centers of disease control & … of disease control and prevention moderator: kayanna scott...

CENTERS OF DISEASE CONTROL AND PREVENTION Moderator: Kayanna Scott

05-21-18/2:30 pm CT Confirmation #7437315

CENTERS OF DISEASE CONTROL & PREVENTION

Moderator: Kayanna Scott May 21, 2018 2:30 pm CT

Coordinator: Welcome, and thank you for standing by. Today's call is being recorded. If

you have any objections, you may disconnect at this time. All participants

will be on a listen-only mode for the duration of the call and I would now like

to turn the call over to Dr. Letitia Presley-Cantrell.

Letitia Presley-Cantrell: Thank you and good afternoon. And welcome to the conference

call to discuss a new notice of funding opportunity for NOFO Titled:

Improving the Health of Americans Through Prevention and Management of

Diabetes and Heart Disease and Stroke, CDC, RFA, DP18-1817.

I am Letitia Presley-Cantrell from the Division for Heart Disease and Stroke

Prevention. So thank you for taking the time to be on the call with us today.

First let me run through today's agenda and the people you will be hearing

from on our end. I'll give an overview of the notice of funding or NOFO. Ms.

Pat Schumacher from the Division of Diabetes Translation will discuss the

application content and Ms. Patricia French from The Office of Grant Services

will discuss submission procedures.



Then I'll turn it back over to Pat to review some resources available to you for

additional information as you prepare your applications. We will end with

time for some of your questions so please type these in the chat box located on

the right of your screen at any point during today's call. In the event your

question is not answered on today's call, you may submit it to the 1817

mailbox at [email protected].

DP18-1817 is competitive and will support state and local governments in the

design, testing and evaluation of novel approaches to address a set of

evidence-based strategies aimed at reducing risk, complications and barriers to

prevent and control diabetes and cardiovascular disease or CBD in high

burden populations. Work will occur in states and local jurisdictions with a

population of 900,000 or more for significant reach may be achieved.

Category A includes diabetes management and Type 2 diabetes prevention

strategies. Category B includes CBD prevention and management strategies.

Each category in this NOFO is competitive and applicants may work, may

apply to work in Category A, Category B or both. Approximately 15 awards

will be made. Each applicants award amount will vary based on whether the

applicant elects to and is successful in competing for one or both categories.

The average award for both Category A and Category B will be $1.5 million.

The average award for a single category would be $750,000. Awards are

expected to range from a minimum of $400,000 per year to a maximum of $3

million per year based on the categories for which the applicant successfully

competes.

The applicant applying as a consortia, one organization must be identified as

the primary fiduciary agent that will receive the award and be responsible for

funds and leadership coordination of recipient activities. By beginning with



the end in mind, DP18-1817 has four long-term outcomes. First, increased

number of persons with diabetes enrolled in the CDC recognized lifestyle

change program who have achieved 5% to 7% weight loss. Second, a

decreased proportion of people with diabetes with an A1c greater than 9.

Third, increased control among adults with known high blood pressure and

lastly, increased control cholesterol management among patients at high risk

of cardiovascular events.

DP18-1817 is organized with two categories. Category A strategies focus on

diabetes management and Type 2 diabetes prevention. Category B, strategies

focus on CBD prevention and management. In both categories, applicants

will select from a menu of strategies as found in the strategy tables on Pages

13 through 20 of the NOFO.

Applicants should focus in areas where they have capacity, subject matter

expertise and potential to achieve greatest reach and impact. Applicants may

apply for Category A, Category B or both in a single application. Applicants

applying for both Category A and Category B should select the minimum of

six strategies from Category A and a minimum of six strategies from Category

B. Each category in this NOFO is competitive. Award amounts will vary

based on whether the applicant applies to work on Category A, Category B or

both and is successful in competing for one or both.

Funding resources and level of effort should be divided equally between

Category A and B strategies. Where appropriate, applicants will apply their

selected Category A and B strategies in the same targeted communities or

setting so that work on these strategies may be mutually reinforcing.

Complementary strategies should be addressed in a way that benefits both

people with pre-diabetes and diabetes or diabetes and people with high blood

pressure and, and with or at risk for high blood cholesterol. Applicants must



provide an evaluation and performance measurement plan that includes a data

management plan. Recipients will submit a more detailed evaluation and

performance management plan within the first six months of the award. CDC

will assist recipients in developing and implementing evaluation plans that are

useful for recipient program improvement and measuring the impact of

innovative strategies for the overall evaluation of the program.

