Department of Health and Human Services
National Institutes of Health
National Institute of Nursing Research
Minutes of the National Advisory Council for Nursing Research

May 17-18, 2011

The 74th meeting of the National Advisory Council for Nursing Research (NACNR) was convened on Tuesday, May 17, 2011, at 1:00 p.m. in Conference Room 6C, Building 31, National Institutes of Health (NIH), Bethesda, Maryland.  The first day of the meeting was an open session and adjourned that same day at approximately 5:18 p.m.  The closed session of the meeting, which included consideration of grant applications, was convened on Wednesday, May 18, 2010, at 9:00 a.m. and continued until adjournment at 12:00 p.m.  Dr. Patricia A. Grady, Chair, NACNR, presided over both sessions of the meeting.


OPEN SESSION

I. CALL TO ORDER, OPENING REMARKS, COUNCIL PROCEDURES, AND RELATED MATTERS

Dr. Grady called the 74th meeting of the NACNR to order, welcoming all Council members (including new Council members), visitors, and staff.  She informed Council that the Institute has received several Plain Language Awards and that Dr. Mary Kerr, NACNR Executive Secretary and National Institute of Nursing Research (NINR) Deputy Director, was representing NINR at the award ceremony that afternoon.  Dr. Denise Russo, Director, NINR Division of Extramural Activities, was substituting for Dr. Kerr.  Dr. Grady also welcomed three new NACNR members who attended the meeting ad hoc:  (1) Dr. Kenton R. Kaufman, Professor of Biomedical Engineering and W. Hall Wendel Jr. Musculoskeletal Research Professor, Mayo Clinic; (2) Dr. Courtney Lyder, Dean, University of California, Los Angeles (UCLA) School of Nursing, Professor of Nursing, Medicine, and Public Health, and Executive Director, UCLA’s Health Instrumentation Safety Institute; and (3) Dr. James A. Tulsky, Director, Duke Center for Palliative Care, Professor of Medicine and Nursing, Duke University, and Director, NINR-funded Duke Center for Self Management in Lifelong Illness.

Conflict of Interest and Confidentiality Statement

Dr. Russo reminded attendees that the standard rules of conflict of interest applied throughout the Council meeting.  Briefly, all closed session material is privileged, and all communications from investigators to Council members regarding any actions on applications being considered during the Council should be referred to NINR staff.  In addition, during either the open or the closed session of the meeting, Council members with a conflict of interest with respect to any topics or any application must excuse themselves from the room and sign a statement attesting to their absence during the discussion of that application.  Dr. Russo also reminded NACNR members of their status as special Federal employees while serving on the Council, and that the law prohibits the use of any funds to pay the salary or expenses of any Federal employee to lobby or otherwise influence state legislatures or Congress.  Specific policies and procedures were reviewed in more detail at the beginning of the closed session and were available in electronic materials provided to the Council.

Minutes of Previous NACNR Meeting

Standing Council members received a copy of the minutes of the January 18-19, 2011, NACNR meeting by electronic mail.  A motion to accept the minutes of the January 18-19, 2011, Council meeting was proposed, seconded, and approved unanimously.  The approved minutes of each quarterly NACNR meeting become part of the Institute’s permanent record and are posted on the NINR Web Site (www.ninr.nih.gov).

Dates of Future Council Meetings

Dates for future NACNR meetings in 2011, 2012, and 2013 have been approved and confirmed.  Council members were asked to confirm their calendars for these meeting dates and contact Drs. Grady or Kerr regarding any conflicts or expected absences.

2011
September 20-21 (Tuesday-Wednesday)

2012
January 17-18 (Tuesday-Wednesday)
May 15-16 (Tuesday-Wednesday)
September 18-19 (Tuesday-Wednesday)

2013
January 22-23 (Tuesday-Wednesday)
May 21-22 (Tuesday-Wednesday)
September 17-18 (Tuesday-Wednesday)

II. REPORT OF THE DIRECTOR, NINR
Dr. Patricia Grady, Director, NINR

The Director’s Report focused on updates since the last Council meeting and on current and impending activities and initiatives related to the NIH and NINR budgets, the NIH overall, and the NINR.

