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Full Text HL-93-10


NIH GUIDE, Volume 21, Number 41, November 13, 1992

RFA:  HL-93-10-L

P.T. 34

  Medical Education 
  Clinical Medicine, General 

National Heart, Lung, and Blood Institute

Letter of Intent Receipt Date:  December 15, 1992
Application Receipt Date:  February 17, 1993


The primary objective of this program is to stimulate the development
and/or improvement of the quality of medical curricula,
physician/patient/and community education, and clinical practice for
the prevention, management, and control of asthma in the United States.


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.  This Request
for Applications (RFA), Asthma Academic Award, is related to the
priority areas of diabetes and chronic disabling diseases.  Potential
applicants may obtain a copy of "Healthy People 2000" (Full Report:
Stock No. 017-001-00474-0) or "Healthy People 2000" (Summary Report:
Stock No. 017-001-00473-1) through the Superintendent of Documents,
Government Printing Office, Washington, DC 20402-9325 (telephone:



Applications may be submitted by domestic universities or schools of
medicine.  Minority institutions and urban institutions from areas with
high rates of morbidity of asthma that have the necessary resources and
facilities and a commitment to providing the awardee with the time to
develop and implement plans consistent with the goals of this
announcement are encouraged to sponsor candidates for these awards.


A candidate for an award must:

o  be an established physician and medical faculty member in an
accredited school of medicine or osteopathy in the United States, its
territories or possessions, and have competence in the management of
asthma, and;

o  be employed by a school of medicine or osteopathy that is located in
an area with high asthma morbidity, such as an institution located in
an inner city;

o  have sufficient clinical training, research, and teaching experience
in pulmonary medicine to develop and implement a high quality
curriculum in asthma encompassing current knowledge and methods
applicable to the control of asthma in individuals of all ages and to
provide leadership in applied research in control of asthma;

o  be a citizen or non-citizen national of the United States or have
been lawfully admitted to the United States for permanent residence at
the time of application;

Individuals who have held another National Institutes of Health (NIH)
career development award (K series) are eligible to apply for the
Asthma Academic Award.  Applications from minority individuals and
women are encouraged.


This RFA is part of the Academic Award Program (K07) of the National
Heart, Lung, and Blood Institute (NHLBI).  Responsibility for the
planning, direction, and execution of the proposed project will be
solely that of the applicant.  The total project period may not exceed
five years and is non-renewable.  It is anticipated that support for
this program will begin September 1993.

A maximum of $50,000 for the salary of the awardee, plus applicable
fringe benefits, a maximum of $20,000 for technical support, and
indirect costs not to exceed eight percent may be requested.


The estimated funds (total costs) for the first year of support for the
entire program will be $300,000.  It is anticipated that three to four
grants will be awarded each year for five years under this program.
The specific number, however, will depend upon the merit and scope of
the applications received and the availability of funds.



Asthma is a serious chronic condition, affecting approximately 10
million Americans.  People with asthma experience over 100 million days
of restricted activity annually, and costs for asthma care exceed $4
billion a year.  Asthma morbidity and mortality rates are increasing.
From 1980 to 1987, the prevalence of asthma in the U.S. increased 29
percent, and the number of asthma deaths increased by 31 percent.
Recent reports indicate that mortality from asthma has been rising
since about 1968 in all age groups.  In 1987, the overall death rate
from asthma was 1.9/100,000 people with females slightly higher than
males.  Many of these deaths were considered to be largely preventable.
The largest increase in asthma-related mortality has been among blacks,
women, and persons over 65 years of age.  Additionally, since about
1950 there has been a widening gap in the death rate from asthma
between blacks and whites.  The asthma mortality rate has been three
times higher in black compared to white males and twice as high in
black than in white females.

Reduction of asthma morbidity has been identified as a new objective in
the U.S. Health Objectives for the Year 2000.  Considerable national
attention is being directed at this problem, including the following
major efforts.  Considerable behavioral and education research has been
conducted in the area of patient/family self management to complement
and enhance medical treatment regimens, and these have yielded several
effective educational programs for patients and their families.  With
representation from 30 governmental, professional, and voluntary health
organizations, a National Asthma Education Program has been initiated
to educate patients, the public, and health care providers about the
disease.  A major early accomplishment of this Program was the
preparation and dissemination of the Guidelines for the Diagnosis and
Management of Asthma.

