Goal 4: Develop Workforce and Resources

Training the new generation: not all about “big data” & "omics"

How do we attract more students/trainees into fields that are not popularized by “catchy” names?

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 :

Training the next generation of scientists

Feasibility and challenges of addressing this CQ or CC :

While the need to train the next generation of scientists in emerging fields (e.g. “omics” and “big data”), we should not overlook the need for nurturing “old fashioned” scientists (e.g. physiologists, integrative biologists) which are on the decline.

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

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35 up votes
12 down votes
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Goal 2: Reduce Human Disease

The missing ingredient in diet and cardiovascular disease prevention research

Determining the dietary patterns and dietary constituents that are most effective in preventing cardiovascular disease events. In addition to the obvious challenge of limited resources, the challenge is overcoming the tension between desire for comparable data produced from low-cost tools and need for higher quality data. Many studies continue using low-cost self-reported diet assessment instruments that produce data ...more »

Submitted by (@nhlbiforumadministrator1)

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

Details on the impact of addressing this CQ or CC :

Addressing the challenge of a dietary assessment method that harnesses recent technological advances in novel biomarker assessments and in metabolomics and microbiome research with best practices in self-reported assessment instruments would enable a giant leap forward in nutrition and cardiovascular disease prevention research. Self-reported instruments require repeated measurements which are expensive or are instruments hampered by measurement error that attenuates estimates of the diet-disease association. Progress on this critical challenge would enable research questions to be addressed using more accurate methods, including questions that ask about best overall diet pattern to prevent cardiovascular disease as well as questions targeted to specific nutrients or diet constituents. Overcoming this obstacle would enable research to move forward in population science research where knowledge of the diet of free-living individuals or community populations is needed as well as among patients in clinical research (other than expensive feeding trials where exact diet is known). There is great potential in stored specimens from epidemiology cohorts and clinical trials to be used with new biomarker assessments to associate earlier diet with hard outcomes accrued in these studies.

Feasibility and challenges of addressing this CQ or CC :

Advances in microbiome research and metabolomics technologies illustrate that progress in the field of biomarker assessments of dietary status is not only feasible but may sharpen our understanding of the relationship of dietary constituents with HLB disease pathologies. In the field of energy balance measurement there are calls for movement away from self-reported diet measures and for researchers and sponsors to focus development on objective measures (http://www.nature.com/ijo/journal/vaop/naam/abs/ijo2014199a.html ). Leadership from NHLBI in this area can move the field forward in validating tools and making them more cost effective.

“You are what you eat” is a familiar aphorism, but research progress on what dietary patterns and dietary constituents are most effective in preventing cardiovascular disease events is impeded by inadequate dietary assessment tools. This critical challenge calls for a major effort, in collaboration with other ICs, to develop methods and innovations in measures using blood, urine, feces, saliva, or other bodily fluids or tissues. These tools eventually need to be cost effective, valid, and reproducible.

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

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14 net votes
31 up votes
17 down votes
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Goal 3: Advance Translational Research

Translational Research for HIV/AIDS and HLB Health and Diseases

What are the best inroads for the NHLBI to support innovative approaches in the next 5-10 years, especially blood cell therapies based on hematopoietic stem cell and novel gene therapy approaches to control or even cure HIV infection?

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 :

HIV control or possibly even HIV cure could result from developing novel cell therapies, especially hematopoietic stem cell (HSC) transplants, and might also result from early use of antiretroviral therapy in acutely HIV-infected individuals.

• Transplantation of HSC including engineered cells has the potential to eradicate HIV reservoirs for HIV cure: the Berlin patient treated with HSC transplant remains free of HIV and is still the only patient cured of HIV infection as of today;

• Identification of acute HIV infections through routine blood donor screening and early anti-retroviral therapy for identified HIV-infected donors can limit or even prevent the establishment of HIV reservoirs.

Feasibility and challenges of addressing this CQ or CC :

• The Berlin patient has provided the proof of concept that HIV infection can be eradicated, that is, sterilizing cure can be achieved, through HSC transplantation in combination with other therapies;

• Recent studies have shown that early identification of HIV infection and treatment of infected individuals with anti-retroviral therapy as soon as possible can significantly limit the size of the HIV reservoirs even if such early treatment may not be able to completely prevent the establishment of HIV reservoirs; routine blood donor screening for both anti-HIV antibodies and HIV RNA among blood donors offers unique opportunities to identify acute HIV infections.

