All questions marked with a red asterisk (*)
require a response. Questions without a red asterisk may or may not
require a response, depending on those questions' applicability to this
study.
1.1* Study Title:
Understanding Program Structure Representation via fNIRS
1.1.1 Full Study Title:
Toward Understanding Program Structure Representation via Functional Near-Infrared Spectroscopy
1.1.2 If there are other U-M studies related
to this project, enter the eResearch ID number (HUM#) or IRBMED Legacy
study number. Examples of related projects include, but are not
limited to:
Projects funded under the same grant
IRBMED Legacy study being migrated into eResearch
Previously approved Umbrella applications (such as Center Grants or approvals for release of funding)
Previously approved projects for which this is a follow up study
1.2* Principal Investigator:
Westley Weimer Note: If the user is not in the system, you may Create A New User Account...
Computer programs are developed using highly structured programming languages that tell the computer what to do. Program representation refers to the way the language is used to create order and structure within the program. For example, banking software may represent an individual account with a sequence of numbers referring to credits and debits over time. This program representation is often a design decision made by one or more software developers. Skilled software developers internalize a number of common structures used to realize large computer programs. While many studies have addressed best practices for code review, style, and software architecture, very few have approached understanding cognitive processes involved in software development. This study proposes using functional near-infrared spectroscopy (fNIRS) to measure those cognitive processes.
We believe that understanding the correlation between manipulation program representation and related tasks will inform the software engineering community about how to better assess or train individuals who write software. This study will ask participants to read code and look at program representations and perform mental rotation tasks while wearing an fNIRS cap to measure these correlations.
Secondly, this study will compare manipulating program representation to mental rotation. Participants will be shown several three-dimensional objects and asked if one can be rotated to match another. Many previous studies in the psychology literature demonstrate a clear relationship between the amount of rotation required to match rotated objects and the time taken to respond to the query.
In this study, participants will answer a pre-questionnarie and complete a training session. Then, they will spend approximately 70 minutes wearing an fNIRS cap rotating between the program representation manipulation
and mental rotation tasks. In the end, they will have a
conversation-based post questionnaire with the study investigator about
how they get the decision for some sample questions they encountered.
The data generated will be used to find correlations between tasks. We hypothesize that cognitive processes involved in program representation will be similar to mental rotation tasks. The similarities between these tasks will help the software engineering community to improve training for individuals involved in software development.
1.10*Estimated Study Start Date (Not required for IRBMED): (mm/dd/yyyy)
2/1/2018
1.11*Estimated Duration of Study:
90 minutes per participant, multiple participants over the course of 12 weeks.
Approved
01-1. Application Type
1-1.1* Select the appropriate application type.
Standard, non-exempt, research project
Note: Please contact the IRB office before continuing with this application type.
Application Type
Description
Human Subjects research involving interaction or intervention(formerly Standard, non-exempt research project - or - Exempt)
Studies that involve either or both of the following:
Interaction, including communication or interpersonal contact between investigator and subject
Intervention, including both physical procedures by
which information or biospecimens are gathered (e.g., venipuncture) and
manipulations of the subject or subject’s environment that are performed
for research purposes
Interaction/Intervention studies may also have a "secondary research" component.
Does the research involve any of the following:
more than minimal risk to participants?
use of drugs or medical devices?
target prisoners as research subjects?
collection of biospecimens from subjects (including blood, saliva, cheek swabs)?
YesNo
Some
studies involving interaction or intervention with subjects meet the
criteria for exemption. Select the category that best describes your
research. Detailed questions to verify eligibility are found on the next
page. For some studies, you will be able to issue a self-determination.
If none of these categories apply to your research select
NONE. Your application will be routed for comprehensive IRB review.
Exemption Category
Secondary research uses of private information or biospecimens
"Secondary
research" are studies that involve ONLY re-using private information
and/or biospecimens that are collected for some other "primary" or
"initial" activity, such as other earlier research studies, a
biorepository holding specimens obtained with "broad consent," clinical
care, or educational records. Includes Exemption 4 and “not regulated”
projects.
Do NOT use this application type for:
Studies that also have an
interaction/intervention component, such as primary collection of
information or biospecimens for the purposes of the study. (Choose
instead "Human subjects research involving interaction or intervention.")
Projects involving secondary use of information/biospecimens for only non- research purposes,
such as QA/QI, case studies on one or two individuals, or use in a
class to teach research methods. (Choose instead "Activities not regulated as human subjects research.")
Activities Not Regulated as human subjects research
Not
all activities that involve people, their data, or specimens are
covered by the regulations governing human subjects research (45 CFR 46
or 21 CFR 50/56).
IRB review is required for the following activities ONLY to assess compliance with HIPAA or other regulations or institutional policies:
Research on existing data or specimens that have been coded before the researcher receives them, but identifiers still exist.
Research Involving Deceased Individuals Only
Pre-review of Clinical Data Sets Preparatory to Research
Standard Public Health Surveillance or Prevention Activities
IRB review is not required for the following activities,
but researchers may wish complete this brief application to generate a
determination letter for funding or publication purposes, or to request
IRB review to confirm the “Not Regulated” determination:
Case Studies
Class Activities
Journalism/Documentary Activities
Oral History
Quality Assurance and Quality Improvement Activities
Research on Organizations
Research using Publicly Available Data Sets
Projects lacking immediate plans for involvement of human subjects, their data, and/or their specimens
Activities
such as training grants, program projects, center grants, or
multi-phase studies not involving human subjects until later years.
Before release of funding, some agencies may require IRB acknowledgement
of the future use of human subjects.
These projects are sometimes referred to as "umbrella projects" or "dry applications."
Use
of an investigational drug or biologic, outside of a clinical trial,
under a single-patient IND issued by the FDA for a patient faced with a
serious or life-threatening disease or condition.
Contact the IRB Chair-on-Call as soon as possible once the decision to use the investigational drug or biologic is made.
Submission for IRB review and approval is required, prior to use if feasible. If this was an emergency use, submit no later than five days after use of the investigational agent.
This includes both one-time use and continuing therapy.
Use
of an investigational device, outside of a clinical trial, when this is
the only option available for a patient faced with a serious or
life-threatening disease or condition.
Contact the IRB Chair-on-Call as soon as possible once the decision to use the investigational device is made.
Submission for IRB review and approval is required, prior to device use if feasible. If this was an emergency use, submit no later than five days after use of the investigational device.
This includes both one-time use and continuing therapy.
Humanitarian Use Device (HUD) under a HDE
Non-research, on-label use of an HUD under a Humanitarian Device Exemption (HDE)
Requesting Review by a Non-UM IRB
Use ONLY to request deferral of IRB oversight for UM activities to a non-UM IRB.
Multi-site Research where U-M is a Coordinating Center and/or IRB of Record
Do not use Multi-site Research application type when U-M is only a performance site - select Standard application type.
Select when U-M is any of the following:
Data Coordinating Center;
Clinical Coordinating Center; or
IRB of Record for non-U-M sites (for U-M to be IRB of Record you must contact your IRB for prior acknowledgement).
When U-M is also a performance site, a separate application is required for local site considerations.
Refer to special requirements at the IRB website.
Note: Please contact the IRB office before continuing with this application type.
01-2. Standard Study Information
1-2.1* Who initiated this study?
Investigator
1-2.2* Are you or any students working on this project being paid from a federally funded training grant?
YesNo
1-2.3 This study is
currently associated with the following department. To associate
this research with a different department, click Select. If the
department has defaulted to "student", click select to specify the
department through which this application is being submitted.
CoE Electrical & Computer Sci
1-2.4 Will the study utilize resources from the following centers?
Select all that apply:
There are no items to display
1-2.5* Is the study related to cancer, cancer risk, or cancer care delivery?
YesNo
1-2.6* Does this study require review by the Rogel Cancer Center Protocol Review Committee (PRC)?
YesNo
1-2.7*
Has the scientific merit of this study already been peer reviewed
(i.e., reviewed by one or more recognized authorities on the
subject)?
YesNo
1-2.7.1* List the peer-review organization(s).
Peer Review Organization
There are no items to display
1-2.8* Is this a clinical trial?
YesNo
1-2.8.1* Please select the trial phase
Trial Phase
Description
If other, please specify:
1-2.9*
Would the integrity of this research study be compromised if the
subject were able to view results of their research tests or medications
in the Patient Portal of MyUofMHealth.org? Research results displayed
to the subject in MyUofMHealth.org will include: lab results, radiology
examinations and outpatient medication lists. Contracts and protocols
should be assessed by the Principal Investigator for specific language
regarding blinding of subjects and their research results.
1-2.10* Does the study involve administration of a cell therapy product?
YesNo
Please
download the Cellular Therapies Scientific Review Committee
Application, linked to in the help text, and upload the document with
your answers to section 44.1.
1.6 Allow this person to
EDIT the application, including any supporting documents/stipulations
requested during the review process:
Yes
1.7 Include this person on all correspondences regarding this application: (Note: This will include all committee correspondence, decision outcomes, renewal notices, and adverse event submissions.)
Credentials: Required for PI, Co-Is and Faculty Advisors
Upload or update your CV, resume, or biographical sketch.
Financial Interest Screening Questions for Study Team Members Not Affiliated with the University of Michigan: Required for all roles except Administrative Staff
Below, you be asked several questions intended to identify Financial Interests and relationships that may be relevant to THIS RESEARCH.
These may include Intellectual Property Interests (IP interests), as
well as relationships with entities whose interests may affect/be
affected by this research. If relevant to this research, you
should also consider companies that compete commercially with the
research sponsor or the manufacturer of the study drug, device or other
investigational item if you know that the competitor's Financial
Interests would reasonably appear to be affected by this research.
In relation to THIS RESEARCH, for the past
12 months, do you or your Family member (your spouse, domestic partner,
or dependent) have or anticipate having any of the following Financial
Interests:
F1. Are any activities or relationships
with an entity, whether paid or unpaid, where that entity's
financial interests could be affected by this research? Examples
include service on a board of directors, service on a scientific
advisory board, consultant, officer, manager, or partner.
F2. An Equity Interest
in any publicly traded or privately owned entity whose financial
interests could be affected by this research, including but not limited
to shares of stock or stock options? DO NOT include equity held in
a mutual, pension, or investment fund over which you have no control
with regard to investment decisions.
F3. An investorship or ownership interest in any Intellectual Property (IP)
that is being tested, evaluated, developed in, or its commercial value
will be affected by this research? This includes IP that is the
subject of a copyright, issued patent or a patent application
(regardless of whether it has been licensed or optioned).
F4. Any payments over
$5,000 (USD) received for the past 12 months (apart from any payments
from the University of Michigan), including salary, honoraria, fees, or
other forms of compensation or anything of value, from any entity that
has a financial interest in this research?
F5. If any of the above is answered "yes", you must complete this form and upload the completed form below.
Conflict of Interest Detail: Required for all roles except Administrative Staff
Current Disclosure Status in M-Inform:This study team member has indicated in M-inform that they do not have any outside interests to disclose.
Providing a product used in this project (e.g., an app, device, compound, drug, software, survey, evaluation);
Holding an option/license to intellectual property used in
this project (e.g., a device, compound, drug, software, survey,
evaluation) that you developed; or
Receiving a subcontract for work on this project?
*Examples of relevant interests or relationships with a
non-UM entity include owning stock in, receiving income from, consulting
with, serving as an officer/director/advisor to, or having some other
related financial/leadership interest or relationship with that entity.
No
D2 If “Yes” to the question above, provide the
name of the outside entity or entities and a brief description of the
interest/relationship(s):
C1 Do you, your spouse,
domestic partner, or dependents have any outside interests or
relationships to companies or entities related to this research that the
IRB should consider?
Examples of outside interests include, but are not limited to the following:
receiving compensation whose value could be affected by the study outcome
IN THE AGGREGATE, expecting to
receive compensation from the sponsor of the research of $10,000 or
greater in the next year
having a proprietary interest in the sponsor of the
research or a product tested by this research including but not limited
to, a patent, trademark, copyright, or licensing agreement, or the right
to receive royalties from product commercialization
individually or collectively, having an ownership interest
(equity or stock options) in the sponsor of the research or product
being tested whose value cannot be readily determined through reference
to public prices
individually or collectively, having an ownership interest
(equity or stock options) in a company or product whose value could be
affected by the study outcome
IN THE AGGREGATE, having an ownership interest (equity or
stock options) in the sponsor of the research that exceeds $10,000 or 1%
when the sponsor is a publicly traded entity
receiving significant payments of other sorts with an
aggregate value of $10,000 or more (or payment of ANY amount to medical
school or hospital employees) made directly by the sponsor of this
research for unrestricted research or education, equipment, consultancy,
or honorarium
holding a position of management or leadership in company
or entity related to this research including, but not limited to,
officer, director, or member of an advisory board.
providing consulting services or serve on a Speaker’s
Bureau, either paid or unpaid, to the financial or non-financial sponsor
of this study
when the sponsor is a publicly traded entity, having any ownership interest (equity or stock options) in the sponsor
expecting to receive any loans, educational support,
contributions of in-kind for equipment, or any other non-compensatory
payment from the sponsor of the research in the next year
C2 Please provide a detailed description of the outside interest in the box below.