Yet, although asthma is a disease that generally can be controlled with
expert medical treatment and self-management, many patients are not
receiving state-of-the-art medical care and/or are not following the
prescribed treatment plans.  Special programs are needed to reach
health care providers in areas remote from major medical centers and to
reach minority and lower socioeconomic level patients in both inner
city and rural areas.  Multidimensional research conducted by
multidisciplinary teams will be required to improve clinical practice
and patient evaluation.  Therefore, the aim of this program is to
stimulate the development and/or improvement of the quality of medical
education, patient and community education, research programs, and
clinical practice focused on the control of asthma.


The objectives of the Asthma Academic Award are to:

o  encourage the development of high quality curricula in schools of
medicine that will significantly increase the opportunities for
students, house staff, and others, to learn the principles and practice
of preventing, managing, and controlling asthma;

o  develop and implement interdepartmental programs with common goals
and standardize diagnostic and therapeutic approaches;

o  promote communication among specialists in primary care, allergy,
and obstetrics and gynecology to ensure appropriate treatment of
pregnant women with asthma;

o  encourage applied research in the control of asthma;

o  promote the development of a faculty capable of providing
appropriate instruction in asthma;

o  provide for outreach programs from medical centers to health
practitioners in the community to enhance optimal care, especially in
areas of high asthma morbidity, such as inner city minority

o  promote an institutional environment that facilitates an interchange
of information and educational evaluation techniques about new
diagnostic, therapeutic and prevention measures in asthma in both
children and adult populations;

o  investigate coordinated clinical approaches to the care of patients
of various ages and ethnic groups who have asthma, such as minorities,
young children, and the elderly;

o  facilitate an interchange of ideas among awardees and institutions;

o  contribute to the public health efforts to control asthma in the
United States.

Of particular interest are programs targeted to inner city populations
and to rural areas that may be in need of education about asthma and
among physicians who are or who will be caring for medically
underserved populations.


Awardee Salary

The salary requested for the awardee must not exceed the actual
institutional salary rates, and must not exceed $50,000 plus fringe
benefits.  A candidate must spend at least 30 percent time on this

An awardee may devote up to a total of 100 percent effort as an
Academic Awardee and as Principal or participating Investigator on any
other NIH-supported grant(s) or contract(s) and may receive
remuneration from such grant(s) or contract(s) accordingly.

Technical Support

Technical support will be provided up to a maximum of $20,000 per year
for the following:

o  personnel other than the awardee if required for the development of
the program.  Salaries will be allowable for technical and support
staff and consultants.  Student stipends are allowable for students
conducting projects directly related to the award;

o  equipment costs are not allowable;

o  consumable supplies essential to the proposed program;

o  funds for educational development to enable the awardee to develop
educational skills and to meet with other awardees to exchange ideas,
methods, and program evaluations.

Awardees may be requested to meet as a group up to two times a year.
These meetings will promote collaborative efforts, provide for some
needed technical support, and encourage an exchange of ideas among the
awardees.  Funds should be allocated for travel for the Principal
Investigator to a midpoint in the country and the principal
investigator must agree to participate in these meetings.

Indirect Costs

Awards will be provided for the reimbursement of actual indirect costs
at a rate up to, but not exceeding, eight percent of the total direct
costs of each award, exclusive of tuition, fees, and expenditures of

Conditions of the Award

Institutions may apply for awards on behalf of named individuals
meeting the criteria for this award.  Awards will be limited to one
from each eligible school over the life of the award.  After the first
year, grants will be renewed for a maximum of four years on a
non-competitive basis depending upon progress being made in meeting the
program's objectives.  An annual report will be required that
summarizes activities relevant to curriculum development at the
institution and other elements of the program plan and outlines future
plans.  This report will serve as the principal basis for renewal of
the grant.

The grant will be made annually for each of the five annual budget
periods.  Awards may not be transferred from one institution to
another.  If an awardee moves to another institution, the award will
continue at the original institution only upon approval by the Division
of Lung Diseases of a suitable replacement proposed by the grantee
institution.  Such a replacement will not lengthen the overall term of
the award.



Although the Asthma Academic Award is not primarily a mechanism to
support research, some awardees may implement some research as a part
of the overall Academic Award program.  If any clinical research is
proposed under this program, the policies of the NIH regarding
inclusion of women and minority apply.

NIH policy is that applicants for NIH clinical research grants and
cooperative agreements are 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 must 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 must be

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 must be addressed in developing a research design
and sample size appropriate for the scientific objectives of the study.
This information must be included in the form PHS 398 in Sections 1-4
of the Research Plan AND summarized in Section 5, Human Subjects.
Applicants are urged to assess carefully the feasibility of including
the broadest possible representation of minority groups.  However, 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 is defined as 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 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 reflected in assigning
the priority score to the application.

