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Date of request
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Today D-M-Y
What study data are you interested in?
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Kardiovize Brno 2030
Applicant's name:
Please provide the name of the applicant, who is the person responsible for or leading the project.
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Applicant's email:
Please provide the e-mail address of the applicant.
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Applicant's position:
Please specify the position of the applicant.
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ICRC employee
FNUSA employee
External applicant
Team:
Please provide the team of which the applicant is part within the ICRC.
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Acute Coronary Syndromes Interventional Cardiac Electrophysiology Applied Neuroscience Research Stroke Dementia Laboratory Oncology Translational Research Kardiovize Brno 2030 Biomedical Engineering Noninvasive Cardiac Imaging Intensive Care Neuromodulation Technology Mechanobiology of Disease Cellular and Molecular Immunoregulation Cell and Tissue Engineering - cGMP (CTEF-cGMP) Medicinal Chemistry Genome Integrity Protein Engineering Cell Signaling Molecular Control of Immune Response Cancer Plasticity Cell and Tissue Regeneration Stem Cells and Disease Modeling Animal Center Biostatistics Biomedical Engineering Facility Cannabis Facility Center for Clinical Studies Other
Clinic/Department:
Please provide the clinic or department of which the applicant is part within the FNUSA.
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Department of Anesthesiology 1st Department of Dermatovenerology 1st Department of Surgery 2nd Department of Surgery 1st Department of Internal Cardio-angiology 1st Department of Neurology 1st Department of Orthopaedics 2nd Department of Internal Medicine Department of Otolaryngology and Surgery of Head and Neck Department of Plastic and Aesthetic Surgery Department of Occupational Medicine Department of Sports Medicine and Rehabilitation Department of Clinical Imaging Department of Neurosurgery Department of Stomatology Central operating rooms Central Sterilization Convalescent and Rehabilitation Department Department of geriatric-palliative care Department of Clinical Biochemistry Department of Clinical Hematology Department of Clinical Speech Therapy Department of Clinical Psychology Department of Therapeutic Nutrition Department of Ophthalmology and Optometry Department of Family Doctors and Occupational medicine Department of Health-Social Care and Home Care Department of Oncological Surgery Department of Urology 1st Department of Pathology Institute of Microbiology Institute Clinical Immunology and Alergology Institute of Forensic Medicine Other
Company Name:
Please specify the company for which the applicant is leading the project.
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Applicant's research background:
Please provide a summary of applicant's research background in 100 words.
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Is this output part of a grant project?
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Yes
No
Name of the provider of a grant project:
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Duration of the grant project:
Please state from when to when the grant is run.
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Please specify how you have secured funding for the project:
E.g. from the budget of the clinic...
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Applicant's publications:
Please list applicant's last five publications. If 5 publications are not available, please list at least the applicant's publications.
Name DOI PDF Publication 1 *must provide value *must provide value *must provide value
Publication 2
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1. publication name
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1. publication doi
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1. publication pdf
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2. publication name
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2. publication doi
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2. publication pdf
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Type of request:
The initial application is always treated as a new data request. A data expansion request is necessary to modify an application that has already been submitted.
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New request
Data expansion request
Changes in the project:
Please choose what changes applicant wants to make to the initial application.
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Project name:
Please provide the intended name of the publication or the primary description of the study.
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Please provide the Project ID you received for the original application:
If you do not know the Project ID, please contact the study Data Specialist.
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Please attach a PDF of the original application:
If you do not have the original application, please contact the study Data Specialist.
If there are more files, upload them in a zip file.
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Expected statistical analysis and interpretation will be provide by:
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We would like to warn you that this service must be approved by your PI / department head. If you have any further questions about Biostatistics services, please contact RNDr. Petra Weselá (petra.wesela@fnusa.cz)
Main aim:
Please outline the primary objective of the project. If there are multiple aims, you may be asked to provide further clarification on the purposes.
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Please specify whether you intend to test hypotheses and/or create new parameters/variables:
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Main hypothesis:
Please specify the main hypothesis of the study. If there are multiple main hypothesis, you may be asked to provide further clarification on the purposes.
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Statistical methods used for testing the hypothesis:
Please specify statistical methods which will be used for testing the hypothesis.
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Brief description of the new parameters/variables:
Please briefly describe what the new parameters/variables will be and how you plan to create them.
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Expected output(s):
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Please provide the name of the conference and the date of the conference:(poster)
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Please provide the name of the conference and the date of the conference:(presentation)
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Please provide more information about this output(s):(application, patent, prototype)
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Please provide more information about other outcome:
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Name Position Employer Handling data? Researcher 1
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1. Researcher
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1. Work position of researcher
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1. Employer of researcher
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1. Researcher: Handling data
2. Work position of researcher
2. Employer of researcher
2. Researcher: Handling data
3. Work position of researcher
3. Employer of researcher
3. Researcher: Handling data
4. Work position of researcher
4. Employer of researcher
4. Researcher: Handling data
5. Work position of researcher
5. Employer of researcher
5. Researcher: Handling data
6. Work position of researcher
6. Employer of researcher
6. Researcher: Handling data
7. Work position of researcher
7. Employer of researcher
7. Researcher: Handling data
8. Work position of researcher
8. Employer of researcher
8. Researcher: Handling data
9. Work position of researcher
9. Employer of researcher
9. Researcher: Handling data
10. Work position of researcher
10. Employer of researcher
10. Researcher: Handling data
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At least one researcher has to be responsible for Conception and design.
At least one researcher has to be responsible for Analysis.
At least one researcher has to be responsible for Interpretation of results.
At least one researcher has to be responsible for Writing the article.
At least one researcher has to be responsible for Critical revision.
At least one researcher has to be responsible for Final approval.
I declare that all researchers are included in the researcher list, its order has been agreed by all researchers, and that all of them have agreed to their roles and responsibilities.
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Confirm
1. I confirm that I have read the rules for data handling and commit to adhere to them.
Terms and Conditions Confirm
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Confirm
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If there are more files, upload them in a zip file.
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