Recipients will be expected to conduct rigorous evaluations for their

innovative strategies and activities. For Category A, recipients will be

required to select at least two strategies to rigorously evaluate. This is

particularly recommended for Strategies A3, A5, A6 and A8 for there is

potential for innovation and opportunities to learn from effective approaches.

For Category B, recipients will be required to select at least two strategies to

rigorously evaluate. Performance measures will be reported for all strategies

selected. This NOFO has Tiered performance measures. Tier 1 measures will

be reported by all recipients. Tier 2 measures will be reported based on the

strategy selected. For Category A, all long-term measures will be tracked by

the CDC. For Category B, the CDC and recipients will work together to

define all short-term measures based on the innovative strategies proposed.

The strategies that do not have a Tier 2 measure listed in the table, applicants

should propose a measure based on plan activities.

Now I'll turn it over to Ms. Pat Schumacher to discuss the application content.

Pat Schumacher: Thanks Letitia. So letters of intent are encouraged for this NOFO. The

purpose of a letter of intent is to allow CDC programs staff to estimate the

number and plan for the review of submitted applications. Letters of intent

should identify the potential applicant, the primary fiduciary agent and if

apply into consortia, a list of the smaller local city or county health



departments that will be participating. The (LOI) should also specify whether

work in Category A, Category B or both categories will be proposed. If

you've already submitted a letter of intent that is missing any of this

information, we encourage you to update it and resend it to us. Letters of

intent are due on May 28, 2018. They should be sent through U.S. express

mail, delivery service, fax or email to (Robert Hancock) using the address, fax

or email address shown on the slide.

Applicants should submit an application that includes all of the required

components described on Pages 39 through 43 of this NOFO. This includes

the project narratives that contains the maximum of 40 pages and addresses

the selected strategies in Category A, Category B or both. The project

narrative should include the following components. The first is background,

the second is approach, the third is applicant evaluation and performance

measurement plan, the fourth is organizational capacity and then finally work

plan.

Note that the work plan is included in the project narratives 40 page limit.

Guidance on the work plan is provided in the NOFO on Pages 23 through 28.

Applicants are required to include all of the elements described. The CDC

will provide feedback and technical assistance to award recipients to finalize

the work plan post award.

Here are a few reminders about developing work plan activities. Twelve

written activities are those actions that will be completed during the budget

period in order to achieve progress towards your performance measure target.

They should be specific and concise and they should include major

milestones. And that includes those milestones or deliverables your

contractors and partner organizations will accomplish during the budget

period to support the strategy or intervention.



Activities should be directly related to the performance measure for the

strategy or intervention. In other words, doing these things will contribute

toward moving the needle on the relevant performance measures.

It needs to be written clearly so that an external audience would be able to

understand what will be accomplished. Conversely, well written activities are

not broad general statements that restate the strategy or intervention. They

should not be repeated every year. And they're not inclusive of each and

every step that you'll take to accomplish a major milestone. For example,

planning an event, carrying the event out, compiling feedback and so forth.

Well written activities are also not inclusive of minor administrative or

logistical steps you'll take toward the achievement of a major milestone. For

example, writing a contract, releasing the contract for bid, arranging the

meeting and so forth. Well written activities are also not inclusive of

acronyms that are not defined or unrelated to the performance measures for

the strategy or intervention you're addressing.

The next slide addresses the budget narrative. The budget narrative is not

included in the 40-page project narrative limit. Applicants should prepare a

budget narrative and justification for the strategies they're proposing to

implement in each category. Category A which is diabetes management and

Type 2 diabetes prevention and Category B which is cardiovascular disease

prevention and management or both.

As a reminder, applicants proposing to work in both categories should divide

funds equally between the two. The total amount of funding requested should

not exceed the award ceiling of $3 million if applying for both categories or

$1.5 millionfor a single category as described on Page 32 under the award



information section of the NOFO. But keep in mind that the average award

for applicants applying to work in both Category A and B will be about a

million and a half. While the average award for work in a single category will

be approximately $750,000. Recipients will be required to attended a three-

day meeting to be held in Atlanta in the first year of the project period and

should budget for key staff working on Category A and Category B strategies

as well as evaluation to participate in that meeting.

