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“Translational Research and Health Disparities: The Nation’s Imperative” by Sidney A. McNairy, Jr., Ph.D., D.Sc.,LHD Former: Associate Director, NCRR and Director Capacity Building Branch National Institutes of Health, DHHS. Seminal Events in Translational Medicine. - PowerPoint PPT Presentation
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“Translational Research and Health Disparities: The Nation’s Imperative”
by
Sidney A. McNairy, Jr., Ph.D., D.Sc.,LHD
Former: Associate Director, NCRR and Director Capacity Building Branch
National Institutes of Health, DHHS
Seminal Events in Translational Medicine
Seminal Events in Translational Medicine
• 1952 -Watson and Crick showed that each strand of the DNA molecule was a template for the other.
• During cell division-alpha helix the two strands separate and on each strand a new "other half" is built, just like the one before. This way DNA can reproduce itself without changing its structure -- except for occasional errors, or mutations.
Seminal Events in Translational Medicine
• 1963 the first descriptions of the self-renewing activities of transplanted mouse bone marrow cells stem (cells found in the bone marrow and blood of mice can "restock" a depleted ovary with new egg cells within weeks)
transplant of adult stem cells – have been used in patients receiving radiation and chemotherapy since the 1950’s.
developments in biotechnology in the 1980s and 1990s saw the introduction of techniques for targeting and altering genetic material and methods for growing human cells in the laboratory (opened the doors for human stem cell research).
Seminal Events in Translational Medicine
in 1998 James Thomson, a scientist at the University of Wisconsin in Madison, successfully removed cells from spare embryos at fertility clinics and grew them in the laboratory. This launched stem cell research into the limelight, establishing the world’s first human embryonic stem cell line which still exists today.
Seminal Events in Translational Medicine (cont’d)
Completed in 2003, the Human Genome Project (HGP) was a 13-year project coordinated by the U.S. Department of Energy and the National Institutes of Health.
During the early years of the HGP, the Wellcome Trust (U.K.) became a major partner; additional contributions came from Japan, France, Germany, China, and others.
PredictivePredictive PreemptivePreemptivePersonalizedPersonalized
2121stst Century Medicine Century Medicine
WHAT CREATED MY INTEREST IN
TRANSLATIONAL RESEARCH
1. SYNTHESIS OF QUIONOLINE
2. 1963 MARCH ON WASHINGTON FOR JOBS/FREEDOM2. ISOLATION AND CHARACTERIZATION OF TRITERPINOID GLYCOSIDES
3. BIOCHEMICAL BASIS OF SICKLE CELL DISEASE LECTURE –GRAND ROUNDS LSU/TULANE
4. MEMBER OF THE AMERICAN HEART ASSOCIATION OF LOUISANA
5. DEVELOPMENT OF RADIOIMMUNOLOGICAL ASSAYS FOR PRO-INSULIN AND TRI-IODTHYRONINE
6. AN OVER THREE DECADE CAREER AT NIH AS A MEMBER OF THE SENIOR EXECUTIVE SERVICE
What created my interest in translational Research
Quinoline Synthesis: condensation of unsubstituted anilines (1) with β-diketones (2) to form substituted quinolines (4) after an acid-catalyzed ring closure of an
intermediate Schiff base (3).[1][2]
Liver tumors (adenomas and hepatomas) were observed in newborn CD-1 miceExposed to quinoline via i.p. injection (LaVoie et al., 1987, 1988; Weyland et al., 1993).
Saponins or Triterpinoid glycosides*
*During my graduate career at Purdue University my research focused on isolation, chemical and biological characterization of tri-Triterpinoid glycosides or saponins.
Some Health benefits of Saponins
Studies have illustrated the beneficial effects on blood cholesterol levels, cancer, bone health and stimulation of the immune system.
“The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy” Dr.
Martin Luther King, Jr.
NIH Mission: Uncover new knowledge that will lead to better health for everyone
27 Institutes and CentersMore than $29 Billion
NIH MISSIONUncover new knowledge that will lead to better health for everyone. NIH conducts research in its own laboratories; supports the research of non-Federal scientists in universities, medical schools, hospitals, and research institutions throughout the country and abroad; helps in the training of research investigators; and fosters communication of medical information.
