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AGENCY FOR INTEGRATED CARE (AIC) INTERMEDIATE AND LONG TERM CARE (ILTC) RESEARCH GRANT

APPLICATION FORM INSTRUCTIONS & CHECKLIST

Administrative Instructions

1. The Principal Investigators (PI) must be employed on a full time basis by either a Singaporean private or Voluntary Welfare Organisation (VWO) ILTC organisation and must spend at least 75% of their time in Singapore. ILTC organisations include community hospitals, nursing homes (including psychiatric nursing homes), day care (including dementia day care centres) and day rehabilitation centres, home nursing, home medical and home rehabilitation services. The PI need not be a Singaporean or Singapore Permanent Resident.

2. Every section and field must be completed. Please indicate “NA” where a particular section or field is not applicable. Any blue text serves as samples. Please replace the text in blue with your own entries.

3. All financial figures should be presented in Singapore dollars (S$).

4. Applications must be submitted both as a hardcopy AND a softcopy in the following manner:

5. Softcopy Submission

Submit soft copies of the application form in both of the following formats:

i. Microsoft Word format: Editable version without signatures; andii. Adobe PDF format: Signed version scanned in full colour

Submit soft copies by email to “iltcresearch@aic.sg”, with the subject heading “The ILTC Research Grant 2018 Submission – [Name of PI’s Institution], [Running Title]” (e.g. “The ILTC Research Grant 2018 – Sunshine Nursing Home, Effect of XX”)

6. Hardcopy Submission

Mail the original hard copy of the application form to :

Agency for Integrated Care Pte LtdResearch and Development Office (RDO)5 Maxwell Road, #10-00, Tower BlockMND Complex, Singapore 069111Attn: ILTC Grant Secretariat

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7. Both hardcopy and softcopy submissions must reach the Research and Development Office (RDO), Agency for Integrated Care (AIC) by 31 August 2018 (Friday), 5pm.

8. Through the act of submitting this application, the applicant acknowledges that the information may be used or disclosed by Agency for Integrated Care Pte Ltd for evaluation, reference and reporting purposes. All information submitted will be treated in confidence.

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AGENCY FOR INTEGRATED CARE (AIC) INTERMEDIATE AND LONG TERM CARE (ILTC) RESEARCH GRANT

APPLICATION FORMSECTION 1 – PROJECT INFORMATION

BASIC PROJECT INFORMATIONFull Proposal TitlePlease limit to 300 charactersRunning TitlePlease limit to 50 charactersHost InstitutionFUNDING DETAILSBudget Requested ($)Duration of Support

SECTION 2 – PROJECT TEAM

2.1 Project TeamPlease provide a complete list of the members of the research team including the PI, co-investigators, collaborators, mentor (if any) and other support staff (e.g. research fellows, assistants and PhD students). Describe the roles and contribution of the Co-I and collaborators in achieving the research objectives.

Member Name, &

Project Role

Title or Position, Department, &Institution or Organization

Proportion of member’s FTE

allocated to this project

Number of concurrent

projects, including this

one

Role in this project

Ms Jane Wu, Principal Investigator

Principal Physiotherapist, Singapore Community Hospital

50% 1 Literature review, academic input into research design, compliance with institutional regulation

Mr John LimCo-Investigator

Research Fellow, Dept of Science and Tech, University of Science and Tech

30% 3 Planning, literature review, research design, participant recruitment, writing up the research project

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2.2 Profiles of Principal Investigator, Co-Investigators, Collaborators & MentorPlease complete the table below for each research team member. (Create as many tables as needed).

Full Name

Title (Miss, Mrs, Ms, Mr, Dr)

Office Mailing Address

Email Address

Phone Number

Fax Number (if applicable)

Current position (Please provide full details, i.e. primary, joint and other appointments, academic or professional, where applicable.):

Academic qualifications (Please indicate name of degree, institution’s name, and year in which degree was awarded.):

Publications in the past 5 years, if any (Please include only publications of direct relevance to project. State impact factors where available.):

Patents filed, if any (Please include patents both related & unrelated to the proposed project.):

Academic and/ or professional awards, if any:

Research outcomes from other grants, if any (e.g. publications, patents, awards):

SECTION 3 – PROJECT DESCRIPTIONPlease provide a detailed write-up covering the following areas.

