Full Text DE-92-04 CLINICAL CORE CENTERS FOR PREVENTIVE AND OPERATIVE DENTISTRY NIH GUIDE, Volume 21, Number 29, August 14, 1992 RFA: DE-92-04 P.T. 04 Keywords: Dentistry Oral Diseases Disease Prevention+ National Institute of Dental Research Letter of Intent Receipt Date: October 31, 1992 Application Receipt Date: December 3, 1992 PURPOSE The National Institute of Dental Research (NIDR) invites applications for the support of Clinical Core Centers for Preventive and Operative Dentistry (CCCPOD). The Centers are intended to serve as focal points for strengthening the Nation's oral health clinical research capability, enhancing clinical decision-making, and facilitating the development of new approaches for dental caries diagnosis, prevention, and treatment in the light of recent knowledge of caries etiology and pathogenesis. The research will focus on early identification of patients at risk for dental caries through identification of microbiological and biochemical markers and on the full range of treatments, from non-operative interventions such as the use of antibacterial and remineralization procedures, to minimal intervention such as preventive resin restorations, to different types of large restorations needed for the treatment of carious lesions. The research also will include the study of failed restorations due to recurrent caries or for any other reasons. The overall intent of this RFA is to attract clinical researchers and clinicians with experience in dental materials science, molecular biology, biochemistry, pulp biology, clinical preventive and operative dentistry as well as those involved in the prevention, diagnosis, and treatment of dental caries. These researchers will conduct multi-disciplinary research on early diagnosis and early treatment of caries, making the distinction between caries as a disease and caries as a lesion. Particular emphasis is placed on the assessment of the presence and severity of infection and prompt treatment prior to evidence of clinical symptoms. The research also should focus on the development of optimal cavity preparations for different types of restorative materials. The principle of cavity preparations must be based on the premise of maintaining tooth structure to prevent the need for large restorations and more complex sequelae. The research should include development and testing of maintenance and health promotion programs and studies on why restorations fail. HEALTHY PEOPLE 2000 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2000," a PHS-led national activity for setting priority areas, and to "Oral Health 2000," a major collaborative initiative between the PHS and professional and private research organizations to improving oral health in the adult and elderly population groups in the U.S.A. This RFA, Clinical Core Centers For Preventive and Operative Dentistry, is related to the priority area of reducing health disparities among Americans by improving oral health. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No. 017-001-00474-0 or Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (telephone 202-783-3238). ELIGIBILITY REQUIREMENTS This competition is open to domestic 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. Foreign organizations are not eligible to apply, but domestic applications may include international components. Although an application must be submitted from a single institution, it may include consortia arrangements with other institutions provided these arrangements are clearly delineated and formally and officially confirmed by signed statements from the responsible official(s) of each institution. Applicant institutions must provide clear evidence of having a suitable clinical research base to ensure appropriate utilization of the added resources that the NIDR would provide through the CCCPOD. This must include meritorious ongoing clinical research projects and/or the capability to develop such clinical research, accompanied by firm funding commitments that ensure that appropriate clinical research projects will be active at the time of a CCCPOD award. MECHANISM OF SUPPORT The CCCPODs will be supported by the National Institutes of Health (NIH) Center Core Grants (P30). Clinical Core Center applications funded under this RFA will be supported for a period of five years, commencing as early as September 1, 1993. This RFA is a one time solicitation. Subsequent support will be contingent upon program needs and availability of funds. In addition to support for pilot or feasibility projects, support will be provided for core resources, the sharing of which will facilitate the total research effort. Each core unit must be utilized by at least two projects. Responsibility for the planning, direction, and execution of the proposed project will be solely that of the applicant. FUNDS AVAILABLE Applicants may request up to $300,000 in direct costs for the first year. If indirect costs are assigned to a subcontract and counted as direct costs, the direct cost maximum of $300,000 may be exceeded by the amount of the indirect costs assigned to the subcontract. Budget increases of no more than four percent per year may be requested for each of the subsequent four years. The NIDR