Goal 3: Advance Translational Research

Advancing translational research requires timely in-depth analysis of large datasets

1. NHLBI investments over the last decade in terms of genomic approaches have yielded many research findings. 2. Rapid analyses of early data identified the "low hanging" fruit (and perhaps some/many important results were missed); this limited the scope of translation (partly because of relatively limited discovery?) 3. Important data are being generated at much greater rate than the data are processed/analyzed thoughtfully. ...more »

Submitted by (@rao000)

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

Details on the impact of addressing this CQ or CC :

If we invest in a few multi-disciplinary data analysis centers (integrating biology with statistical genetics) involving active NHLBI participation (cooperative agreements), the massive amounts of data generated at huge cost could be analyzed more thoughtfully if time and resources are made available. This way, we may be able to identify many more research findings of much greater potential for translation.

Feasibility and challenges of addressing this CQ or CC :

It is feasible to pursue this challenge through cooperative agreements whereby NHLBI scientists can actively participate and ensure that strategic investing is following strategic paths for deep discovery.

Name of idea submitter and other team members who worked on this idea : DC Rao

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11 up votes
10 down votes
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Goal 1: Promote Human Health

What is the potential effect of the burden of COPD on the US workforce?

COPD currently affects approximately 25 million individuals in the US alone, many of whom are of working age, according to the most recent BFRSS data. Many of those people are encouraged by their doctors or families to apply for disability and receive it, even though there are still jobs they could do. This is going to have an impact on business and industry as these people who are at the peak of their careers leave. ...more »

Submitted by (@jmrommes)

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

Details on the impact of addressing this CQ or CC :

I think if this question were answered and that industry understood the impact of COPD on the potential workforce going forward, there would be significant interest from business and industry to do several things:

prevent COPD; develop accommodations that would allow people with COPD to continue to work; reduce the burden to both industry and individuals with COPD by allowing them to continue to work and produce until planned retirement.

Feasibility and challenges of addressing this CQ or CC :

This would not be a difficult question to answer. More difficult would be the education of both individuals and business and industry in how to accommodate people with COPD so they can continue to work until their planned retirement. Techniques and strategies could be developed, however, benefiting both business and the individual.

Name of idea submitter and other team members who worked on this idea : Jean M. Rommes

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8 net votes
15 up votes
7 down votes
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Goal 1: Promote Human Health

ELUCIDATING BASIC MECHANISMS OF SLEEP DEFICIENCY AND CIRCADIAN DISRUPTION ON HEALTH THROUGH THE LIFESPAN

There are developing data from clinical studies that sleep deficiency and circadian disruption have multiple adverse consequences for health. The clinical data provide the base for mechanistic studies. Studies in animal models indicate that both circadian disruption and insufficient sleep later gene expression in peripheral tissues. Moreover, the effect of sleep loss in molecular changes in brain changes with age. ...more »

Submitted by (@jnoel0)

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 is no doubt that insufficient sleep and circadian disruption are very common in our society. There are also compelling epidemiological data that they are associated with multiple adverse consequences, including increased cardiovascular disease, increase in metabolic abnormalities such as insulin resistance and for shift work an increased incidence of specific concern. Animal studies based on microarrays are showing that inadequate sleep and circadian rhythm alter gene expression not only in brain but also in peripheral tissues. These studies are hypothesis-generating and there are many opportunities for hypothesis-driven research in this area to assess mechanisms. Identifying mechanisms will allow investigators to begin to assess mechanisms of individual differences and to identify new pathways for intervention.

Feasibility and challenges of addressing this CQ or CC :

Sleep and circadian research is in a very strong position. Sleep and clock function has now been identified in all the major model systems—C. elegans, Aphysia, Drosophila, zebra-fish, mice, etc. Thus, there is a strong platform to assess conserved pathways for effect of sleep loss and circadian disruption. Moreover, microarray studies have identified likely pathways thereby setting up hypothesis-driven research. There are major opportunities in this area.

