Thank you for participating!

Thank you to all who contributed to the National Heart, Lung, and Blood Institute (NHLBI) Strategic Visioning Forum. Ultimately, over 1,000 ideas were submitted, with more than 42,000 votes. This remarkable response exceeded expectations and provided a wealth of ideas to draw upon as NHLBI moves forward. Please visit the NHLBI Strategic Visioning page to find out more about the NHLBI Strategic Visioning process.


Welcome to the National Heart, Lung, and Blood Institute (NHLBI) Strategic Visioning Forum. The Institute is gathering ideas for the most compelling scientific priorities in the four NHLBI Strategic Goals to address over the next decade.

Goal 2: Reduce Human Disease

Early cognitive rehabilitation

Does early cognitive rehabilitation (while on vent) improve long term cognitive function in ALI survivors?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : American Thoracic Society member

Voting

1 net vote
1 up votes
0 down votes
Active

Goal 2: Reduce Human Disease

CVD as a comorbidity of HIV-1 Infection

Even in cART treated HIV-1 infected subjects, development of CVD is a major co-morbidity. Research is needed to evaluate the role of various biomarkers as well as anti-retrovirals .Role of ethnicity and gender also seems to be important. Since these persons are rather younger, Framingham concept may not applicable.

Submitted by (@mkumar)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

there are about one million HIV-1 infected individuals in the U.S. more than 50% of them are at a risk to develop CVD despite their infection under control. If the risk factors are known, intervention can be introduced.

Feasibility and challenges of addressing this CQ or CC :

Very much doable. It may be carried across the United States so that role of environments, ethnicity and dietary practices may also be taken into consideration.

Name of idea submitter and other team members who worked on this idea : Mahendra Kumar, Debrah Jones Weiss

Voting

-3 net votes
11 up votes
14 down votes
Active

Goal 2: Reduce Human Disease

Utilizing Competition to Enhance NHLBI’s Clinical Trial Enterprise

During this period of diminishing Federal resources and funding, what novel methods can be employed to effectively conduct clinical trials that address existing and emerging medical and public health issues?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Addressing thecritical challenge would improve clinical trial design, clinical trial efficacy and ultimately completion and reporting of trial results. This approach would most likely save money.

Feasibility and challenges of addressing this CQ or CC :

The Other Transaction Authority already exists within the PHS and NIH and this method has been tested at NCI.

Competition is an important element of successful achievement in everything from sports rivalries to scientific innovation. Examples of this can be cited for the Larry Bird and Magic Johnson hoops competition, Muhammad Ali versus Joe Frazier boxing duels, and the contest between the Human Genome Project and Celera for completion of the mapping of the human genome. The US Defense Advanced Research Project Agency (DARPA http://www.darpa.mil) has used the concept of competition to advance the development of never before imagined scientific and technological innovations including development of the internet, the SIRI voice recognition system, UNIX and the cloud, and the global positioning system, among many products and innovations. Under this paradigm great advances are initiated through a public challenge which brings competitors together to achieve a goal set by the government. This is accomplished through the use of the Other Transaction Authority (OTA), which has been extended to the NIH. Subsequent management of the challenge involves the setting of milestones and utilization of “go/no go” decision making. The NCI has used a “DARPA-like” approach to instill competition for the design and conduct of clinical trials and as a result has substantially improved the performance of its clinical trials networks / cooperative groups.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

-1 net votes
6 up votes
7 down votes
Active

Goal 2: Reduce Human Disease

How can the study of rare diseases inform our understanding of common diseases?

How can the study of rare diseases inform our understanding of common diseases?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : Research Advocacy Committee, American Thoracic Society

Voting

1 net vote
1 up votes
0 down votes
Active

Goal 4: Develop Workforce and Resources

Education in glycobiology is nearly non-existent

Aside from a handful of locations around the country, there are no local opportunities for the vast majority of PhD students to learn about glycobiology. A search on NIH Reporter for T32 grants with "glycobiology” reveals two grants (one NCI for cancer cell biology, one NIGMS for pharmacology). Neither of these grants are focused upon glycobiology. In fact, glycobiology is essentially never integrated into any standard ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Feasibility and challenges of addressing this CQ or CC :

I have participated in the American Association of Immunologists Advanced Course in Immunology the past several years. I give a single 90 minute lecture on “glycoimmunology”. While this helps to plant the seed of interest in how glycans impact the immune response and host defense, it is not nearly enough. I suggest the following ideas to begin closing this gap in training:

 

1. Support glycobiology training grants (T32) throughout the country, and not just at the small number of institutions (Emory, UCSD, UGA/CCRC, Johns Hopkins) with existing strength; and 2. Provide an incentive to integrate glycobiology aspects into other T32 proposals targeting the NHLBI to improve integration of the field into the broader context.

