Showing 10 ideas for label trending idea

Goal 1: Promote Human Health

Global cohorts to fill gaps in knowledge trending idea

Given the global burden of disease, what does NHLBI plan to do to establish a diverse global cohort to connect basic sciences to population health, in a way that differences in phenotypes around the world can be studied rapidly? For example, why not start by supporting a coalition of cohorts originally funded by the Global Heart Initiative?

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

Details on the impact of addressing this CQ or CC

A big challenge is for global proposals to get through regular RO1 mechanisms, as the study sections tend to be US-centric. Issuing special RFAs for US institutions to collaborate with global partners and setting special study sections will help.

Feasibility and challenges of addressing this CQ or CC

This should be feasible

Name of idea submitter and other team members who worked on this idea K.M. Venkat Narayan

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5 up votes
13 down votes
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Goal 3: Advance Translational Research

Implementation of Evidence-based Guidelines in LMICs trending idea

How can implementation strategies be tested in low and middle income countries for contextually and culturally adapted evidence-based clinical care guidelines with a focus on prevalent non-communicable diseases with large burdens such as sickle cell disease, hypertension, heart disease, stroke, asthma, and COPD?

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

Details on the impact of addressing this CQ or CC

Evidence-based guidelines for heart, lung, and blood diseases, developed within high income countries are challenging to implement within low and middle income countries because delivery capacity and health care infrastructure is often limited. Contextually, culturally and language adapted guidelines implementable within low and middle income countries can impart substantial benefit while distributing more evenly global knowledge of proven effective interventions while improving health equity. Proven effective interventions would get delivered in an effective manner across low and middle income countries which will improve heart, lung, and blood health outcomes.

Feasibility and challenges of addressing this CQ or CC

The NHLBI Global Health Think Tank recommended research on implementation of contextually, culturally and language-adapted clinical care guidelines in low and middle income countries and encouraged addressing this issue in the near future.

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

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-10 net votes
8 up votes
18 down votes
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Goal 1: Promote Human Health

Environmental Exposures and Atopic Disease trending idea

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:

 

What are the molecular and cellular responses in the lung that occur after environmental stimuli (including allergens) that predict homeostatic resilience or transition to atopic 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 Mitchell Grayson on behalf of the American Academy of Allergy, Asthma, and Immunology

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-7 net votes
8 up votes
15 down votes
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Goal 3: Advance Translational Research

New treatment for HIV and HIV-related lymphoma trending idea

Highly active antiretroviral therapy (HAART), while clearly invaluable, does not halt growth or proliferation of HL, in fact, while AIDS-defining malignancies like Kaposi’s sarcoma (KS) and non-Hodgkin’s lymphoma (NHL) have declined thanks to HAART, the incidence of HL in HIV patients has actually increased, from 14 times higher than that of non-HIV patients in the pre-HAART era to 32 times higher in the HAART era. Typical... 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

Today, approximately 10% (over 3.5 million worldwide) of HIV-infected patients develop lymphoma. The societal cost of HIV-related HL is particularly steep. HL patients are typically young (20s-30s), likely to actively spread virus, and without treatment, represent years of lost productivity.

Feasibility and challenges of addressing this CQ or CC

To this end, it is important to gather a team of collaborators from the fields of immunology, cancer, immunotherapy, and HIV. Through these combined expertise, we hope to lay the groundwork for novel, life-saving therapy for patients with HL in the problematic context of HIV viral infection.

Name of idea submitter and other team members who worked on this idea Dongfang Liu

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-26 net votes
8 up votes
34 down votes
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Goal 3: Advance Translational Research

Direct thrombin inhibitors and anti-Xa (Ten A) inhibitors in trauma patients - physiologic effects and impact on outcomes trending idea

Direct thrombin inhibitors and anti-Xa (Ten A) inhibitors are new, undetectable and irreversible. We have no data on how well these drugs correlate with current measures of coagulopathy such as thromboelastography, or whether antifibrinolytics should be used in patients who are on these drugs. These drugs may increase incidence of traumatic brain injury after minor injury. They are also going to be used increasingly in... 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

Understanding pathophysiology of coagulopathy in trauma patients due to these drugs may lead to innovations in management of coagulopathy and help increase our ability to predict/prognostic poor clinical outcomes in patients on these new anticoagulants, detect these drugs in a timely manner and develop antidotes/reversal agents. 