 

 

For HIV cure, the challenges include:

 

• Generation of HIV-resistant HSCs in adequate quantity for transplantation;

 

• Efficiency of homing and expansion of HIV-resistant HSC transplants;

 

• Efficiency in replacing HIV-infected cells, including CD4+ resting cells as the major HIV reservoirs, with HIV-resistant HSCs following transplantation;

 

• Efficiency in immune reconstitution by HSC transplants;

 

• Safety of HSC transplantation with needed GVHD to eliminate HIV-infected resting T cells while avoiding irreversible damage to the host.

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

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15 up votes
31 down votes
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Goal 2: Reduce Human Disease

Funding Limitations Block Intervention Research

The cap on R01 research grants at $500,000 per year has not changed in over 20 years. In the current fiscal crisis for research it has become an immovable block to submitting intervention studies (randomized clinical trials on treatment). Routine advice from NIH staff is to not even try for a larger study. The cap applies to every year, so one can design a trial that costs less than $2.5 million but exceeds $500,000 in ...more »

Submitted by (@stephen.fortmann)

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

Details on the impact of addressing this CQ or CC :

While it is difficult to argue for increasing funding for anything these days, the $500,000 cap on R01 funding is exerting a perverse bias on research. Very few intervention trials can be accomplished without exceeding this limit in at least one year. This means that trials are limited to those of interest to the NIH staff and to the pharmaceutical industry. Investigators interested in solving therapeutic problems are being force to abandon trials and rely on natural experiments and observational studies, which cannot address all important questions. The natural creativity of the scientific community is being artificially suppressed, distorting the field. The notion that pragmatic trials can substitute for explanatory trials is misplaced. Many unsettled questions cannot be pursued in pragmatic trials, which generally reduce informed consent to a degree to call into question their ethics. It is also unclear that many pragmatic trials can be done under the cap, since they often require extensive work with providers and the healthcare delivery system hierarchy.

Feasibility and challenges of addressing this CQ or CC :

Even a modest change in the cap would be very helpful. Perhaps allowing 1-2 years to be as high as $600,000 without triggering the permission process. Alternatively, the review process for studies exceeding $500,000 could be streamlined if the total does not exceed $2.5 million. Other ways to introduce flexibility are possible. This would allow more ideas to go to review and the staff, who are increasingly deciding which grants get funded, will have more to choose from.

Name of idea submitter and other team members who worked on this idea : Stephen P. Fortmann

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3 net votes
6 up votes
3 down votes
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Goal 4: Develop Workforce and Resources

NOVEL APPROACHES TO TRAINING IN SLEEP AND CIRCADIAN RESEARCH

Sleep and circadian disorders are relatively new areas of medicine. Most universities currently lack a critical mass of investigators to develop institutional T32 grants. Thus, there are, unfortunately, few such programs nationally. The Sleep Research Society has recognized this and is taking active steps to facilitate development of other T32 institutional training grants. This will not, however, help the majority ...more »

Submitted by (@jnoel0)

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

Details on the impact of addressing this CQ or CC :

The current status of research training in sleep and circadian disorders suggest that new approaches are needed. The field has developed one multi-center training grant to bring training to different institutions. This is focused on genetic/genomic approaches. It is run by the University of Pennsylvania which has a well developed program in this area. The fellows in training are, however, at other institutions, i.e., Johns Hopkins, University of Michigan and Stanford. Web-based approaches are used for work-in-progress seminars, grant development workshops and group mentorship, and didactic lectures. This strategy could be used more broadly to develop research training in other areas of sleep and circadian research. Stimulating this would have a major impact on research training in this new field of medicine.

 

Another relevant strategy would be to encourage adding slots in a competitive way for sleep/circadian research to other existing institutional T32 grants.

 

There are multiple mechanisms in place to communicate opportunities to the sleep/circadian academic community, i.e., Sleep-L, administered by the National Center for Sleep Disorders Research; Sleep Research Society biweekly blog; the Sleep Research Network. Specific encouragement of this approach would broaden the base for research training and would be of high impact.

Feasibility and challenges of addressing this CQ or CC :

The field of sleep and circadian research has had a long commitment to facilitating research training. The Sleep Research Society has hosted Trainee Day at our annual meeting for 20 years. The Sleep Research Society is funding early-stage investigators through its Foundation. The American Academy of Sleep Medicine runs, in collaboration with the NHLBI, an event at NIH for early-stage investigators in clinical research. The American Academy of Sleep Medicine Foundation has a “Bridge to K Award” program that provides funds to early-stage investigators who just missed funding on their first application for a K award. The Sleep Research Society has provided travel funds for early-stage investigators to attend recent workshops held by different NIH Institutes including National Heart, Lung and Blood Institute. Thus, there is no doubt of the commitment of the field and its professional organizations.