 

An important point, however, is that outside of the institutions already mentioned, existing glycobiology training opportunities are rare due to a lack of support. Thus, the NHLBI must be willing to help seed nascent training programs through a targeted funding initiative. As a PI of an immunology-focused T32, it is clear to me that competition for a ‘standard’ T32 in glycobiology would be impossible within the standing CSR T32 panel.

Name of idea submitter and other team members who worked on this idea : Brian Cobb

Voting

2 net votes
2 up votes
0 down votes
Active

Goal 2: Reduce Human Disease

Identification and validation of surrogate endpoints for long-term morbidity in Sickle Cell Disease

Research in sickle cell disease (SCD) has mostly focused on preventing or treating acute medical events, such as vaso-occlusive pain, acute chest syndrome, and, in pediatric patients, acute strokes. Chronic SCD complications such as chronic kidney disease or pulmonary hypertension, develop over decades, thus are poor choices for clinical trial endpoints. There is a great need to develop surrogate endpoints that predict ...more »

Submitted by (@hulbertm)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Longitudinal cohorts of SCD patients, spanning childhood and adulthood, with biobanking DNA, plasma, and serum, and standardized clinical and imaging assessments will allow identification predictors of negative clinical outcomes. An NHLBI-funded national SCD clinical registry with biobanking will be necessary to validate any surrogate endpoints.

Name of idea submitter and other team members who worked on this idea : Monica Hulbert

Voting

13 net votes
16 up votes
3 down votes
Active

Goal 2: Reduce Human Disease

Mechanical CPR devices

Can mechanical devices be developed that improved chest compression and augment blood flow during CPR compared to manual CPR?

Submitted by (@rebecca.lehotzky)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : AHA Staff & Volunteers

Voting

0 net votes
3 up votes
3 down votes
Active

Goal 3: Advance Translational Research

Financial and psycosocial impact of transition in sickle cell disease

What are the financial and social implications for individuals living with SCD from adolescence transitioning into adult care? What impact does this transition have on the caregiver and family as a whole?

Submitted by (@sicklecellwarrior)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

It is very difficult for many living with SCD to maintain employment (many people have to rely on disability benefits to survive) finish school, even maintain relationships. Greater understanding of the financial and social impact would enable advocacy and direct patient service organizations to better prepare the transitioning population, reducing the financial strain on the individual and the growing medical debt incurred by hospitals and government social service programs.

Name of idea submitter and other team members who worked on this idea : Sickle Cell Warriors, Inc. community members

Voting

30 net votes
38 up votes
8 down votes
Active

Goal 4: Develop Workforce and Resources

Modernizing Research Training

As the current chair of the Research and Training Division, I would like to convey that the AAAAI membership would like the NHLBI to consider the following in the development of its strategic plan:

 

Since the focus of research has changed over the past decade, training programs need to be encouraged to use newer models of research in their training and mentoring of potential research faculty.

Submitted by (@wheeze)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : Mitchell Grayson on behalf of the American Academy of Allergy, Asthma, and Immunology

Voting

10 net votes
23 up votes
13 down votes
Active

Goal 3: Advance Translational Research

Sustainability and Continuation of Research

While many challenges to advancing research efforts exist, a particularly confounding one for patient advocates is when promising research efforts are funded by NHLBI and the research is completed and published (leading to more questions) and is seemingly forgotten. This lack of continuity leads to further questions and is absent a solid path forward applying what has been learned to next steps in the research effort. ...more »

Submitted by (@teresabarnes)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

By providing a sustainability plan to NHLBI funded projects, researchers can become proactive in seeking ways to further areas of promise. Creating such a plan would allow researchers to consider alternative avenues of funding and collaborations that could move their efforts along. In addition, since NIH is using tax-payer dollars to fund research efforts, it would provide a model that demonstrates the value of doing research and in providing a return on investment of research efforts as well as provide assurance that NIH research efforts are ongoing and promising research is continued instead of shelved.

