HYPOVOLEMIC CIRCULATORY COLLAPSE: MECHANISMS AND OPPORTUNITIES TO IMPROVE
RESUSCITATION OUTCOMES
 
RELEASE DATE:  February 24, 2003
 
RFA NUMBER:  HL-03-015
 
National Heart Lung and Blood Institute (NHLBI)
 (http://www.nhlbi.nih.gov)
United States Army Medical Research and Materiel Command (USAMRMC) 
 (https://mrmc-www.army.mil/)
 
CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER(S):  93.837, 93.838, 
93.839, 12.420

LETTER OF INTENT RECEIPT DATE:  April 23, 2003

APPLICATION RECEIPT DATE:  May 23, 2003

THIS RFA CONTAINS THE FOLLOWING INFORMATION

o Purpose of this RFA
o Research Objectives
o Mechanism(s) of Support 
o Funds Available
o Eligible Institutions
o Individuals Eligible to Become Principal Investigators
o Special Requirements 
o Where to Send Inquiries
o Letter of Intent
o Submitting an Application
o Peer Review Process
o Review Criteria
o Receipt and Review Schedule
o Award Criteria
o Required Federal Citations

PURPOSE OF THIS RFA 

This initiative is intended to identify novel methods to improve 
resuscitation outcomes from severe blood loss and subsequent 
hypovolemic circulatory collapse.  Applications are sought that propose 
innovative research approaches to identify the molecular, cellular, and 
pathophysiologic response of the whole organism to hypovolemia and to 
apply results of such approaches to the identification of potential, 
new approaches to out-of-hospital resuscitation following severe
hypovolemia.
 
RESEARCH OBJECTIVES

Traumatic injury is the leading cause of death for individuals under 
age 44 in the United States.  Overall, trauma results in approximately 
150,000 deaths per year, and severe hypovolemia due to hemorrhage is a 
major factor in nearly half of those deaths.  Rapid response and early 
intervention are key to improving survival since approximately one 
third of trauma deaths occur out-of-hospital and severe blood loss is a 
major cause of deaths occurring within 4 hours of injury.

Current resuscitation strategies for hypovolemia due to severe blood 
loss typically include the immediate restoration of blood pressure 
through the use of intravenous fluids.  However, results from recent 
animal studies suggest that rapid, high volume replacement during 
resuscitation often exacerbates bleeding and may result in increased 
mortality compared to either low volume or delayed fluid replacement.  
Clinical trial findings indicate that survival is not worsened, and may 
be improved, by limiting the initial fluid resuscitation, either by 
delaying the initiation or by titrating to a low systolic blood 
pressure (70 mmHg), so called permissive hypotensive resuscitation 
techniques.  Another promising approach to fluid resuscitation appears 
to be the use of hypertonic saline solutions that require lower volumes 
of fluid and may have beneficial immuno-modulatory effects. 

Beyond these relatively straightforward approaches, initial patient 
management following severe blood loss is complicated by the fact that 
a number of individuals with severe blood loss do not respond to fluid 
restoration and/or the use of agents that increase vasomotor activity 
and peripheral resistance.  These individuals have transitioned from 
reversible hypovolemia to hypovolemic circulatory collapse, and their 
resuscitation outcomes are dismal.

Although the factors that contribute to the transition from reversible 
hypovolemia to circulatory collapse are not known, they likely include 
those associated with ischemia and reperfusion injuries.  The response 
to volume loss consists of biphasic opposing actions that include 
activation of sympathetic and parasympathetic neural reflexes and 
stimulation of inflammatory and anti-inflammatory cytokine pathways.  
Thus there is release of epinephrine and norepinephrine as well as TNF-
alpha and interleukins.  These substances, in turn, may induce vascular 
decompensation, capillary leak, and organ dysfunction (for example, 
induction of severe bradycardia unresponsive to pharmacological 
intervention).  These cascades of opposing events, and the balance 
between them, most likely contribute to development of hypovolemic 
circulatory collapse.  The relative and direct contribution of 
different pathways to the development of circulatory collapse is 
unknown.  Understanding mechanisms and developing approaches that 
improve hypovolemic circulatory collapse resuscitation outcomes is the 
primary goal of this initiative.  Applications must clearly define the 
relationship of the proposed studies to successful out-of-hospital 
resuscitation. 

