Research Project Proposal Form

Reynolds Cardiovascular Research Center Dallas Heart Study

Research Project Proposal Form Reynolds Cardiovascular Research Center – Dallas Heart Study

Investigator (your name):

Project Title (max 300 characters) *:

Project Summary (max 4200 characters). State the project’s broad objectives and aims, and describe concisely the research design and methods for achieving these goals. This is meant to be a stand-alone description of the project when separated from this proposal form. If the project is approved, as is, will be made available to the entire Reynolds Center investigator community:

Project Description:

Hypothesis (Max 1200 characters) *:

Aims of Proposal (Max 3000 characters) *:

Significance & Relevance *:

Method & Analysis Plan *:

Writing Group Members (List proposal senior author last) *:

Planned date for submission of completed manuscripts to Reynolds Center for pre-publication review *:

Keywords (Check all that applies) *:

Research Fields: Coronary Artery Women’s Health Arrhythmias Disease Diet & Nutrition Minority Health: LVH Hispanics Alcohol Use Hyperlipidemia Health Beliefs CHF/ Cardiomyopathy Obesity Acculturation

Form Version: 03/09/2006 Reynolds Cardiovascular Research Center Dallas Heart Study

Other: Congenital Heart Minority Health: African Diabetes Disease Americans Smoking, Tobacco Use Exercise, Physical Hypertension Activity Polycystic Ovary Other Syndrome

Data Types: Survey DNA Sequence Aortic MRI Variants Blood Pressure ECG Pelvic MRI Readings Lab: Blood Chemistries Abdominal Fat MRI Coronary Lab: Urine Chemistries Liver MR Spectroscopy Lab: Lipids Lab: Cardiac MRI Lab: Biomarkers/ Glucose/Chemistries Proteins Other

Reynolds Resource Access Requested (Check all that applies) *: Original Reynolds Data Request Lab Specimen/DNA Request New Image Analysis Request Cohort Study

NDA & Technology Transfer Disclosures:

Identify all funding sources to be used in the study (external and internal sources) *:

Identify all sources of materials to be used in conjunction with the study (external sources and internal) *:

Identify any known relationships between the proposed project and patents, patents pending, or any intellectual property which may be on file with UT Southwestern *:

Form Version: 03/09/2006 Reynolds Cardiovascular Research Center Dallas Heart Study

Identify all contracts or relationships you have with other third parties that might gain access to the results of the study *:

Other comments or information: * Required Information

Form Version: 03/09/2006