Analysis of blood-brain barrier during dengue virus infection of some areas of human brain tissue

General Application Data Project Name (Character Limit: 100) Grant Number {For internal purposes only} Character Limit: 200 Total Budget DIPI is awarding competitive research grants for up to three years and IDR 1.5b/year. Your total budget for the entire duration of the project may not exceed IDR 4.5 billion. Character Limit: 200 Duration of Your Project (in months) Awards are expected to be made in December, 2016 at the latest. Project must be completed by December 31, 2019. Character Limit: 200 Last Name of Principal Investigator Character Limit: 200 First Name of Principal Investigator Character Limit: 200 Highest Degree Obtained Please select the highest academic degree received by the applicant (check one box only). Choices Bachelors/S1 Masters/S2 Doctorate/S3 Professional (IE: Apt.,dr.,drg,drh,Ir.,AK.,B.K.P … etc.) Name of the Applicant’s Institution Character Limit: 250 Work Mailing Address Character Limit: 2000 Other current Professional A liation(s) Character Limit: 1000 E-mail of the Principal Investigator Character Limit: 250 Phone Number Character Limit: 100 14 DIPI MANUAL GRANT 2016 DIPI PROPOSAL APPLIcATION FORM Nationality Choices Indonesian Other If you are not an Indonesian national, please specify your nationality: Character Limit: 200 Residency Status Are you are a resident of Indonesia?: Choices Yes No Gender Please select the applicant’s gender Choices Male Female Grant Focus Area Please select the grant focus area under which your proposal falls (please select ONE focus area only) Choices Identity, Diversity and Culture Life Health and Nutrition Biographical Sketch of Applicant Please include academic background, overall research scienti c interests and goals Character Limit: 3000 How Did You Hear About DIPI’s Research call? Character Limit: 250 Project Summary The summary should be written for the comprehension of readers without technical expertise. Brie y and clearly state the goals of the project, scienti c merit and the associated proposed activities; and describe the anticipated outcomes of the project. Character Limit: 3000 Project Description Prepare the project description with reference to the Section Review Process and criteria provided in the end of this application form and the guidance provided in this and the preceding sections of this solicitation (speci cally Section 5: DIPI Scienti c Review Guidelines of the Grant manual). Please address the following parts of the proposal concisely (within the character limits listed) and include citations in the text with full references. List of references must later be uploaded in the Attachments section at the end of this application form. If needed, you may also upload up to a total of ve gures and/or tables for the entire proposal. Incomplete proposals and those not submitted in the required format will not be considered. Background Summarize the scope of the technical and/or development challenge your research will address including issues relevant to both the local and international context.You can include in this section a brief summary of past work done on the proposed topic as well as any evidence gaps that your research will help ll. Character Limit: 5000 Project Objectives Provide a clear statement of the research project objectives and/or research questions the project will address. It is important that the project objectives are reasonable for the proposed timeline. Character Limit: 2500 Research Plan Describe the project design, procedures, and analyses to be used to accomplish the speci c objectives of the project. If applicable,describe study populations and interventions. Discuss the potential di culties and limitations of the proposed procedures and present alternative approaches to achieve the aims. Character Limit: 10000 DIPI PROPOSAL APPLIcATION FORM DIPI MANUAL GRANT 2016 15 Scienti c Relevance Explain to what extent does the proposed research and experimental design address important gaps in knowledge within the scienti c eld(s)/area(s) explored and DIPI Focus Areas Character Limit: 2500 Broader Impacts Explain to what extent will the proposed research enhance the infrastructure for research and education, such as facilities, instrumentation, networks, and partnerships? To what extent will the results be disseminated broadly to enhance scienti c and technological understanding? To what extent may the proposed activity bene t society? Character Limit: 2500 Sustainability Please list the merits of scienti c output of the research proposed in propelling future scienti c investigations. Describe the prospect and likelihood that the funding will enhance the investigator’s potential and commitment to productive independent scienti c research in the future. Finally, please show how the project will sustain itself past the award life-time. Character Limit: 2500 Innovative Approaches Explain how proposed concepts, approaches, methods, tools, or technologies used in your research may represent an innovative or novel approach. Character Limit: 2500 Personnel Prior Experience and Relevant capabilities of the Principal Investigator Brie y explain the quali cations of the applicant as they relate to the proposed project and illustrate how the project will build upon existing expertise. Later, an additional Letter of Laboratory Group Principal Investigator Agreement will be requested under the Attachments section of this