Sample/Data access Application form
Projects requesting access to data/samples from the MATURA consortium (MAximising Therapeutic Utility in Rheumatoid Arthritis)
NB: A letter approving access to MATURA data/samples will only be issued once this application has been submitted to and approved by the MATURA Project Steering Groups (PSG1 and PSG2).
1. Applicants:
Name / Appointment / Department/InstitutionA
B
C
D
2. Address and telephone number of the institution(s) accommodating the project:
3. Address, telephone number and e-mail of the Principal Applicant
4. Title of project:
5. Summary of the project
Please provide, in no more than 250 words, a clear and simple summary of the proposed project. Include details of its aims; relevance to the aims of MATURA; methods to be used; benefits to both parties, sample sizes (if applicable); and evaluation plans. (A copy of the full study protocol must also be attached, if relevant)
Study design:
Methods:
7. / Proposed starting date: / Proposed duration:8. (a) Which information / resource does your project need to access from MATURA
Material – Peripheral blood / Tick if required / Number and volume of samples requested*Peripheral blood
DNA
Serum
RNA
Clinical data
Patient data (non-sensitive)
Material – Synovial tissue / Tick if required / Number and volume of samples requested*
Synovial Tissue
DNA
Serum
RNA
(b) *Are these numbers of samples requested based on a power calculation?
(c) Briefly describe your calculations
9. What data variables are required to accompany these samples?
Please note that there may be costs incurred to access the data / samples held by the MATURA consortium– you may need to include these in your grant application. Please ask for details from the Work Stream leads of the MATURA Project Steering Groups [contact details below].
10. Ethical approval – is ethical approval in place? Yes/No/N/A
Details:
11. Application form must be approved by representative from your Institution:
APPLICANT A / Signature / (Name)APPLICANT B / Signature / (Name)
APPLICANT C / Signature / (Name)
APPLICANT D / Signature / (Name)
This application must NOT exceed three sides of A4 paper (not including Material Transfer Agreement (draft attached).
Please submit by e-mail plus one original by post (in single spaced typescript) to:
Work Stream 1 – Queen Mary University of London
Professor Costantino Pitzalis
Centre for Experimental Medicine and Rheumatology
William Harvey Research Institute
Barts and The London School of Medicine
John Vane Science Centre
Charterhouse Square
London EC1M 6BQ
E-mail:
Work stream 2 – University of Manchester
Professor Anne Barton,
Arthritis Research UK Epidemiology Unit
Centre of Excellence for Genetics and Genomics
School of Translational Medicine
The University of Manchester
Stopford Building
Oxford Rd
Manchester, M13 9PT
E- mail:
· All relevant information must be included within this form and should not exceed these 3 pages.
· A copy of the full study protocol must also be attached
· Your application shall be considered by the MATURA Consortium Management Board (CMB), an executive board set-up to monitor the MATURA project. If the CMB finds merit in the application, it will forward it with a recommendation to the relevant custodian of the samples for a final decision on it.
· If your application is approved, the MATURA Project Steering Groups will respond to your request to access data/samples within 28 days – so please allow enough time when preparing your grant application to funding bodies. Data / samples will not be released until funding and ethical approvals are obtained and a signed Material Transfer Agreement has been received.
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FINAL version 1, 15th April 2015