iDocument: 0xxxx
Form_LifeLines Application
Proposal number: OV
Version 3
Date : 3-4-2014
(to be completed by LifeLines)
This form applies to an application for the use of LifeLines data or material. It can also be used for the application
for additional data collection in the LifeLines population. The completed form can be submitted via the LifeLines
data catalogue at www.lifelines.net together with the requested data items. For questions please contact
LLscience@umcg.nl. The LifeLines Research Office will contact you upon receiving your application.
1.
Title of the project
2. Date
3. Details of the primary applicant
(The primary applicant should be a senior researcher, i.e. holding a PhD degree or similar qualification. The primary applicant shall be
the contact person for the financial and contractual agreements).
Name
Position / Function
Institute / Organization
Address
ZIP or Postal code & City
Country
Telephone Number
Email
3.1 Other Members of the Project Group
(max 6 other members)
Name:
Position / Function:
Institute / Organization:
Telephone Number
Email
4. Is the proposal linked with previous submitted LifeLines proposal?
(In case on an earlier submitted proposal by the same researchers, please specify the application number: OV..)
No
Yes , please specify:
Research proposal form
1
iDocument: 0xxxx
Form_LifeLines Application
Version 3
Date : 3-4-2014
5. Project description
5.1 Scientific background
(max. 1500 words)
5.2 Research question
5.3 Methods
(Describe the data, study population, analysis plan and statistical methods intended to analyse the data in order to answer the
research question(s))
5.4 How does the project contribute to the central aims of LifeLines and fit within the research
theme “Healthy Ageing”.
(Please specify why data or material of LifeLines is essential for this research project)
5.5 Keywords
6.
Required data or material
6.1 Requested existing data or material
(Please specify the requested data items from the LifeLines data catalogue at www.lifelines.net )
6.2 Additional questionnaire data requested:
No
Yes , please describe:
6.3 Linkage with an external data source:
(Linkage between data from LifeLines and data collected outside LifeLines, for instance: data from case registries, CBS, etc)
No
Yes, please describe:
Research proposal form
2
iDocument: 0xxxx
Form_LifeLines Application
Version 3
Date : 3-4-2014
6.4 Additional measures and/or sample collection during visits to LifeLines centre requested:
No
Yes, please describe:
6.5 Additional data derived from material requested:
(Please specify the biomaterial and the details regarding the bio analysis)
No
Yes, please specify:
Serum derived from Septum Separated Tube
Describe the additional analysis needed:
Serum derived from Tube with Clot activator
Describe the additional analysis needed:
Plasma derived from k2-EDTA tube
Describe the additional analysis needed:
Plasma derived from Citrate tube
Describe the additional analysis needed:
Urine collected bij Early Morning Sampling (native)
Describe the additional analysis needed:
Urine collected bij Early Morning Sampling (mixed with Ascorbic acid)
Describe the additional analysis needed:
Urine collected by 24h Sampling (native) – Adults >= 18 yrs
Describe the additional analysis needed:
Urine collected by 24h Sampling (mixed with Ascorbic acid) – Adults >= 18 yrs
Describe the additional analysis needed:
Urine collected by Times over night sampling (native) – Children <18 yrs
Describe the additional analysis needed:
Urine collected by Times overnight sampling (mixed with Ascorbic acid) – Children <18 yrs
Describe the additional analysis needed:
Whole blood sample derived from Lithium Heparin tube (frozen in LN2 with FCS and
DMSO) – First 23.000 participants
Describe the additional analysis needed:
Research proposal form
3
iDocument: 0xxxx
Form_LifeLines Application
7.
Version 3
Date : 3-4-2014
Description of the required study population
(Describe the study population based, for example, on age, phenotype, etc. and the number of subjects needed.)
8.
Project implementation
(Indicate, what scientific output this research will generate in numbers, such as publications in scientific journals.)
9.
Timeline
(Identify the timing of the various project stages from the initial outset, such as start of the project, data-collection (in case new data
is being collected), data analysis and reporting of findings.)
10. Responsibilities of the project team
(Describe how this proposal fits into the line of research and expertise of the primary applicant and the other members of the
research group (max 500 words). Please specify the role of each project member in the research project and in particular indicate the
project member who will primarily be involved in conducting the research and/or data analysis).
11. Financing of the project.
(Name the intended sources of project funding.)
12. Summary
(Describe in max 100 words your research in layman's terms, preferably in Dutch).
Research proposal form
4