Name of idea submitter and other team members who worked on this idea : Sleep Research Society

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174 net votes
230 up votes
56 down votes
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Goal 3: Advance Translational Research

Novel therapeutics for patients with severe acute lung injury

Can novel therapeutics including cell-based therapy be tested in patients with severe acute lung injury (P/F <200) and shock (need for vasopressors) since these are the patients with the highest mortality (> 30%) based on NHLBI ARDS Network data?

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

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Goal 4: Develop Workforce and Resources

Reducing Personal Education Debt

Because education debt weighs heavily on many early-stage physician-scientists, there is a need for the NHLBI to alleviate this problem and help boost the desirability of research career choices by automatically granting Loan Repayment Program awards to qualified investigators whose research projects are funded by peer-reviewed grants.

Submitted by (@nhlbiforumadministrator1)

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 : NHLBI Staff

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-22 net votes
9 up votes
31 down votes
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Goal 2: Reduce Human Disease

Integrating palliative care into the care of patients with heart, lung, and blood disease

How can we best integrate primary and specialty palliative care into the care of patients with serious heart, lung, and blood diseases?

Submitted by (@jrc000)

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 is increasing awareness of the importance of palliative care in the care of patients with serious illness. Palliative care focuses on improving quality of life and reducing the stress of a serious illness for patients and their families and can be provided together with curative or life-prolonging treatments. It includes both primary palliative care (delivered by all cliniicans who care for patients with serious illness) and specialty palliative care (delivered by physicians, nurses, social workers, chaplains and others with special training in palliative care.) Patients with serious heart, lung, and blood diseases have profound unmet palliative care needs and it is not clear how these needs can best be met.

Feasibility and challenges of addressing this CQ or CC :

Studies show dramatic benefit of integrating palliative care into the care of patients with cancer, but there is little data on the best way to improve palliative care for patients with serious heart, lung, and blood disease. The opportunity exists to support research that develops and evaluates interventions to improve primary and specialty palliative care for patients with heart, lung, and blood diseases.

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31 net votes
37 up votes
6 down votes
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Goal 2: Reduce Human Disease

Cardiac Defibrillator Therapy Management in the Elderly

Older patients have been largely under represented in the landmark clinical trials that have established the beneficial effects of ICD therapy on survival. With older age, comorbidities increase leading to a higher incidence of non-cardiac mortality. This is supported by very well documented decrease in the incidence of appropriate defibrillator shocks. Based on the above, it is important to know whether defibrillator ...more »

Submitted by (@sabas0)

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

Details on the impact of addressing this CQ or CC :

Given the increase in the proportion of older patients in the US, addressing these important questions regarding the value of defibrillator therapy in this stratum of the population is critical to:

1) Avoid unnecessary surgeries with its complications (short term and long term)

2) Reduce the cost of health care, primarily in a Medicare population

Feasibility and challenges of addressing this CQ or CC :

A large multi-center non-inferiority trial of CRT-P vs. CRT-D ( and at alater stage of ICD vs. No ICD) in the elderly is needed to answer these questions. These trials are feasible but require comittment and resources.

Name of idea submitter and other team members who worked on this idea : Samir Saba

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4 net votes
16 up votes
12 down votes
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Goal 2: Reduce Human Disease

What are the mechanisms of lung injury after HCT

Despite major advances in supportive care and tissue typing non relapse mortality rates for adults undergoing hematopoietic cell transplantation are still between 15-20 % at 2 years. Lung injury and respiratory failure is a major causes of death after HCT. Although the BMT-CTN has a focused agenda on GVHD, reduction of lung toxicities will be important to improve outcomes. NHLBI should encourage researched from the ...more »

Submitted by (@giralts)

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

Details on the impact of addressing this CQ or CC :

Discovery of mechanisms of lung injury in the HCT setting are likely to be relevant for the non HCT setting.