Budget Update—

Dr. Grady provided an update on the current status of appropriations and projections for the NINR budget.  The Institute continues to operate under a Continuing Resolution for FY 2011, with a budget of $144.381 million, reflecting a 0.09 percent decrease from the FY 2010 budget.  The NIH budget for FY 2011 of $30.687 billion reflects a similar reduction of 1 percent.  Although this is the first time in its history that the NIH has received a reduction in its budget, the decrease was less than the average 3 percent reduction experienced across the Department of Health and Human Services (HHS).  Dr. Grady commented that the forecast for the FY 2012 budget is not considered optimistic. Dr. Grady next reviewed NINR’s expenditures for FY 2010, which included:  research program grants (RPGs) (72%), of which P01 grants comprise 1.6 percent; Centers (3%); research management and support (9%); training (6%); research and development (3%); intramural research (5%); and other research (2%).  The NINR ranks as second highest among NIH Institutes and Centers (ICs) in its percent of budget support of training.  The budget trends for the NINR during the past 10 years track closely with the trends for the overall NIH.

HHS, NIH, and NINR News—

Dr. Grady reported on news items of interest within the HHS, NIH, and NINR communities.  The HHS has announced strategic plans to reduce health disparities by increasing recruitment of health professionals and medical staff, particularly those from underrepresented populations, who will be trained to assist patients from multicultural backgrounds or to help patients navigate through the health care system.  In addition, HHS partnership activities to improve care and lower costs for Americans will include strategies to keep hospital patients from becoming injured or sicker as well as to help patients heal without complications.

The NIH released a report for the second anniversary of the American Recovery and Reinvestment Act (ARRA) that provides metrics on the impact of the ARRA funds, including support for:  (1) the establishment of community health centers that served 3.2 million people; (2) a $178 million investment to study genomic changes in cancer; (3) the enrollment of 3,500 students in health information technology (IT); and (4) a $370 million investment in anti-obesity and anti-tobacco initiatives. The HHS also announced that $100 million in Affordable Health Care Act grants for innovative ways to prevent disease are available and will be administered by the Centers for Medicare and Medicaid Services (CMS).  Dr. Howard K. Koh, HHS Assistant Secretary of Health, helped celebrate First Lady Michelle Obama’s Let’s Move! Campaign to end childhood obesity.  In addition, HHS Secretary Dr. Kathleen Sibelius participated in a questions and answers radio talk session with nurse researchers that was hosted by nurse.com.  The HHS and the U.S. Department of Agriculture (USDA) have jointly released new dietary guidelines that include information on dietary supplements.

The NIH has proposed the creation of the National Center for Advancing Translational Sciences (NCATS), whose mission is to facilitate translational research efforts around the NIH, complement activities of the private sector, and reinforce NIH’s focus on translational research. Dr. Grady congratulated Council member Dr. Jean McSweeney for her appointment to the NIH Council of Councils, which advises the NIH Division of Program Coordination, Planning, and Strategic Initiatives (DPCPSI) that oversees the NIH Common Fund.  In addition, the NIH has redesigned its Web site home page and has launched a Web portal that promotes transparency of ARRA fund allocation and results.

The NIH Pain Consortium held its sixth annual Symposium on Advances in Pain Research in April 2011.  The National Health Council Web site lists new opportunities for unfunded research, providing a nexus for researchers seeking a sponsor and agencies looking for quality science research to fund.  The NIH continues to offer regional seminars on program funding and grants administration throughout the year.  Among positive trends in health, the recently released Annual Report to the Nation reports a continued decline in cancer rates overall.  In addition, the NIH Office of Dietary Supplements (ODS) has developed an online application that facilitates tracking the use of dietary supplements.  Dr. Grady noted that Dr. Robert M. Kaplan is the new Director of Office of Behavioral and Social Sciences Research (OBSSR), and Dr. Rajesh Ranganathan is the new Senior Advisor for Translational Research in the Office of the Director, with an important role in the start up of NCATS.