It is one of eight health agencies of the Public Health Services which, in turn, is part of the U.S. Department of Health and Human Services. Comprised of 27 separate components, mainly Institutes and Centers, NIH has 75 buildings on more than 300 acres in Bethesda, MD. From a total of about $30 K in 1887, the NIH budget has grown to more than $31 billion in 2009. This was augmented with 10.3 billion via the ARRA supplement
NIH improves the health of the Nation by Conducting and Supporting Research:
• Studying the causes, diagnosis, prevention, and cure of human diseases;
• Investigating the processes of human growth and development;
• Determining the biological effects of environmental contaminants;
• Understanding of mental, addictive and physical disorders; and
• Directing programs for the collection, dissemination, and exchange of information in medicine and health
Opportunities for Translational Research Opportunities for Translational Research
IDeA COBRE INBRE
Lariat and Co-funding
Other
RFIPAFIP
SCORESEPA
NARCH
RCMIRCRII/CCRE
CCHDCRECD
Co-funding
RCMI My Career My Career
335 NCRR and 7 NIAID C06 awards IDeA Program: INBRE- 23 statewide research networks; COBRE- 76 thematic research centersRCMI- 18 sites including 5 clinical research centers; IDeA + RCMI sites include 28 medical schools (8 GCRCs, 3 partner with CTSAs)
Some of The GranteesSome of The Grantees
IDeA
= CT, DC, MA, MD, NH, NJ, VT,
RCMIIDeA
C06
T1→T3T1→T3
COBRECOBRE
RCMIRCMIINBRESCORENARCH
RIMI
INBRESCORENARCH
RIMI
Basic Research
Basic Research
The TRANSLATIONAL RESEARCHParadigm:
Programs that I Developed while at NIH
Clinical ResearchClinical Research
Clinical ResearchClinical Research
CommunityImproved patient
care
Pre-clinical
Basic Research
Community based Research
From Basic Discovery to Translation to Improve Patient Care
animal models
Efficacy
Clinical Trials
Effectiveness DNA→ RNA→ Protein
Secretary’s Task Force on Black and Minority Health….1985
The 1985 Report of the Secretary's Task Force on Black and Minority Health released by then
Secretary of Health and Human Services, Margaret Heckler, documented significant disparities in the
burden of illness and mortality experienced by Blacks and other minority groups in the US
population.
Secretary’s Task Force on Black and Minority Health…..1985
The report laid out an ambitious agenda, including improving minority access to high quality health care, expanding health promotion and health education outreach activities, increasing the number of minority health care providers, and enhancing Federal and State data collection activities to better report on minority health issues.
Why Health Disparities
• Provides the greatest opportunity for understanding factors that influence clinical outcomes in real life settings (gender, ethnicity, age, environment, etc.)
• Translate those findings into strategies to improve clinical outcomes for all persons
• Opportunity to reduce health care system costs
Unequal Access to Health Care*
Language barriers Inadequate insurance coverage Bias among doctors and nurses Lack of minority physicians
* Institute of medicine “unequal treatment: confronting racial and ethnic disparities in health care”
USA POPULATIONYEAR 2050
GROUP PERCENT
WHITE 33
AFRICAN AMERICAN
27
LATINO/HISPANIC
33
Ten Leading Causes of DeathUSA
10 LEADING CAUSES OF DEATH 2009 USA
1 Diseases of heart (heart disease)
2 Malignant neoplasms (cancer)
3 Chronic lower respiratory diseases
4 Cerebrovascular diseases (stroke)
5 Accidents (unintentional injuries)
6 Alzheimer’s disease
7 Diabetes mellitus (diabetes)
8 Influenza and pneumonia
9
Nephritis, nephrotic syndrome and nephrosis (kidney disease)
10 Intentional self-harm (suicide)
Suroce: National Vital Reports Volume 60, Number 3, December 29, 2011. USDHHS, Center for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.
