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 24--25, 2006

The 59th meeting of the National Advisory Council for Nursing Research
(NACNR) was convened on Wednesday, May 24, 2006, at 1:05 p.m. in
Conference Room D, Building 45, National Institutes of Health (NIH),
Bethesda, MD. The first day of the meeting adjourned at approximately
5:35 p.m. The open session of the meeting continued on the next day,
Thursday, May 25, 2006, at 9:00 a.m., and was adjourned 9:30 a.m. The
closed session of the meeting, which included consideration of grant
applications, was immediately convened and continued until adjournment
at on the same day at 1:00 p.m. Dr.Mary E. Kerr, Executive Secretary,
NACNR, opened the meeting on behalf of Dr. Patricia A. Grady, Chair,
NACNR, who joined the meeting during the open session on May 24, and
presided over the remainder of the open session and the closed session.

\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

**OPEN SESSION**

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

Dr. Kerr called the 59th meeting of the NACNR to order, welcoming all
Council members, visitors, and staff on behalf of Dr. Grady.

[Conflict of Interest and Confidentiality Statement]{.underline}

Dr. Kerr 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. Kerr 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 Council
notebooks.

# Minutes of Previous NACNR Meeting

Standing Council members received a copy of the minutes of the January
24-25, 2006, NACNR meeting by electronic mail. No changes or corrections
to the minutes of the January 2006 Council meeting were suggested during
the May meeting. A motion to approve the minutes of the January 24-25,
2006, Council meeting as circulated was proposed and seconded. Comments,
corrections, and changes to the January meeting minutes should be
forwarded to Dr. Grady or Dr. Kerr. The minutes of each quarterly NACNR
meeting are posted on the NINR Web Site (<http://ninr.nih.gov/ninr>).

[Dates of Future Council Meetings]{.underline}

Dates of future meetings in 2006 and 2007 have been approved and
confirmed. Council members should contact Drs. Grady or Kerr regarding
any conflicts or expected absences.

[2006]{.underline}

• September 26-27 (Tuesday-Wednesday)

[2007]{.underline}

• January 23-24 (Tuesday-Wednesday)

• May 22-23 (Wednesday-Thursday)

• September 25-26 (Tuesday-Wednesday)

**II. REPORT OF THE DIRECTOR, NINR** (Dr. Mary Kerr, Deputy 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
budget, NIH, and NINR.

**Budget Updates**---In fiscal year 2006 (FY06), the NINR budget of
\$137,342,000 decreased by approximately 0.5 percent compared with the
prior fiscal year, while the overall NIH appropriation of \$28.5 billion
was reduced by 0.12 percent. The proposed for FY07 budget appropriation
is \$136,650,000 reflecting a reduction of an additional 0.5 percent,
and the overall proposed for NIH budget for FY07 is flat. The NINR
budget for FY06 is \$137,342,000; and the proposed funding for FY07 is
\$136,650,000. The President's FY07 budget was presented to Congress on
February 6, 2006, and final approval of an appropriations bill is
anticipated later this year.

The NINR application success rate is similar to that of other Institutes
and Centers (ICs) with a success rate of 20-25 percent for the past few
years; a rate of approximately 20 percent is estimated for FY06. Despite
recent constraints in funding, NINR continues to support good science,
including new applications, but, by extension, only those who apply have
an opportunity to receive available monies.

**NIH Updates**---In an effort to expand outreach to the community, NIH
Director Dr. Elias Zerhouni established the *NIH Newsletter* and an
e-mail address by which he can be contacted directly,
<zerhounidirect@nih.gov>. A new joint NIH-Department of Health and Human
Services (DHHS) initiative that creates a vision for the future of
health care predictive, personal, and preemptive, also known as "the
three Ps". This new vision to transform care from "curative" to
"preemptive" is consistent with the perspective of nursing science and
holds promise for the future.

Dr. Kerr reported on updates regarding submission of applications to
NIH. The new deadline for electronic submissions is 5:00 p.m. local
time. Common errors that delay electronic submission are failure to
include an identification (ID) number and a mismatch between the
institution's ID number and their DUNS number. Also, NINR has joined the
NIH Omnibus R21 Exploratory Grant Mechanism, which is described in
detail at <http://grants.nih.gov/grants/funding/r21.htm>. The NIH Office
of Extramural Research continues to develop its multiple-PI initiative.
The multiple-PI option requires the designation of a single "Contact
PI," who serves as the liaison between NIH and other PIs and
investigators on a project and who coordinates progress reports for the
research. The multiple-PI program is currently being pilot tested and
will supplement rather than replace other programs and models.
Additional details and information may be found at
<http://grants2.nih.gov/grants/multi_pi/index.htm>.

