Full Text HL-94-001


NIH GUIDE, Volume 22, Number 37, October 15, 1993

RFA:  HL-94-001

P.T. 34

  Medical Education 
  Disease Control+ 
  Disease Prevention+ 

National Heart, Lung, and Blood Institute

Letter of Intent Receipt Date:  December 13, 1993
Application Receipt Date:  February 11, 1994


The primary objective of this Request for Application (RFA) 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, with particular emphasis on support of
minority schools and minority individuals.


The Public Health Service 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 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 202-783-3238).



Applications may be submitted by domestic universities or schools of

Although this announcement is not limited to minority institutions or
individuals, the intent of the program is to assure representation in
the program of minority medical schools and minority individuals,
with special emphasis on Black, Hispanic, Native American, Pacific
Islander and other ethnic or racial group members who have been found
to be underrepresented in biomedical or behavioral research


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;

o  have demonstrated knowledge and commitment to medical education
for medical students, physicians, and patients;

o  have sufficient clinical training, research, and teaching
experience in asthma 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  have the support of the Dean and educational leadership at the

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; and

o  commit 30 to 50 percent effort for a period of five years.

Individuals who have held another 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.  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 30, 1994.


The estimated funds (total costs) for this fiscal year 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.  It is the
intent of the program to assure representation of minority medical
schools and minority individuals, with special emphasis on Blacks,
Hispanics, Native Americans, and Pacific Islanders.

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.



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
deaths from asthma between blacks and whites.  Asthma mortality 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 and the Executive Summary: Management of Asthma During

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 education.  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, including practicing physicians,
to learn the principles and practice of preventing, managing, and
controlling asthma;

o  develop and implement interdepartmental programs with common goals
and standardized 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 diagnosis and management instruction in asthma, with
special emphasis on minority faculty;

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  promote 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  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  facilitate an interchange of ideas among awardees and

o  evaluate the impact of the proposed program;

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

o  enhance the teaching of asthma in minority medical schools and
promote community asthma education in the communities served by these

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.

Since this is a medical education program, funds may be requested for
technical support staff who have complementary expertise to the
principal investigator.  Such personnel may include medical
educators, curricula specialists, program evaluators, or other


1.  Awardee Salary

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

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.

An example of an investigator who receives the Academic Award at a
level of effort of 30 percent, who wishes to devote 60 percent of
effort to other Federally-sponsored research, and whose institutional
salary is $130,000 is as follows:

Academic Award              30 percent effort    $ 37,500*
Other Federally-supported
  grants and contracts      60 percent effort    $ 75,000*
Total salary from Federal
sources                                          $112,500
Salary contribution
from grantee's institution                       $ 17,500
Total Salary                                     $130,000

*(based on the current ceiling of $125,000)

2.  Program Support

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

o  personnel other than the awardee if requested for the development
and evaluation of the educational program.  Salaries will be
allowable for technical and support personnel, e.g., educational and
evaluation specialists.  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;

o  funds for travel for the Principal Investigator to meet with other
awardees and NHLBI staff to exchange ideas, to develop collaborative
projects, and to provide for some needed technical support. (Awardees
may be requested to meet as a group up to two times a year; $2,000
should be allocated for this purpose.)

3.  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 equipment.

4.  Conditions of the Award

Institutions must provide documentation that the applicant would have
the necessary time and resources to implement the proposed plan.  In
some cases it may be necessary for the applicant to be relieved of
some responsibilities for the five years of the grant award in order
to implement the proposed plan.

An institution may apply for an award on behalf of a named individual
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.

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 provided.

The composition of the proposed study population must be described in
terms of gender and racial/ethnic group and approximate percentages
should be included.  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 (rev. 9/91) 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.  Programs involving educational strategies including the
effectiveness of such strategies, such as required by this program,
are considered human subject research.  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


Prospective applicants are asked to submit, by December 13, 1993, 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 RFA number and
title 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:

C. James Scheirer, Ph.D.
Division of Extramural Affairs
National Heart, Lung, and Blood Institute
Westwood Building, Room 548B
Bethesda, MD  20892
Telephone:  (301) 594-7452


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 Information, Division of Research Grants,
National Institutes of Health, 5333 Westbard Avenue, Room 449,
Bethesda, MD 20892, telephone (301) 710-0267.

The RFA label available in the PHS 398 (rev. 9/91) application form
must be affixed to the bottom of the face page of the application.
Failure to use this label could result in delayed processing of the
application such that it may not reach the review committee in time
for review.  In addition, "RFA: HL-94-001-L Asthma Academic Award"
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:

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

Applications must be received at both locations by February 11, 1994
to be assured of review in this competition.  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 return the
application to the applicant.

The initial review may include a preliminary evaluation to determine
scientific merit relative to the other applications received in
response to this program announcement (triage); the NIH will remove
from further consideration applications judged to be noncompetitive
and promptly notify the Principal Investigator and the official
signing for the applicant organization.  Those applications judged to
be competitive will be further evaluated for scientific/technical
merit by the usual peer review procedures, including, if deemed
appropriate, an applicant interview in or near Bethesda at the
applicant's expense. The initial review will be conducted by a
Special Emphasis Panel, 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

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

o  description of the magnitude of the asthma problem and the need
for the program in the area to be served;

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 administration
within a medical school, and planning and conduct of clinical

o  the ability and commitment to working cooperatively with other
awardees to make innovative asthma curricula and materials available;

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 significant 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 agencies;

o  plans for and availability of expertise to implement and evaluate
the proposed program, including strategies for both process and
impact evaluation;

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 sites.


The anticipated date of award is September 30, 1994.  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.  Applicants are urged to contact the program
administrator, as soon as they receive approval from their
institution to apply for this award.

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) 594-7466

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) 594-7420


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 CAR
52 and 45 CAR Part 74.  This program is not subject to the
intergovernmental review requirements of Executive Order 12372 or to
a review by a Health Systems Agency.


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