3.1 Structured Abstract

Please summarize your research project in no more than 300 words. Essential elements of the structured abstract are as follows:

BackgroundAimMethodImpact

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3.2 Background

Briefly describe the background and the importance of the research, providing relevant references where applicable.

3.3 Specific Aims and Objectives

Please state concisely and realistically what the project intends to accomplish; and what hypothesis (or hypotheses) will be tested, if applicable.

3.4 Methods

Describe the following in detail:

a) Experimental design and the research protocolb) Subject research visits (frequency and duration of procedures involved)c) Period of recruitment to accomplish aims of this researchd) Statistical justification (i.e. sample size calculation) and the means by which data will be

analysed and interpreted (i.e. statistical analysis plan, qualitative data analysis plan… etc).e) If applicable, novel methodology used and its advantage(s) over existing methodologiesf) The potential difficulties and limitations of the proposed protocol and alternative approaches

to achieve the research aimsg) Any procedures, situations or materials that may be hazardous to personnel and the

precautions to be exercised

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SECTION 4 – PERFORMANCE INDICATORS

4.1 Performance Indicators

Qualitative Indicator: Impact

Please describe the potential impact of your research findings in the following areas (where applicable):

a) Solving the Problem Identifiedb) Developing new, generalizable knowledge (e.g. understanding risk factors, developing

prediction models for specific disease/disability outcomes, understanding the natural history of a disease, evaluating novel interventions that could prevent/treat diseases)

c) Developing a novel clinical applicationd) Other, please specify.

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Quantitative IndicatorsPlease indicate the final expected targets. State ‘NA’ where indicator is not applicable.

Target Value

Training Research & Development Manpower for ILTC sector

Allied Health Professionals (Specify Discipline(s))

Nurses

Social Workers

Psychologists

Medical Students

Bachelor’s Students

Master’s Students

PhD Students

Research Fellows

Developing Research & Development Networks

Joint Programmes or Projects with Local Universities or Research Organizations

Joint Programmes or Projects with International Universities or Research Organizations

Disseminating Knowledge & Gaining Recognition

Presentation to the Agency for Integrated Care (AIC)

Presentation to the Ministry of Health (MOH)

Poster Presentation at Local Conference

Oral Presentation at Local Conference

Poster Presentation at International Conference

Oral Presentation at International Conference

Publication as Non-peer Reviewed Report

International-Level Research Awards

Additional IndicatorsIf you would like to propose any additional indicators not found in the sections above, please do so in this section. These indicators may be either qualitative or quantitative.

Additional Indicator 1 Target

Additional Indicator 2 Target

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SECTION 5 – MILESTONES AND PROGRAMME PLANPlease complete the table below with the proposed milestones for the project. Do note that fund disbursement is contingent on the actual progress of the project.

5.1 Milestones

# Milestone Description Target Duration Target Completion Date

1

2

3

4

5.2 Programme Plan

Please describe, in detail, how you plan to organize the financial and human resources to complete the intended research project. Please include a Gantt chart outlining the schedule for all phases of the proposed project.

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SECTION 6 – BUDGETNote that salaries of the PI and Co-Investigator(s), and goods & services tax (GST) expenses are not fundable. The ILTC grant also does not fund conference-related fees or travel expenses.

6.1 ManpowerPlease budget for all the manpower required for the project including part-time personnel and those to be shared with other projects. Please use one line for each project team member, including details on whether they are existing personnel in your institution or new staff to be recruited. Provide details on how much time each staff will be committing to the project.Existing or

New(please tick accordingly)

Team Member / Highest Educational

Qualification Attained

FTE Employment Duration (in Years)

Annual Salary for 1 FTE Total Cost

☐ Existing☐ New

Research Assistant / BSc Statistics

0.5 1 $50,000 $25,000

☐ Existing☐ New

Research Assistant / BA Sociology

1 1.5 $50,000 $75,000

☐ Existing☐ New

☐ Existing☐ New

6.2 Equipment Please budget for the equipment you need to purchase to carry out the project. Please provide copies of quotes as an Annex.Item Number Needed Unit Cost Total Cost

6.3 Other Operating Expenses (OOE)This category covers other expenses directly related to the project such as research insurance, etc. Some examples are provided in blue.Category Cost for Project Duration Total Cost

Payments to research participants

IRB Review

Research Insurance

CITI Certification

Grand Total

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6.4 Justification of ExpensesPlease provide justifications for the above manpower (i.e. labour allocation to the proposed technical milestones), equipment (i.e. what equipment and supplies are required, and why existing infrastructure is unsuitable or unavailable where new purchases are proposed) and for each category of OOE described above.

