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EXPIRED

NONINVASIVE MEASUREMENT OF IRON BY MAGNETIC RESONANCE IMAGING

RELEASE DATE:  October 22, 2002

RFA:  DK-03-007  

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
 (http://www.niddk.nih.gov)
National Institute of Biomedical Imaging and Bioengineering (NIBIB)
 (http://www.nibib.nih.gov)

LETTER OF INTENT RECEIPT DATE: January 20, 2003

APPLICATION RECEIPT DATE: February 19, 2003

THIS RFA CONTAINS THE FOLLOWING INFORMATION

o Purpose of this RFA
o Research Objectives
o Mechanism(s) of Support 
o Funds Available
o Eligible Institutions
o Individuals Eligible to Become Principal Investigators
o Special Requirements
o Where to Send Inquiries
o Letter of Intent
o Submitting an Application
o Peer Review Process
o Review Criteria
o Receipt and Review Schedule
o Award Criteria
o Required Federal Citations

PURPOSE OF THIS RFA

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 
and the National Institute of Biomedical Imaging and Bioengineering (NIBIB) 
invite Research Grant Applications (R01 or R21) for projects that have the 
potential to improve the utility of magnetic resonance imaging as a method 
for quantitative determinations of tissue iron, especially in liver, heart 
and brain. A quantitative means of measuring body storage iron that would be 
non-invasive, safe, accurate and readily available, would improve the 
diagnosis and management of patients with iron overload, including hereditary 
hemochromatosis, thalassemia major, sickle cell disease, aplastic anemia, 
myelodysplasia and other disorders.  Magnetic resonance imaging potentially 
provides a useful and widely available technique for examining the three-
dimensional distribution of excess iron in the body, but further research is 
needed to develop a way to make measurements quantitative.

Small businesses are encouraged to respond to a parallel RFA DK-03-009 
(see http://grants.nih.gov/grants/guide/rfa-files/RFA-DK-03-009.html) of 
identical scientific scope that uses the SBIR and STTR mechanisms.

RESEARCH OBJECTIVES

Background

The body iron burden is a principal determinant of clinical outcome in all 
forms of systemic iron overload, whether from transfusion (for thalassemia 
major, sickle cell disease, aplastic, myelodysplastic, or other refractory 
anemias), from increased dietary iron absorption (hereditary hemochromatosis 
and other forms of primary iron overload), or both (refractory anemia with 
increased ineffective erythropoiesis).  Accurate assessment of the body iron 
is essential for managing iron-chelating therapy in transfused patients to 
prevent iron toxicity while avoiding the adverse effects of excess chelator 
administration.  In hereditary hemochromatosis, determination of the 
magnitude of body iron stores permits identification of individuals who would 
benefit from phlebotomy therapy from among those at genetic risk for the 
disease.  

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 
organized an international workshop on the non-invasive measurement of iron 
on April 17, 2001, to assess the current state of the science and to identify 
areas needing further investigation.  The workshop participants concluded 
that additional work was needed to develop better quantitative means of 
measuring body storage iron that would be non-invasive, safe, accurate and 
readily available to improve the diagnosis and management of patients with 
iron overload.  Currently, biomagnetic susceptometry (SQUID) provides the 
only non-invasive method for measurement of tissue iron stores that has been 
calibrated, validated and used in clinical studies.  However, the complexity, 
cost and technical demands of the liquid-helium-cooled superconducting 
instruments required at present have restricted clinical access to the 
method.  Magnetic resonance imaging was identified as an existing, widely 
available technology that, with further research, potentially could answer 
that need. Among conclusions reached, the workshop participants recommended 
further investigation of magnetic resonance imaging as a method for 
quantitative determinations of tissue iron, especially in liver, heart and 
brain.  Detailed information on the workshop is available at the NIDDK 
website: http://www.niddk.nih.gov/fund/other/iron/index.html

Subsequently, an article summarizing the workshop and its recommendations has 
been published (Brittenham GM and Badman DG, Noninvasive Measurement of Iron: 
Report of an NIDDK Workshop, Blood First Edition Paper, prepublished online 
August 29, 2002; DOI 10.1182/blood-2002-06-1723; 
http://www.bloodjournal.org/cgi/reprint/2002-06-1723v1.pdf)

