Comparative transfers to other accounts__. Transfer to "Operating expenses, Public Buildings Service" General Services Administration___. 1967 total estimated obligation___ 1968 estimated obligations___ $116, 296, 000 -2, 482, 000 -558, 000 - 12,000 113, 244, 000 Total change_. Increases: A. Program: 1. Research grants.. 2. Fellowships EXPLANATION OF CHANGES Research grants.-The net increase of $12,920,000 includes $10,860,000 for support of the regular programs and $2,060,000 for general research support, grants. Fellowships.-The increase will be for increased stipend cost and a program increase of 7 postdoctoral awards. The total dollar increase is $130,000. Training grants.-The increase of $147,000 will provide continued support of the graduate training grants program in the various fields of neurological and sensory disorders. Laboratory and clinical research. The program increase of $942,000 will provide supporting costs for the new building and the support of 20 positions required for the expanded programs of intramural research. Collaborative research and development.-The program increase of $390,000 will support two new positions and continued research in the fields of head injury, slow latent and temperate viruses and other degenerative disorders of the central nervous system. Biometry, Epidemiology and field studies.-The increase of $30,000 will provide additional logistic support for the programs established in 1967. Review and approval of grants.-The increase of $25,000 will provide continued support of the staff required for the review and analysis of the grants programs of this Institute. Program direction.-The increase of $14,000 will provide for additional support of administrative staff in the Office of the Director. AUTHORIZING LEGISLATION The legislative authority in Section 301 of the Public Health Service Act which provides for the award of grants for research, research training, and fellowships is included in the section of the justifications under the tab, "Preamble Paragraph" in Volume V. The Public Health Service Act, Title IV, National Research Institutes, Part D, National Institute on Arthritis, Rheumatism, and Metabolic Diseases, National Institute on Neurological Diseases and Blindness, and other Institutes. "Sec. 431(a) The Surgeon General shall establish in the Public Health Service *** an institute for research on neurological diseases (including epilepsy, cerebral palsy, and multiple sclerosis) and blindness * "Sec. 433 (a) Where an institute has been established under this part, the Surgeon General shall carry out the purposes of section 301 with respect to the conduct and support of research relating to the disease or diseases to which the activities of the institute are directed, through such institute and in cooperation with the national advisory council established or expanded by reason of the establishment of such institute. In addition, the Surgeon General is authorized to provide training and instruction in such institute and elsewhere, in matters relating to the diagnosis, prevention, and treatment of such disease or diseases with such stipends and allowances (including travel and subsistence expenses) for trainees and fellows as he may deem necessary, and, in addition, provide for such training, instruction, and traineeships and for such fellowships through grants to public and other nonprofit institutions." The National Institute of Neurological Diseases and Blindness supports research grant programs which include research projects, research program projects, outpatient clinical research projects, clinical research centers, and cerebrovascular and head injury planning grants. The primary objectives of these diversified types of grants are the identification, stimulation, and support of essential research on problems related to the diagnosis, treatment and prevention of diseases of the nervous system, the eye and the ear, and human communication. Some of these diseases are among the major causes of death in the United States (stroke, head injury) or are common causes of permanent disability (epilepsy, paralysis, blindness, deafness, loss of speech). They include diseases of the young (cerebral palsy, epilepsy, aphasia, paraplegia, retinal detachment), and of the aged (stroke, brain tumor, parkinsonism, glaucoma, cataract, otosclerosis). The research grant program of this Institute is extending the crucial role already played in providing the research information, technology, and instrumentation required for a nationwide effect against these major causes of death and disability. PROGRAM PLANS FOR 1967 AND 1968 The budgets for 1967 and 1968 continue to reflect the recently authorized cost sharing arrangements for new and renewal research grants. This plan considers the full direct and indirect costs of the project in arriving at the federal and non-federal share. In fiscal year 1967, approximately 1,531 research projects totalling $61,103,000 will be awarded by the Institute. With the funds requested for 1968, the Institute will award approximately 1.674 research projects totalling $71,963,000. Of the total increase for 1968, $11,835,000 will be used to meet the rising costs of on-going or non-competing research projects. This research will continue the emphasis in fields of epilepsy, vision, brain injury, speech and hearing, and