INNOVATIVE PARTNERSHIPS IN TYPE 1 DIABETES RESEARCH Release Date: October 2, 2001 RFA: RFA-DK-02-023 National Institute of Diabetes and Digestive and Kidney Diseases (http://www.niddk.nih.gov) National Institute of Allergy and Infectious Diseases (http://www.niaid.nih.gov/) National Eye Institute (http://www.nei.nih.gov/) National Institute of Nursing Research (http://www.ninr.nih.gov/) National Heart, Lung, and Blood Institute (http://www.nhlbi.nih.gov/) Letter of Intent Receipt Date: February 14, 2002 Application Receipt Date: March 14, 2002 THIS RFA USES "MODULAR GRANT" AND "JUST-IN-TIME" CONCEPTS. MODULAR INSTRUCTIONS MUST BE USED FOR RESEARCH GRANT APPLICATIONS REQUESTING LESS THAN $250,000 PER YEAR IN ALL YEARS. MODULAR BUDGET INSTRUCTIONS ARE PROVIDED IN SECTION C OF THE PHS 398 (REVISION 5/2001) AVAILABLE AT http://grants.nih.gov/grants/funding/phs398/phs398.html. PURPOSE The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute of Allergy and Infectious Diseases (NIAID), National Eye Institute (NEI), National Institute of Nursing Research (NINR), and National Heart, Lung, and Blood Institute (NHLBI) invite applications to support collaborations between investigators who focus their research efforts on type 1 diabetes or its complications and researchers from other research areas with expertise relevant to type 1 diabetes research. The purpose of this Request for Applications (RFA) is to attract new research talent to type 1 diabetes research, strengthen the ongoing efforts of type 1 diabetes researchers by providing access to specialized expertise or technologies relevant to their research, and facilitate the formation of interdisciplinary research partnerships to investigate significant biological and medical problems associated with type 1 diabetes. Applications should propose collaborative research partnerships between independent principal investigators-- one currently pursuing research relevant to type 1 diabetes and one (or more) with expertise relevant to some aspect of type 1 diabetes, which is not currently being applied by the investigator to research on this disease. This RFA encourages type 1 diabetes researchers to act as talent scouts and to actively identify and recruit leading scientists with relevant scientific expertise to the field of type 1 diabetes research. 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, Innovative Partnerships in Type 1 Diabetes Research, 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/. ELIGIBILITY REQUIREMENTS Applications may be submitted by domestic and foreign for-profit and nonprofit organizations, public and private, such as universities, colleges, hospitals, laboratories, units of State and local governments, and eligible agencies of the Federal government. Racial/ethnic minority individuals, women, and persons with disabilities are encouraged to apply as principal investigators. MECHANISM OF SUPPORT This RFA will use the National Institutes of Health (NIH) exploratory pilot and feasibility project grant (R21) award mechanism. Responders to this initiative may be new or experienced investigators with independent research support who are able to develop new and innovative approaches to study type 1 diabetes. Either of the research partners may serve as the principal investigator, and the research partners do not have to be from the same research institution. Generally, pilot and feasibility proposals are expected to have little preliminary data and are reviewed based on the development of hypotheses and supporting literature. While no preliminary data from the collaboration is required, applicants should include some preliminary data relevant to the proposed project from the partner currently working in the area of type 1 diabetes. Information documenting the ability of the collaborator regarding the technology or expertise s/he will be providing to the partnership should also be provided. Responsibility for the planning, direction, and execution of the proposed project will be solely that of the applicant. The maximum budget request for R21 applications submitted in response to this RFA may not exceed $250,000 in direct costs per year, and may not exceed two years for the total project period. Applicants from institutions that have a Diabetes Endocrinology Research Center (DERC), a Diabetes Research and Training Center (DRTC), or a General Clinical Research Center (GCRC) funded by the NIH National Center for Research Resources may wish to identify the Center(s) as a resource for conducting the proposed research. In such a case, a letter of agreement from either the principal investigator or the GCRC program director should be included with the application. Specific application instructions have been modified to reflect "MODULAR GRANT" and "JUST-IN-TIME" streamlining efforts that have been adopted by the NIH. Complete and detailed instructions and information on Modular Grant applications have been incorporated into the PHS 398 (rev. 5/2001). Additional information on Modular Grants can be found at http://grants.nih.gov/grants/funding/modular/modular.htm This RFA is a one-time solicitation. Future unsolicited competing continuation applications will compete with all investigator-initiated applications and will be reviewed according to the customary peer