THEIR SCREENING LEVELS.

8427
06:07:15,376 --> 06:07:16,811
NOW, I WILL NOTE THAT THE

8428
06:07:16,811 --> 06:07:17,779
PANDEMIC HIT RIGHT IN THE MIDDLE

8429
06:07:17,779 --> 06:07:19,881
OF THIS STUDY, WHICH I'M SURE

8430
06:07:19,881 --> 06:07:21,516
ANY OF YOU WHO WERE DOING ON THE

8431
06:07:21,516 --> 06:07:23,518
GROUND RESEARCH DURING THE

8432
06:07:23,518 --> 06:07:24,119
PANDEMIC UNDERSTAND HOW MUCH

8433
06:07:24,119 --> 06:07:25,353
THAT AFFECTED RESULTS.

8434
06:07:25,353 --> 06:07:26,087
NEXT PLEASE.

8435
06:07:26,087 --> 06:07:27,856
BUT THE OVERALL FINDING HERE,

8436
06:07:27,856 --> 06:07:29,290
OUR OVERALL FINDING FROM THIS

8437
06:07:29,290 --> 06:07:30,592
STUDY WAS THAT WHILE THE

8438
06:07:30,592 --> 06:07:33,128
SCREENING DID SIGNIFICANTLY

8439
06:07:33,128 --> 06:07:34,863
INCREASE DURING THE INTERVENTION

8440
06:07:34,863 --> 06:07:37,165
PERIOD COMPARED TO

8441
06:07:37,165 --> 06:07:38,333
PREINTERVENTION, THAT IMPACT WAS

8442
06:07:38,333 --> 06:07:39,334
NOT SUSTAINED AFTER THAT SICK

8443
06:07:39,334 --> 06:07:40,869
MONTHS OF INTENSIVE SUPPORT.

8444
06:07:40,869 --> 06:07:42,403
WE SAW NO DIFFERENCE IN REFERRAL

8445
06:07:42,403 --> 06:07:44,038
RATES AT ALL, THIS WAS A COUPLE

8446
06:07:44,038 --> 06:07:45,373
YEARS AGO, SO THOSE WERE HARDER

8447
06:07:45,373 --> 06:07:47,642
TO DO THEN, BUT THEY'RE STILL

8448
06:07:47,642 --> 06:07:47,909
NOT EASY.

8449
06:07:47,909 --> 06:07:50,478
I'M SURE IF WE SHOULD HAVE

8450
06:07:50,478 --> 06:07:52,247
PROVIDED MORE LONGER MORE THAN

8451
06:07:52,247 --> 06:07:53,782
SIX MONTHS TO FOLKS, MAYBE WE

8452
06:07:53,782 --> 06:07:55,183
DIDN'T SOMEHOW ADDRESS THE

8453
06:07:55,183 --> 06:07:56,618
BARRIERS FOR SUSTAINED

8454
06:07:56,618 --> 06:07:56,985
IMPLEMENTATION.

8455
06:07:56,985 --> 06:07:58,253
I THINK THE TAKE HOME HERE IS

8456
06:07:58,253 --> 06:07:59,621
THAT COMMUNITY CLINICS

8457
06:07:59,621 --> 06:08:00,889
ESPECIALLY IN PRIMARY CARE

8458
06:08:00,889 --> 06:08:01,856
CLINICS IN GENERAL THAT DON'T

8459
06:08:01,856 --> 06:08:03,024
HAVE A LOT OF RESOURCES ARE

8460
06:08:03,024 --> 06:08:04,692
GOING TO REALLY STRUGGLE TO

8461
06:08:04,692 --> 06:08:06,094
CONDUCT SOCIAL RISK SCREENING IF

8462
06:08:06,094 --> 06:08:07,228
THEY'RE NOT GIVEN REALLY

8463
06:08:07,228 --> 06:08:08,530
SUBSTANTIAL SUPPORT AND

8464
06:08:08,530 --> 06:08:09,798
IMPLEMENTING IT AS A PRACTICE.

8465
06:08:09,798 --> 06:08:11,699
IT IS NOT EASY TO IMPLEMENT.

8466
06:08:11,699 --> 06:08:13,468
IT IS ASKING A LOT FROM CLINICS

8467
06:08:13,468 --> 06:08:15,103
TO DO, ESPECIALLY BECAUSE OF

8468
06:08:15,103 --> 06:08:16,738
THIS ISSUE AROUND REFERRAL AND

8469
06:08:16,738 --> 06:08:18,373
FOLKS NOT WANT TO GO AND

8470
06:08:18,373 --> 06:08:19,574
SOMETHING THAT THEY'RE NOT SET

8471
06:08:19,574 --> 06:08:20,341
UP TO SUPPORT.

8472
06:08:20,341 --> 06:08:22,210
BUT WE'LL TALK ABOUT THAT IN A

8473
06:08:22,210 --> 06:08:22,777
SECOND.

8474
06:08:22,777 --> 06:08:22,977
OKAY.

8475
06:08:22,977 --> 06:08:28,783
NEXT PLEASE.

8476
06:08:28,783 --> 06:08:28,983
OKAY.

8477
06:08:28,983 --> 06:08:31,052
I JUST WANTED TO GIVE YOU JUST A

8478
06:08:31,052 --> 06:08:33,254
RESOURCE HERE IN CASE THIS IS OF

8479
06:08:33,254 --> 06:08:33,488
USE.

8480
06:08:33,488 --> 06:08:35,256
WE DID FIND AGAIN THAT THESE

8481
06:08:35,256 --> 06:08:37,192
CLINICS DO FACE THESE REAL

8482
06:08:37,192 --> 06:08:38,927
BARRIERS TO IMPLEMENTING THIS

8483
06:08:38,927 --> 06:08:42,864
WORK, BUT WE DO HAVE AN

8484
06:08:42,864 --> 06:08:44,299
IMPLEMENTATION GUIDE THAT WE

8485
06:08:44,299 --> 06:08:47,569
MADE AVAILABLE THROUGH THE

8486
06:08:47,569 --> 06:08:52,073
NETWORK SIREN NETWORK, SOCIAL

8487
06:08:52,073 --> 06:08:53,608
RESEARCH INTERVENTION, YOU'LL

8488
06:08:53,608 --> 06:08:55,243
LOVE THEIR WEBSITE, IT IS AN

8489
06:08:55,243 --> 06:08:56,344
ABSOLUTE GOLD MINE OF

8490
06:08:56,344 --> 06:08:57,412
INFORMATION, WE HAVE A VERY

8491
06:08:57,412 --> 06:08:59,180
PRACTICING MACTD APPLIED

8492
06:08:59,180 --> 06:08:59,948
IMPLEMENTATION GUIDE HERE THAT

8493
06:08:59,948 --> 06:09:01,816
WE THINK CAN BE USED ACROSS

8494
06:09:01,816 --> 06:09:04,219
SETTINGS BUT WAS DESIGNED FOR

8495
06:09:04,219 --> 06:09:05,086
PRIMARY CARE, IT'S AVAILABLE

8496
06:09:05,086 --> 06:09:06,721
RKTS IT'S FREE, PLEASE USE IT.

8497
06:09:06,721 --> 06:09:08,456
NEXT, PLEASE.

8498
06:09:08,456 --> 06:09:12,827
LY JUST SECOND DOWN, JUST WALK A

8499
06:09:12,827 --> 06:09:14,495
GIVEN CARE PROVIDER CLINIC OR

8500
06:09:14,495 --> 06:09:16,664
SEGHTD STEP BY STEP THROUGH WHAT

8501
06:09:16,664 --> 06:09:17,899
THEY NEED TO DO TO PROVIDE

8502
06:09:17,899 --> 06:09:20,101
SOCIAL SCREENING, PROVIDES A LOT

8503
06:09:20,101 --> 06:09:22,570
OF RESOURCES.

8504
06:09:22,570 --> 06:09:23,371
ACCOUNTABLE HEALTH COMMUNITIES

8505
06:09:23,371 --> 06:09:25,006
PROJECT WAS A NATIONAL PROJECT

8506
06:09:25,006 --> 06:09:27,175
LED BY CMS SAME SET OF

8507
06:09:27,175 --> 06:09:28,509
QUESTIONS, WHAT IF WE PROVIDE

8508
06:09:28,509 --> 06:09:30,678
MONEY TO CLINICS TO HELP THEM

8509
06:09:30,678 --> 06:09:33,314
CONDUCT SOCIAL RISK SCREENING,

8510
06:09:33,314 --> 06:09:37,919
AND THEY FOUND THAT THE THINGS

8511
06:09:37,919 --> 06:09:40,855
THAT WORKED WERE A CULTURALLY

8512
06:09:40,855 --> 06:09:42,457
TAILORED APPROACH TO MAKE SURE

8513
06:09:42,457 --> 06:09:44,125
THERE WAS TRUST AND PATIENT

8514
06:09:44,125 --> 06:09:45,460
ENGAGEMENT, THIS RELATIONAL

8515
06:09:45,460 --> 06:09:46,661
PIECE BETWEEN THE PERSON ASKING

8516
06:09:46,661 --> 06:09:48,930
ABOUT THE SOCIAL RISKS AND THE

8517
06:09:48,930 --> 06:09:50,598
PATIENT, USING SCREENING DATA TO

8518
06:09:50,598 --> 06:09:51,900
DRIVE IMPROVEMENT IN THEIR

8519
06:09:51,900 --> 06:09:54,068
SCREENING RATES, TRYING

8520
06:09:54,068 --> 06:09:54,869
DIFFERENT MODALITIES OF GETTING

8521
06:09:54,869 --> 06:09:56,371
THE PATIENT OF DOING THE

8522
06:09:56,371 --> 06:09:56,938
SCREENING, BECAUSE SOMETIMES

8523
06:09:56,938 --> 06:09:59,340
DOING IT BY TEXT OR E-MAIL OR

8524
06:09:59,340 --> 06:10:00,842
PATIENT PORTAL MIGHT BE A LITTLE

8525
06:10:00,842 --> 06:10:01,843
MORE COMFORTABLE FOR FOLKS THAN

8526
06:10:01,843 --> 06:10:03,478
DOING IT IN PERSON, IT'S MORE

8527
06:10:03,478 --> 06:10:04,846
EFFICIENT, HAVING A DEDICATED

8528
06:10:04,846 --> 06:10:06,748
SCREENER ROLE WAS HELPFUL AT A

8529
06:10:06,748 --> 06:10:07,882
CLINIC, INTEGRATING THE

8530
06:10:07,882 --> 06:10:09,050
SCREENING INTO EXISTING

8531
06:10:09,050 --> 06:10:10,218
WORKFLOWS IF THAT'S HOW YOU WANT

8532
06:10:10,218 --> 06:10:12,020
TO DO IT, TALKING ABOUT WHAT IS

8533
06:10:12,020 --> 06:10:13,454
THE IMPACT OF SCREENING, THAT'S

8534
06:10:13,454 --> 06:10:14,856
REALLY IMPORTANT, WE TALK ABOUT

8535
06:10:14,856 --> 06:10:16,291
THAT IN THAT GUIDEBOOK I SHARED

8536
06:10:16,291 --> 06:10:17,625
WITH YOU AND MAKING SURE THERE'S

8537
06:10:17,625 --> 06:10:19,160
A WAY FOR THE TEAM TO REALLY

8538
06:10:19,160 --> 06:10:20,662
CONNECT ABOUT WHAT THEY'RE DOING

8539
06:10:20,662 --> 06:10:22,530
SO I THINK THAT WAS AN

8540
06:10:22,530 --> 06:10:23,665
INTERESTING PARALLEL TO THE

8541
06:10:23,665 --> 06:10:25,166
STUDY WHERE WE WERE LIKE WHAT IF

8542
06:10:25,166 --> 06:10:26,868
WE JUST PROVIDE REALLY INTENSIVE

8543
06:10:26,868 --> 06:10:27,669
ONE ON ONE SUPPORT AND THESE

8544
06:10:27,669 --> 06:10:29,137
GUYS WHAT IF WE JUST PROVIDE

8545
06:10:29,137 --> 06:10:33,474
MONEY AND WE'LL SEE WHAT

8546
06:10:33,474 --> 06:10:34,242
HAPPENS.

8547
06:10:34,242 --> 06:10:35,677
NEXT, PLEASE.

8548
06:10:35,677 --> 06:10:38,413
SO ASSISTANCE I'VE TALKED ABOUT,

8549
06:10:38,413 --> 06:10:39,714
TALKING ABOUT REFERRALS, THAT'S

8550
06:10:39,714 --> 06:10:41,149
REALLY WHAT WE MEAN BY

8551
06:10:41,149 --> 06:10:41,783
ASSISTANCE, CAN YOU REFER A

8552
06:10:41,783 --> 06:10:43,184
PATIENT TO HOUSING SUPPORT, ET

8553
06:10:43,184 --> 06:10:44,986
CETERA, ET CETERA, AND HERE IS

8554
06:10:44,986 --> 06:10:45,954
WHAT THE LITERATURE SAYS ABOUT

8555
06:10:45,954 --> 06:10:48,022
THE IMPACT OF ASSISTANCE

8556
06:10:48,022 --> 06:10:50,158
INTERVENTIONS, RIGHT?

8557
06:10:50,158 --> 06:10:51,726
THAT THESE INTERVENTIONS BE IT

8558
06:10:51,726 --> 06:10:53,261
THE CLINICS PROVIDING AN

8559
06:10:53,261 --> 06:10:55,129
INTERNAL SOMETHING WHERE THE

8560
06:10:55,129 --> 06:10:56,331
CLINICS PROVIDING TRANSPORTATION

8561
06:10:56,331 --> 06:10:57,765
OR AN EXTERNAL REFERRAL WHERE

8562
06:10:57,765 --> 06:10:59,467
WE'RE GETTING YOU IN TOUCH WITH

8563
06:10:59,467 --> 06:11:03,871
A MEDICAL SERVICE

8564
06:11:03,871 --> 06:11:07,175
CAN MODESTLY IMPROVE HEALTH

8565
06:11:07,175 --> 06:11:08,276
OUTCOMES.

8566
06:11:08,276 --> 06:11:13,147
STUDIED IN 2017 BY GOTTLIEB ET

8567
06:11:13,147 --> 06:11:14,615
AL. EVIDENCE REVIEW FOUND AS

8568
06:11:14,615 --> 06:11:16,250
ANSWER ASSOCIATED WITH IMPROVED

8569
06:11:16,250 --> 06:11:17,819
WITH A NUMBER OF THESE METRICS

8570
06:11:17,819 --> 06:11:19,454
AND ANOTHER STUDY FOUND NO

8571
06:11:19,454 --> 06:11:20,421
SIGNIFICANT IMPROVEMENTS AND A

8572
06:11:20,421 --> 06:11:22,056
MORE RECENT REVIEW IN HEALTH

8573
06:11:22,056 --> 06:11:23,591
EQUITY ALSO FOUND VERY MIXED

8574
06:11:23,591 --> 06:11:25,760
EVIDENCE ON HOW THESE -- ON THE

8575
06:11:25,760 --> 06:11:27,195
IMPACT OF ASSISTANCE EFFECT.

8576
06:11:27,195 --> 06:11:29,163
THIS IS FASCINATING, RIGHT,

8577
06:11:29,163 --> 06:11:30,264
BECAUSE WE'VE BEEN, THERE'S A

8578
06:11:30,264 --> 06:11:34,102
TON OF EMPHASIS ON LIKE, WELL,

8579
06:11:34,102 --> 06:11:34,869
GET PATIENTS REFERRED BUT

8580
06:11:34,869 --> 06:11:36,070
THERE'S NOT A LOT OF EVIDENCE ON

8581
06:11:36,070 --> 06:11:38,139
IT WORKING OR IT'S VERY MIXED.

