OBS - Preliminary Request Form

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The Ontario Birth Study (OBS) is a research platform developed by the Lunenfeld-Tanenbaum Research Institute and Sinai Health System (SHS). Core material includes self-administered questionnaire data, pregnancy-related clinical and outcome data housed on a database managed by the Applied Health Research Centre of St. Michael's Hospital (collectively, the "Database") as well as biospecimens including blood samples and vaginal swabs which are stored at the Mount Sinai Hospital Biospecimen Repository (the "Biobank").

This application form is a preliminary assessment of research projects that aim to use OBS Data and/or OBS Samples. Your responses will be assessed by the OBS Steering Committee for feasibility based on entries within the Biobank and Database. Upon approval, applicants will gain access to the Data Request Form, which will allow detailed documentation of research efforts.

The names and institutions of all applicants, as well as summaries of the scientific abstracts of all approved projects will be added to the publicly accessible access registry of the OBS.

Project Title:

* must provide value

Principal investigator name:

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______'s institution:

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______'s email address:

* must provide value

______'s telephone number:

* must provide value

______'s address:

* must provide value

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Is ______ the main person to contact for this study?

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Yes

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Main contact name:

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Main contact institution:

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Main contact position:

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Main contact email:

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Main contact telephone number:

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Please provide a clear scientific description of the research project and its specific hypotheses in no more than 300 words.

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Is this study a continuation of an existing study?

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Yes

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Please provide the study name, and indicate if it makes use of any OBS data/samples.

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Do you require questionnaire or clinical datasets for your study?

Yes

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Please select the data types required for your study:

* must provide value

Lifestyle Questionnaire 1

Lifestyle Questionnaire 2

Lifestyle Questionnaire 3

Baseline Clinical Data

Antenatal Clinical Data

Delivery Clinical Data

Neonatal Clinical Data

Diet History Questionnaire

Do you require OBS Kids data for your study?

* must provide value

Yes

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Please select the types of OBS Kids Data required for your study:

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Interview (Mother's depression and anxiety, maternal cognitive sensitivity, M-CHAT-R, ASQ3)

Child's development

Child's height and weight

Child's saliva sample

Do you require biological samples for your study?

* must provide value

Yes

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Please select the biological sample type(s) required to conduct your study:

* must provide value

Maternal Blood Spot Cards

Maternal Serum

Maternal Plasma

Maternal Leukocyte Pellet (limited supply)

Maternal Buffy Coat

Infant Blood Spot Card

Vaginal Swab (limited supply)

Please indicate the volume/amount of the biospecimen(s) you are requesting:

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Please describe any inclusion or exclusion criteria to be applied to your requested datasets/samples:

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By selecting "I Agree", I am verifying that the Principal Investigator listed in this form is aware of this submission, and my intention to use Ontario Birth Study Data for research purposes.

* must provide value

I Agree

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