# Pre-Application Webinar: Effectiveness and Services Trials

## Метаданные

- **Канал:** National Institute of Mental Health (NIMH)
- **YouTube:** https://www.youtube.com/watch?v=E0qrgTG1Gr0

## Содержание

### [0:00](https://www.youtube.com/watch?v=E0qrgTG1Gr0) Segment 1 (00:00 - 05:00)

okay everybody we're going to go ahead and get started um welcome to uh our webinar on the updates to the clinical trials announcements in particular today we'll be talking about pilot Effectiveness research and mental health systems and services uh with me today um I'm Pat Arian I am the director for the division of services and interventions research uh and with me is Joel Cheryl who is the deputy director Mary Rooney who is in our treatment interventions and prevention Branch charad mandadi who's a services and clinical epidemiology Branch Eileen schy um Nick guano and Tamar Keys who are in the division of extramural activities um so uh please use the zoom and Q&A feature to post any questions uh participants can enter questions at any time during the presentations however we will be taking additional questions at also the end of the presentation um and we are recording this webinar and we will send out an email blast as to where it will be hosted so that your colleagues uh you can share this with your colleagues or you can come back and take a look at what uh our discussion was today I do want to apologize for the very quick turnaround in terms of the announcement of this webinar and when it was hosted uh events beyond our control um but we're glad to see that some of you have been able to make it today so um I'm just going to give an overview about the reason for the changes to the Clin Suite of clinical trials PS that specifically that are um uh funded under the division of services and interventions research um I'm also going um then we're going to go over the specific changes to Pilot Effectiveness announcement an overview of the new services and systems research announcement and then Dr Cheryl will go over the simplified peer review um an overview of forms I which is also new and then we'll take your answer your questions so in coming to dier last year um I uh the dier staff and I did a quick review of our portfolio and in particular the budgets for the R34 pilot Effectiveness studies and the yield of the R1 Effectiveness and services announcement in terms of how many applications we were getting specifically in service and system level interventions research the R34 Mount uh and our summary is basically this the R34 Mount has not kept up with the cost of living intervention and adaptation study designs are far more complex than they used to be uh and therefore we felt that uh this is an opportunity for us to rightsize the funding for this particular type of research Effectiveness research and Services Research have different purposes and focus on different targets Effectiveness is focused on the individual or the organism Services systems of care or the organization we still encourage a mechanistic hypothesis and both types of Trials but the methods used to study mechanisms and system level interventions are different than those um the methods used to study therapeutic mechanisms uh so we felt it was important to have a separate RFA or par uh for clinical trials uh to study systems and services interventions so that we can um clarify what we mean by mechanistic studies in the two different types of Trials uh we also another reason for why we wanted to separate out the services and systems level interventions research is that um we have been very we feel very strongly about um uh partnership building and systems research and we feel This is highly critical and are encouraging a more thoughtful partnership process moving forward so that we can deploy best P practices as soon as possible um in both cases we did a thorough review of funding mechanisms that would address the cost of living challenges provide more support for partnership building and hopefully will speed the translation of science into service and that is the rationale for our changes to the um to these particular trial announcements so now I'm going to hand this over to Mary Rooney who will talk about the changes to the pilot Effectiveness research Mary great thank you Pat so yes as Pat mentioned I'm going to be talking about the pilot Effectiveness research announcement um specifically pilot hybrid effectiveness implementation trials for our mental health interventions next slide so uh I'll quickly recap the purpose of this announcement um which is to solicit pilot hybrid Effectiveness implementation research that's consistent with n im's priorities for refining and optimizing preventive and therapeutic interventions the previously demonstrated efficacy for use with broader Target populations or for delivery in routine care school

