NOCTURNAL ASTHMA, CHRONOBIOLOGY AND SLEEP Release Date: January 20, 1999 RFA: HL-99-011 P.T. National Heart, Lung, and Blood Institute Letter of Intent Receipt Date: April 12, 1999 Application Receipt Date: June 16, 1999 THIS RFA USES "MODULAR GRANT" AND "JUST-IN-TIME" CONCEPTS. THIS RFA INCLUDES DETAILED MODIFICATIONS TO STANDARD APPLICATION INSTRUCTIONS THAT MUST BE FOLLOWED WHEN PREPARING APPLICATIONS IN RESPONSE TO THIS RFA. PURPOSE The National Heart, Lung, and Blood Institute (NHLBI) invites research grant applications to conduct studies on the pathogenesis of nocturnal asthma and the role of circadian rhythm and/or sleep/sleep disturbances in this disease process. The overall goal of this program is to establish the cellular and molecular mechanisms which underlie the chronobiology of nocturnal exacerbations of asthma and airway inflammation, as well as the role played by sleep/sleep disturbances. Toward this goal, this initiative strongly encourages scientific collaborations among investigators with interest in asthma, chronobiology, sleep medicine, immunology, physiology, and neurophysiology. Among the disciplines and expertise that are appropriate for this research program are molecular biology, cell biology, immunology, biochemistry, allergy, asthma, chronobiology, sleep medicine, neurophysiology, genetics, pulmonary medicine, and pulmonary physiology. 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 Request for Applications (RFA), Nocturnal Asthma, Chronobiology and Sleep, is related to one or more of the priority areas. 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) or at http://www.crisny.org/health/us/health7.html. 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 National Institutes of Health (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 PHS policy governing such awards. MECHANISM OF SUPPORT This RFA will use the National Institutes of Health (NIH) research project grant (R01) award mechanism. However, 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 and a maximum of 9 modules ($225,000 direct costs) per year may be requested. 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. 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. Responsibility for the planning, direction, and execution of the proposed project will be solely that of the applicant. Administrative adjustments in project period and/or amount may be required at the time of the award. 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. The anticipated award date is April 1, 2000. 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. If so, a letter of agreement either from the GCRC program director or principal investigator should be included with the application. FUNDS AVAILABLE The NHLBI intends to commit approximately $2,100,000 total costs in fiscal year 2000 for the first year of support of this initiative. Award of grants pursuant to this RFA is contingent upon receipt of such funds for this purpose. It is anticipated that approximately 5 to 6 new grants 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 application 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 (indirect) costs will be awarded based on the negotiated rates. Although not co-sponsoring this RFA, other Institutes have an interest in the research area discussed in this RFA. Applications submitted to and not selected for funding by the NHLBI in response to this RFA may be considered for funding by the National Institute of Nursing Research, according to referral guidelines. RESEARCH OBJECTIVES Background Asthma is characterized by increased bronchial responsiveness, airway inflammation and episodic airway obstruction. Nocturnal asthma is a variable exacerbation of the asthmatic condition occurring at night. Nocturnal asthma is associated with increases in symptoms, worsening of lung function, and a greater need for medication. The onset of nocturnal asthmatic attacks are less common in the first part of the night, eighty per cent of asthmatic ventilatory arrests occur between midnight and 8 a.m., and deaths from asthma are more common during these hours. In one study of asthma mortality, 79 percent of the patients who died had a sleep disturbance (arousal) prior to the terminal event. Also, circadian (day-night) variation in the intensity and frequency of late asthmatic responses to antigen have been observed, suggesting an enhancement in those events which regulate airway inflammation at night. The changes in asthma severity are believed to relate to sleep and/or circadian events that regulate airway inflammation.. The regulation of sleep involves complex cascades of biochemical events within the brain which are, in part, analogous to events involved in immune cell regulation. Evidence is accumulating that sleep regulation may share some of the inflammatory and immune events seen in asthma that are under circadian regulation. The consequences of circadian regulation have been shown to exaggerate other diseases and are likely to play a role in the pathogenesis of asthma. However, the roles of circadian rhythm and sleep regulation in asthma are unclear. Studies have not been conducted using paradigms such as "constant routine" or "forced desynchrony" to allow