Several NIH Roadmap opportunities are available, including the 2006 NIH
Director's Pioneer Award Program (DP1). The Pioneer Award supports
individual scientists and gives recipients the intellectual freedom to
pursue new research directions and highly innovative ideas that have the
potential for unusually great impact (RFA-RM-06-005). Another
initiative, the Interdisciplinary Research Consortium will strive to
strengthen the dynamic process of study of human biology and behavior,
and encourage collaboration across divisions within biomedical research
to enhance scientific discovery (RFA-RM-06-008). This initiative
involves training, supplements to existing awards, and establishing
interdisciplinary research centers (U54 with K01, P30, R01, R21, R25,
T90). The program has two phases that start with pre-applications
followed by invitations to some groups to submit full applications. The
pre-applications were due April 18, 2006. The full consortium program
Requests for Applications (RFAs) are available at
<http://grants.nih.gov/grants/guide/rfa-files/RFA-RM-06-008.html>.
Another initiative, the NIH Pathway to Independence ("PI") Award, uses a
K99/R00 mechanism to provide 5 years of support in two phases. Phase one
includes mentored support for the first 1-2 years of the award, and
phase two provides funding for up to 3 additional years of independent
research (http://grants. nih.gov/grants/guide/pa-files/PA-06-133.html).
The award is open to postdoctoral candidates; up to 200 awards are
anticipated in the initial year. An announcement for a T90 award for
cross-training of investigators to create new research teams also has
been released (RFA-RM-06-006). Finally, the NIH plans to reissue the
Institutional Clinical and Translational Science Awards (CTSAs) Program,
with submissions expected to be due early next year
(http://www.ncrr.nih. gov/clinicaldiscipline.asp).

NINR and nursing research are represented at a range of NIH meetings and
conferences. The first Symposium of the NIH Pain Consortium, co-chaired
by Dr. Grady, convened April\
17-18, 2006, on the NIH Campus. The focus of this meeting was on
advances in pain research. Information about the Consortium is available
at [http://painconsortium.nih.gov](http://painconsortium.nih.gov/). The
inaugural conference of the Patient-Reported Outcomes Measurement
Information System (PROMIS) will be held September 11-13, 2006, in
Gaithersburg, MD. Topics will include key PROMIS activities, methods of
patient-reported outcomes (PRO), and PRO measurement systems in
development and in use around the world (<http://www.nihpromis.org/>).
NINR also is supporting and participating in the 10th anniversary
celebration of the Office of Behavioral and Social Sciences Research
(OBSSR), June 21-22, 2006, at the Natcher Conference Center on the NIH
Campus in Bethesda (<http://obssr.od.nih.gov/OBSSR10th/index.htm>). In
closing the NIH update, Dr. Kerr noted that *U.S. News and World Report*
reported that according to recent statistics, the NIH Web Site is the
second-most frequently visited federal web site after the Internal
Revenue Service's site.

**NINR Updates and Outreach**---Papers from the 2004
State-of-the-Science Conference, "Improving End-of-Life Care," have been
compiled into a supplement to the *Journal of Palliative Medicine*
(December 2005, Volume 8, Supplement 1). A free copy is available online
at
<http://www.liebertonline.com/toc/jpm/8/supplement+1;jsessionid=nlErBVFHips6UEoXvV>.
A new feature of the NINR Web Site provides links to podcasts of a range
of audio broadcasts, including NIH radio interviews with NINR Director
Dr. Grady; presentations and the keynote speech at the Science
Symposium, "Nursing Research: Changing Practice, Changing Lives," that
kicked of the NINR 20th anniversary; and others. Streaming video of the
NIH State-of-the-Science Conference on Improving End-of-Life Care also
is available. More information and downloadable podcasts may be found at
<http://ninr.nih.gov/ninr/podcasts/downloads.html> and
<http://ninr.nih.gov/ninr/podcasts/podcast.html>.

Dr. Grady has made several presentations since the last Council meeting,
including "Informing the Nation's Research Agenda," to the Robert Wood
Johnson Foundation on April 6, 2006. She delivered the keynote address
at the Thomas Jefferson University's Jefferson College of Health
Professionals on April 20, 2006 and participated in a panel discussion
titled, "Creating the Preferred Future for Policy that Promotes Patient
Safety," at the University of Maryland School of Nursing on May 12,
2006. In addition, Dr. Grady's "News from NINR" column in Nursing
Outlook was resumed in 2005. In other news from the Office of the
Director, Dr. Kerr extended congratulations to Dr. Grady on being named
one of the "100 Most Powerful Women of Washington" by *Washingtonian
Magazine*. Dr. Sue Marden, Clinical Nurse Specialist, NINR's Symptom
Management Laboratory, received the Rear Admiral Faye G. Abdellah
Publication Award for Nursing Research for her article on of the effect
of intermittent versus continuous highly active antiretroviral therapy
on quality of life in patients with chronic HIV infection (AIDS
20:837-845, 2006).