When developing your budget narratives, applicants must consider whether

the proposed budget is reasonable and consistent with the purpose, outcomes

and program strategies described in the project narrative. Applicants are

strongly encouraged to reduce CDC's budget preparation guidelines at the link

shown on the slide for more information. Cost sharing or matching funds are

not required for this program. But applicants are encouraged to leverage other

resources to promote sustainability. Direct assistance is also not available

through this NOFO.

At this point I'll turn the call over to Patricia French from CDC's Office of

Grant Services and discuss requirements related to the applicant.

Patricia French: Thank you Pat. Applications are due on July 9, 2018 at 11:59 P.M. U.S.

Eastern Daylight Time on www.grants.gov registration. All organizations

must register with grants.gov prior to applying for any notice of funding

opportunity, NOFO, listed on the Web site. If your organization is already

registered with grants.gov, make sure your information is up-to-date within all

applicable systems especially since registration with the system for award

management, SAM, must be renewed each year. If your organization is not

registered with grants.gov, please begin the process immediately since the

entire process can take as long as four weeks to complete. Ensure that you

assign personnel to oversee the registration process and that all organizational



information is current and accurate. Application package, excuse me,

download the application package from grants.gov. Once you have download

the application package, review the required fields and note any questions that

you have. Make sure to obtain answers well in advance of the deadline date

form the agency contact listed in the full NOFO announcement.

Submitting the application; application submissions are not accepted via

email; i.e., regular or express delivery. Email, fax, paper copy CD, portal

device or other electronic devices; applications must be submitted

electronically through grants.gov. After you submit your organizations

application, the application will go through a validation process where it is

checked for electronic error. The validation processes is conducted by

grants.gov and can take up to 48 hours to complete. If any errors are

identified, you must correct them and resubmit the application before the

deadline date. Since common errors include computer viruses, bad filenames,

e.g., too long, special characters, etc., invalid, (dunce) number, expired SAM's

account, applications submitted past the deadline date in compatible software

or incorrect application types. Thank you and I will now turn the presentation

back over to Pat.

Pat Schumacher: All right, thanks Patricia. So as a reminder, applications are due on July 9,

2018. Remember to submit only PDF files in grants.gov. June 29 is the

deadline to submit questions to the 1817 email box if you have any. There are

two key resources available to you as you work on your applications; an email

box and a Web site. The 1817 Web site can be accessed to the link shown on

the slide. The Web site will include responses to frequently asked questions

and a system for electronic submission of questions through the 1817 email

box. The email box address, again, is [email protected]. We'll

continue to add to the list of questions as we receive them. We encourage you

to review the full NOFO as well as the FAQ's already posted on the Web site



before submitting a new question. To ask a question, go to the submit your

question link on the Web site, complete the requested information and click

the submit button to send. Responses to the questions will be posted on the

FAQ section of the Web site.

So at this point we'll transition over to questions. To the extent possible, we'll

try to answer your questions on the call today but in the event that we're not

able to provide an immediate answer, we'll be posting the questions and

answers from today's call on the 1817 Web site. Please check that Web site

frequently for new questions and answers. Before we get to the questions in

the chat box, I'll read through a few we've already received through the 1817

Web site.

The first question asks, the 1817 review section for collaboration on Page 48

of the NOFO referring to memorandums of agreements, memorandums of

understanding or letters of support; Pages 21 and 22 but the actual description

appears on Page 10. Can you confirm this?

Yes, the description of letters of support and MOA's or MOU's are on Page 10

of the NOFO. Though not required, they are encouraged and they can assist

in providing evidence of specific collaborative efforts.

The next question. Could you please tell me who should sign the letter of

intent for the 1817 NOFO? Is it the grant authorizing official or the intended

principal investigator? In this case, either individual would be appropriate.

The PDF of the NOFO cut off the last part of the grid that shows the strategies

and outcome measures on Pages 14 through 20. Can you please share a PDF

that contains the full grid?



We will be posting the strategy table on the 1817 Web site so that should be

up shortly and please just check that Web site. The next question asks, with

the estimated award date of September 29, will each budget period last from

September to September or will the Year 1 budget period lasts from

September 29, 2018 to June 29, 2019 with subsequent budget periods from

June to June.

The 1817 budget period will be on a September cycle. We received a couple

of questions on the budget. The first asks, will a budget template in Excel be

available for the 1817 grant applications. We will not be providing a budget

template for 1817 for the application process. Applicants should refer to

budget guidance and components described on Pages 2, 32 and 42 through 43

of the NOFO.