review procedures. The anticipated award date is September 30, 2002. FUNDS AVAILABLE The sponsoring institutes intend to commit approximately $4 million in FY 2002 to fund 12 to 15 new grants in response to this RFA. An applicant may request a project period of up to 2 years and a budget for direct costs of up to $250,000 per year, excluding indirect costs on consortium arrangements. Because the nature and scope of the research proposed may vary, it is anticipated that the size of each award will also vary. Although the financial plans of the sponsoring institutes 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 applications of outstanding scientific and technical merit. RESEARCH OBJECTIVES Background Type 1 diabetes is an autoimmune disease characterized by the destruction of the insulin-secreting beta cells of the pancreas by cytotoxic T cells. The incidence of type 1 diabetes appears to be increasing worldwide. Although the disease may occur at any age, the onset of type 1 diabetes peaks prior to twenty years of age. In some populations, about one percent of all newborns will develop type 1 diabetes during their lifetime. Those affected with type 1 diabetes suffer from devastating complications including accelerated onset of cardiovascular and peripheral vascular diseases, neuropathy, nephropathy, retinopathy and premature mortality. Objectives and Scope The objectives of this RFA are to attract new research talent to type 1 diabetes research, strengthen the ongoing efforts of type 1 diabetes researchers by providing access to specialized expertise or technologies relevant to their research, and facilitate the formation of interdisciplinary research partnerships to investigate significant biological and medical problems associated with type 1 diabetes. Established type 1 diabetes researchers are encouraged to act as talent scouts and to actively identify and recruit leading scientists with relevant scientific expertise to the field of type 1 diabetes research. Generally, pilot and feasibility applications are expected to have little preliminary data and are reviewed based on the development of hypotheses and supporting literature. While no preliminary data from the collaboration between the two investigators mentioned above is required, applicants should include some preliminary data relevant to the proposed project from the partner currently working in the area of type 1 diabetes. Some information documenting the ability of the collaborator regarding the technology or expertise s/he will be providing to the partnership should also be provided. Applications should propose collaborative research partnerships between independent principal investigators-- one currently pursuing research relevant to type 1 diabetes and one (or more) with expertise relevant to some aspect of type 1 diabetes, which is not currently being applied by the investigator to research on this disease. Although it is not a requirement that the research partner(s) being recruited to diabetes research should never have worked on a project relevant to diabetes or its complications, diabetes-related research should not have been a significant focus of his/her research effort. Review criteria (see below) will include consideration of whether one partner is new to diabetes research and is likely to make substantial contributions to the diabetes research effort. The application will be judged in the context of the objectives of the RFA (see above), a major objective is attracting new talent to diabetes research. Each of the research partners should be a successful independent investigator with a track record of successful research accomplishments. The collaborating investigators need not be at the same institution. If at separate institutions, the application should document how the collaboration will be achieved. One potential mechanism for collaboration between two independent laboratories might be a shared postdoctoral fellow or other research staff position. Funds for travel between the collaborating laboratories can be included in the budget proposal. Either of the research partners may serve as principal investigator for the joint application. The level of effort proposed by the collaborating independent investigators should be appropriate for the scope of the project. R21 applications submitted in response to this RFA may address any topic relevant to type 1 diabetes and its complications ranging from fundamental research on etiology and pathogenesis to applied research focused on the development of methods for prevention, improved treatment, or cure. R21 applications may involve collaborations between diabetes researchers and investigators in diverse fields including, but not limited to, cardiovascular disease, nephrology, ophthalmology, neuroscience, molecular virology, immunology, infectious disease, genetics, epidemiology, behavioral and/or psychosocial research, biophysics, materials science, bioengineering, bioimaging, developmental biology, cell biology, cell signaling, structural biology, genomics, proteomics, or bioinformatics. Examples of types of research projects that are responsive to this RFA include but are not limited to: o Development and/or testing of strategies to prevent or reverse type 1 diabetes and its macro and microvascular