8582
06:11:38,139 --> 06:11:40,775
SO WHAT MAKES AN ASSISTANCE

8583
06:11:40,775 --> 06:11:41,642
INTERVENTION EFFECTIVE, WE HAVE

8584
06:11:41,642 --> 06:11:42,877
A LOT TO LEARN HERE.

8585
06:11:42,877 --> 06:11:44,612
ONE THING THAT DOES SEEM TO BE

8586
06:11:44,612 --> 06:11:46,347
TRUE IS THAT HAVING A NAVIGATOR

8587
06:11:46,347 --> 06:11:48,316
CAN REALLY HELP, SOMEONE WHOSE

8588
06:11:48,316 --> 06:11:50,952
JOB IT IS TO SAY TO A PATIENT

8589
06:11:50,952 --> 06:11:52,453
HEY WE GAVE YOU THIS INFORMATION

8590
06:11:52,453 --> 06:11:54,222
ABOUT A FOOD BANK, CAN I HELP

8591
06:11:54,222 --> 06:11:55,656
YOU MAKE A CONNECTION, THAT

8592
06:11:55,656 --> 06:11:57,191
EXTRA SET OF HELPING HANDS CAN

8593
06:11:57,191 --> 06:11:58,059
MAKE A DIFFERENCE.

8594
06:11:58,059 --> 06:11:59,494
BUT AGAIN, NONE OF THIS IS

8595
06:11:59,494 --> 06:12:00,795
MAKING A BIG DIFFERENCE AND

8596
06:12:00,795 --> 06:12:01,996
THAT'S REALLY IMPORTANT.

8597
06:12:01,996 --> 06:12:02,330
NEXT.

8598
06:12:02,330 --> 06:12:03,531
JUST THE ASSUMPTION, THIS GETS

8599
06:12:03,531 --> 06:12:05,066
TO WHERE I'M GOING WITH THIS IS

8600
06:12:05,066 --> 06:12:06,467
THE ASSUMPTION OF ALL THIS

8601
06:12:06,467 --> 06:12:08,336
EMPHASIS ON MAKING THESE

8602
06:12:08,336 --> 06:12:09,303
REFERRALS, THIS ASSISTANCE

8603
06:12:09,303 --> 06:12:10,505
INTERVENTIONS IS THAT YOU IF

8604
06:12:10,505 --> 06:12:11,606
SCREEN FOR SOCIAL RISKS AND

8605
06:12:11,606 --> 06:12:12,607
REFER PATIENTS TO SERVICES AND

8606
06:12:12,607 --> 06:12:13,808
THE PATIENTS ARE GOING TO GET

8607
06:12:13,808 --> 06:12:15,109
THE SERVICES, THEY'RE GOING ON

8608
06:12:15,109 --> 06:12:16,110
RESOLVE THE RISKS AND THAT'S

8609
06:12:16,110 --> 06:12:17,311
GOING TO LEAD TO IMPROVED HEALTH

8610
06:12:17,311 --> 06:12:19,280
BUT WE DON'T KNOW THAT'S TRUE,

8611
06:12:19,280 --> 06:12:20,381
THERE'S NOT STRONG EVIDENCE FOR

8612
06:12:20,381 --> 06:12:21,983
SUPPORTING THIS PATHWAY, WHAT

8613
06:12:21,983 --> 06:12:23,751
THERE IS EVIDENCE FOR IS A FAR

8614
06:12:23,751 --> 06:12:26,054
MORE COMPLEX PATHWAY THAT REALLY

8615
06:12:26,054 --> 06:12:28,556
INVOLVES THE PATIENT AND CARE

8616
06:12:28,556 --> 06:12:30,224
TEAM RELATIONSHIP.

8617
06:12:30,224 --> 06:12:31,959
OH, I MENTIONED THE NAVIGATION.

8618
06:12:31,959 --> 06:12:33,728
LET'S GO TO THE NEXT SLIDE

8619
06:12:33,728 --> 06:12:37,565
BECAUSE THIS IS A NEXT SLIDE

8620
06:12:37,565 --> 06:12:39,634
FROM GOTLIEB OF THE ALL, WHAT IS

8621
06:12:39,634 --> 06:12:40,768
REALLY THE PATHWAY.

8622
06:12:40,768 --> 06:12:42,904
I WANT FOINT OUT HERE THE

8623
06:12:42,904 --> 06:12:46,207
IMPORTANCE -- POINTED OUT HERE

8624
06:12:46,207 --> 06:12:48,709
THE IMPORTANCE OF IMPROVING

8625
06:12:48,709 --> 06:12:49,777
EMOTIONAL SUPPORT, CONNECTING

8626
06:12:49,777 --> 06:12:51,646
PATIENTS WITH A NAVIGATOR, THE

8627
06:12:51,646 --> 06:12:53,181
PATIENT FEELS MORE CARED FOR,

8628
06:12:53,181 --> 06:12:55,917
THIS IS JUST A MORE COMPLEX SET

8629
06:12:55,917 --> 06:12:58,820
OF PATHWAYS THAN JUST CONNECTED

8630
06:12:58,820 --> 06:13:00,621
WITH SERVICES, THEY GET BETTER,

8631
06:13:00,621 --> 06:13:00,855
RIGHT?

8632
06:13:00,855 --> 06:13:02,390
THAT'S ONE OF THEM, BUT ANOTHER

8633
06:13:02,390 --> 06:13:03,591
IS THEY FEEL MORE SUPPORTED,

8634
06:13:03,591 --> 06:13:06,194
ANOTHER IS THAT THERE'S MORE

8635
06:13:06,194 --> 06:13:08,062
HEALTHCARE SERVICES ARE

8636
06:13:08,062 --> 06:13:09,931
ACCESSED, IT'S MUCH MORE COMPLEX

8637
06:13:09,931 --> 06:13:12,333
THAN JUST REFER AND HOPE.

8638
06:13:12,333 --> 06:13:14,068
AND I HIGHLY RECOMMEND THIS

8639
06:13:14,068 --> 06:13:14,268
PAPER.

8640
06:13:14,268 --> 06:13:15,837
IT'S VERY, VERY HELPFUL TO THINK

8641
06:13:15,837 --> 06:13:17,371
ABOUT WHAT WE'RE DOING RIGHT AND

8642
06:13:17,371 --> 06:13:19,340
WHAT WE'RE DOING WRONG.

8643
06:13:19,340 --> 06:13:21,509
NEXT, PLEASE.

8644
06:13:21,509 --> 06:13:21,742
OKAY.

8645
06:13:21,742 --> 06:13:22,477
AND GUESS WHAT?

8646
06:13:22,477 --> 06:13:24,145
THERE ARE BARRIERS TO

8647
06:13:24,145 --> 06:13:25,680
IMPLEMENTING THESE ASSISTANCE

8648
06:13:25,680 --> 06:13:26,681
REFERRALS, EVEN AS WE KNOW

8649
06:13:26,681 --> 06:13:28,516
THEY'RE NOT THAT GREAT, THERE'S

8650
06:13:28,516 --> 06:13:30,718
NOT MUCH ELSE OUT THERE RIGHT

8651
06:13:30,718 --> 06:13:32,353
NOW, THEY'RE KIND OF THE BEST

8652
06:13:32,353 --> 06:13:34,455
BAND-AID WE'VE GOT, BUT PATIENTS

8653
06:13:34,455 --> 06:13:35,857
WHO ARE OFFERED REFERRALS DON'T

8654
06:13:35,857 --> 06:13:36,724
ALWAYS WANT THEM.

8655
06:13:36,724 --> 06:13:38,392
MAYBE THEY'VE ALREADY TRIED

8656
06:13:38,392 --> 06:13:39,994
THEM, THERE'S A FEAR OF STIGMA,

8657
06:13:39,994 --> 06:13:40,795
DISCRIMINATION, ET CETERA, ET

8658
06:13:40,795 --> 06:13:42,296
CETERA, OUR TEAM FOUND THAT

8659
06:13:42,296 --> 06:13:43,731
ALMOST 80 PERCENT OF COMMUNITY

8660
06:13:43,731 --> 06:13:45,166
HEALTH CENTER PATIENTS WITH

8661
06:13:45,166 --> 06:13:46,467
REPORTED RISK DECLINED A

8662
06:13:46,467 --> 06:13:47,902
REFERRAL THEY WERE OFFERED AND

8663
06:13:47,902 --> 06:13:50,404
THAT RATE OF DECLINATION HAS

8664
06:13:50,404 --> 06:13:53,241
BEEN SHOWN BY OTHERS WITH A TON

8665
06:13:53,241 --> 06:13:56,744
OF VARIATION IN HOW OFTEN FOLKS

8666
06:13:56,744 --> 06:13:59,580
ARE WILLING OR WANT THAT

8667
06:13:59,580 --> 06:14:01,816
INFORMATION, WANT THE REFERRAL,

8668
06:14:01,816 --> 06:14:03,084
THIS IS REALLY IMPORTANT.

8669
06:14:03,084 --> 06:14:07,188
NEXT, PLEASE.

8670
06:14:07,188 --> 06:14:09,257
AND AGAIN, ONE OF THESE BIG

8671
06:14:09,257 --> 06:14:10,758
BARRIERS AS I THINK I ALLUDED TO

8672
06:14:10,758 --> 06:14:12,193
EARLIER IS SORT OF LIKE WELL,

8673
06:14:12,193 --> 06:14:13,594
OKAY, WE'RE TRYING AT THE TIME

8674
06:14:13,594 --> 06:14:15,463
GET PATIENTS TO CONNECT WITH A

8675
06:14:15,463 --> 06:14:16,664
SOCIAL SERVICE BUT ARE THE

8676
06:14:16,664 --> 06:14:17,665
RESOURCES AVAILABLE?

8677
06:14:17,665 --> 06:14:20,601
DO YOU HAVE A HOUSING -- WHERE I

8678
06:14:20,601 --> 06:14:21,836
LIVE, REFERRING PATIENTS TO

8679
06:14:21,836 --> 06:14:23,004
HOUSING SUPPORT THEY'LL BE ON A

8680
06:14:23,004 --> 06:14:24,539
WAITING LIST FOR A FEW YEARS.

8681
06:14:24,539 --> 06:14:26,374
DOES THAT ADDRESS THEIR NEED?

8682
06:14:26,374 --> 06:14:27,408
NOT IMMEDIATELY.

8683
06:14:27,408 --> 06:14:28,376
THAT'S IN A BIG CITY.

8684
06:14:28,376 --> 06:14:31,012
WHAT HAPPENS IF YOU'RE OUT IN A

8685
06:14:31,012 --> 06:14:31,879
MORE RURAL AREA?

8686
06:14:31,879 --> 06:14:33,414
THERE MAY NOT BE RESOURCES WITH

8687
06:14:33,414 --> 06:14:36,050
WHICH TO ADDRESS THE PATIENT'S

8688
06:14:36,050 --> 06:14:37,552
NEED, AND THEN AGAIN THERE'S

8689
06:14:37,552 --> 06:14:39,086
REAL COMPLEXITY AROUND LIKE WHO

8690
06:14:39,086 --> 06:14:41,189
DOES THE REFERRING AND WHEN.

8691
06:14:41,189 --> 06:14:42,924
UNLESS THERE'S SOME KIND OF

8692
06:14:42,924 --> 06:14:44,258
MEDICAID REIMBURSEMENT, AT LEAST

8693
06:14:44,258 --> 06:14:45,893
IN LOW-INCOME CLINICS, IF YOU

8694
06:14:45,893 --> 06:14:47,195
DON'T HAVE SOMEONE ON STAFF WHO

8695
06:14:47,195 --> 06:14:50,364
HAS GOT THE TIME TO DO IT, THEN

8696
06:14:50,364 --> 06:14:52,233
HOW -- IF IT'S NOT REIMBURSABLE,

8697
06:14:52,233 --> 06:14:53,868
IT'S BECOMING MORE REIMBURSABLE,

8698
06:14:53,868 --> 06:14:55,303
AND THAT'S GREAT, THAT WILL MAKE

8699
06:14:55,303 --> 06:14:56,470
A BIG DIFFERENCE I THINK, BUT

8700
06:14:56,470 --> 06:14:57,605
THAT HAS BEEN A BARRIER IN THE

8701
06:14:57,605 --> 06:14:59,440
PAST AND IT'S STILL NOT THE CASE

8702
06:14:59,440 --> 06:15:00,441
EVERYWHERE THAT THERE'S SOMEONE

8703
06:15:00,441 --> 06:15:01,642
PAYING THE STAFF TO DO THE

8704
06:15:01,642 --> 06:15:02,677
REFERRAL AND THE STAFF NEED TO

8705
06:15:02,677 --> 06:15:04,679
KNOW THE LOCAL COMMUNITY-BASED

8706
06:15:04,679 --> 06:15:06,180
ORGANIZATIONS, CBO'S, THEY NEED

8707
06:15:06,180 --> 06:15:07,515
TO KNOW -- AND THESE COMMUNITY

8708
06:15:07,515 --> 06:15:08,182
ORGANIZATIONS SOME OF THEM

8709
06:15:08,182 --> 06:15:09,717
CHANGE A LOT, RIGHT, SO THEY'VE

8710
06:15:09,717 --> 06:15:11,786
GOT TO HAVE AN UP TO DATE LIST.

8711
06:15:11,786 --> 06:15:13,754
I THINK I'M GETTING INTO MY NEXT

8712
06:15:13,754 --> 06:15:13,955
SLIDE.

8713
06:15:13,955 --> 06:15:14,555
PLEASE GO.

8714
06:15:14,555 --> 06:15:16,057
NEXT ONE, PLEASE.

8715
06:15:16,057 --> 06:15:17,058
OH, OKAY.

8716
06:15:17,058 --> 06:15:18,693
SO THAT GETS TO THE ISSUE OF

8717
06:15:18,693 --> 06:15:19,894
WELL HOW DO YOU MAKE SURE YOU

8718
06:15:19,894 --> 06:15:20,995
EVEN KNOW WHAT RESOURCES ARE

8719
06:15:20,995 --> 06:15:21,262
AVAILABLE.

