>> GOOD AFTERNOON EVERYONE. WELCOME TO THOSE HERE IN MASUR AND PEOPLE WATCHING VIDEOCAST I'M FRANCIS COLLINS THE DIRECTOR OF NIH AND I'M GLAD TO DO THE INTRODUCTION TODAY OF THE WEDNESDAY AFTERNOON LECTURE. THIS IS ELIZABETH OFILI WHO WILL SPEAK TO US ON AN INTERESTING TOPIC WITH AN INTERESTING TITLE AND WE'LL LEARN ABOUT THE CONSEQUENCES OF THAT EQUATION AS LEZ ELIZABETH COMES TO SPEAK TO US AND SENIOR ASSOCIATE DEAN FOR CLINICAL AND TRANSLATIONAL RESEARCH AT MOREHOUSE SCHOOL OF MEDICINE AND IS A CARDIOLOGIST AND GOT HER UNDERGRADUATE TRAINING IN NIGERIA AND MASTERS IN PUBLIC LEDGE FROMMONS HOPKINS AND DID INTERNAL RESIDENCY IN OKLAHOMA AND CARDIOLOGY FELLOWSHIP AND IS AT MOREHOUSE WHERE SHE IS SENIOR ASSOCIATE DEAN AND SHE IS THE FIRST WOMAN TO SERVE AS PRESIDENT OF THE ASSOCIATION OF BLACK CARDIOLOGISTS AND AN ELECTED MEMBER OF THE NATIONAL ACADEMY OF MEDICINE AND SHE IS PART OF THE NATIONAL RESEARCH MENTORING NETWORK WHICH IS A MAJOR INVESTMENT TO TRY TO IMPROVE OPPORTUNITIES FOR TRADITIONALLY UNDER REPRESENTED GROUPS TO FIND IT THEIR WAY TO SCIENTIFIC CAREERS A PROGRAM WE'RE EXCITED ABOUT. HER RESEARCH HAS FOCUSSED PARTICULARLY ON UNDERREPRESENTED POPULATION AND VARIOUS ASPECTS OF CARDIOLOGY PARTICULARLY IN THE AREA OF HYPERTENSION AND IS A NOTABLE VOICE IN THIS AREA WE ARE PARTICULARLY FOCUSSED ON RIGHT NOW ON HOW WE COULD DO A BETTER JOB OF DOING RESEARCH THAT POINTS TO THE CAUSES AND BETTER YET WHAT EFFECTIVE IMPLEMENTATIONS MIGHT BE TO DEAL WITH THE PROBLEM OF HEALTH DISPARITIES. I'M PARTICULARLY DELIGHTED TO BE ABLE TO INTRODUCE HER AND ASK YOU ALL PLEASE GIVE A WARM WELCOME TO DR. ELIZABETH OFILI. >> GOOD AFTERNOON. THANK YOU MR. COLLINS FOR THOSE KIND WORDS. IT'S REALLY MY DISTINCT PLEASURE AND HONOR TO BE HERE AND I THANK THE THANK THE SELECTION COMMITTEE FOR THIS COMMUNITY. AS DR. COLIN SAID I'LL BE SPEAKING ABOUT THIS TITLE I CALL DEMOCRATIZING AND HOW WE CAN BE MORE INCLUSIVE IN GETTING INDIVIDUALS TRADITIONALLY UNDERREPRESENTED IN MEDICINE AND RESEARCH TO BE MORE ENGAGED. AND WE HAVE TO BORROW FROM SOCIAL SCIENCE, BEHAVIORAL SCIENCE AND OTHER CARDIOLOGISTS STRINGING FAR AFIELD SO CLEARLY I NEEDED A LOT OF COLLABORATORS. SO I REALLY WELCOME YOU TO CRITIQUE THIS WORK AND GIVE ME YOUR HONEST FEEDBACK. AS FAR AS DISCLOSURES HAVE A PATENT WORD FOCUSSED ON CHRONIC ILLNESS CARE AND IT IS ALSO IN A TRANSFER FACULTY START UP IN COLLABORATION WITH MOREHOUSE SCHOOL OF MEDICINE. I'D LIKE TO REMIND US AND I KNOW ALL OF US IN THE ROOM ARE AWARE OF THAT AT NIH IN TERMS OF THE CHALLENGE OF DIVERSITY AND INCLUSION IN CLINICAL TRIAL AND CERTAINLY IN THE NEW INITIATIVES WITH PRECISION MEDICINE THAT WOULD INVOLVE 1 MILLION PERSON COHORT. WE WILL HAVE AN OPPORTUNITY WITH MOBILE TECHNOLOGY ESPECIALLY AS WE LOOK AT THE ENGAGEMENT OF MINORITY PATIENTS IN UNDERSERVED POPULATIONS. THERE'S ALSO NOW THE NEW RESEARCH THAT'S ALLOWING US TO LINK BEHAVIOR CHANGE TO CLINICAL RESEARCH PARTICIPATION ESPECIALLY WHEN WE'RE TALKING ABOUT CHRONIC HEALTH MANAGEMENT AS YOU'LL SEE. I'D LIKE TO INTRODUCE THIS CONCEPT OF P4 WOMEN'S HEALTH WHICH IS A PREDICTIVE PERSONALIZED PREVENTIVE AND PARTICIPATIVE PROCESS MAKING ITS WAY FORWARD IN INTERVENTION AND I'M INTERESTED HOW WE INTEGRATE NIH NETWORKS AT INSTITUTIONS AND COLLABORATING PARTNERS AS WE APPROACH THIS DIFFICULT QUESTION OF ADDRESSING HEALTH EQUITY RESEARCH. SO I WANT TO BEGIN WHERE I REALLY START TO HAVE THESE KIND OF IDEAS AT THE BEDSIDE OR IN THE COMMUNITIES. THIS IS FNO. SHE'S A 76-YEAR-OLD WOMAN WITH HYPERTENSION, DIAGNOSED WITH DIABETES IN NOVEMBER 2011 AND AT THE TIME HER HEMOGLOBIN WAS AT RATED AND SHE WAS SPONSORED BY THE ATLANTIC TRANSLATION OF SCIENCE INSTITUTE.SIX MONTHS LATER SHE HAD LOST 25 POUNDS WHICH IS HOW YOU SEE HER NOW. HER A1C IS 5.5 AND OFF METFORMIN AND MONITORS HER BLOOD PRESSURE AND BLOOD GLUCOSE DAILY AND TRACKS HER ACTIVITY AS SHE WALKS THROUGH FIVE MILES SIX DAYS A WEEK. WHAT YOU SEE IS THE DATA SHE GETS BACK. THE MONITORING PROCESS IS USING THE TYPE OF PHONE SHE HAS IN HER HAND WHICH IS AN ANDROID PHONE AND THE BLOOD PRESSURE DEVICES ARE CAN COME BACK IN A SYNCHRONIZED MANNER TO THE PHONE. SHE'S ABLE TO TRACK IT