STATE CARDIOVASCULAR DIABETES
IDAHO 13 21
OREGON 12 19
WASHINGTON 20 17
MONTANA 15 6 TEXAS 30 34
LA/MISS 46/50 46/50
MINNESOTA 1 3
UTAH 4 1
America’s Health Rankings
10 Leading Causes of DeathFor African Americans in 2009:
• Heart Disease Cancer Stroke
• Unintentional Injury
• Diabetes Kidney Disease
• Chronic Lower Respiratory Disease
• Kidney Disease
• Homicide
• HIV/AIDS
10 Leading Causes of death for Hispanics/ Latinos in 2009
• Cancer Heart Disease Stroke
• Unintentional Injuries Diabetes
• Chronic Liver Disease and Cirrhosis
• Chronic Lower Respiratory Diseases
• Influenza and Pneumonia
• Homocide
• Nephritis, Nephrotic Syndrome & Nephrosis
10 Leading Causes of Death Asian American & Pacific Islander
Population, U.S., 2007
• Cancer Heart Disease Stroke
• Unintentional injuries
• Diabetes
• Influenza and pneumonia
• Chronic lower respiratory disease
• Suicide
• Nephritis, Nephrotic syndrome, and Nephrosis
• Alzheimer’s Disease
Other At Risk / Vulnerable Populations
• Other At Risk / Vulnerable Populations
• Other vulnerable populations as defined by socio-economic status (social determinants of health, poverty, and education), geography, gender, age, disability status, risk status related to sex and gender, and among other populations identified to be at-risk for health disparities
The Prevention Imperative: Protecting the Health and Well-
Being of America’s Families
• http://www.americashealthrankings.org/Downloads.aspx
The Big Three Threats
OBESITY
CHRONIC DISEASE
SMOKING
33
34
Obesity is one of the fastest growing health issues in our nation
Obesity contributes to variety of diseases
– Heart disease– Diabetes– General poor health
27.5% of Americans are obese compared to almost 11.6% in 1990
This is the first year where no state has under 20% obesity
If current trends continue, 43% of the population will be considered obese by 2018*
*Source: The Future Costs of Obesity; Dr. Kenneth E. Thorpe
11.6%
27.5%
Obesity: The Biggest Threat to Our Health 1990-2011
35
• Health not only means living longer but living healthier and without the presence of disease.
– Diabetes is one major chronic disease that increasingly is getting in the way of our healthiness.
• Diabetes continues to increase, now at 8.7% of the adult population.
– It was 4.4% of the adult population in the 1996 and 8.3% of the adult population in 2010.
• According to a report published in 2010, the U.S. was set to spend $208 billion on diabetes and pre-diabetes in 2011.
– If we don’t turn this around, we will spend $500 billion in 2020
Source: The United States of Diabetes, UnitedHealth Group
4.4%
8.3%
Chronic Disease: Growing Obstacle to Health 1995-2011
Smoking in USA: A Tough Habit to Kick1990-2011
36
• Smoking has been the biggest health battle of the past 40+ years
• Over the past year, the prevalence of smoking decreased from 17.9% to 17.3%
– The lowest in 22 years
• Adverse impact on overall health– Respiratory diseases– Heart disease– Stroke – Cancer
• Despite improvements, more than 1 in 6 people smoke
Prevalence of Smoking Since 1990
29.5%
17.3%
37
The Full 50: This Year’s RankingsRank State
35 Alaska36 Ohio37 Georgia38 Indiana39 Tennessee40 Missouri41 West Virginia42 Nevada43 Kentucky44 Texas
45South
Carolina46 Alabama47 Arkansas48 Oklahoma49 Louisiana50 Mississippi
Rank State1 Vermont2 New Hampshire3 Connecticut4 Hawaii5 Massachusetts6 Minnesota7 Utah8 Maine9 Colorado
10 Rhode Island11 New Jersey12 North Dakota13 Wisconsin14 Oregon15 Washington16 Nebraska17 Iowa
Rank State18 New York19 Idaho20 Virginia21 Wyoming22 Maryland23 South Dakota24 California25 Montana26 Kansas26 Pennsylvania28 Illinois29 Arizona30 Delaware30 Michigan32 North Carolina33 Florida34 New Mexico
Causes of Death in the United States (Most Common, 1999*)
*All data are age adjusted to 2000 total U.S. population.
U.S. Infant Mortality Rates, by Race/Ethnicity of Mother, 1998
Source: CDC, National Center for Health Statistics.
Age-Adjusted Death Rates for Diseases of the Heart* Among Women, by Race/Ethnicity,
1996–1998
*Average annual deaths per 100,000 women, age adjusted to 1940 U.S. standard population, International Classification of Diseases, 9th Rev., codes 390–398, 402, and 404– 429. Source: Journal of Women’s Health and Gender-Based Medicine, Vol. 10, No. 8, 2001.
pp. 717–24.
