Project Grant Applications Research Articles

ACEP-SAEM response to the National Institutes of Health (NIH) proposal to simplify the review framework for research project grant applications.

The Society for Academic Emergency Medicine (SAEM) and American College of Emergency Physicians (ACEP) are responding jointly to this request for information. SAEM and ACEP promote innovative and imaginative strategy development that will transform prehospital and emergent patient care. The National Institutes of Health (NIH) proposal to modify the current grant scoring system to prioritize these principles is a welcome change and we are supportive of these efforts. Focusing on research importance, feasibility, and scientific rigor will make it easier to interpret reviewer critiques and provide investigators with clearer information on score driving factors related to the science itself. While investigator and environment are important factors for successfully conducting research, reducing their overall importance may help with reducing bias and expanding the pool of meritorious applications. We also support combining significance and innovation into a single “importance” score, as the current format gives equal weight to innovation even though related sections tend to be brief. Furthermore, the existing significance section focuses largely on perceived need and scientific rationale with lesser consideration of the true magnitude of impact. Our societies are hopeful that by broadening the concept of overall importance, this new section can better weight funding decisions toward injuries and illnesses where improved outcomes would benefit the greatest number of people. We also agree that the current scoring system overly emphasizes an investigator's prior grant success and institutional reputation in determining an application's merit. Reliance on these factors detracts from the proposal's true “importance” and may perpetuate existing and ongoing challenges with the development and retention of junior investigators, including investigators from historically underrepresented groups. The proposed changes in this area will allow for increased emphasis on the development of highly novel or paradigm-shifting approaches to problems. Nonetheless, consideration of the capacity to execute the proposed work remains a critically important factor. The proposed method of scoring using a descriptive range of “fully capable” to “additional resources needed” deemphasizes quantitative scoring and we believe accomplishes the stated goals. However, we recommend specific clarification that the proposed scale reflects the entirety of the investigatory team (with due consideration of experience with prior collaboration). An important component of the current scoring system not addressed in the proposed changes is the handling of grant resubmissions. It is not clear why resubmissions have a written narrative that is score-driving and subject to bias. We recommend amending this process for each additional criteria to be marked yes or no as to “all major/moderate concerns appropriately addressed.” Reviewers could also have the option of describing “any new major/moderate concerns identified” in the resubmission process. Finally, while we recognize that these scoring revisions are important, we suggest that the NIH consider a more direct acknowledgment of our nation's need to fund a diverse pool of grant applicants. We believe the approach of the three-factor scoring system that emphasizes capability to perform the work is well aligned with this goal, but we would encourage the NIH to consider an explicit acknowledgment of ongoing disparities in our nation's health research programs addressed by these changes.

Program Project Grant Applications (NIDA)

Federal Grants & ContractsVolume 47, Issue 5 p. 7-8 Grants Alerts Program Project Grant Applications (NIDA) First published: 31 January 2023 https://doi.org/10.1002/fgc.32849Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume47, Issue52 February 2023Pages 7-8 RelatedInformation

My Baby's Movements: A Stepped-Wedge Cluster-Randomised Controlled Trial of a Fetal Movement Awareness Intervention to Reduce Stillbirths

