MOLECULAR AND PHYSICAL CHARACTERIZATION OF THE VULNERABLE PLAQUE NIH GUIDE, Volume 26, Number 37, November 7, 1997 RFA: HL-98-003 P.T. National Heart, Lung, and Blood Institute Letter of Intent Receipt Date: February 2,1998 Application Receipt Date: March 11, 1998 THIS RFA USES "MODULAR GRANT" AND "JUST-IN-TIME" CONCEPTS. THIS RFA INCLUDES DETAILED MODIFICATIONS TO STANDARD APPLICATION INSTRUCTIONS THAT MUST BE USED WHEN PREPARING APPLICATIONS IN RESPONSE TO THIS RFA. PURPOSE The purpose of this solicitation is to promote research into the properties of the atherosclerotic vulnerable plaque, especially those that relate to its tendency to progress to erosion or to rupture leading to thromboembolic events, unstable angina, myocardial infarction, and/or sudden death. A special emphasis is placed on multidisciplinary approaches in view of the variety of research disciplines and strategies that are needed to study the vulnerable plaque. Of interest would be studies on pathoanatomical and biochemical issues to identify major determinants of plaque vulnerability to erosion or rupture; humoral and systemic factors involved in coronary thrombosis; the physical forces associated with plaque disruption; and methods to identify and quantify the physicochemical features of plaque in vivo. 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. This RFA is related to the priority area, heart disease and stroke. 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 202-512-1800). ELIGIBILITY REQUIREMENTS Applications may be submitted by domestic and foreign, for-profit and non-profit organizations, public and private, such as universities, colleges, hospitals, laboratories, units of State or local governments, and eligible agencies of the Federal government. Racial/ethnic minority individuals, women, and persons with disabilities are encouraged to apply as Principal Investigators. All current policies and requirements that govern the research grant programs of the NIH will apply to grants awarded under this RFA. Awards under this RFA to foreign institutions will be made only for research of very unusual merit, need, and promise, and in accordance with Public Health Service policy governing such awards. Cell biology, molecular biology, biochemistry, physiology, pathology, genetics, engineering, and physical sciences are among the disciplines and expertise that may be appropriate for this research program. MECHANISMS OF SUPPORT The mechanism available for support of applications in response to this RFA is the collaborative R01 projects. Collaborative R01 projects: a group of investigators must submit collaborative R01 projects for this RFA. Collaborative groups must consist of between two and four research R01 projects and have a common theme. Collaborative R01 projects may be from a single institution or several institutions, may include shared resources, and must demonstrate synergism among the individual components. Applicants must propose a multidisciplinary program, comprising a basic science R01 and up to three other R01s that include clinical studies and imaging technologies to be performed during the grant cycle. If core support is requested, it should be organized as a separate R01 application and submitted as part of the collaboration. Specific application instructions have been modified to reflect "MODULAR GRANT" and "JUST-IN-TIME" streamlining efforts being examined by the NIH. The modular grant concept establishes specific modules in which direct costs may be requested as well as a maximum level for requested budgets. Only limited budgetary information is required under this approach. The just-in- time concept allows applicants to submit certain information only when there is a possibility for an award. It is anticipated that these changes will reduce the administrative burden for the applicants, reviewers and Institute staff. For this RFA, funds must be requested in $25,000 direct cost modules. A feature of the modular grant concept is that no escalation is provided for future years, and all anticipated expenses for all years of the project must be included within the number of modules being requested. Only limited budget information will be required and any budget adjustments made by the Initial Review Group will be in modules of $25,000. A maximum of 10 modules ($250,000 direct costs) per R01 per year may be requested, but a group of collaborative R01 applications cannot exceed a total of 24 modules ($600,000 direct costs) per year for all component R01s, including cores. Instructions for completing the Biographical Sketch have also been modified. In addition, Other Support information and the application Checklist page are not required as part of the initial application. If there is a possibility for an award, necessary budget, Other Support and Checklist information will be requested by NHLBI staff following the initial review. The APPLICATION PROCEDURES section of this RFA provides specific details of modifications to standard PHS 398 application kit instructions. This RFA is a one-time solicitation. Future unsolicited competing continuation applications will compete with all investigator- initiated applications and be reviewed according to the customary peer review procedures. It is anticipated that support for this program will begin in September 1998. Administrative adjustments in project period and/or amount may be required at the time of the award. FUNDS AVAILABLE It is anticipated that for fiscal year 1998, approximately $3,000,000 total costs will be available for the first year of support