ࡱ> y ܪbjbj 4{{` ` 8s$vn&(" & 2#4#4#4#4#4#4#$&)X#2 2 2 X#4-$"""2 d2#"2 2#"""t& R"#C$0s$"O* *O*"O*" 2 2 "2 2 2 2 2 X#X#"2 2 2 s$2 2 2 2 O*2 2 2 2 2 2 2 2 2 ` : VALDOSTA STATE UNIVERSITY Institutional Animal Care and Use Committee (IACUC) Protocol Modification Request Protocol Number: AUP- FORMTEXT      Current Expiration Date:  FORMTEXT      Modification No:  FORMTEXT       Primary Animal User:  FORMTEXT      Co-Investigator(s):  FORMTEXT      Project Title:  FORMTEXT       1. PROPOSED SIGNIFICANT PROTOCOL MODIFICATIONS: Significant modifications are those that potentially impact the number of animals used, the USDA Pain and Distress Category, or the well-being of the animal(s). Please check all that apply and provide the additional information requested.  FORMCHECKBOX  A. Substitution or addition of a faculty or other collaborator who will conduct animal activity: Name:  FORMTEXT       Degrees:  FORMTEXT       Institutional affiliation:  FORMTEXT       Describe training/experience in species and procedures to be used:  FORMTEXT        FORMCHECKBOX  B. Substitution or addition of a student assistant or graduate student who will conduct animal activity on a research protocol: Name:  FORMTEXT       Describe training/experience in species and procedures to be used:  FORMTEXT        FORMCHECKBOX  C. Change in animal species used: Currently approved species:  FORMTEXT       Proposed species:  FORMTEXT       Justification/rationale:  FORMTEXT        FORMCHECKBOX  D. Addition of new vertebrate species: Species name:  FORMTEXT       Common name:  FORMTEXT       Justification/rationale:  FORMTEXT        FORMCHECKBOX  E. Change in sex of animal to be used, if relevant: Previously approved sex:  FORMCHECKBOX  Male  FORMCHECKBOX  Female  FORMCHECKBOX  Both Proposed sex:  FORMCHECKBOX  Male  FORMCHECKBOX  Female  FORMCHECKBOX  Both Justification/rationale:  FORMTEXT        FORMCHECKBOX  F. 5% or greater increase in the number of animals to be used: Previously approved number:  FORMTEXT       Proposed number:  FORMTEXT       Justification/rationale:  FORMTEXT        FORMCHECKBOX  G. Modification of a non-surgical procedure: Describe:  FORMTEXT       Justification/rationale:  FORMTEXT        FORMCHECKBOX  H. Modification of a surgical procedure, such as change in type or dosage of drugs used: Describe:  FORMTEXT       Justification/rationale:  FORMTEXT        FORMCHECKBOX  I. Repeat of an experiment without a change in the number of animals: Describe:  FORMTEXT        FORMCHECKBOX  J. Addition of survival surgery: Describe:  FORMTEXT       Justification/rationale:  FORMTEXT       Post-operative care plan (including monitoring, analgesia, and treatments):  FORMTEXT        FORMCHECKBOX  K. Addition of or change in a procedure that places the animal(s) in USDA Pain and Distress Category D or E:  FORMCHECKBOX  Category D - Pain or distress appropriately relieved with anesthetics, analgesics and/or tranquilizer drugs or other methods for relieving pain or distress but with potential for more than momentary or slight pain or distress  FORMCHECKBOX  Category E - Pain or distress or potential pain or distress that is not relieved with anesthetics, analgesics and/or tranquilizer drugs or other methods for relieving pain or distress) Describe:  FORMTEXT       Justification/rationale:  FORMTEXT       COMPLETE QUESTIONS 2 AND 3 BELOW  FORMCHECKBOX  L. Change in euthanasia agent or method: Previously approved agent/method:  FORMTEXT       Proposed agent/method:  FORMTEXT       Justification/rationale:  FORMTEXT        FORMCHECKBOX  M. Any other change not described above: Previously approved procedure:  FORMTEXT       Proposed procedure:  FORMTEXT       Justification/rationale:  FORMTEXT       Note: The Animal User may make minor modifications to the approved protocol without IACUC approval and report them after-the-fact on the Annual Continuation Review form. 