Stroke
According to the Centers for Disease Control and Prevention: “Southerners and Blacks are more likely to die of Stroke than other Americans.”
Blacks are 40 % more likely to die of stroke than whites (hypertension, less access to health care, obesity, smoking and lack of physical activity)
Type 2 Diabetes
Native Americans, Hispanics, African Americans, and Asian Americans and Pacific Islanders are at particular high risk of developing type 2 diabetes.
The prevalence of diabetes is nearly 70 percent higher in African Americans than in Caucasians.
End Stage Renal Disease
In 1997, the incidence rates were 218 per million population in Caucasians, as compared to 586 in Native Americans and Alaska Natives, and 873 in African Americans.
The leading cause of ESRD is type 2 diabetes.
ESRD Incidence Rate per Million By Race/Ethnicity (2001)
254
988
696
395325
471
0
250
500
750
1000
White Black NativeAmerican
Asian Non-Hispanic
Hispanic
Odds Ratio 1 3.89 2.74 1.56 1 1.45
*P < .0001
Ref
*
*
**
Ref
USRDS. Annual Data Report. 2003; adjusted for age and gender.
Annual Fiscal Impact of Racial/Ethnic Disparities in ESRD
Gross Estimate of ESRD Cost in 2001 Due to “Excess” Minority ESRD Population
22.8
15.8
7
0
5
10
15
20
25
ESRD Costs ESRD Costs withoutexcess minorities
Excess costs fromdisparities
USRDS. Annual Data Report. 2003; adjusted for age and gender.Estimated excess costs if minority ESRD point prevalence rate= White ESRD point prevalence rate based on 2001 point prevalence counts and adjusted point prevalence rates (not adjusted for estimated changes in transplant and other ESRD specific costs)
Dol
lars
(B
illi
ons)
Cancer continues to be the leading cause of death in the U.S.
Only a slight decline in cancer deaths in the last 20 years
CDC estimates that if tobbacco use, poor diet and physical
activity were eliminated, 40 % of cancers would be eliminated
2013 Estimated US Cancer Cases*
*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.
Men854,790
Women805,500
29% Breast
14% Lung & bronchus
9% Colon & rectum
6% Uterine corpus
4% Thyroid
4% Non-Hodgkin lymphoma
4% Thyroid
4% Melanoma of skin
3% Ovary
3% Kidney & renal pelvis
Prostate 28%
Lung & bronchus 14%
Colon & rectum 9%
Urinary bladder 7%
Non-Hodgkin6% lymphoma
Melanoma of skin 5%
Kidney & renal pelvis 5%
Oral cavity 3%
Leukemia 3%
Pancreas 3%
Source: American Cancer Society, 2013
HIV and AIDS
HIV incidence is growing at a faster rate in minority women than in any other group.
In 1998, more than 77 percent of the women infected with AIDS were from minority groups, with 57 percent African American and 20 percent Hispanic.
HIV and AIDS
An estimated 42 M people around the world will be living with HIV/AIDS by the end of 2002 according to the U.N. Program on AIDS and WHO.
29.4 M in sub-Sahara Africa; 6 million south and southeast Asia; Ca 1.0 M in north America
About half the people infected with the AIDS virus world-wide are women (19.2 m); 3.2 M children (under the age of 15).
