Request Form for Neuro Dept. Biostatistician Support

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This survey will be used to place new requests for single-time consultations from the Deptartment of Neurology Biostatistician.

Please complete this survery with as much detail as possible. Daksha Gopal and the Dept. of Neurology Research Committee will review requests and respond to you using the preferred email address you provide.

When filling out this survey, please keep the following in mind:

--Everyone requesting statistical support (including during the planning phase) should complete this form BEFORE contacting our statistician.

--Do not request future support (e.g., do not request help with data analysis if you do not have the data yet).

--Complete all fields to the best of your abilities. It is ok if you don't have all the information.

--Completing this survey has no bearing on IRB/IACUC approval and vice versa.

--One of the goals of this survey is to understand demand, track progress, and if necessary establish priority. For this reason, please do not refer to separate conversations (email or otherwise) when filling out fields and instead provide brief specifics where indicated.

Requestor First and Last Name

* must provide value

Are you faculty?

Yes

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Email of supervising faculty

* must provide value

Date of request (Day-Month-Year)

* must provide value

M-D-Y

Project title

* must provide value

Is this a new or follow on request?

New request

Follow on request

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Project title of prior request

What do you need help with at present?

Please contact Dr. Daksha via email (daksha.gopal@umassmed.edu) for instructions BEFORE sending any data files by email. She may request that datasets follow a specific convention with regard to field labeling, use of codes, inclusion of data dictionaries, and following safety measures (e.g., not including PHI; password to open file; etc.) for a more streamlined interaction.

* must provide value

Study design (pre-proposal including advice on data management, coding)

Management/cleaning of an existing database

Sample size or power calculation

Grant writing (statistics section, effort estimate for budgeting)

Statistical analysis

Abstract/manuscript/progress report (methods section, results tables or figures)

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IRB status

* must provide value

no IRB required (basic science studies or QI projects only)

IRB approved

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IRB #

* must provide value

Is there a deadline for the completion of this request?

Yes

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Deadline type

Grant

Abstract

Manuscript

Other

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Deadline Date.

Please allow for at least 1-2 months from today's date.

* must provide value

M-D-Y

Study Goal (specific aim).

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State your study hypothesis (what you expect the relationship among the variables to be)

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You may include any secondary or exploratory outcomes here

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Study Design Type

I need help to identify the correct study type

randomized controlled trial

retrospective cohort

case control

prospective cohort

other

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Other study type (enter details here).

What are you primary outcome variables

continuous (e.g., size, duration)

ordinal (e.g., normal, MCI, dementia)

category (e.g., absent vs present)

I cannot decide

Do your analyses require consideration of potential confounders?

yes

I don't know

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Number of cases (ok to enter projected number)

Is the study funded?

* must provide value

no funding (current or planned)

this study will be used to support funding requests

this study is funded

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What is the primary funding source?

government (NIH, DoD, other)

foundation grant

industry

internal pilot or other type of grant

departmental

PI personal research funds

other

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Other funding source (enter details here).

Does this include funding for statistical support?

Yes

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Leave this field blank

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