for this initiative. Award of grants pursuant to this RFA is contingent upon receipt of such funds for this purpose. It is anticipated that four to six new collaborative R01 projects will be awarded under this program. Applicants may request up to 4 years of support. The specific number to be funded will, however, depend on the merit and scope of the applications received and on the availability of funds. Direct costs will be awarded in modules of $25,000, less any overlap or other necessary administrative adjustments. Facilities and Administrative costs will be awarded based on the negotiated rates RESEARCH OBJECTIVES Background Coronary heart disease is a major cause of death and disability in the U.S. and other industrialized societies, and accounts for substantial health costs. Its underlying cause is, in most cases, the development of atherosclerotic lesions in the coronary arteries. The classical concepts of progression of atherosclerosis envisaged a progressive increase of lipids and an ensuing tissue reaction. These processes would lead to critical narrowing of the affected artery, yielding anginal syndromes and eventually coronary occlusion with myocardial infarction. However, a major shift in our understanding of how these lesions lead to clinical disease is occurring. Careful clinical and pathologic observations and the flourishing of vascular biology are substantially revising our view. Convincing new clinical data demonstrate that non-occlusive lesions often produce acute coronary syndromes. It is increasingly evident that, although the lesions of atherosclerosis may become sufficiently advanced to produce severe obstruction of the coronary arteries, it is often the less prominent plaque which is particularly prone to disruption, erosion, and thrombosis. The clinical event is frequently the result of severe acute coronary thrombosis. Many of the factors involved in these processes are not fully understood. A multidisciplinary approach is required in view of the many scientific disciplines involved in characterizing the physical forces associated with plaque disruption; the physicochemical features of plaque in vivo; the pathoanatomical and biochemical characteristics of the major determinants of the vulnerability of the plaque to erosion or rupture; and humoral and systemic factors involved in coronary thrombosis. Plaque rupture, the most frequent cause of coronary thrombosis, has been implicated in the episodic progression of coronary stenosis as demonstrated by sequential angiography and is often associated with unstable angina, myocardial infarction, and sudden death. Atherosclerotic plaques that are vulnerable to rupture have a dense infiltrate of macrophages and, to a lesser extent, lymphocytes, within a fibrous cap that overlies a crescentic hypocellular mass of lipids. The ruptured plaque results in exposure of blood to the lipid core and other plaque components and is believed to instigate the majority of coronary thrombi. Pathological studies of the microanatomy of fatal coronary lesions have shown that the physical disruption of plaques usually furnishes the nucleus for thrombotic coronary occlusion. Plaques that fissure or rupture are relatively small, are usually of the advanced or raised fibrolipid type, and have a characteristic microanatomy. The core of the plaque is rich in lipids and contains extracellular matrix material separated from the lumen by a fibrous tissue cap. Within this cap there are smooth muscle cells and monocyte/macrophages, particularly concentrated at the lateral or shoulder area of the plaque. The disruption most commonly involves a fracture of the fibrous cap overlying the lipid core, but may also involve a superficial erosion of the intimal surface. Once the lesion's integrity is breached, thrombosis usually occurs due to contact of the blood with the thrombogenic tissue-factor-rich lipid core and/or collagen in the subendothelium. Major features of plaques that have ruptured include: a thin fibrous cap; a large lipid pool; abundant macrophages and T lymphocytes; a paucity of smooth muscle cells; signs of inflammatory activation of arterial cells and infiltrating leukocytes. Another mechanism of plaque disruption and coronary thrombosis is plaque erosion. Plaque erosion may occur more commonly in younger persons (~50 years old) particularly women, and has recently been identified as an important cause of acute coronary syndrome. Eroded plaques differ from ruptured plaques in that they have a proteoglycan-rich and smooth muscle cell-rich lesion lacking a substantial lipid core, have less luminal narrowing, have less calcification, and may have fewer foci of macrophages and T cells compared with ruptured plaque. The luminal surface is focally eroded and lacks endothelial cells. Acute thrombosis is found at the plaque surface, and it usually occurs due to contact of the blood with the thrombogenic collagen accumulated in the subendothelium. These events may lead to partial or complete occlusion of the artery, resulting in unstable angina, acute myocardial infarction or sudden death. When the thrombus is non-occlusive and rapidly lysed or healed, it may be clinically silent or cause an episode of ischemia at rest. In either case, generation of thrombin and associated products of thrombosis, including platelet-derived factors, can evoke smooth muscle proliferation and promote fibrosis, leading to lesion progression and complication. Exposure of collagen, lipids, and other substances and cells in ruptured or eroded plaques leads to the activation of platelets