Background: Maternal perception of decreased fetal movements (DFM) is associated with stillbirth. The My Baby’s Movements (MBM) trial aimed to evaluate the impact on stillbirth rates of a multifaceted awareness package for women and clinicians. Methods: A stepped wedge cluster randomised controlled trial was undertaken with 8 groups of 3-5 hospitals in Australia and New Zealand at four-monthly intervals, targeting women with a singleton pregnancy without major fetal anomaly at ≥28 weeks’ gestation. The primary outcome was stillbirth at ≥28 weeks’ gestation. Secondary outcomes included obstetric and neonatal outcomes. Analysis was undertaken using generalised linear mixed models controlling for calendar time, clustering, and hospital effects. Findings: From August 2016 to May 2019 there were 304,853 births with 290,219 meeting inclusion criteria: 150,079 in control and 140,140 in intervention periods. The stillbirth rate during the intervention was lower than the control period, although not statistically significant (2·2/1000 births versus 2·4, odds ratio [OR] 0·91, 95% Confidence Intervals [CI] 0·78-1·06, p=0·22). The decrease was larger across calendar time with 2·7/1000 in the first 18 months versus 2·0/1000 in the last 18 months (OR 0·74; 95% CI 0·63-0·86; p≤0·01). Adjusting for calendar time, stillbirth rates between the control and intervention periods were not significantly different: (aOR 1·18, 95% CI 0·93-1·50; p=0·18). No increase in obstetric intervention or adverse neonatal outcome was evident. Interpretation: The MBM intervention did not reduce stillbirths beyond the downward trend over time, suggesting hospitals may have implemented best practice in DFM management outside their randomisation schedule. Based on these findings, the role of interventions for raising awareness of DFM remains unclear. Trial Registration: ACTRN12614000291684. Funding Statement: National Health and Medical Research Council (NHMRC) Project Grant Application (APP1067363). Stillbirth Foundation Australia provided funding to develop the MBM application. Dr Glenn Gardener was provided a Betty McGrath Fellowship through the Mater Research Institute. Additional support was provided by Mater Foundation and the NHMRC Stillbirth Centre of Research Excellence. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Primary ethics approval was obtained from Mater Misericordiae Ltd Human Research Ethics Committee (EC00332) (MML HREC) in 2015. Further jurisdictional ethics approval was obtained from seven participating HRECs include the ACT Health, Northern Sydney Local Health District (NSLHD), Northern Territory Department of Health and Menzies School of Health Research, The Central Health and Disability Ethics Committee (NZ), Melbourne Health, and the Mercy Health. Governance clearance was obtained from all 26 sites involved in the trial.

The National Institutes of Health needs to better balance funding distributions among US institutions

The NIH is the federal steward of biomedical research in the United States. Taxpayers fund the NIH; the NIH supports research into the underlying biology, etiology, and treatment of diseases; and benefits of that research are returned to taxpayers. This is a large and complex enterprise, but at its core are two fundamental principles. The NIH is obligated to distribute its research grants and grant dollars in a fair and impartial manner among qualified investigators nationwide and to maximize the return on taxpayers’ investments. The NIH should rethink how it doles out funding. Studies indicate that research output does not grow linearly with the amount of research project grant support—and that the greatest rates of return are achieved with intermediate levels of funding. Image credit: Dave Cutler (artist). But to meet these obligations, the NIH must establish a better-balanced distribution of funding among institutions. Here, I describe why such changes are needed and propose a specific mechanism for how they could be implemented. The director of the NIH, Francis Collins, has recognized that “the US biomedical research workforce does not currently mirror the nation’s population demographically” and that “recruiting and retaining a diverse set of minds and approaches is vital to harnessing the complete intellectual capital of the nation” (1). These systemic problems stem, in part, from unequal access to NIH grant support among investigators grouped by race (2), gender (3), age (4), institution (5), and state (6). The differences in grant application success rates and award sizes among investigators grouped in various ways affect where the grant dollars go, leading to heavily skewed distributions of funding. For example, less than one in three applicants get any of their NIH research project grant applications funded over a five-year period (7), and among successful applicants, a small minority are strongly … [↵][1]1Email: WahlsWayneP{at}uams.edu. [1]: #xref-corresp-1-1

Association of National Institute of Child Health and Human Development Career Development Awards With Subsequent Research Project Grant Funding