8720
06:15:21,262 --> 06:15:23,197
A LOT OF FOLKS ARE INTERESTED IN

8721
06:15:23,197 --> 06:15:24,799
THESE SOCIAL SERVICE RESOURCE

8722
06:15:24,799 --> 06:15:26,367
LOCATORS AND THERE'S A

8723
06:15:26,367 --> 06:15:27,768
TECHNOLOGY THAT I THINK HAS A

8724
06:15:27,768 --> 06:15:29,503
LOT OF PROMISE IN HELPING TO

8725
06:15:29,503 --> 06:15:31,806
HAVE AN UPDATED SEARCHABLE LIST

8726
06:15:31,806 --> 06:15:33,574
AND SOMETIMES CONNECTIBLE

8727
06:15:33,574 --> 06:15:35,643
INTERFACE FOR CONNECTING FOLKS

8728
06:15:35,643 --> 06:15:37,845
WITH SOCIAL SERVICES BUT THEY'RE

8729
06:15:37,845 --> 06:15:39,580
NOT NECESSARILY CHEAP OR IF THEY

8730
06:15:39,580 --> 06:15:41,749
ARE CHEAP, THEY MAY NOT BE UP TO

8731
06:15:41,749 --> 06:15:42,783
DATE, SOMETIMES EVEN IF THEY'RE

8732
06:15:42,783 --> 06:15:44,719
NOT CHEAP, THEY'RE NOT UP TO

8733
06:15:44,719 --> 06:15:48,889
DATE AND WE'VE HEARD SOMETIMES

8734
06:15:48,889 --> 06:15:50,758
ONES WITH EHR SOMETIMES THEY

8735
06:15:50,758 --> 06:15:53,594
HAVE A LOT OF GLICHES, THERE'S

8736
06:15:53,594 --> 06:15:55,463
TOO MANY OPTIONS IN CASES, I

8737
06:15:55,463 --> 06:15:56,664
DON'T KNOW WHICH ONE TO GO WITH

8738
06:15:56,664 --> 06:15:57,765
AND COMMUNITY BASE THE

8739
06:15:57,765 --> 06:15:58,966
ORGANIZATIONS HAVE TO BE WILLING

8740
06:15:58,966 --> 06:16:00,401
TO ENGAGE RIGHT BECAUSE YOU'LL

8741
06:16:00,401 --> 06:16:01,469
HEAR PEOPLE SAYING I WANT TO

8742
06:16:01,469 --> 06:16:03,004
CLOSE THE LOOP ON SOCIAL SERVICE

8743
06:16:03,004 --> 06:16:04,205
REMPLEZ BUFORT YOU CAN'T CLOSE

8744
06:16:04,205 --> 06:16:05,740
THE LOOP UNLESS SOMEONE ON YOUR

8745
06:16:05,740 --> 06:16:07,041
TEAM CALLS THE PATIENT AND SAYS

8746
06:16:07,041 --> 06:16:08,142
DID YOU MAKE IT, DID YOU GET

8747
06:16:08,142 --> 06:16:09,677
THAT SERVICE, OR YOU'VE GOT TO

8748
06:16:09,677 --> 06:16:11,312
SOMEHOW ADDRESS THE BARRIERS OF

8749
06:16:11,312 --> 06:16:12,079
THESE COMMUNITY-BASED

8750
06:16:12,079 --> 06:16:12,947
ORGANIZATIONS THAT JUST LIKE

8751
06:16:12,947 --> 06:16:14,248
THEY MAY NOT HAVE TIME, WHAT ARE

8752
06:16:14,248 --> 06:16:15,916
THEY GETTING OUT OF IT IF YOU'RE

8753
06:16:15,916 --> 06:16:18,219
NOT PAYING THEM THEN WHY ARE

8754
06:16:18,219 --> 06:16:19,287
THEY GOING TO CLOSE THE LOOP?

8755
06:16:19,287 --> 06:16:21,055
THIS IS A BARRIER I'VE SEEN THIS

8756
06:16:21,055 --> 06:16:23,024
MULTIPLE SETTINGS IN MULTIPLE

8757
06:16:23,024 --> 06:16:24,225
SITUATIONS WHERE THE COMMUNITY

8758
06:16:24,225 --> 06:16:25,826
ORGANIZATIONS ARE JUST LIKE WHY

8759
06:16:25,826 --> 06:16:28,129
ARE YOU -- THIS IS NOT MY

8760
06:16:28,129 --> 06:16:29,363
PROBLEM, LIKE THEY'LL TAKE THE

8761
06:16:29,363 --> 06:16:30,898
PATIENTS BUT THEY DON'T FEEL

8762
06:16:30,898 --> 06:16:32,667
OBLIGATED TO CLOSE THIS LOOP,

8763
06:16:32,667 --> 06:16:34,302
AND THEN HOW DIST CLINIC KNOW

8764
06:16:34,302 --> 06:16:36,137
FLT PATIENT CLOSED THE LOOP?

8765
06:16:36,137 --> 06:16:38,239
SO THIS IS VERY COMPLEX.

8766
06:16:38,239 --> 06:16:39,473
NEXT H PLEASE.

8767
06:16:39,473 --> 06:16:40,775
I DO AGAIN HAVE SOME RESOURCES

8768
06:16:40,775 --> 06:16:43,110
TO OFFER YOU ON HOW TO IMPLEMENT

8769
06:16:43,110 --> 06:16:44,912
THESE KIND OF ASSISTANCE

8770
06:16:44,912 --> 06:16:45,179
REFERRALS.

8771
06:16:45,179 --> 06:16:47,882
ONE IS AGAIN FROM SIREN, THE

8772
06:16:47,882 --> 06:16:48,849
COMMUNITY RESOURCE REFERRAL

8773
06:16:48,849 --> 06:16:50,284
PLATFORM GUIDE, AGAIN THINKING

8774
06:16:50,284 --> 06:16:51,686
ABOUT THE DIFFERENT KINDS OF

8775
06:16:51,686 --> 06:16:53,120
SOCIAL SERVICE RESOURCE LOCATORS

8776
06:16:53,120 --> 06:16:55,089
AND ANOTHER IS IMPLEMENTATION

8777
06:16:55,089 --> 06:16:57,958
TOOLKIT FOR SOCIAL RISK

8778
06:16:57,958 --> 06:16:59,160
REFERRALS FOR PRIMARY CARE MY

8779
06:16:59,160 --> 06:17:00,461
TEAM RECENTLY COMPLETED AND MADE

8780
06:17:00,461 --> 06:17:01,662
AVAILABLE THROUGH SIREN AND THE

8781
06:17:01,662 --> 06:17:02,897
SHRINK RIGHT THERE AND THIS IS

8782
06:17:02,897 --> 06:17:05,499
AGAIN A VERY PRAGMATIC APPLIED

8783
06:17:05,499 --> 06:17:07,702
GUIDE TO THINKING ABOUT THE

8784
06:17:07,702 --> 06:17:09,003
DECISION YOU'LL MAKE AND WHAT

8785
06:17:09,003 --> 06:17:10,538
YOUR OPTIONS ARE IF YOU WANT TO

8786
06:17:10,538 --> 06:17:11,972
CONDUCT SOCIAL RISK REFERRAL

8787
06:17:11,972 --> 06:17:12,406
MAKING.

8788
06:17:12,406 --> 06:17:13,074
NEXT, PLEASE.

8789
06:17:13,074 --> 06:17:15,576
I REALLY WANT TO GET TO

8790
06:17:15,576 --> 06:17:15,876
ADJUSTMENT.

8791
06:17:15,876 --> 06:17:17,144
SO I'VE BEEN TALKING ABOUT

8792
06:17:17,144 --> 06:17:18,512
REFERRALS BUT THEN THERE'S ALSO

8793
06:17:18,512 --> 06:17:19,380
THIS IDEA OF ADJUSTMENT.

8794
06:17:19,380 --> 06:17:20,848
CAN YOU ADAPT THE CARE PLAN TO

8795
06:17:20,848 --> 06:17:22,683
MAKE IT MORE FEASIBLE FOR THE

8796
06:17:22,683 --> 06:17:24,218
PATIENT TO ADHERE TO THE CARE

8797
06:17:24,218 --> 06:17:24,418
PLAN?

8798
06:17:24,418 --> 06:17:24,919
GOT IT.

8799
06:17:24,919 --> 06:17:25,619
THANK YOU.

8800
06:17:25,619 --> 06:17:28,689
I'M RIGHT ON TIME.

8801
06:17:28,689 --> 06:17:29,890
ADJUSTMENTS MIGHT MEAN LIKE

8802
06:17:29,890 --> 06:17:32,326
MAKING SURE THAT THEY'VE GOT A

8803
06:17:32,326 --> 06:17:33,494
GENERIC MEDICATION THAT IS MORE

8804
06:17:33,494 --> 06:17:35,162
AFFORDABLE THAN A NONGENERIC,

8805
06:17:35,162 --> 06:17:36,664
MAKING SURE THEY'RE GETTING A

8806
06:17:36,664 --> 06:17:38,432
POLYPILL TO REDUCE THE CO-PAY,

8807
06:17:38,432 --> 06:17:40,501
CAN YOU MAIL THE PRESCRIPTION TO

8808
06:17:40,501 --> 06:17:41,936
THEIR HOME IF THEY HAVE

8809
06:17:41,936 --> 06:17:43,671
TRANSPORTATION BARRIERS, BUT IS

8810
06:17:43,671 --> 06:17:45,106
THAT A SAFE THING TO DO TO MAIL

8811
06:17:45,106 --> 06:17:46,974
IT TO THEIR HOME, LIKE WILL THEY

8812
06:17:46,974 --> 06:17:48,476
GET THE MEDS IF THEY'RE DROPPED

8813
06:17:48,476 --> 06:17:50,444
OFF ON THEIR DOOR, THERE'S

8814
06:17:50,444 --> 06:17:51,245
COMPLEXITY THERE.

8815
06:17:51,245 --> 06:17:53,314
IF THE PERSON HAS TRANSPORTATION

8816
06:17:53,314 --> 06:17:54,615
INSECURITY, CAN FOLLOW-UP CARE

8817
06:17:54,615 --> 06:17:57,351
BE VIA TELEHEALTH, DOES THE

8818
06:17:57,351 --> 06:17:59,653
PATIENT HAVE ACCESS TO

8819
06:17:59,653 --> 06:18:01,088
TELEHEALTH, WE'RE FINDING THAT

8820
06:18:01,088 --> 06:18:03,124
TELEHEALTH ACCESS IS LESS OF A

8821
06:18:03,124 --> 06:18:05,326
BARRIER THAN IT USED TO BE

8822
06:18:05,326 --> 06:18:06,660
BEFORE THE PANDEMIC BUT

8823
06:18:06,660 --> 06:18:07,862
NEVERTHELESS HAVE TO MAKE SURE

8824
06:18:07,862 --> 06:18:08,529
THAT'S AN OPTION.

8825
06:18:08,529 --> 06:18:09,497
FOR EXAMPLE IF THE PATIENT

8826
06:18:09,497 --> 06:18:11,132
DESCRNT A PLACE TO REFRIGERATE

8827
06:18:11,132 --> 06:18:12,233
THE MEDICATION YOU NEED TO MAKE

8828
06:18:12,233 --> 06:18:14,001
SURE YOU GIVE THEM A MEDICATION

8829
06:18:14,001 --> 06:18:15,269
THAT DOES NOT NEED TO BE

8830
06:18:15,269 --> 06:18:16,504
REFRIGERATED, IF THEY'RE FOOD

8831
06:18:16,504 --> 06:18:17,571
INSECURE AND THEY HAVE DIABETES

8832
06:18:17,571 --> 06:18:18,873
YOU NEED TO THINK ABOUT HOW MUCH

8833
06:18:18,873 --> 06:18:20,441
FOOD THEY'LL HAVE AT THE END OF

8834
06:18:20,441 --> 06:18:22,510
THE MONTH IF THEIR MONTHLY FOOD

8835
06:18:22,510 --> 06:18:23,677
BENEFIT RUNS OUT AND MAYBE HAVE

8836
06:18:23,677 --> 06:18:24,812
TOO MUCH INSULIN, YOU HAVE TO

8837
06:18:24,812 --> 06:18:25,713
THINK ABOUT THAT PIECE.

8838
06:18:25,713 --> 06:18:27,214
THERE IS SOME EMERGING EVIDENCE

8839
06:18:27,214 --> 06:18:29,283
THAT SAYS DO GET BETTER CLINICAL

8840
06:18:29,283 --> 06:18:31,051
OUTCOMES IF YOU MAKE THESE CARE

8841
06:18:31,051 --> 06:18:33,220
PLAN ADJUSTMENTS, MOSTLY WORK

8842
06:18:33,220 --> 06:18:37,858
DONE BY SHALLWEI NEXT R AT THE

8843
06:18:37,858 --> 06:18:39,693
UNIVERSITY OF CHICAGO BUT FOUND

8844
06:18:39,693 --> 06:18:40,861
ADJUSTMENTS ONLY HAPPENING LESS

8845
06:18:40,861 --> 06:18:41,996
THAN 25 PERCENT OF THE TIME IN

8846
06:18:41,996 --> 06:18:43,397
LOTS OF DIFFERENT SETTINGS.

8847
06:18:43,397 --> 06:18:45,065
SO HOW CAN YOU PRESENT SOCIAL

8848
06:18:45,065 --> 06:18:47,001
RISK INFORMATION IN A WAY THAT

8849
06:18:47,001 --> 06:18:48,436
DOES IMPROVE ADJUSTMENT

8850
06:18:48,436 --> 06:18:49,537
PROVISION, COULD WE USE TOOLS IN

8851
06:18:49,537 --> 06:18:51,372
THE EHR, MY TEAM IS RUNNING A

8852
06:18:51,372 --> 06:18:54,775
TRIAL RIGHT NOW ON A SET SET OF

8853
06:18:54,775 --> 06:18:56,510
EHR TOOLS WE DESIGNED WITH

8854
06:18:56,510 --> 06:18:58,279
COMMUNITY MEMBERS PILOTED IN

8855
06:18:58,279 --> 06:19:00,247
COMMUNITY CLINICS, REVISED TOOLS

8856
06:19:00,247 --> 06:19:02,883
ACCORDING TO THE PILOT CLINIC'S

8857
06:19:02,883 --> 06:19:04,051
INPUT AND I'LL TELL YOU RIGHT

8858
06:19:04,051 --> 06:19:05,152
NOW WHAT IS HAPPENING IS THAT NO

8859
06:19:05,152 --> 06:19:07,021
ONE IS USING TOOLS, EVEN THOUGH

8860
06:19:07,021 --> 06:19:07,888
WE DID EVERYTHING RIGHT.

8861
06:19:07,888 --> 06:19:09,290
THEY JUST DON'T, THEY'RE NOT

8862
06:19:09,290 --> 06:19:10,090
USING THEM.

8863
06:19:10,090 --> 06:19:11,058
SO THERE'S A LOT WE HAVE TO

8864
06:19:11,058 --> 06:19:12,726
FIGURE OUT ABOUT HOW TO REALLY

8865
06:19:12,726 --> 06:19:13,794
SUPPORT ADJUSTMENT OCCURRING.

8866
06:19:13,794 --> 06:19:14,361
NEXT, PLEASE.

8867
06:19:14,361 --> 06:19:16,096
I THINK IT'S MY LAST SLIDE, SO

8868
06:19:16,096 --> 06:19:17,631
IF YOU'RE ALL FALLING ASLEEP,

8869
06:19:17,631 --> 06:19:19,300
BEAR WITH ME.

8870
06:19:19,300 --> 06:19:20,601
YES, I THINK THIS IS THE LAST

8871
06:19:20,601 --> 06:19:23,971
ONE, OR NO, SECOND-TO-LAST.