Feasibility and challenges of addressing this CQ or CC

These are eminently feasible with adequate support from the NHLBI. Challenges will be finding collaborations or institutions that have enough clinical volume and adequate basic science/translational research infrastructure to look at these questions seriously.

Name of idea submitter and other team members who worked on this idea Sudha Jayaraman

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-7 net votes
6 up votes
13 down votes
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Goal 4: Develop Workforce and Resources

Training and mentor support in global health trending idea

Why can’t all training grants (T, K, etc) be opened out to all people working in US institutions, regardless of citizenship or green-card?

Why can’t we establish mechanisms for US junior investigators and mentors interested in global NHLBI areas?

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

Details on the impact of addressing this CQ or CC

Current policy does not allow non-citizens and green-card holders to apply for most K and T grants. However, given the changing nature of US workforce, this policy needs to change. Current mechanisms do not easily enable US investigators to get support for global work……training and/or research.

Feasibility and challenges of addressing this CQ or CC

Why not?

Name of idea submitter and other team members who worked on this idea K.M. Venkat Narayan

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-13 net votes
4 up votes
17 down votes
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Goal 2: Reduce Human Disease

What about the impact of regulation of genes in response to external stimulation on human health trending idea

We are focusing a lot on the genes that may be protective or harmful to our lives. But what about the regulation of genes in response to external stimulations, such as psychosocial and/or environmental, that are probably more accountable for whether we live healthier or not.

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

Details on the impact of addressing this CQ or CC

Rationale: Years of research in the mind-heart field have set examples that looking at changes during dynamic stimulations (chronic, acute, and acute superimposed on chronic) are more meaningful for us to better understand how the body truly works. Therefore, research design in mimicking real dynamic process is necessary to truly capture the healthy or harmful phenotypes driven by genotypes. I suggest the NHLBI to establish a platform gathering resources to promote more sophisticated research from basic to clinical to better understand the underlying mechanisms of psychosocial impact on cardiovascular diseases that has come to a sizable problem for the human being in US and world wide.

Feasibility and challenges of addressing this CQ or CC

We have performed researches that allow us to identify phenotypes that are only appearing under emotional stress testing. Currently we are examining whether certain intervention may modify these kinds of changes. Even our studies fail to demonstrate changes with intervention, the findings support future studies focusing on testing dynamic changes under stress that reflects daily living. Resting data obtained in laboratory does not truly represent what human beings experiences.

Name of idea submitter and other team members who worked on this idea Wei Jiang from Duke University

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-4 net votes
5 up votes
9 down votes
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Goal 4: Develop Workforce and Resources

Medical student research training in LMIC settings trending idea

What are the strategies for heart, lung, blood, sleep workforce to gain first-hand international experience in clinical research/implementation research training in low- and middle-income country (LMIC) settings?

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

Details on the impact of addressing this CQ or CC

• Among the students who earn medical degrees in the United States, very few of them have been sufficiently trained to address the health needs of the most vulnerable populations.
• An international exposure in an LMIC setting would have enormous impact on clinical practice and research
• Any medical student interested in broadening their training may have opportunities for clinical and non-clinical hands-on experience and in turn this would increase number of physicians and researchers in global health.

Feasibility and challenges of addressing this CQ or CC

Feasibility: • The NHLBI has a wealth of experience in training and career development programs in general and has supported and worked with global centers of excellence in this area.
• This experience can be used to leverage international experience in clinical practice and research outcomes in LMIC settings.