Investing in the next generation of researchers is essential, as recently highlighted in the 21st Century Cures Act. From its inception, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) has supported training and career development to ensure a robust pipeline of investigators who are prepared to lead their respective fields of inquiry. In recent years, the NICHD has emphasized institutional over individual training awards to a greater degree than many other National Institutes of Health institutes of similar size. To evaluate the success of individuals supported by NICHD career development and training awards, as measured by subsequent application and receipt of independent National Institutes of Health research project grant funding. This retrospective cohort study identified 417 physician-scholars who were supported by NICHD career development awards between October 1, 1999, and September 30, 2001. This period was selected to allow adequate follow-up of research project grant applications and funding. Among these physician-scholars, 355 met inclusion criteria. The primary outcomes were the numbers of research project grant applications submitted and, of these, the numbers that were successfully funded. Among 355 physician-scientists, scholars who had an MD degree only and received a K award or both an individual K award and institutional K12 support were more likely than those who received only K12 support (individual K only vs institutional K12 only: odds ratio [OR], 4.86; 95% CI, 1.83-13.62; both K and K12 vs K12 only: OR, 3.19; 95% CI, 1.46-7.10) to apply for subsequent project grant funding (88.0% vs 82.8% vs 60.1%, respectively; P < .001) and to receive it (60.0% vs 60.9% vs 32.9%, respectively; P < .001). For physicians with both MD and PhD degrees, neither application nor funding rates were statistically significantly different whether their career development was supported by individual or institutional awards. Physician-scholars are more likely to apply for and receive a National Institutes of Health research grant if they are trained on an individual career development award, with or without an institutional training award. Based on the data, the NICHD intends to provide a greater proportion of its career development fund allocation to individual awards. The NICHD recognizes the importance of institutional awards and will continue to support them. The NICHD remains committed to training and intends to maintain its investment in training and career development awards going forward.

Grow Your ORCiD Profile

Do you have an ORCiD profile? You should. Do you know about ORCiD? If not, I suggest you investigate. ORCiD is the Open Researcher and Contributor ID and it provides you with a unique, personalized online profile where you can list publications and research grants and other legitimate academic outputs including blogs. The important aspect of ORCiD is that the information there can be verified; DOIs (Digital Object Identifiers) and URL (Uniform Resource Locator) links to articles are provided. For most major research grant funding bodies, a link can be provided whereby the grant could be verified if necessary. ORCiD provides you with a unique number that will follow you for the remainder of your career—and, in fact, beyond (even beyond your life)—and it can also be linked to Web of Science and your ResearcherID profile and Scopus so that citations and h-index can be checked. One incidental advantage of an ORCiD profile is that it survives name changes—for example, marriage or gender realignment—and it is a great bonus for people from regions where many people have the same name; for example, in the Far East and Middle East. One recent development is the capacity to download a QR code which can be copied and pasted into CVs and PowerPoint® presentations. If you are not convinced so far and not already creating your own ORCiD profile, then read on. In addition to the benefits of having an ORCiD profile, such as a verifiable and portable list of achievements, ORCiD may soon be a common and, indeed, compulsory feature of grant applications, manuscript submissions, and promotion procedures. Already, leading publishers are requesting that you provide your ORCiD number when you create a profile on their online submission systems. To do this, the process is protected by your ORCiD password so nobody else can use this number in the submission process. Therefore, it is an unambiguous identifier for you as an author. Furthermore, it is now becoming common to see the ORCiD logo and an author's number displayed next to their name in the by-line of published articles. In the online version, this provides a link whereby the profile of the author can be checked. Grant awarding bodies are also requesting that applicants provide their ORCiD number along with project grant applications. ORCiD is easy and free to use. It takes only a few minutes to set up a profile; articles already on ResearcherID and Scopus can be transferred across, others can be searched online or entered manually. ORCiD staff are working with groups and organizations to create “macros” that allow citations to be easily imported to your profile. You can “search and link” from various databases, such as CrossRef or EuropePMC, and more are in the works. Research grants can be found using ÜberWizard for ORCID. All data can be entered manually; your employment record must be entered this way. Of course, manual entry takes more time, but the profile does not all have to be completed all at once. Finally, there is provision to write, free text, a profile about yourself, your interests and achievements. The possibilities for using ORCiD are many and only restricted by the imagination of the user. The ORCiD logo and the QR code could be a useful addition to business cards so that people can easily check your profile. ORCiD may come to replace CVs in the process of applying for jobs. Instead of the varied online profiles—or none—of academic staff, a profile picture accompanied by a link to ORCiD and one to ResearcherID could simplify these considerably and obviate the need to update them and avoid having out-of-date and incomplete information on profile pages. Amidst a plethora of online platforms for recording and sharing achievements, some of which have already proven ephemeral, ORCiD is a genuine industry-wide attempt to create an international gold standard. ORCiD is a club to which anyone can belong. I am sure that it will be considered unusual—or simply obstinate—in the near future, in academia, not to have an ORCiD profile. Finished yours yet? Roger Watson, PhD, FAAN, FRCN is Editor-in-Chief, Journal of Advanced Nursing; Editor, Nursing Open, and Professor of Nursing, University of Hull, UK. He is also a member of the Authors-in-Residence for Nurse Author & Editor. Contact Roger by email: r.watson@hull.ac.uk and follow him on Twitter: @rwatson1955. His ORCiD ID is orcid.org/0000–0001–8040–7625