Extramural investigators and research studies also have been cited in
the news and have received special recognition since the last Council
meeting. Dr. Elaine Larson was interviewed for an article titled, "Hand
Sanitizers, Good or Bad?" and Dr. Judith Maloni for "Don't Take This
Lying Down" on bed rest during pregnancy; these articles appeared in the
March 21 and March 26 editions, respectively, of *The New York Times*.
The United Press International (UPI) featured Dr. Judith Mercer's
research on the effect of delayed cord clamping in reducing the
incidence of late-onset sepsis and intraventricular hemorrhage in
premature infants in an April 11 article.\
Dr. Suzanne Bakken, Columbia University School of Nursing, was named
*Computerworld Magazine*'s "Laureate" for 2006 for her work on mobile
decision support for advanced practice nursing (R01 NR08903). Dr. Norma
Metheny, St. Louis University School of Nursing, was awarded the 2006
Distinguished Nutrition Nurse Award by the American Society for
Parenteral and Enteral Nutrition for her research on placement of tube
feedings in different populations to identify low-risk, validated
methods with clinical applications. Investigators are asked to forward
articles and presentation notices to NINR Program Officers to ensure
timely acknowledgement and for tracking of NINR-supported researchers'
publications as part of the Institute's overall outreach efforts.

The Seventh Annual NINR Summer Genetics Institute (SGI), a 2-month,
intensive research training program, is scheduled for June 5-July 28,
2006. The SGI is designed to provide a foundation in genetics for use in
research and clinical practice, expand the research capability among
graduate students and faculty in schools of nursing, and develop and
expand the basis for clinical practice in genetics among advanced
practice nurses. A total of 102 nurses have graduated from the program;
this year's course will welcome 20 new students. Graduates of NINR's SGI
have been successful at publishing in the scientific literature,
submitting research applications that capitalize on their new genetic
knowledge, and integrating genetic content into university curricula.
The deadline for applications for this year's SGI has passed. Additional
information is available at <http://ninr.nih.gov/research/>.

As part of NINR's 20th anniversary celebration, staff participated in
the four 2006 regional nursing research meetings through the
presentation of special panel sessions focusing on research mentorship.
The presentations featured mentor -- mentee pairs and explored lessons
learned in effective mentoring; they were very well attended and were
received with interest and enthusiasm. Another anniversary event is the
20th Anniversary NINR-NIH Clinical Center Joint Collaborative Conference
titled, "Celebrating Nursing Science: The Research-Practice Link," on
Friday, June 16, 2006, at Masur Auditorium in the NIH Clinical Center.
The Conference is open to clinicians and researchers who are interested
in exploring this link; online registration is available, and there is
no charge to attend this conference. NINR's year-long anniversary
celebration will culminate on October 11, 2006, with the 2006 NINR 20th
Anniversary Symposium, which will be held in conjunction with the 2006
National State of the Science in Nursing Research. The theme of the
Anniversary Symposium is, "Making it Happen: The Future of Nursing
Research." Further information and updates on NINR training programs and
research initiatives, meetings, and other activities can be found by
visiting the NINR home page at <http://ninr.nih.gov/ninr/>.

**III. clinical research peer review: continuity and change**

(Dr. Antonio Scarpa, Director, NIH Center for Scientific Review)

In 1945, the NIH established the first study section to review proposed
syphilis research. The modern peer review process evolved from that
point to become the "heart and soul" of NIH. It has produced an
effective partnership between the federal government and research
institutions and has created the best academic medical centers and
biomedical/behavioral and biotechnology research. Peer review also has
optimized treatment and prevention of a myriad of diseases and
conditions. The process established at NIH has been admired and imitated
here and abroad. It also has protected NIH against outside influence.

The mission of the Center for Scientific Review (CSR) is to ensure that
NIH grant applications receive fair, independent, expert, and timely
reviews---free from inappropriate influences---to permit the NIH to fund
the most promising research. CSR has four review divisions and\
23 integrated review groups (IRGs). Nearly all NINR and other
nursing-related applications are routed through the Health of the
Population IRG and the Risk, Prevention, and Health Behavior IRG under
the Division of Clinical and Population-Based Studies. The role and
responsibilities of CSR have grown tremendously in the past several
years as the total number of applications to NIH has doubled, increasing
from about 40,000 in FY98 to almost 80,000 in FY05. The number of
applications referred for CSR review mirrors this trend, with CSR
overseeing the review of about 25,000 submissions in FY98 to more than
50,000 in FY05, which required some 18,000 reviewers and nearly 1,800
study section meetings. In FY05, 459 NINR applications were reviewed by
CSR representing approximately 1 percent of all CSR applications. A
total of 93 CSR study section meetings (5.2 percent of all CSR meetings)
reviewed NINR applications in FY05, an increase from 43 (3.1 percent) in
FY02. Percentile rankings of NINR R01 submissions are commensurate with
or slightly better than those for other ICs.

Although the peer review system used by NIH historically has served the
institution and investigators well, it is outdated and has become very
expensive to maintain. Factors influencing the need for change include
the way research is conducted (e.g., multiple PIs and multidisciplinary
teams on studies, multi-site and international studies) and the types of
diseases affecting Americans (e.g., multi-organ, chronic conditions such
as obesity and aging), all of which require a different level of
investigation and expertise and, in turn, review. Changes in CSR
operations include increased communications within CSR and between CSR
and the ICs, reviewers, and applicants; the goal of this change is to
expand and improve outreach and to ensure awareness and understanding of
new procedures and the reasons for these changes. By implementing these
operational changes, CSR plans to increase uniformity and efficiency of
the review process, facilitate the work of Program Officers, and analyze
review group performances.