C2.1 Where have you submitted a disclosure of this outside interest?
C2.2 Has a management plan been formalized?
C2.2.1 Click the View Management Plan in M-Inform button below to see your management plan for this study.
C2.2.2 If no, describe the
financial interest in sufficient detail to permit the COI Ancillary
Committee and the IRB to determine if such involvement represents a
potential conflict-of-interest and/or should be disclosed to potential
research subjects in the informed consent form.
1.6 Allow this person to
EDIT the application, including any supporting documents/stipulations
requested during the review process:
Yes
1.7 Include this person on all correspondences regarding this application: (Note: This will include all committee correspondence, decision outcomes, renewal notices, and adverse event submissions.)
Yes
Credentials: Required for PI, Co-Is and Faculty Advisors
Upload or update your CV, resume, or biographical sketch.
Financial Interest Screening Questions for Study Team Members Not Affiliated with the University of Michigan: Required for all roles except Administrative Staff
Below, you be asked several questions intended to identify Financial Interests and relationships that may be relevant to THIS RESEARCH.
These may include Intellectual Property Interests (IP interests), as
well as relationships with entities whose interests may affect/be
affected by this research. If relevant to this research, you
should also consider companies that compete commercially with the
research sponsor or the manufacturer of the study drug, device or other
investigational item if you know that the competitor's Financial
Interests would reasonably appear to be affected by this research.
In relation to THIS RESEARCH, for the past
12 months, do you or your Family member (your spouse, domestic partner,
or dependent) have or anticipate having any of the following Financial
Interests:
F1. Are any activities or relationships
with an entity, whether paid or unpaid, where that entity's
financial interests could be affected by this research? Examples
include service on a board of directors, service on a scientific
advisory board, consultant, officer, manager, or partner.
F2. An Equity Interest
in any publicly traded or privately owned entity whose financial
interests could be affected by this research, including but not limited
to shares of stock or stock options? DO NOT include equity held in
a mutual, pension, or investment fund over which you have no control
with regard to investment decisions.
F3. An investorship or ownership interest in any Intellectual Property (IP)
that is being tested, evaluated, developed in, or its commercial value
will be affected by this research? This includes IP that is the
subject of a copyright, issued patent or a patent application
(regardless of whether it has been licensed or optioned).
F4. Any payments over
$5,000 (USD) received for the past 12 months (apart from any payments
from the University of Michigan), including salary, honoraria, fees, or
other forms of compensation or anything of value, from any entity that
has a financial interest in this research?
F5. If any of the above is answered "yes", you must complete this form and upload the completed form below.
Conflict of Interest Detail: Required for all roles except Administrative Staff
Current Disclosure Status in M-Inform:This study team member has indicated in M-inform that they do not have any outside interests to disclose.
Providing a product used in this project (e.g., an app, device, compound, drug, software, survey, evaluation);
Holding an option/license to intellectual property used in
this project (e.g., a device, compound, drug, software, survey,
evaluation) that you developed; or
Receiving a subcontract for work on this project?
*Examples of relevant interests or relationships with a
non-UM entity include owning stock in, receiving income from, consulting
with, serving as an officer/director/advisor to, or having some other
related financial/leadership interest or relationship with that entity.
No
D2 If “Yes” to the question above, provide the
name of the outside entity or entities and a brief description of the
interest/relationship(s):
C1 Do you, your spouse,
domestic partner, or dependents have any outside interests or
relationships to companies or entities related to this research that the
IRB should consider?
Examples of outside interests include, but are not limited to the following:
receiving compensation whose value could be affected by the study outcome
IN THE AGGREGATE, expecting to
receive compensation from the sponsor of the research of $10,000 or
greater in the next year
having a proprietary interest in the sponsor of the
research or a product tested by this research including but not limited
to, a patent, trademark, copyright, or licensing agreement, or the right
to receive royalties from product commercialization
individually or collectively, having an ownership interest
(equity or stock options) in the sponsor of the research or product
being tested whose value cannot be readily determined through reference
to public prices
individually or collectively, having an ownership interest
(equity or stock options) in a company or product whose value could be
affected by the study outcome
IN THE AGGREGATE, having an ownership interest (equity or
stock options) in the sponsor of the research that exceeds $10,000 or 1%
when the sponsor is a publicly traded entity
receiving significant payments of other sorts with an
aggregate value of $10,000 or more (or payment of ANY amount to medical
school or hospital employees) made directly by the sponsor of this
research for unrestricted research or education, equipment, consultancy,
or honorarium
holding a position of management or leadership in company
or entity related to this research including, but not limited to,
officer, director, or member of an advisory board.
providing consulting services or serve on a Speaker’s
Bureau, either paid or unpaid, to the financial or non-financial sponsor
of this study
when the sponsor is a publicly traded entity, having any ownership interest (equity or stock options) in the sponsor
expecting to receive any loans, educational support,
contributions of in-kind for equipment, or any other non-compensatory
payment from the sponsor of the research in the next year
C2 Please provide a detailed description of the outside interest in the box below.
C2.1 Where have you submitted a disclosure of this outside interest?
C2.2 Has a management plan been formalized?
C2.2.1 Click the View Management Plan in M-Inform button below to see your management plan for this study.
C2.2.2 If no, describe the
financial interest in sufficient detail to permit the COI Ancillary
Committee and the IRB to determine if such involvement represents a
potential conflict-of-interest and/or should be disclosed to potential
research subjects in the informed consent form.
1.6 Allow this person to
EDIT the application, including any supporting documents/stipulations
requested during the review process:
Yes
1.7 Include this person on all correspondences regarding this application: (Note: This will include all committee correspondence, decision outcomes, renewal notices, and adverse event submissions.)
Yes
Credentials: Required for PI, Co-Is and Faculty Advisors
Upload or update your CV, resume, or biographical sketch.
Financial Interest Screening Questions for Study Team Members Not Affiliated with the University of Michigan: Required for all roles except Administrative Staff
Below, you be asked several questions intended to identify Financial Interests and relationships that may be relevant to THIS RESEARCH.
These may include Intellectual Property Interests (IP interests), as
well as relationships with entities whose interests may affect/be
affected by this research. If relevant to this research, you
should also consider companies that compete commercially with the
research sponsor or the manufacturer of the study drug, device or other
investigational item if you know that the competitor's Financial
Interests would reasonably appear to be affected by this research.
In relation to THIS RESEARCH, for the past
12 months, do you or your Family member (your spouse, domestic partner,
or dependent) have or anticipate having any of the following Financial
Interests:
F1. Are any activities or relationships
with an entity, whether paid or unpaid, where that entity's
financial interests could be affected by this research? Examples
include service on a board of directors, service on a scientific
advisory board, consultant, officer, manager, or partner.
F2. An Equity Interest
in any publicly traded or privately owned entity whose financial
interests could be affected by this research, including but not limited
to shares of stock or stock options? DO NOT include equity held in
a mutual, pension, or investment fund over which you have no control
with regard to investment decisions.
F3. An investorship or ownership interest in any Intellectual Property (IP)
that is being tested, evaluated, developed in, or its commercial value
will be affected by this research? This includes IP that is the
subject of a copyright, issued patent or a patent application
(regardless of whether it has been licensed or optioned).
F4. Any payments over
$5,000 (USD) received for the past 12 months (apart from any payments
from the University of Michigan), including salary, honoraria, fees, or
other forms of compensation or anything of value, from any entity that
has a financial interest in this research?
F5. If any of the above is answered "yes", you must complete this form and upload the completed form below.
Conflict of Interest Detail: Required for all roles except Administrative Staff
Current Disclosure Status in M-Inform:This study team member has not yet disclosed in M-Inform.
Providing a product used in this project (e.g., an app, device, compound, drug, software, survey, evaluation);
Holding an option/license to intellectual property used in
this project (e.g., a device, compound, drug, software, survey,
evaluation) that you developed; or
Receiving a subcontract for work on this project?
*Examples of relevant interests or relationships with a
non-UM entity include owning stock in, receiving income from, consulting
with, serving as an officer/director/advisor to, or having some other
related financial/leadership interest or relationship with that entity.
No
D2 If “Yes” to the question above, provide the
name of the outside entity or entities and a brief description of the
interest/relationship(s):
C1 Do you, your spouse,
domestic partner, or dependents have any outside interests or
relationships to companies or entities related to this research that the
IRB should consider?
Examples of outside interests include, but are not limited to the following:
receiving compensation whose value could be affected by the study outcome
IN THE AGGREGATE, expecting to
receive compensation from the sponsor of the research of $10,000 or
greater in the next year
having a proprietary interest in the sponsor of the
research or a product tested by this research including but not limited
to, a patent, trademark, copyright, or licensing agreement, or the right
to receive royalties from product commercialization
individually or collectively, having an ownership interest
(equity or stock options) in the sponsor of the research or product
being tested whose value cannot be readily determined through reference
to public prices
individually or collectively, having an ownership interest
(equity or stock options) in a company or product whose value could be
affected by the study outcome
IN THE AGGREGATE, having an ownership interest (equity or
stock options) in the sponsor of the research that exceeds $10,000 or 1%
when the sponsor is a publicly traded entity
receiving significant payments of other sorts with an
aggregate value of $10,000 or more (or payment of ANY amount to medical
school or hospital employees) made directly by the sponsor of this
research for unrestricted research or education, equipment, consultancy,
or honorarium
holding a position of management or leadership in company
or entity related to this research including, but not limited to,
officer, director, or member of an advisory board.
providing consulting services or serve on a Speaker’s
Bureau, either paid or unpaid, to the financial or non-financial sponsor
of this study
when the sponsor is a publicly traded entity, having any ownership interest (equity or stock options) in the sponsor
expecting to receive any loans, educational support,
contributions of in-kind for equipment, or any other non-compensatory
payment from the sponsor of the research in the next year
C2 Please provide a detailed description of the outside interest in the box below.
C2.1 Where have you submitted a disclosure of this outside interest?
C2.2 Has a management plan been formalized?
C2.2.1 Click the View Management Plan in M-Inform button below to see your management plan for this study.
C2.2.2 If no, describe the
financial interest in sufficient detail to permit the COI Ancillary
Committee and the IRB to determine if such involvement represents a
potential conflict-of-interest and/or should be disclosed to potential
research subjects in the informed consent form.
1.6 Allow this person to
EDIT the application, including any supporting documents/stipulations
requested during the review process:
Yes
1.7 Include this person on all correspondences regarding this application: (Note: This will include all committee correspondence, decision outcomes, renewal notices, and adverse event submissions.)
Yes
Credentials: Required for PI, Co-Is and Faculty Advisors
Upload or update your CV, resume, or biographical sketch.
Financial Interest Screening Questions for Study Team Members Not Affiliated with the University of Michigan: Required for all roles except Administrative Staff
Below, you be asked several questions intended to identify Financial Interests and relationships that may be relevant to THIS RESEARCH.
These may include Intellectual Property Interests (IP interests), as
well as relationships with entities whose interests may affect/be
affected by this research. If relevant to this research, you
should also consider companies that compete commercially with the
research sponsor or the manufacturer of the study drug, device or other
investigational item if you know that the competitor's Financial
Interests would reasonably appear to be affected by this research.
In relation to THIS RESEARCH, for the past
12 months, do you or your Family member (your spouse, domestic partner,
or dependent) have or anticipate having any of the following Financial
Interests:
F1. Are any activities or relationships
with an entity, whether paid or unpaid, where that entity's
financial interests could be affected by this research? Examples
include service on a board of directors, service on a scientific
advisory board, consultant, officer, manager, or partner.
F2. An Equity Interest
in any publicly traded or privately owned entity whose financial
interests could be affected by this research, including but not limited
to shares of stock or stock options? DO NOT include equity held in
a mutual, pension, or investment fund over which you have no control
with regard to investment decisions.
F3. An investorship or ownership interest in any Intellectual Property (IP)
that is being tested, evaluated, developed in, or its commercial value
will be affected by this research? This includes IP that is the
subject of a copyright, issued patent or a patent application
(regardless of whether it has been licensed or optioned).
F4. Any payments over
$5,000 (USD) received for the past 12 months (apart from any payments
from the University of Michigan), including salary, honoraria, fees, or
other forms of compensation or anything of value, from any entity that
has a financial interest in this research?
F5. If any of the above is answered "yes", you must complete this form and upload the completed form below.
Conflict of Interest Detail: Required for all roles except Administrative Staff
Current Disclosure Status in M-Inform:This study team member has not yet disclosed in M-Inform.
Providing a product used in this project (e.g., an app, device, compound, drug, software, survey, evaluation);
Holding an option/license to intellectual property used in
this project (e.g., a device, compound, drug, software, survey,
evaluation) that you developed; or
Receiving a subcontract for work on this project?
*Examples of relevant interests or relationships with a
non-UM entity include owning stock in, receiving income from, consulting
with, serving as an officer/director/advisor to, or having some other
related financial/leadership interest or relationship with that entity.
No
D2 If “Yes” to the question above, provide the
name of the outside entity or entities and a brief description of the
interest/relationship(s):
C1 Do you, your spouse,
domestic partner, or dependents have any outside interests or
relationships to companies or entities related to this research that the
IRB should consider?