Time to research Australian female physician-researchers.

Given the concerns that physician-researchers are 'at risk', and ≈50% of Australian medical students are female, the evaluation of female physician-researchers is important. To compare over time (i) research-related metrics of male and female physician-researchers from Sydney Medical School; and (ii) National Health and Medical Research Council (NHMRC) Project grant leadership by gender. The Sydney Medical School (SMS) PhD award lists from 1989 to 2012 were cross-referenced with the Australian Health Practitioner Regulation Agency database, and registered medical practitioners were searched for in the Scopus database for publications and H-indexes. The gender of medical-practitioner Chief Investigator A (CIA) in Australia on funded NHMRC Project grants in 1990 to 2014 was also compared. Of the medical practitioners awarded University of Sydney PhD, females increased from 14 to 55% in 1989-1990 and 2009-2010 and decreased to 38% in 2011-2012 (overall increase, P = 0.047). PhD award timings relative to MBBS and clinical fellowship completions were similar for both genders (P > 0.05). Post-PhD, as many women as men publish and have similar H-indexes, but women publish fewer papers (0.7 vs 1.0 publications per year, P = 0.028). On medical practitioner-led, funded NHMRC project grants between 1999 and 2014, female CIA increased from 7.5 to 19.5%, P < 0.0001. For the 17% of project grant applications funded to commence in 2014, 21% were medical practitioner-led, of whom 19.5% were female. Since 1989, more female medical practitioners are completing SMS PhD at similar times in their careers to males. However, relative to their male peers, they publish less. Fewer female than male medical practitioner-researchers hold NHMRC Project Grant CIA status nationally, although the rates are increasing. In addressing physician-researcher workforce issues, including retention, attention should be given to factors impacting females.

The impact of a streamlined funding application process on application time: two cross-sectional surveys of Australian researchers

ObjectiveTo examine if streamlining a medical research funding application process saved time for applicants.DesignCross-sectional surveys before and after the streamlining.SettingThe National Health and Medical Research Council (NHMRC) of Australia.ParticipantsResearchers who...

The three must-do's of intervention reporting: enhancing sports injury prevention research

Injuries in team ball sports (eg, soccer, handball, volleyball and basketball) are common, accounting for 44% of all non-fatal sports injuries in the 27 EU Nations.1 Combined with high participation rates, this gives team ball sports the potential to pose significant health burdens, and highlights the importance of preventing injuries in this context. As neuromuscular injury prevention programmes for team ball sports gain increasing attention,2–⇓⇓⇓⇓7 the need to establish the effectiveness of these interventions in real-world sports settings has been emphasised.8–⇓⇓⇓⇓13 Conceptual models and frameworks from the broader field of health promotion can potentially facilitate the translation of efficacious interventions into practice, and examples of applying implementation science to sports injury prevention have been reported.9 ,14 ,15 The RE-AIM framework16 ,17 was developed to enhance the translation of research into practice, and has been applied in such diverse fields as falls prevention,18 weight loss19 and mental health.20 Recently, an extension of the framework specific to the community sport context, the RE-AIM Sports Setting Matrix, has also been developed (table 1).14 The RE-AIM framework can be applied across all research phases, from planning and implementation, to reporting and reviewing.17 However, there have been very few assessments of how RE-AIM has actually been used in any context. Recently, the RE-AIM Model Dimension Items Checklist (MDIC) was developed to assist the reviewing of project grant applications.21 This checklist comprises 31 items covering the five RE-AIM dimensions of Reach (4 items), Effectiveness (5 items), Adoption (8 items), Implementation (5 items) and …