expects to commit up to $0.9 million to fund applications submitted in response to this RFA. It is anticipated that one or two awards will be made, however, this funding level is contingent upon the receipt of a sufficient number of applications of high scientific merit. Although this program is provided for in the financial plans of the NIDR, the award of grants pursuant to this RFA is also contingent upon the availability of funds for this purpose. RESEARCH OBJECTIVES Background Historically, operative dentistry has been the primary nucleus of dental practice. It includes everything from prevention of caries and remineralization of initial carious attacks to complex restorative treatment. More than a century of clinical experience has provided traditions for treatment that are deep-rooted in the dental profession. However, these contemporary times demand reconsideration of established views and conventional clinical procedures. Increased longevity has presented the clinician with an aging population with dental care needs different from those of the younger population, which has benefited from early research that confirmed that fluoride prevents caries. Quite different types of dental care will be required in the next few decades for those who have had the benefit of caries prevention programs and those who had most of their teeth filled prior to the preventive era. The NIDRs surveys of children showed dramatic improvement in the oral health of children today. Half the children between five and seventeen years of age have no cavities in their permanent teeth. The treatment needs of children, therefore, will particularly focus upon maintenance of non-restored or minimally restored teeth. Use and effectiveness of sealants, preventive resin restorations, and remineralizing agents must be assessed. And it must not be taken for granted that the great improvement in the oral health of the children of today is a lifelong improvement. Long-term follow-up studies are essential to ascertain a continued positive benefit. In contrast, the 1985-1986 NIDR national survey of working adults and older adults attending senior centers showed substantial deficiencies in adults' oral health, with seniors having the worst overall oral health status; over forty percent are missing all their teeth. The adult generations, with many and large restorations, will require maintenance of their restorations in the coming decades. A focus on longevity of restorations and operative techniques with minimum removal of tooth tissues in the replacement and repair of failed restorations will be important. Furthermore, there is a need for the development of saliva, pellicle, and plaque analysis tests that will establish the presence of infection and the subsequent risk of patients for primary and secondary carious lesions. This will aid in the early diagnosis of both the infection and lesions. Treatment approaches for "active" versus "inactive" carious lesions should be investigated. The NIDR surveys also identified groups of individuals who are at high risk for developing caries, including patients with systemic diseases, individuals who receive orofacial radiation therapy for cancer or who take certain medications, members of minority groups, rural residents, and those who are economically disadvantaged. This knowledge presents a challenge to preventive and operative dentistry to identify individuals at risk, to reduce risk where possible, to utilize the best available means of early detection to minimize progression, and to prevent disease. These and other epidemiological studies coupled with scientific knowledge gained through the broadened scope of dental research have advanced our understanding that caries is a multifactorial disease. Although bacteria on the teeth are the immediate cause of dental caries, a large number of microbiological, environmental, and host factors interact to determine whether or not an individual will be affected, and the nature and extent of the disease if affected. These factors include bacterial flora, fluoride exposure, level of sucrose consumption, nutritional status, underlying systemic disease, salivary proteins, oral hygiene, and others. This multifactorial nature of caries presents a variety of opportunities for prevention. The technological revolution that has occurred in the biomedical sciences with the explosion of cellular and molecular biology and the advent of the tools of biotechnology holds the promise of more biologically-oriented technologies for early detection and prevention of tooth decay. Inclusion of these topics would open up applications in entirely new areas of vaccine development and microbiology beyond diagnostic applications. Diagnostic probes based on microbial genetics and improved saliva substitutes developed using genetic engineering are but a few examples of what is on the horizon of the new preventive operative dentistry. Much research is needed to bring these possibilities into the reality of clinical practice. Materials science, too, has made significant advances, and new materials are continually being introduced to clinicians. Many of these new materials are based on principles and concepts different from those of