Strategies to increase uniformity and efficiency include transitioning
to electronic submissions and reviews; posting all summary statements
within 1 month of study section meetings and summary statements of new
investigators within 1 week; unscoring 50 percent of applications; and
using text fingerprinting and software (e.g., Collexis) to match
applications with summary statements of all reviews within the previous
3 years to facilitate study section or IRG assignment. Nine pilots
already are underway to begin to assess these changes and their
benefits. Feedback identified the following additional desirable changes
in the CSR review: (1) shortening the review cycle; (2) addressing the
concern that clinical research is not properly evaluated; (3) improving
the assessment of innovative, high-risk/high-reward research; and (4)
increasing efforts to recruit and retain more high-quality reviewers.

A recent assessment of all human subject R01s versus R01s not involving
human subjects submitted between 2000 and 2004 identified a preference
toward non-human subject applications. When a subgroup of applications
with specific concerns (i.e. human subjects) were removed from the
overall assessment, there was a close alignment between the two
categories of R01s. Investigators conducting human subjects research are
much less likely to apply for a Type 2A0 or A1 application. And funded
Type 1 new human subjects researchers that do not submit a Type 2 are
less likely to submit for another activity than investigators funded for
non-human subjects research. These findings suggest that the NIH is
losing successful, funded human-subjects investigators at a greater rate
than those not conducting human subjects research (i.e., a loss of 40
percent versus 30 percent, respectively).

The significant increase in applications in the past decade is the major
driver for the payline. About half of this growth is from new
investigators created by the doubling of the NIH budget; additional
contributions are from interest in new technologies, returning
investigators, and an expanding base (e.g., engineering). Study section
improvements include implementation of electronic reviews and use of (or
experimentation with) telephone- or video-enhanced discussions and
asynchronous electronic discussions. Pre-meeting conference calls and
e-mails also help streamline in-person meetings, often by up to 1 day.
Clinical reviewers are still needed, and physicists and computational
biologists are in growing demand. One area for new research
opportunities will require international reviewers (e.g., Fogarty
grants).

Other questions being considered are: Is were raised that warrant
further consideration. In closing, Dr. Scarpa commented that peer review
is essential to the health of the nation. In using coronary heart
disease (CHD) as an example, he stated that through identifying the best
research to advance heart health, the peer review system directed the
significant decrease in CHD deaths in the United States that translated
into saving nearly 1 million lives in 2000 alone, based on the
difference between actual and projected deaths (about 514,000 and
approximately 1,329,000, respectively). The impact is much greater when
advances in the treatment and prevention of other conditions nationally
and worldwide, such as cancer, are considered.

**IV. addressing health disparities in early childhood: the chicago
parent program for supporting low-income ethnic minority parents** (Dr.
Deborah Gross, Rush University College of Nursing)

The objective of the Chicago Parent Program---to develop and test the
effectiveness of a culturally and contextually relevant parenting
program for low-income African-American and Latino parents of young,
preschool-aged children---advances the NINR Strategic Plan goal of
providing leadership in selected areas of science, such as cultural and
ethnic considerations in health and illness, including culturally
sensitive interventions to decrease health disparities among groups by
focusing on health promotion activities and chronic illness management
strategies.

The first assumption in developing an effective parenting program---that
all parents want their children to feel loved, respected, confident, and
good about themselves---often is compounded by additional day-to-day
challenges facing low-income parents. The second assumption is that
culture affects parents' values, beliefs, and behaviors, and the way
parents navigate the world for their children requires cultural
understanding and relevance in creating effective messages and
information about parenting. The third assumption is that providing
services in natural settings (e.g., the home, community programs, early
childhood programs) increases the likelihood of reaching and maintaining
contact with children, youth, and families who face many barriers to
receiving those services in the community.

The Chicago Parent Program builds on the "Incredible Years Program," an
NINR-supported program developed and tested by Dr. Gross and her
colleagues between 1996 and 2001 to identify prevention and intervention
strategies to promote social and emotional well-being and school
readiness in 3- and 4-year-old children and their families in low-income
urban communities (*J Counsel Clin Psych* 71:261-278, 2003). The
researchers used feedback from the parents involved in the Incredible
Years Program in designing the Chicago Parents Program.\
Dr. Gross's team produced a series of videos using real-life scenarios
that included 160 brief vignettes showing how parents can address
situations that arise in relation to mealtimes, bedtimes, morning
routines, misbehavior in public, limit-setting, not following through on
limits, stress management, and problem-solving. Approximately 50 percent
of the families in the videos are African American, about 25 percent are
Latino, and the remaining are from other racial and ethnic groups. Dr.
Gross showed several of the video vignettes during the May Council
meeting.

