Goal 2: Reduce Human Disease

Support for Cardiothoracic Surgery and Pediatric Heart Clinical Trial Networks

Continued and expanded support for the Cardiothoracic Surgical Trials Network (CTSN) and Pediatric Heart Network (PHN) is essential as both design, conduct, and analyze multiple, collaborative clinical trials that evaluate surgical interventions, and related management approaches for the treatment of cardiovascular disease. To date both networks have reported on and developed a portfolio of studies which need continued ...more »

Submitted by (@meaton)

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 work and support provided to date have allowed for the creation of an infrastructure for both the CTSN and PHN. Each network is now providing valuable results to the cardiothoracic surgery specialty which will allow an increase in quality patient care in the years and decades to come. The continued support is essential for the success of these networks as any reduction will limit the resources available for site participation and ultimately results. Due to the existing infrastructure for each network, the financial burden associated with de-funding and then restarting the networks in future years would be at least triple the financial commitment currently in place.

Feasibility and challenges of addressing this CQ or CC :

Conducting multi-center clinical trials is a substantial financial commitment but a vital part for the future of the cardiothoracic surgery specialty.

Name of idea submitter and other team members who worked on this idea : Matt E.

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108 net votes
151 up votes
43 down votes
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Goal 2: Reduce Human Disease

Preventing or reversing myocardial fibrosis

Conduct proof-of-concept studies and explore whether strategies to reverse or prevent fibrosis are feasible.

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 :

This challenge will lead to early studies of potential therapeutics for arrhythmias and heart failure. If successful, this would have huge impact.

Feasibility and challenges of addressing this CQ or CC :

Recent studies have identified some compelling signaling pathways that activate fibrosis so it is feasible to test them through creative experimentation.

Fibrosis and fibrogenesis in the myocardium are clear indications that heart function is either declining or progressing towards decline. Although much of the current research continues to focus on unraveling mechanisms that lead to fibrosis and activation of fibrogenesis, there is as yet less focus on potential mechanisms to prevent or reverse fibrosis. This was in part due to insufficient understanding of major causes of fibrosis and mechanisms that activate fibrogenesis. However, findings from recent studies show that there are several compelling therapeutic targets that are ready to be tested to see whether fibrosis can be reversed or prevented.

May need strategies on how to best to succeed in implementing the research - e.g., what research mechanisms, what kind of teams, what kind of expertise, etc. To fine tune this, a focused workshop for advice may be helpful.

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

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19 net votes
33 up votes
14 down votes
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Goal 1: Promote Human Health

Non-opioid management of pain

The use of opioid agents has increased dramatically in the United States. Prescription drug overdoses now account for more deaths than traumatic injuries in the 1-44 age group. There is a need for more high level evidence to target optimal pain management strategies in the acute (ED) and non-acute settings (office practice) especially for chronic disorders such as low back pain, headaches, fibromyalgia, acupuncture etc. ...more »

Submitted by (@dayam0)

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

Details on the impact of addressing this CQ or CC :

Huge problem in the US compared to other countries where opioid use is more restricted. Potential to enhance population health and reduce accidental death.

Feasibility and challenges of addressing this CQ or CC :

Complex since affecting by many factors and groups that would need to work together in conjunction with patients to change the way we approach pain.

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

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

Using Social Media to Promote Healthy Behaviors

Since most people know that there are behaviors that they need to do to be healthy, can we leverage peer or family pressure or use social media to create a “grass roots” groundswell of health-promoting behaviors?

How might social media platforms such as Facebook and Meetup.com be leveraged for designing low-cost research studies and interventions that promote sustainable healthy lifestyle and behaviors?

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 :

Given the massive use of mobile devices and social media in our society, engaging this critical challenge would have a significant impact on our understanding how this technology can be used in disease prevention and health promotion.

Feasibility and challenges of addressing this CQ or CC :

It is feasible, timely, and cost-effective to study and incorporate into our interventions the use of social media because these applications are already so widely used.

