Sleep deficiency is pervasive in today’s society and associated with an array of threats to health and public safety. The availability of a biomarker(s) for sleep health would turn-the-curve on developing practical and feasible ways to identify individuals at risk for sleep deficiency and prevent/manage associated risks to health and public safety on a large-scale.

Sleep and circadian regulation is coupled to an array of behavioral, physiological and molecular/genetic processes to leverage in the development of biomarkers for sleep health.
Untreated sleep disorders and sleep deficiency pose a significant burden on health and public safety. There is currently no biomarker, or point-of-care technology available to objectively measure an individual’s level of sleep deficiency or susceptibility, a significant barrier to prevention and management.

Understanding the biological rationale behind the benefit of a particular dietary component that promotes CV health will substantiate public health recommendations about diet.

Our understanding of the nitrate/nitrite cycle and of cardiovascular activity of nitric oxide has advanced rapidly in the past 10-15 years. The time is ripe for linking these advances in the science of nitrates to the consequences of dietary nitrate.
The role of dietary fruits and vegetables in the protection against cardiovascular disease is supported by many studies, especially leafy green vegetables. However, identification of the component of fruits and vegetables affording this protection has been elusive. Recent discoveries about the ability of the body to cycle dietary nitrates to produce bioactive nitric oxide via the enterosalivary cycle and lingual microbiome lends strength to the argument that leafy green vegetables may be protective due to their high nitrate content. This possibility should be examined in both large cohort studies and in clinical series. Would be helpful for the USDA to add nitrates to their standard database of food nutrients. NHLBI needs to partner with NCI to coordinate with ongoing research about the potential nitrosylation of dietary nitrites to carcinogenic n-nitrosamines in the setting of low antioxidant intake.

Since sickle cell has multiple layers in medical treatment strategies, how can the same thought process happen when it comes to psychosocial matters? How can the NHLBI develop effective patient engagement trans-disciplinary and multi-level strategies that work with medical strategies to deal with psychosocial matters for individuals and families?

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.

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.

Unless an individual is a candidate for transplantation, sickle cell will be a lifelong challenge. Much effort has been focused in the pediatric area and on physical aspects of the disease. However, adult care and mental/psycho-social health have not been adequately addressed. A holistic approach across the lifespan would fill these gaps and perhaps lead to better health outcomes and addresses NHLBI's goal of reducing the burden of human disease.

Patients with serious heart, lung and blood diseases are often faced with dificult treatment decisions that involve tradeoffs and long-term consequences without adequate understanding of their prognosis and the risks and benefits of treatment. There is emerging consensus that a shared decision-making approach provides the best support for patients and their families in this situcation, but there is evidence that this is not happening and there is inadequate data to guide the best approach to ensuring it does happen. Dramatic advances in treatment technologies make treatment choices ever more complex and often make the tradeoffs more difficult to fully understand. Advances in our ability to help patients and their families through this decision-making process have not kept up with these advances in treatment options.

Incorporation of palliative care approaches, decision aides, and improvements in clinician-patient communication provide the opportunity to make important advances in this area, but have not been fully developed or incorporated. There is an opportunity to advance the communication, decision-making, and implementation science to have a dramatic impact on enhancing healthcare and quality of life for patients and thier families.

Patients would benefit from high quality care coordination; costs to insurance companies would probably decrease as would hospitalizations; would result in better quality of life for patients.

All providers must be willing to share information; PCP's must be willing to screen for COPD and make referrals when indicated; would be a challenge in very rural areas with very few resources.

For the first time, comprehensive guidelines addressing the management of sickle cell disease were issued in 2014 by the NHLBI. (Previous guidelines were not comprehensive.) The 2014 guidelines, which address issues such as health maintenance and the treatment of acute and chronic complications, are based on a systematic review of available evidence; consensus of an expert panel; and published, vetted guidelines by other organizations when evidence was unavailable or insufficient. These guidelines can provide a solid overview of the knowledge essential for the care of people with sickle cell disease.

Identifying primary care providers who can provide routine and preventive care but at the same time are knowledgeable about sickle cell disease, should be a more efficient, less costly method of provide important health services to people with sickle cell disease and should ultimately improve the health and well being of this population, particularly for people who do not live near a sickle cell center.

Addressing this question is very feasible. However, for a variety of reasons, including misconceptions about patients with the condition, it may be challenging to recruit large numbers of primary care providers.

If successful this approach should enable the conduct of cheap pragmatic trials that are fueled by data from clinical care. The integration into clinical care helps assure efficiency and generalizability of results.

The advent of electronic medical records and the explosion of big data technology has made it possible to gain access to and analyze data in a manner that would have been unthinkable 10 years ago. This is already going on in other fields.
Health care systems are increasingly using "big data" approaches to track outcomes in the patients treated with different strategies and drugs, and apply the knowledge gained from outcomes in previous patients to inform decision making in subsequent patients ("learning"). This approach could be used to personalize treatment. A recent example from cancer is to genotype lung tumors, and tailor the treatment of a new patients to drugs producing good results in patients with similar tumor genotypes. When two or more treatments produce similar results, one could randomize. Cardiovascular disease presents a challenge in using genotyping information to personalize treatment, because the manifestations are the results of complex genetic and environmental risk factors.