traditional restorative dental materials. For example, instead of materials that require mechanical retention, we now have materials that attach to microscopic components of the tooth structure that have been revealed by acid etching and materials that are chemically bonded to dental tissues. Public demand has fueled the search for tooth-colored restorative materials to provide a more esthetic alternative to alloys. And public awareness of the importance of biocompatibility testing, examining the interaction of restorative materials within the environment of the mouth, has increased efforts to assess the safety of materials that may remain in the mouth for an individual's lifespan. But the search for new and improved dental restorative materials and techniques must continue. The principle of cavity preparations must be based on "tooth saving techniques" rather than "extension for prevention," i.e., the treatment of caries must maintain tooth structure to prevent the need for large restorations and endodontics sequelae. Research is needed to determine the clinical significance of leakage; assess the relationship of restorative materials and techniques to post-operative pain, pulp pathology, and potential cusp fracture or tooth loss; and develop improved and standardized methods for evaluation of restoration quality that are correlated with clinical data on caries and caries progression. Comparisons of in-vitro data with in-vivo data for assessment of restoration performance should discriminate between statistical significance and clinical relevance. Center Goals The CCCPODs are intended to serve as focal points for strengthening the nation's oral health clinical research capability and facilitating the development of new approaches to the prevention and treatment of caries and failed restorations. Center goals will include: (1) developing state-of-the-art clinical research capacity through supporting shared resources and facilities (core units) that strengthen and expand relevant clinical research; (2) providing a nucleus around which additional clinical studies funded through government or private sources can be conducted; and (3) facilitating and stimulating clinical research to improve oral health in children, adults, senior citizens, and other people at high risk for caries. These high-risk individuals include persons with systemic diseases or oral conditions that increase the risk for recurrent disease, segments of the population that have not shared in the gains in oral health seen in much of the U.S. population. Some examples of research areas to be addressed might include, but should not be limited to, studies: o Identifying high-risk patients before overt infection and clinical disease occurs. o Improving clinical diagnosis of carious lesions. o Establishing criteria for clinical decision-making, for both non-invasive and invasive methods for treating the infection throughout its clinical course. o Developing databases for clinical decision-making. o Identifying which stages in the infection can be handled by preventive measures and which stages require concurrent operative intervention. o Conserving tooth structure through non-invasive or minimally invasive intervention. o Developing criteria for when and how to replace existing restorations. o Assessing treatment patterns in preventive and operative dentistry. o Developing methods to increase the longevity of dental restorations. o Establishing optimal cavity preparations for different restorative materials. o Testing methods for assessing oral health and disease status, including reproducible clinical diagnoses, and developing interventions to prevent and treat caries in medically compromised patients. o Investigating the use of ultrasonics to estimate remaining dentin thickness between cavity walls and underlying pulp. o Investigating the use of fiber optic/microscopic techniques for diagnosis and treatment of dental hard tissues. o Investigating the use of dentinal fluid to assess the health of the underlying pulp. o Investigating the use of new technologies such as laser doppler flow meters to measure pulpal blood flow to evaluate pulpal health of traumatized teeth. o Developing techniques for sealing dentin, enamel, and cementum in a manner that prevents their demineralization. Other examples of potential CCCPOD-supported activities and collaborations include: o Enhancing opportunities for translating new scientific knowledge into improved methods for preventing primary and secondary caries infections and clinical sequelae and failure of restorations. o Encouraging effective interdisciplinary collaboration among researchers and clinicians with expertise relevant to this initiative, especially interaction among disciplines of dental materials science, molecular biology, biochemistry, cariology, pulp biology, and clinical operative dentistry. o Developing and providing core research resources to expand and strengthen ongoing funded clinical research projects by, for example: - Expanding biostatistical participation in implementing projects. - Developing improved computer facilities for direct data entry. - Developing and providing laboratory services or facilities to enhance ongoing research. - Fostering