Highlights

• The translational research paradigm has had a dynamic history.
• We propose further evolution of the paradigm to recognize the complex iterative/recursive nature of the translational research process, the feedback loops and intersections that can occur between various steps in the process, as well as the nonlinear progression from fundamental discovery science to population health impact in real-world settings.
• Current evidence shows that the biomedical research enterprise has been highly successful in early translational research while much less success can be demonstrated for late phase translational research, especially T4 translation research.
• The stakes for T4 translation research and implementation science are very high because complete execution of all steps in the translational research spectrum is required for maximum population health impact.
• The welcome news is that there is an ongoing trans-NIH effort that is contributing to a growing symphony of activity within dissemination and implementation research.