characterization of the relative role of circadian versus sleep factors in asthma. Other limited data suggests that both systems may play a role in these processes. This RFA seeks to encourage research designed to elucidate the cellular and molecular mechanisms underlying nocturnal asthma and its relationship with sleep and circadian events. Some research topics and issues that will be responsive to this program are listed below. These are only examples; applicants are encouraged to propose other topics that address the overall goals of this initiative. o Genetic regulation of nocturnal asthma is poorly understood. Not all individuals experience nighttime episodes of asthma. Who is susceptible for developing nocturnal asthma? Does it represent a more severe degree of "usual" asthma, or does it represent a distinct entity? o Inflammatory and immune events are now recognized as critical factors in the pathophysiology of asthma. What roles do inflammatory and immune events play in nocturnal asthma? Are the factors which produce, amplify, control and resolve inflammation regulated differently in nocturnal asthma? Are there differences in the cellular components (i.e., eosinophils, neutrophils, lymphocytes, macrophages, basophils), or their locations (i.e., airspace, bronchial mucosa, pulmonary tissue, or blood), which differentiate nocturnal asthma from other variants? Is nocturnal asthma a unique manifestation of inflammation, either in timing or character? Which inflammatory cells and mediators are most important in nocturnal asthma, and how can they be blocked most effectively? What are the specific biochemical markers which best reflect the inflammatory process in nocturnal asthma? What causes the increased allergen-related airway responsiveness at night? What are the mechanisms by which changes in inflammatory and immune function lead to airway hyperresponsiveness and obstruction in nocturnal asthma? o The level of airway inflammation as well as immune function vary with clock time. How are the immune and inflammatory processes turned on and off over the 24hr cycle? Are these changes in the inflammatory-immune system controlled by circadian events and/or the sleep/wake cycle? Studies are needed to separate the effect of circadian rhythm from sleep homeostasis on the immunology of the lung and lung function. o The "clock" gene which regulates chronobiologic phenomena has recently been identified. What are the mechanisms by which the central biologic "clock" and other possible genes interface with and control the immune-inflammatory cascade in nocturnal asthma? What are the circadian patterns of inflammatory regulatory cytokines, the source of these cytokines (brain or other areas), and the targets of these events? Is target susceptibility affected by the time of day versus sleep? o Are the circadian rhythms of proinflammatory cytokines in the brain affected by the occurrence of nocturnal asthma? Do central levels of proinflammatory cytokines alter lung physiology and pathology? Proinflammatory cytokines, such as interleukin-1 and tumor necrosis factor alpha, are involved in the physiologic regulation of non-rapid eye movement sleep. They also play a role in asthma. Do sleep pathologies result in altered central proinflammatory cytokine production and/or affect the severity of asthma? What other physiologic changes directly attributable to sleep/sleep pathologies promote the worsening of nocturnal asthma? What are the mechanisms involved? o It has been demonstrated that sleep promotes nocturnal increases in upper airway resistance similar to those in patients with nocturnal asthma. Sleep also leads to reductions in the volume of hyperinflated lungs in such patients. Are these effects mediated through a sleep-associated reduction in inspiratory muscle tone, a decrease in pulmonary compliance, a combination of both, or an alteration in events regulating airway inflammation? Also, how do sleep, time of day, or the synergism between these two parameters contribute to the development of airway inflammation and asthma? o Nitric oxide seems to be involved in the central somnogenic actions of cytokines, growth factor releasing hormone, and adenosine. Nitric oxide may also be involved in asthma. Are the molecular events involved in these phenomena similar? For example, is the production of inducible nitric oxide synthetase necessary for sleep and/or nocturnal asthma? o It is important to understand how the circadian rhythm of endogenous catecholamines and cortisol differ in persons with and without nocturnal asthma. What roles do endogenous and exogenous glucocorticoids, other hormones and neurohumoral mechanisms play in nocturnal asthma, and how do sleep disruptions due to asthma and/or asthma treatment affect the circadian rhythm of endogenous hormones? o Understanding rhythm dependency of medications (chronopharmacology) and knowing how to synchronize medications is essential for rational management of nocturnal asthma. This has already been shown with several asthma medications such as theophylline and corticosteroids. As newer drugs (such as leukotriene active drugs and others) for the treatment of asthma emerge, there is a need to explore their effectiveness