the training of clinical research scientists by providing improved opportunities for collaboration and expanded environments for clinical research. o Developing research opportunities utilizing health care outreach activities in rural areas, dental clinics, minority communities, nursing home settings, senior centers, work sites, or other settings where individuals at high risk of oral disease can be reached for participation in separately funded clinical research projects. Core resources may not be used to support the cost of delivering health care services, but may be used to develop and utilize opportunities for implementing relevant clinical studies. Center Characteristics Strong and effective scientific leadership must be provided. The application should specify provisions that will be made for replacement of the director with a suitably qualified alternative should circumstances require. CCCPOD directors will be responsible for the organization and operation of the program and for communication with the CCCPOD Advisory Panel and with the NIDR on scientific and administrative matters. Directors will be responsible for maintaining high-quality research efforts and for ensuring effective collaboration among CCCPOD scientists. It is essential that the various elements of the CCCPOD be interrelated and that their utilization facilitates an enhanced quality and quantity of clinical oral health research. Each CCCPOD must be a clearly defined organizational entity within a dental school or dental research institution with a director responsible for management of the Center. Funding is intended to support core research resources and facilities that will accelerate the scientific productivity of, or enrich the potential clinical "pay-offs" from, clinical research projects pertinent to improving oral health in children, adults, and high-risk populations. The Center must include a minimum of three core units. One unit must be an administrative core. A biostatistics core unit is also mandatory. The biostatistics component may be incorporated into the administrative core. Other core resources proposed must directly relate to ongoing and planned oral health clinical research relevant to adults and high-risk groups. Examples of core units include: o Diagnostics Core: May provide and develop methods and/or instrumentation to detect early signs or markers of oral disease or dysfunction and to monitor the efficacy of treatments. Particular attention should be devoted to defining criteria to ascertain appropriate timing of replacement of restorations and the calibration of clinicians in diagnoses related to operative dentistry. o Laboratory Core: May provide resources to carry out adjunct studies on clinical trial patients or general population samples. Laboratory cores could, for example, include: biomaterials sciences, pulp biology, behavioral/social sciences, pharmacology, microbiology, immunology, nutrition, or molecular biology. The composition of the laboratory core(s) should reflect the resource needs and added research opportunities arising from ongoing clinical research activities. o Unique Clinical Facilities Core: May provide resources to facilitate research that cannot be carried out in conventional health-care settings, such as the use of mobile units for clinical studies involving elderly or physically disabled individuals or work-site based dental operatories for preventive interventions with employed adults. Collaboration with general dental practice is essential. Priority must focus on "real life dentistry" rather than operative dentistry performed by specially trained dentists who work without time constraints in a dental school environment on selected patients. o Administrative Core: Funds for the Center Director and administrative staff will be provided. This core unit should ensure that CCCPOD participants are provided with shared support services that enhance their research. The Director will be responsible for monitoring the overall quality and the scope of activities. The administrative core may provide limited funds to facilitate improved accrual of patient populations for pilot studies and for subsequent studies supported through collateral funding. Complementary funding from sources other than NIDR should be obtained for costs associated with information transfer and outreach programs. The core will convene an advisory panel of experts from outside the applicant institution at least once a year to review Center activities. The Center Director will be expected to utilize panel recommendations in guiding and strengthening CCCPOD activities. Pilot and feasibility studies also will be administered through the administrative core and will remain under the purview of the CCCPOD Director. o Biostatistics, Experimental Design, Data Management and Analysis Core: This core may provide the staff and other resources needed to enhance programs of clinical research through the application of epidemiology, sampling, biostatistics, and related support methodologies. Specifically, it should foster and strengthen biostatistician-clinical investigator interaction in the design and conduct of clinical research. The above examples are not intended to describe