Examples of outside interests include, but are not limited to the following:
receiving compensation whose value could be affected by the study outcome
IN THE AGGREGATE, expecting to
receive compensation from the sponsor of the research of $10,000 or
greater in the next year
having a proprietary interest in the sponsor of the
research or a product tested by this research including but not limited
to, a patent, trademark, copyright, or licensing agreement, or the right
to receive royalties from product commercialization
individually or collectively, having an ownership interest
(equity or stock options) in the sponsor of the research or product
being tested whose value cannot be readily determined through reference
to public prices
individually or collectively, having an ownership interest
(equity or stock options) in a company or product whose value could be
affected by the study outcome
IN THE AGGREGATE, having an ownership interest (equity or
stock options) in the sponsor of the research that exceeds $10,000 or 1%
when the sponsor is a publicly traded entity
receiving significant payments of other sorts with an
aggregate value of $10,000 or more (or payment of ANY amount to medical
school or hospital employees) made directly by the sponsor of this
research for unrestricted research or education, equipment, consultancy,
or honorarium
holding a position of management or leadership in company
or entity related to this research including, but not limited to,
officer, director, or member of an advisory board.
providing consulting services or serve on a Speaker’s
Bureau, either paid or unpaid, to the financial or non-financial sponsor
of this study
when the sponsor is a publicly traded entity, having any ownership interest (equity or stock options) in the sponsor
expecting to receive any loans, educational support,
contributions of in-kind for equipment, or any other non-compensatory
payment from the sponsor of the research in the next year
C2 Please provide a detailed description of the outside interest in the box below.
C2.1 Where have you submitted a disclosure of this outside interest?
C2.2 Has a management plan been formalized?
C2.2.1 Click the View Management Plan in M-Inform button below to see your management plan for this study.
C2.2.2 If no, describe the
financial interest in sufficient detail to permit the COI Ancillary
Committee and the IRB to determine if such involvement represents a
potential conflict-of-interest and/or should be disclosed to potential
research subjects in the informed consent form.
1.6 Allow this person to
EDIT the application, including any supporting documents/stipulations
requested during the review process:
Yes
1.7 Include this person on all correspondences regarding this application: (Note: This will include all committee correspondence, decision outcomes, renewal notices, and adverse event submissions.)
Yes
Credentials: Required for PI, Co-Is and Faculty Advisors
Upload or update your CV, resume, or biographical sketch.
Financial Interest Screening Questions for Study Team Members Not Affiliated with the University of Michigan: Required for all roles except Administrative Staff
Below, you be asked several questions intended to identify Financial Interests and relationships that may be relevant to THIS RESEARCH.
These may include Intellectual Property Interests (IP interests), as
well as relationships with entities whose interests may affect/be
affected by this research. If relevant to this research, you
should also consider companies that compete commercially with the
research sponsor or the manufacturer of the study drug, device or other
investigational item if you know that the competitor's Financial
Interests would reasonably appear to be affected by this research.
In relation to THIS RESEARCH, for the past
12 months, do you or your Family member (your spouse, domestic partner,
or dependent) have or anticipate having any of the following Financial
Interests:
F1. Are any activities or relationships
with an entity, whether paid or unpaid, where that entity's
financial interests could be affected by this research? Examples
include service on a board of directors, service on a scientific
advisory board, consultant, officer, manager, or partner.
F2. An Equity Interest
in any publicly traded or privately owned entity whose financial
interests could be affected by this research, including but not limited
to shares of stock or stock options? DO NOT include equity held in
a mutual, pension, or investment fund over which you have no control
with regard to investment decisions.
F3. An investorship or ownership interest in any Intellectual Property (IP)
that is being tested, evaluated, developed in, or its commercial value
will be affected by this research? This includes IP that is the
subject of a copyright, issued patent or a patent application
(regardless of whether it has been licensed or optioned).
F4. Any payments over
$5,000 (USD) received for the past 12 months (apart from any payments
from the University of Michigan), including salary, honoraria, fees, or
other forms of compensation or anything of value, from any entity that
has a financial interest in this research?
F5. If any of the above is answered "yes", you must complete this form and upload the completed form below.
Conflict of Interest Detail: Required for all roles except Administrative Staff
Current Disclosure Status in M-Inform:This study team member has indicated in M-inform that they do not have any outside interests to disclose.
Providing a product used in this project (e.g., an app, device, compound, drug, software, survey, evaluation);
Holding an option/license to intellectual property used in
this project (e.g., a device, compound, drug, software, survey,
evaluation) that you developed; or
Receiving a subcontract for work on this project?
*Examples of relevant interests or relationships with a
non-UM entity include owning stock in, receiving income from, consulting
with, serving as an officer/director/advisor to, or having some other
related financial/leadership interest or relationship with that entity.
No
D2 If “Yes” to the question above, provide the
name of the outside entity or entities and a brief description of the
interest/relationship(s):
C1 Do you, your spouse,
domestic partner, or dependents have any outside interests or
relationships to companies or entities related to this research that the
IRB should consider?
Examples of outside interests include, but are not limited to the following:
receiving compensation whose value could be affected by the study outcome
IN THE AGGREGATE, expecting to
receive compensation from the sponsor of the research of $10,000 or
greater in the next year
having a proprietary interest in the sponsor of the
research or a product tested by this research including but not limited
to, a patent, trademark, copyright, or licensing agreement, or the right
to receive royalties from product commercialization
individually or collectively, having an ownership interest
(equity or stock options) in the sponsor of the research or product
being tested whose value cannot be readily determined through reference
to public prices
individually or collectively, having an ownership interest
(equity or stock options) in a company or product whose value could be
affected by the study outcome
IN THE AGGREGATE, having an ownership interest (equity or
stock options) in the sponsor of the research that exceeds $10,000 or 1%
when the sponsor is a publicly traded entity
receiving significant payments of other sorts with an
aggregate value of $10,000 or more (or payment of ANY amount to medical
school or hospital employees) made directly by the sponsor of this
research for unrestricted research or education, equipment, consultancy,
or honorarium
holding a position of management or leadership in company
or entity related to this research including, but not limited to,
officer, director, or member of an advisory board.
providing consulting services or serve on a Speaker’s
Bureau, either paid or unpaid, to the financial or non-financial sponsor
of this study
when the sponsor is a publicly traded entity, having any ownership interest (equity or stock options) in the sponsor
expecting to receive any loans, educational support,
contributions of in-kind for equipment, or any other non-compensatory
payment from the sponsor of the research in the next year
C2 Please provide a detailed description of the outside interest in the box below.
C2.1 Where have you submitted a disclosure of this outside interest?
C2.2 Has a management plan been formalized?
C2.2.1 Click the View Management Plan in M-Inform button below to see your management plan for this study.
C2.2.2 If no, describe the
financial interest in sufficient detail to permit the COI Ancillary
Committee and the IRB to determine if such involvement represents a
potential conflict-of-interest and/or should be disclosed to potential
research subjects in the informed consent form.
1.6 Allow this person to
EDIT the application, including any supporting documents/stipulations
requested during the review process:
Yes
1.7 Include this person on all correspondences regarding this application: (Note: This will include all committee correspondence, decision outcomes, renewal notices, and adverse event submissions.)
Yes
Credentials: Required for PI, Co-Is and Faculty Advisors
Upload or update your CV, resume, or biographical sketch.
Financial Interest Screening Questions for Study Team Members Not Affiliated with the University of Michigan: Required for all roles except Administrative Staff
Below, you be asked several questions intended to identify Financial Interests and relationships that may be relevant to THIS RESEARCH.
These may include Intellectual Property Interests (IP interests), as
well as relationships with entities whose interests may affect/be
affected by this research. If relevant to this research, you
should also consider companies that compete commercially with the
research sponsor or the manufacturer of the study drug, device or other
investigational item if you know that the competitor's Financial
Interests would reasonably appear to be affected by this research.
In relation to THIS RESEARCH, for the past
12 months, do you or your Family member (your spouse, domestic partner,
or dependent) have or anticipate having any of the following Financial
Interests:
F1. Are any activities or relationships
with an entity, whether paid or unpaid, where that entity's
financial interests could be affected by this research? Examples
include service on a board of directors, service on a scientific
advisory board, consultant, officer, manager, or partner.
F2. An Equity Interest
in any publicly traded or privately owned entity whose financial
interests could be affected by this research, including but not limited
to shares of stock or stock options? DO NOT include equity held in
a mutual, pension, or investment fund over which you have no control
with regard to investment decisions.
F3. An investorship or ownership interest in any Intellectual Property (IP)
that is being tested, evaluated, developed in, or its commercial value
will be affected by this research? This includes IP that is the
subject of a copyright, issued patent or a patent application
(regardless of whether it has been licensed or optioned).
F4. Any payments over
$5,000 (USD) received for the past 12 months (apart from any payments
from the University of Michigan), including salary, honoraria, fees, or
other forms of compensation or anything of value, from any entity that
has a financial interest in this research?
F5. If any of the above is answered "yes", you must complete this form and upload the completed form below.
Conflict of Interest Detail: Required for all roles except Administrative Staff
Current Disclosure Status in M-Inform:This study team member has not yet disclosed in M-Inform.
Providing a product used in this project (e.g., an app, device, compound, drug, software, survey, evaluation);
Holding an option/license to intellectual property used in
this project (e.g., a device, compound, drug, software, survey,
evaluation) that you developed; or
Receiving a subcontract for work on this project?
*Examples of relevant interests or relationships with a
non-UM entity include owning stock in, receiving income from, consulting
with, serving as an officer/director/advisor to, or having some other
related financial/leadership interest or relationship with that entity.
No
D2 If “Yes” to the question above, provide the
name of the outside entity or entities and a brief description of the
interest/relationship(s):
C1 Do you, your spouse,
domestic partner, or dependents have any outside interests or
relationships to companies or entities related to this research that the
IRB should consider?
Examples of outside interests include, but are not limited to the following:
receiving compensation whose value could be affected by the study outcome
IN THE AGGREGATE, expecting to
receive compensation from the sponsor of the research of $10,000 or
greater in the next year
having a proprietary interest in the sponsor of the
research or a product tested by this research including but not limited
to, a patent, trademark, copyright, or licensing agreement, or the right
to receive royalties from product commercialization
individually or collectively, having an ownership interest
(equity or stock options) in the sponsor of the research or product
being tested whose value cannot be readily determined through reference
to public prices
individually or collectively, having an ownership interest
(equity or stock options) in a company or product whose value could be
affected by the study outcome
IN THE AGGREGATE, having an ownership interest (equity or
stock options) in the sponsor of the research that exceeds $10,000 or 1%
when the sponsor is a publicly traded entity
receiving significant payments of other sorts with an
aggregate value of $10,000 or more (or payment of ANY amount to medical
school or hospital employees) made directly by the sponsor of this
research for unrestricted research or education, equipment, consultancy,
or honorarium
holding a position of management or leadership in company
or entity related to this research including, but not limited to,
officer, director, or member of an advisory board.
providing consulting services or serve on a Speaker’s
Bureau, either paid or unpaid, to the financial or non-financial sponsor
of this study
when the sponsor is a publicly traded entity, having any ownership interest (equity or stock options) in the sponsor
expecting to receive any loans, educational support,
contributions of in-kind for equipment, or any other non-compensatory
payment from the sponsor of the research in the next year
C2 Please provide a detailed description of the outside interest in the box below.
C2.1 Where have you submitted a disclosure of this outside interest?
C2.2 Has a management plan been formalized?
C2.2.1 Click the View Management Plan in M-Inform button below to see your management plan for this study.
C2.2.2 If no, describe the
financial interest in sufficient detail to permit the COI Ancillary
Committee and the IRB to determine if such involvement represents a
potential conflict-of-interest and/or should be disclosed to potential
research subjects in the informed consent form.
1.6 Allow this person to
EDIT the application, including any supporting documents/stipulations
requested during the review process:
Yes
1.7 Include this person on all correspondences regarding this application: (Note: This will include all committee correspondence, decision outcomes, renewal notices, and adverse event submissions.)
Yes
Credentials: Required for PI, Co-Is and Faculty Advisors
Upload or update your CV, resume, or biographical sketch.
Financial Interest Screening Questions for Study Team Members Not Affiliated with the University of Michigan: Required for all roles except Administrative Staff
Below, you be asked several questions intended to identify Financial Interests and relationships that may be relevant to THIS RESEARCH.
These may include Intellectual Property Interests (IP interests), as
well as relationships with entities whose interests may affect/be
affected by this research. If relevant to this research, you
should also consider companies that compete commercially with the
research sponsor or the manufacturer of the study drug, device or other
investigational item if you know that the competitor's Financial
Interests would reasonably appear to be affected by this research.
In relation to THIS RESEARCH, for the past
12 months, do you or your Family member (your spouse, domestic partner,
or dependent) have or anticipate having any of the following Financial
Interests:
F1. Are any activities or relationships
with an entity, whether paid or unpaid, where that entity's
financial interests could be affected by this research? Examples
include service on a board of directors, service on a scientific
advisory board, consultant, officer, manager, or partner.