in the treatment of nocturnal asthma. Do these medications improve nighttime symptoms, lung function, and decrease inflammation? What are the mechanisms of action of these drugs in relation to circadian patterns or sleep? Do they work by modifying the normal circadian rhythms of endogenous hormones, inflammatory cells and mediators, or through some other mechanism? THESE ARE EXAMPLES ONLY. INVESTIGATORS SHOULD NOT FEEL LIMITED TO THE SUBJECTS MENTIONED ABOVE AND ARE ENCOURAGED TO SUBMIT OTHER TOPICS PERTINENT TO THE OBJECTIVES OF THE RFA. SPECIAL REQUIREMENTS Applications that propose descriptive studies and do not contain hypothesis driven studies directed at understanding the mechanisms associated with nocturnal asthma and its relationship with sleep and/or circadian rhythms will not be responsive to the RFA. The principal focus of applications should be on human studies. Applicants who propose to test hypotheses in animal or in vitro models must demonstrate relevance to nocturnal asthma and its relationship with sleep and/or circadian rhythms in humans. Studies directed solely at sleep-related and/or circadian events, without relevance to nocturnal asthma, will not be responsive to this initiative. Multidisciplinary investigations bringing together investigators with expertise in asthma, immunology, sleep, and chronobiology are strongly encouraged. Large clinical studies or epidemiologic studies are not within the scope of this RFA. 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. Applicants should also include a statement in their application 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 follow 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 FOR GRANTS AND CONTRACTS, Volume 23, Number 11, March 18, 1994, available on the web at: https://grants.nih.gov/grants/guide/notice-files/not94-105.html. INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of the NIH that children (i.e., individuals under the age of 21) must be included in all human subjects research, conducted or supported by the NIH, unless there are scientific and ethical reasons not to include them. This policy applies to all initial (Type 1) applications submitted for receipt dates after October 1, 1998. All investigators proposing research involving human subjects should read the "NIH Policy and Guidelines on the Inclusion of Children as Participants in Research Involving Human Subjects" that was published in the NIH Guide for Grants and Contracts, March 6, 1998, and is available at the following URL address: https://grants.nih.gov/grants/guide/notice-files/not98-024.html. Investigators also may obtain copies of these policies 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 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 subsequent applications, 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 sent to the program staff listed under INQUIRIES by the letter of intent receipt date listed in the heading of this RFA. APPLICATION PROCEDURES The research grant application form PHS 398 (rev. 4/98) 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 and 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: GrantsInfo@nih.gov and on the Internet at https://grants.nih.gov/grants/forms.htm. Sample budgets and justification page will be provided upon request or following the submission of a letter of intent. The RFA label found in the PHS 398 (rev. 4/98) 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 (Nocturnal Asthma, Chronobiology and Sleep) and number (HL-99-011) must be typed on line 2 of the face page of the application form and the YES box must be marked. 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: o FACE PAGE As a reminder, Items 7 should be completed to indicated Modular Direct Costs requested and Items 8 should reflect Total Costs (Modular Direct plus F&A costs). o DETAILED BUDGET FOR THE INITIAL BUDGET PERIOD Do not complete Form Page 4-DD of the PHS 398 (rev 4/98). It is not required nor will it be accepted at the time of application. o BUDGET FOR THE ENTIRE PROPOSED PERIOD OF SUPPORT Do not complete the categorical budget tables on page 5-EE of the PHS 398 (rev. 4/98) Form. Only the requested total direct costs line for each year should 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 9 modules ($225,000 direct cost) per year may be requested for each R01 application. Applicants may request for up to four 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. o BUDGET JUSTIFICATION - Budget justifications should be provided under "Justifications" on Form Page 5-EE of the PHS 398. - 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. - Identify all consultants by name and organizational affiliation and describe the services to be performed. - 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. No specific costs for items or categories should be shown. o 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 of an award, the applicant will be requested to identify actual direct and facilities and administrative costs (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. o 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. - Complete the educational block at the top of the form page; - List current position(s) and those previous positions directly relevant to the application; - List selected peer-reviewed publications directly relevant to the proposed project, with full citation; - 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. o 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. o 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 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 must be sent to Dr. C. James Scheirer, at the address listed under INQUIRIES. APPLICATIONS MUST BE RECEIVED BY JUNE 16, 1999. 