Both the National Heart, Lung, and Blood Institute (NHLBI) and United 
States Army Medical Research and Materiel Command (USAMRMC) have taken 
leadership roles in promoting resuscitation research through the 
organization of and continued involvement in the Post-Resuscitation and 
Initial Utility in Life Saving Efforts (PULSE) workshop.  This research 
initiative is one expression of this ongoing partnership and represents 
a needed step for improving both civilian and military resuscitation 
outcomes.

An understanding is needed of the relative roles of perfusion pressure, 
organs and organ systems (including the lung, heart, and vasculature), 
as well as neurohumoral and other local and systemic responses to 
sudden or severe blood loss that contribute to circulatory collapse and 
poor resuscitation outcomes.  Studies should focus on relating results 
to the whole organism, and should be placed into the context of the 
potential for improving resuscitation outcomes. Responsive applications 
will include the use of appropriate mammalian models to characterize 
the early response to severe blood volume loss and transition to 
circulatory collapse.  Clinical research of a mechanistic or 
observational nature using human subjects may be involved, in 
controlled conditions as during surgical procedures associated with 
massive blood loss; interventional studies in humans will NOT be 
considered responsive. 

Research Areas

Examples of research that might address the response to exsanguination 
and the failure of fluid replacement resuscitation following severe 
hypovolemia and the transition to circulatory collapse are listed 
below. This list is not exhaustive and investigators are encouraged to 
develop additional approaches.  They are encouraged to discuss these 
with NHLBI and USAMRMC staff identified in the WHERE TO SEND INQUIRIES 
section. 

o Use of genomics and proteomics, as well as traditional research 
approaches, to characterize the molecular and physiologic alterations 
involved in the transition between reversible hypovolemia and 
circulatory collapse.

o Identification of factors such as the extent and rate of volume loss, 
nature of injury (i.e. blunt versus penetrating trauma), and 
environmental determinants (e.g., ambient temperature, 'response' 
times) that contribute to the transition between reversible hypovolemia 
and circulatory collapse.

o The use of integrated systems biology, or other high-order systems 
approaches, to elucidate the influence of individual organs or organ 
systems in mediating microcirculatory dysfunction, capillary leak, and 
circulatory collapse.

o Identification and evaluation in animal models of novel interventions 
to delay or prevent the onset of hypovolemic circulatory collapse.

o The identification of markers for successful out-of-hospital 
resuscitation in a setting of severe blood loss.

o Elucidation of autonomic factors contributing to the transition from 
reversible hypovolemia to circulatory collapse. 
 
MECHANISM OF SUPPORT
 
This RFA will use the NIH R01 award mechanism.  As an applicant you 
will be solely responsible for planning, directing, and executing the 
proposed project.  This RFA is a one-time solicitation.  Future 
unsolicited, competing-continuation applications based on this project 
will compete with all investigator-initiated applications and will be 
reviewed according to the customary peer review procedures. The 
anticipated award date is April 1, 2004.  Applications that are not 
funded in the competition described in this RFA may be resubmitted as 
NEW investigator-initiated applications using the standard receipt 
dates for NEW applications described in the instructions to the PHS 398 
application.

This RFA uses just-in-time concepts.  It also uses the modular 
budgeting format.
(see http://grants.nih.gov/grants/funding/modular/modular.htm).   
Specifically, if you are submitting an application with direct costs in 
each year of $250,000 or less, use the modular format.  This program 
does not require cost sharing as defined in the current NIH Grants 
Policy Statement at 
http://grants.nih.gov/grants/policy/nihgps_2001/part_i_1.htm.

