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RESEARCH ON ALCOHOL AND SLEEP Release Date: April 25, 2000 RFA: AA-00-005 National Institute on Alcohol Abuse and Alcoholism Letter of Intent Receipt Date: August 14, 2000 Application Receipt Date: September 14, 2000 THIS REQUEST FOR APPLICATIONS (RFA) USES THE "MODULAR GRANT" AND "JUST-IN-TIME" CONCEPTS. IT INCLUDES DETAILED MODIFICATIONS TO STANDARD APPLICATION INSTRUCTIONS THAT MUST BE USED WHEN PREPARING APPLICATIONS IN RESPONSE TO THIS RFA. PURPOSE The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is seeking grant applications to conduct research on alcohol"s effects on sleep. It is well documented that acute and chronic alcohol consumption cause sleep disturbances. In those with alcoholism, sleep patterns may never return to normal, and continuing sleep problems may be a core factor in alcohol relapse. Despite the adverse effects of alcohol on sleep and the serious implications for alcoholism treatment, the topic of alcohol and sleep is currently an understudied area. The purpose of this Request for Applications (RFA) is to stimulate research on alcohol and sleep in areas that are of particular interest because of the potential contribution to our understanding of the etiology and treatment of alcoholism. These research areas include the neural mechanisms of alcohol- induced sleep disturbances, persistent poor sleep as a risk marker for development of alcoholism in adolescents and non-alcoholic young adults, sleep disorders as a predictor of relapse in abstinent alcoholics, and the health consequences of alcohol"s disruptive effects on sleep particularly the interaction with age, ethnicity, and gender. NIAAA strongly encourages collaboration between experts in sleep research and established alcohol researchers to facilitate the development of research proposals in the area of alcohol and sleep. HEALTHY PEOPLE 2010 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2010," a PHS-led national activity for setting priority areas. This Request for Applications (RFA), Research on Alcohol and Sleep, is related to one or more of the priority areas. Potential applicants may obtain a copy of "Healthy People 2010" at http://www.health.gov/healthypeople/. ELIGIBILITY REQUIREMENTS Applications may be submitted by domestic and foreign, for-profit and non-profit organizations, public and private, such as universities, colleges, hospitals, laboratories, units of State and local governments, and eligible agencies of the Federal Government. Racial/ethnic minority individuals, women, and persons with disabilities are encouraged to apply as Principal Investigators. MECHANISM OF SUPPORT This RFA will use the National Institutes of Health (NIH) Research Project Grant (R01) and the NIAAA Exploratory/Developmental Grant (R21) mechanisms. Responsibility for the planning, direction, and execution of the proposed project will be solely that of the applicant. The total project period for an application submitted in response to this RFA may not exceed 5 years for the R01 mechanism and 3 years for the R21 mechanism. Under the R21 mechanism, direct costs are limited to $100,000 per year (See Program Announcement PA-99-131, "NIAAA Exploratory/Developmental Grant Program," http://grants.nih.gov/grants/guide/pa-files/PA-99-131.html for a complete description of the R21 mechanism). This RFA is a one-time solicitation. Future unsolicited competing continuation applications will compete with all investigator-initiated applications and be reviewed according to the customary peer review procedures. The earliest anticipated award date is March 1, 2001. Applicants may also submit applications for Investigator-Initiated Interactive Research Project Grants (IRPG). Interactive Research Project Grants require the coordinated submission of related research project grants (R01) from investigators who wish to collaborate on research, but do not require extensive shared physical resources. These applications must share a common theme and describe the objectives and scientific importance of the interchange of, for example, ideas, data, and materials among the collaborating investigators. A minimum of two independent investigators with related research objectives may submit concurrent, collaborative, cross- referenced individual R01 applications. Applicants may be from one or several institutions. Further information on these and other grant mechanisms may be obtained from the program staff listed in the INQUIRIES section of this RFA or from the NIAAA Web site http://www.niaaa.nih.gov/ under Research Programs/Program Announcements. Applicants who want to request direct costs exceeding $500,000 in any one year must obtain written agreement from the NIAAA that the application will be accepted for consideration of award. Applicants who want to request a waiver for exceptional circumstances should contact the program staff listed in the INQUIRIES section of this RFA. FUNDS AVAILABLE The NIAAA intends to commit approximately $3 million in FY 2001 to fund eight to ten new and/or competitive continuation grants in response to this RFA. Because the nature and scope of the research proposed might vary, it is anticipated that the size of awards will also vary. Although the financial plans of the NIAAA provide support for this program, awards pursuant to this RFA are contingent upon the availability of funds and the receipt of a sufficient number of meritorious applications. RESEARCH OBJECTIVES Background In the 1960"s and 1970"s, research in the area of alcohol and sleep provided the basic foundations of our knowledge concerning the acute and chronic effects of alcohol on sleep (1-3). In later decades, it was found that alcohol"s disruptive effects on sleep can have serious health consequences including impaired breathing and associated cardiovascular abnormalities. Excessive daytime sleepiness caused by alcohol-induced sleep disturbances can result in memory deficits, impaired social and occupational function, and car crashes. However, research on alcohol and sleep has been modest over the past 20 years, despite the potential ramifications of impairments resulting from the effects of alcohol on sleep, and the fact that failure to normalize sleep following withdrawal from alcohol may be predictive of relapse. Therefore, it is important that an effort be made to renew interest in research on alcohol and sleep particularly in areas that have implications for the etiology and treatment of alcoholism. 