COOK COUNTY BUREAU OF HEALTH
SERVICES
GRANTS NEWSLETTER
Volume 6, Number 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~February,
1998
Back Issues
Published by
OFFICE OF RESEARCH DEVELOPMENT
Hektoen Building
627 South Wood Street
Chicago, IL 60612
FAX: 312-738-3102
Karen M. Smith, PhD, Director
312-633-4940
email: kmsmith@wwa.com
Bennetta Anderson, Administrative Assistant
312-633-4941
Lillian Hampton, IRB Administrator
312-633-7792
email: lhampton@hektoen.org
Funeka Sihlali, RN, Scientific Quality Coordinator
312-572-3506
email: fsihlali@hektoen.org
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COOK COUNTY BOARD
OF
COMMISSIONERS
John H. Stroger, Jr.,
President
|
Jerry
Butler
Allan C. Carr
Earlean Collins
John P. Daley
Gregg Goslin
Carl R. Hansen
Ted Lechowicz
Roberto Maldonado |
William R. Moran
Joseph Mario Moreno
Mike Quigley
Herbert T. Schumann, Jr.
Peter N. Silvestri
Deborah Sims
Bobbie L. Steele
Calvin R. Sutker |
COOK COUNTY BUREAU OF HEALTH
SERVICES
Ruth M. Rothstein, Chief
Affiliates
Ambulatory & Community Health Network
of Cook County
Cermak Health Services of Cook County
Cook County Department of Public Health
Cook County Hospital
Oak Forest Hospital of Cook County
Provident Hospital of Cook County
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WHEN DO YOU NEED A SCIENTIFIC COMMITTEE REVIEW?
Suppose you would like to do a retrospective review of patients' charts
to determine if some aspect of their treatment is correlated with their
clinical outcomes. Do you need to apply to your Scientific Committee (also
known as the IRB) for approval? The answer to this question is a resounding
maybe. There are several criteria for deciding if you need to approach
the IRB at all, if can ask for an exemption from review, or if your project
must be reviewed.
First, is this a research project? The methods described in the example
could be used either to carry out a Quality Assurance (QA) study or to
do a research project. The crucial question is: Why do you want to compile
the data? If your only concern is to improve services within your institution,
and the only recipients of the results will be others at that institution,
then this is most likely a QA study. In that case, you need not contact
the IRB at all.
If, on the other hand, your purpose in doing the study is to generate
generalizable knowledge, which might be applicable in other institutions,
in other settings or with somewhat different populations, then you are
doing research. Research projects must either be reviewed or be declared
exempt from review.
The major characteristic that distinguishes non-research studies from
research is the intended generalizability of the knowledge to be gained
(see definition on next page). One hallmark of generalizable knowledge
is the investigator's intention to publish the results.
When Research Is Exempt from Review
All studies of humans which are undertaken to gain generalizable knowledge
(that is, research studies) must either be reviewed by the Scientific Committee
(IRB) or be found to be exempt from review. The language of the federal
regulations describing what research may be exempt from review is given
at the end of this article.
Among the characteristics that distinguish exemptible from non-exemptible
research are: the degree of risk involved; use of prospective or retrospective
study design; the use of personal identifiers; and the characteristics
of the study population. Definitions of these criteria, as written by federal
regulators, are given in boxes throughout this article.
DEFINITIONS:
Research: (From 45CFR46 -Federal Policy for the Protection
of Human Subjects) Research means a systematic investigation, including
research development, testing and evaluation, designed to develop or contribute
to generalizable knowledge. Activities which meet this definition constitute
research for purposes of this policy, whether or not they are conducted
or supported under a program, which is considered research for other purposes.
For example, some demonstration and service programs may include research
activities.
Human Subject: (From 45CFR46 -Federal Policy for the
Protection of Human Subjects) Human subject means a living individual,
about whom an investigator (whether professional or student) conducting
research obtains:
1. Data through intervention or interaction with the individual, or
2. Identifiable private information.
Intervention includes both physical procedures, by which data are gathered
(for example, venipuncture), and manipulations of the subject or the subject's
environment that are performed for research purposes. Interaction includes
communication or interpersonal contact between investigator and subject.
Minimal Risk:
(From 45CFR46 -Federal Policy for the Protection of Human Subjects)
Minimal risk means that the probability and magnitude of harm or discomfort
anticipated in the research are not greater in and of themselves than those
ordinarily encountered in daily life or during the performance of routine
physical or psychological examinations or tests.
