Seeking Support From the Seeking Support From the NIH for Pediatric Critical NIH for Pediatric Critical
Care ResearchCare ResearchCarol E. Nicholson, MD, MS,FAAP
NIH/NICHD/NCMRR
National National InstitutesInstitutesof Health of Health Bethesda, MDBethesda, MD
NIH consists of 27 Institutes and Centers
= Extramural only
NEI
NCI
NHLBI
NLM NINDS
NIMH
NIAMS
NINR
NCCAM
CIT
CC
NHGRI
NIANIAAA
NIAIDNICHD
NIDCD
NIDCR
NIDDK
NIDA
NIEHSOD
NIGMSNCRR
NIBIBNCMHD
FIC CSR
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?
And, Brought to you by NICHD…….• The National
Center for Medical Rehabilitation Research
• Program for Program for Pediatric Pediatric Critical Care Critical Care and and RehabilitationRehabilitation
ResearchResearch PCCRPCCR
Research Grants71%
All Other 6%
Research Management and Support 3%
IntramuralResearch
10%R&D
Contracts
7%ResearchTraining
3%
NIHNIH(FY 2001 $20.3 billion)
Over 80% of NIH funds support extramural research
www.nih.gov
The Future for Pediatric The Future for Pediatric Acute Care ResearchAcute Care Research
NIH is our Federal Government’s primary agency for support of Biomedical Research.
Funding Mechanisms
• Most $ go to investigator –Most $ go to investigator –initiated proposalsinitiated proposals
• Training• Career Development• Research Grants • Contracts
NICHD Priorities for Research
• Cells to Selves• Developmental Biology• Biobehavioral Development• Reproductive Health• Genetics of Disease Susceptiblity• Health Disparities
Relating NICHD Research Priorities• To the acutely ill and injured child who is
an outpatient: Pediatric Emergency Pediatric Emergency MedicineMedicine
• To the acutely ill and injured child who is an inpatient: Pediatric Critical Care Pediatric Critical Care MedicineMedicine
• To the increasing number of children with special needs beyond acute care:Pediatric Pediatric Rehabilitation and Physical MedicineRehabilitation and Physical Medicine
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
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
Cells to Selves-IICells to Selves-IIMaximizing Outcomes:• Breaking the guilt/blame/family
breakup cycle
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?)– Trauma Trauma (neuroplasticity after brain injury)
Biobehavioral Development-IBiobehavioral Development-I• High Risk Behaviors: Our
adolescent trauma victims: manipulation of the young by marketing, exploitation by criminal and legitimate enterprise.
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: 826,000 826,000 children were victims in 1999! Our physical findings and conclusions are constantly attacked due to inadequate supporting research.
* Child Maltreatment 1999: DHHS
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.
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?
Reproductive Health for the Reproductive Health for the 2121stst Century Century• 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.
Genetics and Fetal Antecedents Genetics and Fetal Antecedents of Disease Susceptiblityof Disease Susceptiblity• Genetic polymorphisms in critical Genetic 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
Targeting Sudden Infant Death Targeting 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?
Six Topics linking PCCM with Rehabilitation Medicine• Resuscitation Outcomes• ICU Myopathy• Near Drowning• Respiratory Failure• Shock, hypoperfusion states• Triage of Critically Ill Children
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
Small Grants: R03 and R21
• Pilot studies; planning and feasibility; innovative, high-risk approaches
• Development of new methodology or technology
• New investigators especially encouraged
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!
SBIR/STTR in Pediatric SBIR/STTR in Pediatric Critical Care ResearchCritical Care Research
• We are proud We are proud to be gadget to be gadget freaks in the freaks in the PICU, OR, ED PICU, OR, ED or wherever or wherever the kids need the kids need innovation !innovation !
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
Training and Career Development
• Individual FellowshipsGraduate students (F31) or Postdoc (F32)
• Institutional Training Grants (T32) Support graduate training, postdocs,
fellows in clinical and basic science investigation
• Career Development MechanismsEmerging basic science and clinical
investigatorsFully trained clinicians now entering
research
Loan Repayment• http://www.lrp.nih.gov/NIHLRP/
about/index.htm
Special Research Initiatives
• Request for Applications (RFA)
• Program Announcements (PA)
• Request for Proposals (RFP)
Useful NIH Websites:
• NIH Home page: www.nih.gov
• CRISP (searchable database of all
NIH-funded grants):www.commons.cit.nih.gov/crisp/
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.html
What happens if……….
• My RFA responsive Application is not funded?
• The NIH Guide doesn’t solicit the kind of research I want to do?
Proposal may be resubmitted !
• As an investigator initiated proposal, new number, new or modified clock!
• Discuss with program staff: policy not yet published!
•Progress in Medicine Progress in Medicine Depends on Depends on YourYour Vision; Vision; Don’t stop making things Don’t stop making things better, EVER….better, EVER….
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.”
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 [email protected]
California Dreamin’
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