### [5:00](https://www.youtube.com/watch?v=E0qrgTG1Gr0&t=300s) Segment 2 (05:00 - 10:00)

Community or online settings as well as research on implementation strategies that support the delivery and sustainability of evidence supported interventions in accessible settings um the with our reissue of this announcement um as Pat mentioned the largest changes really are to the budget and the funding mechanism and there's one change to the scope so starting with the funding mechanism uh in the previous version this was an R34 an M uh with the increase in the budget uh this is now an ro1 mechanism however the scale and scope of the research stays squarely focused in the pilot domain as I just described with an emphasis on assessing the feasibility acceptability of the approach and generating the preliminary data that is needed to support a well-powered fullscale ro1 trial in the future um and the direct costs for the projects have now increased to total of $750,000 over the course of the full budget period um which is three years and it also uses utilizes a modular budget even though it's an ro1 in terms of the um scope of the research in that that's uh we're soliciting it's remains largely unchanged except that we are now requiring the inclusion of a pilot hybrid Effectiveness trial which by definition includes methods for evaluating intervention Effectiveness as well as implementation factors and in our prior version this was something that we encouraged but it wasn't something that was required so that's um a pretty significant change of something to attend to because it will be uh something we'll be looking at in terms of how whether or not the application is responsive to the funding opportunity announcement and lastly one additional very important point to note is that this announcement because we have switched from an R34 mechanism to an ro1 mechanism we uh will not be able to allow resubmissions so if you have an application that you uh submitted and was reviewed under the R34 mechanism you will need to submit a new application uh under the ro1 mechanism you will not be able to uh submit a resubmission from your prior um application and those are the key points uh at the end I'm happy to take additional questions through the Q&A great next slide uh yes thank you Mary um now I'm going to hand this over to charad mandadi yes thank you so I'm pleased to provide a brief introduction to a new clinical trial funny announcement Effectiveness trials to test system preventions um so the purpose of this funding opportunity is that it uses an r61 r33 expor for a developmental phased award mechanism to support Milestone driven feasibility and infrastructure development during the r 61 phase um followed by a well powerered clinical trial during the r33 phase so in this instance um the r33 is not considered developmental but really rather should be used to test the effectiveness of um system interventions or implementation strategies so in terms of the award information please note application budgets are not limited or capped um and should reflect the needs of the proposed work and the award cannot exceed 5 years and that includes a maximum of up to two years uh for the r61 phased pH followed by um a maximum of four years for the r33 phase and the scope of the project really should determine um the project period for each of those phases next slide please so just to provide a brief um context for the research supported by this announcement so assistant interventions are operationalized as those that Target systems of care um as Pat mentioned rather than individuals and intend to issues such as access and adoption delivery and organization utilization and quality Mental Health Services with the ultimate goal really of improved clinical functional or population level outcomes so the focus of the intervention could be across multiple organizational systems or settings or at multiple levels within a single organization or setting um finally the research and methods proposed here should really go beyond assessing whether the intervention is effective or not um and should Advance our understanding of and test specifically how why for whom or in what settings or circumstances the system intervention may be effective um and make sure to include a detailed analytic plan um and the specific variables that can be used to address those questions next slide so when preparing your application and this uh is a bit different we're switching to the R3 6133 so it'll be important to take into account the basic nature of the award and follow any specific instructions that are listed in the funded announcement or in the published announcement um the r61 phase is typically a one to twoyear planning phase that largely focused on collecting feasibility data and

### [10:00](https://www.youtube.com/watch?v=E0qrgTG1Gr0&t=600s) Segment 3 (10:00 - 15:00)

establishing the infrastructure that will be needed for the conduct of the r33 clinical trial so applications must include a plan that delineates our 61 Milestones that signify the completion of major elements that are going to be necessary to support the larger scale project that's being proposed in the r33 um these Milestones should include a description of well- defined um quantifiable achievable justifiable um scientifically Justified benchmark marks um deliverables thresholds that will allow program staff to assess progress during the r61 phase and also that will establish the feasibility and the empirical basis for pursuing the r33 work so activities may be varied it really depends on the focus of the intervention um and uh the stage of intervention development the activities can include collecting feasibility or Pilot data for the intervention or intervention components in situations where preliminary data are not available um developing research practice Partnerships as Dr Aran mentioned um and engaging with the community and clinical collaborators and end users to ensure intervention appropriateness and feasibility and potential sustainability and scalability demonstrating ability to access key data sets and um fin demonstrating feasibility of recruiting retaining and randomizing participants for the trial um that's being proposed in the r33 um which brings us to that phase so the r33 really is to provide the definitive test of and test the effectiveness of that system intervention or implementation strategies that are being ried refined during the r61 so for transition to this phase investigators will need to submit a package that includes a progress report summarizing achievement of milestones and that material will be evaluated by NIMH staff uh program staff and um to help inform our 33 funding decisions and again when preparing your application please do um be mindful of those specific instructions for application submission that pertain to the information that's necessary and the formatting for the two phases of the project next slide and then finally I just went to end with a quick summary of the types of studies that would not be response to this funding announcement and um you know if submitted unfortunately would not be reviewed or considered um for funding and these would include applications that don't explicitly test how or in what circumstances the intervention may be effective and again do not include the analytic plan and specification of variables applications that propose to test interventions or infl ation strategies in academic research settings as opposed to routine clinical Care Community settings um those that propose to test um implementation strategies that Focus only on the individual level um again there's other funding announcements that are more appropriate for that work and then finally applications that propose um health literacy interventions without specifically examining the impact on factors like access and engagement or outcomes and Care um and of course if you have any questions again regarding responsiveness and program priorities that relate to this announcement please feel free to reach out um and thank you so much um so now I'm gonna hand this over to Jo uh Dr Cheryl to discuss the simplified peerreview framework okay thank you so um next our plan is to very briefly highlight a few NIH changes to the application and review processes and we note that these changes are not specific to these particular PS rather in both cases these are NIH level changes that apply to Applications submitted on or after January 25th 2025 so we're flagging these changes because they'll apply to the first receipt date for the PS we're covering in this webinar um so first based on input from the field NIH developed revisions to the peer review process and a simplified framework for NIH peer review criteria as described in notice od2 24-1 Z the new framework for peer review applies to various project Grant applications submitted on or after January 25th 20125 the simplified review framework is intended to focus reviewers on key uh questions specifically should the proposed research be conducted and can the proposed research project be conducted so should it be conducted and can it be conducted uh next slide please so um the simplified framework for nhp review reorganizes the former five regulatory review criteria into three factors the significance and Innovation criteria are now included under Factor one importance the approach Criterion is now included under Factor two which covers the approach rigor and feasibility and the investigators and environment criteria are now included under Factor three which includes