Manpower:

Equipment:

OOE:

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SECTION 7 – INFORMATION ON PREVIOUS & ONGOING FUNDING, INSTITUTIONAL REVIEW BOARD (IRB) APPROVAL, RESEARCH INSTITUTION STATUS

7.1 Previous Applications for AIC ILTC Research GrantPlease list all the previous applications for the AIC ILTC Research grant, whether they are completed, ongoing or terminated. Indicate “NA” if this is the first time you are applying for the AIC ILTC Research Grant.

Project Status Approved Funding ($)

Balance Amount ($)

Grant Duration

Grant End Date

Effect of XX on YY Ongoing $50,000 $20,000 1.5 year 31 Jan 2019

7.2 Projects Currently Ongoing or Under Evaluation for Non-AIC ILTC Research GrantPlease list all the grants/sources of research funding, which you are planning or are currently in the midst of applying for. Provide details of the source, quantum obtained or applied for, and the components of the research to be covered by the quantum. Indicate the capacity in which the application was filed (e.g. PI, co-investigator, or collaborator). Indicate “NA” if you are not planning or currently in the midst of applying for non-AIC ILTC research grants.

Project Funding Agency

Funding Applied for ($) Grant Duration

Application ID

Status

7.3 Institutional Review Board (IRB) Approval

1. Has this research protocol been submitted for Institutional Review Board (IRB) review?

☐ Yes ☐ No

2. If yes, what is the outcome? ☐ Approved☐ Pending amendments☐ Rejected☐ Not applicable

7.4 Research Institution Status

1. Is your organization a Research Institution (RI)? ☐ Yes ☐ No2. If no, please indicate how you intend to satisfy HBRA’s research supervision requirement:

☐ Through my mentor’s organization that is an established RI☐ Through an alternative arrangement (no mentor) with an established RI☐ Other:

SECTION 8 – DECLARATION AND SIGNATURES

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8.1 Undertaking by Principal Investigator and Co- Investigator(s)

In signing the Grant Application, the Principal Investigator and all Co- Investigators undertake on any Grant Award, to:

Not send similar versions or part(s) of this proposal to other agencies for funding. Submit supporting documents of ethics approval obtained from the relevant Institutional

Review Board (IRB) for studies involving human subjects. Be actively engaged in the execution of the research and comply with all laws, rules and

regulations pertaining to Human Biomedical Research Act (HBRA) including the Singapore Good Clinical Practice guidelines and the Personal Data Protection Act (PDPA).

Ensure that AIC’s funding is acknowledged in all publications. Ensure that all publications arising from research wholly or partly funded by AIC will be

forwarded to AIC.

Principal Investigator

_____________________________Name and Signature:Designation:Host Institution:Date:

Co-Investigator (Create/Remove section where applicable)

_____________________________Name and Signature:Designation:Institution:Date:

Collaborator (Create/Remove section where applicable)

_____________________________Name and Signature:Designation:Institution:Date:Mentor (Create/Remove section where applicable)

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_____________________________Name and Signature:Title:Institution:Date:

8.2 Undertaking by the Host Institution

In signing the Grant Application, the Host Institution undertakes, on any Grant Award, to:

Provide appropriate support during the grant period. Ensure that the funds provided are used for the appropriate purposes. Ensure that the research project complies with all laws, rules and regulations pertaining to

animal and human ethics, including the Singapore Good Clinical Practice guidelines and the Human Biomedical Research Act (HBRA).

Have in place a code of practice for research integrity and procedures to deal with unethical research practices.

Director of Host Institution

_______________________________Name and Signature:Designation:Institution: Date:

If the Principal Investigator is the Director of the Host Institution, undertaking by the Director’s Reporting officer is required.

Director’s Reporting Officer

_______________________________Name and Signature:Designation:InstitutionDate:

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