NHLBI Strategic Plan Training and Career Development
Implementation Workgroup Summary
Executive Summary
The National Heart, Lung, and Blood Institute (NHLBI),
Strategic Plan Training and Career Development Implementation
Workgroup meeting was held July 30-31, 2008 in Bethesda,
Maryland. Drs. Linda Van Horn, Chairperson, and Helena Mishoe opened
the meeting both expressing sincere gratitude to all members
who were able to attend. Dr. Susan Shurin, Deputy Director,
NHLBI, provided opening comments and extended a welcome
on behalf of Dr. Elizabeth Nabel, Director, NHLBI.
The workgroup provided insight regarding how to begin
implementing the training Strategic Plan recommendations
provided within the NHLBI Strategic Plan. The complete
Strategic Plan is the culmination of over a two year
period in conjunction with over 600 individuals and feedback
from the NHLBI’s many intermediary groups. Dr. Shurin
charged the workgroup and asked that they also take into
consideration the Strategic Plan recommendations that
were provided as additional guidance to further ensure
that the NHLBI scientific and professional training programs
are well aligned with the research needs and opportunities
for the future. As part of the research agenda, Dr. Shurin
stressed the critical importance of including racial and
ethnic groups and gender diversity in our training efforts.
Dr. Mishoe acknowledged the challenges ahead wherein the
National Institutes of Health (NIH) must make a strategic
shift to manage resources over the next several years
while funding levels are not likely to change significantly.
She stressed the importance of keeping a clear strategic
vision when making recommendations regarding training
resource allocation. She urged the group to help set
priorities as the NHLBI moves forward to implement the
training and career development Strategic Plan recommendations.
The workgroup encompassed
a distinguished group of individuals with expertise in
research training, clinical medicine, basic and translation
research, clinical research, and the quantitative sciences.
In addition, Drs. Helena Mishoe, Melissa Antman, Rina
Das and Carl Roth, NHLBI staff members, made presentations
to provide background and framework for several discussion
questions that were addressed by the workgroup.
We anticipate that the complete program book will be made
available in an electronic format in the near future.
However, to provide context for this summary document
the following materials were provided in the program book.
- Agenda and Invited Participants - (Pages 1-2,
and Pages 14-15, respectively )
- NIH and NHLBI Research Training Applications and
Awards Data (1999-2007)
- (Presentation made by Dr. Rina Das for Dr. Blaine
Moore)
- NHLBI Training and Strategic Plan Recommendations
considered by workgroup (Pages 11-13)
- (Presentation made by Dr. Helena O. Mishoe)
- Pilot Analysis of F, T, and K Awards Using the Functions
of the Research, Condition, and Disease Categorization
(RCDC) System
- (Presentation made by Dr. Melissa Antman)
- NHLBI Training Efforts in Epidemiology
- Special Research Training Initiatives and CTSA Training
Opportunities
- Diversity Research Training Programs and Global
Health Training Efforts
- New NHLBI Training Initiatives
- NHLBI Training Committee
- Appendix
- Slide set: Dr. Carl Roth Presentation entitled
"NHLBI Training Grants: Funding Recommendations
Received Council Concurrence"
- Definitions of Activity Codes: Training and
Career Development Programs
- FY 2008 Funding and Operating Guidelines, NRSA
and Career Development Awards, NHLBI
The workgroup was asked to provide input on six questions
that focused on NHLBI research training priorities and
professional competencies needed for the future. Discussions
included approaches to training the best and the brightest
scientists capable of rapidly bringing new information
to the bedside as well as to communities, ensuring a future
diverse research workforce, best approaches to mentoring,
and exploring training policies that may enhance our training
and career development efforts. The discussions often
overlapped the various questions, but helped to sharpen
the focus of specific topics and recommendations.
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Questions 1 and 2
1. What are the 3-5 highest priority cross-cutting recommendations
listed under Training Strategic
Plan Recommendation? How should we move
forward to implement the recommendations? Are there ‘low
hanging fruit’ to be implemented now that will have an
impact on trainees? Are there additional priority training
needs that we have not identified? How can they be implemented
in the most efficient manner?
2. What are the best approaches (strategies or mechanisms)
to ensure that the scientific and professional competencies
that will come to predominate are introduced into our
training programs? Are there specific programs/partnerships
that we should leverage to address strategic plan recommendations?
