Goal 4: Develop Workforce and Resources

Retaining Young Investigators

To ensure that young investigators remain in the field, the National Institutes of Health should consider strategies for assisting these investigators in making the career and funding move from mentored career development awards and career development awards for independent investigators (K awards) to research awards (including but not limited to R01 awards).

Submitted by (@skrenrich)

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 : Cystic Fibrosis Foundation

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14 net votes
15 up votes
1 down votes
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Goal 2: Reduce Human Disease

Understanding the Genetic & Epigenetic Basis of Congenital Heart Disease?

Over the last thirty years, our fundamental understanding of the genetics and pathogenesis of congenital heart disease has lagged the tremendous advances in the surgical and clinical care of infants with this group of disorders. We need to close this gap with investigation into the genetic basis of congenital heart malformations to develop new models of disease. The goall is translate an improved molecular genetic and ...more »

Submitted by (@jamesr.priestmd)

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

Details on the impact of addressing this CQ or CC :

Congenital heart disease (CHD) is the most common congenital malformation and the most common cause of mortality during the first year of life. Approximately 70% of cases occur sporadically without a strong family history or identifiable genetic syndrome, and the primary heritable basis of most non-syndromic CHD has yet to be identified. Studies of affected kindreds, syndromic disease, and more recently genome wide association studies (GWAS) have shed light on a handful of causal loci, while exome sequencing and studies of structural variation uncovering rare de novo variants in trios have yielded only an 8-10% rate of diagnosis in cohorts with CHD. Despite the application of contemporary techniques and study design to genetic discovery in CHD, the majority of the genetic risk for human cardiac malformations remains unexplained.

Feasibility and challenges of addressing this CQ or CC :

One key challenge is that many of the stakeholders including those affected with congenital heart disease (children), along with the physicians make a diagnosis and referral (obstetricians, neonatologists, general pediatricians), are generally funded by other agencies (NICHD). Trans-agency collaboration and cooperation is necessary to improve the translational research structures necessary to improve disease.

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22 net votes
37 up votes
15 down votes
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Goal 2: Reduce Human Disease

Genetic variants of complex diseases in Asian American Subgroups

What are the genetic variants influencing complex heart, lung, blood, and sleep traits and diseases in Asian American subgroups?

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 :

High impact, given that in the U.S.: a) Asian Americans are the fastest growing racial/ethnic group, and b) heart diseases and chronic lower respiratory diseases are the second and fourth leading causes of death, respectively, among Asian Americans

Feasibility and challenges of addressing this CQ or CC :

Genetic and genomic technologies are currently available for such a study.

Although there is a growing number of genetic studies in Asian countries such as China, the research findings are not necessarily generalizable to Asian Americans, who differ in various ‘exposure variables’ including diet, behaviors, and environment. Furthermore, there is a need to conduct research among Asian American subgroups (see list immediately below) rather than lumping them into a single category, given the heterogeneity across subgroups. Sufficient sample sizes are needed to provide reliable estimates of gene-by-environment interactions; however, Asian Americans are often underrepresented in research studies in the U.S. Asian American subgroups, in order of highest to lowest % in the U.S.: Chinese; South Asians (ancestry from Indian subcontinent), Filipino, Vietnamese, Korean, and Japanese.

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

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-4 net votes
8 up votes
12 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 3: Advance Translational Research

facilitate journal submissions by creating a common submission template

To increase the efficiency of getting timely findings published and to decrease the administrative busywork of learning formatting requirements of each journal for each new submission and of reformatting manuscripts for submission to a new journal. Although this may only take a day or 2 to do, multiplied by thousands of investigators and by all their publications each year this administrative time adds up and takes away ...more »

Submitted by (@lindapeterson)

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

Details on the impact of addressing this CQ or CC :

Formatting and especially reformatting journal submissions to fit different journal specifications (if a manuscript (MS) isn't accepted at the first journal) takes time, which decreases the efficiency of getting new translational (and all) scientific findings published. If the NHLBI could partner with e.g., cardiology journals to develop a common app. at least for the first submission, this would decrease the amount of administrative busywork needed to reformat MSs and improve efficiency of publication. This would be akin to the "Common Application" used by many colleges, which has increased ease and competitiveness of the applications and decreased formatting time. After acceptance a MS could be formatted according to the journal specs.

Feasibility and challenges of addressing this CQ or CC :

Challenge would be to have the journals agree on a common application format.

