Your progress is automatically saved as you fill out this form. Don’t worry about losing your data—you can return at any time to complete your submission.123456789101. General information Title of the study * Date of submission DD/MM/YY New submission Yes No Revised Yes No Հաջորդ2. Key study personnel and study contacts PI – add name * Other research personnel * ADD DELETE Previous Հաջորդ3. Study description Select the category that best describes the aim of this proposal Research Teaching/Training Other - specify 3.1. Study objectives – Lay Summary:Please describe in lay terms the objectives of this study. Include the potential scientific benefits of the proposed study for human or animal health, the environment, the advancement of knowledge, or the good for society (up to 300 words). 3.2. Funding:Multiple funding sources may be used for a single IACUC protocol. However, the study objectives described in the protocol must align with the objectives proposed within the grant. Internal External Funder Name: Funding Type: Grant/Contract Number: Grant/Contract Period: Grant/Contract Type (Primary Grantee or Sub-grantee): Project Number: Grant/Project Title: Principal Investigator (PI) Name: 3.3. Collaborations:Will you be sharing animal specimens (live animals, tissue, blood, organs, etc.) with any labs within Orbeli Institute of Physiology? Yes No Will you be collaborating with institutions (domestic and international) outside of Orbeli Institute of Physiology for this project?Please note: A collaboration refers to the sharing of funding and/or other resources (e.g., animal specimens, equipment, etc.).If Yes, list all collaborative institutions: Yes No 3.4 Will you be importing or exporting animal specimens (live animals, tissue, blood, organs, etc.) or research products to/from these institutions? Yes No 3.5 Location of animal procedures: Vivarium: Yes NoProcedures to be performed Please, list procedures: Laboratory and Room number: Please, list procedures: Will animals be housed outside of vivarium for more than 12 hours? Yes (If Yes, please explain the reason:) No Previous Հաջորդ4. Animal requirements 4.1. Justification for Animal Use:The rationale and justification for using live vertebrate animals rather than alternatives (computer modeling, cell cultures, etc.) The complexity of the processes to be studied cannot be duplicated or modeled in simpler systems There is not enough information known about the processes to be studied, therefore it is not possible to design nonliving models Other Please, explain/justify: 4.2. Alternatives and refinement related literature search:Complete below providing information for at least two databases searched. Database: Search date: Period covered: Keywords: Add 4.3. Provide a synopsis of findings related to alternatives and refinements for potentially painful procedures: 4.4. Please, specify the species, strain, and number of animals to be used for each:Include one strain per row. Species: Strain: Number of animals: Age and/or Body weight: Add Specific requirements for animals if any (i.e. Specific pathogen free, spontaneous mutant, transgenic, etc.): 4.5. Species and strain justification: The anatomy and/or physiology is best suited to the study This is the lowest species suitable for the proposed study There is a large database that allows for comparison with previous data Other: 4.6. Justification for number of animals to be used: If possible, number of animals should be determined by statistical power analysis. As an alternative, number of animals may be determined based on comparable studies for which the expected effect sizes were shown statistically significant (narrative up to 500 words) 4.7. Source of animals: Orbeli Institute of Physiology Other - state the vendor/source: Previous Հաջորդ5. Experimental Design Please explain the experimental design for each objective of the study, including the experimental groups and their respective numbers. This description should detail the procedures and outline the process from animal acquisition to the endpoint. Provide an overview of the work to be done on tissues following euthanasia. Include in-depth descriptions of surgical procedures in the Surgery section: 5.1. Animal identification method: Ear tag Ear punch Tattoo or color mark Other (specify): 5.2. Sample Collection:Will specimens be collected from living animals? Yes No Please, include one sample type per entry Add 5.3. Drugs and/or other agents to be administered:Will any drugs and/or any other agents be administered to animals? Yes No List all drugs and/or any other agents that will be administered to animals on this project: Drug/Agent name: Administration Route: Dosage: Volume: Frequency: Duration: Add 5.4. Will neuromuscular blocking agents (paralytics) be used? Yes No 5.5. Severity of procedures Non-recovery Mild Medium Severe 5.6. Measures taken to relieve pain and distress (please, describe) 5.7. Humane endpoints: describe the clinical signs/criteria that dictate the animal will be removed from the study or euthanized.Note: humane endpoint is the point at which pain or distress in an experimental animal is prevented, terminated or relieved. 