The next question asked are specific Category A. The first is can cooperative

agreement funds be used to purchase non-mydriatic retinal cameras? And the

response to that is no. Cooperative agreement funds may not be used to

purchase medical equipment.

The next question asks, can cooperative agreement funds be used to support

startup costs for a new national (CPP) program? Yes, cooperative agreement

funds may be used under Strategy 8.2 to support the initial startup, up to two

years, for a new CDC recognized organizations in underserved areas of the

state to serve high-burden populations but it's also important to remember that

the goal is to help these organizations work toward long-term sustainability

for their program.

Initial startup costs may include items such as space rentals, coach or

participant teaching materials, lifestyle coach training, Medicare diabetes

prevention program application fees when appropriate and related costs.



Some additional questions on Category A. For 1817 are we allowed to use

funds for media airtime? This one is a little difficult to answer definitively

without more information. So you're invited to submit a follow-up question

on the 1817 through that mailbox. But in general, purchase of media airtime

may be appropriate for some strategies seeking to reach and enroll

underserved populations in the National Diabetes Prevention Program or in

diabetes self management education and support programs. However, in all

cases, it's important to understand your target audience as well as current

barriers to access and utilization of these programs in your state before

embarking on media efforts.

The next question relates to Strategy A.4. Support advanced - advanced

training for lifestyle coaches working at the CDC Recognized Lifestyle

Change Programs to strength skills needed to engage and retain participants.

The question asks, what does the CDC define as advanced training? Please

provide examples.

Advanced training for lifestyle coaches refers to training beyond the initial

training requirements described in the diabetes prevention and recognition

program standards. This training should supplement coach skills since

program evaluation findings demonstrate that well trained and highly

motivated coaches have a huge impact on participant outcomes.

Applicants may use funds to support coach participation in advanced training

provided by organizations with an existing MOU with CDC. Additional

guidance on the strategy will be provided post award. The next question asks

would the referrals to online CDC recognized organizations satisfy the

telehealth strategy? And if so, can we count persons in health professional

shortage area to participate in online programs as telehealth delivery sites. In



this case, the answer would be no. Virtual online programs do not count as

telehealth delivery sites.

The next question asks, can cooperative agreement funds - we've answered

this question on non-mydriatic retinal cameras and the answer to that is no.

And at this point we'll transfer over to some of the questions we're seeing in

the chat box. We have a question that asks about support for lifestyle coach

training for the (National VPP). I actually included that in an earlier answer

so this relates to work under Strategy 8.2. So, if a recipient is providing

payment for start-up costs for a new program in an underserved area serving

high burden populations that would be allowed as part of startup costs.

Will equipment be allowed to be purchased for telehealth? And, again, no,

this is - the equipment is not allowed for purchase with 1817 funds.

Letitia Presley-Cantrell: So there's a question from the Illinois Department of Public Health

that says, will those who receive the enhanced 1305 and/or (1422) grants be

given priority over the other states since they are further along? And the

answer to that question is no. This is a competitive notice of funding

opportunity. Each application will be reviewed and will go through a review

process and those that are successful will be notified at the outcome of that

process.

Pat Schumacher: Do all strategies that we select have to be applied to every geographic area

identified? In other words, can we apply different strategies to different

neighborhoods? In that one, yes. You can apply different strategies in

different areas where that makes sense to do.



The next question asks, can we pay to create contracts or pay to run the

National Diabetes Prevention Program Lifestyle Change program or

(unintelligible)? Again, under Strategy 8.2, some startup costs to create new

CDC recognized organizations in underserved areas, this is for the National

Diabetes Prevention Program is allowed. In terms of starting up new (DSME)

programs, in that case the answer would be no.

The next question is could a certified, and I think they mean recognized or

accredited diabetes self-management program, oh okay. Could a certified

diabetes self-management program delivered by a non-(ABA) recognized or

(unintelligible) accredited provider be considered along with the (DSME)

provided by those providers. In this case, the focus is on (ABA) recognized or

(AATE) accredited diabetes self-management education program.

The next question asks, if the organization applies or both Category A and B,

is it possible they could be funded for only one category? And the answer is

yes. This is competitive and both of those categories will be competed

separately. A related question is that data applies for both categories but the

review is stronger in only one category. Will their application still be

considered for the stronger category? Yes, in that case they would.

Give us just a minute as we scroll down some of the rest of the questions in

the chat box.