1. Insomnia as a Pathway to Alcoholism In healthy subjects, acute alcohol in doses of .16 - 1.0 g/kg suppresses REM sleep and increases deep non-rapid eye movement sleep (nonREM). Initial latency to sleep is reduced, but paradoxically, wake time during the latter half of the sleep period is increased (2). The reduced time to fall asleep produced by alcohol may encourage continued use of alcohol at bedtime. Epidemiological studies have found that 28 percent of those who complain of insomnia reported using alcohol to help them sleep, and further, individuals who reported having two weeks or more of insomnia were more likely to have met diagnostic criteria for alcoholism at one year follow-up (4). A recent study found that insomniacs were more likely to self-administer ethanol before bedtime than non-insomniacs (5). Furthermore, a low dose of ethanol before bedtime made subtle improvements in the insomniacs" sleep and mood, suggesting that ethanol may be more reinforcing for insomniacs. Therefore, the degree to which ethanol use in insomniacs extends beyond the therapeutic context into daytime use is an important line of research. Tolerance development to low doses of alcohol in insomniacs is also a possibility, which could lead to increased doses, although this has not been investigated. Finally, for the elderly who use alcohol at bedtime to counteract insomnia, there is increased risk for falls during the night. Thus, whether insomnia precedes the development of alcohol abuse, and the clinical significance of the sequencing of these two disorders particularly with respect to age and gender are important research questions. 2. Sleep Disorders as a Pathway to Relapse Chronic actively drinking alcoholics take longer to fall asleep, have poor sleep efficiency, and show marked disorganization of sleep patterns with frequent awakenings, shortened REM periods, and reduced nonREM sleep. Sleep is severely disturbed during withdrawal, and the severe REM deprivation leads to "pressure" for REM sleep (1-3). Sleep in abstinent alcoholics is also characterized by delayed sleep onset, frequent awakenings, and reduced amounts of nonREM sleep. Thus, a major question is whether the sleep disturbances may predict relapse during withdrawal and long-term abstinence. Recent studies (6- 7) shed some light on this issue. Increased REM density at the time of admission to a 1-month inpatient alcohol treatment program predicted relapse in primary alcoholics with and without secondary depression by 3 months following hospital discharge. However, many questions remain regarding the nature of the sleep disruption following prolonged abstinence, whether sleep parameters as predictors of relapse change during different phases of the abstinent withdrawal syndrome, and what factors may mediate it such as diagnostic heterogeneity, age, gender, severity and other consequences of alcohol. Finally, the role of treatments for the withdrawal syndrome (e.g., the benzodiazepine receptor agonists) in possibly exacerbating the alcohol-induced sleep disturbance, or the ability of naltrexone and other therapeutic agents (e.g., SSRIs) in reducing sleep disturbances and relapse rates, remains to be explored. Further therapeutic trials using new treatments that target sleep or circadian dysfunction (e.g., L-tryptophan, bright light therapy) and that include subjective and objective sleep measurements, relapse rates, and psychiatric states are clearly needed. In addition to humans, animal models of alcohol relapse (8) are now available to study the relationship among effects of chronic alcohol on sleep, new drug treatments, and relapse outcomes. 3. Biological Mechanisms of Alcohol-Related Sleep Disturbances Neurotransmitters, Neuropeptides, Cytokines: Sleep disturbances have been described in alcoholic patients during active drinking and during different stages of recovery, however little is known about the underlying biological mechanisms. Research on the basic mechanisms of sleep has implicated circuits involving multiple neurotransmitters in the generation of sleep-wake states (9), and changes in these same neurotransmitters that modulate sleep could contribute to ethanol"s effects on the sleep-wake cycle. For example, serotonin has a prominent role in regulation of certain aspects of REM sleep and modulation of onset of nonREM sleep. Loading with 5-hydroxytryptophan (5-HTP), a serotonin precursor, decreased REM fragmentation and stabilized REM sleep in abstinent alcoholics, suggesting that serotonin dysfunction is involved in alcohol-induced sleep disorders (10). NMDA antagonists reduced REM sleep frequency in rats in a manner similar to ethanol (11), implicating glutamate as a selective modulator of sleep. Adenosine is another neurotransmitter affected by alcohol that is also an important modulator of sleep/wake control (12). However, there is no research to date connecting disrupted sleep with alcohol- adenosine interactions. Disturbances in the sleep of abstinent alcoholics could also have a neurohormonal basis. Reduction in slow wave sleep is one of the hallmarks of long-term alcohol administration. Growth hormone releasing factor (GHRF) increases slow wave sleep in several species, whereas corticotropin