ARMSTRONG ATLANTIC STATE UNIVERSITY

ANIMAL USE PROPOSAL

Final Use Category Assigned (circle): A B C D AUP No. ______
IACUC Approval Signature: ______Date of Approval: ______

IACUC Reviewer: ______

This form has been developed to facilitate review of requests to use animals for specific research, teaching, or biological testing projects. The review process has been designed to communicate methods and materials for using animals through administrative officials and attending veterinarians to the Institutional Animal Care and Use Committee (IACUC). This process will help assure that provisions are made for compliance with the Animal Welfare Act, the Public Health Service Policy on Humane Care and Use of Laboratory Animals, and the DHHS Guide for the Care and Use of Laboratory Animals. This completed form must be approved by the IACUC before the project or course is initiated and before animals can be procured. Approved AUPs and AUP numbers are valid for up to three years subject to approval of modifications and annual reviews.

Use this form only for NEW AUPs or for those whose 3-year approval for use has expired.

For ANNUAL REVIEWS or MODIFICATIONS to an approved AUP, use the 1-page “AUP Annual Review or Modification” form. After 3 years a new complete AUP must be submitted and assigned a new AUP number. The number of animals used must be declared annually and their documentation is the responsibility of the Principal Investigator.

MULTIPLE FUNDING AGENCIES: Submit only one AUP for identical procedures, animal species and numbers of animals proposed in grant requests to different funding agencies. Use the same AUP number for each grant application. If funded, submit “AUP Annual Review or Modification” form with changes from original AUP, such as funding agency, procedures, or number of animals. Unless authorized by a Modification, the number of animals used must not exceed the number authorized on the original approved AUP regardless of the sources of funding.

1. / Project or Course Title:
2. / Name of Principal Investigator: / E-mail:
Title of PI: / Phone:
Department:
Bldg./Room: / Last 10 digits of new UGA ID:
Please list all persons from your laboratory who will work with animals and the procedures they will perform.
Name: / Procedures:
Name: / Procedures:
Name: / Procedures:
3. / Source of Funding: / Proposal Deadline:
Anticipated Starting Date: / Study Completion Date
4. / THE PI assumes responsibility for compliance with the policies stated above including assuring that myself and my staff are trained and qualified to perform the procedures on animals as indicated in this Animal Use Proposal and assures the Committee that this research does not unnecessarily duplicate previous experiments. The PI must hold AASU faculty status. Students, including post-docs, residents and others “in training”, and non-AASU employees can only serve as Co-Investigators.
The Attending Veterinarian verifies that the elements of this proposal have been assessed regarding the use of appropriate techniques in utilization of animals and that consultation with the PI will occur as necessary to resolve issues to minimize pain and distress.

Signature of PI: ______Date: ______

Signature of Attending Veterinarian (Independent of PIs): ______

5. / For proposals submitted for, or related to U.S. Public Health Service funding, please complete this item: The Dean, Department Head, or College Review Committee (indicate by underline) concurs with the scientific relevance of conducting this protocol. For non-PHS related proposals, this aspect of review is relegated to the institution, agency, or other funding source.
Printed Name: / Signature:
6. / Will any aspect of the experimental study (course) or animal
husbandry be conducted at another institution? / Yes No
If Yes, where?
Was the proposal approved by the IACUC of that institution? / Yes No
7. / Abstract of Proposal: Describe succinctly, in lay terms, how the animals will be used and what the contribution from using animals will be. Continue on separate page, if necessary.
8. / Does this proposal include the maintenance of a breeding colony? / Yes No
9. / Animals to be used in this study per year:
Animal Species
(Common name) / Max. No.
To be Used
Per Year* /