and the coagulation cascade system. The resulting thrombus may lead to marked reduction in myocardial perfusion and the development of an unstable coronary syndrome, or it may become organized and incorporated into the diseased vessel, thus contributing to the progression of atherosclerosis. This process may be potentially influenced by new antithrombotic agents such as inhibitors of thrombin, thromboxane, and serotonin receptor antagonists, and monoclonal antibodies or peptides aimed at blocking platelet membrane receptors or adhesive proteins. However, much remains to be understood regarding the thrombogenicity of plaque materials before and after plaque rupture, the contribution of the reorganization of a thrombus to plaque progression, and the role of various vascular wall cells. In addition, it is not clear how, why, or at what stage a plaque would erode. Factors important to these plaque transformations need to be delineated. Force imbalances within the plaque volume or in the area of stenosis, due, for example, to sudden changes in intraluminal coronary pressure or tone, or bending and twisting of an artery during each heart contraction, may be important physical factors that influence the probability of plaque vulnerability. Thus, imaging technology is emerging as an important research tool. Several techniques have the potential for quantifying plaques in vivo, such as intravascular ultrasonography, ultrasound imaging from the body surface, magnetic resonance imaging, and ultra fast computed tomography (electron beam CT). Identification of plaque composition and the distribution of components such as lipids, fibrous tissues, and calcium within the plaque may be related to its potential rupture and erosion. Ultrasound, magnetic resonance spectroscopy, and radioisotope imaging offer some promise for accomplishing this. The characterization of these relatively less stenotic plaques prone to erosion or rupture, and the recognition that they contribute to unstable angina and myocardial infarction, has important implications. Early identification of potentially vulnerable plaques may lead to changes in the indications for patients considered for bypass surgery, angioplasty, and other procedures, and may identify new strategies and novel approaches for prevention and treatment of the vulnerable plaque. This offers a possible explanation of why cholesterol lowering therapy has a favorable effect on clinical events as has been shown by the results of several recent trials. Objectives It is proposed to support four to six collaborative projects for research into the properties of the vulnerable atherosclerotic plaque, especially its tendency to erode or rupture and its thrombotic consequences. Applications must be multidisciplinary. Furthermore, to accelerate the transition from bench to bed-side, this RFA requests the use of clinical studies and of imaging technologies to be performed during the grant cycle to achieve its objectives. Areas of special emphasis and examples of research topics that may be applied to humans and animal models amenable to the development of the vulnerable plaque and which would be responsive to this RFA may include, but are not limited to the following: o Studies to explore the molecular mechanisms that link the characteristics of vulnerable plaques on cellular gene expression of various extracellular matrix materials, and substances affecting plaque integrity. Also included may be studies on plaque elastomechanics and the physical forces associated with plaque rupture or erosion, i.e., evaluate forces internal and external to the artery wall using experimental models, animal models, and mathematical and computer simulations. o Studies of inflammatory factors in the development of vulnerable plaques and the thrombogenicity of plaque materials before and after rupture or erosion. These could include in vivo studies of the exposure of plaque material to circulating blood, and determinants of coronary thrombosis, enzymatic release, inflammatory activation of arterial cells and infiltrating leukocytes, abscess development, or exposure of procoagulant activity after plaque rupture or erosion. o Studies of plaque composition and the distribution of various components within the plaque utilizing evolving modalities of imaging such as magnetic resonance, ultrasound, or computed tomography imaging. Imaging studies over time of individuals with plaques that are likely to rupture or erode may also be valuable for obtaining imaging markers associated with plaque rupture or for imaging microemboli in vivo. Studies of vulnerable plaques in the abdominal aorta and carotid arteries may be especially useful because of their accessibility with non-invasive imaging techniques and the potential for pathologic and histologic validation. o Clinical studies that enhance understanding of the progression, stabilization, and regression of the vulnerable plaque. Such studies are not to be epidemiological, but could address questions such as what imaging parameters are associated with thromboembolic events, what may be the significance of raised lesions, and whether vascular remodeling is predictive of thromboembolic events. These examples often overlap, and applicants are required to propose multidisciplinary approaches to address more than one of these areas. Clinical studies and use of image technologies are required, and should be performed during the grant cycle. This initiative will not support grants that focus on large epidemiological studies or clinical trials. In addition, any application