F2. An Equity Interest
in any publicly traded or privately owned entity whose financial
interests could be affected by this research, including but not limited
to shares of stock or stock options? DO NOT include equity held in
a mutual, pension, or investment fund over which you have no control
with regard to investment decisions.
F3. An investorship or ownership interest in any Intellectual Property (IP)
that is being tested, evaluated, developed in, or its commercial value
will be affected by this research? This includes IP that is the
subject of a copyright, issued patent or a patent application
(regardless of whether it has been licensed or optioned).
F4. Any payments over
$5,000 (USD) received for the past 12 months (apart from any payments
from the University of Michigan), including salary, honoraria, fees, or
other forms of compensation or anything of value, from any entity that
has a financial interest in this research?
F5. If any of the above is answered "yes", you must complete this form and upload the completed form below.
Conflict of Interest Detail: Required for all roles except Administrative Staff
Current Disclosure Status in M-Inform:This study team member has not yet disclosed in M-Inform.
Providing a product used in this project (e.g., an app, device, compound, drug, software, survey, evaluation);
Holding an option/license to intellectual property used in
this project (e.g., a device, compound, drug, software, survey,
evaluation) that you developed; or
Receiving a subcontract for work on this project?
*Examples of relevant interests or relationships with a
non-UM entity include owning stock in, receiving income from, consulting
with, serving as an officer/director/advisor to, or having some other
related financial/leadership interest or relationship with that entity.
No
D2 If “Yes” to the question above, provide the
name of the outside entity or entities and a brief description of the
interest/relationship(s):
C1 Do you, your spouse,
domestic partner, or dependents have any outside interests or
relationships to companies or entities related to this research that the
IRB should consider?
Examples of outside interests include, but are not limited to the following:
receiving compensation whose value could be affected by the study outcome
IN THE AGGREGATE, expecting to
receive compensation from the sponsor of the research of $10,000 or
greater in the next year
having a proprietary interest in the sponsor of the
research or a product tested by this research including but not limited
to, a patent, trademark, copyright, or licensing agreement, or the right
to receive royalties from product commercialization
individually or collectively, having an ownership interest
(equity or stock options) in the sponsor of the research or product
being tested whose value cannot be readily determined through reference
to public prices
individually or collectively, having an ownership interest
(equity or stock options) in a company or product whose value could be
affected by the study outcome
IN THE AGGREGATE, having an ownership interest (equity or
stock options) in the sponsor of the research that exceeds $10,000 or 1%
when the sponsor is a publicly traded entity
receiving significant payments of other sorts with an
aggregate value of $10,000 or more (or payment of ANY amount to medical
school or hospital employees) made directly by the sponsor of this
research for unrestricted research or education, equipment, consultancy,
or honorarium
holding a position of management or leadership in company
or entity related to this research including, but not limited to,
officer, director, or member of an advisory board.
providing consulting services or serve on a Speaker’s
Bureau, either paid or unpaid, to the financial or non-financial sponsor
of this study
when the sponsor is a publicly traded entity, having any ownership interest (equity or stock options) in the sponsor
expecting to receive any loans, educational support,
contributions of in-kind for equipment, or any other non-compensatory
payment from the sponsor of the research in the next year
C2 Please provide a detailed description of the outside interest in the box below.
C2.1 Where have you submitted a disclosure of this outside interest?
C2.2 Has a management plan been formalized?
C2.2.1 Click the View Management Plan in M-Inform button below to see your management plan for this study.
C2.2.2 If no, describe the
financial interest in sufficient detail to permit the COI Ancillary
Committee and the IRB to determine if such involvement represents a
potential conflict-of-interest and/or should be disclosed to potential
research subjects in the informed consent form.
1.6 Allow this person to
EDIT the application, including any supporting documents/stipulations
requested during the review process:
Yes
1.7 Include this person on all correspondences regarding this application: (Note: This will include all committee correspondence, decision outcomes, renewal notices, and adverse event submissions.)
No
Credentials: Required for PI, Co-Is and Faculty Advisors
Upload or update your CV, resume, or biographical sketch.
Financial Interest Screening Questions for Study Team Members Not Affiliated with the University of Michigan: Required for all roles except Administrative Staff
Below, you be asked several questions intended to identify Financial Interests and relationships that may be relevant to THIS RESEARCH.
These may include Intellectual Property Interests (IP interests), as
well as relationships with entities whose interests may affect/be
affected by this research. If relevant to this research, you
should also consider companies that compete commercially with the
research sponsor or the manufacturer of the study drug, device or other
investigational item if you know that the competitor's Financial
Interests would reasonably appear to be affected by this research.
In relation to THIS RESEARCH, for the past
12 months, do you or your Family member (your spouse, domestic partner,
or dependent) have or anticipate having any of the following Financial
Interests:
F1. Are any activities or relationships
with an entity, whether paid or unpaid, where that entity's
financial interests could be affected by this research? Examples
include service on a board of directors, service on a scientific
advisory board, consultant, officer, manager, or partner.
No
F2. An Equity Interest
in any publicly traded or privately owned entity whose financial
interests could be affected by this research, including but not limited
to shares of stock or stock options? DO NOT include equity held in
a mutual, pension, or investment fund over which you have no control
with regard to investment decisions.
No
F3. An investorship or ownership interest in any Intellectual Property (IP)
that is being tested, evaluated, developed in, or its commercial value
will be affected by this research? This includes IP that is the
subject of a copyright, issued patent or a patent application
(regardless of whether it has been licensed or optioned).
No
F4. Any payments over
$5,000 (USD) received for the past 12 months (apart from any payments
from the University of Michigan), including salary, honoraria, fees, or
other forms of compensation or anything of value, from any entity that
has a financial interest in this research?
No
F5. If any of the above is answered "yes", you must complete this form and upload the completed form below.
Conflict of Interest Detail: Required for all roles except Administrative Staff
Current Disclosure Status in M-Inform:This study team member has not yet disclosed in M-Inform.
Providing a product used in this project (e.g., an app, device, compound, drug, software, survey, evaluation);
Holding an option/license to intellectual property used in
this project (e.g., a device, compound, drug, software, survey,
evaluation) that you developed; or
Receiving a subcontract for work on this project?
*Examples of relevant interests or relationships with a
non-UM entity include owning stock in, receiving income from, consulting
with, serving as an officer/director/advisor to, or having some other
related financial/leadership interest or relationship with that entity.
D2 If “Yes” to the question above, provide the
name of the outside entity or entities and a brief description of the
interest/relationship(s):
C1 Do you, your spouse,
domestic partner, or dependents have any outside interests or
relationships to companies or entities related to this research that the
IRB should consider?
Examples of outside interests include, but are not limited to the following:
receiving compensation whose value could be affected by the study outcome
IN THE AGGREGATE, expecting to
receive compensation from the sponsor of the research of $10,000 or
greater in the next year
having a proprietary interest in the sponsor of the
research or a product tested by this research including but not limited
to, a patent, trademark, copyright, or licensing agreement, or the right
to receive royalties from product commercialization
individually or collectively, having an ownership interest
(equity or stock options) in the sponsor of the research or product
being tested whose value cannot be readily determined through reference
to public prices
individually or collectively, having an ownership interest
(equity or stock options) in a company or product whose value could be
affected by the study outcome
IN THE AGGREGATE, having an ownership interest (equity or
stock options) in the sponsor of the research that exceeds $10,000 or 1%
when the sponsor is a publicly traded entity
receiving significant payments of other sorts with an
aggregate value of $10,000 or more (or payment of ANY amount to medical
school or hospital employees) made directly by the sponsor of this
research for unrestricted research or education, equipment, consultancy,
or honorarium
holding a position of management or leadership in company
or entity related to this research including, but not limited to,
officer, director, or member of an advisory board.
providing consulting services or serve on a Speaker’s
Bureau, either paid or unpaid, to the financial or non-financial sponsor
of this study
when the sponsor is a publicly traded entity, having any ownership interest (equity or stock options) in the sponsor
expecting to receive any loans, educational support,
contributions of in-kind for equipment, or any other non-compensatory
payment from the sponsor of the research in the next year
No
C2 Please provide a detailed description of the outside interest in the box below.
C2.1 Where have you submitted a disclosure of this outside interest?
C2.2 Has a management plan been formalized?
C2.2.1 Click the View Management Plan in M-Inform button below to see your management plan for this study.
C2.2.2 If no, describe the
financial interest in sufficient detail to permit the COI Ancillary
Committee and the IRB to determine if such involvement represents a
potential conflict-of-interest and/or should be disclosed to potential
research subjects in the informed consent form.
02. Sponsor/Support Information
The following sections request details
about the current or pending sponsorship/support of this study. Consider
all of the choices below and complete the appropriate sections.
* Note: At
least one of the following sections must be answered. Multiple forms of
funding or support must be added one at a time.
2.1 Please select all
Proposal Approval Forms (PAFs), Awards (AWDs), and/or Unfunded
Agreements (UFAs) associated with this study.
Click here to indicate that a PAF(s) has not been initiated.
ID
Title
PI
Direct Sponsor
Prime Sponsor
State
Has SUBKs?
Related Awards
There are no items to display
Award ID
Title
PI
Direct Sponsor
Prime Sponsor
State
Has SUBKs?
Project Period
Awarded PAFs
There are no items to display
UFA ID
Title
PI
State
Category
Start Date
End Date
There are no items to display
Note: As of 6/10/2018, details
of the External Sponsor/Support have been replaced by linking to
submissions in the eResearch Proposal Management system.
3.1* Indicate all functions that will be performed at University of Michigan locations.
Select all that apply:
Recruitment (including screening)
Interaction (e.g., information gathering, survey, interview, focus groups, etc.)
Intervention
(e.g., use of drug or device, medical procedures, educational
intervention, group intervention, social/psychological intervention
etc.)
Observation of behavior (direct or indirect)
Qualitative research (e.g., 'member checking', open-ended questions, etc.)
Primary or secondary analysis (data/specimen)
Storage (data and/or specimen): Responsible for the management, security and transfer of study data and/or specimens.
If other, please specify.
If University of Michigan will be performing coordinating center activities, contact your IRB prior to continuing to ensure you have chosen the appropriate application type for your project.
3.1.1*
As the Operations, Coordinating or Lead Center describe the mechanisms
in place to ensure that management, data analysis, and Data Safety and
Monitoring systems are adequate for each site.
3.1.2* Describe the plan for communicating interim results (e.g. adverse events, unanticipated events or interim data):
3.1.3* Describe the plan for communicating any protocol modification by the site(s):
3.2* Will U-M be the IRB of Record?
An IRB is considered the IRB of Record when it assumes IRB responsibilities for another institution.
3-1.6 If known, provide the Federalwide Assurance (FWA) number for this location.
FWA00004969
3-1.7 If applicable, indicate what
organization, agency or government office has reviewed this research and
provided its approval (e.g., IRB, ethics committee, school district
office, prison official, nursing home administrator).
3-1.8 Upload any location site approval documentation here:
Name
Version
There are no items to display
05. Research Design
5.1* Is there a stand-alone scientific protocol document and/or research plan associated with this application?
YesNo
5.1.1* Click ADD to attach the document(s) electronically.
Name
Version
There are no items to display
5.1.2* Indicate the section where each of the following are covered in the attached protocol:
Objective
We seek to study the cognitive processes and neural representation associated with completing data structure manipulation tasks typical in the software engineering discipline. We also seek to investigate differences in neural representation between manipulating data structures and performing mental rotation tasks.
Specific Aim/Hypothesis
We hypothesize that neural representation is similar whether a human is performing data structure manipulation or mental rotation tasks.
Background Information
The process of designing software, called software engineering, involves several stages. While many models exist for this process, most of them contain the same ore phases: requirements specification, software design, implementation, verification, and maintenance. Briefly, requirements specifications describes the process of deciding how to software is supposed to behave. Then, based upon these requirements, a number of design decisions are made for the software system in the software design stage. Implementation describes the time actually coding the software system. In the verification stage, software is tested to ensure that it adheres to its specifications. After the software is sufficiently tested, it is deployed for use. Finally, the maintenance stage describes the ongoing process of repairing the software when a defect is found and supporting the users of the software.
These stages all take time, though software maintenance is by far the most time-consuming aspect of software development This stems from a number of reasons, but primarily from the fact that it is much more difficult to repair a defect after the development stage. This could be true because the software engineers are less familiar with the code as time goes by, or because making a change to repair a defect can affect other parts of the software the were built on top of the defect. Regardless of cause, it has been empirically demonstrated that the majority of software costs come from this maintenance process. As a result, software companies are eager to deploy any solution that will decrease the time spent in maintenance.
One common approach to reducing time spent maintaining software is to make fewer mistakes in the initial implementation process. Implementing software frequently involves the design and manipulation of data structures, which are used to represent data within the program. For example, banking software may represent individual accounts as a sequence of numbers corresponding to debits and credits over time. Such a sequence could be stored in a list within the banking software. Unfortunately, structures can become quite complicated in production software. As a result, structures that are too complex for developers to manipulate mentally may cause implementation errors leading to buggy software and expensive maintenance. Thus, understanding how humans think about data structures is critical to reducing errors introduced by structures that are overly complex or by developers who fail to completely understand structures in large codebases.