Discussion Summary
The discussion began in response to a comment made by
NIH leadership in another forum that approximately 5 percent
of the NIH grantees have a funded research career that
spans 20 plus years. No data was available for consideration.
Several workgroup members commented that the Training
Strategic Plan recommendations focus predominately on
recruitment efforts of young investigators into research
careers. It must be acknowledged that we are clearly
challenged with retaining research scientists that have
a sustainable career, which is likely due in large part
to the shortage and high competition for limited funds.
- With our inability to offer young scientists a
long term career, we appear to have a “Darwinian Model:
The Survival of the Fittest”. Is this cost effective
for the NIH to invest so significantly into training
programs at the beginning of the pipeline (loan repayment,
K awards, priority funding for first time R01 new
investigators) with such a limited number of scientists
coming out on the “other end” i.e., a full career
in medical research, terminating in retirement? It
is recognized that the lack of stable soft-money-based
careers is a major impediment to attracting the best
and the brightest into biomedical research.
- New investigators must be brought in and mid-career
scientists must be sustained. New physician investigators
are often performing extended clinical training when
they should be conducting their most productive research.
The current system takes too long for funding, especially
K awards since physicians generally do not have the
luxury of several resubmissions.
- In addition, the U.S. will likely continue to face
competition for its best and brightest scientists.
The decline in the U.S. economy relative to those in the rest of
the world is facilitating the strengthening of science
elsewhere. New investigators often see their mentors
challenged to maintain research support and funded
lab personnel and even their own salaries. Finances
and quality of life may likely be an important consideration
for the current and next generation of scientists.
Also, Business and Law are formidable competitors
for current and future researchers. The workgroup
commented that we must commit to creating an environment
that affords the next generation of scientists a productive
and sustained research career in this country if so
desired. The following recommendations were provided.
- Invest in K-12 programs that promote science
and mathematics, establish role model programs,
and develop strategies to engage early.
- Consider increasing salary for K awards to
make salaries comparable to those paths otherwise
open to physician scientists. There is a high
financial penalty for those who go into research.
- Must work to maintain current research investment,
sustainability is critical. Provide funding advantage
for at least first and second competing renewals
while developing more long-term strategies to
help sustain individuals that choose a research
career. There was considerable discussion that
there had to be better ways to achieve stability
in mid-career.
- Consider increasing salary for F33 to make
it more attractive to mid-career or more senior
scientists that need to ‘retool’ their research
skill sets and allow re-training in new areas.
- Encourage institutions to provide bridge funding.
- Consider one year bridge award or ‘retooling
award’ to help sustain mid-career investigators.
The workgroup applauded the NHLBI for their longstanding
commitment and significant efforts to support new investigators
and they encourage the NHLBI to continue.
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High Priority Research Training Areas
The workgroup concurred with the training Strategic Plan
recommendations and identified several emphasis areas
and specific approaches.
Translational research training is a timely and high priority
area. The NHLBI should not ‘recreate the wheel’. The CTSA
infrastructure was designed for this purpose and a partnership
should be forged. Questions were raised regarding: (1)
How CTSA resources can be made available for non-CTSA
institutions? and (2) How the mid-career and PhD scientists
can fit into the CTSA program? The workgroup recommended
targeted support for translational research training in
the following manner:
- Provide at least 30 supplements (slots) to the
CTSA program specifically for translational research
for two years support. The NHLBI should consider
using a mechanism similar to the Diversity Supplements
Program or the NHLBI-NIGMS MSTP model used to support
MD/PhD training slots.
In addition to translational research, training in the
quantitative sciences was identified as a high priority
area. Upcoming scientists must be knowledgeable and have
a fundamental skill set in the quantitative sciences.
- Training programs should include courses such as
Bioinformatics, Systems Biology, Analysis of Biological
Networks, Foundations of Algorithms, Computational
Techniques in Systems Biology, and Linear Algebra.
Since some institutions may currently be limited in the
above or related course offerings, the NHLBI should strongly
encourage virtual training in the quantitative sciences
for its trainees. The workgroup encouraged new scientific
vibrancy in the NHLBI T32 training programs to ensure
training is kept up to date. To ensure the training structure
is nimble and has the ability to move quickly into new
directions, an assessment of the current training structure
was encouraged.