that focuses on cerebrovascular disease or stroke (other than vascular effects and blood flow) should be addressed to the National Institute of Neurological Disorders and Stroke. SPECIAL REQUIREMENTS Upon initiation of the program, the NHLBI will sponsor periodic meetings to encourage exchange of information among investigators who participate in this program. Travel funds for a one day meeting each year, most likely to be held in Bethesda, Maryland, should be included in the modules. should request travel funds for a 1 day meeting each year, most likely to be held in Bethesda, Maryland. Applicants should also include a statement in their applications indicating their willingness to participate in these meetings. INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of the NIH that women and members of minority groups and their subpopulations must be included in all NIH supported biomedical and behavioral research projects involving human subjects, unless a clear and compelling rationale and justification is provided that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research. This policy results from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43). All investigators proposing research involving human subjects should read the "NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research," which have been published in the Federal Register of March 28, 1994 (FR 59 14508-14513) and in the NIH Guide to Grants and Contracts, Volume 23, Number 11, March 18, 1994. Investigators also may obtain copies of the policy from the program staff listed under INQUIRIES. Program staff may also provide additional relevant information concerning the policy. LETTER OF INTENT Prospective applicants are asked to submit, by February 2, 1998, a letter of intent that includes a descriptive title of the proposed research, the name, address, and telephone number of the Principal Investigator, the identities of other key personnel and participating institutions, and the number and title of the RFA in response to which the application may be submitted. Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows NHLBI staff to estimate the potential review workload and to avoid conflict of interest in the review. The letter of intent is to be mailed, or faxed, to: Dr. C. James Scheirer Division of Extramural Affairs National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Room 7220, MSC 7924 Bethesda, MD 20892-7924 Telephone: (301) 435-0266 FAX: (301) 480-3541 Email: [email protected] APPLICATION PROCEDURES The research grant application form PHS 398 (rev. 5/95) is to be used in applying for these grants, with the modifications noted below. These forms are available at most institutional offices of sponsored research; from the Division of Extramural Outreach and Information Resources, National Institutes of Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone 301/710-0267, email: [email protected]; and on the internet at https://grants.nih.gov/grants/funding/phs398/phs398.html. The RFA label found in the PHS 398 application form must be affixed to the bottom of the face page of the application. Failure to use this label could result in delayed processing of the application such that it may not reach the review committee in time for review. In addition, the RFA title [Characterization of the Vulnerable Plaque] and number [HL-98-003] must be typed on line 2 of the face page of the application form and the YES box must be marked. State on the face page, Title Line (line 1), of each application that the submission is part of a "Collaborative R01". The individual components and cores must be submitted as one packet accompanied by a cover letter that lists the principal investigators of each R01. Include this letter with each of the individual R01s, and in each R01 list the collaborating projects and principal investigators on page 2, under "Performance Sites". In addition, the description section for each R01 within a collaborative R01 should be the same and the applicants should define how and why the individual participants propose to collaborate. Applicants should elaborate on the significance and nature of the collaboration in an Introduction section of the "Research Plan" of each component R01. Sample budgets and justification page will be provided upon request or following the submission of a letter of intent from Mr. William Darby at the address listed below. BUDGET INSTRUCTIONS The total direct costs must be requested in accordance with the program guidelines and the modifications made to the standard PHS 398 application instructions described below: FACE PAGE As a reminder, Item 7 should be completed to indicated Modular Direct Costs requested and Item 8 should reflect Total Costs (Modular Direct plus F&A costs). DETAILED BUDGET FOR THE INITIAL BUDGET PERIOD Do not complete Form Page 4 of the PHS 398 (rev 5/95). It is not required nor will it be accepted at the time of application. BUDGET FOR THE ENTIRE PROPOSED PERIOD OF SUPPORT Do not complete the categorical budget tables on page 5 of the PHS 398 (rev. 5/95) Form. Only the requested total direct costs line for each year must be completed based on the number of $25,000 modules being requested. Applicants may not request a change in the amount of each module. A maximum of 24 modules ($600,000 direct costs) for a whole collaborative application, including cores, per year may be requested, and a maximum of 10 modules ($250,000 direct cost) per R01 unit per year may be requested . Applicants may request up to 4 years of support for this RFA. Direct cost