OVER SEVERAL MONTH OR WEEKS DEPENDING ON HER APPOINTMENT SCHEDULE ABLE TO RESPOND WHEN YOU LOOK AT THE BLOOD PRESSURE GRAPH IT'S COLOR CODED IN RED, YELLOW, GREEN AND ALLOWS HER IN A QUICK WAY TO KNOW WHETHER SHE SHOULD ACT OR NOT AND WHEN SHE SHARES THE DATA WITH HER DOCTOR DURING THE VISIT IT ALLOWS FOR A MORE EFFECTIVE CLINICAL ENCOUNTER. SO CLEARLY THIS TECHNOLOGY IS BECOMING MORE COMMON THE PROBLEM IS A LOT OF INDIVIDUALS USING IT ARE THOSE THAT ARE RELATIVELY WELL OR WANT TO BE PHYSICALLY ACTIVE OR HAVING A CHALLENGE GETTING IT IN THE HANDS OF INDIVIDUALS WITH CHRONIC ILLNESSES. AS YOU KNOW CHRONIC DISEASES ARE THE LEADING CAUSE OF DEATH AND DISABILITY IN THE UNITED STATES AND WE'RE TALKING ABOUT HEART DISEASE, STROKE, CANCER, TYPE II DIABETES, OBESITY, ARTHRITIS AS THE MORE COMMON ONES AND THEY'RE QUITE EXPENSIVE AND INTERESTINGLY AS WE LOOK AT THE NUMBER OF ADULTS EFFECTED 117 MILLI MILLION PEOPLE WITH AT LEAST ONE CHRONIC DISEASE AND RECOGNIZE CLEARLY THERE ARE SOME BEHAVIORAL RISK FACTORS THAT ARE ASSOCIATED COMMONLY WE WILL RECOGNIZE LACK OF EXERCISE OF PHYSICAL ACTIVITY AND POOR NUTRITION, THINGS WE CAN ACTUALLY TRACK AND INTEGRATE INTO OUR CARE. ONE OF THE CHALLENGES HERE ALL OF US KNOW IS WHAT IS IT THAT WOULD ENABLE US TO SUSTAIN PHYSICAL ACTIVITY FROM A BEHAVIOR CHANGE STANDPOINT. WHEN WE LOOK AT THE AMOUNT OF MONEY INVOLVED, $264 BILLION CLEARLY IT'S A MAJOR IMPACT TO THE HEALTH CARE SYSTEM. WHAT IS EXCITING TO US AS WE BEGAN TO APPROACH THIS CHALLENGE IS THE EVIDENCE THAT AMONG INDIVIDUALS WHO ARE LIVING WITH CHRONIC DISEASE, SELF-MONITORING OR TRACKING OF HEALTH CARE INDICATORS APPEAR TO EFFECT HOW AN INDIVIDUAL WILL ACTUALLY RESPOND AND ACT ON THAT CHRONIC DISEASE AND I'M NOT SHOWING THAT INFORMATION HERE BUT IT TURNS OUT MINORITY APPRECIATES AND AFRICAN-AMERICANS ARE MORE LIKELY TO TRACK IN SOME FASHION NOT ALWAYS ELECTRONICALLY BUT IN SOME FASHION SO IT'S AN OPPORTUNITY. IT BRINGS ME TO THE OTHER AREA WE BELIEVE SAY HUGE OPPORTUNITY. MANY OF US WERE VERY EXCITED WHEN PRESIDENT BARACK OBAMA IN THE STATE OF THE UNION ADDRESS BEFORE THE LAST ONE JANUARY 2015 SAID WE HAVE AN OPPORTUNITY TO LOOK AT NEW MEDICAL BREAKTHROUGHS AND THIS IS AGAIN WHAT THE NIH THROUGH THE INNOVATION AROUND AS WELL AS WITH THE DIRECTOR HAVE PUT OUT AN INITIATIVE CALLED THE PRECISION MEDICINE INITIATIVE. NOW, OBVIOUSLY THERE'S AN OPPORTUNITY TO INTEGRATE TECHNOLOGY GENOME SCIENCE AS WELL AS BEHAVIOR AND ENVIRONMENTAL RISK. HOWEVER, I THINK THE QUESTION IS RELEVANT WHEN WE ASK THIS, HOW WILL THE PRECISION MEDICINE INITIATIVE ENSURE DIVERSITY AND INCLUSION. THE REASON THE QUESTION IS IMPORTANT IS THE MOST RECENT IOM ROUND TABLE WHICH I WAS A PARTICIPANT IN AND IT SIMPLY ASKED AND PRESENTED STRATEGIES FOR ENSURING DIVERSITY INCLUSION AND PARTICIPATION IN CLINICAL TRIALS. THERE WERE NO MAJOR BREAKTHROUGHS AT THE WORKSHOP BUT WE WERE ALL ASKED TO CONTINUE TO LOOK AT INNOVATION IN TECHNOLOGY AND ENGAGEMENT IN ADDRESSING THIS CRITICAL PROBLEM. SO WITH COLLABORATORS WE'RE LOOKING AT THE FACT THAT AN INDIVIDUAL OBVIOUSLY IS PART OF AN ENTIRE ECO SYSTEM THAT INCLUDES OBVIOUSLY FAMILY MEMBERS, SOCIAL NETWORKS AND OTHER MACRO LEVEL ENVIRONMENTAL INTERACTIONS AND WE KNOW THIS HAS IMPACT ON DISEASE BUT WE DON'T REALLY KNOW NUMBER ONE, HOW TO PROPERLY DOCUMENT AND INTEGRATE THESE VARIOUS FACTORS AND HOW TO ACTUALLY ASK A QUESTION ARE WE INFLUENCING ANY OF THESE BEHAVIORS OR CHANGES WHEN WE DO ANY FORM OF INTERVENTION IN CHRONIC DISEASE. SO JUST TO REMIND US AND THIS IS WHERE I'M GOING SPEND TIME. IN TERMS OF INDIVIDUAL FACTORS WE KNOW AN INDIVIDUAL HAS TO HAVE A SKILL SET AND THERE'S A BIOLOGY AND WHATEVER THE DEMOGRAPHIC CATEGORY IS AND OF COURSE MOTIVATION. THE NETWORKS AROUND THEM WERE FINDING WHETHER IT'S FAMILY, FRIENDS PLAY AN IMPORTANT ROLE AND WE WON'T TALK ABOUT THESE BUT I WILL MENTION AN ACTIVITY WITH THE CHURCH SETTING AS WELL AS WITHIN THE HEALTH SYSTEM BUT OBVIOUSLY THESE ARE OPPORTUNITIES AS WE BEGIN TO UNDERSTAND BETTER HOW TO MEASURE AND DOCUMENT AND PUT IT TO USE FOR ANY GIVEN INDIVIDUAL. SO THIS IS WAY WE STARTED OUT WITH THIS TECHNOLOGY. THIS IS ACTUALLY FUNDED BY THE NATIONAL