### [15:00](https://www.youtube.com/watch?v=E0qrgTG1Gr0&t=900s) Segment 4 (15:00 - 20:00)

expertise and resources so this reframing focuses reviewers on three Central questions Factor one how important is the PO research Factor two how rigorous and feasible are the methods and factor three whether the investigators in the institution have the expertise and the resources necessary to carry out the process the project next slide please next notice OD 24 - 086 informs applicants of changes to the Grant application forms and the application guide instructions specifically a transition from forms H to forms I for applications again submitted for due dates on or after January 25th 2025 next slide please uh the application guides and for forms I application packages are posted to the how to apply application guide and again because these Effectiveness and system intervention PRS we're covering in this webinar today have initial receipt dates after 202 January 25th 2025 these PRS are posted with fors ey forms next slide please so just very briefly some key changes to research project grants under for's ey are outlined in notice od2 24- 086 and these include a new attachment field for the recruitment plan to enhance diversity on the PHS 398 research training program plan and required use of common forms for biographical sketch and current and pending other support um again these application packages are attached to these new pars next slide please and then briefly before we take questions about the effectiveness in systems intervention PRS next we thought we would summarize and compare the PRS to help address some potential questions about how to decide which PR to use based on the nature of the intervention you're studying the stage of science Etc next slide please in terms of the nature of the intervention the pilot Effectiveness and full-scale hybrid Effectiveness PS are relevant for testing preventive and therapeutic interventions across modalities that includes pharmacological interventions psychosocial inter itions digitally facilitated interventions combinations of interventions Etc and they're also relevant for testing other interventions that Target the behavior of individuals so for example interventions to promote service use users access to or engagement in mental health services and implementation strategies that Target provider behavior for training or supervision strategies for example in contrast the systems intervention prer is used for interventions that Target systems rather than individuals as Shad said the focus could be at multiple levels within the system including the service user provider and the system next slide please in terms of the stage of intervention Development Across these PS for Effectiveness trials testing individual level interventions the pilot hybrid Effectiveness implementation PR is used for early stage pilot testing while the full scale effectiveness implementation PR is used for trials that are informed by Pilot data and designed and powered to definiely test Effectiveness the systems level intervention PR uses a phased Milestone driven approach to move from feasibility to full scale testing the r61 phase involves Milestone driven feasibility and infr infrastructure development the r33 phase involves trials that are designed and powered to definitively test effect effess next slide please relatedly the goals of the trial differ depending on the stage of intervention development and testing for pilot hybrid trials Effectiveness trials the goals involve examining feasibility of the intervention strategy a preliminary evaluation of the intervention's impact on outcomes and at least one highpath siiz mechanism and importantly collecting data needed in support of a subsequent definitive trial the fullscale hybrid Effectiveness implementation trial should be designed and powered to test outcomes examine mechanisms and examine factors that impact implementation and the phased system intervention PR project should focus first on establishing feasibility um and establishing Partnerships and preliminary examination of Effectiveness and then in the r33 phase definitively testing the interventions Effectiveness