The assessment of the program included 292 families from seven daycare
centers in the Chicago area. The study population was approximately 58
percent African American and 34 percent Latino. Children in the study
were 2-4 years old, and nearly all of the parents (84 percent) were
single. Outcome data were collected at baseline, immediately
post-intervention, and at 6 months and 1 year post-intervention.
Findings are based on parent self-reports, teacher reports, and
investigator observations of parent and child behavior. Results indicate
that the greatest impact was associated with intervention dose (i.e.,
number of sessions attended), engagement in the intervention, and
consumer satisfaction during participation and at the end of the
program. The overall attendance (dose) was relatively low, with parents
on average attending 39 percent of the scheduled sessions (4.7/12
sessions); one-third attended no sessions, which Dr. Gross noted is a
common problem with prevention research. Compared to controls, the
intervention group had significant improvements in parent discipline
(increased follow-through on commands and limits and decreased corporal
punishment) and in child behavior based on parental reports and
investigator observations. Improvements were maintained through 1-year
follow-up. No effects were found for parenting self-efficacy; however,
parents reported being very satisfied with the program; 100 percent
reported they would recommend or highly recommend the program. Parents
also found the vignettes helpful or very helpful 94 percent of the time.
A recent issue of *Research in Nursing & Health* included an article on
participation in this trial (Garvey et al., Volume 29, pages 212-222,
2006; abstract at
<http://www3.interscience.wiley.com/cgi-bin/abstract/112605929/ABSTRACT>),
and an upcoming special issue of this journal will include study
findings.

The Head Start of Chicago, which serves more than 16,000 children in
more than 500 schools, has expressed interest in the program.
Recommendations for continuation of this work include evaluation of
strategies for improving recruitment, retention, and adherence rates in
health disparities research; support of innovative approaches for
increasing participation rates that can be replicated in community
settings; and evaluation of the cost-effectiveness of different
participation-enhancing strategies with different populations at risk
for health disparities.

**V. nih at the crossroads: myths, realities, and strategies for the
future** (Dr. Elias Zerhouni, NIH Director)

Numerous events and factors have impacted the NIH budget, including the
federal and trade deficits, Department of Defense and Homeland Security
priority requirements, Hurricane Katrina needs, and domestic budget
cuts. The aftermath of the doubling of the NIH budget also is apparent,
especially given these additional financial constraints and Congress's
support shifting to the physical sciences. Another factor is the rate of
biomedical research inflation, which is nearly twice that of general
inflation. Questions about success rates have been focused on whether
NIH is moving from its core mission and placing too much emphasis on
translational as opposed to basic science; whether NIH is shifting
towards solicited, agency-driven research (Requests for Applications
\[RFAs\] and Program Announcements \[PAs\]) at the expense of
unsolicited, investigator-initiated research, which is considered the
hallmark of success; and whether the NIH Roadmap is consuming research
funds.

Dr. Zerhouni explained that contrary to the first assumption, the only
engine for basic research in the United States is the NIH, and NIH
remains committed to ensuring that at least 50 percent of its research
funds support basic research. A slight distortion occurred in FY02 and
FY03 following the infusion of \$2 billion for biodefense research and
supporting infrastructure. By FY05, the allocation for basic research
had returned to 55 percent. Although industry spends more money overall
on research than NIH, most of those funds are dedicated to applied
research. NIH also remains committed to funding unsolicited research,
which consistently has accounted for more than 90 percent of grant
awards over the past decade. Finally, the Roadmap budget comprises only
a small fraction of the total NIH budget, accounting for 1 percent of
NIH funding in FY06 and 1.2 percent in FY07 and subsequent years. As Dr.
Zerhouni explained, the Roadmap is not one large initiative; rather, it
is composed of many initiatives, and in FY05, the Roadmap funded 345
individual grants to more than 300 PIs. About 40 percent of the awards
funded basic research, 40 percent supported translational studies, and
20 percent went to high-risk investigations. The Roadmap provides a
process to promote and synergize innovative research across ICs to
address major cross-cutting NIH priorities. It follows a different peer
review process involving short applications and applicant-driven ideas.
Dr. Zerhouni acknowledged NINR's participation in Roadmap teams and
initiatives.