CENTER FOR ADVANCED AND TRADITIONAL SCIENCE AND THE MINORITY HEALTH AND HEALTH DISPARITIES THROUGH OUR RESPECTIVE PROGRAMS AT MOREHOUSE AND THE ATLANTA CTSA. THIS WOMAN IS A DIABETIC WOMAN AND THIS GENTLEMEN IS PART OF THE CHURCH CALLED BIG BETHEL AME CHURCH. WHAT'S SPECIAL ABOUT THE CHURCH IS THE MINISTER WAS INTERESTED IN THIS TYPE OF INITIATIVE THAT INVOLVES TECHNOLOGY. THEY HAVE LOTS OF DIABETICS AND OUR RESEARCH TEAM WAS INTERESTED IN LEARNING MORE ABOUT THIS LED BY THE MOREHOUSE SCHOOL OF MEDICINE. SO THERE WAS A UNIQUE BE WAY TO ENGAGE. REMEMBER, THIS IS NOT A HEALTH SYSTEM. I DIDN'T MENTION THAT. THIS IS ACTUALLY IN THE CHURCH SETTING. AND AS YOU CAN SEE YOU CAN'T SEE THE MONITOR BECAUSE THERE'S A PRIVACY SCREEN RELATE TO THAT AND SUBSEQUENTLY THE INFORMATION IS NOW ON THE iPHONE AS WELL AS THE ANDROID PHONE. HERE'S AN ENCOUNTER WITH A TRUSTED CHURCH MEMBER AND ONE OF THE INTERESTING THINGS WE FOUND WE EVALUATED ABOUT 350 INDIVIDUALS ROUGHLY HALF WERE IN THE CHURCH SETTING AND THE OTHER HALF WERE IN PRIMARY CARE PRACTICES. THE INDIVIDUALS IN THE CHURCH SETTINGS DID MUCH BETTER. WE ALSO DID AN ASSESSMENT AND I'LL SHOW YOU SOME DATA IN A FEW SLIDES ASSESSMENT WITH THE CITY OF ATLANTA WHICH IS A WORK SITE. WE TOTALLY -- THE WHOLE THING DID NOT WORK. LATER ON WE FOUND OUT IN THE WORK SETTING PEOPLE ARE RELUCTANT TO ENGAGE ABOUT THEIR HEALTH. IT WOULD MAKE SENSE NOW THAT WE'VE GONE THROUGH IT BUT AT FIRST WE THOUGHT WE COULD DO IT IN A CHURCH TOO AND WHY DIDN'T IT WORK IN THE DOCKING TO BE DOCTOR'S OFFICE? IT WORKED BUT YOU CAN SEE FROM THE QUALITATIVE ASSESSMENTS THE PARTICIPANTS HAD SOME UNIQUE CONNECTION WITH THE HEALTH COACHES AS THEY PARTICIPATED. I JUST WANT TO INTRODUCE WHAT WE CALL THIS HEALTH 360X. AGAIN IT'S A PATIENT ENGAGEMENT TECHNOLOGY. THIS IS EXACTLY HOW WE PRESENT IT TO THE PARTICIPANTS. WE KEEP IT VERY SIMPLE. WE USE LARGE FONT SO THEY UNDERSTAND AND THEY KNOW THAT THIS ALLOWS THEM TO ENGAGE THEIR HEALTH, MANAGE THEIR HEALTH AND INTERACT WITH THEIR HEALTH COACH OR A PHYSICIAN. THEY'RE ABLE TO VIEW, RECORD AND PRINT THEIR HEALTH DATA AND ABLE TO MANAGE HEALTH THROUGH THIS MOBILE APP AND ABLE TO CONNECT WITH PHYSICIAN AND HEALTH COACHES AND AN ONLINE COMMUNITY. HOW DO WE USE IT? WE TEACH THEM IN SESSIONS AND THEY WORK WITH A COACH IN ASSESSING BLOOD GLUCOSE AND TRACK FITNESS, IDENTIFYING NUTRITION AND MANAGE THEIR MEDICATIONS. THEY CAN DOWNLOAD THIS TECHNOLOGY FROM THE APPLE STORE OR THE ANDROID STORE. WE HAVE THE ABILITY TO INTEGRATE THE AMERICAN ASSOCIATION DIABETES CURRICULUM TO HELP THEM AND TRACK WHEN THEY WORK THROUGH THE CURRICULUM OR NOT. SOME OF THE ASPECTS IS BASED OB A WEB PLATFORM BECAUSE WE CAN'T PUT ALL OF THAT ON AN iPHONE. AND WE SHARE WITH THEM THERE'S A LOCK BOX AND SECURITY AND IT'S STORED AT THE DATA CENTER A PARTNER OF MOREHOUSE SCHOOL OF MEDICINE. THE MOST IMPORTANT THING THE PARTICIPANTS SEEM TO ENJOY IS THEY CAN IN THE -- INTERACT WITH COACHES AND WE CALL THEM E-PATIENTS AND WHAT IS THE THEORETICAL BASIS OF THIS PROCESS? WELL, SO THIS IS WHAT'S KNOWN AS THE HEALTH INFORMATION TECHNOLOGY APPLICATION. IT DOES INCORPORATE CONSTRUCTS AND WE USE A SYSTEM CALLED THE COM-B. IT SPEAKS TO A WAY TO TRACK, ASSESS AND MANAGE BEHAVIOR. THERE'S AN ACCOUNTABILITY ELEMENT TO THAT. THEY GET THE INCENTIVE OF FEEDBACK BASED ON THE CONSTRUCT. WHAT'S IN THE CONSTRUCT? YOU HAVE THE ELEMENT WITHIN THE TECHNOLOGY THAT ALLOWS YOU TO LOOK AT CURRICULUM AND CREATE STORIES ABOUT YOUR HEALTH AND ALSO IMPORTANTLY WE'RE ABLE TO LOOK AT CAPABILITY AND ENHANCED CAPABILITY AND OPPORTUNITY FOR BEHAVIOR CHANGE AND ABLE TO TEST MOTIVATION. THIS TERMS THE LEVELS OF THE CHANGES HELP US FIGURE OUT DO WE NEED TO DO MORE TRAINING AND GO BACK TO SOME OF OUR INTERVENTION ELEMENTS. SO IN OUR INITIAL ASSESSMENT ABOUT 300 PARTICIPANTS WERE INVOLVED. THE AVERAGE AGE 62 AND 44% WERE OVER 65 YEARS OLD AND 70% WOMEN AND OF COURSE THERE WERE MORE OVERWEIGHT AND WITH DIABETES. THIS IS WHAT THEY SEE ON A REGULAR BASIS AND WHAT THE HEALTH COACH WORKS WITH THEM ON AND SOME DIVE DEEPER IN TERMS OF NUTRITION AND ACTIVITY BUT THIS IS THE BASIC ASSESSMENT AND MONITORING. >> SO WHAT