Prospective Studies:
(excerpt from the OPRR IRB Guidebook) Studies designed to observe outcomes
or events that occur subsequent to the identification of the group of subjects
to be studied. Prospective studies need not involve manipulation or intervention
but may be purely observational or involve only the collection of data.
IRBs should note that prospective studies do not qualify for exemption
under Federal Policy 45 CFR 46.101(b)(4) because the data or specimens
are not extant at the time the study begins.
Retrospective Studies:
(excerpt from the OPRR IRB Guidebook) Research conducted by reviewing
records from the past (e.g., birth and death certificates, medical records,
school records or employment records) or by obtaining information about
past events elicited through interviews or surveys. Case control studies
are an example of this type of research.
Identifiable Private Information:
(From 45CFR46 -Federal Policy for the Protection of Human Subjects)
Private information includes information about behavior that occurs in
a context, in which an individual can reasonably expect that no observation
or recording is taking place, and information, which has been provided
for specific purposes by an individual and which the individual can reasonably
expect will not be made public (for example, a medical record). Private
information must be individually identifiable (i.e., the identity of the
subject is or may readily be ascertained by the investigator or associated
with the information), in order for obtaining the information to constitute
research involving human subjects. IRB to be clinically routine, and therefore
minimal risk. In contrast, when prisoners (or jail detainees) are to be
enrolled in research, the standard for minimal risk is not the set of risks
routinely encountered in prison, but rather the risks typical of a nonprisoner's
life.
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Minimal Risk:
For a research project to be exempt from review, it must entail minimal
risk for study subjects. If the protocol calls for any increase over the
risk normally encountered in the setting in which the research takes place,
it cannot be exempt. In practical terms, this means that procedures performed
during routine physical examinations, such as measurement of blood pressure,
are considered minimal risk, even though this is a relatively rare occurrence
in the everyday life of most people. Even mildly invasive procedures, such
as a blood draw, might be considered minimal risk if they are part of a
routine exam.
On the other hand, a procedure that might be clinically routine for
a particular class of patient -- e.g., endoscopy for persons with gastric
ulcers -- would not be considered minimal risk because it is not routine
for patients in general.
Minimal risk also has different shades of meaning depending on the
characteristics of the study population. In fetal research, for instance,
ultrasound or even amniocentesis might be judged minimally risky by an
IRB.
Retrospective vs Prospective Research
One of the most frequent uses of exemption from review is for retrospective
studies of information originally gathered for clinical purposes. Retrospective
reviews can be a fertile source of hypotheses about clinical outcomes and
practice, which can then be employed in controlled prospective research.
The key point about retrospective research is that the data must already
exist (be "on the shelf") when the research begins. If the information
is not already extant, then the study is not truly retrospective.
Since very few types of prospective designs are eligible for exemption,
a study in which some or all of the data has yet to be gathered will likely
be subject to review, and will often require the patient's prior consent.
It would not be considered a legitimate practice to initiate a new method,
procedure, intervention, etc. with an eye to developing generalizable knowledge
(that is to say, to publish the results) before getting IRB approval, or
without the patients' informed consent, and then summarize the results
in a "retrospective" study.
Identifiable Private Information
Patients who provide information to clinicians have every expectation
that this information is collected solely for their own treatment, and
will therefore remain confidential and private. If, subsequent to its collection,
the clinician wishes to use this information retrospectively for research
purposes every effort must be made to dissociate the information from the
patients' identities. This can be accomplished by using an alphanumeric
code to distinguish individuals and omitting identifiers from the research
data sheets -- omitting not only names, but also addresses, phone numbers,
medical record numbers, etc. Identifying patients by their initials is
not an adequate removal of identification. Ideally, once the data has been
compiled, any list that links the identification codes to patient names,
medical record numbers or other identifiers will be destroyed.
Obviously, any study that follows individual patients through time will
not be feasible without retaining personal identifiers. This kind of study
is not likely to be exempt from review.
Specific Populations
It was noted above that the meaning of "minimal risk" varies somewhat
depending on the population being studied. In addition, federal regulations
limit the use of exemptions from review for studies of some types of subjects:
Research involving pregnant women, fetuses or prisoners may not be exempted.
Survey or interview studies of children also cannot be exempted, unless
the study involves only observation of public behavior with no interaction
between the investigator and the child. In other words, an observational
study of playground behavior might be exempted, but an interview study
of children on the playground could not be.