application form. Character Limit: 2500 List of Personnel Please list all key personnel serving as co-Principal Investigator(s), Researcher(s) and Technical Sta . Key personnel are de ned as all individuals who will contribute in a substantive, meaningful way to the scienti c development or execution of the project, whether or not salaries are requested. Students and post-doctoral researchers should be included if they meet this de nition, as well as any other signi cant contributors. Include their names, last degree obtained and technical/scienti c role in proposed research project. Later, you will be asked to upload cVs of key personnel under the Attachments section of this application form. Members whereby salaries are requested will be required to include alongside their cVs an additional Letter of Laboratory Group Membership Agreement described in the Attachments section at end of this application form. Character Limit: 4000 collaborations Describe collaborations with domestic and international partners.This includes in-country partners such as government ministries, non-governmental organizations, and research institutes/universities. connections to private companies, international networks or resources, and international organizations should also be described if applicable. Explain the nature of these collaborations and describe what each partner will speci cally contribute to the Research Plan. If you do not have existing collaborations you may skip this entry. Character Limit: 4000 Training Provide examples of any seminars, workshops, conferences,or other training activities planned as part of the project, including estimates of the numbers and types of people to be trained (undergraduate students, graduate students, postdoctoral researchers, laboratory technicians,industry professionals, policymakers, and other stakeholders). For example: How many PhD Students and publications will be expected to graduate from this research project? Character Limit: 4000 16 DIPI MANUAL GRANT 2016 DIPI PROPOSAL APPLIcATION FORM Data Sharing and Dissemination Plan Include a plan describing how the research ndings will be disseminated to key stakeholders and the broader scienti c community, e.g.,via publication of results, submission of information to publicly accessible databases, informational meetings for stakeholders, or via other means appropriate to your eld. Character Limit: 3000 Timeline For the anticipated duration of the award, provide a list of major project activities and milestones along with the estimated time required to complete each. You may type in your timeline in the text area here or upload it later in the Attachments section of this application form if it is in a separate le, such as spreadsheet or graphical format. Character Limit: 3000 Human Subjects, Health, and Environmental Protection Statutes, acts, laws, and regulations related to scienti c research and development involving activities resulting in a potential high-risk and negative impact on human health and safety, the preservation of the environment and other living systems are governed by UU. No. 18 2002 on the National System of Research Development and the Application of Science and Technology, Article 30(2) and Article 22(2). This is further de ned by PP No. 48 2009, Article 22(3) UU No. 18/2002 on the requirements of such permits and by PP No.8 2012 on what constitutes such activities considered to be a potential high-risk of negative impact and the governmental organization authorized to give such permits. Grantee will be responsible for obtaining the necessary permits prior to the start of the proposed research activity. A. Activities Related to Biomedical Research Please check appropriate box if the following is used in the proposed research (ONE OR BOTH BOXES): Choices Human Subjects Vertebrate Animals If both or either of the above subjects are used, please state: • possible ethical consideration; • potential risk and/or negative impact on human health and safety; • potential risk and/or negative impact on the preservation of the environment and other living systems. Character Limit: 2500 DIPI PROPOSAL APPLIcATION FORM DIPI MANUAL GRANT 2016 17 B. Use of Human Subjects on Proposed Research I. Previous Experiments If the study involves the use of humans subjects, have experiments been conducted on animals previously? If not, please explain why humans are used as initial subjects for the study. Character Limit: 1000 II. Negative Impacts Please list potential direct or indirect negative impacts. This includes methods of intervention where possible negative impacts are foreseen. Character Limit: 1000 III. Duration Please describe the length of time the human subjects will be involved in the study. Character Limit: 1000 IV. consent Explain your plan for obtaining consent. If the subjects are informed verbally without written consent, or if they are unable to give their consent, please provide a justi cation and explain the tracking system to be implemented in order to protect the subjects. Character Limit: 1500 V. Damages can subjects sue for damages? If yes, what would be the amount of the compensation (in IDR)? Character Limit: 500 VI. Will The Human Subject Be Insured? (check ONE BOX ONLY) Choices Yes No Budget Applicants may request up to IDR 1.5B (or approximately US$100K) per year for up to 3 years. This can include: I. Equipment Rental/Use Fee, Materials, Supplies and consumables, II. Salaries and Stipends of Principal