DID WE LEARN? STARTED WITH THE BASELINE BLOOD PRESSURE FOR DIABETES THAT'S HIGH WE WERE ABLE TO SUSTAIN SIGNIFICANT REDUCTION AT 12 WEEKS AND MAINTAIN AT 52 WEEKS THE DIFFERENCE WAS THERE A HEALTH COACH INVOLVED AND THERE WAS A WEEKLY ASSESSMENT BY THE HEALTH COACH BUT AT THE END OF 12 WEEKS THE HEALTH COACH WAS ONLY PARTICIPATED ON AN AS-NEEDED BASIS AND WE WERE ABLE TO SHOW SOME PERSISTENCE AND WE WERE EXCITED ESPECIALLY SINCE WE SAW MORE OF AN IMPACT COME WITH THE CHURCH GROUP COMPARED TO THE HEALTH SYSTEM GROUP. THIS IS THE BLOOD GLUCOSE AND PHYSICAL ACTIVITY INCREASED. AND ONE THING FOLKS ASKED AS THE DATA WAS PRESENTED WERE WHAT ARE SOME OF THE BARRIERS WE ENCOUNTERED AND WITH THE QUALITATIVE AND SEMI QUALITATIVE ASSESSMENT AND USE FOCUS GROUPS AND ONE OF THE INFORMATION THAT WAS TRACKED WAS HOW LONG PEOPLE STAYED WITH THE APP AND STAYED TO TRACK BEHAVIOR BEFORE THEY DISCONNECTED JUST TO TEST PERSISTENCE AND IT DIDN'T SEEM LIKE AGE OR ETHNICITY WAS A BARRIER TO ENGAGING. SIMILARLY WHETHER AN INDIVIDUAL OWNED A COMPUTER OR NOT DIDN'T SEEM TO BE A BARRIER. WHEN THEY WANTED TO WORK ON THE LAP TO BE AVAILABLE AT THE CHURCH OR GROCERY STORES BUT MANY OF THEM WORKED WITH THE PHONE AS YOU SAW WITH OUR EXAMPLE. ONE OTHER ITEM WAS THE ABILITY TO USE A COMPUTER AS PROVIDED. YOU ARE ABLE TO SEE THEY DID NOT SEEM TO BE A CLEAR DIFFERENCE IN TERMS OF ENGAGEMENT WE CHECKED IF THEY'RE ENGAGED OR CHECKING OUT. WE NOTICED PEOPLE WHO HAD ANXIETY ABOUT THEIR ABILITY TO USE THE INTERNET OR DISCOMFORT IN PUTTING HEALTH INFORMATION ONLINE EXPERIENCED SIGNIFICANT BARRIERS. IF THEY HAD ANXIETY THEY WERE LESS LIKELY TO BE IN THE 24 PERCENTILE OR IF THEY WERE UNCOMFORTABLE THEY WERE LESS LIKELY TO REMAIN ENGAGED. SO ONE OF THE ASSESSMENTS CONDUCTED WAS WE WANTED TO SEE WHAT WAS AND WHAT KEPT PEOPLE PERSISTENT AND ONE WERE EMPOWERMENT AND ENGAGEMENT AND THAT POPPED OUT. THEY'RE WORKING ON A WORD CLOUD LATER ON BUT I WANTED TO PULL OUT SOME THOUGHTS HERE BECAUSE IT RESONATED ACROSS THE BOARD. I MET THE GROUP AS THEY FINISHED THEIR WORK AND I COMMENT I THOUGHT WAS RELEVANT IS FROM UPLOADING IT MONDAY AND THE GRAPH WAS TELLING ME MY SUGAR WAS HIGH AND I NEEDED TO REDUCE MY SALT INTAKE SO THERE'S ACTIVE ENGAGEMENT AND INTERACTION SO IF YOU KNOW THAT AND AFTER WE UPLOAD THE INFORMATION I NOTICE IT'S GIVING ME BACK THINGS I CAN DO TO HELP MYSELF. FROM THE STANDPOINT OF EMPOWERMENT IS WHEN YOU HAVE TO GO TO THE DOCTOR YOU TAKE TIME OUT BUT WITH THE SYSTEM I HAVE IT IN MY HAND AND CAN INTERACT AND THAT'S WHAT THE COMMENT WAS ABOUT. IT'S IN FRONT OF YOU ON THE SCREEN AND ANOTHER IS SAYING I'M LEARNING AND IT'S HELPING ME WITH THE DIABETES AND I'M LEARNING ON THE COMPUTER AND YOU'LL RECALL THESE INDIVIDUALS WERE NOT NECESSARILY HIGHLY EDUCATED OR YOUNG. IT MAKES IT EASIER BECAUSE HAVE YOU SOMEONE YOU CAN TALK TO. WE'RE KINDRED SPIRITS BECAUSE WE HAVE THE SAME CONDITION. WE DIDN'T KNOW HOW LONELY IT IS ABOUT HOW DIABETICS FEEL WITH PROBLEMS LIKE THIS. I'M GOING TO GO ON TO HOW THIS HAS BEEN EVALUATED IN THE NEXT STAGE. THE CONCLUSION WAS THAT HAVING THESE KINDS OF TECHNOLOGY PEOPLE ARE NOT JUST GOING ADOPT IT. WE NEED AN EFFORT TO HELP THEM IDENTIFY THEMSELVES IN THE TECHNOLOGY THROUGH THEIR MEASUREMENTS. THIS IS PART OF MY TAKE ON THAT EQUALS ME BECAUSE I'M LEARNING ABOUT MYSELF AND IT SEEMS TO RELATE TO HOW WELL I ENGAGE IN TERM OF MY HEALTH AND FOLLOW-UP. I WANT TO SWITCH GEARS TO MORE TRADITIONAL RESEARCH WHERE WE LOOKED AT INDIVIDUALS WITH OBESITY AND ONCE AGAIN TRYING TO FIGURE OUT HOW TO ENGAGE IN LONG-TERM BEHAVIOR MODIFICATION. THIS IS AN EXPRESSION PROFILE AND ONE OF THE -- LET ME ORIENT. I KNOW YOU CAN'T THIS BUT THESE ARE THE LEAD INDIVIDUALS TO THE RIGHT OF THE MAP AND THE OBESE INDIVIDUALS AND WHAT WE NOTICE IS REGULATION ON INFLAMTORY FACTORS AND THOSE AMONG OBESE IN REGULATION OF INFLAMMATORY FACTORS AND DOWN REGULATION OF IMMUNE FACTORS SO THAT'S WHAT SOME OF THESE MARKERS ARE BUT THE MAIN THING WE SHARE WITH OUR PARTICIPANTS IS IT IS A DIFFERENT HEAT MAP IF YOU'RE LEAN VERSUS OBESE. KIND OF OPPOSITE. THE OTHER THING WE SHARED WITH THEM AND THEY GOT IT BECAUSE IT'S CELLS WE ASSESS IN