"Minimal Risk" May Have Multiple Meanings
(excerpts from the OPRR IRB Guidebook)
For Children:
Assessing Probable Risks. Central to IRBs' consideration of research
involving children is the determination of what constitutes minimal risk.
Procedures that usually present no more than minimal risk to a healthy
child include: urinalyses, obtaining small blood samples, EEGs, allergy
scratch tests, minor changes in diet or daily routine, and/or the use of
standard psychological or educational tests. The assessment of the probability
and magnitude of the risk, however, may be different in sick children and
may vary depending on the diseases or conditions the subjects may have.
For example, obtaining blood samples from a hemophiliac child may present
more than minimal risk to the child.
On the other hand, IRBs may consider that children suffering from chronic
illnesses who are accustomed to invasive procedures are placed at minimal
risk by involvement in similar research procedures, in contrast to children
who have not had such experiences. The IRB must also consider the extent
to which research procedures would be a burden to any child, regardless
of whether the child is accustomed to the proposed procedures.
For Fetuses:
The primary requirement for approval in this category is an IRB determination
that the risk to the fetus is "minimal." The broad definition of minimal
risk places great responsibility for good judgment on IRB members. The
definition suggests that if the estimated risk to the fetus is no more
than that from established procedures routinely used in an uncomplicated
pregnancy or in a pregnancy with complications comparable to those being
studied, the risk is considered minimal. Ultrasound exams, maternal exercise
comparable to job- or recreation-related levels, amniocentesis, and delivery
in a sitting position might be considered minimally risky in most pregnancies.
For Prisoners:
Minimal Risk: Risk of physical or psychological harm that is no greater
in probability and severity than that ordinarily encountered in the daily
lives, or in the routine medical, dental or psychological examinations
of healthy persons [45 CFR 303(d)]. IRBs should note that this definition
differs somewhat from that given for noninstitutionalized, competent adults...
An understanding of minimal risk provided in 45 CFR 46 Subpart C is
critical. The risks to which prisoners may be exposed by participating
in the research is not compared with the risks 'normally encountered...by
prisoners,' but rather with risks 'normally encountered in the daily lives,
or in the routine medical, dental or psychological examinations of healthy
persons,' i.e. nonprisoners. Dubler and Sidel (1989) have argued that in
assessing risk, IRBs:
1. Ought not to use the risks that face prisoners in the prison
setting as the standard for acceptable risk;
2. Ought not to judge even apparently ordinary risks at face value
[e.g., confidentiality in prison is impossible to maintain];
3. Ought to allow only risks that are commensurate with those accepted
by nonprisoners...
Who Decides Which Projects Must Be Reviewed?
A key principle of both federal regulations and accepted research practice
is that investigators do not declare their own research exempt without
confirmation from a disinterested and knowledgeable official. The reasons
for this principle are obvious: There are several tests that a project
must pass to be considered exempt, and those tests are subject to interpretation.
When a project falls into a gray area, it is clearly better to have a person
without an interest in the research make the final determination.
For institutions that maintain a Multiple Project Assurance with the
federal government (see box on Page 7), this means that there must be a
standard procedure in place for validating claims of exemption, and a system
for keeping track of those exemptions.
At Cook County Hospital, the exemption procedure entails filling out
a one-page Request for Exemption, which the Chair or Co-Chair of the Scientific
Committee reviews. A response is made in writing of the approval (or non-approval
) of the exemption, along with the criteria under which the exemption is
made. This process takes a few days at most, and ensures that projects
are not misclassified as exempt when in fact they should be reviewed. The
procedure described applies to all research conducted at Cook County Hospital,
Hektoen Institute, and the Cermak Health Services. It is also used by investigators
in the Ambulatory & Community Health Network and the Cook County Department
of Public Health as needed.
The "CCH Guidelines for Research Investigators" can be picked up in
the Research Development Resource Room, 603 Durand, every weekday from
8:00 am to 4:00 pm. Any investigator from an affiliate that follows these
guidelines should read them thoroughly before beginning any research. Investigators
at Provident Hospital or Oak Forest Hospital should consult their own Scientific
Committee guidelines to find out how to request an exemption.
