Goal 3: Advance Translational Research

Increasing the adoption of low tidal volume ventilation in ARDS patients

How can we use implementation science to increase the adoption of low-tidal volume ventilation in patients with acute respiratory distress syndrome (ARDS)?

Submitted by (@lar000)

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

Details on the impact of addressing this CQ or CC :

Low tidal volume ventilation has been shown to significantly reduce mortality in ARDS patients (from 40% to 31% in the ARMA trial published in NEJM in 2000), but it is inconsistently adopted (frequently with rates <50% in both community and academic settings). Improving adherence has the potential to significantly improve mortality in patients with ARDS.

Feasibility and challenges of addressing this CQ or CC :

Given the rapid growth and interest in the field of implementation science over the past several years, addressing this question is now feasible.

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-10 net votes
2 up votes
12 down votes
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Goal 4: Develop Workforce and Resources

Career Development in "Group Based" Science

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:

 

NHLBI should be challenged on how best to provide career development grants to junior faculty involved in “group based” clinical and bench science.

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

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7 net votes
26 up votes
19 down votes
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Goal 3: Advance Translational Research

What are the most effective strategies for reducing alarm fatigue and optimizing cardiorespiratory monitor alarm management?

Hospital cardiorespiratory monitors have great potential to save lives, but are hampered by high false alarm rates that contribute to alarm fatigue. While the long term solution is developing new medical devices that will do this better, few hospitals will benefit from new device innovations in the next decade. In order to better identify early signs of cardiorespiratory deterioration in the hospital at an early stage ...more »

Submitted by (@chrisbonafide)

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

Details on the impact of addressing this CQ or CC :

Improved strategies for optimally detecting deterioration using existing bedside cardiorespiratory monitoring technologies has the potential to impact the care of hundreds of thousands of hospitalized adults and children each year.

Feasibility and challenges of addressing this CQ or CC :

This is highly feasible with a fairly modest allocation of resources. This work falls under heart and lung disease, hospital medicine, nursing research, and implementation science.

Name of idea submitter and other team members who worked on this idea : Chris Bonafide, MD, MSCE

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

Making R01 funding work for the Medical Sciences

We need to spread R01 funding around more to ensure that the best science has funding adequate to move forward. To do this I believe changing how we think about R01 funding and expenditures can be used to put the NIH funds to better use. Too often successful researchers have the majority of their salaries on R01s and the institutions have little skin in the game. PI salaries can be a large part of the escalating budget ...more »

Submitted by (@wjones7)

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 impact of spreading the funding would be to improve funding rates, improve funding of new investigators, and supporting more diverse science. Negative impacts would include reduced funding some large labs. In my experience, in some cases, this would be a good thing. There could be special programs and exceptions for large labs that make significant important contributions and serve as resources to reduce negative impact. Review of grants should include information on manuscript retractions and large labs with many retractions should be carefully scrutinized for defunding.

Feasibility and challenges of addressing this CQ or CC :

Such changes would have to be made incrementally over time since this will require states and institutions to pick up some of the cost of science and therefore must be phased in to allow for time to adjust the workforce in specific places to align with budgetary constraints. Institutions might be encouraged to do more fundraising to actually support science to fill gaps.

Name of idea submitter and other team members who worked on this idea : Keith Jones with major input from Pieter de Tombe

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28 net votes
44 up votes
16 down votes
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Goal 4: Develop Workforce and Resources

Science communication skills of researchers

How do we add communication skills to our training programs to improve scientists’ communication with the public?

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 :

Improving the ability of scientists to communicate the importance of their research will make science attractive to younger generations, increase collaborations and funding opportunities, and may increase general public support for research and researchers.

Feasibility and challenges of addressing this CQ or CC :

Tested models already exist in other countries. The public seems to be increasingly interested in reading press releases about discoveries in different areas, which now are regularly published in popular press (e.g., NYT)

Researchers rarely receive formal training for teaching, public speaking, and many lack even basic communication training. Learning how to better communicate science can help increase the attractiveness and impact of science by engaging colleagues, collaborators, attracting interest from potential future scientists, subjects for clinical studies, funding agencies, and the public in general. Being able to explain the research goals, scientific approach, and discoveries in clear and simple terms, makes science sound "cool" and can attract wide interest (for instance, think "CSI"). In other countries, science communication is part of the science graduate curriculum and their funding agencies require having a communication plan for the wide dissemination of findings of the research proposed (which is part of the application score!).