releasing factor (CRF) produces hyperarousal, reductions in slow wave sleep, insomnia, and delayed sleep onset (3). Hypothalamic-pituitary-adrenal (HPA) and hypothalamic- pituitary-somatotropic (HPS) systems are disrupted in acute alcohol intoxication and in abstinent alcoholics (3,13). However, few studies in humans or animals have examined whether sleep dysregulation in alcoholism and hormonal disturbances are causally related. Cytokines such as interleukin-1 (IL1) beta and tumor necrosis factor (TNF) alpha induce increases in duration of nonREM sleep (14). These same somnogenic growth factors are also involved in alcohol toxicity (15-16). However, the mechanistic relationship among cytokines, alcohol toxicity and sleep dysfunction is virtually unexplored. In sum, there have been very few animal or human studies that have attempted to link brain mechanisms important in the regulation of sleep and sleep pathologies associated with long-term effects of alcohol. The specific target neurochemical systems could include but are not limited to serotonin, acetylcholine, adenosine, specific neuropeptides such as GHRF, CRF, and neuropeptide Y, and cytokines such as IL-1, TNF. Alcohol-Induced Brain Structural Damage and Sleep: It is well known that chronic alcohol use produces structural brain changes particularly in frontal regions of the brain. Therefore, some investigators have hypothesized that chronic alcohol exposure disrupts sleep through its direct toxic effects on brain areas that regulate sleep (17-18). New imaging technologies such as MRI and SPECT combined with EEG measures of sleep could determine whether structural or functional changes in brain sleep circuits are responsible for sleep disturbances in chronic alcoholics. Alcohol and Circadian Rhythms: Circadian rhythms, generated by an internal clocklike mechanism and synchronized by external cues (e.g., light, food, temperature) and internal hormonal signals (e.g., melatonin), are important determinants of the ability to sleep. Furthermore, an individual"s acquisition, response, and continuation of alcohol use may be entrained to circadian rhythms, and in turn, alcohol may affect the underlying circadian mechanism itself. For example, alcohol"s sedative effects differ depending on whether the same dose is given in the morning or the evening (19), and night shiftworkers are more likely to consume alcohol and use alcohol as a sleep aid than day shift workers (20). Alcohol disrupts hormonal and behavioral circadian rhythms in humans and animals (21-23), and recently chronic alcohol exposure in rats was found to produce an irreversible depression of peptide immunoreactivity and mRNA levels in the suprachiasmatic nucleus, which is considered the biological clock in rodents (3). Thus, disturbed circadian processes could be a mechanism of sleep disruption in alcoholics. Sophisticated studies are needed to dissociate homeostatic (need for sleep) and circadian (temporally-related) processes to determine the mechanisms by which ethanol is having its major effects. Other important issues relate to ethanol"s potential as a chronobiotic, i.e., a substance that can alter circadian phase, and the effect of phase advances or delays on alcohol consumption. 4. Alcohol, Sleep Development, Adolescence, and Predispositional Factors Alcohol and Sleep Development: Although there is extensive literature on prenatal effects of alcohol on brain development, very little is known about alcohol"s effects on fetal and early neonatal (i.e., during breast feeding) sleep development, including the circadian clock systems. A recent study (24) found that infants tend to fall asleep sooner, but sleep for significantly shorter periods of time, immediately after consuming alcohol through mothers" milk. In addition, infants are more active during wakefulness after consuming alcohol through mothers" milk, although the mechanisms underlying the reduction in sleep remains to be elucidated. Investigators have demonstrated that perturbations of the serotonergic system early in development has long lasting effects on adult sleep behavior (25). Furthermore, the same cytokines that enhance sleep (e.g., IL-1, TNFalpha and TNFbeta) are present in developing brain, affect developmental events (26), and are implicated in alcohol toxicity. Thus, the relationship among fetal alcohol exposure, neurotransmitter function, cytokine production, and trajectories of sleep development is an important area of investigation. Adolescence, Sleep, and Alcoholism Risk: Developmental changes in sleep and sleep patterns occur during adolescence. There is a gradual decrease in the amount of REM sleep, and a significant drop-off in delta sleep around the time of adolescence. Other sleep changes during adolescence include greater daytime sleepiness, greater tendency to sleep in the morning, and a predisposition toward shifting to late-night schedules (27-28). Adolescent sleep patterns are influenced by intrinsic sleep/wake control mechanisms and circadian timing systems, although the exact biological mechanism for the phase delays is unknown. Extrinsic factors such as parental control, peers, homework, extracurricular activities and athletics, jobs and school starting times also play a role in the delayed sleep time of adolescents. A recent study found an association among later and more irregular sleep schedules, perceived daytime tiredness, and increased use of cigarettes and alcohol, particularly in boys (age 15)(29). However, the relationship of this association to biological or social factors is unknown. More importantly, increased alcohol use combined with sleep deprivation could have serious health consequences including impaired cognitive and motor performance, and increased risk for car crashes. We know that during adolescence, the brain continues to undergo development, particularly in the