WHAT KINDS OF RESEARCH MAY BE EXEMPTED
The following excerpt from federal regulations (45 CFR Part 46) details
the criteria by which a project may qualify for exemption from review:
Unless otherwise required by Department or Agency heads, research activities
in which the only involvement of human subjects will be in one or more
of the following categories are exempt from this policy:
(1). Research conducted in established or commonly accepted
educational setting, involving normal educational practices, such as (I)
research on regular and special education instructional strategies, or
(ii) research on the effectiveness of or the comparison among instructional
techniques, curricula, or classroom management methods.
(2). Research involving the use of educational tests (cognitive, diagnostic,
aptitude, achievement), survey procedures, interview procedures or observation
of public behavior, unless:
(i) information obtained is recorded in such a manner that human subjects
can be identified, directly or through identifiers linked to the subjects;
and (ii) any disclosure of the human subjects' responses outside the research
could reasonably place the subjects at risk of criminal or civil liability
or be damaging to the subjects' financial standing, employability, or reputation.
(3) Research involving the use of educational tests (cognitive, diagnostic,
aptitude, achievement), survey procedures, interview procedures, or observation
public behavior that is not exempt under paragraph (b)(2) of this section,
if:
(i) the human subjects are elected or appointed public officials or
candidates for public office; or (ii) Federal statute(s) require(s) without
exception that the confidentiality of the personally identifiable information
will be maintained throughout the research and thereafter.
(4) Research involving the collection or study of existing data, documents,
records, pathological specimens, or diagnostic specimens, if these sources
are publicly available or if the information is recorded by the investigator
in such a manner that subjects cannot be identified, directly or through
identifiers linked to the subjects.
(5) Research and demonstration projects which are conducted by or subject
to the approval of Department or Agency heads, and which are designed to
study, evaluate, or otherwise examine: (i) Public benefit or service
programs;(ii) procedures for obtaining benefits or services under those
programs;(iii) possible changes in or alternatives to those programs or
procedures; or (iv) possible changes in methods or levels of payment for
benefits or services under those programs.
(6) Taste and food quality evaluation and consumer acceptance studies,(I)
if wholesome foods without additives are consumed or (ii) if a food is
consumed that contains a food ingredient at or environmental contaminant
at or below the level found to be safe, by the Food and Drug Administration
or approved by the Environmental Protection Agency or the Food Safety and
Inspection service of the U.S. Department of Agriculture.
WHO DECIDES WHAT IS EXEMPT?
(Excerpts from the Cook County Hospital/Hektoen Institute/Cermak Health
Services "Multiple Project Assurance of Compliance with DHHS Regulations
for Protection of Human Research Subjects". This document is included in
the CCH "Guidelines for Research Investigators", as is the Belmont Report,
referred to below.)
All human subject research which is exempt under Section 101(b)(1-6)
or 101(I) will be conducted in accordance with: (1) the Belmont Report,
(2) this institution's administrative procedures to ensure valid claims
of exemption, and (3) orderly accounting for such activities.
The Scientific Committee Chair or Co-Chair is responsible for reviewing
the preliminary determinations of exemption by investigators and supervisors
and for making the final determination based on Section 101 of the regulations.
Notice of concurrence for all exempt research will be promptly conveyed
in writing to the investigator. All nonexempt research will be forwarded
to the Scientific Committee (IRB).
Research investigators who intend to involve human research subjects
will not make the final determination of exemption from applicable Federal
regulations or provisions of this Assurance.
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SEMINARS, CONFERENCES, WORKSHOPS, ETC
[A long-term calendar showing most of the major academic medical society
meetings can be found on the web at: http://www.aamc.org/meetings/mjmtgcal.htm]
Medicare: National Changes, Local Implications is a one-day conference
sponsored by the Health and Medicine Policy Research Group. It will be
held March 10 in the Regal Knickerbocker Hotel in Chicago. For more information,
call 312-922-8057.
Prevention 98 is the Annual Meeting of the Association of Teachers of
Preventive Medicine and the American College of Preventive Medicine. It
will take place April 2-5 in San Francisco. For more information, call
202-466-2569.
Chicago & Great Lakes Health Services Research Forum: The second
annual meeting sponsored by local research entities will be held March
12-13 at the University of Chicago, Ida Noyes Hall. For more information
call Carolyn Martin at 847-256-1359.
Effective Teaching: Improving Your Skills and Effective Teaching: Problem-Based
Learning are two continuing education courses for health professions faculty
offered by the Allegheny University of the Health Sciences. These courses
will take place in Philadelphia on June 8-12, and June 15-19, respectively.
For more information call 215-762-6400.