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

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20 net votes
41 up votes
21 down votes
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Goal 1: Promote Human Health

Understanding NANCs and Neuropeptide Function in the Heart

Understanding the complexity of NANC transmitter release and neuropeptide function could be helpful in establishing new, effective therapeutic strategies for treating heart disease.

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 :

Could lead to the development of fundamental knowledge required to develop effective new therapeutic interventions to treat heart disease.

Feasibility and challenges of addressing this CQ or CC :

Several studies have already demonstrated associations been NANC transmitter release and neuropeptide co-localization with pathogenic changes in cardiac function.

Identification within cardiac nerves of neural peptides that are co-released with traditional transmitters is an interesting and still emerging story. Studies with nonadrenergic, noncholinergic (NANC) transmitters in both the atria and ventricle have shown that a variety of neuropeptides also are localized within the heart, and several, including vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), substance P, and calcitonin gene-related peptide, have been shown to markedly affect heart rate and modulate cardiac function. NPY is also elevated in heart failure patients, and other neuropeptides, including VIP, calcitonin gene related peptide (CGRP), substance P (SP) and their receptors are associated with various types of cardiomyopathies.

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

Voting

3 net votes
14 up votes
11 down votes
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Goal 3: Advance Translational Research

Halt the Epidemic of Atrial Fibrillation

Effective approaches are needed to halt the epidemic of atrial fibrillation (AF) and its associated morbidity.

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 :

Reduce the almost epidemic increase in the occurrence of AF in the aging U.S. population. This is a critical need for which basic science and clinical tools presently exist to address and resolve into a means to reduce the clinical consequences of AF.

Feasibility and challenges of addressing this CQ or CC :

To accomplish this goal the following approaches could be taken:

GENETIC: Investigate genetic factors that drive susceptibility to atrial fibrillation in various disease states and “lone” AF.

BASIC: Investigate the principles underlying electrical and structural remodeling which facilitate and perpetuate atrial fibrillation. Use a systems approach to aid the understanding of the role of neurohormonal and other organ system influences on human cardiac electromechanical activity. Develop new imaging modalities to better characterize conduction abnormalities in three dimensions. Investigate the nature of chamber-specific channels as potential targets for AF therapies. Encourage the development of new thrombin inhibitors and other potent but safe anticoagulants.

TRANSLATIONAL: Investigate promising pharmacologic or other interventions designed to reduce the incidence of atrial fibrillation in animal models with spontaneously occurring atrial fibrillation. Create the infrastructure for a “dynamic repository” of clinically obtained fresh human cardiac tissue for the study of AF.

CLINICAL: Improve the collection of atrial fibrillation as an endpoint in large phenotyped cohorts. Evaluate the safety and efficacy of ablative procedures relative to appropriate pharmacologic therapies. Evaluate interventions which may prevent first development and recurrence of AF (statins, ACE-I/ARB, beta blockers). Investigate the use of new antiplatelet thienopyridines for stroke prevention in AF.

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

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3 net votes
13 up votes
10 down votes
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Goal 3: Advance Translational Research

Expand the H3Africa Partnership Model to Decrease HLB diseases

Is there a way to decrease the risks for HLB disease leveraging the H3Africa genomics platform? • Leverage partnerships providing resources to the H3African populations • Identify the best collaborative partners to reach out to the low resource population • Find the best mechanism for collaborations to facilitate the interventions in low resource settings • Merge NHLBI research objectives and goals with those of potential ...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 :

• Leverage the existing infrastructure (NHLBI & UnitedHealth investment in the Centers of Excellence in Kenya and South Africa; NIH and Wellcome Trust investment in H3Africa) to decrease the burden of HLB using genomics in low resource settings

• Proof of concept: H3African countries & affiliated sites can be used to create a T4 model

• Extension: expand the H3Africa model to other LMICs

Feasibility and challenges of addressing this CQ or CC :

• Existing NHLBI investment in capacity building in some of the H3African countries can be leveraged to address heart, lung, blood, sleep diseases

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

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

Addressing Health Inequities through Nontraditional Partnerships

What non-traditional partnerships can be leveraged to address health inequities?