Forging Partnerships
With limited resources, the NHLBI should seek new partners
to help support research training efforts. The goal is
to leverage all available resources to increase the number
of highly trained investigators.
- The workgroup recommended that the NHLBI sponsor
a summit to explore financial partnerships with various
entities to support research training. Among the partners
are the professional societies, industry, pharmaceutical
companies, other government agencies, and ACGME (Accreditation
Council for Graduate Medical Education).
Team Science
It has become increasingly clear that Science must be
done in teams. Not everyone on the team will be a Principal
Investigator on an NIH grant. Members on a research team
have different roles, none that are less important. NIH
should consider supporting team science that includes
research training and support for various levels of a
research team (i.e., non-research associates).
- K awards submissions should be encouraged.
Team science in individual K awards (K23, K08) should
include a team of mentors with multidisciplinary research
backgrounds. K24 programs are especially poised to
encourage team science and cross disciplinary training.
Inclusion of computational/quantitative research training
must be done early in the program and is strongly
encouraged.
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Question
3
What are the most critical parameters that must be in
place to ensure we train a cadre of clinical scientists
capable of rapidly bringing new information to the bedside?
Discussion Summary
Clinical Training is expanding at an increased rate and
requires more time commitment. The workgroup raised the
question, ‘How do we build a career path for physician
scientists?’ Clinical training and research currently
are separate efforts. The workgroup discussed the potential
value of linking these efforts for continuity which will
help maintain the clinicians’ skill set as well as their
interest in research.
It is critically important to maintain the foundation
of basic science in clinical education. Basic scientists
and clinical mentors must function as a team with frequent
meetings and discussions of interdisciplinary approaches
to their trainee’s project.
Is the answer to decouple research training from clinical
training and create a research track for clinically trained
scientists? There was significant discussion comparing
two types of T32 programs: (1) those in which clinical
training, supported by the hospital, and research training,
supported by T32, are fully integrated; and (2) programs
that completely unlink clinical training and T32-supported
research training. Data is not available to help determine
which of the two training models are the most effective.
The group acknowledged that being a successful researcher,
who is competitive for grants, requires significant laboratory
time. Physician scientists cannot build their career
without dedicated research time. To this end, some workgroup
members expressed support for a physician scientist track
or the unlinked model (like K awards) as a better approach
to invest limited resources into research training.
The physician scientist’s track would allow strong research
competency with narrowed clinical responsibilities. This
track would allow physicians to make research their career
and eliminate the need to constantly balance between clinical
and research obligations. The workgroup agreed that this
is quite a difficult challenge that would require medical
schools to sanction this kind of effort. Other organizations
must also be a part of the solution. The workgroup commented
that the NIH cannot do this alone and that perhaps the
IOM (Institute of
Medicine) should explore this new paradigm in a more comprehensive
manner. Data is clearly needed to appropriately assess
the best models for research training.
Graduate training generally is too narrow and should be
broadened. There is a need for more clinically trained
PhDs. Therefore, graduate students should take medical
school courses to ensure a comprehensive knowledge of
disease mechanisms and enhance their ability to interact
with physicians on clinical projects. Clinically trained
PhDs should be allowed and strongly encouraged to apply
for the K23 and K08 mechanisms.
How do you introduce clinical research early in one's
career? How do we impart the creativity of science to
the next generation? The working group commented that
while they are aware of new and potentially excellent
models out there; they also recognized that the winning
strategies of the past will not be those of the future.
Currently, we need to determine best practices, identify
gaps, and strategies that will best facilitate the emerging
scientists of the future.
The following recommendations were made:
- Convene a workgroup of the best and brightest medical
students, fellows, and young investigators, to help
identify best practice approaches and current needs
in the area of early basic-clinical research engagement.
- Follow the workgroup with an RFA for a K07 mechanism
that includes support for a coordinating center to
support the most innovative best practice approaches.
- Support a modified training mechanism to implement
these best practice approaches.
- Reinvest at the undergraduate level and
include summer research programs such as summer science
camps to engender early buy in and intrigue long term
commitment.
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Question 4
What strategies can be implemented to help ensure we develop
a research workforce of the highest quality based on our
nation’s diversity?
Discussion Summary
- NHLBI should explore model programs such as those
supported by the NIGMS to engage young students from
diverse backgrounds in the sciences early. Partnerships
with the National Science Foundation and the Department
of Education are encouraged.