Of the 41.8 Million People Living with HIV/AIDS Worldwide………
Women46%
Men46%
Children 8%
46% Women
8% Children
46% Men
SOME WAYS TO ADDRESS HEALTH DISPARITIES
BASIC RESEARCH
CLINICAL RESEARCH
COMMUNITY ENGAGEMENT
Trial DesignTrial Design
AdvancedAdvanced Degree-GrantingDegree-Granting
ProgramsPrograms
ParticipantParticipant& Community& CommunityInvolvementInvolvement
RTRN RTRN BiostatisticsBiostatistics
ClinicalClinicalResourcesResources
BiomedicalBiomedicalInformaticsInformatics
ClinicalClinicalResearchResearch
EthicsEthics
CTRsCTRs
NIHNIH
OtherOtherInstitutionsInstitutions
IndustryIndustry
RCMI/IDeA Awards: A Home for Clinical and Translational Science
Louisiana IDeA CTR
CTSA Medical
University of South
Carolina
CTSA Medical
University of South
Carolina
Collaborations
Louisiana Clinical and Translational Science Center (LA CaTS)
West Virginia IDeA CTR
University of West Virginia Clinical and Translational Science Institute
University of
Kentucky
Indiana University
Ohio State University
Department of Health and Human Resources
West VA Higher Education Policy Commission
Endorsement Collaboration
University of Cincinnati
Other Regional Institutions
Appalachian Translational Research Network
IDeA / CTSA Collaborations Supported IDeA / CTSA Collaborations Supported by DRI/ARRAby DRI/ARRA
WA
OR
CA
NV
AZNM
MT
UT
WY
CO
SD
ND
NE
KS
OK
TXAK
AR
MO
IA
MN
WI
IL IN
MI
OH
KY
TN
MS AL GA
FL
LA
NC
SC
VAWV
PA
NY
VTNH
ME
MA
DEMD
RIID
HI
Biosurveillance ProjectBiosurveillance Project(U of Idaho(U of Idaho
U of Washington)U of Washington)
MetabolomicMetabolomicImmunotherapy for Q FeverImmunotherapy for Q Fever
(Montana State U )(Montana State U )Translational Neuro. CoreTranslational Neuro. Core
(U of Montana)(U of Montana)
Colorectal Cancer Colorectal Cancer Screening ProjectScreening Project
(U of Nevada , Reno(U of Nevada , Reno& UC Davis)& UC Davis)
Pregnancy outcome in Pregnancy outcome in DiabetesDiabetes
(U of Kentucky & (U of Kentucky & Vanderbilt)Vanderbilt)
NIMHD/NCRR-Division of Research Infrastructure
Comprehensive Centers On Health Disparities:
Meharry Medical College - Nashville, Tenn.
Charles Drew University – Los Angelus, Ca.
Morehouse School of Medicine – Atlanta, Ga.
UPR Medical Sciences/ Universidad Central del Caribe/ Ponce School of Medicine –San Juan, Puerto Rico
NIMHD/NCRR-Division of Research Infrastructure
Comprehensive Centers On Health Disparities:
Meharry Medical College: examine the effect of depression on immune function in HIV-positive women, and increased HIV risk associated with sexual abuse and drug use in the African American community. develop and disseminate diverse preventive strategies for addressing HIV/AIDS disparities in the African American
NIMHD/NCRR-Division of Research Infrastructure
Comprehensive Centers On Health Disparities
Charles Drew University:conduct research on chronic kidney disease (CKD) aimed at reducing disparities in CKD and CKD risk factors for disadvantaged African American and Latino patients. increase the participation of medically under-served minorities in evidence-based health promotion and disease prevention directed toward CKD
NIMHD/NCRR-Division of Research Infrastructure
Comprehensive Centers On Health Disparities
Morehouse School of Medicine:* conduct population-based community studies of stroke
risk factors; prevention; incidence; prevalence; natural occurrence and/or recurrence; stroke outcome; and patient adherence to education in the African American community.
serve as a regional resource in stroke education and intervention in the Southeastern United States.
*Supported by NCRR; NINDS; and NHLBI
SOME WAYS TO ADDRESS HEALTH DISPARITIES
BASIC RESEARCH
CLINICAL RESEARCH
COMMUNITY ENGAGEMENT
COBRE for Cancer and Signal Transduction West Virginia University
WV lung cancer rates exceed national average
•WVU is working to establish an NCI-designated Cancer Center for WV and Appalachia
•COBRE research focuses on cancer health disparities in WV (lung, breast, ovarian, cervical, head & neck)
•To date, nine COBRE junior faculty have obtained independent funding, while 5 additional faculty are currently supported
February 2007
http://www.alaska.edu/canhr/
Research Centers in Minority Institutions (RCMI) Research Centers in Minority Institutions (RCMI) 18 Centers in 10 states, the District of Columbia, and Puerto Rico18 Centers in 10 states, the District of Columbia, and Puerto Rico
Xavier UniversityUniversidad Central del Caribe
Ponce School of Medicine
= RCMI G12 Centers
= RCMI Clinical Research Centers
Charles R. Drew University
University of Texasat El Paso
University of Hawaii at Manoa
Texas Southern University
University of Texas at San Antonio
Jackson State University
City College CUNY
Hunter College CUNY
Howard University
Tuskegee University
Clark Atlanta University
Florida A&M University
Morehouse School of Medicine
U Puerto Rico Medical Sciences Campus
Meharry Medical College
Why Health disparities
• Provides the greatest opportunity for understanding factors that influence clinical outcomes in real life settings (gender, ethnicity, age, environment, etc.)