Under physiologic conditions, the concentration of iron in the human body is 
carefully regulated and normally maintained at about 40 mg Fe/kg body weight 
in women and about 50 mg Fe/kg in men, distributed between functional, 
transport and storage compartments. Iron overload arises from a sustained 
increase in iron supply over iron requirements and develops with conditions 
in which the regulation of intestinal iron absorption is altered (hereditary 
hemochromatosis, refractory anemia with ineffective erythropoiesis), bypassed 
(transfusional iron overload), or both.  Regardless of the cause, progressive 
iron accumulation eventually overwhelms the body's capacity for safe 
sequestration of the excess, resulting in a variety of pathologies.  The 
prognosis in patients with iron overload is influenced by many factors 
(Harmatz P, et. al. Severity of iron overload in patients with sickle cell 
disease receiving chronic red blood cell transfusion therapy. Blood. 2000; 
96:76-79). While ferritin and hemosiderin iron almost surely are not the 
species directly responsible for the adverse effects of iron, the overall 
magnitude of storage iron accumulation seems to be a principal determinant of 
clinical outcome in all forms of systemic iron overload.  

The reference method for evaluating the extent of body iron excess in 
systemic iron overload is measurement of the hepatic storage iron 
concentration (Brittenham GM, et. al., Noninvasive methods for quantitative 
assessment of transfusional iron overload in sickle cell disease, Semin 
Hematol. 2001;38:37-56).  Total body iron stores can be measured by 
quantitative phlebotomy, but this approach cannot be used in transfusion-
dependent patients with iron overload and is generally acceptable only if the 
procedure provides therapeutic benefit.  The measurement of plasma ferritin 
provides an indirect estimate of body iron stores, but the usefulness of this 
measure is limited by the many common clinical conditions in which the plasma 
ferritin is not a reliable indicator of body iron.  While liver biopsy with 
chemical analysis of tissue iron content provides the most quantitative 
direct measure of iron status generally available, the discomfort and risk of 
the procedure limits its acceptability to patients and precludes its frequent 
use in serial observations.

Magnetic Resonance Imagining (MRI) uses the magnetic properties of the body 
to provide detailed three-dimensional images of any structure or tissue. With 
MRI, tissue iron is detected indirectly by the effects on relaxation times of 
ferritin and hemosiderin iron interacting with nearby hydrogen nuclei.  The 
interactions are complex, involving factors such as tissue hydration, the 
water diffusion coefficient within the tissue, the distribution of iron and 
water within the tissue examined, the number of iron atoms per molecule of 
ferritin and hemosiderin (called the loading factor) and, because ferritin 
iron and hemosiderin iron have different effects on both T1 and T2 (Vymazal 
J, Urgosik D, Bulte JW. Differentiation between hemosiderin- and ferritin-
bound brain iron using nuclear magnetic resonance and magnetic resonance 
imaging. Cell Mol Biol (Noisy-le-grand). 2000;46:835-842), the relative 
proportion of these two iron storage materials.  

Conventional MRI measurements are affected by the instrument used, the 
applied field strength, the repetition time used in the imaging sequence, the 
method used to analyze the relaxation curves, and other technical aspects of 
the measurement procedure.  Comparison of absolute signal intensities from 
one MRI unit to another is unreliable because of substantial intermachine 
variation (Bonkovsky HL, et. al., Hepatic iron concentration: noninvasive 
estimation by means of MR imaging techniques. Radiology. 1999;212:227-234).  
In the absence of a theoretical understanding of the effects of iron on MRI, 
empirical efforts to estimate hepatic iron concentrations have used a variety 
of instruments, magnetic field strengths, imaging sequences (spin-echo, 
gradient recalled-echo), and parameters (T1 and T2 relaxation times, and 
signal intensity ratios as measured in proton, T1-, T2- or T2*-weighted 
images) but no standard or generally accepted method has been adopted for 
clinical application.  To date, MRI has been more useful as a screening 
technique for the detection of marked iron overload than as a means for 
quantitative measurement.  In particular, with increasing iron 
concentrations, the signal intensity of the liver is reduced to such an 
extent that discrimination between different concentrations becomes 
impossible (Angelucci E, et. al., Limitations of magnetic resonance imaging 
in measurement of hepatic iron. Blood. 1997;90:4736-4742), at least with 
current technology.