budgets will remain constant throughout the life of the project (i.e. the same number of modules requested for all budget periods). Any necessary escalation should be considered when determining the number of modules to be requested. However, in the event that the number of modules requested must change in any future year due to the nature of the research proposed, appropriate justification must be provided. Total Direct Costs for the Entire Proposed Project Period should be shown in the box provided. BUDGET JUSTIFICATION o Budget justifications should be provided under "Justifications" on Form Page 5 of the PHS 398. o List the names, role on the project and proposed percent effort for all project personnel (salaried or unsalaried)and provide a narrative justification for each person based on his/her role on the project. o Identify all consultants by name and organizational affiliation and describe the services to be performed. o Provide a general narrative justification for individual categories (equipment, supplies, etc.) required to complete the work proposed. More detailed justifications should be provided for high cost items. Any large one-time purchases, such as large equipment requests, must be accommodated within these limits. CONSORTIUM/CONTRACTUAL COSTS If collaborations or subcontracts are involved that require transfer of funds from the grantee to other institutions, it is necessary to establish formal subcontract agreements with each collaborating institution. A letter of intent from each collaborating institution should be submitted with the application. Only the percentage of the consortium/contractual TOTAL COSTS (direct and facilities and administrative costs) relative to the total DIRECT COSTS of the overall project needs to be stated at this time. The following example should be used to indicate the percentage cost of the consortium, "The consortium agreement represents 27% of overall direct costs requested in the first year." A budget justification for the consortium should be provided as described in the "Budget Justification" section above (no Form Page 5 required for the consortium). Please indicate whether the consortium will be in place for the entire project period and identify any future year changes in the percentage relative to the parent grant. If there is a possibility for an award, the applicant will be requested to identify actual direct and indirect costs for all years of the consortium. Please note that total subcontract costs need not be calculated in $25,000 modules. However, when subcontract funds are added to the parent grant budget, the total direct cost amount must be included in the number of $25,000 modules requested. BIOGRAPHICAL SKETCH A biographical sketch is required for all key personnel, following the modified instructions below. Do not exceed the two-page limit for each person. o Complete the educational block at the top of the form page; o List current position(s) and those previous positions directly relevant to the application; o List selected peer-reviewed publications directly relevant to the proposed project, with full citation; o The applicant has the option to provide information on research projects completed and/or research grants participated in during the last five years that are relevant to the proposed project. OTHER SUPPORT - Do not complete the "Other Support" pages (Form Page 7). Selected other support information relevant to the proposed research may be included in the Biographical Sketch as indicated above. Complete Other Support information will be requested by NHLBI staff if there is a possibility for an award. CHECKLIST No "Checklist" page is required as part of the initial application. A completed Checklist will be requested by NHLBI staff if there is a possibility for an award. The applicant should provide the name and phone number of the individual to contact concerning fiscal and administrative issues if additional information is necessary following the initial review. Applications not conforming to these guidelines will be considered unresponsive to this RFA and will be returned without further review. Submit a signed, typewritten original of the application and three signed, photocopies, in one package to: CENTER FOR SCIENTIFIC REVIEW (formerly Division of Research Grants) NATIONAL INSTITUTES OF HEALTH 6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710 BETHESDA, MD 20892-7710 BETHESDA, MD 20817 (for express/courier service) At the time of submission, two additional copies of the application should be sent to Dr. C. James Scheirer, at the same address given above in the section on LETTER OF INTENT. Applications must be received by March 11, 1998. If an application is received after that date, it will be returned to the applicant without review. The Center for Scientific Review (CSR) will not accept any application in response to this RFA that is essentially the same as one currently pending initial review, unless the applicant withdraws the pending application. The CSR will not accept any application that is essentially the same as one already reviewed. This does not preclude the submission of substantial revisions of applications already reviewed, but such applications must include an introduction addressing the previous critique. REVIEW CONSIDERATIONS Upon receipt, applications will reviewed for completeness by CSR and responsiveness by NHLBI. Incomplete and/or unresponsive applications will be returned to the applicant without further consideration. Remaining applications may be subjected to a streamlined review