8872
06:19:23,971 --> 06:19:26,073
SO JUST ANOTHER JUST POINTED

8873
06:19:26,073 --> 06:19:28,042
ABOUT ADJUSTMENT, IT'S KIND OF

8874
06:19:28,042 --> 06:19:29,677
INTERESTING THAT WHEN CLINICIANS

8875
06:19:29,677 --> 06:19:31,212
DO HAVE INFORMATION ABOUT THE

8876
06:19:31,212 --> 06:19:34,515
PATIENT'S SOCIAL RISKS, ONE

8877
06:19:34,515 --> 06:19:35,916
SURVEY THAT WE CONDUCTED FOUND

8878
06:19:35,916 --> 06:19:37,551
THAT AND THIS WASN'T A HUGE

8879
06:19:37,551 --> 06:19:38,619
NUMBER, BUT IT WAS STILL RIGHT

8880
06:19:38,619 --> 06:19:40,187
AT THE POINT OF CARE WHICH WAS

8881
06:19:40,187 --> 06:19:42,590
COOL, THAT THE CLINICIANS DID

8882
06:19:42,590 --> 06:19:49,029
REPORT THAT THE PATIENT SOCIAL

8883
06:19:49,029 --> 06:19:52,099
RISKS INFLUENCE -- POINT OF

8884
06:19:52,099 --> 06:19:54,168
INFLUENCED CARE ABOUT A THIRD OF

8885
06:19:54,168 --> 06:19:56,136
THE DISPIEM INTERESTING IN

8886
06:19:56,136 --> 06:19:56,904
CONVERSATION FROM THE PATIENT

8887
06:19:56,904 --> 06:19:57,905
ONLY ABOUT HALF THE TIME FROM

8888
06:19:57,905 --> 06:20:00,975
THE EHR SO OUR WHOLE FAMILY SIS

8889
06:20:00,975 --> 06:20:02,142
ON AWARE NGS AND GETTING THAT

8890
06:20:02,142 --> 06:20:03,911
DATA INTO EHR THAT MIGHT BE

8891
06:20:03,911 --> 06:20:05,312
USEFUL FOR REPORTING PURPOSES

8892
06:20:05,312 --> 06:20:07,314
BUT MAYBE THAT'S NOT THE WAY

8893
06:20:07,314 --> 06:20:08,949
THAT CARETAKERS WANT TO GET THAT

8894
06:20:08,949 --> 06:20:09,717
INFORMATION AND I THINK THIS IS

8895
06:20:09,717 --> 06:20:11,018
A REALLY IMPORTANT POINT TWHEAF

8896
06:20:11,018 --> 06:20:12,186
NOT DIALED IN YET.

8897
06:20:12,186 --> 06:20:13,988
LAST SLIDE, PLEASE.

8898
06:20:13,988 --> 06:20:15,623
WHAT DO WE STILL NEED TO KNOW?

8899
06:20:15,623 --> 06:20:18,359
WELL, THE ANSWER IS A LOT.

8900
06:20:18,359 --> 06:20:21,395
WE DON'T REALLY KNOW WHAT

8901
06:20:21,395 --> 06:20:24,365
PATHWAYS TO FOLLOW TO ENSURE

8902
06:20:24,365 --> 06:20:26,000
THAT SOCIAL RISK SCREENING AND

8903
06:20:26,000 --> 06:20:27,268
REFERLINGS LEAD TO IMPROVED

8904
06:20:27,268 --> 06:20:28,135
HEALTH OUTCOMES.

8905
06:20:28,135 --> 06:20:29,937
WE CAN MAKE A LITTLE IMPROVEMENT

8906
06:20:29,937 --> 06:20:31,472
BUNLT A BIG IMPROVEMENT AND A

8907
06:20:31,472 --> 06:20:33,107
LITTLE IMPROVEMENT IS MAYBE NOT

8908
06:20:33,107 --> 06:20:33,541
ENOUGH.

8909
06:20:33,541 --> 06:20:35,843
WHAT PREACHES TO ADDRESSING

8910
06:20:35,843 --> 06:20:37,578
SOCIAL RISKS ARE MOST EE FICTIVE

8911
06:20:37,578 --> 06:20:39,346
AND FOR WHICH PATIENTS, VARIETY

8912
06:20:39,346 --> 06:20:40,581
THERE, WE HAVEN'T SCRATCHED THE

8913
06:20:40,581 --> 06:20:41,549
SURFACE OF THAT.

8914
06:20:41,549 --> 06:20:43,117
WHAT METHODS, AGAIN THIS IS

8915
06:20:43,117 --> 06:20:44,652
WHERE I'M INTERESTED AS

8916
06:20:44,652 --> 06:20:46,353
COMMUNITY HEALTH CENTER WHAT

8917
06:20:46,353 --> 06:20:47,688
METHODS EFFECTIVE FOR DOING THIS

8918
06:20:47,688 --> 06:20:49,089
IN COMMUNITY HEALTH CENTER

8919
06:20:49,089 --> 06:20:50,624
SETTINGS, ARE THERE POTENTIAL

8920
06:20:50,624 --> 06:20:51,959
HARMS FOR THE SCREENING?

8921
06:20:51,959 --> 06:20:53,394
REMEMBER THE CHECKLIST IF YOU'RE

8922
06:20:53,394 --> 06:20:54,361
A PATIENT AND YOU DW AND YOU

8923
06:20:54,361 --> 06:20:57,431
FEEL LIKE YOUR PROVIDER IS

8924
06:20:57,431 --> 06:20:59,166
HOUSING INSECURE, NOT ENOUGH TO

8925
06:20:59,166 --> 06:21:01,135
EAT, THAT COULD ALSO IMPACTED

8926
06:21:01,135 --> 06:21:02,102
NEGATIVELY YOUR TRUST, THAT

8927
06:21:02,102 --> 06:21:03,203
DOESN'T FEEL GOOD.

8928
06:21:03,203 --> 06:21:04,405
AGAIN, HOW MUCH IMPACT CAN WE

8929
06:21:04,405 --> 06:21:06,040
EVEN THINK WE'RE GOING TO MAKE

8930
06:21:06,040 --> 06:21:08,242
WITH SCREENING AND REFERRALS

8931
06:21:08,242 --> 06:21:09,777
SPECIFICALLY GIVEN HOW

8932
06:21:09,777 --> 06:21:10,978
INADEQUATELY THIS COUNTRY FUNDS

8933
06:21:10,978 --> 06:21:11,912
SOCIAL SERVICES?

8934
06:21:11,912 --> 06:21:14,648
I MEAN, AND WE COULD TALK ABOUT

8935
06:21:14,648 --> 06:21:16,850
THAT YOU ADAY IF YOU WANT.

8936
06:21:16,850 --> 06:21:18,018
AND I WOULD PUT TO THIS

8937
06:21:18,018 --> 06:21:21,021
GRURNTION HOW -- GROUP HOW ARE

8938
06:21:21,021 --> 06:21:21,755
THESE IMPACTS DIFFERENT OR

8939
06:21:21,755 --> 06:21:24,592
SPECIFIC TO PVD.

8940
06:21:24,592 --> 06:21:27,995
I BELIEVE THAT IS THE LAST

8941
06:21:27,995 --> 06:21:29,396
SLIDE.

8942
06:21:29,396 --> 06:21:29,597
NEXT.

8943
06:21:29,597 --> 06:21:30,297
LET'S CHECK.

8944
06:21:30,297 --> 06:21:31,599
MAKE SURE I DIDN'T LEAVE

8945
06:21:31,599 --> 06:21:32,466
SOMETHING OUT.

8946
06:21:32,466 --> 06:21:33,901
YES.

8947
06:21:33,901 --> 06:21:34,101
GREAT.

8948
06:21:34,101 --> 06:21:37,304
ALL RIGHT.

8949
06:21:37,304 --> 06:21:40,174
>> THANK YOU SO MUCH, DR.
GOLD.

8950
06:21:40,174 --> 06:21:42,109
THAT WAS EXCELLENT.

8951
06:21:42,109 --> 06:21:44,178
VERY PRACTICAL TALK FOR US.

8952
06:21:44,178 --> 06:21:46,380
I'M SURE PEOPLE TOOK A LOT FROM

8953
06:21:46,380 --> 06:21:46,680
THAT.

8954
06:21:46,680 --> 06:21:48,782
ONE QUESTION I HAD FOR YOU SINCE

8955
06:21:48,782 --> 06:21:50,284
YOU'RE THE LAST ONE, YOU'LL BE

8956
06:21:50,284 --> 06:21:52,052
THE FIRST ONE UP FOR THE

8957
06:21:52,052 --> 06:21:54,455
QUESTION SESSION.

8958
06:21:54,455 --> 06:21:58,325
SO WHEN IT COMES TO, WHEN DID

8959
06:21:58,325 --> 06:22:00,127
YOU CALM IT, NOT SOCIAL

8960
06:22:00,127 --> 06:22:00,794
DETERMINANTS BUT --

8961
06:22:00,794 --> 06:22:01,929
>> I PREFER SOCIAL RISKS.

8962
06:22:01,929 --> 06:22:03,864
>> SOCIAL RISKS.

8963
06:22:03,864 --> 06:22:04,131
VERY GOOD.

8964
06:22:04,131 --> 06:22:05,933
>> I CAN TELL YOU WHY, BUT
WE

8965
06:22:05,933 --> 06:22:07,234
DON'T NEED TO GO INTO IT.

8966
06:22:07,234 --> 06:22:07,434
YEAH.

8967
06:22:07,434 --> 06:22:10,871
>> SO WE'VE HAD MULTIPLE

8968
06:22:10,871 --> 06:22:12,906
DISCUSSANTS ASK ME, WHAT -- AND

8969
06:22:12,906 --> 06:22:17,745
I WOULD LIKE TO GET YOUR OPINIOF

8970
06:22:17,745 --> 06:22:19,847
MEASUREMENT TOOL, SORT OF

8971
06:22:19,847 --> 06:22:20,581
STANDARDIZED MEASUREMENT TOOL

8972
06:22:20,581 --> 06:22:21,682
WOULD YOU RECOMMEND FOR PEOPLE

8973
06:22:21,682 --> 06:22:23,984
WHO ARE TRYING TO IMPLEMENT THIS

8974
06:22:23,984 --> 06:22:25,185
INTO THEIR CLINIC?

8975
06:22:25,185 --> 06:22:26,453
>> GREAT QUESTION AND I
HEAR IT

8976
06:22:26,453 --> 06:22:27,154
ALL THE TIME.

8977
06:22:27,154 --> 06:22:29,123
SO FIRST OF ALL, I WOULD JUST

8978
06:22:29,123 --> 06:22:30,658
SAY THAT IN ONE OF THE GUIDES ON

8979
06:22:30,658 --> 06:22:32,626
THE IMPLEMENTATION GUIDE I GAVE

8980
06:22:32,626 --> 06:22:34,061
YOU, WE TALK ABOUT THAT QUITE A

8981
06:22:34,061 --> 06:22:34,228
BIT.

8982
06:22:34,228 --> 06:22:36,563
THIS IS AN INTERESTING QUESTION.

8983
06:22:36,563 --> 06:22:37,865
OVERALL, I WOULD SAY USE

8984
06:22:37,865 --> 06:22:39,199
WHATEVER TOOL IS MORE

8985
06:22:39,199 --> 06:22:41,368
COMFORTABLE FOR YOU, LIKE IF

8986
06:22:41,368 --> 06:22:42,670
YOUR STAFF LIKES ONE TOOL,

8987
06:22:42,670 --> 06:22:43,904
THERE'S A WHOLE BUNCH OF

8988
06:22:43,904 --> 06:22:44,672
DIFFERENT TOOLS OUT THERE, IF

8989
06:22:44,672 --> 06:22:46,206
YOU REQUEST TO THE SIREN WEBSITE

8990
06:22:46,206 --> 06:22:47,941
THEY'VE GOT A WHOLE PAGE THAT

8991
06:22:47,941 --> 06:22:49,243
COMPARES DIFFERENT SOCIAL RISK

8992
06:22:49,243 --> 06:22:50,577
SCREENERS THAT ARE OUT THERE,

8993
06:22:50,577 --> 06:22:52,212
NONE OF THEM HAVE -- THE FOLKS

8994
06:22:52,212 --> 06:22:57,451
WHO CREATED THE PREPARE TOOL,

8995
06:22:57,451 --> 06:22:59,186
PREPARE, THEY CLAIM THAT IT HAS

8996
06:22:59,186 --> 06:23:00,621
BEEN VALIDATED.

8997
06:23:00,621 --> 06:23:02,489
I WOULD SAY THEIR DEFINITION OF

8998
06:23:02,489 --> 06:23:04,224
VALIDATED IS NOT MY DEFINITION

8999
06:23:04,224 --> 06:23:06,326
OF VALIDATED, AND IT'S A LONG

9000
06:23:06,326 --> 06:23:08,495
TOOL, AND I'VE HEARD MANY USERS

9001
06:23:08,495 --> 06:23:09,596
SAY I DON'T WANT TO USE THAT

9002
06:23:09,596 --> 06:23:10,898
TOOL, IT'S TOO LONG.

9003
06:23:10,898 --> 06:23:12,332
NOW, YOU MIGHT JUST HAVE TO USE

9004
06:23:12,332 --> 06:23:13,634
THE SCREENING TOOL THAT YOU'RE

9005
06:23:13,634 --> 06:23:16,403
REQUIRED TO USE IF IT'S TIED TO

9006
06:23:16,403 --> 06:23:18,806
REIMBURSEMENT LIKE THE

9007
06:23:18,806 --> 06:23:19,440
ACCOUNTABILITY HEALTH

9008
06:23:19,440 --> 06:23:20,641
COMMUNITY'S TOOL THERE'S A FOUR

9009
06:23:20,641 --> 06:23:21,742
QUESTION EXPRERGS A LOT OF FOLKS

9010
06:23:21,742 --> 06:23:23,043
NOW IF YOU'RE TRYING TO DO THIS

9011
06:23:23,043 --> 06:23:25,245
AS PART OF A PROJECT WITH CMS

9012
06:23:25,245 --> 06:23:26,580
YOU'LL PROBABLY HAVE TO USE

9013
06:23:26,580 --> 06:23:27,548
THEIR TOOL AND I THINK THAT'S

9014
06:23:27,548 --> 06:23:28,415
FINE AS WELL.

9015
06:23:28,415 --> 06:23:30,184
BUT MY OVERARCHING ADVICE ON

9016
06:23:30,184 --> 06:23:31,251
THIS IS JUST LOOK AT THE

9017
06:23:31,251 --> 06:23:32,252
DIFFERENT TOOLS THAT ARE OUT

9018
06:23:32,252 --> 06:23:33,587
THERE AND USE WHICHEVER ONE

9019
06:23:33,587 --> 06:23:34,988
FEELS LIKE IT'S GOING TO WORK

9020
06:23:34,988 --> 06:23:36,423
BETTER FOR YOUR PATIENTS.

9021
06:23:36,423 --> 06:23:37,591
MAYBE YOU WANT TO RUN DIFFERENT

9022
06:23:37,591 --> 06:23:38,826
TOOLS BY YOUR PATIENTS AND SEE

9023
06:23:38,826 --> 06:23:40,260
WHAT THEY FEEL MORE COMFORTABLE

9024
06:23:40,260 --> 06:23:40,461
WITH.

9025
06:23:40,461 --> 06:23:43,297
THERE IS NO ONE TOOL THAT IS

9026
06:23:43,297 --> 06:23:44,598
HIGHLY BETTER THAN THE OTHERS,

9027
06:23:44,598 --> 06:23:45,666
THERE IS NO EVIDENCE THAT ANY OF

9028
06:23:45,666 --> 06:23:48,602
THE TOOLS ARE BETTER THAN THE

9029
06:23:48,602 --> 06:23:48,836
OTHERS.

9030
06:23:48,836 --> 06:23:49,870
I DON'T THINK -- HOW DO YOU EVEN

9031
06:23:49,870 --> 06:23:51,505
LIKE VALIDATE SOMEONE BEING

9032
06:23:51,505 --> 06:23:52,973
HOMELESS OR HOUSING INSECURE?

9033
06:23:52,973 --> 06:23:55,542
I DON'T KNOW IF THAT EVEN CAN BE

9034
06:23:55,542 --> 06:23:55,743
DONE.

9035
06:23:55,743 --> 06:23:56,443
>> GOOD POINT.

