Goal 2: Reduce Human Disease

Vascular Origins of Cognitive Decline

A comprehensive research plan is needed to identify the vascular causes of cognitive decline, to develop early treatment options, and most ideally, develop effective measures to maintain cognitive function.

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

Details on the impact of addressing this CQ or CC

Reduction in the number of elderly with cognitive impairment would not only increase quality of life but would reduce health care costs. Research is indicating that the pathologic decline in cognitive function is complex and may involve multiple pathways of cardiovascular and metabolic origin.

Feasibility and challenges of addressing this CQ or CC

Addressing this issue requires research on vascular biology, tools for brain imaging and measurements of cognitive decline, all of which are advancing in development and implementation. The 2013 BRAIN Initiative includes $100 million in commitments from 5 federal agencies, including $46 million from NIH in grant awards focusing on new tools and techniques.
The frequently observed cognitive decline with aging can occur in a mild state or can progress to forms of dementia that are devastating to individuals and families and require a functioning and affordable support system for the affected individual. The vascular origin of this decline is only beginning to be understood. With increasing numbers of the US population surviving to their 80s and 90s, healthy cognition is critical for these elderly to be able to live independent functioning lives. .

As always commitment of funds is required as well as identifying appropriate research populations and efficient study designs.

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

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30 net votes
51 up votes
21 down votes
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Goal 2: Reduce Human Disease

How do we address health disparities especially in our most vulnerable populations?

How do we address health disparities especially in our most vulnerable populations, including children?

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

Name of idea submitter and other team members who worked on this idea Research Advocacy Committee, American Thoracic Society

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

Genetic engineering in lung progenitor cells

Can genome engineering be used to correct or alter lung stem/progenitor cells to ameliorate lung disease and promote regeneration?

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

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

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-15 net votes
3 up votes
18 down votes
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Goal 2: Reduce Human Disease

Towards Collaborative Funding of Clinical Trials

A way for clinical trial investigators to submit ONE application with ONE review and ONE funding decision, and the application would ask for funding from multiple funders (e.g. NHLBI and another IC, NHLBI and PCORI, NHLBI and AHA, NHLBI and CIHR, NHLBI and MRC).

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

Details on the impact of addressing this CQ or CC

It would be much easier for investigators from multiple sites/countries to secure funding for large-scale trials from multiple sponsors. They would only have to submit ONE application, respond to ONE review, and anticipate ONE funding decision.

Feasibility and challenges of addressing this CQ or CC

Clinical trials have become increasingly difficult to afford, yet the need for them has never been greater. Many other sponsors (CIHR, PCORI, AHA, MRC, European Union) are eager to work with NHLBI to enable user-friendly multi-sponsor funding. Some similar type arrangements are already happening with other IC's (e.g. NINDS is working with CIHR and the UK MRC).
Large-scale clinical trials often require involvement of multiple sites, often located in > 1 country. Furthermore, the expense of trials often raises questions as to whether funders could collaborate, all contributing a certain amount. However, there is no simple user-friendly way for applicants to bring secure multiple sources of funding. Ideally, the division of funds would be agreed upon prior to application. In case of foreign funders, no monies would cross borders -- i.e. for NHLBI and UK MRC applications, the NHLBI would fund American sites while the UK MRC would fund UK sites, but all funding goes to ONE trial with ONE protocol and ONE data set.

One challenge would be politics. Who will do the review? NIH has traditionally acted as if it is the only agency capable to doing a valid review. Would NIH be willing to accept a review conducted by another sponsor? Would other sponsors be willing to accept a review fully run by NIH?

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

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-1 net votes
8 up votes
9 down votes
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Goal 2: Reduce Human Disease

RCT of stepped-care depression treatment on CV events & death

Does treating depression improve survival and reduce major adverse cardiac events in acute coronary syndrome patients?

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 substantial evidence base now exists showing that depression is associated with a two-fold increased risk of death and recurrent CV events in cardiac patients, leading to a recent AHA scientific statement recommending its elevation to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome (Lichtman et al., 2014). Yet there is currently no clinical trial evidence that reducing depression improves cardiac morbidity and mortality. A clinical trial, using new, more effective depression treatment methods, such as collaborative care approaches that combine psychological counseling with medication in stepped-care fashion, is needed to determine whether effective treatment of depression can improve survival and reduce clinical cardiovascular events in cardiac patients.

Feasibility and challenges of addressing this CQ or CC

Newer stepped-care treatments for depression, combining medication and psychotherapy, have recently been developed and found to more effectively reduce depression than earlier treatments. By using these newer treatment methods to substantially lower depression, we can better answer the question as to whether treating the newly acknowledged risk factor of depression in ACS patients can improve clinical outcomes in these patients.

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

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5 net votes
22 up votes
17 down votes
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Goal 2: Reduce Human Disease

Asthma Disparities in Low income children

What are the most effective methods to reduce asthma disparities in low income children?

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

Details on the impact of addressing this CQ or CC

Despite advances in care, asthma inequities are persistent among low income children. What are the most effective measures to close the gap?

Feasibility and challenges of addressing this CQ or CC

There are multiple strategies but what are the most effective treatment options in low income children who have higher morbidity and mortality?

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4 net votes
9 up votes
5 down votes
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Goal 2: Reduce Human Disease

How can the study of rare diseases inform our understanding of common diseases?

How can the study of rare diseases inform our understanding of common diseases?

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

Name of idea submitter and other team members who worked on this idea Research Advocacy Committee, American Thoracic Society

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

The effects of environmental factors on heart, lung, blood, sleep disease development across the lifespan

How do growth, development, exposure, and behavior affect heart, lung, blood, sleep disease development and outcome throughout the lifespan?