Additional recent publications on both theoretical and practical efforts to 
develop non-invasive methods for measurement of tissue iron are presented in 
the article by Brittenham and Badman, referenced above.

Research Goals and Topics

At present, MRI provides a means of probing the three-dimensional 
distribution of excess iron in the body, but further efforts are needed to 
make measurements quantitative.  The following are examples of basic and 
clinical research that could be addressed in the application of MRI to the 
measurement of tissue iron:

o improve understanding of the contribution of ferritin and hemosiderin iron 
to magnetic resonance effects to guide development of optimal methods for 
measuring relaxation times and susceptibility,
o improve techniques for data acquisition, choice of field strength, 
selection of timing parameters, reduction of noise, identification of region 
of interest and selection of analytic methods;
o devise phantoms and/or other means for calibrating and validating iron 
concentration detected by magnetic resonance imaging that could enhance 
standardization between different laboratories;
o develop new methods for non-invasive measurements of iron deposition in the 
heart, in endocrine tissue, and in specific areas of the brain to determine 
the role of abnormalities of brain iron in the pathogenesis of 
neurodegenerative disorders, including Alzheimer's disease, amyotrophic 
lateral sclerosis, prion diseases, mitochondrial disorders and Parkinson's 
disease.
o determine whether a dual field approach, used by some for MRI measurement 
of brain iron with promise of greater accuracy than conventional single-field 
images, can be applied to assessment of liver iron.
o investigate the most appropriate magnetic resonance method for determining 
relaxation times and susceptibility.
o determine which data acquisition method is best with selected timing 
parameters.
o develop improved methods of selecting a region-of-interest.
o examine the mechanistic contribution of iron in iron-containing materials 
(e.g. ferritin and hemosiderin) to magnetic resonance relaxation, to be able 
to select the optimum measurement field strength and methods.
	 
These topics are suggestions for further research, only, and investigators 
are encouraged to develop and propose other lines of investigation relevant 
to the purposes of the RFA.

MECHANISM(S) OF SUPPORT

This RFA uses the National Institutes of Health (NIH) research project grant 
(R01) award mechanism. Pilot studies, using the R21 mechanism, will be 
considered, if limited in scope and duration. The total requested project 
period for an R01 application submitted in response to this RFA may not 
exceed four years for full-scale R01 projects, and two years for R21 pilot 
studies.  As an applicant, you will be solely responsible for planning, 
directing, and executing the proposed project. Future unsolicited competing 
continuation applications based on this project will compete with all 
investigator-initiated applications and will be reviewed according to the 
customary peer review procedures.  The anticipated award date is September 
30, 2003.

This RFA uses just-in-time concepts.  It also uses the modular as well as the 
non-modular budgeting formats. 
(See http://grants.nih.gov/grants/funding/modular/modular.htm).  
Specifically, if you are submitting an application with direct costs in each 
year of $250,000 or less, use the modular format. 

FUNDS AVAILABLE

The NIDDK intends to commit approximately $1,000,000 in FY 2003, and the 
NIBIB intends to commit approximately $250,000, to fund 4 to 7 new grants 
submitted in response to this RFA. An applicant may request a project period 
of up to four years and a budget for direct costs of up to $250,000 per year. 
Because the nature and scope of the proposed research will vary from 
application to application, it is anticipated that the size and duration of 
each award will also vary. Although the financial plans of the NIDDK 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. At this time, it is not known whether this RFA will be 
reissued.

ELIGIBLE INSTITUTIONS
 
You may submit (an) application(s) if your institution has any of the 
following characteristics:
	
o For-profit or non-profit organizations 
o Public or private institutions, such as universities, colleges, hospitals, 
and laboratories 
o Units of State and local governments
o Eligible agencies of the Federal government  
o Domestic or foreign

INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS   

Any individual with the skills, knowledge, and resources necessary to carry 
out the proposed research is invited to work with their institution to 
develop an application for support.  Individuals from underrepresented racial 
and ethnic groups as well as individuals with disabilities are always 
encouraged to apply for NIH programs.   

Among the types of expertise potentially useful in this research may be 
investigators active in the development of non-invasive measures of iron, 
scientists and engineers interested in improving MRI technology, clinicians 
who care for patients with iron disorders, and experts in the physics and 
chemistry of iron and in iron metabolism. Projects proposing collaborations 
among such individuals are particularly encouraged.

