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Discovering new pathobiological mechanisms and understanding them is critical for improving heart, lung, blood, and sleep (HLBS) health. Such discoveries and research can potentially lead to clinical and implementation studies, which in turn can inform new therapeutic strategies and clinical practice. Important areas to focus on, with the help of emerging technologies such as molecular imaging and nanotechnology, include mechanisms involved in the pathogenesis of rare and common diseases, disease-related structural and functional changes, and the clinical significance of these changes. In addition, tracking of disease onset and progression across the lifespan is essential because it has the potential to inform our understanding of the conversion of chronic conditions into acute disease and the effects of early exposures and interventions, including lifestyle changes.