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Regione Emilia-Romagna Programma di ricerca Regione-Università

Area 1 - Bando Giovani ricercatori “Alessandro Liberati” 2013

PART A.

IDENTIFICATION OF THE APPLICANT AND OTHER PARTICIPANTS

A1. Principal Investigator

*Name *Surname

*Date of Birth: Day Month Year

*Address

*Phone number

Fax number

*

A2. *Affiliation

A3. *Type of Research:

A4. *Thematic Area:

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A5.

*A5.1 Title (max 200 characters)

*A5.2 Running title (max 50 characters)

A5.3 Keywords

*Keyword 1

Keyword 2

Keyword 3

RU1

RU2

RU3

N. INSTITUTION SCIENTIFIC

COORDINATOR SHORT DESCRIPTION OF THE ORIGINAL

CONTRIBUTION TO THE PROJECT (max 500 characters)

RU4

RU5

RU6

A6. Research Units

N. INSTITUTION SCIENTIFIC

COORDINATOR SHORT DESCRIPTION OF THE ORIGINAL

CONTRIBUTION TO THE PROJECT (max 500 characters)

A7. *Budget

*A7.1 Provisional cost of the Project (in Euros) (expected total costs, including direct and indirect costs, as well as costs for subcontracting and/or outsourcing. In case of Co-Funding, the Provisional Cost is the sum of the latter and the Requested Funding)

*A7.2 Co-Funding:

*A7.3 Requested Funding (in Euros)

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*A7.4 List of Personnel

Progressive

Number

Research

Unit (*1)

Title and

Position

Contract of

employment

(*2)

Area of

expertise

& Role (*3)

Months

per

person

Full Time

Equivalent

Salary

(€)

(*1) List of Research Units

(*2) 1 Contratto a tempo determinato / 2 Co.Co.Pro / 3 Dottorato di ricerca (o equivalente) / 4 Assegno diTotal (€) ricerca /

5. Other (to be specified)

(*3) 1 Coordinator / 2 Statistician / 3 Methodologist / 4 Study monitor, Data Collector, CRO / 4 Clinical Follow up monitor /

5 Other (to be specified)

1. Equipment

2. Software

3 Disposable (laboratory

supplies)

4. Stationary

5. Other (to be specified)

Total Budget (€)

*A7.6 Services

Total Budget for the Project (€)

1. Data Collection (eg: e-CRF)

2. Travel, registration fee and

participation to meetings / conferences

(max 2,500 Euros))

3. Publications

4. Other (to be specified)

Total Budget(€)

*A7.5 Equipment and Disposable

Total Budget for the Project (€)

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*A7.7 Summary of Budget breakdown

Year 1 (€) Year 2 (€) Total (€)

Personnel

Equipment and Disposable

Services

Overheads

(max 10% of the sum of the previous four

items)

Total Budget(€)

A8. Administrative Coordinator

*Name *Surname

*Affiliation

*Address

*Phone number

Fax number

*E-mail address

A9. *Resubmission

A10. In order to pursue the stated objectives, do you intend to make use of:

*A10.1 Stem Cells:

*A10.2 Animals:

*A10.3 Biological samples:

*A10.4 Human subjects :

*A10.5 Registered Drugs:

*A10.6 Unregistered Drugs:

*A10.7 Medical device:

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Regione Emilia-Romagna Programma di ricerca Regione-Università

Area 1 - Bando Giovani ricercatori “Alessandro Liberati” 2013

PART B.

PROJECT DESCRIPTION

B1. Summary

B1.1 *Abstract (including: 1. Background, 2. Aims/Objectives, 3. Methods, 4. Expected results) (max 2,000 characters)

B1.2 *List of Acronyms (in alphabetical order)

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B2. Description

B2.1 *Background and Rationale (At least 3 relevant references must be included, possibly in the form of review/systematic review. References should be appropriately reported in section B2.1.1. The foreseen added value of the proposal should also be stressed) (max 3,500 characters)

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B2.1.1 *Bibliography

B2.2 Preliminary data (max 2,500 characters)

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B2.3 *Detailed description of Specific Aims / Primary and secondary Objectives (the experimental design for each specific aim / objective should be reported) (max 4,000 characters)

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B2.4 *Research methodology and Statistical analyses [If applicable, do specify: I. Inclusion and

exclusion criteria for individuals/patients/animals/cells/samples to be enrolled/used in the study; II. Type

of planned intervention(s); III. Settings; IV. Expected Outcome(s) and outcome measure systems; V.

Samples number / sample size of the target population. VI. Data collection (modality and timing). VII.

Potential risks/problems and alternative strategies. VIII. Plan for protection of human subjects from

research-related risks (for Clinical Research only)]

(max 9,000 characters)

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B3. Feasibility

B3.1 *Equipment, facilities and resources available at the participating Institutions (max 2,500 characters)

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B3.2 *Interaction among Research Units (max 3,000 characters)

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B3.3 *Principal Investigator Curriculum vitae (max 3,000 characters)

B3.4 *Principal Investigator List of relevant publications (up to 10 publications relevant for the presented project, published in the period 2007-2013)

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B3.5 *Curriculum vitae and relevant publications of Research Units Scientific Coordinators

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B4. Timeline

B4.1 *Milestones and deliverables (max 2,000 characters)

B4.2 *Gantt chart must be uploaded separately

B5. *Transferability to, and impact on, the regional Healthcare Service (both qualitative and

quantitative indicators must be included and commented) (max 2,000 characters)