prefrontal cortex, an area thought to mediate higher cognitive functions. The prefrontal cortex has connections with the mesolimbic reward circuit, sleep circuits, and is a target of alcohol"s toxic effects. Thus, increased alcohol use associated with sleep deprivation may alter these developing systems, making an individual more susceptible to sleep disturbances, alcohol abuse or dependence, or both. Conversely, an inborn neurotransmitter abnormality that provokes a sleep disorder may trigger a cycle of increased alcohol intake that injures the developing brain system further. Recent evidence in nonhuman primates suggests that abnormal sleep patterns and serotonergic activity may be risk markers for alcoholism. That is, low 5-HIAA concentrations in infancy, which are predictive of excessive alcohol consumption during adolescence, are also associated with delayed sleep onset and increased daytime activity (30). However, more research is needed in humans and animals to determine whether sleep disturbances are a predictor of heavy drinking or alcoholism in adolescents at differing genetic risk, and/or whether susceptibility to the effects of alcohol on sleep may vary during adolescence. Alcohol, Sleep and Genetics: Recent advances in sequencing the mouse genome offer new opportunities for discovering genes that may be involved in complex behaviors such as alcoholism and sleep. One technique, random mutagenesis, could help determine whether sleep and alcoholism are genetically related. For example, using different strains of mice, animals can be "pre-screened" for abnormal alcohol preference and/or sleep architecture in offspring of mutagenized mice, yielding a "few" animals to be more intensely evaluated for abnormal alcohol preference and/or sleep architecture. Once genetic transmission of an abnormal phenotype is found, it is possible to use a variety of genetic and molecular techniques to determine the gene involved in regulation of the behavior under study, and to characterize the genetic alteration that led to the mutant phenotype. Such an approach could yield new insights into the genetic mechanisms that are involved in the regulation of sleep, alcohol consumption, and circadian rhythmicity as well as how these complex behaviors influence each other. 5. Health Consequences of Alcohol-Induced Sleep Disturbances Alcohol and Sleep-Disordered Breathing. Alcohol facilitates the occurrence of obstructive sleep apneas (OSA) during sleep by relaxing upper airway dilator muscles and depressing the central nervous system response to airway occlusion. As a result, alcohol use in the evening is associated with an of increased risk of OSA, increased severity of hypoxemia in individuals with OSA, increased risk of stroke, cardiovascular morbidity, and functional consequences of disrupted sleep such as motor vehicle crashes (31). Males, elderly, snorers, and individuals with OSA are at particularly high risk for this alcohol administration effect. Abstinent alcoholics have increased prevalence of obstructive sleep apnea, hypoxemia, and sleep-related breathing and movement disturbances. Of interest is that sleep disordered breathing is not seen in alcoholic women. Even though the association between alcohol and OSA is well documented, the occurrence of OSA in non-alcoholics and sober alcoholics is an important clinical problem. Many questions remain as to the daytime consequences of drinking and sleep apnea (including motor vehicle accidents, impaired psychomotor, cognitive performance) and medical consequences such as a stroke, hypertension, and myocardial infarction as they interact with gender and age. Also the reversibility of OSA following abstinence, or the development of OSA in non-alcoholic drinkers is also unknown. Research Areas of Interest This RFA is soliciting applications on alcohol and sleep in an effort to increase research in this understudied area. While previous clinical studies have provided basic information on alcohol-induced sleep disorders, they relied on small numbers of subjects and manual scoring of EEG sleep records. New methodologies using quantitative measures of EEG such as spectral analysis or period/amplitude analysis are now available and can be applied to analysis of sleep disturbances in alcohol dependence and potentially link that disturbance to underlying neural activity. Forced desynchrony techniques could be used to dissociate alcohol"s effects on circadian vs. homeostatic processes. Animal models of alcohol dependence and relapse are now available that could be used for controlled studies of alcohol-induced sleep disturbances, the underlying neural mechanisms of these disturbances, and their contribution to relapse. Longitudinal studies would be useful in studying the developmental trajectories of sleep disorders in adolescents and their relationship to onset of alcohol problems in adulthood, as well as the reversibility vs. persistence of sleep disorders and sleep-disordered breathing with abstinence. Areas needing further research include, but are not limited to: o Studies on the nature, degree, specificity, and duration of sleep disruption that occurs with alcohol withdrawal (e.g., are the changes sleep-stage specific?), and what factors influence it (e.g., is the degree and nature of REM rebound related to age, gender, ethnicity, alcohol dose or duration of drinking?). o Use of sleep deprivation techniques to characterize sleep disorders in alcoholic patients. o Studies on the nature of the relationship among sleep disturbance, the development of alcohol- use disorders and the likelihood of relapse after alcoholism treatment. o Studies, including clinical trials, on pharmacologic and nonpharmacologic treatments of insomnia in patients with alcohol abuse and alcoholism, and whether treatment of sleep disorders in alcoholics prevents relapse. o Use of standardized