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mgpJQ7EG6WSpa5a4bjd9xDbwYWhscTHYLepnYLagPg3TYeW5wIPTfsbffBSQubYQRBSxWLLZH2ewkofsdsxKShVkMD434GHV

Layton Aging and Alzheimer's Center and ORCATECH Data Request Form

Returning?

A A A

To request data from the Layton Aging and Alzheimer's Center and ORCATECH, please enter the fields below and submit this form.

If you have any questions about this form or your request, please reach out to either: Nora Mattek or Sarah Gothard

Date of Request

* must provide value

D-M-Y

Principal Investigator Information: * all fields required

PI First Name
PI Last Name
PI Email
PI Telephone

Primary Affiliation:

* must provide value

OHSU

Other

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Please fill in the inforation about the PI's primary academic affiliation: * all fields required

Institution name
Institution street address
Institution city
Institution state
Institution zip-code

Are you the primary study contact for the requesting project?

* must provide value

Yes

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Are you the PI?

Yes

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Study primary contact information (other than PI): * all fields required

Primary contact first name
Primary contact last name
Primary contact email
Primary contact phone number

Project Title

* must provide value

Describe your project and its aims:

* must provide value

Expand

Is this a funded project?

* must provide value

Yes (specify funder(s))

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The following section will ask you about the types of data you are interested in receiving.

Here are data dictionaries associated with the data streams in our center:

NACC UDS Clinicial Data: https://naccdata.org/data-collection/forms-documentation/uds-3
Additional Clnical Data: Other Clinical Data
Digital Biomarker Data: Digital Biomarker Sensor Data Dictionary
Biospecimen Data: TBD
Imaging Data: TBD

When do you need the data from this request?

D-M-Y H:M

What is your intended use for this data?

* must provide value

Abstract

Dissertation/Student Project

Grant: Currently Awarded

Grant: Potential Submission

Poster

Publication

Research: Exploratory

Support Center Operations

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Select the variable groups your are requesting (please review the above data dictionaries for more details about the variables listed). Select all that apply.

* must provide value

Audio/Video Recording Data

Bio-specimen Data

Brain Pathology

Digital Biomarker Sensor Data

Imaging Data

NACC UDS Clinical Data

Non-NACC Clinical Data (demographic data, online weekly health data, online reported data, sleeping, loneliness, social isolation, physical activities, comorbidities measures, other cognition measurements)

Neuropsychological Testing Data

Online Health Update Forms

Online Survey Data (Not Health Update Form)

Transcribed Speech Data

You have indicated you would like CSF: How much would you like (half ml increments)

* must provide value

You have indicated you would like DNA: How much would you like (half ml increments)

* must provide value

You have indicated you would like Plasma: How much would you like (half ml increments)

* must provide value

You have indicated you would like Serum: How much would you like (half ml increments)

* must provide value

You have indicated you would like Urine: How much would you like (half ml increments)

* must provide value

What are you sample parameters?

* must provide value

Please describe the clinical and/or demographic data you need for your sample pull? If none, please mark "NA".

* must provide value

If you know the name of the study you wish your data to come from, please enter it here:

Please use the data dictionaries provided above to upload a '.csv' or '.doc' of specific variables you are interested in receiving in your data set.

Upload file

Please list any existing fully available data sets you would be interested (a list can be found on our website here)

What is your preferred method of file type?

CSV

Excel Spreadsheet

Other

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Do you need the whole cohort or a subset?

* must provide value

Whole Cohort

Subset

Unkown

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You indicated you needed a subset of the cohort requested. Please provide more details regarding your subset, including any known identifiers (subject IDs, OADC numbers, home IDs, etc)

* must provide value

Upload file

What timepoints do you need?

* must provide value

Baseline only

All timepoints

Other/Specific timepoints

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Does this request require a statistical consult?

Yes

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.