Challenges: • NHLBI would have to develop additional training mechanism(s) to foster clinical practice and research in an LMIC area.

• Resources for this unique training may be a challenge.

• Helping patients from vulnerable populations would involve confronting cultural differences and language barriers.

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

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-30 net votes
5 up votes
35 down votes
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Goal 2: Reduce Human Disease

Consequences of ABO or Rh Type Specific versus Non-Type Specific Platelet Transfusions trending idea

What are the consequences, clinically and immunologically, of ABO or Rh type specific vs. non-type specific platelet transfusions? There is widely varying practice as to ABO and Rh matching of platelets for transfusion. Most studies demonstrate that use of ABO unmatched (non-identical) platelets are associated with increased 1) platelet refractoriness (small randomized trials), 2) red cell transfusion needs and hemolysis,... 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

Large randomized trials would answer the ABO and Rh related critical clinical outcomes question for platelet transfusions in all patients who commonly receive multiple platelet transfusions. This would include most patients with acute hematologic diseases, patients undergoing complex cardiac surgery, solid and stem cell transplant recipients and trauma patients. In addition, modeling the effects of ABO and Rh incompatibility/non-identity in animal models and in vitro would provide data on basic platelet immunobiology.
In vitro and animal model studies that might be relevant include effects of ABO immune complexes on endothelial cell and glycan interactions with other cells of the vasculature and blood. Effects on TLR, interleukin receptors and secreted cytokines are additional considerations.

Feasibility and challenges of addressing this CQ or CC

A randomized trial in patients undergoing induction therapy for acute leukemia and/or allogeneic stem cell transplant would accrue enough patients rapidly to answer this question in, at most, two-three years, given the repeated transfusions of platelets to such patients. A comparison of current practice, or intentionally employing ABO/Rh major mismatched platelets (no risk of hemolysis) as the control arm, versus only ABO/Rh identical platelets in the experimental arm is feasible and ethical. Outcomes such as bleeding, time to engraftment and survival (100 day and long term) are important and scientifically of interest. Companion scientific mechanism studies of effects on inflammation, immunity (adaptive and innate) and hemostasis and thrombosis would be feasible in vitro, in animal models and in the patients in the clinical trial. A similar trial would be informative in patients undergoing complex adult or pediatric cardiac surgery (e.g., combined valve/CABG, LVAD insertion, single ventricle physiology operations) or adult/pediatric ECMO settings.
4. References

  1. Carr R, et al. Br J Haematol 1990;75:408-13.
  2. Heal JM, et al. Ann Hematol 1993;66:309.
  3. Heal JM, et al. EurJHaematol 1993;50:110-7.
  4. Blumberg N, et al. Transfusion 2001;41:790-3.
  5. Shanwell A, et al. Vox Sanguinis 2009;96:316-23.
  6. Inaba K, et al. Arch Surg 2010;145:899-906. 

Name of idea submitter and other team members who worked on this idea Cassandra Josephson on behalf of the Platelet Committee from the State of the Science Meeting 2015

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-4 net votes
25 up votes
29 down votes
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Goal 2: Reduce Human Disease

PUFA Toxicity trending idea

Our diets contain 20 times more omega-6 fatty acids than the diets of humans before agriculture, industrial solvent extraction of seed oils and hydrogenation. These acids including linoleic and arachidonic acids are precursors to eicosanoids that mediate inflammation and blood clotting and the amount in our diet has been shown to correlate with negative health outcomes. Should NHLBI fund more research into the effects... 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

Federal regulations could limit the amount of omega-6 fatty acids in foods and significantly reduce the incidence of atherosclerosis, strokes, heart attacks, asthma and autoimmune disease.

Feasibility and challenges of addressing this CQ or CC

Evidence already exists but should be confirmed in large scale studies

Name of idea submitter and other team members who worked on this idea James Shoemaker MD PhD

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-4 net votes
9 up votes
13 down votes
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