the full range of possible activities nor to direct applicants to these areas. Inclusion of core units of all these types in a single proposed center is not required nor even necessarily advisable. In structuring CCCPOD applications, applicants should consider their institution's areas of special clinical research potential, its profile of currently funded clinical research projects, and determine which areas present the greatest need for shared resources. Cores may provide support for personnel, including the necessary expertise to direct cores, equipment, supplies, services, facilities, and limited travel. In addition, they may provide funds for the integration of activities with other research centers in the same or related biomedical or behavioral/social science areas for purposes of program enrichment. This award also will provide up to 20 percent of total Center costs for pilot and feasibility studies. These are the only research studies that will be directly supported by this mechanism. Each pilot or feasibility study should not extend for a period of more than two years. The goals are to provide start-up funds for new projects, to train young investigators under the direction of clinical scientists and to encourage established investigators to utilize recent research developments. Detailed procedures for the review and selection of feasibility/pilot studies should be included in the application. It is anticipated that following the completion of the pilot or feasibility studies, investigators will apply for independent support to extend preliminary findings. The CCCPOD will not provide direct funding for ongoing research projects. These must be funded through other sources or support mechanisms. Policies governing research grant programs of the NIH will prevail. APPLICANTS FROM INSTITUTIONS THAT HAVE A GENERAL CLINICAL RESEARCH CENTER (GCRC) FUNDED BY THE NIH NATIONAL CENTER FOR RESEARCH RESOURCES MAY WISH TO IDENTIFY THE GCRC AS A RESOURCE FOR CONDUCTING THE PROPOSED RESEARCH. IN SUCH A CASE, A LETTER OF AGREEMENT FROM EITHER THE GCRC PROGRAM DIRECTOR OR PRINCIPAL INVESTIGATOR COULD BE INCLUDED WITH THE APPLICATION. STUDY POPULATIONS SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF NIH POLICIES CONCERNING INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH STUDY POPULATIONS The NIH policy, as applied to this RFA, is that applicants for NIH clinical research grants will be required to include minorities and women in study populations so that research findings can be of benefit to all persons at risk of the disease, disorder or condition under study; special emphasis should be placed on the need for inclusion of minorities and women in studies of diseases, disorders and conditions which disproportionately affect them. This policy is intended to apply to males and females of all ages. If women or minorities are excluded or inadequately represented in clinical research, particularly in proposed population-based studies, a clear compelling rationale should be provided. The composition of the proposed study population must be described in terms of gender and racial/ethnic group. In addition, gender and racial/ethnic issues should be addressed in developing a research design and sample size appropriate for the scientific objectives of the study. This information should be included in the form PHS 398 (rev. 9/91) in items 1-4 of the Research Plan and summarized in item 5, Human Subjects. Applicants are urged to assess carefully the feasibility of including the broadest possible representation of minority groups. However, the NIH recognizes that it may not be feasible or appropriate in all research projects to include representation of the full array of United States racial/ethnic minority populations (i.e., Native Americans (including American Indians or Alaskan Natives), Asian/Pacific Islanders, Blacks, Hispanics). The rationale for studies on single minority population groups should be provided. For the purpose of this policy, clinical research includes human biomedical and behavioral studies of etiology, epidemiology, prevention (and preventive strategies), diagnosis, or treatment of diseases, disorders or conditions, including but not limited to clinical trials. The usual NIH policies concerning research on human subjects also apply. Basic research or clinical studies in which human tissues cannot be identified or linked to individuals are excluded. However, every effort should be made to include human tissues from women and racial/ethnic minorities when it is important to apply the results of the study broadly, and this should be addressed by the applicants. If the required information is not contained within the application, the application will be returned. Peer reviewers will address specifically whether the research plan in the application conforms to these policies. If the representation of women or minorities in a study design is inadequate to answer the scientific question(s) addressed and the justification for the selected study population is inadequate, it will be considered a scientific weakness or deficiency in the study design and will be reflected in assigning the priority score to the application. For foreign awards, the