9036
06:23:56,443 --> 06:23:58,512
>> MY ANSWER TO THAT IS IT

9037
06:23:58,512 --> 06:23:59,813
DOESN'T REALLY MATTER BUT I

9038
06:23:59,813 --> 06:24:00,914
HIGHLY RECOMMEND GOING TO THE

9039
06:24:00,914 --> 06:24:02,015
SIREN WEBSITE AND LOOKING AT

9040
06:24:02,015 --> 06:24:02,983
THEIR COMPARISON OF THE

9041
06:24:02,983 --> 06:24:05,285
DIFFERENT TOOLS BECAUSE THAT'S A

9042
06:24:05,285 --> 06:24:07,554
USEFUL RESOURCE.

9043
06:24:07,554 --> 06:24:10,390
>> JUST A GREAT TALK.

9044
06:24:10,390 --> 06:24:12,159
YOU KNOW, I HAVE A COUPLE

9045
06:24:12,159 --> 06:24:12,426
QUESTIONS.

9046
06:24:12,426 --> 06:24:13,927
YOU BROUGHT UP THE WHOLE POINT

9047
06:24:13,927 --> 06:24:15,796
ABOUT THE ASSISTANCE

9048
06:24:15,796 --> 06:24:17,464
INTERVENTIONS AND LOOKING AT THE

9049
06:24:17,464 --> 06:24:19,933
POINT THAT THE PATIENT CAN BE

9050
06:24:19,933 --> 06:24:21,702
REFERRED BUT THERE MAY NOT BE

9051
06:24:21,702 --> 06:24:22,770
ADEQUATE RESOURCES.

9052
06:24:22,770 --> 06:24:24,638
HAS ANYBODY LOOKED IN THE

9053
06:24:24,638 --> 06:24:25,939
PARTICULAR COMMUNITY AT THE

9054
06:24:25,939 --> 06:24:29,476
RATIO OF, SAY, REFERRALS TO

9055
06:24:29,476 --> 06:24:29,743
RESOURCES?

9056
06:24:29,743 --> 06:24:31,779
SO TO SAY, YOU KNOW, GEE, WE

9057
06:24:31,779 --> 06:24:33,647
KIND OF DID WHAT WE WERE TRYING

9058
06:24:33,647 --> 06:24:35,149
TO DO BUT IT WASN'T THERE?

9059
06:24:35,149 --> 06:24:37,451
>> THAT IS A GREAT
QUESTION.

9060
06:24:37,451 --> 06:24:39,753
IF ANYONE HAS -- I'M NOT -- IF

9061
06:24:39,753 --> 06:24:41,588
ANYONE HAS, I'M NOT AWARE OF IT,

9062
06:24:41,588 --> 06:24:43,223
THAT DOESN'T MEAN IT'S NOT OUT

9063
06:24:43,223 --> 06:24:43,423
THERE.

9064
06:24:43,423 --> 06:24:45,325
I'M WORKING WITH SOME COLLEAGUES

9065
06:24:45,325 --> 06:24:46,927
RIGHT NOW TO SEE IF WE CAN STUDY

9066
06:24:46,927 --> 06:24:47,194
THAT.

9067
06:24:47,194 --> 06:24:49,363
I'M NOT AWARE OF ANYONE WHO HAS

9068
06:24:49,363 --> 06:24:51,331
DONE THAT YET BUT THAT MAY MEAN

9069
06:24:51,331 --> 06:24:52,666
THAT I'VE MISSED ARCH ARTICLE OR

9070
06:24:52,666 --> 06:24:52,933
SOMETHING.

9071
06:24:52,933 --> 06:24:54,067
>> THEN I GUESS THE SECOND

9072
06:24:54,067 --> 06:24:55,602
QUESTION, BECAUSE I HEAR ABOUT

9073
06:24:55,602 --> 06:24:58,906
THIS TOO, IS, HAS ANYBODY SHOWN

9074
06:24:58,906 --> 06:25:00,507
THAT, YOU KNOW, IMPLEMENTING

9075
06:25:00,507 --> 06:25:02,476
THESE KINDS OF PROGRAMS, SAY

9076
06:25:02,476 --> 06:25:04,878
EVEN SOMETHING AS SIMPLE AS JUST

9077
06:25:04,878 --> 06:25:06,113
IMPLEMENTING THE NAVIGATOR, HAS

9078
06:25:06,113 --> 06:25:08,515
LED TO A REDUCTION IN HEALTHCARE

9079
06:25:08,515 --> 06:25:08,715
COSTS?

9080
06:25:08,715 --> 06:25:12,219
AND I ASK THAT BECAUSE THAT IS

9081
06:25:12,219 --> 06:25:14,388
WHAT WILL GET PEOPLE'S ATTENTION

9082
06:25:14,388 --> 06:25:15,122
TO MAKE CHANGES.

9083
06:25:15,122 --> 06:25:16,156
>> YES.

9084
06:25:16,156 --> 06:25:17,591
I VERY RECENTLY SAW AN ARTICLE

9085
06:25:17,591 --> 06:25:20,661
ON THE ROI OF SOCIAL RISK

9086
06:25:20,661 --> 06:25:20,994
INTERVENTION.

9087
06:25:20,994 --> 06:25:22,095
I WILL TRY AND FIND THAT FOR YOU

9088
06:25:22,095 --> 06:25:24,031
AND PUT IT IN THE CHAT

9089
06:25:24,031 --> 06:25:24,331
MOMENTARILY.

9090
06:25:24,331 --> 06:25:25,899
IF I CANNOT FIND IT QUICKLY, I

9091
06:25:25,899 --> 06:25:26,934
WILL E-MAIL IT.

9092
06:25:26,934 --> 06:25:28,635
THERE IS A RECENT ARTICLE ON

9093
06:25:28,635 --> 06:25:28,836
THAT.

9094
06:25:28,836 --> 06:25:30,170
I DON'T HAVE IT AT MY

9095
06:25:30,170 --> 06:25:32,239
FINGERTIPS, BUT I'LL TRY AND

9096
06:25:32,239 --> 06:25:33,607
FIND IT FOR YOU.

9097
06:25:33,607 --> 06:25:36,510
>> BECAUSE I THINK, YOU
KNOW,

9098
06:25:36,510 --> 06:25:38,812
EVEN TOO, YOU KNOW, THINKING

9099
06:25:38,812 --> 06:25:40,981
ABOUT THIS FOR SOMEONE WHO

9100
06:25:40,981 --> 06:25:43,183
LIVES, THINKING IN A PRECISION

9101
06:25:43,183 --> 06:25:44,384
MEDICINE WORLD, THIS IS ALMOST

9102
06:25:44,384 --> 06:25:47,120
LIKE YOU HAVE TO TAKE A

9103
06:25:47,120 --> 06:25:49,423
PERSONALIZED OR INDIVIDUALIZED

9104
06:25:49,423 --> 06:25:52,693
APPROACH TO EACH PERSON TO

9105
06:25:52,693 --> 06:25:54,761
IDENTIFY, YOU KNOW, THE SOCIAL

9106
06:25:54,761 --> 06:25:57,064
RISKS AND THEN TO IMPLEMENT SOME

9107
06:25:57,064 --> 06:25:59,499
KIND OF PROGRAM THAT WORKS FOR

9108
06:25:59,499 --> 06:26:01,468
THAT PARTICULAR PERSON.

9109
06:26:01,468 --> 06:26:02,069
>> YEAH.

9110
06:26:02,069 --> 06:26:03,737
THE NEED FOR IT TO BE

9111
06:26:03,737 --> 06:26:05,405
PERSONALIZED IS OBVIOUS, RIGHT?

9112
06:26:05,405 --> 06:26:06,607
I MEAN, AND YET --

9113
06:26:06,607 --> 06:26:07,307
>> ABSOLUTELY.

9114
06:26:07,307 --> 06:26:11,612
>> AND YET IT CAN BE
SOMEWHAT

9115
06:26:11,612 --> 06:26:13,380
SYSTEM MATIZED, RIGHT?

9116
06:26:13,380 --> 06:26:18,418
THAT'S THE NICE THING ABOUT JUST

9117
06:26:18,418 --> 06:26:19,286
HAVING -- MY RECOMMENDATION

9118
06:26:19,286 --> 06:26:21,021
AGAIN WILL BE, CLINICS HAVE TO

9119
06:26:21,021 --> 06:26:22,556
DO WHAT WORKS FOR THEM, BUT I

9120
06:26:22,556 --> 06:26:24,424
WOULD SAY, AND THIS IS BASED ON

9121
06:26:24,424 --> 06:26:26,727
THE RESEARCH THAT I'VE READ IS

9122
06:26:26,727 --> 06:26:30,764
LIKE ASK ABOUT FOOD, HOUSING,

9123
06:26:30,764 --> 06:26:32,733
TRANSPORTATION AND MEDICATION

9124
06:26:32,733 --> 06:26:33,634
AFFORDABILITY.

9125
06:26:33,634 --> 06:26:33,901
RIGHT?

9126
06:26:33,901 --> 06:26:35,569
BECAUSE GETTING MEDS IN THE BODY

9127
06:26:35,569 --> 06:26:38,839
IS FAR HARDER THAN YOU THINK,

9128
06:26:38,839 --> 06:26:39,406
RIGHT?

9129
06:26:39,406 --> 06:26:41,141
BECAUSE OF ALL THESE OTHER

9130
06:26:41,141 --> 06:26:42,142
BARRIERS, HOUSING,

9131
06:26:42,142 --> 06:26:44,211
TRANSPORTATION, OH, GOD, I CAN'T

9132
06:26:44,211 --> 06:26:46,747
GET MY PRESCRIPTION, BLAH, BLAH,

9133
06:26:46,747 --> 06:26:47,114
BLAH.

9134
06:26:47,114 --> 06:26:48,048
SO YOU COULD START WITH SOME

9135
06:26:48,048 --> 06:26:49,583
SORT OF BASIC BUILDING BLOCKS

9136
06:26:49,583 --> 06:26:51,652
THERE AND THEN ONCE YOU HAVE AN

9137
06:26:51,652 --> 06:26:52,953
INDIVIDUAL PATIENT WHO IS LIKE

9138
06:26:52,953 --> 06:26:54,488
YEAH ACTUALLY THEIR FOOD IS AN

9139
06:26:54,488 --> 06:26:55,689
ISSUE, THEN YOU COULD SORT OF

9140
06:26:55,689 --> 06:26:56,189
PERSONALIZE IT.

9141
06:26:56,189 --> 06:26:57,457
THIS IS WHY THAT PERSONAL

9142
06:26:57,457 --> 06:26:59,826
CONVERSATION IS SO IMPORTANT,

9143
06:26:59,826 --> 06:27:00,060
RIGHT?

9144
06:27:00,060 --> 06:27:01,828
AND IT'S WHY PATIENTS DON'T LIKE

9145
06:27:01,828 --> 06:27:03,597
BEING TREATED LIKE CHECK BOX IN

9146
06:27:03,597 --> 06:27:05,132
TERMS OF MY SOCIAL NEEDS AND

9147
06:27:05,132 --> 06:27:07,301
IT'S WHY CLINIC STAFF AT LEAST

9148
06:27:07,301 --> 06:27:08,735
THOSE WHO WORK WITH LOW-INCOME

9149
06:27:08,735 --> 06:27:11,038
PATIENT AS A CALLING DON'T FEEL

9150
06:27:11,038 --> 06:27:12,372
GREAT ABOUT IT, LIKE WE NEED TO

9151
06:27:12,372 --> 06:27:13,674
HAVE THAT CONVERSATION.

9152
06:27:13,674 --> 06:27:15,509
WHY HAVING A NAVIGATOR CAN

9153
06:27:15,509 --> 06:27:16,743
REALLY BE HELPFUL BECAUSE THEN

9154
06:27:16,743 --> 06:27:18,145
THAT PERSON IS GETTING THAT

9155
06:27:18,145 --> 06:27:19,212
PERSONALIZED CARE.

9156
06:27:19,212 --> 06:27:22,149
I DID FIND THAT ROI ARTICLE, I

9157
06:27:22,149 --> 06:27:24,284
CAN PUT IT IN THE THE CHA, IT'S

9158
06:27:24,284 --> 06:27:25,686
A VERY RECENT ARTICLE SO THAT

9159
06:27:25,686 --> 06:27:27,487
SHOULD ANSWER YOUR QUESTION.

9160
06:27:27,487 --> 06:27:28,455
>> THAT'S GREAT.

9161
06:27:28,455 --> 06:27:30,390
THANK YOU.

9162
06:27:30,390 --> 06:27:32,859
>> RACHEL, DO YOU THINK
THAT, IS

9163
06:27:32,859 --> 06:27:34,828
IT IMPORTANT, DO YOU THINK, TO

9164
06:27:34,828 --> 06:27:36,730
HAVE SOMEONE IN THE COMMUNITY

9165
06:27:36,730 --> 06:27:38,932
LIKE A COMMUNITY HEALTH WORKER

9166
06:27:38,932 --> 06:27:43,203
INTERACTING WITH THE NAVIGATOR

9167
06:27:43,203 --> 06:27:43,403
TO --

9168
06:27:43,403 --> 06:27:45,906
>> OR BEING THE NAVIGATOR.

9169
06:27:45,906 --> 06:27:47,541
>> BEING THE NAVIGATOR,
OKAY.

9170
06:27:47,541 --> 06:27:49,576
>> THAT'S A GREAT
QUESTION.

9171
06:27:49,576 --> 06:27:51,411
WE ARE ACTIVELY CONDUCTING A

9172
06:27:51,411 --> 06:27:54,448
TRIAL RIGHT NOW IN, WELL, WE'RE

9173
06:27:54,448 --> 06:27:55,782
RECRUITING FOR A TRIAL, THAT

9174
06:27:55,782 --> 06:27:58,185
WILL BE IN 26 COMMUNITY HEALTH

9175
06:27:58,185 --> 06:28:00,153
CENTERS WHRKS WE HIT RECRUIT --

9176
06:28:00,153 --> 06:28:02,222
WHEN WE HIT RECRUITMENT, THAT IS

9177
06:28:02,222 --> 06:28:04,291
LOOKING AT WHAT DOES IT TAKE TO

9178
06:28:04,291 --> 06:28:06,626
IMPLEMENT SOCIAL RISK SCREENING

9179
06:28:06,626 --> 06:28:07,928
AND REFERRAL MAKING THAT IS

9180
06:28:07,928 --> 06:28:09,329
DRIVEN BY COMMUNITY HEALTH

9181
06:28:09,329 --> 06:28:09,796
WORKERS.