Letitia Presley-Cantrell: So there's a question that says, under the goal of link community

resources and clinical services that support bidirectional referrals, self-

management and lifestyle change for patients with high blood pressure, high

blood cholesterol and who have had a cardiac event. One of the long-term

outcomes listed is increased participation in evidence-based lifestyle

interventions among patients with high blood pressure and high blood



cholesterol. Which of these interventions, if any, qualify? Please see a listing

of these interventions that we will post on the FAQ Web site, so we will post

that list and then you can go there for further clarification.

Pat Schumacher: Okay, the next questions asks, makes a comment about the following sentence

is ambiguous, on Page 6 where is says work will occur in state and local

jurisdictions with a population of 900,000 or more where significant reach

may be achieved. As for clarification on that, the 900,000 population

threshold sets the parameter for eligible applicant jurisdictions. So that could

be state, large city or consortia, smaller local city and county health

departments.

So interventions may be proposed for implementation in areas with a mix of

population density but must have sufficient combined populations to allow the

strategy supported by this NOFO to reach significant numbers of people.

There's a question asking what do you consider advanced training under

activity - under Strategy A4? Again, this is training for lifestyle coaches that

supplements the basic training that they're required to receive under the

(BPRP) standards. So this is training in addition to that but further builds

great skills.

A related question asks about advanced training. Will this include any of the

following motivational interviewing, implicit bias training, refresher training

and facilitation training? And, yes, those would be appropriate.

And, again, just give us a minute as we're scrolling through the chat box.

Letitia Presley-Cantrell: There's a question for any of the long-term outcomes, do we need

to provide number changes? For example, for the decreased number of

patients with HBa1c greater than 9%, do we need to say the percent change



over the course of the five-years? For example, the 20% decrease in this

measure. For your applications, you're only required to report the baseline

and targets for your short-term measures. If you're discussing your long-term

outcomes and measures in your narrative, you should give some indication of

the goal that you're working for over the five-year period in terms of the

specific performance measure reporting. Those will be further defined and

operationalized once the applicants are funded.

Pat Schumacher: Okay, the question about the project narrative work plan is the maximum

number of pages, 20 or 40? The total number of pages is 40. So there's

another question about the national (BPP) startup cost for a new CDC

recognized organizations in the first two years and so clarity on that. So yes it

is for the first two years of the cooperative agreement so that is consistent with

how we've handled this previously.

Letitia Presley-Cantrell: How much detail do you want included in the draft data

management plan? We just say that all of the components will be addressed

in the full DMP in the first six months, and that's (detailed). So for the

applications, we do need to make sure that the five points that are laid out in

the NOFO are addressed related to the data management plan. You can give a

sentence or two for each. You don’t have to go into great detail so we do need

those key points addressed and then we'll give further guidance for the six

months data management plan.

So, let me see. So for - there's a question that says, can funds be used to

support telehealth infrastructure, for example, software? The answer to that is

yes, software yes.

Pat Schumacher: So there's a question in follow-up to a response I gave earlier. Just to confirm,

we can take the startup of new CDC recognized organizations to reach high



burden populations but we cannot pay for startup of diabetes self-management

education? And yes, that is correct.

There's a question, do we have to have baseline data on all performance

measures? In the work plan, please report a baseline for all of the short-term

performance measures that align with the strategies that you have selected and

if you don’t have the exact data please provide an estimate.

Pat Schumacher: So there is a question asking, I believe this relates to Category A to comment,

if online programming is allowable, this is especially relevant for rural

populations. In terms of getting people enrolled, increasing enrollment in

CDC recognized organizations, online programs as long as they have CDC

recognition would apply there.

So another question on lifestyle coach training. It says to clarify, it sounds

like we cannot pay for basic lifestyle coach training, can you pay for a master

trainer to be trained? So, again, let me just clarify, under Strategy A2, there is

the opportunity to pay for startup costs for new programs, new CDC

recognized organizations and if you are paying for startup costs, that could

include lifestyle coach training, that basic training, in addition to the other

costs I've named. Can we pay for master trainer training. In that case, we'll

talk to you post-award and provide additional guidance on that.

Letitia Presley-Cantrell: So for California, there is a question, could a state entity make a

competitive application for specific region of high risk populations with over

a million people and the answer to that is yes.

Pat Schumacher: So there's a question on the budget. If the health department is applying for

both categories, should there be one budget or separate budgets? In this case

you should break out your budget separately for Category A and Category B.



Give us just a minute as we're continuing to scroll through the questions.