Dr. Grady noted that NINR’s celebration of its 25th Anniversary continues.  The Institute and the NIH Clinical Center co-sponsored a conference on Symptom Mechanisms, Measurement, and Management in mid-May 2011.  The NINR also is co-sponsoring “Science in the Cinema,” an annual summer film event hosted by the AFI Silver Theatre and Cultural Center.  Additional activities include a summit on the state-of-the-science of palliative care in August as well as a scientific symposium, “Bringing Science to Life:  A Healthier Tomorrow,” in October 2011.

The Institute received many thoughtful comments from the public regarding its strategic plan and is revising the document.  A new YouTube video, “Inside the SGI,” shares comments from students from the 2010 NINR Summer Genetics Institute (SGI) regarding how the program has helped them further their research careers.  Nursing Spectrum celebrated NINR’s 25th Anniversary in an article about the Institute’s accomplishments during the past two decades.  NINR-supported nurse researchers Drs. Linda Aiken and Mary Naylor published an article on their transitional care research activities in Health Affairs.  Dr. Kathleen Puntillo received recognition recently for her intensive care unit (ICU) work in symptom management.  Dr. Grady announced that Dr. Yvonne Bryan, previously Chief, NINR Office of Extramural Programs, has been named Special Assistant, NINR Office of the Director (OD); Dr. Bryan recently was interviewed by Minority Nurse.

Dr. Grady provided an update on activities NINR’s Intramural Research Program (IRP), including an article in Stroke by intramural researchers on elucidating biomarkers for stroke diagnosis.  Dr. Ray Dionne, NINR Scientific Director, participated in a meeting on collaboration with Clinical and Translational Science Awards (CTSA) to advance pain research.  Dr. Grady also congratulated Dr. Leo Saligan, Deputy Clinical Director, IRP, who received a prestigious Faye G. Abdellah Award for Nursing Research.  Other activities have included Staff Training in Extramural Programs (STEP), which held a discussion on pain treatment and management.  Planning is underway for the 2011 SGI as well as the NINR-supported Pain Methodologies Boot Camp, which is focused on pain assessment and measurement and will be held in July 2011.  The NINR is promoting a “green” environment and has participated in the combined federal campaign service.  The Institute also has received Plain Language and Clear Communication Awards.  Dr. Grady presented closing remarks at a women’s history month event.  She announced that Dr. Jeanette Hosseini was named Acting Chief, NINR Office of Extramural Activities.  Dr. Grady encouraged Council members to go to NINR website for  NINR’s current funding opportunities.

NINR Outreach—

Dr. Grady informed Council members that Ms. Melissa Barrett, NINR Communications Director, prepared a handout on recent NINR outreach activities.  Council Members were invited to peruse the document for recent NINR news and to visit the NINR Web Site (www.ninr.nih.gov) for additional information.

III. ADVANCES IN GENETICS OF SYMPTOMS – EXTRAMURAL—
Dr. Ann Cashion, Professor and Chair, University of Tennessee Health Science Center

Dr. Cashion described research that considers the interplay between genetics and patient symptoms.  The study particularly examined the rise of obesity among kidney transplant recipients which mirrors the upward trend in the general population.  Obesity is a multifactorial, complex disorder, in which certain genes are maladaptive in today’s environment of excess food supply and diminished activity.  The study focused on three areas:  (1) diet and physical activity, which examined body mass index (BMI), daily food intake, and amount of sleep and exercise; (2) genetic transcript data, which examined abdominal subcutaneous adipose tissue samples and found hierarchical clustering among 936 genes that were correlated with weight gain; and (3) experiences of gaining weight during the first year following kidney transplant.