All applications for clinical research submitted to NIH are required to
address these policies.  NIH funding components will not award grants
or cooperative agreements that do not comply with these policies.


Prospective applicants are asked to submit, by December 15, 1992, a
letter of intent that includes 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 subsequent applications, the information
that it contains is helpful in planning for the review of applications.
It allows NHLBI staff to estimate the potential review workload and to
avoid conflict of interest in the review.

The letter of intent is to be sent to:

James C. Scheirer, Ph.D.
Division of Extramural Affairs
National Heart, Lung, and Blood Institute
Westwood Building, Room 548B
Bethesda, MD  20892
Telephone:  (301) 496-7383


Applications are to be submitted on the grant application form PHS 398
(rev. 9/91).  Application kits are available at most institutional
offices of sponsored research and may be obtained from the Office of
Grants Inquiries, Division of Research Grants, National Institutes of
Health, 5333 Westbard Avenue, Room 449, Bethesda, MD 20892, telephone
(301) 496-7441.  The title and number of the request for grant
application must be typed on Line 2a of the face page of the
application form and the "YES" box must be marked.

Submit a signed, typewritten original of the application, including the
checklist, and three signed photocopies, in one package to:

Division of Research Grants
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**

At the time of submission, two additional copies of the application
must also be sent to:

James C. Scheirer, Ph.D.
Division of Extramural Affairs
National Heart, Lung, and Blood Institute
Westwood Building, Room 548B
Bethesda, MD  20892

Applications must be received by February 17, 1993.  If an application
is received after that date, it will be returned to the applicant
without review.  The Division of Research Grants (DRG) will not accept
any application in response to this announcement that is essentially
the same as one currently pending initial review, unless the applicant
withdraws the pending application.  The DRG 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.


Upon receipt, applications will be reviewed by NIH staff for
completeness and responsiveness.  Incomplete applications will be
returned to the applicant without further consideration.  If the
application is not responsive to the RFA, NHLBI staff will 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.

The review includes an assessment of the written application and the
letters of reference, and may be followed by an interview with the
candidate in Bethesda, MD.  Travel expenses for this interview must be
paid by the applicant institution.  The initial review will be
conducted by a Special Review Committee, managed by the Division of
Extramural Affairs, National Heart, Lung, and Blood Institute.  The
secondary review will be by the National Heart, Lung, and Blood
Advisory Council.

Applications for this Asthma Academic Award will be evaluated in terms
of the following criteria:

o  the overall merit of the proposed five-year plan for improving the
institution's interdepartmental curricula in asthma control;

o  access to a population with high incidence of asthma;

o  the qualifications and background of the candidate, including
experience in teaching, curriculum development, and research;

o  the institution's commitment to implement the proposed curriculum
and to continue a program in education about asthma control after the
termination of the award;

o  the involvement of appropriate disciplines in the development,
implementation, and evaluation of the program;

o  design and evaluation of educational interventions for health care
providers and for patients with asthma, especially in areas with high
morbidity from asthma, such as inner city minority communities;

o  plans for communication and cooperation between specialists in adult
and pediatric pulmonary medicine, family practice, internal medicine,
community medicine, and other specialties;

o  plans for collaborative projects with other organizations that have
responsibility for and interest in asthma control, for example, health
departments, medical and nursing associations, and voluntary health

o  the potential for the program making an impact on the control of
asthma among populations served;

o  the potential for replication or adaptation of the program at other


The anticipated date of award is September 30, 1993.  Factors that will
be taken into consideration in making awards include the scientific
merit of the proposed program, as evidenced by the priority score, and
the availability of funds.  Subject to the availability of necessary
funds and consonant with the objectives of the Asthma Academic Award,
the Division of Lung Diseases will provide funds for a project period
up to five years.


Written and telephone inquiries concerning this RFA are encouraged.
The opportunity to clarify any issues or questions from potential
applicants is welcome.

Direct inquiries regarding programmatic issues to:

Joan M. Wolle, Ph.D., M.P.H.
Division of Lung Diseases
National Heart, Lung, and Blood Institute
Westwood Building, Room 640
Bethesda, MD  20892
Telephone:  (301) 496-7668

Direct inquiries regarding fiscal matters to:

Raymond L. Zimmerman
Grants Operations Branch
National Heart, Lung, and Blood Institute
Westwood Building, Room 4A17
Bethesda, MD  20892
Telephone:  (301) 496-4970


This program is described in the Catalog of Federal Domestic Assistance
No. 93.838.  Grants are made under the authorization of the Public
Health Service Act, Title III, Section 301 (Public Law 78-410, as
amended by Public Law 99-158, 42 US 241 and 285) and administered under
PHS 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.


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