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  1. 1. Seeking Support From theSeeking Support From the NIH for Pediatric CriticalNIH for Pediatric Critical Care ResearchCare Research Carol E. Nicholson, MD, MS,FAAP NIH/NICHD/NCMRR
  2. 2. NationalNational InstitutesInstitutes of Healthof Health Bethesda, MDBethesda, MD
  4. 4. Advanced Technologies – New approaches to studying protein structure and function will bring great insights into the study of diseases and the design of new drugs What will the future hold for PCCM Research?
  5. 5. And, Brought to you by NICHD……. • The National Center for Medical Rehabilitation Research • Program forProgram for Pediatric CriticalPediatric Critical Care andCare and RehabilitationRehabilitation ResearchResearch PCCRPCCR
  6. 6. Research Grants 71% All Other 6% Research Management and Support 3% Intramural Research 10% R&D Contracts 7% Research Training 3% NIHNIH (FY 2001 $20.3 billion) Over 80% of NIH funds support extramural research
  7. 7. www.nih.gov The Future for Pediatric AcuteThe Future for Pediatric Acute Care ResearchCare Research
  8. 8. NIH is our Federal Government’s primary agency for support of Biomedical Research.
  9. 9. Funding Mechanisms • Most $ go to investigator –initiatedMost $ go to investigator –initiated proposalsproposals • Training • Career Development • Research Grants • Contracts
  10. 10. NICHD Priorities for Research • Cells to Selves • Developmental Biology • Biobehavioral Development • Reproductive Health • Genetics of Disease Susceptiblity • Health Disparities
  11. 11. Relating NICHD Research Priorities • To the acutely ill and injured child who is an outpatient: Pediatric EmergencyPediatric Emergency MedicineMedicine • To the acutely ill and injured child who is an inpatient: Pediatric Critical CarePediatric Critical Care MedicineMedicine • To the increasing number of children with special needs beyond acute care:PediatricPediatric Rehabilitation and Physical MedicineRehabilitation and Physical Medicine
  12. 12. ALL pediatric subspecialties fit into the PCCR research program • Linking what we do to outcomes for children • Mortality is not an adequate outcome measure, in pediatric research
  13. 13. Cells to Selves-ICells to Selves-I • Neuroplasticity after traumatic or asphyxial brain injury: what acute and rehabilitation strategies will: – Maximize neurodevelopmental outcome for every child – Ensure families of injured children are supported and not exploited
  14. 14. Cells to Selves-IICells to Selves-II Maximizing Outcomes: • Breaking the guilt/blame/family breakup cycle
  15. 15. Developmental BiologyDevelopmental Biology • Mechanisms of age related responses to : – DrugsDrugs (pressors, inotropes) – SepsisSepsis (SIRS , genomics may change with development) – VentilationVentilation (susceptibility to infection in special needs kids) -- Ischemia and AnoxiaIschemia and Anoxia (prognosis in the young? Rehabilitation?) – TraumaTrauma (neuroplasticity after brain injury)
  16. 16. Biobehavioral Development-IBiobehavioral Development-I • High Risk Behaviors: Our adolescent trauma victims: manipulation of the young by marketing, exploitation by criminal and legitimate enterprise.
  17. 17. Biobehavioral Development-IIBiobehavioral Development-II • Line sepsis:Line sepsis: Compliance with complex regimes in outpatient management of serious illness: realistic in special needs kids? • Child Abuse and Neglect:Child Abuse and Neglect: 826,000826,000 children were victims in 1999! Our physical findings and conclusions are constantly attacked due to inadequate supporting research. * Child Maltreatment 1999: DHHS
  18. 18. Health Disparities:Health Disparities: Bridging the Gap-IBridging the Gap-I • PICU’s and ER’sPICU’s and ER’s continue to be disproportionately populated by the poorest and sickest of children. • Could we identify 5 diagnosesCould we identify 5 diagnoses that bring most of them to our understaffed units? Using this data to seek the assistance of policymakers.
  19. 19. Health Disparities;Health Disparities; Bridging the Gap-IIBridging the Gap-II • Culturally Sensitive Care:Culturally Sensitive Care: Can we prove it reduces morbidity and mortality?
