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To request any non-BMI ACTRI services, please refer to:
https://actri.ucsd.edu/centers-services/index.html

For Biomedical Informatics Services, please complete the request form below.
*Required information

Please select Service Type:

Biomedical Informatics

Enter any information or questions you have in the text box below.

If available/applicable, Please upload your research proposal

If available/applicable, Please upload a copy of your consent form

Please Scroll all the way to the bottom to hit the submit button

Clinical Research Services

Please specify which type of Clinical Research Service you are requesting: *

Budgeting Assistance for CTRI Services

Clinical Coordinators

Clinical Consultation

Data Safety Monitoring Board (DSMB)

Dietitian

IND or IDE Support

IRB submission

MRI Services

Pharmacy Services

Phase I Unit

Regulatory Consultation

Subject Recruitment Consultation

Ultrasound

Use of the Clinic

Please upload a copy of your IRB Research Plan*.

Please upload a copy of your Consent Form *.

Please provide a short description of the Project.

Project Design

Design assistance for community based research
Design assistance to address health disparity issues

Please specify what type of Clinical Research Services you are requesting:

Vital Signs

Medication administration

ECG

Nutritionist consult

Medical Center Admission

DEXA

Phlebotomy

Exercise Testing

Large Volume blood draw

RN assistance with procedure/testing

Phlebotomy/processing- simple

Skin biopsy

Phlebotomy/processing – complex

23hr stay

PK visit

Room use only

Point of care testing – pregnancy test, U/A, drug screen

Other

IV placement

Do you need access to Epic?

Admitting Priv?

Other

Does the study have a Data Safety Monitoring Plan (DSMP)?

Would you like help establishing a DSMP?

Biomedical Informatics Services

Please specify what type of Biomedical Informatics Services you are requesting: *

REDCap Access

Velos Services

Biospecimen Management and Tracking System

IT Services

Access to Accrual to Clinical Trials (ACT/ENACT) National Consortium of Medical Schools including UCSD.

Velos Access

Virtual Research Desktop (VRD)
(HIPAA Secure desktop for research)

UC Health Data Warehouse (UCHDW) - access to Databricks

TriNetX - Web tool for research feasibility and exploring UCSD patient cohorts

Nightingale - Database level access for UCSD research eligible patients

Aggregated Registry for Molecular Oncology Research (ARMOR)

Radiology - Enterprise Imaging for Research **Click link here to submit: https://go.ucsd.edu/3XqEnNp

Data Extraction Concierge Service (DECS), **Click link here to submit: https://ucsd-actri.jotform.com/243017739206859

Division (i.e, Cardiology, Pulmonology, Emergency Medicine etc...)*

Please specify what type of Velos Service is needed (please check all that apply):

Study Creation

Training

Calendars

Data migration

Custom Forms

Other

Custom Reports

Other (please specify)

Please specify what type of IT services

Desktop Support

Tableau

VPN access

Other

New User Account

Other (please describe)

Tableau Information

Tableau license versions*

Creator - $504/year
Explorer - $252/year

Requestor Information

If you have questions about this form, or general DECS related questions please attend our weekly virtual office hours. Simply join the zoom meeting link on Thursdays from 1:00PM – 2:00PM
https://uchealth.zoom.us/j/81732217241?pwd=Yk9rc0NPTGRTMnFxQkxhSTFaVEo2UT09&from=addon

Qualified Requestor Name*

Qualified Requestor Email Address*

IRB Information

Please Attach the IRB Approval Letter (if Applicable)

Which UC sites are you requesting limited/identified data from?

UCSD

UCIrvine

UCLA

UCDavis

UCSF

UC Health Data Warehouse

Data Description

Name of the data set*

Brief description of data/statement of work

Requested Due Date:*

What kind of images are you requesting?

MRI from Clinical PACS
CT from Clinical PACS
Plain Radiographs from Clinical PACS
Other:

Other

By default, imaging data will be de-identified during export to ensure HIPAA compliance. Does your study require that imaging data retain PHI in DICOM tags or pixel data after export?*

No (exported images will be deidentified by default)
Yes (PHI must be retained in exported images)

Inclusion Criteria (Specify the conditions to include patients in the cohort) (max 5000 chars)*

(The diagnosis/condition should be in ICD9/10 codes)

Inclusion Criteria (Specify the conditions to include patients in the cohort) (max 5000 chars)*

(The diagnosis/condition should be in ICD9/10 codes)

Please include accession numbers if available

Inclusion Criteria (Alternate Upload of Requirements)