criteria for diagnosing insomnia in alcoholic individuals, and development of sleep-related rating scales for alcoholic individuals. o Studies on chronological sequencing of insomnia and alcoholism (primary insomnia/secondary alcoholism and vice versa) and how sequencing of these disorders relates to age, gender, demographic, clinical, familial, and biological factors. o Studies on biological and genetic mechanisms that may predispose to both sleep disturbance and alcoholism. o Studies on nature of sleep disturbances in adolescence, whether these sleep disturbances are the precursor or result of heavy drinking in adolescents, and determination of personality, emotional, and sleep characteristics of adolescents who may be at risk for later alcoholism. o Studies on whether disruption of circadian or homeostatic processes is the source of alcohol-induced sleep disturbances. o Studies of whether waking EEG phenotypes are reflected in the sleep EEG of alcoholics, and whether waking EEG may be predictive of sleep disturbance. o Studies of alcohol"s effects on basic mechanisms of sleep circuits including the role of neurotransmitters, neuropeptides, and cytokines in alcohol-induced sleep disturbances. o Studies on the daytime and medical consequences of drinking and sleep apnea, as well as parameters that increase risk of developing OSA. o The effects of fetal and early neonatal alcohol exposure on sleep development. INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of the NIH that women and members of minority groups and their subpopulations must be included in all NIH-supported biomedical and behavioral research projects involving human subjects, unless a clear and compelling rationale and justification is provided that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research. This policy results from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43). All investigators proposing research involving human subjects should read the "NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research," which was published in the Federal Register of March 28, 1994 (FR 59 14508-14513) and in the NIH Guide for Grants and Contracts, Vol. 23, No. 11, March 18, 1994, available on the Web at http://grants.nih.gov/grants/guide/notice-files/not94-100.html. INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of NIH that children (i.e., individuals under the age of 21) must be included in all human subjects" research, conducted or supported by the NIH, unless there are scientific and ethical reasons not to include them. This policy applies to all initial (Type 1) applications submitted for receipt dates after October 1, 1998. All investigators proposing research involving human subjects should read the "NIH Policy and Guidelines" on the Inclusion of Children as Participants in Research Involving Human Subjects that was published in the NIH Guide for Grants and Contracts, March 6, 1998, and is available at the following URL address: http://grants.nih.gov/grants/guide/notice-files/not98-024.html . Investigators also may obtain copies of these policies from the program staff listed under INQUIRIES. Program staff may also provide additional relevant information concerning the policy. URLS IN NIH GRANT APPLICATIONS OR APPENDICES All applications and proposals for NIH funding must be self-contained within specified page limitations. Unless otherwise specified in a NIH solicitation, internet addresses (URLs) should not be used to provide information necessary to the review because reviewers are under no obligation to view the Internet sites. Reviewers are cautioned that their anonymity may be compromised when they directly access an Internet site. LETTER OF INTENT Prospective applicants are asked to submit a letter of intent that includes a descriptive title of the proposed research, the name, address, and telephone number of the Principal Investigator, the identities of other key personnel and participating institutions, and the number and title of the RFA in response to which the application may be submitted. Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows Institute staff to estimate the potential review workload and avoid conflict of interest in the review. The letter of intent is to be sent to RFA-AA-00-005 Extramural Project Review Branch National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard, Suite 409, MSC 7003 Bethesda, MD 20892-7003 by the letter of intent receipt date listed in the heading of this RFA. APPLICATION PROCEDURES The research grant application form PHS 398 (rev. 4/98) is to be used in applying for these grants. These forms are available at most institutional offices of sponsored research and from the Division of Extramural Outreach and Information Resources, National Institutes of Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone 301/710-0267, email: GrantsInfo@nih.gov. SPECIFIC APPLICATION INSTRUCTIONS FOR MODULAR GRANTS The modular grant concept establishes specific modules in which direct costs may be requested, as well as a maximum level for requested budgets. Only limited budgetary information is required under this approach. The just-in-time concept allows applicants to submit certain information only when there is a possibility for an award. It is anticipated that these changes will reduce the administrative burden for the applicants, reviewers, and Institute staff. The research grant application form PHS 398 (rev. 4/98) is to be used in applying for these grants, with the modifications noted below. BUDGET INSTRUCTIONS Modular Grant applications will request direct costs in $25,000 modules, up to a total direct cost request of $250,000 per year. (Applications that request more than $250,000 direct costs in any year must follow the traditional PHS 398 application instructions.) The total direct costs must be requested in accordance with the