  20. 20. Reproductive Health for the 21Reproductive Health for the 21stst CenturyCentury • Infertility;Infertility; etiologies? Risk factors related to health/illness events in early life? • Maternal Lifestyle Parameters:Maternal Lifestyle Parameters: age, physical parameters, comorbidities, demographics of situations which are risk predictors for serious childhood illness and injury.
  21. 21. Genetics and Fetal Antecedents ofGenetics and Fetal Antecedents of Disease SusceptiblityDisease Susceptiblity • Genetic polymorphisms in criticalGenetic polymorphisms in critical illness:illness: Sepsis and trauma: IL-6 responses now characterized by a polymorphism in a promoter gene: How should therapy be designed, how should triage be affected by genotype? Heeson, Critical Care Medicine March, 2002
  22. 22. Targeting Sudden Infant DeathTargeting Sudden Infant Death SyndromeSyndrome • Preventive StrategiesPreventive Strategies: dramatic incidence decline initially • Pathophysiology:Pathophysiology: still poorly understood. Genomics? • Targeted Education/Outreach:Targeted Education/Outreach: Could the incidence be reduced to zero through preventive strategies? If not, why not?
  23. 23. Six Topics linking PCCM with Rehabilitation Medicine • Resuscitation Outcomes • ICU Myopathy • Near Drowning • Respiratory Failure • Shock, hypoperfusion states • Triage of Critically Ill Children
  24. 24. Research Project Award: R01 • Focus on specific set of aims • Investigator-initiated applications , usually…many exceptions • Research plan hypothesis driven • Budget: typically $150-250,000 per year • May request up to 5 years • Renewable
  25. 25. Small Grants: R03 and R21 • Pilot studies; planning and feasibility; innovative, high-risk approaches • Development of new methodology or technology • New investigators especially encouraged
  26. 26. R03’s and R21’s • Not renewable • Can’t be used to supplement funded projects • Budget: R03: $50,000/yr R21: $275,00/2 years • Please contact program staff before you choose a funding mechanism!
  27. 27. SBIR/STTR in Pediatric CriticalSBIR/STTR in Pediatric Critical Care ResearchCare Research • We are proudWe are proud to be gadgetto be gadget freaks in thefreaks in the PICU, OR, EDPICU, OR, ED or wherever theor wherever the kids needkids need innovation !innovation !
  28. 28. Small Business Technology Transfer (STTR, R41/42) and Small Business Innovation Research (SBIR, R43, R44) • STTR: Phase I: $100,000 (1 year) • Phase II: $500,000 (2 years) • SBIR: Phase I: $100,000 (6 months) • Phase II: $750,000 (2 years
  29. 29. Training and Career Development • Individual Fellowships Graduate students (F31) or Postdoc (F32) • Institutional Training Grants (T32) Support graduate training, postdocs, fellows in clinical and basic science investigation • Career Development Mechanisms Emerging basic science and clinical investigators Fully trained clinicians now entering research
  30. 30. Loan Repayment • http://www.lrp.nih.gov/NIHLRP/about
  31. 31. Special Research Initiatives • Request for Applications (RFA) • Program Announcements (PA) • Request for Proposals (RFP)
  32. 32. Useful NIH Websites: • NIH Home page: www.nih.gov • CRISP (searchable database of all NIH-funded grants): www.commons.cit.nih.gov/crisp/
  33. 33. Useful NIH Websites: • Center for Scientific Review (study section descriptions and rosters): www.csr.nih.gov • NIH Guide (research initiatives, policy announcements): www.grants.nih.gov/grants/guide/index.ht
  34. 34. What happens if………. • My RFA responsive Application is not funded? • The NIH Guide doesn’t solicit the kind of research I want to do?
  35. 35. Proposal may be resubmitted ! • As an investigator initiated proposal, new number, new or modified clock! • Discuss with program staff: policy not yet published!
  36. 36. •Progress in Medicine Depends onProgress in Medicine Depends on YourYour Vision; Don’t stop makingVision; Don’t stop making things better, EVER….things better, EVER….
  37. 37. For Many in Acute Care Medicine, this is a New Journey • Every journey begins with a single step • Contact me for “Seven Steps” • PCCR’s availability to you: “Walk Together.”
  38. 38. NIH/NICHD….NIH/NICHD…. • Welcome your projects in the clinical and basic sciences! • Contact us often….you will make our day! • Carol E. Nicholson, MD, MS, FAAP 301-435-6843 Nicholca@mail.nih.gov
  39. 39. California Dreamin’
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