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 :

- Broaden reach to underserved populations

- Increase ability to generate evidence based solutions to address health inequities

- Bring expertise and resources to core partner (NIH)

- Enhance ability to identify unanticipated problems and strengthen efforts across all phases of the implementation research agenda

Feasibility and challenges of addressing this CQ or CC :

Feasibility:

- Increased emphasis on health and health inequities by non-profit and particularly, for-profit organizations

- Affordable Care Act (ACA) includes both general and explicit provisions that could narrow the health disparities gaps through implementation research.

- Can leverage and build upon current research partnerships that exist between government agencies and health care delivery systems to address questions of major public health importance

- Opportune time to employ implementation research addressing health inequities through non-traditional research partnership with sectors such as education, state and local government, transportation (built environment), penal and re-entry systems (health risks and disparities), ministries of health, and for-profits, foundations, and non-profits with health care focus.

 

 

Challenges:

 

 

- Risk of disagreements and friction among partners and management with different priorities

 

- Synchronization of timing for decision making

 

- Achieving partners’ concurrence on decisions that provide the most cost effective solutions

 

- Time needed to establish trust among partners that do not routinely partner to address health inequities

 

- There are limited resources dedicated to fostering Public Private Partnerships

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

Voting

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

Exposing students of all ages to Discovery science

What kinds of incentives, reforms, and exposures would work best with students from diverse and disadvantaged backgrounds to pursue careers in science?

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 :

• It would produce an excited scientific workforce that will enhance healthcare and sustain discovery in the fields served by NHLBI.

Feasibility and challenges of addressing this CQ or CC :

• It is entirely feasible to develop programs for teachers and incentives for students.

• Pilot programs may be needed to establish feasibility of clinical training for PhDs and research training for MDs.

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

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7 net votes
20 up votes
13 down votes
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Goal 4: Develop Workforce and Resources

Basic and Clinical Multi-disciplinary Partnerships to Understand Lung Disease

Basic scientists and clinicians have different training and bring different perspectives to lung disease research. Additionally, mechanisms that facilitate interactions of scientists from different fields may improve communication and facilitate novel ideas for lung disease research. I would like to see a funding mechanism that encouraged such partnerships in addressing fundamental disease questions and/or treatments. ...more »

Submitted by (@bmoore)

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

Details on the impact of addressing this CQ or CC :

This mechanisms could bring more perspectives to bear on questions in lung disease and would facilitate multi-disciplinary interactions and ideas.

Feasibility and challenges of addressing this CQ or CC :

If single awards, budgets would need to be large enough to allow for funding basic science as well as providing dollars to collect clinical samples. It should be possible to support some core facility infrastructure if needed and allow a budget that could account for basic scientists, animal work, study coordinators, clinicians, etc. Perhaps the RFA could require at least 3 different fields to be represented to try to facilitate multi-disciplinary approaches. Such a mechanism could help replace the loss of grants like SCOR grants and PPGs.

Name of idea submitter and other team members who worked on this idea : Beth Moore

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3 net votes
11 up votes
8 down votes
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Goal 3: Advance Translational Research

Implementation science research to reduce adverse effects of SCD

From various publications and reports, we have characterized the risks associated with sickle cell disease (SCD) and understand many of the barriers for treatment of SCD in LMICs. How can implementation science research be used to reduce the negative outcomes of SCD in low/middle income countries?

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 deaths and negative outcomes associated with SCD and in LMICs

• Provide the evidence base that supports culturally relevant implementation strategies that reduce deaths associated with SCD in LIMCs

Feasibility and challenges of addressing this CQ or CC :

• Yes

, this is feasible

• Common goals and deliverables between NHLBI and partners will need to be identified

• Partnerships can be with international organizations, Ministries of Health and other partners

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

Voting

18 net votes
31 up votes
13 down votes
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