Given this information, the major fundamental driver is large capacity
building throughout the United States at research institutions and a
dramatic increase in the number of tenure-track faculty; this factor
accounts for about 90 percent of the increase in applicants and
applications to NIH after 2004. The two other factors include budget
appropriations that have fallen below inflation since 2003, and the
4-year budget cycling phenomenon. In the 2 years since the end of the
doubling, NIH has received as many new applications (8,359) as it did
during the 5-year doubling period between 1999 and 2003 (8,303). The
same trend exists for the number of new applicants. The number of
applications per applicant increased only slightly, from 1.2 to\
1.4 applications per investigator. Thus, the near-doubling of the total
number of applications submitted (from about 24,000 in 1998 to 43,000 in
2005) combined with increases in costs per grant and recent budget
constraints has produced tension between the supply and demand. Further
complicating this scenario is the availability (or lack thereof) of new
funds in any one year. Uncommitted funds are derived from ending grants
that were started 4-5 years ago combined with the budget increase from
the current year, which, for FY06, was flat. However, 2003 commitments
will become available in 2007, which will allow for a 3 percent increase
in competing grants, even with another flat budget. In sum, because the
number of applications per applicant increased, the success rate
understates the funding rate. In FY05, the success rate for applications
was 22.3 percent, whereas for individual applicants it was 27.6 percent.
In FY06, the estimated rates for applications and individual applicants
are 19.8 and 25 percent, respectively. Dr. Zerhouni emphasized that the
payline is not the funding cut-off line.

Key to adapting to these and future changes and scenarios is knowing the
facts and correcting misunderstandings, developing adaptive strategies
(e.g., New Pathway to Independence Program, IC efforts to promote new
investigators, supply/demand management), and conveying a clear unified
message. Accompanying these approaches is the need to transform medical
research in the 21st century, from treating disease after symptoms
appear and normal function is lost to intervening to prevent disease
before symptoms appear and preserving normal function as long as
possible; to understanding preclinical molecular events and developing
the ability to detect patients at risk; and applying these strategies to
greatly improve disease prevention and management to decrease financial
and disability costs. The scope of the problem relative to the challenge
may be conveyed through review of ongoing costs for diseases of greatest
public health concern. For example, the total investment per American
over the past 30 years to affect a 63 percent decrease in mortality from
CHD is approximately \$110, or \$3.70 per year. Applying a similar
calculation to the hundreds to thousands of other conditions and
illnesses facing Americans, it is easy to see the impact of health care
costs in the absence of transforming medical research and practice. A
new paradigm for this transformation involves predictive,
personalization, preemptive, and participation components. Nursing
research can be expected to play a significant role in moving medicine
from being curative to being preemptive.

**VI. ninr mission and strategic plan draft, 2006-2010** (Dr. Joan
Austin, Council Member, and Ms. Mary Miers, NINR)

A working committee within Council, the Strategic Planning Workgroup,
which is chaired by Dr. Kerr, has taken the lead on drafting NINR's
Strategic Plan for 2006-2010. Planning for and development of NINR's
Strategic Plan for 2006-2010 began in June 2005, with the Strategic
Planning Retreat. The Council Strategic Planning Workgroup met in August
to shape the major themes of the first draft of the Plan, which were
discussed with the Council Planning Subcommittee and presented at the
September 2005 Council meeting. The Subcommittee continued to make
progress on the Plan and met through monthly teleconferences between
October 2005 and January 2006, when the revised draft was presented to
Council for review, after which the Plan was revised further, presented
at the National Nursing Research Roundtable Annual Meeting in March
2006, and posted for 2 months on the NINR Web Site for public comment.
The Plan was revised again and presented to Council for review at the
May 2006 NACNR meeting. The final Plan and supporting text will be
prepared for publication over the summer, and the finished product will
be released on October 11, 2006, at the 20th Anniversary Research
Symposium, "Making it Happen: The Future of Nursing Research."

Forty-two responses were received during the public comment period, some
with multiple signatories, and included four comments from professional
organizations and seven from nursing school Deans or Associate Deans of
Research. Additional comments were submitted by investigators, students,
and nurses in community practice. The public advised NINR to expand
informatics to enhance patient safety, nursing practice, and research;
develop and use new technologies; support end-of-life research and
further development of infrastructure for the field; provide support for
health disparities research efforts; add more research on
nurse-sensitive and system-related outcomes; and emphasize partnerships
including the use of existing databases. Additional comments from within
NINR included suggestions to re-examine sections on caregiving, symptom
management, and self-management to eliminate overlap and emphasize
scientific discovery (in addition to translation and delivery of care)
to ensure clarity outside the nursing research community; add goals for
areas of research; and address editorial notes.

Both NINR's mission statement and the Strategic Plan for 2006-2010 were
amended to reflect these comments and recommendations. The mission
statement was revised to reflect decisions about placement of text on
self-management, symptom management, and caregiving into a single
section on quality of life. The new mission is "to promote and improve
the health of individuals, families, communities, and populations, and
to support and conduct clinical and basic research and research training
on illness across the life span. The research focus encompasses health
promotion and disease prevention, improving quality of life, eliminating
health disparities, and promoting research on the end of life. NINR
seeks to extend nursing science by integrating the biological and
behavioral sciences, applying new technologies to nursing research
questions, improving research methods, and developing nursing research
investigators." Revisions to the Strategic Plan reflect NINR proposals
for restructuring the planning document and comments received. The draft
plan is now founded on four strategic objectives, which are similar to
the prior four major themes, and four areas of research emphasis, which
consolidate the prior six priority research areas with the new umbrella
"quality of life" area. Goals tied to each of the four areas of research
emphasis also have been identified, as follows:

-   *Health promotion and disease prevention:* To provide evidence-based
    tools and interventions for achieving health-promoting and
    risk-reducing behaviors over time. A new area of research to be
    supported under this emphasis category involves investigations of
    opportunities to identify and ameliorate the long-term consequences
    of prematurity, including near-term infants at risk for
    complications.

