UHBristolNIHR Pump Priming Scheme 2010-11

FLEXIBILITY & SUSTAINABILITY FUNDING (FSF)

Completed applications should be emailed to:

by 5.00 p.m. Friday 10 September 2010

Please refer to the guidance document prior to completing this form.

1. APPLICANT DETAILS
Name:
Job Title:
Department/Division:
Email:
Telephone:
Do you hold a substantive or honorary contract with UHBristol? / Yes No
Qualifications held:
2. SUPPORT REQUIRED
What do you require funding for?
Research Sessions/PAs
Funding for salaries and/or consumables
Research Sessions/PAsANDfunding for salaries and/or consumables
If you require Research Sessions/PAsplease provide details including job title, grade, salary and the number of sessions/PAs and length of time for which you require funding.
If you require funding for salaries or consumables please detail the breakdown of costs providing a brief justification for each element.
Amount requested for Research Sessions/PAs: £
Amount requested for salaries or consumables funding: £
Total amount requested: £
Start Date: / End Date:
3. LAY/PLAIN ENGLISH SUMMARY OF PROPOSED NIHR PROJECT
(500 words max)
4. SCIENTIFIC SUMMARYOF PROPOSED NIHR PROJECT
i. Background
Detail the size and nature of the problem to be addressed; include a brief literature review (500 word max)
ii. Aims and objectives
Detail the research question and how this is going to be addressed (400 word max)
iii. Plan of investigation and methodology
Include all stages of the study design. Methods of data collection, measures and techniques of analysis should be described and justified for both qualitative and quantitative designs. (500 word max)
iv. Potential impact
Detail the impact that the results of this study could have within your field and to the NHS e.g. potential patient benefit, service improvement, cost savings. Include how you plan to disseminate your findings. (400 words max)
5. NEXT STEPS/FUTURE NIHR GRANT APPLICATIONS
Outline how the funding will enable future NIHR research grant applications
(400 words max)
Please specify details of the NIHR grant application(s) you plan to make:
(note progress towards meeting these deadlines will be monitored by R&I)
Name of NIHR Call
Deadline:
Key stages of application development
Name of NIHR Call
Deadline:
Key stages of application development
6. RESEARCH DESIGN SERVICE
Name of the contact within the Research Design Service with whom you have discussed your research plans.
What were their recommendations?
7. STATISTICAL SUPPORT
If your study requires statistical analysis have you discussed this with a statistician?
YES NO
If yes, please provide their name, institution and a summary of their recommendations?
8. PUBLIC PATIENT INVOLVEMENT (PPI)
Provide details of any PPI in setting your research question/designing your research project with reference to the three levels on involvement detailed below (200 words max):
1) Consultation: Researchers consult service users about the research, e.g. through contacts, one-off meetings.
2) Collaboration: This includes active, on-going partnerships between researchers and service users
3) User led/user controlled: Service users lead the research and are in control of the research.
9. INTELLECTUAL PROPERTY
Is there likely to be any intellectual property derived from this project?
YES NO
Please provide brief details:
10. PUBLICATIONS
Please provide details of all publications since 1 January 2008
Please provide details of up to ten of your best publications prior to 2008
11. PREVIOUS AND CURRENT FUNDING
Please provide details of all previous and current research funding, specifying whether your role was as Chief/Lead Applicant, Co-Applicant, or Collaborator
12. NIHR SPECIALTY AREA Please indicate which specialty area(s) you work in:
Age and Ageing / Anaesthetics
Cancer / Cardiovascular
Clinical Genetics / Critical Care
DENDRON / Dermatology
Diabetes (DRN) / Ear Nose Throat
Epilepsy & Other Nervous System / Gastrointestinal
Hepatology / Health Services Research
Immunology & Microbiology / Infectious Diseases & Inflammation
Injuries & Accidents / Malignant Haematology
Metabolic Endocrine (not Diabetes) / Children’s Medicine (MCRN)
Mental Health (MHRN) / Musculoskeletal
Non-Malignant Haematology / Ophthalmology
Oral & Dental / Paediatrics
Primary Care (PCRN) / Public Health
Renal / Reproductive Health & Childbirth
Rheumatoid Arthritis / Respiratory
Surgery / Stroke Research Network (SRN)
Urogenital
13. DIVISIONAL GENERAL MANAGER APPROVAL
In my capacity as the Divisional Manager for the Division that supports the above named member of staff, I confirm that I support and approve this FSF application. We have discussed (where applicable) providing clinical backfill for the post and we will release their time to complete the programme of research work described above.
Divisional Manager’s Name:
Division
Email:
Telephone:
Signature*:
Date:

* Please copy your Divisional Manager into the electronic application and ask him/her to email confirming support for this application.

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