OFFICE OF RESEARCH
Scientific Review Committee
Please contact Karen Capobianco
(505-272-1127 or src@salud.unm.edu)
before attempting to complete this form
OFFICE OF RESEARCH
Scientific Review Committee
Request for Scientific Review
All proposals must be reviewed by the Scientific Review Committee (SRC) before they are submitted to the
UNM Human Research Protections Office (HRPO).
Application Date:
Proposal Title:
Principal Investigator:
Title:
Department or Affiliation:
Telephone:
SRC#:
UNM Faculty:
Yes
No
Email:
Contact Person (if different than above):
Telephone:
Email:
Designated faculty pathologist for this proposal (required if requesting diagnostic materials):
Other investigators and/or collaborators for this project:
If you are requesting materials from UNM Surgical Pathology, please obtain the approval/signature of the
Division Chief of Surgical Pathology or Designee. A signature is also required for the HRPO’s “Biological
Specimens Attachment”.
_______________________________________________________________
Date: ___________________
Signature of Division Chief of Surgical Pathology or Designee
Scientific Review Committee: Application (Version09June2015)
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Please note: Proposals to utilize archived and prospectively-collected specimens, including those from the
Human Tissue Repository (HTR), HTR satellite repositories, Surgical Pathology, and Hematopathology must be
submitted to the SRC. Any changes to an SRC-approved protocol will require additional review. If this is an
amendment to an SRC-approved protocol, please track changes. Questions? Please contact Karen Capobianco
(505-272-1127 or src@salud.unm.edu) or visit
hsc.unm.edu/research/compliance_and_support/scientific_review_committee.html.
The HTR serves as the University of New Mexico’s honest broker. Therefore, HTR staff will exclusively handle all
identifiable materials for SRC proposals.
Please limit to five pages.
1. Background:
2. Rationale and Significance:
3. Research Objectives with Specific Aims:
4. Specific Methods [please include assays to be performed]:
5. Relevant Patient Characteristics (inclusion/exclusion criteria):
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6. Specimen Details:
Source
Number of
Donors
EXAMPLE:
100
Surgical Pathology Archives
Specimen
Description
Breast
(ductal tumor)
Sample
Type
Paired
Normal?
FFPE
Yes
Number of Samples
per Donor
2 block per case
Quantity per Sample
5 sections per block,
5µm thick sections
Additional comments:
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Assay to be
Performed
IHC
7. Power Calculation or Justification/Rationale for Number of Subjects Selected
While we respect the fact that most studies are of a pilot nature, investigators should show evidence that
consultation with a biostatistician has occurred and outline a data analysis plan in the proposal, including
assumptions of power calculation. We believe that consulting with a biostatistician early in the
exploratory phases of research will help avoid pursuing spurious signals and ultimately increase research
reproducibility and productivity. For more information on these issues, please see the recent report from
the NIH on reproducibility in exploratory studies:
www.nature.com/news/policy-nih-plans-to-enhance-reproducibility-1.14586
8. Brief Description of Funding Source:
9. Plans to Return Remaining Tissue to the HTR or a Satellite Repository, if applicable (Note: this does not
include archival diagnostic paraffin blocks from Surgical Pathology):
10. Comments or Other Relevant Information, if necessary:
11. Relevant Literature References:
For SRC use only
Date Application Received:
Repository Director or Designee:
HRPO#:
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