process by a Special Emphasis Panel convened by NHLBI Scientific Review Office to determine their scientific merit relative to other applications received in response to the RFA. The roster of reviewers for the RFA will be available on the NHLBI home page approximately four weeks prior to the scheduled review date. Applications determined to be meritorious will be evaluated for scientific and technical merit by the review committee, be discussed and receive a priority score. All other applications will not be discussed or scored. The initial review group will evaluate all applications as individual investigator-initiated grant applications. Additionally, the IRG will comment on the overall strength and likelihood of effective collaboration of each collaborative program. Each R01 within a collaborative program will receive a priority score. Secondary review of the applications will be conducted by the National Heart, Lung, and Blood Advisory Council (NHLBAC). Other review criteria and major factors to be considered in the evaluation of the applications will include: 1) Significance Does this study address an important problem? If the aims of the application are achieved, how will scientific knowledge be advanced? What will be the effect of these studies on the concepts or methods that drive this field? 2) Approach Are the conceptual framework, design, methods, and analyses adequately developed, well integrated, and appropriate to the aims of the project? Does the applicant acknowledge potential problem areas and consider alternative tactics? 3) Innovation Does the project employ novel concepts, approaches or method? Are the aims original and innovative? Does the project challenge existing paradigms or develop new methodologies or technologies? 4) Investigator Is the investigator appropriately trained and well suited to carry out this work? Is the work proposed appropriate to the experience level of the principal investigator and other researchers (if any)? 5) Environment Does the scientific environment in which the work will be done contribute to the probability of success? Do the proposed experiments take advantage of unique features of the scientific environment or employ useful collaborative arrangements? Is there evidence of institutional support? 6) Collaboration Do the submitted collaborative R01 projects represent collaborative research among investigators from different disciplines? What are the likelihood of effective collaboration among the investigators, and the likelihood of success of the research objectives proposed? The personnel category will be reviewed for appropriate staffing based on the requested percent effort. The direct costs budget request will be reviewed for consistency with the proposed methods and specific aims. Any budgetary adjustments recommended by the reviewers will be in $25,000 modules. The duration of support will be reviewed to determine if it is appropriate to ensure successful completion of the requested scope of the project. AWARD CRITERIA Applications will receive a secondary level of review by National Heart, Lung, and Blood Advisory Council (NHLBAC) in September 1998. The earliest anticipated date of award is September 1998. Applicants should be aware that, in addition to scientific merit, program priorities and program balance, the total costs of the proposed project and the availability of funds will be considered by NHLBI staff as well as NHLBAC in making funding recommendations. In addition, NHLBI appreciates the value of complementary funding from other public and private sources including foundations and industrial concerns. In circumstances in which applications have similar scientific merit, but vary in cost competitiveness, NHLBI is likely to select the more cost competitive application for funding. Schedule Letter of Intent Receipt Date: February 2, 1998 Application Receipt Date: March 11, 1998 Date of Initial Review: June/July 1998 Review by NHLBI Advisory Council: September 3-4, 1998 Anticipated Award Date: September 30,1998 INQUIRIES Inquiries concerning this RFA are encouraged. Potential applicants may request sample budget pages. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues and requests for sample budget pages to: Momtaz Wassef, Ph.D. or Alan Berson, Ph.D. Division of Heart and Vascular Diseases National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Suite 10186 Bethesda, MD 20892-7956 Telephone: (301) 435-0550 or (301) 435-0513 FAX: (301) 480-2848 or (301) 480-1454 Email: [email protected] or [email protected] Direct inquiries regarding fiscal matters to: Mr. William Darby Grants Operations Branch National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Suite 7128 Bethesda, MD 20892-7128 Telephone: (301) 435-0177 FAX: (301) 480-3310 Email: [email protected] AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.837. Awards are made under authorization of the Public Health Service Act, Title IV, Part A (Public Law 78-410, as amended by Public Law 99-158, 42 USC 241 and 285) and administered under 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. The PHS strongly encourages all grant and contract recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro- Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of a facility) in which regular or routine education, library, day care, health care or early childhood development services are provided to children. This is consistent with the PHS mission to protect and advance the physical and mental health of the American people.
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