 

The impact of these new initiatives would be to broaden the base for research training beyond a few institutions. The number of institutions with a critical mass of investigators to mount successful T32 institutional training grants is not sufficient to provide the necessary future biomedical research workforce in this area. Novel approaches, based on modern communication IT technology, are needed.

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

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209 up votes
67 down votes
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Goal 3: Advance Translational Research

Move toward more probative research

As some of us described in a recent publication, in the fields of nutrition and obesity, and perhaps in other fields as well, there is often a great deal of research which uses up resources, investigator time, journal pages, and attention span for questions that do not advance the field. We call for scientists, reviewers, and funding decision makers to collectively ask much more rigorously, "How will this proposed study ...more »

Submitted by (@nhlbiforumadministrator)

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

Details on the impact of addressing this CQ or CC :

A quintessential example of this state of affairs is the large number of studies involving breakfast consumption and obesity. On the order of 100 studies have been done testing the association of breakfast eating vs. breakfast skipping with obesity. This seemed to lead to the belief and widely stated public health message that breakfast should be consumed to prevent obesity or promote weight loss. While the first several such epidemiologic studies were reasonable to conduct, what was needed thereafter were RCTs to test for causal effect. Instead the scientific community provided itself with a large body of observational studies to the point where an association was established far beyond any reasonable doubt (P≈10-42). Only recently have a handful of investigators conducted the RCTs needed to advance knowledge further, i.e. the "probative" studies. These have failed to support the hypothesis that breakfast consumption vs skipping leads to better weight control.

Feasibility and challenges of addressing this CQ or CC :

Similarly, we seem to be faced with a large stream of studies of varying quality testing the hypothesis that modest increases in physical activity in school settings for children will lead to important differences in weight outcomes. Yet, considerable research has already demonstrated to a reasonable degree of certainty that school-based programs with modest increases of physical activity do not have major effects on children's BMIs. This does not mean that physical activity is not important for other outcomes, or that there is not some way of inducing physical activity that would lead to major changes in BMI, but repetitively trying one minor variation on school-based programs after another is not the best use of our resources. These are just examples.

Name of idea submitter and other team members who worked on this idea : David B. Allison, Ph.D.; Kevin Fontaine, Ph.D.; Kathryn A. Kaiser, Ph.D.; Andrew W. Brown, Ph.D.; Edward C. Archer, Ph.D.

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1 net vote
2 up votes
1 down votes
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Goal 4: Develop Workforce and Resources

Safeguarding Mentorship for the Next Generation

There is a need to ensure that mentors have adequate skills, time, and incentives to mentor successfully.

Submitted by (@nhlbiforumadministrator)

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

Details on the impact of addressing this CQ or CC :

Continuity of research discoveries requires that outstanding mentors impart their passion and research skills to the next generation. Opportunities and incentives must be provided to ensure that highly qualified scientists can devote adequate time and effort to mentor promising junior colleagues, as well as enhance their own research output.

Feasibility and challenges of addressing this CQ or CC :

Mentor-directed opportunities can be immediately made available to provide protected time and salary for scientists with a passion for mentoring.

The current K24 mechanisms have been shown to be quite beneficial, not only for the mentor who can advance his career in the academe, but more so for the trainees who are exposed to the science that the mentor brings. However, K24 awards are primarily for patient-oriented research which enhance clinical skills. Non-clinical biomedical research will also benefit from similar programs.

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168 up votes
30 down votes
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Goal 3: Advance Translational Research

Culturally competent T4 research interventions to reduce heart, lung, blood, sleep

Using previous federal and partner infrastructure, what are the best methods to promote culturally competent T4 interventions that will reduce cardiopulmonary risk factors in global populations with a disproportionate burden of heart, lung, blood, sleep diseases?

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 :

Reduction of cardiopulmonary risk factors

Reduction of health inequities

Feasibility and challenges of addressing this CQ or CC :

Proven, evidence-based interventions exist for common diseases that can be adapted to reduce burden in low resource settings.

However,determining the best way to adapt existing interventions that are culturally competent and effective is a sensitive issue.

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

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-7 net votes
9 up votes
16 down votes
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Goal 3: Advance Translational Research

Infrastructure for human translational research

With the reduction in NCAT support for human translational research, infrastructure support will need to come from the NHLBI. This will increase the cost of most human, mechanistic based RO1 studies by 20-30%. This will exceed the current cap of $500K in many circumstances. The cap will need to be raised or NHLBI and other institutes need to determine how NIH can continue to provide this critical infrastructure.