THE TEST IT MEANS THERE'S THE POTENTIAL FOR THIS TO BECOME A PERMANENT PART OF THEIR VASCULAR FUNCTION. THERE'S AN ABNORMALITY OF THE BLOOD VESSELS AND PREDISPOSITION TO THE CONDITION BASED SIMPLY ON OBESITY. SO WE SHARE THE INFORMATION WITH OUR COMMUNITY GROUP. THIS GENTLEMEN IS THE CHAIR OF OUR COMMUNITY ADVISORY BOARD AND CAME WITH US TO THE RADIO STATION AND SPOKE UP ABOUT WHAT NEEDED TO BE DONE. HERE WE'VE RECRUITED HIM AS A CITIZEN SCIENTIST. WE DIDN'T HAVE TO HAVE THAT COMMUNICATION. THIS IS ANOTHER MODEL WE'RE TESTING TO SEE HOW THEIR ENGAGEMENT PERSISTS BASED ON THEIR INTERACTION AND KNOWLEDGE OF THE SCIENCE. I WANT TO REMIND EVERYONE THAT GOING TO THE COMMUNITY TAKES A LOT OF EFFORT SO WE AT MOREHOUSE SCHOOL OF MEDICINE HAVE A MOBILE RESEARCH UNIT WHICH IS THE FIRST OF ITS KIND IN GEORGIA STRICTLY USED FOR RESEARCH AND AS YOU CAN SEE WE CAN DO EXAMS AND STRESS TESTING IN THE BACK HERE. SINCE I'M A CARDIOLOGIST WE CAN PARK THIS AT MAJOR HEALTH FAIRES AND INDOOR ACTIVITIES. THIS IS INSIDE AND WE SET UP TENTS AND DO ALL THESE ASSESSMENTS. THIS IS A COMMUNITY NURSE. THIS IS A MASTER OF SCIENCE TRAINER AND SHE PROVIDES COMMUNICATION TO THE PARTICIPANTS AND IS ALWAYS ON THE MOBILE UNIT. YOU CAN'T SEE THIS YET. IT SAYS FREE SCREENING AND I KNOW MANY OF YOU RECOGNIZE THAT. FOLKS WILL COME IF YOU PROVIDE THEM A STRATEGY TO ALSO GET SOME HEALTH CARE. THE WAY WE DECIDED TO WORK WITH THIS OPPORTUNITY IS TO ENGAGE SOME STRATEGY WE LEARNED FROM DR. LEROY HOOD WHEN HE VISITED MOREHOUSE AND IT'S SIMPLY A SYSTEMS APPROACH TO ADDRESSING PREVENTION. WE'RE FOCUSSING ON WOMEN BECAUSE AS YOU SAW WE HAVE A LOT OF OBESITY AND THERE'S AN ACTIVE INTEREST AND THIS IS A MODEL BASED ON PREDICTIVE, PERSONALIZED AND PREVENTIVE AND P PARTICIPA PARTICIPATORY MODEL. THIS LOOKS AT ARTERIAL STIFFNESS AND LOOKS AT DISEASE OF THE BLOOD VESSEL SO WE'RE ABLE TO RUN THIS PARTICULAR ASSESSMENT IN THE FIELD AND AS YOU CAN SEE HERE THERE IS ACTUALLY -- SHE'S YOUNG SO SHE HAS A VERY GOOD PROFILE BUT IT'S THE VISUAL. YOU CAN VISUALLY LOOK AT A NORMAL WEIGHT FORM VERSUS ABNORMAL WEIGHT FORM AND THIS IS HELPFUL AS WE ENGAGE IN THE FIELD. THIS PARTICULAR TECHNOLOGY HAS BEEN TESTED IN THE MESA STUDY AS WELL AS A NUMBER OF OTHER INDIVIDUALS NOT NECESSARILY AFRICAN-AMERICAN BUT SHOWED A SEPARATION MUCH BETTER THAN FRAMINGHAM IN TERMS OF THE EVENT RATE FOR THOSE THAT HAVE ABNORMAL WEIGHT FORMS VERSUS THOSE THAT HAVE A NORMAL WEIGHT FORM. AND WE TOOK IT ON THE ROAD. THIS IS A LARGE AFRICAN-AMERICAN WOMEN'S ORGANIZATION IN BIRMINGHAM. WE DROVE THE UNIT TO BIRMINGHAM AND THERE WERE OVER 1,000 WOMEN IN THIS ROOM. WHAT WAS AMAZING TO ME WAS THEIR WILLINGNESS TO COME IN AND QUEUE UP AND BE IN LINE TO PARTICIPATE BUT WE HAD TO DO A MODIFICATION. SIMILARLY WE WENT TO THE NATIONAL MEDICAL ASSOCIATION AND THIS TIME WERE LOOKING AT WOMEN PHYSICIANS AND IT'S INTERESTING. WHEN I PULLED UP THE DATA I THOUGHT BECAUSE THEY WERE INDIVIDUALS THAT A LARGE PERCENTAGE OF THEM HAD GRADUATE DEGREES OR Ph.Ds AND SOME COLLEGE WE WOULD NOT FIND THE TYPE OF RISKS WE WERE OBSERVING BUT OF COURSE A THIRD HAD A PROBLEM IN TERMS OF BLOOD PRESSURE THIS IS WHAT WE LOOK AT IN TERMS OF ELASTICITY. THIS SAY HIGHER NUMBER. MUCH HIGHER THAN WHAT WE HAD SEEN IN ANY OTHER REVIEW. AGAIN THE NUMBERS ARE NOT LARGE BUT WE WERE QUITE ALARMED BY THE NUMBER OF DISEASE THAT WE SAW. IT DIDN'T MATTER WHETHER WE LOOKED AT LARGE OR SMALL ARTERIAL COMPLIANCE. WE WONDERED IF IT MATTERED TO THIS WOMEN AND THEY WERE WILLING TO TAKE ACTION AND FOUND THE SAME THING AS THEY SAW THE DATA. SO THE EVENTUAL IS IMPORTANT. THE NEXT QUESTION IS IF WE ENGAGED AS INDIVIDUALS WOULD THEY PERSIST IN AN ONLINE FORUM, LEARNING ABOUT THEIR HEALTH AND ENGAGING WITH A HEALTH COACH AND RECORDING WITH OUR ONLINE TOOL. THE DATA SHOWED OVER A COUPLE MONTH SOME MOBILE INSTALLS, SOME REGISTERED USERS AS YOU SEE AND THIS IS SOME SOCIAL MEDIA STUFF I DON'T COMPLETELY UNDERSTAND. I WAS TOLD LIFE TIME IMPRESSIONS OF 79,000 IS A GOOD THING. I DON'T KNOW, I'D KIND OF LIKE TO HAVE 1 MILLION. IT'S A BROAD RANGE OF PEOPLE YOUNG PEOPLE AND ELDERLY. THERE'S A LOT OF TRAFFIC FOR PEOPLE WHO HAVE INTEREST IN