SPECIAL REQUIREMENTS
 
In order to be responsive to this RFA, applications must focus on studies 
that could lead to improved quantitative MRI measurements of body iron in 
target organs (brain, heart, liver, endocrine organs) of iron overloaded 
individuals.  Applications addressing alternative technologies will not be 
eligible for consideration and will be returned to the applicant.
 
Upon initiation of the program, the NIDDK and NIBIB will sponsor annual 
meetings to encourage the exchange of information among investigators who 
participate in this program, perhaps in conjunction with other related 
Institute-sponsored programs.  In the preparation of the budget for the grant 
application, applicants should include travel funds for the one meeting each 
year to be held in Bethesda, Maryland.  Applicants should also include a 
statement in the applications indicating their willingness to participate in 
such meetings.

WHERE TO SEND INQUIRIES

We encourage inquiries concerning this RFA and welcome the opportunity to 
answer questions from potential applicants.  Inquiries may fall into three 
areas:  scientific/research, peer review, and financial or grants management 
issues:

o Direct your questions about scientific/research issues to:

David G. Badman, Ph.D.
Hematology Program Director
National Institute of Diabetes and Digestive and Kidney Diseases
6707 Democracy Blvd., Room 621 MSC 5458
Bethesda, MD  20892-5458
Telephone:  (301) 594-7717
FAX:  (301) 480-3510
Email:  db70f@nih.gov

John W. Haller, Ph.D.
Health Scientist Administrator
National Institute of Biomedical Imaging and
Biomedical Engineering
National Institutes of Health
6707 Democracy Blvd., Suite 920
Bethesda, MD 20892-2077
Telephone:  (301) 451-4780
FAX:  (301) 480-4973
Email: hallerj@mail.nih.gov

o Direct your questions about peer review issues to:

Francisco O. Calvo, Ph.D.
Chief, Review Branch 
Division of Extramural Activities
National Institute of Diabetes and Digestive and Kidney Diseases
6707 Democracy Boulevard, Rm.752, MSC 5452
Bethesda, MD 20892-5452
(for express/courier service: Bethesda, MD 20817)
Telephone:  (301) 594-8897
FAX:  (301) 480-3505
Email: fc15y@nih.gov

o Direct your questions about financial or grants management matters to:

Ms. Aretina Perry-Jones
Grants Management Specialist
Division of Extramural Activities
National Institute of Diabetes and Digestive and Kidney Diseases
6707 Democracy Blvd., Room 745 MSC 5456
Bethesda, MD  20892-5456
Telephone:  (301) 594-8862
FAX:  (301) 480-3504
Email:  ap19s@nih.gov

Pamela L. Mayer 
Grants Management Analyst 
National Institute of Biomedical Imaging and Biomedical Engineering
2 Democracy Plaza, Suite 900
Telephone: 301-451-4791 
FAX: 301-480-4974 
Email: mayerp@mail.nih.gov

LETTER OF INTENT
 
Prospective applicants are asked to submit a letter of intent that includes 
the following information:

o Descriptive title of the proposed research
o Name, address, and telephone number of the Principal Investigator
o Names of other key personnel 
o Participating institutions
o Number and title of this RFA 

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 IC staff to estimate the potential review workload and plan 
the review.
 
The letter of intent is to be sent by the date listed at the beginning of 
this document.  The letter of intent should be sent to:

Francisco O. Calvo, Ph.D.
Chief, Review Branch 
Division of Extramural Activities
National Institute of Diabetes and Digestive and Kidney Diseases
6707 Democracy Boulevard, Rm.752, MSC 5452
Bethesda, MD 20892-5452
(for express/courier service: Bethesda, MD 20817)
Telephone:  (301) 594-8897
FAX:  (301) 480-3505
Email: fc15y@nih.gov

SUBMITTING AN APPLICATION

Applications must be prepared using the PHS 398 research grant application 
instructions and forms (rev. 5/2001).  The PHS 398 is available at 
http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive 
format.  For further assistance contact GrantsInfo, Telephone (301) 710-0267, 
Email: GrantsInfo@nih.gov.

ADDITIONAL R21 APPLICATION PROCEDURES

All application instructions outlined in the PHS 398 application kit are to 
be followed, with the following requirements for R21 applications:  

1.  R21 applications will use the "MODULAR GRANT" and "JUST-IN-TIME" 
concepts, with direct costs requested in $25,000 modules, up to the total 
direct costs limit of $250,000 per year. 