-   *Improving quality of life:* To promote optimal quality of life for
    healthy or at-risk individuals, patients, and caregivers in a
    variety of settings.

-   *Eliminating health disparities:* To identify the factors that
    contribute to health disparities, and to design interventions for
    underserved, at-risk, and vulnerable groups.

-   *End-of-life research:* To improve the end-of-life experience for
    patients, families, and caregivers, and to develop a strong research
    program to address end-of-life issues. A new area of research to be
    supported through this portfolio is the development of informatics
    tools that will facilitate the integration and analysis of data from
    end-of-life studies.

VII. **UPDATE: NINR HEALTH DISPARITIES PORTFOLIO** (Dr. Paul Cotton,
     Office of Extramural Programs, NINR)

NINR defines health disparities as the differences in the incidence,
prevalence, mortality, and burden of disease and other adverse health
conditions that exist between specific population groups within the
United States, including African Americans, Asian and Asian Pacific
Islanders, Hispanics and Latinos, and Native Americans and Native
Alaskans. Medically underserved populations are defined as populations
with inadequate access to or reduced utilization of high-quality health
care, such as low-literacy, rural, and low-income populations and the
disabled. NINR has used and will continue to use Institute of Medicine
(IOM) reports in shaping its health disparities strategic plans and
initiatives. Two prominent nurse scientists,\
Dr. Martha Hill of Johns Hopkins University and Dr. Antonia Villarruel
of the University of Michigan, have participated in the development of
two IOM reports on health disparities, *Unequal Treatment: Confronting
Racial and Ethnic Disparities in Health Care*, which was published in
2003, and *Examining the Health Disparities Research Plan of the
National Institutes of Health: Unfinished Business*, which was published
earlier this year.

NINR's Strategic Plan on Reducing Health Disparities focuses on
research, infrastructure, and outreach. The research goals outlined in
the 2000-2005 Strategic Plan included encouragement of innovative
applications that address health disparities, and support for
investigator-initiated research proposals that address health
disparities. Infrastructure goals included enhancing infrastructure for
an increased emphasis on health disparities and enhancing mentorship,
training, and research opportunities for minority students and
researchers. Outreach goals included maintaining involvement with
minority professional nursing organizations\
(e.g., National Coalition of Ethnic Minority Nurse Associations), and
enhancing communication and dissemination activities between minority
investigators.

NINR initiatives stemming from the health disparities strategic plan
include Funding Opportunity Announcements (FOAs) (e.g. RFAs, PAs, and
PARs). Examples of research training FOAs designed to increase the
number of well-trained minority researchers include the NINR Mentored
Research Scientist Development Award for Underrepresented or
Disadvantaged Investigators (PAR-05-135) and Research Supplements to
Promote Diversity in Health-Related Research (PA-05-015).
Research-focused FOAs in NINR's portfolio designed to address specific
health conditions are Health Disparities Among Minority and Underserved
Women (PA-04-153), Health Promotion Among Racial and Ethnic Minority
Males (PA-04-027), Enrolling Women and Minorities in HIV/AIDS Research
Trials (PAS-03-168), Reducing Preterm and Low Birth Weight in Minority
Families (PA-04-027), Community Participation in Research (PAR-05-026),
and Social and Cultural Dimensions of Health (PA-05-029). NINR also
supports 17 P20 Partnership Centers across the United States and Puerto
Rico. Each Partnership Center is a relationship between a school of
nursing with an established research-intensive program that focuses on
health disparities and a minority-serving institution that is developing
a research program. NINR also supports four P30 Centers of Excellence in
both rural and urban settings, each with a focus on health disparities.
Within the past 5 years, areas of research emphasis in NINR's Health
Disparities portfolio have included chronic disease, caregiving,
neighborhood and housing, pregnancy outcomes, technology, and
underserved populations. As a result of its initiatives, NINR has seen a
29 percent increase in the number of applications and a 25 percent
increase in the funding of awards for health disparities research
between 1999 and 2005.