FUNDS AVAILABLE
 
The NHLBI and USAMRMC each intend to commit approximately $2 million in 
FY 2004 to fund 10 to 12 new grants in response to this RFA. An 
applicant may request a project period of up to 4 years and a budget 
for direct costs of up to $250,000 per year. Because the nature and 
scope of the proposed research will vary from application to 
application, it is anticipated that the size and duration of each award 
will also vary. Although the financial plans of the NHLBI and USAMRMC 
provide support for this program, awards pursuant to this RFA are 
contingent upon the availability of funds and the receipt of a 
sufficient number of meritorious applications.

Since the total costs for a subcontract or consortium are included in 
the direct cost request, one additional module of $25,000 above the cap 
may be requested for the facilities and administrative costs associated 
with third party agreements.  A module requested for this purpose must 
be clearly identified in the budget justification section of the 
application, and will be restricted for this purpose only at the time 
of award.
 
ELIGIBLE INSTITUTIONS
 
You may submit (an) application(s) if your institution has any of the 
following characteristics:

o For-profit or non-profit organizations 
o Public or private institutions, such as universities, colleges, 
hospitals, and laboratories 
o Units of State and local governments
o Eligible agencies of the Federal government  
o Domestic or foreign
o Faith-based or community-based organizations
 
INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS   

Any individual with the skills, knowledge, and resources necessary to 
carry out the proposed research is invited to work with their 
institution to develop an application for support.  Individuals from 
underrepresented racial and ethnic groups as well as individuals with 
disabilities are always encouraged to apply for NIH programs.   
 
SPECIAL REQUIREMENTS 
 
For applications to be considered responsive to this RFA, the proposed 
studies must address the transition between reversible hypovolemia and 
circulatory collapse following severe blood loss.  Studies 
investigating the development of multi-organ failure or sepsis will not 
be considered responsive and will be returned to the applicant without 
further consideration.  

Proposed studies may involve human subjects research of a mechanistic 
nature and only in a controlled environment (i.e. identification of 
biomarkers in surgery with severe blood loss). Clinical trials and 
human interventional studies are beyond the scope of this initiative 
and will be considered non-responsive.  For those studies involving 
observational studies with human subjects, a data and safety monitoring 
plan is required.  More information is available on the NHLBI web site 
at http://www.nhlbi.nih.gov/funding/policies/index.htm under the 
section entitled NHLBI Clinical Research.
 
In addition to annual progress reports, the Principal Investigators of 
the grants funded under this RFA will be expected to attend and 
participate in yearly grantee meetings to present the findings of the 
research supported and to suggest future research directions.  Funds 
for travel to such meetings must be incorporated into the standard NIH 
travel allowance for Principal Investigators.  For planning purposes, 
assume the meetings will be held in Bethesda, MD.

General Clinical Research Centers

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 from either the GCRC program 
director or principal investigator should be included with the 
application. 

WHERE TO SEND INQUIRIES

We encourage inquiries concerning this RFA and welcome the opportunity 
to answer questions from potential applicants.  Inquiries may fall into 
three areas:  scientific/research, peer review, and financial or grants 
management issues:

o Direct your questions about scientific/research issues to:

David M. Balshaw, Ph.D.
Division of Heart and Vascular Diseases
National Heart Lung and Blood Institute
6701 Rockledge Dr., Room 9194 (MSC 7940)
Bethesda, MD 20892-7940 (20817 for Courier)
Telephone:  (301) 435-0504
FAX:  (301) 480-1454
Email:  BalshawD@nhlbi.nih.gov

Andrea Harabin, Ph.D.
Division of Lung Diseases
National Heart Lung and Blood Institute
6701 Rockledge Dr., Room 10124 (MSC 7952)
Bethesda, MD 20892-7952 (20817 for Courier)
Telephone:  (301) 435-0222
FAX:  (301) 480-3557
Email:  HarabinA@nhlbi.nih.gov