2. Although preliminary data are not required for an R21 application, they 
may be included.

3.  Sections a-d of the Research Plan of the R21 application may not exceed 
15 pages, including tables and figures.  

4.  R21 appendix materials should be limited, as is consistent with the 
exploratory nature of the R21 mechanism, and should not be used to circumvent 
the page limit for the research plan.   Copies of appendix material will only 
be provided to the primary reviewers of the application and  will not be 
reproduced for wider distribution.  The following materials may be included 
in the appendix:

o Up to five publications, including manuscripts (submitted or accepted 
for publication), abstracts, patents, or other printed materials 
directly relevant to the project.  These may be stapled as sets.
o Surveys, questionnaires, data collection instruments, and clinical 
protocols.  These may be stapled as sets.
o Original glossy photographs or color images of gels, micrographs, etc., 
provided that a photocopy (may be reduced in size) is also included 
within the 15 page limit of items a-d of the research plan

SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS: Applications requesting 
up to $250,000 per year in direct costs must be submitted in a modular grant 
format.  The modular grant format simplifies the preparation of the budget in 
these applications by limiting the level of budgetary detail.  Applicants 
request direct costs in $25,000 modules.  Section C of the research grant 
application instructions for the PHS 398 (rev. 5/2001) at 
http://grants.nih.gov/grants/funding/phs398/phs398.html includes step-by-step 
guidance for preparing modular grants.  Additional information on modular 
grants is available at 
http://grants.nih.gov/grants/funding/modular/modular.htm.

USING THE RFA LABEL: The RFA label available in the PHS 398 (rev. 5/2001) 
application form must be affixed to the bottom of the face page of the 
application.  Type the RFA number on the label.  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 RFA label is also available at: 
http://grants.nih.gov/grants/funding/phs398/label-bk.pdf.
 
SENDING AN APPLICATION TO THE NIH: 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 (2) additional copies of the application and 
five (5) sets of appendices must be sent to:

Francisco Calvo, Ph.D.
Chief, Review Branch 
Division of Extramural Activities
National Institute of Diabetes and Digestive and Kidney Diseases
6707 Democracy Boulevard, Rm.752, MSC 5452
Bethesda, MD 20892-5452
(for express/courier service: Bethesda, MD 20817)
Telephone:  (301) 594-8897
FAX:  (301) 480-3505
Email: fc15y@nih.gov

APPLICATION PROCESSING: 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.

PEER REVIEW PROCESS  

Upon receipt, applications will be reviewed for completeness by the CSR and 
responsiveness by the NIDDK.  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 appropriate NIH 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 (IC) in accordance with the review criteria stated below.  As 
part of the initial merit review, all applications will:

o Receive a written critique
o 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 and assigned a priority score
o Receive a second level review by the National Diabetes and Digestive and 
Kidney Diseases Advisory Council and the National Advisory Council for 
Biomedical Imaging and Bioengineering.
 
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 your application in order to judge the likelihood that the 
proposed research will have a substantial impact on the pursuit of these 
goals: 

o Significance 
o Approach 
o Innovation
o Investigator
o Environment
  
The scientific review group will address and consider each of these criteria 
in assigning your application's overall score, weighting them as appropriate 
for each application.  Your 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, you 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 your study address an important problem? If the aims 
of your application are achieved, how do they advance scientific knowledge?  
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?  Do you acknowledge potential problem areas and consider alternative 
tactics?

(3) INNOVATION:  Does your project employ novel concepts, approaches or 
methods? Are the aims original and innovative?  Does your project challenge 
existing paradigms or develop new methodologies or technologies?

(4) INVESTIGATOR: Are you appropriately trained and well suited to carry out 
this work?  Is the work proposed appropriate to your experience level as the 
principal investigator and to that of other researchers (if any)?

(5) ENVIRONMENT:  Does the scientific environment in which your 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?

ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your 
application will also be reviewed with respect to the following:

o PROTECTIONS:  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.

o INCLUSION:  The adequacy of plans to include subjects from both genders, 
all racial and ethnic groups (and subgroups), and children as appropriate for 
the scientific goals of the research.  Plans for the recruitment and 
retention of subjects will also be evaluated. (See Inclusion Criteria 
included in the section on Federal Citations, below)

o BUDGET:  The reasonableness of the proposed budget and the requested period 
of support in relation to the proposed research.