Preliminary results showed significant weight gain by kidney transplant recipients, with black patients gaining significantly more weight than whites 6 months after the transplant.  Dietary intake had little variation, but fat, carbohydrates, and cholesterol intake was found to be significant at all time points.  Physical activity levels generally were light, and sleep decreased over time.  The study also found that close to 2,000 transcripts were associated with obesity.  Dr. Cashion said that ongoing and future studies will compare adipose and blood transcripts, conduct whole transcriptome analyses, and develop and test obesity single nucleotide polymorphism (SNP) chips, as well as conduct cost and intervention studies.

IV. UPDATE ON GENETIC TECHNOLOGY PORTFOLIO—
Dr. Lois Tully, Office of Extramural Programs, NINR

Dr. Tully provided an update concerning NINR’s support of genetic technology.  She reminded the Council that 2011 marks the 10th anniversary of the publication of the first papers that described the nearly complete sequence of the human genome.  This mapping has provided many opportunities to examine the genome in new ways, such as conducting large-scale gene sequencing studies as well as identifying and using inter-individual differences in DNA sequencing to inform individualized, personalized health care.  The environment also plays a role, with epigenetic modifications causing genes to express or not express.  Numerous examples exist in the literature that describe gene-environment interactions.

The NIH has been a leader in advancing genetic research throughout its ICs, including through nursing supported research from the NINR.  The Institute currently supports 32 awards that include genetic components:  56 percent of them are research projects, and 44 percent address training.  Specific studies include epigenetic and psycho-neurologic symptoms in women with breast cancer; affective and genomic mediators of sustained behavior change; interactions between oxidative stress-related genes and nutrients in preeclampsia; and long-term changes in weight and adipokines and associations with genetic variations.

Nursing research has helped in advancing genetic studies.  Dr. Tully described published findings from NINR-supported research, including:  the effects of training on gene expression in humans with paralysis; new globulin genetic polymorphisms and relation to function outcomes after traumatic brain injury (TBI); and apolipoprotein (APO) E genetic association with seizure development after severe TBI.  Other findings focus on the association of serotonin transporter gene polymorphism with post-stroke depression, association of tryptophan hydroxylase gene polymorphisms with irritable bowel syndrome, and pregnancy as foreground in cystic fibrosis carrier test decisions in primary care.  Dr. Tully noted that more research is needed to better understand the factors that impact gene expression.

V. ADVANCES IN UNDERSTANDING SYMPTOMS BIOLOGY AND MANAGEMENT—
Dr. Raymond Dionne, Scientific Director, Intramural Research Program, NINR

Dr. Dionne provided a report on advances in understanding symptoms biology and management.  Symptom management is complex.  Although symptoms management of chronic disease remains an elusive goal, the recognition of the wide individual variability of symptom presentation and therapeutic responses, the repertoire of validated tools, and the application of genomic methods have helped move the research forward during the past decade.

The NINR has expanded its classical approach to genetics and symptom management to incorporate an exploratory method—that is, gene expression methods have been adopted as an unbiased approach to identify places of interest along the symptom pathway.  This paradigm movement is from observation to genome-wide association studies (GWAS) and to epigenetic and sequenced data.  NINR researchers, and nurse scientists, now apply genome-wide methods to identify molecular and genetic elements that are targets.  They use molecular and genetic dissection of multi-system disorders to advance understanding of symptoms biology leading to novel targets for intervention.

NINR’s Intramural Research Program’s (IRP) focus in symptom management encompasses biological mechanisms, single and clustered symptoms, and measurement of symptom intensity and the effect on quality of life.  The NINR IRP’s research also focuses on molecular and biological variability to inform the optimal clinical intervention for the individual patient. 

Current methods for unbiased target identification include polymerase chain reaction (PCR) and other laboratory methods, as well as target pathway interventions.  Based on the idea that gene expression can reveal novel mediators of pain in humans, a candidate gene association study with the rationale of improving therapeutic management at the molecular level supported the hypothesis that inflammation cascade involves chemokine receptors:  upregulation of specific genes was found to be correlated with inflammation and may help identify the critical pathway of pain.