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

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1 net vote
7 up votes
6 down votes
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Goal 2: Reduce Human Disease

Problem of sudden cardiac death

Among major causes of cardiac mortality cardiac arrest stands as a cause of death that rivals all other causes in terms of frequency. There has been at best only modest improvement in resuscitation over recent years. No wonder with so little NHLBI funding going into this cause compared to acute MI and heart failure. Hopefully the IOM report on cardiac resuscition will be a call to action that will highlight these NIHBI ...more »

Submitted by (@mlw500)

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

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0 net votes
4 up votes
4 down votes
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Goal 4: Develop Workforce and Resources

Expanding short term Junior Faculty Training Programs such as the Summer Training Programs for Junior Faculty (PRIDE): More Pgms

Expanding the training efforts (e.g. greater number of funded summer programs, extend training beyond 2 summers, provision for 5-year grants so an additional cohort can be included) would be highly beneficial.

Submitted by (@treva0)

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

Details on the impact of addressing this CQ or CC :

Expand training efforts by increasing number of programs. The PRIDE is now turning away outstanding applicants due to the limited number of training slots across the different program. Since each program is currently training as many scholars as is feasible given their current infrastructure and resources, a solution may include increasing the number of independent programs in the PRIDE or number of trainees a given program can support. This will lead to increasing the number of independent researchers in the health-related fields who come from diverse backgrounds. Flexibility to increase the training period: Some junior faculty need more assistance than others. Some trainees from less research-intensive institutions may have had fewer opportunities to participate in research and thus have less experience and fewer (sometimes no) publications. They would greatly benefit from an initial period dedicated to increasing core research skills and publications prior to proposing and seeking independent grant funds. In the long run, they will be more likely to succeed given the extended training since the PRIDE offers opportunities to collaborate with nationally known researchers and provides access to data resources and the possibility of increasing their publication record. Also, a small percentage of the slots may be reserved for repeat participation in structured manner that provides escalating levels of support.

Name of idea submitter and other team members who worked on this idea : Treva Rice for the PRIDE (Programs to increase diversity among individuals engaged in health-related research): Joe GN “Skip” Garcia, Francisco Moreno Girardin Jean-Louis, Gbenga Ogedegbe, DC Rao, Victor Davila-Roman, Mohamed Boutjdir, Betty Pace, Juan Gonzales, Bettina M Beech, Keith Norris, Marino Bruce, Alicia Fernandez, Kirsten Bibbins-Domingo, and Margaret Handley.

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5 net votes
11 up votes
6 down votes
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Goal 2: Reduce Human Disease

Cause of disparity in prevalence and progression of various vascular disorders

What are the causative factors underlying the disparity in prevalence and progression of various vascular disorders (PAD, CVD, aneurysm) across populations?

Submitted by (@societyforvascularsurgery)

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

Details on the impact of addressing this CQ or CC :

­Genetic, epigenetic, biochemical, nutritional, environmental, and psychosocial factors should be characterized.

Name of idea submitter and other team members who worked on this idea : Society for Vascular Surgery

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

Reproducibility Initiatives in Heart, Lung and Blood Research

Scientists feel tremendous pressure to publish numerous scientific papers in order to receive NIH funding and tenure at academic institutions. Cognitive biases of scientists and publication biases of journals that publish this barrage of papers will likely result in the publication of findings that are probably not reproducible (see "Why Most Published Research Findings Are False" by John P. A. Ioannidis in PLOS Medicine ...more »

Submitted by (@jalees)

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 distinguishing research findings which are reproducible from those which aren't, researchers will be able to build future research programs on solid scientific foundations.

 

There are many reasons for why research may not be reproducible, ranging from simple biological variations (cells from one supplier may behave differently than cells from a different supplier) to conscious/unconscious biases or misconduct. No matter what the underlying cause is, irreproducible research findings that are not recognized as such will result in a tremendous waste of time and resources. Graduate students or postdoctoral trainees may waste entire years of their precious training period conducting experiments that are based on published papers which may turn out to be irreproducible.

 

NHLBI could significantly improve the quality of research by building an infrastructure that supports the assessment of reproducibility and widely shares these findings.

Feasibility and challenges of addressing this CQ or CC :

One of the challenges for assessing reproducibility of published work is that it is considered not very innovative and there is no funding available. NIH grants are awarded to highly innovative proposals which venture into new territories and not proposals which want to confirm the validity of published work. However, the returns of investing into reproducibility testing might be enormous because irreproducible results would be identified and weeded out, thus preventing loss of resources and time.

 

The NHLBI could develop funding mechanisms specifically designed to support research proposals that will test the reproducibility of high impact findings that have not yet been independently verified. The study sections would review these proposals using novel criteria designed for such studies. The emphasis of the study section review would lie on questions such as "Is this an important enough question that it merits reproducibility testing?" instead of the traditional "Is this a cutting-edge technology that nobody has previously used?"