Exclusion Criteria (Specify the conditions to exclude patients from the cohort)(max of 5000 chars)

(The diagnosis/condition should be in ICD9/10 codes)

Formulas (Define any formulas required for data field generation )

List of Variables to be included in the Data Set separated by commas (e.g. Gender, Age, etc).*

Comments

Bioinformatics Data Analysis (Center for Computational Biology and Bioinformatics)

Please specify which platform you are requesting:*

Next generation sequencing analysis – RNAseq
Next generation sequencing analysis – ChIPseq
Next generation sequencing analysis – ATACseq
Next generation sequencing analysis – Variant Analysis (Exome)
Next generation sequencing analysis – Variant Analysis (Whole genome)
Next generation sequencing analysis – Single cell RNAseq”
Next generation sequencing analysis -- Other
Next generation sequencing data integration
Data mining for prognosis prediction
Biomarker identification
Network analysis
Microarray analysis
Methylation array analysis
Medical image analysis (MRI, CT, etc)
Microbiome analysis
Metagenomics analysis
Machine learning
Custom data analysis
Custom pipeline development
Cloud computing

Please specify Other Platform you are requesting

Model Organism:*

NGS / Array Platform:*

Illumina
Pac Bio
Ion Torrent
Affymetrix
Other:

Please specify Other Platform you are requesting

Please specify your index number (UCSD)

If there are any external deadlines, please indicate (please allow at least 3 weeks out from today):

Please indicate if you are in agreement with our Authorship Policies:*

http://healthsciences.ucsd.edu/som/medicine/divisions/med-genetics/core-services/ccbb/services/Pages/authorship.aspx

Yes
No
Other:

Other

Project Abstact

Specific aim(s)

Clinical and translation impact of the project.

How does this project relate to the vision and mission of the Altman Clinical and Translation Research Institute (https://actri.ucsd.edu/about/Pages/MissionandVision.aspx)?

Justification of project feasibility.

Please include description of similar or pilot data and/or citations of relevant current literature

Organism(s) and experimental system(s) included.

For example, “human patients”, “human-derived cell lines", “mouse macrophage knock-out cell lines”, etc.

If you are proposing a non-human study, please select "Yes' and respond to the following two questions.

Please describe your action plan for translating the findings of this research into humans.

What evidence from human studies exists to support testing your specific hypotheses in animal models?

Study Design

Please include all available details of sample number and distribution,

such as "samples in 3 tissues (heart, lung, and blood) from each of 6 disease sufferers and 6 age-matched healthy
controls"

If applicable, please upload a spreadsheet (one row per sample) with relevant phenotype and sample information.

If applicable, please describe the comparisons you want made on this dataset.

Data type(s) to be included in analysis.

For example, “whole genome DNA-Seq”, “RNA-Seq”, “ChIP-Seq”, etc.

If your project proposes data mining of public datasets for comparison, please provide the data source
and identifier.For example, “GEO dataset GDS5879”, “ENCODE experiment ENCSR840QOH”, etc.

Analysis deliverable(s) requested.

For example, “list of genes differentially expressed between disease and control conditions”, “diagram showing gene expression level overlaid on network of known interactions among apoptosis pathway genes”, etc.

Specific analysis method(s), if any, requested.

Default is to leave this to the discretion of experts at CCBB, but we are happy to perform specific analyses, if needed.
Please provide citations for any specific analysis approaches or techniques that you want CCBB to follow in this
project (e.g., “Please perform metagene analysis as described in Jaffrey et al, Bioinformatics 2016”).

Data generation status:

Data already generated
Data not yet ready for analysis

Date data expected to be ready for analysis:

Expected outcome of project.

For example, “manuscript”, “grant”, “grant renewal”, etc.

Funding status of analysis work:

Fully funded as part of an existing grant/award/gift
Partially funded as part of an existing grant/award/gift
Unbudgeted-for extension of an Aim in a funded project
Unfunded, to be used as preliminary data for a grant submission or manuscript

Please provide source/amount of funding

Please describe what part of the work is funded

Please describe the original funded aim that will be extended

Consultation and Analysis

Please specify what type of Consultation and Analysis Services you are requesting: *

Community Research Consultation

Ethics Consultation

Health Disparities

Introduction to community agencies

Rural and Hispanic Health Research Consultation

Project Design

Do you want to plan to obtain the service at Rady Children’s Hospital

Click Check Box If:

Prepaid Free Service
Otherwise, Please Provide an Index Number

Biostatistics

Pre-Proposal
Data Analysis

UCSD internal proposal # (from the RES form)*

If you have an external deadline (such as grant or abstract submission deadline) please provide your deadline.