• Translate those findings into strategies to improve clinical outcomes for all persons
• Opportunity to reduce health care system costs
“Colloborating through the RCMI TranslationalResearch Network
• The RCMI Translational Research Network (RTRN) will be a cooperative research network that will facilitate translational research in health disparity areas.
• A consortium of clinical investigators from the RCRII, RCMI, CRECD & CCHD programs; institutions, GCRCs, and relevant organizations including community health centers, with an interest in health disparity areas;
• Data and Technology Coordinating Center (DTCC)
RCMI Translational Research Network
Intra-RCMI Network via DTCC
Reducing & Eliminating
Health Disparities
RCMI Basic Science Research
RCMI Clinical Research
RCMI Educational Programs
RCMI-DTCC
RTRN Pilot Project The Effect of 25 Hydroxy-Vitamin D3 [25 (OH)D3] on
Cardiovascular Risk Factors and Cardiovascular Function
Cardiovascular disease (CVD) and related disorders are the leading cause of death in the nation. Hypertension, diabetes and obesity are more prevalent in ethnic populations and Caucasians. Early data has linked an increased rated of cardiovascular disease in ethnic populations to an insufficiency of Vitamin D3. Research teams at Charles Drew University – in collaboration with the RTRN Data Technology Coordinating Center (DTCC) have conduced the first clinical study for the network. The study examined the effects of Vitamin D on vascular function and selected cardiovascular risk factors and also served as a model for standardizing the network’s research processes and achieving good clinical practices and uniform standards (HIPAA). The study is a randomized trial observing 130 African-American participants taking either Vitamin D3 or a placebo once a month for 90 days.
Principal Investigators:
Keith Norris, M.D. (Charles Drew University)Gary Gibbons, M.D. (Morehouse School of Medicine)
Genomics/ProteomicsGenomics/Proteomics
Clinical/PhysiologicClinical/Physiologic
Socio-culturalSocio-cultural
Reducing Health DisparitiesReducing Health Disparities
PolicyPolicy
CommunityCommunity
Systems and Translational Research Approaches for RCMI
Systems and Translational Research Approaches for RCMI
Infrastructure Development and the Creation of a Translational Research Network Infrastructure Development and the Creation of a Translational Research Network
Improving Clinical Outcomes
Improving Clinical Outcomes
The DTCC at Jackson State University
• Collaboration between database and computational/computer science innovators
• Provide a scalable coordinated clinical data management system for collection, storage, and analysis of data of the RCMI CRCs and other collaborators
• Provide a portal and tools for integration of developed and publically available data sets for data mining at RCMI institutions*
• Provide web based recruitment and referral; and • Develop a user friendly resource site for the public,
research scientists, and clinicians.
RCMI Translational Research Network
Builds upon & will expand RCMI strengths in:• Racial/ethnic diversity & Bioethics• Clinical Research Center infrastructure• Genomic, Proteomics & Molecular Medicine• Pharmacology• Biostatistics & Epidemiology• Information Technology & Related Systems• Geographic Information Systems• Computational Biology• Neuroimaging• Other
1-A Health Disparities Opportunity
Collaborative research in health disparity areas:including longitudinal studies of individuals with diseases that disproportionately impact minority populations, clinical studies, phase I and II clinical trials, and/or pilot and demonstration projects focused on health disparitiesIdeas may emanate from clinical to include understanding basic components or vice-versa
Training for translational investigation in health disparity research - primarily, but not limited to clinical investigators
1-A Health Disparities Opportunity (cont’d)
Test bed for distributed clinical data management that incorporates novel approaches and technologies for data management, data mining, and data sharing across specific health disparity areas, data types, and platforms;
Access to information related to health disparities for basic and clinical researchers, academic and practicing physicians, patients, the lay public, and health policy makers.
2-A Health Disparities Opportunity
Facilitate the identification of biomarkers for disease risk, disease severity/activity, and clinical outcome
Encourage the development of new approaches for diagnosis, prevention, and treatment based on continuous improvements in understanding of disease/health
To Improve Health Outcomes & Reduce/Eliminate Disparities
RTRN Translational Research Cluster System (www.rtrn.net)
• THE END
“The Power of One who Believed- Thirty-five Years and Counting”