Diabetes Research Center Washington University Faculty Membership Application Instructions 1. 2. 3. Read the Washington University DRC Membership Guidelines, available by clicking here. Complete the application form. Return Application, NIH biosketch, and Other Support page electronically to: Karen Muehlhauser Program Manager Diabetes Research Center Washington University School of Medicine kmuehlha@dom.wustl.edu Date of Submission: (mm/dd/yy) Last Name: First Name: Middle Initial: Degree: Academic Title: Department: Division: Institution: Address: E-Mail: Telephone: Short Name for PubMed Search: Admin Asst: Admin Asst E-mail: Admin Asst Tel: Research Interests Select as many as apply: Area Complications Metabolic Regulation and Obesity Signal Transduction/Hormone Action Islet Biology and Immunology Prevention and Control Category Basic Translational Clinical Population/Community-Based Please provide a one-paragraph description of your diabetes/metabolism-related research (less than 250 words): Other Memberships Select all that apply: Digestive Diseases Research Core Center (DDRCC) O’Brien Center for Kidney Disease Research Nutrition Obesity Research Center (NORC, formerly CNRU) Clinical Translational Science Award (CTSA) Support Please list your Current Support. Please add additional rows to table as necessary. Sponsor Name Award Number Title Start Date End Date Annual Direct Costs 1-2 sentences describing goals and relation to diabetes/metabolism, if any Please list your Pending Support. Please add additional rows to table as necessary. Sponsor Name Award Number Title Start Date End Date Annual Direct Costs 1-2 sentences describing goals and relation to diabetes/metabolism, if any DRC Collaboration List DRC members with whom you collaborate. For a complete listing of our membership please click here. Please add additional rows to table as necessary. Last Name First Name Projected Core Use What is your planned use of DRC Biomedical Cores? Indicate all that apply and estimate your annual use and for which of your grants use of the Core is relevant. Details regarding core services offered are available by clicking here. Annual Usage Estimate Diabetes Models Phenotyping Core Services Biochemical analysis Glucose and/or insulin tolerance testing Body composition Metabolic rate by indirect calorimetry Blood pressure determination Hyperinsulinemic euglycemic clamping Tissue analysis Quantitative atherosclerosis analysis of mouse aorta Mouse provision and training (breeding, genotyping, feeding) RT PCR Immunoassay Core Services Blood chemistry Urine chemistry Lipids Core diabetes hormones Other tests Send out with special pricing (Quest and Others) Custom service Immunology of Type 1 Diabetes Core Services Obtain inbred strain for diabetes research Development of new Type 1 diabetes-relevant model through creation of transgenic line Development of new Type 1 diabetes-relevant model using targeted mutation of homologous recombination Cell lines or isolation immune cells Teaching of diabetes monitoring, examination of mice Antibodies and peptides Applicable Grant Number Mass Spectrometry Core Services Identification/quantification of fatty acids, steroids & their derivatives, other complex liquids Identification of peptides/proteins Metabolic studies of disposition of stable isotope labeled substrates Identification of unknown biologically active substance Mass spectrometry bioinformatics Metabolomic analysis of targeted small molecule Training/education in mass spectrometry, sample preparation, or interpretation of spectra Other Morphology and Metabolic Analysis Core Services Paraffin slides, stained or unstained Frozen slides, stained or unstained Tissue block Routine and immuno EM EM training Islet isolation from rodents Assays for beta-cell mass, proliferation, or function Procurement of human islets Consultation for islet-related studies Transgenic and ES Core Services Production of transgenic mice Production of chimeric mice for knock out and knock in Single day injection service Cryopreservation Assisted reproduction Speed congenics Consultation In which of the following DRC programs do you plan to participate? Pilot and Feasibility (click here for a detailed description of the program) Enrichment Program (seminar series, click here for schedules) Submission Please return this completed form with your current NIH biosketch (PHS 398/2590 Rev. 06/09) in Word format and Other Support Page in Word format, electronically to Karen Muehlhauser at kmuehlha@dom.wustl.edu. Please be sure the Personal Statement section of your biosketch indicates how your work relates to diabetes and metabolism. Thank you. Jean E. Schaffer, M.D. Director, Diabetes Research Center Washington University School of Medicine