stroke. There are four major mechanisms of grant support utilized by the Institute to accomplish its research program objectives; these are: 1. Research project grants In fiscal year 1967, special emphasis is being given to studies of head injury. epilepsy, glaucoma, stroke, and deafness. In addition, national cooperative programs in the planning stage in 1966 were launched on a pilot basis in two major research areas: (1) the natural history, diagnosis and treatment of epilepsy: and (2) the prevention of stroke in patients with high blood pressure. The program of outpatient clinical research units which was launched in the areas of vision and of human communications (speech and hearing) will be extended to the cerebrovascular area in 1968. Much is yet to be learned regarding the care of ambulatory patients with paralysis and/or aphasia due to cerebrovascular damage. 2. Categorical clinical research centers and program projects Neurological and sensory disease clinical research centers and program projects provide the research resources and support for selected multidisciplinary clinical research teams engaged in coordinated attacks on the major problems of death and disability involving the nervous system or special senses of vision or hearing. These research teams are organized on either an institutional or multi-institutional (regional) basis and enable investigators in key disciplines to assist each other in developing and testing the new principles and methods which must be perfected to stop the continuing increase and progression of dreaded disorders such as stroke, epilepsy, head injury, blindness, and deafness. During 1967, three additional centers were initiated in the brain research area, two in the areas of stroke, one in the eye research area, and one in the deafness and human communication area, making a total of 50 active clinical research centers. An additional five centers focusing on major clinical areas are ready to be launched in fiscal year 1968. 3. Outpatient clinical research units The program of outpatient clinical research units originally launched in two selected areas, disorders of vision and disorders of hearing, speech and human communication, has been extended to include cerebrovascular disorders. In 1968 eleven additional outpatient clinical research projects will be initiated, three on disorders of vision, four on disorders of hearing and human communication, and four on cerebrovascular disorders. 4. Specialized research centers (planning grants) Clinical center planning grants are awarded for planning the development of additional clinical research centers on important problems of national need. During 1967, planning grants for head injury research as a result of brain damage were initiated on a pilot basis as well as one additional planning grant for Cerebrovascular Centers. An additional six planning grants in head injury research and two in the cerebrovascular area will be initiated in 1968. In research fields of great clinical significance such as head injury and cerebrovascular disease, the Institute can help to mobilize the research resources of the nation to reduce and eventually overcome the consequences of these disabling afflictions by assisting in the development of research teams in newly evolving research centers throughout the nation. During fiscal year 1968, special emphasis will be given to the following areas of neurological and sensory disease research: (a) Vision In the United States over 400,000 people are legally blind, one million have visual impairment so severe they cannot read a newspaper, 300,000 are handicapped to the extent they cannot work, and 3,500,000 have only partial vision. In view of the magnitude of the problem, the Institute is making every effort to develop a complete program for eye research and training to determine the cause, prevention, treatment, and remediation of blindness and visual disorders. In November 1964 an ad hoc Subcommittee on Vision and Its Disorders was established on the recommendation of the NANDB Council. The Subcommittee and its task forces spent two years in an effort to "review the present status of knowledge about the major causes of blindness and visual disability and to summarize the most pressing problems for investigation as well as the most exciting research leads." The report of that expert panel is now available as a basis for the planning and development of additional national activities in this important area. The Institute has now established a permanent Subcommittee on Vision and Its Disorders and is considering the development of a Teacher-Investigator Award Program to strengthen the teaching and clinical investigative aspects of ophthalmology. Some 24 other recommendations also are under consideration. Volume II of the report, containing scientific status papers which provide a comprehensive scientific review of the fields of vision and blindness, is now being made available to the scientific community. Implementation of these recommendations will enlarge and strengthen the program which the National Institute of Neurological Diseases and Blindness has developed for eye research and training. In addition to the program of individual research projects for the study of blindness, the Institute also supports eye clinical research centers. These centers