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 be reviewed for completeness by CSR and responsiveness by NHLBI. Incomplete and/or unresponsive applications will be returned to the applicant without further consideration. Applications that are complete and responsive to the RFA will be evaluated for scientific and technical merit by an appropriate peer review group convened by the NHLBI in accordance with the review criteria stated below. As part of the initial merit review, a process will be used by the initial review group in which applications receive a written critique and undergo a process in which only those applications deemed to have the highest scientific merit, generally the top half of the applications under review, will be discussed, assigned a priority score, and receive a second level review by the National Heart, Lung, and Blood Advisory Council (NHLBAC). Review Criteria The goals of NIH-supported research are to advance our understanding of biological systems, improve the control of disease, and enhance health. In the written comments, reviewers will be asked to discuss the following aspects of the application in order to judge the likelihood that the proposed research will have a substantial impact on the pursuit of these goals. Each of these criteria will be addressed and considered in the assigning the overall score, weighing them as appropriate for each application. Note that the application does not need to be strong in all categories to be judged to have major scientific impact and thus deserve a high priority score. For example, an investigator may propose to carry out important work that by its nature is not innovative but is essential to move a field forward.. 1) Significance. Does 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? In addition to the above criteria, in accordance with NIH policy, all applications will also be reviewed with respect to the following: o The adequacy of the research plans to include both genders, minorities and their subgroups, and children as appropriate for the scientific goals of the research. Plans for the recruitment and retention of subjects will also be evaluated. o The reasonableness of the proposed budget and duration in relation to the proposed research. o The adequacy of the proposed protection for humans, animals or the environment, to the extent that may be adversely affected by the project proposed in the application. The initial review group will also examine the provisions for the protection of human subjects and the safety of the research environment. The personnel category will be reviewed for appropriate staffing based on the requested percent effort and justification provided. 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. Schedule Letter of Intent Receipt Date: April 12, 1999 Application Receipt Date: June 16, 1999 Date of Initial Review: September/October 1999 Review by NHLB Advisory Council: February 10, 2000 Anticipated Award Date: April 1, 2000 AWARD CRITERIA Award criteria that will be used to make award decisions include: o Scientific merit (as determined by peer review) o Total costs of the proposed project and availability of funds o Programmatic priorities and program balance INQUIRIES Inquiries concerning this RFA are encouraged. Potential applicants may request sample budget pages as previously stated. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues to: Susan Banks-Schlegel, Ph.D. Division of Lung Diseases National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Room 10018, MSC 7952 Bethesda, MD 20892-7952 Telephone: (301) 435-0202 FAX: (301) 480-3557 Email: SchlegeS@gwgate.nhlbi.nih.gov James Kiley, Ph.D. Division of Lung Diseases National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Room 10018, MSC 7952 Bethesda, MD 20892-7952 Telephone: (301) 435-0202 FAX: (301) 480-3557 Email: KileyJ@gwgate.nhlbi.nih.gov Direct inquiries regarding review matters to: C. James Schreirer, Ph.D. 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: JS110J@nih.gov Direct inquiries regarding fiscal matters to: Raymond L. Zimmerman Division of Extramural Affairs National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Room 7154, MSC 7926 Bethesda, MD 20892-7926 Telephone: (301) 435-0171 FAX: (301) 480-3310 Email: ZimmermR@gwgate.nhlbi.nih.gov AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance, No. 93.838. Awards are made under authorization of the Public Health Service Act, Title IV, Part A (Public Law 78-410, 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 a Health Systems Agency Review. The PHS strongly encourages all grant 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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