Letitia Presley-Cantrell: And keep in mind, if there are questions that you have that are not

answered today, you can send them to the 1817 email box and we will

respond to those questions and post them onto the frequently asked questions

part of the Web site.

So there's a question, if you can use 1815 budget template for the 1817

application and the answer to that is no.

Pat Schumacher: So there's a question asking if an organization that has recognition would like

to use funding to bring the program to a new geographic area, especially rural

areas that do not currently have a CDC recognized organization, could they

use startup costs to span to these new areas? The answer there is potentially

yes but we would need to talk with you a little bit further post-award to get

some additional details on what you plan to do there.

Letitia Presley-Cantrell: So there's a question that says, would it be allowed to, would we be

allowed to, fund the connection fees to a state health information exchange

and/or the EHR interface with the (HIE) to support work on A7, B2 and B6

and so for the - the answer to that for - the answer to that would be yes. So,

you can use it for those.

Pat Schumacher: There's a question about are you going to publish the presentation on the 1817

Web site? Yes, we'll have a link to the recording of the Webinar on the Web

site.

So we have a question that asks can you elaborate on reporting? If several

counties are working together on an application but (have) different strategies,



is it okay to report only on the strategies that each county is working on or do

all counties report on all strategies? And in this case, if several counties are

coming together on one application, together that one application has to

address all of the strategies that you're selecting.

Letitia Presley-Cantrell: There's a question, would you please explain about rigorous

evaluations? So for this NOFO, since we're asking applicants to conduct

innovative strategies, we need to make sure there's really strong evaluations to

see if these innovative strategies are working and so some of the examples

that we gave in the NOFO in terms of the kinds of things you should be doing

that include pre and post data collection looking at the changeover time and

the various outcomes of interest, you can look at doing, having comparison

groups or control groups; anything that would make a stronger evaluation and

we also are requiring that 10% of your funding is used for evaluation. So

those are some examples. We really want to see some strong evaluations

proposed for your selected innovative strategy.

So we've got a repeat question around the scoring of MOU's and letters of

support and so what we are looking for there is that any MOU or letter of

support that you have that is going to substantiate or provide evidence of your

relationship and how that will be beneficial or instrumental towards the

impact and outcomes that you described is going to put you in better standing

in terms of the review process. So please remember that, you know, we don’t

want just any letter of support but those that are directly going to be related to

the work you're performing and the impact that you plan to propose impact

that you plan to have.

Pat Schumacher: So there's a follow-up to a question we answered earlier about an application

from a consortia of different counties. Can the counties focus on different

strategies or is the expectation that all county partners tackle all strategies?



So, again, in this case all counties would not need to address all strategies. If

you're coming in as one applicant together, collectively, you'll need to address

all strategies.

So there's a question asking if we're applying for both Category A and

Category B, should we have two separate abstract narratives and so forth?

No, in that case it's one application. So, you will not need a separate narrative

and a separate abstract and so forth. In this case, applicants can apply, as we

said, for either category or both, if you're single and clearly delineated

application.

Letitia Presley-Cantrell: So there's a question that asks, if the questions asked and answered

today will be included on your post? Only the questions that are not answered

today will be on the frequently asked questions on the FAQ's, but the

presentation today itself will be available.

Pat Schumacher: So there's a question asking about the template listing side activities. Is that

the maximum number per strategy? We don’t have a maximum number of

activities per strategy. That is up to each applicant to determine.

Letitia Presley-Cantrell: So there's a question that asks, can agencies submit on multiple

applications with different partners? Please look for a response for that on the

FAQ site and I think we're going to be able to take one more question and

then we'll have to wrap the call up for today.

So there's a question that says, for strategies in different geographical areas as

referenced earlier, excuse me, I'm sorry, does mutually reinforcing apply?

And that only applies where it makes sense. Clearly if you have areas that

you want to be working and there is reason to have staff to do those strategies



in that area, you'll have to explain and identify these strategies and what you

propose in those areas in terms of the work.

Pat Schumacher: All right, at this point we're going to close the call for today. Thank you very

much for your questions and again, questions that we didn’t get to on today's

call will be posted on the 1817 Web site. So on behalf of our National Center

for Chronic Disease Prevention and Health Promotion, I want to thank you all

for your time this afternoon and for your interest in this notice of funding

opportunity. This concludes our call for this afternoon.

Coordinator: Thank you for your participation in today's conference, you may disconnect at

this time.

END

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