### [20:00](https://www.youtube.com/watch?v=E0qrgTG1Gr0&t=1200s) Segment 5 (20:00 - 25:00)

and examining factors that account for or moderate the effectiveness next slide please the PS also differ in terms of the prerequisite data that are required for each application for the pilot Effectiveness implementation PR pilot data regarding the effectiveness of the intervention are not required rather pilot testing is in fact the goal of these projects but information support the feasibility of conducting the pilot work in the practice setting is important to include for the full scale Effectiveness implementation PS there should be pilot data regarding the intervention's effectiveness in support of the hypotheses and for the phase system intervention PR the prerequisite information differs for each phase for the r61 phase there should be some prior evidence supporting the feasibility of completing the work in the practice setting for the r33 phase the prerequisite information comes from having met the r61 Milestones including evidence supporting the feasibility of engaging practices and practice partners and feasibility of enrollment Etc and pilot data regarding the intervention's effectiveness and support of the r33 hypotheses next slide please finally uh the PRS differ in terms of the project period based on the scope of work so for the pilot Effectiveness implementation PR these modular ro1s are limited to no more than three years for the full scale Effectiveness implementation trials the project period should be justified based on the scope of the work and the maximum project period is five years for the phase system intervention PR the maximum project period is five years but depending on the current state of the interventions development applicants have some flexibility the r61 can be 1 to two years and the r33 can be 3 to four years next slide please we really want to emphasize that the information that uh Dr Rooney and Dr mavandadi presented is included in the PS in the announcement all the information is included in the announcement this is merely a summary today um and we want to emphasize the importance of reviewing all the sections of the PS before applying for example section one describes the background and purpose of the pr in detail details the scope of research including examples of responsive and non-responsive studies section four includes very critical information about what to include in the research section and in the application these are the application instructions um in order to build and submit a responsive application and in parallel in section five reviewers are asked to address review criteria specific to the pr the review criteria in section five parallel the instructions in section four so it behaves all application all applicants to review the instructions and these review criteria ensure that their applications are responsive and complete um and we also want to note that for each of these announcements program contacts are listed at the end and we always encourage potential applicants to contact us as far in advance as possible um before submitting an application to discuss the match to NIMH priorities and the match to these various ARS that we use for Effectiveness and system intervention research and we recommend that you start that process by emailing the program contexts listed in the announcements a brief one to two page description of the project you're considering so you can follow up with discussion okay I think that moves us to our question and answers and we will be uh taking a look at what you all are entering in the question and answer function in Zoom not seeing anything right away but we'll give it a moment yep I don't see any um questions either uh so this is your opportunity to add it we have a little bit of time um okay seeing a hand raised but we're asking that you put your questions in the Q&A function in Zoom please do you all see where that is

### [25:00](https://www.youtube.com/watch?v=E0qrgTG1Gr0&t=1500s) Segment 6 (25:00 - 30:00)

is we can't answer my question if you can't see it so well um given that there's nothing popping up maybe we could take uh raised hands um and just uh let's see um maybe we can unmute um Dr repo F mind hi I I'm not a doctor but thank you so much I was just saying there's no way for us to post any questions it's all disabled we can't post in the chat hence there are no questions to be posted I'm so sorry about that um we see the Q&A on our side um and so I'm not sure why you're not um you guys aren't seeing that but I apologize uh given that then um if that's your only comment I'll move to Dr taxel if we can unmute him please thanks hi uh yeah yes that was my thing for us the chat is disabled the question answer is disabled so we are not able to type in anything and we cannot unmute ourselves so we cannot say anything okay do you have a question for us um yes I did um right in the beginning there was a slide which mentioned something about modular budgets it was I think the first or the second slide in the entire presentation uh that is in regards to the um pilot to the pilot Effectiveness ro1 yes yeah um and so what that means is that uh the um each year is capped by um do you remember Mary do you want to take that um but uh yeah and you don't have to write a detailed budget with a modular budget you just you do have to write a justification um but you basically ask for you know no more than 225 is that right Mary do you remember the number believe it's two I believe it's 250 a year 250 that's right okay I did have one more question and um I will sort of um unmute myself after that my uh last question is that is there any platform on the NIH website through which we can understand the assist process you know how to actually submit the applications because uh I understand they take a lot of time it takes about 5 6 weeks to uh complete the NIH form for any submission and uh there are a lot of details that are required so is there like an upcoming webinar or any resource material on how to fill in the application there are various resources on the NIH website about the submission process and uh that probably the best place for uh an introduction to the process also if you're with a university or a research center that has a research office or a business office they can be an excellent resource for helping you with the application information okay thank you um and I just want to say um Eric the Q&A is open now so you can ask you can add your question there um I'm going to go to uh Jen bogs uh who uh wanted examples of implementation strategy outcomes at the systems level for the r 6133 versus implementation strategies measured at the provider level for the ro1 so um the best way I think to think about the um system levels R 6133 is that many of the implementation strategies that are going combined to address access quality cost you know um of you know of care probably have already been tested as implementation spe specific implementation strategies so for example um provider training would be an example of you know like say a hybrid type 3 comparing two different types of training strategies to support um the delivery of evidence-based practice by providers would be that would go to the ro1 whereas a um systems level intervention would uh utilize a number of implementation strategies to get at better access to care better quality of care good examples of that are the collaborative care studies for depression uh as well as the special uh coordinated specialty care for psych early psychosis so these are usually packaged interventions that um uh address a number of factors that we know interact in a very specific way to um to impact the quality um accessibility fit for purpose of all of interventions that already found to be effective we already know what the mechanisms are for those specific person level interventions we're just trying to get those out into the field and we need to understand how