program guidelines and the modifications made to the standard PHS 398 application instructions described below: PHS 398 FACE PAGE - Items 7a and 7b should be completed, indicating Direct Costs (in $25,000 increments up to a maximum of $250,000) and Total Costs [Modular Total Direct plus Facilities and Administrative (F&A) costs] for the initial budget period. Items 8a and 8b should be completed indicating the Direct and Total Costs for the entire proposed period of support. DETAILED BUDGET FOR THE INITIAL BUDGET PERIOD - Do not complete Form Page 4 of the PHS 398. It is not required and will not be accepted with the application. BUDGET FOR THE ENTIRE PROPOSED PERIOD OF SUPPORT - Do not complete the categorical budget table on Form Page 5 of the PHS 398. It is not required and will not be accepted with the application. NARRATIVE BUDGET JUSTIFICATION - Prepare a Modular Grant Budget Narrative page. (See http://grants.nih.gov/grants/funding/modular/modular.htm. for sample pages.) At the top of the page, enter the total Direct Costs requested for each year. This is not a Form page. Under Personnel, list key project personnel, including their names, percent of effort, and roles on the project. No individual salary information should be provided. However, the applicant should use the NIH appropriation language salary cap and the NIH policy for graduate student compensation in developing the budget request. For Consortium/Contractual costs, provide an estimate of total costs (Direct plus F&A) for each year, each rounded to the nearest $1,000. List the individuals/organizations with whom consortium or contractual arrangements have been made, the percent effort of key personnel, and the role on the project. Indicate whether the collaborating institution is foreign or domestic. The total cost for a consortium/contractual arrangement is included in the overall requested Modular Direct Cost amount. Include the letter of intent to establish a consortium. Provide an additional narrative budget justification for any variation in the number of modules requested. BIOGRAPHICAL SKETCH - The Biographical Sketch provides information used by reviewers in the assessment of each individual"s qualifications for a specific role in the proposed project, as well as to evaluate the overall qualifications of the research team. A biographical sketch is required for all key personnel, following the instructions below. No more than three pages may be used for each person. A sample biographical sketch may be viewed at: http://grants.nih.gov/grants/funding/modular/modular.htm. - Complete the educational block at the top of the Form page, - List position(s) and any honors, - Provide information, including overall goals and responsibilities, on research projects ongoing or completed during the last three years, and, - List selected peer-reviewed publications, with full citations. CHECKLIST - This page should be completed and submitted with the application. If the F&A rate agreement have been established, indicate the type of agreement and the date. All appropriate exclusions must be applied in the calculation of the F&A costs for the initial budget period and all future budget years. The applicant should provide the name and phone number of the individual to contact concerning fiscal and administrative issues if additional information is necessary following the initial review. The RFA label available in the PHS 398 (rev. 4/98) application form must be affixed to the bottom of the face page of the application. Failure to use this label could result in delayed processing of the application such that it may not reach the review committee in time for review. In addition, the RFA title and number must be typed on line 2 of the face page of the application form and the YES box must be marked. The sample RFA label available at: http://grants.nih.gov/grants/funding/phs398/label-bk.pdf has been modified to allow for this change. Please note this is in pdf format. Submit a signed, typewritten original of the application, including the Checklist, and three signed, photocopies in one package to: CENTER FOR SCIENTIFIC REVIEW NATIONAL INSTITUTES OF HEALTH 6701 ROCKLEDGE DRIVE, ROOM 1040, MSC 7710 BETHESDA, MD 20892-7710 BETHESDA, MD 20817 (for express/courier service) At the time of submission, two additional copies of the application must be sent to: RFA :AA-00-005 Extramural Project Review Branch National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard, Suite 409, MSC 7003 Bethesda, MD 20892-7003 Rockville, MD 20852 (for express/courier service) Applications must be received by the application receipt date listed in the heading of this RFA. If an application is received after that date, it will be returned to the applicant without review. The Center for Scientific Review (CSR) will not accept any application in response to this RFA that is essentially the same as one currently pending initial review, unless the applicant withdraws the pending application. The CSR will not accept any application that is essentially the same as one already reviewed. This does not preclude the submission of substantial revisions of applications already reviewed, but such applications must include an introduction addressing the previous critique. REVIEW CONSIDERATIONS Upon receipt, applications will be reviewed for completeness by the CSR and responsiveness by the NIAAA. Incomplete applications will be returned to the applicant without further consideration. If the application is not responsive to the RFA, CSR staff may contact the applicant to determine whether to return the application to the applicant or submit it for review in competition with unsolicited applications at the next review cycle. Applications that are complete and responsive to the RFA will be evaluated for scientific and technical merit by an appropriate peer review group convened