George Nemo, Ph.D.
Division of Blood Diseases and Resources
National Heart Lung and Blood Institute
6701 Rockledge Dr., Room 10142 (MSC 7950)
Bethesda, MD 20892-7950 (20817 for Courier)
Telephone:  (301) 435-0075
FAX:  (301) 480-0868
Email:  NemoG@nhlbi.nih.gov

Col. Robert Vandre, DDS
Combat Casualty Care Research
United States Army Medical Research and Materiel Command
504 Scott St
Ft. Detrick, MD 21702-5012
Telephone:  (301) 619-7919
FAX:  (301) 619-7067
Email:  Robert.Vandre@det.amedd.army.mil

o Direct your questions about peer review issues to:

Anne P. Clark, Ph.D.
Chief, Review Branch
Division of Extramural Affairs
National Heart, Lung, and Blood Institute 
6701 Rockledge Drive 7214, MSC 7924
Bethesda, MD 20892-7924 (20817 for express/courier service)
Telephone:  (301)435-0270 
FAX:  (301)480-0730
Email:  ClarkA@nhlbi.nih.gov

o Direct your questions about financial or grants management matters 
to:

Robert Vinson
Grants Management Specialist
Division of Extramural Affairs
National Heart, Lung, and Blood Institute
6701 Rockledge Drive 7156, MSC 7926
Bethesda, MD 20892-7926 (20817 for express)
Telephone:  (301) 435-0166
FAX:  (301) 480-3310
Email:  VinsonR@nhlbi.nih.gov 
 
LETTER OF INTENT
 
Prospective applicants are asked to submit a letter of intent that 
includes the following information:

o Descriptive title of the proposed research
o Name, address, and telephone number of the Principal Investigator
o Names of other key personnel 
o Participating institutions
o Number and title of this RFA 

Although a letter of intent is not required, is not binding, and does 
not enter into the review of a subsequent application, the information 
that it contains allows IC staff to estimate the potential review 
workload and plan the review.
 
The letter of intent is to be sent by the date listed at the beginning 
of this document.  The letter of intent should be sent to Dr. Anne 
Clark at the address listed under WHERE TO SEND INQUIRIES.

SUBMITTING AN APPLICATION

Applications must be prepared using the PHS 398 research grant 
application instructions and forms (rev. 5/2001).  The PHS 398 is 
available at http://grants.nih.gov/grants/funding/phs398/phs398.html in 
an interactive format.  For further assistance contact GrantsInfo, 
Telephone (301) 435-0714, Email: GrantsInfo@nih.gov.
 
SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS: All applications 
must be submitted in a modular grant format.  The modular grant format 
simplifies the preparation of the budget in these applications by 
limiting the level of budgetary detail. Applications requesting one 
module ($25,000) above the cap due to subcontract or consortium 
facilities and administrative costs associated with third party 
agreements must also be submitted in modular format and may request up 
to $275,000 per year in direct costs. Applicants request direct costs 
in $25,000 modules.  Section C of the research grant application 
instructions for the PHS 398 (rev. 5/2001) at 
http://grants.nih.gov/grants/funding/phs398/phs398.html includes step-
by-step guidance for preparing modular grants.  Additional information 
on modular grants is available at 
http://grants.nih.gov/grants/funding/modular/modular.htm.

USING THE RFA LABEL: The RFA label available in the PHS 398 (rev. 
5/2001) application form must be affixed to the bottom of the face page 
of the application.  Type the RFA number on the label.  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 and number must be typed on line 2 of the face 
page of the application form and the YES box must be marked. The RFA 
label is also available at: 
http://grants.nih.gov/grants/funding/phs398/label-bk.pdf.
 
SENDING AN APPLICATION TO THE NIH: Submit a signed, typewritten 
original of the application, including the Checklist, 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 and 
all five collated sets of appendix material must be sent to Dr. Anne 
Clark at the address listed under WHERE TO SEND INQUIRIES.
 
Please note that applications delivered by individuals are no longer 
accepted; all applications must either come via courier delivery or the 
United States Postal Service 
(http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-012.html).
 