Gender equity is an important issue. The working group
applauded the NHLBI for the new K01 Re-Entry Biomedical
Sciences and participation in the recent NIGMS RFA entitled:
Research on Causal Factors and Interventions that Promote
and Support the Careers of Women in Biomedical and Behavioral
Science and Engineering
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Question 5
What are the best approaches to mentoring in a multidisciplinary
training environment and how should they be evaluated?
Discussion Summary
Mentoring is viewed as one of the most important aspects
of training new investigators. The NHLBI should ramp
up the importance of mentoring and promote a standardized
approach for trainees to secure survival skills that also
includes leadership and communication, realizing that
the new world of team science, multiple Principal Investigators
and interdisciplinary, translational medicine may require
an entirely new concept of mentorship.
The workgroup provided several recommendations.
- Institutions should consider sponsoring a survival
skill/mentoring core to be utilized by all T32s at
their institution.
- Team mentorship (interdisciplinary) is critically
important. The NHLBI should require interdisciplinary
mentoring teams.
- Protected time for K awardees is essential (e.g.,
K08/K23 awardees). A letter should be sent out every
quarter as an audit for compliance with 75% protected
time and a statement should be included on a progress
report to be signed by the Principal Investigator
confirming that the trainee has been afforded 75%
time to conduct research. The loan repayment program
uses a similar approach. NHLBI must hold mentors
accountable. Often the clinical supervisor is not
among the K awardees' mentors and is often distant
from the training experience.
- Consider supporting a mentoring core, lab management,
as part of the T32 program
- Institutions should be encouraged to integrate
a pool of research mentors across training mechanisms.
- Mentoring is critically important but requires
a significant time commitment. Mentors should
be paid similar to what takes place under the
K24 mechanism.
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Question
6
Comments/questions on policy update presentation? Are
there new or modified policy suggestions that we should
consider to enhance our training and career development
efforts?
Discussion Summary
The NHLBI made several significant policy changes in the
T32 programs in FY07. The goal is to continue to support
the most meritorious training grants while ensuring funds
are available to support new training grants. Dr. Carl
Roth presented the recommendations that received Council
concurrence. After the presentation, a lengthy discussion
took place regarding the significant investment the NHLBI
has in ongoing T32 programs versus new programs.
How does the institute ensure the latest technologies
and the most up-to-date research training is taking place
on its training programs? The workgroup recommended
continued encouragement and support for new training programs.
With the significant investment in continuation programs,
the working group felt that it is critically important
to ensure innovative scientific vibrancy in the training
programs and recommended the following:
- Introduce a new review criterion or identify a
review emphasis for the training study section on
the program relevance with respect to maintaining
currency with the latest developments in biomedical
research (e.g., computational sciences, systems biology).
- Supports Master’s degree on T32 to maintain research
skill set and keep clinically trained individuals
engaged in research.
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Concluding Comments
The workgroup acknowledged that the proposed training
and career development recommendations include both short
and long-term proposals that will require programmatic
and fiscal collaborations with other government entities,
as well as other public and private sectors.
The workgroup agreed that a high priority area for the
NIH and its partners is to establish an environment that
affords the current and future generation of research
scientists a productive and sustained research career.
To this end, the NHLBI should gather data on best practices
and current needs in the area of early basic and clinical
research engagement to recruit and retain the best and
brightest diverse research workforce. In addition, data
should be collected on various research training models
to help determine the most effective strategy to recruit
and retain scientists, with a particular emphasis on clinical
scientists.
The NHLBI must help ensure multidisciplinary mentoring
for trainees, including survival skills mentoring, and
explore ways to compensate mentors. Accountability strategies
should be put into place to make certain trainees are
afforded the designated protected time on career development
awards.
Research training in new and expanded scientific areas
will likely include novel program development, and the
ability to leverage and target efforts on new and ongoing
training programs. The NHLBI should partner with the
NCRR (National Center for Research Resources) to take
full advantage of the CTSA program to expand and sharpen
their efforts in translational research. In addition
to translational research, the workgroup identified training
in the quantitative sciences as a high priority area. Research
training programs should include courses such as Bioinformatics,
Systems Biology, Analysis of Biological Networks, Foundations
of Algorithms, Computational Techniques in Systems Biology,
and Linear Algebra. Innovative scientific vibrancy in
training programs must be maintained through the peer
review process, areas of emphasis designated by the NHLBI,
and restructuring of training programs as appropriate.