9182
06:28:09,796 --> 06:28:11,765
I THEORIZE, I HYPOTHESIZE THAT

9183
06:28:11,765 --> 06:28:12,966
COMMUNITY HEALTH WORKERS ARE A

9184
06:28:12,966 --> 06:28:14,167
BIG PART OF THE SOLUTION HERE,

9185
06:28:14,167 --> 06:28:15,902
THAT WE SHOULD JUST BE LIKE,

9186
06:28:15,902 --> 06:28:17,571
YEAH, THIS IS NOT FOR THE

9187
06:28:17,571 --> 06:28:18,739
PROVIDER, THIS MAYBE ISN'T EVEN

9188
06:28:18,739 --> 06:28:20,607
FOR THE MA, THIS IS A ROLE FOR

9189
06:28:20,607 --> 06:28:22,676
THE COMMUNITY HEALTH WORKER OR

9190
06:28:22,676 --> 06:28:23,677
THE SOCIAL WORKER AND THEY HAVE

9191
06:28:23,677 --> 06:28:25,412
TO FIGURE OUT A WORKFLOW SO THAT

9192
06:28:25,412 --> 06:28:26,646
PATIENT IS GETTING CONTACTED AND

9193
06:28:26,646 --> 06:28:27,614
SUPPORTED BUT I THINK A

9194
06:28:27,614 --> 06:28:28,615
COMMUNITY HEALTH WORKER IS

9195
06:28:28,615 --> 06:28:29,816
PROBABLY A REALLY GREAT SOLUTION

9196
06:28:29,816 --> 06:28:31,451
TO THIS PROBLEM, THEY'RE NOT

9197
06:28:31,451 --> 06:28:32,452
EXPENSIVE, THEY'RE LESS

9198
06:28:32,452 --> 06:28:33,553
EXPENSIVE, AND THEY'RE PART OF

9199
06:28:33,553 --> 06:28:34,654
THE COMMUNITY AND THEY'RE GOING

9200
06:28:34,654 --> 06:28:35,956
TO BE ABLE TO PROVIDE THAT

9201
06:28:35,956 --> 06:28:36,823
PERSONALIZED CARE.

9202
06:28:36,823 --> 06:28:38,458
I'LL LET YOU KNOW WHAT WE FIND

9203
06:28:38,458 --> 06:28:40,293
WITH THE STUDY, BUT I SUSPECT

9204
06:28:40,293 --> 06:28:41,628
THE COMMUNITY HEALTH WORKERS ARE

9205
06:28:41,628 --> 06:28:44,097
A BIG PART OF THE SOLUTION.

9206
06:28:44,097 --> 06:28:44,364
>> GREAT.

9207
06:28:44,364 --> 06:28:46,533
>> WHAT WE NEED THOUGH IS
THEN

9208
06:28:46,533 --> 06:28:48,301
TO PAY FOR THEM.

9209
06:28:48,301 --> 06:28:49,636
THEN THEY HAVE TO BE REIMBURSED

9210
06:28:49,636 --> 06:28:50,704
AND THAT WILL BE MOST OF THE

9211
06:28:50,704 --> 06:28:52,806
TIME THROUGH MEDICAID OR

9212
06:28:52,806 --> 06:28:54,207
MEDICARE AND THEN THE STATE

9213
06:28:54,207 --> 06:28:55,642
VARIATION WHAT THEY'LL PAY FOR

9214
06:28:55,642 --> 06:28:57,277
IS GOING TO BE MORE AND MORE

9215
06:28:57,277 --> 06:29:00,580
LIKE STATE, YOU KNOW, STATE

9216
06:29:00,580 --> 06:29:02,115
DISPARITIES, AS WE'VE SHOWN MANY

9217
06:29:02,115 --> 06:29:03,950
TIMES WITH FOR EXAMPLE MEDICAID

9218
06:29:03,950 --> 06:29:05,819
EXPANSION, PATIENTS IN MEDICAID

9219
06:29:05,819 --> 06:29:06,787
EXPANSION STATES HAVE MUCH

9220
06:29:06,787 --> 06:29:08,555
BETTER OUTCOMES THAN THOSE THAT

9221
06:29:08,555 --> 06:29:08,789
DON'T.

9222
06:29:08,789 --> 06:29:09,956
MANY ARTICLES ON THIS.

9223
06:29:09,956 --> 06:29:11,825
>> DO YOU KNOW, IS THERE A

9224
06:29:11,825 --> 06:29:12,826
CREDENTIALING PROCESS FOR

9225
06:29:12,826 --> 06:29:13,860
COMMUNITY HEALTH WORKERS?

9226
06:29:13,860 --> 06:29:14,828
>> YES, THERE IS.

9227
06:29:14,828 --> 06:29:16,096
I DON'T THINK IT'S VERY

9228
06:29:16,096 --> 06:29:18,331
COMPLICATED, THOUGH.

9229
06:29:18,331 --> 06:29:19,266
I COULD BE WRONG.

9230
06:29:19,266 --> 06:29:20,467
DON'T QUOTE ME ON THAT.

9231
06:29:20,467 --> 06:29:21,802
BUT I DON'T THINK IT'S VERY

9232
06:29:21,802 --> 06:29:22,069
DIFFICULT.

9233
06:29:22,069 --> 06:29:24,504
>> OKAY.

9234
06:29:24,504 --> 06:29:26,073
JANE, YOU HAD A QUESTION I THINK

9235
06:29:26,073 --> 06:29:26,940
FOR DR. BRITAIN.

9236
06:29:26,940 --> 06:29:27,774
>> I DID.

9237
06:29:27,774 --> 06:29:29,342
I WAS JUST GOING TO BRING THAT

9238
06:29:29,342 --> 06:29:30,644
UP, IF HE WAS AROUND.

9239
06:29:30,644 --> 06:29:31,545
>> YES.

9240
06:29:31,545 --> 06:29:32,946
>> HI.

9241
06:29:32,946 --> 06:29:36,750
SO YEAH, I DID WANT TO ASK YOU,

9242
06:29:36,750 --> 06:29:39,386
YOU KNOW, I REALLY LOVE THE VA

9243
06:29:39,386 --> 06:29:39,619
STUDIES.

9244
06:29:39,619 --> 06:29:42,456
CAN YOU TELL ME, DO YOU KNOW

9245
06:29:42,456 --> 06:29:44,991
WHAT PERCENTAGE OF U.S. VETSZ

9246
06:29:44,991 --> 06:29:46,860
ACTUALLY AK -- VETS ACTUALLY

9247
06:29:46,860 --> 06:29:49,329
ACCESS NEWS, THE V -- ACTUALLY

9248
06:29:49,329 --> 06:29:51,698
ACCESS AND USE THE VA SYSTEM AND

9249
06:29:51,698 --> 06:29:52,966
WOULD BE INCLUDED IN YOUR

9250
06:29:52,966 --> 06:29:53,400
DATABASE?

9251
06:29:53,400 --> 06:29:54,334
>> THAT'S A GOOD QUESTION.

9252
06:29:54,334 --> 06:29:55,936
I THINK YOU'RE GETTING TO THE

9253
06:29:55,936 --> 06:29:57,904
NOTION THAT THEY HAVE ACCESS AND

9254
06:29:57,904 --> 06:30:04,377
SEEK CARE OUTSIDE OF VA ACCESS.

9255
06:30:04,377 --> 06:30:05,846
I DON'T KNOW HARD NUMBERS.

9256
06:30:05,846 --> 06:30:09,082
I WILL SAY THAT FOR COMORBIDITY

9257
06:30:09,082 --> 06:30:10,717
AND OUTCOME DATA IN THOSE

9258
06:30:10,717 --> 06:30:11,885
STUDIES, WE DO INCORPORATE

9259
06:30:11,885 --> 06:30:14,054
MEDICARE AND MEDICAID DATA AND

9260
06:30:14,054 --> 06:30:16,022
FEE FOR SERVICE DATA, WHICH IS

9261
06:30:16,022 --> 06:30:17,824
ONE OF THE REASONS SOME OF THOSE

9262
06:30:17,824 --> 06:30:18,892
STUDIES LOOK A LITTLE OUT OF

9263
06:30:18,892 --> 06:30:21,995
DATE BECAUSE THERE'S A DELAY IN

9264
06:30:21,995 --> 06:30:23,396
GAINING ACCESS TO MEDICARE AND

9265
06:30:23,396 --> 06:30:25,932
FEE FOR SERVICE DATA, SO THE

9266
06:30:25,932 --> 06:30:27,334
STUDIES THAT WE PUBLISH

9267
06:30:27,334 --> 06:30:29,836
INCORPORATE THAT, BUT I DON'T

9268
06:30:29,836 --> 06:30:31,505
KNOW OFF HAND WHAT THOSE

9269
06:30:31,505 --> 06:30:32,372
PROPORTIONS ARE.

9270
06:30:32,372 --> 06:30:32,839
>> YEAH.

9271
06:30:32,839 --> 06:30:34,341
I MEAN, AND I ASK THIS BECAUSE

9272
06:30:34,341 --> 06:30:35,976
THE LAST THAT I HAD HEARD AS

9273
06:30:35,976 --> 06:30:38,812
WELL WAS THAT IT WAS OFTEN IN

9274
06:30:38,812 --> 06:30:40,780
THE LOWER, YOU KNOW, IT WAS

9275
06:30:40,780 --> 06:30:43,950
ABOUT 30% WHO SOUGHT ALL ROUTINE

9276
06:30:43,950 --> 06:30:45,185
HEALTHCARE AT THE VA HEALTHCARE

9277
06:30:45,185 --> 06:30:46,686
SYSTEM AND THAT WHEN PEOPLE

9278
06:30:46,686 --> 06:30:48,455
LOOKED AT SOCIOECONOMIC STATUS,

9279
06:30:48,455 --> 06:30:51,925
THAT IT WAS THE INDIVIDUALS WHO,

9280
06:30:51,925 --> 06:30:53,460
YOU KNOW, TENDED TO SCALE UP THE

9281
06:30:53,460 --> 06:30:54,694
LOWER END.

9282
06:30:54,694 --> 06:30:56,863
SO I JUST THINK THAT EVEN

9283
06:30:56,863 --> 06:30:58,298
REGARDLESS OF WHAT IT IS, THE

9284
06:30:58,298 --> 06:31:01,034
FACT THAT YOU'RE FINDING SO

9285
06:31:01,034 --> 06:31:02,602
CLOSELY MIRROR WHAT'S SEEN AT

9286
06:31:02,602 --> 06:31:04,538
VANDERBILT IS REALLY

9287
06:31:04,538 --> 06:31:04,838
FASCINATING.

9288
06:31:04,838 --> 06:31:07,908
>> YEAH, THAT WAS ONE OF
THE

9289
06:31:07,908 --> 06:31:09,009
TAKE-HOMES AND IT'S BEEN A

9290
06:31:09,009 --> 06:31:10,977
SURPRISE FOR ME IS HOW SIMILAR

9291
06:31:10,977 --> 06:31:12,412
THE COMORBIDITY PROFILES ARE,

9292
06:31:12,412 --> 06:31:14,147
WITH A COUPLE OF EXCEPTIONS THAT

9293
06:31:14,147 --> 06:31:17,584
I NOTED, AND THE PH PROFILES.

9294
06:31:17,584 --> 06:31:18,051
>> YEAH.

9295
06:31:18,051 --> 06:31:19,052
THE OTHER THING THOUGH THAT WAS

9296
06:31:19,052 --> 06:31:20,453
INTERESTING WAS THE STUDY YOU

9297
06:31:20,453 --> 06:31:22,088
WERE SHOWING AS WELL LOOKING AT

9298
06:31:22,088 --> 06:31:24,391
HEART FAILURE AND COPD WITH

9299
06:31:24,391 --> 06:31:28,328
HEART FAILURE INCREASING RISK.

9300
06:31:28,328 --> 06:31:31,398
IS THAT ALL CAUSED -- ALL HEART

9301
06:31:31,398 --> 06:31:35,001
FAILURE, OR IS THAT MOSTLY

9302
06:31:35,001 --> 06:31:35,802
HEF PEF?

9303
06:31:35,802 --> 06:31:38,505
>> IT'S EHR PHENOTYPING SO
TAKE

9304
06:31:38,505 --> 06:31:40,473
THAT WHAT IT'S WORTH.

9305
06:31:40,473 --> 06:31:41,374
THAT WAS LUMPING.

9306
06:31:41,374 --> 06:31:43,210
WE DO HAVE SUBGROUP ANALYSIS

9307
06:31:43,210 --> 06:31:46,613
THAT SPLITS THAT OUT IN THAT

9308
06:31:46,613 --> 06:31:49,683
PAPER, AND HEF REF HAD HIGHER

9309
06:31:49,683 --> 06:31:52,285
INCIDENCE RATES THAN HEF PEF,

9310
06:31:52,285 --> 06:31:53,820
NOT DRAMATICALLY DIFFERENT.

9311
06:31:53,820 --> 06:31:55,121
>> INTERESTING.

9312
06:31:55,121 --> 06:31:55,488
YEAH.

9313
06:31:55,488 --> 06:32:02,162
SO THAT'S REALLY GOOD.

9314
06:32:02,162 --> 06:32:03,597
I THINK GABBY HAS A QUESTION.

9315
06:32:03,597 --> 06:32:04,664
>> YES, PLEASE.

9316
06:32:04,664 --> 06:32:08,034
I WAS REALLY FASCINATED BY THE

9317
06:32:08,034 --> 06:32:12,739
VETERANS TALK AS WELL, AND WHAT

9318
06:32:12,739 --> 06:32:17,777
STRUCK ME IS THIS ONE SLIDE THAT

9319
06:32:17,777 --> 06:32:20,280
YOU SHOWED THAT ALTHOUGH

9320
06:32:20,280 --> 06:32:22,349
PULMONARY HYPERTENSION WAS

9321
06:32:22,349 --> 06:32:24,784
STRONGLY SUGGESTED BY ECHO, IT

9322
06:32:24,784 --> 06:32:26,186
WASN'T CODED.

9323
06:32:26,186 --> 06:32:28,922
DOES THAT MEAN THAT IF IT'S NOT

9324
06:32:28,922 --> 06:32:31,224
CODED, THEN PATIENTS DON'T GET

9325
06:32:31,224 --> 06:32:33,627
MANAGEMENT FOR PULMONARY

9326
06:32:33,627 --> 06:32:33,960
HYPERTENSION?

9327
06:32:33,960 --> 06:32:36,229
I ASSUME.

9328
06:32:36,229 --> 06:32:37,764
>> THAT'S A GREAT
QUESTION.

9329
06:32:37,764 --> 06:32:40,433
I MEAN, FROM PERSONAL

9330
06:32:40,433 --> 06:32:42,168
EXPERIENCE, I KNOW I MISCODE

9331
06:32:42,168 --> 06:32:42,902
PROBABLY ALL THE TIME.

9332
06:32:42,902 --> 06:32:44,404
WE SORT OF DO THAT A LITTLE BIT

9333
06:32:44,404 --> 06:32:45,872
OUT OF CONVENIENCE AND WHAT'S

9334
06:32:45,872 --> 06:32:47,407
SORT OF THE PROXIMAL DIAGNOSIS

9335
06:32:47,407 --> 06:32:48,708
THAT WE'RE SEEING THE PROBLEM

9336
06:32:48,708 --> 06:32:49,376
THAT DAY.

9337
06:32:49,376 --> 06:32:52,979
SO SOME OF THAT IS, YOU KNOW,

9338
06:32:52,979 --> 06:32:56,383
JUST SORT OF USUAL CLINICAL

9339
06:32:56,383 --> 06:32:56,583
CARE.

9340
06:32:56,583 --> 06:32:58,585
I DON'T KNOW FOR SURE WHETHER

9341
06:32:58,585 --> 06:33:01,321
THE ABSENCE OF A CODE EQUALS THE

9342
06:33:01,321 --> 06:33:02,522
ABSENCE OF TREATMENT OF

9343
06:33:02,522 --> 06:33:03,590
CARDIOVASCULAR DISEASE, BUT ALSO

9344
06:33:03,590 --> 06:33:06,226
KEEP IN MIND THAT AMONG THE

9345
06:33:06,226 --> 06:33:12,132
VETERANS, YOU KNOW, GROUP ONE

9346
06:33:12,132 --> 06:33:14,467
PH'S IS LESS COMMON IN GENERAL.

9347
06:33:14,467 --> 06:33:17,804
>> YEAH.

9348
06:33:17,804 --> 06:33:18,071
THANK YOU.

