DRC Application Form - Diabetes Research Center

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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
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