Submitted by (@gwilliams)

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

Details on the impact of addressing this CQ or CC :

With the pending loss of infrastructure support by NCAT for human translational, mechanistic studies, a contiued decline in resources to support this critical resources for N of 1 studies. With appropriate support there will be increased capacity to determine which pre-clinical data is applicable to humans and to design more percise, mechanism based clinical trials to increase the likelihood of precision, personalized medicine for many of NHLBI's targeted diseases, e.g, hypertension, stroke, cardiovascular disease with diabetes and hypertension, asthma, and sleep apnea.

Feasibility and challenges of addressing this CQ or CC :

The template for addressing this challenge is already available. The specific funding mechanism(s) will need to be addressed.

Name of idea submitter and other team members who worked on this idea : Gordon Williams, Gail Adler, Charles Czeisler, Ellen Seely, Lindsey Baden

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3 net votes
6 up votes
3 down votes
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Goal 3: Advance Translational Research

Developing a Research Community for T4 Translation Research

What incentives will encourage current and new NHLBI investigators to pursue late translation (T4) research of proven effective interventions in heart, lung, blood, and sleep diseases? One of NHLBI’s current strategic plan’s goals is to translate discovery and early translation research knowledge to late stage T4 translation for use in populations so that it has significant positive health impacts and provides a return ...more »

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 :

A robust global T4 translation research community that will implement proven-effective interventions across populations resulting in a significant positive health impact

Feasibility and challenges of addressing this CQ or CC :

The NHLBI Global Health and Health Inequities Think Tanks identified T4 translation research as an important area that needs development in the very near future.

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

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8 up votes
11 down votes
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Goal 2: Reduce Human Disease

Basic Research for HIV/AIDS and HLB Health and Diseases

What HIV/AIDS-related basic research can NHLBI support in the next 5-10 years to investigate the fundamental mechanisms of HIV-related heart, lung, and/or blood (HLB) diseases alone and in the context of antiretroviral therapy (ART) to improve heart, lung, and blood health outcomes in HIV infections as well as the fundamental mechanisms of hematopoietic stem cell transplantation in potential elimination or eradication ...more »

Submitted by (@nhlbiforumadministrator1)

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

Details on the impact of addressing this CQ or CC :

Widespread availability of effective antiretroviral therapy (ART) has changed the epidemiology of AIDS. HIV-infected patients on ART can expect to live for many decades, but now chronic diseases are increasingly replacing acute infections as important causes of morbidity and death. A growing body of evidence suggests that HIV may alter and/or accelerate the natural history of fundamental processes underlying atherosclerosis, pulmonary arterial hypertension (PAH), chronic obstructive pulmonary disease (COPD), pulmonary co-infections, anemia, coagulation, thrombotic disorders, and immune senescence.

 

 

 

However, the mechanisms by which HIV and ART may modify these processes have not been fully elucidated, primarily because of the multiple direct and indirect pathways by which HIV and ART induce cellular dysfunction. Advancing knowledge of which cell types are affected by HIV (and serve as reservoirs), as well as increased understanding of the vital interactions between HIV and the host cells as well as interactions between HIV and other elements of the human virome and the broader microbiome is essential to elucidating the pathogenesis of HIV-related HLB diseases.

The use of basic research models will complement and extend the results of clinical studies.

Feasibility and challenges of addressing this CQ or CC :

For HIV infection and heart, lung, and blood health and diseases:

• NHLBI investments in this aspect, including the three RFAs in 2014-2015, two on basic research and one on clinical research, have laid good foundation.

• Collaborations between HIV investigators and HLB investigators that have been facilitated by the NHLBI investments including the three RFAs.

• The Berlin patient has provided the proof of concept that HIV infection can be eradicated, that is, sterilizing cure can be achieved, through HSC transplantation in combination with other therapies.

• New technologies that have been developed recently, such as the deep sequencing techniques and research supported by the NIH Human Microbiome Program and other programs have allowed us to better understand microbiome, especially bacteria in and on humans, and we began to realize the magnitude of the human virome.

 

?

 

For HLB comorbidities of HIV infection, the challenges include:

 

• Closer collaboration between HIV investigators and HLB investigators;

 

• Leverage of resources available both in HIV research and in HLB research.

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

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-22 net votes
14 up votes
36 down votes
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Goal 4: Develop Workforce and Resources

Enhancing T4 Implementation Research Expertise

We need to increase our base of T4 implementation research expertise among researchers, reviewers, and investigators.

Submitted by (@nhlbiforumadministrator)

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

Details on the impact of addressing this CQ or CC :

Increase our base of expertise in a relatively new field. Increase the number of funded grants and projects that include T4 implementation research.

Feasibility and challenges of addressing this CQ or CC :

Additional training for T4 implementation research can be added to the training infrastructure currently in place at the NHLBI/NIH.

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

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-6 net votes
4 up votes
10 down votes
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