To our knowledge, only two previous studies have considered looking at the cognitive processes involved in coding, and both used fMRI rather than fNIRS. Understanding understanding source code with functional magnetic imaging was published in the International Conference on Software Engineering in 2014. In this study, the cognitive processes involved in the act of code comprehension - reading and understanding code - are measured in an fMRI. The results of this experiment support the aforementioned claim: reading code is very similar to reading any other natural language. While this study intrigued many researchers in the software engineering community, it did not carry any opportunity for impacting the practices of the field. The other study, Decoding the representation of code in the brain: An fMRI study of code review and expertise, was published in ICSE in 2017 and received a distinguished paper award. This study investigated the neural activity involved in code comprehension and prose review, ultimately finding a distinction between the two tasks. Our study aims to apply many of the same techniques, but learn about a process that is used very commonly in the software engineering field. It is our hope that the results will be both intriguing and impactful to real software companies and institutions.
Methodology
1. Recruitment Graduate students, undergraduate students, professors, and any adult who has the fundamental knowledge of data structure(equivalent to EECS280 and EECS281 in the university of Michigan) would all be considered eligible.
We use three ways to advertise this study: (i) In-class advertisement Participants will be identified by their presence in various Computer science venues (classes,etc.). We target the EECS 300 and 400 level classes and labs. We will give a short presentation about our study.
To prevent concerns of coercion, we will take the following steps (PI Weimer's class also follows the same steps):
1) The instructor will not advertise or be involved in the selection or recruitment of participants. Instead, Research Fellow Kevin Leach, Graduate Student Yu Huang and/or undergrad Xinyu Liu will adversie the study and recruit participants.
In any of the classes, if the investigator is the instructor or
teaching assistant of the class, they will be excluded from the
advertisement and selection of participants correspondingly in the
class. In any class, we do not do real-time recruitment. The recruitment
will only be done through emails offline.
2) We will make it very clear in the presentation that students will not be given extra credit. The participation is not relavant to their course grade at all.
3) The recruitment is completely out of the calss through emails. The instructor has no access to the participation information.
(ii) Email advertisement We will send an advertisement email to the computer science mailing list. In the email, we will demonstrate the information of the study including basic requirement, incentives, the design of the study and recruitment contact information(Graduate Yu Huang's email).
(iii) Flyers We will put flyer in the EECS hallway, Beyster Hallway, and pirepont commons hallway to advertise the study. On the flyer, we will demonstrate the information of the study including basic requirement, incentives, the design of the study and the recruitment contact information(Graduate Yu Huang's email).
Participants will be recruited through emails: contact the study team by emailing Graduate Yu huang their intention. Then, we will arrange an experiment time and email the participant the time and location of the experiment. The email will be sent to the participant within 3 days after they inform us their intention of participation.
2. Consent Process Through recruitment (as introduced in the recruitment), every participant is scheduled with an appointment. They will complete the experiment in the fNIRS lab of the University of Michigan assisted with the study investigators. Before the experiment, the participant needs to read through the consent form and sign it to confirm their wills of participation.
3. Description of the experiment 1)The participant will finish a short questionnaire (about 2 minutes) to record information like gender, sex, year in school, programming
language experience. In the questionnaire, a uniq ID is assigned to
each participant. that unique ID (not identifiable) will also be used to
name the fNIRS data file. So the fNIRS data is connected with the
participant.
2)The study investigators will fit the fNIRS cap on the participant's head. At the same time, the participant will be shown a training video(20 minutes) which introduces the organization of the experiment and overviews the terminology and relevant data structure knowledge used in the experiment.
3)After the training video, the experiment will be conducted on the computer in the lab. The experiment includes questions on data structure program tasks and 3D mental rotation tasks. All the mental rotation tasks are from a publicly published library. Each task lasts for no longer than 30 seconds. Between the data structure tasks and mental rotation tasks, there will be a 5 minute break. Water and snacks are served. The experiment will last for about 80 minutes including the training video.
All the experiment tasks are in the attached tasks.pptx file. Every task is an two-option question. The participant needs to press the corresponding key of the keyboard to provide the answer.
4)Then the experiment is done. After the experiment, we will ask the participant with a short questionnaire. The study investigators will bring up a few of the sample questions in the experiment and ask the participant to explain their decision. This post questionnaire is audio-based
that will last about 10 minutes In the end, we will give the
participant $50 check or cash based on their own option. In total, the
entire study for one participant will take about 80 minutes.
If
the participant withdraws the study before the experiment is finished,
we will still pay the participant $20 cash or check based on their own
preference immediately after they stop the experiment.
5)
With all the fnirs data we collect, we will employ techniques from
graph theory and statistical machine learning to model spatial
dependencies across brain regions and use those to predict (i.e. decode) individual difference factors.
4. security The email address will be safely stored and there is no identifiable info of the fNIRS signal data at all. For incentives, we will not collect anything more that what HSIP requires. For each participant who completed the study, we will pay a $50 check or cash right after the they complete the experiment. For those who stopped and did not finish the experiment, we will pay them $20 check or cash instead. This is done through HSIP.
All the experiment data is stored in a secured university server.
Statistical Design
1)
We intend to collect basic information from participants including
gender, the year in school, programming language, so that we can
determine if differences in gender, sex, programming language, and levels of experience affect the neural activations associated with these tasks; and
2) We will employ techniques from graph theory and statistical machine learning to model spatial dependencies across brain regions and use those to predict (i.e. decode) individual difference factors.
5.1.3* Study team Experience: Briefly outline the experience and competence of the study team to pursue the proposed study.
PI Weimer has previously conducted IRB-approved fMRI research involving software engineering tasks while at the University of Virginia. Research Fellow Kevin Leach and graduate student Yu Huang have both conducted IRB-approved human studies. All three have published peer-reviewed publications based upon such human studies.
PI Weimer has extensive experience researching program analysis and software engineering.
In
this study, PI Weimer will supervise the design of the experiment and
data analysis, but will not involve in the recruitment of the
participants. Research Fellow Kevin Leach, graduate student Yu Huang and
undergrad Xinyu Liu will design the experiment with PI Weimer. Yu
Huang, Xinyu Liu and Kevin Leach will recruit participants and do the
fNIRS experiments with the participants. Xiaosu Hu, Jessica Kim and
Ioulia Kovelman are collaborators from Department of Psychology who are
running the fNIRS labs. They will help to get the experiment equipment
set up and data processing. The data analysis work will be conducted by
Kevin Leach, Tyler Santander, Yu Huang, Xinyu Liu under the supervision
of PI Weimer, also with the help of Xiaosu Hu, Jessica Kim and Ioulia
Kovelman.
5.2* Will the involvement of ANY subjects in this study be limited to analysis of their existing data or specimens?
YesNo
5.2.1* How many subjects are represented in the data or specimens to be analyzed?
(do not enter commas, dots, or special characters)
5.3* Will the study involve recruitment and/or participation of subjects in order to produce new data (e.g., surveys, interaction, intervention)? [Require sections 8-1 and 11-3]
YesNo
5.4* List the inclusion and exclusion criteria for this study population and/or data set. (If covered in attached protocol, indicate section)
Participants
will be excluded if they don't have fundamental computer science data
structure knowledge, which is equivalent to EECS 280 and EECS281 in the
University of Michigan or if they do not sign the consent form. More
details is in the consent form in 10.1
5.5 Identify any racial,
ethnic, or gender group(s) that will be specifically excluded from
participation in this research study and provide a compelling
justification for such exclusion:
None.
5.6* Indicate the age range (in years) of the subject population in this study.
Minimum Age:
18
Maximum Age:
65If no upper limit, enter "999"
5.7*
Will the study be conducted according to ICH-GCP E6 guidelines? Check
the study protocol (especially Signature Page and Ethical Guidelines
section) prior to answering this question. If the answer is “yes” – see
helptext for details.
YesNo
5.8*
The primary risk of conducting research with secondary data or
specimens is a breach of confidentiality or privacy, which may cause
psychological, social/reputation, legal, or financial harm. Indicate any
risks to subjects other than these risks from a breach of
confidentiality or privacy. If there are none, answer “none.”
In
its review of research applications, the IRB considers whether research
procedures are consistent with sound research design in order to yield
the expected results. Scientific merit is examined in relationship
to the risks and benefits of the research. This
section covers the overall research design of the project. Later
sections will ask more specific questions about benefits, risks, special
review considerations, targeted populations, recruitment strategies,
and experimental methodologies/procedures.
5-1.1* Objective: What is the overall purpose of this research study?
We seek to study the cognitive processes and neural representation associated with completing data structure manipulation tasks typical in the software engineering discipline. We also seek to investigate differences in neural representation between manipulating data structures and performing mental rotation tasks.
5-1.2*
Specific Aim(s): What is (are) the specific aim(s) of this study and/or
what hypothesis (hypotheses) is (are) to be tested?
We hypothesize that neural representation is similar whether a human is performing data structure manipulation or mental rotation tasks.
5-1.3* Background: What prior information or knowledge exists to support the conduct of this study?
The process of designing software, called software engineering, involves several stages. While many models exist for this process, most of them contain the same ore phases: requirements specification, software design, implementation, verification, and maintenance. Briefly, requirements specifications describes the process of deciding how to software is supposed to behave. Then, based upon these requirements, a number of design decisions are made for the software system in the software design stage. Implementation describes the time actually coding the software system. In the verification stage, software is tested to ensure that it adheres to its specifications. After the software is sufficiently tested, it is deployed for use. Finally, the maintenance stage describes the ongoing process of repairing the software when a defect is found and supporting the users of the software.
These stages all take time, though software maintenance is by far the most time-consuming aspect of software development This stems from a number of reasons, but primarily from the fact that it is much more difficult to repair a defect after the development stage. This could be true because the software engineers are less familiar with the code as time goes by, or because making a change to repair a defect can affect other parts of the software the were built on top of the defect. Regardless of cause, it has been empirically demonstrated that the majority of software costs come from this maintenance process. As a result, software companies are eager to deploy any solution that will decrease the time spent in maintenance.
One common approach to reducing time spent maintaining software is to make fewer mistakes in the initial implementation process. Implementing software frequently involves the design and manipulation of data structures, which are used to represent data within the program. For example, banking software may represent individual accounts as a sequence of numbers corresponding to debits and credits over time. Such a sequence could be stored in a list within the banking software. Unfortunately, structures can become quite complicated in production software. As a result, structures that are too complex for developers to manipulate mentally may cause implementation errors leading to buggy software and expensive maintenance. Thus, understanding how humans think about data structures is critical to reducing errors introduced by structures that are overly complex or by developers who fail to completely understand structures in large codebases.
To our knowledge, only two previous studies have considered looking at the cognitive processes involved in coding, and both used fMRI rather than fNIRS. Understanding understanding source code with functional magnetic imaging was published in the International Conference on Software Engineering in 2014. In this study, the cognitive processes involved in the act of code comprehension - reading and understanding code - are measured in an fMRI. The results of this experiment support the aforementioned claim: reading code is very similar to reading any other natural language. While this study intrigued many researchers in the software engineering community, it did not carry any opportunity for impacting the practices of the field. The other study, Decoding the representation of code in the brain: An fMRI study of code review and expertise, was published in ICSE in 2017 and received a distinguished paper award. This study investigated the neural activity involved in code comprehension and prose review, ultimately finding a distinction between the two tasks. Our study aims to apply many of the same techniques, but learn about a process that is used very commonly in the software engineering field. It is our hope that the results will be both intriguing and impactful to real software companies and institutions.
5-1.4*Briefly
outline the special expertise and qualifications of the PI,
Co-Investigators, and/or Faculty Advisors to conduct and/or oversee the
particular procedures or activities involved in this particularstudy. This will supplement information provided in the study team CVs.
PI Weimer has previously conducted IRB-approved fMRI research involving software engineering tasks while at the University of Virginia. Research Fellow Kevin Leach and graduate student Yu Huang have both conducted IRB-approved human studies. All three have published peer-reviewed publications based upon such human studies.
PI Weimer has extensive experience researching program analysis and software engineering.
In
this study, PI Weimer will supervise the design of the experiment and
data analysis, but will not involve in the recruitment of the
participants. Research Fellow Kevin Leach, graduate student Yu Huang and
undergrad Xinyu Liu will design the experiment with PI Weimer. Yu
Huang, Xinyu Liu and Kevin Leach will recruit participants and do the
fNIRS experiments with the participants. Xiaosu Hu, Jessica Kim and
Ioulia Kovelman are collaborators from Department of Psychology who are
running the fNIRS labs. They will help to get the experiment equipment
set up and data processing. The data analysis work will be conducted by
Kevin Leach, Tyler Santander, Yu Huang, Xinyu Liu under the supervision
of PI Weimer, also with the help of Xiaosu Hu, Jessica Kim and Ioulia
Kovelman.
5-1.5*
Methodology: Describe the design and procedures to be used to
accomplish the specific aims of the study. Describe the advantages of
any innovative methodologies.
1. Recruitment Graduate students, undergraduate students, professors, and any adult who has the fundamental knowledge of data structure(equivalent to EECS280 and EECS281 in the university of Michigan) would all be considered eligible.