Funding for mental health research: the gap remains

To examine the levels and growth rates of absolute funding to mental health research from 2001 to 2010, compared with other National Health Priority Areas (NHPAs), and the relative rate of mental health funding compared with other NHPAs, by taking disease burden into account. The quality of Australian research in mental health was also examined using objective indicators of research strength. Retrospective analysis of levels of funding overall and as a function of mental health domains using data from the National Health and Medical Research Council, with and without adjustment for burden of disease. A keyword analysis was used to assess the success rate of mental health project grant applications. Objective indicators of the quality of Australian mental health research were sought from citation indicators. Funding for mental health research relative to disease burden; funding according to disease category; project grant success rates. Using actual and adjusted figures, mental health research received a lower proportion of health funding than other NHPAs, including cancer, diabetes and cardiovascular disease. Research projects into substance misuse and autism were proportionately better funded than those in anxiety, depression or schizophrenia. A significant proportion of mental health research funding was awarded to research into ageing. Citation data indicated that mental health research in Australia performed better than research in neuroscience, clinical medicine, microbiology, and pharmacology and toxicology, and at a comparable level to immunology research, despite poor levels of funding. Low levels of funding for mental health research appear to be largely attributable to low capacity. Mental health research in Australia is of high quality, and efforts are needed to build capacity.

Curing Cell Lines

Curing Cell Lines

On building a community of practice: reflective narratives of academic learning and growth

This paper traces the evolution of an academic community of practice and identifies the individual and collective outcomes of participation for the members. The impetus for the community was the joint development of a learning and teaching project grant application that aimed to improve teacher education in music curriculum, and the subsequent implementation of that project. The paper draws on a range of data sources including individual reflective journals, audio‐records and transcriptions of meetings, email archives and discussion board posts of the project team members. The purpose of the paper is to illuminate and interrogate the processes and enabling conditions that supported the development of this academic community of practice, and consider the implications for academics.

NHMRC grant applications: a comparison of “track record” scores allocated by grant assessors with bibliometric analysis of publications

To investigate the correlation between the publication "track record" score of applicants for National Health and Medical Research Council (NHMRC) project grants and bibliometric measures of the same publication output; and to compare the publication outputs of recipients of NHMRC program grants with those of recipients under other NHMRC grant schemes. For a 15% random sample of 2000 and 2001 project grant applications, applicants' publication track record scores (assigned by grant assessors) were compared with bibliometric data relating to publications issued in the previous 6 years. Bibliometric measures included total publications, total citations, and citations per publication. The program grants scheme underwent a major revision in 2001 to better support broadly based collaborative research programs. For all successful 2001 and 2002 program grant applications, a citation analysis was undertaken, and the results were compared with citation data on NHMRC grant recipients from other funding schemes. Correlation between publication track record scores and bibliometric indicators. The correlation between mean project-grant track record scores and all bibliometric indicators was poor and below statistically significant levels. Recipients of program grants had a strong citation record compared with recipients under other NHMRC funding schemes. The poor correlation between track record scores and bibliometric measures for project grant applications suggests that factors other than publication history may influence the assignment of track record scores.