Even if people haven’t memorized the American Heart Association’s seven factors related to heart health (get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, stop smoking), most know that these are the behaviors that they need to do to be healthy. Despite this knowledge, heart disease is still the leading cause of death in the United States; about 1 in 3 U.S. adults has high blood pressure; diabetes affects nearly 26 million in the U.S.; and about 19% of U.S. adults are smokers. According to the CDC, in 2011 over 50% of those 18 years of age or older did not meet the recommended goal for aerobic exercise (150 minutes per week of moderate-intensity activity such as walking). Obesity is an epidemic: about one-third of American adults are obese (BMI ≥ 30 kg/m2). People know what to do, but why don’t they do it? Our built environments and culture do not intrinsically promote a healthy lifestyle. In the absence of a culture that promotes walking or biking over driving cars and that promotes fast and fattening food over more healthy food choices, can we use peer networks to promote healthy behaviors? For example, Meetup.com is a tool that people use to meet for activities that include hiking, tennis, and physical fitness boot camps.

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

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17 net votes
52 up votes
35 down votes
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Goal 1: Promote Human Health

Intersecting Developmental Biology with Vascular Physiology and Biology

Although many think of the vasculature as a lump sum of vessels that all react in a similar fashion to a certain stimulus, e.g., alpha-adrenergic activation, this is not the situation. For example, coronary resistance vessels show little to no direct response to alpha-adrenergic activation while resistance vessels in most organs show marked constriction. Another example is the response of different vessels to angioplasty ...more »

Submitted by (@wchilian)

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 challenge facing many specialists in vascular medicine, vascular surgery, and cardiology is understanding the ramifications, and the basis, of the vascular pathology in the context of the organ system. Another way of re-stating this as a question is: Are the unique attributes of the vascular biology, pathology and physiology of a particular organ system connected to specific aspects of development. This question would help both the basic on clinical scientists understand the basis of why a blood vessel in the kidney may be different than one in the heart, or in the brain with the goal of devising more selective therapies to approach vascular disease in specific organs. Scientists in the area of vascular development have long appreciated that vascular cells in different organs arise from different embryological origins; yet how this information translates into the intricacies of vascular control, or responses to pathology is not resolved. Understanding the basic biological mechanisms of how the embryological source of the vasculature affects pathology and physiology could engender treatment of vascular disorders.

Feasibility and challenges of addressing this CQ or CC :

This idea could be implemented by encouraging multi-PI efforts from vascular developmental biologists, and investigators engaged in studies of microvascular control mechanisms and/or vascular biologists interested in vascular pathologies such as restenosis and vascular lesions. Advances in fate mapping techniques have enabled developmental biologists to track embryological origins of cells into specific organ systems into adulthood. With such a multi-faceted approach a better understanding of vascular physiology and pathophysiology will be obtained that hopefully will be translated into more effective treatments.

Name of idea submitter and other team members who worked on this idea : William M. Chilian

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15 net votes
26 up votes
11 down votes
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Goal 2: Reduce Human Disease

Shift from NHLBI guided research to individual investigator initiative

NHLBI directed research should be abandoned and switched to investigator initiated research. I respectfully suggest read the following assay by Brown and Goldstein, Science 2012; 338: 1033-1034 The best way to run the science sponsored by the NIH (or NHLBI) is not to guide it (analogy to running science from ivory tower) but let the investigators decide what is worth pursuing. Get rid of NHLBI-directed research initiative ...more »

Submitted by (@nhlbiforumadministrator)

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 : AJ Marian

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47 net votes
63 up votes
16 down votes
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Goal 2: Reduce Human Disease

Clinical Trials in Pediatric Sleep Disorders - Effect of adenotonsillectomy

Effect of adenotonsillectomy on neurocognitive and behavioral outcomes in infants and and toddlers with obstructive sleep apnea syndrome.

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 :

The CHAT study showed few significant changes in cognitive outcomes in school-aged children with OSAS. However, these children (aged 5-9 years) may have suffered from OSAS too long to allow for reversibility of central nervous system damage. The peak prevalence of OSAS occurs in much younger children. Theoretically, these children are much more likely to show cognitive improvement after treatment, due to a shorter duration of OSAS (with its resultant hypoxemic damage) and increased plasticity of their nervous system. These young children are often not treated, due to either underdiagnosis or concern about the increased risks of adenotonsillectomy in very young children. Thus, if it is found that early treatment reverses cognitive damage, the clinical management of these children would be profoundly affected.

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

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1 up votes
1 down votes
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Goal 2: Reduce Human Disease

Sleep Apnea - Diagnostic Test

The notion that in order to be treated with CPAP for sleep apnea you first must have a diagnostic test, which involves either a sleep laboratory or a home study, needs to be examined.