mobilize a national broad scale attack on visual disorders through the development and application of multidisciplinary approaches to these complex problems. Support is now being provided for 9 clinical research centers for blindness and visual disorders, each concentrating on special clinical problems such as, cataract, glaucoma, disorders of the cornea, infections of the eye, disturbances of eye movement, but retaining a broad approach to the overall problem of blindness. An additional 3 centers are providing information about the fundamental mechanisms through which light impulses are converted to nervous energy and transmitted to the brain for interpretation. Thus, they are broadly concerned with sensory and perceptual disorders. The visual outpatient clinical research program initiated on a pilot basis in 1966 and 1967 will be expanded. Heretofore, the participation of outpatients with visual disorders in research has been limited by inadequate facilities. Since a large proportion of individuals with vision problems are treated on an outpatient basis, this meant that valuable clinical material was lost to research. It is already clear that the visual outpatient clinical program will be highly successful in correcting this situation as well as in providing focal points for improved clinical research in all geographic areas of the nation. (b) Head injury Head Injury Clinical Research Centers are complex, interinstitutional, interdepartmental or interdisciplinary programs which often require careful planning involving a major investment in time and effort of both clinical investigators and institution officials. Many institutions found it difficult to prepare proposals for Clinical Research Centers in this area without financial assistance for adequate planning. Thus, a program of specialized center awards (planning grants) for Head Injury Clinical Research Centers was initiated in 1967. This program will be expanded in 1968. Pilot programs. which will already have been started with planning grants, will be expanded and converted into Clinical Research Centers. These Centers will concentrate their efforts on various aspects of the head injury problem such as its epidemiology, the physical forces involved in causing head injury, improved diagnostic and therapeutic procedures, the physiological consequences of head injury, the function and structure of the blood-brain barrier, and the problems of cerebral edema. (c) Stroke Stroke is one of the most common causes of death and not infrequently strikes at a time when the individual is at the peak of his career. For those who do not die, the disease usually means a life of physical disability and mental incapacity. Aphasia, paralysis, and incontinence are the too often tragic consequences of stroke. As in the case of all medical problems, prevention is the most desirable objective. This requires the development of tests and methods to detect diseases and narrowed blood vessels of the brain in time to prevent complete obstruction. Ways to re-open clogged cerebral vessels and to replace vessels which are diseased beyond repair must be devised and improved; methods for improving collateral circulation to areas not receiving adequate blood are being identified. The research clinic, which actually works with patients of this kind year after year, is the site to which we must look for important developments in this area. Sixteen clinical research centers for stroke research are presently being supported in 1967, of which 7 are in the planning stages. With the assistance of planning grants, efforts will continue to encourage the development of stroke clinical research centers in additional geographic areas and in institutions which have clinical material that otherwise would not be utilized, but which lack the extensive financial resources required to organize one of these complex centers without assistance. Also, support for outpatient clinical research centers in this area, which was begun in 1967, will be extended in 1968. This is especially important because these ambulatory patients frequently are the best source of information on the early diagnosis of stroke and on the mechanisms that can restore an adequate functional state. These clinical research centers and outpatient units constitute the main thrust of the Institute's attack on the stroke problem. Much basic laboratory research is still required and needs to be supported: the clinical research center program, however, provides the means by which laboratory findings about the causes, the epidemiology, the treatment, and the prevention of stroke are translated into clinically-used tools. (d) Disorders of human communication (hearing, language, and speech) An ad hoc Task Force on Disorders of Human Communications had been organized by the Institute to review the present state and the problems of communicative disorders and to advise the Institute in regard to needed future programs. Communicative disorders are somewhat unusual in that there is a growing feeling on the part of experts that many aspects of such disorders can be corrected primarily, if not solely, by early treatment and education. For this reason, it is especially important that these disorders be detected and diagnosed as early as possible before they become firmly established and corrective measures |