Conversation with Joseph V. Brady

Conversation with Joseph V. Brady

NIH Response to Open Letter

Although we appreciate hearing the views of some of our most respected scientists, the open letter from some of our colleagues in the microbiology community (“An open letter to Elias Zerhouni,” S. Altman et al. , Letters, 4 Mar., p. [1409][1]) does not provide a complete picture of funding for the biodefense and nonbiodefense research programs of the National Institutes of Health (NIH), particularly the National Institute of Allergy and Infectious Diseases (NIAID) ([1][2]). The letter argues that biodefense research efforts have diverted resources from nonbiodefense research at NIH. This is simply not the case. Funding for biodefense research has been additive to nonbiodefense research efforts supported by NIAID. The letter focuses only on support for research on the agents that cause tularemia, anthrax, plague, glanders, melioidosis, and brucellosis. NIAID biodefense funding is used to support research on a much broader list of more than 50 pathogens, which include “traditional” biodefense pathogens, such as those that cause anthrax and smallpox, as well as newly emerging infectious agents such as the SARS coronavirus and pathogens that cause diseases that affect people around the world on a daily basis ([2][3]). The terrorist attacks of September 11, 2001, and the dissemination of anthrax spores through the U.S. mail later that fall prompted the administration, with bipartisan support from Congress, to dramatically increase biodefense spending. Approximately $1.5 billion was added to the NIH budget in 2003 specifically to address concerns raised by bioterrorism, and this level of funding has been maintained with small to modest increases in subsequent years. (see [table][4]). These resources could have been allocated to other agencies that likely would not have embraced the academic microbiology and infectious diseases community, as is the tradition of NIH. View this table: Before the designation of “biodefense funding,” many pathogens with bioterror potential (e.g., the agents of anthrax and plague) were funded from a general pool of microbiology funds. With the establishment of the designation of biodefense money, studies of many pathogens previously funded from the general pool of microbiology money were funded by biodefense money, allowing additional grants for nonbiodefense pathogens. Also, in the period from 2000 to 2005, funding for NIAID nonbiodefense research increased by more than 50% and generally kept pace with the overall increases in NIH research funding for other diseases (see [table][4]). The accounting methodology used by the authors of the letter took into account only a fraction of the overall biodefense and nonbiodefense programs at NIH ([1][2]). In addition, the authors' analyses were based on searches of public databases that were not designed for comparative analyses of relative support for research areas. The authors' assertion that the peer-review process has been “threatened by unintended consequences of the 2001–2002 decision… to prioritize research of high biodefense, but low public-health significance” is unfounded. Indeed, in 2004, the success rates for NIAID biodefense and nonbiodefense research project grant applications were comparable at 25.9% (316 grants awarded) and 23.5% (845 grants awarded), respectively. More broadly, we disagree with the notion that biodefense concerns are of “low public-health significance.” The United States has experienced an anthrax attack, and security experts repeatedly express concern that future attacks with biological weapons are likely, if not inevitable. We look forward to continuing a dialogue with our colleagues in the microbiology community with regard to the biodefense and nonbiodefense research agenda of the NIH. 1. 1.[↵][5] National Institute of Allergy and Infectious Diseases, Open Letter in Science Regarding NIH Biodefense Funding: Questions and Answers (available at [www2.niaid.nih.gov/newsroom/Releases/scienceletter.htm][6]). 2. 2.[↵][7] The complete list can be viewed at [www.niaid.nih.gov/Biodefense/bandc_priority.htm][8]. [1]: /lookup/doi/10.1126/science.307.5714.1409c [2]: #ref-1 [3]: #ref-2 [4]: #T1 [5]: #xref-ref-1-1 View reference 1. in text [6]: http://www2.niaid.nih.gov/newsroom/Releases/scienceletter.htm [7]: #xref-ref-2-1 View reference 2. in text [8]: http://www.niaid.nih.gov/Biodefense/bandc_priority.htm

