1 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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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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E-mail address
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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
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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)
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RU Designation and Department
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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"Indicate the exact amount of Co-Funding"
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(€)
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(€)
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"Co-Funding Organization"
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(€)
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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)
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Total (€)
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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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"Title of the previously submitted project, if different from the one currently presented"
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"Indicate the relevant Call"
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Regione Emilia-Romagna Programma di ricerca Regione-Università
Area 1 - Bando Giovani ricercatori “Alessandro Liberati” 2013
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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RU1
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Relevant publications (up to 5 publications relevant for the presented project, published in the period 2007-2013)
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Curriculum Vitae of RU1 Scientific Coordinator (max. 2,000 characters)
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Curriculum Vitae of RU2 Scientific Coordinator (max. 2,000 characters)
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Relevant publications (up to 5 publications relevant for the presented project, published in the period 2007-2013)
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Curriculum Vitae of RU3 Scientific Coordinator (max. 2,000 characters)
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Relevant publications (up to 5 publications relevant for the presented project, published in the period 2007-2013)
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RU2
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RU3
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RU1
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RU2
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RU3
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Curriculum Vitae of RU4 Scientific Coordinator (max. 2,000 characters)
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Relevant publications (up to 5 publications relevant for the presented project, published in the period 2007-2013)
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Curriculum Vitae of RU5 Scientific Coordinator (max. 2,000 characters)
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Relevant publications (up to 5 publications relevant for the presented project, published in the period 2007-2013)
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Curriculum Vitae of RU6 Scientific Coordinator (max. 2,000 characters)
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Relevant publications (up to 5 publications relevant for the presented project, published in the period 2007-2013)
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RU4
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RU5
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RU6
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RU4
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RU5
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RU6
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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)