The BMT CTN prospectively collects data on lung toxicity on all HCT recipients on trial, samples exist in the repository that could be used for biomarker discovery.

Feasibility and challenges of addressing this CQ or CC :

Main challenge is to get the two teams of investigators working together

Name of idea submitter and other team members who worked on this idea : Sergio Giralt

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59 net votes
88 up votes
29 down votes
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Goal 2: Reduce Human Disease

Sleep Apnea - Trial of Treatment vs No Treatment of Snoring

Randomized trial of the treatment of snoring vs. no treatment.

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 :

Snoring is increasingly implicated as potential disruptor of carotid artery intima and function. Repetitive vibratory trauma has been hypothesized as cause of this. Intermediate markers of cardiovascular risk such as intimal thickening have been linked to snoring as independent from sleep apnea. This field is ready for a larger scale trial in which snoring is intervened upon and IMT is measured as one of several endpoints. Other endpoints could be QOL measures, sleepiness, etc. Another reason this field is ready to be addressed is we now have inexpensive nasal resistors, which treat snoring without the need for surgery, oral appliances, or CPAP. These would allow the sleep medicine field to do a trial of such therapy vs. a sham therapy.

Name of idea submitter and other team members who worked on this idea : ATS Member

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1 net vote
1 up votes
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Goal 2: Reduce Human Disease

Imaging indicators of metabolic syndrome and cardiopulmonary disease

Critical Challenge

Submitted by (@str0001)

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

Details on the impact of addressing this CQ or CC :

Obesity and metabolic syndrome affect a large portion of the population and affects multiple organ systems. Identifying obesity phenotypes by imaging will impact the significant healthcare issue presented by MetS and could provide a reliable, non-invasive index of disease severity, guide prevention and intervention response.

Feasibility and challenges of addressing this CQ or CC :

Metabolic syndrome, abnormal metabolism, may be potentially linked to obesity and cardiopulmonary disease. Theories exist but are in need of clarification. The relationship between metabolic syndrome and multiple other diseases including chronic obstructive lung disease, coronary atherosclerosis, and obesity warrants further investigation and can be elucidated through imaging. Advances in computed tomography (CT) and magnetic resonance imaging (MR) enable assessment of the cardiopulmonary manifestations, with promising MR techniques to complement high-resolution imaging data achievable with chest CT and coronary CT angiography. Assessment of CT and MR techniques in combination with three-dimensional quantitative analysis of manifestations of metabolic syndrome such as fat deposits derived from different adipocytes (white fat versus brown fat) such as in the subcutaneous, visceral, epicardial, and perivascular regions is feasible with current technology and may enable differentiation of those with varying risks of cardiovascular and pulmonary disease. The association of imaging parameters, metabolic syndrome, and associated diseases are in need of investigation, and knowledge gained may prove crucial for identifying those at risk for metabolic syndrome and at higher risk for complications in the large population of our country affected by obesity.

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

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6 net votes
10 up votes
4 down votes
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Goal 2: Reduce Human Disease

Why does loss of endoglin in adult blood cells lead to cardiac hypertrophy in HHT patients

Liver arteriovenous venous malformations creates a high flow shunt that over time creates high output cardiac failure with no effective treatments.

Submitted by (@mariannes.clancy)

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 : Marianne Clancy MPA, Chris Hughes PhD

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Goal 2: Reduce Human Disease

Diet and prevention of cardiovascular events

In the US, what kind of diet(s) is/are best for preventing hard cardiovascular events?

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 :

Provide an evidence base for public policy on diet.

Feasibility and challenges of addressing this CQ or CC :

The Spaniards have shown that this kind of trial is possible. We have tools and interest in place for pragmatic trials.

 

The PREDIMED trial (done in Spain) randomized ~7000 adults and found that a diet supplemented with olive oil or nuts reduced cardiovascular events compared to a "low-fat" diet. However, in Spain the Mediterranean diet is arguably the norm.

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

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8 net votes
20 up votes
12 down votes
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