 

How do you improve organ function/capacity during childhood?

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

Details on the impact of addressing this CQ or CC

Defining earliest elements of disease and strategies for prevention

Feasibility and challenges of addressing this CQ or CC

If we don’t start now, it will never get done
. Challenges:
• Determine if elements of cell aging, including stem cell aging and senescence, affect disease progression and the effectiveness of therapeutic interventions
• Can we develop iPS based or other cell based bioengineered tools to more precisely define cellular and molecular responses to particular exposures?
• How do we identify, prioritize and measure relevant environmental exposures?

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

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12 net votes
32 up votes
20 down votes
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Goal 2: Reduce Human Disease

Can we break the silos at NHLBI? Why are we not working on studiying heart and lung issues in blood cancer survivors?

There is an increasing number of blood cancer survivors in the United States. Many of them have treatment induced heart and lung comorbidities (i.e CHF, pulmonary fibrosis, early aging, etc). However, there does not seem to be a concerted effort by the NHLBI to leverage their relationship with the NCI or the BMT CTN to address this issue. NHLBI should be developing a funding mechanism for cardiopulmonary researchers to... more »

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

Details on the impact of addressing this CQ or CC

Would create an infrastructure for cardiopulmonary researchers to work with hematology researchers.
Reduce burden of therapy with curative intent
Develop insight into cardiopulmonary diseases outside of the cancer arenal

Feasibility and challenges of addressing this CQ or CC

Very feasible with the Blood and Marrow Transplant Clinical Trials Network and the National Clinical Trials Network

Name of idea submitter and other team members who worked on this idea Sergio Giralt

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66 net votes
96 up votes
30 down votes
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Goal 2: Reduce Human Disease

Postoperative respiratory failure

Ventilating patients in the operating room constitutes the largest number of patients exposed to mechanical ventilation in this country and world wide [many millions of patients]. Postoperative pulmonary problems may, in part, due to the mechanical ventilation received in the OR. Yet, this cohort has never been systematically studied in terms of the effect of specific ventilatory patterns on postoperative outcomes. Data... more »

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

Feasibility and challenges of addressing this CQ or CC

There is an international trial [Provilho] but no US trials.

Name of idea submitter and other team members who worked on this idea American Thoracic Society member

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

Can At-home sleep studies change the rural area diagnosis of obstructive sleep apnea

At home sleep tests or personal monitors (PM) have been shown to effectively provide an adequate diagnosis of OSA with the proper pre-screening tests and evaluation. These methods can be adopted by hospitals and if used effectively can save money to the patients and healthcare facility. With the Affordable Healthcare Act the focus is on providing quality care for less money, but many hospitals are slow to adapt. Sleep... more »

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

Details on the impact of addressing this CQ or CC

Setting up a protocol for rural hospitals, or all healthcare facilities in developing and taking care of patients with sleep disorder breathing.

Name of idea submitter and other team members who worked on this idea Jeremy Plambeck

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11 net votes
33 up votes
22 down votes
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Goal 2: Reduce Human Disease

Make Tuberculosis elimination a priority

With current diagnostic technology and current treatment available the US should be able to eliminate TB if adequate resources are invested in public health infrastructure. Make plans to end TB by providing adequate support to TB control programs.

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

Details on the impact of addressing this CQ or CC

It is within our power to drastically impact the rates of TB in our country. As TB case rates decline, so is the funding to the TB programs. As funding is reduced so is the skilled workforce to handle the cases of TB that arise. Today's cases of TB are more complex, including multi-drug restant strains. We need to invest in our workforce and adequately fund TB until it's eventual elimination. To reduce funds early will result in an eventual increase in TB cases from inadequate case finding and latent TB infection treatment.

Feasibility and challenges of addressing this CQ or CC

If provided with adequate funding, the US can eliminate TB.

Name of idea submitter and other team members who worked on this idea Karen Simpson

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-5 net votes
8 up votes
13 down votes
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Goal 2: Reduce Human Disease

Resistance to smoking-related disease

What are the factors that determine resistance to smoking-related heart and lung disease?

 

What are the common pathways amenable to intervention to prevent smoking related to heart and lung disease?

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

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

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-2 net votes
7 up votes
9 down votes
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Goal 2: Reduce Human Disease

Redefining asthma: origins of obstructive airways disease

Can detailed longitudinal study of lung disease in infancy/early childhood improve our understanding of the origins of obstructive airways disease, and the variation seen in asthma phenotypes and severity?

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

Details on the impact of addressing this CQ or CC

Asthma is, to some extent, an umbrella term that encompasses a broadly heterogenous (in severity, symptoms, and pathophysiology) group of obstructive lung diseases. This is even more true if we examine the "wheezy infant," a population defined almost exclusively by the presence of wheeze, cough, or noisy breathing with very little understanding of disease mechanism or pathophysiology, and few evidence-based treatment options. Improving our understanding of the pathophysiology of wheeze and recurrent cough in early childhood, and how these evolve into various phenotypes of "asthma," through comprehensive longitudinal study of infants and young children may lead to better endotyping of disease and improved therapeutic options, as well as the possibility of disease prevention.

Feasibility and challenges of addressing this CQ or CC

We lack adequate biomarkers (of inflammation, structural and functional lung disease, microbiome, nutrition, etc) to investigate lung disease in infancy and early childhood. Identifying biomarkers with adequate sensitivity, and with a safety profile that allows for repeated measures in large groups of children, will be key to identifying the early childhood origins of all lung diseases.

Name of idea submitter and other team members who worked on this idea Jessica Pittman

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-7 net votes
7 up votes
14 down votes
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