Investigators, co-Investigators research assistants/technicians, Research Sta Wages, III. Travel Expenses related to sampling of material(s)/data, training and other skills and education capacity-building IV. Other Direct costs includes computing and Technical Data Infrastructure, Publication costs, Workshops and conferences, Facilities and Other resources, Intellectual Property Registration and Processing, V. Overhead. Budget Form Provide an itemized budget for the project using the budget form provided. Projects may last no more than three years, and proposals for multi-year projects must provide annual budgets separately detailing the expected costs for each year. Value for the investment will be an important consideration in proposal evaluation and selection, so all costs should be reasonable and necessary. If your project involves more than one institution in Indonesia, please prepare a separate budget table for each, so that it is clear what funds each institution needs, regardless of whether you would ask for all the funds to be disbursed to the lead institution or whether you would ask for separate awards to be made to each participating institution. 18 DIPI MANUAL GRANT 2016 DIPI PROPOSAL APPLIcATION FORM !”#$ &’ (!)*(*+*(&!, Note: List all amounts in IDR only. Describe per categorical item, add additional item lines if necessary. Year1 Year2 Year3 Project Total (if requested) (if requested) Equipment and Supplies 1. Equipment Rental/Use Fee Rp0.00 2. Materials, Supplies & Consumables Rp0.00 3. Computing and Technical Data Infrastructure Rental/Use Fee Rp0.00 Equipment Costs Total (I) Rp0.00 Rp0.00 Rp0.00 Rp0.00 Salaries and Stipends (list each position on separate line and indicate % of time to be spent – add more lines if needed) 1. Principal Investigator Rp0.00 2. Co-Principal Investigator(s) Rp0.00 3. Researcher(s) Rp0.00 4. Technician(s) Rp0.00 5. Research Staff Wages Rp0.00 Salaries and Stipends Costs Total (II) Rp0.00 Rp0.00 Rp0.00 Rp0.00 Travel 1. Domestic Travel Rp0.00 2. Daily Allowance/Per Diem, Domestic Travel Rp0.00 3 International Travel Rp0.00 4. Daily Allowance/Per Diem, International Rp0.00 Travel Costs Total (III) Rp0.00 Rp0.00 Rp0.00 Rp0.00 Other Direct Costs 1. Computer Services Rp0.00 2. Publication Costs Rp0.00 3. Workshops and conferences Rp0.00 4. Facilities and other resources 5. Intellectual Property Registration & Processing Rp0.00 Other Direct Costs Total (IV) Rp0.00 Rp0.00 Rp0.00 Rp0.00 Overhead Costs 1. General purpose/office supplies Rp0.00 2. Clerical & Administrative wages 3. Electricity and other utilities Rp0.00 Overhead Costs Total (v) Rp0.00 Rp0.00 Rp0.00 Rp0.00 Grand Total Project Costs I+II+III+IV+V Rp0.00 Rp0.00 Rp0.00 Rp0.00 DIPI PROPOSAL APPLIcATION FORM DIPI MANUAL GRANT 2016 19 Budget Request Justi cation I. Equipment and Supplies Provide an explanation and justi cation for the purchase of materials, supplies, consumables required for the research is allowed. However, major equipment purchase will not be allowed and only equipment rental fees/use fee will be allowed. Where possible, projects should leverage existing durable equipment. Character Limit: 3000 II. Salaries and Stipends Provide an explanation and justi cation for any salary or stipend support requested, including a list of the positions to be supported and the role each will play in the project and the percentage of their time that would be devoted to the project. Character Limit: 3000 III. Travel Costs List travel costs related to sampling of material(s)/data, training and other skills and education capacity- building related to research study. Provide the number, duration, location, and purpose for any project- related trips for which funds are requested, along with the titles or positions of the travelers. Character Limit: 3000 IV. Other Direct Costs Describe and provide justi cation for related direct costs related to research activities. This includes computer services, publication costs, workshops and conferences, facilities and other resources in support of research study. Character Limit: 3000 V. Overhead List possible overhead costs as necessary in support of research activities. If requested, overhead should be kept to a minimum. Examples include general purpose/o ce supplies, clerical and administrative wages, electricity and other utilities. Character Limit: 3000 VI. Collaborating Institutions (If Any) If your project involves other institutions besides your own, please list them, brie y describe the roles they will play in the project, and indicate whether they will support their costs with their own resources or with funds requested in your project budget (Note: Only Indonesian-based collaborating institution will be eligible to receive DIPI funding). Character Limit: 3000 VII. Other Funding Sources List the source and amount of any other funds that you have received or applied for from other sources to support your research. Character Limit: 3000 Attachments Please upload the following items in your proposal submission as instructed in this section. Those marked by red asterix* are required in order to complete the proposal submission process. References Harvard System Figures and Tables Upload figures, and diagrams (if any) in a single document and refer to them in your project description (for example, Figure 1, Table 2, etc.). Please do not exceed figures/tables combined and do not include additional project narrative in this document.

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