Drs. Van Horn and Mishoe thanked the workgroup participants
for offering their valuable time, enthusiasm, and candor
throughout the meeting discussion. Dr. Mishoe provided
a brief summary of the working group meeting and final
remarks. She indicated that the workgroup members may
be called upon in the future as the NHLBI moves forward
in the implementation of the training and career development
strategic plan effort. The NHLBI emphasized its commitment
to evaluate progress as it implements strategies to ensure
a future cadre of well-trained investigators to assume
leadership of America’s biomedical and behavioral research.
Related Links:
NHLBI Strategic
Plan: Shaping the Future of Research-Training and Career
Development Recommendations Considered by the Workgroup
Workgroup Participant List
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NHLBI Strategic Plan: Shaping the Future
of Research
Training and Career Development Recommendations
Considered by the Workgroup
The NHLBI remains committed to the training of individuals
across the academic spectrum. The Institute currently
supports a large portfolio of fellowships and training
and career development programs conducting research
related to heart, lung, blood, and blood diseases and
sleep disorders. The strategic planning process presents
an important and exciting opportunity to evaluate progress
in training and to explore new strategies to ensure
that a cadre of well-trained investigators will continue
the leadership of NHLBI research into the future.
Twenty-three working groups were convened by the four
NHLBI programmatic divisions during the strategic planning
process. The programmatic divisions are the Division
of Cardiovascular Diseases (DCVD), Division of Lung
Diseases (DLD), Division of Blood Diseases and Resources
(DBDR), and the Division of Prevention and Population
Sciences (DPPS). To ensure a diversity of ideas and
recommendations, the Institute requested that each working
group include a discussion of specific and cross-cutting
training needs and opportunities. Training, as used
in the Program Book, encompasses fellowships
(F), training (T), and career development (K). The
major recommendations for the cross-cutting training
areas resulting from the combined efforts of all of
the working group discussions are summarized below.
Recommendations
A. General
- Continue NHLBI efforts to support funding for new
investigators, including the current policy of more
advantageous paylines.
- Enhance the training of basic researchers and clinical
scientists in new, emerging areas of science and methodologies.
- Support new training opportunities in behavioral
research and prevention.
- Enhance training in the most up-to-date methods
within established disciplines such as the fields
of epidemiology and health services research to hasten
the application of emerging knowledge and technologies
to combat heart, lung, and blood diseases, and sleep
disorders.
B. Personalized Medicine/Genomics/Bioinformatics/Biotechnology
- Develop a personalized medicine scholars program,
including ethics training.
- Expand training components in all grant mechanisms
to increase –omics training across all levels
of experience.
- Support short course(s) in bioinformatics, genetics,
and genomics for trainees and senior level investigators.
- Enhance training opportunities in computational
biology and quantitative sciences. Integrate educational
activities in common with other NIH Institutes and
Centers in –omics and quantitative sciences.
- Provide pre-doctoral training programs for computational
biology, physiology and pathophysiology. Also, consider
supplemental support to existing graduate and post-graduate
training grants for training of medical students and
fellows in quantitative approaches to biomedical research.
- Provide training in software development, maintenance,
documentation, validation, and integration of clinical
informatics systems (clinical and clinical/translational
IT).
C. Multidisciplinary and Interdisciplinary Training Needs
- Develop researchers trained in multidisciplinary
and interdisciplinary team science.
- Support cross-training of investigators in
genomics, clinical research, and bioinformatics.
Provide flexible interdisciplinary pre- and post-doctoral
programs between experimental and computational
biomedical sciences.
- Support the development of interdisciplinary
curricula. Promote training opportunities in
new, emerging technologies, including nanotechnology,
imaging, -omics, analytic software development,
bioengineering, and cellular therapeutics.
- Foster interdisciplinary interactions and training
involving research teams. Teams of the future
will include physical scientists, computational
biologists, engineers, molecular biologists, geneticists,
and clinicians.
- Support mini-sabbaticals to foster cross-training
experiences. Develop new training mechanisms
to encourage team science.
D. Promote training efforts in translational research
- Develop training opportunities in translational
behavioral science research, including both Phase
I (basic science discoveries to intervention) and
Phase II (clinical interventions to community and
clinical practice settings).