 

Challenges would include identifying journals that would published results of these studies and agreeing on what constitutes reproducibility (i.e. is it enough if the major conclusion or effect is reproduced even though the effect size may be very different?).

Name of idea submitter and other team members who worked on this idea : Jalees Rehman

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2 net votes
5 up votes
3 down votes
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Goal 2: Reduce Human Disease

Anemia, oxygen delivery, and red blood cell transfusion

In neonatal, pediatric, and adult patients with critical illness, what is the best means to identify: (1) the degree to which anemia contributes to insufficient oxygen (O2) delivery and (2) the likelihood that O2 delivery will be improved by red blood cell (RBC) transfusion? These questions are most relevant to critically ill populations that exhibit unique physiology, including those with low cardiac output (cardiac ...more »

Submitted by (@nareg.roubinian)

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

Details on the impact of addressing this CQ or CC :

In the critically ill, RBC transfusion is indicated to improve O2 delivery. Although RBC transfusion increases hemoglobin concentration (Hb) and thereby blood O2 content, it does not necessarily follow that O2 delivery to tissues is likewise increased. Current approaches to transfusion decision making in critical care settings maintain an ‘adequate’ RBC mass well above a level that may limit tissue O2 delivery. With improved understanding of vascular signaling and gas transport by RBCs and of the array of defects comprising the RBC ‘storage lesion’, we appreciate that this strategy must be balanced by consideration that: (1) donor and recipient RBCs do not exhibit similar physiology and (2) RBC transfusion may cause harm (beyond transfusion reactions and transmission of infection) – and that this harm appears progressive with: transfusion volume, frequency and donor exposure. As such, ‘restrictive’ Hb thresholds for RBC transfusion are appreciated to be at least non-inferior to ‘liberal’ Hb thresholds for a broad array of conditions. A paradigm shift is emerging in approach to the critically ill, with re-consideration of the ‘Hb trigger’ strategy, itself. Ideally, the decision to transfuse should be based upon individual and context-specific consideration of the degree to which anemia contributes to tissue O2 delivery.

Feasibility and challenges of addressing this CQ or CC :

We need to identify specific physiologic endpoints linked to outcomes as well as determine the appropriate thresholds for these goals. We must improve current means to assess functionality of the circulating RBC mass and its specific relationship to tissue O2 delivery in both humans and animal models. Approaches to resolve this gap could be conducted in the following areas during the next 3-5 years (studies may be independent or ancillary to clinical transfusion trials). Examples include but are not limited to the following: (1) clinical and translational research studies examining physiologic tolerance of acute and chronic anemia in the critically ill populations; (2) basic and clinical research exploring accuracy, precision and reliability of novel approaches to quantify and monitor O2 consumption and delivery (global/regional). Investigations should also determine the relationship of these measures to clinically relevant patient outcomes, both global (mortality, ventilator dependence, length of stay, etc.) and organ-specific; and (3) studies evaluating the process of transfusion decision making in the setting of critical illness.

Name of idea submitter and other team members who worked on this idea : Nareg Roubinian, MD and Naomi Luban, MD for the 2015 NHLBI State of the Science in Transfusion Medicine.

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40 net votes
54 up votes
14 down votes
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Goal 1: Promote Human Health

How common is Omega 3 nutritional deficiency, and how can people make sure they're getting enough Omega 3?

If I understand correctly what I've read, it may be tough to get enough Omega 3 because Omega 3 & Omega 6 compete with each other & many people consume much more Omega 6 than Omega 3. http://www.drweil.com/drw/u/QAA400149/balancing-omega-3-and-omega-6.html I fear the situation might be even worse for vegetarians, because from what I've read, it appears much easier to get the DHA & EPA forms of Omega 3 from animal sources. ...more »

Submitted by (@apollia112)

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

Details on the impact of addressing this CQ or CC :

See comments

Feasibility and challenges of addressing this CQ or CC :

See comments

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

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-5 net votes
3 up votes
8 down votes
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Goal 3: Advance Translational Research

Can hair follicle stem cells be transformed into new cells or organs?

Dr. Cotsarelis of the Univ. of Pennsylvania identified the bulge area of the hair follicle, which is now thought to contain the hair's stem cells. These cells would seem to be readily available and unique to an individual person. Can further work be done to transform these cells into now only hair cells but other organ tissues?

Submitted by (@info00)

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

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-15 net votes
5 up votes
20 down votes
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