Dr. Cotton highlighted findings from NINR-supported research on health
disparities. Dr. MaryFran Sowers' investigation of ethnic differences in
cardiovascular risk factor burden in nearly 3,000 women between 42 and
52 years old found that African-American and Hispanic women had the
highest composite risk scores (P \< 0.01). A substantial component of
risk associated with ethnicity could be attributed to socioeconomic
status and geographic location. Dr. Martha Hill studied 309 inner city
African-American men 21-54 years old in a comparison of an intensive
blood pressure control intervention that included a comprehensive
educational, behavioral, and pharmacological intervention team versus a
less intensive, standard referral that included medication and
educational material for the patient but no orchestrated team care
approach. During the 36-month study, men receiving the more-intensive
intervention had a higher percentage of blood pressure control and
decreased progression of left ventricle mass.\
Dr. Thelma Patrick confirmed the inverse relationship between
homocysteine and folic acid in African-American women with preeclampsia,
a finding that has implications for the development of arteriosclerosis
in this population. Dr. Clarann Weinert found that computer-delivered
interventions to chronically ill women in rural settings appeared to be
associated with increased social support and self-esteem compared with
controls who did not receive the interventions.\
Dr. Patricia Reagan's study of more than 3,000 women investigated how
preterm birth is influenced by social context broadly defined as
measures of neighborhood disadvantage and cumulative exposure to
state-level income inequity, after controlling for individual risk
factors. Evidence indicated that neighborhood poverty rates and housing
vacancy rates were associated with an increase in preterm births among
African Americans and Hispanics. Dr. Anne Skelly electronically tracked
the movement of 121 study participants for 1 week to demonstrate how
maps of where people live and carry out their daily activities can be
used by health care providers to plan highly targeted diabetes
intervention programs.

Upon review of the NINR portfolio and published literature, staff have
identified possible emerging areas of research on health disparities for
further consideration, including near-term births, children, persons
with disabilities, symptom management, quality of life, hard-to-reach
populations, chronic disease, and continued training.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Following this presentation and discussion, Dr. Grady thanked
participants and attendees for their time and interest and then
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, US 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 81 research and training grant
applications on which NINR was the primary Institute; these applications
requested a total of \$19,444,882. (direct costs year 01). The Council
also considered 99 applications on which another Institute/Center was
primary and NINR was secondary; these applications requested a total of
\$37,400,420(direct costs year 01). The Council concurred with the IRG
recommendations on these 180grant applications.

**ADJOURNMENT**

The 59th meeting of the NACNR was adjourned at 1:00 p.m. on May 25,
2006.

**CERTIFICATION**

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

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\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Patricia A. Grady, Ph.D., R.N., F.A.A.N Mary E. Kerr, Ph.D., R.N.,
F.A.A.N.

Chair Executive Secretary

National Advisory Council for Nursing National Advisory Council for
Nursing

Research Research

**MEMBERS PRESENT**

Dr. Patricia A. Grady, Chair

Dr. Mary E. Kerr, Executive Secretary

Dr. Joan Austin

Mrs. Rosemary Crisp

Dr. David Dinges

Dr. Kathleen Dracup

Dr. Joyce Newman Giger

Dr. Felicia Hodge

Mr. James Linn

Dr. Sandra Millon-Underwood

Dr. Gary Morrow

Dr. Frances Munet-Vilaro

Dr. Anna Alt-White, *Ex Officio*

Dr. John Murray, *Ex Officio*

**MEMBERS OF THE PUBLIC PRESENT**

Ms. Debbie Campbell, AACN

Ms. Mary Cerny, CSI, Inc.

Dr. Deborah Gross, Rush University

Dr. Melinda Ray, National League for Nursing

Dr. Claudette Varricchio, private citizen

**FEDERAL EMPLOYEES PRESENT**

Mr. Brian Albertini, NINR/NIH

Dr. Nell Armstrong, NINR/NIH

Dr. Alexis Bakos, NINR/NIH

Mr. Ray Bingham, NINR/NIH

Dr. Yvonne Bryan, NINR/NIH

Dr. Fungai Chanetsa, CSR/NIH

Dr. Paul Cotton, NINR/NIH

Ms. Elizabeth Crawford, NINR/NIH

Dr. Ray Dionne, NINR/NIH

Dr. Bill Elwood, CSR/NIH

Ms. Rebecca Erickson, NINR/NIH

Ms. Ana Ferreira, NINR/NIH

Dr. John Grason, OD/NIH

Dr. Ann Hardy, CSR/NIH

Dr. Martha Hare, NINR/NIH

Dr. Karen Huss, NINR/NIH

Dr. Kathy Mann Koepke, NINR/NIH

Dr. Sue Marden, NINR/NIH

Dr. Donna Jo McCloskey, NINR/NIH

Dr. Trudy McFarland, CSR/NIH

Ms. Jacquelyn McKissic, NINR/NIH

Ms. Mary Miers, NINR/NIH

Ms. Marlene Mroczka, NINR/NIH

Ms. Lanny Newman, NINR/NIH

Dr. John Richters, NINR/NIH

Dr. Jose Ruiz, NINR/NIH

Dr. Antonio Scarpa, CSR/NIH

Dr. Mary Scheetz, ORI/DHHS

Dr. Barbara Smothers, NINR/NIH

Ms. Allisen Stewart, NINR/NIH

Mr. Neil Thalier, OER

Dr. Mindy Tinkle, NINR/NIH

Ms. Tonya Truesdale-Young, NINR/NIH

Ms. Renee Walker, NINR/NIH

Ms. Julinenne Willlis, NINR/NIH

Dr. Elias Zerhouni, OD/NIH