NINR researchers will continue to take advantage of improvements in phenotyping, sensory testing, and sophisticated imaging methods to better correlate symptoms with well characterized gene expressions, and use the data to conduct epigenetic studies.  An integrated approach to the biology of complex symptoms will help with hypothesis-driven research and the management of individual treatment.

Comments addressed:

  • Benefits of supporting high risk research.
  • Translational opportunities, particularly with regard to patient outcomes.
  • The uniqueness of the program, which matches biomarkers and genomic/molecular science with patient symptoms, thereby helping determine the best interventions. 

VI. SCIENTIFIC REVIEW PANEL—
Dr. Yujing Liu, Chief, NINR Office of Review

Dr. Liu provided an overview of the NINR grants review process.  Grant applications to the Institute are reviewed through both NINR Office of Review and NIH Center for Scientific Review (CSR).  Review groups include Standing Committees and Special Emphasis Panels.  These groups each review specific types of applications, such as:  investigator-initiated research projects and small business research (R grants); career development and training (K, F and T grants); and Centers and Program projects (P grants).  NIH has implemented changes to the peer review process that include  the identification of early stage investigator applications, enhanced review criteria, a new scoring system, structured critiques, and clustering of new investigator applications.  The application forms also have been revised to include shorter page limits and new instructions.  Current NINR review activities include the review of F and K grant applications, and R01/R21 applications in response to four RFAs concerning genomics and symptom management, HIV/AIDS risk and developing adolescents, and aspects of palliative care and end-of-life (EOL) care research.

Dr. Liu next moderated an interactive panel discussion among Council members and NINR Scientific Review Officers (SROs), who oversee NINR’s review process for grant applications.  Points raised during the discussion included:

  • Reviewers traditionally weight the “approach” as the most significant factor in scoring.  The SRO has the responsibility of reminding reviewers to consider the extent to which the research likely will be significant and impactful to the science field or provide innovation.
  • Reviewers are educated through materials and pre-review meeting communications to explain and clarify the reviewers’ role.  Workshops also are held to educate reviewers.  Scores should reflect the aggregate comments from all reviewers, and reviewers are expected to prepare clear and accurate critiques that capture comments from the entire panel.
  • When possible, one or more of the original reviewers are involved in the second review of applications that have been revised and resubmitted.  Applicants are encouraged to allocate 1 page of their resubmission to highlight major changes based on original reviewers’ comments.
  • Principal investigators (PIs) have the responsibility to review the Funding Opportunity Announcement (FOA), understand the mission and purpose of the FOA, and use a cover letter to indicate preferred study section(s) and funding Institute as well as suggested secondary and tertiary funding agencies.
  • The distribution of grants that the NINR funds is:  R01, 36 percent; R21, 23 percent; F (31, 32), 10 percent; and others.
  • There is no official metric to quantify the performance of reviewers, although SROs might keep notes about outstanding reviewers.  A matrix concerning the performance of a study section is available, as is basic guidance from the CSR.
  • Reviewers are asked to emphasize the overall impact that the science will have on the research field, such as by considering whether the research will address a notable barrier or gap.  For studies that are innovative but appear costly, the review criteria should include scalability.
  • A resubmission that is not funded cannot be amended for a third submission.

Council members requested that the NINR develop and post on its Web site a frequently asked questions (FAQ) page regarding these topics. This request will be implemented by staff in  Office of Review.


Following this update, Dr. Grady thanked participants and attendees for their time and interest and adjourned the open session of the meeting.

CLOSED SESSION

This portion of the meeting was closed to the public in accordance with the determination that this session was concerned with matters exempt from mandatory disclosure under Sections 552b(c)(4) and 552b(c)(6), Title 5, U.S. Code, and Section 10(d) of the Federal Advisory Committee Act, as amended (5, USC Appendix 2).  Members absented themselves from the meeting during discussion of and voting on applications from their own institutions or other applications in which there was a potential conflict of interest, real or apparent.  Members were asked to sign a statement to this effect.