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They include, but are not limited to, the following: (1) Change in title of the research project; (2) Substitution or addition of students on an instructional protocol; (3) Less than a 5% increase in the number of animals used; (4) Addition of another strain of the same animal species, providing the number of animals used does not exceed a 5% increase in the number approved; and (6) New or additional source of funding for the research. If you are not certain that your proposed modification(s) are consider minor, please consult with the IACUC Chair or the IACUC Administrator. 2. JUSTIFICATION OF PAINFUL PROCEDURES (USDA PAIN AND DISTRESS CATEGORY D OR E): Provide a written explanation of the procedures producing pain or distress for any portion of the protocol and the reason drugs cannot be used to fully alleviate pain/distress. Include the species, number of animals affected, and the criteria used for determining the experimental endpoint or the timely intervention for removal of animals from the pain and distress.  FORMTEXT       List the database searches completed to determine that less painful or distressful procedures are not available. DatabaseKeywordsDate FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       List other references used to determine that less painful or distressful procedures are not available. Include full citation.  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       CERTIFICATIONS: By electronically entering my name below, I certify that I am the responsible Animal User for this protocol and that the information contained in this Protocol Modification Request is accurate to the best of my knowledge and belief. I further assure the IACUC that this research or instructional activity does not unnecessarily duplicate previous experiments or activities and that the number of animals needed has been minimized. If I am utilizing procedures that fall within USDA Pain and Distress Categories D or E, I certify that I have consulted appropriate bibliographic resources and believe that the animal model I am using is the most appropriate for conducting my research or instructional activity and that there is no alternative to performing the potentially painful or distressful procedures. Further, I agree to consult with the Attending Veterinarian as appropriate to ensure that pain and distress are minimized and that the well-being of the animals is maximized. Electronic Signature of Primary Animal User:  FORMTEXT      Date Submitted:  FORMTEXT       Attending Veterinarian Review (for Protocol Modification Request that involves a USDA Pain and Distress Category of D or E): By electronically entering my name below, I certify that I am the Attending Veterinarian and that I have reviewed this proposed Protocol Modification and find the proposed changes appropriate and acceptable. I will consult with the Animal User as necessary to resolve issues to minimize pain and distress. Electronic Signature of Attending Veterinarian:  FORMTEXT       Date Submitted:  FORMTEXT           VSU Institutional Animal Care and Use Committee Protocol Modification Request Form Rev: 04.10.2012 Page  PAGE 1 of  NUMPAGES 3 R^0ҔԔҘxx$ $ ^`a$gd0$ $ ^a$gd1$ $ ^`a$gd1$ $ a$gd0 ^`gd}] h`hgd}] h$dN`hgd}] ĔȔҔԔԗ֗ؗ<̷sfR>,#ht,h05CJOJQJ^JaJ&ht,hL56CJOJQJ^JaJ&ht,h056CJOJQJ^JaJht,h1OJQJ^J4jht,h0CJOJQJU^JaJmHnHu/jht,h0CJOJQJU^JaJ ht,h0CJOJQJ^JaJ)jht,h0CJOJQJU^JaJ#ht,h15CJOJQJ^JaJ ht,h0CJOJQJ^JaJ ht,h1CJOJQJ^JaJ<ʘ̘Ԙܘ "$&0246JLNXZ\^rtv񳦒{g{S{'j ht,hXfOJQJU^J'j ht,hXfOJQJU^J,jht,hXfOJQJU^JmHnHu'jht,hXfOJQJU^Jht,hXfOJQJ^J!jht,hXfOJQJU^Jht,hXfCJOJQJ^Jht,hXf5CJ OJQJ^Jht,hL5OJQJ^Jht,hXf5OJQJ^JҘܘ /kd$$IflF 6$|) 4F t06    44 lazytl/ $ *$ ,B$Ifa$gdl/ !$ *$ ,B^`a$gdXf 4\2kd $$IflF 6$|) 4F t06    44 lazytl/ $ *$ ,B$Ifa$gd#u/$ *$ ,B$Ifa$gdl/ 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