HEALTH, MIND AND BODY AND WE HAVE A HEALTH 360X ONLINE COMMUNITY PATS THWART OF OUR RESEARCH AT MOREHOUSE SCHOOL OF MEDICINE AND WE DO EVENTS AND PEOPLE SIGN UP AND FROM TIME TO TIME THEY'LL CREATE SPECIFIC INCENTIVES TO ENGAGE THE COMMUNITY. SO THE WAY I THINK ABOUT THIS IS WHILE MOBILE TECHNOLOGY IS NOT NEW WHAT WE THINK IS NEW AND INNOVATIVE IS THE OPPORTUNITY TO ENGAGE INDIVIDUALS WHO ARE ARE TRADITIONALLY DIFFICULT TO ENGAGE AND SUSTAIN THAT ENGAGEMENT BECAUSE IT OPENS THE DOOR FOR US TO DO A NUMBER OF OTHER THINGS. RIGHT ANY THEY GO IN WHEN THEY WANT. LEARNING ABOUT THEIR HEALTH AND SPECIFIC DISEASES THAT ARE MORE COMMON AND DIABETES, DITE, MANY PEOPLE WANT TO KNOW ABOUT THAT. IN TRYING TO GO TO THE NEXT STAGE I JUST WANT TO BRING UP A PROBLEM AND CHALLENGE WE HAVE IN CLINICAL MEDICINE. I'M A CARDIOLOGIST AND I'M TALKING ABOUT TO YOU ABOUT OTHER THINGS. FOR THOSE WHO CAN THIS SAYS NOVEMBER 2004. AND THERE'S ON THE THERAPY FOR HEART FAILURE INCLUDING NEUROHORMONAL BLOCKERS INCREASES SURVIVAL AMONG BLACK PATIENTS WITH ADVANCED HEART FAILURE. A FEW OF YOU MAY ASK WHAT'S THE BIG DEAL. THE BIG DEAL WITH THIS IS PRIOR TO THIS WE DID NOT HAVE DRUGS THAT WORKED EFFECTIVELY AMONG BLACKS. THIS IS THE STUDY AND SHOWED THE MORTALITY ADVANTAGE AND THE GUIDELINES WERE CHANGED RIGHT AWAY BUT THE ANALYSIS WAS CONDUCTED BY A COLLEAGUE LOOKING AT GUIDELINES IN HOSPITALS AND WHAT IT ESSENTIALLY SAID WAS LESS THAN 20% OF ELIGIBLE PATIENTS WERE GETTING THIS THERAPY. THIS IS ANOTHER PROBLEM WE HAVE. V EVEN WHEN WE HAVE GOOD THERAPY DOCTORS DON'T NECESSARILY PRESCRIBE IT AND WHERE WE HAVE AN OPPORTUNITY TO NOT JUST LOOK AT A NEW DRUG BUT HOW ARE WE USING EXISTING THERAPY. THIS IS WHERE I'D LIKE TO INTRODUCE OUR PARTNERS ACROSS THE RESEARCH CENTERS AND MINORITY INSTITUTION. THERE ARE 18 SUCH INSTITUTIONS AROUND THE COUNTRY AND YOU CAN SEE THEY'RE SPREAD OUT SO WE HAVE COVERAGE WITH AFRICAN-AMERICAN AND PACIFIC-ISLANDERS AND HISPANIC. THESE ARE NIH FUNDED CENTERS. FIVE ARE HEALTH SYSTEMS. THEY HAVE A COMMUNITY PARTNERSHIP SIMILAR TO MOREHOUSE AND OUR CHALLENGE IT TO BROADEN INSTITUTIONS AND THEY HAVE A NETWORK THEY PARTNER WITH AND WE HAVE A DATA COORDINATING CENTER AND WORK ON AN AGREEMENT. ANOTHER PARTNERSHIP THAT'S IMPORTANT IS THE CLINICAL DATA RESEARCH NETWORK AND THIS IS WHAT THEY'RE ENGAGING IN COLLABORATION WITH HOWARD MEDICAL SCHOOL. I'M GOING TO QUICKLY SAY TO ME WHAT IS EXCITING THE IMA DOESN'T HAVE TO BE TOUCHED. THE TECHNOLOGY IS ABLE TO BE A SIDE CAR. YOU CAN SEE THERE'S MANY SYMPTOMS INVOLVED INCLUDING MOREHOUSE AND GRADY AND NOW WE'RE BRINGING IN THREE RCMI PARTNERS, HOWARD, MEHARRY AND THE UNIVERSITY OF PUERTO RICO AND WE'RE ABLE TO IDENTIFY INDIVIDUALS BASED ON ICB CODE. PART OF THE PARTNERSHIP ARE PHYSICIANS PARTNERING WITH US. I BORROWED THE SLIDE FROM MY COLLEAGUE IN NASA AND NASA HAS BEEN INTERESTED IN THE N EQUALS ONE BECAUSE THEY LIKE TO STUDY THE OPPORTUNITY WITH ASTRONAUTS BECAUSE THEY'RE SPECIAL INDIVIDUALS BUT WE'RE USING THAT MODEL AND SUGGESTING EVERY PATIENT WHO IS POTENTIALLY PARTICIPATING IF THEY CAN GET THEIR INFORMATION IN A MEANINGFUL WAY WOULD ALLOW US AS WE SAW WITH SNL ENGAGE THE PROCESS. THE FLAG BLINKED ON ME AND I HAD AND I'LL VERBALLY DESCRIBE IT THE NATIONAL RESEARCH MENTORING NETWORK IS A NETWORK THAT IS PART OF WHAT WE CALL A DIVERSITY CONSORTIUM AND DR. VALENTINE AS YOU KNOW IS LEADING THE EFFORT. ONE OF THE OPPORTUNITIES WE HAVE IS THE INFRASTRUCTURE IS BEING SET UP FOR ACTIVELY ENGAGING TRAINING AND BECAUSE I DON'T HAVE THE SLIDE I HAVE TO REMIND YOU DR. MERCEDES IS HERE AND SO CHECK IT OUT AND YOU CAN JOIN AS A MENTOR ORS -- OR AS A SCHOLAR AND THERE'S A TRAINING OPPORTUNITY AND WHAT'S MORE EXCITING IS WE HAVE AN OPPORTUNITY TO PARTICIPATE IN COLLABORATORY SPACES IN PROCESS SO INDIVIDUALS WITH SPECIFIC AFFINITY GROUP OR RESEARCH AREAS CAN FIND LIKE MINDED INDIVIDUALS AND BE ACTIVELY ENGAGED. IN CONCLUSION IT REQUIRES MULTILEVEL-CENTERED PATIENT APPROACHES AND OFFER OPPORTUNITIES TO LINK RESEARCH WITH HEALTH SERVICE OF THOSE COMMUNITIES. MORE TECHNOLOGY WITH AN N EQUALS ME INNOVATION APPROACH AND SOCIAL NETWORKS WITH MENTORING ARE A TESTABLE