Office of Research Development Workshops
These workshops are open to any County-affiliated investigator or grant-seeker.
Enrollment for some sessions is limited, so please register only for those
you will be able to attend.
Grant Writing Seminar:
Gives an overview of the entire process of developing a project
and applying for funding. Includes information on approaching both governmental
and private funders, describes an approach to developing grant budgets,
discusses stylistic and content issues that are frequent stumbling blocks
in writing grant applications.
Constructing a Grant Budget:
Covers many of the technical aspects of developing an accurate
time line and budget for a grant proposal.
What Are All These Forms? Interacting With the Scientific Committee:
Gives an orientation to procedures -- and the associated forms
-- used by the Scientific Committee to
ensure that patients are protected from undue risks in research. The
Bureau forms will be discussed, and new policies and changes in federal
regulations will be covered.
To register for any of these, call Bennetta Anderson at 312-633-4941.
If you would like to schedule one or more of these workshops in your Department
or at another site, please call Karen Smith at 633-4940.
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FUNDING OPPORTUNITIES
National Institutes of Health:
All NIH announcements from the past several years, including full
text versions of RFA's and PA's, can be reached on the web at: http://grants.nih.gov/grants/guide/index.html
To have the NIH Guide sent automatically to your e-mail address every
week, click on the LISTSERV link on this page and follow the instructions.
To ask specific questions about NIH grant programs, send e-mail to:
grantsinfo@nih.gov
NIH RFA'S AND RFP'S:
These are one time only opportunities. Call 312-633-4940 to check
for due dates or to get copies of full announcements
EFFECTS OF ALCOHOL ADVERTISING ON UNDERAGE DRINKING (RFA AA-98-002)
National Institute on Alcohol Abuse and Alcoholism
MYCOLOGY RESEARCH UNITS (RFA AI-98-002) National Institute of Allergy
and Infectious Diseases
MENTAL HEALTH RESEARCH FOR SURVIVORS OF TORTURE AND RELATED TRAUMA
(RFA MH-98-012) National Institute of Mental Health
ALZHEIMER'S DISEASE DATA COORDINATING CENTER (RFA AG-98-004) National
Institute on Aging
THE NIH OSTEOPOROSIS AND RELATED BONE DISEASES RESOURCE CENTER (RFA
AR-98-007) National Institute of Arthritis and Musculoskeletal and Skin
Diseases, National Institute on Aging, National Institute of Child Health
and Human Development, National Institute of Dental Research, National
Institute of Environmental Health Sciences, Office of Research on Women's
Health
TRANSITION TO INDEPENDENT POSITIONS (TIP) (RFA ES-98-001) National Institute
of Environmental Health Sciences
DRUG ABUSE PREVENTION AND COMMUNICATIONS RESEARCH (RFA DA-98-006)
National Institute on Drug Abuse
CYSTIC FIBROSIS RESEARCH CENTER (RFA DK-98-011) National Institute of
Diabetes and Digestive and Kidney Diseases
SPECIALIZED CENTERS OF RESEARCH IN ISCHEMIC HEART DISEASE (RFA HL-98-007)
National Heart, Lung, and Blood Institute, Office of Alternative Medicine
TROPICAL DISEASE RESEARCH UNITS (RFA AI-98-004) National Institute of
Allergy and Infectious Diseases
PEDIATRIC BRAIN TUMOR CLINICAL TRIALS CONSORTIUM (RFA CA-98-007)
National Cancer Institute
PEROXISOME PROLIFERATORS AND MECHANISMS OF CARCINOGENESIS
(RFA ES-98-003) National Institute of Environmental Health Sciences
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NIH PROGRAM ANNOUNCEMENTS
(PA'S): These are ongoing funding priorities, with due dates usually
October 1, February 1 and June 1 of each year. Note that HIV-related applications
are due January 2, May 1 and September. Past PA's, many of which are still
open, can be searched at the NIH
Guide web site.