9349
06:33:18,071 --> 06:33:21,775
>> I'LL ASK SOMEWHAT OF
IKS A

9350
06:33:21,775 --> 06:33:23,276
CONTROVERSIAL QUESTION, EVAN.

9351
06:33:23,276 --> 06:33:24,944
THIS IS FOR YOU, BUT ANYBODY CAN

9352
06:33:24,944 --> 06:33:28,315
ANSWER, I SUPPOSE, AS WELL.

9353
06:33:28,315 --> 06:33:30,850
SO YOU BROUGHT UP THE POINT,

9354
06:33:30,850 --> 06:33:33,353
OBVIOUSLY EVEN OUTSIDE OF PH,

9355
06:33:33,353 --> 06:33:37,490
THE DIFFICULTY IN RESEARCHING

9356
06:33:37,490 --> 06:33:37,957
HOMELESSNESS.

9357
06:33:37,957 --> 06:33:39,693
I'M ASSUMING THAT THAT WAS AN

9358
06:33:39,693 --> 06:33:43,063
ISSUE OUTSIDE OF PH ALSO.

9359
06:33:43,063 --> 06:33:46,599
YOU KNOW, RECENTLY, THE SUPREME

9360
06:33:46,599 --> 06:33:49,536
COURT HAS SOMEWHAT CRIMINALIZED

9361
06:33:49,536 --> 06:33:49,869
HOMELESSNESS.

9362
06:33:49,869 --> 06:33:51,504
DO YOU FEEL LIKE THAT THESE

9363
06:33:51,504 --> 06:33:53,039
ISSUES THAT WE ARE MOVING

9364
06:33:53,039 --> 06:33:55,975
TOWARDS AS A SOCIETY MIGHT BE AN

9365
06:33:55,975 --> 06:33:58,812
IMPEDIMENT TO STUDYING EVEN MORE

9366
06:33:58,812 --> 06:34:02,682
THE HOMELESS POPULATION?

9367
06:34:02,682 --> 06:34:04,551
>> SO GREAT QUESTION.

9368
06:34:04,551 --> 06:34:06,586
I'LL START WITH A DISCLAIMER

9369
06:34:06,586 --> 06:34:09,356
THAT I'M AN EXPERT AT ALL ON THE

9370
06:34:09,356 --> 06:34:10,323
SOCIAL ISSUES AROUND

9371
06:34:10,323 --> 06:34:11,958
HOMELESSNESS OR THE INHERENT

9372
06:34:11,958 --> 06:34:14,060
POLITICAL ISSUES THERE EITHER.

9373
06:34:14,060 --> 06:34:16,563
YOU KNOW, BUT I DO THINK THAT

9374
06:34:16,563 --> 06:34:18,198
THERE ARE OBVIOUSLY INHERENT

9375
06:34:18,198 --> 06:34:19,165
CHALLENGES WITH UNDERSTANDING

9376
06:34:19,165 --> 06:34:23,002
ANY CHRONIC DISEASE IN THAT

9377
06:34:23,002 --> 06:34:26,840
POPULATION, SO FOCUSING ON PH

9378
06:34:26,840 --> 06:34:27,807
SPECIFICALLY IS A LITTLE BIT

9379
06:34:27,807 --> 06:34:29,676
SORT OF HARD TO JUSTIFY WHEN

9380
06:34:29,676 --> 06:34:31,544
THERE IS PROBABLY LOWER HANGING

9381
06:34:31,544 --> 06:34:33,847
FRUIT TO UNDERSTAND AROUND

9382
06:34:33,847 --> 06:34:35,048
CARDIOPULMONARY AND

9383
06:34:35,048 --> 06:34:37,784
CARDIOVASCULAR DISEASE.

9384
06:34:37,784 --> 06:34:39,853
BUT OTHERWISE, I FEEL SORT OF

9385
06:34:39,853 --> 06:34:41,187
UNQUALIFIED TO HAVE A STRONG

9386
06:34:41,187 --> 06:34:44,557
OPINION ON SORT OF THE POLITICAL

9387
06:34:44,557 --> 06:34:47,293
ASPECTS.

9388
06:34:47,293 --> 06:34:47,660
OTHERS MAY NOT.

9389
06:34:47,660 --> 06:34:49,929
>> WELL, I CAN TELL YOU
IT'S

9390
06:34:49,929 --> 06:34:52,332
BEEN AN ISSUE HERE TRYING TO

9391
06:34:52,332 --> 06:34:53,867
STUDY METHAMPHETAMINE USE, I

9392
06:34:53,867 --> 06:34:56,836
MEAN, IT BEING CRIMINALIZED, OF

9393
06:34:56,836 --> 06:34:57,070
COURSE.

9394
06:34:57,070 --> 06:35:01,508
SO IT'S BEEN AN ISSUE FOR US.

9395
06:35:01,508 --> 06:35:03,510
ANY OTHER QUESTIONS FOR THE

9396
06:35:03,510 --> 06:35:05,678
GROUP FROM THE DISCUSSANTS?

9397
06:35:05,678 --> 06:35:08,848
I DON'T SEE ANYTHING IN THE

9398
06:35:08,848 --> 06:35:17,824
CHAT.

9399
06:35:17,824 --> 06:35:23,830
I HAVE A QUICK QUESTION FOR

9400
06:35:23,830 --> 06:35:26,666
DR. BERNARDO.

9401
06:35:26,666 --> 06:35:29,536
IS HE STILL THERE?

9402
06:35:29,536 --> 06:35:34,240
SORRY.

9403
06:35:34,240 --> 06:35:36,743
IS THERE BERNARDO STILL THERE?

9404
06:35:36,743 --> 06:35:38,611
>> I DON'T SEE HIM IN THE

9405
06:35:38,611 --> 06:35:40,313
ATTENDEE LIST.

9406
06:35:40,313 --> 06:35:44,083
>> YOU DO NOT OR -- SORRY,

9407
06:35:44,083 --> 06:35:44,517
JACKIE?

9408
06:35:44,517 --> 06:35:45,051
>> I DO.

9409
06:35:45,051 --> 06:35:45,852
>> I'M STILL ON.

9410
06:35:45,852 --> 06:35:48,788
>> OH, OKAY.

9411
06:35:48,788 --> 06:35:51,724
SO ROBERTO YOU SHOWED A MAP OF

9412
06:35:51,724 --> 06:35:52,826
SEGREGATION IN THE U.S.,

9413
06:35:52,826 --> 06:35:56,095
ALTHOUGH YOU ALLUDED TO THAT

9414
06:35:56,095 --> 06:35:59,098
BEING A FAIRLY OLD MAP.

9415
06:35:59,098 --> 06:36:02,368
I'M GOING TO ADVOCATE SLIGHTLY

9416
06:36:02,368 --> 06:36:04,204
FOR THE NATIVE AMERICAN

9417
06:36:04,204 --> 06:36:07,707
POPULATION HERE BECAUSE WE

9418
06:36:07,707 --> 06:36:09,676
HAVEN'T DISCUSSED MUCH IN THAT

9419
06:36:09,676 --> 06:36:11,511
REGARD, BUT IN ARIZONA, I'M SURE

9420
06:36:11,511 --> 06:36:15,014
YOU KNOW, YOU TRAINED HERE, MANY

9421
06:36:15,014 --> 06:36:18,651
PEOPLE DO KNOW THAT THE NATIVE

9422
06:36:18,651 --> 06:36:21,921
AMERICAN POPULATION IS A

9423
06:36:21,921 --> 06:36:22,622
SIGNIFICANT PRESENCE.

9424
06:36:22,622 --> 06:36:24,757
IN FACT, I HAVE A CLINIC AT THE

9425
06:36:24,757 --> 06:36:26,192
APACHE RESERVATION.

9426
06:36:26,192 --> 06:36:29,662
WE SEE PATIENTS FROM THE NAVAJO,

9427
06:36:29,662 --> 06:36:31,865
THE APACHE RESERVATIONS.

9428
06:36:31,865 --> 06:36:36,669
IT STRIKES ME THAT ALTHOUGH

9429
06:36:36,669 --> 06:36:41,207
ARIZONA IS A NONSEGREGATED AREA

9430
06:36:41,207 --> 06:36:43,810
THAT IF YOU LOOK AT THE

9431
06:36:43,810 --> 06:36:50,717
DISPARITY THAT IS WE SEE BETWEEE

9432
06:36:50,717 --> 06:36:51,584
SEE OF THE NATIVE AMERICANS WHO

9433
06:36:51,584 --> 06:36:54,754
LIVE ON THE RESERVATION VERSUS

9434
06:36:54,754 --> 06:36:56,623
THOSE WHO DO NOT THERE STILL

9435
06:36:56,623 --> 06:36:57,590
SEEMS TO BE SUBSTANTIAL

9436
06:36:57,590 --> 06:36:58,825
SEGREGATION IN THAT REGARD.

9437
06:36:58,825 --> 06:37:00,159
CAN YOU COMMENT IN REGARD TO

9438
06:37:00,159 --> 06:37:03,396
WHAT YOU THINK IS A BUT WAY FOR

9439
06:37:03,396 --> 06:37:06,432
US TO CAPTURE NATIVE AMERICAN

9440
06:37:06,432 --> 06:37:08,201
INTERESTS, ESPECIALLY THOSE WHO

9441
06:37:08,201 --> 06:37:11,604
LIVE OR DO NOT LIVE ON THE

9442
06:37:11,604 --> 06:37:14,440
RESERVATION WITH REGARD TO

9443
06:37:14,440 --> 06:37:17,310
SEGREGATION?

9444
06:37:17,310 --> 06:37:19,579
>> THAT'S A COMPLICATED

9445
06:37:19,579 --> 06:37:21,981
QUESTION, FRANZ.

9446
06:37:21,981 --> 06:37:25,351
I WISH NINA WERE STILL IN THE

9447
06:37:25,351 --> 06:37:26,252
AUDIENCE BECAUSE SHE COULD ALSO

9448
06:37:26,252 --> 06:37:27,654
CONTRIBUTE TO THIS DISCUSSION,

9449
06:37:27,654 --> 06:37:29,389
BUT NATIVE AMERICANS IS A

9450
06:37:29,389 --> 06:37:31,157
HISTORICALLY NEGLECTED

9451
06:37:31,157 --> 06:37:33,226
POPULATION IN MUCH NEED OF MORE

9452
06:37:33,226 --> 06:37:34,561
DETAILED RESEARCH WHEN IT COMES

9453
06:37:34,561 --> 06:37:39,165
TO RARE DISEASES, SUCH AS PH.

9454
06:37:39,165 --> 06:37:41,901
LTS VERY CHALLENGING TO GET --

9455
06:37:41,901 --> 06:37:44,070
IT IS VERY CHALLENGING TO GET

9456
06:37:44,070 --> 06:37:45,371
PERMISSION TO DO RESEARCH WITH

9457
06:37:45,371 --> 06:37:46,806
THIS SPECIFIC GRURP BEING AS YOU

9458
06:37:46,806 --> 06:37:48,775
PROBABLY KNOW.

9459
06:37:48,775 --> 06:37:50,743
-- WITH THIS SPECIFIC GROUP, AS

9460
06:37:50,743 --> 06:37:51,711
YOU PROBABLY KNOW.

9461
06:37:51,711 --> 06:37:52,845
THERE ARE MANY APPROVAL FORMS

9462
06:37:52,845 --> 06:37:54,681
THAT YOU NEED TO GET TO BE

9463
06:37:54,681 --> 06:37:59,252
AUTHORIZED TO BE ABLE TO WORK

9464
06:37:59,252 --> 06:38:05,024
WITH THE NATIVE AMERICAN

9465
06:38:05,024 --> 06:38:08,394
POPULATIONS, AND WHICH ONE OF US

9466
06:38:08,394 --> 06:38:10,063
HAS BEEN ABLE TO TAKE CARE OF

9467
06:38:10,063 --> 06:38:11,965
SOME OF THESE PATIENTS, I DID

9468
06:38:11,965 --> 06:38:13,933
WHEN I WAS LIVING IN OKLAHOMA,

9469
06:38:13,933 --> 06:38:15,902
IT'S JUST VERY CHALLENGING BUT

9470
06:38:15,902 --> 06:38:19,706
THE HEALTHCARE SYSTEM THEY HAVE,

9471
06:38:19,706 --> 06:38:20,940
I CAN'T REMEMBER THE NAME, BUT

9472
06:38:20,940 --> 06:38:22,041
THE HEALTHCARE SYSTEM THEY HAVE

9473
06:38:22,041 --> 06:38:23,443
IS VERY RESTRICTIVE.

9474
06:38:23,443 --> 06:38:25,011
YOU NEED TO GET APPROVAL FOR --

9475
06:38:25,011 --> 06:38:26,045
>> IHS.

9476
06:38:26,045 --> 06:38:29,582
>> IHS, THAT IS CORRECT,
FOR

9477
06:38:29,582 --> 06:38:31,551
EVERY SINGLE TESTING OR

9478
06:38:31,551 --> 06:38:36,889
PRESCRIPTION YOU WANT TO DO, IS

9479
06:38:36,889 --> 06:38:40,293
WE THINK A RARE DISEASE,

9480
06:38:40,293 --> 06:38:43,029
CERTAINLY HAS A DETRIMENTAL

9481
06:38:43,029 --> 06:38:44,897
EFFECT ON MINORITIES, NATIVE

9482
06:38:44,897 --> 06:38:47,066
AMERICANS ARE BY FAR I THINK THE

9483
06:38:47,066 --> 06:38:49,802
MOST DISADVANTAGED GROUP.

9484
06:38:49,802 --> 06:38:51,237
AND I DON'T HAVE A CLEAR ANSWER

9485
06:38:51,237 --> 06:38:55,608
TO YOU ABOUT HOW TO SUCCESSFULLY

9486
06:38:55,608 --> 06:38:57,710
PROCEED WITH RESEARCHING THIS

9487
06:38:57,710 --> 06:38:59,212
POPULATION, BUT I THINK WE

9488
06:38:59,212 --> 06:39:02,815
SHOULD CERTAINLY CONSIDER DOING

9489
06:39:02,815 --> 06:39:03,049
THAT.

9490
06:39:03,049 --> 06:39:09,155
AND I WOULD SAY I BELIEVE

9491
06:39:09,155 --> 06:39:11,791
PD-OMICS -- PROTEOMICS, EVEN

9492
06:39:11,791 --> 06:39:13,593
THOSE 14 PAGES WOULD BE

9493
06:39:13,593 --> 06:39:15,294
SOMETHING THAT WOULD BE WORTH

9494
06:39:15,294 --> 06:39:16,729
PURSUING FURTHER INVESTIGATION

9495
06:39:16,729 --> 06:39:18,464
BECAUSE IN REALITY WE HAVE

9496
06:39:18,464 --> 06:39:19,899
NOTHING, NOTHING TO COMMENT

9497
06:39:19,899 --> 06:39:21,467
ABOUT WHAT'S THE REALITY OF

9498
06:39:21,467 --> 06:39:22,635
NATIVE AMERICAN PATIENTS WITH

9499
06:39:22,635 --> 06:39:27,373
PH.

9500
06:39:27,373 --> 06:39:28,875
>> OKAY.

9501
06:39:28,875 --> 06:39:30,076
ANY OTHER QUESTIONS, COMMENTS IS

9502
06:39:30,076 --> 06:39:32,378
IT THANK YOU, DR. BERNARDO FOR

9503
06:39:32,378 --> 06:39:36,215
THAT.