MODEL OF SCIENTIFIC DISCOVERY. THE MODEL SHOULD SUPPORT WORKFORCE DIVERSITY USING COMMUNITY-BASED PARTICIPATORY AND TEAM APPROACH AND THE SLIDE I LOST IS DESCRIBING A REGISTRY IN COLLABORATION WITH THE ASSOCIATION WITH BLACK CARDIOLOGISTS AND LOOKING FOR THE PROBLEM I SHARED TO YOU ABOUT HEART FAILURE WHERE INDIVIDUALS ARE NOT GETTING THE DRUGS THEY NEED SO WE ARE NOW ENGAGING NOT JUST ACADEMIC CENTERS BUT THE CARDIOLOGISTS AND PRIVATE PRACTICE TO LOOK CRITICALLY EVEN AFTER A DRUG IS APPROVED CAN WE IDENTIFY WHAT WORKS BEST FOR WHICH PATIENT. PRETTY MUCH THE FRAMEWORK OF PRE PRECISION MEDICINE INITIATIVE. SO THIS IS AN EXCITING TIME AND AS I COME TO THE CONCLUSION I DO WANT TO ACKNOWLEDGE MANY INDIVIDUALS THAT ARE PART OF THIS WORK. THE FACULTY STAFF AND TRAINEES OF THE CLINICAL RESEARCH CENTER AT THE MOREHOUSE SCHOOL OF MEDICINE. THE COMMUNITY ADVISORY BOARD AND COMMUNITY PHYSICIANS NETWORK OF MOREHOUSE SCHOOL OF MEDICINE AND THE COLLABORATION WITH EMERY UNIVERSITY, MOREHOUSE MEDICINE AND GRADY HEALTH SYSTEMS AND EMERY UNIVERSITY CHILDREN'S HEALTH CARE OF ATLANTA AND THE RCMI TRANSLATIONAL NETWORK AND THE RESEARCH NETWORK WITH THE PRIMARY INSTITUTION AT HARVARD AND STAFF AT CONSORTIUM PARTNERS OF THE NATIONAL RESEARCH MENTORING NETWORK AND OF COURSE I'M GRATEFUL TO MY PATIENTS AND STAFF AT MOREHOUSE AND I THANK YOU ALL VERY MUCH FOR YOUR ATTENTION. >> THANK YOU SO MUCH MR. OFILI. WE CAN TAKE SOME QUESTIONS. PLEASE COME TO THE MICROPHONE. >> THE MEASUREMENTS SUCH AS GLUCOSE AND BLOOD PRESSURE ARE THEY AUTONOMY OR VIA HEALTH CLINIC VISITS. >> TAKEN AT HOME. ON THE PLATFORM THERE'S A GLUCOSE COMPUTER THAT THE DEVICE MANUFACTURERS PUT THEM ON AND IT DOESN'T MATTER WHAT A PATIENT BUYS SUCH AS TO BE ON A HOME PRESSURE MONITOR YOU CAN MONITOR IT AND BECAUSE WE'RE CONNECTED AND PART OF THAT ECO SYSTEM OR TECHNOLOGY INTERACTION WITH HEALTH WE GET THE DATA SO PATIENTS DON'T HAVE TO ENTER IT. >> IT MAY BE OF INTEREST TO YOU IS LAST WEDNESDAY THE FDA APPROVED THE ARTIFICIAL PANCREAS OF MEDTRONIC. I'M NOT SURE FIT HAS TO BE CHECKED BUT THAT WOULD BE SOMETHING VERY INTERESTING IN THE FIELD. APPARENTLY THE FDA IT TAKES DOWN BLOOD GLUCOSE DOWN RELIABLY ENOUGH AND SOMETHING YOU MAY WANT TO INTEGRATE IN YOUR STUDIES, NO? >> ABSOLUTELY. >> THANK YOU. FROM THE AREA OF THE PATIENTS IN CARDIOLOGY AND HEART DISEASE AND HOW IS THE DROP OUT RATE FOR PATIENTS YOU ARE FOLLOWING? >> VERY GOOD QUESTION. THE DROP OUT RATE WAS VERY LOW AND THE REASON WAS WE WERE THE MAIN THING THAT MAKES THIS SYSTEM WORKS IS THE HEALTH COACHES. WE HAVE FOR EXAMPLE A PATIENT AS PART OF THE CHURCH COMMUNITY THAT WAS NOT SHOWING UP TO THE DOCTOR AND THE HEALTH COACHES GET INVOLVED WITH IT. IN THE REAL WORLD THOUGH OF CLINICAL PRACTICE WE'RE HAVING TO REPLICATE THIS USING CARE COORDINATORS. THEY'RE NAVIGATORS WHO INTERACT LIKE THE WAY SOCIAL WORKERS WOULD DO. THOUGH IT SEEMS LIKE A COMPLICATED THING THE NUMBER OF MEMBERS THAT NEED THAT LEVEL OF ENGAGEMENT IS RELATIVELY SMALL BUT THE KEY IS TO IDENTIFY THEM BECAUSE IF YOU DON'T THEY COME BACK OVER AND OVER AGAIN. I DIDN'T MENTION THIS BUT WE HAVE AN INITIATIVE CALLED MOREHOUSE CHOICE THAT INCLUDES GRADY HOSPITAL WHICH IS A SAFETY NET HOSPITAL AND TWO FEDERALLY QUALIFIED CENTERS AND LOOKING AT DIABETES AND ASKING THROUGH THE MEDICARE SHARED SAVINGS PROGRAM WHICH MEANS IF YOU SAVE MONEY WE'RE ABLE TO SHARE IT WITH YOU AND WERE ABLE TO SAVE $3 MILLION FROM TAKING CARE OF THESE, NOT LOT BUT HIGH-RISK PATIENTS. I THINK THEY'RE NOW INCREASING DATA AND BECAUSE OUR PATIENTS ARE HIGH RISK THEY'RE INTERESTED IN REPLICATING THE MODEL IN A LARGER GROUP OF INDIVIDUALS. THAT'S A GOOD QUESTION. THANK YOU. >> THANK YOU, GOOD LUCK. >> THANK YOU OFILI FOR A WONDERFUL TALK. I HAVE A QUESTION AROUND THE INCLUSION AND PARTICIPATE IN CLINICAL TRIALS TO THE CORE OF YOUR TALK. ARE WE SEEING IMPROVEMENT OR INCREASES IN THE PARTICIPATION RATE AND HOW CAN WE FURTHER AUGMENT THAT. >> THAT'S A VERY GOOD QUESTION. THE GOOD NEWS IS WE ACTUALLY ARE SEEING IMPROVEMENTS BUT IT DOES TAKE THE TYPE OF INFRASTRUCTURE I WAS DESCRIBING WHERE WE HAVE MEMBERS OF THE COMMUNITY THAT HAVE COME IN TO BE PART OF OUR