- Foster training in translation I and II research,
including creation of a new Translation Investigator
Award.
- Establish formal training opportunities for lay
health workers to educate the community in a culturally-appropriate
manner regarding aspects of clinical trials (e.g.,
consent forms, safety concerns, and historical community
concerns).
- Develop strategies to foster the development of
interdisciplinary teams and bi-directional relationships
between clinical scientists and lay communities.
E. Continue to enhance and encourage training and retention
of clinical investigators
- Create funding opportunities for junior faculty
finishing a fellowship and/or after the completion
of the K08 and K23 awards. Awards should be coupled
with loan repayment.
- Establish an NHLBI Pioneer Award to support “start
up” of new clinical scientists.
- Improve support of biostatisticians and clinical
trialists to improve clinical trial methodologies.
F. Establish new and leverage existing training partnerships.
- Foster efforts to promote interactions with the
CTSA program through supplements to existing grants
or linking K24 awards with CTSAs.
- Increase collaboration with professional societies
to improve training and cross-discipline fertilization.
G. Emphasize and promote mentoring
- Develop strategies to improve the quality and number
of available mentors and promote a global approach
to mentoring that includes science, career development,
and best practices in research laboratory management.
The above recommendations are not to be considered all
inclusive. Specific recommendations made by the Strategic
Plan working groups for individual division programs are
not represented in this document, but rather in the NHLBI
Strategic Plan.
The NHLBI continues to explore new ways to foster the
research independence of new investigators.
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NHLBI Strategic Plan Training and Career Development
Implementation Workgroup
Participant List
Rockledge II Room 9100/9104
Bethesda, Maryland
July 30-31, 2008
Chair
Linda Van Horn, Ph.D., RD
Professor, Preventive Medicine and Associate Dean for
Faculty Development
Northwestern University, Feinberg School of Medicine
680 N Lake Shore Drive, Suite 1102
Chicago, IL 60611
Donna Arnett, Ph.D.
Chair and Professor
University of Alabama at Birmingham
School of Public Health
1665 University Blvd.
Birmingham, AL 35294
David Center, M.D.
Professor
Boston University
715 Albany Street
Pulmonary Center, R304
Boston, MA 02118
Sonia Flores, Ph.D.
Associate Professor of Medicine
University of Colorado
Denver HSC/Aurora
UCHSC
4200 E. Ninth Avenue
Denver, CO 80262
Gary Gibbons, M.D.
Director
Cardiovascular Research Institute
Morehouse School of Medicine
720 Westview Drive, S.W.
Research Wing #228
Atlanta, GA 30310
Bruce Furie, M.D.
Professor
Beth Israel Deaconess Medical
Center
Division of Hemostasis and Thrombosis
330 Brookline Ave., E/Tcc-9
Boston, MA 02215
Susan Maroney, D.V.M., Ph.D.
Research Scientist 1
Blood Center of Wisconsin, Inc.
8727 Watertown Plank Road
P.O. Box 2178
Milwaukee, WI 53201
Suzanne Oparil, M.D.
Professor
University of Alabama at Birmingham
703 19th South
ZRB 1034
Birmingham, AL 35294
Allan I. Pack, M.B., Ch.B., Ph.D.
Professor of Medicine
Chief, Division of Sleep Medicine/Department of Medicine
Director, Center for Sleep and Respiratory Neurobiology
University of Pennsylvania School of Medicine
125 South 31st Street, Suite 2100
Philadelphia, PA 19104
Julie A. Panepinto, M.D., M.S.P.H.
Assistant Professor, Pediatrics
Medical College of Wisconsin
8701 Watertown Plank Road
P.O. Box 26509
Milwaukee, WI 53226
Richard W. Pastor, Ph.D.
Senior Scientist
Laboratory of Computational Chemistry
National Heart, Lung, and Blood Institute
National Institutes of Health
5635
Fishers Lane, Room T921 MSC 9314
Bethesda, MD 20892-9314
Harvey B. Pollard, M.D., Ph.D.
Professor and Chair
Department of Anatomy, Physiology and Genetics
USU School of Medicine (USUHS)
4301 Jones Bridge Road
Bethesda, MD 20814
Edward Snyder, M.D.
Professor, Laboratory Medicine
Yale University School of Medicine
Blood Bank CB-459
Yale New Haven Hospital
20 York Street
New Haven, CT 06510
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