We use three ways to advertise this study: (i) In-class advertisement Participants will be identified by their presence in various Computer science venues (classes,etc.). We target the EECS 300 and 400 level classes and labs. We will give a short presentation about our study.
To prevent concerns of coercion, we will take the following steps (PI Weimer's class also follows the same steps):
1) The instructor will not advertise or be involved in the selection or recruitment of participants. Instead, Research Fellow Kevin Leach, Graduate Student Yu Huang and/or undergrad Xinyu Liu will adversie the study and recruit participants.
In any of the classes, if the investigator is the instructor or
teaching assistant of the class, they will be excluded from the
advertisement and selection of participants correspondingly in the
class. In any class, we do not do real-time recruitment. The recruitment
will only be done through emails offline.
2) We will make it very clear in the presentation that students will not be given extra credit. The participation is not relavant to their course grade at all.
3) The recruitment is completely out of the calss through emails. The instructor has no access to the participation information.
(ii) Email advertisement We will send an advertisement email to the computer science mailing list. In the email, we will demonstrate the information of the study including basic requirement, incentives, the design of the study and recruitment contact information(Graduate Yu Huang's email).
(iii) Flyers We will put flyer in the EECS hallway, Beyster Hallway, and pirepont commons hallway to advertise the study. On the flyer, we will demonstrate the information of the study including basic requirement, incentives, the design of the study and the recruitment contact information(Graduate Yu Huang's email).
Participants will be recruited through emails: contact the study team by emailing Graduate Yu huang their intention. Then, we will arrange an experiment time and email the participant the time and location of the experiment. The email will be sent to the participant within 3 days after they inform us their intention of participation.
2. Consent Process Through recruitment (as introduced in the recruitment), every participant is scheduled with an appointment. They will complete the experiment in the fNIRS lab of the University of Michigan assisted with the study investigators. Before the experiment, the participant needs to read through the consent form and sign it to confirm their wills of participation.
3. Description of the experiment 1)The participant will finish a short questionnaire (about 2 minutes) to record information like gender, sex, year in school, programming
language experience. In the questionnaire, a uniq ID is assigned to
each participant. that unique ID (not identifiable) will also be used to
name the fNIRS data file. So the fNIRS data is connected with the
participant.
2)The study investigators will fit the fNIRS cap on the participant's head. At the same time, the participant will be shown a training video(20 minutes) which introduces the organization of the experiment and overviews the terminology and relevant data structure knowledge used in the experiment.
3)After the training video, the experiment will be conducted on the computer in the lab. The experiment includes questions on data structure program tasks and 3D mental rotation tasks. All the mental rotation tasks are from a publicly published library. Each task lasts for no longer than 30 seconds. Between the data structure tasks and mental rotation tasks, there will be a 5 minute break. Water and snacks are served. The experiment will last for about 80 minutes including the training video.
All the experiment tasks are in the attached tasks.pptx file. Every task is an two-option question. The participant needs to press the corresponding key of the keyboard to provide the answer.
4)Then the experiment is done. After the experiment, we will ask the participant with a short questionnaire. The study investigators will bring up a few of the sample questions in the experiment and ask the participant to explain their decision. This post questionnaire is audio-based
that will last about 10 minutes In the end, we will give the
participant $50 check or cash based on their own option. In total, the
entire study for one participant will take about 80 minutes.
If
the participant withdraws the study before the experiment is finished,
we will still pay the participant $20 cash or check based on their own
preference immediately after they stop the experiment.
5)
With all the fnirs data we collect, we will employ techniques from
graph theory and statistical machine learning to model spatial
dependencies across brain regions and use those to predict (i.e. decode) individual difference factors.
4. security The email address will be safely stored and there is no identifiable info of the fNIRS signal data at all. For incentives, we will not collect anything more that what HSIP requires. For each participant who completed the study, we will pay a $50 check or cash right after the they complete the experiment. For those who stopped and did not finish the experiment, we will pay them $20 check or cash instead. This is done through HSIP.
All the experiment data is stored in a secured university server.
5-1.6* Statistical Design: Describe the statistical design of the research study, including methods used to analyze data.
1)
We intend to collect basic information from participants including
gender, the year in school, programming language, so that we can
determine if differences in gender, sex, programming language, and levels of experience affect the neural activations associated with these tasks; and
2) We will employ techniques from graph theory and statistical machine learning to model spatial dependencies across brain regions and use those to predict (i.e. decode) individual difference factors.
06. Benefits and Risks
6.1 * Describe the potential benefits of this research to society.
There are no direct health benefits to the participants. The primary benefits of the study are best realized at the societal and scientific levels. The data gained from this study, along with the conclusions drawn from it, will help shape and improve the software engineering skills through improvements in training and the education in computer science.
6.2 * Will results of the research be communicated back to the subjects?
YesNo
6.2.1 * Explain the plan and process.
6.3 * Describe any direct risks to the public or community, which could result from this research?
The two expected risks are boredom and stiffness from wearing the fNRIS cap. There are no known physical risks associated with the use of fNIRS.
6.4 *Does this project involve study arms that have differing levels of benefit or risks to subjects?
YesNo
6.5 * Benefits and Risks:
Click "Add" to begin entering the benefit and risk level detail information associated with this study.
If a study involves multiple arms or phases that pose
different levels of risk or direct benefits to subjects, then create an
entry for each arm or phase using the "OK and Add Another" option at the
bottom of this page. Only one entry is necessary if the risk
level and the direct benefit to subjects is the same for the entire
project, even if the study involves multiple arms or phases.
6.5.1 * Name of Arm (experimental group, study wave, etc.)
HUM00139618
6.5.2 * Description of Arm (experimental group, study wave, etc.)
6.6 * Are there potential direct benefits of this research to the subjects?
YesNo
6.6.1 * Describe the potential direct benefits.
6.7 *
Provide a description of the foreseeable risks to subjects. For
studies involving multiple arms or phases, enter the risks for this arm
or phase only.
Provide a description of the foreseeable risks to the subjects.
For EACH identified risk, include:
Likelihood of the risk,
Seriousness to the subject; and
What measures will be taken to minimize the risk
(for example, study design includes the substitution of procedures
already being performed on the subject for diagnostic or treatment
purposes, or in a study of Post-Traumatic Stress Disorder, the
investigator takes steps to identify, manage, or refer as appropriate,
subjects for whom the study may evoke very difficult emotions)
If
possible, please use the following categories to assess the likelihood:
"Common" (i.e., approximate incidence > 25%)
"Likely" (i.e., approximate incidence of 10-25%)
"Infrequent" (i.e., approximate incidence of 1-10%)
"Rare" (i.e., approximate incidence < 1%):
Minor risks that could
result from the use of the fNIRS device is breach of confidentiality,
boredom, and slight discomfort while wearing the device. To avoid these
risks, we will ask participants if they are uncomfortable with the
device on. If they are uncomfortable, we will adjust the device to
minimize discomfort. Participants will be instructed that they can
leave the study at any time (including if they are bored). The light
emitted from the device is less intense than a light bulb and is safe
for use with adults.
6.8 *
What is the level of risk of harm to the subjects, resulting from this
arm of the research? For studies involving multiple arms or
phases, enter the level of risk for this arm or phase only.
Risk Level
Description
6.9 * Discuss why the risks to the subjects are reasonable in relation to the anticipated benefits.
fNIRS is an
experimental brain imaging method that is helping to provide new
neuroimaging data in populations that are unsuited for fMRI studies, can
be performed at a much lower cost than fMRI, and admits more
ecologically valid experimentation than in an fMRI. As the potential
risks are minimal and temporary, they are reasonable in relation to the
novel information that will be learned as a result.
07. Special Considerations
7.1* Does this study involve human tissue or biological specimens (use, collection, or secondary analysis) (e.g. blood, urine, bone marrow, skin, etc.)? [Require Section 18]
YesNo
7.1.1* Will genetic analysis be performed on any specimens acquired in conjunction with this study? [Require Section 20]
YesNo
7.2* Does this study involve the secondary analysis of a pre-existing data set, including data associated with any specimens identified in response to question 7.1? [Require Section 24]
YesNo
7.3*
Will the research involve the access, collection, use,
maintenance, or disclosure of protected health information (PHI)? PHI
is:
information about
a subject's past, present, or future physical or mental health, the
provision of healthcare to a subject, or payment for the provision of
healthcare to a subject; AND
maintained by a HIPAA-covered entity (e.g. healthcare provider, healthcare plan, or healthcare clearinghouse).
[Require Section 25]
[Require Section 25-1]
YesNo
07-1. Special Considerations - Continued
7-1.1* Will subjects receive payment or other incentives for their participation in the study? [Require Section 13]
YesNo
7-1.2*
Will subjects undergo healthcare-related treatments or procedures
(standard of care and/or research) as part of the study? [Require Section 14]
YesNo
7-1.3* Does this study involve the deception or concealment of subjects? [Require Section 27]
YesNo
7-1.4*
Excluding routine email correspondence, does this study involve the use
of the Internet or email as an integral part of the research design or
will sensitive information be transmitted by e-mail? [Require Section 28]
YesNo
7-1.5* Will the study collect data using surveys, interviews, or focus groups? [Require Section 29]
YesNo
7-1.6* Does this study require subjects to listen to an audio recording or view images? [Require Section 31]
YesNo
7-1.7* Will any drugs, biologics, radiopharmaceuticals, nutritional (e.g., herbal or alternative medication) supplements or other material be administered, implanted, or applied to the subjects as the object of the study? [Require Section 15]
YesNo
PLEASE NOTE: Since drugs are being used in this study, a MiChart order may need to be created; please allow sufficient time for the MiChart orderset to be created before starting your study.
7-1.8* Will the study involve a placebo (drug, device, procedure, intervention, surgery, etc.) control group? [Require Section 17]
YesNo
7-1.8.1* Is the placebo for a drug? [Require Section 15]
YesNo
7-1.9* Will the study involve human embryonic stem cells (hESCs) or induced pluripotent stem cells? [Require Section 19]
YesNo
7-1.10* Will the study have a Data and Safety Monitoring Plan (DSMP)? [Require Section 32]
YesNo
7-2. Special Consideration - Continued
7-2.1*
Will any devices be used, administered, implanted, or applied to the
subjects, or will human specimens be used to test in vitro diagnostic
devices? [IRBMED Applications Require Section 16]
YesNo
7-2.1.1*
Describe all devices that are the OBJECT of the study, or ARE RELEVANT
to the study. If this study is designed to test the safety or efficacy
of any of these devices, then this project is FDA-regulated and must be
reviewed by IRBMED.
fNIRS device in the UMich Psychology lab.
7-2.2* Is the research testing or utilizing a health-related mobile software application that is:
Designed for a handheld (e.g., smartphone) or wearable mobile device (e.g., exercise tracking), or
Tailored to a mobile platform (i.e., a handheld commercial
or off-the-shelf computing platform, with or without wireless
connectivity) but executed (run) from a server
and the mobile software application/platform performs any of the following:
Uses a built-in feature of a device such as light, vibration, or camera to perform a medical device function.
Connects or links to an existing device to control its operation, function, or energy source.
Uses patient-specific data from a connected device
including a sensor or electrode to monitor, manipulate, calculate, or
analyze information.
Conveys diagnostic information, or provides education materials or encouragement.
Performs calculations, conversions, measurements or interpretations.
YesNo
Note: If there is intent to
introduce the mobile medical app into commercial distribution or to
publish via an app store (e.g., Google or Apple), you must contact the
Office of Technology Transfer at 734-763-0614 or um-software@umich.edu to discuss licensure and U-M branding.
7-2.2.1*
Is the mobile technology intended for use in performing a medical
device function (i.e. for diagnosis of disease or other conditions, or
the cure, mitigation, treatment, or prevention of disease)? If so, it is
a medical device, regardless of the platform on which it is run. [IRBMED Applications Require Section 16]
YesNo
7-2.2.2* Describe the health-related mobile software application and its intended use.
7-2.3* Will the subjects be exposed to any ionizing radiation during the course of this study? [Require Section 21]
YesNo
7-2.3.1* Will radiopharmaceuticals be administered to subjects as part of this study? [Require Section 15]
YesNo
7-2.4* Will any organs, tissues, or cells from humans (including fetal tissue) or animals be administered to the subjects for the purposes of this study? [Require Section 22]
YesNo
7-2.5* Does this study involve a gene transfer intervention or an intervention based on recombinant DNA technology? [Require Section 23]
YesNo
08. Subject Participation
8.1* Please indicate the number of subjects to be enrolled from ALL study locations to achieve the goal of the study:
30
8.2* Enter the estimated number of subjects to be enrolled at each University of Michigan site:
8.2* Enter the estimated number of subjects to be enrolled at each site:
8-1.1* At what point in the study are you planning on beginning the recruitment of subjects?
0-2 years after approval
8-1.2* Indicate which of the following established subject pools, if any, will be used for recruitment.
Select all that apply:
N/A
Provide Related UM IRB Project Number or Subject Pool Description:
8-1.3*
Describe the manner in which potential study subjects will be
recruited. List how, when, who will recruit and where they will
be recruited. Include any provisions to protect or maintain subject
privacy.