Feasibility and challenges of addressing this CQ or CC :

Since this type of sustainability plan is used elsewhere, it would be feasible and practical. In order to make it easier for researchers to be compliant, the plan becomes part of the RFP and not a request on the back end of a research effort.

Name of idea submitter and other team members who worked on this idea : Teresa Barnes

Voting

87 net votes
106 up votes
19 down votes
Active

Goal 2: Reduce Human Disease

Diaphragmatic dysfunction in critical illness

Diaphragmatic dysfunction occurs more frequently than clinically recognized in the setting of acute critical illness or injury. This contributes to both incipient and prolonged respiratory failure, as well as the growth of long-term acute care/rehab hospitalizations. We need a better understanding of the mechanisms of dysfunction as well as strategies to mitigate loss of diaphragmatic muscle mass, ultimately leading ...more »

Submitted by (@greg.martin)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

This problem can be addressed through a combination of Integrative physiology and real-time data analytics.

Feasibility and challenges of addressing this CQ or CC :

Patients receiving critical care services in the United States are among the most close monitored, including continuous monitoring of cardiorespiratory physiology. Integrating high dimensional data from ICU data streams and applying big data analytics, in combination with primetime genomic and metabolomic technologies, makes answering this question imminently feasible.

Name of idea submitter and other team members who worked on this idea : Society of Critical Care Medicine Executive Committee/Council

Voting

-1 net votes
1 up votes
2 down votes
Active

Goal 3: Advance Translational Research

Immunologic predictors of cardiac function following apheresis for dilated cardiomyopathy

Apheresis has been used to treat dilated cardiomyopathy yet the mechanism of action and predictors of response are unknown and clinical utility needs to be confirmed. What is the clinical utility, mechanism of action, and predictors of response?

Submitted by (@winters.jeffrey)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Dilated cardiomyopathy (DCM) is progressive ventricular enlargement and dysfunction, responsible for 10,000 deaths and 46,000 hospitalizations in the U.S. annually. It is the primary indication for heart transplantation. It may represent viral infection triggered autoimmunity with myocardial autoantibodies identified in 80% of patients and higher autoimmune disease prevalence in patients.

 

Immunoadsorption and plasma exchange have been used to treat DCM. Staphylococcal protein A agarose (SPAA) columns have the largest published evidence with improved left ventricular (LV)ejection fraction, decreased LV circumference, decreased BNP, improved exercise tolerance, improved oxygen uptake, increased regulator T-cells, decreased stimulatory T-cells, decreased costimulatory T-cells, and improved quality of life. Decreased morbidity and mortality with fewer patients progressing to transplantation and lower health care costs has been described. Given organ shortages, morbidity, and expense of transplantation, a treatment that delays or avoids transplantation would improve health and reduced costs.

 

Immunological variables such as IgG subtypes, Th1, Th2, Th17 and T regulatory cell number, associated cytokines, and nuclear transcription factors implicated in DCM pathogenesis could correlate with LV function following apheresis and identify apheresis selection criteria and offer a novel mechanism to investigate how autoantibody reduction influences cellular immune components.

Feasibility and challenges of addressing this CQ or CC :

DCM is the most common cause of cardiac transplantation with a large number of patients available for study. There are numerous standardized tools for measuring patient quality of life and function for those suffering from congestive heart failure. There are readily available assays for examining potential immunologic variables. If TPE is examined, this procedure is readily available.

 

Challenges would include the fact that the immunoadsorption columns that have been used are not cleared by the Food and Drug Administration and therefore there is limited to no experience with their use in the U.S. Immunologic evaluations could also require endomyocardial biopsy which represents an invasive procedure which could limit patient enrollment and increase risk.

Name of idea submitter and other team members who worked on this idea : Bruce Saichais on behalf of ASFA

Voting

54 net votes
80 up votes
26 down votes
Active