### [30:00](https://www.youtube.com/watch?v=E0qrgTG1Gr0&t=1800s) Segment 7 (30:00 - 35:00)

to address the system and service barriers for that um the next question is the r 6133 considered similar to the R1 budget type it is uncapped so very similar um except for you will have a budget for the r61 phase and then r33 phase okay um our technical Innovation projects using unconventional brain Imaging and AI something that would be considered by the program is it suitable to submit without any preliminary data you ask a very important question uh it's one that we're grappling with here um I think it really depends on what you mean by let's say AI or how AI is being utilized uh and the amount of data that's available to support its U the its um uh Effectiveness so for instance if you are looking at AI to support an evidence-based um treatment we see that as optimization of an intervention using um mathematic or engineering principles and that would come to us or might you know depending on how much of uh data there is so if you still need to you've got proof of concept right so you've got some plinary signal in your intervention um that uh that would go to the effective efficacy um uh P which we did not discuss here uh and so you'd need to test the efficacy first of that intervention before you put it into the um into a test of its Effectiveness which would be much more at a population or specific population level um kind of uh study um if you've got that e uh um efficacy data you know that um at least in a you know smaller kind of study you've got some enough data to kind of convince the FDA that this is something that is safe then you know um you could consider uh the effectiveness um P Joel do you want to add anything to that or Mary I think that's great I just think that the question also included uh unconventional brain Imaging if this is a procedure that's not been tested or demonstrated uh efficacious as Dr Arian said there are other announcements that are appropriate for initial treatment development and testing okay um okay and then um yes uh so from um Michelle Padley uh asking if the slides will be available after this after the webinar they will be and we will be putting them out there uh you know post letting you know um as soon as we can where those slides are posted okay um the next one is from Sarah Jackson um for clarification if someone hypothetically applied for the pilot hybrid would they still be eligible for the F full five-year follow-up um EGD effectiveness or would they need to complete the effectiveness component in only two years a total of five which would to or technically a total of eight so I think if I understand your question correctly if you apply for the R1 under for the pilot Effectiveness and you find some you you collect feasibility data it's very similar to the R34 it's just that the budgets increased uh and the requirement for the um hybrid trials is for both um ro1s for the pilot Effectiveness and for the um full test of Effectiveness so you could theoretically apply for um a 5year but you need to justify the um the timeline like you would in any um application okay uh and let's see um then there's one from an anonymous uh participant I'm submitting a grant do on January 30th um do I use the new forms ey or have as I've been currently working on the forms Joel um so I I'm not sure that the announcements we're talking about have January 30th um receipt dates um you might be talking about another uh funding opportunity announcement or notice of funding opportunity um I follow the guide instructions uh for that are attached to the mechanism you're using in the announcement for the announcements that we're talking about today they all have receipt dates after January 25th 2025 and they will use the forms ey if any of our colleagues in DEA want to elaborate we welcome additional input that is correct they all February dates so they will use the forms I which are being associated with the uh packages at this