RESEARCH TO GO OUT ESPECIALLY WHEN WE START TALKING ABOUT STORING SAMPLES AND DOING BIOPSIES AND THINGS FOR GENETICS. PEOPLE GET ANXIOUS. BEHAVIORAL PROTOCOLS ARE EASIER TO RECRUIT FOR BUT WHENEVER YOU HAVE TO DONATE SAMPLES PEOPLE GET SUSPICIOUS SO THE MORE INTENSE THE INTERVENTION THE MORE YOU'RE GOING TO HAVE TO ENGAGE IN TERMS OF MAKING SURE INDIVIDUALS UNDERSTAND THAT -- THEY NEED TO KNOW WHAT ALL THE PROTECTIONS ARE AND EVEN SO ONE OF THE THINGS THEY'VE SHARED WITH US IS WE DON'T WANT YOU TO COME JUST WHEN HAVE A PROTOCOL. COME ALL THE TIME SO WE SPEND TIME EVERY WEEKEND WITH SOME COMMUNITY OR THE OTHER DOING OUTREACH AND IT PAYS OFF WHEN WE THEN HAVE TO GO OUT AND DO THE PROTOCOL SO WE ARE RECRUITING MUCH BETTER AT LEAST WITHIN OUR COMMUNITY. >> ONE OTHER QUICK QUESTION WHEN I SAW YOUR TITLE N EQUALS ME I IMMEDIATELY THOUGHT OF THE RASH OF SCIENTIST WHO'S PUBLIC THEIR OWN GENOMES AND WERE YOU ENCOURAGING THIS APPROACH AND SHOWING IT WORKS FOR N EQUALS ONE OR N EQUALS ME. SO MY QUESTION IS ARE YOU SEEING IN YOUR PATIENTS AN OPPORTUNITY TO DO THIS? >> YES. IN FACT THE VASCULAR TESTING TOOL IS THE OPPORTUNITY TO ENGAGE THIS AND ONE OF THE QUESTIONS THAT HAVE COME UP THEY SAID I DON'T UNDERSTAND WHY I HAVE AN ABNORMAL VASCULAR SCAN. TELL ME WHAT ELSE I NEED TO DO. I THINK WHEN PEOPLE BELIEVE THEY'RE RECEIVING SOME INFORMATION OF VALUE THEN THEY WILL GO THE NEXT STEP BECAUSE EVERYBODY WANT TO BE BETTER SO WE'RE STORING THE SAMPLES AND THEY KNOW WHEN WE GET RESOURCES WE'LL DO THE GENOMICS TESTING BUT THE BIGGER QUESTION THEY ALWAYS ASK IS ARE YOU GOING RETURN THE INFORMATION TO ME AND THAT'S THE OTHER PART WE NEED TO BE VERY CLEAR ABOUT THAT THIS IS YOUR DATA. IT WILL COME BACK TO YOU AND WHEN WE USE IT YOU'RE NOT IDENTIFIED. PEOPLE ARE VERY ANXIOUS ABOUT THAT. IT'S A GOOD QUESTION, THANK YOU, DR. VALENTINE. >> I'M INTRIGUED BY THE CONCEPT OF THE CITIZEN SCIENTIST. FOR EXAMPLE, HOW MUCH TRAINING DOES IT TAKE TO BE ONE OF YOUR HEALTH COACHES? >> A LOT OF TRAINING. THE HEALTH COACHES TEND TO BE REGULAR PEOPLE. WE HAVE TEN HEALTH COACHES BECAUSE THEY NEED A PANEL OF INDIVIDUALS AT ANY ONE TIME AND WE TRAIN THEM ON THE TECHNOLOGY, WE TRAIN THEM ON DIABETES AND WE TRAIN THEM ON HOW TO INTERACT IN TERMS OF COMMUNICATION. SOME OF THEM MAYBE HAVE A RELATIVE WITH DIABETES OR INTEREST IN A HEALTH-RELATED FIELD BUT GENERALLY THEY'RE NOT CLINICIANS OR NURSES. THEY GENERALLY HAVE EITHER HIGH SCHOOL OR HIGHER EDUCATION. WE FIND THAT AS LONG AS THE CURRICULUM IS WELL LAID OUT THEY'RE ABLE TO FOLLOW IT AND WE DO USE LIKE IF IT'S A DIABETES WE BRING AN EXPERT ON DIABETES TO HELP THEM WITH THE TRAINING. >> AND HAVE YOU FOUND IT HAS TO BE CULTURALLY SENSITIVE? >> YES, ABSOLUTELY. ABSOLUTELY. THAT'S PART OF WHAT THE COMMUNICATION THEY WERE SHARING WITH US WERE INDICATING. ONE REASON WE WERE EXCITED ABOUT THIS IS WHEN WE BROUGHT EVERYBODY BACK WE SAW INDIVIDUALS THAT WERE ESSENTIALLY CRYING BECAUSE THEY SAID WE DIDN'T THINK ANYBODY CARED ENOUGH ABOUT ME. THE HEALTH COACH HAS TO PLAY A BIG ROLE. NOW I'LL TELL YOU WHAT I DIDN'T TELL YOU IN THE BEGINNING I WAS DEALING WITH A WOMAN AND ONE DAY SHE WAS VERY EXCITED SHE SAID FRANKIE IS COMING I SAID WHO IS FRANKIE AND SHE SAID MY HEALTH COACH AND I SAID OH. I CAME BACK THAT DAY AND SHE WAS ALL SMILES AND SAID LOOK, FRANKIE SAID -- THIS IS A NURSE AND I'M A DOCTOR AND I DEVELOPED THE TECHNOLOGY AND SHE SAID FRANKIE SAID I MUST NOT GET TO ORANGE OR THERE'S A PROBLEM AND I SAID,"ORANGE IS JUST 131." SHE SAID NO ORANGE. SHE AND FRANKIE GOT INTO AMAZING INTERACTION AND SHARE RECIPE AND DIFFERENT THINGS. THAT'S THE N EQUALS ONE BUT WE SAW IT AMONG THE INDIVIDUALS THAT PARTICIPATED AND THAT'S WHY SHE PARTICIPATED WITH THE CHURCH GROUP AND IT WAS BETTER IN THE CHURCH GROUP BECAUSE IN PRACTICE PEOPLE WERE DOING A LOT OF OTHER THINGS. THEY DIDN'T HAVE THE TIME TO ENGAGE. >> THANK YOU. >> ONE LAST QUESTION IS IT AS EFFECTIVE WITH MEN AS WOMEN. WE TEND TO TRACK THEM AND THERE WAS NO DIFFERENCE IN RESPONSE RATE. THERE WAS A DIFFERENCE IF PEOPLE -- BECAUSE WE CAN TRACK HOW FREQUENTLY THEY'RE ON THE CURRICULUM. IF THEY DON'T ENGAGE IS WHEN WE SAW A DIFFERENCE.