Strain

/ Sex /

Facility Location

For addt’l space use line below. / Source
Facility Location:
*For breeding colonies, indicate the maximum number to be maintained in the colony at any time.
Note: Excluding breeding colonies, the number of animals procured and the number of animals used under this AUP must be documented by the investigator each year. By law, this number must not be greater than the maximum approved in this AUP.
a) / Give the basic rationale for using animals in the research or teaching protocol.
b) / Explain why the species was selected.
c) / Explain how the numbers needed were determined.
10. / Indicate non-surgical procedures and describe on a separate sheet.
a) / Specimen collection from live animals
Type and volume of samples
Frequency and duration of collection
Method of collection
b) / Specimen collection from euthanized animals
Type
Source
c) / Induction of neoplasia. Type:
d) / Use of infectious agents approval from Biosafety Officer
Signature______Date______
Name of agent
Amount of dose / Route of administration
Biosafety level
e) / Use of radioisotopes (Request approval from Environmental Safety Services,
Radiation Safety Officer).
Isotope
Amount/Dose
Route
f) / Use of carcinogens (Request approval from Biosafety Officer).
Carcinogen
Amount/Dose
g) / Administration of test substances not listed above.
Amount/Dose
Route
h) / Tranquilizers, anesthetics, analgesics or antagonists used in any of the above procedures (specify below):
Species / Agent/Conc. / Dose (mg/kg) / Route
11. / Indicate Surgical Procedures:
a) / Type of surgical procedure. A complete description on a separate page should include what species will be used for each particular procedure, who will administer and what the pre- and post-operative care will be, special post-surgical needs of the animal, the length of time the animal will be kept alive following surgery, and any anticipated complications.
Terminal, i.e. animals will be euthanized under anesthesia when surgery is completed. / Yes No
Survival, i.e. animals will recover from anesthesia following surgery. / Yes No
b) / Anesthetic and analgesic agents to be used in surgical procedures:
Species / Agent/Conc. / Dose (mg/kg) / Route
c) / Indicate monitoring and life support systems to be utilized.
Respiratory rate / Heart rate
Mucous membrane color / Reflexes
EKG / Blood gases
Body Temperature / Blood Pressure
Other
12. / Euthanasia procedures:
a) / Technique / Species
CO2 inhalation
Barbiturate overdose
Cervical dislocation
Other Methods
(Specify)
b) / Name and title of person performing euthanasia / 1.
2.
3.
13. / If the answer to any of the following questions is Yes, please write an explanation on the bottom of this page.
a) / Will any technique be performed which would result in prolonged loss of sensation or paralysis? / Yes No
b) / Will any technique be performed which will involve prolonged physical restraint
other than routine caging and handling? / Yes No
c) / Will any technique be performed which will involve any non-standard husbandry
techniques (feedings, watering, housing, environment)? / Yes No
d) / Will any substance such as Complete Freund’s Adjuvant be injected which could cause
chronic inflammation and/or pain? If yes, describe what will be used and the schedule
for the injections. / Yes No
e) / Will animals be subjected to potentially painful procedures for identification, i.e. toe
clipping, branding, etc? / Yes No
f) / Will it be necessary for live animals to be removed from the immediate care facility? / Yes No
g) / Will this experiment involve the study of stress, pain, or abnormal behavior in live
animals which cannot be alleviated with drugs because their use would interfere with
the research goal? / Yes No
h) / Will animals be subjected to more than one major survival surgical procedure?
(Major survival surgery is defined as the penetration of a body cavity with anything
larger than a needle or a surgical procedure that results in permanent loss of function.) / Yes No
i) / Will any adverse effects or overt signs of illness be expected? If “Yes”, explain. / Yes No
14. / The placing of animal usage into categories according to potential pain and distress, and annual reporting to the U.S.D.A. is required by the Animal Welfare Act. For each species of animal involved, please read the attached Animal Use Category definitions and indicate which categories, A,B,C, or D, apply to this project:

Species

/

Use Categories

/
15. / What techniques will be used to minimize potential pain and/or distress (e.g. frequency of observations or euthanasia of sick or moribund animals)?
a) / The animals will be observed times a day or every hours. Any sick or moribund animals will be treated or euthanized.
b) / Other (describe)
16. / If your study was categorized above as B or C, are there alternatives to the painful procedure? / Yes No
a) / If “Yes”, list the alternatives:
b) / If alternatives are available but will not be used, justify the procedures used in this proposal.
c) / If “No”, describe the methods and source you used to determine there are no alternatives to the procedures in this proposal. For example, Biological Abstracts, Index Medicus, AGRICOLA, Animal Welfare Information Center.
When a database search is performed, the following information should, at a minimum, be disclosed per USDA Policy #12.
Data Base Searched
/ Date of Search
/ Period Covered
/ Key Words
17. / Does the information in this form agree with the animal use section of the grant application? / Yes No
18. / If this study involves collections of use of animals requiring governmental permits, please provide the name and number of the permit:

Animal Use Categories

Category A includes the use of animals in experimental procedures that would be expected to produce little or no pain or distress.

Examples: 1. Holding, in a cage, animals for use in research or teaching, i.e. breeding colonies

2. Routine procedures such as injections, blood sampling, and euthanasia using approved guidelines.

3. Physical examinations.

4. Behavioral observations in laboratory animals or captive wild-life.

5. Procedures in which anesthetized animals do not regain consciousness.

If the result of any of the above procedures is painful or distressful, the procedure should be listed under Category B or C below.

Category B includes the use of animals in procedures that involve minor pain or distress of short duration, or in procedures where pain and distress are alleviated through the use of anesthetics, analgesics, and tranquilizers.

Examples: 1. Procedures causing pain or distress which can be relieved by the appropriate use analgesics, anesthetics, or tranquilizers.

2. Exposure of blood vessels or chronic implantation of catheters.

3. Behavioral studies or procedures that involve short-term restraint.

4. Food/water deprivation for short periods.

5. Noxious stimuli from which escape is possible.

6. Surgical procedures which may result in some minor postsurgical pain or distress.

7. Diagnostic procedures such as laparoscopy or needle biopsies or one-time laparoscopies.

8. Use of Complete Freund's Adjuvant under approved guidelines.

9. Surgical procedures done under general anesthesia where the animals are euthanized while under a surgical plane of anesthesia.

Category C includes the use of animals in procedures that involve potential for significant but unavoidable pain or distress to the animals.

Convened quorum of the IACUC will review all Category C, multiple major surgeries, and any other proposal as requested by any member(s).

Examples: 1. Procedures causing pain or distress which cannot be relieved by pain-relieving drugs or tranquilizers.

2. Purposeful induction of behavioral stress, loss of sight, or similar debilitation to test the effects.

3. Major surgical procedures such as the invasion and exposure of body cavities, orthopedics, major dental work that result in substantial post-operative pain or distress which cannot be relived by the appropriate use of anesthetics, analgesics, or tranquilizers.

4. Induction of an anatomic or physiological deficit that will result in pain or distress.

5. Application of noxious stimuli from which escape is impossible or prolonged periods of physical restraint.

6. Procedures that produce pain or distress in which anesthetics are not used, such as toxicity studies, microbial virulence testing, radiation sickness, certain infections, and stress or shock research.

7. Studies causing inflammation, tissue damage, or neoplasia that results in morbidity.

Category D includes the use of invertebrate animals, cell cultures, embryonated eggs, certain biologic products, tissues obtained post-mortem from vertebrate animals, or observation of non-captivewildlife species.

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