APPLICATION PROCESSING: Applications must be received on or before the 
application receipt date listed in the heading of this RFA.  If an 
application is received after that date, it will be returned to the 
applicant without review. 

Although there is no immediate acknowledgement of the receipt of an 
application, applicants are generally notified of the review and 
funding assignment within 8 weeks.

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.  However, when a previously unfunded application, 
originally submitted as an investigator-initiated application, is to be 
submitted in response to an RFA, it is to be prepared as a NEW 
application.  That is the application for the RFA must not include an 
Introduction describing the changes and improvements made, and the text 
must not be marked to indicate the changes.  While the investigator may 
still benefit from the previous review, the RFA application is not to 
state explicitly how.

Principal investigators should not send supplementary material without 
first contacting the Scientific Review Administrator (SRA).  The SRA 
will be identified in the letter sent to you indicating that your 
application has been received.
 
PEER REVIEW PROCESS  
 
Upon receipt, applications will be reviewed for completeness by the CSR 
and responsiveness by the NHLBI and the USAMRMC.  

Incomplete applications will be returned to the applicant without 
further consideration.  And, if the application is not responsive to 
the RFA, CSR staff may 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 appropriate NIH 
review cycle.

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, all 
applications will:

o Receive a written critique
o 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 and assigned a priority score
o Receive a second level review by the NHLBI National Advisory Council.
 
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 your application in order to judge the likelihood 
that the proposed research will have a substantial impact on the 
pursuit of these goals: 

o Significance 
o Approach 
o Innovation
o Investigator
o Environment

The scientific review group will address and consider each of these 
criteria in assigning your application's overall score, weighting them 
as appropriate for each application.  Your application does not need to 
be strong in all categories to be judged likely to have major 
scientific impact and thus deserve a high priority score.  For example, 
you 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 your study address an important problem? If the 
aims of your application are achieved, how do they advance scientific 
knowledge?  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?  Do you acknowledge potential problem areas and 
consider alternative tactics?

(3) INNOVATION:  Does your project employ novel concepts, approaches or 
methods? Are the aims original and innovative?  Does your project 
challenge existing paradigms or develop new methodologies or 
technologies?

(4) INVESTIGATOR: Are you appropriately trained and well suited to 
carry out this work?  Is the work proposed appropriate to your 
experience level as the principal investigator and to that of other 
researchers (if any)?

(5) ENVIRONMENT:  Does the scientific environment in which your 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?

ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, the 
following items will be considered in the determination of scientific 
merit and the priority score:

o PROTECTIONS:  The adequacy of the proposed protection for humans, 
animals, or the environment, to the extent they may be adversely 
affected by the project proposed in the application.

o INCLUSION:  The adequacy of plans to include subjects from both 
genders, all racial and ethnic groups (and subgroups), and children as 
appropriate for the scientific goals of the research.  Plans for the 
recruitment and retention of subjects will also be evaluated. (See 
Inclusion Criteria included in the section on Federal Citations, below)

o BUDGET:  The reasonableness of the proposed budget and the requested 
period of support in relation to the proposed research.

RECEIPT AND REVIEW SCHEDULE

Letter of Intent Receipt Date:  April 23, 2003
Application Receipt Date:  May 23, 2003 
Peer Review Date:  October, 2003
Council Review:  February 12, 2004
Earliest Anticipated Start Date:  April 1, 2004

AWARD CRITERIA

Award criteria that will be used to make award decisions include:

o Scientific merit (as determined by peer review)
o Availability of funds
o Programmatic priorities.
 