### [35:00](https://www.youtube.com/watch?v=E0qrgTG1Gr0&t=2100s) Segment 8 (35:00 - 40:00)

time okay thank you thanks um the next question comes from Hannah Frank um do all of these funding announcements require a clear test of Target engagement as has been the case in past PS for the pilot Effectiveness um you know you would be uh proposing that there would be um targets that you would be measuring and you would have to demonstrate the feasibility of being able to do that and full scale Effectiveness study likewise because you were testing the effectiveness of an intervention you need to confirm that the targets for that intervention are retained because of the you know um the need to test that for novel populations um you know or uh adaptations that you may have made to the intervention uh you know that's still required there for the services interventions we're interested in the mechanisms um that you think that the service intervention is um using to address quality reach Etc um so your measures are going to be less ardakan you know or at the person level they're going to be more at the systems level okay um okay so for the full scale Effectiveness implementation trial announcement can you speak to the level of pilot data that is needed uh it would be similar to what you would do in any of the um ro1s uh you know in the past where you would need to demonstrate the feasibility of your um of your study design um preliminary proof of concept for the intervention uh nothing's different there okay um and then uh Eric lens uh writes for analytic strategy required by the r 6133 I assuming that the grant needs to provide a strategy to be tested in the r33 not the r61 phase correct um and would this be the case that the r61 phase may be used to refine this strategy yes so the main test of the um intervention effect is in the r33 the r61 is used to for things like partnership building making sure that you can actually extract electronic health record data uh making sure that uh you know the the ability to actually do the implementation strategies um or the the service package is um is feasible uh it's that timeline you need to work out those Kinks uh and including like you know Is it feasible to like if you still wanted to test like the effect of an inter I mean theoretically the interventions that you're testing already have gone through that Effectiveness test and um reconfirmation of the um Target mechanism but if you wanted to continue to measure other things like that you'd need to you could use the r61 phase to um uh determine the feasibility the burden Etc of that um for the r33 phase and um a second question from Eric is I'm wondering about the changes to peer review framework the framework can it be done should it be done makes a lot of sense what motivated NIH um level change and I think Karen might be better to answer that question thanks Pat I appreciate that um give me a second I'll let me get on um video it's a fair thing to do ah okay well my video won't come on so the change has been done um the impetus for that was to address uh review bias and looking at finding ways to reduce reviewer burden but also so bias and in the revieww process so you'll notice uh with the retooling of the section five um so the they're are no longer questions but statements but they're trying to find a better way to get at the information that's necessary without introducing um bias to the best of their ability so uh you I would say something that Joel had mentioned before making sure you look at each section um I would hone in on sections four and five explicitly uh when you're looking just to understand exactly what is necessary to answer the call for the particular funding announcement so do hone in on what is being asked of you and what the reviewers are going to be evaluating you on and that is really the impetus for the change in NIH is trying to really make sure that the science and the Merit of the science is being focused on as opposed to the individual

### [40:00](https://www.youtube.com/watch?v=E0qrgTG1Gr0&t=2400s) Segment 9 (40:00 - 42:00)

or the individual institution I hope that's helpful thank you Karen um let's see uh and then um oh and then Tamara um thank you Tamara for putting this in the chat in the Q&A regarding the submit submitting the application viist the NIH has a training site with a video showing how to submit the application via assist and Tamara has kindly put the link to that in um the Q&A uh which you can hopefully screenshot or maybe even um hover over uh to um put it into your uh browser uh history uh and then um uh and then I Eileen's also um put in the chat more details about uh the NIH government policy and compliance um for peer uh topics around peer review if you want to read more about the the process that um came about for uh changing the review criteria uh there's also a link there um I'm hovering over it and I it looks like you can click on it and put it in your browser history uh and then finally we have another um question why do we continue to focus on efficacy and population uh rather than on individuals not sure what the question is asking but my interpretation or my answer is that we do test um you know intervention efficacy um at the individual level uh and uh we test the effectiveness of those interventions at the population level uh and um the rationale for focusing on individuals is to determine what the safety effect Effectiveness um efficacy issues are for that um intervention at the population level we're interested in how to best reach um you know or what the differential effects are of treatment across populations as well as ways to make sure that people can get access to high quality Care all right so not seeing any other um questions uh any final thoughts from uh our crew well thank you very much for your time and um I and again I apologize for the last minute notification uh but glad to see um you know very good attendance here and we will be sending out a link soon with um with the slides and a recording of this uh webinar uh thank you very much and uh good luck with the rest of your day

---
*Источник: https://ekstraktznaniy.ru/video/33577*