REVIEW OF APPLICATIONS

The members of the NACNR considered 108 research and training grant applications on which NINR was the primary Institute; these applications requested a total of $28,034,066 (direct costs year 01).  The Council also considered 510 applications on which another Institute/Center was primary and NINR was secondary; these applications requested a total of $150,115,330 (direct costs year 01).  The Council concurred with the IRG recommendations on these 618 applications.

ADJOURNMENT

The 74th meeting of the NACNR was adjourned at 12:00 p.m. on May 18, 2011.

CERTIFICATION

I hereby certify that the foregoing minutes are accurate and complete.

Patricia A. Grady, Ph.D., R.N., F.A.A.N   
Chair   
National Advisory Council for Nursing  Research

Mary Kerr, Ph.D., R.N., F.A.A.N.
Executive Secretary
National Advisory Council for Nursing Research

MEMBERS PRESENT
Dr. Patricia A. Grady, Chair
Dr. Denise Russo
Dr. Marion Broome
Dr. Glenna Dowling
Dr. Stan Finkelstein
Dr. Everette Freeman
Dr. Kevin Frick
Dr. Barbara Guthrie
Dr. Diana Lake
Dr. Elaine Larson
Dr. Jean McSweeney
Dr. Kathleen Potempa
Capt. Maggie Richard, Ex Officio
Dr. Marla Salmon
Dr. Gail Stuart
Dr. Anna Alt-White
Dr. Janet Williams

Ad Hoc Participants
Dr. Kenton Kaufman
Dr. Courtney Lyder
Dr. James Tulsky

MEMBERS OF THE PUBLIC PRESENT
Lauren Inouye, American Association of Critical Care Nurses
Louise Kaplan, American Nurses Association
Wendy Miller
Esther Smith-Howell, Indiana University School of Nursing
Elisabeth Smith, American Association of Critical Care Nurses
Darlene Summers, Consolidated Solutions and Innovations
Christine Zambricki, American Association of Nurse Anesthetists

FEDERAL EMPLOYEES PRESENT
Mr. Brian Albertini, NINR/NIH
Dr. Noreen Aziz, NINR/NIH
Dr. David Banks, NINR/NIH
Mr. Bill Branson, OD/NIH
Dr. Yvonne Bryan, NINR/NIH
Dr. Paul Cotton, NINR/NIH
Dr. Arseima Del Valle-Pinero, NINR/NIH
Dr. Raymond Dionne, NINR/NIH
Ms. Crystal Esler, NINR/NIH
Ms. Ana Ferreira, NINR/NIH
Dr. Jeanette Hosseini, NINR/NIH
Dr. Karen Huss, NINR/NIH
Ms. Deborah Jennings, NINR/NIH
Ms. Ellie Johnson, NINR/NIH
Ms. Annie Joseph, NHLBI/NIH
Dr. Weiqun Li, NINR/NIH
Dr. Yujing Liu, NINR/NIH
Ms. Diana Ly, NINR/NIH
Dr. Susan Marden, NINR/NIH
Ms. Angela Marshall, NINR/NIH
Dr. Jeri Miller, NINR/NIH
Dr. Priscah Mujuru, CSR/NIH
Ms. Mary Murray, NINR/NIH
Dr. Mario Rinaudo, NINR/NIH
Ms. Candice Scott, NINR/NIH
Ms. Judy Sint, NINR/NIH
Ms. Cheryl Stevens, NINR/NIH
Mr. Shawn Stocking, NINR/NIH
Dr. Tamizchelvi Thyagarajan, NINR/NIH
Dr. Xenia Tigno, NINR/NIH
Dr. Lois Tully, NINR/NIH
Dr. Joan Wasserman, NINR/NIH
Dr. Linda Weglicki, NINR/NIH
Mr. Max Whitfield, NINR/NIH
Ms. Laura Williams, NINR/NIH
Mr. Kevin Wilson, NINR/NIH