Our recruitment is planned as:
1. Recruitment Graduate students, undergraduate students, professors, and any adult who has the fundamental knowledge of data structure(equivalent to EECS280 and EECS281 in the university of Michigan) would all be considered eligible.
We use three ways to advertise this study: (i) In-class advertisement Participants will be identified by their presence in various Computer science venues (classes,etc.). We target the EECS 300 and 400 level classes and labs. We will give a short presentation about our study.
To prevent concerns of coercion, we will take the following steps (PI Weimer's class also follows the same steps):
1) The instructor will not advertise or be involved in the selection or recruitment of participants. Instead, Research Fellow Kevin Leach, Graduate Student Yu Huang and/or undergrad Xinyu Liu will adversie the study and recruit participants.
In any of the classes, if the investigator is the instructor or
teaching assistant of the class, they will be excluded from the
advertisement and selection of participants correspondingly in the
class. In any class, we do not do real-time recruitment. The recruitment
will only be done through emails offline.
2) We will make it very clear in the presentation that students will not be given extra credit. The participation is not relevant to their course grade at all.
3) The recruitment is completely out of the class through emails. The instructor has no access to the participation information.
(ii) Email advertisement We will send an advertisement email to the computer science mailing list. In the email, we will demonstrate the information of the study including basic requirement, incentives, the design of the study and recruitment contact information(Graduate Yu Huang's email).
(iii) Flyers We will put flyer in the EECS hallway, Beyster Hallway, and pirepont commons hallway to advertise the study. On the flyer, we will demonstrate the information of the study including basic requirement, incentives, the design of the study and the recruitment contact information(Graduate Yu Huang's email).
Participants will be recruited through emails: contact the study team by emailing Graduate Yu huang their intention. Then, we will arrange an experiment time and email the participant the time and location of the experiment. The email will be sent to the participant within 3 days after they inform us their intention of participation.
Through recruitment (as introduced in the recruitment), every participant is scheduled with an appointment. They will complete the experiment in the fNIRS lab of the University of Michigan assisted with the study investigators. Before the experiment, the participant needs to read through the consent form and sign it to confirm their wills of participation.
How to protect the subject privacy other than the protection in the recruitment: The email address will be safely stored and there is no identifiable info
of the fNIRS signal data at all (we use de-identified unique Id to
connect the fnirs data and questionnaire). For incentives, we will not collect anything more that what HSIP requires. For each participant who completed the study, we will pay a $50 check or cash right after the they complete the experiment. For those who stopped and did not finish the experiment, we will pay them $20 check or cash instead. This is done through HSIP.
All
the experiment data is stored in a secured university server. Also, all
the fnirs data is deidentified. Only the study team member have access
to it.
8-1.3.1 If applicable, how will prospective subjects' healthcare providers (e.g., physician, dentist, etc.) be involved in the recruitment and/or be notified of their individual patients' participation in the study?
8-1.4* Explain how the recruitment strategy is equitable and represents the population required for the study. If the information is covered in the attached protocol, please indicate section.
Any
adult eligible for fNRIS can participate in this study provided they
demonstrate the required basic programming expertise for completing the
software engineering tasks. The requirement of the basic knowledge of
programming is included in all types of the advertisement of this study.
Every candidate participant will be assessed for minimal expertise
using the same set of questions after receiving informed consent (the
pre-questionnaire in section29.1).
8-1.5*
Does the recruitment strategy involve contacting individuals
multiple times in an effort to secure their initial enrollment into
the study?
YesNo
8-1.5.1* Describe how frequently and in what manner individuals will be contacted. If the information is covered in the attached protocol, please indicate section.
8-1.6* Indicate which methods will be used for recruitment?
Check all that apply:
Face-to-face contact (e.g. during a health care visit or an interview at a home address, etc.)
Email
Public advertisement (e.g., bulletin boards, newspapers, radio, TV, websites, or on-hold telephone scripts, etc.)
If other please specify:
8-1.7 How will any email, address, and/or telephone lists be obtained?
8-1.8* What materials will be used for recruitment? The IRB must approve all recruitment materials.
See Help for important information regarding the requirements for recruitment materials
Check all that apply:
Pre-screening questions
Flyers
Oral scripts
Email messages
If other please specify:
If Web pages will be used, provide the Web
address (URL) for the location where the pages will be posted (also
upload the content of the pages below):
Upload recruitment materials here:
See Help for more information about working with documents (e.g. uploading, downloading, and editing).
The general adult population (aged 18 or older); or
A subgroup of the general population which does not specifically target:
Pregnant women and/or fetuses
Lactating women
Women of child-bearing potential
Prisoners
Cognitively impaired adults
College students
Economically or educationally disadvantaged persons
Patients of the study team
Employees, students or trainees of the study team
Family members of the study team
where the survey is the sole interaction with the subject and does not pose more than minimal risk?
YesNo
09-1. Subject Populations
9-1.1* Is the research designed to include or allow the following populations?
Select all that apply
Normal, healthy subjects
Adultsage 18 and older
Minors able to consentto
treatments or procedures involved in the research, under the applicable
law of the jurisdiction in which the research will be conducted (e.g.
emancipated minors or minors seeking treatment for certain conditions.)
Children and/or Viable Neonates(i.e.
persons who have not yet reached the legal age for consent to
treatments or procedures involved in the research, under the applicable
law of the jurisdiction in which the research will be conducted)
[Require Sections 33 and 41]
Neonates of uncertain viability and/or nonviable neonates
(do not check this box if the research is solely retrospective. For
retrospective research regarding neonates of uncertain viability, check
the box for 'Children'. See Help for additional information.) [Require
Section 34]
Individuals and/or products involving human in vitro fertilization
Pregnant women and/or fetuses [Require Sections 35 and 41]
Lactating women [Require Section 36]
Women of child-bearing potential [Require Section 37]
Prisoners (If
the research includes a study population that is likely to become
incarcerated during the conduct of the research, also select this
category) [Require Section 38 and 41]
Cognitively impaired adults [Require Sections 39 and 41]
College students [Require Sections 40 and 41]
Economically or educationally disadvantaged persons [Require Section 41]
Patients of the study team [Require Section 41]
Employees, students or trainees of the study team [Require Section 41]
Family members of the study team [Require Section 41]
Unknown, unspecified population
10. Informed Consent - Adults
10.1* What type of informed consent will be obtained from adults or minors legally able to consent to treatments or procedures involved in the research?
With signature:
Comprehensive written
Written assent for cognitively or decisionally impaired adults
Without signature (waiver of documentation):
Comprehensive written
Comprehensive oral consent script
Assent for cognitively or decisionally impaired adults
Waivers of informed consent:
Request for waiver of informed
consent/parental permission/legally authorized representative consent
(Note: no longer required for screening/recruitment)
Request for waiver of assent for cognitively or decisionally impaired adults
Other:
Short form, comprehensive oral script, and witness
Request for alteration of informed consent requirements
Pre-existing consent(s) covers this activity
Re-consent/assent subjects for use of existing data/records/specimens for a new research purpose
10.1.2*
Describe the process to seek and obtain informed consent and/or assent
from adults. If requesting a waiver of documentation of assent, provide
justification here.
Research Fellow Kevin Leach and/or graduate student Yu Huang and/or Undergrad Xinyu Liu will sit with the subject and explain the
experiment, the process of the study, their rights, risks, and
benefits. Subjects will be given as much time as they require to read,
understand, and sign off on the informed consent form.
10.1.3* Is the cognitive capacity of the subjects expected to change significantly during the study?
YesNo
10.1.3.1*
Describe the plan to re-consent the subject or the subject’s legally
authorized representative after the change in the cognitive capacity of
the subject.
10-1.1*
All documents related to consent, assent, permission, and or debriefing
documents, including oral scripts must be uploaded here. If you are
requesting a waiver of documentation of informed consent, upload a copy
of any written materials to be provided to participants, and provide a
written description of any information to be provided orally.
10-1.1*
All template documents related to consent, assent, permission, and or
debriefing documents, including oral scripts must be uploaded here. If
you are requesting a waiver of documentation of informed consent, upload
a copy of any written materials to be provided to participants, and
provide a written description of any information to be provided orally.
10-1.1.1*
Does the Informed Consent use the sentences required for Applicable
Clinical Trials: "A description of this clinical trial will be available
on www.ClinicalTrials.gov, as required by US law. This website will not
include information that can identify you. At most, the website will
include a summary of the results. You can search this website at any
time."?
YesNo
10-1.2* Will the subjects be audiotaped, videotaped, or photographed (identifiable images of subject) during the research?
11.2* Explain how the subjects' privacy will be protected.
The email address will be safely stored and there is no identifiable info of the fNIRS signal data at all. For incentives, we will not collect anything more that what HSIP requires.
All the experiment data is stored in a secured university server.
11.3* How
will the study team protect research records, data, and/or specimens
against inappropriate use or disclosure, or malicious or accidental loss
or destruction in order to protect the confidentiality of subject data?
Select all that apply:
Locked office
Locked cabinet or storage unit
Restricted access
Secure laptop
Individual ID plus password protection
Encryption of digital data
Network restrictions
Security software (firewall, anti-virus,
anti-intrusion) is installed and regularly updated on all servers,
workstations, laptops, and other devices used in the project
Safe disposition/destruction of data or devices, as
appropriate (e.g., shredding paper documents, destroying disks or thumb
drives, secure erasure of electronic media)
If other please specify:
11.4* Does either statement apply to this research:
Research has NIH,
CDC, or FDA funding, or other federal funding from an agency that
automatically issues a Certificate of Confidentiality as part of the
terms of the award:
The study will include identifiable sensitive information,
identifiable biospecimens, individual human-level genomic
data/biospecimens, or any information about an individual for which
there is at least a very small risk, as determined by current scientific
practices or statistical methods, that some combination of the
information, a request for the information, and other available data
sources could be used to deduce the identity of an individual.
or
Research does NOT have NIH, CDC, or FDA funding, or
other federal funding from an agency that automatically issues a
Certificate of Confidentiality as part of the terms of the award:
The study will include identifiable, sensitive information
or identifiable biospecimens that, if revealed, might place the subjects
at risk for personal safety, criminal or civil liability, or damage to
their financial standing, employability, insurability, or reputation.
[Require Section 11-2]
YesNo
11.5* Will data be provided to a repository as part of a data sharing agreement?
YesNo
11.5.1* Please indicate the repository:
Select all that apply:
There are no items to display
If Other, please specify:
11.6* What will happen to the data and/or any specimens at the conclusion of this study?
Select all that apply:
Retain for future research use - requires Section 11-4
11.6.1*
If the data and/or specimens will be destroyed, describe the specific
plan that will be employed following the required retention period.
11.6.2*
If the data and/or specimens will be retained for study
recordkeeping purposes, provide the following information (if
covered in the attached protocol, please indicate section):
expected duration of the retention period,
any changes in the conditions or arrangements for storage
of research data/specimens during the retention period, if different
from those listed above in question 11.3.
11-1. Identifiable Data
Completion of this section is required based on the response provided to question 11.1.
11-1.1* Indicate how subjects are identified in the research records.
Select all that apply:
Coded or Indirect Identifiers - data record
includes a link to direct identifiers (e.g., name, initials, phone
number, SSN, or medical record number linked to data record but stored
separately)
No Identifiers (De-identified, Anonymous, or Anonymized) - stored data record is stripped of all identifiers
11-1.2* Explain the necessity for collecting or maintaining data linked to subjects' identities. If the information is covered in the attached protocol, please indicate section.
HSIP will require name and address for distributing the incentives. Emails will be used for recruitment. But the email address will not be linked with the experiment data.
11-1.3* How long will the identifiers be retained?
Until the participants have been remunerated.
11-1.4* Will individually identifiable sensitive data be accessed, collected, used, maintained, or disclosed in the study?
YesNo
11-1.4.1*
Will a continuous, periodic, or automatic feed of sensitive data be set
up to provide data directly from any University information system (e.g., M-Pathways, U-M Data Warehouse, CareWeb)?
YesNo
11-1.4.2* Will sensitive data be accessed by individuals who are not University employees?
YesNo
11-1.4.3*
Will sensitive data be stored on or accessed from computer equipment
that is not maintained and supported by a University IT services
provider (e.g., ITS, MCIT, MSIS) - such as home computers,
grant-funded computers, etc.?
YesNo
11-1.4.4* Will sensitive data be stored on portable devices (e.g., laptops, PDAs, flash drives) in unencrypted form?
YesNo
11-3. End of Subject Participation
11-3.1* What specific criteria will be used to prematurely end a particular subject's participation in the study (If covered in attached protocol or informed consent, indicate specific location).
If
the participant does not confirm the consent or they do not have the
required fundamental knowledge, they will be removed from the study. In
the consent form, we indicate: The researchers may remove you from the study even if you want to continue your participation if the researchers believe it is not in your best interest to continue, if your condition changes and requires treatment, or if you do not follow the instructions from the researchers.
11-3.2*
If a participant withdraws from the research, what is the plan to use,
disclose, store, or destroy the participant's data and/or specimen?
Destroy any electronic data related to the participant securely, and destroy copies of the survey used to filter participants.