29 Erythropoletin improves the oxygen carrying capacity of mouse blood without changing hypoxia in a murine tumour model

Surrogate endpoints for prostate cancer-specific mortality after curative primary treatment are not well established. We sought to assess time to biochemical failure (TTBF) and prostate-specific antigen doubling time (PSADT) after failure of curative treatment as candidates for this endpoint.PSA and survival data from the Trans-Tasman Radiation Oncology Group (TROG) 96.01 trial were used to assess surrogate candidates. Between June 28, 1996, and Feb 16, 2000, 802 eligible men with locally advanced prostate cancer were randomly allocated to prostatic irradiation alone, or to 3 or 6 months of maximum short-term androgen deprivation (STAD) before and during radiation. Successful surrogates were required to satisfy the Prentice criteria and to predict the trial finding. The TROG 96.01 trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12607000237482.6 months of STAD was shown to significantly decrease prostate cancer-specific mortality compared with radiation alone, but 3 months of STAD did not result in a decrease. Relative to radiation alone, the hazard ratio of prostate cancer-specific mortality from randomisation was 0·95 (95% CI 0·63–1·41; p=0·79) in the 3-month STAD treatment arm and 0·56 (0·36–0·88; p=0·01) in the 6-month arm. PSADT predicted the trial finding and satisfied all four Prentice criteria at the cutpoints of less than 12 months and less than 15 months, with proportion of treatment effect ratios between 0·36 and 0·56. Time to biochemical failure was better than PSADT at predicting the trial finding and satisfying all four Prentice criteria at cutpoints of less than 1·5, less than 2, and less than 2·5 years, with proportion of treatment effect ratios between 0·45 and 0·64.This study provides proof of principle that TTBF and PSADT can be useful as surrogate endpoints for prostate cancer-specific mortality and offer potential to substantially reduce follow up in clinical trials. These endpoints now require assessment in multi-trial meta-analyses before use in clinical trials.National Health and Medical Research Council (Australia; Project Grant Applications 9936572, 209801, 455520); Hunter Medical Research Institute (Newcastle, NSW, Australia); AstraZeneca (Sydney, NSW, Australia); and Schering-Plough (Sydney, NSW, Australia).

Summary Statements of The NIH Nursing Research Grant Applications

Summary statements from the Nursing Research Study Section, Division of Research Grants, NIH, between October, 1986 and June, 1988 were used to identify reasons for recommending approval or disapproval of grant applications with RO1 and R29 activity codes. The 917 comments (25 +/- 4 per critique), sorted into one of nine categories (Aims, Significance, Investigator, Budget, Resources, Design, Sample, Techniques, Data Analysis) for analysis, were classified as Strengths (positive comments) or Weaknesses (negative comments). The weaknesses of approved applications were confined mostly to the categories of Design and Techniques. Disapproved applications had few strengths and many weaknesses in Design, Sample, Techniques, and Data Analysis. Critiques of First Award (R29) and traditional research project grant applications (RO1) were similar. The approved applications addressed meaningful problems, had well-synthesized literature reviews, and were solvable by available techniques. The research plans were consonant with stated aims, and the methods sections reflected understanding of the principles underlying the techniques to be used. A supportive environment and adequate research resources, including access to the study population were common to these applications. Disapproved applications provided poor synthesis of the literature, methods inconsistent with the aims, and often reflected inadequate understanding of techniques to be used.

Positive programming

A data-driven approach to allocating federal resources for primary care systems in rural areas is presented. This approach was developed and implemented by the Public Health Service (PHS) when it undertook its Rural Health Initiative Program. Nationally available small-area data were used to identify "priority counties" and PHS regional office staffs were asked to take an active role in developing rural health system projects in these counties. This approach was adopted to avoid the problem of the many communities eligible for and in need of funds that do not get them because they lack the organization and knowledgeable personnel required to develop a project grant application. The paper defines and discusses the "positive programming" approach (believed to be the first attempt to allocate federal health service delivery resources actively on the basis of small-area data), discusses the present shortcomings of the approach (including data limitations), and presents the results of implementing the approach. In the first year, 23% of the priority counties and 13% of the nonpriority counties were served, while in the second year 39% of the priority counties and 17% of the nonpriority counties were served. The substantial increase in the percentage of priority counties served reflects the effectiveness of the positive programming effort.