REQUIRED FEDERAL CITATIONS

INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: It is the 
policy of the NIH that women and members of minority groups and their 
sub-populations must be included in all NIH-supported clinical research 
projects unless a clear and compelling justification is provided 
indicating 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 clinical research should read the AMENDMENT 
"NIH Guidelines for Inclusion of Women and Minorities as Subjects in 
Clinical Research - Amended, October, 2001," published in the NIH Guide 
for Grants and Contracts on October 9, 2001 
(http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html);
a complete copy of the updated Guidelines are available at 
http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_
2001.htm.  The amended policy incorporates: the use of an NIH definition 
of clinical research; updated racial and ethnic categories in 
compliance with the new OMB standards; clarification of language 
governing NIH-defined Phase III clinical trials consistent with the new 
PHS Form 398; and updated roles and responsibilities of NIH staff and 
the extramural community.  The policy continues to require for all NIH-
defined Phase III clinical trials that: a) all applications or 
proposals and/or protocols must provide a description of plans to 
conduct analyses, as appropriate, to address differences by sex/gender 
and/or racial/ethnic groups, including subgroups if applicable; and b) 
investigators must report annual accrual and progress in conducting 
analyses, as appropriate, by sex/gender and/or racial/ethnic group 
differences.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN 
SUBJECTS:  The NIH maintains a policy 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 is available at 
http://grants.nih.gov/grants/funding/children/children.htm.

REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS: NIH 
policy requires education on the protection of human subject 
participants for all investigators submitting NIH proposals for 
research involving human subjects.  You will find this policy 
announcement in the NIH Guide for Grants and Contracts Announcement, 
dated June 5, 2000, at
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: 
The Office of Management and Budget (OMB) Circular A-110 has been 
revised to provide public access to research data through the Freedom 
of Information Act (FOIA) under some circumstances.  Data that are (1) 
first produced in a project that is supported in whole or in part with 
Federal funds and (2) cited publicly and officially by a Federal agency 
in support of an action that has the force and effect of law (i.e., a 
regulation) may be accessed through FOIA.  It is important for 
applicants to understand the basic scope of this amendment.  NIH has 
provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.

Applicants may wish to place data collected under this RFA in a public 
archive, which can provide protections for the data and manage the 
distribution for an indefinite period of time.  If so, the application 
should include a description of the archiving plan in the study design 
and include information about this in the budget justification section 
of the application. In addition, applicants should think about how to 
structure informed consent statements and other human subjects 
procedures given the potential for wider use of data collected under 
this award.

URLs IN NIH GRANT APPLICATIONS OR APPENDICES: All applications and 
proposals for NIH funding must be self-contained within specified page 
limitations. Unless otherwise specified in an NIH solicitation, 
Internet addresses (URLs) should not be used to provide information 
necessary to the review because reviewers are under no obligation to 
view the Internet sites.   Furthermore, we caution reviewers that their 
anonymity may be compromised when they directly access an Internet site.

HEALTHY PEOPLE 2010: The Public Health Service (PHS) is committed to 
achieving the health promotion and disease prevention objectives of 
"Healthy People 2010," a PHS-led national activity for setting priority 
areas. This RFA is related to one or more of the priority areas. 
Potential applicants may obtain a copy of "Healthy People 2010" at 
http://www.health.gov/healthypeople.

AUTHORITY AND REGULATIONS: This program is described in the Catalog of 
Federal Domestic Assistance at http://www.cfda.gov/ and is not subject 
to the intergovernmental review requirements of Executive Order 12372 
or Health Systems Agency review.  Awards are made under the 
authorization of Sections 301 and 405 of the Public Health Service Act 
as amended (42 USC 241 and 284) and under Federal Regulations 42 CFR 52 
and 45 CFR Parts 74 and 92.  Awards by the USAMRMC are made under the 
authority of 10 USC 2358.  All awards are subject to the terms and 
conditions, cost principles, and other considerations described in the 
NIH Grants Policy Statement.  The NIH Grants Policy Statement can be 
found at http://grants.nih.gov/grants/policy/policy.htm.
 
The PHS strongly encourages all grant recipients to provide a smoke-
free workplace and discourage the 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.

Weekly TOC for this Announcement
NIH Funding Opportunities and Notices

	Office of Extramural Research (OER)			National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892			Department of Health and Human Services (HHS)
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