by the NIAAA in accordance with the review criteria stated below. As part of the initial merit review, all applications will receive a written critique and undergo a process in which only those applications deemed to have the highest scientific merit, generally the top half of the applications under review, will be discussed, assigned a priority score, and receive a second level review by the NIAAA National Advisory Council. Review Criteria The goals of NIH-supported research are to advance our understanding of biological systems, improve the control of disease, and enhance health. In the written comments reviewers will be asked to discuss the following aspects of the application in order to judge the likelihood that the proposed research will have a substantial impact on the pursuit of these goals. Each of these criteria will be addressed and considered in assigning the overall score, weighting them as appropriate for each application. Note that the application does not need to be strong in all categories to be judged likely to have major scientific impact and thus deserve a high priority score. For example, an investigator may propose to carry out important work that by its nature is not innovative but is essential to move a field forward. (1) Significance: Does this study address an important problem? If the aims of the application are achieved, how will scientific knowledge be advanced? What will be the effect of these studies on the concepts or methods that drive this field? (2) Approach: Are the conceptual framework, design, methods, and analyses adequately developed, well-integrated, and appropriate to the aims of the project? Does the applicant acknowledge potential problem areas and consider alternative tactics? (For the R21 mechanism, a strong rationale and conceptual framework are normally sufficient for establishing the feasibility of the project, in lieu of extensive preliminary data.) (3) Innovation: Does the project employ novel concepts, approaches, or methods? Are the aims original and innovative? Does the project challenge existing paradigms or develop new methodologies or technologies? (4) Investigator: Is the investigator appropriately trained and well-suited to carry out this work? Is the work proposed appropriate to the experience level of the principal investigator and other researchers, if any? (5) Environment: Does the scientific environment in which the work will be done contribute to the probability of success? Do the proposed experiments take advantage of unique features of the scientific environment or employ useful collaborative arrangements? Is there evidence of institutional support? In addition to the above criteria, in accordance with NIH policy, all applications will also be reviewed with respect to the following: o The adequacy of plans to include both genders, minorities and their subgroups, and children as appropriate for the scientific goals of the research. Plans for the recruitment and retention of subjects will also be evaluated. o The reasonableness of the proposed budget and duration in relation to the proposed research. o The adequacy of the proposed protection for humans, animals, or the environment, to the extent they may be adversely affected by the project proposed in the application. Additional consideration pertinent to the review of Exploratory/Developmental Grant (R21) applications: o Pilot/feasibility studies may contain little or no preliminary data. Review should focus on whether the rationale for the study is well developed and whether the proposed research is likely to generate data that will lead to a regular research project grant or full-scale clinical trial. Adequate justification for the proposed work may be provided through literature citations, data from other sources, or investigator-generated data. Schedule Letter of Intent Receipt Date: August 14, 2000 Application Receipt Date: September 14, 2000 Peer Review Date: Fall 2000 Council Review: February 8, 2001 Earliest Anticipated Start Date: March 1, 2001 AWARD CRITERIA Award criteria that will be used to make award decisions include: o scientific merit (as determined by peer review) o availability of funds o programmatic priorities INQUIRIES Inquiries concerning this RFA are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues on neuroscience and basic research to: Ellen D. Witt, Ph.D. Division of Basic Research National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard, Suite 402, MSC 7003 Bethesda, MD 20892-7003 Telephone: (301) 443-6545 FAX: (301) 594-0673 Email: ewitt@willco.niaaa.nih.gov Direct inquiries regarding programmatic issues on clinical/treatment research to: Joanne Fertig, Ph.D. Division of Clinical and Prevention Research National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard, Suite 505, MSC 7003 Bethesda, MD 20892-7003 Telephone: (301) 443-0635 Fax: (301) 443-8774 Email: jfertig@willco.niaaa.nih.gov Direct inquiries regarding fiscal matters to: Linda Hilley Office of Planning and Resource Management National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard, Suite 504, MSC 7003 Bethesda, MD 20892-7003 Telephone: (301) 443-4703 FAX: (301) 443-3891 Email: lhilley@willco.niaaa.nih.gov AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.273. Awards are made under authorization of the Public Health Service Act, Title IV, Part A (Public Law 78-410, as amended by Public Law 99-158, 42 USC 241 and 285) and administered under NIH grants policies and Federal Regulations 42 CFR 52 and 45 CFR Part 74. This program is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. The PHS strongly encourages all grant recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of a facility) in which regular or routine education, library, day care, health care, or early childhood development services are provided to children. This is consistent with the PHS mission to protect and advance the physical and mental health of the American people. References 1. Vitiello, M.V. (1997) Sleep, alcohol and alcohol abuse. Addiction Biology, 2:151-158. 