DIET, LIFESTYLE AND CANCER IN U.S. SPECIAL POPULATIONS (PA-98-028) National
Cancer Institute
MOLECULAR AND CELLULAR BIOLOGY OF METASTATIC TUMOR CELLS (PA-98-029)
National Cancer Institute
SYMPTOM MANAGEMENT FOR CHRONIC NEUROLOGICAL CONDITIONS (PA-98-030) National
Institute of Nursing Research, National Institute on Aging, National Institute
of Child Health and Human Development, National Institute on Deafness and
Other Communication Disorders, National Institute of Neurological Disorders
and Stroke
METHODOLOGY AND MEASUREMENT IN THE BEHAVIORAL AND SOCIAL SCIENCES
(PA-98-031) National Institute on Aging, National Institute on Alcohol
Abuse and Alcoholism, National Cancer Institute, National Institute of
Child Health and Human Development, National Institute of Dental Research,
National Institute on Drug Abuse, National Institute of Mental Health,
National Institute of Nursing Research, National Heart, Lung, and Blood
Institute,Office of Behavioral and Social Sciences Research, Office of
Alternative Medicine
ROLE OF LIMBIC SYSTEM AND BRAIN ONTOGENY IN DRUG ABUSE (PA-98-032) National
Institute on Drug Abuse
ACUPUNCTURE CLINICAL TRIAL PILOT GRANTS (PAS-98-033) Office of Alternative
Medicine, National Cancer Institute, National Heart, Lung and Blood Institute,
National Institute of Dental Research, National Institute of Arthritis
and Musculoskeletal and Skin Disorders, National Institute of Neurological
Disorders and Stroke, National Institute on Drug Abuse, Agency for Health
Care Policy and Research
THE PATHOGENESIS OF CHRONIC SINUSITIS (PA-98-034) National Institute
of Allergy and Infectious Diseases, National Institute on Deafness and
Other Communication Disorders
NICHD CAREER TRANSITION AWARD (PAR-98-025) National Institute of Child
Health and Human Development
PILOT STUDIES TO DEVELOP NOVEL SYSTEMS FOR GENE DELIVERY (PAR-98-026)
National Institute of Diabetes and Digestive and Kidney Diseases, National
Institute of Mental Health
CANCER SURVIVORSHIP STUDIES IN ESTABLISHED EPIDEMIOLOGIC COHORTS
(PA-98-027) National Cancer Institute
OTHER OPPORTUNITIES
TBA
ARTS AND AT-RISK YOUTH, Office of Juvenile Justice and Delinquency
Prevention (202-307-5911)
TBA
COMMUNITY VOLUNTEER COORDINATOR PROGRAM,Office of Juvenile Justice
and Delinquency Prevention (202-307-5911)
TBA
LEARNING DISABILITIES AMONG AT-RISK JUVENILES,Office of Juvenile Justice
and Delinquency Prevention (202-307-5911)
TBA
FIELD-INITIATED RESEARCH, Office of Juvenile Justice and Delinquency
Prevention (202-307-5911)
April 1 (Bidders' Conferences March 10-12)
COMMUNITY PREVENTION OF ALCOHOL, TOBACCO OR DRUG ABUSE, Illinois Department
of Human Services (312-814-2148)
March 16 (Concept Paper)
VIOLENCE AGAINST WOMEN, National Institute of Justice (202-307-0145)
August 5 through September 30
PROSTATE CANCER RESEARCH, Milken Family Foundation (800-757-CURE)
April 20
ENVIRONMENTAL JUSTICE, Environmental Protection Agency (703-841-0483)
March 31, July 31, November 30
GENERAL HEALTHCARE, Max and Victoria Dreyfous Foundation (914-682-2008)
March 31
CHILDHOOD BLOOD LEAD SURVEILLANCE, Centers for Disease Control and
Prevention (770-488-7060)
July 1
HIV/AIDS SERVICES, Until There's a Cure Foundation (http://www.utac.org)
Open
CHILDREN'S HEALTH SERVICES, Dorothea Haus Ross Foundation (716-473-6006)
May 4
FAMILY VIOLENCE SERVICES, Agency for Children and Families (202-401-5529)
May 1
COMMUNITY FOOD AND NUTRITION, Agency for Children and Families (202-401-5333)
May 11
SUBSTANCE ABUSE AND MENTAL HEALTH CONFERENCE GRANTS, Substance Abuse
and Mental Health Services Administration (301-443-0553)
May 11
HIV/AIDS TREATMENT, ADHERENCE, HEALTH OUTCOMES AND COST STUDY, Substance
Abuse and Mental Health Services Administration (301-443-7817)
April 24
SERVICES FOR CHILDREN WITH DISABILITIES, Department of Education (202-260-9182)
May 15 (Letter of Intent)
PATIENT SAFETY RESEARCH, National Patient Safety Foundation (http://www.ama-assn.org/med-sci/npsf/main.htm)
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