complications o Research to discover the biochemical mechanisms by which diabetes genes function to create susceptibility to diabetes and its complications o Identification of viral or environmental triggers of type 1 diabetes and mechanisms by which such triggers initiate an autoimmune response o Development and/or testing of glucose sensors and/or insulin delivery devices that offer advantages over current devices o Research to identify islet stem cells, understand their differentiation, growth and development, and develop improved methods for isolation, maintenance, growth and propagation, or differentiation of beta cells/islets o Research on signaling pathways involved in the regulation of normal pancreatic beta cell function o Research on strategies to develop new or improved sources of beta cells/islets or to enhance the regeneration or viability of beta cells/islets o Development and/or testing of improved methods of immunoalteration of beta cells/islets or of the immune response in an attempt to prevent autoimmune and host-versus-graft destruction of beta cells/islets o Development of immunobarrier technology to protect transplanted islets or engineered insulin-producing cells from autoimmune destruction or rejection o Definition of the genetic, molecular or cellular processes and the sequence of events in the pathogenesis of hyperglycemia-induced injury so that potential sites for intervention can be identified o Development or testing of innovative pharmacological agents and interventions to prevent or halt the progression of type 1 diabetes or its long-term complications o Development of animal models of type 1 diabetes and its complications which closely parallel the human disease useful for exploring the pathogenesis and therapy of type 1 diabetes or its complications o Development of strategies and tools to improve diabetes management and outcomes o Development of tests that will facilitate clinical trials such as measures of risk for diabetes and/or complications or measures of response to therapy INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of the NIH that women and members of minority groups and their sub-populations must be included in all NIH-supported biomedical and behavioral research projects involving human subjects, unless a clear and compelling rationale and justification are 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 research involving human subjects should read the UPDATED "NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research," published in the NIH Guide for Grants and Contracts on August 2, 2000 (http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-048.html), a complete copy of the updated Guidelines are available at http://grants.nih.gov/grants/funding/women_min/guidelines_update.htm: The revisions relate to NIH defined Phase III clinical trials and require: a) all applications or proposals and/or protocols to 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) all investigators to report accrual, and to conduct and report analyses, as appropriate, by sex/gender and/or racial/ethnic group differences. INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS. It is the policy of NIH that children (i.e., individuals under the age of 21) must be included in all human subjects research, conducted or supported by the NIH, unless there are scientific and ethical reasons not to include them. This policy applies to all initial (Type 1) applications submitted for receipt dates after October 1, 1998. All investigators proposing research involving human subjects should read the NIH Policy and Guidelines on the Inclusion of Children as Participants in Research Involving Human Subjects that was published in the NIH Guide for Grants and Contracts, March 6, 1998, and is available at the following URL address: http://grants.nih.gov/grants/guide/notice-files/not98-024.html. Investigators may also obtain copies of these policies from the program staff listed under INQUIRIES. Program staff may also provide additional relevant information concerning the policy. 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. This policy announcement is found in the NIH Guide for Grants and Contracts Announcement dated June 5, 2000, at the following website: http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html. 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. Reviewers are cautioned that their anonymity may be compromised when they directly access an Internet site. 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. LETTER OF INTENT Prospective applicants are asked to submit, by February 14, 2002, a letter of intent that includes a descriptive title of the proposed research, the name, address, and telephone number of the Principal Investigator, the identities of other key personnel and participating institutions, and the number and title of the RFA in response to which the application may be submitted. Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows NIDDK staff to estimate the potential review workload and plan the review. The letter of intent is to be sent to: Chief, Review Branch Division of Extramural Activities, NIDDK 6707 Democracy Boulevard, Rm. 752 MSC 5452 Bethesda, MD 20892-5452 (for express/courier service: Bethesda, MD 20817) Telephone: (301) 594-8885 FAX: (301) 480-3505 APPLICATION PROCEDURES The PHS 398 research grant application instructions and forms (rev. 5/2001) at http://grants.nih.gov/grants/funding/phs398/phs398.html must be used in applying for these grants. This version of the PHS 398 is available in an interactive, searchable PDF format. Beginning January 10, 2002, however, the NIH will return applications that are not submitted on the 5/2001 version. For further assistance contact GrantsInfo, Telephone 301/710-0267, Email: GrantsInfo@nih.gov. All application instructions outlined in the PHS 398 application kit are to be followed, with the following requirements for R21 applications: 1. R21 applications will use the MODULAR GRANT and JUST-IN-TIME concepts, with direct costs requested in $25,000 modules, up to the total direct costs limit of $250,000 per year. 2. Although preliminary data are not required for an R21 application, they may be included. SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS The modular grant concept establishes specific modules in which direct costs may be requested as well as a maximum level for requested budgets. Only limited budgetary information is required under this approach. The just-in-time concept allows applicants to submit certain information only when there is a possibility for an award. It is anticipated that these changes will reduce the administrative burden for the applicants, reviewers and NIH staff. The research grant application form PHS 398 (rev. 5/2001) at http://grants.nih.gov/grants/funding/phs398/phs398.html is to be used in applying for these grants, with modular budget instructions provided in Section C of the application instructions. 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. 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 time of submission, two additional copies of the application must be sent to: Chief, Review Branch Division of Extramural Activities National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health 6707 Democracy Boulevard, Room 752 MSC 5452 Bethesda, MD 20892-5452 (for express/courier service: Bethesda, MD 20817) Applications must be received by the application receipt date listed in the heading of the RFA. If an application is received after that date, it will be returned to the applicant without review. Supplemental documents containing significant revision or additions will not be accepted, unless applicants are notified by the Scientific Review Administrator. The Center for Scientific Review (CSR) will not accept any application in response to this RFA that is essentially the same as one currently pending initial review, unless the applicant withdraws the pending application. The CSR will not accept any application that is essentially the same as one already reviewed. This does not preclude the submission of substantial revisions of applications previously reviewed, but such applications must include an Introduction addressing the previous critique. REVIEW CONSIDERATIONS Upon receipt, applications will be reviewed for completeness by the CSR and responsiveness by the NIDDK. Incomplete and/or non-responsive applications will be returned to the applicant without further consideration. Applications that are complete and responsive to the RFA will be evaluated for scientific and technical merit by an appropriate peer review group convened by the NIDDK in accordance with the review criteria stated below. As part of the initial merit review, all applications will receive a written critique and undergo a process in which only those applications deemed to have the highest scientific merit, generally the top half of the applications under review, will be discussed, assigned a priority score, and receive a second level review by the appropriate NIH 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 the application in order to judge the likelihood that the proposed research will have a substantial impact on the pursuit of these goals. Each of these criteria will be addressed and considered in assigning the overall score, weighting them as appropriate for each application. Note that the 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, an investigator may propose to carry out important work that by its nature is not innovative but is essential to move a field forward. (1) Significance: Does this study address an important problem in type 1 diabetes research? If the aims of the application are achieved, how will scientific knowledge be advanced? What will be the effect of these studies on the concepts or methods that drive this field? (2) Approach: Are the conceptual framework, design, methods, and analyses adequately developed, well-integrated, and appropriate to the aims of the project? Does the applicant acknowledge potential problem areas and consider alternative tactics? (3) Innovation: Does the project employ novel concepts, approaches or methods? Are the aims original and innovative? Does the project challenge existing paradigms or develop new methodologies or technologies? (4) Investigators: Are the investigators appropriately trained and well suited to carry out this work? Is the work proposed appropriate to the experience level of the principal investigator and other researchers? Is the research partnership innovative? Does the partnership include