Please provide your Index number (if known).

Other (please describe)

Type of budget*

Investigator Initiated Project (grant, foundation or PI funding)
Industry Sponsored Clinical Trial

Assistance Required

Information on costs for CTRI services
Assistance with preparing a clinical trial budget

Laboratory Services

Please specify what type of Laboratory Services you are requesting: *

Biomarker Assays

Biomarker Consultation

Processing of Tissue, Blood, Biofluids

Digital Imaging Hub

Biobanking

Biostat Services

Are you planning to obtain pre-paid service at Rady's Children's Hospital?

Service Type *

Hover over

for additional information

Check all that apply

Pre-Award Support (Study Design)
Post-Award Support (Study Design, Data Analysis)

UCSD Proposal Number (RES)

Please provide your external deadline (such as grant or abstract submission deadline) [mm/dd/yyyy]: *

Pre-Award Support

Please read and acknowledge the Biostatistics Pre-Award Service Level Agreement (SLA).

I confirm that I have read the SLA and agree to its terms. *

VRD Information

OFC Project (Not Required)

OFC Task (Not Required)

OFC Fund (Not Required)

Purpose of VRD Usage

VRD Additional Users
Please state their full name and email below
If you have multiple users, please separate users by comma

Data Information

Data Type

PHI
non-PHI

Size (GB, TB, etc)

Duration (How long will you need VRD access)

Study Information

Study Title

Do you have an IRB #?

Yes
No
In Progress

IRB #*

Are you planning to contact patients?*

Contact Information

Are you a CTRI Member

Please provide your membership status.

General
Associate
Affiliate

Please provide your membership status. If you are not a CTRI member please go to CTRI Membership to apply. Once you have applied for membership, check "pending" below and proceed with this request for services.

Pending
Not a CTRI member

Please specify the following information: *

PI First Name*

PI Last Name*

Title*

PI Phone*

PI Email*

Department*

Requestor Contact Information same as PI

Please specify the following information: *

Requestor First Name*

Requestor Last Name*

Requestor Phone*

Requestor Email*

Requestor Department*

Organizational Affiliation

University of California, San Diego (UCSD)

San Diego State University (SDSU)

J. Craig Venter Institute

Salk Institute for Biological Sciences

La Jolla Institute for Allergy and Immunology (LIAI)

San Diego Veteran Affairs Medical Center

Palomar Pomerado Health

Sanford/Burnham Institute for Medical Research

Rady's Children's Hospital San Diego

Sanford Symposium

Other

Other (please describe)

Is this funded research?*

Yes
No (unfunded)

Funding Agency: *

NIH or other federal support with study section review
Industry Sponsored Study
CTRI Pilot Project Award
CTRI KL2 Award
CTRI TL1 Award
Foundation Support
Investigator Initiated without NIH or other federal study section review
Other

If Other, please specify *

Institute / Funding mechanism (e.g. NIDDK RO1)

Recharge Information*

RECHARGE INFORMATION REQUIRED

To ensure the quality of our service and minimize project initiation time, all Biostatistics and Data Extraction Concierge Service (DECS) requests are now required to provide Oracle Financial Cloud (OFC) billing information. If you are requesting free pre-award for voucher services, fees will only be assessed if work is continued beyond the allowable amount. For legacy campus recharge indexes, work with your fund manager to obtain new OFC code format.

Please specify the following information:*

Fund Manager Name*

Fund Manager Email*

OFC Project*

OFC Task*

OFC Fund

Would you like to participate in the CTRI Voucher Program?

Yes. Review Eligibility Requirements click here

Describe how the data will be used to support a grant application.

Please upload study abstract

Access Information*

Please specify following information: *

User First Name *

User Last Name *

User Email *

Please specify following information: *

UCSD PI First Name *

UCSD PI Last Name *

UCSD PI Title *

UCSD PI Email *

Add any further information or additional questions you would like to submit with this service request

Access Justification *

Summarize why you need access to the registry (research question) and how you intend to use it

Requestor Information*

Please specify following information: *

Requestor First Name *

Requestor Last Name *

Requestor Title/ Role

Requestor Phone *

Requestor Email *

Please Download CCBB Voucher Application

Which COVID-19 Registry would you like access to?

UC-Wide COVID-19 Research Data Set- Data Use Agreement (DUA) Required-
Limited dataset including five UC Health Systems