policy on inclusion of women applies fully; since the definition of minority differs in other countries, the applicant must discuss the relevance of research involving foreign population groups to the United States' populations, including minorities. All applications for clinical research submitted to the NIH are required to address these policies. NIH funding components will not award grants or cooperative agreements that do not comply with these policies. LETTER OF INTENT Prospective applicants are asked to submit, by October 31, 1992, a letter of intent that includes a descriptive title of the proposed research, the name, address, and telephone of the Principal Investigator (PI), the identities of other key personnel and participating institutions, and the 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 is helpful in planning for the timely review of applications. It allows NIDR staff to estimate the potential review workload and to avoid possible conflict of interest in review. The letter of intent is to be addressed to: Joyce A. Reese, D.D.S, M.P.H. Director, Biomaterials, Pulp Biology and Dental Implants Program Extramural Program National Institute of Dental Research Westwood Building, Room 505 Bethesda, MD 20892-4500 Telephone: (301) 496-7884 FAX: (301) 496-4180 APPLICATION PROCEDURES Applications are to be prepared on form PHS 398 (rev. 9/91), Application for PHS Grant, which may be obtained from the Office of Grants Inquiries, Division of Research Grants National Institutes of Health, 5333 Westbard Ave, Room 449, Bethesda, Maryland 20892, telephone 301-496-7441, and from most institution's Office of Research and Sponsored Programs. The RFA label available in the PHS 398 application form must be affixed to the bottom of the face page of the original 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, in order to identify the application as a response to this RFA, check "yes" on item 2a on the face page of the application and enter the RFA title "Clinical Core Centers for Preventive and Operative Dentistry" and the RFA number DE-92-04. The instructions accompanying form PHS 398 are to be followed as much as possible, but some modifications will be necessary. For example, a new Table of Contents must be prepared giving page numbers for all items in the application. Pagination must be consecutive throughout the application. Each project, including pilot or feasibility projects and core units, must be identified by number and PI. A consolidated budget for the complete CCCPOD for the entire project period must be presented (use page 5, form PHS 398). Separate, detailed, annual and total budgets for the entire project period for each project and core must be presented (use pages 4-5, PHS 398). In addition, a summary table should be included providing budget totals for each pilot project and core unit, as well as the entire program, for all years of support. Direct and indirect costs are to be given. Funds may be requested for professional, technical, and administrative personnel, consultant services, equipment, supplies, travel, patient costs directly related to the research, minor renovations, and other costs. Detailed justification of budget requests will be required. In both planning and presenting the total project and each core or pilot/feasibility project, specific attention should be given to efforts to contain costs and ensure cost-competitive implementation of research goals. In accordance, provide a summary of financial support from NIDR and non-NIDR sources for studies that will complement and expand the program supported by the CCCPOD grant. Explain how these will further the goals of the CCCPOD and make it more cost effective. Awardees will be expected to update this information on an annual basis. Under Research Plan, describe the goals of the center and explain how the proposed core resources and pilot/feasibility studies will contribute toward achieving those goals. Describe the administrative structure, the responsibilities of the center director, individual investigators, advisory groups, and the proposed mechanisms for monitoring scientific progress. Each core unit must be presented as in a research project grant application, that is, the instruction pages 19-24 of form PHS 398 should be followed. The 25 page limitation will apply to each core unit and pilot/feasibility study. Abstracts (page 2, form PHS 398) must be completed for the entire application and for each core unit, and each pilot or feasibility study proposed for initiation during the first two years of the award. Submit a signed, typewritten original of the application, including the Checklist, and three signed exact photocopies, in one package to: Division of Research Grants National Institutes of Health Westwood Building, Room 240 Bethesda, MD 20892-4500** At the time of submission, two additional copies of the application must also be sent to: H. George Hausch, Ph.D. Chief, Scientific Review Office Extramural Program National Institute of Dental Research Westwood Building, Room 519 Bethesda, MD 20892-4500 Telephone: (301) 496-7658 Applications must be received by December 3, 1992. If an application is received after that date, it will be returned to the applicant