9504
06:39:36,215 --> 06:39:38,484
>> MY ONLY COMMENT IS, I'M
YOUR

9505
06:39:38,484 --> 06:39:41,220
NEIGHBOR TO THE NORTH, RIGHT?

9506
06:39:41,220 --> 06:39:46,059
AND, YOU KNOW, IT'S A UNIQUE

9507
06:39:46,059 --> 06:39:48,194
HISTORY WITH NATIVE AMERICANS,

9508
06:39:48,194 --> 06:39:53,266
AND I MENTOR A PHYSICIAN, A

9509
06:39:53,266 --> 06:39:54,467
PULMONARY PHYSICIAN OF NATIVE

9510
06:39:54,467 --> 06:39:56,569
AMERICAN DESCENT WHO MOVED HERE

9511
06:39:56,569 --> 06:39:59,372
FROM ROCHESTER, MAYO CLINIC, AND

9512
06:39:59,372 --> 06:40:01,674
I LEARNED A LOT BY WORKING

9513
06:40:01,674 --> 06:40:03,142
ALONGSIDE OF HER, THINGS I

9514
06:40:03,142 --> 06:40:04,210
DIDN'T KNOW AS SOMEBODY WHO

9515
06:40:04,210 --> 06:40:05,945
WORKED A LOT WITH HEALTH

9516
06:40:05,945 --> 06:40:07,814
DISPARITY RESEARCH, THE NATURE

9517
06:40:07,814 --> 06:40:09,982
OF THE SOVEREIGN STATE, THE

9518
06:40:09,982 --> 06:40:13,486
COMMUNITY AND HOW, YOU KNOW, YOU

9519
06:40:13,486 --> 06:40:14,921
REALLY DO -- AND I WOULD SAY

9520
06:40:14,921 --> 06:40:16,222
WITH ANY MINORITY COMMUNITY, BUT

9521
06:40:16,222 --> 06:40:17,857
THEY GIVE US A GOOD REMINDER

9522
06:40:17,857 --> 06:40:19,859
THAT IF YOU WANT TO COME AND DO

9523
06:40:19,859 --> 06:40:21,394
RESEARCH IN A COMMUNITY THAT'S

9524
06:40:21,394 --> 06:40:22,595
UNDERREPRESENTED CIALG THE BEST

9525
06:40:22,595 --> 06:40:25,331
IDEA IS -- THE BEST IDEA STONT

9526
06:40:25,331 --> 06:40:27,834
SAY I WANT TO DO RESEARCH ON

9527
06:40:27,834 --> 06:40:29,368
THIS POPULATION, THE BEST

9528
06:40:29,368 --> 06:40:30,436
APPROACH IS TO COME IN AND

9529
06:40:30,436 --> 06:40:31,237
UNDERSTAND WHAT THEIR THOUGHTS

9530
06:40:31,237 --> 06:40:32,405
AND WHAT THEIR LEADER AND

9531
06:40:32,405 --> 06:40:33,172
COMMUNITY IS THINKING AND THEN

9532
06:40:33,172 --> 06:40:34,607
AFTER THAT, YOU KNOW, TRY TO

9533
06:40:34,607 --> 06:40:35,908
PARTNER WITH THEM AND THEN BRING

9534
06:40:35,908 --> 06:40:37,043
ON RESEARCH LATER.

9535
06:40:37,043 --> 06:40:39,345
IT'S NOT, YOU KNOW -- AND I

9536
06:40:39,345 --> 06:40:41,414
THINK THERE'S A I'VE LANDER A

9537
06:40:41,414 --> 06:40:42,915
LOT OF LESSONS FROM THOSE

9538
06:40:42,915 --> 06:40:44,350
APPROACHES AND WE DO EMPLOY SOME

9539
06:40:44,350 --> 06:40:46,552
OF THOSE APPROACHES WITH OUR

9540
06:40:46,552 --> 06:40:47,420
COHORT AND I THINK YOU'RE

9541
06:40:47,420 --> 06:40:52,125
FAMILIAR WITH THAT -- 4,000

9542
06:40:52,125 --> 06:40:54,093
MEXICAN AMERICANS FROM MOUNTAIN

9543
06:40:54,093 --> 06:40:57,497
PARK HEALTH CENTER, LARRY

9544
06:40:57,497 --> 06:40:59,098
MANDARINO OVER THERE WAS THE

9545
06:40:59,098 --> 06:41:00,767
STAT STARTER OF THAT, I'M NOW

9546
06:41:00,767 --> 06:41:02,001
SUPPORTING THAT, AND WE CONTINUE

9547
06:41:02,001 --> 06:41:03,603
THAT KIND OF APPROACH WITH DMUNT

9548
06:41:03,603 --> 06:41:05,571
AS WELL, WHERE WE DON'T COME IN

9549
06:41:05,571 --> 06:41:06,939
AND SAY WE WANT TO DO RESEARCH.

9550
06:41:06,939 --> 06:41:08,808
WE COME IN AND POSE QUESTIONS

9551
06:41:08,808 --> 06:41:09,642
ABOUT THINGS THAT MIGHT BE

9552
06:41:09,642 --> 06:41:10,943
RELEVANT TO THE COMMUNITY AND

9553
06:41:10,943 --> 06:41:12,578
THEN WE ENGAGE THEM AND SPEAK

9554
06:41:12,578 --> 06:41:14,881
WITH THEM AND THEN BRING UP

9555
06:41:14,881 --> 06:41:16,282
RESEARCH AT A LATER TIME.

9556
06:41:16,282 --> 06:41:18,251
YOU KNOW, I THINK THAT THOSE ARE

9557
06:41:18,251 --> 06:41:19,986
THE KIND OF THINGS THAT HELP

9558
06:41:19,986 --> 06:41:21,654
BREAK BARRIERS OF DISTRUST

9559
06:41:21,654 --> 06:41:22,955
ESPECIALLY IN POPULATIONS THAT

9560
06:41:22,955 --> 06:41:25,691
WERE TARGETED FOR ANNIHILATION

9561
06:41:25,691 --> 06:41:26,459
GENERATIONS AGO.

9562
06:41:26,459 --> 06:41:28,027
WE REALLY HAVE TO DO THE HARD

9563
06:41:28,027 --> 06:41:29,829
WORK TO ENGAGE THOSE COMMUNITIES

9564
06:41:29,829 --> 06:41:32,732
IN A DIFFERENT WAY BECAUSE WE

9565
06:41:32,732 --> 06:41:35,368
JUST -- IT'S THE RIGHT THING TO

9566
06:41:35,368 --> 06:41:35,735
DO.

9567
06:41:35,735 --> 06:41:41,140
AND THIS POPULATION IS NO

9568
06:41:41,140 --> 06:41:42,008
EXCEPTION.

9569
06:41:42,008 --> 06:41:42,675
IN PULMONARY HYPERTENSION.

9570
06:41:42,675 --> 06:41:44,944
>> LET ME JUST ADD ON TO
THAT,

9571
06:41:44,944 --> 06:41:46,813
ONE PARTICULARLY VULNERABLE

9572
06:41:46,813 --> 06:41:48,014
POPULATION, ROBERTO, I DON'T

9573
06:41:48,014 --> 06:41:51,851
KNOW IF YOU'VE ENCOUNTERED THE

9574
06:41:51,851 --> 06:41:53,719
CHOCTAW POPULATION BUT THEIR

9575
06:41:53,719 --> 06:41:56,122
RATES OF SCLERODERMA OR FIVE TO

9576
06:41:56,122 --> 06:41:57,657
TEN TIMES HIGHER THAN THE

9577
06:41:57,657 --> 06:42:01,060
GENERAL POPULATION AND THINKING

9578
06:42:01,060 --> 06:42:03,229
ABOUT PULMONARY VASK ALREADY

9579
06:42:03,229 --> 06:42:05,631
DISEASE, BASED IN OKLAHOMA,

9580
06:42:05,631 --> 06:42:06,632
PARTICULARLY SOUTHEAST, I DON'T

9581
06:42:06,632 --> 06:42:07,934
KNOW IF YOU HAD ANY EXPERIENCE

9582
06:42:07,934 --> 06:42:10,136
IN YOUR TIME IN OKLAHOMA,

9583
06:42:10,136 --> 06:42:11,971
ROBERTO, BUT THAT MIGHT BE A

9584
06:42:11,971 --> 06:42:12,839
PARTICULARLY VULNERABLE

9585
06:42:12,839 --> 06:42:14,173
POPULATION FOR VASCULAR DISEASE

9586
06:42:14,173 --> 06:42:15,608
THAT WE COULD CONSIDER AS A

9587
06:42:15,608 --> 06:42:18,644
PRIORITY IN OUR PRIORITY

9588
06:42:18,644 --> 06:42:18,945
STATEMENTS.

9589
06:42:18,945 --> 06:42:21,714
>> THAT'S A GREAT IDEA,
STEVE.

9590
06:42:21,714 --> 06:42:22,715
YES.

9591
06:42:22,715 --> 06:42:24,350
THE FREQUENCY OF CONNECTIVE

9592
06:42:24,350 --> 06:42:25,885
TISSUE DISEASE WAS CERTAINLY

9593
06:42:25,885 --> 06:42:28,120
HIGHER THAN OTHER POPULATIONS,

9594
06:42:28,120 --> 06:42:30,356
AT LEAST IN OKLAHOMA THE

9595
06:42:30,356 --> 06:42:33,092
FREQUENCY OF METHAMPHETAMINE USE

9596
06:42:33,092 --> 06:42:35,161
WAS ALSO HIGHER THAN WHAT I

9597
06:42:35,161 --> 06:42:37,363
WOULD HAVE EXPECTED.

9598
06:42:37,363 --> 06:42:41,400
SO I BELIEVE NATIVE AMERICANS

9599
06:42:41,400 --> 06:42:42,835
HAVE MULTIPLE -- CERTAINLY

9600
06:42:42,835 --> 06:42:44,604
CONNECTIVE TISSUE DISEASE WAS A

9601
06:42:44,604 --> 06:42:46,339
FREQUENT PHENOTYPE WE

9602
06:42:46,339 --> 06:42:47,707
ENCOUNTERED AND I THINK WE

9603
06:42:47,707 --> 06:42:49,709
SHOULD PARTNER TO STUDY THIS

9604
06:42:49,709 --> 06:42:56,449
POPULATION IN MUCH MORE DETAIL.

9605
06:42:56,449 --> 06:42:58,918
>> ALL RIGHT.

9606
06:42:58,918 --> 06:43:01,821
WELL, WITH THAT, I'M GOING TO

9607
06:43:01,821 --> 06:43:06,359
MOVE ON TO JUST A SHORT OVERVIEW

9608
06:43:06,359 --> 06:43:07,260
OF TOMORROW.

9609
06:43:07,260 --> 06:43:08,361
WE'RE A LITTLE OVER TIME.

9610
06:43:08,361 --> 06:43:10,196
IT'S BEEN A GREAT DAY.

9611
06:43:10,196 --> 06:43:12,398
I HAVE TO SAY, WITH SOME

9612
06:43:12,398 --> 06:43:13,733
EXCELLENT SPEAKERS, EXCELLENT

9613
06:43:13,733 --> 06:43:16,602
TALKS AND EXCELLENT DISCUSSION.

9614
06:43:16,602 --> 06:43:18,537
TOMORROW WE WILL CONTINUE WITH

9615
06:43:18,537 --> 06:43:20,840
HEALTH DISPARITIES IN PULMONARY

9616
06:43:20,840 --> 06:43:22,375
VASCULAR DISEASE LOOKING

9617
06:43:22,375 --> 06:43:24,010
SPECIFICALLY AT HEAT EXPOSURE

9618
06:43:24,010 --> 06:43:27,380
WITH DR. MARON, DR. LIM AND

9619
06:43:27,380 --> 06:43:29,815
THERE MATHAI WILL GIVE US SOME

9620
06:43:29,815 --> 06:43:31,550
MORE INSIGHTS INTO

9621
06:43:31,550 --> 06:43:32,084
IMPLEMENTATION SCIENCE.

9622
06:43:32,084 --> 06:43:36,255
AND THEN WE'LL MOVE ON TO THE

9623
06:43:36,255 --> 06:43:39,425
OMICS PRESENTATIONS AND GENOMICS

9624
06:43:39,425 --> 06:43:44,897
WHICH I'M REALLY EXCITED TO SEE,

9625
06:43:44,897 --> 06:43:50,803
WITH DR. ORTEGA AND DR. GLEN AND

9626
06:43:50,803 --> 06:43:52,104
DR. DESAI AND LASTLY WE'LL

9627
06:43:52,104 --> 06:43:56,809
FINISH THINGS UP WITH THE

9628
06:43:56,809 --> 06:43:58,110
PVD OMICS SESSION BEFORE WE MOVE

9629
06:43:58,110 --> 06:44:00,646
TO IT A DISCUSSION SESSION.

9630
06:44:00,646 --> 06:44:01,514
DR. LEOPOLD, DO YOU HAVE ANY

9631
06:44:01,514 --> 06:44:02,581
OTHER COMMENTS FOR THE DAY?

9632
06:44:02,581 --> 06:44:04,784
>> I JUST WANT TO SAY IT
REALLY

9633
06:44:04,784 --> 06:44:07,520
HAS BEEN A FANTASTIC DAY OF

9634
06:44:07,520 --> 06:44:09,055
TALKS, AND I'M REALLY LOOKING

9635
06:44:09,055 --> 06:44:11,357
FORWARD TO CONTINUING THE

9636
06:44:11,357 --> 06:44:11,958
DISCUSSION TOMORROW.

9637
06:44:11,958 --> 06:44:15,061
AND MANY THANKS TO TODAY'S

9638
06:44:15,061 --> 06:44:17,763
SPEAKERS.

9639
06:44:17,763 --> 06:44:23,836
>> DR. X I AO?

9640
06:44:23,836 --> 06:44:24,737
>> NOTHING TO ADD.

9641
06:44:24,737 --> 06:44:26,672
JUST TO ECHO WHAT JANE SAID,

9642
06:44:26,672 --> 06:44:28,541
THIS IS A REALLY WONDERFUL

9643
06:44:28,541 --> 06:44:29,742
MEETING AND I LEARNED A LOT FROM

9644
06:44:29,742 --> 06:44:30,776
ALL THE SPEAKERS.

9645
06:44:30,776 --> 06:44:32,578
THANK YOU TO EVERYONE'S EFFORT.

9646
06:44:32,578 --> 06:44:33,679
I'M LOOKING FORWARD FOR

9647
06:44:33,679 --> 06:44:34,947
TOMORROW'S MEETING.

9648
06:44:34,947 --> 06:44:35,982
>> ALL RIGHT.

9649
06:44:35,982 --> 06:44:36,182
GREAT.

9650
06:44:36,182 --> 06:44:38,384
WE WILL SEE EVERYONE AT

9651
06:44:38,384 --> 06:44:39,485
10:00 A.M. EASTERN TIME

9652
06:44:39,485 --> 06:44:39,752
TOMORROW.

9653
06:44:39,752 --> 06:44:41,220
THANKS AGAIN.

9654
06:44:41,220 --> 06:44:41,754
HAVE A GOOD DAY.

9655
06:44:41,754 --> 06:44:43,122
>> ALL RIGHT.

9656
06:44:43,122 --> 06:44:43,356
THANKS.

9657
06:44:43,356 --> 06:44:46,125
>> BYE-BYE.

9658
06:44:46,125 --> 06:44:48,694
[THE MEETING CONCLUDED AT

9659
06:44:48,694 --> 06:44:58,938
5:38 P.M. EST]