5.8. Death as an endpoint: provide scientific justification why it is not possible to euthanize the animal at the earlier point of the study.Note: death as an endpoint refers to the studies when animals are not euthanized but die as a direct result of the experimental manipulation. Protocols requiring death as an endpoint must contain scientific rationale and consideration of alternate endpoints. Previous Հաջորդ6. Biosafety of the proposed activity. Will your study include: (check all boxes that apply) N/A Rodent cell lines Transgenic animals Human cell lines Biological hazards Radioactive materials Previous Հաջորդ7. Surgery 7.1. Will surgical procedures be performed? Y/N Yes NoNote: Monitoring sheets are required for animals undergoing surgical procedures. Intraoperative monitoring includes evaluation of anesthetic depth, body temperature, cardiac and respiratory rates. Postoperative (after recovery from anesthesia) monitoring should evaluate physiologic functions (intake and elimination), postoperative pain signs, postsurgical infections, surgical incision site condition, and timely removal of sutures or clips. Please provide details on monitoring procedures: 7.2. Surgery to be performed Major/Minor Survival Surgery or Non-Survival Surgery: Procedure: Description of Procedure: Pre-surgery actions (e.g. physical examination, food/water restrictions, skin preparation, pre-medication, etc.): Aseptic techniques (e.g. surgical site preparation, sterilization of instruments, surgical attire, etc.): Anesthetics/Analgesics: Intra-operative care (e.g. body temperature support, ophthalmic ointment, fluid replacement, etc.): Intra-operative monitoring for condition and anesthesia depth (e.g. pedal reflex (toe pinch), respiratory rate, mucous membrane color, body temperature, heart rate, etc.): Monitoring frequency throughout the procedure: Wound closure techniques (wound clips, suture – type, size, etc.): Post-operative monitoring and care: How pain and distress will be assessed: Frequency of post-operative monitoring and its duration: 7.3. Is more than one survival surgery planned for one animal? Yes No Previous Հաջորդ8. Euthanasia Select euthanasia method: Anesthetic overdose With prior sedation: Yes No Carbon dioxide Cervical dislocation With prior sedation: Yes No Concussion/percussive blow to the head Decapitation (to be used only if other options are not available!) Previous Հաջորդ9. Animal housing and care 9.1. Will enrichment be provided? Yes No Specify: 9.2. Is physical restraint for conscious animals planned for longer than 15 minutes at any point throughout the study? Yes No 9.3. Is food/water restriction planned for this study (unrelated to surgery)? Yes No 9.4. Other specific conditions that negatively affect animal wellbeing? Yes No Specify: 9.5. Adverse consequencesPlease, describe predictable consequences that may result from the procedure (e.g. inflammation, trauma, weight loss, paralysis, death): 9.6. Describe what care will be provided for animals experiencing adverse consequences (e.g. use of analgesics, fluid replacement, etc.) Previous Հաջորդ10. Key study personnel and Training“Personnel forms must be completed for each individual authorized to conduct procedures involving animals under the proposal, including the PI, Co-PI, research staff, students, and other research personnel” Name Title Laboratory/Department Cell/Emergency contact info Training Animal Care and Use basic training OHS training Surgery training Euthanasia - DD/MM/YY Other training - please, indicate training provided and by whom person is trained Procedures to be performed (please, check all that apply) Husbandry Anesthesia Non-surgical procedure Non-Survival Surgery Survival Surgery Live Sample collection Radiation of Live Animals Էֆտանազիա Other Procedures If other indicated – please, list all Relevant training and degree – describe relevant professional training and degree Training date Degree/Certificate Add Personnel Entry Previous Submit