an independent investigator new to type 1 diabetes research with appropriate expertise to contribute significantly to diabetes research? Is the research partnership interdisciplinary and does it merge scientific expertise based upon strong experimental rationale and sound project goals? (5) Environment: Does the scientific environment in which the work will be done contribute to the probability of success? Do the proposed experiments take advantage of unique features of the scientific environment or employ useful collaborative arrangements? Is there evidence of institutional support? In addition to the above criteria, in accordance with NIH policy, all applications will also be reviewed with respect to the following: o Adequacy of plans to include both genders, minorities and their subgroups, and children as appropriate for the scientific goals of the research. Plans for the recruitment and retention of subjects will also be evaluated. o The reasonableness of the proposed budget and duration to the proposed research. o The adequacy of the proposed protection of humans or the environment, to the extent that they may be adversely affected by the project proposed in the application. o Availability of special opportunities for furthering research programs through the use of unusual talent resources, populations, or environmental conditions in other countries which are not readily available in the United States or which provide augmentation of existing U.S. resources. Schedule Letter of Intent Receipt Date: February 14, 2002 Application Receipt Date: March 14, 2002 Peer Review Date: June/July, 2002 Council Review: September, 2002 Earliest Anticipated Start Date: September 30, 2002 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. INQUIRIES Inquiries concerning this RFA are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues to: James F. Hyde, Ph.D. Division of Diabetes, Endocrinology and Metabolic Diseases National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health 6707 Democracy Boulevard, Rm. 603, MSC 5460 Bethesda, MD 20892-5460 Telephone: (301) 594-7692 FAX: (301) 435-6047 E-mail: jh486z@nih.gov Elaine Collier, M.D. Division of Allergy, Immunology, and Transplantation NIAID 6700-B Rockledge Drive, Room 5135, MSC 7640 Bethesda, MD 20892-7640 Telephone: (301) 496-7104 FAX: (301) 402-2571 E-mail: ec5x@nih.gov Peter A. Dudley, Ph.D. Division of Extramural Research National Eye Institute Executive Plaza South, Suite 350 Bethesda, MD 20892-7164 Telephone: (301) 496-0484 FAX: (301) 402-0528 Email: pad@nei.nih.gov Nell Armstrong, Ph.D., R.N. Program Director National Institute of Nursing Research National Institutes of Health Building 45, Room 3AN-12 Bethesda MD 20892-6300 Telephone: (301) 594-5973 FAX: (301) 480-8260 E-mail: na21f@nih.gov Momtaz Wassef, Ph.D. Leader, Atherosclerosis Research Group Division of Heart and Vascular Diseases National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Suite 10186 Bethesda, MD 20892-7956 Telephone: (301) 435-0550 FAX: (301) 480-2848 E-mail: mw47d@nih.gov Direct inquiries regarding fiscal matters to: Donald Ellis Grants Management Branch Division of Extramural Activities National Institute of Diabetes and Digestive and Kidney Diseases 6707 Democracy Boulevard, Room 709B MSC 5456 Bethesda, MD 20892-5456 Telephone: (301) 594-8849 FAX: (301) 594-9523 E-mail: de30z@nih.gov Pamela G. Fleming Grants Management Officer Division of Extramural Activities National Institute of Allergy and Infectious Diseases 6700-B Rockledge Drive, Room 2119, MSC 7614 Bethesda, MD 20892-7614 (Regular Mail) Bethesda, MD 20817 (Express Mail) Phone: (301) 402-6580 FAX: (301) 493-0597 E-mail: pf49e@nih.gov Margie Baritz Grants Management Specialist National Eye Institute 6120 Executive Blvd Suite 350, MSC 7164 Bethesda, MD 20892-7164 Telephone: (301) 496-5884 FAX: (301) 496-9977 E-mail: mb41k@nih.gov Robert L. Tarwater Grants Management Specialist Office of Grants and Contracts Management National Institute of Nursing Research National Institutes of Health Building 45, Room 3AN.12 Bethesda, Maryland 20892-6300 Telephone: (301) 594-2807 FAX: (301) 480-8260 E-mail: rt28o@nih.gov Ms. Jane Davis Grants Operations Branch National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Suite 7156 Bethesda, MD 20892-7926 Telephone: (301)435-0166 FAX: (301)480-3310 E-mail: jd53j@nih.gov AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.847 (NIDDK), 93.855, Immunology, Allergy and Transplantation Research (NIAID), 93.867 (NEI), 93.361 (NINR), and 93.837 (NHLBI). Awards are under authorization of the Public Health Service Act, Title IV, Part A (Public Law 78-410, as amended by Public Law 99-158, 42 USC 241 and 285) and administered under NIH grants policies and Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92. This program is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. The PHS strongly encourages all grant and contract recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of a facility) in which regular or routine education, library, day care, health care or early childhood development services are provided to children. This is consistent with the PHS mission to protect and advance the physical and mental health of the American people.


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