RECEIPT AND REVIEW SCHEDULE

Letter of Intent Receipt Date:      January 20,2003
Application Receipt Date:           February 19, 2003
Peer Review Date:                   June/July 2003
Council Review:                     September 2003
Earliest Anticipated Start Date:    September 30, 2003

AWARD CRITERIA

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.

REQUIRED FEDERAL CITATIONS 

MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD: Research components 
involving Phase I and II clinical trials must include provisions for 
assessment of patient eligibility and status, rigorous data management, 
quality assurance, and auditing procedures.  In addition, it is NIH policy 
that all clinical trials require data and safety monitoring, with the method 
and degree of monitoring being commensurate with the risks (NIH Policy for 
Data Safety and Monitoring, NIH Guide for Grants and Contracts, June 12, 
1998: http://grants.nih.gov/grants/guide/notice-files/not98-084.html).  

INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: It is the policy of 
the NIH that women and members of minority groups and their sub-populations 
must be included in all NIH-supported clinical research projects unless a 
clear and compelling justification is provided indicating 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 clinical research should read the AMENDMENT "NIH 
Guidelines for Inclusion of Women and Minorities as Subjects in Clinical 
Research - Amended, October, 2001," published in the NIH Guide for Grants and 
Contracts on October 9, 2001 
(http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html); a complete 
copy of the updated Guidelines are available at 
http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm    
The amended policy incorporates: the use of an NIH definition of clinical 
research; updated racial and ethnic categories in compliance with the new OMB 
standards; clarification of language governing NIH-defined Phase III clinical 
trials consistent with the new PHS Form 398; and updated roles and 
responsibilities of NIH staff and the extramural community.  The policy 
continues to require for all NIH-defined Phase III clinical trials that: a) 
all applications or proposals and/or protocols must provide a description of 
plans to conduct analyses, as appropriate, to address differences by 
sex/gender and/or racial/ethnic groups, including subgroups if applicable; 
and b) investigators must report annual accrual and progress in conducting 
analyses, as appropriate, by sex/gender and/or racial/ethnic group 
differences.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS:  
The NIH maintains a policy 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 is available at 
http://grants.nih.gov/grants/funding/children/children.htm. 

REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS: NIH 
policy requires education on the protection of human subject participants for 
all investigators submitting NIH proposals for research involving human 
subjects.  You will find this policy announcement in the NIH Guide for Grants 
and Contracts Announcement, dated June 5, 2000, at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: The 
Office of Management and Budget (OMB) Circular A-110 has been revised to 
provide public access to research data through the Freedom of Information Act 
(FOIA) under some circumstances.  Data that are (1) first produced in a 
project that is supported in whole or in part with Federal funds and (2) 
cited publicly and officially by a Federal agency in support of an action 
that has the force and effect of law (i.e., a regulation) may be accessed 
through FOIA.  It is important for applicants to understand the basic scope 
of this amendment.  NIH has provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.

Applicants may wish to place data collected under this RFA in a public 
archive, which can provide protections for the data and manage the 
distribution for an indefinite period of time.  If so, the application should 
include a description of the archiving plan in the study design and include 
information about this in the budget justification section of the 
application. In addition, applicants should think about how to structure 
informed consent statements and other human subjects procedures given the 
potential for wider use of data collected under this award.

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 an 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.   Furthermore, 
we caution reviewers that their anonymity may be compromised when they 
directly access an Internet site.

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 
RFA 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.

AUTHORITY AND REGULATIONS: This program is described in the Catalog of 
Federal Domestic Assistance Nos. 93.849 and 93.286 and is not subject to the 
intergovernmental review requirements of Executive Order 12372 or Health 
Systems Agency review.  Awards are made under authorization of Sections 301 
and 405 of the Public Health Service Act as amended (42 USC 241 and 284)(or 
other authorizations) and administered under NIH grants policies described at 
http://grants.nih.gov/grants/policy/policy.htm (cite other relevant policies) 
and under Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92 (cite 
other relevant regulations). 

The PHS strongly encourages all grant recipients to provide a smoke-free 
workplace and discourage the 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.



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