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 :

This idea is far reaching and possibly ahead of the curve a bit but it represents a direction that the sleep apnea field eventually should explore. Consider developing a clinical diagnosis of sleep apnea based on clinical symptoms and exam findings and then randomized those patients meeting the definition to a trial of autocpap for 3 months or to a traditional evaluation (home diagnostic test then APAP) for 3 months. Close follow up is necessary but with wireless telephony now available for CPAP and estimates of AHI available through CPAP adherence downloads, this study is feasible. If such a case diagnosis of sleep apnea can be developed (and I believe it can), then many more patients may be able to be treated. This approach, if successful, would shake-up the field considerably and potentially opens up treatment to many more OSA sufferers.

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

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2 net votes
2 up votes
0 down votes
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Goal 3: Advance Translational Research

Immune-Mediated hematologic disorders

What is the optimal approach to prevent and treat immune mediated hematologic disorders (autoimmune hemolytic anemia, immune thrombocytopenic purpura, etc) and complications of hematologic disease (inhibitors in hemophilia, transfusion-related alloimmunization, etc)

Submitted by (@barbarak)

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

Details on the impact of addressing this CQ or CC :

Therapies for these disorders are suboptimal and current treatments are associated with significant side effects. Transfusion is limited by development of alloantibodies..

Feasibility and challenges of addressing this CQ or CC :

NHLBI should support clinical trials in this area. Improved understanding of the biology and biomarkers predictive of disease development would aid in defining therapeutic approaches and trials.

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-1 net votes
17 up votes
18 down votes
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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

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-1 net votes
6 up votes
7 down votes
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Goal 3: Advance Translational Research

Develop biomarker panel to predict CVD risk in -omics era

There is a need to utilize the vast data generated in -omics research to develop biomarker panels for better prediction of cardiovascular disease (CVD) risks. •Cardiovascular diseases develop over decades and different panels of markers may be required for different stages •Lead molecules as potential biomarkers need to be selected by a panel of experts •Standard procedures about sample preparation, data acquisition, ...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 :

•Develop specific and sensitive markers for early prevention with more predictive power. Biomarkers that can detect specific perturbations in the system, such as metabolic status and vascular integrity prior to the occurrence of the diseases can be used for early preventive treatment of cardiovascular diseases.

 

•Identify vulnerable population who cannot be identified by the current LDL-HDL profiling

 

•Allow for more personalized treatment

Feasibility and challenges of addressing this CQ or CC :

•An increase in system biology studies using –omic approaches have provided huge data to mine through and find potential biomarkers, such as microRNA, DNA, lipids, proteins, and other metabolites, which can be used to assess changes proceeding cardiovascular diseases occurrence.

 

•The NIH-wide Big Data to Knowledge (BD2K) initiative launched in 2012 may have laid out some framework.

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

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

Why are CHD Mortality Rates Much Higher in United States Than in Japan or Mediterranean Countries?

There remain very substantial unexplained international geographic variations in the incidence of CHD. Japan, for example, and some of the Mediterranean countries have CHD incidence rates for both men and women that are 1/3-1/4 of those in the United States.

Submitted by (@kullerl)

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

Details on the impact of addressing this CQ or CC :

Migrants from these countries have substantial increase in their CHD rates within a very short time after emigration to the United States or to other countries, strongly suggesting that fundamental genetic differences do not account for these variations in the rates. Reduction of the CHD rates in the United States to those in low risk countries will have the most profound effect on CHD and CVD incidence and mortality.

Feasibility and challenges of addressing this CQ or CC :

Research to further evaluate the probable dietary determinants of these extremely low rates and their implications to the United States should be a high priority. This includes careful study of fatty acids, especially polyunsaturated fatty acids, soy proteins, etc., interrelationships with markers of inflammation and inflammatory diseases. Japan, for example, not only has low CHD rates but also low rates of rheumatoid arthritis (RA), chronic obstructive pulmonary disease even in the presence of high levels of cigarette smoking, multiple sclerosis, all of which would suggest that inflammation may be contributing to these variations in risk of disease. Furthermore, there is growing evidence that omega-3 fatty acids and perhaps other fatty acids may play an important role in T cell function and the development of CVD.

Name of idea submitter and other team members who worked on this idea : Lewis H. Kuller, MD, DrPH

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-8 net votes
10 up votes
18 down votes
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