11-4. Retention of Data and/or Specimens Detail
Retention may be for future research by the investigator and/or the creation of a bank or repository.
Completion of this section is required based on the response provided to question 11.6.
11-4.1* What is the intent or purpose of retaining the data and/or specimens?
For follow up work and dissemination to the academic community. This domain of research is largely unexplored and related data is difficult to obtain. The academic community would benefit greatly from having (anonymized) data available for comparison in subsequent studies.
11-4.2* Where will you store the data and/or specimens?
Only at the University of Michigan
If Other Institutions, please specify:
11-4.3* Describe the arrangements for the storage conditions, management, and security of the data and/or specimens. Include the following as applicable:
Personnel access to data and/or specimens
Whether identifiers will be removed and the key to any code destroyed
For coded data and/or specimens, indicate who holds key to
the code and where it is stored in relation to the data and/or specimens
Storage plan
Plan to protect privacy in transfer to other collaborators.
PI
Weimer has secure office space allocated in the Beyster building for
storing sensitive information. Only PI Weimer and Research Fellow Leach
will have key access to the office.
Participant
identifiers(emails for recruitment only) will not be stored after the
recruitment. Research data will be stored on encrypted volumes secured
by a passphrase that will be shared between PI Weimer, Research Fellow
Leach, and UMich collaborator Xiaosu Hu.
13. Subject Payments Or Other Incentives
Completion of this section is required based on the response provided to question 7-1.1 or 7-3.3.
13.1* Indicate all payments or other incentives provided to subjects for their participation in this study:
Select all that apply:
Cash
Check
If other, please specify:
13.2*
If the subject is a child (under the age of majority), are any of the
payments or incentives intended for the parent/guardian of the child?
N/A
13.3*
Estimate the maximum total payment (including cash, checks, gift cards,
and other cash-equivalent incentives) that an individual subject could
receive for participating in this research in a single calendar year.
13.3.1*
Please indicate what information you will be collecting from subjects
in order to distribute their incentive or compensation.
Select all that apply:
Name
Address
Email
13.4*
Describe the frequency of the payments or incentives. If applicable,
list any healthcare procedure(s) that will be provided to subjects at no
charge.
One payment will be issued immediately after the participant completes the fNIRS study.
13.5* What is the justification for offering these payments or incentives?
The
study will take approximately 90 minutes of the participants' time.
Additionally, participants are required to have a minimal expertise with
computer science. We want to compensate participants for their time at
a reasonable rate.
13.6* What is the plan to compensate subjects withdrawing from the research prior to completing the entire study.
Participants that withdraw will receive $20 check or cash.
29. Survey Research
Completion of this section is required based on the response provided to question 7-1.5.
29.1* Provide a list of all surveys and interviews used in the study:
29.13* Will the research involve the use of focus groups?
YesNo
29.13.1* How will the identity of individuals participating in the groups be protected?
29.14* Is any of the material disturbing?
YesNo
29.15*
Describe the arrangements made to provide professional counseling or
support resources to any subjects desiring such assistance as a result
of their participation in the study.
29.16* Indicate how the list of counseling or support resources will be provided:
If other, please specify:
Survey Detail
29.2* Survey or interview name:
background questionnaire (pre-questionnaire)
29.3* Is the design or development of this survey instrument dependent on receipt of funding or hiring of personnel?
YesNo
29.4* In what manner will the survey or interview be conducted (e.g., in-person, Internet, mail, telephone, etc.)? Special
Note: For electronic surveys, the eResearch ID number must be included
in the informed consent document (uploaded in section 10-1) or other
material that serves as the informed consent.
in-person
29.5* What is the predicted response rate?
100 %
29.6* What is the total number of questions?
6
29.7* What is the anticipated cumulative amount of time required for each subject?
2 minutes
29.8* What is the total number of interviews/data collection interactions with an individual subject?
1
29.9* Does the survey or interview contain questions of a sensitive nature (e.g., mental illness, sexual abuse, illicit drug use, etc.)?
YesNo
29.10* Is the survey or interview likely to produce psychological discomfort or negative feelings in the subjects?
YesNo
29.11* Has the survey instrument been validated or used in standard practice?
YesNo
29.11.1* If yes, describe the origin of the instrument.
The
background questionnaire is a paper-based survey. It is very short and
to collect very basic information of the participant. The information
does not contain any identifiable information.
29.3* Is the design or development of this survey instrument dependent on receipt of funding or hiring of personnel?
YesNo
29.4* In what manner will the survey or interview be conducted (e.g., in-person, Internet, mail, telephone, etc.)? Special
Note: For electronic surveys, the eResearch ID number must be included
in the informed consent document (uploaded in section 10-1) or other
material that serves as the informed consent.
in-person audio-based questionnaire
29.5* What is the predicted response rate?
100 %
29.6* What is the total number of questions?
6
29.7* What is the anticipated cumulative amount of time required for each subject?
5 minutes
29.8* What is the total number of interviews/data collection interactions with an individual subject?
1
29.9* Does the survey or interview contain questions of a sensitive nature (e.g., mental illness, sexual abuse, illicit drug use, etc.)?
YesNo
29.10* Is the survey or interview likely to produce psychological discomfort or negative feelings in the subjects?
YesNo
29.11* Has the survey instrument been validated or used in standard practice?
YesNo
29.11.1* If yes, describe the origin of the instrument.
the
post questionnaire is an audio-based questionnaire. It asks how the
participant reason about the questions. Audio-based questionnaire saves
the participant's time. Also, the conversation is to debrief the
participant from the 70-minute computer-based experiment.
Check here to indicate that the material is not available electronically.
31.2* Are any of the materials likely to produce psychological discomfort or negative feelings in the subjects?
YesNo
31.2.1*
Describe the arrangements made to provide professional counseling or
support resources to any subjects desiring such assistance following
their participation in the study.
31.2.2* Indicate how the list of counseling or support resources will be provided:
If other, please specify:
32. Data Safety And Monitoring Plan
Completion of this section is required based on the response provided to question 7-1.10.
The
principal investigator (PI) has the ultimate responsibility for the
conduct of this research study. The study-specific scientific protocol
should include detailed information about tests and procedures employed
to safeguard the health and safety of the subjects. Additionally, the PI
must prepare a specific data and safety monitoring plan taking into
account national guidelines and the study's complexity, risk, and size.
The plan should include the administrative processes for recording and
evaluating the data quality and integrity. The plan should also specify
the responsibilities of research team members and the schedules for
reviewing and reporting study progress and adverse events.
Components
of this plan relating to the protection of subject privacy and data
confidentiality should already have been included in the
Confidentiality/Security section of this application.
Additionally,
certain members of the research team must complete the PEERRS mandatory
training on human subject protection. This includes personnel joining
the study team after the initiation of the study.
The Risk Level has been indicated as:
Name
Risk Level
Direct Benefit
HUM00139618
No more than minimal risk
no
32.1*
Indicate who will provide study information and instructions to the
subjects beyond what is included in the informed consent document.
Select all that apply:
There are no items to display
If other, please specify:
32.2* Indicate who will obtain informed consent from the subjects.
Select all that apply:
Co-I
If other, please specify:
32.3* Indicate what mechanism(s) will be used for monitoring subjects and identifying adverse events.
Mechanism (Select at least one:)
Conducted by:
Direct interviews/ physical exams conducted by:
Select all that apply:
Co-I
Review of lab work, tests, procedures, etc. by:
Select all that apply:
PI
Co-I
Telephone follow-up conducted by:
Select all that apply:
There are no items to display
Self-reporting by subject
Instructions must be included in the Informed Consent Document.
Other
Reminder: Adverse Events that come to the attention
of any member of the study team must be reported to the PI in a timely
manner.
32-1. Data and Safety Monitoring Plan - AE Reporting
Adverse Event (AE) Reporting
32-1.1* Adverse events will be reported to:
Organization
Reporting Mechanism
IRB
eResearch AE/ORIO submission
DSMB/DSC/independent monitor
UMHS Cancer Center DSMB
Federal oversight agencies (FDA, RAC, etc)
Sponsor (federal, industry, private, etc)
Other
If other, please specify:
32-1.2* Indicate the AE reporting timetable that will be used to report adverse events to the IRB:
Standard IRBMED AE reporting timetable
32-1.2.1*
Indicate the reason for selecting the study-specific AE reporting
rather than the Standard IRBMED AE Reporting Timetable.
Select all that apply:
There are no items to display
If other, please specify:
32-1.2.2*
Provide the study-specific AE reporting plan. If the
study-specific AE reporting plan is included in the previously uploaded
scientific protocol, indicate section.
32-1.3* Affirm that the adverse events will be reported to the IRB according to the following generalized AE GRADING SCALE:
0 - No adverse event
1 - Mild AE – No treatment needed
2 - Moderate AE – Resolved with treatment
3 - Severe AE – Inability to carry on normal activities, required professional medical attention
4 - Life-threatening or disabling AE
5 - Fatal AE
32-1.4* Will Serious Adverse Events (SAEs) be categorized according to the following FDA definition?
N/A - not FDA-regulated
Death
A life-threatening adverse drug experience
Inpatient hospitalization or prolongation of existing hospitalization
A persistent or significant disability/incapacity
A congenital anomaly/birth defect
Important medical events that may not result in death, be
life-threatening, or require hospitalization may be considered a serious
adverse drug experience when, based upon appropriate medical judgment,
they may jeopardize the patient or subject and may require medical or
surgical intervention to prevent one of the outcomes listed in this
definition. Examples of such medical events include allergic
bronchospasm requiring intensive treatment in an emergency room or at
home, blood dyscrasias or convulsions that do not result in inpatient
hospitalization, or the development of drug dependency or drug abuse.
32-1.5*
Affirm that either the principal investigator or a co-investigator will
determine the ATTRIBUTION/RELATEDNESS for each adverse event.
Definitely related
Probably related
Possibly related
Unlikely to be related
Definitely not related
32-1.6* Affirm that the EXPECTEDNESS will be assigned for each adverse event according to the following definitions:
Unexpected adverse events (i.e., has NOT been addressed or described
in one or more of the following: Informed consent document(s) for this
study, IRB application for this study, grant application or study
agreement, protocol or procedures for this study, investigators'
brochure or equivalent (for FDA regulated drugs or devices), DSMB/DSC
Reports, published literature, other documentation)
Expected adverse events (i.e., has been addressed or described
in one or more of the following: Informed consent document(s) for this
study, IRB application for this study, grant application or study
agreement, protocol or procedures for this study, investigators'
brochure or equivalent (for FDA regulated drugs or devices), DSMB/DSC
Reports, published literature, other documentation, or characteristics
of the study population)
32-2. Data Safety and Monitoring Plan - Monitoring the Study
Monitoring the Study
32-2.1*
Indicate the frequency with which the study team will conduct scheduled
assessments of study recruitment, data integrity and quality, adverse
events, withdrawals, and compliance with protocol plan.
Monthly
If other, please specify:
32-2.1.1* If quarterly or other, provide a justification for the assessment schedule.
32-2.2* Study
oversight and safety monitoring may be required based on the
nature, size, and complexity of the study. Indicate the
responsible entities.
Select all that apply:
No additional monitoring is required – the
nature, size, and complexity of this study does not require additional
safety monitoring to that provided by the IRB.
Independent monitor
Internal committee
Sponsor
Data and Safety Monitoring Board (DSMB) or Data Safety Committee (DSC)
UMHS Cancer Center DSMB
Other
If other, please specify:
If no additional monitoring is required, jump to 32-2.3.
32-2.2.1 Provide the names and areas of expertise of those providing this additional monitoring
32-2.2.2 Indicate the frequency with which the additional monitoring activities will be conducted.
If other, please specify:
32-2.2.3 Indicate the data that will be reviewed.
Select all that apply:
There are no items to display
32-2.2.4 If a DSMB or DSC charter exists, upload it here.
Completion of this section is required based on the response provided to question 9-1.1 or 9-2.1.
The following subject populations, vulnerable to coercion or undue influence, have been identified for inclusion in the study.
College Students
41.1* What is the justification for the inclusion of these subject populations?
It requires the
participants to have some basic software knowledge as what is covered in
a 200-level courses in the CS department in University of Michigan. The
participants will spend around 90 minutes using a computer and wearing a
fNIRs cap. Thus the recruitment is open to college students, or
research fellows/professors who is able to take such an experiment.
41.2*
Describe the additional safeguards that have been included in this
study to protect the rights and welfare of these subjects.
All participants will
read through and sign a consent form based on their own wills. The
participants can quit the experiment anytime during the experiment. In
this case, they will still receive a $20 check or cash based on their
own preference.
44. Additional Supporting Documents
44.1 Please upload any additional
supporting documents related to your study that have not already been
uploaded. Examples include, but are not limited to, data collection
sheets, newsletters, subject brochures, and instructional brochures.
Name
Version
There are no items to display
44.2 Enter any information that should
show in a “Supporting Documents” list on the current submission’s
approval notice, such as document names and version numbers or version
dates. Text entered here will AUTOMATICALLY appear word-for-word on the
approval letter.
45. End of Application
The form
was successfully submitted. Click 'Exit' or 'Finish' to leave the
form.