2. Aldrich, M.S. (1998) Effects of alcohol on sleep. In Gomberg, E.S.L., Hegedus, A.M., Zucker, R.A. (Eds) National Institute on Alcohol Abuse and Alcoholism Research Monograph No. 33, Alcohol Problems and Aging, NIH Pub. No. 98-4163, Bethesda, MD, pp. 281-300. 3. Ehlers, C. L. (in press) Alcohol and Sleep. In Noronha, A. (Ed). NIAAA Research Monograph No. 34: Review of NIAAA"s Neuroscience and Behavioral Research Portfolio, NIH Publication No. 00-4520, Bethesda, MD. 4. Ford, D.E., Kamerow, D. B. (1989) Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA, 262:1479-1484. 5. Roehrs, T., Papineau, K., Rosenthal, L., Roth, T. (1999) Ethanol as a hypnotic in insomniacs: self administration and effects on sleep and mood. Neuropsychopharmacology, 20:279-286. 6. Gillin, J.C., Smith, T.L., Irwin, M., Butters, N., Demodena, A., Schuckit, M. (1994) Increased pressure for rapid eye movement sleep at time of hospital admission predicts relapse in nondepressed patients with primary alcoholism at 3-month follow-up. Archives of General Psychiatry, 51:189-197. 7. Clark, P.C., Gillin, J.C., Golshan, S., Demodena, A., Smith, T.L., Danowski, S., Irwin, M., Schuckit, M. (1999) Polysomnography and depressive symptoms in primary alcoholics with and without a lifetime diagnosis of secondary depression and in patients with primary depression. Journal of Affective Disorders, 52:177-185. 8. Heyser, C.J., Schulteis, G., Koob, G.F. (1997) Increased ethanol self- administration after a period of imposed ethanol deprivation in rats trained in a limited access paradigm. Alcoholism: Clinical and Experimental Research, 21:784-791. 9. Jones, B. (1994) Basic mechanisms of sleep-wake states. In Kryger, M.H., Roth, T., Dement, W.C. (Eds) Principles and Practice of Sleep Medicine, Philadelphia: W.B. Saunders Company, pp. 145-162. 10. Zarcone, V.P., Hoddes, E. (1975) Effects of 5-hydroxytryptophan on fragmentation of REM sleep in alcoholics. American Journal of Psychiatry, 132:74-76. 11. Prospero-Garcia, O., Criado, J.R., Henriksen, S.J. (1994) Pharmacology of ethanol and glutamate antagonists on rodent sleep: a comparative study. Pharmacology, Biochemistry, and Behavior, 49:413-416. 12. Bennington, J.H., Heller, H.C. (1995) Restoration of brain energy metabolism as the function of sleep. Progress in Neurobiology, 45:347-360. 13. Wand, G. (in press) HPA axis: changes and risk for alcoholism. In Noronha, A. (Ed). NIAAA Research Monograph No. 34: Review of NIAAA"s Neuroscience and Behavioral Research Portfolio, NIH Publication No. 00-4520, Bethesda, MD. 14. Krueger, J.M., Obal, F., Fang, J. (1999) Humoral regulation of physiological sleep: cytokines and GHRH. Journal of Sleep Research, 8, 53-59. 15. Deaciuc, I.V. (1997) Alcohol and cytokine networks. Alcohol, 14:421-430. 16. Zakhari, S., Ghosh, S., Szabo, G., Medford, R., Diehl, A. (1996) NF-kappaB, prototypical cytokine-regulated transcription factor: implications for alcohol - mediated responses. Alcoholism: Clinical an Experimental Research, Supplement, 20:236A-242A. 17. Benson, K., Cohen, M., Zarcone, V. (1978) REM sleep time and digit span impairment in alcoholics. Journal of Studies on Alcohol, 39:1488-1498. 18. Ishibashi, M., Nakazawa, Y., Yokoyama, T., Koga, Y, Miyahara, Y., Hayashida, N., Katsuaki, O. (1987) Cerebral atrophy and slow wave sleep of abstinent alcoholics. Drug and Alcohol Dependence, 19:325-332. 19. Roth, T., Roehrs, T., Merlotti, L. (1989) Ethanol and daytime sleepiness. Alcohol, Drugs, and Driving, 5/6:357-362. 20. Richardson, G.S., Miner,J.D., Czeisler, C.A. (1989) Impaired driving performance in shiftworkers: the role of the circadian system in a multifactorial model. Alcohol, Drugs, and Driving, 5/6:265-273. 21. Baird, T.J., Briscoe, R.J., Vallett, M., Vanecek, S.A., Holloway, F.A., Gauvin, D.V. (1998) Phase-response curve for ethanol: alterations in circadian rhythms of temperature and activity in rats. Pharmacology, Biochemistry and Behavior, 61:303-315. 22. Rajakrishnan, V., Subramanian, P., Viswanathan, P., Menon, V.P. (1999) Effect of chronic ethanol ingestion on biochemical circadian rhythms in Wistar rats. Alcohol, 18:147-152. 23. Mukai, M., Uchimura, N., Hirano, T., Ohshima, H., Ohshima, M., Nakamura, J. (1998) Circadian rhythms of hormone concentrations in alcohol withdrawal. Psychiatry and Clinical Neurosciences, 52:238-240. 24. Mennella, J.A., Gerrish, C.J. (1998) Effects of exposure to alcohol in mother"s milk on infant sleep. Pediatrics, 101:915. 25. Frank, M.G., Heller, H.C. (1997) Neonatal treatments with the serotonin uptake inhibitors clomipramine and zimelidine, but not the noradrenaline uptake inhibitor desipramine, disrupt sleep patterns in adult rats. Brain Research, 768:287-293. 26. Merrill, J.E., Jonakait, G.M. (1995) Interactions of the nervous system and immune systems in development, normal brain homeostasis, and disease. FASEB Journal, 9:611-618. 27. Carskadon, M.A., Vieira, C., Acebo, C. (1993) Association between puberty and delayed phase preference. Sleep, 16:258-262. 28. Dahl, R. E. (1998) The development and disorders of sleep. Advances in Pediatrics, 45:73-90. 29. Tynjala, J., Kannas, L., Levalahti, E. (1997) Perceived tiredness among adolescents and its association with sleep habits and use of psychoactive substances. Journal of Sleep Research, 6:189-198. 30. Zajicek, K., Higley, J.D., Suomi, S., Linnoila, M. (1997) Rhesus macaques with high CSF 5-HIAA concentrations exhibit early sleep onset. Psychiatry Research, 73:15-25. 31. Aldrich, M.S., Brower, K.J., Hall, J.M. (1999) Sleep-disordered Breathing in Alcoholics. Alcoholism: Clinical and Experimental Research, 21:134-140.
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