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

NHLBI Cohort Populations for T4 Implementation Research

How best can NHLBI observational cohorts be utilized to study observational T4 Implementation Research among both general and vulnerable US populations?

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 :

• Would help identify key factor associated with successful implementation that could be studied in interventional T4 implementation research

• Result would refine implementation strategies and health and social policy aimed to reduce heart, lung, blood, sleep diseases and conditions

• Builds on excellent established platform of research with high quality outcomes in well characterized study populations over long term follow-up.

Feasibility and challenges of addressing this CQ or CC :

• Big data is developing methods to link large data sets from national, state, and community level surveys – surveys that can define exposures to various policies and interventions in place, time, and population.

• A family of high quality cohorts are available for ancillary observation studies

• Collection of community level and more broad policy level exposures is feasible through data already collected and through potentially new data collection.

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

Voting

-4 net votes
11 up votes
15 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

Voting

7 net votes
20 up votes
13 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

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

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

Voting

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

Promotion of interdisciplinary and team science by T-32 Institutional Training Grants.

Are T32s doing a sufficient job of promoting interdisciplinary and team science? Should we change the way these programs are structured?

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 :

T-32 programs train few thousands junior biomedical scientists every year. Training grants that succeed in integrating multiple discipline will produce a workforce that is more attuned to the needs of modern medicine and will be more competitive in the job market of the 21st century.

Feasibility and challenges of addressing this CQ or CC :

Activities along this line can be implemented immediately by strongly encouraging the institutions to revise or re-design their training programs.

Interdisciplinary training has become a necessity in the present time; there is a strong interest in today’s medicine at looking at the patient in its entirety and at disease processes from all angles. This requires data integration and scientists that are familiar with the language of different disciplines and can ask scientific and medical questions that span these disciplines.

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

Voting

25 net votes
37 up votes
12 down votes
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Goal 2: Reduce Human Disease

What types of questions are most likely to improve the health of the public? The importance of discovery science.

Congressional eagerness to see research funding translate into improvements in health care may make studies that address “how-to-deliver-care-questions” seem attractive. But the answers to “how–questions” are often so context dependent that the findings are neither generalizable nor durable. The answers to “how–questions” too often become obsolete when the health-care system, the electronic medical record, or the insurance ...more »

Submitted by (@psaty0)

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

Details on the impact of addressing this CQ or CC :

Improvement in the health of the public.

Feasibility and challenges of addressing this CQ or CC :

It is easily a matter of focus.

Name of idea submitter and other team members who worked on this idea : Psaty & Tracy

Voting

22 net votes
29 up votes
7 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

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18 net votes
31 up votes
13 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

Voting

7 net votes
26 up votes
19 down votes
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