without review. REVIEW CONSIDERATIONS Applications will be evaluated by a special review committee, convened by the NIDR Scientific Review Branch. Prior to the initial review, a triage mechanism may be used to screen applications that are noncompetitive to the RFA. The PI and the institution will be notified if this occurs. "Applicant interviews or site visits may not be conducted, and the application should therefore be complete". Secondary review will be conducted by the National Advisory Dental Research Council. Applications must be received by December 3, 1992, so they can be reviewed and considered for funding in Fiscal Year 1993. Applications judged to be noncompetitive or nonresponsive to the RFA, and those received after December 3, 1992 or exceeding the budget limitation will be returned without review. Waivers of the receipt deadline and budget limitation will not be granted. Major factors to be considered in evaluation of applications include: o The scientific, clinical and administrative qualifications, experience and commitment of the center director and his/her ability to provide effective leadership; o The potential of the CCCPOD to advance and promote high-quality clinical dental research relevant to improving the oral health in high-risk and adult populations; o The adequacy of plans to ensure efficient collaboration, interaction, and dissemination of information among investigators and effective monitoring of progress toward CCCPOD goals. e.g., external and internal review committees; o Availability of a base of ongoing, meritorious clinical research projects or projects with firm funding commitments permitting optimal utilization of CCCPOD resources; o The commitment of the institution to the proposed CCCPOD; o The appropriateness and relevance of proposed pilot or feasibility projects to be conducted during the first two years of the award; o The scientific merit, appropriateness and relevance of the proposed pilot/feasibility projects, and core units, the soundness of the methodology proposed in the research plan; o The appropriateness and relevance of the proposed clinical and laboratory facilities; o The competence of individuals participating in core units and pilot/feasibility studies and their commitment to the goals of the CCCPOD; o The appropriateness of the budget; o The feasibility and relevance of plans for fostering training in clinical research methodology for dental faculty and new investigators through utilizing existing funded projects, pilot/feasibility projects, and/or training grant mechanisms supported by the NIH or by other public or private funds; and o The availability of appropriate clinical and study populations; the effectiveness of efforts to include women and minorities in study populations, to the extent consistent with the projected conduct of pilot and feasibility studies. The inclusion of pilot projects or cores deemed to have limited scientific merit or that are considered peripheral to the CCCPOD's objectives, may be considered a reflection of the center director's judgment and may adversely affect the rating of the application. Component pilot projects or cores lacking significant and substantial merit will not be recommended for further consideration. Pilot projects or cores with only adequate merit that are not deemed essential to success of the CCCPOD may be recommended for deletion. AWARD CRITERIA In addition to scientific merit, program priorities, and program balance, the total cost of the CCCPOD to the NIDR will be considered by NIDR staff and the National Advisory Dental Research Council in making funding recommendations. One consideration will be the extent to which complementary projects, supported from non-NIDR funds, contribute to the cost-effectiveness of the proposed CCCPOD. In circumstances in which applications have similar scientific merit, but vary in cost-competitiveness, the NIDR is likely to select the more cost-competitive application for funding. Applicants are encouraged to seek additional support from public and private sector sources, such as industry, foundations, or other government agencies to support studies that expand and complement the research supported by the CCCPOD. A description of the objectives and funding for these studies must be included in the application. Following funding, interim peer review to evaluate progress may be conducted by the NIDR. Funding for subsequent years may be contingent on successful outcomes of such reviews. INQUIRIES The opportunity to clarify any issues or questions from potential applicants are welcome. Direct inquiries regarding programmatic issues to Dr. Joyce A. Reese at the address listed under LETTER OF INTENT. Direct inquiries regarding fiscal matters to: Ms. Theresa Ringler Chief, Grants Management Section National Institute of Dental Research Westwood Building, Room 518 Bethesda, MD 20892 Telephone: (301) 496-7437 FAX: (301) 402-1260 AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.1212. Awards will be 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 PHS grants policies and Federal Regulations 42 CFR Part 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. .
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